Zimbabwe - Demographic and Health Survey - 1995

Publication date: 1995

Zimbabwe Demographic and Health Survey 1994 # Central Statistical Office @DHS Demographic and Health Surveys M~cr~nte@tional Inc. Zimbabwe Demographic and Health Survey 1994 Central Statistical Office Harare, Zimbabwe Macro International Inc. Calverton, Maryland USA September 1995 This report summarises the findings of the 1994 Zimbabwe Demographic and Health Survey (ZDHS) conducted by the Central Statistical Office (CSO) of the Government of Zimbabwe. Macro International lnc. provided technical assistance. Funding was provided by the U.S. Agency for International Development. The ZDHS is part of the worldwide Demographic and Health Surveys (DHS) programme, which is designed to collect data on fertility, family planning, and maternal and child health. Additional reformation about the Zimbabwe survey may be obtained from the Central Statistical Office, P.O. Box 8063, Causeway, Harare, Zimbabwe (Telephone: 706-681; Fax: 708-854). Additional information about the DHS programme may be obtained by writing to: DHS, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (Telephone: 301-572-0200; Fax: 301 - 572-0999). Recommended citation: Central Statistical Office [Zimbabwe] and Macro International Inc. 1995. Zimbabwe Demographic and Health Survey, 1994. Calverton, Maryland: Central Statistical Office and Macro International Inc. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER 1 1.1 1.2 1.3 1.4 1.5 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5.1 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.5.2 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.5.3 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.5.4 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.5.5 Response Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 2.1 2.2 2.3 CHARACTERIST ICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . 9 Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2. I. 1 Age-Sex Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.1.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.1.3 Educational Level of Household Members . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.1.4 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.2.1 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.3.1 Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.3.2 Education Level of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.3.3 School Attendance and Reasons for Leaving School . . . . . . . . . . . . . . . . . . . . 20 2.3.4 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.3.5 Women's Employment Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2.3.6 Employer and Form of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.3.7 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.3.8 Decision on Use of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.3.9 Child Care While Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 iii CHAPTER3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 CHAPTER4 Page FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fertility by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Adolescent Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 FERTILITY REGULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.1 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.3 Current Use of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.4 Quality of Pill Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.5 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.6 Knowledge of Contraceptive Effects of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.7 T iming of Female Sterilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.8 Source of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 4.9 Discontinuation of Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.10 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.11 Reasons for Nonuse of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.12 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.13 Exposure to Family Planning Messages in the Electronic Media . . . . . . . . . . . . . . . . . 61 4.14 Acceptability of Use of Electronic Media to Disseminate Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.15 Exposure to Family Planning Messages in Print Media . . . . . . . . . . . . . . . . . . . . . . . . 63 4.16 Contact of Nonusers with Family Planning Providers . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.17 Attitudes of Male and Female Respondents toward Family Planning . . . . . . . . . . . . . . 65 4.18 Attitudes of Couples toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 CHAPTER5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . 69 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Marital Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Postpartum Amenorrhoea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . 83 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 CHAPTER 6 6.1 6.2 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 iv 6.3 6.4 Page Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Wanted and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 CHAPTER 7.1 7.2 7.3 7.4 7.5 7 EARLY CHILDHOOD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Background and Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Levels and Trends in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Socioeconomic Differentials in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . . 102 Biodemographic Differentials in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . 103 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 CHAPTER 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Assistance and Medical Care at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 CHAPTER 9.1 9.2 9.3 9 MATERNAL AND CHILD NUTRIT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 9.1.1 Initiation of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 9.1.2 Age Pattern of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 9.1.3 Types of Supplemental Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 9.1.4 Frequency of Food Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 9.1.5 Differentials in Food Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Nutritional Status of Children under Age Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 9.2.1 Measures of Nutritional Status in Childhood . . . . . . . . . . . . . . . . . . . . . . . . 132 9.2.2 Levels of Child Undernutrition in Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . . 134 9.2.3 Trends in Undernutrition in Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Maternal Anthropometric Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 CHAPTER 10 A IDS AND OTHER SEXUALLY TRANSMITTED D ISEASES . . . . . . . . . . . . . 141 10.1 Awareness of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 10.2 Self-reporting of Recent Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . 144 10.3 AIDS Knowledge and Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 V Page 10.4 Perception of the Risk of Getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 10.5 Behaviour Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 10.6 Number of Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 10.7 Source of Condom Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 10.8 Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 CHAPTER 11 MATERNAL MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 11.1 The Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 11.2 Direct Estimates of Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 11.3 Direct Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 11.4 Indirect Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 11.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 APPENDIX A SAMPLE IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 A. 1 Sampling Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 A.2 Characteristics of the ZDHS Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 A.3 Sample Allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 A.4 Systematic Selection of EAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 A.5 Sampling Probabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 A.6 Sample Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 APPENDIX C DATA QUAL ITY TABULAT IONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 APPENDIX D WORLD SUMMIT FOR CHILDREN INDICATORS . . . . . . . . . . . . . . . . . . . . . 217 APPENDIX E QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 vi TaMe 1.1 Table 1.2 Table 1.3 TaMe 2.1 Table 2.2 Table 2.3 Table 2.4 TaMe 2.5.1 TaMe 2.52 TaMe 2.6 TaMe 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 TaMe 2,12.1 TaMe 2.12.2 Table 2.13 TaMe 2.14 Table 2.15 Table 2.16 TaMe 2.17 Table 3.1 Table 3.2 Table 3.3 TaMe 3.4 TaMe 3.5 Table 3.6 Table 3,7 Table 3.8 Table 3.9 TABLES Page Population size and growth rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Demographic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . 13 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 School attendance and reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Access to mass media: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Access to mass media: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Decision on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Trends in current fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Trends in fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 vii TaMe 3.10 TaMe 3.11 Table 4.1 Table 422 Table 4.3 TaMe 4A Table 4.5.1 Table 4.5.2 Table 4.6 Table 4.7 TaMe 4.8 Table 4.9 Table 4.10 Table 4.11 TaMe 4.12 TaMe 4.13 TaMe 4.14 Table 4.15 Table 4.16 TaMe 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.2 I Table 4.22 TaMe 4.23 TaMe 4.24 Table 4.25 TaMe 4.26 Table 4.27 Table 5. I TaMe 5.2 TaMe 5.3.1 Page Adolescent pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Children born to adolescent women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Knowledge of contraceptive methods among couples . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Trends in knowledge of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Current use of family planning: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Current use of family planning: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Trends in current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Current use of family planning by background character i s t i cs . . . . . . . . . . . . . . . . . . . 47 Pill use compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Interruption in pill use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Problems in pill use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Use of pill brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Number of children at filst use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 T iming of sterilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Reasons for selecting current source of supply for contraceptive methods . . . . . . . . . . 56 Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Reasons for discontinuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Heard about family planning on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Wives ' perceptions of their husbands' attitude toward family planning . . . . . . . . . . . . 66 Attitudes of couples toward famdy planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Marital exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Polygyny: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 viii Table 5.3.2 Table 5.4.1 Table 5.4.2 Table 5.5 Table 5.6 Table 5.7 Table 5.8.1 Table 5.8.2 Table 5.9.1 Table 5.9.2 Table 5.10 Table 5.11 Table 5.12 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5.1 Table 6.5.2 Table 6.5.3 Table 6.6 Table 6.7.1 Table 6.7.2 Table 6.8 Table 6.9 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Page Polygyny: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Number of co-wives: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Number of wives: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Median age at first intercourse: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Median age at first intercourse: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Postpartum amenorrhoea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . 84 Median duration of postpartum insusceptibility by background characteristics . . . . . . 85 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . . . . . . . 90 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Need for family planning services: currently married women . . . . . . . . . . . . . . . . . . . 91 Need for family planning services: unmarried women . . . . . . . . . . . . . . . . . . . . . . . . . 92 Need for family planning services: all women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Mean ideal number of children by background characteristics: women . . . . . . . . . . . 96 Mean ideal number of children by background characteristics: men . . . . . . . . . . . . . . 96 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . 102 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . 103 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . 109 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 11 ix Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 9. I Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 9.8 Table 9.9 Table 9.10 Table I 0. t. 1 Table 10.1.2 Table 10.2.1 Table 10.2.2 Table 10.3 Table 10.4.1 Table 10 4.2 Table I 0.5.1 Table 10.5.2 Table 10.6.1 Table 10.6.2 Table 10.7.1 Table 10.7.2 Page Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . . . . 114 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Prevalence and treatment of acute respiratory infection and prevalence of fever . . . . 118 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Imtial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Types of foods recei~ ed by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . 129 Types of food received by children in preceding week . . . . . . . . . . . . . . . . . . . . . . . . 131 Types of foods recei~ ed by children by background characteristics . . . . . . . . . . . . . . 133 Nutritional status of (hildren by demographic characteristics . . . . . . . . . . . . . . . . . . 135 Nutritional status of t hildren by background characteristics . . . . . . . . . . . . . . . . . . . . 136 Trends in nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Nutritional status of mothers by background characteristics . . . . . . . . . . . . . . . . . . . . 138 Knowledge of sexually transmitted diseases: women . . . . . . . . . . . . . . . . . . . . . . . . 142 Knowledge of sexually transmitted diseases: men . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Self-reporting of sexually transmitted diseases in the last year: women . . . . . . . . . . 144 Self-reporting of sexually transmitted diseases in the last year: men . . . . . . . . . . . . 145 Action taken by respondents who reported a sexually transmitted disease in the last year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Knowledge of AIDS and sources of AIDS information: women . . . . . . . . . . . . . . . . 147 Knowledge of AIDS and sources of AIDS information: men . . . . . . . . . . . . . . . . . . 148 Knowledge of ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Knowledge of ways Io avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Awareness of AIDS health issues: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Awareness of AIDS health issues: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Perception of the rist~ of getting AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Perception of the ris!, of getting AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Table 10.8 Table 10.9 Table 10.10 Table 10.11.1 Table 10.11.2 Table 10.12.1 Table 10.12.2 Table 10.13 Table 10.14.1 Table 10.14.2 Table 10.15.1 Table 10.15.2 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Table A. 1 Table A.2 Table B. 1 Table B.2.1 Table B.2.2 Table B.3.1 Table B.3.2 Table B.4.1 Table B.4.2 Table B.5 "I able B.6 Table B.7 Table B.8 Table B.9 Table B.10 Table B. 11 Table B. 12 Page Perception of the risk of getting HIWAIDS among couples . . . . . . . . . . . . . . . . . . . . 155 Reasons for perception of small/no risk of getting HIV/AIDS . . . . . . . . . . . . . . . . . . 155 Reasons for perception of moderate/great risk of getting HIWAIDS . . . . . . . . . . . . . 156 AIDS prevention behaviour: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 AIDS prevention behaviour: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Number of sexual partnels: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Number of sexual partnels: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Payment for sexual relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Knowledge of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Knowledge of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Reasons for using condoms and with whom: women . . . . . . . . . . . . . . . . . . . . . . . . . 166 Reasons for using condoms and with whom: men . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Adult mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Indirect estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Sampling errors - National sample: women, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . 192 Sampling errors- Sampling errors - Sampling errors - Sampling errors - Sampling errors - Sampl ing er rors - Sampling errors - Sampling errors - Sampling errors - Sampling errors - Sampling errors - Sampling errors - Sampling errors - National sample: men, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . 193 Urban sample: women, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . 194 Urban sample: men, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . 195 Rural sample: women, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . 196 Rural sample: men, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . 197 Manicaland, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Mashonaland Central, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . 199 Mashonaland East, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . . 200 Mashonaland West, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . 201 Matabeleland North, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . 202 Matabeleland South, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . 203 Midlands, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Masvingo, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 xi Table B. 13 Table B. 14 Table C. 1 Table C2 Table C.3 Table CA. Table C.5 Table C.6 Table D. 1 Page Sampling errors - Harare, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Sampling errors - Bulawayo, Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Age distribution of e4igible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 World Summit for Children Indicators: Zimbabwe 1994 . . . . . . . . . . . . . . . . . . . . . . 219 xii Figure2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure4.3 Figure 4.4 Figure4.5 Figure5.1 Figure 5.2 Figure 6.1 Figure6.2 Figure 6.3 Figure 7.1 Figure 7.2 Figure 8.1 Figure 8.2 Figure 8.3 Figure 9.1 Figure 9.2 Figure 10.1 Figure 10.2 Figure l l . I FIGURES Page Population Pyramid of Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 School Enrolment by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Housing Characteristics by Residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Total Fertility Rate by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Age-specific Fertility Rates, 1988 and 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Percentage of Adolescent Women Who Are Mothers or Pregnant with First Child, by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Use of Specific Contraceptive Methods among Currently Married Women . . . . . . . . . . . 44 Current Use of Family Planning, Selected Countries in Southern and East Africa, 1992-1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Current Use of Family Planning by Background Characteristics . . . . . . . . . . . . . . . . . . . . 48 Distribution of Current Contraceptive Users by Source of Supply . . . . . . . . . . . . . . . . . . 55 Contraceptive Discontinuation Rates (%) for First Year of Use, by Method . . . . . . . . . . . 57 Percentage of Months in Last 5 Years Spent in Marital Union by Women Age 15-49 . . . 71 Percentage of Currently Married Women Whose Husbands Have at least One Other Wife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Fertility Preferences among Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . . . 88 Fertility Preferences among Currently Married Women by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Percentage of Currently Married Women with Unmet Need and Met Need for Family Planning Services by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . 94 Trends in Infant and Under-five Mortality, 1988 and 1994 . . . . . . . . . . . . . . . . . . . . . . . 10! Under-five Mortality by Selected Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Antenatal Care, Tetanus Vaccinations, Place of Delivery, Delivery Assistance . . . . . . . 108 Percentage of Children Age 12-23 Months with Specific Vaccinations . . . . . . . . . . . . . 116 Prevalence of Respiratory Illness and Diarrhoea in the Last Two Weeks by Age of the Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Prevalence of Stunting by Age of Child and Length of Birth Interval . . . . . . . . . . . . . . . 135 Nutritional Status of Children under Three Years, Mean Z-scores by Age in Months . 137 Change in Behaviour after Hearing about HIV/AIDS, by Sex . . . . . . . . . . . . . . . . . . . . . 159 Percentage of Women Age 15-49 Who Do Not Know a Source for Condoms . . . . . . . . 165 Female Adult Mortality by Age Group 0-9 Years before the Survey, 1994 ZDHS and Three Model Life Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Male Adult Mortality by Age group 0-9 Years before the Survey, 1994 ZDHS and Three Model Life Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 xiii PREFACE The Central Statistical Office (CSO) conducted the second Zimbabwe Demographic and Health Survey (ZDHS) between July and November 1994. The first ZDHS was fielded in 1988. The surveys were undertaken as part of the worldwide Demographic and Health Survey program, which has been implemented in Africa, Asia, Latin America and the Middle East. This report presents the major findings of the 1994 ZDHS; a preliminary report was published in January 1995. The 1994 ZDHS collected information on fertility, nuptiality, fertility preferences, family planning, infant and child mortality and health-related matters such as breastfeeding practices, antenatal care, children' s immunisations, childhood diseases, nutritional status of mothers and young children, and awareness and behaviour regarding sexually transmitted diseases, including Acquired Immune Deficiency Syndrome (AIDS). The CSO extends its acknowledgment and gratitude to the various agencies and individuals in the government, donor community, and public sector for the concerted support that facilitated the successful implementation of the survey. Specific mention, however, is due to the following: Ministry of Health and Child Welfare (MOH&CW) and the Zimbabwe National Family Planning Council (ZNFPC) for their significant technical inputs; • United States Agency for International Development (USAID) for funding the survey; Macro International Inc. (Maryland, USA) for providing technical assistance throughout the ZDHS project; All of the field personnel who were engaged during the survey; for commitment to high- quality work under difficult conditions; and • Finally, the ZDHS respondents for their patience and cooperation. C.N. Parirenyatwa Acting Director of Census and Statistics Central Statistical Office P.O. Box CY 342 Causeway Harare, Zimbabwe XV SUMMARY OF FINDINGS The 1994 Zimbabwe Demographic and Health Survey (ZDHS) is a nationally representative survey of 6,128 women age 15-49 and 2,141 men age 15-54. The ZDHS was implemented by the Central Statistical Office (CSO), with significant technical guidance provided by the Ministry of Health and Child Welfare (MOH&CW) and the Zimbabwe National Family Planning Council (ZNFPC). Macro International Inc. (U.S.A.) provided technical assistance throughout the course of the project in the context of the Demographic and Health Surveys (DHS) programme, while financial assistance was provided by the U.S, Agency for International Development (USAID/Harare). Data collection for the ZDHS was conducted from July to November 1994. As in the 1988 ZDHS, the 1994 ZDHS was designed to provide information on levels and trends in fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. How- ever, the 1994 ZDHS went further, collecting data on: compliance with contraceptive pill use, knowledge and behaviours related to AIDS and other sexually transmitted diseases, and mortality related to pregnancy and childbearing (i.e., maternal mortality). The ZDHS data are intended for use by programme managers and policymakers to evaluate and improve family planning and health programmes in Zimbabwe. Fertility. Survey results show that Zimbabwe has experienced a fairly rapid decline in fertility over the past decade. At current fertility levels, a Zimbabwean woman will bear 4.3 children in her lifetime, down 22 percent from the 1988 ZDHS when the total fertility rate was 5.5. children per woman. (In the early 1980s, the fertility rate was well above 6 children per woman.) A rural woman can expect to have 4.9 children, almost two children more than an urban woman (3.l children). Fertility differentials by women's educational status are even more striking; at current rates, women with no education will bear an average of 5.2 children, compared with 4.7 and 3.2 children for women with primary and secondary school education, respectively. Despite the decline in fertility, childbearing still begins early for many women. One in five women age 15-19 has begun childbearing (i.e., has already given birth or is pregnant with her first child). More than half of women have had a child before age 20. Births that occur too soon after a previous birth face higher risks of undemutrition, illness, and death. The 1994 ZDHS indicates that 12 percent of births in Zimbabwe take place less than two years after a prior birth. Marriage. The age at which women and men marry has risen slowly over the past 20 years. Currently, women marry for the first time at an average age of 19.8 years, compared with 25.5 years for men. Women who have attended secondary school generally marry three years later (20.8 years) than women with no education (17.5 years). Nineteen percent of currently married women are in a polygynous union (i.e., their husband has at least one other wife). This represents a small rise in polygyny since the 1988 ZDHS when 17 percent of married women were in polygynous unions. While men marry an average of six years later than women, women and men become sexually active at about the same age; in the youngest age cohort for which estimates are available (age 20-24), first sex occurs at a median age of 18.8 years for women and 18.7 years for men. xvii Fertility Preferences. Aro,md one-third of both women and men in Zimbabwe want no more children. Another 36 percent of women and 40 percent of men would like to delay their next child for two years or longer. Thus, 72 percent of women and 73 percent of men want either to limit or to space their births. When asked how many child-en they would like to have if they could live their lives over and choose exactly, both women and men report an average ideal family size of 4.3 children. In the 1988 ZDHS, women reported an ideal family size of 4.9 children. The survey results show that, of births in the last three years, 1 in 10 was unwanted and in 1 in three was mistimed. If all unwanted births were avoided, the fertility rate in Zimbabwe would fall from 4.3 to 3.5 children per woman. Family Planning. Knowledge and use of family planning in Zimbabwe has continued to rise over the last several years. The 1994 ZDHS shows that virtually all married women (99 percent) and men (100 percent) were able to cite at least one modem method of contraception. The pill, condoms, female sterlisa- tion, and injectables are the most widely known methods. Overall, 48 percent of currently married women are using a method of contraception. Use of modem methods has increased from 36 percent in the 1988 ZDHS to 42 percent in the 1994 ZDHS. The pill is the predominant method of contraceptio a used by Zimbabwean couples: 78 percent of modem method users are pill users. However, small increase~; in the use of injectables and condoms were noted in the 1994 ZDHS. Contraceptive use varies widely among geographic and socioeconomic subgroups. Fifty-eight per- cent of married women in Harare are using a modem method versus 28 percent in Manicaland. Modem meth- od use is twice as high amongst women with secondary education (55 percent) as those with no education (26 percent). Government-sponsored providers remain the chief source of contraceptive methods in Zimbabwe. Around one-third of users obtained their method from rural or municipal clinics, and nearly one-quarter from chnics and community-based distribution (CBD) workers of the Zimbabwe National Family Planning Council (ZNFPC). About 12 percent of modem method users obtain their method through the private sector, up from 4 percent in the 1988 ZDHS. Survey results show that 15 percent of married women have an unmet need for family planning (either for spacing or limiting births). This group comprises married women who are not using a method of family planning but want either to wait two years or more for their next birth (9 percent) or want no more children (6 percent). The level ofun -net need is higher in Matabeleland North (30 percent) and Matabeleland South (27 percent) than elsewhere in the country. Childhood Mortality. One of the main objectives of the ZDHS was to document the levels and trends in mortality among children under age five. The 1994 ZDHS results show that child survival prospects have not improved since the late 1980s. For the most recent five-year period (1990-94), under-five mortality was 77 deaths per 1,000 live birth:i and infant mortality was 53 deaths per 1,000 live births. These are virtually the same mortality levels ~s those estimated from the 1994 ZDHS for the period 1985-89--under- five mortality of 75 per 1,000 and infant mortality of 50 per 1,000. Comparison of the 1994 ZDHS mortality rates with data from other source~,, provides further evidence of the recent stagnation in the dechne in childhood mortality in Zimbabwe. xviii The ZDHS results show that childhood mortality is especially high when associated with two factors: short preceding birth interval and low level of maternal education. The risk of dying is doubled when a child is born after an interval of less than 24 months, and children of women with no education have an under-five mortality rate two-thirds higher than children of women who attended secondary school or higher. Maternal and Child Health. Utilisation of antenatal services is high in Zimbabwe; in the three years before the survey, mothers received antenatal care for 93 percent of births. The median number of antenatal visits per pregnancy was 5.8. Most antenatal care is provided by nurses and trained midwives (77 percent), but the percentage provided by doctors (23 percent) has risen in recent years. Still, over one-quarter of women who do receive care start during the third trimester of pregnancy--too late to receive the optimum benefits of antenatal care. Mothers reported receiving at least one tetanus toxoid injection for 82 percent of births in the three years before the survey. Tetanus toxoid is a powerful weapon in the fight against neonatal tetanus, a deadly disease that strikes newborn infants. About 70 percent of births take place in health facilities; however, this figure varies from around 53 percent in Manicaland and Mashonaland Central to 94 percent in Bulawayo. It is important for the health of both the mother and child that trained medical personnel are available in cases of prolonged or obstructed delivery, which are major causes of maternal morbidity and mortality. The ZDHS collected information that allows estimation of mortality related to pregnancy and child- bearing (i.e., maternal moraltity). For the 10-year period before the survey, the maternal mortality ratio was estimated to be 283 deaths per 100,000 live births. A Zimbabwean woman has a 1 in 59 chance of dying from maternal causes during her lifetime. Childhood immunisation levels are high in Zimbabwe. The ZDHS found that 80 percent of children age 12-23 months are fully vaccinated against the major childhood diseases; only 4 percent have received no vaccinations. Sixty-seven percent of children received all recommended vaccinations during the first year of life. In the two weeks preceding the survey, 25 percent of children under three years of age experienced symptoms of acute respiratory infection (ARI)--cough with short, rapid breathing. Around half of these children were taken to a health facility or doctor for treatment. Twenty-four percent of children under age three were reported to have had diarrhoea in the two weeks preceding the survey. The percentage of children with diarrhoea rises sharply with age, peaking at age 12-17 months, and falling thereafter. Diarrhoeal prevalence is substantially higher in rural areas (26 percent) than urban areas (18 percent) of Zimbabwe. Around 30 percent of children with diarrhoea are taken to a health facility for treatment. Nearly 4 in 5 children receive oral rehydration therapy in the recommended form--i.e., sugar-salt-water solution--to treat their diarrhoea. Nutrition. Almost all children (99 percent) are breastfed for some period of time; however, only 40 percent are breastfed within the first hour of life (91 percent within the first day after birth). The median duration of breastfeeding in Zimbabwe is 18.5 months; however, the introduction of supplementary liquids and foods occurs too early. Over half of children under two months of age are given some form of supple- mentary feeding. Until age 4-6 months, exclusive breasffeeding (i.e., without any other food or liquid) is rec- ommended because it provides all the necessary nutrients and avoids exposure to disease agents; yet, only 16 percent of children under 4 months are exclusively breastfed. xix When food supplementation begins, wide disparity exists in the types of food received by children in different geographic and socioecoaomic groups. Generally, children living in urban areas (Harare and Bulawayo, in particular) and children of more educated women receive protein-rich foods (e.g., meat, eggs, etc.) on a more regular basis than other children. In the ZDHS, children undei three years of age and their mothers were weighed and measured to obtain data for estimating levels of undernutrition. The results indicate that 21 percent of children under three are stunted (i.e., short for their age), ~. condition reflecting chronic undernutrition; and 6 percent are wasted (i.e., thin for their height), a problem indicating acute or short-term food deficit. Children age 12-23 months and children of high birth order are aL greater risk of poor nutritional status than other children. There are substantial provincial variations in the nutritional status of children. The prevalence of stunting ranges from 13 percent in Mtdlands and Bulawayo to more than 25 percent in Matabeleland North, Mashonaland Central, and Matabeleland South. Wasting vanes from 2 percent in Mashonaland East to 10 percent in Matabeleland North. Women whose body mass index (BMI)--weight in kilograms divided by the squared height in metres--falls below 18.5 are considered at nutritional risk. The data show that 5 percent of mothers of young children have a BMI value below 18.5. The percentage of mothers with a low BMI varies from 1 percent in Harare to 11 percent in Matabeleland North province. AIDS-related Knowledge a ud Behaviour. All but a fraction of Zimbabwean women and men have heard of AIDS, but the quality of that knowledge is sometimes poor. Over one-quarter of women and 15 percent of men do not believe that a 1" ealthy-looking person can carry the AIDS virus. Nearly I in 5 women and 1 in 16 men do not know a way ~ o avoid getting the AIDS virus. Condom use and limiting the number of sexual partners were cited most frequently by both women and men as ways to avoid the AIDS ~ irus. Generally, men have more complete knowledge of AIDS-related information than women. Radio is the primary source of AIDS-related information for both women and men, but other sources are also commonly cited. Women are more likely to obtain information from health workers and friends or relatives; me~l are more likely to get information from printed materials, especially newspapers. Women, more than men, perceive themselves at risk of getting HIV/AIDS. Nearly one-quarter of women but only 12 percent of men reported that they were at moderate or great risk of getting HIV/AIDS. When asked why they believed them:;elves at high risk, 59 percent of women reported that their spouse/part- ner had another sexual partner (compared with 2 percent of men). While general knowledge of condoms is nearly universal among both women and men, when asked where they could get a condom, 30 l:,ercent of women and 20 percent of men could not cite a single source. About half of women with no education do not know where to obtain condoms. Less than one-third of wom- en but more than two-thirds of men r~'~ported that they had used a condom at some time. Questions were also asked regarding condom use during sex in the last four weeks. For men who had sex with a non-spouse in the last four weeks, 60 percent used a condom at least some of the time; with spouses, condom use was only 12 percent. For women, the comparable figures were 38 percent condom use during non-spousal sex and 7 percent use during sex with their huz~bands. XX xxi ZIMBABWE ZAMBIA MASHONALAND WEST MASHONALAND CENTRAL EAST MATABELELAN3 NORTH MIDLANDS MANICALAND BOTSWANA MATABELELAND SOUTH MASVINGO MOZAMBIQUE SOUTH AFRICA xxii CHAPTER 1 INTRODUCTION 1.1 Geography and Economy Zimbabwe lies just north of the Tropic of Capricorn between the Limpopo and the Zambezi Rivers. The country is landlocked, bordered by Mozambique in the east, South Africa in the south, Botswana in the west and Zambia in the north and northwest. It is part of a great plateau, which constitutes the major feature of the geography of southern Africa. Although only about five percent of Zimbabwe' s land area is more than 1,500 metres above sea level, almost all of the country is more than 300 metres above sea level with nearly 80 percent lying more than 900 metres above sea level. About 70 percent of the country's surface area is made up of granite, schists and igneous rocks, which serve as the basis for Zimbabwe's mineral wealth. Soil types range from sandy/loamy in the high veld to sandy in the west. The sunny, temperate to hot climate attracts tourists and provides the basis for agricultural production, especially along the central ridge. Generally, temperature decreases and rainfall increases with altitude, ranging from the cool, wet eastern highlands to the hot, dry river valleys of the Zambezi, Limpopo and Sabi rivers. Zimbabwe has abundant natural resources, including 8.6 million hectares of potentially arable land and over 5 million hectares of forest, national parks and wildlife estates. There are adequate supplies of surface and ground water for electric power, irrigation, and domestic and industrial use. Mineral resources are varied and extensive, including gold, asbestos, coal, nickel, iron, copper, lithium, and precious stones such as emeralds. The economy is fairly diversified, with relatively developed commercial, industrial, mining and agricultural sectors. Manufacturing and agriculture are the leading producers for both the domestic and export markets, with mining contributing more to export earnings than to the domestic economy. In addition to mining, major industries include food production, construction, chemicals, textiles, wood and furniture, and transport equipment. Main agricultural exports include tobacco, maize, cotton, sugar, and groundnuts. The agriculture sector has well-developed commercial and communal farming systems. The communal sector output has increased, although it is still lacking essential physical and social infrastructure. Government development efforts lay increased emphasis on strengthening this sector, as reflected in the Government' s Economic Policy Statement of Growth With Equity. One of the major objectives of Zimbabwe's development efforts has been the alleviation of poverty and the fulfilment of basic needs--i.e., health, nutrition, education and training, housing, social services, water, law and order, etc. With the adoption in 1991 of the "Framework for Economic Reform," the Government introduced a five-year Economic and Structural Adjustment Programme (ESAP). With financial support from the World Bank and the International Monetary Fund, the Government implemented adjustment programmes in industry, trade, and agriculture. 1.2 Population In 1992, the population of Zimbabwe was 10.4 million, an increase of 6.4 million from the 1961/62 population census. Estimates of total population are available from the beginning of the century up to 1951 when the census began inclusion of non-Africans. Table 1.1 shows that the average annual growth in the population reached a peak of 3.5 percent in 1951 and 1961, then &opped to 3.0 percent in 1982. The national average annual population growth rate between 1982 and 1992 was 3.1 percent. If growth were to continue at this pace, the population would be expected to double in about 23 years. Table 1.2 shows a small increase in the percentage of the population that is of African descent, from 98 percent in 1982 to 99 percent in 1992. The population of European descent has decreased from 2 percent to less than one percent in 1992. The 1992 Popula- tion Census results estimate the crude birth rate (CBR) and the crude death rate (CDR) to be 34.5 births per thousand population and 9.5 deaths per thousand popula:ion, respectively, yielding a natural increase of 25 per thousand. Zimbabwe has a relatively young population; 45 percent of the 1992 census population were below age 15 while about 3 percent were 65 years and over. Table 1.2 Demographic indicators Selected demographic indicators, Zlmbabcce 1982 and 1992 1982 1992 ln&cator Census Census Total population (thousands) 7,608 10,412 Distribution by ethmc group (%) African 97.7 98.8 European 1.9 0.8 Coloured 0.3 0.3 Asian 0.1 0.1 Distribution by age group (%) 0-14 479 45.1 15-64 49.1 51.3 65+ 3 0 3.3 Not stated -- 0.3 Crude birth rate (CBR) births per 1,0130 population Crude death rate (CDR) deaths per 1,000 population Number of males per 100 l~males m the total population Life expectancy at birth Source: Central Statistical Office, 1994 39.5 34.5 10.8 9.5 96 95 57.4 61.0 Table 1,1 Population size and growth rate Population size and annual rate of increase m the population, Zimbabwe, 1901-1992 Annual growth Population rate Year (thousands) (percent) 1901 713 -- 1911 907 2.4 1921 1,147 2.4 1931 1,464 2.5 1941 2,006 3.2 1951 2,829 3.5 1961 3,969 3.5 1969 5,134 3.3 1982 7,608 3.0 1992 10,412 3 1 Source: Central Statistical Office, 1994 1.3 Family Planning Policies and Programmes Family planning services have been available in Zimbabwe since 1953. With the es- tablishment of the Family Planning Association (FPA) in 1965, responsibility for the previously uncoordinated family planning services was as- signed to a single organisation. Initially, family planning service delivery in Zimbabwe was largely clinic-based. Govern- ment family planning services were integrated in- to the maternal and child health (MCH) delivery system at hospitals and clinics and only medical personnel were allowed to prescribe hormonal contraceptives. In 1976, the Ministry of Health granted permission for "field educators" to resup- ply clients with pills and condoms as a strategy for improving clients' access to family planning services. The field educators then became "pill agents," who formed the basis of the current com- munity-based distribution (CBD) system. In 1985, the ruling party's ZANU-PF Congress resolved to promote family planning not just for child spacing and welfare reasons but to limit family size. In the same year, the Child Spacing and Family Planning Council (CSFPC) became a parastatal under the Ministry of Health through an Act of Parliament and was renamed the Zimbabwe National Family Planning Council (ZNFPC). The ZNFPC's mandate is to promote family planning through the provision of information and services to all sectors of the community. The Council is also required to train medical and para-medical personnel in family planning service delivery. In addition, ZNFPC is tasked with the procurement of contraceptives for the public sector facilities and hence supplies contraceptives to over 1,000 non-ZNFPC hospitals and clinics. Through its network of 34 clinics and the commumty-based distribution system, the ZNFPC continues to be one of the major providers of family planning services in Zimbabwe. ZNFPC clinics provide a wide range of contraceptive methods including the pill, condoms, chemical barrier methods, IUDs and injectables. ZNFPC provides female and male sterilisation at two of its facilities, one in Harare and another in Bulawayo. ZNFPC introduced implants in 1992, although provision of this method is still limited to three ZNFPC facilities--the three central hospitals--and a few private practitioners in Harare and Bulawayo. In 1992, in line with its objective to broaden the method mix, ZNFPC reintroduced injectables which, since 1980, had been restricted to a limited clientele. The Ministry of Health and Local Government health facilities provide pills, condoms, chemical and barrier methods, and injectables. Where the health facility is adequately equipped, IUDs are inserted and sterilisation procedures performed. Voluntary Surgical Contraception (VSC) is generally available in the public sector facilities at district and provincial levels, since these facilities have well-equipped operating theatres and doctors trained in VSC. The community-based distribution (CBD) system is the principal outreach mechanism for family planning service delivery in rural areas and is generally referred to as the "backbone" of the ZNFPC pro- gramme. Community-based distribution (CBD) workers are selected by communities before they are sent for the basic six-week CBD Initial Course. They are trained to inform and educate communities on the benefits of family planning, motivate clients to use family planning, initiate clients who want to use oral contraceptives, resupply established clients with pills and condoms in their homes, and refer clients wanting to use other non-supply methods to local clinics. The work force of 800 CBD workers covers approximately 29 percent of the rural population in Zimbabwe. The current success of the family planning programme has been made possible partly through the effective and coordinated implementation of the Five Year Strategy (1991 - 1996). The ZNFPC' s strategy has clearly stated and quantified objectives and aims to broaden the method mix with emphasis on long-term and permanent methods of contraception; reduce the total fertility rate from an estimate of 5.5 to 4.5 children per woman; increase financial sustainability through the sale of contraceptives and charging for services while ensuring access by low income groups; and to increase the proportion of family planning services delivered by the private sector from 5 to 17 percent by 1996. The success of the family planning programme in Zimbabwe is, therefore, largely due to the Govern- ment's political commitment to the programme. 1.4 Health Priorities and Programmes The Ministry of Health and Child Welfare (MOH&CW) has made significant progress in ensuring access to health care services for rural communities through increasing the number of health facilities in rural areas. The past decade has seen an expansion of the water and sanitation programme as a strategy to control diarrhoeal diseases; the expansion of the immunisation programme for children under five and expectant mothers aimed at improving the health status of mothers and children; the provision of free health care services for those earning less than $Z400 a month, who make up the majority of the population; and the training of traditional midwives in order to improve the quality of care for mothers who do not deliver at health facilities. The supplementary feeding programmes for children under five and expectant mothers in drought-stricken areas has improved the health status of "at-risk" groups. The upgrading of the health care facilities through Family Health Projects I and II has improved the quality of health care services in rural areas. In line with the Primary Health Care (PHC) approach, the 1980s saw a shift m the emphasis of health service provision from curative to preventive services. The main components of PHC include maternal and child health (MCH) services, family planning, health and nutrition education, expanded programme on immunisation (EPI); control of comrrtunicable diseases (CCD), water and sanitation, provision of basic and essential preventive and curative care, and provision of drugs through the Essential Drugs Programme. All health faclhties provide integrated MCH services such that, for example, if a mother visits a clinic with an undernourished child, the nur~, ing staff are expected to also check the immunisation status of the child and to immunise the child if necessar3. Other aspects of MCH, such as family planning, should be discussed during client-staffinteraction and appropriate services provided, if necessary. This "supermarket approach" allows users access to a whole range of health care services that are normally available under one roof. Th~s minimises unnecessary trips by clients who might otherwise have to come on a special day for famdy planning and on another day for immunisation. The majority of health servLces in Zimbabwe are provided by the public sector, comprised of MOH&CW and Local Government authorities in both urban and rural areas. The Health Service Delivery System is divided into four levels ofc~ re, i.e., primary, secondary, tertiary and quartenary (central) depending on the level of staff training at the institution and the equipment available at the facility. In the rural areas, Rural Health Centres (RHCs) are the lowest level of health care facilities and are staffed by state- certified nurses and midwives and environmental health technicians. In urban areas, the Primary Care Clinics are the lowest level clinics and are generally staffed by state-registered nurses and midwives. The RHCs and urban primary care facilities refer complicaled cases to District Hospitals, which have both doctors and nurses, are better equipped, and have an operating theatre and a laboratory. The district hospitals, in turn, refer their difficult cases to the Provincial Hospitals which ultimately refer to the Central Hospitals. The importance which the MDH&CW attaches to MCH services is evidenced by the establishment of an MCH department in the Ministry of Health. The MCH Department, made up of the Nursing Direc- torate, the Nutrition Unit, the Health Education Unit and the EPI Unit, designs and implements integrated health programmes aimed at improving the health status of mothers and children. The department also identi- fies and prioritises health problems of mothers and children and formulates strategies to alleviate the prob- lems. Pregnant mothers are encouraged to attend antenatal sessions and to deliver at health centres. The MCH Department, in collaboration with other sectors, convinced the Government to grant pregnant working women 90 days paid maternity leave and one hour of breastfeeding time per day until the child is six months old. 1.5 Objectives and Organisation of the Survey The 1994 ZDHS is one of a ~eries of surveys undertaken by the Central Statistical Office (CSO) as part of the Zimbabwe National Household Survey Capability Programme (ZNHSCP) and the worldwide DHS programme. The ZNFPC and MOI-[&CW contributed significantly to the technical development of the ZDHS study design, implementatior~, and analysis of results. The 1994 ZDHS was funded by the U.S. Agency for International Developraent (USAID), and technical assistance was provided by Macro International Inc. (Calverton, Maryland, U.S.) through its contract with USAID. 4 The primary objectives of the 1994 ZDHS were to provide up-to-date information on: fertility levels; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health, and awareness and behaviour regarding AIDS and other sexually transmitted diseases. The 1994 ZDHS is a follow-up of the 1988 ZDHS, also implemented by CSO. While significantly expanded in scope, the 1994 ZDHS provides updated estimates of basic demographic and health indicators covered in the earlier survey. 1.5.1 Sample Design and Implementation The area sampling frame used for the 1994 ZDHS was the 1992 Zimbabwe Master Sample (ZMS92) developed by the Central Statistical Office following the 1992 Population Census. The ZMS92 included 395 enumeration areas (EAs) stratified by province and land use sector. For purposes of the ZDHS, 18 sampling strata were identified: urban and rural strata for each of g provinces, plus Harare (including Chitungwiza) and Bulawayo, which are exclusively urban strata. The sample for the 1994 ZDHS was selected in two stages. In the first stage, 230 EAs were selected with equal probability. Then, within each of these 230 EAs, a complete household listing and mapping exercise was conducted in March 1994, forming the basis for the second-stage sampling. For the listing exercise, permanent CSO enumerators were trained in ZDHS listing and cartographic methods at the University of Zimbabwe over a three-day period. Institutional populations (army barracks, hospitals, police camps, etc.) were not listed. From these household lists, households to be included in the ZDHS were selected, with the sample "take" from each EA being proportional to its size based on the household listing results. All women age 15- 49 years in those households were eligible to be interviewed in the ZDHS. Further, a 40 percent systematic subsample of these households was selected, within which interviews with all males age 15-54 years were to be conducted as well. Since the objective of the survey was to produce estimates of specific demographic and health indic ators for each of the 10 provinces, the sample design allowed for an oversample of smaller ZDHS strata. The overall target sample was 6,000 women and approximately 2,200 men. The ZDHS sample is not self- weighting at the national level (weights are required to estimate national-level indicators). Details concerning the ZDHS sample design are provide in Appendix A; estimations of sampling errors are included in Appendix B. 1.5.2 Questionnaires Four types of questionnaires were used for the ZDHS: the Household Questionnaire, the Women's Questionnaire, the Men's Questionnaire, and the community-level Service Availability Questionnaire. The contents of these questionnaires were based on the DHS Model "A" Questionnaire, which is designed for use in countries with moderate to high levels of contraceptive use. The Household Questionnaire was used to list all the usual members and visitors of selected households. Some basic information was collected on characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. In addition, the Household Questionnaire collected information on characteristics of the household's dwelling units, such as the source of water, type of toilel facilities, materials used for the floor of the house, and ownership of various consumer and durable good.,;. The Women's Questionnair,. • was used to collect information on women age 15-49. These women were asked questions on the followi'lg topics: Background characleristics (education, residential history, etc.) Reproductive history Knowledge and use of family planning methods, including compliance with pill use Fertility preference.,: Antenatal and delivery care Breastfeeding and weaning practices Vaccinations and health of children under age three Marriage and sexual activity Woman's status and husband's occupation Awareness and behaviour regarding AIDS and other sexually transmitted diseases Adult mortality including maternal mortality. Unlike the 1988 ZDHS, a "calendar" was used in the 1994 ZDHS to collect information on the respondent' s history since January 1989 concerning reproduction, contraceptive use, reasons for discontinua- tion of contraception, marriage, anti migration. In addition, interviewing teams measured the height and weight of all children under the age of three years and women who had a birth since January 1991. The Men's Questionnaire was administered to all men age 15-54 living in every 2.5 households in the ZDHS sample (i.e., a 40 percert subsample). The Men's Questionnaire collected much of the same information found in the Women's :~uestionnaire, but was shorter because it did not contain questions on reproductive history and maternal a~d child health. The Service Availability Questionnaire was administered to community leaders during the household listing operations in March 1994. Community-level information was collected on the nearest health and family planning services available to residents of each of the 230 clusters of households included in the ZDHS sample. 1.5.3 Training and Fieldwork The ZDHS questionnaires were pretested in April 1994. Twenty qualified nurses were trained to implement the pretest during a three-week training period. Three language versions of the questionnaires were produced: Shona, Ndebele, and English. The pretest fieldwork was conducted over a one-week period in areas surrounding Gweru, where both Shona and Ndebele households could easily be identified. Approxi- mately 150 pretest interviews were :onducted, debriefing sessions were subsequently held with the pretest field staff, and modifications to th~ questionnaire were made based on lessons drawn from the exercise. Pretest interviewers were retained to serve as field editors and team supervisors during the main survey. Training of field staff for the main survey was conducted over a four-week period, June-July 1994. Permanent CSO staff trained 70 incoming interviewer trainees, most of whom were trained nurses. The training course consisted of instruction in general interviewing techniques, field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children, mock interviews between participants in the classroo m, and practice interviews with real respondents in areas outside ZDHS sample points. Trainees who performed satisfactorily in the training programme were selected as inter- viewers, while the remainder were r~rtained to assist in office operations. During this period, field editors and team supervisors were provided with additional training in methods of field editing, data quality control procedures, and coordination of fieldwork. The fleldwork for the ZDHS was carried out by 10 interviewing teams, one designated for each province. Each team consisted of one team supervisor, one field editor, five to six female interviewers, one or two male interviewers and one driver. Thus, in total, there were 10 team supervisors, 10 field editors, 54 female interviewers, 12 male interviewers and 10 drivers. Six permanent senior CSO staff coordinated and supervised fieldwork activities. Data collection took place over a four-month period, 20 July to 28 November 1994. 1.5.4 Data Processing All questionnaires for the ZDHS were returned to the CSO for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing computer identified errors. The data were processed on five microcomputers. Data entry and editing were accomplished using the computer program ISSA (Integrated System for Survey Analysis). Data processing commenced on I August 1994 and was completed on 14 December 1994. 1.5.5 Response Rates Table 1.3 shows response rates for the ZDHS. A total of 6,483 households was selected in the sample, of which 6,075 were currently occu- pied. The shortfall was largely due to households no longer existing in the sampled clusters at the time of the interview. Of the 6,075 existing house- holds, 5,984 were interviewed, yielding a house- hold response rate of 99 percent. In the interviewed households, 6,408 eli- gible women were identified and of these, 6,128 were interviewed, yielding a response rate of 96 percent. In the 40 percent subsample of house- holds, 2,339 eligible men were identified, of which 2,141 were successfully interviewed (92 percent response). The principal reason for non- response among both eligible men and women was the failure to find them at home despite re- peated visits to the household. The lower response rate among men than women was due to the more frequent and longer absences of men. The refusal rate in the ZDHS was very low (less than 1 per- cent for both women and men). Table I 3 Results of the household and mdtvxdual mtervmws Number of households, number of interviews and response rates, Ztmbabwe 1994 Residence Result Urban Rural Total Household interviews Households sampled 1,829 4,654 6,483 Households occupied 1,759 4,316 6,075 Households interviewed 1,71 ] 4,273 5,984 Household response rate 97.3 Individual interviews Number ol ehgible women 1,833 Number ol ehgible women intervtewed 1,745 Eligible woman response rate 95.2 Number of eligible men 766 Number of ehglble men interviewed 681 Eligible man response rate 88.9 99.0 98.5 4,575 6,408 4,383 6,128 95.8 95.6 1,573 2,339 1,460 2,141 92.8 91.5 Rural response rates were higher than urban response rates; the difference being especially pronounced for the men's survey. In urban areas, 89 percent of eligible men were interviewed compared with 93 percent of men in rural areas. 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter presents information on some socioeconomic characteristics of the household population and the individual survey respondents, such as: age, sex, education, and place of residence. It also examines the environmental profile of households in the ZDHS sample. Taken together, these descriptive data provide a context for the interpretation of demographic and health indices, and can furnish an approximate indication of the representativeness of the survey. The background characteristics of men age 15 to 54 years and women age 15 to 49 years are discussed in the last part of the chapter. This information is useful for understanding the factors which affect reproduction and contraceptive use behaviour. 2.1 Household Population The ZDHS household questionnaire was used to collect data on the demographic and social characteristics of all usual residents of the sampled household, and visitors who had spent the previous night in the household) 2.1.1 Age-Sex Composition The distribution of the ZDHS household population is shown in Table 2.1, by five-year age groups, according to sex and urban-rural residence. The ZDHS households constitute a population of 27,889 persons. Fifty-one percent of the population are females and 49 percent are males. There are larger numbers of the populatlon m the younger age groups than in the older age groups of each sex in both urban and rural areas. The age-sex structure of the population is shown by use of a population pyramid in Figure 2.1. The pyramid is wide-based, a pattern that is typical of high-fertility populations. The number of children under five is less than the number age 5-9 years, a finding that is consistent with a recent fertility decline (see Chapter 3). The population distribution by broad age groups in Table 2.2 shows that the proportion of children under 15 years of age is currently around 46 percent, that of persons over 65 years of age is about 4 percent. The population has a low median age of about 17 years. There has been a general decline since 1982 in the proportion of the population under 15 years and an increasing median age. The 1992 census and the 1994 ZDHS show fairly similar distributions by age. The dependency ratio ~" calculated from the ZDHS 1994 is A household relcrs to a person or group of related and unrelated persons who live together in the same dwclhng unit(s), who acknowledgc one adult male or female as head of household, who share the same housekeeping arrangements, and are considered as one unit. A member of the household is any person who usually hves m the houschold and a visitor Is someone who is not a usual member of the household but had slept in the household the night befure the interview date. The household population presented in this chapter includes, unless otherwise stated, all usual members of the household who slept in the household the mght before the survey and visitors (de facto population). z The dependency ratio Is defined as the sum of all persons age under 15 years or over 64 years divided by the number of persons age 15-64, muhlphed by 100. Table 2.1 Household population by age, residence and sex Percent distribution of the de facto household population by five-year age groups, according to sex and urban-rural residence, Zimbabwe 1994 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 11.9 14.1 12.9 15.8 14.1 14.9 14.7 14.1 14.4 5-9 12,9 12.4 12.6 17.8 16.7 17.2 16.4 15.6 16.0 10-14 11.1 12.2 11.6 18.4 16.4 17.3 16.3 15.3 15.8 15-19 9.8 12.6 11.2 13.1 10.2 11.6 12.2 10.8 11.5 20-24 I0.7 13.4 12.0 7.5 8.1 7.8 8.4 9.5 8.9 25-29 9.6 9.0 9.3 4.7 5.8 5.3 6.1 6.6 6.4 30-34 8.7 8.7 8.7 3.8 5.5 4.7 5.1 6.3 5.7 35-39 6.9 5.6 6.3 3.0 4.5 3.8 4.1 4.8 4.5 40-44 5.8 3.9 4.9 2.4 3.6 3.0 3.4 3.7 3.5 45-49 3.8 2.7 3.3 2,3 3.1 2.7 2.7 3.0 2.9 50-54 2.7 2.0 2.4 2.4 3.1 2,8 2.5 2.8 2.7 55-59 2.2 1.0 1.6 2.0 2,3 2,2 2.1 2.0 2.0 60-64 1.7 1.2 1,5 2.2 2.1 2.1 2.0 1.9 2.0 65-69 0.9 0.6 0.8 1.6 1.3 1.4 1.4 1.I 1.2 70-74 0.6 0.4 0.5 1.2 1.1 1.2 1.1 1.0 1.0 75-79 0.3 0.2 0.2 0.9 1.0 0.9 0.7 0.8 0.7 80+ 0.2 0.2 0.2 0.9 1.0 1.0 0.7 0.8 0.8 Missin~Don't know 0.1 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0 Total 100.0 i00.0 lO0.O 100.0 100.0 100.0 I00.0 100.0 I00.0 Number 3,810 3,669 7,479 9,852 10,554 20,410 13,661 14,223 27,889 Age 80+ 75-79 70-74 65-6@ 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 Figure 2.1 Population Pyramid of Zimbabwe 5-9 0-4 10 5 0 5 Percent 10 ZDHS 1994 10 Table 2.2 Population by age fromselected sources Percent distribution of the population by age group, selected sources, Zimbabwe, 1982-1994 1982 1987 1992 1993 1994 ZDHS Age Census ICDS 1 Census IMS 2 group (De facto) (De jure) (De facto) (De jure) De facto De jure < 15 47.7 47.7 45.1 45.0 46.2 45.7 15-64 49.2 49.1 51.3 52.0 50.0 50.3 65+ 2.9 3.2 3.3 3.0 3.8 3.9 Not stated 0.3 0.3 0.0 0.0 0.0 Total 100.0 100.0 100.0 100,0 100.0 100.0 Median age 16.1 16.0 17.1 17,1 16.6 16.8 Dependency ratio 102.9 103.7 94.4 92.5 99.7 98.5 I lntercensal Demographic Survey 2 Indicator Monitonng Survey 99.7, which means that there is roughly 1 person under 15 years or over 64 years in Zimbabwe for every person age 15-64 years. 2.1.2 Household Composition Table 2.3 shows that about one in three Zimbab- wean households is headed by a female. There is a larg- er proportion of female-headed households in rural areas (39 percent) than in urban areas (19 percent). The aver- age household size is 4.7 persons. Urban households are on average smaller (3.8 persons) than rural households (5.1 persons). Twenty-two percent of households have foster children; 11 percent of urban households and 28 percent of rural households. Foster children are those persons under 15 years of age who have no natural par- ent in the household. Information regarding fosterhood and orphan- hood of children under 15 years of age is presented in Table 2.4. About 48 percent of children under 15 years of age are living with both their parents, 28 percent are living with their mothers (but not with their fathers), 4 percent with their fathers (but not their mothers) and 18 percent are living with neither their natural mother nor natural father. Of the children under 15 years of age, 7 percent have lost their fathers, 3 percent have lost their mothers. About 1 percent of children have lost both parents. Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and whether household includes foster chddren, according to urban-rural resldence, Zimbabwe 1994 Characteristic Residence Urban Rural Total Household headship Male 81.4 60.6 67.3 Female 18.6 39.4 32.7 Total 100.0 I00.0 100.0 Number of usual members I 19.3 10.7 13.4 2 17.3 10,1 12.4 3 15.4 11.5 12.8 4 14.0 13.5 13.6 5 10.8 14.0 12.9 6 9.4 11.8 I 1.0 7 6.2 10.0 8.8 8 3.1 6.9 5.7 9+ 4.4 I 1.5 9.2 Total 100.0 100.0 100.0 Mean size 3.8 5.1 4.7 Percent with foster children 10.8 27.5 22.1 Note: Table is based on de jure members; i.e., usual residents. 11 Table 2,4 Fosterhood and orphanhood Percent distribution of de facto chddren vnder age fifteen by survtva[ of parents and chi ld's hvmg arrangements, according to chdd 's age, sex, urban-rura[ residence and prownce~ Zimbabwe 1994 LI Jmg Living w~th "nother with father Not hwng w~th but nc,t father but not mother e~ther parent L lwng Missing with Father Mother mfo on Number both Father Father Mother Mother Both only only Both father/ of Characteristic parents ahve dead ahve dead ahve ahve ahve dead mother Total chddren Age 0 2 54 7 34.4 1.7 0 6 0.0 6 7 3-5 50.9 25 1 3.2 l 6 0 2 15 3 6-8 47.6 225 44 3.4 07 15.3 9-11 44.9 219 5.2 39 10 15.4 12+ 415 18.0 65 5.1 14 174 Sex Male 48 7 24 2 4.3 3 2 Female 46.8 24 l 4 2 2 9 04 09 I 5 7 07 134 I 07 149 I 02 02 I 2 I(FO0 2,341 1 I 03 1.4 100.0 2,558 2. I 0.6 2.2 100 0 2,680 28 13 2 1 100,0 2,737 39 12 32 1000 2,560 1.8 07 I 8 100.0 6,478 2.3 0 7 2 3 100 0 6,394 Residence Urban 641 125 36 55 0.9 93 0.9 14 03 [6 11300 2,780 Rural 432 27.4 44 2.3 06 15.5 12 23 08 22 100.0 10,095 Province Mamcaland 40.3 28.9 5.6 2 8 0.7 12 5 0 8 3 2 I 3 3 8 100.0 2,000 Mashonaland Central 51.6 21.9 4.3 20 0.9 148 0.7 16 07 14 100.0 1,092 Mashonaland East 44 9 303 2.4 I 6 0.2 143 I 6 2 I 09 1.8 100 0 1,409 Mashonaland West 53 3 16 2 4 3 4A [ 2 157 I 3 2 I 1.3 0.5 1000 1,415 Matabeleland North 418 293 2,8 29 09 16.8 [ 0 17 0.6 22 1000 987 MatabeIetand South 32 6 310 3 9 2 2 0,0 24 6 I 0 28 06 [ 4 100 0 807 Midlands 445 27.7 46 29 0.4 144 1,1 I 1 03 3,0 100.0 1,664 Masvmgo 44.3 2%4 6 I I 7 10 13 3 1.5 27 03 I 7 100.0 1,494 Harare 703 82 32 5,8 07 78 14 12 0.2 12 1000 1,432 Bulawayo 534 197 36 5.0 08 127 03 1.6 06 23 100.0 576 Total 478 242 42 3.0 07 14.2 ] ] 2 ] 07 20 100.0 12,875 Note: By convention, foster chddren are those who are not hying with either parent This includes orphans, I e , children both of whose parents are dead. 2.1.3 Educational Level of Household Members Tables 2.5.1 and 2.5,2 show the distribution of female and male household members (age 6 and above) by the highest level of education ever attended (even if they did not complete that level), and the median number of years of education completed, according to age, urban-rural residence, and province. Generally, educational attainment t:; slightly htgher for males than females. About 90 percent of males have attended school versus 84 percent of females. Very few young persons of either sex have not attended school. While most Zimbabweans attend school, a relatively small proportion are able to continue to higher levels of education. The median number of years of schooling completed for females and males is 5 and 6 years, respectively. Twenty-four percent of females and 31 percent of males have reached the secondary level of education, and less than 2 percent have gone beyond secondary school. An encouraging trend towards increasmg educational attainment is observed by looking at age differences in the median number of years completed. The median educational attainment peaks at over 9 completed years for females (age 20-24) and I 1 years for males (25-29). As expected, educational attainment is greater in urban than rural areas. 12 Table 25.1 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Zimbabwe 1994 Don't Median Background No edu- know/ years of characteristic cation primary Secondary Higher missing Total Number schooling Age I 6-9 207 785 00 00 0,7 1000 1,793 I I 10-14 1 4 902 8 I 00 0.3 1000 2,174 50 15-19 15 41.5 566 02 0.2 1t30.0 1,541 82 20-24 3 8 34.1 60.8 I 2 0 2 100 0 1,344 9 4 25-29 9 4 38 8 48.1 3 6 11.1 100 0 944 8.3 30-34 16 4 58.2 23 2 2.1 0 I 100.0 899 7.0 35-39 232 628 118 1.3 08 100.0 684 5.4 40-44 24.6 634 105 I 3 0.2 1000 524 54 45-49 26 3 62 5 7 2 2 2 1 g I1)0.0 424 4 7 50-54 38 I 548 44 1.6 1 I 100.0 401 3,0 55-59 43,0 527 1.5 1.8 I 0 1000 281 2.1 60-64 47.9 46 8 2.5 1 9 0.8 100 0 267 1.2 65+ 61.3 33 I 2 3 I 4 1.8 1000 515 0.0 Residence Urban 5,3 49 0 43.0 2 6 0.2 100 0 3,067 7 6 Rural 19 1 63.6 162 0.5 06 100.0 8,729 4.4 Province Mamcaland 182 640 160 09 08 1000 1,778 45 Mashonaland Central 25 1 58,0 16 2 0.0 0 6 100.0 968 3 7 Mashonaland East 148 64,1 196 0,6 09 100,0 1,219 4,9 Mashonaland West 22 5 593 t6.6 0.9 0,8 100 0 1,265 4.3 Matabeleland North 22 I 62.2 14 4 0.4 0 9 100.0 785 4 2 Matabeleland South 160 64.2 190 0.2 0.5 1000 698 5.2 Midlands 12 5 61 I 25 0 0 9 0.4 100 0 1,520 5 6 Masvmgo 17 1 66 0 16 8 0 I 0 I 100.0 1,324 4,5 Harare 4 0 46.4 45 9 3.6 0 I 100.0 1,593 7.9 Bulawayo 49 527 41 2 1 1 0,1 1000 648 74 Total 155 598 232 10 05 1000 11,796 54 I Excludes 3 women for whom an age was not reported. 13 Table 2.5.2 Educational level of the male household populauon Percent distribuhon of the de lhcto male household population age six and over by highest level of education attended, and medl~n number of years of schooling, according to selected background charactenstics, Zimbabwe 1994 Don't Median Background No edu- know/ years of charactemst~c canon Primary Secondary Higher missing Total Number schoohng Age I 6-9 21 8 77,8 00 00 10-14 I 3 92.5 60 00 15-19 I 8 37 3 6(1.7 0 I 20-24 I 8 24 3 70 4 2 6 25-29 2.2 23.1 675 6.7 30-34 4 9 40 6 48 5 4 9 35-39 66 568 319 39 40-44 8 7 62 8 22 6 4,0 45-49 14,6 62 4 16 6 4 9 50-54 15 6 69 5 9 2 3 4 55-59 19 I 66 3 9 0 3 3 60-64 32 9 59 8 4 2 0 8 65+ 37,4 54 3 4 2 1 5 04 1000 1.777 I 0 02 100,0 2,230 47 0 1 1000 1,661 82 08 1000 1.145 10.9 06 100.0 834 11.1 1.1 1000 703 9.1 0 8 I(X) 0 561 7,5 I 9 100 0 463 7 2 I 5 I(YO 0 373 6 8 23 1000 340 57 24 1000 287 5,4 23 1000 278 32 2 7 100 0 532 2 5 Residence Urban 45 442 472 37 03 1000 3,252 80 Rural I I 4 64 3 22 I I 1 1,0 100 0 7,939 5 2 Province Mamcaland 10 l 63 0 24 6 I 4 0 8 I (X) 0 1,602 5 4 Mashonaland Central 13.8 617 232 03 09 I(X) O 953 5A Mashonaland East 9 6 62.2 25 5 1 5 I 3 100.0 1,130 5 8 Mashonaland West 14 0 58 0 25 5 1 1 I 4 100 0 1,329 5.4 Matabeleland North 13 0 670 17 7 0 8 I 6 100.0 715 4 8 Matabeleland South 106 672 202 09 I 0 1000 557 54 Midlands 8 0 6(11 284 2 2 1 2 100 0 1,341 6 4 Masvmgo 100 670 225 05 01 100,0 1,162 5.0 Harare 42 403 500 54 0.1 1000 1.752 9,1 Bulawayo 2 7 50.6 44 6 2 0 0.1 100 0 651 7 8 Total 94 585 29,4 19 (/8 100,0 11,191 62 i Excludes 8 men for whom an age was not reported 2.1.4 School enrolment In Table 2.6, school enrolment ratios by age group, sex and residence for the population age 6 to 24 years are presented. A school enrolment ratio is the number of enroled persons at a specific age group per hundred persons in that particular age group. Eighty-three percent of persons age 6-15 are in school; urban enrolment is slightly higher (89 percent) than rural enrolment (82 percent). There is, however, a higher enrolment ratio in rural areas than in urban areas for age group 16 to 20 years because persons start school later in rural areas. Age group 21-24 has slightly more persons attending school in the urban areas (9 percent) than in the rural areas (6 percent) because college attendance is more common in urban areas. 14 Table 2.6 School enrolment Percentage of the de facto household population age 6-24 years enrolled m school, by age group, sex, and urban- rural residence, Zimbabwe 1994 Male Female Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 6-10 85.8 77.9 79.6 88.0 78.2 80 I 86.9 78.0 79.9 11-15 93.4 87.3 88.4 90.8 84.8 86.1 92.0 86.1 87.2 6-15 89.2 82.5 83.9 89.3 81.3 82.9 89.3 81.9 83.4 16-20 40.9 45.4 44.2 25.0 27.5 26.6 31.9 37.1 35.6 21-24 127 9.5 10.7 5 I 3 5 4.0 8.6 6.2 7.1 Figure 2.2 shows that the rate of school entrance is nearly the same for boys as for girls, but that girls tend to drop out at an earlier stage than boys. Eighty percent of both girls and boys are enroled at age 6-10, and 86-88 percent at age 11-15, but by age 16-20 only 27 percent of females are still in school versus 44 percent of males. By age 21-24, 4 percent of women and 11 percent of men are still in school. 1 O0 Percent Figure 2.2 80 60 40 20 0 School Enrolment by Age and Sex i 6-10 11-15 16-20 21-24 Age Group ZDHS 1994 15 2.2 Housing Characteristics Information on the characteristics of the sam- pled households is shown in Table 2.7. The physical characteristics of the household have .in important bear- ing on environmental exposure to disease, as well as re- flecting the household's economic condition. Twenty-eight percent of the households in Zim- babwe have electricity. There is a significant difference in access to electricity between urban and rural areas. Eighty percent of urban households have electricity compared with 3 percent of rural households (see Figure 2.3). About 33 percent of all households have water piped into their residence, yard, or Flot; 93 percent of households in urban areas have piped water, but only 4 percent of households in rural areas. I31 rural areas, bore- holes are the main source of drinking water (42 percent), followed by unprotected wells ( 17 percent). The median time to get to the source of drinking water is 20 minutes in rural areas and less than a minute m urban areas. Sixty-five percent of Zimbabwean households have toilet facilities. Most households in urban areas (95 percent) have flush toilets. Twenty-nine percent of households in rural areas have Blair toilets ~ and 17 per- cent have traditional pit toilets. About one-half of the households in rural areas have no toilet facility. The most commonly used flooring materials are cement and earth/dung. Eighty-five percent of house- holds in urban areas have cement floors. Almost all households in rural areas have either cement or earth/ dung floors and less than 1 percent af the households have other types of floors. The ZDHS collected data on the number of rooms used for sleeping. This information gives a mea- sure of household crowding. There is an average of 2.5 persons per sleeping room. Table 2.7 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Zimbabwe 1994 Characteristic Residence Urban Rural Total Electricity Yes 80.4 3.4 28.1 No 19.3 96.4 71.7 Missing/Don't know 0.3 0.2 0.2 Total 100.0 100.0 100.0 Source of drinking water Piped into res./yard/plot 92.6 4.3 32.6 Communal tap 4.8 13.3 10.6 Protected well 0.9 9.4 6.7 Unprotected well 0.8 16.7 I 1.6 Borehole 0.7 42.4 29.0 Spring 0.0 0.6 0.4 River/stream 0.1 11 1 7.5 Pond/dam/lake 0.0 1.9 1.3 Other 0.1 0 1 0.1 Missing/Don't know 0.0 0.2 0.2 Total 100.0 100.0 100.0 Time to water source (in minutes) <15 minutes 98.4 36.1 56.1 Median time to source 0.5 20.4 10.4 Sanitation facility Own flush toilet 65.8 1.9 22.4 Shared flush toilet 28.8 0.6 9.6 Traditional pit toilet 3.3 16.9 12.6 Blair toilet 1.4 29.4 20.4 No facility 0.5 50.8 34 7 Other 0.0 0.1 0.0 Missing/Don't know 0 1 0.4 0 3 Total 100.0 100.0 100.0 Floor material Earth/dung 4.0 58.5 41 0 Wood planks 1.1 0.0 0.4 Parquet/polished wood 2.5 0.1 0.9 Vinyl/asphalt strip 0.7 0.0 0.2 Ceramic tiles 1.4 0.I 0.5 Cement 85.4 40.8 55.1 Carpet 4.7 0.2 1.6 Missing/Don't know 0.2 0.3 0.3 Total 100.0 100.0 1000 Persons per sleeping room 1-2 69.2 61.7 64.1 3-4 24.9 30.3 28.6 5-6 3.8 5.7 5.1 7 + 1.4 1.9 1.7 Missing/Don't know 0 8 0.3 0.5 Total 100.0 100.0 100.0 Mean persons per room 2 3 2.6 2 5 Number of households 1,919 4,065 5,984 3 Venti lated, improved pit toilets 16 Figure 2.3 Housing Characteristics by Residence Percent of Households 1 O0 80 60 40 20 Electricity Piped Water Flush Toilet [ ] Urban i / 1Rura l 1 ZDHS 1994 2.2.1 Household Durable Goods Table 2.8 shows the percentage of households owning certain durable goods by residence. The availa- bility of durable consumer goods is a rough measure of household socioeconomic status. Among the selected durable goods, a radio is available in 43 percent of the households, a bicycle in 18 percent of the households, and televisions and modem oxcarts in 15 percent of the households. The proportion of households with durable goods varies by urban-rural residence, e.g., 65 percent of households in urban areas have a radio compared with 32 percent of rural households, 24 percent of households in urban areas have a refrigerator, compared with 2 percent of households in rural areas. Overall, 27 percent of urban households and 53 percent of rural households have none of the selected durable goods. Table 2.8 Household durable goods Percentage of households possessing various durable consumer goods, by urban-rural residence, Ztmbabwe 1994 Characteristic Residence Urban Rural Total Radio 65.4 31 9 42 6 Television 39.0 3.6 15.0 Refrigerator 24.0 1.7 8 9 Bicycle 21.2 16.4 18.0 Motorcycle 1.3 0 5 0 8 Prtvate car 13.7 2 0 5 7 Modern oxcart 6.8 19 4 15 4 None of the above 26 5 52.7 44.3 Number of households 1,919 4,065 5,984 2.3 Characteristics of Survey Respondents 2.3.1 Background Characteristics Background characteristics of the 6,128 women and 2,141 men interviewed in the ZDHS are presented in Table 2.9. The distribution of the respondents according to age shows a similar pattern 17 Table 2.9 Background characteristics of respondents Percent distribution of womea and men by selected background characteristics, Zimbabwe 1994 Women Men Number of women Number of men Background Weighted Un- Weighled Un- characteristic percent Weighted wetghted percent Weighted weighted Age 15-19 24.0 1,472 1,486 28.2 604 619 20-24 20.7 1,269 1,231 18.7 399 397 25-29 14.9 915 911 13 5 288 278 30-34 14.2 871 876 I 1.2 241 229 35-39 10.8 661 666 9.1 195 201 40-44 8.7 532 542 8.9 190 186 45-49 6.6 407 416 5.2 I 11 117 50-54 NA NA NA 5 3 113 114 Marital status Never mamed 26 9 1,646 1,663 46 9 1,004 1,018 Married 61.8 3,788 3,777 48 5 1,1138 1,015 Widowed 3.5 214 208 0 4 9 10 Divorced 7.8 478 478 4 2 90 98 Missing 0.0 2 2 0.0 0 0 Residence Urban 32.2 1,975 1,745 37.2 797 681 Rural 67.8 4,153 4,383 62.8 1,344 1,460 Province Mamcaland 13.7 839 550 12.6 269 179 Mashonaland Central 8.3 510 627 8.4 181 243 Mashonaland East 9 4 579 580 8.9 190 196 Mashonaland West 10.3 632 589 12.3 264 258 Matabeleland North 6.0 366 681 4.7 100 193 Matabeleland South 5 0 3115 587 4 3 91 179 Midlands 13 2 810 716 12 4 265 234 M asvingo I 0 6 652 604 9 3 200 190 Harare 17.1 1,048 608 20 0 428 227 Bulawayo 6.3 388 586 7 2 154 242 Education No education 11.1 682 712 4.1 88 91 Primary 47.3 2,898 2,961 40.2 860 921 Secondary 40.0 2,451 2,377 51.7 1,107 1,052 Htgher 1.6 96 78 4.0 86 77 Religion Tradmonal 6 5 397 421 14 9 319 347 Spiritual 32 9 2,018 2,052 26 8 575 556 Christian 56.6 3,471 3,348 49 5 1,061 1,038 Other 3.9 238 304 8 7 187 200 Ethnieity African 98.2 6,015 6,017 98.3 2,105 2,107 European 0.8 50 47 0.9 20 18 Coloured 0.4 22 25 0.7 14 14 Asian 0. I 7 7 0.0 1 I Other 0 1 7 7 0 I I I Total IIKI0 6,128 6,128 100.0 2,141 2,141 NA = Not applicable for females and males, The propomen of respondents in each age group declines with increasing age for both sexes. About 45 percent of the woraen and 47 percent of the men are in the age range 15 to 24 years; 29 percent of females and 25 percent of hales are in the 25- to 34-year age range; and the rest of the respondents are in the 35- to 49-year age range. 