Zimbabwe DHS Final Report (2010-2011)

Publication date: 2012

Zimbabwe Demographic and Health Survey 2010-11 Zimbabwe National Statistics Agency Harare, Zimbabwe ICF International, Inc. Calverton, Maryland USA March 2012 ZIMBABWEANS AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS The 2010-11 Zimbabwe Demographic and Health Survey (2010-11 ZDHS) was implemented by the Zimbabwe National Statistics Agency (ZIMSTAT). The funding for the ZDHS was provided by the United States Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), the United Nations Children’s Fund (UNICEF), the United Kingdom Department for International Development (DFID), the European Union (EU), and the Government of Zimbabwe. ICF International supported the project through the MEASURE DHS project, a USAID-funded project providing support, technical assistance, and funding for population and health surveys in countries worldwide. Additional information about the ZDHS may be obtained from the Zimbabwe National Statistics Agency, P.O. Box CY 342, Causeway, Harare, Zimbabwe (Telephone: (263-4) 793-971/2 and 797-756; Fax (263-4) 794-757; E-mail: census@mweb.co.zw). Information about the MEASURE DHS project may be obtained from ICF International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200, Fax: 301-572- 0999, E-mail: info@measuredhs.com, Internet: http://www.measuredhs.com. Cover photo ©2010 Rex Harris • www.flickr.com/photos/sheepdog_rex/ • Used with permission. Recommended citation: Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International. 2012. Zimbabwe Demographic and Health Survey 2010-11. Calverton, Maryland: ZIMSTAT and ICF International Inc. Table of Contents • iii CONTENTS TABLES AND FIGURES . ix PREFACE . xv MILLENNIUM DEVELOPMENT GOAL INDICATORS . xvii MAP OF ZIMBABWE . xviii CHAPTER 1 INTRODUCTION 1.1 Geography and Economy . 1 1.2 Population . 2 1.3 Objectives of the Survey . 3 1.4 Survey Implementation . 4 1.4.1 Sample Design . 4 1.4.2 Questionnaires . 4 1.4.3 Anthropometry, Anaemia, and HIV Testing . 5 1.4.4 Training of Field Staff . 7 1.4.5 Fieldwork . 7 1.4.6 Data Processing . 7 1.5 Response Rates . 8 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2.1 Household Characteristics . 9 2.1.1 Drinking Water . 9 2.1.2 Sanitation Facilities and Waste Disposal . 11 2.1.3 Housing Characteristics . 12 2.1.4 Household Durable Goods . 13 2.2 Household Wealth . 14 2.3 Hand Washing . 15 2.4 Household Population by Age, Sex, and Residence . 16 2.5 Household Composition . 18 2.6 Birth Registration . 19 2.7 Children’s Living Arrangements, School Attendance, and Parental Survival . 20 2.8 Education of the Household Population . 22 2.8.1 Educational Attainment . 22 2.8.2 School Attendance Ratios . 23 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents . 27 3.2 Educational Attainment by Background Characteristics . 29 3.3 Literacy . 31 3.4 Exposure to Mass Media . 33 3.5 Employment Status . 35 3.6 Occupation . 38 3.7 Type of Employment . 40 3.8 Health Insurance Coverage . 41 3.9 Use of Tobacco . 43 iv • Table of Contents CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY 4.1 Marital Status . 47 4.2 Polygyny . 48 4.3 Age at First Marriage . 50 4.4 Age at First Sexual Intercourse . 51 4.5 Recent Sexual Activity . 53 CHAPTER 5 FERTILITY 5.1 Current Fertility . 57 5.2 Fertility by Background Characteristics . 58 5.3 Fertility Trends . 59 5.4 Children Ever Born and Living . 60 5.5 Birth Intervals . 61 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . 62 5.7 Median Duration of Postpartum Insusceptibility by Background Characteristics . 63 5.8 Menopause . 65 5.9 Age at First Birth . 65 5.10 Median Age at First Birth by Background Characteristics . 66 5.11 Teenage Pregnancy and Motherhood . 67 CHAPTER 6 FERTILITY PREFERENCES 6.1 Fertility Preferences by Number of Living Children . 69 6.2 Desire to Limit Childbearing by Background Characteristics . 70 6.3 Ideal Number of Children . 72 6.4 Mean Ideal Number of Children by Background Characteristics . 73 6.5 Fertility Planning Status . 74 6.6 Wanted Fertility Rates . 75 CHAPTER 7 FAMILY PLANNING 7.1 Knowledge of Contraceptive Methods . 77 7.2 Current Use of Contraception . 79 7.3 Current Use of Contraception by Background Characteristics . 81 7.4 Source of Modern Contraceptive Methods . 84 7.5 Use of Social Marketing Brand Pills . 85 7.6 Use of Social Marketing Brand Condoms . 86 7.7 Informed Choice . 86 7.8 Rates of Discontinuing Contraceptive Methods . 87 7.9 Reasons for Discontinuing Contraceptive Methods . 88 7.10 Knowledge of the Fertile Period . 89 7.11 Need and Demand for Family Planning . 90 7.12 Future Use of Contraception . 93 7.13 Exposure to Family Planning Messages in the Media . 94 7.14 Contact of Nonusers with Family Planning Providers . 96 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Background and Assessment of Data Quality . 99 8.2 Infant and Child Mortality Levels and Trends . 101 8.3 Socioeconomic Differentials in Early Childhood Mortality . 102 8.4 Biodemographic Differentials in Early Childhood Mortality . 103 8.5 Perinatal Mortality . 104 8.6 High-Risk Fertility Behaviour . 105 Table of Contents • v CHAPTER 9 MATERNAL HEALTH CARE 9.1 Antenatal Care . 107 9.2 Number and Timing of Antenatal Visits . 109 9.3 Components of Antenatal Care . 109 9.4 Tetanus Toxoid . 111 9.5 Place of Delivery . 113 9.6 Assistance during Delivery . 114 9.7 Postnatal Care for the Mother . 116 9.8 Postnatal Care for the Newborn . 119 9.9 Problems in Accessing Health Care . 122 CHAPTER 10 CHILD HEALTH 10.1 Child’s Weight and Size at Birth . 125 10.2 Vaccination of Children . 127 10.3 Prevalence and Treatment of Acute Respiratory Infection . 130 10.4 Prevalence and Treatment of Fever . 131 10.5 Diarrhoeal Disease . 133 10.5.1 Prevalence of Diarrhoea . 133 10.5.2 Treatment of Diarrhoea . 134 10.5.3 Feeding Practices during Diarrhoea . 135 10.6 Knowledge of ORS Sachets . 137 10.7 Disposal of Children’s Stools . 137 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS 11.1 Nutritional Status of Children . 139 11.1.1 Measurement of Nutritional Status among Young Children . 139 11.1.2 Data Collection . 140 11.1.3 Levels of Child Malnutrition. 141 11.1.4 Trends in Child Malnutrition . 143 11.2 Breastfeeding . 144 11.2.1 Initiation of Breastfeeding . 144 11.2.2 Breastfeeding Status by Age . 146 11.2.3 Median Duration of Breastfeeding . 148 11.3 Dietary Diversity among Young Children . 149 11.3.1 Foods and Liquids Consumed by Infants and Young Children . 150 11.3.2 Infant and Young Child Feeding (IYCF) Practices . 151 11.4 Anaemia Prevalence in Children . 154 11.5 Micronutrient Intake and Supplementation among Children . 156 11.6 Presence of Iodized Salt in Households . 158 11.7 Adults’ Nutritional Status . 159 11.7.1 Nutritional Status of Women . 159 11.7.2 Nutritional Status of Men . 161 vi • Table of Contents 11.8 Anaemia Prevalence in Adults . 162 11.8.1 Anaemia Prevalence among Women . 162 11.8.2 Anaemia Prevalence among Men . 163 11.9 Micronutrient Intake among Mothers . 164 CHAPTER 12 MALARIA 12.1 Ownership of Mosquito Nets . 167 12.2 Indoor Residual Spraying . 168 12.3 Use of Mosquito Nets by Persons in the Household . 169 12.3.1 Use of Mosquito Nets by Children Under Five Years . 170 12.3.2 Use of Mosquito Nets by Pregnant Women . 171 12.4 Use of Intermittent Preventive Treatment of Malaria in Pregnancy . 173 12.5 Prevalence, Diagnosis, and Prompt Treatment of Fever among Young Children . 174 12.6 Prevalence of Anaemia in Children . 176 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 180 13.2 Knowledge about Mother-to-Child Transmission . 185 13.3 Attitudes towards People Living with HIV/AIDS . 187 13.4 Attitudes towards Negotiating for Safer Sexual Relations with Husbands . 189 13.5 Attitudes towards Condom Education for Young People. 190 13.6 Multiple Sexual Partners . 192 13.7 Paid Sex . 196 13.8 Coverage of HIV Testing Services . 197 13.9 Male Circumcision. 201 13.10 Self-reporting of Sexually Transmitted Infections . 202 13.11 Injections . 204 13.12 HIV/AIDS-Related Knowledge and Behaviour among Young People . 206 13.12.1 Knowledge about HIV/AIDS and Source for Condoms . 206 13.12.2 First Sex . 207 13.12.3 Premarital Sex . 208 13.12.4 Multiple Sexual Partners . 210 13.12.5 Age-mixing in Sexual Relationships . 211 13.12.6 Coverage of HIV Testing Services . 212 CHAPTER 14 HIV PREVALENCE 14.1 Coverage Rates for HIV Testing . 216 14.2 HIV Prevalence . 218 14.2.1 HIV Prevalence by Age and Sex . 218 14.2.2 HIV Prevalence by Other Socioeconomic Characteristics . 219 14.2.3 HIV Prevalence by Other Sociodemographic and Health Characteristics . 221 14.2.4 HIV Prevalence by Sexual Risk Behaviour. 222 14.3 HIV Prevalence among Young People . 224 14.4 HIV Prevalence by Other Characteristics Related to HIV Risk . 226 14.5 Male Circumcision and HIV Prevalence . 227 14.6 HIV Prevalence among Couples . 228 Table of Contents • vii CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Women’s and Men’s Employment . 231 15.2 Women’s Control Over Their Own Earnings and Relative Magnitude of Women’s Earnings . 232 15.3 Women’s Ownership of Assets . 236 15.4 Women’s and Men’s Participation in Decision making . 238 15.5 Attitudes towards Wife Beating . 242 15.6 Women’s Empowerment Indicators . 246 15.7 Current Use of Contraception by Women’s Empowerment . 247 15.8 Ideal Family Size and Unmet Need by Women’s Empowerment . 247 15.9 Women’s Empowerment and Reproductive Health Care . 248 15.10 Differentials in Infant and Child Mortality by Women’s Empowerment . 249 CHAPTER 16 DOMESTIC VIOLENCE 16.1 Measurement of Violence . 252 16.1.1 The Use of Valid Measures of Violence . 252 16.1.2 Ethical Considerations . 253 16.1.3 Subsample for the Violence Module . 254 16.2 Women’s Experience of Physical Violence . 254 16.3 Force at Sexual Initiation . 255 16.4 Experience of Sexual Violence . 256 16.5 Experience of Different Forms of Violence . 258 16.6 Violence During Pregnancy . 259 16.7 Marital Control by Husband or Partner . 261 16.8 Forms of Spousal Violence . 263 16.9 Violence by Spousal Characteristics and Women’s Indicators . 266 16.10 Frequency of Spousal Violence . 267 16.11 Onset of Spousal Violence . 269 16.12 Types of Injuries to Women due to Spousal Violence . 269 16.13 Violence by Women against Their Husband . 270 16.14 Help-Seeking Among Women Who Have Experienced Violence . 272 16.15 Changes in Domestic Violence between 2005-06 and 2010-11 . 274 CHAPTER 17 ADULT AND MATERNAL MORTALITY 17.1 Data . 275 17.2 Direct Estimates of Adult Mortality . 276 17.2.1 Levels of Adult Mortality . 277 17.2.2 Trends in Adult Mortality . 277 17.3 Direct Estimates of Maternal Mortality . 278 REFERENCES . 281 APPENDIX A SAMPLE IMPLEMENTATION . 285 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 295 APPENDIX C DATA QUALITY TABLES . 313 APPENDIX D PERSONS INVOLVED IN THE 2010-11 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY . 321 APPENDIX E QUESTIONNAIRES . 327 Tables and Figures • ix TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Population size and growth rate . 2 Table 1.2 Demographic indicators . 3 Table 1.3 Results of the household and individual interviews . 8 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION Table 2.1 Household drinking water . 10 Table 2.2 Household sanitation facilities . 11 Table 2.3 Household characteristics . 12 Table 2.4 Household possessions . 13 Table 2.5 Wealth quintiles . 15 Table 2.6 Hand washing . 16 Table 2.7 Household population by age, sex, and residence . 17 Table 2.8 Household composition . 18 Table 2.9 Birth registration of children under age five . 19 Table 2.10 Children's living arrangements and orphanhood . 20 Table 2.11 School attendance by survivorship of parents . 21 Table 2.12.1 Educational attainment of the female household population . 22 Table 2.12.2 Educational attainment of the male household population . 23 Table 2.13 School attendance ratios . 24 Figure 2.1 Population pyramid . 17 Figure 2.2 Age-specific attendance rates of the de facto population 5 to 24 years . 25 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . 28 Table 3.2.1 Educational attainment: Women . 29 Table 3.2.2 Educational attainment: Men . 30 Table 3.3.1 Literacy: Women . 32 Table 3.3.2 Literacy: Men . 32 Table 3.4.1 Exposure to mass media: Women . 33 Table 3.4.2 Exposure to mass media: Men . 34 Table 3.5.1 Employment status: Women . 36 Table 3.5.2 Employment status: Men . 37 Table 3.6.1 Occupation: Women. 39 Table 3.6.2 Occupation: Men . 40 Table 3.7 Type of employment: Women . 41 Table 3.8.1 Health insurance coverage: Women . 42 Table 3.8.2 Health insurance coverage: Men . 43 Table 3.9.1 Use of tobacco: Women . 44 Table 3.9.2 Use of tobacco: Men . 45 Figure 3.1 Women’s employment status in the past 12 months . 35 CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY Table 4.1 Current marital status . 47 Table 4.2.1 Number of women's co-wives . 48 Table 4.2.2 Number of men's wives . 49 Table 4.3 Age at first marriage . 50 Table 4.4 Median age at first marriage by background characteristics . 51 Table 4.5 Age at first sexual intercourse . 52 x • Tables and Figures Table 4.6 Median age at first sexual intercourse by background characteristics . 53 Table 4.7.1 Recent sexual activity: Women . 54 Table 4.7.2 Recent sexual activity: Men . 55 CHAPTER 5 FERTILITY Table 5.1 Current fertility . 58 Table 5.2 Fertility by background characteristics . 58 Table 5.3.1 Trends in age-specific fertility rates . 59 Table 5.3.2 Trends in age-specific and total fertility rates . 60 Table 5.4 Children ever born and living . 61 Table 5.5 Birth intervals . 62 Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility . 63 Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility . 64 Table 5.8 Menopause . 65 Table 5.9 Age at first birth . 66 Table 5.10 Median age at first birth . 66 Table 5.11 Teenage pregnancy and motherhood . 67 Figure 5.1 Trends in age-specific fertility rates . 60 CHAPTER 6 FERTILITY PREFERENCES Table 6.1 Fertility preferences by number of living children . 70 Table 6.2.1 Desire to limit childbearing: Women . 71 Table 6.2.2 Desire to limit childbearing: Men . 71 Table 6.3 Ideal number of children by number of living children . 73 Table 6.4 Mean ideal number of children by background characteristics . 74 Table 6.5 Fertility planning status . 75 Table 6.6 Wanted fertility rates . 76 CHAPTER 7 FAMILY PLANNING Table 7.1 Knowledge of contraceptive methods . 78 Table 7.2 Current use of contraception by age . 80 Table 7.3.1 Current use of contraception by background characteristics . 82 Table 7.3.2 Trends in the current use of contraception . 83 Table 7.4 Source of modern contraceptive methods . 84 Table 7.5.1 Use of social marketing brand pills . 85 Table 7.5.2 Use of social marketing brand condoms . 86 Table 7.6 Informed choice . 87 Table 7.7 12-month contraceptive discontinuation rates . 88 Table 7.8 Reasons for discontinuation . 89 Table 7.9 Knowledge of fertile period . 90 Table 7.10.1 Need and demand for family planning among currently married women . 91 Table 7.10.2 Need and demand for family planning for all women and for women who are not currently married . 92 Table 7.11 Future use of contraception . 94 Table 7.12 Exposure to family planning messages . 95 Table 7.13 Contact of nonusers with family planning providers . 96 Figure 7.1 Trends in contraceptive use among currently married women . 83 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 101 Table 8.2 Mortality rates for the five years preceding the survey . 101 Table 8.3 Early childhood mortality rates by socioeconomic characteristics . 102 Table 8.4 Early childhood mortality rates by demographic characteristics . 103 Table 8.5 Perinatal mortality . 105 Tables and Figures • xi Table 8.6 High-risk fertility behaviour . 106 CHAPTER 9 MATERNAL HEALTH CARE Table 9.1 Antenatal care . 108 Table 9.2 Number of antenatal care visits and timing of first visit . 109 Table 9.3 Components of antenatal care . 111 Table 9.4 Tetanus toxoid injections . 112 Table 9.5 Place of delivery . 113 Table 9.6 Assistance during delivery . 115 Table 9.7 Timing of first postnatal checkup for the mother . 117 Table 9.8 Type of provider of first postnatal checkup for the mother. 118 Table 9.9 Timing of first postnatal checkup for the newborn . 120 Table 9.10 Type of provider of first postnatal checkup for the newborn . 121 Table 9.11 Problems in accessing health care . 122 CHAPTER 10 CHILD HEALTH Table 10.1 Child's weight and size at birth. 126 Table 10.2 Vaccinations by source of information . 128 Table 10.3 Vaccinations by background characteristics . 128 Table 10.4 Trends in vaccination coverage . 129 Table 10.5 Prevalence and treatment of symptoms of ARI . 131 Table 10.6 Prevalence and treatment of fever . 132 Table 10.7 Prevalence of diarrhoea . 133 Table 10.8 Diarrhoea treatment . 135 Table 10.9 Feeding practices during diarrhoea . 136 Table 10.10 Knowledge of ORS sachets . 137 Table 10.11 Disposal of children's stools . 138 Figure 10.1 Trends in vaccination coverage among children 12-23 months . 130 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS Table 11.1 Nutritional status of children . 142 Table 11.2 Initial breastfeeding . 145 Table 11.3 Breastfeeding status by age . 146 Table 11.4 Median duration of breastfeeding . 149 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 150 Table 11.6 Infant and young child feeding (IYCF) practices . 152 Table 11.7 Prevalence of anaemia in children . 155 Table 11.8 Micronutrient intake among children . 157 Table 11.9 Presence of iodized salt in household . 158 Table 11.10.1 Nutritional status of women . 159 Table 11.10.2 Nutritional status of men . 161 Table 11.11.1 Prevalence of anaemia in women . 162 Table 11.11.2 Prevalence of anaemia in men . 164 Table 11.12 Micronutrient intake among mothers . 165 Figure 11.1 Nutritional status of children by age . 143 Figure 11.2 Trends in nutritional status of children under age five . 144 Figure 11.3 Infant feeding practices by age . 147 Figure 11.4 IYCF indicators on breastfeeding status . 148 Figure 11.5 IYCF indicators on minimum acceptable diet . 153 Figure 11.6 Trends in anaemia status among children age 6-59 months . 156 Figure 11.7 Trends in nutritional status among women age 15-49 . 160 Figure 11.8 Trends in anaemia status among women age 15-49 . 163 xii • Tables and Figures CHAPTER 12 MALARIA Table 12.1 Household possession of mosquito nets . 168 Table 12.2 Indoor residual spraying against mosquitoes . 169 Table 12.3 Use of mosquito nets by persons in the household . 170 Table 12.4 Use of mosquito nets by children . 171 Table 12.5 Use of mosquito nets by pregnant women . 172 Table 12.6 Prophylactic use of antimalarial drugs and use of intermittent preventive treatment (IPTp) by women during pregnancy . 173 Table 12.7 Prevalence, diagnosis, and prompt treatment of children with fever . 175 Table 12.8 Type and timing of antimalarial drugs taken by children with fever . 176 Table 12.9 Haemoglobin < 8.0 g/dl in children . 177 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 13.1 Knowledge of AIDS . 180 Table 13.2 Knowledge of HIV prevention methods. 181 Table 13.3.1 Comprehensive knowledge about HIV/AIDS: Women . 183 Table 13.3.2 Comprehensive knowledge about HIV/AIDS: Men . 184 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV . 186 Table 13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 187 Table 13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 188 Table 13.6 Attitudes toward negotiating safer sexual relations with husband . 190 Table 13.7 Adult support of education about condom use to prevent AIDS . 191 Table 13.8.1 Multiple sexual partners: Women . 192 Table 13.8.2 Multiple sexual partners: Men . 193 Table 13.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 195 Table 13.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 196 Table 13.11.1 Coverage of prior HIV testing: Women . 198 Table 13.11.2 Coverage of prior HIV testing: Men . 199 Table 13.12 Pregnant women counseled and tested for HIV . 201 Table 13.13 Male circumcision . 202 Table 13.14 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 203 Table 13.15 Prevalence of medical injections . 205 Table 13.16 Comprehensive knowledge about HIV/AIDS and of a source of condoms among young people . 206 Table 13.17 Age at first sexual intercourse among young people . 207 Table 13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among young people . 209 Table 13.19.1 Multiple sexual partners in the past 12 months among young people: Women . 210 Table 13.19.2 Multiple sexual partners in the past 12 months among young people: Men . 211 Table 13.20 Age-mixing in sexual relationships among women and men age 15-19 . 212 Table 13.21 Recent HIV tests among young people . 213 Figure 13.1 Women and men seeking advice or treatment for STIs . 204 Figure 13.2 Trends in age at first sexual intercourse . 208 CHAPTER 14 HIV PREVALENCE Table 14.1 Coverage of HIV testing by residence and province . 216 Table 14.2 Coverage of HIV testing by selected background characteristics . 217 Table 14.3 HIV prevalence by age . 218 Table 14.4 HIV prevalence by socioeconomic characteristics . 220 Table 14.5 HIV prevalence by demographic characteristics . 222 Table 14.6 HIV prevalence by sexual behaviour . 223 Table 14.7 HIV prevalence among young people by background characteristics . 225 Table 14.8 HIV prevalence among young people by sexual behaviour . 226 Table 14.9 HIV prevalence by other characteristics . 226 Table 14.10 Prior HIV testing by current HIV status . 227 Table 14.11 HIV prevalence by male circumcision . 228 Tables and Figures • xiii Table 14.12 HIV prevalence among couples . 229 Figure 14.1 HIV prevalence among all adults age 15-49, and by sex, Zimbabwe 2005-06 and 2010-11 . 219 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings of currently married women and men . 232 Table 15.2.1 Control over women's cash earnings and relative magnitude of women's cash earnings: Women . 233 Table 15.2.2 Control over men's cash earnings . 235 Table 15.3 Women's control over their own earnings and over those of their husbands . 236 Table 15.4.1 Ownership of assets: Women . 237 Table 15.4.2 Ownership of assets: Men . 238 Table 15.5 Participation in decision making . 239 Table 15.6.1 Women's participation in decision making by background characteristics . 240 Table 15.6.2 Men's participation in decision making by background characteristics . 242 Table 15.7.1 Attitude toward wife beating: Women . 244 Table 15.7.2 Attitude toward wife beating: Men . 245 Table 15.8 Indicators of women's empowerment . 246 Table 15.9 Current use of contraception by women's empowerment . 