Belarus - Multiple Indicator Cluster Survey - 2012

Publication date: 2012

Republic of Belarus Monitoring the Situation of Children and Women Multiple Indicator Cluster Survey 2012 National Statistical Committee of the Republic of Belarus United Nations Children’s Fund (UNICEF) Republic of Belarus Multiple Indicator Cluster Survey of the Situation of Children and Women 2012 Final Report National Statistical Committee of the Republic of Belarus United Nations Children’s Fund (UNICEF) June 2013 Co-authors: National Statistical Committee of the Republic of Belarus United Nations Children’s Fund (UNICEF) The Multiple Indicator Cluster Survey of the situation of children and women in Belarus (MICS4) was conducted in 2012 by the National Statistical Committee of Belarus in partnership with the statistical offices of the administrative regions and Minsk City. Financial, technical and methodological support was provided by the United Nations Children’s Fund (UNICEF). MICS is an international household survey programme developed by UNICEF. In Belarus, it was conducted as a part of the fourth global round of MICS surveys, designed to monitor the situation of children and women, and to obtain information on key measures of national progress toward meeting the Millennium Development goals and other internationally agreed commitments. The survey methodology is based on the models and standards developed for the global MICS project to collect data on the situation of children and women worldwide. For more information on MICS, please refer to www.childinfo.org. In Belarus, the objective of MICS4 was to obtain objective data on the health of mothers and children, and on child development and upbringing. By comparison to the previous survey, it presents new data on a range of important issues related to children, including nutrition, health, prevalence of child labour, disciplining, and early child development. It also contains information on other nationally relevant issues, such as women’s reproductive behavior, attitudes of men and women to domestic violence, young people’s sexual behavior and overall life satisfaction. Recommended citation: National Statistical Committee of the Republic of Belarus, United Nations Children’s Fund (UNICEF), 2013. Multiple Indicator Cluster Survey of the Situation of Children and Women in the Republic of Belarus (МИКС4), 2012. Final Report. Minsk, Belarus: National Statistical Committee of the Republic of Belarus, the United Nations Children’s Fund (UNICEF). This material may be reprinted, quoted or otherwise reproduced, providing that the source is properly acknowledged. National Statistical Committee of the Republic of Belarus Pr. Partizansky 12, 220070, Minsk, Tel.: (+375 17) 2495200 Internet: www.belstat.gov.by United Nations Children’s Fund (UNICEF) in the Republic of Belarus ul. Krasnoarmeyskaya 22A, 220019 Minsk Tel.: (+375 17) 2105589 Internet: www.unicef.org SUMMARY TABLE OF FINDINGS 3 Summary Table of Findings1 Multiple Indicator Cluster Surveys on the situation of children and women (MICS) and Millennium Development Goals (MDG) Indicators, Republic Belarus, 2012 Topic MICS Indicator Number MDG Indicator Number Indicator Value NUTRITION 2.4 Children ever breastfed 92.5 percent 2.5 Early initiation of breastfeeding 53.0 percent 2.6 Exclusive breastfeeding under 6 months 19.0 percent 2.7 Continued breastfeeding at 1 year 27.9 percent 2.8 Continued breastfeeding at 2 years 11.5 percent 2.9 Predominant breastfeeding under 6 months 41.4 percent 2.10 Duration of breastfeeding (median) 5.9 months 2.11 Bottle feeding 66.5 percent 2.12 Introduction of solid, semi-solid or soft foods 64.3 percent 2.13 Minimum meal frequency 74.2 percent 2.14 Age-appropriate breastfeeding 19.6 percent Breastfeeding, Infant and Young Child Feeding 2.15 Milk feeding frequency for non-breastfed children 88.7 percent 2.18 Low-birth weight infants 4.1 percent Low Birth Weight 2.19 Infants weighed at birth 99.8 percent CHILD HEALTH 3.8 Oral rehydration therapy with continued feeding 61.2 percent 3.9 Care-seeking for suspected pneumonia 93.4 percent Care of Illness 3.10 Antibiotic treatment of suspected pneumonia 76.7 percent Solid Fuel Use 3.11 Solid fuels 0.6 percent WATER AND SANITATION 4.1 7.8 Use of improved drinking water sources 99.6 percent 4.2 Water treatment (33.2) percent 4.3 7.9 Use of improved sanitation 95.7 percent Water and Sanitation 4.4 Safe disposal of child’s faeces 56.0 percent 1 See Appendix E for details on indicators definitions. MICS4, Republic of Belarus. Final Report SUMMARY TABLE OF FINDINGS MICS MDG Topic Indicator Value Indicator Indicator Number Number REPRODUCTIVE HEALTH 5.3 5.3 Contraceptive prevalence rate 63.1 percent Contraception and Unmet Need 5.4 5.6 Unmet need 7.0 percent 5.5a 5.5b 5.5 Antenatal care coverage at least once by skilled personnel at least four times by any provider 99.7 99.7 percent percent 5.6 Content of antenatal care 99.7 percent 5.7 5.2 Skilled attendant at delivery 100.0 percent 5.8 Institutional deliveries 99.9 percent Maternal and Newborn Health 5.9 Caesarean section 25.3 percent 5.10 Post-partum stay in health facility 100.0 percent 5.11 Post-natal health check for the newborn 100.0 percent Post-natal Health Checks 5.12 Post-natal health check for the mother 99.9 percent CHILD DEVELOPMENT 6.1 Support for learning 95,7 percent 6.2 Father’s support for learning 68.4 percent 6.3 Learning materials: children’s books 92.0 percent 6.4 Learning materials: playthings 78.9 percent 6.5 Inadequate care 4.0 percent 6.6 Early child development index 93.9 percent Child Development 6.7 Attendance to early childhood education 87.6 percent EDUCATION 7.1 2.3 Literacy rate among young people women age 15-24 years men age 15-24 years 100.0 100.0 percent percent 7.2 School readiness 96.7 percent 7.3 Net intake rate in primary education 70.9 percent 7.4 2.1 Primary school net attendance ratio (adjusted) 91.7 percent 7.5 Secondary school net attendance ratio (adjusted) 96.6 percent 7.6 2.2 Children reaching last grade of primary school 100.0 percent 7.7 Primary completion rate 103.3 percent 7.8 Transition rate to secondary school 100.0 percent 7.9 3.1 Gender parity index (primary school) 0.97 ratio Literacy and Education 7.10 3.1 Gender parity index (secondary school) 1.02 ratio 4 MICS4, Republic of Belarus. Final Report SUMMARY TABLE OF FINDINGS 5 MICS MDG Topic Indicator Value Indicator Indicator Number Number CHILD PROTECTION 8.2 Child labour 1.4 percent 8.3 School attendance among child labourers 99.4 percent Child Labour 8.4 Child labour among students 1.4 percent 8.6 Marriage before age 15 women age 15-49 men age 15-49 0.1 0.1 percent percent 8.7 Marriage before age 18 women age 20-49 years men age 20-49 years 6.2 1.1 percent percent 8.8 Currently married or in union women age 15-19 years men age 15-19 years 7.4 1.3 percent percent Early Marriage 8.10a 8.10b Spousal age difference women age 15-19 years women age 20-24 years (0.8) 6.4 percent percent 9.17 Children’s living arrangements 2.0 percent Children’s Living Arrangements 9.18 Prevalence of children with one or both parents dead 4.3 percent DOMESTIC VIOLENCE Domestic Violence 8.14 Attitudes towards domestic violence women age 15-49 years men age 15-49 years 4.1 4.2 percent percent HIV / AIDS and SEXUAL BEHAVIOUR 9.1 Comprehensive knowledge about HIV prevention women age 15-49 years men age 15-49 years 55.2 56.8 percent percent 9.2 6.3 Comprehensive knowledge young people about HIV prevention women age 15-24 years men age 15-24 years 56.1 50.9 percent percent 9.3 Knowledge of mother-to-child transmission of HIV women age 15-49 years men age 15-49 years 65.3 50.0 percent percent HIV/AIDS Knowledge and Attitudes 9.4 Accepting attitudes towards people living with HIV women age 15-49 years men age 15-49 years 0.7 1.6 percent percent MICS4, Republic of Belarus. Final Report SUMMARY TABLE OF FINDINGS MICS MDG Topic Indicator Value Indicator Indicator Number Number 9.5 Respondents who know where to be tested for HIV women age 15-49 years men age 15-49 years 97.1 95.2 percent percent 9.6 Respondents who have been tested for HIV and know results women age 15-49 years men age 15-49 years 24.4 19.7 percent percent 9.7 Sexually active young people who have been tested for HIV and know results women age 15-24 years men age 15-24 years 33.4 23.1 percent percent 9.8 HIV counselling during antenatal care 65.6 percent 9.9 HIV testing during antenatal care 89.6 percent 9.10 Young people who have never had sex women age 15-24 years men age 15-24 years 57.8 42.0 percent percent 9.11 Sex before age 15 among young people women age 15-24 years men age 15-24 years 0.7 3.4 percent percent 9.12 Age-mixing among sexual partners women age 15-24 years men age 15-24 years 5.4 1.2 percent percent 9.13 Sex with multiple partners women age 15-49 years men age 15-49 years 2.1 9.4 percent percent 9.14 Condom use during sex with multiple partners women age 15-49 years men age 15-49 years 39.4 53.6 percent percent 9.15 Sex with non-regular partners women age 15-24 years men age 15-24 years 38.6 68.6 percent percent Sexual Behaviour 9.16 6.2 Condom use with non-regular partners women age 15-24 years men age 15-24 years 68.5 82.1 percent percent MASS MEDIA and ICT Access to Mass Media MT.1 Access to mass media women age 15-49 years men age 15-49 years 43.1 51.7 percent percent 6 MICS4, Republic of Belarus. Final Report SUMMARY TABLE OF FINDINGS 7 MICS MDG Topic Indicator Value Indicator Indicator Number Number MT.2 Use of computers women age 15-24 years men age 15-24 years 96.7 95.9 percent percent Use of Information/ Communication Technologies MT.3 Use of Internet women age 15-24 years men age 15-24 years 94.1 93.3 percent percent TOBACCO and ALCOHOL USE TA.1 Tobacco use women age 15-49 years men age 15-49 years 18.5 55.2 percent percent Tobacco Use TA.2 Smoking before age 15 women age 15-49 years men age 15-49 years 3.5 18.5 percent percent TA.3 Alcohol use women age 15-49 years men age 15-49 years 60.5 74.2 percent percent Alcohol Use TA.4 Use of alcohol before age 15 women age 15-49 years men age 15-49 years 3.6 9.3 percent percent SUBJECTIVE WELL-BEING SW.1 Life satisfaction women age 15-24 years men age 15-24 years 65.4 65.5 percent percent SW.2 Perception of happiness women age 15-24 years men age 15-24 years 93.7 90.2 percent percent Subjective Well- being SW.3 Perception of a better life among women age 15-24 years men age 15-24 years1 52.3 41.9 percent percent MICS non-standard indicators Child Discipline Violent discipline 64.5 percent Awareness of benefits of iodized salt consumption 94.4 percent Nutrition Reported use of iodized salt for cooking 85.4 percent Experience of domestic violence 11.8 percent Domestic Violence Help seeking to stop violence 39.7 percent ( ) – Figures that are based on 25-49 unweighted cases. MICS4, Republic of Belarus. Final Report Contents Summary Table of Findings. 3 Contents . 8 List of Tables . 10 List of Figures . 14 Abbreviations and Notes. 15 Acknowledgements. 16 Executive Summary. 18 I. Introduction . 24 Background. 25 Survey Objectives . 26 II. Sample and Survey Methodology . 27 Sample Design. 28 Questionnaires. 29 Training and Fieldwork. 30 Data Processing. 31 III. Sample Coverage and the Characteristics of Households and Respondents. 32 Sample Coverage . 33 Characteristics of Households . 33 Characteristics of Respondents .35 IV. Nutrition . 42 Breastfeeding, Infant and Young Child Feeding . 43 Iodine Deficiency Prevention . 47 Low Birth Weight. 49 V. Child Health . 57 Oral Rehydration Treatment . 58 Care Seeking for Suspected Pneumonia and Antibiotic Treatment of Pneumonia. 59 Solid Fuel Use. 60 VI. Water and Sanitation. 66 Use of Improved Water Sources. 67 Use of Improved Sanitation. 70 VII. Reproductive Health . 80 Contraception. 81 Unmet Need for Contraception . 82 Antenatal Care . 84 Assistance at Delivery. 85 Place of Delivery . 86 Post-Natal Health Checks. 86 8 MICS4, Republic of Belarus. Final Report VIII. Child Development . 99 Early Childhood Education and Learning. 100 Early Childhood Development Index. 104 IX. Literacy and Education . 111 Literacy among Young Women and Men. 112 School Readiness . 112 Primary and Secondary School Participation. 112 X. Child Protection. 119 Child Labour. 120 Child Discipline . 120 Early Marriage. 122 Children’s Living Arrangements . 123 XI. Domestic Violence . 132 XII. HIV / AIDS and Sexual Behaviour. 146 Knowledge about HIV Transmission and Misconceptions about HIV / AIDS . 147 Accepting Attitudes toward People Living with HIV . 151 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care. 153 Sexual Behaviour Related to HIV Transmission . 154 XIII. Access to Mass Media and Use of Information / Communication Technology . 178 Access to Mass Media . 179 Use of Information / Communication Technologies . 180 XIV. Tobacco and Alcohol Use . 186 Tobacco Use. 187 Alcohol Use. 188 XV. Subjective Well-being . 196 Appendix A. Sample Design . 206 Appendix B. Wealth Index . 212 Appendix C. Estimates of Sampling Errors. 213 Appendix D. Data Quality Tables. 236 Appendix E. MICS4 Indicators: Numerators and Denominators. 245 Appendix F. Questionnaires . 251 Appendix G. List of Personnel Involved in the Survey . 308 MICS4, Republic of Belarus. Final Report 9 List of Tables Table HH.1. Results of household, women’s, men’s and under-5’s interviews . 36 Table HH.2. Household members age distribution by sex. 37 Table HH.3. Household composition . 38 Table HH.4. Women’s background characteristics. 39 Table HH.4M. Men’s background characteristics . 40 Table HH.5. Under-5 children’s background characteristics. 41 Table NU.1. Initial breastfeeding . 50 Table NU.2. Breastfeeding . 51 Table NU.3. Duration of breastfeeding . 51 Table NU.4. Age-appropriate breastfeeding. 52 Table NU.5. Introduction of solid, semi-solid or soft foods . 52 Table NU.6. Minimum meal frequency . 53 Table NU.7. Bottle feeding . 54 Table NU.8. Reported iodized salt consumption . 55 Table NU.9. Low birth weight infants. 56 Table CH.1. Oral rehydration solutions and recommended homemade fluids . 61 Table CH.2. Feeding practices during diarrhoea. 62 Table CH.3. Oral rehydration therapy with continued feeding and other treatments. 62 Table CH.4. Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia . 63 Table CH.5. Knowledge of the two danger signs of pneumonia. 64 Table CH.6. Solid fuel use. 65 Table WS.1. Use of improved water sources. 72 Table WS.2. Household water treatment . 73 Table WS.3. Time to source of drinking water . 74 Table WS.4. Person collecting water . 75 Table WS.5. Types of sanitation facilities. 76 Table WS.6. Use and sharing of sanitation facilities . 77 Table WS.7. Disposal of a child’s faeces . 78 Table WS.8. Drinking water and sanitation ladders . 79 Table RH.1. Knowledge of contraceptive methods. 89 Table RH.2. Use of contraception. 90 Table RH.3. Unmet need for contraception . 92 Table RH.4. Antenatal care coverage. 93 Table RH.5. Number of antenatal care visits . 93 Table RH.6. Assistance during delivery. 94 10 MICS4, Republic of Belarus. Final Report Table RH.7. Post-partum stay in health facility. 95 Table RH.8. Post-natal health checks of newborns. 96 Table RH.9. Post-natal care (PNC) visits for newborns within one week after discharge . 97 Table RH.10. Post-natal health checks for mothers . 98 Table CD.1. Early childhood education . 106 Table CD.2. Support for learning. 107 Table CD.3. Learning materials. 108 Table CD.4. Inadequate care . 109 Table CD.5. Early child development index. 110 Table ED.1. School readiness. 115 Table ED.2. Primary school entry. 115 Table ED.3. Primary school attendance. 116 Table ED.4. Secondary school attendance . 117 Table ED.5. Education gender parity . 118 Table CP.1. Child labour . 124 Table CP.2. Child labour and attendance of educational institutions . 125 Table CP.3. Child discipline . 126 Table CP.4. Early marriage among women . 127 Table CP.4M1. Early marriage among men age 15-49 years . 128 Table CP.4M2. Early marriage among men age 15-59 years . 128 Table CP.5. Trends in early marriage among women. 129 Table CP.5M. Trends in early marriage among men. 129 Table CP.6. Spousal age difference. 130 Table CP.7. Children’s living arrangements . 131 Table DV.1. Attitudes toward domestic violence among women. 137 Table DV.1M. Attitudes toward domestic violence among men . 138 Table DV.2. Experience of domestic violence. 139 Table DV.3. Help seeking to stop violence. 140 Table DV.4. Experience of physical abuse by parents in childhood . 141 Table DV.5. Causes of domestic violence in opinion of women. 142 Table DV.5M. Causes of domestic violence in opinion of men . 143 Table DV.6. Measures to combat domestic violence in opinion of women . 144 Table DV.6M. Measures to combat domestic violence in opinion of men. 145 Table HA.1. Knowledge about HIV transmission, misconceptions about HIV / AIDS and comprehensive knowledge about HIV transmission among women . 157 Table HA.1M. Knowledge about HIV transmission, misconceptions about HIV / AIDS and comprehensive knowledge about HIV transmission among men. 158 Table HA.2. Knowledge about HIV transmission, misconceptions about HIV / AIDS and comprehensive knowledge about HIV transmission among young women . 159 MICS4, Republic of Belarus. Final Report 11 Table HA.2M. Knowledge about HIV transmission, misconceptions about HIV / AIDS and comprehensive knowledge about HIV transmission among young men . 160 Table HA.3. Knowledge of mother-to-child HIV transmission among women. 161 Table HA.3M. Knowledge of mother-to-child HIV transmission among men. 162 Table HA.4. Accepting attitudes of women toward people living with HIV / AIDS . 163 Table HA.4M. Accepting attitudes of men toward people living with HIV / AIDS . 164 Table HA.5. Knowledge of a place for HIV testing among women. 165 Table HA.5M. Knowledge of a place for HIV testing among men . 166 Table HA.6. Knowledge of a place for HIV testing among sexually active young women. 167 Table HA.6M. Knowledge of a place for HIV testing among sexually active young men . 168 Table HA.7. HIV counselling and testing during antenatal care . 169 Table HA.8. Sexual behaviour of young women that increases the risk of HIV infection . 170 Table HA.8M. Sexual behaviour of young men that increases the risk of HIV infection. 171 Table HA.9. Sex with multiple partners, women. 172 Table HA.9M. Sex with multiple partners, men . 173 Table HA.10. Sex with multiple partners among young women. 174 Table HA.10M. Sex with multiple partners among young men. 175 Table HA.11. Sex with non-regular partners among young women. 176 Table HA.11M. Sex with non-regular partners among young men. 177 Table MT.1. Exposure to mass media among women . 182 Table MT.1M. Exposure to mass media among men. 183 Table MT.2. Use of computers and internet by young women . 