18 Sixty-two percent of females compared with 49 percent of males are currently married. Male respondents were much more likely than female respondents to have never married. The proportion of males in urban areas (37 percent) is larger than that of females (32 percent). This is expected since men are more likely to migrate to cities and towns in search of work. For both sexes, the largest proportion of the population is in Harare province while the lowest proportion is in Matabeleland South province. The proportion of women who have never been to school is nearly three times greater than that of men (11 versus 4 percent). Men are much more likely to reach secondary school (52 percent) than women (40 percent). Table 2.9 also shows that with respect to religion, the majority of the respondents are Christians, fol- lowed by those who adhere to Spiritual religions. (Pentecostal churches are classified as Spiritual in the ZDHS.) Ninety-eight percent of respondents are of African descent. 2.3.2 Education Level of Survey Respondents Presented in Table 2.10 are the percentage distributions of female and male respondents by highest level of education attended, according to age, urban-rural residence, and province. Younger people have Table 2.10 Level of education Percent distribution of women and men by the highest level of education attended, according to selected background characteristics, Zimbabwe 1994 Women Men Highest level of education Highest level of education Number Number Background No edu- Second- of No edu- Second- of characteristic catton Primary ary+ Total women cation Primary ary+ Tolal men Age 15-19 1.0 40.2 58.8 100.0 1,472 1.5 37.0 61.5 100.0 604 20-24 3.2 33.8 62.9 100.0 1,269 0,4 22.7 76.9 100.0 399 25-29 8.8 37.8 53.4 1/30.0 915 1,6 18.8 79.7 100.0 288 30-34 16.5 57,7 25.8 100.0 871 3.1 43.5 53.4 100.0 241 35-39 24.2 63.7 12.1 100.0 661 5.5 60,9 33.6 100.0 195 40-44 23.4 65.7 10.9 100.0 532 12.0 58.9 29.1 100.0 190 45-49 28.7 63.3 8.0 100.0 407 18.2 64.1 17.7 100.0 111 50-54 NA NA NA NA NA 10.0 76.0 14.0 100.0 113 Residence Urban 3.5 33.5 63.0 1(30.0 1,975 1.8 25.4 72.8 100.0 797 Rural 14.8 53.9 31.4 100.0 4,153 5.5 48.9 45.6 100.0 1,344 Province Manicaland 14.4 52.6 33.0 100.0 839 6.1 48.3 45.6 100.0 269 Mashonaland Central 23.0 49.3 27.7 1(30.0 510 4.8 48.6 46.6 100.0 181 Mashonaland East 10.4 50.9 38.7 100.0 579 2.6 39.6 57.8 100.0 190 Mashonaland West 16.9 52.5 30.6 100.0 632 5.9 49,6 44.6 100.0 264 Matabeleland North 16.2 55.6 28.1 100.0 366 6.2 54.2 39.6 100.0 100 Matabeleland South 8.5 54.8 36.7 100.0 305 4.7 61.7 33.6 100.0 91 Midlands 9.5 46.5 44.0 100.0 810 2.9 37.9 59.2 100.0 265 Masvmgo •2.4 57.3 30.3 100.0 652 9.2 43.5 47.3 100.0 200 Harare 2.1 31.1 66.8 100.0 1,048 0.9 20.3 78.9 100.0 428 Bulawayo 2.9 34.5 62.6 100.0 388 1.2 33.9 64.9 100.0 154 Total 11.1 47.3 41,6 100.0 6,128 4,1 40.2 55.7 100.0 2,141 NA = Not applicable 19 attended higher levels of education than older people. The majority of both women and men in urban areas have at- tended at least secondary school while the majority of people in rural areas have not gone beyond the primary level of education. Among the provmces, lta- rare and Bulawayo have the largest pro- portions of men and women who have attended secondary school or above. 2.3.3 School Attendance and Reasons for Leaving School Women age 15 to 24 years who were not currently attending school were asked in the ZDHS why they had stopped attending school. One of the most important determinants of a wcm- an's social and economic status is aer level of education. Knowledge of the reasons why women leave school can prowde guidance for policies designed to enhance women's status. Table 2.11 shows the percent distribution of women age 15 to 24 years by whether they are attending school and, ffnot, their reasons for leav- itag school, accordmg to highest levei of education attended. Twenty-three percent of women age 15 to 24 years are currently attend- ing school. Of the remainmg women (school-leavers), the vast majority re- ported that they left because they could not afford the costs. This is especially true for those women who left after hav- ing completed primary school. Once women start attending secondary schc.ol, school costs are still the primary rea~,,on for leaving, but other reasons~.g., did not pass exams--become increasin:gly important. About 9 percent of women reported that they left school because they were pregnant (5 percent) or be- cause they got married (4 percent). Table 2.11 School attendance and reasons lor leaving school Percent dlsmbution of women 15 to 24 by whether attending school and reason for leaving school, according to highest level of education attended and residence, Zimbabwe 1994 Educatxonal attainment Reason for Incomplete Complete Incomplete leaving school primary primary secondary Total URBAN Currently attending 4 5 2.9 23 7 19.8 Got pregnant 4,2 2 2 5.1 4 6 Got married 0.0 0 7 3.7 3 I Take care of younger children 0.0 0.0 0.0 0,0 Family need help 0 0 0.0 0.0 0.0 Could not pay school fees 64 2 79.9 32.2 40.8 Need to earn money 3.2 0,0 1.6 I 4 Graduated/Enough school 0,0 0 0 7.7 6 2 Did not pass exams 6 2 3.7 22 0 18.6 Did not hke school 6 5 2 5 1.4 1.7 School not accessxble 0 0 0.0 0 0 0,0 Other 11 0 5.2 1 9 2.7 Don't know/mlssxng 0 0 2.9 0 7 1.0 Total 100 0 100,0 100 0 100.0 Number 28 141 718 887 RURAL Currently attending 21.4 2.2 37.4 24 6 Got pregnant 2 8 2.5 6.0 4.4 Got married 6 0 3.8 4.7 4,8 Take care of younger chddren 1 1 0 2 0.1 0 4 Family need help 0.6 0 2 0.1 0 2 Could not pay school tees 49.2 81 2 34.3 50 0 Need to earn money 0.6 I 2 0.9 0.9 Graduated/Enough school 0 I 0. I I 8 1.0 Did not pass exams I 0 1.0 10 3 5.8 Did not hke school 4.6 1 6 0.5 1.7 School not accessible 2.6 0.6 0,3 0.9 Other 9.6 4.6 3.0 4.9 Don't know/mtssmg 0.4 0.6 0 6 0.6 Total 100.0 100.0 100./) 100.0 Number 383 471 917 1,771 TOTAL Currently attending 2/).3 2 4 31.4 23 (/ Got pregnant 2.9 2 4 5.6 4.5 Got married 5 6 3.1 4 3 4 2 Take care of younger chddren I 0 0.2 0.1 0 2 Famdy need help 0,5 0.2 (h I 0.2 Could not pay school fees 50.2 80 9 33.4 46 9 Need to earn money 0.8 1 0 1.2 I. I Graduated/Enough school 0.1 (t 1 4.4 2 7 Did not pass exams 1 3 1,6 15.5 It) I Did not hke school 4,7 I 8 0.9 1.7 School not accesstble 2.4 0 5 1).2 0.6 Other 9.7 4.8 2.5 4, I Don't know/missing 11.4 I 1 116 0,7 Total 100,0 1000 100.0 100.0 Number 411 611 1,636 2,657 Note: Excluded are 28 women who completed secondary schooh 20 Women in rural areas (50 percent) are more likely to leave school because they cannot pay school costs than women in urban areas (41 percent). A larger proportion of women in urban areas (l 9 percent) than in rural areas (6 percent) left school because they failed examinations. 2.3.4 Access to Mass Media Tables 2.12.1 and 2.12.2 show the percentage of female and male respondents exposed to different types of mass media by age, urban-mral residence, province and level of education. It is important to know which types of persons are more/less likely to be reached by the media for purposes of plannmg programmes intended to spread information about health and family planning. About 50 percent of the women and 60 percent of men read newspapers or magazines at least once a week, 28 percent women and 41 percent men watch television at least once a week and 43 percent women and 51 percent men listen to radio every day. Table2A2.1 Access to mass medla: women Percentage of women who usually read a newspaper once a week, watch televlsxon once a week, or listen to radio daily, by selected background charactensncs, Zimbabwe 1994 Mass media No Read Watch Listen to All Number Background mass newspaper television radxo three of characteristic media weekly weekly daily media women Age 15-19 26.6 62.5 27,8 40.7 17.9 1,472 20-24 26.5 58.6 31 8 49.5 22.0 1,269 25-29 30,9 50.8 30.9 47.6 19.2 915 30-34 37.3 42.5 32,0 44.6 19.7 871 35-39 44.8 36,1 22 7 39.0 13.6 66 I 40-44 45.4 36.3 20.0 36.2 12 2 532 45-49 51.7 28.9 17. I 33.7 10 5 407 Residence Urban 7.5 74.1 66.6 73 I 46.2 1,975 Rural 46.6 38.2 9.3 28.8 4,3 4,153 Province Manicaland 47.9 38.7 10.1 30.0 6.5 839 Mashonaland Central 40.0 45.2 10.0 31.7 5.2 510 Mashonaland East 38.6 45.8 15 0 35.8 8.6 579 Mashonaland West 29.9 50.4 25.5 39.2 10.7 632 Matabeleland North 60.2 26.1 9.3 24 2 5.0 366 Matabeleland South 54.9 28 9 7.2 28.5 3.6 305 Midlands 27.8 55.2 27 4 41.6 14.6 810 Masvmgo 54.7 26.6 10 3 26,9 4 8 652 Harare 6.1 80.4 68.9 75.2 51.2 1,048 Bulawayo 8.5 68.3 64.5 75.9 45.2 388 Education No education 74.8 2.4 6 3 21.9 0.5 682 Primary 41,0 40.1 18.4 36 2 9.3 2,898 Secondary+ 15.2 73.5 44.2 566 32.0 2,547 Total 34.0 49.8 27.8 43.1 17.8 6,128 21 Table 2.12,2 Access to mass media: men Percentage of men who usually read a newspaper once a week, watch television once a week, or listen to radio daily, by selected background charactensttcs, Zimbabwe 1994 Mass media No Read Watch Listen to All Number Background mass newspaper television radio three of characteristic media weekly weekly daily media men Age 15-19 28.7 51.6 33.3 43.4 15.9 604 20-24 16.3 68.6 47.0 53.2 28.3 399 25-29 15.3 73 9 48.6 61 6 31 7 288 30-34 19.4 62.4 48.1 57 5 30.6 241 35-39 24.0 58.3 44.3 56 4 33 2 195 40-44 20.0 61.9 44.9 54.2 27 5 190 45-49 34.6 47.0 28.0 42 7 16 0 I 1 I 50-54 42.3 40.2 25.9 39.8 12.7 113 Residence Urban 4.4 84.9 69.8 68.7 48.2 797 Rural 346 44.7 23.8 40.8 10.3 1,344 Province Manicaland 43.3 33.8 19.7 40.5 10.4 269 Mashonaland Central 14.5 74.6 30,9 453 127 181 Mashonaland East 26.4 49.8 31.0 42.4 13.0 190 Mashonaland West 16.1 67.7 36 9 54 7 20.3 264 Matabeleland North 50.9 33.1 16.2 33.1 10.9 100 Matabeleland South 26.9 63.0 5.2 34.2 4.6 91 Midlands 21 6 55.4 54.7 49.9 27.2 265 Masvingo 56 1 20.0 16 6 39 8 12 I 200 Harare 4.0 85.9 70.9 69 2 49 8 428 Bulawayo 2.1 86.8 71.1 70.7 45.5 154 Education No education 66.7 4.8 13.5 23.7 0.0 88 Primary 34 8 42.6 27.3 41.3 12.4 860 Secondary+ 11.9 76.0 52.8 60.4 34.9 1,193 Total 23.4 59.7 41.0 51.2 24.4 2,141 Thirty-four and 23 percent of the females and males, respectively, have no access to mass media. The proportion of persons with no azcess to mass media is higher in rural areas than in urban areas. Young men and women, the educated, and persons in Harare and Bulawayo provinces are more likely to read news- papers, watch television and listen to the radio than other persons. 2.3.5 Women's Employment Status The ZDHS collected information from women regarding their current employment situation.4 Table 2.13 shows that 49 percent of women are not currently employed, 23 percent are employed all year, about 20 percent are employed seasonall), and 8 percent are employed occasionally. There are proportionately more women who work seasonally in rural areas (26 percent) than in urban areas (6 percent), whereas, urban 4 Employment is defined as receiving payment in cash or kind for work. 22 Table 2.13 Employment Percent distribution of women by whether currently employed and distribution of employed women by continuity of employment, according to background characteristics, Zimbabwe 1994 Not currently employed Currently employed Did not work Worked All year in last in Background 12 last 12 5+ days <5 days Season- Occasion- characteristic months months per week per week ally ally Missing Total Number Age 15-19 66.7 4.5 11.2 1.2 11,1 5.1 02 1000 1,472 20-24 47.6 5.6 18 6 2 6 17.1 8.2 0 3 100 0 1,269 25-29 35.0 3.7 27 0 3 7 19 6 10.8 0.1 100 0 915 30-34 32 7 4.6 25.9 3.2 24 5 9 I 0 1 100.0 871 35-39 34.9 2 8 20 7 6 3 24.7 10.6 0 0 100.0 661 40-44 32 7 4,3 23.3 5.4 26 2 8.0 0,1 100.0 532 45-49 37.3 2.9 22.4 5.1 29 2 3 1 0.0 100.0 407 Residence Urban 42.8 3 2 33 5 3,9 6.4 10.2 0 0 100.0 1,975 Rural 45.8 4.8 13.6 3.0 25 8 6.8 0.2 100.0 4,153 Province Manicalaed 70.7 1 7 11 5 0 9 10.5 4.7 0,0 100.0 839 Mashonaland Central 22.2 6 1 21.6 6.6 36 6 6.3 0.5 100.0 510 Mashonaland East 41.4 3.5 14.9 3 4 29 0 7.2 0 7 100.0 579 Mashonaland West 28.4 5 4 18,5 2.4 33.2 12.1 0.0 10O.0 632 Matabeleland North 83.4 2.0 5 4 I 2 6.3 1.6 0.0 100.0 366 Matabeleland South 69.1 4 3 12,1 5.1 4.3 4.9 0.2 100 O 305 Midlands 37.3 9.9 22 9 3 2 18.9 7.7 0 1 100 0 810 Masvmgo 25.6 4.8 14.7 3 4 40.6 11 0 0.0 100.0 652 Harare 40.3 2.0 35.2 4 6 6,2 11.7 0.0 100,0 1,048 Bulawayo 55.3 2.7 28 5 2 7 6.5 4 1 0.2 100,0 388 Education No education 42 3 4.2 15.9 2.9 29 4 5.2 0.0 100 0 682 Primary 41 6 4.7 17.6 3.6 24 3 8.1 0.1 100 0 2,898 Secondary+ 49 2 3 9 23,9 3. I 11 4 8 3 0.2 100 0 2,547 Total 448 43 20.0 3.3 195 7.9 01 1000 6,128 women are more likely to report regular full-time employment (34 percent) than rural women (14 percent). Similarly, regular full-time work tends to increase and seasonal work decreases with increasing level of education. Substantial provincial variations exist in employment characteristics of women. Women in Matabele- land North and South and Manicaland are much more likely than women in other provinces to report not having been employed in the last 12 months. Seasonal work is most commonly reported in the provinces of Masvingo (41 percent), Mashonaland Central (37 percent), and Mashonaland West (33 percent). Regular, full-time employment is most common in Harare (35 percent) and Bulawayo (29 percent). 23 2.3.6 Employer and Form of Earnings Table 2.14 shows the percent distribution of the 3,113 employed women by employer and form of earnings, according to background characteristics. About 45 percent of the women are self-employed and earning cash, 9 percent are self-emp oyed and not earning cash, 29 percent are employed by nonrelatives and earning cash, and only 1 percent are employed by nonrelatives without earning cash. Fifteen percent of employed women work for relative:;; more than half of these earn cash for their work. Masvingo province has the largest proportion (31 percent) of women who are employed by relatives without earning cash. About 10 perc ent of employed women in mral areas work for relatives without earning cash, compared with only 1 percent in urban areas. The distribution of employed women by employer and form of earnings varies little by leve of education, although fewer women with secondary or more education are employed by relatives without earning cash. Table 2.14 Employer and torm of earnm~ Percent distribution of currently employed women by employer and form of earnxngs, according to background characteristics, Zimbabwe 1994 Employed by Employed by Self-employed a nonrelatxve a relative Does Does Does Background Earns not earn Earns not earn Earns not earn charactenstxc cash cash cash cash cash cash Missing Total Number Age 15-19 29 6 5 4 43 6 1.0 8.8 I I 4 0 1 100.0 422 20-24 44.7 7.9 32 1 I 2 6.9 6 8 0 4 100.0 593 25-29 45.1 8 3 33 6 0 7 8 2 4 0 0 2 100.0 561 30-34 48 3 8.2 26 2 1.2 9.7 6.0 0.3 100.0 546 35-39 53 8 12.9 15 8 1 4 9 0 6 9 0 1 100.0 412 40-44 504 10.8 23 8 I 6 7.2 60 02 100.0 335 45-49 46 3 15.6 20 5 0 4 9.5 7 7 0 0 100.0 244 Residence Urban 49 9 3.3 40 2 I 2 4.4 1 0 0.1 100.0 1,067 Rural 429 12.4 23 l I 0 10.5 98 03 100.0 2,046 Province Mamcaland 39.0 14 8 37 6 0.6 6 0 1 9 0 0 100.0 231 Mashonaland Central 36.8 15 4 37 1 0.6 7 3 2.4 0 5 100.0 364 Mashonaland East 53.3 8 8 18 3 0.3 11 8 6.8 0.6 100.0 316 Mashonaland West 44.9 12.2 30 0 0.5 8 6 3.8 0.0 100.0 418 Matabeleland North 45.5 14.1 33.3 3.0 2 1 1.0 1.0 10O 0 53 Matabeleland South 53.4 2.7 34.4 4 1 2 7 2.0 0.7 100.0 80 Midlands 63.0 11 7 20.3 1.9 0.3 2.6 0.3 100.0 428 Masvmgo 24 7 8 6 10.0 1.4 23 9 31.4 0.0 100 0 454 Harare 50.4 3 1 396 1 1 5.1 06 0.0 100.0 605 Bulawayo 46 3 (3 8 48.4 0 4 2.4 I 2 0 4 100 0 163 Education No educatxon 37 4 15.5 30 4 I 6 6.8 8 1 0.2 100.0 365 Prxmary 47.3 IC.3 234 1.2 9.9 7.7 0.1 100.0 1,554 Secondary+ 45.0 ~.0 35 8 0.7 6 9 5.2 0.3 100.0 1,193 Total 45.3 93 289 1 I 84 6.8 0.2 100.0 3,113 24 2.3.7 Occupation Information on current occupation of employed women is shown in Table 2.15. Forty percent of the women have agricultural occupations and 60 percent have nonagricultural occupations. The majority of women who have agricultural occupations work on communal/resettlement land, while the majority of women who do not work in agriculture have sales or services occupations. As expected, employment in nonagricultural occupations is relatively more common among women who live in urban areas and those who have more formal education. Table 2.15 Occupation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Z~mbabwe 1994 Agricultural Nonagricultural Corn- Prof Background Own munal Rented Other's tech/ Sales/ Skdled Unskdled characteristic land land land land manag services manual manual Missing Total Number Age 15-19 6.2 22.5 0.2 10.5 1.7 45.5 12.5 0.9 0.0 100.0 422 20-24 4.2 21.5 0.1 9.8 7.4 35.8 18.8 2.1 04 100.0 593 25-29 4.0 17.2 0.8 10.2 17.2 28.0 20.3 2,1 0.2 100.0 561 30-34 6.8 22.8 0.5 10.9 13.7 23.5 20,5 I 3 00 100.0 546 35-39 6.6 27.8 1.1 7.3 7.0 24.2 23.1 2.9 0.0 100,0 412 40-44 7.3 31.2 0.0 6,6 7.5 28.3 15.8 3.2 0.0 100.0 335 45-49 11.3 32.9 0.2 8.2 10.9 22.1 13.8 0.6 0.0 100.0 244 Residence Urban 2.5 1.0 0.4 1.5 15.0 49.7 27.6 2.3 0.0 100.0 1,067 Rural 8.0 35.8 0.4 13.4 7.0 19.9 13.6 1.7 0.1 100.0 2,046 Province Mamcaland 1.3 20.6 0.0 12.2 164 36.2 10.6 2.6 0~0 100.0 231 Mashonaland Central 23.0 16.8 0.2 28.4 4.1 15.2 11.8 0.2 0.2 100,0 364 Mashonaland East 3.2 42.0 0.6 12.9 6.6 19.7 13.7 1.0 0.3 100,0 316 Mashonaland West 7.6 29.3 0,8 18 3 5 5 17.8 17.9 2.8 0.0 100.0 418 Matabeleland North 12.0 2.0 1.0 3.0 20.1 37.7 23,2 1.0 0.0 100 0 53 Matabeleland South 1.4 6.8 1.4 14.2 9.8 43.1 20.0 3.4 0.0 100.0 80 Midlands 4.4 24.0 0.5 3.6 11.3 33.2 20.4 2.4 0.3 100 0 428 Masvingo 24 58.5 0.4 1.4 3.2 16.6 16.1 1.4 0.0 100.0 454 Harare 3.7 0.6 0.3 1.1 15.7 49.0 27 9 I 7 0 0 100.0 605 Bulawayo 1 2 0.0 0.0 0.0 18.7 57.7 17.5 4.9 0.0 100.0 163 Education No education 7.7 33.8 0.8 25.9 2.6 14 5 11.3 3.4 0.0 100.0 365 Prtmary 7.1 29.9 0.3 10.4 2.8 29.4 18.1 2.0 0.1 100.0 1,554 Secondary+ 4.4 13.0 0.4 2.9 21.0 35.9 20.9 1,4 0.2 100.0 1,193 Total 6.1 23.9 0.4 9.3 9.7 30.1 18.4 1.9 0.1 100.0 3,113 Note: Professional, technical, managerial includes professional, technical, clerical and managerial occupations. 25 2.3.8 Decision on Use of Earnings Information on who decidcs how to use the cash earned by employed women can be used as a measure of the status of women. Table 2.16 shows that 56 percent of the 2,575 women who receive cash earnings decide for themselves how to spend their money, and 31 percent decide jointly with their hus- band/partner. Only 7 percent of women who earn cash reported that their husband/partner decides how their earnings will be used. Younger, urban women with more education are less likely to report that their hus- band/partner decides how to spend 1heir earnings, but this pattern is not a strong one. Sixty-seven percent of emp oyed women in urban areas make their own decision on how to use the money they earn, compared with 49 percent of employed women in rural areas. A woman's education level also influences her level of control o,ler decision-making. As a woman's level of education increases, so does her ability to decide on how her owl income will be used. Table 2.16 Decxsion on use of earnm,~s Percent distribution of women receiving cash earnings by person who decides on use of earnings, according to background characteristics, Zimbabwe 1994 Person who decides how earnings are used Jointly with Jointly Background Self Husband/ husband/ Someone with characterxsuc only partner partner else someone Missing Total Number Age 15-19 59. I 3.3 10.7 22.0 4.6 0.3 100.0 347 20-24 59.0 5.2 27. l 6.3 1.7 0.7 100.0 497 25-29 53.6 7.7 37.0 0.6 0.8 0.3 100.0 487 30-34 53.3 7.0 38.5 0.5 0 2 0.4 100.0 461 35-39 53 1 9 3 35 9 0.5 0.5 0.6 100.0 325 40-44 56.2 6 8 35.4 0.6 0.9 0.0 100.0 273 45-49 55 5 11 7 32 2 0.0 0 6 0.0 100.0 186 Residence Urban 66.6 5.7 23.4 3.5 0.4 0.4 100.0 1,008 Rural 48.7 7.7 36.1 5.2 I 9 0.3 100.0 1,568 Province Manicaland 66.2 16.6 10.9 3.9 2.3 0.0 100.0 19 l Mashonaland Central 40.2 7.6 42.9 8.7 0.6 0.1 100.0 296 Mashonaland East 46 7 5 7 41.9 2.3 3. I 0.4 100.0 265 Mashonaland West 4Z0 8.8 43.3 4.9 0.9 0.0 100.0 349 Matabeleland North 66.8 5.0 19.5 5.0 1 2 2 4 100 0 44 Matabeleland South 67.0 9.5 16.7 1.8 5 0 0.0 100.0 73 Midlands 60 7 4 8 27.5 5.4 0.6 0.9 100.0 357 Masvingo 47 I 6 4 39.3 4.8 2.5 0.0 100.0 266 Harare 66.5 5.1 23.4 3.9 0,6 0.6 100.0 576 Bulawayo 72 8 3.3 21.8 1.3 0.4 0 4 I Cgl,0 158 Education No education 42.2 12.3 44. I 0.6 0.7 0.0 100 0 273 Primary 55.4 7.1 320 4.3 1.1 0,1 100.0 1,255 Secondary+ 59.5 5.3 26 8 5.8 1.8 0.8 100.0 1,047 Marital status Currently mamed 414 10.2 46.8 0.7 05 04 100.0 1,712 Not mamed 84 0 0 3 0.1 12.1 3 1 0 4 100 0 863 Total 55 7 6.9 31.2 4.5 1.3 0.4 100.0 2,575 26 2.3.9 Child Care While Working Presented in Table 2.17 is the percent distribution of employed women, by whether they have a child under six years of age. The table also shows the percent distribution of employed mothers with a child under six years, by the type of child minder (caretaker) used by the mother while at work. Slightly over half (52 percent) of employed women have a child under six years of age. Table 2,17 Child care while working Percent distribution of employed women (i.e., worked in the last 12 months) by whether they have a child under six years of age, and the percent distribution of employed mothers who have a chtld under six by person who cares for child while mother ts at work, according to background characteristics, Zimbabwe 1994 Background ch~racT~fLST]C Employed wt)men wah Chdd's caretaker whde mother is at work One or more No chd- chdd dren Hus- Not Number under under Re- band/ Other Child Instltu-Other Other worked of six at six at spond- pan- rela- Neigh Hired ts m tlonal female male since employed home home ent net ttve bor Friend help school care child child birth I Other Mlsstng Total mothers Residence Urban 58,1 419 403 14 246 [ 5 10 20.0 08 17 41 (16 07 02 33 1000 1,067 Rural 433 567 542 1,0 163 1 1 I 1 2.8 0,5 2,3 112 52 09 06 3.3 1000 2,(146 Education Noeducatlon 435 565 55,7 08 82 16 2(1 1,7 00 34 163 54 00 00 48 I{X)0 365 Primary 46,2 538 546 14 176 12 1.1 18 03 16 108 5,0 1.0 0.8 32 1000 1,554 Secondary+ 52,6 474 421 08 239 I I 0.7 183 12 23 42 1,9 0,9 03 30 100.0 1,193 Work status For famdy member 456 544 508 00 14.9 08 30 20 10 09 15,5 83 00 04 32 1000 473 For someone else 627 373 300 03 23,0 12 10 201 08 68 8.8 19 I1 04 46 1000 935 Self-employed 413 587 575 17 18,1 13 06 45 04 0,8 7,8 3.5 10 05 26 1000 1,698 Province Manicaland 516 484 613 00 80 00 O0 9,3 00 00 40 67 00 411 67 1000 231 Mashonaland Central 443 557 549 08 127 2,5 04 18 08 85 105 4,4 0,4 00 25 100 (] 364 MashonalandEast 402 598 689 0,0 112 I I 00 22 05 13 68 3,2 05 00 49 I(X)0 316 MashonalandWest 422 578 482 14 251 0,9 09 59 09 I 3 101 1,7 1,3 04 18 1000 418 Matabeleland North 50,3 497 386 42 161 2 {} 0.0 8,7 20 00 14 1 40 83 20 0.0 1000 53 Matabeleland South 518 482 398 4,2 22,7 00 00 25 14 14 14.0 14 42 00 8.4 1000 80 Midlands 490 510 524 20 16,6 16 1.1 58 00 10 127 36 0,0 00 37 1000 428 Masvingo 42.5 5%5 487 12 161 04 4.0 1,2 0,0 0,8 139 104 08 08 24 100,0 454 Harare 58,7 41.3 393 07 283 14 0.0 21,4 14 14 34 00 07 00 21 100,0 605 Bulawayo 581 41.9 252 1,0 301 19 19 243 00 39 49 00 I,t) 00 58 1000 163 Occupation Agricultural Nonagrtcultural Employment status All year, full week All year, pan week Seasonal Occasional 397 603 593 116 128 10 16 07 04 29 106 60 08 08 31 1000 1,237 541 459 42,7 16 236 13 06 135 07 14 81 22 09 02 3.3 1000 1,873 58,0 42,0 360 09 239 12 09 [94 09 31 72 15 07 06 4.5 I(X)0 1,227 393 607 501 13 191 12 05 2.8 14 18 158 27 04 07 28 1000 203 406 594 600 I0 134 I 1 10 07 04 17 102 60 12 05 30 1000 1,196 46,9 53,1 53,2 1.7 22,4 1,4 18 5,2 00 1,3 75 3,7 04 02 1 1 1000 483 Total 484 516 503 I I 18.6 12 1 1 7,6 06 2.1 92 39 08 05 33 100,0 3,113 Note Totals include 7 women with work status missing, 3 women with occupation missing, and 4 women with employment status :tossing Figures may not add to I(X) 0 due to rounding, Respondent was employed during the preceding 12 months, but was not working at the rime of the survey, therefore, current caretaker status ~s not apphcahle 27 Fifty percent of women with a child under six years look after their own children while at work, and 19 percent have relatives (other than husband) to look after their children. In urban areas, 20 percent of em- ployed mothers who have a child under six years use hired help as child minders compared with only 3 per- cent in rural areas. Over 21 percent of women in Harare and Bulawayo use hired help as child minders com- pared with less than 10 percent of women in each of the other provinces. Women who have attended ~econdary or higher education are more likely to use hired help as child minders ( 18 percent) than women with either no education or primary education (2 percent each). Use of oth- er children, especially female children, to take care of a woman's children under six during working hours increases from 6 percent of employed women with secondary education to 16 percent of women with primary education to 22 percent of women without any education. 28 CHAPTER 3 FERTILITY In the ZDHS, data were collected on current and completed fertility. Drawing from the birth histories of women interviewed in the survey, the chapter begins with a description of current fertility, followed by differentials in fertility. Attention is next focused on trends in fertility, including examination of age-specific fertility rates in time periods going back 15 to 20 years. The chapter concludes with a presentation of information regarding age of women at first birth and patterns of adolescent childbearing. The fertility indicators presented in this chapter are based on reports provided by women age 15-49 years regarding their reproductive histories. As in the 1988 ZDHS, each woman was asked to provide information on the total number of sons and daughters to whom she had given birth who were living with her, the number living elsewhere, and the number who had died. In the birth history, women reported on the detailed history of each live birth separately, including such information as: name, month and year of birth, sex, and survival status. For children who had died, information on age at death was collected. 3.1 Current Fertility The most widely used measures of current fertility are the total fertility rate (TFR) and its component age-spe- cific fertility rates (ASFR). The TFR is defined as the num- ber of children a woman would have by the end of her child- bearing years if she were to pass through those years bearing children at the currently observed age-specific rates. Table 3.1 shows the age-specific and aggregate fer- tility measures calculated from the 1994 ZDHS data. The to- tal fertility rate (TFR) for Zimbabwe is 4.29 children per woman. Peak childbearing occurs during ages 20-24 and 25- 29, dropping sharply after age 34. Fertility among urban women is substantially lower (3.1 children/woman) than among rural women (4.9 children/woman). This pattern of lower urban fertility is evident at every age. Table 3.1 Current ferhhty Age-specific and cumulative fertility rates and the cmde birth rate for the three years preceding the survey, by urban-rural residence, Zimbabwe 1994 Residence Age group Urban Rural Total 15-19 72 113 99 20-24 169 232 210 25-29 163 211 194 30-34 132 194 172 35-39 69 137 117 40-44 9 66 52 45-49 (4) 16 14 TFR15-49 3.09 4.85 4.29 TFRI5-44 3.08 4.77 4.22 GFR 115 164 148 CBR 30.5 32.0 31.6 Note: Rates are for the penod 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Rates in parentheses are based on 125 to 249 woman-years of exposure. TFR: Total fertday rate, expressed per woman GFR: General ferhhty rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population I Numerators tbr the age-specific fertility rates are calculated by summing the number of live births that occurred in the 1-36 months preceding the survey (determined by the date of interview and birth date of the child), and classifying them by age (in five-year groups) of the mother at the time of birth (determined by the mother's birth date). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-36 months preceding the survey. 29 3.2 Fertility by Background Characteristics Table 3.2 and Figure 3.1 show dif- ferentials in fertility by urban-mr~l resi- dence and level of education. Educational attainment is closely linked to a woman's fertility; the TFR for women with no formal education is 5.2 children per woman, versus 4.7 for women with primary educati on and 3.3 for women with at least some secondary education. Table 3.2 also allows a general as- sessment of differential trends in fertility over time among population subgroups. The mean number of children ever born to women age 40-49 is a measure of fertility in the past. A comparison of current (total) fertility with past (completed) fertility shows that there have been substantial and Table 3.2 FertdltV by background characteristics Total l~rtdlty rate for the three years preceding the survey, percentage currently pregnant and mean number of chddren ever born to women age 40-49, by selected background characteristics, Zimbabwe 1994 Mean number of children Total Percentage ever born Background femhty currently to women characteristic rate I pregnant I age 40-49 Residence Urban 3 09 7.48 4 74 Rural 4 85 8.85 6 79 Education No education (5.21) 10.30 6.77 Primary 4.65 8.48 6.38 Secondary+ 3.32 7.81 4.38 Total 4.29 8.41 6.29 Note: Rates m parentheses indicate that one or more of the component age-specffxc rates is based on fewer than 250 woman-years of exposure. IWomen age 15-49 years roughly equivalent declines in both nrban and rural areas and within all three education categories. Overall, the comparison of past and present t;ertility indicators suggests a decline of about two children per woman, from 6.3 to 4.3 children per woman Figure 3.1 Total Fertility Rate by Background Characteristics ZIMBABWE RESIDENCE Urban Rural EDUCATION No Education Primary Secondary + 4.3 ~ ~ 3.1 4.9 Is,2 4., 33 2 3 4 Births per Woman 5 ZDHS 1994 30 At the time of the survey, over 8 percent of interviewed women reported that they were pregnant. This is an underestimate of the true percent pregnant because many women at early durations of pregnancy will not yet know for sure that they are pregnant and some women may not want to declare that they are pregnant. Still, differ- entials in pregnancy status closely parallel differentials in current fer- tility. 3.3 Ferti l ity Trends Table 3.3 examines trends in fertility in Zimbabwe by com- paring the results of the 1994 ZDHS with the earlier 1988 ZDHS. This comparison is appropriate because the methods of data collec- tion and rate calculation were identical in the two surveys. The TFR calculated from the 1988 ZDHS was 5.5 children per woman, com- pared with 4.3 derived from the 1994 ZDHS, demonstrating a decline in fertility of 22 percent during the period between 1985-88 and 1991-94. Examination of changes in age-specific fertility rates in Figure 3.2 shows a roughly equal decline (in absolute ten]as) at all ages above 15-19 years. These similar absolute declines, however, translate to a greater proportional decline at older ages. Table 3.3 Trends m current ferhhty rates Age-specific fertility rates and total ferhhty rates, Zimbabwe, 1985-1994 1988 1994 ZDHS ZDHS Age group 1985-88 1991-94 15-19 103 99 20-24 247 210 25-29 247 194 30-34 219 172 35-39 160 117 40-44 86 52 45-49 36 14 Total fertlhty rate 5 5 4 3 Source: CSO and IRD, 1989 300 Figure 3.2 Age-specific Fertility Rates 1988 and 1994 Births per 1,000 Women 250 200 150 100 50 15-19 i i , i 20-24 25-29 30-34 35-39 40-44 Age Group 45-49 31 Tab les 3.4 and 3.5 prov ide further ev idence o f a substantial fert i l i ty dec l ine in Z imbabwe. Tab le 3.4 shows the age-spec i f ic fert i l i ty rates (ASFR) for f ive-year periods preceding the survey. With in each age group, substant ia l and sustained dechnes in ASFRs are observed f rom 10-14 years before the survey (c i rca 1980-84) to 0-4 years before the sur~ ey (c irca 1990-94). 2 Table 3.4 Frends in age-specxfic lertility rates Age-specific lbmhty rates for five-year periods preceding the survey, by mother's age at the time of birth, Z~mbabwe 1994 Number of years preceding the survey Mother's age 0-4 5-9 10-14 15-19 15-19 105 119 167 155 20-24 212 250 307 312 25-29 199 262 3115 283 30-34 177 232 271 [2661 35-39 133 182 1205] 40-44 63 [1261 45-49 [20] Note: Age-specific li:rtdlty rates are per 1,000 women Estimates in brackets are truncated. Table 3.5 l'rends m fertility by marital duration Fertility rales for ever-married women by duration (years) since first mamage for five-year periods preceding the survey, Zirlbabwe 1994 Marriage duration at birth Number of years preceding the survey 0-4 5-9 10-14 15-19 0-4 309 334 372 364 5-9 210 271 322 319 10-14 178 248 285 280 15-19 147 199 234 1231] 20-24 99 158 [159] 25-29 33 [60] Note: Duration-specific fertility rates are per 1,000 women Estimates in brackets are truncated. 2 The rates for the older age groups (shown in brackets in Table 3.4) become progressively more truncated [or earlier periods. For example, rates cannot be calculated for women age 45-49 years for the period 5-9 years before the survey because these women would have been over age 50 years at the time of the survey and were not interviewed 32 Fertility rates for ever-married women by duration since first marriage for five-year periods preceding the survey are shown in Table 3.5. This table is analogous to Table 3.4, but is confined to ever-married women and replaces age with duration since first marriage. The data confirm a sharp decline in fertility and indicate that the drop has occurred within marriage and at all marital durations. 3.4 Chi ldren Ever Born and Living The distribution of women by the number of children ever born is presented in Table 3.6 for all women and for currently married women. The table also shows the mean number of children ever born (CEB) to women in each five-year age group. On average, women in their early twenties have given birth to about one child, women in their early thirties have had nearly 4 children, and women currently at the end of their childbearing years have had well over 6 children. Of the 6.6 children ever born to women age 45-49, only 5.8 have survived. Table 3.6 Children ever born and hvmg Percent dxstnbution of all women and of currently married women age 15-49 by number of chddren ever born (CEB) and mean number ever born and hvmg, according to five-year age groups, Zimbabwe 1994 Number ofchddren ever born (CEB) Number Mean no, Mean no Age of of of hying group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 85.3 128 17 0.1 01 0.0 O0 00 00 00 00 1000 1,472 017 016 20-24 326 355 227 79 I I 02 00 00 00 00 0.0 100,0 1,269 I 10 101 25-29 77 211 301 218 115 45 23 06 02 02 00 I(X),0 915 236 218 30-34 3 2 7 1 12 1 19,8 22,7 17.0 10.2 4,4 2,4 0,5 06 100 0 871 3 89 3 56 35-39 2 1 3,9 6,5 10.0 155 17.4 17,8 13,5 6,5 49 I 9 1000 661 5 13 465 40-44 2.4 3,5 6,1 53 68 14.8 15,4 15,6 11,7 9,5 89 1000 532 608 545 45-49 1.1 3.4 5.6 5 8 83 10.3 12,7 147 14.5 65 17,I 100,0 407 6 57 577 Total 293 155 129 97 80 70 59 45 3.0 I 9 22 1000 6,128 269 2.44 CURRENTLY MARRIED WOMEN 15-19 460 453 7.9 06 02 00 0,0 00 0,0 00 0,0 10~)0 276 064 059 20-24 143 409 32.0 109 I 6 0,3 0,0 00 0,0 00 0.0 1130(I 798 I 45 I 34 25-29 4 4 18.3 31.4 243 12,4 5.4 3,0 05 0,2 0 2 0.0 100 0 726 2 55 2.37 30-34 17 5.7 109 184 243 18,9 110 51 29 06 04 1000 722 409 376 35-39 10 26 50 79 149 17.4 200 153 78 58 2.4 1000 530 549 497 40-44 22 32 51 43 61 15.0 151 162 130 101 96 1000 425 626 561 45-49 07 32 27 5.6 8 I 92 123 163 166 70 18 1 11300 311 686 599 Total 80 175 169 125 108 96 82 64 45 27 3(1 I(X),0 q,788 366 331 The results for younger women who are currently married differ from those for the sample as a whole because of the large number of young unmarried women with minimal fertility. Differences at older ages generally reflect the impact of marital dissolution (either divorce or widowhood). Only 1 percent of married women age 45-49 have never had a child. Under the proposition that desire for children is universal in Zimbabwe, this 1 percent is a rough measure of primary infertility or the inability to bear children. 33 3.5 Birth Intervals Information on the length of birth intervals provides insight into birth spacing patterns. Research has shown that children born too soon after the birth of a previous birth are at increased risk of poor health, particularly when the interval is less than 24 months. Table 3.7 shows the distribution of births in the five years before the survey by the inter~al since the previous birth, according to various background and bio- demographic variables. One in eight children are bona after a "too short" interval (less than 24 months). The median interval length is shorter among births to young women and when the child born previously is no longer alive. The median birth interval length is 37 mo rths for all births, but only 29 months if the mother is less than 20 years old, and only 27 months if the child 9orn previously is dead. Birth intervals are substantially longer in urban than rural areas. This could be related to the higher rates of contraceptive use (for spacing) among urban women. Table 3.7 Birth intervals Percent distribution of non-first births in the five years precedmg the survey by number of months since previous birth, according to demographic and soctoeconomlc characteristics, Zimbabwe 1994 Number of months since previous birth Characteristic 7-17 18 23 24-35 36-47 48+ Median number ol Number months since of Total previous birth births Age of mother 15-19 51 19.9 57,7 139 35 1000 290 31 2029 45 95 40,4 250 205 1000 347 1,253 30-39 4.0 5 8 29,0 24 8 36,4 100,0 4(h6 1,295 40+ 44 7.5 24.7 245 38.9 1000 41.2 361 Birth order 2-3 3 8 8.5 35 2 24 3 28 2 100.0 36.9 1,310 4 6 4 4 5.8 31 5 25 8 32.6 100.0 39.2 L069 7 + 5 2 9.5 34 2 23,9 27.3 100 0 36.3 562 Sex of prior birth Male 50 75 343 250 282 1000 37 1 1.482 Female 3 6 8 0 33 0 24.5 31 0 [00 0 37 7 1.458 Survival of prior birth Living 2 8 7 1 33.9 25,3 30 8 100 0 38 0 2.719 Dead 222 148 31.1 174 145 1000 277 222 Residence Urban 4 4 7.6 27 4 22 2 38.4 100,0 41. I 701 Rural 4 3 7 8 35.6 25 5 26 9 100 0 36.7 2,239 Education No educatxon 39 8,0 314 256 312 1000 382 504 Primary 3 8 7 1 33.9 25 5 29 8 100 0 37 6 1,683 Secondary+ 5 7 9,0 34 5 22 6 28 2 100,0 36,3 753 Total 43 77 336 247 29.6 1000 374 2,941 Note' First births are excluded. The interva for mulnple births ts the number of months since the preceding pregnancy that ended m a hve bffth 34 3.6 Age at First Birth Table 3.8 shows that the median age at first birth in Zimbabwe is around 20 years for most age groups. While this broad measure has not changed since the 1988 ZDHS, more detailed analysis of trends in age at first birth does reveal a decline in early childbearing. For example, whereas about 33 percent of the cohort of women currently age 30-34 had a birth before age 18, only 29 percent of women currently age 25- 29, and 23 percent of women age 20-24 had started childbearing before age 18. This slow but steady trend reflects positively on efforts to keep girls and women in school through more advanced levels to improve their social and economic status. Table 3.8 Age at first bmh Percent distribution of women 15-49 by age at first Nrth, according to current age, Zimbabwe 1994 Women Median with Age at first bmh Number age at no of first Current age Nrths <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 85.3 1 1 95 4.1 NA NA NA 100.0 1,472 a 20-24 32.6 2.5 20.7 23.7 15.1 5 4 0.0 100.0 1,269 a 25 29 7 7 6 2 22.4 25.7 18.7 15 2 4.1 100 0 915 19.7 30 34 3.2 6 1 27.2 25.3 19.7 126 6.0 1000 871 19.3 35-39 2.1 64 22.9 26.9 21.1 13.4 7.1 100.0 661 19.5 40-44 2.4 5.8 20.6 27.4 20.4 13 7 9.7 100.0 532 19.7 45-49 1.1 8 0 22.5 24.5 18.3 14.7 10.8 100.0 407 19.6 NA = Not apphcable a Omitted because less than 50 percent of the women m the age group x to x+4 have had a btrth by age x Table 3.9 summarizes the median age at first birth for different age cohorts across residential and educational subgroups. For all age groups of women, the median age at first birth is higher in urban areas than m rural areas. Similarly, age at first birth increases markedly with increasing level of education; for example, within the cohort age 25-29, women without any education have their first birth around age 17 compared with age 21 for women with a secondary or higher education. Table 3.9 Median age at first bmh Median age at first Nrth among women age 25-49 years, by current age and selected background characteristics, Zimbabwe 1994 Current age Background Ages charactensnc 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 20 0 19.7 19.8 19 8 19.8 19.8 Rural 19 5 19.1 19.4 19.7 19.5 19.4 Education No education 17.4 17.8 19 I 19.8 19.7 18.9 Primary 18.5 19.1 19 5 19.5 19.1 19.2 Secondary+ 21.0 21.0 20.5 21.3 21.8 21.0 Total 19.7 19.3 19.5 19.7 19 6 19.6 Note: The medians for cohorts 15-19 and 20-24 could not be determined because half the women have not yet had a birth. 35 3.7 Adolescent Fertility The issue of adolescent fertility is an important one on both health and social grounds. Children born to very young mothers are at increased risk of sickness and death. Adolescent mothers themselves are more likely to experience adverse pregnancy outcomes and, in addition, are more constrained in their ability to pursue educational opportunities than young women who delay childbearing. Table 3.10 shows the percenl distribution of women age 15-19 who were mothers or were pregnant with their first child at the time of the survey, according to selected background characteristics. The proportion of adolescents who are already mothers is 15 percent, and another 5 percent are currently pregnant. The proportion of adolescents already on the pathway to family formation rises rapidly with age, from 3 percent at age 15 to 44 percent at agc~ 19 (see Figure 3.3). Rural adolescents and those with less education tend to start childbearing earlier. Table 3.10 Adolescent pregnancy and motherhood Percentage of woraen 15-19 who are mothers or pregnant with thetr first child, by selected background characteristics. Zimbabwe 1994 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 1.5 1.4 2.9 310 16 6.2 3.4 9.7 305 17 8.2 8.0 16.2 3L0 18 25.4 5 6 3 I.l 297 19 37.0 7 2 44.1 249 Residence Urban I 1,8 3 4 15.3 436 Rural 15.9 5.7 21.6 1,036 Education No education * * " 14 Primary 23,4 5.4 28 9 592 Secondary+ 8,2 4.6 12.8 865 Total 14.7 5 0 19.7 1,472 Note' An astensb indicates that a figure is based on fewer than 25 women and has been suppressed. 36 Figure 3.3 Percentage of Adolescent Women Who Are Mothers or Pregnant with First Child, by Age Percent 50 4O 30 2O 10 0 15 16 17 18 19 Age in Years ZDHS 1994 Table 3.11 indicates that 37 percent of women age 19 had at least one child, with nearly 5 percent reporting that they had at least two children. The percentage of adolescents with at least one child increases with age from 2 percent among women age 15 to 37 percent among those age 19. Table 3.11 Children born to adolescent women Percent distribution of women 15-19 by number of children ever born (CEB), according to single year of age, Zimbabwe 1994 Age 0 1 2+ Number of Mean chddren ever born number Number of of Total CEB women 15 98.5 16 93.8 17 91.8 18 74.6 19 63.0 Total 85.3 1.5 0.0 100.0 0.01 310 6.2 0 0 100 0 0 06 305 7.5 0.7 1000 0.09 310 20.8 4 6 100 (I 0 31 297 32.0 4.9 100 0 0.42 249 12.8 1 9 I(X)0 0 17 1,472 37 CHAPTER 4 FERTILITY REGULATION This chapter presents the ZDHS results regarding various aspects of contraceptive knowledge, attitudes, and behaviour. While the focus is placed on women, some results from the male survey will also be presented, since men play an important role in the realisation of reproductive goals. To get an indication of interspousal communication and (perceived) agreement in the attitudes and knowledge of couples regarding family planning the responses of men were, where possible, paired with responses obtained from their spouses m the same household. Family planning methods will be grouped into three principal types in the following presentation: modem methods, traditional methods (periodic abstinence and withdrawal), and folk methods. Modem methods are ordered with short-term methods (pill, condoms, and vaginal methods, which include diaphragm, foam, jelly, and foaming tablets) listed first, followed by long-term methods (IUD, injectables, and implants) and permanent methods (female and male sterilisation). 4.1 Knowledge of Contraceptive Methods Women and men who are adequately informed about their options regarding methods of contracep- tion are better able to develop a rational approach to planning their families. Information on knowledge of contraception was collected by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the inter- viewer described the method and asked if the respondent recognised it. As married men and women in Zimbabwe have the greatest level of exposure to the risk of pregnancy, the following presentation places em- phasis on this subgroup. Table 4.1 shows the percentage of all women and men, currently married women and men, and sexually active unmarried women and men who know specific contraceptive methods. Knowledge of family planning methods is nearly universal, with 98 percent of all women age 15-49 and all men age 15-54 knowing at least one modem method of family planning. Knowledge of contraceptive methods is slightly more exten- sive, on average, among men than women, with the exception of the sexually active unmarried population, amongst whom women tend to be more knowledgeable than men. Married women and men know an average of 6.5 and 7.1 methods, respectively, compared with 6.7 and 6.3 methods for sexually-active unmarried women and men. The difference is especially pronounced regarding long-term and permanent methods; married men know considerably more about such methods than sexually active unmarried men. Among both currently married women and men, the pill and condoms are the best known methods of family planning. The IUD and injectables tend to be better known among female respondents; whereas, male respondents are more likely to know about male and female sterilisation, withdrawal, and periodic abstinence. Due to their recent introduction into the family planning programme in Zimbabwe and thus lower availability, implants are the least known method, reported by only 16 percent of currently married women and men. Vaginal methods (diaphragm, foam, jelly, and foaming tablets) are also not commonly known among both female and male respondents. Folk methods of family planning (mostly strings and various types of herbs and herb mixtures) were cited by 29 percent of married women and 28 percent of married men. 39 Table 4 1 Knowledge of contraceptive methods Percentage of all women, of ct rrently married women, and of sexually active unmarried women and the percentage of all men, of cJrrently married men, and of sexually acttve unmamed men who know specific contraceptave methods by specific methods, Zimbabwe 1994 Women Men Sexually Sexually Currently active Currently active Contraceptnve All marrned unmarried All married unmarried method women women women men men men Any method 97.8 98,8 99.4 97 5 99 9 99 5 Any modern method 97 5 98.5 99.2 97.4 99.7 99.5 Pill 96 0 97.9 97.9 94.7 98.9 97.0 Condom 93.7 94.6 97 5 96.2 98.9 99.0 Dlaphragm/Foam/JellyFFablets 21 1 22.0 29.5 29 4 30,7 32.8 IUD 67 6 74.2 79.0 55.0 65,8 55.0 lnjectables 79 7 87.4 90 7 65.6 81.2 58.2 Implant 13.8 16 1 17.2 13,1 16,1 12.6 Female sterilisation 69 7 75,0 75 8 76.4 83.7 75.0 Male stenhsation 42.5 47 3 46 9 48.8 53.4 49.2 Any traditional method 64.2 74 6 73.9 74.2 87.5 79.5 Periodic abstinence 33.2 34.4 42.6 58.7 65.8 66.5 Withdrawal 56.8 70.0 66.4 64.2 82.8 65.4 Folk method 23 3 29.4 29,5 19.5 27.9 18.6 Any traditional/folk method 67 8 78 4 95.6 76.0 89.1 80.4 Number of women/men 6,128 3,788 288 2,141 1,038 219 Mean number of methods 6,0 6.5 6,7 6 2 7 1 6.3 Table 4.2 shows the correspondence between the contraceptive knowledge of husbands and wives (711 couples) in the ZDHS sample of households. For most methods, both spouses will have knowledge of the method. The exceptions are for the least known methods (i.e., vaginal methods, implants, periodic abstinence, and folk methods); in these cases, usually only the husband knows the method or only the wife. Knowledge of contraceptive methods has increased considerably since the mid 1980's. Table 4.3 shows changes in knowledge of specific methods of family planning between the 1984 Zimbabwe Reproduc- tive Health Survey (ZRHS), the 1988 ZDHS, and the 1994 ZDHS. Eighty-three percent of all women in the 1984 ZRHS reported that they had aeard of at least one family planning method compared with 98 percent in the 1994 ZDHS. Thus, in the 10 !~ears between the two surveys, the level of general contraceptive knowl- edge increased by 18 percent. There has also been large increases in the proportion of women who know spe- cific family planning methods. For example, the proportion who have heard of the IUD has increased from 40 percent in 1984 to 68 percent in 1994 and the proportion who have heard of male sterilisation increased fourfold during the same period. Kaowledge of injectables increased from 63 percent in 1984 to 80 percent in 1994. 40 Table 4.2 Knowledge of contraceptive methods among couples Percent distribution of couples by contraceptive knowledge, according to specific methods, Zimbabwe 1994 Husband Wife Both knows, knows, Neither Contraceptive know wife husband knows method method not not method Total Any method 99.4 0.6 0,0 0.0 100.0 Any modern method 99.2 0.7 0. I 0.0 100.0 Pdl 98.0 0.9 1.0 0. I 100 0 Condom 96.2 2.8 0.8 0.2 100 0 Diaphragm/Foam/Jelly/Tablet s 10.3 20.5 12.9 56.4 100.0 IUD 57.4 10.0 19.7 12.9 100 0 lnjectables 77. I 6.2 13.8 3.0 100 0 Implant 5.9 10.5 13.3 70.3 100.0 Female sterilisation 64.4 19.2 11.9 4.5 100.0 Male sterilisation 30.5 23.8 20.0 25.7 100.0 Any traditional method 70.4 19,3 7 5 2.9 100.0 Periodic abstinence 26.9 39.8 9.8 23.5 100.0 W~thdrawal 58.2 25.4 9.5 6.9 1130.0 Folk method 10.2 16.3 19.8 53.6 100.0 Table 4.3 Trends in knowledge of family planning methods Percentage of all women who know specific contracepUve methods, Zimbabwe 1984, 1988, 1994 Knowledge of contraception Contraceptive 1984 1988 1994 method ZRHS ZDHS ZDHS Any method 82.8 96.3 97.8 Any modern method NA 95.4 97.5 Pill 80.5 93.6 96.0 Condom 48.3 76.7 93.7 Diaphragm NA 14.0 NA Foam/Jelly/Foaming Tablets 17.4 a 13.5 21.1 a IUD 40.2 51.6 67.6 lnjectables 62.6 62.2 79.7 Implant NA NA 13.8 Female sterilisation 40.0 49.7 69.7 Male sterilisation 10.8 16.4 42.5 Any traditional method NA 75.3 64.2 b Periodic abstinence 20.4 28.1 33 2 Withdrawal 56.1 63.4 56 8 Other c NA 34.2 NA Folk method NA NA 23.3 Any traditional/folk method NA NA 67.8 Number of women 2,123 2,643 3,788 NA = Not applicable a Includes diaphragm b Excludes folk methods c Includes herbs and other folk methods Source: ZNFPC and WPAS, 1985; CSO and IRD, 1989 41 4.2 Ever Use of Contraception All men and women interviewed in the ZDHS who said that they had heard of a method of family planning were asked if they had ever used any method (with the intention of delaying or avoiding pregnancy). Table 4.4 shows the percentage of women who have ever used family planning, according to method type and age. Eighty percent of currently married women reported having used a method of family planning at some time; 72 percent have used a modem method, 30 percent have used a tradttional method, and 7 percent have used a folk method. The most commonly used modem methods are the pill (66 percent), condoms (24 percent), and injectables ( 12 percent'~. Other modern methods are less commonly cited, none exceeding 5 per- cent. Comparing the 1994 ZDHS with the 1988 ZDHS (data not shown), the overall level of ever use of family planning has remained virtually unchanged: 79 percent in 1988 and 80 percent in 1994. Yet, ever use of modem methods has increased from 63 to 72 percent, and ever use of traditional/folk methods has de- creased from 48 to 34 percent over the same period. Table 4.4 Ever use of contracepnon Percentage of all women, of currently marrie,J women, and of sexually active unmarried women who have ever used any contraceptive method, by specific method an, l age, Zimbabwe 1994 Age Modem method Tradntlonal method Any Diaphragm/ Female Male modern In Foam/ sten- sten- Any Periodic WLth- Any Number Any meth- .ect- Jelly/ Con- hsa hsa- lm- mid absln- draw- Folk trad / of method od Pill IUD ~,bles Tablet dora tnon tlon plant method nen~.e al method fl4k women ALL WOMEN 15-19 13.8 122 86 O0 02 Ol 64 00 00 O0 37 13 26 04 40 1,472 20-24 63.0 60,1 521 05 26 01 277 OI Ol 0,3 169 53 135 29 186 1,269 25-29 85.8 81,8 761 29 49 07 342 II6 O0 03) 234 46 21 1 50 273 915 30-34 84.1 78,4 740 40 33 09 269 18 02 03 3(77 41 292 70 347 871 35-39 81 I 74.4 691 29 ;!28 03 229 4/I 0.3 02 373 52 348 112 424 661 40-44 81,4 691 625 36 274 14 185 55 06 00 389 66 380 129 452 532 4549 714 50.3 423 33 220 1 I 61 69 04 O0 372 63 360 138 443 407 Total 61.7 56 1 504 19 9.5 05 207 1,7 (72 t) 1 22 I 4 2 202 5 7 25 3 6,128 CURRENTLY MARRIED WOMEN 15-19 495 440 356 0,0 I 0 00 179 0It 0.0 00 144 43 108 09 146 276 20-24 788 746 686 178 32 02 317 01 Ol 04 232 61 195 37 254 798 25-29 886 838 797 34 53 04 324 06 00 00 244 41 222 56 286 726 3034 847 784 739 43 132 1 I 257 21 02 03 338 45 321 69 371 722 35~39 804 729 685 33 ).14 04 205 33 04 (12 396 51 371 108 447 53(1 40-44 815 682 617 3.4 ~-66 I 1 174 57 07 O0 396 6,1 392 135 454 425 4549 725 512 428 32 ~16 09 63 81 05 00 395 76 387 135 454 311 Total 79,7 72.0 664 2,7 12 0 06 24.4 2 3 02 I) 2 303 5 3 280 74 34 I 3,788 SEXUALLY ACTIVE UNMARRIED WOMEN Total 843 807 609 19 134 118 510 24 00 00 244 8 1 200 82 294 288 42 Ever use of modem methods among currently married women was about two times greater than ever use of traditional and folk methods combined (72 vs 34 percent), with older women having used traditional and folk methods more than their younger counterparts. Sexually active unmarried women were more likely to report ever use of modem methods (81 per- cent) than married women (70 percent); this difference is explained by greater use of condoms among unmar- ried women. 4.3 Current Use of Contraceptive Methods The contraceptive prevalence rate (CPR) for Zimbabwe--the percentage of currently married women who are using a method of family planning--is 48 percent (see Table 4.5.1). Most current users of contraception are using a modem method; the CPR for modem methods is 42 percent, while 4 percent and 2 percent of currently married women were using traditional methods and folk methods, respectively, which are considered less effective for the prevention of unwanted pregnancy. Figure 4.1 shows the distribution of currently married women by method currently used. Table 4.5.1 Current use of family planning: women Percent distribution of all women, of currently married women and of sexually active unmarried women who are currently using a contraceptive method by specific method, according to age, Zimbabwe 1994 Age Modem method Traditional method Any Female Male Pefi- Not modern In- steri- steri- Any odic With- cur- Number Any meth- Ject- Con- hsa- lisa- lm- trad. absti- draw- Folk rently of method od Pill IUD ables dom hon tion plant method aence al method using Total women ALL WOMEN 15-19 82 75 6.1 O0 0,2 1.3 O0 0.0 0.0 0.5 0.2 0.3 02 91.8 I000 1,472 20-24 38.3 36.3 31 5 0.1 1,4 3 0 0 I 0.0 0 3 1.1 0.2 1 0 0 9 61.7 100 0 1,269 25-29 53.4 492 41.0 14 2,8 3.4 06 0,0 0.0 27 0,3 2.5 15 466 1000 915 30*34 48,9 42.2 31.0 1 7 42 3.1 1 8 0 2 0.2 5.3 0.1 5.2 1 4 51 1 100.0 871 35-39 47 2 39.7 26.6 0 8 5.2 2.8 4.0 0,2 0.2 5 0 0.2 4.9 2.4 52.8 100.0 661 40-44 42 0 33.4 19.4 0 8 4.7 2 7 5.5 0.3 0,0 5 8 0.3 5 5 2 7 58.0 100.0 532 45-49 23.3 18.2 87 0.0 1.6 06 6.9 04 0.0 4.0 00 4.0 I 1 767 100.0 407 Total 35,1 31 1 236 0.6 2.4 24 1,7 0.1 0 1 2.8 02 26 1 2 649 1000 6,128 CURRENTLY MARRIED WOMEN 15-19 31.4 29 8 26.2 0.0 1 0 2.6 0.0 00 0.0 1.4 0.0 1 4 0.2 68 6 100.0 276 20-24 49.9 474 429 0.1 17 21 0.I 0.0 04 14 0.0 1.4 I 1 50.1 100.0 798 25-29 58.1 53.0 455 1.7 2.9 23 06 00 0.0 3.4 0.2 3.1 1.7 419 100.0 726 30-34 51.8 440 32.4 1.9 42 30 2.1 02 0.2 6,3 0.1 61 1.6 482 100.0 722 35-39 49.9 41 2 28.8 1.0 5 4 2 3 3.3 0.2 0 2 6.3 0.2 6. I 2.4 50 1 100.0 530 40-44 45 1 35.5 21.2 0 9 4,4 2.8 5.7 0 4 0.0 6.6 0.0 6 6 3 0 54.9 100.0 425 45-49 27 5 20 8 10 3 0.0 1.7 0 2 8.1 0.5 0 0 5.2 0.0 5.2 1.5 72 5 100.0 31 I Total 481 422 33.1 10 32 23 2.3 02 02 4.3 0.1 42 17 51.9 1000 3,788 SEXUALLY ACTIVE UNMARRIED WOMEN Total 560 52,6 31.9 02 45 13.6 2.4 00 00 2.6 1.8 08 0.9 440 1000 288 43 Figure 4.1 Use of :Specific Contraceptive Methods among Currently Married Women Not Using 52% Tr=~H't'~n=l/FoIk Methods 6% Modern Methods 1% tdorn 2% emale Sterilisation 2% Injectables 3% 3°/o ZDHS 1994 The pill is by far the most commonly used contraceptive method: 33 percent of married women are current users of the pill. Three percent of married women are using contraceptive injectables, 2 percent are using condoms, and 2 percent have been sterilised. All other modem methods are used by 1 percent of women or less. Withdrawal was reported by 4 percent of married women as their current method of family planning, and 2 percent are trying to avoid pregnancy using folk methods (e.g., strings and herbs). Modem method use rises with age from 30 percent of married women age 15-19 to a peak of 53 percent at age 25-29, after which use falls to a low of 21 percent among women 45-49. Female sterilisation, traditional methods, and to lesser e).tent, injectables are used more commonly by older women. Modern method use is higher among sexually active unmarried women (53 percent) than among married women (42 percent). The difference is largely attributable to the much greater use of condoms among the unmarried (14 percent) than the currently married (2 percent), which suggests that the intention for extramarital condom use involves more than pregnancy prevention and probably indicates disease prevention strategies as well. Reported use of family plar.ning by men (and their partners) is higher than that reported by women (see Table 4.5.2). The CPR for married men age 15-54 is 60 percent; for modem methods, the CPR is 55 percent.~ Most of the female-male difference is explained by greater reported use of the pill (43 percent) and condoms (6 percent) among men. "l'he level of use of other methods among married men roughly parallels that of married women. i It should be kept in mind that the rate of contraceptive use among males could be shghtly over- or underestimated, because men in polygamous or multi-pa rmer relationships may systematically report on the contracepting or non-contra- cepting pair. 44 Table 4.5.2 Current use of family planning, men Percent distribution of all men, of currently married men and of sexually active unmarried men who are currently using a contraceptive method by specific method, according to age, Zimbabwe 1994 Modern method Traditional method Any Female Male Pert- Not modern In- sten- sten- Any odlc With- cur- Number Any meth- ject- Con- lisa- hsa- trad absti- draw* Folk rently of Age method od Pall IUD ables dom tton tion method nence al method using Total men ALL MEN 15-19 11,8 114 04 0.0 00 l l . l 00 0.0 0.4 0.2 02 00 882 100.0 604 20-24 37 7 36 6 10,8 0 0 0 0 25.7 0.0 0 0 0 4 0.0 0.4 0 7 62.3 100.0 399 2529 57.8 550 334 10 0.6 199 00 00 2.0 01 19 0.9 422 1000 288 30-34 63.8 599 44.6 1 3 20 11 6 0.3 03 2.6 1.0 1.6 I 3 362 100.0 241 35-39 58 7 52.4 40 8 1 0 4.6 5 1 1.0 0.0 3.7 0 5 3.2 2.6 41 3 100.0 195 40-44 646 56.0 340 1 8 5.6 130 1 7 00 5.9 00 59 2.7 354 1000 190 45-49 51.5 44 I 30 1 0 0 2.4 6 5 5 1 0.0 5.5 2.2 3 3 2.0 48,5 100 0 I I I 50-54 43.8 382 257 09 25 4t 24 2.5 0.9 0.0 09 4.7 56.2 1000 113 Total 41 4 38 2 21 3 0.6 1 5 14 1 0.7 0 2 l 9 0.4 1.6 1 2 58 6 100.0 2,141 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * 1000 l0 20-24 50.6 47 2 41 2 0.0 0.0 6 0 0 0 0.0 1.5 0 0 1 5 1,9 49.4 100 0 99 25*29 63.0 603 517 1.4 1.0 6.3 00 00 2.1 0.2 20 06 37.0 1000 177 30-34 66 6 62 0 52.0 I 5 2 3 5 6 0.3 0 3 3 I I 2 1.9 1 5 33 4 100 0 204 35-39 63.0 55.9 44.4 1 1 5 I 4,3 I 1 0 0 4 1 0,6 3 5 2 9 37 0 100.0 176 40-44 665 570 37.0 16 62 104 1.8 00 65 00 6.5 30 335 1000 171 45-49 540 45.9 31.2 00 26 65 5.6 00 60 24 3.7 21 460 100.0 101 50-54 482 41.9 28.8 10 29 37 27 29 10 0.0 1.0 53 51,8 100.0 101 Total 604 545 425 1.1 30 62 14 0.3 36 06 3.0 2.3 39.6 100.0 1,038 SEXUALLY ACTIVE UNMARRIED MEN Total 57.6 56 7 6 3 0 5 0.0 49 9 0.0 0 0 0.9 0 0 0 9 0.0 42 4 100 0 219 Note: No men were using mlplants An asterisk Indicates that a figure Is based on fewer than 25 men and has been suppressed There exists a sharp contrast between married men and sexually active unmarried men regarding pill and condom use. Fully one-half of unmarried men report using condoms (vs. 6 percent of married men), but only 6 percent report using the pill (vs. 43 percent of married men). This may represent differing reproduc- tive and health (disease prevention) strategies related to marital status. That sexually active unmarried wom- en are reporting higher levels of pill use (32 percent) than their male counterparts (6 percent) could mean that these men are often not told by their partners of pill use. This implies some level of simultaneous pill and condom use in high-risk groups that is not directly captured in these data. 2 Compared with other countries in southern and east Africa where DHS surveys have been conducted, Zimbabwe has the highest level of contraceptive use (48 percent) (see Figure 4.2). Over the last decade, use of modem contraception has increased by 56 percent, from 27 percent of married women in the 1984 ZRHS to 36 percent in the 1988 ZDHS to its current level of 42 percent (see Table 4.6). The recent increase since the 1988 ZDHS is explained by an increase in the use of injectables from essentially no use to 3 percent, an increase in pill use from 31 to 33 percent, and a small increase in condom use (for contraceptive purposes) 2 Further, conventional wxsdom suggests that use of female-dependent methods such as the pill may be underestimated from male data, and that use of condoms may be underestimated from female data. 45 Figure 4.2 Current Use of Family Planning, Selected Countries in Southern and East Africa, 1992-1994 ZIMBABWE 1994 Kenya 1993 Narnlbla 1992 Tanzania 1994 Zambia 1992 Malawl 1992 Note: Currently married women age 15-49 20 W 3 3 10 20 3O Percent J 48 40 50 from 1 to 2 percent. Although the current method mix indicates continued dominance of the pill, the percentage of modem method use accounted for by the pill is starting to drop from 86 percent in 1988 to 78 percent in 1994. Rates for other modern methods have remained roughly c,mstant at low levels, while use of traditional or folk methods has dropped slightly from 7 to 6 percent. Table 4.7 and Figure 4.3 show that some women are more likely to use contraceptives than others. Urban women are much more likely to use modem methods (54 percent) than rt ral women (37 percent); this applies to all methods except female sterilisation and injectables which are used at simi- lar rates by both urban and rural women. Tradition- al and folk methods are more likely to be used in rural than urban areas. Use of modern methods is highest in Harare (58 percent) and lowest in Mani- caland (28 percent), Matabeleland North (29 per- cent), and Matabeleland South (29 percent). The IUD is used most by women in Harare and Bula- wayo; injectables are most common among women in Masvingo, Midlands, and Mashonaland East provinces. Withdrawal is used mo~,t frequently in Midlands (9 percent) and Manicaland (7 percent). Table 4.6 Trends m current use of contraception Percentage of currently married women who were using specific contraceptwe methods at the time of the survey, Zimbabwe 1984, 1988, t994 Current use of contraception Contraceptive 1984 1988 1994 method ZRHS ZDHS ZDHS Any method 38.4 43.1 48.1 Any modern method 26.6 36.1 42.2 PIll 22.6 31.0 33.1 Condom 0 7 1.2 2 3 Vaginal method 0 1 0.0 0 0 IUD 0.7 1.1 1.0 lnjectables 0.8 0.3 3.2 Implant NA NA 0 2 Female sterilisation I 6 2.3 2 3 Male stenhsation 0 1 0.2 0 2 Any traditional method I 1.8 7.0 6.0 Safe penod I 0.6 0.3 0.1 Withdrawal 6.5 5 1 4.2 Periodic abstinence 2.1 NA NA Other 2 2.6 1.5 1.7 Number of women 2,123 2,643 3,788 NA = Not apphcable i Includes only rhythm method ]n the 1984 ZRHS 2 Reported as "folk" methods in 1994 ZDHS Source: ZNFPC and WPAS, 1985; CSO and IRD, 1989 46 Table 4.7 Current use of family planning by background characteristics Percent distnbutton of currently married women by contraceptzve method currently used, according to selected background characteristics, Zimbabwe 1994 Any modern Background Any meth- characteristic method od Pill Modem method Tradinonal method Female Other Pen- Not In- sten- modern Any odic With- cur- Number ject- Con- l isa- meth- trad absti- draw- Folk rently of IUD ables dom tion od method hence al method using Total women Residence Urban 57.6 53.9 42.0 2.2 3.6 2.9 2.5 0.7 2.9 0.2 2.6 Rural 44.2 37.3 29.4 0.5 3.0 2.1 2.2 0.2 4.9 0.1 4.8 0.9 42.4 100.0 1,114 20 55,8 1000 2,674 Province Manxcaland 35.9 27.6 21,4 1.4 0 8 3.4 0 5 0,0 6.7 0.0 6.7 1.6 64.1 100.0 543 MashonalandCentral 48.5 42.3 36.5 0.3 1,5 1.8 2.4 0.0 4.4 0.l 4.3 1.8 51.5 100.0 342 Mashonaland East 52.3 47.4 37.1 0.3 4.2 2.3 2.9 0.5 3.8 0.3 3 5 1.1 47.7 100.0 377 Mashonaland West 49.1 44.6 39.6 0.0 2 8 1.8 0 5 0,0 2.7 0.0 2.7 1.7 50.9 100.0 429 Matabeleland North 33.6 28.5 21,4 0.4 3.0 2.0 1.4 0.2 2.5 0 0 2 5 2 7 66.4 100.0 239 Matabeleland South 33.9 29.4 20.5 0.6 2.8 1.1 4.2 0.3 1,5 0 3 I 2 3.0 66.1 100.0 183 Midlands 58.2 46.7 34.5 0.5 4,8 3.2 3 5 0.2 8,9 0.0 8.9 2.6 41.8 100,0 472 Maswngo 42.0 37.6 28.0 0.0 5.2 1.1 3 3 0.0 3,3 0.0 3.3 1.1 58.0 100,0 393 Harare 61.6 57.7 45.7 2.2 3,6 2.8 25 0.8 2,8 0.3 2.5 1.1 38.4 100.0 619 Bulawayo 47.9 44.8 30.6 4.5 2.8 1.4 42 1.4 2.4 0.3 2.1 0.7 52.1 100.0 191 Education No education 32.8 25.9 22.4 0.0 0.6 1.2 1,6 0.0 5.8 0.0 5.8 1.1 67.2 100.0 552 Primary 46.4 38.9 29.4 0.5 4.1 2.1 2.7 0.1 5.0 0,1 4.9 2.5 53.6 100.0 1,992 Secondary+ 57.7 54.7 43.8 2.2 2.8 3.0 2.1 0.8 2.5 0 2 2 3 0,5 42.3 100.0 1,244 No. of living children 0 7 I 6.9 4.6 0.0 0.0 1.6 0.8 0.0 1).2 0 0 0 2 0.0 92.9 100.0 349 1 47.1 45.1 39.9 0.9 1.3 2.6 0.3 00 1.2 0.2 1.0 0.7 52.9 100.0 707 2 58 0 55.1 48.3 1.2 2.2 1.7 0.7 1.0 1.8 0.2 1 7 1.0 42.0 100.0 664 3 53.2 46.7 36.4 2.4 3.7 2.2 1.9 0 2 3.5 0.0 3.5 3.0 46.8 100.0 487 4+ 51.9 41.8 28.9 0.6 5.0 2.6 4.4 0 3 7.9 0 1 7.8 2.3 48.1 100.0 1,580 Total 48.1 42.2 33 I 1.0 3 2 2.3 2.3 0 3 4.3 0.1 4.2 1.7 51.9 100.0 3,788 Higher contraceptive use was found to be associated with increasing level of education. Use of modem methods increases from 26 percent among married women with no education to 55 percent among women with secondary education or higher. Use of modem methods increases with the number of children a woman has, up to two children, then declines thereafter. 47 Figure 4.3 Curfent Use of Family Planning by Background Characteristics RES,% Rural PROVINC Matabeleland Nort~ Matabetel nd S ut SVI° O Mashonaland Cent fal shonaland est I~ashonaland V~ast Midlands Harare EDUCATION NO Ed catton I~rlmarv Secondary ~- NO LfVING CHILDREN ? 4+ , ~ 144 ;~ ~13~0 142 ~ ~ ~ 48 i • ~ F 58 ~m 7 o ~ ~ i i 58 54 20 40 60 Percent Note: Currently married women age 15-49 ZDHS 1994 4.4 Quality of Pill Use The vast majority of contraceptive users in Zimbabwe rely on the pill. Since the effectiveness and safety of the pill depends on how well women comply with instructions on its use, the ZDHS included a series of questions on the quality of pill use. Table 4.8 gives information c,btained from the 24 percent of all women who reported that they were currently taking the pill. Correct use c,fthe pill is an indirect indication of the effectiveness of the counselling clients receive when they start using oral contraceptives. Among reported pdls users, 89 percent were able to show a packet to the interviewer. Among pill users able to show a packet, there was evidence that not all users were taking their pills correctly. ZDHS interviewers examined the pill packets to determine if pill s were taken in the proper sequence. Eight) percent of current pill users showed ZDHS interviewers pill packets in which pills were missing in the correct order, but this includes in the denominator those who could not show a packet at all and users who had no pills missing from the packet and could have been starting a new packet. Therefore, the figure of 80 percent compliance may be underestimated (i.e., some users unable to show the packet may have been taking the pills correctly). When asked about the last time they took a pill, 96 percent of pill users reported that they last took a pill less than two days ago. 48 Table 4.8 Pill use comphance Percentage of women using the pill and the percentage of pdl users who have a packet at home, have taken pills in order, and who took a pill less than two days ago, by background charactensucs, Zimbabwe 1994 Pdl users who: Percent Number Could Took Took Number Background using of show pills pill <2 of pill characteristic pill women package in order days ago users Age 15-19 6.1 1,472 87.6 80.5 96.6 90 20-24 31.5 1,269 89.0 81.0 95.1 399 25-29 41.0 915 89.4 80.7 94.6 375 30-34 31.0 871 89.8 81.2 97.1 270 35-39 26.6 661 93.9 83.7 95.2 176 40-44 19.4 532 81.8 64.6 97.0 103 45-49 8.7 407 89.1 83.6 96.6 36 Residence Urban 28.1 1,975 89.9 83.0 96.9 556 Rural 21.5 4,153 88.8 78.3 94.8 893 Province Mamcaland 14.9 839 92.8 85.4 96.1 125 Mashonaland Central 26.5 510 92.5 86.3 96.1 135 Mashonaland East 26.5 579 92.0 87.3 95.3 153 Mashonaland West 31.5 632 84.3 73.0 94.7 199 Matabeleland North 16.3 366 97.3 84.8 96.4 60 Matabeleland South 16.0 305 96.2 81.6 98.5 49 Midlands 25.3 810 85.2 71.6 94.1 205 Masvingo 19 9 652 83.4 70 9 92 6 130 Harare 29.8 1,048 91.7 86.2 98.9 312 Bulawayo 20.8 388 85.2 74.6 91.0 81 Education No education 21.2 682 90.4 80.4 97.4 145 Primary 22.9 2,898 89.7 78 3 96 4 664 Secondary+ 25. I 2,547 88.5 82.0 94.4 640 Total 23.6 6,128 89.3 80.1 95 6 1,449 In order to study the quality of knowledge about pill use, several questions were included in the ZDHS to determine whether women using the pill comply with instructions to take the pill daily and what women do when they forget to take the pill. Table 4.9 shows that about 56 percent of current pill users reported that they had never failed to take the pill. Of the 44 percent of users who ever interrupted pill use, only about one-third (36 percent) took the correct action after missing a pill: taking two pills the next day. 49 Table 4.9 Interruption in pill use Percentage of women using the pill who reported they never taxied to take pill, the percentage who ~ver interrupted use, and the percentage who took the correct action after missing one pill, by background characteristics, Zimbabwe 1994 Took correct Never Ever action failed interrupted at~er Number Background to take use of mxssmg of pill characteristic pill pill pdl users Age 15-19 62.3 37.7 66 3 90 20-24 56.1 43.9 33 2 399 25-29 57.6 42.4 36 1 375 30-34 51.8 48.2 35 5 270 35-39 57.2 42.8 31 9 176 40-44 50.5 49.5 35.2 103 45-49 52.4 47 6 28.1 36 Residence Urban 61.6 38 4 39.9 556 Rural 52.0 48.0 34.1 893 Province Mamcaland 56. I 43.9 34.0 125 Mashonaland Central 52.0 48.0 31.2 135 Mashonaland East 43.3 56.7 39.6 153 Mashonaland West 64.3 35.7 25.3 199 Matabeleland North 71.0 29.0 37.9 60 Matabeleland South 79.5 20.5 32 6 49 Midlands 47.7 52.3 28.4 205 Masvingo 27.8 72.2 32.5 130 Harare 66.3 33.7 57.4 312 Bulawayo 62.3 37 7 28.3 81 Education No education 53.6 46.4 34.2 145 Primary 57.0 43.0 34.8 664 Secondary+ 54.9 45. I 37.7 640 Total 55 7 44.3 36.0 1,449 The quality of pill use varies by age. Younger women were slightly less likely to fail to take a pill than older women, and more likely to take appropriate corrective action. Interrupted pill use was reported most commonly among women in Masvingo (72 percent), Mashonaland East (57 percent), and Midlands (52 percent). Urban pill users were less likely than rural users to have interrupted pill use. Table 4.10 presents the frequencies of reported problems experienced by pill users in the last month, according to whether or not the women interrupted her pill use in the last month. Over two-thirds of pill users (69 percent) reported experiencing a problem in the last month: 96 percent of women who interrupted their pill use and 61 percent of those who did not. Perhaps the most notable finding is that 21 percent of pill users said they forgot/misplaced their pills and 16 percent reported having run out of pills. These two problems were 4-8 times more common among women who interrupted pill use than other women. Loss of libido, spotting or bleeding, and missing a period were also commonly cited as problems by pill users, especially by those women whose pill use was interrupted. 50 Pill Brands of Current Users To obtain information on the type of pill brands used in Zimbabwe, the ZDHS interviewer asked to see the packet of pills that the respondent was currently using and recorded the brand name. If the packet was not available, the interviewer used a visual display of types of pills, developed for the ZDHS, to ask the user which brand she was currently using. Table 4.11 shows the distribution of current pills users by brand of pill used and current breastfeeding status. The two brands available through the public sector, Lo-Femenal and Overette, account for 97 percent of all pill use in Zimbabwe. In line with the current recommendations, the majority (71 percent) of pill users who are not breastfeeding use Lo-Femenal, a low dose pill; while the majority (88 percent) of breastfeeding pill users use Overette, a progestin-only pill which does not reduce milk production. Table 4.10 Problems in pill use Frequency of reported problems durmg pill use, by whether pill use was interrupted in the last month, Zimbabwe 1994 Problem mentioned in the last month Interruptton of pill use m last month Yes No Total Spotting/bleeding 23.2 16.9 18.3 Other illness 17.6 16 5 16.7 Period did not come 16.5 10.4 I 1.8 Ran out of pills 39.8 8.9 16.0 Forgot/misplaced 64.2 7.8 20.8 Loss of libido 52.9 41.5 44.0 Other 4.3 3.9 4.0 Any problem 95.8 60.7 68.7 Number of pill users 334 I,I 13 1,449 The ZDHS asked pill users how they paid for their last packet of pills. Only 10 percent reported receiving free pills. Of the remainder, the average reported cost per packet was 1.1 Zimbabwe dollar (data not shown). Table4.11 Useofpi l l brands Percent distribution of pill users by the brand of pills used, according to breastfeeding status, Zimbabwe 1994 Currently breast feeding Pill brand Yes No Total Lo-Femenal 9.3 70.7 48 5 Logynon 1.6 1.1 1.3 Micronor 0.6 0.7 0.6 Ovrette 88.0 25.6 48. I Trinordiol 0.0 1.0 0.7 Other 0.0 0.8 0.5 Don't know 0.3 0.0 0.1 Mxssmg 0.3 0 I 0.2 Total 100.0 1000 100.0 Number 522 927 1,449 51 4.5 Number of Children at First Use of Contraception Family planning methods may be used by couples for either spacing births or limiting family size. Table 4.12 shows the distribution ef ever-married women by age group and the number of children the woman had when she first used contraception. The results indicate that Zimbabwean women are adopting family planning methods at an earlier stage of the family building process than before. Younger cohorts of women reported first use at lower parity than older cohorts of women. For example, the oldest cohorts (age 40-49) of ever-married women repo'ted first use after having 2.6 births on average, compared with around 1.5 births among the youngest cohorts (age under 30). From another perspective, 12 percent of the age 15-19 cohort started contracepting before ti'Le birth of their first child, compared with only 2 percent of the age 45-49 cohort. Table 4.12 Number of children at first use of contraception Percent dLstributmn of ever-married wemen by number of hying children at the time of first use of contraception, and medmn number ~f children at first use, according to current age, Zimbabwe 1994 Never Number of hvmg chddren at ttme used of first use of contraception Number contra- of Current age ception 0 I 2 3 4+ Missing Total women Medmn 15 19 49.6 11.9 3¢,,2 2.1 0.0 00 02 1110.0 306 1.4 20-24 20.7 7.5 6(~.4 4.8 0.2 0.0 0.3 100.0 909 1.5 25-29 I I 5 6.8 6z.9 13,2 2.6 0,9 0.1 100.0 845 1 6 3(134 15.0 3.1 4~,8 193 92 6 1 04 1000 842 1.8 35-39 184 23 3z-3 17.7 11.3 15.8 0.2 1000 653 22 40-44 18 I 2 5 29 3 16.0 I 1.3 22.7 0.0 1/)0.0 520 2 6 45-49 28.3 2.1 2(~.1 12.7 83 219 06 [000 405 2.6 Tola[ 19 9 5 0 4Y 8 12.8 6.0 8.2 0.3 100 0 4,480 1 7 4.6 Knowledge of Contraceptive Effects of Breastfeeding lnlbrmation on knowledge of the contraceptive effect of breastfeeding is shown in Table 4.13. Over half of currently married Zimbabwe.an women beheve that breastfeeding does not effect the chance of a woman becoming pregnant. Only I 0 percent correctly reported that breastfeeding can reduce the risk of pregnancy. Differentials in knowledge of the contraceptive effect of breastfeeding were very small or negligible. Only one m fourteen women has ever used breastfeeding to avoid pregnancy; only 2 percent are currently relying on breastfl~eding a:; a contraceptive. Urban women and women with at least a secondary educatton were least likely to use breasffeeding to avoid pregnancy. Women in Masvmgo province are more likely than women from other provinces to rely on this method. Three percent of currently married women meet the criteria for use of the lactational amenorrhoeic method (LAM) of family planning) LAM users are currently married women who are breastfeedmg a child under six months of age, and are stdl postpartum amenorrhoetc and are not b.eding the child anything but breast milk, iir breast nnlk and plain water 52 Table 4.13 Perceived contraceptive effect of breastfeeding Perceived risk of pregnancy associated with breastfeedmg and percentage of currently married women who previously relied on breastfeeding to avoid pregnancy and who currently rely on breastfeedmg to avoid pregnancy and percentage who meet lactational amenorrhoelc method (LAM) criteria, according to selected background characteristics, Zimbabwe 1994 Perceived risk of pregnancy associated with breastfeedmg Reb~tnce on breastfeeding to avoid pregnancy Meet Number Background Un- In- De- Don't Prevt Cur- LAM of characleristic changed creased creased Depends know Total ously rently cnteNa women Age 15-19 53.6 20.4 8.8 120 5.2 100.0 0.6 0.6 27 276 20-24 53,1 20.4 9.8 13.3 3.4 100.0 4.5 1.3 3.7 798 25-29 51.1 19.0 12.2 15.8 1.9 100.0 6.4 2.8 3.0 726 30-34 507 22.2 9.3 16.2 1 6 100.0 7.2 1.7 2.8 722 35-39 53.0 17.9 12.2 16.0 0.9 100.0 13 I 3.3 1.7 530 40-44 53.8 18.8 8.6 17.9 09 10(10 104 1.5 1.0 425 45-49 51.8 16.9 10.8 19.5 I I 1000 10.2 0.4 03 311 Residence Urban 51.5 16.5 12.2 17.3 2.5 100.0 6.0 0.6 20 I,II4 Rural 52.6 21.0 9,6 15.0 1.9 1000 8.0 2.4 2.7 2,674 Province Manicaland 63.2 14 3 7,4 13.8 1.4 100.0 3.3 1.6 4.1) 543 Mashonaland Central 44.0 29.1 14.4 11.0 1.5 100.0 5.3 0.8 0.6 342 Mashonaland East 77.8 10.3 4.3 7 1 0,5 100.0 2.4 0.3 26 377 Mashonaland West 48.3 25.7 6.0 15 3 4,8 100.0 4.7 0.7 1 5 429 Matabeleland North 74.0 5.1 9.2 4.9 6.7 100.0 7 0 1,8 6.7 239 Matabeleland South 82.8 2.2 9.3 5.6 0 1 100.0 6 9 1.8 3.4 183 Midlands 35.6 34.3 13.1 I4.6 2.3 100.0 10 I 2 6 2.6 472 Masvingo 19.9 30.5 12.0 36.6 I.I 100.0 20.8 7 5 1.4 393 Harare 46.0 14.5 14.5 23.7 1.4 100.0 7.5 0.3 1.7 619 Bulawayo 66.0 163 125 3.1 2.1 100.0 5.9 1.7 1.7 191 Education No education 53.2 20.5 10 3 14 I 2.0 100.0 8.7 2.9 2 6 552 Primary 52.0 20.9 9 3 16 3 1.5 100.0 8.9 2 4 I.g 1,992 Secondary+ 52.2 173 12.1 15.3 3.0 100.0 45 0.6 3.5 1,244 T,.~t al 52.2 19.7 10.4 15.6 2 1 100.0 7.4 1.9 2.5 3,788 4.7 Timing of Female Sterilisation Table 4.14 shows the distribution of sterilised women by their age at the time of sterilisation, according to the number of years since the procedure was done. These findings should, however, be treated Table 4.14 Timing of sterilisatlon Percent distribution of sterilised women by age at the time of stertllsation, according to the number of years since the operatton, Zimbabwe 1994 Age at t~me of sterthsatlon Number Years since of Median operation <25 25-29 30-34 35-39 40-44 45-49 Total women age I <4 2.2 16.3 19.3 38 3 19 4 4.5 100.0 47 35.0 4-7 6.9 4.9 28.2 35.8 20,7 3.5 100.0 31 34 8 8+ 16.l 26 8 32,1 25.0 0.0 0.0 100.0 27 30.7 Total 7.2 15.6 25.2 34 2 14 8 3.0 100.0 106 33 8 I Medlan age was calculated only lk)r women less than 40 years of age to avoid problems of censon ng 53 with caution since the number of women sterilised is small and misreporting of ages can distort the results. The results indicate that 77 percent o f women who are sterilised had the procedure after reaching age 30, and 52 percent after reaching age 35. The median reported age at sterilisation was 34 years. 