Zimbabwe - Demographic and Health Survey - 2000

Publication date: 2000

Zimbabwe 1999Demographic andHealth Survey Central Statistical Office MEASURE DHS+ Macro International Inc. Z i b b 1999 D hi d H lth S World Summit for Children Indicators: Zimbabwe 1999 _________________________________________________________________________________________________ BASIC INDICATORS Value _________________________________________________________________________________________________ Childhood mortality Infant mortality rate (adjusted rate) 65 per 1,000 Under-five mortality rate 102 per 1,000 Childhood undernutrition Percent stunted 27 Percent wasted 6 Percent underweight 13 Clean water supply Percent of households within 15 minutes of a safe water supply1 63 Sanitary excreta disposal Percent of households with flush toilets or VIP latrines 60 Basic education Percent of women 15-49 with completed primary education 73 Percent of men 15-49 with completed primary education 82 Percent of girls 6-12 attending school 87 Percent of boys 6-12 attending school 86 Percent of women 15-49 who are literate 90 Children in especially Percent of children who are orphans (both parents dead) 2.1 difficult situations Percent of children who do not live with their natural mother 27 Percent of children who live in single adult households 14 _________________________________________________________________________________________________ SUPPORTING INDICATORS_________________________________________________________________________________________________ Women's Health Birth spacing Percent of births within 24 months of a previous birth2 11 Safe motherhood Percent of births with medical prenatal care 73 Percent of births with prenatal care in first trimester 21 Percent of births with medical assistance at delivery 72 Percent of births in a medical facility 62 Percent of births at high risk 42 Family planning Contraceptive prevalence rate (any method, currently married women) 54 Percent of currently married women with an unmet demand for family planning 13 Percent of currently married women with an unmet need for family planning to avoid a high-risk birth 10 Nutrition Maternal nutrition Percent of mothers with low BMI 4 Low birth weight Percent of births at low birth weight (of those reporting numeric weight) 10 Breastfeeding Percent of children under 4 months who are exclusively breastfed 38 Child Health Vaccinations Percent of children whose mothers received tetanus toxoid vaccination during pregnancy 62 Percent of children 12-23 months with measles vaccination 79 Percent of children 12-23 months fully vaccinated 75 Diarrhoea control Percent of children with diarrhoea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) 69 Acute respiratory infection Percent of children with acute respiratory infection in preceding 2 weeks who were taken to a health facility or provider 50 _________________________________________________________________________________________________ 1 Excludes surface water 2 First births are excluded Zimbabwe Demographic and Health Survey 1999 Central Statistical Office Harare, Zimbabwe Macro International Inc. Calverton, Maryland, U.S.A. December 2000 Central Statistical Office Macro International Inc This report presents results from the 1999 Zimbabwe Demographic and Health Survey (ZDHS) conducted by the Central Statistical Office (CSO) of the Government of Zimbabwe. Financial assistance for the survey was provided by the U.S. Agency for International Development (USAID) and the United Nations Children’s Fund (UNICEF); Macro International Inc. provided technical assistance. The ZDHS is part of the worldwide MEASURE Demographic and Health Surveys (DHS+) project which is designed to collect, analyse and disseminate data on fertility, family planning, maternal and child health, and HIV/AIDS. Additional information about the 1999 ZDHS may be obtained from the Central Statistical Office, P.O. Box CY 342, Causeway, Harare, Zimbabwe (telephone: 706-681; fax: 708-854). Information about the MEASURE DHS+ project may be obtained from Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999). Suggested citation: Central Statistical Office [Zimbabwe] and Macro International Inc. 2000. Zimbabwe Demographic and Health Survey 1999. Calverton, Maryland: Central Statistical Office and Macro International Inc. Contents * iii CONTENTS Page Tables and Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Geography and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Objectives of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.4 Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS . . . . . 7 2.1 Household Population by Age, Sex, and Residence . . . . . . . . . . . . . . . . . . . . . . . 7 2.2 Population by Age According to Selected Sources . . . . . . . . . . . . . . . . . . . . . . . . 7 2.3 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.4 Fosterhood and Orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.5 Educational Level of Household Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.6 School Enrolment Ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.7 Grade Repetition and Dropout Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.8 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.9 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS . . . . . . . . . . . . . . . . . . . . . . . . . 19 3.1 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3.2 Educational Attainment by Background Characteristics . . . . . . . . . . . . . . . . . . 19 3.3 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 3.4 Women’s Employment Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 3.5 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.6 Employer and Form of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.7 Decision on Use of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3.8 Control Over Earnings by Contribution to Household Expenditures . . . . . . . . . 30 3.9 Household Decisionmaking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.10 Final Say in Household Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.11 Women’s Agreement with Reasons for Wife Beating . . . . . . . . . . . . . . . . . . . . . 33 3.12 Women’s Agreement with Reasons for Refusing Sexual Relations . . . . . . . . . . . 35 iv * Contents Page CHAPTER 4 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.2 Fertility by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 4.3 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.4 Trends in Age-specific Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.6 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.7 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.8 Median Age at First Birth by Background Characteristics . . . . . . . . . . . . . . . . . 46 4.9 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 CHAPTER 5 FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5.1 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 5.2 Knowledge of Contraceptive Methods by Background Characteristics . . . . . . . . 50 5.3 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 5.4 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.5 Current Use of Contraception by Background Characteristics . . . . . . . . . . . . . . 56 5.6 Current Use of Contraception by Women’s Status . . . . . . . . . . . . . . . . . . . . . . . 60 5.7 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . 60 5.8 Knowledge of the Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.9 Source of Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.10 First-year Contraceptive Discontinuation Rates . . . . . . . . . . . . . . . . . . . . . . . . 64 5.11 Reasons for Discontinuing Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . 66 5.12 Future Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 5.13 Reasons for Nonuse of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 5.14 Preferred Methods of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . 68 5.15 Exposure to Family Planning Messages on the Radio and Television . . . . . . . . . 68 5.16 Exposure to Family Planning Messages in the Print Media . . . . . . . . . . . . . . . . 70 5.17 Contact of Nonusers with Family Planning Providers . . . . . . . . . . . . . . . . . . . . 71 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . 73 6.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 6.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 6.3 Number of Co-wives and Wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.4 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 6.5 Median Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 6.6 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.7 Median Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 6.8 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 6.9 Postpartum Amenorrhoea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . 84 6.10 Median Duration of Postpartum Insusceptibility by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 6.11 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Contents * v Page CHAPTER 7 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 7.1 Fertility Preference by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . 87 7.2 Fertility Preference by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 7.3 Desire to Limit Childbearing by Background Characteristics . . . . . . . . . . . . . . . 90 7.4 Need for Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 7.5 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 7.6 Mean Ideal Number of Children by Background Characteristics . . . . . . . . . . . . 96 7.7 Fertility Planning Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 7.8 Wanted Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 CHAPTER 8 EARLY CHILDHOOD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 8.1 Background and Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . 101 8.2 Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 8.3 Background and Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . 103 8.4 Biodemographic Differentials in Early Childhood Mortality . . . . . . . . . . . . . . 105 8.5 Perinatal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 8.6 High-risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 CHAPTER 9 REPRODUCTIVE AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . 111 9.1 Perceived Problems in Accessing Women’s Health . . . . . . . . . . . . . . . . . . . . . . 111 9.2 Perceived Big Problems in Accessing Women’s Health by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 9.3 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 9.4 Number of Antenatal Care Visits and Stage of Pregnancy . . . . . . . . . . . . . . . . 115 9.5 Antenatal Care Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 9.6 Place of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 9.7 Assistance During Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 9.8 Delivery Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 9.9 Postnatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 9.10 Postnatal Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 9.11 Use of Smoking Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 9.12 Childhood Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 9.13 Prevalence and Treatment for Acute Respiratory Infection (ARI) . . . . . . . . . . 132 9.14 Possession and Use of Bednets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 9.15 Prevalence of Fever and Source of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 134 9.16 Hand-washing Facilities in the Household . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 9.17 Appropriate Hand Washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 9.18 Disposal of Children’s Stool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 9.19 Prevalence of Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 9.20 Knowledge of Sugar-Salt-Water Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 9.21 Diarrhoea Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 9.22 Feeding Practices During Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 9.23 Women’s Status and Children’s Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 144 vi * Contents Page CHAPTER 10 INFANT FEEDING AND CHILDHOOD AND MATERNAL NUTRITION . 145 10.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 10.2 Initial Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 10.3 Breastfeeding Status by Child’s Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 10.4 Median Duration and Frequency of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . 147 10.5 Foods Received by Children in the Preceding 24 Hours . . . . . . . . . . . . . . . . . . 149 10.6 Frequency of Foods Received by Children in the Preceding Seven Days . . . . . 150 10.7 Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 10.8 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 10.9 Nutritional Status of Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 CHAPTER 11 AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES . . . . . . . . . . . 159 11.1 Knowledge of ways to Prevent HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 11.2 Knowledge of Other AIDS-related Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 11.3 Stigma Associated with AIDS and Acceptability of AIDS-related Messages in the Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 11.4 Testing for the HIV/AIDS Virus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 11.5 Knowledge of Other Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . 174 11.6 Self-reporting of Recent Sexually Transmitted Infections . . . . . . . . . . . . . . . . 177 11.7 Treatment-Seeking and Other Behaviours in Response to STIs . . . . . . . . . . . . 181 11.8 Number of Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 11.9 Payment for Sexual Relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 11.10 Knowledge of Sources for Male and Female Condoms . . . . . . . . . . . . . . . . . . 187 11.11 Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 CHAPTER 12 ADULT AND MATERNAL MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . 195 12.1 The Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 12.2 Direct Estimates of Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 12.3 Direct Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 APPENDIX D ZDHS HEAD OFFICE STAFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Tables and Figures * vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Population size and growth rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Table 1.2 Demographic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Table 1.3 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . . . . . . . . . . . . . . . . . . . . . . . . 8 Table 2.2 Population by age, according to selected sources . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.4 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table 2.5 Educational attainment of household population . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.6 School enrolment ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.7 Grade repetition and dropout rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 2.8 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.9 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Figure 2.1 Population pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Figure 2.2 Net enrolment ratios by sex and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure 2.3 Housing characteristics by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 3.2 Educational attainment by background characteristics . . . . . . . . . . . . . . . . . . . 22 Table 3.3 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 3.4 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 3.5 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 3.6 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 3.7 Decision on use of earnings and contribution of earnings to household expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3.8 Control over earnings according to household expenditures . . . . . . . . . . . . . . . 30 Table 3.9 Household decisionmaking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 3.10 Final say in household decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 3.11 Women’s agreement with reasons for wife beating . . . . . . . . . . . . . . . . . . . . . . 34 Table 3.12 Women’s agreement with reasons for refusing sexual relations . . . . . . . . . . . . . 36 Figure 3.1 Educational attainment by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Figure 3.2 Percent distribution of women 15-49 by employment status . . . . . . . . . . . . . . . 26 Figure 3.3 Percent distribution of employed women 15-49 who receive cash earnings by person who decides on use of earnings . . . . . . . . . . . . . . . . . . . . . 30 viii * Tables and Figures Page CHAPTER 4 FERTILITY Table 4.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 4.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 4.3 Trends in current fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Table 4.4 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 4.5 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 4.6 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 4.7 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.8 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . . 46 Table 4.9 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Figure 4.1 Total fertility rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 41 Figure 4.2 Age-specific fertility rates by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . 42 Figure 4.3 Percentage of adolescent women who are mothers or pregnant with first child, by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 5.2 Knowledge of contraceptive methods by background characteristics . . . . . . . . . 51 Table 5.3 Trends in knowledge of family planning methods . . . . . . . . . . . . . . . . . . . . . . . 52 Table 5.4 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 5.5 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 5.6 Trends in current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table 5.7.1 Current use of contraception by background characteristics: women . . . . . . . . 58 Table 5.7.2 Current use of contraception by background characteristics: men . . . . . . . . . . . 59 Table 5.8 Current use of contraception by women’s status . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 5.9 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 5.10 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 5.11 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . 63 Table 5.12 First-year contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 5.13 Reasons for discontinuing contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5.14 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 5.15 Reasons for nonuse of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 5.16 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . 68 Table 5.17.1 Exposure to family planning messages on radio and television: women . . . . . . 69 Table 5.17.2 Exposure to family planning messages on radio and television: men . . . . . . . . 70 Table 5.18 Exposure to family planning messages in print media . . . . . . . . . . . . . . . . . . . . 71 Table 5.19 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . . . 72 Figure 5.1 Use of specific contraceptive methods among currently married women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Figure 5.2 Current use of family planning among currently married women 15-49 by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Figure 5.3 Current use of contraception by source of supply . . . . . . . . . . . . . . . . . . . . . . . 64 Figure 5.4 First-year contraceptive discontinuation rates by method . . . . . . . . . . . . . . . . . 65 Tables and Figures * ix CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Page Table 6.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Table 6.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table 6.3 Number of co-wives and wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 6.4 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 6.5 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 6.6 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 6.7.1 Median age at first sexual intercourse: women . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 6.7.2 Median age at first sexual intercourse: men . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 6.8.1 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 6.8.2 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 6.9 Postpartum amenorrhoea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . 84 Table 6.10 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table 6.11 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Figure 6.1 Percentage of currently married women whose husbands have more than one wife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Figure 6.2 Median age at first marriage among women 25-49 . . . . . . . . . . . . . . . . . . . . . . 78 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . 88 Table 7.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 7.3 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . . 90 Table 7.4 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table 7.5 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 7.6.1 Mean ideal number of children by background characteristics: women . . . . . . 96 Table 7.6.2 Mean ideal number of children by background characteristics: men . . . . . . . . . 97 Table 7.7 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Table 7.8 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Figure 7.1 Fertility preferences among currently married women 15-49 . . . . . . . . . . . . . . 89 Figure 7.2 Percentage of currently married women 15-49 who want no more children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Figure 7.3 Percentage of currently married women with unmet need and met need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 CHAPTER 8 EARLY CHILDHOOD MORTALITY Table 8.1 Early childhood mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Table 8.2 Early childhood mortality by socioeconomic characteristics . . . . . . . . . . . . . . 104 Table 8.3 Early childhood mortality by biodemographic characteristics . . . . . . . . . . . . . 106 Table 8.4 Perinatal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 x * Tables and Figures Page Table 8.5 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Figure 8.1 Trends in infant and under-five mortality, 1988, 1994, and 1999 . . . . . . . . . . 103 Figure 8.2 Infant mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 105 CHAPTER 9 REPRODUCTIVE AND CHILD HEALTH Table 9.1 Perceived problems in accessing women’s health care . . . . . . . . . . . . . . . . . . . 112 Table 9.1 Perceived big problems in accessing women’s health care by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 9.3 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table 9.4 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . 115 Table 9.5 Antenatal care content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Table 9.6 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Table 9.7 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Table 9.8 Delivery characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table 9.9 Postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Table 9.10 Postnatal care providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Table 9.11 Use of smoking tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Table 9.12 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Table 9.13 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Table 9.14 Vaccinations in first year of life by current age . . . . . . . . . . . . . . . . . . . . . . . . 131 Table 9.15 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . 133 Table 9.16 Possession and use of bednets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 9.17 Prevalence of fever and source of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Table 9.18 Hand-washing facilities in households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table 9.19 Appropriate hand washing by background characteristics . . . . . . . . . . . . . . . . 138 Table 9.20 Appropriate hand washing by selected household characteristics . . . . . . . . . . 139 Table 9.21 Disposal of children’s stools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Table 9.22 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Table 9.23 Knowledge of sugar-salt-water solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table 9.24 Diarrhoea treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table 9.25 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Table 9.26 Women’s status and children’s health care . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Figure 9.1 Distribution of births by number of antenatal care visits . . . . . . . . . . . . . . . . . 116 Figure 9.2 Distribution of births by timing of first antenatal care visit . . . . . . . . . . . . . . . 116 Figure 9.3 Delivery characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Figure 9.4 Percentage of children age 12-23 months with specific vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Figure 9.5 Diarrhoea prevalence by child’s age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Tables and Figures * xi Page CHAPTER 10 INFANT FEEDING AND CHILDHOOD AND MATERNAL NUTRITION Table 10.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Table 10.2 Breastfeeding status by child’s age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table 10.3 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . 148 Table 10.4 Foods received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . 149 Table 10.5 Frequency of foods received by children in preceding 7 days . . . . . . . . . . . . 150 Table 10.6 Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Table 10.7 Nutritional status of children by demographic characteristics . . . . . . . . . . . . 154 Table 10.8 Nutritional status of children by background characteristics . . . . . . . . . . . . . 156 Table 10.9 Nutritional status of women by background characteristics . . . . . . . . . . . . . . 158 Figure 10.1 Prevalence of stunting by age of child and mother’s education . . . . . . . . . . . 157 CHAPTER 11 AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES Table 11.1.1 Knowledge of ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . . 161 Table 11.1.2 Knowledge of ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . 162 Table 11.2.1 Knowledge of programmatically important ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Table 11.2.2 Knowledge of programmatically important ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Table 11.3.1 Knowledge of various AIDS-related issues: women . . . . . . . . . . . . . . . . . . . . 166 Table 11.3.2 Knowledge of various AIDS-related issues: men . . . . . . . . . . . . . . . . . . . . . . . 167 Table 11.4.1 Discussion of HIV/AIDS prevention with cohabiting partner and acceptability of discussion of AIDS in the media: women . . . . . . . . . . . . . . . 168 Table 11.4.2 Discussion of HIV/AIDS prevention with cohabiting partner and acceptability of discussion of AIDS in the media: men . . . . . . . . . . . . . . . . . . 169 Table 11.5.1 Social aspects of AIDS prevention and mitigation: women . . . . . . . . . . . . . . 170 Table 11.5.2 Social aspects of AIDS prevention and mitigation: men . . . . . . . . . . . . . . . . . 171 Table 11.6.1 Testing for the HIV/AIDS virus: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Table 11.6.2 Testing for the HIV/AIDS virus: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Table 11.7.1 Knowledge of signs and symptoms of STIs in men: women . . . . . . . . . . . . . . 175 Table 11.7.2 Knowledge of signs and symptoms of STIs in men: men . . . . . . . . . . . . . . . . 176 Table 11.8.1 Knowledge of signs and symptoms of STIs in women: men . . . . . . . . . . . . . . 177 Table 11.8.2 Knowledge of signs and symptoms of STIs in women: men . . . . . . . . . . . . . . 178 Table 11.9.1 Self-reporting of sexually transmitted infections (STIs) and STI symptoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Table 11.9.2 Self-reporting of sexually transmitted infections (STIs) and STI symptoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Table 11.10 Treatment-seeking behaviour among self-reported STI cases . . . . . . . . . . . . . 181 Table 11.11 Other actions taken by respondents who reported an STI in the past 12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Table 11.12.1 Number of sexual partners: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Table 11.12.2 Number of sexual partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Table 11.13 Payment for sexual relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Table 11.14.1 Knowledge of source for condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Page xii * Tables and Figures Table 11.14.2 Knowledge of source for condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Table 11.15.1 Knowledge of source for female condoms: women . . . . . . . . . . . . . . . . . . . . 189 Table 11.15.2 Knowledge of source for female condoms: men . . . . . . . . . . . . . . . . . . . . . . . 190 Table 11.16.1 Use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Table 11.16.2 Use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Table 11.17 Use of condoms during commercial sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Figure 11.1 Percent distribution of women by number of AIDS-prevention methods known, according to level of education . . . . . . . . . . . . . . . . . . . . . . 165 Figure 11.2 Percentage of women and men by need for HIV testing services and urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Figure 11.3 Percent distribution of unmarried men by number of sexual partners in last 12 months, according to drinking pattern in last 30 days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Figure 11.4 Percentage of women and men who used a condom at last sex with a noncohabiting partner, by urban-rural residence . . . . . . . . . . . . . . . . 193 CHAPTER 12 ADULT AND MATERNAL MORTALITY Table 12.1 Data on siblings: completeness of the reported data . . . . . . . . . . . . . . . . . . . 196 Table 12.2 Adult mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Table 12.3 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Figure 12.1 Trends in age-specific mortality among women 15-49 . . . . . . . . . . . . . . . . . . 198 Figure 12.2 Trends in age-specific mortality among men 15-49 . . . . . . . . . . . . . . . . . . . . 198 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Table A.2 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Zimbabwe 1999 . . . . . . . . . . . 207 Table B.2 Sampling errors - National sample: Zimbabwe 1999 . . . . . . . . . . . . . . . . . . . 208 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Table C.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . 210 Table C.3 Age distribution of eligible and interviewed men . . . . . . . . . . . . . . . . . . . . . . 211 Table C.4 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Table C.5 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Table C.6 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Table C.7 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Preface * xiii PREFACE The Central Statistical Office (CSO) conducted the third Zimbabwe Demographic and Health Survey (ZDHS) between August and November 1999. The last ZDHS was fielded in 1994. The surveys were undertaken as part of the worldwide Demographic and Health Surveys programme, which has been implemented in Africa, Asia, Latin America, and the Near East. This report represents the major findings of the 1999 ZDHS; a preliminary report was published in March 2000. The 1999 ZDHS collected information on fertility, nuptuality, 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, awareness and behaviour regarding sexually transmitted diseases, including HIV/AIDS. The Central Statistical Office extends its acknowledgment and gratitude to the various agencies and individuals in the government, the donor community, and the public sector for unrelenting support that facilitated the successful implementation of the survey. Specific mention, however, is due to the following: the Ministry of Health and Child Welfare (MOH&CW) and the Centre for Population Studies of the University of Zimbabwe for their significant technical inputs; the Zimbabwe Family Planning Council (ZNFPC) for logistical and technical support; the U.S. Agency for International Development (USAID) and the United Nations Children’s Fund (UNICEF) for assisting with funding for the survey; Macro International Inc. (Maryland, USA) for providing funds and technical assistance throughout the ZDHS project; all the field personnel engaged during the survey for commitment to high-quality work under difficult conditions; and finally, the ZDHS respondents for their patience and cooperation. L. M. Machirovi Director, Census and Statistics Central Statistical Office P.O. Box CY 342 Causeway, Harare, Zimbabwe xiv * Summary of Findings * xv SUMMARY OF FINDINGS The 1999 Zimbabwe Demographic and Health Survey (ZDHS) is a nationally represen- tative survey that was implemented by the Central Statistical Office (CSO) from August to November 1999. Although significantly ex- panded in content, the 1999 ZDHS is a follow- on to the 1988 and 1994 ZDHS surveys and provides updated estimates of the basic demo- graphic and health indicators covered in the earlier surveys. The 1999 ZDHS was conducted in all of the ten provinces of Zimbabwe. The ZDHS received technical guidance from the Ministry of Health and Child Welfare (MOH&CW), the Zimbabwe National Family Planning Council (ZNFPC), and the Centre for Population Studies, University of Zimbabwe. Macro International Inc. (USA) provided techni- cal assistance throughout the course of the project in the context of the Demographic and Health Surveys (DHS) programme, while finan- cial assistance was provided by the U.S. Agency for International Development (USAID/Harare). The project received additional funding from the UNICEF office in Zimbabwe. Like the 1988 ZDHS and the 1994 ZDHS, the 1999 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. Specific questions were also asked about the respondent’s knowledge, attitude, and practice regarding the HIV/AIDS virus and other sexu- ally transmitted diseases. Like the1994 ZDHS, the 1999 ZDHS also collected data on mortality related to pregnancy and childbearing (i.e., maternal mortality). The ZDHS data are in- tended for use by programme managers and policymakers to evaluate and improve family planning and health programmes in Zimbabwe. Fertility. The 1988, 1994, and 1999 ZDHS results show that Zimbabwe continues to experience a fairly rapid decline in fertility. At current fertility levels, a Zimbabwean woman will have on average 4.0 children during her reproductive years, 1.5 fewer children than the number recorded in the 1988 ZDHS. In general, urban women tend to have smaller families than rural women (3.0 and 4.6 children per woman, respectively). The low level of fertility among urban women is also reflected in the lower fertility among women in the urban provinces of Harare and Bulawayo who on average have fewer than 3.0 children, com- pared with 4.0 or more children in other prov- inces. Fertility differentials by women's educa- tional status are notable; women who had no formal education have on average more than 5.0 children, while women with higher than a secondary education have fewer than 2.0 chil- dren. Marriage. The median age at first marriage in Zimbabwe has risen slowly over the past 30 years. Women age 20-24 marry about one year later than women 40-49 (19.7 years and 18.8 years, respectively). The proportion of women married by age 15 declined from 9 percent among those age 45-49 to 2 percent among women age 15-19 years. Another indicator of later marriage among women in Zimbabwe is the decline in the proportion of women age 25-49 who were married by age 20 (62 percent in 1994 com- pared with 58 percent in 1999). Urban women marry more than one year later than rural women. Women who stay in school tend to marry later; women who have attended second- ary school generally marry almost five years later (23.5 years) than women with no educa- tion (17.8 years). The median age at first marriage varies significantly across provinces, ranging from a low of 18.3 years in Mashonaland Central to 20.6 years or older in Bulawayo and Matabeleland South. Men enter into first union at a much later age than women; the median age at first marriage for men is 24.5 years, compared with 19.4 years for women. Only 13 percent of men are married by age 20, compared with 58 percent of women. xvi * Summary of Findings Although men marry on average five years later than women, women and men become sexually active at about one year apart. The median age at first sexual intercourse is 19.7 years for men and 18.7 years for women. Polygyny. One in six women in Zimba- bwe reported being in a polygynous union. Older women and women who live in rural areas are more likely than other women to have cowives. The prevalence of polygyny varies across provinces. Bulawayo has the lowest level (5 percent), while Mashonaland Central and Manicaland show the highest levels (31 percent and 25 percent, respectively). Fertility Preferences. More than half (53 percent) of the married women in Zimba- bwe would like to have another child. Among these women, 19 percent want one child within two years and 32 percent would prefer to wait two or more years before having their next child. Two-fifths (41 percent) of married women want no more children or have been sterilised. Thus, the majority of women (73 percent) want either to space their next birth or to end childbearing altogether. This represents the proportion of women who are potentially in need of family planning services. When asked how many children they would like to have if they could live their lives over and choose exactly, currently married women and monogamous men report an aver- age ideal family size of 4.3 children. A man’s marital status influences his ideal family size. Whereas the ideal number of children among all married men is 4.5, the corresponding number for men in a monogamous union is 4.3 and the number for men in multiple unions is 6.6 children. Another measure of fertility preference is the wanted fertility rate, which is calculated in the same manner as the conventional total fertility rate, except that unwanted births are excluded from the numerator. For the three years preceding the survey, the wanted fertility rate was 3.4 children, compared with the actual average of 4 children. In other words, if all unwanted births were avoided, the fertility rate in Zimbabwe would fall from 4.0 to 3.4 children per woman. Family Planning. Since 1994, knowl- edge of family planning in Zimbabwe has been universal and has not varied across subgroups of the population. The pill, condoms, and injectables are the most widely known methods. Currently, 54 percent of currently mar- ried women are using a method of contracep- tion. Overall, there has been an upward trend in the current use of family planning methods since 1984. Moreover, use of modern methods has increased faster than overall use. The most dramatic increase in modern contraceptive use in the five years between 1994 and 1999 is shown by injectables (3 percent to 8 percent). During the same period, the use of the pill increased from 33 percent to 36 percent of married women. Use of traditional methods, however, declined from 6 percent to 3 percent. Currently married women in rural areas are less likely to use modern family planning methods than their counterparts in urban areas (44 percent as opposed to 62 percent). Use of modern family planning methods is highest in the urban provinces of Harare (63 percent) and Bulawayo (60 percent). Manicaland has the lowest level of modern contraceptive use (34 percent). Modern contraceptive use is almost twice as high among women with a secondary education (66 percent) as among women with no education (35 percent). Government-sponsored facilities remain the chief providers of contraceptive methods in Zimbabwe. The distribution of sources of con- traceptive supplies for current users shows that most users (77 percent) obtain their contracep- tives from the public sector, followed by 17 percent who obtain their methods from the private medical sector. The participation of the private medical sector in family planning ser- vice delivery increased by more than a third between 1994 and 1999 (from 12 to 17 per- cent). Summary of Findings * xvii The level of unmet need for family planning changed slightly in the past five years (15 percent in 1994 compared with 13 percent in 1999). The decline is primarily for spacing births. Combined with 54 percent of married women who are currently using a contraceptive method, the total demand for family planning comprises two-thirds of the married women in Zimbabwe. Thus, if all married women who say they want to space or limit their children were to use family planning methods, the contracep- tive prevalence rate would increase from 54 percent to 68 percent. Antenatal Care. Utilisation of antenatal services is high in Zimbabwe; in the five years before the survey, mothers received antenatal care from a trained medical professional for 93 percent of their most recent births; 13 percent from a doctor and 80 percent from a trained nurse or a midwife. The median number of antenatal care visits is 4.7, which is fewer than the six visits recommended by the goal-oriented antenatal protocols in Zimbabwe. Furthermore, one in four women attended the first antenatal care visit during the sixth to seventh month of pregnancy, while 3 percent attended at eight months or later. Data from the 1999 ZDHS show that the percentage of mothers who had four or more antenatal visits (64 percent) is lower than that recorded in the 1994 ZDHS (75 percent). Among women who went for an antena- tal visit, nine in ten had their blood pressure measured, eight in ten gave a urine sample, three in four gave a blood sample, eight in ten received a tetanus toxoid (TT) injection, and six in ten received iron tablets. Delivery Characteristics. In 1999, the percentage of births delivered in health facilities (72 percent) was slightly higher than the per- centage recorded in the 1994 ZDHS (69 per- cent). Place of delivery varies greatly by urban- rural residence; urban women are more likely to deliver in a health facility than rural women (89 percent compared with 64 percent). This differential is also reflected by province; where- as nine in ten babies in Harare and Bulawayo were born in a health facility, four in ten babies in Manicaland were delivered at home. In the 1999 ZDHS, 73 percent of live births in the past five years were assisted by skilled personnel during delivery; 12 percent were assisted by a doctor, 61 percent were assisted by a nurse or midwife, and 18 percent were assisted by a traditional birth attendant. Childhood Vaccination. Three in four children 12-23 months have been vaccinated against six diseases (tuberculosis, diphtheria, pertussis, tetanus, polio, and measles). Two in three children completed the vaccination sched- ule by the time they turned one year. Comparison with data from the 1994 ZDHS shows that there has been a decline in vaccination as well as vaccination card cover- age. For vaccination, coverage declined from 80 percent in 1994 to 75 percent in 1999. For vaccination cards, coverage declined from 79 percent in 1994 to 69 percent in 1999. The decline may be attributed to various factors including the government’s reduced capacity for financing health services. Childhood Diseases. In the 1999 ZDHS, mothers were asked whether their children under the age of five years had been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. Based on the mother’s report, 16 percent of the children had had the illness. One in two children with respiratory illness were taken to a health facility for treatment. Overall, 14 percent of the children under age five had experienced diarrhoea at some time in the two weeks preceding the survey. One in three of these children was taken to a health provider for treatment. A large proportion of mothers did not practice proper management of childhood disease. Only about half of the children with diarrhoea were given increased fluid intake, one-fourth were given less fluid, and one-fourth were given the same amount of fluid. xviii * Summary of Findings Since fever is the major symptom of malaria, in the ZDHS, mothers were asked whether their children under five years had had a fever in the two weeks preceding the survey. Overall, one in four children was reported to have had a fever in the two weeks before to the survey. The use of treated bednets is a principal means of health intervention to control the mosquitoes that transmit malaria. Information on the availability of bednets in the house and whether any of the children under five years in the household slept under the bednet the night before the survey was also collected in the 1999 ZDHS. Overall, only 10 percent of households have a bednet. In 3 percent of the households with children under five, the children slept under a bednet the night before the survey. Childhood Mortality. Data from sur- veys since 1988 indicate that early childhood mortality in Zimbabwe declined until the late 1980s, after which there was stagnation and an upward trend in the past five years. From the 1999 survey, infant mortality was estimated at 65 per 1,000 and under-five mortality was estimated at 102 per 1,000 for the 1994-99 period. Previous studies found that elevated childhood mortality is associated with short birth intervals. Data from the 1999 ZDHS support this theory; children born less than two years after a preceding sibling are more than twice as likely to die in infancy as those born 2 to 3 years after a preceding sibling (112 com- pared with 44 per 1,000). There is a strong negative association between a mother’s level of education and children’s survival; whereas the under-five mortality rate of children whose mothers have had no education is 119 per 1,000 live births, that of children whose moth- ers have a secondary education is only 21 per 1,000. Adult and Maternal Mortality. As in 1994, the 1999 ZDHS collected information that allows estimation of adult and maternal mortality. Adult mortality rose sharply from the period of the late 1980s-early 1990s to the mid- late 1990s. The maternal mortality ratio referring to the 1995-1999 period is estimated to be 695 maternal deaths per 100,000 live births. This estimate is more than double the estimate from the 1994 ZDHS (283 maternal deaths per 100,000 live births). If the trend is evaluated based on sibling history data in the 1999 ZDHS, a twofold increase is observed. The proportion of all female deaths that are maternal has changed from 15 percent based on data from the pre-1995 period to about 10 percent based on the most recent estimate from the 1999 ZDHS. This change indicates that nonmaternal female mortality (e.g., AIDS-related) has risen more rapidly than overall mortality. Perceived Problems in Accessing Women’s Health Care. Women are sometimes perceived to have problems in seeking health care services for themselves. The 1999 ZDHS data indicate that urban women are, in general, less likely than rural women to perceive prob- lems in getting health care. In both rural and urban areas, the majority of women did not perceive knowing where to go, getting permis- sion, and lack of a female service provider as problems to accessing women’s health care. Whereas one in four urban women perceived getting the money needed for treatment as a problem, the corresponding proportion among rural women is 39 percent. However, rural women cited lack of a nearby facility and hav- ing to take transport as major problems (45 percent and 43 percent, respectively). It is worth noting that fear of verbal abuse by the health service provider was reported by 14 percent of women regardless of residence. Nutrition. Breastfeeding is nearly universal in Zimbabwe; 98 percent of the chil- dren born in the past five years were breastfed at some time. Overall, 63 percent of the chil- dren were breastfed within an hour of birth. In Zimbabwe, supplementation starts early and exclusive breastfeeding is not common. Within four months after birth, 27 percent of children had received water, and 34 percent were given other supplements. Half of the children under age 3 in Summary of Findings * xix Zimbabwe were breastfed until 19.6 months. Although the median duration of breastfeeding varies only slightly by the child’s sex, urban or rural residence, and mother’s education, it varies by region, ranging from 18 months in Bulawayo to 23 months in Matabeleland North. Overall, 93 percent of children under 6 months old were breastfed 6 times or more in the 24 hours preceding the interview. In the ZDHS, all female respondents and all children under five were weighed and mea- sured to obtain data for estimating the levels of undernutrition. The results indicate that 27 percent of the children under five are stunted (i.e., short for their age), a condition reflecting chronic undernutrition; 6 percent are wasted (i.e., thin for their height), a problem indicating acute or short-term food deficit; and 13 percent are underweight, which may reflect stunting, wasting, or both. There are substantial provin- cial variations in the nutritional status of chil- dren. The prevalence of stunting ranges from 35 percent in Manicaland to 16 percent in Bulawayo. Wasting varies from 19 percent in Mashonaland West to 1 percent in Bulawayo. The nutritional status of women is represented by two indices: the height and body mass index (BMI). The BMI is computed as the ratio of weight in kilograms to the square height in centimetres (kg/cm2). Women whose BMI falls below 18.5 and women whose height is below 145 cm are considered at nutritional risk. The mean BMI for women in the 1999 ZDHS sample is 23.6 and 6 percent of women have a BMI of less than 18.5. The average height of women is 159.4 cm, and less than 2 percent of women are shorter than 145 cm. AIDS-related Knowledge and Behav- iour. Although practically all Zimbabwean women and men have heard of AIDS, the qual- ity of that knowledge is sometimes poor; 17 percent of women and 7 percent of men could not cite a single means to avoid getting HIV/AIDS. The percentage of female respondents who know someone who has the AIDS virus or someone who has died from AIDS, increased from 50 percent in 1994 to 60 percent in 1999. The corresponding proportions for male respondents are 49 percent and 64 percent, respectively. For both men and women, condom use and limiting sexual activity to one partner or fewer were the two most widely cited means of avoiding HIV/AIDS. Based on 1999 ZDHS data, men are about three times more likely than women to have used a condom during their last sexual encounter with any partner (28 percent and 9 percent, respectively). Condoms are used much less frequently during sex with cohabiting partners (includes mostly spouses) for both women (4 percent) and men (7 percent), compared with sex with noncohabiting partners (women, 42 percent; men, 70 percent). It is clear that both women and men understand that sex outside of a stable relationship entails greater risk. An important and troubling finding is that one-half of the women and one-third of the men in the age group 15-19 do not know where to get a condom. Since the 1994 ZDHS, knowledge of a source for condoms has much improved in all age groups, except this most vulnerable group, within which knowledge has worsened. Between 1994 and 1999, the percentage of respondents age 15-19 not knowing a source for condoms has increased from 40 to 50 percent (women) and from 24 to 32 percent (men). ZDHS respondents were asked whether they had ever been tested for HIV or the AIDS virus. Twelve percent of women and 9 percent of men reported that they had already been tested for HIV. Respondents who said that they had not were asked whether they would like to be tested. More than six in ten women and men who have never been tested wanted to be tested. With 12 percent of women already having had the test, 17 percent of the demand for AIDS testing has been satisfied. The corresponding figure for men is lower (14 percent). Furthermore, respondents who had not been tested were asked whether they knew of a specific place where they could go to get the test for the AIDS virus. The results show xx * Summary of Findings that 63 percent of women and 67 percent of men were not aware of a place where they could be tested. The 1999 ZDHS collected information on the respondent’s drinking habits (including getting “drunk”) over the past three months, which can be analysed against patterns of sexual activity. Drinking alcoholic beverages is associated with higher rates of both extramari- tal sexual activity and multiple partnering in unmarried individuals. Men who get drunk more than once in 30 days are twice as likely to be engaged in sexuality activity outside their marriage(s) than married men who do not drink (24 percent compared with 11 percent). Among unmarried men, 5 percent who do not drink had two or more partners in the past 12 months, compared with 33 percent of those who had been drunk more than once in the past 30 days. ZIMBABWE ZAMBIA BOTSWANA SOUTH AFRICA MOZAMBIQUE 0 50 100 Kilometres Bulawayo Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Limpopo River Zambezi River Dots indicate location of sample points for 1999 ZDHS Introduction * 1 INTRODUCTION 1 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 on the east, South Africa on the south, Botswana on the west, and Zambia on the north and northwest. It is part of a great plateau, which constitutes the major feature of the geology of southern Africa. Almost the entire surface area of Zimbabwe is more than 300 metres above sea level, with nearly 80 percent of the land lying more than 900 metres above sea level and about 5 percent lying more than 1,500 metres above sea level. About 70 percent of the surface rock in Zimbabwe is granite, schist, or igneous, and it is rich in mineral wealth. Soil types range from clay or sandy loam in the high veldt to Kalahari sands in the hot and dry western part of the country. The climate of Zimbabwe is a blend of cool, dry, sunny winters and warm, but wet summers. Average annual precipitation totals increase with increasing altitude; however, temperature drops with increasing altitude. The Eastern Highlands of the country are therefore associated with cool and wet conditions, while the Sabi, Limpopo, and Zambezi valleys are hot and dry. Mining and agriculture are the backbone of the country’s economy, even though the country is richly endowed with some of the world’s most impressive manmade and natural tourist attractions, such as the Great Zimbabwe Ruins and Victoria Falls. Zimbabwe has abundant natural resources, including 8.6 million hectares of potentially arable land and more than 5 million hectares of forests, national parks, and wildlife estates. There are adequate supplies of surface and ground water, which could be harnessed for generation of electric power, irrigation of crops, 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 diversified but biased toward agriculture and mining, which are by far the country’s major foreign-currency earning sectors. Besides mineral processing, major industries include food processing, construction, chemicals, textiles, wood and furniture, and production transport equipment. The main agricultural export products are tobacco, maize, cotton, sugar, and groundnuts. The agriculture sector has well-developed commercial and communal farming systems. The communal sector’s contribution towards the production of industrial raw materials and food products has increased substantially since 1980, despite its poor physical and socioeconomic infrastructure. Zimbabwe is in the final phases of its second five-year economic development programme, the Zimbabwe Programme for Economic and Social Transformation 1996-2000 (ZIMPREST). It was envisaged that the Government of Zimbabwe would implement ZIMPREST with financial support from the World Bank, the International Monetary Fund, and other international organisations. However, the financial aid has not been received. ZIMPREST advocated adequate and sustainable economic growth and social development to reduce poverty and create a basis for all of Zimbabwe’s citizens to provide a better life for themselves and their children. These goals were to be achieved 2 * Introduction Table 1.1 Population size and growth rate Population size and annual rate of increase in the population, Zimbabwe, 1901-1997 _________________________________ 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 1997 11,789 2.5_________________________________ Source: Central Statistical Office, 1999 Table 1.2 Demographic indicators Selected demographic indicators, Zimbabwe 1992 and 1997 __________________________________________________ 1992 1997 Indicator Census IDS __________________________________________________ Total population (thousands) 10,412 11,789 Distribution by ethnic group (percent) African 98.8 99.0 European 0.8 u Coloured 0.3 u Asian 0.1 u Distribution by age group (percent) 0-14 45.1 43.0 15-64 51.3 53.0 65+ 3.3 4.0 Not stated 0.3 0.0 Crude birth rate (CBR) births per 1,000 population 34.5 34.7 Crude death rate (CDR) deaths per 1,000 population 9.5 12.2 Number of males per 100 females in the total population 95 92 Life expectancy at birth 61.0 57.0 __________________________________________________ U = Unknown (not available) Source: Central Statistical Office, 1999 through policy changes to encourage the use of labour- intensive technologies and market-friendly initiatives that enhance access to productive resources for a large part of the population. The government has been restructured for efficient delivery of key services to achieve economic growth targets. 1.2 POPULATION In 1997, the population of Zimbabwe was 11.8 million, an increase of 1.4 million from 10.4 million in 1992. Estimates rather than actual counts of the total population are available from the beginning of the century through 1951, when the census began to include nonAfri- cans. Table 1.1 shows that the average annual growth in the population reached a peak of 3.5 percent in 1951 and 1961 then dropped to 3.0 percent in 1982. The annual population growth rate between 1992 and 1997 was 2.5 percent. Table 1.2 shows that the popula- tion of people of African descent was 99 percent in 1997. The population of Euro- peans, Asians, and Coloureds made up the remaining 1 percent in 1997. The 1997 Intercensal Demographic Survey (IDS) estimated the crude birth rate (CBR) and the crude death rate (CDR) to be about 35 births per thousand popula- tion and 12 deaths per thousand popula- tion, respectively, yielding a natural in- crease rate of about 23 per thousand. Forty-three percent of the population of Zimbabwe was below age 15, 53 percent was between the ages of 15 and 64, and a very small proportion (4 percent) was age 65 or more. 1.3 OBJECTIVES OF THE SURVEY The 1999 Zimbabwe Demographic and Health Survey (ZDHS) is one of a series of surveys undertaken by the Cen- tral Statistical Office (CSO) as part of the Zimbabwe National Household Survey Capability Programme (ZNHSCP) and the worldwide MEASURE DHS+ programme. The Zimbabwe National Family Planning Council (ZNFPC), the Department of Population Studies of the University of Introduction * 3 Zimbabwe (UZ), the National AIDS Coordinating Programme (NACP), and the Ministry of Health and Child Welfare (MOH&CW) contributed significantly to the design, implementation, and analysis of the ZDHS results. The U.S. Agency for International Development (USAID) provided funds for the implementation of the 1999 ZDHS. Macro International Inc. provided technical assistance through its contract with USAID. UNICEF/Zimbabwe supported the survey by providing additional funds for fieldwork transportation. The primary objectives of the 1999 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 1999 ZDHS is a followup of the 1988 and 1994 ZDHS surveys, also implemented by CSO. The 1999 ZDHS is significantly expanded in scope and provides updated estimates of basic demographic and health indicators covered in the earlier surveys. 1.4 ORGANISATION OF THE SURVEY SAMPLE DESIGN AND IMPLEMENTATION The sampling frame used for the 1999 ZDHS was the 1992 Zimbabwe Master Sample (ZMS92) developed by the CSO after the 1992 Population Census. The same enumeration areas (EAs) of the 1994 ZDHS were used in the 1999 ZDHS. The ZMS92 included 395 enumeration areas stratified by province and land use sector. For purposes of the ZDHS, 18 sampling strata were identified: urban and rural strata for each of the eight provinces, and Harare (including Chitungwiza) and Bulawayo provinces, which are exclusively urban strata. The sample for the 1999 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 May 1999, forming the basis for the second-stage sampling. For the listing exercise, permanent CSO enumerators were trained in listing and cartographic methods. All private households were listed. The list excluded people living in institutional households (army barracks, hospitals, police camps, etc.). Households to be included in the ZDHS were selected from the EA household lists, with the sample being proportional to the total number of households in the EA. All women age 15-49 years in those households were eligible to be interviewed in the ZDHS. Furthermore, a 50 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 indicators for each of the 10 provinces, the sample design allowed for an oversample of smaller strata. The overall target sample was 6,208 women and 2,970 men. The ZDHS sample is not self- weighting at the national level (i.e., weights are required to estimate national-level indicators). Details concerning the ZDHS sample design are provided in Appendix A and estimations of sampling errors are included in Appendix B. 4 * Introduction QUESTIONNAIRES Four types of questionnaires were used for the ZDHS: the Household Questionnaire, the Women’s Questionnaire, the Men’s Questionnaire, and the Cluster Location form. 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. The Household Questionnaire also collected information on characteristics of the household’s dwelling units, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various consumer and durable goods. The Women’s Questionnaire was used to collect information on women age 15-49 years. These women were asked questions on the following topics: Background characteristics (education, residential history, etc.) Reproductive history Knowledge and use of family planning methods Fertility preferences Antenatal and delivery care Breastfeeding and weaning practices Vaccinations and health of children under age five 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. As in the 1994 ZDHS, a “calendar” was used in the 1999 ZDHS to collect information on the respondent’s history since January 1994 concerning reproduction, contraceptive use, reasons for discontinuation of contraception, marriage, and migration. In addition, interviewing teams measured the height and weight of all children under the age of five years and of all women age 15- 49. The Men’s Questionnaire was administered to all men age 15-54 living in every second household in the ZDHS sample (i.e., a 50 percent sample). The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain questions on reproductive history and maternal and child health. CSO Provincial Supervisors administered the Cluster Location Form. This exercise was carried out in January 2000. Global Positioning System (GPS) receivers were used to calculate the position (in terms of latitude and longitude) of each of the 230 clusters in the ZDHS. These positions can be used to link other data about Zimbabwe (e.g., average rainfall) to the information collected during the 1999 ZDHS. Introduction * 5 TRAINING AND FIELDWORK The ZDHS questionnaires were pretested in April 1999. Eleven qualified nurses and university graduates were trained to implement the pretest during a two-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 Bulawayo and Gweru, where both Shona and Ndebele households could easily be identified. Approximately 150 pretest interviews were conducted, debriefing sessions were subsequently held with the pretest field staff, and modifications to the 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, in July 1999. Permanent CSO staff, as well as staff of ZNFPC, UZ, and Macro International Inc., trained 90 interviewer trainees, most of whom were trained nurses or university graduates. 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 classroom, and practice interviews with real respondents in areas outside the 1999 ZDHS sample points. Trainees who performed satisfactorily in the training programme were selected as interviewers, while the remainder were retained 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. Ten interviewing teams carried out the fieldwork for the 1999 ZDHS; one team was designated for each province. Each team consisted of one team supervisor, one field editor, five or six female interviewers, one or two male interviewers, and one driver. In total, there were 10 team supervisors, 10 field editors, 54 female interviewers, 12 male interviewers, 7 data capture clerks, and 10 drivers. Six permanent senior CSO staff coordinated and supervised fieldwork activities. Data collection took place over a four-month period, from 15 August to 30 November 1999. DATA PROCESSING All questionnaires for the 1999 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 programme Integrated System for Survey Analysis (ISSA). Data processing commenced on 15 September 1999 and was completed on 21 January 2000. RESPONSE RATES Table 1.3 shows response rates for the ZDHS. A total of 7,010 households were selected in the sample, of which 6,512 were currently occupied. The shortfall was largely due to some households no longer existing in the sampled clusters at the time of the interview. Of the 6,512 existing households, 6,369 were interviewed, yielding a household response rate of 97.8 percent. In the interviewed households, 6,208 eligible women were identified and of these, 5,907 were interviewed, yielding a response rate of 95.2 percent. In a 50 percent subsample of households, 2,970 eligible men were identified, of which 2,609 were successfully interviewed (87.8 percent response). The principal reason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. The lower response rate among men than among women was due to the more frequent and longer absences of men. 6 * Introduction Table 1.3 Results of the household and individual interviews Number of households, number of interviews and response rates, according to urban-rural residence, Zimbabwe 1999 ___________________________________________________ Residence _______________ Result Urban Rural Total ___________________________________________________ FEMALE ___________________________________________________ Household interviews Households sampled Households found Households interviewed Household response rate Individual interviews: women Number of eligible women Number of eligible women interviewed Eligible woman response rate 2,058 4,952 7,010 1,988 4,524 6,512 1,923 4,446 6,369 96.7 98.3 97.8 1,940 4,268 6,208 1,809 4,098 5,907 93.2 96.0 95.2 ___________________________________________________ MALE ___________________________________________________ Household interviews Households sampled Households found Households interviewed Household response rate Individual interviews: men Number of eligible men Number of eligible men interviewed Eligible man response rate 1,021 2,467 3,488 977 2,270 3,247 942 2,227 3,169 96.4 98.1 97.6 1,009 1,961 2,970 845 1,764 2,609 83.7 90.0 87.8 1 A household refers to a person or group of related and unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as head of household, who share the same housekeeping arrangements, and who are considered one unit. A member of the household is any person who usually lives in the household and a visitor is someone who is not a usual member of the household but had slept in the household the night before 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 night before the survey and visitors (de facto population). 2 The dependency ratio is defined as the sum of all persons under age 15 years or over 64 years divided by the number of persons age 15 to 64, multiplied by 100. Household Population and Characteristics * 7 2HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 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 resi- dence. The environmental profile of households in the ZDHS sample is also examined. 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. 2.1 HOUSEHOLD POPULATION BY AGE, SEX, AND RESIDENCE The 1999 ZDHS household questionnaire was used to collect data on the demographic and social characteristics of all usual residents of the sampled household and on visitors who had spent the previous night in the household.1 Table 2.1 shows the distribution of the 1999 ZDHS household population by five-year age groups, according to sex and urban-rural residence. The ZDHS households constitute a population of 26,224 persons; 51 percent of the population are female and 49 percent are male. There are larger numbers of the population in the younger age groups than in the older age groups of each sex, particularly in rural areas. The age-sex structure of the population is shown by use of a population pyramid in Figure 2.1. The pyramid has a wide but tapering base, a pattern that is consistent with a population experiencing a decline in fertility. The number of children under five is less than the number age 5 to 9 years, which in turn is also less than the 10 to 14 age group, a finding that is consistent with a recent fertility decline (see Chapter 4). 2.2 POPULATION BY AGE ACCORDING TO SELECTED SOURCES The population distribution by broad age groups in Table 2.2 shows that the proportion of children under 15 years of age has declined from around 46 percent in 1994 to 42 percent in 1999, while that of persons over 65 years of age is about 4 percent. The median age of the population has increased from 16.6 years in 1994 to 17.9 in 1999. There has been a general decline in the proportion of the population under 15 years and an increase in the median age since 1982. The dependency ratio2 calculated from the 1999 ZDHS has declined to 87 from around 100 in 1994. This means that there are about 87 persons in the “dependent” age (under 15 years and over 65 years) for every 100 persons in the working force (age 15 to 64 years in Zimbabwe. 8 * Household Population and Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age group, according to sex and urban-rural residence, Zimbabwe 1999____________________________________________________________________________________________________ Urban Rural Total_______________________ _______________________ _______________________ Age group Male Female Total Male Female Total Male Female Total____________________________________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Missing/Don't know Total Number 12.9 13.0 12.9 14.6 13.3 14.0 14.1 13.2 13.6 10.6 10.4 10.5 16.3 15.1 15.7 14.4 13.6 14.0 9.6 11.3 10.4 17.9 16.7 17.3 15.1 15.0 15.1 10.2 13.0 11.5 14.2 10.5 12.3 12.9 11.2 12.0 13.1 15.2 14.2 7.0 7.8 7.4 9.1 10.1 9.6 11.8 10.9 11.4 5.4 6.6 6.0 7.5 7.9 7.7 7.9 6.8 7.4 4.1 4.5 4.3 5.4 5.2 5.3 5.1 5.6 5.3 3.5 4.5 4.0 4.0 4.9 4.4 4.7 3.5 4.1 2.7 3.7 3.2 3.4 3.6 3.5 4.4 2.5 3.5 2.7 3.0 2.8 3.3 2.8 3.0 2.8 3.0 2.9 2.0 4.1 3.1 2.3 3.8 3.0 3.1 1.4 2.3 2.4 2.5 2.5 2.6 2.2 2.4 1.6 1.5 1.5 2.2 2.2 2.2 2.0 2.0 2.0 0.9 1.0 1.0 1.8 2.0 1.9 1.5 1.7 1.6 0.7 0.4 0.5 1.2 1.2 1.2 1.0 1.0 1.0 0.3 0.4 0.3 1.2 0.9 1.0 0.9 0.7 0.8 0.2 0.2 0.2 0.7 1.4 1.1 0.5 1.0 0.8 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 4,346 4,085 8,430 8,571 9,223 17,794 12,917 13,307 26,224 Figure 2.1 Population Pyramid, Zimbabwe 1999 70+ 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Age 0246810 0 2 4 6 8 10 Percent Male Female ZDHS 1999 Household Population and Characteristics * 9 Table 2.2 Population by age, according to selected sources Percent distribution of the population by age group, according to selected sources, Zimbabwe 1999 _______________________________________________________________________ 1982 1987 1992 1994 1999 Census ICDS1 Census ZDHS ZDHS Age group (De facto) (De jure) (De facto) (De facto) (De jure) _______________________________________________________________________ <15 47.7 47.7 45.1 46.2 42.4 15-64 49.2 49.1 51.3 50.0 53.3 65+ 2.9 3.2 3.3 3.8 4.2 Missing/Don't know 0.3 - 0.3 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 Median age 16.1 16.0 17.1 16.6 17.9 Dependency ratio 102.9 103.7 94.4 99.7 87.4 _______________________________________________________________________ 1 Intercensal Demographic Survey Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and presence of foster children in household, according to urban-rural residence, Zimbabwe 1999_________________________________________ Residence_____________ Characteristic Urban Rural Total_________________________________________ Sex of head of household Male Female Total Number of usual members 0 1 2 3 4 5 6 7 8 9+ Total Mean size Percentage with foster children 1 76.9 60.2 66.5 23.1 39.8 33.5 100.0 100.0 100.0 0.0 0.1 0.0 21.0 12.2 15.6 17.9 10.8 13.5 18.4 14.2 15.8 14.1 15.3 14.8 11.2 14.6 13.3 7.3 11.8 10.1 4.3 8.3 6.8 2.4 5.2 4.1 3.4 7.6 6.0 100.0 100.0 100.0 3.5 4.6 4.2 11.2 27.4 21.2 _______________________________________ Note: Table is based on de jure members; i.e., usual residents. 1 Foster children are children under age 15 living in households with neither their mother nor their father present. 2.3 HOUSEHOLD COMPOSITION Table 2.3 shows that a female heads about one in three households in Zimbabwe (34 percent). The proportion of female-headed households has increased slightly since 1994 from 39 to 40 percent and 19 to 23 percent in rural and urban areas, respectively. The average household size has declined slightly from 4.7 persons in 1994 to 4.2 persons in 1999. Urban households are on average smaller (3.5 persons) than rural households (4.6 persons). Overall, 21 percent of households have foster children, as do 11 percent of urban households and 27 percent of rural households. Foster children are those persons under 15 years of age that have no natural parent in the household. 2.4 FOSTERHOOD AND ORPHANHOOD Detailed information on fosterhood and orphanhood of children under 15 years of age is presented in Table 2.4. Less than half (46 percent) of children under 15 years of age are living with both their parents, 26 percent are living with their mother (but not with their father), 5 percent with their father (but not their mother), and 20 percent are living with neither their natural mother nor their natural father. A higher proportion of children lives with both parents in urban areas (58 percent) than in rural areas (42 percent). Whereas 19 percent of children in urban areas live with their mother and 8 percent live 10 * Household Population and Characteristics Table 2.4 Fosterhood and orphanhood Percent distribution of de jure children under age 15 by survival status of parents and child's living arrangements, according to background characteristics, Zimbabwe 1999______________________________________________________________________________________________________ Living Living with mother with father but not father but not mother Not living with either parent____________ _______________________________________ Missing Living Father Mother informa- with alive/ alive/ tion on Number Background both Father Father Mother Mother Both Mother Father Both father/ of characteristic parents alive dead alive dead alive dead dead dead mother Total children______________________________________________________________________________________________________ Age 0-2 3-5 6-9 10-14 Sex Male Female Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Total 57.8 30.1 2.5 0.9 0.3 5.2 0.6 0.5 0.2 2.0 100.0 2,156 50.4 22.2 4.1 1.8 0.6 13.3 0.7 2.4 0.9 3.3 100.0 2,115 42.1 18.7 6.3 4.3 1.1 15.3 1.7 4.1 2.2 4.1 100.0 3,023 39.0 15.8 8.4 5.5 2.0 14.1 1.9 5.1 3.6 4.5 100.0 4,018 46.9 20.3 5.6 3.8 1.2 12.2 1.2 3.5 1.9 3.3 100.0 5,659 44.3 20.7 6.2 3.5 1.1 12.9 1.6 3.4 2.2 4.1 100.0 5,653 57.6 13.9 4.6 7.0 1.1 7.8 1.3 1.5 1.4 3.7 100.0 2,869 41.5 22.8 6.4 2.5 1.2 14.2 1.4 4.1 2.3 3.7 100.0 8,444 43.0 24.4 7.0 1.6 1.8 10.8 1.0 3.8 2.8 3.9 100.0 1,967 55.0 17.4 5.2 2.4 0.7 10.2 1.3 2.9 2.5 2.4 100.0 1,028 40.6 23.4 4.6 4.5 0.4 14.9 2.7 4.6 1.7 2.7 100.0 1,089 49.2 12.9 7.4 4.9 3.0 11.8 1.0 3.3 2.3 4.1 100.0 1,114 39.7 23.4 5.5 2.3 0.6 16.8 1.0 3.5 1.3 5.9 100.0 693 32.1 27.2 5.8 2.0 0.8 18.5 1.4 3.2 1.1 7.9 100.0 691 42.1 18.3 6.8 4.3 1.0 15.2 2.0 4.2 1.9 4.1 100.0 1,504 40.8 26.2 7.0 1.7 0.7 14.2 0.9 4.2 3.3 1.1 100.0 1,382 60.2 13.2 3.2 7.7 1.0 6.6 1.1 1.9 1.1 4.0 100.0 1,284 50.9 18.9 5.1 6.3 1.3 10.7 1.7 0.8 1.0 3.2 100.0 561 45.6 20.5 5.9 3.6 1.2 12.6 1.4 3.4 2.1 3.7 100.0 11,313 ___________________________________________________________________________________________________________ Note: By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. with their father, in rural areas, the corresponding percentages are 29 percent and 4 percent, respectively. Of the children under 15 years of age, 11 percent have lost their father and 5 percent have lost their mother. The proportion of children who have lost both parents has increased from 1 percent in 1994 to 2 percent in 1999. Children in Harare are the most likely to live with both parents, while those in Matabeleland South are the least likely. Children in Matabelaland South are also more likely than other children to live apart from their parents although the parents are still alive. 2.5 EDUCATIONAL LEVEL OF HOUSEHOLD MEMBERS Table 2.5 shows 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 is slightly higher for males than for females. Nine in ten males have attended school versus 86 percent of females. Household Population and Characteristics * 11 Table 2.5 Educational attainment of household population Percent distribution of the de facto male and female household populations age six and over by highest level of education attained, and the median number of years of schooling, according to selected background characteristics, Zimbabwe 1999___________________________________________________________________________________________________________ Level of education Number Median _________________________________________________ of number Background No Some Some Don’t know/ women/ of years of characteristic education primary secondary Higher missing Total men schooling____________________________________________________________________________________________________________ MALE___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Missing/Don't know Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Total 27.2 71.9 0.0 0.0 0.9 100.0 1,523 0.1 1.5 89.0 9.4 0.0 0.1 100.0 1,955 4.0 1.3 32.7 65.1 0.6 0.3 100.0 1,663 7.8 1.5 26.5 66.4 5.5 0.1 100.0 1,169 10.1 1.5 22.7 68.7 7.1 0.0 100.0 972 10.2 2.7 20.1 63.9 13.1 0.3 100.0 695 10.3 4.6 42.6 41.2 10.2 1.4 100.0 519 7.8 9.3 52.7 30.0 6.9 1.0 100.0 440 6.6 7.9 61.9 25.6 3.6 1.1 100.0 421 6.4 12.5 61.4 20.8 5.1 0.2 100.0 294 6.0 15.1 60.4 18.5 4.8 1.1 100.0 341 5.5 23.7 58.9 12.0 4.6 0.8 100.0 257 4.1 39.5 49.5 7.5 2.9 0.7 100.0 512 1.9 10.0 12.6 25.0 0.0 52.4 100.0 8 8.1 4.0 33.1 55.0 7.3 0.6 100.0 3,689 8.8 11.6 61.2 25.1 1.7 0.4 100.0 7,079 4.9 9.3 57.7 30.0 2.9 0.0 100.0 1,669 5.5 12.3 58.7 27.3 1.4 0.4 100.0 923 4.9 12.5 56.0 29.2 1.3 1.0 100.0 1,030 5.4 12.5 57.3 27.9 1.8 0.5 100.0 1,116 5.3 11.0 57.7 29.0 1.8 0.5 100.0 593 5.5 9.3 63.1 24.0 2.9 0.7 100.0 554 5.0 8.3 55.4 31.5 4.4 0.5 100.0 1,290 6.0 9.6 59.4 28.5 2.5 0.0 100.0 1,150 5.2 3.5 27.8 59.2 8.6 0.9 100.0 1,727 10.0 4.8 36.8 53.1 5.0 0.3 100.0 716 8.2 9.0 51.6 35.4 3.6 0.5 100.0 10,768 6.2 ____________________________________________________________________________________________________________ FEMALE___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Missing/Don't know Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Total 26.5 72.7 0.0 0.0 0.8 100.0 1,475 0.3 1.4 86.6 11.9 0.0 0.2 100.0 2,002 4.2 2.0 31.7 65.9 0.2 0.2 100.0 1,497 8.1 1.9 31.7 62.1 4.0 0.3 100.0 1,339 9.1 3.7 33.0 58.7 4.5 0.0 100.0 1,054 8.6 6.0 37.8 51.0 5.0 0.1 100.0 692 8.1 17.5 58.2 20.2 3.9 0.1 100.0 646 5.7 21.8 62.4 11.8 2.9 1.0 100.0 480 4.8 22.8 63.0 11.6 2.2 0.5 100.0 374 4.6 33.3 54.1 9.3 2.9 0.4 100.0 503 3.2 38.4 52.2 4.5 3.4 1.6 100.0 290 2.0 44.8 44.8 8.5 2.0 0.0 100.0 264 1.1 56.5 38.7 2.4 0.9 1.5 100.0 583 0.0 90.5 0.0 0.0 0.0 9.5 100.0 10 0.0 5.5 37.1 52.6 4.4 0.5 100.0 3,480 8.0 18.2 60.8 19.8 0.9 0.3 100.0 7,730 4.2 16.9 61.0 20.0 1.9 0.1 100.0 1,787 4.5 22.2 55.7 21.5 0.4 0.3 100.0 936 3.9 15.7 60.3 22.5 1.0 0.6 100.0 1,022 4.6 20.0 56.6 22.1 0.5 0.8 100.0 1,074 4.3 17.8 57.4 23.1 1.5 0.3 100.0 630 4.5 13.7 58.5 26.0 1.4 0.5 100.0 663 5.1 13.1 55.3 29.2 1.9 0.4 100.0 1,438 5.2 16.5 58.0 23.7 1.7 0.1 100.0 1,330 4.6 3.7 34.7 56.7 4.4 0.5 100.0 1,620 8.4 5.5 39.6 50.6 4.0 0.3 100.0 710 7.7 14.2 53.5 29.9 2.0 0.4 100.0 11,209 5.4 12 * Household Population and Characteristics In Zimbabwe, although most of the population has a formal education, only a relatively small proportion goes beyond secondary school. The median number of years of schooling completed for females and males is 5.4 and 6.2 years, respectively. Among females, 32 percent have reached the secondary level of education and 2 percent have gone to higher education. The corresponding percentages for males are 39 percent and 4 percent, respectively. This trend toward increasing educational attainment is encouraging since the percentages of females and males who had gone to secondary or higher education in 1994 were 24 percent and 31 percent, respectively. As expected, educational attainment is greater in urban than in rural areas. 2.6 SCHOOL ENROLMENT RATIOS In Table 2.6, school enrolment ratios by level of schooling, sex, residence, and province for the population age 6 to 24 years are presented. The Net Enrolment Ratio (NER) is an indicator of participation in schooling among children of official school age and the Gross Enrolment Ratio (GER) indicates the participation of all children between the ages of 7 and 18. Data in Table 2.6 show that, among persons age 7 to 12, 65 percent are enrolled in primary school and 77 percent of persons 13 to 18 are enrolled in secondary school. For primary education, females are more likely to be enrolled in school than males. On the other hand, for secondary education, among persons 13 to 18, males are more likely to be in school than females (81 percent compared with 73 percent). At the primary level, NERs in urban areas are higher than in rural areas, but in the secondary level the pattern is reversed (see Figure 2.2). Consistent with this finding, enrolment in primary education in the urban provinces (Harare and Bulawayo) is higher than in other provinces, but enrolment in secondary education is lower than in other provinces. With reference to GER, the ratios are much higher than 100 for primary education, indicating that a large proportion of children over the age of 12 are still enrolled in primary school. For secondary education, the percentages are much lower than 100, indicating that many people age 13 to 18 are not currently enrolled in secondary education. Household Population and Characteristics * 13 Table 2.6 School enrolment ratios Net enrolment ratios (NER) and gross enrolment ratios (GER) for the de facto household population age 7-18 years, by level of schooling, sex, residence, and province, Zimbabwe 1999 ________________________________________________________________________________________ Net enrolment ratio1 Gross enrolment ratio2 Residence ____________________________ ___________________________ and province Male Female Total Male Female Total ________________________________________________________________________________________ PRIMARY SCHOOL ________________________________________________________________________________________ Residence Urban 78.6 75.9 77.2 128.4 126.3 127.4 Rural 60.4 64.0 62.2 143.4 134.6 139.0 Province Manicaland 60.2 60.0 60.1 149.0 141.3 145.3 Mashonaland Central 60.2 62.9 61.6 141.2 133.7 137.4 Mashonaland East 64.8 67.3 66.0 133.7 130.7 132.2 Mashonaland West 62.4 62.7 62.5 138.4 134.9 136.8 Matabeleland North 61.0 71.4 66.1 132.4 128.6 130.4 Matabeleland South 62.4 67.8 65.0 136.3 130.2 133.3 Midlands 61.4 68.4 65.0 140.9 126.2 133.1 Masvingo 61.8 63.2 62.4 148.7 142.4 145.6 Harare 83.7 76.9 80.0 130.4 126.8 128.5 Bulawayo 78.2 79.0 78.7 128.4 119.6 123.6 Total 63.9 66.5 65.2 140.0 132.7 136.3 ________________________________________________________________________________________ SECONDARY SCHOOL ________________________________________________________________________________________ Residence Urban 77.9 65.3 71.0 72.8 57.7 64.5 Rural 81.9 78.2 80.2 39.7 34.1 37.1 Province Manicaland 91.8 78.0 85.5 48.1 35.5 42.1 Mashonaland Central 78.0 66.4 71.8 38.4 29.6 33.8 Mashonaland East 79.4 81.6 80.4 46.0 39.2 42.9 Mashonaland West 74.2 79.9 77.1 36.0 35.5 35.7 Matabeleland North 74.2 75.0 74.6 34.0 39.0 36.2 Matabeleland South 66.7 74.0 70.4 32.5 41.5 36.8 Midlands 75.3 72.3 73.9 43.4 41.0 42.3 Masvingo 89.1 76.5 83.1 43.6 37.3 40.7 Harare 79.8 63.7 71.2 81.9 56.8 67.9 Bulawayo 75.8 66.5 70.9 70.2 61.3 65.5 Total 80.5 72.5 76.6 47.4 41.2 44.4 ________________________________________________________________________________________ 1 The NER for primary school is the percentage of the primary-school-age (7-12 years) population that is enrolled in primary school. The NER for secondary school is the percentage of the secondary-school-age (13-18 years) population that is enrolled in secondary school. By definition the NER cannot exceed 100%. 2 The GER for primary school is the total number of primary school students, regardless of age, expressed as the percentage of the official primary-school-age population. The GER for secondary school is the total number of secondary school students, regardless of age, expressed as the percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GER can exceed 100%. 14 * Household Population and Characteristics Figure 2.2 Net Enrolment Ratios by Sex and Residence, Zimbabwe 1999 79% 76% 78% 65% 60% 64% 82% 78% Male Female Male Female Urban Rural PRIMARY SCHOOL SECONDARY SCHOOL ZDHS 1999 2.7 REPETITION AND DROPOUT RATES Repetition and dropout rates describe the flow of students through the school system. Table 2.7 shows the repetition and dropout rates by grade and form, according to sex and residence. Repetition rates are high at the lowest and highest levels. The rates do not vary much by urban-rural residence except in form 4. However, they vary across provinces. Repetition rates in grades 1 and 2 are highest in Midlands and Matabeleland South, respectively. The repetition rates are highest in form 4 in Mashonaland Central, Matabeleland South and Masvingo. Overall, dropout rates in grade 7 and in forms 3 and 4 are high for both males and females throughout the country. In general, the rates are higher in rural than in urban areas. Girls are more likely than boys to drop out of school after grade 5. Household Population and Characteristics * 15 Table 2.7 Repetition and dropout rates Repetition and dropout rates for the de facto household population age 7-18 years by school grade/form, sex, residence, and province, Zimbabwe 1999 __________________________________________________________________________________________________________ Grade Form __________________________________________________ __________________________ Characteristic 1 2 3 4 5 6 7 1 2 3 4 __________________________________________________________________________________________________________ REPETITION RATE1 __________________________________________________________________________________________________________ Sex Male 6.1 5.5 3.2 3.3 2.1 1.9 3.6 1.4 3.5 1.1 7.6 Female 5.9 3.5 4.2 2.8 1.1 2.9 4.0 0.7 2.1 2.8 9.5 Residence Urban 3.3 2.4 4.6 0.3 0.0 0.0 1.9 1.2 1.4 2.1 12.1 Rural 6.7 5.1 3.4 3.8 2.1 3.0 4.3 1.0 3.7 1.7 5.4 Province Manicaland 8.6 3.8 2.4 2.9 2.2 3.5 1.1 0.0 4.6 3.4 5.1 Mashonaland Central 9.0 6.9 4.1 0.0 2.2 3.3 2.7 2.4 2.4 0.0 12.2 Mashonaland East 1.3 4.6 1.0 1.2 1.2 1.3 5.9 0.0 1.8 0.0 8.3 Mashonaland West 6.7 3.3 4.1 4.4 3.7 0.0 1.7 0.0 0.0 0.0 3.9 Matabeleland North 1.2 0.7 0.0 0.9 1.1 1.9 3.3 0.0 6.6 0.0 6.9 Matabeleland South 7.7 12.2 7.7 3.3 3.4 3.1 4.9 0.0 4.6 3.2 11.8 Midlands 12.2 4.1 5.6 6.0 1.0 4.9 5.1 0.0 0.0 2.0 5.8 Masvingo 3.7 4.8 6.1 5.8 0.9 2.1 7.5 3.5 7.1 3.4 12.4 Harare 2.0 3.0 2.6 0.0 0.0 0.0 3.1 2.9 2.2 0.0 9.8 Bulawayo 0.0 2.4 0.0 1.9 0.0 0.0 0.0 0.0 1.6 3.6 9.0 Total 6.0 4.5 3.7 3.0 1.6 2.4 3.8 1.1 2.9 1.9 8.5 __________________________________________________________________________________________________________ DROPOUT RATE2 __________________________________________________________________________________________________________ Sex Male 2.3 1.9 1.2 3.1 4.4 2.8 13.5 3.0 8.3 6.7 73.3 Female 2.2 1.8 2.2 1.7 2.6 5.5 20.2 5.7 10.3 15.4 71.8 Residence Urban 0.0 0.0 0.0 1.4 1.0 2.4 11.9 3.1 10.5 10.6 64.0 Rural 2.8 2.3 2.2 2.7 4.2 4.5 18.6 4.8 8.5 11.3 84.6 Province Manicaland 4.4 1.9 2.9 2.1 3.4 3.4 18.0 4.6 7.1 8.7 83.7 Mashonaland Central 3.5 1.9 4.7 2.2 6.3 8.5 18.2 2.4 12.7 12.3 76.5 Mashonaland East 2.3 2.0 1.2 1.1 1.3 0.0 8.5 1.8 2.2 0.0 50.0 Mashonaland West 2.1 2.2 1.1 5.6 4.4 8.2 11.7 7.3 12.3 6.9 95.0 Matabeleland North 0.7 0.8 1.7 1.1 1.8 3.3 20.4 4.4 9.9 16.1 89.6 Matabeleland South 0.8 1.6 1.6 0.0 3.0 2.0 28.0 7.1 6.2 20.1 58.4 Midlands 3.5 3.7 0.0 4.5 6.4 8.5 27.2 8.3 9.8 18.1 85.9 Masvingo 0.0 1.5 2.4 0.9 2.8 4.1 12.7 3.2 7.6 11.1 76.5 Harare 0.0 0.0 0.0 2.4 2.2 0.0 14.6 2.1 10.3 8.5 61.0 Bulawayo 0.0 0.0 0.0 1.8 0.0 0.0 5.9 1.6 18.2 11.4 57.6 Total 2.3 1.9 1.7 2.4 3.5 4.1 16.8 4.2 9.2 11.0 72.7 __________________________________________________________________________________________________________ 1 The repetition rate is the percentage of students in a given grade/form that are repeating that grade/form. 2 The dropout rate is the percentage of students in a given grade/form in the previous school year who are not attending school. 3 Ventilated, improved pit (VIP) toilets 16 * Household Population and Characteristics Table 2.8 Housing characteristics Percent distribution of households by housing characteristics, according to residence, Zimbabwe 1999_____________________________________________________ Residence______________ Characteristic Urban Rural Total_____________________________________________________ Electricity Yes No Missing Total Source of drinking water Piped into residence Piped into yard/plot Public tap Protected well Unprotected well Borehole Spring River/stream Pond/lake/dam Other Total Time to water source (in minutes) <15 minutes Median time to source Sanitation facility Flush toilet Traditional pit toilet (VIP) Latrine/Blair toilet No facility/bush/field Other Missing Total Main floor material Earth/sand Dung Wood planks Parquet or polished wood Vinyl or asphalt strips Ceramic tiles Cement Carpet Other Missing Total Total 87.4 8.3 38.4 12.5 91.5 61.4 0.1 0.2 0.2 100.0 100.0 100.0 49.5 2.1 20.2 41.4 4.0 18.2 7.5 11.3 9.8 0.7 12.8 8.2 0.3 17.7 11.1 0.5 41.6 25.9 0.0 0.5 0.3 0.0 8.0 5.0 0.0 1.7 1.0 0.1 0.3 0.2 100.0 100.0 100.0 98.7 42.3 63.8 0.0 14.9 4.5 93.7 2.2 37.1 2.7 22.0 14.6 2.9 35.9 23.3 0.3 39.5 24.6 0.1 0.2 0.1 0.3 0.2 0.3 100.0 100.0 100.0 1.3 24.7 15.8 0.0 20.1 12.5 1.5 0.0 0.6 0.7 0.1 0.3 0.4 0.1 0.2 3.3 0.1 1.3 81.9 54.5 64.9 10.5 0.5 4.3 0.2 0.0 0.1 0.2 0.0 0.1 100.0 100.0 100.0 2,424 3,945 6,369 2.8 HOUSING CHARACTERISTICS Information on the characteristics of the sampled households is shown in Table 2.8. The physical characteristics of the household reflect the household’s economic condition and have an important bearing on environmental exposure to disease. The proportion of households that have access to electricity in Zimbabwe has increased from 28 percent in 1994 to 38 percent in 1999. There is a significant difference in access to electricity between urban and rural areas. Although 87 percent of urban households have electricity, only 8 percent of rural households have electricity (see Figure 2.3). Piped water is available in 48 percent of all households, 98 percent in urban areas compared with 17 percent in rural areas. In rural areas, boreholes are the main source of drinking water (42 percent), followed by unprotected wells (18 percent). The median time to get to the source of drinking water is about 15 minutes in rural areas and less than a minute in urban areas. The proportion of households that have toilet facilities in Zimbabwe has increased from 65 percent in 1994 to 75 percent in 1999. Most households in urban areas (94 percent) have flush toilets. In rural areas, the most common toilet is either the Blair toilet3 (36 percent) or the traditional pit latrine (22 percent). Four in ten households in rural areas have no toilet facility. This proportion declined from 51 percent in 1994 to about 40 percent in 1999. The most commonly used flooring materials are cement (65 percent) and earth/dung (28 percent). In urban areas, 82 percent of households have cement floors compared with 55 percent in rural areas. Earth/dung floors are found in 45 percent of rural households. Household Population and Characteristics * 17 Table 2.9 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Zimbabwe 1999 ____________________________________________________ Residence Durable ______________ consumer goods Urban Rural Total ____________________________________________________ Radio Television Telephone Refrigerator Bicycle Motorcycle Private car Modern oxcart None of the above Number of households 73.4 38.5 51.8 52.1 7.6 24.5 16.6 1.3 7.1 33.6 2.5 14.3 18.3 21.0 20.0 0.9 0.6 0.7 16.0 2.0 7.4 16.5 6.3 10.2 18.4 53.1 39.9 2,424 3,945 6,369 Figure 2.3 Housing Characteristics by Residence, Zimbabwe 1999 87% 98% 94% 8% 17% 2% 38% 48% 37% Electricity Piped Water Flush Toilet Urban Rural Total ZDHS 1999 2.9 HOUSEHOLD DURABLE GOODS Table 2.9 shows the percentage of households owning certain durable goods by residence. The availability of durable consumer goods is a rough measure of a household’s socioeconomic status. Among the selected durable goods, a radio is available in 52 percent, a bicycle in 20 percent, a television in 25 percent, and a modern oxcart in 10 percent of the households. The proportion of households with durable goods varies by urban-rural residence. Urban households are more likely than rural households to own modern conveniences powered by electricity, such as a radio (73 percent compared with 39 percent) and a refrigerator (34 percent compared with 3 percent). Overall, 18 percent of urban households and 53 percent of rural households have none of the selected durable goods. Characteristics of Respondents * 19 CHARACTERISTICS OF RESPONDENTS 3 This chapter presents information on some demographic and socio-economic characteristics of the survey respondents, such as age, education, and place of residence. These characteristics are for men age 15-54 and women age 15-49. This information is useful for understanding the factors that affect reproductive and contraceptive use behaviour as they provide a context for the interpretation of the demographic and health indices. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Background characteristics of the 5,907 women and 2,609 men interviewed in the 1999 ZDHS are presented in Table 3.1. The distribution of the respondents according to age shows a similar pattern for males and females. The proportion of respondents in each age group declines with increasing age for both sexes. Forty-six percent of women and 47 percent of men are in the 15-24 age group, 29 percent of women and 27 percent of men are 25-34, and the remaining female respondents are 35-49, while the remaining male respondents are 35-54. Fifty-six percent of females compared with 46 percent of males are currently married. Male respondents were much more likely than female respondents to have never married (48 percent for males and 28 percent for females). Four percent of female respondents and 1 percent of males stated that they were widowed. Men are also less likely to be divorced than women. Although about 4 percent of women reported that they were divorced, 2 percent of men reported so. The proportion of males in urban areas (42 percent) is larger than that of females (39 percent). This is expected since men dominate in the rural-to-urban migration flows in search of work. The largest proportion of both male and female respondents (20 percent and 18 percent, respectively) is in Harare. About 15 percent of women and men are from Manicaland. The other provinces have populations ranging from 5 percent of the women and 6 percent of the men in Matabeleland North to 13 percent of women and men in Midlands. The majority of the respondents (84 percent of women and 66 percent of men) are Christians. Males, however, are more likely (17 percent) to be atheist than females (8 percent). Men are also more likely to be traditionalist (14 percent) than females (4 percent). 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Overall, the level of education in Zimbabwe is high, and males are more educated than females. The proportion of women who have never been to school is more than two times greater than that of males (7 percent and 3 percent, respectively). Men are more likely to reach secondary school (60 percent) than women (50 percent). Men are also twice as likely (6 percent) to have more than a secondary education than females (3 percent) (see Figure 3.1). 20 * Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Zimbabwe 1999______________________________________________________________________________________ Number of women Number of men__________________ __________________ Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted______________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Marital status Never married Married Living together Widowed Divorced Not living together Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education level attained No education Primary Secondary Higher Currently attending school Yes No Religion Traditional Christian Muslim None Other Missing All women 24.5 1,447 1,468 27.3 713 761 21.9 1,294 1,232 19.4 506 506 17.5 1,034 1,011 16.5 430 376 11.3 668 650 10.8 281 271 10.8 637 672 8.4 220 218 7.9 466 492 6.8 178 184 6.1 361 382 6.8 177 173 NA NA NA 4.0 104 120 27.7 1,637 1,683 48.0 1,252 1,287 56.3 3,325 3,130 46.4 1,210 1,180 4.8 283 423 1.1 29 23 4.2 251 249 1.4 37 36 3.5 206 196 2.0 51 53 3.5 205 226 1.1 30 30 38.6 2,279 1,809 41.8 1,090 845 61.4 3,628 4,098 58.2 1,519 1,764 14.9 882 556 13.8 360 233 8.1 477 567 9.1 236 307 7.8 461 464 8.3 217 214 9.5 559 491 10.3 268 225 5.1 302 601 5.6 146 264 5.4 321 631 4.6 120 233 12.5 741 673 11.8 308 291 10.7 629 633 8.6 225 238 18.2 1,077 562 19.7 514 271 7.7 457 729 8.2 214 333 6.7 396 437 2.5 66 78 40.2 2,377 2,518 31.8 830 933 50.2 2,965 2,803 59.6 1,556 1,458 2.8 168 149 6.0 157 140 11.3 668 662 17.0 443 450 87.5 5,167 5,178 82.5 2,151 2,145 3.5 207 187 14.2 370 331 83.9 4,956 4,869 65.6 1,713 1,668 0.5 31 29 1.2 31 29 8.4 498 612 16.8 438 524 3.3 195 192 2.1 54 54 0.3 20 18 0.2 5 3 100.0 5,907 5,907 100.0 2,609 2,609 ____________________________________________________________________________________ NA = Not applicable Characteristics of Respondents * 21 Figure 3.1 Educational Attainment by Sex, Zimbabwe 1999 7% 40% 50% 3%3% 32% 60% 6% No Education Primary Secondary Higher Female Male ZDHS 1999 Presented in Table 3.2 are the percentage distributions of female and male respondents by highest level of education attended, according to age, urban-rural residence, and province. Overall, men are more likely than women to be educated. Younger people are more likely to be educated and to reach higher levels of education than older people. The proportion of women without education ranges from 1 percent for women age 15-19 years, to 21 percent for women age 45-49. These proportions range from almost zero percent for men age 15-19 years to 14 percent for men over 50 years. The majority of women age 45-49 (62 percent) have a primary education; on the other hand, the majority of women age 15-19 have a secondary education (68 percent). This pattern is similar for males. Whereas 58 percent of men 45-49 have a primary education, 70 percent of men 15-19 have gone to secondary school. Rural people are less educated than their urban counterparts. About 10 percent of rural women do not have an education, compared with 2 percent of urban women. The corresponding figures for men are 3 percent and 2 percent for rural men and urban men, respectively. Whereas only 34 percent of rural women have a secondary education or higher, 76 percent of urban women have at least a secondary education. The improvement in levels of education reflects the significant expansion and improved accessibility to the educational system after independence in 1980. The distribution of education is fairly similar across provinces with the exceptions of Harare and Bulawayo, which are urban centers, and Midlands province. Matabeleland North, Mashonaland West, and Mashonaland Central have the highest levels of women reporting no education (10 percent, 12 percent, and 16 percent, respectively). All the provinces have a majority of women who have attended primary school. In all provinces, the majority of men have gone to secondary school. 22 * Characteristics of Respondents Table 3.2 Educational attainment by background characteristics Percent distribution of women and men by highest level of schooling attended, according to selected background characteristics, Zimbabwe 1999___________________________________________________________________________________________ Highest level of schooling attended Number________________________________________ of Background No edu- women/ characteristic cation Primary Secondary Higher Total men___________________________________________________________________________________________ WOMEN___________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo All women 1.3 30.7 67.5 0.4 100.0 1,447 1.8 32.2 63.1 2.9 100.0 1,294 2.9 34.5 58.4 4.2 100.0 1,034 5.5 37.9 51.2 5.4 100.0 668 17.9 60.1 18.4 3.6 100.0 637 20.5 64.4 12.0 3.1 100.0 466 21.4 61.8 14.5 2.3 100.0 361 1.7 22.6 70.9 4.9 100.0 2,279 9.9 51.3 37.2 1.6 100.0 3,628 9.1 49.9 37.7 3.4 100.0 882 16.3 45.6 37.6 0.6 100.0 477 6.5 47.7 43.9 1.9 100.0 461 11.5 50.2 37.7 0.5 100.0 559 10.1 46.4 40.9 2.6 100.0 302 3.6 47.9 46.1 2.4 100.0 321 6.1 39.9 51.8 2.2 100.0 741 6.6 48.1 42.7 2.7 100.0 629 0.9 20.5 73.8 4.8 100.0 1,077 1.4 23.5 70.1 5.1 100.0 457 6.7 40.2 50.2 2.8 100.0 5,907 ___________________________________________________________________________________________ MEN___________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo All men 0.1 29.8 70.0 0.1 100.0 713 1.1 25.9 67.9 5.1 100.0 506 1.1 18.1 72.3 8.5 100.0 430 1.0 18.4 62.4 18.3 100.0 281 3.6 46.5 42.2 7.6 100.0 220 6.7 50.5 36.3 6.5 100.0 178 9.6 57.6 26.6 6.1 100.0 177 14.0 60.0 22.6 3.4 100.0 104 1.5 14.8 74.2 9.6 100.0 1,090 3.3 44.0 49.2 3.5 100.0 1,519 2.2 35.4 57.7 4.6 100.0 360 3.1 45.1 50.7 1.2 100.0 236 0.9 40.8 55.4 2.8 100.0 217 3.0 38.3 49.9 8.8 100.0 268 3.6 40.5 50.1 5.8 100.0 146 4.7 40.9 49.3 5.1 100.0 120 1.6 35.0 55.7 7.7 100.0 308 5.6 41.7 47.4 5.2 100.0 225 1.5 10.3 80.8 7.4 100.0 514 2.1 19.2 69.4 9.3 100.0 214 2.5 31.8 59.6 6.0 100.0 2,609 3.3 ACCESS TO MASS MEDIA Table 3.3 shows the percentage of female and male respondents who were exposed to different types of mass media by age, urban-rural residence, province, and level of education. It is important to know which types of persons are more likely to be reached by the media to plan Characteristics of Respondents * 23 Table 3.3 Access to mass media Percentage of women and men who usually read a newspaper weekly, watch television weekly, and listen to the radio daily, by selected background characteristics, Zimbabwe 1999___________________________________________________________________________________________ Number No Reads a Watches Listens to All of Background mass newspaper television the radio three women/ characteristic media weekly weekly daily media men___________________________________________________________________________________________ WOMEN___________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women 43.8 32.1 33.1 42.8 17.2 1,447 40.5 32.4 34.0 46.9 17.2 1,294 42.0 28.2 32.1 47.1 16.0 1,034 40.1 29.6 38.4 49.5 18.3 668 52.4 16.8 28.6 38.7 10.9 637 59.5 15.2 23.0 30.8 7.5 466 56.6 15.8 21.7 35.1 9.1 361 12.5 52.9 65.6 69.5 34.5 2,279 65.9 11.1 10.5 26.9 3.0 3,628 60.3 14.8 17.5 31.9 6.2 882 51.1 19.0 21.8 38.3 8.2 477 60.4 18.5 17.4 30.4 7.5 461 52.4 17.6 23.2 38.1 8.6 559 56.8 15.4 22.1 35.2 7.9 302 63.2 17.0 12.4 26.3 4.4 321 52.9 17.1 23.9 36.1 8.2 741 64.4 15.7 13.9 26.1 5.8 629 10.5 54.8 68.7 73.3 37.9 1,077 9.6 62.4 64.9 72.2 38.7 457 79.4 0.4 6.1 17.0 0.0 396 61.4 9.1 16.3 31.0 3.3 2,377 30.2 42.3 44.8 55.4 24.8 2,965 4.4 80.9 80.3 66.6 49.5 168 45.3 27.2 31.8 43.3 15.2 5,907 ___________________________________________________________________________________________ MEN___________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All men 39.7 30.0 35.0 46.8 16.9 713 29.9 46.6 42.6 56.0 27.0 506 21.6 59.7 49.7 64.9 37.0 430 19.0 54.0 44.9 64.1 29.5 281 28.8 41.1 40.6 58.8 25.5 220 28.4 39.8 41.5 53.5 20.3 178 32.7 39.1 40.0 58.4 27.8 177 42.3 29.6 33.8 46.7 15.1 104 5.4 78.2 74.4 74.2 52.2 1,090 48.6 17.5 17.3 42.4 5.7 1,519 41.8 24.5 24.5 51.9 13.5 360 37.0 30.3 24.1 48.6 10.0 236 38.9 22.2 24.0 51.3 10.6 217 31.4 26.2 42.6 52.1 13.9 268 31.6 46.8 42.9 51.5 27.3 146 47.0 28.0 17.5 39.2 10.1 120 34.5 32.6 32.7 53.0 17.8 308 64.6 17.8 11.8 30.2 9.2 225 5.2 85.6 76.4 71.6 55.7 514 4.2 74.2 73.9 83.5 51.4 214 61.8 2.9 18.4 30.9 2.9 66 50.1 16.0 22.3 40.8 7.7 830 21.3 55.0 48.2 61.6 31.0 1,556 5.5 82.5 80.9 85.6 68.1 157 30.5 42.9 41.2 55.7 25.2 2,609 1 Employment is defined as receiving payment in cash or kind for work. 24 * Characteristics of Respondents programmes intended to spread information about health and family planning. Twenty-seven percent of female respondents and 43 percent of male respondents read newspapers at least once a week, 32 percent of women and 41 percent of men watch television at least once a week, and 43 percent of women and 56 percent of men listen to the radio daily. It is important to note that there are differentials by sex and residence in accessing the different forms of mass media. Generally, urban residents and men are more likely to have access to all forms of mass media than rural residents and women. Whereas 66 percent of rural women and 13 percent of urban women reported having no access to any form of mass media, 49 percent of rural males compared with 5 percent of urban males have no access to any form of media. Men and women age 20-35, those who are better educated, and persons living in Harare and Bulawayo are more likely to read newspapers, watch television, and listen to the radio than other persons. 3.4 WOMEN’S EMPLOYMENT STATUS The 1999 ZDHS collected information from women about their current employment situation.1 Table 3.4 shows that 51 percent of women are not currently employed, 23 percent are employed all year, 17 percent are employed seasonally, and 5 percent are employed occasionally (see Figure 3.2). Rural women are more likely to work in seasonal jobs (23 percent) than urban women (6 percent). On the other hand, urban women are more likely to report regular full-time employment (33 percent) than rural women (18 percent). Regular full-time work tends to increase and seasonal work decreases with increasing level of education. Substantial provincial variations exist in the employment characteristics of women. Women in Matabeleland North, Matabeleland South, and Mashonaland East are much more likely than women in other provinces to report not having been employed in the past 12 months. Seasonal work is most commonly reported in Midlands (33 percent), Masvingo (31 percent), and Mashonaland Central (24 percent). Women in Harare (32 percent) and Bulawayo (38 percent) are more likely to report working for the whole year. Characteristics of Respondents * 25 Table 3.4 Employment Percent distribution of women by employment status and continuity of employment, according to selected background characteristics, Zimbabwe 1999__________________________________________________________________________________________ Not currently employed_________________ Did not work Worked Currently employed in last in _________________________ Number Background 12 last 12 Season- Occasion- of characteristic months months All year ally ally Missing Total women__________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women 69.1 5.1 11.0 9.3 2.8 2.8 100.0 1,447 45.6 8.4 20.4 16.1 5.3 4.2 100.0 1,294 36.9 4.6 30.0 16.5 7.1 4.8 100.0 1,034 33.9 1.8 32.5 21.0 4.0 6.8 100.0 668 33.7 2.3 32.6 20.8 4.1 6.3 100.0 637 35.4 3.6 26.8 22.6 4.4 7.3 100.0 466 34.1 4.7 25.9 25.4 4.3 5.6 100.0 361 45.8 4.4 32.5 6.4 6.4 4.4 100.0 2,279 45.7 5.2 17.5 23.1 3.5 5.0 100.0 3,628 52.7 4.3 16.6 11.1 3.1 12.2 100.0 882 32.3 6.6 25.9 24.2 9.9 1.0 100.0 477 55.6 2.2 25.4 14.7 2.2 0.0 100.0 461 43.1 3.2 19.7 19.8 1.2 12.9 100.0 559 73.6 1.2 15.4 6.6 1.7 1.5 100.0 302 62.2 3.3 16.6 9.2 3.3 5.5 100.0 321 24.4 12.9 18.4 33.3 7.9 3.2 100.0 741 41.6 3.4 19.7 31.2 2.5 1.6 100.0 629 48.4 3.9 32.0 6.4 6.0 3.2 100.0 1,077 43.6 4.3 38.1 6.6 5.5 1.9 100.0 457 43.7 3.3 21.2 25.0 2.2 4.6 100.0 396 41.9 5.2 20.7 22.6 4.0 5.6 100.0 2,377 50.8 5.1 23.0 11.6 5.6 3.9 100.0 2,965 13.9 2.4 70.0 2.1 1.8 9.9 100.0 168 45.7 4.9 23.3 16.6 4.6 4.8 100.0 5,907 26 * Characteristics of Respondents Figure 3.2 Percent Distribution of Women 15-49 by Employment Status, Zimbabwe 1999 Not currenlty employed, did not work in the last 12 months 46% Missing 5% Employed occasionally 5% Employed seasonally 17% Employed all year 23% Not currently employed, worked in the last 12 months 5% ZDHS 1999 3.5 OCCUPATION Information on current occupation of employed women is shown in Table 3.5. Thirty- nine percent of women have agricultural occupations and 61 percent work in non-agricultural jobs. The majority of women who work in agriculture work on family farms, while those with nonagricultural jobs work in sales and services (38 percent) and professional, technical, and managerial occupations (11 percent). As expected, employment in nonagricultural occupations is relatively more common among women who live in urban areas and those who have a formal education. Characteristics of Respondents * 27 Table 3.5 Occupation Percent distribution of currently employed women by occupation (agricultural and nonagricultural) and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Zimbabwe 1999 _____________________________________________________________________________________________________________ Agricultural Nonagricultural ____________________________ _______________________________ Communal/ Prof./ Sales Manual Number Background Own Resettle- Rented Other Tech./ and ________________ of characteristic land ment land land Manag. services Skilled Unskilled Missing Total women _____________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women 27.4 1.6 0.0 13.9 2.2 47.8 5.8 0.9 0.4 100.0 374 21.7 2.4 0.7 11.3 7.4 45.9 8.9 1.8 0.0 100.0 595 20.9 1.7 0.0 11.1 13.8 38.4 13.3 0.9 0.0 100.0 605 29.8 2.1 0.9 7.2 16.9 28.9 13.5 0.8 0.0 100.0 429 25.1 3.0 0.0 8.3 10.3 37.4 13.8 2.2 0.0 100.0 407 33.5 2.2 0.8 7.1 11.4 32.5 11.3 1.2 0.0 100.0 284 33.9 2.8 0.0 10.2 10.7 27.4 12.4 2.7 0.0 100.0 222 5.0 0.1 0.4 1.1 17.8 56.5 18.4 0.8 0.0 100.0 1,134 39.3 3.5 0.3 15.8 5.9 26.5 6.8 1.8 0.1 100.0 1,782 25.4 3.2 0.4 15.3 7.2 40.5 6.2 1.2 0.4 100.0 379 29.5 2.7 0.0 27.2 2.9 27.5 8.6 1.6 0.0 100.0 291 21.4 0.5 0.0 23.0 9.2 36.7 8.1 1.0 0.0 100.0 195 31.2 3.4 0.0 26.2 6.3 27.0 4.2 1.6 0.0 100.0 300 2.2 0.0 3.1 2.2 19.4 51.0 21.5 0.6 0.0 100.0 76 6.9 0.9 0.9 6.5 16.3 50.0 13.7 4.8 0.0 100.0 111 44.2 4.4 0.7 1.4 5.1 30.8 11.4 2.0 0.0 100.0 465 53.7 3.3 0.0 2.7 8.5 21.1 9.8 0.8 0.0 100.0 346 7.1 0.0 0.4 1.5 20.1 54.9 15.3 0.7 0.0 100.0 514 1.1 0.0 0.0 0.0 18.4 56.3 22.9 1.3 0.0 100.0 238 31.5 3.0 0.0 32.0 1.4 24.1 5.8 2.3 0.0 100.0 210 35.1 3.3 0.3 13.9 1.9 36.6 7.5 1.4 0.0 100.0 1,257 19.1 1.1 0.5 3.7 12.2 45.0 16.8 1.4 0.1 100.0 1,308 0.7 1.1 0.0 1.4 85.1 9.9 1.8 0.0 0.0 100.0 141 26.0 2.2 0.3 10.1 10.5 38.2 11.3 1.4 0.1 100.0 2,916 _____________________________________________________________________________________________________________ Note: Prof./Tech./Manag. includes professional, technical, clerical, and managerial occupations. 3.6 EMPLOYER AND FORM OF EARNINGS Table 3.6 shows the percent distribution of the 2,916 women who are currently employed and their form of earnings, according to background characteristics. More than half of the women are self-employed: 47 percent earn cash, and 7 percent are not earning cash. About 46 percent of women work for others: 35 percent are employed by a nonrelative, and 11 percent work for a relative. Masvingo has the largest proportion (22 percent) of women who are employed by relatives without earning cash. On the other hand, women in Matabeleland North are the most likely to be self-employed and earning cash. In rural areas, 10 percent of employed women 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 by level of education, with women with a secondary or higher education being much more likely than women with less education to be employed by a nonrelative in a job for which they are paid in cash. 28 * Characteristics of Respondents Table 3.6 Employer and form of earnings Percent distribution of currently employed women by employer and type of earnings, according to background characteristics, Zimbabwe 1999____________________________________________________________________________________________________ Employed by Employed by Self-employed a nonrelative a relative_______________ ______________ _______________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash1 cash2 cash1 cash2 cash1 cash2 Missing Total women______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women 22.2 5.0 48.4 0.8 5.1 17.9 0.5 100.0 374 39.2 6.2 42.4 0.5 5.1 6.3 0.3 100.0 595 49.2 5.6 38.7 0.7 1.1 3.9 0.7 100.0 605 50.9 9.6 31.2 0.7 3.8 3.6 0.1 100.0 429 58.3 7.4 24.8 0.2 4.9 4.2 0.2 100.0 407 57.9 8.5 21.0 0.3 7.1 5.1 0.0 100.0 284 55.8 10.8 20.5 0.9 6.8 4.8 0.3 100.0 222 51.6 2.7 41.6 0.5 2.0 1.2 0.4 100.0 1,134 43.4 10.0 30.1 0.6 5.9 9.7 0.3 100.0 1,782 53.7 0.8 31.0 0.8 10.5 2.8 0.4 100.0 379 39.8 12.4 41.4 0.5 2.8 2.5 0.5 100.0 291 32.1 11.2 50.5 1.0 4.6 0.5 0.0 100.0 195 26.0 14.4 43.1 0.7 6.7 9.1 0.0 100.0 300 58.6 1.7 38.6 0.0 0.0 1.1 0.0 100.0 76 52.4 0.9 41.0 1.3 4.0 0.4 0.0 100.0 111 54.3 11.3 17.8 0.5 3.4 12.2 0.4 100.0 465 49.6 8.9 14.3 0.0 4.9 22.2 0.0 100.0 346 45.9 3.7 46.3 0.7 1.9 0.7 0.7 100.0 514 56.6 0.0 40.8 0.3 1.6 0.3 0.5 100.0 238 39.4 8.8 38.6 0.0 8.2 4.6 0.4 100.0 210 49.8 9.2 27.6 0.7 5.1 7.3 0.4 100.0 1,257 48.6 5.6 35.3 0.7 3.4 6.2 0.2 100.0 1,308 9.9 1.2 84.2 0.0 1.4 1.9 1.4 100.0 141 46.6 7.2 34.6 0.6 4.4 6.4 0.4 100.0 2,916 ____________________________________________________________________________________________________ 1 Includes both women who receive only cash and those who receive cash and in-kind payment. 2 Includes both women who receive in-kind payment and those who receive no payment. 3.7 DECISION ON USE OF EARNINGS Information on who decides how to use the cash earned by employed women can be used as a measure of the status of women. Table 3.7 shows that 63 percent of the 2,502 women who receive cash earnings decide for themselves how to spend their money and 24 percent decide jointly with their husband/partner. Only 8 percent of women who earn cash reported that their husband/partner decides how their earnings will be used (see Figure 3.3). Younger, urban women with more education are less likely to report that their husband/partner decides how to spend their earnings, but this pattern is not a strong one. Characteristics of Respondents * 29 Table 3.7 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of women receiving cash earnings by person who decides how earnings are used, according to selected background characteristics, Zimbabwe 1999 __________________________________________________________________________________________ Person who decides how earnings are used ___________________________________________ Jointly Jointly with with Number Background Self Husband/ husband/ Someone someone of characteristic only partner partner else else Total women __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Marital status Not married Currently married Total 59.1 7.5 10.0 19.2 4.1 100.0 285 64.0 7.2 21.0 6.1 1.7 100.0 518 60.9 10.7 26.0 0.6 1.8 100.0 541 60.4 7.5 30.7 0.6 0.7 100.0 370 66.4 6.3 26.2 0.9 0.3 100.0 359 64.7 5.9 27.1 1.0 0.8 100.0 244 61.7 11.6 26.3 0.4 0.0 100.0 185 72.6 4.7 18.7 3.2 0.9 100.0 1,084 54.8 10.7 28.1 4.5 1.9 100.0 1,419 60.6 8.1 25.0 3.4 3.0 100.0 361 54.1 14.8 23.3 6.6 1.2 100.0 246 43.3 10.0 39.2 4.1 3.5 100.0 170 56.3 10.6 30.0 2.2 0.9 100.0 228 61.8 6.0 29.9 2.3 0.0 100.0 74 73.2 5.5 14.1 6.1 1.2 100.0 108 53.5 10.1 29.5 5.5 1.1 100.0 353 64.8 9.8 17.9 5.5 1.9 100.0 238 77.6 4.3 16.1 1.6 0.4 100.0 487 69.0 2.4 23.5 4.0 1.1 100.0 237 53.4 12.4 28.1 3.6 2.5 100.0 182 58.5 9.3 26.8 4.0 1.3 100.0 1,040 68.6 6.5 19.0 4.4 1.5 100.0 1,144 53.5 6.6 39.3 0.0 0.7 100.0 136 86.9 0.2 0.3 10.2 2.4 100.0 873 49.4 12.3 36.7 0.6 0.9 100.0 1,629 62.5 8.1 24.0 3.9 1.4 100.0 2,502 30 * Characteristics of Respondents Table 3.8 Control over earnings according to household expenditures Percent distribution of women who receive cash earnings by person who decides how earnings are used and marital status, according to perceived proportion of household expenditures met by earnings, Zimbabwe 1999 _______________________________________________________________________________________________________________________ Married or separated Not married ________________________________________________ _______________________________________________ Jointly with: Jointly with: ____________ Hus- Some- ____________ Hus- Some- Contribution Hus- Some- band/ one Hus- Some- band/ one to household Self band/ one partner else Num- Self band/ one partner else Num- expenditures only partner else only only Total ber only partner else only only Total ber _______________________________________________________________________________________________________________________ All 54.9 29.0 0.5 14.2 1.4 100.0 372 90.1 0.0 0.7 0.0 9.1 100.0 207 Half or more 57.8 30.9 1.1 8.7 1.4 100.0 535 82.1 0.3 2.3 0.5 14.9 100.0 219 Less than half 45.7 40.5 0.9 12.3 0.6 100.0 860 80.5 0.7 4.4 0.2 14.2 100.0 252 None/almost none 78.4 11.8 2.1 7.0 0.7 100.0 133 89.0 0.0 2.3 0.0 8.7 100.0 167 Total 53.2 33.5 1.0 11.2 1.0 100.0 1,903 84.9 0.3 2.5 0.2 12.1 100.0 845 Figure 3.3 Percent Distribution of Employed Women 15-49 Who Receive Cash Earnings by Person Who Decides on Use of Earnings, Zimbabwe 1999 Respondent 63% Husband/ Partner 8% Someone Else 4% Jointly 25% ZDHS 1999 3.8 CONTROL OVER EARNINGS BY CONTRIBUTION TO HOUSEHOLD EXPENDITURES Table 3.8 indicates the perceived proportion of household expenditures met by earnings by marital status and the woman’s control over her earnings. Among married or separated women who stated that they decide on their own how to use their earnings, 35 percent said that the decision to use the earnings is made jointly with their husband/partner or by someone else. In addition, 11 percent said that the decision is made entirely by their husband/partner. Unmarried women are more likely to have control over the spending of the cash they earn than married women. Among women whose earnings are used to meet household expenses, those who contribute at least half of the household expenditures are more likely to have sole control over decisions about the use of their income than women who contribute less. Characteristics of Respondents * 31 Table 3.9 Household decisionmaking Percent distribution of women by person who makes specific household decisions and marital status, according to type of decision, Zimbabwe 1999 ___________________________________________________________________________________________________________________________ Married or separated Not married ________________________________________________ _______________________________________________ Jointly with: Jointly with: ____________ Hus- Some- ____________ Hus- Some- Hus- Some- band/ one Hus- Some- band/ one Household Self band/ one partner else Num- Self band/ one partner else Num- decision only partner else only only Total ber only partner else only only Total ber ___________________________________________________________________________________________________________________________ Own health care 50.5 12.0 0.3 30.0 7.2 100.0 3,802 40.0 0.7 1.6 0.4 57.4 100.0 2,094 Large household purchases 18.0 39.9 0.7 34.3 7.1 100.0 3,802 21.9 0.8 1.4 0.3 75.6 100.0 2,094 Daily household purchases 57.4 19.6 0.9 15.3 6.7 100.0 3,802 23.5 0.7 2.2 0.3 73.2 100.0 2,094 Visits to family or relatives 31.3 42.8 1.2 19.6 5.0 100.0 3,802 33.7 0.6 4.9 0.3 60.5 100.0 2,094 What food to cook each day 83.6 5.8 1.1 3.3 6.1 100.0 3,802 29.8 0.7 3.6 0.2 65.7 100.0 2,094 3.9 HOUSEHOLD DECISIONMAKING One of the indicators of women’s status is the ability to undertake specific household decisions. Table 3.9 shows the percentage distribution of women by type of decision made at household level about health care, large household purchases, daily household purchases, visits to family or relatives, and food cooked every day. Married or separated women are more likely to make their own decisions in seeking health care (51 percent), daily household purchases (57 percent), and the type of food to be cooked each day (84 percent) than non-married women. They are more likely to decide jointly with their husband when purchasing large household goods (40 percent) and when visiting family or relatives (43 percent). For 30 percent of married or separated women, decisions on seeking health care are made by the husband only. Similarly, 34 percent of women reported that their husband makes decisions about large household purchases. It is interesting to note that single women are less likely to make any of the specified decisions. The proportion of these women reporting that someone else makes decisions ranged from 57 percent for health care to 76 percent for large household purchases. These results tend to suggest that single women are still living in their parents' households where decisions are being made by other people. 3.10 FINAL SAY IN HOUSEHOLD DECISIONS Table 3.10 shows the percent distribution of women who say that they alone or jointly have the final say in decision-making in various areas by socioeconomic and demographic characteristics. In general, older women, women who have ever been married, those with a larger number of children, those who live in urban areas, those who have a better education, and those who are earning cash are more likely to have a final say in household decisions. The proportion of women reporting that they make decisions on health care alone or jointly with someone else ranges from 29 percent of women age 15-19 to 71 percent of women age 40-49. Similarly, the corresponding percentages for making decisions alone or with someone else in making large purchases ranges from 14 percent for women age 15-19 years to 69 percent for women age 40-49. For making decisions on daily purchases, the percentages range between 18 percent for women 15-19 to 85 percent for women 40-49. 32 * Characteristics of Respondents Table 3.10 Final say in household decisions Percentage of women who say that they alone or jointly have the final say in specific household decisions, according to background characteristics, Zimbabwe 1999 ______________________________________________________________________________________________________ Alone or jointly has final say in: _______________________________________________ Visits to Has final Has final Own Making Making family, What food say in all say in no Number Background health large daily relatives, to cook specified specified of characteristic care purchases purchases friends daily decisions decisions women1 ______________________________________________________________________________________________________ Age 15-19 29.2 14.4 17.9 26.2 27.2 9.3 54.5 1,445 20-29 58.6 46.7 63.4 67.2 75.8 31.8 12.1 2,326 30-39 69.2 66.8 83.0 80.8 92.9 49.3 3.3 1,298 40-49 71.0 69.0 85.1 83.9 96.0 53.1 2.0 826 Marital status Never married 32.2 11.1 12.6 26.7 21.1 8.6 56.1 1,637 Married or in union 62.1 58.9 78.8 75.4 92.1 39.6 4.0 3,597 Divorced, separated, widowed 76.5 65.1 71.4 80.9 75.2 58.5 9.5 662 Number of living children 0 34.9 19.0 22.7 33.5 31.4 12.9 48.1 1,852 1-2 62.4 53.6 70.7 71.8 82.5 37.9 8.7 2,076 3-4 65.9 64.3 82.4 79.4 93.0 46.0 3.5 1,078 5+ 69.1 64.5 82.7 80.5 96.3 48.4 1.9 890 Residence Urban 58.0 49.8 62.9 69.1 71.9 35.9 15.8 2,284 Rural 53.8 44.1 57.5 58.3 69.6 31.4 21.2 3,612 Province Manicaland 49.3 37.8 54.7 49.4 69.2 27.3 25.0 877 Mashonaland Central 49.8 46.5 62.6 68.4 75.0 24.0 11.5 470 Mashonaland East 64.9 54.5 63.6 67.5 74.0 45.9 17.9 463 Mashonaland West 71.1 62.1 70.0 75.3 78.1 51.0 12.0 567 Matabeleland North 69.0 49.4 64.8 66.7 71.9 38.7 14.0 301 Matabeleland South 57.5 53.7 57.2 55.6 65.9 37.0 26.5 323 Midlands 40.4 42.5 54.7 57.4 65.7 24.4 25.7 736 Masvingo 49.0 32.9 52.5 49.8 65.8 22.3 23.2 626 Harare 57.1 45.7 61.5 70.3 70.8 33.6 15.5 1,075 Bulawayo 62.7 53.5 60.2 69.6 70.9 39.6 16.1 458 Education No education 66.2 60.8 74.4 74.0 89.4 45.7 6.8 394 Primary 58.8 50.7 65.2 66.9 78.7 36.6 13.5 2,371 Secondary 49.7 39.5 51.9 56.1 60.6 27.2 26.0 2,963 Higher 84.6 70.8 80.8 85.1 85.0 59.3 4.7 167 Current employment Not employed 48.9 36.0 48.9 51.4 60.2 26.5 28.8 2,700 For cash 62.8 57.1 69.9 74.2 79.9 40.7 9.9 2,748 Not for cash 49.2 42.4 61.4 57.9 75.2 26.5 17.3 446 All women 55.4 46.3 59.6 62.5 70.5 33.1 19.1 5,896 ______________________________________________________________________________________________________ 1 Includes 2 women with missing information on current employment Characteristics of Respondents * 33 Divorced, separated, and widowed women are more likely to have a final say in all specified decisions than women who are either married or in union or never married. The percentages are 59 percent for divorced, separated, and widowed women compared with 40 percent for women who are either married or in union and 9 percent for single women. A woman’s number of living children influences her level of control over decisionmaking. As the number of living children increases, so does a woman’s ability to make a decision. Although only 13 percent of women with no living children have a final say in all specified decisions, 48 percent of women with more than five living children do so. It should be noted that parity increases with age. Urban residence is positively related to decisionmaking. In urban areas, 36 percent of women have a final say in all specified decisions compared with 31 percent of women in rural areas. Interestingly, there is no clear relationship between women’s education and decisionmaking. Whereas 46 percent of females with no formal education reported that they have a final say in all specified decisions, 59 percent of those with a higher education reported the same, compared with 37 percent and 27 percent of those with primary and secondary education, respectively. Decisionmaking in all specified areas varies across provinces, ranging from 22 percent in Masvingo to 51 percent in Mashonaland West. Women who were currently employed and earning cash are more likely to make decisions than women who are either unemployed or employed but not earning cash. Whereas 41 percent of those employed and earning cash have the final say in all specified decisions, 27 percent of the unemployed and those working but not earning cash reported the same. 3.11 WOMEN’S AGREEMENT WITH REASONS FOR WIFE BEATING Information on women’s agreement with reasons justifying a husband to beat his wife by socio-economic and demographic characteristics are presented in Table 3.11. The reasons justifying a husband to beat his wife included in the survey are wife burning the food, arguing with husband, going out without telling the husband, neglecting the children, and refusing sexual relations. The proportion of women in each group agreeing with at least one specified reason justifying a husband to beat his wife declines with increasing age and education. For example, 58 percent of women age 15-19 agreed with at least one specified reason compared with 47 percent of women 40-49. Although 58 percent of women with no education agreed with at least one reason for wife beating, the corresponding percentage for women with higher than secondary education is only 16 percent. Similarly, the proportion of women agreeing with none of the specified reasons increases with age and education. Marital status and number of children make a slight difference in terms of women’s perception on reasons justifying a husband beating his wife. It is interesting to note that women who have been married for less than five years are slightly more likely to agree with one of the specific reasons than other women. As expected, urban women are less likely to agree with all of the reasons for wife beating than rural women. Sixty percent of urban women agreed with none of the specified reasons justifying a husband beating his wife, compared with 42 percent of women residing in rural areas. 34 * Characteristics of Respondents Table 3.11 Women's agreement with reasons for wife beating Percentage of women who agree with specific reasons justifying a husband beating his wife and percentage who agree with at least one or with none of the reasons, according to background characteristics, Zimbabwe 1999______________________________________________________________________________________________________ Reasons justifying a husband beating his wife________________________________________________ Agrees Agrees Goes out with at with none Burns Argues without Neglects Refuses least one of the Number Background the with telling the sexual specified specified of characteristic food him him children relations reason reasons women1______________________________________________________________________________________________________ Age 15-19 20-29 30-39 40-49 Marital status Never married Married or in union <5 years 5+ years Divorced, separated, widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Current employment Not employed For cash Not for cash Number of decisions in which woman has final say 0-1 2-3 4-5 All women 15.7 34.7 32.1 36.8 16.9 57.9 42.1 1,445 11.4 32.0 27.5 31.8 22.9 51.2 48.8 2,326 9.8 28.1 24.7 27.5 25.1 45.4 54.6 1,298 10.5 30.7 25.8 25.5 25.5 46.5 53.5 826 11.8 28.3 25.7 32.5 13.6 49.7 50.3 1,637 12.1 33.6 28.7 31.0 25.8 52.0 48.0 3,597 12.9 37.6 30.7 34.7 23.7 55.9 44.1 1,089 11.8 31.8 27.8 29.4 26.7 50.3 49.7 2,508 11.5 29.1 27.8 29.1 24.6 47.8 52.2 662 12.0 29.8 27.1 32.7 15.7 50.9 49.1 1,852 11.6 32.1 27.4 30.1 22.8 50.2 49.8 2,076 12.0 29.7 27.3 30.3 27.4 50.4 49.6 1,078 12.7 36.5 30.5 31.7 28.6 53.3 46.7 890 7.0 21.2 19.1 24.4 14.4 39.8 60.2 2,284 15.1 38.2 33.2 35.4 27.3 57.9 42.1 3,612 10.0 28.7 24.9 26.3 21.6 45.9 54.1 877 18.6 41.9 30.2 37.8 26.7 63.3 36.7 470 12.8 28.5 31.9 26.3 27.0 50.0 50.0 463 19.4 35.0 31.3 34.8 33.2 56.6 43.4 567 15.4 37.8 23.9 41.5 19.9 54.8 45.2 301 13.7 44.6 39.2 48.3 19.2 67.3 32.7 323 11.3 39.6 37.0 36.2 22.9 61.3 38.7 736 14.4 39.9 33.2 33.1 33.1 55.1 44.9 626 7.6 19.7 19.9 24.0 14.9 38.4 61.6 1,075 3.2 16.1 12.8 21.5 6.0 34.3 65.7 458 18.9 43.0 32.7 34.0 32.3 57.7 42.3 394 15.6 38.4 31.7 34.2 29.4 56.6 43.4 2,371 8.7 26.2 25.3 29.5 16.0 47.4 52.6 2,963 2.6 5.1 4.2 11.5 7.9 16.1 83.9 167 12.4 32.2 28.3 33.1 20.4 51.5 48.5 2,700 10.3 29.2 25.1 28.1 22.5 48.3 51.7 2,748 19.6 42.2 41.1 38.5 32.4 62.9 37.1 446 13.8 33.0 29.4 35.1 18.3 54.0 46.0 1,719 14.0 36.7 31.3 34.3 26.3 56.3 43.7 1,301 9.9 28.5 25.2 27.4 22.9 46.6 53.4 2,876 12.0 31.6 27.8 31.2 22.3 50.9 49.1 5,896 ____________________________________________________________________________________________________________ 1 Includes 2 women with missing information on current employment Characteristics of Respondents * 35 Significant variation exists at the provincial level, with Bulawayo province having the smallest proportion of women agreeing with at least one of the specified reasons justifying a husband beating his wife (34 percent) and Matabeleland South province have the largest proportion (67 percent). Women who are financially independent are less likely to agree with wife beating. Women who are employed and earning cash are the least likely (48 percent) to agree with any specified reasons justifying wife beating compared with women who are not earning cash (63 percent) and those who are unemployed (52 percent). Women who have more areas in which they make decisions are somewhat less likely to agree with at least one of the specified reasons for wife beating compared with those who have fewer areas in which they make decisions. The corresponding percentages are 47 percent for women who have four to five decisions compared with 54 percent for women who have zero to one decision. 3.12 WOMEN’S AGREEMENT WITH REASONS FOR REFUSING SEXUAL RELATIONS Women’s ability to refuse sex shows their power to bargain sexual behaviour, which in turn affects their chances of getting infected with sexually transmitted infections (STIs). In the ZDHS, respondents were asked whether they think that the specified reasons are justified for a wife to refuse having sex with her husband or partner. The reasons listed in the survey are tiredness or not in the mood, recently gave birth, knows that her husband has sexual relations with other women, and knows that her husband has an STI. In general, older women, formerly married women, urban women, better-educated women, and women who earn cash are less likely to agree with any reason for refusing sexual relations. Older women are less likely to report tiredness, knowledge of husband having sexual relations with other women, and knowledge of husband having an STI as reasons for refusing sexual relations. However, they are more likely to report having given birth recently as a reason for refusing sexual relations. Marital status also influences women’s reasons for refusing sexual relations. Women who have never been married are more likely (40 percent) to agree with all of the specified reasons for refusing sex, compared with women who are married or in union (33 percent) or women who are divorced, separated, or widowed (35 percent). Women who have been married for more than five years are less likely to agree with all of the specified reasons for refusing sex; 31 percent compared with 38 percent of those who were married for less than five years. There is a negative relationship between the proportion of women agreeing with all of the reasons for refusing sex and the number of children a woman has. Urban women are more likely than rural women to agree with all of the specified reasons for refusing sexual relations with a partner or husband. For instance, 58 percent of urban women gave tiredness or not in the mood as a reason for refusing sex, compared with 50 percent of rural women. There are variations between provinces; the percentage of women who agreed with all of the specified reasons for refusing sexual relations with a partner or husband ranges from 22 percent for Mashonaland West to 51 percent for Matabeleland North. 36 * Characteristics of Respondents Table 3.12 Women's agreement with reasons for refusing sexual relations Percentage of women who agree with specific reasons justifying a wife refusing to have sexual relations with her husband and percentages who agree with all and with none of the reasons, according to background characteristics, Zimbabwe 1999______________________________________________________________________________________________________ Reasons justifying a wife refusing sexual relations with husband__________________________________________ Knows Agrees Agrees husband has with all with none Tired, Gave sexual rela- Knows of the of the Number Background not in birth tions with husband specified specified of characteristic mood recently other women has STD reasons reasons women1______________________________________________________________________________________________________ Age 15-19 20-29 30-39 40-49 Marital status Never married Married or in union <5 years 5+ years Divorced, separated, widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Current employment Not employed For cash Not for cash Number of decisions in which woman has final say 0-1 2-3 4-5 Number of reasons wife beating justified 0 1-3 4-5 All women 52.3 70.5 64.6 72.9 37.3 14.7 1,445 55.1 83.6 64.4 71.2 36.4 7.4 2,326 51.7 85.5 64.3 72.7 35.8 6.3 1,298 47.7 85.3 57.7 66.0 27.9 7.7 826 54.1 72.3 67.6 74.9 40.3 14.6 1,637 51.6 84.5 61.6 69.7 33.1 6.8 3,597 57.0 83.8 65.2 71.8 37.5 6.6 1,089 49.2 84.9 60.1 68.8 31.2 6.9 2,508 54.7 83.8 63.4 70.2 35.0 7.1 662 53.4 72.7 66.1 72.5 37.9 13.7 1,852 56.4 84.2 65.1 72.4 37.8 6.8 2,076 50.3 85.7 59.4 69.2 31.7 6.7 1,078 45.1 85.5 59.2 68.2 28.4 7.0 890 57.5 82.5 69.4 74.4 41.4 6.7 2,284 49.5 80.1 59.7 69.2 31.4 10.4 3,612 43.7 78.7 58.6 73.1 28.7 10.0 877 59.1 83.0 58.0 66.9 32.7 6.8 470 54.5 74.4 56.5 59.9 32.3 13.1 463 44.4 67.0 46.3 46.8 21.8 21.5 567 63.3 88.8 72.9 80.7 50.7 6.7 301 59.7 95.1 78.7 89.6 49.4 1.8 323 51.7 86.8 66.0 74.4 33.6 3.5 736 45.3 78.9 63.9 73.5 31.3 11.5 626 57.1 80.1 68.3 73.8 40.6 7.5 1,075 60.6 88.6 73.7 80.3 46.2 4.9 458 48.3 80.9 47.3 60.8 23.8 10.7 394 46.8 80.1 57.7 66.8 29.3 11.0 2,371 56.4 81.0 69.4 75.5 40.2 7.5 2,963 77.7 95.6 79.3 83.7 61.3 1.8 167 53.4 78.5 65.4 72.3 37.6 10.7 2,700 52.1 83.0 62.3 70.7 33.9 7.8 2,748 51.7 84.4 59.7 68.2 30.1 6.2 446 51.7 72.2 64.3 73.2 37.2 14.5 1,719 52.1 86.2 62.1 71.2 33.3 5.3 1,301 53.5 84.0 63.6 70.0 35.1 7.4 2,876 53.8 78.8 63.1 69.4 37.5 11.6 2,894 52.5 83.5 64.4 73.8 34.0 6.1 2,306 48.3 82.2 62.0 70.3 30.5 7.5 695 52.6 81.0 63.5 71.2 35.3 9.0 5,896 ____________________________________________________________________________________________________________ 1 Includes 2 women with missing information on current employment Characteristics of Respondents * 37 There is a positive relationship between education and women’s agreement with various reasons for refusing sexual relations with a husband or partner. For example, 78 percent of women with a higher than secondary education agreed that a woman is justified in refusing to have sex with a partner because they were tired or not in the mood, the percentage for women with a primary education is 47 percent, and the percentage for women with a secondary education is 56 percent. This pattern holds for other reasons for refusing sexual relations with a partner or husband. Women who are unemployed are more likely to agree with all of the specified reasons cited for refusing sexual relations with a husband or partner (38 percent), compared with those who were employed and earning cash (34 percent) and those who were working but not earning cash (30 percent). Women who have fewer areas in which they have final say in making decisions are slightly more likely to agree with all of the specified reasons for refusing sex compared with those who have more areas in which they have final say. The corresponding percentages are 37 percent for women with zero to one area and to 35 percent for women with four to five areas. The proportion of women agreeing with all of the specified reasons for refusing sex is negatively associated with the number of reasons justifying wife beating. While 38 percent of women who agreed with all of the specified reasons for refusing sex found no reason that justified wife beating, 31 percent of women who cited more than four reasons that justified wife beating agreed with all the reasons for refusing sex. 1 Numerators for the age-specific fertility rates are calculated by summing the number of live births that occurred in the 1 to 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 to 36 months preceding the survey. Fertility * 39 Table 4.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate and general fertility rate for the three years preceding the survey, by urban-rural residence, Zimbabwe 1999_________________________________________________ Residence______________ Age group Urban Rural Total_________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 TFR 15-44 GFR CBR 93 125 112 170 224 199 147 202 180 87 161 135 68 128 108 (27) (54) 46 * * 15 2.96 4.57 3.96 2.96 4.47 3.89 116 157 141 31.3 30.5 30.8 _________________________________________________ TFR: Total Fertility Rate for ages 15-49 expressed per woman GFR: General Fertility Rate (births divided by the number of women 15-44) expressed per 1,000 women CBR: Crude Birth Rate expressed per 1,000 population Note: Rates are for the period 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. An asterisk indicates that the rate is based on less than 125 woman-years of exposure and has been suppressed. FERTILITY 4 In the 1999 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 on age of women at their 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 previous ZDHS surveys, 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. 4.1 CURRENT FERTILITY The most widely used measures of current fertility are the total fertility rate (TFR) and its component age-specific fertility rates (ASFRs). The TFR is defined as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age- specific rates.1 Table 4.1 shows the age-specific and aggregate fertility measures calculated from the 1999 ZDHS data. The total fertility rate for Zim- babwe is four children per woman. Peak child- bearing occurs during ages 20-24 and 25-29, dropping sharply after age 34. Fertility among 40 * Fertility Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and mean number of children ever born to women age 40-49 years, by selected background characteristics, Zimbabwe 1999___________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant age 40-49___________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 2.96 7.1 4.54 4.57 8.2 6.40 4.68 8.8 6.40 4.86 8.6 6.52 4.15 8.4 5.90 4.10 8.6 5.45 4.10 7.8 6.19 4.81 9.1 5.66 4.05 7.4 5.97 3.94 6.2 6.48 2.98 7.3 4.81 2.98 6.2 4.81 5.21 7.0 6.33 4.48 8.0 6.12 3.41 7.9 4.61 1.87 5.8 2.58 3.96 7.8 5.87 ___________________________________________________ 1 Rate for women age 15-49 years urban women is substantially lower (three children per woman) than among rural women (4.6 children per woman). This pattern of lower fertility in urban areas is evident in every age group. 4.2 FERTILITY BY BACKGROUND CHARACTERISTICS Table 4.2 and Figure 4.1 show differ- entials in fertility by urban-rural residence and level of education. The TFR ranges from three births per woman in the urban prov- inces of Harare and Bulawayo to 4.9 births per woman in Mashonland Central. Educational attainment is closely linked to a woman's fertility; the TFR for women with no formal education and women with a primary education is four or more children per woman, while that for women with at least some secondary educa- tion is three or fewer children per woman. Table 4.2 also allows a general as- sessment of differential trends in fertility over time among population subgroups. The mean number of children ever born to wom- en 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 roughly equivalent declines in both urban and rural areas and within all provincial and educa- tion categories. Overall, the comparison of past and present fertility indicators suggests a decline of about two children per woman, from 5.9 to 4.0 children per woman. At the time of the survey, 8 percent of interviewed women reported that they were pregnant. This percentage 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. Differentials in pregnancy status closely parallel differentials in current fertility. Fertility * 41 Table 4.3 Trends in current fertility rates Age-specific fertility rates and total fertility rates, Zimbabwe, 1984-1999 __________________________________________ 1988 1994 1999 ZDHS ZDHS ZDHS _______ _______ _______ Age group 1984-88 1991-94 1996-99 __________________________________________ 15-19 103 99 112 20-24 247 210 199 25-29 247 194 180 30-34 219 172 135 35-39 160 117 108 40-44 86 52 46 45-49 36 14 15 Figure 4.1 Total Fertility Rates by Background Characteristics, Zimbabwe 1999 4.0 3.0 4.6 4.7 4.9 4.2 4.1 4.1 4.8 4.1 3.9 3.0 3.0 5.2 4.5 3.4 1.9 ZIMBABWE RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary Higher Total Fertility Rate (Births per Woman) ZDHS 1999 4.3 FERTILITY TRENDS Table 4.3 examines trends in fertility in Zimbabwe by comparing the results of the 1999 ZDHS with the two earlier ZDHS surveys (1988 and 1994). This comparison is appropriate because the methods of data collection and rate calculation were identical in all the surveys. The TFR calculated from the 1988 ZDHS was 5.5 children per woman, compared with 4.3 derived from the 1994 ZDHS and 4.0 from the 1999 ZDHS. This change in the TFR demonstrates a decline in fertility of 27 percent during the period between 1984-88 and 1996-99. Examina- tion of changes in age-specific fertility rates in Figure 4.2 shows large absolute declines in fertility at all ages above 15-19 years. These similar absolute declines, however, translate to a greater proportional decline at older ages. 42 * Fertility Table 4.4 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey by mother's age at the time of the birth, Zimbabwe 1999______________________________________________ Number of years preceding survey Mother's _________________________________ age at birth 0-4 5-9 10-14 15-19______________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 108 107 118 152 201 224 261 298 182 209 263 282 145 190 237 [298] 112 152 [225] - 49 [122] - - [18] - - - ______________________________________________ Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Figure 4.2 Age-Specific Fertility Rates by Urban-Rural Residence, Zimbabwe 1999 " " " " " " " + + + + + + + $ $ $ $ $ $ $ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Group 0 50 100 150 200 250 300 Births per 1,000 Women 1988 ZDHS 1994 ZDHS 1999 ZDHS$ + " 1984-88 1991-94 1996-99 ZDHS 1999 4.4 TRENDS IN AGE-SPECIFIC FERTILITY RATES The data in Table 4.4 provide further evidence of a substantial fertility decline in Zimbabwe. Table 4.4 shows the age-specific fertility rates for five-year periods preceding the survey. Because women age 50 and above were not interviewed in the survey, the rates are successfully truncated as the number of years before the survey increases. Within Wmong women under age 35, substantial and sustained declines in ASFRs are observed from 15 to 19 years before the survey to 0 to 4 years before the survey. 4.5 CHILDREN EVER BORN AND LIVING The distribution of women by the number of children ever born is presented in Table 4.5 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 more than three children, and women currently at the end of their childbearing years have had more than six children. Of the more than six children ever born to women age 45-49, 5.5 have survived. Fertility * 43 Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Zimbabwe 1999 ______________________________________________________________________________________________________ Mean Mean number Number of children ever born Number number of __________________________________________________________ of of living Age 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ______________________________________________________________________________________________________ ALL WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 All ages 83.8 14.3 1.7 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,447 0.18 0.17 30.7 41.0 22.2 5.0 0.7 0.3 0.1 0.0 0.0 0.0 0.0 100.0 1,294 1.06 0.97 7.7 25.1 32.6 21.5 9.0 2.7 1.2 0.1 0.1 0.0 0.0 100.0 1,034 2.13 1.92 5.2 11.7 20.2 25.8 18.6 9.5 6.3 2.4 0.4 0.0 0.0 100.0 668 3.09 2.85 3.7 5.5 7.7 13.8 20.6 19.0 11.8 8.4 5.4 1.9 2.1 100.0 637 4.52 4.18 2.7 3.4 6.2 8.5 13.5 12.9 16.9 15.3 7.8 8.1 4.7 100.0 466 5.54 5.01 1.9 2.5 6.6 7.8 6.9 10.9 16.6 12.7 10.9 11.8 11.3 100.0 361 6.29 5.54 29.9 19.2 15.0 10.5 7.5 5.4 4.6 3.2 1.9 1.6 1.3 100.0 5,907 2.31 2.10 ______________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 All ages 42.3 49.9 6.7 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 314 0.66 0.60 13.6 48.2 29.6 6.9 0.9 0.5 0.2 0.0 0.0 0.0 0.0 100.0 820 1.36 1.25 3.5 21.2 34.9 24.2 11.1 3.5 1.3 0.1 0.1 0.0 0.0 100.0 788 2.35 2.14 2.8 9.0 19.8 27.9 20.6 9.7 6.8 3.0 0.4 0.0 0.0 100.0 543 3.29 3.05 2.4 3.3 7.0 11.9 20.9 20.6 13.5 9.3 6.4 1.9 2.7 100.0 495 4.83 4.47 2.2 3.2 5.1 6.3 12.7 13.3 17.0 17.5 9.4 8.4 5.0 100.0 375 5.77 5.23 1.9 2.4 7.0 6.0 6.6 9.4 16.9 13.2 11.9 12.8 11.9 100.0 272 6.46 5.72 8.7 22.3 19.9 13.9 10.4 7.3 6.3 4.6 2.8 2.1 1.8 100.0 3,609 3.13 2.85 ______________________________________________________________________________________________________ CEB = Children ever born 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). Close to 2 percent of married women age 45-49 have never had a child. Under the proposition that desire for children is universal in Zimbabwe, this percentage represents a rough measure of primary infertility or the inability to bear children. 4.6 BIRTH INTERVALS Information on the length of birth intervals provides insight into birth spacing patterns. Research has shown that children born too soon after a previous birth are at increased risk of poor health, particularly when the interval is less than 24 months. Table 4.6 shows the distribution of births in the five years before the survey by the interval since the previous birth, according to various background and biodemographic variables. 44 * Fertility Table 4.6 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since preceding birth, according to selected background characteristics, Zimbabwe 1999 _____________________________________________________________________________________________________ Median number of months Months since preceding birth Number since ____________________________________________ of preceding Characteristic 7-17 18-23 24-35 36-47 48+ Total births birth ______________________________________________________________________________________________________ Age 15-19 20-29 30-39 40+ Birth order 2-3 4-6 7 + Sex of preceding birth Male Female Survival of preceding birth Dead Living Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total (21.7) (7.7) (44.2) (23.2) (3.2) 100.0 29 28.9 4.9 8.6 32.2 27.9 26.3 100.0 1,199 37.1 2.9 5.5 24.8 21.2 45.6 100.0 905 45.2 2.4 4.9 24.2 23.7 44.7 100.0 243 44.1 3.9 6.7 28.7 26.9 33.9 100.0 1,314 39.5 5.3 6.7 28.1 21.1 38.8 100.0 736 41.6 2.4 9.4 30.5 25.0 32.6 100.0 327 39.4 5.1 7.6 27.2 24.9 35.2 100.0 1,190 40.1 3.1 6.5 30.3 24.8 35.3 100.0 1,187 39.8 20.3 16.1 28.0 16.3 19.4 100.0 245 28.5 2.2 6.0 28.8 25.8 37.1 100.0 2,131 41.3 4.9 7.2 20.4 23.5 43.9 100.0 671 43.4 3.8 7.0 32.0 25.4 31.8 100.0 1,706 38.9 4.7 10.4 33.7 22.9 28.3 100.0 426 37.0 3.0 4.2 29.9 30.3 32.6 100.0 238 40.7 4.2 7.5 28.0 22.4 37.8 100.0 213 41.6 2.1 5.9 25.1 28.8 38.2 100.0 240 43.0 2.3 4.5 27.8 28.0 37.5 100.0 130 40.8 4.6 5.7 37.6 19.7 32.3 100.0 153 36.6 6.0 8.6 29.5 26.4 29.5 100.0 313 37.8 2.6 6.6 30.2 24.9 35.6 100.0 252 39.7 4.1 5.4 21.8 25.9 42.9 100.0 282 43.1 7.7 7.7 19.1 14.8 50.7 100.0 131 48.3 2.9 8.1 31.2 26.9 30.9 100.0 233 38.9 4.6 6.6 28.8 25.4 34.6 100.0 1,209 40.1 3.7 7.7 28.3 24.0 36.2 100.0 901 39.5 (6.1) (0.0) (19.2) (13.6) (61.0) 100.0 35 - 4.1 7.1 28.7 24.9 35.2 100.0 2,377 39.9 ____________________________________________________________________________________________________ Note: First births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Figures in parentheses are based on 25-49 unweighted births. Fertility * 45 Table 4.7 Age at first birth Percent distribution of women age 15-49 by age at first birth, according to current age, Zimbabwe 1999 ____________________________________________________________________________________________________ Median Age at first birth Number age at No _____________________________________________ of first Current age birth <15 15-17 18-19 20-21 22-24 25+ Total women birth ____________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 83.8 0.7 10.1 5.4 NA NA NA 100.0 1,447 a 30.7 2.8 17.2 27.6 17.3 4.5 0.0 100.0 1,294 a 7.7 2.7 20.1 24.2 22.0 17.9 5.3 100.0 1,034 20.3 5.2 3.9 19.4 23.2 21.2 17.2 9.9 100.0 668 20.3 3.7 4.4 23.5 33.3 16.0 12.3 6.8 100.0 637 19.3 2.7 6.5 21.8 23.9 23.3 15.5 6.3 100.0 466 19.8 1.9 4.5 21.3 27.9 21.1 11.0 12.2 100.0 361 19.7 ____________________________________________________________________________________________________ NA = Not applicablea Omitted in populations where less than 50 percent of the women in the age group × to × + 4 have had a birth by age × About one in nine children are born after a “too short” interval (less than 24 months). The median interval length is shorter among births to young women and when the older sibling is no longer alive. The median birth interval length is 40 months for all births, but only 29 months among children whose mother is less than 20 years old and among children whose older sibling did not survive. Birth intervals are substantially longer in urban than in rural areas. This difference could be related to the higher rates of contraceptive use (for spacing) among urban women (see Chapter 5). By province, the longest birth interval is observed in Bulawayo and the shortest in Matabeleland South. Birth intervals do not vary greatly by education. 4.7 AGE AT FIRST BIRTH Table 4.7 shows that the median age at first birth in Zimbabwe is about 20 for most age groups. Although 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 28 percent of women age 35-39 had a birth before age 18, only 23 percent of women currently age 30-34 and 20 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. 46 * Fertility Table 4.8 Median age at first birth by background characteristics Median age at first birth among women age 25-49 years, by current age and selected background characteristics, Zimbabwe 1999__________________________________________________________________________________ Current age Women Background ____________________________________________ age characteristic 25-29 30-34 35-39 40-44 45-49 25-49_________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women 21.0 21.2 19.4 20.0 20.0 20.5 19.7 19.7 19.3 19.7 19.6 19.6 19.7 20.2 19.2 19.9 19.9 19.6 19.6 19.5 19.2 19.6 20.3 19.5 19.2 19.8 19.0 21.5 18.5 19.5 19.5 19.7 19.6 19.1 20.4 19.6 19.4 19.6 20.3 17.8 19.3 19.4 20.4 19.1 19.0 19.5 19.5 19.6 20.6 20.1 19.8 20.1 19.1 20.2 20.6 20.4 19.4 20.3 19.9 20.1 21.5 21.3 19.4 20.5 20.5 20.9 20.9 20.6 19.0 18.9 19.0 19.9 17.9 18.1 18.6 19.4 19.3 18.8 18.8 19.2 19.2 19.5 19.6 19.2 20.8 21.3 20.2 20.6 20.2 20.9 a 23.6 22.1 23.1 29.0 24.0 20.3 20.3 19.3 19.8 19.7 19.9 _________________________________________________________________________________ a Omitted because less than 50 percent of the women ages 25 to 29 have had a birth by age 25 4.8 MEDIAN AGE AT FIRST BIRTH BY BACKGROUND CHARACTERISTICS Table 4.8 summarises 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 in 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 18, compared with age 21 for women with a secondary education. Fertility * 47 Table 4.9 Teenage pregnancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child, by background characteristics, Zimbabwe 1999_______________________________________________________________ Percentage who are: Percentage_________________ who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women_______________________________________________________________ Age 15 16 17 18 19 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Total 2.6 2.3 4.9 261 4.3 1.4 5.6 348 12.9 5.5 18.4 306 28.6 3.4 32.0 254 36.3 9.3 45.6 277 13.1 3.0 16.1 508 17.9 5.0 22.8 938 12.1 3.0 15.1 253 26.0 5.2 31.2 122 19.4 2.9 22.3 102 25.2 10.3 35.5 127 16.7 6.0 22.7 77 20.4 2.3 22.7 83 14.8 5.9 20.8 202 12.0 2.4 14.4 156 12.5 2.7 15.2 215 13.6 3.4 17.0 110 * * * 19 25.6 5.3 30.8 444 11.9 3.7 15.6 977 16.2 4.3 20.5 1,447 _______________________________________________________________ Note: Total includes 6 unweighted women who have higher than secondary education. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 4.9 TEENAGE PREGNANCY AND MOTHERHOOD The issue of adolescent fertility is important 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 are also more constrained in their ability to pursue educational opportunities than young women who delay childbearing. Table 4.9 shows the percent distribution of women age 15-19 who have given birth 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 16 percent, and another 4 percent are currently pregnant with their first child. The proportion of adolescents already on the path to family formation rises rapidly with age, from 5 percent at age 15 to 46 percent at age 19 (see Figure 4.3). Rural adolescents and those with less education tend to start childbearing earlier. 48 * Fertility Figure 4.3 Percentage of Adolescent Women Who Are Mothers or Pregnant with First Child, by Age, Zimbabwe 1999 3% 4% 13% 29% 36% 2% 1% 6% 3% 9% 15 16 17 18 19 Age of Woman Mothers Pregnant with First Child ZDHS 1999 Family Planning * 49 FAMILY PLANNING 5 This chapter focuses on women who are sexually active since these women have the greatest risk of exposure to pregnancy and consideration for regulating their fertility. However, results from the interviews with men are presented alongside those of the women’s interviews since men play an equally important role in the realisation of reproductive health and family planning decisions and behaviour. Family planning methods are grouped into two broad categories, namely, modern methods and traditional methods. Modern family planning methods are further categorised into three subgroups: short-term methods (the pill, condoms, the lactational amenorrhoea method (LAM), diaphragms, foaming tablets, jelly, and the emergency contraceptive pill), long term methods (injectables, implants and IUDs) and permanent methods (female and male sterilisation). Traditional methods consist of periodic abstinence, withdrawal, and various folk methods such as strings and herbs. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Information on the knowledge of family planning methods was collected by asking respondents to name the various methods that a couple can use to delay or avoid a pregnancy. If the respondent could not name any method(s) spontaneously, the interviewer prompted by mentioning and describing each of the methods that had not been mentioned spontaneously and asking whether the respondent had ever heard about the particular method(s). Knowledge of family planning methods in Zimbabwe is nearly universal, meaning that men and women are well informed about the options they have for regulating births and planning their families (Table 5.1). The level of knowledge of at least one modern family planning method among currently married women is almost universal (99 percent), while that of all women 15-49 is 97 percent. Similarly, the level of knowledge of modern family planning methods is high among women who are not married but sexually active and women who reported that they did not have any sexual experience. On average, women know close to seven family planning methods, reflecting an increase in the average number of methods known by women from six methods in 1994. Women who have no sexual experience have the least knowledge of family planning methods (five). Oral contraceptives and male condoms remain the methods most widely known by women of all subgroups. For all women, the proportion who know about the pill is 94 percent, and the proportion who know about the male condom is 92 percent, while injectables are reported by 86 percent of women 15-49. Knowledge of contraception among men is higher than among women. For all groups of men, knowledge of any method and modern methods is universal. The most well-known methods among men are the condom and the pill (98 percent and 93 percent, respectively). 50 * Family Planning Table 5.1 Knowledge of contraceptive methods Percentage of all women and men, of currently married women and men, and sexually active unmarried women and men, and of women with no sexual experience who know any contraceptive method, by specific method, Zimbabwe 1999___________________________________________________________________________________________ Women Men___________________________________ _________________________ Sexually Sexually Currently active No Currently active Contraceptive All married unmarried sexual All married unmarried method women women women1 experience2 men men men1___________________________________________________________________________________________ Any method Any modern method Pill IUD Injectables Implants Condom Female condom Diaphragm Foam/Jelly Female sterilisation Male sterilisation Lactational amenorrhoea3 Emergency contraception Any traditional method Periodic abstinence Withdrawal Other Number of women and men Mean no. of methods known 96.9 98.7 99.5 90.2 99.1 99.7 99.6 96.7 98.5 99.5 90.1 99.1 99.7 99.6 94.3 97.6 97.1 82.5 93.0 98.0 94.9 63.8 70.2 72.5 39.5 44.5 52.4 48.5 86.4 92.5 92.0 64.3 72.2 85.3 69.1 24.8 27.8 32.4 12.1 12.9 15.3 16.0 92.2 94.2 98.1 83.8 97.8 98.3 98.4 57.4 57.8 72.8 49.9 58.7 59.7 68.3 20.2 20.5 18.5 20.9 20.6 20.6 25.3 11.9 12.8 17.1 8.6 8.1 9.0 12.6 58.1 63.5 64.1 40.1 54.0 59.7 63.9 38.8 42.8 40.2 27.6 41.9 46.0 47.6 30.4 36.5 34.9 11.4 19.0 25.7 16.4 11.2 11.9 14.2 8.2 11.2 11.1 15.1 58.8 69.0 64.3 27.1 56.9 66.4 62.0 27.1 29.4 30.8 18.5 31.5 35.2 39.4 51.7 62.5 58.5 18.0 47.8 56.1 50.2 12.2 15.2 14.4 1.7 11.3 19.2 7.8 5,907 3,609 199 1,217 2,609 1,239 250 6.8 7.4 7.6 4.9 6.2 6.9 6.7 ___________________________________________________________________________________________ 1 Unmarried women/men who have had sexual intercourse in the 30 days preceding the survey2 Women who have never had sexual intercourse3 Knowledge of Lactational Amenorrhoea Method (LAM) includes women who know that to use the method a woman must be exclusively or fully breastfeeding, be less than 6 months postpartum, be postpartum amenorrhoeic and who know to use another contraceptive method when any of the previous criteria do not hold. 5.2 KNOWLEDGE OF CONTRACEPTIVE METHODS BY BACKGROUND CHARACTERISTICS Knowledge of family planning methods among women is universal without any significant variation across subgroups (Table 5.2). For all age groups, at least 94 percent of currently married women know about a modern family planning method. For men, this percentage is 100 percent in most age groups. There is little variation in knowledge of modern methods among currently married women and men by type of residence (rural and urban), age group, and province of residence. Knowledge of family planning methods is at least 98 percent for both rural and urban areas. Similarly, knowledge of any modern family planning methods for currently married women and men with no education is comparably high (95 percent and 100 percent, respectively). There has been an upward trend in the knowledge of family planning methods since 1984 (Table 5.3). The knowledge of family planning methods became nearly universal in the 1994 ZDHS. This level has been maintained over the past five years. There were also significant increases in the knowledge of specific modern family planning methods besides the pill and male Family Planning * 51 Table 5.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and men who know at least one contraceptive method and who know at least one modern method, by selected background characteristics, Zimbabwe 1999 _______________________________________________________________________________ Women Men__________________________ _________________________ Knows Knows Knows any Number Knows any Number Background any modern of any modern of characteristic method method1 women method method1 men_______________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total women 95.5 94.4 314 * * 4 99.4 99.4 820 100.0 100.0 110 98.8 98.6 788 99.9 99.9 283 99.3 99.1 543 100.0 100.0 239 98.7 98.4 495 98.3 98.3 194 98.4 98.4 375 100.0 100.0 163 99.6 99.0 272 100.0 100.0 158 NA NA NA 100.0 100.0 87 99.7 99.7 1,306 99.7 99.7 546 98.2 97.8 2,303 99.7 99.7 693 97.3 96.2 561 99.0 99.0 139 99.0 98.8 325 100.0 100.0 127 97.8 97.8 310 100.0 100.0 117 97.0 96.7 367 100.0 100.0 147 98.8 98.6 180 99.3 99.3 61 99.4 99.1 170 100.0 100.0 46 100.0 100.0 444 100.0 100.0 143 99.0 98.7 367 100.0 100.0 102 99.7 99.7 667 99.3 99.3 271 100.0 100.0 217 100.0 100.0 86 95.8 94.8 310 100.0 100.0 49 98.7 98.4 1,665 99.6 99.6 461 99.3 99.2 1,523 99.7 99.7 617 100.0 100.0 111 100.0 100.0 112 98.7 98.5 3,609 99.7 99.7 1,239 ______________________________________________________________________________ Note: An asterisk indicates the figure is based on fewer than 25 cases. NA = Not applicable 1 Includes pill, IUD, injectables, vaginal methods (diaphragm/foam/jelly), female condom, male condom, female sterilisation, male sterilisation, implants, mucus/Billings/ovulation, basal body temperature, symptothermal, and lactational amenorrhoea method (LAM) condoms over the period. Significant increases are particularly associated with the methods that were introduced during the 1990s. For example, the lifting of the restricted use of Depo-Provera in 1992 resulted in increased promotional materials and information on the method that had a positive impact on the knowledge of this method. Knowledge of injectables increased by 7 percentage points among all women between 1994 and 1999. Knowledge of implants, which were introduced in the programme in 1993, increased from 14 percent in 1994 to 25 percent in 1999, while that of emergency contraception, a new and very limited method in Zimbabwe, stands at 11 percent among all women in 1999. There was a small decline in knowledge of the IUD, from 68 percent to 64 percent between 1994 and 1999. 52 * Family Planning Table 5.3 Trends in knowledge of family planning methods Percentage of all women who know specific contraceptive methods, Zimbabwe 1984-1999 ___________________________________________________________ Knowledge of contraception __________________________________ Contraceptive 1984 1988 1994 1999 method ZRHS ZDHS ZDHS ZDHS___________________________________________________________ Any method Any modern method Pill Condom Diaphragm Foam/Jelly/Foaming Tablets IUD Injectables Implants Female sterilisation Male sterilisation Any traditional method Periodic abstinence Withdrawal Other Number of women 82.8 96.3 97.8 96.9 U 95.4 97.5 96.7 80.5 93.6 96.0 94.3 48.3 76.7 93.7 92.2 U 14.0 U 20.2 17.4 a 13.5 21.1 a 11.9 40.2 51.6 67.6 63.8 62.6 62.2 79.7 86.4 U U 13.8 24.8 40.0 49.7 69.7 58.1 10.8 16.4 42.5 38.8 U 75.3 67.8 58.8 20.4 28.1 33.2 27.1 56.1 63.4 56.8 51.7 U 34.2 U 12.2 2,123 2,643 6,128 5,907 ____________________________________________________________ U = Unknown (not available)a Includes diaphragm Source: ZNFPC and WPAS, 1985; CSO and IRD, 1989; CSO and MI, 1995 5.3 EVER USE OF CONTRACEPTION All women and men interviewed in the 1999 ZDHS who said they had heard about a family planning method were asked whether they had ever used any method (with the intention of regulating their fertility). Table 5.4 shows the percentages of women who have ever used a family planning method. The top panel presents the figures for all women, the second panel shows the figures for currently married women, and the third panel shows the figures for sexually active unmarried women. Figures for men are shown at the bottom of the table. Among currently married women, 83 percent reported having ever used a method of family planning and 79 percent have used a modern method. Comparison with the 1994 ZDHS shows that ever use of modern methods among currently married women has increased from 72 percent in 1994 to 79 percent in 1999. The pill is the method most widely used by currently married women (71 percent), followed by injectables (23 percent) and male condoms (20 percent). Ever use of other modern methods is low; only 9 percent of married women have ever used LAM. Family Planning * 53 Ta bl e 5. 4 E ve r u se o f c on tra ce pt io n Pe rc en ta ge o f a ll w om en , c ur re nt ly m ar rie d w om en , u nm ar rie d se xu al ly a ct iv e w om en , a nd m en w ho h av e ev er u se d a co nt ra ce pt iv e m et ho d, b y m et ho d an d ag e, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ M od er n m et ho d Tr ad iti on al m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Em er - An y N um be r A ny Fe m al e Fe m al e M al e ge nc y tra di - Pe rio di c of An y m od er n In je ct - Im - C on - co n- D ia - Fo am / st er ili - st er ili - co nt ra - tio na l ab st i- W ith - O th er w om en / Ag e m et ho d m et ho d Pi ll IU D ab le s pl an t do m do m ph ra gm Je lly sa tio n sa tio n LA M ce pt io n m et ho d ne nc e dr aw al m et ho ds m en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ AL L W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 15 .7 14 .8 10 .3 0. 1 1. 2 0. 1 7. 6 0. 0 0. 0 0. 6 0. 0 0. 0 0. 6 0. 1 2. 6 0. 7 2. 1 0. 2 1, 44 7 64 .8 62 .7 53 .6 0. 6 12 .3 0. 4 19 .2 0. 1 0. 0 1. 4 0. 0 0. 0 5. 4 0. 9 12 .2 3. 0 9. 8 0. 8 1, 29 4 85 .8 84 .4 76 .4 1. 3 22 .4 0. 4 27 .2 0. 3 0. 2 0. 9 0. 4 0. 0 8. 7 0. 1 18 .7 4. 8 14 .7 1. 7 1, 03 4 87 .4 85 .2 77 .5 3. 8 25 .3 1. 3 25 .4 0. 1 0. 0 2. 6 1. 5 0. 0 6. 3 0. 5 19 .0 2. 3 17 .1 1. 5 66 8 86 .6 83 .2 73 .1 5. 7 30 .9 0. 9 19 .5 0. 3 0. 4 0. 8 5. 4 0. 0 9. 8 1. 2 27 .5 4. 4 23 .7 4. 0 63 7 83 .7 76 .5 66 .6 4. 7 31 .9 0. 6 14 .8 0. 7 0. 0 2. 7 6. 9 0. 7 11 .5 1. 1 32 .6 3. 1 28 .2 4. 7 46 6 76 .3 65 .4 50 .6 6. 2 33 .2 0. 2 9. 9 1. 0 0. 0 0. 6 7. 9 0. 0 10 .3 1. 0 38 .2 7. 2 32 .3 5. 2 36 1 63 .6 60 .8 52 .6 2. 2 17 .6 0. 5 17 .6 0. 2 0. 1 1. 2 1. 9 0. 1 6. 2 0. 6 16 .6 3. 1 13 .9 1. 8 5, 90 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C U RR EN TL Y M AR RI ED W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 52 .5 49 .3 42 .6 0. 3 3. 4 0. 1 20 .1 0. 0 0. 0 2. 0 0. 0 0. 0 2. 6 0. 4 9. 1 1. 4 8. 6 0. 2 31 4 79 .9 77 .3 70 .1 0. 7 13 .9 0. 7 19 .7 0. 1 0. 0 1. 4 0. 0 0. 0 7. 0 1. 1 14 .9 2. 1 13 .2 0. 9 82 0 91 .2 89 .7 82 .4 1. 3 23 .7 0. 2 25 .7 0. 4 0. 2 0. 6 0. 6 0. 0 9. 9 0. 2 20 .5 4. 9 16 .3 1. 8 78 8 90 .0 87 .6 81 .0 3. 1 25 .3 1. 5 23 .1 0. 1 0. 0 2. 0 1. 7 0. 0 6. 5 0. 6 20 .9 2. 4 18 .8 1. 8 54 3 88 .6 84 .9 75 .2 6. 1 33 .3 1. 2 17 .2 0. 2 0. 5 0. 8 5. 4 0. 0 10 .3 1. 6 29 .9 5. 0 26 .3 4. 4 49 5 84 .1 76 .0 66 .2 4. 2 33 .9 0. 8 11 .7 0. 5 0. 0 1. 1 7. 2 0. 8 13 .5 1. 3 33 .1 3. 5 29 .2 3. 9 37 5 78 .6 67 .9 51 .2 6. 5 34 .6 0. 2 9. 3 0. 8 0. 0 0. 2 9. 8 0. 0 10 .0 0. 9 39 .1 7. 0 33 .2 4. 8 27 2 83 .0 79 .3 70 .9 2. 7 23 .1 0. 7 19 .6 0. 3 0. 1 1. 2 2. 6 0. 1 8. 5 0. 8 22 .3 3. 6 19 .3 2. 3 3, 60 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ SE XU AL LY A C TI VE U N M AR RI ED W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 15 -1 9 20 -2 4 25 + To ta l 41 .6 41 .6 6. 3 0. 0 1. 7 0. 0 39 .3 0. 0 0. 0 2. 9 0. 0 0. 0 0. 0 2. 3 4. 6 0. 0 4. 6 0. 0 28 85 .3 84 .1 48 .9 3. 9 19 .8 0. 0 55 .7 1. 3 0. 0 9. 4 0. 0 0. 0 6. 1 0. 0 15 .5 9. 9 8. 9 1. 0 49 88 .1 86 .7 69 .1 6. 5 32 .9 0. 5 55 .0 0. 0 0. 5 9. 6 4. 3 0. 0 6. 2 0. 0 16 .2 4. 6 10 .9 3. 3 12 2 81 .0 79 .8 55 .4 5. 0 25 .3 0. 3 53 .0 0. 3 0. 3 8. 6 2. 7 0. 0 5. 3 0. 3 14 .4 5. 3 9. 5 2. 2 19 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Al l m en C ur re nt ly m ar rie d Se xu al ly a ct iv e u nm ar rie d 66 .7 65 .1 40 .3 1. 1 9. 5 0. 5 49 .7 0. 0 0. 2 1. 5 1. 1 0. 0 3. 8 0. 5 17 .7 5. 6 13 .8 2. 5 2, 60 9 92 .4 89 .9 75 .5 2. 0 17 .8 0. 8 59 .0 0. 0 0. 3 1. 1 2. 1 0. 0 7. 0 0. 7 27 .9 8. 3 21 .6 4. 7 1, 23 9 88 .1 87 .4 19 .7 0. 3 5. 5 0. 8 85 .5 0. 0 1. 0 6. 5 0. 0 0. 0 1. 4 1. 2 21 .2 10 .5 15 .7 1. 6 25 0 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ LA M = L ac ta tio na l a m en or rh oe a m et ho d 54 * Family Planning Eight in ten sexually active unmarried women reported having used a method of family planning at sometime, with virtually all of them using a modern method. The pill is the method most widely used by these women (55 percent). Other popular methods include male condoms (53 percent) and injectables (25 percent). Only 5 percent of sexually active unmarried women have ever used LAM. It is interesting to note that sexually active unmarried women are much more likely than currently married women to have used male condoms (53 percent compared with 20 percent). Sexually active unmarried women are as likely to have used the pill as the male condom (55 percent and 53 percent, respectively). Two in three men have used a modern method at some time. Among all men, 50 percent have used condoms and 40 percent have used pills. The next most popular methods reported by men are withdrawal (14 percent), injectables (10 percent) and periodic abstinence (6 percent). Married men reported higher ever-use rates than all men and sexually active unmarried men, for all methods except male and female condoms, and periodic abstinence. Reporting of ever use of condoms is much higher for sexually active unmarried men than for married men. Ever use of modern family planning methods among sexually active unmarried men is 87 percent, and virtually all of these men reported that they had used condoms at sometime. 5.4 CURRENT USE OF CONTRACEPTION The contraceptive prevalence rate (CPR), or the percentage of currently married women who are using a family planning method, in Zimbabwe is 54 percent, while the CPR for modern family planning methods is 50 percent (Table 5.5). Figure 5.1 shows the distribution of currently married women by method currently used. The pill is the most commonly used method of contraception among currently married women, followed by injectables (8 percent) and female sterilisation (3 percent). There was a pronounced increase in the use of injectables from 3 percent in 1994 to 8 percent in 1999, while the current use of male condoms for avoiding pregnancy decreased slightly. The use of modern family planning methods among currently married women rises with age from 39 percent among women 15-19 to 59 percent for women 25-29, after which it falls to 30 percent for women 45-49. The increase in the use of the pill was observed for younger age groups, reaching a peak at age 25-29 and a low of 9 percent for women age 45-49. A similar pattern in the distribution of current use for modern methods among married women is observed in the 1994 ZDHS, except that in the 1999 ZDHS the use rates are higher for most age groups. Comparisons between the 1994 ZDHS and the 1999 ZDHS show that the highest gains in current use of modern family planning methods were realised at ages 15-19 and 30-34. It is interesting to note that the overall level of use of modern family planning methods among sexually active unmarried women is slightly higher than that for currently married women, which is probably due to the high level of use of condoms among single women 15-24 and use of the pill among unmarried women age 25 and over. The current use of both male and female condoms among married women remains low. Whereas the current use of male condoms decreased among currently married women, it has increased by about 5 percent among sexually active unmarried women. However, female condoms are not commonly used among both currently married women and sexually active unmarried women. Family Planning * 55 Ta bl e 5. 5 C ur re nt u se o f c on tra ce pt io n Pe rc en ta ge o f a ll w om en , c ur re nt ly m ar rie d w om en , s ex ua lly a ct iv e un m ar rie d w om en , a nd m en w ho a re c ur re nt ly u sin g a co nt ra ce pt iv e m et ho d, b y m et ho d an d ag e, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ M od er n m et ho d Tr ad iti on al m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ An y N um be r A ny Fe m al e M al e tra di - Pe rio di c N ot of An y m od er n In je ct - Im - C on - Fo am / D ia - st er ili - st er ili - tio na l ab st i- W ith - O th er cu rr en tly w om en / Ag e m et ho d m et ho d Pi ll IU D ab le s pl an t do m Je lly ph ra gm sa tio n sa tio n LA M m et ho d ne nc e dr aw al m et ho ds us in g To ta l m en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ AL L W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 11 .2 10 .3 7 .5 0. 0 0 .7 0. 0 1 .8 0. 1 0. 0 0. 0 0. 0 0. 1 0. 8 0. 0 0. 7 0. 1 88 .8 10 0. 0 1, 44 7 40 .5 39 .5 31 .2 0. 0 4 .1 0. 4 2 .8 0. 0 0. 0 0. 0 0. 0 1. 0 1. 0 0. 0 0. 9 0. 1 59 .5 10 0. 0 1, 29 4 53 .6 52 .2 38 .6 0. 4 7 .7 0. 4 3 .7 0. 0 0. 0 0. 4 0. 0 1. 0 1. 3 0. 2 0. 8 0. 3 46 .4 10 0. 0 1, 03 4 52 .6 50 .8 34 .3 1. 5 11 .1 0. 7 1 .7 0. 0 0. 0 1. 5 0. 0 0. 1 1. 7 0. 0 1. 3 0. 4 47 .4 10 0. 0 66 8 50 .9 48 .5 25 .4 1. 7 11 .6 0. 6 2 .7 0. 0 0. 0 5. 4 0. 0 1. 2 2. 4 0. 0 2. 1 0. 3 49 .1 10 0. 0 63 7 42 .2 35 .2 16 .2 1. 6 7 .9 0. 5 1 .4 0. 0 0. 0 6. 9 0. 7 0. 0 7. 0 0. 2 5. 4 1. 4 57 .8 10 0. 0 46 6 31 .4 24 .1 7 .0 2. 6 5 .9 0. 0 0 .4 0. 0 0. 4 7. 9 0. 0 0. 0 7. 2 0. 9 4. 9 1. 4 68 .6 10 0. 0 36 1 37 .7 35 .6 23 .8 0. 7 5 .9 0. 4 2 .3 0. 0 0. 0 1. 9 0. 1 0. 6 2. 1 0. 1 1. 6 0. 4 62 .3 10 0. 0 5, 90 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ C U RR EN TL Y M AR RI ED W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 42 .1 38 .6 33 .2 0. 0 2 .5 0. 0 2 .3 0. 0 0. 0 0. 0 0. 0 0. 6 3. 5 0. 0 3. 4 0. 2 57 .9 10 0. 0 31 4 53 .7 52 .3 44 .5 0. 0 4 .2 0. 7 1 .6 0. 0 0. 0 0. 0 0. 0 1. 4 1. 4 0. 1 1. 2 0. 2 46 .3 10 0. 0 82 0 60 .9 59 .4 45 .8 0. 3 8 .4 0. 2 2 .8 0. 0 0. 0 0. 6 0. 0 1. 2 1. 5 0. 2 1. 1 0. 2 39 .1 10 0. 0 78 8 58 .2 56 .0 38 .5 1. 6 12 .0 0. 9 1 .3 0. 0 0. 0 1. 7 0. 0 0. 1 2. 1 0. 0 1. 6 0. 5 41 .8 10 0. 0 54 3 56 .8 53 .7 29 .1 2. 2 12 .7 0. 8 2 .1 0. 0 0. 0 5. 4 0. 0 1. 5 3. 1 0. 0 2. 8 0. 4 43 .2 10 0. 0 49 5 46 .4 38 .6 19 .0 1. 0 9 .2 0. 7 0 .7 0. 0 0. 0 7. 2 0. 8 0. 0 7. 8 0. 3 6. 7 0. 8 53 .6 10 0. 0 37 5 39 .4 30 .4 9 .1 3. 0 7 .8 0. 0 0 .2 0. 0 0. 6 9. 8 0. 0 0. 0 9. 0 1. 0 6. 5 1. 5 60 .6 10 0. 0 27 2 53 .5 50 .4 35 .5 0. 9 8 .1 0. 5 1 .8 0. 0 0. 0 2. 6 0. 1 0. 9 3. 2 0. 2 2. 6 0. 4 46 .5 10 0. 0 3, 60 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ SE XU AL LY A C TI VE U N M AR RI ED W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 15 -1 9 20 -2 4 25 + To ta l 34 .7 34 .7 2 .3 0. 0 0 .0 0. 0 29 .6 2. 9 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 65 .3 10 0. 0 2 8 46 .0 46 .0 8 .2 0. 0 6 .5 0. 0 31 .3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 54 .0 10 0. 0 4 9 63 .6 60 .8 31 .1 3. 3 9 .9 0. 0 12 .1 0. 0 0. 0 4. 3 0. 0 0. 0 2. 8 1. 0 0. 0 1. 8 36 .4 10 0. 0 12 2 55 .3 53 .5 21 .4 2. 0 7 .7 0. 0 19 .3 0. 4 0. 0 2. 7 0. 0 0. 0 1. 7 0. 6 0. 0 1. 1 44 .7 10 0. 0 19 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Al l m en C ur re nt ly m ar rie d Se xu al ly a ct iv e u nm ar rie d 43 .2 40 .8 22 .3 0. 0 3 .5 0. 2 13 .7 0. 0 0. 0 1. 0 0. 0 0. 1 2. 4 0. 7 0. 9 0. 9 56 .8 10 0. 0 2, 60 9 65 .5 61 .1 45 .4 0. 1 7 .4 0. 4 5 .7 0. 0 0. 0 2. 0 0. 0 0. 2 4. 4 1. 0 1. 6 1. 7 34 .5 10 0. 0 1, 23 9 62 .5 60 .4 4 .9 0. 0 0 .0 0. 0 55 .5 0. 0 0. 0 0. 0 0. 0 0. 0 2. 0 1. 3 0. 8 0. 0 37 .5 10 0. 0 25 0 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ LA M = L ac ta tio na l a m en or rh oe a m et ho d 56 * Family Planning Figure 5.1 Use of Specific Contraceptive Methods Among Currently Married Women, Zimbabwe 1999 Pill 36% Not Using 47% Withdrawal 3% Other Traditional Methods 1% Other Modern Methods 2% Female Sterilisation 3% Condom 2% Injectables 8% ZDHS 1999 Current use of any family planning method is higher among currently married men than among all men (66 percent compared with 43 percent). Pills are the most commonly used methods reported by married men (45 percent), followed by injectables (7 percent). Although 14 percent of all men reported that they were currently using condoms, only 6 percent of currently married men were currently using condoms. However, more than half (56 percent) of sexually active unmarried men were using condoms. This discrepancy may represent different reproductive health goals and different perceptions of the risk of acquiring sexually transmitted diseases related to marital status. Overall, there is an upward trend in the current use of family planning methods among currently married women since 1984 (see Table 5.6). On average, the prevalence increased at a rate of roughly 1 percent every year between 1984 and 1999. Moreover, use of modern methods has increased faster than overall use, from 27 percent in the 1984 ZRHS to 42 percent in the 1994 ZDHS and to 50 percent in the 1999 ZDHS. The most dramatic increase in modern contraceptive use in the five years between 1994 and 1999 is shown by injectables (3 percent to 8 percent). During the same period, the use of the pill increased from 33 percent to 36 percent. Use of traditional methods, however, declined from 6 percent to 3 percent. 5.5 CURRENT USE OF CONTRACEPTION BY BACKGROUND CHARACTERISTICS Analysis of current use by background characteristics permits an examination of differences in the method mix among current users in the various subgroups (Tables 5.7.1 for women and 5.7.2 for men). These tables allow for the comparison of levels of use among population groups. In general, the pattern of contraceptive use by background characteristics is similar to that found in the 1994 ZDHS. Family Planning * 57 Table 5.6 Trends in current use of contraception Percentage of currently married women who were using specific contraceptive methods at the time of the survey, Zimbabwe 1984-1999 _____________________________________________________________ Current use of contraception __________________________________ Contraceptive 1984 1988 1994 1999 method ZRHS ZDHS ZDHS ZDHS_____________________________________________________________ Any method Any modern method Pill Condom Vaginal method IUD Injectables Implants Female sterilisation Male sterilisation Any traditional method Safe period1 Withdrawal Periodic abstinence Other2 Number of women 38.4 43.1 48.1 53.5 26.6 36.1 42.2 50.4 22.6 31.0 33.1 35.5 0.7 1.2 2.3 1.8 0.1 0.0 0.0 0.0 0.7 1.1 1.0 0.9 0.8 0.3 3.2 8.1 NA NA 0.2 0.5 1.6 2.3 2.3 2.6 0.1 0.2 0.2 0.1 11.8 7.0 6.0 3.2 0.6 0.3 0.1 NA 6.5 5.1 4.2 2.6 2.1 NA NA 0.2 2.6 1.5 1.7 0.4 2,123 2,643 3,788 3,609 _____________________________________________________________ NA = Not applicable 1 Includes only rhythm method in the 1984 ZRHS 2 Reported as "folk" methods in 1994 ZDHS Source: ZNFPC and WPAS, 1985; CSO and IRD, 1989; and CSO and MI, 1995 Currently married women in rural areas are less likely to use family planning methods than their counterparts in urban areas (48 percent as opposed to 63 percent). This scenario holds across all methods of contraception. Use of family planning methods is highest in the urban provinces of Harare (64 percent) and Bulawayo (62 percent). Manicaland has the lowest level of contraceptive use among currently married women (see Figure 5.2). Contraceptive use is associated positively with the user’s level of education, married women with less education have relatively more-limited contraceptive use than better-educated women. For example, 41 percent of currently married women with no education use family planning methods compared with 69 percent of women with higher than a secondary education. Few married women who are childless use family planning methods (8 percent), while at least 57 percent of women with children are using contraception. Contraceptive use rises with the number of living children up to two children and declines thereafter. Contraceptive use among men shows some of the patterns observed among women. Prevalence is higher among urban men, men living in Harare and the Midlands, better-educated men, and men with at least one living child. Among modern methods, condoms and injectables are more likely to be reported by men with no education, while better-educated men tend to report using the pill and female sterilisation. 58 * Family Planning Ta bl e 5. 7. 1 C ur re nt u se o f c on tra ce pt io n by b ac kg ro un d ch ar ac te ris tic s: w om en Pe rc en t d ist rib ut io n of c ur re nt ly m ar rie d w om en b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to s el ec te d ba ck gr ou nd c ha ra ct er ist ic s, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ M od er n m et ho d Tr ad iti on al m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ An y A ny Fe m al e M al e tra di - Pe rio di c N ot N um be r An y m od er n In je ct - Im - st er ili - st er ili - tio na l ab st i- W ith - cu rr en tly O th er of Ag e m et ho d m et ho d Pi ll IU D ab le s pl an t C on do m sa tio n sa tio n LA M m et ho d ne nc e dr aw al us in g m et ho ds To ta l w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Re si de nc e U rb an R ur al Pr ov in ce M an ic al an d M as ho na la nd C en tra l M as ho na la nd E as t M as ho na la nd W es t M at ab el el an d N or th M at ab el el an d So ut h M id la nd s M as vi ng o H ar ar e B ul aw ay o Ed uc at io n N o ed uc at io n P rim ar y S ec on da ry H ig he r N o. o f l iv in g ch ild re n 0 1 2 3 4 + To ta l 63 .1 61 .8 44 .5 1. 9 7 .6 1. 3 2. 1 3. 7 0. 0 0. 7 1. 2 0. 1 1. 1 0. 0 36 .9 10 0. 0 1, 30 6 48 .1 43 .9 30 .3 0. 4 8 .3 0. 1 1. 6 2. 0 0. 1 1. 0 4. 3 0. 2 3. 4 0. 7 51 .9 10 0. 0 2, 30 3 40 .9 33 .6 22 .3 0. 5 6 .1 0. 0 1. 4 1. 6 0. 3 1. 1 7. 4 0. 5 6. 5 0. 3 59 .1 10 0. 0 56 1 53 .3 49 .8 36 .9 0. 8 9 .6 0. 0 1. 5 1. 0 0. 0 0. 0 3. 6 0. 0 2. 8 0. 7 46 .7 10 0. 0 32 5 57 .4 55 .4 40 .1 1. 3 9 .9 0. 0 1. 3 2. 6 0. 0 0. 3 1. 9 0. 0 1. 9 0. 0 42 .6 10 0. 0 31 0 57 .5 55 .3 45 .8 0. 5 5 .2 0. 8 0. 5 1. 6 0. 0 0. 8 2. 2 0. 0 1. 9 0. 3 42 .5 10 0. 0 36 7 48 .3 44 .6 31 .8 0. 2 8 .9 0. 0 1. 6 1. 8 0. 0 0. 2 3. 6 0. 9 2. 3 0. 5 51 .7 10 0. 0 18 0 41 .6 36 .2 18 .9 0. 5 10 .3 0. 0 2. 3 3. 7 0. 0 0. 6 5. 4 0. 3 2. 8 2. 3 58 .4 10 0. 0 17 0 49 .7 45 .9 32 .7 0. 6 7 .4 0. 2 1. 9 2. 2 0. 0 0. 8 3. 7 0. 0 2. 6 1. 1 50 .3 10 0. 0 44 4 55 .5 53 .3 31 .3 0. 5 13 .7 0. 0 1. 5 3. 3 0. 3 2. 8 2. 2 0. 0 2. 0 0. 3 44 .5 10 0. 0 36 7 63 .5 62 .9 48 .9 1. 1 5 .7 2. 0 2. 3 2. 3 0. 0 0. 6 0. 6 0. 0 0. 6 0. 0 36 .5 10 0. 0 66 7 62 .0 60 .2 30 .5 4. 0 10 .1 0. 6 4. 0 9. 8 0. 3 0. 9 1. 7 0. 3 1. 4 0. 0 38 .0 10 0. 0 21 7 40 .8 35 .2 21 .1 0. 3 9 .6 0. 0 0. 8 2. 6 0. 3 0. 5 5. 7 0. 0 3. 7 2. 0 59 .2 10 0. 0 31 0 48 .8 44 .4 30 .4 0. 5 8 .2 0. 0 1. 2 2. 9 0. 0 1. 1 4. 4 0. 3 3. 6 0. 5 51 .2 10 0. 0 1, 66 5 60 .2 58 .9 43 .7 1. 0 7 .8 1. 2 2. 3 2. 1 0. 0 0. 7 1. 3 0. 0 1. 3 0. 0 39 .8 10 0. 0 1, 52 3 69 .0 65 .6 38 .3 8. 9 6 .7 0. 6 5. 1 4. 6 1. 4 0. 0 3. 4 0. 0 3. 4 0. 0 31 .0 10 0. 0 11 1 7 .7 6 .6 3 .1 0. 2 0 .8 0. 0 2. 6 0. 0 0. 0 0. 0 1. 1 0. 0 1. 1 0. 0 92 .3 10 0. 0 37 2 58 .3 56 .2 47 .3 0. 5 4 .5 0. 6 2. 1 0. 3 0. 0 0. 8 2. 1 0. 0 2. 0 0. 2 41 .7 10 0. 0 84 8 61 .8 60 .8 48 .3 1. 6 6 .4 0. 1 1. 8 0. 8 0. 2 1. 6 0. 9 0. 1 0. 6 0. 3 38 .2 10 0. 0 73 1 60 .8 58 .9 37 .9 1. 0 12 .3 2. 0 1. 4 3. 6 0. 0 0. 7 1. 9 0. 1 1. 6 0. 2 39 .2 10 0. 