184 Table MT.2M. Use of computers and internet by young men. 185 Table TA.1. Current and ever use of tobacco among women. 190 Table TA.1M. Current and ever use of tobacco among men . 191 Table TA.2. Age at first use of cigarettes and frequency of use among women. 192 Table TA.2M. Age at first use of cigarettes and frequency of use among men . 193 Table TA.3. Use of alcohol among women . 194 Table TA.3M. Use of alcohol among men. 195 Table SW.1. Domains of life satisfaction among young women . 200 Table SW.1M. Domains of life satisfaction among young men. 201 Table SW.2. Life satisfaction and perception of happiness among young women . 202 Table SW.2M. Life satisfaction and perception of happiness among young men. 203 Table SW.3. Subjective perception of a better life among young women. 204 Table SW.3M. Subjective perception of a better life among young men. 205 Table SD.1. Distribution of the sample clusters (primary sample units) for the Republic of Belarus MICS4, by strata. 207 Table SD.2. Final recommended sample size. 208 Table SE.1. Indicators selected for sampling error calculations. 214 12 MICS4, Republic of Belarus. Final Report Table SE.2. Sampling errors: Republic of Belarus. 216 Table SE.3. Sampling errors: Urban areas . 218 Table SE.4. Sampling errors: Rural areas . 220 Table SE.5. Sampling errors: Brest Region . 222 Table SE.6. Sampling errors: Vitebsk Region. 224 Table SE.7. Sampling errors: Gomel Region . 226 Table SE.8. Sampling errors: Grodno Region. 228 Table SE.9. Sampling errors: Minsk City. 230 Table SE.10. Sampling errors: Minsk Region . 232 Table SE.11. Sampling errors: Mogilev Region . 234 Table DQ.1. Age distribution of household population . 236 Table DQ.2. Age distribution of eligible and interviewed women. 237 Table DQ.2M. Age distribution of eligible and interviewed men . 238 Table DQ.3. Age distribution of under-5s in household and under-5 questionnaires . 238 Table DQ.4. Women's completion rates by socio-economic characteristics of households . 239 Table DQ.4M. Men's completion rates by socio-economic characteristics of households . 240 Table DQ.5. Completion rates for under-5 questionnaires by socio-economic characteristics of households . 241 Table DQ.6. Completeness of reporting . 242 Table DQ.7. Presence of mother in the household and the person interviewed for the under-5 questionnaire . 243 Table DQ.8. Selection of children age 2-14 years for the child discipline module . 243 Table DQ.9. School attendance by single age. 244 MICS4, Republic of Belarus. Final Report 13 List of Figures Figure HH.1. Age and sex distribution of household population. 34 Figure NU.1. Percentage of mothers who started breastfeeding within one hour or one day of birth . 44 Figure NU.2. Infant feeding patterns by age. 45 Figure NU.3. Percentage of households reporting use of iodized salt for cooking. 48 Figure NU.4. Percentage of infants weighting less than 2500 grams at birth. 49 Figure CH.1. Percent distribution of household members using solid fuels by place of cooking. 61 Figure WS.1. Percent distribution of household members by source of drinking water . 68 Figure RH.1. Contraceptive methods used by women age 15-49 years currently married or in union . 82 Figure CD.1. Early childhood education of children age 36-59 months. 100 Figure CD.2. Percentage of children age 36-59 months, with whom an adult household member engaged in activities that promote learning and school readiness . 102 Figure CD.3. Percentage of children who have children’s books in the household. 103 Figure CD.4. Percentage of children age 36-59 months who are developmentally on track according to their age. 105 Figure CP.1. Percentage of children age 2-14 years subjected to violent discipline methods . 122 Figure DV.1. Percentage of women and men who justified domestic violence . 134 Figure HA.1. Percentage of women age 15-49 years who have comprehensive knowledge about HIV transmission. 149 Figure HA.2. Knowledge on mother-to-child transmission of HIV . 151 Figure HA.3. Accepting attitudes toward people living with HIV / AIDS. 152 Figure HA.4. Testing for HIV among sexually active young people age 15-24 years . 154 Figure HA.5. Percentage of young people age 15-24 years who had sex with a partner 10 or more years older in the last 12 months. 155 Figure HA.6. Percentage of young people age 15-24 years who had sex with non-regular partners . 156 Figure MT.1. Percentage of population age 15-24 years with the access to a computer or the internet . 181 Figure SW.1. Domains of life satisfaction among young people . 197 Figure SD.1. Location of clusters for MICS4 . 208 Figure DQ.1. Number of household population by single ages . 237 14 MICS4, Republic of Belarus. Final Report Abbreviations and Notes AIDS Acquired Immune Deficiency Syndrome EA Enumeration Area ECDI Early Childhood Development Index GPI Gender Parity Index HIV Human Immune Deficiency Virus ICT Information and Communication Technologies IDD Iodine Deficiency Disorder IUD Intrauterine Device JMP WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation LAM Lactational Amenorrhea Method MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey NAR Net Attendance Ratio ORS Oral Rehydratation Solution ORT Oral Rehydratation Treatment PNC Post-natal Care PNHC Post-natal Health Check PSU Primary Sampling Unit SPSS Statistical Package for Social Sciences STI Sexually Transmitted Infection UN United Nations Organisation UNAIDS United Nations Joint Programme on HIV/AIDS UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session [on HIV/AIDS] UNICEF United Nations Children’s Fund WHO World Health Organisation Figures that are based on fewer than 25 unweighted cases are not shown in the data tables. Figures that are based on 25-49 unweighted cases are shown in brackets. Occasional minor discrepancies between the sum and the total are due to rounding. 0,0 – negligible quantity - – not observed MICS4, Republic of Belarus. Final Report 15 Acknowledgements Foreword and acknowledgement by Vladimir I. Zinovsky, Chairman of the National Statistical Committee of the Republic of Belarus The Multiple Indicator Cluster Survey (MICS4) is based on an internationally recognized methodology and provides a unique opportunity to obtain a wide range of data on the situation of children and women in the Republic of Belarus. The survey data supplements the existing sources of official statistical information on the quality of the population living standards by drawing the attention of the government and the public to important new issues and aspects. I am hopeful that the survey findings will be of practical relevance to the government and the civil society by informing the subsequent planning and implementation of the social programmes that respond to both national and regional needs. The outcomes of the survey will also provide an important source of data for the monitoring of progress toward the Millennium Development Goals. Successful completion of this survey and publication of this Final Report is the result of coordinated efforts and professional work by a range of experts at different levels. I wish to express my special thanks to Yuri Oksamitniy, UNICEF Representative in the Republic of Belarus, and Valentina Dogonova, UNICEF Monitoring and Evaluation Coordinator, for the extensive technical, methodological and financial support received towards this survey. I wish to express the confidence that this fruitful exercise will lead to new collaborative initiatives. Let me also thank the contributors from the national government bodies, and managers and experts from the national and regional statistical authorities for their valuable inputs to the successful implementation of this project. Chairman, National Statistical Committee of the Republic of Belarus V.I. Zinovsky 16 MICS4, Republic of Belarus. Final Report Foreword and acknowledgements by Yuri V. Oksamitniy, Representative of the United Nations Children’s Fund (UNICEF) in the Republic of Belarus Strengthening the system for monitoring and evaluation of the situation of children and women is a priority area of cooperation of the United Nations Children’s Fund and the Republic of Belarus. UNICEF has extended its programme support for the Belarus Multiple Indicator Cluster Survey (MICS) that is a recognized tool for monitoring progress toward meeting the national goals and global commitments on children. The National Statistical Committee coordinated the work on the nationwide household survey, which was based on the MICS methodology. The Final Report on the 2011-2013 MICS4 has been made possible by the coordinated efforts of multiple national and international experts. Close collaboration was maintained between the national team and the UNICEF units in Minsk, Geneva and New York throughout every stage of the MICS4 process, including planning, methodological and technical support. The MICS4 survey tools were adapted to the national needs. Training activities were organised for the survey teams that were engaged in fieldwork for data collection, data processing and creation of the survey database. The data obtained through the survey was analysed to supply this Report on the situation of children and women. The survey findings have been subject to on-going quality control, and international comparability of the data has been ensured. The UNICEF Office in the Republic of Belarus extends its sincere appreciation to all the managers and staff of the units, divisions and departments of the national and regional statistics authorities, and also to multiple experts, researchers, technical support staff, and numerous contributors from the UN system and the Ministries of Education, Health, Labour and Social Protection, Economy, Foreign Affairs of the Republic of Belarus for their professionalism, enthusiasm and extensive efforts in implementing the fourth round of MICS. We offer our special thanks to Vladimir Ivanovich Zinovsky, Chairman of the National Statistical Committee, and Elena Ivanovna Kukharevich, Deputy Chairperson of the National Statistical Committee and national MICS4 coordinator, for their strategic oversight and overall guidance and coordination of MICS4 process. We are confident that the findings of MICS4 will be of practical use for protection of the legitimate rights and interests of children in the Republic of Belarus. UNICEF Representative in the Republic of Belarus Yuri V. Oksamitniy MICS4, Republic of Belarus. Final Report 17 Executive Summary EXECUTIVE SUMMARY The Multiple Indicator Cluster Survey (MICS4) of the situation of children and women in the Republic of Belarus is a sample household survey representative at the national level. For selected indicators, the survey is also representative at the regional level. The main aim of the survey was to collect impartial information on mother and child health protection, child development and education for monitoring progress towards achieving the national goals and global commitments related to the welfare of children - including those contained in the child-specific Development Goals of the Millennium Declaration, and in the Convention on the Rights of the Child. Sample Coverage • The 8,284 interviewed households had 20,398 residents, including 9,549 men and 10,849 women. • Overall, 5,745 women age 15-49 years and 2,769 men age 15-59 years participated in the survey. Questionnaires for children under five were completed for 3,443 children including 1,771 boys and 1,672 girls. Breastfeeding and Infant and Young Child Feeding • Approximately one in two women (53 percent) who gave birth to a child in the two years preceding the survey initiated breastfeeding within one hour of birth, and one-quarter (26.3 percent) of infants were not breastfed within the first day of birth. • Only 19 percent of children under 6 months of age were exclusively breastfed, much below the recommended rate of exclusive breastfeeding. Some 27.9 percent of children age 12-15 months and 11.5 percent of children age 20-23 months were continuously breastfed. • About three-quarters (74.2 percent) of children age 6-23 months were receiving solid, semi-solid and soft foods consistent with the minimum recommended number of meals within twenty-four hours. Iodine Deficiency Prevention • Overall, 95 percent of households nation-wide know about the advantages of iodized salt consumption as the basic affordable measure for prevention of iodine deficiency disorders. • Some 85.4 percent of households reported the use of iodized salt for cooking, including 39.2 percent of households that always used iodised salt for cooking. Low Birth Weight • All infants were weighted at birth, with about 4 percent of them weighing less than 2500 grams. Oral Rehydration Treatment • Overall, 3.4 percent of children under 5 had diarrhoea in the two weeks preceding the survey. • Nearly three-quarters (73.5 percent) of children received at least one of the recommended home- based treatments during the episode of diarrhoea (oral rehydration solutions or recommended homemade fluids). • More than 60 percent of children who had diarrhoea received the recommended oral rehydration therapy (i.e. oral rehydration solutions, or recommended homemade fluids, or increased fluid intake) and continued feeding. Care Seeking for Suspected Pneumonia and Antibiotic Treatment of Pneumonia • About 7 percent of children age 0-59 months had symptoms of suspected pneumonia during the two weeks preceding the survey. The majority (93.4 percent) of those children were taken to an appropriate health facility to seek medical help. MICS4, Republic of Belarus. Final Report 19 EXECUTIVE SUMMARY • In the last 2 weeks preceding the survey, three quarters (76.7 percent) of children under 5 with suspected pneumonia received antibiotics for treatment. • Only 14.7 percent of mothers / caretakers of children under 5 know of the two danger signs of pneumonia – fast and difficult breathing. Solid Fuel Use • Less than 1 percent of all households in Belarus use solid fuels (wood) for cooking. Water and Sanitation • Almost the entire population of Belarus (99.6 percent) uses improved sources of drinking water (water piped into dwelling, yard or plot, public tap / stand-pipe, and tube or protected well are the most common). • Two-thirds of the population use safe water treatment methods, regardless of whether the water comes from an improved or unimproved water source. The most common drinking water treatment method is boiling, used by 41 percent of the population. • In Belarus, nearly the entire population of the republic (98.4 percent) lives in the households with improved hygienic and sanitary facilities, and 95.7 percent of the citizens use improved sanitation, i.e., they do not share improved sanitation facilities with other households. • Overall, 56 percent of children age 0-2 years live in the households that practice safe disposal of child’s faeces. Contraception • All women age 15-49 years know of at least one method of contraception, the average number of contraceptive methods known to a woman of reproductive age is 10.9. • About 63 percent of married or in union women use contraception. More than one-half (51.2 percent) of women uses modern contraceptive methods and one in nine women (11.9 percent) uses traditional contraceptive methods. • The most common contraceptive method is a male condom used by 22.3 percent of women married or in union. One in seven women (15.1 percent) reported the use of an intrauterine device and one in ten (10.3 percent) – the use of a contraceptive pill. Unmet need for contraception • Overall, 7 percent of women age 15-49 years who are married or in union have unmet need for contraception, including 3.8 percent for spacing, and 3.2 percent for limiting. Antenatal Care • There is universal coverage of pregnant women by antenatal care in the Republic of Belarus. Of all pregnant women, 99.7 percent received at least 4 antenatal care visits by a skilled medical provider during pregnancy. Assistance at Delivery • All deliveries in the two years preceding the survey occurred in a health facility and were attended by skilled medical personnel. • Some 97 percent of deliveries were assisted by a doctor. Post-Natal Care • All infants born in the two years preceding the survey received post-natal health checks after birth by a medical provider. 