247 Table 15.10 Women's empowerment and ideal number of children and unmet need for family planning . 248 Table 15.11 Reproductive health care by women's empowerment . 249 Table 15.12 Early childhood mortality rates by indicators of women's empowerment . 250 Figure 15.1 Number of decisions in which currently married women participate . 241 CHAPTER 16 DOMESTIC VIOLENCE Table 16.1 Experience of physical violence . 254 Table 16.2 Persons committing physical violence . 255 Table 16.3 Force at sexual initiation . 256 Table 16.4 Experience of sexual violence . 257 Table 16.5 Age at first experience of sexual violence . 258 Table 16.6 Persons committing sexual violence . 258 Table 16.7 Experience of different forms of violence . 259 Table 16.8 Violence during pregnancy . 260 Table 16.9 Degree of marital control exercised by husbands . 262 Table 16.10 Forms of spousal violence . 263 Table 16.11 Spousal violence by background characteristics . 265 Table 16.12 Spousal violence by husband's characteristics and empowerment indicators . 266 Table 16.13 Frequency of spousal violence . 268 Table 16.14 Onset of marital violence . 269 Table 16.15 Injuries to women due to spousal violence . 270 Table 16.16 Violence by women against their spouse . 271 Table 16.17 Help seeking to stop violence . 272 Table 16.18 Sources from where help was sought . 273 Table 16.19 Trends in domestic violence in the past 12 months . 274 Figure 16.1 Percentage of ever-married women who have experienced specific forms of violence committed by their most recent husband/partner, ever and during the past 12 months . 264 CHAPTER 17 ADULT AND MATERNAL MORTALITY Table 17.1 Data on siblings . 276 Table 17.2 Adult mortality rates . 277 Table 17.3 Maternal mortality . 278 xiv • Tables and Figures APPENDIX A SAMPLE IMPLEMENTATION . 285 Table A.1 Population . 285 Table A.2 Sample allocation of clusters and households . 286 Table A.3 Sample allocation of completed interviews with women and men . 287 Table A.4 Sample implementation: Women . 287 Table A.5 Sample implementation: Men . 288 Table A.6 Coverage of HIV testing by social and demographic characteristics: Women . 289 Table A.7 Coverage of HIV testing by social and demographic characteristics: Men . 290 Table A.8 Coverage of HIV testing by sexual behaviour characteristics: Women . 291 Table A.9 Coverage of HIV testing by sexual behaviour characteristics: Men . 292 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 298 Table B.2 Sampling errors for national sample . 299 Table B.3 Sampling errors for urban sample . 300 Table B.4 Sampling errors for rural sample . 301 Table B.5 Sampling errors for Manicaland sample . 302 Table B.6 Sampling errors for Mashonaland Central sample . 303 Table B.7 Sampling errors for Mashonaland East sample . 304 Table B.8 Sampling errors for Mashonaland West sample . 305 Table B.9 Sampling errors for Matabeleland North sample . 306 Table B.10 Sampling errors for Matabeleland South sample . 307 Table B.11 Sampling errors for Midlands sample . 308 Table B.12 Sampling errors for Masvingo sample . 309 Table B.13 Sampling errors for Harare sample . 310 Table B.14 Sampling errors for Bulawayo sample . 311 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 313 Table C.2.1 Age distribution of eligible and interviewed women . 314 Table C.2.2 Age distribution of eligible and interviewed men . 315 Table C.3 Completeness of reporting . 316 Table C.4 Births by calendar years . 317 Table C.5 Reporting of age at death in days . 318 Table C.6 Reporting of age at death in months . 319 Table C.7 Nutritional status of children based on NCHS/CDC/WHO international reference population . 320 APPENDIX D PERSONS INVOLVED IN THE 2010-11 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY . 321 APPENDIX E QUESTIONNAIRES . 327 Preface • xv PREFACE he 2010-11 Zimbabwe Demographic and Health Survey (2010-11 ZDHS) presents the major findings of a survey of a large, nationally representative sample of nearly 11,000 households. This survey was conducted by the Zimbabwe National Statistics Agency (ZIMSTAT) from late September 2010 through March 2011. The 2010-11 ZDHS is a follow-up to the 1988, 1994, 1999, and 2005-06 ZDHS surveys and provides updated estimates of basic demographic and health indicators. In contrast with past ZDHS surveys, the 2010-11 ZDHS was carried out using electronic personal digital assistants (PDAs) rather than paper questionnaires for recording responses during interviews. A preliminary report was published in June 2011. The primary objective of the 2010-11 ZDHS is to provide current information for policymakers, planners, researchers, and programme managers. Topics include fertility levels; nuptiality; sexual activity; fertility preferences; knowledge 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; malaria prevention and treatment; awareness and behaviour regarding HIV and other sexually transmitted infections; and domestic violence. Additionally, the 2010-11 ZDHS provides population-based prevalence estimates for anaemia among men, women, and young children and for HIV among women age 15-49 and men age 15-54. ZIMSTAT extends its acknowledgement and gratitude to the various agencies and individuals in the government, donor community, and public sector for support that facilitated the successful implementation of the survey. Specific mention is due to the following: the Ministry of Health and Child Welfare (MOHCW), the National Microbiology Reference Laboratory (NMRL), the USAID/Zimbabwe Mission, the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), the United Nations Children’s Fund (UNICEF), the Centers for Disease Control and Prevention (CDC), the United Kingdom Department for International Development (DFID), the European Union (EU), the National AIDS Council (NAC), Population Services International (PSI), University of Zimbabwe (UZ), the Joint United Nations Programmes on HIV and AIDS (UNAIDS), the Zimbabwe National Family Planning Council (ZNFPC), and the World Health Organization (WHO). ICF International provided technical assistance and funding to the 2010-11 ZDHS through the MEASURE DHS project, a USAID-funded programme supporting the implementation of population and health surveys in countries worldwide. Finally, we wish to thank all field personnel for commitment to high-quality work under difficult conditions and all ZDHS respondents for their patience and cooperation. Mutasa Dzinotizei Director General Zimbabwe National Statistics Agency T Millennium Development Goal Indicators • xvii Millennium Development Goal Indicators, Zimbabwe 2010-11 Sex Total Indicator Male Female 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under 5 years of age 11.1 8.4 9.7 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 87.4 88.8 88.1 2.3 Literacy rate of 15-24 year-olds2 95.2 96.2 95.7a 3. Promote gender equality and empower women 3.1 Ratio of girls to boys in primary, secondary, and tertiary education 3.1a Ratio of girls to boys in primary education3 na na 1.0 3.1b Ratio of girls to boys in secondary education3 na na 1.0 3.1c Ratio of girls to boys in tertiary education3 na na 0.7 4. Reduce child mortality 4.1 Under five mortality rate4 87 68 84 4.2 Infant mortality rate4 64 44 57 4.3 Proportion of 1 year old children immunised against measles 78.1 80.2 79.1 5. Improve maternal health 5.1 Maternal mortality ratio5 na na 960 5.2 Proportion of births attended by skilled health personnel6 na na 66.2 5.3 Contraceptive prevalence rate7 na 58.5 na 5.4 Adolescent birth rate8 na 114.6 na 5.5 Antenatal care coverage 5.5a At least one visit na 89.8 na 5.5b Four or more visits na 64.8 na 5.6 Unmet need for family planning na 12.8 na 6. Combat HIV/AIDS, malaria and other diseases 6.1 HIV prevalence among population age 15-24 3.6 7.3 5.5 6.2 Condom use at last high-risk sex9 73.7 48.0 60.9 6.3 Percentage of population age 15-24 years with comprehensive correct knowledge of HIV/AIDS10 47.0 51.9 49.5a 6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years 0.91 0.94 0.92 6.7 Percentage of children under 5 sleeping under insecticide-treated bednets 9.2 10.2 9.7 6.8 Percentage of children under 5 with fever who are appropriately treated with anti-malarial drugs11 2.1 2.5 2.3 Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source12 95.1 68.7 76.7 7.9 Percentage of population with access to improved sanitation13 49.8 31.8 37.3 na = Not applicable a The total is calculated as the simple arithmetic mean of the percentages in the columns for males and females 1 Based on reported attendance, not enrollment, in primary education among primary school age children (6-10 year-olds). The rate also includes children of primary school age attending secondary education. This is a proxy for MDG indicator 2.1, Net enrollment ratio. 2 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence. 3 Based on reported net attendance not gross enrollment, among 6-12 year-olds for primary, 13-18 year-olds for secondary and 19-24 year-olds for tertiary education. 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. 5 Expressed in terms of maternal deaths per 100,000 live births in the 7-year period preceding the survey 6 Among births in the five years before the survey 7 Percentage of currently married women age 15-49 using any method of contraception 8 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 9 Higher-risk sex refers to sexual intercourse with a non-marital, non-cohabitating partner. Expressed as a percentage of men and women age 15- 24 who had higher-risk sex in the past 12 months. 10 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about transmission or prevention of HIV. 11 Measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and received any anti-malarial drug 12 Percentage of de-jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tubewell or borehole, protected dug well, protected spring, rainwater collection, or bottled water 13 Percentage of de-jure population whose household has a flush toilet, ventilated improved pit latrine, or pit latrine with a slab, and does not share this facility with other households xviii • Map of Zimbabwe Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY AND ECONOMY imbabwe lies just north of the Tropic of Capricorn between the Limpopo and 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, 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 that could be harnessed for generation of electric power, irrigation of crops, and domestic and industrial use. Mineral resources are varied and extensive, including platinum, gold, asbestos, coal, nickel, iron, copper, lithium, and precious stones such as emeralds and diamonds. The economy is diversified but biased toward agriculture and mining, which are by far the country’s major foreign-currency earning sectors. In addition to mineral processing, major industries include food processing, construction, chemicals, textiles, wood and furniture, and production transport equipment. In recent years the mining industry has faced challenges such as frequent power outages, inefficient infrastructure, flight of skilled workers, and shortages of funds for working capital and recapitalisation. The manufacturing industry also has suffered constraints such as deindustrialisation, inadequate and erratic supply of key economic enablers (namely electricity, fuel, coal, and water), and the high cost of establishing business. The agriculture sector has well-developed commercial and communal farming systems. As a result of the country’s resettlement scheme, Zimbabwe now has some A1 and A2 farms that previously were largely commercial farms. The communal and resettlement sector’s contribution to the production of industrial raw materials and food products has increased substantially since 1980, despite its poor physical and socioeconomic infrastructure. The agricultural sector continues to face many challenges such as poor irrigation, unaffordable inputs, and low capitalisation levels. The main agricultural export product is tobacco, along with maize, cotton, sugar, and groundnuts. However, the economic challenges of recent years have affected export crops. Z 2 • Introduction In 2011, the inclusive government of Zimbabwe implemented a five-year strategic development plan, the Zimbabwe 2011-2015 Medium Term Plan (MTP) (MEPIP, 2011). It outlines the economic policies, projects, and programmes that will guide the nation and set priorities through 2015. The goals of the MTP are to maintain macroeconomic stability, restore the economy’s capacity to produce goods and services competitively, and empower people to fully participate in the economy so as to achieve the vision of the plan. The MTP empowers Zimbabweans both socially and economically in order to eradicate poverty and ensure sustainable development. 1.2 POPULATION According to the 2002 census, the population of Zimbabwe was 11.6 million. 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 non-Africans. Table 1.1 presents population growth rates compiled from the population censuses. The average annual growth in the population reached a peak of 3.5 percent in 1951 and 1961 and then dropped to 3 percent between 1982 and 1992. The annual population growth rate between 1992 and 2002 was 1.1 percent. Table 1.1 Population size and growth rate Population size and annual rate of increase in the population, Zimbabwe 1901-2002 Year Population (’000) Annual growth rate (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 2002 11,632 1.1 Source: Central Statistical Office, 2002 Table 1.2 shows that the population of people of African descent was 99 percent in 2002. The population of European, Asian, and Coloured descendants made up the remaining 1 percent in 2002. The 2002 census estimated the crude birth rate and the crude death rate to be about 30 births per thousand population and 17 deaths per thousand population, respectively. Forty-one percent of the population of Zimbabwe was below age 15, 55 percent was between age 15 and 64, and a very small proportion (4 percent) was age 65 or above. Introduction • 3 Table 1.2 Demographic indicators Selected demographic indicators, Zimbabwe 1992 and 2002 Indicator 1992 Census 2002 Census Total population (thousands) 10,412 11,632 Distribution by ethnic group (percent) African 98.8 99.3 European 0.8 0.4 Coloured 0.3 0.2 Asian 0.1 0.1 Distribution by age group (percent) 0-14 45.1 40.6 15-64 51.3 55.0 65+ 3.3 4.0 Not stated 0.3 0.4 Crude birth rate (births per 1,000 population) 34.5 30.3 Crude death rate (deaths per 1,000 population) 9.5 17.2 Number of males per 100 females in the total population 95 94 Life expectancy at birth 61.0 45.0 Source: Central Statistical Office, 2002 1.3 OBJECTIVES OF THE SURVEY The 2010-2011 Zimbabwe Demographic and Health Survey (2010-11 ZDHS) is one of a series of surveys undertaken by the Zimbabwe National Statistics Agency (ZIMSTAT) as part of the Zimbabwe National Household Survey Capability Programme (ZNHSCP) and the worldwide MEASURE DHS programme. The Ministry of Health and Child Welfare (MOH&CW) and the Zimbabwe National Family Planning Council (ZNFPC) contributed significantly to the design and implementation of the 2010-11 ZDHS and to the analysis of the survey results. Financial support for the 2010-11 ZDHS was provided by the government of Zimbabwe, the United States Agency for International Development (USAID), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United Kingdom Department for International Development (DFID), the European Union (EU), the United Nations Population Fund (UNFPA), the United Nations Development Fund (UNDP), the United Nations Children’s Fund (UNICEF), and the Centers for Disease Control and Prevention (CDC). The Demographic and Health Research Division of ICF International provided technical assistance during all phases of the survey. The 2010-11 ZDHS is a follow-on to the 1988, 1994, 1999, and 2005-06 ZDHS surveys and provides updated estimates of basic demographic and health indicators covered in these earlier surveys. Data on malaria prevention and treatment, domestic violence, anaemia, and HIV/AIDS were also collected in the 2010-11 ZDHS. In contrast to the earlier surveys, the 2010-11 ZDHS was carried out using electronic personal digital assistants (PDAs) rather than paper questionnaires for recording responses during interviews. The primary objective of the 2010-11 ZDHS is 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 knowledge and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs). 4 • Introduction 1.4 SURVEY IMPLEMENTATION 1.4.1 Sample Design The sample for the 2010-11 ZDHS was designed to provide population and health indicator estimates at the national and provincial levels. The sample design allows for specific indicators, such as contraceptive use, to be calculated for each of Zimbabwe’s 10 provinces (Manicaland, Mashonaland Central, Mashonaland East, Mashonaland West, Matabeleland North, Matabeleland South, Midlands, Masvingo, Harare, and Bulawayo). The sampling frame used for the 2010-11 ZDHS was the 2002 Population Census. Administratively, each province in Zimbabwe is divided into districts and each district into smaller administrative units called wards. During the 2002 Population Census, each of the wards was subdivided into enumeration areas (EAs). The 2010-11 ZDHS sample was selected using a stratified, two-stage cluster design, and EAs were the sampling units for the first stage. Overall, the sample included 406 EAs, 169 in urban areas and 237 in rural areas. Households were the units for the second stage of sampling. A complete listing of households was carried out in each of the 406 selected EAs in July and August 2010. Maps were drawn for each of the clusters, and all private households were listed. The listing excluded institutional living facilities (e.g., army barracks, hospitals, police camps, and boarding schools). A representative sample of 10,828 households was selected for the 2010-11 ZDHS. All women age 15-49 and all men age 15-54 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. Anaemia testing was performed in each household among eligible women and men who consented to being tested. With the parent’s or guardian’s consent, children age 6-59 months were also tested for anaemia. Also, among eligible women and men who consented, blood samples were collected for laboratory testing of HIV in each household. In addition, one eligible woman in each household was randomly selected to be asked additional questions about domestic violence. 1.4.2 Questionnaires Three questionnaires were used for the 2010-11 ZDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires were adapted from model survey instruments developed for the MEASURE DHS project to reflect population and health issues relevant to Zimbabwe. Relevant issues were identified at a series of meetings with various stakeholders from government ministries and agencies, nongovernmental organizations (NGOs), and international donors. Also, more than 30 individuals representing 19 separate stakeholders attended a questionnaire design meeting on 8-9 February 2010. In addition to English, the questionnaires were translated into two major languages, Shona and Ndebele. The Household Questionnaire was used to list all of the usual members and visitors of selected households. Some basic information was collected on the characteristics of each person listed, including his or her age, sex, education, and relationship to the head of the household. For children under age 18, survival status of the parents was determined. The data on age and sex obtained in the Household Questionnaire were used to identify women and men who were eligible for an individual interview. Additionally, the Household Questionnaire collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, Introduction • 5 materials used for the floor of the house, ownership of various durable goods, and ownership and use of mosquito nets (to assess the coverage of malaria prevention programmes). The Woman’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: • Background characteristics (age, education, media exposure, etc.) • Birth history and childhood mortality • Knowledge and use of family planning methods • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Women’s work and husbands’ background characteristics • Malaria prevention and treatment • Awareness and behaviour regarding AIDS and other sexually transmitted infections (STIs) • Adult mortality, including maternal mortality • Domestic violence The Man’s Questionnaire was administered to all men age 15-54 in each household in the 2010-11 ZDHS sample. The Man’s Questionnaire collected much of the same information found in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health. In this survey, instead of using paper questionnaires, interviewers used personal digital assistants to record responses during interviews. The PDAs were equipped with Bluetooth technology to enable remote electronic transfer of files (e.g., transfer of assignment sheets from team supervisors to interviewers and transfer of completed questionnaires from interviewers to supervisors). The PDA data collection system was developed by the MEASURE DHS project using the mobile version of CSPro. CSPro is software developed jointly by the U.S. Census Bureau, the MEASURE DHS project, and Serpro S.A. 1.4.3 Anthropometry, Anaemia, and HIV Testing The 2010-11 ZDHS incorporated three “biomarkers”: anthropometry, anaemia testing, and HIV testing. In contrast to the data collection procedure for the household and individual interviews, data related to biomarkers were initially recorded on a paper form (the Biomarker Data Collection Form) and subsequently entered into the PDA. The protocol for anaemia testing and for blood specimen collection for HIV testing was reviewed and approved by the Medical Research Council of 6 • Introduction Zimbabwe (MRCZ), the Institutional Review Board of ICF Macro (now ICF International), and the CDC. Anthropometry. In all households, height and weight measurements were recorded for children age 0-59 months, women age 15-49, and men age 15-54. Anaemia testing. Blood specimens for anaemia testing were collected from all children age 6-59 months, women age 15-49, and men age 15-54 who voluntarily provided written consent to be tested. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-12 months with especially small or thin fingers) and collected in a microcuvette. Haemoglobin analysis was carried out on site using a battery-operated portable HemoCue analyzer. Results were provided verbally and in writing. Parents of children with a haemoglobin level under 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, nonpregnant women, pregnant women, and men were referred for follow-up care if their haemoglobin levels were below 7 g/dl, 9 g/dl, and 9 g/dl, respectively. All households in which anthropometry and/or anaemia testing was conducted were given a brochure explaining the causes and prevention of anaemia. HIV testing. ZDHS biomarker technicians collected blood specimens for laboratory testing of HIV from all women age 15-49 and men age 15-54 who provided written consent to be tested. The protocol for blood specimen collection and analysis was based on the anonymous linked protocol developed for MEASURE DHS. This protocol allows for merging of HIV test results with the sociodemographic data collected in the individual questionnaires after removal of all information that could potentially identify an individual. Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. If a respondent consented to HIV testing, five blood spots from the finger prick were collected on a filter paper card to which a barcode label unique to the respondent was affixed. A duplicate label was attached to the Biomarker Data Collection Form. A third copy of the same barcode was affixed to the Blood Sample Transmittal Form to track the blood samples from the field to the laboratory. Respondents were asked whether they would consent to having the laboratory store their blood sample for future unspecified testing. If respondents did not consent to additional testing using their sample, it was indicated on the Biomarker Data Collection Form that they refused additional tests, and the words “no additional testing” were written on the filter paper card. Each household, whether individuals consented to HIV testing or not, was given an informational brochure on HIV/AIDS and a list of fixed sites providing voluntary counselling and testing services in surrounding districts within the province. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected in the field, along with the completed questionnaires, and transported to ZIMSTAT in Harare to be logged in and checked; they were then transported to the National Microbiology Reference Laboratory (NMRL) in Harare. Once it arrived at NMRL, each blood sample was logged into the CSPro HIV Test Tracking System database, given a laboratory number, and stored at -20˚C until tested. The HIV testing protocol stipulated that blood could be tested only after questionnaire data collection had been completed, data had been verified and cleaned, and all unique identifiers other than the anonymous barcode number had been removed from the data file. The algorithm called for testing all samples on Introduction • 7 the first assay test, an enzyme-linked immunosorbent assay (ELISA), the Ani Labsystems HIV EIA. A negative result was considered negative. All samples with positive results were subjected to a second ELISA, the Vironostika® HIV Uni-Form II Plus O (Biomerieux). Positive samples on the second test were considered positive. If the first and second tests were discordant, a third confirmatory test, the HIV 2.2 western blot (DiaSorin), was administered. The final result was considered positive if the western blot confirmed it to be positive and negative if the western blot confirmed it to be negative. If the western blot results were indeterminate, the sample was considered indeterminate. 1.4.4 Training of Field Staff ZIMSTAT staff and a variety of experts from government ministries, NGOs, and donor organizations participated in a three-day training of trainers session conducted from 30 June to 2 July 2010. Immediately following this training session, pretest training and fieldwork took place. For two weeks in July 2010, 16 participants were trained to administer both paper and electronic questionnaires, take anthropometric measurements, and collect blood samples for anaemia and HIV testing. A representative from the NMRL assisted in training participants on use of finger pricks for blood collection and on proper handling and storage of dried blood spots for HIV testing. The pretest fieldwork was conducted over four days and covered approximately 100 households. Debriefing sessions were held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. ZIMSTAT recruited and trained 125 people for the main fieldwork to serve as supervisors, deputy supervisors, interviewers, and reserve interviewers. Training of field staff for the main survey was conducted during a four-week period in late August and September 2010. The training course consisted of instruction regarding interviewing techniques and field procedures, a detailed review of questionnaire content, instruction on how to administer the paper and electronic questionnaire, 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 2010-11 ZDHS sample points. In addition, interviewers who were assigned as team biomarker technicians completed field practice in anthropometry, anaemia testing, and blood collection. Team supervisors and deputy supervisors were trained in data quality control procedures, fieldwork coordination, and use of special programs for the PDAs. Deputy supervisors were also trained in using Global Positioning System (GPS) receivers to obtain coordinates for sample clusters. 1.4.5 Fieldwork Fifteen interviewing teams carried out data collection for the 2010-11 ZDHS. Each team consisted of one team supervisor, one deputy supervisor, three female interviewers, three male interviewers, and one driver. Three of the interviewers on each team also served as biomarker technicians. Electronic data files were transferred from each interviewer’s PDA to the team supervisor’s PDA each day. Thirteen senior staff members from ZIMSTAT coordinated and supervised fieldwork activities. Electronic data files were transferred to ZIMSTAT staff PDAs during field visits. Participants in fieldwork monitoring also included a survey technical specialist, a consultant, and two data processing staff from the MEASURE DHS project as well as representatives from other organisations supporting the survey, including NMRL, UNFPA, USAID, and ZNFPC. Data collection took place over a six-month period, from 29 September 2010 through late March 2011. 8 • Introduction 1.4.6 Data Processing All electronic data files for the ZDHS were returned to the ZIMSTAT central office in Harare, where they were stored on a password-protected computer. The data processing operation included secondary editing, which involved resolution of computer-identified inconsistencies and coding of open-ended questions. Two members of the data processing staff processed the data. Data editing was accomplished using CSPro software. Office editing and data processing were initiated in October 2010 and completed in May 2011. 1.5 RESPONSE RATES Table 1.3 shows response rates for the 2010-11 ZDHS. A total of 10,828 households were selected for the sample, of which 10,166 were found to be occupied during the survey fieldwork. The shortfall was largely due to members of some households being away for an extended period of time and to structures that were found to be vacant at the time of the interview. Of the 10,166 existing households, 9,756 were successfully interviewed, yielding a household response rate of 96 percent. A total of 9,831 eligible women were identified in the interviewed households, and 9,171 of these women were interviewed, yielding a response rate of 93 percent. Of the 8,723 eligible men identified, 7,480 were successfully interviewed (86 percent response rate). The principal reason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the households. The lower response rate among men than among women was due to the more frequent and longer absences of men from the households. Nevertheless, the response rates for both women and men were higher in the 2010-11 ZDHS than in the 2005-06 ZDHS (in which response rates were 90 percent for women and 82 percent for men). Table 1.3 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Zimbabwe 2010-11 Residence Result Urban Rural Total Household interviews Households selected 3,718 7,110 10,828 Households occupied 3,558 6,608 10,166 Households interviewed 3,325 6,431 9,756 Household response rate1 93.5 97.3 96.0 Interviews with women age 15-49 Number of eligible women 3,808 6,023 9,831 Number of eligible women interviewed 3,437 5,734 9,171 Eligible women response rate2 90.3 95.2 93.3 Interviews with men age 15-54 Number of eligible men 3,253 5,470 8,723 Number of eligible men interviewed 2,539 4,941 7,480 Eligible men response rate2 78.1 90.3 85.8 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 9 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter presents information on demographic and socioeconomic characteristics of the household population such as age, sex, education, and place of residence. The environmental profile of households included in the 2010-11 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. In the 2010-11 ZDHS, a household referred to a person or group of related and unrelated persons who lived together in the same dwelling unit(s), who acknowledged one adult male or female as the head of the household, who shared the same housekeeping arrangements, and who were considered a single unit. Information was collected from all usual residents of each selected household and visitors who had stayed in the selected household the night before the interview. Those persons who stayed in the selected household the night before the interview (whether usual residents or visitors) represent the de facto population; usual residents alone constitute the de jure population. To maintain comparability with other surveys, all tables in this report refer to the de facto population unless otherwise specified. 2.1 HOUSEHOLD CHARACTERISTICS The physical characteristics of households and the availability and accessibility of basic household facilities are important in assessing the general welfare and socioeconomic condition of the population. The 2010-11 ZDHS collected information on a range of housing characteristics. These data are presented for households and are further disaggregated by residence. 2.1.1 Drinking Water Table 2.1 shows information on drinking water. The source of drinking water is an indicator of water quality. Sources that are likely to be of suitable quality are listed under “improved source,” while sources not of suitable quality are listed under “non-improved source,” reflecting the categorizations of the WHO/UNICEF Joint Monitoring Programme (JMP) for Water and Sanitation (WHO/UNICEF JMP, 2012). T Key Findings • Seventy-nine percent of Zimbabwean households are using an improved source of drinking water. • Ownership of mobile phones has risen dramatically since the 2005-06 ZDHS. Whereas 14 percent of households owned a mobile phone in 2005-06, 62 percent of households reported owning a mobile phone in the 2010-11 ZDHS. • Five in ten children under age 5 have a birth certificate or have had their birth registered. • Approximately one-fifth of children under age 18 are orphaned (that is, one or both parents are not living). • Ninety-three percent of males and 91 percent of females age 6 and over have ever attended school. 10 • Housing Characteristics and Household Population Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Zimbabwe 2010-11 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source Piped water into dwelling/yard/plot 71.0 7.3 28.8 71.5 5.1 25.4 Public tap/standpipe 5.5 4.2 4.7 5.2 3.1 3.7 Tubewell/borehole 11.6 37.0 28.4 12.0 38.5 30.4 Protected dug well 6.5 20.8 16.0 6.2 21.0 16.5 Protected spring 0.0 1.1 0.7 0.1 1.0 0.7 Rainwater 0.0 0.0 0.0 0.0 0.0 0.0 Bottled water 0.2 0.0 0.1 0.2 0.0 0.1 Non-improved source Unprotected dug well 3.6 17.3 12.7 3.4 18.4 13.8 Unprotected spring 0.3 3.5 2.4 0.4 3.6 2.6 Tanker truck/cart with drum 0.7 0.1 0.3 0.4 0.1 0.2 Surface water 0.2 8.6 5.8 0.3 9.2 6.4 Other source 0.2 0.1 0.1 0.4 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 94.9 70.4 78.7 95.1 68.7 76.7 Time to obtain drinking water (round trip) Water on premises 80.1 23.2 42.4 79.9 21.6 39.4 Less than 30 minutes 14.2 47.3 36.1 14.3 47.1 37.1 30 minutes or longer 5.1 28.4 20.6 5.3 30.4 22.8 Don't know 0.6 1.0 0.9 0.4 0.9 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 16.0 4.9 8.6 16.2 4.7 8.2 Bleach/chlorine added 13.4 14.9 14.4 14.5 15.8 15.4 Strained through cloth 0.0 0.1 0.1 0.0 0.1 0.1 Ceramic, sand or other filter 0.5 0.2 0.3 0.6 0.3 0.4 Solar disinfection 0.2 0.0 0.1 0.1 0.0 0.0 Other 0.3 0.7 0.6 0.3 0.6 0.6 No treatment 72.6 80.9 78.1 71.6 80.3 77.6 Percentage using an appropriate treatment method2 27.1 18.7 21.5 28.1 19.3 22.0 Number 3,290 6,466 9,756 12,344 28,057 40,401 1 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. The majority of households in Zimbabwe (79 percent) have access to an improved source of water (95 percent in urban areas and 70 percent in rural areas). This proportion is virtually the same as that found in the 2005-06 ZDHS. With regard to specific sources, 29 percent of households have water piped into the dwelling, yard, or plot, while 28 percent of households use a tubewell/borehole, 16 percent use a protected dug well, and 5 percent use a public tap or standpipe. Seven in 10 urban households drink water that is piped into the dwelling, yard, or plot. In rural areas, tubewells/boreholes are the main source of drinking water (37 percent), followed by protected and unprotected dug wells (21 percent and 17 percent, respectively). In 80 percent of urban households, water is available within the dwelling or plot (on premises). In contrast, three-quarters of rural households obtain water from a source not on the premises, with 28 percent of these households reporting that it takes 30 minutes or longer (round trip) to access drinking water. Most households (78 percent) do not treat their drinking water. Nine percent of households boil their water, and 14 percent use bleach or chlorine. The latter proportion is higher than in 2005-06, Housing Characteristics and Household Population • 11 when 2 percent of households reported that they used bleach or chlorine to treat water used for drinking. Among urban households, 73 percent do not treat their water, compared with 81 percent in rural areas. Much of this difference is attributable to the higher proportion of urban than rural households that report boiling water prior to drinking it (16 percent and 5 percent, respectively). 2.1.2 Sanitation Facilities and Waste Disposal Table 2.2 presents information on the proportion of households that have access to hygienic sanitation facilities by type of toilet/latrine. A household’s sanitation facility is classified as unhygienic if it is shared with other households or if it is unimproved (i.e., it does not effectively separate human waste from human contact). The types of facilities considered improved are toilets that flush or pour flush into a piped sewer system, septic tank, or pit latrine; ventilated improved pit (VIP) latrines or Blair toilets; and pit latrines with a slab. Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Zimbabwe 2010-11 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility 44.9 30.8 35.5 49.8 31.8 37.3 Flush/pour flush to piped sewer system 36.0 1.9 13.4 40.6 1.6 13.5 Flush/pour flush to septic tank 5.2 1.2 2.5 5.5 0.9 2.3 Flush/pour flush to pit latrine 1.4 0.5 0.8 1.5 0.4 0.7 Ventilated improved pit (VIP) latrine/Blair toilet 1.3 16.4 11.3 1.2 17.6 12.6 Pit latrine with slab 1.0 10.7 7.4 1.0 11.3 8.1 Shared facility1 48.5 18.9 28.9 44.0 15.5 24.2 Flush/pour flush to piped sewer system 38.5 0.6 13.4 35.9 0.4 11.3 Flush/pour flush to septic tank 3.7 0.3 1.5 3.0 0.2 1.0 Flush/pour flush to pit latrine 2.5 0.1 0.9 2.1 0.1 0.7 Ventilated improved pit (VIP) latrine/Blair toilet 1.8 11.5 8.2 1.5 9.1 6.8 Pit latrine with slab 2.1 6.4 4.9 1.6 5.7 4.4 Non-improved facility 6.6 50.3 35.6 6.2 52.7 38.5 Flush/pour flush not to sewer/septic tank/pit latrine 1.0 0.1 0.4 0.9 0.1 0.3 Pit latrine without slab/open pit 1.9 11.5 8.3 2.1 12.5 9.3 Bucket 1.7 0.0 0.6 1.5 0.0 0.5 No facility/bush/field 1.9 38.6 26.2 1.6 40.0 28.3 Other 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,290 6,466 9,756 12,344 28,057 40,401 1 Facilities that would be considered improved if they were not shared by two or more households Thirty-six percent of households in Zimbabwe have improved toilet facilities that are not shared with other households. Slightly less than half of these households have flush toilets, mainly toilets connected to a piped sewer system (13 percent). Nineteen percent of households use some type of a latrine that is not shared with other households. Most urban households with improved, not shared facilities have toilets that are piped to a sewer system or flushed to a septic tank or pit latrine (43 percent). In rural areas, the most common improved, non-shared toilets are VIP latrines and Blair toilets (16 percent), followed by pit latrines with a slab (11 percent). Slightly more than one-quarter of Zimbabwean households have improved facilities that are shared with other households. Urban households are more than twice as likely to share an improved facility as rural households (49 percent and 19 percent, respectively). Half of rural households have an unimproved facility, compared with 7 percent of urban households. The most common unimproved facilities in urban households are buckets, pit latrines without a slab/open pits, and no 12 • Housing Characteristics and Household Population facility/bush/field (2 percent each). Thirty-nine percent of households in rural areas have no toilet facility, a slightly lower proportion than that reported in the 2005-06 ZDHS (45 percent). 2.1.3 Housing Characteristics Table 2.3 presents information on a number of household dwelling characteristics along with the percentage of households using various types of fuel for cooking and the frequency of smoking inside the home. These characteristics reflect the household’s socio- economic situation. They also may influence environmental conditions that have a direct bearing on household members’ health and welfare. Thirty-seven percent of households in Zimbabwe have access to electricity that is connected via power lines. There is a significant difference in access to electricity between urban and rural areas. In urban areas 83 percent of households have electricity, compared with 13 percent in rural areas. The most commonly used flooring material is cement (67 percent), followed by dung (16 percent) and earth/sand (13 percent). In urban areas, 87 percent of households have cement floors, compared with 58 percent in rural areas. Earth/sand or dung floors are found in 41 percent of rural dwelling units. Data were collected on the number of sleeping rooms per household. Forty-two percent of households have one room used for sleeping, while 33 percent have two rooms and 25 percent have three or more rooms. The number of rooms used for sleeping does not vary much by place of residence. Information on type of fuel used for cooking and place for cooking was obtained to assess the extent to which household members may be exposed to the potentially harmful effects of smoke from cooking with solid fuels, that is, coal, plant materials, and animal waste (WHO, 2011). Slightly less than 7 of 10 households in Zimbabwe use some type of solid fuel. Almost all households using solid fuels cook with wood. In rural areas, 94 percent of households use wood for cooking, compared with 20 percent in urban areas. A majority of urban households use electricity for cooking (73 percent); in contrast, only 6 percent of rural households use electricity for this purpose. Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Zimbabwe 2010-11 Housing characteristic Residence Total Urban Rural Electricity Yes 83.2 13.3 36.9 No 16.8 86.7 63.1 Total 100.0 100.0 100.0 Flooring material Earth/sand 1.6 18.2 12.6 Dung 0.4 23.1 15.5 Wood planks 0.6 0.4 0.5 Parquet or polished wood 1.6 0.2 0.7 Vinyl or asphalt strips 0.4 0.1 0.2 Ceramic tiles 5.0 0.2 1.9 Cement 86.8 57.5 67.4 Carpet 3.2 0.2 1.2 Other 0.4 0.1 0.2 Total 100.0 100.0 100.0 Rooms used for sleeping One 48.7 38.3 41.8 Two 29.0 35.7 33.4 Three or more 22.2 26.0 24.8 Total 100.0 100.0 100.0 Place for cooking In the house 77.5 33.3 48.2 In a separate building 4.5 54.4 37.6 Outdoors 17.9 12.3 14.2 No food cooked in household 0.1 0.0 0.0 Total 100.0 100.0 100.0 Cooking fuel Electricity 73.2 5.6 28.4 LPG/natural gas/biogas 0.4 0.0 0.2 Kerosene/paraffin 5.2 0.2 1.9 Jelly 0.1 0.0 0.0 Coal/lignite 0.0 0.0 0.0 Charcoal 0.2 0.1 0.1 Wood 19.8 93.9 68.9 Straw/shrubs/grass 0.0 0.0 0.0 Agricultural crop waste 0.0 0.0 0.0 Other 0.9 0.0 0.3 No food cooked in household 0.1 0.0 0.0 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 20.0 94.1 69.1 Frequency of smoking in the home Daily 11.7 20.3 17.4 Weekly 2.1 3.8 3.2 Monthly 1.8 1.7 1.7 Less than monthly 1.7 1.9 1.8 Never 82.7 72.3 75.9 Total 100.0 100.0 100.0 Number 3,290 6,466 9,756 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood, straw/shrubs/grass, and agricultural crop waste Housing Characteristics and Household Population • 13 The potential for exposure to harmful effects of smoke from using solid fuels for cooking is increased if cooking occurs within the home itself rather than outdoors or in a separate building. Forty-eight percent of households in Zimbabwe cook in the house, 38 percent cook in a separate building, and 14 percent cook outdoors. Seventy-eight percent of urban households cook in the house, compared with 33 percent of rural households. On the other hand, two-thirds of rural households cook in a separate building or outdoors, versus just over a fifth of urban households. Information on frequency of smoking inside the home was obtained to assess the percentage of households in which there is exposure to secondhand smoke, which causes health risks in children and adults who do not smoke. Pregnant women who are exposed to secondhand smoke have a higher risk of delivering a low birth weight baby (Windham et al., 1999), and children exposed to secondhand smoke are at increased risk for respiratory and ear infections and poor lung development (U.S. Department of Health and Human Services, 2006). Seventeen percent of Zimbabwean households report that someone smokes at the home daily, 3 percent report that someone smokes at least once a week, 2 percent report that someone smokes monthly, and 2 percent report that someone smokes less frequently than once a month. In 76 percent of households, smoking never occurs in the home. Overall, smoking inside the home is less frequent in urban areas than in rural areas; smoking never occurs in 72 percent of rural households, compared with 83 percent of urban households. 