4.8 Source of Family Planning Methods Information on sources of modem contraceptives currently used is useful for family planning programme managers and implementors. In the ZDHS, women who reported using a modem method of contraception at the time of the survey were asked where they obtained the method the last time. Table 4.15 shows that a large majority of current users (85 percent) obtained their methods from public sector sources. The most corn mon source of contraceptives in the public sector are rural and municipal clinics (32 percent), followed by the Zimbabwe National Family Planning Council's (ZNFPC) community- based distribution (CBD) workers (18 percent) and Government hospitals and clinics (15 percent). Private sector sources were reported by 12 percent of current users and other private sources account for 2 percent of current users. Table 4.15 Source of supply for modern contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of the method, according Io specific methods, Zimbabwe 1994 Source of supply P2ll Contraceptive method Female All InJect- Con- sterili- modern IUD ~bles dora satmn methods Publ ic 87 9 65 3 85 8 67.3 78 6 85.1 Government hospital/chine 11.7 31 5 30 3 13.4 36.0 15.4 Rural/municipal clinic 35 6 5 2 26 8 22,2 16.0 31.9 Rural health centre 7 9 0 0 10.2 7 3 15 1 8.3 ZNImpC l clinic 4 6 24 7 7.0 3.6 0 0 4 8 MOH 2 mobile clinic 2 8 0.0 1 8 4.1 0.0 2 6 ZNFPC CBD 3 worker 22 3 0.0 3 4 13.7 I 4 18.4 Mission faclhty 3 0 3 9 6 4 2.9 10.1 3.6 Other public 0.1 0.0 0.0 0 0 0.0 0 I Medical private 105 28.8 13.2 13.3 164 11,7 Private hospital/clinic 3.0 7 2 5 9 3.9 15.2 4 I Pharmacy 2 7 1 7 0.0 5.3 0 0 2.5 Private doctor 3 3 19 9 7.1 0,4 1 2 3.6 Village (communay) worker 1.4 0 0 0 0 3 7 0.0 I 4 Other prtvate 0.1 0.0 0 2 0 0 0.0 0A Other private 0.7 I 7 1 0 18 3 1.8 2.2 Shop 0,1 1.7 0.0 I00 O0 0.9 Church 01 0.0 00 00 00 01 Friend/relative 0.4 0 0 0 0 4 5 0.0 0.6 Other 0 0 0 0 1.0 3 8 1.8 0 5 Missing 0 8 4.2 0 0 1.2 3.1 I 0 Total 1000 1000 100.0 100.0 1000 1000 Number of users 1,449 38 149 149 106 1,904 Note: The total includes 12 users of other modern methods IZNFTC = Zimbabwe National Family Planmng Councd 2MOH = Ministry of Health (and Child Welfare) 3CBD = Commumty-base¢i dlstnbuuon 54 Overall, public sector sources supply 88 percent of pill users, 86 percent of injectables users, 65 percent of IUD users and 67 percent of condom users. Seventy-nine percent of female sterilisations were done in public sector facilities. Private sector sources supply 11 percent of pill users, 29 percent of IUD users, and 13 percent of injectable and condom users. Figure4.4 summarises the distribution of current users of modem methods by source of method. Women who are currently using a modem method of contraception were asked why they used that particular source. The results are shown in Table 4.16. More than one in five women said they knew of no other source for their method. Over half of women said that their current source was used because it was closest to home. Five percent of women cited each of the three reasons; lower cost, staff competence and friendliness, and use of other services at the same facility. Figure 4.4 Distribution of Current Contraceptive Users by Source of Supply ZNFPC Clinic 5% Private Sector 1 Other 3% ZNFPC CBD Workers 18% Government Hospital/Clinic* 30% Rural/Municipal Clini . * includes mission facilities, rural health centres, and mobile chnics ZDHS lgg4 55 Table 4.16 Reason for selecting current sources of supply lbr contraceptive methods Percent distribution of current users of mode'n contraceptive methods by main reason for using current source of the method, according to source, Ztmbabwe 1994 Source of supply Main reason for using current source of ~upply Staff Use Know Closer Trans- compe- other no Closer to port tent, Offers Shorter serv- Low Don't Number other to market/ avad- friend more waalng ices cost, know/ of source home work able ly pnvacy r ime there cheaper Other Missing Total users Public Government hospttal/chmc 30.6 34.1 4.7 2.5 7.7 0.5 1.4 I 1.0 5.3 1.9 0.2 100.0 252 Rural/mumclpal chnlc 24.2 58.2 I 2 1.3 3 5 0.7 1.0 3.7 3.8 2.3 0.1 100.0 592 Rural health centre 27.3 65.2 1,4 0.4 1,5 0.0 0 7 2.8 0.0 0 7 0.11 100.0 146 ZNFPC I chmc I 1.9 42.7 8.7 0.0 11.5 1.6 2.8 6.8 13.9 0.0 0.0 100.0 84 MOH 2 mobile chmc 14.7 74.0 9.2 0.0 0.0 0.0 0.0 0.0 2.1 0.0 0.0 100.0 49 ZNFPC CBD s worker 17.6 62.5 0.6 0.6 3,8 2.1 0 8 0.0 6.8 5 2 0 0 100,0 350 Mission facdtty 24 5 51.9 0.0 1.8 5.3 0.0 0.0 5.1 10.4 0.9 0.0 100.0 59 Medical private Prtvate hospttal/cllmc 18.7 39.8 L0 0.9 5.2 2.5 2 0 10 3 8.7 8 9 0.0 100.0 66 Pharmacy 10.1 17.4 18.7 0.0 7.2 4.1 286 37 3.8 6.5 0.0 100.0 47 Private doctor 4.6 20 7 6 6 1 4 8.8 2 8 27 3 13.9 0 0 13.9 0.0 100.0 62 Village (commumty) worker 18 I 70.5 0.0 0.0 5.7 0 t) 0 0 0 0 0 0 0.0 5.7 100.0 26 Other private 15.0 25. I 0.0 9 4 5.2 13.2 9.0 5.5 0.0 13.6 4.0 100.0 31 Total 21.6 52 0 2.8 1.2 4.8 1.3 2,9 4.6 4.9 3.4 0.4 100.0 1,791 Note: Total includes 16 mtssmg users, 2 "other" pubhc, 2 "other" medical private, and 8 "other" private. tZNFPC = Zimbabwe National Famdy Plant mg Council 2MOH = Ministry of Health (and Chdd Welfare) 3CBD = Commumty-based dxstnbution 4.9 Discont inuat ion of Contracept ive Use Couples can realise their reproductive goals only when they use contraceptive methods consistently. A parhcular concern for family planning programmes is the rate at which users discontinue use of contraception and the reasons for su:h discontinuation. In the ZDHS calendar, all segments of contraceptive use between January 1989 and the date of interview were recorded along with reasons for any discontinuation of use during this period. One-year contraceptive discontinuation rates, based on the information collected m the ZDHS calendar, are presented in Table 4.17. 4 4 The discontmuation rates presented here include only those segments of contraceptive use that began since January 1989. The rates apply to the three to sl~:ty-three month penod prior to the survey; exposure during the month of inter- view and the two months pnor to the interview are excluded to avoid the biases that may be introduced by unrecognized pregnancies. These cumulative discontinuation rates represent the proportion of users discontinuing a method within twelve months of starting use. The rates are calculated by dividing the number of women discontinuing a method by the number exposed at that duration The smgle-month rates are then cumulated to produce a one-year rate. In calculating the rate, the various reasons for discontinuation are treated as competing risks. 56 Table 4.17 Contraceptive discontinuation rates First-year contracepnve discontinuation rates (%) due to method fadure, desire for pregnancy, health reasons, and other reasons, according to specific methods, Zimbabwe 1994 Reason for discontinuation lnfre- Wanted quent more To Side sex/ Husband Access/ effec- lncon- Marital C~mtracepttve Method become effects/ Husband disap- avalla- tire vement dlsso- All method ladure pregnant Health away Cost proves bility method to use luUon Other reasons Pill 2, I 3.5 4,7 0.6 0.5 0,9 0.6 0.4 0.2 0.6 1.2 15 5 Condom 4.5 12.6 1.9 8.7 0.4 3.9 0.7 4.8 2.9 0.7 2,9 44.1 InjectEon 1.4 3.1 5.4 1.8 0.0 0.8 2.1 0.0 0.0 O0 1,3 15.9 Withdrawal 9.3 5.9 0.0 0.6 0,0 2.2 0.0 5 0 1.6 0 4 3.8 28.8 Other 6 1 12.4 0.8 0,8 0.0 1,3 0.0 3.6 0,4 0.0 I 8 27,3 All methods 3.3 4.8 3 8 1.4 0.4 1,3 0.6 1.4 0,6 0.5 1.8 19,9 The results indicate that one in five family planning users in Zimbabwe stop using a contraceptive method within 12 months of starting use. Five percent of users stop using because they want to become pregnant, 4 percent as a result of side effects or health concems, 3 percent due to method failure (i.e., they became pregnant while using), 1 percent because of spousal disapproval, 1 percent because of infrequent sex or husband was away, and 1 percent because a more effective method was desired. One-year discontinuation rates are much lower for the pill (! 6 percent) and injectables (16 percent) than for the condom (44 percent), withdrawal (29 percent), and other methods (27 percent) (see Figure 4.5). Figure 4.5 Contraceptive Discontinuation Rates (%) for First Year of Use, by Method PILL rNJECTABLES CONDO~ WITHDRAWAL 16 16 29 44 10 20 80 40 Percent 50 ZDHS 1994 57 Table 4.18 also looks at reasons for discontinuation, but from a different perspective; all of the 2,989 discontinuations occurring in the la~':t five years (regardless of duration of use) are distributed by reason for discontinuation, according to methcd. In the early stages of family building, couples generally prefer using reversible family planning methods, so they can conceive later. The desire to become pregnant (42 percent) is the most common reason given by respondents for discontinuing use of a family planning method. About 45 percent of pill users, 32 percent of condom users, 30 percent of IUD users and 40 percent each of withdrawal and folk method users discontinue using these methods be.zause they want to become pregnant. The low efficacy of traditional and folk methods is evidenced by the high failure rate of these meth- ods during use (i.e., accidental pregnancy). For example, nearly a third of discontinuations of withdrawal and folk methods were reported to be a result of method failure. Side effects and health concerns (less than I percent) are less frequently mentioned as reasons for dis- continuation of traditional methods '.han the pill (19 percent), IUD (26 percent), and injectables (29 percent). Condoms users cited inconvenience and infrequent sex as reasons for discontinuation more often than users of other methods. Table4.18 Reasons for dlscontmuatioEn Percent distribution of discontinuatl~ns of contraceptwe methods in the last five years by maxn reason for discontinuation, according to speclf c methods, Zimbabwe 1994 Method Periodic Reason for abstl- With- Folk discontinuation Pxll IUD lnjectables Condom nence drawal method Total Became pregnant 12 1 9.4 8.2 7.7 53.6 30.3 29.3 14.9 To become pregnant 44.6 28.5 21.1 32.3 19 7 39.0 39.7 41.9 Husband disapproved 3.2 0 0 8.6 7.9 1.5 4.5 2.0 3 7 Side effects 9.0 8.7 23.2 2 I 0.0 0 3 0.4 7.2 Health concerns 10. I 17.0 5 8 1.7 0.0 0.0 0.7 7.9 Access/availabdity 2 6 0.0 10 7 2.9 0 0 0.0 0.7 2.3 More effective method 1.9 6.5 5.8 8.8 3 4 9.8 7.7 3.7 lnconvement to use 1.8 0.0 0.0 7.2 0.0 2.6 0.8 2.2 Infrequent sex 3.2 0 0 4.3 15.5 8.0 1.1 2.8 4 0 Cost 2.2 3.4 0.0 0.9 0.0 0.0 0.0 1.7 Fatalistic 0. I 0.0 0.0 0.0 0 0 0.0 0.0 0.1 Menopause 0.7 0.0 5 3 0.4 0.0 2.0 0.4 0.8 Marital dissolution 2.6 4.4 0.0 1.8 0.0 1.5 0.0 2 3 Other 1.9 6. l 2.7 I. 1 1.5 0.3 6.8 1.9 Missing 4.1 16.0 4.3 9.8 12.4 8.5 8.6 5.5 Total 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 Number of discontmuatlons 2,178 39 41 237 35 329 127 2,989 Note: Total includes 2 users of "other" modern methods. 58 4.10 Intention to Use Family Planning Among Nonusers An important indicator of the changing demand for family planning is the extent to which nonusers of contraception plan to use family planning in the future. Women who were not using contraception at the time of the survey were asked about their intention to use family planning in the future. The results are presented in Table 4,19. Almost two-thirds (65 percent) of currently married nonusers say they intend to use family planning in the future--54 percent in the next 12 months. One-third of women said they do not intend to use, while 1 percent were unsure. The proportion intending to use, and especially the timing of intended use, varies with the number of living children. For example, the proportion who intend to use within the next 12 months is much lower among childless nonusers than among those with children, and the proportion who intend to use later is lower among women with four or more children. With regard to the relationship between previous use of family planning and intention to use in the future, those women who have used in the past are much more likely to use in the future than those who have never used before. Table 4.19 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by past experience with contraception and intention to use in the future, according to number of hvmg children, Zimbabwe 1994 Past experience Number of living children l with contraception and future intentions 0 1 2 3 4+ Total Never used contraception Intend to use in next 12 months 31.6 35.2 13.1 7.0 6.5 16.0 Intend to use later 17.8 3.5 3.8 2.4 1.1 3.9 Unsure as to timing 0.0 0.3 0.2 0.0 0.1 0 | Unsure as to retention 1.1 0.4 0.2 0.0 0.0 0.2 Do not intend to use 25.5 15.1 15.8 16.8 20.1 18.6 Never had sex 3.1 0.0 0.0 0.0 0.0 0.3 Missing 0.0 0.0 0.0 0.0 0.1 0.0 Previously used contraception Intend to use in next 12 months 7.2 28.8 50.2 49.6 42.5 38.2 Intend to use later 7.4 8.5 7.0 I 1.2 4.8 7.0 Unsure as to timing 0.0 0.0 0.2 0.4 0.0 0.1 Unsure as to intention 0.0 0.2 0.0 0.0 0.4 0.2 Do not intend to use 4.9 8 0 9.3 12.6 24.2 15.1 Missing 1.6 0.0 0.3 0.0 0.4 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 All currently married nonusers Intend to use m next 12 months 38.7 64.0 63.3 56.6 49.0 54.2 Intend to use later 25.2 12.1 10.8 13.6 5.9 10 9 Unsure as to timing 0.0 0.3 0.4 0.4 0.1 0 2 Unsure as to intention 1.1 0.6 0.2 0.0 0.4 0.4 Do not intend to use 30.4 23.1 25.1 29.4 44.3 33.6 Never had sex 3.1 0.0 0.0 0.0 0.0 0.3 Missing 1.6 0.0 0.3 0.0 0.4 0.4 Total 100.0 100.0 1130.0 100.0 100.0 100.0 Number of women 207 392 314 247 805 1,965 Ilncludes current pregnancy 59 4.11 Reasons for Nonuse of Contracept ion Table 4,20 presents the main reasons for not using family planning given by currently married nonusers who do not intend to use a contraceptive method in the future. Religious restrictions, a desire for more children, and husband's disapproval were the most important reasons given by women under 30 years of age for not intending to use contraception in future. While desire for additional children was also an important reason for not using family planning among older women, the most important reasons cited among nonusers 30 years and over were related to perceived subfecundity and infecundity. 4.12 Preferred Method of Contracept ion for Future Use Future demand for specific methods of family planning can be assessed by asking nonusers which method they intend to use. Table 4.21 presents information on method preferences for married non- contraceptors who say they intend tc use in the future. A majority of these women (59 percent) mtend to use pills, down from 67 percent in the 1988 ZDHS. At the same time, the intention to use injectables has more than doubled from 10 percent in 1988 to 23 percent in 1994, suggesting a shift toward preference for long- term methods of family planning. The increased availability of injectables since their reintroduction in 1992 may have influenced this shift in method preference. Women who mtend to use lamily planning in the next 12 months have method preferences similar to those of women who intend to use later. Table 4.20 Reasons lbr not using contraception Percent distribution of women who are ilot using a contraceptive method and who do not lr tend to use In the future, by main reason for not using, according to age, Zimbabwe 1994 Age Reason lk:,r not using contraception <30 30-49 Total Infiequent sex 5,7 5,6 5,6 Menopausal/hysterectomy 0 0 21:9 17,7 Subfecund/mllzcund 9.8 17.'9 16.3 Want children 19.3 15.5 16.3 Respondent opposed 9 3 8 5 8 7 Husband opposed 12,9 4.I 6.3 Others opposed 0.4 0, ] 0.3 Religion 24.3 7. ~ 11. I Knows no method 4 7 1.5 2,2 Knows no source 1 6 0.3 0,6 Health concerns 3.8 6 2 5.8 Side efl?cts 6 0 5 3 5 4 Hard to get 0 0 0.1 0 1 Cost 0.4 0 5 0 5 Inconvenient 0.4 0.9 0.8 lnterleres with body 0 8 2.0 I 7 Other 0.5 0.4 0,4 Don't know 0.0 0 2 0.2 Total I000 lO0.0 1000 Number of women 128 533 661 Table 4 21 Preli:rred method of contraception for future use Percent distribution of currently roamed women who are not using a contraceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Zimbabwe 1994 Intend to use In next After Preferred method 12 12 of contraception months months Total Pill 58.1 65.1 59,3 Condom 2.7 2.6 2,7 Dtaphragm/Foam/felly/'Tablets (I 2 0.(I 0.2 IUD 4.3 1.1 3.8 lnjectables 23.3 19.9 22.7 Implant 1.9 0 7 1 7 Female sterllisation 3.9 4 8 4.1 Male stenlisation 0,3 0.0 0,2 Periodic abstinence 0.2 0.3 0.2 Withdrawal 2.2 2.6 2.2 Folk method I 4 2 4 1.6 Missing 1.5 0.5 1.4 Total I00 0 I00.0 100.0 Number of women 1,064 214 1,282 Note: Total includes 4 women who are unsure about the timing of future use. 60 4.13 Exposure to Family Planning Messages in the Electronic Media Radio and television are the major potential sources of information about family planning in the electronic media. Information on the level of public exposure to a particular type of media allows policy- makers to ensure the use of the most effective media for the various target groups. To assess the effectiveness of such media on the dissemination of family planning information, all female and male respondents in the survey were asked if they had heard messages about family planning on radio or seen them on television during the 6-month period preceding the interview. Table 4.22 shows that a greater percentage of men than women are exposed to the major electronic media. Seventy percent of men and 52 percent of women reported that they had heard or seen a family planning message on radio or television during the month prior to the interview. Twenty-two percent of women and 31 percent of men have heard a family planning message on the radio and seen a family planning message on the television in the last six months. Sharp contrasts in access to media messages are observed between urban and rural residents. Sixty percent of rural women have not been reached through the media in the last 6 months, compared with only 23 percent of urban women. Table 4 22 Heard about family planning on radio and television Percent distribution of women and of men by whether they have heard a radio or television message about family planning m the six months prior to the interview, according to selected background characteristics, Zimbabwe 1994 Heard about famdy planning on radio or televismn Women Men Heard Tele~ Heard Number Heard Tele- Heard Number Background on Radio wsmn on of on Radio vision on of characteristic neither only only both Total women neither only only both Total men Residence Urban 23.2 23.4 6.3 46.9 100 0 1,975 15.8 26.9 7.5 49.7 100.0 797 Rural 60.0 282 1.2 10.6 100.0 4.153 38.9 39.1 2.5 19.4 100.0 1,344 Province Manicaland 66.8 21.0 1.4 10.9 100.0 839 38.0 37.5 1.3 23.2 100.O 269 Mashonaland Central 55.7 31.6 1.0 11.7 100.O 510 33.9 39.1 3.5 23.1 IO0.0 181 Mashonaland East 52.9 30.6 1.2 15.2 100.0 579 35.8 39.8 7 4 17.1 lO0.0 190 Mashonaland West 50.2 29.8 2,4 17.5 100.O 632 17.1 44.0 1.1 37.7 100.0 264 Matabeleland North 65.0 240 1.6 9.4 100.0 366 54.6 30.0 3.2 12.2 100.0 100 Matabeleland South 53.5 309 0.7 14.9 1000 305 67.3 22.4 2.4 7.8 100.0 91 Midlands 44.1 32.4 2.3 21.2 100.0 810 25.2 32 8 4.7 37.3 100.0 265 Masvingo 60.8 25.4 1.9 11.9 1000 652 44.5 40.4 0.0 15.1 100.0 200 Harare 25.2 21.2 6.6 46.9 100.0 1,048 15.9 26.9 8.8 48.5 1130.0 428 Bulawayo 16.2 25.8 7.3 50.7 100.0 388 21.5 28.9 7.0 42.6 100.0 154 Education No education 79.5 15.1 0.1 5.3 100.0 682 60.2 30.4 4.2 5.3 100.0 88 Primary 54 1 29.0 1.4 15.4 100.0 2,898 42 1 36.5 2.3 19.0 100.0 860 Secondary+ 33 0 27.2 5.2 34.7 100.0 2,547 19 6 33.5 5.8 41.1 100.0 1,193 Total 48 1 26.7 2.9 22 3 100.0 6,128 30.3 34.6 4.3 30.7 100.0 2,141 Note: Figures may not add to 100.0 due to rounding. 61 The proportion of respondents who had been exposed to family planning messages on radio or television varied across provinces. Fifty-one percent of women and 43 percent of men in Bulawayo had seen/heard family planning message~, on the television and radio; whereas, only 9 percent of women and 8 percent of men in Matabeleland North had been exposed to messages in both media. Education of women and men is closely correlated with media exposure; only 20 percent of women and 40 percent of men with no formal education had heard or seen a family planning message on the radio or television. 4.14 Acceptabil ity of Use of Electronic Media to Disseminate Family Planning Messages To determine the level of acceptance of the dissemination of family planning information through the media, ZDHS asked men and woraen whether it was acceptable to disseminate famtly planning informa- tion on radio or television. Overall, the large majority of women and men interviewed, 92 and 94 percent, respectively, reported that it was acceptable to use radio or television to air family planning messages (see Table 4.23). Accepta- Table 4,23 Acceptability of medxa messa~,,es on family planning Percentage of women and of men who bel eve that n ts acceptable to have messages about farmly planning on the radio or televtsion, by selected background characteristics, Zimbabwe 1994 Acceptab]hty oF Iamdy planning messages on radio or television Women Men Not Number Not Number Background Accept- accep'- of Accept accept- of characterisuc able able Unsure Total women able able Unsure Total men Age 15-19 90.2 8.5 1.3 100.0 1,472 94.2 4.1 I 6 100,0 604 20-24 949 4.2 07 100.0 1,269 96,6 3.3 0 1 100.0 399 25-29 95.0 4.3 0.7 100.0 915 96.6 3.4 00 100.11 288 30-34 92.6 6.9 0.5 100.0 871 94.3 5.7 0.0 100.0 241 35-39 905 78 I 6 100.0 661 90.3 9.5 03 1000 195 40-44 91,5 8.0 0.5 100.0 532 94.4 5.6 00 100.0 190 45-49 84,4 13 6 2,1 100.0 407 90.2 9 8 0 0 100.0 I I I 50-54 NA NA NA NA NA 83.8 15.3 1.0 10(I.0 113 Residence Urban 94.7 5,0 (/.3 100.0 1,975 94.5 5 5 0 0 100.0 797 Rural 90.7 7.9 1.3 10O.0 4,153 93.5 5 6 0 9 100.0 1,344 Province Mamcaland 86 7 11 5 I 8 100 0 839 88.4 10.5 I. I 100 0 269 Mashonaland Central 93.6 6.4 0.0 100.0 510 97.2 2.8 00 100,0 181 Mashonaland East 93.6 6. I 0.4 100.0 579 94.4 5.6 0 0 100.0 190 Mashonaland West 89.9 9.8 0.3 100.0 632 96.6 3.4 0.0 I(X) 0 264 Matabeleland North 83.5 6.7 9.8 100.0 366 93.8 4.1 2 I 1000 100 Matabeleland South 92.4 7.3 0.2 100.0 305 91.0 7 2 1 8 100.0 91 Midlands 93.8 6 I 0.1 1000 810 95.5 4,5 0.0 100.0 265 Masvingo 94.6 5,3 0.2 100.0 652 94.2 3.1 2.7 100 0 200 Harare 93.4 6.1 0.3 100.0 1,048 93.8 6 2 0 0 100 0 428 Bulawayo 98.0 2 ( 0.0 100 0 388 93 0 7 0 0.0 100.0 154 Education No education 79.9 16.1 3.9 10O,0 682 91,2 76 1.2 1000 88 Primary 9[.1 7 t 0.9 100.0 2,898 9I 6 7 2 1,2 100.0 860 Secondary+ 96.2 3.' 0.3 100.0 2,547 958 4,2 0.0 1000 1,193 Total 92.0 7.0 ] 0 100.0 6,128 939 56 06 100.0 2,141 NA = Not applicable 62 bility of radio and television as a source of information is highest among women and men in the age range 20-29, and relatively low among the youngest (15-19 years) and oldest (45+ years) men and women. Rural respondents were slightly more likely than urban respondents to view family planning messages in the media as unacceptable. Women and men who have attended higher levels of education are much more likely to accept family planning messages on radio or television than less educated women and men. 4.15 Exposure to Family Planning Messages in Print Media Female respondents were asked if they had been exposed to a family planning message through a newspaper/magazine article, a poster, or leaflet/brochure (i.e., print media) during the 6 months prior to the interview. The results are presented in Table 4.24. Forty-nine percent of the women interviewed reported that they had no exposure to print media that contained family planning information. The most commonly reported source of a family planning message (print media) was posters (36 percent), followed by news- papers/magazines (30 percent) and leaflet/brochures (25 percent). Women in rural areas were less likely to have been exposed to print media on family planning than their urban counterparts. Almost 60 percent of mral women were not exposed to any form of print media, compared with only 32 percent of urban women. The proportion exposed to any print media increases direct- ly with educational level. Women who had been exposed to family planning messages in newspapers/maga- zines increased from 3 percent among women with no formal education to over 40 percent among women with at least some secondary education. Table 4.24 Famdy planning messages m print Percentage of women who received a message about family planning through the print media in the six months prior to the interview, according to selected background characteristics, Zimbabwe 1994 Type of print media containing family planning message Number Background No Newspaper/ Leaflet/ of characteristic source magazine Poster brochure women Residence Urban 32 4 51.0 47.4 31.9 1,975 Rural 57 I 20.3 304 21.9 4,153 Province Mamcaland 74.4 [ 6. I 14.4 7.6 839 Mashonaland Central 56.0 26. I 32.4 21.2 510 Mashonaland East 40.2 26.7 47.4 34.8 579 Mashonaland West 55.2 24.5 30.2 30.4 632 Matabeleland North 64.8 14.9 26.9 14.6 366 Matabeleland South 56.9 22 6 31.0 25.9 305 Midlands 32.1 34.8 49.0 37. I 810 Masvingo 59.9 17.0 25.9 16.6 652 Harare 31.2 52.0 51.5 33.1 1,048 Bulawayo 34.0 54.9 38.6 22.9 388 Education No education 84.8 3.3 13.2 5.7 682 Primary 56.9 19.8 31.0 19.3 2,898 Secondary+ 30.8 49.2 47.6 37.1 2,547 Total 49. I 30.2 35.9 25.2 6,128 63 The role of print media as a channel for communicating family planning messages to the public varies by province. For example, 16 percent of women in Manicaland reported having received family planning messages from newspapers/magazines, compared with 55 percent in Bulawayo. The results highlight the need to use different types of media far different population subgroups. 4.16 Contact of Nonusers with Fami ly P lanning Providers Community-based distribution (CBD) workers, who are largely based in rural areas, are expected to visit women and men of reproductive age who are nonusers of modem family planning methods to discuss options and, when indicated, motivate, them to adopt a method of family planning. To get an indication of the frequency of such visits, women were asked whether they had been visited by a CBD worker within the last 12 months. Table 4.25 shows that only 12 percent of nonusers reported having been visited by a CBD worker during the 12 months preceding the ZI)HS (i.e., sum of first 3 columns). As expected, nonusers in rural areas were more commonly visited by CBD workers (14 percent) than their urban counterparts (6 percent). Table 4.25 Contact of nonusers wnb l;~md ~, planning providers Percent distribution of nonusers of family !:lannmg by whether they were vistted by a ZNFPC famdy plannmg fieldworker (CBD worker) or spoke with a health taclli y staff member about family planning (FP) methods during the 12 months prior to mterwew, according to selected background characteristms, Zimbabwe 1994 Nonusers of famdy planning Visited by CBD worker Not visited by CBD worker Visited VlsUed health facdlty health lacdity Did not Did not No FP Dis Did no vlsu Dis- D~d not wsu servLces or Number Background cussed discus., health cussed discuss health mformatlon of charactensuc FP laP famhty FP FP facdtty Missing provided Total nonusers Residence Urban 1.5 1.8 2.6 10.6 26.7 56.2 0.6 82.9 l (YO.B 1,184 Rural 48 4.8 4.5 •2.0 281 456 O.I 73.7 100.0 2,792 Province Mamcaland 1.9 2.4 3 1 9.7 264 56.2 0.2 82.6 I00.0 619 Mashonaland Central 6.8 3.0 4.7 I 1.7 17.6 56.0 0.0 73 7 100.0 327 Mashonaland East 4.4 5.9 5.7 IO.I 32.8 41.1 00 739 100.0 361 Mashonaland West 1.9 5.8 5.3 12.3 23.0 51.6 0 0 74.6 100.0 383 Matabeleland North 5.2 7.6 5.2 13.0 31.9 37. ] () 0 69.0 100.0 268 Matabeleland South 6.0 2.9 5.1 11.2 25.8 48 8 0,2 74.6 100 0 219 Midlands 3.3 3.1 3.8 16.3 28.6 44.6 0.2 73.2 1000 469 Masvmgo 8.2 7.4 3.9 13.6 37.1 29.9 0.0 66.9 I000 455 Harare 2.0 1.7 2.5 10.4 26.1 56 3 1.1 82.4 100.0 615 Bulawayo 0.8 1 0 2.0 6.9 26.2 63.1 0,0 89.3 100.0 260 Education No educatmn 4.4 4.3 5.9 11.7 23.5 49 6 0.6 73.1 100 0 464 Primary 5.3 4.2 4 6 11.5 24.8 49,4 0 I 74.3 100 0 1,832 Secondary+ 2 I 3,5 2.7 11.7 31.9 47 8 0.3 79 7 100.0 1,680 100.0 3,976 Total 3.8 3.9 3.9 11.6 27.7 48.8 0.3 76.5 CBD = Community-based distribution ZNFPC = Zimbabwe National Family Plarmmg Council 64 To get insight into the level of "missed opportunities"--i.e., opportunities to motivate nonusers to adopt family planning that were not utilised--nonusers were also asked whether they had visited a health facility in the last 12 months and whether anyone at the health facility had discussed family planning with them during their visit. Overall, 77 percent of nonusers were not visited by a CBD worker and did not discuss family planning with a health facility staff person in the 12 months before the survey. This represents a large pool of potential users of family planning that could be targeted for family planning counselling. Nearly half (49 percent) of nonusers did not receive a visit from a CBD worker and did not go to a health facility in the last 12 months. To reach these women a more vigorous outreach programme will be needed. Still, 39 percent of nonusers were not visited by a CBD worker but did visit a health facility in the last 12 months. However, 70 percent of these women (28 percent of all nonusers) received no family planning information or services during this recent visit. This is a significant fraction of nonusers and represents missed opportunities to motivate nonusers to adopt family planning. 4.17 Attitudes of Male and Female Respondents toward Family Planning Use of effective contraceptive methods is facilitated when couples have a positive attitude towards family planning. Attitudinal data were collected by asking women whether they approve of couples using family planning and what they perceived as their husband's attitude towards family planning. This information is useful in the formulation of family planning policies, since it indicates the extent to which further education and publicity are needed to gain or increase acceptance of family planning. Widespread disapproval of contraception may act as a major barrier to adoption of methods. The results presented in Table 4.26 are confined to currently married, nonsterilised women and exclude those who had never heard of a contraceptive method. Overall, 94 percent of married women who know of a contraceptive method approve of family planning, and 82 percent believe that their husband approves. Overall, 81 percent of women said that both they and their husbands approved of family planning; only 4 percent of women reported that both they and their husbands disapproved. When there is a percewed disagreement between spouses, it is more common for the wife to report that her husband disapproves and she approves (11 percent), than that the husband approves and she disapproves (1 percent). The likelihood that a woman will report that both she and her husband approve of family planning is highest (86 percent) among women age 20-24 years and declines with age to 63 percent among women age 45-49. The level of approval varies between urban and rural areas; couples in urban areas are more likely to approve of family planning than those in rural areas (88 and 78 percent, respectively). Approval by both husband and wife was above 80 percent in all provinces except Matabeleland North (64 percent), Manicaland (67 percent), Matabeleland South (68 percent), and Masvingo (79 percent). Less educated women are more likely to disapprove of family planning themselves and are also more likely to say that their spouses disapprove or that they do not know their spouse's views. 65 Table 4.26 Wxves' perceptions of their husbands' atutude toward famdy planning Percent distrtbution of currently married non:;tenhsed women who know of a contraceptive method by wife's attitude toward famdy planning and wife's perception of her husband's attitude toward family planning, according to selected background characteristics, Zimbabwe 1994 Wife approves of coup es Wife disapproves of couples using family planning usmg fanuly planning H~ls- Hus- Husband band's Husband band's Number Background Husband disap- attuude Husband disap- attitude Wife Husband Wife of characterlsnc approves proves unkl~own approves proves unknown unsure Missing Total approves approves women Age 15-19 841 71 2.4 08 49 04 02 00 1000 849 936 268 20-24 862 6.8 25 10 28 01 06 01 1000 874 955 791 25-29 848 9.2 2.0 13 17 0.1 06 04 1 (Yd.0 863 964 719 30-34 803 12.0 17 0.8 33 0.4 09 04 100.0 81.4 945 698 35-39 785 127 26 1.4 41 0.2 06 O0 lO0.O 798 938 499 40-44 740 158 2 5 1.1 4.3 03 I 8 02 1000 757 925 394 45-49 626 183 50 0.5 91 16 29 00 L000 631 859 280 Residence Urban 881 68 .~,1 05 16 02 05 03 I(X) 0 886 973 1,079 Rural 772 127 ';.6 13 45 04 1 1 01 1000 788 927 2,571 Province Mamcaland 67 1 190 7 3 09 95 00 03 t) 0 1000 679 894 523 Mashonaland Central 84 4 6 5 ~ 2 1.8 26 t) 3 0 8 0 5 I(YO 0 865 946 332 Mashonaland East 862 9 4 (~ 5 0.6 2 8 0.0 03 (13 1000 86 8 963 360 Mashonaland West 842 86 ~0 23 15 02 10 03 1000 86.4 950 424 Matabeleland North 640 135 109 12 31 12 62 00 1000 664 884 227 Matabeleland South 678 184 ].4 32 85 00 03 03 1000 71 I 879 169 Midlands 839 11.4 tL5 0 5 3.2 02 0.2 00 100 0 844 958 455 Moxvmgo 790 13.0 ] 7 08 26 I 2 17 00 1000 807 937 379 Harare 89 7 6,3 : 0 03 1 4 0 0 0 0 0 3 100 0 90,0 983 602 Bulawayo 878 48 ] 8 04 22 I I 1 ~i 04 I(X) O 882 948 180 Education No educanon 667 159 L.4 23 74 06 25 03 1000 693 872 518 Primary 78,0 130 2.6 09 4 I 0,4 09 0 1 1(~0 79 I 937 1.919 Secondary+ 90,2 57 I 3 0.8 l 3 0.1 04 04 100,0 91 I 975 L,213 Total 805 11,0 :14 I 0 3.6 03 0,9 02 1000 81 7 940 3,650 NOLO: The question was not asked of slenhsed women 4.18 Att i tudes of Couples toward Fami ly P lanning The fact that both women and men in the same household were interviewed provided an opportunity to link responses obtained from cu-rently married women with those obtained independently from their husbands. A total of 711 couples were linked in this way. Table 4.27 shows the percent distribution of these couples by both spouses' approval af family planning, by age difference between husband and wife, and couples' education. In 91 percent of couples, both spouses reported that they approved of family planning. In only 1 percent of the couples did both disapprove. When only one spouse disapproved, it was just as likely to be the wife as the husband (3 per, zent). Generally, as the age difference between husband and wife increases so does the likelihood that either disapproves of family planning. Couples are less likely to disapprove of family planning when both spouses are educated. 66 Table 4.27 Attitudes of couples toward family planning Percent distribution of couples by approval of family planning, according to age difference between spouses and level of education, Zimbabwe 1994 Wife Husband Percent Both approves, approves, Don't m Age Both &sap- husband dis- wife dis- know/ agree- difference approve prove approves approves Missing ment Total Number Wife older (94.6) (0.0) (2.0) (0.0) (3.4) (94.6) 100 0 32 92.4 0.4 1.9 2,0 3.3 92.8 100.0 253 90.5 0.5 4.4 2.4 2.1 91.0 100 0 248 89.8 1.4 3.2 4.7 0.9 91.2 100.0 179 84.9 0.0 5.6 4,1 5.4 84.9 100.0 107 92.3 0.8 2.7 2.5 1.8 93 1 100.0 604 91.2 0.7 3.1 2.7 2.3 91 8 100.0 711 Husband older by: 0-4 years 5-9 years 10+ years Education One or both spouses uneducated Both educated Total Note: Figures in parentheses are based on 25 to 49 women. 67 CHAPTER 5 OTHER PROXIMATE DETERMINANTS OF FERTILITY This chapter focuses on the principal factors, other than contraception, that affect a woman's risk of becoming pregnant. These include: nuptiality, sexual activity, postpartum amenorrhoea and abstinence from sexual relations. Marriage and sexual initiation signal the onset of women's exposure to the risk of childbearing; postpartum amenorrhoea and abstinence affect the interval between births. These factors determine the length and pace of reproductive activity and are, therefore, important in understandmg fertthty. 5.1 Mar i ta l Status The distribution of women according to their marital status ~ is shown in the upper panel of Table 5.1. The data shows that 27 percent of women of reproductive age in Zimbabwe have never married, 62 percent are currently married, and 11 percent are widowed or divorced. The proportion never married Table 5.1 Current marital status Percent distribution of women and men by current marital status, according to age, Zimbabwe 1994 Marital status Never Age married Married Widowed Diw~rced Total Number WOMEN 15-19 79.2 18.8 0.1 1.9 100.0 1,472 20-24 28.4 62.9 0.7 8 I 100.0 1,269 25-29 7.5 79.3 2.6 10.4 100.0 915 30-34 3.3 82.9 3.9 9.9 100 0 871 35-39 1.2 80.2 7 0 I 1.6 100.0 661 40-44 2 3 79.8 8.8 9.0 100.0 532 45-49 0.6 76.4 13 0 10.0 100 0 407 Total 26.9 61.8 3.5 7.8 100.0 6,128 MEN 15-19 98.2 1.6 0 0 0 2 100.0 604 20-24 73.5 24.7 0 0 I 8 I00.0 399 25-29 32.2 61 5 0 6 5.7 100.0 288 30-34 5.8 84.8 0 8 8 6 100.0 241 35-39 1.9 90 0 0 0 8.0 100.0 195 40-44 2.1 90.4 0 6 6.9 [ 00.0 190 45-49 0.9 91.2 1.0 6.9 100.0 111 50-54 0.9 89.2 3.1 6.9 100 0 113 Total 469 48.5 0.4 4.2 100.0 2,141 Note: Figures may not add to I00.0 due to rounding i In the ZDHS, marriage includes both formal and informal umons Informal unions are those in which a man and woman stay together intending to have a lasting relationship, even if a formal civil or rehgJous ceremony has not yet occurred. 69 declines sharply from 79 percent in age group 15-19 to less than 1 percent among women 45-49 years of age. Marriage is thus nearly universal in Zimbabwe. The proportion of women who are currently married increases with age until age group 30-34 and then declines slowly because of the increasing levels of widowhood with age. The proportion divorced ts evenly distributed across all age groups except age group 15-19 where the proportion is very small. The lower panel of Table 5. l shows that 47 percent of the men interviewed have never been married, 49 percent are currently married and 4 percent are divorced, while less than 1 percent are widowed. Compared with women, a much greater proporlion of the interviewed men (20 percentage points more) have never been married. Widowhood is almost noaexistent for men, suggesting that men are more likely than women to remarry upon the death of a spouse Divorce is also lower among men than women. Virtually no change has oc :urred in marital patterns over the 6-year period since the 1988 ZDHS except that the proportion of women who are widowed increased slightly from 3 percent in the 1988 ZDHS to 4 percent in the 1994 ZDHS. Men were not interviewed in the 1988 ZDHS. 5.2 Marital Exposure Table 5.2 presents inforraation on variations in marital exposure by age and background characteristics. The calendar part ot the ZDHS female questionnaire collects information about the marriage experience of women during the five. years preceding the survey. The proportion of this period spent m union depends on the age at first union, marital disruption (divorce and widowhood) and remarriage. Since the Table 5.2 Marital exposure For all women 15-49, the percentape of months in the five years prior to the survey spent m marital union, by age and selected background chara,:teristlcs, Zimbabwe 1994 Current age Background characteristic 15- ] 9 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 46 35.8 73.5 81 8 74.6 76.1 65.7 50.5 Rural 7.,1 51.6 78.1 87.1 874 857 829 58.7 Province Mamcaland 7. ~ 52.0 83 0 98.0 82.2 82.7 (83.2) 58.6 Mashonaland Central 10.3 55 9 78.1 79.3 88.4 90.2 (84.7) 60.1 Mashonaland East 4.7 55.9 78.8 90.4 87.6 88.6 (94.0) 61 1 Mashonaland West 10.4 56.9 80.9 83.0 77.5 78.4 (74.5) 59.1 Matabeleland North 11.7 48.6 (73.1) (86.4) (88 5) (86.6) (88.6) 58.6 Matabeleland South 3. t 38.5 (64.3) (78.5) (88.4) (82.5) (79.0) 53.5 Midlands 5.4 40 4 70.0 85.4 87.0 85.6 75. I 54.9 Masvmgo 5. I 50.3 80.0 86.0 82 5 84 1 (79.5) 55.9 Harare 5. ~ 33.7 79.8 85.4 76.4 (79.0) (57.7) 51.4 Bulawayo 2). 34.6 65.1 67.8 86.0 72.6 (72.6) 47.8 Education No educahon (41. ~.) (71.0) 81.2 89.0 87.3 80.6 81.3 82.7 Primary 10.7 61,4 84.4 85.9 81.8 83,7 77.4 65.1 Secondary+ 3.1 35.9 70.0 81 3 84.4 85,1 (84.9) 38.6 Total 6.5 45.7 76.5 85 3 83.5 83.1 79.1 56.1 Note. Figures m parentheses are 'r,ased on 25 to 49 women. 70 proportion of women age 15-19 who are widowed or divorced is usually very small (about 2 percent in Zimbabwe), marital exposure for this age group is affected mainly by age at first marriage. At the older age groups, widowhood and divorce may be more important, especially within the context of universal marriage. The percentage of months in the five years before the survey spent in marital union displays an inverted J-shape curve when presented according to age of women; increasing from 7 percent among women age 15-19 to 85 percent in age group 30-34 and then declining to 79 percent in age group 45-49 (see Figure 5.1 ). At every age, rural women are more likely to be in union in the five years prior to the survey than urban women, which is reflected in provincial variations as well. Bulawayo and Harare (both highly urbanized) have the lowest marital exposure in the five years prior to the survey, while Mashonaland East, Mashonaland Central, and Mashonaland West have the highest exposure levels. Marital exposure is negatively related to female education. Overall, marital exposure declines from 83 percent among women with no formal education, to 65 and 39 percent, respectively, among women with primary and secondary or more education. However, the relationship between marital exposure and education varies with age. In younger age groups, marital exposure declines with increasing level of education, but appears to increase with education at older ages. Among women age 15-19 years, marital exposure declines from 41 percent for those with no education to 3 percent for those with secondary or higher education, The same pattern is observed for age group 20-24. However, for the two oldest age groups, women with secondary or higher education have the longest marital exposure in the five years prior to the survey. The low marital exposure of more educated women in the younger age groups reflects increasing age at entry into union, while higher exposure in older age groups may reflect lower divorce or widowhood rates in the past among more educated women. Figure 5.1 Percentage of Months in Last 5 Years Spent in Marital Union by Women Age 15-49 ZIMBABWE AGE GROUP 15-1{) 20-24 25-29 30-34 35-39 40-44 45-49 RESIDENCE Urban Rural EDUCATION No Education Primary Secondary + 56 ~////////////////////////////////~ 51 ] 83 I B5 1 39 0 20 40 60 50 Percent 100 ZDHS 1994 71 5.3 Polygyny The extent of polygyny ir Zimbabwe was measured by asking all currently married female respondents the question: "Besides yourself, how many other wives does your husband have?" For currently married men, the question was: "How many wives do you have?" The proportion of currently married women in a polygynous union according to age group and selected background characteristics is shown in Table 5.3.1 and in Figure 5.2. Overall, 19 percent of currently married women in Zimbabwe are in polyg- ynous unions. Older women are more likely to be in polygynous unions than younger women. Also, polygyny is higher among rural women than urban women. There are provincial variations in polygyny levels with Harare having the lowest level (11 percent) and Manicaland the highest (27 percent). Provincial variations in polygyny levels cut ttcross ethnic and geographic boundaries. For instance, the level of polygyny in Matabeleland North is 'wice that in Mataheleland South. Table 5 3 1 Polygyny: women Percentage of currently married woolen in a polygynous union, by age and selected background characteristics, Zimbabwe 1994 Age of woman Residence 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 7.t~ 8.6 16.8 12.6 109 13.7 22.7 12.8 Rural 14.~ 14.2 18.9 228 24.8 26.0 302 21.1 Province Mamcaland (12.6) 16.9 205 33.3 37.2 (31.8) (38.1) 26.5 Mashonaland Central (6.9) 19.0 15.3 17.6 30.1 28.7 (31 3) 20.7 Mashonaland East * 10 0 11.9 10.1) 24.0 (19 0) (23.2) 14.7 Mashonaland West (18.9) 10.6 16.1 13 3 13.1 (18.9) (23 2) 15.0 Matabeleland North (32.:) 21.0 22.7 27 9 31.1 23.3 (28.6) 25.9 Matabeleland South * 98 12.1 6.8 199 (15.6) (15.5) 127 Midlands (17. L.) I 1.3 21.5 21.0 19 8 (27.7) (31.7) 20.6 Masvingo ( 11 .:!) 12 2 26.1 29.4 18.6 (24.4) (27.4) 21.8 Harare (4Y,) 4.5 12.5 15 0 (6.8) (15.2) * 10.9 Bulawayo * 24.4 26 2 10.7 13.0 (16.2) * 19 I Education No education * (35.0) 24.2 36.3 29 1 33.6 39 6 32.8 Primary 17.3 17.4 21.4 17.3 20.1 203 27.3 19.8 Secondary+ 6 7.2 14.7 12.1 9.5 (18.9) (3.7) 105 Total 12.8 12.4 18.2 19.4 21.1 23.1 28.8 18.6 Note: Figures in parentheses are based on 25-49 women, an asterisk indicates that a figure is based on fewer than 25 women and has been suppessed. There is an inverse relationship between female education and polygyny. The proportion of currently married women in a polygynous union decreases from 33 percent among women with no formal education to 11 percent among those with at least some secondary education. Compared with the 1988 ZDHS, polygyny appears to be on the increase in Zimbabwe, especially in urban areas and among women with at least primary education. Overall, polygyny increased from 17 percent in the 1988 ZDHS to 19 percent in the current survey. Among urban women, the increase is from 9 to 13 72 Figure 5.2 Percentage of Currently Married Women Whose Husbands Have at least One Other Wife ZIMBABWE RESIDENCE Urban Rural EDUCATION No Education Primary Secondary + 19 J JJJ JJ JJ JJ JJ t3 f JJ J J fJ JJ JJ Jf S JfJJJJJJJ 21 I,, 5 10 t 5 20 25 30 35 Percent ZDHS 1994 percent. For women with only primary education, polygyny increased from 16 to 20 percent between the two surveys, and from 7 to I 1 percent for those with secondary or higher education. This trend has not been commonly observed in sub-Saharan Africa; most countries have shown modest declines in the practice of polygyny. The finding does, however, parallel results from other countries in the province, especially with respect to surprising rises in polygyny among educated women? The data for currently married men is shown in Table 5.3.2. Only 8 percent of the men interviewed are in a polygynous union and this varies greatly with age. Less than 2 percent of men under age 30 are in a polygynous union, compared with about 17 percent of those age 45 and over. Rural men are also more likely to have multiple wives than urban men. There is substantial provincial variation in the distribution of men who are in a polygynous union, ranging from 4 percent in Mashonaland ~East to 15 percent in Matabeleland North. Men with primary or no education are more than twice as likely to be in a polygynous union as those with secondary or more education. While polygyny is 66 percent higher among women with no education compared with those with only primary education, there is no difference in polygyny levels between men with primary education and those with no education. 2 Pebley, Ann., Warlara Mbugua, and Noreen Goldman. 1988. Polygyny and fertihty in sub-Saharan Africa. Fertility Determinants Research Notes 21:6-10. 73 Tab le 5 .3 .2 Po lygyny: men Percentage o f cur rent ly marr ied met in a po lygynous un ion , by age and se lected background character is t ics , Z imbabwe 1994 Age o f man Res idence 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Tota l Residence Urban 1.4 0.0 7.7 14.4 4.4 (I 1.9) (I 1.1) 6.8 Rura l 1.9 3.5 5,6 104 11.7 21.3 17.5 9.7 P rov ince Mantca land * * * * * * * 14.2 Mashona land Cent ra l * * * * * * * 7 1 Mashona land East * * * * * * * 4 .2 Mashona land West * * * * * * * 8 .0 Matabe le land Nor th * * * * * * * 14.8 Matabe le land South * * * * * * * 8.3 M id lands * * * * * * * 12.5 Masv ingo * * * * * * * 9 .6 Harare * * * * * * * 5 .4 Bu lawayo * * * * * * * 5,2 Education No educat ion * * * * * * * I 1.9 P r imary * (1.5) (4.9) 14.9 8.8 176 18.8 l l . l Secondary+ * 2.0 7.7 75 9.5 * * 5.1 Tota l 1.7 1.9 6.6 12.2 8.3 18.0 15.3 8.4 Note , F igures in parentheses are besed on 25-49 men; an aster isk ind icates that a f igure is based on fewer than 25 men and has been suppressed, "]'here are too few marr ied men age 15-19 to show separate ly . Table 5.4.1 shows the distribution of currently married women by number of co-wives, according to selected background characteristi,=s. The table shows that 81 percent of all currently married women are in a monogamous union, 14 percent are in polygynous unions with one co-wife, and only a small proportion (5 percent) are in polygynous marrtages with two or more co-wives. In general, women in groups with relatively high levels ofpolygyny are also more likely to have more than one co-wife. This is true of women over age 30, rural women, those with no formal education, and women in Manicaland and Matabeleland North provinces. Less than 2 percent of the men have three or more wives (see Table 5.4.2). 74 Table 5.4 1 Number of co-wives: women Percent distribution of currently married women by number of co-wwes, according to background characteristics, Zimbabwe 1994 Number of co-wives Number Background of characteristic 0 1 2+ Missing Total women Age 15- l 9 87.2 10.4 2.5 0.0 100.0 276 20-24 87.6 9.7 2.7 0. I 100.0 798 25-29 81.8 13.4 4.2 0.5 100.0 726 30-34 80.6 12.7 6.4 0.2 100.0 722 35-39 78.9 16.0 4.8 0.3 100.0 530 40-44 76 9 16 4 6.3 0.4 100.0 425 45-49 71.2 21.9 6.2 0.8 100.0 31 I Residence Urban 87.2 9.2 2.8 0.8 100.0 1,114 Rural 78.9 15.5 5.5 0.I 100.0 2,674 Province Manicaland 73.5 18.3 8.2 0 0 100.0 543 Mashonaland Central 79.3 17.1 3.3 0.3 100.0 342 Mashonaland East 85.3 10.7 4.0 0.0 100.0 377 Mashonaland West 85.0 I 1.5 3.2 0.3 100 0 429 Matabeleland North 74.1 18.5 7.2 0.2 100.0 239 Matabeleland South 87.3 8.2 4.2 0.3 1 (30.0 183 Midlands 79.4 15.5 4.7 0.5 100.0 472 Masvingo 78.2 17.3 4 5 0.0 100.0 393 H arare 89.1 6.1 3.9 0.8 100.0 619 Bulawayo 80.9 16.3 2.1 0.7 100.0 191 Education No education 67.2 24.3 8.3 0.2 1(30.0 552 Primary 80.2 14.4 5.2 0.2 100.0 1,992 Secondary+ 89.5 7.7 2.2 0.6 1000 1,244 Total 81.4 13.7 4.7 0.3 100.0 3,788 75 Table 5.4.2 Numberofwive~: men Percent dtstributxon of currently married men by number of wives, according to background characteristics, Zimbabwe 1994 Number of wives Number Background of characteristic 1 2 3+ Missing Total men Age 20-24 98.3 1.7 0 0 0.0 100.0 99 25-29 98.1 1.0 0.8 0.0 100.0 177 30-34 93.4 5.8 0.8 0.0 100 0 204 35-39 86 3 8.4 3.8 1.5 100.0 176 40-44 90 7 7.7 0 6 1.0 100.0 17 I 45-49 82.0 12.6 5.4 0.0 100.0 101 50-54 84 7 13,5 1.8 0.0 100.0 101 Residence Urban 92.5 5.9 0.9 0.7 100.0 452 Rural 89.9 7 3 2.4 0 3 100 0 586 Province Mantcaland 84.5 l 1 8 2 4 I 4 10O.0 125 Mashonaland Central 92.9 6.2 0.9 0.0 100.0 90 Mashonaland East 94.7 4.2 0.0 I I 100 0 89 Mashonaland West 92.0 4.1 3.9 0,0 100.0 127 Matabeleland North 85,2 12.3 2.4 0,0 100.0 42 Matabeleland South 91.7 8,3 0.0 0.0 100.0 32 Midlands 85.4 8 6 3,9 2 2 100.0 121 Masvingo 90 4 8 3 1.3 0 0 100.0 83 Harare 94.6 4.7 0.8 0,0 100.0 243 Bulawayo 94.8 4.4 0,7 0.0 1(~0.0 86 Educat ion No education 88 1 10.2 1.6 0.0 100.0 67 Primary 87.9 8.8 2.3 1.1 100.0 500 Secondary+ 94.9 4.0 1.2 0.0 1130.0 472 Total 91. I 6.7 I 7 0 5 100 0 1,038 Note. There are too few malned men age 15-19 to show separately. 5.4 Age at First Marriage For most societies, marria~,e marks the point in a woman's life when childbearing first becomes socially acceptable. Women who marry early will, on average, have longer exposure to reproductive risk; therefore, early age at first marriage often implies early age at childbearing and higher fertility for a society. Information on age at first marriage was obtained by asking all ever-married respondents the month and year they started living together with their first spouse. The median age at first ma'riage in Zimbabwe has risen slowly from 18.9 years among women age 40-49 to 19.8 years among women age 20-24 (representing recent marital patterns) (see Table 5.5). The proportion of women married by age 15 declined from 11 percent among those age 45-49 to 3 percent among women age 15-19 years. Overall, 62 percent of Zimbabwean women currently age 25-49 were married by age 20. 76 Table 5.5 Age at first marriage Percentage of women and men who were first married by specific exact age and median age at first marriage, according to current age, Zimbabwe 1994 WOMEN Current age 15 Percentage who were Percentage Median first married by exact age: who had Number age at never of first 18 20 22 25 married women marriage 15-19 3.1 NA NA 20-24 6.4 31.0 51.7 25-29 9.4 34.2 56.4 30-34 I 1.4 41.9 64.8 35-39 9.5 40.1 65.0 40-44 9.4 37.0 62.1 45-49 10.9 40.5 61.7 20-49 9.1 36.5 59.0 25-49 10.1 38.5 61.7 NA NA 79.2 1,472 a NA NA 28.4 1,269 19.8 73.0 87.7 7.5 915 19.3 78.0 89.8 3.3 871 18.7 82.5 93.5 1.2 661 18.8 77.2 87.4 2.3 532 18.9 78.4 89.6 0.6 407 ! 8.9 74.5 84.7 10.3 4,656 19.2 77.4 89.6 3.5 3,387 18.9 MEN Current age 20 22 25 28 Percentage who were Percentage Median first married by exact age: who had Number age at never of first 30 married men marriage 20-24 7.3 NA NA NA NA 73.5 399 a 25-29 5.6 17.7 45.5 65,6 67.8 32.2 288 a 30-34 8.7 20.9 45.5 71.8 86.1 5.8 241 25.5 35-39 13.6 32.1 61.7 76.2 82.9 1.9 195 23.8 40-44 12.0 27.2 52.3 77.1 83.2 2.1 190 24.7 45-49 5.9 19,7 45.9 63 0 71.6 0.9 111 25.5 50-54 12.1 21.5 40.7 56.5 63.5 0.9 113 26.7 30-54 10.7 24.8 50. I 70.8 79~8 2.8 849 25.0 NA = Not applicable aOmitted because less than 50 percent of the women or men in the age group x to x+4 were first married by age x. Comparison with data from the male survey shows that men enter into first union at a much later age than women: the median age at first marriage for men is 25 years, compared with 19 years for women. Only 11 percent of men are married by age 20, compared with 62 percent of women. Table 5.6 examines the median age at first marriage for women age 20-49 by selected background characteristics. The overall median age at first marriage observed for women age 25-49 is 18.9 years. How- ever, the table shows large differentials in the median age at first marriage by background characteristics. Urban women marry about one year later than rural women. There are even greater variations by province. Mashonaland West has the lowest median age at first marriage (17.5 years) while Bulawayo and Matabele- land South have the highest (20.8 and 20.1 years, respectively). The median age at marriage in the other provinces ranges from 18.4 to 19.6 years. 77 Table 5.6 Median age at first marriage Median age at first marriage among woraen age 20-49 years, by current age and selected background characteristics, Zimbabwe 1994 Cu~ent age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban a 20.0 19.5 19.2 19.3 18.7 20.0 19 5 Rural 19.1 19.0 18.3 18.6 18.8 18.9 18.8 18.7 Province Manicaland 19 7 18.2 17.5 19.3 18 9 18 9 18.7 18.5 M ashonaland Central 18.3 19 0 18.3 17 9 18,7 17 7 18,4 18.4 Mashonaland East 18.6 18.8 18.3 18.1 18.6 19.0 18.5 18.5 Mashonaland West 18.3 17.7 17.7 17.2 17.4 17.6 17.7 17.5 Matabeleland North 19 3 20. I 19.0 18.8 18.6 20.4 19 3 19.3 Matabeleland South a 21. I 19.8 20.0 19 2 19.4 a 20.1 Midlands a 20 4 19.0 19 4 19.1 20.0 19 8 19 6 Masvmgo 19.1 18.7 18.7 18.9 18.8 18.9 18.8 18.8 Harare a 19.7 19.3 19.4 18.8 18.3 19.9 19.3 Bulawayo a 21.3 20.3 19.8 22 I 20 8 a 20 8 Education No education (16.5) 16.2 16.6 177 182 19.4 17.4 175 Primary 18.0 18.0 18.4 18.9 18.8 18 5 18.4 18.5 Secondary+ a 20.7 21.0 20.4 21 0 20.5 a 20.8 Total 19.8 19 3 18.7 18.8 18.9 18.9 19 2 18.9 Note: The median for women 15-19 cotld not be determmed because some women may stdl get married before reaching age 20. Figures in parentheses are based on 25 to 49 women. a Omitted because less than 50 percent of the women in the age group .t to x+4 were first married by age x~ There is a marked relationship between female education and median age at first marriage. The median age at first marriage for women with no formal education is 17.5 years, compared with 18.5 years for those with primary education and 20.8 years for women with secondary or higher education. Within educational groups, age at first marriage has remained virtually constant since the 1988 ZDHS. Overall age at marriage has increased solely because the proportion of women who are educated to the secondary level (and marry later) has increased substantially. 5.5 Age at First Sexual Intercourse Age at first marriage is often used as a proxy for the onset of women's exposure to the risk of pregnancy. However, since some women are sexually active before marriage, the age at which women initiate sexual intercourse more precisely marks the beginning of their exposure to reproductive risk. The percentage of women wad men who have ever had intercourse by specific ages is given m Table 5.7. The median age at first sexual intercourse for women has risen slowly in recent years from 18.0 years for cohort age 30-34 to 18.8 for cohort age 20-24] This corresponds roughly to the one-year rise in age at first marriage discussed in the previous section. Among women in the 15-19 age group, 70 percent have never had sex. This proportion drops to 17 percent for women age 20-24, and by age 25-29 almost all women have become sexually active. 3 , , The decrease m me&an age at fiist sex observed between the cohort age 45-49 and the cohort age 30-34 is al- most certainly an artifact of recall problems among the older women who tend to overestimate their age at first sex. 78 Table 5.7 Age at first sexual intercourse Percentage of women and men who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at first intercourse, according to current age, Z~mbabwe 1994 Current age 15 18 20 22 WOMEN Percentage who had Percentage Number Median first intercourse by exact age: who of age at never had women/ first 25 intercourse men intercourse 15-19 5.2 NA NA NA NA 70.3 1,472 a 20-24 7.4 38.6 64.5 NA NA 17,3 1,269 18.8 25-29 10.8 45.1 68.9 82.4 90.4 2.1 915 18.4 30-34 12. I 49.4 72.8 84.8 89. I 0.7 871 18.0 35-39 12.0 49.1 74 5 86.5 90.9 0 3 661 18. l 40-44 10.2 40.9 67.3 79.9 85.7 0. I 532 18.6 45-49 13.6 46.6 66.6 77.9 85.7 0.0 407 18.3 20-49 10.5 44.4 68.8 81.1 86.5 5.3 4,656 184 25-49 11.6 46.5 70.5 82.9 88 9 0.8 3,387 18.3 MEN 15-19 7.9 NA NA NA NA 67. I 604 a 20-24 7.6 38.3 71.8 NA NA 13.9 399 18.7 25-29 6.8 34.0 61.8 80.3 92.4 I. I 288 19.0 30-34 5.0 29.4 58.9 79.4 88.9 0.0 241 19.1 35-39 7.0 31.3 55.7 78.6 92 8 0.0 195 19 6 40-44 3 4 22.5 52. I 77.4 88.7 0.0 190 19.8 45-49 5 8 24.9 49.4 73.5 82.4 0.0 111 20.0 50-54 4.4 11.3 32.8 56.8 80.4 0.0 113 21.0 25-54 5.6 27.5 54.5 76.3 889 0.3 1,137 196 NA = Not applicable a Omitted because less than 50 percent in the age group x to x+4 had had intercourse by age x The data from male respondents show a different picture, one of decreasing age at first sex from about 21.0 years in the cohort currently age 50-54 to 18.7 years for the cohort age 20-24. The median age at first sex for men (all ages) is 19.6 years, compared with 18.3 years for women. Although men enter into marriage, on average, six years later than women, they start sexual relations only 16 months later than women. Looking at trends over age cohorts, it can be seen that the difference in the median age at first sex between men and women has declined considerably from over 20 months in the cohort age 45-49 years, to only seven months for the cohort age 25-29 years, to essentially no difference in the cohort age 20-24 years. Tables 5.8.1 and 5.8.2 show differentials in the median age at first sexual intercourse by background characteristics for women age 20-49 years and men age 20-54 years. With respect to place of residence, on average, rural women start sexual relations six months earlier than urban women. There is little variation by province. Harare province has the highest median age at first sexual intercourse (18.9 years) while Mashonaland West and Matabeleland South have the lowest (17.3 years). Women with secondary or more education initiate sexual relations at least two years later, on average, than those with no formal education. 79 Table 5.8.1 Median age at first intercourse: women Median age at first sexual intercourse among women age 20-49 years, by current age and selected background characteristics, Zimbabwe 1994 Cu~ent age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvmgo Harare Bulawayo Education No education Primary Secondary+ Total 19.9 18.8 18.7 18.3 18.8 18.6 19.0 18.6 18.2 18,2 17.7 17.9 18.5 18 3 18 1 18.1 :,¢ * * ,g * * 18.6 18.3 18.5 18 5 18.2 18.1 17.5 17.3 17.4 17.4 17.3 17.3 18.7 18.7 18.2 18.2 19.4 18.9 18.6 18.5 17.5 16.0 16.8 17.0 18.3 19 3 17 4 17.4 17.4 17 2 17.8 18 0 18.5 17.7 17.8 17.9 19.7 19 5 19.3 19 2 20.1 20.3 19.6 19 5 18 8 18.4 18.0 18.1 18.6 18.3 18.4 18.3 Note: Ftgures in parentheses are based on 25-49 women; an asterisk indicates that a figure is based on fewer than 25 women and has been suppressed. a Omitted because less than 50 percent of the women had had intercourse for the first time by age 20. Table 5.8.2 Median age at first intercoarse: men Median age at first sexual intercourse ~ mong men age 20-54 years, by current age and selected background characteristtcs, Zimbabwe 1994 Current age Men Background age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 50-54 25-54 Residence Urban 19.0 19.6 18.8 19.4 20.1 19.4 20.5 19.6 Rural 18.4 18 6 19.4 19 7 19.5 20 2 21.8 19 6 Province M anicaland * * * * * * * 19.5 Mashonaland Central * * * * * * * 20.8 Mashonaland East * * * * * * * 20.1 Mashonaland West * * * * * * * 19.2 Matabeleland North * * * * * * * 18.0 Matabeleland South * * * * * * * 18 9 Midlands * * * * * * * 19.6 Masvingo * * * * * * * 20.3 Harare * * * * * * * 19.4 Bulawayo * * * * * * * 20.0 Education No education * * * * * * * 20.6 Primary 18.2 18.6 18.9 20.0 19.3 19.8 20.9 19.6 Secondary+ 18.8 19.2 19.2 19.0 20.6 19.6 (21.5) 19,4 Total 18.7 19 0 19.1 19.6 19.8 20 0 21 0 19.6 Note: Numbers in parentheses are based on 25-49 men; an asterisk indicates that a figure es based on fewer than 25 men and has been suppressed. a Omitted because less than 50 percenl of the men had had intercourse for the first time by age 20. 80 For men, the median age at first sexual intercourse does not vary much by urban-rural residence. By province, it ranges from 18.0 years in Matabeleland North to 20.8 years in Mashonaland Central province. Education is negatively related to the median age at first sexual intercourse among men. Men with no formal education have a median age of 20.6 years when they first become sexually active, which declines to t9.6 and 19.4 years for men with primary and secondary or more education, respectively. Thus, while educated women initiate sexual activity much later than those with no education, the reverse is true for men. For both men and women, however, the gap between age at first sexual intercourse and age at first marriage increases with education. For women, those with no education spend only one month, on average, between their first sexual encounter and marriage. This increases to 7 and 16 months respectively, for those with primary and secondary or more education. For men, the increase is from 4.9 years among those with no education to 6.0 years among those with secondary or more education. 5.6 Recent Sexual Activity Although only 5 percent of the women age 20-49 have never had sexual intercourse, not all those who have ever had sex are currently sexually active. In the absence of effective contraception, the probability of becoming pregnant is highly dependent upon the frequency of intercourse. Information on sexual activity, therefore, can be used to refine measures of exposure to pregnancy. Men and women who have ever had sex were asked how long ago their last sexual activity occurred and the frequency in the last four weeks. Tables 5.9.1 and 5.9.2 show the distribution of sexual activity by background characteristics for all female and male respondents. A little over half (53 percent) of all women interviewed were sexually active in the four weeks preceding the survey, 7 percent were in postpartum abstinence, 16 percent were abstaining for reasons other than recent childbirth, and 21 percent had never had sex. Recent sexual activity is higher among women between the ages of 25 and 44, women married for less than 25 years, women living in the urban areas, women with little or no education, and those using some type of contraception. There also exist small provincial variations in sexual activity, ranging from 46 percent among women in Matabeleland South to 57- 58 percent of those in Harare and Mashonaland West. The proportion of women who are postpartum abstaining for under two years declines at older ages and at longer marital durations. Women in rural areas, those with no education, and those who are not using any form of contraception are much more likely to be postpartum abstaining. Abstinence unrelated to childbirth increases sharply with increasing age and duration of marriage, especially for abstinence exceeding two years in length. There are substantial differences among the provinces, ranging from 12 percent in Harare to over 20 percent in Matabeleland North and South. More educated women tend to start sexual activity later than less educated women but are more active once they start. Only 1 percent of uneducated women 15-49 have not yet had sex, compared with 14 percent of women with primary schooling and 35 percent of women with secondary education or more. On the other hand, among women who have ever had sex, all forms of abstinence decline with increasing level of education. Half of the men interviewed were sexually active in the four weeks preceding the survey, 21 percent have never sex, and the remaining 28 percent have had sex but not recently. Only 46 percent of men who have never been married have never had sex, compared with 78 percent of women. Current sexual activity is only slightly higher among men in a polygynous union (87 percent) than men in a monogamous union (82 percent). Only 40 and 18 percent of formerly and never-married men, respectively, were sexually active in the four weeks preceding the survey. 81 Table5.9.1 Recent sexual actlvity: women Percent distribution of women by sexual actiwty in the four weeks preceding the survey, and among those not sexually active, the length of time they have been abstaining and whether postpartum or not postpartum, according to selected background characteristics and contraceptive method currently used, Zimbabwe 1994 Not sexually active in last 4 weeks Background Sexually Abstaining Abstaining characteristic/ active (postpartum) (not postpartum) Never Number contraceptive in last had of method 4 weeks 0-1 years 2+ years 0-1 years 2+ years sex Missing Total women Age 15-19 16.3 4 2 0.4 7.4 0 6 70.3 0 7 100.0 1,472 20-24 53.8 8.2 1.5 14.9 1.2 17,3 3.0 100.0 1.269 25-29 70.7 7.3 0,2 13,2 2.8 2.1 3.6 100.0 915 30-34 70.3 8,2 1.1 14.7 2.2 0.7 2.8 100.0 871 35-39 68.4 5,2 0.8 16.8 5.3 0.3 3.3 100.0 661 40-44 69.3 5,0 0.4 14.8 6.3 0.1 4.0 100.0 532 45-49 63.0 0,4 0.3 19.0 13 1 0.0 4.4 100.0 407 Duration of union (years) Never roamed 5.4 3 1 1.4 10.0 1.4 77,5 1.2 100.0 1.646 0-4 71 0 109 02 14.2 0.7 0.5 2.5 1000 1,088 5-9 730 7 1 06 13.5 2.1 0.1 3.5 100,0 883 10 14 70.8 7 I 0.8 14.7 3.5 0 0 3.2 100.0 744 15-19 73.3 6 6 0.8 13 9 2 9 0.0 2 5 100.0 739 2(I-24 71 5 4 3 0.2 14.1 5 5 (1 (1 4.5 100.0 532 25-29 64 9 2 8 0,5 16.7 10.9 0 0 4.3 100.0 345 30+ 55 6 0 7 0,0 19.8 18.8 0.0 5.1 100.0 15 I Residence Urban 56.4 3 3 0.8 10.5 3.2 23 7 2.0 100.0 1,975 Rural 51.7 7 3 0.7 14.6 3 1 19 6 3.0 100.0 4,153 Province Mamcaland 47.6 7 9 0 5 12, I 3.9 23 3 4.7 100.0 839 Mashonaland Central 55.9 60 1.4 12.0 3.0 17.8 3.9 100.0 510 Mashonaland East 50.9 5 9 0.7 15.8 3 I 22.7 0 9 100,0 579 Mashonaland West 57.6 8 I 0.3 11.9 3.7 14 9 3.4 100.0 632 Matabeleland North 50.6 l 1 4 0.9 21.0 2.8 l 1 2 2.2 1130 0 366 Matabeleland South 46.3 10,9 0.9 24 7 [. [ 13.1 2,9 100.0 305 Mtdlands 54.7 5.5 0.4 11 8 3.5 21.3 2.9 100.0 810 Masvmgo 53.5 3,5 0 5 15.3 1.5 24.3 1.3 I(X) 0 652 Harare 57.1 2 I 1.2 7.7 4 I 26.0 I 8 100.0 1,048 Bulawayo 51.9 5 I 0.9 14.7 I 7 22 4 3 4 100.0 388 Education No education 63 5 9 7 1.0 14.5 5.8 1 2 4.3 100.0 682 Primary 58.9 5.9 06 14,2 3.7 13.5 3.1 1000 2,898 Secondary+ 44.0 5.1 0.8 11.9 1.7 34.6 1.8 100 0 2.547 Contraceptive method No method 38 2 7.4 0.8 14 4 4.4 32.2 2.6 100.0 3,976 Pill 82 5 4.0 0.6 9.8 0 7 0.0 2.4 100 0 1,449 IUD (85.6) (C.0) (0.0) (10.5) (0.0) (001 (3.9) 100.0 38 Stenhsatlon 76 9 C 0 0 0 13.2 5.9 0.0 4 0 100.0 112 Condom 78.6 C.4 0.0 17.3 0.0 0 0 3.7 100.0 149 Other 76.5 3.8 1.3 ] 3.4 0.4 0.0 4 6 100 0 392 Total 53.2 ~.0 0.7 13.3 3.l 20.9 2.7 100.0 Note: Total includes I I women using periodic abstinence. Figures in parentheses are based on 25-49 women. 6.128 82 Table 5.9.2 Recent sexual actwity: men Percent distribution of men by sexual activity in the four weeks preceding the survey, according to selected background characteristics, Zimbabwe 1994 Not Sexually sexually active active Background in last in last Never Number characteristic 4 weeks 4 weeks had sex Missing Total of men Age 15-19 9.9 23.0 67.1 0.0 100.0 604 20-24 40.8 45.3 13.9 0.0 100.0 399 25-29 66.3 32.6 1.1 0.0 100.0 288 30-34 80.9 19.1 0.0 0,0 100.0 241 35-39 77.3 22.7 0.0 0.0 100.0 195 40-44 79.1 20.5 0.0 0.4 1 (30.0 190 45-49 77.1 20.7 0.0 2.2 1(30.0 111 50-54 71.9 26.3 0.0 1.8 1 (30.0 I 13 Marital status Never married 17.8 35.9 46.3 0.0 100 0 1.004 Polygynous umon 87.4 12.6 0.0 0.0 100.0 93 Monogamous union 82.1 17.4 0.0 0 5 100.0 945 Formerly in union 40.2 59.1 0.0 0.g t00.0 99 Residence Urban 58.3 26.9 14.6 0.2 100.0 797 Rural 45.5 28.3 25.9 0.3 100.0 1,344 Education No education 53.5 39.6 6.9 0.0 100.0 88 Primary 55.2 25.2 19.5 0.1 100.0 860 Secondary+ 46.5 28.8 24.3 0.3 100.0 1.193 Total 50.3 27.8 21.7 0.2 100.0 2,141 5.7 Postpartum Amenorrhoea, Abstinence and Insusceptibility Postpartum amenorrhoea refers to the interval between childbirth and the return of menstruation. During this period, the risk of pregnancy is much reduced. How long this protection from conception following childbirth lasts, depends on the length and intensity of breastfeeding and the length of time before the resumption of sexual intercourse. Women who gave birth during the three years prior to the survey were asked about their breastfeeding practices, the duration of amenorrhoea, and sexual abstinence. Women are considered insusceptible if they are not exposed to the risk of pregnancy, either because they are amenor- rhoeic or are still abstaining from sex following a birth. The results are presented in Table 5.10. The period of postpartum amenorrhoea is considerably longer than the period of postpartum abstinence and is, therefore, the principal determinant of the length of postpartum insusceptibility (to the risk of pregnancy) in Zimbabwe. The median duration of amenorrhoea is 13 months, the duration of abstinence four months, and the period of insusceptibility is 14 months. All women are virtually insusceptible to pregnancy during the first two months following a birth, and both amenorrhoea and abstinence are important factors in their insusceptibility. However, starting from the second month after a birth, the contribution of abstinence to the period of insusceptibility is greatly reduced as more women resume sexual relations. At 12-13 months after a birth, more than half of the women are still amenorrhoeic, while only I 1 percent are still abstaining. At 18-19 months postpartum, the proportion amenorrhoeic drops sharply from 24 percent to 9 percent in the 20-21 months postpartum. This coincides with the modal age at full weaning for children in 83 Table 5.10 Postpartum amenorrhoea T abstinence and msusceptib011y Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrhoeic, abstaxnmg and insusceptible, by number of months since birth, and median and mean durations, Zimbabwe 1994 Number Months Amenor- lnsus- of since birth rhoeic Abstaining ceptlble births < 2 92.2 97.0 100 0 126 2-3 82.9 57.8 89.5 138 4-5 80.8 29.4 84.3 124 6-7 77.1 29.4 84.1 141 8-9 69.2 16.8 71.8 153 10-11 57.4 9.6 61.8 135 12-13 54.9 11.4 59 7 118 14-15 41.5 11.8 48.8 1(19 16-17 27.6 10.3 34.3 105 18-19 24.1 5.3 28.2 145 20-21 8.5 7.5 15.6 122 22-23 9.1 127 19.7 117 24-25 2.9 I 0.0 12.9 134 26-27 1.2 4 8 5.9 138 28-29 3.0 2.9 6.0 111 30-31 1.8 4.3 5.2 122 32-33 0.0 4 0 4.0 154 34-35 0 0 2.1 2.1 137 Total 35.6 18.2 41 0 2,331 Median 12.9 3.5 14.1 Mean 13 0 6.8 14.9 Prevalence/ Incidence mean I 12.6 6.5 14 6 1The prevalertce-incidence mean is borrowed from epidemlology and is definec[ as the number of children whose mothers are amenorrhoeic (prevalence) dwided by the average number of births per month (incidence). Zimbabwe (see Chapter 9). Only 5 percent of postpartum women are still abstaining at durations 18-19 months. Table 5.11 shows the median durations of postpartum amenorrhoea, abstinence, and insusceptibility by various background characteristic s. Postpartum insusceptibility does not vary much by age. Rural women have longer periods of amenorrhoea, sexual abstinence, and insuscepbitility than urban women. Harare and Midlands provinces have the shortest durations of postpartum amenorrhoea (about 1 I months) while Mashonaland Central and Matabeleland North have the longest durations (about 17 months). Postpartum abstinence is shortest in Harare (2 mcnths) and longest in Matabeleland South (7 months). Overall, therefore, women in Harare have the shortest period of insusceptibility (11 months) while those in Matabeleland North have the longest (17 months). Provincial variations in the duration of insusceptibility closely parallel pro- vlncial variations in the length of breastfeeding (see Chapter 9). Postpartum amenorrhoea avd abstinence are inversely related to mother's education. Postpartum amenorrhoea varies from 16 months for women with no education to 13 and 12 months, respectively, for those with only primary and secondary or more education. Similarly, abstinence varies from 7 months for women with no education to 4 and 3 months for those with primary and secondary or more education, respec- tively. Women with no education h~Lve a median period of insusceptibility of 16 months, compared with 14 84 Table 5.11 Median durauon of postpartum msusceptiNlity by background characteristics Median number of months of postpartum amenorrhoea, postpartum abstinence, and postpartum insusceptlbihty, by selected background characteristics, Zimbabwe 1994 Postpartum Number Background Postpartum Postpartum insuscep- of characteristic amenorrhoea abstmence tibility women Age <30 12.3 3.2 13.9 1,472 30+ 13.5 4.2 14.3 859 Residence Urban 10.6 2.5 11.2 607 Rural 13.6 3,9 14.7 1,724 Province Manicaland 13.3 5 3 14.3 307 Mashonaland Central 15.6 3 6 15.6 199 Mashonaland East 13 I 3. I 13.9 238 Mashonaland West 12.3 3.5 14.6 275 Matabeleland North 15.5 4.7 17. I 181 Matabeleland South 13.2 7.0 14.6 134 Midlands 10.6 2 8 11.0 328 Masvingo 13.4 2 6 14.4 242 Harare I 0.5 2 2 I 0.5 310 Bulawayo 12.5 4.7 15 2 I 17 Education No educanon 16.2 7 4 16.3 294 Primary 12.7 3.6 13.5 1,163 Secondary+ I 1.7 3.0 14.6 874 Total 12.9 3.5 14. I 2,33 I Note. Medians are based on current status. and 15 months for those with primary and secondary or more education, respectively. These findings suggest that many educated women consciously use postpartum abstinence to protect themselves from the risk of pregnancy. They appear to abstain from sexual intercourse only when they are not amenorrhoeic, thereby extending the period of protection from the risk of pregnancy. Less educated women may abstain because of tradition; much of their period of abstinence occurs when they are in breastfeeding-induced amenorrhoea. 5.8 Termination of Exposure to Pregnancy Above age 30, the risk of pregnancy declines with age as increasing proportions of women become infecund. Although the onset of infecundity is difficult to determine for an mdividual woman, there are ways of estimating it for a population. Table 5.12 presents data on two indicators of decreasing exposure to the risk of pregnancy for women age 30 years and over: menopause and long-term abstinence. 85 Table 5.12 Termination of exposure to the risk of pregnancy Indicators of menopause and long-term abstinence among currently man-Led women age 30-49, by age, Zimbabwe 1994 Long-term Menopause I abstinence 2 Age Percent Number Percent Number 30-34 1.6 482 0 2 722 35-39 3 8 392 0.2 530 40-41 3.8 176 0 8 205 42-43 8.7 138 0.9 157 44-45 16.7 122 2.1 133 46-47 22.1 132 I 7 139 48-49 44.5 1 (30 0.5 102 Total 8.8 1,542 0.6 1,988 tpercentage of non-pregnant, non-amenorrhoeic currently married women whose last menstrual period occurred six or more months ~precedmg the survey or who report that they are menopausal. ercentage of currently mamed women who did not have mtercourse in the three years preceding the survey. The percentage of women v, ho have reached menopause refers to the proportion of currently married women who are neither pregnant nor postpartum amenorrhoeic and have not had a menstrual period in the six months preceding the survey or who report being menopausal. The table shows that the proportion of menopausal women increases stead:ly with age, particularly after age 40, from 2 to 4 percent among women age 30-41 to 45 percent among women age 48-49. The percentage of women practising long-term abstinence refers to the proportion of currently married women who did not have sexual intercourse in the three years preceding the survey. As the table shows, long-term abstinence is not ~ major contributor to lower fertility. The proportion of currently married women who have not had sexual intercourse for the last three years is less than 1 percent, except among those age 44-47 (2 percent). 86 CHAPTER 6 FERTILITY PREFERENCES Women and men were asked a series of questions to ascertain their fertility preferences, that is, their desire to have a (another) child, the length of time they wanted to wait before having a (another) child, and the number of children they considered to be ideal. These data make the quantification of fertility preferences possible and, in combination with data on contraceptive use, allow estimation of the demand for family planning, either to space or to limit births. 6.1 Desire for More Children Table 6.1 presents fertility preferences among women and men by number of living children. While 57 percent of currently married women would like to have another child, only 21 percent want one within two years. Thirty-six percent would prefer to wait two or more years. Over one-third of married women want no more children. Thus, the large majority of women (72 percent) want either to space their next birth or to end childbearing altogether (see Figure 6.1). Taken at face value, this represents the proportion of women who are potentially in need of some method of family planning. Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women and men by desire for more children, according to number of hwng children, Zimbabwe 1994 Desire for children Number of hving children I 0 I 2 3 4 5 6+ Total WOMEN Have another soon 2 75.9 29.9 21.7 20 3 14.9 10.6 4,4 20,9 Have another later ~ 7.1 61.2 53.7 43.6 29.1 23.5 9,8 35.8 Have another, undecided when 0.5 0.7 0.6 0.1 0.0 0.6 0.1 0.4 Undecided 1.1 0.8 3.2 3.2 3.5 1.8 2.5 2.4 Want no more 1 3 5.2 18.4 29.4 47.3 58.5 74.7 35.6 Stenhsed 1.2 0.3 1,1 2.0 3.5 2.8 5.6 2.5 Declared mfecund 9.4 1.9 1.2 1.4 1.8 2,2 2.8 2.4 Missing 3.5 0.0 0,0 0.0 0,0 0.0 0.0 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100 0 100.0 Number of women 232 725 699 507 454 380 792 3,788 MEN Have another s~on 2 57.9 28.5 19.7 19.8 15.7 16.8 6.9 20.8 Have another later 3 39.3 60.9 51.3 53.6 32.9 17.8 19.7 39.5 Have another, undecided when 0.0 1.9 0.3 1.8 0.0 0.0 0.6 0.8 Undecided 1.1 0.4 2.9 1 9 3.4 3.3 3.0 2.3 Want no more 1.8 7 3 23.1 20.5 47.2 58.6 63.3 33.8 Stenhsed 0.0 0.0 1.6 1.7 0.0 3 6 3.6 1.7 Declared mfecund 0,0 1.0 1.2 0 7 0.9 0,0 2.9 1.3 Total 100,0 100.0 100.0 100.0 100.0 1000 100.0 100.0 Number of men 93 175 162 148 116 88 257 1,038 qncludes current pregnancy -Wan nex blr h wl hm 2 years +Want to delay next birth for 2 or more years 87 Figure 6.1 Fertility Preferences among Currently Married Women 15-49 Want no more 36% Undecided 2% Infecund 2% . Want Sterilised child soon 3% (within 2 years) 21% ~ Want child later (after 2 years) 36% ZDHS 1994 Figure 6.2 Fertility Preferences among Currently Married Women by Number of Living Children Perce~ 1^- 0 1 2 3 4 5 6+ Number of Living Children ZDHS1994 88 As expected, the desire to discontinue childbearing increases sharply with increasing number of children, from one percent among married women with no children to 75 percent among women with 6 or more children (see Figure 6.2). A similar pattern of changing fertility desires associated with increasing number of children is observed among male respondents. Table 6.2 shows women's fertility preferences by age. The desire to limit births rises rapidly with age, from 8 percent of married women age 15-19 to 66 percent of those age 45-49. Conversely, the desire to space births declines with age. In other words, the potential need for family planning services is greatest among older women for limiting childbearing and among younger women for spacing births. The net effect of these two opposing patterns is that the proportion of women falling into one of these two groups is roughly constant across age groups at between 66 and 75 percent of women. Table 6.2 Fertility preferences by age Percent distribution of currently married women by desire for more chddren, according to age, Zimbabwe 1994 Age of woman Desire lor chddren 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon t 30.4 21.2 25.0 22.2 18.3 14.8 I 1.5 20.9 Have another later 2 57.9 63.6 49.4 29.2 15.5 7.0 2.4 35.8 Have another, undecided when 0.9 0.6 0.4 0.1 0.2 0.4 0.0 0.4 Undecided 0.7 1.9 2.6 3.9 3.8 0.8 0.8 2.4 Want no more 7.9 11.7 20.4 41.2 56.3 66.3 66.1 35.6 Sterlhsed 0.0 0.1 0.6 2 3 3.6 6.1 8.6 2.5 Declared inl~cund 0.8 0.6 1.3 1.1 2.3 4.7 10.6 2.4 Missing 1.3 0.4 0.2 0,0 0.0 0.0 0.0 0.2 Total 100.0 i00.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 276 798 726 722 530 425 311 3,788 IWant next birth w~thm 2 years 2Want to delay next birth for 2 or more years Table 6.3 presents data on fertility desires of the 631 monogamous couples who live together in the same household, by the number of living children. Most couples (61 percent) agree in their desires to either to have more children (49 percent) or stop having children (22 percent). As seen with the reports of both women and men, the desire to stop having children rises rapidly with increasing number of living children. Table 6.4 presents the percentage of currently married women and men who want no more children, by number of living children and selected background characteristics. Women living in urban areas (40 percent) reported wanting no more children more often than women living in rural areas (37 percent). This difference becomes more pronounced as the number of children increases. The urban-rural difference in de- sire to limit childbearing is more pronounced among men than women. The desire to have no more children increases with increasing level of education; however, since the education of both women and men is closely linked to the number of living children, useful interpretation of the data requires observation within categories of number of living children. For example, looking at women who have three l i ving children, the desire to limit childbearing is nearly three times higher among respondents with secondary education (44 percent) than among those with no education (16 percent). 