0 50 7 56 .5 49 .8 27 .9 1. 1 12 .3 0. 2 1. 3 5. 9 0. 1 0. 8 6. 7 0. 4 5. 3 1. 0 43 .5 10 0. 0 1, 15 1 53 .5 50 .4 35 .5 0. 9 8 .1 0. 5 1. 8 2. 6 0. 1 0. 9 3. 2 0. 2 2. 6 0. 4 46 .5 10 0. 0 3, 60 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ LA M = L ac ta tio na l a m en or rh oe a m et ho d Family Planning * 59 Ta bl e 5. 7. 2 C ur re nt u se o f c on tra ce pt io n by b ac kg ro un d ch ar ac te ris tic s: m en Pe rc en t d ist rib ut io n of c ur re nt ly m ar rie d m en b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to s el ec te d ba ck gr ou nd c ha ra ct er ist ic s, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ M od er n m et ho d Tr ad iti on al m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ An y A ny Fe m al e tra di - Pe rio di c N ot N um be r An y m od er n In je ct - Im - st er ili - tio na l ab st i- W ith - cu rr en tly O th er of Ag e m et ho d m et ho d Pi ll IU D ab le s pl an t C on do m sa tio n LA M m et ho d ne nc e dr aw al us in g m et ho ds To ta l m en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Re si de nc e U rb an R ur al Pr ov in ce M an ic al an d M as ho na la nd C en tra l M as ho na la nd E as t M as ho na la nd W es t M at ab el el an d N or th M at ab el el an d So ut h M id la nd s M as vi ng o H ar ar e B ul aw ay o Ed uc at io n N o ed uc at io n P rim ar y S ec on da ry H ig he r N o. o f l iv in g ch ild re n 0 1 2 3 4 + To ta l 73 .4 69 .2 53 .1 0. 1 7 .4 0. 5 5 .5 2. 6 0. 0 4 .2 0. 5 2. 3 1 .4 26 .6 10 0. 0 54 6 59 .3 54 .7 39 .3 0. 0 7 .3 0. 3 5 .9 1. 6 0. 3 4 .5 1. 4 1. 1 2 .0 40 .7 10 0. 0 69 3 47 .9 44 .3 33 .3 0. 0 5 .2 0. 0 4 .7 1. 0 0. 0 3 .6 0. 0 2. 6 1 .0 52 .1 10 0. 0 13 9 67 .0 61 .4 45 .2 0. 0 11 .1 0. 0 4 .0 0. 6 0. 6 5 .6 2. 7 1. 1 1 .7 33 .0 10 0. 0 12 7 61 .7 60 .9 40 .9 0. 0 6 .9 1. 7 7 .9 3. 4 0. 0 0 .9 0. 0 0. 0 0 .9 38 .3 10 0. 0 11 7 62 .1 55 .7 39 .7 0. 0 8 .0 0. 0 4 .8 3. 2 0. 0 6 .3 1. 4 3. 6 1 .4 37 .9 10 0. 0 14 7 57 .4 49 .4 36 .7 0. 0 7 .3 0. 0 4 .7 0. 7 0. 0 8 .0 2. 0 4. 0 2 .0 42 .6 10 0. 0 6 1 63 .4 50 .7 38 .1 0. 0 6 .2 0. 0 4 .2 1. 1 1. 1 12 .7 0. 0 2. 1 10 .6 36 .6 10 0. 0 4 6 72 .5 67 .9 49 .8 0. 0 4 .6 0. 0 10 .5 3. 0 0. 0 4 .6 1. 4 1. 6 1 .6 27 .5 10 0. 0 14 3 59 .4 54 .1 39 .4 0. 0 10 .4 0. 0 1 .8 1. 6 0. 9 5 .3 3. 5 1. 8 0 .0 40 .6 10 0. 0 10 2 81 .8 79 .7 65 .0 0. 0 7 .0 0. 7 6 .3 0. 7 0. 0 2 .1 0. 0 0. 0 2 .1 18 .2 10 0. 0 27 1 53 .4 49 .6 28 .6 0. 8 7 .5 0. 8 5 .3 6. 8 0. 0 3 .8 0. 0 3. 0 0 .8 46 .6 10 0. 0 8 6 55 .5 47 .4 24 .6 0. 0 11 .1 0. 0 11 .7 0. 0 0. 0 8 .1 3. 3 1. 8 3 .0 44 .5 10 0. 0 4 9 60 .4 54 .9 40 .1 0. 0 6 .8 0. 2 5 .1 2. 5 0. 2 5 .5 1. 1 2. 8 1 .6 39 .6 10 0. 0 46 1 68 .1 64 .4 48 .5 0. 0 8 .2 0. 6 5 .9 1. 0 0. 2 3 .7 0. 9 0. 9 2 .0 31 .9 10 0. 0 61 7 76 .4 74 .6 59 .1 0. 6 3 .5 0. 0 4 .8 6. 7 0. 0 1 .7 0. 0 1. 3 0 .4 23 .6 10 0. 0 11 2 16 .0 16 .0 5 .1 0. 0 1 .0 0. 0 9 .9 0. 0 0. 0 0 .0 0. 0 0. 0 0 .0 84 .0 10 0. 0 12 9 69 .5 67 .5 54 .4 0. 0 5 .3 0. 0 7 .3 0. 6 0. 0 2 .1 0. 6 0. 9 0 .6 30 .5 10 0. 0 27 1 70 .4 66 .4 54 .4 0. 0 6 .1 1. 4 4 .6 0. 0 0. 0 3 .9 0. 0 2. 5 1 .5 29 .6 10 0. 0 21 3 73 .5 70 .4 53 .7 0. 0 11 .1 0. 4 3 .7 0. 9 0. 6 3 .0 0. 5 0. 7 1 .8 26 .5 10 0. 0 15 3 71 .9 64 .4 44 .6 0. 1 9 .6 0. 2 4 .9 4. 7 0. 3 7 .5 2. 1 2. 5 2 .9 28 .1 10 0. 0 47 3 65 .5 61 .1 45 .4 0. 1 7 .4 0. 4 5 .7 2. 0 0. 2 4 .4 1. 0 1. 6 1 .7 34 .5 10 0. 0 1, 23 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ LA M = L ac ta tio na l a m en or rh oe a m et ho d 60 * Family Planning Figure 5.2 Current Use of Family Planning Among Currently Married Women 15-49 by Background Characteristics, Zimbabwe 1999 54% 63% 48% 41% 53% 57% 58% 48% 42% 50% 56% 64% 62% 41% 49% 60% 69% ZIMBABWE RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary Higher ZDHS 1999 5.6 CURRENT USE OF CONTRACEPTION BY WOMEN’S STATUS A woman’s status and self-image affect her ability to control her fertility and to choose a suitable contraceptive method. A woman who feels that she is unable to control other aspects of her life may be less likely to feel she can make and carry out decisions on her fertility. She may also feel the need to choose methods that are less likely to be revealed or that do not depend on her husband’s cooperation. Table 5.8 shows that the above assumptions hold true in Zimbabwe as far as using a family planning method. Women who have more say in making household decisions, those who have more reasons to refuse having sex with their partner and women who do not justify wife beating are more likely to use contraception. 5.7 NUMBER OF CHILDREN AT FIRST USE OF CONTRACEPTION Couples use family planning methods for timing births, for spacing births, or to completely avoid pregnancy. An examination of first use of contraception among ever-married women by the number of living children shows that younger women initiated contraceptive use at lower parities than older women (Table 5.9). The data shows that in general, few women begin using contraception before they have had a child (4 percent). Family Planning * 61 Ta bl e 5. 8 C ur re nt u se o f c on tra ce pt io n by w om en ’s s ta tu s Pe rc en t d ist rib ut io n of c ur re nt ly m ar rie d w om en b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to s el ec te d in di ca to rs o f w om en ’s s ta tu s, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ M od er n m et ho d Tr ad iti on al m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ An y A ny M al e Fe m al e tra di - Pe rio di c N ot N um be r An y m od er n In je ct - Im - C on - st er ili - st er ili - tio na l ab st i- W ith - O th er cu rr en tly of Ag e m et ho d m et ho d Pi ll IU D ab le s pl an t do m sa tio n sa tio n LA M m et ho d ne nc e dr aw al m et ho ds us in g To ta l w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ N um be r of d ec is io ns w ith w om an h av in g fi na l s ay 0 -1 40 .9 35 .7 27 .1 0. 0 4. 8 0. 0 1. 6 1. 5 0. 0 0. 8 5. 2 0. 0 4. 8 0. 4 59 .1 10 0. 0 37 1 2 -3 51 .7 48 .4 36 .2 0. 4 8. 0 0. 2 1. 6 1. 1 0. 1 0. 9 3. 3 0. 1 2. 9 0. 4 48 .3 10 0. 0 97 9 4 -5 56 .4 53 .6 36 .5 1. 3 8. 7 0. 7 1. 9 3. 5 0. 1 0. 9 2. 8 0. 2 2. 1 0. 5 43 .6 10 0. 0 2, 25 8 N um be r of r ea so ns to r ef us e se xu al re la tio ns 0 51 .4 50 .5 37 .4 0. 0 8. 5 0. 3 0. 7 2. 2 0. 0 1. 4 1. 0 0. 0 1. 0 0. 0 48 .6 10 0. 0 24 4 1 -2 52 .8 49 .3 36 .7 0. 4 6. 6 0. 3 1. 8 2. 2 0. 0 1. 1 3. 5 0. 2 2. 8 0. 6 47 .2 10 0. 0 1, 18 0 3 -4 54 .2 50 .9 34 .6 1. 3 8. 9 0. 6 1. 8 2. 9 0. 1 0. 7 3. 3 0. 2 2. 7 0. 4 45 .8 10 0. 0 2, 18 4 N um be r of r ea so ns to ju st ify w ife b ea tin g 0 55 .9 52 .9 35 .7 1. 4 8. 5 0. 8 2. 3 3. 3 0. 1 0. 7 3. 0 0. 2 2. 5 0. 3 44 .1 10 0. 0 1, 72 9 1 -3 52 .7 49 .3 36 .8 0. 4 7. 3 0. 3 1. 5 1. 9 0. 1 1. 0 3. 4 0. 2 2. 7 0. 5 47 .3 10 0. 0 1, 41 1 4 -5 47 .4 44 .1 30 .3 0. 7 9. 0 0. 0 0. 7 2. 4 0. 0 1. 0 3. 3 0. 1 2. 6 0. 5 52 .6 10 0. 0 46 9 To ta l 53 .5 50 .4 35 .5 0. 9 8. 1 0. 5 1. 8 2. 6 0. 1 0. 9 3. 2 0. 2 2. 6 0. 4 46 .5 10 0. 0 3, 60 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ LA M = L ac ta tio na l a m en or rh oe a m et ho d 62 * Family Planning Table 5.9 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception and median number of children at first use, according to current age, Zimbabwe 1999____________________________________________________________________________________________________ Median Never number of used Number of living children at time of first use of contraception Number children at contra- _____________________________________________________ offirst use of Current age ception 0 1 2 3 4+ Missing Total women contraception 1 _________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 46.9 8.3 41.7 1.5 0.0 0.0 1.7 100.0 329 0.4 19.8 5.1 67.3 6.7 0.6 0.2 0.4 100.0 930 0.5 9.8 5.0 70.1 11.4 2.3 0.9 0.5 100.0 933 0.6 11.3 3.5 63.4 13.3 5.2 3.0 0.3 100.0 642 0.6 12.6 3.3 43.3 17.3 12.2 11.3 0.0 100.0 620 0.9 16.0 2.5 34.9 16.7 11.5 18.1 0.2 100.0 458 1.3 23.8 3.1 27.9 11.5 12.9 20.4 0.4 100.0 359 1.6 17.3 4.4 55.1 11.3 5.5 6.0 0.4 100.0 4,270 0.7 _________________________________________________________________________________________________________ 1 Median among those who have ever used contraception Table 5.10 Knowledge of fertile period Percent distribution of women by knowl- edge of the fertile period during the ovulatory cycle, Zimbabwe 1999 ________________________________ Perceived All fertile period women ________________________________ During menstrual period Right after period has ended Halfway between periods Just before period begins At any time Other Don’t know Missing Total Number 1.4 30.3 11.6 9.2 11.9 0.9 34.3 0.4 100.0 5,907 ________________________________ Note: Total includes 9 unweighted women who are using periodic abstinence as a family planning method. 5.8 KNOWLEDGE OF THE FERTILE PERIOD An elementary knowledge of reproductive physiology provides a useful background for successful practice of coitus-associated methods such as withdrawal, condom, and vaginal methods. Knowledge is particularly critical in the case of periodic abstinence. The 1999 ZDHS included a question designed to obtain information on respondent’s understanding of the time when a woman was most likely to become pregnant during the menstrual cycle. Considering the responses from 5,907 respondents to this inquiry, it is clear that knowledge of the fertile period is minimal among women. Only 12 percent of women were able to identify the correct period (Table 5.10). About a third of all women (34 percent) could not state when this period is during the menstrual cycle. It should be noted, however, that the precoded response categories in this question are only one way of dividing the cycle into periods. It is possible that women who gave “other” answers such as “one week after her menstruation” were coded in the category “right after her period ended” instead of in the category “in the middle of the cycle.” Thus, more women may actually have correct understanding of the fertile period than is presented in Table 5.10. 5.9 SOURCE OF SUPPLY To document the main sources of supply for users of different contraceptive methods, all users of family planning methods were asked to state where they had obtained their current method(s) the last time. Detailed information of the source of family planning methods by method Family Planning * 63 Table 5.11 Source of supply for modern contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply, according to specific methods, Zimbabwe 1999 ____________________________________________________________________________ Female All Inject- sterili- modern Source of supply Pill IUD ables Condom sation methods1 ____________________________________________________________________________ Public sector Government hospital/clinic Rural/municipal clinic Rural health centre ZNFPC (fixed) clinic ZNFPC mobile clinic MOH mobile clinic ZNFPC CBD worker MOH CBD worker Other public Private medical sector Private hospital/clinic Pharmacy Private doctor Private CBD worker Other private Other private Shop Friends/relatives Mission facility Other Don’t know/missing Total Number of women 80.5 (53.4) 84.4 40.1 61.7 76.7 9.6 (13.6) 14.0 4.5 34.0 11.7 35.2 (10.0) 30.4 17.5 11.3 31.0 20.5 (0.0) 33.0 8.3 13.6 20.7 3.2 (22.5) 4.5 2.5 0.0 3.9 2.4 (3.7) 0.6 0.7 0.0 1.8 1.3 (0.0) 1.5 0.0 0.0 1.1 4.8 (3.7) 0.1 1.8 0.0 3.4 3.4 (0.0) 0.0 4.3 0.0 2.6 0.2 (0.0) 0.3 0.5 2.9 0.3 15.7 (44.2) 10.9 21.3 22.6 16.5 2.6 (12.1) 2.8 1.9 16.2 3.6 7.7 (0.0) 0.0 15.3 4.6 6.5 3.5 (32.1) 7.6 0.0 0.0 4.6 1.7 (0.0) 0.0 2.7 0.0 1.3 0.2 (0.0) 0.5 1.4 1.8 0.4 3.6 (2.4) 4.7 36.3 13.4 6.4 0.3 (0.0) 0.0 18.1 0.0 1.4 0.3 (0.0) 0.0 15.2 0.0 1.2 2.9 (2.4) 4.5 1.4 13.4 3.6 0.1 (0.0) 0.2 1.6 0.0 0.2 0.2 (0.0) 0.0 2.3 2.2 0.4 100.0 100.0 100.0 100.0 100.0 100.0 1,404 42 350 137 109 2,068 ____________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. CBD = Community-based distribution 1 Total includes women who reported using female condom, foam or jelly, male sterilisation, and lactational amenorrhoea method (LAM). is complicated by the fact that some respondents do not know for sure the name of the source. Therefore, data on this indicator should be used with some caution. The distribution of sources of contraceptive supplies for current users shows that most users (77 percent) obtained their contraceptives from the public sector followed by 17 percent who obtained their methods from the private medical sector (see Table 5.11). Compared with the findings in the 1994 ZDHS, there has been an increase in the participation of the private medical sector in family planning service delivery from 12 percent to 17 percent by 1999. The majority of current users of the pill (81 percent), injectables (84 percent), and female sterilisation (62 percent), obtain their methods from the public sector. However, the supply of condoms seems more evenly distributed across the three main groups of contraceptive suppliers (public sector, private medical sector, and the other category) mentioned by clients. 1 The discontinuation rates presented here include only those segments of contraceptive use that began since January 1994. The rates apply to the 3- to 63-month period before the survey; exposure during the month of interview and the two months prior 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 12 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 single-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. 64 * Family Planning Figure 5.3 Current Use of Contraception by Source of Supply, Zimbabwe 1999 ZDHS 1999 Rural/municipal clinic 31% Rural health centre 21% Other public 4% Private medical 17% Other private 6% Government hospital/ clinic 12% ZNFPC clinics/CBD 9% Within the public sector, government hospitals and health centres are reported as the main source of contraceptive supplies (see Figure 5.3). In general, the proportion of current users who obtain their contraceptive supplies from the ZNFPC community-based distribution (CBD) workers is declining. The percentage of users obtaining supplies from a ZNFPC CBD worker declined from 18 percent in 1994 to 3 percent in 1999. The most often used source for condoms are shops and rural/municipal clinics (18 percent each) and pharmacies and friends or relatives (15 percent each). 5.10 FIRST-YEAR CONTRACEPTIVE DISCONTINUATION RATES Couples can realise their reproductive goals only when they use contraceptive methods consistently. Of particular concern to family planning programmes is the rate at which users discontinue use of contraception and the reasons for such discontinuation. Life-table contraceptive discontinuation rates derived from the survey are presented in Table 5.12. These are cumulative first- year discontinuation rates and represent the proportion of users discontinuing a method within 12 months after the start of use. The rates are calculated by dividing the number of discontinuations for each reason at each duration of use in single months by the number of months of exposure at that duration. The single-month rates are then summed to produce a one-year rate. The reasons for discontinuation are treated as competing risks (net rates). Three specific reasons for discontinuation are tabulated: method failure (became pregnant while using contraception), desire to become pregnant, and switching to another method.1 Family Planning * 65 Table 5.12 First-year contraceptive discontinuation rates Proportion of contraceptive users who discontinue use of a method by 12 months after beginning its use, by reason for discontinuation, according to specific method, Zimbabwe 1999 _______________________________________________________________________________ Reason for discontinuation ____________________________________________ Desire to Switched All Method Method become to another other discontinued failure pregnant method reasons Total ________________________________________________________________________________ Pill 1.8 3.5 4.0 7.1 16.3 Injectables 1.1 3.2 9.4 12.5 26.2 Condom 4.2 6.7 9.7 22.9 43.3 Withdrawal 1.6 9.5 7.4 3.1 21.6 All methods 1.8 3.8 5.9 8.7 20.2 Figure 5.4 First-Year Contraceptive Discontinuation Rates by Method, Zimbabwe 1999 16% 26% 43% 22% Pill Injectables Condom Withdrawal ZDHS 1999 The results indicate that one in five family planning users in Zimbabwe stop using a contraceptive method within 12 months of starting use. Four percent of users stop using because they want to become pregnant, 6 percent stop because the women switched to another method, and 2 percent stop because of method failure (i.e., they became pregnant while using). Discontinuation rates are much higher for the condom (43 percent) than for the pill (16 percent) or injectables (26 percent) (see Figure 5.4). Among the modern contraceptive methods, condoms present the highest failure rate; 4 percent of users became pregnant while using them. 66 * Family Planning Table 5.13 Reasons for discontinuing contraceptive methods Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason for discontinuation, according to specific method, Zimbabwe 1999 ______________________________________________________________________________________ Lacta- tional Periodic Reason for Inject- Con- amenor- absti- With- All discontinuation Pill ables dom rhoea nence drawal methods ______________________________________________________________________________________ Became pregnant while using Wanted to become pregnant Husband disapproved Side effects Health concerns Access/availability Wanted a more effective method Inconvenient to use Infrequent sex Costs too much Fatalistic Menopause Marital dissolution Other Don't know Missing Total Number of women 12.7 6.9 5.8 13.6 (17.7) 16.4 11.7 39.6 18.8 27.9 13.4 (9.8) 51.9 35.4 3.3 1.4 9.4 3.3 (5.3) 6.4 3.5 10.3 27.0 0.4 0.0 (0.0) 0.0 11.3 6.4 14.8 1.4 0.0 (0.0) 0.0 6.9 3.6 6.6 3.6 0.0 (0.0) 0.0 3.7 3.9 0.5 6.7 34.3 (22.4) 6.5 4.6 2.6 1.2 6.5 1.9 (0.0) 0.7 2.5 3.8 5.5 12.8 0.0 (18.5) 1.3 4.5 2.9 6.4 1.4 0.0 (0.0) 0.0 3.0 0.5 0.0 1.1 0.0 (0.0) 0.0 0.4 0.6 0.3 0.0 0.0 (0.0) 2.9 0.6 2.1 1.7 2.3 0.0 (0.0) 0.0 1.9 3.7 6.1 12.0 17.8 (0.0) 1.3 5.0 0.1 0.0 0.3 0.0 (0.0) 0.0 0.1 3.8 2.9 8.5 15.6 (26.3) 12.6 5.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,951 420 167 76 29 143 2,835 ______________________________________________________________________________________ Note: Numbers in parentheses are based on 25-49 unweighted cases. 1 Total includes women who used IUD, implants, female condom, foam or jelly, and traditional methods. 5.11 REASONS FOR DISCONTINUING CONTRACEPTIVE METHODS Table 5.13 presents the distribution of all discontinuations among ever users during the four years preceding the ZDHS. Among 2,835 discontinuations that occurred since January 1994, the most common reason for discontinuing use is the desire to become pregnant. This reason applies to all methods except LAM, for which 34 percent of the users wanted to have a more effective method. The desire to become pregnant is expressed by 40 percent of pill users. Across all modern family planning methods, there is also a significant proportion of women who discontinued use because they experienced method-related side effects and/or because they were concerned about their health (18 percent). It is worth noting that four in ten women who discontinued using injectables stopped because of side effects (27 percent) and health concerns (14 percent). The low efficacy of traditional and folk methods is evidenced by the comparatively high proportions of discontinuations that were due to pregnancy. 5.12 FUTURE USE OF CONTRACEPTION An important indicator of the changing demand for family planning is the extent to which nonusers of contraception plan to use family planning methods in the future as this provides a forecast of potential demand for services. Currently married women who were not using contraception at the time of the survey were asked about their intention to use family planning in the future (Table 5.14). Two-thirds of the currently married nonusers indicated that they intend to use family planning methods in the future, Family Planning * 67 Table 5.14 Future use of contraception Percent distribution of currently married women and men who are not using a contraceptive method by intention to use a method in the future, according to number of living children, Zimbabwe 1999 ____________________________________________________________________________________________________ Number of living children1 _________________________________________ Total Total Intention 0 1 2 3 4+ women men ____________________________________________________________________________________________________ All currently married nonusers Intends to use Unsure as to intention Does not intend to use Don’t know/Missing Total Number of women and men 63.5 78.6 73.6 75.7 52.7 66.7 67.9 6.5 4.2 5.3 1.5 3.6 4.1 3.6 30.0 17.2 20.8 22.0 43.0 28.7 21.0 0.0 0.0 0.3 0.8 0.7 0.4 7.5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 233 350 311 236 547 1,676 428 ___________________________________________________________________________________________________ 1 Includes current pregnancy Table 5.15 Reasons for nonuse of contraception Percent distribution of currently married women and men who are not using a contraceptive method and who do not intend to use in the future by main reason for not intending to use, according to age, Zimbabwe 1999 _____________________________________________________________ Women Men ______________________ ______ Age ______________ All All Reason <30 30-49 ages ages _____________________________________________________________ Not married Infrequent sex Menopausal/hysterectomy Subfecund/infecund Wants more children Respondent opposed Husband opposed Others opposed Religious prohibition Knows no method Knows no source Health concerns Fear side effects Lack of access Costs too much Inconvenient to use Interferes with body processes Other Don't know Missing Total Number of women and men 0.0 0.5 0.4 0.0 1.6 8.6 6.8 3.1 0.0 23.9 17.9 25.6 9.1 19.6 17.0 9.6 11.1 8.7 9.3 12.0 8.2 2.6 4.0 4.6 9.7 3.1 4.8 1.5 0.0 0.1 0.1 0.0 36.9 8.5 15.7 26.3 1.2 0.2 0.5 1.0 0.0 0.0 0.0 0.4 3.0 4.5 4.1 3.6 7.5 5.6 6.1 0.5 0.0 0.3 0.2 0.0 2.1 2.6 2.5 0.0 0.4 0.4 0.4 2.3 2.4 2.4 2.4 1.4 2.9 6.3 5.5 2.8 3.9 1.7 2.3 5.1 0.0 0.4 0.3 0.0 100.0 100.0 100.0 100.0 122 360 482 90 while 29 percent said they do not intend to use. The proportion of women who intend to use a meth- od is highest among women with one to three children and lowest among those with at least four children. The pattern for men is similar to that for women. 5.13 REASONS FOR NONUSE OF CONTRACEPTION Table 5.15 presents the main reasons for not using family planning given by currently mar- ried nonusers who said that they did not intend to use a contracep- tive method in the future. Religious prohibition, a desire for more chil- dren, and husband’s disapproval were the most important reasons given by women under 30 years of age, while menopause and per- ceived subfecundity and infecudity were given as the most important reasons for nonuse by women above 30 years of age. For men, the most often cited reasons are that their wife is menopausal or has had a hysterectomy and reli- gious prohibition (26 percent each). 68 * Family Planning Table 5.16 Preferred method of contra- ception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, Zimbabwe 1999 ______________________________________ Percentage of women who intend to use a method Preferred method in the future ______________________________________ Pill IUD Injectables Implants Condom Female condom Female sterilisation Male sterilisation Lactational amenorrhoea Periodic abstinence Withdrawal Folk method Missing Total Number of women 56.8 1.6 26.5 1.8 1.2 0.7 4.7 0.2 0.1 0.2 2.3 1.3 2.7 100.0 1,119 5.14 PREFERRED METHODS OF CONTRACEPTION FOR FUTURE USE Future demand for specific methods of family planning can be assessed by asking nonusers which method they intend to use. Table 5.16 presents informa- tion on method preferences for married women who are not using contraception but say that they intend to use in the future. A majority of these women (57 percent) intend to use the pill, about 27 percent intend to use injectables, and 5 percent consider female sterilization. Compared with the 1994 ZDHS, there is a slight increase in the intention to use injectables, and less interest in the pill and IUD. The intention to use condoms as a means for preventing a pregnancy also declined (3 percent in 1994 to 1 percent in 1999). 5.15 EXPOSURE TO FAMILY PLANNING MESSAGES ON THE RADIO AND TELEVISION Radio and television are the major potential sources of information about family planning in the electronic media. Information on the level of public exposure to a particular type of media allows policy makers to ensure the use of the most effective media for the various target groups. To assess the effectiveness of such media on the dissemination of family planning information, all female and male respondents in the survey were asked whether they had heard messages about family planning on radio or seen them on television during the few months preceding the interview (Tables 5.17.1 for women and 5.17.2 for men). Overall, one in four women reported that they had heard or seen a family planning message on both radio and television during the month before the interview, 22 percent heard a message on the radio only, and 3 percent heard a message on the television only. These proportions do not vary significantly by the woman’s age. However, sharp contrasts in access to media messages are observed between urban and rural residents. Respondents in urban areas are about three times as likely as rural women to have access to both radio or television broadcasts. Rural women are more likely than urban women not to have heard a message on either radio or television (63 percent of rural women compared with 31 percent of women in urban areas). The proportion of women who were exposed to family planning messages varied across provinces, ranging from 33 percent in Matabeleland North to 67 percent in Harare and 78 percent in Bulawayo. Exposure to family planning messages increases with the respondent’s level of education; women with higher than a secondary education are much more likely to be exposed to messages than women with no education. Family Planning * 69 Table 5.17.1 Exposure to family planning messages on radio and television: women Percent distribution of women by whether or not they have heard a radio or television message about family planning in the last few months prior to the interview, according to selected back- ground characteristics, Zimbabwe 1999 ______________________________________________________________________________ Heard family planning message on radio/television ___________________________________ Tele- Number Background Radio vision of characteristic Both only only Neither Total women ______________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 20.4 18.4 3.1 58.1 100.0 1,447 25.8 23.0 3.8 47.3 100.0 1,294 26.9 26.5 2.8 43.8 100.0 1,034 31.6 24.6 4.5 39.3 100.0 668 23.6 22.0 2.2 52.0 100.0 637 22.3 21.0 2.4 54.4 100.0 466 20.4 17.7 1.5 60.4 100.0 361 42.0 20.6 6.8 30.6 100.0 2,279 13.5 23.0 0.8 62.7 100.0 3,628 16.2 18.0 0.8 65.1 100.0 882 14.0 25.0 1.8 59.1 100.0 477 25.8 28.5 1.3 44.4 100.0 461 24.1 24.2 2.0 49.8 100.0 559 13.8 17.7 1.3 67.1 100.0 302 14.4 21.2 2.2 62.1 100.0 321 16.4 23.6 3.5 56.3 100.0 741 14.9 26.3 2.0 56.8 100.0 629 40.2 19.2 7.5 33.1 100.0 1,077 53.8 19.8 4.8 21.7 100.0 457 10.5 12.5 0.2 76.5 100.0 396 15.5 22.4 1.3 60.9 100.0 2,377 31.5 23.6 4.5 40.4 100.0 2,965 60.5 13.0 12.6 14.0 100.0 168 24.5 22.1 3.1 50.3 100.0 5,907 In general, men seem to be more exposed to family planning messages through the electronic media than their female counterparts. Like women, however, exposure to family planning messages on the radio and television varies across provinces. Men in Harare and Bulawayo (86 percent and 81 percent, respectively) have the highest level of exposure. For the remaining provinces, exposure to family planning messages through the electronic media ranges from 40 percent in Matabeleland South to 69 percent in Mashonaland West. Exposure to family planning messages also varies with men’s education; men with at least some secondary education are more exposed to messages than those with primary or no education. 70 * Family Planning Table 5.17.2 Exposure to family planning messages on radio and television: men Percent distribution of men by whether or not they have heard a radio and/or television message about family planning in the last few months prior to the interview, according to selected background characteristics, Zimbabwe 1999 ________________________________________________________________________________________ Heard family planning message on radio/television ____________________________________________ Tele- Number Background Radio vision of characteristic Both only only Neither Missing Total men ________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 20.0 23.1 4.2 52.7 0.0 100.0 713 28.1 29.7 6.1 36.2 0.0 100.0 506 35.7 34.0 3.2 27.1 0.0 100.0 430 36.4 36.9 2.8 23.9 0.0 100.0 281 35.6 31.2 4.1 29.1 0.0 100.0 220 30.0 31.0 3.3 33.4 2.2 100.0 178 29.8 34.0 1.3 34.9 0.0 100.0 177 28.1 33.7 3.1 35.1 0.0 100.0 104 53.9 21.7 7.2 16.8 0.4 100.0 1,090 11.0 36.0 1.5 51.5 0.0 100.0 1,519 17.9 43.4 0.8 37.3 0.6 100.0 360 10.8 37.7 1.5 50.0 0.0 100.0 236 14.9 30.9 2.8 51.5 0.0 100.0 217 28.9 37.7 2.1 31.3 0.0 100.0 268 25.9 26.6 1.7 45.8 0.0 100.0 146 19.5 17.7 3.5 59.2 0.0 100.0 120 15.6 30.2 6.8 47.4 0.0 100.0 308 9.8 35.4 1.1 53.7 0.0 100.0 225 60.1 17.7 8.1 13.7 0.4 100.0 514 53.5 21.6 5.7 19.2 0.0 100.0 214 15.9 21.0 2.9 60.3 0.0 100.0 66 14.0 32.7 1.1 51.9 0.3 100.0 830 34.2 30.4 4.4 30.8 0.1 100.0 1,556 60.6 16.7 14.0 8.6 0.0 100.0 157 28.9 30.0 3.9 37.0 0.2 100.0 2,609 5.16 EXPOSURE TO FAMILY PLANNING MESSAGES IN THE PRINT MEDIA Respondents were asked whether they had been exposed to a family planning message in a newspaper or magazine article (i.e., print media) during the last few months preceding the interview (see Table 5.18). Three in four women interviewed (73 percent) reported that they had no exposure to print media that contained family planning information. Women age 25-34 years report the highest exposure of messages through the print media, compared with other age groups. Women in rural areas are less likely to have been exposed to print media on family planning than their urban counterparts (15 percent of rural women compared with 45 percent of urban women). The proportion of women who were exposed to family planning messages in print media increases directly with their education: 8 percent among women with no formal education to 37 percent or higher among women with a secondary education. Family Planning * 71 Table 5.18 Exposure to family planning messages in print media Percentage of women who saw a message about family planning in the print media (newspaper or magazine) in the last few months prior to the interview, according to selected background characteristics, Zimbabwe 1999 __________________________________________________________ Saw family planning message in print media Number Background ___________________ of characteristic Yes No Total women __________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total women 23.5 76.5 100.0 1,447 28.9 71.1 100.0 1,294 31.5 68.6 100.0 1,034 31.9 68.1 100.0 668 23.7 76.3 100.0 637 23.3 96.7 100.0 466 18.6 81.4 100.0 361 45.0 55.0 100.0 2,279 15.3 84.7 100.0 3,628 15.3 84.7 100.0 882 17.7 82.3 100.0 477 29.9 70.1 100.0 461 25.0 75.0 100.0 559 11.1 88.9 100.0 302 18.3 81.7 100.0 321 18.7 81.3 100.0 741 19.0 81.0 100.0 629 43.6 56.4 100.0 1,077 57.3 42.7 100.0 457 8.2 91.8 100.0 396 14.1 85.9 100.0 2,377 36.6 63.4 100.0 2,965 74.6 25.4 100.0 168 26.7 73.3 100.0 5,907 5.17 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Community-based distribution (CBD) workers, who are largely based in rural areas, are expected to visit women and men of reproductive age who are nonusers of modern family planning methods to discuss options and, when indicated, motivate them to adopt a method of family planning. To obtain an indication of the frequency of such visits, women were asked whether a CBD worker visited them within the past 12 months. To get insight into the level of “missed opportuni- ties,” i.e., opportunities to motivate nonusers to adopt family planning, nonusers were also asked whether they had visited a health facility in the past 12 months and whether anyone at the health facility had discussed family planning with them during their visit. Women who were visited by a health worker in the health facilities in the past 12 months for personal care or care of their children were also asked whether health providers at the facility spoke to them about family planning methods. 72 * Family Planning Table 5.19 Contact of nonusers with family planning providers Percent distribution of women who do not use contraception by whether they were visited by a family planning service provider or spoke with a health facility (HF) staff member about family planning methods (FP) during the 12 months prior to interview, according to selected background characteristics, Zimbabwe 1999 ______________________________________________________________________________________________________________ Visited by FP provider Not visited by a FP provider Neither__________________________ __________________________ visited by Attended Attended Did not Attended Attended Did not FP provider HF and HF but attend HF and HF but attend nor Number Background discussed did not health discussed did not health discussed of characteristic FP1 discuss FP1 facility FP1 discuss FP1 facility FP at HF2 Total women____________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary More than secondary Total 0.6 2.1 3.7 2.6 23.1 67.9 91.0 100.0 1,285 2.4 1.3 2.9 9.9 30.8 52.7 83.4 100.0 770 3.4 3.6 4.3 14.9 31.5 42.3 73.8 100.0 480 4.5 2.8 6.4 14.4 29.4 42.4 71.8 100.0 317 4.2 3.8 8.2 9.4 24.4 49.7 74.1 100.0 312 2.5 3.8 4.7 6.2 26.1 56.7 82.8 100.0 269 1.2 2.7 7.6 4.0 20.4 64.2 84.5 100.0 248 1.0 1.4 3.0 8.5 27.5 58.6 86.1 100.0 1,305 2.8 3.1 5.4 7.2 25.9 55.4 81.4 100.0 2,376 1.7 2.8 2.5 6.5 30.7 55.8 86.5 100.0 623 2.4 2.8 5.8 8.2 31.5 49.4 80.9 100.0 284 3.0 1.5 5.9 5.2 10.3 74.2 84.5 100.0 269 2.8 4.3 13.3 5.2 17.3 56.7 74.0 100.0 322 0.4 4.6 2.1 5.5 39.4 48.0 87.4 100.0 198 4.8 5.5 5.5 9.7 32.1 42.5 74.6 100.0 221 1.7 1.4 4.4 10.3 24.0 58.1 82.1 100.0 484 3.9 3.7 5.8 9.8 28.2 48.5 76.8 100.0 406 0.6 0.3 1.6 7.7 26.5 63.3 89.8 100.0 600 2.1 1.4 2.8 7.4 26.2 60.2 86.4 100.0 273 3.3 1.7 7.6 3.2 22.8 61.0 83.8 100.0 258 2.6 3.1 5.1 7.8 24.7 56.6 81.3 100.0 1,465 1.5 2.3 3.8 8.2 27.8 56.5 84.3 100.0 1,885 5.6 0.0 3.5 8.0 42.0 40.9 82.9 100.0 73 2.2 2.5 4.6 7.7 26.5 56.6 83.0 100.0 3,681 _____________________________________________________________________________________________________ 1 Spoke with health facility staff about family planning methods 2 Was not visited by a CBD worker and either did not attend a health facility in preceding 12 months or attended facility but did not speak with a staff member about family planning methods The data in Table 5.19 show that family planning workers visited 10 percent of nonusers. Overall, 83 percent of nonusers were not visited by a CBD worker, did not visit a health facility, or visited a health facility but did not discuss family planning with a staff person in the 12 months before the survey. This represents a large pool of potential users of family planning who could be targeted for family planning counselling. Around six in ten nonusers did not receive a visit from a CBD worker and did not go to a health facility in the past 12 months. To reach these women, a more vigorous outreach programme will be needed. Although 34 percent of nonusers were not visited by a CBD worker, they did visit a health facility in the past 12 months. However, seven in ten of these women (27 percent of all nonusers) received no family planning information or services during their recent visit. This is a significant fraction of nonusers and represents missed opportunities to motivate nonusers to adopt family planning. Proximate Determinants of Fertility * 73 Table 6.1 Current marital status Percent distribution of women and men by current marital status, according to age, Zimbabwe 1999____________________________________________________________________________________________ Marital status_______________________________________________________ Number of Never Living Not living women/ Age married Married together Widowed Divorced together Total men____________________________________________________________________________________________ WOMEN____________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 All ages 77.3 19.2 2.5 0.0 0.2 0.8 100.0 1,447 28.1 56.8 6.6 1.2 3.2 4.0 100.0 1,294 9.8 71.0 5.1 2.9 5.5 5.6 100.0 1,034 3.9 74.9 6.5 5.8 5.1 3.9 100.0 668 2.7 72.9 4.8 10.2 5.2 4.1 100.0 637 1.6 76.6 4.0 9.5 4.9 3.4 100.0 466 0.6 70.9 4.5 15.7 4.0 4.2 100.0 361 27.7 56.3 4.8 4.2 3.5 3.5 100.0 5,907 ____________________________________________________________________________________________ MEN____________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 All ages 99.2 0.6 0.0 0.0 0.1 0.0 100.0 713 76.4 21.0 0.8 0.1 0.8 0.8 100.0 506 27.0 62.0 3.8 1.4 3.1 2.7 100.0 430 7.5 84.7 0.6 1.7 3.6 1.9 100.0 281 5.9 86.8 1.5 2.9 2.1 0.8 100.0 220 2.1 90.8 0.8 1.9 2.5 2.0 100.0 178 1.3 88.0 1.0 4.2 5.6 0.0 100.0 177 1.2 83.6 0.0 7.6 4.3 3.2 100.0 104 48.0 46.4 1.1 1.4 2.0 1.1 100.0 2,609 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6 This chapter focuses on the principal factors, other than contraception, that affect a woman’s exposure to the risk of becoming pregnant. These include nuptiality, sexual activity, postpartum amenorrhoea, and abstinence from sexual relations. Marriage and sexual initiation signal the onset of women’s exposure to the risk of childbearing; postpartum amenorrhoea and abstinence are largely spacing variables that affect the interval between births, while menopause marks the end of reproduction. These factors determine the length and pace of reproductive activity and are important in understanding fertility. 6.1 MARITAL STATUS The proportion of never-married women declines sharply from 77 percent in age group 15-19 to less than 1 percent among women 45-49 years of age. Marriage is thus nearly universal in Zimbabwe. The proportion currently married or living together has not changed from the level in 1994. The lower panel of Table 6.1 shows that 48 percent of the men interviewed have never been married, 46 percent are currently married, 1 percent are widowed, while 3 percent were either divorced or separated. Compared with women, a much greater proportion of the interviewed men (20 percentage points more among men) have never been married. Divorce is less common for men than women, suggesting that men are more likely than women to remarry after divorce. 74 * Proximate Determinants of Fertility Table 6.2 Polygyny Percentage of currently married women and men in a polygynous union by age and selected background characteristics, Zimbabwe 1999_____________________________________________________________________________________________________ Current age Background ___________________________________________________________ All All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ women men _____________________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women All men 8.2 8.5 10.1 6.0 2.3 7.7 8.1 NA 7.6 7.5 16.9 19.2 18.7 21.9 20.7 23.9 19.2 NA 20.0 10.8 20.6 29.1 31.1 22.5 20.6 32.3 10.0 NA 25.1 8.4 29.9 38.4 29.1 34.5 26.2 27.2 31.8 NA 31.2 13.1 7.7 8.7 8.0 17.4 19.6 7.7 8.3 NA 11.2 6.9 9.8 15.8 5.4 20.1 17.2 27.6 16.2 NA 15.0 11.2 14.0 12.7 10.9 25.7 18.7 12.0 9.3 NA 15.1 12.0 0.0 6.9 14.1 12.2 12.1 6.6 10.6 NA 10.0 15.6 11.5 12.5 9.8 15.3 14.7 21.8 31.8 NA 15.0 8.4 7.1 12.4 17.5 15.7 8.8 23.3 24.2 NA 15.3 6.2 12.5 5.7 12.9 5.1 2.9 8.0 6.3 NA 7.8 9.1 5.3 4.1 6.5 5.1 4.5 2.4 2.9 NA 4.6 6.8 54.6 38.6 44.4 24.7 27.8 28.7 25.9 NA 30.2 19.3 14.6 21.5 19.4 20.7 15.5 18.4 16.3 NA 18.4 12.1 12.1 10.0 11.4 12.1 1.0 7.7 4.0 NA 10.2 6.8 NA 0.0 3.3 6.8 2.6 17.1 0.0 NA 4.9 7.6 14.3 14.8 15.2 15.9 14.7 19.2 15.9 NA 15.5 NA 0.0 6.5 8.3 8.4 6.4 9.7 13.7 17.7 NA 9.4 ______________________________________________________________________________________________________ NA = Not applicable 6.2 POLYGYNY The extent of polygyny in Zimbabwe was measured by asking all currently married female respondents the question: “Besides yourself, how many other wives does your husband have?” For currently married men, the question was: “How many wives do you have?” The proportion of currently married women who are part of a polygynous union by age and selected background characteristics is shown in Table 6.2 and in Figure 6.1. One in six currently married women in Zimbabwe reported being part of a polygynous union. Older women are only slightly more likely to report their husband has more than one wife than younger women. Polygyny is higher among rural women than among urban women. The extent of polygyny varies across provinces; Bulawayo has the lowest level (5 percent) and Mashonaland Central and Manicaland have the highest (31 percent and 25 percent, respectively). There is an inverse relationship between female education and polygyny; polygyny decreases as women’s education increases. The proportion of women with no formal education who are part of a polygynous union is 30 percent; the proportion among women with a primary education is 18 percent, while for those with at least some secondary education it is at the most 10 percent. Between 1988 and 1994, polygyny appears to have been on the increase in Zimbabwe. However, in the last five years there seems to have been a downward trend. Overall, polygyny increased from 17 percent in the 1988 ZDHS to 19 percent in the 1994 ZDHS and declined to 16 percent in 1999 ZDHS. Proximate Determinants of Fertility * 75 Figure 6.1 Percentage of Currently Married Women Whose Husbands Have More than One Wife, Zimbabwe 1999 16% 8% 20% 25% 31% 11% 15% 15% 10% 15% 15% 8% 5% 30% 18% 10% 5% ZIMBABWE RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary Higher ZDHS 1999 The data for currently married men are shown in the bottom row and the last column in Table 6.2. Overall, 9 percent of the men interviewed are in a polygynous union, and this proportion increases with age. Rural men are more likely to have multiple spouses than urban men. There is substantial provincial variation in the distribution of men who are in a polygynous union, ranging from 6 percent in Masvingo to 16 percent in Matabeleland South. Men with primary or no education are more than twice as likely to be in a polygynous union as those with secondary or more education. 6.3 NUMBER OF CO-WIVES AND WIVES Table 6.3 shows the distribution of currently married women by number of co-wives and men by the number of wives, according to selected background characteristics. The table shows that 85 percent of all currently married women are in a monogamous union, 12 percent are in a polygynous union with one co-wife, and only a small proportion (4 percent) are in a marriage with two or more co-wives. In general, women in groups with relatively high levels of polygyny are also more likely to have more than one co-wife. This is true of women over age 30, rural women, those with no formal education, and women in Mashonaland Central and Manicaland provinces. In the case of men, nine in ten reported having only one wife, 5 percent have two wives, and 1 percent report having three or more wives. 76 * Proximate Determinants of Fertility Table 6.3 Number of co-wives and wives Percent distribution of currently married women by number of co-wives and currently married men by number of wives, according to selected background characteristics, Zimbabwe 1999 ___________________________________________________________________________________________________________________ Currently married women Currently married men ___________________________________________ __________________________________________ Two or Three No One more Number or more Number Background co- co- co- DK/ of One Two other DK/ of characteristic wives wife wives missing Total women wife wives wives missing Total men __________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women 85.7 10.2 4.1 0.0 100.0 314 * * * * 100.0 4 85.2 11.7 2.8 0.3 100.0 820 93.5 2.0 0.0 4.5 100.0 110 84.8 11.9 2.8 0.5 100.0 788 91.7 2.8 0.0 5.5 100.0 283 84.1 11.5 4.3 0.1 100.0 543 91.6 4.9 0.8 2.7 100.0 239 85.3 11.0 3.5 0.2 100.0 495 93.6 4.5 0.4 1.6 100.0 194 80.8 14.4 4.8 0.0 100.0 375 90.3 5.7 2.0 1.9 100.0 163 84.1 13.1 2.8 0.0 100.0 272 86.3 6.3 2.7 4.6 100.0 158 NA NA NA NA NA 0 82.3 13.3 3.6 0.8 100.0 87 92.4 6.8 0.6 0.3 100.0 1,306 92.5 3.9 0.0 3.7 100.0 546 80.0 14.8 5.1 0.2 100.0 2,303 89.2 5.8 1.9 3.1 100.0 693 74.9 18.1 6.5 0.4 100.0 561 91.6 4.2 4.2 0.0 100.0 139 68.8 24.1 6.6 0.5 100.0 325 86.9 8.0 1.1 4.0 100.0 127 88.8 6.4 4.5 0.3 100.0 310 93.1 2.6 0.9 3.4 100.0 117 85.0 11.7 3.3 0.0 100.0 367 88.8 4.5 0.7 5.9 100.0 147 84.9 11.4 3.4 0.2 100.0 180 88.0 6.0 2.7 3.3 100.0 61 90.0 8.6 1.4 0.0 100.0 170 84.4 9.2 1.1 5.3 100.0 46 85.0 11.7 3.0 0.3 100.0 444 91.6 5.0 0.7 2.7 100.0 143 84.7 11.2 3.8 0.3 100.0 367 93.8 5.3 0.9 0.0 100.0 102 92.2 7.2 0.6 0.0 100.0 667 90.9 3.5 0.0 5.6 100.0 271 95.4 4.3 0.3 0.0 100.0 217 93.2 6.8 0.0 0.0 100.0 86 69.8 20.2 9.2 0.9 100.0 310 80.7 11.6 3.6 4.0 100.0 49 81.6 14.0 4.2 0.2 100.0 1,665 87.9 6.0 2.5 3.6 100.0 461 89.8 8.4 1.8 0.1 100.0 1,523 93.2 3.2 0.0 3.6 100.0 617 95.1 4.9 0.0 0.0 100.0 111 92.4 7.2 0.0 0.4 100.0 112 84.5 11.9 3.5 0.2 100.0 3,609 90.6 5.0 1.1 3.3 100.0 1,239 ___________________________________________________________________________________________________________________ Note: An asterisk indicates that a figure is based on fewer than 25 cases and has been surpressed. NA = Not applicable 6.4 AGE AT FIRST MARRIAGE For most societies, marriage marks the point in a woman’s life when childbearing first becomes socially acceptable. Women who marry early will, on average, have longer exposure to reproductive risk; therefore, early age at first marriage often implies early age at childbearing and higher fertility for a society. Information on age at first marriage was obtained by asking all ever- married respondents the month and year they started living together with their first spouse. The median age at first marriage in Zimbabwe has risen slowly from 18.8 years among women age 45-49 to 19.7 years among women age 20-24 (representing recent marital patterns) (see Table 6.4). The proportion of women married by age 15 declined from 9 percent among those age 45-49 to 2 percent among women age 15-19 years. Overall, 58 percent of Zimbabwean women currently age 25-49 were married by age 20. Sixty-two percent of such women were married at age 20 in 1994. Proximate Determinants of Fertility * 77 Table 6.4 Age at first marriage Percentage of women and men who were first married by specific exact ages and median age at first marriage, according to current age, Zimbabwe 1999____________________________________________________________________________________________ WOMEN____________________________________________________________________________________________ Median Percentage first married by exact age: Percentage Number age at_________________________________________ never of first Current age 15 18 20 22 25 married women marriage____________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Women 20-49 Women 25-49 1.9 NA NA NA NA 77.3 1,447 a 4.6 28.7 52.9 NA NA 28.1 1,294 19.7 6.5 30.1 52.3 71.0 85.4 9.8 1,034 19.8 5.9 28.0 54.1 68.7 85.3 3.9 668 19.7 8.7 40.5 65.3 78.2 89.4 2.7 637 18.6 11.4 39.4 62.3 80.1 90.0 1.6 466 18.9 8.8 37.1 61.4 78.8 85.7 0.6 361 18.8 6.8 32.4 56.4 71.9 82.5 11.6 4,460 19.4 7.8 33.9 57.8 74.2 86.9 4.9 3,166 19.3 ____________________________________________________________________________________________ MEN____________________________________________________________________________________________ Percentage Median Percentage who were first married by exact age: who had Number age at_________________________________________ never of first Current age 20 22 25 28 30 married men marriage____________________________________________________________________________________________ 25-29 30-34 35-39 40-44 45-49 50-54 Men 25-54 14.0 26.9 56.5 NA NA 27.0 430 24.3 14.0 26.7 58.2 77.8 88.1 7.5 281 24.3 12.1 27.3 46.3 66.2 74.4 5.9 220 25.4 14.1 33.7 59.7 77.4 87.8 2.1 178 24.1 12.6 26.3 53.4 77.4 84.3 1.3 177 24.7 6.2 18.6 53.8 79.6 89.9 1.2 104 24.6 13.0 27.1 55.0 73.9 80.9 11.3 1,390 24.5 ____________________________________________________________________________________________ NA = Not applicablea Omitted when less than 50 percent of respondents in the age group x to x+5 have married by age x Comparison with data from the male survey shows that men enter into first union at a much later age than women: the median age at first marriage for men is 25 years, compared with 19 years for women. Only 13 percent of men age 25-54 are married by age 20, compared with 58 percent of women age 25-49. 6.5 MEDIAN AGE AT FIRST MARRIAGE Table 6.5 examines the median age at first marriage for women age 25-49 by selected background characteristics. The overall median age at first marriage observed for women age 25-49 is 19.3 years. However, the table shows large differentials in the median age at first marriage by background characteristics. Urban women marry about one year later than rural women. There are even greater variations by province. Mashonaland West has the lowest median age at first marriage (18.7 years) while Bulawayo and Matabeleland South have the highest (20.6 and 20.7 years, respectively). The median age at marriage in the other provinces ranges from 18.3 in Mashonaland Central to 19.9 in Harare (see Figure 6.2). 78 * Proximate Determinants of Fertility Table 6.5 Median age at first marriage Median age at first marriage among women age 25-49 years, and men age 25-54 by current age and selected background characteristics, Zimbabwe 1999__________________________________________________________________________________________ Current age Women Men Background _____________________________________________ age age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 25-54_________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 20.7 20.4 19.2 19.6 19.1 20.0 24.7 19.3 19.0 18.4 18.6 18.7 18.8 24.3 18.9 18.9 18.2 17.9 18.7 18.5 24.9 18.4 18.8 18.1 17.7 19.0 18.3 23.5 18.7 19.6 18.6 20.3 19.0 19.0 24.7 18.9 18.9 18.2 18.5 18.5 18.7 22.6 20.9 21.2 19.5 18.0 18.5 19.8 24.8 21.2 21.4 21.1 19.8 20.2 20.7 24.7 20.2 20.1 18.9 19.2 17.9 19.6 24.4 19.8 19.1 18.0 19.1 18.9 19.1 24.6 21.0 19.8 18.8 19.6 18.7 19.9 24.7 21.5 20.8 19.8 20.4 19.4 20.6 a 16.5 16.9 17.6 18.3 18.1 17.8 24.9 18.2 18.5 18.4 18.6 18.6 18.5 23.9 20.4 20.7 20.5 20.4 20.7 20.5 24.5 24.6 23.9 22.7 23.3 22.0 23.5 a 19.8 19.7 18.6 18.9 18.8 19.3 24.5 __________________________________________________________________________________________ a Omitted for populations in which less than 50 percent of the men have married for the first time by age 25 Figure 6.2 Median Age at First Marriage among Women 25-49, Zimbabwe 1999 19.3 20.0 18.8 18.5 18.3 19.0 18.7 19.8 20.7 19.6 19.1 19.9 20.6 17.8 18.5 20.5 23.5 ZIMBABWE RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary Higher Median Age ZDHS 1999 Proximate Determinants of Fertility * 79 Table 6.6 Age at first sexual intercourse Percentage of women and men who had first sexual intercourse by specified exact ages and median age at first intercourse, according to current age, Zimbabwe 1999_____________________________________________________________________________________________ Percentage who had first Percentage Number Median sexual intercourse by exact age: never of age at_________________________________________ having women/ first Current age 15 18 20 22 25 intercourse men intercourse____________________________________________________________________________________________ WOMEN____________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 3.2 NA NA NA NA 67.7 1,447 a 5.3 35.0 63.1 NA NA 15.9 1,294 a 6.6 33.2 60.2 76.6 86.2 2.4 1,034 19.1 7.6 35.3 58.4 74.4 83.4 1.2 668 19.1 9.4 49.9 72.0 81.9 87.1 0.3 637 18.0 11.6 45.3 69.6 82.5 88.1 0.2 466 18.4 8.2 43.2 65.3 79.2 82.9 0.0 361 18.5 7.4 38.5 63.9 77.4 83.7 5.4 4,460 18.8 8.3 40.0 64.2 78.4 85.7 1.1 3,166 18.7 ____________________________________________________________________________________________ MEN____________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 25-54 6.3 NA NA NA NA 70.6 713 a 7.5 30.7 56.5 NA NA 23.5 506 19.5 5.3 30.5 62.3 77.4 89.9 3.3 430 19.1 5.0 26.5 52.6 72.6 87.3 0.1 281 19.7 3.1 29.4 54.5 74.9 88.1 0.6 220 19.2 3.6 23.3 48.3 65.2 84.5 0.0 178 20.2 3.2 31.6 51.6 68.4 86.0 0.0 177 19.9 2.2 18.0 30.4 63.2 81.0 0.0 104 20.8 4.2 27.8 53.5 72.2 87.2 1.1 1,390 19.7 _____________________________________________________________________________________________ NA = Not applicablea Omitted when less than 50 percent of women in the age group x to x + 5 have had intercourse by age x There is a marked relationship between female education and median age at first marriage. The median age at first marriage for women with no formal education is 17.8 years, compared with 18.5 years for those with a primary education. It is 20.5 years for women with a secondary education and 23.5 years for those with more than a secondary education. Within educational groups, age at first marriage has remained virtually constant since the 1994 ZDHS. Overall, age at marriage has increased solely because the proportion of women who are educated to the secondary level (and marry later) has increased substantially. 6.6 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage is often used as a proxy for the onset of women’s exposure to the risk of pregnancy. However, since some women are sexually active before marriage, the age at which women initiate sexual intercourse more precisely marks the beginning of their exposure to reproductive risk. The percentage of women and men who have ever had intercourse by specific ages is given in Table 6.6. The median age at first sexual intercourse for women has risen slowly in recent years from 18.0 years for women age 35-39 to 19.1 for women age 25-29. Among women in the 15-19 age group, 68 percent have never had sex. Seventy-seven percent of women in this 15-19 cohort have never married (see Table 6.4), an indication that around 10 percent have had premarital sex. The proportion reporting never having had sex drops to 16 percent for women age 20-24, and by age 25- 29 almost all women (98 percent) have become sexually active. 80 * Proximate Determinants of Fertility Table 6.7.1 Median age at first sexual intercourse: women Median age at first sexual intercourse among women age 20-49 years, by current age and selected background characteristics, Zimbabwe 1999___________________________________________________________________________________________ Current age Women Women Background ___________________________________________________ age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49___________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All women 19.7 19.7 19.8 18.5 18.8 18.3 19.4 19.3 18.5 18.7 18.6 17.8 18.1 18.6 18.4 18.4 18.3 18.1 18.8 17.5 18.0 18.8 18.2 18.2 18.1 18.5 18.8 18.0 18.1 18.7 18.3 18.4 18.9 19.6 19.0 18.2 19.3 18.0 18.9 18.9 18.6 18.9 18.8 18.1 18.5 18.6 18.6 18.6 18.3 18.5 18.0 18.2 16.6 16.8 18.1 18.0 18.0 18.6 17.8 18.1 17.6 18.1 18.0 18.1 19.1 19.5 19.7 18.5 18.6 19.5 19.2 19.3 19.3 19.2 19.0 17.8 17.9 18.8 18.9 18.7 19.8 20.3 19.8 19.4 19.6 18.9 19.8 19.8 19.6 19.1 19.4 17.9 18.1 17.9 18.8 18.6 16.7 16.5 17.1 17.0 17.7 17.8 17.2 17.3 17.8 18.1 18.0 17.8 18.1 18.5 18.0 18.1 19.6 19.7 20.2 19.0 19.4 18.8 19.6 19.7 a 22.1 22.8 20.7 20.9 21.9 a 21.8 18.9 19.1 19.1 18.0 18.4 18.5 18.8 18.7 ___________________________________________________________________________________________ a Omitted for populations in which less than 50 percent of the women had intercourse for the first time by age 20 Men started having sexual intercourse at a later age than women. Among men age 20-24, 24 percent had never had sex while among women, the corresponding proportion is 16 percent. In general, men begin having sex about one year older than women (median age at first intercourse is 19.7 for men compared with 18.7 years for women). The data from male respondents show a pattern of decreasing age at first sex from about 20.8 years for age 50-54 to 19.5 years for age 20-24. Although men enter into marriage, on average, five years later than women (see Table 6.4), they start sexual relations only 12 months later than women. Looking at trends over age cohorts, it can be seen that the difference in the median age at first sex between men and women has declined considerably from one and a half years in the cohort age 45-49 years, to no difference for the cohort age 25-29 years. 6.7 MEDIAN AGE AT FIRST SEXUAL INTERCOURSE Tables 6.7.1 and 6.7.2 show differentials in the median age at first sexual intercourse by background characteristics for women age 20-49 years and men age 25-54. With respect to place of residence, on average, rural women start sexual relations about a year earlier than urban women. The highest median age at first sexual intercourse is 19.8 years for Harare, while Matabeleland North and Matabeleland South have the lowest (18.0 and 18.1 years, respectively). Women with more than a secondary education initiate sexual relations on average about five years later than those with no formal education. The gap between age at first sexual intercourse and age at first marriage increases with education. Proximate Determinants of Fertility * 81 Table 6.7.2 Median age at first sexual intercourse: men Median age at first sexual intercourse among men age 25-54 years, by current age and selected background characteristics, Zimbabwe 1999 ________________________________________________________________________________ Current age Men Background ___________________________________________________ age characteristic 25-29 30-34 35-39 40-44 45-49 50+ 25-54 ________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All men 19.2 20.0 19.0 20.0 19.3 20.6 19.5 18.9 19.5 19.7 20.2 20.2 21.1 19.8 21.5 23.2 21.8 22.4 22.0 24.8 22.0 18.1 20.3 20.3 19.2 20.9 20.4 20.1 18.3 18.5 18.5 20.0 22.0 20.5 18.8 18.7 19.0 18.5 19.7 19.3 22.5 19.0 18.9 18.1 20.2 20.3 18.0 21.5 18.9 18.3 18.7 21.5 20.0 19.5 19.7 19.4 19.8 18.9 19.8 19.6 18.7 20.0 19.5 19.5 20.8 18.9 22.3 20.5 24.0 20.6 18.9 20.2 18.3 19.7 19.3 21.5 19.2 19.7 19.2 20.1 20.0 20.0 20.4 20.0 19.5 21.7 21.3 24.0 20.3 21.0 21.0 19.2 18.9 19.3 19.8 20.3 21.2 19.9 18.9 19.8 19.1 20.4 19.3 20.3 19.4 20.3 20.1 19.0 19.5 19.0 24.1 19.9 19.1 19.7 19.2 20.2 19.9 20.8 19.7 Unlike women, men’s median age at first sex shows more variation by province. Men in Manicaland started having sex at a much older age (22 years) than their counterparts in other provinces. In other provinces, the highest median age at first sexual intercourse is 20.6 years in Masvingo, while Mashonaland East and Matabeleland North have the lowest age at first sexual intercourse (18.8 and 18.9 years, respectively). Initiation of sex among men is inversely related to their education. Men with no education initiate sexual relations later than those with a formal education. 6.8 RECENT SEXUAL ACTIVITY Although only 5 percent of the women age 20-49 have never had sexual intercourse, not all those who have ever had sex are currently sexually active. In the absence of effective contraception, the probability of becoming pregnant is highly dependent upon the frequency of intercourse. Information on sexual activity, therefore, can be used to refine measures of exposure to pregnancy. Men and women who have ever had sex were asked how long ago their last sexual activity occurred. Tables 6.8.1 and 6.8.2 show the distribution of women and men by sexual activity according to background characteristics. 82 * Proximate Determinants of Fertility Table 6.8.1 Recent sexual activity: women Percent distribution of women by sexual activity in the four weeks preceding the survey, and among those not sexually active, the duration of abstinence and whether postpartum or not postpartum abstaining, according to selected background characteristics, Zimbabwe 1999 __________________________________________________________________________________________________________ Not sexually active in last four weeks _________________________________ Background Sexually Postpartum Not postpartum Never characteristic/ active abstaining abstaining had Number contraceptive in last _________________ _________________ inter- of method 4 weeks 0-1 years 2+ years 0-1 years 2+ years course Missing Total women __________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marriage duration (years) Never married 0-4 5-9 10-14 15-19 20-24 25-29 30+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Contraceptive method No method Pill IUD Sterilisation Periodic abstinence Other (including breastfeeding) Total 18.6 3.7 0.3 8.9 0.4 67.7 0.2 100.0 1,447 53.4 7.9 1.8 18.7 1.3 15.9 0.9 100.0 1,294 67.4 7.0 2.2 17.0 3.4 2.4 0.6 100.0 1,034 70.2 5.6 0.7 16.9 4.2 1.2 1.2 100.0 668 65.8 4.7 1.1 20.3 6.9 0.3 1.0 100.0 637 66.8 1.7 0.6 20.0 10.0 0.2 0.6 100.0 466 58.7 0.9 0.1 23.4 15.1 0.0 1.7 100.0 361 5.6 3.8 1.9 12.4 1.8 74.2 0.3 100.0 1,637 72.6 8.6 1.2 15.7 0.5 0.4 0.9 100.0 1,198 69.2 7.1 0.9 18.3 3.6 0.2 0.8 100.0 938 75.3 4.6 0.4 15.6 3.1 0.0 1.0 100.0 677 67.0 4.9 1.0 18.7 7.5 0.0 0.9 100.0 537 64.8 2.8 0.7 21.5 9.1 0.0 1.2 100.0 494 66.6 1.4 0.5 18.7 11.5 0.0 1.3 100.0 312 52.8 0.0 0.0 29.7 17.5 0.0 0.0 100.0 115 54.9 3.1 1.0 14.3 3.3 22.6 0.9 100.0 2,279 50.1 6.6 1.2 17.7 4.3 19.5 0.7 100.0 3,628 47.6 6.3 0.9 17.2 4.5 22.7 0.8 100.0 882 56.9 7.8 0.5 13.8 3.0 17.3 0.7 100.0 477 53.7 5.6 1.7 15.3 3.7 19.0 1.1 100.0 461 57.0 5.7 0.4 13.5 7.5 15.3 0.5 100.0 559 52.7 6.9 1.4 21.8 2.3 14.6 0.3 100.0 302 46.4 7.8 1.6 26.4 1.3 15.4 1.1 100.0 321 50.1 4.9 0.8 16.8 3.7 22.5 1.2 100.0 741 44.9 4.5 1.6 17.0 4.7 26.7 0.6 100.0 629 58.9 2.5 1.1 11.6 3.0 22.2 0.7 100.0 1,077 46.9 4.3 1.8 21.3 4.0 21.4 0.4 100.0 457 59.0 7.5 0.6 18.2 9.4 2.8 2.4 100.0 396 57.3 5.8 1.2 18.9 4.6 11.6 0.6 100.0 2,377 45.9 4.6 1.1 14.4 2.6 30.7 0.6 100.0 2,965 65.9 2.3 0.4 11.6 4.7 13.8 1.3 100.0 168 35.2 6.7 1.6 16.7 5.8 33.2 0.9 100.0 3,681 83.5 3.0 0.3 12.1 0.5 0.0 0.7 100.0 1,404 (78.6) (0.0) (0.0) (21.4) (0.0) (0.0) (0.0) 100.0 42 72.6 3.4 0.4 16.5 7.1 0.0 0.0 100.0 113 * * * * * * * 100.0 8 72.8 2.4 0.4 23.2 0.6 0.1 0.4 100.0 660 51.9 5.2 1.1 16.4 3.9 20.7 0.8 100.0 5,907 __________________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted women. An asterisk indicates that a figure is based on fewer than 25 unweighted women and has been suppressed. Proximate Determinants of Fertility * 83 Table 6.8.2 Recent sexual activity: men Percent distribution of men by sexual activity in the four weeks preceding the survey, according to selected background characteristics, Zimbabwe 1999 ________________________________________________________________________ Not Sexually sexually Never active active had Number Background in last in last inter- of characteristic 4 weeks 4 weeks course Total men ________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Marital status Never married In polygynous union In monogamous union Formerly married Residence Urban Rural Education No education Primary Secondary Higher Total 7.7 21.7 70.6 100.0 713 37.5 38.9 23.5 100.0 506 69.2 27.6 3.3 100.0 430 78.4 21.4 0.1 100.0 281 83.4 16.0 0.6 100.0 220 81.1 18.9 0.0 100.0 178 73.6 26.4 0.0 100.0 177 69.6 30.4 0.0 100.0 104 16.8 32.3 51.0 100.0 1,252 93.4 6.6 0.0 100.0 75 83.6 16.4 0.0 100.0 1,164 34.4 65.6 0.0 100.0 118 53.5 27.0 19.5 100.0 1,090 46.7 25.2 28.1 100.0 1,519 55.8 42.6 1.6 100.0 66 54.4 24.8 20.9 100.0 830 44.1 26.9 29.0 100.0 1,556 75.5 16.5 8.1 100.0 157 49.6 26.0 24.5 100.0 2,609 A little more than half (52 percent) of all women interviewed were sexually active in the four weeks preceding the survey, 6 percent were in the period of postpartum abstinence, 20 percent were abstaining for reasons other than recent childbirth, and 21 percent had never had sex. Recent sexual activity is higher among women between the ages of 25 and 44, women married for less than 20 years, women living in the urban areas, women with more than a secondary education, and those using some type of contraception. There are also small provincial variations in sexual activity, ranging from 45 percent among women in Masvingo to 59 percent and 57 percent in Harare and Mashonaland West, respectively. The proportion of women who are postpartum abstaining for less than two years declines at older ages and at longer marital durations. Women in rural areas, those with no education, and those who are not using any form of contraception are much more likely to be postpartum abstaining. Abstinence unrelated to childbirth increases sharply with increasing age and duration of marriage. There are substantial differences among the provinces, ranging from 15 percent in Harare to more than 24 percent in Matabeleland North and South and Bulawayo. 84 * Proximate Determinants of Fertility Table 6.9 Postpartum amenorrhoea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrhoeic, abstaining, and insusceptible, by number of months since birth, and median durations, Zimbabwe 1999_______________________________________________________________ Percentage of births for which the mother is:_________________________________ Number Months Amenor- Insus- of since birth rhoeic Abstaining ceptible births_______________________________________________________________ <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28-29 30-31 32-33 34-35 Total Median Mean Prevalence/ Incidence mean 85.6 86.5 94.9 111 75.3 52.6 83.2 143 74.9 31.0 81.2 100 67.3 20.9 71.6 126 60.2 15.0 65.8 99 52.4 9.6 55.4 109 55.6 11.9 61.3 142 40.4 14.8 48.4 116 46.6 7.9 51.3 144 32.7 9.5 38.6 116 22.6 4.5 24.9 119 15.0 6.3 20.0 125 4.9 7.7 12.6 121 3.0 12.2 14.3 131 2.2 3.6 5.7 112 4.0 2.2 6.2 109 1.0 2.2 3.2 131 3.2 0.0 3.2 105 36.0 16.6 41.3 2,159 12.4 3.2 15.6 NA 13.3 6.3 15.1 NA 12.8 5.9 14.7 NA ______________________________________________________________ NA = Not applicable In general, women with no education are more likely to be abstaining because of a recent birth or for reasons unrelated to childbirth than women who have a formal education. As expected, women using contraception are less likely to be abstaining in the previous 4 weeks than those who are not using. Half of the men interviewed in the survey reported having sex in the four weeks prior to the survey. Men in their 30s and 40s, those who are in polygynous unions, and men with higher than a secondary education are more likely to be sexually active in the recent weeks. 6.9 POSTPARTUM AMENORRHOEA, ABSTINENCE AND INSUSCEPTIBILITY Postpartum amenorrhoea refers to the interval between childbirth and the return of menstruation. During this period, the risk of pregnancy is greatly reduced. How long this protection from conception after childbirth lasts, depends on the length and intensity of breastfeeding and the length of time before the resumption of sexual intercourse. Women who gave birth during the three years prior to the survey were asked about their breastfeeding practices, the duration of amenorrhoea, and sexual abstinence. Women are considered insusceptible if they are not exposed to the risk of pregnancy, either because they are amenorrhoeic or are still abstaining from sex after a birth. The results are presented in Table 6.9. Proximate Determinants of Fertility * 85 Table 6.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea, postpartum absti- nence, and postpartum insusceptibility, by selected background characteristics, Zimbabwe 1999____________________________________________________________ Median duration of postpartum:__________________________ Number Background Amenor- Absti- Insuscep- of characteristic rhoea nence tibility births____________________________________________________________ Age <30 30+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 12.5 2.8 15.3 1,546 11.9 4.6 16.7 614 10.6 2.3 11.6 716 13.2 3.7 15.5 1,443 9.9 3.4 11.6 347 13.5 4.1 15.6 205 7.8 3.5 8.0 185 17.6 3.5 18.3 215 15.6 4.0 17.5 110 13.0 4.1 15.6 133 13.3 2.5 13.8 279 14.8 3.5 15.1 214 11.1 1.7 12.5 347 11.0 3.9 12.2 125 11.0 5.4 17.4 137 14.7 4.0 15.6 936 11.6 2.4 15.5 1,044 (8.2) (0.4) (8.5) 42 12.4 3.2 15.6 2,159 ____________________________________________________________ Note: Medians are based on current status. The period of postpartum amenorrhoea is considerably longer than the period of postpartum abstinence and is therefore the principal determinant of the length of postpartum insusceptibility (to the risk of pregnancy) in Zimbabwe. The median duration of amenorrhoea is 12 months, the duration of abstinence is 3 months, and the period of insusceptibility is 16 months. All women are virtually insusceptible to pregnancy during the first two months after a birth, and both amenorrhoea and abstinence are important factors in their insusceptibility. However, starting from the second month after a birth, the contribution of abstinence to the period of insusceptibility is greatly reduced as more women resume sexual relations. At 12 to 13 months after a birth, more than half (56 percent) of the women are still amenorrhoeic, while only 12 percent are still abstaining. The proportion amenorrhoeic drops sharply from 33 percent at 18-19 months postpartum to 5 percent for 24 to 25 months postpartum. This coincides with the modal age at full weaning for children in Zimbabwe (see Chapter 10). 6.10 MEDIAN DURATION OF POSTPARTUM INSUSCEPTIBILITY BY BACKGROUND CHARACTERISTICS Table 6.10 shows the median durations of postpartum amenorrhoea, abstinence, and insusceptibility by various background characteristics. Postpartum insusceptibility does not vary much by age. Rural women have longer periods of amenorrhoea, sexual abstinence, and insusceptibility than urban women. Mashonaland East and Manicaland have the shortest durations 86 * Proximate Determinants of Fertility Table 6.11 Menopause Percentage of women age 30-49 who are menopausal, Zimbabwe 1999 _________________________________ Percentage Number meno- of Age pausal1 women _________________________________ 30-34 3.4 668 35-39 5.1 637 40-41 6.7 204 42-43 10.0 188 44-45 12.2 178 46-47 25.1 165 48-49 30.9 92 Women 30-49 8.4 2,132 _________________________________ 1 Percentage of all women (denominator) whose last menstrual period occurred six or more months preceding the survey or who report that they are menopausal (numerator). of postpartum amenorrhoea (8 and 10 months, respectively), while Mashonaland West and Matabeleland North have the longest durations (18 and 16 months, respectively). Postpartum absti- nence is shortest in Harare (2 months), compared with the other provinces, which range from 3 to 4 months. Overall, women in Mashonaland East have the shortest period of insusceptibility (8 months), while those in Matabeleland North and Mashonaland West have the longest (18 months). Provincial variations in the duration of insusceptibility closely parallel provincial variations in the length of breastfeeding (see Chapter 10). Postpartum amenorrhoea and abstinence are inversely related to mother’s education. Postpartum amenorrhoea varies from 11 months for women with no education to 15 and 12 months, respectively, for those with only primary and secondary education and 8 months for women with an educational level higher than secondary school. Similarly, abstinence varies from 5 months for women with no education to 4 and 2 months for those with primary and secondary education, respectively. It is almost nil (0.4 months) for those with more than a secondary education. Women with no education have a median period of insusceptibility of 17 months, compared with 16 months for those with primary and secondary education, and 9 months for those with more than a secondary education. 6.11 MENOPAUSE Above age 30, the risk of pregnancy declines with age as increasing proportions of women become infecund. Although the onset of infecundity is difficult to determine for an individual woman, there are ways of estimating it for a population. Table 6.11 presents data on menopause, an indicator of decreasing exposure to the risk of pregnancy for women age 30 years and over. The percentage of women who have reached menopause refers to the proportion of currently married women who are neither pregnant nor postpartum amenorrhoeic and have not had a menstrual period in the six months preceding the survey or who report being menopausal. The table shows that the proportion of menopausal women increases steadily with age, particularly after age 40, from 3 percent among women age 30-34 to 31 percent among women age 48-49. Fertility Preferences * 87 FERTILITY PREFERENCES 7 Information on fertility preferences is of considerable importance to family planning programme planners because it allows an assessment of the need for contraception, whether for birth spacing or for birth limiting, and the extent of unwanted and mistimed pregnancies. Data on fertility preferences can also be useful as an indicator of the direction that future fertility may take. The respondents were asked about whether they wanted more children and, if so, how long they would prefer to wait before the next child, and if they could start afresh, how many children in all they would want. Interpretation of data on fertility preferences has always been the subject of some controversy. Critics consider the data misleading because information gathered from women does not take into account the effect of social pressures or attitudes of other family members, particularly the husband who may exert a major influence on reproductive decisions. Although this argument is correct in principle, its importance is doubtful in practice because evidence from surveys in which both husbands and wives are interviewed suggests that there is no radical difference between the views of the two sexes. 7.1 FERTILITY PREFERENCE BY NUMBER OF LIVING CHILDREN Table 7.1 presents fertility desires among women by number of living children. The table takes the timing desired for the next birth into account in classifying women according to their fertility desires. More than half (53 percent) of married women in Zimbabwe would like to have another child. Among these women, 19 percent want a child within two years and the majority (32 percent) would prefer to wait two or more years before having their next birth. Two-fifths (41 percent) of married women want no more children or have been sterilised. Thus, the majority of women (73 percent) want either to space their next birth or end childbearing altogether (see Figure 7.1). As expected, the desire for more children declines noticeably as the number of living children increases (see Table 7.1). Eighty-five percent of married women with no children want to have a child soon (within two years), whereas only 4 percent of women with six or more children want to have another soon. Among women with three or more children, the desire to limit childbearing predominates with the proportion saying that they do not want another child increasing from 42 percent among women with three children to 77 percent among women with six or more children. Men’s fertility preferences are similar to those of women. The most notable difference is the comparatively high proportion (37 percent) of men with no children who express a desire to delay the first birth for two or more years. 88 * Fertility Preferences Table 7.1 Fertility preferences by number of living children Percent distribution of currently married women and men by desire for more children, according to number of living children, Zimbabwe 1999 ______________________________________________________________________________________________________ Number of living children1 ___________________________________________________________ Desire for children 0 1 2 3 4 5 6+ Total ______________________________________________________________________________________________________ WOMEN ______________________________________________________________________________________________________ Have another soon2 Have another later3 Have another, undecided when Undecided Want no more Sterilised Declared infecund Missing Total Number of women 84.6 25.2 14.4 13.9 8.7 3.8 3.6 18.9 4.1 57.8 44.2 34.4 19.0 10.7 6.3 32.2 2.8 1.8 2.3 1.0 0.5 1.1 0.4 1.4 0.4 4.7 7.8 5.5 5.2 3.8 4.6 5.1 4.2 9.5 29.3 41.7 59.3 71.6 77.3 38.2 0.0 0.3 1.0 3.3 5.0 6.6 6.1 2.7 3.9 0.8 1.0 0.2 2.3 1.8 1.9 1.4 0.0 0.0 0.0 0.0 0.0 0.7 0.0 0.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 261 845 762 544 401 271 524 3,609 ______________________________________________________________________________________________________ MEN ______________________________________________________________________________________________________ Have another soon2 Have another later3 Have another, undecided when Undecided Want no more Sterilised Declared infecund Missing Total Number of men 52.6 23.6 17.1 20.0 18.8 8.0 9.6 20.6 36.6 58.9 48.5 29.0 17.2 21.9 11.5 34.7 4.3 3.0 2.2 4.0 3.1 1.1 2.0 2.8 2.9 2.8 3.7 4.8 7.8 6.0 10.4 5.4 1.4 9.7 28.5 39.9 45.2 53.1 56.5 32.1 0.0 0.6 0.0 0.9 4.0 8.5 3.0 2.0 2.3 1.4 0.0 1.3 3.8 1.4 6.2 2.3 0.0 0.0 0.0 0.0 0.0 0.0 0.9 0.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 129 271 213 153 137 122 214 1,239 ______________________________________________________________________________________________________ 1 Includes current pregnancy 2 Wants next birth within two years 3 Wants to delay next birth for two or more years Fertility Preferences * 89 Table 7.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, according to age, Zimbabwe 1999__________________________________________________________________________________________ Current age______________________________________________________ Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total__________________________________________________________________________________________ Have another soon1 Have another later2 Have another/undecided when Undecided Want no more Sterilised Declared infecund Missing Total Number of women 29.0 23.1 20.0 21.9 13.1 11.2 6.8 18.9 56.2 53.4 41.8 26.8 10.0 4.8 1.4 32.2 3.3 1.5 1.9 1.3 0.2 1.6 0.0 1.4 3.3 5.6 6.6 5.7 5.8 3.6 1.4 5.1 8.2 16.4 28.9 41.9 64.0 66.0 72.7 38.2 0.0 0.0 0.6 1.7 5.4 8.1 9.8 2.7 0.0 0.0 0.2 0.6 1.1 4.7 7.8 1.4 0.0 0.0 0.0 0.0 0.4 0.0 0.0 0.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 314 820 788 543 495 375 272 3,609 __________________________________________________________________________________________ 1 Wants next birth within two years 2 Wants to delay next birth for two or more years Figure 7.1 Fertility Preferences Among Currently Married Women 15-49, Zimbabwe 1999 Want no more 38% Undecided 7% Want child later (after 2 years) 32% Have another soon (within 2 years) 19% Sterilised 3% Declared infecund/Missing 2% ZDHS 1999 7.2 FERTILITY PREFERENCES BY AGE Table 7.2 shows data on fertility desires among women by age. The desire to limit births rises rapidly with age, from 8 percent of married women age 15-19 to 73 percent of those age 45-49 years. Conversely, the desire to space births is predominant among young women and it declines with age. The need for family planning services is therefore greatest among older women for limiting and among younger women for spacing births. 90 * Fertility Preferences Table 7.3 Desire to limit childbearing by background characteristics Percentage of currently married women and men who want no more children by number of living children and selected background characteristics, Zimbabwe 1999____________________________________________________________________________________________ Number of living children1 Background _________________________________________________ characteristic 0 1 2 3 4 5 6+ Total____________________________________________________________________________________________ WOMEN___________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 5.4 12.8 41.1 62.1 80.5 82.1 94.7 43.6 3.3 7.5 21.8 35.7 56.6 76.1 81.2 39.4 0.0 10.0 13.6 16.7 64.0 67.3 77.8 35.0 8.1 9.7 23.7 28.5 59.6 74.9 85.0 38.5 0.0 7.5 33.3 43.9 61.9 87.5 90.0 43.6 5.0 6.6 27.0 37.8 46.6 80.2 85.4 35.4 0.0 7.4 47.5 39.6 55.4 74.8 87.1 46.1 5.5 8.6 44.9 54.5 55.7 79.1 82.4 50.7 5.6 15.2 32.3 56.2 68.4 70.6 80.0 43.1 0.0 5.9 27.5 33.0 51.0 84.4 79.7 40.0 9.1 9.5 35.0 64.0 88.9 80.0 94.1 38.5 0.0 17.1 50.0 69.8 90.0 87.5 94.4 57.6 0.0 15.0 29.7 27.6 58.0 62.6 74.9 53.1 3.9 8.6 25.6 35.1 62.0 76.8 85.1 45.9 3.7 10.1 31.7 54.5 70.2 88.9 92.1 32.8 19.6 10.6 55.2 81.0 100.0 100.0 100.0 43.2 4.2 9.8 30.3 45.0 64.3 78.2 83.3 40.9 ____________________________________________________________________________________________ MEN___________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 2.3 16.3 40.1 50.0 60.5 66.1 60.4 39.5 0.7 5.0 18.3 32.7 39.0 57.1 59.1 29.8 0.0 29.1 21.6 42.6 74.7 67.2 46.9 36.4 0.0 11.7 14.1 33.3 14.4 41.5 52.8 25.3 0.0 0.0 26.0 35.7 59.7 58.1 71.3 29.5 0.0 5.2 16.3 54.0 65.7 86.8 82.7 36.4 0.0 7.7 27.8 46.0 37.5 58.9 66.7 41.4 * 14.6 13.2 55.4 21.7 62.7 71.1 42.5 11.3 3.8 34.6 17.6 39.4 47.0 48.6 28.4 0.0 20.2 25.9 30.0 23.6 55.6 50.3 31.3 0.0 12.8 44.4 42.1 69.2 68.4 55.6 36.4 0.0 3.7 38.9 43.5 81.2 72.7 77.3 42.1 0.0 0.0 19.0 42.5 47.7 32.9 56.5 44.4 3.1 8.6 17.6 32.6 47.7 58.9 63.7 39.3 0.7 9.8 33.0 43.5 48.4 66.4 49.5 28.6 0.0 17.2 34.9 57.9 59.1 83.0 75.2 38.7 1.4 10.3 28.5 40.8 49.3 61.6 59.5 34.1 ____________________________________________________________________________________________ Note: Women and men who have been sterilised are considered to want no more children. An astrisk indicates a figure is based on fewer than 25 cases and has been suppressed.1 Includes current pregnancy 7.3 DESIRE TO LIMIT CHILDBEARING BY BACKGROUND CHARACTERISTICS Table 7.3 shows the percentage of currently married women who want no more children by number of living children and selected background characteristics. A larger proportion of urban women (44 percent) than rural women (39 percent) want to stop childbearing (see Table 7.3 and Figure 7.2). This is observed for all women with different numbers of living children. The results Fertility Preferences * 91 Figure 7.2 Percentage of Currently Married Women 15-49 Who Want No More Children, Zimbabwe 1999 41% 44% 39% 35% 39% 44% 35% 46% 51% 43% 40% 39% 58% 53% 46% 33% 43% ZIMBABWE RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary Higher ZDHS 1999 suggest that urban women are more likely to begin to want to limit their family size at lower parities than rural women. For example, 62 percent of urban women with three children say they do not want another child, compared with 36 percent of rural women with three children. Differentials by province of residence indicate that Bulawayo province has the largest proportion of women who wanted no more children (58 percent), while Manicaland and Mashonaland West provinces show the lowest percentage (35 percent). It is interesting to note that women in Harare, an urban centre, did not show a strong preference for limiting childbearing (39 percent, which is lower than in several other provinces). The percentage wanting no more children is positively associated with the woman’s educational level. Women with a higher education want to begin to limit when they have two children, while among women who never attended school, the majority do not express a desire to limit until they have four children. Men present a similar pattern; rural men and men with no education are less likely to want to stop having children than other men. Matabeleland South has the largest proportion of men who want no more children (43 percent), while Mashonaland Central shows the lowest percentage (25 percent). 92 * Fertility Preferences 7.4 NEED FOR FAMILY PLANNING The proportion of women who want to stop childbearing or who want to space their next birth is a crude measure of the extent of need for family planning, since not all of these women are exposed to the risk of pregnancy and some of them may already be using contraception. This section presents a more refined measure of need for family planning. Women who are currently married and who say that they either do not want any more children or that they want to wait two or more years before having another child but are not using contraception are considered to have an unmet need for family planning. Women who are using family planning methods are said to have a met need for family planning. Women with unmet need and met need together constitute the total demand for family planning. Table 7.4 and Figure 7.3 present data on unmet need, met need, and total demand for family planning. These indicators help to evaluate the extent to which the family planning programme in Zimbabwe is meeting the demand for services. Thirteen percent of married women have an unmet need for family planning services (7 percent for spacing and 6 percent for limiting births). Combined with the 54 percent of married women who are currently using a contraceptive method, the total demand for family planning comprises two-thirds of married women in Zimbabwe. At present, about four-fifths of the potential demand for family planning is being met. Thus, if all married women who say they want to space or limit their children were to use family planning methods, the contraceptive prevalence rate could be increased from 54 percent to 68 percent. As expected, unmet need for spacing is higher among younger women, while unmet need for limiting childbearing is higher among older women. There is a striking difference in unmet need between urban and rural areas, with urban areas at 8 percent and rural areas at 16 percent. Among the provinces, Matabeleland South has the highest unmet need (22 percent) and Harare has the lowest (6 percent) (see Figure 7.3). Unmet need in other provinces ranges between 11 percent and 16 percent. Unmet need is negatively associated with the woman’s education; it is lower among women with at least some secondary schooling (10 percent or less) than among less-educated or uneducated women (16 percent, each). The need for family planning services for all women and unmarried women are presented at the bottom of Table 7.4. The low level of unmet need among unmarried women is due to the fact that many are younger women who have not yet started their families. Fertility Preferences * 93 Table 7.4 Need for family planning Percentage of all women, currently married women, and unmarried women with unmet need for family planning, and with met need for family planning, and the total demand for family planning, by selected background characteristics, Zimbabwe 1999 ____________________________________________________________________________________________________________ Met need for Unmet need for family planning Total demand for Percentage family planning1 (currently using)2 family planning3 of ______________________ ______________________ _____________________ demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fied women ___________________________________________________________________________________________________________ Respondent’s age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total women currently married Total women not currently married All women 11.1 1.3 12.4 38.6 3.5 42.1 50.5 4.8 55.3 77.6 314 9.5 1.4 10.9 46.0 7.7 53.7 57.6 10.0 67.6 83.8 820 8.3 2.8 11.1 40.8 20.1 60.9 50.8 23.2 74.0 85.0 788 6.2 4.6 10.8 29.2 29.0 58.2 36.4 34.0 70.4 84.7 543 6.1 11.5 17.6 12.5 44.3 56.8 19.6 56.5 76.1 76.9 495 5.1 12.0 17.1 5.3 41.1 46.4 10.4 53.4 63.8 73.1 375 1.4 13.6 14.9 0.3 39.1 39.4 2.4 52.8 55.2 72.9 272 4.1 3.8 7.9 33.8 29.2 63.1 39.8 33.6 73.4 89.3 1,306 9.2 6.6 15.8 26.9 21.2 48.1 37.0 28.2 65.2 75.8 2,303 8.7 7.5 16.2 23.7 17.3 40.9 33.3 25.3 58.6 72.4 561 9.1 5.8 14.8 31.7 21.6 53.3 41.0 27.7 68.7 78.4 325 8.3 5.8 14.1 30.1 27.2 57.4 38.8 33.3 72.1 80.4 310 7.4 3.8 11.2 35.2 22.3 57.5 44.2 26.1 70.3 84.1 367 7.7 7.8 15.5 24.2 24.1 48.3 33.0 32.6 65.6 76.4 180 11.2 10.3 21.5 19.0 22.6 41.6 30.9 33.9 64.7 66.7 170 8.0 5.9 13.9 24.6 25.1 49.7 34.4 31.1 65.6 78.9 444 7.9 5.6 13.6 31.1 24.5 55.5 39.3 30.4 69.6 80.5 367 2.9 3.4 6.3 37.6 25.9 63.5 43.4 30.2 73.6 91.4 667 7.8 3.5 11.2 24.2 37.8 62.0 32.6 41.8 74.4 84.9 217 7.1 8.9 16.1 13.6 27.2 40.8 22.3 36.8 59.1 72.8 310 8.5 7.6 16.1 23.5 25.3 48.8 32.9 33.5 66.4 75.8 1,665 6.5 2.9 9.5 38.6 21.6 60.2 46.8 24.9 71.6 86.8 1,523 1.7 2.1 3.8 36.7 32.3 69.0 38.4 35.1 73.6 94.8 111 7.3 5.6 12.9 29.4 24.1 53.5 38.0 30.2 68.2 81.0 3,609 1.0 1.1 2.1 6.1 6.7 12.8 7.6 7.8 15.5 86.4 2,298 4.9 3.8 8.7 20.3 17.3 37.7 26.2 21.5 47.7 81.7 5,907 ___________________________________________________________________________________________________________ 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and say they want to wait two or more years for their next birth. Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Pregnant and amenorrhoeic women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need (they need a better method of contraception), but are included in total demand for contraception (since they would have been using had their method not failed). 94 * Fertility Preferences Figure 7.3 Percentage of Currently Married Women With Unmet Need and Met Need for Family Planning Services, Zimbabwe 1999 66% 71% 64% 57% 68% 72% 69% 64% 63% 64% 69% 70% 73% 57% 65% 70% 73% ZIMBABWE RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary Higher Unmet need Met need ZDHS 1999 7.5 IDEAL NUMBER OF CHILDREN This section focuses on the respondent’s ideal number of children, implicitly taking into account the number of children that she already has. The respondent, regardless of her marital status, was asked to mention the number of children she would choose if she could start afresh. Women who had no children were asked, “If you could choose exactly the number of children to have in your whole life, how many would that be?” For women who had children, the question was rephrased as follows: “If you could go back to the time when you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” The data in the top portion of Table 7.5 indicate that the majority of women were able to give a numeric answer to this hypothetical question. Only 2 percent gave a non-numeric answer such as “it is up to God,” “any number” or “does not know.” Table 7.5 shows that the ideal number of children is 3.9 among all women and 4.3 among married women, regardless of the actual number of surviving children. Seventy-one percent of women in Zimbabwe would like to have four or fewer children, while 27 percent would like to have more than four children. In interpreting findings in Table 7.5, it is important to remember that the actual and ideal number of children tend to be related. There are several reasons for this. First, to the extent that women are able to implement their fertility desires, women who want large families would achieve large families. Second, since women with large families are on average older women, they may prefer a greater number of children because of the attitudes towards childbearing to which they were exposed to during the early stages of their reproductive lives. Last, some women may have difficulty admitting that they would have fewer children than they currently have if they could begin childbearing again. Such women are likely to report their actual number of children as their preferred number. Indeed, women who have fewer children do report a smaller ideal number of Fertility Preferences * 95 Table 7.5 Ideal and actual number of children Percent distribution of all women and men by ideal number of children and mean ideal number of children for all women and men and for currently married women and men, according to number of living children, Zimbabwe 1999__________________________________________________________________________________________ Number of living children1 Ideal number ___________________________________________________ of children 0 1 2 3 4 5 6+ Total__________________________________________________________________________________________ WOMEN__________________________________________________________________________________________ 0 1 2 3 4 5 6+ Non-numeric response Total Number of women Mean ideal number for:2 All women Number of women Currently married women Number of women 1.3 0.3 0.4 0.5 0.4 0.0 0.5 0.6 3.3 5.8 1.0 1.5 1.1 0.9 0.5 2.6 33.2 28.1 22.3 8.8 9.0 7.4 4.0 21.4 21.8 22.5 15.6 17.1 5.9 5.6 4.1 16.5 24.6 29.1 42.0 36.1 37.8 25.4 19.3 30.1 7.8 7.4 7.7 12.7 11.2 24.0 7.8 9.4 6.0 6.0 9.7 21.7 32.3 32.6 57.0 17.1 2.1 0.8 1.4 1.6 2.4 4.2 6.8 2.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,722 1,190 932 660 478 320 604 5,907 3.2 3.3 3.7 4.3 4.7 5.0 6.1 3.9 1,687 1,181 919 649 467 307 563 5,774 3.5 3.4 3.7 4.3 4.7 5.0 6.2 4.3 255 839 752 535 392 259 488 3,520 __________________________________________________________________________________________ MEN__________________________________________________________________________________________ 0 1 2 3 4 5 6+ Non-numeric response Total Number of men Mean ideal number for:2 All men Total men Mean ideal number for: Currently married men Number of men Monogamous men Number of men Polygynous men Number of men 0.1 0.0 0.8 0.0 0.0 0.0 0.0 0.1 1.6 4.2 0.4 1.1 0.6 1.5 0.7 1.6 19.7 19.2 15.7 9.1 8.4 9.7 8.0 16.5 28.5 33.3 25.8 26.9 10.4 6.0 2.7 24.4 27.1 27.1 40.0 25.7 33.9 15.4 16.4 27.1 13.7 9.8 10.1 22.3 20.7 24.3 11.0 14.1 7.9 5.0 6.7 11.9 25.1 42.8 58.0 14.7 1.4 1.4 0.6 2.9 0.9 0.3 3.1 1.5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,380 323 240 165 147 129 224 2,609 3.6 3.4 3.7 4.2 4.6 5.5 7.1 4.1 1,360 319 239 160 145 129 217 2,570 3.6 3.4 3.7 4.2 4.6 5.4 7.2 4.5 125 267 211 150 136 122 206 1,218 3.7 3.3 3.7 4.0 4.6 5.3 6.5 4.3 114 249 200 140 126 112 165 1,106 3.1 4.6 3.8 6.9 4.8 5.6 9.9 6.6 11 18 12 11 10 9 42 112 __________________________________________________________________________________________ 1 Includes current pregnancy 2 Means are calculated excluding the women and men giving non-numeric responses. 