20 MICS4, Republic of Belarus. Final Report EXECUTIVE SUMMARY • An initial post-natal care visit at home was provided by a medical provider within one week after discharge from a maternity facility, including to 14.4 percent of newborns within the same day of discharge and to 65.2 percent – on the next day following the discharge. • From all women who received post-natal care (PNC) visits for mothers within one week after discharge from a health facility, 89.2 percent of women were checked at a public sector health facility, 7.8 percent at home and 3 percent at private sector health facilities. Child Development • Overall, 87.6 percent of children age 36-59 months attended organized early childhood education programmes. • For 95.7 percent of children age 36-59 months an adult household member was engaged in more than four activities promoting learning and school readiness during the three days preceding the survey. On average, adults were engaged in 5.5 types of activities with children. • Fathers’ engagement in one or more types of activities promoting learning and school readiness of a child was registered in 68.4 percent of cases; the average number of activities was 2.3. • Over 90 percent of children under 5 live in households where at least 3 children’s books are present, and about 80 percent of children live in households with 10 and more books. • During the week preceding the survey, 4 percent of children under 5 were left with inadequate care (alone or in the care of another child under 10 years of age). • Overall, 93.9 percent of children under 5 are developmentally on track in accordance with age. School Readiness • About 97 percent of children who were attending the first grade of primary school at the time of the survey attended pre-school educational institutions in the previous year. Primary and Secondary School Participation • Overall, 70.9 percent of all children in the republic who were of primary school entry age (6 years) attended the first grade of primary school. • About 92 percent of children of primary school age attended primary or secondary school. • In Belarus, all children starting grade one of primary school, will eventually reach grade 5. The transition rate to secondary school was 100 percent across all regions. • The gender parity index was 0.97 in primary school and 1.02 in secondary school. Literacy among Young Women and Men • In the Republic of Belarus, literacy among young women and men is universal. Child Labour • Overall, only 1.4 percent of children age 5-14 years are involved in various forms of child labour and for majority of these children such labour activities are unpaid. • Of this 1.4 percent of children involved in various forms of child labour, nearly all (99.4 percent) were attending educational institutions – preschool or school. Child Discipline • Some two-thirds (64.5 percent) of children age 2-14 years have experienced at least one form of psychological pressure or physical punishment by their parents or other adults in the household. • One in three (33.1 percent) children lives in the households that rely exclusively on non-violent disciplining methods. MICS4, Republic of Belarus. Final Report 21 EXECUTIVE SUMMARY Early Marriage • In the Republic of Belarus, 7.4 percent of women age 15-19 years were married or in union at the time of the survey. • Among women age 20-49 years 6.2 percent got married or entered a union before age 18. • Overall, 6.4 percent of women were married or in union with a man who was older by 10 or more years. Children’s Living Arrangements • According to the survey findings, three-quarters (75.1 percent) of children age 0-17 years live with their both parents, one in five (22.1 percent) children lives with one parent only, and 2 percent with neither of their biological parents. Attitudes toward Domestic Violence • Only 4.1 percent of women and 4.2 percent of men age 15-49 years justify the husband / partner in beating their wife / partner for at least one of the specified reasons. • Most often men and women justify violence in instances when a woman neglects the children. Knowledge about HIV Transmission and Misconceptions about HIV / AIDS • About 88 percent of women and men age 15-49 years reported that they knew of the two main ways of preventing HIV transmission. • Among all women age 15-49 years 60.2 percent know that a healthy looking person can have the HIV virus and have rejected the two most common misconceptions about HIV. Among men such proportion is 62.7 percent. • Slightly more than a half of young women and about a half of young men (age 15-24 years) have comprehensive knowledge about HIV transmission. • Overall, about 97 percent of women and more than 90 percent of men in the republic knew that HIV can be transmitted from mother to child. The proportion of respondents who knew about all three ways of HIV mother-to-child transmission was 65.3 percent among women and 50 percent among men. • More than 97 percent of women and 95 percent of men age 15-49 years know where to be tested for HIV. And, one in four (24.4 percent) women and one in five (19.7 percent) men have already been tested and told the result. Sexual Behaviour Related to HIV Transmission • Only 0.7 percent of young women and 3.4 percent of young men had sex for the first time before age 15. • Overall, 5.4 percent of women and 1.2 percent of men age 15-24 years had sex with a partner who was older by 10 years or more. • In the 12 months preceding the survey, more than one third (38.6 percent) of young women and two thirds (68.6 percent) of young men had sex with a non-regular partner. Access to Mass Media • Almost an equal proportion (about 96 percent) of women and men age 15-49 years watch television, 77.4 percent of women and 71.5 percent of men read newspapers, and slightly over one-half (51.3 percent) of women and two thirds (67.1 percent) of men listen to the radio at least once a week. • Overall, 43.1 percent of women and 51.7 percent of men in the republic are exposed to all three types of media (i.e. television, radio, newspapers) at least once in a week. 22 MICS4, Republic of Belarus. Final Report EXECUTIVE SUMMARY Use of Information / Communication Technologies • Among young people almost all women (98.6 percent) and men (98.4 percent) have ever used a computer. • During the month preceding the survey about 90 percent of women and men were using a computer at least once per week. • Overall, 95.3 percent of young women and 94.2 percent of young men in the republic have ever used the internet. • During the month preceding the survey, 89.5 percent of women and 87.6 percent of men age 15-24 years were accessing the internet at least once a week. Tobacco Use • Slightly more than a half (51.8 percent) of women and 84.2 percent of men age 15-49 years reported having ever used a tobacco product. • Among current male and female users of tobacco, cigarettes are the most common type of tobacco product. One in six women (17.6 percent) and one in two men (52.1 percent) smoked only cigarettes during the last one month. • Some 3.5 percent of women and 18.5 percent of men smoked at least one cigarette for the first time before age 15. Alcohol Use • During the month preceding the survey, three fifths (60.5 percent) of women and three quarters (74.2 percent) of men age 15-49 years had at least one drink of alcohol. • Some 3.6 percent of women and 9.3 percent of men had their first drink of alcohol before age 15. Subjective Well-being • Nation-wide, two thirds (65.4 percent) of young women and about an equal share (65.5 percent) of young men are very or partly satisfied with the selected aspects of their lives. • Nearly 96 percent of young women and men age 15-24 years are satisfied with their friendships; and 93.8 percent of women and 92.1 percent of men are satisfied with their family lives. • Nearly all young people (93.7 percent of women and 90.2 percent of men) reported being very or somewhat happy. • Young people age 15-24 years shared an optimistic view of their futures. Some 85.6 percent of young women and 80.9 percent of young men expect their lives to improve after one year. MICS4, Republic of Belarus. Final Report 23 I. Introduction INTRODUCTION Background This final report is based on the results of the 2012 Multiple Indicator Cluster Survey (MICS) of the situation of children and women in the Republic of Belarus. The survey was conducted by the National Statistical Committee in collaboration with the chief statistical divisions of the administrative regions and Minsk City. It benefited from the methodological, financial and technical support of the United Nations Children’s Fund (UNICEF). The data obtained through the survey covers the most relevant aspects of children’s lives, such as nutrition, health, prevalence of child labour, disciplining methods in the family, and early childhood development. The MICS4 survey also includes a range of new data on women’s reproductive behaviour, attitudes of men and women toward domestic violence, young people’s sexual behaviour, tobacco and alcohol use among teenagers and youth, access to media, young people’s life satisfaction, and other matters of relevance to Belarus. The survey responds to the need for reliable systems to monitor progress towards achieving the targets and objectives contained in a number of international covenants. These include the Millennium Declaration, adopted by 191 UN member states in September 2000 and the Action Plan «A World Fit for Children», approved by 189 UN member states in May 2002. Both documents reflect the commitments made by the international community at the World Summit on Children in 1990. By signing these agreements, the heads of states and governments undertook strong commitments to work toward improving the situation of women and children in their respective countries, and to monitor progress towards this goal. Commitment to action: national and international reporting obligations By signing the Declaration and Plan of Action «A World Fit for Children», the heads of state and government committed themselves, inter alia, to monitoring progress towards achieving the targets and goals contained therein. «We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning». («A World Fit for Children», Paragraph 60) «…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions…». («A World Fit for Children », Paragraph 61) Paragraph 61 of the Plan of Action also requests UNICEF to assist in the preparation of periodic progress reports: «…As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action». The Millennium Declaration (Paragraph 31) contains a similar request regarding periodic reporting of progress: «…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action». MICS4, Republic of Belarus. Final Report 25 INTRODUCTION As a follow-up to the World Summit on Children in 1990, the United Nations Children’s Fund developed a uniform list of indicators and a methodology for collecting statistically reliable and internationally comparable data with a view to building the capacity of the national governments to monitor the situation of children and to gauge progress in implementing the Convention on the Rights of the Child. Today, MICS has become a recognized tool for measuring progress in implementing the national targets and global commitments on improving the welfare of children. As a party to the international covenants on children and human development, the Republic of Belarus attributes great priority to meeting its international obligations; it is implementing concrete measures to monitor progress and build the capacity of its statistical systems, given their decisive role in informing the national strategic planning processes. The national goals on improving the situation and protecting the rights of children are supported by specific interventions to be implemented in 2011-2015, including those specified in a range of the state programmes, such as National Demographic Security Programme, National Action Plan on Improving the Situation of Children and Protecting their Rights for 2012-2016, State Programme of National Action to Prevent and Control Alcohol Abuse and Alcohol Dependence, State HIV Prevention Programme, State Programme on Creating a Barrier-free Environment, and State Programme on Developing Pre-school, General Secondary and Post-secondary Education, among others. In this respect, monitoring of indicators characterizing the situation of children in the country is an important mission. Survey Objectives The main objectives of the 2012 Multiple Indicator Cluster Survey of the Situation of Women and Children in the Republic of Belarus were as follows: • To review and assess new indicators relevant to the assessment of the situation of women and children in the Republic of Belarus, to monitor progress towards implementing the Millennium Development Goals and the objectives postulated in the Declaration and Action Plan «A World Fit for Children», and to inform future actions on these objectives; • To inform the planning and evaluation processes of the Government and public services of the Republic of Belarus on the implementation of the social programmes on women, children and youth at the national and regional levels, and to facilitate the efforts to identify and reach out to the most needy and vulnerable populations; • To improve the monitoring systems in the Republic of Belarus, enhance professional skills among experts engaged in development, analysis and implementation of such monitoring systems; • To create an information resource to ensure international comparability of the data. 26 MICS4, Republic of Belarus. Final Report II. Sample and Survey Methodology SAMPLE AND SURVEY METHODOLOGY Sample Design The sample for the Belarus Multiple Indicator Cluster Survey (MICS4) was designed to provide estimates for the indicators describing the situation of children and women that are statistically reliable at the national level, for urban and rural areas, and for Belarus’ seven subnational administrative units (Brest, Vitebsk, Gomel, Grodno, Minsk and Mogilev Regions and Minsk City). The sampling frame was based on the data and cartographic materials from the 2009 Belarus Population Census. The primary sampling units (PSUs) were the enumeration areas (EAs) defined for the census. The sampling frame was stratified by the seven regions and three residency categories: big cities, small towns and rural areas. At the second sampling stage the households listed in each sample EA were grouped into two categories: households with and without children under 5. The survey units were selected in two stages. At the first stage, the enumeration areas were selected systematically within each stratum with probability proportional to size. At the second sampling stage, selection of households was completed in the identified enumeration area, based on the updated list of households with children under 5 and households without children under 5 (or with older children). A total of 20 households were selected in each sample enumeration area. Random systematic sampling was used to select a separate sample of households within each second stage stratum (households with and without children under the age of 5 years). In each cluster, one in three households was randomly selected for interviews with all men age 15-59 years of that household. The selection was performed separately for households with and without children under five years of age. The total sample consisted of 8,520 households, including 3,408 households with children under 5 years of age and 5,112 households without children of this age group. The sample was stratified by regions, urban and rural areas, and at the second stage by households with or without children under 5 years of age. This sample was not self-weighting. To report the results at the national and regional level, statistical weighting procedures were applied. A more detailed description of the sample design can be found in Appendix A. Questionnaires Four sets of questionnaires were used in the MICS4 survey: 1. Household Questionnaire. 2. Questionnaires for individual women. 3. Questionnaires for individual men. 4. Questionnaires for children under five. These questionnaires were based on standard MICS4 questionnaires1 that were adapted to reflect the conditions and objectives of the survey specific to the Republic of Belarus. Standard MICS4 questionnaires were translated from English into Russian. During the development of the adapted version of the questionnaires, the National Statistical Committee of the Republic of Belarus cooperated with specialists from the Ministry of Health of the Republic of Belarus, the Ministry of Education of the Republic of Belarus, the Ministry of Labour and Social Protection of the Republic of Belarus, the Ministry of Foreign Affairs of the Republic of Belarus, and with experts of 1 Standard MICS4 questionnaires can be found on www.childinfo.org. 28 MICS4, Republic of Belarus. Final Report SAMPLE AND SURVEY METHODOLOGY international organizations: the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the United Nations Joint Programme on HIV/AIDS (UNAIDS). The Republic of Belarus MICS4 questionnaires included the following modules: Household Questionnaire (used to collect information on all de jure household members (usual residents), the household, its dwelling, property characteristics and well-being): • Household Information Panel. • Household Listing Form. • Education. • Water and Sanitation. • Household Characteristics. • Child Labour. • Child Discipline. • Iodine Deficiency Prevention (IDD). Questionnaire for Individual Women (administered to all women age 15-49 years living in the households): • Women’s Information Panel. • Woman’s Background. • Access to Mass Media and Use of Information / Communication Technology. • Live Birth. • Desire for Last Birth. • Maternal and Newborn Health. • Post-Natal Health Checks. • Illness Symptoms. • Contraception. • Reproductive Health. • Marriage / Union. • Attitudes toward Domestic Violence. • Sexual Behaviour. • HIV / AIDS. • Tobacco and Alcohol Use. • Life Satisfaction. Questionnaire for Individual Men (administered in one out of three households to all men age 15-59 years): • Men’s Information Panel. • Man’s Background. • Access to Mass Media and Use of Information / Communication Technology. • Marriage / Union. • Attitudes toward Domestic Violence. • Sexual Behaviour. • HIV / AIDS. • Tobacco and Alcohol Use. • Life Satisfaction. MICS4, Republic of Belarus. Final Report 29 SAMPLE AND SURVEY METHODOLOGY Questionnaire for Children under Five (administered to mothers of each child under 5 years of age. In cases when the mother was not living in the household, a primary caretaker for the child was identified and interviewed): • Under-Five Child Information Panel. • Age. • Early Childhood Development. • Breastfeeding. • Care of Illness. Compared to the third round of MICS (MICS3), conducted in 2005 in the Republic of Belarus, the MICS4 survey was expanded to include new modules, such as Access to Mass Media and Use of Information/Communication Technology, Sexual Behaviour, Tobacco and Alcohol Use, and Life Satisfaction. Pursuant to the National Strategy for Elimination of Iodine Deficiency Disorders in the Republic of Belarus through Universal Salt Iodization, adopted in 2000, exclusive use of iodised salt has been mandated in the bakery, meat processing and confectionary industries, universal availability of iodised salt in all retail outlets has been achieved, and the use of iodised salt has begun in the infant food. Therefore, the MICS4 survey did not include testing for iodine content of the cooking salt used by the households by applying salt test kits that are part of the standard MICS4 survey tools. Instead, the module «Iodine Deficiency Prevention» was designed to measure household members’ knowledge about the benefits of iodized salt and the prevalence of using such salt for cooking by the households. As proposed by the Ministry of Labour and Social Protection of the Republic of Belarus, the module «Attitudes toward Domestic Violence» was supplemented by questions with reference to respondent’s opinion about the causes of domestic violence, the most effective responses to such violence, and questions regarding the participants’ experience of physical abuse by their parents in childhood. In addition, the Questionnaire for Individual Women included questions regarding violence experienced by the women respondents. Given the fact that the Republic of Belarus has a well-organized system for recording the vital events of its citizens and residents, and its official infant and under-five mortality statistics are internationally recognized as reliable and objective, registration of infant and under-five mortality was not addressed by this survey and the standard «Child Mortality» module was excluded from the Questionnaire for Individual Women. It should also be noted that the Republic of Belarus has made considerable progress in reducing infant and child mortality in recent years, consistent with its international commitments contained in the Millennium Development Goals. The adapted MICS4 questionnaires were pre-tested in Minsk City and Minsk Region in January and February 2012. Based on the findings of the pre-test, improvements were made to the wording of some of the questions. A copy of the Belarus MICS4 questionnaires is provided in Appendix F. Training and Fieldwork The specialists from the National Statistical Committee of the Republic of Belarus engaged in the MICS4 survey were trained in a series of regional workshops organized in 2011-2012 by the UNICEF Headquarters, New York, and the Regional UNICEF Office for Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS), Geneva. The workshops took place 30 MICS4, Republic of Belarus. Final Report SAMPLE AND SURVEY METHODOLOGY in Istanbul, Turkey (March 2011), Chisinau, Moldova (February 2012), Minsk, Belarus (May 2012), and Amman, Jordan (October-November 2012). Training of fieldwork staff of the local state statistical authorities was conducted for 12 days in March 2012. Fifty-six participants were trained to work as field team supervisors, editors and interviewers for the survey The training programme included lectures and presentations on the survey guidance, the interviewing techniques, and on the contents of the questionnaires. Participants were engaged in role-playing and mock interviews between trainees to gain practice in asking questions. Tests were administered to assess participant knowledge. Towards the end of the training period, the field teams were given the opportunity to practise their interviewing skills and survey questionnaires knowledge on the ground. The workshop on MICS4 field training benefited from inputs by the National Statistical Committee of the Republic of Belarus, UNICEF and UNAIDS Offices in the Republic of Belarus and psychologists and sociologists from the Centre of System Business Technologies (SATIO). The data for the MICS4 survey were collected by seven field teams; each was comprised of one supervisor, one editor and five interviewers. Fieldwork began at the end of March and concluded on 2 July 2012. Data Processing Data entry was carried out by a team of 15 data entry clerks, including two supervisors. The data were entered on 15 computers using the CSPro software. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. At all stages, data processing relied on the use of procedures and standard programmes developed under the global MICS4 and adapted to the Belarus questionnaires. Data processing began simultaneously with data collection in April 2012 and concluded in July 2012. During August-December 2012, databases were edited and the the main output tables of the survey findings were generated. The data were analysed using the Statistical Package for Social Sciences (SPSS) software programme, Version 18. The model syntax and tabulation plans used in the analysis were developed by UNICEF and adapted to the Republic of Belarus MICS4 questionnaires by the National Statistical Committee of the Republic of Belarus. The results of the preliminary MICS4 data analysis were communicated to the country government and were posted on the official website of the National Statistical Committee of the Republic of Belarus in February 2013. MICS4, Republic of Belarus. Final Report 31 III. Sample Coverage and the Characteristics of Households and Respondents SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 33 Sample Coverage Of the 8,520 households selected for the sample, 8,407 households were found to be occupied. Of these, 43 were occupied by more than one household that agreed to take part in the survey, yielding a total of 8,450 households. Of this number, 8,284 households were successfully interviewed with the Household Questionnaire resulting in a total response rate of 98 percent. In the interviewed households, 5,911 women age 15-49 years were identified; of these, 5,745 women gave complete answers to all items in the Questionnaire for Individual Women, yielding a response rate of 97.2 percent. The interviewed households included 6,924 men age 15-59 years; of these, 2,925 men were identified in the households selected for interviews with all men. Of the total number of eligible men, 2,769 men were successfully interviewed and provided complete answers to the Questionnaire for Individual Men, which corresponds to a response rate of 94.7 percent. In addition, 3,465 children under age 5 were identified in the interviewed households, and 3,443 Questionnaires for Children under Five were completed for those children, with a response rate of 99.4 percent. The overall response rates, calculated for the interviewed women age 15-49 years, men age 15-59 years and children under 5, are 95.3 percent, 93.3 percent and 97.4 percent, respectively (Table HH.1). The response rate for rural households was 97.5 percent and for urban households 99.4 percent. Across the regions, the response rate for households varied from 98.1 percent in Gomel and Minsk Regions to 99.2 percent in Grodno Region, it was the lowest in Minsk City, at 95.6 percent. It should be noted that the response rate for men (94.7 percent) was somewhat lower than that for women (97.2 percent). It was highest among the mothers / caretakers of children under 5 (99.4 percent). Characteristics of Households The age and sex distribution of the surveyed population is provided in Table HH.2. In 8,284 interviewed households, 20,398 household members were listed, including 9,549 men and 10,849 women. The average household size estimated by the survey was 2.46. Household population in the 0-14 age group numbered 3,472 persons, or 17 percent, including 1,765 boys (18.5 percent of all male respondents) and 1,706 girls (15.7 percent of the female respondents). Population in the 15-64 age group was 14,245 persons, or 69.8 percent of the total household population, including 6,908 men, or 72.3 percent of the total male population, and 7,337 women, or 67.6 percent of the total female population. There were 2,677 respondents aged 65+, representing 13.1 percent of the population, including 875 men and 1,801 women (representing 9.2 percent and 16.6 percent of the total male and female populations, respectively). The number of children age 0-17 years was 4,046 persons or 19.8 percent of the total number of household members participated in the survey, including 2,079 boys, or 21.8 percent, and 1,968 girls, or 18.1 percent of the household members of the corresponding sex. Compared to the 2009 population census, the proportion of children in the age group of 0-14 years obtained through the MICS4 survey was higher by 2.3 percentage points, while the share of the population in the age groups 15-64 and 65+ was lower by 1.2 and 1.1 percentage points, respectively. According to the survey findings, men represent 46.8 percent of the general population and women 53.2 percent. In the 2009 population census, these proportions were 46.5 percent and MICS4, Republic of Belarus. Final Report SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 34 MICS4, Republic of Belarus. Final Report 53.5 percent, respectively, and had changed little as of 1 January 2013. Thus, there were no notable differences in sex distribution of the surveyed population in MICS4 and the distribution obtained from the population census and demographic statistics. Figure HH.1. Age and sex distribution of household population, Republic of Belarus, 2012 0123456 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 0 1 2 3 4 5 6 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age, years Percent Men Women It should be noted that while the population below age 30 has more men than women of the same age, the number of women begins to exceed the number of men in the age group of 30-34 years; and at age 70 and above, women are 2.2 times more numerous than men. This is consistent with the trends in the age distribution of men and women observed in the demographic statistics as of January 2013. Tables HH.3 - HH.5 provide basic background information on the surveyed households and their members, by presenting the weighted as well as the unweighted numbers. The remaining tables in this report include only weighted numbers. The weighted and unweighted numbers of households are equal, since sample weights have been normalized. Further details on the statistical weighting are presented in Appendix A. Of the total number of households, 72.8 percent are urban, and 27.2 percent are rural. More than one-half (56.4 percent) of the households consist of 2-3 members. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 35 There are 33.5 percent of households with children under 18 years of age, and 15.6 percent of households with at least one child under 5 years of age. The share of households with at least one woman age 15-49 years is 49.2 percent, and with at least one man age 15-59 years – 63.5 percent1. Characteristics of Respondents Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female respondents age 15-49 years, male respondents age 15-49 years and 15-59 years, and children under 5 years of age. Of the total number of women age 15-49 years, 74.7 percent lived in urban areas and 25.3 percent in rural areas. At the time of survey, 69.4 percent of women in this age group were married or in union, 12 percent were widowed, divorced or separated, and 18.6 percent were never married or in union. By motherhood status, 75.9 percent of women had ever given birth, and 12.7 percent of women gave birth in the two years preceding the survey. The proportion of women with vocational-technical or secondary specialized education was 44.3 percent, and 36.7 percent had higher education. In terms of wealth, 13.5 percent of women lived in the poorest (by the wealth index) households and 24.1 percent in the richest households. According to the survey findings, 72.9 percent of men age 15-59 years were urban, and 27.1 were rural. At the time of the survey, 68.7 percent of men were married or in union, 9.9 percent were widowed, divorced or separated, and 21.4 percent were never married or in union. One-quarter (25.9 percent) of men had higher education and about a half (47.8 percent) had vocational-technical or secondary specialized education. The number of men was roughly similar across households with different level of wealth. Of the total number of children under age 5, there were 51.9 percent of boys and 48.1 percent of girls. Three-quarters (74.6 percent) were urban, and about one-quarter (25.4 percent) rural. The children were uniformly distributed across all age subgroups divided by the number of complete years of life, with around 20 percent in each subgroup. At the time of survey, over 80 percent of mothers/caretakers of children under 5 had specialized (vocational-technical, secondary specialized or higher) education, 15.5 percent had general secondary education, and only 2.5 percent had general basic education. The smallest number of children under 5 lived in the poorest households (13.3 percent), and the greatest in the richest households (29.1 percent). 1 Data table not shown in this report. MICS4, Republic of Belarus. Final Report SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table HH.1. Results of household, women’s, men’s and under-5’s interviews Number of households, women, men and children under 5 by results of household, women’s, men’s and under-5’s interviews, and household, women’s, men’s and under-5’s response rates, Republic of Belarus, 2012 Area Region Urban Rural Brest Vitebsk Gomel Grodno Minsk City Minsk Mogilev Total Households Sampled 6202 2361 1220 1160 1300 980 1595 1300 1008 8563 Occupied 6122 2328 1191 1144 1267 980 1579 1293 996 8450 Interviewed 5971 2313 1178 1132 1243 972 1509 1268 982 8284 Household response rate 97.5 99.4 98.9 99.0 98.1 99.2 95.6 98.1 98.6 98.0 Women age 15-49 years Eligible 4313 1598 864 759 882 692 1098 932 684 5911 Interviewed 4189 1556 812 736 835 689 1078 919 676 5745 Women’s response rate 97.1 97.4 94.0 97.0 94.7 99.6 98.2 98.6 98.8 97.2 Women’s overall response rate 94.7 96.7 93.0 96.0 92.9 98.8 93.8 96.7 97.4 95.3 Men age 15-59 years Eligible 2090 835 432 390 416 358 556 480 293 2925 Interviewed 1983 786 385 369 375 355 540 465 280 2769 Men’s response rate 94.9 94.1 89.1 94.6 90.1 99.2 97.1 96.9 95.6 94.7 Men’s overall response rate 93.3 93.3 88.2 93.4 88.0 97.9 96.4 94.9 94.1 93.3 Children under 5 Eligible 2490 975 457 376 463 446 770 595 358 3465 Mothers / caretakers interviewed 2477 966 447 374 456 446 769 595 356 3443 Under-5’s response rate 99.5 99.1 97.8 99.5 98.5 100.0 99.9 100.0 99.4 99.4 Under-5’s overall response rate 97.0 98.4 96.7 98.4 96.6 99.2 95.4 98.1 98.0 97.4 36 MICS4, Republic of Belarus. Final Report SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 37 Table HH.2. Household members age distribution by sex Distribution of the household population by different age groups by sex, Republic of Belarus, 2012 Males Females Total Number Percent Number Percent Number Percent Age 0-4 748 7.8 687 6.3 1435 7.0 5-9 507 5.3 520 4.8 1027 5.0 10-14 511 5.3 499 4.6 1010 4.9 15-19 516 5.4 412 3.8 927 4.5 20-24 662 6.9 601 5.5 1263 6.2 25-29 789 8.3 764 7.0 1553 7.6 30-34 713 7.5 754 7.0 1467 7.2 35-39 721 7.6 745 6.9 1466 7.2 40-44 676 7.1 670 6.2 1345 6.6 45-49 684 7.2 760 7.0 1444 7.1 50-54 891 9.3 1058 9.8 1949 9.6 55-59 701 7.3 929 8.6 1630 8.0 60-64 555 5.8 644 5.9 1199 5.9 65-69 243 2.5 398 3.7 641 3.1 70-74 267 2.8 536 4.9 803 3.9 75-79 193 2.0 405 3.7 598 2.9 80-84 124 1.3 297 2.7 422 2.1 85+ 48 0.5 165 1.5 213 1.0 Missing / DK - - 5 0.0 5 0.0 Dependency age groups 0-14 1765 18.5 1706 15.7 3472 17.0 15-64 6908 72.3 7337 67.6 14245 69.8 65+ 875 9.2 1801 16.6 2677 13.1 Missing / DK - - 5 0.0 5 0.0 Children and adult populations Children age 0-17 2079 21.8 1968 18.1 4046 19.8 Adults 18+ 7471 78.2 8877 81.8 16347 80.1 Missing / DK - - 5 0.0 5 0.0 Total 9549 100.0 10849 100.0 20398 100.0 MICS4, Republic of Belarus. Final Report SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table HH.3. Household composition Percent distribution of households by selected characteristics, Republic of Belarus, 2012 Number of households Weighted percent Weighted Unweighted Sex of household head Male 49.6 4108 4239 Female 50.4 4176 4045 Region Brest 14.3 1184 1178 Vitebsk 13.4 1114 1132 Gomel 15.1 1251 1243 Grodno 11.4 946 972 Minsk City 18.9 1562 1509 Minsk 15.0 1244 1268 Mogilev 11.9 982 982 Area Urban 72.8 6029 5971 Rural 27.2 2255 2313 Number of household members 1 23.7 1959 1419 2 34.2 2834 2168 3 22.2 1842 2143 4 14.5 1199 1702 5 or more 5.4 450 852 Education1 of household head None 0.2 13 10 Primary 4.0 331 250 General basic 8.5 708 632 General secondary 19.0 1570 1569 Vocational-technical / Secondary specialized 43.5 3601 3665 Higher 24.9 2061 2158 Total 100.0 8284 8284 1 Hereinafter, education of the household member corresponds to the highest education grade the respondent had or was attending at the time of survey. 38 MICS4, Republic of Belarus. Final Report SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 39 Table HH.4. Women’s background characteristics Percent distribution of women age 15-49 years by selected background characteristics, Republic of Belarus, 2012 Number of women age 15-49 years Weighted percent Weighted Unweighted Region Brest 15.5 888 812 Vitebsk 12.7 728 736 Gomel 15.3 880 835 Grodno 10.9 627 689 Minsk City 19.5 1120 1078 Minsk 15.2 874 919 Mogilev 10.9 628 676 Area Urban 74.7 4293 4189 Rural 25.3 1452 1556 Age 15-19 8.6 494 399 20-24 12.6 721 823 25-29 16.2 934 1330 30-34 16.3 936 1129 35-39 16.0 918 838 40-44 14.1 812 586 45-49 16.2 930 640 Marital / Union status Currently married / in union 69.4 3985 4302 Widowed 2.2 129 106 Divorced 8.1 463 408 Separated 1.7 100 108 Never married / in union 18.6 1068 821 Motherhood status Ever gave birth 75.9 4362 4826 Never gave birth 24.1 1383 919 Births in last two years Had a birth in last two years 12.7 730 1324 Had no birth in last two years 87.3 5015 4421 Education None 0.0 2 1 Primary 0.0 2 1 General basic 3.3 187 207 General secondary 15.8 905 933 Vocational-technical / Secondary specialized 44.3 2543 2517 Higher 36.7 2106 2086 Wealth index quintile1 Poorest 13.5 774 839 Second 20.1 1157 1167 Middle 20.1 1154 1095 Fourth 22.2 1278 1256 Richest 24.1 1382 1388 Total 100.0 5745 5745 1 Methods for calculation of the wealth index are given in Appendix B. MICS4, Republic of Belarus. Final Report SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table HH.4М. Men’s background characteristics Percent distribution of men age 15-49 years and men of 15-59 years by selected background characteristics, Republic of Belarus, 20121 Men age 15-49 years Men age 15-59 years Number of men Number of men Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Region Brest 14.7 304 298 14.6 404 385 Vitebsk 13.6 280 293 13.0 361 369 Gomel 15.0 310 288 15.4 427 375 Grodno 11.1 229 269 11.9 329 355 Minsk City 18.7 386 458 17.4 481 540 Minsk 15.3 315 360 15.9 440 465 Mogilev 11.6 240 215 11.8 327 280 Area Urban 74.3 1534 1590 72.9 2019 1983 Rural 25.7 530 591 27.1 750 786 Age 15-19 9.6 198 182 7.2 198 182 20-24 14.0 288 269 10.4 288 269 25-29 16.9 350 452 12.6 350 452 30-34 16.2 335 432 12.1 335 432 35-39 15.8 326 361 11.8 326 361 40-44 13.8 286 252 10.3 286 252 45-49 13.6 281 233 10.1 281 233 50-54 na na na 14.6 403 331 55-59 na na na 10.9 302 257 Marital / Union status Currently married / in union 63.9 1320 1579 68.7 1904 2070 Widowed 0.5 10 12 1.2 34 34 Divorced 6.4 133 100 7.2 198 152 Separated 1.5 32 23 1.5 41 29 Never married / in union 27.6 569 467 21.4 592 484 Education General basic 4.5 92 116 3.7 102 123 General secondary 20.2 418 417 22.6 626 594 Vocational-technical / Secondary specialized 47.8 987 1045 47.8 1324 1330 Higher 27.5 567 603 25.9 717 722 Wealth index quintile Poorest 17.0 351 351 19.1 529 504 Second 20.8 430 463 20.9 578 583 Middle 19.6 405 409 19.5 541 517 Fourth 19.1 394 429 18.9 524 539 Richest 23.5 484 529 21.5 597 626 Total 100.0 2064 2181 100.0 2769 2769 na – not applicable. 