89 Table 6.3 Desire for more chddren among monogamous couples Percent dismbutlon of monogamously marned couples by desire for more children, according to number of hving chddren, Zimbabwe 1994 Itusband Wife Both Number of Both more/ more/ want Husband/ Number hwng want wd~ husband no wife of chddren more ~lo more no more more infecund Other I Total couples Same number 0 (98.4) (0.0) (0 0) (1.6) (0.0) (0.0) 1{30.0 40 1-3 61.7 13.4 7.5 7.1 4.3 6.1 100.0 216 4-6 23 I 17.0 4.9 47.7 0.0 7 3 100.0 103 7+ (4 9) (8.6) (10.7) (60 9) (7 3) (7 6) 100.0 43 Different number Husband > wife 48.8 6.9 14.7 19,5 3.6 6.5 100.0 173 Wife > husband 47,2 10,6 6 0 25.9 2,7 7.6 100,0 55 Total 49.0 10.8 8.6 22 I 3.2 6 2 100.0 631 Note. Figures m parentheses are base~i on 25-49 couples. i Undecided, not yet had sex, mxssmg Table 6.4 Destre to hmlt childbearing Percentage of currently married women and men who want no more children, by number of hying children and selected background charactertstlcs, Zxmbabwe 1994 Number of living children I Background characteristic 0 1 2 3 4 5 6+ Total WOMEN Residence Urban 4 5 6 2 28.6 47.9 65,0 79.4 88,6 39.9 Rural 1.5 5.1 14.6 22.8 44.9 54 5 78.9 37 3 Education No education (9, I ) (7.5) 16 4 15.8 31.5 50.3 73.3 45,6 Primary 1, I 3,4 15.2 26.6 50.7 59.5 82 5 42.9 Secondary+ 2 6 6.8 23.7 43.5 69.7 (85.7) (89 0) 26.8 Total 2.5 5.5 19.5 31.4 50.8 61 4 80.3 38,0 MEN Residence Urban (1.6) 5.0 34.1 33.7 52.5 82.4 88.7 41.9 Rural I 9 9.7 15.7 13.0 42,1 44.9 56.8 30.5 Education No education * * * * * * 57.0 41 0 Primary 3.4 3.7 17.3 22,3 37.4 55.9 65.1 39,4 Secondary+ I I 8 7 26 5 24.4 (62.5) (78.9) (80 2) 30.5 Total 1 8 7 3 24.6 22.2 47.2 62 2 66.9 35 5 Note. Women who have been sterdlsed ~re considered to want no more children. F~gures in parentheses are based on 25-49 ~lersons; an asterisk md/cates that a figure ts based on fewer than 25 persons and has been suppressed. ncludes current pregnancy 90 Table 6.5.1 Need for family plannmg services: currently married women Percentage of currently married women with urtmet need for family planning, and met need for family planning, and the total demand for family planning serwces, by selected background characteristics, Ztmbabwe 1994 Met need for Unmet need for family planning Total demand for Percentage family planning L (currently using) 2 family planning ~ of demand Number Background For For For For For For satls of charactefistJc spacing hmumg Total spacing hmitthg Total spacing limiting Total fled women Age 15-19 188 1 1 19.9 27.9 3.5 314 502 4.6 54.8 63.7 276 20-24 13.3 0.7 14 0 42.7 7.2 49 9 58 4 7.9 66.3 78.9 798 25-29 9.0 1.9 10.8 44.3 13.7 58.1 55.4 16.2 71.6 84.9 726 30-34 9 I 5 I 14.1 24.9 26.9 51.8 36.9 32.1 69.0 79.5 722 35°39 8.9 12 2 21 2 14.0 36.0 49.9 23 1 48.7 71.8 70.5 530 40-44 2.4 15.3 17.7 5.6 39 5 45.1 8.9 55.3 64.2 72 5 425 45-49 1.0 8. I 9 1 1 9 25 7 27.5 2.9 34.9 37 8 75.8 311 Residence Urban 5.8 3.4 9 3 31 1 26.5 57.6 39 2 30 1 69.2 86.6 1,114 Rural 10.6 6.6 17 2 25 3 18 9 44.2 37 6 25 9 63.5 73 0 2,674 Province Manicaland 8 9 3.6 12.6 23 4 12.4 35.9 34 0 17 2 51 2 75.5 543 Mashonaland Central 9.4 3.3 12 7 29.5 18.9 48 5 39.9 22.5 62.4 79.7 342 Masbonaland East 9 8 7 9 17.6 25.5 26.8 52 3 37.0 35.0 72.0 75 5 377 Masbonaland West 80 4.2 12.2 32.5 166 49.1 41.5 20.8 62.3 804 429 Matabeleland Noah 18.6 11 9 30.4 18 9 14.8 33.6 39.2 26.6 65.8 53.8 239 Matabeleland South 15.1 11.6 26.6 13.5 20.4 339 30.0 32.0 62.0 57.1 183 Midlands 7.3 5.5 12 8 32.1 26 1 58.2 41 8 32 5 74.3 82.7 472 Masvingo 11 1 8.1 19.2 23.1 189 42.0 35.9 27.3 63 1 69.6 393 Harare 56 2.2 7.8 33 I 28.4 61.6 41.5 30.6 72 1 89.2 619 Bulawayo 6.6 7.3 13.9 22 2 25.7 47.9 30.9 33 0 63.9 78.3 191 Education No education 9.5 9 7 19.2 15 5 17.4 32.8 26.0 27.4 53.4 64 0 552 Primary 10.0 6.6 16 6 22.6 23.8 46 4 34.2 30.8 64 9 74.5 1,992 Secondary+ 7.9 2.3 10.2 39.2 184 577 49.7 21.1 70.8 85.6 1,244 Total 9 2 5 6 14.9 27.0 21 1 48.1 38.1 27.1 65 2 77 2 3,788 IUnmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women whose last blab was mistimed, and women who are neither preguant nor amenorrhoeic and who are not using any method of family planning and say they want to wait two or more years for their next b~ah. Also included in unreel need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last chdd was unwanted and women who are neither pregnant nor amenorrhoeic and who are not using any method of famdy planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrhoeic women who became pregnant while using a method (these women are in need of better contraception). Also excluded are menopausal or infecund women. ZUsing for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting Is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3Total demand includes pregnant or amenorrhoeic women who became pregnant whde using a method (method failure) They account for 2.0 percent of all currently mamed women. 6.2 Need for Family Planning Services Women who are currently married and who say either that they do not want any more children or that they want to wait two or more years before having another child, but are not using contraception, are considered to have an unreel need for family planning. ~ Women who are using family planning methods are said to have a met need for family planning. Women with unmet and met need together constitute the total demand for family planning. 2 Tables 6.5.1, 6.5.2 and 6.5.3 present data on unmet need, met need and total For an exact description of the calculation, see footnote 1 in Table 6.5.1. 2 For a minor exception to this rule, see footnote 3 in Table 6.5.1. 91 Table 6.5.2 Need for family, p lanning services: unmarried women Percentage of unmarned women with unmet need for family planning, and met need lbr famdy planning, and the total demand for family p lanning services, by selected background characterisucs, Z imbabwe 1994 Met need for Unmet need for family planmng Total demand for Percentage famdy planning I (currently u~ing) 2 family planning 3 of demand Number Background For For For For For For satis- of charactensnc spacing hm~ting Total spacing limiting Total spacing hm]t]ng Total led women Age 15-19 I 1 02 I 3 22 0.6 2.8 3.4 08 42 683 1,195 20-24 1.7 05 22 14 I 4.5 18.6 17.1 5 1 22.2 900 471 25-29 2.2 2.2 4.4 209 147 35.5 23.3 177 41 I 892 189 3034 25 49 7.5 134 215 34.9 163 269 43.2 826 149 3539 12 4.1 53 65 29.5 361 77 33.6 413 87.2 131 40-44 14 86 IO0 30 265 295 4,4 362 406 75.3 107 4549 0.0 84 84 00 96 96 0.0 186 18.6 547 96 Residence Urban 19 21 40 8.0 94 174 100 116 216 814 861 Rural 1.1 14 2.5 64 5 7 12 1 80 73 153 83.6 1,479 Province Mamcaland I I 18 29 48 3.8 86 64 56 120 757 296 Mashonaland Central 1.5 05 2.1 5.3 5.0 10.4 7.4 60 134 84 7 168 Mashonaland East 0.5 0.5 1.0 4.0 6 1 10 1 4 6 6 6 I I.I 909 202 Mashonaland West 00 1 I 1.1 11.2 76 188 11 2 86 19.8 94.6 203 Matabeleland North 3 8 17 5 5 69 7.2 14 1 I I 1 8.9 200 72.8 127 Matabeleland South 22 3 3 5 5 115 7.9 19.4 15.6 116 27 2 79.6 122 Midlands 07 17 24 104 92 196 117 109 226 894 338 Maswngo 08 2.5 3.4 36 88 124 44 118 162 791 259 Harare I 2 1 2 2.4 5.2 6.8 12.0 64 8 0 14 5 83.3 429 Bulawayo 4.0 3,4 7.4 10.4 8.1 18.5 148 12 I 26.8 725 197 Educat ion No education 2 2 5 5 77 10.3 17.9 28.2 125 249 374 79.4 130 Primary 1.4 26 4 1 63 9.3 15.7 8.1 120 20 1 79.7 906 Secondary+ 1.2 07 19 72 44 115 88 51 139 864 1,303 Total 14 1.7 3.1 7.0 70 141 87 8.9 176 82.6 2,340 IUnmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoe~c women whose last birth was misnmed, and women who are neither pregnant nor amenorrhoelc and who are not using any method of family planning and say they want to walt two or more years for their ne:~t birth Also Included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth Unmet need for hmiting refers to pregnant women whose pregnancy was unwanted, amenorrhoelc women whose last child was unwanted and women who are neither pregnant nor amenorrhoelc and who are not using any method of family planning and who want no more chddren. Excluded from the unmet need category are pregnant and amenorrho~:lc women who became pregnant while u~lng a method (these women are in need of better contraception), Also excluded are menopausal or lnfecund women. 2Using for ~wa~ing is defined as women wt,o are using some method of family planning and say they want to have another child or are undecided whether to have another Us:ng for limtting is defined as women who are using and who want no more chddren. Note that the specific methods used are not taken into account here. 3Total demand includes pregnant or amenorrhoelc women who became pregnant whde using a method (method fadure). They account for 0.6 percent of all currently roamed women demand for family planning, accorc ing to whether the need is for spacing or limiting births. The findings are presented for currently married women, women not currently married, and all women combined. The following discussion focuses on the data from currently married women (see Table 6.5.1). Fifteen percent of married women in Zimbabwe have an unmet need for family planning services, 9 percent for spacing purposes and 6 percent for limiting births. Combined with the 48 percent of married women who are currently using a contraceptive method, the total demand for family planning includes about 92 Table 6.5.3 Need for famdy planning services: all women Percentage of all women with unmet need for family planning, and met need for family planning, and the total demand for famdy planning serwces, by selected background characterisucs, Zimbabwe 1994 Met need for Unmet need for family planning Total demand for Percentage famdy planning I (currently using) 2 family planning 3 of demand Number Background For For For For For For saris- of characterisuc spacing hmiting Total spacing limiting Total spacing hmltmg Total fled women Age 15-19 44 0.4 4 8 7.0 1.1 8 2 12.2 1 5 13.7 64.9 1,472 20-24 9.0 0.6 9.6 32.1 6.2 38 3 43.1 6.8 49 9 80.8 1,269 25-29 76 20 9.5 395 139 53.4 48.8 16.5 653 854 915 30-34 7.9 5 0 13 0 23.0 26.0 48.9 33 3 31.2 64.5 79 9 871 35-39 7.4 10.6 18.0 12.5 34.7 47.2 200 45.7 657 726 661 40-44 2.2 14.0 16.1 5.1 369 42,0 80 51.5 59.4 72.9 532 45-49 0 8 8.2 9 0 1 4 21.9 23 3 2.2 31.0 33.2 73.0 407 Residence Urban 4. I 2.9 7.0 21.0 19 0 40.0 26,4 22 0 48.5 85.6 1,975 Rural 7.2 4.7 120 18.6 14.2 328 27,1 193 46.3 742 4,153 Province Manicaland 6 2 3,0 9.2 16.9 9 4 26.2 24.3 13.1 37,4 75 5 839 Mashonaland Central 6 8 2 4 9.2 21 6 I4.4 35.9 29.2 17.1 46.3 80,2 510 Mashonaland East 6.5 5.3 11.8 18 0 19.6 37 6 25.7 25 I 50 8 76 7 579 Mashonaland West 5.4 3.2 8 6 25.7 13 7 39.3 31 8 16.9 48 7 82.3 632 Matabeleland North 13 4 8 3 21 8 14.7 12 1 26.9 29 5 20.5 49.9 56.4 366 Matabeleland South 9.9 83 18.2 12,7 154 28.1 24.3 23.8 48.1 62.1 305 Midlands 4 6 3.9 8.5 23 1 19,0 42.1 29.3 23.5 52.7 83 9 810 Masvingo 7.0 5.9 12.9 15.3 14.9 30.3 23,4 21.1 44,5 71 0 652 Harare 3.8 1.8 5,6 21 7 19.6 41 3 27.1 21 4 48.5 88.5 1,048 Bulawayo 5 3 5.3 10.6 16.2 16.7 329 22.7 224 45A 76.5 388 Education No educatxon 8A 8.9 17.0 14.5 17.5 31.9 23.4 26.9 50.3 662 682 Prxmary 7.3 5.3 12.7 17 5 19.3 36,8 26.0 24,9 509 75 2 2,898 Secondary+ 4.5 1.5 5,9 22 8 11.3 34 1 28.8 12 9 41.7 85.7 2,547 78 0 6,128 Total 62 4.1 10.4 19.4 157 35.1 26.9 20.2 47,0 iUnmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women whose last birth was mlsnmed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of famdy planning and say they want to wait two or more years for their next birth. Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoelc women whose last child was unwanted and women who are neither pregnant nor amenorrhoeic and who are not using any method of famdy planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrhoe~c women who became pregnant whde using a method (these women are m need of better contraception). Also excluded are menopausal or infecund women. 2Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting xs defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3Total demand Includes pregnant or amenorrhoeic women who became pregnant whde using a method (method failure) They account for 1.5 percent of all currently mamed women. two-thirds of married women in Zimbabwe. Thus, if all married women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 48 percent to 63 . percent of married women. Over three-quarters of the potential demand for family planning in Zimbabwe is being satisfied (see second to last column in Table 6.5.1). The overall unmet need for family planning follows a U-shaped pattern by age group, with the greatest need observed at ages under 25 and over 34. Unmet need for spacing purposes is higher among the 93 younger women, while unmet need tor limiting childbearing is higher among the older women. The level of unmet need is also more pronounced among rural women than urban women; and it is nearly two times higher among uneducated women th~n among women with secondary education (see Figure 6.3). Large provincial differences are observed in unmet need for contraception, from only 8 percent of married women in Harare to 27 perc.~nt in Matabeleland South and 30 percent in Matabeleland North. Some notable differences exist between the contraceptive needs of married and unmarried women. In general, overall demand for family planning is much lower among unmarried women (18 percent) than among married women (65 percent). However, a larger percentage of the total demand is being satisfied among the unmarried (83 percent), so that only 3 percent of this group has an unmet need for contraception. Figure 6.3 Percentage of Currently Married Women with Unmet Need and Met Need for Family Planning Services by Background Characteristics ZIMBABWE ~ RESIDENCE Urban Rural EDUCATION No Education Primar~ Secondary + J @ I 10 20 30 40 50 60 70 80 90 100 Percent ZDHS 1994 6.3 Ideal Family Size Information on what womert and men feel is the ideal family size was elicited through two questions. Respondents who had no children were asked, "If you could choose exactly the number of children to have in your whole life, how many would that be?" For respondents who had children, the question was rephrased as follows: "If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?" Some respondents, especially those for whom fertility control is an unfamiliar concept, would naturally have some difficulty in answering this hypothetical question. 94 The results in Table 6.6 indicate that the vast majority of women and men were able to give a numeric answer to this question; only 1 percent of women and 2 percent of men gave a non-numeric answer such as "it is up to God," "any number" or "do not know." Among those women who gave numeric responses, the average ideal number of children was 4.3, which is a significant decline from 4.9 in the 1988 ZDHS. The average ideal number of children reported by women and men is identical (4.3). When considering only currently married women and men, the mean number of children is slightly lower for women (4.7) than men (4.9). Table 6.6 Ideal and actual number of children Percent distribution of all women and men by ideal number of children and mean ideal number of children for all women and for currently married women and men, according to number of living children, Zimbabwe 1994 Number of living children 1 Ideal number of chddren 0 I 2 3 4 5 6+ Total WOMEN 0 0.2 0.1 0.1 0.5 0.0 0.2 0.1 0.2 1 1.8 5.1 0.7 0.2 0.4 1.8 0.4 1.7 2 29.5 18.5 16.4 6.3 7.1 5.9 4.0 16.0 3 18.8 22.4 12.0 13.7 2.9 5.8 4.3 13.5 4 32.8 33.6 47.1 42.2 36.5 21.7 24.6 34.2 5 9.2 10.8 9.9 15.4 12.6 18.0 8 8 11.1 6+ 7.4 9.4 13.4 21.2 39.4 45.8 55 8 22.7 Non-numeric response 0.3 0.3 0.5 0.3 1.0 0.8 2.1 0 7 Total 100.0 100.0 100.0 100.0 10t3.0 100.0 100.0 100.0 Number of women 1,725 1,030 862 630 532 444 905 6,128 Mean ideal number for: All women 3.5 3.6 4.0 4.4 5.1 5.3 6.1 4 3 Currently married women 3.8 3.8 4.1 4.5 5.1 5.4 6.2 4.7 MEN 0 0.5 0.0 0.6 0.0 0.4 0.0 0.0 0.3 1 2.1 1.9 3.2 0.3 0.0 0.0 0.0 1.5 2 21.5 14.2 14.7 5.2 9.9 3.5 8.9 16.0 3 27.7 27.3 21.7 13.2 2 4 2.4 4.2 20.6 4 26.1 33.0 36.2 41.0 33 7 29. I 23.0 28.9 5 12.8 15.3 11.5 14.3 15.9 19.7 6.8 12.8 6+ 8 4 7.7 10.1 23.7 37.7 41.5 52.2 18.1 Non-numeric response 0 9 0.6 2.2 2.3 0.0 3.7 4.9 1.7 Total 100.0 100,0 100.0 1000 100.0 100.0 100.0 100.0 Number of men 1,108 212 183 161 120 92 265 2,141 Mean ideal number for: All men 3.6 3.8 3,8 4.7 5.1 5.9 6.9 4.3 Currently married men 3,3 3.7 3.8 4.7 5.0 5.8 6.9 4.9 Monogamously mamed men 3.3 3.7 3.7 4 7 4.9 6.1 6.4 4.7 Note The means exclude women who gave non-numeric responses. ~lncludes current pregnancy The ideal number of children increases with the actual number of living children. The mean ideal number of children increase from 3.5 and 3.6 among childless women and men to 6.1 and 6.9, respectively, among women and men with 6 or more children. This correlation between actual and ideal number is driven by at least two phenomena. First, to the extent that women and men implement their preferences, those who want smaller families will tend to achieve small families. Second, women and men may upward "adjust" their 95 ideal number of children, as the aclual number of children increases (i.e., rationalisation). Despite the likelihood that some rationalisation occurs, there are considerable numbers of women and men who do report smaller ideal family sizes than their actual number of children. For example, 42 percent of women and 43 percent of men who have 6 or more li,~ing children reported that they consider less than 6 children to be ideal. Tables 6.7.1 and 6.7.2 show the mean ideal number of children for all women and for all men by age and selected background characteristics. The mean ideal family size increases with respondent's age from 3.4 children for women age 15-19 to 6.0 for women age 45-49. Among men, ideal family size rises from 3.7 among men age 15-19 to 6.8 among men 45-49. At every age, rural women and men have higher family size norms than urban women and men. Ideal family size is strongly related to education level attained; as education increases, desired family size decreases sharply. Table67.1 Meantdeal numberol chddren by background characteristics: women Mean ideal number of children for all women, by age and selected background characteristics, Zimbabwe 1994 Age of woman Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Res idence Urban 2.8 3 0 3.6 3,8 4.4 4.6 5.0 3 5 Rural 3.7 4.0 4.3 5.4 5.7 6.1 6.3 4.7 Educat ion No education * (4.6) 5 I 6.1 6. I 6.7 6.9 6.1 Primary 3.8 4.1 4.7 4,9 5.2 5,5 5 7 4.7 Secondary+ 3.2 3.3 3 5 3.7 4 0 4.5 (4.5) 3.4 Total 3.4 3.7 4.1 4.8 5.3 5 7 6.0 4.3 Note: Figures in parentheses are based on 25 to 49 women; an asterJsk indicates th~l a figure Js based on fewer than 25 women and has bee 1 suppressed. Table 6.7.2 Mean ideal number of chil:lren by background charactensttcs: men Mean 1deal number of chxldren for men, by age and selected background characteristics, Zimbabwe 1994 Background Age of man characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+54 Total Res idence Urban 2.8 3.1 3,3 3.9 4.6 4 9 (5.1) (4.8) 3 7 Rural 4,0 3.8 3.9 4.7 5.4 6 3 7.7 6.8 4 7 Educat ion No education Primary Secondary+ * * * * * * * * 6.3 4.2 3.8 4.2 4+8 5.6 6,2 7 3 6 2 5+1 3 4 3.4 3 5 3.9 4 0 (4 3) * * 3 6 Total 3.7 3 5 3.6 4 3 5.1 5,6 6.8 6.1 4.3 Note Figures in parentheses are based on 25 to 49 men; an asterisk indicates that z figure is based on fewer than 25 men and has been suppressed. 96 6.4 Wanted and Unwanted Fertility Women were asked a series of questions regarding all of their children born in the last five years and any current pregnancy to determine whether that pregnancy was planned, unplanned, or mistimed (wanted at a later time). These questions form a potentially powerful indicator of the degree to which couples successfully control their fertility. Also, the data can be used to gauge the effect of the prevention of unwanted births on period fertility rates. Table 6.8 shows the percent distribution of births in the five years before the survey by whether the birth was wanted then, wanted later, or not wanted. Ten percent of recent births were reported to be unwanted, while another 34 percent were reported as mistimed (wanted later). The percentage of births that were mistimed or unwanted goes up with birth order, from 36 percent of first births to 53 percent of fourth and higher order births. Similarly, a much larger proportion of births to older women are unwanted than are those to younger women. While less than 10 percent of births to women under age 35 are unwanted, around one-half of births to women 40 and older are unwanted. Table 6.8 Fertihty planning status Percent distribution of births in the three years preceding the survey and current pregnancxes, by fertility planning status, according to birth order and mother's age, Zimbabwe 1994 Planning status of birth Birth order Number and mother's Wanted Wanted Not of age then later wanted Missing Total births Birth order 1 64.2 29.9 5.7 0. I 1130.0 762 2 63.7 33.6 2.6 0.1 100.0 599 3 57 3 38.1 4,6 0.0 100,0 40g 4+ 46.8 34,6 18.2 0.4 100.0 1,111 Age at birth <20 51.8 41.4 6.6 02 100.0 508 20-24 62.6 34.8 2.6 0.0 100.0 875 25-29 61.6 31.8 6.6 0.1 100.0 607 30-34 57.6 32.1 9.5 0.8 100.0 497 35-39 40.4 30.4 29.2 0.0 100.0 274 40-44 36,2 16.5 46 2 1.1 100.0 102 45-49 * * * * 100 0 16 Total 56 4 33.7 9 7 0.2 100.0 2,879 Note: Birth order includes current pregnancy. An asterisk indicates that a figure is based on fewer than 25 births (and current pregnancies) and has been suppressed. Table 6.9 presents wanted fertility rates. The wanted fertility rate is calculated in the same manner as the total fertility rate, but unwanted births are excluded from the numerator. For this purpose, unwanted births are defined as those which exceed the number considered ideal by the respondent. (Note: Women who did not report a numeric ideal family size were assumed to want all their births.) This rate represents the level of fertility that would have prevailed in the three years preceding the survey if all unwanted births had been prevented. A comparison of the total wanted fertility rate and the actual total fertility rate suggests the potential demographic impact of the elimination of unwanted births. 97 The total wanted fertility rate is 3.5 for Zimbabwe as a whole, roughly one child lower than the actual total fertility rate. The gap between wanted and observed fertility is greater among women with living in rural areas and those with less than a secondary education. Table 6.9 Wanted fertility rates Total wznted fertdity rates and total fertday rates for the three years prece&ng the survey, by selected background characteristics, Zimbabwe 1994 Total wanted Total Background fertility fertxlxty characteristic rate rate Residence Urban 2.6 3 1 Rural 3.9 4.9 Education No education 4 4 5.2 Prxmar ¢ 3 7 4.6 Seconc ary+ 2.9 3 3 Total 3.5 4.3 Note: Rates are based on btrths to women 15-49 m the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 3.2. 98 CHAPTER 7 EARLY CHILDHOOD MORTALITY 7.1 Background and Assessment of Data Quality This chapter presents information on mortality among children under five years of age in Zimbabwe. Specifically, estimates are presented on levels, trends and differentials in neonatal, postneonatal, infant, and child mortality. This information is relevant to both the demographic assessment of the population and the evaluation of health policies and programmes. Estimates of infant and child mortality may be used as inputs into population projections, particularly if the level of adult mortality is known from another source or can be inferred with reasonable confidence. Information on mortality of children also serves the needs of agencies providing health services by identifying sectors of the population which are at high mortality risk. The rates of childhood mortality presented here are defined as follows: Neonatal mortality (NN): the probability of dying within the first month of life, Postneonatal mortality (PNN): the arithmetic difference between infant and neonatal mortality, Infant mortality (tq0): the probability of dying between birth and the first birthday, • Child mortality (4q0: the probability of dying between exact age one and the fifth birthday, • Under-five mortality (sq0): the probability of dying between birth and the fifth birthday. All rates are expressed as deaths per 1,000 live births, except child mortality which is expressed as deaths per 1,000 children surviving to the first birthday. The mortality rates presented in this chapter are calculated from information drawn from the questions asked in the birth history section of the women's questionnaire. Preceding the birth history, probing questions are posed on the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live with the mother, the number who live elsewhere, and the number who have died). In the birth history, for each live birth, information is collected on sex, month and year of birth, survivorship status and current age, and age at death if the child died. The quality of mortality estimates calculated from retrospective birth histories depends upon the completeness with which births and deaths are reported and recorded. The most potentially serious data quality problem is the selective omission from the birth histories of births that did not survive, which will lead to underestimation of mortality rates. Other potential problems include displacement of birth dates, which may cause a distortion of mortality trends, and misreporting of age at death, which may distort the age-pattern of mortality. When selective omission of childhood deaths occurs, it is usually most severe for deaths which occur very early in infancy. If early neonatal deaths are selectively underreported, the result would be an abnormally low ratio of deaths under seven days to all neonatal deaths and an abnormally low ratio of neonatal to infant mortality. Underreporting of early infant deaths is usually more common for births that occurred further back in time; hence, it is useful to examine the ratios over time. 99 Inspection of these ratios (shewn in Appendix Tables C.5. and C.6) indicates that significant numbers of early infant deaths have not been emitted in the 1994 ZDHS. First, the proportion of neonatal deaths that occur in the first week of life is quite high, 68 percent. Further, this proportion is roughly constant over the 20 years before the survey (between 62 and 72 percent). Second, the proportion of infant deaths that occur during the first month of life is plausible (49 percent) and is stable over the 20 years preceding the survey (varying between 45 and 53 percent). This cursory inspection oftbe mortality data reveals no evidence of selective underreporting or age at death misreporting. It is also important to note that any method of measuring childhood mortality that relies on mothers' reports (e.g., birth histories) rests on the assumption that female adult mortality is not high or, if it is high, that there is little or no correlation between the mortality risks of mothers and their children. In countries with high rates of female adult mortality, these assumptions may not hold and the resulting childhood mortality rates will be understated to some de~,ree. 7.2 Levels and Trends in Early Childhood Mortality Table 7.1 presents childhood mortality rates for periods 0-4, 5-9, and 10-14 years before the survey. Under-five mortality for the period 0-4 before the survey (circa 1990-1994) is 77 deaths per 1,000 births. This means that, currently, 1 in 13 Zimbabwean children does not live to the fifth birthday. About one-third of under-five deaths occur during each of the three relevant age segments: neonatal mortality (<1 month) is 24 per 1,000; posmeonatal mortality (1-11 months) is 28 per 1,000; and child mortality (1-4 years) is 26 per 1,000 live births. Infant mortality stands at 53 deaths per 1,000 births. Tal?le 7.1 Infant and child mortality Infant and child mortality rates by five-year periods preceding the survey, Zimba- bwe 1994 Years Neonatal Posmeonatal Infant Child Under-five preceding monahty mortality mortality mortahty mortality survey (NN) (PNN) (Iq0) (4ql) (sq0) 0-4 24.,1 28.4 52.8 25.6 77. I 5-9 25.~ 24,1 49,6 26.5 74.8 10-14 25.,1 34.3 59.6 44.4 101.4 The 1994 ZDHS data indic~tte that survival at all ages under five years has not improved from the period 1985-1989 to 1990-1994. "[o evaluate the quality of estimates on levels and trends in childhood mortality, it is useful to examine changes over time based on retrospective data from the present survey, but in the context of estimates derived from previously collected data of the same type. Figure 7.1 shows trends m infant and under-five mortality based on data from the 1988 and 1994 ZDHS surveys. The consistency between the data from the two surveys is remarkable. From the 1988 survey, infant mortality was estimated at 53 per 1,000 and under-five mortality at 75 per 1,000 for the 1984-1988 period, which are nearly identical to rates for the comparable calendar period from the 1994 survey. Further, both surveys tdentify a drop of almost equal magnitude in infant aud child mortality during the 1980s. Thus, there is clear indicatton of falling rates of early childhood mortality in Zimbabwe up until the late 1980s, after whJch there Js little or no improvement in child survival prospects. 100 Figure 7.1 Trends in Infant and Under-five Mortality 1988 and 1994 Deaths/1000 Live Births 120 100 80 60 40 20 0 • ' ' ' " ' " " '~ '~r - f • .'" ~ ive Mortality Infant Mortality t 975 t 980 1985 1990 t 995 Calendar Year "'" 1988 ZDHS -m- tgg4 ZDHS "~ 1988 ZDHS Three possible explanations for these recent trends are suggested. First, a recent worsening of economic condition in Zimbabwe households may have altered decisionmaking regarding use of health services and the purchase of appropriate nutrition supplements. Second, over the last five years, the direct and indirect impact of the AIDS epidemic on child health and survival may have been felt. Lastly, it may be that in the context of past significant declines in childhood mortality driven by simple, targeted health interventions--without addressing the background causes of poor health, e.g., poverty--there would come a time when mortality rates would stabilise at a lower, but still troublingly high level. Most likely, the recent stagnation in mortality decline is due to a combination of these and other factors. 7.3 Socioeconomic Differentials in Early Childhood Mortality Differentials in infant and child mortality by urban-rural residence and mother's level of education are presented in Table 7.2. The mortality estimates are calculated for a ten-year period before the survey so that the rates are based on sufficient number of cases in each category to ensure statistically reliable estimates. Under-five mortality is significantly higher in rural areas (80 per 1,000) than in urban areas (63 per 1,000) (see Figure 7.2), and the urban-rural difference is especially pronounced during the 1-4 year age segment• There is a strong link between a mother's level of education and children's survival. The children of uneducated mothers experience an under-five mortality rate of 93 per 1,000 compared with 79 and 57 per 1,000 for children of women with primary education and secondary or more education, respectively• This education-survival relationship is strong at all ages under five years• Educated mothers are more likely to use the available health services and have greater knowledge of nutrition, hygiene and other practices relating to child care. 101 Table 7.2 Infant and chdd mqrtahty by background charactenstxcs Infant and child mortality rates for the ten-year period preceding the survey, by selected socioeconomic character stics, Zimbabwe 1994 Neonatal Postneonatal Infant Chdd Under-f ive Background mortality mortality mortality mortality mortality characteristic (NN) (PNN) (lqo) (4ql) (sq0) Residence Urban 23.4 20.9 44.3 19.5 63.0 Rural 25.5 28.1 53.6 28.2 80.3 Education No educauon 28.3 33.4 61.6 33.6 93. l Primary 27 8 26.1 53.9 26.2 78.7 Secondary+ 17.0 21.6 38 6 18.7 56.6 Total 24.9 26.3 51.2 26.0 75 9 RESIDENCE Urban Rural MATERNAL EDUCATION No Education Primary Secondary + BIRTH INTERVAL < 2 years 2-3 yeare 4 years + Figure 7.2 Under-five Mortality by Selected Characteristics 0 20 40 60 80 1 O0 120 Deaths per 1000 Live Births 140 ZDHS 1994 7.4 Biodemographic Differentials in Early Childhood Mortality The relationship between early childhood mortality and various demographic variables is examined in Table 7.3. Male children experience higher mortality than their female counterparts. Under-five mortality rates for males and females are 82 and 70 deaths per 1,000 births, respectively. The excess mortality among male children diminishes after infaacy. The relationship between cl ldhood mortality and mother s age at birth shows the expected U-shaped pattern at all ages under five years; with children of the youngest and the oldest women experiencing the 102 Table 7.3 Infant and child mortality by demographic characteristics Infant and child mortality rates for the ten-year period preceding the survey, by selected demographic characteristics, Zimbabwe 1994 Neonatal Postneonatal Infant Chdd Under-five Demographic mortahty mortahty mortality mortality mortality characteristic (NN) (PNN) (Iq0) (4ql) (sq0) Sex of child Male Female Age of mother at birth < 20 20-29 30-39 40-49 Birth order 1 2-3 4-6 7+ Previous birth interval <2yrs 2-3 yrs 4 yrs + Medical maternity care t No antenatal or delivery care Either antenatal or delivery care Both antenatal and delivery care Size at birth 1 Very small Small Average or larger 27.5 29.4 56.9 26.4 81.8 22.4 23.1 45.5 25.6 69.9 26.2 28.5 54.7 32.3 85.3 26.8 26.7 53.5 24.9 7% I 19.8 22.4 42.3 22. I 63.5 (31.0) 39.7* 70.7* 46.4* 113.9" 27.2 25.9 53.2 27.3 79.0 25.4 26.0 51.4 23.6 73.8 22.2 27.9 50.1 25.2 74.0 26.1 23.9 49.9 31.8 80.2 46.2 41.2 87.4 46.2 129.5 17.8 24.6 42.4 21.9 63 4 25.2 19.1 44.4 16.8 60.5 25.1" 72.3* 97.4* 23.3 39.9 63.2 17.4 30.5 47.9 50.2* 54.7* 104.9" (23.7) (50.9) (74.5) 16.0 30.6 46.6 Total 24.9 26.3 51.2 26.0 75.9 ( ) Rate based on 250-499 births * Rate based on less than 250 births i Refers to births m the 3 years before the survey. highest risk of death. A similar, but less pronounced, pattern occurs regarding birth order. Generally, first- order births and very high order births (7+) are observed to have higher mortality rates than births of order 2-6. A marked relationship exists between the length of the preceding birth interval and risk of early childhood mortality. The ZDHS data indicate that short birth intervals significantly reduce a child's chances of survival. Children born less than two years after a preceding sibling are more than twice as likely to die in infancy as those born two to three years after a preceding sibling (87 vs. 42 per 1,000). During ages 1-4 years, children born after a short interval are nearly three times more likely to die than their counterparts born after a long interval (46 vs. 17 per 1,000). This striking link between the pace of childbearing and child survival rates persists in all age groups examined. These findings point up the potential for mortality reduction that could result from successful efforts to promote birth spacing in Zimbabwe. 103 Maternal care during pregnancy and delivery has a significant bearing on the health of both mother and child and thus on the risk of early childhood mortality. The ZDHS data show that children born to women who obtained both antenata, and delivery care from medically trained persons have considerably lower mortality than children whose mothers received only antenatal or delivery care, or received neither. A child's size at birth is an important indicator of the risk of dying during infancy, particularly during the first months of life. In the ZDHS mothers were asked whether the reference child was very small, small, average srze, large, or very large at Birth. This type of subjective assessment has been shown to correlate closely with actual birth weight. Newborns perceived by their mothers to be very small or small are much more likely to die in the first year than those perceived as average or larger in size. As expected, the differential is especmlly large during the neonatal period. 7.5 High-Risk Fertility Behaviour Many studies have demonstrated the strong relationship between the pattern of women's fertility and their children's chances of survival (Boerrna and Bicego, 1992; United Nations, 1994). Results presented in the previous section bear this out. Typically, infants and young children have a higher risk of dying if they are born to very young mothers or cider mothers, if they are born after a short interval, or if their mothers have already had many children. In the following analysis, mothers are classified as too young if they are less than 18 years old at the time of birth, and too old if they are age 35 years or more at the time of birth. A short birth interval is defined as or e less than 24 months, and a high-order birth as one occurring after four or more previous births (l.e., birth order 5 or higher). Births are also cross-classified by combinations of these characteristics. Thus, a birth may have from zero to three potentially high-risk characteristics. Column one of Table 7.4 st ows the percentage of births over the five years before the survey that fall into various risk categories. Forty-four percent of births fall into at least one high-risk category, with about 16 percent having multiple high-risk characteristics. Risk ratios are presented in column two; the risk ratio is the ratio of the proportion in a category who have died to the proportion in the reference category who have died. Births in the reference category are those who do not fall into any high-risk category. Two points need emphasis. First, high birth order is not associated with higher mortality risk in Zimbabwe unless coupled with short birth interval. Since such a large percentage of high-risk births are of high birth order in Zimbabwe, this operates to diminist, the associated risk ratios in the overall single high-risk category (0.92) and the overall multiple high-risk category (1.03). Second, the primary factor leading to heightened mortality risk in Zimbabwe is short birth interval, as a single or multiple high-risk factor. The latter finding again underscores the need to reduce, through timely use of contraception, the number of closely spaced births. Column three of Table 7.4 ~;hows the distribution of currently married, nonsterilised women by the risk category into which a currently conceived birth would fall. A comparison of this percentage with the distribution of actual births in the last five years indicates that without fertility control, the percentage of births falling into each of the multiple high-risk categories would rise. Overall, the percentage of births with multiple high-risk characteristics w~uld rise from 16 to 35 percent. 104 Table 7.4 High-risk fertility behavlour Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality, and the percent distribuuon of currently married women at risk of concewing a child with an elevated risk of mortahty, by category of increased risk, Zimbabwe 1994 Births in 5 years preceding the survey Percentage of currently R~sk Percentage Risk marrwd category of births ratio women a Not in any high-risk category 55.7 1.0 36.9 I' Single high-risk category Mother's age < 18 7.2 1.1 0.9 Mother's age > 34 1.1 0.6 5.2 Birth interval < 24 months 5.0 1.3 13.2 Bxrth order > 4 15.5 0.8 9.2 Subtotal 28.8 0.9 28.5 Multiple high-risk category Age <18 & birth interval <24 c mo 0.3 0.7 0.5 Age >34 & birth interval <24 mo 0.0 0.0 0.2 Age >34 & birth order >4 11.6 0.7 25.0 Age >34 & birth interval <24 & birth order >4 1.4 2.2 4.2 Birth interval <24 & birth order >4 2.2 2.2 4.8 Subtotal 15.5 1.0 34.7 In any high-risk category 44.3 1.0 63. l Total 100.0 100.0 Number of births 3,941 3,788 Note: Risk ratio as the ratio of the proportion dead of births in a specific high- risk category to the proportlon dead of births not in any high-risk category. aWomen were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth less than 15 months ago, and latest birth of order 4 or ~lgher. Includes sterilised women Clncludes the combined categories Age <18 and birth order >4. 105 CHAPTER 8 MATERNAL AND CHILD HEALTH This chapter presents the ZDHS findings in three areas of importance to maternal and child health: maternal care and characteristics of the newborn, childhood vaccinations, and common childhood illnesses and their treatment. Combined with data on childhood mortality, this information can be used to identify subgroups of women whose babies are "at risk" because of nonuse of maternal health services, and to provide information to assist in the planning of appropriate improvements in services. Data were obtained for all live births that occurred in the three years preceding the survey. 8.1 Antenatal Care Table 8.1 shows the percent distribution of births in the three years preceding the survey by source of antenatal care received during pregnancy, according to maternal and background characteristics. Inter- Table 8.1 Antenatal care Percent &stribut~on of births in the three years preceding the survey by source of antenatal care dunng pregnancy, according to selected background characteristics, Zimbabwe 1994 Antenatal care provider I Nurse/ Traditional Number Background Trained birth of characteristic Doctor midwife attendant 2 No one Missing Total births Mother's age at birth < 20 20.1 75.3 0,3 4.1 0.3 100.0 421 20-34 22.3 70.9 1.3 5.4 0.1 I00.0 1,603 35+ 15.4 73.8 1.4 9.0 0.4 100.0 303 Birth order I 27.8 67.7 0.7 3.8 0.0 100.0 613 2-3 21.2 72.4 0.7 5.5 0.2 100.0 818 4-5 20.3 72.9 1.8 4.8 0.3 100 0 414 6+ 12.9 76.4 1.7 8.8 0.2 100.0 483 Residence Urban 38.3 57. I 0.9 3.6 0.1 100.0 608 Rural 14.9 77.4 1.2 6.3 0.2 100.0 1,720 Province Manicaland 9.0 76.3 4.9 9.8 0.0 100.0 307 Mashonaland Central 18.5 73.0 0.0 8.5 0.0 100.0 202 Mashonaland East 17.7 73.0 0.4 8.8 0.0 100.0 240 Mashonaland West 17.7 76.8 0.0 5.5 0.0 100.0 274 Matabeleland North 9.4 85.9 0.0 4.7 0.0 100.0 183 Matabeleland South 17.1 77.6 0.0 5.3 0.0 100.0 132 Midlands 19.6 75.7 0.0 3.7 1.0 |00.0 324 Masvingo 18.7 77.2 1.8 2.3 0.0 100.0 240 Harare 37.2 58.3 1 7 2.8 0.0 100.0 310 Bulawayo 60.3 34.5 0.0 4.6 0.6 I00.0 115 Mother's education No educaUon 8.2 83.8 0.6 7.0 0.4 100.0 292 Primary 15.4 75.6 1.8 7.0 0.2 100.0 1,169 Secondary+ 32.9 63.5 0.3 3.3 0.0 100.0 867 All b~rths 21.0 72.1 1.1 5.6 0.2 1000 2,328 Note: Fxgures are for births m the period 1-35 months preceding the survey. If the respondent mentioned more than one provider, only the most qualified provider is considered. 2 Traditional mldwile 107 viewers were instructed to record all persons a woman had seen for care, but in the table, only the provider with the highest qualifications is cor sidered (if more than ore person was seen). For 93 percent of births, mothers received antenatal care from a doctor, or trained nurse or midwife. Women received antenatal care from a traditional birth attendant (TBA) ~ for only 1 percent of births and no antenatal care at all for 6 percent of births. Thus, almost all women rezeive antenatal care, relying mostly on a nurse or midwife (72 percent) or a doctor (21 percent) (see Figure 8 1 ). It should be kept in mind, however, that the type and quality of care is not reflected in these figures. The 1994 ZDHS findings indicate that little change has occurred in antenatal care coverage since the 1988 ZDHS, when it was estimated that 91 percent of births received antenatal care from a medically-trained person. The small increase to 93 percent in the 1994 ZDHS is due to a rise in use of doctors from 18 to 21 percent. The mother's age at birth and the child's birth order are related to use of antenatal care. Increasing maternal age and higher birth order are associated with lower use of medically-trained personnel, especially doctors, during pregnancy. Women with six or more previous births are more than twice as likely to have had no antenatal care during the cun'ent pregnancy as women with no previous births. The primary difference in the use of antenatal services between urban and rural areas is in the use of physicians. Urban women are more I han twice as likely to have received antenatal care from a doctor as rural women. Provincial differences in the use of antenatal care services are small, with the exception of Bulawayo and Harare, where doctors are used ~ ommonly, and Manicaland and Matabeleland North, where doctors are less commonly used. Figure 8.1 Antenatal Care, Tetanus Vaccinations, Place of Delivery, Delivery Assistance ANTENATAL CA':tE w Doctor Nurse/Midwife ~ No Cne~ TETANUS VAC C IN ANTIcOrN ~.~ C,ne P~/S. Two or More PLACE OF DELIVERY Health Factlity Home DELIVERY ASSISTANCE Doctor Nurse/Midwife Traditional Birth Attendant m Relative/Other k~'~ No One m E 21 72 ~6 ~/J//JJJJ//~J17 130 ] e9 m 1 3 20 4O 6O Percent Note: Based on births in the 3 years p, eceding the survey. 80 ZDHS 1994 ~l.e., traditional midwife 108 The use of antenatal care services is strongly associated with mother's education. Women with at least some secondary education are twice as likely to have received antenatal care and four times as likely to have received care from a doctor as women with no educa- tion. Antenatal care is most effective in avoiding adverse pregnancy outcomes when it is sought early in pregnancy and is continued through to delivery. Obstetricians generally recommend that antenatal visits be made on a monthly basis to the 28th week (seventh month), fortnightly to the 36th week (eighth month) and then weekly until the 40th week (until birth). If the first antenatal visit is made at the third month of pregnancy, this optimum schedule translates to a total of at least 12-13 visits during the pregnancy. Information about the number and timing of visits made by pregnant women is presented in Table 8.2. For 74 percent of births, mothers made four or more antenatal care visits, indicating that women are aware of the importance of regular attendance. Yet, for a signifi- cant proportion of births (23 percent), mothers made fewer than four visits; the median number of antenatal care visits was 5.8, far fewer than the recommended number of 12. By the start of the sixth month of pregnancy, over one-third of Zimbabwean women have not made a single antenatal visit (see Table 8.2). The median duration of gestation at which the first antenatal care visit was made was 5.1 months. This delayed use of services, whether because of poor access or poor knowledge by mothers, makes it diffi- cult for the optimum benefits of antenatal care to be realized. Table 8.2 Number of antenatal care visits and stage of pregnancy Percent distribution of hve births m the three years preceding the survey by number of antenatal care vtsits, and by the stage of pregnancy at the time of the first visit, Zimbabwe 1994 Characteristic Percent Number of visits 0 5.6 1 14 2-3 16.4 4+ 74.0 Don't know/missing 2.5 Total 100.0 Median 5.8 Number of months pregnant at time of first visit No antenatal care 5 6 <6 months 65.1 6-7 months 24 8 8+ months 3. I Don't know/mxssing I 4 Total 100.0 Median 5.1 Number of births 2,328 Note: Figures are for bmhs in the period 1-35 months preceding the survey. An important component of antenatal care in Zimbabwe is ensuring that pregnant women and children are adequately protected against tetanus. Tetanus toxoid injections are given during pregnancy for prevention of neonatal tetanus, one of the principal causes of death among infants in many settings around the world. For full protection, a pregnant woman should receive two doses of the toxoid. However, if a woman has been vaccinated during a previous pregnancy, she may only require one dose for a current pregnancy. Table 8.3 presents data on tetanus toxoid coverage during pregnancy for all births in the three years preceding the ZDHS. Less than half of births received the protection of two or more doses of tetanus toxoid during pregnancy, while 36 percent received protection from one dose and 17 percent were not protected by any tetanus toxoid vaccination. As was seen with use of antenatal care services, tetanus toxoid coverage is related to mother's age and birth order of the child. Younger women and women of low parity are more likely to have received two doses of tetanus vaccination. These latter findings, however, may not represent genuine differences in protection against tetanus since older, higher parity women are more likely to have received tetanus toxoid in previous pregnancies. Compared with rural births, births occurring in urban areas are slightly more likely to have received two doses of tetanus toxoid and slightly less likely to have received no tetanus toxoid protection. Regarding provincial differentials, births in Manicaland have the lowest coverage (26 percent with no protection); in all other provinces between 13 and 18 percent of births have no protection against tetanus. I09 Table 8.3 Tetanus toxo~d vaccinatxons Percent distribution of hve births m the three years preceding the survey by number of tetanus toxoid rejections during pregnancy, according to background characteristics, Zimbabwe 1994 Number of tetanus toxoid rejections Two Number Background One doses Don't know/ of characteristic None dose or more Missing Total births Mother's age at birth < 20 11.4 35.6 52.3 0.6 100.0 421 20-34 16.3 36.1 46.0 1.5 100.0 1,603 35+ 25.5 37.7 35.6 1.2 100.0 303 Birth order I 12.2 32.3 54.1 I 4 100 0 613 2-3 13.7 35.2 50.0 1.1 100 0 818 4-5 18.8 40.6 38.6 1.9 I00.0 414 6+ 25.4 39.4 34.3 I 0 100.0 483 Residence Urban 14.2 31 8 51.8 2.1 100.0 608 Rural 17.5 37.8 43.7 1.0 100.0 1,720 Province Mantcaland 26 4 38.3 35.4 0.0 100 0 307 Mashonaland Central 17.7 31.4 49 I 1.9 100.0 202 Mashonaland East 14.6 32.2 51.5 1.7 100.0 240 Mashonaland West 14. I 28.8 56.7 0.4 100.0 274 Matabeleland North 13 4 46.2 39.2 1 2 100 0 183 Matabeleland South 15.4 44.3 39. I 1.2 100.0 132 Midlands 15.9 36.4 46.7 1.0 100.0 324 Masvingo 13.9 45.2 40.1 0 9 100 0 240 Harare 15.0 30.0 52 2 2.8 100.0 310 Bulawayo 17.8 38 5 40 8 2.9 100.0 115 Mother's education No education 19.6 46.0 33 3 1.1 100.0 292 Primary 18.3 37 9 42.8 I 0 100.0 1,169 Secondary+ 13.4 30.8 54.0 I 8 100 0 867 All births 16.6 36.3 45.8 1.3 100.0 2,328 Note: Figures are for births m the period 1-35 months preceding the survey. Women's educat ion is l inked to tetanus toxoid vaccinat ion. For example , only one-third o f births to women who have no formal edut;ation were protected with two doses o f tetanus toxoid, compared with more than hal f o f births to women with some secondary educat ion. Educated women may have greater access to medica l services, may have a bett~ r understanding o f the benefits o f vaccinat ion, or may be more mot ivated to take advantage o f the avai lab le services. 8.2 Ass istance and Medica l Care at Del ivery Another important component o f efforts to reduce the health r isks o f mothers and chi ldren is increas ing the proport ion o f babies that are de l ivered in medica l faci l i t ies. Proper medica l attention and hygien ic condi t ions dur ing del ivery can reduce the r isk o f compl icat ions and infect ions that can cause the 110 death or serious illness of either the mother or the baby. Respondents were asked to report the place of birth of all children born in the three years before the survey (see Table 8.4). At the national level, 69 percent of births in the last three years were delivered in health facilities. Women age 35 years or older are more likely than younger women to deliver at home. Similarly, higher birth order is associated with a greater likelihood of home delivery. A child born in a rural area is four times more likely to have been delivered at home than an urban child. Apart from Harare and Bulawayo, the provinces of Masvingo, Midlands, and Mashonaland East showed the greatest proportions of births delivered in health facilities. Table 8~4 Place of delivery Percent distribution of bxrths m the three years preceding the survey by place of dehvery, according to selected background characteristics, Zimbabwe 1994 Place of dehvery Number Background Health At Don't know/ of characteristic facility home Mlssmg Total births Mother's age at birth < 20 71.3 28.7 0.0 100.0 421 20-34 70.4 28.9 0.7 100.0 1,603 35+ 57.5 41.0 1.5 100.0 303 Birth order 1 79.4 206 0.0 100.0 613 2-3 71.0 28.2 0.7 100.0 818 4-5 67.2 31 9 0.9 100.0 414 6+ 53.4 45.4 1.2 100.0 483 Residence Urban 90.9 8.5 0 6 100.0 608 Rural 61.I 38 2 0 7 100.0 1,720 Province Mamcaland 52.5 46.4 I.I I00,0 307 Mashonaland Central 52.7 46.1 1.3 100.0 202 Mashonaland East 73.3 25.8 0.9 100.0 240 Mashonaland West 54.9 45.1 0.0 100.0 274 Matabeleland North 54.8 44.9 0.3 100 0 183 Matabeleland South 64.6 35.0 0.4 100 0 132 Midlands 75.2 23.7 1.1 100.0 324 Masvingo 76.8 22.3 0.9 100.0 240 Harare 92.8 7 2 0.0 100.0 310 Bulawayo 93.7 5.7 0.6 100 0 I 15 Mother's education No education 39.2 59.1 1.7 100.0 292 Primary 62.4 36.8 0.7 100.0 1,169 Secondary+ 87.6 12.2 0.2 100.0 867 Antenatal care visits None 10.5 89.5 0.0 100.0 131 1-3 visits 61.0 38.5 0.5 100.0 415 4 or more visits 75.3 24.2 0.5 100.0 1,724 Don't know/Missing 67.0 25.1 8.0 100.0 59 All births 68 9 30.4 0.7 100.0 Note: Figures are for btrths xn the period 1-35 months preceding the survey. 2,328 111 There is a marked relationsh p between mother's education and place of delivery. The proportion of births delivered in a health facility increases from 39 percent among women with no education to 88 percent among women with secondary education or higher. Women who have visited a health professional during pregnancy are much more likely to deliver in a health facility than women who have had no such contact. Only 11 percent of women who did not receive any antenatal care delivered in a health facility, compared with 75 percent of women with four or more antenatal visits. The type of assistance a woraan receives during the birth of her child has important health conse- quences for both mother and child. Births that occur at health facilities are more likely to be assisted by trained medical personnel than births occurring at home. Table 8.5 shows that 69 percent of births were delivered under the supervision of persons with medical training, mostly nurses or trained midwives. Tradi- tional birth attendants assisted in 1"~ percent of births, while relatives and friends provided the prtmary assistance in 11 percent of births. Three percent of births were delivered without any assistance. Table 8.5 Assistance during dehvery Percent distribution of blahs in the three years preceding the survey by type of assistance during dehvery, according to selected background characteristics, Zimbabwe 1994 Attendant assisting during delivery Nur~e/ Traditional Don't Number Background Trait ed birth Relative/ No know/ ol characteristic Doctor m~d~ lie attendant I Other one Mtssmg Total btrths Mother's age at birth < 20 13,1 57.~ 18.7 9.7 0 5 0.0 100.0 421 20-34 13.2 57.6 16.6 10.4 2 I 0 1 100.0 1,603 35+ 7.8 50.2 19.8 14.5 7 3 0.4 100.0 303 Birth order I 19.0 59.;~ 13.1 7.8 0,3 00 100.0 613 2-3 12.2 59.5 17.4 100 0.8 0 1 100.0 818 4-5 10.3 57. Z 17.5 12 6 2 1 0.3 100.0 414 6+ 6.5 47 ? 22 6 14.5 8.5 0.2 100 0 483 Residence Urban 24.0 67.1 4. t 3.9 0.8 0 I 100.0 608 Rural 8.4 53.1 22. I 13.3 3. I 0.1 I00.0 1,720 Province Manicaland 6.1 46. ~ 20.2 23.4 3 9 0.0 100,0 307 Mashonaland Central 7.8 45,? 37.1 8 5 0.9 0.0 100.0 202 Mashonaland East 8.7 64 7 16.9 8.5 1.3 0 0 100 0 240 Mashonaland West 6.7 47.~ 25.9 14 5 5.1 0,0 100.0 274 Matabeleland North 8 9 47.1 22.2 18.7 3.2 0.0 100.0 183 Matabeleland South 7.2 57.~ 16.0 16.0 2.9 00 100.0 132 Midlands I 1.9 62.9 18.2 2.5 3 8 1),7 100.0 324 Masvmgo 11.8 66 3 8.2 11 8 2 3 11,0 100.0 240 Harare 26.7 66.7 4.4 2.2 0.0 O.fi 100.0 310 Bulawayo 35.6 58.6 1,7 3.4 0.0 0.6 100 0 115 Mother's education No education 2 4 39.2 27,0 19 3 11.7 0.4 100.0 292 Primary 7,8 54.7 22 0 13.8 1.6 0.1 100,0 I,I 69 Secondary+ 22.1 65.3 8,0 4.0 0 6 0,0 100 0 867 Antenatal care visits None 2,3 7,3 46. I 37.7 6.6 0.0 100.0 131 1-3 visits I 1.1 502 23.2 13.5 I 9 0 0 100.0 415 4 or more visits 13.8 61 8 14.0 8.2 2 1 0 0 100,0 1,724 Don't know/Mtssmg 4 5 63 4 10.0 8.2 9.2 4 8 I(X).O 59 Total 12.5 56 7 17.4 10.8 2 5 0 1 100.0 2,328 Note. Figures are Ibr Nrths m the pertcd 1-35 months preceding the survey If the respondent mentioned more than one attendant, only the most qualified altendant was considered m this table I Tradltmnal midwife 112 There has been virtually no change in the level of assistance provided to Zimbabwean women at delivery since the 1988 ZDHS, when 70 percent received assistance from medically trained personnel, and 3 percent received no assistance. The only shift seems to be that since the 1988 ZDHS, there has been an increase in births attended by traditional birth attendants and a decrease in births attended by friends and relatives only. Maternal age and child's birth order are associated with type of assistance at delivery. Older women and women who have already had many births are more likely to receive no assistance at delivery, whereas, first births and births to younger women tend to receive better care during delivery, including more frequent supervision by a physician. Urban women are much more likely than rural women to receive the benefits of medical supervision during delivery; thus, Harare and Bulawayo provinces show much higher proportions of deliveries under medical supervision than other provinces. In contrast, over 20 percent of births in Manicaland and Matabele- land North are delivered with only friends or relatives assisting, or without any person at all assisting. Mashonaland Central has the highest proportion of births attended by a traditional birth attendant (37 per- cent). Maternal education is closely tied to better supervision at delivery. Women with some secondary education are twice as likely to receive medical assistance and nearly ten times as likely to receive assistance from a doctor as women who have no education. Women who receive antenatal care during pregnancy are more likely to deliver with medical assistance. Seventy-six percent of births to women who had at least four antenatal care visits were assisted at delivery by trained medical personnel, compared with only I0 percent of women who did not receive antenatal care. The combination of poor antenatal care and inadequate medical supervision at delivery increases the risk of poor pregnancy outcome, including maternal mortality. 8.3 Characteristics of Delivery According to mothers' reports, 6 percent of babies born in Zimbabwe are delivered by caesarean section (Table 8.6). Caesarean sections (C-sections) are less common amongst rural women, older women, women with a large number of children, and those with little or no education. Provincial estimates of C- section prevalence vary from 1 percent of deliveries in Mashonaland West to 12 percent in Matabeleland South. Respondents were asked if their babies had been weighed at birth, and if so, how much each baby weighed. In addition, mothers were asked for their assessment of whether the child was very large, larger than average, average size, smaller than average, or very small at birth. For more than two-thirds of births, a birth weight was reported. Among births for which a birth weight was reported, 12 percent (8 percent of all births) were reported to have a weight of less than 2.5 kilograms, which is considered low birth weight. Low birth weight has been shown to place a baby at high risk of early infant death. Nineteen percent of all births were reported to be either small (I 3 percent) or very small (6 percent) at birth. 113 Table 8.6 Delivery characteristics: caesarean sectlon~ birth weight and size Among births in the three years preceding the survey, the percentage of dehveries by caesarean section, and the percent dxstnbution by birth weight and Ihe mother's estimate of baby's size at birth, according to selected background characteristics, Zimbabwe 1994 Birth weight Size of child at birth Dehvery Less 2.5 kg Smaller Average Number Background by than or Don't Very than or Don't of characteristic C-section 2.5 kg more know small average larger know Total births Age <20 5 9 11.4 59.8 28.9 6 5 17.8 75 6 0 I 100.0 421 20-34 6.4 8 0 62.8 29 2 6.3 11.0 82.6 0.1 100,0 1,603 35+ 4.4 5.4 47.0 47.6 4.1 14 9 80 7 0.4 100 0 303 Birth order I 9 2 10.7 69.2 20 1 6 9 14.5 78,5 0.1 100 0 613 2-3 5.3 8.1 63.0 28.9 5.6 10 5 83 9 0 I 100.0 818 4-5 5.0 65 61 3 323 5 1 124 82 1 0.4 1000 414 6+ 4 2 6.9 43 I 50.0 6 6 14 6 78 7 0.2 100.0 483 Residence Urban 71 I1 1 775 113 7.7 83 839 01 1000 608 Rural 5.7 7,2 54.1 38.7 5 5 14 3 80 1 0 2 100,0 1,720 Province Manicaland 56 75 445 480 4.9 [36 81~5 O0 1000 307 Mashonaland Central 6 4 6.8 53 1 40. I 4.0 I 1.5 84 5 0 0 100 0 202 Mashonaland East 5 l 7.4 66.4 26.2 2 6 15.9 81,6 0.0 100 0 240 Mashonaland West 1.2 7 8 59.9 32 3 4 7 14 1 81.2 0.0 100.0 274 Matabeleland North 3.0 7.0 43.7 49.3 7.0 12.8 796 06 1000 183 Matabeleland South 11,6 3 9 60,2 36.0 7.2 I 1,7 81 2 0 0 100 0 132 Mxdlands 7,5 1 I. 1 55,9 33.0 10.4 I 1,6 77 3 0 7 100 0 324 Masvmgo 8.2 5 9 64.7 29 4 4 0 [9 4 76,6 0 0 100.0 240 Harare 7.2 11,7 78.9 9,4 7.8 5.6 86 7 0 0 100 0 310 Bulawayo 6.3 10,3 810 8,6 8.0 12.1 793 06 1000 115 Mother's education No education 1.7 6 1 29.3 64 6 7.8 15 0 76.7 0.6 100.0 292 Primary 5.5 7 5 54 8 37.8 5 0 13 9 81 0 0 l 100 0 1,169 Secondary+ 8 2 10.0 77 9 12.0 6 9 10.4 82 7 0 l 100 0 867 All chddren 6.0 8.3 60.2 31 5 6.1 12 7 81.1 0.2 1000 2.328 Note Figures are for births xn the period 1-35 months preceding the survey 8.4 Vaccinations In o rder to ass is t in the eva luat ion o f the Expanded Programme o f Immunisat ion (EPI) , the ZDHS co l lec ted in fo rmat ion on vacc inat ion coverage for all ch i ldren born in the three years preced ing the survey, a l though the data presented here are restr icted to ch i ld ren who were a l ive at the t ime o f the survey. The EP I la rge ly fo l lows the Wor ld Hea l th Organ isat ion (WHO) gu ide l ines for vacc inat ing ch i ldren. In o rder to be cons idered fu l ly vacc inated, a ch i ld shou ld rece ive one dose o f BCG vaccine, three doses each of DPT and po l io vacc ine , and one dose of meas les vacc ine. BCG shou ld be g iven at b i r th or f i rst c l in ic contact and protects aga ins t tubercu los i s ; DPT protects aga ins t d iphther ia , pertuss is , and tetanus. DPT and po l io requ i re three vacc inat ions at approx imate ly three, four, and f ive months o f age; meas les shou ld be g iven at or soon 114 after reaching nine months. WHO recommends that children receive the complete schedule of vaccinations before 12 months of age. Information on vaccination coverage was collected in two ways: from child health cards shown to the interviewer and from mothers' verbal reports. The majority of health centres and clinics in Zimbabwe provide cards on which vaccinations are recorded. If a mother was able to present such a card to the interviewer, this was used as the source of information, with the interviewer recording vaccination dates directly from the card. In addition to collecting vaccination information from cards, there were two ways of collecting the information from the mother herself. If a vaccination card had been presented, but a vaccine had not been recorded on the card as being given, the mother was asked to recall whether or not that particular vaccine had been given. If the mother was not able to provide a card for the child at all, she was asked to recall whether or not the child had received BCG, polio and DPT (including the number of doses for each), and measles vaccinations. Information on vaccination coverage is presented in Table 8.7, according to the source of information used to determine coverage, i.e., the child health card or mother's report. Data are presented for children age 12-23 months, thereby including only children who should be fully vaccinated. For example, 78 percent of children had a BCG vaccination recorded on their available card. However, not all children who are vaccinated have cards available; 17 percent of children did not have a card but were reported by their mothers to have received the BCG vaccine. Thus, overall, 96 percent of children age 12-23 months are estimated to have been vaccinated against tuberculosis. Vaccinations are most effective when given at the proper age; according to the card information, 95 percent of children receive the BCG vaccine by 12 months of age. Figure 8.2 summarises vaccination coverage in Zimbabwe. Table 8.7 Vaccmations by source of information Percentage of chddren 12-23 months who had received specific vaccines at any time before the survey, by whether the reformation was from a vaccination card or from the mother, and the percentage vaccinated by 12 months of age, Ztmbabwe 1994 Percentage of chddren who received: DPT Polio Percent Number Source of of of reformation BCG 1 2 3+ 1 2 3+ Measles An t None chddren children Vaccinated at any time before the survey Vaccination card 78.4 77 3 75.9 73 2 77.6 75.8 73 2 72.1 70.3 0 5 79.1 547 Mother's report 17.4 16.9 15.7 11.9 17.0 16.1 12 2 14.2 9.8 3.6 20.9 145 EHher source 95.7 94.2 91,5 85.2 94 5 91.9 85 4 86.3 80.1 4.1 100.0 691 Vaccinated by 12 months of age 94.6 93.1 89.1 80.4 93.4 89.4 80.3 73.9 67.2 4.9 100.0 691 Note: For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. IChddren who are fully vaccinated (i.e., those who have received BCG, measles and three doses of DPT and poho). 115 Figure 8.2 Percentage of Children Age 12-23 Months with Specific Vaccinations Percent 100 80 g6 6O 20 BCG £5 e,~ 94 ~,~ 86 F t 2 3 1 2 3 Measles All None Poio DPT Note. Based on hea)th cards and mothers' reports ZDHS 1994 Coverage for the first doses 3f polio and DPT is nearly universal, 93 to 95 percent depending on the vaccine and timing. Coverage declines after the first dose, with 92 and 85 percent of children receiving the second and third doses of both vaccines, respectively. This yields a dropout rate 2 of about 10 percent for both DPT and polio vaccine. Eighty-six percent of children age 12-23 months were vaccinated against measles; 74 percent before their first birthday. Less than 5 percent of children age 12-23 months had received no vaccinations. Overall, 80 percent of children age 12-23 months had all the recommended vaccinations, 67 percent before their first birthday. The 1988 ZDHS reported coverage at 86 percent (all vaccinations, children 12-23 months); however, this estimate is biased upwards because it is based only on data from children with health cards (i.e., it assumes that vaccination coverage among children without cards is as high as among those with cards). Boerma et al. (1990) recalculated coverage from the 1988 ZDHS data, including reports from mothers on whether the children without cards had ever been vaccinated. Using these data, a more plausible 1988 estimate of 79 percent was obtained. A reasonable interpretation of these findings is that vaccination coverage remains roughly unchanged since 1988 at about 80 percent. Table 8.8 presents vaccination coverage (according to card information and mothers' reports) among chddren age 12-23 months by selected background characteristics. The differentials in coverage are very similar irrespective of vaccine type. Looking at the differentials in complete coverage (i.e., all vaccines received), there is virtually no difference between boys and girls. Children of high birth order (6+) tend to have lower coverage than children of lower birth order. Children from urban areas have a slightly higher coverage rate (84 percent) than rural children (78 percent). Complete coverage increases with increasmg 2 The dropout rate is defined as the percentage of children receiving the first dose who do not subsequently receive the third dose of DPT or polio vaccine 116 Table 8.8 Vaccinations by background characteristics Percentage of children 12-23 months who had received specific vaccines by the rune of the survey (according to the vaccination card or the mother's report) and the percentage with a vaccination card, by selected background characteristics, Zimbabwe 1994 Percentage of chtldren wtto received: Percent wnh DPT Poho vaccl Number Background nanon of characteristic BCG I 2 3+ I 2 3+ Measles All j None card children Sex Male 95.3 92.9 89.8 82 6 93 6 90.7 84.1 86 3 79.2 4 7 78 5 330 Female 96.1 953 93.1 87.5 95.4 929 866 86.3 809 3.5 796 361 Birth order 1 97.1 94 3 93.5 88.0 94.9 94 2 88.7 89 I 84 8 2 9 78,9 184 2 3 96.6 95.6 92.4 87 2 96.0 92~9 87 8 88 1 80.0 3 4 78 3 249 4-5 972 968 95.4 891 972 95.9 895 900 84.1 28 824 120 6+ 91 0 89.1 g4.0 74 3 89 1 83.5 73 4 76.3 70.7 g 0 77 8 139 Residence Urban 96.6 96 0 94.8 89.6 96 0 94.5 89.6 8%7 84.2 3 4 79,2 215 Rural 95,3 93.3 90 0 83.1 93 9 90 7 83.5 85.7 78 2 4.4 79 0 476 Mother's education No education 91.7 92 7 87.8 76.7 92 7 86.4 76,4 78.9 72 7 6.7 81,5 94 Primary 95 1 92.9 90.1 82,5 93 5 90.7 82 9 84 3 76.8 4,9 78.8 336 Secondary+ 97.9 96.4 942 91 7 96.6 95.3 91.9 91 6 87 1 2 1 78 5 261 All children 957 942 91.5 85.2 945 91.9 854 86.3 80.1 41 791 691 IChddren who are fully vaccinated (i e., those who have received BCG, measles and three doses of DPT and polio). maternal education, from 73 percent among children of uneducated mothers to 87 percent among children of mothers with some secondary education. 8.5 Acute Respiratory Infection Pneumonia is a leading cause of childhood mortality in Zimbabwe. The programme to control acute respiratory infections (ARI) aims at treating cases of ARI early before complications develop. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths due to pneumonia. Emphasis is, therefore, placed on recognition of signs of impending severity, both by mothers and primary health care workers so that help can be sought. The prevalence of ARI was estimated by asking mothers if their children under age three had been ill with coughing accompanied by short, rapid breathing, in the two weeks preceding the survey. These symptoms are compatible with pneumonia. It should be borne in mind that morbidity data collected in surveys are subjective--i.e., mother's perception of illness--and not validated by medical personnel. Table 8.9 shows that 25 percent of children under three years of age were ill with a cough and short, rapid breathing at some time in the two weeks preceding the survey. Prevalence of respiratory illness varies by age of the child, rising to a peak at 6-11 months of age, then falling slowly to a low at 24-35 months of age (see Figure 8.3). Sex of the child is not associated significantly with AR1, but prevalence does increase slightly with increasing birth order of the child. 117 Table 8.9 Prevalence and treatment of acute respiratory infection and prevalence of fever Percentage of children under three 3,ears who were ill with a cough accompanied by short, rapid breathing (acute respiratory infection) during the two weeks preceding the survey, the percentage of ill children who were taken to a health facthty, and the pe "centage of children with fever during the two weeks preceding the survey, by selected background characterist,cs, Zimbabwe 1994 Percentage of children with Percentage cough and rapid of chik ren breathing who were Percentage Background with cou,~ h and taken to a health of chddren charactensttc rap~d breathing facdtty or provider I with a fever Number of chddren Child's age < 6 months 23.4 47.2 30.4 384 6-11 months 33.7 52.3 50.5 406 12-17 months 27.8 54.4 43.6 322 18-23 months 24.8 56.9 41.3 369 24-29 months 20 8 56.4 35.8 352 30-35 months 21.5 46.1 36.2 387 Sex Male 26.? 51.0 39 5 1,080 Female 24. f, 53.4 39.9 1,142 Birth order 1 23.:~ 46.5 36.3 586 2-3 25.5 58.6 38.6 776 4-5 25.2 53.2 42.7 392 6+ 28. 47.6 43 2 466 Residence Urban 15.2 63 6 34.5 585 Rural 29.0 50.0 41.5 1,636 Province M anicaland 26.4 42.0 41.9 282 Mashonaland Central 27 ~ 52.1 44.2 192 Mashonaland East 21.0 (41 5) 35.0 230 Mashonaland West 41 .~ 53.0 51.4 255 Matabeleland North 22 5 (48.2) 21.0 173 Matabeleland South 9 ~ * 12 3 128 Midlands 33.2 58.8 52.5 309 Masvmgo 33.7 48.0 53.1 228 Harare 11 7 (66.7) 38.5 309 Bulawayo 12.7 * I0 4 115 Mother's education No education 29.9 52.5 44.7 272 Pnmary 27.4 48.4 41.7 1,108 Secondary+ 21.3 58.4 35.4 841 All children 25.4 52.2 39.7 2,221 Note. Figures are for children born m the period 0-35months preceding the survey. Figures m parentheses are based on 25-49 dl chddren. An asterisk indicates that a figure is based onfewerthan 25 children and has been suppressed. qncludes health centre, hospttal, chnic, and private doctor 118 40 30 20 10 Figure 8.3 Prevalence of Respiratory Illness and Diarrhoea in the Last Two Weeks by Age of the Child Percent , / , - - - . I i i i i i 6 12 18 24 30 36 Age of Chitd {Months) ZDHS 1994 Urban-rural and provincial differences are substantial. Children in rural areas are almost twice as likely to have been ill with ARI in the last two weeks (29 percent) as urban children (15 percent). Children in Harare and Bulawayo have relatively low levels of reported ARI at around 12-13 percent. Amongst the rural-based provinces, ARI prevalence (0-35 months) varies widely from 42 percent in Mashonaland West province to only 10 percent in Matabeleland South province. Whether this wide range of apparent ARI prevalence reflects genuine differences in morbidity, or is due to differences in perceptions of disease or disease severity cannot be ascertained from these data. The ZDHS data do show that children of women with secondary education were 25 percent less likely to be ill with ARI than children of women with less education. Fifty-two percent of children with respiratory illness were taken to a health facility of some kind. The youngest (0-5 months) and oldest (30-35 months) of under-three children have lowest rates of health facility use. Urban children with ARI were more likely to be taken for health services than their rural counterparts. Education-related differentials in facility use are small or negligible. 8,6 Fever Malaria is endemic throughout most of Zimbabwe and is a common cause of hospital admission for all age groups. Since the major manifestation of malaria is fever, mothers were asked whether their children under age three had a fever in the two weeks preceding the survey. Table 8.9 (column 3) shows that 40 percent of children under three years of age were reported to have had fever in the two weeks prior to the survey. As with respiratory illness, prevalence of fever peaks at age 6-11 months (51 percent). Differentials by sex and birth order of the child are negligible, but urban-rural, provincial, and maternal education-related differences are substantial and roughly parallel those already described regarding ARI prevalence. 119 8.7 Diarrhoea Dehydration caused by severe diarrhoea is a major cause of morbidity and mortality among young children. A simple and effective response to a child's dehydration is a prompt in- crease in fluid intake, i.e., oral rehydration therapy (ORT). In Zimbabwe, the use of a sugar- salt-water solution (SSS) to combat dehydrating diarrhoea is the particular method of ORT pro- moted by the Control of Diarrhoeal Disease (CDD) programme in the Ministr) of Health. The chief concern of the CDD is to prevent de- hydration or to treat it early before it becomes life-threatening. In the ZDHS, women who had a birth in the last three years were asked questions regard- ing their knowledge of SSS and treatment of diarrhoea in general. For all children experienc- ing a bout of diarrhoea in the last two weeks, mothers were asked whether there was blood in the stools, whether fluid intake was increased or decreased, whether the child was gi yen a sugar- salt-water solution, and what else was given to the child in response to the diarrhoea. Table 8.10 presents the plevalence of diarrhoea in children under three years of age. Twenty-four percent of children had experienced diarrhoea at some time in the two weeks preced- ing the survey; 3 percent of childrer had experi- enced bloody diarrhoea. Diarrhoeal prevalence increases with age to a peak at 12-17 months (36 percent) then falls again at older age~ (see Figure 8.3). A similar pattern is observed regarding bloody diarrhoea except that prewlence levels off at around 4 percent between 12.35 months. Sex and birth order of the child are not important factors related to diarrheea. Children from different parts of the country are, however, exposed to varying risks of diarrhoea. Rural chil- Table 8.10 Prevalence of diarrhoea Percentage of chddren underthree years who had dia~hoea and dla~hoea with blood m the two weeks preceding the survey, by selected background charactenshcs, Zimbabwe 1994 Diarrhoea in the preceding 2 weeks Number Background All Diarrhoea of characterlsnc dmrrhoea weth blood children Child's age < 6 months 13.8 1 7 384 6-11 months 33 2 2,6 406 12-17 months 36.0 4 5 322 18-23 months 27 3 3.5 369 24-29 months 17 I 4 4 352 30-35 months 14 4 3 5 387 Sex Male 25.1 3.3 1,080 Female 21.9 3.3 1,142 Birth order I 231 2 9 586 2-3 23.1 3.7 776 4-5 23 2 2 7 392 6+ 24 8 3 6 466 Residence Urban 17 9 1.7 585 Rural 25 5 3 9 1,636 Province Mamcaland 25.4 2. I 282 Mashonaland Central 27 4 2 7 192 Mashonaland East 19 0 3 I 230 Mashonaland West 27.1 3.7 255 Matabeleland North 24.9 5.8 173 Matabeleland South 11.9 3 0 128 Midlands 26 5 3 5 309 Masvmgo 30 0 4,8 228 Harare 19.0 1.7 309 Bulawayo 14.5 4.0 115 Mother's education No educateon 28,7 4.1 272 Primary 23.9 3.8 1,108 Secondary+ 21.1 2.3 841 All chddren 23.5 3.3 2,221 Note' FDgures are for chddren born m the penod 0-35 months precedmg the survey. dren have a 40 percent greater char ce of contracting diarrhoea than urban children and are more than twice as likely to have bloody diarrhoea as their urban counterparts. Prevalence is highest in Masvingo (30 percent) and lowest in Matabeleland Soutt (12 percent). The children of women with more education are less commonly sick with diarrhoea and bloody diarrhoea than children whose mothers have less education. 120 General knowledge of sugar-salt-water solution is nearly universal (99 percent) among mothers; yet when asked about specific eating and drinking regimes for sick children, the findings are less encouraging (Table 8.11). Among women with children under three, 17 percent said that a child who is sick with diarrhoea should get less to drink, and 22 percent said they should get less to eat. Women who are more educated and those living in urban areas tend to be more knowledgeable about appropriate feeding and drinking practices for children with diarrhoea. Table 8.11 Knowledge of dmrrhoea care Percentage of mothers wtth births m the last three years who know about the use of sugar-salt-water solution for treatment of diarrhoea (oral rehydration therapy-ORT) and the percent distribution by knowledge of appropnate feeding during diarrhoea, according to background characteristics, Zimbabwe 1994 Quantities that should be given during dian'boea Know about sugar- Liquids Solid foods salt-water solutton for Don't Don't Number Background treatment know/ know/ of characteristic of dxarrhoea Less Same More Missing Less Same More Missing Total mothers Age 15-19 96.8 20.7 15.8 61.0 2,6 20.1 33.6 45.0 1.3 100.0 208 20-24 98.5 173 11.3 70.5 0.9 20,6 25.2 53.1 0.8 100.0 680 25-29 99.1 13.9 8.8 76.4 1.0 207 27.0 51.6 0,8 1~.0 471 30-34 98 8 18.1 8.9 72.6 0.4 27.1 26 2 46.3 0.5 100.0 419 35+ 99.6 14A 8.8 76.3 0.8 22.7 26 6 49.5 1.0 100 0 379 Residence Urban 99.0 11.2 8 0 80 3 0.6 19.9 31 5 47 6 0 7 100.0 575 Rural 98.6 18.4 11.1 694 I 1 23.0 25.2 50.9 0.8 1000 1,581 Province Mamcaland 97.9 17.1 8,5 74.5 0.0 22.0 25.7 51.8 0 5 100.0 282 Mashonaland Central 98.9 147 11.0 74.3 0.0 19.8 275 51.7 0.9 100.0 188 Mashonaland East 99.5 93 8.7 80.6 1.4 29,8 25.6 44.6 0.0 I f~0 219 Mashonaland West 98.7 16.2 11.4 72.0 0.4 20.1 17.5 62,4 0 0 100.0 250 Matabeleland North 97.4 21.3 8 1 65 1 5.5 27.2 20 8 46 8 4 8 1130 0 165 Matabeleland South 98.7 28.9 8.4 609 I 7 24.2 32.7 43A 0.0 1000 125 Midlands 98.9 17,1 11.6 70 9 0.4 18.0 29.7 51 9 0.4 100.0 294 Masvmgo 99.5 22 1 15.5 61.9 0.5 24.9 25 3 48 9 0 9 100.0 220 Harare 98 9 7 4 7.4 85.1 0.0 19.4 28.6 51.4 0.0 100 0 302 Bulawayo 98.2 23.4 13,2 60 5 3 0 20.4 45.5 31.1 3.0 100 0 111 Mother's education No educanon 97.2 21 6 I4.3 62.3 1.7 31 9 24 2 43.2 0.7 100,0 272 Primary 98.6 19.6 10.8 68.8 0.9 22.6 25 0 51 8 0 5 100,0 1,077 Secondary+ 99 3 10 5 8 3 80.4 0.8 18.4 30 3 49.9 1 2 100 0 807 All mothers 98.7 16.5 10.3 72 3 1 0 22.2 26.8 50 0 0.8 100.0 2,155 Table 8.12 shows treatment of recent episodes of diarrhoea among children under three years, as reported by the mother. The ZDHS indicates that 30 percent of children with diarrhoea in the last two weeks were taken to a health facility for treatment; older children and children of more educated women were more likely to be taken to a facility. 121 Table 8.12 Treatment of diarrhoea Among children under three years who had diarrhoea in the two weeks preceding the survey, the percentage taken for treatment to a health facility or provider, the percentage who received oral rehydration therapy (either sugar- salt-water solution (SSS) or other recommended home fluids (RHF)) and increased fluids, the percentage who received neither oral rehydratlon therapy nor increased fluids, and the percentage receiving other treatments, by background characteristics, Zimbabwe 1994 Other treatments Percentage taken to Oral rehydratlon therapy Neither Home a health In- ORT nor remedy/ No Number Background facihty or SSS or creased increased Injec- treat- treat- of characteristic provider t SS8 RHF RHF fluids flmds tion ment ment chddren Chi ld 's age < 6 months 26 6 62A 7 8 62.4 45.3 26.8 0 0 27 7 21.9 53 6-11 months 27 2 77 ~ 19.0 79.2 59.7 15 9 0.0 27.5 11.1 135 12-17 months 25 2 77 ~ 9 3 77.8 59.9 12.4 0.9 24.7 10.4 116 18-23 months 28.8 83.5 10 6 83.7 55.4 9.9 0 0 34 9 5 9 101 24-29 months 39.9 84~' 13.7 849 623 10.2 0.0 38.2 4.6 6(I 30-35 months 39 1 86{; 13 1 86.7 71.1 9 3 1 8 28 8 6 4 56 Sex Male 28.9 78.t, 140 792 56.6 155 0.0 29.8 109 271 Female 30.7 79 [; 11 5 79.8 61.5 I 1.8 0.8 29.6 8.5 250 Birth order 1 27.2 75.5 11 4 75 5 53.5 17.1 0.0 26.5 12.5 135 2-3 36.2 80.5 148 80.5 56.7 15.7 I 2 33 1 120 179 4-5 284 80 't 13.8 826 63.8 9.1 0.0 347 5.7 91 6+ 238 80.2 10.7 80.2 65 1 102 00 24.4 63 116 Residence Urban 26 7 81.11 14.0 83.5 77.3 5 6 0 0 28 6 4 8 105 Rural 30.5 78~ 12.5 78.5 544 157 05 30.0 110 416 Mother 's education No education 22.2 73.3 12 6 73.3 62.7 19.6 0.0 28.9 13 0 78 Primary 29 6 80 I 11.9 80 4 53.4 12.9 0.4 29.2 8.1 265 Secondary+ 33.3 79 ~ 14 3 80 9 65.6 12.3 0.6 30.8 10.9 178 All children 297 792 12.8 79.5 59.0 137 04 297 98 521 RHF --. Other recommended home fired SSS = Sugar-salt-water solution Jlncludes health centre, hospital, clinic, and private doctor Sugar-salt-water solution C~SS) was used to treat 79 percent of children with diarrhoea, 13 percent received other types of recommencted home fluids (RHF). However, for only 59 percent of children with diarrhoea mothers reported giving the children more to drink than before the diarrhoea. If accurate, this suggests that some children (20 percent) are receiving SSS without increasing fluid intake. Overall, 14 percent of children were given neither SSS nor RHF nor increased fluids, placing this group at higher risk of mortality. Very few children with diarrhoea were given antibiotic injections, but 30 percent were provided some sort of home-based traditionat remedies, predominantly herbal medicines. Ten percent of children did not receive any treatment for their ,:liarrhoea. 