96 * Fertility Preferences Table 7.6.1 Mean ideal number of children by background characteristics: women Mean ideal number of children for all women, by age and selected background characteristics, Zimbabwe 1999 __________________________________________________________________________________________ Current age Background _____________________________________________________ Total characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 women __________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total women 2.6 2.8 3.2 3.5 4.2 4.2 4.8 3.2 3.6 3.8 4.2 4.6 5.2 5.7 6.1 4.4 3.6 4.2 4.7 4.6 5.6 6.3 6.1 4.7 3.5 3.7 4.0 4.6 5.2 6.3 6.6 4.4 3.4 3.7 4.1 4.3 5.0 4.9 5.7 4.1 3.1 3.4 3.8 4.6 4.8 4.8 5.6 4.0 2.9 3.3 3.7 4.6 4.7 5.5 6.0 3.9 3.2 3.3 3.4 4.4 4.4 5.2 5.7 3.8 3.3 3.4 3.8 4.2 4.7 5.6 6.1 4.0 3.8 3.6 4.2 4.6 5.3 5.6 5.9 4.4 2.6 2.7 3.1 3.2 4.2 4.0 4.8 3.1 2.6 2.8 3.0 3.5 4.0 4.1 4.3 3.2 3.2 4.1 5.6 5.0 5.5 6.5 6.5 5.7 3.7 3.9 4.3 4.9 5.1 5.2 5.8 4.6 3.1 3.0 3.4 3.7 3.9 4.6 4.5 3.3 2.0 2.5 2.6 2.8 3.3 2.9 3.0 2.8 3.2 3.3 3.8 4.1 4.9 5.3 5.7 3.9 children than women with more children. The average ideal family size is 3.3 for women with one child, compared with 6.1 among women with six or more children. In general, men want a larger family than women do. In terms of the mean ideal number of children, men want 4.1, compared with 3.9 reported by women. The relationship between the actual and ideal number of children is again observed; men who have fewer children report a smaller ideal number of children than men with more children. For example, the average ideal family size is 3.4 for men with one child, compared with 7.1 for men with six or more children. Interestingly, polygynous men want a much larger family than monogamous men (6.6 children and 4.3 children, respectively). 7.6 MEAN IDEAL NUMBER OF CHILDREN BY BACKGROUND CHARACTERISTICS Presented in Table 7.6.1 is the ideal number of children by age and by background characteristics of all women. Data in the table shows that younger, better-educated, and urban women are more likely to have lower long-term fertility goals. The mean ideal number of children increases with age, from 3.2 among women age 15-19 to 5.7 among women age 45-49. At every Fertility Preferences * 97 Table 7.6.2 Mean ideal number of children by background characteristics: men Mean ideal number of children for all men, by age and selected background characteristics, Zimbabwe 1999 ____________________________________________________________________________________________________ Current age Background _____________________________________________________ Total characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ men ____________________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total men 3.2 3.2 3.2 3.4 3.9 4.5 4.5 4.8 3.5 4.0 3.8 3.8 4.3 4.9 6.6 6.2 7.1 4.5 4.3 3.7 3.6 4.7 5.5 8.8 5.2 7.6 4.6 3.5 3.8 3.8 4.9 4.8 6.8 5.6 9.7 4.6 3.7 3.9 3.9 3.7 4.5 4.9 6.7 6.1 4.2 3.8 3.8 3.2 3.3 3.9 5.5 6.6 5.8 4.0 3.7 3.7 3.5 3.9 4.3 6.3 5.0 5.2 4.1 3.4 3.8 3.5 4.0 3.4 4.2 4.2 3.8 3.7 3.7 3.3 3.7 3.2 5.3 4.2 6.7 7.6 4.1 4.4 3.5 4.0 4.8 4.7 6.2 5.5 6.6 4.7 3.3 3.3 3.3 3.4 3.5 4.7 4.6 4.8 3.5 3.4 3.1 3.2 4.0 4.3 4.7 4.3 4.5 3.6 6.0 5.2 2.9 4.5 5.3 6.3 9.4 5.4 6.3 4.1 3.8 4.3 4.7 4.8 6.8 5.1 6.9 4.8 3.6 3.4 3.3 3.8 4.2 4.5 5.2 5.4 3.7 2.0 2.8 3.2 3.6 3.0 4.2 3.3 5.8 3.4 3.8 3.5 3.5 3.9 4.4 5.8 5.4 6.3 4.1 age group, rural women have higher family size norms than urban women. This is further reflected in the fact that women in Harare and Bulawayo have the smallest ideal family size norms (3.1 and 3.2 children, respectively). The ideal number of children for women in most provinces was between 3.8 and 4.7 children. Differentials in the ideal number of children among men are presented in Table 7.6.2. As with women, younger, better-educated, and urban men are more likely to have lower long-term fertility goals. Men in Masvingo, Manicaland, and Mashonaland Central tend to want a large family (4.6 or more children), while those in Harare, Bulawayo, and Matabebeland South want 3.7 or fewer children. 7.7 FERTILITY PLANNING STATUS The issue of unplanned and unwanted fertility was further investigated in the 1999 ZDHS by asking women who had births during the five years before the survey whether the births were planned (i.e., wanted at the time), mistimed (i.e., wanted but not at the time), or not wanted at all. The responses to those questions provide a measure of the degree to which Zimbabwean couples have been successful in controlling childbearing. In addition, the information can be used to estimate the effect on period fertility if unwanted pregnancies had been prevented. 98 * Fertility Preferences Table 7.7 Fertility planning status Percent distribution of births (including current pregnancy) in the five years preceding the survey by fertility planning status, according to birth order and mother’s age at birth, Zimbabwe 1999_______________________________________________________________________ Planning status of birth Birth order _________________________ Number and mother’s Wanted Wanted Not of age at birth then later wanted Missing Total births_______________________________________________________________________ Birth order 1 2 3 4+ Age at birth <20 20-24 25-29 30-34 35-39 40-44 45-49 Total 67.1 29.8 2.9 0.2 100.0 1,287 67.3 28.6 3.7 0.4 100.0 934 65.0 29.7 5.3 0.0 100.0 610 52.1 32.0 15.6 0.3 100.0 1,188 59.0 37.4 3.4 0.1 100.0 812 65.3 30.5 3.6 0.6 100.0 1,319 67.4 27.6 5.0 0.0 100.0 871 66.1 26.4 7.5 0.0 100.0 537 49.0 29.7 20.9 0.4 100.0 349 42.6 15.6 41.8 0.0 100.0 113 * * * * 100.0 17 62.4 30.2 7.2 0.2 100.0 4,019 _______________________________________________________________________ Note: Includes current pregnancy; an asterisk indicates that a figure is based on fewer than 25 unweighted births and has been suppressed. The questions on the planning status of recent births required the female respondent to recall accurately her wishes at one or more points in the past five years and report them honestly. These questions are open to several errors. A woman may not remember accurately how she felt about a particular pregnancy. She also may not be willing to admit that she had not wanted a child at its conception. Conversely, if the child has become an economic or health burden, she may now claim that it was unwanted. Despite these potential problems of comprehension, recall and truthfulness, results from previous surveys have yielded plausible responses, with the most probable effect of biases in the answers being a net underestimation of the level of unwanted fertility. Table 7.7 shows the distribution of births in the five years before the survey by whether a birth was wanted then, wanted later, or not wanted. Overall, 62 percent of all births were wanted at the time of conception, 30 percent were reported as mistimed (wanted later), and 7 percent of recent births were reported to be unwanted. The percentage of births that was mistimed or unwanted goes up with birth order from 33 percent of first births to 48 percent of fourth and higher order births. Similarly, a much larger proportion of births to older women are unwanted than are those to younger women. Whereas about 4 percent of births to women under age 25 are unwanted, slightly more than two-fifths of births to women 40 and older are unwanted. 7.8 WANTED FERTILITY RATES Using information on whether births occurring in the five years before the survey were wanted or not, a total “wanted” fertility rate has been calculated. This measure is calculated in the same manner as the conventional total fertility rate, except that unwanted births are excluded from the numerator. A birth is considered as wanted if the number of living children at the time of conception was less than the current ideal number of children as reported by the respondent. Wanted fertility rates express the level of fertility that theoretically would result if all unwanted births were prevented. Fertility Preferences * 99 Table 7.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the five years preceding the survey, by selected background characteristics, Zimbabwe 1999_____________________________________________ Total wanted Total Background fertility fertility characteristic rates rates_____________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother’s education No education Primary Secondary Higher Total 2.6 3.0 3.8 4.6 4.0 4.7 4.2 4.9 3.6 4.2 3.5 4.1 3.2 4.1 3.7 4.8 3.5 4.0 3.4 3.9 2.6 3.0 2.6 3.0 4.6 5.2 3.8 4.5 3.0 3.4 1.7 1.9 3.4 4.0 _____________________________________________ Note: Rates are calculated based on births to women age 15-49 in the period 1-59 months preceding the survey. The total fertility rates are those presented in Table 3.2. Comparison of the actual fertility rate with the wanted rate indicates the potential demographic impact of eliminating unwanted births. This indicator is highly relevant for a country such as Zimbabwe, that currently has an official policy to reduce the birth rate and thus the rate of population growth. Table 7.8 shows that the wanted fertility rate for the three years preceding the survey was 3.4 children, compared with the actual average of 4 children. In other words, Zimbabwean women are currently having an average of 0.6 children more than they actually want. The table also shows that regardless of place of residence and level of education, the wanted fertility rate is lower than the total fertility rate. Women in Matabeleland South have the largest gap of slightly more than one child. Women in this province would have four rather than five children if unwanted births were prevented. Women with higher levels of education seem to be the most successful in achieving their fertility goal. Early Childhood Mortality * 101 EARLY CHILDHOOD MORTALITY 8 8.1 BACKGROUND AND ASSESSMENT OF DATA QUALITY In 1999, Zimbabwe was home for 1.7 million children under age five. Every year, about 400,000 babies are born in Zimbabwe; many do not survive to reach their first birthday. This chapter presents information on levels, trends and differentials in neonatal, postneonatal, infant, and child mortality. This information is important to both the demographic assessment of the population and the evaluation of health policies and programmes. Estimates of infant and child mortality may be used as inputs into population projections, particularly if the level of adult mortality is known from another source or can be inferred with reasonable confidence. Information on the mortality of children also serves the needs of agencies providing health services by identifying sectors of the population that are at high mortality risk. The rates of childhood mortality presented here are defined as follows: • Neonatal mortality (NN): the probability of dying within the first month of life, • Postneonatal mortality (PNN): the arithmetic difference between infant and neonatal mortality • Infant mortality (1q0): the probability of dying between birth and the first birthday • Child mortality (4q1): the probability of dying between exact age one and the fifth birthday • Under-five mortality (5q0): the probability of dying between birth and the fifth birthday. All rates are expressed as deaths per 1,000 live births, except child mortality, which is expressed as deaths per 1,000 children surviving to the first birthday. Information drawn from the questions asked in the birth history section of the women’s questionnaire is used to calculate the mortality rates presented in this chapter. First, the respondents are asked a series of questions about their childbearing experience. In particular, they are asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died. In the birth history, for each live birth, information is collected on sex, month and year of birth, survivorship status and current age, and age at death if the child died. The quality of mortality estimates calculated from retrospective birth histories depends on the mother’s ability to recall all of the children she had given birth to, as well as their birth dates and age at death. The most potentially serious data quality problem is the selective omission of births that did not survive from the birth histories, which will lead to underestimation of mortality rates. Other potential problems include displacement of birth dates, which may cause a distortion of mortality trends, and misreporting of age at death, which may distort the age-pattern of mortality. 102 * Early Childhood Mortality Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality for five-year periods preceding the survey, Zimbabwe 1999 __________________________________________________________________ Years Neonatal Postneonatal Infant Child Under-five preceding mortality mortality1 mortality mortality mortality the survey (NN) (PNN) (1q0) (4q1) (5q0)__________________________________________________________________ 0-4 28.9 36.2 65.0 39.6 102.1 5-9 23.3 30.6 53.8 24.4 76.9 10-14 19.3 20.5 39.8 20.0 59.0 ________________________________________________________________ 1 Computed as the difference between the infant and the neonatal mortality rates. Inspection of the data quality indicates that there is no evidence of selective underreporting or misreporting of age at death. First, the number of early infant deaths that have been omitted is insignificant, the proportion of neonatal deaths that occur in the first week of life is roughly constant over the 15 years before the survey (between 70 and 78 percent) and the proportion of infant deaths that occur during the first month of life is plausible (47 percent) and is constant over the 15 years preceding the survey (varying between 44 and 47 percent) (see Appendix C). It is also important to note that any method of measuring childhood mortality that relies on mothers’ reports (e.g., birth histories) rests on the assumption that female adult mortality is not high, or if it is high, that there is little or no correlation between the mortality risks of mothers and their children. In countries with high rates of female adult mortality, these assumptions may not hold and the resulting childhood mortality rates will be understated to some degree. 8.2 INFANT AND CHILD MORTALITY Table 8.1 presents childhood mortality rates for three five-year periods before the survey. The data show that under-five mortality is 102 per 1,000 live births, which means that one in ten children born in the past five years did not live to their fifth birthday. Two in three of these deaths occurred before age one. During the same period, the deaths in each of the three relevant age segments are 29 per 1,000 for neonatal mortality (<1 month), 36 per 1,000 for postneonatal mortality (1-11 months), and 40 per 1,000 for child mortality (1-4 years). The 1999 ZDHS data indicate that survival at all ages below five years had not improved from the period 1985-1989 to the period 1995-1999. To evaluate the quality of estimates on levels and trends in childhood mortality, estimates based on retrospective data from the present survey are compared with previously collected data of the same type. Figure 8.1 shows trends in infant and under-five mortality based on data from the 1988, 1994 and 1999 ZDHS surveys. The consistency between the data from the three surveys is remarkable. From the 1988 survey, infant mortality was estimated at 53 per 1,000 and under-five mortality at 75 per 1,000 for the 1984-1988 period, which are nearly identical to rates for the comparable calendar period from the 1994 survey. From the 1999 survey, infant mortality was estimated at 54 per 1,000 and under-five mortality at 77 per 1,000 for the 1989-94 period, which are nearly identical to rates for the comparable calendar period from Early Childhood Mortality * 103 Figure 8.1 Trends in Infant and Under-Five Mortality 1988, 1994, and 1999 - - -# # # * **) ) ) , ,, $ $ $ 1975 1980 1985 1990 1995 2000 Calendar Year 0 20 40 60 80 100 120 Deaths per 1,000 Live Births 1988 ZDHS 1994 ZDHS 1988 ZDHS 1994 ZDHS 1999 ZDHS 1999 ZDHS $ , ) * # - Under-five Mortality Infant Mortality ZDHS 1999 the 1994 survey. Furthermore, all surveys identify a drop of almost equal magnitude in infant and child mortality during the 1980s and an increase during the 1990s. Thus, there is clear indication of falling rates of early childhood mortality in Zimbabwe up until the late 1980s, after which there is a decline in child survival prospects. Three possible explanations have been cited for the recent increase in childhood mortality rates (CSO and MI, 1995). They include the worsening of Zimbabwe’s economic condition and the direct and indirect impact of the AIDS epidemic. Furthermore, to achieve significant health improvement, it was suggested that programmes need to address the underlying causes of poor health, such as poverty. In the five years since 1994, the economy of the country has declined dramatically, which may have altered household decisions on the use of health services facilities even more. 8.3 SOCIOECONOMIC DIFFERENTIALS IN EARLY CHILDHOOD MORTALITY Table 8.2 shows differentials in infant and child mortality by residence, mother’s level of education and type of antenatal care and delivery assistance. The mortality estimates are calculated for a ten-year period before the survey so that the rates are based on a sufficient number of cases in each category to ensure statistically reliable estimates. Survival rates are much higher in urban than in rural areas. For example, the infant mortality rate is 47 in urban areas, compared with 65 deaths per 1,000 live births in rural areas (see Figure 8.2). There is substantial variation between provinces. For infant mortality, the rate in Mashonaland Central is twice as high as in Matabeleland North (87 deaths per 1,000 live births compared with 39). It is interesting to note that Harare and Bulawayo, being the most urbanised areas in the country, do not necessarily exhibit the best mortality condition. 104 * Early Childhood Mortality Table 8.2 Early childhood mortality by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality for the ten-year period preceding the survey, by selected socioeconomic characteristics, Zimbabwe 1999 __________________________________________________________________________ Post- Neonatal neonatal Infant Child Under-five Socioeconomic mortality mortality1 mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0)__________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary More than secondary Medical maternity care2 No antenatal or delivery care Either antenatal or delivery care Both antenatal and delivery care Total 21.8 25.4 47.2 22.8 69.0 28.2 37.2 65.3 36.7 99.7 34.3 41.3 75.6 54.4 125.8 37.6 49.0 86.6 27.2 111.4 30.3 33.4 63.7 39.2 100.4 20.9 31.8 52.7 36.4 87.1 (17.4) 21.5 38.8 19.2 57.3 (25.3) 22.8 48.1 21.9 69.0 34.5 35.2 69.7 29.9 97.6 11.5 35.7 47.2 23.0 69.1 17.9 26.6 44.5 27.4 70.7 26.3 20.3 46.6 20.6 66.2 42.9 38.2 81.1 41.0 118.8 28.6 32.1 60.6 35.4 93.9 20.3 35.3 55.6 27.6 81.7 * * * * 21.3 (64.2) 61.5 125.7 NA NA 36.0 38.5 74.6 NA NA 17.7 29.3 47.0 NA NA 26.2 33.5 59.7 32.5 90.3 ______________________________________________________________________________ Note: Rates in parentheses are based on 250 to 499 exposed persons. Rates based on fewer than 250 exposed persons are not shown (*). NA = Not applicable 1 Computed as the difference between the infant and the neonatal mortality rates 2 Rates for the five-year period before the survey. Medical care is that given by a doctor, nurse, trained midwife, or received in a hospital, clinic, health center, or health post. There is a strong negative association between a mother’s level of education and children’s survival; whereas the children of uneducated mothers experience an under-five mortality rate of 119 per 1,000, that of children of women with higher than a secondary education is only 21 per 1,000. This education-survival relationship is detected at all ages under five years. Better-educated mothers are likely to have greater knowledge of nutrition, hygiene, and other practices related to child care and are more likely to use health services. Maternal care during pregnancy and delivery plays a significant role in the health of both mother and child and thus in the risk of early childhood mortality. The 1999 ZDHS data show that children born in the five-year period preceding the survey to women who obtained both antenatal Early Childhood Mortality * 105 Figure 8.2 Infant Mortality by Background Characteristics, Zimbabwe 1999 65 47 65 76 87 64 53 39 48 70 47 45 47 81 61 56 ZIMBABWE RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary Deaths per 1,000 Live Births ZDHS 1999 Note: Rates are for the 10-year period preceding the survey except the rate for all Zimabwe (5-year period). and delivery care from medically trained persons are less than half as likely to die during infancy as children whose mothers received neither. Having either antenatal or delivery care decreases the mortality risks significantly. 8.4 BIODEMOGRAPHIC DIFFERENTIALS IN EARLY CHILDHOOD MORTALITY The relationship between early childhood mortality and various demographic variables is examined in Table 8.3. In general, male children experience slightly higher mortality than their female counterparts. Infant mortality for males and females is 63 and 56 deaths per 1,000 births, respectively, while under-five mortality rates for males and females are 95 and 85 deaths, respectively. The relationship between childhood mortality and mother’s age at birth shows the expected U-shaped pattern at all ages under five years; with children of the youngest and the oldest women experiencing the highest risk of death. A similar, but less pronounced, pattern occurs for birth order. Generally, first-order births and very high-order births (seventh or more) have higher mortality rates than births of orders two through six. Data from the 1994 ZDHS show the same patterns. Studies have found that a longer birth interval increases a child’s chance of survival. Data from the 1999 ZDHS support this theory; children born less than two years after a preceding sibling are more than twice as likely to die in infancy as those born two to three years after a preceding sibling (112 compared with 44 per 1,000). This link between the pace of childbearing and child survival rates is observed in all age groups. These findings point out the potential for mortality reduction that could result from successful efforts to promote birth spacing in Zimbabwe. 106 * Early Childhood Mortality Table 8.3 Early childhood mortality by biodemographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality for the ten-year period preceding the survey, by selected biodemographic characteristics, Zimbabwe 1999______________________________________________________________________________________ Post- Neonatal neonatal Infant Child Under-five Biodemographic mortality mortality1 mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0)______________________________________________________________________________________ Sex of child Male Female Mother's age at birth < 20 20-29 30-39 40-49 Birth order 1 2-3 4-6 7+ Previous birth interval < 2 years 2-3 years 4 or more years Birth size2 Small and very small Average or larger Don't know 28.3 34.8 63.1 34.5 95.4 24.1 32.2 56.2 30.5 85.0 34.5 31.6 66.1 33.0 97.0 24.9 33.3 58.2 33.9 90.1 21.2 32.6 53.9 27.9 80.3 * 57.0 89.1 (43.7) (128.9) 30.6 35.0 65.5 25.1 89.0 22.4 30.9 53.3 34.1 85.6 26.4 28.8 55.1 36.5 89.6 26.1 48.2 74.3 38.1 109.6 53.7 58.1 111.8 48.7 155.1 17.7 26.4 44.1 37.1 79.6 21.2 32.7 53.9 25.0 77.6 64.1 54.7 118.8 NA NA 20.5 31.4 51.9 NA NA 162.2 160.2 322.4 NA NA ______________________________________________________________________________________ Note: Rates based on 250 to 499 exposed persons are in parentheses. Rates based on fewer than 250 exposed persons are not shown (*). NA = Not applicable 1 Computed as the difference between the infant and the neonatal mortality rates. 2 Rates for the five-year period before the survey. A child’s size at birth is an important indicator of the risk of dying during infancy, particularly during the first months of life. In the 1999 ZDHS, in addition to recording the actual birth weight, interviewers asked mothers whether the reference child was very small, small, average size, large, or very large at birth. This type of subjective assessment has been shown to correlate closely with actual birth weight. Newborns perceived by their mothers to be very small or small are twice as likely to die in the first year than those perceived as average or larger in size. As expected, the differential is especially large during the neonatal period. 8.5 PERINATAL MORTALITY Table 8.4 presents the level of mortality at the earliest stage of life. The distinction between a stillbirth and an early neonatal death (deaths in the first week after birth) is recognised as a fine one. Furthermore, the causes of stillbirths and early neonatal deaths are closely linked, and examining one in isolation from the other can understate the true level of mortality around delivery. For this reason, deaths around delivery are combined into the perinatal mortality rate. Information on stillbirths is available for the five years preceding the survey and is collected using the calendar at the end of the women’s questionnaire. Early Childhood Mortality * 107 Table 8.4 Perinatal mortality Stillbirths, early neonatal deaths and perinatal mortality rate by selected background characteristics for the ten-year period preceding the survey, Zimbabwe 1999____________________________________________________________________________________________________ Number of pregnancies of 7 or more Background Number of Number of early Perinatal months duration characteristic stillbirths1 neonatal deaths2 mortality rate3 in the last 10 years____________________________________________________________________________________________________ Mother's age at birth <20 20-29 30-39 40-49 Previous pregnancy interval <15 months 15-26 months 27-38 months 39+ months Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher Total 8 23 42.7 739 34 37 37.1 1,936 6 20 33.9 761 4 3 65.3 118 4 13 55.1 304 14 16 44.5 681 8 4 19.4 599 12 18 35.7 831 21 26 40.5 1,164 32 58 37.6 2,390 8 18 44.3 568 3 12 44.2 335 4 9 41.2 314 4 4 23.2 347 0 4 19.8 183 3 6 40.8 221 8 13 45.2 454 5 2 18.3 359 13 12 44.4 562 5 6 53.4 211 1 10 44.2 248 30 41 44.3 1,601 22 32 33.1 1,632 0 1 13.3 73 53 84 38.5 3,554 ____________________________________________________________________________________________________ 1 Stillbirths are fetal deaths to pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths to live-born children at days 0 to 7 since birth. 3 Perinatal mortality rate is the sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months of duration. Table 8.4 indicates that the perinatal mortality rate for the country as a whole is 39 deaths per 1,000 pregnancies. The differentials in perinatal mortality across selected background characteristics of the mothers are similar to those in neonatal mortality. The rate increases with shorter pregnancy intervals and declines with women’s education. However, unlike neonatal mortality, perinatal mortality is not lower in urban areas or provinces with urban characteristics (Harare and Bulawayo). 108 * Early Childhood Mortality 8.6 HIGH-RISK FERTILITY BEHAVIOUR Typically, infants and young children have a higher risk of dying if they are born to very young mothers or older mothers, if they are born after a short interval, or if their mothers have already had many children. In the following analysis, mothers are classified as too young if they are less than 18 years old at the time of the birth, and too old if they are age 35 years or more at the time of the birth. A short birth interval is defined as less than 24 months, and a high-order birth is defined as occurring after four or more previous births (i.e., birth order 5 or higher). A birth may be at an elevated risk of dying due to a combination of characteristics. The first column of Table 8.5 shows the percentage of births in the five years before the survey classified by various risk categories. Overall, 42 percent of births are in at least one high-risk category: 28 percent are in a single high-risk category, and 14 percent have multiple high-risk characteristics. The second column shows the risk ratios, which are calculated as the ratio of the proportion in a category who have died to the proportion in the reference category who have died. Births in the reference category are those who do not fall into any high-risk category (risk ratio equals 1.00). The primary factor leading to heightened mortality risk in Zimbabwe is short birth interval, as a single (1.71) or multiple high-risk factor, followed by high birth order (1.34). However, since the largest percentage of high-risk births in Zimbabwe are of high birth order (16 percent), this operates to reduce the associated risk ratios in the overall single high-risk category (1.3) and the overall multiple high-risk category (1.6). The third column of Table 8.5 shows the distribution of currently married women by the risk category into which a currently conceived birth would fall. The data in the table shows that 29 percent of women are not in any elevated mortality risk category and 7 percent have only given birth once. Among those who are in a situation that causes an elevated mortality risk (64 percent of women), 30 percent have a single high risk and 34 percent have multiple risks. A comparison of this percentage with the distribution of actual births in the past five years indicates that without fertility control, the percentage of births falling into each of the multiple high-risk categories would rise from 14 percent to 34 percent. Early Childhood Mortality * 109 Table 8.5 High-risk fertility behaviour Percent distribution of children born in the five years preceding the survey by category of elevated risk of dying and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Zimbabwe 1999 ______________________________________________________________________ Births in the 5 years preceding the survey Percentage _____________________ of currently Percentage married Risk category of births Risk ratio women1 ______________________________________________________________________ Not in any high-risk category Unavoidable risk category (First births) Single high-risk category Mother's age <18 Mother's age >34 Birth interval <24 months Birth order >3 Subtotal Multiple high-risk category Age <18 & birth interval <24 months2 Age >34 & birth interval <24 months Age >34 & birth order >3 Age >34 & birth interval <24 months and birth order >3 Birth interval <24 months and birth order >3 Subtotal In any avoidable high-risk category Total Number of births 32.5 1.00 29.2 a 25.8 1.15 6.9 7.5 1.02 1.1 0.5 0.89 3.8 3.7 1.71 11.8 15.8 1.34 13.3 27.5 1.29 30.0 0.2 3.43 0.4 0.0 - 0.1 10.5 1.39 24.7 0.9 1.79 2.7 2.6 2.35 6.0 14.2 1.62 33.9 41.7 1.40 63.9 100.0 NA 100.0 3,559 NA 3,609 ______________________________________________________________________ Note: Risk ratio is the ratio of the proportion dead among births in a specific high- risk category to the proportion dead among births not in any high-risk category. NA = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child, if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the combined categories age <18 and birth order >3. a Includes sterilised women Reproductive and Child Health * 111 REPRODUCTIVE AND CHILD HEALTH 9 This chapter presents findings from areas of importance to reproductive and child health, namely, antenatal and delivery care, complications of pregnancy and delivery, postnatal care, characteristics of the neonate, vaccinations, and common childhood illnesses and their treatment. Combined with information about pregnancy complications and neonatal and infant mortality rates, the data help to identify groups who are underserved. The data on premature births, birth weight, and the baby’s size at birth provide useful information to reduce infant mortality through a reduction in low birth weight. Data were obtained for all live births in the five years preceding the survey. 9.1 PERCEIVED PROBLEMS IN ACCESSING WOMEN’S HEALTH Women are sometimes perceived to have problems in seeking health care services for themselves. Many factors can prevent women from getting medical advice or treatment for themselves. In the ZDHS, women were asked to state whether the seven factors presented in Table 9.1 are perceived as a big problem or not a problem in getting medical advice or treatment when they are sick. This table presents the distribution of urban and rural women separately by how big a problem each of the factors is for seeking care. The 1999 ZDHS data indicate that urban women are, in general, less likely than rural women to perceive problems in getting health care. In both rural and urban areas, the majority of women did not perceive knowing where to go, getting permission and lack of a female service provider as a problem in accessing women’s health care. Getting the money needed for treatment was perceived as a problem by 26 percent of urban women and 39 percent of rural women. Lack of a nearby facility and having to take transport were cited as major problems by rural women (45 percent and 43 percent, respectively). It is worth noting that fear of verbal abuse by the health service provider was reported by 14 percent of women regardless of residence. Urban women are less likely to mention not wanting to go to health care facilities alone as a big problem, compared with rural women (6 percent and 16 percent, respectively). 9.2 PERCEIVED BIG PROBLEMS IN ACCESSING WOMEN’S HEALTH BY BACKGROUND CHARACTERISTICS Table 9.2 shows the percentage of women who reported problems in accessing health care for themselves by type of problem and selected background characteristics. In general, older women, women with larger numbers of children, formerly married women, women with no education, and women who did not work for cash reported having more problems in getting health care for themselves. The data show that invariably, women perceived getting money for treatment and not having a health facility nearby as big problems. Older women, women with high birth order children, and formerly married women are more likely to have a big problem in getting the money needed for treatment, compared with younger women, women with a smaller number of children, and currently married women. 112 * Reproductive and Child Health Table 9.1 Perceived problems in accessing women's health care Percent distribution of urban women and of rural women by perceived extent of problem in accessing women's health care, according to selected factors, Zimbabwe 1999 _______________________________________________________________________________ Perceived extent of problem accessing women's health care __________________________ Not Number Big a big of Factor problem problem Missing Total women _______________________________________________________________________________ URBAN WOMEN _______________________________________________________________________________ Knowing where to go 3.7 96.2 0.1 100.0 2,279 Getting permission to go 1.6 98.2 0.2 100.0 2,279 Getting money for treatment 26.1 73.7 0.3 100.0 2,279 Distance to health facility 9.1 90.6 0.3 100.0 2,279 Have to take transport 8.8 91.0 0.3 100.0 2,279 Not wanting to go alone 5.5 94.2 0.3 100.0 2,279 Lack of a female health provider 6.2 93.5 0.3 100.0 2,279 Fear of verbal abuse by health provider 13.6 86.2 0.3 100.0 2,279 _______________________________________________________________________________ RURAL WOMEN _______________________________________________________________________________ Knowing where to go 5.1 94.8 0.1 100.0 3,628 Getting permission to go 3.8 96.0 0.2 100.0 3,628 Getting money for treatment 38.8 60.9 0.3 100.0 3,628 Distance to health facility 44.5 55.2 0.3 100.0 3,628 Have to take transport 43.0 56.9 0.1 100.0 3,628 Not wanting to go alone 15.9 83.9 0.2 100.0 3,628 Lack of female health provider 9.7 90.1 0.2 100.0 3,628 Fear of verbal abuse by health provider 13.7 86.2 0.2 100.0 3,628 A woman’s educational level plays a significant role in getting the money needed for treatment. Women with no education are more likely to have problems in obtaining the money for treatment (55 percent), compared with 8 percent of women with higher than a secondary education. Living in urban centers, only 7 percent of women in Harare and Bulawayo reported the lack of a health facility nearby as a problem. Women with no education are much more likely than women with an education to perceive going to a health facility alone as a problem (20 percent compared with 2 percent). Reproductive and Child Health * 113 Table 9.2 Perceived big problem in accessing women's health care by background characteristics Percentage of women who reported they had a big problem in accessing health care for themselves, by type of problem and selected background characteristics, Zimbabwe 1999_____________________________________________________________________________________________________________ Type of big problem in accessing health care______________________________________________________________________ Getting Fear of money Distance Not Lack of verbal Any Knowing Getting for to Having wanting female abuse by of the Number Background where permission treat- health to take to go health health specified of characteristic to go to go ment facility transport alone provider provider problems women1_____________________________________________________________________________________________________________ Age 15-19 20-29 30-39 40-49 Number of living children 0 1-2 3-4 5+ Marital status Never married Married Divorced, separated, widowed Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Current employment Not employed Works for cash Does not work for cash 6.0 4.8 30.2 30.4 29.4 13.7 11.7 17.5 56.0 1,447 4.1 2.5 30.7 28.2 27.2 10.5 7.3 12.4 52.3 2,329 3.6 2.1 36.4 30.5 29.1 10.7 6.8 12.0 57.3 1,305 4.5 2.4 45.3 39.5 38.9 14.6 7.9 12.7 64.6 827 5.4 3.8 29.8 26.9 26.8 11.9 10.9 16.4 54.2 1,854 4.0 2.4 30.2 28.4 25.9 10.4 6.8 11.7 51.6 2,079 4.4 2.6 39.0 33.0 32.8 12.4 7.0 13.8 59.7 1,080 4.3 2.9 44.5 42.1 41.4 14.9 8.3 12.1 65.8 894 5.0 3.7 30.4 27.6 26.9 12.2 10.9 16.4 53.9 1,637 4.2 2.8 32.8 32.1 30.8 11.5 7.4 12.5 54.8 3,609 5.0 2.0 48.6 32.0 31.4 13.2 7.0 13.2 67.9 662 2.7 4.5 40.8 40.1 40.5 14.9 5.4 11.1 66.4 882 10.2 4.5 34.5 51.2 49.4 21.8 18.7 17.4 69.9 477 8.6 4.3 43.8 47.9 44.0 12.1 6.0 12.5 69.0 461 5.0 3.1 33.6 33.0 32.9 9.7 9.2 13.3 52.3 559 3.0 2.2 27.9 51.1 46.1 27.0 11.4 22.8 64.9 302 4.3 2.6 30.4 32.5 31.7 14.9 6.2 12.8 49.1 321 4.0 2.5 39.6 36.0 33.6 10.8 9.6 13.3 62.4 741 3.4 4.7 32.3 27.9 27.8 11.6 9.2 12.4 53.3 629 3.9 0.7 26.2 7.8 8.4 4.4 5.7 11.4 40.2 1,077 2.6 1.4 27.7 7.1 5.5 6.0 7.3 18.1 42.9 457 8.9 6.1 54.5 51.0 48.5 19.6 12.6 13.7 73.3 396 5.3 3.8 40.6 38.5 37.3 14.7 9.6 13.6 64.1 2,377 3.5 2.0 27.2 23.1 22.2 9.2 7.0 13.6 48.5 2,965 1.3 0.0 8.4 9.9 12.9 2.2 4.6 15.1 33.5 168 4.2 3.2 33.7 31.2 30.2 11.8 8.6 14.0 54.9 2,701 4.7 2.7 32.3 28.7 27.5 11.8 7.9 13.2 54.7 2,757 5.6 2.7 44.9 41.9 41.4 13.0 9.6 13.8 71.2 447 _____________________________________________________________________________________________________________ 1 Total includes 2 women with missing information on current employment 9.3 ANTENATAL CARE Information on antenatal care (ANC) is of great value in identifying subgroups of women who do not utilise such services and is useful in planning improvements in the services. The data on ANC from the 1999 ZDHS provide detail on the type of service provider, the number of ANC visits made, the stage of pregnancy at the time of the first and last visits, and the services and information provided during ANC including whether tetanus toxoid was received. Table 9.3 shows the percent distribution of last live births in the five years preceding the survey by source of antenatal care received, according to background characteristics. ZDHS 114 * Reproductive and Child Health Table 9.3 Antenatal care Percent distribution of last live births in the five years preceding the survey by source of antenatal care (ANC) during pregnancy, according to maternal and background characteristics, Zimbabwe 1999__________________________________________________________________________________________ Antenatal care provider1____________________________________________ Tradi- tional Trained birth Number Background nurse/ attendant/ of characteristic Doctor midwife other2 No one Missing Total births__________________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher All births3 10.2 80.6 1.2 8.0 0.0 100.0 537 14.5 80.1 0.9 4.3 0.2 100.0 1,874 11.0 78.2 2.6 7.8 0.4 100.0 359 15.3 78.9 1.0 4.8 0.0 100.0 876 14.0 80.6 0.7 4.5 0.2 100.0 1,064 10.7 82.0 1.3 5.7 0.3 100.0 444 8.9 78.4 2.9 9.5 0.4 100.0 386 23.5 71.1 0.3 4.9 0.2 100.0 958 7.7 84.6 1.7 5.8 0.2 100.0 1,812 6.6 74.1 5.7 13.3 0.4 100.0 418 10.6 86.4 0.3 2.7 0.0 100.0 262 7.4 81.8 0.4 10.3 0.0 100.0 240 12.7 81.8 0.7 4.7 0.0 100.0 275 10.6 88.2 0.0 1.1 0.0 100.0 150 9.8 87.6 0.0 2.3 0.3 100.0 165 11.0 84.2 0.9 3.6 0.3 100.0 341 9.2 88.5 0.7 1.6 0.0 100.0 285 23.6 71.5 0.0 4.5 0.4 100.0 464 30.6 64.2 0.4 4.8 0.0 100.0 170 5.0 88.9 0.8 5.3 0.0 100.0 181 7.7 82.2 2.2 7.6 0.3 100.0 1,208 16.9 78.7 0.4 3.9 0.1 100.0 1,316 61.0 39.0 0.0 0.0 0.0 100.0 65 13.2 79.9 1.2 5.5 0.2 100.0 2,770 __________________________________________________________________________________________ 1 If more than one source of ANC care was mentioned, only the provider with the highest qualifications is considered in this tabulation. 2 Includes "don't know" 3 Includes last live births in the period 0-59 months preceding the survey respondents were asked whether they had seen anyone for antenatal care during the pregnancy for this birth. The interviewer was instructed to record all responses if more than one source of antenatal care was mentioned. However, for the purposes of this tabulation only, the provider with the highest qualifications is considered if there is more than one response. For 93 percent of births, mothers received antenatal from a trained medical professional; 13 percent received care from a doctor; and 80 percent received care from a trained nurse or a midwife. Women received antenatal care from a traditional birth attendant for only 1 percent of the births, while 6 percent of the births received no antenatal care. The child’s birth order is negatively related to the use of antenatal care; children of higher birth order are less likely to receive care from trained personnel, especially doctors. Whereas 10 percent of children whose mothers have six or more previous births received no antenatal care, among children who had no sibling, the percentage is 5 percent. Reproductive and Child Health * 115 Table 9.4 Number of antenatal care visits and stage of pregnancy Percent distribution of last live births in the five years preceding the survey by number of antenatal care (ANC) visits, and by the stage of pregnancy at the time of the first visit, Zimbabwe 1999__________________________________ Number and timing Percentage of ANC visits of births__________________________________ Number of ANC visits None 1 visit 2-3 visits 4+ visits Don't know/missing Total Median number of visits (for those with ANC) Number of months pregnant at the time of the first ANC visit No antenatal care <6 months 6-7 months 8+ months Don't know/missing Total Median months pregnant at first visit (for those with ANC) Number of live births1 5.5 1.1 15.4 64.3 13.7 100.0 4.7 5.5 67.4 23.6 2.6 0.9 100.0 4.9 2,770 __________________________________ 1 Includes last live births in the period 0-59 months preceding the survey The major difference in the use of antenatal services between urban and rural women is the type of care provider. Urban women are three times more likely to receive antenatal care from a doctor than rural women. On the other hand, trained nurses or midwives are more likely to provide antenatal care in the rural areas (85 percent compared with 71 percent). Antenatal care coverage is lowest in Manicaland and Mashonaland East. Women in Harare and Bulawayo are most likely to consult a doctor for antenatal care. The mother’s education is strongly related to use of antenatal services; better-educated mothers are more likely to use skilled personnel. Although six in ten women with higher than a secondary education went to a physician for antenatal care, only 5 percent of women with no education did. 9.4 NUMBER OF ANTENATAL CARE VISITS AND STAGE OF PREGNANCY Antenatal care is most effective in avoiding adverse pregnancy outcomes when it is sought early in pregnancy and continued through to delivery. The ZDHS respondents were asked how many antenatal visits they made during the pregnancy preceding the last live birth in the five years before the survey and how many months pregnant they were at the time of the first visit. Information about the number and timing of visits made by pregnant women is presented in Table 9.4, Figure 9.1, and Figure 9.2. In the 1999 ZDHS, for 64 percent of the births, mothers had four or more antenatal care visits. For 14 percent of the births, no information on number of antenatal care visits is available. The median number of antenatal care visits is 4.7; however, the goal-oriented antenatal protocols in Zimbabwe recommend six visits. Figure 9.2 shows that two-thirds of pregnant women had their first checkup by the sixth month of pregnancy, 24 percent had their first visit during the sixth to seventh month of pregnancy, and 3 percent had their first visit at eight months or later. Six percent of births received no antenatal care at all. The median duration of pregnancy at the first antenatal care visit was 4.9 months. The delay in utilizing antenatal care services, which may be due to poor access or lack of knowledge, makes early identification and management of risk factors difficult. 116 * Reproductive and Child Health Figure 9.1 Distribution of Births by Number of Antenatal Care Visits Figure 9.2 Distribution of Births by Timing of First Antenatal Care Visit None 6% 1 visit 1% 2-3 visits 15% 4+ visits 64% Don't know/ Missing 14% < 6 months 67% 6-7 months 24% No antenatal care 6% Don't know/ Missing 1% 8+ months 3% ZDHS 1999 9.5 ANTENATAL CARE CONTENT The content of antenatal care is important in judging its value. Pregnancy complications are an important source of maternal and child mortality and morbidity. Therefore, information on the signs of complications and testing for complications should be routinely included in all antenatal care visits. To help assess ANC services, respondents were asked about whether they had been advised about complications or had had certain screening tests during at least one of the antenatal visits. The 1999 ZDHS data indicate that four in ten of the women who received antenatal care were informed of the signs of pregnancy complications (Table 9.5). Women in urban areas are more likely to receive this information than those in the rural areas (55 percent compared with 35 percent). Women who live in the urban provinces (Harare and Bulawayo) are the most likely to have been informed of pregnancy complications (57percent and 56 percent, respectively). Among the other provinces, Matabeleland North has the lowest percentage of women who had received information on the signs of pregnancy complications (19 percent), while the remaining provinces range from 32 percent to 48 percent. Women’s age and the child’s birth order are not as strongly associated with being given information of the signs of pregnancy complications as residence. A woman’s education, however, has a marked positive association with being informed of the signs of pregnancy complications. Women with higher than a secondary education are almost twice as likely to be given this information as women with no education (55 percent compared with 29 percent). Reproductive and Child Health * 117 Table 9.5 Antenatal care content Percentage of last live births in the five years preceding the survey for which mothers received antenatal care, by content of antenatal care and selected background characteristics, Zimbabwe 1999_____________________________________________________________________________________________________________ Informed of signs of Received pregnancy Blood Urine Blood tetanus Received Received Number Background compli- pressure sample sample toxoid iron anti- of characteristic cations measured given given injection tablets malarial births_____________________________________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 5+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All births1 35.9 82.8 74.2 71.1 77.8 57.4 20.8 537 44.4 91.3 83.0 77.5 81.2 60.0 23.6 1,874 39.1 85.8 76.1 68.5 68.4 61.5 19.7 359 44.4 89.0 81.3 78.1 80.3 60.6 21.6 876 42.3 90.2 81.9 75.5 81.6 58.7 23.1 1,064 41.7 90.1 80.1 74.6 77.9 60.9 23.1 444 36.9 83.9 74.3 67.6 69.2 59.0 22.3 386 54.7 92.9 91.3 87.2 79.8 59.0 12.5 958 35.4 86.8 74.6 68.7 78.4 60.1 27.8 1,812 37.4 74.3 67.1 55.3 67.3 64.4 46.7 418 39.0 90.6 78.9 69.4 81.7 64.6 20.6 262 32.2 78.5 74.0 64.4 71.9 32.6 15.3 240 36.2 94.2 83.6 81.0 81.1 66.9 13.1 275 18.9 92.0 77.4 77.4 86.4 60.8 15.1 150 32.1 95.1 90.6 93.4 86.5 64.0 6.3 165 45.0 92.6 73.7 71.2 85.7 65.8 40.4 341 48.4 91.1 79.2 75.6 84.7 66.2 27.0 285 56.6 94.2 92.6 86.8 76.4 50.8 9.1 464 56.1 94.5 93.7 93.0 78.2 63.5 6.6 170 28.8 87.5 71.7 61.7 74.2 66.5 23.7 181 34.6 85.0 74.1 68.3 74.9 57.7 23.2 1,208 50.2 92.1 86.5 82.1 83.6 60.4 21.6 1,316 54.5 100.0 97.6 95.4 69.0 64.1 26.1 65 42.1 88.9 80.4 75.1 78.9 59.7 22.5 2,770 _____________________________________________________________________________________________________________ 1 Includes last live births in the period 0-59 months preceding the survey Table 9.5 shows that nine in ten women who went for an antenatal care visit had their blood pressure measured. Age, child’s birth order, education, and residence have little or no influence on the respondent’s chances of having her blood pressure measured. Urine samples were collected for 80 percent of women who received antenatal care. Urban and better-educated women are more likely to give urine samples than rural women (91 to 98 percent compared with 72 to 75 percent). Three in four women who attended an antenatal care visit gave a blood sample. Urban women are more likely to give a blood sample than rural residents (87 percent compared with 69 percent). This difference in coverage is possibly due to the access to medical laboratory services. Large differentials are also found between provinces. The proportion who gave a blood sample ranges from 55 percent in Manicaland to 93 percent in Matabeleland South and Bulawayo. Women with higher than a secondary education are much more likely to have given a blood sample during an antenatal care visit than women with no education (95 percent compared with 62 percent). 118 * Reproductive and Child Health Neonatal tetanus, anemia, and maternal anemia are major causes of mortality in early infancy. Overall, eight in ten women who attended an antenatal care visit received a tetanus toxoid (TT) injection. Maternal age and child’s birth order are associated with receiving TT injection. Older women (age 35 or older when giving birth), women with high-order births, women living in Manicaland, and women with higher than a secondary education are less likely to receive TT injection than other women. Iron tablets were given to 60 percent of the women who received antenatal care. This percentage varies little across all subgroups of women, except by province of residence. Women in Mashonaland East are the least likely to have received iron tablets (33 percent), while the proportion in other provinces is at least 51 percent. Among the women who attended an antenatal care visit, 23 percent received antimalarial drugs. The lower coverage of antimalarial drugs may be due to the practice of giving them only to women in malaria-endemic areas. Coverage of antimalarial drugs varies by type of place of residence; rural women are more than twice as likely to receive antimalarial drugs as urban women (28 percent compared with 13 percent). Moreover, although almost half of the pregnant women in Manicaland (47 percent) were given antimalarial tablets, in Matabeleland South, Harare, and Bulawayo, antimalarial drugs were prescribed to less than 10 percent of the pregnant women. 9.6 PLACE OF DELIVERY Increasing the number of babies that are delivered in health facilities is an important factor in reducing the health risks to both the mother and the baby. Proper medical attention and hygienic conditions during delivery can reduce the risks of complications and infections that can cause morbidity and mortality to either the mother or the baby. Respondents were asked to report on delivery care for all births during the five years before the survey. Table 9.6 shows that 72 percent of births occurred in health facilities. This figure is slightly higher than that recorded in the 1994 ZDHS (69 percent). Younger mothers and women with fewer children are more likely to deliver in a health institution than older women (78 percent for women under 20 years old compared with 59 percent for women 35 years old and over). High-order births are associated with a greater likelihood of being delivered at home; 38 percent for mothers with six or more children compared with 14 percent for women with one child. Place of delivery varies by urban-rural residence; urban women are more likely to deliver in a health facility than rural women (89 percent compared with 64 percent). A child in a rural area is almost four times more likely to have been born at home than an urban child (31 percent compared with 8 percent). Although 91 percent of babies in Harare and Bulawayo were born in a health facility, in other provinces this coverage ranges from 51 percent to 80 percent. Home deliveries are most prevalent in Manicaland (44 percent) and least prevalent in Harare (6 percent) and Bulawayo (8 percent). There is a marked association between mother’s education and place of delivery. Table 9.6 shows that women with no education are much more likely than better-educated women to deliver at home (56 percent compared with 1 percent). This may be because educated women have greater access to medical services, a better understanding of the benefits of delivery at a health facility, or motivation to take advantage of the available services. Reproductive and Child Health * 119 Table 9.6 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery, according to selected background characteristics, Zimbabwe 1999________________________________________________________________________________ Place of delivery_______________________________________ Don't Number Background Health At know/ of characteristic facility home Other Missing Total births1________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher Number of antenatal care visits None 1-3 visits 4+ visits Don't know/missing All births1 78.0 19.5 1.0 1.5 100.0 749 72.6 23.1 0.9 3.3 100.0 2,387 59.3 30.6 0.6 9.4 100.0 424 84.1 14.1 0.5 1.3 100.0 1,170 72.9 23.4 1.3 2.4 100.0 1,326 64.7 29.1 0.7 5.5 100.0 569 50.6 38.0 0.7 10.7 100.0 494 89.1 8.3 0.4 2.2 100.0 1,159 64.0 30.5 1.1 4.4 100.0 2,401 51.1 43.9 1.3 3.7 100.0 573 64.7 31.3 0.2 3.8 100.0 338 73.3 20.6 1.6 4.4 100.0 313 65.8 27.3 0.0 6.9 100.0 349 63.1 33.2 0.9 2.7 100.0 186 76.7 21.6 0.0 1.7 100.0 222 73.0 22.9 0.7 3.4 100.0 457 79.6 13.3 2.4 4.7 100.0 359 90.6 5.9 0.7 2.8 100.0 552 90.8 7.7 0.3 1.2 100.0 211 43.1 46.2 0.7 9.9 100.0 253 62.8 31.6 0.9 4.7 100.0 1,605 84.8 12.5 0.9 1.8 100.0 1,629 97.8 1.1 0.0 1.1 100.0 73 34.5 56.4 1.6 7.5 100.0 152 67.5 26.4 0.6 5.5 100.0 457 77.4 19.2 0.8 2.5 100.0 1,780 70.9 23.9 1.0 4.2 100.0 1,170 72.2 23.3 0.9 3.7 100.0 3,559 ________________________________________________________________________________ 1 Includes births in the period 0-59 months preceding the survey 9.7 ASSISTANCE DURING DELIVERY The type of assistance a woman receives during the birth of a child has important health consequences for both the mother and the child. As with antenatal care, ZDHS interviewers were asked to record all responses if more than one person assisted during delivery. However, for the purposes of this tabulation, only the most highly qualified attendant is considered if there is more than one response. In the 1999 ZDHS, skilled personnel assisted 73 percent of live births in the past five years during delivery, 18 percent were assisted by a traditional birth attendant, and 3 percent were not assisted during delivery. Of those births assisted by trained medical professionals, the majority were delivered by a nurse or midwife. 120 * Reproductive and Child Health Table 9.7 Assistance during delivery Percent distribution of live births in the five years preceding the survey by type of assistance during delivery, according to selected background characteristics, Zimbabwe 1999 ______________________________________________________________________________________________ Attendant assisting during delivery1 __________________________________________________ Tradi- Trained tional Don't Number Background nurse/ birth Relative/ No know/ of characteristic Doctor midwife attendant other one Missing Total births2 _______________________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher Number of antenatal care visits None 1-3 visits 4+ visits Don't know/missing All births 11.6 67.0 14.4 5.3 1.3 0.4 100.0 749 11.7 61.2 17.6 6.2 2.9 0.4 100.0 2,387 10.8 48.3 23.2 8.3 8.8 0.6 100.0 424 15.0 69.3 10.4 3.9 1.0 0.5 100.0 1,170 11.7 61.7 17.6 6.6 2.0 0.4 100.0 1,326 8.7 56.3 22.8 7.1 4.8 0.3 100.0 569 6.6 43.9 28.6 10.3 10.2 0.5 100.0 494 18.7 70.7 6.7 1.7 1.4 0.7 100.0 1,159 8.1 56.1 22.8 8.5 4.1 0.3 100.0 2,401 6.9 44.1 28.5 16.7 3.7 0.0 100.0 573 5.0 60.6 29.4 1.2 3.8 0.0 100.0 338 9.5 64.1 15.2 6.7 4.1 0.3 100.0 313 12.0 54.6 22.4 4.6 5.5 0.8 100.0 349 7.1 56.9 24.5 8.8 2.7 0.0 100.0 186 9.3 67.8 20.3 0.2 1.5 0.9 100.0 222 11.8 61.4 14.8 8.6 3.0 0.4 100.0 457 9.8 69.0 10.2 6.3 4.2 0.5 100.0 359 19.8 71.2 5.2 1.0 1.7 1.0 100.0 552 24.4 66.4 6.5 1.5 1.2 0.0 100.0 211 3.4 39.4 33.1 14.1 8.6 1.4 100.0 253 7.1 56.1 23.8 8.4 4.5 0.2 100.0 1,605 15.4 69.6 9.9 3.3 1.3 0.5 100.0 1,629 52.3 46.6 0.0 0.0 1.1 0.0 100.0 73 5.2 27.7 35.2 23.8 7.5 0.6 100.0 152 9.6 57.7 20.2 7.2 5.3 0.0 100.0 457 12.9 65.1 15.6 3.8 2.4 0.1 100.0 1,780 11.2 59.9 17.3 7.5 3.1 1.0 100.0 1,170 11.6 60.9 17.6 6.3 3.2 0.4 100.0 3,559 _______________________________________________________________________________________________ 1 If the respondent mentioned more than one attendant, only the most qualified attendant is considered in this tabulation. 2 Includes births in the period 0-59 months preceding the survey Reproductive and Child Health * 121 Maternal age and child’s birth order are associated with the type of assistance at delivery. Older women and women who have had many births are somewhat more likely to receive no assistance at delivery than other women. This situation was also noted in the 1994 ZDHS. Type of place of residence also determines the level of assistance at delivery. Urban women tend to use skilled personnel more than rural women (89 percent compared with 64 percent). Whereas a physician assisted 19 percent of births in urban areas, only 8 percent of births in rural areas had this service. On the other hand, births in rural areas are more likely to be assisted by a traditional birth attendant or relative (23 percent) than in urban areas (7 percent). The gap between the urban and rural levels may be due to access to skilled personnel. Although nine in ten deliveries in Harare and Bulawayo were assisted by skilled personnel, in other provinces, the coverage ranges from 51 percent in Manicaland to 79 percent in Masvingo. It should be noted that one in five deliveries in Manicaland were assisted by a relative or were unattended. Maternal education is closely related to assistance during delivery. Women with secondary and higher education are more likely to seek assistance from medical personnel during delivery. Although more than half (52 percent) of the women with higher than a secondary education were assisted by a physician, only 3 percent of the women without any education had the service of a physician during delivery. No woman with higher than a secondary education was assisted by a relative or a birth attendant during delivery. Women who received antenatal care from a medically trained person during pregnancy were more likely to deliver with medical assistance (data not shown). Among women who had four or more antenatal visits, 78 percent were assisted at delivery by skilled personnel, compared with 33 percent of women who had no antenatal care. Women who did not receive antenatal care were more likely to be assisted by a traditional birth attendant or by no one. 9.8 DELIVERY CHARACTERISTICS In the 1999 ZDHS, respondents were asked whether the delivery was by caesarean section (C-section). The baby’s birth weight was also recorded. Since the birth weight may not be known for some babies, mothers were asked for their assessment of whether their child was very small, smaller than average, average, or larger. According to the 1999 ZDHS, 7 percent of babies were delivered by caesarean section (Figure 9.3). The same level was recorded in the 1994 ZDHS. Caesarean sections are most common among first births, urban births, and births to women in the urban provinces of Harare and Bulawayo (see Table 9.8). The sharpest difference in caesarean-section coverage is shown by mother’s education. Women with higher than a secondary education are ten times more likely to have an operation at delivery than women with no education (22 percent compared with 2 percent). The high rate of caesarean-section operations among educated women may be explained by the fact that these women are more likely to reside in urban areas where access to physicians and to facilities that offer the service is more available. 122 * Reproductive and Child Health Figure 9.3 Delivery Characteristics, Zimbabwe 1999 7% 7% 5% 11% Caesarean delivery < 2.5 kg Very small Smaller than average BIRTH WEIGHT BIRTH SIZE ZDHS 1999 Among children with recorded weight at birth, 7 percent weighed less than 2.5 kg, which is considered low birth weight. The majority of women (83 percent) assessed the size of the babies at birth as average or larger. Among births for whom the weight was known, first-born children, children born to women under age 20, and children born to mothers who never attended school were more likely than other children to have a low birth weight and to be assessed by the mother as very small or smaller than average. Reproductive and Child Health * 123 Table 9.8 Delivery characteristics Among births in the five years preceding the survey, the percentage of deliveries by caesarean section, and the percent distribution by birth weight and by the mother's estimate of baby's size at birth, according to selected background characteristics, Zimbabwe 1999______________________________________________________________________________________________ Birth weight Size of child at birth______________________ _______________________________ Delivery Does Smaller Average Does Number Background by not Very than or not of characteristic C-section <2.5 kg 2.5+ kg know small average larger know births______________________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher Number of births1 7.8 9.9 70.7 19.5 5.9 12.5 80.8 0.8 749 6.4 7.1 69.3 23.6 5.3 10.4 83.2 1.1 2,387 6.2 4.2 58.0 37.7 5.2 8.0 85.5 1.2 424 9.9 9.3 76.0 14.7 4.6 12.2 82.2 0.9 1,170 5.5 7.2 70.4 22.4 5.9 11.0 81.8 1.3 1,326 5.3 6.2 63.0 30.8 6.2 7.5 85.4 0.9 569 3.9 4.2 50.1 45.7 5.2 8.9 84.9 1.1 494 9.6 8.3 82.4 9.2 5.3 9.4 84.0 1.2 1,159 5.3 6.8 61.4 31.8 5.5 11.1 82.4 1.0 2,401 4.5 4.8 48.1 47.1 4.3 7.2 88.5 0.0 573 4.5 6.8 64.5 28.7 7.7 10.5 81.3 0.5 338 6.3 8.3 70.5 21.3 4.8 7.9 83.2 4.1 313 5.4 9.5 63.2 27.3 2.6 10.2 85.7 1.4 349 3.3 6.6 56.9 36.4 6.9 13.9 79.2 0.0 186 7.6 4.0 75.5 20.4 2.2 18.9 78.7 0.2 222 8.6 7.0 66.6 26.4 6.3 15.0 77.7 1.1 457 6.5 6.3 79.0 14.7 7.3 9.4 82.7 0.5 359 9.0 10.4 82.3 7.3 6.3 9.0 82.6 2.1 552 10.7 8.3 84.8 6.8 5.4 8.6 86.0 0.0 211 2.1 6.3 40.7 53.0 10.1 9.3 78.5 2.1 253 4.4 7.1 59.7 33.2 5.4 10.6 82.9 1.1 1,605 9.0 7.9 79.7 12.3 4.9 10.5 83.6 0.9 1,629 21.6 1.4 95.5 3.1 1.7 14.0 84.3 0.0 73 6.7 7.3 68.3 24.4 5.4 10.6 83.0 1.1 3,559 ____________________________________________________________________________________________ 1 Includes births in the period 0-59 months preceding the survey 9.9 POSTNATAL CARE Postnatal care is important for mothers for treatment of complications arising from delivery. Information on postnatal care also highlights how the mother takes care of herself. The timing of postnatal care is important. To provide the best outcome possible, it should occur within two days of the delivery since this is the critical period when most maternal deaths occur. It is assumed that deliveries in a health facility will entail a postnatal check before the mother is discharged. Table 9.9 focuses, therefore, on the information obtained on postnatal care for births that took place outside a health facility. Among 627 births that occurred outside a health facility, more than half (56 percent) of the mother’s did not receive a postnatal checkup. The low coverage of postnatal care may be due to the lack of knowledge of the importance of the checkup. Among those who had a postnatal checkup, only 14 percent had the checkup within two days after delivery; 11 percent received a checkup three to seven days after birth; and 13 percent had a postnatal checkup four or more weeks after delivery. 124 * Reproductive and Child Health Table 9.9 Postnatal care Among last live births in the five years preceding the survey, percentage for which mothers delivered in a health facility, and percent distribution of those for which mothers delivered outside a health facility, by timing of first postnatal checkup, according to background characteristics, Zimbabwe 1999_____________________________________________________________________________________________________________ Timing of first postnatal checkup for births to mothers who delivered outside a health facility Number_________________________________________ of Delivered 3-7 8-27 4+ Did not Total births in Within days days weeks Don’t receive number outside Background health 2 days after after after know/ postnatal of a health characteristic facility of birth birth birth birth missing care Total births facility1_____________________________________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Total 79.7 12.5 12.0 3.8 14.3 0.0 57.3 100.0 537 102 74.9 16.4 11.5 6.4 14.0 0.1 51.6 100.0 1,874 418 62.1 4.9 6.6 3.7 10.4 0.0 74.4 100.0 359 107 85.1 16.6 13.7 5.2 9.5 0.0 55.0 100.0 876 123 75.8 16.5 9.3 6.0 18.5 0.2 49.5 100.0 1,064 236 66.8 11.8 17.3 6.2 8.6 0.0 56.1 100.0 444 128 53.5 8.8 4.6 4.2 12.6 0.0 69.7 100.0 386 140 89.9 24.3 7.5 6.5 11.4 0.0 50.3 100.0 958 80 65.8 12.3 11.2 5.3 13.7 0.1 57.3 100.0 1,812 547 53.0 8.0 4.2 2.5 9.7 0.0 75.6 100.0 418 181 66.0 7.1 11.2 9.2 16.3 0.0 56.1 100.0 262 78 76.8 10.6 10.6 6.4 23.4 0.0 48.9 100.0 240 47 68.6 20.4 8.3 1.4 8.3 0.0 61.7 100.0 275 73 64.0 13.5 11.0 8.4 25.3 0.0 41.8 100.0 150 50 77.9 15.1 32.2 4.3 12.8 1.4 34.1 100.0 165 34 74.7 12.0 11.2 7.2 17.9 0.0 51.6 100.0 341 76 80.3 33.1 25.1 8.4 4.2 0.0 29.3 100.0 285 45 90.9 23.5 5.9 5.9 11.8 0.0 52.9 100.0 464 33 * * * * * * * 100.0 170 11 45.9 7.0 8.3 10.3 14.4 0.0 59.9 100.0 181 82 64.7 12.9 10.6 5.2 10.7 0.1 60.4 100.0 1,208 373 85.6 18.7 12.3 3.9 18.9 0.0 46.2 100.0 1,316 170 74.2 13.8 10.8 5.5 13.4 0.1 56.4 100.0 2,770 627 _____________________________________________________________________________________________________________ Note: An asterisk indicates that a figure is based on 25-49 cases and has been suppressed. 1 Includes one woman with higher than secondary education. Maternal age and child’s birth order are related to postnatal checkup within two days of birth. Women under age 35 and women with a low parity are more likely to receive postnatal care within two days of birth than older women and those with six or more children. Women in urban areas are more likely to have an early postnatal checkup than rural women. They are also slightly more likely to have a checkup at some time than rural women. Differentials across provinces show that mothers in Manicaland are least likely to have a postnatal checkup. Along with women in Mashonaland Central, they are also the least likely to have an early postnatal checkup (8 percent and 7 percent, respectively). Nineteen percent of women with a secondary education who delivered outside a health facility received a postnatal checkup within two days after delivery compared with only 7 percent of the women with no education. Reproductive and Child Health * 125 9.10 POSTNATAL CARE PROVIDERS The 1999 ZDHS respondents were asked whether they had seen anyone for post natal care. As with antenatal care, ZDHS interviewers were asked to record all responses if there was more than one provider. However, for the purposes of this tabulation, only the most highly qualified provider is considered if there is more than one response. Table 9.10 shows the percent distribution of the last live births occurring outside a health facility in the five years preceding the survey by type of postnatal-care service provider according to background characteristics. The findings show that the majority of women who received postnatal care were seen by a trained nurse or midwife. Urban women are more likely to receive postnatal care than rural women. When only doctors are considered, urban women are six times as likely as rural women to have received postnatal care from a doctor. The coverage of antenatal care among births outside a health facility varies significantly across provinces. Although the number of births is too small to draw a conclusion, women in Manicaland are much less likely to receive postnatal care from a medically trained care provider (14 percent) than women in other provinces. 9.11 USE OF SMOKING TOBACCO Smoking tobacco during pregnancy increases the risk of having a small or low birth weight baby. Even occasional use of tobacco adversely affects women’s health status and children’s health, precipitating respiratory illnesses. The impact of smoking by women in general, as well as during pregnancy, is important for both the women’s own health and that of their young children. This is new information included in this survey. The 1999 ZDHS shows that virtually no women smoked, regardless of background characteristics and maternity status. For the 1 percent of women who did smoke, half reported smoking cigarettes and the other half smoked other tobacco. Older women and women with no education are more likely to smoke than younger women. 126 * Reproductive and Child Health Table 9.10 Postnatal care providers Percent distribution of last live births occurring outside of a health facility in the five years preceding the survey by type of postnatal care provider, according to background characteristics, Zimbabwe 1999_________________________________________________________________________________________ Provider of postnatal care1_____________________________________________ Trained Traditional Don't No Number Background nurse/ birth know/ postnatal of characteristic Doctor Midwife attendant Missing care Total births2,3_________________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Number of decisions with woman having final say 0-1 2-3 4-5 Number of reasons to refuse sexual relations 0 1-2 3-4 Number of reasons to justify wife beating 0 1-3 4-5 All births 0.8 31.9 1.0 9.0 57.3 100.0 102 1.8 27.6 1.3 17.7 51.6 100.0 418 0.7 13.7 1.8 9.4 74.4 100.0 107 2.7 40.2 2.1 0.0 55.0 100.0 123 1.1 27.6 0.0 21.7 49.5 100.0 236 1.1 21.9 2.3 18.6 56.1 100.0 128 1.1 14.2 2.1 13.0 69.7 100.0 140 6.6 33.4 0.0 9.8 50.3 100.0 80 0.7 24.8 1.5 15.6 57.3 100.0 547 0.8 13.5 0.8 9.3 75.6 100.0 181 1.0 28.6 0.0 14.3 56.1 100.0 78 (0.0) (29.8) (0.0) (21.3) (48.9) 100.0 47 0.0 21.9 4.1 12.3 61.7 100.0 73 0.8 40.5 0.0 16.9 41.8 100.0 50 2.3 35.1 0.0 28.5 34.1 100.0 34 0.0 30.5 0.0 17.9 51.6 100.0 76 (2.1) (37.3) (8.4) (23.0) (29.3) 100.0 45 * * * * * * 33 * * * * * * 11 2.8 17.1 1.2 19.0 59.9 100.0 82 0.5 22.9 2.0 14.2 60.4 100.0 373 2.8 36.5 0.0 14.5 46.2 100.0 170 1.6 30.1 1.3 13.4 53.5 100.0 114 2.9 17.7 2.0 14.8 62.6 100.0 188 0.5 29.2 0.9 15.5 53.9 100.0 325 (3.4) (35.0) (0.0) (15.8) (45.8) 100.0 42 1.8 27.0 3.4 13.3 54.4 100.0 191 1.0 24.4 0.5 15.6 58.5 100.0 394 1.8 23.4 1.2 13.6 59.9 100.0 245 1.0 26.5 2.1 18.0 52.4 100.0 259 1.4 29.7 0.0 10.9 58.0 100.0 123 1.4 25.9 1.3 14.9 56.4 100.0 627 _________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 1 If the respondent mentioned more than one provider, only the most qualified is considered in this tabulation. 2 Includes last births in the period 0-59 months preceding the survey for which the mother delivered outside a health facility. 3 Total includes one woman with higher than secondary education. Reproductive and Child Health * 127 Table 9.11 Use of smoking tobacco Percentage of women who use tobacco for smoking, according to selected background characteristics and maternity status, Zimbabwe 1999______________________________________________________________ Uses tobacco_________________________ Does Number Background not Cigar- Other of characteristic smoke ettes tobacco women______________________________________________________________ Age <20 20-34 35+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Maternity status Currently pregnant Currently breastfeeding Neither Total 99.7 0.1 0.0 1,881 99.2 0.4 0.4 2,771 95.5 1.7 2.6 1,256 98.5 0.7 0.7 2,279 98.6 0.5 0.8 3,628 99.7 0.0 0.3 882 98.7 0.7 0.5 477 98.9 0.6 0.4 461 97.3 1.3 0.7 559 97.7 0.7 1.5 302 98.6 0.2 1.3 321 98.7 0.3 1.1 741 98.4 0.8 0.7 629 98.8 0.7 0.5 1,077 98.2 0.7 1.1 457 93.5 2.9 3.4 396 98.6 0.3 1.1 2,377 99.4 0.4 0.1 2,965 97.2 2.8 0.0 168 99.2 0.2 0.6 459 99.4 0.1 0.3 1,138 98.3 0.7 0.9 4,310 98.6 0.6 0.7 5,907 9.12 CHILDHOOD VACCINATIONS The induction of an immune response through vaccination is a widely accepted public health strategy for the prevention of vaccine-preventable infectious diseases. To enable evaluation of the Expanded Programme of Immunization (EPI), the 1999 ZDHS collected information on vaccine coverage for all children born since January 1994. To be considered fully vaccinated a child should have received one dose of BCG vaccine, three doses of each DPT and polio vaccine, and one dose of measles vaccine. Zimbabwe has a defined schedule for the administration of these vaccines. BCG should be given at birth or at first clinic contact and protects against tuberculosis; DPT protects against diphtheria, pertussis, and tetanus. DPT and polio require three vaccinations at approximately three, four, and five months of age; measles should be given at or soon after reaching nine months. Source of Information Information on vaccination coverage was collected in two ways: from child health cards shown to the interviewer and from mothers’ verbal reports. The majority of health centres and clinics in Zimbabwe provide cards on which vaccinations are recorded. If a mother was able to present such a card to the interviewer, it was used as the source of information, with the interviewer 128 * Reproductive and Child Health Table 9.12 Vaccinations by source of information Percentage of children 12-23 months who had received specific vaccines at any time before the survey, by source of information (vaccination card or mother's report), and percentage vaccinated by 12 months of age, Zimbabwe 1999______________________________________________________________________________________________________ Percentage of children who had received:____________________________________________________________________ DPT1 Polio Number Background ___________________ ____________________ of characteristic BCG 1 2 3 1 2 3 Measles All2 None children______________________________________________________________________________________________________ Vaccinated at any time before survey Vaccination card Mother's report Either source Vaccinated by 12 months of age3 68.4 67.8 66.7 65.1 68.2 66.9 65.0 62.3 60.9 0.0 479 19.7 19.7 18.3 15.8 19.5 18.2 15.7 16.9 14.0 11.6 220 88.1 87.5 85.0 80.9 87.7 85.1 80.7 79.1 74.8 11.6 699 87.4 87.5 84.6 77.5 87.5 84.7 77.6 71.4 67.3 11.8 699 _______________________________________________________________________________________________________ 1 Mothers were specifically asked whether the child had received polio vaccine. The DPT coverage rate for children without a written record is assumed to be the same as that for polio vaccine. 2 Children who are fully vaccinated, i.e., those who have received BCG, measles, and three doses of DPT and polio vaccine (excluding polio vaccine given at birth). 3 For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. recording vaccination dates directly from the card. In addition to collecting vaccination information from cards, there were two ways of collecting the information from the mother herself. If a vaccination card had been presented, but a vaccine had not been recorded on the card as being given, the mother was asked to recall whether that particular vaccine had been given. If the mother was not able to provide a card for the child at all, she was asked to recall whether the child had received BCG, polio and DPT (including the number of doses for each), and measles vaccinations. In line with WHO recommendations, children should complete the schedule of vaccinations before 12 months of age. Moreover, vaccines are most effective when given at the appropriate age. Information on childhood immunizations was obtained for all the respondent’s children under five years of age. Vaccination coverage was assessed among children age 12-23 months because it is expected that by one year of age they should have received all the vaccines. Differences in vaccination coverage between subgroups of the population assist in programme planning. Changes in the vaccination programme over time are examined by looking at changes in the vaccination coverage levels during the first year of life for four age cohorts. Table 9.12 provides information on the percentage of children age 12-23 months who had received specific vaccinations at the time of the survey according to the source of information. For 69 percent of the children, the mother produced a vaccination card, and for 31 percent of the children, information was based on mothers’ recall. Three in four children 12-23 months have been vaccinated against the six diseases; 61 percent were recorded on the health card, and mothers reported 14 percent. Vaccinations are most effective when given at the proper age; 67 percent of children were vaccinated by the time they turned one year old. With respect to specific immunizations, children were least likely to have received a measles vaccination (Figure 9.4) Comparison with data from the 1994 ZDHS shows that there has been a decline in vaccination as well as vaccination card coverage. Whereas in 1994, eight in ten mothers were able Reproductive and Child Health * 129 Figure 9.4 Percentage of Children Age 12-23 Months with Specific Vaccinations, Zimbabwe 1999 ZDHS 1999 88% 88% 85% 81% 88% 85% 81% 79% 75% BCG 1 2 3 1 2 3 Measles All DPT Polio to show a vaccination card for their children, this proportion has declined to 69 percent in 1999. Similarly, in 1994, 80 percent of children received all vaccinations, compared with 75 percent in 1999. The decline may be attributed to various factors, including the government’s reduced capacity for financing the health services. Vaccination Coverage Table 9.13 presents data for the percentage of children 12-23 months who had received each vaccine by the time of the survey. There were slight differentials in vaccination coverage by the sex of the child; female children were slightly more likely to be fully immunized than male children (76 percent and 74 percent, respectively). Likewise, male children were more likely to have received no vaccinations against the preventable childhood diseases than female children (14 percent compared with 10 percent). Birth order appears to have a negative association with vaccination coverage; whereas 79 percent of first-order births have received full vaccination, the percentage for children of sixth or higher birth order is 60 percent. Similarly, higher-order children are also more likely not to have received any vaccination (22 percent among children of birth order six or higher compared with 10 percent of first-order children). There were also differences related to the availability of vaccination cards (69 percent of first-birth order children compared with 60 percent of children of birth order six and above. Urban children have better vaccination coverage (81 percent) than rural children (72 percent). Rural children are more likely than urban children to have received no vaccinations (14 percent and 8 percent, respectively). Conversely, children in the rural areas are more likely to have a vaccination card than children in the urban areas (72 percent compared with 61 percent). Significant differentials appeared in vaccination coverage by region. The Midlands had the highest (88 percent) overall coverage, followed by Mashonaland West (84 percent). Bulawayo and 130 * Reproductive and Child Health Table 9.13 Vaccinations by background characteristics Percentage of children 12-23 months who had received specific vaccines by the time of the survey (according to the vaccination card or the mother's report), and the percentage with a vaccination card, according to selected background characteristics, Zimbabwe 1999____________________________________________________________________________________________________________ Percentage of children who had received: Percent-____________________________________________________________________ age with DPT1 Polio No vacci- Number Background ___________________ ____________________ vacci- nation of characteristic BCG 1 2 3 1 2 3 Measles All2 nations card children___________________________________________________________________________________________________________ Sex of child Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher All children 85.9 85.5 84.1 79.9 85.4 84.2 79.4 77.4 74.1 13.5 70.6 352 90.3 89.5 85.9 81.9 90.1 86.0 82.0 80.9 75.6 9.7 66.5 347 89.9 89.9 86.0 84.2 89.9 85.8 83.7 84.0 79.0 9.7 69.0 230 90.8 90.5 89.0 84.0 90.8 89.1 83.8 82.1 76.9 8.8 70.0 274 86.6 85.7 83.3 80.4 85.7 83.3 80.4 77.6 75.8 13.4 73.0 89 78.5 75.9 74.0 66.3 76.6 74.7 66.3 62.2 59.8 21.5 60.4 106 92.5 92.5 90.2 86.1 92.5 89.9 87.0 86.2 81.3 7.5 61.3 227 86.0 85.1 82.5 78.4 85.4 82.8 77.7 75.7 71.7 13.6 72.0 472 75.5 74.0 71.1 62.9 74.0 71.1 62.9 66.6 60.0 24.5 57.8 103 92.1 88.1 85.4 82.8 90.7 89.4 84.1 78.8 73.5 7.9 78.8 60 61.4 61.4 58.6 58.6 60.0 57.1 57.1 55.7 52.9 37.1 55.7 70 95.9 95.9 94.6 93.2 95.9 94.6 90.5 85.4 84.0 4.1 71.9 75 93.7 93.7 91.6 85.5 93.7 91.6 84.4 78.0 72.9 6.3 87.4 40 95.2 94.0 91.6 88.0 94.0 91.6 88.0 78.9 77.7 4.8 78.1 40 95.4 95.4 93.9 89.7 95.4 93.9 89.7 91.1 87.6 4.6 86.1 96 95.9 95.9 91.9 86.5 97.3 91.9 85.1 85.1 78.4 2.7 78.4 70 88.7 88.7 86.8 83.0 88.7 86.8 84.9 84.9 81.1 11.3 43.4 102 100.0 100.0 95.7 91.4 100.0 94.3 91.4 87.1 81.4 0.0 72.9 44 88.0 85.2 85.2 77.8 87.0 87.0 75.6 69.4 67.2 12.0 74.8 45 85.1 83.8 81.0 76.7 84.7 81.3 76.4 74.2 70.0 14.6 68.5 321 91.0 91.3 88.7 85.2 90.7 88.4 85.3 85.2 80.3 8.7 66.9 321 * * * * * * * * * * * 12 88.1 87.5 85.0 80.9 87.7 85.1 80.7 79.1 74.8 11.6 68.6 699 ____________________________________________________________________________________________________________ Note: An asterisk indicates that the figure is based on fewer than 25 children and has been suppressed. 1 Mothers were specifically asked whether the child had received polio vaccine. The DPT coverage rate of children without a written record is assumed to be the same as that for polio vaccine. 2 Children who are fully vaccinated, i.e., those who have received BCG, measles, and three doses of DPT and polio vaccine (excluding polio vaccine given at birth). Harare have a similar coverage of 81 percent. However, low vaccination coverage was recorded in Mashonaland East (53 percent) and Manicaland (60 percent). In the remaining provinces, vaccination coverage ranges from 73 percent (Matabeleland North) to 78 percent (Masvingo and Matabeleland South). High percentages of unvaccinated children were found in provinces with low coverage such as Mashonaland East (37 percent) and Manicaland (25 percent). The percentage of unvaccinated children in the remaining provinces ranges from 3 percent in Masvingo to 8 percent in Mashonaland Central. It is worth noting that 11 percent of the children in Harare have never received any vaccinations. The highest percentages of children with vaccination cards were registered in Matabeleland North and the Midlands (87 percent and 86 percent, respectively). Harare did not fare well with regard to health card coverage; less than half (43 percent) of the children in Harare had vaccination cards. Reproductive and Child Health * 131 Table 9.14 Vaccinations in first year of life Among children one to four years of age, the percentage with a vaccination card and the percentage who had received each vaccine during the first year of life, according to current age of the child, Zimbabwe 1999_____________________________________________________________________ All Current age of child in months children___________________________________ 12-59 Vaccine 12-23 24-35 36-47 48-59 months_____________________________________________________________________ Vaccination card seen by interviewer Percentage vaccinated at 0-11 months1 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles All vaccinations2 No vaccinations Number of children 68.6 60.9 54.2 55.2 60.0 87.4 88.8 85.6 88.0 87.5 87.5 88.4 85.3 87.1 87.1 84.6 84.0 80.7 82.9 83.1 77.5 76.3 71.7 73.1 74.8 87.5 88.6 85.1 88.1 87.3 84.7 85.0 81.4 83.4 83.7 77.6 76.9 72.5 72.9 75.1 71.4 73.6 72.8 67.7 71.4 67.3 65.0 61.3 58.2 63.1 11.8 10.3 11.9 11.1 11.3 699 669 629 611 2,608 _____________________________________________________________________ 1 Information was obtained either from a vaccination card or from the mother if there was no written record. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as that for children with a written vaccination record. 2 Children who have received BCG, measles, and three doses each of DPT and polio vaccines, excluding polio 0, which is given at birth The mothers’ level of education seems to influence their children’s vaccination status. Eighty percent of children whose mothers have a secondary education had received vaccinations, compared with 67 percent whose mothers have no education. Conversely, children whose mothers have no education are more likely to have received no vaccination than children whose mothers have a secondary education (12 percent compared with 9 percent). However, children whose mothers have a primary education (15 percent) are less likely to have received any vaccinations than children whose mothers have no education. Children of mothers with no education are more likely to have a health card than mothers of children who have a secondary education (75 percent compared with 67 percent). Vaccinations in the First Year of Life Table 9.14 shows the percentage of children 12-59 months of age who have a vaccination card, as well as the percentage of children who received each vaccine during the first year of life. Information was based on records on the vaccination card and mother’s recall. The table illustrates changes in the vaccination programme over time. The coverage of health cards shows an increasing trend: from 55 percent for children born between 1994 and 1995, to 69 percent for children born between 1997 and 1998. Vaccination coverage also shows an increasing trend; 58 percent of children born in 1994-1995 have received full vaccination compared with 67 percent of children born in 1997-1998. 132 * Reproductive and Child Health There are insignificant differences in the coverage for each vaccine. However, throughout the 1994-1998 period, the percentage of children who missed the opportunity to be vaccinated against these diseases remained at the same level (about 11 percent). 9.13 PREVALENCE AND TREATMENT FOR ACUTE RESPIRATORY INFECTION (ARI) Information on treatment practices for and utilisation of health services by children with the three common childhood illnesses which are diarrhoea, acute respiratory infection, and fever, help assess the impact of national programmes aimed at reducing the prevalence of these illnesses. Current strategies such as Integrated Management of Childhood Illnesses (IMCI) try to prevent deaths from pneumonia and malaria as well as diarrhoea. The information on prevalence and treatment of acute respiratory infection (ARI) and fever is useful to assess coverage of these programmes and to plan for improvements. ARI, primarily pneumonia, is a common cause of illness and death in infancy and childhood. In Zimbabwe, ARI is a leading cause of childhood mortality. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths from pneumonia. Emphasis is placed on recognition of the signs of impending severity, both for mothers and primary health care workers, so that help can be sought. In the 1999 ZDHS, the prevalence of ARI was collected based on the mother’s perception of illness and was not validated by medical personnel. Mothers were asked whether their children under the age of five years had been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. Table 9.15 shows that 16 percent of the children were reported to have the illness. The prevalence of respiratory illness varies by the age of the child, rising to a peak at 6-23 months of age, then falling thereafter. The sex of the child is not associated significantly with ARI. The prevalence of ARI does not have a clear pattern in relation to the child’s birth order. Urban-rural and provincial differences, however, are substantial. Children in rural areas are much more likely than urban children to have been ill with ARI in the past two weeks (18 percent and 11 percent, respectively). Children in Matabeleland North and Bulawayo have the lowest levels of reported ARI (4 to 5 percent). In other provinces, ARI prevalence varies widely from 28 percent in Mashonaland Central to 10 percent in Mashonaland West. The 1999 ZDHS data show that the mother’s education has a small impact on the children’s ARI prevalence, except for women with higher than a secondary education who have the lowest level. Whether this wide range of apparent ARI prevalence reflects genuine differences in morbidity or is due to differences in perceptions of the disease or its severity cannot be ascertained from these data. One in two children with a respiratory illness were taken to a health facility of some kind. Use of health facilities does not vary significantly across the child’s background characteristics, except province of residence. Children in Masvingo and Harare are the most likely to be taken to a health facility for treatment of ARI (64 percent), while those in Manicaland and Mashonaland East are the least likely to get help from a health provider (39 percent or less). Reproductive and Child Health * 133 Table 9.15 Prevalence and treatment of acute respiratory infection Percentage of children under five years who were ill with a cough accompanied by short, rapid breathing (ARI) during the two weeks preceding the survey, percentage of children with ARI taken to a health facility or provider, by selected background characteristics, Zimbabwe 1999________________________________________________________________ Percentage Percentage of children of children with cough with ARI taken accompanied to a health Number Background by rapid facility or of characteristic breathing (ARI) provider1 children________________________________________________________________ Child's age <6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex of child Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher All children2 13.8 44.4 351 20.6 54.1 310 20.6 53.3 699 16.8 51.7 669 12.5 41.3 629 11.5 49.1 611 16.0 50.1 1,660 15.6 49.5 1,609 14.9 53.4 1,082 17.6 49.4 1,229 15.2 47.0 509 13.9 45.5 450 11.3 54.6 1,079 18.1 48.4 2,191 16.2 38.9 510 27.8 49.5 302 17.1 36.7 285 9.6 57.8 323 5.4 47.8 174 14.6 54.0 205 22.6 44.1 420 17.5 63.5 338 13.3 63.9 518 4.2 46.2 194 17.8 39.2 223 15.6 48.9 1,460 16.1 52.5 1,514 9.5 49.0 72 15.8 49.8 3,269 ________________________________________________________________ ARI = Acute respiratory infection 1 Includes health post, health centre, hospital, or private doctor 9.14 POSSESSION AND USE OF BEDNETS Fever is a major manifestation of malaria, although it also accompanies various other illnesses. Malaria is endemic throughout most of Zimbabwe and is a common cause of hospital admissions for all age groups. The use of treated bednets is a principal health intervention to control the mosquitoes that transmit malaria. This table examines household possession of bednets and their use by young children during the night preceding the interview. This night is taken as typical of use; however, since the prevalence of mosquitoes varies according to season and other climatic conditions, the interpretation of the results needs to take into account both the time of year and the location of the household. 