2.1.4 Household Durable Goods Information on ownership of durable goods and other possessions is presented in Table 2.4 by residence. In general, ownership of household effects, means of transportation, and agricultural land and farm animals is a rough measure of a household’s socio- economic status. Table 2.4 shows that, with respect to household effects, 38 percent of households have a radio, 36 percent have a television, 62 percent have a mobile telephone, and 4 percent have a non-mobile phone. Urban households are more likely than rural households to own modern conveniences powered by electricity, such as a radio (49 percent and 32 percent, respectively) and a television (74 percent and 17 percent, respectively). Eighteen percent of Zimbabwean households own a solar panel, which may be a convenient means to power or charge electrical devices, especially in the absence of access to electricity that is available via power lines. Consistent with the observation that access to electricity that is connected is much lower in rural areas than urban areas (Table 2.3), ownership of solar panels is much higher in rural areas (25 percent) than urban areas (5 percent). Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, livestock/farm animals, and bank account by residence, Zimbabwe 2010-11 Possession Residence Total Urban Rural Household effects Battery/generator 11.0 13.2 12.4 Solar panel 5.1 24.7 18.1 Radio 48.9 32.3 37.9 Television 73.7 17.3 36.3 Mobile telephone 90.1 48.0 62.2 Non-mobile telephone 11.0 0.6 4.1 Refrigerator 45.9 4.3 18.3 Computer 10.2 0.8 4.0 Means of transport Bicycle 20.7 23.5 22.6 Animal drawn cart 9.6 23.9 19.0 Motorcycle/scooter 1.6 0.9 1.1 Car/truck 15.6 3.1 7.3 Boat with a motor 0.6 0.1 0.3 Wheelbarrow 26.5 33.5 31.1 Tractor 1.0 0.7 0.8 Ownership of agricultural land 30.9 79.6 63.2 Ownership of farm animals1 31.1 80.0 63.5 Ownership of bank account 40.4 12.2 21.7 Number 3,290 6,466 9,756 1 Cattle, horses, mules/donkeys, goats, sheep, pigs, rabbits, or chickens/poultry 14 • Housing Characteristics and Household Population The most common means of transportation owned by households in both urban and rural areas is a wheelbarrow (27 percent in urban areas and 34 percent in rural areas). Bicycles, owned by 21 percent of urban households and 24 percent of rural households, are also a common means of transport. Around 1 in 4 rural households and 1 in 10 urban households own an animal drawn cart. Urban households are much more likely to own a car or truck than rural households (16 percent and 3 percent, respectively). A small proportion of households in both urban and rural areas own a motorcycle or scooter (2 percent and 1 percent, respectively). Sixty-three percent of households own agricultural land, and 64 percent own farm animals. Among urban households, 31 percent own agricultural land, compared with 80 percent in rural areas. In Zimbabwe, 22 percent of households have a bank account. Households in urban areas are over three times more likely than households in rural areas to have a bank account (40 percent versus 12 percent). 2.2 HOUSEHOLD WEALTH Information on household assets was used to create an index that is used throughout this report to represent the wealth of the households interviewed in the 2010-11 ZDHS. The wealth index was developed and tested in a large number of countries in relation to inequalities in household income, use of health services, and health outcomes (Rutstein et al., 2000). It has been shown to be consistent with expenditure and income measures (Rutstein, 1999). The wealth index is constructed using household asset data, including ownership of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics such as source of drinking water, sanitation facilities, and type of flooring material. In its current form, which takes account of urban-rural differences in these items and characteristics, the wealth index is created in three steps.1 In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. For purposes of creating scores, categorical variables are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators. The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are formed by assigning the household score to each de jure household member, ranking each person in the population by that score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Thus, throughout this report, wealth quintiles are expressed in terms of quintiles of individuals in the overall population rather than quintiles of individuals at risk for any one health or population indicator. For example, quintile rates for infant mortality refer to infant mortality rates per 1,000 live births among all people in the population quintile concerned, as distinct from quintiles of live births or newly born infants, who constitute the only members of the population at risk of mortality during infancy. 1 The approach to the construction of the wealth index in ZDHS surveys prior to the 2010-11 survey did not take into account urban-rural differences. Housing Characteristics and Household Population • 15 Table 2.5 presents wealth quintiles by urban-rural residence and province. Also included in the table is the Gini Coefficient, which indicates the level of concentration of wealth, 0 being an equal distribution and 1 a totally unequal distribution. Almost all of the urban population is represented in the fourth and highest quintiles (91 percent), while around 6 in 10 households in rural areas are in the lowest and second wealth quintiles. The wealth quintile distribution among provinces shows large variations. As expected, the two urban provinces, Bulawayo and Harare, have the largest proportions in the highest wealth quintile (69 percent and 53 percent, respectively). In contrast, Matabeleland North and Masvingo have the largest proportions in the lowest wealth quintile (61 percent and 33 percent, respectively). Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles and the Gini Coefficient, according to residence and province, Zimbabwe 2010-11 Residence/province Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 0.0 1.1 8.2 36.9 53.9 100.0 12,344 0.09 Rural 28.8 28.3 25.2 12.6 5.1 100.0 28,057 0.40 Province Manicaland 17.5 21.5 29.2 20.4 11.3 100.0 5,623 0.38 Mashonaland Central 25.9 28.8 21.6 13.2 10.5 100.0 3,936 0.41 Mashonaland East 10.2 29.7 34.1 15.5 10.6 100.0 4,158 0.31 Mashonaland West 18.2 24.4 22.1 22.8 12.5 100.0 4,650 0.35 Matabeleland North 61.0 13.5 8.6 8.5 8.3 100.0 2,181 0.59 Matabeleland South 26.8 23.2 26.7 17.3 6.1 100.0 2,293 0.39 Midlands 27.0 23.7 15.9 17.6 15.7 100.0 5,230 0.45 Masvingo 33.0 27.4 20.0 12.1 7.5 100.0 4,397 0.43 Harare 0.0 1.6 10.1 35.4 52.9 100.0 5,916 0.10 Bulawayo 0.0 0.3 2.1 28.3 69.4 100.0 2,016 0.08 Total 20.0 20.0 20.0 20.0 20.0 100.0 40,401 0.39 2.3 HAND WASHING Hand washing with soap and water is ideal. However, hand washing with a non-soap cleaning agent such as ash or sand is an improvement over not using any cleansing agent. To obtain hand-washing information, interviewers asked to see the place where members of the household most often washed their hands; information on the availability of water and/or cleansing agents was recorded only for households where the hand washing place was observed. Table 2.6 shows that interviewers observed the place most often used for hand washing in 56 percent of households. Interviewers were able to observe the hand washing place more often in urban areas (67 percent) than in rural areas (51 percent). The most common reason interviewers were not able to observe the place where members of the household washed their hands was that there was no specific place designated for hand washing (data not shown). 16 • Housing Characteristics and Household Population Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap and other cleansing agents, Zimbabwe 2010-11 Background characteristic Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed Total Number of households with place for hand washing observed Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Residence Urban 66.8 3,290 60.5 1.1 28.7 3.2 0.0 6.4 100.0 2,197 Rural 51.0 6,466 32.8 1.9 35.6 3.9 1.7 24.2 100.0 3,295 Province Manicaland 51.6 1,436 42.7 1.4 49.4 1.7 0.4 4.4 100.0 741 Mashonaland Central 24.0 890 45.9 0.7 31.7 3.5 0.0 18.2 100.0 214 Mashonaland East 38.6 1,042 43.4 4.6 23.6 7.6 4.7 16.1 100.0 402 Mashonaland West 38.2 1,077 53.9 3.7 31.6 2.1 0.8 8.0 100.0 412 Matabeleland North 65.4 495 26.3 1.2 24.7 4.5 2.2 41.2 100.0 324 Matabeleland South 70.1 511 21.8 0.0 24.2 8.3 0.6 45.1 100.0 358 Midlands 81.5 1,153 44.3 1.2 34.6 6.1 2.1 11.8 100.0 939 Masvingo 74.4 1,066 24.3 0.6 35.2 2.1 0.4 37.4 100.0 792 Harare 56.3 1,564 55.9 2.2 32.5 2.0 0.0 7.4 100.0 881 Bulawayo 82.1 522 78.2 0.2 20.5 0.6 0.2 0.3 100.0 428 Wealth quintile Lowest 51.0 1,835 22.3 2.4 33.4 3.4 2.6 35.9 100.0 935 Second 46.2 1,785 25.7 2.2 40.0 4.7 2.2 25.2 100.0 825 Middle 43.9 1,933 35.1 1.1 36.8 4.6 1.2 21.2 100.0 849 Fourth 61.3 2,144 45.8 1.7 36.4 3.6 0.3 12.2 100.0 1,315 Highest 76.2 2,059 69.4 0.9 23.6 2.6 0.1 3.4 100.0 1,568 Total 56.3 9,756 43.9 1.6 32.8 3.6 1.1 17.1 100.0 5,492 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent Among households where the hand washing place was observed, the most common hand washing agent was soap and water (44 percent), followed by water only (33 percent), soap but no water (4 percent), water with another cleansing agent (2 percent), and, finally, another cleansing agent but no water (1 percent). In the case of 17 percent of the households, no water, soap, or any other cleansing agent was observed at the hand washing place; lack of water and a cleansing agent decreased with increasing wealth quintile. 2.4 HOUSEHOLD POPULATION BY AGE, SEX, AND RESIDENCE The 2010-11 ZDHS Household Questionnaire collected 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. Table 2.7 shows the distribution of the 2010-11 ZDHS household population by five-year age groups, according to sex and residence. A total of 40,343 individuals resided in the 9,756 households successfully interviewed; 21,249 were female (representing 53 percent of the population), and 19,094 were male (representing 47 percent of the population). The age-sex structure of the population is shown in the population pyramid in Figure 2.1. The broad base of the pyramid indicates that Zimbabwe’s population is young, a scenario typical of countries with high fertility rates. The proportion of children under age 15 was around 43 percent in 2010-11, while the proportion of individuals age 65 and older was about 5 percent. Housing Characteristics and Household Population • 17 Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Zimbabwe 2010-11 Age Urban Rural Total Male Female Total Male Female Total Male Female Total <5 14.0 12.3 13.1 16.2 14.9 15.5 15.5 14.1 14.8 5-9 11.6 10.5 11.0 16.0 14.3 15.1 14.7 13.2 13.9 10-14 10.5 10.3 10.4 17.0 14.6 15.8 15.1 13.3 14.1 15-19 9.6 11.9 10.8 10.8 8.9 9.8 10.4 9.8 10.1 20-24 10.9 12.7 11.9 7.2 7.9 7.6 8.3 9.4 8.9 25-29 10.8 11.2 11.0 6.4 7.3 6.9 7.8 8.5 8.2 30-34 8.4 8.6 8.5 5.1 5.9 5.5 6.1 6.7 6.4 35-39 6.9 5.8 6.3 4.4 5.1 4.8 5.2 5.3 5.2 40-44 5.0 4.2 4.6 3.1 3.1 3.1 3.7 3.5 3.6 45-49 2.9 3.5 3.2 2.3 3.1 2.7 2.4 3.2 2.8 50-54 2.8 3.1 2.9 1.9 3.9 3.0 2.2 3.7 3.0 55-59 2.7 2.1 2.4 2.5 2.8 2.7 2.6 2.6 2.6 60-64 1.3 1.3 1.3 2.0 2.5 2.3 1.8 2.1 2.0 65-69 1.2 0.9 1.0 1.6 1.6 1.6 1.4 1.4 1.4 70-74 0.4 0.6 0.5 1.1 1.4 1.3 0.9 1.2 1.0 75-79 0.6 0.6 0.6 1.1 1.0 1.0 0.9 0.9 0.9 80+ 0.5 0.6 0.5 1.2 1.6 1.4 1.0 1.3 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,714 6,589 12,303 13,380 14,660 28,040 19,094 21,249 40,343 Figure 2.1 Population Pyramid ZDHS 2010-11 80+ 75-79 70-74 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 FemaleMale 18 • Housing Characteristics and Household Population 2.5 HOUSEHOLD COMPOSITION Table 2.8 shows that a female heads 45 percent of the households in Zimbabwe. This is an increase from the proportion in 2005-06, when 38 percent of households were headed by females. Almost all of the growth in female-headed households has taken place in urban areas; the proportion of female-headed households increased in urban areas from 29 percent to 45 percent during the period between the two surveys while remaining essentially stable in rural areas (43 percent in 2005-06 and 44 percent in 2010-11). Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Zimbabwe 2010-11 Characteristic Residence Total Urban Rural Household headship Male 54.6 55.9 55.4 Female 45.4 44.1 44.6 Total 100.0 100.0 100.0 Number of usual members 0 0.3 0.2 0.3 1 13.1 10.9 11.6 2 15.2 11.4 12.7 3 20.3 17.1 18.2 4 20.5 17.9 18.8 5 13.3 15.5 14.7 6 8.7 10.7 10.0 7 4.1 7.3 6.2 8 2.1 3.7 3.1 9+ 2.5 5.2 4.3 Total 100.0 100.0 100.0 Mean size of households 3.8 4.3 4.1 Percentage of households with orphans and foster children under age 18 Foster children1 23.9 36.9 32.6 Double orphans 5.8 10.7 9.0 Single orphans2 14.4 22.0 19.5 Foster and/or orphan children 29.2 42.6 38.1 Number of households 3,290 6,466 9,756 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent The average household size has decreased slightly, from 4.5 people in 2005-06 to 4.1 people in 2010-11. Urban households are, on average, slightly smaller (3.8 people) than rural households (4.3 people). Information was also collected on the living arrangements and survival status of all children under age 18 residing in the ZDHS sample households. These data can be used to assess the extent to which households are faced with a need to care for orphaned or foster children. Orphans include children whose mother or father has died (single orphans) as well as children who have lost both parents (double orphans). In the case of foster children, both parents are alive but the children are living in a household where neither their natural mother nor natural father resides. Overall, 38 percent of households in Zimbabwe are caring for foster and/or orphaned children. Rural households are more Housing Characteristics and Household Population • 19 likely than urban households to be caring for foster and/or orphaned children (43 percent versus 29 percent). 2.6 BIRTH REGISTRATION The registration of births is the inscription of the facts of each birth into an official log kept at the registrar’s office. Information on the registration of births was collected in the household interview, where respondents were asked whether children under age 5 residing in the household had a birth certificate. If they responded that the child did not have a birth certificate, an additional question was posed to ascertain whether the child’s birth had ever been registered with the births and deaths registry. Table 2.9 shows the percentage of de jure children under age 5 whose births were officially registered and the percentage who had a birth certificate at the time of the survey. Table 2.9 Birth registration of children under age five Percentage of de jure children under age five whose births are registered with the civil authorities, according to background characteristics, Zimbabwe 2010-11 Background characteristic Children whose births are registered Number of children Percentage who had a birth certificate Percentage who did not have a birth certificate Percentage registered Age <2 17.7 21.4 39.1 2,524 2-4 40.2 15.8 56.0 3,388 Sex Male 30.4 17.9 48.3 2,938 Female 30.8 18.5 49.3 2,974 Residence Urban 48.1 17.1 65.2 1,600 Rural 24.1 18.6 42.7 4,312 Province Manicaland 28.1 15.4 43.5 884 Mashonaland Central 28.8 17.3 46.1 608 Mashonaland East 28.3 23.2 51.5 616 Mashonaland West 25.6 11.7 37.3 684 Matabeleland North 32.7 25.0 57.7 299 Matabeleland South 28.7 28.1 56.8 346 Midlands 26.2 22.5 48.8 773 Masvingo 21.9 13.6 35.5 693 Harare 47.1 13.6 60.7 759 Bulawayo 50.0 27.4 77.4 249 Wealth quintile Lowest 16.6 18.8 35.4 1,387 Second 21.2 19.9 41.1 1,282 Middle 27.9 19.5 47.4 1,180 Fourth 38.1 16.7 54.8 1,187 Highest 59.8 15.1 74.9 877 Total 30.6 18.2 48.8 5,912 20 • Housing Characteristics and Household Population The proportion of de jure children whose births were registered was 49 percent. Thirty-one percent had a birth certificate, and 18 percent did not. There is little variation by sex in the proportion of children registered, but there is evidence that children age 2-4 are more likely than those under age 2 to be registered (56 percent and 39 percent, respectively). Children in urban households are more likely to have their birth registered than children in rural households (65 percent and 43 percent, respectively). The proportion of registered births was highest in Bulawayo (77 percent). Children in Masvingo were least likely to have their births registered (36 percent). Households in the highest wealth quintile were most likely to register children’s births, and households in the lowest quintile were least likely (75 percent versus 35 percent). A comparison of the 2005-06 ZDHS with the 2010-11 ZDHS reveals that the percentage of children under age 5 whose births were registered has dropped sharply (74 percent versus 49 percent). 2.7 CHILDREN’S LIVING ARRANGEMENTS, SCHOOL ATTENDANCE, AND PARENTAL SURVIVAL As mentioned above, information was collected on the living arrangements and survival status of all children under age 18 residing in the ZDHS sample households to assess the potential burden on households of the need to provide for orphaned or foster children. These data were also used to assess the situation from the perspective of the children themselves. Table 2.10 presents the proportion of children under age 18 who are not living with one or both parents, either because the parent(s) died or for other reasons. Table 2.10 Children's living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Zimbabwe 2010-11 Background characteristic Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Per- centage not living with a biological parent Per- centage with one or both parents dead1 Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing information on father/ mother Age 0-4 54.1 27.7 2.3 1.0 0.2 10.2 0.5 1.3 0.7 2.0 100.0 12.6 5.1 5,912 <2 60.9 31.9 1.5 0.3 0.0 4.0 0.1 0.2 0.2 0.8 100.0 4.5 2.0 2,524 2-4 49.0 24.6 3.0 1.5 0.4 14.8 0.7 2.0 1.0 2.8 100.0 18.7 7.4 3,388 5-9 42.3 17.9 5.2 3.0 0.6 16.1 2.0 5.2 3.8 3.8 100.0 27.1 17.4 5,596 10-14 34.6 13.6 9.4 3.0 1.9 12.8 2.9 8.0 9.8 4.0 100.0 33.5 33.0 5,715 15-17 28.2 10.0 10.3 2.9 1.9 15.0 4.0 9.7 14.9 3.3 100.0 43.5 41.4 2,489 Sex Male 42.1 18.8 6.1 2.5 1.1 12.5 2.0 5.4 5.9 3.4 100.0 25.8 21.1 9,881 Female 41.5 18.4 6.3 2.2 0.9 14.0 2.1 5.4 6.1 3.1 100.0 27.6 21.4 9,832 Residence Urban 47.0 17.7 6.4 3.3 1.0 12.3 1.8 3.9 4.6 1.9 100.0 22.7 18.2 5,002 Rural 40.0 18.9 6.1 2.1 1.1 13.6 2.1 5.9 6.5 3.7 100.0 28.0 22.3 14,711 Province Manicaland 40.8 21.3 6.2 2.7 1.0 13.6 1.7 5.3 5.5 1.9 100.0 26.1 20.1 2,848 Mashonaland Central 50.7 16.2 6.3 1.7 0.6 10.8 2.2 4.4 5.2 1.8 100.0 22.7 19.2 1,985 Mashonaland East 39.0 18.1 6.2 2.0 0.7 15.2 2.9 5.1 6.8 4.0 100.0 30.0 22.5 2,117 Mashonaland West 47.2 17.0 6.0 1.9 0.9 11.2 2.1 4.9 6.4 2.5 100.0 24.6 20.6 2,338 Matabeleland North 37.1 19.7 8.2 1.9 1.4 13.3 2.2 6.0 5.2 5.1 100.0 26.7 23.8 1,126 Matabeleland South 25.2 21.8 7.1 1.6 0.5 17.7 2.2 7.0 7.3 9.5 100.0 34.2 25.2 1,217 Midlands 42.9 14.1 5.6 3.0 1.5 13.1 2.2 6.8 7.0 4.0 100.0 29.0 23.7 2,605 Masvingo 35.6 23.8 6.0 2.3 1.4 13.7 1.6 6.3 6.7 2.7 100.0 28.3 22.4 2,326 Harare 52.6 15.7 5.8 2.9 1.0 11.2 1.4 3.8 4.3 1.2 100.0 20.8 16.8 2,300 Bulawayo 31.3 22.8 6.3 4.1 1.3 16.1 2.5 5.2 5.5 4.9 100.0 29.2 21.8 850 Wealth quintile Lowest 44.3 18.4 7.2 1.9 1.2 10.2 1.5 5.0 6.2 4.2 100.0 22.8 21.8 4,457 Second 39.8 19.2 6.2 1.3 0.9 13.8 2.3 6.0 6.5 3.9 100.0 28.6 22.4 4,385 Middle 36.5 19.2 6.8 1.8 1.0 15.0 2.8 6.6 7.0 3.5 100.0 31.3 24.8 4,104 Fourth 43.3 18.8 5.7 2.9 0.9 13.7 1.8 5.2 5.4 2.4 100.0 26.1 19.4 3,635 Highest 46.4 17.1 4.7 4.7 1.2 14.0 1.9 4.1 4.3 1.7 100.0 24.3 16.6 3,132 Total <15 43.8 19.9 5.6 2.3 0.9 13.0 1.8 4.8 4.7 3.3 100.0 24.3 18.4 17,224 Total <18 41.8 18.6 6.2 2.4 1.0 13.2 2.0 5.4 6.0 3.3 100.0 26.7 21.3 19,713 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both parents dead, and one parent dead but missing information on survival status of the other parent Housing Characteristics and Household Population • 21 Around 6 in 10 Zimbabwean children under age 18 are not living with both parents. More than one-quarter of children are not living with either parent. Just over one-fifth of children under age 18 are orphaned, that is, one or both parents are dead. The percentage of orphaned children increases rapidly with age, from 5 percent of children under age 5 to 41 percent of children age 15-17. Rural children (22 percent) are more likely to be orphaned than urban children (18 percent). Harare (17 percent) had the lowest proportion of children orphaned, and Matabeleland South had the highest (25 percent). The percentage of children with one or both parents dead peaks at the middle wealth quintile (25 percent) and is lowest at the highest wealth quintile (17 percent). Table 2.11 presents data on school attendance rates and parental survivorship among de jure children age 10-14. The table contrasts the situation among children whose parents are both dead (double orphans) with that among children whose parents are both alive and the children are living with at least one parent. The school attendance ratio in the final column of the table allows an assessment of the extent to which orphaned children are disadvantaged in terms of access to education; ratios below 1.0 indicate that access to education is more limited for double orphans. Table 2.11 School attendance by survivorship of parents For de jure children age 10-14, the percentage attending school by parental survival and the ratio of the percentage attending, by parental survival, according to background characteristics, Zimbabwe 2010-11 Background characteristic Percentage attending school by survivorship of parents Both parents deceased Number Both parents alive and living with at least one parent Number Ratio1 Sex Male 85.9 281 95.0 1,489 0.90 Female 89.6 281 95.2 1,441 0.94 Residence Urban 90.8 101 96.3 732 0.94 Rural 87.1 460 94.7 2,197 0.92 Province Manicaland 94.5 82 93.7 406 1.01 Mashonaland Central 94.1 (42) 94.6 310 1.00 Mashonaland East 91.6 67 94.4 326 0.97 Mashonaland West 71.9 74 96.4 392 0.75 Matabeleland North 76.4 26 93.9 176 0.81 Matabeleland South 84.9 39 94.5 128 0.90 Midlands 89.7 91 95.0 364 0.94 Masvingo 86.3 77 94.9 355 0.91 Harare 97.6 (47) 96.6 355 1.01 Bulawayo 86.3 (16) 98.2 116 0.88 Wealth quintile Lowest 82.1 137 91.3 675 0.90 Second 89.7 146 95.0 649 0.94 Middle 91.1 142 95.1 554 0.96 Fourth 81.9 85 97.2 540 0.84 Highest 97.9 51 98.1 511 1.00 Total 87.8 561 95.1 2,930 0.92 Notes: Table is based only on children who usually live in the household. Figures in parentheses are based on 25-49 unweighted cases. 