122 Generally, therapeutic intervention increases with increasing age and birth order of the child. For example, increased fluid intake increases from 45 percent among children under 6 months to 71 percent among children 30-35 months. Similarly, non-treatment drops sharply with increasing age and birth order of the child. Urban children and children of more educated women are also more likely to be treated at a facility or with some form of oral rehydration, but the relationship is not very pronounced. Table 8.13 shows that over half of children sick with diarrhoea were given less food during the illness, and 22 percent received less to drink. These patterns reflect a lack of practical knowledge among some women regarding the nutritional requirements of children during episodes of diarrhoeal illness. Table 8.I3 Feeding practices during diarrhoea Percent distribution of children under three who had diarrhoea in the past two weeks by amount of solid foods given and amount of fluids gwen, Zimbabwe 1994 Fecdxng practices Total Amount of solid foods Same 24.0 Increase 24.0 Decrease 51.5 Don't know/mtssing 0.5 Amount of fluids Same 18.8 Increase 59.0 Decrease 22.3 Total I09,6 Number of children 521 Note. Ftgures are for children born in the period 0-35 months preceding the survey. 123 CHAPTER 9 MATERNAL AND CHILD NUTRITION The ZDHS collected data from mothers regarding the feeding patterns of all of their children under three years of age. In this chapter, the data are used to evaluate infant feeding practices, including breast- feeding durations, introduction of supplementary weaning foods, and use of feeding bottles. As part of the survey, the heights and weights of all children under three and their mothers were measured, allowing cross- sectional assessment of maternal and child nutritional status. 9.1 Breastfeeding and Supplementation The pattern of infant feeding has important influences on both the child and the mother. Feeding practices are the principal determinants of a child's nutritional status. Poor nutritional status in young children exposes them to greater risks of morbidity and mortality. Breastfeeding affects mothers through the biological suppression of return to fertile status, thereby affecting the length of the inter-birth interval and pregnancy outcome. These effects are influenced by both the duration and frequency of breastfeeding, and by the age at which the child receives foods and liquids to supplement breast milk. 9.1.1 Initiation of Breastfeeding Colostrum, which is contained in the very first breast milk after delivery, has been shown to be highly nutritious and to contain a high concentration of antibodies which protect babies from infection before the child's immune system has matured. To facilitate early initiation of breastfeeding, the Ministry of Health and Child Welfare (MOH&CW) has promoted "rooming in" in maternity hospitals to ensure that newly-born babies are kept with their mothers at bedside, allowing feeding on demand as opposed to scheduled feeding in nursery. The baby-friendly hospital initiative is being actively promoted. Bottle feeding is discouraged and mothers are educated to breastfeed exclusively until the child is 4-6 months old. Use of infant formula is advised only in those few cases that are medically indicated. Table 9.1 shows that breastfeeding is nearly universal in Zimbabwe with 99 percent of children born in the last three years having been breastfed at some time. 1 Overall, 40 percent of children were breastfed within an hour of birth and 91 percent in the first 24 hours after delivery; however, this varies by province. Over 50 percent of newborns in Matabeleland South, Matabeleland North, and Masvingo were breastfed within an hour of delivery, while less than 30 percent of newly-born babies received the same attention in Midlands and Mashonaland East provinces. Children are slightly less likely to receive early breastfeeding if they were delivered at home or if the delivery was assisted by a traditional midwife (TBA). 9.1.2 Age Pattern of Breastfeeding Breast milk contains all the nutrients needed by children in the first 6 months of life and is an uncontaminated nutritional source. Supplementing breast milk before 4 months of age is unnecessary and is indeed discouraged since the likelihood of contamination and resulting risk of diarrhoeal disease are high. Early supplementation also reduces breast milk output, since the production and release of milk is modulated by the frequency and intensity of suckling. The remaining I percent are comprxsed, in large part, of children who died during the neonatal period and were probably unable to breastfeed. 125 Table 9.1 lmtlal breastfeedmg Percentage of children ~om in the three years preceding the survey who were ever breastt~d, and the percentage of last-born children who started breastfeedmg within one hour of birth and within one day of birth, by selected background characteristics, Zimbab~ce 1994 Among last-born children, percentage who started breastfeeding: Percentage Within Within Number Background ever 1 hour 1 day of characteristic breastfed of birth of birth children Sex Male 98.5 39.5 89.9 1,159 Female 98.9 40.6 91.6 1,205 Residence Urban 98.7 41.7 90 2 617 Rural 98 7 39 4 91.0 1,747 Province Mamcaland 98.6 31.2 91.6 311 Mashonaland Centra' 98.7 41.2 85.4 203 Mashonaland East 98.9 29 1 92.2 244 Mashonaland West 98. I 39.4 91,4 279 Matabeleland North 97.4 52.6 85.3 184 Matabeleland South 99 0 59.8 92,3 135 Midlands 98.9 27.5 92.5 33 I Masvingo 99.6 50 7 95,1 245 Harare 99 5 45.9 90. I 314 Bulawayo 97 8 40 8 87,9 118 Mother's education No education 98 9 44.9 92.8 297 Primary 98.7 39.2 91.2 1,183 Secondary* 98.6 39.5 89,5 884 Assistance at delivery Medically trained person 98.8 41.3 91.6 1,640 Tradmonal birth attendant 98.7 35 4 88,0 406 Other or none 98.5 40.0 90.8 316 Place of delivery Health facility 98,8 41,3 91.6 1,633 At home 98 6 37.6 89.2 715 All children 98,7 40,0 90.8 2.364 Note: Total includes 3 children for whom data on assistance at delivery are missing and 15 children for whom place of dehvery is missing. Tab le 9.2 shows breast feeding pract ises f rom birth unti l the third birthday. By 10-11 months of age, 95 percent o f ch i ldren are stil l breastfed; even by 16-17 months, 72 percent are being breastfed. By 22-23 months o f age, only 20 percent ar~ stil l rece iv ing some breast milk, and by the end of the third year all ch i ldren have been complete ly weaned. 126 Table 9.2 Breastfeeding status Percent distribution of hving children by current breastfeeding status, according to child's current age in months, Zimbabwe 1994 Percentage of living children who are: Bmastfeeding and: Number Not Exclusively Plato of breast- breast- water Supple- living Age in months feedang fed only ments Total children <2 0.4 18.6 29.0 51,9 100.0 127 2-3 2. I 13.7 18.9 65~2 100.0 ] 34 4-5 0.5 0.9 9.0 89.6 100.0 124 6-7 0.8 0.8 3.8 94,7 100.0 133 8-9 1.4 0.0 1.9 96,7 I(30.0 144 10-11 5.0 1.3 0.0 93,7 100.0 129 12-13 10.8 1.8 0.0 87.4 lOO.O 116 14-15 10.7 0.0 0.0 89.3 100.0 107 16-17 28.0 0,7 0.0 71,3 100.0 99 18-19 41.8 0.0 0.0 58,2 100.0 143 20-21 68.4 0.0 0.5 31,2 100.0 111 22-23 80.4 0.0 0.0 19.6 100.0 115 24-25 90.5 0.8 0.0 8,7 100.0 127 26-27 94.8 0.0 0.0 5,2 100.0 126 28-29 96.7 0.0 0.0 3.3 100.0 100 30-31 98.1 0.0 0.0 1.9 100.0 113 32-33 98.4 0.0 0.0 1.6 100.0 141 34-35 100.0 0.0 0.0 0.0 100.0 133 0-3 months 1.3 16.1 23.9 58.8 100.0 261 4-6 months 0.8 I. 1 7.3 90.8 I(30.0 199 7-9 months 1.0 0.0 2.1 96,9 100.0 202 Note: Breastfeeding status refers to preceding 24 hours. Children classified as breastfeeding and plain water only receive no supplements. Supplementation of breast milk starts early in Zimbabwe. Exclusive breastfeeding 2 is not common; only 19 percent of children under 2 months, and 16 percent of children under 4 months of age are fed only breast milk. Most children are given plain water (29 percent) or other foods and liquids (52 percent) in addition to breast milk during the first two months. By 2-3 months, two-thirds of children are given some form of food supplementation; by 4-5 months, 90 percent of children have received supplements in addition to breast milk. Table 9.3 shows that the duration and frequency of breastfeeding vary by background characteristics of the mother. At the national level, the median duration of any breastfeeding is over 18 months. The median durations of exclusive breastfeeding and full breastfeeding (breastfeeding plus plain water only) are both less than one month. Median length of breastfeeding tends to be longer in rural areas (19.2 months) than in urban areas (17.6 months); and amongst uneducated women (20.1 months) compared with women who have some primary education (19.0 months) or secondary education (17.8 months). Breastfeeding duration is longest in Masvingo province (20.1 months) and shortest in Bulawayo (16.8 months). 2 Exclusive breastfeeding is the practise of feeding with breast milk only, as recommended by the World Health Organisation, for the first 4-6 months of life. 127 Table 9.3 Median duration and frequency of hreastfeeding Median duration of any breastfeeding, exclusive breastfeedmg, and full breastfeeding among children under three years of age, and the percentage of children under 6 months of age who were breastfed stx or more times in the 24 hours preceding the interview, according to background charactetastics, Zimbabwe 1994 Children under 6 months Vledlan duration m months I Number of Breastfed children 6+ times ~ny Exclusive Full under in Number Background breast- breast- breast- 3 years preceding of characteristic feeding feeding feeding 2 of age 24 hours children Sex Male [ 8.5 0 4 0.6 Female J 8.6 0.5 1.0 Residence Urban 17.6 0.5 1.3 Rural 19.2 0.5 0.7 Province Mamcaland 18. I 0.5 2.0 Mashonaland Central 18.6 0.4 0.4 Mashonaland East 18.1 0,5 0 7 Mashonaland West 18.7 0.4 0.5 Matabeleland North 19.3 0.6 2.6 Matabeleland South 17 5 1.0 2.4 Midlands 18.2 0.4 0 7 Masvmgo 20 1 0.4 0 6 Harare 19.0 0.5 1.8 Bulawayo 16.8 0 6 0 7 Education No education 20.1 0.5 1.7 Primary 19.0 0.5 0 6 Secondary+ 17.8 0 4 0.9 Assistance at delivery Health professtonal 18.4 0.5 0.8 Trad. birth attendant 18.5 0.4 0.6 Other or none 19.6 0.4 0.6 Total 18,5 0.5 0 7 Mean Prevalence/Incidence 4 1,159 93,3 180 1,205 94 3 205 617 90.6 89 1,747 94.8 296 311 203 244 279 184 135 331 245 314 118 297 97.3 40 1,183 96.3 179 884 90.3 166 1,640 93 6 263 406 96,6 63 316 92.0 59 2,3643 93.8 384 18.8 1.4 2.6 98.8 18.2 07 20 i Medians and means are based on current status 2 Either exclusive breastfeeding or breastfeeding and plain water only 3 Total includes 3 children for whom data on assistance at dehvery are missing. 4 Prevalence-incidence mean The daily frequency of brea~,~tfeeding in Zimbabwe tends to be high. Ninety-four percent of children under 6 months of age were breastfed 6 times or more in the 24 hours preceding the survey. 9.1.3 Types of Supplemental Foods Table 9.4 presents information on the types of foods received by children in the first three years of life, according to whether or not the child is still bemg breastfed. As shown previously, exclusive 128 Table 9.4 Types of foods received by children xn preceding 24- hours Percentage of children under 36 months of age who received specific types of food in the 24 hours before the interview, and the percentage using a bottle with a nipple, by breastfeedmg status and chdd's age in months, Zimbabwe 1994 Meat/ Using Breast poultry/ Fruits/ bottle Number Age milk Infant Other Other fish/ vege- with a of (in months) only formula milk liquid eggs Porridge tables Other nipple chddren BREASTFEEDING CHILDREN 0-1 18.7 4.8 3.4 35.3 0.0 20.1 0.0 0 9 4.8 126 2-3 14 0 3 3 8 I 33.4 0.9 51.1 2 5 1.3 6.2 131 4-5 09 5.2 16.0 34.7 109 85.1 17.7 19.9 53 123 6-7 0.8 3.5 14.4 36 2 17 5 86.4 32.8 50.5 5.7 132 8-9 0.0 5.0 21.0 46.4 33.7 87.6 50.4 79.2 8.2 142 10-11 1 4 8 8 25.1 49.2 36.1 87.5 71.9 83.7 5.8 123 12-13 2 0 1.0 24.2 45 2 48 8 85.2 79.9 88.0 2 4 103 I4-15 0.0 4.4 26.5 44.7 52.6 92.3 92.1 91.3 5 1 95 16-17 1.0 3.4 25.2 65.7 53.2 85.4 85.3 92.5 3.8 72 18-23 0.0 1.3 27.7 56.4 58.5 88.9 84.0 93.0 5.5 141 24-35 (39) (2.1) (13.7) (49.6) (59.8) (83.2) (81.7) (85.8) (4.1) 26 0-3 months 16.3 4.0 5.8 34.3 0.4 35 9 1.3 1.1 5.5 257 4-6 months 1.1 4.5 15.5 35.9 12.0 84 6 20.4 27.2 6 5 197 7-9 months 0.0 4 6 19.0 42.8 30.3 88.2 48.3 75.0 6.5 200 Total 4 1 4.1 18.5 44.0 302 76.3 49.4 58.2 54 1,215 NON-BREASTFEEDING CHILDREN I2-17 NA 11 4 34.6 53.0 52.9 76 7 69.9 76.9 22.4 52 18-23 NA 3 4 40.5 64.3 60.9 82.3 75.8 85.0 6.6 228 24-29 NA 2 7 34 0 60.0 53.0 76.2 80.0 84.2 4.5 331 30-35 NA 2.9 28 8 59 4 54 2 77.0 82 7 86 1 2 6 382 Total NA 3.9 33.5 60.4 55.2 78.2 79.6 84.5 5.7 1,006 Note: Figures m parentheses are based on 25-49 cases. NA = Not apphcable breastfeeding is not commonly practised; even among the youngest children (0-3 months) only 16 percent of children are fed breast milk only and this drops to 1 percent by the fourth month. Infant formula is not commonly used in Zimbabwe. Before 10 months of age, only 4-5 percent of children are given formula. Infant formula is more often used at ages 10-11 months among children still being breastfed (9 percent) and at ages 12-17 months among non-breastfeeding children (11 percent). Use of other types of milk (e.g., cow's milk) is fairly common. Even among children still being breastfed, use of "other" milk rises to 25-28 percent during months 10-23. Among children under three who are no longer breastfeeding, about one-third are receiving "other" milk; and peak use occurs at ages 18-23 months (41 percent). "Other" liquids include all liquids other than plain water and milk, e.g., juice and sugar water. Other liquids are introduced very early. Over one-third of children under 2 months are receiving other liquids, and this rises to over half of children by age 16-17 months, irrespective of breastfeeding status. 129 Meats, poultry, fish and eggs ~:ontain protein and other nutrients important for growth, recovery from illness, and mental development. The percentage of children receiving these foods rises from 12 percent at age 4-6 months, to 30 percent at age 7-9 months, to over 50 percent by age 14 months and above. Regardless of breastfeeding status, at all ages ov,~r 14 months, more than 50 percent of Zimbabwean children received some meats, fish, poultry, or eggs in the average day. Porridge is a common weaning food in Zimbabwe. By 2-3 months of age, half of all children are receiving some porridge and by age 4-5 months, 85 percent are getting porridge on a daily basis. Fruits and vegetables are introduced into the diet more slowly. Only 1 percent of children under 4 months of age are receiving fruits and vegetables, 20 percent at age 4-6 months, 48 percent at age 7-9 months, 72 percent at age 10-11 months, and 80 percent by age 12-13 months. Children who are being breastfed are slightly more likely than non-breastfeeding children (at comparable ages) to be receiving porridge, fruits, vegetables, and "other" foods. Bottle feeding is not commonly practised in Zimbabwe. Only 5 percent of children under 2 months were given a bottle with a nipple in addition to breast milk. Among children still breastfed, bottle feeding peaks at age 8-9 months (8 percent). At age 12-17 months, non-breastfeeding children are more likely to be using a bottle (22 percent) than bteastfeeding children (4 percent). 9.1.4 Frequency of Food Supplementation A balanced diet is achieved hy regularly eating a nutritious variety of foods in sufficient quantmes. Young children are more likely to consume an adequate diet if given small but frequent meals each day (4-5 times). In the ZDHS, interviewers read from a list a specific food types, asking the mother to report on the number of days over the last seven days that the child received each of these foods. Table 9.5 shows the percentage of children who received specific food types in the last seven days, and among those who received these foods, the average number of days per week food was received, by age and breastfeeding status of the child Starting at age 4-5 months, virtually all breastfeeding children receive plain water every day. Non- breastfeeding children are slightly less likely to receive plain water, but those who do, receive it every day. The percentage of breastfeeding chi dren receiving other types of mdk increases with age from 13 percent of children age 0-3 months to around half of children during the second year of life. The percentage of breastfeeding children receiving other liquids shows a similar increase with age. Non-breast feeding children are more hkely to receive other types of milk and other liquids than their breastfeeding counterparts at comparable ages. The percentage of children receiving eggs, poultry, or fish increases sharply with age from 1 percent of children age 0-3 months, to around 50 percent at age 12-13 months, to over 60 percent of children at age 14 months and older. Meat-eating shows a similar pattern with age. Irrespective of breastfeeding status, children receive eggs, poultry, fish, and meat about three times per week. About l in 5 children under 2 months of age receives porridge regularly (6 days of the week). By age 2-3 months over half of children are getting porridge virtually every day, and by 6 months of age over 90 percent of children receive porridge almost every day. At comparable ages, breastfeeding children are slightly more likely to be fed porridge than non-breastfeeding children. 130 Uo Table 9 5 Types of food received by children m preceding week Percentage of children under 36 months of age who received specific types of food in the week before the interview and the mean number of days children were fed these foods, by breastfeeding status and child's age in months, Zimbabwe 1994 Poultry/ Fruits/ Number Plato water Other milk Other liqmds Eggs/Fish Meat Porridge Vegetables Other of Age chil- (m months) Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean dren BREA S 1PIcAv.~DING CHILDREN 0-1 76.2 5.4 12.0 53 243 5.3 00 - 0.0 - 194 57 0.0 - 1.7 6.5 126 2-3 86 9 6 4 13.6 5.5 24 5 3 8 2 8 1,6 1 1 1 0 55 7 6 5 4.7 2.7 3.6 5 6 131 4-5 98 2 6,4 24.0 5 5 42 1 3,6 11.8 3 6 11 7 3 3 86.4 6.6 26 3 4.9 26 4 4 7 123 6-7 98 0 6 8 22.1 3 7 43.1 2.8 26.3 2 4 21.1 2.1 90.6 6.8 46 3 4.5 54,8 6.0 132 89 1000 69 277 4,7 54.1 4.0 439 3.3 35.0 3.1 93.2 64 717 46 g4.0 6.3 142 10-1 I 98 6 6 8 43 6 4.2 54 9 3.7 52 1 2.9 48.1 2.9 93 3 6 6 86.0 5 8 89.5 6 7 123 12-13 99.0 6 9 39 1 3.9 45 0 4.3 49.4 2.5 60 1 2 4 88 6 6.4 89.5 5.4 93.1 6 6 103 14 15 100.0 6.7 45 9 3.8 53 5 4 3 63.3 3.2 64 5 3 0 89.9 6.5 96 6 5.4 92 9 6 6 95 16-17 99.0 6~8 53.8 3.4 73.7 4 1 63.0 2 4 73.3 3 1 86.2 6.6 97 8 5 2 96.0 6.2 72 18-23 100 0 7 0 48.3 4 1 75.4 4 5 65.9 2.7 65.5 3 2 89.9 6 3 98.6 5 7 94.3 6.6 141 24-35 (960) (70) (41 2) (44) (51.0) (5.1) (602) (2.1) (58.3) (2.5) (86.5) (62) (86.3) (62) (91.3) (70) 26 0-3 months 817 59 129 5.4 244 45 14 16 06 10 379 63 2.4 2.7 2.7 59 257 4-6 months 975 65 229 5.0 399 33 15.1 28 116 30 86.8 6.7 308 4.6 322 53 197 7-9 months 100.0 6.9 26.5 4.4 53 5 3 7 40.9 3 1 34 6 2.8 93.5 6.4 67 4 4 6 80.3 6.2 200 Total 95.3 6.6 31.8 4 3 48.3 4.0 36.4 2.8 35.9 2.9 78.9 6 5 59.6 5.3 61.8 6 4 1,215 NON-BREASTFEEDING CHILDREN 12-17 83.6 7 0 55 0 5.5 68.1 4,7 48 7 3.8 60.2 4.0 77 9 6 9 75 3 5.0 80.3 6 6 52 18-23 88.0 7 0 53.8 4 7 65.7 4 8 67 3 3.0 70.1 3.5 84 8 6 5 86 0 5.6 86.5 6 7 228 24-29 90 4 6.9 53.3 4 3 67.5 4 5 63 1 2.5 67 3 3.3 77 6 6 3 89 3 5.6 88 2 6 7 331 3035 916 7.0 474 40 655 46 622 31 673 33 812 61 896 58 88.3 6.7 382 Total 90 1 7 0 51 5 4.4 66 3 4 6 62.9 2 9 67.3 3.4 80.9 6 3 87.9 5 7 87.4 6 7 1,006 Note: Figures m parentheses are based on 25-49 cases Fruits and vegetables are first introduced into the diet for the majority of children during ages 4-11 months. No children received fruits or vegetables in the first two months, but by the first birthday 90 percent were getting these important foods five days per week. At comparable ages, breastfeeding children are more likely to receive fruits and vegetables than their non-breastfeeding counterparts. 9.1.5 Differentials in Food Supplementation Table 9.6 shows the percent distribution of children by the types of food received in the last seven days, by background characteristics. The data indicate there is little or no variation in feeding patterns by sex of the child. Children living in rural areas receive a less varied diet than children in urban areas. Rural children are especially disadvantaged with respect to the food types: milk, eggs/poultry/fish, and meat. Young children in Harare and Bulawayo are over 50 percent more likely to eat these protein-containing foods on a regular basis than children living in the other largely rural provinces. Since mother's level of education is closely related to the economic status of the household, it is not surprising that the children of educat,ed women have greater access to a wide variety of foods. For example, only 36 percent of children of women with no formal education were given some meat in the last week, compared with 56 percent of children of women with some secondary education. 9.2 Nutritional Status of Children under Age Three The anthropometric data on height and weight collected in the ZDHS permit measurement and evaluation of the nutritional status of young children in Zimbabwe. This evaluation allows identification of subgroups of the child population that are at increased risk of faltered growth, disease, impaired mental development, and death. Also, by comparing the 1994 ZDHS results with those obtained from the 1988 ZDHS--which used similar methods--trends in child undernutrition can be assessed. 9.2.1 Measures of Nutritional S~atus in Childhood Evaluation of nutritional status is based on the rationale that in a well-nourished population, there is a statistically predictable distribution of children of a given age with respect to height and weight. Use of a standard reference population facilitates analysis of any given population over time, as well as comparison of subgroups of the population. One of the most commonly used reference populations, and the one used in this report, is the NCHS (U.S. National Centre for Health Statistics) standard, which is recommended for use by the World Health Organisation ('WHO). Three standard indices of physical growth that describe the nutritional status of children are presented: height-for-age • weight-for-height weight-for-age Each of these indices gives different information about growth and body composition that can be used to assess nutritional status. 132 Table 9.6 Types of foods received by children by background characteristics Percentage of children under 36 months of age who received specific types of food m the week before the interview, and the mean number of days children were fed these foods, by selected background characteristics, Ztmbabwe 1994 Poultry/ Fruits/ Number Plum water Other mdk Other hqu~ds Eggs/Fxsh Meat porridge Vegetables Other of Background chll- chaeacterisucs Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean Percent Mean dren Sex Male 92.7 6.8 39.9 43 55 9 4 4 50 0 2.8 51 5 3 I 80.5 6 4 71.8 5.5 73 2 6.6 1,080 Female 93 2 6 8 41.5 4 4 57 0 4 3 46 9 2.9 48.8 3 3 79.1 6 5 73 0 5 5 73.6 6.6 1,142 Residence Urban 91 9 6.8 58.9 4.9 71 l 4 8 64 0 3.7 68 6 4 5 83 6 6 7 77.6 5.6 73 3 6.4 585 Rural 93 4 6 8 34.2 4.0 51.2 4 1 42 8 2.4 43 5 2 5 78.5 6 3 70 6 5 5 73.5 6.6 1,636 Province Manicaland 92 6 6.8 27 8 4 6 35.8 4.6 46.6 2 6 43 3 2.2 77.8 6.4 67.9 5.8 72 3 6.7 282 Mashonaland Central 95 4 6.8 38 0 3.6 60 5 3 9 43 4 2.7 46 6 2 4 81.7 6 1 75.2 6.0 79 5 6.6 192 Mashonaland East 94 1 6.8 37 8 4 3 55.4 4 1 46 7 2.4 43 1 2 7 78.7 6 5 74 8 6.0 73.0 6.9 230 Mashonaland West 92 5 6 7 32.8 4 3 54.3 4 1 44 5 3.1 45.5 3 0 78.0 6 5 72 0 5 7 70 7 6 3 255 Matabeleland North 93 5 6 7 32 8 3 9 39.2 4.5 36.8 2 5 43.9 2.8 79 0 6.4 65 8 4 4 72 5 6 8 173 Matabeleland South 90 9 6 8 45 5 4 7 40.2 4.3 29.4 1 9 46.8 2.7 78 0 6.6 65A 4.2 72 6 6 8 128 Midlands 93 2 6.8 41 1 3 8 65 6 4.3 50 3 2.7 49 0 3 0 76.4 6 3 72.1 5.5 69 0 6.6 309 Masvmgo 92 9 6.9 33.4 3.9 58 9 4 0 43 I 2.3 43 8 2 5 81.3 6 0 69 7 5 3 76.2 6.3 228 Harare 916 6 7 59.8 4.9 72 6 49 687 3.7 71.5 45 849 67 782 5 8 73.2 63 309 Bulawayo 931 69 699 52 78.6 4.7 630 35 68.8 4.8 838 6.8 832 4.9 821 64 115 Education No education 93 1 6.g 18.2 4.0 41 0 4 t 31 9 2.1 36 3 2 3 79.1 6 3 69 3 5 6 73.3 6.6 272 Primary 948 68 403 41 53.5 41 477 26 49.0 27 808 6.3 739 5.5 757 6.6 1,108 Secondary+ 90 5 6 8 48 5 4 7 65.3 4.7 54.7 3 4 56.1 3.9 78 7 6 6 71.5 5.4 70 4 6.4 841 T~tal 93 0 6.8 40.7 4A 56 5 4 3 48.4 2.9 50 l 3 2 79.8 6 4 72 4 5 5 73 4 6 6 2,221 Height-for-age is a measure of linear growth. A child who is below minus two standard deviations (-2 SD) from the median of the NCHS reference population in terms of height-for-age is considered short for his/her age, or stunted, a condition reflecting the cumulative effect of chronic undernutrition. If the child is below minus three standard deviations (-3 SD) from the reference mean, then the child is considered to be severely stunted. A child between -~. SD and -3 SD is considered moderately stunted. Weight-for-height describes current nutritional status. A child who is below minus two standard deviations (-2 SD) from the reference mean for weight-for-height is considered too thin for his/her height, or wasted, a condition reflecting acule or recent nutritional deficit. As with stunting, wasting is considered severe if the child is more than three standard deviations below the reference mean. Severe wasting is closely linked to mortality risk. Weight-for-age is a composite index of weight-for-height and height-for-age and, thus, does not distinguish between acute undernutrition (wasting) and chronic undernutrition (stunting). A child can be underweight for his age because he is stunted, because he is wasted, or because he is wasted and stunted. Weight-for-age is a good overall indicator of a population's nutritional health. In the survey, all surviving :hildren born since January 1991 were eligible for height and weight measurement. Of the 2,221 children (age 0-35 months at the time of the survey) eligible for measurement, 2,076 (93 percent) were weighed ant] measured. The reason most commonly reported for not measuring a child was that the child was not at anme. Of the children who were both weighed and measured, 62 (3 percent) were considered to have implausibly low or high values for height-for-age or weight-for-height. The following analysis focuses on the 2,014 children, age 0-35 months, for whom complete and plausible anthrnpometric data were collected. 9.2.2 Levels of Child Undernutrition in Zimbabwe Table 9.7 shows the percentage of children age 0-35 months classified as undernourished according to height-for-age, weight-for-height, and weight-for-age indices, by the child's age and selected demographic characteristics. Over one-fifth (21 l:ercent) of children under three years were classified as stunted, almost one-third of whom were severely stunted. The prevalence of stunting increases with age, peaking at 12-23 months (31 percent), then falls slightly among children 24-35 months of age (see Figure 9.1 ). The prevalence of stunting varies very little by sex, but increases with increasing birth order from 18 percent among first bJrths, to 24 percent among children of birth orders 6 or greater. Children born after a short birth interval (less than 24 months) are much mole likely to be stunted than children born after longer birth intervals. The weight-for-height inde~ gives information about children's recent experience regarding food intake. Wasting represents failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of recent illness, or of seasonal variations in the food supply. About 6 percent of children under three in Zimbabwe are wasted; | percent are severely wasted. Wasting is most common during ages 6-23 months, indicating Lhat food supplementation during the weaning period may be inadequate. Male children and children of very nigh birth order (6+) are at greater risk of severe wasting than girls and children of lower birth order. Over one-seventh (16 percent) of children under three in Zimbabwe are underweight--which may reflect stunting, wasting, or both. Low weight-for-age is most common during the second year (age 12-23 months). Again, boys are at higher risk than girls for being underweight. Low weight-for-age increases sharply with decreasing length of the interval between births, from 12 percent among children with intervals 48 months or greater in length, to 23 percent among children with intervals less than 24 months. 134 Table 9.7 Nutritional status of children by demographic characteristics Percentage of children 0-35 months of age who are classified as undernourished according to three anthropometnc indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by demographic characteristics, Zimbabwe 1994 Demographic characteristac Height-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD 1 -3 SD -2 SD t -3 SD - 2 SD I children Age <6 months 1.0 3.5 0.8 3.0 0.0 1.8 353 6-11 months 2,2 10.2 0.8 7.6 1.8 9.9 386 12-23 months 9.8 31.0 0.9 7.4 4.0 22.9 635 24-35 months 7.6 28.7 0.6 3.6 4.3 19.2 640 Se~ Male 6.9 21.7 1.1 6.5 3.4 17.3 991 Female 5.3 21.1 0.4 4.5 2.6 13.8 1,023 Birth order I 4.7 17.5 0.5 5.8 2 8 140 510 2-3 6.3 20.8 0.6 4.9 3 3 14.7 699 4-5 5.7 25.0 0.1 5.0 3.1 14.1 365 6+ 7.6 24 1 1.7 6.5 2.7 19.8 440 Birth interval 2 < 24 months 12.3 31.2 1.0 6.8 8.0 23.3 153 24-47 months 6.0 23.4 1.2 6.2 2.5 17. I 864 48+ months 5.8 19.2 0.1 3.1 2.5 11.6 483 Total 6.1 21.4 0.7 5.5 3.0 15.5 2,014 Note: Figures are for children born in the period 0-35 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as undernourished tf their z-scores are below minus two or minus three standard deviations (-2 SD or -3 SD) from the me&an of the reference populauon. l lncludes children who are below -3 SD 2Excludes first births Figure 9.1 Prevalence of Stunting by Age of Child and Length of Birth Interval ZIMBABWE AGE OF CHILD (MOS.)L~ 1-5m 6-11~ BIRTH INTERVAL (MOB.)L ~ < 24~ 24-47m~ 48 +~ 0 121 J~r-~ 4 110 131 j29 119 1 23 5 10 15 20 25 30 Percent of children stunted 131 35 ZDHS 1994 135 Table 9.8 shows the variation in undernutrition indices by urban-rural residence, province, and education of the mother. Children living in rural areas are 30 percent more likely to have low height-for-age (stunting) than their urban counterparts. Provincial variations in nutritional status should be viewed with caution since the numbers on which the estimates are based are small in some cases. Despite this, some useful observations can be made; for instance, there is a twofold difference in overall stunting and a fourfold difference in severe stunting between the province with the lowest level of stunting (Midlands) and the province with the highest level of stt~nting (Matabeleland North). Children of women with no education are twice as likely to be stunted as children of women with at least some secondary education. Variations in wasting and low weight-for-age by background characteristics follow similar patterns to those observed for stunting. Rural children, children of uneducated women, and children living in Matabeleland North are particularly disadvantaged. Table 9.8 Nutritional status of children by background characteristics Percentage of chddren 0-35 months of age who are classified as undernourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and wmght-for-age, by background characteristics, Zimbabwe 1994 Background characteristic tlelght-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number betow below below below below below of -3 SD -2 SD L -3 SD -2 SD I -3 SD - 2 SD 1 children Residence Urban 5.6 17 6 0.5 6.1 1.8 12.5 518 Rural 1~.3 22.8 0.8 5 3 3.4 16.6 1,495 Province Mamcaland I~ 0 19.2 0.6 6 2 3.6 12.8 248 Mashonaland Central II.6 27.7 1,4 5.3 4.8 19.2 179 Mashonaland East 4 8 22,8 0.0 1.9 2 4 11.6 212 Mashonaland West ~1.0 22.3 0 9 6.8 4.4 19 7 239 Matabeleland North & 1 28 5 2.4 9.8 6 I 24.0 157 Matabeleland South 6.0 26.2 0.5 5. I 4.1 17.9 118 Midlands 2 I 12.8 0.4 7.5 0.9 13.6 275 Masvingo 'i 8 24.6 0.5 2.1 I 6 15.2 208 Harare '7.0 20.9 0 6 5.7 2.5 14 6 272 Bulawayo ~.8 12.8 0 6 3.2 0.0 7 1 103 Education No education 9,8 27.1 0.6 6 0 4.7 25 5 251 Primary 6.9 25.0 0.9 5.4 3.3 17.0 1,023 Secondary+ t,6 14.6 0.5 5 3 2.1 10 1 740 Total ~5.1 21.4 0.7 5.5 3.0 15.5 2,014 Note: Figures are for children bo-n in the period 0~35 months preceding the survey. Each index is expressed m terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO internauonal reference populauon. Children are classified as undernounshed if their z-scores are below minus two or minus three standard devianons (-2 SD or -3 SD) from the median of the reference population. tlncludes chddren who are below -3 SD 136 Figure 9.2 shows mean z-scores 3 for the three anthropometric indices by age, again demonstrating the remarkable deterioration in nutritional status that begins shortly after birth, continuing through the first year and a half, and then levelling off or improving slightly thereafter to the third birthday. Figure 9.2 Nutritional Status of Children under Three Years, Mean Z-scores by Age in Months Z-score 2 1 -2 -3 1'2 3b Age in Months 35 Note: Compared with the median of the International Reference Population ZDHS 1994 9.2.3 Trends in Undernutrition in Zimbabwe The anthropometric data collected in the 1994 ZDHS are very similar to those obtained during the 1988 ZDHS, except that the age range of eligibility for collecting the data changed from 3-59 months in the earlier survey to 0-35 months in the present survey. To allow comparison, results from both surveys were reanalysed using the shared age range 3-35 months. Table 9.9 shows that the percentage of children age 3-35 months who are underweight (low weight-for-age) has increased by one-third from 13 percent in 1988 to 17 percent in 1994. Per- haps more troubling is that the percentage of children who are severely underweight has doubled from 1.5 percent to over 3 percent during the same period. The prevalence of chronic un- dernutrition (stunting) decreased from 30 to 23 percent between the two surveys, while acute undernutrition (wasting) rose from 1 to 6 percent. It may be misleading to draw conclusions about Table 9.9 Trends in nutritional status of children Among children 3-35 months of age, the per- centage classified as undernourished accord- mg to height-for-age, weight-for-height, and weight-for-age, 1988 ZDHS and 1994 ZDHS 1988 1994 Index ZDHS ZDHS Height-for-age <-2 SD 29.8 23.3 <-3 SD 8.0 6.7 Weight-for-height <-2 SD 1.2 5.8 <-3 SD 0.3 0 8 Weight-for-age <-2 SD 12.7 16.9 <-3 SD 1.5 3.3 Number of chzldren 817 1,841 3 A z-score is interpreted as the number of standard deviation units above or below the mean of the standard reference population. In this case, the reference population is the NCHS/WHO/CDC standard. 137 the overall trend in nutritional status in Zimbabwe from the change in wasting because the change refers to conditions immediately preceding tfe two surveys and could therefore represent short-term fluctuations in food availability. 9.3 Maternal Anthropometr ic Status In the ZDHS, data were collected on the height and weight of women who had at least one birth since January 1991. This sample of women is thus not representative of all women 15-49, and will overrepresent high fertility age groups, for example, women 25-34 years. Several measures have be u ~ed to assess the nutritional status of women (Krasovec and Anderson, 1991). In this report, two indices ar~ presented: the height of women and the body mass index (BMI)--an indicator combining height and weight data. Table 9.10 presents the mean values of the maternal anthropometric indicators and the proportion of women falling into various high-risk categories, by background characteristics of women. A woman's height is associated with past socioeconomi.z status and nutrition during childhood and adolescence. Maternal height can be is used to predict the risk of d ~fficult delivery, since small stature is often associated with small pelvis size. The risk of having a low birth weight baby also seems to be higher for short women. The optimal cut- Table 9.10 Nutritional status of mothers by background characterisucs Mean height and percentage of women shorter than 145 centimetres, mean body mass index (BMI) and the percentage of women whose BMI is less than 18.5, by selected background charactensUcs, Zimbabwe 1994 Height BMI Background Percent Percent characteristic Mean <145 cm Number Mean <18 5 Number Residence Urban 1596 00 551 24.7 2.3 478 Rural 159.3 09 1,549 22.5 6.0 1,321 Province Manlcaiand 159,0 I. 1 268 23. [ 3 8 236 Mashonaland Central 158.8 0 9 184 22.0 5.4 158 Mashonaland East 160.8 09 217 22.7 4.7 188 Mashonaland West 159.0 1.3 249 22.7 7.1 207 Matabeleland North 160.0 0.0 164 21 8 I l 1 140 Matabeleland South 160.2 0.0 124 22.5 7,2 105 Midlands 158.8 0.8 279 23 2 5 2 240 Masvlngo 158.8 1.0 218 23 1 3 6 180 Harare 159 6 0.0 290 24.8 0,7 252 Bulawayo 160 3 0.0 107 24.3 5.7 93 Education No education 157 7 2.8 262 22.3 4 6 208 Primary 159.4 0.5 1,052 22.8 6.6 908 Secondary+ 160.1 0.3 786 23 7 3 1 683 Total 159 4 0 7 2,100 23.1 5.0 1,799 Note Table includes only women who had a birth in the three years preceding the survey. The BMI index excludes pregnant women and those who are less than 3 months postpartum 138 off point, below which a woman can be identified as at risk, is in the range of 140-150 centimetres. The mean height of mothers measured in the ZDHS was 159 cm. Less than 1 percent of mothers were under 145 cm in height. 4 Women under 20 years of age and women with no education are more likely to be under 145 cm than older women and women with some education. There is little variation by province in women's height. Various indices of body mass are used to assess thinness and obesity. The most commonly used body mass index (BMI) is defined as weight in kilograms divided by squared height in metres. A cut-off point of 18.5 has been recommended for defining energy deficiency among nonpregnant women. The mean BMI among the weighed and measured mothers 5 was 23.1, with 5 percent having a BMI below 18.5 reflecting a nutritional deficit. There are large differentials across background characteristics in the percentage of mothers assessed as undernourished using the BMI. Rural women are more than twice as likely to be too thin as urban women. Women with some secondary education are significantly less likely to have a low BMI than their less educated counterparts. Variations in maternal undemutrition among the provinces are also substantial, ranging from 1 percent of mothers in Harare to 11 percent in Matabeleland North. 4 If 150 cm is used as the cut-off, 5 percent of women would be considered at risk. s Pregnant women were excluded from the BMI analyses because precise data on gestational age, necessary for adjustments, were not available. 139 CHAPTER 10 AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES AIDS poses a serious public health problem in Zimbabwe. By the early 1990s, it was estimated that 8 to 12 percent of pregnant women were infected with HIV, the virus that causes AIDS (IPC, 1994). HIV is transmitted principally through sexual intercourse with an infected individual. Infection can also occur through the use of infected syringes and the transfusion of infected blood products such as plasma, platelets, etc. Further, HIV can be transmitted via the placenta from an infected mother to the fetus. When the AIDS epidemic was first identified in the early 1980s, it was viewed largely as a health problem that required the resources and energy of the Ministry of Health alone to tackle. It has become increasingly clear that the epidemic is affecting all areas of economic and social life in Zimbabwe, and will thus require a sustained, multisectorial effort to combat. The National AIDS Coordination Programme (NACP) has been tasked with spearheading the nation's efforts to fight the disease on all fronts. The future course of what is now a worldwide epidemic depends to a large extent on the level of AIDS awareness among the general public. The data obtained from the ZDHS provide a unique opportunity for assessing knowledge and practices regarding transmission of the AIDS virus and other sexually- transmitted diseases (STDs). A primary objective of this chapter is to establish the prevalence of relevant knowledge, perceptions, and behaviours at the national level and within geographic and socioeconomic subgroups of the population. In this way, programmes can target their efforts at those individuals and groups most in need and most at risk of infection. 10.1 Awareness of Sexually Transmitted Diseases Tables 10.1.1 and 10.1.2 show the percentage of women and men who have (spontaneous) knowledge of specific STDs, by various background characteristics. Among both women and men, AIDS is by far the most widely known STD. Without probing, 85 percent of women and 84 percent of men cited AIDS. (After probing, these figures are 99 percent for women and 100 percent for men--see Tables 10.4.1 and 10.4.2.) The next most commonly reported STD was gonorrhoea, but men were considerably more likely (66 percent) than women (32 percent) to spontaneously report the disease. This gender-related pattern also occurs regarding two other fairly common STDs, syphilis and chancroid. Only 9 percent of women and 3 percent of men could not cite a single STD. Both women and men are less likely to be informed about STDs if they lack formal education, if they live in rural areas, and if they are younger (15-19 years) or older (40+ years). It is difficult to generalise regarding provincial variation in STD knowledge. Such variation appears to depend on the particular disease, and whether women or men are considered. For instance, among women, knowledge of syphilis ranges from 13 percent in Mashonaland Central to 43 percent in Bulawayo; among men, knowledge of syphilis ranges from 13 percent in Matabeleland South to 58 percent in Mashonaland West. 141 Table 10.1.1 Knowledge of sexually transmitted diseases, women Percentage of women who know of specific sexually transmitted diseases, by background characteristics, Zimbabwe 1994 Number Background HIV/ Gemtal Chan- Don't of charactertstlc Syphxhs Gonorrhoea AIDS 1 warts croid Other know any women Age 15-19 21 5 21,2 84.6 1 5 3.6 24.2 13.2 1,472 20-24 30.1 35.3 86.1 2.7 5.6 27 4 7.2 1,269 25-29 36.7 39.7 86.1 3.6 8.2 25,9 6 0 915 30-39 31 2 36.9 85.6 5 6 9.0 27.0 7.4 1,532 40-49 25.2 30. I 84.7 4.3 7.6 26. I 9.7 940 Current marital status Never married, no sex 23.1 23.9 86.1 1.3 3.3 21.9 11.7 1,276 Never married, had sex 36.7 37.4 89.1 5.8 5.4 22.3 4.2 370 Currently married 29.2 33.3 84.6 3.9 7.4 27.4 8.8 3,788 Formerly mamed 30.5 38.6 86.4 4.2 9.8 29 0 6.8 692 Residence Urban 41,5 44,2 91.3 4.4 4.3 24.3 3 3 1,975 Rural 22 4 26,5 82,6 3.1 7 8 27.0 11.5 4,153 Province Manicaland 27.0 34,3 82.2 2.1 3,6 14.2 14 5 839 Mashonaland Central 13.4 23,9 77 6 3.5 5.0 33.7 15.6 510 Mashonaland East 19 5 27,7 87.8 3.5 7.0 38.5 6.5 579 Mashonaland West 27.1 36,2 78.6 1 4 8.0 21.2 146 632 Matabeleland North 16.1 20,8 74 3 3.0 9.9 34.7 15.3 366 Matabeleland South 36.1 42,9 86.6 1 9 9,2 9.7 9,1 305 Midlands 36. ] 26.8 90 1 7. ] 6.2 26.7 5.0 g I 0 Masvingo 19.8 18,4 84.7 3.4 15.6 29.6 8.7 652 Harare 39.3 42.6 92.6 3.9 2.6 27,6 1.8 1,1148 Bulawayo 43.2 47,1 91.3 3.6 4.8 24.9 3.8 388 Education No education 13.6 18.3 69.8 3.0 7.1 25,9 23.9 682 Pri mary 21.0 25.9 83.9 3 5 7.6 28.1 10.2 2,898 Secondary+ 41 2 43.0 91.3 3.7 5 5 23.9 3 3 2,547 Total 28.5 32.2 85 4 3.5 6.7 26. I 8.9 6,128 Note: Figures are based on spontaneous knowledge of sexually transmitted diseases (i.e., without probing) t See Table 10.4.1 for level of knowledge of HIV/AIDS after probing. 142 Table 10.1.2 Knowledge of sexually transmitted diseases: men Percentage of men who know of specific sexually transmitted diseases, by background characteristics, Zimbabwe 1994 Number Background HIV/ Genital Chan- Don't of characteristic Syphilis Gonorrhoea AIDS I warts croid Other know any men Age 15-19 24.9 36.0 89.1 2.8 12. I 24.8 4.4 604 20-24 48.l 68.8 84.7 6~9 29.4 22.9 2.1 399 25-29 52.4 84,8 84.9 8.5 40.5 21,6 0.9 288 30-39 48.9 81.3 79.6 10.2 48.9 19.8 1.8 436 40-49 44.0 77,2 80.0 7,6 45.5 21.5 3.5 301 50-54 27.5 77,6 87.4 7.2 41.0 17,8 2.6 113 Current marital status Never married, no sex 27.3 34.6 89.9 2.3 10.8 20.8 5.4 464 Never married, had sex 41.4 63.2 84.9 6.6 24.7 26.1 1.9 539 Currently married 46.6 79.8 82.9 8 2 45.2 20.6 2.0 1,038 Formerly marned 36 2 82.0 72.5 11.8 51.4 23.0 2.4 99 Residence Urban 50.9 80.0 87.7 7.0 36.3 20.1 1.1 797 Rural 34.5 5%5 82.4 6.5 30.8 23.4 3.7 1,344 Province Manicaland 53.6 58,9 85.0 1.7 21.2 14.4 2.3 269 Mashonaland Central 17.8 42.3 83,5 0.9 22.4 44.0 2.6 181 Mashonaland East 31.9 62,3 91.3 9.7 40.8 13.3 1,0 190 Mashonaland West 58.3 83,3 82.0 8.9 49 8 11.1 0.8 264 Matabeleland North 17.8 46.3 90.2 0.5 3.6 42.2 3.1 100 Matabeleland South 13.3 51.7 77.0 2.0 18.7 44.6 7.6 91 Midlands 29.8 65,1 70.6 20.9 37.2 34.9 1.6 265 Masvmgo 36,3 55.1 77.4 2.0 31A 2.7 11.8 200 Harare 54.2 81,9 93.4 6 2 38.3 19.8 1.3 428 Bulawayo 43.0 72,3 88.8 5.0 33.1 23 I 0.4 154 Education No education 25.4 62,4 78.5 5 8 36.4 19.3 9.8 88 Primary 25.9 57.5 82.4 6.2 37.4 24.1 4. I 860 Secondary+ 52.4 72,2 86.3 7.2 29,3 20.9 1.3 1,193 Total 40.6 65,9 84.4 6.7 32.8 22.2 2.7 2,141 Note: Figures are based on spontaneous knowledge of sexually transmitted diseases (i.e., without probing). i See Table 10.4.2 for level of knowledge of HIV/AIDS after probing 143 10.2 Self-reporting of Recent Sexually Transmitted Diseases The ZDHS asked respondent~ whether they had had any sexual t ransmitted d iseases in the last 12 months. I f so, the respondent was asked to name the part icular STD, and to report what act ion ( i f any) was taken in response to the most recent episode, Tab les 10.2.1 and 10.2.2 show that about 3 percent o f women and 5 percent o f men reported hav ing an STD in the last year. Th is is l ikely to be an underest imate o f the true f requency o f STDs for two reasons. IZirst, many STD cases wi l l be unrecognised because: (a) no obvious, p ro longed symptoms were exper ienced, ~ (b) no health care was sought, or (c) the prob lem was misd iagnosed or misunderstood by the respondent when diagnosed. Perhaps more tmportant ly, many women and men wi l l fai l to report a recent STD because ot the mherent social st igma. Table 10.2A Self-reportingofsexuall,~transmated dxseases in the last year: women Percentage of women who reported haeing sexually transmitted dtseases (STDs) dunng the 12 months preceding the survey, by spectfic STDs and background characteristics, Zimbabwe 1994 Number Background Any HIV/ Gertftal Cha•- of characteristic STD S cphdls Gonorrhoea AIDS warts chrotd Other women Age 15-19 0 7 0.2 0.2 0.0 0.0 0.1 0.1 1,472 20-24 3.6 0.8 I I 0.0 0.3 0.5 0.9 1,269 25-29 3.2 0.5 1,8 0.2 0.2 0.3 0,5 915 30-39 4.0 1.0 1.9 0 l 0.3 0.5 0.4 1,532 40-49 2.3 0.7 1.3 0.0 0 0 0.0 0.5 940 Current marital status Never married, no sex 0 0 0.0 0 0 0.0 0.0 0.0 0.0 1,276 Never married, had sex 0.9 0.4 0.4 0.0 0.0 l) 0 0 0 370 Currently roamed 3.6 0 8 1.6 ().1 0 1 0.4 0,7 3,788 Formerly married 4, I 0 9 1.7 0 0 0.8 0,2 0.6 692 Residence Urban 2.0 0 6 0.8 0, I 0.0 0.3 0.2 1,975 Rural 3.1 0.6 I 4 0.0 0.3 0.3 0 6 4,153 Province Mamcaland 4 0 l.l 2 I 0 2 0.2 0.4 0.5 839 Mashonaland Central 3.3 0.3 1 4 0.0 0.3 0 0 I 0 510 Mashonaland East 2 6 0 0 1.9 l) 0 0.2 0.2 0.4 579 Mashonaland West 3.3 0 2 1.6 0.0 0.0 0.9 0.7 632 Matabeleland North 2.6 0.3 1.6 0.0 0 3 0 4 0 0 366 Matabeleland South 2.0 0 2 1.1 0.0 0 0 0 1 0 7 305 Midlands 2.0 1.2 0.5 0 0 0.0 0.2 0.4 810 Masvmgo 3.5 0.8 0.7 0.0 0 8 0 5 0 7 652 Harare 2 1 0.8 0.8 0 2 0.(I 0 2 0.2 1,048 Bulawayo 1.2 0.3 0.5 0.0 0.0 0.t) 0.3 388 Education No education 2 5 0.3 0 7 0.0 0.3 (I 5 0 5 682 Primary 3.5 0 9 1.7 0,1 0 2 0.3 0.5 2,898 Secondary+ 2.0 0.4 0.8 0 II 0. I 0.2 0.4 2,547 Total 2.7 0.6 I 2 0. I 0.2 0.3 0.5 6,128 t This is obviously the case for most current HIV infections m Zimbabwc, but also apphes regarding many other recent STD infections, especially among women. 144 Table 10.2.2 Self-reporting of sexually transmitted diseases in the last year: men Percentage of men who reported having sexually transmitted diseases (STDs) during the 12 months preceding the survey, by specific STDs and background characteristics, Zimbabwe 1994 Number Background Any H|V/ Genital Chan- of characteristic STD Syphilis Gonorrhoea AIDS warts chrold Other men Age 15-19 1.0 0.2 0.6 0.0 0.0 0.2 0.0 604 20-24 6.2 0.8 2.8 0.0 0.7 1.8 0.5 399 25-29 9.8 1.2 5.4 0.0 0.8 1.5 0.8 288 30-39 6.0 0.2 3.0 0.0 0.4 2.6 0.2 436 40-49 3,1 0.0 1,9 0.0 0.0 1.2 0.0 301 50-54 1.9 0.0 1.9 0.0 0.0 0.0 0.0 113 Current marital status Never married, no sex 0.0 0.0 0.0 0.0 0.0 0.0 0.0 464 Never married, had sex 6.6 I.I 3.0 0.0 0.7 1.0 0.7 539 Currently married 4.6 0.3 2.4 0.0 0.3 1.8 0.1 1.038 Formerly marned 13.8 0.0 9.6 0.0 0.0 3.7 0.0 99 Residence Urban 4.8 0.5 2.2 0.0 0.5 1.6 0.2 797 Rural 4,4 0.4 2.5 0.0 0.2 1.2 0.2 1,344 Province Manicaland 2 2 0.5 2.2 0.0 0.0 0.0 0.0 269 Mashonaland Central 3,7 0 2 1 3 0.0 0.0 1.3 0.9 181 Mashonaland East 4.9 0.0 3.4 0.0 0.5 1.6 0.0 190 Mashonaland West 6,5 0.4 4.2 0.0 0.0 1.9 0.0 264 Matabeleland North 2,1 0.5 1.0 0.0 0.0 0.0 0.0 100 Matabeleland South 5.9 1.2 2.0 0.0 0.2 1.2 0.8 91 Midlands 5,5 0.0 2 9 0,0 0.8 0 8 1.0 265 Masvingo 2,7 0.5 0.5 0.0 0.0 1.6 0.0 200 Harare 4.8 0.9 1.8 0.0 0.9 1.8 0.0 428 Bulawayo 6.2 0.0 3.7 0.0 0.0 2.5 0.0 154 Education No education 2.9 0.0 0.9 0.0 0.0 2.0 0.0 88 Primary 4,5 0.1 2.3 0.0 0.1 1.7 0.3 860 Secondary+ 4.7 0,7 2.5 0 0 0.5 1.0 0.2 1,193 Total 4,5 0.4 2.4 0.0 0.3 1.3 0.2 2,141 Table 10.3 presents information on the 168 women and 97 men who reported an STD in the last 12 months. Ninety-four percent of women and 85 percent of men sought treatment for their reported STD, but a smaller percentage of men (63 percent) than women (84 percent) informed their partner(s) of the infection. When asked what, if anything, was done to prevent infecting the respondent's partner, 77 percent of women and 27 percent of men reported that they did nothing. Caution should be used in interpreting these findings, since it could well be that the majority of infected women were infected by their (only) partner. Among infected men, 34 percent reported that they avoided sex, 34 percent said that they took some kind of medicine, and 16 percent reported using condoms to prevent spreading the infection to their partners. 145 Table 10.3 Action taken by respondents who reported a sexually transmated dtsease m the last year Among respondents who reported a se:~ually transmitted disease (STD) durmg Ihe 12 months prior to the survey, the percentage who sought advice or treatment, the percentage who reformed their partner(s) and the percentage who took measures to avotd mfectmg Ihexr partner(s), according to sex of the respondent, Ztmbabwe 1994 Among respo)tdems who had an STD: Percentage who d~d s~)methmg to aw)td infecting partner Percentage Pelcentage Number who who No of Background sought in Formed Avoid Used Took measure women/ characteristic treatment p ~rtners sex condoms medtcme Other taken men Females (15-49) 94 I 83 8 64 5,6 12,9 I 4 766 168 Males (15-54) 85 3 63,2 33 7 15,5 33 6 2 5 27 2 97 10.3 AIDS Knowledge and Awareness If women and men reported that they had heard of AIDS, a series of questions were asked about their knowledge and attitudes regarding A (DS and the HIV vires. Tables 10 4. I and 10.4.2 show that virtually all women (99 percent) and men ( 100 percent) know of AIDS. This is an improvement since the 1988 ZDHS, when 86 percent of women age 15-49 reported that they knew of AIDS. (Men were not interviewed in the 1988 survey.) The most common single source of knowledge about AIDS ts the radio: 64 percent of women and 75 percent of men said they had lea-ned something about AIDS on the radio. For women, the next most common source of AIDS information is health workers (45 percent) and friends/relatives (41 percent); for men, the next most common source is the newspaper (46 percent). Men, especially those with at least a secondary education, report more sources of information on AIDS than women. A small percentage of women and men receive AIDS information from the church. The data show that 26 percent of women learned something about AIDS from watching television, a significant rise since the 1988 ZDHS when only 7 percent of women reported this source. 146 Table 10.4.1 Knowledge of AIDS and sources of AIDS information: women Percentage of women who have ever heard of AIDS, percentage who recelved information about AIDS from specific sources, and mean number of sources of information about AIDS, by background characteristics, Zimbabwe 1994 Ever he~d Background of ch~acte~snc AIDS Radio TV Sources of AIDS information Corn- Mean mumW Friend/ number News- Pamph- Health Mosque/ meet- Rela- Work Other Num- of paper let worker church School ing t~ve place source bet sources Age 15-19 98.4 59.3 26.6 33.6 I0.0 28.3 3.1 38.0 4.9 34.0 0.5 1.8 1,472 2.4 20-24 99.1 70.9 33.3 34.7 12 3 49.9 2.1 11.8 8.6 34 8 0 7 2 l 1,269 2.6 25-29 99 4 73.1 28.9 30.8 10.4 52.0 3 3 4.4 10A 39.2 2.9 2 8 915 2 6 30-39 98.6 63.5 25 3 20.2 8.3 52.4 4.5 3 8 13.6 45.5 3.4 2.5 1,532 2.5 40-49 98.3 55.1 16.4 16 3 7 8 45.3 5.8 2.3 15 8 53 4 2 3 2.5 940 2 3 Marital status Never married 99.0 62.6 31.9 37.3 10.4 29.1 2 9 37 2 4.4 33.8 0.8 2 0 1,646 2.6 Currently roamed 98.6 64.2 24.1 23.8 9.8 50.4 3 9 5 0 12 2 43.7 2.0 2 1 3,788 2 4 Formerly married 98.9 67.5 262 24 1 8.1 53.1 4.7 3.7 13.8 41 0 3.7 4.2 692 25 Residence Urban 99.8 82.1 53.6 40.5 11 8 42 7 5A 12.0 6.1 35.3 2.6 4.2 1,975 3.0 Rural 98 3 55 6 13.5 21.2 8.8 46.0 3 0 14.3 12.3 43.4 1.6 1 4 4,153 2.3 Province Mamcaland 97.9 512 108 15.7 7.0 356 2.7 179 10.7 45.0 1.3 0.2 839 2.0 Mashonaland Central 99 2 62 5 16.0 22.4 6.8 44 2 1.4 11.1 15 2 42 0 2 5 2.5 510 2.3 Mashonaland East 99.5 58.7 17.8 32 1 10 8 52.6 3.5 16.3 7 9 48 8 1 8 0 7 579 2.5 Mashonaland West 99.3 65 8 22 8 22.8 I 1.4 49.0 6.9 10 5 13.1 44.0 0.9 1.9 632 2.5 Matabeleland North 93 4 45 8 12.6 18.7 10.9 42,4 1 9 9.4 9.0 43.7 I 0 3 0 366 2.1 Matabeleland South 97.0 56.6 14 3 29 3 14 1 56.2 2.3 13.6 19 7 40 3 1 3 0 7 305 2 6 Midlands 99.0 70.1 27 1 31.0 9.0 50.9 2.8 14.9 11.6 31.4 2 2 0.9 810 2 5 Masvmgo 995 503 133 12.5 7.4 44.0 34 159 106 461 1.8 2.6 652 2.1 Harare 100,0 83.9 58 6 44 6 13.2 44.2 6.2 11.5 4 4 42 3 3.0 2.1 1,048 3 I Bulawayo 99.1 80.5 49.3 38.2 7 7 32 8 2.4 10.4 8 7 16.9 1.9 13.5 388 2 6 Education No education 94.8 42.6 5.2 3.1 2.3 36.7 4.0 3 7 16.4 57.7 2.1 2.3 682 1 9 Primary 98.6 60.1 16 8 18.6 7.4 49.5 4.2 7 5 12 5 46 I 1.7 I 7 2,898 2.3 Secondary+ 99.9 745 43.1 44.0 14.5 42,0 30 23.1 6.2 30.3 2,1 3 1 2,547 2.9 Total 98 7 64.2 26.4 27.4 9 8 44 9 3.7 13.5 10.3 40 8 1 9 2 3 6,128 2.5 Note' Mean number of sources is based on respondents who have heard of AIDS. 147 Table 10.4.2 Knowledge of A IDS and souces of AIDS information: men Percentage of men who have ever heard of AIDS. percentage who received information about AIDS from specific sources, and mean number of sources of reformation about AIDS, by background characteristics, Z imbabwe 1994 Sources of AIDS informatton Ever Com- Mean heard munity Frtend/ number Background of News- Pamph- Health Mosque/ meet- Rela- Work Other Num- of charactensttc AIDS Radio TV paper let worker church School lng tire place source ber sources Age 15-19 991 602 26.0 362 185 266 13 46.0 48 34,0 05 7.2 604 26 20-24 100 0 82.3 42 0 57.7 22 9 37.6 2 7 20 9 4.5 32. I 1.6 8 1 399 3 I 2529 1000 865 46.0 561 26.9 39.3 3.4 I10 7.4 353 99 119 288 33 3/)-39 99.7 847 41 8 520 19.9 41,0 1.8 29 66 372 129 98 436 3 1 40-49 99.7 75 I 285 405 16.2 42 1 07 2,1 140 382 207 7 I 301 29 50 54 100,0 67.3 25.6 31.2 12 1 40.0 3 9 0.9 16 3 47,9 I [ 5 3.2 113 2 6 Marital status Never mamed 994 687 335 43.1 20.4 31 0 1.9 35.8 52 340 20 8 1 1,004 29 Currently married 99 9 81.9 37 0 50 2 19 7 40.4 2 0 4 9 9 4 36 9 13 8 S 6 1,038 3 1 Formerly married 100,0 733 337 41.0 20.8 451 25 31 77 426 67 73 99 28 Residence Urban 1000 85.8 58.3 608 231 37.9 19 15.4 52 313 149 78 797 34 Rural 99.4 69 1 21 5 37.9 18,3 35 2 2 1 21 6 8.6 38.5 3 8 8 6 1,344 2 7 Province Manicaland 99.5 707 20.3 36.9 21 1 55.5 60 35.7 159 61 9 109 56 269 34 Ma~h~)nalal~lCcnlral lOO.0 76 l 26C 47.3 10,1 31.3 00 12.7 8.8 167 2 I 13 I 181 24 Mashonaland East 100.0 703 31C 462 15.4 317 04 17.9 26 273 16 87 190 2.5 Mashonaland West 1000 89,7 314 31 5 15.1 32.8 1 1 16.5 1 9 82 7 2 0 1 2 264 3 1 Matabeleland North 99 0 65 2 20.~ 43,2 27 1 29 1 1.0 19.2 3 1 32.4 5 2 5 8 100 2 5 Matabeleland South 98 8 57 8 184 40.4 12 9 29.9 1.2 9 9 25.1 20 5 3.1 I 8 91 2,2 MLdlands 99.2 69 5 33 ~ 42.5 23.4 46 0 2.2 23 5 8 3 10 0 6 9 24 7 265 2 9 Masvmgo 98 9 521) 13,2 25 7 15.9 19.6 1 5 24 3 4 9 32 8 5 5 h 7 200 2 0 Harare 1000 87.7 60.~ 69.6 286 36.6 I 8 154 3 I 286 15,4 70 428 35 Bulawayo 100.0 86.8 63.,~ 62.8 198 31.8 29 74 12J) 223 161 17 154 33 Education No educanon 988 55.8 8Z 63 06 22.3 00 0.0 88 66.1 132 55 88 19 Prtmary 99.3 690 21 I 31.4 135 36.2 19 122 8,7 406 81 69 8611 25 Sectmdary+ 1000 813 47~, 602 26.3 372 2.2 258 63 30.1 74 95 1,193 33 T¢~tal 996 75.3 35.? 464 201 36.2 20 19.3 74 358 79 83 2,141 29 Note Mean mimber of sources is based on lespondents who have heard of AIDS Tables 10.5.1 and 10.5.2 show the percentage of women and men who know of specific ways to avoid getting HIV/AIDS. About 9 percent of women and 4 percent of men reported that there was no way to avoid getting AIDS. Of the rema: nder, all but 6 percent of women and 3 percent of men could cite at least one way to avoid HIV/AIDS. By far, the most frequently cited way was use of condoms: 57 percent of women and 66 percent of men me~ationed condoms as a way to avoid AIDS. The next most commonly reported way was by having only one sex partner: 41 percent of women and 52 percent of men mentioned th~s as a way to avoid AIDS. Only 1 percent of women and men reported a way to avoid AIDS that reflected misinformation, such as avoiding mosquito bites and kissing, or seeking the care of a traditional healer. 148 Table 10 5.1 Knowledge of ways to avoid H1V/A1DS: women Percentage of women who know of specific ways to avotd HIV/A1DS and percentage with misinformation, by background characteristics, Zimbabwe 1994 Ways m avoid AIDS Have Percent- No only Avoid age with way to Abstain one sex with Avoid Avoid Don't any Numbe~ Background avoid from Use sexual prosti- trans- lnjec- Other know mism of characterisUc AIDS sex condoms partner tutes fusions tmns ways any way formatmn~ women Age 15d9 98 139 56.2 349 9.4 26 72 11.2 5.7 1.0 1,448 20-24 7.8 10.3 62 2 41 7 7.7 3,4 6 8 8,8 3.7 0 g 1,258 25-29 7 4 8,6 60.8 47 9 8.0 3.8 7,5 9.5 4.2 0.9 909 30-39 8.9 10.8 59.0 42.5 8.2 2.8 6.7 9.5 5.6 1.3 1,511 40-49 13.2 11 4 44.6 37 9 9.9 1.8 4.9 8.9 9 3 1.0 924 M aril,M status Never mamed 8 9 16, I 57.2 35.7 9 4 3,5 6,8 11.3 5 0 0.6 1,628 Currently married 9 7 8.2 55 6 44.0 8.3 2.6 6.5 9, I 5.8 1.2 3,736 Formerly married 8.5 15 8 65 3 33 8 8 0 2.9 7 7 9.1 5 6 1.0 685 Residence Urban 3,6 13.3 67.6 47.7 7,7 4 8 7.2 13.3 1.7 0.6 1,971 Rural 12.1 10.2 52.0 37.2 9.0 I 9 6.4 7 9 7.4 I 2 4,080 Province Manicaland 9.5 15.1 53 1 40,0 10.0 6.5 15.8 5 8 8 7 Mashonaland Central 16,3 6 1 51.7 24.5 6.3 I 0 6.0 8.2 6.6 Mashonaland East 10.9 7.6 52.5 40 2 7.2 0.8 4.6 6 6 6,4 Mashonaland West 8 3 12.5 61.0 39,6 14 7 1.4 9 7 8.0 8 3 Matabeleland North 13 8 5.1 44 7 29.2 3.7 I I 2.0 8.6 18.7 Matabeleland South 18.5 12.6 60.5 39 8 8 1 1.9 6 5 17,1 3 4 Midlands 7 0 7 9 62.7 47.5 10.5 2 7 5.2 6 8 1,8 Masvingo 13.2 11.7 45.1 37.6 4.9 1 7 1.2 8 2 5,2 Harare 2.8 15.3 65 1 46,5 5 8 2,8 5.6 15.1 1 3 Bulawayo 4.3 12 2 67.8 50.8 15.5 7 9 6,2 16 4 1.9 Education No education 19.9 9.1 33 5 32.0 6 7 0.7 2 4 3,8 14 2 Primary 11.4 10.5 533 368 9.0 2.1 59 8 1 72 Secondary+ 4 4 12.5 67.3 47.2 8 6 4,3 8.6 13.0 1.6 I 5 821 0 7 506 0 5 576 0,5 627 I 7 342 I 3 296 I 4 802 I 5 648 0.3 1,048 2 385 3 647 2 2,859 0.7 2,545 Total 9.3 11.2 57 1 40,6 8 6 2.9 6 7 9.7 5.6 1.0 6,05 I I Includes avoiding mosqmto bites and kissing; seeking protection from a traditional healer, 149 Table 10 5.2 Knowledge o f ways to avoid HIV/AIDS: men Percentage of men who know ofspectfic ways to avozd HIV/A1DS and percentage with misinformation, by background characteristxcs. Z imbabwe 1994 Ways to avoid AIDS Have Percent- No only Avoid age with way to Abstain one sex with Avoid Avoid Don't any Number Background avoid from Use sexual prostn- trans- injec- Other know raisin- of charactertstlc AIDS sex condoms partner lutes tuslons tions ways any way formation ~ men Age 15-19 32 21,4 65,3 37,9 8.6 1.4 57 19.6 38 07 599 20-24 3 6 15 0 75,3 55.3 4 8 2.3 3 I 15.2 1,8 I I 399 25-29 1.7 15 9 73 6 59.2 8.6 3.1 5,0 20.0 1.3 0 9 288 30-39 3 7 14,6 64 3 59,4 8 1 3.1 7 1 13.1 09 1 1 434 40-49 6.0 I l 3 56 1 58.9 9.9 1,7 3.3 10,0 44 O0 299 5054 46 14.4 507 55,3 5A 00 5,0 10.3 6.6 0,5 113 Mar i ta l status Never married 2 9 20,2 69 4 42,9 7.1 1 4 4.9 19.2 3 3 I I 997 Currently mzrrwd 4.0 12 0 63 0 63,3 8 8 2.9 5 3 12 9 I 9 0 5 1.037 Formerly marrted 6.5 22,0 64 7 3L 7 4,6 I 5 3.8 9.6 5.7 0 5 99 Residence Urban 2 3 16.9 67.7 62,6 7 6 3,8 5.9 17,7 1 1 0,3 797 Rural 4.4 160 65,1 462 7,9 1.1 45 145 3,7 10 1.336 Province Manica/and 3.4 24,2 68.0 57,6 23.4 1.7 3 5 23,4 I 7 1,7 267 Mashonaland Central 3 5 7,6 69 0 50.3 2,4 I 2 5 4 13 6 0,9 0,4 181 Mashonaland East 4 I 11 3 68 1 47 0 7 0 1.0 3 6 13,9 I 6 1,0 190 Mashonaland West 4 1 29.7 6~ ,9 41,9 2 3 I 7 3.6 6 0 1. [ 0,4 264 Matabeleland North 3 6 4 7 7( 7 32,1 6 3 0,0 1 0 12,0 8 3 1,6 99 Matabeleland South 20.7 9 5 4~.7 28 7 0 0 1,4 6 3 12.8 13 6 12 90 Midlands 0 8 13,2 69 2 51,5 5 I I 2 14.6 23.1 3 6 1,4 263 Masvmgo 1.1 I1 2 52 5 52,9 5 9 L6 0 5 10.5 5 5 05 198 Harare I 3 1&9 6"~.4 66,5 10.1 3.1 2 6 16,3 O0 0,0 428 Bulawayo 7 0 12.0 6-', 3 57.4 3 3 7 0 9.5 19 8 3 7 0,4 154 Education No educatnm 55 13.5 4g 1 442 128 0,0 00 68 96 0,6 87 Prnnary 5 9 13 9 60.8 45 2 7.6 0,6 2 8 I 1 3 4,6 0 4 854 Secondary+ 18 182 7 1 58.0 75 33 70 19,5 09 10 1,192 Total 36 16.3 66.1 523 7.8 2,1 5.0 157 2.7 08 2.133 k Includes avotding mosqmto bztes and knssmg; seekzng protection from a traditzonal healer. Knowledge of ways to a~oid HIV/AIDS follows expected patterns by level of education and residence. For both women and men, safe patterns of sexual behaviour (e.g., use of condoms, restricting sex to one panner) are less commonly reported by respondents who have little or no education, and those hving in rural areas. 150 Tables 10.6.1 and 10.6.2 show the percentage of women and men who are aware of certain AIDS- related health issues, by background characteristics. The data show that virtually all women and men know that "the AIDS virus can be transmitted from mother to child during pregnancy or childbirth" and that AIDS cannot be cured at this time. A somewhat different picture emerges regarding responses to the question on whether or not "a healthy-looking person can have the AIDS v'rus, ' About 26 percent of women and 15 percent of men responded incorrectly to this question--i.e., no, a healthy-looking person cannot have the AIDS virus. Women and men who live in rural areas and those who have no formal education, are most likely to be misinformed on this question; 31 percent of rural women and 42 percent of women with no schooling do not know that a healthy-looking person can be HIV-infected. Table 10.6.1 Awareness of AIDS health issues: women Percentage of women who are aware of certain AIDS-related health issues, by background charactensucs, Zimbabwe 1994 Can Do you Can a healthy- Can AIDS be personally looking person AIDS transmitted know have the be from mother someone AIDS vxrus? cured? to child? with AIDS? Background characteristic Yes No Yes Yes Number of women Age 15-19 69,9 95.6 9 t .9 40.5 1,448 20-24 79,7 96.1 95,2 46.9 1,258 25-29 78.4 96.5 94.3 54.0 909 30-39 75.1 96.0 93.1 55. l 1,511 40-49 69.0 95.5 91.6 54.0 924 Current marital status Never married 74,1 96.2 93.0 40.7 1,628 Currently married 74.2 96.0 93.3 53.4 3,736 Formerly marned 75,9 94.8 93,1 50.1 685 Residence Urban 84,6 95.1 97.3 58 4 Rural 69.4 96.3 91.2 45.4 1,971 4,080 Province Manicaland 69,1 95.6 90.3 57.7 821 Mashonaland Central 66.9 95.2 92.3 44.7 506 Mashonaland East 71.9 97.8 94.6 51.8 576 Mashonaland West 70.9 96.6 90.9 41.7 627 Matabeleland North 70.7 91.5 86.4 34 7 342 Mataheleland South 82,5 96.1 90.6 28.7 296 Midlands 82. I 97.3 96.3 52.0 802 Masvmgo 57.2 98.0 89.1 40.1 648 Harare 81,9 97.9 98.4 64.3 1,048 Bulawayo 94,0 85.5 96.7 48.4 385 Education No education 58,3 94.3 83.0 34.4 647 Primary 69.8 95.9 92.2 50.5 2,859 Secondary+ 83,6 96.3 96.9 52.4 2,545 Total 74.4 95.9 93.2 49.6 6,051 151 Table 10.6.2 Awareness of AIDS health issues: men Percentage of men who are aware of certain AIDS-related health issues, by background characteristics, Zimbabwe 1994 Can Do you Can a healthy- Can AIDS be personally looking person AIDS transmitted know have the be from mother someone AIDS virus? cured'~ to chdd? wah AIDS? Number Background of c'haracter~s~Jc Yes No Yes Yes men Age 15-19 80.6 95.0 88.7 37.2 599 20-24 89.5 97.1 95.0 44.2 399 25-29 92.2 97 0 95,8 50.0 288 30-39 87,3 95.9 94 7 60.5 434 40-49 82.9 92.9 92.5 59.2 299 50-54 77.3 91 5 84.6 56.2 113 Current marital status Never married 83.9 95.7 90 7 40.5 997 Currently married 86,9 95.7 94.3 57.2 1,037 Formerly married 83.7 89.7 88.6 50.8 99 Residence Urban 93 4 95.4 97.0 61.0 797 Rural 80.5 95.4 89.6 41.9 1,336 Province Mamcaland 91.0 96. I 96.1 41 9 267 Mashonaland Central 73.4 96.5 90.3 47.6 181 Mashonaland East 74.0 94.9 94.3 56 7 190 Mashonaland West 90.5 99,6 90.4 34.8 264 Matabeleland Noah 74.0 95.3 81.8 28.3 99 Matabeleland South 72.0 90.5 70.5 35.9 90 Midlands 87 8 94,7 92.7 55 6 263 Masvmgo 76.2 92.3 90.8 32.5 198 Harare 94,3 95.6 98.2 67.4 428 Bulawayo 92.6 93.8 93 8 58 3 154 Education No education 63.7 87.2 81 I 40 7 87 Primary 77.9 95.0 86 7 45.7 854 Secondary+ 92.3 96.3 97.2 52 I 1,192 Total 85 4 95.4 92 4 49.1 2,133 The ZDHS asked the question, "Do you personally know someone who has AIDS or has died of AIDS?" Overall, nearly half of women and men reported that they knew someone who had AIDS or had died of AIDS. Respondents living in urban areas and those with more education are more likely to have had personal knowledge of someone ~¢ith AIDS than respondents living in rural areas and those with no education. 152 10.4 Perception of the Risk of Getting HIV/AIDS Female and male respondents who had heard of AIDS were asked whether their "chances of getting the AIDS virus" were great, moderate, small, or nil. Interviewers then followed-up by asking the respondents why they thought their chances were great/moderate, on one hand, or small/nil on the other. Tables 10.7.1 and 10.7.2 show that 77 percent of women and 88 percent of men said that they had little or no chance of being infecting. Only 7 percent of women and 3 percent of men said that their chances were great. Table 10.7.1 Perception of the risk of getting AIDS: women Percent distribution of women who have heard of AIDS by their percept:on of the risk of getting AIDS, according to background characteristics, Zimbabwe 1994 Chances of genmg AIDS Number Background No risk Don't of characteristic at all Small Moderate Great know Total women Age 15-19 70.1 20.6 6.3 3.1 0.0 100.0 1,448 20-24 49.4 29.1 14.0 7.5 0.0 100.0 1,258 25-29 32.7 35.7 23.8 7.8 0.0 I(30.0 909 30-39 32.8 34.5 24.4 8.2 0.2 100.0 1,511 40-49 43.1 31.6 18.6 6.6 0.1 100.0 924 Marital status Never married 68.2 20.9 6.7 4.2 0.0 100.0 1,628 Currently mamed 37.8 33.1 21.4 7.6 0.1 100.0 3,736 Formerly married 44.7 32.8 16.5 6.1 0.0 100.0 685 No. of sexual partners other than husband in last 12 months 0 47.6 29.4 16.6 6.3 0.! 100.0 5,710 1 33.4 32.2 23.7 10.8 0.0 100.0 91 2-3 33.6 34.5 19.8 12.1 0.0 100.0 113 4+ 31.3 38.5 23.5 6.7 0.0 100.0 116 Residence Urban 44.7 30.3 17.3 7.6 0.1 1000 1,971 Rural 47.7 29.5 16.7 6.0 0.0 100.0 4,080 Province Mamcaland 44.6 38.6 7.3 9.5 0.0 100.0 821 Mashonaland Central 63.3 11.5 23.1 2.0 0.1 100.0 506 Mashonaland East 47.7 27.9 19.1 5.3 0.0 100.0 576 Mashonaland West 45.1 32.8 14.9 7.2 0.0 100.0 627 Matabeleland Noah 43.3 38.5 11.3 6.8 0.2 100.0 342 Matabeleland South 42.2 32.9 13 6 10.9 0.4 100.0 296 Midlands 48.0 25,8 20.5 5.7 00 100.0 802 Masvingo 41.4 31.5 23.5 3.7 0.0 100.0 648 Harare 46.2 25.7 20.7 7.2 0.2 1(30.0 1,048 Bulawayo 45 3 39.4 7.9 7 4 0.0 100.0 385 Education No education 43.6 30.9 18.9 6.4 0.1 I00.0 647 Primary 44.1 30,9 18.0 6.9 0.1 100.0 2,859 Secondary+ 50.5 282 15.2 6.1 00 100.0 2,545 6,051 Total 46.7 29.8 16.9 6.5 0.1 1(30.0 Note: Total includes 21 women who reported "don't know" to number of sexual partners in last 12 months. 153 Table 10,7 2 Percepuon of tt~e risk of getting AIDS: men Percent dlstnbutlon of men who have heard of AIDS by their perception of the risk of getting AIDS, according to backgrould characteristics, Zimbabwe 1994 Chances of getting AIDS Number Background No risk Don't of characteristic at all Small Moderate Great know Total men Age 15-19 72.3 20.4 4.9 2.5 0.0 10O.0 599 20-24 54.3 35.7 7.7 2.3 0 0 100.0 399 25-29 43.8 39.7 13.2 3.3 0.0 100.0 288 30-39 43.7 39.7 13.3 3.3 0.0 100.0 434 40-49 50.7 35.0 10 1 4.2 0.0 100.0 299 50-54 55.7 26.9 10.8 4,9 1.8 100.0 113 Marital status Never married 6L7 28.0 7.0 2.4 0.0 1(30.0 997 Currently marned 5(,0 35.4 I1 2 3.3 0.0 100.0 1,037 Formerly married 3";.1 40.8 12.1 7.9 2.0 100.0 99 No. of sexual partners other than wife in last 12 months 0 5&J 31.1 8.5 2.2 0.1 1000 1,820 I 31;.9 40.8 13.6 6.6 0.0 100.0 230 2-3 3(~.5 34.5 12.6 15 5 1.0 100.0 55 4+ (50.5) (20.9) (20.1) (8.4) (0.0) 100.0 22 Residence Urban 4,1.6 39.3 12.1 3.9 00 100.0 797 Rural 61 8 27.9 7.6 2.6 0.2 1130.0 1,336 Province Manicaland 6t 8 27.5 4,2 3.9 0.6 100.0 267 Mashonaland Central 8k3 10.9 5.4 0.4 0.0 100.0 181 Mashonaland East 6,5.8 20.0 l 1. ] 2.1 0.0 100.0 ] 90 Mashonaland West 4,3,5 47.6 9,3 2.6 0.0 100.0 264 Matabeleland North 47.6 35.0 13.7 3.7 0.0 100.0 99 Matabe/eland South 45.8 34.3 9.5 8.9 0.6 100.0 90 Midlands 51.2 47.4 1.0 0.4 0.0 100 0 263 Masvmgo 6~t.3 18.9 15.4 1.5 0.0 100.0 198 Harare 46.7 34.4 13.7 5.3 0 0 100.0 428 Bulawayo 48.8 36.0 11.6 3.7 0.0 100.0 154 Education No education 49.4 35.5 11.7 3.4 0.l) 100.0 87 Primary 60.6 26.9 8.8 3.5 0.2 100 0 854 Secondary+ 52.0 35.8 9.4 2.8 0.0 100.0 ],192 Total .~5.3 32.2 9.3 3.1 0.1 100.0 2,133 Note: Figures in parenthes~!s are based on 25-49 men, The ZDHS made use of th,~ fact that women and men were interviewed separately to link data on currently married men and their wives living in the same household. This makes it possible to look at couples as units of study. Table 10.8 shows that among couples who know about AIDS, 21 percent share a similar view that they are at no risk of getting AIDS, However, over half of the husbands reported that they had no risk of getting AIDS, compared with about one-third of wives. In about one-quarter of couples, the husband reported that his risk of getting infected was small or nil, but the wife stated that her risk was moderate or 154 Table t0.g Perception of the risk of getfmg HIV/AIDS among couples Percent disttibutton of couples who know about AIDS by husband's and wife's I perceptions of risk of getting AIDS, Zimbabwe 1994 Chances of getting A1DS: husband Number Perception of No risk of risk of AIDS at all Small Moderate Great Total couples Chances of getting AIDS: wife No risk at all 21.1 l 1.0 3.0 0.8 35.9 253 Small 18.2 I 1.2 3.9 1.4 34.7 245 Moderate 8.8 8.4 2.2 0.8 20.2 143 Great 3.7 3.4 1.2 0.6 8.9 63 Total 52.1 34.0 10.3 3.6 100.0 706 Number 368 240 73 25 706 706 Note: Total includes 2 missing couples. great. This fear--reflected disproportionately in wives' perceptions of risk--is likely to be based on information about marital relationships not captured in these data. Table 10.9 presents information on reasons why individual women and men perceive their risk of getting the AIDS virus as low or nil. Roughly equal proportions of women and men stated that their risk was low or nil because they were abstaining from sex altogether (28 and 27 percent, respectively). Women (59 percent) were more likely than men (47 percent) to report that sticking to one partner was the reason for their low risk; while men (26 percent) were more likely than women (5 percent) to report that condom use was the reason for their low risk of getting the AIDS virus. Table 10.9 Reasons fbr perception of small/no risk of getting HIV/AIDS Percentage of women and men who think they have a small or no risk of getting AIDS, by reasons for that percepUon of risk, Zimbabwe 1994 Number No of Marital Abstain Use One sex Limited blood No mjec- women/ status from sex condom partner partners transfusion tlons Other men WOMEN Never married 71. I 5.3 15 3 2 2 2.0 4.3 8 7 1,450 Currently married |.1 3 0 87 8 2 8 0.8 0.9 9.9 2fo47 Formerly married 42 5 17.0 36.8 5.7 1.0 2 1 6 3 53 I All women 27.8 5.4 59 2 3 0 1.2 2.1 9 2 4,630 MEN Never married 51 4 28.0 19.2 8.4 0.9 1.7 13 2 904 ] Currently marned 1.9 20 6 78 2 12.4 0.6 1.4 7 2 886 Formerly roamed 21.6 52.3 23 7 23 4 0 0 0.0 10.9 77 All men 26.7 25.5 47 4 I I 0 0.7 1.5 10 3 1,867 155 Table 10.10 shows the percentage of women and men who think they have a moderate or great risk of getting AIDS, by the stated reasons for their perceptions. The majority of women (59 percent) believe that they are at moderate or great risk because they fear their spouse/partner has another partner; very few men (2 percent) report this reason. Only 8 '9ercent of women, compared with 30 percent of men, reported that they were at moderate or great risk becau,~.e they had many sex partners. Twenty-f ive percent of women and 55 percent of men gave a variety of othe r reasons (many not logical) for their perceptions of moderate or high risk. Interpretation of these "other" responses will require further analysis from a social/psychological perspective. Table 10.10 Reasons for perception of moderate/great risk of ,getting HIV/AIDS Percett/age of women and mer~ who think/hey have a moderate or great ask of getting AIDS, by reasons /or that percept/on of risk, Zimbabwe 1994 Number Don't Many Spouse Had Had of Marital use sex has blood ifljec- women/ status condom partners partner transfusion tnons Other men WOMEN Never marrned 7 6 12.2 9 5 9 7 12.1 51.6 178 Currently marrzed 6.7 4 0 72.3 1.6 2 8 20.5 1,084 Formerly roamed 19 5 33.3 26 8 5 4 7 5 24.0 154 All women 8.2 8.2 59 4 3.0 4 4 24 8 1,417 MEN Never marned 14 5 25.9 2.0 0 0 2 I 60.9 93 Currently roamed 13 3 30.0 1 I 3 1 7 0 53 9 151 Formerly married * * * * * * 20 All men 14 8 30.2 1.7 1 8 4.8 54.9 264 Note: An asterisk rod/cares th~.t a figure is based on fewer than 25 cases and has been suppressed. 10.5 Behaviour Change ZDHS respondents who had heard of AIDS were asked whether or not they had changed their behaviour since they learned of the disease. I f they responded positively they were asked what they did. Tables 10.1 1.1 and 10.11.2 and Figure 10.1 show that 79 percent of women, compared with 38 percent of men, said that they had not changed their behaviour. Only 4 percent of women and 23 percent of men began using condoms, about 10 percent o" women and 34 percent of men began restricting sex to one partner, and 3 percent of women and 5 percent af men stopped having sex. The data show that respondents living in rural areas and those with no education are more likely to have not changed their sexual behavionr (in response to the perceived risk of AIDS) than respondents l iving in urban areas and those who are more educated. About 82 percent of women in rural areas did not change their sexual behaviour, compared with 72 percent in urban areas; at the same time, 44 percent of men in rural areas, compared with 27 percent in urban areas, did not change their sexual behaviour. I f respondents felt that their chances of getting AIDS was small or nil, they were more likely to have not changed their sexual behaviour but this pattern is not pronounced. 156 Table 10,11.1 AIDS prevention behavlour: women Percentage of women who have heard of AIDS and have ever had sex, by specific changes in behavlour in order to avoid AIDS, perception of AIDS risk, and background characteristics, Zimbabwe 1994 Change in behaviour to avoid AIDS No change Began Restricted Other Non- Number Background in sexual Stopped using to one Fewer sexual sexual of characteristic behavtou~ sex condom partner partners behawour behawour women Perception of AIDS risk Among those who believe AIDS always fatal No/small risk 79.7 3.7 3.7 9.4 1.7 3 1 0.9 4,416 Moderate/great risk 75.3 2.1 5.9 11.7 2.3 4.2 1.5 1,384 Among those who do not believe AIDS always fatal, or don't know No/small risk 85.2 1.9 3.9 6.8 1.1 2.5 1.2 214 Moderate/great risk (73.8) (4.6) (2.0) (15.7) (0.0) (4.0) (2.0) 33 Age 15-19 80.1 6.8 1.5 5.2 1,9 4.4 1.5 1,448 20-24 74.5 3.5 4.5 13.3 2.2 3.4 1.2 1,258 25-29 74.4 1.1 6.5 13.8 2.5 4.0 1.9 909 30-39 80.5 1.3 5.5 10.1 1.5 2.9 0.6 1,511 40-49 84.7 2.9 3.4 8.4 0.7 1.8 0.1 924 Marital status Never married 77.6 8.1 3,0 5.6 2.4 4.0 1.7 1,628 Currently married 84,2 0.2 2.3 9.6 0.7 3.4 0.8 3,736 Formerly married 53.0 8.8 16.9 22.0 6.2 1.3 1.0 685 Residence Urban 71,9 4.4 5.0 13.7 2.2 5.2 1.4 1,971 Rural 82.3 2.8 3.8 8.1 1.6 2.5 0.9 4,080 Province Manicaland 84.7 3.1 3.0 4.2 2,0 3.0 2.6 821 Mashonaland Central 84,0 3.4 4,3 5.8 1.3 2.4 0,3 506 Mashonaland East 86.6 1.7 1.5 7 2 I. 1 2.5 1. I 576 Mashonaland West 70,0 4.4 7.2 13.6 3,4 3.5 0.7 627 Matabeleland North 82.7 0.8 3.6 10.2 1.6 0.9 0.6 342 Matabeleland South 76.9 3.8 5.9 13.3 0.5 3.2 0.2 296 Midlands 72.9 4.3 4 4 ] 4 4 3.0 2.4 1.0 802 Masvmgo 85,3 1.3 4.2 5.4 1.8 2.7 0.3 648 Harare 76.6 4.6 3.9 10.2 1.0 6 1 1.3 1,048 Bulawayo 68.7 3.6 4.6 20,0 1.2 4.3 1.0 385 Education No education 89,6 1.2 3. I 5.7 0,6 0.5 0.0 647 Primary 81.9 2.8 4.2 8.6 1.5 2.2 0.6 2,859 Secondary+ 72,8 4.4 4.4 12.4 2.4 5.4 1.9 2,545 Total 78.9 3.3 4.2 9.9 1.8 3 3 1.1 6,051 Note: Total includes 4 women who responded "don't know" about risk status. Figures in parentheses are based on 25-49 women. 157 Table 10 11.2 AIDS prevention beha,,lour: men Percentage of men who have heard oI AIDS and have ever had sex, by specific changes in behaviour m order to avoid AIDS, perception of AIDS risk, and background characteristics, Zimbabwe 1994 Change in behaviour to avoid A1DS No change Began Restricted Other Non- Number Background m sexual Stopped using m one Fewer sexual sexual of characteristic behawour sex condom partner partners behaviour behavlour men Perception of AIDS risk Among those who believe AIDS always fatal No/small risk 38.5 5.5 22.2 34 9 9.6 0.3 3.8 1,789 Moderate/great risk 28.1 2,7 30.4 36.0 13.4 0.4 4.0 245 Among those who do not believe AIDS always fatal, or don't know No/small risk 47.5 7.3 20.2 22. I 9.9 0 8 2.1 78 Moderate/great risk * * * * * * " 19 Age 15-19 62.8 11.5 11.8 10,2 2.9 03 6.0 599 20-24 30 3 6.6 36.6 29.0 13.3 0,2 5 2 399 25-29 18.4 3.7 34.6 50.0 12.9 0.7 2 6 288 30-39 23.2 1.1 26,0 50.8 145 0.7 2.5 434 40-49 36.1 0.6 16.5 48,1 9.4 0 0 1.7 299 50-54 388 0.9 IL7 43.4 12.7 0.0 0.5 113 Marital status Never mamed 49.5 10.7 22.6 15.0 7.8 0.3 5 3 997 Currently married 27.0 0.2 21.5 54.3 l 1.0 0.4 2.6 1,037 Formerly mamed 29.4 4.4 44.5 21,3 22 2 0 0 I 0 99 Residence Urban 26,8 6.7 24,8 44.6 9.9 0.6 3.9 797 Rural 44.1 4.5 22.1 28,3 10 1 0 2 3.7 1,336 Province Manicaland 45.1 3.4 21.7 28.4 15.7 0.0 3.4 267 Mashonaland Central 32.0 10.6 19.3 38.0 5 3 0 fi 3.5 181 Mashonaland East 29 5 5 1 25 4 38.5 9.2 1.0 3.1 190 Mashonaland West 42.5 I 9 46.7 29.4 5.9 0.0 0 0 264 Matabeleland North 44.2 3.2 21.0 24.2 19 4 0.0 6.3 99 Matabeleland South 61.3 2.4 9.7 16,6 9.7 0.6 4.1 90 Midlands 38.4 9.3 14.1 26.5 13 2 0 0 7.3 263 Masvingo 58.2 1.6 126 24,0 5.9 0.0 2.6 198 Harare 21.6 5.3 23.8 50,7 106 0.4 4.0 428 Bulawayo 31.8 9.5 22,7 43.0 6 2 1.7 5.4 154 Education No education 57.7 1.2 12.0 31,6 5.9 0 0 1.2 87 Primary 43.9 2.8 19.8 33.3 9.5 0.0 I 6 854 Secondary+ 31.7 7.4 26.3 35,4 10.6 0.6 5.5 1,192 Total 37.6 5.3 23.1 34.4 10.0 0.3 3.8 2,133 Note: Total includes 2 men who responded "don't know" about risk status. An asterisk indicates that a figure is based on tewer than 25 men and has been suppressed. 