134 * Reproductive and Child Health Table 9.16 Possession and use of bednets Percent distribution of households by presence of bednets, and among households with children under five years, the percent distribution by use of bednets by children under five on the night preceding the interview, according to selected background characteristics, Zimbabwe 1999_________________________________________________________________________________________________________________ Among households with children under five years, use of bednets by children Presence of bednet in household under five on the night preceding the interview________________________________________ __________________________________________________ Number Number of None of Background house- All Some of the house- characteristic Yes No Missing Total holds children children children1 Missing Total holds2__________________________________________________________________________________________________________________ Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education of head of household No education Primary Secondary Higher Total 4.1 95.9 0.0 100.0 1,008 0.7 0.0 98.9 0.4 100.0 413 14.3 85.7 0.0 100.0 516 4.0 0.0 93.0 3.0 100.0 245 8.0 92.0 0.0 100.0 591 1.3 0.0 95.4 3.4 100.0 235 10.1 89.6 0.3 100.0 632 2.6 0.4 93.6 3.4 100.0 266 13.0 87.0 0.0 100.0 303 1.9 0.0 93.4 4.6 100.0 148 6.7 93.3 0.0 100.0 307 2.2 0.3 97.2 0.3 100.0 156 9.5 90.5 0.0 100.0 733 4.2 0.0 94.4 1.4 100.0 335 8.2 91.8 0.0 100.0 636 2.1 0.6 96.6 0.6 100.0 290 14.7 85.0 0.3 100.0 1,215 5.1 0.4 90.7 3.8 100.0 417 14.3 85.5 0.1 100.0 427 6.9 0.8 88.7 3.6 100.0 155 3.6 96.4 0.0 100.0 890 1.3 0.3 96.6 1.8 100.0 323 6.5 93.4 0.1 100.0 2,834 1.8 0.1 96.8 1.3 100.0 1,198 14.1 85.8 0.2 100.0 2,212 4.0 0.4 92.1 3.5 100.0 1,001 28.8 71.2 0.0 100.0 390 12.3 0.0 83.7 4.0 100.0 121 10.2 89.7 0.1 100.0 6,369 3.0 0.2 94.4 2.3 100.0 2,659 ___________________________________________________________________________________________________________________ 1 Includes households without a bednet 2 Includes households with missing information on education of the head of household. Overall, only 10 percent of households with children under age 5 have a bednet. The presence of a bednet in a house varies by province, with households in Harare, Bulawayo, and Mashonaland Central reporting the highest percentages (14 to 15 percent) and Manicaland reporting the lowest (4 percent). There is a strong relationship between the household head’s education and the presence of a bednet in the house. Households whose head has a secondary or higher education are much more likely (14 percent or higher) than households whose head has primary or no education (7 percent or less) to have a bednet. In households with children under age 5, only 3 percent of the children in the house slept under the bednet the night prior to the survey. Again, Harare and Bulawayo show the highest percentage of children sleeping under a bednet. The household head’s education again plays an important role in determining whether children in the house sleep under a bednet. In households with children under 5 whose head has a secondary or higher education, 12 percent of the children slept under a bednet, compared with 4 percent or less in households whose head has less education. 9.15 PREVALENCE OF FEVER AND SOURCE OF TREATMENT Since fever is the major manifestation of malaria, in the 1999 ZDHS mothers were asked whether their children under five years had had a fever in the 2 weeks preceding the survey. Overall, one in four children under 5 was reported to have had a fever in the two weeks prior to the survey. The prevalence varies by the child’s age, reaching a peak of 37 percent or higher among children age 6-23 months. Reproductive and Child Health * 135 Table 9.17 Prevalence of fever and sources of treatment Percentage of children under five years who were ill with a fever during the two weeks preceding the survey, and among those with fever, the percentage taken to specific sources of treatment, by selected background characteristics, Zimbabwe 1999_____________________________________________________________________________________________________________ Among children with fever, percentage taken to: ____________________________________________________________________ Percentage Health of chil- center Number Background dren with Private (Mission Field Traditional of characteristic fever physician Hospital1 facility)1 worker Pharmacy Shop practitioner Other children_____________________________________________________________________________________________________________ Child's age <6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex of child Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All children2 18.1 3.0 3.0 17.3 1.5 0.0 6.4 0.0 4.0 351 39.0 2.1 5.3 26.0 2.5 2.1 8.4 0.7 2.8 310 36.5 3.0 7.0 29.0 0.0 2.0 7.3 1.1 4.8 699 25.8 1.9 5.9 24.3 2.8 2.3 9.0 0.0 4.4 669 20.6 2.7 5.4 15.9 0.4 2.3 10.0 0.8 3.0 629 16.6 4.4 4.5 31.3 0.9 0.0 12.1 0.0 2.5 611 26.4 3.2 7.3 23.5 1.1 1.9 7.6 0.5 4.6 1,660 25.1 2.3 3.9 26.5 1.4 1.5 9.9 0.6 2.9 1,609 22.8 4.8 3.6 25.5 0.0 1.9 9.2 0.0 3.0 1,082 28.2 3.4 7.4 22.5 1.6 2.5 7.3 1.1 2.5 1,229 23.7 0.0 5.8 26.0 2.6 0.8 12.5 0.7 6.1 509 28.9 0.0 4.9 29.5 1.3 0.0 8.0 0.0 6.8 450 22.6 9.3 7.4 16.8 0.0 4.2 6.7 0.0 0.0 1,079 27.3 0.1 5.0 28.3 1.7 0.7 9.5 0.8 5.4 2,191 32.6 0.0 5.5 23.9 0.0 0.0 13.7 0.9 9.2 510 29.5 0.9 9.6 22.3 2.7 1.4 16.0 1.8 4.5 302 27.2 1.3 2.6 19.2 1.3 0.0 5.1 0.0 7.7 285 18.2 3.3 10.0 22.2 5.1 1.7 3.4 0.0 1.7 323 15.2 0.0 18.2 20.6 0.0 0.0 0.0 1.6 0.0 174 14.7 0.0 6.4 31.9 3.2 1.6 4.8 0.0 0.0 205 35.1 0.0 3.0 30.7 0.7 0.7 11.1 0.7 2.7 420 25.9 0.0 7.5 34.4 2.2 2.2 5.4 0.0 2.2 338 26.7 12.5 2.8 19.4 0.0 5.6 5.6 0.0 0.0 518 11.0 11.8 2.9 26.5 0.0 5.9 0.0 0.0 0.0 194 25.4 0.0 3.4 18.4 4.5 0.0 18.6 0.0 0.0 223 26.0 0.2 5.3 24.8 1.5 1.5 8.5 1.1 6.3 1,460 25.8 5.5 6.4 26.9 0.5 2.1 7.1 0.1 2.2 1,514 23.5 7.4 3.7 6.0 0.0 5.6 17.4 0.0 0.0 72 25.8 2.8 5.7 25.0 1.2 1.7 8.7 0.5 3.8 3,269 _____________________________________________________________________________________________________________ 1 Includes both public and private facilities 2 Children born in the period 0-59 months preceding the survey There is negligible difference in the prevalence of fever by sex of the child. Birth order does not show a clear pattern on differentials by prevalence of fever. Rural children are more likely than their urban counterparts to get fever (27 percent compared with 23 percent). Prevalence of fever varies by province, ranging from 11 percent in Bulawayo to 35 percent in the Midlands. Mothers’ education has no significance to the prevalence of fever. Less than half of the children with fever (49 percent) were taken somewhere for treatment or given something to treat the fever. The most popular source of treatment is a health centre (25 percent), followed by shops (9 percent) and hospitals (6 percent). This could be influenced by 136 * Reproductive and Child Health the availability of over-the-counter drugs for the relief of fever and pain, such as cafenol and paracetamol. The percentage of mothers who sought treatment from a traditional practitioner for their child’s fever is less than 1 percent. Regarding treatment of fever, there are slight differentials in the sources of treatment according to the child’s sex; male children are more likely to be taken to a hospital, while female children are more likely to be taken to a health centre. Rural women are more likely to seek treatment for their children from a health centre than those in urban areas (28 percent and 17 percent, respectively). Seeking treatment from private physicians is almost exclusively limited to mothers in urban areas. Use of private physicians is more pronounced in the urban provinces of Bulawayo and Harare (12 to 13 percent). Getting treatment from a shop is more popular among women with no education and women with higher than secondary education (17 to 18 percent), while children whose mothers have a primary or secondary education are more likely to seek treatment from a health centre (25 to 27 percent). 9.16 HAND-WASHING FACILITIES IN THE HOUSEHOLD The connection between hand washing and diarrhoea is well established. Increasing the frequency of hand washing and improving the quality of necessary materials, such as running water, soap cleanser and a basin, substantially decreases the occurrence of diarrhoea in young children. Table 9.18 shows the percentage of households by the type of hand-washing facilities available in the house as seen by the interviewer. Overall, 11 percent of households have the three required materials; 27 percent have water, 14 percent have soap, and 21 percent have a basin to collect the water. Large disparities existed between urban and rural areas with respect to hand- washing materials and facilities. Although 27 percent of households in the urban areas have all of the necessary materials for washing hands, the corresponding proportion in the rural areas is only 2 percent. The availability of hand-washing materials and facilities was generally low in the rural provinces, ranging from 2 in Manicaland to 12 percent in Matabeleland North. In the urban provinces, the proportions are expectedly much higher: 27 percent in Harare and 34 percent in Bulawayo. Households with piped water are the most likely to have the three hand-washing requirements (22 percent). Only 1 percent of other households have these materials. One in four households that has a water source in their dwelling has all of the required hand-washing materials, while only 2 percent or less of other households do. Reproductive and Child Health * 137 Table 9.18 Hand-washing facilities in households Percentage of households with hand-washing materials and facilities, by selected background characteristics, source of water supply, and time to water source, Zimbabwe 1999________________________________________________________________________ Hand-washing materials and facilities__________________________________ All three Number Background Soap require- of characteristic Water or ash Basin ments1 households________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Source of water Piped Protected well Open well Surface Other/Missing Time to water source In dwelling <2 minutes 2-4 minutes 5-9 minutes 10+ minutes Missing Total 64.1 31.5 43.4 26.6 2,424 4.8 2.7 6.3 1.7 3,945 12.1 3.2 7.3 2.0 1,008 11.8 5.1 10.4 3.1 516 11.4 6.3 9.9 3.2 591 17.8 8.7 17.1 7.2 632 22.4 14.0 33.6 11.5 303 13.7 5.5 9.3 4.3 307 15.2 5.2 9.7 4.5 733 14.8 10.0 13.6 9.1 636 59.9 30.5 44.8 26.9 1,215 79.1 43.6 41.5 34.4 427 53.7 26.2 36.7 22.1 3,072 4.0 1.7 7.2 1.1 520 2.6 2.1 4.8 1.1 2,358 2.5 0.7 5.9 0.7 400 9.4 9.4 0.0 0.0 19 57.2 29.0 39.9 24.5 2,800 66.7 0.0 11.4 0.0 25 19.4 3.2 11.7 0.0 124 6.8 2.4 7.3 1.7 460 2.0 1.4 4.5 0.5 2,871 13.1 2.2 5.5 2.2 89 27.4 13.6 20.5 11.2 6,369 ________________________________________________________________________ 1 Water, soap or ash or other cleanser, and basin. 9.17 APPROPRIATE HAND WASHING Diarrhoea is transmitted by a faeco-oral route. Hence, hygienic practices such as hand washing are critical in the control of diarrhoea. The control of diarrhoeal disease (CDD) programme, which emphasizes fluid replacement and hygienic behaviours such as hand washing, is aimed at preventing and reducing the virulence of diarrhoeal diseases. Table 9.19 displays the actual occurrence of hand washing at appropriate times when health can be seriously affected, before feeding a child, and after cleaning a child who has defecated. It should be noted that there may be some bias in the results since they are based on the mother’s report and not actual observation of the behaviour. In general, three in four women with children under five years old washed their hands at appropriate times; 84 percent before feeding the child and 76 percent after cleaning the child. There are minimal differences between rural and urban areas and some differences across provinces. Women in Matabeleland South are the least likely to perform these practices, while women in Mashonaland East and Mashonaland West are the most likely to wash their hands at the appropriate times. Although appropriate hand washing was practised across all levels of education, 66 percent of women with higher than a secondary education washed their hands after cleaning a child that had defecated, compared with 79 percent of mothers with no education. 138 * Reproductive and Child Health Table 9.19 Appropriate hand washing by background characteristics Percentage of women with living children under 5 years of age who wash their hands at appropriate times, by background characteristics, Zimbabwe 1999___________________________________________________ Hand washing at appropriate times__________________ After cleaning Before child Number Background feeding that has of characteristic child defecated women___________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 86.7 77.9 914 82.3 75.4 1,720 81.2 74.9 386 81.0 77.1 244 89.6 83.5 229 90.2 80.4 265 82.4 76.0 144 76.8 68.3 157 82.0 76.1 326 79.1 70.6 278 87.9 80.1 443 84.6 69.5 162 77.7 78.9 162 83.8 75.3 1,149 84.6 77.4 1,257 84.2 65.8 64 83.8 76.3 2,633 Table 9.20 presents the percentage of women with children under five according to their hand-washing practice and the materials and facilities available in the household. Data from the 1999 ZDHS show that hand-washing practice does not vary by the source of water; time to water sources, or availability of soap, water, and basin to collect the water. 9.18 DISPOSAL OF CHILDREN’S STOOL Table 9.21 presents the percent distribution of children under five years of age by the way in which their stool is disposed of, according to background characteristics and the type of toilet facilities in household. In general, three in four children have their stool contained. There were disparities in the disposal of children’ stools between urban and rural residents. In the urban areas, the most common method of disposal was the toilet or latrine (77 percent). In the rural areas, the usual modes for disposing of stool are: to throw it in the toilet or latrine (38 percent), bury it in the yard (24 percent), or to throw it outside the dwelling (inside and outside of the yard) (20 percent). The disposal of stool in the toilet or latrine by region ranges from a low of 36 percent in Matabeleland North to 67 and 73 percent in Bulawayo and Harare, respectively. This could be related to the availability of toilets in the urban provinces. The mother’s education has an influence on the method of disposal of stool. Women with no education tend to bury their children’s stool in and outside the yard (57 percent), while those with higher than a secondary education mainly use the toilet (85 percent). Reproductive and Child Health * 139 Table 9.20 Appropriate hand washing by selected household characteristics Percentage of women with living children under 5 years of age who wash their hands at appropriate times, by source of water supply, time to water source, hand-washing materials, and presence in the household of a child with diarrhea in the two weeks preceding the survey, Zimbabwe 1999_____________________________________________________ Hand washing at appropriate times__________________ After cleaning Before child Number Household feeding that has of characteristic child defecated women_____________________________________________________ Source of water Piped 84.0 77.1 1,161 Protected well 86.8 77.2 221 Open well 82.9 75.2 1,053 Surface 84.3 76.4 190 Other/Missing 81.2 69.3 8 Time to water source In dwelling 85.2 77.3 1,070 <2 minutes * * 5 2-4 minutes 70.3 62.6 41 5-9 minutes 83.5 72.4 203 10+ minutes 83.1 76.6 1,281 Missing 88.6 76.1 33 Hand-washing materials Water 84.4 77.4 629 Soap or ash 84.3 77.2 288 Basin 85.5 78.8 485 All three requirements1 84.1 76.8 239 Total 83.8 76.3 2,633_____________________________________________________ Note: An asterisk indicates that the estimate is based on fewer than 25 women and has been suppressed. 1 Water, soap or ash or other cleanser, and basin 9.19 PREVALENCE OF DIARRHOEA Dehydration caused by severe diarrhoea is a major cause of morbidity and mortality among young children. A simple and effective response to dehydration is a prompt increase in fluid intake, i.e., oral rehydration therapy (ORT). In Zimbabwe, the use of a sugar-salt-water solution to combat dehydration from diarrhoea is the particular method of ORT promoted by the Control of Diarrhoeal Disease programme in the Ministry of Health, i.e., recommended home fluid (RHF). The chief concern of the CDD is to prevent dehydration or to treat it early before it becomes life-threatening. In the 1999 ZDHS, women who had a birth in the past five years were asked questions about their knowledge of sugar-salt-solution and treatment of diarrhoea in general. For all children experi- encing a bout of diarrhoea in the past two weeks, mothers were asked whether there was blood in the stool, whether fluid intake was increased or decreased, whether the child was given a sugar-salt- water solution, and whether anything else was given to the child in response to the diarrhoea. 140 * Reproductive and Child Health Table 9.21 Disposal of children's stools Percent distribution of children under five years of age by way in which child's fecal matter is disposed of, according to background characteristics and type of toilet facilities in households, Zimbabwe 1999 _____________________________________________________________________________________________________________ Stools contained Stools uncontained ________________________ ___________________________________________ Child always Thrown uses into Buried Thrown Thrown Not Number Background toilet/ toilet/ in outside outside Washed disposed Other/ of characteristic latrine latrine yard dwelling yard away of Missing Total children1 _____________________________________________________________________________________________________________ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher Toilet facilities None Pit latrine Improved latrine Flush toilet Other/Missing Total 26.1 51.0 5.8 0.3 1.2 13.6 0.1 1.8 100.0 914 7.7 37.7 23.9 4.4 15.9 5.7 2.5 2.1 100.0 1,720 7.3 52.9 20.6 2.4 4.8 9.2 2.8 0.0 100.0 386 3.2 54.8 22.5 3.9 9.5 4.4 0.7 1.0 100.0 244 7.8 47.4 23.5 2.6 13.1 1.3 0.9 3.5 100.0 229 14.1 41.1 17.5 5.7 11.0 8.7 0.8 1.1 100.0 265 24.3 12.0 16.6 3.5 36.7 2.3 1.2 3.5 100.0 144 17.7 23.8 11.7 5.5 29.1 6.9 0.3 5.0 100.0 157 9.8 43.9 24.0 5.0 11.0 2.9 1.6 1.9 100.0 326 11.5 29.3 25.0 2.4 14.9 8.1 6.8 2.0 100.0 278 18.6 54.5 1.3 0.0 0.0 22.5 0.0 3.0 100.0 443 43.2 23.9 21.6 1.9 5.4 2.3 0.4 1.2 100.0 162 6.2 28.0 27.5 5.3 24.2 4.8 2.4 1.7 100.0 162 11.6 37.7 21.4 4.5 13.6 7.1 2.1 1.9 100.0 1,149 16.6 47.7 13.6 1.5 7.1 10.2 1.2 2.2 100.0 1,257 28.4 56.5 5.9 0.0 0.0 7.7 0.0 1.5 100.0 64 2.1 5.3 40.0 9.1 29.9 5.9 4.9 2.9 100.0 730 10.8 60.9 12.3 1.3 5.3 6.5 0.9 2.1 100.0 391 11.2 64.6 11.2 0.8 5.6 5.0 0.5 1.2 100.0 632 27.6 48.8 6.2 0.4 1.2 14.0 0.1 1.8 100.0 874 16.7 65.4 0.0 0.0 0.0 0.0 0.0 17.9 100.0 6 14.1 42.3 17.7 3.0 10.8 8.4 1.6 2.0 100.0 2,633 _____________________________________________________________________________________________________________ 1 Children under five years of age Table 9.22 presents the prevalence of diarrhoea in children under five years of age. Overall, 14 percent of the children had experienced diarrhoea at some time in the two weeks preceding the survey. Diarrhoeal prevalence increases with age to peak at 6-23 months (25 to 28 percent) then falls again at older ages (see Figure 9.5). Reproductive and Child Health * 141 Table 9.22 Prevalence of diarrhoea Percentage of children under five years with diarrhoea during the two weeks preceding the survey, by selected background characteristics, Zimbabwe 1999___________________________________________ Diarrhoea Number Background preceding of characteristic 2 weeks children1___________________________________________ Child's age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex of child Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher All children1 6.1 351 27.7 310 25.0 699 13.5 669 7.5 629 5.5 611 14.3 1,660 13.4 1,609 12.5 1,082 15.6 1,229 13.5 509 12.8 450 11.9 1,079 14.8 2,191 18.4 510 13.3 302 14.3 285 12.9 323 7.4 174 11.0 205 17.8 420 17.5 338 10.4 518 7.1 194 16.7 223 15.5 1,460 11.6 1,514 18.9 72 13.9 3,269 ___________________________________________ 1 Children born in the period 0-59 months preceding the survey The sex and birth order of the child have little impact on the prevalence of diarrhoea. Residence, however, makes a difference to a child’s risk of having diarrhoea. Rural children are more likely than urban children to have diarrhoea (15 percent compared with 12 percent). The prevalence of diarrhoea is highest in Manicaland, the Midlands, and Masvingo (18 percent) and lowest in Matabeleland North and Bulawayo (7 percent). Variation in diarrhoea prevalence by mother’s education is generally negligible. The slightly higher prevalence of diarrhoea among children of women with higher education could be linked to the greater awareness of the problem among better-educated women. 142 * Reproductive and Child Health Table 9.23 Knowledge of sugar-salt-water solution Percentage of mothers with births in the five years preceding the survey who know about the use of sugar-salt-water solution (recommended home fluid) for treatment of diarrhoea in young children, by selected background characteristics, Zimbabwe 1999__________________________________________________ Percentage of mothers who know about Number Background sugar-salt-water of characteristic solution mothers___________________________________________________ Age 15-19 20-24 25-29 30-34 35+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher Total 92.3 230 96.4 687 97.3 523 98.9 265 97.2 313 97.8 665 96.0 1,353 94.3 322 96.7 195 98.9 174 92.5 200 98.4 105 95.7 120 97.4 253 98.6 209 97.1 326 99.5 115 90.8 132 94.8 866 99.0 979 (97.6) 41 96.6 2,018 6% 28% 25% 14% 8% 6% < 6 6-11 12-23 24-35 36-47 48-59 Child's Age in Months ZDHS 1999 Figure 9.5 Diarrhoea Prevalence by Child's Age, Zimbabwe 1999 9.20 KNOWLEDGE OF SUGAR-SALT-WATER SOLUTION Table 9.23 shows the percentage of mothers who know about the use of sugar- salt-water solution (recommended home fluid) to treat diarrhoea in young children, among women who had a birth in the five years preceding the survey. General knowl- edge of sugar-salt-water solution among mothers is nearly universal (97 percent); yet when asked about specific eating and drink- ing regimes for sick children, the findings are less encouraging (see Table 9.25). Young mothers (age 15-19), those living in Manica- land and Mashonaland West, and mothers with no education are less likely than other mothers to know about sugar-salt-water solution. 9.21 DIARRHOEA TREATMENT Dehydration resulting from severe diarrhoea, is among the leading causes of childhood morbidity and mortality in Zimba- bwe and the condition is amenable to treat- ment by oral rehydration therapy. The combi- nation of a high mortality rate and the avail- ability of effective treatment make diarrhoea and its treatment high-priority concerns for health services. Reproductive and Child Health * 143 Table 9.24 Diarrhoea treatment Among children under five years who had diarrhoea in the two weeks preceding the survey, the percentage taken for treatment to a health provider, the percentage who received oral rehydration therapy (ORT) (recommended home fluids (RHF) or increased fluids), and the percentage given other treatments, according to selected background characteristics, Zimbabwe 1999___________________________________________________________________________________________________________ ORT___________________ Other treatments Percentage Recom- Neither ___________________ taken to mended RHF nor Home Number Background a health home Increased increased Injec- remedy/ of characteristic provider1 fluid fluids fluids tion other Missing children___________________________________________________________________________________________________________ Child's age <6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex of child Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher All children 23.0 34.6 45.1 43.9 0.0 41.3 36.7 21 30.0 62.0 48.2 24.7 1.2 62.2 14.2 86 32.3 73.0 55.7 17.0 0.0 55.6 8.8 175 29.6 71.7 45.6 19.8 0.0 70.6 6.9 91 39.7 71.0 49.5 17.5 0.0 70.5 5.0 47 38.5 80.4 49.1 16.6 0.0 58.7 13.5 33 34.8 67.5 49.9 18.5 0.4 62.1 10.5 238 29.1 71.1 51.4 22.3 0.0 59.7 10.9 215 36.1 62.8 50.9 22.5 0.0 63.1 12.0 135 31.5 71.3 49.7 19.4 0.5 59.5 11.4 191 32.5 78.0 55.0 16.3 0.0 65.1 9.4 69 24.5 66.6 47.8 23.2 0.0 55.9 6.7 58 29.5 68.3 54.8 17.2 0.0 68.7 7.1 129 33.2 69.5 49.0 21.5 0.3 57.9 12.1 324 21.2 61.1 41.6 29.1 0.0 69.8 4.9 94 38.9 71.0 56.3 17.9 0.0 67.9 9.9 40 41.4 78.1 53.6 12.2 0.0 36.6 9.8 41 28.6 59.6 38.0 35.6 0.0 38.0 30.8 42 (28.8) (61.4) (38.6) (26.1) (0.0) (22.8) (19.6) 13 40.0 87.1 48.5 10.7 0.0 49.3 2.1 23 28.0 66.6 43.8 24.7 1.4 68.5 15.5 75 42.9 71.4 69.8 17.5 0.0 65.1 11.1 59 (32.1) (75.0) (60.7) (3.6) (0.0) (78.6) (3.6) 54 * * * * * * * 14 (25.0) (60.0) (29.7) (37.4) (0.0) (57.2) (15.4) 37 27.9 67.8 50.1 21.0 0.0 55.4 11.1 226 38.9 73.5 55.0 15.7 0.0 67.9 9.2 176 * * * * * * * 14 32.1 69.2 50.6 20.3 0.2 61.0 10.7 453 __________________________________________________________________________________________________________ Note: Figures in parentheses are based on 25 to 49 children who had diarrhoea. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. RHF = Recommended home fluid (homemade sugar-salt-water solution)1 Includes health centre, hospital, clinic, and private doctor In the 1999 ZDHS, for each child under 5 years of age, mothers were asked whether the child had experienced an episode of diarrhoea in the two weeks prior to the survey. Mothers were also asked what treatment was given to those children who had diarrhoea. Table 9.24 shows that one of three children under five who were reported to have had diarrhoea in the two weeks before the survey were taken to a health provider. A larger proportion of children were given the recom- mended home fluids (69 percent), 61 percent were given home remedies, and 51 percent were given increased fluids. Older children, male children, first order children, and rural children are more likely to have been taken to a health facility for treatment than other children. Recommended home fluid (RHF), sugar-salt-water solution, is widely used (62 to 80 percent) for children age 6 months and above. The low use of RHF for children below 6 months of age (35 percent) is probably due to the promotion of exclusive breastfeeding. Home remedies 144 * Reproductive and Child Health Table 9.25 Feeding practices during diarrhoea Percent distribution of children under five years who had diarrhoea in the two weeks preceding the survey, by amount of liquid given and amount of food given compared with normal practice, Zimbabwe 1999_______________________________________ Percent_______________________________________ Amount of fluid given Same as usual 25.4 More 50.6 Less 22.6 Don't know/missing 1.4 Amount of food given Same as usual 27.5 More 15.6 Less 56.0 Don't know/missing 0.9 Total 100.0 Number of children1 453 _______________________________________ 1 Children born in the period 0-59 months preceding the survey Table 9.26 Women's status and children's health care Percentage of children age 12-23 months who were fully vaccinated, and among children under five years who were ill with ARI, fever, or diarrhoea in the two weeks preceding the survey, the percentage taken to a health provider, by women’s decision- making capability, Zimbabwe 1999_____________________________________________________________________________ Percentage Percentage of ill children under of children five years who were taken to a Indicator 12-23 months health provider for treatment of:2 of women's fully __________________________________ status vaccinated1 ARI Fever Diarrhoea_____________________________________________________________________________ Number of decisions with woman having final say 0-1 13.1 6.9 4.3 4.5 2-3 22.4 18.6 13.3 13.9 4-5 42.6 24.4 17.1 13.7 All children3 699 517 843 453_____________________________________________________________________________ 1 Received BCG, measles, and three doses of DPT and polio. 2 Includes health post, health centre, hospital, private doctor 3 Children born in the period 0-59 months preceding the survey are widely used to treat children of all ages. The insignificant percentage for administration of injections as part of diarrhoea management could be indicative of the possible appropriateness of diarrhoea treatment protocols in use. 9.22 FEEDING PRACTICES DURING DIARRHOEA The data in Table 9.25 show that a large proportion of mothers did not practice proper manage- ment of childhood disease. For example, only half of the children with diarrhoea were given an increased amount of fluid. The remaining children were either given less fluids (23 percent) or the same amount of fluids (25 percent). The same pattern is shown for the amount of food given to children with diarrhoea; 56 percent were given less food, 28 percent were given the same amount, and only 16 percent received more food. 9.23 WOMEN’S STATUS AND CHILDREN’S HEALTH CARE Status and self-respect can be major determi- nants of a mother’s ability to obtain adequate health care for her children. In the 1999 ZDHS, women were asked about their ability to make decisions in the family. In Table 9.26, preventative and curative aspects of health care are presented according to this indicator of the status of women. There is a strong positive relationship between women’s independence and children’s health care. Children whose mothers have the most decisionmaking power are more likely to be fully vaccinated and to get treatment for all childhood diseases. For example, 43 percent of children of women with four to five decisions have been vaccinated, compared with 13 percent of children of mothers who can make no decision or only one decision. Infant Feeding and Childhood and Maternal Nutrition * 145 10INFANT FEEDING AND CHILDHOOD AND MATERNAL NUTRITION 10.1 BREASTFEEDING AND SUPPLEMENTATION The 1999 ZDHS collected data from mothers on the feeding patterns of all of their children under five years of age. In this chapter, the data are used to evaluate infant feeding practices, including breastfeeding duration, introduction of supplementary weaning foods, and use of feeding bottles. As part of the survey, the height and weight of all children under five and of women age 15-49 were measured. The pattern of infant feeding has important influences on both the child and the mother. Feeding practices are the principal determinants of a child’s nutritional status. Poor nutritional status in young children exposes them to greater risks of morbidity. Biologically, breastfeeding suppresses the mother’s return to the fertile status and, hence, the length of the birth interval and the level of fertility. These effects are influenced by both the duration and frequency of breastfeeding and by the age at which the child receives foods and liquids to supplement breast milk. 10.2 INITIAL BREASTFEEDING Colostrum, which is contained in the first breast milk after delivery, has been shown to be highly nutritious and has a high concentration of antibodies that protect babies from infection. The Zimbabwe Ministry of Health and Child Welfare (MOH&CW) has promoted “rooming in” in maternity hospitals to ensure that newborn babies are kept with their mother at bedside, allowing feeding on demand as opposed to scheduled feeding in the nursery. Currently, about 22 percent of all hospitals in Zimbabwe have been designated baby friendly. Table 10.1 shows that breastfeeding is nearly universal in Zimbabwe, with 98 percent of children born in the past five years having been breastfed at some time. Overall, 63 percent of children were breastfed within an hour of birth. The proportion of children who receive early breastfeeding varies by province. Whereas more than 70 percent of newborns in Harare, Bulawayo, Mashonaland West, and Matabeleland North were breastfed within an hour of delivery, in Manicaland, only 44 percent of newborns received the same attention. Children are less likely to receive breast milk during the first hour of birth if they live in rural areas, were delivered by a traditional midwife, were born at home, or were born to mothers with a higher education. Whereas two in three babies were given breast milk within the first hour of birth, 92 percent were breastfed within the first 24 hours after delivery. Variations across subgroups of children are much smaller than early breastfeeding. 146 * Infant Feeding and Childhood and Maternal Nutrition Table 10.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and who started breastfeeding within one hour and within one day of birth, by background characteristics, Zimbabwe 1999 _______________________________________________________________________ Percentage who started breastfeeding: _______________________ Percentage Within Within Number Background ever 1 hour 1 day of characteristic breastfed of birth of birth1 children _______________________________________________________________________ Sex Male 97.4 62.2 90.9 1,827 Female 98.1 63.8 92.1 1,732 Residence Urban 98.4 69.5 92.4 1,159 Rural 97.4 59.7 91.1 2,401 Region Manicaland 96.9 43.6 89.7 573 Mashonaland Central 96.5 57.8 93.4 338 Mashonaland East 97.5 68.4 86.3 313 Mashonaland West 98.0 70.8 94.7 349 Matabeleland North 98.3 85.3 94.0 186 Matabeleland South 97.9 66.9 84.3 222 Midlands 96.7 55.3 91.6 457 Masvingo 99.2 65.2 96.9 359 Harare 99.0 70.2 91.6 552 Bulawayo 97.9 71.7 91.5 211 Education No education 96.0 54.0 93.0 253 Primary 97.5 62.2 92.4 1,605 Secondary 98.3 65.8 90.8 1,629 Higher 98.7 45.6 82.7 73 Assistance at delivery Medically trained 97.8 68.2 93.1 2,578 Traditional midwife 97.6 53.0 90.3 626 Other or none 97.8 42.2 83.8 339 Place of delivery Health facility 97.8 68.0 93.0 2,569 At home 97.5 50.0 88.2 828 Other 100.0 57.2 96.8 31 Total 97.7 63.0 91.5 3,559 _______________________________________________________________________ Note: Total includes some children for whom assistance at delivery and place of delivery are missing. 1 Includes children who started breastfeeding within one hour of birth. 10.3 BREASTFEEDING STATUS BY CHILD’S AGE Breast milk contains all the nutrients needed by children in the first six months of life and is an uncontaminated nutritional source. Supplementing breast milk before 4 months of age is unnecessary and is indeed discouraged since the likelihood of contamination and resulting risk of diarrhoeal disease are high. Early supplementation also reduces breast milk output since the production and release of milk is modulated by the frequency and intensity of suckling. Infant Feeding and Childhood and Maternal Nutrition * 147 Table 10.2 Breastfeeding status by child's age Percent distribution of living children under three years of age by breastfeeding status, according to child's age in months, Zimbabwe 1999______________________________________________________________________________ Breastfeeding and: __________________ Not Plain Number Child's age breast- Exclusively water Supple- of in months feeding breastfed only ments Total children______________________________________________________________________________ <4 4-6 7-9 <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28-29 30-31 32-33 34-35 0.4 38.9 26.6 34.0 100.0 257 0.6 7.2 6.3 85.9 100.0 165 4.5 0.0 4.9 90.6 100.0 141 0.8 60.7 20.6 17.9 100.0 113 0.0 21.7 31.5 46.8 100.0 143 0.0 11.5 9.5 79.0 100.0 94 0.8 0.8 4.3 94.1 100.0 123 7.1 0.0 3.5 89.4 100.0 89 5.1 0.0 0.0 94.9 100.0 98 3.5 0.8 1.4 94.3 100.0 125 8.3 1.0 1.9 88.7 100.0 102 23.4 0.0 0.0 76.6 100.0 140 29.2 0.0 0.0 70.8 100.0 105 56.9 0.7 0.9 41.5 100.0 110 72.3 0.0 0.0 27.7 100.0 117 88.4 0.0 0.0 11.6 100.0 110 94.6 0.0 0.3 5.1 100.0 123 97.2 0.0 0.0 2.8 100.0 107 98.7 0.0 0.0 1.3 100.0 104 100.0 0.0 0.0 0.0 100.0 127 100.0 0.0 0.0 0.0 100.0 99 ______________________________________________________________________________ Note: Breastfeeding status refers to last 24 hours. Children classified as breastfeeding and plain water only receive no supplements. Table 10.2 shows breastfeeding practices from birth until the third birthday. Supplementation starts early in Zimbabwe; exclusive breastfeeding is not common. Among children under four months old, 27 percent had received water and 34 percent were given other supplements. Although the practice of exclusive breastfeeding to age four months is relatively low, compared with that in 1994, it has increased. In fact, compared with the situation in 1994, there is a general increase in breastfeeding and a decline in early supplementation. The change may be due to nutrition education messages that discourage early supplementation. By the time children reach two and a half years, all but 1 percent of children have been completely weaned. 10.4 MEDIAN DURATION AND FREQUENCY OF BREASTFEEDING Table 10.3 shows that half of the children under age three in Zimbabwe were breastfed until 19.6 months. The median duration does not vary by the child's sex and urban or rural residence. However, the length of breastfeeding varies slightly by mother's education; mothers with a secondary education have a shorter duration, compared with those with a primary education or less. Breastfeeding durations vary by region, ranging from 18 months in Bulawayo to 23 months in Matabeleland North. Type of assistance at delivery makes little difference in duration of breastfeeding. 148 * Infant Feeding and Childhood and Maternal Nutrition Table 10.3 Median duration and frequency of breastfeeding Median durations of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children under three years, and the percentage of children under six months who were breastfed six or more times in the 24 hours preceding the survey, according to background characteristics, Zimbabwe 1999 ___________________________________________________________________________________________________ Children under Median duration (months) of breastfeeding six months among children under three years1 __________________ _____________________________________________ Percentage Any Exclusive Predominant Number breastfed Number Background breast- breast- breast- of 6+ times in of characteristic feeding feeding feeding2 children last 24 hours children ___________________________________________________________________________________________________ Sex of child Male Female Residence Urban Rural Region Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Mother's education No education Primary Secondary Higher Assistance at delivery Medically trained Traditional midwife Other or none All children Mean1 for all children P/I3 19.6 1.2 2.6 1,140 91.7 187 19.7 1.5 2.7 1,052 94.9 164 19.1 1.6 3.0 721 95.8 114 20.2 1.2 2.5 1,470 91.9 237 19.3 1.6 1.9 353 90.1) 53 20.2 0.6 1.7 210 (85.9) 37 19.2 1.5 3.0 187 (89.6) 29 19.4 2.1 3.6 219 (92.1) 38 22.9 0.8 3.5 110 (97.5) 17 20.2 0.8 3.5 136 (90.5) 20 19.4 2.2 4.1 283 (100.0) 43 21.1 1.2 1.8 217 (89.4) 36 19.2 1.3 3.1 349 100.0 59 18.0 0.7 2.9 128 (93.1) 18 20.4 2.2 3.2 142 95.8 19 20.8 1.0 2.4 956 91.3 148 18.7 1.5 2.8 1,051 94.3 181 (14.3) (2.5) (2.5) 42 * 3 19.6 1.3 2.7 1,595 92.1 256 20.7 1.2 2.4 377 96.8 57 19.0 1.8 2.6 213 95.1 36 19.6 1.3 2.7 2,191 93.2 351 19.0 2.6 3.9 NA NA NA 18.6 1.9 3.3 NA NA NA ___________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 cases; an asterisk indicates that a figure is based on fewer than 25 children and has been suppressed. NA = Not applicable 1 Median and mean based on current status 2 Either exclusively breastfed or received only plain water, water-based liquids, and/or juice. 3 Prevalence-incidence mean Infant Feeding and Childhood and Maternal Nutrition * 149 Table 10.4 Foods received by children in preceding 24 hours Percentage of children under three years of age who received specific foods in the 24 hours preceding the interview, by breastfeeding status and child's age. Zimbabwe 1999______________________________________________________________________________________________ Percentage of children who received specific foods in preceding 24 hours __________________________________________________________________________ Solid/semisolid foods_________________________________ Meat/ Grains/ Tubers/ Using Breast fish/ bread/ roots/ bottle Number Child's age milk Infant Other Other poultry/ cereal/ plan- with a of in months only formula milk liquids eggs porridge tains Other nipple children______________________________________________________________________________________________ BREASTFEEDING CHILDREN______________________________________________________________________________________________ <4 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-23 24-29 30-35 <2 months 4-6 months 7-9 months Total 61.2 1.1 0.0 2.1 0.0 16.6 0.0 2.4 3.0 112 21.7 3.4 1.1 4.3 0.0 44.8 0.4 9.4 2.2 143 11.5 5.7 4.2 24.4 6.7 71.3 6.6 33.6 10.4 94 0.8 0.7 5.1 41.1 14.9 88.9 10.5 59.8 9.9 122 0.0 3.1 12.8 57.4 30.0 90.7 18.9 72.2 18.4 83 0.0 1.6 8.8 54.7 33.9 100.0 15.8 81.9 4.1 93 0.8 3.0 15.8 63.6 47.3 96.2 13.3 83.7 6.7 121 1.1 1.5 18.2 62.8 48.2 92.5 12.2 86.8 1.2 94 0.0 0.0 12.6 65.6 43.0 97.1 19.2 91.4 4.9 107 0.5 0.6 13.8 76.6 48.0 97.0 14.1 91.9 6.4 154 * * * * * * * * * 22 * * * * * * * * * 1 39.1 2.4 0.6 3.3 0.0 32.4 0.2 6.4 2.6 256 7.2 3.6 5.0 33.3 7.3 78.2 8.4 44.1 10.7 164 0.0 2.2 9.3 48.9 27.6 90.8 15.6 68.2 14.5 135 10.0 1.9 9.1 45.7 27.3 79.0 10.7 60.9 6.3 1,147 ______________________________________________________________________________________________ NONBREASTFEEDING CHILDREN ______________________________________________________________________________________________ Total 0.0 1.3 23.2 77.8 50.9 84.8 15.2 82.9 4.4 882 ______________________________________________________________________________________________ Note: Breastfeeding status refers to last 24 hours. Percentages may sum to more than 100 percent because child may have received more than one type of supplement. The category of tubers and roots also includes plantains and unripe bananas. An asterisk indicates a figure is based on fewer than 25 cases and has been suppressed. Overall, 93 percent of the children under six months old were breastfed six times or more in the 24 hours preceding the interview. On average, children were fed 7.7 times during the day and six times at night (data not shown). The frequency of daytime feeding varies only slightly by the sex of the child, mother’s education, and urban or rural residence. Differences in frequency of feeding by province are also slight. 10.5 FOODS RECEIVED BY CHILDREN IN THE PRECEDING 24 HOURS Table 10.4 presents the percentage of children under three years by type of foods received in the 24 hours before the interview. Among breastfeeding children, use of infant formula is uncommon in the early months of a child’s life. This is true not only among breastfeeding children, but also among nonbreastfeeding children. However, introduction of solid food and food made of grain such as sadza, porridge or thin gruel is early; 17 percent of infants have started receiving these types of food in their first month. By age 10-11 months, all children under three have been given solid food. As expected, nonbreastfeeding children are more likely to have received solid foods than breastfeeding children. 150 * Infant Feeding and Childhood and Maternal Nutrition Table 10.5 Frequency of foods received by children in preceding 7 days Mean number of days specific foods were received by children under three years of age in the 7 days preceding the interview, by breastfeeding satus and child's age, Zimbabwe 1999__________________________________________________________________________________________________________ Mean number of days children received specific foods in preceding 7 days____________________________________________________________________________________ Solid/semisolid foods_______________________________________________________ Other Grains/ Vita- milk/ bread/ Fruit/ Beans/ Meat/ Any min-A- Number Child's age Infant cheese/ Other cereal/ vege- Tubers/ legumes/ fish/ solid rich of in months formula yogurt liquids porridge tables plantains lentils eggs food foods children__________________________________________________________________________________________________________ BREASTFEEDING CHILDREN__________________________________________________________________________________________________________ <2 2-3 4-5 6-7 8-9 10-11 12-15 16-19 20-23 24-27 28-31 32-35 <4 months 4-5 months 6-9 months Total 0.1 0.0 2.5 1.1 0.0 0.0 0.1 0.0 1.1 0.0 112 0.1 0.2 5.1 3.2 0.1 0.0 0.2 0.0 3.3 0.2 143 0.4 0.5 5.9 4.9 1.1 0.3 1.5 0.3 5.2 1.2 94 0.0 1.0 6.6 6.1 2.5 0.8 2.3 0.8 6.6 2.9 122 0.2 1.2 6.8 6.3 3.8 1.0 2.7 1.7 6.6 4.3 83 0.2 0.7 6.9 6.9 5.2 0.8 3.1 2.2 7.0 5.5 93 0.2 1.3 7.0 6.5 5.5 0.7 2.6 2.5 6.8 5.7 214 0.1 1.1 7.0 6.7 6.0 1.1 2.6 2.4 7.0 6.1 181 0.0 0.9 7.0 6.6 5.9 0.9 2.1 2.5 7.0 6.1 80 * * * * * * * * * * 19 * * * * * * * * * * 4 * * * * * * * * * * 0 0.1 0.1 4.0 2.3 0.1 0.0 0.1 0.0 2.3 0.1 256 0.4 0.5 5.9 4.9 1.1 0.3 1.5 0.3 5.2 1.2 94 0.1 1.1 6.7 6.2 3.0 0.9 2.5 1.2 6.6 3.5 205 0.1 0.8 6.1 5.5 3.6 0.7 1.9 1.5 5.7 3.8 1,147 __________________________________________________________________________________________________________ NONBREASTFEEDING CHILDREN __________________________________________________________________________________________________________ <16 16-19 20-23 24-27 28-31 32-35 Total * * * * * * * * * * 25 0.2 2.7 7.0 7.0 6.2 2.3 3.3 3.6 7.0 6.2 63 0.0 2.1 7.0 6.8 6.6 1.2 3.3 3.4 7.0 6.7 147 0.1 1.8 7.0 6.8 6.3 0.9 2.8 3.4 7.0 6.5 213 0.1 1.7 7.0 6.8 6.4 1.0 2.8 2.9 7.0 6.5 206 0.1 1.8 7.0 6.9 6.4 1.2 2.7 3.4 7.0 6.6 226 0.1 1.9 7.0 6.8 6.3 1.2 2.8 3.3 7.0 6.5 882 __________________________________________________________________________________________________________ Note: Breastfeeding status refers to last 7 days. The category of tubers and roots also includes plantains and unripe bananas. An asterisk indicates that a figure is based on fewer than 25 children and has been suppressed. 10.6 FREQUENCY OF FOODS RECEIVED BY CHILDREN IN THE PRECEDING SEVEN DAYS Table 10.5 shows the frequency of feeding of specific foods in the seven days before the interview. Among breastfeeding children, other liquids, foods made of grain, and solid food were given on average on six of the seven days preceding the survey. For children under two months old, other liquids were given on average 2.5 days in the past week, and solid foods including food made of grain were given one day in the week before the survey. Meat, fish, and eggs were given on average about two days in the week preceding the survey. Nonbreastfeeding children are as likely to receive infant formula as breastfeeding children but are more likely to have been given supplements compared to breastfeeding children. Infant Feeding and Childhood and Maternal Nutrition * 151 10.7 MICRONUTRIENTS The 1999 ZDHS included several questions to evaluate the micronutrient status of mothers and children. Micronutrient deficiency is a serious contributor to childhood morbidity and mortality. Micronutrients are available in foods and can also be provided through food fortification and direct supplementation. Breastfeeding children benefit from supplementing the mother, especially with vitamin A. Table 10.6 shows that three in four children under age three received food rich in vitamin A. Older children and children who were not breastfed in the past 24 hours tend to get vitamin- A- rich foods. Children whose mothers have a secondary education or higher are more likely to have been given foods rich in vitamin A. There is virtually no difference according to the child’s sex and urban-rural residence, and there are only small differences by province of residence. Looking at the mother’s age at birth, children of young mothers (15-19 years) are the least likely to have received foods rich in vitamin A. Children of women with a higher than secondary education are the most likely to have received foods rich in vitamin A. Night blindness is used as an indicator of severe vitamin A deficiency, especially among pregnant women. The second part of the table is limited to the last-born child under three years. Four percent of these children are born to mothers who reported experiencing night blindness during pregnancy. This symptom of vitamin A deficiency does not vary much across subgroups of children. However, it is more prevalent among mothers of high birth order children and women in the Midlands and Masvingo. Mothers of children age 19-23 months are less likely to have had night blindness during pregnancy. Pregnant women were recommended to take iron tablets during pregnancy. In 1999, less than 6 percent of pregnant women took 90 or more iron tablets. This proportion varies across subgroups of mothers. Mothers of first order children, those who live in the Midlands and Masvingo, and women who have higher than a secondary education are more likely to have taken 90 or more iron tablets during their pregnancy. However, less than 5 percent of mothers in Mashonaland Central, Mashonaland East, Mashonaland West, Matabeleland North, and Matabeleland South took 90 or more iron tablets during their last pregnancy. It is interesting that in Harare, only 1 percent of mothers took 90 or more iron tablets during pregnancy. 10.8 NUTRITIONAL STATUS OF CHILDREN The anthropometric data on height and weight collected in the 1999 ZDHS permit the measurement and evaluation of the nutritional status of young children in Zimbabwe. This evaluation allows identification of subgroups of the child population that are at increased risk of faltered growth, disease, impaired mental development, and death. Trends in child malnutrition can also be assessed by comparing the 1999 ZDHS results with those obtained from the 1994 ZDHS. Evaluation of nutritional status is based on the rationale that in a well-nourished population, there is a statistically predictable distribution of children of a given age regarding height and weight. Use of a standard reference population facilitates analysis of any given population over time, as well as comparison of subgroups of the population. One of the most commonly used reference populations, and the one used in this report, is the NCHS (U.S. National Centre for Health Statistics) standard, which is recommended for use by the World Health Organisation (WHO). 152 * Infant Feeding and Childhood and Maternal Nutrition Table 10.6 Micronutrients Percentage of children under three years of age who received vitamin- A-rich foods and among last- born children under three years of age, percentage whose mother suffered from night blindness during the pregnancy and percentage whose mother received iron supplements, by background characteristics and breastfeeding status, Zimbabwe 1999_____________________________________________________________________________________ Last-born children under three years Children under three years __________________________________________________________ Mother Mother took Received was night 90+ iron vitamin- Number blind tablets Number Background A-rich of during during of characteristic foods children pregnancy pregnancy children_____________________________________________________________________________________ Child's age 0-6 months 7-11 months 12-18 months 19-23 months 24-35 months Sex of child Male Female Birth order 1 2-3 4-5 6+ Breastfeeding status Exclusive or predominant breastfeeding Complementary foods Not breastfeeding Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Mother's age at birth <20 years 20-24 years 25-29 years 30-34 years 35+ years Total 19.9 422 3.6 4.1 413 79.5 239 5.4 6.5 237 90.0 423 5.3 6.3 416 91.0 276 1.9 8.4 271 87.1 669 4.5 4.9 563 73.4 1,040 4.5 5.8 972 73.4 989 3.9 5.6 928 73.1 679 3.4 7.5 635 72.2 795 4.3 5.0 757 72.5 289 4.1 4.8 262 78.4 267 5.9 4.5 247 7.0 223 7.1 3.4 221 76.5 924 3.7 5.8 915 86.9 882 4.0 6.3 765 76.4 668 2.8 3.8 628 71.9 1,361 4.9 6.7 1,273 75.5 321 3.6 5.4 299 71.6 187 4.3 2.5 176 65.5 170 4.4 2.5 160 70.5 204 5.3 3.2 189 71.0 106 1.2 0.4 101 67.5 126 1.3 4.1 113 77.0 265 9.2 12.4 243 75.7 207 6.0 16.8 201 75.9 326 1.9 1.2 311 76.2 116 1.8 5.3 107 73.6 126 5.4 8.7 117 72.3 884 4.5 4.4 817 73.5 979 3.8 6.1 926 91.5 41 4.3 15.8 41 68.6 434 3.6 5.3 398 73.3 667 3.6 6.0 632 74.7 450 5.8 6.0 419 78.4 238 3.5 5.8 227 74.9 239 4.9 5.2 225 73.4 2,029 4.2 5.7 1,900 _____________________________________________________________________________________ Note: Breastfeeding status refers to last 24 hours. Infant Feeding and Childhood and Maternal Nutrition * 153 Three standard indices of physical growth that describe the nutritional status of children are presented: • height-for-age • weight-for-height • weight-for-age Each of these indices gives different information about growth and body composition that can be used to assess nutritional status. Height-for-age is a measure of linear growth. A child who is below minus two standard deviations (-2 SD) from the median of the NCHS reference population in terms of height-for-age is considered short for his/her age, or stunted, a condition reflecting the cumulative effect of chronic malnutrition. If the child is below minus three standard deviations (-3 SD) from the reference mean, then the child is considered severely stunted. A child between -2 SD and -3 SD is considered moderately stunted. Weight-for-height describes current nutritional status. A child who is below minus two standard deviations from the reference mean for weight-for-height is considered too thin for his/her height, or wasted, a condition reflecting acute or recent nutritional deficit. As with stunting, wasting is considered severe if the child is more than three standard deviations below the reference mean. Severe wasting is closely linked to mortality risk. Weight-for-age is a composite index of weight-for-height and height-for-age and thus does not distinguish between acute malnutrition (wasting) and chronic malnutrition (stunting). A child can be underweight for his/her age because s/he is stunted, because s/he is wasted, or because s/he is wasted and stunted. Weight-for-age is a good overall indicator of a population's nutritional health. In the survey, all children listed in the Household Questionnaire who were born since January 1994 were eligible for height and weight measurement. Of the 3,209 children (age 0-59 months at the time of the survey) eligible for measurement, 2,520 (78 percent) had consistent height and weight measures. The following analysis focuses on these children. Table 10.7 shows the percentage of children under age five classified as malnourished according to height-for-age, weight-for-height, and weight-for-age indices, by the child’s age and other selected demographic characteristics. The percentage of stunted children (below -2 SD) is 27 percent. Male children are more likely to be stunted than female children (28 percent compared with 25 percent). The extent of stunting increases with birth order but decreases with birth interval. Stunting also increases with age, peaking at age 12-23 months. In fact, all anthropometric indices peak at this age group, which may coincide with the weaning period. Comparisons with data from the 1994 ZDHS are complicated by the fact that previously, only children under age three born to interviewed women were weighed and measured, while the 1999 survey included all children under age five in the household. 154 * Infant Feeding and Childhood and Maternal Nutrition Table 10.7 Nutritional status of children by demographic characteristics Percentage of children under five years classified as malnourished according to three anthropometric indices of nutrition status: height-for-age, weight-for-height and weight-for-age, by selected demographic characteristics, Zimbabwe 1999____________________________________________________________________________________________________ Height-for-age Weight-for-height Weight-for-age______________________ ______________________ ______________________ Per- Per- Per- Per- Per- Per- centage centage Mean centage centage Mean centage centage Mean Number Demographic below below Z-score below below Z-score below below Z-score of characteristic -3 SD -2 SD1 (SD) -3 SD -2 SD1 (SD) -3 SD -2 SD1 (SD) children____________________________________________________________________________________________________ Child's age <6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex Male Female Birth order 1 2-3 4-5 6 + Birth interval First birth <24 months 24-47 months 48 months All children2 2.1 6.0 0.1 0.9 7.2 0.5 0.0 1.9 0.6 272 3.6 17.4 -0.6 2.4 7.0 0.1 0.3 9.5 -0.5 246 14.7 36.9 -1.4 2.7 9.7 -0.2 3.4 18.2 -1.0 563 12.1 30.1 -1.3 1.3 4.5 -0.0 2.3 17.3 -0.9 507 7.1 25.8 -1.1 1.0 5.3 -0.1 1.0 12.9 -0.8 465 9.7 27.2 -1.2 1.1 5.1 -0.0 0.5 10.5 -0.8 467 10.3 28.0 -1.1 2.0 7.2 -0.1 1.8 13.4 -0.7 1,287 8.5 24.8 -0.9 1.2 5.7 0.0 1.3 12.6 -0.6 1,233 8.1 23.5 -1.0 1.7 6.9 -0.1 1.3 11.7 -0.7 766 9.4 26.9 -1.0 1.6 6.0 0.0 1.6 12.7 -0.6 946 9.8 28.3 -1.1 1.0 6.1 -0.0 1.4 13.7 -0.7 425 11.6 29.2 -1.2 2.0 6.8 -0.0 1.9 15.5 -0.8 383 8.2 23.6 -1.0 1.7 7.1 -0.1 1.4 11.9 -0.7 774 11.1 29.9 -1.2 1.7 5.2 0.1 1.7 16.8 -0.7 179 10.5 28.2 -1.1 1.6 5.8 0.0 1.4 14.2 -0.7 963 8.8 26.4 -0.9 1.4 7.0 -0.0 1.8 11.2 -0.6 604 9.4 26.5 -1.0 1.6 6.4 -0.0 1.5 13.0 -0.7 2,520 ____________________________________________________________________________________________________ Note: Each of the indices is expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO International Reference Population. The percentage of children who are more than three or more than two standard deviations below (i.e., away in the negative direction) the median of the International Reference Population (-3 SD and -2 SD) are shown according to demographic characteristics.1 Includes children who are below -3 standard deviations from the Interntional Reference Population median2 Children born in the period 0-59 months preceding the survey The weight-for-height index gives information about children’s recent experience with food intake. Wasting represents failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of recent illness or of seasonal variations in the food supply. Overall, 6 percent of children under five are wasted. Stunting is accompanied by wasting in all subgroups of children except by birth order. First order children are the least likely to be stunted, but the most likely to be wasted. Overall, 13 percent of children are underweight, which may reflect stunting, wasting, or both. Malnutrition increases with the child’s age and peaks for children 12-23 months. Children 12- 35 months have the least desirable nutritional status (Figure 10.1). In general, based on the three indices, boys have slightly lower nutritional status than girls. Low weight-for-age increases sharply with decreasing length of birth interval, from 17 percent among children with intervals less than 24 months to 11 percent among children with intervals 48 months or longer. Infant Feeding and Childhood and Maternal Nutrition * 155 Figure 10.1 Prevalence of Stunting by Age of Child and Mother's Education, Zimbabwe 1999 27% 6% 17% 37% 30% 26% 27% 35% 29% 23% 14% ZIMBABWE AGE OF CHILD (MONTHS) < 5 6-11 12-23 24-35 36-47 48-59 MOTHER'S EDUCATION No education Primary Secondary Higher Severe Stunting Moderate Stunting ZDHS 1999 Table 10.8 shows the variation in malnutrition indices by urban-rural residence, province, and mother’s education. In general, urban children have better nutritional status than rural children. For example, 21 percent of urban children are stunted, compared with 29 percent of rural children. The percentage of children who are stunted in Mashonaland West, Manicaland, and Masvingo is about twice as high as in the province with the lowest level (Bulawayo). Children of women with no formal education are more likely to be stunted than children whose mothers have at least some secondary education (35 percent compared with 14 percent). Variations in wasting and low weight-for-age by background characteristics follow patterns similar to those observed for stunting. Children living in rural areas, children of uneducated women, and children living in Mashonaland West and Mashonaland East are particularly prone to wasting. Lower levels of wasting and weight-for-age do not necessarily suggest an improved nutritional status, but rather an adaptation to chronic food shortage. Children’s nutritional status is inversely related to their mother’s education (Figure 10.1). This was true for all three anthropometric indices. Children whose mothers have had no education are more than twice as likely to be stunted as children whose mothers have higher than a secondary education. 156 * Infant Feeding and Childhood and Maternal Nutrition Table 10.8 Nutritional status of children by background characteristics Percentage of children under five years of age classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by selected background characteristics, Zimbabwe 1999 ____________________________________________________________________________________________________ Height-for-age Weight-for-height Weight-for-age ______________________ ______________________ ______________________ Per- Per- Per- Per- Per- Per- centage centage Mean centage centage Mean centage centage Mean Number Background below below Z-score below below Z-score below below Z-score of characteristic -3 SD -2 SD1 (SD) -3 SD -2 SD1 (SD) -3 SD -2 SD1 (SD) children ____________________________________________________________________________________________________ Residence Urban Rural Region Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher All children2 6.9 20.6 -0.8 1.0 3.7 0.2 0.7 7.5 -0.4 803 10.6 29.2 -1.1 1.9 7.7 -0.1 1.9 15.6 -0.8 1,717 12.5 35.3 -1.4 0.5 3.8 0.0 0.7 16.3 -0.8 420 9.5 25.2 -1.1 0.4 7.4 -0.2 2.3 17.4 -0.8 211 10.8 27.0 -0.8 3.9 12.7 -0.3 2.0 15.2 -0.8 203 11.5 32.1 -0.7 7.9 19.4 -0.3 3.3 16.7 -0.7 217 7.3 23.9 -1.2 1.0 5.9 -0.3 4.1 18.9 -1.0 161 6.3 23.0 -1.2 0.9 2.9 -0.1 1.7 15.3 -0.8 168 5.2 22.9 -1.0 0.3 2.9 -0.1 1.4 9.9 -0.7 365 16.0 31.3 -1.0 1.5 8.8 0.2 0.4 11.3 -0.5 257 6.8 20.5 -0.8 1.1 3.7 0.2 1.1 5.8 -0.4 364 6.5 16.2 -0.9 0.0 1.2 0.2 0.4 8.1 -0.5 155 13.1 35.3 -1.4 3.0 8.2 -0.3 3.4 21.2 -1.1 192 10.9 29.2 -1.1 1.4 7.4 -0.1 1.9 15.8 -0.8 1,115 7.5 22.9 -0.9 1.6 5.4 0.1 0.9 9.1 -0.5 1,161 4.6 13.5 -0.7 0.0 3.8 0.5 0.0 8.8 -0.1 52 9.4 26.5 -1.0 1.6 6.4 -0.0 1.5 13.0 -0.7 2,520 ____________________________________________________________________________________________________ Note: Each of the indices is expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO International Reference Population. The percentage of children who are more than three or more than two standard deviations below (i.e., away in the negative direction) the median of the International Reference Population (-3 SD and -2 SD) are shown according to demographic characteristics. 1 Includes children who are below -3 standard deviations from the International Reference Population median 2 Children born in the period 0-59 months preceding the survey 10.9 NUTRITIONAL STATUS OF WOMEN The nutritional status of women is represented by two indices: height and body mass index (BMI). The BMI is computed as the ratio of weight in kilograms to the square height in centimetres (kg/cm2). The average height of women in the 1999 ZDHS sample is 159 cm, and less than 2 percent of the women are shorter than 145 cm. There are small differences across residence; however, women’s height seems to have a positive relation with their education. Using a cutoff point of 145 cm, below which a woman will be identified as being at risk, women 15-19 years old, rural women, women in Mashonaland West, and those with no education are more likely to be shorter than 145 cm. Infant Feeding and Childhood and Maternal Nutrition * 157 Table 10.9 Nutritional status of women by background characteristics Among women age 15-49, mean height and percentage under 145 cm, mean body mass index (BMI), percentage whose BMI is below 18.5, mean DHS Z-score, and percentage wasted, by selected background characteristics, Zimbabwe 1999 __________________________________________________________________________________________ Height Weight-for-height1 ______________________ ______________________________________ Mean Per- body Per- Per- Mean centage Number mass centage Number Mean centage Number Background height below of index below of DHS below of characteristic in cm 145 cm women (kg/m2) 18.5 women Z-score -2 SD women __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-49 Residence Urban Rural Region Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 157.6 2.9 1,374 22.0 9.6 1,372 -0.3 2.3 1,366 159.3 1.6 1,230 22.8 4.6 1,233 -0.1 0.6 1,222 160.2 1.4 981 23.5 5.8 982 -0.2 2.9 977 159.8 1.9 631 24.7 2.0 633 -0.1 1.5 631 160.5 1.0 1,398 25.3 3.9 1,397 -0.1 4.8 1,394 160.0 1.2 2,108 24.3 5.1 2,107 0.1 1.8 2,099 159.0 2.1 3,507 23.1 5.8 3,510 -0.3 3.1 3,490 158.1 1.8 838 23.4 4.3 840 -0.2 2.2 837 .159.0 1.1 424 22.7 4.8 424 -0.4 3.0 420 .160.0 1.3 453 23.7 6.6 454 -0.1 3.7 452 .157.2 7.7 517 23.8 6.1 522 -0.2 3.8 508 159.8 0.3 305 22.9 8.0 305 -0.4 4.5 305 159.6 0.5 291 23.3 6.5 291 -0.3 3.3 291 159.9 1.3 748 23.3 7.7 748 -0.2 2.8 746 160.2 1.5 617 23.1 3.6 614 -0.2 2.0 614 160.2 1.1 963 24.1 4.6 961 0.1 0.9 959 .160.0 0.5 459 24.7 5.7 459 0.1 2.7 458 .158.4 3.5 647 22.6 8.7 647 -0.5 4.9 642 .159.2 1.8 2,422 23.5 5.2 2,424 -0.2 2.9 2,412 .159.8 1.3 2,200 23.7 5.0 2,200 -0.0 1.6 2,190 160.6 1.9 318 24.9 5.7 318 0.2 1.8 317 .159.7 0.0 28 23.9 8.7 28 -0.2 1.6 28 159.4 1.8 5,615 23.6 5.6 5,618 -0.2 2.6 5,590 __________________________________________________________________________________________ Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in centimenters (kg/m2). The DHS Z-score is based on a study of elite mothers in DHS surveys and indicates the number of standard deviation units (SD) from the median of the DHS de facto reference population. The percentage of mothers who are more than two standard deviations below (i.e., away in the negative direction) the median of the DHS reference population (-2 SD) are shown according to background characteristics. 1 Excludes pregnant women and women with a birth in the preceding 2 months Table 10.9 shows that the mean BMI for women in Zimbabwe is 23.4, and 5 percent of women have a BMI of less than 18.5. Women with no education have the highest risk of chronic energy deficiency—9 percent of these women have a BMI of less than 18.5. Women age 15-19 tend to be shorter and are more likely to have a BMI of less than 18.5. However, many of these women have not reached their mature stature. Using a BMI of 18.5 as a cutoff point, Midlands and Matabeleland North have the highest percentage of women with a BMI lower than 18.5, while Masvingo and Manicaland have the lowest percentage (4 percent). 1 These estimates of survival times assume no use of anti-retroviral therapies. AIDS and other STDs * 159 AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES 11 Acquired Immune Deficiency Syndrome (AIDS) is one of the most serious public health and development challenges to ever affect sub-Saharan Africa. In Zimbabwe, it is estimated that one in four adults age 15-49 is currently infected with HIV, the virus that causes AIDS (UNAIDS/WHO, 2000). This estimate would mean that 1.4 million men and women will develop or already have developed AIDS. Furthermore, 56,000 children under age 15 are estimated to be HIV-infected. About three-quarters of all AIDS cases occur among people in the most economically productive age group, 20-45 years. The deaths of these individuals constitute a serious economic and social tragedy in the lives of surviving family, friends, and employers. The principal mode of HIV transmission in Zimbabwe is heterosexual contact, which accounts for an estimated 92 percent of all HIV infections in the country (NACP, 1999). The duration between HIV infection and the onset of AIDS varies but averages about nine to ten years, and death typically ensues within one to two years of symptom onset.1 The second most important mode of transmission is perinatal transmission (7 percent of all HIV infections), in which the mother passes HIV to the child during pregnancy or around the time of birth. It has been estimated that approximately 30 percent of babies born to HIV-positive mothers will be infected around the time of birth. It is now understood that the virus may also be passed from mother to infant during breastfeeding. Most children infected perinatally will die before their fifth birthday. The children of HIV-infected parents who are not themselves infected are still at a great disadvantage due to the health-related and social consequences of losing one or both parents to AIDS. It is estimated that since 1990, the number of Zimbabwean children under 15 who are living without one or both parents has grown from about 400,000 to more than 1 million (Hunter and Williamson, 2000), with most of the increase being the result of sharp rises in the rates of adult mortality (see Chapter 12). The future course of Zimbabwe’s AIDS epidemic depends on a number of important variables including the level of AIDS-related knowledge among the general public, social stigmatisation, risk behaviour modification, access to high-quality services for sexually transmitted diseases (STD), and the provision of HIV testing and counseling. Zimbabwe’s National AIDS Co-ordination Programme (NACP) is at the forefront of the efforts to bring down the barriers to effective HIV/AIDS programmes and has provided a “Strategic Framework for a National Response to HIV/AIDS” (NACP, 1999) to galvanise a national commitment. The data obtained from the 1999 ZDHS provide a good opportunity to assess levels and trends for some of these factors. This chapter first presents the findings about current levels of general and more specific knowledge on AIDS-related issues. Since knowledge of one’s own HIV serostatus is considered an important step leading to constructive attitude and behaviour change, information on the prevalence of HIV testing is provided. Next, findings are presented on the level of knowledge of and experience with other sexually-transmitted infections which are important co- factors in HIV transmission. The chapter concludes by providing information on patterns of sexual activity and condom use. The principal objective of this chapter is to establish the prevalence of 160 * AIDS and other STDs relevant knowledge, perceptions, and behaviours at the national level and also within geographic and socioeconomic subgroups of the population. In this way, AIDS control programmes can target those groups of individuals most in need of information and most at risk of infection. 11.1 KNOWLEDGE OF WAYS TO PREVENT HIV/AIDS If women and men reported that they had heard of AIDS, they were asked whether and how HIV/AIDS can be avoided. Two types of questions were asked on the ways to avoid getting HIV/AIDS. First, an open-ended question was asked, and respondents were allowed to provide any and all ways that they knew without prompting. Next, women and men were asked specific questions on whether using condoms and limiting their sexual activity to one partner can reduce their chances of getting AIDS. Tables 11.1.1 and 11.1.2 provide results on AIDS prevention knowledge. The first column shows that 4 percent of women and 1 percent of men said that they did not know of AIDS or the virus that causes AIDS. The second column gives the overall percentage of men and women who could not cite a single way of avoiding HIV/AIDS, either because they did not know about HIV/AIDS at all, because they said they did not know whether it could be avoided, because they thought it could not be avoided, or because they thought it could be avoided but could not cite a single way of preventing transmission. The results shows that 17 percent of women and 7 percent of men could not cite a way to avoid getting HIV/AIDS. Large differentials are observed across geographic and socioeconomic characteristics of the populations. For both men and women, the youngest and oldest age groups had the lowest levels of knowledge about ways to avoid AIDS. Level of education is very closely linked to level of AIDS prevention knowledge. About 45 percent of women without any formal education did not mention a way to avoid HIV/AIDS, compared with less than 1 percent of those with more than a secondary school education. Rural men and especially rural women were much less knowledgeable than their urban counterparts. For both men and women, residence in the provinces of Manicaland, Matabeleland North, and Matabeleland South was associated with less AIDS prevention knowledge; men in Masvingo also displayed relatively low levels of knowledge. The tables also allow an assessment of the knowledge of specific ways to prevent HIV/AIDS (without prompting). The two most widely cited ways to avoid HIV/AIDS were, for both men and women, condom use (76 percent for men, 66 percent for women) and limiting the number of sexual partners (69 percent for men, 63 percent for women). Sexual abstinence was mentioned by 30 percent of men and 17 percent of women. AIDS prevention programmes focus their messages and efforts on three important aspects of behaviour: use of condoms, limiting the number of sexual partners or staying faithful to one partner, and delaying sexual debut for young persons (i.e., abstinence). In the first three columns of Tables 11.2.1 and 11.2.2, the percentage of women and men who reported none, one, or two or more ways to avoid AIDS are shown. More than two-thirds of men and more than one-half of women were able to report two or more of the key ways to prevent AIDS. Women were more than twice as likely as men to lack knowledge of any of the key ways to prevent AIDS (18 percent for women, 8 percent for men). Figure 11.1 shows the strong link between a woman’s education level and her knowledge of practical ways to prevent HIV/AIDS. AIDS and other STDs * 161 Table 11.1.1 Knowledge of ways to avoid HIV/AIDS: women Percentage of women who know of ways to avoid HIV/AIDS, by selected background characteristics, Zimbabwe 1999 _________________________________________________________________________________________________________________ Ways to avoid HIV/AIDS ___________________________________________________________________ Does not Avoid Does know a Abstain Limit Avoid sex not way to from number of sex with with Avoid Avoid Number Background know avoid sexual Use sexual prosti- homo- trans- injec- of characteristic AIDS AIDS relations condom partners tutes sexuals fusions tions Other women _________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 5.6 20.7 24.3 59.0 55.7 2.2 0.1 1.3 2.5 11.1 1,447 2.9 13.7 16.6 73.3 65.6 2.5 0.1 0.8 1.1 9.0 1,294 3.5 13.1 14.0 73.5 68.0 3.5 0.3 0.8 1.4 8.3 1,034 2.2 14.0 14.3 67.4 66.9 2.3 0.1 0.8 1.4 9.3 1,305 3.2 23.5 11.5 52.7 60.6 2.5 0.1 1.0 0.8 8.7 827 2.5 13.2 22.9 75.8 61.8 1.3 0.0 1.7 2.2 10.2 422 5.4 17.7 29.8 59.4 58.9 2.1 0.2 1.6 2.7 13.0 1,215 3.2 16.9 11.3 65.2 66.1 3.0 0.2 0.8 1.1 8.5 3,609 2.8 16.4 19.3 73.2 56.0 1.9 0.0 0.1 1.5 7.2 662 1.9 9.4 20.5 75.7 70.4 1.4 0.2 1.1 1.4 9.7 2,279 4.5 21.4 14.5 59.3 58.7 3.3 0.1 0.9 1.7 9.2 3,628 4.3 27.8 12.7 48.5 48.5 1.5 0.0 0.5 1.0 8.5 882 2.5 15.2 17.3 68.7 57.0 5.9 0.4 0.8 1.9 12.5 477 5.4 18.8 13.6 70.9 63.8 11.4 0.9 3.4 4.3 19.0 461 8.6 19.8 14.8 69.5 63.4 1.8 0.2 1.0 1.1 6.4 559 3.2 33.9 20.1 54.3 50.6 0.0 0.0 0.9 1.6 7.6 302 3.6 22.0 10.5 60.5 53.4 1.7 0.4 1.1 2.9 12.7 321 1.4 7.7 20.3 62.6 71.2 2.5 0.0 0.6 1.7 8.5 741 3.6 13.6 17.9 65.1 69.8 1.9 0.0 0.9 0.1 6.3 629 2.8 12.5 17.3 73.8 68.3 0.9 0.0 0.4 1.2 8.7 1,077 0.1 5.5 23.9 83.0 78.1 0.4 0.0 1.2 1.4 8.4 457 8.8 44.7 7.8 37.4 39.5 2.1 0.0 0.3 0.2 3.6 396 5.6 24.1 11.7 58.2 54.9 2.4 0.1 0.5 0.8 6.3 2,377 1.4 8.1 20.4 74.6 71.8 2.8 0.1 1.2 2.3 12.1 2,965 0.0 0.4 46.5 80.6 84.8 3.0 1.1 3.9 2.2 20.2 168 3.5 16.8 16.8 65.6 63.2 2.6 0.1 1.0 1.5 9.4 5,907 On the right side of Tables 11.2.1 and 11.2.2 are the ZDHS results when prompting was used to ascertain whether women and men know about condom use and limiting the number of sexual partners as ways to prevent HIV infection. When women were prompted, their reported knowledge of condom use for HIV/AIDS protection rose from 66 percent (unprompted) to 73 percent. In the same way, men’s knowledge rose from 76 percent to 81 percent. Without prompting, 63 percent of women and 69 percent of men reported limiting the number of sexual partners as a way to avoid HIV/AIDS. When prompted, the percentages rose to 75 percent and 81 percent, respectively. 162 * AIDS and other STDs Table 11.1.2 Knowledge of ways to avoid HIV/AIDS: men Percentage of men who know of ways to avoid HIV/AIDS, by selected background characteristics, Zimbabwe 1999 _________________________________________________________________________________________________________________ Ways to avoid HIV/AIDS ___________________________________________________________________ Does not Avoid Does know a Abstain Limit Avoid sex not way to from number of sex with with Avoid Avoid Number Background know avoid sexual Use sexual prosti- homo- trans- injec- of characteristic AIDS AIDS relations condom partners tutes sexuals fusions tions Other men _________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 1.5 11.9 25.3 72.8 56.2 5.9 0.6 0.6 3.3 15.9 713 0.5 5.0 34.8 80.5 68.0 6.8 1.3 2.1 2.8 15.6 506 0.7 3.6 31.0 84.7 77.9 7.6 3.7 3.8 1.3 10.2 430 0.9 4.5 30.6 75.6 81.0 9.8 1.3 3.0 1.4 8.5 500 0.7 8.4 27.4 69.7 69.7 7.2 1.2 1.3 0.6 7.7 356 1.8 14.5 29.7 63.6 64.4 8.6 0.9 0.6 0.0 11.0 104 0.4 5.4 29.8 86.1 62.6 5.9 0.9 1.0 2.4 14.2 614 1.6 12.7 33.0 67.3 58.7 5.8 1.3 1.5 2.8 17.1 638 0.8 5.5 26.8 74.6 77.9 8.4 1.8 2.9 1.5 9.7 1,239 1.6 9.8 38.3 85.3 65.1 13.4 2.5 0.0 0.9 1.3 118 0.5 4.2 44.8 77.8 75.3 6.7 3.3 3.7 2.1 11.6 1,090 1.2 9.7 18.6 74.7 64.4 7.9 0.2 0.7 1.9 12.6 1,519 2.4 11.5 27.7 64.1 53.7 11.8 0.4 0.4 0.8 21.1 360 0.3 4.5 16.2 83.8 68.4 10.4 0.0 0.6 0.9 7.8 236 2.3 8.9 26.1 83.2 76.7 3.2 1.8 1.8 2.8 14.0 217 0.4 5.5 25.4 76.2 65.6 13.4 0.0 0.4 1.5 11.8 268 0.6 12.2 23.4 73.6 72.3 3.3 0.0 0.3 1.4 16.7 146 1.2 15.3 37.2 75.0 47.5 1.2 0.0 1.6 3.1 17.8 120 0.3 2.8 16.6 86.8 78.3 8.2 0.0 1.9 5.2 9.5 308 0.0 14.5 10.0 60.0 60.8 0.7 0.7 0.4 0.8 5.9 225 1.1 2.6 47.6 74.9 77.9 5.5 5.9 5.9 2.2 8.1 514 0.0 7.8 52.0 86.2 75.7 9.9 0.6 1.8 1.2 14.7 214 6.6 29.3 18.5 45.2 42.2 4.5 0.0 0.0 0.0 3.0 66 1.6 13.5 19.8 71.3 59.6 7.0 0.9 0.8 1.0 8.7 830 0.5 4.0 32.9 79.4 73.6 7.8 1.8 2.8 2.4 13.9 1,556 0.0 0.4 52.8 80.4 84.3 6.3 2.2 0.8 4.7 17.4 157 0.9 7.4 29.6 76.0 69.0 7.4 1.5 2.0 2.0 12.2 2,609 AIDS and other STDs * 163 Table 11.2.1 Knowledge of programmatically important ways to avoid HIV/AIDS: women Percentage of women who know of programmatically important ways to avoid HIV/AIDS, according to background characteristics, Zimbabwe 1999____________________________________________________________________________________ Number of programmatically important ways to avoid After prompting, the HIV/AIDS known percentage citing:____________________________ ____________________ Knows Limiting Knows two number Number Background one or more Condom of of characteristic None way ways Total use partners women____________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 21.9 27.2 50.9 100.0 66.8 69.0 1,447 14.3 25.1 60.6 100.0 79.0 77.3 1,294 13.7 23.9 62.2 100.0 79.8 78.4 1,034 14.5 27.9 57.7 100.0 77.2 78.0 1,305 24.7 29.7 45.6 100.0 60.7 69.6 827 13.9 25.1 61.0 100.0 80.7 78.4 422 19.0 26.5 54.5 100.0 68.5 72.4 1,215 17.7 26.8 55.5 100.0 73.0 75.2 3,609 16.8 27.3 55.9 100.0 77.7 72.2 662 10.1 24.7 65.2 100.0 81.9 82.1 2,279 22.2 27.9 49.8 100.0 67.7 69.8 3,628 29.3 33.2 37.4 100.0 60.2 61.5 882 17.2 26.8 56.0 100.0 75.6 70.3 477 19.6 23.5 56.9 100.0 74.1 71.3 461 20.1 21.0 58.8 100.0 73.6 71.7 559 34.2 18.7 47.0 100.0 57.4 62.7 302 22.7 30.3 47.1 100.0 69.8 74.7 321 8.4 34.9 56.7 100.0 74.6 81.7 741 14.2 25.6 60.3 100.0 75.3 80.8 629 12.9 25.4 61.6 100.0 79.2 77.8 1,077 5.6 17.8 76.5 100.0 87.5 90.7 457 45.8 25.1 29.1 100.0 43.4 46.3 396 24.7 29.5 45.7 100.0 66.0 66.4 2,377 9.0 25.2 65.8 100.0 82.0 83.7 2,965 0.4 16.1 83.6 100.0 89.2 94.9 168 17.5 26.7 55.8 100.0 73.2 74.5 5,907 ____________________________________________________________________________________ Note: Programmatically important ways include: condom use, limiting sex to a single faithful partner, limiting the number of sexual partners, and sexual abstinence. The methodology used in the 1999 ZDHS to estimate knowledge about AIDS is relatively new. As such, comparisons with the 1994 ZDHS are difficult. However, some comparisons are useful. Between 1994 and 1999, unprompted knowledge about the condom as a way to avoid HIV/AIDS has risen from 57 percent to 66 percent in women and from 66 percent to 76 percent in men. Differentials in Tables 11.2.1 and 11.2.2 follow essentially the same patterns as those observed in Tables 11.1.1 and 11.1.2, with strong associations between AIDS prevention knowledge and education and age of the respondent, rural-urban residence, and province of residence. Men and women in Manicaland, those living in rural areas, those with less education, and those at younger (below 20 years) and older (40 or more years) ages tended to possess less knowledge of key ways to prevent AIDS. 164 * AIDS and other STDs Table 11.2.2 Knowledge of programmatically important ways to avoid HIV/AIDS: men Percentage of respondents by knowledge of programmaticallyimportant ways to avoid HIV/AIDS, according to background characteristics, Zimbabwe 1999____________________________________________________________________________________ Number of programmatically important ways to avoid After prompting, the HIV/AIDS known percentage citing:____________________________ ____________________ Knows Limiting Knows two number Number Background one or more Condom of of characteristic None way ways Total use partners men____________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 13.1 31.7 55.2 100.0 77.8 73.9 713 6.0 22.6 71.5 100.0 85.1 84.0 506 4.2 16.7 79.1 100.0 89.3 87.1 430 5.5 19.2 75.3 100.0 79.5 88.6 500 10.3 24.7 65.0 100.0 75.4 78.2 356 14.5 27.2 58.3 100.0 68.6 73.3 104 6.0 27.2 66.7 100.0 90.4 82.4 614 13.9 28.4 57.7 100.0 72.5 74.1 638 6.7 20.8 72.5 100.0 79.6 85.2 1,239 9.8 16.3 74.0 100.0 87.0 75.9 118 4.5 17.5 77.9 100.0 83.2 88.4 1,090 11.2 28.6 60.2 100.0 79.0 76.3 1,519 15.9 32.2 51.8 100.0 72.8 70.1 360 4.8 27.0 68.1 100.0 88.8 83.2 236 9.3 15.0 75.7 100.0 84.6 82.7 217 6.7 31.2 62.2 100.0 78.3 73.3 268 12.2 24.2 63.6 100.0 80.9 84.2 146 17.0 23.8 59.2 100.0 77.8 76.6 120 3.8 18.9 77.3 100.0 91.4 89.3 308 14.5 43.8 41.7 100.0 64.0 68.6 225 2.6 16.2 81.2 100.0 81.2 90.0 514 8.4 11.4 80.2 100.0 87.1 89.2 214 31.4 30.7 37.8 100.0 52.7 52.6 66 15.5 28.9 55.7 100.0 74.9 71.4 830 4.6 22.0 73.4 100.0 84.6 86.7 1,556 0.4 13.7 85.9 100.0 84.6 93.5 157 8.4 23.9 67.6 100.0 80.7 81.4 2,609 ____________________________________________________________________________________ Note: Programmatically important ways include: condom use, limiting sex to a single faithful partner, limiting the number of sexual partners, and sexual abstinence. 11.2 KNOWLEDGE OF OTHER AIDS-RELATED ISSUES Tables 11.3.1 and 11.3.2 show the distribution of women and men by their responses to questions intended to evaluate important aspects of a person’s knowledge base of HIV/AIDS. When asked whether a “healthy-looking person can have the AIDS virus,” 76 percent of women and 85 percent of men correctly responded “yes.” This result is about the same as that obtained from the 1994 ZDHS (74 percent of women and 85 percent of men). The women and men least likely to respond correctly to this question tended to be young, sexually inexperienced, rural, and less educated. Men living in Manicaland and Masvingo were less likely to understand this issue, whereas women living in all rural provinces were uniformly less knowledgeable on this issue than women in Harare and Bulawayo. AIDS and other STDs * 165 Figure 11.1 Percent Distribution of Women by Number of AIDS-Prevention Methods Known, According to Level of Education, Zimbabwe 1999 No Education Primary Secondary Higher 0 20 40 60 80 100 Number of AIDS-Prevention Methods No methods 1 method 2+ methods Percent ZDHS 1999 The results show that most women (86 percent) and men (87 percent) know that “the AIDS virus can be transmitted from mother to child.” In the 1994 ZDHS, 92 percent of men and 93 percent of women responded similarly to the same question, suggesting that either knowledge has diminished (unlikely) or respondents’ understanding of the issue is more complex than before. For this reason, more detailed questions were posed. When asked when the AIDS virus could be transmitted from a mother to her child, 66 percent of women and 61 percent of men responded “during pregnancy”; 33 percent of women and 36 percent of men responded “during breastfeeding.” The 1999 ZDHS asked, “Do you personally know someone who has the AIDS virus or who has died from AIDS?” The same question was asked in the 1994 ZDHS, allowing assessment of changes in personalisation of the epidemic. In 1994, 49 percent of both women and men responded that they knew someone who had the AIDS virus or who had died from AIDS; these figures increased to 60 percent and 64 percent in the 1998 ZDHS, reflecting the spread of the AIDS tragedy across Zimbabwe’s social landscape. 11.3 STIGMA ASSOCIATED WITH AIDS AND ACCEPTABILITY OF AIDS-RELATED MESSAGES IN THE MEDIA In the 1999 ZDHS, married women and men who had ever heard of AIDS were asked whether they had ever discussed AIDS prevention with their spouse. Tables 11.4.1 and 11.4.2 show that 60 percent of women and 81 percent of men reported that they had ever had this discussion. The background differentials are not large, but some general statements can be made. Having received more education is associated with a greater level of communication between spouses on AIDS prevention, as is urban (as opposed to rural) residence. 166 * AIDS and other STDs Ta bl e 11 .3 .1 K no w le dg e of v ar io us A ID S- re la te d iss ue s: w om en Pe rc en t d ist rib ut io n o f w om en b y re sp on se s t o qu es tio ns a bo ut v ar io us A ID S- re la te d iss ue s, a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ D o yo u kn ow C an a h ea lth y- C an th e AI D S vi ru s Is th e AI D S vi ru s so m eo ne p er so na lly lo ok in g pe rs on be tr an sm itt ed tra ns m itt ed fr om w ho h as A ID S or ha ve th e AI D S vi ru s? fro m m ot he r t o ch ild ? m ot he r t o ch ild d ur in g: 2 ha s di ed fr om A ID S? __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ D on 't D on 't N um be r Ba ck gr ou nd kn ow / kn ow / Pr eg - Br ea st - D on 't of ch ar ac te ris tic Ye s N o U ns ur e1 Ye s N o U ns ur e1 na nc y D el iv er y fe ed in g Ye s N o kn ow 1 w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Ag e 1 5- 19 2 0- 24 2 5- 29 3 0- 39 4 0- 49 M ar ita l s ta tu s N ev er m ar rie d H as h ad s ex H as n ev er h ad s ex M ar rie d or in u ni on D iv or ce d, w id ow ed Re si de nc e U rb an R ur al Pr ov in ce M an ic al an d M as ho na la nd C en tra l M as ho na la nd E as t M as ho na la nd W es t M at ab el el an d N or th M at ab el el an d So ut h M id la nd s M as vi ng o H ar ar e B ul aw ay o Ed uc at io n N o ed uc at io n P rim ar y S ec on da ry H ig he r To ta l 68 .6 20 .9 10 .5 81 .1 5. 9 13 .0 59 .4 14 .7 28 .7 47 .1 47 .2 5. 7 1, 44 7 79 .1 12 .4 8. 5 87 .7 3. 5 8. 7 65 .9 15 .1 37 .3 56 .1 40 .9 3. 0 1, 29 4 78 .5 13 .1 8. 4 87 .8 3. 3 8. 9 67 .2 13 .4 37 .0 62 .5 33 .9 3. 7 1, 03 4 81 .4 10 .0 8. 7 88 .1 2. 8 9. 1 71 .5 14 .1 32 .4 69 .4 28 .3 2. 3 1, 30 5 70 .7 14 .4 14 .9 83 .0 3. 7 13 .3 66 .4 11 .2 29 .0 69 .9 27 .0 3. 2 82 7 81 .1 12 .1 6. 7 88 .7 5. 2 6. 2 67 .7 16 .0 32 .6 58 .2 38 .8 3. 0 42 2 70 .9 19 .1 9. 9 81 .5 5. 5 13 .0 59 .4 17 .4 28 .1 47 .1 47 .4 5. 5 1, 21 5 76 .4 13 .4 10 .3 86 .5 3. 3 10 .3 68 .0 12 .4 34 .4 64 .2 32 .5 3. 2 3, 60 9 77 .7 12 .3 10 .0 85 .7 4. 1 10 .2 64 .8 14 .4 33 .7 60 .6 36 .5 3. 0 66 2 86 .5 7. 3 6. 2 89 .5 3. 2 7. 3 66 .4 16 .7 37 .3 66 .4 31 .6 2. 0 2, 27 9 69 .0 18 .8 12 .2 83 .0 4. 5 12 .5 65 .5 12 .2 30 .1 55 .8 39 .6 4. 6 3, 62 8 71 .8 16 .2 11 .9 83 .7 3. 4 12 .9 64 .9 15 .0 30 .0 58 .8 36 .9 4. 3 88 2 66 .9 23 .3 9. 8 86 .4 3. 4 10 .2 63 .4 8. 9 38 .5 48 .9 48 .4 2. 7 47 7 72 .4 16 .4 11 .2 81 .9 5. 4 12 .7 64 .2 23 .9 38 .1 60 .6 34 .1 5. 4 46 1 71 .8 10 .4 17 .8 79 .0 3. 6 17 .4 64 .2 14 .7 33 .4 55 .7 34 .9 9. 3 55 9 74 .6 10 .0 15 .3 82 .6 4. 5 12 .9 64 .0 10 .9 40 .5 57 .1 39 .7 3. 2 30 2 76 .4 16 .4 7. 2 86 .1 6. 1 7. 8 71 .3 8. 9 34 .8 51 .8 44 .6 3. 6 32 1 74 .3 20 .0 5. 6 88 .8 5. 6 5. 6 67 .7 8. 2 24 .6 67 .3 31 .3 1. 4 74 1 70 .7 19 .3 10 .0 86 .2 4. 4 9. 4 67 .8 11 .4 25 .1 52 .7 43 .6 3. 7 62 9 84 .3 7. 7 8. 0 86 .5 2. 8 10 .6 60 .7 18 .5 34 .7 67 .8 29 .4 2. 8 1, 07 7 90 .0 5. 3 4. 6 93 .0 2. 2 4. 8 77 .6 13 .4 40 .2 64 .6 35 .3 0. 1 45 7 54 .0 19 .7 26 .3 64 .9 3. 8 31 .3 48 .2 4. 3 21 .2 48 .5 42 .7 8. 8 39 6 67 .0 18 .6 14 .4 80 .7 5. 0 14 .3 64 .2 8. 9 27 .3 57 .2 37 .1 5. 6 2, 37 7 84 .3 11 .0 4. 7 91 .5 3. 4 5. 2 69 .6 17 .6 37 .6 62 .1 36 .4 1. 6 2, 96 5 10 0. 0 0. 0 0. 0 97 .7 0. 0 2. 3 62 .8 43 .3 57 .3 85 .8 14 .2 0. 0 16 8 75 .7 14 .4 9. 9 85 .5 4. 0 10 .5 65 .8 13 .9 32 .9 59 .9 36 .5 3. 6 5, 90 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 1 In cl ud es p er so ns w ho d o no t k no w o f H IV /A ID S at a ll 2 M ay s um to m or e th an 1 00 p er ce nt b ec au se m ul tip le re sp on se s w er e al lo w ed AIDS and other STDs * 167 Ta bl e 11 .3 .2 K no w le dg e of v ar io us A ID S- re la te d iss ue s: m en Pe rc en t d ist rib ut io n of m en b y re sp on se s t o qu es tio ns a bo ut v ar io us A ID S- re la te d iss ue s, a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ D o yo u kn ow C an a h ea lth y- C an th e AI D S vi ru s Is th e AI D S vi ru s so m eo ne p er so na lly lo ok in g pe rs on be tr an sm itt ed tra ns m itt ed fr om w ho h as A ID S or ha ve th e AI D S vi ru s? fro m m ot he r t o ch ild ? m ot he r t o ch ild d ur in g: 2 ha s di ed fr om A ID S? __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ D on 't D on 't N um be r Ba ck gr ou nd kn ow / kn ow / Pr eg - Br ea st - D on 't of ch ar ac te ris tic Ye s N o U ns ur e1 Ye s N o U ns ur e1 na nc y D el iv er y fe ed in g Ye s N o kn ow 1 m en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Ag e 1 5- 19 2 0- 24 2 5- 29 3 0- 39 4 0- 49 5 0- 54 M ar ita l s ta tu s N ev er m ar rie d H as h ad s ex H as n ev er h ad s ex M ar rie d or in u ni on D iv or ce d, w id ow ed Re si de nc e U rb an R ur al Pr ov in ce M an ic al an d M as ho na la nd C en tra l M as ho na la nd E as t M as ho na la nd W es t M at ab el el an d N or th M at ab el el an d So ut h M id la nd s M as vi ng o H ar ar e B ul aw ay o Ed uc at io n N o ed uc at io n P rim ar y S ec on da ry H ig he r To ta l 80 .9 10 .9 8. 3 84 .1 4. 1 11 .8 57 .5 17 .4 32 .0 40 .6 57 .8 1. 6 71 3 84 .9 10 .7 4. 3 89 .9 1. 3 8. 8 63 .9 21 .0 40 .0 63 .8 35 .6 0. 6 50 6 90 .4 5. 5 4. 1 89 .2 2. 0 8. 9 63 .6 22 .4 35 .7 75 .3 24 .0 0. 7 43 0 87 .0 6. 2 6. 8 87 .4 1. 8 10 .9 60 .7 18 .9 42 .1 72 .1 27 .0 0. 9 50 0 87 .1 5. 0 7. 9 89 .3 1. 4 9. 3 65 .2 14 .0 32 .6 80 .7 18 .2 1. 1 35 6 80 .9 8. 2 10 .9 78 .5 1. 9 19 .5 58 .2 16 .3 24 .9 73 .8 24 .3 1. 8 10 4 87 .1 8. 5 4. 4 89 .3 2. 1 8. 5 66 .7 19 .6 36 .0 61 .4 38 .1 0. 5 61 4 79 .7 11 .5 8. 8 81 .6 4. 0 14 .4 53 .6 19 .8 31 .8 42 .6 55 .7 1. 8 63 8 87 .5 6. 3 6. 3 88 .6 1. 6 9. 8 62 .8 17 .6 37 .6 75 .0 24 .2 0. 9 1, 23 9 82 .8 8. 1 9. 1 90 .5 1. 7 7. 8 62 .5 20 .7 39 .3 71 .1 26 .8 2. 1 11 8 93 .0 2. 8 4. 2 89 .9 1. 1 9. 1 59 .2 27 .3 36 .0 72 .1 27 .3 0. 6 1, 09 0 79 .7 12 .0 8. 2 85 .2 3. 2 11 .5 63 .0 12 .5 35 .8 57 .6 41 .0 1. 3 1, 51 9 76 .1 13 .6 10 .2 84 .9 3. 7 11 .4 55 .4 20 .7 30 .8 56 .2 41 .3 2. 4 36 0 80 .6 15 .7 3. 7 92 .3 0. 9 6. 8 67 .7 6. 6 37 .3 58 .1 41 .3 0. 6 23 6 79 .8 12 .2 7. 9 88 .3 1. 9 9. 8 69 .6 14 .9 43 .9 62 .1 35 .6 2. 3 21 7 85 .0 10 .4 4. 6 88 .4 2. 6 8. 9 65 .6 22 .2 35 .0 72 .4 26 .9 0. 8 26 8 85 .6 7. 8 6. 7 88 .9 5. 3 5. 9 64 .5 14 .5 54 .5 61 .1 38 .3 0. 6 14 6 83 .8 8. 5 7. 7 85 .8 3. 2 10 .9 76 .2 6. 8 28 .3 45 .5 53 .3 1. 2 12 0 93 .1 2. 5 4. 3 92 .4 0. 9 6. 6 71 .9 15 .6 50 .6 59 .5 40 .2 0. 3 30 8 77 .2 8. 4 14 .4 74 .0 3. 6 22 .4 52 .5 10 .1 22 .7 59 .2 40 .8 0. 0 22 5 91 .9 3. 3 4. 8 87 .5 1. 1 11 .4 50 .6 31 .0 23 .6 77 .9 21 .0 1. 0 51 4 93 .4 3. 3 3. 3 87 .7 2. 7 9. 6 61 .3 21 .9 49 .5 61 .6 37 .8 0. 6 21 4 65 .7 8. 8 25 .4 57 .1 3. 6 39 .3 42 .9 9. 7 19 .4 66 .2 27 .1 6. 6 66 74 .7 13 .1 12 .2 78 .2 4. 2 17 .6 57 .3 8. 2 30 .0 56 .4 42 .0 1. 7 83 0 90 .2 6. 3 3. 5 92 .2 1. 5 6. 3 64 .8 21 .9 38 .4 64 .7 34 .7 0. 6 1, 55 6 10 0. 0 0. 0 0. 0 97 .2 0. 0 2. 8 58 .1 46 .3 49 .4 90 .7 9. 3 0. 0 15 7 85 .3 8. 2 6. 5 87 .2 2. 3 10 .2 61 .4 18 .7 35 .9 63 .7 35 .3 1. 