1 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with at least one parent The results in Table 2.11 show that double orphans are slightly less likely than children whose parents are both alive and who live with at least one parent to be currently in school (88 percent and 95 percent, respectively). An examination of school attendance ratios suggests that 22 • Housing Characteristics and Household Population double orphans in Mashonaland West (0.75) and Matabeleland North (0.81) are the most disadvantaged relative to children whose parents are both alive and who live with at least one parent. 2.8 EDUCATION OF THE HOUSEHOLD POPULATION 2.8.1 Educational Attainment The educational level of household members is among the most important characteristics of the household because it is associated with many factors that have a significant impact on health- seeking behaviour, reproductive behaviour, use of contraception, and the health of children. Tables 2.12.1 and 2.12.2 show the distribution of female and male household members age 6 and above by the highest level of schooling 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, province, and wealth quintile. The majority of Zimbabweans have attained some education, and there is very little difference by sex in educational attainment. Overall, 94 percent of males age 6 and over have ever attended school, compared with 91 percent of females. Table 2.12.1 Educational attainment of the female household population Percent distribution of the de facto female household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Zimbabwe 2010-11 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 16.9 82.8 0.1 0.2 0.0 0.0 0.0 100.0 2,299 0.6 10-14 1.0 71.0 10.4 17.5 0.1 0.0 0.0 100.0 2,818 4.7 15-19 1.2 8.9 12.9 75.3 1.1 0.5 0.1 100.0 2,081 8.7 20-24 0.9 7.4 14.8 68.4 3.7 4.5 0.2 100.0 1,992 10.0 25-29 1.4 8.0 16.9 65.2 1.7 6.0 0.6 100.0 1,810 10.0 30-34 2.2 9.1 18.3 61.8 1.3 6.6 0.6 100.0 1,432 9.5 35-39 3.2 11.9 19.7 58.7 0.6 5.2 0.6 100.0 1,125 8.7 40-44 5.9 15.3 17.8 54.2 0.4 5.4 1.0 100.0 736 8.4 45-49 14.6 28.1 23.8 25.7 0.3 5.8 1.7 100.0 678 6.3 50-54 22.9 34.4 22.2 14.1 0.0 3.4 3.0 100.0 777 4.7 55-59 19.8 40.6 20.8 13.9 0.0 2.7 2.2 100.0 547 4.5 60-64 26.5 48.1 11.3 10.1 0.1 1.0 2.8 100.0 451 3.2 65+ 41.4 42.5 7.6 4.6 0.2 1.3 2.4 100.0 1,012 1.3 Residence Urban 3.3 22.9 9.3 55.2 2.2 6.0 1.1 100.0 5,656 8.9 Rural 11.0 39.6 15.1 32.1 0.3 1.3 0.5 100.0 12,102 5.9 Province Manicaland 8.4 37.2 13.9 36.0 0.6 3.5 0.4 100.0 2,409 6.3 Mashonaland Central 12.6 40.9 14.3 29.4 0.4 2.1 0.4 100.0 1,652 5.6 Mashonaland East 7.4 35.4 15.1 39.6 0.7 1.3 0.6 100.0 1,840 6.4 Mashonaland West 9.5 37.2 14.0 37.0 0.4 1.1 0.8 100.0 1,967 6.2 Matabeleland North 15.9 37.8 16.0 28.2 0.3 0.9 1.0 100.0 953 5.3 Matabeleland South 8.1 38.1 17.9 33.6 0.3 1.4 0.7 100.0 999 6.2 Midlands 9.5 35.6 12.1 39.6 0.6 2.2 0.3 100.0 2,292 6.3 Masvingo 10.9 38.8 14.6 32.5 0.4 2.5 0.4 100.0 2,005 6.0 Harare 3.2 21.4 8.3 57.0 2.5 6.3 1.3 100.0 2,683 9.2 Bulawayo 3.4 23.6 11.2 52.6 2.6 4.8 1.8 100.0 960 8.6 Wealth quintile Lowest 16.5 44.4 16.5 22.0 0.1 0.0 0.6 100.0 3,521 4.5 Second 10.2 41.1 15.9 32.0 0.1 0.1 0.5 100.0 3,477 5.8 Middle 9.7 37.3 14.0 37.3 0.4 0.8 0.6 100.0 3,474 6.2 Fourth 4.6 28.3 12.3 50.4 1.0 2.7 0.6 100.0 3,547 7.5 Highest 2.2 21.4 7.9 54.4 2.9 10.0 1.2 100.0 3,740 9.7 Total 8.6 34.3 13.3 39.4 0.9 2.8 0.7 100.0 17,759 6.5 Note: In Zimbabwe, primary level is referred to as grades 1-7. Secondary level is referred to as forms 1-6. With the primary and secondary levels combined, there is a total of 13 years of schooling. 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level Housing Characteristics and Household Population • 23 Table 2.12.2 Educational attainment of the male household population Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Zimbabwe 2010-11 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 19.0 80.8 0.1 0.1 0.0 0.0 0.0 100.0 2,256 0.5 10-14 1.2 76.7 8.8 13.1 0.0 0.0 0.2 100.0 2,879 4.5 15-19 1.0 13.3 13.0 70.6 1.2 0.4 0.5 100.0 1,995 8.4 20-24 0.7 7.7 10.8 65.8 7.6 6.5 0.8 100.0 1,587 10.2 25-29 1.2 6.3 11.5 66.0 5.8 8.3 1.0 100.0 1,481 10.3 30-34 1.3 6.2 12.3 65.7 3.7 9.8 1.1 100.0 1,161 10.3 35-39 1.0 5.9 14.8 65.7 2.7 8.9 0.9 100.0 986 10.2 40-44 1.7 5.3 9.8 67.4 2.0 12.0 1.9 100.0 701 10.3 45-49 2.7 16.1 17.2 49.4 2.8 9.7 2.0 100.0 467 9.5 50-54 6.2 21.3 31.2 31.1 0.9 7.1 2.3 100.0 416 6.7 55-59 8.1 32.7 23.4 26.7 0.7 4.6 3.9 100.0 494 6.3 60-64 14.6 33.0 21.1 19.7 0.4 4.1 7.1 100.0 346 5.8 65+ 20.9 43.3 14.2 12.0 0.4 4.9 4.2 100.0 810 3.8 Residence Urban 3.0 20.5 6.6 54.2 5.0 9.0 1.5 100.0 4,769 10.1 Rural 6.5 41.5 13.1 34.8 0.9 2.2 0.9 100.0 10,811 6.1 Province Manicaland 4.4 38.1 11.5 38.4 1.7 4.9 1.0 100.0 2,133 6.5 Mashonaland Central 5.8 39.7 12.1 38.3 1.2 2.2 0.7 100.0 1,542 6.3 Mashonaland East 4.8 36.6 12.2 41.5 1.0 3.4 0.5 100.0 1,610 6.6 Mashonaland West 6.5 37.5 11.1 39.2 1.3 2.4 2.0 100.0 1,912 6.4 Matabeleland North 11.2 42.4 17.5 25.1 1.0 1.7 1.1 100.0 823 5.4 Matabeleland South 5.2 43.6 17.5 29.4 1.2 1.9 1.3 100.0 857 6.0 Midlands 6.8 35.6 10.8 41.0 1.2 4.1 0.5 100.0 2,005 6.6 Masvingo 6.6 43.7 11.2 33.0 1.4 3.6 0.5 100.0 1,583 5.9 Harare 2.9 18.3 5.7 56.8 6.2 8.6 1.5 100.0 2,357 10.2 Bulawayo 2.7 23.0 8.8 50.2 4.2 8.2 2.8 100.0 758 9.0 Wealth quintile Lowest 10.0 50.4 13.7 24.9 0.1 0.1 0.9 100.0 2,813 4.7 Second 6.5 43.1 13.8 34.7 0.7 0.5 0.8 100.0 3,049 6.0 Middle 5.5 38.9 12.8 39.3 0.9 1.1 1.4 100.0 3,226 6.3 Fourth 3.6 25.6 10.2 52.9 2.3 4.2 1.2 100.0 3,170 8.5 Highest 2.3 20.1 5.6 49.6 6.4 14.6 1.3 100.0 3,322 10.2 Total 5.5 35.1 11.1 40.8 2.2 4.3 1.1 100.0 15,580 6.7 Note: In Zimbabwe, primary level is referred to as grades 1-7. Secondary level is referred to as forms 1-6. With the primary and secondary levels combined, there is a total of 13 years of schooling. 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level The median number of years of educational attainment is slightly higher for males (6.7 years) than for females (6.5 years). As expected, regardless of sex, educational attainment is higher among urban than rural residents. Among both males and females, the median number of years of schooling is lowest in Matabeleland North and highest in Harare and Bulawayo. Educational attainment rises with wealth quintile, peaking in the highest wealth quintile for both sexes. 2.8.2 School Attendance Ratios In Table 2.13, school attendance ratios are presented by level of schooling and sex, residence, province, and wealth quintile. The net attendance ratio (NAR) is an indicator of participation in schooling among children of official school age—age 6-12 for primary school and age 13-18 for secondary school—and the gross attendance ratio (GAR) indicates participation at each level of schooling among those of any age between 5 and 24. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level.2 Finally, the Gender Parity Index (GPI), or the ratio of female to male attendance rates at the primary and secondary levels, indicates the magnitude of the gender gap 2 Students who are overage for a given level of schooling may have started school overage, may have repeated one or more grades, or may have dropped out of school and later returned. 24 • Housing Characteristics and Household Population in school attendance. A GPI less than one indicates that a smaller proportion of females than males attend school. Table 2.13 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Zimbabwe 2010-11 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 85.6 90.1 88.0 1.05 97.5 100.0 98.8 1.03 Rural 86.8 86.5 86.6 1.00 106.5 103.1 104.8 0.97 Province Manicaland 88.7 85.6 87.2 0.97 109.9 100.3 105.1 0.91 Mashonaland Central 88.8 88.7 88.7 1.00 109.0 106.1 107.6 0.97 Mashonaland East 86.1 86.4 86.2 1.00 104.0 98.9 101.5 0.95 Mashonaland West 84.7 85.3 85.0 1.01 102.3 105.2 103.7 1.03 Matabeleland North 82.6 86.9 84.8 1.05 108.5 105.2 106.8 0.97 Matabeleland South 89.6 89.2 89.4 1.00 103.3 106.8 104.9 1.03 Midlands 83.2 87.3 85.3 1.05 102.8 103.6 103.2 1.01 Masvingo 88.3 87.6 87.9 0.99 105.7 100.7 103.2 0.95 Harare 87.2 88.4 87.8 1.01 98.0 97.4 97.7 0.99 Bulawayo 85.4 92.9 89.3 1.09 97.2 104.9 101.3 1.08 Wealth quintile Lowest 83.6 83.0 83.3 0.99 105.1 98.5 101.7 0.94 Second 88.1 88.4 88.3 1.00 106.7 105.5 106.1 0.99 Middle 86.4 87.6 87.0 1.01 107.0 106.1 106.6 0.99 Fourth 85.8 89.1 87.5 1.04 103.4 101.9 102.6 0.99 Highest 89.6 90.4 90.0 1.01 98.0 100.0 99.0 1.02 Total 86.6 87.3 87.0 1.01 104.5 102.3 103.4 0.98 SECONDARY SCHOOL Residence Urban 61.7 56.4 58.7 0.91 70.9 62.9 66.4 0.89 Rural 42.7 44.4 43.5 1.04 49.5 49.2 49.3 0.99 Province Manicaland 48.8 49.1 48.9 1.01 56.9 52.4 54.8 0.92 Mashonaland Central 39.7 35.9 37.9 0.90 47.9 38.7 43.5 0.81 Mashonaland East 53.4 56.2 54.8 1.05 58.6 61.9 60.2 1.06 Mashonaland West 43.1 40.4 41.8 0.94 52.3 47.3 50.0 0.90 Matabeleland North 28.8 44.3 36.2 1.54 34.7 48.7 41.4 1.41 Matabeleland South 35.6 39.9 37.7 1.12 38.3 43.4 40.8 1.13 Midlands 44.7 51.4 48.0 1.15 54.5 56.3 55.4 1.03 Masvingo 49.7 46.6 48.2 0.94 58.7 54.0 56.3 0.92 Harare 60.0 52.3 55.7 0.87 65.1 58.8 61.6 0.90 Bulawayo 67.7 62.6 64.7 0.92 74.1 70.1 71.8 0.95 Wealth quintile Lowest 26.7 30.5 28.7 1.14 31.2 34.2 32.7 1.10 Second 42.6 45.2 43.8 1.06 47.7 49.3 48.5 1.03 Middle 46.9 48.6 47.6 1.04 55.3 54.5 54.9 0.98 Fourth 52.4 51.1 51.7 0.97 60.3 55.5 57.9 0.92 Highest 69.4 62.6 65.6 0.90 80.7 70.8 75.0 0.88 Total 47.3 48.2 47.8 1.02 54.7 53.6 54.1 0.98 1 The NAR for primary school is the percentage of the primary-school age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school age (13-18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary- school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a 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 GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR(GAR) for females to the NAR(GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR(GAR) for females to the NAR(GAR) for males. The results in Table 2.13 show that, 87 percent of children age 6 to 12 attend primary school and 48 percent of children age 13 to 18 attend secondary school. There is virtually no difference in the NARs for males and females at either the primary or secondary level. At the primary level, the NAR in urban areas is only slightly higher than in rural areas (88 percent and 87 percent, respectively), Housing Characteristics and Household Population • 25 while there is a much wider gap in the NAR between urban and rural areas at the secondary level (59 percent and 44 percent, respectively). By province, only small differences in NAR are observed at the primary school level. In contrast, at the secondary level, there is a high degree of variation in NAR. Bulawayo (65 percent) has the highest NAR and Matabeland North the lowest (36 percent). Attendance is higher among wealthy households than poorer households at both the primary and secondary levels, with greater differences observed at the secondary level. For example, 29 percent of children age 13 to 18 in the lowest wealth quintile attend secondary school, compared with 66 percent in the highest wealth quintile. At the primary school level, the GAR is 103 percent. This figure exceeds the primary school NAR (87 percent) by 16 percent, indicating that a number of children outside the official school age population are attending primary school. At the secondary level, the GAR (54 percent) is closer to the NAR (48 percent), indicating that fewer children outside of the official school age population are attending secondary school. The GPIs for the NAR and GAR are close to 1 at both the primary and secondary school levels. Reflecting the high level of primary school attendance among both boys and girls, variations in GPIs by background characteristics are generally minor and, in a number of subgroups, favour girls. At the secondary level, GAR GPI differences are generally somewhat larger than those observed at the primary level. For example, Table 2.13 shows that the gender gap is somewhat wider in the highest wealth quintile (0.88) than in the lowest wealth quintile (1.10), where, in fact, more girls than boys attend secondary school. Age-specific attendance rates (ASARs) for the population age 5 to 24 are presented in Figure 2.2 by age and sex. The ASAR indicates participation in schooling at any level, from primary to higher levels of education. The trends are the same for males and females. Approximately half of children attend school by age 6. In the 8-13 age group, 9 of 10 children attend school. At age 14, attendance rates begin to decline with increasing age, and the decline is faster for females than males after age 15. Figure 2.2 Age-specific Attendance Rates of the de facto Population 5 to 24 Years ZDHS 2010-11 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percent Male Female Characteristics of Respondents • 27 CHARACTERISTICS OF RESPONDENTS 3 his chapter presents information on demographic and socioeconomic characteristics of the survey respondents such as age, education, place of residence, marital status, employment, and wealth status. This information is useful for understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviours, as they provide a context for the interpretation of demographic and health indices. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Background characteristics of the 9,171 women age 15-49 and 7,480 men age 15-54 interviewed in the 2010-11 ZDHS are presented in Table 3.1. The distribution of respondents according to age shows a similar pattern for men and women. The proportion of respondents in each age group declines with increasing age for both sexes. Forty-one percent of women and 44 percent of men are in the 15-24 age group, and 33 percent of women and 31 percent of men are in the 25-34 age group. Fifty-nine percent of women and 50 percent of men are married, while 3 percent of women and 1 percent of men are in informal unions. Male respondents are much more likely than female respondents to have never married (45 percent versus 24 percent). Six percent of female respondents and 1 percent of male respondents are widowed. Men are less likely to be divorced or separated than women (3 percent versus 8 percent). The proportion of men in urban areas (37 percent) does not vary much from that of women (39 percent). The largest proportions of both male and female respondents live in Harare (18 percent and 19 percent, respectively) and Manicaland (14 percent and 13 percent, respectively). The smallest proportions live in Matabeleland North and Matabeleland South (5 percent each). T Key Findings • Literacy rates are high in Zimbabwe: 94 percent of women and 96 percent of men are literate. • Among women who were employed in the past 12 months, 36 percent worked in sales and services. Among men who were employed in the past 12 months, 29 percent worked in agriculture. • Twenty-one percent of men report that they smoke cigarettes, while less than 1 percent of women report using any form of tobacco. Both proportions are comparable to those reported in the 2005-06 ZDHS. 28 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Zimbabwe 2010-11 Background characteristic Women Men Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 21.2 1,945 1,980 24.4 1,735 1,848 20-24 20.1 1,841 1,815 19.3 1,372 1,332 25-29 18.4 1,686 1,696 17.4 1,236 1,186 30-34 14.1 1,296 1,287 13.6 970 962 35-39 11.5 1,051 1,034 11.6 828 818 40-44 8.0 732 727 8.3 589 570 45-49 6.8 620 632 5.3 379 388 Religion Traditional 0.6 57 63 3.9 280 249 Roman Catholic 8.4 773 764 10.0 712 696 Protestant 16.8 1,539 1,511 13.9 991 935 Pentecostal 21.1 1,939 1,850 14.5 1,030 997 Apostolic Sect 38.0 3,488 3,396 27.7 1,968 1,955 Other Christian 8.4 768 953 7.7 550 556 Muslim 0.5 43 40 0.6 42 41 None 6.1 558 589 21.5 1,526 1,666 Other 0.1 6 5 0.1 10 9 Marital status Never married 24.0 2,197 2,332 45.3 3,221 3,322 Married 59.4 5,443 5,317 49.7 3,531 3,402 Living together 2.8 260 261 0.8 53 62 Divorced/separated 7.8 711 680 3.4 238 255 Widowed 6.1 560 581 0.9 66 63 Residence Urban 38.7 3,548 3,437 36.9 2,621 2,412 Rural 61.3 5,623 5,734 63.1 4,488 4,692 Province Manicaland 13.4 1,227 1,011 13.7 972 789 Mashonaland Central 9.5 871 904 10.4 738 789 Mashonaland East 9.0 824 847 9.4 667 714 Mashonaland West 11.2 1,026 970 12.3 872 836 Matabeleland North 4.8 443 767 4.9 349 557 Matabeleland South 5.1 467 835 4.9 352 650 Midlands 12.2 1,123 979 12.5 885 808 Masvingo 9.9 909 816 8.2 585 517 Harare 18.8 1,722 1,196 18.4 1,307 894 Bulawayo 6.1 558 846 5.4 382 550 Education No education 2.3 212 224 0.8 56 69 Primary 28.0 2,568 2,650 21.2 1,508 1,671 Secondary 65.1 5,966 5,904 70.7 5,027 4,893 More than secondary 4.6 424 393 7.3 519 471 Wealth quintile Lowest 16.9 1,546 1,707 15.1 1,074 1,223 Second 17.4 1,594 1,585 17.1 1,216 1,244 Middle 18.3 1,681 1,589 19.3 1,371 1,355 Fourth 22.6 2,073 2,060 23.4 1,664 1,606 Highest 24.8 2,278 2,230 25.1 1,786 1,676 Total 15-49 100.0 9,171 9,171 100.0 7,110 7,104 50-54 na na na na 370 376 Total 15-54 na na na na 7,480 7,480 Note: Education categories refer to the highest level of schooling attended, whether or not that level was completed. na = Not applicable Education is an important factor in influencing an individual’s attitude and outlook on various aspects of life. Generally, educational attainment in Zimbabwe is high; 78 percent of men and 70 percent of women have attended secondary school or higher. Twenty-one percent of men and 28 percent of women have attended only primary school. One percent of men and 2 percent of women have no education. Characteristics of Respondents • 29 The majority of the respondents (74 percent of men and 93 percent of women) are Christians. Men (22 percent) are more likely than women (6 percent) to report no religion. Men are also more likely to practice traditional religion than women (4 percent and 1 percent, respectively). 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Tables 3.2.1 and 3.2.2 present the percent distributions of female and male respondents by highest level of education attained, according to age, urban-rural residence, and province. Overall, the results show a high level of education in Zimbabwe among both female and male respondents. Men have a slight advantage in average educational attainment, having completed a median of 10 years of schooling compared with 9 years among women. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Zimbabwe 2010-11 Background characteristic Highest level of schooling Total Median years completed Number of women No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 0.3 8.4 13.6 72.6 2.4 2.7 100.0 9.2 3,786 15-19 0.1 9.2 12.7 76.0 1.3 0.7 100.0 8.8 1,945 20-24 0.5 7.6 14.7 69.0 3.5 4.7 100.0 10.0 1,841 25-29 1.4 9.0 16.1 66.1 1.4 6.0 100.0 10.0 1,686 30-34 1.6 9.5 19.5 61.9 0.7 6.7 100.0 9.3 1,296 35-39 2.4 12.2 20.8 58.0 0.7 5.9 100.0 8.7 1,051 40-44 5.9 16.7 16.5 55.2 0.4 5.4 100.0 8.4 732 45-49 14.3 32.5 22.7 24.8 0.3 5.3 100.0 6.1 620 Residence Urban 0.8 4.4 8.8 75.3 2.7 7.9 100.0 10.2 3,548 Rural 3.3 15.8 21.5 56.2 0.7 2.5 100.0 8.0 5,623 Province Manicaland 1.9 12.8 18.3 60.1 1.3 5.7 100.0 8.7 1,227 Mashonaland Central 5.3 23.4 17.5 49.7 0.6 3.4 100.0 7.1 871 Mashonaland East 2.0 6.9 18.8 68.4 1.5 2.4 100.0 9.0 824 Mashonaland West 2.7 16.3 18.7 59.7 0.6 2.0 100.0 8.3 1,026 Matabeleland North 4.5 16.0 27.4 50.2 0.4 1.5 100.0 7.2 443 Matabeleland South 1.6 10.0 25.7 59.4 0.9 2.4 100.0 8.3 467 Midlands 2.7 11.2 15.0 65.8 0.8 4.5 100.0 9.0 1,123 Masvingo 2.4 14.1 21.7 56.4 0.7 4.6 100.0 8.4 909 Harare 0.7 4.6 7.6 76.3 3.1 7.8 100.0 10.2 1,722 Bulawayo 1.1 2.0 10.7 75.6 3.5 7.0 100.0 10.2 558 Wealth quintile Lowest 5.7 25.5 27.5 41.1 0.2 0.1 100.0 6.6 1,546 Second 3.1 16.3 23.0 57.2 0.1 0.2 100.0 7.8 1,594 Middle 2.4 12.5 17.1 65.5 0.8 1.7 100.0 8.5 1,681 Fourth 1.3 6.2 13.4 73.3 1.6 4.3 100.0 10.0 2,073 Highest 0.4 2.4 7.2 73.1 3.6 13.2 100.0 10.3 2,278 Total 2.3 11.4 16.6 63.6 1.5 4.6 100.0 9.0 9,171 Note: In Zimbabwe, primary level is referred to as grades 1-7. Secondary level is referred to as forms 1-6. With the primary and secondary levels combined, there is a total of 13 years of schooling. 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level 30 • Characteristics of Respondents Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Zimbabwe 2010-11 Background characteristic Highest level of schooling Total Median years completed Number of men No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 0.6 10.0 11.5 70.9 4.1 3.0 100.0 9.3 3,107 15-19 0.7 12.2 11.9 74.0 1.1 0.2 100.0 8.6 1,735 20-24 0.6 7.1 10.9 66.9 8.0 6.5 100.0 10.2 1,372 25-29 0.7 6.5 12.2 65.2 5.0 10.5 100.0 10.2 1,236 30-34 0.6 6.2 13.3 65.9 2.7 11.3 100.0 10.2 970 35-39 0.7 7.1 16.4 64.5 1.8 9.4 100.0 10.1 828 40-44 1.4 5.3 10.9 68.7 1.5 12.2 100.0 10.3 589 45-49 2.2 18.6 16.3 51.3 2.1 9.5 100.0 8.9 379 Residence Urban 0.1 2.1 5.8 72.9 6.5 12.5 100.0 10.4 2,621 Rural 1.2 12.4 16.6 63.9 1.7 4.3 100.0 8.9 4,488 Province Manicaland 0.4 9.0 11.9 67.8 2.3 8.7 100.0 9.8 972 Mashonaland Central 1.3 15.9 14.8 62.1 2.0 3.8 100.0 8.7 738 Mashonaland East 0.3 6.5 12.8 72.3 1.8 6.3 100.0 10.0 667 Mashonaland West 0.4 9.0 16.3 68.0 2.5 3.8 100.0 9.3 872 Matabeleland North 5.8 16.8 26.8 44.3 2.3 4.0 100.0 7.1 349 Matabeleland South 0.2 12.1 28.0 52.8 2.7 4.2 100.0 7.9 352 Midlands 0.6 9.7 10.7 70.9 2.7 5.3 100.0 9.7 885 Masvingo 1.3 11.4 11.1 65.2 2.8 8.2 100.0 9.7 585 Harare 0.2 1.8 4.9 74.1 7.5 11.5 100.0 10.4 1,307 Bulawayo 0.0 1.6 8.0 70.3 5.2 15.0 100.0 10.3 382 Wealth quintile Lowest 2.6 22.9 22.4 51.6 0.3 0.2 100.0 7.0 1,074 Second 1.0 11.2 19.7 66.0 1.2 1.0 100.0 8.6 1,216 Middle 0.6 9.6 15.3 70.4 1.9 2.2 100.0 9.2 1,371 Fourth 0.5 4.3 8.8 76.8 3.0 6.6 100.0 10.2 1,664 Highest 0.0 1.4 3.4 66.2 8.6 20.4 100.0 10.6 1,786 Total 15-49 0.8 8.6 12.6 67.2 3.5 7.3 100.0 10.0 7,110 50-54 5.7 28.2 29.9 28.9 1.1 6.2 100.0 6.5 370 Total 15-54 1.0 9.6 13.5 65.3 3.4 7.2 100.0 9.9 7,480 Note: In Zimbabwe, primary level is referred to as grades 1-7. Secondary level is referred to as forms 1-6. With the primary and secondary levels combined, there is a total of 13 years of schooling. 