158 Figure 10.1 Change in Behaviour after Hearing about HIV/AIDS, by Sex NO CHANGE IN BEHAVIOUR ~.,,-~. CHANGE IN BEHAVIOUR Restrict to One Partner Began Using Condom Fewer Partners Stopped All Sex Other I ~--jjjjj~-jjjjfjj~ 20 40 60 80 100 Percent 1994 ZDHS 10.6 Number of Sexual Partners Given the evidence that the vast majority of HIV infections in Zimbabwe are contracted through heterosexual contact, information on sexual behaviour is important in designing and monitoring intervention programmes to control the spread of the disease. The ZDHS included questions about sexual activity in the four weeks preceding the survey: with the respondent's spouse, and (in separate questions) with other partners. Regarding sex with the spouse or other partners, questions were asked on condom use during sexual intercourse in the last four weeks. Tables 10.12.1 and 10.12.2 show the percent distribution of currently married and unmarried women and men by number of persons with whom they had sex in the last four weeks, according to background characteristics. Overall, men reported having more sexual partners than women. Very few married women reported extra-marital liaisons, while 20 percent said that they had not had sex at all in the last four weeks; thus, the mean number of partners for currently married women was 0.8. For married men, only 15 percent reported abstaining in the last four weeks, while 12 percent reported sex with two or more women; the mean number of sex partners for married men was 1.1. Less than 1 percent of married women reported sex outside of marriage (i.e., partners excluding spouse), compared with 7 percent of married men. Among women and men who are not currently married, the picture is quite different. Thirteen percent of unmarried women and 21 percent of unmarried men reported being sexually active in the four weeks preceding the survey. Sexual activity decreases with increasing level of education among both unmar- ried women and men. 159 Table 10.12.1 Number of recent sexual partners: women Percent distribution of currently married and unmamed women by the number of sexual partners m the four weeks preceding the survey, according to selected background characteristics, Zimbabwe 1994 Currently roamed women Unmamed women Number of partners Number of partners including spouse Number excluding spouse Number Nt;mber of partners Number Background of of of charactensuc 0 1 2-3 Missing Total women Mean 0 1 Missing Total women Mean 0 1 2-3 4+ Missing Total women Mean Age 15 19 27.6 72.1 0.2 00 100.0 276 0.7 998 0.2 0.0 100.0 276 0.0 96.5 3.0 0.3 0.1 0 1 10130 1,195 0 1 20-24 20.1 79.8 0 1 0.1 100.0 798 0.8 99.3 0.4 0.3 100.0 798 0.0 83 6 15 2 0.1 0 2 0.9 1000 472 0 2 25-29 16 8 82 3 0.7 0.3 100.0 726 0 8 98 7 1.2 0 I 100.0 726 0.0 71.1 27.5 1 2 0.3 0 0 100 0 189 0.3 30-39 20.5 79.2 0.0 0 2 100.0 1,252 0.8 99.2 0.2 0.6 100.0 1,252 0 0 66.5 28.3 2.7 1.0 1 4 1000 280 0 5 4049 19.4 803 0 1 0.i 1000 736 08 992 0.7 0.1 1000 736 0.0 74.3 25.1 0.0 00 0.5 100.0 204 0.3 Marital duration Never married NA NA NA NA 1000 0 NA NA NA NA 100 0 0 NA 93 9 5.6 0.3 0.1 0A 100 0 1,646 0 1 0-4 22 6 77.0 0.2 0 2 100.0 968 0 8 99.3 0 4 0 3 100.0 968 0.0 67.0 31.2 0 0 0.0 1 8 100.0 120 0.3 5-9 18.5 80.9 0.2 03 100.0 756 0.8 990 0.7 0.3 100.0 756 00 65.1 31.3 0.8 0.9 19 1000 127 0.4 10-14 ~93 803 0.3 0.1 1000 625 08 991 0.6 03 100.0 625 0.0 683 288 2.9 0.0 0.0 1000 118 03 15+ 19 4 80.4 0.1 0 I 100.0 1,439 0.8 99.2 0.5 0 3 100.0 1,439 0.0 70.0 26.4 1 3 09 1 5 100.0 329 0.4 Residence Urban 11.9 87.5 0.2 04 100.0 1,114 09 99.2 0.5 04 100.0 1,114 0.0 83.3 15.0 1 0 04 0.4 100.0 861 02 Rural 23.4 764 02 0A 100.0 2,674 0.8 99.2 0.6 03 100.0 2,674 00 88.0 10.9 0.4 0.2 05 1130.0 1,479 01 Education No educanon 25.7 73.7 0.5 0 0 100.0 552 0.7 98.7 IA 0.2 100.0 552 0 0 68.5 28.8 1 8 0.8 0.0 100.0 130 0.5 Primary 195 803 01 00 1000 1,992 08 992 05 0.3 1000 1,992 00 83.1 15.1 1.0 0.2 07 100.0 906 0.2 Secondary+ 18 2 81 1 0.2 0.5 100 0 1,244 0 8 99 4 0 3 0 3 I00 0 L244 0.0 90.3 8.9 0.2 0.3 0.3 100 0 1,303 0.1 Total 20 0 79 6 0.2 0 2 1000 3,788 0.8 99.2 0.5 0.3 100.0 3,788 0 0 86.3 12.4 06 0.3 04 100.0 2,340 0 2 NA = Not apphcable i Table 10.12.2 Number of recent sexual partners: men Percent dtstnbution of currently mamed and unmarried men by the number of sexual partners m the four weeks precedmg the survey, according to selected background characteristics, Z~mbabwe 1994 Currently married men Unmamed men Number of partners Number of partners mcluding spouse Number excluding spouse Number Number of partners Number Background of of of characteristic 0 1 2-3 4+ Missing Total men Mean 0 1 2-3 4+ Missing Total men Mean 0 1 2-3 4+ Missing Total men Mean Age I5-19 23.9 66.0 0.0 00 10.1 1(30.0 10 0.7 89.9 0.0 0.0 0.0 10.1 100.0 10 00 89.5 8.6 1.4 0.5 00 100.0 595 0.1 20-24 12.7 78.7 7.6 1.0 0.0 100.0 99 1.0 904 8.6 0.0 1.0 0.0 100.0 99 0.1 70.5 23.7 4.8 0.8 0.2 i000 301 0.4 25-29 16.9 76 2 5.3 1.6 0.0 100.0 177 0.9 92.4 6.8 04 0.3 0.0 100.0 177 0.1 61.7 293 4.7 0.9 3.4 100.0 111 0.4 30-39 129 739 113 1.2 07 100.O 380 12 94.0 47 0.9 0.4 00 100.0 380 0.2 476 38.6 12.1 0.0 18 100.0 56 0.6 4049 15.8 67.9 14.2 07 1.4 100.0 273 1.0 923 7.3 0.0 0.0 0.4 100.0 273 0.1 44.7 43.0 10.5 1.8 0.0 100.0 28 0.8 50-54 20.4 65.4 13.4 0.8 0.0 100.0 101 1.0 94.7 5.3 0.0 0.0 0.0 1000 101 0.1 * * * * * 1000 12 * Marital duration Never married NA NA NA NA NA 100.0 0 NA NA NA NA NA NA 100.0 0 NA 80.6 15.6 3.0 0.5 0.2 1000 1,004 0.3 04 15.5 77.3 5.5 1.4 0.3 100.0 311 1.0 91.0 6.8 1.3 0.5 0.3 1000 311 0.1 58.5 249 6.6 0.0 10.1 100.0 29 0.4 5-9 17.7 71.3 9.7 1.3 00 100.0 193 1.1 94.4 4.7 0.0 0.8 0.0 100.0 193 0.3 * * * * * 1130.0 14 * 10-14 10.3 76.0 133 0.4 00 100.0 166 1.1 934 66 0.0 0.0 0.0 100.0 166 0.1 41 1 49.6 9.3 0.0 0.0 100.0 25 0.7 15+ 15 7 66.9 146 1 0 1.8 100.0 370 1.1 93 6 6.1 0.0 0.0 0.3 100.0 370 0.1 57.0 29.7 11.5 1.7 0.0 100.0 31 0.7 Residence Urban 12.8 75.4 101 0.9 09 100.0 452 1.1 93.2 63 0.1 0.4 0.0 100.0 452 02 76.8 18.9 2.7 0.5 1.1 100.0 345 0.3 Rural 17.0 69 8 11.3 1 2 0.6 100.0 586 1.0 92 8 6.0 0.6 0.3 0.4 100.0 586 0 1 78.6 16.6 3.9 0.7 0.2 100.0 758 0.3 Education Noeducat~on 308 57.0 12.2 00 00 100.0 67 0.9 929 71 0.0 0.0 0.0 100.0 67 01 * * * * * 1000 21 * Primary 18 3 664 13 5 08 1.I 100.0 500 1.0 92.8 6.2 07 0.1 0.2 100.0 500 0A 75.8 16.6 6.0 1.1 0.4 1000 360 0.4 Secondary+ 96 80.6 7.8 1.6 0.5 100.0 472 1 1 93.2 5.9 02 05 02 1000 472 0.2 79.1 17 9 2.1 0.4 05 100.0 721 0.2 Total 15.2 72 3 10.8 1.1 07 100.0 1,038 1.1 93 0 6.1 0.4 0.3 0.2 100.0 1,038 0 1 78 0 17.3 3.5 0.6 0.5 1000 1,103 0.3 Note: An asterisk Indicates that a figure is based on fewer than 25 unmamed men and has been suppressed NA = Not apphcable As a follow-up to questions on recent sexual activity, the ZDHS included a question on whether or not the respondent "gave or received money, gifts or favours in return for sex in the last 4 weeks." Table 10.13 shows that 3 percent of women1 and 7 percent of men reported giving or receiving compensation in exchange for sex. Sex for payment o1" favours is about eight times more common among unmarried women and three times more common among unmarried men than among their married counterparts. Among married respondents, sex for favours is not strongly associated with level of education; however, among unmarried respondents the practice decreases with increasing level of education. Table 10.13 Payment for sexual relations Among women and men who ever had sexual intercourse, the percentage who gave or received money, git~s, or favours m return tbr sex in the last 4 weeks by reantal status and background characteristtcs, Zimbabwe 1994 Women Men Currently Not currently Currently Not currently married married Total mamed married Total Background characterisoc Percent Number Percent Number Percent All Percent Number Percent Number Percent All Age 15-19 1.8 273 12.8 165 6.0 437 * 10 80 189 7.6 199 20-24 1.8 795 9 4 254 3 6 1,049 2 5 99 10 5 245 8.2 344 25-29 1.5 726 7 7 170 2 7 896 5.0 177 11.0 108 7 3 285 30-39 1.0 1,252 11.8 272 2.9 1,524 4.8 380 19.0 56 6 6 436 40 49 0.7 736 9.6 203 2 7 939 4 3 273 (21 2) 28 5.9 301 50-54 NA NA ~A NA NA NA 3 9 101 * 12 5 3 113 Residence Urban 0.9 1,113 9 6 394 3 2 1,506 5 5 452 9 1 229 6.7 681 Rural 1.4 2,669 10.7 670 3.2 3,339 3 4 586 12 3 410 7 1 996 Education No education 0.8 552 15 7 122 3 5 674 4.0 67 * 15 5 8 82 Primary l 1 1,987 11.3 519 3.2 2,506 44 500 169 192 79 692 Secondary+ 1.7 1,243 7 5 423 3 1 1,665 4 3 472 8 5 431 6 3 902 Total 1 2 3,782 ] 0.3 1,064 3.2 4,846 4.3 L,038 I 1 2 638 6 9 1,677 Note: Figures in parentheses are based on 25-49 cases An asterisk indicates that a figure ~s based on l~wer than 25 cases and has been suppressed. NA = Not apphcable 10.7 Source of Condom Supply Because of the important role condom use plays in combatting the transmission of H1V, respondents who reported knowing about condoras were asked where they could be obtained. Tables 10.14.1 and 10.14.2 show that knowledge about condoms is almost universal in Zimbabwe. Ninety-seven percent of women and 99 percent of men reported that the~ knew about condoms. More than half of both women (59 percent) and men (56 percent) reported that they could obtain condoms from a source in the public sector) On the other hand, 30 percent of women and 20 percent of men said that they did not know where they could obtain condoms. Knowledge of a source for condoms is greater among respondents who live in urban areas and those who have some formal schooling (see Figure 102). The provinces of Matabeleland North and Mashonaland West have the largesl proportions of women and men who could not cite a single source for condoms. 2 The public sector includes government facilities, mission facilities, and programmes run by the Zimbabwe National Family Planning Council (ZNFPC). 162 Table 10.14.1 Knowledge of condoms: women Percentage of women who know about condoms and the percentage who know a specific source for condoms, by background characteristics, Zimbabwe 1994 Source for condoms Know Private Don't Number Background about Public medical Private Other know a of characteristic condoms sector sector pharmacy source source women Age 15-19 98,3 50.7 1.6 2.4 %3 38.0 430 20-24 98,8 61.4 2.9 3.4 6.0 26.3 1,038 25-29 99.3 64.0 3.8 4.7 5.4 22. I 890 30-39 97,1 61.2 3.0 3.7 4.3 27.8 1,503 40-49 92,5 50.4 2.3 2.8 3.2 41.3 923 Current marital status Never married 98,4 50.1 2.2 5.1 I 1.4 31.2 369 Currently roamed 97.0 59.1 3.0 3.6 4.4 30.0 3,729 Formerly married 97,1 61.8 2.6 2.4 4.4 28.8 685 Residence Urban 99,2 53.3 2.7 9.0 10.8 24.2 1,503 Rural 96.2 61.2 3.0 1.0 2.3 32.5 3,282 Province Mamcaland 92,3 58.6 8.6 0.3 3.3 29.2 627 Mashonaland Central 97.5 53.8 0.4 0.9 3.4 41.5 415 Mashonaland East 97.0 76.5 1.5 1.5 1.8 18.7 446 Mashonaland West 97.8 52.4 6.6 3.1 4.9 33.0 534 Matabeleland North 93,8 44.1 4.0 1.2 2.6 48.0 305 Matabeleland South 98.3 64.9 0.4 0.8 2.1 31.8 257 Mtdlands 98.1 55.2 1.6 2.8 4.0 36.5 634 Masvingo 97,5 70.4 0.0 0.6 2.9 26.2 49 I Harare 99,6 63.8 1.6 9.3 9.6 15.8 776 Bulawayo 98.7 35.6 1.3 13.7 13.7 35.6 299 Education No education 86.9 47.6 2.2 0.8 1.2 48.2 639 Primary 97.9 61.5 2.8 1.5 2.9 31.2 2,482 Secondary+ 99.8 58.9 3.2 7.6 9.5 20.9 1,664 Total 97.1 58.7 2.9 3.5 4.9 29.9 4,785 163 Table 10,14.2 Knowledge o1" condoms men Percentage of men who know about condoms and the percentage who know a specific source for condoms, by background characlenstlcs, Zimbabwe 1994 Source for condoms Know Private Don't Background about Public medtcal Private Other know a characterisnc condoms sector sector pharmacy source ~ource Number of men Age 15-19 99.2 55.8 0.4 2 2 18.2 23.4 199 20-24 10().0 61.4 2.7 4 6 17.1 14.2 344 25-29 99.1 61.0 0,4 5.4 18.6 14.6 285 30-39 99.8 53.2 3.6 3.2 19 4 20 5 434 40-49 99.5 52,7 3.3 7.2 14.5 22.4 299 50-54 95,1 42.8 3.2 5.5 7.5 41,0 I 13 Current marital status Never married 99.6 58.6 1.6 3.5 18.6 17.6 538 Currently married 99.3 54.1 3 0 5 5 15 7 21 6 1,037 Formerly married 97 3 57.0 0.6 1.0 20 9 20 5 99 Residence Urban 99,8 44 0 4 3 9.6 26.7 15.5 Rural 98.9 63,8 1.1 1.2 10.3 23.5 681 994 Province Mamcaland 98.3 61.2 1.0 0.8 12 8 24 1 176 Mashonaland Central 100.0 48.6 0.2 0.8 17.5 33.0 147 Mashonaland East 100.0 71.9 0 0 3.8 8.3 16.0 148 Mashonaland West 99,5 74.1 1 5 0.0 5.5 18.9 205 Matabeleland North 99.4 47.4 11.5 0.0 6 2 34 9 86 Mataheleland South 96.8 58.1 0.8 I 6 12.8 26.7 67 Midlands 100 0 52.1 5 7 2 2 18.3 21.7 210 Masvingo 96,2 65.8 1 6 0.8 9 3 22 5 132 Harare 100.0 43 7 1.5 13.7 31,0 I 0,2 371 Bulawayo 99.5 44.0 3 8 8 6 24.4 19.1 133 Education No educanon 98 0 48 8 1.3 0.0 14.0 35.8 81 Primary 98 7 56.4 1.9 1,8 12.6 27.3 691 Secondary+ 99,8 55.8 2 9 7.2 20.6 13 5 902 Total 99 3 55.7 2.4 4.6 17.0 20.3 1,674 164 Figure 10.2 Percentage of Women Age 15-49 Who Do Not Know a Source for Condoms ZIMBABWE AGE 15-19 20-24 25-291 30-39 40-491 RESIDENCE Urban Rural' EDUCATION[ 10 20 30 40 Percen'~ A 5O ZDHS 1994 10.8 Use of Condoms Tables 10.15.1 and 10.15.2 show the percentage of women and men who ever used condoms for contraceptive purposes, for STD prevention, or for either reason. Thirty-three percent of women and 69 percent of men reported ever using a condom (for either reason). While 26 percent of women used condoms for contraceptive purposes and 18 percent to avoid STDs, 66 percent of men used condoms for contraceptive purposes and 38 percent to avoid STDs. Thus, it is clear that many women and men have both contraception and STD prevention in mind when they use condoms. Use of condoms for contraceptive purposes is higher than use for disease prevention in nearly all population subgroups. Overall, women and men who live in urban areas and those who have some education are more likely to use condoms than women and men who live in rural areas or who have no education. Use of condoms is not strongly associated with a person's perceived risk of HIV/AIDS. This finding could be explained by two counter-balancing facts. Women and men may use condoms because they perceive themselves at high risk, but others perceive themselves at high risk because they do not use condoms. Tables l 0,15.1 and l 0.15.2 also show the prevalence of condom use during sex in the last four weeks, by type of sexual contact (i.e., spouse or non-spouse). The data indicate that condom use is much higher when the partner is not a spouse. Among female respondents who had sex with their husbands, 7 percent said that a condom was used at least some of the time. Among women who had sex outside (or before) marriage, the level of condom use with those partners was 38 percent. Among men, there is a similarly large differential in condom use regarding marital and non-marital sex--12 percent and 60 percent, respectively. 165 Table 10. 15 ! Reasons for using condoms and wzth whom: women Among women who ever had sex, the percentage who used condoms, by specific reasons (family planmng and to avmd sexually transmitted diseases (STDs)), and of those having sex m the last four weeks, the percentage using condoms with a spouse and with a non-spouse, by perception of AIDS risk, background charactenstics, and changes m behaviour to avoid AIDS, 'Zimbabwe 1994 l~eason for using condom Of those having sex m the last 4 weeks, condom was used w~th: Number Number Number Background Family Avoid Either of of Non- of characteristxc planning STDs reason women Spouse women spouse women Perception of AIDS risk Among those who beheve AIDS always fatal No/small rtsk 25.8 17.3 32.6 3,296 6.8 Moderate/great risk 30. I 20 2 35.5 1,288 9.1 Among those do not beheve AIDS always fatal, or don't know No/small risk 10.6 12.8 18.1 167 4 0 Moderate/great risk (22.7) (25.7) (35.2) 31 * Age 15-19 21.8 18.4 28.5 430 6.4 20-24 33.8 22.0 40.7 1,038 8.1 25-29 35.2 21.7 41.3 890 8.4 30-39 25.5 17.5 32.6 1,503 7.9 40-49 13 2 102 18.2 923 5.1 2,008 40.8 220 855 38 I 103 93 * 14 21 * 5 196 (26.1) 41 629 51.9 78 595 42.7 63 978 38 5 100 581 24 3 58 Province Manicaland 23 4 13.4 29.4 627 5.1 391 (43 3) 34 Mashonaland Central 26.5 16.1 34.1 415 9.1 276 (39.6) 25 Mashonaland East 30.1 15.6 36.5 446 10.8 286 * 9 Mashonaland West 25.8 20.7 35.5 534 6.3 342 (38.7) 34 Matabeleland North 14.2 11.9 19.7 305 3.8 157 * 23 Matabeleland South 23.8 23.9 34.3 257 7.9 115 * 24 Midlands 33.1 22.0 35,8 634 7.7 396 39.3 60 Masvmgo 21.4 17.5 23.6 491 6.5 310 (26.3) 40 Harare 30.9 17.6 38.4 776 8.8 548 (55.6) 47 Bulawayo 25.2 22.8 34.5 299 5.4 159 (34.3) 46 Education No education 14.5 9.3 18.9 639 4.2 389 (35.4) 47 Prtmary 24 1 16.7 30.4 2,482 7.0 1,581 32 5 166 Secondary+ 34.4 23.1 41.8 1,664 9.2 1,009 47.3 128 Change in behaviour to avoid AIDS No change 21.8 10.9 27.0 3,719 6.3 2,509 23,3 153 Stopped sex 21.9 17.9 26.5 95 * 1 * 1 Used condom 78.4 100.0 100.0 252 49.8 69 80.1 88 Only one partner 36.2 33.1 46.7 585 6.4 287 40.9 113 Fewer partners 43.8 54.6 59.0 87 * 20 (45.4) 25 Other 37.1 25.2 45.6 140 9.4 102 * 2 Not stated (31.6) (19 2) (35.2) 40 * 24 * 2 Total 26.4 17.9 32.8 4,785 7.4 2,979 38.4 341 Note: F~gures in parentheses are bused on 25-49 women. An asterisk indicates that a figure is based on fewer than 25 women and has been suppressed NA = Not apphcable 166 Marital status Never marrlod 34.4 38.9 44.5 369 NA 0 42.7 100 Currently married 24.7 12.4 29.7 3,729 7.4 2,979 (21.1) 25 Formerly married 31 3 36.7 43.8 685 NA 0 38.5 215 Residence Urban 30.4 20.4 38.4 1,503 7.9 973 47.3 149 Rural 24.6 16.8 30.3 3,282 7.2 2,006 31.6 192 Table 10.15.2 Reasons for using condoms and w~th whom: men Among men who ever had sex. the percentage who used condoms, by specific reasons (family planning and to awfid sexually transmitted diseases (STDs)), and of those having sex in the last four weeks, the percentage using condoms with a spouse and with a non-spouse, by perception of AIDS risk, background characteristics, and changes in behaviour to avotd AIDS, Zimbabwe I994 Reason for using condom Of those having sex in the last 4 weeks, condom was used w~th Number Number Number Background Family Avoid Either of of Non- of characteristic planning STDs reason men Spouse men spouse men Perception of AIDS risk Among those who beheve AIDS always fatal No/small risk 67.7 39.5 70.0 1,367 Moderate/great risk 64.9 33.4 68.4 229 Among those who do not beheve AIDS always fatal, or don't know No/small risk 45.1 30.4 54.8 59 (21.1) Moderate/great risk * * * 17 * Age 15-19 65.5 50.9 71.6 199 * 20-24 81.0 57.2 82.7 344 18.2 25-29 81.0 43.7 82.9 285 9.2 30-39 66.8 31.1 69.6 434 13.7 40-49 49.0 21.5 51.8 299 8.9 50-54 31.3 14.8 32.3 113 83 10.8 704 64.8 232 16.1 115 42.0 65 29 * 12 5 * 4 6 48.4 62 82 68.5 98 143 65.7 56 321 59.4 52 221 (48.0) 35 79 * 9 Marital status Never roamed 75.9 56.8 78.7 538 NA 0 60.5 194 Currently marrted 60.6 27.1 63.3 1,037 l 1.8 853 61.4 7 l Formerly married 75.0 51.7 77.7 99 NA 0 (52 8) 48 Residence Urban 69.1 37.4 72.6 681 12.1 384 685 I,I I7 Rural 64.6 38.6 66.7 994 I 1.5 469 54.6 203 Province Mamcaland 60.8 35.5 63.5 i76 6.5 97 * 23 Mashonaland Central 68.9 31.6 71.6 147 18.2 73 (67.9) 28 Mashonaland East 77.0 42.6 80.7 148 13.2 74 * 19 Mashonaland West 71.1 66.2 74 I 205 I2.8 I03 (61.9) 48 Matabeleland North 48.7 27.3 49.9 86 (13.8) 34 (36.2) 26 Matabeleland South 52.3 26.4 57.9 67 * 23 * 20 Midlands 75.9 37.8 75.9 210 9.7 107 71.3 56 Masvingo 52.3 23.0 54.5 132 9.9 59 * 14 Harare 69.0 37.1 73.1 371 11.8 207 71.4 53 Bulawayo 62,2 32.1 63.6 133 12.7 75 (65.1) 27 Education No education 48.1 16.6 48.7 81 (13.7) 45 * 9 Primary 54.9 30.6 57.6 691 10.8 397 47.4 122 Secondary+ 76.8 45 8 79,7 902 12,5 412 69.6 182 Change in behaviour to avoid AIDS No change 40.8 11.6 42.9 430 8.0 219 26 3 77 Stopped sex ,*5.2 24.9 54 2 58 NA 0 * I Used condom 94.8 100.0 100.0 493 22.8 174 79.6 155 Only one partner 71.7 30.7 72.9 732 11.3 486 65.8 80 Fewer partners 73.9 56.1 77.9 214 17.2 95 62.6 59 Other * * * 6 * 2 NA 0 Not slated 76.7 31.9 76.7 54 (2.0) 26 * 7 Total 66.4 38.1 69.1 1,674 11.8 853 59.5 313 Note: Figures m parentheses are based on 25-49 men. An asterisk indicates that a figure is based on fewer than 25 men and has been suppressed. NA = Not apphcable 167 CHAPTER 11 MATERNAL MORTALITY Data were collected in the ZDHS that allow estimation of maternal mortality using both direct and indirect estimation procedures, and estimation of overall adult female and male mortality. The information concerns the survivorship of all live births of the respondent's natural mother (siblings). The direct approach to estimating adult and maternal mortality maximizes use of the available data, using information on the age of surviving siblings, the age at death of siblings who died, and the number of years since the sibling died. This allows the data to be aggregated to determine the number of person-years of exposure to mortality risk and the number of sibling deaths occurring in defined calendar periods. Rates of maternal and adult mortality are obtained by dividing maternal (or all female or male adult) deaths by person-years of exposure (Rutenberg and Sullivan, 1991). The indirect approach to estimation of maternal mortality, or the sisterhood method, has simpler data requirements than the direct method. None of the information on dates and ages related to the respondent's sisters is used, and the data on all sisters are used to estimate the life-time risk of maternal death. As the estimates pertain to the life-time experience of respondents' sisters, a well-defined calendar reference period is not derived but represents mortality conditions over the past 50 years or so. Assuming changes in mortality over time are linear, the reference period can be said to be centred about 12-13 years before the survey date (Graham et al., 1989). I I . I The Data Each respondent was first asked to give the total number of her mother's live births. Then the respondent was asked to provide a list of all of the children born to her mother starting with the first-born, and whether or not each of these siblings was still alive at the survey date. For living siblings, current age was collected; for deceased siblings, age at death and years since death were collected. Interviewers were instructed that when a respondent could not provide precise information on siblings' ages or number of years since their death, approximate but still quantitative answers were acceptable. For sisters who died at ages I 0 years or older, three questions were used to determine if the death was maternity-related: "Was [NAME OF SISTER] pregnant when she died?" and if not, "Did she die during childbirth?" and if not, "Did she die within six weeks of the birth of a child or pregnancy termination?" The estimation of adult and maternal mortality by either direct or indirect means requires reasonably accurate reporting of the number of sisters and brothers the respondent ever had, the number that have died, and the number of sisters who died of maternity-related causes. There is no definitive procedure for establishing the completeness or accuracy of retrospective data on sibling survivorship. Table 11. I shows the number of siblings reported by respondents and the completeness of the reported data on current age, age at death, and years since death. Respondents did not report the sex of 0.1 percent of their siblings. The sex ratio of enumerated siblings (the ratio of brothers to sisters) was 1.00, which is slightly lower than expected ~ and may indicate underreportmg of brothers by respondents. In very few cases (< 0.1 percent) sibling's ages were not reported by respondents. For deceased siblings, complete reporting of age at death and years since death was nearly universal. Ninety-nine percent of deceased siblings have both age at death and years since death reported. L However, previous censuses and surveys in Zimbabwe have found similarly low sex ratios (CSO, 1994). 169 Table 11.1 Data on sibhngs Number of siblings reported by survey respondents and completeness of reported data on slbhng age, age at death (AD) and years si~ce death (YSD), Zimbabwe 1994 Sisters Brothers All siblings Number Percentage Number Percentage Number Percentage Allsiblings 19,229 100.0 19,293 100.0 38,521 100.0 Livmg 16,496 85.8 16,211 84.0 32,708 849 Dead 2,717 14.1 3,063 15.9 5,780 15.0 Missing survival reformation 15 0.1 19 0.1 34 0.1 Living siblings 16,496 100.0 16,211 100.0 32,708 100.0 Age reported 16,480 99.9 16,203 100.0 32,683 99.9 Age missing 16 0.1 8 0.1 24 0.1 Dead siblings 2,717 100.0 3,063 100.0 5,780 100.0 AD and YSD reported 2,696 99.2 3,024 98.7 5,720 99.0 AD OR YSD or both mtssing 22 0.8 38 1.3 60 1.0 Rather than exclude the small number of siblings with missing data from further analysis, information on the birth order of siblings in conjunction with other information was used to impute the missing data. 2 The sibling survivorship data, including ~:ases with imputed values, were used in the direct estimation of adult and maternal mortality. 11.2 Direct Estimates of Adult Mortality Another way to assess the quality of data used to estimate maternal mortality is to evaluate the plausibility and stability of overall adult mortality. It is reasoned that if estimated rates of overall adult mortality are implausible, rates based on a subset of deaths--i.e., maternal deaths in particular--are unlikely to be free of serious problems. Table 11.2 presents age-spe cific mortality rates for women and men age 15-49 years for the ten-year period preceding the survey, calculated through direct procedures. Since the number of deaths on which the rates are based is not large (only 37 "r female and 453 male deaths), the estimated five-year, age-specific rates are subject to considerable sampling variation. Still, the age-specific estimates of mortality are quite stable, showing expected increases in both female and male rates with increasing age. Female and male rates are roughly equal until age 30, after which male mortality increases more steeply, so that the net effect is for male mortality (15-49 years) to exceed female mortality by some 26 percent. 2 The imputation procedure is based on the assumption that the reported birth ordering of sibhngs in the birth history is correct. The first step is to calculate birth dates. For each hying sibling with a reported age and for each dead sibling with complete reformation on both age at death and years since death, the birth date was calculated. For a sibling miss- ing these data, a birth date was imputec within the range defined by the birth dates of the bracketing siblings. In the case of living sibhngs, an age was then cah:ulated from the imputed birth date. In the case of dead sthlings, if either age at death or years since death was reportec, that information was combined with the birth date to produce the missing infor- mation. If both pieces of information were missing, the distribution of the ages at death for siblings for whom the years since death was unreported, but age w death was reported, was used as a basts for imputing the age at death. 170 Table 11.2 Adult mortality rates Estimates of female and male adult mortahty rates for the period 0-9 years before the survey, and model life table rates, Zimbabwe 1994 WOMEN Age Deaths Exposure Model Life Table Rates I Coale- Coa le- United ZDHS Demeny Demeny Nations mortality WEST NORTH GENERAL rates (64 yrs) (66 yrs) (67 yrs) 15-19 46 24,562 1.87 1.63 1.77 1 04 20-24 63 25,064 2.51 2 20 2.22 1.42 25-29 82 22,608 3.63 2.51 2.63 1.77 30-34 72 18,109 3.99 3.00 2,99 2.22 35-39 59 12,450 4.75 3.53 3.42 2.87 40-44 34 7,402 4.62 4.46 4.41 3.84 45-49 21 3,973 5.18 6.01 5,30 5 38 15-49 377 114,169 3.34 a 2.81 2.80 2 12 MEN Age Deaths Model Life Table Rates j Coale- Coa le- Umted ZDHS Demeny Demeny Nations mortality WEST NORTH GENERAL Exposure rates (61 yrs) (62 yrs) (62 yrs) t5-19 34 24,035 1.44 2.04 2.55 L.50 20-24 63 24,404 2 59 2.89 3.70 2 21 25-29 82 21,741 3.78 3.03 3.81 2.52 30-34 91 17,335 5 26 3.44 4 05 2 99 35-39 65 12,026 5.41 4.23 4.52 3.95 40-44 69 7,256 9.56 5.75 5.61 5.50 45-49 48 4,060 11.90 8.20 7.13 7.98 15-49 454 110,857 4.17 a 3 41 3.86 2.92 ] Model lif? tables were selected at a level of mortality approximately corresponding to a sex-specific probability of dying between bmh and age 5 for the period 0-9 years before the survey (Le., 82 per 1,000 tbr males, 70 per 1,000 for females) Life expectancies are given in parentheses. a Age adjusted Figure 11.1 shows the age-pattern of female and male mortality between ages 15 and 49, compared with age-specific rates as described in selected reference or model mortality schedules (see Table 11.2). Embodied in a model life table is a tel ationship between mortality during childhood and mortality during later years. Some models posit high child relative-to-adult mortality levels; others describe low child-relative-to adult mortality. By selecting model mortality schedules based on the observed under-five mortality level, it is possible to assess whether adult rates are higher or lower than would be expected. Here, the ZDHS under-five mortality estimates of 70 per 1,000 for females and 82 per 1,000 for males (see Table 7.3) are used to enter the model mortality schedules: models West and North of the Coale-Demeny life tables and the United Nations' General model (see Table l 1.2). 171 Figure 11.1 Female Adult Mortality by Age Group 0-9 Years before the Survey, 1994 ZDHS and Three Model Life Tables Deaths per 1000 14 12 10 8 6 4 2 0 15-19 2(,-24 25-29 30-34 35-39 40-44 45-49 Age Group Male Adult Mortality by Age Group 0-9 Years before the Survey, 1994 ZDHS and Three Model Life Tables Deaths per 1000 14 10 8 6 4 15-19 ;!0-24 25-29 30-34 35-39 40-44 45-49 Age Group 172 The figure shows that until age 24 for women and age 29 for men, the ZDHS rates are roughly within model expectations, although female rates tend to be at the upper limit. From 30 years of age and upwards, male mortality substantially exceeds rates described in the reference schedules especially at 40 years of age and above. The same is true regarding female mortality between ages 25 and 40, although the excess risk is not as pronounced. These findings indicate that underreporting of deceased siblings is unlikely to be a serious problem in the ZDHS data. The fact that the estimated rates exceed model rates may be realistically explained by the recent deterioration in adult survival prospects due to the AIDS problem. An analysis of trends in adult mortality would be a useful extension to this line of inquiry; unfortunately, the sparseness of the data will not support a statistically reliable look across the relevant calendar periods. 11.3 Direct Estimates of Maternal Mortality Direct age-specific estimates of maternal mortality from the reported survivorship of sisters are presented in Table 11.3 for the period 0-9 years before the survey. The number of maternal deaths (56) is rather small, so that age- specific rates should be interpreted with caution. The preferred approach is to determine a single estimate for all childbearing ages (15-49 years). For the ten-year period before the survey (1985-94), the rate of mortality due to causes related to preg- nancy and childbearing is 0.458 maternal deaths per 1,000 woman-years of exposure. Maternal deaths represent approxi- mately 15 percent of all deaths to women age 15-49. Twenty- six percent of all maternal deaths occurred during pregnancy, 46 percent around childbirth, and 26 percent in the six-week period following pregnancy termination or childbirth. The maternal mortality rate can be converted to a ma- ternal mortality ratio and expressed per 100,000 live births by dividing the mortality rate by the general fertility rate of0.162 operating during the same time period. In this way, the obstet- rical risk of pregnancy and childbearing is underlined. By di- rect estimation procedures, the maternal mortality ratio is esti- mated as 283 maternal deaths per 100,000 live births during the period 1985-94. Table 11.3 Dxrect estimates of maternal mortality Direct esnmates of maternal mortahty for the period 0-9 years before the survey, Zimbabwe 1994 Mortahty Age Deaths Exposure rates 15-19 3.6 24,562 0.147 20-24 I 1.8 25,064 0.472 25-29 14.6 22,608 0.645 30-34 19.9 18,109 1.101 35-39 2.8 12,450 0.223 40-44 1.4 7,402 O. 190 45-49 1.9 3,973 0.474 15-49 560 114,169 0.458 General Fertility Rate (GFR) 0.162 Maternal Mortality Ratio (MMR) 1 283 Iper 100.000 live births; calculated as the maternal mortality rate divided by the general ferhhty rate. 11.4 Indirect Estimates of Maternal Mortality The data on the survivorship of sisters can also be used to estimate maternal mortality by an indirect technique, i.e., the sisterhood method. In this method, the data are aggregated by five-year age groups of respondents. For each age group, information on the number of maternal deaths among all sisters of respondents and on the number of "sister units" of risk is used to estimate the lifetime risk of dying from maternal causes. The method also provides an overall estimate of maternal mortality for sisters of all respondents combined which refers to a period in time centred 12-13 years prior to the survey. The indirect estimates of maternal mortality are given in Table 11.4. When aggregating the data over all respondents, the lifetime risk of maternal death is 0.017, a risk of dying of maternal causes of about 1 in 59. The lifetime risk of maternal mortality can be converted to an estimate of the maternal mortality ratio: 243 maternal deaths per 100,000 live births, applicable to a period around the year 1982 (see formula in Table 11.4). 173 Table 11.4 Indirect estimates o maternal mortahty Indirect estimates of maternal mortahty, Zimbabwe 1994 Number Number of of sisters Age rcspondents 15+ group (a) (b) Number S~ster Lifetime of units of risk of maternal Adjustment exposure maternal deaths factor to risk death (c) (d) (a)=(b)*(d) (13=(c)/(e) 15-19 1,472 4,257 9.2 0.107 456 0.020 20-24 1,269 3,672 19.5 0 206 756 0 026 25-29 915 2,646 21.7 0.343 908 0.024 30-34 871 2,461 14.0 0.503 1,238 0.011 35-39 662 1,970 17 9 0.664 1,308 0 014 40-44 532 1,573 19 5 0.802 1,262 0.015 45-49 407 1,089 14 4 0.900 980 0 015 Tl~tal (15-49) 6,128 17,668 116.9 6,907 0.017 TFR 1981-85 7.0 ch,ldren per woman MMR 243 p<~r 100,000 live births TFR = Total fertd~ty rate MMR = Maternal Mortahty R,mo = (1 - [(1 - Lifeume nsk] IIIFR) " 100,000, where TFR represents the total fertihty rate 10~14 years preceding the survey. Note. Figures in column (b) are adjusted for age dlstribuuon of respondent's sisters (see Graham et al, 1989) 11.5 Conclusion In conclusion, the maternal mortality ratio was estimated to be 283 per 100,000 live births by direct means, applicable to a 1985-94 time period; and 243 per 100,000 live births by the sisterhood (indirect) method referring to a time period centred around the year 1982. Since the indirect estimate is essentially a weighted average of maternal mortality conditions occurring over the last 50 years or so (weighted towards more recent exposure), the lower indirect estimate may be attributed to a worsening maternal mortality picture over the past 10-15 years, problem~ in underreporting for earlier periods, or simply the result of sampling fluctuations. A cautious reading of the ~'DHS findings is that the maternal mortality ratio over the last 10 years is 283 per 100,000 and that there may exist within this recent period an upward trend (i.e., a worsening of mortality conditions). 174 REFERENCES Boerma, J. Ties, and George Bicego. 1992. Preceding birth intervals and child survival: Searching for pathways of influence. Studies in Family Planning 23(4):243-256. Boerma, J. Ties, A. Elisabeth Sommerfelt, Shea O. Rutstein, and Guillermo Rojas. 1990. Immunization: Levels, trends and differentials. DHS Comparative Studies No. I. Columbia, Maryland: Institute for Resource Development/Macro Systems Inc. Central Statistical Office (CSO) [Zimbabwe]. 1994. Census 1992: Zimbabwe national report. Harare. Central Statistical Office (CSO) [Zimbabwe] and the Institute for Resource Development/Macro Systems Inc. (1RD). 1989. Zimbabwe Demographic and Health Supwey 1988. Columbia, Maryland. Graham, Wendy, William Brass, and Robert W. Snow. 1989. Estimating maternal mortality: The sisterhood method. Studies in Family Planning 20(3):125-135. Krasovec, Katherine and Mary-Ann Anderson, eds. 1991. Matemal nutrition and pregancy outcomes: Anthropometric assessment. PAHO Scientfic Pubication No. 259. Washington, D.C.: Pan American Health Organisation. International Programs Center (IPC), Population Division, U,S. Bureau of the Census. 1994. HIV/AIDS Surveillance Data Base, June 1994. Washington, D.C.: U.S. Bureau of the Census. Pebley, Ann, Wariara Mbugua, and Noreen Goldman. 1988. Polygyny and fertility in sub-Sabaran Africa. Fertility Determinants Research Notes 21:6-10. Rutenberg, Naomi, and Jeremiah M. Sullivan. 1991. Direct and indirect estimates of maternal mortality from the sisterhood method. In Proceedings of the DHS World Conference, Washington, D.C. August 5-7, 1991, Vol. 3, 1669-1696. Columbia, Maryland: IRD/Macro International Inc. United Nations. 1994. The health rationale for family planning: Timing of births and child survival. New York. Zimbabwe National Family Planning Council (ZNFPC) and Westinghouse Public Applied Systems (WPAS). 1985. Zimbabwe Reproductive Health Survey 1984. Columbia, Maryland; ZNFPC and WPAS. 175 APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION The Zimbabwe Demographic and Health Survey (ZDHS) covers the population residing in private households throughout the country. The ZDHS was designed to produce reliable national estimates as well as urban and rural estimates of demographic rates (particularly fertility and childhood mortahty rates), maternal and child health indicators, and contraceptive knowledge and use. Estimates of selected variables were produced for each of the 10 provinces in the country. In addition to the mare sample of women, a subsample of men between the ages of 15 and 54 were interviewed to allow for the study of AIDS knowledge and other topics. A.1 Sampling Frame The area sampling frame for the ZDHS was the 1992 Zimbabwe Master Sample (ZMS92), which was developed by the Central Statistical Office (CSO) following the 1992 Population Census for use in demographic and socio-economic surveys. The sample for ZMS92 was designed to be almost nationally representative: people residing on state land (national parks, safari areas, etc.) and in institutions, which account for less than one percent of the total population, were not included. The sample was stratified and selected in two stages. With the exception of Harare and Bulawayo, each of the other eight provinces in the country was stratified into four groups according to land use: communal land, large-scale farming, urban and semi-urban areas, and small scale fanning and resettlement areas. In Harare and Bulawayo, only an urban stratum was formed. The primary sampling unit (PSU) was the enumeration area (EA), as defined in the 1992 Population Census. A total of 395 EAs were selected with probability proportional to size, the size being the number of households enumerated in the 1992 Population Census. The selection of the EAs was a systematic, one- stage operation, carried out independently for each of 34 strata. In each stratum, implicit stratification was introduced by ordering the EAs geographically within the hierarchy of administrative units (wards and districts within provinces). An evaluation of the ZMS92 showed that it oversampled urban areas: in the ZMS92 the proportion of urban households is about 36 percent while, according to the preliminary results of the 1992 Population Census, this proportion is about 32 percent. A.2 Characteristics of the ZDHS Sample The sample for the ZDHS was selected from the ZMS92 master sample in two stages. In the first stage, 230 EAs were selected with equal probabilities. Since the EAs in the ZMS92 master sample were selected with probability proportional to size from the sampling frame, equal probability selection of a subsample of these EAs for the ZDHS was equivalent to selection with probability proportional to size from the entire sampling frame. A complete listing of the households in the selected EAs was carried out. The list of households obtained was used as the frame for the second-stage sampling, which was the selection of the households to be visited by the ZDHS interviewing teams during the main survey fieldwork. Women between the ages of 15 and 49 were identified in these households and interviewed. In 40 percent of the households selected for the main survey, men between the ages of 15 and 54 were interviewed with a male questionnaire. 179 A.3 Sample Allocation Stratification in the ZDHS consisted of grouping the ZMS92 strata into two main strata only: urban and rural. Thus the ZDHS rural stratum consists of communal land, large scale farming, and small scale farming and resettlement areas, while the ZDHS urban stratum corresponds exactly to the urban/semi-urban stratum of the ZMS92. The followiag table shows the distribution of the population in Zimbabwe to the different strata, according to the 1992 Population Census: Table 1 Population Distribution (1992 Population Census) Province Urban Rural Total Total 2837316 7564451 10401767 Manicaland 146209 1391467 1537676 (14.78%) Mashonaland Cenual 21456 835862 857318 (8.24%) MashonalandEast 41044 992292 1033336 (9.93%) Mashonaland West 177620 939308 1116928 (10.74%) MatabelelandNorth 59483 581474 640957 (6.16%) Matabeleland South 10807 580940 591747 (5.69%) Midlands 249811 1052403 1302214 (12.52%) Masvingo 51746 1170099 1221845 (11.75%) Harare 1458204 20606 1478810 (14.22%) Bulawayo 620936 620936 (5.97%) A proportional allocation of the target number of 6,000 women to the 18 strata would yield the following sample distribution: Table 2 Proportional Sample Allocation Province Urban Rural Total Total 1635 4365 6000 Mamcaland 84 803 887 Mashonaland Cenlral 12 483 495 Mashonaland East 24 572 596 Mashonaland West 102 542 644 Malabeleland Norh 34 336 370 Matabeleland Sou~ h 6 335 341 Midlands 144 607 751 Masvingo 30 675 705 Harare 841 12 853 Bulawayo 358 358 The above proportional allocation would result in a completely self-weighting sample but did not allow for reliable estimates for prcvinces. Results of other demographic and health surveys show that a minimum sample of 1,000 women i:; required in order to obtain estimates of fertility and childhood mortality rates at an acceptable level of samFling errors. Given that the total sample size for the ZDHS could not be increased for the provinces so as to achieve the required level of sampling errors, it was decided that estimates of complex rates would not be produced at the provincial level. Furthermore, since some of the provinces are quite small and would be allocated small sample size, it was decided that the total sample would be allocated equally to the 10 provin.:es for estimates of selected variables other than complex rates The 180 following sample allocation was adopted after taking into account three factors: (1) a minimum sample of 600 completed interviews for each province; (2) close to proportional allocation for urban and rural areas in each province---except when the resulting stratum size was less than 40, in which case the minimum stratum size was 40--and (3) the number of EAs available in the ZMS92 master sample. According to this sampling scheme, stratum weights would be necessary for data analysis. Table 3 Proposed Sample Allocation Province Urban Rural Total Total 1700 4300 6000 Manicaland 60 540 600 Mashonaland Central 40 560 600 Mashonaland East 40 560 600 Mashonaland West 100 500 600 Matabeleland North 60 540 600 Matabeleiand South 40 560 600 Midlands 120 480 600 Masvingo 40 560 600 Harare 600 600 Bulawayo 600 600 The number of EAs selected for each stratum was calculated by dividing the expected number of women by the average take in the EA. Analytical studies of surveys of the same nature suggest that the optimum number of women to be interviewed is around 20-25 in each urban PSU and 30-35 in each rural PSU. Expecting on average 20 women in each urban EA and 30 women in each rural EA, the distribution of EAs was as follows (the number of EAs to be selected was calculated as the number of women/average EA take): Table 4 Number of EAs to be Selected Province Urban Rural Total Total 85 145 230 Manicaland 3 18 21 Mashonaland Central 2 19 21 Mashonaland East 2 19 21 Mashonaland West 5 l 7 22 Matabeleland North 3 18 21 Matabeleland South 2 19 21 Midlands 6 16 22 Masvmgo 2 19 21 Harare 30 30 Bulawayo 30 30 181 The number of households selected so as to yield the target sample was calculated as follows: Number of HHs = Number o f women Number of women per hh x Overall response rate According to the 1988 Zimb~.bwe Demographic and Health Survey there were 1.03 women age 15-49 per household. The overall response rate found in the same survey was around 90 percent. Using these two parameters m the above equation, it was expected that, on average, 22 households were selected in each urban EA, and 32 households were selecte:t in each rural EA. A.4 Systematic Selection of EAs The 230 EAs were selected from the ZMS92 in a systematic manner, with equal probability, and independently in each stratum, after the EAs were ordered according to the order of selection of the ZMS92. The selection interval is calculated as follows: A h a h where A~, is the number of EAs that existed in the ZMS92 for the h 'h stratum, and a h is the number of EAs selected for the ZDHS. A.5 Sampling Probabilities The sampling probabilities uere calculated separately for each sampling stage and for each stratum. The following notations were used: Plh, Pet. P cm is the sampling probability for the i 'h EA in the h 'h stratum according to the ZMS92. ts the sampling probability for the i '~' EA in the h" stratum for ZDHS. is the sampling probability for the household in the i '~ EA of the h ~ stratum. Ptt,, is calculated as follow~, : Plh, Ah.Mlh~ E Mlhi where A j, is the number of EAs sele :ted in the ZMS92 h t'~ stratum, Mih , is the number of households in the i °' EA according to the 1992 Population Census, and EM m is the number of households in the h" stratum, according to the 1992 Population Census. P2*, iS the inverse of the EA selection interval: a h P2hi - Ah 182 In order for the sample to be self-wmghting within each stratum, the stratum overall probabdity fh = P~h,'P2h,'P,h, must be the same for each household in the sample• That is, L e3h i - with Pthi'P2hi fh -- nh • th wherenh is thenumbero fhouseho ldsse lec ted ln theh stratum and Nh ts the projected number of households in 1994 for the h ~h stratum• The selection of households was systematic with equal probabilities, and the household sampling interval lh, in the i 'h EA of the h '~ stratum was calculated as: 1 /hi-- k h × e3hi where k h is the correction factor in the h 'h stratum to correct for the fact that ZMS92 oversampled the urban areas• The correction factor k h was calculated as the ratio of the household distribution according to the 1992 census over the household distribution according to ZMS92, for each stratum. For each EA, a list of households was obtained for the ZDHS prior to the mam survey fieldwork, and the above interval was applied to the list in order to select the households. A.6 Sample Implementation A summary of the ZDHS sample implementation is provided in Tables A.1 (total sample) and A.2 (male subsample). A total of 6,483 households were selected, of which 6,075 were found to be occupied. Of the occupied households, 5,984 were successfully interviewed, yielding a household response rate of 98.5 percent. The household response rate shows only moderate variation between provinces. The lowest household response rate was recorded in Harare (95 percent). Of all eligible women, 95.6 percent were successfully interviewed. Only 0.3 percent of women refused to be interviewed, and 2.4 percent were not at home. A very small percentage (0.2 percent) of interviews with eligible women were incomplete. Of the eligible men, 91.5 percent were successfully interviewed. The percentage of incomplete inter- views for men is lower than for women because, although only a small percentage (0.6 percent) refused to be interviewed, approximately 4 percent were not at home. The percentage of male interviews completed is higher in rural areas (92.8 percent) than in urban areas (88.9 percent). 183 TableA.l SampleimplementaUon: women Percent distribution of households and eligible women in the DHS sample by results of the interviews and household, ehgible women, and overall response rates, according to province and urban-rural residence, Zimbabwe 1994 Result Province Residence Ma- Ma Ma- Main- Mata- shona- shona- shona- bele- bele Maraca- land land land land land Mid- Mas- Bula- land Central East West North Soulh lands vmgo Harare wayo Urban Rural Total Selected households Completed (C) 92 5 90.0 93 [ 93.8 90.9 91 3 93.0 91 4 91 9 95 2 93.5 91.8 92.3 Household present but no competent respondent at home (HP) 1 7 1 5 06 08 0.6 06 0.6 08 3 1 05 1 8 0.8 I.I Refused (R) 0.0 0.0 0 0 0.2 0 0 0 0 0 0 0 0 I 4 0.6 0.7 0 0 0 2 Dwelling not found (DNF) 0.0 03 02 0.0 01 0.0 00 02 02 0.2 0.1 01 0.1 Household absent (HA) 4,3 40 5,1 2.6 3.6 48 34 46 11 24 22 4.1 3.6 Dwelling vacant (DV) 1,1 3.8 0.9 22 3.9 22 2.3 25 23 10 1.5 2.5 2.2 Dwelhng destroyed (DD) 0.3 04 00 0.5 0.9 1.1 0.7 0.3 00 0.2 0.1 06 0,4 Other(O) 00 00 00 0.0 00 00 00 02 00 00 0.0 00 00 Totalpercent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1000 1000 100.0 100.0 100.0 Number 630 683 642 647 668 641 697 606 645 624 1,829 4,654 6,483 Household response rate (HRR) 1 98.1 98 1 99 2 99.0 99 2 99.3 99 4 98.9 95.2 98.7 97.3 99.0 98 5 Eligible women Completed (EWC) 95 5 95 7 97 2 95.9 96 5 92 0 97 2 95 0 94 7 96 5 95.2 95 8 95 6 Not at home (EWNH) 2.8 2 4 1 3 1.6 1 1 5.5 2 2 3 8 2.0 1.5 2 2 2 5 2 4 Postponed (EWP) 0.0 0.0 0 2 0 0 0 0 0.0 0 0 0 2 0.2 0.0 0.1 0 0 0.0 Refused (EWR) 0.0 0.0 0.2 0.2 0.3 0.0 0.0 0.8 1 1 0 5 0 7 0.2 0.3 Partly completed (EWPC) 02 00 00 0.5 00 0.2 01 0.2 0.5 0.3 0.4 0,1 02 Incapacitated (EWI) 09 0.6 0,8 0.8 0,4 0.8 0,0 0.2 0.0 0,7 04 05 05 Other (EWO) 0.7 12 0.3 10 1.7 16 0.5 (i 0 16 0.5 1.0 0.9 0.9 Totalpercent 100.0 1000 1000 1000 1000 100.0 1000 100.0 100.0 100.0 100.0 100.0 100.0 Number 576 655 597 614 706 638 737 636 642 607 1,833 4,575 6,408 Eligible woman response rate (EWRR) 2 95 5 95.7 97.2 95.9 96.5 92.0 97.2 95 0 94 7 96 5 95 2 95 8 95.6 Overal l response rate (ORR)s 93 7 93.9 96.3 95 0 95.7 91 4 96.6 94 0 90 1 95.3 92 6 94.8 94.2 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found The ehgible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapat itated and "other." The overall response rate is the product of the household and woman response rates 1Using the number of households falhng into specific response categories, the household response rate (HRR) is calculated as. C C+HP+R+DNF 2Using the number of ehgible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as' EWC EWC + EWNH + EWP ÷ EWR + EWPC + EWl + EWO 3The overall response rate (ORR) Is calculated as ORR = HRR * EWRR 184 Table A 2 Sample implementation: men Percent dtstributton of households and eltgible men in the DHS sample by results of the inter'~iews and housel~otd, eligible men, and overall response rates, according to province and urban-rural residence. Zimbabwe 1994 Result Province Residence Ma- Ma- Ma- Mata- Mata- shona- shona- shona- bele- bele- Maraca- land land land land land Mid- Mas- Bula- land Central East West North South lands vingo Harare wayo Urban Rural Total Selected households Completed (C) 83 3 78.3 84.9 86 2 80 I 8 I. 1 83,4 81.3 81.6 89.2 85.5 81.9 82 9 Household present but no competent respondent at home (HP) 3.9 3 2 1.4 I 7 1 3 1.4 1.4 1.8 7.1 I 1 4.1 1 8 2.4 Refused (R) 0 0 0.0 0.0 0.3 0.0 0.0 0.0 0.0 3 2 1 4 1 6 0.0 0 5 Dwelhng not found (DNF) 0.0 0.6 0 3 0 0 0.3 0.0 0.0 0 4 0.4 0.4 0.2 0 2 0 2 Household absent (HA) 9,6 8.6 11.3 5 9 7.8 10.5 8.1 10 I 2.5 5.4 4,9 9 2 8.0 Dwelitt~g vacant (DV) 2,5 8.3 2.1 4.8 8.5 4.7 5.4 5 4 5 3 2 2 3.5 5.6 5 0 Dwelling destroyed (DD) 0.7 1.0 0 0 I 0 2.0 2.4 1 7 0.7 0.0 0.4 0.2 I 3 1 0 Other(O) 00 00 0.0 0.0 00 0.0 00 0.4 0,0 00 00 00 00 Totalpercent 100.0 I00.0 100.0 I000 1000 100.0 100.0 100.0 100.0 1000 II3£1.0 1000 100.0 Number 281 313 291 290 306 296 296 278 282 278 811 2,100 2,911 Household response rate (HRR) I 95 5 95.3 98.0 97 7 98.0 98.4 98.4 97.4 88r5 96.9 93 5 97.6 96 4 Eligible men Completed (EMC) 91.8 97 2 92 9 93.5 92.8 87.3 90.3 90 5 85.3 93.4 88.9 92.8 91.5 Not at home (EMNH) 5.1 1.6 4.3 14 24 6.8 4.6 6.2 75 23 5.5 3.5 4.1 Postponed (EMP) 0 5 0 0 0 5 0.0 0.0 0.0 0.0 0.0 0 8 0 0 0.3 0 1 0.2 Refused (EMR) 0.5 0 0 0 9 1 1 0.0 1.0 0.0 0 0 0.8 I 9 1.3 0.3 0 6 Partly completed (EMPC) 0 0 0 0 0.0 0.0 0.0 0.0 0 8 0.0 0 4 0 4 0.4 0 1 0.2 Incapamtated (EMI) 05 0.4 05 1.1 1.9 05 0.4 I 0 00 04 03 08 06 Other (EMO) 1.5 0,8 0.9 2 9 2.9 4.4 3.9 2.4 5.3 1.5 3.4 2 4 2 7 Totalpercent 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 100.0 Number 195 250 211 276 208 205 259 210 266 259 766 1,573 2,339 Eligible man response rate (EMRR) 2 91 8 97 2 92.9 93.5 92 8 87.3 90 3 90.5 85.3 93.4 88.9 92 8 91.5 O~erall response rate (ORR) 3 87 7 92 7 91.0 91.3 90 9 85 9 88 9 88.1 75 5 90.5 83.1 90 6 88.2 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found The eligible man response rate Is calculated for completed interviews as a proportion of completed~ not at home, postponed, refused, partially completed, incapacitated and "other " The overall response rate is the product of the household and man response rates IUsing the number of households falling into specific response categories, the household response rate (HRR) is calculated as" C C+HP+R+DNF 2Using the number of ehgJble men falling into specific response categories, the ehgible man response rate (EMRR) is calculated as: EMC EMC + EMNH + EMP + EMR + EMPC + EMI + EMO ~The overall response rate (ORR) is calculated as" ORR = HRR * EMRR 185 APPENDIX B ESTIMATES OF SAMPLING ERRORS APPENDIX B ESTIMATES OF SAMPLING ERRORS The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the ZDHS to minimise this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the ZDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the ZDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the ZDHS is the ISSA Sampling Error Module. This module used the Taylor linearisation method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearisation method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: in which var(r) - 1 - f "h mh 2 Zh -x ~ m h - 1 Zhi - h--I mh Zhi = Yh i - r , Xhi , and z h : yh - r .xh where h m h Yr, Xh~ f represents the stratum which varies from 1 to H, is the total number of enumeration areas selected in the h th stratum, is the sum of the values of variable y in EA i in the h 'h stratum, is the sum of the number of cases in EA i in the h 'h stratum, and is the overall sampling fraction, which is so small that it is ignored. 189 The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo-independent replications are thus created. In the ZDHS, there were 230 non-empty clusters. Hence, 230 replications were created. The variance of a rate r is calculated as follows: k var ( r ) - k( l _ l ) i~ l ( r i - r ) 2 in which where r rf,j k = kr - (k-1)r ( i ) F i is the estimate computed from the full sample of 230 clusters, is the estimate computed from the reduced sample of 229 clusters ( i th cluster excluded), and is the total number of clusters. In addition to the standard error, ISSA computes the design effect (DEFT) for each estimate, which is defined as the ratio between the s:andard error using the given sample design and the standard error that would result i fa simple random sample had been used. A DEFT value of t .0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the samphng error due to the use of a more complex and less statistically efficient design. ISSA also computes the relative error and confidence limits for the estimates. Sampling errors for the ZDHS are calculated for selected variables considered to be of primary interest. The results are presented iu this appendix for the country as a whole, for urban and rural areas. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B. 1. Sampling errors for selected variables are shown for the 10 provinces. Tables B.2 to B.14 present the value of the statistic (R), its standard err,Jr (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R_+2SE), for each variable. The DEFY is conside "ed undefined when the standard error considering simple random sample is zero (when the estimate is close t3 0 or 1 ). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to childbearing. In general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. There are some differentials in the relative standard error for the estimates of subpopulations. For example, for the variable with secondary education or higher, the relative standard errors as a percent of the e~,;timated mean for the whole country, for urban areas, and for Manicaland are 2.4 percent, 2.9 percent, and 7.4 percent, respectively. The confidence interval (e.g., as calculated for children ever born ro women age 15-49) can be interpreted as follows: the overall average from the national sample is 2.7 and its standard error is .04. Therefore, to obtain the 95 percent confidence hmits, one adds and subtracts twice the standard error to the sample estimate, i.e., 2.7±.04. There is a high probability (95 percent) that the true average number of children ever born to all women age 15 to 49 is between 2.6 and 2.8. 190 Table B.1 L~st of selected variables for sampling errors~ Zimbabwe 1994 Variable Description Base populatmn WOMEN Urban residence Proportion No education Proportmn With secondary education or higher Proportion Never mamed (in umon) Proportmn Currently roamed (in umon) Proportion Married before age 20 Proportmn Had first sexual intercourse before 18 Proportion Children ever born Mean Children ever born to women over 40 Mean Children surviwng Mean Knowing any contraceptwe method Proportion Knowing any modem contraceptive method Proportmn Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modern method Proportion Currently using pill Proportion Currently using IUD Proportion Currently using injectables Proportion Currently using condom Proportion Currently using female stenlisation Proportion Using pubhc sector source Proportion Want no more children Proportmn Want to delay at least 2 years Proportmn Ideal number of chddren Mean Mothers received tetanus injection Proportion Mothers received medical care at Nrth Proportmn Had dmrrhoea m the last 2 weeks Proportion Treated with sugar-salt-water solutmn Proportmn Sought medical treatment Proportion Having health card, seen Proportmn Recewed BCG vaccinatmn Propomon Received DPT vaccmatton (3 doses) Proportion Received poho vaccination (3 doses) Proportion Recewed measles vaccination Proportmn Fully immumsed Proportion Weight-for-height Proportion Hmght-for-age Proportion Weight-for-age Proportton Total fertihty rate (3 years) Rate Neonatal mortality rate (0-4 years) Rate Posmeonatal mortality rate (0-4 years) Rate Inlant mortaltty rate (0-4 years) Rate Child mortality rate (0-4 years) Rate Under-five mortality rate (0-4 years) Rate All women 15-49 All women 15-49 All women 15-49 All women 15-49 All women 15-49 Women 20-49 Women 20-49 All women 15-49 Women age 40-49 All women 15-49 Currentl ~ married women 15-49 Currentl, mamed women 15-49 Currentl ~ married women 15-49 Currentl ~ married women 15-49 Currentl, married women 15-49 Currentl, married women 15-49 Currentl ~ married women 15-49 Currentl ~ married women 15-49 Currentl ~ roamed women 15-49 Curreml, roamed women 15-49 Current users of modern method Currently married women 15-49 Currently roamed women 15-49 AII women 15-49 Births m last 3 years Births m last 3 years Children 0-35 months Children under 3 with dtarrhoea m last 2 weeks Children under 3 with dtarrhoea in last 2 weeks Children I2-23 months Children 12-23 months Chddren 12-23 months Chddren 12-23 months Chtldren 12-23 months Children 12-23 months Children 0-35 months Chddren 0-35 months Children 0-35 months Woman-years of exposure to chtldbeanng Number of births Number of births Number of births Number of blrths Number of births MEN Urban residence Proportion No education Proportton W~th secondary educatton or h~gher Proportton Never married (m union) Proportion Currently married (m union) Proportion Knowing any contraceptive method Proportion Knowing any modern contraceptive method Proportion Ever used any contraceptive method Proportion Currenlly usmg any method Proportton Currently using a modern method Proportmn Currently using pdl Proportion Currently using IUD Proportion Currently usmg injectables Proportion Currently using condom Proportton Currently using fema{e sterd~sation Proportion Want no more children Proportion Ideal number of children Mean All men 15-54 All men 15-54 All men 15-54 All men 15-54 All men 15-54 Currently married men 15-54 Currently married men 15-54 Currently married men 15-54 Currently married men 15-54 Currently married men 15-54 Currently married men 15-54 Currently roamed men 15-54 Currently married men 15-54 Currently roamed men 15-54 Currently roamed men 15-54 Currently mamed men 15-54 All men 15-54 191 Table B.2.1 Samphng errors - National sample: women~ Z imbabwe 1994 Number of cases Standard I)eslgn Relative Confidence hmlts ~, alue error Unwe[ghted Weighted ef}~cl error Variable (R) (SE) iN) (WN) (DEFT} (SE/R) R-2SE R+2SE Urban residence 322 .009 No education A l l .008 With secondary education or higher 416 .010 Never married (xn umon) 269 .006 Currently married (m umon) 618 .007 Mamed before age 20 591 (~8 Had first sexual intercourse before 18 444 .008 Chddren ever born 2 692 041 Chddren ever born to women over 40 6 290 095 Chddren surviving 2 439 .037 Knowing any contraceptive method 988 002 Knowing any modern method 985 .003 Ever used any contracepave method 797 011 Currently using any raethod 481 .010 Currently using a modern method 422 .009 Currently using pall .331 .009 Currently using IUD ,010 .002 Currently using mjectables 032 .004 Currently usmg condom 023 002 Currently using female sterdxsatmn 023 003 Currently usxng periodic abstinence 00l 000 Currently using wxthdrawal 042 004 Using pubhc sector source .851 013 Want no more children 356 009 Want to delay at least 2 years .358 009 Ideal number of children 4 330 038 Mothers received tetanus mjectmn 821 011 Mothers received medical care at birth 692 .014 Had dmrrhoea m the last 2 weeks 235 010 Treated with sugar-salt-water soluuon 792 .017 Sought medical treatment 297 023 Having health card, seen 791 .017 Received BCG vaccination 957 ,009 Received DPT vaccinatmn (3 doses) 852 015 Received polio vaccinatmn (3 doses) .854 015 Received measles vaccination 863 015 Fully immunised .801 017 Wetght-for-he~ght 058 007 Height-for-age .233 010 Weight for-age 169 009 Total ferldlty rate (3 years) ~.,289 109 Neonatal mortahty rate (0-4 years) 2 ~ 406 2,871 Postneonatal mortality rate (0-4 years) 2'~ 427 2 862 Infant mortality rate (0-4 years) 52.83t 4 (726 Chtld mortahty rate (0-4 years) 25 615 2 617 Under five mortahty rate (0 4 years) 77.094 5 018 6128 6128 6128 6128 6128 6128 6128 6128 6128 6128 4642 4656 4642 4656 6128 6128 958 940 6128 6128 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 3777 3788 1861 1904 3777 3788 3777 3788 6080 6085 2400 2328 2400 2328 2292 2221 52q 521 523 521 709 691 709 691 709 691 709 691 709 69/ 709 691 1907 1841 1907 1841 1907 1841 NA 16949 4187 4(~4 4195 4083 4195 4083 4210 4094 4218 410~ 1 514 028 304 340 I 974 071 095 .127 I 609 024 395 436 I 058 022 257 281 I 165 012 604 633 1,154 .(}14 574 .607 1 149 ()19 427 460 I 171 ()15 2609 2.775 I 063 015 6 100 6.480 I 158 3)15 2 365 2.513 I 132 002 .984 992 I 367 3X)3 979 .990 I 645 014 775 .818 I 262 .021 461 502 1 160 X)22 403 440 1 139 026 .313 348 IA53 .190 006 .013 1,262 I 13 025 ,039 961 102 .018 028 I 104 117 018 029 U nd (X)0 001 ,001 I 310 102 033 050 I 613 016 .824 .878 1 167 026 337 .374 I 154 025 340 376 IA40 009 4.255 4 406 I 345 014 .798 843 1,394 020 664 720 I 068 041 215 254 961 (122 757 .826 158 (178 .251 344 1(15 022 756 825 156 [X)9 940 975 108 018 822 .882 142 018 824 885 135 017 833 .893 110 021 767 .835 247 I 18 045 072 965 041 214 252 [ 037 054 151 188 I 244 025 4 071 4.507 IA I I 118 18.664 3 147 I 117 10l 22704 34.151 I I10 (776 44781 6885 I 031 102 2 381 3 849 I 126 065 67059 87 130 NA = Not apphcable Und = Undefined 192 Table B.2.2 Sampling errors - National sample: men~ Zimbabwe 1994 Number of cases Standard Design Relative Confidence hm~ts Value error Unweighted Weighted effect error Variable (R) (SE/ (N) (WN) (DEFT) (SE /R) R-2SE R+2SE Urban residence No educatmn With secondary education or higher Never married (in umon) Currently married (m umon) Knowing any contraceptive method Knowing any modem method Ever used any contraceptive method Currently using any method Currently using a modern method Currently using pdl Curre.tly using IUD Currently using injectables Currently using condom Currently using female sterilisauon Currently using periodic abstinence Currently using withdrawal Want no more children Ideal number of chddren .372 .015 2141 214I 1.455 041 .342 .403 .041 .006 2141 2141 1.304 136 .030 .052 .557 .015 2141 2141 I 428 .028 .527 588 ,469 .014 2141 2141 1.335 .031 .440 .498 485 013 2141 2141 1.216 027 .459 .511 .999 .001 I015 1038 1.026 .001 ,997 1.000 .997 .002 1015 1038 1.092 .002 993 1.000 927 009 1015 1038 I.I14 010 .909 .945 .604 .019 1015 1038 1.209 .031 ,567 ,641 .545 .019 1015 1038 L215 .035 .507 583 .425 .017 1015 1038 1.093 .040 .391 459 .011 .004 1015 1038 1.131 .341 .003 .018 030 006 1015 1038 1.185 .210 .018 .043 062 008 1015 1038 1.076 .131 .046 .079 .014 .004 1015 1038 1 151 308 .005 .022 .006 .003 1015 1038 1.160 .472 000 .012 030 .007 1015 1038 1.234 .221 017 .043 .350 ,019 1015 1038 1.291 .055 311 388 4.292 .067 2101 2105 I 225 016 4.158 4.427 193 Table B.3.1 Sampl ing errors - Urban sample: women T Z imbabwe 1994 Number of cases Standard l)eslgn Relattve Confidence hmlls Value error Unweighted Weighted effect error Vanable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban restdence 1,000 .000 No education .035 .006 With secondary education or higher 630 .018 Never mamed (in union) 313 ,012 Currently roamed 0n union) 564 ,013 Married betbre age 20 501 017 Had first sexual intercourse before 18 362 016 Chtldren ever born "; 039 062 Children ever born to women over 40 ,~.739 ,192 Children surviving I 903 054 Knowing any contraceptive method .997 ,002 Knowing any modern method 996 002 Ever used any contraceptive method 845 .014 Currently using any method 576 .017 Cunently using a modern method 539 015 Currently using pill 420 014 Currently using IUD 022 .006 Currently using mjectables 036 ,007 Currently using condom 029 .004 Currently using l)male sterlhsauon 025 005 Currently using penodtc abstmence 002 .002 Currently using withdrawal 026 009 Using pubbc sector source ,775 ,027 Want no more children 370 013 Want to delay at/east 2 years 332 Ol 7 Ideal number ol children t.546 ,051 Mothers recmved tetanus mlectmn 837 .019 Mothers receLved med:cal care at bffth 91 I 016 Had diarrhoea m the last 2 weeks .179 017 Treated with sugar salt-water solutmn 818 .048 Sought medical treatment 267 063 Having health card, seen 792 033 Received BCG vaccination .966 ,015 Received DPT vaccmatLon (3 doses) 896 023 Received poho vaccmamm (3 doses) 896 024 Re,'e~ved measles v~tccmatlon 877 ,026 Fully mamuntsed 842 024 Weight lol-he]ght 065 (119 Hc]ght-tor age 190 021 Welght-lor-age 135 023 Total fertility rate (3 years) 3,098 ,147 Neanatal mortahty rate (0-9 years) 23,394 5.015 Posmeonatal mortahty rate (0-9 years) 2 900 3,312 Infant mortahty rate (0-9 years) 44 294 6 240 Child mortahty rate (0-9 years) 19.539 3 686 Under five mortahty rate (0-9 years) ( 2.968 6 974 1745 1975 1745 1975 1745 1975 1745 1975 1745 1975 1341 1540 1341 1540 1745 1975 209 231 1745 1975 959 1114 959 1114 959 1114 959 1114 959 1114 959 1114 959 1114 959 1114 959 1114 959 1114 959 1114 959 1114 642 740 959 1114 959 1114 1732 1959 537 608 537 608 515 585 85 105 85 105 187 215 187 215 187 215 187 215 /87 215 187 215 424 479 424 479 424 479 NA 5601 1795 2027 1797 2030 1797 2030 1800 2034 1802 2037 Und 000 1 000 1 000 1 273 160 024 046 1,587 .029 .594 ,667 I 117 040 288 .338 1 073 023 538 589 I 244 034 467 535 I 202 044 330 393 1 186 031 1 914 2 163 1 102 041 4,354 5.123 I 098 028 I 795 2 010 1 091 ,002 .993 1.000 I 061 002 992 I 000 1.156 .016 .818 872 094 ,030 .541 ,611 959 029 .508 ,569 881 033 392 .448 177 255 .011 033 I 10 186 .022 .049 ,809 152 020 037 1 069 216 ,014 036 I 082 706 000 006 1 669 328 .009 .043 1 660 035 720 830 859 036 344 397 I 112 .051 ,298 .365 1,401 (114 3 444 3 648 I 13~ 023 799 875 I 29 :~ 018 878 944 1,023 ,(196 144 213 1 197 059 .722 914 I ]58 234 .142 392 I 133 042 726 .859 1 152 ,(116 936 997 I 054 026 850 943 I 068 1126 .849 .944 I 077 029 825 ,928 .923 1129 793 89 I I 564 289 027 102 1 068 110 .148 ,232 1 356 167 090 180 1.080 .047 2 805 3 391 I 284 .214 13 364 33 424 I 048 158 14.276 27 525 1 240 141 31.814 56.775 1 021 189 12 168 26.911 I 175 111 49.020 76916 NA = Not applicable Und = Undefined 194 Table B.3.2 Sampling errors - Urban sample: men~ Zimbabwe 1994 Number of cases Standard Design Relati've Confidence hirers Value error UnweJghted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE /R) R-2SE R+2SE Urban residence No education With secondary education or higher Never married (m union) Currently manned (in umon) Knowing any contraceptive method Knowing any modem method Ever used any contraceptive method Currently using any method Currently using a modern method Currently using pdl Currently using IUD Currently using injectables Currently using condom Currently using female sterilisation Currently using periodic abstinence Currently using withdrawal Want no more children Ideal number of children 1.000 .000 681 797 Und .000 11300 1,000 .018 ,006 681 797 1,140 ,326 .006 ,029 .728 .023 681 797 1,351 .032 .682 .774 396 031 681 797 1 636 077 335 458 .567 .028 681 797 1,459 .049 .512 .622 1,000 .000 382 452 Und .000 1.000 1.000 1.000 .000 382 452 Und .000 1000 1000 940 013 382 452 1.087 ,014 914 966 .699 ,022 382 452 954 .032 654 744 .638 .028 382 452 1.143 .044 .582 .694 .481 .025 382 452 .960 ,051 .432 ,530 014 007 382 452 1.106 .481 001 027 .033 .011 382 452 1 156 321 012 054 .080 .014 382 452 1.036 .180 ,051 ,109 .024 .009 382 452 1.105 359 .007 .042 ,009 006 382 452 1 184 .634 000 021 .033 .012 382 452 1.340 373 008 057 .410 ,032 382 452 1.270 .078 .346 474 3.694 .086 671 789 1.075 023 3.521 3,866 Und = Undefined 195 Table B.4.1 Samphng errors - Rural sampl ~'. women r Ztmbabwe 1994 Number of cases Standard Design Relative Confidence hmtts Vdue error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFr) (SE/R) R 2SE R+2SE Urban restdence (100 000 No educauon ] 48 011 With ~eeondary education or higher 314 011 Never mamed (in umon) ;!47 .007 Currently mamed (m umon) 044 .009 Mamed before age 20 .t~35 009 Ftad hrst sexual intercourse before 18 ,184 .010 Chddren ever born 3 I}02 054 Chddren ever born to women over 40 6 795 099 Chddren surwvmg 2 694 .048 Knowing any contracepttve method .')85 003 Knowing any modern method :)80 ,004 Ever used any contraceptwe method 777 .014 Ctmen0y using any method M2 .012 Currently using a modern method ~73 .011 Currently using pill 294 ,01 I Currently using IUD 305 001 Currently using mjectables ~)30 .004 Currently using condom [321 003 Currently usmg female stenhsation .322 003 Currently usmg periodic abstinence 1301 000 Currently usmg withdrawal .048 005 Usmg pubhc sector source 899 .013 Want no more chtldren 349 .012 Want to delay at least 2 years 369 011 Ideal number id chddren 4 703 049 Mothers recewed tetanus ir~lectlon 815 014 Mothers recewed medical care at birth 614 .017 Had dmrrhoca m the last 2 weeks 255 .01 I Treated wtth sugar-salt-water solution 785 018 Sought medtcal treatment 305 025 Hawng Ilealth card, seen 790 .020 Recewed BCG vaccination 953 .011 Recetvcd DPT vaccmatxon (3 doses) 831 019 Received poho vaccination (3 doses) 835 019 Received measle~ vaccmatmn 857 .018 Fully Immumsed 782 022 Welght-tor-helght 056 007 Helght-lltr age 248 All I Weight-lot-age 181 .010 Total ferhhty rate (3 years) ,I 850 .I 15 Neonatal mortahty rate (0-9 years) 2." 467 2 23 I Posmeonata[ mortahty rate (0-9 years) 21. 096 2.436 Infant mortahty rate (0-9 years) 57 563 3 634 Chdd mortahty rate (0-9 years) 21. 233 2.392 Lh]der hve mortahty rate (0-9 years) ~, 284 4 412 4383 4153 4383 4153 4383 4153 4383 4153 4383 4153 3301 3117 3301 3117 4383 4153 749 709 4383 4153 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 2818 2674 1219 1164 2818 2674 2818 2674 4348 4126 1863 1720 1863 1720 1777 1636 438 416 438 416 522 476 522 476 522 476 522 476 522 476 522 476 1483 1361 1483 1361 1483 1361 NA 11348 6481 6045 6487 6050 6487 6050 6523 6088 6529 6094 Und Und 000 .000 2128 077 .125 .171 I 636 037 291 337 1 021 027 234 261 I 229 014 626 662 1,104 015 616 653 1 122 0211 464 503 I 210 018 2,894 3 110 1 018 015 6 598 6 992 I 206 018 2 597 2 791 1.155 .003 979 .990 1 415 004 973 988 [ 780 018 749 805 1.298 027 418 .466 1 233 030 350 395 I 255 1137 272 "~ 15 914 255 002 .007 1 325 142 022 039 I 042 136 1115 026 1 112 138 I)16 029 Und 000 ,[}01 001 1.230 103 038 1158 I 452 014 874 924 1.287 033 326 373 1 160 029 348 390 [ 490 ,010 4 6116 4 8(X) 419 017 788 842 390 027 581 648 078 045 232 277 898 023 749 82 I 108 080 256 354 086 025 7511 .829 155 011 931 975 122 023 .794 869 166 023 797 874 159 021 821 893 183 1)28 739 826 065 I 17 114 ~ 069 92(1 1)4~ 227 269 928 1/53 ] 62 2111 2 [ 8 I)24 4 620 5 08 I 032 088 21 004 29 929 1.1/98 087 2~ 224 32 968 [ 158 068 46 296 6 83[1 11163 085 2Z 450 331117 [ 163 055 71 459 89 109 NA = Not apphcable UOd -- Undelmed 196 Table B,4.2 Samphng errors - Rural sample: men, Ztmbabwe 1994 Number of cases Standard Design Relative Confidence [nmts Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban residence .000 .000 1460 1344 Und Und .COO .000 No education 055 008 1460 1344 I 341 146 039 071 With secondary education or higher 456 017 1460 1344 1 287 .037 .422 489 Never married (in union) .512 .015 1460 1344 h l l0 028 .483 .541 Currently mamed (in umon) 436 014 1460 1344 h041 031 409 .463 Knowing any contraceptive method .998 002 633 586 1 076 .002 .994 1 COO Knowing any modern method 994 .004 633 586 h 148 004 .987 1.000 Ever used any contraceptive method 917 012 633 586 1.124 013 893 ,942 Currently using any method .530 .027 633 586 1 353 .051 .476 584 Currently using a modern method 474 .025 633 586 1.271 053 .423 .524 Currently using pall .381 ,023 633 586 I 200 .061 .335 428 Currently using 1UD 00g 004 633 586 l 096 473 .00O 016 Currently using lnjectables 029 008 633 586 1.186 .275 .013 .044 Currently using condom 049 009 633 586 I 085 191 030 .067 Currently usmg female sterdtsatton .005 .003 633 586 1.046 .571 ,COO ,01 I Currently usmg periodic abstinence 004 002 633 586 .904 .606 000 008 Currently usmg withdrawal 027 007 633 586 1.053 249 .014 .041 Want no more children 303 023 633 586 I 263 076 ,257 .350 Ideal number of chddren 4.652 .085 1430 1316 I 198 018 4.482 4821 Und = Undefined 197 Table B.5 Samphng errors - Mamcaland. Z imbabwe 1994 Number of cases St~mdard Design Relative Confidence htmts Value error Unwelghted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban residence 110 013 550 No education 144 .036 550 With sec~mdary educatton or higher 33(7 024 550 Never married (m union) 253 018 550 Currently married (m umon) 647 .022 550 Married before age 20 .635 .025 404 Had first sexual intercourse before 18 423 027 404 Children ever born L854 171 550 Chddren ever horn to women over 40 5.673 .293 93 Children surviving 2 561 156 550 Knowing any contraceptive method 969 010 357 Knowing any modern method .958 .015 357 Ever used any contraceptive method ,730 ,056 357 Currently using any method 359 .039 357 Currently using a modern method 276 029 357 Currently using pdl 214 021 357 Currently using IUD 014 005 357 Currently using mlectables .008 006 357 Currently using condom ,034 010 357 Currently using female sterflisatxon 005 .004 357 Currently using pertod]c abstinence ,000 ,000 357 Currently using withdrawal 067 .016 357 Usmg pubhc sector source .853 035 113 Want no more chddren 283 .032 357 Want to delay at least 2 years 41 I 027 357 )deal number of chddren 5 037 154 545 Mothers recetved tetanus rejection 736 047 202 Mothers received medical care at birth .525 047 202 Had dtarrhoea in the last 2 weeks 254 .032 186 Treated with sugar-salt-water solution 615 051 47 SotJghl r~edlc~l treatment 130 050 47 Having health card, ~een .840 035 55 Recetved BCG vaccination 929 .(735 55 Recetvcd DPT vaccmauon (3 doses) 805 068 55 Received pcd]o vaccmauon (3 doses) 805 068 55 Rccetved measles vaccination 836 049 55 FulLy tmrnuntsed 764 069 55 Welght-fbr-he]ght ,070 022 145 Height-lot-age 218 030 145 Wetght-lor age .145 033 145 839 1003 122 083 136 839 2 396 .249 073 216 839 I 212 074 281 379 839 947 069 218 289 839 I 081 034 .603 691 616 1.022 .039 .586 684 616 1.107 064 368 477 839 1.363 .060 2.512 3 196 142 1.166 .044 6,088 7 258 839 1 384 061 2 249 2.874 543 1 084 010 949 .989 543 1.442 016 927 989 543 2 372 .076 619 842 543 1,535 109 281 4q7 543 I 215 104 .218 ~33 543 974 099 171 .256 543 849 372 1)04 025 543 1.307 760 (300 02L 543 1 068 303 013 054 543 I 011 721 000 013 543 Und Und 000 000 543 1.220 .242 034 099 175 1 056 041 782 ,924 543 I 341 113 219 347 543 1.024 .065 358 465 831 I 588 ,031 4 730 5 345 307 I 420 064 642 831 ~07 1 277 089 432 61~ 282 990 126 190 318 72 689 ,082 513 716 72 ],0]2 ,383 030 230 84 708 042 770 91(7 84 1,018 038 858 1000 84 1.274 085 668 941 84 I 274 .085 668 941 84 971 058 738 9~3 84 I 205 09~ .626 903 219 972 321 025 115 219 877 140 157 278 219 1 078 227 .079 210 Und = Undefined 198 Table B.6 Sampl ing errors - Mashonaland Central~ Z imbabwe 1994 Number of cases Standard Design Relative Confidence hmlts Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban residence .038 .003 No education 230 026 With secondary education or higher ,277 025 Never married (m union) .203 ,016 Currently married (m union) .67 t ,016 Mamed before age 20 681 023 Had first sexual intercourse before 18 .439 .027 Chddren ever born 2.887 130 Children ever horn to women over 40 6 680 266 Children surviving 2.511 .096 Knowing any contraceptive method .995 .002 Knowing any modern method 992 003 Ever used any contraceptwe method ,800 027 Currently using any method .485 .038 Currently using a m~dern method .423 .042 Currently using pill .365 .039 Currently using IUD 003 .002 Currently using injectables .015 .008 Currently using condom ,018 .008 Currently using female sterihsation 024 .007 Currently using periodic abstinence .001 ,000 Currently using withdrawal ,043 .012 Using pubhc sector source 922 023 Want no more chridren .290 015 Want to delay at least 2 years 376 .022 Ideal number of children 4 900 ,093 Mothers received tetanus injection ,805 ,028 Mothers received medical care at birth .535 ,037 Had diarrhoea in the last 2 weeks 274 .018 Treated with sugar salt-water solution 804 033 Sought medical treatment .311 ,063 Having health card, seen 837 .047 Recmved BCG vaccmatton .955 ,023 Received DPT vacclnatton (3 doses) .894 ,023 Received polio vaccination (3 doses) ,879 .026 Received measles vaccmatlon 864 037 Fully immumsed .834 037 WeLght-for-he~ght ,056 .012 Height-for-age 294 .031 Weight fi~r-age .204 .020 627 510 .376 ,076 .032 044 627 510 1,547 113 178 282 627 510 I 375 ,089 228 ,326 627 510 1.003 079 171 235 627 510 ,850 024 ,639 703 469 385 I 053 ,033 636 726 469 385 1.162 .061 385 ,492 627 510 1 126 .045 2.627 3.147 110 92 1.121 .040 6 148 7.213 627 510 .988 ,038 2.318 2 703 417 342 ,697 002 ,990 1000 417 342 810 ,003 986 ,999 417 342 1.391 ,034 745 854 417 342 1 532 077 .409 560 417 342 1.719 098 ,340 ,507 417 342 1,662 ,108 286 443 417 342 1.010 ,986 000 007 417 342 1.309 ,528 .000 030 417 342 1.228 .450 002 033 417 342 .977 .308 .009 038 417 342 Und .000 .001 001 417 342 I 231 286 .018 067 201 160 1.187 024 .877 .967 417 342 677 052 ,260 320 417 342 927 ,059 33I 420 627 510 1.052 ,019 4 713 5,086 243 202 1 054 035 .749 861 243 202 1.098 069 462 609 233 192 .615 ,066 238 310 63 53 665 ,041 .738 870 63 53 1.084 .202 185 436 71 57 1.053 .056 744 930 71 57 .908 024 .909 1.000 71 57 621 026 ,848 940 71 57 674 .030 ,826 932 71 57 .904 ,043 790 938 71 57 826 ,044 760 9(17 203 169 .769 .220 .031 ,081 203 169 1003 107 .231 .357 203 169 ,697 099 163 .244 Und = Undefined 199 Table B.7 Samphng errors - Mashonaland Eas L Z imbabwe 1994 N ul'nber of cases Standard _ _ Destgn Relattve Confidence hmlts Value error Unwetghted Weighted effect error Variable (R) (SE) (N) (WNt (DEFT) (SE.tR) R-2SE R+2SE Urban resLdence 047 003 No educaUon 104 027 With secondary educatton or hxgher 387 03 I Never married (in umon) 254 .016 Currently married (m umon) 651 019 Married before age 20 685 022 Had first sexual intercourse before 18 475 .032 Children ever born ! 