0 2, 60 9 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 1 In cl ud es p er so ns w ho d o no t k no w o f H IV /A ID S at a ll 2 M ay s um to m or e th an 1 00 p er ce nt b ec au se m ul tip le re sp on se s w er e al lo w ed 168 * AIDS and other STDs Table 11.4.1 Discussion of HIV/AIDS prevention with cohabiting partner and acceptability of discussion of AIDS in the media: women Percentage of married women who discussed HIV/AIDS prevention with their cohabiting partner, and the percentage of all women who have heard of AIDS who think it is acceptable for AIDS to be discussed on the radio, on the TV, and in the newspapers, according to background characteristics, Zimbabwe 1999_____________________________________________________________________________________ Ever discussed ways to Number prevent of HIV/AIDS Number Acceptable for women with their of AIDS to be discussed on: who Background cohabiting married ______________________________ know of characteristic partner women Radio TV Newspaper AIDS_____________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Total 43.8 314 95.8 95.7 96.2 1,366 60.2 820 96.0 95.9 96.1 1,256 63.7 788 96.8 95.9 96.4 998 66.8 1,039 95.6 94.8 95.6 1,276 53.7 648 91.5 90.1 91.5 801 NA NA 96.1 95.7 96.1 411 NA NA 95.8 95.9 96.3 1,150 60.3 3,609 95.3 94.6 95.2 3,494 NA NA 94.6 93.4 94.9 643 69.8 1,306 97.9 97.4 97.8 2,235 54.9 2,303 93.8 93.1 93.8 3,463 51.5 561 93.1 91.8 93.0 844 52.1 325 90.7 90.5 90.7 465 54.5 310 98.0 97.5 98.0 436 61.8 367 95.3 95.3 95.3 511 55.7 180 96.9 96.7 96.7 292 61.8 170 95.8 94.0 95.6 310 62.7 444 93.3 92.5 93.5 731 59.4 367 95.0 94.4 95.2 607 67.0 667 98.0 97.8 98.2 1,047 79.3 217 98.6 98.1 98.5 456 36.4 310 84.1 83.2 83.9 362 52.2 1,665 93.5 92.7 93.5 2,244 73.0 1,633 98.1 97.7 98.1 3,093 60.3 3,609 95.4 94.8 95.4 5,698 ___________________________________________________________________________________ NA = Not applicable All men and women who knew of AIDS were asked to report whether they thought it was acceptable for AIDS-related messages to be broadcast on television and radio and to be published in newspapers. More than 90 percent of both women and men reported that it was acceptable for AIDS to be discussed in each of these media. Tables 11.5.1 and 11.5.2 provide responses to questions that are intended to evaluate the level of stigma attached to HIV/AIDS, PLWAs (persons living with AIDS), and condoms. First, respondents were asked, “If a person learns that he or she is infected with the AIDS virus, should the person be allowed to keep this fact private or should this information be available to the community?” Only 38 percent of women and 33 percent of men thought that HIV-positive individuals should be allowed to keep their HIV status private. Fear of public disclosure has been AIDS and other STDs * 169 Table 11.4.2 Discussion of HIV/AIDS prevention with cohabiting partner and acceptability of discussion of AIDS in the media: men Percentage of married men who discussed HIV/AIDS prevention with their cohabiting partner, and the percentage of all men who have heard of AIDS who think it is acceptable for AIDS to be discussed on the radio, on the TV, and in the newspapers, according to background characteristics, Zimbabwe 1999_____________________________________________________________________________________ Ever discussed ways to prevent Number HIV/AIDS Number Acceptable for of with their of AIDS to be discussed on: men who Background cohabiting married ______________________________ know of characteristic partner men Radio TV Newspaper AIDS_____________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Total 56.3 4 94.8 91.2 94.5 703 75.0 110 96.6 94.9 96.7 503 79.2 283 97.7 95.2 96.9 427 86.6 433 98.1 94.7 97.0 496 80.6 321 95.5 91.3 95.4 353 68.7 87 96.0 93.3 97.2 103 NA NA 96.3 94.2 96.3 611 NA NA 94.8 90.6 94.1 628 81.0 1,239 97.6 94.7 97.1 1,229 NA NA 93.3 89.0 93.9 116 84.5 546 97.2 95.6 96.8 1,085 78.2 693 95.8 91.7 95.5 1,500 69.8 139 95.8 86.3 94.6 351 83.1 127 94.8 89.1 94.8 235 83.4 117 97.1 95.7 97.1 212 81.5 147 94.3 93.6 93.9 267 78.0 61 94.4 92.8 95.3 145 87.4 46 97.6 96.4 98.0 119 76.0 143 98.4 96.1 98.4 307 77.2 102 98.0 96.4 97.2 225 86.0 271 96.3 94.4 95.1 508 87.2 86 97.6 96.1 98.2 214 55.3 49 93.1 91.5 91.5 62 78.6 461 94.7 90.1 93.6 817 84.2 729 97.3 94.9 97.4 1,706 81.0 1,239 96.4 93.3 96.0 2,584 ____________________________________________________________________________________ NA = Not applicable implicated as an important barrier to HIV testing and programmes aimed at assisting PLWAs and their families. Respondents were further asked, “If a relative of yours became ill with AIDS would you be willing to care for her or him in your own household?” Most men and women (88 percent) responded that they would be willing to take care of a relative who had AIDS. Still, significant percentages of men and women in certain subgroups of the population are less sympathetic than others. For example, 21 percent of women in the province of Matabeleland South would not be willing to care for a relative with AIDS in their household compared with only 5 percent in Bulawayo. 170 * AIDS and other STDs Table 11.5.1 Social aspects of AIDS prevention and mitigation: women Percent distribution of women who know of HIV/AIDS by responses to questions on various social aspects of AIDS prevention and mitigation, according to selected background characteristics, Zimbabwe 1999______________________________________________________________________________________________________ Believe person Believe with AIDS should Willing to children age 12-14 be allowed to care for relative should be taught keep status private with AIDS at home how to use condom______________________ ______________________ ______________________ Number Background Don't Don't Don't of characteristic Yes No know Yes No know Yes No know women______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Total 34.4 62.3 3.3 82.8 15.6 1.7 34.4 60.6 5.0 1,366 36.9 58.9 4.2 86.0 10.8 3.3 40.7 54.5 4.8 1,256 35.9 59.9 4.2 88.8 9.8 1.5 39.1 57.3 3.6 998 40.0 54.9 5.1 91.2 6.3 2.5 37.2 56.5 6.3 1,276 43.3 52.5 4.2 90.4 7.5 2.0 34.5 58.1 7.5 801 35.8 59.8 4.4 84.8 13.2 2.0 53.8 42.3 3.9 411 31.5 64.2 4.4 85.3 12.5 2.2 32.2 62.2 5.5 1,150 39.4 56.5 4.1 87.9 9.8 2.3 36.4 58.2 5.5 3,494 40.7 55.2 4.2 90.8 7.1 2.1 40.6 54.1 5.3 643 35.6 59.7 4.7 89.3 7.9 2.9 42.9 52.4 4.7 2,235 39.1 57.1 3.9 86.3 11.8 1.8 33.6 60.6 5.7 3,463 38.7 55.9 5.4 88.5 9.2 2.3 27.8 66.8 5.4 844 31.0 65.3 3.7 90.0 8.7 1.4 33.4 61.9 4.7 465 37.8 59.0 3.2 87.9 8.2 3.9 33.5 60.6 5.9 436 41.4 54.3 4.3 86.5 11.9 1.6 36.8 50.3 12.9 511 54.5 39.8 5.7 83.0 14.1 3.0 57.9 36.6 5.4 292 46.2 51.8 2.0 76.7 20.8 2.5 54.3 42.6 3.0 310 32.7 63.6 3.7 88.7 10.9 0.5 35.1 62.3 2.6 731 37.3 60.2 2.4 85.3 13.8 0.9 28.1 69.2 2.8 607 35.9 59.0 5.1 88.8 7.7 3.5 38.5 54.9 6.6 1,047 34.6 60.9 4.5 91.9 4.9 3.2 51.1 45.6 3.3 456 48.6 45.9 5.5 85.4 12.0 2.6 27.2 57.5 15.3 362 41.5 53.8 4.7 86.3 11.7 2.0 34.2 59.8 6.0 2,244 33.7 62.7 3.7 88.6 9.1 2.4 40.7 55.6 3.7 3,093 37.7 58.1 4.2 87.5 10.3 2.2 37.3 57.4 5.4 5,698 It has been suggested that children should be introduced to AIDS-prevention messages before they reach an age at which sexual activity typically begins. The ZDHS 1999 asked men and women whether they thought children age 12-14 years should be taught about using a condom to avoid AIDS. The results were mixed, with men more likely to accept the idea (50 percent) than women (37 percent). For both women and men, education and residence in the provinces of Matabeleland North and Matabeleland South were associated with a more positive attitude towards early introduction to the idea of condom use to avoid AIDS. AIDS and other STDs * 171 Table 11.5.2 Social aspects of AIDS prevention and mitigation: men Percent distribution of men who know of HIV/AIDS by responses to questions on various social aspects of AIDS prevention and mitigation, according to selected background characteristics, Zimbabwe 1999______________________________________________________________________________________________________ Believe person Believe with AIDS should Willing to children age 12-14 be allowed to care for relative should be taught keep status private with AIDS at home how to use condom______________________ ______________________ ______________________ Number Background Don't Don't Don't of characteristic Yes No know Yes No know Yes No know men______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Total 33.9 64.6 1.5 86.7 10.9 2.4 48.6 47.3 4.1 703 31.2 66.4 2.4 88.3 10.0 1.6 50.4 47.1 2.6 503 35.5 61.3 3.2 86.6 11.3 2.1 53.3 43.8 2.9 427 31.1 62.8 6.2 91.8 5.5 2.6 54.0 43.9 2.1 496 34.9 61.8 3.3 88.8 7.9 3.3 42.5 55.5 2.0 353 32.2 64.8 3.0 89.7 8.3 2.1 40.8 54.7 4.5 103 32.8 64.4 2.8 87.1 9.5 3.4 58.1 39.5 2.4 611 32.5 65.4 2.1 86.1 11.9 2.0 42.3 52.8 4.9 628 34.3 61.9 3.7 90.5 7.6 1.9 48.2 49.2 2.6 1,229 26.5 69.0 4.6 84.9 11.0 4.1 59.0 41.0 0.0 116 38.0 58.7 3.2 86.5 10.7 2.8 47.6 50.7 1.7 1,085 29.7 67.2 3.1 89.8 8.2 2.0 51.1 45.0 3.9 1,500 31.3 62.3 6.4 86.5 10.4 3.1 38.9 50.9 10.2 351 18.4 79.7 1.8 93.2 5.9 0.9 42.5 55.9 1.5 235 38.8 59.3 1.9 90.4 4.3 5.3 61.7 36.8 1.4 212 56.4 41.7 1.9 94.1 4.8 1.1 46.4 50.4 3.3 267 27.6 71.0 1.4 84.7 12.0 3.4 61.7 34.9 3.4 145 25.3 70.6 4.1 86.5 11.1 2.5 66.6 32.2 1.2 119 15.8 81.8 2.4 91.8 7.8 0.4 57.7 40.4 1.9 307 13.9 83.9 2.2 96.5 2.8 0.7 50.2 49.0 0.8 225 45.1 51.9 3.0 78.7 19.4 1.9 45.5 53.4 1.1 508 42.9 52.0 5.1 90.4 3.3 6.3 46.8 50.5 2.7 214 38.7 59.8 1.4 91.3 5.6 3.1 34.8 54.7 10.5 62 33.5 62.8 3.7 86.0 11.0 2.9 44.4 50.7 4.9 817 32.8 64.2 2.9 89.4 8.5 2.1 52.6 45.6 1.7 1,706 33.2 63.7 3.2 88.4 9.2 2.4 49.6 47.4 3.0 2,584 11.4 TESTING FOR THE HIV/AIDS VIRUS ZDHS respondents were asked whether they had ever been tested for HIV or the AIDS virus. If they said that they had not, respondents were then asked whether they would like to be tested. If they said they would like to be tested, respondents were asked whether they knew of a specific place where they could go to get the test for the AIDS virus. Tables 11.6.1 and 11.6.2 show that 12 percent of women and 9 percent of men reported that they had already been tested for HIV, with urban men and women, those with more education, and those in peak childbearing years (women age 20-39; men age 25-49) experiencing the highest levels of HIV/AIDS testing. 172 * AIDS and other STDs Table 11.6.1 Testing for the HIV/AIDS virus: women Percent distribution of women by whether they have been tested for the AIDS virus or would like to be tested, and among those not tested, the source(s) cited for HIV testing, according to selected background characteristics, Zimbabwe 1999______________________________________________________________________________________________________ Among those not tested, would you like to be Among those not tested, tested for the AIDS virus? source(s) cited for HIV testing1 Number Already ____________________ ______________________________ of tested for Don't Number Do not Private women Background HIV/AIDS know/ of know a Public medical not characteristic virus Yes No Unsure women source facility facility Other tested______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 6.1 61.6 23.6 8.7 1,447 69.2 23.0 10.8 0.1 1,278 14.0 62.2 18.0 5.7 1,294 59.8 29.2 15.7 0.4 1,075 16.6 56.9 20.6 5.9 1,034 57.9 33.0 13.0 0.6 827 14.8 56.2 22.5 6.5 1,305 61.8 28.3 14.0 0.7 1,084 7.3 57.4 27.9 7.4 827 67.2 25.1 9.5 0.2 741 16.1 58.7 20.7 4.5 422 58.6 31.2 14.2 0.0 343 3.1 61.9 25.3 9.7 1,215 68.0 23.9 11.8 0.1 1,111 13.5 58.3 21.8 6.5 3,609 62.2 27.9 13.3 0.5 3,008 15.4 59.1 20.0 5.5 662 63.7 29.9 10.4 0.6 542 16.8 51.1 25.7 6.4 2,279 55.1 33.4 16.7 0.6 1,851 8.6 64.2 20.1 7.2 3,628 68.3 24.0 10.4 0.3 3,153 8.8 63.2 21.8 6.2 882 67.4 23.9 12.3 0.2 766 7.4 73.3 14.2 5.2 477 54.2 37.4 16.0 0.2 430 9.0 62.7 17.7 10.6 461 70.8 25.7 7.8 1.3 394 7.3 61.5 18.3 12.9 559 72.4 23.4 5.7 0.0 470 4.7 66.0 22.4 6.9 302 74.8 15.5 10.4 0.0 278 15.4 50.5 29.4 4.8 321 59.0 34.9 10.5 0.2 261 13.7 61.1 21.1 4.1 741 61.7 28.9 10.6 0.4 629 7.9 62.5 24.1 5.5 629 64.8 22.8 14.7 0.2 557 19.9 48.8 23.0 8.4 1,077 57.8 29.3 17.3 0.9 832 15.2 48.3 33.3 3.2 457 54.9 34.2 17.3 0.3 387 4.8 56.4 25.1 13.7 396 80.5 14.8 4.9 0.0 342 8.0 61.9 21.6 8.6 2,377 69.8 24.0 9.1 0.1 2,055 15.2 58.3 21.9 4.6 2,965 57.6 31.4 15.3 0.5 2,475 21.4 41.8 30.1 6.6 168 29.1 39.5 40.1 2.9 132 11.8 59.1 22.2 6.9 5,907 63.4 27.5 12.7 0.4 5,004 ______________________________________________________________________________________________________ 1 May sum to more than 100 percent because multiple responses were allowed. The overall desire or demand to be tested includes those who responded that they have not yet been tested but would like to be tested (i.e., unmet demand) and those who have already been tested (i.e., met demand). In this approach, columns 1 and 2 of Table 11.6 can be added together to estimate the total demand for HIV testing. For instance, 71 percent of women and 66 percent of men have a desire to be tested (see Figure 11.2). For women, 12 percent had already had the test, indicating that only 17 percent of the demand has been satisfied. The corresponding figure for men is even less (14 percent). The same approach can be used across background characteristicsof the population. For example, 8 percent of the HIV-testing demand is satisfied among women who have never been to school, compared with 33 percent among women with more than a secondary school education. Among men in Masvingo Province, only 5 percent of the demand for testing is met, compared with 27 percent of men in Harare. AIDS and other STDs * 173 Table 11.6.2 Testing for the HIV/AIDS virus: men Percent distribution of men by whether they have been tested for the AIDS virus or would like to be tested, and among those not tested the source(s) cited for HIV testing, according to background characteristics, Zimbabwe 1999______________________________________________________________________________________________________ Among those not tested, would you like to be Among those not tested, tested for the AIDS virus? source(s) cited for HIV testing1 Number Already ____________________ ______________________________ of tested for Don't Number Do not Private men Background HIV/AIDS know/ of know a Public medical not characteristic virus Yes No Unsure men source facility facility Other tested______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 2.8 59.4 32.0 5.8 713 75.4 19.0 6.5 1.0 683 7.3 62.1 26.9 3.7 506 63.5 27.2 13.1 0.0 466 12.0 56.6 26.1 5.3 430 58.9 30.2 15.5 0.5 375 13.3 53.5 29.0 4.2 500 61.0 28.8 14.6 0.0 430 15.7 49.2 30.4 4.8 356 68.9 21.7 12.5 1.1 297 7.7 56.3 28.3 7.7 104 64.7 25.7 13.3 0.0 95 6.5 61.1 27.9 4.5 614 64.0 27.1 12.6 0.0 571 3.4 56.1 33.5 7.0 638 75.2 18.1 7.6 1.2 606 12.7 55.5 27.6 4.2 1,239 62.6 27.5 13.9 0.5 1,072 17.1 52.3 26.9 3.7 118 69.5 24.6 9.2 0.0 96 13.1 43.4 36.7 6.8 1,090 58.2 28.9 16.6 1.3 942 6.3 66.5 23.6 3.6 1,519 72.1 22.1 8.5 0.0 1,403 5.6 65.7 19.4 9.3 360 76.7 14.9 8.8 0.0 331 7.6 71.2 20.0 1.2 236 64.4 29.7 13.5 0.0 218 4.2 47.6 44.9 3.3 217 69.1 30.4 0.5 0.0 203 12.8 66.7 18.9 1.5 268 66.2 29.9 8.3 0.0 233 6.7 58.9 30.0 4.5 146 60.1 20.4 22.5 0.0 135 6.7 53.5 37.8 2.0 120 75.9 21.5 5.2 0.0 111 14.5 64.6 19.6 1.3 308 59.4 30.8 14.6 0.0 263 3.8 77.7 17.0 1.5 225 79.1 17.3 7.6 0.0 217 14.0 37.6 39.5 8.9 514 60.4 23.5 17.4 2.2 436 6.6 36.3 48.0 9.0 214 57.9 32.5 15.1 1.3 200 3.8 57.2 31.0 8.0 66 82.0 11.7 6.3 0.0 59 5.6 60.5 28.9 5.0 830 77.9 17.9 6.0 0.3 770 10.0 56.2 29.3 4.5 1,556 62.9 27.9 12.5 0.7 1,393 21.6 43.1 27.5 7.8 157 28.6 40.0 41.7 0.0 123 9.2 56.8 29.1 4.9 2,609 66.5 24.8 11.8 0.5 2,346 ______________________________________________________________________________________________________ 1 May sum to more than 100 percent because multiple responses were allowed. Among respondents who reported that they have not yet been but would like to be tested for the AIDS virus, 63 percent of women and 67 percent of men were not aware of a place where they could be tested. Among women not yet tested for HIV, four in five women without any education do not know of a place to receive a test, compared with fewer than one in three women with a secondary school education. About 28 percent of women and 25 percent of men cited a government- run facility where they could be tested; 13 percent of women and 12 percent of men mentioned a private medical facility. Urban respondents and respondents with more education were more likely to cite privately run health facilities. 174 * AIDS and other STDs Figure 11.2 Percentage of Women and Men by Need for HIV Testing Services and Urban-Rural Residence, Zimbabwe 1999 ZIMBABWE Women Men WOMEN Urban Rural MEN Urban Rural Need for HIV Testing Services Already tested Not tested, wants to be tested Percent 12 59 9 57 17 51 9 64 13 43 6 67 ZDHS 1999 11.5 KNOWLEDGE OF OTHER SEXUALLY TRANSMITTED DISEASES In the 1999 ZDHS, respondents were asked to report on their knowledge of and experience with sexually transmitted infections other than HIV/AIDS. Men and women were asked to report, in an open-ended question, on any signs and symptoms that they think would characterise an STI in a man and in a woman. Tables 11.7.1 and 11.7.2 (male symptoms) and Tables 11.8.1 and 11.8.2 (female symptoms) provide a summary of those results. The symptoms that are included or counted in this analysis (both male and female symptoms) are genital discharge/dripping, foul- smelling discharge, burning pain on urination, redness/inflammation in genital area, genital sore/ulcers, swelling in genital area, genital warts, and blood in urine. Not surprisingly, the results indicate that men know more than women about STI symptoms in men and women know more than men about STI symptoms in women. Forty-three percent of women and 21 percent of men said either that they did not know about STIs (other than AIDS) or they did not cite any symptom. An additional 4 percent of women and 8 percent of men reported symptoms other than the common ones listed above. About one-quarter of women and one-half of men were able to cite two of the symptoms listed above. AIDS and other STDs * 175 Table 11.7.1 Knowledge of signs and symptoms of STIs in men: women Percent distribution of women by knowledge of signs and symptoms associated with sexually transmitted infections (STIs) in men, according to selected background characteristics, Zimbabwe 1999 _________________________________________________________________________ Knowledge of specific signs or symptoms of STIs in men1 ______________________________________ No Does not Knows Knows knowledge know at least two Number Background of any STI one or more of characteristic STIs2 symptoms symptom symptoms Total women __________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 60.8 5.6 21.3 12.3 100.0 1,447 45.7 3.4 27.2 23.7 100.0 1,294 35.9 3.9 29.4 30.8 100.0 1,034 31.5 3.9 26.6 38.0 100.0 1,305 32.7 2.8 26.2 38.3 100.0 827 39.1 6.8 28.6 25.5 100.0 422 63.3 5.8 19.1 11.8 100.0 1,215 38.0 3.0 27.1 31.8 100.0 3,609 32.6 4.9 29.7 32.8 100.0 662 41.3 4.5 28.3 25.9 100.0 2,279 43.6 3.8 24.3 28.3 100.0 3,628 55.5 3.6 19.5 21.4 100.0 882 39.9 2.6 26.2 31.3 100.0 477 50.4 3.9 14.0 31.7 100.0 461 44.5 0.9 16.0 38.6 100.0 559 48.5 5.7 23.6 22.2 100.0 302 25.7 9.9 35.3 29.1 100.0 321 26.4 7.4 38.0 28.3 100.0 741 39.5 3.7 23.4 33.4 100.0 629 49.8 2.7 27.8 19.8 100.0 1,077 33.2 3.7 36.1 27.0 100.0 457 48.7 2.4 20.7 28.2 100.0 396 43.4 3.6 23.8 29.3 100.0 2,377 42.8 4.7 27.8 24.7 100.0 2,965 16.8 4.2 34.6 44.3 100.0 168 42.7 4.1 25.9 27.4 100.0 5,907 __________________________________________________________________________ 1 See text for explanation of symptoms included. 2 Includes those not knowing of STIs at all (except for HIV/AIDS). Women generally have better knowledge of STIs in women than STIs in men, but not that much better. Only one in three women were able to report two or more of the common symptoms of an STI in women. Among men, the picture is worse, with only one in five men being able to report two or more STI symptoms in women. 176 * AIDS and other STDs Table 11.7.2 Knowledge of signs and symptoms of STIs in men: men Percent distribution of men by knowledge of signs and symptoms associated with sexually transmitted infections (STIs) in men, according to selected background characteristics, Zimbabwe 1999 __________________________________________________________________________ Knowledge of specific signs or symptoms of STIs in men1 ______________________________________ No Does not Knows Knows knowledge know at least two Number Background of any STI one or more of characteristic STIs2 symptoms symptom symptoms Total men __________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 38.2 7.1 26.2 28.5 100.0 713 19.0 12.7 22.5 45.8 100.0 506 15.3 6.9 19.1 58.7 100.0 430 10.9 6.6 18.7 63.9 100.0 500 10.2 4.4 16.4 69.0 100.0 356 8.6 4.4 11.5 75.5 100.0 104 17.3 7.8 26.3 48.7 100.0 614 43.4 9.9 23.0 23.9 100.0 638 11.0 6.3 17.7 65.0 100.0 1,239 12.4 8.0 16.3 63.3 100.0 118 22.5 10.0 24.0 43.4 100.0 1,090 19.0 5.8 18.8 56.5 100.0 1,519 26.7 10.9 16.5 45.9 100.0 360 13.6 3.2 14.5 68.7 100.0 236 14.0 17.2 33.7 35.0 100.0 217 14.4 2.7 18.0 64.9 100.0 268 18.9 10.3 16.1 54.7 100.0 146 19.4 2.0 16.4 62.2 100.0 120 10.4 2.0 14.4 73.2 100.0 308 23.2 0.0 16.8 60.0 100.0 225 33.2 13.7 32.5 20.7 100.0 514 14.4 5.7 18.3 61.6 100.0 214 15.2 0.0 8.6 76.2 100.0 66 21.4 6.0 18.3 54.3 100.0 830 21.5 8.8 23.4 46.4 100.0 1,556 7.9 7.4 15.8 69.0 100.0 157 20.5 7.5 21.0 51.0 100.0 2,609 __________________________________________________________________________ 1 See text for explanation of symptoms included. 2 Includes those not knowing of STIs at all (except for HIV/AIDS). As expected, knowledge of STIs varies widely across socioeconomic characteristics of the population. Of particular concern is the very low level of knowledge among young men and women. Only 12 percent of women under age 20 were able to cite two or more common STI symptoms (both male and female). Sixty percent of this same population were either not aware of non-HIV STIs at all or were not able to cite a single STI symptom. AIDS and other STDs * 177 Table 11.8.1 Knowledge of signs and symptoms of STIs in women: women Percent distribution of women by knowledge of signs and symptoms associated with sexually transmitted infections (STIs) in women, according to selected background characteristics, Zimbabwe 1999 __________________________________________________________________________ Knowledge of specific signs or symptoms of STIs in women1 ______________________________________ No Does not Knows Knows knowledge know at least two Number Background of any STI one or more of characteristic STIs2 symptoms symptom symptoms Total women __________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 59.2 5.7 22.7 12.5 100.0 1,447 42.1 4.2 25.2 28.6 100.0 1,294 30.8 3.7 27.3 38.2 100.0 1,034 27.0 3.1 23.4 46.6 100.0 1,305 27.4 1.7 27.3 43.5 100.0 827 34.0 6.6 27.9 31.5 100.0 422 62.5 5.9 19.7 11.9 100.0 1,215 33.4 2.6 26.3 37.7 100.0 3,609 28.9 5.0 24.4 41.8 100.0 662 36.0 4.9 26.6 32.5 100.0 2,279 40.7 3.2 23.7 32.3 100.0 3,628 53.0 3.3 15.7 27.8 100.0 882 37.8 2.8 24.5 35.0 100.0 477 47.6 1.9 14.9 35.6 100.0 461 38.4 0.7 17.0 43.8 100.0 559 42.4 6.1 23.9 27.6 100.0 302 23.8 6.6 35.6 34.0 100.0 321 26.0 7.5 37.4 29.1 100.0 741 34.6 3.7 24.3 37.7 100.0 629 44.3 3.7 24.6 27.4 100.0 1,077 27.4 2.9 36.6 33.1 100.0 457 44.7 1.1 20.0 34.2 100.0 396 39.5 2.8 23.6 34.1 100.0 2,377 38.9 5.2 26.4 29.5 100.0 2,965 16.8 1.9 26.9 54.4 100.0 168 38.9 3.9 24.8 32.4 100.0 5,907 __________________________________________________________________________ 1 See text for explanation of symptoms included. 2 Includes those not knowing of STIs at all (except for HIV/AIDS). 11.6 SELF-REPORTING OF RECENT SEXUALLY TRANSMITTED INFECTIONS The 1999 ZDHS asked respondents whether they had a sexually transmitted infection other than HIV/AIDS) in the last 12 months. They were also asked whether they had experienced a genital sore or ulcer and whether they had any genital discharge in the past 12 months. Although these symptoms have been shown useful in identifying STIs in men, they are less useful in women since women are likely to experience many more non-STI conditions of the reproductive tract that produce a discharge. Furthermore, the symptoms of STIs in women are often not easily recognised. It should 178 * AIDS and other STDs Table 11.8.2 Knowledge of signs and symptoms of STIs in women: men Percent distribution of men by knowledge of signs and symptoms associated with sexually transmitted infections (STIs) in women, according to selected background characteristics, Zimbabwe 1999__________________________________________________________________________ Knowledge of specific signs or symptoms of STIs in women1______________________________________ No Does not Knows Knows knowledge know at least two Number Background of any STI one or more of characteristic STIs2 symptoms symptom symptoms Total men__________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 65.2 8.3 15.6 10.9 100.0 713 53.0 14.0 14.9 18.1 100.0 506 40.0 10.4 23.5 26.1 100.0 430 37.6 13.2 19.3 29.8 100.0 500 31.8 12.2 21.4 34.5 100.0 356 33.3 7.4 15.5 43.8 100.0 104 35.6 11.7 21.1 31.5 100.0 1,239 41.2 13.4 19.3 26.0 100.0 118 50.8 11.9 17.6 19.6 100.0 614 68.9 9.1 13.1 8.9 100.0 638 47.3 11.8 21.7 19.2 100.0 1,090 47.8 10.9 15.7 25.6 100.0 1,519 52.4 21.8 9.7 16.1 100.0 360 44.2 6.9 15.1 33.8 100.0 236 37.4 22.5 27.0 13.1 100.0 217 50.0 12.2 19.9 17.9 100.0 268 51.4 10.8 18.9 18.9 100.0 146 45.3 6.5 15.2 33.0 100.0 120 33.9 0.9 10.5 54.7 100.0 308 57.5 0.4 19.7 22.5 100.0 225 45.0 15.1 28.0 11.8 100.0 514 64.6 5.4 12.6 17.4 100.0 214 42.5 5.6 14.3 37.6 100.0 66 50.4 11.6 16.1 21.9 100.0 830 48.7 11.2 19.1 21.0 100.0 1,556 23.3 12.1 22.5 42.1 100.0 157 47.6 11.2 18.3 22.9 100.0 2,609 __________________________________________________________________________ 1 See text for explanation of symptoms included. 2 Includes those not knowing of STIs at all (except for HIV/AIDS). also be understood that reporting of STIs and recognised STI symptoms is subject to a downward bias (i.e., underreporting) due to the social stigma attached to STIs. This reporting bias is probably more pronounced for women than for men. Tables 11.9.1 and 11.9.2 show that about 4 percent of both women and men reported an STI in the past 12 months. When asked whether they had experienced a genital discharge in the past 12 months, 6 percent of women and 4 percent of men reported that they had. Four percent of both women and men reported a genital sore or ulcer. The pattern of these reports suggests that some of the discharge reports by women are not related to STIs; however, this interpretation has not been validated. It should be mentioned that in the 1994 ZDHS, specific questions on STI symptoms were AIDS and other STDs * 179 Table 11.9.1 Self-reporting of sexually transmitted infections (STIs) and STI symptoms: women Among women who have ever had sex, the percentage who had a sexually transmitted infection and/or associated (self- reported) symptoms during the 12 months prior to the survey, according to background characteristics, Zimbabwe 1999 ___________________________________________________________________________________________________________ Had sexually Had Had genital transmitted infection genital discharge sore or ulcer Had in last 12 months? in last 12 months? in last 12 months? either__________________ __________________ __________________ discharge Don't Don't Don't or ulcer Number Background know/ know/ know/ last 12 of characteristic Yes No Missing Yes No Missing Yes No Missing months women___________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Drinking behaviour (last 30 days) Never drank Drinks, but did not get drunk Drinks, got drunk once Drinks, got drunk 2+ times Total 1.9 71.1 1.1 5.0 67.9 1.1 3.2 69.7 1.1 6.8 467 3.8 77.1 0.4 7.6 71.9 1.8 4.2 75.3 1.7 9.5 1,088 4.0 80.7 0.4 6.4 77.3 1.5 4.9 78.9 1.3 8.8 1,009 3.7 80.3 0.3 6.9 76.1 1.3 3.4 79.6 1.3 8.3 1,295 3.3 76.7 0.4 4.5 73.9 2.1 2.9 75.7 1.8 5.8 826 2.8 80.3 1.2 4.8 78.4 1.2 4.2 79.0 1.2 7.0 422 3.5 77.5 0.3 6.5 73.4 1.5 3.8 76.2 1.4 8.4 3,603 4.1 79.7 0.7 6.4 75.8 2.3 3.5 78.8 2.2 7.2 660 3.7 86.3 0.7 8.1 80.3 2.4 4.4 84.1 2.2 10.2 1,764 3.4 73.1 0.3 5.3 70.5 1.1 3.5 72.4 1.0 6.8 2,921 3.6 58.4 0.4 4.4 56.7 1.3 2.8 58.3 1.3 5.8 681 3.7 75.9 0.7 12.4 67.1 0.7 4.6 75.1 0.5 14.2 395 2.1 70.2 0.3 2.9 68.1 1.6 2.7 69.1 0.8 4.3 374 6.1 73.0 1.0 4.6 68.6 6.9 4.0 69.0 7.1 6.3 474 1.1 75.0 0.2 1.3 75.1 0.0 1.3 75.1 0.0 2.4 258 2.1 88.4 0.2 2.7 87.7 0.4 2.5 87.9 0.4 4.1 272 3.8 88.6 0.8 7.3 83.7 2.2 5.3 85.7 2.2 9.6 574 4.9 79.5 0.0 9.3 75.1 0.0 4.5 79.9 0.0 10.9 461 2.7 84.9 0.2 8.7 78.0 1.1 5.0 81.9 0.9 11.4 838 4.2 92.5 0.5 4.4 92.8 0.0 2.6 94.6 0.0 5.2 359 3.2 60.5 0.3 4.3 59.2 0.4 1.9 61.7 0.4 5.4 385 3.5 73.1 0.5 5.8 69.5 1.8 4.3 71.0 1.8 7.9 2,100 3.7 85.8 0.5 7.2 81.3 1.5 3.7 85.0 1.3 8.7 2,199 3.2 77.8 0.4 5.7 74.2 1.5 3.4 76.7 1.4 7.2 3,958 5.0 80.5 1.0 10.0 74.7 1.8 5.6 79.1 1.8 12.8 578 2.1 77.0 0.0 8.6 66.4 4.1 5.9 70.5 2.7 12.4 72 11.3 73.1 0.8 7.3 75.4 2.6 12.2 70.6 2.6 13.4 75 3.6 78.1 0.5 6.3 74.2 1.6 3.8 76.8 1.5 8.1 4,685 not asked, but men did report that they had had an STI in the past 12 months more frequently than women in the sample (5 percent and 3 percent, respectively). That in the 1999 ZDHS, men and women reported about equal rates of infections (4 percent) should not be overinterpreted. The difference is small and well within sampling and expected measurement error. The level of stigma associated with STIs may also have changed, leading to more complete (i.e., higher) reports by women. Some important differentials are observed in STI reports. As expected, men and women at ages of peak sexual activity (20-39 years) show the highest levels of reported STIs and STI symptoms. Differences among subgroups based on marital status are not very pronounced, although 180 * AIDS and other STDs Table 11.9.2 Self-reporting of sexually transmitted infections (STIs) and STI symptoms: men Among men who have ever had sex, the percentage who had a sexually transmitted infection and/or associated (self-reported) symptoms during the 12 months prior to the survey, according to background characteristics, Zimbabwe 1999 ___________________________________________________________________________________________________________ Had sexually Had Had genital transmitted infection genital discharge sore or ulcer Had in last 12 months? in last 12 months? in last 12 months? either__________________ __________________ __________________ discharge Don't Don't Don't or ulcer Number Background know/ know/ know/ last 12 of characteristic Yes No Missing Yes No Missing Yes No Missing months men___________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Drinking behaviour (last 30 days) Never drank Drinks, but did not get drunk Drinks, got drunk once Drinks, got drunk 2+ times Total 1.4 90.2 0.9 1.2 90.9 0.5 3.2 88.9 0.5 4.3 210 4.7 91.4 0.7 4.1 92.0 0.7 4.5 91.5 0.7 7.2 387 6.3 90.2 0.2 4.3 92.3 0.0 3.6 93.0 0.0 6.5 416 2.6 93.7 0.0 3.2 93.0 0.0 4.6 91.7 0.0 5.7 499 3.2 92.5 0.5 5.5 89.6 1.1 4.4 91.2 0.5 6.3 356 0.0 93.2 0.0 2.6 90.6 0.0 2.6 88.7 1.8 2.6 104 4.1 89.8 0.9 3.4 90.9 0.6 3.5 90.7 0.6 5.9 614 2.8 93.7 0.0 3.8 92.6 0.2 3.8 92.7 0.0 5.4 1,239 9.3 83.0 1.6 6.3 86.1 1.6 9.8 80.9 3.2 12.1 118 3.2 92.9 0.5 2.6 93.3 0.7 3.5 92.4 0.7 4.9 878 4.0 91.0 0.3 4.7 90.4 0.2 4.5 90.6 0.2 6.8 1,092 2.6 90.8 0.0 1.6 91.8 0.0 1.0 92.4 0.0 2.6 221 3.4 95.0 0.0 12.8 85.7 0.0 12.0 86.5 0.0 15.0 185 8.2 85.2 0.0 6.6 86.9 0.0 4.9 88.5 0.0 9.3 185 5.8 86.7 0.4 4.9 87.5 0.4 3.5 88.9 0.4 7.5 230 2.6 95.5 0.0 1.5 96.7 0.0 1.5 96.7 0.0 3.0 108 5.4 90.8 0.0 2.7 93.5 0.0 2.7 93.5 0.0 4.3 90 1.9 96.3 1.0 2.7 95.9 0.6 4.7 94.0 0.6 5.5 240 2.6 93.5 0.7 3.1 93.0 0.7 2.0 94.1 0.7 4.4 138 2.7 93.2 0.5 1.4 94.1 0.9 4.1 91.4 0.9 4.1 417 2.1 91.7 0.8 2.1 92.1 0.4 2.5 91.7 0.4 3.7 155 3.3 86.3 2.6 4.7 85.9 1.6 2.7 87.9 1.6 4.7 65 3.6 90.7 0.4 5.6 88.8 0.3 6.1 88.1 0.6 8.6 657 3.6 92.8 0.2 2.8 93.5 0.4 3.1 93.3 0.2 4.6 1,249 2.5 90.1 0.5 2.1 90.3 0.6 2.9 89.8 0.4 4.3 782 2.8 95.2 0.5 2.9 95.1 0.5 3.1 94.6 0.9 4.2 544 5.4 93.9 0.0 5.7 93.7 0.0 6.9 92.5 0.0 8.5 159 5.8 90.2 0.2 7.0 89.2 0.0 6.3 89.9 0.0 10.0 477 3.6 91.9 0.4 3.8 91.7 0.4 4.1 91.4 0.4 6.0 1,971 men who were divorced or widowed tended to report STIs at a higher rate than other men. Rural men report slightly more STIs than their urban counterparts, but the same is not true for women. Provincial differentials in STI prevalence vary between men and women and are confused by large differences between the reports of STIs as opposed to STI symptoms. For example, in men, the highest levels of reported STI symptoms (either discharge or sore/ulcer) occur in the three Mashonaland provinces (Central, East, and West). Among women, reports of STI symptoms are highest in Mashonaland Central, Harare, and Masvingo. Women who have received more education were more likely to report an STI in the past 12 months than less-educated women. For men, this relationship is not pronounced. AIDS and other STDs * 181 Table 11.10 Treatment-seeking behaviour among self-reported STI cases Among women and men who had a sexually transmitted infection (STI) or STI symptom in the 12 months prior to the survey, the percentage who sought treatment or advice, and the source of treatment or advice, Zimbabwe 1999 _____________________________________________________________________________________ Source of treatment or advice ________________________________________ Sought Clinic, any hospital, Number kind of or Friends of treatment private Traditional or women/ or advice doctor healer Shop relatives men _____________________________________________________________________________________ Women Men 65.3 56.7 2.3 0.2 0.2 406 83.5 66.0 12.0 2.0 4.7 130 In the 1999 ZDHS, women and men were asked to report on their drinking habits (alcoholic beverages) and whether and how often they became “drunk” in the past 30 days. It is thought that drinking, especially excessive drinking, increases the likelihood of risky sexual behaviour that could lead to STIs. The results indicate a strong association between drinking behaviour and risk of getting an STI in both men and women. For example, a report of either genital discharge or sore/ulcer in men is more than twice as likely if a man reported having been drunk in the past 30 days, compared with men who did not drink at all. 11.7 TREATMENT-SEEKING AND OTHER BEHAVIOURS IN RESPONSE TO STIS If respondents reported an STI or an STI symptom (i.e., discharge or sore/ulcer) in the past 12 months, they were asked questions on their actions in response to the illness. Table 11.10 presents information on the 406 women and 130 men who reported an STI or symptom in the past 12 months. Men were more likely than women to have reported that they sought some type of treatment or advice (84 percent and 65 percent, respectively). The male-female difference is narrowed when looking specifically at whether a health facility was the source for treatment (66 percent for men and 57 percent for women). Men were much more likely than women to go to a traditional healer in response to an STI (12 percent and 2 percent, respectively). Shops, friends, and relatives were cited infrequently as a source for care of an STI. Table 11.11 shows that about three-quarters of women and two-thirds of men reporting an STI in the past year said that they had informed (all of) their partner(s). Twenty-eight percent of men and 15 percent of women said that they did not inform (any of) their partner(s). Missing values were common in this variable, especially among women (11 percent), probably because many respondents to this question had not actually reported an STI (i.e., they reported discharge or sore/ulcer) and did not think they would have a reason to “inform” their partner(s). 182 * AIDS and other STDs Table 11.11 Other actions taken by respondents who reported an STI in the past 12 months Among women and men who had a sexually-transmitted disease during the 12 months prior to the survey, the percentage who informed their partner and the percentage who took other measures to avoid infecting their partner, Zimbabwe 1999 _____________________________________________________________________________________________________________________ Among those who did Number of Did something to something to avoid women/men Informed partner avoid infecting partner infecting partner, who did ______________________ ______________________________ Number the percentage who: something Partner of women/ ______________________ to avoid already men with Avoided Used Used infecting Yes No Missing Yes No infected Missing an STI sex condoms medicine partner _____________________________________________________________________________________________________________________ Women 73.4 15.3 11.4 43.3 33.5 12.1 11.0 406 40.5 14.7 62.2 176 Men 66.7 27.7 5.6 65.9 26.0 2.6 5.6 130 29.7 21.8 63.6 85 Almost two-thirds of men but less than one-half of women reported that they had taken some action to avoid infecting their partner(s). This is rather misleading without further examination. First, as mentioned above, some women who had a discharge, for instance, may not have had an STI. The large number of missing responses to this question is certainly related to this conceptual problem in the survey instrument. Second, and more important, in 12 percent of reported STI cases among women, the respondent reported that it was her partner that brought the infection into the partnership. This scenario was reported much less commonly by men (3 percent). Among the 176 women and 85 men reporting that they had done something to avoid infecting their partner(s), use of medicine was the most common action taken (62 percent for women and 64 percent for men). Avoiding sex, the second most commonly reported action, was reported more frequently by women (41 percent) than men (30 percent). 11.8 NUMBER OF SEXUAL PARTNERS Given the evidence that most HIV infections in Zimbabwe are contracted through heterosexual contact, information on sexual behaviour is important in designing and monitoring intervention programmes to control the spread of the disease. The 1999 ZDHS included questions on the respondent’s last three sexual partners in the 12 months preceding the survey. Two broad partner types were defined: those cohabiting with the respondent (mostly spouses) and those not cohabiting with the respondent at the time of the last sexual encounter with that partner. For male respondents, a question was asked about whether they had paid for sex in the past 12 months. Information on use of condoms at the last sexual encounter with each of these partner types was also collected. Tables 11.12.1 and 11.12.2 show the percent distributions of men and women by number of persons with whom they had sex in the past 12 months, by background characteristics, according to marital status. These data show that men reported having more sexual partners than women. Only 1 percent of currently married women reported extramarital sexual activity in the past 12 months, compared with 16 percent of married men. About 3 percent of married men reported two or more extramarital partners in the past year, while virtually no married women reported the same. Among unmarried men, 42 percent had some sexual activity in the previous 12 months—more than one-quarter of these reported two or more partners. Unmarried women reported less sexual activity than unmarried men. About 27 percent of the unmarried women reported having had AIDS and other STDs * 183 Ta bl e 11 .1 2. 1 N um be r o f s ex ua l p ar tn er s: w om en Pe rc en t di st rib ut io n of c ur re nt ly m ar rie d an d un m ar rie d w om en , by n um be r of p er so ns w ith w ho m t he y ha d se xu al i nt er co ur se i n th e la st 1 2 m on th s, a cc or di ng t o ba ck gr ou nd c ha ra ct er ist ic s, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C ur re nt ly m ar rie d: n um be r o f C ur re nt ly m ar rie d: n um be r o f pa rtn er s in cl ud in g sp ou se pa rtn er s ex cl ud in g sp ou se an d co ha bi tin g pa rtn er s an d co ha bi tin g pa rtn er s U nm ar rie d w om en : nu m be r o f p ar tn er s __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ N um be r o f __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ D on 't D on 't cu rr en tly D on 't N um be r o f Ba ck gr ou nd kn ow / kn ow / m ar rie d kn ow / un m ar rie d ch ar ac te ris tic 0 1 2+ M iss in g To ta l 0 1 2+ M iss in g To ta l w om en 0 1 2+ M iss in g To ta l w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Ag e 1 5- 19 2 0- 24 2 5- 29 3 0- 39 4 0- 49 M ar ita l s ta tu s N ev er m ar rie d H as h ad s ex H as n ev er h ad s ex M ar rie d or in u ni on D iv or ce d, w id ow ed Re si de nc e U rb an R ur al Pr ov in ce M an ic al an d M as ho na la nd C en tra l M as ho na la nd E as t M as ho na la nd W es t M at ab el el an d N or th M at ab el el an d So ut h M id la nd s M as vi ng o H ar ar e B ul aw ay o Ed uc at io n N o ed uc at io n P rim ar y S ec on da ry H ig he r D ri nk in g be ha vi ou r (l as t 3 0 da ys ) N ev er d ra nk D rin ks , b ut d id n ot ge t d ru nk D rin ks , g ot d ru nk o nc e D rin ks , g ot d ru nk 2+ ti m es To ta l 1. 2 97 .1 1. 1 0. 6 10 0. 0 97 .8 1. 6 0. 0 0. 6 10 0. 0 31 4 89 .6 9. 5 0. 8 0. 0 10 0. 0 1, 13 3 1. 6 96 .5 1. 6 0. 3 10 0. 0 97 .7 1. 6 0. 4 0. 3 10 0. 0 82 0 60 .8 34 .0 5. 2 0. 0 10 0. 0 47 4 2. 6 96 .9 0. 6 0. 0 10 0. 0 98 .9 0. 8 0. 2 0. 0 10 0. 0 78 8 46 .6 47 .7 5. 7 0. 0 10 0. 0 24 7 1. 7 98 .0 0. 3 0. 0 10 0. 0 99 .1 0. 7 0. 2 0. 0 10 0. 0 1, 03 9 51 .9 42 .3 5. 7 0. 0 10 0. 0 26 6 4. 6 94 .7 0. 4 0. 3 10 0. 0 98 .6 1. 1 0. 0 0. 3 10 0. 0 64 8 70 .1 25 .4 4. 5 0. 0 10 0. 0 17 9 N A N A N A N A N A N A N A N A N A M A N A 29 .1 63 .9 7. 0 0. 0 10 0. 0 42 2 N A N A N A N A N A N A N A N A N A N A N A 10 0. 0 0. 0 0. 0 0. 0 10 0. 0 1, 21 5 2. 3 96 .8 0. 7 0. 2 10 0. 0 98 .5 1. 1 0. 2 0. 2 10 0. 0 3, 60 9 N A N A N A N A M A N A N A N A N A N A N A N A N A N A N A N A N A 51 .9 41 .7 6. 4 0. 0 10 0. 0 66 2 1. 0 97 .8 0. 7 0. 5 10 0. 0 97 .9 1. 4 0. 3 0. 5 10 0. 0 1, 30 6 69 .4 27 .5 3. 1 0. 0 10 0. 0 97 3 3. 1 96 .1 0. 7 0. 0 10 0. 0 98 .9 0. 9 0. 2 0. 0 10 0. 0 2, 30 3 75 .9 21 .0 3. 1 0. 0 10 0. 0 1, 32 6 4. 4 95 .6 0. 0 0. 0 10 0. 0 99 .5 0. 5 0. 0 0. 0 10 0. 0 56 1 81 .0 15 .2 3. 8 0. 0 10 0. 0 32 1 2. 7 96 .3 1. 0 0. 0 10 0. 0 98 .4 1. 4 0. 2 0. 0 10 0. 0 32 5 76 .8 19 .8 3. 4 0. 0 10 0. 0 15 3 2. 6 97 .4 0. 0 0. 0 10 0. 0 10 0. 0 0. 0 0. 0 0. 0 10 0. 0 31 0 80 .3 15 .8 3. 9 0. 0 10 0. 0 15 1 1. 4 96 .8 0. 8 1. 0 10 0. 0 97 .3 1. 3 0. 3 1. 0 10 0. 0 36 7 74 .2 22 .7 3. 1 0. 0 10 0. 0 19 2 1. 6 97 .4 0. 9 0. 0 10 0. 0 99 .1 0. 9 0. 0 0. 0 10 0. 0 18 0 53 .1 44 .6 2. 4 0. 0 10 0. 0 12 1 2. 6 95 .2 2. 3 0. 0 10 0. 0 96 .9 1. 7 1. 4 0. 0 10 0. 0 17 0 45 .6 48 .5 5. 9 0. 0 10 0. 0 15 1 1. 8 96 .1 1. 8 0. 3 10 0. 0 97 .7 1. 7 0. 3 0. 3 10 0. 0 44 4 78 .3 18 .2 3. 4 0. 0 10 0. 0 29 7 2. 8 97 .2 0. 0 0. 0 10 0. 0 99 .7 0. 3 0. 0 0. 0 10 0. 0 36 7 87 .6 10 .2 2. 2 0. 0 10 0. 0 26 2 1. 1 98 .0 0. 9 0. 0 10 0. 0 98 .3 1. 4 0. 3 0. 0 10 0. 0 66 7 74 .3 23 .4 2. 3 0. 0 10 0. 0 41 0 2. 3 96 .8 0. 3 0. 6 10 0. 0 97 .7 1. 7 0. 0 0. 6 10 0. 0 21 7 58 .4 39 .5 2. 1 0. 0 10 0. 0 23 9 5. 4 93 .6 1. 0 0. 0 10 0. 0 98 .2 1. 5 0. 3 0. 0 10 0. 0 31 0 71 .8 24 .2 4. 0 0. 0 10 0. 0 87 2. 9 95 .9 1. 0 0. 2 10 0. 0 98 .5 1. 1 0. 2 0. 2 10 0. 0 1, 66 5 65 .1 29 .7 5. 2 0. 0 10 0. 0 71 2 1. 3 98 .2 0. 4 0. 1 10 0. 0 98 .6 1. 1 0. 2 0. 1 10 0. 0 1, 52 3 77 .8 20 .1 2. 2 0. 0 10 0. 0 1, 44 3 0. 0 99 .4 0. 0 0. 6 10 0. 0 99 .4 0. 0 0. 0 0. 6 10 0. 0 11 1 59 .9 40 .1 0. 0 0. 0 10 0. 0 57 2. 1 97 .2 0. 6 0. 1 10 0. 0 98 .8 1. 0 0. 1 0. 1 10 0. 0 3, 10 3 77 .0 21 .0 2. 0 0. 0 10 0. 0 2, 02 1 4. 0 94 .4 1. 2 0. 5 10 0. 0 98 .3 0. 5 0. 7 0. 5 10 0. 0 41 3 52 .0 40 .5 7. 5 0. 0 10 0. 0 21 7 3. 9 95 .3 0. 8 0. 0 10 0. 0 95 .3 4. 7 0. 0 0. 0 10 0. 0 50 * * * * * 24 (2 .3 ) (9 1. 7) (6 .0 (0 .0 ) 10 0. 0 (8 7. 8) (6 .2 ) (6 .0 ) (0 .0 ) 10 0. 0 41 (1 5. 4) (5 0. 0) (3 4. 7) (0 .0 ) 10 0. 0 36 2. 3 96 .8 0. 7 0. 2 10 0. 0 98 .5 1. 1 0. 2 0. 2 10 0. 0 3, 60 9 73 .2 23 .7 3. 1 0. 0 10 0. 0 2, 29 8 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 ca se s an d ha s be en s up pr es se d. N A = N ot a pp lic ab le 184 * AIDS and other STDs Ta bl e 11 .1 2. 2 N um be r o f s ex ua l p ar tn er s: m en Pe rc en t d ist rib ut io n of c ur re nt ly m ar rie d an d un m ar rie d m en , b y nu m be r o f p er so ns w ith w ho m th ey h ad se xu al in te rc ou rs e in th e la st 1 2 m on th s, a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C ur re nt ly m ar rie d: n um be r o f C ur re nt ly m ar rie d: n um be r o f pa rtn er s in cl ud in g sp ou se pa rtn er s ex cl ud in g sp ou se an d co ha bi tin g pa rtn er s an d co ha bi tin g pa rtn er s U nm ar rie d m en : n um be r o f p ar tn er s __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ N um be r o f __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ D on 't D on 't cu rr en tly D on 't N um be r o f Ba ck gr ou nd kn ow / kn ow / m ar rie d kn ow / un m ar rie d ch ar ac te ris tic 0 1 2+ M iss in g To ta l 0 1 2+ M iss in g To ta l m en 0 1 2+ M iss in g To ta l m en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Ag e 1 5- 19 2 0- 24 2 5- 29 3 0- 39 4 0- 49 5 0- 54 M ar ita l s ta tu s N ev er m ar rie d H as h ad s ex H as n ev er h ad s ex M ar rie d or in u ni on D iv or ce d, w id ow ed Re si de nc e U rb an R ur al Pr ov in ce M an ic al an d M as ho na la nd C en tra l M as ho na la nd E as t M as ho na la nd W es t M at ab el el an d N or th M at ab el el an d So ut h M id la nd s M as vi ng o H ar ar e B ul aw ay o Ed uc at io n N o ed uc at io n P rim ar y S ec on da ry H ig he r D ri nk in g be ha vi ou r (l as t 3 0 da ys ) N ev er d ra nk D rin ks , b ut d id n ot ge t d ru nk D rin ks , g ot d ru nk o nc e D rin ks , g ot d ru nk 2+ ti m es To ta l 16 .5 37 .2 46 .3 0. 0 10 0. 0 * * * * * 4 77 .6 18 .3 4. 1 0. 0 10 0. 0 70 9 0. 0 78 .4 21 .6 0. 0 10 0. 0 77 .4 15 .3 7. 3 0. 0 10 0. 0 11 0 42 .1 38 .5 19 .0 0. 4 10 0. 0 39 5 0. 0 83 .4 16 .6 0. 0 10 0. 0 81 .4 16 .2 2. 4 0. 0 10 0. 0 28 3 20 .1 54 .1 24 .4 1. 4 10 0. 0 14 7 0. 0 89 .5 10 .0 0. 4 10 0. 0 87 .0 11 .8 0. 8 0. 4 10 0. 0 43 3 26 .2 52 .5 19 .2 2. 2 10 0. 0 67 1. 8 84 .2 13 .7 0. 3 10 0. 0 84 .1 12 .7 2. 9 0. 3 10 0. 0 32 1 (4 0. 8) (3 1. 6) (2 5. 5) (2 .1 ) 10 0. 0 35 1. 6 84 .8 11 .9 1. 7 10 0. 0 85 .7 9. 4 3. 2 1. 7 10 0. 0 87 * * * * * 17 N A N A N A N A N A N A N A N A N A N A N A 19 .2 59 .5 20 .9 0. 3 10 0. 0 61 4 N A N A N A N A N A N A N A N A N A N A N A 10 0. 0 0. 0 0. 0 0. 0 10 0. 0 63 8 0. 6 85 .3 13 .8 0. 4 10 0. 0 83 .9 13 .2 2. 5 0. 4 10 0. 0 1, 23 9 N A N A N A N A N A N A N A N A N A N A N A N A N A N A N A N A N A 25 .7 41 .8 28 .6 4. 0 10 0. 0 11 8 0. 3 86 .2 13 .1 0. 3 10 0. 0 84 .3 12 .8 2. 5 0. 3 10 0. 0 54 6 50 .8 33 .9 15 .2 0. 1 10 0. 0 54 4 0. 9 84 .5 14 .3 0. 4 10 0. 0 83 .6 13 .5 2. 5 0. 4 10 0. 0 69 3 61 .7 27 .9 9. 6 0. 7 10 0. 0 82 6 2. 1 89 .0 7. 8 1. 0 10 0. 0 91 .1 6. 8 1. 0 1. 0 10 0. 0 13 9 73 .3 23 .1 2. 3 1. 3 10 0. 0 22 1 0. 6 82 .1 17 .3 0. 0 10 0. 0 79 .3 18 .5 2. 3 0. 0 10 0. 0 12 7 59 .1 27 .9 12 .3 0. 7 10 0. 0 10 9 0. 0 95 .6 4. 4 0. 0 10 0. 0 92 .1 7. 9 0. 0 0. 0 10 0. 0 11 7 42 .4 47 .4 9. 1 1. 0 10 0. 0 10 0 0. 0 78 .8 20 .6 0. 7 10 0. 0 74 .9 19 .2 5. 2 0. 7 10 0. 0 14 7 46 .2 27 .7 25 .3 0. 8 10 0. 0 12 1 0. 0 77 .4 22 .6 0. 0 10 0. 0 76 .7 18 .7 4. 7 0. 0 10 0. 0 61 54 .3 23 .8 21 .9 0. 0 10 0. 0 85 (1 .1 ) (8 5. 2) (1 3. 8) (0 .0 ) 10 0. 0 (8 5. 2) (1 1. 7) (3 .2 ) (0 .0 ) 10 0. 0 46 53 .0 39 .2 7. 1 0. 7 10 0. 0 74 0. 0 82 .9 17 .1 0. 0 10 0. 0 82 .9 13 .2 3. 9 0. 0 10 0. 0 14 3 52 .3 28 .6 19 .1 0. 0 10 0. 0 16 5 1. 8 83 .5 14 .7 0. 0 10 0. 0 85 .3 13 .8 0. 9 0. 0 10 0. 0 10 2 74 .9 20 .0 5. 1 0. 0 10 0. 0 12 3 0. 7 88 .8 9. 8 0. 7 10 0. 0 86 .7 10 .5 2. 1 0. 7 10 0. 0 27 1 54 .7 35 .9 9. 4 0. 0 10 0. 0 24 3 0. 0 81 .2 18 .8 0. 0 10 0. 0 78 .9 18 .0 3. 0 0. 0 10 0. 0 86 50 .5 34 .0 15 .0 0. 5 10 0. 0 12 9 (1 .8 ) (7 8. 6) (1 7. 6) (2 .0 ) 10 0. 0 (7 5. 1) (2 2. 0) (0 .8 ) (2 .0 ) 10 0. 0 49 * * * * 10 0. 0 16 1. 3 83 .3 15 .1 0. 3 10 0. 0 82 .6 13 .8 3. 3 0. 3 10 0. 0 46 1 58 .5 27 .0 13 .8 0. 7 10 0. 0 36 9 0. 1 87 .1 12 .4 0. 3 10 0. 0 85 .8 11 .8 2. 1 0. 3 10 0. 0 61 7 58 .8 29 .7 11 .2 0. 3 10 0. 0 93 9 0. 0 86 .0 14 .0 0. 0 10 0. 0 82 .8 15 .0 2. 3 0. 0 10 0. 0 11 2 (3 0. 7) (5 9. 3) (1 0. 0) (0 .0 ) 10 0. 0 45 0. 5 88 .6 10 .4 0. 5 10 0. 0 88 .5 9. 2 1. 8 0. 5 10 0. 0 41 0 70 .6 24 .1 5. 0 0. 3 10 0. 0 94 4 1. 5 87 .8 10 .0 0. 7 10 0. 0 86 .2 11 .7 1. 4 0. 7 10 0. 0 37 0 37 .5 40 .1 22 .0 0. 5 10 0. 0 22 3 0. 0 83 .9 16 .1 0. 0 10 0. 0 83 .0 13 .9 3. 1 0. 0 10 0. 0 11 0 23 .6 43 .3 29 .9 3. 2 10 0. 0 54 0. 0 79 .2 20 .8 0. 0 10 0. 0 76 .4 19 .2 4. 4 0. 0 10 0. 0 34 0 15 .3 50 .4 33 .3 1. 0 10 0. 0 14 8 0. 6 85 .3 13 .8 0. 4 10 0. 0 83 .9 13 .2 2. 5 0. 4 10 0. 0 1, 23 9 57 .4 30 .3 11 .8 0. 5 10 0. 0 1, 37 0 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 ca se s an d ha s be en s up pr es se d. N A = N ot a pp lic ab le 2 Thirty-six percent of married men and 15 percent of unmarried men reported being drunk at least once in the past 30 days, compared with 3 percent of both married and unmarried women. AIDS and other STDs * 185 Figure 11.3 Percent Distribution of Unmarried Men by Number of Sexual Partners in Last 12 Months, According to Drinking Pattern in Last 30 Days, Zimbabwe 1999 0 20 40 60 80 100 Number of Partners None One Two or more 37.5 Never drinks Drinks, never drunk Drunk once Drunk 2+ times DRINKING PATTERN IN LAST 30 DAYS 71 Percent ZDHS 1999 any sex in the past year. Of those women who did report having had sex, a smaller percentage reported having had sex with more than one partner than men did (12 percent versus 28 percent). Among currently married men and women, having multiple partners is not closely tied to age although there is a tendency among married men for extramarital activity to diminish with age. In both unmarried men and women, the age group 25-29 is the period of peak sexual activity. More than 50 percent of unmarried women and about 80 percent of unmarried men age 25-29 are sexually active. The 1999 ZDHS collected information on the respondent’s drinking habits (including getting “drunk”) over the past 30 days, which can be cross-tabulated with patterns of sexual activity. Drinking (alcoholic beverages) is associated with higher rates of both extramarital sexual activity and multiple partnering among unmarried individuals. This is true of both men and women, but the percentage of men who drink and who get drunk is much larger.2 Eleven percent of married men who do not drink are engaged in sexuality activity outside their marriage(s), compared with 24 percent of men who get drunk more than once in 30 days. Among unmarried men, 5 percent who do not drink had two or more partners in the past 12 months, compared with 33 percent of those who had been drunk more than once in the past 30 days (Figure 11.3). 186 * AIDS and other STDs Table 11.13 Payment for sexual relations Among men who have ever had sexual intercourse, the percentage who gave or received money, gifts, or favours in return for sex in the last 12 months, by marital status and background characteristics, Zimbabwe 1999 _____________________________________________________________________________________ Currently married men Unmarried men All men Background _________________ _________________ __________________ characteristic Percent Number Percent Number Percent Number _____________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Residence Urban Rural Education No education Primary Secondary Drinking behaviour (last 30 days) Never drank Drinks, but did not get drunk Drinks, got drunk once Drinks, got drunk 2+ times Total * 4 2.1 205 3.0 210 6.1 110 11.1 276 9.7 387 6.4 283 16.0 133 9.5 416 3.9 433 7.4 65 4.4 499 6.7 321 22.3 35 8.3 356 1.7 87 8.1 17 2.7 104 5.7 546 12.7 332 8.3 878 5.2 693 7.0 399 5.9 1,092 10.1 49 4.7 15 8.8 65 5.4 461 10.7 196 7.0 657 5.1 729 9.3 521 6.9 1,249 1.4 410 4.9 372 3.0 782 2.8 370 8.8 174 4.7 544 8.5 110 19.8 49 12.0 159 12.2 340 19.9 137 14.4 477 5.4 1,239 9.6 732 7.0 1,971 _______________________________________________________________________________________ Note: An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 11.9 PAYMENT FOR SEXUAL RELATIONS In the 1999 ZDHS, male respondents were asked whether they had ever “paid for sex” in the past 12 months. Table 11.13 shows that 7 percent of men age 15-54 who ever had sex have engaged in sex for money within the past year. Unmarried men are nearly twice as likely to have paid for sex in the past year than married men. No clear patterns exist in the relationship between paying for sex and age and educational level of the man. Among unmarried men, urban residence is associated with a much greater likelihood (as opposed to rural residence) of having paid for sex in the past 12 months. Among married men, the urban-rural difference is negligible. For both married and unmarried men, the likelihood that a man engages in commercial sex increases sharply with increasing use of alcohol. Only 3 percent of all men who did not drink in the past 30 days reported paying for sex, compared with 5 percent of men who drank but did not get “drunk,” 12 percent who reported getting “drunk” only once in the past 30 days, and 14 percent who got “drunk” more often than that. AIDS and other STDs * 187 Table 11.14.1 Knowledge of source for condoms: women Percent distribution of women by knowledge of a specific source for condoms, according to background characteristics, Zimbabwe 1999 __________________________________________________________________________ Source for condoms Does not ____________________________________ know a Number Background source for Private Shop/ of characteristic condoms Public medical Pharmacy Other women __________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 50.0 30.1 2.4 3.0 14.5 1,447 24.1 51.9 4.0 6.8 13.1 1,294 14.8 65.6 4.1 4.3 11.2 1,034 17.8 64.0 3.4 5.1 9.7 1,305 29.4 57.2 2.9 4.3 6.3 827 21.7 46.3 8.9 6.8 16.3 422 52.8 23.9 1.3 5.6 16.3 1,215 22.3 61.1 3.3 4.0 9.3 3,609 18.7 60.7 4.0 5.7 10.9 662 19.3 48.2 4.3 11.0 17.2 2,279 33.7 55.0 2.7 0.8 7.8 3,628 37.1 50.5 1.9 1.0 9.4 882 23.1 63.7 4.3 1.2 7.8 477 26.9 66.0 0.4 1.5 5.2 461 32.7 52.4 3.7 3.9 7.3 559 37.9 38.0 11.2 2.7 10.3 302 26.8 58.8 6.8 1.3 6.3 321 26.9 56.7 3.3 1.3 11.8 741 35.0 50.0 3.1 1.7 10.2 629 22.1 42.2 2.3 15.1 18.4 1,077 13.3 55.6 2.9 8.8 19.5 457 49.0 45.6 3.0 0.3 2.2 396 32.1 56.4 3.1 1.3 7.2 2,377 23.4 50.7 3.5 6.9 15.5 2,965 7.1 41.0 6.0 24.7 21.2 168 28.2 52.4 3.4 4.7 11.4 5,907 11.10 KNOWLEDGE OF SOURCES FOR MALE AND FEMALE CONDOMS Because of the important role that the male condom plays in combatting the transmission of HIV, respondents were asked where they could be obtained. The female condom has recently been introduced in Zimbabwe. To establish a baseline for knowledge of this option, a separate set of questions was asked of men and women on where female condoms could be obtained. MALE CONDOMS Tables 11.14.1 and 11.14.2 show that more than one-quarter of women and one-sixth of men could not cite a place where they could obtain a (male) condom. Knowledge of a source for condoms varies widely, with the lowest levels of knowledge among men and women who are less educated and those living in rural areas, particularly in the provinces of Manicaland, Masvingo, and Matabeleland North. An important and troubling finding is that one-half of women and one-third of men in the age group 15-19 do not know where to get a condom. Since the 1994 ZDHS, knowledge of a source for condoms has much improved in all age groups, except this most 188 * AIDS and other STDs Table 11.14.2 Knowledge of source for condoms: men Percent distribution of men by knowledge of a specific source for condoms, according to background characteristics, Zimbabwe 1999 __________________________________________________________________________ Source for condoms Does not ____________________________________ know a Number Background source for Private Shop/ of characteristic condoms Public medical Pharmacy Other men __________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 31.7 31.0 5.2 3.9 28.2 713 12.8 33.7 4.8 4.3 44.3 506 6.6 32.6 6.5 6.6 47.7 430 7.2 38.9 9.5 7.2 37.1 500 15.2 38.5 10.9 6.6 28.9 356 24.3 36.0 5.5 5.7 28.6 104 6.5 27.5 5.0 2.4 58.6 614 38.2 32.7 3.6 5.3 20.2 638 11.1 39.7 9.5 7.4 32.3 1,239 12.0 26.8 9.0 2.5 49.7 118 9.1 24.2 5.4 12.2 49.0 1,090 22.1 42.0 8.1 0.7 27.2 1,519 32.8 30.9 8.9 2.0 25.4 360 14.0 44.6 10.4 0.0 30.9 236 15.0 31.8 19.1 0.5 33.7 217 15.2 37.6 12.2 3.5 31.6 268 21.6 33.0 17.3 0.8 27.3 146 18.2 53.1 0.0 0.4 28.3 120 10.0 40.2 4.7 2.8 42.3 308 25.3 58.1 0.8 1.4 14.4 225 11.1 13.7 1.1 18.1 56.1 514 6.0 36.3 1.8 9.0 46.8 214 28.0 33.7 8.4 0.0 30.0 66 25.3 39.0 9.4 1.4 25.0 830 12.9 32.8 5.7 6.8 41.7 1,556 3.9 28.3 6.0 16.6 45.3 157 16.7 34.5 7.0 5.5 36.3 2,609 vulnerable group, within which knowledge has worsened. Between 1994 and 1999, the percentage of respondents age 15-19 not knowing a source for condoms has increased from 40 percent to 50 percent among women and 24 percent to 32 percent among men. When respondents were asked where a person could go for condoms, 50 percent of women and 35 percent of men responded that they could go to a public (government-run) facility. Men were more likely than women to cite private facilities, pharmacies, and especially “other” sources. “Other” sources, which includes friends, relatives, schools, and shops (other than private pharmacies), were cited by more than one-third of male respondents. As expected, public facilities are more commonly cited by rural residents and those with less education, for whom fewer options exist and less disposable income is available for purchase of condoms from private vendors and institutions. AIDS and other STDs * 189 Table 11.15.1 Knowledge of source for female condoms: women Percent distribution of women by knowledge of a specific source for female condoms, according to background characteristics, Zimbabwe 1999 __________________________________________________________________________ Source for condoms Does not ____________________________________ know a Number Background source for Private Shop/ of characteristic condoms Public medical Pharmacy Other women __________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 90.7 4.4 0.6 2.4 2.0 1,447 78.6 10.3 1.0 5.9 4.2 1,294 78.9 12.7 0.3 5.4 2.8 1,034 77.3 13.2 1.0 5.8 2.6 1,305 84.2 10.2 0.7 2.8 2.1 827 75.8 10.7 1.0 7.1 5.3 422 88.9 3.9 0.6 3.7 2.8 1,215 80.8 11.6 0.8 4.5 2.3 3,609 80.8 11.2 0.7 3.9 3.5 662 69.9 14.0 1.1 9.5 5.5 2,279 89.8 7.3 0.5 1.3 1.1 3,628 93.6 4.6 0.0 1.0 0.8 882 81.0 13.8 0.7 1.9 2.6 477 88.6 7.5 0.2 2.8 0.8 461 85.9 8.6 0.7 3.7 1.1 559 85.9 6.5 3.3 2.8 1.5 302 76.3 16.8 2.8 2.7 1.4 321 84.8 9.8 1.4 2.2 1.8 741 87.7 6.7 0.0 2.5 3.0 629 71.5 10.1 0.5 11.0 6.8 1,077 64.2 21.4 0.1 9.7 4.5 457 90.7 7.6 0.4 0.0 1.3 396 89.8 7.8 0.5 0.8 1.1 2,377 77.1 11.7 0.9 6.4 4.0 2,965 40.7 13.9 2.2 34.2 8.9 168 82.1 9.9 0.7 4.5 2.7 5,907 FEMALE CONDOMS Neither men nor women were very familiar with places where female condoms could be obtained. About four out of five men and women did not know a single source for this new method of protection (Tables 11.15.1 and 11.15.2). One-half of this lack of practical knowledge is due to the fact that women and men simply have never heard of the female condom; the other half knew of female condoms but did not know where a person could go to get one. As with the male condom, lack of knowledge of sources for female condoms is more common in the youngest age group (15-19), among rural residents, and among the least educated segments of the population. In Manicaland, only 6 percent of women reported knowledge of a source for female condoms versus as high as 36 percent of women in Bulawayo. 190 * AIDS and other STDs Table 11.15.2 Knowledge of source for female condoms: men Percent distribution of men by knowledge of a specific source for female condoms, according to background characteristics, Zimbabwe 1999 __________________________________________________________________________ Source for condoms Does not ____________________________________ know a Number Background source for Private Shop/ of characteristic condoms Public medical Pharmacy Other men __________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Has had sex Has never had sex Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 92.7 1.3 0.8 3.6 1.6 713 81.3 3.8 0.4 11.4 3.1 506 73.0 6.2 1.1 13.1 6.7 430 80.0 5.7 0.9 8.4 5.0 500 83.9 5.2 1.7 6.6 2.6 356 88.6 3.9 0.9 5.5 1.1 104 80.6 6.0 1.2 8.3 3.9 1,239 80.3 5.3 1.1 6.7 6.7 118 80.8 2.5 0.7 12.1 3.9 614 92.1 1.6 0.5 4.1 1.8 638 70.0 4.4 1.2 17.3 7.1 1,090 93.0 3.8 0.7 1.5 0.9 1,519 86.2 4.6 1.2 2.2 5.7 360 90.3 5.5 0.6 0.9 2.7 236 93.5 2.3 0.5 3.3 0.4 217 89.3 5.1 1.1 1.7 2.7 268 88.6 3.9 1.7 3.6 2.2 146 91.0 6.3 0.0 1.6 1.2 120 84.5 6.3 2.5 5.4 1.4 308 97.4 0.7 0.0 1.1 0.7 225 68.3 2.2 0.7 21.0 7.7 514 66.1 5.7 0.0 25.5 2.7 214 93.8 5.1 0.0 0.0 1.1 66 95.1 2.0 0.8 1.4 0.7 830 80.4 4.7 0.8 9.4 4.6 1,556 47.6 8.4 2.3 33.5 8.2 157 83.4 4.1 0.9 8.1 3.5 2,609 Government-run health facilities and private pharmacies are the two most commonly cited sources for female condoms among both men and women, but men tended to mention pharmacies more often and women mentioned the health facilities more often. 11.11 USE OF CONDOMS Tables 11.16.1 and 11.16.2 show the percentages of men and women who used a condom during their last sexual encounter, by partner type and background characteristics. Based on 1999 ZDHS data, men are about three times more likely than women to have used a condom at their last sexual encounter—taking all types of partners together (i.e., any partner). The last sexual encounter (with any partner) involved use of a condom 9 percent of the time for women and 27 percent of the time for men. AIDS and other STDs * 191 Table 11.16.1 Use of condoms: women Among women who had sex in the past year, percentage who used condoms during last sexual intercourse with cohabiting and non-cohabiting partners, by selected background characteristics, Zimbabwe 1999 _____________________________________________________________________________________ Used condom during last sexual intercourse with: _______________________________________________________________ Spouse or Non-cohabitating cohabiting partner partner Any partner ____________________ ____________________ ___________________ Background Number Number Number characteristic Percentage of women Percentage of women Percentage of women ______________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Never married Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Drinking behaviour (last 30 days) Never drank Drinks, but did not get drunk Drinks, got drunk once Drinks, got drunk 2+ times Total 7.1 314 36.8 115 14.7 424 3.8 835 44.3 175 9.8 993 6.4 792 49.1 113 11.3 898 3.7 1,039 40.8 111 7.2 1,148 2.0 615 33.6 58 4.6 669 NA NA 41.7 292 41.4 295 4.1 3,498 (37.2) 49 4.1 3,520 14.0 97 43.3 230 34.7 316 4.7 1,311 50.0 288 12.4 1,585 4.1 2,284 33.8 283 7.0 2,546 3.2 544 (37.3) 55 6.4 597 6.6 326 (56.5) 30 10.2 351 3.8 313 * 18 6.9 331 3.5 368 (46.0) 49 8.0 410 3.7 181 27.0 54 8.7 233 5.6 169 26.1 83 11.9 248 4.3 446 50.4 61 8.6 499 3.0 362 (46.6) 26 6.0 388 4.3 669 53.8 100 10.3 765 7.5 217 37.5 95 16.6 310 3.8 292 (41.3) 28 6.4 316 3.5 1,658 37.4 222 6.9 1,859 5.3 1,645 45.2 322 11.6 1,956 4.2 3,099 37.0 422 7.8 3,496 4.3 407 55.7 98 13.7 498 (6.2) 48 * 18 20.4 66 (15.7) 39 54.5 34 31.3 70 4.3 3,595 42.0 572 9.1 4,132 _____________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 cases. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. NA = Not applicable 192 * AIDS and other STDs Table 11.16.2 Use of condoms: men Among men who had sex in the past year, percentage who used condoms during last sexual intercourse with cohabiting and non-cohabiting partners, by selected background characteristics, Zimbabwe 1999 ________________________________________________________________________________________ Used condom during last sexual intercourse with: __________________________________________________________________ Spouse or Non-cohabitating cohabiting partner partner Any partner ____________________ ____________________ ____________________ Background Number Number Number characteristic Percentage of men Percentage of men Percentage of men _______________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-54 Marital status Never married Married or in union Divorced, widowed Residence Urban Rural Province Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary+ Drinking behaviour (last 30 days) Never drank Drinks, but did not get drunk Drinks, got drunk once Drink, got drunk 2+ times Total * 4 59.1 160 57.8 161 11.1 109 75.1 248 54.6 338 6.2 276 79.4 161 28.9 398 5.6 423 66.7 96 12.3 479 7.0 310 62.6 56 12.0 334 4.2 87 * 10 7.6 92 NA NA 70.3 489 70.5 493 6.1 1,194 70.2 168 8.2 1,227 * 12 69.2 74 61.1 83 5.8 529 80.1 342 32.1 809 7.0 680 61.4 388 24.0 993 3.7 135 62.7 64 22.1 191 11.3 122 77.2 64 29.9 170 4.4 115 74.6 64 29.3 173 4.3 142 58.8 90 19.6 209 8.0 61 (43.5) 49 21.6 99 (6.5) 45 (63.1) 38 31.4 80 11.0 143 71.8 98 32.1 222 2.7 102 (61.1) 43 14.2 131 6.6 260 84.0 142 31.7 377 6.1 84 78.3 77 39.0 149 (3.1) 48 * 18 12.3 58 5.7 445 54.1 203 17.9 603 7.2 716 77.6 509 33.6 1,142 5.1 406 68.6 305 30.8 681 8.8 355 74.1 175 27.9 501 6.9 111 73.0 55 23.5 150 5.7 330 68.9 193 24.6 463 6.5 1,209 70.2 731 27.7 1,803 ________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 cases. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. NA = Not applicable AIDS and other STDs * 193 Figure 11.4 Percentage of Women and Men Who Used a Condom at Last Sex with a Noncohabiting Partner, by Urban-Rural Residence, Zimbabwe 1999 42% 70% 50% 34% 80% 61% ZIMBABWE Women Men WOMEN Urban Rural MEN Urban Rural ZDHS 1999 Condoms are used much less during sex with cohabiting partners (includes mostly spouses) for both women (4 percent) and men (7 percent), compared with sex with non-cohabiting partners (42 percent for women and 70 percent for men). It is clear that both women and men understand that sex outside of a stable relationship entails greater risk. No clear patterns emerge for the association between age of the respondent and use of condoms, except that in sex with non-cohabiting partners, young persons (under 20) and older persons (40+) are least likely to use a condom. Urban men and women were more likely to use a condom at last sexual encounter with any partner than their rural counterparts. The urban-rural differential is especially pronounced for condom use with non-cohabiting partners (Figure 11.4). Women living in urban areas are 50 percent more likely to use a condom during sex with non-cohabiting partners than women in rural areas. Education is uniformly associated with higher reported condom use by men; the same is true among women but less pronounced. It might be expected that drinking, especially drinking to excess, would be associated with risky behaviour, namely non-use of condoms. This is not the pattern that emerges from the 1999 ZDHS. For men, condom use at last sexual encounter does indeed decrease with increased reported drinking, but this relationship is spurious and due to a large number of nondrinkers having had recent sex with a noncohabiting partner. For women, however, a clear pattern does emerge. Although the numbers are not large, women who drink more and get drunk more frequently are more likely to use condoms than women who do not drink. This does not mean, of course, that 194 * AIDS and other STDs Table 11.17 Use of condoms during commercial sex Among men who paid for sex in the past 12 months, percentage who used a condom at last paid intercourse, by background characteristics, Zimbabwe 1999 ____________________________________________ Percentage Background using a Number characteristic condom of men ____________________________________________ Age 15-19 25-29 40-54 Marital status Currently married Not married Residence Urban Rural Education Did not attend secondary Attended secondary Drinking behaviour (last 30 days) Did not get drunk Got drunk one or more times Total (74.5) 43 88.8 61 (75.5) 32 75.7 67 87.0 70 98.2 73 62.5 64 66.3 52 92.6 86 (80.0) 49 82.2 88 81.5 137 drinking is protective or that it leads to more condom use. It suggests that drinkers are self-selected into a category of sexual activity that recognises and, to a certain degree, is responding to a higher risk context. In the 1999 ZDHS, men were asked to report whether they used a condom during their last sexual encounter with a women who was paid for sex. Table 11.17 shows that of men who paid for sex in the past 12 months, 82 percent used a condom at last paid sexual encounter. Age, marital status, and drinking habits of respondents are not closely associated with condom use in commercial sex. However, condom use is markedly higher among urban residents and among those with a higher educational level. Adult and Maternal Mortality * 195 ADULT AND MATERNAL MORTALITY 12 Earlier in this report, estimates of mortality during the first years of life were presented and discussed. Early childhood mortality varies substantially as an index of social and economic development and thus tends to be predictably high in disadvantaged settings. Mortality during later childhood and adolescence is, on the other hand, relatively low in all societies, but begins to rise with age starting in the late teenage years. The pattern and pace of the rise in adult mortality with increasing age is tied closely to the occupational profile, fertility pattern, and epidemiological characteristics of a population. Two aspects of adult mortality dynamics are of particular interest in the Zimbabwean context. First, given tremendous rises in the prevalence of HIV infection and AIDS (discussed in the previous chapter) over the last decade, Zimbabwe is expected to suffer increases in both female and male adult mortality in the near term. Second, mortality related to pregnancy and childbearing (maternal mortality) is an important indicator for women’s and reproductive health programmes in the country. The 1999 ZDHS women’s questionnaire included a sibling history, which is a detailed account of the survivorship of all of the live-born children of the respondent’s mother (i.e., maternal siblings). These data allow direct estimation of overall adult mortality by sex, as well as maternal mortality in particular. The direct approach to estimating adult and maternal mortality maximises use of the available data, using information on the age of surviving siblings, the age at death of siblings who died, and the number of years ago the sibling died. This approach allows the data to be aggregated to determine the number of person-years of exposure to mortality risk and the number of sibling deaths occurring in defined calendar periods. Rates of maternal mortality are obtained by dividing maternal deaths in a calendar period by person-years of exposure to death. Similarly, adult mortality rates are obtained by dividing female or male adult deaths in a calendar period by person-years of exposure to death. 12.1 THE DATA Each respondent was first asked to give the total number of her mother’s live births. Then the respondent was asked to provide a list of all of the children born to her mother starting with the first-born. Then the respondent was asked whether each of these siblings was still alive at the survey date. For living siblings, current age was collected; for deceased siblings, age at death and years since death were collected. Interviewers were instructed that when a respondent could not provide precise information on age at death or years since death, approximate but quantitative answers were acceptable. For sisters who died at ages 12 years or above, three questions were used to determine whether the death was maternity-related: “Was [NAME OF SISTER] pregnant when she died?” and if negative, “Did she die during childbirth?” and if negative, “Did she die within 2 months after the end of a pregnancy or childbirth?” The estimation of adult and maternal mortality by either direct or indirect means requires reasonably accurate reporting of the number of sisters and brothers the respondent ever had, the number that have died, and (for maternal mortality) the number of sisters who have died of ma- ternity-related causes. There is no definitive procedure for establishing the completeness or accuracy of retrospective data on sibling survivorship. However, the 1999 ZDHS sibling history data do not show any obvious defects that would indicate poor data quality or systematic underreporting. 1 The imputation procedure is based on the assumption that the reported birth ordering of siblings in the history is correct. The first step is to calculate birth dates. For each living sibling with a reported age and each dead sibling with complete information on both age at death and years since death, the birth date was calculated. For a sibling missing these data, a birth date was imputed within the range defined by the birth dates of the bracketing siblings. In the case of living siblings, an age was then calculated from the imputed birth date. In the case of dead siblings, if either the age at death or years since death was reported, that information was combined with the birth date to produce the missing information. If both pieces of information were missing, the distribution of the ages at death for siblings for whom the years since death was unreported, but age at death was reported, was used as a basis for imputing the age at death. 196 * Adult and Maternal Mortality Table 12.1 Data on siblings: completeness of the reported data Number of siblings reported by survey respondents and completeness of the reported data on age, age at death, and years since death, Zimbabwe 1999 _________________________________________________________________________________ Sisters Brothers Total Sibling status and _________________ ________________ _________________ completeness of reporting Number Percent Number Percent Number Percent _________________________________________________________________________________ All siblings Living Dead Missing survival status Living siblings Age reported Age missing Dead siblings AD and YSD reported Only AD missing Only YSD missing AD and YSD missing 17,344 100.0 17,074 100.0 34,418 100.0 15,219 87.7 14,594 85.5 29,813 86.6 2,089 12.0 2,451 14.4 4,540 13.2 37 0.2 29 0.2 65 0.2 15,219 100.0 14,594 100.0 29,813 100.0 15,098 99.2 14,448 99.0 29,546 99.1 121 0.8 146 1.0 267 0.9 2,089 100.0 2,451 100.0 4,540 100.0 1,832 87.7 2,123 86.6 3,955 87.1 100 4.8 157 6.4 257 5.7 44 2.1 46 1.9 90 2.0 113 5.4 125 5.1 238 5.2 __________________________________________________________________________________ AD = Age at death YSD = Years since death Table 12.1 shows the number of siblings reported by the respondents and the completeness of the data reported on current age, age at death, and years since death. Of the 34,418 siblings reported in the sibling histories of ZDHS respondents, survival status was not reported for only 65 (less than 1 percent). Among surviving siblings, current ages (used to estimate exposure to death) were not reported for less than 1 percent of siblings. Among deceased siblings, complete reporting of age at death and years since death was nearly universal. For 87 percent of deceased siblings, both age at death and years since the death (or year of death) were reported. In 8 percent of cases, either the age at death or the years since death (or year of death) was missing while for 5 percent of deceased siblings, both these items were missing. Rather than exclude siblings with missing data from further analysis, information on the birth order of siblings in conjunction with other information was used to impute the missing data.1 The sibling survivorship data, including cases with imputed values, were used in the direct estimation of adult and maternal mortality. Adult and Maternal Mortality * 197 Table 12.2 Adult mortality rates Adult mortality rates for periods by age, Zimbabwe 1999_____________________________________________________________________________ 1999 DHS 1994 ZDHS______________________________________________ __________ Mortality rates (\1000) Mortality Exposure ____________________ rate for Age Deaths years 0-4 years 5-9 years 0-9 years_____________________________________________________________________________ WOMEN_____________________________________________________________________________ 15-19 32 11,246 2.82 1.75 1.87 20-24 74 12,354 6.01 3.26 2.51 25-29 125 11,165 11.17 5.34 3.63 30-34 135 9,149 14.72 5.31 3.99 35-39 112 7,107 15.73 5.13 4.75 40-44 58 4,525 12.85 6.73 4.62 45-49 33 2,506 13.16 5.97 5.18 15-49 568 58,052 9.14 4.13 3.34_____________________________________________________________________________ MEN_____________________________________________________________________________ 15-19 16 10,873 1.49 1.05 1.44 20-24 54 11,634 4.63 1.74 2.59 25-29 106 10,991 9.63 5.38 3.78 30-34 167 8,445 19.81 7.09 5.26 35-39 147 6,584 22.36 7.34 5.41 40-44 101 4,297 23.50 7.19 9.56 45-49 71 2,439 29.05 11.13 11.90 15-49 662 55,263 11.35 4.42 4.17 12.2 DIRECT ESTIMATES OF ADULT MORTALITY One way to assess the quality of the data used to estimate maternal mortality is to evaluate the plausibility and stability of overall adult mortality. It is reasoned that if estimated rates of overall adult mortality are implausible, rates based on a subset of deaths—i.e., maternal deaths in particular—are unlikely to be free of serious problems. As described above, levels and trends in overall adult mortality have very important implications in their own right for health and social programmes in Zimbabwe, especially for the potential of the AIDS epidemic. Table 12.2 shows age-specific mortality rates for men and women age 15-49, for a calendar period 0-4 and 5-9 years before the 1999 ZDHS. Also shown are identically calculated estimates drawn from the 1994 ZDHS for a period 0-9 years before that survey. This comparison allows two approaches to assess mortality trends. The first is to look at the trend between two calendar periods using retrospective reports within the same survey; the other is to look at the trend based on calendar periods immediately before both the 1994 and 1999 surveys. Since the number of deaths on which the rates are based is not very large (between 200 and 700 deaths per estimate), the estimated age-specific rates are subject to some sampling variation and indeed display fluctuations between age groups (Figure 12.1) that are not related to the force of mortality per se. Given this fact, it is recommended that for purposes of trend evaluation, attention be focused on the estimates for the 15-49 age range. 198 * Adult and Maternal Mortality Figure 12.1 Trends in Age-specific Mortality among Women 15-49, Zimbabwe 1999 2 3 4 4 5 5 5 3 6 11 15 16 13 13 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Group Deaths per 1,000 Women Early 1990s Mid-late 1990s ZDHS 1999 Figure 12.2 Trends in Age-specific Mortality among Men 15-49, Zimbabwe 1999 1 3 4 5 5 10 12 2 5 10 20 22 24 29 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Deaths per 1,000 Men Early 1990s Mid-late 1990s Age Group ZDHS 1999 Adult and Maternal Mortality * 199 Table 12.3 Direct estimates of maternal mortality Maternal mortality rates for periods by age, Zimbabwe 1999 _____________________________________________________________________________ 1999 DHS 1994 ZDHS ______________________________________________ __________ Mortality rates (\1000) Mortality Maternal Exposure ____________________ rate for Age deaths years 0-4 years 5-9 years 0-9 years _____________________________________________________________________________ 15-19 5.4 11,246 0.477 0.101 0.147 20-24 14.4 12,354 1.163 0.677 0.472 25-29 13.4 11,165 1.199 0.615 0.645 30-34 13.7 9,149 1.500 1.019 1.101 35-39 9.9 7,107 1.395 0.617 0.223 40-44 2.4 4,525 0.532 1.253 0.190 45-49 0.0 2,506 0.000 0.000 0.474 15-49 59.2 58,052 0.943 0.561 0.458 General Fertility Rate (GFR) 0.135 0.160 0.162 Maternal Mortality Ratio (MMR)1 695 350 283 _____________________________________________________________________________ 1 Per 100,000 live births; calculated as the maternal mortality rate divided by the general fertility rate. Despite some fluctuations in the age-specific rates, the results of this analysis are unambiguous. Figure 12.2 clearly shows that, whether using just the data of the 1999 survey or comparing estimates from the 1994 against the 1999 survey, adult mortality has risen sharply between the period of the late 1980s-early 1990s and the mid-late 1990s. Indeed, when looking at the summary measure of mortality for the age group 15-49, a two- to threefold increase in both male and female mortality is observed. Of particular interest is the broad age-pattern “signature” to the rises in mortality, with the largest changes for men occurring from age 30 and older. For women, an earlier impact is observed (age 25 and over). This mortality age pattern is consistent with the age pattern of HIV infection in Zimbabwe (i.e., younger women with older men). 12.3 DIRECT ESTIMATES OF MATERNAL MORTALITY Maternal deaths are a subset of all female deaths, those associated with pregnancy and childbearing. The same approach to presentation of the maternal mortality results is used as was used for presentation of overall adult mortality. Age-specific estimates of maternal mortality from the reported survivorship of sisters are shown in Table 12.3 for the periods 0-4 and 5-9 years before the survey, alongside estimates based on the 1994 ZDHS data for the period 0-9 years before that survey. 2 The rate for the whole age range 15-49 is standardised on the ZDHS household age structure. 3 These figures of 10 to 15 percent are rather low in comparison with proportionate maternal mortality estimates by Stanton and Hill (1997) in their exhaustive review of similar data collected around the world. This may mean that maternal mortality, and thus overall female adult mortality, was underreported in both the 1994 and 1999 surveys. An alternative explanation, perhaps more realistic, is that the mortality picture in Zimbabwe, dominated in recent years by a single disease, should indeed be expected to produce proportionate maternal mortality rates lower than elsewhere. 200 * Adult and Maternal Mortality Again, the number of maternal deaths is small, so age-specific rates should not be overinterpreted. The preferred approach is to calculate one estimate for all childbearing ages (15-49 years). For the period 0-4 years before the survey (1995-1999), the rate of mortality due to causes related to pregnancy and childbearing years is 0.943 maternal deaths per 1,000 woman-years of exposure.2 The maternal mortality rate can be converted to a maternal mortality ratio and expressed per 100,000 live births by dividing the rate by the general fertility rate of 0.135 operating during the same time period. In this way, the obstetrical risk of pregnancy and childbearing is underlined. By direct estimation procedures, the maternal mortality ratio is estimated to be 695 maternal deaths per 100,000 live births, applicable to the period 1995- 1999. This estimate of the maternal mortality ratio far exceeds, by a factor of 2.5, that estimated from the 1994 ZDHS (283 maternal deaths per 100,000 live births). If instead the trend is evaluated based on the changes captured within the 1999 ZDHS sibling histories, i.e., the change between 5-9 and 0-4 years before the survey, a twofold increase is observed. The proportion of all female deaths that are maternity-related has changed as well from 15 percent based on data from the pre-1995 period to about 10 percent based on the most recent estimate from the 1999 ZDHS.3 This means that non-maternal female mortality (e.g., AIDS-related), has risen more rapidly than mortality per se. References * 201 REFERENCES Central Bureau of Statistics (CBS), Ministry of Planning and National Development [Kenya]. 1996. Mortality. Analytical Report, Vol. 5, Kenya Population Census 1989. Nairobi, Kenya: Central Bureau of Statistics. Central Statistical Office (CSO) [Zimbabwe] and the Institute for Resource Development/Macro Systems Inc. (IRD). 1989. Zimbabwe Demographic and Health Survey 1988. Columbia, Maryland. Central Statistical Office (CSO) [Zimbabwe] and Macro International Inc. (MI). 1995. Zimbabwe Demographic and Health Survey 1994. Calverton, Maryland [USA] Forsythe, S., B. Rau, N. Alrutz, E. Gold, J. Hayman, and L. Lux. 1996. AIDS in Kenya: Socioeconomic impact and policy implications. Arlington, Virginia: Family Health International (FHI), AIDS control and Prevention Project (AIDSCAP). Hunter, S. and J. Williamson. 2000. Children on the brink. Updated estimates and recommendations for intervention. Washington, D.C.: The Synergy Project and U.S. Agency for International Development. National AIDS Co-ordination Programme (NACP). 1999. Strategic framework for a national response to HIV/AIDS, 2000-2204. Harare, Zimbabwe: NACP. Stanton, C., N. Abderrahim, and K. Hill. 1997. Maternal mortality indicators: An assessment of data quality and implications for data use. DHS Analytical Reports No. 4. Calverton, Maryland: Macro International Inc. United Nations (UNAIDS) and World Health Organisation (WHO). 2000. Epidemiological fact sheet on HIV/AIDS and sexually transmitted infections, 2000 Update. Geneva, Switzerland. Zimbabwe National Family Planning Council (ZNFPC) and Westinghouse Public Applied Systems (WPAS). 1985. Zimbabwe Reproductive Health Survey 1984. Columbia, Maryland: ZNFPC and WPAS. Appendix A * 203 Table A.1.1 Sample implementation: women Percent distribution of households and eligible women in the ZDHS sample by results of the household and individual interviews and household, eligible women, and overall response rates, according to province and urban-rural residence, Zimbabwe 1999 _____________________________________________________________________________________________________________________ Residence Province _____________ _________________________________________________________________________ Ma- Ma- Ma- Mata- Mata- shona- shona- shona- bele- bele- Manica- land land land land land Mid- Mas- Bula- Result Urban Rural land Central East West North South lands vingo Harare wayo Total ____________________________________________________________________________________________________________________ Selected households Completed (C) Household present but no competent respondent at home (HP) Refused (R) Dwelling not found (DNF) Household absent (HA) Dwelling vacant/address not a dwelling (DV) Dwelling destroyed (DD) Other (O) Total Number of households Household response rate (HRR)1 Eligible women Completed (EWC) Not at home (EWNH) Postponed (EWP) Refused (EWR) Partly completed (EWPC) Incapacitated (EWI) Other (EWO) Total Number of women Eligible woman response rate (EWRR)2 Overall response rate (ORR)3 93.4 89.8 94.1 90.0 85.4 85.0 87.8 89.2 94.4 91.1 96.1 95.1 90.9 0.9 0.9 0.4 0.4 0.9 1.5 0.4 2.3 0.7 0.7 0.0 1.4 0.9 1.5 0.2 0.1 0.0 0.4 1.0 0.4 0.1 0.0 0.1 2.9 0.6 0.6 0.8 0.5 0.4 0.3 1.0 2.5 0.7 0.3 0.0 0.4 0.1 0.1 0.6 1.1 4.5 3.4 3.7 7.9 3.4 5.6 4.4 2.3 3.8 0.1 0.4 3.5 1.9 3.0 1.5 3.8 4.0 3.9 2.9 2.6 2.0 3.7 0.6 2.1 2.7 0.3 1.0 0.0 1.7 0.0 2.6 1.7 0.9 0.4 0.1 0.1 0.1 0.8 0.1 0.2 0.0 0.0 0.4 0.1 0.4 0.3 0.1 0.0 0.0 0.1 0.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2,058 4,952 681 703 697 685 696 704 702 707 716 719 7,010 96.7 98.3 98.9 99.2 97.4 94.5 98.2 97.1 99.3 98.6 96.9 97.9 97.8 93.2 96.0 95.7 95.3 97.1 93.0 96.8 94.0 97.0 96.2 89.5 96.7 95.2 2.5 2.3 2.9 2.7 1.9 2.3 1.4 3.9 1.7 2.9 2.2 1.9 2.4 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 2.5 0.4 0.7 0.3 0.4 1.5 0.6 0.6 0.1 0.0 6.1 0.1 1.0 0.3 0.1 0.0 0.3 0.0 0.2 0.0 0.3 0.0 0.2 0.3 0.0 0.1 0.8 1.0 0.7 1.0 0.4 2.3 1.1 0.6 1.2 0.6 1.0 0.8 1.0 0.6 0.2 0.0 0.3 0.2 0.8 0.0 0.4 0.0 0.2 1.0 0.5 0.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,940 4,268 581 595 478 528 621 671 694 658 628 754 6,208 93.2 96.0 95.7 95.3 97.1 93.0 96.8 94.0 97.0 96.2 89.5 96.7 95.2 90.2 94.4 94.7 94.5 94.5 87.9 95.1 91.3 96.2 94.9 86.7 94.6 93.1 __________________________________________________________________________________________________________________ Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, postponed, refused, dwelling not found, household absent, dwelling vacant, dwelling destroyed, and "other." The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated, and "other." The overall response rate is the product of the household and woman response rates. 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C ____________________ * 100 C + HP + R + DNF 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC _______________________________________________ * 100 EWC + EWNH + EWP + EWR + EWPC + EWI + EWO 3 The overall response rate (ORR) is calculated as: ORR = (HRR * EWRR) ÷ 100 SAMPLE DESIGN APPENDIX A 204 * Appendix A Table A.1.2 Sample implementation: men Percent distribution of households and eligible men in the ZDHS sample by results of the household and individual interviews and household, eligible men, and overall response rates, according to province and urban-rural residence, Zimbabwe 1999 ____________________________________________________________________________________________________________________ Residence Province ____________ ________________________________________________________________________ Ma- Ma- Ma- Mata- Mata- shona- shona- shona- bele- bele- Manica- land land land land land Mid- Mas- Bula- Result Urban Rural land Central East West North South lands vingo Harare wayo Total ____________________________________________________________________________________________________________________ Selected households Completed (C) Household present but no competent respondent at home (HP) Refused (R) Dwelling not found (DNF) Household absent (HA) Dwelling vacant/address not a dwelling (DV) Dwelling destroyed (DD) Other (O) Total Number of households Household response rate (HRR)1 Eligible men Completed (EMC) Not at home (EMNH) Postponed (EMP) Refused (EMR) Partly completed (EMPC) Incapacitated (EMI) Other (EMO) Total Number of men Eligible man response rate (EMRR)2 Overall response rate (ORR)3 94.6 91.1 84.4 85.4 88.3 90.1 95.2 90.4 95.3 93.8 92.3 90.3 90.9 0.9 0.3 0.9 2.0 0.9 3.1 0.3 1.1 0.0 1.4 1.1 1.1 1.1 0.0 0.0 0.9 0.6 0.3 0.0 0.0 0.0 3.6 0.0 1.6 0.1 0.5 0.6 0.0 1.1 2.6 0.9 0.0 0.0 0.6 0.0 0.3 0.8 0.5 0.6 2.4 3.7 7.1 4.4 5.2 3.7 1.4 3.4 0.0 0.9 1.5 3.9 3.2 1.5 2.6 4.8 2.6 2.3 2.5 2.3 4.2 0.8 3.4 2.4 2.9 2.7 0.0 2.3 0.0 2.3 1.7 0.3 0.6 0.3 0.3 0.0 0.3 1.0 0.8 0.0 0.0 0.9 0.0 0.3 0.3 0.3 0.0 0.0 0.3 0.2 0.2 0.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 333 348 352 343 343 353 351 354 359 352 1,021 2,467 3,488 98.4 99.7 96.7 94.2 97.7 96.7 99.7 98.2 96.3 98.2 96.4 98.1 97.6 91.4 93.6 87.0 81.2 90.7 84.1 91.8 91.5 82.6 85.2 83.7 90.0 87.8 6.3 3.4 7.7 7.9 5.5 12.3 5.0 7.3 5.8 12.8 9.9 6.2 7.5 0.0 0.0 0.0 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.4 0.3 0.4 5.4 2.4 0.7 0.3 0.0 9.1 1.3 4.6 0.9 2.1 0.0 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.1 0.1 0.1 1.2 0.0 2.4 1.1 0.7 1.1 1.6 0.8 0.6 0.3 0.3 1.2 0.9 0.8 2.7 2.0 4.3 0.7 1.1 1.3 0.4 1.5 0.5 1.4 1.6 1.5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 255 328 246 277 291 277 317 260 328 391 1,009 1,961 2,970 91.4 93.6 87.0 81.2 90.7 84.1 91.8 91.5 82.6 85.2 83.7 90.0 87.8 89.9 93.3 84.2 76.5 88.7 81.3 91.5 89.9 79.6 83.6 80.7 88.3 85.7 __________________________________________________________________________________________________________________ Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, postponed, refused, dwelling not found, household absent, dwelling vacant, dwelling destroyed, and "other." The eligible man response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated, and "other." The overall response rate is the product of the household and man response rates. 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C __________________ * 100 C + HP + R + DNF 2 Using the number of eligible men falling into specific response categories, the eligible man response rate (EMRR) is calculated as: EMC _______________________________________________ * 100 EMC + EMNH + EMP + EMR + EMPC + EMI + EMO 3 The overall response rate (ORR) is calculated as: ORR = (HRR * EMRR) ÷ 100 Appendix B * 205       ∑∑ m z - z 1-m m x f-1 = var(r) h 2 h2 hi m 1=ih hH 1=h2 h ESTIMATES OF SAMPLING ERRORS APPENDIX B The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 1999 ZDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 1999 ZDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 1999 ZDHS sample is the result of a two-stage stratified design, and consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 1999 ZDHS is the ISSA Sampling Error Module (ISSAS). This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: in which 206 * Appendix B ) r - r ( ) 1-k ( k 1 = var(r) i 2k 1=i ∑ r ) 1-k ( - r k = r (i)i where h represents the stratum which varies from 1 to H, mh is the total number of enumeration areas selected in the h th stratum, yhi is the sum of the values of variable y in EA i in the h th stratum, xhi is the sum of the number of cases in EA i in the h th stratum, and f is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudoindependent replications are thus created. In the 1999 ZDHS, there were 230 non-empty clusters. Hence, 230 replications were created. The variance of a rate r is calculated as follows: in which where r is the estimate computed from the full sample of 230 clusters, R(I) is the estimate computed from the reduced sample of 229 clusters (i th cluster excluded), and k is the total number of clusters. In addition to the standard error, ISSAS computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. ISSAS also computes the relative error and confidence limits for the estimates. Sampling errors for the 1999 ZDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Table B.2 presents the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to childbearing. In general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The confidence interval (e.g., as calculated for Children ever born to women age 15-49) can be interpreted as follows: the overall average from the national sample is 2.3 and its standard error is .04. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 2.3±.04. There is a high probability (95 percent) that the true average number of children ever born to all women age 15 to 49 is between 2.2 and 2.4. Appendix B * 207 Table B.1 List of selected variables for sampling errors, Zimbabwe 1999______________________________________________________________________________________________ Variable Estimate Base population______________________________________________________________________________________________ WOMEN______________________________________________________________________________________________ Urban residence Proportion All women 15-49 No education Proportion All women 15-49 Secondary education or higher Proportion All women 15-49 Never married (in union) Proportion All women 15-49 Currently married (in union) Proportion All women 15-49 Married before age 20 Proportion Women 20-49 Had first sexual intercourse before 18 Proportion Women 20-49 Children ever born Mean All women 15-49 Children ever born to women over 40 Mean Women age 40-49 Children surviving Mean All women 15-49 Know any contraceptive method Proportion Currently married women 15-49 Know any modern contraceptive method Proportion Currently married women 15-49 Ever used any contraceptive method Proportion Currently married women 15-49 Currently using any method Proportion Currently married women 15-49 Currently using a modern method Proportion Currently married women 15-49 Currently using pill Proportion Currently married women 15-49 Currently using IUD Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using Norplant Proportion Currently married women 15-49 Currently using condom Proportion Currently married women 15-49 Currently using female sterilisation Proportion Currently married women 15-49 Currently using male sterilisation Proportion Currently married women 15-49 Currently using abstinence Proportion Currently married women 15-49 Currently using withdrawal Proportion Currently married women 15-49 Using public sector source Proportion Current users of modern method Want no more children Proportion Currently married women 15-49 Want to delay at least 2 years Proportion Currently married women 15-49 Ideal number of children Mean All women 15-49 Mothers received tetanus injection Proportion Births in last 5 years Mothers received medical care at birth Proportion Births in last 5 years Had diarrhoea in the last 2 weeks Proportion Children 1-59 months Sought medical treatment Proportion Children under 5 with diarrhoea in last 2 weeks Having health card, seen Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received DPT vaccination (3 doses) Proportion Children 12-23 months Received polio vaccination (3 doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Fully immunised Proportion Children 12-23 months Weight-for-height Proportion Children 1-59 months Height-for-age Proportion Children 1-59 months Weight-for-age Proportion Children 1-59 months Total fertility rate (3 years) Rate Woman-years of exposure to childbearing Neonatal mortality rate (0-4 years) Rate Number of births Infant mortality rate (0-4 years) Rate Number of births Child mortality rate (0-4 years) Rate Number of births Under-five mortality rate (0-4 years) Rate Number of births Postneonatal mortality rate (0-4 years) Rate Number of births______________________________________________________________________________________________ MEN______________________________________________________________________________________________ Urban residence Proportion All men 15-54 No education Proportion All men 15-54 Secondary education or higher Proportion All men 15-54 Never married (in union) Proportion All men 15-54 Currently married (in union) Proportion All men 15-54 Know any contraceptive method Proportion Currently married men 15-54 Know any modern contraceptive method Proportion Currently married men 15-54 Ever used any contraceptive method Proportion Currently married men 15-54 Currently using any method Proportion Currently married men 15-54 Currently using a modern method Proportion Currently married men 15-54 Currently using pill Proportion Currently married men 15-54 Currently using IUD Proportion Currently married men 15-54 Currently using injectables Proportion Currently married men 15-54 Currently using Norplant Proportion Currently married men 15-54 Currently using condom Proportion Currently married men 15-54 Currently using female sterilisation Proportion Currently married men 15-54 Currently using male sterilisation Proportion Currently married men 15-54 Currently using abstinence Proportion Currently married men 15-54 Currently using withdrawal Proportion Currently married men 15-54 Want no more children Proportion Currently married men 15-54 Want to delay at least 2 years Proportion Currently married men 15-54 Ideal number of children Mean All men 15-54 208 * Appendix B Table B.2 Sampling errors - National sample: Zimbabwe 1999_________________________________________________________________________________________________ Number of cases Standard ___________________ Design Relative Confidence limits Value error Unweighted Weighted effect error ________________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE_________________________________________________________________________________________________ WOMEN_________________________________________________________________________________________________ Urban residence 0.386 0.012 5907 5907 1.925 0.032 0.361 0.410 No education 0.067 0.005 5907 5907 1.441 0.070 0.058 0.077 Secondary education or higher 0.530 0.012 5907 5907 1.793 0.022 0.507 0.554 Never married (in union) 0.277 0.008 5907 5907 1.363 0.029 0.261 0.293 Currently married (in union) 0.611 0.009 5907 5907 1.365 0.014 0.594 0.628 Married before age 20 0.564 0.012 4439 4460 1.616 0.021 0.540 0.588 Had first sexual intercourse before 18 0.385 0.010 4439 4460 1.434 0.027 0.364 0.406 Children ever born 2.307 0.039 5907 5907 1.207 0.017 2.229 2.385 Children ever born to women over 40 5.866 0.106 874 827 1.161 0.018 5.654 6.078 Children surviving 2.097 0.034 5907 5907 1.162 0.016 2.029 2.165 Know any contraceptive method 0.987 0.002 3553 3609 1.339 0.003 0.982 0.992 Know any modern contraceptive method 0.985 0.003 3553 3609 1.569 0.003 0.978 0.991 Ever used any contraceptive method 0.830 0.009 3553 3609 1.431 0.011 0.812 0.848 Currently using any method 0.535 0.010 3553 3609 1.243 0.019 0.515 0.556 Currently using a modern method 0.504 0.012 3553 3609 1.371 0.023 0.481 0.527 Currently using pill 0.355 0.010 3553 3609 1.270 0.029 0.334 0.375 Currently using IUD 0.009 0.002 3553 3609 1.097 0.189 0.006 0.013 Currently using injectables 0.081 0.005 3553 3609 1.181 0.067 0.070 0.092 Currently using Norplant 0.005 0.002 3553 3609 1.313 0.306 0.002 0.008 Currently using condom 0.018 0.003 3553 3609 1.182 0.148 0.012 0.023 Currently using female sterilisation 0.026 0.003 3553 3609 1.129 0.116 0.020 0.032 Currently using male sterilisation 0.001 0.001 3553 3609 1.087 0.622 0.000 0.002 Currently using abstinence 0.002 0.001 3553 3609 1.083 0.454 0.000 0.003 Currently using withdrawal 0.026 0.004 3553 3609 1.524 0.157 0.018 0.034 Using public sector source 0.755 0.015 2037 2101 1.585 0.020 0.725 0.785 Want no more children 0.382 0.010 3553 3609 1.172 0.025 0.363 0.401 Want to delay at least 2 years 0.322 0.009 3553 3609 1.133 0.028 0.304 0.340 Ideal number of children 3.930 0.045 5746 5774 1.773 0.012 3.839 4.020 Mothers received tetanus injectection 0.617 0.011 3643 3559 1.399 0.018 0.596 0.639 Mothers received medical care at birth 0.724 0.014 3643 3559 1.641 0.020 0.696 0.753 Had diarrhoea in the last 2 weeks 0.139 0.006 3350 3269 1.004 0.044 0.126 0.151 Sought medical treatment 0.321 0.025 436 453 1.120 0.079 0.271 0.372 Having health card, seen 0.686 0.025 724 699 1.408 0.036 0.636 0.736 Received BCG vaccination 0.881 0.017 724 699 1.394 0.019 0.847 0.915 Received DPT vaccination (3 doses) 0.809 0.021 724 699 1.421 0.026 0.767 0.852 Received polio vaccination (3 doses) 0.807 0.021 724 699 1.411 0.026 0.765 0.849 Received measles vaccination 0.791 0.020 724 699 1.287 0.025 0.751 0.831 Fully inmunised 0.748 0.022 724 699 1.352 0.030 0.703 0.793 Weight-for-height 0.064 0.006 2632 2520 1.156 0.090 0.053 0.076 Height-for-age 0.265 0.010 2632 2520 1.144 0.039 0.244 0.285 Weight-for-age 0.130 0.008 2632 2520 1.162 0.061 0.114 0.146 Total fertility rate (3 years) 3.964 0.115 NA 16342 1.302 0.029 3.734 4.194 Neonatal mortality rate (0-4 years) 28.854 3.792 3727 3640 1.192 0.131 21.270 36.438 Infant mortality rate (0-4 years) 65.032 4.845 3735 3650 1.082 0.074 55.343 74.721 Child mortality rate (0-4 years) 39.610 4.575 3763 3683 1.264 0.116 30.459 48.761 Under-five mortality rate (0-4 years) 102.066 6.755 3772 3694 1.198 0.066 88.555 115.577 Postneonatal mortality rate (0-4 years) 36.178 3.593 3734 3650 1.112 0.099 28.992 43.364___________________________________________________________________________________________________________ MEN___________________________________________________________________________________________________________ Urban residence 0.418 0.017 2609 2609 1.769 0.041 0.384 0.452 No education 0.025 0.003 2609 2609 1.069 0.130 0.019 0.032 Secondary education or higher 0.657 0.012 2609 2609 1.264 0.018 0.633 0.680 Never married (in union) 0.480 0.012 2609 2609 1.204 0.025 0.456 0.503 Currently married (in union) 0.475 0.012 2609 2609 1.192 0.025 0.452 0.498 Know any contraceptive method 0.997 0.002 1203 1239 1.246 0.002 0.993 1.000 Know any modern contraceptive method 0.997 0.002 1203 1239 1.246 0.002 0.993 1.000 Ever used any contraceptive method 0.924 0.009 1203 1239 1.175 0.010 0.906 0.942 Currently using any method 0.655 0.018 1203 1239 1.340 0.028 0.618 0.692 Currently using a modern method 0.609 0.018 1203 1239 1.301 0.030 0.573 0.646 Currently using pill 0.454 0.018 1203 1239 1.274 0.040 0.417 0.490 Currently using IUD 0.001 0.001 1203 1239 0.791 1.001 0.000 0.002 Currently using injectables 0.074 0.008 1203 1239 1.068 0.109 0.057 0.090 Currently using Norplant 0.004 0.002 1203 1239 1.313 0.622 0.000 0.008 Currently using condom 0.057 0.007 1203 1239 0.991 0.116 0.044 0.071 Currently using female sterilisation 0.020 0.004 1203 1239 1.093 0.218 0.011 0.029 Currently using male sterilisation 0.000 0.000 1203 1239 NA NA 0.000 0.000 Currently using abstinence 0.010 0.003 1203 1239 1.045 0.301 0.004 0.016 Currently using withdrawal 0.016 0.004 1203 1239 1.066 0.238 0.009 0.024 Want no more children 0.321 0.017 1203 1239 1.286 0.054 0.286 0.355 Want to delay at least 2 years 0.347 0.015 1203 1239 1.103 0.044 0.316 0.377 Ideal number of children 4.089 0.069 2569 2570 1.365 0.017 3.950 4.228___________________________________________________________________________________________________________ NA = Not applicable Appendix C * 209 Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Ethiopia 2000 __________________________________________________________________________________________ Males Females Males Females ________________ ________________ ________________ _________________ Age Number Percent Number Percent Age Number Percent Number Percent __________________________________________________________________________________________ <1 375 2.9 335 2.5 37 82 0.6 141 1.1 1 362 2.8 364 2.7 38 105 0.8 109 0.8 2 377 2.9 355 2.7 39 101 0.8 115 0.9 3 347 2.7 345 2.6 40 110 0.9 107 0.8 4 355 2.7 361 2.7 41 85 0.7 104 0.8 5 332 2.6 339 2.5 42 89 0.7 91 0.7 6 367 2.8 332 2.5 43 83 0.6 103 0.8 7 403 3.1 392 2.9 44 74 0.6 76 0.6 8 365 2.8 385 2.9 45 106 0.8 103 0.8 9 388 3.0 367 2.8 46 83 0.6 95 0.7 10 395 3.1 405 3.0 47 99 0.8 80 0.6 11 351 2.7 364 2.7 48 56 0.4 47 0.4 12 400 3.1 386 2.9 49 77 0.6 48 0.4 13 395 3.1 392 2.9 50 73 0.6 133 1.0 14 414 3.2 454 3.4 51 48 0.4 112 0.8 15 359 2.8 272 2.0 52 81 0.6 125 0.9 16 402 3.1 366 2.8 53 45 0.3 67 0.5 17 331 2.6 308 2.3 54 48 0.4 66 0.5 18 282 2.2 266 2.0 55 80 0.6 57 0.4 19 289 2.2 284 2.1 56 66 0.5 67 0.5 20 257 2.0 304 2.3 57 75 0.6 55 0.4 21 189 1.5 271 2.0 58 61 0.5 47 0.4 22 248 1.9 274 2.1 59 59 0.5 63 0.5 23 227 1.8 245 1.8 60 75 0.6 99 0.7 24 248 1.9 245 1.8 61 45 0.4 39 0.3 25 254 2.0 232 1.7 62 52 0.4 45 0.3 26 176 1.4 238 1.8 63 44 0.3 45 0.3 27 188 1.5 208 1.6 64 40 0.3 35 0.3 28 156 1.2 197 1.5 65 58 0.4 63 0.5 29 198 1.5 179 1.3 66 27 0.2 37 0.3 30 206 1.6 185 1.4 67 52 0.4 42 0.3 31 158 1.2 144 1.1 68 26 0.2 29 0.2 32 133 1.0 133 1.0 69 29 0.2 49 0.4 33 111 0.9 123 0.9 70+ 320 2.5 363 2.7 34 87 0.7 107 0.8 Don't know/ 35 124 1.0 139 1.0 Missing 8 0.1 10 0.1 36 108 0.8 142 1.1 Total 12,917 100.0 13,307 100.0 __________________________________________________________________________________________ Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. DATA QUALITY TABLES APPENDIX C 210 * Appendix C Table C.2 Age distribution of eligible and interviewed women Percent distribution of the de facto household population of women age 10-54, and of interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted) by five-year age groups, Zimbabwe 1999 __________________________________________________________ Household population of Interviewed Percentage women age 10-54 women age 15-49 of eligible Age ________________ ________________ women group Number Percent Number Percent interviewed __________________________________________________________ 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 15-49 2,002 NA NA NA NA 1,497 24.6 1,416 24.6 94.6 1,339 22.0 1,258 21.9 94.0 1,054 17.3 997 17.4 94.6 692 11.4 651 11.3 94.1 646 10.6 617 10.7 95.6 480 7.9 456 7.9 95.0 374 6.2 352 6.1 93.9 503 NA NA NA NA 6,082 NA 5,747 NA 94.5 __________________________________________________________ Note: The de facto population includes all residents and nonresidents who slept in the household the night before interview. Weights for both household population of women and interviewed women are household weights. Age is based on that reported in the household schedule. NA = Not applicable Appendix C * 211 Table C.3 Age distribution of eligible and interviewed men Percent distribution of the de facto household population of men age 10-69, and of interviewed men age 15-54, and percentage of eligible men who were interviewed (weighted) by five-year age groups, Zimbabwe 1999 __________________________________________________________ Household population of Interviewed Percentage men age 10-69 men age 15-54 of eligible Age ________________ ________________ men group Number Percent Number Percent interviewed __________________________________________________________ 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ 15-64 998 NA NA NA NA 787 24.0 702 27.2 89.2 570 17.4 503 19.5 88.3 488 14.9 421 16.3 86.3 328 10.0 275 10.7 83.8 257 7.8 212 8.2 82.6 200 6.1 175 6.8 87.4 201 6.1 179 6.9 88.8 122 3.7 110 4.3 89.6 191 5.8 NA NA NA 132 4.0 NA NA NA 102 NA NA NA NA 3,276 NA 2,576 NA 78.6 __________________________________________________________ Note: The de facto population includes all residents and nonresidents who slept in the household the night before interview. Weights for both household population of women and interviewed women are household weights. Age is based on that reported in the household schedule. NA = Not applicable 212 * Appendix C Table C.4 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Zimbabwe 1999 ____________________________________________________________________ Percentage Number missing of Subject Reference group information cases ____________________________________________________________________ Birth date Births in last 15 years Month only Month and year Age at death Among births in last 15 years Age/date at first union1 Ever-married women Respondent's education All women Child's size at birth Births in last 0-59 months Anthropometry Living children age 0-59 months Height Weight Height or weight Diarrhoea in last 2 weeks Living children age 0-59 months 0.5 9,521 0.0 9,521 0.6 775 0.7 4,270 0.2 5,907 4.1 2,806 7.6 3,269 6.9 3,269 7.7 3,269 5.7 3,269 ______________________________________________________________________________ 1 Both year and age missing Appendix C * 213 Ta bl e C .5 B irt hs b y ca le nd ar y ea rs D ist rib ut io n of b irt hs b y ca le nd ar y ea rs fo r l iv in g (L ), de ad (D ), an d al l ( T) c hi ld re n, a cc or di ng to re po rti ng c om pl et en es s, se x ra tio a t b irt h, a nd ra tio o f b irt hs b y ca le nd ar ye ar , Z im ba bw e 19 99 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Pe rc en ta ge w ith N um be r o f b irt hs co m pl et e bi rth d at e1 Se x ra tio a t b irt h2 C al en da r r at io 3 M al e Fe m al e C al en da r __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ _ ye ar L D T L D T L D T L D T L D T L D T __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 19 99 19 98 19 97 19 96 19 95 19 94 19 93 19 92 19 91 19 90 19 95 -1 99 9 19 90 -1 99 4 19 85 -1 98 9 19 80 -1 98 4 < 19 80 Al l 60 1 60 66 0 1 00 .0 1 00 .0 1 00 .0 92 .3 91 .1 92 .1 N A N A N A 28 8 28 31 7 31 2 31 34 4 61 2 75 68 7 99 .1 95 .4 98 .7 1 14 .3 95 .6 1 12 .0 1 01 .1 13 9. 3 1 04 .3 32 6 37 36 3 28 5 38 32 4 60 9 48 65 7 99 .8 1 00 .0 99 .8 1 13 .2 1 13 .1 1 13 .2 1 04 .2 6 8. 6 1 00 .4 32 3 26 34 9 28 5 23 30 8 55 7 65 62 2 99 .8 97 .8 99 .6 96 .1 1 02 .4 96 .7 98 .2 13 2. 9 1 01 .0 27 3 33 30 6 28 4 32 31 6 52 5 50 57 5 99 .8 99 .2 99 .8 1 01 .5 1 81 .5 1 06 .6 93 .2 9 2. 0 93 .1 26 5 32 29 7 26 1 18 27 8 57 1 43 61 4 99 .9 93 .0 99 .4 1 03 .4 85 .6 1 02 .1 1 10 .7 10 3. 5 1 10 .1 29 0 20 31 0 28 0 23 30 4 50 6 34 54 0 99 .2 98 .1 99 .1 88 .1 1 00 .6 88 .8 94 .4 7 9. 3 93 .3 23 7 17 25 4 26 9 17 28 6 50 1 42 54 3 99 .0 93 .3 98 .6 1 06 .1 2 50 .7 1 12 .9 98 .1 12 2. 5 99 .6 25 8 30 28 8 24 3 12 25 5 51 5 35 55 0 99 .1 95 .6 98 .9 91 .1 1 22 .4 92 .8 1 03 .0 8 9. 5 1 02 .0 24 6 19 26 5 27 0 16 28 5 50 0 35 53 5 98 .8 94 .9 98 .6 85 .7 1 15 .5 87 .5 N A N A N A 23 1 19 25 0 26 9 16 28 6 2 ,9 03 2 98 3 ,2 00 99 .7 98 .2 99 .5 1 03 .3 1 09 .6 1 03 .9 N A N A N A 1 ,4 75 1 56 1 ,6 30 1 ,4 28 1 42 1 ,5 70 2 ,5 93 1 89 2 ,7 82 99 .2 94 .8 98 .9 94 .7 1 24 .7 96 .5 N A N A N A 1 ,2 61 1 05 1 ,3 66 1 ,3 31 84 1 ,4 15 2 ,0 19 1 98 2 ,2 17 99 .1 97 .8 99 .0 1 06 .6 1 29 .9 1 08 .5 N A N A N A 1 ,0 42 1 12 1 ,1 54 97 7 86 1 ,0 63 1 ,1 45 1 73 1 ,3 17 99 .3 97 .1 99 .0 94 .2 1 16 .4 96 .9 N A N A N A 55 5 93 64 8 59 0 80 66 9 57 5 1 02 67 8 98 .7 94 .0 98 .0 1 13 .2 1 50 .4 1 18 .1 N A N A N A 30 6 61 36 7 27 0 41 31 1 9 ,2 34 9 59 10 ,1 93 99 .3 96 .8 99 .1 1 01 .0 1 21 .7 1 02 .7 N A N A N A 4 ,6 39 5 26 5 ,1 65 4 ,5 95 4 33 5 ,0 28 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ N A = N ot a pp lic ab le 1 Bo th y ea r a nd m on th o f b irt h gi ve n 2 (B m /B f)* 10 0, w he re B m a nd B f a re th e nu m be rs o f m al e an d fe m al e bi rth s, re sp ec tiv el y 3 [2 B x /(B x- 1+ B x + 1) ]* 10 0, w he re B x i s th e nu m be r o f b irt hs in c al en da r y ea r x 214 * Appendix C Table C.6 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods preceding the survey (unweighted), Zimbabwe 1999 ________________________________________________________ Number of years preceding survey Age at ______________________________ Total death (days) 0-4 5-9 10-14 15-19 0-19 ________________________________________________________ <1 1 2 3 4 5 6 7 8 11 14 16 21 24 29 30 Missing Total 0-30 Percent early neonatal1 34 26 15 20 96 25 13 15 3 56 10 5 7 3 24 2 7 1 3 13 1 2 1 0 5 2 0 0 0 3 1 0 1 0 2 11 6 6 16 40 2 0 0 1 3 0 1 0 0 1 8 8 3 7 27 0 0 1 0 1 2 4 1 0 6 0 1 0 0 1 0 2 0 0 2 0 2 1 0 2 1 0 0 0 1 100 76 52 54 282 75.7 70.2 77.9 54.3 70.5 ________________________________________________________ 1 0-6 days/0-30 days Appendix C * 215 Table C.7 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at ages under one month, for five-year periods preceding the survey (weighted), Zimbabwe 1999 _____________________________________________________________ Number of years preceding survey Age at _________________________________ Total death (months) 0-4 5-9 10-14 15-19 0-19 _____________________________________________________________ <1 a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 18 20 21 23 24+ 1 year Percent neonatal1 Total 102 76 52 54 284 8 14 9 10 41 20 9 5 5 39 28 17 13 4 61 14 8 6 4 31 6 5 3 2 16 7 9 7 8 32 8 9 5 0 22 5 5 3 5 18 9 12 6 7 33 3 5 0 4 11 7 7 2 3 19 5 6 1 3 16 0 1 0 0 1 0 0 0 1 1 0 2 0 0 2 2 5 4 1 11 1 2 0 0 3 1 1 0 0 2 0 0 0 0 1 1 0 0 0 1 39 29 12 17 98 47.0 43.7 47.1 50.7 46.7 216 174 111 106 607 _____________________________________________________________ a Includes deaths under 1 month reported in days 1 Under 1 month/under 1 year Appendix D * 217 ZDHS HEAD OFFICE STAFF APPENDIX D PROJECT DIRECTOR: LAZARUS M. MACHIROVI SURVEY DIRECTOR: WASHINGTON T. MAPETA CSO DATA PROCESING Sifiso Ndlovu Supervisor Batsirai Changa Juliet Ngwenya Reggies Mamina Peter Katambarare Editors Joseph Matorofa Qinisani Ndlovu Tichaona Chirimanyemba Gladys Moyo Natalia Mabhumbo Maxwell Chinganga Tapiwa Nyamupa OTHER ORGANIZATIONS Dr. Marvelous Mhloyi (University of Zimbabwe) Dr. Ravai Marindo (University of Zimbabwe) Caroline Marangwanda (Zimbabwe National Family Planning Council) Ronica Nyakauru (Zimbabwe National Family Planning Council) Hazel Dube (Zimbabwe National Family Planning Council) Dr. K. Shodu (Ministry of Health and Child Welfare) Mabuzane (Ministry of Health and Child Welfare) MACRO INTERNATIONAL Sri Poedjastoeti George Bicego Trevor Croft Dr. Almaz Sharman 218 * Appendix D FIELD TEAMS MANICALAND MASHONALAND CENTRAL Supervisor Supervisor Rumbidzayi Vundla Emily Badza/ Perpeture Majiri Editor Editor Annie Mapani/ Roda Machaya Idah Mandikiyana Interviewers Interviewers Monica Ziki Ruth Magocha Priscilla Chimhau Kennedy Mugovera Abigail Matsapa John Paul Makoni Thomas Mukudu Dorothy Mbengo Beatrice Nyahuye Sheilla Dotoro Bridget T. Dube Driver: Mandudzo Drivers: Thikarhali and Mukuhwa MASHONALAND EAST MASHONALAND WEST Supervisor Supervisor Grace Onyimo Petronella Mildred Jaison Editor Editor Albertina Takaidza Samson Gombingo Interviewers Interviewers Caroline Mutsawo Priscilla Jaramba Chipo E. Nhamo Moreblessing Samkange Daniel Munandi Hellen Kandemiri Primrose Chidawanyika Ruth Mudokwani Rumbidzai S. Mlambo Amon Misinga Nerisa Pilime Mabel Gatsi Drivers: Chakare and Musara Lynette Dube Driver: Ticharwa MATABELELAND NORTH MATABELELAND SOUTH Supervisor Supervisor Talence Semwayo Bongani Ndlovu Editor Editor Willard Moyo Sinikiwe D. Mlilo Interviewers Interviewers Annida F. Angolwishe Mavuto W. Nyirenda Grace Volo Nombeko Mlotshwa Juanita Gundu Sehlulekile Gumede Thinah Sihoma Vusani Ntini Widzani Nleya Nhlanhla Ndlovu Drivers: Ngwenya and Ribengwa Driver: Sibanda Appendix D * 219 MIDLANDS PROVINCE MASVINGO PROVINCE Supervisor Supervisor Mary Mubayi Charity Chibi Editor Editor Precious Basikoro/ Verna Chakanyuka Rose Nyoni Interviewers Interviewer Hillary Chibi Zivisai Chinoda Mercy Bopoto Beauty Magara Tabitha S. N. Dumba Fadzai E. Makasi Audrey Kusvabadika Curlen Ndlovu John Chakasikwa Armstrong Chiromo Lilian Magodo Vivianne Gorova Driver: Mukamba Drivers: Well Matare and Nyanyiwa BULAWAYO PROVINCE HARARE PROVINCE Supervisor Supervisor Phathekile Busi Ndlovu Florence Matikiti Editor Editor Duduzela Elizabeth Silonda Machine Simbiso/ Raymond F. Mapwashike Interviewers Interviewers Yvonne E. K. Mpofu Sandra Mhonyera Salome Ndlovu Enes Zininga David Viyazhante Petronella Fichani Thandekile Zozi Fungai Kavhu Bernadette Mono Agnes Choenyana Themba S. Nkomo Mutsa Chikede Nomsa T. Dube Vongai Choga Simiso Ndebele Allen Mwanza Driver: Farai Mandeya Drivers: Chingara and Dzingai HE1 1999 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD QUESTIONNAIRE IDENTIFICATION NAME OF HOUSEHOLD HEAD___________________________________________________________________ WARD NAME_________________________________________________________________________________ CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (URBAN=1, RURAL=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LARGE CITY/SMALL CITY/TOWN/RURAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (LARGE CITY=1,SMALL CITY=2, TOWN = 3, RURAL=4) MALE SURVEY (YES=1, NO=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +)))0)))0))), *! *! !*! !* .)))3)))3)))1 *!!!*!!!* .)))3)))1 !!!*!!!* /)))1 *!!!* /)))1 *!!!* /)))1 *!!!* .)))- INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE INTERVIEWER’S NAME RESULT* +)))0))), DAY *!!!*!!!* /)))3)))1 MONTH *!!!*!!!* +)))0)))3)))3)))1 YEAR *!1 *!!!*!!!*!!!* .)))2)))3)))3)))1 NAME *!!!*!!!* .)))3)))1 RESULT *!!!* .)))- NEXT VISIT: DATE TOTAL NO. OF VISITS +))), *!!!* .)))-TIME *RESULT CODES: 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 4 POSTPONED 5 REFUSED 6 DWELLING VACANT OR ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 DWELLING NOT FOUND 9 OTHER ____________________________________________________ (SPECIFY) TOTAL PERSONS IN HOUSEHOLD +))0)), *! *! * .))2))- TOTAL ELIGIBLE WOMEN +))0)), *! !*! * .))2))- TOTAL ELIGIBLE MEN +))0)), *! * ! * .))2))- LANGUAGE OF QUESTIONNAIRE: ENGLISH +))), *!3!* .)))- LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE +))0)), *!!*!!* .))2))- LANGUAGE OF SHONA = 1; NDEBELE = 2; ENGLISH = 3; OTHER = 4 INTERVIEW: +))), *!!!* .)))- SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY NAME +))0)), *!!*!!* .))2))- NAME +))0)), *!!*!!* .))2))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))-DATE DATE HE2 HOUSEHOLD SCHEDULE Now we would like some information about the people who usually live in your household or who are staying with you now. LINE NO. USUAL RESIDENTS AND VISITORS RELATIONSHIP TO HEAD OF HOUSEHOLD RESIDENCE SEX AGE ELIGI- BILITY PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS 0-14 YEARS OLD** Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household. (NAME) What is the relationship of (NAME) to the head of the household?* Does (NAME) usually live here? Did (NAME) stay here last night? Is (NAME) male or female? How old is (NAME)? AGE IN COMPLE -TED YEARS “CIRCLE” LINE NUMBER OF ALL WOMEN AGE 15-49 “ROOF” LINE NUMBER OF ALL MEN AGE 15-54 “BOX” LINE NUMBER OF ALL CHILDREN UNDER AGE 6 Is (NAME)’s natural mother alive? IF ALIVE Is (NAME)’s natural father alive? IF ALIVE Does (NAME)’s natural mother live in this household? IF YES: What is her name? RECORD MOTHER’S LINE NUMBER Does (NAME)’s natural father live in this household? IF YES: What is his name? RECORD FATHER’S LINE NUMBER (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) YES NO YES NO M F INYEARS YES NO DK YES NO DK 01 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 01 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 02 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 02 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 03 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 03 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 04 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 04 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 05 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 05 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 06 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 06 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 07 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 07 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 08 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 08 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 09 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 09 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 10 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 10 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 11 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 11 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 12 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 12 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 13 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 13 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 14 +)))0))), *!!!*!!!* .)))2)))- 1 2 1 2 1 2 +))0)), *!!*!!* .))2))- 14 1 2 8 +)))0))), *!!!*!!!* .)))2)))- 1 2 8 +)))0))), *!!!*!!!* .)))2)))- *CODES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01 = HEAD 02 = WIFE OR HUSBAND 03 = SON OR DAUGHTER 04 = SON-IN-LAW OR DAUGHTER-IN-LAW 05 = GRANDCHILD 06 = PARENT 07 = PARENT-IN-LAW 08 = BROTHER OR SISTER 10 = OTHER RELATIVE 11 = ADOPTED/FOSTER/STEPCHILD 12 = NOT RELATED 98 = DON’T KNOW ** Q.9 THROUGH Q.12 THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD. IN Q.10 AND Q.12, RECORD ‘00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE ***CODES FOR Qs. 14, 15C AND 15F EDUCATION LEVEL: 0 = PRESCHOOL 1 = PRIMARY 2 = SECONDARY 3 = HIGHER 8 = DON’T KNOW EDUCATION GRADE: 00 = LESS THAN 1 YEAR COMPLETED 98 = DON’T KNOW HE3 LINE NO. EDUCATION IF AGE 3 YEARS OR OLDER IF AGE 3 -24 YEARS Has (NAME) ever been to school? What is the highest level of school (NAME) attended or attending?*** What is the highest grade (NAME) completed at that level?*** Is (NAME) currently attending school? Was (NAME) ever in attendance in school at any point during this school year? During this school year, what level and grade [is (NAME) attending / was (NAME) enrolled in]? Did (NAME) attend school during the previous school year? Was (NAME) ever in attendance in school at any point during the previous school year? During the previous school year, what level and grade [did (NAME) attend/was (NAME) enrolled in]? (13) (14) (15A) (15B) (15C) (15D) (15E) (15F) YES NO LEVEL GRADE YES NO YES NO LEVEL GRADE YES NO YES NO LEVEL GRADE 01 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 02 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 03 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 04 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 05 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 06 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 07 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 08 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 09 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 10 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 11 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 12 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 13 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 14 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15C 1 2 9 GO TO 15D +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 2 9 GO TO 15F 1 2 9 NEXT LINE +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)), TICK HERE IF CONTINUATION SHEET USED .))- Just to make sure that I have a complete listing: 1) Are there any other persons such as small children or infants that we have not listed? YES +))), .)))2) )< ENTER EACH IN TABLE NO +))),.)))- 2) In addition, are there any other people who may not be members of your family, such as domestic servants, lodgers or friends who usually live here? YES +))), .)))2) )< ENTER EACH IN TABLE NO +))),.)))- 3) Are there any guests or temporary visitors staying here, or anyone else who slept here last night, who have not been listed? YES +))), .)))2) )< ENTER EACH IN TABLE NO +))),.)))- HE4 HE5 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 16 What is the main source of drinking water for members of your household?1 PIPED WATER PIPED INTO OWN DWELLING . . . . . . . 11 PIPED INTO YARD/PLOT . . . . . . . . . . . 12 PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . 13 WELL WATER PROTECTED WELL . . . . . . . . . . . . . . . 21 UNPROTECTED WELL . . . . . . . . . . . . . 22 BOREHOLE . . . . . . . . . . . . . . . . . . . . . . 23 SURFACE WATER SPRING . . . . . . . . . . . . . . . . . . . . . . . . . 31 RIVER/STREAM . . . . . . . . . . . . . . . . . . 32 POND/LAKE/DAM . . . . . . . . . . . . . . . . . 33 RAINWATER . . . . . . . . . . . . . . . . . . . . . . . 41 OTHER 96 (SPECIFY) ))< 18 ))< 18 ))< 18 ))< 18 17 How long does it take you to go there, get water, and come back? +)))0)))0))), MINUTES . . . . . . . . . . . . . . . *!!!*!!!*!!!* .)))2)))2)))- ON PREMISES . . . . . . . . . . . . . . . . . . . . . 996 18 What kind of toilet or sanitation facility do most members of your household use? FLUSH TOILET . . . . . . . . . . . . . . . . . . . . . 11 PIT TOILET/LATRINE TRADITIONAL PIT TOILET . . . . . . . . . . 21 VENTILATED IMPROVED PIT (VIP) LATRINE/BLAIR TOILET . . . . 22 NO FACILITY/BUSH/FIELD . . . . . . . . . . . . 31 OTHER 96 (SPECIFY) ))< 19 18A With how many other households do you share this facility? RECORD “OO” IF TOILET NOT SHARED +)))0))), OTHER HOUSEHOLDS . . . . . . . . *!!!*!!!* .)))2)))- 19 Does your household have: Electricity? A radio? A television? A telephone? A refrigerator? YES NO ELECTRICITY . . . . . . . . . . . . . . . 1 2 RADIO . . . . . . . . . . . . . . . . . . . . . 1 2 TELEVISION . . . . . . . . . . . . . . . . 1 2 TELEPHONE . . . . . . . . . . . . . . . . 1 2 REFRIGERATOR . . . . . . . . . . . . . 1 2 19A What type of fuel does your household mainly use for cooking? ELECTRICITY . . . . . . . . . . . . . . . . . . . . . . 01 LPG/NATURAL GAS . . . . . . . . . . . . . . . . . 02 BIOGAS . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 KEROSENE/PARAFFIN . . . . . . . . . . . . . . . 04 COAL, LIGNITE . . . . . . . . . . . . . . . . . . . . . 05 CHARCOAL . . . . . . . . . . . . . . . . . . . . . . . . 06 FIREWOOD, STRAW . . . . . . . . . . . . . . . . . 07 DUNG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08 OTHER 96 (SPECIFY) 21 MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION. NATURAL FLOOR EARTH/SAND . . . . . . . . . . . . . . . . . . . 11 DUNG . . . . . . . . . . . . . . . . . . . . . . . . . . 12 RUDIMENTARY FLOOR WOOD PLANKS . . . . . . . . . . . . . . . . . . 21 FINISHED FLOOR PARQUET OR POLISHED WOOD . . . 31 VINYL OR ASPHALT STRIPS . . . . . . . 32 CERAMIC TILES . . . . . . . . . . . . . . . . . 33 CEMENT . . . . . . . . . . . . . . . . . . . . . . . 34 CARPET . . . . . . . . . . . . . . . . . . . . . . . . 35 OTHER 96 (SPECIFY) 22 Does any member of your household own: A modern oxcart/scotchcart? A bicycle? A motorcycle? A car or truck? YES NO MODERN OXCART . . . . . . . . . . . 1 2 BICYCLE . . . . . . . . . . . . . . . . . . . 1 2 MOTORCYCLE . . . . . . . . . . . . . . 1 2 CAR/TRUCK . . . . . . . . . . . . . . . . . 1 2 22A Does your household have any bednets that are used while sleeping? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<22E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP HE6 22B CHECK 5 AND 7 : NUMBER OF CHILDREN UNDER AGE 5 WHO SLEPT IN THE HOUSEHOLD LAST NIGHT NONE +))), .)))2)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) ))))))))))))))))))) ONE +))), TWO OR MORE +))), /)))- .)))2))))))))))))))))))))))))))))))))))))))) * ? )))<22E )))<22D 22C Did (NAME) sleep under a bednet last night? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )), ))2<22E 22D Did all, some or none of the children under age 5 who slept in the household last night sleep under a bednet? ALL CHILDREN . . . . . . . . . . . . . . . . . . . . . . 1 SOME CHILDREN . . . . . . . . . . . . . . . . . . . . 2 NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 22E Does your household have any place which is used for hand washing? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<23 22F ASK TO SEE THE PLACE USED MOST OFTEN AND OBSERVE IF THE FOLLOWING ITEMS ARE PRESENT YES NO WATER/TAP . . . . . . . . . . . . . . . . . 1 2 SOAP, ASH OR OTHER CLEANSING AGENT . . . . . . . 1 2 BASIN . . . . . . . . . . . . . . . . . . . . . . 1 2 23 TYPE OF SALT TEST OF IODINE. 00 PPM (NO IODINE/UNDETECTABLE) . . . 1 01-14 PPM . . . . . . . . . . . . . . . . . . . . . . . . . . 2 15+ PPM . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 HE7 WEIGHT, HEIGHT AND HEMOGLOBIN MEASUREMENT CHECK COLUMNS (8): RECORD THE LINE NUMBER, NAME AND AGE OF ALL WOMEN AGE 15-49 AND ALL CHILDREN UNDER AGE 6. WOMEN 15-49 HEIGHT AND WEIGHT MEASUREMENT OF WOMEN 15-49 LINE NO. FROM COL.(8) NAME FROM COL.(2) AGE FROM COL.(7) What is (NAME)’s date of birth? WEIGHT (KILOGRAMS) HEIGHT (CENTIMETERS) MEASURED LYING DOWN OR STANDING UP RESULT 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER (24) (25) (26) (27) (28) (29) (30) (31) YEARS +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +))), *!!!* .)))- CHILDREN UNDER AGE 6 WEIGHT AND HEIGHT MEASUREMENT OF CHILDREN BORN IN 1994 OR LATER LINE NO. FROM COL.(8) NAME FROM COL.(2) AGE FROM COL.(7) What is (NAME)’s date of birth? WEIGHT (KILOGRAMS) HEIGHT (CENTIMETERS) MEASURED LYING DOWN OR STANDING UP RESULT 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER LYING STAND. +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))),+)))0))),+)))0)))0)))0))), *!!!*!!!**!!!*!!!**!!!*!!!*!!!*!!!* .)))2)))-.)))2)))-.)))2)))2)))2)))- +)))0)))0))), +))), *!0!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- 1 2 +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))),+)))0))),+)))0)))0)))0))), *!!!*!!!**!!!*!!!**!!!*!!!*!!!*!!!* .)))2)))-.)))2)))-.)))2)))2)))2)))- +)))0)))0))), +))), *!0!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- 1 2 +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))),+)))0))),+)))0)))0)))0))), *!!!*!!!**!!!*!!!**!!!*!!!*!!!*!!!* .)))2)))-.)))2)))-.)))2)))2)))2)))- +)))0)))0))), +))), *!0!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- 1 2 +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))),+)))0))),+)))0)))0)))0))), *!!!*!!!**!!!*!!!**!!!*!!!*!!!*!!!* .)))2)))-.)))2)))-.)))2)))2)))2)))- +)))0)))0))), +))), *!0!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- 1 2 +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))),+)))0))),+)))0)))0)))0))), *!!!*!!!**!!!*!!!**!!!*!!!*!!!*!!!* .)))2)))-.)))2)))-.)))2)))2)))2)))- +)))0)))0))), +))), *!0!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- 1 2 +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))),+)))0))),+)))0)))0)))0))), *!!!*!!!**!!!*!!!**!!!*!!!*!!!*!!!* .)))2)))-.)))2)))-.)))2)))2)))2)))- +)))0)))0))), +))), *!0!*!!!*!!!* *!!!* .)))2)))2)))-.)))- +)))0)))0))), +))), *!!!*!!!*!!!* *!!!* .)))2)))2)))-.)))- 1 2 +))), *!!!* .)))- TICK HERE IF CONTINUATION SHEET USED +)),.))- HE8 HEMOGLOBIN MEASUREMENT OF WOMEN 15-49 CHECK COLUMN (26): LINE NO. OF PARENT/ RESPONSIBLE ADULT. RECORD ‘00' IF NOT LISTED IN HOUSEHOLD SCHEDULE READ CONSENT STATEMENT TO WOMAN/PARENT/RESPONSIBLE ADULT* CIRCLE CODE (AND SIGN) HEMOGLOBIN LEVEL (G/DL) RESULT 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER (32) (33) (34) (35) (36) AGE 15-17 AGE 18-49 GRANTED REFUSED 1 2 * GO TO 34 =)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- 1 2 * GO TO 34 =)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- 1 2 * GO TO 34 =)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- HEMOGLOBIN MEASUREMENT OF CHILDREN BORN IN JANUARY 1994 OR LATER LINE NO. OF PARENT/ RESPONSIBLE ADULT. RECORD ‘00' IF NOT LISTED IN HOUSEHOLD SCHEDULE READ CONSENT STATEMENT TO PARENT/RESPONSIBLE ADULT* CIRCLE CODE (AND SIGN) HEMOGLOBIN LEVEL (G/DL) RESULT 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- +)))0))), *!!!*!!!* .)))2)))- 1 ? SIGN 2 * NEXT LINE =)))- +)))0))), +))), *!!!*!!!* *!!!* .)))2)))-.)))- +))), *!!!* .)))- * CONSENT STATEMENT As part of this survey, we are studying anemia among women and children. Anemia is a serious health problem which results from poor nutrition. This survey will assist the government to develop programs to prevent and treat anemia. We request that you (and all children born in January 1994 or later) participate in the anemia testing part of this survey and give a sample of blood from a finger or heel. The test uses disposable sterile instruments that are clean and completely safe. The blood will be analyzed with new equipment and the results of the test will be given to you right after the blood is taken. The results will be kept confidential. May I now ask that you (and NAME OF CHILD[REN]) participate in the anemia test. However, if you decide not to have the test done, it is your right and we will respect your decision. Now please tell me if you agree to have the test(s) done. WE1 1999 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY WOMEN’S QUESTIONNAIRE IDENTIFICATION NAME OF HOUSEHOLD HEAD WARD NAME CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (URBAN=1, RURAL=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LARGE CITY/SMALL CITY/TOWN/RURAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (LARGE CITY=1, SMALL CITY=2, TOWN=3, RURAL=4) NAME AND LINE NUMBER OF WOMAN +)))0)))0))), **!!!*!!!*!!!***** .)))3)))3)))1 *!!!*!!!* .)))3)))1 !!!*!!!* /)))1 *!!!* /)))1 *!!!* +)))3)))1 *!!!*!!!* .)))2)))- INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE INTERVIEWER’S NAME RESULT* +)))0))), DAY *!!!*!!!* /)))3)))1 MONTH *!!!*!!!* +)))0)))3)))3)))1 YEAR*!!!*!!!*!!!*!!!* .)))2)))3)))3)))1 NAME *!!!*!!!* .)))3)))1 RESULT *!!!* .)))- NEXT VISIT: DATE TOTAL NO. OF VISITS +))), *!!!* .)))-TIME *RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER ___________________________ (SPECIFY) LANGUAGE OF QUESTIONNAIRE: ENGLISH +))), *!3!* .)))- LANGUAGE OF SHONA = 1; NDEBELE = 2; ENGLISH = 3; OTHER = 4 INTERVIEW: +))), *!!!* .)))- SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY NAME +)))0))), *!!!*!!!* .)))2)))- NAME +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))-DATE DATE WE2 SECTION 1. RESPONDENT’S BACKGROUND INTRODUCTION AND CONSENT Hello. My name is ________________ and I am working with the Central Statistical Office. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health and that of your children. This information may help the country plan health services. Whatever answers you provide will be confidential and will not be shown to other persons. We hope you will participate in this survey since your views are important. Shall we proceed with the interview? RESPONDENT AGREES TO BE RESPONDENT DOES NOT AGREE . . . . . . . . . . 2 ))< END INTERVIEWED . . . . . . . . . . . 1 9 I HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT AND SHE HAS AGREED TO BE INTERVIEWED. SIGNATURE OF INTERVIEWER_______________________________________________________ NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 RECORD THE TIME. +)))0))), HOUR . . . . . . . . . . . . . . . *!!!*!!!* /)))3)))1 MINUTES . . . . . . . . . . . . *!!!*!!!* .)))2)))- 102 First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, on a commercial farm or in another rural area? CITY . . . . . . . . . . . . . . . . . . . . . . . . 1 TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 COMMERCIAL FARM . . . . . . . . . . 3 OTHER RURAL . . . . . . . . . . . . . . . 4 103 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD ‘00' YEARS. +)))0))), YEARS . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- ALWAYS . . . . . . . . . . . . . . . . . . . . 95 VISITOR . . . . . . . . . . . . . . . . . . . . 96 )), ))2<105 104 Just before you moved here, did you live in a city, in a town, on a commercial farm or in another rural area? CITY . . . . . . . . . . . . . . . . . . . . . . . . 1 TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 COMMERCIAL FARM . . . . . . . . . . 3 OTHER RURAL . . . . . . . . . . . . . . . 4 105 In what month and year were you born? +)))0))), MONTH . . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW MONTH . . . . . . . . 98 +)))0)))0)))0))), YEAR . . . . . . . *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- DON’T KNOW YEAR . . . . . . . . 9998 106 How old were you at your last birthday? COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. AGE IN COMPLETED +)))0))), YEARS . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 107 Have you ever attended school? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<114 108 What is the highest level of school you attended: primary, secondary, or higher? PRIMARY . . . . . . . . . . . . . . . . . . . . 1 SECONDARY . . . . . . . . . . . . . . . . . 2 HIGHER . . . . . . . . . . . . . . . . . . . . . 3 109 What is the highest (grade/form/year) you completed at that level? +)))0))), GRADE/FORM . . . . . . . . *!!!*!!!* .)))2)))- 113 CHECK 108: PRIMARY +))), SECONDARY +))), /)))- OR HIGHER .)))2)))))))))))))))))))))))))))))))))))))))))) ? )))<115 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE3 114 Can you read and understand a letter or newspaper easily, with difficulty, or not at all? EASILY . . . . . . . . . . . . . . . . . . . . . . 1 WITH DIFFICULTY . . . . . . . . . . . . . 2 NOT AT ALL . . . . . . . . . . . . . . . . . . 3 )))<116 115 Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY . . . . . . . . . . 1 AT LEAST ONCE A WEEK . . . . . . 2 LESS THAN ONCE A WEEK . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . 4 116 Do you listen to the radio almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY . . . . . . . . . . 1 AT LEAST ONCE A WEEK . . . . . . 2 LESS THAN ONCE A WEEK . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . 4 117 Do you watch television almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY . . . . . . . . . . 1 AT LEAST ONCE A WEEK . . . . . . 2 LESS THAN ONCE A WEEK . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . 4 118 What is your religion? TRADITIONAL . . . . . . . . . . . . . . . . 1 CHRISTIAN . . . . . . . . . . . . . . . . . . 2 MUSLIM . . . . . . . . . . . . . . . . . . . . . 3 NONE . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER_______________________6 (SPECIFY) 120 Have you ever drank an alcohol-containing beverage? YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<123 121 In the last 30 days, on how many days did you drink an alcohol- containing beverage? +)))0))), NUMBER OF DAYS . . . . . *!!!*!!!* .)))2)))- NONE/NEVER . . . . . . . . . . . . . . . . 997 )))<123 122 In the last 30 days, on how many occasions did you get “drunk”? +)))0))), NUMBER OF TIMES . . . . . *!!!*!!!* .)))2)))- NONE/NEVER . . . . . . . . . . . . . . . . 997 123 In the last 3 months, have you had any kind of injection? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<201 124 In the last 3 months, how many times did you have an injection? NUMBER OF +)))0))), INJECTIONS . . . . . . . . . *!!!*!!!* .)))2)))- EVERY DAY . . . . . . . . . . . . . . . . 998 124A What was the injection for? RECORD ALL RESPONSES. MEDICAL TREATMENT . . . . . . . . A OTHER . . . . . . . . . . . . . . . . . . . . . B 125 The last time you had an injection, who was the person who gave you the injection? HEALTH PROFESSIONAL . . . . . . . . 1 PHARMACIST . . . . . . . . . . . . . . . . . . 2 TRADITIONAL HEALER . . . . . . . . . . 3 FRIEND/RELATIVE . . . . . . . . . . . . . . 4 SELF . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER ________________________6 (SPECIFY) WE4 SECTION 2: REPRODUCTION NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 Now I would like to ask about all the births you have had during your life. Have you ever given birth? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<206 202 Do you have any sons or daughters to whom you have given birth who are now living with you? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<204 203 How many sons live with you? And how many daughters live with you? IF NONE, RECORD ‘00'. +)))0))), SONS AT HOME . . . . . . . . . *!!!*!!!* /)))3)))1 DAUGHTERS AT HOME . . . *!!!*!!!* .)))2)))- 204 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<206 205 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE, RECORD ‘00'. +)))0))), SONS ELSEWHERE . . . . . . *!!!*!!!* /)))3)))1 DAUGHTERS ELSEWHERE *!!!*!!!* .)))2)))- 206 Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<208 207 How many boys have died? And how many girls have died? IF NONE, RECORD ‘00'. +)))0))), BOYS DEAD . . . . . . . . . . . . . *!!!*!!!* /)))3)))1 GIRLS DEAD . . . . . . . . . . . . *!!!*!!!* .)))2)))- 208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD ‘00'. +)))0))), TOTAL . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 209 CHECK 208: Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct? +))), +))), PROBE AND YES /)))- NO .)))2))<CORRECT * 201-208 AS ? NECESSARY. 210 CHECK 208: ONE OR MORE +))), NO BIRTHS +))), BIRTHS /)))- .)))2)))))))))))))))))))))))))))))))))))))))))))) ? )))<227 WE5 211 Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 212 213 214 215 216 217 IF ALIVE: 218 IF ALIVE: 218A IF ALIVE: 219 IF DEAD: 220 What name was given to your (first/ next) baby? (NAME) Were any of these births twins? Is (NAME) a boy or a girl? In what month and year was (NAME) born? PROBE: What is his/her birthday? Is (NAME) still alive? How old was (NAME) at his/her last birthday? RECORD AGE IN COM- PLETED YEARS. Is (NAME) living with you? RECORD HOUSEHO LD LINE NUMBER OF CHILD (RECORD ‘00' IF CHILD NOT LISTED IN HOUSEHO LD) How old was (NAME) when he/she died? IF ‘1 YR’, PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS. Were there any other live births between (NAME OF PREVIOU S BIRTH) and (NAME)? 01 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (NEXT BIRTH) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- 02 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 03 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 04 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 05 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 06 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 07 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 212 213 214 215 216 217 IF ALIVE: 218 IF ALIVE: 218A IF ALIVE: 219 IF DEAD: 220 WE6 What name was given to your next baby? (NAME) Were any of these births twins? Is (NAME) a boy or a girl? In what month and year was (NAME) born? PROBE: What is his/her birthday? Is (NAME) still alive? How old was (NAME) at his/her last birthday? RECORD AGE IN COM- PLETED YEARS. Is (NAME) living with you? RECORD HOUSEHO LD LINE NUMBER OF CHILD (RECORD ‘00' IF CHILD NOT LISTED IN HOUSEHO LD) How old was (NAME) when he/she died? IF ‘1 YR’, PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS. Were there any other live births between (NAME OF PREVIOU S BIRTH) and (NAME)? 08 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 09 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 10 SING 1 MULT 2 BOY . 1 GIRL . 2 +)))0))), MONTH *!!!*!!!* .)))2)))- YEAR +)))0)))0)))0))), *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- YES . . 1 NO . . . 2 * ? 219 AGE IN YEARS +)))0))), *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 LINE NUMBER +)))0))), *!!!*!!!* .)))2)))- * ? (GO TO 220) +)))0))), DAYS . . . . . . . . 1 *!!!*!!!* /)))3)))1 MONTHS . . . . . 2 *!!!*!!!* /)))3)))1 YEARS . . . . . . . 3 *!!!*!!!* .)))2)))- YES . . 1 NO . . . 2 223 Have you had any live births since the birth of (NAME OF LAST BIRTH)? YES . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . 2 224 COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS +))), NUMBERS ARE +))), ARE SAME /)))- DIFFERENT .)))2)))< (PROBE AND RECONCILE) * ? CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. +))), *!!!* /)))1 *!!!* /)))1 *!!!* /)))1 *!!!* .)))- 225 CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN JANUARY 1994 OR LATER. IF NONE, RECORD ‘0'. +))), *!!!* .)))- 226 FOR EACH BIRTH SINCE JANUARY 1994 ENTER ‘B’ IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD ‘P’ IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF ‘P’s MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE ‘B’ CODE. 227 Are you currently pregnant? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . 8 )), ))2<230 WE7 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 228 How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER ‘P’s IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR TOTAL NUMBER OF COMPLETED MONTHS. +)))0))), MONTHS . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 229 At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all? THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 LATER . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . 3 230 Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<235 231 When did the last such pregnancy end? +)))0))), MONTH . . . . . . . . . . . . . . . . . *!!!*!!!* +)))0)))3)))3)))1 YEAR . . . . . . . . . . . *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- 232 CHECK 231: LAST PREGNANCY +))), LAST PREGNANCY +))), ENDED IN /)))- ENDED BEFORE .)))2))))))))))))))))))))))))))))))))))))))))) JAN. 1994 OR LATER ? JAN. 1994 ))<236 233 How many months pregnant were you when the last such pregnancy ended? RECORD NUMBER OF COMPLETED MONTHS. ENTER ‘T’ IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND ‘P’ FOR THE REMAINING NUMBER OF COMPLETED MONTHS. +)))0))), MONTHS . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 234 Have you ever had any other pregnancies which did not result in a live birth? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<236 235 ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1994. ENTER ‘T’ IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND ‘P’ FOR THE REMAINING NUMBER OF COMPLETED MONTHS. 235A IN THE BOXES AT THE BOTTOM OF THE CALENDAR, FILL IN THE MONTH AND YEAR OF TERMINATION OF THE LAST NON-LIVE BIRTH PREGNANCY PRIOR TO JANUARY 1994. 236 When did your last menstrual period start? __________________________ (DATE, IF GIVEN) +)))0))), DAYS AGO . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS AGO . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS AGO . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS AGO . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- IN MENOPAUSE . . . . . . . . . . . . . . . . 994 BEFORE LAST BIRTH . . . . . . . . . . . . 995 NEVER MENSTRUATED . . . . . . . . . . 996 237 From one menstrual period to next, is there a time when a woman is more likely to become pregnant if she has sexual relations? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 )), ))2<301 238 Is this time during her period, right after her period has ended, just before her period begins or in the middle of her menstrual cycle? DURING HER PERIOD . . . . . . . . . . . . . 1 RIGHT AFTER HER PERIOD HAS ENDED . . . . . . . . . . 2 JUST BEFORE HER PERIOD BEGINS . 3 IN THE MIDDLE OF THE CYCLE . . . . . 4 OTHER__________________________6 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 WE8 SECTION 3. CONTRACEPTION Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 303. 301 Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)? 303 Have you ever used (METHOD)? 01 FEMALE STERILIZATION Women can have an operation to avoid having any more children. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? Have you ever had an operation to avoid having any (more) children? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 02 MALE STERILIZATION Men can have an operation to avoid having any more children. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? Have you ever had a partner who had an operation to avoid having children? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 03 PILL Women can take a pill every day YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 05 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 08 FEMALE CONDOM : Women can place a rubber sheath in their vagina before sexual intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 09 DIAPHRAGM Women can place a diaphragm in their vagina before intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 11 LACTATIONAL AMENORRHEA METHOD (LAM) Women can use a specially taught method of pregnancy avoidance to delay the return of the menstrual period by feeding their child nothing but breast milk for up to six months after a birth. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 13 WITHDRAWAL Men can be careful and pull out before climax. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 14 EMERGENCY CONTRACEPTION: Women can take pills the day after sexual intercourse to avoid becoming pregnant. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? YES . . . . . . . . . . . . . . . . . . 1 _________________________ (SPECIFY) _________________________ (SPECIFY) NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 304 CHECK 303: NOT A SINGLE +))), AT LEAST ONE +))), “YES” /)))- “YES” .)))2)))))))))))))))))))))))))))))))))))))))))))< SKIP TO 309 (NEVER USED) ? (EVER USED) WE9 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 305 Have you ever used anything or tried in any way to delay or avoid getting pregnant? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<307 306 ENTER ‘0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. ))))))))))))))))))))))))))))))))))))))))<332 307 What have you used or done? CORRECT 303 AND 304 (AND 301 IF NECESSARY). 309 Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any? IF NONE, RECORD ‘00'. +)))0))), NUMBER OF CHILDREN . . *!!!*!!!* .)))2)))- 311 CHECK 303 (01): WOMAN NOT +))), WOMAN +))), STERILIZED /)))- STERILIZED .)))2)))))))))))))))))))))))))))))))))))))))) ? ))<314A 312 CHECK 227: NOT PREGNANT +))), PREGNANT +))), OR UNSURE /)))- .)))2))))))))))))))))))))))))))))))))))))))))))) ? )))<325 313 Are you currently doing something or using any method to delay or avoid getting pregnant? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<325 314 314A Which method are you using? CIRCLE ‘A' FOR FEMALE STERILIZATION. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD. FEMALE STERILIZATION . . . . . . . . A MALE STERILIZATION . . . . . . . . . . . B PILL . . . . . . . . . . . . . . . . . . . . . . . . . . C IUD . . . . . . . . . . . . . . . . . . . . . . . . . . D INJECTIONS . . . . . . . . . . . . . . . . . . . E IMPLANTS . . . . . . . . . . . . . . . . . . . . F CONDOM . . . . . . . . . . . . . . . . . . . . . G FEMALE CONDOM . . . . . . . . . . . . . H DIAPHRAGM . . . . . . . . . . . . . . . . . . . I FOAM/JELLY . . . . . . . . . . . . . . . . . . J LACT. AMEN. METHOD . . . . . . . . . . K PERIODIC ABSTINENCE . . . . . . . . . L WITHDRAWAL . . . . . . . . . . . . . . . . . M OTHER________________________ X (SPECIFY) ), * * * /<324 * * * * * * * )- NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE10 318 Where did the sterilization take place? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _____________________________________________________ (NAME OF PLACE) PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . . 11 PROVINCIAL HOSPITAL . . . . . . . 12 DISTRICT/RURAL HOSPITAL . . . 13 OTHER PUBLIC_______________ 16 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . 31 PRIVATE DOCTOR . . . . . . . . . . . 32 OTHER PRIVATE MEDICAL _________________36 (SPECIFY) OTHER________________________96 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . 98 318A Before the sterilization operation, were (you/your husband/your partner) told that you would not be able to have any (more) children? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 321 In what month and year was the sterilization performed? +)))0))), MONTH . . . . . . . . . . . . . . . *!!!*!!!* +)))0)))3)))3)))1 YEAR . . . . . . . . . *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- 322 CHECK 321: STERILIZED BEFORE +))), JANUARY 1994 /)))- +)))))))))))))))))))))))))))))))- ? ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1994 THEN SKIP TO ))))))))))<327 STERILIZED IN JANUARY 1994 +))), OR LATER /)))- +))))))))))))))))))))) )))))))))- ? ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION. ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH OF DATE OF OPERATION. THEN SKIP TO ))))))))))<325 324 ENTER METHOD CODE FROM 314 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE. IF CURRENT METHOD STARTED IN JANUARY 1994 OR LATER, ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN THE SAME MONTH THAT USE OF CURRENT METHOD BEGAN. ILLUSTRATIVE QUESTIONS: • When did you start using this method continuously? • How long have you been using this method continuously? • When you started using this method, where did you obtain it? NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE11 325 I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1994 USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. IN COLUMN 1, ENTER METHOD USE CODE OR ‘0' FOR NONUSE IN EACH BLANK MONTH. ILLUSTRATIVE QUESTIONS: COLUMN 1: • When was the last time you used a method? Which method was that? • When did you start using that method? How long after the birth of (NAME)? • How long did you use the method then? IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE. ILLUSTRATIVE QUESTIONS: COLUMN 2: • Where did you obtain the method when you started using it? • Where did you get advice on how to use the method [ for LAM, rhythm, or withdrawal]? IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1. ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT. ILLUSTRATIVE QUESTIONS: COLUMN 3: • Why did you stop using the (METHOD)? • Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: • How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER ‘0' IN EACH SUCH MONTH IN COLUMN 1. 327 CHECK 314/314A: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CIRCLED IN 314/314A, CIRCLE CODE FOR HIGHEST METHOD IN LIST NOT ASKED . . . . . . . . . . . . . . . . . . . 00 FEMALE STERILIZATION . . . . . . . . 01 MALE STERILIZATION . . . . . . . . . . 02 PILL . . . . . . . . . . . . . . . . . . . . . . . . . 03 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . 04 INJECTIONS . . . . . . . . . . . . . . . . . . 05 IMPLANTS . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . 08 DIAPHRAGM . . . . . . . . . . . . . . . . . . 09 FOAM/JELLY . . . . . . . . . . . . . . . . . . 10 LACTATIONAL AMEN. METHOD . . 11 PERIODIC ABSTINENCE . . . . . . . . 12 WITHDRAWAL . . . . . . . . . . . . . . . . . 13 OTHER METHOD . . . . . . . . . . . . . . 96 ))<332 ))<334 ))<328I ))<328I ))<328I ))<328I ))<328I ))<334 ) ))<334 ) ))<334 328B CHECK COLUMN 1 OF CALENDAR FOR LENGTH OF USE OF CURRENT METHOD: STARTED USING AFTER +))), STARTED USING +))), JANUARY 1994 /)))- IN JANUARY 1994 .)))2)))))))))))))))))))))))))) ? OR BEFORE )))<328K 328G You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) on (DATE). At that time, were you told about side effects or problems you might have with the method? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<328I 328H Were you told what to do if you experienced side effects? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 328I When you were given the (CURRENT METHOD), were you told about other methods of family planning which you could use? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 328K CHECK 314/314A: CIRCLE METHOD CODE: NOT ASKED . . . . . . . . . . . . . . . . . . . 00 FEMALE STERILIZATION . . . . . . . . 01 MALE STERILIZATION . . . . . . . . . . 02 PILL . . . . . . . . . . . . . . . . . . . . . . . . . 03 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . 04 INJECTIONS . . . . . . . . . . . . . . . . . . 05 IMPLANTS . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . 08 DIAPHRAGM . . . . . . . . . . . . . . . . . . 09 FOAM/JELLY . . . . . . . . . . . . . . . . . . 10 LACTATIONAL AMEN. METHOD . . 11 PERIODIC ABSTINENCE . . . . . . . . 12 WITHDRAWAL . . . . . . . . . . . . . . . . . 13 OTHER METHOD . . . . . . . . . . . . . . 96 ))<332 )))<334 ))<334 ))<334 ))<334 ) ))<334 ))<334 328L Where did you obtain (CURRENT METHOD) the last time? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _______________________________________________ (NAME OF PLACE) PUBLIC SECTOR GOVT. HOSPITAL/CLINIC . . . . . . . 11 RURAL/MUNICIPAL CLINIC . . . . . 12 RURAL HEALTH CENTER . . . . . . 13 ZNFPC (FIXED) CLINIC . . . . . . . . . 14 ZNFPC MOBILE CLINIC . . . . . . . . 15 MOH MOBILE CLINIC . . . . . . . . . . 16 ZNFPC CBD . . . . . . . . . . . . . . . . . . 17 MOH CBD . . . . . . . . . . . . . . . . . . . 18 OTHER PUBLIC________________19 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . 31 PHARMACY . . . . . . . . . . . . . . . . . . 32 PRIVATE DOCTOR . . . . . . . . . . . . 33 CBD . . . . . . . . . . . . . . . . . . . . . . . . 34 OTHER PRIVATE MEDICAL__________________36 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . 41 CHURCH . . . . . . . . . . . . . . . . . . . . 42 FRIENDS/RELATIVES . . . . . . . . . . 43 OTHER_______________________ 96 (SPECIFY) ), * * * * * * * * * * /<334 * * * * * * * * * * )- 332 Do you know of a place where you can obtain a method of family planning? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<334 333 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. ___________________________________________________ (NAME OF PLACE) PUBLIC SECTOR GOVT. HOSPITAL/CLINIC . . . . . . . 11 RURAL/MUNICIPAL CLINIC . . . . . 12 RURAL HEALTH CENTER . . . . . . 13 ZNFPC (FIXED) CLINIC . . . . . . . . . 14 ZNFPC MOBILE CLINIC . . . . . . . . 15 MOH MOBILE CLINIC . . . . . . . . . . 16 ZNFPC CBD . . . . . . . . . . . . . . . . . . 17 MOH CBD . . . . . . . . . . . . . . . . . . . 18 OTHER PUBLIC________________19 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . 31 PHARMACY . . . . . . . . . . . . . . . . . . 32 PRIVATE DOCTOR . . . . . . . . . . . . 33 CBD . . . . . . . . . . . . . . . . . . . . . . . . 34 OTHER PRIVATE MEDICAL__________________36 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . 41 CHURCH . . . . . . . . . . . . . . . . . . . . 42 FRIENDS/RELATIVES . . . . . . . . . . 43 OTHER_______________________ 96 (SPECIFY) 334 In the last 12 months, were you visited by a CBD who talked to you about family planning? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 335 In the last 12 months, have you attended a health facility for care for yourself (or your children)? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<401 336 Did any staff member at the health facility speak to you about family planning methods? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WE13 SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING 401 CHECK 225: ONE OR MORE +))), NO +))), BIRTHS /)))- BIRTHS .)))2)))))))))))))))))))))))< (SKIP TO 470) IN JAN. 1994 * IN JAN. 1994 OR LATER ? OR LATER 402 ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1994 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES). Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately) 403 LINE NUMBER FROM Q212 LAST BIRTH +)))0))), LINE NUMBER . . . . . *!!!*!!!* .)))2)))- NEXT-TO-LAST BIRTH +)))0))), LINE NUMBER . . . . . . . . *!!!*!!!* .)))2)))- 404 FROM Q212 AND Q216 NAME _____________________ +)), +)), ALIVE /))- DEAD /))- ? ? NAME _____________________ +)), +)), ALIVE /))- DEAD /))- ? ? 404A Has (NAME) been registered? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 405)=)))))))1 DON’T KNOW . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 405)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 404B Does (NAME) have a birth certificate? IF YES: May I see it, please? YES, SEEN . . . . . . . . . . . . . . . . 1 YES, NOT SEEN . . . . . . . . . . . 2 NO CERTIFICATE . . . . . . . . . . 3 YES, SEEN . . . . . . . . . . . . . . . . . . . 1 YES, NOT SEEN . . . . . . . . . . . . . . 2 NO CERTIFICATE . . . . . . . . . . . . . 3 405 At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all? THEN . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 407)=)))))))- LATER . . . . . . . . . . . . . . . . . . . 2 NO MORE . . . . . . . . . . . . . . . . 3 (SKIP TO 407)=)))))))- THEN . . . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 412)=)))))))- LATER . . . . . . . . . . . . . . . . . . . . . . 2 NO MORE . . . . . . . . . . . . . . . . . . . 3 (SKIP TO 412)=)))))))- 406 How much longer would you like to have waited? +)))0))), MONTHS . . . . . . . 1 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . 2 *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . 998 +)))0))), MONTHS . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . . 2 *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . . . 998 407 Did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . B TRADITIONAL MIDWIFE TRAINED . . . . . . . . . . . . . . C UNTRAINED . . . . . . . . . . . . D TRAINING UNCERTAIN . . . E OTHER________________ X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . Y (SKIP TO 410)=)))))))- 408 How many months pregnant were you when you first received antenatal care for this pregnancy? +)))0))), MONTHS . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . 98 409 How many times did you receive antenatal care during this pregnancy? +)))0))), NO. OF TIMES . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . 98 409A CHECK 409: NUMBER OF TIMES RECEIVED ANTENATAL CARE ONCE +))), /)))- ? (SKIP TO 409C) MORE THAN ONCE OR DK +))), /)))- * ? WE14 LAST BIRTH NAME _____________________ NEXT-TO-LAST BIRTH NAME _____________________ 409B How many months pregnant were you the last time you received antenatal care? +)))0))), MONTHS . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . 98 409C During this pregnancy, were any of the following done at least once? Were you weighed? Was your height measured? Was your blood pressure measured? Did you give a urine sample? Did you give a blood sample? YES NO WEIGHT . . . . . . . . . . 1 2 HEIGHT . . . . . . . . . . 1 2 BLOOD PRESSURE 1 2 URINE SAMPLE . . . . 1 2 BLOOD SAMPLE . . . 1 2 409D Were you told about the signs of pregnancy complications? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 410)=)))))))1 DON’T KNOW . . . . . . . . . . . . . 8 409E Were you told where to go if you had these problems? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . 8 410 During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 411A)=)))))))1 DON’T KNOW . . . . . . . . . . . . . 8 410A During this pregnancy, how many times did you get this injection? +))), NO. OF TIMES . . . . . . . . *!!!* .)))- DON’T KNOW . . . . . . . . . . . . . 8 411A During this pregnancy, were you given or did you buy any iron tablets? SHOW TABLET. YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 411C)=)))))))1 DON’T KNOW . . . . . . . . . . . . . 8 411B During the whole pregnancy, how many tablets did you take? NUMBER OF +)))0)))0))), TABLETS . . . . *!!!*!!!*!!!* .)))2)))2)))- DON’T KNOW . . . . . . . . . . . 998 411C During this pregnancy, did you have difficulty with your vision during the daylight? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . 8 411D During this pregnancy, did you suffer from night blindness? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . 8 411E During this pregnancy, were you given or did you buy any drugs in order to prevent malaria? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 412)=)))))))1 DON’T KNOW . . . . . . . . . . . . . 8 411F Which drug was that? RECORD ALL MENTIONED. ASPIRIN . . . . . . . . . . . . . . . . . . A FANSIDAR . . . . . . . . . . . . . . . . B CHLOROQUINE . . . . . . . . . . . C DELTAPRIM . . . . . . . . . . . . . . D NOROLON . . . . . . . . . . . . . . . . E QUININE . . . . . . . . . . . . . . . . . F OTHER___________________ X (SPECIFY) WE15 LAST BIRTH NAME _____________________ NEXT-TO-LAST BIRTH NAME _____________________ 412 When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small? VERY LARGE . . . . . . . . . . . . . . 1 LARGER THAN AVERAGE . . . 2 AVERAGE . . . . . . . . . . . . . . . . 3 SMALLER THAN AVERAGE . . 4 VERY SMALL . . . . . . . . . . . . . . 5 DON’T KNOW . . . . . . . . . . . . . 8 VERY LARGE . . . . . . . . . . . . . . . . . 1 LARGER THAN AVERAGE . . . . . . 2 AVERAGE . . . . . . . . . . . . . . . . . . . 3 SMALLER THAN AVERAGE . . . . . 4 VERY SMALL . . . . . . . . . . . . . . . . . 5 DON’T KNOW . . . . . . . . . . . . . . . . 8 413 Was (NAME) weighed at birth? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 415)=)))))))1 DON’T KNOW . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 415)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 414 How much did (NAME) weigh? RECORD WEIGHT FROM HEALTH CARD OR MOTHER’S CARD, IF AVAILABLE. GRAMS FROM+)))0)))0)))0))), CARD . . 1 *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- GRAMS FROM+)))0)))0)))0))), RECALL 2 *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- DON’T KNOW . . . . . . . . . 99998 GRAMS FROM +)))0)))0)))0))), CARD . . . . . 1 *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- GRAMS FROM +)))0)))0)))0))), RECALL . . . 2 *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- DON’T KNOW . . . . . . . . . . . . 99998 415 Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . B TRADITIONAL MIDWIFE TRAINED . . . . . . . . . . . . . . C UNTRAINED . . . . . . . . . . . . D TRAINING UNCERTAIN . . . E OTHER________________ X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . Y (SKIP TO 417)=)))))))- HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . B TRADITIONAL MIDWIFE TRAINED . . . . . . . . . . . . . . . . . C UNTRAINED . . . . . . . . . . . . . . . D TRAINING UNCERTAIN . . . . . . E OTHER________________ X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . . . Y (SKIP TO 417)=)))))))- 416 Where did you give birth to (NAME)? HOME YOUR HOME . . . . . . . . . . 11 (SKIP TO 418A)=)))))))1 OTHER HOME . . . . . . . . . 12 PUBLIC SECTOR CENTRAL HOSPITAL . . . . 21 PROVINCIAL HOSPITAL . 22 DIST/RURAL HOSPITAL . 23 RURAL HEALTH CENTRE 24 (SKIP TO 418A)=)))))))1 RURAL/MUNICIPAL CLC . 25 OTHER PUBLIC _________________26 (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . 31 OTHER PVT. MEDICAL____________ 36 (SPECIFY) MISSION FACILITY . . . . . . . . 41 OTHER___________________ 96 (SPECIFY) (SKIP TO 418A)=)))))))- HOME YOUR HOME . . . . . . . . . . . . . 11 (SKIP TO 418A)=)))))))1 OTHER HOME . . . . . . . . . . . . 12 PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . 21 PROVINCIAL HOSPITAL . . . . 22 DIST/RURAL HOSPITAL . . . . 23 RURAL HEALTH CENTRE . . . 24 (SKIP TO 418A)=)))))))1 RURAL/MUNICIPAL CLC . . . . 25 OTHER PUBLIC _________________26 (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . . . . 31 OTHER PVT. MEDICAL____________ . 36 (SPECIFY) MISSION FACILITY . . . . . . . . . . . 41 OTHER___________________ 96 (SPECIFY) (SKIP TO 418A)=)))))))- 417 Was (NAME) delivered by caesarian section? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 418A After (NAME) was born, did anyone check on your health? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 419)=)))))))- YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 420)=)))))))- WE16 LAST BIRTH NAME _____________________ NEXT-TO-LAST BIRTH NAME _____________________ 418B How many days or weeks after the delivery did the first check take place? RECORD ‘00' DAYS IF SAME DAY. +)))0))), DAYS AFTER DEL 1 *!!!*!!!* /)))3)))1 WEEKS AFTER DEL2 *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . 998 418C Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON. HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . 1 NURSE/MIDWIFE . . . . . . . . 2 TRADITIONAL MIDWIFE TRAINED . . . . . . . . . . . . . . 3 UNTRAINED . . . . . . . . . . . . 4 TRAINING UNCERTAIN . . . 5 OTHER________________ 6 (SPECIFY) 418D Where did this first check take place? HOME YOUR HOME . . . . . . . . . . 11 OTHER HOME . . . . . . . . . 12 PUBLIC SECTOR CENTRAL HOSPITAL . . . . 21 PROVINCIAL HOSPITAL . 22 DIST/RURAL HOSPITAL . 23 RURAL HEALTH CENTRE 24 RURAL/MUNICIPAL CLC . 25 OTHER PUBLIC _________________26 (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . 31 PRIVATE DOCTOR . . . . . 32 OTHER PVT. MEDICAL____________ 36 (SPECIFY) MISSION FACILITY . . . . . . . . 41 OTHER___________________ 96 (SPECIFY) 419 Has your period returned since the birth of (NAME)? YES . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 421)=)))))))- NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 422)=)))))))- 420 Did your period return between the birth of (NAME) and your next pregnancy? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 424)=)))))))- 421 For how many months after the birth of (NAME) did you not have a period? +)))0))), MONTHS . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . 98 +)))0))), MONTHS . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . . . . 98 422 CHECK 227: RESPONDENT PREGNANT? NOT +)), PREGNANT +)), PREG- /))- OR UNSURE .))1 NANT ? (SKIP TO 424)=))- 423 Have you resumed sexual relations since the birth of (NAME)? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 425)=)))))))- WE17 LAST BIRTH NAME _____________________ NEXT-TO-LAST BIRTH NAME _____________________ 424 For how many months after the birth of (NAME) did you not have sexual relations? +)))0))), MONTHS . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . 98 +)))0))), MONTHS . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . . . . 98 425 Did you ever breastfeed (NAME)? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 431)=)))))))- YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 431)=)))))))- 426 How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, RECORD ‘00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. IMMEDIATELY . . . . . . . . . . . 000 +)))0))), HOURS . . . . . . . . . 1 *!!!*!!!* /)))3)))1 DAYS . . . . . . . . . . 2 *!!!*!!!* .)))2)))- IMMEDIATELY . . . . . . . . . . . . . . 000 +)))0))), HOURS . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 DAYS . . . . . . . . . . . . . 2 *!!!*!!!* .)))2)))- 427 CHECK 404: CHILD ALIVE? ALIVE +)), DEAD +)), /))- .))1 ? (SKIP TO 429)=))- ALIVE +)), DEAD +)), /))- .))1 ? (SKIP TO 429)=))- 428 Are you still breastfeeding (NAME)? YES . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 432)=)))))))- NO . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 432)=)))))))- NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 429 For how many months did you breastfeed (NAME)? +)))0))), MONTHS . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . 98 +)))0))), MONTHS . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . . . . 98 431 CHECK 404: CHILD ALIVE? ALIVE +)), /))- * * * * * ? (SKIP TO 434) DEAD +)), /))- ? (GO BACK TO 404 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440) ALIVE +)), /))- * * * * * ? (SKIP TO 434) DEAD +)), /))- ? (GO BACK TO 404 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440) 432 How many times did you breastfeed last night between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. NUMBER OF +)))0))), NIGHTTIME FEEDINGS*!!!*!!!* .)))2)))- NUMBER OF +)))0))), NIGHTTIME FEEDINGS *!!!*!!!* .)))2)))- 433 How many times did you breastfeed yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. NUMBER OF +)))0))), DAYLIGHT FEEDINGS*!!!*!!!* .)))2)))- NUMBER OF +)))0))), DAYLIGHT FEEDINGS . *!!!*!!!* .)))2)))- 434 Did (NAME) drink anything from a bottle with a teat yesterday or last night? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . 8 WE18 LAST BIRTH NAME _____________________ NEXT-TO-LAST BIRTH NAME _____________________ 437 Now I would like to ask you about the types of foods [NAME] has been fed over the last seven days, including yesterday. How many days during last seven days was [NAME] given each of the following? FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, ASK: How many times yesterday or last night was [NAME] given [ITEM]? A. Plain water? B. Commercially prepared baby formula? C. Fresh cow or goat milk? D. Any other milk such as tinned or powdered milk? E. Fruit juice? F. Any other liquids such as glucose water, tea, herbal teas/roots, or mahewu? G. Any other foods made from grains such as sadza, bread, porridge or thin gruel? H. Pumpkin, squash, sweet potatoes, or carrots? I. Potatoes or other food made from tubers? J. Any green leafy vegetables? K. Mango or pawpaw? L. Beans, groundnuts, or peanut butter? M. Any other fruits and vegetables such as oranges, bananas or tomatoes? N. Meat, poultry, fish, or eggs? O. Cheese or yogurt? IF 7 OR MORE TIMES, RECORD ‘7'. IF DON’T KNOW, RECORD ‘8'. LAST 7 DAYS NUMBER OF DAYS +))), A *!!!* /)))1 B *!!!* /)))1 C *!!!* /)))1 D *!!!* *!!!* /)))1 E *!!!* /)))1 F *!!!* *!!!* /)))1 G *!!!* /)))1 *!!!* H *!!!* /)))1 *!!!* I *!!!* /)))1 J *!!!* /)))1 K *!!!* /)))1 L *!!!* /)))1 M *!!!* *!!!* /)))1 N *!!!* /)))1 O *!!!* .)))- YESTERDAY/ LAST NIGHT NUMBER OF TIMES +))), A *!!!* /)))1 B *!!!* /)))1 C *!!!* /)))1 D *!!!* *!!!* /)))1 E *!!!* /)))1 F *!!!* *!!!* /)))1 G *!!!* /)))1 *!!!* H *!!!* /)))1 *!!!* I *!!!* /)))1 J *!!!* /)))1 K *!!!* /)))1 L *!!!* /)))1 M *!!!* *!!!* /)))1 N *!!!* /)))1 O *!!!* .)))- LAST 7 DAYS NUMBER OF DAYS +))), A *!!!* /)))1 B *!!!* /)))1 C *!!!* /)))1 D *!!!* *!!!* /)))1 E *!!!* /)))1 F *!!!* *!!!* /)))1 G *!!!* /)))1 *!!!* H *!!!* /)))1 *!!!* I *!!!* /)))1 J *!!!* /)))1 K *!!!* /)))1 L *!!!* /)))1 M *!!!* *!!!* /)))1 N *!!!* /)))1 O *!!!* .)))- YESTERDAY/ LAST NIGHT NUMBER OF TIMES +))), A *!!!* /)))1 B *!!!* /)))1 C *!!!* /)))1 D *!!!* *!!!* /)))1 E *!!!* /)))1 F *!!!* *!!!* /)))1 G *!!!* /)))1 *!!!* H *!!!* /)))1 *!!!* I *!!!* /)))1 J *!!!* /)))1 K *!!!* /)))1 L *!!!* /)))1 M *!!!* *!!!* /)))1 N *!!!* /)))1 O *!!!* .)))- 438 How many times was (NAME) fed solid or semi-solid (mashed or pureed) food yesterday or last night? IF 7 OR MORE TIMES, RECORD ‘7'. +))), NUMBER OF TIMES . . . . *!!!* .)))- DON’T KNOW . . . . . . . . . . . . . 8 +))), NUMBER OF TIMES . . . . . . . *!!!* .)))- DON’T KNOW . . . . . . . . . . . . . . . . 8 439 GO BACK TO 404A IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440. GO BACK TO 404A IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440. WE19 SECTION 4B. IMMUNIZATION AND HEALTH 440 ENTER THE NAME AND LINE NUMBER OF EACH LIVING CHILD BORN SINCE JANUARY 1994 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE CHILDREN. BEGIN WITH THE YOUNGEST CHILD. (IF THERE ARE MORE THAN 2 LIVING CHILDREN, USE ADDITIONAL QUESTIONNAIRES). 441 LINE NUMBER FROM Q212 LAST BIRTH +)))0))), LINE NUMBER . . . . . . . . *!!!*!!!* .)))2)))- NEXT-TO-LAST BIRTH +)))0))), LINE NUMBER . . . . . . . *!!!*!!!* .)))2)))- 442 FROM Q212 AND Q216 NAME _____________________ NAME _____________________ ALIVE +)), /))- * * * * * * ? DEAD +)), /))- ? (GO TO 442 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 464A) ALIVE +)), /))- * * * * * * ? DEAD +)), /))- ? (GO TO 442 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 464A) 443 Do you have a card where (NAME’S) vaccinations are written down? IF YES: May I see it please? YES, SEEN . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 445)=)))))))- YES, NOT SEEN . . . . . . . . . . . . . . 2 (SKIP TO 447)=)))))))- NO CARD . . . . . . . . . . . . . . . . . . . . 3 YES, SEEN . . . . . . . . . . . . . . . . . . 1 (SKIP TO 445)=)))))))- YES, NOT SEEN . . . . . . . . . . . . . 2 (SKIP TO 447)=)))))))- NO CARD . . . . . . . . . . . . . . . . . . . 3 444 Did you ever have a vaccination card for (NAME)? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 447)=)))))))1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 447)=)))))))1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 445 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2) WRITE ‘44' IN ‘DAY’ COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. BCG POLIO 1 POLIO 2 POLIO 3 DPT 1 DPT 2 DPT 3 MEASLES DAY MONTH YEAR +)))0)))H)))0)))H)))0)))0)))0))), BCG*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 P1*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 P2*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 P3*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 D1*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 D2*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 D3*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 MEA*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* .)))2)))J)))2)))J)))2)))2)))2)))- DAY MONTH YEAR +)))0)))H)))0)))H)))0)))0)))0))), BCG*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 P1*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 P2*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 P3*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 D1*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 D2*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 D3*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* /)))3)))O)))3)))O)))3)))3)))3)))1 MEA*!!!*!!!5!!!*!!!5!!!*!!!*!!!*!!!* .)))2)))J)))2)))J)))2)))2)))2)))- WE20 LAST BIRTH NAME_____________________ NEXT-TO-LAST BIRTH NAME 446 Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign? RECORD ‘YES’ ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, DPT 1-3, AND/OR MEASLES VACCINE(S). YES . . . . . . . . . . . . . . . . . . . . . . . . 1 (PROBE FOR VACCINATIONS =)- AND WRITE ‘66' IN THE CORRESPONDING DAY COLUMN IN 445) ))))))), (SKIP TO 448H)=)))))))- NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 448H)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 (PROBE FOR VACCINATIONS =)- AND WRITE ‘66' IN THE CORRESPONDING DAY COLUMN IN 445) ))))))), (SKIP TO 448H)=)))))))- NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 448H)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 447 Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 449)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 449)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 448 Please tell me if (NAME) received any of the following vaccinations: 448A A BCG vaccination against tuberculosis, that is, an injection in the right arm or shoulder that caused a scar? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . 8 448B Polio vaccine, that is, drops in the mouth? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 448E)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 448E)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 448D How many times was the polio vaccine received? +))), NUMBER OF TIMES . . . . . . . *!!!* .)))- +))), NUMBER OF TIMES . . . . . . *!!!* .)))- 448E DPT vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 448G)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 448G)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 448F How many times? +))), NUMBER OF TIMES . . . . . . . *!!!* .)))- +))), NUMBER OF TIMES . . . . . . *!!!* .)))- 448G An injection to prevent measles? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . 8 448H Were any of the vaccinations (NAME) received during the last two years given as a part of a national immunization day campaign? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . 8 449 Has (NAME) been ill with a fever at any time in the last 2 weeks? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . 8 450 Has (NAME) had an illness with a cough at any time in the last 2 weeks? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 451A)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 451A)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 451 When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . 8 451A CHECK 449 AND 450: FEVER OR COUGH? “YES” IN 449 OR 450 +)), /))- ? OTHER +)), /))- * ? (SKIP TO 454) “YES” IN 449 OR 450 +)), /))- ? OTHER +)), /))- * ? (SKIP TO 454) 452 Did you seek advice or treatment for the illness? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 454)=)))))))- YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 454)=)))))))- LAST BIRTH NAME_____________________ NEXT-TO-LAST BIRTH NAME WE21 453 Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED. PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . . A PROVINCIAL HOSPITAL . . . . . . B DIST/RURAL HOSPITAL . . . . . . C RURAL HEALTH CENTRE . . . . . D RURAL/MUNICIPAL CLC . . . . . . E VILLAGE COMM WORKER . . . . F OTHER PUBLIC __________________G (SPECIFY) MISSION FACILITY . . . . . . . . . . . . H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . . . . . . . I PVT. DOCTOR . . . . . . . . . . . . . . J PHARMACY . . . . . . . . . . . . . . . . K VILLAGE COMM. WORKER . . . . L OTHER PVT. MEDICAL____________ . . M (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . N TRAD. PRACTITIONER . . . . . . O OTHER__________________ X (SPECIFY) PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . A PROVINCIAL HOSPITAL . . . . . B DIST/RURAL HOSPITAL . . . . . C RURAL HEALTH CENTRE . . . . D RURAL/MUNICIPAL CLC . . . . . E VILLAGE COMM WORKER . . . F OTHER PUBLIC __________________G (SPECIFY) MISSION FACILITY . . . . . . . . . . . H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . . . . . . I PVT. DOCTOR . . . . . . . . . . . . . J PHARMACY . . . . . . . . . . . . . . . K VILLAGE COMM. WORKER . . . L OTHER PVT. MEDICAL____________ . M (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . N TRAD. PRACTITIONER . . . . . O OTHER__________________ X (SPECIFY) 453A CHECK 449: HAD FEVER? “YES” IN 449 +)), /))- * * ? “NO”/”DK” in 449 +)), /))- ? (SKIP TO 454) “YES” IN 449 +)), /))- * * ? “NO”/”DK” IN 449 +)), /))- ? (SKIP TO 454) 453B Did (NAME) take any antimalarial drugs for the fever? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 454)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 454)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 453C What drug was that? RECORD ALL MENTIONED. PARACETAMOL . . . . . . . . . . . . . . A ASPIRIN . . . . . . . . . . . . . . . . . . . . . B FANSIDAR . . . . . . . . . . . . . . . . . . . C CHLOROQUINE . . . . . . . . . . . . . . D DELTAPRIM . . . . . . . . . . . . . . . . . E NOROLON . . . . . . . . . . . . . . . . . . F OTHER____________________X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . Z PARACETAMOL . . . . . . . . . . . . . A ASPIRIN . . . . . . . . . . . . . . . . . . . . B FANSIDAR . . . . . . . . . . . . . . . . . . C CHLOROQUINE . . . . . . . . . . . . . D DELTAPRIM . . . . . . . . . . . . . . . . E NOROLON . . . . . . . . . . . . . . . . . F OTHER____________________X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . Z 454 Has (NAME) had diarrhea in the last 2 weeks? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 464)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 464)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 457 When (NAME) had diarrhea, was he/she given less than usual to drink, about the same amount, or more than usual to drink? LESS . . . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . . . 2 MORE . . . . . . . . . . . . . . . . . . . . . . . 3 DON’T KNOW . . . . . . . . . . . . . . . . 8 LESS . . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . . 2 MORE . . . . . . . . . . . . . . . . . . . . . . 3 DON’T KNOW . . . . . . . . . . . . . . . 8 458 Was he/she given less than usual to eat, about the same amount, or more than usual to eat? LESS . . . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . . . 2 MORE . . . . . . . . . . . . . . . . . . . . . . . 3 DON’T KNOW . . . . . . . . . . . . . . . . 8 LESS . . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . . 2 MORE . . . . . . . . . . . . . . . . . . . . . . 3 DON’T KNOW . . . . . . . . . . . . . . . 8 459 Was he/she given any of the following to drink: A sugar-salt-water solution (SSS)? Any other liquid? YES NO DK SSS. . . . . . . . . . . . 1 2 8 OTHER LIQUID. . . 1 2 8 YES NO DK SSS. . . . . . . . . . . . 1 2 8 OTHER LIQUID. . . 1 2 8 460 Was anything (else) given to treat the diarrhea? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 462)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 462)=)))))))1 DON’T KNOW . . . . . . . . . . . . . . . 8 WE22 LAST BIRTH NAME______________________ NEXT-TO-LAST BIRTH NAME_____________________ _ 461 What was given to treat the diarrhea? Anything else? RECORD ALL MENTIONED. PILL OR SYRUP . . . . . . . . . . . A INJECTION . . . . . . . . . . . . . . . . B (I.V.) INTRAVENOUS . . . . . . . . C HOME REMEDIES/ HERBAL MEDICINES . . . . . D OTHER ___________________ X (SPECIFY) PILL OR SYRUP . . . . . . . . . . A INJECTION . . . . . . . . . . . . . . . B (I.V.) INTRAVENOUS . . . . . . . C HOME REMEDIES/ HERBAL MEDICINES . . . . D OTHER ___________________ X (SPECIFY) 462 Did you seek advice or treatment for the diarrhea? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 464)=)))))))- YES . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 464)=)))))))- 463 Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED. PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . A PROVINCIAL HOSPITAL . . . B DIST/RURAL HOSPITAL . . . C RURAL HEALTH CENTRE . . D RURAL/MUNICIPAL CLC . . . E VILLAGE COMM WORKER . F OTHER PUBLIC __________________G (SPECIFY) MISSION FACILITY . . . . . . . . . H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . . . . I PVT. DOCTOR . . . . . . . . . . . J PHARMACY . . . . . . . . . . . . . K VILLAGE COMM. WORKER . L OTHER PVT. MEDICAL____________ M (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . N TRAD. PRACTITIONER . . . . O OTHER__________________ X (SPECIFY) PUBLIC SECTOR CENTRAL HOSPITAL . . . . . A PROVINCIAL HOSPITAL . . B DIST/RURAL HOSPITAL . . C RURAL HEALTH CENTRE . D RURAL/MUNICIPAL CLC . . E VILLAGE COMM WORKER F OTHER PUBLIC __________________G (SPECIFY) MISSION FACILITY . . . . . . . . H PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . . . I PVT. DOCTOR . . . . . . . . . . J PHARMACY . . . . . . . . . . . . K VILLAGE COMM. WORKER L OTHER PVT. MEDICAL____________ M (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . N TRAD. PRACTITIONER . . . O OTHER__________________ X (SPECIFY) 464 GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 464A. GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 464A. WE23 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 464A CHECK 442, ALL COLUMNS: NUMBER OF LIVING CHILDREN BORN SINCE JANUARY 1994 ONE OR +))), NONE +))), MORE /)))- .)))2))))))))))))))))))))))))))))))))))))))))))) ? )))<470 464B The last time you fed your children, did you wash your hands immediately before feeding them? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEVER FED CHILDREN . . . . . . . . . . . 3 464C The last time you had to clean (your child/one of your children) after (he/she) defecated, did you wash your hands immediately afterwards? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEVER CLEANED CHILDREN . . . . . . 3 464D What usually happens with your child(ren)’s stools when they do not use any toilet facility? ALWAYS USE TOILET/LATRINE . . . 01 DISPOSED OF IN TOILET/LATRINE . 02 DISPOSED OF OUTSIDE DWELLING 03 DISPOSED OF OUTSIDE YARD . . . . 04 BURY IN THE YARD . . . . . . . . . . . . . 05 WASHED AWAY . . . . . . . . . . . . . . . . 06 NOT DISPOSED OF . . . . . . . . . . . . . 07 OTHER_________________________96 (SPECIFY) 469 CHECK 459, ALL COLUMNS: NO CHILD +))), ANY CHILD +))), RECEIVED SSS /)))- RECEIVED SSS .)))2))))))))))))))))))))))))))))))))))))))))) ? ))<470A 470 Have you ever heard of a special solution prepared using sugar and salt and water that is used for the treatment of diarrhea? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 470A CHECK 218: HAS ONE OR MORE +))), HAS NO CHILDREN +))), CHILDREN LIVING /)))- LIVING WITH HER .)))2))))))))))))))))) WITH HER ? )<470C 470B When (your child/one of your children) is seriously ill, can you decide by yourself whether the child should be taken for medical treatment? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DEPENDS . . . . . . . . . . . . . . . . . . . . . . 