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level Younger respondents are more likely to be educated and to have reached higher levels of education than older respondents. For example, the proportion of women with no education ranges from less than 1 percent among those age 15-19 to 14 percent among those age 45-49. Women age 15-19 also are more than twice as likely as women age 45-49 to have attended at least some secondary school (78 percent versus 30 percent). Similarly, 75 percent of men age 15-19 have attended at least some secondary school, compared with 63 percent of men age 45-49. The improvement in level of education among younger cohorts reflects the significant expansion of and improved accessibility to the educational system after independence in 1980. Rural respondents are less educated than their urban counterparts. For example, 59 percent of rural women have attended secondary school or higher, as compared with 86 percent of urban women. Similarly, 92 percent of urban men have attended secondary school or higher, compared with 70 percent of rural men. Characteristics of Respondents • 31 Harare and Bulawayo, which are urban centres, have the most educated populations; in these provinces, 1 percent or less of both male and female respondents have never attended school, and more than 9 in 10 men and 8 in 10 women have attended secondary school or higher. Mashonaland Central and Matabeleland North have the highest proportions of women with no education (5 percent each) and the lowest proportions of women with at least some secondary schooling (54 percent and 52 percent, respectively). Matabeleland North has by far the highest proportion of men with no education (6 percent versus 1 percent or less in the other provinces) and the lowest proportion with a secondary or higher education (51 percent versus 60 percent or more in the other provinces). Higher wealth status is associated with greater educational attainment. For example, the proportion of female respondents who have attended secondary school or higher varies from 41 percent in the lowest quintile to 90 percent in the highest quintile. Among male respondents, 95 percent in the highest wealth quintile have attended secondary school or higher, compared with 52 percent in the lowest quintile. 3.3 LITERACY Literacy is widely acknowledged as benefiting both individuals and society. It is also associated with a number of positive health outcomes. In the 2010-11 ZDHS, literacy status was determined by respondents’ ability to read all or part of a sentence. Respondents who had not attended school or had attended only primary school were asked to demonstrate their ability to read. Those with a secondary education or higher were assumed to be literate. Tables 3.3.1 and 3.3.2 show the percent distributions of women and men by level of schooling attended and level of literacy, along with the percentage of respondents who are literate, according to background characteristics. Literacy rates in Zimbabwe are very high; overall, 94 percent of women and 96 percent of men are literate. Given the high overall rate, variations in literacy across subgroups of the population are generally small. The rate is lower among women age 45-49 (79 percent) than among both women in younger age cohorts (90 percent or higher) and men in the same age cohort (94 percent). Women and men in urban areas have slightly higher literacy rates (98 percent and 99 percent, respectively) than their rural counterparts (91 percent and 94 percent, respectively). Bulawayo and Harare have the highest literacy rates for both women (99 percent and 98 percent, respectively) and men (99 percent each). Mashonaland Central has the lowest literacy rate for women (86 percent), while Matabeleland North has the lowest rate for men (84 percent). As with educational attainment, literacy is directly associated with wealth status. 32 • Characteristics of Respondents Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Zimbabwe 2010-11 Background characteristic Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 77.6 13.6 5.0 3.6 0.2 0.0 100.0 96.2 3,786 15-19 78.0 12.8 5.5 3.4 0.3 0.0 100.0 96.3 1,945 20-24 77.2 14.5 4.4 3.7 0.1 0.1 100.0 96.1 1,841 25-29 73.5 16.3 5.2 4.9 0.0 0.1 100.0 95.0 1,686 30-34 69.4 18.5 6.6 5.3 0.2 0.0 100.0 94.5 1,296 35-39 64.6 21.2 7.7 6.3 0.1 0.2 100.0 93.5 1,051 40-44 60.9 20.8 8.3 9.6 0.2 0.3 100.0 90.0 732 45-49 30.5 33.0 15.6 20.4 0.1 0.5 100.0 79.0 620 Residence Urban 86.0 9.8 2.5 1.7 0.0 0.1 100.0 98.2 3,548 Rural 59.4 22.5 9.1 8.7 0.2 0.1 100.0 91.0 5,623 Province Manicaland 67.1 22.5 4.9 5.4 0.1 0.0 100.0 94.4 1,227 Mashonaland Central 53.7 25.8 6.3 14.0 0.0 0.1 100.0 85.8 871 Mashonaland East 72.3 14.6 8.1 5.0 0.0 0.0 100.0 95.0 824 Mashonaland West 62.3 21.2 7.9 8.6 0.0 0.0 100.0 91.4 1,026 Matabeleland North 52.1 25.5 10.2 9.8 2.1 0.2 100.0 87.9 443 Matabeleland South 62.7 20.3 9.9 6.7 0.3 0.0 100.0 92.9 467 Midlands 71.1 18.1 6.5 4.0 0.0 0.2 100.0 95.7 1,123 Masvingo 61.8 16.3 13.0 8.5 0.0 0.4 100.0 91.1 909 Harare 87.1 8.6 2.8 1.4 0.0 0.0 100.0 98.6 1,722 Bulawayo 86.1 11.2 1.1 1.5 0.0 0.1 100.0 98.4 558 Wealth quintile Lowest 41.3 30.2 13.1 14.6 0.6 0.2 100.0 84.5 1,546 Second 57.6 23.0 9.7 9.6 0.1 0.1 100.0 90.3 1,594 Middle 68.0 19.3 6.4 6.2 0.0 0.1 100.0 93.7 1,681 Fourth 79.2 14.0 4.2 2.5 0.1 0.1 100.0 97.4 2,073 Highest 90.0 7.1 2.2 0.7 0.0 0.1 100.0 99.3 2,278 Total 69.7 17.6 6.5 6.0 0.1 0.1 100.0 93.8 9,171 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Zimbabwe 2010-11 Background characteristic Secondary school or higher No schooling or primary school Total Percentage literate1 Number of men Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 78.0 10.5 6.7 4.7 0.1 0.0 100.0 95.2 3,107 15-19 75.3 11.4 7.6 5.6 0.0 0.0 100.0 94.3 1,735 20-24 81.4 9.4 5.6 3.4 0.2 0.0 100.0 96.3 1,372 25-29 80.6 10.8 5.7 2.9 0.0 0.0 100.0 97.1 1,236 30-34 79.9 11.0 5.5 3.5 0.2 0.0 100.0 96.3 970 35-39 75.8 13.9 6.7 3.5 0.0 0.2 100.0 96.4 828 40-44 82.4 9.3 5.0 3.3 0.0 0.0 100.0 96.7 589 45-49 62.9 20.1 10.6 6.4 0.0 0.0 100.0 93.6 379 Residence Urban 92.0 5.0 2.0 0.9 0.0 0.0 100.0 99.1 2,621 Rural 69.8 15.2 9.0 5.8 0.1 0.0 100.0 94.0 4,488 Province Manicaland 78.7 11.6 5.6 4.0 0.0 0.0 100.0 96.0 972 Mashonaland Central 68.0 18.4 8.9 4.7 0.0 0.0 100.0 95.3 738 Mashonaland East 80.4 9.2 5.5 4.9 0.0 0.0 100.0 95.1 667 Mashonaland West 74.2 18.0 5.6 2.2 0.0 0.0 100.0 97.8 872 Matabeleland North 50.6 15.4 17.5 15.6 0.8 0.2 100.0 83.5 349 Matabeleland South 59.7 17.0 14.8 7.9 0.6 0.0 100.0 91.5 352 Midlands 79.0 11.0 6.0 4.0 0.0 0.0 100.0 96.0 885 Masvingo 76.3 11.1 7.5 4.9 0.0 0.2 100.0 94.9 585 Harare 93.2 3.4 2.6 0.8 0.0 0.0 100.0 99.2 1,307 Bulawayo 90.4 6.4 1.7 1.5 0.0 0.0 100.0 98.5 382 Wealth quintile Lowest 52.1 22.9 14.3 10.4 0.3 0.0 100.0 89.3 1,074 Second 68.1 17.9 8.6 5.2 0.0 0.1 100.0 94.7 1,216 Middle 74.5 14.2 7.9 3.4 0.0 0.0 100.0 96.5 1,371 Fourth 86.4 6.6 4.2 2.8 0.0 0.0 100.0 97.2 1,664 Highest 95.2 2.5 1.2 1.0 0.1 0.0 100.0 98.9 1,786 Total 15-49 78.0 11.4 6.4 4.0 0.1 0.0 100.0 95.9 7,110 50-54 36.2 39.0 17.9 6.9 0.0 0.0 100.0 93.1 370 Total 15-54 75.9 12.8 7.0 4.2 0.1 0.0 100.0 95.7 7,480 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence Characteristics of Respondents • 33 3.4 EXPOSURE TO MASS MEDIA The 2010-11 ZDHS collected information on respondents’ exposure to common print and electronic media. Respondents were asked how often they read a newspaper, listened to the radio, or watched television. This information is important because it indicates the extent to which Zimbabweans are regularly exposed to mass media, often used to convey messages on family planning, HIV/AIDS awareness, and other health topics. Tables 3.4.1 and 3.4.2 show the percentages of female and male respondents who were exposed to different types of mass media by age, urban-rural residence, province, level of education, and wealth quintile. Sixteen percent of women and 31 percent of men read newspapers at least once a week, 36 percent of women and 42 percent of men watch television at least once a week, and 33 percent of women and 49 percent of men listen to the radio at least once a week. Overall, only 8 percent of women and 17 percent of men are exposed to all three media at least once per week. Almost half of women and one-third of men are not exposed to any of the three media on a regular basis. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Zimbabwe 2010-11 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 17.7 38.1 34.1 8.8 46.7 1,945 20-24 17.2 38.6 35.9 9.3 45.3 1,841 25-29 17.1 36.9 33.1 9.0 48.3 1,686 30-34 15.5 35.1 32.1 7.6 48.1 1,296 35-39 14.4 30.1 29.9 7.2 53.9 1,051 40-44 16.1 33.4 30.3 7.4 51.6 732 45-49 10.8 27.5 25.4 5.6 61.2 620 Residence Urban 30.2 67.8 44.9 16.9 21.1 3,548 Rural 7.4 15.2 24.9 2.8 66.8 5,623 Province Manicaland 15.9 29.9 38.5 7.1 47.6 1,227 Mashonaland Central 11.3 24.1 32.7 4.1 53.8 871 Mashonaland East 12.3 21.4 33.7 4.4 55.3 824 Mashonaland West 8.7 28.9 27.3 4.7 57.5 1,026 Matabeleland North 4.7 15.9 6.5 0.6 79.3 443 Matabeleland South 5.4 12.3 15.9 1.7 76.6 467 Midlands 10.8 29.0 23.2 5.3 59.2 1,123 Masvingo 8.3 16.6 21.1 3.5 68.2 909 Harare 32.6 65.8 47.2 18.4 20.9 1,722 Bulawayo 35.5 84.9 55.1 23.5 9.4 558 Education No education 0.6 11.4 13.4 0.0 79.8 212 Primary 3.6 17.5 23.6 1.5 68.0 2,568 Secondary 19.1 41.5 36.1 9.6 42.4 5,966 More than secondary 58.8 72.7 48.1 34.1 14.5 424 Wealth quintile Lowest 1.9 2.4 11.3 0.2 87.3 1,546 Second 4.5 6.8 20.9 1.2 74.4 1,594 Middle 8.7 13.1 28.8 2.2 62.3 1,681 Fourth 18.2 52.8 41.1 9.0 30.8 2,073 Highest 37.8 79.0 50.3 22.4 12.5 2,278 Total 16.2 35.5 32.6 8.3 49.1 9,171 34 • Characteristics of Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Zimbabwe 2010-11 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 20.0 38.1 43.2 11.0 40.7 1,735 20-24 32.0 45.2 51.4 17.0 30.2 1,372 25-29 36.4 45.6 50.4 18.2 29.0 1,236 30-34 35.7 42.3 52.5 20.0 30.8 970 35-39 35.9 42.1 49.7 19.5 33.5 828 40-44 39.0 43.4 52.7 21.1 29.4 589 45-49 31.0 38.9 49.1 19.4 37.8 379 Residence Urban 57.3 72.1 55.2 32.5 12.7 2,621 Rural 16.1 24.9 45.6 7.8 45.4 4,488 Province Manicaland 29.1 37.2 54.8 16.9 32.2 972 Mashonaland Central 18.6 28.3 50.9 8.8 38.9 738 Mashonaland East 23.9 28.1 50.0 9.7 37.3 667 Mashonaland West 25.4 43.8 59.8 16.7 29.3 872 Matabeleland North 21.0 27.3 32.0 13.3 56.5 349 Matabeleland South 14.1 19.4 28.3 7.0 62.4 352 Midlands 27.4 38.3 42.2 11.5 37.5 885 Masvingo 11.5 21.2 30.9 2.3 54.8 585 Harare 58.0 69.9 56.6 32.3 13.2 1,307 Bulawayo 61.3 85.7 59.6 39.9 6.2 382 Education No education 1.3 18.0 19.3 1.3 73.3 56 Primary 8.3 20.3 38.9 3.8 53.0 1,508 Secondary 34.2 46.1 52.4 18.9 29.4 5,027 More than secondary 73.9 71.8 51.1 37.2 10.2 519 Wealth quintile Lowest 5.1 10.1 32.4 2.0 63.9 1,074 Second 11.2 17.3 46.0 3.9 47.9 1,216 Middle 18.6 25.3 48.7 8.3 41.8 1,371 Fourth 39.9 56.5 55.2 22.2 21.7 1,664 Highest 62.5 78.5 56.2 36.3 9.4 1,786 Total 15-49 31.3 42.3 49.2 16.9 33.4 7,110 50-54 26.4 42.1 49.2 13.9 33.1 370 Total 15-54 31.1 42.3 49.2 16.7 33.3 7,480 The proportions of respondents who are not exposed to any media on at least a weekly basis are highest among women age 45-49 and among men age 15-19 (61 percent and 41 percent, respectively). Urban residents are more likely to be exposed to all forms of mass media than rural residents. Overall, 67 percent of rural women and 45 percent of rural men reported having no exposure to any form of mass media at least once a week, compared with 21 percent of urban women and 13 percent of urban men. Harare and Bulawayo residents are more likely to read newspapers, watch television, and listen to the radio than people living in other provinces. Women in Matabeleland North and men in Matabeleland South are most likely to report having no exposure to any of the three media (79 percent and 62 percent, respectively). Not surprisingly, media exposure is related to education among both women and men. For example, 80 percent of women with no education report that they are not exposed to any media on at least a weekly basis, compared with 15 percent of women with more than a secondary education. Similarly, 73 percent of men who never attended school have no exposure to any media at least once a week, as compared with 10 percent of men with more than a secondary education. Characteristics of Respondents • 35 Media exposure among women and men is also affected by wealth status. For example, 38 percent of women in the highest wealth quintile read a newspaper at least once a week, compared with 2 percent of women in the lowest wealth quintile. Among men, 63 percent in the highest wealth quintile and 5 percent in the lowest quintile read a newspaper at least once a week. Seventy-nine percent of both women and men in the highest wealth quintile watch television at least once a week, in contrast to 2 percent of women and 10 percent of men in the lowest wealth quintile. Differences between wealth quintiles are less pronounced with respect to listening to the radio at least once a week. Fifty percent of women and 56 percent of men in the highest wealth quintile listen to the radio at least once a week, compared with 11 percent of women and 32 percent of men in the lowest wealth quintile. 3.5 EMPLOYMENT STATUS The 2010-11 ZDHS asked respondents several questions about their current employment status and continuity of employment in the 12 months prior to the survey. Figure 3.1 and Table 3.5.1 present the proportion of women who were currently employed (i.e., who were working in the seven days preceding the survey), the proportion who were not currently employed but had been employed at some time during the 12 months before the survey, and the proportion who had not been employed at any time during the 12-month period. Table 3.5.2 presents employment status data for men. Overall, 37 percent of women reported that they were currently employed. An additional 6 percent of women were not currently employed but had worked in the 12 months preceding the survey. Approximately 7 in 10 men age 15-49 were either currently employed (61 percent) or had worked in the year prior to the survey (8 percent). Figure 3.1 Women’s Employment Status in the Past 12 Months ZDHS 2010-11 Insert long title here 57% Insert really long tit 6% Currently employed 37% Did not work in last 12 months 57% Not currently employed, but worked in last 12 months 6% 36 • Characteristics of Respondents Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Zimbabwe 2010-11 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Currently employed1 Not currently employed Age 15-19 14.8 4.3 80.9 100.0 1,945 20-24 33.0 8.1 58.9 100.0 1,841 25-29 42.1 6.1 51.9 100.0 1,686 30-34 46.6 7.2 46.2 100.0 1,296 35-39 46.3 6.4 47.3 100.0 1,051 40-44 56.1 4.9 39.0 100.0 732 45-49 48.4 3.3 48.3 100.0 620 Marital status Never married 24.6 6.0 69.4 100.0 2,197 Married or living together 38.0 6.1 55.9 100.0 5,703 Divorced/separated/widowed 55.0 5.7 39.3 100.0 1,271 Number of living children 0 24.2 6.0 69.8 100.0 2,510 1-2 41.4 6.0 52.6 100.0 3,731 3-4 44.2 6.7 49.1 100.0 2,052 5+ 39.8 4.3 55.9 100.0 878 Residence Urban 44.4 6.3 49.3 100.0 3,548 Rural 32.6 5.8 61.6 100.0 5,623 Province Manicaland 48.2 4.5 47.3 100.0 1,227 Mashonaland Central 50.8 9.8 39.3 100.0 871 Mashonaland East 39.4 4.9 55.7 100.0 824 Mashonaland West 29.9 5.5 64.6 100.0 1,026 Matabeleland North 16.1 3.1 80.8 100.0 443 Matabeleland South 22.4 6.3 71.3 100.0 467 Midlands 30.4 6.5 63.1 100.0 1,123 Masvingo 22.0 4.4 73.6 100.0 909 Harare 47.5 6.7 45.8 100.0 1,722 Bulawayo 37.1 7.4 55.5 100.0 558 Education No education 35.2 3.2 61.6 100.0 212 Primary 35.0 5.9 59.1 100.0 2,568 Secondary 35.7 6.1 58.2 100.0 5,966 More than secondary 72.2 6.2 21.6 100.0 424 Wealth quintile Lowest 23.9 6.0 70.2 100.0 1,546 Second 29.5 6.0 64.5 100.0 1,594 Middle 36.7 5.8 57.6 100.0 1,681 Fourth 43.4 6.3 50.3 100.0 2,073 Highest 46.2 6.0 47.9 100.0 2,278 Total 37.2 6.0 56.8 100.0 9,171 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents • 37 Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Zimbabwe 2010-11 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Currently employed1 Not currently employed Age 15-19 27.0 5.1 67.9 100.0 1,735 20-24 61.1 9.8 29.1 100.0 1,372 25-29 75.1 9.0 15.9 100.0 1,236 30-34 77.0 7.1 15.9 100.0 970 35-39 76.8 8.6 14.5 100.0 828 40-44 78.4 5.7 15.9 100.0 589 45-49 74.2 7.8 18.0 100.0 379 Marital status Never married 43.1 6.9 50.0 100.0 3,221 Married or living together 77.1 8.1 14.8 100.0 3,584 Divorced/separated/widowed 69.4 8.9 21.7 100.0 304 Number of living children 0 46.5 7.0 46.6 100.0 3,594 1-2 77.1 8.7 14.2 100.0 1,889 3-4 78.5 7.4 14.0 100.0 1,122 5+ 70.2 8.0 21.7 100.0 504 Residence Urban 67.5 6.6 26.0 100.0 2,621 Rural 57.8 8.2 34.1 100.0 4,488 Province Manicaland 58.1 8.2 33.7 100.0 972 Mashonaland Central 81.0 4.6 14.4 100.0 738 Mashonaland East 58.9 11.6 29.6 100.0 667 Mashonaland West 58.2 8.6 33.1 100.0 872 Matabeleland North 35.6 7.0 57.4 100.0 349 Matabeleland South 49.9 10.4 39.8 100.0 352 Midlands 62.5 9.2 28.3 100.0 885 Masvingo 50.6 4.6 44.8 100.0 585 Harare 72.0 5.5 22.4 100.0 1,307 Bulawayo 54.5 8.1 37.4 100.0 382 Education No education 46.0 3.7 50.4 100.0 56 Primary 60.3 8.4 31.2 100.0 1,508 Secondary 59.8 7.6 32.6 100.0 5,027 More than secondary 80.5 5.5 14.1 100.0 519 Wealth quintile Lowest 47.1 10.5 42.4 100.0 1,074 Second 55.0 8.8 36.2 100.0 1,216 Middle 62.1 7.1 30.8 100.0 1,371 Fourth 68.9 6.7 24.4 100.0 1,664 Highest 66.6 6.2 27.3 100.0 1,786 Total 15-49 61.3 7.6 31.1 100.0 7,110 50-54 68.7 8.7 22.6 100.0 370 Total 15-54 61.7 7.6 30.7 100.0 7,480 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Women and men in the 15-19 age group are less likely to be currently employed than their counterparts in older age groups, a finding that is partially due to the fact that many in this age cohort are students. Women who are divorced, separated, or widowed are more likely to be currently employed (55 percent) than other women. Men who are married or living with their partner are more likely to be currently employed (77 percent) than men who have never been married or who are divorced, separated, or widowed. 38 • Characteristics of Respondents Women and men with no children are less likely to be currently employed than those who have children. This finding may be linked to the fact that the former are typically younger than those with children. A higher percentage of urban women and men (44 percent and 68 percent, respectively) than their rural counterparts (33 percent and 58 percent, respectively) are currently employed. There are substantial provincial variations in women’s and men’s employment status. Women in Manicaland, Mashonaland Central, and Harare are much more likely to be currently employed than women in other provinces; around half of women in each of these provinces reported that they were employed in the seven days before the survey. Men in Mashonaland Central, Harare, and Midlands are much more likely than men in other provinces to be currently employed (81 percent, 72 percent, and 63 percent, respectively). Women and men with more than a secondary education were most likely to be currently employed (72 percent and 81 percent, respectively). Women with more than a secondary education were twice as likely as those with less education to be currently employed. Among men, unemployment decreased with increasing level of education. The proportion of women who were currently employed increased with increasing wealth quintile. Among men, a similar trend was observed. Twenty-four percent of women in the lowest wealth quintile were currently employed as compared to 46 percent in the highest wealth quintile. For men the employment rate ranges from 47 percent in the lowest wealth quintile to a peak of 69 percent in the fourth wealth quintile. 3.6 OCCUPATION Respondents who were currently employed or had worked in the 12 months preceding the survey were further asked to specify their occupation. Information on the current occupation of employed women and men is shown in Tables 3.6.1 and 3.6.2. Women are most likely to be employed in sales and services (36 percent), followed by agriculture (21 percent). Men age 15-49 are most commonly employed in agriculture (29 percent) and unskilled manual labour (23 percent). Urban women are most often employed in sales and services (45 percent). Among urban men, the most common occupations are skilled manual labour (26 percent) and unskilled manual labour (24 percent). In rural areas, the majority of women (35 percent) and men (45 percent) are employed in agriculture. Mashonaland West has the highest percentage of women in agricultural occupations (37 percent), while Mashonaland Central has the highest percentage of men working in agriculture (56 percent). Matabeleland North has the highest percentage of women in sales and services (52 percent), and Harare has the highest percentage of men employed in that sector (22 percent). Harare and Bulawayo have the highest percentages of men employed in skilled manual labour (26 percent and 30 percent, respectively). Masvingo has the highest percentage of women in professional, technical, and managerial occupations (17 percent), while Matabeleland North has the highest percentage of men in those occupations (16 percent). Characteristics of Respondents • 39 Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Zimbabwe 2010-11 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Other Don’t know/ missing Total Number of women Age 15-19 0.3 1.7 30.9 0.4 14.7 32.0 19.2 0.0 0.9 100.0 371 20-24 4.9 4.1 37.1 2.0 21.2 9.8 17.9 1.4 1.6 100.0 757 25-29 9.8 3.1 38.7 0.8 18.9 6.9 19.4 1.7 0.6 100.0 812 30-34 11.5 4.5 35.9 2.7 16.5 7.4 18.6 1.9 1.1 100.0 698 35-39 10.2 2.9 36.9 1.9 15.5 6.0 21.6 3.5 1.4 100.0 554 40-44 12.7 3.2 34.6 0.7 17.1 3.8 24.4 2.1 1.5 100.0 447 45-49 7.9 1.6 32.1 1.7 18.2 4.9 29.9 1.8 1.9 100.0 320 Marital status Never married 9.8 5.6 30.4 2.4 14.9 26.0 6.5 1.6 2.6 100.0 672 Married or living together 8.7 2.7 36.2 1.4 18.2 3.8 26.3 1.8 0.9 100.0 2,515 Divorced/separated/widowed 6.6 3.0 39.9 1.3 19.0 12.5 14.6 2.1 1.0 100.0 772 Number of living children 0 9.3 5.4 32.5 2.3 14.5 22.6 9.2 2.2 2.0 100.0 758 1-2 10.5 3.3 38.3 1.5 19.0 6.8 17.7 2.1 0.8 100.0 1,768 3-4 7.3 2.7 35.6 0.9 18.8 5.6 26.6 1.3 1.3 100.0 1,045 5+ 1.4 0.3 32.6 2.1 16.1 4.2 40.8 1.1 1.3 100.0 387 Residence Urban 9.3 5.1 45.1 2.2 18.1 11.3 3.2 3.6 2.1 100.0 1,801 Rural 7.8 1.7 28.3 1.0 17.5 7.6 35.2 0.4 0.5 100.0 2,158 Province Manicaland 9.7 0.8 30.5 2.0 18.5 7.7 29.9 0.7 0.2 100.0 646 Mashonaland Central 5.3 2.1 31.4 0.1 18.4 6.6 34.7 0.2 1.3 100.0 528 Mashonaland East 7.1 3.4 30.6 0.5 14.0 11.4 31.5 1.4 0.0 100.0 365 Mashonaland West 4.9 2.0 26.5 1.6 20.4 6.4 37.1 0.7 0.3 100.0 363 Matabeleland North 13.2 1.3 52.4 1.5 12.7 13.3 3.6 1.2 0.9 100.0 85 Matabeleland South 7.6 3.6 35.5 1.0 20.7 16.5 7.5 1.5 6.2 100.0 134 Midlands 9.9 4.3 33.2 1.2 16.5 8.8 25.3 0.5 0.3 100.0 415 Masvingo 17.2 2.2 39.6 1.3 15.4 7.5 16.6 0.0 0.3 100.0 240 Harare 8.0 5.3 44.6 2.1 18.7 10.6 2.8 5.7 2.2 100.0 934 Bulawayo 9.6 6.0 44.0 4.2 17.4 12.0 3.0 0.3 3.5 100.0 248 Education No education 0.0 0.0 16.4 0.0 23.6 10.3 48.8 0.0 0.8 100.0 82 Primary 0.3 0.1 29.4 1.3 17.3 14.0 36.3 1.0 0.3 100.0 1,050 Secondary 5.3 3.7 42.4 1.5 19.4 8.5 15.8 2.1 1.4 100.0 2,494 More than secondary 60.9 11.1 13.2 3.1 5.7 0.0 0.8 2.5 2.6 100.0 332 Wealth quintile Lowest 0.2 0.3 30.3 1.4 17.1 7.8 42.3 0.5 0.1 100.0 462 Second 2.5 0.4 27.4 0.4 17.2 8.4 43.2 0.0 0.4 100.0 566 Middle 7.4 1.2 35.9 1.0 16.6 6.8 29.4 1.0 0.8 100.0 713 Fourth 7.7 3.9 42.2 1.9 20.0 8.8 11.9 2.2 1.5 100.0 1,029 Highest 15.9 6.5 36.7 2.2 17.2 12.1 3.9 3.4 2.1 100.0 1,188 Total 8.5 3.3 35.9 1.5 17.8 9.3 20.7 1.8 1.2 100.0 3,959 Occupation also varies with level of education. Sixty-one percent of women and 55 percent of men with more than a secondary education are employed in the professional, technical, and managerial sector. Women and men with no education or only a primary education most commonly work in the agricultural sector. Employed women and men in the lowest wealth quintile are concentrated in agricultural occupations (42 percent and 52 percent, respectively). Sales and services is the most common occupation among women in the highest wealth quintile (37 percent). Men in the highest wealth quintile are most commonly employed in skilled manual labour (24 percent). 