40 MICS4, Republic of Belarus. Final Report SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 41 Table HH.5. Under-5 children’s background characteristics Percent distribution of children under five years of age by selected background characteristics, Republic of Belarus, 2012 Number of under-5 children Weighted percent Weighted Unweighted Sex Male 51.9 1786 1771 Female 48.1 1657 1672 Region Brest 16.1 553 447 Vitebsk 11.2 387 374 Gomel 13.8 474 456 Grodno 9.5 326 446 Minsk City 26.8 922 769 Minsk 12.9 445 595 Mogilev 9.8 336 356 Area Urban 74.6 2567 2477 Rural 25.4 876 966 Age 0-5 months 8.3 287 247 6-11 months 12.3 424 403 12-23 months 20.9 719 712 24-35 months 19.3 664 669 36-47 months 20.0 690 682 48-59 months 19.1 659 730 Mother / Caretaker’s Education General basic 2.5 86 109 General secondary 15.5 532 540 Vocational-technical / Secondary specialized 40.8 1405 1439 Higher 41.2 1420 1355 Wealth index quintile Poorest 13.3 457 505 Second 17.4 598 662 Middle 18.7 643 615 Fourth 21.6 743 737 Richest 29.1 1002 924 Total 100.0 3443 3443 MICS4, Republic of Belarus. Final Report IV. Nutrition NUTRITION 43 Breastfeeding, Infant and Young Child Feeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition. WHO / UNICEF have the following feeding recommendations: • Exclusive breastfeeding for the first six months; • Continued breastfeeding for two years or more; • Safe and age-appropriate complementary foods beginning at 6 months; • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds. It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: • Early initiation of breastfeeding (within 1 hour of birth). • Exclusive breastfeeding rate (< 6 months). • Predominant breastfeeding (< 6 months). • Continued breastfeeding rate (at 1 year and at 2 years). • Duration of breastfeeding. • Age-appropriate breastfeeding (0-23 months). • Introduction of solid, semi-solid and soft foods (6-8 months). • Minimum meal frequency (6-23 months). • Milk feeding frequency for non-breastfeeding children (6-23 months). • Bottle feeding (0-23 months). Table NU.1 shows the proportion of children born in the two years preceding the survey who were ever breastfed, those who were first breastfed within one hour of birth, and those who received a prelacteal feed. In spite of the exclusive importance of early breastfeeding in terms of lactation control and establishment of physical and emotional relations between the mother and the child, only 53 percent of children in the Republic of Belarus were first breastfed within one hour of birth. The proportion of mothers who initiated breastfeeding within one day of birth (including mothers who began to breastfeed within one hour of birth) was 73.7 percent. Provision of necessary postnatal care to the mother and the child is the main factor behind the delay in breastfeeding initiation, given the fact that all (100 percent) births in Belarus take place in health institutions and are attended by skilled medical personnel. Breastfeeding within one hour of birth was started by 55 percent of urban women, and 45.7 percent of rural women. Early breastfeeding is positively correlated to the mother’s education: with the increase in the level of mother’s education the share of children with the timely breastfeeding is also increased. The proportion of the mothers who began to breastfeed early also varied across the wealth index quintiles, from 43.5 percent for the poorest quintile, to 60.7 percent for the richest quintile. Likewise, the proportion of women who began to breastfeed within 24 hours of birth was 68.5 percent for the poorest quintile, and 76.9 percent for the richest quintile (Figure NU.1). MICS4, Republic of Belarus. Final Report NUTRITION Figure NU.1: Percentage of mothers who started breastfeeding within one hour or one day of birth, Republic of Belarus, 2012 (percent) 76.973.8 70.7 74.873.8 68.5 73.373.7 60.7 55.0 47.8 57.2 46.643.545.7 53.0 0 20 40 60 80 Within one day Withing one hour Wealth Index Quintile Republic of Belarus Urban areas Rural areas Poorest Second Middle Fourth Richest The overall proportion of newborns who received a prelacteal feed (mainly milk formula) in the first three days of birth was 41.7 percent. It was highest in Minsk (59.2 percent) and among the wealthiest households (48 percent). Breastfeeding status in Table NU.2 is based on the responses given by mothers / caretakers regarding food and liquids taken by children within the 24 hours preceding the survey. This table shows the proportion of infants who were breastfed during the first 6 months of life and also the proportion of children who were still being breastfed at 12-15 months and 20-23 months of age. «Exclusive breastfeeding» refers to infants who were receiving only breast milk (also vitamins, minerals and medication); «predominantly breastfed» refers to infants who were receiving only breast milk and were given only plain water and other non-diary liquids. According to the survey findings, 19 percent of children under 6 months of age were exclusively breastfed, and 41.4 percent were predominantly breastfed, a level considerably lower than recommended. No differences were found in the rate of exclusive breastfeeding among girls and boys under 6 months of age (20.1 percent and 18.2 percent, respectively). On average, 27.9 percent of children across the republic were still being breastfed at age 12-15 months, and 11.5 percent at age 20-23 months. Infant feeding is in the focus of the paediatrician training curricula. Maternity training courses («Young Mother» schools) and post-natal home visits place significant emphasis on appropriate child feeding. Breastfeeding is being actively promoted. At the same time, the national paediatric community does not recommend exclusive breastfeeding of children after 1 year of age. The age distribution of children by the pattern of feeding is presented in Figure NU.2. The data obtained through the survey reveals that most children receive not only breast milk but also other liquids or foods even at the earliest stages. By the age of 4-5 months the proportion of infants who were exclusively breastfed is only 4 percent. One in five infants of this age was receiving breast milk and milk formula, and one in ten was receiving breast milk and other foods. 44 MICS4, Republic of Belarus. Final Report NUTRITION 45 Figure NU.2. Infant feeding patterns by age, Republic of Belarus, 2012 0% 20% 40% 60% 80% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age, in months Exclusive breastfeeding Breastmilk and only plain water Breastmilk and non-diary liquids Breastmilk and other milk/complementary foods Breastmilk and other foods No breastfeeding Table NU.3 shows the median duration of breastfeeding by selected background characteristics. The median duration of breastfeeding among children under 3 years of age is 5.9 months for any breastfeeding, 0.6 months for exclusive breastfeeding and 1.6 months for predominant breastfeeding. Girls are breastfed longer than boys for any breastfeeding (the median duration is 6.7 and 5.7 months, respectively). Table NU.4 shows the proportion of infants under 24 months of age receiving adequate feeding. Different criteria of feeding adequacy are applied depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants age 6-23 months are considered to be adequately fed if they are receiving breast milk and solid, semi-solid or soft food. According to the survey findings on the patterns of feeding in the Republic of Belarus, only 19.8 percent of children age 6-23 months (including 17.8 percent of boys and 21.9 percent of girls) were appropriately fed, and almost identical among urban and rural infants (19.7 percent and 20 percent, respectively). At age 0-5 months, 19 percent of infants were receiving appropriate feeding, including 18.2 percent of boys and 20.1 percent of girls. MICS4, Republic of Belarus. Final Report NUTRITION Mother's education was found to be a significant factor affecting infant feeding adequacy at all ages. The proportion of children receiving adequate feeding was considerably higher among infants whose mothers had higher education than among those whose mothers had general secondary or vocational-technical / secondary specialized education (25 percent compared to 12-17 percent). Adequate complementary feeding of children from 6 months to two years of age is particularly important for growth and development. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. The national paediatric school recommends complementary feeding with cereals, vegetable, meat and fruit purees and juices from age 5-6 months. Children under 2 years of age from low- income families are guaranteed free monthly supply of complimentary foods that meet nutritional requirements and physiological needs, including infant formula, dairy products and kefir, canned vegetables, fish and fruits, juice and instant cereals. The Republic of Belarus is implementing the State Programme «Infant and Child Feeding». Through the support and funding provided by the government under this programme, capacities have been put in place to produce a variety of baby foods, including therapeutic and protective dietary products, infant and milk formula, vegetable, fruit and meat purees, and juices. All the products are suitable for young children in the early stages of life and conform to international food safety and quality standards. As a result of the state policies, all children are guaranteed access to appropriate foods of good quality. These are supplied free of charge to children from the low-income families. According to the survey findings, 64.3 percent of infants age 6-8 months were receiving solid, semi-solid, or soft foods, including 57.6 percent among children who were still being breastfed, and 69.5 percent among non-breastfeeding children (Table NU.5). Table NU.6 presents the proportion of breastfeeding and non-breastfeeding children age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the day or night preceding the interview. Among currently breastfed children age 6-8 months, children who are fed the minimum recommended number of times are defined as children who received solid, semi-solid or soft foods two or more times during the day or night preceding the interview. Among currently breastfed children age 9-23 months, children who are fed the minimum recommended number of times are defined as children who received solid, semi-solid or soft foods, at least, 3 times during the day or night preceding the interview. Among currently non-breastfeeding children age 6-23 months, children who are fed the minimum recommended number of times are defined as children who received solid, semi-solid or soft foods, at least, 4 times during the day or night preceding the interview. Overall, around three-quarters (74.2 percent) of children age 6-23 months were receiving solid, semi-solid and soft foods the minimum number of times within the 24 hours preceding the interview. Among currently breastfeeding children, this proportion exceeds one-third (40.3 percent) of children age 6-23 months, and varies significantly according to the area (44.9 percent among urban children, and 24.2 percent among rural children). 46 MICS4, Republic of Belarus. Final Report NUTRITION 47 Among non-breastfeeding children, an overwhelming majority (86.3 percent) of children were receiving solid, semi-solid and soft foods and milk formula 4 or more times within the twenty-four hours preceding the interview, with no substantial rural-urban differentials. Bottle feeding is a part of the infant and child feeding practice in the Republic of Belarus, as seen from Table NU.7. According to the survey findings, two-thirds (66.1 percent) of children under 6 months of age and a similar (66.5 percent) proportion of children age 0-23 months were bottle-fed. There is evidence indicating a relationship between bottle-feeding and mother’s education. The proportion of bottle-fed children whose mothers had a general basic education was 80.5 percent compared to 59.1 percent among children whose mothers had a higher education. Iodine Deficiency Prevention Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and deteriorated work performance. In order to prevent adverse impacts of iodine deficiency on human health, the Republic of Belarus has put in place the legislation mandating the use of iodized salt by food industries and in public catering. These efforts have been made since 2000, when the National Strategy for Elimination of Iodine Deficiency Disorders through Universal Salt Iodization (USI) established the mechanisms to achieve the following outcomes: • improved production of iodized salt and its universal availability in retail trade; • increased public awareness about the benefits of iodized salt consumption and provision of relevant training to specialists; • mandatory use of iodized salt in the food industries and public catering; • monitoring of the population’s iodine status. The «Food Safety Law» of the Republic of Belarus (No. 217-З, dated 29.06.2003), mandates the use of iodized salt in food industries and public catering. Procedures for monitoring the quality and safety of foods and components thereof are defined by the Council of Ministers of the Republic of Belarus. The authority to inspect the quality and safety of raw and processed foods, materials and products on behalf of the state is exercised by the Ministry of Health of the Republic of Belarus, the Ministry of Agriculture and Foods of the Republic of Belarus, the Ministry of Trade of the Republic of Belarus, the State Committee on Standards of the Republic of Belarus, the Committee of State Control of the Republic of Belarus, and by other state bodies subject to their respective mandates. The Republic of Belarus has established an effective monitoring system for prevention of iodine deficiency disorders. The main elements of this system are: • control of iodized salt quality by the manufacturer (mainly, Mozyrsol), consistent with the national and international (ISO) quality standards; • sanitary and hygienic monitoring: control of iodized salt quality in the retail and food industries, and monitoring the quantity of iodized salt on sale; • monitoring and assessment of the use of iodized salt by households; • medical monitoring (regular medical tests, including urine iodine measurement and analysis of statistics on the prevalence of thyroid disorders). MICS4, Republic of Belarus. Final Report NUTRITION According to the data of continuous monitoring, the measures implemented by the Government have been sufficient to achieve adequate iodine intake of the entire population and elimination of iodine deficiency disorders. Analytical data on IDD/USI issue is prepared annually for the State Report “On Sanitary and Hygienic Situation in the Republic of Belarus”. The module «Iodine Deficiency Prevention» included into MICS4 was designed to collect data on the indicators most relevant for the Republic of Belarus. Overall, 94.5 percent of households know about the benefits of iodized salt consumption as the basic affordable measure for prevention of iodine deficiency disorders. The awareness was found to be higher among urban than among rural households (96 percent and 90.4 percent, respectively), and reached 97.1 percent among the households in Minsk City (Table NU.8). Nation-wide, 85.4 percent of households reported the use of iodized salt for cooking, including 39.2 percent who were using it all of the time. Approximately equal shares of urban and rural households reported the use iodized salt for cooking always or sometime (86.3 percent and 83.1 percent, respectively). Iodized salt consumption was found to vary by households’ wealth. The proportion of households reporting the use of iodized salt for cooking on a regular basis ranges from about one- half among the richest households to only one-third (28.9 percent) among the poorest households, the lowest rate among all types of households by the wealth index (Figure NU.3). Figure NU.3. Percentage of households reporting use of iodized salt for cooking, Republic of Belarus, 2012 (percent) 50.741.3 45.538.037.428.933.639.2 42.245.0 45.148.345.848.349.546.2 0 20 40 60 80 100 always sometime Wealth Index Quintile Republic of Belarus Urban areas Rural areas Poorest Second Middle Fourth Richest Reporting use of iodized salt Mogilev and Gomel Regions were found to be the areas with the lowest rate of iodized salt consumption. In these two regions, the proportion of the households who reported not using iodized salt (21.1 and 19.7 percent, respectively) was nearly 2 times higher than the relevant proportions recorded in Minsk City, Minsk Region and Vitebsk Region. On average, 14.5 percent of households in the republic have reported not using iodized salt for cooking. Every fourth (22.7 percent) household with the lowest level of well-being does not use iodized salt, and this is 3.3 times more than among the richest households. At the same time, it should be accentuated that food production industry in the Republic of Belarus uses only iodised salt. 48 MICS4, Republic of Belarus. Final Report NUTRITION 49 Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also of the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for infants. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of certain diseases; they are likely to remain skeletal, with reduced muscle strength throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In recognition of the relevance of low birth weight prevention, the Republic of Belarus has implemented the Comprehensive Programme of Pregnancy Planning and Prevention of Miscarriage for 2008-2010. As a result, the proportion of premature births has stabilised at 4.1 percent. Starting from 2011, miscarriage and low birth weight prevention have been addressed through the National Demographic Security Programme for 2011-2015. In addition, pregnant women benefit from a range of social entitlements, allowances and incentives that contribute to prevention of miscarriage and enable good birth outcomes. These include the right of pregnant women and of women of child-bearing age to be relieved of physically demanding work and to be transferred to less exerting jobs, monetary incentives to pregnant women who register with a state antenatal clinic within 12 weeks of gestation; paid maternity leave and affordable and timely access to medical services at outpatient and hospital facilities. The new version of the clinical protocols on pregnancy and birth management, adopted at the end of 2012, includes sections on prevention of miscarriage and foetal growth retardation. In general, the measurement of birth weight does not present a problem for Belarus, given that all (99.9 percent) deliveries take place in medical facilities, where all newborns are weighed. According to the survey findings, 99.8 percent of babies in the Republic of Belarus were weighted at birth, and about 4.1 percent had weight below 2,500 grams (Table NU.9). Low birth weight prevalence varies somewhat across the regions, from 3.2 percent in Grodno and Minsk Regions to 5.4 percent in Gomel Region (Figure NU.4). The percentage of low birth weight babies born to mothers with higher education is 3.1 percent, and among babies born to mothers with general secondary education, 7 percent. Figure NU.4. Percentage of infants weighting less than 2500 grams at birth, Republic of Belarus, 2012 (percent) 3.9 4.3 5.4 3.2 4.0 3.2 5.24.1 0 1 2 3 4 5 6 Brest Vitebsk Gomel Grodno Minsk City Minsk Mogilev Regions Republic of Belarus MICS4, Republic of Belarus. Final Report NUTRITION Table NU.1. Initial breastfeeding Percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Republic of Belarus, 2012 Percentage who were first breastfed Percentage who were ever breastfed1 Within one hour of birth2 Within one day of birth Percentage who received a prelacteal feed Number of last- born children in the two years preceding the survey Area Urban 93.1 55.0 73.8 44.2 571 Rural 90.6 45.7 73.3 32.5 159 Age 0-11 months 93.3 52.8 71.7 44.1 348 12-23 months 92.2 53.1 75.8 39.5 372 Assistance at delivery3 Skilled attendant 92.5 52.9 73.7 41.6 729 Place of delivery4 Public sector health facility 92.5 53.0 73.7 41.7 729 Mother’s education General basic (87.5) (33.1) (69.3) (46.6) 11 General secondary 85.1 46.0 61.1 33.8 111 Vocational-technical / Secondary specialized 93.2 50.2 74.3 38.5 281 Higher 94.6 58.4 77.6 46.9 327 Wealth index quintiles Poorest 87.6 43.5 68.5 24.8 83 Second 93.0 46.6 73.8 41.0 123 Middle 94.1 57.2 74.8 37.1 139 Fourth 88.6 47.8 70.7 45.9 156 Richest 95.7 60.7 76.9 48.0 229 Total 92.5 53.0 73.7 41.7 730 1 MICS indicator 2.4. 