978 108 Chddren ever born to women over 40 6 568 .186 Children surviving L708 ,092 Knowing any contraceptive method 986 006 Knowing any modern method 984 006 Ever used any contraceptive method 843 022 Currently using any method 523 .0i7 Currently usmg a modern method .474 ,019 Currently using pdl 37[ 030 Currently usmg IUD 003 .003 Currently using injectables 042 ,013 Currently using condom 023 007 Currently usmg female stenhsatton 029 012 Currently using periodic abstinence 003 ,003 Currently using wtthdrawal .035 010 Using pubhc sector source 924 021 Want no more children 416 032 Want to delay at least 2 years ,381 026 Ideal number of chtldren 4.543 152 Mothers received tetanus injection 837 .040 Mothers recetved medical care at birth 733 .039 Had dtarrhoea m the last 2 weeks .190 021 Treated with sugar-salt-water solution .930 039 Sought medical treatment 461 .062 Hawng health card. seen 768 054 Received BCG vaccmatmn 919 027 Received DPT vaccination (3 doses) ,870 046 Recetved poho vaccmation (3 doses) 854 039 Recetved measles vaccination 892 032 Fully lmmumsed 827 .044 Wetght-for-hetgh( .021 017 Height-for-age 239 .027 Wetght-for-age 127 015 580 580 580 580 580 439 439 580 100 580 378 378 378 378 378 378 378 378 378 378 378 378 198 378 378 579 241 241 2311 43 43 64 64 64 64 64 64 194 194 194 579 3511 579 2 151 579 1547 579 ,884 579 965 438 .989 438 1,338 579 896 100 752 579 841 377 015 377 980 377 154 377 675 377 733 377 192 377 981 377 229 377 838 377 349 377 1014 377 1.071 197 1103 377 1.250 377 1042 578 1.840 240 1 589 240 I 282 230 813 44 1,013 44 823 63 I 004 63 778 63 11194 63 886 63 821 63 918 194 1.622 194 840 194 614 1166 041 053 262 050 159 081 324 450 063 ,222 286 029 ,613 689 032 ,641 729 067 ,411 .539 036 2.763 3 193 028 6,196 6.940 034 2,524 2 891 .006 ,974 999 006 ,971 .997 ,026 ,800 886 033 ,488 ,558 040 ,437 .512 .080 ,312 431 969 ,000 .008 301 .017 068 278 .010 037 403 ,006 052 1.002 000 008 289 015 .056 023 .882 966 076 352 .479 068 329 .433 033 4 239 4.847 047 ,757 .916 .053 .655 811 I10 .148 232 042 851 1.000 .135 .337 585 070 660 .875 029 .865 972 053 777 .963 046 775 933 036 828 956 053 739 915 795 .000 .055 114 185 .293 116 .097 156 200 Table B.8 Sampl ing errors - Mashonaland Wes b Z imbabwe 1994 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFI') (SE/R) R-2SE R+2SE Urban residence .217 030 No educauon .169 .028 With secondary educatton or higher 306 .035 Never roamed (in union) .186 .014 Currently married 0n union) .679 015 Mamed before age 20 729 .028 Had first sexual intercourse before 18 571 037 Children ever born 2.886 135 Chddren ever born to women over 40 6 517 .255 Chddren survwing 2.558 .116 Knowing any contraceptive method .995 005 Knowing any modern method 990 .006 Ever used any contraceptive method .806 ,022 Currently using any method 491 026 Curretttty using a modern method .446 .026 Currently using pdl .396 .020 Currently using IUD .000 (~0 Currently using injectables .028 .013 Currently using condom 018 ,004 Currently using female stenhsation 005 004 Currently using permdlc abstinence 000 .000 Currently using withdrawal 027 .009 Using pubhc sector source 853 046 Want no more children .287 .022 Want to delay at least 2 years .424 .033 Ideal number of children 4 458 114 Mothers received tetanus mjectmn 855 .036 Mothers recetved medical care at birth ,545 ,046 Had diarrhoea in the last 2 weeks .271 .039 Treated with sugar-salt-water solutmn .816 047 Sought medmal treatment 215 .057 Hawng health card, seen .804 .050 Received BCG vaccinatmn 947 041 Received DPT vaccination (3 doses) .855 .038 Received poho vaccination (3 doses) .868 .043 Received measles vaccination .908 .035 Fully .nmunised ,855 .038 Wmght-tbr-belght 076 030 Height for-age 249 ,030 Wmght-fnr-age .219 .017 589 631 589 631 589 631 589 631 589 63 I 455 488 455 489 589 631 89 95 589 631 400 429 400 429 400 429 400 429 400 429 400 429 400 429 400 429 400 429 400 429 400 429 400 429 211 227 400 429 400 429 585 627 256 274 256 274 239 255 65 69 65 69 76 81 76 81 76 81 76 8 I 76 81 76 81 201 215 201 215 201 215 1 754 .137 .158 277 1.786 .163 114 ,224 1.829 .114 ,236 375 892 .077 158 215 .775 ,022 .649 709 1.351 .039 673 ,786 1.576 .064 497 644 1.196 .047 2.617 3 156 .973 .039 6007 7 027 1.154 .045 2 326 2 790 1.399 .005 ,985 1 000 I 177 .006 978 I 000 1.131 .028 761 850 I 053 054 438 544 1.036 .058 395 498 .819 .051 356 436 Und Und .000 000 1.593 .473 001 (154 557 ,208 010 025 1002 .713 .000 012 Und Und .000 000 1.087 325 010 .045 I 866 053 .762 944 ,966 .076 ,244 ,331 1,330 .078 358 490 I 414 025 4 231 4 686 1.564 043 782 .928 1 381 085 453 638 1.332 .144 193 350 .969 ,058 .722 910 I 107 265 ,101 328 1.078 .062 704 903 1.587 .043 865 1000 .933 .044 .780 931 1,103 .050 782 954 1.059 .039 838 979 .933 ,044 780 931 I 601 394 016 .135 .991 .122 .188 309 592 .079 184 254 Und = Undefined 201 Table B 9 Samphng errors - Matabeleland North 7 Z imbabwe 1994 Number of cases Standard Design Relatxve Confidence bruits Value error Unwelghted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SFJR) R-2SE R+2SE Urban residence 093 .029 No educauon 162 025 Wtth secondary education or higher .281 ,030 Never roamed (in union) 266 .026 Currently marrted (in umon) 653 03 I Manied before age 20 564 .036 Had first sexual intercourse before 18 .590 Ol 6 Children ever born 2.995 101 Children ever born to women over 40 6 266 .273 Chddren surv]wng 2.723 .1(30 Knowing any contraceptive method .964 .010 Knowing any modem method .958 01 I Ever used any contraceptive method .660 025 Currently using any method 336 .027 Currently using a modern method .285 ,024 Currently using pall .214 .025 Currently using IUD .004 ,003 Currently using mjectables 030 .013 Currently using condom ,020 007 Currently using Ii~male stenhsatlon 014 005 Currently using pertodlc abstmence 000 .000 Currently using withdrawal 025 005 Using public sector source .811 .068 Want no more children 416 ,021 Want to delay at least 2 years .325 020 Ideal number of children 4 442 10g Mothers received tetanus mjecuon .854 ,016 Mothers received medical care at bffth 560 .063 Had dtarrhoea m the last 2 weeks ,249 026 Treated with sugar-salt-water solution 729 .047 Sought mod~cal treatment .285 042 Having health card, seen .801 061 Received BCG vaccination 1,000 000 Received DPT vaccination (3 doses) 874 034 Received poho vaccination (3 doses) 864 .047 Received measles vaccination .948 .020 Fully immumsed 822 .035 Weight for-height 105 .018 Height-for-age .308 ,035 Weight-for-age .262 .029 681 366 2.593 311 .035 151 681 366 I 745 .152 113 212 681 366 1,713 105 .222 340 681 366 I 509 ,096 215 318 681 366 I 711 .048 591 316 511 275 1.629 063 ,493 636 511 275 750 ,028 557 623 681 366 928 .034 2 793 3 196 108 58 976 044 5 720 6,813 681 366 .999 037 2 524 2.923 445 239 I 125 010 ,945 984 445 239 1.171 .012 .935 980 445 239 I 119 .038 610 710 445 239 1.198 080 .282 390 445 239 1 109 083 237 .332 445 239 I 307 .119 163 265 445 239 1.005 .7)3 000 ,0Jl 445 239 1,558 421 005 055 445 239 1048 ,346 006 034 445 239 968 .388 003 025 445 239 Und Und 000 000 445 239 .695 .207 014 035 153 83 2 132 084 675 946 445 239 890 ,050 .375 458 445 239 .920 063 284 366 660 355 1.3[)0 024 4.225 4 658 342 183 .836 019 821 .887 342 183 2.224 112 .434 685 324 173 1.100 .105 ,197 .302 81 43 954 .065 634 823 81 43 .832 147 201 369 95 51 1.467 076 .680 922 95 51 Und 000 1,000 1 000 95 51 1.006 .039 805 943 95 51 I 320 054 77(1 957 95 51 .869 021 .908 .987 95 51 882 042 752 891 266 142 .973 ,174 .068 141 266 142 I 235 .114 238 .378 266 142 1.083 110 205 320 Und = Undefiiaed 202 Table B 10 Samphng errors - Matabeleland South~ Z imbabwe 1994 Number of c~ses Standard Design Relative Confidence bruits Value error Unwelghted Weighted effect error Variable (R) (SE) (N) (WN) (DEFF) (SE/R) R-2SE R+2SE Urban residence 030 ,007 No educauon .085 024 With secondary education or higher .367 .033 Never marrted (to. union) 298 028 Currently married (in union) .601 .023 Mart'ted before age 20 475 024 Had first sexual intercourse before 18 606 023 Children ever born 3.097 178 Children ever born to women over 40 7.043 276 Children surviving 2 847 180 Ktt~wtttg any contraceptive method 964 .013 Knowing any modern method 961 .015 Ever used any contraceptwe method 650 031 Currently using any method ,339 .037 Currently using a modern methnd .294 037 Currently using pill 205 .033 Currently using IUD 006 ,004 Currently using mjectables .028 ,007 Currently using condom .011 .004 Currently using female sterilisauon .042 016 Currently using periodic abstinence 003 .003 Currently using withdrawal .012 004 Using public sector s~uree 943 .014 Want no more chddren .437 040 Want to delay at least 2 years 262 .025 Ideal number of children 4 289 .139 Mothers received tetanus rejection 834 .039 Mothers received medical care at bxrth .650 055 Had dmrrhoea m the last 2 weeks . 119 028 Treated with sugar-sort water sotutton .g93 .054 Sought medical treatment 393 .074 Having health card, seen ,770 .061 Received BCG vaccination 974 019 Received DPT vaccination (3 doses) .844 048 Received polio vaccination (3 doses) 844 ,048 Received measles vaccination .883 026 FulLy tmmumsed .780 045 Weight-lor-hetght 051 ,013 Height-for age .289 046 Welghl-for-age 193 034 587 305 .947 223 ,016 ,043 587 305 2 113 286 036 A34 587 305 1635 089 31)2 432 587 305 t.459 .093 .242 353 587 305 1135 038 .555 647 456 236 1.033 .051 .427 .524 456 236 .985 .037 .561 651 587 305 I 447 .057 2 741 3 453 104 56 1.042 .039 6491 7595 587 305 I 588 063 2 487 3 206 350 183 l 321 .014 938 ,99I 350 183 I 434 015 .932 .991 350 183 1.221 048 587 712 350 183 1.446 108 ,266 412 350 183 I 505 .125 .221 368 380 183 1.532 ,162 .139 .271 350 183 954 .661 .000 ,014 350 183 .833 263 .013 043 350 183 .711 ,357 .003 ,019 350 183 1.481 .381 ,010 ,073 350 183 1.003 985 .1300 009 350 183 .693 ,338 004 1)20 151 76 ,721 014 .916 ,970 350 183 1.500 1)91 357 517 350 183 1 073 096 .212 .313 582 302 I 712 032 4 011 4,568 251 132 1 599 046 .757 .911 251 132 1,761 084 541 760 242 128 I 328 .238 062 .175 28 15 .936 .060 .785 1.0(30 28 15 805 189 244 542 79 42 1.305 ,079 .647 .892 79 42 1.049 019 937 I 000 79 42 1.187 057 749 940 79 42 I 187 057 749 940 79 42 .732 030 831 936 79 42 .978 .058 .689 870 202 107 .847 253 .025 .076 202 107 1475 160 197 382 202 107 1,208 .177 124 .261 203 Table B. 11 Sampling errors - Midlands~ Zimbabwe } 994 Number of cases Standard Design Relative Confidence hmits Value error Un,.veighted Wetghted effect error Variable (R) (SE) (N) (WN) (DEFT) ISE/R) R-2SE R+2SE Urban residence .220 .024 No educanon 095 .019 Wtth secondary educanon or higher .440 031 Never married (m umon) 284 Ol 8 Currently mamed (m umon) .583 .023 Marned before age 20 .525 024 Had first sexual intercourse before 18 413 .019 Children ever born , .821 134 Chddren ever born to women over 40 (,.716 308 Children surviving ~' 569 122 Knowing any contracepttve method 998 002 Knowing any modem method 995 .003 Ever used any contraceptive method 906 014 Currently using any method .582 .027 Currently using a modem method .467 025 Currently using pill 345 .031 Currently using IUD .005 .003 Currently using mjectables 048 ,011 Currently using condom 032 007 Currently using l~male stenhsatlon 035 .007 Currently using perlodtc absnnence .000 1300 Currently using w*thdrawal .089 017 Using pubhc sector source 850 027 Want no more ehddren .369 .025 Want to delay at least 2 years .360 .025 Ideal number of children 4232 086 Mothers received tetanus mjectmn .831 .017 Mothers received medical care at btrth 748 .027 Had diarrhoea in the last 2 weeks 265 .033 Treated with sugar-salt water solution .835 043 Sought medmal treatment .418 .075 Having health card, seen 766 .05 I Received BCG vaccinanon 974 018 Received DPT vaccmanon (3 doses) .803 050 Received polio vaccmauon (3 doses) 801 .050 Received measles vaccination 801 056 Fully immumsed 717 .062 Weight-for-height .078 018 Height-for-age 142 018 Weight-for-age .151 022 716 810 1.559 AI0 172 .269 716 810 I 715 198 .058 133 716 810 1 688 071 377 .503 716 810 1045 062 .249 .319 716 810 1.235 039 538 .629 554 627 I 120 045 .478 573 554 627 .902 .046 375 .451 716 810 I 237 048 2.552 3 089 l l2 126 1150 046 6.100 7.332 716 810 I 237 047 2 325 2 813 420 472 985 002 993 1000 420 472 967 .003 .989 1.000 420 472 .967 0]5 .879 .934 420 472 1.118 .046 .528 .636 420 472 1.030 054 416 .517 420 472 1.319 089 .284 406 420 472 .965 .693 .000 .011 420 472 1012 221 .026 069 420 472 813 219 018 046 420 472 816 209 .020 050 420 472 Und Und 000 000 420 472 I 189 185 056 123 250 283 1.205 032 .795 .904 420 472 I 073 069 .318 .419 420 472 1 084 071 309 .411 714 808 1.187 .020 4.059 4.405 288 324 722 .020 797 .864 288 324 1003 .036 .694 .802 275 309 1.204 123 .200 330 74 82 985 052 .749 921 74 82 1 287 .180 267 568 82 93 I 089 066 .664 867 82 93 1 024 018 938 1.000 82 93 I 150 063 .702 904 82 93 1 135 .062 701 .901 82 93 1.267 070 .689 913 82 93 1 252 087 592 841 220 247 .971 .225 043 114 220 247 740 127 .106 178 220 247 925 148 106 .195 Und = Undefined 204 Table B. 12 Samphng errors - Masvingo~ Zimbabwe 1994 Number of cases Standard Design Relat lye Confidence hmits Value error Unwelghted Weighted effect en'or Vanahle (R) (SE/ (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban residence .064 .012 No educatzon 124 .022 With secondary education or higher .303 033 Never mamed (m umon) .270 .012 Currently married (in union) .603 026 Married before age 20 .646 ,023 Had first sexual intercourse before 18 .473 .021 Children e,~er born 2 929 , | 18 Children ever born to women over 40 6 809 .186 Children sur'~l'~mg 2 622 .107 Knowing any contraceptive method 997 ,003 Knowing any modern n~ethod 997 .003 Ever used any contraceptive method .761 023 Curret~tly using any method .420 .03 I Currently using a modern method 376 031 Currentty ustttg ptlt ,280 .034 Currently using IUD 000 .ON) Currently using mjectables .052 .015 Currently using condom 01 I .003 Currently using female sterihsation ,033 ~fil0 Currently using periodic abstinence ,000 000 Currently using withdrawal 033 .007 Using public sector source 971 012 Want no more children ,376 ,03 I Want to delay at least 2 years .309 031 Ideal number of chddren 4592 .101 Mothers received tetanus injection 852 .020 Mothers received medical care at birth .777 .022 Had d~arrhoea in the last 2 weeks .300 021 Treated with sugar-salt-water solution .747 053 S~3ugbt medical 'treatment 317 .087 Having health card. seen .745 057 Received BCG ,Jaccmation 949 .023 Received DPT vaccmaUon (3 doses) 765 042 Received polio vaccination (3 doses) ,799 053 Received measles vaccination 731 ,053 Fulty tmraumsed .680 ,055 Weight-for-height 022 .007 Height-for-age .261 015 Weight-for-age .162 029 604 652 1 252 ,195 039 089 604 652 I 618 .175 .081 .168 604 652 1.750 .108 .238 369 604 652 .680 .046 245 294 604 652 1.327 .044 .550 .656 437 471 |000 .035 .601 ,692 437 471 .887 .045 430 515 664 652 957 ,040 2.693 3 166 97 106 570 .027 6 437 7 182 604 652 .954 ,041 2.409 2.835 363 393 1.004 .003 .992 1000 363 393 1004 .003 .992 1.000 363 393 I 047 .031 ,714 ,808 363 393 1.203 .074 .358 .483 363 393 1 225 ,083 .314 .438 363 393 1.424 .120 .213 .347 363 393 Und Und .000 .000 363 393 1.250 279 ,023 .082 363 393 .593 ,301 .004 017 363 393 1.091 .311 012 053 363 393 Und Und .000 .000 363 393 .737 .210 .019 .047 168 179 921 ,012 946 99'5 363 393 1.217 .082 .314 .438 363 393 I 259 ,099 .248 .370 603 650 1.124 ,022 4.391 4.794 223 240 .769 ,O23 .813 .892 223 240 .762 ,028 .733 .821 211 228 ,670 .072 .257 .343 63 68 967 .071 .641 853 63 68 .982 ,|81 .202 .432 59 64 I 017 .077 .630 .860 59 64 .800 ,024 .903 .995 59 64 .756 .054 .682 .848 59 64 t.018 ,066 694 905 59 64 ,924 .073 ,625 ,837 59 64 .914 .081 570 .791 182 196 .658 ,322 .008 .037 182 196 .471 .059 230 292 182 196 1069 .180 .103 220 Und = Undefined 205 Table B.I 3 Samphng errors - Hararev Z imbabwe 1994 Number of cases Standard Design Relative Confidence hmttg Value error Unwelghted Weighted el feet error Variable (R) (SE) (NI (WN) (DEFT) (SFJR) R-2SE R+2SE Urban residence 11300 000 No education 021 007 With secondary education or higher 668 029 Never married (munmn) 309 018 Currently morned (munmn) 590 020 Morned before age 20 508 024 Had first sexual intercourse before 18 297 ,018 Chddren ever born 1.962 092 Chddren ever born to women over 40 4 554 ,289 Children surviving I 844 075 Knowing any contracepUve melbod 1.000 .000 Knowing any modem method I {300 000 Ever used any contraceptive method .858 022 Currently usmg any method 616 024 Currently using a modern method 577 023 Currently using pill A57 OI 8 Currently using IUD 1)22 009 Currently using mjectables 026 010 Currently using condom 028 006 Currently using female stenhsatton 025 008 Currently usmg periodic abstinence 003 003 Currently using wLthdrawal 025 014 Using pubhc seclor source 742 046 Want no more chddren 370 020 Want to delay at least 2 years 357 025 Ideal number of chddren ~ 566 083 Mothers recmved tetanus injection 822 03 I Mothers recewed medical care at bft~h 93q 023 Had dtarrhoea in the last 2 weeks 190 027 Trealed w)th sugar-salt-waler solution 853 063 Sought medical treatment 265 .088 Having health card, seen 791 ,050 Recetved BCG vaccination 970 .022 Received DPT vaccmatmn (3 doses) 925 027 Received polio vaccmaUon (3 doses) 925 027 Recmved measles vaccmatton 896 037 Fully immumsed 881 032 Weight- for-height 061 027 Hmght-for-age 224 035 Wetght-for-age 156 037 608 1048 608 1048 608 1048 608 1048 608 1048 482 831 482 831 608 1048 65 112 608 1048 359 619 359 619 359 619 359 619 359 619 359 619 359 619 359 619 359 619 359 619 359 619 359 619 233 402 359 619 359 619 602 1038 180 310 180 310 179 309 34 59 34 59 67 115 67 115 67 115 67 115 67 115 67 115 147 253 147 253 147 253 Und ,000 I 000 Id)O0 229 337 007 036 526 044 609 726 946 057 .274 345 998 034 551 .630 059 047 460 557 854 060 261 332 066 047 I 779 2 145 .999 063 3 976 5 132 937 041 I 694 I 994 Und .000 1.000 I 1300 Und 000 I 000 1 000 1 182 .025 814 902 950 040 567 664 869 039 531 622 674 039 421 492 I 123 393 005 040 999 273 016 056 717 224 .015 040 1 010 333 008 042 I 032 I 032 .000 009 1 706 562 000 053 1,588 061 651 .834 786 054 330 41 I 984 070 307 406 1 324 023 3 401 3.732 [ 063 038 760 885 I 213 024 888 979 908 141 137 243 1 042 074 726 980 1 164 333 088 441 994 063 692 ,890 I 057 .023 926 I 000 848 029 871 980 848 029 871 .980 992 042 821 970 837 1)38 814 .947 I 367 442 007 I 15 1 002 157 154 295 I 221 235 083 230 Und = Undefined 206 Table B.14 Sampl ing errors - Bulawayo~ Z imbabwe 1994 Number nf cases Standard Design Relative Confidence limits Value error UnweJghled Wmghted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Urban residence 1.000 .000 No education .029 .006 With secondary educatxon or higher .626 022 Never married (in union) .377 023 Currently married (in union) .491 .019 Mamed before age 20 .402 025 Had first sexual intercourse before 18 402 .032 Chddren ever born 2.039 073 Chddren ever born to women over 40 4 512 .243 Children surviving 1 927 065 Knnwmg any contraceptive method .993 005 Knowing any modern method .993 .005 Eve~ used any contraceptive method 788 025 Currently using any method .479 031 Currently using a modern method 448 032 Currently using pill .306 .032 Currently using IUD .045 .011 Currently using mjectables .028 .010 Currently usmg condom .014 005 Currently using female stenhsation 042 013 Currently using periodic abstinence .003 .004 Currently usmg withdrawal .021 007 Using public sector source .787 .037 Want no more chddren ,438 ,023 Want to delay at least 2 years 212 028 Ideal number of children 3.280 .073 Mothers recetved tetanus rejection ,793 ,040 Mothers recewed medical care at bmh 943 023 Had dmrrhoea m the last 2 weeks .145 027 Treated with sugar salt-water solu6on .880 .065 Sought medtcal treatment 280 123 Havit~g health card, seen 770 076 Recewed BCG vaccination .967 022 Recewed DPT vaccination (3 doses) 869 055 Received poho vaccinatmn (3 doses) .902 ,050 Recewed measles vaccination .918 ,033 Fully lmmumsed 836 058 Welght-l~)r-hetght 027 .013 Height-lot age 136 033 Weight-for age 075 1)16 586 388 Und .000 1000 1.000 586 388 841 .201 .017 041 586 388 1.077 034 583 669 586 388 1.145 .061 331 423 586 388 .932 ,039 453 530 435 288 1,066 .062 352 452 435 288 I 340 078 ,339 465 586 388 ,815 .036 I 893 2 185 80 53 800 054 4 026 4.999 586 388 770 034 1.797 2.056 288 191 1.002 .005 983 I 000 288 191 1002 005 983 I000 2gg 191 1.032 032 738 .g3g 288 191 1.050 ,065 417 541 288 191 1 096 072 ,384 512 288 191 1161 103 242 369 28B 191 912 248 .023 .068 288 191 I 022 .357 .008 .048 288 191 .667 .332 005 023 288 191 1.082 306 016 .067 288 I91 I 012 1 012 ,000 ,011 288 191 .818 .331 007 035 183 121 1 211 047 713 .860 288 191 792 053 .391 .484 288 191 1.142 .130 157 267 583 386 1 220 022 3 133 3 426 174 115 1228 050 714 873 174 t15 1182 024 897 .988 173 1[5 996 185 091 198 25 17 1005 074 749 1.000 25 17 1.367 .439 034 526 61 40 1.413 .099 618 923 61 40 ,943 .022 924 I 000 61 40 1.267 063 759 978 61 40 1312 056 .802 1.000 61 40 935 036 852 984 61 40 1 217 .069 721 952 147 97 I 007 494 000 054 147 97 1.174 246 069 203 147 97 761 220 042 108 Und = Undefmed 207 APPENDIX C DATA QUALITY TABULATIONS Table C.1 Household age distribution Single-year age dlstributmn of the de facto household population by sex (wexghted), Zimbabwe 1994 Males Females Males Females Age Number Percent Number Percent Age Number Percent Number Percent <1 399 2.9 403 2.8 37 90 0.7 115 0.8 1 343 2.5 367 2.6 38 103 0.8 146 1.0 2 400 2.9 427 3.0 39 104 0.8 118 0.8 3 441 3.2 390 2.7 40 111 0.8 140 1.0 4 424 3.1 418 2.9 41 84 0.6 98 0.7 5 463 3 4 421 3.0 42 131 1.0 123 0.9 6 413 3.0 404 2.8 43 71 0.5 77 0.5 7 450 3.3 458 3.2 44 65 0.5 86 0.6 8 478 3.5 476 3.3 45 89 0.7 99 0.7 9 437 3.2 454 3.2 46 59 0.4 100 0.7 10 467 3.4 481 3.4 47 93 0.7 92 0.6 I 1 465 3.4 433 3.0 48 59 0.4 67 0.5 12 481 3.5 457 3.2 49 72 0.5 66 0.5 13 410 3.0 459 3.2 50 72 0.5 76 0.5 14 406 3.0 344 2.4 51 56 0.4 80 0.6 15 353 2.6 313 2.2 52 83 0.6 85 0.6 16 347 2.5 322 2.3 53 56 0.4 59 0.4 17 338 2,5 314 2,2 54 74 0.5 102 0.7 18 337 2.5 319 2.2 55 63 0.5 95 0.7 19 287 2. I 274 1.9 56 71 0.5 55 0.4 20 287 2.1 324 2.3 57 50 0.4 42 0.3 21 228 1.7 279 2.0 58 54 0.4 49 0.3 22 232 1.7 274 1.9 59 ,48 0.4 40 0.3 23 I ?3 1.3 222 1.6 60 82 0.6 85 0.6 24 225 1.6 245 1.7 61 27 0.2 30 0.2 25 209 1.5 229 1.6 62 74 0.5 54 0.4 26 170 1.2 215 1.5 63 36 0.3 34 0.2 27 154 1.1 169 1.2 64 60 0.4 64 0 4 28 163 1.2 173 1.2 65 66 0.5 43 0.3 29 137 1.0 158 1.1 66 39 0.3 38 0.3 30 176 1.3 244 1.7 67 26 0.2 27 0.2 31 118 09 14~. 1.0 68 33 0.2 20 0.1 32 177 1.3 210 1.5 69 25 0.2 30 0.2 33 93 0.7 127 0.9 70+ 342 2.5 357 2.5 34 137 1.0 173 1.2 Don't know/ 35 146 I.I 150 1.1 Missing 8 0.1 3 0.0 36 118 0.9 156 1,l Total 13,661 100.0 14,223 100.0 Note: The de facto population includes all residents and nonresidents who slept in the household the mght before the interview. 211 Table C.2 Age d~stnbution of eligible and interviewed women Percent distnbutian of the de facto household population of women age 10-54 and of interviewed women age 15-49, and the percentage of ehgtble women who were interviewed (weighted) by five-year age groups, Zimbabwe 1994 Household popu- lation of women Interviewed women Age Number Percent Number Percent Percent mlervlewed (weighted) 10-14 2,1"4 - - - 15-19 1,5,ll 24.2 1,458 24.0 94.6 20-24 1,344 21.1 1,288 21 2 95 9 25-29 9,14 14.8 910 15.0 96.4 30-34 8Cl9 14.1 871 14.3 96.8 35-39 6~4 10.8 653 10.7 95.4 40-44 524 8.2 508 8.3 96.9 45-49 4~.4 6.7 399 6.6 94.1 50-54 4,)1 15-49 6,3.52 6,087 95.7 Note: The de fa~ to population includes all residents and nonresidents who slept in the household the mght before interview. 212 Table C.3 Completeness of reporting Percentage of observations missing inlbrmation for selected demographic and health questions (weighted), Zimbabwe 1994 Percentage Number missing of Subject Reference group information cases Birth date Btrths in last 15 years Month only 0.3 I 1,668 Month and year 0.0 11,668 Age at death Deaths to births in last 15 years 0.5 908 Age/date at first umon t Ever-married women 0.7 4,482 Respondent's education All women 0.1 6,128 Child's size at birth Births m last 35 months 7.4 1,750 Anthropometry 2 Living children age 0-35 months Height missing 6.4 2,221 Weight missing 6.3 2,221 Height or weight missing 6.5 2,221 Diarrhoea in last 2 weeks Living children age 0-35 months 3.3 2,221 I Both year and age missing 2 Child not measured 213 Table C.4 Births by calendar years Distribution of births by Western calendar years for hvmg (L), dead (D), and all (T) chi ldren, according to reporting completeness, sex ratio at birth, and ratio ()f births by calendar year, Z imbabwe 1994 Percentage wllh Sex ratio Number of births complete birth date I at btrth 2 Calendar ratio 3 Male Female Year L D T L D T L D T L D T L D T L D T 94 587 28 616 100.0 100.0 I0').0 91.7 583 899 - - 281 10 291 306 18 324 93 725 33 758 lO0.O 1000 It)30 948 126.2 96,0 110.5 68.1 1076 353 19 37/ 372 15 387 92 725 69 794 1000 990 9~.9 94,6 194.9 100.5 987 1652 102,3 352 46 398 373 23 396 91 744 51 795 100,0 100.0 103.0 101.2 93.2 1007 1008 727 98,4 374 24 399 370 26 396 90 751 70 821 100.0 100.0 103.0 1006 1167 101,8 99.7 119.1 101 1 377 38 414 375 32 407 89 762 67 829 1000 1000 100.0 1112 104,9 110.7 1034 1120 104,0 401 34 436 361 33 394 88 723 50 773 99.5 97 8 99.4 97.5 112.8 98,4 929 78 6 91,9 357 26 383 366 23 390 87 795 59 854 999 991 998 985 1564 1017 107.5 113.3 1078 394 36 430 400 23 423 86 755 55 810 996 94.4 99.2 103.7 1579 1066 101.2 941 100,7 385 34 418 371 21 392 85 698 57 755 994 1000 994 990 93 7 986 347 28 375 351 30 380 90-94 3,533 252 3,784 IO90 99.7 [CO.O 96.8 1195 981 1,737 137 /,874 1,796 i15 1.910 85-89 3,734 288 4.022 99.7 98.4 99.6 101.9 121.6 1032 1,885 158 2,043 1.849 130 1,979 80-84 3.382 363 3,745 99,7 97.8 99,5 102.4 107.8 1029 1,711 188 1.899 1,671 175 1.846 75-79 2.237 314 2,552 99.5 97.6 S9.3 1077 1215 ]093 1,160 173 ].332 1.077 142 ],2)9 <75 2,060 332 2,392 99.1 96,7 ~8.8 104.2 123,6 1067 1,051 184 1,235 1.009 148 1,158 All 14,946 1,54816,495 997 980 c, 95 1019 1183 103.3 7,544 839 8.383 7,402 709 8,112 NA = Not apphcable t Both year and month of barb given 2(Bm/BI)* 100, where B m and B I are the numbers of male and female births, respectively ~[2Bx/(B x l+Bx+l)]* I00, where B x is the number of births m calendm" year x 214 Table C.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods preceding the survey, Zimbabwe 1994 Number of years preceding the survey Age at death Total (in days) 0.4 5-9 10-14 15-19 0-19 <1 24 30 31 21 106 1 14 17 20 11 63 2 9 3 5 8 25 3 6 5 5 7 23 4 3 2 I 3 9 5 3 2 3 2 10 6 7 3 2 3 15 7 I1 12 6 11 40 8 0 1 I 1 3 9 0 0 1 0 1 10 1 1 1 0 4 I1 0 0 0 1 1 12 1 0 0 0 1 13 0 0 0 0 0 14 6 11 9 7 33 15 1 2 O 0 3 16 0 0 0 0 0 17 I 0 0 0 I 18 0 0 0 0 0 19 0 0 0 0 0 20 0 3 0 0 3 21 4 5 7 2 19 22 0 0 1 0 1 23 0 0 0 0 0 24 0 1 0 1 2 25 0 I 0 0 1 26 1 0 1 0 2 27 0 0 0 0 0 28 1 1 0 0 2 29 0 0 0 1 1 30 0 0 0 3 3 31+ I 0 0 0 1 Total 0-30 94 98 95 82 370 Percent early neonatal I 71,0 62.1 72.1 66.6 67.9 1(0-6 days/0-30 days) * 100 215 Table C.6 Reporttng of age at death m months Distribution of repoa.ed deaths under two years of age by age at death m months and the pe -centage of infant deaths reported to occur at ages under one month, for fiv,~-year periods preceding the survey, Z}mbabwe 1994 Number of years preceding the survey Age at death Total (in months) 0-4 5-9 10-14 15-19 0-19 < I a 94 98 95 82 370 I 9 9 13 9 39 2 13 9 9 3 35 3 20 21 13 11 64 4 13 4 11 3 30 5 3 3 8 7 22 6 9 8 17 9 43 7 9 6 9 5 30 8 9 11 6 11 38 9 5 11 20 9 46 10 6 5 5 3 20 11 7 6 7 4 24 12 10 ]0 14 12 46 13 5 6 2 6 19 14 1 1 4 2 8 15 0 5 7 6 18 16 I 1 0 I 2 17 3 I 0 4 8 18 8 9 13 II 41 19 4 0 I 5 9 20 1 2 7 3 12 21 2 2 2 3 9 22 3 2 2 l 8 23 4 4 0 2 10 24+ 1 2 2 0 5 1 year 6 2 8 4 21 Total 0-11 198 191 213 157 760 Percent neonatal b 47.6 51.4 44.5 52.5 48.7 alncludes deaths under I month reported m days b(Under 1 month/under 1 year) * 100 216 APPENDIX D WORLD SUMMIT FOR CHILDREN INDICATORS Table D.I World Summxt Ior Children Indicators: Zimbabwe 1994 BASIC INDICATORS Value Infant mortality Maternal mortality Chddhood undernutrmon Clean watersupply Samtary excreta disposal Basm education Children in especially difficult s~tuaUons lnlhnt mortahty rate Under-five mortahty rate Maternal mortahly ratm Percent stunted Percent wasted Percent underweight Percent of households within 15 minutes of a safe water supply Percent of households with flush toilets or VIP latrines Percent of women 15-49 with completed primary education Percent of men 15-49 with completed primary education Percent of girls 6-12 attending school Percent of boys 6-12 attending school Percent of women 15-49 who are literate Percent of children who are orphans (both parents dead) Percent of children who do not live with their natural mother Percent of children who hve in single adult households 53 per 1,000 77 per 1,000 283 per 100,000 21.4 5.5 15.5 56.1 52,4 63.0 73.5 83.8 83.7 85.7 0.7 23.8 12.8 SUPPORTING INDICATORS Women's Health Birth spacmg Safe motherhood Family planning Nutrition Maternal nutrinon Low birth weight Breastfeeding lodme Child Health Vaccinations Percent ol births within 24 months of a previous bmh Percent of births w~th medical prenatal care Percent of Nrths with prenatal care in first trimester Percent of Nrths w~th medical assistance at delivery Percent of barths m a medical facility Percent of btrths at high risk Contraceptwe prevalence rate (any method, married women) Percent t~l' currently married women with an unmet demand for family planning Percent of currently married women with an unmet need for family p]anmng to avoid a high-risk birth 12.0 93 I 25.5 69.4 69 I 44.3 48.1 14.9 107 Percent of mothers with low BMI 5.1 Percent o! births at low birth weight (of those reporting numeric weight) 12.0 Percent of children under 4 months who are exclusively breastfed 15.8 Percent of households with iodized salt U Percent o1 chddren whose mothers received tetanus toxoid vaccination durmg pregnancy 82 1 Percent of children 12-23 months with measles vaccination 86.3 Percent of chddren 12-23 months fully vaccinated 80.1 Diarrhoea control Percent of children with diarrhoea m preceding 2 weeks who received oral rehydratmn therapy (sugar-salt-water solution) 79.5 Acute respiratory xnf~ctlon Percent of children wilh acute respiratory refection m preceding 2 weeks who were seen by medical personnel 52 2 U = Unknown (no lntbrmatton) 219 APPENDIX E QUESTIONNAIRES ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE IDENTIF ICAT ION WARD/V ILLAGE NAME OF HOUSEHOLD HEAD CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (urban=l , ru ra l=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MA IN TOWN/OTHER URBAN/RURAL . . . . . . . . . . . . . . (main town=l , o ther u rban=2, ' ru r& i~ i . . . . . . . . . INTERVIEWER V IS ITS 1 2 3 F INAL V IS IT DATE INTERVIEWER'S NAME RESULT*** NEXT V IS IT : DATE T IME ***RESULT CODES: 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT T IME OF V IS IT 3 ENT IRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD 4 POSTPONED 5 REFUSED 6 DWELL ING VACANT OR ADDRESS NOT A DWELL ING 7 DWELL ING DESTROYED 8 DWELL ING NOT FOUND 9 OTHER (spec i fy ; DAY MONTH YEAR NAME RESULT TOTAL NUMBER OFVIS ITS I I TOTAL IN HOUSEHOLD TOTAL: EL IG IBLE WOMEN EL IG IBLE MEN L INE NO. OF HHOLD ~ I I RESPONDENT l J , LANGUAGE OF QUEST IONNAIRE: ENGL ISH INTV: SHONA . . . . . . . 1 NDEBELE . . . 2 ENGL ISH . . . 3 OTHER 6 DATE I[DATE OFF ICE ][ KEYED EDITOR BY HI 223 t~ HOUSEHOLD SCHEDULE No~ we would Like some informatio~ about the people who usuatty live in your household or who are staying with you now. LINE NO. USUAL RESIDENTS AND VISITORS Please give ~e the n~es of the persons ~o usually Live in ~our household and guests of the house- hold who stayed here Last night, startir~ 3 ~ith the head of the ho~sehold. rELATIONSHIPI TO HEAD OF HOUSEHOLD* ~hat is the relationship of (NAME) to Che heed of the household?. ~E) uall Live I ere? RESIDENCE I SEX ] AGE : IS I Did HOW old (NAME) (NAME) is steep mate (NAME)? here J or last female night? ? (I) EDUCAT I OR IF AGE 5 YEARS OR OLDER Has (NAHE) ever been to ;chest? IF ATTENDED SCHOOL What is IF AGE the highest LESS Level of THAN school 25 (NAME) YEARS attended?.** What is the highest Is gr~/years (NAME) (NAME) still in completed school? a~ that Level?** (2) • (3) I (~) | (5) • (61 (7) (8) (9) (101 PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD *~ Is IF ALIVE Is (NAHE)'s (NAME)'s natural Does natural mother (NANE)'s father alive? natural alive? mother live in this house- hold7. IF YES: ~/nat is her name? RECORD ;.|GTHER~S LINE NURSER (11) (12) (13) IF ALIVE D~ (NAME)'s natural father live in this ho~e- hold? IF YES: Mhat is his rmmo? RECORD ,"ATHER' S LINE RUI4BER (I~) 01 02 03 04 05 06 07 08 10 ~fES NO YES NO ; M F IN YEARS fES NO LEVEL YEARS YES NO YES NO DK ____~,z z~~ ,~. 128 . a F - - " - I t • • i i i ~- l ~12. 2 12 ~ . . . 2 ~ - 1 2 . . 120~- l , a z . - - ~ i • • i i t I __.~2 2L12 ~. . 2~1~~ , ~8~, 112 . . 1 2 , , 128 , 1 2 2 1 2 2 1 2 1 2 8 • • i i i YES NO DK 128 28 28 28 28 28 28 28 28 28 ELIGI- BILITY CIRCLE LINE , NUMBER ELIGIBLE WOMEN "ROOF" LINE i NUMBER ~LIGIBLE MEN 01 O2 O3 O4 05 O6 07 08 O9 10 H2 t~ r~ HOUSEHOLD SCHEDULE CONTINUED (1) (2) (3) I I 11 • | 12 m i~I, ,1' I .~ "i =FMFI i i o 20 ~-~ (4) | (S) | (6) ~ ~ I ( 7 ) (8) (9) I (10) fEB NO YES NO N F IN YEARS rES NO LEVEL YEARS YES NO | • • ; ; J | | | | I I | | == = ~ I 1 2 1 2 2 ~-'l--~ 1 , F'I I-~--- Z | | | | I I 1,12 2F-F~12 ~F T , | | | | I i 1212 2F~12 F~FT , | | • _- : i ' ~] ~F~ 1 2 1 2 1 2 1 2 2 | • _- : I 1212 2F-~-112 ~ , | | | _- : I 1 2 L 1 2 1 2 ~ - 1 1 2 9 ~ - . . . , , 1 Z i 1 2 1 ' ~ 1 2 F~ [~'-- Z (11) (12) Im~mm YES NO OK I I I i 28 i 28 I 1 2 8 I 1 , 8 I 1 2 8 I I 2 8 m m m m l m YES NO DK 2 8 ~-~ 12 I I = Z 8 ~ 13 I [ • I I 2 8 ~'~ 15 I i = 2 8 ~ 16 28 ~11, I I I I 28 I -~1 19 I I I/ 28 [~ ~ 20 TICK HERE IF CONTINUATION SHEET USED [] TOTAL NUMBER OF ELIGIBLE MEN ~-~ TOTAL NUNBER OF ELIGIBLE I,H31'IEN~-~ Just to make sure that ! have a complete listing: 1) Are there any other persons such as small children or infants that we have not listed? YES ~-] ~ ENTER EACH IN TABLE NO [] 2) In addition, are there any other people who may r~ot be members of your family, such as domestic servants, lodgers or friends Who usually Live here? 3) Are there any guests or temporary visitors staying here, or anyone else Who slept here Last night that have not been listed? I * CODES FOR O,3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01= HEAD 05 = GRANDCHILD 09= OTHER RELATIVE 02= WIFE OR HUSBAND 06 = PARENT 10= ADOPTED/FOSTER CHILD 03= SON OR DAUGHTER 07 = PARENT'IN'LAW 11= NOT RELATED 04= SON-IN-LA~ OR DAUGHTER-[N-LA~ 08 = BROTHER OR SISTER 9B= DK *** These questions refer to the biologicaL parents of the child. Record O0 if parent not member of household. YES ~ ~ ENTER EACH IN TABLE NO [] I'--I YES ~r ~ ENTER EACH IN TABLE NO L-.J I ** CODES FOR O.9 LEVEL OF EOUCATION: 1= PRIMARY YEARS: 2= SECONDARY DO=LESS THAN 1 YEAR COHPLETED 3= HIGHER 98=DK 8= DK H3 NO. QUESTIONS AND FILTERS 16 I/nat is the main source of drinking water for members of your househo(d? COOING CATEGORIES PIPED WATER PIPED INTO OWN RESIDENCE/YARD/PLOT . . . . . . . . . . . 11 CORMUNAL TAP . 1Z WELL WATER PROTECTED WELL . 21 UNPROTECTED WELL . Z2 BOREHOLE . 23 SURFACE WATER SPR|NG . 31 RIVER/STREAM . 32 POND/DAM/LAKE . 33 RAINWATER . 41 OTHER 96 (SPECIFY) 17 HOW long does it take to go there, ~tet Mater, r ~ | and come back? MINUTES . I111 I ON PREMISES . 996 18 What kind of toilet facility does your household have? SKIP I ,-18 ~18 I FLUSH TOILET OWN FLUSH TOILET . 11 SHARED FLUSH TOILET . 12 PIT TOILET/LATRINE TRADITIONAL PIT TOILET . 21 BLAIR TOILET . 22 NO FACILITY . 31 OTHER 96 (SPECIFY) 19 Does your household have: Electricity? A radio? A television A refrigerator? YES NO ELECTRICITY . I 2 RADIO . I 2 TELEVISION . 1 2 REFRIGERATOR . 1 2 20 How many rooms in your household ar J used for sleeping? 21 MAIN MATERIAL OF THE FLOOR. 22 RECORD (~BSERVAT I ON. Does any member of your household own: A ~ern oxcart? A b icyc le? A motorcycle? A car? ROOMS . NATURAL FLOOR EARTH/DUNG . 11 RUDIMENTARY FLOOR WOO0 PLANKS . 21 FINISHED FLOOR PARQUET OR POLISHED WOOD . 31 VINYL OR ASPHALT STRIPS . 32 CERAMIC TILES . 33 CEMENT . 34 CARPET . 35 OTHER 96 (SPECIFY) YES NO MOOERN OXCART . 1 2 BICYCLE . . . . . . . . . . . . . . . . . . . . . . . 1 2 MOTORCYCLE . 1 2 CAR . I 2 H4 226 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY FEMALE QUEST IONNAIRE IDENTIF ICAT ION WARD/V ILLAGE NAME OF HOUSEHOLD HEAD CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (urban=l, rural=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MA IN TOWN/OTHER URBAN/RURAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i i (main town=l, o ther urban=2, rural=3) NAME AND L INE NUMBER OF WOMAN I i INTERVIEWER V IS ITS DATE INTERVIEWER'S NAME RESULT*** NEXT VISIT: DATE T IME 1 2 ***RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 3 F INAL V IS IT DAY MONTH YEAR NAME RESULT ~ TOTAL NUMBER ~: :~: :~7~ OF V IS ITS 7 OTHER II (specify) LANGUAGE OF QUEST IONNAIRE: ENGL ISH ~--~: TE L AOER FIELOEOITO I[ [KE D SHONA . . . . . . . 1 / /N~ C7- -q / I N~E BY NDEBELE . 2 ENGL ISH . 3 ~ OTHER 6 ][DATE ' ~ ' JtDATE F1 227 SECflOR 1. RESPONDENT~S BACKGROUND NO, I QUESTIONS AND FILTERS I COOING CATEGORIES I SKIP 102 RECORD THE TIME, First I would like to ask so~ q~sti~s aloft you and your household. For most of the time until you were 12 years o ld , d id you live in a town or in a rura I area? IF TOt4N: Which t~m? MAIN TO~N . . . . . . . . . . . . . . . . . . . . . . . . . . I m OTHER URBAN . . . . . . . . . . . . . . . . . . . . . . . . 2 I RURAL . 3 105 In ~at month and year were you ~rn? HONTH . DK ~NTH . 98 YEAR . ~ DK YEAR . 98 AGE IN C~PLETEO YEARS . C~PARE AND CONNECT 105 AND/OR 1~ IF INCONSISTENT. 107 I Have you ever attend~ school? IYES . 11 NO . 2 ~114 108 |~at is the highest Level of schoo{ you attendS: I PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . I | I priury, s~ocldary, or higher? l SECONDARY . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I NIGHER . 3 at that level? YEARS . 110 [ CHECK 106: AGE 24 AGE 25 I I I ~ I ~ I ~ B I B ~ T[~ OR ABOVE ~] .113 111 I Are you currently attending school', I YES . 1 ~113 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 112 |~nat WaS the uin reason you sto~ attending school? SECONDARY OR HIGHER [--] GOT PREGNANT . 01 GOT MARRIED . 02 HAD TO CARE FOR YOUNGER CHILDREN.03 FAMILY NEEDED HELP ON FARM OR IN BUSINESS . 04 COULD NOT PAY SCHCX)L FEES . OS NEEDED TO EARN HONEY . 06 GRADUATED/HAD ENOUGH SCHOOLING.07 BAD GRADES . 08 DID HOT LIKE SCHOOL . 09 SCHOOL NOT ACCESSIBLE/TO0 FAR . 10 OTHER 96 (SPECIFY) DK . 98 .115 I F2 228 flO. I QUESTIONS AND FILTERS i 114 I Can you read and understand • letter or newspaper easily, I with difficulty, or not at ell? I COOING CATEGORIES I SKIP I EASILY . 1 I WITH DIFFICULTY . Z NOT AT ALL . 3 ~116 115 I Do you usuatty read a newspaper or magazine at feast once a I YES . 1 I I week? I NO . 2 I 11' I D° Y~ °aua 'Y Lia"n T° e red'° every O'Y? I YES HO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 '1 117 I Do you USUally Watch television at least once a week? I YES . 1 I I I RO.o . . . . . . . . . . . . . . . . . . . . o . . . . o . . . . 2 I 118 I ~hat is your reLigion? TRADITIONAL . 1 I SPIRITUAL . 2 I CHRISTIAN . 3 OTHER . 6 (specify) 119 1201 121 RECORD ETHNICITY, CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE THE WOMAN INTERVIEWED IS ~OT A USUAL ~ IS A USUAL RESIDENT L~ RESIDENT I ,o. I would like to ask about the place in which you I usually Live. I Do you usually live in a town or in a rural area? I IF TO~N: Which town? THE WOMAN INTERVIEWED V~ BLACK . 1 WHITE . 2 COLOURED . 3 ASIAN . 4 OTHER . . . . 6 (specify) MAIN T(~,/R . . . . . . . . . . . . . . . . . . . . . . . . . . I OTNER URBAN . 2 RURAL AREA . 3 OUTSIDE ZIMBABWE . 4 I II =201 I I ' =,123 I 122 In which province is that Located? MANICALARD . 01 MASHONALANO CENTRAL . 02 HASHONALAND EAST . 03 MASHONALAND WEST . 04 MATABELELAND NORTH . 05 MATADELELAND SOUTH . 06 MIDLANDS . 07 14ASVINGO . 08 HARARE/CHITUNGWIZA . 09 8ULAWAYO . 10 123 Row I would like to ask about the househoLd in which you usually ~ive? What is the min source of drinking water for members of your household? PIPED WATER PIPEO INTO G~N RESIDENCE/YARD/PLOT . 11 COMMUNAL TAP . 12 WELL WATER PROTECTED WELL . 21 UNPROTECTED WELL . 22 BOREHOLE . 23 SURFACE WATER SPRING . 31 RIVER/STREAM . 32 POND/LAKE . 33 DAM . 34 RAINWATER . 41 I -~125 ----~125 I OTHER 96 (SPECIFY) l and come beck? MINUTES . ON PREMISES . 996 229 F3 NO. QUESTIONS AND FILTERS SKIP 125 IJhat kind of toilet facftity does yoiJr household have? CODING CATEGORIES FLUSH TOILET Ol4N FLUSH TOILET . 11 SHARED FLUSH TOILET . 12 PIT TOILET/LATRINE TRADITIONAL PIT TOILET . . . . . . . . . . 21 BLAIR TOILET . 22 NO FACILITY . . . . . . . . . . . . . . . . . . . . . . . 31 OTHER 96 (SPECIFY) 1261 Does your household have: I Electricity? A rad io? A televisiOn A re f r igerator? I YES NO I ELECTRICITY . 1 2 RADIO . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 TELEVISION . I 2 REFRIGERATOR . . . . . . . . . . . . . . . . . . 1 2 127 Could you describe the main materia' of the floor of your home? NATURAL FLOOR EARTH~DUNG . . . . . . . . . . . . . . . . . . . . . . ~ RUDIMENTARY FLOOR kO00 PLANKS . 71 FINISHED FLOOR PARQUET OR POLISHED UGGO . 3~ VINYL OR ASPHALT STRIPS . 32 CERAMIC TILES . 33 CEMENT . 34 CARPET . 35 OTHER 96 (SPECIFY) 128 Does anymember of your household cwn: A modern oxcart? A bicycle? A motorcycle? A car? YES NO MODERN OXCART . 1 2 BICYCLE . 1 2 ROTORCYCLE . 1 2 CAR . 1 2 F4 230 SECTION 2. REPROOUCTIOR NO. I QUESTIONS AND FILTERS I COOING CATEGORIES J sKiP 201 I Now l would Like to ask about all the births you have J YES . 1 J I had during your life. Have you ever given birth? I NO . 2 ~206 2OZ I DO you have any sons or daughters to whom you have (YES . 11 given birth uho ere now Living with you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~204 And how many daughters live with you? DAUGHTERS AT NONE . IF NONE RECORD '00 ~. 204 IDo you heve,ny sons or daughters to whom you have I YES . 1 | given birth uho are alive but do not live with you? NO . 2 ~206 And how many daughters are alive but do not Live ~ith you? DAUGHTERS ELSEWHERE . ~_~ IF NONE RECORD I00% 206 | Have you ever given birth to a boy or a girl who was | I born alive but later died? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 IF NO, PROBE: Any baby who cried or showed signs of life NO . 2 r208 but survived only a few hours or days? I 2O7 209 How boys have died? many And hoM many girls have died? IF NONE RECORD IOO=. | SUN ANSWERS TO 203, 2051 AND 207, AND ENTER TOTAL. %F NONE RECORD '00% CHECK 208: Just to make sure that I have this riBht: you have had in TOTAL births during your life. is that correct? PROBE AND li • CORRECT 201-206 TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . YES NO J AS NECESSARY NO BIRTHS ~ ~225 I ! F5 231 211 How ] would like to talk to you about all of your births, whether still alive or not, starting with the first one you had. RECORD NN4ES OF ALL THE BIRTHS IN 21~. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 212 ~at name was given to your your (first/ next) baby7 (NAME) 0, I o, I 213 Were a~ of these births twins? SING.1 MULT.2 SING.1 MULT.2 SING.1 MULT.2 SING.1 MOLT.2 SING.1 HULT.2 SING.1 MULT.2 SING.1 MULT.2 214 215 Is In what nK~th (NAME) ar~:i year tms a boy (NAME) born? or 8 girl? PROBE: What is h s/ her birthday? OH: In whalt seasor l Wa/; he/she born? 216 Is (NAME) stiLL alive? 217 IF ALIVE: How old was (NAME) at his/her Last bir thday? RECORD AGE IN COMPLETED YEARS. MONTH. . | I I YES.1 AGE IN YEARS YEAR HO! 219 218 IF ALIVE: Is (NAME) Living with you? YES . . . . 1 NO . . . . . 2 t (NEXT ~rJ BIRTH) 219 IF DEAO: How old Was (NAME) when he/she died? IF '1 YR.' PRONE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH ; t4C~/THS IF LESS THAN THAN Tt~K) YEARS; OR YEARS. DAYS . I MONTHS.2 YEARS.3 I OY.I IRL.2 MONTH.| I I YES.1 AGE IN YEARS YEAR., NO. . . ! • 219 YES . 1 NO . (GO TO 220 ) DAYS . 1 JJJ MONTHS.2 YEARS.3 P r - ~ MONTH.,| | I YES.1 AGE IN YEARS YEAR HO! 219 YES . 1 NO . (GO TO 220 ) DAYS . 1 i l l MONTHS.2 YEARS.3 I OY.1 IRL.2 MONTH. I l l YES. .1 AGE IN YEARS YEAR. NO.! 219 YES . 1 NO . . . . . 2] (GO TO ~J 220 ) DAYS . 1 I I I MONTHS,.2 YEARS.3 I OY.1 IRL.2 r ~ MONTH.| I I YES.1 AGE IN YEARS ,EAR. NO.! 219 YES . 1 NO . . . . . 2] (GO TO 4 j 220 ) DAYS . 1 I l l MONTHS.2 YEARS.3 I OY.1 IRL.2 F ~ MONTH./ I I YES.1 AGE IN YEARS YEAR. NO,,,! ~ 219 YES . 1 NO . 2 t (GO TO 4 J 220 ) DAYS . 1 I l l MONTHS.2 YEARS.] ] - ~ MONTH.| I I YES,,1 AGE IN YEARS YEAR NO! 29 YES . 1 NO . 2 t (GO TO 220 ) DAYS . 1 I 11 MONTHS.2 YEARS.3 220 FROM YEAR OF BIRTH OF (NN4E) SUBTRACT YEAR OF PREVIOUS BIRTH; iF 4 YRS. OR HOME, ASK: Were there any other Live births between the birth of (NAME) ar'~ the birth of PREVIOUS BIRTH) YES . . . . . . . . . . . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 232 F6 242 24] Mhat rm~e lere aW was Riven )f these to your )irths next baby? :~ins? (NAME) I SING,.1 NULT.2 ! AME' a boy BOY.1 GIRL.2 215 In uhst month and year Mes (NN4E) born? PROBE: What is his/ her birthday? OR: In ~4hat season was he/she born? NORTH. YEAR. MONTH. YEAR,. 9~ SING.1 BOY.1 MULT.2 GIRL.2 lOJ SING,.1 BOY.1 HULT.2 GIRL.2 J MONTH. --~- IYEAR Z16 Ss [NAME) Bt i t I ~l(ve? YES.1 NO.2 219 Z17 IF ALIVE: Nou old MeS (NAHE) St his/her Last birthday? RECORD AGE IN CORPLETED YEARS. AGE IN YEARS YES.1 AGE IN YEARS NO. 2 219 Z18 1F ALIVE: I s (NH4E) tivinR uith you? 219 IF DEAD: Now old Mas (BANE) when he/she died? IF '1 YR.' PROBE: How many months old uas (NAME~? RECORD DAYS IF LESS THAN 1 MONTE ; MONTHS IF LESS THAN THAN TWO 2ZO FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR Of PREVIOUS BIRTH; I f 4 YRS. OR NORE, ASK: gere there any other live births between the birth of (NAME) and the birth of YES.1 AGE IN YEARS NO. 2 219 i YES . 1 NO . 2 (GO TO 4 I 220 ) YEARS i OR YEARS. (PREVIOUS BIRTH) t I YES . 1 DAYS . 1 MONTHS.2 i NO . 2 I YEARS.] I YES . 1 DAYS . 1 I YES . 1 I NO . 2 MONTHS.2 NO . 2 I (GO TO 4 YEARS.] I 220 ) ~-- ; YES . 1 DAYS . 1 YES . 1 I NO . 2 ! MONTHS.2 --~--- NO . 2 I (GO TO 4 YEARS.3 I 22R ) ---- I $1NG.1 BOY.1 MONTH. 221 !z22 P~JLT.2 GIRL.2 YEAR. SUBTRACT YEAR OF LAST BIRTH FROR 1994: IF 4 YRS. OR MORE, ASK: I YES.1 AGE IN YER . 1 DAYS . 1 YES . 1 YEARS NO.2 NO . 2 MONTHS.2 NO . . . . . . . . . . . . 2 • (GO TO ~ YEARS.3 Z19 220 ) YES . 1 NO . 2 Have you had any tire births since the birth of (NN4E OF LAST BIRTH)? COHPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS ~ BUMBEBS ARE ARE SAME DIFFERENT [-~ L (PROBE AND RECONCILE) / CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. FOR EACH LIVING CHILO: CURRENT AGE IS RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR AGE AT DEATH 12 MONTHS OR 1 YR. : PROBE TO DETERMINE EXACT NUMBER OF MONTHS. m 233 F7 NO. I QUESTIONS AND FILTERS 225 | Are you pregnant no~? I I COOING CATEGORIES I SKIP Ires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO. . . . °o,o,,,,. . . . . . . . .2 UNSURE . 8 ~228 Z26 1 HOU many months pregnant are you? ~ I MONTHS . ENTER ip, IN COLUMN 1 OF CALENDAR IN MONTH OF INTERVIEM AND IN EACH PRECEDING MONTH PREGNANT. 227 THEN . 1 LATER . 2 ~,229 NOT AT ALL . 3 I At the time you bee~me pregnant, did you want to become pregnant then, did you rant to wait until tater, or did you not uant to becog~ pregnant at eli? 228 ~hen did your last n~nstruaI period start? DAYS AGO . . . . . . . . . . . . . . . . . . . . 1 WEEKS AGO . 2 MONTHS AGO . ] YEARS AGO . 4 IN MENOPAUSE . 994 BEFORE LAST BIRTH . 995 NEVER MENSTRUATED . 996 229 I Have you ever had a pregnancy that niscarried, was aborted, I YES . 1 I I or ended in e stit(birth? I NO . 2 ~301 230 I When did the test such pregnancy e~t? 232 J LAST PREGNANCY ENDED BEFORE JAN. 1989 I How many months pregnant ~ere you when the Last pregnancy ended? ENTER ~T' IN COLUt4N 1 OF THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' IN EACH PRECEDING MONTH OF PREGNANCY. MONTH . YEAR . MONTHS . . . . . . . . . . . . . . . . . . . . . . . . [~] 233 | Have you ever had ~ny other pregnarcies ahich did not resuttJ YES . 1 | I l i n a live birth? NO . 2 ~301 I ENTER iT, IN COLUMN 1 OF THE CALENEAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND itp, IN EACH PRECEDING MONTH OF PRECNANCY. F8 234 SECTION ], CONTRACEPTION 301 Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or n~eth~s have you heard about? CIRCLE COOE 1 IN 302 FOR EACH METHO0 MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHO0 NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 lE HETHOU IS RECOGNIZED, AND COUE 3 IF NOT RECOGNIZED. THEN, FOR EACH RETHO0 WiTH COUE 1 OR 2 CIRCLED iN 302, ASK 30] BEFORE PROCEEDING TO THE NEXT RETBO0. I 302 Have you ever heard of (METHOU)? 303 Have you ever used (METHO0)? READ DESCRIPTIOR OF EACfl HETHOU. I 01~ PiLL Wo~en can take a piLL YES/SPONTANEOUS . 1 YES . 1 every day. YES/PROBED . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 O~ IUO W~nen can have a Loop or coil YES/SPONTANEOUS . 1 YES . 1 placed inside them by a doctor or • YES/PROSED . 2 nurse. NO . 37 RO . 2 O~ iNJECTiONS Women can have an injection by e doctor or nurse YES/SPONTANEOUS . 1 YES . 1 ~hich stops them from becoming YES/PROBED . 2 pregnant for several months. NO . 33 SO . 2 O~ iMPLANTS Women can have several sn~[[ rods placed in their Ul:~oer YES/SPONTANEOUS . 1 YES . 1 arm by a doctor or nurse which can YES/PROSED . 2 prevent pregnancy for several years. NO . 3~ NO . Z O~ DiAPHRACd4, FOAMiRG TABLETS Wornen can place a diaphragm, foaming tablet, YES/SPONTANEOUS . 1 YES . 1 sponge, jetty~ or cream inside YES/PROBES . . . . . . . . . . . . . . . . . . . . . . . . 2 themselves before intercourse, NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 NO . 2 06J CONDOM Men can use a ru~er sheath YES/SPONTANEOUS . 1 YES . 1 during sexual intercourse. YES/PROBED . 2 NO . ~ NO . 2 O~ FEMALE STERILIZATION Women can YES/SPONTANEOUS . 1 Have you ever had an operation to have an operation to avoid having YES/PRO~ED . Z avoid havins any more chiLdrenT any more children. NO . 3] YES . 1 ! NO . 2 O~ ~ALE STERILIZATION Men can have an YEB/SPORTAHEE~JS . 1 YES . 1 operation to avoid having any more YES/PROSED . 2 children. NO . 3q SO . 2 O~J SAFE PERiDO, RHYTHM Every month that a ~oman is sexuaLLy YES/SPONTANEOUS . 1 YES . 1 active she can avoid having sexual YES/PROBED . 2 intercourse on the days of the NO . 37 NO . 2 month she is most tikety to get pregnant. 1~ WITHDRAWAL Men can be careful and YES/SPOSTANEOUS . 1 YES . 1 putt out before climax. YES/PROBED . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1~ Have you heard of any other ways or YES/SPONTANEOUS . 1 methods that uomen or men can use NO . to avoid pregnancy? 1) YES . 1 (SPECIFY) NO . 2 2). YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 (SPECIFY) NO . 2 AT LEAST OSE "YES" [-7 ~SKIP TO 308 (EVER USED) 235 F9 NO. I GUESTIONS AND FILTERS 3o5 I Have you ever used anything or tried in any uay to delay or I avoid getting pregnant? 306 I ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK NONTH. 1 307 l~at have you used or done? I CORRECT 303 AJ~) 304 (AND 302 IF )~ECESSARY). l COOING CATEGORIES l SKIP I YES . 1 -~t.307 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I ;342 l I I 308 Now I would Like to ask you about th,~ first time that you did something or used a method to awid getting pregnant. ~nat was the first method you ever used? PILL . 01 ILK) . OZ INJECTIONS . 03 IMPLANTS . 04 g ]APRRAGN/FOAN [ NG TABLET/SPONGE, . . 05 C~D~ . 06 FENALE STERILIZATION . 07 MALE STERILIZATION . 08 SAFE PER ]O0/RHYTHM . 09 I~ I T HDRA~AL . 10 OTHER 96 (SPECIFY) 309 How many living children did you have It that time, if any7 I I NUMBER OF CHILDREN . I11 IF NONE, RECORD '00' . CHECK 303: k~4AN NOT WORAN STERILIZED [~ STERILIZED F--] CHECK 225: I NOT PREGNANT PREGNANT I OR UNSURE ~ ~ ~33T 312 |Are you currently doing something or using any method to I YES . 1 I I delay or avoid Retting pregnant? [ NO . 2 ~337 313 313A Which method are you using? NOTE: OO NOT ASK Q.313A IF THE 1~4A)4 IS HOT STERILIZED) YOU have sa id that yOU had an oper,~tion that keeps you from getting pregnant. Is that cor-ect? IF RESPONDENT SAYS lIND", CORRECT 303-$04 (AND ]02 IF NECCESSARY). IF RESPONDENT CONFIRMS ~ITB A "YES" t CIRCLE '071FO~ FENALE STERILIZATI3N. PILL . 01 IUO . 02 INJECTIONS . 03 IMPLANTS . 04 DIAPHRAGM/FOAMING TABLET/SPONGE,. ,05 CONDOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FEMALE STERIL IZATION . . . . . . . . . . . . . . 07 HALE STERIL IZATION . . . . . . . . . . . . . . . . 08 SAFE PERIOO/RBYTBN . . . . . . . . . . . . . . . . 09 W I THDRAWAL . 10 OTHER 96 (SPECIFY) °''' I . ' l consult a doctor or a nurse ? NO . 2 DK . 8 315 I ~ 336 ~328 ~333 -~336 I No~ I would Like to ask some questions about the | ~ | brand of pitt that you are using. Please show me I I the package of pills you are now using. BRAND NAHE NOT ABLE TO SHOU . 98 ~318 RECORD NAME OF BRAND. AND CIRCLE CORRECT CQOE. PILL HISSING OUT OF ORDER . 2 NO PILL MISSING . 3 FIO 236 WO. ~ QUESTIONS AND FILTERS J 317 Why is it thet you have not taken the piLLs (in order)? SKIP COOING CATEGORIES ~ TO m DOESN'T KNOW WHAT TO DO . 01 J HEALTH REASONS . 02 | FOLLOWING INSTRUCTIONS ON PACKET/GIVEN BY SOURCE . 03 320 NEW PACKET . 04 MENSTRUATING . 05 OTHER 96 (SPECIFY) | 318 Why don't you have e package of pills in the house? RAN OUT . 01 COST TOO NUCH . 02 HUSBAND AWAY . 03 MENSTRUAT I NG . 04 OTHER 96 (SPECIFY) 319 I Do you know the brand name of the pills you are now using? J or: SHOW BRAND CHART FOR PILLS I PLease tell me which of these is the brand of pills that you are using. ~ECORD NAME OF BRABD. BRAND NAME OK . 9B 320 At any time in the pest month, have you experienced any of the following (READ EACH PROBLEM): Had spatting or bteedin g nmre than once? Had other illness? Period did not conm when expected? Ran out of pills? Forgot to take pitt or misplaced package? Loss of Libido? Any other problem? YES NO SPOTTING/BLEEDING . 1 2 OTHER ILLNESS . 1 2 PERIO0 DID NOT CO#~E . 1 2 RAN OUT OF PILLS . 1 2 FORGOT/MISPLACED . 1 2 LOSS OF LIBIDO . 1 2 OTHER 1 2 (SPECIFY) 321 At any time in the past month, did you fail to take a pill for even one day because of the problem that you mentioned or for any other reason: IF YES: Whet Was the main reason you stopped taking the pill? SPOTTING/BLEEDING . 01 OTHER ILLNESS . 02 PERIOD DID NOT COME . O] RAN OUT OF PILLS . 04 FORGOT~MISPLACED . . . . . . . . . . . . . . . . . 05 NOT SEXUALLY ACTIVE . 06 OTHER . 96 (SPECIFY) NEVER STOPPED TAKING THE PILL.97 322 sometimes people forget to take the pitt. What did you do the Last time you forgot to take the pitt? J NEVER FORGOT . 01 I TOOK ONE PILL THE NEXT DAY . 02 TOOK T~/O PILLS THE NEXT DAY . 03 USED ANOTHER METHO0 . 04 OTHER 96 (SPECIFY) 323 When was the Last time you took a pitt? v I DAYSAO0 . . . . . . . . . . . . . . . . . . . . . MORE THAN ONE MONTH AGO . . . . . . . . . . 97 TWO DAYS AGO I I OR LESS ~ ~326 I Fll 237 325 NO. I QUESTIONS AND FILTERS I~ly aren't you takfr~J the pi[[ these days? SKIP TO CODING CATEGORIES HUSBAND AWAY . . . . . . . . . . . . . . . . . . . . . 01 FORGOT . 02 HEALTH REASONS . 03 COST TOO MUCH . 04 NO NEED TO TAKE DALLY . 05 RAN OUT . 06 MENSTRUATING . 07 OTHER 96 (SPECIFY) I . I consult a doctor or a nurse ? NO . 2 OK,, . . . . . . . . . , . . . . . . . . . , . . . . . . . . . ,S 327 How much does one (packet/cycle) o': pills cost you? COST (CENTS) . RECORD IN CENTS. FREE . 996 336 OK . 99B 328 Where did the steritisatJon take pt,tce? IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PI~ORE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE T4E APPROPRIATE CODE, (NAME OF PLACE) PUBLIC SECTOR CENTRAL HOSPITAL . 11 PROVINCIAL HOSPITAL . 12 DISTRICT/RURAL HOSPITAL . . . . . . . . . 13 OTHER PUBLIC 16 (SPECIFY) MISSION FACILITY . 19 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PRIVATE DOCTOR . 23 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER 96 (SPECIFY) DK . 98 3291boy~regretthat(you/yourhus~nd) hadtheo~rationnotlYES . 1 I tO hive any (more) children? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ---~.331 PARTNER ~ANTS ANOTHER CHILD . 02 SIDE EFFECTS . 03 CHILO DIED . 04 OTHER 96 (SPECIFY) 331 33Z 333 In what month add year was the ste-ilization performed? CHECK 331: STERILIZED BEFORE ~ JANUARY 1989 I ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH SACK TO JANUARY 1989. THEN SKIP TO ~340A Between the first day of e woman,~ period and the first day of her next period, are there certain times when she has e greater chance of becoming pregnant than other times? i MONTH . ~ l YEAR . STERILIZED ON OR AFTER JANUARY 1989 [~ F-- ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION. THEN SKIP TO =33T YEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO, . , . . . . . . . . . . . . . . . . . . . . . . . . , . , 2 DK . 8~335 238 F12 NO. QUESTIONS AND FILTERS 334 During which times of the nK~nthIy cycle does • woman have the greatest chance of becoming pregnant? COOING CATEGORIES DURING HER PERIOD . 01 RIGHT AFTER HER PERIOD HAS ENDED . 02 IN THE MIDDLE OF THE CYCLE . 03 JUST BEFORE HER PERIOD GEGINS . 04 OTHER 96 (SPECIFY) OK . 98 SKIP 335 How do you determine which days of your monthly cycle not to have sexual relations? BASED ON CALENDAR . 01 BASED (314 BODY TEMPERATURE . 02 BASED ON CERVICAL MUCUS (BILLINGS METHOD) . 03 EASED OR BODY TEMPERATURE AND CERVICAL MUCUS . 04 NO SPECIFIC SYSTEM . 05 OTHER 96 (SPECIFY) 336 ENTER METHOD CODE FROM 313 IN CURRENT MONTH IN COLUHN 1 OF CALENDAR. THEM DETERMINE WHEN SHE STARTED USING METHOD THIS TIME, ENTER METHOD COOE IN EACH MONTH OF USE. ILLUSTRATIVE QUESTIONS: ghen did you start using continuously? How Long have you been using this method continuously? 337 338 I would Like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NORUSE, STARTING WITH MOST RECENT USE~ SACK TO JANUARY 1989. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. IN EACH MONTH, ENTER CODE FOR METHOD OR 'O I FOR NONUSE IN COLUMN 1. IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS THE NUMBER OF INTERRUPTIONS OF CONTRACEPTIVE USE IN COLUMN 1. ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOt#ED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT• ILLUSTRATIVE QUESTIONS: COLUMN 1: • When was the last time you used a methed? Which method was that? • When did you start using that method? How Long after the birth of (NAME) ~ • How tong did you use the method then? COLUMN 2: • Why did you stop using the (METHOD)? • Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREQRABT, ASK: "How nk~ny months did it take you to get pregnant after you stol:~ed using (METHOD)?" AND ENTER zo' IN EACH SUCH MONTH IN COLUMN 1. CHECK 225: NOT PREGNANT ~ PREGNANT [~ OR UNSURE CHECK 311 AND 313: CIRCLE METHOD CODE: NOT ASKED . DO PILL . 01 IUD . 02 INJECTIONS . 03 IMPLANTS . 04 DIAPHRAGM/FOAMING TABLET/CREAM . 05 CONDOH . 06 FEMALE STERILIZATION . 07 HALE STERILIZATION . 08 SAFE PERIOO/RHYTHM . 09 WITHDRAWAL . 10 OTHER . 96 ~343 I ~342 I ~340A ~--~343 239 F13 NO. SKIP 339 OUESTIONS AND I:ILTERS Where did you obtain (METHOD) the Las~ time? IF SOURCE iS HOSPITAL, HEALTH CENrRE, OR CLINIC, WRITE THE N/U4E OF THE PLACE. PR~3E TO IDENTIFY THE TYPE OF SOURCE AND CLRCLE THE APPROPRIATE CODE. (NAME OF PLACE) COOING CATEGORIES PUBLIC SECTOR GOVERNMENT HOSPITAL/CLINIC . 11 RURAL/MUNICIPAL CLINIC . 12 RURAL HEALTH CENTRE . 13 ZNFPC MOBILE CLINIC . 14 NON MOBILE CLINIC . 15 ZNFPC CBD . 16 MOH CBD . 17 OTHER PUBLIC 18 (SPECIFY) MISSION FACILITY . 19 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PHARMACY . 22 PRIVATE DOCTOR . 23 CBD . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER PRIVATE SECTOR SHOP . 31 CHURCH . 32 FRIENDS/RELATIVES . 33 OTHER 96 (SPECIFY) 340 ~ DO you know another place where you could have obtained I (METHOD) the Last time? j YES . 1 I I NO . 2 L345 340AI At the time of the sterilisation operatLon, did you know J I another place where you could have received the operation? I 341 People select the place where they g(,t Family planning MAIN OTHER serv ices fo r var iousreasons . REASON REASON In your case, what was the main reason you went to the )Lace you did rather than to some other place? RECORD RESPONSE BELOW AND CIRCLE COOE. Any other reason? RECORD RESPONSE BELOW AND CIRCLE COOE. ACCESS-RELATED REASONS CLOSER TO HOME . 11 11 CLOSER TO MARKET/WORK . 12 12 AVAILABILITY OF TRANSPORT.13 13 SERVICE-RELATED REASONS STAFF MORE COMPETENT/ FRIENDLY . 21 21 CLEANER FACILITY . 22 22 OFFERS MORE PRIVACY . 23 23 SHORTER WAITING TIME . 24 24 LONGER HRS. OF OPERATION.2S 25 USE OTHER SERVICES AT THE FACILITY . 26 26 LOWER COST/CHEAPER . 31 31 WANTED ANONYMITY . 41 41 NO OTHER REASON . 95 OTHER 96 (SPECIFY) OTHER 96 (SPECIFY) OK . 98 ~345 F14 240 NO. QUES1IOMS AND FILTERS 342 What fs the mafn reason you are not using a uN~thod of contraception to avoid pregnancy? Any other reeson? RECORD MAIM AND OTHER REASON IH SEPARATE COt.UMHS. COOING CATEGORIES MAIN OTHER REASON REASON HOT MARRIED . 11 11 FERTILITY-RELATED REASONS NOT HAVING SEX . 21 21 INFREQUEHT SEX . 22 22 MENOPAUSAL/HYSTERECTOMY.,.23 23 SUBFECUNO/ INFECUND . . . . . . . . 24 24 POBTPARTUM/BREASTFEEDIRG.2S 25 WANTS MORE CHILDREN . 26 26 OPPOSITION TO USE RESPONDENT OPPOSED . 31 31 HUSBAND OPPOSED . 32 32 OTHERS OPPOSED . 33 33 REL[GIOUS PROHIBITION . 34 34 LACK OF KHOWLEOGE KNOMS NO METHOD . ~I ~ KNC~S NO SOURCE . 42 42 METHOD-RELATED REASONS HEALTH CONCERNS . 51 51 FEAR OF SIDE EFFECTS . 52 $2 LACK OF ACCESS/TO0 FAR . 53 53 COST TOO MUCH . 54 54 INCONVENIENT TO USE . 55 55 INTERFERES WITH BODYIS NORMAL PROCESSES . 56 56 NO OTHER REASON . 95 OTHER 96 (SPECIFY) OTHER 96 SKIP (SPECIFY) DK . 98 34] IDo you know of, place where you can obta,n a method of I YES . 1 . family pla~ing? NO . 2 --~--~345 I 344 .Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, ~RITE THE MARE OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) PUBLIC BECTC~ GOVERNMENT HOSPITAL/CLINIC . 11 RURAL/MUNICIPAL CLINIC . 12 RURAL HEALTH CENTRE . 13 ZNFPC MOBILE CLINIC . 14 MOH MOBILE CLINIC . 15 ZNFPC CBD . . . . . . . . . . . . . . . . . . . . . . . 16 MOH CBD . 17 OTHER PUBLIC 18 (SPECIFY) MISSION FACILITY . 19 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PHARMACY . 22 PRIVATE DOCTOR . 23 COD . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER PRIVATE SECTOR SHOP . 31 CHURCH . 32 FRIENDS/RELATIVES . 33 OTHER 96 (SPECIFY) i I o . . I F15 241 NO. ~ QUESTIONS AND FILTERS I 346 | Have you v is i ted • health facility I in the tes t 12 months? I COOING CATEGORIES I SKIP I YES . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~349A I 347 I Did anyone at the health fac| Lily speak to you about family I YES . 1 I planning methods? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 'he P ° 'Oe °ul . 'I uith family planning information or ;ervices? NO . 2 349AJOo you think that breestfeeding can iffect a woman's chance I YES . 1 1.401 of becoming pregnant? NO . 2- DK . 8 | 349B|1 Do you think that a ~o~an~s chance of becoming pregnant is IJ INCREASED . 1 J =401 increased or decreased by breastfeeding? DECREASED . 2 DEPENDS . 3 OK**, . . . ., . . . . . . . . . . . . . . ,.8 J.0, J 351 NO BIRTHS Nave you ever relied on breastfeedir g as a method of avoiding pregnancy? CHECK 225: NOT PREGNANT PREGNANT OR UNSURE [~ I [YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO. . . . . .2 . -~.401 [~ J ~401 353 I Are you currently relying on breastfeedin g to avoid getting pregnant? YES . 1 NO . 2 I F16 242 SECTION 4A, PREGNANCY AND BREASTFEEDING 402 4,03 404 405 CHECK 223: ONE OR MORE BIRTHS SINCE NO BIRTHS SINCE JAM. 19el [~ SKIP TO 4*69) v ~ I ENTER THE LINE NUHBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE, ASK THE QUESTIC~B ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MQRE THAN 2 BIRTHS, USE ADDITIONAL FORMS). ROW I would Like to ask you sol~ more questions abaut the health of all your children born in the past three years. (We mill talk about one child at a time.) I LINE NUHBER FROI4 g212 J I FROM Q212 [ AND Q216 I At the time you bac~wne pregnant with (NAME), J did you want to become pregnant then, I did you want to wait u~tit tater, or did you want no (more) children at all? LAST . BIRTH ~ J LINE NUMBER , , , NAME I ALIVE [~ DEAD [~ THEN . (SKIP TO 40?)4 m LATER . 2 I RO MORE . . . . . . . . . . . . . . . . . . (SKIP TO 407)4 t'J NEXT-TO-LAST BIRTH LINE NUMBER . Ill NAME ALIVE ~ DEAD v ~INI~N v m THEN . 1- (SKIP TO 407)4 LATER . 2 NO MORE . ]- (SKIP TO AOT)m 406 J How much Longer would you like to have waited? I MONTRS . 1 ~ [ YEARS . 2 DK . 998 MONTHS . 1 I J l YEARS . 2 DK . 998 407 When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. HEALTH PROFESSIONAL DOCTOR . A NURSE~MIDWIFE . . . . . . . . . . B AUXILIARY MIDWIFE . C TRADITIONAL MIDWIFE TRAINED . D UNTRAINED . E TRAINING UNCERTAIN . F OTHER X (SPECIFY) NO ONE . Y-- (SKIP TO 410)4 HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . g AUXILIARY MIDWIFE . C TRADITIONAL MIDWIFE TRAINED . D UNTRAINED . E TRAINING UNCERTAIN . F OTHER X (SPECIFY) NO ONE . Y-- (SKIP TO 410)4 608 J Now many months pregnant were you when J you first received antenatal care? MONTHS . ~ MONTHS . OK . 98 DK . 98 409 I How many times did you receive antenatal care ~-~ I during this pregnancy? NO. OF TIMES . NO. OF TIMES . DK . 98 DK . 98 610 J When you were pregnant with {NAME) were you YES . 1 J YES . 1 J given an injectic~ in the right upper arm to I J prevent the baby from getting tetanus, that NO . 2--1 NO . 2-- l is, convulsions after birth? (SKIP TO 412)4 J (SKIP TO 412)4 DK . ~ m DK . 411 During this pregnancy, how n~ny times did you ~ get this injection? TIMES . TIMES . DK . 8 DK . 8 F17 243 m i 412 Where did you give birth to (MANE)? LAST BIRTH NAME HOME YOUR HOME . . . . . . . . . . . . . 11 OTHER HOME . 12 PUBLIC SECTOR CENTRAL BOSPI TAL . 21 PROVINCIAL HOSPITAL.22 DIST/RURAL HOSPITAL.2] RURAL HEALTH CENTRE.24 RURAL/MUNICIPAL CLNC.25 OTHER PUBLIC 26 (SPECIFY) MISSION HOSPI TAL/CLNC. 29 PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC. ,31 OTHER PRIVATE MEDICAL 56 (SPECIFY) OTHER 96 (SPECIFY) NEXT-TO-LAST BIRTH NAME HOME YOUR HOME . 11 OTHER HOME . 12 PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . 21 PROVINCIAL HOSPITAL.22 DI ST/RURAL HOSPITAL.23 RURAL HEALTH CENTRE.24 RURAL MUNICIPAL CLNC.25 OTHER PUBLIC Z6 (SPECIFY) MISSION HOSPITAL/CLNC.29 PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC.,31 OTHER PRIVATE MEDICAL 36 (SPECIFY) OTHER 96 (SPECIFY) I 413 Who assfsted w(th the delivery of (~ANE)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . B AUXILIARY MIDWIFE . C OTHER PERSON TRADITIONAL MIDWIFE TRAINED . D UNTRAINED . E TRAINING UNCERTAIN.F RELATIVE/FRIEND . G OTHER X (SPECIFY) NO ONE . Y HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . B AUXILIARY MIDWIFE . C OTHER PERSON TRADITIONAL MIDWIFE TRAINED . D UNTRAINED . E TRAINING UNCERTAIN.F RELATIVE/FRIEND . G OTHER X (SPECIFY) NO ONE . Y 414 At the time of the birth of (NAME), did you have: Long Labor, that is, did your regular contractions Last more than 12 hours? Excessive bleeding that was so much that you felt that it threatened your Life? A high fever with bad smelling vaginal discharge? Convulsions not caused by fever? Any other complications? IF YES: What kind of complication? YES NO PROLONGED LABOR . 1 2 EXCESSIVE BLEEDING . 1 2 HIGH FEVER WITH FOUL VAG. DISCHARGE . 1 2 CONVULSIONS . 1 2 OTHER 1 2 (SPECIFY) YES NO PROLONGED LABOR . 1 2 EXCESSIVE BLEEDING . 1 2 HIGH FEVER WITH FOUL VAG. DISCHARGE . 1 2 CONVULSIONS . 1 2 OTHER 1 2 (SPECIFY) 415 I Was (NAME)delivered by caesarian section? [ YES . . . . . . . . . . . . . . . . . . . . . . 1 I YES . 1 NO . 2 NO . 2 416 m ~ (NAME) woe barn, was he/she: I very lar@e, VERY LARGE . 1 VERY LARGE . 1 Larger than average, LARGER THAN AVERAGE . 2 LARGER THAN AVERAGE . 2 average, AVERAGE . 3 AVERAGE . 3 smaller than average, SMALLER THAN AVERAGE . 4 SMALLER THAN AVERAGE . 4 or very small? VERY SMALL . 5 VERY SMALL . . . . . . . . . . . . . . . 5 OK . 8 DK . 8 F18 244 417 Was (NAME) weighed at birth? LAST BIRTH I NEXT-TO-LAST BIRTH NAME I NAME YES . 1 I YES . 1 NO . 2 NO . 2-] (SKIP TO 419), - ] [ (SKIP TO 420)J GRAMS . GRAMS . OK . 9998 DK . 9998 "'i o ' - , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O,o 420 | Did your period return between the birth of YES . 1 I (NAME) and your next pregnancy? NO . 2 7 (SKIP TO 424)d f 423 | Have you resumed sexual relations since the I YES . I i-- ::::::::::::::::::::::: :L:~ ::::::I I birth of (NAME)? I NO . 2-~ -- --I . . . . . . . J ,~42, , . J J l ~ l 424 | For how many months after the birth of (NAME) L | I did you noIhave sexual relations? MONTHS . l MONTHS . | ~0. . :.:.,~0~ . :.:., I I ~' . ' 1~ ' . '~ 425 Oid you ever breastfeed (NAME)? (SKIP TO 427), -] (SKIP TO 427 1~ No . 2 I NO . 2 426 Why did you not breastfeed (NAME)? MOTHER ILL/WEAK . 01- CHILD ILL/WEAK . O2-- CHILD DIED . 03- NIPPLE/BREAST PROBLEM.O4- INSUFFICIENT MILK . 05-- MOTHER WORKING . 06- CHILD REFUSED . 07-- OTHER 96- (SPECIFY) (SKIP TO 432)4 MOTHER ILL/WEAK . Ol- CHILD ILL/WEAK . DE- CHILD DIED . 03- NIPPLE/BREAST PROBLEM.O4- INSUFFICIENT MILK . 05- MOTHER WORKING . 06- CHILD REFUSED . 07- OTHER 96- (SPECIFY) (SKIP TO 432)= 427 How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. CHECK 404: CHILD ALIVE? IMMEDIATELY . OOO HOURS . 1 ~T~ DAYS . 2 DEAD [~ (SKIP TO 430) IMMEDIATELY . . . . . . . . . . . . OOO HOURS . 1 ~-~ DAYS . 2 ALIVE DEAD (SKIP TO 430) F19 245 LAST BIRTH NAME 429 Are you still breastfeeding (NAME)? I YES . 17I YES . 1- I (SKIP TO 433)~ " I (SKIP TO 433)4 NO . 2 I . NO . 2 430 | For how many months did you breastfeed (NAME)? ~ r ~ I MONTHS . I I I MONTHS . I J ) DE . 98 OK . 98 431 Why did you =top breastfeeding (NAME.)? NEXT'TO'LAST BIRTH NAME 432 433 CHECK 404: CHILD ALIVE? HOW many times did you breastfeed I~lst night between sunset and sunrise? MOTHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . 03 NIPPLE/BREAST PROBLEM.04 INSUFFICIENT MILK . 05 MOTHER WORKING . O6 CHILD REFUSED . 07 WEANING AGE/AGE TO STOP.D8 BECAME PREGNANT . 09 HUSBAND DISAPPROVED . 10 STARTED USING CONTRACEPTION . 11 OTHER 96 (SPECIFY) ALIVE DEAD SKIP TO 435) (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 443) NUMBER OF MOTHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . O3 NIPPLE/BREAST PROBLEM.04 INSUFFICIENT MILK . 05 MOTHER WORKING . 06 CHILD REFUSED . 07 WEANING AGE/AGE TO STOP.06 BECAME PREGNANT . 09 HUSBAND DISAPPROVED . 10 STARTED USING CONTRACEPTION . 11 OTHER 96 (SPECIFY) ALIVE [~ DEAD ~ (SKIP TO 435) (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 443) NUMBER OF NIGHTTIME FEEDINGS . ~ ] ~ IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. during the daylight hours? NUMBER OF NUMBER OF DAYLIGHT DAYLIGHT IF ANSWER IS NOT NUMERIC, FEEDINGS . FEEDINGS . PROBE FOR APPROXIMATE NUMBER* nipple yesterday or last night? NO . 2 NO . 2 DK . 8 DK . 8 436 YES NO DK YES NO DK At any time yesterday or Last night, was (NAME) given any of the following:* Plain water? Sugar water? Juice? Herbs/roots? Baby formula? Fresh milk? Tinned or powdered milk? Any other liquids? Porridge? Thin fermented porridge (mehewu)? Fruits/vegetables? Eggs, fish, or poultry? Meat? Any other solid or semi-solid foods~ PLAIN WATER . 1 2 8 SUGAR WATER . 1 2 8 JUICE . I 2 8 HERBS/ROOTS . 1 2 8 BABY FORMULA . 1 2 8 FRESH MILK . 1 2 TINNED/PO~DR'D MLK.I 2 8 OTHER LIQUIDS . 1 2 8 PORRIDGE . 1 2 8 MAHEWU . 1 2 8 FRUITS/VEGETABLES.1 2 8 EGGB/FISH/POULTRY.,I 2 8 MEAT . I 2 B OTHER SOLID/ SEMI-SOLID FGOOB,.1 2 8 PLAIN WATER . I 2 8 SUGAR WATER . I 2 8 JUICE . I 2 8 HERBAL TEA . I 2 8 BABY FORMULA . 1 2 8 B FRESH MILK . I 2 8 TINNED/POWDB'D MLK.I 2 8 OTHER LIQUIDS . I 2 8 PORRIDGE . I 2 8 MAHEWIJ . I 2 8 FRUITS/VEGETABLES.1 2 8 EGGB/FISH/P~LTRY.I 2 8 MEAT . I 2 8 OTHER SOLID/ SEMI-SOLID FOOOB.1 2 8 246 F2O LAST BIRTH ] NEXT-TO'LAST SIRTH NAME I NAHE I T . ',YES '= "NO/OK" 637 I CHECK 636: [ ~ "NO/OK" ~ "YES" FOOD OR LIQUID GIVEN YESTERDAY? OR MORE OR NORE| J J (SKIP TO 440) / (SKIP TO 640) NOT ASKED NOT ASKED (SKIP TO 440) (SKIP TO 440) m 439 I Did (NAME) get anything at a(I, other than I YES._ . 1 J YES . 1 breastmi[k, to eat or drink yesterday I I I during daylight hours or last night? NO . 2~ i ) NO . ~-~ I F YES: What did INANE) eat or drink? (SKIP TO 441), JJ (SKIP TO 441)a CORRECT ~,36. I ° l - - r ' - - - - ° ° n °1 D (NANIE) eat yesterday, including both meals and NUMBER OF TINES . NLINBER OF TIMES . snacks? OK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . 8 441 On how many days during the last seven days was (NAME] given any of the following: Plain water? Any kind of milk (other than breast milk)? Any liquids other than plain water or milk? Any type of porridge? Fruits or vegetables? Eggs, fish, or poultry? Heat? Any other solid or semi-so(id foods? IF DON'T KNIt4, RECORD '8' RECORD THE NUMBER OF DAYS. PLAIN WATER . MILK . OTHER LIQUIDS . . . . . . . . . . PORRIDGE . J FRUITS/VEGETABLES . ~ EGGS/FISH/POULTRY . NEAT . OTHER SOLID/SENI" SOLID FOODS . GO BACK TO 405 IN NEXT COLUNN; OR, IF NO NORE BIRTHS, GO TO 443. RECORD THE NUMBER OF DAYS. PLAIN WATER . MILK . OTHER LIQUIDS . PORRIDGE . FRUITS/VEGETABLES . . . . . EGGS/FISH/POULTRY . HEAT . OTHER SOLID/SEMI- SOLID FO00S . GO RACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 443, F21 247 SECTION 4B. IMMUNIZATION AND HEALTH 445 446 ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN Z BIRTHS USE ADDITIONAL FORMS.) LINE NUMBER FROM 0212 LAST BIRTH I NEXT-TO-LAST BIRT~__~ LINE . ~ LINE . FRON 0212 AND 0216 Do you have a card where (NAME'S) ~accinations are written down? IF YES: May I see it please? NAME ALIVE DEAD [~ (GO TO 445 IN NEXT COLUMN; OR, IF NO MORE BIRTHS GO TO 469.) YES, SEEN . 1-1 (SKIP TO 448 )4 / YES, NOT SEEN . 2-1 (SKIP TO 451). / NO CARD . . . . . . . . . . . . . . . . . . ] NAME ALIVE DEAD E~ (GO TO 445 IN NEXT COLUMN; OR, IF NO MORE BIRTHS GO TO 469.) YES, SEEN . 1-1 (SKIP TO 448 )~ / YES, NOT SEEN . . . . . . . . . . . . 2 -1 (SKIP TO 451), J NO CARD . 3 447 449 Did you ever have a vaccination card for (NAME)? BIRTH WEIGHT RECORDED ON CARD? IF YES: COPY BIRTH WEIGHT. (1) COPY VACCINATION DATES FOR EACtl VACCINE FROM THE CARD. (2) WRITE =44 = IN IDAY' COLU~4N IF CARD SHOt'S THAT A VACCINATION WAS GIVEN, ltUT NO DATE IS RECORDED. BCG Polio 1 Polio 2 Polio ] DPT 1 DPT 2 DPT ] Measles YES . 1- (SKIP TO 451)~----- YES . 1- GRAMS . [ ~ , NO . 2 DAY MO YR YES . 1 (SKIP TO 451)4 NO . 2 ~ YES . 17 GRAMS . ~ ] ~ J BO.*o . • . 2 OAY MO YR 450 Has (NAME) received any vaccir~ti=~s that are not recorded on this card? RECORD ~YES' ONLY IF RESPONDENt MENTIONS BCG, POLIO 1-3j DPT 1-3, AND/ON MEASLES VACCINE(S). YES . 1 I YES . 1 (PROBE FOR VACCINATIONS ~ (PROBE FOR VACCINATIONS ,~ AND WRITE =~= IN THE I AND WRITE '66' IN THE CORRESPONDING DAY COLUMR IN "9) 1 CORRESPONDING DAY .o . . . . . . . . . . . . . . . . . . . . . . . z NoCOLUMN IN 449> OK . ,SKIP TO ,SKIP F22 248 451 I I STZRTH ) NEXT TOLAS RTH I . .E I Did (NAME) ever receive any vaccinations to J YES . 1 I YES . 1 prevent him/her from getting diseases? I NO . 2~ J NO . 2-1 (SKIP TO 453 )~ /I (SKIP TO 45] )J l ~ I| s~ DK . .~l . DK m 452 Ptease tet[ me if (NAME) received any of the following vaccinations= A BCG vaccination against tuberculosis, that is, an injection in the right upper arm that left e scar? Polio vaccine, that is, drops in the mouth? IF YES: Now many times? DPT vaccination, that is, an injection, usuatt given at the sMe time as polio drops? IF YES: How nBny times? An injection to prevent measles? YES.°°.° . .1 NO . 2 DK . : . 8 YES°° . . . . , ° °°° . . . . . . ° ° . . .1 NOo.==, ,ooo . . . . . , , , o . ° , °°2 NUMBER OF TINES . . . . . . . . YES.°°° . °°°°°.1 NO . °.°. . ,,,°°,,,,2 DK.o°o . oo°°° . °8 NUMSER OF TIMES . YES.°.° . . . o°1 NO . 2 DK . 8 YES . °°° . °°o1 NO, . °° . °. . 2 DK . B YES . °°° . .° . 1 NO° . ,° . °°. . 2 DK . 8 NUMBER OF TIMES . [] YES . .°° . .,.1 NO . 2 DK . 8 NUMBER OF TIMES . YES . 1 NO . 2 OK. . .° . 8 4s3 I Has (NAME) been ill with a fever at any time inl YES . 1 I YES . 1 I the last 2 weeks? I NO . 2 J NO . 2 DK . 8 DK . 8 °'° J " " ("~E' been 'i " th " °°°gh at any time i°] YEs OK . . . . . . . . . . . . . . . . . . . . . . , ,ES . . . . . . . . . . . . . . . . . . . . . . the last 2 weeks? NO . 2-71 NO . 27 (SKIP TO 458), p~JI (SKIP TO 458)4 ~-J . I DK . G55 ,~hen (MAME) .as ill with a cough, did he/she J YES . 1J YES . 1 J breathe faster than usual with short, rapid NO . 2 NO . 2 breaths? DK . 8 DK . 8 ,56 , Did you seek advice or treatment J YES . 171 YES . 1 J for the cough? NO . 2 NO . 2- (SKIP TO 458)~ (SKIP TO 458)~ F23 249 LAST BIRTH J NEXT-TO-LAST BIRTH I NAME MANE 457 Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED. PUBLIC SECTOR CENTRAL HOSPITAL . A PROVINCIAL HOSPITAL. B DIST/RURAL HOSPITAL. C RURAL HEALTH CENTRE. D RURAL/MUNICIPAL CLNC. E VILLAGE COI4N. ~/ORKER. F OTHER PUBLIC G (SPECIFY) MISSION HOSPITAL/CLNC. H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLiNIC. l PRIVATE DOCTOR . J PHARMACY . K VILLAGE COte4. WORKER,,.L OTHER PRIVATE MEDICAL M (SPECIFY) OTHER PRIVATE SECTOR SHOP . N TRAD. PRACTITIONER . 0 PUBLIC SECTOR CENTRAL HOSPITAL . A PROVINCIAL HOSPITAL. B DIST/RURAL HOSPITAL. C RURAL HEALTH CENTRE. g RURAL/MUNICIPAL CLNC. E VILLAGE COMM, I~ORKER. F OTHER PUBLIC G (SPECIFY) MISSION HOSPITAL/CLNC. H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC., I PRIVATE DOCTOR . J PHARMACY . K VILLAGE COMM, WORKER.,L OTHER PRIVATE MEDICAL M (SPECIFY) OTHER PRIVATE SECTOR SHOP . N TRAD. PRACTITIONER . 0 OTHER X OTHER X (SPECIFY) (SPECIFY) ,,8 H . ( .E ) hoddiarrheain,heIas,,.o--k,?lYES . . . . . . . . . . . . :71YES . . . . . . . . . . . . . . . . . . , NO . 2 NO . 2-- (SKIP TO 468), (SKIP TO 468)4 D~ . . . . . . . . . . . . . . . . . . . . . . . B - J I DK . 8- '"1 I'" . I . NO . 2 NO . 2 DK . 8 DK . 8 460 On the worst day of the diarrhea, h~)g many i NUMBER OF BOgEL ~ I NUMBER OF BOWEL bowel movements did (NAME) have? I MOVEMENTS . . . . . . . . . . . I I I I MOVEMENTS . LII 1 DK . 98 DK . 98 461 J Was he/she given the same amount to drink as J SANE . 1 J SAME . 1 I before the diarrhea, or more, or re;s? I MORE . 2 ] MORE . 2 LESS . 3 LESS . 3 DK . 8 DK . 8 462 Was he/she given the same amount of food to eat SANE . 1 I SAME . 1 as before the diarrhea, or more, or ess? MORE . 2 I MORE . 2 LESS . 3 LESS . 3 DK . 8 DK . 8 463 m was (MANE) given a Salt and sugar solution to ~ YES . 1 I YES . 1 I drink? I No . . . . . . . . . . . . . . . . . . . . . . . 2 I No . . . . . . . . . . . . . . . . . . . . . . . 2 DK . 8 OK . 8 F24 250 464 gas anything (eLse) given to treat the diarrhoes? LAST BIRTH NAME YES . . . . . . . . . . . . . . . . . . . . . . 1 BO . 2--1 (SKIP TO 4~)4 _ J DK .o.,,.,,.**.°.* NA/4ENEXT'TO-LAST BIRTH I YES.,. . . . . . .,.1 (SNIP TO 466)4 _ J 465 Uhat was given to treat the diarrhoea? Anything else? RECORD ALL MENTIONED, RECOMMENDED HONE FLUID.A PILL OR SYRUP . B INJECTION . C ( I .V . ) INTRAVENOUS . D NONE REMEDIES/ HERBAL MEDICINES . E REC(~@4ENDED HONE FLUID.A PILL OR SYRUP . B INJECTION . C ( l .V . ) INTRAVENOUS . D HONE REMEDIES/ HERBAL MEDICINES . E OTHER X OTHER X (SPECIFY) (SPECIFY) 466 I Did you seek advice or treatment for the I YeS . 1 I YES . 1 I diarrhoea? I NO . 2-71 NO . Z- (SKIP TO 468)~ / " | (SKIP TO 468)9 467 Nhere did you seek advice or treatment? AnyWhere else? RECORD ALL MENTIONED. PUBLIC SECTOR CENTRAL HOSPITAL . A PROVINCIAL HOSPITAL,. B DIST/RURAL HOSPITAL. C RURAL HEALTH CENTRE. D RURAL/HUNICIPAL CLNC. E VILLAGE COMH. NORKER. F OTHER PUBLIC G (SPECIFY) MISSION HOSPITAL/CLNC. H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC. I PRIVATE DOCTOR . J PHARMACY . X VILLAGE COMM, ~ORKER.L OTHER PRIVATE MEDICAL N (SPECIFY) OTHER PRIVATE SECTOR SHOP . N TRAD. PRACTITIONER . 0 OTHER X (SPECIFY) GO BACK TO 445 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 469. PUBLIC SECTOR CENTRAL HOSPITAL . A PROVINCIAL HOSPITAL. B DIST/RURAL HOSPITAL. C RURAL HEALTH CENTRE. D RURAL/HAJNICIPAL CLNC. E VILLAGE COHM. WORKER. F OTHER PUBLIC G (SPECIFY) MISSION HOSPITAL/CLNC. H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC. I PRIVATE DOCTOR . J PHARMACY . K VILLAGE COMM. NORKER.L OTHER PRIVATE NEDICAL N (SPECIFY) OTHER PRIVATE SECTOR SHOP . N TRAD. PRACTITIONER . 0 OTHER X (SPECIFY) GO BACK TO 445 IN NEXT COLUNN; OR, IF NO MORE BIRTHS, GO TO 469. F25 251 NO. ~ QUESTIONS AND FILTERS 469 | When a child has diarrhea, should he/she be given tess I to drink than usual, about the same m~ount, or more than usual? I CODING CATEGORIES ~ SKIP I . I ABOUT SAME AMOUNT OF TO DRINK . 2 MORE TO DRINK . 3 OK . ,,., . , . . . . . . . ,. . ,.8 4o1_ c dh d r rh - -h /sh vo ess ILSSTOEAT . 1 I to ~pt than usual, about the same =BUnt, or more AB~ClT SANE AMOUNT TO EAT . 2 than usual? MORE TO EAT . ] OK . . . o . . . . . . , . .°. . .8 471 when a child is sick with diarrhoea, what signs of illness would teil you that he/she should be taken to a health fscitity? Any other signs? RECORD ALL MENTIORED. REPEATED WATERY STOOLS . A ANY WATERY STOOLS . B REPEATED VOI4LTING . C AHY VCNiTIHG . D BLOOD iN STOOLS . E FEVER . F MARKED THIRST . G NOT EATING/NOT DRINKING WELL . H GETTING SICKER/VERY SICK . I NOT GETTING BETTER . J OTHER X (SPECIFY) DK . Z 472 474 When a child is sick with s cough, 'dhat signs of illness would tell you that he/she should be taken to a health facility? Any other sfgns? RECORD ALL MENTIONED. ANY CHILD RECEIVED SALT-SUGAR SOLUTION Have you ever heard of a special solution prepared using salt and sugar and water that is u~;ed for the treatment of d iar rhoea? FAST BREATHING . A DIFFICULT BREATHING . B NOISY BREATHING . C FEVER . D UNABLE TO DRINK . . . . . . . . . . . . . . . . . . . . E NOT EATING/NOT DRINKING WELL . F GETTING SiCKER/VERY SICK . G HOT GETTING BETTER . H OTHER X (SPECIFY) D K . . . . . , . . . . . . = . . o = = . o , . . . . . . . . . . . . Z 1~501B I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I | NO . 2~501 ! 475 I Have you ever used this solution f.r treating diarrhoea? I YES. . . . • . ,. . 1 NO. . . . . . . . . . . . .,. . . . . .2 I F26 252 NO. 502 SECTION 5. MARRIAGE QUESTIONS AND FILTERS COOING CATEGORIES PRESENCE OF OTHERS AT THIS POINT. Are you currently mrried? I YES NO CHILDREN UNDER 10 . 1 2 l l ~ H U S B A N D / P A R T N E R . 1 2 OTHER MALES . 1 2 OTHER FEMALES . 1 2 I YES, CURRENTLY MARRIED . 1 NO, NOT CURRENTLY MARRIED . 2 | SNIP ~SO6 503 ~ Have you ever been married or Lived with a man? I 504 | ENTER ~0' IN COLUMN 3 OF CALENDAR IN THE MONTH OF INTERVIEW, i AND IN EACH MONTH BACK TO JANUARY 1989 , THEN SKIP TO 505 | What is your marital status now: see you widowed or | divorced? YES°o°°.°,°,.°°o°o.°o°o.°°°o°°°°.°R NO . 2 I WID~ED . 1 DIVORCED . 2 =505 I | ~514 ~510 506 | is your husband Living with you now or is he staying I LIVES WITH HER . 1 J I elsewhere? I STAYING ELSEWHERE . 2 I have? NUMBER OF OTHER WIVES . 510 I Have you been married or Lived with a man only once, or morel ONCE . 1 | I than once? ] MORE THAN ONCE . 2 I 511 In what month and year did you start livin9 with your (first) husband? NOTE: IF RESPONDENT SAYS SHE HAS NEVER LIVED WITH A HUSSAND, PRORE FOR DATE OF FIRST MARRIAGE AND RECORD HER ANSWER. MONTH . . . . . . . . . . . . . . . . . . . . . . . . . DK MONTH . 98 YEAR . ~ ~513 DK YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 I 512 513 514 515 515A How old were you when you started living with him? I I AGE.,.,,.,,, . ,,,.,.,.o J J I DETERMINE MONTHS MARRIED OR IN UNION SINCE JANUARY 1989. ENTER ~X = IN COLUMN 3 OF CALENDAR FOR EACH MONTH ~RRIED ~ IN UNION, AND ENTER 'O I FOR EACH MONTH NOT MARRIED/NOT IN UNION, SINCE JANUARY 1989. FOR WOMEN NOT CURRENTLY IN UNION OR WITH MORE THAN ONE UNION: PROBE FOR DATE COUPLE STARTED LIVING TOGETHER OR DATE WIDOWED/DIVORCED/SEPARATED, AND FOR STARTING DATE OF ANY SUBSEQUENT UNION. THEN SKIP TO CHECK 210: BIRTHS ORE OR MORE ~ NO BLRTHS ~-~ Now I need to ask you some questions about seKual activity in order to gain a better urxJerstanding of so~ne family ~tanning issues. ~hen was the last time you had sexual intercourse? Now I need to ask you some questions about sexual activity in order to Rain a better uederstaeding of some family olanning issues. ~hen was the last tir~e you had sexual intercourse, if ever? NEVER . DO0 DAYS AGO . 1 WEEKS AGO . 2 MONTHS AGO . 3 YEARS AGO . 4 BEFORE LAST BIRTH . . . . . . . . . . . . . . . . 996 ~515 I ~515A I ~613 F27 253 NO, 516 QUESTIONS AND FILTERS CHECK 302: KNOUS CONDOM I V Now l r~ed to ask you some more questions about Sexual let|vity. The [est t f~ you had sex e was e condom used? DOES #OF KNOW CO~OON V Hou I need to ask you some more questions about sexual activity, Soqlefnen use a condoM, which means that they ptJt a rubber sheath on their penis during sexual intercourse. The last tiroe you had sex, *~s a condom used? COOING CATEGORIES SKIP YES. , . . . . . . . . . . . . . . . . . . . . ° . . . . . . , ,1 NO. . . . . . . . . . . . . ° . . . . . . . . . . . . . . . ° . .2 0 ~ . ° o . . o . . . . . . . , . . . . . . . . . . . . ° . . . ° ° 8 517 J DO you kno. Here you can get coedoes? | YES . 1 m I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~519 518 Mhere is that? 520 IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINICe WRITE THE RN4E OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE TIlE APPROPRIATE COOE. (NAME OF PLACE) PUBLIC SECTOR GOVERNMENT HOSPITAL/CLINIC . 10 RURAL/MUNICIPAL CLINIC . . . . . . . . . . 11 ZNFPC CLINIC . 12 RURAL HEALTH CENTRE . 13 ZNFPC MOSILE CLINIC . 16 MOH MOBILE CLINIC . 15 ZMFPC CSD . 16 NON CBD . 17 OTHER PUBLIC 18 (SPECIFY) MISSION FACILITY . 