3 470C Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem, or no problem for you? Knowing where to go. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Getting permission to go. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Getting money needed for treatment. . . . . . . . . . . . . . . . . . . . . . . . . . Not having a health facility nearby. . . . . . . . . . . . . . . . . . . . . . . . . . . . Having to take transport. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not wanting to go alone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Concern that there may not be a female health provider. . . . . . . . . . . Fear of verbal abuse by health provider . . . . . . . . . . . . . . . . . . . . . . . . BIG SMALL NO PROBLEM PROBLEM PROBLEM 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 470D Do you currently smoke cigarettes or tobacco? IF YES: What type of tobacco do you smoke? YES, CIGARETTES . . . . . . . . . . . . . . . A YES, PIPE . . . . . . . . . . . . . . . . . . . . . . B YES, OTHER TOBACCO . . . . . . . . . . . C NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . E ))<470F 470E In the last 24 hours, how many times did you smoke? +)))0))), TIMES . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 470F The last time you prepared a meal for your family, before starting, did you wash your hands? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEVER PREPARED MEALS . . . . . . . . 3 WE24 SECTION 5. MARRIAGE AND SEXUAL ACTIVITY . NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 502 Are you currently married or living with a man? YES, CURRENTLY MARRIED . . . . . . . 1 YES, LIVING WITH A MAN . . . . . . . . . 2 NO, NOT IN UNION . . . . . . . . . . . . . . . 3 )), ))2<507 504 Have you ever been married or lived with a man? YES, FORMERLY MARRIED . . . . . . . . 1 YES, LIVED WITH A MAN . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ))<506 ))<511 505 ENTER ‘0’ IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 1994 ))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))<515 506 What is your marital status now: are you widowed, divorced, or separated? WIDOWED . . . . . . . . . . . . . . . . . . . . . . 1 DIVORCED . . . . . . . . . . . . . . . . . . . . . . 2 SEPARATED . . . . . . . . . . . . . . . . . . . . 3 )), ))3<511 ))- 507 Is your husband/partner living with you now or is he staying elsewhere? LIVING WITH HER . . . . . . . . . . . . . . . . 1 STAYING ELSEWHERE . . . . . . . . . . . 2 507A RECORD THE HUSBAND’S LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD ‘00'. +)))0))), *!!!*!!!* .)))2)))- 508 Besides yourself, how many wives does your husband have? +)))0))), NUMBER OF CO-WIVES . . . *!!!*!!!* .)))2)))- 511 Have you been married or lived with a man only once, or more than once? ONCE . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MORE THAN ONCE . . . . . . . . . . . . . . . 2 512 Now we will talk about your (first) husband/partner. In what month and year did you start living with him? +)))0))), MONTH . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW MONTH . . . . . . . . . . . 98 +)))0)))0)))0))), YEAR . . . . . . . . . . *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- DON’T KNOW YEAR . . . . . . . . . . . 9998 ))<514 513 How old were you when you started living with him? +)))0))), AGE . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 514 DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE JANUARY 1994. ENTER ‘X’ IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER ‘0' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 1994. FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS. FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS. 514A CHECK 502: NOT CURRENTLY MARRIED CURRENTLY +))), AND NOT CURRENTLY +))), MARRIED OR /)))- LIVING WITH A MAN .)))2)))))))))))))))))) LIVING WITH A MAN ? ))<515 514B CHECK 314/314A: ANY CODE +))), NOT ASKED +))), CIRCLED /)))- (NO CODE CIRCLED) .)))2)))))))))))))))))) ? ))<515 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE25 514C You have told me that you are using contraception. Would you say that using contraception is mainly your decision, mainly your husband’s/partner’s decision or did you both decide together? RESPONDENT . . . . . . . . . . . . . . . . . . . 1 HUSBAND/PARTNER . . . . . . . . . . . . . 2 JOINT DECISION . . . . . . . . . . . . . . . . . 3 OTHER_________________________6 (SPECIFY) 515 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)? NEVER . . . . . . . . . . . . . . . . . . . . . . . . 00 +)))0))), AGE IN YEARS . . . . . . . . . . *!!!*!!!* .)))2)))- FIRST TIME WHEN MARRIED . . . . . 96 ))<525 517 When was the last time you had sexual intercourse? +)))0))), DAYS AGO . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS AGO . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS AGO . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS AGO . . . . . . . . . . 4 *!!!*!!!* .)))2)))- ))<525 518 The last time you had sexual intercourse, was a condom used? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<519 518A What was the main reason you used a condom on that occasion? OWN CONCERN PREVENT STD/HIV 1 OWN CONCERN TO PREVENT PREGNANCY . . . . . . . . . . . . . . . . . . . 2 OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY . . . . . . . . 3 DID NOT TRUST PARTNERS/FEELS PARTNER HAS OTHER PARTNERS . 4 PARTNER INSISTED . . . . . . . . . . . . . . 5 OTHER_________________________ 6 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . 8 519 What is your relationship to the man with whom you last had sex? IF “GIRLFRIEND OR FIANCEE”, ASK “the last time you had sex with this partner, were you living with him?” IF “YES”, RECORD ‘1' IF “NO. RECORD ‘2' SPOUSE/COHABITING PARTNER . . . 1 GIRL FRIEND/FIANCEE . . . . . . . . . . . 2 OTHER FRIEND . . . . . . . . . . . . . . . . . . 3 CASUAL ACQUAINTANCE . . . . . . . . . 4 COMMERCIAL SEX WORKER . . . . . . 5 RELATIVE . . . . . . . . . . . . . . . . . . . . . . 6 OTHER _________________________7 (SPECIFY) )))<520 519A How long have you had a sexual relationship with this man? +)))0))), DAYS . . . . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS . . . . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS . . . . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- 520 Have you had sex with anyone else in the last 12 months? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<525 522 The last time you had sexual intercourse with this other man, was a condom used? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<523 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE26 522A What was the main reason you used a condom on that occasion? OWN CONCERN PREVENT STD/HIV 1 OWN CONCERN TO PREVENT PREGNANCY . . . . . . . . . . . . . . . . . . . 2 OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY . . . . . . . . 3 DID NOT TRUST PARTNERS/FEELS PARTNER HAS OTHER PARTNERS . 4 PARTNER INSISTED . . . . . . . . . . . . . . 5 OTHER _________________________6 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . 8 523 What is your relationship to this man? IF “GIRLFRIEND OR FIANCEE”, ASK “the last time you had sex with this partner, were you living with him?” IF “YES”, RECORD ‘1' IF “NO. RECORD ‘2' SPOUSE/COHABITING PARTNER . . . 1 GIRL FRIEND/FIANCEE . . . . . . . . . . . 2 OTHER FRIEND . . . . . . . . . . . . . . . . . . 3 CASUAL ACQUAINTANCE . . . . . . . . . 4 COMMERCIAL SEX WORKER . . . . . . 5 RELATIVE . . . . . . . . . . . . . . . . . . . . . . 6 OTHER_________________________7 (SPECIFY) )))<524 523A How long have you had a sexual relationship with this man? +)))0))), DAYS . . . . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS . . . . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS . . . . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- 524 Altogether, with how many different men have you had sex in the last 12 months? +)))0))), NUMBER OF PARTNERS . . *!!!*!!!* .)))2)))- 525 Do you know of a place where one can get condoms? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<527 526 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _______________________________________________ (NAME OF PLACE) PUBLIC SECTOR GOVERNMENT HOSP./CLINIC . . . . 11 RURAL/MUNICIPAL CLINIC . . . . . . . 12 RURAL HEALTH CENTRE . . . . . . . . 13 ZNFPC (FIXED) CLINIC . . . . . . . . . . 14 ZNFPC MOBILE CLINIC . . . . . . . . . . 15 MOH MOBILE CLINIC . . . . . . . . . . . 16 ZNFPC CBD . . . . . . . . . . . . . . . . . . . 17 MOH CBD . . . . . . . . . . . . . . . . . . . . . 18 OTHER PUBLIC _________________19 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . 31 PHARMACY . . . . . . . . . . . . . . . . . . . 32 PRIVATE DOCTOR . . . . . . . . . . . . . 33 CBD . . . . . . . . . . . . . . . . . . . . . . . . . . 34 OTHER PRIVATE MEDICAL____________________ 36 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . 41 CHURCH . . . . . . . . . . . . . . . . . . . . . . 42 FRIENDS/RELATIVES . . . . . . . . . . . 43 OTHER_________________________96 (SPECIFY) 526A If you wanted to, could you yourself easily get a condom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW/UNSURE . . . . . . . . . . . 8 527 Do you know of a place where one can get female condoms? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<601 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE27 528 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _______________________________________________ (NAME OF PLACE) PUBLIC SECTOR GOVERNMENT HOSP./CLINIC . . . . 11 RURAL/MUNICIPAL CLINIC . . . . . . . 12 RURAL HEALTH CENTRE . . . . . . . . 13 ZNFPC (FIXED) CLINIC . . . . . . . . . . 14 ZNFPC MOBILE CLINIC . . . . . . . . . . 15 MOH MOBILE CLINIC . . . . . . . . . . . 16 ZNFPC CBD . . . . . . . . . . . . . . . . . . . 17 MOH CBD . . . . . . . . . . . . . . . . . . . . . 18 OTHER PUBLIC _________________19 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . 31 PHARMACY . . . . . . . . . . . . . . . . . . . 32 PRIVATE DOCTOR . . . . . . . . . . . . . 33 CBD . . . . . . . . . . . . . . . . . . . . . . . . . . 34 OTHER PRIVATE MEDICAL____________________ 36 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . 41 CHURCH . . . . . . . . . . . . . . . . . . . . . . 42 FRIENDS/RELATIVES . . . . . . . . . . . 43 OTHER_________________________96 (SPECIFY) 528A If you wanted to, could you yourself easily get a female condom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW/UNSURE . . . . . . . . . . . 8 WE28 SECTION 6. FERTILITY PREFERENCES NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 601 CHECK 314/314A: NEITHER +))), HE OR SHE +))), STERILIZED /)))- STERILIZED .)))2))))))))))))))))))))))))))))))))))))))))))) ? )))<612 602 CHECK 227: NOT PREGNANT +))), OR UNSURE /)))- * ? Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children? PREGNANT +))), /)))- * ? Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children? HAVE (A/ANOTHER) CHILD . . . . . . . . 1 NO MORE/NONE . . . . . . . . . . . . . . . . . 2 SAYS SHE CAN’T GET PREGNANT . . 3 UNDECIDED/DON’T KNOW AND PREGNANT . . . . . . . . . . . . . . . 8 AND NOT PREGNANT . . . . . . . . . . . 8 )))<604 )))<606 ) )<605 )))<606 603 CHECK 227: NOT PREGNANT +))), OR UNSURE /)))- * ? How long would you like to wait from now before the birth of (a/another) child? PREGNANT +))), /)))- * ? After the birth of the child you are expecting now, how long would you like to wait before the birth of another child? +)))0))), MONTHS . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . . . . . 2 *!!!*!!!* .)))2)))- SOON/NOW . . . . . . . . . . . . . . . . . . . 993 SAYS SHE CAN’T GET PREGNANT 994 AFTER MARRIAGE . . . . . . . . . . . . . 995 OTHER________________________ 996 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . 998 ), * * *)<606 * * )- 604 CHECK 227: NOT PREGNANT +))), PREGNANT +))), OR UNSURE /)))- .)))2))))))))))))))))))))))))))))))))))))))))) ? )))<608 604A CHECK 313: USING A METHOD? NOT NOT +))), CURRENTLY +))), CURRENTLY +))), ASKED /)))- USING /)))- USING .)))2)))))))))))))))))))))))))) ? ? )))<605 604B CHECK 603: NOT +))), 24 OR MORE MONTHS +))), 0-23 MONTHS +))), ASKED /)))- OR 02 OR MORE YEARS /)))- OR 01 YEAR .)))2))))))))))))))))))))))))))) ? ? )<608 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE29 604C CHECK 602: WANTS +)), A/ANOTHER CHILD /))- ? You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why? RECORD ALL MENTIONED. WANTS NO (MORE) +)), CHILDREN /))- ? You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why? NOT MARRIED . . . . . . . . . . . . . . . . . . . A FERTILITY-RELATED REASONS NOT HAVING SEX . . . . . . . . . . . . . . B INFREQUENT SEX . . . . . . . . . . . . . C MENOPAUSAL/HYSTERECTOMY. D SUBFECUND/INFECUND . . . . . . . . E POSTPARTUM AMENORRHEIC . . . F BREASTFEEDING . . . . . . . . . . . . . G FATALISTIC . . . . . . . . . . . . . . . . . . H OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . I HUSBAND OPPOSED . . . . . . . . . . . J OTHERS OPPOSED . . . . . . . . . . . . K RELIGIOUS PROHIBITION . . . . . . . L LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . M KNOWS NO SOURCE . . . . . . . . . . N METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . O FEAR OF SIDE EFFECTS . . . . . . . . P LACK OF ACCESS/TOO FAR . . . . Q COST TOO MUCH . . . . . . . . . . . . . R INCONVENIENT TO USE . . . . . . . . . S INTERFERES WITH BODY’S NATURAL PROCESSES . . . . . . . . T OTHER__________________________ X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 605 In the next few weeks, if you discovered that you were pregnant, would it be a big problem, a small problem, or no problem for you? BIG PROBLEM . . . . . . . . . . . . . . . . . . . 1 SMALL PROBLEM . . . . . . . . . . . . . . . . 2 NO PROBLEM . . . . . . . . . . . . . . . . . . . . 3 SAYS SHE CAN’T GET PREGNANT . . 4 606 CHECK 313: USING A METHOD? NOT NOT +))), CURRENTLY +))), CURRENTLY +))), ASKED /)))- USING /)))- USING .)))2)))))))))))))))))))))))))) ? ? )))<612 608 Do you think you will use a method to delay or avoid pregnancy at any time in the future? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 )), ))2<610 609 Which method would you prefer to use? FEMALE STERILIZATION . . . . . . . . . 01 MALE STERILIZATION . . . . . . . . . . . . 02 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 INJECTIONS . . . . . . . . . . . . . . . . . . . . 05 IMPLANTS . . . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . . . 08 DIAPHRAGM . . . . . . . . . . . . . . . . . . . . 09 FOAM/JELLY . . . . . . . . . . . . . . . . . . . . 10 LACT. AMEN. METHOD . . . . . . . . . . . 11 PERIODIC ABSTINENCE . . . . . . . . . . 12 WITHDRAWAL . . . . . . . . . . . . . . . . . . 13 OTHER___________________________ 96 (SPECIFY) UNSURE . . . . . . . . . . . . . . . . . . . . . . . 98 ), * * * * * /<612 * * * * * * * * * )- NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE30 610 What is the main reason that you think you will not use a method at any time in the future? NOT CURRENTLY MARRIED . . . . . . 11 FERTILITY-RELATED REASONS INFREQUENT SEX . . . . . . . . . . . . 22 MENOPAUSAL/HYSTERECTOMY 23 SUBFECUND/INFECUND . . . . . . . 24 WANTS AS MANY CHILDREN AS POSSIBLE . . . 26 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . 31 HUSBAND OPPOSED . . . . . . . . . 32 OTHERS OPPOSED . . . . . . . . . . . 33 RELIGIOUS PROHIBITION . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . 41 KNOWS NO SOURCE . . . . . . . . . 42 METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . . . . . . 52 LACK OF ACCESS/TOO FAR . . . 53 COST TOO MUCH . . . . . . . . . . . . 54 INCONVENIENT TO USE . . . . . . . 55 INTERFERES WITH BODY’S NORMAL PROCESSES . . . . . 56 OTHER_________________________ 96 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . 98 ), * * * * * * * * * * * * /<612 * * * * * * * * * * * * * )- 611 Would you ever use a method if you were married? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . 8 612 CHECK 216: HAS LIVING CHILDREN +)), /))- ? If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? NO LIVING CHILDREN +)), /))- ? If you could choose exactly the number of children to have in your whole life, how many would that be? +)))0))), NUMBER . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- OTHER_________________________ 96 (SPECIFY) )))<614 PROBE FOR A NUMERIC RESPONSE. 613 How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter? BOYS +)))0))), NUMBER . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- OTHER________________________ 96 (SPECIFY) GIRLS +)))0))), NUMBER . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- OTHER________________________ 96 (SPECIFY) EITHER +)))0))), NUMBER . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- OTHER_________________________ 96 (SPECIFY) 614 Would you say that you approve or disapprove of couples using a method to delay or avoid getting pregnant? APPROVE . . . . . . . . . . . . . . . . . . . . . . 1 DISAPPROVE . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW/UNSURE . . . . . . . . . . . 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE31 616 In the last few months have you heard about family planning: On the radio? On the television? In a newspaper or magazine? YES NO RADIO . . . . . . . . . . . . . . . . . . . 1 2 TELEVISION . . . . . . . . . . . . . . 1 2 NEWSPAPER OR MAGAZINE 1 2 618 In the last few months, have you discussed the practice of family planning with your friends, neighbours, or relatives? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<620 619 With whom? Anyone else? RECORD ALL MENTIONED. HUSBAND/PARTNER . . . . . . . . . . . . . A MOTHER . . . . . . . . . . . . . . . . . . . . . . . B FATHER . . . . . . . . . . . . . . . . . . . . . . . . C SISTER(S) . . . . . . . . . . . . . . . . . . . . . . D BROTHER(S) . . . . . . . . . . . . . . . . . . . . E DAUGHTER . . . . . . . . . . . . . . . . . . . . . F SON . . . . . . . . . . . . . . . . . . . . . . . . . . . G MOTHER-IN-LAW . . . . . . . . . . . . . . . . H FRIENDS/NEIGHBOURS . . . . . . . . . . . . I OTHER__________________________ X (SPECIFY) 620 CHECK 502: YES, +))), YES, +))), NO, +))), CURRENTLY /)))- LIVING /)))- NOT IN .)))2))))))))))))))))))))))))))))))))))))))))))) MARRIED ? WITH A MAN ? UNION )))<623A 621 Husbands and wives do not always agree on everything. Now I want to ask you about your husband’s/partner’s views on family planning. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy? APPROVES . . . . . . . . . . . . . . . . . . . . . 1 DISAPPROVES . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . 8 622 How often have you talked to your husband/partner about family planning in the past year? NEVER . . . . . . . . . . . . . . . . . . . . . . . . . 1 ONCE OR TWICE . . . . . . . . . . . . . . . . 2 MORE OFTEN . . . . . . . . . . . . . . . . . . . 3 623 Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want? SAME NUMBER . . . . . . . . . . . . . . . . . . 1 MORE CHILDREN . . . . . . . . . . . . . . . . 2 FEWER CHILDREN . . . . . . . . . . . . . . . 3 DON’T KNOW . . . . . . . . . . . . . . . . . . . 8 623A Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when: She is tired or not in the mood? . . . . . . . . . . . . . . . . . . . . . . . . . . . . She has recently given birth? . . . . . . . . . . . . . . . . . . . . . . . . . . . . She knows he has sex with women other than his wife (wives)?. . . . She knows he has the AIDS virus? . . . . . . . . . . . . . . . . . . . . . . . . . YES NO DK TIRED/MOOD . . . . . . . 1 2 8 RECENT BIRTH . . . . . 1 2 8 OTHER WOMEN . . . . 1 2 8 HAS THE AIDS VIRUS 1 2 8 WE32 SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 701 CHECK 502 AND 504: CURRENTLY +))), FORMERLY +)))0)))))))))))))))))))))))))))))))))))))))))))))))))))) MARRIED/ /)))- MARRIED/ .)))- LIVING WITH * LIVED WITH NEVER MARRIED +))), A MAN ? A MAN AND NEVER .)))2))))))))))))))))) LIVED WITH A MAN ))<703 ) ))<709 702 How old was your husband/partner on his last birthday? +)))0))), AGE IN COMPLETED YEARS *!!!*!!!* .)))2)))- 703 Did your (last) husband/partner ever attend school? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<706 704 What was the highest level of school he attended: primary, secondary, or higher? PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . 1 SECONDARY . . . . . . . . . . . . . . . . . . . . . 2 HIGHER . . . . . . . . . . . . . . . . . . . . . . . . . 3 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 ))<706 705 What was the highest (grade/form/year) he completed at that level? +)))0))), GRADE . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW . . . . . . . . . . . . . . . . . . . 98 706 CHECK 701: CURRENTLY MARRIED/ LIVING WITH A MAN +))), /)))- ? What is your husband’s/partner’s occupation? That is, what kind of work does he mainly do? FORMERLY MARRIED/ LIVED WITH A MAN +))), /)))- ? What was your (last) husband’s/ partner’s occupation? That is, what kind of work did he mainly do? +)))0))), *!!!*!!!* __________________________.)))2)))- __________________________ __________________________ 709 Aside from your own housework, are you currently working? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<712 710 As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things or any other work? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<712 711 Have you done any work in the last 12 months? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<723A 712 What is your occupation, that is, what kind of work do you mainly do? +)))0))), *!!!*!!!* __________________________.)))2)))- __________________________ __________________________ 713 CHECK 712: WORKS IN +))), DOES NOT WORK +))), AGRICULTURE /)))- IN AGRICULTURE .)))2))))))))))))))))))))))))))))))))))))))))))) ? )--))<715 714 Do you work mainly on your own land, do you work on communal land, or do you rent land, or work on someone else's land? OWN/FAMILY LAND . . . . . . . . . . . . . . . 1 COMMUNAL/RESETTLEMENT . . . . . . . 2 RENTED LAND . . . . . . . . . . . . . . . . . . . 3 SOMEONE ELSE'S LAND . . . . . . . . . . . 4 715 Do you do this work for a member of your family, for someone else, or are you self-employed? FOR FAMILY MEMBER . . . . . . . . . . . . . 1 FOR SOMEONE ELSE . . . . . . . . . . . . . 2 SELF-EMPLOYED . . . . . . . . . . . . . . . . . 3 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP WE33 716 Do you usually work throughout the year, or do you work seasonally, or only once in a while? THROUGHOUT THE YEAR . . . . . . . . . . 1 SEASONALLY/PART OF THE YEAR . . 2 ONCE IN A WHILE . . . . . . . . . . . . . . . . . 3 720 Are you paid in cash or kind for this work or are you not paid at all? CASH ONLY . . . . . . . . . . . . . . . . . . . . . . 1 CASH AND KIND . . . . . . . . . . . . . . . . . . 2 IN KIND ONLY . . . . . . . . . . . . . . . . . . . . 3 NOT PAID . . . . . . . . . . . . . . . . . . . . . . . . 4 )), ))2<723 720A Who mainly decides how the money you earn will be used? RESPONDENT . . . . . . . . . . . . . . . . . . . 1 HUSBAND/PARTNER . . . . . . . . . . . . . . 2 RESPONDENT AND HUSBAND/PARTNER JOINTLY . . . 3 SOMEONE ELSE . . . . . . . . . . . . . . . . . . 4 RESPONDENT AND SOMEONE ELSE JOINTLY . . . . . . . . . . . . . . . . . . . . . . 5 722A On average, how much of your household’s expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all? ALMOST NONE . . . . . . . . . . . . . . . . . . . 1 LESS THAN HALF . . . . . . . . . . . . . . . . . 2 ABOUT HALF . . . . . . . . . . . . . . . . . . . . . 3 MORE THAN HALF . . . . . . . . . . . . . . . . 4 ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 NONE, HER INCOME IS ALL SAVED. . 6 723 Do you usually work at home or away from home? HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 AWAY . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 723A Who in your family usually has the final say on the following decisions: Your own health? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Large household purchases?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Daily household purchases? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Visits to family, friends, or relatives? . . . . . . . . . . . . . . . . . . . . . . . . . . What food should be cooked each day?. . . . . . . . . . . . . . . . . . . . . . . . RESPONDENT = 1 HUSBAND/PARTNER = 2 RESPONDENT & HUSBAND/PARTNER JOINTLY = 3 SOMEONE ELSE = 4 RESPONDENT & SOMEONE ELSE JOINTLY = 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 728A PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING OR NOT PRESENT) PRS/ PRS/ NOT LISTN. NOT PRS LISTN CHILDREN <10 . . . . 1 2 8 HUSBAND . . . . . . . . 1 2 8 OTHER MALES . . . . 1 2 8 OTHER FEMALES . . 1 2 8 728B Sometimes a husband is annoyed or angered by things which his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations: If she goes out without telling him?. . . . . . . . . . . . . . . . . . . . . . . . . . . . If she neglects the children? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If she argues with him? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If she refuses sex with him? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If she burns the food? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO DK GOES OUT . . . . . . . . 1 2 8 NEGL. CHILDREN . . 1 2 8 ARGUES . . . . . . . . . 1 2 8 REFUSES SEX . . . . 1 2 8 BURNS FOOD . . . . . 1 2 8 WE34 SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 801 Now I would like to talk about something else. Have you ever heard of an illness called AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<816 802 Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 )), ))2<810 803 What can a person do? Anything else? RECORD ALL MENTIONED. ABSTAIN FROM SEX . . . . . . . . . . . . . . A USE CONDOMS . . . . . . . . . . . . . . . . . . B LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER . . C LIMIT NUMBER OF SEXUAL PARTNERS . . . . . . . . . D AVOID SEX WITH PROSTITUTES . . . E AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS . . . . . . . . F AVOID SEX WITH HOMOSEXUALS . G AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVEN . . . . . H AVOID BLOOD TRANSFUSIONS . . . . I AVOID INJECTIONS . . . . . . . . . . . . . . J AVOID KISSING . . . . . . . . . . . . . . . . . . K AVOID MOSQUITO BITES . . . . . . . . . . L SEEK PROTECTION FROM TRADITIONAL HEALER . . . . . . . M AVOID SHARING RAZORS/BLADES N OTHER__________________________W (SPECIFY) OTHER__________________________ X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 804 CHECK 803: NEITHER CODE ‘C’ +))), CODE ‘C’ AND/OR +))), NOR CODE ‘D’ /)))- CODE ‘D’ CIRCLED .)))2)))))))))))))))))) CIRCLED ? )) )<807 805 In your view, is a person’s chance of getting AIDS influenced by the number of partners he or she has? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 )), ))2<807 806 If a person has sex with only one partner, does this person have a greater or a lesser chance of getting AIDS than a person who has sex with many partners? GREATER CHANCE OF AIDS . . . . . . . 1 LESSER CHANCE OF AIDS . . . . . . . . . 2 807 CHECK 803: DID NOT MENTION MENTIONED USE OF A USE OF A CONDOM +))), CONDOM DURING SEX +))), DURING SEX /)))- (CODE ‘B’ CIRCLED) .)))2))))))))))))))))) (CODE ‘B’ NOT CIRCLED) * ? )) )<810 808 In your view, is a person’s chance of getting AIDS affected by using a condom every time he or she has sexual intercourse? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UNSURE/DON’T KNOW . . . . . . . . . . . . 8 )), ))2<810 809 If a person uses a condom every time he or she is engaged in sexual intercourse, does this person have a greater or a lesser chance of getting AIDS than someone who doesn’t use a condom? GREATER CHANCE OF AIDS . . . . . . . 1 LESSER CHANCE OF AIDS . . . . . . . . . 2 810 Is it possible for a healthy-looking person to have the AIDS virus? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 811 Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WE35 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 812 Can the virus that causes AIDS be transmitted from a mother to a child? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . 8 )), ))2<813 812A When can the virus that causes AIDS be transmitted from a mother to a child? Any other times? RECORD ALL RESPONSES DURING PREGNANCY . . . . . . . . . . . A AT DELIVERY . . . . . . . . . . . . . . . . . . B DURING BREASTFEEDING . . . . . . . C OTHER TIMES. . . . . . . . . . . . . . . . . . D DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 813 CHECK 502: CURRENTLY MARRIED/ NOT CURRENTLY MARRIED/ LIVING WITH A MAN NOT LIVING WITH A MAN +)), +)), /))- .))2)))))))))))))))) ? ))<814A 814 Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 814A In your opinion, is it acceptable or unacceptable for AIDS to be discussed: on the radio? on the TV? In newspapers? ACCEPTABLE UNACCEPT RADIO . . . . . . . . . . 1 2 TELEVISION . . . . . 1 2 NEWSPAPER . . . . . 1 2 815A If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community? CAN BE KEPT PRIVATE . . . . . . . . . . . . 1 AVAILABLE TO COMMUNITY . . . . . . . . 2 DK/NOT SURE . . . . . . . . . . . . . . . . . . . . 8 815B If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK/NOT SURE/DEPENDS . . . . . . . . . . 8 815C Should persons with the AIDS virus who work with other persons such as in a shop, office, or farm be allowed to continue their work or not? CAN CONTINUE WORK . . . . . . . . . . . . 1 SHOULD NOT CONTINUE WORK . . . . 2 DK/NOT SURE/DEPENDS . . . . . . . . . . 8 815D Should children aged 12-14 be taught about using a condom to avoid AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK/NOT SURE/DEPENDS . . . . . . . . . . 8 815E Have you ever been tested to see if you have the AIDS virus? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )<815HX 815F Would you want to be tested for the AIDS virus? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW/UNSURE . . . . . . . . . . . . 3 815G Do you know a place where you could go to get an AIDS test? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<816 WE36 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 815H 815HX Where can you go for the test? Where did you go for the test? Any other places? RECORD ALL MENTIONED. PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . . . . A PROVINCIAL HOSPITAL . . . . . . . . B DISTRICT HOSPITAL . . . . . . . . . . . C RURAL HEALTH CENTRE . . . . . . . D RURAL/MUNICIPAL CLINIC . . . . . . E OTHER PUBLIC _________________ G (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . . H PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . I PRIVATE DOCTOR . . . . . . . . . . . . . J OTHER PRIVATE MEDICAL___________________ K (SPECIFY) TRADITIONAL HEALER . . . . . . . . . . . . L OTHER_________________________ X (SPECIFY) 816 (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<901 817 In a man, what signs and symptoms would lead you to think that he has such an infection? Any others? RECORD ALL MENTIONED. ABDOMINAL PAIN . . . . . . . . . . . . . . . . A GENITAL DISCHARGE/DRIPPING . . . B FOUL SMELLING DISCHARGE . . . . . C BURNING PAIN ON URINATION . . . . D REDNESS/INFLAMMATION IN GENITAL AREA . . . . . . . . . . . . . . . E SWELLING IN GENITAL AREA . . . . . . F GENITAL SORES/ULCERS . . . . . . . . G GENITAL WARTS . . . . . . . . . . . . . . . . H BLOOD IN URINE . . . . . . . . . . . . . . . . . I LOSS OF WEIGHT . . . . . . . . . . . . . . . J IMPOTENCE/STERLILITY . . . . . . . . . . K NO SIGNS/SYMPTOMS . . . . . . . . . . . . L OTHER__________________________W (SPECIFY) OTHER__________________________ X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 818 In a woman, what signs and symptoms would lead you to think that she has such an infection? Any others? RECORD ALL MENTIONED. ABDOMINAL PAIN . . . . . . . . . . . . . . . . A GENITAL DISCHARGE/DRIPPING . . . B FOUL SMELLING DISCHARGE . . . . . C BURNING PAIN ON URINATION . . . . D REDNESS/INFLAMMATION IN GENITAL AREA . . . . . . . . . . . . . . . E SWELLING IN GENITAL AREA . . . . . . F GENITAL SORES/ULCERS . . . . . . . . G GENITAL WARTS . . . . . . . . . . . . . . . . H BLOOD IN URINE . . . . . . . . . . . . . . . . . I LOSS OF WEIGHT . . . . . . . . . . . . . . . J INFERTILITY/STERILITY . . . . . . . . . . . K NO SIGN/SYMPTOMS . . . . . . . . . . . . . L OTHER__________________________W (SPECIFY) OTHER__________________________ X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 819 CHECK 515: HAS HAD SEXUAL HAS NOT HAD SEXUAL INTERCOURSE +))), INTERCOURSE +))), /)))- .)))2)))))))))))))))))))))))))) ? )) ))<901 WE37 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 820 Now I would like to ask some questions about your health in the last 12 months. During the last 12 months, have you had a sexually- transmitted disease? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . 8 820A Sometimes women experience a discharge from their vagina. During the last 12 months have you had a discharge from your vagina? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 820B Sometimes women experience a sore or ulcer in or near their vagina. During the last 12 months have you had a a sore or ulcer in or near your vagina? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 822 CHECK 820, 820A AND 820B: HAD STI DID NOT HAVE STI +)), +)), /))- .))2))))))))))))))))))))))))))) ? )<901 825 The last time you had (INFECTION FROM 820/820A/820B), did you seek advice or treatment? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<827 826 Where did you seek advice or treatment? RECORD ALL MENTIONED. PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . . . . . . . . . . . . . . A PROVINCIAL HOSPITAL . . . . . . . . . . . . . . . . . . B DISTRICT HOSPITAL . . . . . . . . . . . . . . . . . . . . C RURAL HEALTH CENTRE . . . . . . . . . . . . . . . . D RURAL/MUNICIPAL CLINIC . . . . . . . . . . . . . . . . E VILLAGE COMMUNITY WORKER . . . . . . . . . . . F OTHER PUBLIC _________________ G (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . . . . . . . . . H PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . . . . . . . . . . I PHARMACY . . . . . . . . . . . . . . . . . . . . . . . . . . . . J PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . . . . . K VILLAGE COMMUNITY WORKER . . . . . . . . . . . L OTHER PRIVATE MEDICAL____________________ M (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N RELATIVE/FRIENDS . . . . . . . . . . . . . . . . . . . . O TRADITIONAL HEALER . . . . . . . . . . . . . . . . . . . P OTHER______________________ X (SPECIFY) 827 When you had (INFECTION FROM 820/820A/820B), did you inform the persons with whom you have been having sex? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SOME/ NOT ALL . . . . . . . . . . . . . . . . . . . . . . . . 3 828 When you had (INFECTION FROM 820/820A/820B) did you do something to avoid infecting your sexual partner(s)? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PARTNER ALREADY INFECTED . . . . . . . . . . . 3 )), ))2<901 829 What did you do? Anything else? RECORD ALL RESPONSES STOPPED SEXUAL INTERCOURSE . . . . . . . . . . A USED CONDOMS . . . . . . . . . . . . . . . . . . . . . . . . . B TOOK MEDICINES . . . . . . . . . . . . . . . . . . . . . . . C OTHER_________________________________ X (SPECIFY) WE38 SECTION 9. MATERNAL MORTALITY NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 901 Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you? NUMBER OF BIRTHS +)))0))), TO NATURAL MOTHER . . . *!!!*!!!* .)))2)))- 902 CHECK 901: +))), +))), /)))- ONLY ONE BIRTH .)))2)))))))))))))))))))))))))))))))))) TWO OR MORE BIRTHS ? (RESPONDENT ONLY) ))<916 903 How many of these births did your mother have before you were born? NUMBER OF +)))0))), PRECEDING BIRTHS . . . . . *!!!*!!!* .)))2)))- 904 What was the name given to your oldest (next oldest) brother or sister? [1] [2] [3] [4] [5] [6] 905 Is (NAME) male or female? MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 906 Is (NAME) still alive? YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [2] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [3] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [4] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [5] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [6] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [7] 907 How old is (NAME)? +)))0))), *!!!*!!!* .)))2)))- GO TO [2] +)))0))), *!!!*!!!* .)))2)))- GO TO [3] +)))0))), *!!!*!!!* .)))2)))- GO TO [4] +)))0))), *!!!*!!!* .)))2)))- GO TO [5] +)))0))), *!!!*!!!* .)))2)))- GO TO [6] +)))0))), *!!!*!!!* .)))2)))- GO TO [7] 908 In what year did (NAME) die? 1 9 1 9 1 9 1 9 1 9 1 9 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 909 How many years ago did (NAME) die? +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- 910 How old was (NAME) when he/she died? +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [2] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [3] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [4] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [5] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [6] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [7] 911 Was (NAME) pregnant when she died? YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 912 Did (NAME) die during childbirth? YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 913 Did (NAME) die within 2 months after the end of a pregnancy or childbirth? YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 915 How many children did (NAME) give birth to during her lifetime? +)))0))), *!!!*!!!* .)))2)))- GO TO [2] +)))0))), *!!!*!!!* .)))2)))- GO TO [3] +)))0))), *!!!*!!!* .)))2)))- GO TO [4] +)))0))), *!!!*!!!* .)))2)))- GO TO [5] +)))0))), *!!!*!!!* .)))2)))- GO TO [6] +)))0))), *!!!*!!!* .)))2)))- GO TO [7] IF NO MORE BROTHERS OR SISTERS, GO TO 916 WE39 904 What was name given to your oldest (next oldest) brother or sister? [7] [8] [9] [10] [11] [12] 905 Is (NAME) male or female? MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 MALE . . . . . 1 FEMALE . . . 2 906 Is (NAME) still alive? YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [8] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [9] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [10] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [11] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [12] YES . . . . . . 1 NO . . . . . . . 2 .)<GO TO 908 DK . . . . . . . . 8 .)<GO TO [13] 907 How old is (NAME)? +)))0))), *!!!*!!!* .)))2)))- GO TO [8] +)))0))), *!!!*!!!* .)))2)))- GO TO [9] +)))0))), *!!!*!!!* .)))2)))- GO TO [10] +)))0))), *!!!*!!!* .)))2)))- GO TO [11] +)))0))), *!!!*!!!* .)))2)))- GO TO [12] +)))0))), *!!!*!!!* .)))2)))- GO TO [13] 908 In what year did (NAME) die? 1 9 1 9 1 9 1 9 1 9 1 9 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 GO TO 910=)- DK . . . . . 9998 909 How many years ago did (NAME) die? +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- 910 How old was (NAME) when he/she died? +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [8] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [9] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [10] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [11] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [12] +)))0))), *!!!*!!!* .)))2)))- IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [13] 911 Was (NAME) pregnant when she died? YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 912 Did (NAME) die during childbirth? YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 YES . . . . . . 1 GO TO 915=)- NO . . . . . . . 2 913 Did (NAME) die within two months after the end of a pregnancy or childbirth? YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 YES . . . . . . 1 NO . . . . . . . 2 915 How many children did (NAME) give birth to during her lifetime? +)))0))), *!!!*!!!* .)))2)))- GO TO [8] +)))0))), *!!!*!!!* .)))2)))- GO TO [9] +)))0))), *!!!*!!!* .)))2)))- GO TO [10] +)))0))), *!!!*!!!* .)))2)))- GO TO [11] +)))0))), *!!!*!!!* .)))2)))- GO TO [12] +)))0))), *!!!*!!!* .)))2)))- GO TO [13] IF NO MORE BROTHERS OR SISTERS, GO TO 916 916 RECORD THE TIME. +)))0))), HOURS . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- +)))0))), MINUTES . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- WE40 INTERVIEWER’S OBSERVATIONS TO BE FILLED IN AFTER COMPLETING INTERVIEW COMMENTS ABOUT RESPONDENT: COMMENTS ON SPECIFIC QUESTIONS: ANY OTHER COMMENTS: SUPERVISOR’S OBSERVATIONS NAME OF THE SUPERVISOR:______________________________________ DATE: __________________________ EDITOR’S OBSERVATIONS NAME OF EDITOR:__________________________________________________ DATE:_______________________________ WE41 INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN. INFORMATION TO BE CODED FOR EACH COLUMN COL.1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE B BIRTHS P PREGNANCIES T TERMINATIONS 0 NO METHOD 1 FEMALE STERILIZATION 2 MALE STERILIZATION 3 PILL 4 IUD 5 INJECTIONS 6 IMPLANTS 7 CONDOM 8 FEMALE CONDOM 9 DIAPHRAGM F FOAM OR JELLY L LACTATIONAL AMENORRHEA METHOD A PERIODIC ABSTINENCE W WITHDRAWAL X OTHER ____________________ (SPECIFY) COL 2: SOURCE OF CONTRACEPTION 1 GOVT. HOSPITAL/CLINIC 2 GOVT. RURAL/MUNICIPAL CLINIC 3 GOVT. RURAL HEALTH CENTRE 4 ZNFPC FIXED CLINIC 5 ZNFPC MOBILE CLINIC 6 MOH MOBILE CLINIC 7 ZNFPC CBD 8 MOH CBD 9 OTHER PUBLIC A MISSION FACILITY B PVT. HOSPITAL/CLINIC C PHARMACY D PRIVATE DOCTOR E PRIVATE CBD/FIELD WORKER F OTHER PRIVATE MEDICAL G SHOP H CHURCH I FRIENDS/RELATIVES X OTHER_____________________ (SPECIFY) COL 3: DISCONTINUATION OF CONTRACEPTIVE USE 0 INFREQUENT SEX/HUSBAND AWAY 1 BECAME PREGNANT WHILE USING 2 WANTED TO BECOME PREGNANT 3 HUSBAND DISAPPROVED 4 WANTED MORE EFFECTIVE METHOD 5 HEALTH CONCERNS 6 SIDE EFFECTS 7 LACK OF ACCESS/TOO FAR 8 COST TOO MUCH 9 INCONVENIENT TO USE F FATALISTIC A DIFFICULT TO GET PREGNANT/MENOPAUSAL D MARITAL DISSOLUTION/SEPARATION X OTHER ________________________ (SPECIFY) Z DON’T KNOW COL.4: MARRIAGE/UNION X IN UNION (MARRIED OR LIVING TOGETHER) 0 NOT IN UNION TERMINATION OF LAST NON-LIVE BIRTH PREGNANCY PRIOR TO JANUARY 1994 IF NO PREVIOUS NON-LIVE BIRTH PREGNANCY, RECORD ‘00' FOR MONTH AND ‘0000' FOR YEAR +)))0))), MONTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* +)))0)))3)))3)))1 YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- 1 2 3 4 12 DEC 01 01 DEC 11 NOV 02 02 NOV 10 OCT 03 03 OCT 09 SEP 04 04 SEP 1 08 AUG 05 05 AUG 1 9 07 JUL 06 06 JUL 9 9 06 JUN 07 07 JUN 9 9 05 MAY 08 08 MAY 9 04 APR 09 09 APR 03 MAR 10 10 MAR 02 FEB 11 11 FEB 01 JAN 12 12 JAN 12 DEC 13 13 DEC 11 NOV 14 14 NOV 10 OCT 15 15 OCT 09 SEP 16 16 SEP 1 08 AUG 17 17 AUG 1 9 07 JUL 18 18 JUL 9 9 06 JUN 19 19 JUN 9 8 05 MAY 20 20 MAY 8 04 APR 21 21 APR 03 MAR 22 22 MAR 02 FEB 23 23 FEB 01 JAN 24 24 JAN 12 DEC 25 25 DEC 11 NOV 26 26 NOV 10 OCT 27 27 OCT 09 SEP 28 28 SEP 1 08 AUG 29 29 AUG 1 9 07 JUL 30 30 JUL 9 9 06 JUN 31 31 JUN 9 7 05 MAY 32 32 MAY 7 04 APR 33 33 APR 03 MAR 34 34 MAR 02 FEB 35 35 FEB 01 JAN 36 36 JAN 12 DEC 37 37 DEC 11 NOV 38 38 NOV 10 OCT 39 39 OCT 09 SEP 40 40 SEP 1 08 AUG 41 41 AUG 1 9 07 JUL 42 42 JUL 9 9 06 JUN 43 43 JUN 9 6 05 MAY 44 44 MAY 6 04 APR 45 45 APR 03 MAR 46 46 MAR 02 FEB 47 47 FEB 01 JAN 48 48 JAN 12 DEC 49 49 DEC 11 NOV 50 50 NOV 10 OCT 51 51 OCT 09 SEP 52 52 SEP 1 08 AUG 53 53 AUG 1 9 07 JUL 54 54 JUL 9 9 06 JUN 55 55 JUN 9 5 05 MAY 56 56 MAY 5 04 APR 57 57 APR 03 MAR 58 58 MAR 02 FEB 59 59 FEB 01 JAN 60 60 JAN 12 DEC 61 61 DEC 11 NOV 62 62 NOV 10 OCT 63 63 OCT 09 SEP 64 64 SEP 1 08 AUG 65 65 AUG 1 9 07 JUL 66 66 JUL 9 9 06 JUN 67 67 JUN 9 4 05 MAY 68 68 MAY 4 04 APR 69 69 APR 03 MAR 70 70 MAR 02 FEB 71 71 FEB 01 JAN 72 72 JAN ME1 1999 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY MEN’S QUESTIONNAIRE IDENTIFICATION NAME OF HOUSEHOLD HEAD WARD NAME CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROVINCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (URBAN=1, RURAL=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LARGE CITY/SMALL CITY/TOWN/RURAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (LARGE CITY=1, SMALL CITY=2, TOWN=3, RURAL=4) NAME AND LINE NUMBER OF MAN +)))0)))0))), *!!!*!!!*!!!* .)))3)))3)))1 *!!!*!!!* .)))3)))1 *!!!* /)))1 *!!!* /)))1 *!!!* +)))3)))1 *!!!*!!!* .)))2)))- INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE INTERVIEWER’S NAME RESULT* +)))0))), DAY *!!!*!!!* /)))3)))1 MONTH *!!!*!!!* +)))0)))3)))3)))1 YEAR*!!!*!!!*!!!*!!!* .)))2)))3)))3)))1 NAME *!!!*!!!* .)))3)))1 RESULT *!!!* .)))- NEXT VISIT: DATE TOTAL NO. OF VISITS +))), *!!!* .)))-TIME *RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER ___________________________ (SPECIFY) LANGUAGE OF QUESTIONNAIRE: ENGLISH +))), *!3!* .)))- LANGUAGE OF SHONA = 1; NDEBELE = 2; ENGLISH = 3; OTHER = 4 INTERVIEW: +))), *!!!* .)))- SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY NAME +)))0))), *!!!*!!!* .)))2)))- NAME +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))- +)))0))), *!!!*!!!* .)))2)))-DATE DATE ME2 SECTION 1. RESPONDENT’S BACKGROUND INTRODUCTION AND CONSENT Hello. My name is ________________ and I am working with the Central Statistical Office. We are conducting a national survey about the health of women, men, and children. We would very much appreciate your participation in this survey. I would like to ask you about your health and that of your children. This information may help the country plan health services. Whatever answers you provide will be confidential and will not be shown to other persons. We hope you will participate in this survey since your views are important. Shall we proceed with the interview? RESPONDENT AGREES TO BE RESPONDENT DOES NOT AGREE . . . . . . . . . . 2 ))< END INTERVIEWED . . . . . . . . . . . 1 9 I HAVE READ THE ABOVE STATEMENT TO THE RESPONDENT AND HE HAS AGREED TO BE INTERVIEWED. SIGNATURE OF INTERVIEWER_______________________________________________________ NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 RECORD THE TIME. +)))0))), HOUR . . . . . . . . . . . . . . . *!!!*!!!* /)))3)))1 MINUTES . . . . . . . . . . . . *!!!*!!!* .)))2)))- 102 First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, on a commercial farm or in another rural area? CITY . . . . . . . . . . . . . . . . . . . . . . . . 1 TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 COMMERCIAL FARM . . . . . . . . . . 3 OTHER RURAL . . . . . . . . . . . . . . . 4 103 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD ‘00' YEARS. +)))0))), YEARS . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- ALWAYS . . . . . . . . . . . . . . . . . . . . 95 VISITOR . . . . . . . . . . . . . . . . . . . . 96 )), ))2<105 104 Just before you moved here, did you live in a city, in a town, on a commercial farm or in another rural area? CITY . . . . . . . . . . . . . . . . . . . . . . . . 1 TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 COMMERCIAL FARM . . . . . . . . . . 3 OTHER RURAL . . . . . . . . . . . . . . . 4 105 In what month and year were you born? +)))0))), MONTH . . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW MONTH . . . . . . . . 98 +)))0)))0)))0))), YEAR . . . . . . . *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- DON’T KNOW YEAR . . . . . . . . 9998 106 How old were you at your last birthday? COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. AGE IN COMPLETED +)))0))), YEARS . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 107 Have you ever attended school? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<114 108 What is the highest level of school you attended: primary, secondary, or higher? PRIMARY . . . . . . . . . . . . . . . . . . . . 1 SECONDARY . . . . . . . . . . . . . . . . . 2 HIGHER . . . . . . . . . . . . . . . . . . . . . 3 109 What is the highest (grade/form/year) you completed at that level? +)))0))), GRADE/FORM . . . . . . . . *!!!*!!!* .)))2)))- 113 CHECK 108: PRIMARY +))), SECONDARY +))), /)))- OR HIGHER .)))2))))))))))))))))))))))))))))))))))))))))) ? )))<115 114 Can you read and understand a letter or newspaper easily, with difficulty, or not at all? EASILY . . . . . . . . . . . . . . . . . . . . . . 1 WITH DIFFICULTY . . . . . . . . . . . . . 2 NOT AT ALL . . . . . . . . . . . . . . . . . . 3 )))<116 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP ME3 115 Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY . . . . . . . . . . 1 AT LEAST ONCE A WEEK . . . . . . 2 LESS THAN ONCE A WEEK . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . 4 116 Do you listen to the radio almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY . . . . . . . . . . 1 AT LEAST ONCE A WEEK . . . . . . 2 LESS THAN ONCE A WEEK . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . 4 117 Do you watch television almost every day, at least once a week, less than once a week or not at all? ALMOST EVERY DAY . . . . . . . . . . 1 AT LEAST ONCE A WEEK . . . . . . 2 LESS THAN ONCE A WEEK . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . 4 118 What is your religion? TRADITIONAL . . . . . . . . . . . . . . . . 1 CHRISTIAN . . . . . . . . . . . . . . . . . . 2 MUSLIM . . . . . . . . . . . . . . . . . . . . . 3 NONE . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER_______________________6 (SPECIFY) 120 Have you ever drank an alcohol-containing beverage? YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<123 121 In the last 30 days, on how many days did you drink an alcohol- containing beverage? +)))0))), NUMBER OF DAYS . . . . . *!!!*!!!* .)))2)))- NONE/NEVER . . . . . . . . . . . . . . . . . 97 )))<123 122 In the last 30 days, on how many occasions did you get “drunk”? +)))0))), NUMBER OF TIMES . . . . . *!!!*!!!* .)))2)))- NONE/NEVER . . . . . . . . . . . . . . . . . 97 123 In the last 3 months, have you had any kind of injection? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<126 124 In the last 3 months, how many times did you have an injection? +)))0))), NUMBER OF INJECTIONS *!!!*!!!* .)))2)))- EVERY DAY . . . . . . . . . . . . . . . . . . . 98 124A What was the injection for? RECORD ALL RESPONSES. MEDICAL TREATMENT . . . . . . . . . A OTHER . . . . . . . . . . . . . . . . . . . . . . . B 125 The last time you had an injection, who was the person who gave you the injection? HEALTH PROFESSIONAL . . . . . . . . 1 PHARMACIST . . . . . . . . . . . . . . . . . . 2 TRADITIONAL HEALER . . . . . . . . . . 3 FRIEND/RELATIVE . . . . . . . . . . . . . . 4 SELF . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER -----------------------------------------6 (SPECIFY) 126 Are you currently working? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<201 127 What is your occupation, that is, what kind of work do you mainly do? +)))0))), *!!!*!!!* __________________________.)))2)))- __________________________ __________________________ ME4 SECTION 2: REPRODUCTION NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 Now I would like to ask about your children. I am interested only in the children that are biologically yours. Have you ever had children? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<206 202 Do you have any sons or daughters who are now living with you? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<204 203 How many sons live with you? And how many daughters live with you? IF NONE, RECORD ‘00'. +)))0))), SONS AT HOME . . . . . . . . *!!!*!!!* /)))3)))1 DAUGHTERS AT HOME . . *!!!*!!!* .)))2)))- 204 Do you have any sons or daughters who are alive but do not live with you? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<206 205 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE, RECORD ‘00'. +)))0))), SONS ELSEWHERE . . . . . *!!!*!!!* /)))3)))1 DAUGHTERS ELSEWHERE *!!!*!!!* .)))2)))- 206 Have you ever had a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<208 207 How many boys have died? And how many girls have died? IF NONE, RECORD ‘00'. +)))0))), BOYS DEAD . . . . . . . . . . . . *!!!*!!!* /)))3)))1 GIRLS DEAD . . . . . . . . . . . *!!!*!!!* .)))2)))- 208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD ‘00'. +)))0))), TOTAL . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- 209 CHECK 208: Just to make sure that I have this right: you have had in TOTAL _____ children during your life. Is that correct? +))), +))), PROBE AND YES /)))- NO .)))2))< CORRECT * 201-208 AS ? NECESSARY. ME5 SECTION 3. CONTRACEPTION Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 303. 301 Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)? 303 Have you ever used (METHOD)? 01 FEMALE STERILIZATION Women can have an operation to avoid having any more children. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? Have you ever had a partner who had an operation to avoid having any more children? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 02 MALE STERILIZATION Men can have an operation to avoid having any more children. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? Have you ever had an operation to avoid having children? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 03 PILL Women can take a pill every day YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 05 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 08 FEMALE CONDOM : Women can place a rubber sheath in their vagina before sexual intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 09 DIAPHRAGM Women can place a diaphragm in their vagina before intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 11 LACTATIONAL AMENORRHEA METHOD (LAM) Women can use a specially taught method of pregnancy avoidance to delay the return of the menstrual period by feeding their child nothing but breast milk for up to six months after a birth. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 13 WITHDRAWAL Men can be careful and pull out before climax. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 14 EMERGENCY CONTRACEPTION: Women can take pills the day after sexual intercourse to avoid becoming pregnant. YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? YES . . . . . . . . . . . . . . . . . . 1 _________________________ (SPECIFY) _________________________ (SPECIFY) NO . . . . . . . . . . . . . . . . . 2 ), ? YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 304 CHECK 303: NOT A SINGLE +))), AT LEAST ONE +))), “YES” /)))- “YES” .)))2))))))))))))))))))))))))))))))))))))))))))))< SKIP TO 313 (NEVER USED) ? (EVER USED) ME6 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 305 Have you or any of your partners ever used anything or tried in any way to delay or avoid getting pregnant? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<334 307 What have you used or done? CORRECT 303 AND 304 (AND 301 IF NECESSARY). 313 Are you or any of your partners currently doing something or using any method to delay or avoid getting pregnant? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<334 314 Which method are you using? IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD. FEMALE STERILIZATION . . . . . . . . A MALE STERILIZATION . . . . . . . . . . . B PILL . . . . . . . . . . . . . . . . . . . . . . . . . . C IUD . . . . . . . . . . . . . . . . . . . . . . . . . . D INJECTIONS . . . . . . . . . . . . . . . . . . . E IMPLANTS . . . . . . . . . . . . . . . . . . . . F CONDOM . . . . . . . . . . . . . . . . . . . . . G FEMALE CONDOM . . . . . . . . . . . . . H DIAPHRAGM . . . . . . . . . . . . . . . . . . . I FOAM/JELLY . . . . . . . . . . . . . . . . . . J LACT. AMEN. METHOD . . . . . . . . . . K PERIODIC ABSTINENCE . . . . . . . . . L WITHDRAWAL . . . . . . . . . . . . . . . . . M OTHER________________________ X (SPECIFY) ), * * * /<334 * * * * * * * )- 318 Where did the sterilization take place? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _____________________________________________________ (NAME OF PLACE) PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . . 11 PROVINCIAL HOSPITAL . . . . . . . 12 DISTRICT/RURAL HOSPITAL . . . 13 OTHER PUBLIC_______________ 16 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . 31 PRIVATE DOCTOR . . . . . . . . . . . 32 OTHER PRIVATE MEDICAL _________________36 (SPECIFY) OTHER________________________96 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . 98 318A Before the sterilization operation, were (you/your wife/your partner) told that you would not be able to have any (more) children? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 321 In what month and year was the sterilization performed? +)))0))), MONTH . . . . . . . . . . . . . . . *!!!*!!!* +)))0)))3)))3)))1 YEAR . . . . . . . . . *!1!*!9!*!!!*!!!* .)))2)))2)))2)))- 334 In the last 12 months, were you visited by a CBD who talked to you about family planning? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 335 In the last 12 months, have you attended a health facility for care for yourself (or your children)? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<401 336 Did any staff member at the health facility speak to you about family planning methods? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ME7 SECTION 4. MARRIAGE AND SEXUAL ACTIVITY NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 401 Are you currently married or living with a woman ? YES, CURRENTLY MARRIED . . . . . . . . 1 YES, LIVING WITH A WOMAN . . . . . . . 2 NO, NOT IN UNION . . . . . . . . . . . . . . . . 3 )))<403 )))<405 402 How many wives do you have? +)))0))), NUMBER OF WIVES . . . . . . . *!!!*!!!* .)))2)))- 403 How many (other) women are you living with as if you were married? RECORD ‘00' IF THE RESPONSE IS “NONE” +)))0))), NUMBER OF . . . . . . . . . . . . . *!!!*!!!* LIVE-IN PARTNERS .)))2)))- 404 WRITE THE NAMES AND LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE OR WIVES. IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE ‘00' IN THE LINE NUMBER BOX. THE NUMBER OF BOXES FILLED MUST BE EQUAL TO THE NUMBER OF WIVES. IF THE SUM OF 402 AND 403 IS ‘01' Please tell me the name of your wife/partner 1 __________________________________________________________ IF THE SUM OF 402 AND 403 IS ’02' OR MORE Please tell me the names of all your wives and live-in partners 1 __________________________________________________________ 2 __________________________________________________________ 3 __________________________________________________________ 4 __________________________________________________________ LINE NUMBER +)))0))), . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- +)))0))), . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- +)))0))), . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- +)))0))), . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- +)))0))), . . . . . . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- ))) , * * * * * * * * * /<408 * * * * * * - 405 Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all? REGULAR SEXUAL PARTNER . . . . . . . 1 OCCASIONAL SEXUAL PARTNER . . . . 2 NO SEXUAL PARTNER . . . . . . . . . . . . . 3 406 Have you ever been married or lived with a woman? YES, FORMERLY MARRIED . . . . . . . . . 1 YES, LIVED WITH A WOMAN . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 )))<408 )))<411 407 What is your marital status now: are you widowed, divorced or separated? WIDOWED . . . . . . . . . . . . . . . . . . . . . . . 1 DIVORCED . . . . . . . . . . . . . . . . . . . . . . . 2 SEPARATED . . . . . . . . . . . . . . . . . . . . . 3 408 Have you been married or lived with a woman only once, or more than once? ONCE . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MORE THAN ONCE . . . . . . . . . . . . . . . . 2 409 CHECK 408: MARRIED/LIVED +))), WITH A WOMAN .)))1 ONLY ONCE * ? In what month and year did you start living with your wife/partner? MARRIED/LIVED +))), WITH A WOMAN /)))- MORE THAN ONCE * ? Now we will talk about your first wife/partner. In what month and year did you start living with her? +)))0))), MONTH . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- DON’T KNOW MONTH . . . . . . . . . . . . 98 +)))0)))0)))0))), YEAR . . . . . . . . . . . *!!!*!!!*!!!*!!!* .)))2)))2)))2)))- DON’T KNOW YEAR . . . . . . . . . . . . 9998 )))<411 410 How old were you when you started living with her? +)))0))), AGE . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP ME8 411 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)? NEVER . . . . . . . . . . . . . . . . . . . . . . . . . 00 +)))0))), AGE . . . . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- FIRST TIME WHEN MARRIED . . . . . . 96 ))<437 412 When was the last time you had sexual intercourse? +)))0))), DAYS AGO . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS AGO . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS AGO . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS AGO . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- DO NOT REMEMBER . . . . . . . . . . . . 998 )<434 413 The last time you had sexual intercourse, did you use a condom? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 )<417 414 What was the main reason you used a condom on that occasion? OWN CONCERN TO PREVENT STD/HIV . . . . . . . . . . . . . . . . . . . . . . . . 1 OWN CONCERN TO PREVENT A PREGNANCY . . . . . . . . . . . . . . . . . . . . 2 OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY . . . . . . . . . 3 DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS . . . . . . . 4 PARTNER INSISTED . . . . . . . . . . . . . . . 5 OTHER__________________________ 6 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 417 What is your relationship to the woman with whom you last had sex? IF “BOYFRIEND OR FIANCE”, ASK “the last time you had sex with this partner, were you living with her?” IF “YES”, RECORD ‘1' IF “NO”, RECORD ‘2' SPOUSE/COHABITING PARTNER . . . . 1 BOYFRIEND/FIANCE . . . . . . . . . . . . . . 2 FRIEND/ACQUAINTANCE . . . . . . . . . . . 3 RELATIVE . . . . . . . . . . . . . . . . . . . . . . . 4 CUSTOMER (FOR SEX) . . . . . . . . . . . . 5 OTHER__________________________ 8 (SPECIFY) )))<419 418 How long have you had a sexual relationship with the woman you last had sex with? +)))0))), DAYS . . . . . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS . . . . . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS . . . . . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- 419 Have you had sex with anyone else in the last 12 months? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<434 420 The last time you had sexual intercourse with another woman, did you use a condom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )) <424 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP ME9 421 What was the main reason you used a condom on that occasion? OWN CONCERN TO PREVENT STD/HIV . . . . . . . . . . . . . . . . . . . . . . . . 1 OWN CONCERN TO PREVENT A PREGNANCY . . . . . . . . . . . . . . . . . . . . 2 OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY . . . . . . . . . 3 DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS . . . . . . . 4 PARTNER INSISTED . . . . . . . . . . . . . . . 5 OTHER__________________________ 6 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 424 What is your relationship to this woman? IF “BOYFRIEND OR FIANCE”, ASK “the last time you had sex with this partner, were you living with her?” IF “YES”, RECORD ‘1' IF “NO” RECORD ‘2' SPOUSE/COHABITING PARTNER . . . . 1 BOYFRIEND/FIANCE . . . . . . . . . . . . . . 2 FRIEND/ACQUAINTANCE . . . . . . . . . . . 3 RELATIVE . . . . . . . . . . . . . . . . . . . . . . . 4 CUSTOMER (FOR SEX) . . . . . . . . . . . . 5 OTHER___________________________ 8 (SPECIFY) )))<426 425 How long have you maintained a sexual relationship with this woman? +)))0))), DAYS . . . . . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS . . . . . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS . . . . . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- 426 Other than these two women, have you had sex with anyone else in the last 12 months? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<434 427 The last time you had sexual intercourse with this other woman, did you use a condom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW CONDOMS . . . . . . . 3 )), /<431 ))- 428 What was the main reason you used a condom on that occasion? OWN CONCERN TO PREVENT STD/HIV . . . . . . . . . . . . . . . . . . . . . . . . 1 OWN CONCERN TO PREVENT A PREGNANCY . . . . . . . . . . . . . . . . . . . . 2 OWN CONCERN TO PREVENT BOTH STD/HIV AND PREGNANCY . . . . . . . . . 3 DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS . . . . . . . 4 PARTNER INSISTED . . . . . . . . . . . . . . . 5 OTHER__________________________ 6 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP ME10 431 What is your relationship to this woman? IF “BOYFRIEND OR FIANCE”, ASK “the last time you had sex with this partner, were you living with her?” IF “YES”, RECORD ‘1' IF “NO” RECORD ‘2' SPOUSE/COHABITING PARTNER . . . . 1 BOYFRIEND/FIANCE . . . . . . . . . . . . . . 2 FRIEND/ACQUAINTANCE . . . . . . . . . . . 3 RELATIVE . . . . . . . . . . . . . . . . . . . . . . . 4 CUSTOMER (FOR SEX) . . . . . . . . . . . . 5 OTHER__________________________ 8 (SPECIFY) )))<433 432 How long have you maintained a sexual relationship with this woman? +)))0))), DAYS . . . . . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS . . . . . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS . . . . . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- DOES NOT REMEMBER . . . . . . . . . . 998 433 Altogether, with how many different women have you had sex in the last 12 months? +)))0))), NUMBER OF PARTNERS . . . *!!!*!!!* .)))2)))- 434 Have you ever paid for sex? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<437 435 How long ago was the last time you paid for sex? +)))0))), DAYS AGO . . . . . . . . . . . . . 1 *!!!*!!!* /)))3)))1 WEEKS AGO . . . . . . . . . . . 2 *!!!*!!!* /)))3)))1 MONTHS AGO . . . . . . . . . . 3 *!!!*!!!* /)))3)))1 YEARS AGO . . . . . . . . . . . 4 *!!!*!!!* .)))2)))- DOES NOT REMEMBER . . . . . . . . . . 998 436 The last time that you paid for sex, did you use a condom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 437 Do you know of a place where one can get condoms? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<440 ME11 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 438 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _______________________________________________ (NAME OF PLACE) PUBLIC SECTOR GOVERNMENT HOSP./CLINIC . . . . . 11 RURAL/MUNICIPAL CLINIC . . . . . . . . 12 RURAL HEALTH CENTRE . . . . . . . . . 13 ZNFPC FIXED CLINIC . . . . . . . . . . . . 14 ZNFPC MOBILE CLINIC . . . . . . . . . . . 15 MOH MOBILE CLINIC . . . . . . . . . . . . 16 ZNFPC CBD . . . . . . . . . . . . . . . . . . . . 17 MOH CBD . . . . . . . . . . . . . . . . . . . . . . 18 OTHER PUBLIC _________________ 19 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . . 31 PHARMACY . . . . . . . . . . . . . . . . . . . . 32 PRIVATE DOCTOR . . . . . . . . . . . . . . 33 CBD . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 OTHER PRIVATE MEDICAL____________________ 36 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . . 41 CHURCH . . . . . . . . . . . . . . . . . . . . . . . 42 FRIENDS/RELATIVES . . . . . . . . . . . . 43 OTHER_________________________ 96 (SPECIFY) 439 If you wanted to, could you yourself easily get a condom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW/UNSURE . . . . . . . . . . . . 8 440 Do you know of a place where one can get female condoms? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<501 441 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _______________________________________________ (NAME OF PLACE) PUBLIC SECTOR GOVERNMENT HOSP./CLINIC . . . . . 11 RURAL/MUNICIPAL CLINIC . . . . . . . . 12 RURAL HEALTH CENTRE . . . . . . . . . 13 ZNFPC FIXED CLINIC . . . . . . . . . . . . 14 ZNFPC MOBILE CLINIC . . . . . . . . . . . 15 MOH MOBILE CLINIC . . . . . . . . . . . . 16 ZNFPC CBD . . . . . . . . . . . . . . . . . . . . 17 MOH CBD . . . . . . . . . . . . . . . . . . . . . . 18 OTHER PUBLIC _________________ 19 (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . . 21 PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . . 31 PHARMACY . . . . . . . . . . . . . . . . . . . . 32 PRIVATE DOCTOR . . . . . . . . . . . . . . 33 CBD . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 OTHER PRIVATE MEDICAL____________________ 36 (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . . 41 CHURCH . . . . . . . . . . . . . . . . . . . . . . . 42 FRIENDS/RELATIVES . . . . . . . . . . . . 43 OTHER_________________________ 96 (SPECIFY) 442 If you wanted to, could you yourself easily get a female condom? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW/UNSURE . . . . . . . . . . . . 8 ME12 SECTION 5. FERTILITY PREFERENCES NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 501 CHECK 401: CURRENTLY NOT +))), CURRENTLY MARRIED OR +))), IN UNION /)))- LIVING WITH A WOMAN .)))2-))))))))))))))))))))))))))))) ? )))<503A 502 CHECK 405: NOT IN UNION BUT HAS ONLY AN OCCASIONAL HAS A REGULAR +))), SEXUAL PARTNER OR +))), SEXUAL PARTNER /)))- NO SEXUAL PARTNER .)))2))))))) ? )))<505A 503 CHECK 401 and 405: A HAS A WIFE OR LIVING WITH WOMAN +))), /)))- ? # Is your wife / the woman you are living with currently pregnant? # Are any of your wives/ any of the women your are living with currently pregnant? B HAS A REGULAR SEXUAL +))), PARTNER /)))- ? # Is your regular partner currently pregnant? # Is one of your regular partners currently pregnant? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DO NOT KNOW/UNSURE . . . . . . . . . . . . 8 )), /<505A ))- 504 When she became pregnant, did you want her to become pregnant then, did you want her to have a child but wanted to wait or did you not want her to have a child at all? THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 WANTED TO WAIT . . . . . . . . . . . . . . . . . 2 NOT AT ALL. . . . . . . . . . . . . . . . . . . . . . . 3 )), /<505B ))- 505 CHECK 503: A WIFE/PARTNER NOT PREGNANT +))), OR UNSURE, OR /)))- HAS NO * WIFE/*PARTNER ? Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children? B WIFE/PARTNER PREGNANT +))), /)))- * ? Now I have some questions about the future. After the child your wife/partner is expecting now, would you like to have another child, or would you prefer not to have any more children? HAVE (A/ANOTHER) CHILD . . . . 1 NO MORE/NONE . . . . . . . . . . . . . 2 SAYS WIFE CAN’T GET PREGNANT . . . . . . . . . . . . . . . . . 3 SAYS HE CAN’T HAVE ANY MORE4 UNDECIDED/DON’T KNOW . . . . 8 )), * * /<505B * * ))- 506 CHECK 503: WIFE/PARTNER NOT PREGNANT +))), OR UNSURE, OR /)))- HAS NO WIFE/ * PARTNER ? # How long would you like to wait to have a child? # How long would you like to wait to have another child? WIFE/PARTNER PREGNANT +))), /)))- * ? After the child your wife/partner is expecting, how long would you like to wait before the birth of another child? +)))0))), MONTHS . . . . . . . . . 1 *!!!*!!!* /)))3)))1 YEARS . . . . . . . . . . . 2 *!!!*!!!* .)))2)))- SOON/NOW . . . . . . . . . . . . . . . 993 SAYS WIFE CAN’T GET PREGNANT . . . . . . . . . . . . . . . 994 AFTER MARRIAGE . . . . . . . . . 995 OTHER___________________ 996 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . 998 507 CHECK 314: USING A METHOD NOT +))), NOT USING +))), CURRENTLY +))), ASKED /)))- CURRENTLY /)))- USING .)))2)))))))) ? ? )))<512 508 Do you think you will use a method to avoid pregnancies within the next 12 months? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . . 8 )))<510 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP ME13 509 Do you think you will use a method to avoid pregnancies at any time in the future? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . . 8 )), ))2<511 510 Which method would you prefer to use? FEMALE STERILIZATION . . . . . . . . . . . 01 MALE STERILIZATION . . . . . . . . . . . . . 02 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 INJECTIONS . . . . . . . . . . . . . . . . . . . . . 05 IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . . . . 08 DIAPHRAGM/FOAM/JELLY . . . . . . . . . . 09 LACTATIONAL AMENORRHEA . . . . . . 10 RHYTHM/PERIODIC ABSTINENCE . . . 11 WITHDRAWAL . . . . . . . . . . . . . . . . . . . . 12 OTHER___________________________ 96 (SPECIFY) UNDECIDED . . . . . . . . . . . . . . . . . . . . . 98 , * * * * * * /<512 * * * * * * * - 511 What is the main reason that you think you will never use a method? NOT CURRENTLY MARRIED . . . . . . . . 11 FERTILITY-RELATED REASONS INFREQUENT SEX . . . . . . . . . . . . . . . 22 WIFE MENOPSAL/HYSTER . . . . . . . . 23 WIFE SUB/INFECUND . . . . . . . . . . . . . 24 DESIRE MORE CHILDREN . . . . . . . . . 26 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . . . 31 WIFE OPPOSED . . . . . . . . . . . . . . . . . 32 OTHERS OPPOSED . . . . . . . . . . . . . . 33 RELIGIOUS PROHIBITION . . . . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . . . . 41 KNOWS NO SOURCE . . . . . . . . . . . . . 42 METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . . . . . . . . . . 52 LACK OF ACCESS/TOO FAR . . . . . . . 53 COST TOO MUCH . . . . . . . . . . . . . . . . 54 INCONVENIENT TO USE . . . . . . . . . . 55 INTERFERES WITH BODY’S NORMAL PROCESSES . . . . . . . . . . . 56 OTHER___________________________ 96 (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . . 98 512 CHECK 203 and 205: HAS LIVING CHILDREN +)), /))- ? If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? NO LIVING CHILDREN +)), /))- ? If you could choose exactly the number of children to have in your whole life, how many would that be? +)))0))), NUMBER . . . . . . . . . . . . . . . . . *!!!*!!!* .)))2)))- OTHER___________________________ 96 (SPECIFY) PROBE FOR A NUMERIC RESPONSE. 513 Would you say that you approve or disapprove of couples using a method to avoid getting pregnant? APPROVE . . . . . . . . . . . . . . . . . . . . . . . . 1 DISAPPROVE . . . . . . . . . . . . . . . . . . . . . 2 NO OPINION . . . . . . . . . . . . . . . . . . . . . . 3 514 Is it acceptable or not acceptable to you for information on family planning to be provided on the radio? ACCEPTABLE . . . . . . . . . . . . . . . . . . . . . 1 NOT ACCEPTABLE . . . . . . . . . . . . . . . . . 2 NO OPINION . . . . . . . . . . . . . . . . . . . . . . 8 515 Is it acceptable or not acceptable to you for information on family planning to be provided on the television? ACCEPTABLE . . . . . . . . . . . . . . . . . . . . . 1 NOT ACCEPTABLE . . . . . . . . . . . . . . . . . 2 NO OPINION . . . . . . . . . . . . . . . . . . . . . . 8 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP ME14 516 In the last few months have you heard about family planning: On the radio? On the television? In a newspaper or magazine? YES NO RADIO . . . . . . . . . . . . . . . . . . . . . . 1 2 TELEVISION . . . . . . . . . . . . . . . . . 1 2 NEWSPAPER OR MAGAZINE . . . 1 2 ?? In the last few months have you discussed the practice of family planning with your friends, neighbours, or relatives? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )))<520 ERR With whom? Anyone else? RECORD ALL MENTIONED. WIFE/PARTNER . . . . . . . . . . . . . . . . . . . A MOTHER . . . . . . . . . . . . . . . . . . . . . . . . . B FATHER . . . . . . . . . . . . . . . . . . . . . . . . . . C SISTER(S) . . . . . . . . . . . . . . . . . . . . . . . . D BROTHER(S) . . . . . . . . . . . . . . . . . . . . . . E DAUGHTER . . . . . . . . . . . . . . . . . . . . . . . F SON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G MOTHER/FATHER-IN-LAW . . . . . . . . . . . H FRIENDS/NEIGHBOURS . . . . . . . . . . . . . . I OTHER____________________________X (SPECIFY) ERR CHECK 401: CURRENTLY +))), LIVING +))), NOT IN +))), MARRIED /)))- WITH A WOMAN /)))- UNION .)))2)))))))))))))))))))))))))))))) ? ? ))<601 ERR Husbands and wives do not always agree on everything. Now I want to ask you about your wife’s/partner’s views on family planning. Do you think that your wife/partner approves or disapproves of couples using a method to avoid pregnancy? APPROVES . . . . . . . . . . . . . . . . . . . . . . . 1 DISAPPROVES . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . . 8 ERR How often have you talked to your wife/partner about family planning in the past year? NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ONCE OR TWICE . . . . . . . . . . . . . . . . . . 2 MORE OFTEN . . . . . . . . . . . . . . . . . . . . . 3 ERR Do you think your wife/partner wants the same number of children that you want, or does she want more or fewer than you want? SAME NUMBER . . . . . . . . . . . . . . . . . . . . 1 MORE CHILDREN . . . . . . . . . . . . . . . . . . 2 FEWER CHILDREN . . . . . . . . . . . . . . . . . 3 DON’T KNOW . . . . . . . . . . . . . . . . . . . . . 8 524 Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when: She is tired or not in the mood? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . She has recently given birth? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . She knows he has sex with women other than his wife (wives)? . . . . . . . . She knows he has the AIDS virus? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO DK TIRED/MOOD . . . . . . . 1 2 8 RECENT BIRTH . . . . . 1 2 8 OTHER WOMEN . . . . 1 2 8 HAS THE AIDS VIRUS. 1 2 8 ME15 SECTION 6: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 601 Now I would like to talk about something else. Have you ever heard of an illness called AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<616 602 Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 )), ))2<610 603 What can a person do? Anything else? RECORD ALL MENTIONED. ABSTAIN FROM SEX . . . . . . . . . . . . . . A USE CONDOMS . . . . . . . . . . . . . . . . . . B LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER . . C LIMIT NUMBER OF SEXUAL PARTNERS . . . . . . . . . D AVOID SEX WITH PROSTITUTES . . . E AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS . . . . . . . . F AVOID SEX WITH HOMOSEXUALS . G AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVEN. . . . . H AVOID BLOOD TRANSFUSIONS . . . . I AVOID INJECTIONS . . . . . . . . . . . . . . J AVOID KISSING . . . . . . . . . . . . . . . . . . K AVOID MOSQUITO BITES . . . . . . . . . . L SEEK PROTECTION FROM TRADITIONAL HEALER . . . . . . . M AVOID SHARING RAZOR BLADES . . N OTHER__________________________W (SPECIFY) OTHER__________________________ X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 604 CHECK 603: NEITHER CODE ‘C’ +))), CODE ‘C’ AND/OR +))), NOR CODE ‘D’ /)))- CODE ‘D’ CIRCLED .)))2)))))))))))))))))) CIRCLED ? )) )<607 605 In your view, is a person’s chance of getting AIDS influenced by the number of partners he or she has? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 )), ))2<607 606 If a person has sex with only one partner, does this person have a greater or a lesser chance of getting AIDS than a person who has sex with many partners? GREATER CHANCE OF AIDS . . . . . . . 1 LESSER CHANCE OF AIDS . . . . . . . . . 2 607 CHECK 603: DID NOT MENTION MENTIONED USE OF A USE OF A CONDOM +))), CONDOM DURING SEX +))), DURING SEX /)))- (CODE ‘B’ CIRCLED) .)))2)))))))))))))))))) (CODE ‘B’ NOT CIRCLED) * ? )) )<610 608 In your view, is a person’s chance of getting AIDS affected by using a condom every time he or she has sexual intercourse? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UNSURE/DON’T KNOW . . . . . . . . . . . . 8 )), ))2<610 609 If a person uses a condom every time he or she is engaged in sexual intercourse, does this person have a greater or a lesser chance of getting the AIDS virus than someone who doesn’t use a condom? GREATER CHANCE OF AIDS . . . . . . . 1 LESSER CHANCE OF AIDS . . . . . . . . . 2 610 Is it possible for a healthy-looking person to have the AIDS virus? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . . 8 611 Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 x ME16 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 612 Can the virus that causes AIDS be transmitted from a mother to a child? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . . 8 )), ))2<613 612A When can the virus that causes AIDS be transmitted from a mother to a child? Any other times? RECORD ALL RESPONSES DURING PREGNANCY . . . . . . . . . . . A AT DELIVERY . . . . . . . . . . . . . . . . . . B DURING BREASTFEEDING . . . . . . . C OTHER TIMES. . . . . . . . . . . . . . . . . . D DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 613 CHECK 401: CURRENTLY MARRIED/ NOT CURRENTLY MARRIED/ LIVING WITH A WOMAN +))), NOT LIVING WITH A WOMAN +))), /)))- .)))2))))))))))))))) ? )) )<614A 614 Have you ever talked about ways to prevent getting the virus that causes AIDS with (your wife/the woman you are living with)? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 614A In your opinion, is it acceptable or unacceptable for AIDS to be discussed: on the radio? on the TV? In newspapers? ACCEPTABLE UNACCEPTABLE RADIO. . . . . . 1 2 TV. . . . . . . . . . 1 2 NEWSPAPER. 1 2 615A If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community? CAN BE KEPT PRIVATE . . . . . . . . . . . . 1 AVAILABLE TO COMMUNITY . . . . . . . . 2 DK/NOT SURE . . . . . . . . . . . . . . . . . . . . 8 615B If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK/NOT SURE/DEPENDS . . . . . . . . . . 8 615C Should persons with the AIDS virus who work with other persons such as in a shop, office, or farm be allowed to continue their work or not? CAN CONTINUE WORK . . . . . . . . . . . . 1 SHOULD NOT CONTINUE WORK . . . . 2 DK/NOT SURE/DEPENDS . . . . . . . . . . 8 615D Should children aged 12-14 be taught about using a condom to avoid AIDS? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK/NOT SURE/DEPENDS . . . . . . . . . . 8 615E Have you ever been tested to see if you have the AIDS virus? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )<615HX 615F Would you want to be tested for the AIDS virus? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW/UNSURE . . . . . . . . . . . . 3 615G Do you know a place where you could go to get an AIDS test? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<616 ME17 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 615H 615HX Where can you go for the test? Where did you go for the test? Any other places? RECORD ALL MENTIONED. PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . . . . A PROVINCIAL HOSPITAL . . . . . . . . B DISTRICT HOSPITAL . . . . . . . . . . . C RURAL HEALTH CENTRE . . . . . . . D RURAL/MUNICIPAL CLINIC . . . . . . E OTHER PUBLIC _________________ G (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . . H PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . I PRIVATE DOCTOR . . . . . . . . . . . . . J OTHER PRIVATE MEDICAL___________________ K (SPECIFY) TRADITIONAL HEALER . . . . . . . . . . . . L OTHER_________________________ X (SPECIFY) 616 (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<630 617 In a man, what signs and symptoms would lead you to think that he has such an infection? Any others? RECORD ALL MENTIONED. ABDOMINAL PAIN . . . . . . . . . . . . . . . . A GENITAL DISCHARGE/DRIPPING . . . B FOUL SMELLING DISCHARGE . . . . . C BURNING PAIN ON URINATION . . . . D REDNESS/INFLAMMATION IN GENITAL AREA . . . . . . . . . . . . . . . E SWELLING IN GENITAL AREA . . . . . . F GENITAL SORES/ULCERS . . . . . . . . G GENITAL WARTS . . . . . . . . . . . . . . . . H BLOOD IN URINE . . . . . . . . . . . . . . . . . I LOSS OF WEIGHT . . . . . . . . . . . . . . . J IMPOTENCE/STERILITY . . . . . . . . . . . K NO SIGNS/SYMPTOMS . . . . . . . . . . . . L OTHER__________________________W (SPECIFY) OTHER__________________________ X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 618 In a woman, what signs and symptoms would lead you to think that she has such an infection? Any others? RECORD ALL MENTIONED. ABDOMINAL PAIN . . . . . . . . . . . . . . . . A GENITAL DISCHARGE/DRIPPING . . . B FOUL SMELLING DISCHARGE . . . . . C BURNING PAIN ON URINATION . . . . D REDNESS/INFLAMMATION IN GENITAL AREA . . . . . . . . . . . . . . . E SWELLING IN GENITAL AREA . . . . . . F GENITAL SORES/ULCERS . . . . . . . . G GENITAL WARTS . . . . . . . . . . . . . . . . H BLOOD IN URINE . . . . . . . . . . . . . . . . . I LOSS OF WEIGHT . . . . . . . . . . . . . . . J INFERTILITY/STERILITY . . . . . . . . . . . K NO SIGN/SYMPTOMS . . . . . . . . . . . . . L OTHER__________________________W (SPECIFY) OTHER__________________________ X (SPECIFY) DON’T KNOW . . . . . . . . . . . . . . . . . . . Z 619 CHECK 411: HAS HAD SEXUAL HAS NOT HAD INTERCOURSE +))), SEXUAL INTERCOURSE +))), /)))- .)))2)))))))))))) ? )) ))<630 ME18 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 620 Now, I would like to ask some questions about your health in the last 12 months. During the last 12 months, have you had a sexually-transmitted infection? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . 8 620A Sometimes men experience a discharge from their penis. During the last 12 months, have you had a discharge from your penis? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . 8 620B Sometimes men experience a sore or ulcer on or near their penis. During the last 12 months, have you had a sore or ulcer on or near your penis? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON’T KNOW . . . . . . . . . . . . . . . . . . 8 622 CHECK 620/620A/620B: HAD STI DID NOT HAVE STI +))), + ))), /)))- .)))2))))))))))))) ))))))))))))))))))))))))))))))))))) ? )) ))<630 625 The last time you had (INFECTION FROM 620/620A/620B), did you seek advice or treatment? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ))<627 626 Where did you seek advice or treatment? Any other places? RECORD ALL RESPONSES. PUBLIC SECTOR CENTRAL HOSPITAL . . . . . . . . . . . . A PROVINCIAL HOSPITAL . . . . . . . . . B DISTRICT HOSPITAL . . . . . . . . . . . . C RURAL HEALTH CENTRE . . . . . . . . D RURAL/MUNICIPAL CLINIC . . . . . . . E VILLAGE COMMUNITY WORKER . . . F OTHER PUBLIC _________________ G (SPECIFY) MISSION FACILITY . . . . . . . . . . . . . . H PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . . . . . . . I PHARMACY . . . . . . . . . . . . . . . . . . . . J PRIVATE DOCTOR . . . . . . . . . . . . . K VILLAGE COMMUNITY WORKER . . . L OTHER PRIVATE MEDICAL____________________ M (SPECIFY) OTHER SOURCE SHOP . . . . . . . . . . . . . . . . . . . . . . . . N RELATIVE/FRIENDS . . . . . . . . . . . . O TRADITIONAL HEALER . . . . . . . . . . P OTHER_________________________ X (SPECIFY) 627 When you had (INFECTION FROM 620/620A/620B), did you inform the persons with whom you have been having sex? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SOME/ NOT ALL . . . . . . . . . . . . . . . . 3 628 When you had (INFECTION FROM 620/620A/620B) did you do something to avoid infecting your sexual partner(s)? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PARTNER ALREADY INFECTED . . . 3 )), ))2<630 629 What did you do? Anything else? RECORD ALL RESPONSES STOPPED SEXUAL INTERCOURSE . A USED CONDOMS . . . . . . . . . . . . . . . . B TOOK MEDICINES . . . . . . . . . . . . . . . C OTHER__________________________X (SPECIFY) 630 RECORD THE TIME. +)))0))), HOUR . . . . . . . . . . . . . . *!!!*!!!* /)))3)))1 MINUTES . . . . . . . . . . . *!!!*!!!* .)))2)))- ME19 INTERVIEWER’S OBSERVATIONS TO BE FILLED IN AFTER COMPLETING INTERVIEW COMMENTS ABOUT RESPONDENT: COMMENTS ON SPECIFIC QUESTIONS: ANY OTHER COMMENTS: SUPERVISOR’S OBSERVATIONS NAME OF THE SUPERVISOR:______________________________________ DATE: __________________________ EDITOR’S OBSERVATIONS NAME OF EDITOR:__________________________________________________ DATE:_______________________________ Table 2.6 School enrolment ratios Net enrolment ratios (NER) and gross enrolment ratios (GER) for the de facto household population age 7-18 years, by level of schooling, sex, residence, and province, Zimbabwe 1999 ________________________________________________________________________________________ Net enrolment ratio1 Gross enrolment ratio2 Residence ____________________________ ___________________________ and province Male Female Total Male Female Total ________________________________________________________________________________________ PRIMARY SCHOOL ________________________________________________________________________________________ Residence Urban 83.7 86.1 84.9 99.7 100.9 100.3 Rural 79.4 80.9 80.2 112.4 106.6 109.6 Region Manicaland 78.6 76.5 77.6 117.0 108.1 112.6 Mashonaland Central. 78.5 81.1 79.8 111.8 107.2 109.5 Mashonaland East 78.5 82.9 80.6 107.0 106.0 106.5 Mashonaland West 80.9 79.7 80.4 109.6 105.2 107.6 Matabeleland North 79.7 86.4 83.1 101.7 101.9 101.8 Matabeleland South 82.8 81.1 82.0 108.7 101.4 105.0 Midlands 80.5 83.0 81.8 107.7 101.7 104.6 Masvingo 83.0 81.2 82.1 121.3 111.5 116.5 Harare 81.2 88.8 85.0 94.0 102.6 98.3 Bulawayo 83.5 86.6 85.1 100.0 100.9 100.5 Total 80.4 82.1 81.3 109.5 105.3 107.4 ________________________________________________________________________________________ SECONDARY SCHOOL ________________________________________________________________________________________ Residence Urban 59.9 49.0 53.9 69.4 55.0 61.5 Rural 33.9 31.4 32.8 38.5 33.0 35.9 Region Manicaland 43.8 33.1 38.6 47.7 33.5 40.8 Mashonaland Central. 28.2 25.8 27.0 36.2 27.5 31.8 Mashonaland East 36.5 35.0 35.8 43.2 38.4 41.1 Mashonaland West 27.6 33.5 30.4 33.1 33.5 33.3 Matabeleland North 31.3 36.8 33.8 32.5 36.8 34.4 Matabeleland South 29.1 37.4 33.0 31.6 41.0 36.0 Midlands 36.3 35.7 36.0 41.4 40.3 40.9 Masvingo 37.4 33.3 35.5 42.0 36.9 39.6 Harare 67.5 49.0 57.2 79.5 54.4 65.5 Bulawayo 59.8 51.4 55.4 68.6 58.3 63.2 Total 39.9 36.7 38.3 45.6 39.5 42.7 ________________________________________________________________________________________ 1 The NER for primary school is the percentage of the primary-school-age (7-12 years) population that is enrolled in primary school. The NER for secondary school is the percentage of the secondary-school-age (13-18 years) population that is enrolled in secondary school. By definition the NER cannot exceed 100%. 2 The GER for primary school is the total number of primary school students, regardless of age, expressed as the percentage of the official primary-school-age population. The GER for secondary school is the total number of secondary school students, regardless of age, expressed as the percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GER can exceed 100%. ERRATA Central Statistical Office [Zimbabwe] and Macro International Inc. 2000. Zimbabwe Demographic and Health Survey 1999. Calverton, Maryland: Central Statistical Office and Macro International Inc. Page 13 Table 2.6 - The numbers in the table are incorrect. See new Table 2.6 below Table 10.9 Nutritional status of women by background characteristics Among women age 15-49, mean height and percentage under 145 cm, mean body mass index (BMI), percentage whose BMI is below 18.5, mean DHS Z-score, and percentage wasted, by selected background characteristics, Zimbabwe 1999 __________________________________________________________________________________________ Height Weight-for-height1 ______________________ ______________________________________ Mean Per- body Per- Per- Mean centage Number mass centage Number Mean centage Number Background height below of index below of DHS below of characteristic in cm 145 cm women (kg/m2) 18.5 women Z-score -2 SD women __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-49 Residence Urban Rural Region Manicaland Mashonaland Centr. Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo Education No education Primary Secondary Higher Total 157.6 2.9 1,374 22.0 9.6 1,372 -0.3 2.3 1,366 159.3 1.6 1,230 22.8 4.6 1,233 -0.1 0.6 1,222 160.2 1.4 981 23.5 5.8 982 -0.2 2.9 977 159.8 1.9 631 24.7 2.0 633 -0.1 1.5 631 160.5 1.0 1,398 25.3 3.9 1,397 -0.1 4.8 1,394 160.0 1.2 2,108 24.3 5.1 2,107 0.1 1.8 2,099 159.0 2.1 3,507 23.1 5.8 3,510 -0.3 3.1 3,490 158.1 1.8 838 23.4 4.3 840 -0.2 2.2 837 .159.0 1.1 424 22.7 4.8 424 -0.4 3.0 420 .160.0 1.3 453 23.7 6.6 454 -0.1 3.7 452 .157.2 7.7 517 23.8 6.1 522 -0.2 3.8 508 159.8 0.3 305 22.9 8.0 305 -0.4 4.5 305 159.6 0.5 291 23.3 6.5 291 -0.3 3.3 291 159.9 1.3 748 23.3 7.7 748 -0.2 2.8 746 160.2 1.5 617 23.1 3.6 614 -0.2 2.0 614 160.2 1.1 963 24.1 4.6 961 0.1 0.9 959 .160.0 0.5 459 24.7 5.7 459 0.1 2.7 458 .158.4 3.5 647 22.6 8.7 647 -0.5 4.9 642 .159.2 1.8 2,422 23.5 5.2 2,424 -0.2 2.9 2,412 .159.8 1.3 2,200 23.7 5.0 2,200 -0.0 1.6 2,190 160.6 1.9 318 24.9 5.7 318 0.2 1.8 317 159.4 1.8 5,615 23.6 5.6 5,618 -0.2 2.6 5,590 __________________________________________________________________________________________ Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in centimeters (kg/m2). The DHS Z-score is based on a study of elite mothers in DHS surveys and indicates the number of standard deviation units (SD) from the median of the DHS de facto reference population. The percentage of mothers who are more than two standard deviations below (i.e., away in the negative direction) the median of the DHS reference population (-2 SD) are shown according to background characteristics. 1 Excludes pregnant women and women with a birth in the preceding 2 months Pages 58-59 Tables 5.7.1 and 5.7.2 - The column headings (only) “Not currently using” and “Other methods” should be transposed. Page 149 Table 10.4 - Two labels in the first column are incorrect: <4 should be <2 and <2 should be <4 Page 157 Table 10.9 - The numbers for Region and Education are misaligned. See new Table 10.9 below Front Matter World Summit for Children Indicators: Zimbabwe 1999 Title Page Citation Page Table of Contents Tables and Figures Preface Summary of Findings Map of Zimbabwe Chapter 01 - Introduction Chapter 02 - Household Population and Housing Characteristics Chapter 03 - Characteristics of Respondents Chapter 04 - Fertility Chapter 05 - Family Planning Chapter 06 - Other Proximate Determinants of Fertility Chapter 07 - Fertility Preferences Chapter 08 - Early Childhood Mortality Chapter 09 - Reproductive and Child Health Chapter 10 - Infant Feeding and Childhood and Maternal Nutrition Chapter 11 - AIDS and Other Sexually Transmitted Diseases Chapter 12 - Adult and Maternal Mortality References Appendix A - Sample Design Appendix B - Estimates of Sampling Errors Appendix C - Data Quality Tables Appendix D - ZDHS Head Office Staff Appendix E - Questionnaires Household Questionnaire Women's Questionnaire Men's Questionnaire Errata

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