40 • Characteristics of Respondents Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Zimbabwe 2010-11 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Other Don’t know/ missing Total Number of men Age 15-19 1.5 0.0 8.5 9.0 19.3 6.1 53.9 0.9 0.8 100.0 557 20-24 5.2 1.9 12.6 17.0 26.8 3.4 29.0 2.5 1.5 100.0 973 25-29 8.0 4.9 14.1 20.8 24.3 2.2 22.2 2.7 0.9 100.0 1,040 30-34 9.3 3.2 12.0 22.1 21.9 4.2 23.2 2.8 1.2 100.0 816 35-39 10.9 4.9 8.6 21.9 21.8 3.2 25.7 1.4 1.6 100.0 707 40-44 14.2 5.5 8.7 22.2 20.0 2.4 23.8 2.0 1.2 100.0 496 45-49 12.1 3.6 5.0 25.8 16.4 2.8 31.4 2.8 0.2 100.0 311 Marital status Never married 7.2 2.6 11.5 13.7 23.6 3.8 34.3 2.2 1.2 100.0 1,609 Married or living together 9.0 4.0 10.6 22.8 21.2 3.4 25.6 2.3 1.1 100.0 3,053 Divorced/separated/widowed 5.5 1.5 10.2 17.0 31.9 1.9 28.3 1.4 2.1 100.0 238 Number of living children 0 7.8 2.9 11.3 14.3 23.7 4.1 32.9 1.9 1.0 100.0 1,920 1-2 8.5 3.8 13.3 22.1 22.6 3.5 22.1 2.8 1.3 100.0 1,621 3-4 9.7 4.4 8.1 23.6 21.5 2.4 27.1 1.6 1.4 100.0 965 5+ 5.3 2.0 6.1 24.7 18.6 2.5 37.5 2.7 0.6 100.0 394 Residence Urban 11.7 6.2 19.0 25.8 23.6 4.4 4.0 3.9 1.5 100.0 1,941 Rural 6.0 1.6 5.6 15.5 21.8 2.8 44.7 1.1 0.9 100.0 2,960 Province Manicaland 11.9 4.1 6.8 19.4 28.8 1.9 23.0 0.0 4.2 100.0 644 Mashonaland Central 3.8 1.9 5.4 12.6 15.3 2.5 55.8 1.6 1.1 100.0 632 Mashonaland East 6.9 2.3 5.9 14.3 24.9 2.7 40.4 2.3 0.5 100.0 470 Mashonaland West 4.1 2.6 8.3 17.0 25.0 2.9 37.4 2.6 0.3 100.0 583 Matabeleland North 15.8 0.7 13.7 24.8 19.7 6.1 15.8 2.5 0.8 100.0 149 Matabeleland South 6.3 2.7 6.6 15.1 36.7 1.9 26.0 3.4 1.4 100.0 212 Midlands 7.2 1.3 8.6 21.4 25.0 2.2 34.2 0.0 0.2 100.0 635 Masvingo 9.5 2.3 6.1 14.7 14.9 4.2 47.9 0.3 0.2 100.0 323 Harare 10.9 6.8 22.3 25.9 19.4 5.3 3.4 4.7 1.2 100.0 1,014 Bulawayo 9.2 5.1 19.2 30.4 20.5 6.8 3.1 5.9 0.0 100.0 239 Education No education (5.7) (0.0) (2.6) (13.2) (23.4) (0.0) (55.0) (0.0) (0.0) 100.0 28 Primary 0.6 0.4 5.5 15.4 25.3 7.5 43.8 1.2 0.3 100.0 1,037 Secondary 4.5 3.8 12.8 21.8 23.8 2.6 26.9 2.6 1.3 100.0 3,390 More than secondary 54.8 7.9 9.9 12.6 6.0 0.5 4.3 2.0 1.9 100.0 446 Wealth quintile Lowest 0.4 0.6 4.6 14.8 23.7 2.8 51.6 1.2 0.4 100.0 619 Second 2.0 0.8 5.0 15.1 22.4 2.3 51.0 0.8 0.6 100.0 776 Middle 2.7 0.7 8.3 17.7 24.4 3.6 38.7 1.5 2.4 100.0 949 Fourth 9.1 3.7 13.2 21.2 26.3 4.9 18.3 2.9 0.5 100.0 1,258 Highest 18.9 8.0 17.2 24.2 17.1 2.9 6.8 3.4 1.6 100.0 1,299 Total 15-49 8.2 3.4 10.9 19.5 22.5 3.4 28.6 2.2 1.1 100.0 4,901 50-54 9.0 3.8 6.5 21.1 17.0 4.0 32.4 3.8 2.4 100.0 287 Total 15-54 8.3 3.5 10.7 19.6 22.2 3.5 28.8 2.3 1.2 100.0 5,187 Note: Figures in parentheses are based on 25-49 unweighted cases. 3.7 TYPE OF EMPLOYMENT Table 3.7 shows the percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural). Fifty percent of women engaged in agricultural work and 77 percent of women engaged in nonagricultural work are paid in cash only. Most of the remaining women in both occupational categories receive a combination of cash and in-kind payments; however, 13 percent of women working in agriculture and 3 percent of women in nonagricultural occupations are not paid for their work. Seventy-four percent of women engaged in agricultural work and 53 percent of women engaged in nonagricultural work are self-employed. Regardless of their occupation, most other women work for someone outside the family rather than a family member. Sixty percent of women engaged in agricultural work are seasonally employed, and 60 percent of women engaged in nonagricultural work are employed all year. Characteristics of Respondents • 41 Table 3.7 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Zimbabwe 2010-11 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 49.9 77.1 71.6 Cash and in-kind 35.2 19.5 22.7 In-kind only 2.4 0.9 1.2 Not paid 12.5 2.5 4.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 1.7 3.4 3.1 Employed by nonfamily member 24.7 43.3 39.5 Self-employed 73.7 53.3 57.4 Total 100.0 100.0 100.0 Continuity of employment All year 32.3 60.2 54.4 Seasonal 59.7 22.8 30.3 Occasional 8.0 17.0 15.3 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 818 3,101 3,959 Note: Total includes women with information missing on type of employment. 3.8 HEALTH INSURANCE COVERAGE The 2010-11 ZDHS collected data on respondents’ health insurance coverage (Tables 3.8.1 and 3.8.2). The majority of women (93 percent) and men (91 percent) do not have health insurance. Among women with health insurance, most are covered by social security or other employer plans. Six percent of women have insurance through their employer, less than 1 percent are covered under a privately purchased commercial plan, and the remaining women are covered through some other mechanism. As expected, women who reside in urban areas and women in the highest wealth quintile are most likely to have health insurance. Education is strongly associated with health insurance coverage. Nearly half of women with more than a secondary education have health insurance, compared with 2 percent of women with no education, 1 percent with only a primary education, and 7 percent with only a secondary education. As was the case with women, men are most commonly covered by social security and other employer-based plans; 7 percent of men are covered through their employer, 2 percent are covered under a privately purchased commercial plan, and less than 1 percent are covered through some other mechanism. Again, higher education greatly increases the chance a man will have health insurance coverage. Forty-two percent of men with more than a secondary education have health insurance, compared with 3 percent of men with no education, 1 percent with only a primary education, and 8 percent with only a secondary education. 42 • Characteristics of Respondents Table 3.8.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Zimbabwe 2010-11 Background characteristic Social security Other employer- based insurance Mutual Health Organization/ community- based insurance Privately purchased commercial insurance Other None Number of women Age 15-19 0.6 3.3 0.2 0.4 0.0 95.6 1,945 20-24 0.8 3.6 0.3 0.9 0.1 94.4 1,841 25-29 0.6 5.0 0.8 0.5 0.0 93.2 1,686 30-34 1.3 5.6 0.5 1.8 0.0 91.3 1,296 35-39 1.1 5.3 0.5 1.0 0.0 92.1 1,051 40-44 1.6 7.4 0.5 1.9 0.0 89.1 732 45-49 1.3 8.0 0.5 0.9 0.0 89.3 620 Residence Urban 1.3 9.8 0.9 1.8 0.0 86.5 3,548 Rural 0.7 1.7 0.2 0.4 0.0 97.0 5,623 Province Manicaland 0.7 3.1 0.1 0.6 0.2 95.4 1,227 Mashonaland Central 0.5 4.5 0.3 0.8 0.0 93.8 871 Mashonaland East 0.8 2.7 0.3 0.4 0.0 96.1 824 Mashonaland West 1.1 2.4 0.2 0.4 0.0 96.0 1,026 Matabeleland North 0.2 2.0 0.3 0.5 0.0 97.0 443 Matabeleland South 0.0 2.1 0.0 2.6 0.0 95.4 467 Midlands 0.6 5.9 0.2 0.9 0.0 92.6 1,123 Masvingo 2.0 2.1 0.3 1.2 0.0 94.4 909 Harare 1.0 10.1 1.1 1.4 0.0 86.5 1,722 Bulawayo 1.7 7.6 1.5 0.7 0.0 88.8 558 Education No education 0.5 1.0 0.0 0.0 0.0 98.4 212 Primary 0.3 0.8 0.0 0.1 0.0 98.8 2,568 Secondary 0.8 4.9 0.4 0.8 0.0 93.2 5,966 More than secondary 6.6 30.1 4.5 8.7 0.5 51.1 424 Wealth quintile Lowest 0.0 0.5 0.0 0.0 0.0 99.5 1,546 Second 0.4 0.4 0.0 0.0 0.0 99.1 1,594 Middle 0.4 1.3 0.0 0.2 0.0 98.2 1,681 Fourth 0.7 4.6 0.4 0.8 0.0 93.4 2,073 Highest 2.4 13.7 1.3 2.9 0.1 80.0 2,278 Total 0.9 4.8 0.4 0.9 0.0 93.0 9,171 Characteristics of Respondents • 43 Table 3.8.2 Health insurance coverage: Men Percentage of men age 15-49 with specific types of health insurance coverage, according to background characteristics, Zimbabwe 2010-11 Background characteristic Social security Other employer- based insurance Mutual Health Organization/ community- based insurance Privately purchased commercial insurance Other None Number of men Age 15-19 0.2 2.1 0.4 1.3 0.4 95.8 1,735 20-24 0.5 3.4 0.8 1.5 0.4 93.7 1,372 25-29 1.1 6.5 1.1 2.5 0.0 89.3 1,236 30-34 0.4 7.9 0.8 2.0 0.1 89.1 970 35-39 1.1 7.7 0.7 3.6 0.1 87.1 828 40-44 0.4 10.1 1.0 2.8 0.0 86.0 589 45-49 2.0 11.5 0.7 0.7 0.0 85.7 379 Residence Urban 1.3 10.1 1.5 4.0 0.4 83.3 2,621 Rural 0.3 3.2 0.3 0.8 0.1 95.5 4,488 Province Manicaland 1.5 5.7 0.4 2.0 0.0 91.4 972 Mashonaland Central 0.4 2.8 0.0 1.5 0.4 95.0 738 Mashonaland East 0.1 2.4 0.9 1.0 0.3 95.4 667 Mashonaland West 0.2 3.3 0.2 0.5 0.3 95.7 872 Matabeleland North 0.8 1.8 0.5 1.1 0.0 95.9 349 Matabeleland South 1.4 2.9 0.4 2.7 0.0 92.8 352 Midlands 0.1 9.2 0.8 2.2 0.0 88.0 885 Masvingo 0.3 6.3 0.6 1.1 0.1 91.6 585 Harare 0.9 9.1 1.7 3.3 0.6 84.7 1,307 Bulawayo 1.1 8.3 1.4 5.1 0.0 85.1 382 Education No education 0.0 2.8 0.0 0.0 0.0 97.2 56 Primary 0.1 1.3 0.0 0.0 0.0 98.6 1,508 Secondary 0.5 5.1 0.5 2.0 0.2 92.0 5,027 More than secondary 4.4 24.5 5.1 8.5 1.1 58.1 519 Wealth quintile Lowest 0.1 0.1 0.0 0.0 0.0 99.9 1,074 Second 0.0 1.1 0.2 0.2 0.1 98.4 1,216 Middle 0.1 2.1 0.0 0.4 0.0 97.4 1,371 Fourth 0.7 6.2 0.6 1.8 0.0 91.0 1,664 Highest 1.8 14.6 2.3 6.0 0.7 75.6 1,786 Total 15-49 0.7 5.7 0.7 2.0 0.2 91.0 7,110 50-54 2.0 10.3 0.5 3.4 0.0 84.0 370 Total 15-54 0.7 5.9 0.7 2.1 0.2 90.6 7,480 3.9 USE OF TOBACCO The 2010-11 ZDHS collected information on women’s and men’s tobacco use. Tobacco use has been shown to adversely affect both the health of users and those around them and is considered by the World Health Organization to be the primary cause of preventable deaths worldwide (WHO, 2011). Tables 3.9.1 and 3.9.2 present the percentages of women and men who smoke cigarettes or a pipe or use other tobacco products (e.g., snuff). Table 3.9.2 also includes information obtained from male cigarette smokers on number of cigarettes smoked in the 24 hours before the interview. Almost all women (more than 99 percent) and a large majority of men age 15-49 (78 percent) reported that they do not use tobacco. Given the small number of women who report using tobacco, it is not informative to examine the pattern of tobacco use among women by background characteristics. Among men, tobacco use is lowest among those under age 25. It is somewhat more common among men living in rural areas than among urban residents and more common among men in Mashonaland Central than among men living in other provinces. Tobacco use among men generally decreases with increasing education and wealth status. 44 • Characteristics of Respondents Most of the male respondents who use tobacco products smoke cigarettes. Overall, one in five men smoke cigarettes. Among cigarette users, 8 in 10 smoked at least three cigarettes within 24 hours of prior to the interview, and nearly one-third smoked 10 or more cigarettes during the same period. Table 3.9.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity status, Zimbabwe 2010-11 Background characteristic Uses tobacco Does not use tobacco Number of women Cigarettes Pipe Snuff Other tobacco Age 15-19 0.1 0.0 0.1 0.0 99.8 1,945 20-24 0.0 0.0 0.1 0.0 99.9 1,841 25-29 0.3 0.0 0.4 0.0 99.3 1,686 30-34 0.1 0.0 0.3 0.0 99.6 1,296 35-39 0.1 0.0 0.4 0.0 99.5 1,051 40-44 0.3 0.0 0.7 0.1 99.0 732 45-49 0.5 0.2 2.0 0.0 97.7 620 Maternity status Pregnant 0.0 0.0 0.4 0.1 99.5 758 Breastfeeding (not pregnant) 0.1 0.0 0.2 0.0 99.7 1,902 Neither 0.2 0.0 0.4 0.0 99.4 6,511 Residence Urban 0.3 0.0 0.3 0.0 99.4 3,548 Rural 0.1 0.0 0.4 0.0 99.5 5,623 Province Manicaland 0.0 0.0 0.4 0.0 99.6 1,227 Mashonaland Central 0.1 0.0 0.3 0.0 99.6 871 Mashonaland East 0.0 0.0 0.5 0.0 99.5 824 Mashonaland West 0.0 0.0 0.7 0.0 99.3 1,026 Matabeleland North 0.7 0.3 1.1 0.0 98.4 443 Matabeleland South 0.4 0.0 0.8 0.3 98.6 467 Midlands 0.2 0.0 0.0 0.0 99.8 1,123 Masvingo 0.0 0.0 0.1 0.0 99.9 909 Harare 0.2 0.0 0.2 0.1 99.6 1,722 Bulawayo 0.5 0.0 0.2 0.0 99.3 558 Education No education 0.6 0.6 1.9 0.0 97.5 212 Primary 0.2 0.0 0.6 0.1 99.2 2,568 Secondary 0.2 0.0 0.2 0.0 99.6 5,966 More than secondary 0.0 0.0 0.2 0.0 99.8 424 Wealth quintile Lowest 0.2 0.1 0.6 0.0 99.3 1,546 Second 0.0 0.0 0.2 0.0 99.7 1,594 Middle 0.1 0.0 0.4 0.0 99.5 1,681 Fourth 0.2 0.0 0.3 0.0 99.5 2,073 Highest 0.2 0.0 0.3 0.0 99.5 2,278 Total 0.2 0.0 0.4 0.0 99.5 9,171 Characteristics of Respondents • 45 Table 3.9.2 Use of tobacco: Men Percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Zimbabwe 2010-11 Background characteristic Uses tobacco Does not use tobacco Number of men Percent distribution of men who smoke cigarettes by number of cigarettes in the past 24 hours Total Number of cigarette smokers Cigarettes Pipe Snuff Other tobacco 0 1-2 3-5 6-9 10+ Don't know Age 15-19 3.8 0.1 0.2 1.1 95.5 1,735 9.2 21.4 48.7 6.3 14.4 0.0 100.0 66 20-24 17.6 2.0 0.7 3.2 80.8 1,372 7.5 21.1 31.8 18.7 19.5 1.6 100.0 241 25-29 30.6 1.4 1.3 4.8 67.9 1,236 2.8 17.4 28.5 16.1 34.1 1.0 100.0 378 30-34 28.1 2.4 1.8 3.8 70.4 970 6.6 13.1 28.9 12.5 37.6 1.2 100.0 272 35-39 28.5 1.7 2.4 3.0 69.2 828 2.0 13.1 31.4 19.0 33.8 0.8 100.0 236 40-44 24.2 1.4 3.4 2.5 72.3 589 4.7 11.7 33.5 14.2 35.2 0.7 100.0 143 45-49 32.8 4.9 4.7 2.4 64.7 379 6.2 8.7 25.8 17.9 39.2 2.2 100.0 124 Residence Urban 17.2 0.4 0.8 2.4 81.6 2,621 5.7 13.6 28.1 15.0 37.0 0.5 100.0 452 Rural 22.4 2.2 1.8 3.2 75.6 4,488 4.6 16.2 32.0 16.2 29.7 1.4 100.0 1,007 Province Manicaland 23.2 2.2 1.6 2.9 74.9 972 4.6 19.7 33.2 14.7 27.1 0.8 100.0 225 Mashonaland Central 26.8 5.9 2.8 4.6 69.7 738 2.8 14.7 35.1 17.0 29.9 0.6 100.0 198 Mashonaland East 23.1 1.5 1.0 6.6 75.6 667 0.4 14.2 24.8 20.8 39.3 0.5 100.0 154 Mashonaland West 23.9 0.0 1.1 1.8 74.7 872 3.6 14.5 33.2 14.7 32.4 1.4 100.0 208 Matabeleland North 14.0 0.5 1.5 0.1 85.6 349 8.7 16.3 29.8 18.3 20.1 6.8 100.0 49 Matabeleland South 22.0 1.3 1.4 0.3 77.5 352 6.7 13.4 28.9 22.0 28.5 0.6 100.0 77 Midlands 18.3 0.5 1.7 4.4 79.0 885 6.4 15.6 32.0 12.0 33.4 0.6 100.0 162 Masvingo 17.5 3.0 2.5 0.8 81.2 585 10.5 12.0 30.0 11.8 32.7 3.1 100.0 103 Harare 16.8 0.5 0.7 2.8 82.2 1,307 6.3 15.5 27.1 15.1 36.0 0.0 100.0 219 Bulawayo 16.8 0.2 0.7 1.1 81.9 382 4.9 14.8 29.1 18.1 30.3 2.8 100.0 64 Education No education 21.5 2.5 4.0 1.3 75.2 56 * * * * * * 100.0 12 Primary 27.5 2.7 2.6 4.9 69.5 1,508 3.3 13.7 34.3 17.9 28.9 1.9 100.0 414 Secondary 19.3 1.3 1.1 2.6 79.4 5,027 4.4 16.3 29.1 15.6 34.0 0.7 100.0 971 More than secondary 12.1 0.5 1.3 0.8 86.9 519 19.0 15.1 33.4 8.9 23.7 0.0 100.0 63 Wealth quintile Lowest 26.2 2.8 2.2 4.4 71.1 1,074 5.8 15.1 34.1 14.3 29.0 1.7 100.0 281 Second 21.7 1.8 2.0 4.3 76.1 1,216 4.1 14.5 27.1 20.6 32.7 1.1 100.0 264 Middle 24.3 2.6 1.9 2.6 74.5 1,371 4.2 14.0 32.5 17.6 30.8 0.9 100.0 333 Fourth 19.5 0.8 0.9 2.3 79.2 1,664 6.0 16.7 28.7 14.8 32.2 1.6 100.0 324 Highest 14.4 0.6 0.9 1.9 84.4 1,786 4.4 16.9 31.2 11.7 35.5 0.4 100.0 258 Total 15-49 20.5 1.6 1.5 2.9 77.8 7,110 4.9 15.4 30.8 15.9 31.9 1.1 100.0 1,459 50-54 33.8 3.6 4.0 1.3 63.6 370 0.0 12.6 35.3 15.8 34.4 1.9 100.0 125 Total 15-54 21.2 1.7 1.6 2.8 77.1 7,480 4.5 15.2 31.1 15.9 32.1 1.2 100.0 1,584 Note: An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. Marriage and Sexual Activity • 47 MARRIAGE AND SEXUAL ACTIVITY 4 arriage is a primary indication of the exposure of women to the risk of pregnancy and therefore is important to the understanding of fertility. Populations in which women marry at a young age tend to have high fertility and initiate early childbearing. For this reason, there is an interest in age at marriage. More direct measures of the beginning of exposure to pregnancy are also included in this chapter: age at first intercourse and the frequency of intercourse. 4.1 MARITAL STATUS Table 4.1 presents the percent distribution of women and men by current marital status. The proportion of women who have never married (or lived with a man) declines sharply with age, from 74 percent of women age 15-19 to 2 percent of women age 45-49. Marriage is thus nearly universal in Zimbabwe. Although nearly all men eventually marry, men tend to marry later than women and thus a higher percentage of men than women age 15-49 are not currently married (45 percent versus 24 percent). Six in ten women and five in ten men age 15-49 are currently married or living together with a partner as though married (Married and Living together columns, Table 4.1). Eight percent of women and 3 percent of men age 15-49 are separated or divorced, the same levels seen in the 2005-06 ZDHS. Six percent of women and 1 percent of men age 15-49 are widowed. Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Zimbabwe 2010-11 Age Marital status Total Percentage of respondents currently in union Number of respondents Never married Married Living together Divorced Separated Widowed WOMEN 15-19 74.1 21.7 1.5 1.0 1.7 0.0 100.0 23.2 1,945 20-24 25.0 63.1 2.7 3.5 4.9 0.8 100.0 65.7 1,841 25-29 9.5 74.8 4.0 4.2 5.4 2.1 100.0 78.8 1,686 30-34 5.4 75.2 2.8 4.7 5.7 6.1 100.0 78.1 1,296 35-39 2.9 73.4 4.2 5.1 4.1 10.4 100.0 77.6 1,051 40-44 3.6 63.5 3.2 5.2 3.4 21.2 100.0 66.7 732 45-49 1.6 62.6 1.4 4.8 2.9 26.6 100.0 64.0 620 Total 24.0 59.4 2.8 3.7 4.1 6.1 100.0 62.2 9,171 MEN 15-19 98.9 0.9 0.1 0.0 0.1 0.0 100.0 1.0 1,735 20-24 71.2 25.1 1.0 1.2 1.4 0.1 100.0 26.1 1,372 25-29 30.2 63.1 1.6 2.8 2.1 0.2 100.0 64.7 1,236 30-34 10.0 82.0 0.7 3.1 3.5 0.8 100.0 82.6 970 35-39 3.5 88.9 0.6 2.2 2.3 2.5 100.0 89.5 828 40-44 3.6 88.6 0.9 3.0 1.8 2.0 100.0 89.5 589 45-49 1.9 89.5 0.5 1.0 1.6 5.6 100.0 89.9 379 Total 15-49 45.3 49.7 0.8 1.7 1.6 0.9 100.0 50.4 7,110 50-54 1.9 88.1 0.7 1.9 2.7 4.6 100.0 88.8 370 Total 15-54 43.2 51.6 0.7 1.7 1.7 1.1 100.0 52.3 7,480 M Key Findings • Median age at first marriage among women is 19.7 years; median age at first marriage for men is 24.8 years. • The average woman and man in Zimbabwe initiate sexual activity before marriage. The median age at first sexual intercourse is 18.9 years for women and 20.6 years for men. • Eleven percent of currently married women are married to men who are in a polygynous union; 5 percent of currently married men are in a polygynous union. 48 • Marriage and Sexual Activity 4.2 POLYGYNY Polygyny (the practice of having more than one wife) has implications for the frequency of exposure to sexual activity and therefore fertility. The extent of polygyny in Zimbabwe was measured by asking all women currently married or living with a man the question: “Does your husband/partner have other wives, does he live with other women as if married, or does he maintain a small house?” If the answer is yes, the woman is asked: “Including yourself, in total, how many wives or live-in partners does he have?” Currently married men or men living with a woman are asked: “Do you have other wives, or do you live with other women as if married?” If the answer is yes, the man is asked: “Altogether, how many wives or live-in partners do you have?” Table 4.2.1 shows the distribution of currently married women by the number of co-wives, according to selected background characteristics. The majority of married women report their husband or partner has no other wives (84 percent). Eleven percent of women report their husbands have more than one wife, while 5 percent report that they don’t know if their husbands have other wives. These figures are the same as reported in the 2005-06 ZDHS. Table 4.2.1 Number of women's co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Zimbabwe 2010-11 Background characteristic Number of co-wives Total Number of women 0 1 2+ Don’t know Age 15-19 90.5 4.7 1.4 3.4 100.0 452 20-24 88.9 5.8 0.9 4.4 100.0 1,210 25-29 84.0 8.6 2.2 5.2 100.0 1,329 30-34 84.5 7.9 2.3 5.4 100.0 1,012 35-39 80.6 11.5 3.6 4.2 100.0 815 40-44 78.3 12.7 5.4 3.6 100.0 488 45-49 76.4 14.7 4.3 4.6 100.0 397 Residence Urban 85.4 6.0 1.1 7.5 100.0 1,937 Rural 83.5 10.2 3.2 3.1 100.0 3,766 Province Manicaland 77.7 12.4 4.1 5.8 100.0 798 Mashonaland Central 80.7 13.6 2.4 3.3 100.0 626 Mashonaland East 88.5 8.9 2.5 0.2 100.0 541 Mashonaland West 86.0 8.6 2.9 2.5 100.0 718 Matabeleland North 75.4 8.4 4.4 11.8 100.0 257 Matabeleland South 80.7 8.2 1.1 10.1 100.0 230 Midlands 88.8 8.1 2.5 0.6 100.0 695 Masvingo 87.5 8.3 2.8 1.4 100.0 626 Harare 85.1 5.1 0.9 8.9 100.0 972 Bulawayo 85.9 3.1 1.1 9.9 100.0 239 Education No education 71.4 12.7 12.1 3.8 100.0 154 Primary 80.9 11.4 3.8 3.9 100.0 1,827 Secondary 86.3 7.4 1.5 4.9 100.0 3,485 More than secondary 86.8 6.2 1.1 5.8 100.0 237 Wealth quintile Lowest 81.2 11.3 4.6 2.9 100.0 1,109 Second 83.6 11.4 2.8 2.3 100.0 1,085 Middle 85.5 8.8 2.7 3.0 100.0 1,077 Fourth 85.1 6.6 1.1 7.2 100.0 1,291 Highest 85.3 6.3 1.4 7.0 100.0 1,141 Total 84.2 8.8 2.5 4.6 100.0 5,703 The proportion of women with co-wives increases with age. The proportions of women who report having no co-wives are lowest in Manicaland, Mashonaland Central, Matabeleland North, and Matabeleland South. Marriage and Sexual Activity • 49 There is an inverse relationship between education and polygyny. Women with no education are least likely to report having no co-wives (71 percent) compared with women who are educated. The difference is especially pronounced when compared with women who have more than secondary education (87 percent). Patterns of polygyny across other background characteristics are less clear because the level of “don’t know” responses also varies across background characteristics. For example, although the percentage of women who report having one or more co-wives decreases with increasing wealth quintile (from 16 to 8 percent), the percentage of women who say they don’t know whether or not their husband has other wives increases with increasing wealth quintile (from 3 to 7 percent). In general though, the pattern does seem to indicate a decreasing level of polygyny with increasing wealth quintile. Though only 5 percent of men age 15-49 report themselves as having more than one wife, as many as 10 percent of men age 50-54 report having more than one wife (Table 4.2.2). Provinces in which 6 percent or more of men age 15-49 report having more than one wife are Matabeleland North, Mashonaland East, Mashonaland Central, and Masvingo. The percentage of men age 15-49 who report being in a polygynous union declines somewhat with increasing education and wealth quintile. Table 4.2.2 Number of men's wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, Zimbabwe 2010-11 Background characteristic Number of wives Total Number of men 1 2+ Age 15-19 * * 100.0 17 20-24 94.9 5.1 100.0 358 25-29 96.7 3.3 100.0 800 30-34 94.5 5.5 100.0 802 35-39 95.0 5.0 100.0 740 40-44 95.7 4.3 100.0 528 45-49 95.9 4.1 100.0 341 Residence Urban 97.2 2.8 100.0 1,301 Rural 94.5 5.5 100.0 2,283 Province Manicaland 95.3 4.7 100.0 496 Mashonaland Central 94.0 6.0 100.0 421 Mashonaland East 93.6 6.4 100.0 334 Mashonaland West 95.8 4.2 100.0 468 Matabeleland North 93.2 6.8 100.0 160 Matabeleland South 99.2 0.8 100.0 124 Midlands 95.2 4.8 100.0 450 Masvingo 94.5 5.5 100.0 320 Harare 97.2 2.8 100.0 653 Bulawayo 97.9 2.1 100.0 159 Education No education (94.0) (6.0) 100.0 31 Primary 95.0 5.0 100.0 788 Secondary 95.4 4.6 100.0 2,461 More than secondary 97.6 2.4 100.0 304 Wealth quintile Lowest 93.2 6.8 100.0 637 Second 93.3 6.7 100.0 615 Middle 96.6 3.4 100.0 646 Fourth 96.9 3.1 100.0 857 Highest 96.4 3.6 100.0 829 Total 15-49 95.5 4.5 100.0 3,584 50-54 89.7 10.3 100.0 329 Total 15-54 95.0 5.0 100.0 3,913 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 50 • Marriage and Sexual Activity 4.3 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 pregnancy and a greater number of lifetime births. 