19 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PHARMACY . 22 PRIVATE DOCTOR . 23 CBD . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER PRIVATE SECTOR SHOP . 51 CHURCH . ]2 FRIENDS/RELATIVES . ]3 OTHER 96 (SPECIFY) NOT CURRENTLY MARRIED M~o did you have sex with the last tf~e you had sexual intercourse? Was it uith your hut;band or ~as it with someone else? J HUSBAND . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SOIHE ONE ELSE . . . . . . . . . . . . . . . . . . . . . . 2 j~528 I I 52,1,~v.,~h~Osex~,,h,ou~us~,oth,,.st,our~eeks, lYEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' , NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,,.524 DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 ~1 "" ~-" u" ~ 'n ' °' '~°" °°c'~°°~' I '~ ~'~ '~ '~ '~ ~-~"~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~'1 IF YES." ~Jas it each time or so~netin~es? NEVER . 3 F28 254 .o I QUESTIONS AND FILTERS 1 524 | Have you hid Qex ~ith enyor~ other than your husband I in the Last four weeks? I COOING CATEGORIES I SKIP I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . 2 ~ 5]2 52'l "hh°w' =n °'h'r'h'ny°urhus h'vey°uh'dl--oFPE SONS.x ,,h,o,h.,.s, 4weeks, . . 198 NON m~ time have you h~ sex with some~e a~rt NUMBER OF TIMES . fr~ y~r hus~ in the test 4 weeks? DK . 98 527 Was a cond~ us~ on any of these occasi~s? YES, EACH TIME . 1 YES, S~ETIMES . 2 532 IF YES: Was it each tim or sometime? NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] I S2S | Mare Y~ h~ sex . i th ~yone ~n the t~st Four ~eeks? | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ | I I NO . 2 ~ 532 I ° - -=°v°° - -n ek I . . How ~ny tims have you had sex with someone NUMSER OF TIMES . in the Lest 4 weeks? DK . 98 531 gas a cond~us~ ~ any of these occasions? | YES, EACH TIME . 1 | I YES, $~ETIMES . 2 I IF YES: ~as it each ti~ or someti~s? NEVER . 3 532 How old were you uhen you first had sexual intercourse? ~ | AGE. . . . I WHEN FIRST MARRIED . 96 F29 255 SECTION 6. FERTILITY PREFERENCES 602 CHECK 225: NOT PREGNANT OR UNSURE I Now I have s~ ~stions a~t the future. g~ld you like to have (a/a~ther) child or w~ld you prefer ~t to have any (~re) childr~? PREGNANT 9 I Now I have s~ questions eteut the future. After the child you are exacting, would you like to have another child or would you prefer not to hiwe any more chi tdr~? HAVE (A/ANOTHER) CHILD . 1 NO MORE/NONE . 2 SAYS SHE CANIT GET PREGNANT . ] UNDECIDED/DK . 8 ,606 ~604 ! 603 605 CHECK 225: NOT PREGNANT ~ UNSURE 9 I How tong would you like to wait froe now before the birth of (a/another) child? PREGNANT 9 Now tong would you like to wait after the birth of the child you are exl~cting before the birth of another child? PREGNANT MONTHS . I YEARS . 2 SOON/NOL4 . 993 SAYS SHE CAN'T GET PREGNANT . 994 AFTER MARRIAGE . 995 [--1 If you bec~ preg~nt in the ~xt few weeks, would you be happy, unhappy, or would it OTHER 996 (SPECIFY) OK . 998 ~606 I I~606 I NAPPY . I UNHAPPY . 2 WOULD NOT MATTER . 3 CHECK 312: USING A METHOD? I NOT NOT CURRENTLY ASKED v[ ~ USIN~ CURRI~NTLY 9 • USING ~ ~613 607 DO you inte~ to use a meth~ to delay or avoid pregnancy lJ YES . I J ~609 within the next 12 months? NO . 2 DK . g 608 m Do you intend to use a raethod at any time in the future? J YES . 1 J I I NO . 2 DK . 8 | b610 609 Which method would you prefer to use? PILL . 01 IUD . 02 INJECTIONS . 03 IMPLANTS . 04 DIAPHRAGM/FOAMING TABLET/JELLY . 05 CONDOf'~ . 06 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 SAFE PERIOD . 09 WITHDRAWAL . 10 OTHER 96 (SPEEIFY) UNSURE . 98 ~613 F30 256 NO. J QUESTIONS AND FILTERS I COOING CATEGORIES I SKIP 610 What is the main reason you never intend to use a method? 612 CODE 11 NOT CIRCLED I Would you ever use a ~ethod if you were married? NOT MARRIED . . . . . . . . . . . . . . . . . . . . . . . 11 FERTILITY-RELATED REASONS INFREQUENT SEX . 22 NENOPAUSAL/HYSTERECTONY . 23 SUSFECURD/IHFECUND . 26 WANTS NONE CHILDREN . 26 OPPOSITION TO USE RESPONDENT OPPOSED . 31 HUSBAND OPPOSED . 32 OTHERS OPPOSED . . . . . . . . . . . . . . . . . . 33 RELIGIOUS PROHIBITION . 34 LACK OF KNOWLEDGE KNOWS NO METHOD . 41 KNOMS NO SOURCE . 42 METHOO-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . 52 LACK OF ACCESS/TO0 FAR . 53 COST TOO MUCH . 54 INCONVENIENT TO USE . 55 INTERFERES WITH BODY'S NORMAL PROCESSES . 56 OTHER 96 (SPECIFY) OK . 98 i-7 =613 I I YES . 1 I N O . . . , , . , . . . , , . . . , . . , . , , , . . 2 OK, . ooo . ,,, . . . . . . . . . . . . 8 613 CHECK 216: HAS LIVING CHILOREH / I If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? PROBE FOR A NUMERIC RESPONSE, r-7 NO LIVING CHILDREN L~ / I If you could choose exactly the number of children to have in your whole Life, how many would that be? NURSER . OTHER (SPECIFY) 96 ~--~615 614 How many of these children would you Like to be boys end how many would you like to be girls? I SOYS GIRLS EITHER NOMHER . . . . OTHER 999996 (SPECIFY) 615 | Do you approve or disapprove of couples using a gtethod J APPROVE . 1 | I of family planning to avoid getting pregnant? I DISAPPROVE . 2 7 NO OPINION . 3 / ,617 616 I Have you ever recotTmended fami lY planning to a friend, IYES . 1 I relative, or anyone else? NO . 2 F]l 257 NO. I QUESTIONS AND FILTERS 617 I Is it acceptable or not acceptable tc you for information I on family planning to be provided: On the radio? On the television? By a CBD? I COOING CATEGORIES ] SKIP NOT I ACCEPT- ACCEPT" ABLE ABLE DK RADIO . 1 2 8 TELEVISION . I 2 8 CBD . 1 2 8 618 In the last six months have you haarcl or learned about family planning: On the radio? On the te lev i s ion? In a newspaper or magazine? From a poster? From leaflets or brochures? From a CBD? YES NO RADIO . 1 2 TELEVI$IOH . . . . . . . . . . . . . . . . . . . . . 1 2 NEWSPAPER OR MAGAZINE . . . . . . . . . . 1 2 POSTER . 1 2 LEAFLETS OR BROCHURES . 1 2 CBD . 1 2 619 | In the test s ix months have you discussed the pract i ce of I YES . 1 | I family planning with your friends or relatives? I NO . 2 =621 620 With whom? Anyone else? RECORD ALL MENTIONED. HUSBAND/PARTNER . A MOTHER . B FATHER . C SZSTER(S) . D BROTHER(S) . E DAUGHTER . F MOTHER-IN'LAW . G FRIENDS . H OTHER X (SPECIFY) 621 623 I Do you think most, some, or none of the women you know use I HOST . 1 I some kind of fmJty planning? I S=E . 2 I NONE . 3 DK. . . . .° . °°8 I CURRENTLY [~ ~626 MARR I ED I I Now I want to ask you aloout your hus:~ar~d=s view on family ptonning. Do you think that your husband approves or disapproves of couples using a method to avoid pregnancy? I APPROVES . 1 DISAPPROVES . 2 DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 624 J Have you and your husband ever discussed the number of IrES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I children you would like to have? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I°°°° °k°uu - - - ° ° ° J . I that you want, or does he want more or fewer than you want? MORE CHILDREN . 2 FEWER CHILDREN . 3 OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 F32 258 NO. 627 QUESTIONS AND FILTERS CODING CATEGORIES SKIP CHECK 515: NEVER BAD | I HAD SEXUAL SEXUAL INTERCOURSE [~ INTERCOURSE r~ ~701 sometimes a woman become preBnant uhen she does not want i to be. Have you ever become pregnant when you did not want I to be? YES . 1 | NO . 2 ~701 I when you did not went to be? YEARS AGO . 629 When that happened to you, what did you do about it? STOPPED THE PREGNANCY . 01 ATTEMPTED TO STOP THE PREGNANCY BUT FAILED . 02 HAD A MISCARRIAGE . 03 NOTHING/CONTINUED THE PREGNANCY.O4 OTHER 96 (SPECIFY) DK . 98 I ~632 ~636 I 630 What was done? PRAYER/GOD'S WILL . 01 STRENUOUS t,K)RK . 02 SCRUBBING FLOORS . 03 BITTER DRINKS (HERBS) . 04 TABLETS . 05 HARD MASSAGE/SQUEEZING ABDOMEN . 06 OBJECT IN WOMB . 07 INJECTION . . . . . . . . . . . . . . . . . . . . . . . . . 08 SUCTION . 09 CURRETAGE . 10 OTHER 96 (SPECIFY) DK . 98 631 Who provided the methods for you? Anyone etse? DOCTOR . A TRAINED NURSE/MIDWIFE . B | UNTRAINED BIRTH ATTENDANT . C PHARMACIST . D RELATIVE/FRIEND . E 633 OTHER X (SPECIFY) NO ONE . Y 632 What do you think caused you to have a miscarriage? PRAYER/GOD'S WILL . 01 STRENUOUS WORK . 02 SCRUBBING FLOORS . 03 SITTER DRINKS (HERBS) . 04 TABLETS . 05 HARD MASSAGE/SQUEEZING ABDOMEN . 06 OBJECT PLACED IN WOMB . 07 INJECTION . 08 SUCTION . 09 CURRETAGE . 10 SOMETHING WRONG WITH BABY . 11 HAD A FIGHT . 12 RESPONDENT WAS SICK . 13 OTHER 96 (SPECIFY) OK . 9B 633 | Did you have any health probtems as a resutt? I YES . 1 | I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~636 634 IWere you hospitatised? [ YES . I | NO . 2 ~636 I Di° eve h've "n"rIie --nt" oreB°' th't °r I YES . ' 1 someone else stopped? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 259 F33 SECTION 7, HUSBAND'S BACKGROUND AND UOMAN'S WORK QUESTIONS AND FILTERS I COOING CATEGORIES I ASKED YES NO [-7 ASK QUESTIONS ABOUT ASK I~JESTIQ~S ABOUT CURRENT HUSBAND ~:)ST RECENT HUSBAND NO. J 701 CHECK 503: 702 Did your (last) hL~sband/partner ever attend school? J YES . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - 703 | What was the highest level of school he attended: PRIMARY . 1 | j primary, secondary, or higher? SECONDARY . 2 I HZGHER . 3 DK . 8 ~705 704 I HOW many years did he complete at t:lat level? ~ I I YEARS . I D K , , , , , , , , . o , o o . , . , . . • . . . . . . • . 705 I What is (was) your (Last) husband/plrtner's occupation? I That is, what kind of work does (di,~) he mainly do? I l l I SKIP I ~708 I | r705 707 DOES (DID) [--7 NOT WORK IN AGRICULTURE I (Ooes/did) your husband~partner wore mainly on his own land or on family Land, on coeznuna[ [and, or (does/did) he rent [and , or (does/did) he work on someone etse's Land? i~ 708 I HIS LAND . 1 C~4MUNAL/REEETTLEMENT LAN;:::II:I.2 I RENTED LAND . 3 SOMEONE ELSE'S LAND . 4 tOn I Aside from your own housework, are ¢ou currently working? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~711 I I NO . 2 l 709 m As you know, some worn take up job; for which they are paid | | in cash or kind. Others sell thing;, have a smart business I I I or work on the family farm or in th~ family business. I I | Are you currently doing any of thes~ things or any other I YES . 1 ~711 | work? I No . 2 I 710 |Have you done any work in the Last 12 months? I YES . 1 | I I NO . 2 ~726 711 | What is your occupation, that is, wlat kind of work do you I mainly do? 713 DOES NOT WORK IN AGRICULTURE [~ I Do you work mainly on your own land or on family Land, do you work on communal land, or do yoJ rent land, or work on I someone etse's land? OWN LAND . 1 CDMMUNAL/RESETTLEMEHT LAND . 2 RENTED LAND . 3 SOMEONE ELSE'S LAND . 4 714 1 I 260 F34 NO. I QUESTIONS AND FILTERS 1 714 I Do (did) you de this work for a mulber of your family. I for s~e~eone else. or are you setf-empLoyedT l COOING CATEGORIES J SKIP I . ' I FOR SUMEONE ELSE . 2 SELF-EMPLOYED . 3 715 I Do you uauatty work throughout the year, or I THROUGHOUT THE YEAR . 1 ~717 I de you work seasonally, or only once in a while? J SEASONALLY . 2 , ONCE IN A WHILE . 3 -t718 NUMBER OF MONTHS . , . j (in the.nth, you wor,ed,, No. many deys.--N OiO you J D ' usually work? NUMBER OF DAYS . ~719 I ' l°u*n *e*"* "n*" ° I did you work? NUMBER OF DAYS . working? NUMBER OF HOURS . DK . 98 720 , Do you earn cash for your work? I YES . 1 , I I NO . 2 ~ 723 PROBE: Do you make money for working? 721 J How much do you usually earn for this work? PER DAY . 1 I PROBE: Is this by the day. by the week. or by the month? PER WEEK . 2 RECORD IN ZIMBABWEAN DOLLARS PER MONTH . 3 722 CHECK 502: CURRENTLY MARRIED [~ YES, / I Who mainly decides how the money you earn will be used: you. your husbend/l:~rtner , you and your husl:,ar~:i/partner jointly, or so~eone else? NO, NOT CURRENTLY I~ MARRIED I Who mainly decides how the money you earn wilt be used: you, someone else I or you and someone else jointly? RESPONDENT DECIDES . 1 HUSBAND/PARTNER DECIDES . 2 JOINTLY WITH HUSBAND/PARTNER . 3 SOHEONE ELSE DECIDES . 4 JOINTLY WITH SOHEONE ELSE . 5 723 Do you usually work at home or away from home? CHECK 217 AND 218: IS A CHILD LIVING AT HOHE WHO IS AGE 5 OR LESS? YES HO HI~E**.° . .°, . ,.1 AWAY . 2 I ,-726 725 Who usually takes care of (NAME OF YOUNGEST CHILD AT HOHE) while you are working? RESPONDENT . 01 HUSBAND/PARTNER . 02 OLDER FEMALE CHILD . 03 OLDER MALE CHILD . 04 OTHER RELATIVES . 05 NEIGHBORS . 06 FRIENDS . 07 SERVANTS/HIRED HELP . . . . . . . . . . . . . . . 08 CHILD IS IN SCHOOL . 09 INSTITUTIONAL CHILDCARE . 10 HAS NOT WORKED SINCE LAST BIRTH.,95 OTHER 96 (SPECIFY) 261 F35 NO. QUESTIONS AND FILTERS 726 Who in your household decides eheth(~r to purchase a major household item, such as a radio or ~:elevision? RECORD ALL NENTIONED THEN ASK: Who has the greatest say in the fil~( decision to make such a purchase? COOING CATEGORIES RESPONDENT . A HUSBAND/PARTNER . B OTHER SENIOR MALE . C OTHER SENIOR FEMALE . . . . . . . . . . . . . . . . D OTHER . E NO ONE . F COOE OF PERSON WITH L----I GREATEST SAY IN DECISION SKIP 727 Who in your household decides wheth,~r you should work outside the home? RECORD ALL MENTIONED THEN ASK: Who has the greatest say in the fit~al decision for you to work outs{de the home7 RESPONDENT . A HUSBAND/PARTNER . B OTHER SENIOR MALE . C OTHER SENIOR FEHALE . D OTHER . E NO ONE . F COOE OF PERSON ~ITH GREATEST SAY IN DECISION 7'28 Who decides how many children you will have? RECORD ALL MENTIONED THEN ASK: Who has the greatest say in deciding how many children to have? RESPONDENT . A HUSBAND/PARTNER . B OTHER SENIOR MALE . C OTHER SENIOR FEMALE . D OTHER . E NO ONE . F CQOE OF PERSON ~ITH I J GREATEST SAY IN DECISION 729 730 751 Have you rived in only one c¢11munit! or in more than one I ONE COMMUNITY . 1 | comTclnJty since Jarv~ary 1989? I MORE THAN ONE C(]¢qUNITY . 2 r731 I ENTER (IN COL. 4 OF CALENDAR) THE APPROPRIATE COOE FOR CURRENT COMMUNITY. ('1 ~ MAIN TDWN, '2 ~ OTHER URBAN, '31 RURAL AREA). I BEGIN IN THE MONTH OF INTERVIEW AND CONTINUE WITH ALL PRECEDING MONTHS BACK TO JAN. 1989 THEN SKIP TO In ehet month and year did you move to (NAME OF COMMUNITY OF INTERVIEW)? ENTER (IN COL. 4 OF CALENDAR) 'X ~ IN THE MONTH AND YEAR OF THE HOVE, AND IN SUBSEQUENT MONTHS ENTER THE APPROPRIATE CQOE FOR TYPE OF COMHUNITY ('1' MAIN TOWN, 121 OTHER URBAN, +]' RURAL AREA). CONTINUE pROBING FOR PREVIOUS C~MUNITIES AND RECORD MOVES AND TYPES OF COMMUNITIES ACCORDINGLY, ILLUSTRATIVE QUESTIONS • Where did you live before . • In what month and year did you arrive there? • Is that place in a main town, another urban area, or s rural area? I~B01 I F36 262 SECTION 8. AIDS AND SEXUALLY TRANSMITTED DISEASES NO. I OOESTIONS AND FILTERS I COOING CATEGORIES J sxIP 801 I Nave you heard about diseases that can be transmitted I YES . 1 | I through sex? J NO . 2 =814 802 804 Which diseases have you heard about? RECORD ALL RESPONSES V I During the Last 12 ~ths, did you have any of these diseases? SYPHILIS . A GONORRHEA . B AIDS/HIV INFECTION . C GENITAL WARTS / CONDYLOMATA . D CHANCROID . E OTHER W OTHER X (SPECIFY) D K . . . , , . , . . . . . . . . . . . . . . ,°. . . . . . °o.Z HAS NEVER I HAD SEX ~ JB13 I YES . 1 I NO . 2 7 DK . 8-- zS13 805 Which? RECORD ALL RESPONSES SYPHILIS . A GONORRHEA . S AIDS/H1V INFECTION . C GENITAL WARTS / CONDYLOMATA . . . . . . . D CNAHCRO|D . . . . . . . . . . . . . . . . . . . . . . . . . E OTHER W OTHER X (SPECIFY) DON'T KNOW . Z 808 When you had the mst recent episode of (DISEASE FROM 0.805) did you seek advice or treatmnt? J ADVICE /TREATMENT . 1 J SELF TREATMENT . 2 DID NOT DO ANYTHING . . . . . . . . . . . . . . . 3| pSlO 809 ~here did you seek a~ice or treat~nt? Any other place or person? RECORD ALL MENTIONED PUBLIC SECTOR CENTRAL HOSPITAL . A PROVINCIAL HOSPITAL . B DISTRICT/RURAL HOSPITAL . C RURAL HEALTH CENTRE . D RURAL/MUNICIPAL CLINIC . E VILLAGE COMMUNITY WORKER . F OTHER PUBLIC SECTOR . G (specify) MISSION HOSPITAL/CLINIC . H PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . I PHARMACY . J PRIVATE DOCTOR . K VILLAGE COMMUNITY WORKER . L OTHER NED. PRIVATE SECTOR . M (specify) OTHER PRIVATE SECTOR SHOP . N RELATIVES/FRIENDS . 0 TRADITIONAL HEALER . P OTHER X (specify) 810 I When you had (DISEASE of Q.805) did you advise your partner m YEs . 1 J I to seek treatment? | NO . 2 I 811 I Uh~ you had (DISEASE of O.aOS) did you do something not to I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | I infect your partner? J NO . 2~ PARTNER ALREADY INFECTED . 3 1 181] F]7 263 NO. J 812 I 814 ITnat did you do? RECORD ALL MENTIONED QUESTIONS ANTI FILTERS SEE QUESTION 802 DID MOT MENTION 'AIDS' Have you ever heard of an iitness catted AIDS? J COOING CATEGORIES J SKIP I NO SEXUAL INTERCOURSE . A I USED CONDOMS . B RECEIVED MEDICAL TREN4EMT . C OTHER X (SPECIFY) MENTIONED 'AIDS' ~ J ¢815 i YES . 1 | NO . 2 ~831 815 Frm which sources of information have you learned nmst about AIDS? Any other sources? RECORD ALL MENTIONED RADIO . A TV. . . . ,,B NEWSPAPERS/MAGAZINES . C pAMPLETS/POSTERS . D HEALTH LJORKERS . E MOSQUES/CHURCHES . F SCHOOLS/TEACHERS . G COMMUNITY MEETINGS . H FRIENDS/RELATIVES . I UORK PLACE . J OTHER . X (SPECIFY) 816 How can a person geE the AIDS vir~s? Any other ways? RECORD ALL MENTIOMED SEXUAL INTERCOURSE . A SEX WITH PROSTITUTES . . . . . . . . . . . . . . R HOMOSEXUAL CONTACT . C SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS . D BLOOU TRANSFUSION . E INJECTIONS . F KISSING . G MOSQUITO BITES . H OTHER W (SPECIFY) OTHER X (SPECIFY) DK . Z 817 I virus?IS there anything ° pers°n can d° t° av°Jd Retting the AIDS I NoYES . . 21 I DK . ~/ ~821 818 What can a person do to avoid getl"ing the AIDS virus? Any other ways? RECORO ALL ICEMTIONED SAFE SEX . A ABSTAIN FROM SEX . B USE CONDOMS DURING SEX . C AVOID MULTIPLE SEX PARTNERS . O AVOID SEX WITH PROSTITUTES . E AVOID SEX WITH HOMOSEXUALS . F AVOID BLOOD TRANSFUSIONS . G AVOID INJECTIONS . H AVOID KISSING . I AVOID MOSQUITO BITES . J SEEK PROTECTION FROM FROM TRADITIONAL HEALER . K OTHER U (SPECIFY) OTHER X (SPECIFY) DK . Z F38 264 What does ==safe sex" ~an to you? 820 RECORD ALL MENTIONED ABSTAIN FROM SEX . A USE CONDOMS DURING SEX . B AVOID MULTIPLE SEX PARTNERS . C AVOID SEX WITH PROSTITUTES . D AVOID SEX WITH HOMOSEXUALS . E OTHER X (SPECIFY) DK.,o,oo, . ,o,oo° . . . . . . . Z 821 I Is it possibte for a healthy-rooking person to have I YES . 1 I I the AIDS virus? I MO . 2 I OK.°°°°°., . o.o°. . .o8 822 I Can AIDS be cured, or do all persons with AIDS die from I YES, THERE IS A CURE . 1 I I the disease? I NO, EVERYONE WITH AIDS DIES . 2 I DK.,o. . . . . . . . . . ,°° . . . . . . . . . , . 8 I °'°'''''°s I . I during pregnancy or childbirth? NO . 2 DK . ooo.°°°. . . . . . . . . . . . . °.8 I °°" °r I . I has died of kIDS? NO . 2 DK°o°° . °°. . . . . . . . . . . . . . . . . . . 8 825 Do you think a person Who has AIDS should be cared for at | HOHE CARE . 1 home, cared for in a medica[ facility, or left atone to I MEDICAL FACILITY . . . . . . . . . . . . . . . . . . 2 take care of himself/herself? LEFT ALONE . 3 DE . 8 826 Do you think your chances of Retting the AIDS virus are I NO RISK AT ALL . 1 I small, moderate, great, or no risk at all? j SMALL . 2 I MODERATE . ] 7 GREAT . 4~ ~828 827 Why do you think that you have (NO RISK/A SMALL CHANCE) of setting the AIDS virus? Any other reasons? RECORD ALL MENTIONED ABSTAIN FROM SEX . A - USE CONDOMS DURING SEX . B HAVE ONLY ONE SEX PARTNER . C - LIMITED NUMBER OF SEX PARTNERS.D NO HOMOSEXUAL CONTACT . E NO BLOOD TRANSFUSIONS . F NO [NJECTZONS . G OTHER X (SPECIFY) DE . Z ~829 828 Why do you think that you have a (MOOERATE/GREAT) chance of getting the AIDS virus? Any other reasons? RECORD ALL MENTIONED DO NOT USE CONDOHS . A MULTIPLE SEX PARTNERS . B SPOUSE HAS MULTIPLE PARTNERS . C HOMOSEXUAL CONTACT . D HAD BLOOD TRANSFUSION . E HAD INJECTZONS . . . . . . . . . . . . . . . . . . . . F OTHER X (SPECIFY) DE,.o. . .°° . . . . . . . . . . . . . . . . . Z 829 [ Since you heard of kIDS, have you changed your J YES . 1 | I behavior to prevent getting the AIDS virus? J NO . 2 ~ 831 F39 265 go. J 830 What did you do? Anything etse? Anything else? RECORD ALL NENT%ONED QUESTIONS ANE FILTERS j COOING CATEGORIES STOPPED ALL SEX . A STARTED US%NG CONDOHS . B RESTRICTED SEX TO ONE PARTNER . C REDUCED NUHBER OF PARTNERS . D NO gORE HOI4OSEXUAL CONTACTS . E STOPPED INJECTIONS . F OTHER X (SPECIFY) DK . Z J SKIP 831 833 Some peopte use a condom during sexual intercourse to avoid getting the AIDS virus or other sexua|Iy transmitted diseases. Have you ew~r heard of this? Have you ever used a condom during sex to avoid | getting or transmitting diseases, ~;uch as the AIDS virus? I YES . 1 I--1 ol YES . 1 I I NO . ,. . . . . . . . . . .,., . . . . . . . 2 834 Have you given or received money, ~lifts or favours in return for sex at any time in the last 4 ~eeks? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO,,. . . . . . . . . . . . . . . . . . . . . . .,.2 F40 266 901 S+~CTIOR 9. NATERNAL HORTA~TY Now I would like to ask you sore questions about your brothers and sisters, that is, all of the children bern to your natural mother, inctudfng those uho are riving with you, those irving elsewhere, and those who have died. How many children did your mother give birth to, incLuding you? I NUMBER OF BIRTHS TO ~ | NATURAL MOTHER . I I I I CHECK 901: TRiO OR MORE BIRTHS ONLY ORE BIRTH (RESPONDENT ONLY) [~ = SKIP TO 915 903 | How many of these births did your mother have before you were NI~BER OF I born? PRECEDING BIRTHS . I [ J 904 What was [1] [23 [3] [4] [5] [6] [7] the name given to your oldest (next oldest) brother or sister? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i , , i i i , 905 Is (NAME) HALE . 1 MALE . 1 MALE . 1 HALE . 1 MALE . 1 MALE . 1 MALE . 1 rmsie o r female? FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 i = = i = i i 906 Is (NAME) YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 still alive? NO . 21 NO . 21 NO . 21 NO . 2] NO . 2] NO . 2] NO . 2 1 GO TO 908< J GO TO 90~<J GO TO 908<J GO TO 908< J GO TO 908<J GO TO 908< J GO TO 908< J DK . DK . DK . DK . D~ . OK . <8] DK . GO TO [2] GO TO [3:< 8] GO TO [4) <8~ GO TO [5] <8] GO TO [6]< ~ GO TO [7]<8~ GO TO [B] <8~ GO TO [23 GO TO [3:) GO TO [4] GO TO [5] GO TO [H GO TO (7] GO TO [8] 908 How many yea ,agoOiO I--]--] I--l---I VI---] I J 3 I (~AHE) die? 909 flow old --("--,+an I--y--I I--T--I UJ--I I--I--l I 13 she/he died? IF MALE OR DIED BEFORE 10 YEARS GO TO [21 IF MALE ~ DIED BEFORE 10 YEARS GO TO [31 IF MALE OR DIED BEFORE 10 YEARS GO TO [41 IF MALE OR DIED BEFORE 10 YEARS GO TO [5] IF MALE OR DIED BEFORE 10 YEARS GO TO [6] IF MALE OR DIED BEFORE 10 YEARS GO TO [7] IF HALE OR DIED BEFORE 10 YEARS GO TO [B] 910 Did (NAME) YES . 11 YES . 1] YES . '11 YES . '11 YES . '11 YES . '11 YES . 1 '1 die during GO TO 914< J DO TO 914< -J GO TO 914< +~ GO TO 914< J GO TO 914< ~ GO TO 914<~ GO TO 916< ~ childbirth? NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 z 911 Was (NAME) YES . 11 YES . 11 YES . 11 YES . '11 YES . '11 YES . 11 YES . 11 pregnant when £~3 TO 913< ~ GO TO 913< ~ GO TO 913 <-j GO TO 913< ~ GO TO 913< ~ GO TO 913< ~ GO TO 913< ~ she died? NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 912 Did (NAME) die within six YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 weeks after the end of a NO . 2 NO . 2 NO . Z NO . 2 NO . 2 NO . 2 NO . 2 pregnancy or childbirth? i i [ i [ i [ 913 Did (NAME) YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 die because of complications NO . 21 NO . Z 1 No . 21 NO . Z 1 NO . Zl NO . Z 1 NO . Z 1 of pregnancy GO TO [2]< a GO TO [)]<J GO TO [4]<J GO TO [5]< J GO TO [6]< j GO TO (7]< j GO TO [8]< j or childbirth? DK . . . . . . . . . 8 OK . 8 DK . 8 DK . 8 DK . 8 DK . 8 DK . 8 914 How many chitdren had (NAME, given l--[--i I--T--] i --i i--Y--/ I--[--I ; b i r th to before that pregnancy? 268 F41 [8] [9] [10] [11] [12] [13] [14] 904 What Was [ i the name g~ven I to your otdest (next otdest] sister?br°ther or , - . . . . . . . . . . . . , . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . 905 Is (NAME] HALE . 1 MALE . 1 MALE . 1 MALE . 1 HALE . 1 IHALE . 1 MALE . 1 mate or i female? FEMALE . 2 .FEMALE . 2 ,FEMALE . 2 FEMALE . 2 FEMALE . 2 IFEMALE . 2 ,FEMALE . 2 906 Is (NAME) YES . 1 YES . I YES 1 YES. . 1 YES . 1 YES. . 1 YES . 1 stir[ ative? NO . 21 NO . 21 NO . 21 NO . 21 NO . 2 lIND . 21 NO . 2 l GO TO 908< J GO TO 908<Jj GO TO 908< J GO TO 908< J ' GO TO 908 <J` GO TO 908< J GO TO 908< J DK . DK . DK . DK . i oo TO DO TO [10] GO ,0 [11] GO TO [12] !D Go . . . . . . . . . ,0 . . . . . . . . . TO ° oo . . . . . . . . . TO J 907 Row Did is ] [.El? iF-F 'F-F--1 IF-- I GO TO [9] L GO TO [10] GO TO [111 GO TO [12] GO TO [13] GO TO [14] GO TO [15] B 908 How many (NAME) die? i 909 HON o(d [ 910 Did (NAME] die during chitdbirth? 911 Was (NN4E) pregnant when she died? r912 Did (NAME] die within six weeks after the ~ of a pre~y or [childbirth? 913 Did (NAME] die because of 'complications of pregnancy lot childbirth? 914 How many children had [NAME) given birth to before that pregnancy? IF MALE OR DIED BEFORE 10 YEARS GO TO [9] ===s========= YES . 1] ~TO 914< ~ WO . 2 IyES . 1 GO TO 913< '] I NO . 2 YES . 1 I NO . 2 YES . 1 N O . 21 GO TO [9]<J DK . B IF MALE OR DIED BEFORE 10 YEARS GO TO [10] --r,=_-_-=¢_-_-==== YES . 1" 1 GO TO 914< ~ WO . 2 YES . 11 GO TO 913< -J MO . 2 YES . 1 I NO . 2 YES . 1 NO . 21 GO TO [10]< J DK . 8 IF HALE OR DIED BEFORE 10 YEARS GO TO [11] YES . I 1 GO TO 914< -j ~0 . 2 IYES . 1 GO TO 913< '] I NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 l GO TO [11]<J DK . B IF MALE OR DIED BEFORE 10 YEARS GO TO [12] YES . .I] GO TO 914~ NO . 2 YES . 1 GO TO 913<'] NO . 2 YES . 1 NO . 2 YES . I NO . 2] GO TO [12]< J DK . 8 IF MALE OR DIED BEFORE 10 YEARS GO TO [13] =¢==== ==¢= = YES . 11 GO TO 914< ~ NO . 2 YES . 1 GO TO 913<'] NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 l O0 TO [13]< J DK . B IF MALE OR DIED BEFORE 10 YEARS GO TO [14] YES . I l GO TO 914<-; NO . 2 YES . I l GO TO 913< -J NO . 2 YES . 1 NO . 2 YES . 1 NO . 21 GO TO [14]< J DK . 8 IF MALE OR DIED BEFORE 10 YEARS GO TO [15] = = - - - = = = = - = = = GO TO 914< I~ NO . 2 YES . I GO TO 913< '] NO . 2 YES . I NO . 2 YES . 1 NO . 21 GO TO [15]< a DK . 8 RECORD THE TIME. F42 269 SECTION 10. HEIGHT AND ~EIGHT CHECK 215: ONE OR MORE BIRTHS [--7 NO BIRTHS SINCE JAB. 1991 ~ SINCE JAN. 1991 ~ ~ END INTERVIEI~ER: IN 1002 (COLUMNS 2-4) RECORD THE LIkE NUI4BER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE. IN 100] AND 1004 RECORD THE NN4E ANC BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991. IN 1006 AND 10C8 RECORD HEIGHT AND UEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR klORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN ] LIVING CHILDREH BORN SINCE JANUARY 1991, 1002 LINE NO. FROM Q.212 USE ADOITIOI~AL FORMS). 1003 NAME FROM Q.212 FOE CHILDREN 10D4 DATE OF BIRTH FROM Q.215, AND ASK FOR DAY OF BIRTH 1005 BCG SCAR ON TOP OF RIGHT SHOULDER 1006 HEIGHT (in centimeters) 1007 WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP? 1008 MEIGHT (in kilograms) 1009 DATE UEIGHED AND MEASURED 1L~ RESPONDENT (NAME) DAY . MONTH . YEAR . MEASURED . 1 NOT PRESENT . ] REFUSED . 4 OT~ER . 6 (SPECIFY) f-n 1010 RESULT 1011 NAME OF MEASURER: L2J YOUNGEST LIVING CHILD F-n (NkJ4E) DAY . MONTH . YEAR . SCAR SEEN . 1 NO SCAR . 2 n-F][] LYING . 1 STANDING . 2 DAY . MONTH . YEAR . CHILD MEASURED.1 CHILD SICK . 2 CHILD NOT PRESENT . 3 CHILD REFUSED.~ MOTHER REFUSED.~ OTHER . 6 (SPECIFY) NEXT'TO" YOUNGEST LIVING CHILD (NAME) DAY . MONTH . YEAR . SCAR SEEN . I NO SCAR . 2 LYING . 1 STANDING . 2 DAY . MONTH . YEAR . CHILD MEASURED.1 CHILD SICK . 2 CHILD NOT PRESENT . ] CHILD REFUSED.4 MOTHER REFUSED,5 OTHER . 6 (SPECIFY) L4J SECOND'TO- YOUNGEST LIVING CHILD (NAME) DAY . MONTH . YEAR . SCAR SEEN . I NO SCAR . 2 LYING . I STANDING . 2 F-F .D DAY . MONTH . YEAR . CHILD MEASURED.1 CHILD SICK . 2 CHILD NOT PRESENT . 3 CHILD REFUSED.4 MOTHER REFUSED.5 OTHER . 6 (SPECIFY) NAME OF ASSISTANT: U1 270 F43 Comments about Respondent: INTERVIEk~ERIS OBSERVATION s TO be fitted in after completing interview Co~ment a on Specific Questions: Any Other comments: SUPERVISOR'B OBSERVATIONS Name of Supervisor: Date: EDITORaS OBSERVATIONS Na~ne of Editor: Date: F44 271 INSTRUCTIONS: ONLY ONE CODE StlOULD APPEAR IN ANY BOX. FOR COLUMNS 1, 3, AND 4 ALL MONTHS SHOULD BE FILLED IN. INFORMATION TO BE CODED FOR EA(:H COLUMN COL.1: girths, Pregnancies, Co.traceptive Use g BIRTHS P PREGNANCIES T TERMINATIONS O NO METHOD 1 PILL 2 IUO 3 INJECTIONS 4 IMPLANTS 5 DIAPHRAGM/FOAM/JELLY 6 CONDGM 7 FEMALE STERILIZATION 8 MALE STERILIZATION 9 SAFE PERIOD A MI THDRAUAL X OTHER (SPECIFY) COL.2: Discontinuation of Contp-aceptive Use 0 INFREQUENT SEX/HUSBAMI) AWAY 1 BECAME PREGNANT MHILE USING 2 WANTED TO BECOME PREGNANT 3 HUSBAND DISAPPROVED 4 WANTED MORE EFFECTIVE METHOD 5 HEALTH CONCERNS 6 SIDE EFFECTS 7 LACK OF ACCESS/TOO FAR 8 COST TOO MUCH 9 INCONVENIENT TO USE F FATALISTIC A DIFFICULT TO GET PREGNANT/MENOPAUSE O MARITAL DISSOLUTION/SEPARATION X OTHER (SPECIFY) Z DONIT KNO~ COL.3: Marriage/Union X IN UNION (MARRIED) O NOT IN UNION COL.4: Moves and Types of CommJnities X CHANGE OF COMMUNITY 1 MAIN TOWN Z OTHER URBAN AREA 3 RURAL AREA 12 DEC 11 NOV 10 OCT 09 SEP 1 08 AUG 9 07 JUL 9 06 JUN 4 05 MAY 04 APR 03 MAR 02 FEB 01 JAN 12 DEC 11 NOV 10 OCT 09 SEP 1 08 AUG 9 07 JUL 9 06 JUN 3 05 MAY 04 APR 03 MAR 02 FEB 01 JAN 1 2 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 ZO 21 22 23 24 12 DEC 25 11 NOV 26 10 OCT 27 09 SEP 28 1 08 AUG 29 9 07 JUL 30 9 06 JUH 31 2 05 MAY 32 04 APR 33 03 MAR 34 02 FEB 35 01 JAN 36 12 DEC 37 11 NOV 38 10 OCT 39 09 SEP 40 I 08 AUG 41 9 07 JUL 42 9 06 JUN 43 1 05 MAY 44 04 APR 45 03 MAR 46 02 FEB 47 01 JAN 48 ~ 9 11 NOV 50 10 OCT 51 09 SEP 52 I 08 AUG 53 9 07 JUL 54 9 06 JUN 55 O OS MAY 56 04 APR 57 O] MAR 58 02 FEB 59 01 JAN 60 3 4 01 DEC 02 NOV 03 OCT 04 SEP 05 AUG 1 06 JUL 9 07 JUH 9 08 MAY 4 09 APR 10 MAR 11 FEB 12 JAN 13 DEC 14 NOV 15 OCT 16 SEP 17 AUG 1 18 JUL 9 19 JUH 9 20 MAY 3 21 APR 22 MAR 23 FEB 24 JAN 25 DEC 26 NOV 27 OCT 28 SEP 29 AUG 1 30 JUL 9 31 JUH 9 32 MAY 2 33 APR 34 MAR 35 FEB 36 JAN 37 DEC 38 NOV 39 OCT 40 SEP 41 AUG I 42 JUL 9 43 JUN 9 44 MAY I 45 APR 46 MAR 47 FEB 48 JAN DEC 50 NOV 51 OCT 52 SEP 53 AUG I 54 JUL 9 55 JUN 9 56 MAY 0 57 APR 58 MAR 59 FEB 60 JAN 12 DEC 61 11 NOV 62 10 OCT 63 09 SEP 64 08 AUG 65 07 JUL 66 06 JUN 67 05 MAY 68 04 APH 69 03 MAR 70 02 FEB 71 01 JAN 72 61 DEC 62 NOV 63 OCT 64 SEP 65 AUG I 66 JUL 9 67 JUN 8 68 MAY 9 69 APR 70 MAR 71 FEB 72 JAN 272 F45 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY MALE QUEST IONNAIRE IDENTIF ICAT ION WARD/V ILLAGE NAME OF HOUSEHOLD READ CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (urban=l , ru ra l=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MA IN TOWN/OTHER URBAN/RURAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (main town=l , o ther u rban=Z, rura l=Z) NAME AND L INE NUMBER OF MAN E INTERVIEWER V IS ITS 1 2 3 F INAL V IS IT DATE INTERVIEWER'S NAME RESULT*** NEXT V IS IT : DATE T IME DAY MONTH Y EAR NAME RESULT TOTAL NUMBER OF V IS ITS 1 1 ***RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER (spec i fy ) LANGUAGE OF QUEST IONNAIRE: ENGL ISH LANG.INTERV: ][ TEAM LEADER FIELD EDITO. SHONA . . . . . . . 1 || / ] NDEBELE . . . 2 IlNAME ~ IINAME ENGL ISH . 3 // - - - - I I I II " I I I DATE ' ' ' ~ M1 273 SECTION 1. RESPONDENT'S BACKGROUND NO. I QUESTIONS AND FILTERS I COOING CATEGORIES I SKIP 102 RECORD THE TIME. I First I woutd Like to ask some questions about you and your househotd. For most of the time ur*til you were 12 years old, did you l ive in a town or (n ~, rural area? IF TO~JH: Which town? I MAIN TOWN . 1 OTHER URBAN . 2 RURAL . $ 105 In what month end year were you born? MONTH . III DK MONTH . 98 YEAR . ~-~ DK YEAR . 98 106 I H°w °ld were Y°U at y°ur last birthday? I ~-~ I AGE IN COMPLETED YEARS . COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. 107 I Have you ever attended schoo(? I YES . 1 I I I NO . 2 ~114 108 , What is the highest revel of school you attended: I PRIMARY . i I l primary, secondary, or higher? SECONDARY . 2 HIGHER . 3 at that fever? YEARS . CHECK 106: I AGE 24 AGE 25 OR BELOW ~ OR ABOVE [--7 Lll] 111 I Are you currently attending school? I YES . 1 ~113 NO . 2 I 11Z What was the r~in reason you stopl>~ attending schooL? SECONDARY OR HIGHER GOT MARRIED . 01 HAD TO CARE FOR YOUNGER CHILDREN.02 FAMILY NEEDED HELP ON FARM OR IN BUSINESS . 03 COULD NOT PAY SCHOOL FEES . 04 NEEDED TO EARN MONEY . 05 GRADUATED/HAD ENOUGH SCHOOLING . 06 BAD GRADES . 07 DID NOT LIKE SCHOOL . 08 SCHOOL NOT ACCESSIBLE/TOO FAR . 09 OTHER 96 (SPECIFY) DK . 98 ILl15 I M2 274 NO, I QUESTIONS AND FILTERS 114 m Can you read and understand s Letter or newspaper easily, with difficulty, or not at all? I CODING CATEGORIES I SKIP J EASILY . I I WITH DIFFICULTY . . . . . . . . . . . . . . . . . . . . 2 ROT AT ALL . 3 ~116 115 I D° Y°U usually read a newspaper or magazine at Least °ncea I Y E S w e e k ? NO . . 21 I 116 ID° Y°U usually listen to e radi° everyday? I YESNO. . . .,.21 I 117 I D° Y°U usuat tY watch televisi°n at least °nee e week? I YEs NO . . 2 1 I 118 I ghst is your religion? I TRADITIONAL . 1 I SPIRITUAL . 2 CHRISTIAN . 3 OTHER . 6 (specify) 119 I RECORD ETHNICITY. BLACK . 1 I WHITE . 2 COLOUREO . 3 ASIAN . 4 OTHER . 6 (specify) 120 I Are you currently working? I YES . 1 -~122 I I NO . 2 l 1211 Have you done any work in the last 12 months? IYES . Im NO . 2 P201 122 124 What is your occupation, that is, what kind of work do you mainly do? DOES NOT ~RK IN AGRICULTURE [~ Do you work mainly on your own Land or on family land, or do you rent land e or work on co~lmunal land or on someone else's tend? fT1 I O~JM LAND . 1 RENTED LAND . 2 COMNUNAL/RESETTLENENT LAND . 3 SOMEONE ELSEiS LAND . 4 ~125 I 12' I °° '°° °°" " ~°rk ' ° r ' - - ' °' Y°ur '° ' Y '°' I ~°' F " ' L ' -E ' . I someone else or are you self-employed? FOR SOMEONE ELSE . 2 SELF-EMPLOYED . ] 126 | DO you usually work at this job throughout the year, or I do you work seasonally, or only once in a while? I THROUGHOUT THE YEAR . 1 I * 128 SEASONALLY . 2 ONCE IN A WHILE . ] 12' I°ur ° "h ' "s ' " ' r " °~ '° ' - s ° ° Y°u w°rk't'h s I ~1 job? NUMBER OF MOfiTHS . 128 In a typical day, week, or month how much do you earn for this job? RECORD IN ZIMBABWE DOLLARS PER DAY . 1 PER WEEK . 2 PER NORTH . 3 NO CASH EARNED . 999995 275 M3 SECTION 2. MARRIAGE AND REPROOUCTION NO. I 201 I QUESTIONS AND FILTERS Are you currentty mrried? I COOING CATEGORIES J SKIP J YES, CURRENTLY MARRIED . 1 J NO, NOT CURRENTLY MARRIED . 2 J204 202 I Now many eives do you have? Does (Do) your wife (wives) rive in this househotd? RECORD: LINE NUMBER(S) OF THE WIFE (WIVES) IN HOUSEHOLD g4JESTIONNAIRE IF YES, What is (are) her name(s)? I ,206 204 I Nave you ever been married or rived with • woman? I YES . 1 I I I NO . 2 ~209 2o, i What is your marital ,tstus no,= are YOo,idowed or I WID~EO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 divorced? OIVORCED . 2 206 In what month and year did you start living with your ~ m (first) wife? MONTH . I I I I DK MONTH . 98 YEAR . ~-~ ~208 [ I I I DK YEAR . 98 AGE . B ~ L B ~ CURRENTLY MARRIED [~ L210 I REGULAR PARTNER . 1 I OCCASIONAL PARTNER(S} . 2 NO PARTNER AT ALL . 3 209 CHECK 201: NOT CURRENTLY MARRIED I DO you currentty have s regutar partner, or occasional partner(s) or no partner st air? 210 Now I need to ask you some questions about sexuat activity in order to gain a better understanding of some family ptanning issues. When was the kast time you had sexual intercourse with anyone? NEVER . ODD DAYS AGO . 1 WEE~S AGO . 2 MONTHS AGO . 3 YEARS AGO . 4 ~301 211 How old were you when you first had ~exuat intercourse? AGE . ~1 WHEN FIRST MARRIED . 96 H4 276 NO. J OUESTIONS AND FILTERS 2121 "ou i would like to ask about all the children you have had during your life. 0o you have children? I C~ING CATEGORIES I sKIP I YES . 1 | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 "~217 213 | Do you have any sons or daughters .ho are now living with ] YES . 1 | I you? I NO . 2 ~215 I I-- . And hoM many daughters live uith you? DAUGHTERS AT HOHE . IF NONE RECORD '00 ~. 215 | DO you have any sons or daughters who are alive but do not I YES . 1 | I live Mith you? | NO . 2 ¢217 216 JSoumeny sons are alive but do not live with you? l SONS ELSEWHERE . And hou many daughters are alive but do not live Mith you? DAUGHTERS ELSEWHERE . IF NONE RECORD IO0 I . 217 Nave you ever had a son or a daughter Mho was born alive I I but later died? I I YES . 1 IF NO, PROSE: Any baby Mho cried or showed signs of Life NO . 2 ¢219 but survived only a few hours or days? I 218 220 22Z HOM many boys have died? And hoM many girls have died? IF HONE RECORD '00 ' . SUN ANSMERS TO 214, 216, AND 218, AND ENTER TOTAL. IF NONE RECORD '00 =. CHECK 219: Just to make sure that I have this right: you have had in TOTAL correct? children during your life. YES r~ so [-7 Is that PROBE AND ¢ CORRECT 212-219 AS NECESSARY In what month and year was your last child born? ITOTA . . . . . . . . . . . . . . . . . . . . . . . . . HAS HAD NO CHILDREN NONTH . DK HONTH . 98 YEAR . .301 223 1 is your last child s t i " alive? lYEg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 224 I~nen your Mile became pregnant ,ith this last child, did THEN . 1 I I you want her to become pregnant then, did you Mant her to LATER . 2 I Malt until later, or did you not want her to become NOT AT ALL . 3 pregnant at all? H5 277 SE~TJOB 3: CONTRACEPTION 301 Now l would Like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy , Which w~*ys or methods have you heard about? CIRCLE CODE I IN 302 FOR EACH METHYl MENTIONED SPONTANEOUSLY THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND COOE ] IF NOT RECOGNIZED. THEN {:HECK IN 30] IF HE HAS EVER HAD SEX. IF NO, GO TO 401. IF YES, GO ON WITH 304. THEN, FOB EACH METHOD ~I"H CODE 1 OR Z CIRCLED IN 302, ASK 304 BEFORE PROCEEDING TO THE NEXT METHOD. 1[ PILL W~n can take a pill every day. 302 Have you ever heard of (METHOD)? 1) READ DESCRIPTION OF EACH METHOD. YES/SPONTANEOUS . 1 YES/PROBED . 2 NO . ] 3 303 CHECK 210 :HAS NEVER HAD ~ [ ~ H A S HAD SEX &401 504 Have you ever used (METHOD) Nith anyone? YES . 1 NO . ., . , . . . Z O • IUD Women can have a Loop or coil YES/SPONTANEOUS . 1 YES . 1 placed inside them by a doctor or a YES/PROBED . 2 nurse. NO . 3~ NO . 2 INJECTIONS Women can have an injection YES/SPONTANEOUS . I YES . I by a doctor or a nurse which stops them YES/PROBED . Z From becoming pregnant fo r months. NO . 31 NO . 2 IMPLANTS Women can have 5 small rods YES/SPONTANEOUS . 1 YES . 1 placed in the arm by a doctor which can YES/PROBED . 2 prevent pregnancy for several years. NO . 31 flO . Z ~J DIAPHRAGM,FOAMING TABLETS. Woman can YES/SPONTANEOUS . 1 YES . 1 place a diaphragm, foaming tablet, YES/PROBED . 2 sponge, jetty, or cream inside NO . 37 NO . Z themselves before sexual intercourse. / .~J CONDOM Men cen use a rubber sheath YES/SPONTANEOUS . 1 YES . 1 dur ing sexual in tercourse . YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . 3 7 NO . 2 07~ FEMALE STERILIZATION Women can have an YES/SPONTANEOUS . 1 Has your wife ever had this operation to avoid having any more YES/PROBED . 2 operation? children. NO . 3 YES . 1 NO . 2 ~J MALE STERILIZATION Men can have an YES/SPONTANEOUS . 1 Have you ever had this operation? operation to avoid having any more YES/PROBED . 2 YES . 1 chitdren. NO . 31 NO . 2 ~J SAFE PERIOD, RHYTHM Every month th~bt a woman is sexually active the couptq~ YES/SPONTANEOUS . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 can avoid having sex on the days YES/PROBED . 2 of the month she is more Likely to get NO . 37 NO . 2 pregnant. ! WITHDRAWAL Men can be careful and ~Jlt YES/SPONTANEOUS . 1 YES . 1 out before climax. YES/PROBED . 2 NO . 3 7 NO . Z YES/SPONTANEOUS . I NO . (SPECIFY} (SPECIFY} 2) l~J Have you heard of any other ways or methods that wo~en or men can use to avoid pregnancy? YES . . . .1 NO . 2 YES., . . . . . ,1 NO . Z I AT LEAST ONE [~ =308 "YES" (EVER USED) 278 M6 HO. I QUESTIONS AND FILTERS 306 I Have you ever used anything or tried anything in any way I to de~ay or avoid having a child? I COOING CATEGORIES I SKIP NO . 2 +316 307 309 What have you used or done? CORRECT 304-305 (AND 302 IF NECESSARY) CHECK 303: MAN NOT MAN STERILIZED [~ STERILIZED I Are you currently doing so~thing or using any method to delay or avoid having a child? ffff[[JJJJJiffi:L hlh:iff,:E,E=!;,';;F;EffFffffiff ffliff JJffiff JJiL::,ff Li:: :~::q ='=!ffffffffffff~]~Jff] I YES . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~316 310 310A Which method ere you using? ~OTE: DO NOT ASK Q.310A IF THE MAN IS HOT STERILIZED) You have said that you had an operation that keeps you from getting a woman pregnant, Is that correct? IF RESPONDENT SAYS "NO", CORRECT 303-304 lAND 302 IF NECCESSARY). IF RESPONDENT CONFIRMS WITH A "YES", CIRCLE z08' FOR MALE STERILIZATION, PILL . 01 -1 IUO . 02 | INJECTIONS . 03 > IMPLANTS . 04 315 DIAPHRAGM/FOM4IMG TABLET/SPONGE.05 CONDOM . 06 FEMALE STERILIZATION . 07 | MALE STERILIZATION . 08 I SAFE PERIOO/RHYTNM . 09 WITHDRAWAL . 10 1.316 _y" 96 (SPECIFY) | OTHER 311 Where did the steritisation take place? IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE* PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE COOE. (NAME OF PLACE) PUBLIC SECTOR CENTRAL HOSPITAL . 11 PROVINCIAL HOSPITAL . 12 DISTRICT/RURAL HOSPITAL . 1] OTHER PUBLIC 16 (SPECIFY) MISSION FACILITY . 19 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PRIVATE DOCTOR . 23 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER 96 (SPECIFY) DK . 98 312 I Do you regret that (you/your wife)had the operation not to I YES . 1 I I have any (more) children? I NO . 2 ~314 ]1] Why do you regret the operation? I RESPONDENT WANTS ANOTHER CHILD . 01 WIFE WANTS ANOTHER CHILD . 02 SIDE EFFECTS . 03 CHILD DIED . 04 OTHER 96 (SPECIFY) 314 In what month and year was the sterilization performed? M7 279 NO. J QUESTIONS AND FILTERS J SKIP 315 ghere did you obtain (METHOD) the last time? 317 IF SOURCE IS HOSPITAL, HEALTH CEHTRE, OR CLINIC, MRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NANE OF PLACE) J COOING CATEGORIES PUBLIC SECTOR GOVERNMENT HOSPITAL/CLINIC . 11 RURAL/MUNICIPAL CLINIC . 12 RURAL HEALTH CENTRE . 13 ZNFPC MOBILE CL%NIC . 14 MOH MOBILE CLINIC . 15 ZNFPC CBD . 16 HOH CBD . 17 OTHER PUBLIC 18 (SPECIFY) MISSION FACILITY . 19 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PHARMACY . 22 PRIVATE DOCTOR . 23 CBD . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER PRIVATE SECTOR SHOP . 31 CHURCH . 32 FRIENDS/RELATIVES . 33 OTHER 96 (SPECIFY) Is your wife (or one of your ~ives)/regutar partner pregnantJ now? I I NOT CURRENTLY MARRIED AND I NOT HAVING A REGULAR PARTNER [~ ~319 I I YES . I l HO . 2 UNSURE . 8 ~319 318 320 When she became pregnant, did you wnnt her to become THEN . 1 pregnant then, did you want her to =dait until later, or did LATER . 2 you not want this pregnancy at all? NOT AT ALL . 3 I NEVER HAD SEX [-~ CHECK 302: KNOWS CONDOM I Y Now I need to ask you some more questions about sexual activity. The last time you had sex, was a condom used? DOES NOT KNOW CONDOM [~ I V NOW I ~eed to ask you s~)re questions about ;extmt activity. S~ ~n use a condom, which means that they I:4Jt a rubber sheath on their penis during sexual intercourse. The [a~t time you had Sex, M~S a Condom used? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 I 1.0, I 321 I Do you know where you can get condo~s? | YES . 1 | I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-----~323 M8 280 NO. I 322 Uhere is that? QUESTIONS AND FILTERS IF SOURCE IS BOSPITAL, BEALTB CENTER( OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE COOEo (NAME OF PLACE) 324 ? v I SKIP COOING CATEGORIES PUBLIC SECTOR GOVERNNEHT HOSPITAL/CLINIC . 10 RURAL/)4tJNI CI PAL CLINIC. . .11 ZBFPC CLINIC . 12 RURAL HEALTH CENTRE . 13 ZNFPC MOBILE CLINIC. . 14 NON MOBILE CLINIC. . .15 ZNFPC CBD . 16 ROH CBD . 1, OTHER PUBLIC 18 (SPECIFY) NISSION FACILITY. . 19 PRIVATE NEDICAL SECTOR PRIVATE NQSPITAL/CLIHIC . 21 PHARRACY . 22 PRIVATE DOCTOR . 23 CBD . 25 OTHER PRIVATE REDICAL 26 (SPECIFY) OTHER PRIVATE SECTOR SHOP . 31 CHURCH . 32 FR I ENDS/RELAT | VES . 33 OTHER 96 (SPECI FY~ NOT CURRENTLY MARRIED [-~ I Jnterc°urse?Wh°else?did you have sex withwa s it ~ith ;:ertaS~et~rmewaYs°Uihta:,t~xsU~leone I j~332 I SOMEONE WIFE . . 1 E L S E Z I i.v.,oo h.d sox , h,our I 32, I "aSIF YES: ~ condo, ,t .con .ny o f t , - or the~eao=t,.s?°°°as'°"~ I YES'yES'NEVER---.------. EACNS°~ETIRES''''''''''''''''TI'E . 1''''2''3 I 328 I Nave,. the;,OUlasthadfoorae× .,t,ks?a~o,e other than your .,re I YES . . 2 I 401 32, Sox~,*th itho.~o thparsonaast othoro~st,a,, you~ ,ifo have you ha~ I ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OF ~N~ONS ~,RURHER I 330 fromHOW manyyourtimeseife inhaVetheYOUtasthadGseXweeks?eJth someone apart I DK . . 98 NUMBER OF TIRES ~-~ I 332 I Nave you had sex with anyone in the last four weeks? I YES . . 2 m r 401 281 M9 NO. ~ GUESTIONS AND FILTERS m 333 I With hoM many persons have you had sex I in the test 4 weeks? I CODING CATEGORIES I SKIP DK . 98 How many times have you had sex with someone NUMBER OF TIHES . in the Last 4 weeks? DK . 98 335 Was a coq~Jom used on any of these (,ccasions? IF YES: Was i t each tin~ or son~tin~s? YES, EACH TIME . 1 m YES, BOIdETIHES . 2 I NEVER . 3 HI0 282 SECTION 4. FERTILITY PREFERENCES 402 CHECK 317 AND 201: WIFE (WIVES) NOT I '~ PREGNANT OR UNSURE OR MAN NOT CURRENTLY MARRIED r Now I have some questions about the future. Would you Like to have (a/another) child or would you prefer not to have any (more) children? WIFE PREGNANT 9 I Now I have some questions about the future, After the child your wife is expecting, would you Like to have another child or would you prefer not to have any more children? HAVE (A/ANOTHER) CHILD . 1 NO MORE/NONE . 2 SAYS WIFE CANIT GET PREGNANT. .3 UNDECIDED/DK . 8 ~406 r404 I 403 405 407 CHECK 317 AND 201: WIFE (WIVES) NOT IPREGNANT OR UNSURE OM HAM NOT CURRENTLY MARRIED r i How Long wo~td you Like to wait from now before the birth of (a/another) child? WIFE PREGNANT I N~ l~ l ~u ld y~ Like to wait after the birth of the child your wife is expecting before the birth of another child? MONTHS . 1 YEARS . 2 SOON/NOW . 993 SAYS WIFE CAHIT GET PREGNANT . 99~ AFTER MARRIAGE . 995 OTHER 996 (SPECIFY) OK . 998 WIFE PREGNANT OR MAN NOT CURRENTLY MARRIED [~ If your wife became pregnant in the next few weeks, would I HAPPY . 1 you be happy, unhal~Oy, or would it I UNHAPPY . 2 not miter very much? N~)ULD NOT MATTER . 3 CHECK 309: USING A METHO0? I NOT vE ~ NOT ~ CURRENTLY ASKED CURRENTLY USING USING , l l l l l l l DO you in tend to use a method to de lay or avoid pregnancy I within the next 12 months? I 7 ~o6 I YES . 1 ~409 NO . 2 | DK . 8 I 408 I Do you intend to use a method at any time in the future? ] YESNo . . 21 J OK . 8 ~ ~.410 409 Which method would you pre fer to use? PILL . 01 - ]UD . 02 INJECTIONS . . . . . . . . . . . . . . . . . . . . . . . . 03 IMPLAWTS . . . . . . . . . . . . . . . . . . . . . . . . . . 0/* DIAPHRAGM~FOAM~JELLY . . . . . . . . . . . . . . 05 CONDOM . 06 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 SAFE PERIO0 . 09 WITHDRAWAL . 10 OTHER 96 (SPECIFY) UNSURE . 98 ~413 Mll 283 NO. OUESTIONS AR[~ FILTERS CODING CATEGORIES S~IP 410 What is the main reason you never i~tend to use a method? Wou(d you ever use a method if you were married? NOT NARRIEO . 11 FERTILITY-RELATED REASONS INFREQUENT SEX . 22 WIFE MENOPAUSAL/NYSTERECTOHY . 23 SUBFECUND/INFECUND . 24 WANTS MORE CHILDREN . 26 OPPOSITION TO USE RESPONDENT OPPOSED . 31 WIFE OPPOSED . 32 OTHERS OPPOSED . 33 RELIGIOUS PROHIBITION . 34 LACK OF KNOWLEDGE KNOWS NO METHO0 . 41 KNOWS NO SOURCE . 42 METHOO-RELATED REASONS HEALTH CONCERNS . 51 FEAR OF SIDE EFFECTS . 52 LACK OF ACCESS/TO0 FAR . 53 COST TOO MUCH . 54 INCONVENIENT TO USE . 55 INTERFERES WITH BOOY'B NORMAL PROCESSES . 56 OTHER 96 (SPECIFY) DK . 98 CODE 11 NOT CIRCLED 412 I YES . 1 RO . . . . . . . . * . . . . . . . . . . . . . . . * . . . . . . . 2 DK . . . . . . . . , . . . . . . . . . . . . ,oo . . . . . . , . . 8 l~413 I I 413 CHECK 214 AND 216: HAS LIVING CHILDREN / I If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, hoe many would that be? PROBE FOR A NUMERIC RESPONSE. v-n NO LIVING CHILDREN L.~ / I If you could choose exactly the number of children to have in your whole life, how many would that be? HUMBER . . . . . . . . . . . . . . . . . . . . . . . . ~ J OTHER 96 ~----415 (SPECIFY) I 614 How many of these children would you like to be boys and how many would you like to be girI~;? soYs OIRLS EIT,ER ] NUMB, . ~- -~ 7~--~ ~--~ 999996 OTHER (SPECIFY) 415 I Do you approve or d|sapprove of coJples using a method J APPROVE . 1 I of family planning to avoid Betting pregnant? DISAPPROVE . 2 NO OPINION . 3 ~41T 4,61 N.y. y~ ev.r r~--nd~ ,amily PLa~ins to. frie~. IYES . L I relative, or anyone else? NO . 2 M12 284 .o I QUESTIONS AND FILTERS 417 [ Is it acceptable or not acceptable to you for information I on family planning to be provided: On the radio? On the television? By a CBD? I COOING CATEGORIES I SKIP NOT J ACCEPT" ACCEPT- ABLE ABLE OK RADIO . 1 2 8 TELEVISION . 1 2 8 CBO . 1 2 8 418 In the last six e~onths have you heard or ~earned about family planning: On the radio? On the television? In a newspaper or magazine? From a pester? From leaflets or brochures? From a CBD? YES NO RADIO . 1 2 TELEVISION . 1 2 NEWSPAPER OR MAGAZINE . 1 2 POSTER . 1 2 LEAFLETS OR BROCHURES . 1 2 CSD . 1 2 419 I In the last six months have you discussed the practice of I YES . 1 | fmily planning with your friends or relatives? NO . 2 ~421 420 With whom? Anyone else? RECORD ALL MENTIONED. WIFE . k MOTHER . B REGULAR PARTNER (NOT WIFE) . C FATHER . D SISTER(S) . E BROTHER(S) . F DAUGHTER . G MOTHER-IN-LAW . H FRIENDS . I OTHER X (SPECIFY) 421 423 I Do you think met , s~, or none of the men you know use some kind of family planning? Row I want to ask you about your wife's vie~ on family planning. NO, ROT CURRENTLY MARRIED Do you think that your wife approves or disapproves of couples using a ~thod to avoid pregnancy? I MOST . 1 SOHE . 2 NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] DK . 8 I APPROVES . 1 DISAPPROVES . 2 DK . • . . . . . . . . . . . . . . . . . . .+o.ow8 I II'°ll I '2 ' I Nave Y°U'nd y°ur wife "" r dis°u" the nu ' r ° ' I YES . '1 children you would like to have? NO . 2 425 Do you think your wife wants the same number of children I SAME NUMBER . 1 that you want, or does she want more or fewer than you I MORE CHILDREN . 2 want? FEWER CHILDREN . 3 DK . 8 M13 285 SECTION 5. AIDS AND SEXUALLY TRANSMITTED DISEASES NO. I QUESTIONS AND FILTERS I CODING CATEGORIES I SKIP 501 I Have you heardthro~Jgh sex ? about diseases that can be transmitted I YES . . 2 | ~514 502 504 Which diseases have you heard about? RECORD ALL RESPONSES During the Last 12 m~tha# did you P,ave any of these diseases? SYPHILIS. . .A GONORRHEA . B AIDS/NIV INFECTION . C GENITAL t/ARTS / CONOVLOMATA . O CHANCROID . E OTHER W OTHER X (SPECIFY) OK . Z I , m 1,5,31 [ 505 ~ich? RECORD ALL RESPONSES SYPHILIS . .A GONORRHEA . B AIDS/HIV INFECTION . C GENITAL WARTS / CONDYLOMATA . O CHANCROID . E OTHER W OTHER X (SPECIFY) DON'T KNOW . Z 506 1 During a discharge(he laStfrom12yourmOnthS,penis?did you have I YES . . . ? O K 8 J 507 I Ourings sore theor ulcer |mat 12on nx>nthS,you r penis?did you have I YES . . . 8 I 509 Where did you seek advice or treat•.=nt? Any other place or person? RECORD ALL MENTIONED PUBLIC SECTOR CENTRAL HOSPITAL . A PROVINCIAL HOSPITAL . B DISTRICT/RURAL HOSPITAL . C RURAL HEALTH CENTRE . D RURAL/MUN I C( PAL CLINIC . E VILLAGE COMMUNITY gORKER . F OTHER PUBLIC SECTOR . G (speci fy) MISSION HOSP ITAL~CL IN IC . . . . . . . . . . . . H PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . l PHARMACY . J PRIVATE DOCTOR . K VILLAGE COMMUNITY WORKER . L OTHER MED. PRIVATE SECTOR . M (specify) OTHER PRIVATE SECTOR SHOP . N RELATIVES/FRIENDS . 0 TRADITIONAL HEALER . P OTHER X (specify) 286 M14 , o I OUES,,oNs ,NO E,LTERS I 510 | When you had (OISEASE of 505. 506, 507) did you advise your | I partner to seek treatment? I CODING CATEGORIES J SKIP l YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I NO . . . . ° . o . , . . . . . ,. . . . . . . . o. . . . . . . . 2 I 5111 I/nen you hed (DISEASE of 505, 506, 507) did you do J YES . 1 | s~clth~n9 not to infect your partner? RO . 2 PARTNER ALREADY INFECTED . ]t =513 512 I 5% k~st d|d you do? RECORD ALL MENTIONED NO SEXUAL INTERCOURSE . A USED CONDOMS . B RECEIVED MEDICAL TREANENT . C OTHER X (SPECIFY) MENTIONED 'AIDS' F~ I I Have you ever heard of an ittness catted AIDS? | YES . 1 | I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~531 515 Frm which sources of information have you teamed most about AIDS? Any other sources? RECORD ALL MENTIONED RADIO . A T V , o , ° , . . , , , o . . . . . . . ° . . . . . . . °° . . . . B NEWSPAPERS/MAGAZINES . C PAMPLETS/POSTERS . D HEALTH WORKERS . E MOSQUES/CHURCHES . F SCHOOLS/TEACHERS . G COMMUNITY MEETINGS . H FRIENDS/RELATIVES . l WORK PLACE . J OTHER . X (SPECIFY) 516 How can a parson get the AIDS virus? Any other ways? RECORD ALL MEHTIONEO SEXUAL INTERCOURSE . A SEX WITH PROSTITUTES . B HOMOSEXUAL CONTACT . C SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS . O BLDO0 TRANSFUSION . E iNJECTiONS . F KiSSIHG . G MOSQUITO SITES . H OTHER W (SPECIFY) OTHER X (SPECIFY) DK . Z 517 I Is there anyth'ng " pers°n can d° t° av°id getting the AIDS I Y E S v i r u s ? NO . . 21 , OK . 8 t L521 518 What can a parson do to avoid getting the AIDS virus? Any other ways? RECORD ALL MENTIONED SAFE SEX . A ABSTAIN FROM SEX . B USE CONDOMS DURING SEX . C AVOID MULTIPLE SEX PARTNERS . D AVOID SEX WITH PROSTITUTES . E AVOID SEX WITH HOMOSEXUALS . F AVOID BLDOD TRAHSFUSiONS . G AVOID INJECTIONS . H AVOID KISSING . ] AVOID MOSQUITO BITES . J SEEK PROTECTION FROM FROM TRADITIONAL HEALER . K OTHER W (SPECIFY) OTHER X (SPECIFY) DK . Z 287 M15 What does "safe sex" mean to you? 520 RECORD ALL NENTIORED ABSTAIN FRO/4 SEX . A USE CONDORS DURING SEX . B AVOID MULTIPLE SEX PARTNERS . C AVOID SEX gITH PROSTITUTES . D AVOID SEX WITH HOMOSEXUALS . . . . . . . . E OTHER X (SPECIFY) DK . Z '~'1 '" '~ ~°"'~'''°~''~~°°~'°' ~'°~ ~° ~" I ~ . '1 the AIDS virus? NO . 2 DK . . . .8 disease? NO, EVERYONE ~ITH AIDS DIES . 2 DK . 8 ~1 ~'° ~'''°' ~'~°~ ~ ~-°'"~'~ ~'~ ~° °~''° I ~ . I during pregnancy or childbirth? NO . 2 DR . 8 ~1 °° ~ ~-u~ ~'-°~ ~° ~''''°~ °~ I ~" . I has died of AIDS? NO . 2 DR . 8 I . '1 home, cared for in a medical facility, or Left alone to take MEDICAL FACILITY . 2 care of himself/herself? LEFT ALONE . 3 OK . 8 5261 Do you think your chances of gettins the AIDS virus are I NO RISK AT ALL . 1 I small, moderate, great, or no risk at all? J SHALL . 2 I I MODERATE . 3 GREAT . ~| .528 527 Why do you think that you have (NO HISK/A SMALL CHANCE) of getting the AIDS virus? Any other reasons? RECORD ALL MENTIONED ABSTAIN FROH SEX . A USE CONDO~IS DURING SEX . B HAVE ONLY ONE SEX PARTNER . C LIMITED NUMBER OF SEX PARTNERS.D NO HOMOSEXUAL CONTACT . E NO BLOOD TRANSFUSIONS . F NO INJECTIONS . G OTHER K (SPECIFY) DR . Z . ~529 528 ~hy do you think that you have a (M(OERATE/OREAT) chance of setting the AIDS virus? Any other reasons? RECORD ALL MENTIONED DO NOT USE CONDOMS . A MULTIPLE SEX PARTNERS . B SPOUSE HAS MULTIPLE PARTNERS . C HOMOSEXUAL CONTACT . D HAD BLOOD TRANSFUSION . E HAD INJECTIONS . F OTHER X (SPECIFY) DK . Z 529 | Since you heard of AIDS, have you changed your | YES . 1 | I behavior to prevent setting the AID,~I virus? I NO . 2 ~-~ 531 M16 288 NO. I 530 ~1~at did you do? Anything else? Anything else? RECORD ALL NENTIO!~ED QUESTIONS AND FILTERS COOING CATEGORIES STOPPEO ALL SEX . A STARTED USING CONDONE . D RESTRICTED SEX TO ONE PARTNER . C REDUCEO NUMBER OF PARTHERg . O NO NORE HOMOSEXUAL CONTACTS . E STOPPED INJECTIONS . F OTHER X (SPECIFY) O H . . . o o . . . . . o . . . . . °°° . . . . . ° . . . . . . °Z I SKIP 531 533 Some people use a condom during sexual intercourse to avoid getting the AIDS virus or other sexually transmitted diseases. Have you ever heard of this? V Have you ever used a condom during sex to avoid getting or transmitting diseases, such as the AIDS virus? YES. . . . • . • . ,.1 NO.,. . . . . . .° . 2 HAS NEVER HAD SEX I ~6011 I YES . 1 NO. . . . . . o. . . . . . o . . . . . . . . . . . . . . . . . 2 534 Have you given or received money, gifts or favours in return for sex at any tinge in the test 4 weeks? YES . 1 N O . , . , . . . , , , . . . . . ,. . . . . o . . . . . . . . . . ~ M17 289 SECTION (,. MATERNAL MORTALITY 601 J Now I Would like to ssk you some questions about your brothers end sisters, that is, all of the children born to your natural ~other, including those who are living with you, those living elsewhere, and those who have di<~. How many children did your mother give birth to, including you? CHECK ~01: TWO OR MORE BIRTFIS ONLY ONE BIRTH (RESPONDENT ONLY) ( I ~ SKIP TO 615 NUMBER OF PRECEDING BIRTHS . I l l I l l 603 | How many of these births did your mother have before you were I born? 604 What was [1] [2] [3] [4] [5] [6] [7] the name given to your oldest {next oldest) brother or sister? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , , [ ] , (>05 Is (~JU4E) MALE . 1 MALE . 1 HALE . 1 MALE . 1 MALE . 1 MALE . 1 HALE . 1 maie or female? FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 [ i ¢ i i i i 606 Is (NAME) !YES . I YES . I YES . I YES . I YES . I YES . I YES . I still alive? NO . 21 NO . 21 NO . 21 NO . 21 NO . 21 NO . 21 NO . 2 l GO TO 608< J GO TO 6OD<J GO TO 608< J GO TO 608< J GO TO 608<J GO TO 608< J GO TO 6O8<J DK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . DK . x 607 How old is ; GO TO [2] GO TO i31 GO TO [4] GO TO i5] GO TO [6] GO TO [7] GO TO [8] ! 608 Now many (NAME) die? 609 How Did she/he died? IF MALE OR DIED BEFORE 10 YEARS GO TO [2] IF MALE OR DIED BEFORE 10 YEARS GO TO [3] ==========~== IF HALE OR DIED BEFORE 10 YEARS GO TO [4] IF MALE OR DIED 6EFORE 10 YEARS GO TO [5] iF MALE OR DIED BEFORE 10 YEARS GO TO [6] ===¢========= IF MALE OR DIED BEFORE 10 YEARS GO TO [7] iF MALE OR DIED 6EFORE 10 YEARS 60 TO [8] ============= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = ~ = = = = = = = = ~ = = = = = ~ = = = = = = = = = = = = = ~ = = = = ~ = = = = = = ~ = = = = = = ~ = = = = = = 610 D~d (NAME) YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 die during GO TO 614< '] GO TO 614<'] GO TO 614<'] GO TO 614< '] GO TO 614< -~ GO TO 614< '] GO TO 614<'] childbirth? NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 611 Was (NAME) YES . I] YES . I] YES . ,]I YES . ,]I YES . '11 YES . ,]I YES . I ,] pregnant when GO TO 613( ~ GO TO 613< ~ GO TO 613< ~ GO TO 613< ~ GO TO 613< J GO TO 613< ~ GO TO 613< ~ ishe died? NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 I I I 612 Did (NAME) I die within six IyES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 weeks after the erK~ of a NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 pregnancy or I childbirth? J , , , , , i 1613 Did (MANE) YES . 1 YES . 1 YES . 1 YES . 1 YES . I YES . 1 YES . 1 die because of complications NO . 2] NO . 2] NO . 2] NO . 2] NO . 2] NO . 2] NO . 2 1 of pregnancy GO TO [2]< J GO TO [3]< 3 GO TO [4] <J GO TO [5]< J GO TO [6]< ~ GO TO [7]< J GO TO [8]<J or childbirth? = DK . 8 OK . 8 DK . 8 DK . 8 DK . 8 OK . 8 DK . 8 614 How many children had birth to beforel that pregnancy? 290 M~8 [8] [9] [10] [11] [12] [13] [14] 604 What was the name given to your oldest (next oldest) brother or . sister? i i i i 605 Is (NAME) MALE . 1 MALE . 1 MALE . 1 MALE . 1 MALE . 1 male or female? FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 i i i i i 606 Is (NAME] YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 stilt alive? NO . 21 NO . 21 NO . 21 NO . 21 NO . 21 NO . 21 NO . 27 GO TO 608< J GO TO 608< J GO TO 608< J GO TO 608< J GO TO 608< J GO TO 608< J O0 TO 608< J OK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . DK . . . . . . . . . <8] GO TO [9]< 8] GO TO [10]< 8] O0 TO [11]< 8] 60 TO [12]< 8] GO TO [13]< 8] GO TO [14]< 8] GO TO [15] 607 Bow old is i GO TO [91 O0 TO [101 GO TO [11] GO TO [12] GO TO [131 GO TO [141 GO TO [15] 608 HOW many i ye'rs"°did F--F ] I--] ] I F ]--] F I 1 (NAME) die? 609 How old she/he died? 610 Did (NAME) die dur ing childbirth? 611 Was (NAME) pregnant when she died? 612 Did (NAME) die within six weeks after the end of a pregnancy or childbirth? 613 Did (NAME) die because of complications of pregnancy or childbirth? 614 How many children had (NAME) given birth to before that pregnancy? 1F MALE OR DIED BEFORE 10 YEARS GO TO [9] ====~z======= YES . 1 GO TO 614<'] NO . 2 IF MALE OR DIED BEFORE 10 YEARS GO TO [10] YES . 1 GO TO 614<'] NO . 2 YES . l-,iYEB . 1 'l GO TO 613< -i O0 TO 613< J RO . 2 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 l GO TO [9] <J YES . 1 NO . 2 YES . 1 NO . 2 GO TO [10]<] IF MALE OR DIED BEFORE 10 YEARS GO TO [11] YES . 1 GO TO 614<'] NO . 2 YES . 1 GO TO 613< -~ NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 GO TO [111 <] IF MALE OR DIED BEFORE 10 YEARS GO TO [12] YES . 1 GO TO 614< '] NO . . . . . . . . . 2 YES . 1 GO TO 613<'] i i MALE . 1 MALE . 1 i i YES . 1 YES . 1 IF MALE OR IF MALE OR DIED BEFORE DIED BEFORE 10 YEARS 10 YEARS O0 TO [13] GO TO [14] i = = = = = = = = = = = = = = = = = = = = = = = = = = = YES . 1 YES . 1 GO To 614<'] GO TO 614<'] IBO . 2 ~RO . 2 I !YES . 1 YES . 1 GO TO 613< '] GO TO 613< '] IF MALE OR DIED BEFORE 10 YEARS GO TO [15] YES . 1 GO TO 614<'] MO . . . . . . . . . 2 YES . . . . . . . . I GO TO 613< 'l WO . . . . . . . . . 2 NO . . . . . . . . . 2 NO . . . . . . . . . 2 NO . . . . . . . . . 2 YES . 1 YES . 1 NO . 2 NO . 2 YES . 1 YES . 1 YES . 1 MO . 2 )K . 8 )K . . . . . . . . . 8 OK . 8 YES . 1 WO . 2 YES . 1 NO . 2 GO TO [12]<] YES . 1 /~0 . . . . . . . . . 2 NO . . . . . . . . . 2 NO . . . . . . . . . 2 GO TO [13]< ] GO TO [14]< ] GO TO [151< ] OK . . . . . . . . . 8 OK . 8 OK . B OK . . . . . . . . . 8 RECORD THE TIME. M19 291 comments about Respondent: iNTERVIEWER'S OBSERVATIONS To be fitted in after completing interview COl'gll'~Qnt B or'i Specific Questions: Any Other Comments: SUPERVISOR~S OBSERVATIONS Name of Supervisor: Date: ED|TORmS OBSERVATIONS Name of Ed i to r : Date: M20 292 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY CENTRAL STAT IST ICAL OFF ICE SERVICE AVAILABIL ITY QUEST IONNAIRE IDENTIF ICAT ION WARD/V ILLAGE NAME CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (urban=l , ru ra l =2) . . . . . . . . . . . . . . . . . . . . . INTERVIEWER NAME SUPERVISOR NAME F IELD EDITED BY NAME DATE DATE OF V IS IT OFF ICE EDITED BY DAY MONTH Y EAR NAME NAME KEYED BY KEYED BY 293 SECTIOM1A. CONt4UNITY CHARACTERISTICS NO. I QUESTIONS ] COOING CATEGORLES [ SKIP TO TYPE OF LOCALITY (in which cluster is fetid) I 101 RAIN TOWN . 1 = 106 OTHER URSAN . 2 = 106 RURAL . ] I I 102 103 104 105 106 107 108 108a 108b Whet is the nmne of the nearest urban center? Now far is it in kilometers to the nenrest urban center? KN. TO NEAREST URBAN CENTER . IIII Set is the mast comnonLy used type of transportation to go to the nearest urban center? NOTOR]ZED . . . . . . . . . . . . . . . . . . . . . . . 1 ANLNAL . 2 WALKING . ] CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER ,.5 Whet is the main access route to (THIr; LOCALITY)? ALL WEATHER ROAD . 1 SEASONAL ROAD . 2 RIVER/RAILWAY . 3 PATH . 4 i J Whet are the major economic activitie; of (LOCALITY'S) inhabitants? RECORD THREE ACTIVITIES Is there telephone service in (LOCALITY)? Sometimes children who play normally in the day have difficulty seeing and moving around in the twilight and after the sun goes doun. In the evening these ch i ld ren may sit alone, hold onto their mother's clothes, be unable to find their toys, or see to eat. Are you familiar with this condition? What do you call this condition? TRY TO GET THE LOCAL N/tHE OF THIS DISEASE AGRICULTURE . A LIVESTOCK . B FLSHIHG . C TRADiNG/NARKETLNG . D NANUFACTURING . E NLNING . . . . . . . . . . . . . . . . . . . . . . . . . . F OTHER .G YES . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . 1 NO . 2 - Do you know of any children in the community who have this condition in the past month? YES . 1 NO . 2 1-1 109 294 No. 109 QUESTIONS COOING CATEGORIES SKIP TO Ptesse tett me if the fottouing things are in the (LOCALITY) Is there a primary echoot here? Is there a secondary school here? Is malt detivered here? Is there a cinema here? Is there a bank here? Is there regular pubtJc transportation here? KILl'METERS PRIMARY $Ct~OOL . SECONDARY SCHOOL . POSTAL SERVICE . CINEMA . BANK . PUBLIC TRANSPORTATION . ~ - ~ NOTE: FOR EACH I IF IN LOCALITY+ RECORD "DO". IF NOT IN LOCALITY, ASK HOW FAR. RECORD IN KILO/tETER$. IF DO HOT KNOW, WRITE "98". IF MORE THAN 97, RECORD "97". 1-2 295 SECTION lB. HEALTH AND FAMILY PLANNING PROGRAMS IN THE CO~4UNXTY NO. 110 11De 110b 110c 110¢ 111 111e 111~ 112 112a OUESTZONS COOING CATEGORIES SKIP TO ODes a coenmunity-based distributor (CBD) of family planning YES . I methods and information operate in [LOCALITY]? NO . 2 ; 111 How often does a CSD visit? go. OF TIMES I I I PEg MONTH.I I I I YEAR.2 Does the CBD provide family planning counselling? YES . 1 NO . 2 Are the following methods available from the family planning field worker? a: Pitt? b: condom? c: Vaginal Methods? PILL: YES . 1 MO . . . 2 CONDOM: YES . 1 NO . . . .°~ VAGIMALS: YES . 1 NO . 2 Now many CGDs operate in this area ? TOTAL NO. OF CGOs . How many are 2NFPC workers ? NO. OF ZNFPC CBDs . How many are MOHCW workers. ? NO. OF MOHCW CBDs . Is this area visited regularly by a nx,bile family planning YES . 1 clinic operated by ZMFPC? NO . 2 ~ 112 How often does this mobile clinic visit [LOCALITY]? r ~ NO. OF TIMES Ill PER MONTH.1 I I I YEAR.2 Are the following methods available from the ZNFPC mobile clinic? a: Pill? b: IUD? c: Condo~s? d: Injection? e: Vagina[ Methods? PILL: YES . 1 NO. . . . 2 IUO: YES . 1 CONDOMS: YES . 1 NO . 2 INJECTION: YES . 1 NO . 2 VAGIMALS: YES . 1 NO . .° . .2 Is this area visited regularly by a n~)bile family planning YES . 1 clinic operated by an organisation other than ZNFPC? NO . 2 ~ 113 Now often does this mobile clinic visFt [LOCALITY]? r ~ NO. OF T%MES I l l PER MONTH.1 I I I YEAR.2 1-3 296 Wo. 112b OUESTIONS CGOING CATEGORIES SKIP TO Are the foLLowing ~eth~s avaiLabLe from the mobile clinic not operat~d by 2NFPC? a: PILL? b: IUD? c: condoms? d: Injecti~? e: Vaginal Nethods? PILL: YES . 1 NO.°°° . o.°o., . o,.2 IUD: YES . 1 NO . ,,,.,,.,.oo . ,,.2 CONDOHE: YES . 1 NO . 2 INJECTION: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . 2 VAGINALS: YES . 1 NO . 2 1-4 297 No. 113 113~ 114 114a 114~ QUESTIONS CODING CATEGORIES SKIP TO Is there a traditional midwife who is available to women in YES . 1 [LOCALITY] to assist during delivery~ NO . 2 - • 114 Was the tradftiona[ midwife had any special training YES . 1 from the government or Ministry of Health or other NO . 2 organization? DON'T KNO~ . 8 i Does a village community worker regularly operate in [LOCALITY]? YES . 1 SECT]OI NO . 2 - • 2 Does the vitinge community worker pro,vide: a: Basic medications? b: Advice on water and sanitation? c: Pro~otion of breastfeeding? d: Advice on inc~(ne generation? e: Advice on antenatal care? f: Advice on i~isations? g: Advice on family planning service~;? BASIC MEDICATIONS: YES . 1 NO . 2 WATER AND SANITATION: YES . 1 NO . .o . ,, . ,2 BREASTFEEDIHG PROMOTION: YES . 1 NO . INCOME GENERATION: YES . 1 NO . 2 ANTENATAL CARE: YES . 1 NO . 2 IMMUNIZATIONS: YES . 1 NO . 2 FAMILY PLANNING: YES . 1 NO . 2 Mow often does the village comgt~nity worker visit? , NO. OF T]MES I I I PER MONTH. 1 I I I YEAR.2 1-5 298 SECTION 2. FACILITY IDENTIFICATION SECTION What is the name of the doctor with a private practice who is nearest to [LOCALITY]? What is the name of the nearest private pharmacy to [LOCALITY]? What is the name of the nearest rural health center providing general health services to [LOCALITY]? [RURAL CLUSTERS ONLY) What is the name of the nearest clinic providing general health services to [LOCALITY]? What is the name of the nearest hospital providing general health services to [LOCALITY]? 2-1 299 A. PRIVATE DOCTOR ~0. ~201 1202 k203 k204 k205 k206 t207 Z208 ~209 ~210 QUESTIONS NAME OF PRIVATE DOCTOR (COPY FROM SECTIOM 2, COVER PAGE). COOING CATEGORIES PRIVATE DOCTOR'S NAME SKiP TC NONE KNOWN . 98 --~ B201 How far is it (In kms) from here? r - ~ KILOMETERS . I I r (~A~ITE IN ~OO ~ IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OF~ MORE, RECORD ~97 ~, i What is the most coax~ type of transi~rt to the doctor's practice? Now toni does it take to get from here to [PRIVATE DOCTOR'S NN4E] using [THE HOST COMMON NODE OF 1RANSPORT]? Does this private doctor provide : antenatal care? delivery care? child [mmunisation? family planning services? MOTORIZED (E.G. BUS) . 1 CYCLING . 2 ANIMAL . ] WALKING . 4 OTHER 5 NOURS . II MINUTES . J ~ ] YES NO DK ANT[NATAL CARE . 1 2 8 DELIVERY CARE . I 2 8 CHILD IMMUNISATION.1 2 8 FAMILY PLANNING . 1 2 8 L PRIVATE DOCTORIE NAME Who is the nearest doctor w[th a priva+te practLce who provides family planning services to this comnR,tty? A210 NOTE: Doctor's practice other than the one mentioned in A201. . DON'T KNOW . 98 - ~,- A210 HOW far is i t (in kms) from here? KILOMETERS . I I r (WRITE IN IDOl IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OF MORE, RECORD a97'.) What is the most coition type of transi~rt to the doctor's practice? MOTORIZED (E.G. BUS) . 1 CYCLING . 2 ANIMAL . 3 WALKING . 4 OTHER 5 How tong does it take to get from her(, to [PRIVATE DOCTOR'S I I NAME] using [THE MOST COt4MON MOOR OF 1RANEPORT]? HOURS . I I MINUTES . How many private doctor practices in lotat are there within NO. PRIVATE DOCTORS ]O kilometers? WITHIN ]0 KM . I I I 2-2 300 B. PHARMACY qO. |201: J202 3203 |20& 1205 1206 1207 1208 1209 1210 1211 1212 QUESTIONS NAME OF PHARMACY (COPY FROM SECTION 2 COVER PAGE). CODING CATEGORIES PHARMACY NAME NONE KNOWN . 98 -~ C201 i Is that a government pharmacy or ts it operated by a GOVERNMENT . 1 non-government organization ? NON-GOVERNMENT . 2 HOW far is it (in kms) from here? KILOMETERS . ~-~ (WRITE IN '00 ~ IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD 197% i What is the most co¢~ type of transport to the pharmacy? MOTORIZED (E.G. BUS) . 1 CYCLING . 2 ANIMAL . 3 WALKING . 6 OTHER 5 HOW tong does it take to get from here to (PHARMACY NAME) using [THE NOST CO~IHON MODE OF TRANSPORT]? HOURS . ; MINUTES . . . . . . . . . . . . . . . . . . . . J i Does this pharn~cy seLL or provide family planning supplies? YES . 1 -~ 8212 NO.,.,.,,.,.,.**.,,,, . 2 DON'T KNC~4 . 8 What is the name of the nearest pharmacy which seLLs family PHARMACY planning supplies to this com~nity? NAME DOR~T KNOW . 98 -~ 8212 Is that a government pharmacy or is it operated by a GOVERNMENT . 1 non-government organization ? NON-GOVERNMENT . 2 How far is it (in kms) from here? I ~ KILOHETERS . I I r (WRITE IN 'DO' IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOHETERS OR MORE~ RECORD =97=. i What is the most common type of transport to the pharmacy? MOTORIZED (E.G. BUS) . 1 CYCLING . 2 ANIMAL . 3 WALKING . 4 OTHER 5 Now tong does it take to get from here to (PHARMACY NAME) using [THE HOST COHHON NODE OF TRANSPORT]? HOURS . MINUTES . How many private pharmacies in total are there within ]O NO. PHARMACIES kilometers? WITHIN 30 KM . I I I SKIP TO 2-3 301 C. RURAL HEALTH CENTER (ONLY RURAL CLUSTERS) No. C201 C202 C203 C204 ;205 ~206 ;207 3208 :209 ;210 ;211 ;212 :213 QUESTIONS NAME OF RURAL HEALTH CENTER (COPY FROM SECTION 2 COVER PAGE), COOING CATEGORIES SKIP TO RURAL HEALTH CENTER NAME NONE KNOWN . 98 ---p i Is that a government health center or is it opearated by a GOVERNMENT . 1 non-government organization? NON-GOVERNMENT . 2 How far is it (in ~) from here? KILG~4ETERS . I l l (WRITE IN =00 M IF LESg THAN 1 KILOMETER. IF 1 TO 96 KILOI4ETERS, RECORD THE NUMBER. IF 97 KILOMETERS O~ MORE, RECORD ~97' . ) i gnat is the most common type of transoort to the health center? MOTORIZED (E.G. BUS) . 1 How Long ~es it take to get from her,~ to (HEALTH CENTER NAME) using [THE MOST COMMON ROOE OF TRANSP)RT]? Does this rural health center provide : antenatal care? delivery care? growth promotion? child immunisation? family planning services? CYCLING . 2 ANI~L . 3 WALKING . 4 OTHER 5 HOURS . MINUTES . YES NO DK ANTENATAL CARE . 1 2 8 DELIVERY CARE . 1 2 8 GROWTH PRC~4OTION . I 2 8 CHILD IMMUNISATION.1 2 8 FAMILY PLANNING . 1 2 8 L HEALTH CENTER NAME What is the name of the nearest rural health center providing family planning services to this con~ality? D201 C213 WALKING . 4 OTHER 5 Now long does it take to get from here~ to (HEALTH CENTER NAME) using [THE MOST COMMON NCX)E OF TRANSPEIRT]? Does this health center provide : YES NO DK antenatal care? ANTENATAL CARE . 1 2 8 delivery care? DELIVERY CARE . 1 2 8 growth promotion? GR(~JTH PROHOTION . 1 2 8 child inTnunisation? CHILD IMMUNISATION.1 2 8 i How many rural health centers in total are there within NO. HEALTH CENTERS 30 kilometers? WITHIN 30 KM . I l l 2-4 3O2 HOURS . MINUTES . CYCLING . 2 ANIMAL . 3 NONE KNC~N . . . . . . . . . . . . . . . . . . . . . . . . 9B ---~ C213 t Is that a government health center or is it operated by a GOVERNMENT . I non-goverr~nt organization? NON-GOVERNMENT . 2 HOW far is it (in kms) from here? KILOMETERS . I I I (WRITE IN '00' IF LESS THAN 1 KILOHETER. IF 1 TO 96 KILOtlETERS, RECORD THE NUMBER. IF 97 KILOHETERS Oft 1~3RE, RECORD =97~.) i ghat is the most common ty~oe of translmrt to the health center? MOTORIZED (E.G. BUS) . 1 D. CLINIC NO. )201 ~202 )203 E)204 )205 )206 ]207 QUESTIONS NAME OF CLINIC (COPY FROM SECTION 2 COVER PAGE) COOING CATEGORIES CLINIC NAME NONE KNOWN . 98 ---P, E201 I is that a government clinic, is |t operated by ZNFPC, or is GOVERNMENT . 1 l it operated by some other non-government organization? ZNFPC . 2 I OTHER ORGANIZATION . 3 HOW far is it (in kms) from here? KiLOHETERS . ~ (~iTE IN 'DO' IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOI4ETERS OR MORE, RECORD '97M,) What is the ~ost c~n type of t ranspor t to the cL in ic? flow tong does it take to get from here to (CL]NIC NAME) using [THE MOST COt4HON NOOE OF TRANSPORT]? Does this clinic provide : antenatal care? delivery care? growth promotion? child immunisation? family planning services? What is the name of the nearest clinic providing fami|y planning services to this community? )208 Is that a government clinic, is it operated by ZNFPC, or is it operated by some other non-government organization? )209 )210 )211 MOTORIZED (E.G. BUS) . 1 CYCLING . 2 ANIMAL . 3 WALKING . 4 OTHER 5 HOURS** . . . . . . . . . . . . . . . . . . . MINUTES . )212 )213 m L YES NO DK ANTENATAL CARE . 1 2 8 DELIVERY CARE . 1 2 8 GROWTH PROT~OTiON . 1 2 8 CHILD IMMUNISATION.1 2 8 FAMILY PLANNING . 1 2 8 t CLiNiC NAHE SKIP TO 0213 How tong does it take to get from here to (CLINIC NAME) using [THE HOST COHHON MOOE OF TRANSPORT]? HOURS . MINUTES . Does this clinic provide: YES NO DK antenatal care? ANTENATAL CARE . 1 2 8 <:#elivery care? DELIVERY CARE . . . . . . . . I 2 8 growth pronlotion? GROWTH PROHOTION . 1 2 8 child immunisation? CHILD ]MMUNISATION.1 2 8 [ Row many clinics in tots[ ere there within 30 kilometers? NO. CLINLCS WITHIN 30 KH . l l l 2-S 303 CYCLING . 2 ANIMAL . 3 WALKING . 4 OTHER 5 GOVERNMENT . 1 ZNFPC . 2 OTHER ORGANIZATION . 3 How far is it (in kms) from here? KIU~HETERS . ~ (WRITE IN IOOI IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD 197%) i What is the most common type of transport to the clinic? MOTORIZED (E,G, BUS) . 1 NONE KNOWN . 98 -~ D213 E. HOSPITAL N°" I E201 E202 E203 E204 E20S E206 E207 E208 E209 E210 E211 E212 E213 OUESTIOflS NA~E OF HOSPITAL (COPY FROR SECTION 2 COVER PAGE) Is that s goverrment hospitmt or is il Operated by z r~-goverr~nt orgenizatior~? N~ far is it (in km=) from here? (WRITE iN IOOl IF LESS THAN 1KILONETER. IF I TO 96 KILOHETERS RECORD THE NLINBER. IF 97 KILORETERS GR MORE, RECORD J 97%) What is the most comn~n type of trans;ort to the hospitaL? How Lone does it take to Get from here to (HOSPITAL NAME) usir~ (THE HOST CONN(~ 14QOE OF TRANSPORT]? Does this hospital provide: antenatal care? delivery caret growth promotion? child imlunisetion? famity ptmnning services? What is the rum of the r~earest hospit;=t providing family prattling services to this cQ~znunity? HOSP)TAL NAME COOING CATEGORIES SKiP TC NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 - -~ 301 GOVERNMENT . 1 NON-GOVERNMENT . . . . . . . . . . . . . . . . . . . . . KILONETERS . MOTORIZED (E.G. BUS) . 1 CYCLING . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . 4 OTHER 5 HOURS . MINUTES . YES NO DK ANTENATAL CARE . 1 2 8 DELIVERY CARE . 1 2 8 GROWTH PROMOTION . 1 2 8 CHILD IMMUNISATION.1 2 G FAMILY PLANNING . 1 2 8 L HOSPITAL NAME NONE KNOf~N . 98 -~ is that a government hospital or is is operated by a GOVERNMENT . 1 r~n-goverrcnent organization? NON-GOVERNMENT . 2 How far is it (in kms) from here? KILOMETERS . ~-~ (WRITE IN 'OO' IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR 140RE, RECORD ~97'.) i What is the ~st common type of translxrt to the hospital? MOTORIZED (E.G. BUS) . 1 HOW tong does it take to Get from here to (HOSPITAL NAME) using [THE HOST C(~4NON MOOE OF TRANSPORT]? CYCLING . 2 AN)HAL . 3 WALKING . 4 OTHER 5 HOURS . . . . . . . . . . . . . . . . . . . . MINUTES . ----] Does this Hospital provide: YES NO DK antenatal care? ANTENATAL CARE . 1 Z 8 delivery care? DELIVERY CARE . 1 2 8 growth prOmotion? GROWTH PROHOTION . 1 2 8 child immunisetion? CHILD INMUNISAT]ON.1 2 8 How many hospitals in total are there within 30 kilometers? NO. HOSPITAL W]THiN 30 KM . I I I 2-6 304 -~ E213 E213 SECTION 3. CONTRACEPT]VE METHO0 AND HEALTH SERVICES PROVISION (NEAREST PROVIDER) NO. 301 302 303 304 305 306 307 308 309 310 311 312 QUESTIONS What is the name of the nearest pLace Mhere birth control pills can be obtained? Hov far is it (in Ions) from here? (WRITE IN '00' IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS RECORD THE NUMBER, IF 97 KILOMETERS OR MORE, RECORD m97'.) What is the name of the nearest place or provider to this community uhere condoms can be obtained? Hou far is it (in kms) from here? (~RITE IN '00' IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD e97'.) What is the name of the nearest place to this com~Jnity Mhere family planning injection can be obtained? How far is it (in kms) from here? (WRITE IN =00' IF LESS THAN 1 KILOMETER. IF I TO 96 KILOMETERS RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD 197'.) What is the name of the nearest facility or provider to this community where ]UDs can be inserted? How far is it (in lima) from here? (WRITE IN '00' IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD '97'.) What is the name of the nearest facility or provider to this community where female sterilization can be obtained? Now far is it (in kms) from here? (WRITE IN '001 1F LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD '97%) What is the name of the nearest facility or provider to this community Mhere spermacidal jetty or diaphragms can be obtained? How far is it (in kms) from here? (WRITE IN '00' IF LESS THAN 1 KILOMETER. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. iF 97 KILOMETERS OR MORE e RECORD '97'.) 3"1 CODING CATEGORIES SKIP TO NEAREST PROVIDER NAME (PILL) i NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 - - ' - l - KILOMETERS . NEAREST PROVIDER NAME (CONDOMS) NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 - - - - ' l . KILOMETERS . 303 305 NEAREST PROVIDER NAME (INJECTION) NONE KNOWN . 98 ---l. 307 KILOMETERS . ~ NEAREST PROVIDER NAME (IUO) NONE KNOWN . 98 ---~ 309 KILOMETERS . NEAREST PROVIDER NAME (STERLISATION) NONE KNOWN . 98 ---~ 311 KiLOWETERS . ~[~ NEAREST PROVIDER NAME (VAGINALS) ! / NONE KNOWN . 98 ~,. 313 KILOHETERS . ~ 305 ~0. 513 514 515 516 517 518 519 520 $21 322 323 QUESTIONS COOING CATEGORIES SKIP TO i NEAREST PROVIDER NAME (INMUNISATION) What is name of the nearest place to tl~is coramunity Where immunisations for children are normatl¢ obtained? NONE KNOWN . 98 --~. IS this immunisation service provided from a fixed feciIity, FIXED FACILITY . 1 an outreach program, or from e private doctor? OUTREACH PROGRAM . 2 PRIVATE DOCTOR . ] NONE KN(~JN . 98 How far is it (in kms) from here? KILOMETERS . I J I (WRITE IN '00' IF LESS THAW 1 KILOMETEr. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR klORE, RECORD '97'.) i If child is sick with cough (respiratory disease), what is the NEAREST PROVIDER NAME (COUGH) name of the nearest place where treatment can be obtained? NONE KNOWN . 98 ---~ How far is it (in kJIS) from here? KILOMETERS . ~ (WRITE IN 'DO' IF LESS THAN 1KILOtlETEt. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD '97'.) i Mat is the name of the nearest place to this coo11~Jnity where NEAREST PROVIDER NN4E (ANTENATAL CARE) antenatal care can be obtained? Now far is it (in kom) from here? (WRITE IN 'DO' IF LESS THAN 1 KILOMETEr. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD '97'.) Met is the name of the nearest facility to this community where a woman can deliver her baby wit~ n~dicat supervision? NONE KNO~WN . 98 KILOMETERS . Now far is it (in ki) from here? (WRITE IN '00' IF LESS THAN 1 KILOMETEr. IF 1 TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR MORE, RECORD '97'.) If a woman has e complication in delivery, what is the name of the nearest place she can be treated? How far is it (in mona) from here? I ~ KILOMETERS . I I I (WRITE IN ~00' IF LESS THAN 1 KLLOMETEI. IF I TO 96 KILOMETERS, RECORD THE NUMBER. IF 97 KILOMETERS OR MORE. RECORD '97'.) 316 318 --~ 320 NEAREST PROVIDER NAME (DELIVERY SERV.) NONE KNOWN . 98 ---',- 322 KILOMETERS . ~ i NEAREST PROVIDER NAME (DELIVERY COMP.) NONE KNOWN . 98 --~ 324 3-2 306 324. CLUSTER INFORMANTS 1o 2. 3. 4. 325. NAHE POSITION/TITLE/OCCUPATION (HEALTH IdORKER) (OTHER MATURE WOMAN) TOTAL NUMBER OF INFORMANTS IN THE CLUSTER . 3-3 307 Front Matter Title Page Citation Page Table of Contents List of Tables List of Figures Preface Summary of Findings Map of Zimbabwe Chapter 1 - Introduction Chapter 2 - Characteristics of Households and Respondents Chapter 3 - Fertility Chapter 4 - Fertility Regulation Chapter 5 - Other Proximate Determinants of Fertility Chapter 6 - Fertility Preferences Chapter 7 - Early Childhood Mortality Chapter 8 - Maternal and Child Health Chapter 9 - Maternal and Child Nutrition Chapter 10 - AIDS and Other Sexually Transmitted Diseases Chapter 11 - Maternal Mortality References Appendix A - Sample Design and Implementation Appendix B - Estimates of Sampling Errors Appendix C - Data Quality Tabulations Appendix D - World Summit for Children Indicators Appendix E - Questionnaires Household Schedule Questionnaire Female Questionnaire Male Questionnaire Service Availability Questionnaire

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