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

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