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. Table 4.3 presents the percentages of both women and men who first married by specific exact ages and the median age at first marriage, according to current age. The median age at marriage among women has risen by about one year, from 18.7 years among women age 45-49 to 19.9 years among women age 25-39. The proportion of women married by age 15 declined from 8 percent among those age 40-49 years to 3 percent among women age 15-19 years. Overall, three in ten women age 20-49 married by the time they were 18, and half married by age 20. Table 4.3 Age at first marriage Percentage of women and men age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Zimbabwe 2010-11 Current age Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage 15 18 20 22 25 WOMEN 15-19 2.8 na na na na 74.1 1,945 a 20-24 3.9 30.5 55.2 na na 25.0 1,841 19.6 25-29 4.9 29.7 50.8 68.8 83.7 9.5 1,686 19.9 30-34 5.1 27.6 50.8 66.1 81.4 5.4 1,296 19.9 35-39 7.3 29.9 50.8 68.8 81.8 2.9 1,051 19.9 40-44 8.1 32.5 54.5 67.2 79.4 3.6 732 19.6 45-49 7.5 40.0 63.8 78.3 90.0 1.6 620 18.7 20-49 5.6 30.7 53.4 na na 10.5 7,226 19.7 25-49 6.1 30.8 52.8 69.0 82.9 5.5 5,385 19.7 MEN 15-19 0.1 na na na na 98.9 1,735 a 20-24 0.3 2.2 9.0 na na 71.2 1,372 a 25-29 0.2 3.7 11.9 28.7 52.7 30.2 1,236 24.6 30-34 0.5 2.8 9.9 24.3 53.2 10.0 970 24.7 35-39 1.0 4.3 9.9 25.5 53.0 3.5 828 24.6 40-44 1.2 4.4 12.6 22.9 45.8 3.6 589 25.4 45-49 0.6 4.7 11.4 23.1 48.2 1.9 379 25.2 20-49 0.5 3.4 10.6 na na 28.0 5,375 a 25-49 0.6 3.8 11.1 25.6 51.5 13.2 4,002 24.8 20-54 0.6 3.5 10.7 na na 26.3 5,745 a 25-54 0.6 3.9 11.3 25.8 51.9 12.2 4,373 24.8 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women or men began living with their spouse or partner for the first time before reaching the beginning of the age group Men tend to enter into marriage at a later age than women. The median age at first marriage among men age 25-49 is 24.8, five years older than women. Only 1 in 10 men age 20-49 marries by age 20, compared with 5 in 10 women in the same age group. Marriage and Sexual Activity • 51 Table 4.4 presents the median age at first marriage among women and men, by background characteristics. Among women age 25-49, median age at marriage is more than one year older among urban women (20.9) than among rural women (19.2). The lowest median age at marriage is observed in Mashonaland Central (18.1 years), while the highest is seen in Bulawayo (21.7 years). Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, and median age at first marriage among men age 25-54, according to background characteristics, Zimbabwe 2010-11 Background characteristic Women age Men age 20-49 25-49 25-54 Residence Urban a 20.9 a Rural 19.1 19.2 24.0 Province Manicaland 19.4 19.4 24.7 Mashonaland Central 18.1 18.1 23.0 Mashonaland East 19.2 19.4 a Mashonaland West 18.7 18.8 23.7 Matabeleland North a 20.2 a Matabeleland South a 21.0 a Midlands 19.5 19.6 24.1 Masvingo 19.6 20.1 a Harare a 20.9 a Bulawayo a 21.7 a Education No education 17.8 17.7 24.1 Primary 18.0 18.0 23.5 Secondary a 20.4 24.8 More than secondary a 23.4 a Wealth quintile Lowest 18.5 18.7 23.7 Second 18.8 19.0 23.9 Middle 19.3 19.4 24.7 Fourth 19.9 20.0 24.6 Highest a 21.3 a Total 19.7 19.7 24.8 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. a = Omitted because less than 50 percent of the respondents began living with their spouses/partners for the first time before reaching the beginning of the age group There is a marked relationship among women’s level of education and median age at marriage. The median age at first marriage among women age 25-49 with no formal education is 17.7 years, and it rises steadily to 23.4 years among those with more than a secondary education. There is a positive correlation between wealth and age at marriage. The median age at marriage among women age 25-49 in the lowest quintile is two and a half years younger than women in the highest wealth quintile (18.7 and 21.3 years of age, respectively). Median age at first marriage among men age 25-54 is 24.8 years, which is five years older than the median age among women age 25-49. Differences in the median age at first marriage among men by background characteristics are not as large as those observed among women. 4.4 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage can be used as a proxy for the beginning of exposure to the risk of pregnancy. However, because 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 risks. 52 • Marriage and Sexual Activity The percentages of women and men who had sexual intercourse by specific exact ages are presented in Table 4.5. The median age at first intercourse among women age 25-49 is 18.9 years. Six percent of women age 25-49 have had sexual intercourse by age 15 and 38 percent by age 18. By age 20, about six in ten Zimbabwean women have had sexual intercourse. Table 4.5 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had intercourse, and median age at first sexual intercourse, according to current age, Zimbabwe 2010-11 Current age Percentage who had first sexual intercourse by exact age: Percentage who never had sexual intercourse Number Median age at first sexual intercourse 15 18 20 22 25 WOMEN 15-19 3.9 na na na na 66.0 1,945 a 20-24 3.7 38.0 64.2 na na 15.0 1,841 18.9 25-29 5.0 34.6 57.9 74.3 86.1 3.6 1,686 19.3 30-34 3.9 35.8 60.1 75.3 87.0 2.3 1,296 19.1 35-39 6.1 39.3 59.4 75.1 84.3 0.8 1,051 18.9 40-44 7.2 41.2 63.1 75.7 84.5 0.3 732 18.7 45-49 6.8 48.6 73.2 84.4 90.2 0.3 620 18.1 20-49 5.0 38.2 62.0 na na 5.2 7,226 18.9 25-49 5.5 38.3 61.2 76.1 86.2 1.9 5,385 18.9 15-24 3.8 na na na na 41.2 3,786 a MEN 15-19 3.6 na na na na 75.3 1,735 a 20-24 4.2 22.9 48.3 na na 26.9 1,372 a 25-29 2.9 21.5 43.6 62.2 82.7 6.7 1,236 20.6 30-34 2.5 20.4 43.0 61.4 78.0 2.2 970 20.6 35-39 2.0 20.3 42.0 62.3 78.9 0.8 828 20.7 40-44 1.4 18.5 38.6 59.0 74.3 1.1 589 20.9 45-49 2.8 20.1 43.6 64.7 76.7 0.3 379 20.5 20-49 2.9 21.1 43.9 na na 9.1 5,375 a 25-49 2.4 20.4 42.4 61.8 79.0 2.9 4,002 20.6 15-24 3.9 na na na na 53.9 3,107 a 20-54 2.7 20.8 43.6 na na 8.5 5,745 a 25-54 2.3 20.1 42.2 61.7 78.7 2.7 4,373 20.6 na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Zimbabwean men exhibit a slightly older median age at first intercourse compared with women. Among men age 25-49, the median age at first intercourse is 20.6 years. Two percent of men age 25-49 have had sexual intercourse by age 15 and 20 percent by age 18. By age 20, about four in ten men have initiated sexual intercourse (42 percent). Table 4.6 presents the median age at first sexual intercourse among women and men, by background characteristics. The most notable pattern is the increasing median age at marriage among women with increasing education. The median age rises steadily, from 17 among women with no education to 22 among women with more than secondary education, an increase of five years of age. Other differentials by background characteristics differ by only a year or two. Marriage and Sexual Activity • 53 Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 20-49 and age 25-49, and median age at first sexual intercourse among men age 25-54, according to background characteristics, Zimbabwe 2010-11 Background characteristic Women age Men age 20-49 25-49 25-54 Residence Urban a 20.0 20.8 Rural 18.3 18.4 20.6 Province Manicaland 18.9 18.9 21.4 Mashonaland Central 17.9 18.0 20.2 Mashonaland East 18.4 18.3 20.5 Mashonaland West 18.5 18.5 20.3 Matabeleland North 18.0 18.0 20.0 Matabeleland South 17.9 17.9 19.1 Midlands 18.9 18.9 20.6 Masvingo 19.0 19.2 21.1 Harare a 20.5 21.2 Bulawayo 19.8 19.7 20.8 Education No education 16.9 16.9 20.8 Primary 17.4 17.4 20.2 Secondary 19.5 19.7 20.8 More than secondary a 22.3 21.5 Wealth quintile Lowest 17.8 17.9 20.3 Second 18.1 18.3 20.6 Middle 18.5 18.5 20.8 Fourth 19.4 19.5 20.8 Highest a 20.3 20.7 Total 18.9 18.9 20.6 a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group 4.5 RECENT SEXUAL ACTIVITY 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 had sex were asked how long ago they most recently had sexual intercourse. Tables 4.7.1 and 4.7.2 show the distribution of women and men by recent sexual activity, by background characteristics. Although about eight in ten women age 15-49 have ever had sexual intercourse (Table 4.7.1), only about five in ten women age 15-49 are currently sexually active – that is, they have had sexual intercourse in the four weeks preceding the survey. Seventeen percent of women had been sexually active within the 12-month period prior to the survey, although not in the month prior to the interview. Thirteen percent of women have had sexual intercourse, but not for one or more years. Eighteen percent of women age 15-49 have never had sexual intercourse. A higher percentage of women between the ages of 25 and 39 is currently sexually active than women of other ages. Women in union are much more likely to report recent sexual activity than women who are divorced, separated, widowed, or never married; three-quarters of currently married women report being recently sexually active. 54 • Marriage and Sexual Activity Table 4.7.1 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Zimbabwe 2010-11 Background characteristic Timing of last sexual intercourse Never had sexual intercourse Total Number of women Within the past 4 weeks Within 1 year1 One or more years2 Missing Age 15-19 18.5 11.2 3.6 0.8 66.0 100.0 1,945 20-24 53.5 22.2 8.0 1.2 15.0 100.0 1,841 25-29 64.7 21.5 9.3 0.9 3.6 100.0 1,686 30-34 64.5 17.6 14.7 0.8 2.3 100.0 1,296 35-39 62.1 17.0 18.8 1.4 0.8 100.0 1,051 40-44 54.9 14.2 28.7 1.9 0.3 100.0 732 45-49 47.8 14.5 35.0 2.4 0.3 100.0 620 Marital status Never married 4.7 11.6 6.9 1.3 75.5 100.0 2,197 Married or living together 76.5 16.9 5.6 1.0 0.1 100.0 5,703 Divorced/separated/widowed 12.3 29.4 56.4 2.0 0.0 100.0 1,271 Marital duration3 0-4 years 74.4 20.1 4.1 1.2 0.2 100.0 1,580 5-9 years 79.5 16.1 4.2 0.2 0.0 100.0 1,126 10-14 years 78.3 14.5 6.5 0.6 0.0 100.0 876 15-19 years 77.6 14.3 7.3 0.8 0.0 100.0 597 20-24 years 74.5 15.0 8.7 1.8 0.0 100.0 368 25+ years 71.3 17.0 9.5 2.2 0.0 100.0 383 Married more than once 77.0 16.8 5.2 1.0 0.0 100.0 771 Residence Urban 46.7 15.4 13.8 1.4 22.8 100.0 3,548 Rural 52.8 18.6 12.5 1.1 15.2 100.0 5,623 Province Manicaland 49.8 19.6 12.2 0.6 17.8 100.0 1,227 Mashonaland Central 61.5 15.4 8.9 0.7 13.5 100.0 871 Mashonaland East 53.5 16.8 14.1 0.0 15.6 100.0 824 Mashonaland West 59.3 13.3 10.8 1.3 15.2 100.0 1,026 Matabeleland North 44.1 23.5 14.0 4.9 13.5 100.0 443 Matabeleland South 40.6 25.4 15.6 0.6 17.7 100.0 467 Midlands 51.4 14.7 12.8 1.2 19.9 100.0 1,123 Masvingo 48.8 20.9 13.5 1.1 15.8 100.0 909 Harare 47.3 13.3 15.4 1.4 22.6 100.0 1,722 Bulawayo 37.1 23.9 12.2 1.3 25.4 100.0 558 Education No education 51.6 16.6 25.4 3.9 2.5 100.0 212 Primary 56.3 20.1 14.2 1.3 8.2 100.0 2,568 Secondary 47.9 16.3 11.8 1.0 23.0 100.0 5,966 More than secondary 49.4 16.4 15.5 1.2 17.5 100.0 424 Wealth quintile Lowest 55.6 19.4 12.3 1.4 11.3 100.0 1,546 Second 51.8 20.4 11.9 1.3 14.5 100.0 1,594 Middle 51.5 17.5 14.7 0.8 15.6 100.0 1,681 Fourth 51.8 16.1 13.5 1.1 17.5 100.0 2,073 Highest 43.8 14.9 12.4 1.2 27.7 100.0 2,278 Total 50.4 17.3 13.0 1.2 18.1 100.0 9,171 1 Excludes women who had sexual intercourse within the past 4 weeks 2 Excludes women who had sexual intercourse within the past 4 weeks or within 1 year 3 Excludes women who are not currently married Marriage and Sexual Activity • 55 Table 4.7.2 Recent sexual activity: Men Percent distribution of men age 15-49 by timing of last sexual intercourse, according to background characteristics, Zimbabwe 2010-11 Background characteristic Timing of last sexual intercourse Never had sexual intercourse Total Number of men Within the past 4 weeks Within 1 year1 One or more years2 Missing Age 15-19 6.0 10.9 6.9 0.8 75.3 100.0 1,735 20-24 33.6 27.6 11.5 0.4 26.9 100.0 1,372 25-29 66.1 19.1 6.7 1.4 6.7 100.0 1,236 30-34 78.5 13.9 3.9 1.5 2.2 100.0 970 35-39 83.2 11.3 3.6 1.1 0.8 100.0 828 40-44 81.9 12.2 3.6 1.2 1.1 100.0 589 45-49 78.0 13.0 6.9 1.8 0.3 100.0 379 Marital status Never married 10.6 21.1 11.7 0.9 55.6 100.0 3,221 Married or living together 88.7 9.5 0.7 1.0 0.1 100.0 3,584 Divorced/separated/widowed 29.2 44.2 23.9 2.7 0.0 100.0 304 Marital duration3 0-4 years 87.2 11.6 0.3 0.5 0.3 100.0 903 5-9 years 90.7 7.6 0.4 1.3 0.0 100.0 654 10-14 years 90.3 8.1 0.5 1.1 0.0 100.0 535 15-19 years 87.6 9.3 1.1 2.1 0.0 100.0 332 20-24 years 88.7 9.9 0.9 0.4 0.0 100.0 161 25+ years 84.6 10.1 3.7 1.7 0.0 100.0 57 Married more than once 88.6 9.5 1.0 1.0 0.0 100.0 941 Residence Urban 50.0 17.0 7.4 1.7 24.0 100.0 2,621 Rural 51.3 15.8 6.3 0.7 26.0 100.0 4,488 Province Manicaland 51.5 14.8 6.4 0.6 26.8 100.0 972 Mashonaland Central 55.3 15.6 6.7 0.3 22.0 100.0 738 Mashonaland East 48.9 17.8 5.8 0.7 26.9 100.0 667 Mashonaland West 53.6 13.6 5.5 0.9 26.4 100.0 872 Matabeleland North 50.1 17.6 5.1 1.9 25.4 100.0 349 Matabeleland South 44.1 24.7 7.3 1.2 22.7 100.0 352 Midlands 51.1 15.7 6.7 1.0 25.6 100.0 885 Masvingo 53.5 11.5 6.2 1.3 27.5 100.0 585 Harare 51.2 15.5 8.5 0.7 24.1 100.0 1,307 Bulawayo 37.6 27.0 6.9 4.8 23.7 100.0 382 Education No education 49.3 18.2 3.9 0.4 28.3 100.0 56 Primary 52.4 16.9 6.9 0.8 23.0 100.0 1,508 Secondary 49.3 15.8 6.5 1.1 27.3 100.0 5,027 More than secondary 61.0 18.3 7.7 2.1 11.0 100.0 519 Wealth quintile Lowest 60.1 13.4 5.6 0.7 20.2 100.0 1,074 Second 50.7 15.1 5.6 0.5 28.1 100.0 1,216 Middle 47.8 17.1 6.9 0.6 27.6 100.0 1,371 Fourth 50.7 16.1 7.4 1.7 24.1 100.0 1,664 Highest 47.6 18.1 7.3 1.5 25.5 100.0 1,786 Total 15-49 50.8 16.2 6.7 1.1 25.2 100.0 7,110 50-54 78.8 11.7 6.7 2.5 0.2 100.0 370 Total 15-54 52.2 16.0 6.7 1.1 24.0 100.0 7,480 1 Excludes men who had sexual intercourse within the past 4 weeks 2 Excludes men who had sexual intercourse within the past 4 weeks or within 1 year 3 Excludes men who are not currently married Five in ten men age 15-49 report having had sexual intercourse within the four weeks preceding the interview. Sixteen percent of men had been sexually active within the 12-month period prior to the survey, but not in the month prior to the interview, and 7 percent had not been sexually active for one or more years. Twenty-five percent of men age 15-49 have never had sexual intercourse. Two-thirds of men age 25-29 are currently sexually active, similar to levels observed among women. However, among younger ages (15-24) a higher percentage of women are sexually active, as compared with men; among older ages (30-49) a higher percentage of men are sexually active, as compared with women. Never married, and divorced, separated, or widowed men are also more likely than women to report being sexually active. Fertility • 57 FERTILITY 5 n the 2010-2011 ZDHS, data were collected on current and completed fertility. The birth histories of women interviewed in the survey contribute to a description of level and differentials in current fertility. Attention is next focused on trends in fertility, including examination of age-specific fertility rates in periods going back 15 to 20 years. Measures of several proximate determinants of fertility that influence exposure to the risk of pregnancy are also presented: duration of postpartum amenorrhoea, postpartum abstinence, and menopause. The chapter concludes with a presentation of information on age of women at their first birth and patterns of teenage childbearing. The fertility indicators presented in this chapter are based on reports of reproductive histories provided by women age 15-49. 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 and who were living with her, the number living elsewhere, and the number who had died, in order to obtain the total number of live births. In the birth history, women reported the details of each live birth separately, including such information as name, month, year of birth, sex, and survival status. For children who had died, information on age at death was collected. 5.1 CURRENT FERTILITY Measures of current fertility presented in this chapter include age-specific fertility rates (ASFRs), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR). These rates are presented for the three-year period preceding the survey, a period covering a portion of the calendar years 2007 through 2011. The three-year period was chosen to calculate rates (rather than a longer or a shorter period) as a balance among providing the most current information, reducing sampling error, and avoiding problems of the displacement of births. Age-specific fertility rates are useful in understanding the age pattern of fertility. Numerators of ASFRs are calculated by identifying live births that occurred in the period 1 to 36 months preceding the survey (determined from the date of interview and date of birth of the child); they are then classified by the age of the mother (in five-year groups) at the time of the child’s birth. The denominators of these rates are the number of woman-years lived by the survey respondents in each of the five-year age groups during the specified period. I Key Findings • The total fertility rate for Zimbabwe is 4.1 children per woman. This represents a small increase since the 2005-06 ZDHS (3.8 children per woman). • Fertility among urban women is markedly lower (3.1 children per woman) than among rural women (4.8 children per woman). • Among women who had a live birth in the three years preceding the survey, the median duration of insusceptibility to pregnancy is 12.7 months. • Twelve percent of women age 30-49 are menopausal. • The median age at first birth among women age 25-49 is 20.2. 58 • Fertility The TFR is a common measure of current fertility and 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 current age-specific fertility rates. The GFR represents the number of live births per 1,000 women of reproductive age. The CBR is the number of live births per 1,000 population. The latter two measures are based on birth history data for the three-year period before the survey and the age-sex distribution of the household population. Table 5.1 shows the age-specific and aggregate fertility measures calculated from the 2010-11 ZDHS. The total fertility rate for Zimbabwe is 4.1 children per woman. Peak childbearing occurs during ages 20-24 and 25-29, then drops sharply after age 39. Fertility among urban women is markedly lower (3.1 children per woman) than among rural women (4.8 children per woman). This pattern of lower fertility in urban areas is evident in every age group. 5.2 FERTILITY BY BACKGROUND CHARACTERISTICS Table 5.2 show differentials in fertility by urban-rural residence, province, level of education, and wealth quintile. The TFR ranges from about three births per woman in the urban provinces of Harare (3.1) and Bulawayo (2.8) to a high of 4.8 births per woman in Manicaland. Educational attainment is closely linked to a woman’s fertility: the TFRs for women with no formal education and women with a primary education are 4.5 and 4.9 children per woman, respectively, while that for women with at least some secondary education is 3.9 children or fewer per woman. Table 5.2 also allows for a general assessment of differential trends in fertility over time among population subgroups. The mean number of children ever born to women age 40-49 years is a measure of past fertility. The mean number of children ever born to older women who are nearing the end of their reproductive period is an indicator of average completed fertility of women who began childbearing during the three decades preceding the survey. If fertility remained constant over time and the reported data on both children ever born and births during the three years preceding the survey are reasonably accurate, the TFR and the mean number of children ever born for women 40-49 Table 5.1 Current fertility Age-specific and total fertility rate, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Zimbabwe 2010-11 Age group Residence Total Urban Rural 15-19 71 144 115 20-24 167 245 212 25-29 160 217 194 30-34 120 167 149 35-39 79 117 104 40-44 14 46 35 45-49 5 15 12 TFR(15-49) 3.1 4.8 4.1 GFR 115 172 150 CBR 34 34 34 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population Table 5.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Zimbabwe 2010-11 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 3.1 7.3 3.5 Rural 4.8 8.9 5.0 Province Manicaland 4.8 8.8 4.9 Mashonaland Central 4.5 9.1 5.0 Mashonaland East 4.5 7.3 4.2 Mashonaland West 4.5 8.5 5.0 Matabeleland North 4.1 7.7 5.2 Matabeleland South 4.2 6.6 4.6 Midlands 4.2 7.6 4.8 Masvingo 4.7 11.1 4.6 Harare 3.1 8.4 3.5 Bulawayo 2.8 4.8 3.2 Education No education 4.5 6.1 5.4 Primary 4.9 9.5 5.2 Secondary 3.9 8.1 3.7 More than secondary 2.5 4.3 2.8 Wealth quintile Lowest 5.3 9.9 5.4 Second 5.1 10.2 5.0 Middle 4.4 9.8 4.9 Fourth 3.8 7.7 3.9 Highest 2.6 5.2 3.5 Total 4.1 8.3 4.5 Note: Total fertility

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