2 MICS indicator 2.5. 3 1 unweighted case "Traditional birth attendant" has been excluded. 4 1 unweighted case "At home" and 1 unweighted case "Other" have been excluded. ( ) – Figures that are based on 25-49 unweighted cases. 50 MICS4, Republic of Belarus. Final Report NUTRITION 51 Table NU.2. Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Republic of Belarus, 2012 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (continued breastfeeding at 1 year)3 Number of children Percent breastfed (continued breastfeeding at 2 years)4 Number of children Sex Male 18.2 40.7 164 24.8 120 10.2 103 Female 20.1 42.2 123 32.0 94 12.5 135 Area Urban 18.7 42.6 198 28.4 167 9.7 188 Rural 19.8 38.7 89 26.1 47 18.3 50 Total 19.0 41.4 287 27.9 214 11.5 238 1 MICS indicator 2.6. 2 MICS indicator 2.9. 3 MICS indicator 2.7. 4 MICS indicator 2.8. Table NU.3. Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Republic of Belarus, 2012 Median duration (in months) of Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Number of children age 0-35 months Sex Male 5.7 0.6 1.6 1108 Female 6.7 0.5 1.6 986 Area Urban 5.9 0.6 1.9 1600 Rural 5.9 0.5 0.7 494 Mother’s education General basic 0.0 0.0 0.0 34 General secondary 5.0 0.5 0.7 321 Vocational-technical / Secondary specialized 3.5 0.6 1.5 821 Higher 8.8 0.6 2.5 918 Wealth index quintiles Poorest 4.4 0.7 2.1 258 Second 9.0 0.5 0.6 340 Middle 4.3 0.4 0.6 403 Fourth 5.3 0.4 1.4 460 Richest 6.9 1.0 2.6 633 Median 5.9 0.6 1.6 2094 Mean for all children (0-35 months) 8.9 1.0 2.4 2094 1 MICS indicator 2.10. MICS4, Republic of Belarus. Final Report NUTRITION Table NU.4. Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Republic of Belarus, 2012 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percent appropriately breastfed2 Number of children Sex Male 18.2 164 17.8 594 17.9 757 Female 20.1 123 21.9 549 21.6 673 Area Urban 18.7 198 19.7 919 19.5 1117 Rural 19.8 89 20.0 224 19.9 313 Mother’s education General basic (*) 4 (17.2) 19 (18.4) 23 General secondary (12.0) 55 13.0 157 12.7 212 Vocational-technical / Secondary specialized 16.8 115 15.9 441 16.1 556 Higher 24.5 113 25.2 526 25.0 639 Wealth index quintiles Poorest (28.6) 48 20.7 112 23.1 160 Second (16.3) 47 24.1 192 22.6 239 Middle (11.5) 57 15.3 220 14.5 277 Fourth 8.1 55 15.9 251 14.5 306 Richest 27.9 80 22.5 368 23.5 448 Total 19.0 287 19.8 1143 19.6 1430 1 MICS indicator 2.6. 2 MICS indicator 2.14. (*) – Figures that are based on fewer than 25 unweighted cases. ( ) – Figures that are based on 25-49 unweighted cases. Table NU.5. Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, Republic of Belarus, 2012 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods1 Number of children age 6-8 months Sex Male (59.4) 42 71.4 55 66.3 97 Female (55.8) 44 67.5 56 62.3 100 Area Urban 61.8 74 66.5 87 64.4 161 Rural (*) 12 (80.2) 24 (64.0) 36 Total 57.6 86 69.5 111 64.3 197 1 MICS indicator 2.12. (*) – Figures that are based on fewer than 25 unweighted cases. ( ) – Figures that are based on 25-49 unweighted cases. 52 MICS4, Republic of Belarus. Final Report NUTRITION 53 Table NU.6. Minimum meal frequency1 Percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non- breastfeeding children) the minimum number of times or more during the day or night preceding the interview, Republic of Belarus, 2012 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Percent receiving at least 2 milk feeds2 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Percent with minimum meal frequency3 Number of children age 6-23 months Sex Male 39.0 142 90.4 87.4 452 75.8 594 Female 41.6 158 86.8 84.9 391 72.4 549 Age 6-8 months 40.2 86 96.6 90.3 111 68.5 197 9-11 months 35.5 89 93.0 87.0 138 66.7 227 12-17 months 40.5 86 92.5 92.0 266 79.4 352 18-23 months (51.7) 39 81.2 80.0 328 77.0 367 Area Urban 44.9 233 88.0 86.0 685 75.6 919 Rural 24.2 67 92.0 87.5 158 68.7 224 Mother’s education General basic (*) 4 90.7 (87.3) 15 (81.4) 19 General secondary (35.8) 35 93.0 89.8 123 77.9 157 Vocational-technical / Secondary specialized 35.4 97 90.0 86.1 344 75.0 441 Higher 43.7 164 86.0 85.2 361 72.2 526 Wealth index quintiles Poorest (24.6) 27 92.1 92.2 86 76.0 112 Second 26.3 64 89.4 83.8 128 64.6 192 Middle 51.0 48 88.7 86.9 173 79.1 220 Fourth 43.1 57 89.8 87.1 193 77.1 251 Richest 46.7 104 86.6 84.5 263 73.8 368 Total 40.3 300 88.7 86.3 843 74.2 1143 1 For infants age 6-8 months currently breastfed the minimum number of times for receiving solid, semi-solid or soft foods – not less than 2 times within twenty-four hours; for children age 9-23 months currently breastfed the minimum number of times for receiving solid, semi-solid or soft foods – not less than 3 times within twenty-four hours; for non-breastfeeding children age 6-23 months the minimum number of times for receiving solid, semi-solid or soft foods – not less than 4 times within twenty-four hours. 2 MICS indicator 2.15. 3 MICS indicator 2.13. (*) – Figures that are based on fewer than 25 unweighted cases. ( ) – Figures that are based on 25-49 unweighted cases. MICS4, Republic of Belarus. Final Report NUTRITION Table NU.7. Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day preceding the interview, Republic of Belarus, 2012 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Sex Male 68.8 757 Female 64.0 673 Age 0-5 months 66.1 287 6-11 months 81.5 424 12-23 months 57.8 719 Area Urban 65.9 1117 Rural 68.8 313 Mother’s education General basic (80.5) 23 General secondary 76.9 212 Vocational-technical / Secondary specialized 70.5 556 Higher 59.1 639 Wealth index quintiles Poorest 69.1 160 Second 72.2 239 Middle 63.9 277 Fourth 67.7 306 Richest 63.4 448 Total 66.5 1430 1 MICS indicator 2.11. ( ) – Figures that are based on 25-49 unweighted cases. 54 MICS4 in the Republic of Belarus. Final Report NUTRITION 55 Table NU.8. Reported iodized salt consumption Percent distribution of households by reported consumption of iodized salt for cooking, Republic of Belarus, 2012 Percentage of households reporting use of iodized salt for cooking Percentage of households that are aware of benefits of iodized salt consumption Always Sometime Not using Other Total Number of households Region Brest 93.8 44.9 40.4 14.5 0.1 100.0 1184 Vitebsk 94.6 31.5 57.2 11.3 0.0 100.0 1114 Gomel 90.5 43.3 36.9 19.7 0.0 100.0 1251 Grodno 94.6 36.1 49.3 14.6 0.0 100.0 946 Minsk City 97.1 46.0 43.4 10.3 0.3 100.0 1562 Minsk 95.3 39.5 48.7 11.8 0.0 100.0 1244 Mogilev 95.0 28.1 50.7 21.1 0.1 100.0 982 Area Urban 96.0 41.3 45.0 13.6 0.1 100.0 6029 Rural 90.4 33.6 49.5 16.8 0.1 100.0 2255 Wealth index quintiles Poorest 87.3 28.9 48.3 22.7 0.1 100.0 1930 Second 93.7 37.4 45.8 16.9 0.0 100.0 1691 Middle 96.1 38.0 48.3 13.7 0.0 100.0 1738 Fourth 98.4 45.5 45.1 9.2 0.2 100.0 1577 Richest 99.0 50.7 42.2 6.9 0.2 100.0 1348 Total 94.5 39.2 46.2 14.5 0.1 100.0 8284 MICS4, Republic of Belarus. Final Report NUTRITION Table NU.9. Low birth weight infants Percentage of last-born children in the 2 years preceding the survey that are estimated to have weighed below 2500 grams at birth, Republic of Belarus, 2012 Percent of live births: Below 2,500 grams1 Weighed at birth2 Number of last-born children in the two years preceding the survey Region Brest 3.9 100.0 126 Vitebsk 4.3 98.9 89 Gomel 5.4 99.6 91 Grodno 3.2 100.0 57 Minsk City 4.0 99.8 207 Minsk 3.2 100.0 96 Mogilev 5.2 100.0 64 Area Urban 4.3 99.8 571 Rural 3.6 99.8 159 Mother’s education3 General secondary 7.0 99.9 111 Vocational-technical / Secondary specialized 4.2 99.6 281 Higher 3.1 99.8 327 Wealth index quintiles Poorest 5.0 99.6 83 Second 2.5 100.0 123 Middle 5.6 99.8 139 Fourth 5.1 99.3 156 Richest 3.1 100.0 229 Total 4.1 99.8 730 1 MICS indicator 2.18. 2 MICS indicator 2.19. 3 11 unweighted cases "General basic education” have been excluded. 56 MICS4, Republic of Belarus. Final Report V. Child Health CHILD HEALTH Oral Rehydration Treatment The Plan of Action «A World Fit for Children» calls for a reduction in the incidence of diarrhoea by 25 percent. Indicators in this domain:  Prevalence of diarrhoea.  Oral rehydration treatment (ORT).  Treatment for diarrhoea at home.  ORT and continued breastfeeding. During the MICS4 survey, the prevalence of diarrhoea in the Republic of Belarus was estimated by asking mothers or caretakers of children under 5 whether their child had an episode of diarrhoea in the two weeks preceding the survey. When the mothers or caretakers reported that their child had diarrhoea, they were asked what the child had to eat or drink during illness and whether children received more or less meals or fluids than usually. It should be noted that diarrhoea is not a highly relevant problem for infant and child health in the Republic of Belarus, as safe drinking water and certified foods are readily available, and skilled medical assistance can be obtained upon request, including specialist and inpatient care when needed. No cases of child mortality caused by diarrhoea have been reported in the last decade in the Republic of Belarus. In formulating its obligations under the MDGs, the Republic of Belarus in compliance with the country’s development level has committed itself to reduce, by 2015, the under-five mortality rate by 50% relative to 1990. According to the survey findings, overall proportion of children under 5 years of age who had diarrhoea during the two weeks preceding the survey was 3.4 percent (Table CH.1). Due to a small number of observations, the data are presented by sex and residence area only. No noticeable differences in diarrhoea incidence were observed by the area of residence. The proportion of girls who had diarrhoea was 1 percentage point higher than proportion of boys (3.9 and 2.9 percent, respectively). Table CH.1 also shows the percentage of children receiving various types of recommended fluids during the episode of diarrhoea. Of the total number of children under 5 who had diarrhoea, over 45 percent received fluids from ORS packet or pre-packaged ORS fluid, while 52.1 percent received recommended homemade fluids. Differences were observed by the area of residence: the proportion of children treated with ORS during the episode of diarrhoea was 50.8 percent in urban areas and 29.8 percent in rural areas. Almost three-quarters (73.5 percent) of children with diarrhoea received one or more types of recommended home treatments (i.e., oral rehydration solutions or recommended homemade fluids). Over 50 percent of children under 5 years of age who had diarrhoea drank more than usual, 36.7 percent drank the same, and 9.8 percent drank less than usual (Table CH.2). 58 MICS4, Republic of Belarus. Final Report Some 36.7 percent ate the same, and about 4 percent ate more than usual. However, 15.5 percent of children ate less than usual, and over 5 percent ate almost none. Overall, CHILD HEALTH 59 for 79.1 percent of children with diarrhoea feeding was continued (they were eating somewhat less, same or more than usual), and about 20 percent ate much less or almost none. Table CH.3 presents the percentage of children age 0-59 months who received oral rehydration treatment (ORT) during the episode of diarrhoea in the 2 weeks preceding the survey and continued feeding, as well as the proportion of children with diarrhoea who received other treatments. Overall, more than three-quarters (76.6 percent) of children with diarrhoea received ORS or increased amount of fluids, and 81.2 percent received ORT (ORS, recommended homemade fluids or increased fluids). Combining data from Table CH.2 with those from Table CH.3, it is observed that more than 60 percent of children received ORT and continued feeding, as recommended. Some differences in treatment of children with diarrhoea at home were observed, depending on the area. In urban areas, 83 percent of children with diarrhoea received ORT and continued feeding, while in rural areas the figure was 76 percent. Differences were observed in the management of diarrhoea in boys and girls. The proportion of children who received ORT and continued feeding was about 74 percent among boys and just over one-half among girls. In some cases, children with diarrhoea received other treatments in addition to ORT. Some 22.3 percent of children received antibiotics in pills or syrup, and about 18 percent of children received antimotility drugs. Among all children with diarrhoea in the 2 weeks preceding the survey 8 percent of children did not receive any treatment. Care Seeking for Suspected Pneumonia and Antibiotic Treatment of Pneumonia In the survey methodology, a child with suspected pneumonia is defined as having an illness with a cough accompanied by rapid or difficult breathing, whose symptoms were not due to a problem in the chest or blocked nose. The relevant indicators are:  Prevalence of suspected pneumonia.  Care seeking for suspected pneumonia.  Antibiotic treatment for suspected pneumonia.  Knowledge of the danger signs of pneumonia. Table CH.4 presents the data on prevalence of suspected pneumonia in children age 0-59 months and also a health provider (if care was sought outside the home). According to the survey findings, the overall proportion of children who had symptoms of pneumonia in the 2 weeks preceding the survey was 6.8 percent. Of this number, an overwhelming majority (93.4 percent) of children were taken to an appropriate health facility. In urban areas, 91 percent of children with suspected pneumonia were taken to a polyclinic and 7.8 percent to a hospital. In rural areas, 11.1 percent of children with suspected pneumonia were taken to a local outpatient clinic, 37.6 percent of children to a polyclinic, and 28.6 percent of children to a hospital. Table CH.4 also presents data on the use of antibiotics for treatment of suspected pneumonia in children under 5. In the Republic of Belarus, 76.7 percent of children under 5 years of age with suspected pneumonia received an antibiotic in the last 2 weeks preceding the survey. In urban areas, the figure was 80.4 percent, and in rural areas 57.5 percent. MICS4, Republic of Belarus. Final Report CHILD HEALTH Table CH.5 presents data related to knowledge of the danger signs of pneumonia. It is clear that the mother or caretaker’ knowledge of the danger signs of pneumonia is an important determinant of care-seeking behaviour. Fever is the most commonly identified symptom for immediately taking a child age 0-59 months to a health facility (indicated by 89.2 percent of mothers/ caretakers). Some 51.5 percent of mothers recognize difficult breathing and 22.1 percent fast breathing as symptoms for taking a child immediately to a health provider. Over 45 percent (46.6 percent) of mothers pointed out that they would immediately take their child to a health provider if the child’s condition deteriorated. Other reasons for seeking immediate medical care are distributed as follows: blood in stool (26.1 percent); child is not able to drink or breastfeed (9.7 percent), and other symptoms (23.2 percent). Only 2.8 percent identified low fluid intake as a reason for seeking immediate medical care for their child. Overall, 14.7 percent of mothers/caretakers of children know the two danger signs of pneumonia – fast or difficult breathing. The figure is the highest among mothers in Minsk Region (23.2 percent) and Gomel Region (23.1 percent) and the lowest among mothers in Minsk City (2.5 percent). There are no notable variations by area or household’s wealth index in the percentage of mothers / caretakers of children age 0-59 months who can correctly identify the two danger signs of pneumonia for which they would immediately seek medical care. Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma, and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking (Table CH.6). Overall, 0.6 percent of all household members in the Republic of Belarus were using solid fuels (wood) for cooking during the survey period. Use of solid fuels for cooking in urban areas was very low – only 0.2 percent of the population, while in rural areas the figure was 1.5 percent. The proportion of household members using solid fuels for cooking notably varied with respect to the educational level of the household head and the household wealth. Solid fuel is very uncommon among the richest households, while 2.7 percent of the poorest households use solid fuels for cooking. Solid fuel is not used for cooking in Minsk City. 60 MICS4, Republic of Belarus. Final Report CHILD HEALTH MICS4, Republic of Belarus. Final Report 61 In Belarus, the most common cooking fuels are natural gas and propane (used by 68.3 percent and 21.7 percent of households, respectively). It should be noted that the use of solid fuels per se is not a source of indoor air pollution, because the pollutant concentration depends on the place of cooking and the type of the fuel used. Data on the use of solid fuels for cooking by place of cooking are presented in Figure CH.1. Figure CH.1. Percent distribution of household members using solid fuels by place of cooking, Republic of Belarus, 2012 (percent) 6.8% 2.5% 90.7% in a separate room used as a kitchen elsewhere in the house in a separate building Place of cooking: According to the survey findings, over 90 percent of the household members using solid fuels for cooking usually cook in the kitchen, about 7 percent cook elsewhere in the house, and 2.5 percent cook in a separate building. Table CH.1. Oral rehydration solutions and recommended homemade fluids Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions (ORS) and recommended homemade fluids, Republic of Belarus, 20121 Children with diarrhoea who received Percentage of children who had diarrhoea in the last two weeks Number of children age 0-59 months Oral rehydration solutions (fluid from ORS packet or pre-packaged ORS fluid) Any recommended homemade fluids ORS or any recommended homemade fluid Number of children age 0-59 months with diarrhoea in the last two weeks Sex Male 2.9 1786 52.7 50.3 77.1 52 Female 3.9 1657 39.5 53.5 70.6 65 Area Urban 3.4 2567 50.8 51.4 73.2 86 Rural 3.5 876 (29.8) (54.0) (74.1) 31 Total 3.4 3443 45.3 52.1 73.5 117 ( ) – Figures that are based on 25-49 unweighted cases. Note that in this table percentage of children who had been receiving various types of fluids during episodes of diarrhoea may total to more than 100 percent since mothers/caretakers could report more than one type of fluid. CHILD HEALTH 62 MICS4, Republic of Belarus. Final Report Table CH.2. Feeding practices during diarrhoea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Republic of Belarus, 20121 Drinking practices during diarrhoea: Eating practices during diarrhoea: H ad d ia rrh oe a in la st tw o w ee ks N um be r o f c hi ld re n ag e 0- 59 m on th s G iv en m uc h le ss to d rin k G iv en s om ew ha t le ss to d rin k G iv en a bo ut th e sa m e to d rin k G iv en m or e to d rin k To ta l G iv en m uc h le ss to e at G iv en s om ew ha t le ss to e at G iv en a bo ut th e sa m e to e at G iv en m or e to e at St op pe d fo od H ad n ev er b ee n gi ve n fo od To ta l N um be r o f c hi ld re n ag e 0- 59 m on th s w ith d ia r- rh oe a in th e la st 2 w ee ks Sex Male 2.9 1786 4.3 6.1 35.5 54.1 100.0 7.7 32.8 48.3 8.8 0.7 1.7 100.0 52 Female 3.9 1657 6.0 3.5 37.6 52.9 100.0 21.7 43.1 27.5 0.0 6.8 0.8 100.0 65 Area Urban 3.4 2567 1.3 4.5 37.8 56.5 100.0 13.3 41.7 41.8 0.5 1.0 1.7 100.0 86 Rural 3.5 876 (16.4) (5.2) (33.6) (44.7) 100.0 (21.9) (29.5) (22.2) (13.5) (12.8) (0.0) 100.0 31 Total 3.4 3443 5.2 4.6 36.7 53.4 100.0 15.5 38.5 36.7 3.9 4.1 1.2 100.0 117 ( ) – Figures that are based on 25-49 unweighted cases. Table CH.3. Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding or other treatments, Republic of Belarus, 2012 Children with diarrhoea who received Pill or syrup Injections O R S o r i nc re as ed fl ui ds O R T (O R S o r r ec om m en de d ho m em ad e flu id s or in cr ea se d flu id s) O R T w ith c on tin ue d fe ed in g1 A nt ib io tic A nt im ot ilit y Zi nc O th er U nk no w n A nt ib io tic In je ct io n N on -a nt ib io tic In je ct io n U nk no w n In tra ve no us H om e re m ed y / H er ba l m ed ic in e O th er Pe rc en ta ge o f c hi ld re n w ho w er e no t g iv en a ny tr ea tm en t o r d ru g N um be r o f c hi ld re n ag e 0- 59 m on th s w ith d ia rrh oe a in th e la st 2 w ee ks Sex Male 79.0 83.9 73.7 18.4 25.6 0.0 21.3 7.6 0.0 0.0 0.0 1.2 6.7 15.8 5.0 52 Female 74.7 79.0 51.2 25.3 11.7 0.0 15.4 1.5 1.2 0.0 0.0 2.2 10.1 13.2 10.3 65 Area Urban 80.3 83.0 68.2 22.9 16.5 0.0 19.0 4.5 0.9 0.0 0.0 2.3 11.6 12.3 7.5 86 Rural (66.2) (76.0) (41.3) (20.4) (21.7) (0.0) (15.1) (3.2) (0.0) (0.0) (0.0) (0.0) (0.0) (20.2) (9.3) 31 Total 76.6 81.2 61.2 22.3 17.9 0.0 18.0 4.2 0.7 0.0 0.0 1.7 8.6 14.4 8.0 117 1 MICS indicator 3.8. ( ) – Figures that are based on 25-49 unweighted cases. Note that in this table percentage of children who had diarrhoea and received different types of treatment may total to more than 100 percent since children might be receiving more than one type of therapy. CHILD HEALTH 63 Table CH.4. Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Percentage of children age 0-59 months with suspected pneumonia in the last two weeks who were taken to a health provider and percentage of children who were given antibiotics, Republic of Belarus, 2012 Percentage of children with suspected pneumonia who were taken to: Public sector Pe rc en ta ge o f c hi ld re n w ho h ad su sp ec te d pn eu m on ia in th e la st tw o w ee ks N um be r o f c hi ld re n ag e 0- 59 m on th s H os pi ta l P ol yc lin ic O ut pa tie nt c lin ic O th er o rg an iz at io n M ob ile / e m er ge nc y ca re P riv at e ph ys ic ia n R el at iv es / f rie nd s An y ap pr op ria te p ro vi de r1 Pe rc en ta ge o f c hi ld re n w ith su sp ec te d pn eu m on ia w ho re ce iv ed an tib io tic s2 N um be r o f c hi ld re n ag e 0- 59 m on th s w ith s us pe ct ed p ne um on ia in th e la st tw o w ee ks Sex Male 7.2 1786 12.1 82.5 1.4 1.2 3.4 0.0 0.6 92.4 79.5 129 Female 6.4 1657 10.0 82.4 2.2 2.0 0.0 0.9 0.7 94.7 73.2 106 Area Urban 7.7 2567 7.8 91.0 0.0 0.2 2.2 0.5 0.8 96.1 80.4 197 Rural 4.3 876 (28.6) (37.6) (11.1) (8.4) (0.0) (0.0) (0.0) (79.5) (57.5) 38 Total 6.8 3443 11.1 82.4 1.8 1.6 1.9 0.4 0.7 93.4 76.7 235 1 MICS indicator 3.9. 2 MICS indicator 3.10. ( ) – Figures that are based on 25-49 unweighted cases. Note that in this table percentage of children who were taken to a public health institution or a private health provider may total to more than 100 percent since children might be taken for care seeking into several places. MICS4, Republic of Belarus. Final Report CHILD HEALTH Table CH.5. Knowledge of the two danger signs of pneumonia Percentage of mothers / caretakers of children age 0-59 months by knowledge of symptoms that would cause to take the child immediately to a health facility, and percentage of mothers / caretakers who recognize fast and difficult breathing as signs for seeking care immediately, Republic of Belarus, 2012 Percentage of mothers / caretakers of children age 0-59 months who think that a child should be taken immediately to a health facility if the child Is n ot a bl e to d rin k or br ea st fe ed B ec om es s ic ke r D ev el op s a fe ve r H as fa st b re at hi ng H as d iff ic ul t b re at hi ng H as b lo od in s to ol Is d rin ki ng p oo rly H as o th er s ym pt om s M ot he rs / c ar et ak er s w ho re co gn iz e th e tw o da ng er si gn s of p ne um on ia N um be r o f m ot he rs / c ar et ak er s of c hi ld re n ag e 0- 59 m on th s Region Brest 11.2 54.5 90.9 21.9 66.0 19.6 2.2 14.5 12.1 259 Vitebsk 9.4 47.2 91.8 23.8 47.8 29.5 2.6 10.1 17.6 188 Gomel 8.5 42.9 92.1 28.4 58.5 30.9 3.8 33.2 23.1 224 Grodno 6.9 28.9 87.1 28.2 46.1 8.5 1.7 11.5 21.6 146 Minsk 8.0 46.8 84.0 11.5 36.8 26.7 1.3 30.1 2.5 439 Minsk 16.7 52.9 91.5 30.6 62.6 38.8 5.9 18.0 23.2 203 Mogilev 6.9 46.2 92.5 24.6 53.4 24.0 3.7 38.2 20.2 150 Area Urban 9.9 47.2 88.6 21.0 50.4 27.2 3.0 23.7 14.2 1223 Rural 8.9 44.8 91.1 25.6 54.7 22.7 2.3 21.7 16.2 386 Mother’s education General basic 4.3 31.9 93.1 14.1 46.1 23.7 1.7 26.9 7.8 33 General secondary 8.9 38.7 91.0 20.9 50.5 25.0 3.1 21.6 14.1 248 Vocational-technical / Secondary specialized 9.8 47.8 91.6 22.9 51.1 22.5 2.3 22.8 15.6 654 Higher 10.1 49.2 85.9 22.2 52.4 30.1 3.2 24.1 14.4 674 Wealth index quintile Poorest 8.0 38.4 92.9 25.9 59.4 23.8 1.6 25.2 19.2 209 Second 11.9 45.1 92.1 24.7 58.2 26.0 3.8 21.7 18.9 267 Middle 7.0 43.9 89.2 21.7 50.1 25.7 2.7 18.6 13.2 298 Fourth 9.2 51.5 88.9 18.9 47.2 24.1 2.4 25.3 12.7 355 Richest 11.2 49.1 86.1 21.6 48.2 28.8 3.2 24.6 12.8 480 Total 9.7 46.6 89.2 22.1 51.5 26.1 2.8 23.2 14.7 1609 Note that in this table responses may total to more than 100 percent since mothers / caretakers of children age 0-59 months could report several symptoms. 64 MICS4, Republic of Belarus. Final Report CHILD HEALTH MICS4, Republic of Belarus. Final Report 65 Table CH.6. Solid fuel use Percent distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Republic of Belarus, 2012 Percentage of household members in households using Electricity Liquefied Petroleum Gas / propane Natural gas Wood Total Solid fuels for cooking1 Number of household members Region Brest 1.5 24.0 73.9 0.6 100.0 0.6 3120 Vitebsk 2.6 30.3 65.8 1.2 100.0 1.2 2714 Gomel 5.8 23.7 69.4 1.0 100.0 1.0 3073 Grodno 1.7 22.5 75.5 0.3 100.0 0.3 2270 Minsk City 35.8 0.1 64.1 - 100.0 - 3720 Minsk 3.7 27.2 68.7 0.4 100.0 0.4 3146 Mogilev 6.0 32.5 61.0 0.6 100.0 0.6 2355 Area Urban 12.5 7.3 80.0 0.2 100.0 0.2 14778 Rural 1.3 59.8 37.5 1.5 100.0 1.5 5620 Education of household head2 Primary 0.6 56.3 40.8 2.3 100.0 2.3 510 General basic 3.4 44.0 50.1 2.5 100.0 2.5 1371 General secondary 5.8 30.3 63.2 0.7 100.0 0.7 4075 Vocational-technical / Secondary specialized 8.9 20.0 70.7 0.4 100.0 0.4 9302 Higher 15.8 8.5 75.6 0.1 100.0 0.1 5116 Wealth index quintile Poorest 1.1 76.1 20.1 2.7 100.0 2.7 4080 Second 2.9 29.5 67.4 0.1 100.0 0.1 4076 Middle 9.6 2.8 87.6 - 100.0 - 4084 Fourth 15.8 0.4 83.8 - 100.0 - 4078 Richest 17.7 - 82.3 - 100.0 - 4080 Total 9.4 21.7 68.3 0.6 100.0 0.6 20398 1 MICS indicator 3.11. 2 10 unweighted cases "No education" have been excluded. VI. Water and Sanitation WATER AND SANITATION 67 The relevant MICS indicators, characterizing water and sanitation facilities1 in the households are: • Use of improved drinking water sources. • Use of adequate water treatment method. • Time to source of drinking water. • Person collecting drinking water. • Use of improved sanitation. • Sanitary disposal of child’s faeces. Use of Improved Water Sources Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. One of the development goals defined by the Millennium Declaration is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. A World Fit for Children calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The distribution of the population by the main source of drinking water is shown in Table WS.1 and Figure WS.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot), public tap/standpipe, tube well/borehole, protected well. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as handwashing and cooking. According to the survey findings, the largest shares of population use drinking water that is piped into the dwellings (82.4 percent) and water from protected wells (8.7 percent). Almost the entire population of the Republic of Belarus (99.6 percent) uses improved sources of drinking water, including 99.8 percent in urban areas and 99.1 percent in rural areas. Regional variations in the population’s access to improved sources of drinking water are not observed. The types of drinking water sources used by the population vary significantly by the area of residence. Water piped into dwelling is used by 91.5 percent of the population in urban areas, and by 58.5 percent in rural areas. Protected wells are the second most common source of drinking water in rural areas used by 25.9 percent of the rural residents, while in urban areas only 2.1 percent of citizens use water from such source. For rural dwellers tube-wells / bore-holes (used by 6.5 percent) and public tap / stand-pipe (used by 6 percent of population) is the third most common water source. For urban population these indicators are 0.6 percent and 2 percent, respectively. 1 Detailed information on water and sanitation and some reference documents can be found on the UNICEF website www.childinfo.org/wes.html. MICS4, Republic of Belarus. Final Report WATER AND SANITATION Figure WS.1. Percent distribution of household members by source of drinking water, Republic of Belarus, 2012 Water piped to dwelling 82.4% Water piped to plot or yeard 0.6% Tube-well / bore-hole 2.2% Public tap / stand- pipe 3.2% Bottled water 2.6% Protected well 8.7% Other 0.4% The types of sources of drinking water also vary across the regions. For example, water piped into the dwelling, plot or yard is used by 92.9 percent of the population in Minsk City and 84.3 percent in Grodno Region. In contrast, 75.1 percent and 78.4 percent of the population have access to piped water source in Brest and Gomel Regions. In all regions, except Minsk City and Mogilev Region, a protected well is the second important source of drinking water used by 8.6 percent of the population in Vitebsk Region and 13.5 percent in Grodno and Brest Regions. In Minsk City, the second most important source of drinking water is bottled water used by 6.9 percent of the population, in Mogilev Region it is a public tap / stand-pipe (used by 9.3 percent). Variations are also observed by the educational level of the household head and the household wealth. Among households headed by a member with higher education, the two most common sources of drinking water are water piped into the dwelling (91.6 percent) and bottled water (5.1 percent). Piped water is used by only 37.1 percent of the population living in households headed by a member with primary education. The main sources of drinking water source for this group of population are protected wells (44.3 (9.9 percent). percent) and public taps / stand-pipes he richest population (by the wealth index) mainly T uses drinking water piped into the dwelling (98.2 percent), as compared to 32.9 percent of the poorest population whose main sources of drinking water are protected wells (used by 40.8 percent). 68 MICS4, Republic of Belarus. Final Report WATER AND SANITATION 69 A source of drinking water. lso, 15.4 percent of the population from the poorest households use a public tap / stand-pipe as a s indicated above, the majority of the population in Belarus has access to drinking water from th able WS.2 presents the distribution of household members by the water treatment method used in ccording to the survey findings, boiling is the most common drinking water treatment method he use of appropriate water treatment methods is associated with the educational level of the ho se of a household water treatment method is found to be somewhat related to the level of wealth mong the household members who use drinking water from unimproved water sources (such a verall, one-third (33.1 percent) of the population in the republic does not use any treatment method able WS.3 presents the amount of time it takes for the household members to obtain water. Note th ccording to the survey findings, for the majority (94.5 percent) of the population the drinking water s nly 0.2 percent of the household population spend 30 minutes or more to collect water, mostly from an artesian well or springs in woodland parks or forests. A e centralised water supply, which is subject to strict water quality standards monitoring. Nevertheless, the survey also covered household water treatment methods. Methods such as boiling and using a filter (ceramic, sand or other filters) are considered as proper treatment of drinking water. T the household. A , used by 41 percent of household members, including 43.5 percent in urban areas and 34.3 percent in rural areas. The second most common method is filtering, reported by 33.5 percent of the population. The proportion of citizens using this method is higher in urban than in rural areas (39 percent and 18.9 percent, respectively). Settling is used by 11.9 percent of the population (12.7 percent in urban and 9.8 percent in rural areas). T usehold head. Filtering is used by 50.1 percent of the population residing in households headed by a member with higher education, as compared to 5.1 percent in households headed by a member with primary education, and boiling (to make the water more suitable for drinking) is practised by 39 percent and 32.4 percent of the population of such households, respectively. U of the population. Thus, the share of the richest population using filter for drinking water treatment is 56.1 percent, and of the poorest population – 9 percent, a difference of six times. Among the wealthiest population boiling is practiced by 42.8 percent, and among the poorest population by 31.6 percent; water settlement is used by 12.8 percent of the richest, and by 9.6 percent of the poorest population. A s unprotected wells) safe water treatment methods are practised by 33.2 percent1. O s, including about 50 percent in rural areas and 26.7 percent in urban areas. The highest percentage of population not using any water treatment methods is in the poorest households (59.2 percent) and in the households, where the household head has primary education (60.8 percent). T at data in this table refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. A ource is on the premises (in the dwelling or yard), including for 97.4 percent for urban, and 86.9 percent for rural residents. The rest of the households are to get to the water source and bring water. Overall, for 5 percent of the population it takes less than 30 minutes to get to the water source and bring water, for 12 percent in rural and for 2.4 percent in urban areas, and for 24.1 percent in the poorest households. O 1 Data table not shown in this report. MICS4, Republic of Belarus. Final Report WATER AND SANITATION Table WS.4 presents information on the person who usually collects water in the household. In households without the source of drinking water on the premises (in the dwelling or in the yard), water is collected by adult men (52.9 percent) or adult women (44 percent). In urban areas the percen se of Improved Sanitation tage of men who bring water to households is much higher than that of women (61.1 percent and 37.2 percent, respectively) while in rural households the figures varied little (48.9 percent and 47.3 percent, respectively). U Inad and personal hygiene is associated with a range of diseases equate disposal of human excreta inclu ing diarrhoeal diseases and polio. Improved sanitation can reduce diarrheal disease by more than d a third, and can considerably lessen the adverse health impacts. Improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation facilities for excreta disposal include flush or pour flush to a piped s rus lives in households with improved sanitation facilities for excreta disposal, including 99.4 percent in urban a ercent in all regions except Gomel and Minsk Regions, where the figures are 94.7 percent and 96.8 percent, respectively. he area of residence. In urban areas, the flush / pour flush to sewer systems are most common (reported by 86.1 percent of the ho sed by the population also vary by the level of education of the household head. Toilets with flush / pour flush to sewer systems are used by 88.4 percent of the population residing level of wealth of the household. Use of flush / pour flush to sewer systems is universal among members of the we ewer system, septic tank, or latrine; ventilated improved pit latrine and pit latrine with slab. According to the survey findings, 98.4 percent of the population in the Republic of Bela nd 95.9 percent in rural areas (Table WS.5). Practically, this proportion is close to 100 p The types of sanitation facilities used for excreta removal vary by t usehold population); in rural areas, pit latrines with septic tanks and slabs are mostly used (reported by 38.3 percent). The types of toilets u in households headed by a member with higher education, and by only one-quarter (26.5 percent) of the population from households headed by a member with primary education. Even greater variations are observed in the use of improved sanitation facilities by the althiest households. In the poorest households, only 4.4 percent of the population use this type of toilet, and the majority (68.2 percent) uses pit latrines with slabs. The MDGs and WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify households as using an improved sanitation if they are using improved sanitation facilities but not sharing a facility between two or more households and not using a public toilet facility. According to the survey findings, 95.7 percent of the household population use improved sanitation, i.e., they use improved sanitation facilities that are not shared with other households (Table percent of the household members in Belarus use an improved sanitation facility that is shared with other households, including 1.8 percent who share such facility with fewer than 5 households and 1 percent with 5 or more households. Use of a shared facility is more common in WS.6). About 3 70 MICS4, Republic of Belarus. Final Report WATER AND SANITATION 71 urban faeces by children age 0-2 years. olds practising safe disposal of the child’s faeces, the share of such children is 55.1 percent in urban and 58.8 percent in rural areas. Notable variations are observed across the regions gating and refining the data on drinking-water and sanitation and reflecting them in “ladder” format. This ladder allows a disaggregated analysis of trends in a three rung la er and sanitation ladders h of household members using improved sources of drinking water and improved sanitary means for excreta disposal. rcent (96.2 percent in urban and 93.3 percent in rural areas). This proportion varies across the regions (from 92.5 percent in Mogilev to 98.6 than in rural areas (3.1 percent compared to 1.8 percent of households). These are mostly households that do not have a separate dwelling and live in family-type halls of residence. Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Table WS.7 presents data on disposal of the last According to the survey findings in the Republic of Belarus, 56 percent of children age 0-2 years live in househ . In Vitebsk Region, 75 percent of children age 0-2 years live in the households that practise safe disposal of the child’s faeces and in Grodno Region the figure is only 41.1 percent. The rest of the population practises less sanitary removal of a child’s stool. Overall in the country, for 42.4 percent of children, child's faeces are thrown into garbage while for 1.4 percent of children put / rinsed into a drain or ditch. In its 2008 report1 the Joint Monitoring Programme (JMP) developed a new way of presenting the access figures, by disaggre dder for drinking water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of the population: • with no sanitation facilities at all; • with unimproved sanitation facilities; • sharing improved sanitation facilities with members of other households; • using improved sanitation facilities. Table WS.8 presents the distribution of household population by drinking wat . T e table also shows the percentage In the Republic of Belarus, the overall proportion of the population with access to improved sources of drinking water and improved sanitation, is 95.4 pe percent in Grodno Region). No considerable differences are observed by the educational level of the household head, however, the figure varies by the well-being level. Among the poorest households, 88.7 percent of the population have access to improved sources of drinking water and improved sanitation, while among the richest households the figure is 99.7 percent. 1 WHO / UNICEF JMP(2008), MDG assessment report http://www.wssinfo.org/fileadmin/user_upload/resources/1251794333-JMP_08_en.pdf. MICS4, Republic of Belarus. Final Report WATER AND SANITATION Table WS.1. Use of improved water sources Percent distribution of household population by main source of drinking water and percentage of household population using improved drinking water sources, Republic of Belarus, 2012 Main source of drinking water Improved sources Unimproved sources Pi pe d in to d w el lin g Pi pe d in to y ar d / pl ot P ub lic ta p/ st an d- pi pe Tu be -w el l / bo re -h ol e P ro te ct ed w el l B ot tle d w at er U np ro te ct ed w el l O th er T ot al Pe rc en ta ge u si ng im pr ov ed so ur ce s of d rin ki ng w at er 1 N um be r o f h ou se ho ld m em be rs Region Brest 74.8 0.3 1.1 7.5 13.5 2,2 0.2 0.3 100.0 99.5 3120 Vitebsk 82.7 0.8 6.5 0.5 8.6 0,2 0.3 0.3 100.0 99.4 2714 Gomel 77.8 0.6 3.3 3.2 10.8 4,2 0.0 - 100.0 99.9 3073 Grodno 84.2 0.1 0.9 0.0 13.5 0,7 0.4 - 100.0 99.6 2270 Minsk City 92.9 - - - - 6,9 - 0.1 100.0 99.9 3720 Minsk 80.7 0.6 2.8 1.5 12.6 1,2 0.2 0.4 100.0 99.4 3146 Mogilev 81.9 2.0 9.3 2.6 3.3 0,5 0.0 0.4 100.0 99.6 2355 Area Urban 91.5 0.3 2.0 0.6 2.1 3,3 - 0.2 100.0 99.8 14778 Rural 58.5 1.4 6.0 6.5 25.9 0,7 0.5 0.4 100.0 99.1 5620 Education of household head2 Primary 36.2 0.9 9.9 7.1 44.3 - 1.3 0.3 100.0 98.5 510 General basic 61.3 1.1 7.5 3.4 25.4 0,4 0.8 0.1 100.0 99.1 1371 General secondary 78.4 0.5 4.2 3.9 11.3 1,5 0.1 0.1 100.0 99.8 4075 Vocational-technical / Secondary specialized 84.9 0.8 3.1 1.9 6.7 2,2 0.1 0.3 100.0 99.6 9302 Higher 91.4 0.2 0.5 0.7 1.9 5,1 - 0.1 100.0 99.9 5116 Wealth index quintile Poorest 30.2 2.7 15.4 9.1 40.8 0,4 0.8 0.5 100.0 98.7 4080 Second 92.8 0.3 0.3 1.9 2.2 2,2 - 0.3 100.0 99.7 4076 Middle 95.9 - - 0.1 0.3 3,5 - 0.2 100.0 99.8 4084 Fourth 94.9 - - - - 5,0 - 0.1 100.0 99.9 4078 Richest 98.2 - - - - 1,8 - - 100.0 100.0 4080 Total 82.4 0.6 3.2 2.2 8.7 2,6 0.2 0.2 100.0 99.6 20398 1 MICS indicator 4.1; MDG indicator 7.8. 2 10 unweighted cases "No education" have been excluded. 72 MICS4, Republic of Belarus. Final Report WATER AND SANITATION 73 Table WS.2. Household water treatment Percentage of household population by drinking water treatment method used in the household, Republic of Belarus, 2012 Percentage of household population who Used for water treatment None Boil Filter Let it stand and settle Other Do not know Number of household members Region Brest 42.1 39.4 28.1 11.2 1.3 - 3120 Vitebsk 36.2 44.5 28.6 9.3 1.2 0.1 2714 Gomel 26.7 54.1 27.5 11.7 1.1 - 3073 Grodno 39.4 38.1 32.4 8.1 1.3 - 2270 Minsk City 16.3 39.4 54.2 15.5 0.7 - 3720 Minsk 35.7 36.4 32.1 10.0 1.6 - 3146 Mogilev 42.6 33.2 24.2 16.6 0.8 - 2355 Area Urban 26.7 43.5 39.0 12.7 1.2 - 14778 Rural 49.9 34.3 18.9 9.8 0.8 0.0 5620 Education of household head1 Primary 60.8 32.4 5.1 11.8 0.6 - 510 General basic 51.0 35.9 12.4 13.4 0.2 - 1371 General secondary 41.4 39.5 23.2 10.9 0.8 - 4075 Vocational-technical / Secondary specialized 31.2 43.8 33.6 12.2 1.1 - 9302 Higher 22.2 39.0 50.1 11.7 1.7 0.1 5116 Wealth index quintile Poorest 59.2 31.6 9.0 9.6 0.9 - 4080 Second 37.2 40.9 27.4 10.7 0.6 0.1 4076 Middle 27.8 44.9 34.6 14.6 1.6 - 4084 Fourth 25.8 44.7 40.2 11.8 1.0 - 4078 Richest 15.3 42.8 56.1 12.8 1.6 - 4080 Total 33.1 41.0 33.5 11.9 1.1 0.0 20398 1 10 unweighted cases "No education" have been excluded. Note that in this table responses may total to more than 100 percent since households may be using more than one drinking water treatment method. MICS4, Republic of Belarus. Final Report WATER AND SANITATION Table WS.3. Time to source of drinking water Percent distribution of household population according to time to go to source of drinking water, get water and return, Republic of Belarus, 2012 Percentage of household members Users of improved drinking water sources and time to source of drinking water Users of unimproved drinking water sources and time to source of drinking water Less than 30 minutes 30 minutes or more Do not know Water on premises Less than 30 minutes 30 minutes or more Water on premises Total Number of household members Region Brest 1.6 0.1 - 97.8 0.0 0.3 0.2 100.0 3120 Vitebsk 8.6 0.0 0.2 90.6 0.1 - 0.5 100.0 2714 Gomel 7.4 0.5 0.2 91.9 0.0 0.0 0.0 100.0 3073 Grodno 2.1 - - 97.5 0.2 - 0.2 100.0 2270 Minsk City - - - 99.9 0.1 - - 100.0 3720 Minsk 5.1 0.1 - 94.1 0.4 0.1 0.1 100.0 3146 Mogilev 11.9 0.2 0.1 87.3 0.1 0.3 - 100.0 2355 Area Urban 2.3 0.1 0.0 97.4 0.1 0.1 0.0 100.0 14778 Rural 11.7 0.3 0.2 86.9 0.3 0.2 0.5 100.0 5620 Education of household head1 Primary 15.8 - 0.6 82.0 0.8 - 0.8 100.0 510 General basic 14.8 0.1 0.2 83.9 0.5 - 0.5 100.0 1371 General secondary 6.8 0.0 - 92.9 0.1 0.0 0.1 100.0 4075 Vocational-technical / Secondary specialized 4.3 0.1 0.1 95.1 0.1 0.2 0.2 100.0 9302 Higher 0.6 0.3 - 99.0 0.1 0.0 - 100.0 5116 Wealth index quintile Poorest 23.7 0.3 0.3 74.4 0.4 0.2 0.7 100.0 4080 Second 0.6 0.3 - 98.8 0.0 0.3 - 100.0 4076 Middle 0.2 0.1 - 99.5 0.1 0.1 - 100.0 4084 Fourth - - - 99.9 0.1 - - 100.0 4078 Richest - - - 100.0 - - - 100.0 4080 Total 4.9 0.1 0.1 94.5 0.1 0.1 0.1 100.0 20398 1 10 unweighted cases "No education" have been excluded. 74 MICS4, Republic of Belarus. Final Report WATER AND SANITATION 75 Table WS.4. Person collecting water Percentage of households without drinking water on premises, and percent distribution of households without drinking water on premises according to the person usually collecting drinking water used in the household, Republic of Belarus, 2012 Percentage of households according to the person collecting drinking water Percentage of households without drinking water on premises Number of households Adult woman Adult man No answer Total Number of households without drinking water on premises Area Urban 2.9 6029 37.2 61.1 1.7 100.0 175 Rural 16.0 2255 47.3 48.9 3.7 100.0 360 Education of household head1 Primary (17.9) 331 (59.9) (32.3) (7.8) 100.0 59 General basic 16.9 708 56.5 40.7 2.8 100.0 120 General secondary 8.2 1570 34.4 62.9 2.7 100.0 129 Vocational-technical / Secondary specialized 5.4 3601 37.1 60.4 2.5 100.0 195 Higher (1.4) 2061 (44.4) (55.6) - 100.0 29 Wealth index quintile Poorest 26.4 1930 45.6 51.2 3.2 100.0 509 Total 6.5 8284 44.0 52.9 3.1 100.0 535 1 10 unweighted cases "No education" have been excluded. ( ) – Figures that are based on 25-49 unweighted cases. MICS4, Republic of Belarus. Final Report WATER AND SANITATION Table WS.5. Types of sanitation facilities Percent distribution of household population according to type of toilet facility used by the household, Republic of Belarus, 2012 Percentage of household population using Improved sanitation facility Unimproved sanitation facility Flush / pour flush to Pit latrine with Piped sewer system Septic tank Pit latrine Ventila- tion Slab Pit latrine without slab Other Total Number of household members Region Brest 63.8 9.9 1.6 9.8 14.7 0.2 - 100.0 3120 Vitebsk 71.4 3.9 0.9 0.3 21.9 0.3 1.4 100.0 2714 Gomel 60.8 3.6 10.0 2.2 18.1 5.2 0.1 100.0 3073 Grodno 79.0 0.3 1.9 0.1 18.6 0.2 - 100.0 2270 Minsk City 99.7 0.1 0.1 - - - - 100.0 3720 Minsk 60.5 11.4 4.7 3.3 16.9 3.2 - 100.0 3146 Mogilev 58.0 8.3 3.5 0.7 29.5 0.0 - 100.0 2355 Area Urban 86.1 2.7 2.1 1.0 7.5 0.5 0.1 100.0 14778 Rural 32.7 12.4 6.2 6.3 38.3 3.6 0.5 100.0 5620 Education of household head1 Primary 26.5 5.2 1.4 9.3 51.7 5.9 - 100.0 510 General basic 41.1 3.9 3.8 3.6 41.7 5.3 0.5 100.0 1371 General secondary 63.6 7.0 2.9 4.4 20.4 1.2 0.4 100.0 4075 Vocational-technical / Secondary specialized 72.4 5.5 3.9 2.2 14.6 1.2 0.2 100.0 9302 Higher 88.4 4.2 2.3 0.3 4.5 0.3 - 100.0 5116 Wealth index quintile Poorest 4.4 6.6 4.6 9.7 68.2 5.7 0.8 100.0 4080 Second 55.5 17.7 11.1 2.6 11.6 1.2 0.3 100.0 4076 Middle 97.1 2.3 0.5 - - - - 100.0 4084 Fourth 99.9 0.1 - - - - - 100.0 4078 Richest 100.0 - - - - - - 100.0 4080 Total 71.4 5.3 3.2 2.5 16.0 1.4 0.2 100.0 20398 1 10 unweighted cases "No education" have been excluded. 76 MICS4, Republic of Belarus. Final Report WATER AND SANITATION 77 Table WS.6. Use and sharing of sanitation facilities Percent distribution of household population according to type of hygienic sanitation facilities for excreta disposal, Republic of Belarus, 2012 Percentage of household population using Improved sanitation facilities Unimproved sanitation facilities Shared by Shared by Not shared1 5 or less households more than 5 households Not shared 5 or less households more than 5 households Total Number of household members Region Brest 97.8 1.1 0.9 0.2 - - 100.0 3120 Vitebsk 95.8 1.7 0.8 1.4 0.1 0.2 100.0 2714 Gomel 93.4 0.3 1.0 5.0 0.2 - 100.0 3073 Grodno 99.0 0.8 0.0 0.2 - - 100.0 2270 Minsk City 96.4 2.0 1.7 - - - 100.0 3720 Minsk 94.8 1.1 0.9 2.5 0.6 0.2 100.0 3146 Mogilev 92.9 6.1 1.0 0.0 - - 100.0 2355 Area Urban 96.3 1.9 1.2 0.5 0.1 - 100.0 14778 Rural 94.1 1.4 0.4 3.8 0.2 0.1 100.0 5620 Education of household head2 Primary 92.8 0.9 0.3 5.6 0.0 0.3 100.0 510 General basic 92.4 1.3 0.5 5.0 0.5 0.3 100.0 1371 General secondary 96.1 1.3 1.0 1.4 0.3 - 100.0 4075 Vocational-technical / Secondary specialized 95.4 2.2 1.0 1.2 0.1 0.1 100.0 9302 Higher 97.1 1.5 1.1 0.3 - - 100.0 5116 Wealth index quintile Poorest 89.8 2.8 1.0 5.5 0.6 0.3 100.0 4080 Second 94.6 2.1 1.9 1.4 0.1 - 100.0 4076 Middle 96.1 2.3 1.6 - - - 100.0 4084 Fourth 98.3 1.4 0.2 - - - 100.0 4078 Richest 99.7 0.2 0.1 - - - 100.0 4080 Total 95.7 1.8 1.0 1.4 0.1 0.1 100.0 20398 1 MICS indicator 4.3; MDG indicator 7.9. 2 10 unweighted cases "No education" have been excluded. MICS4, Republic of Belarus. Final Report WATER AND SANITATION Table WS.7. Disposal of a child’s faeces Percent distribution of children age 0-2 years according to place of disposal of child’s faeces, and the percentage of children age 0-2 years whose stools were disposed of safely the last time the child passed stools, Republic of Belarus, 2012 Percentage of children using different places of child’s faeces disposal Child used toilet Put / rinsed into toilet or latrine Put / rinsed into drain or ditch Thrown into garbage Other Total Percentage of children whose last stools were disposed of safely1 Number of children age 0-2 years Type of sanitation facility in dwelling Improved 5.6 50.8 1.2 42.1 0.3 100.0 56.4 2073 Unimproved (2.0) (18.8) (14.4) (64.9) - 100.0 (20.8) 24 Region Brest 12.6 38.6 1.4 46.2 1.3 100.0 51.2 338 Vitebsk 1.2 74.6 3.6 20.6 - 100.0 75.8 255 Gomel 2.1 56.5 1.3 40.1 - 100.0 58.6 275 Grodno 0.6 40.5 0.5 58.4 - 100.0 41.1 171 Minsk City 6.8 44.1 0.1 49.0 - 100.0 50.9 591 Minsk 6.8 46.8 3.5 42.5 0.3 100.0 53.7 266 Mogilev 2.5 63.8 0.2 33.4 0.2 100.0 66.2 201 Area Urban 5.5 49.6 0.4 44.5 - 100.0 55.1 1603 Rural 5.5 53.3 4.6 35.5 1.0 100.0 58.8 494 Mother’s education General basic 1.9 57.7 6.2 33.1 1.1 100.0 59.7 34 General secondary 2.9 44.7 1.4 51.0 0.0 100.0 47.6 321 Vocational-technical / Secondary specialized 5.7 54.2 2.4 37.2 0.5 100.0 59.9 824 Higher 6.4 48.8 0.2 44.4 0.2 100.0 55.2 918 Wealth index quintile Poorest 2.0 53.3 5.8 37.3 1.6 100.0 55.3 258 Second 6.6 48.8 1.9 42.7 0.1 100.0 55.3 340 Middle 6.2 51.4 1.2 40.9 0.2 100.0 57.6 403 Fourth 8.0 48.4 0.3 43.3 - 100.0 56.4 463 Richest 4.2 51.1 0.2 44.5 - 100.0 55.3 633 Total 5.5 50.5 1.4 42.4 0.3 100.0 56.0 2097 1 MICS indicator 4.4. ( ) – Figures that are based on 25-49 unweighted cases. 78 MICS4, Republic of Belarus. Final Report Table WS.8. Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Republic of Belarus, 2012 Percentage of household population using Improved drinking water1 Unimproved sanitation Piped into dwelling, plot or yard Other Unimproved drinking water Total Improved sanitation2 Shared improved sanitation facilities Unimproved sanitation facilities Total Improved water sources and improved sanitation Number of household members Region Brest 77.4 22.1 0.5 100.0 97.8 2.0 0.2 100.0 97.3 3120 Vitebsk 83.8 15.6 0.6 100.0 95.8 2.5 1.7 100.0 95.3 2714 Gomel 82.6 17.3 0.1 100.0 93.4 1.3 5.3 100.0 93.4 3073 Grodno 84.8 14.7 0.4 100.0 99.0 0.8 0.2 100.0 98.6 2270 Minsk City 99.9 - 0.1 100.0 96.4 3.6 - 100.0 96.3 3720 Minsk 82.5 16.9 0.6 100.0 94.8 2.0 3.2 100.0 94.3 3146 Mogilev 84.4 15.2 0.4 100.0 92.9 7.1 0.0 100.0 92.5 2355 Area Urban 95.1 4.7 0.2 100.0 96.3 3.1 0.6 100.0 96.2 14778 Rural 60.5 38.6 0.9 100.0 94.1 1.8 4.1 100.0 93.3 5620 Education of household head3 Primary 37.1 61.4 1.5 100.0 92.8 1.3 5.9 100.0 92.0 510 General basic 62.8 36.3 0.9 100.0 92.4 1.8 5.9 100.0 91.4 1371 General secondary 80.4 19.4 0.2 100.0 96.1 2.3 1.6 100.0 95.9 4075 Vocational-technical / Secondary specialized 87.8 11.8 0.4 100.0 95.4 3.2 1.4 100.0 95.0 9302 Higher 96.7 3.2 0.1 100.0 97.1 2.6 0.3 100.0 97.0 5116 Wealth index quintile Poorest 33.3 65.4 1.3 100.0 89.8 3.7 6.4 100.0 88.7 4080 Second 95.1 4.6 0.3 100.0 94.6 4.0 1.5 100.0 94.2 4076 Middle 99.5 0.4 0.2 100.0 96.1 3.9 - 100.0 96.0 4084 Fourth 99.9 - 0.1 100.0 98.3 1.7 - 100.0 98.2 4078 Richest 100.0 - - 100.0 99.7 0.3 - 100.0 99.7 4080 Total 85.6 14.1 0.4 100.0 95.7 2.7 1.6 100.0 95.4 20398 1 MICS indicator 4.1; MDG indicator 7.8. 2 MICS indicator 4.3; MDG indicator 7.9. 3 10 unweighted cases "No education" have been excluded. VII. Reproductive Health REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 81 Contraception Appropriate family planning is very important to the health of women and children by: • preventing pregnancies that are too early or too late; • extending the period between births; • limiting the number of children. It is critical to ensure that all couples have access to information and services to prevent pregnancies that are too early, too closely spaced, too many or too late. Awareness about the different methods of contraception is a critical step toward ensuring access to the appropriate contraception method and its use, which in turn, enables the use of an adequate method of family planning. According to the survey findings, all women age 15-49 years in the Republic of Belarus know at least one method of contraception; also all women are aware of modern contraceptive methods; and more than 98 percent of women know about traditional contraceptive methods (Table RH.1). Modern contraceptive methods include female and male sterilization, contraceptive pills, intrauterine devices, injectables, implants, condoms, diaphragms, and vaginal foams / jelly. Traditional contraceptive methods include lactational amenorrhoea method (LAM), periodic abstinence, and withdrawal. The largest proportions of the women know about such modern contraceptive methods as male condoms (99.9 percent), contraceptive pills (98.9 percent) and intrauterine devices (98.1 percent). Nearly 91 percent of women know about female sterilization. With regard to traditional contraceptive methods, most respondents named withdrawal (97.4 percent) and periodic abstinence (94 percent). The survey found no variations in women’s knowledge about birth control methods by the area of residence, education, wealth, or marital status. The use of a contraceptive method was reported by 63.1 percent of women who were married or in union at the time of the survey (Table RH.2). The most common contraceptive method is a male condom used by 22.3 percent of women who are currently married or in union. The intrauterine device is the next most common method used by 15.1 percent of women. Use of contraceptive pills was reported by one in ten women, about 8 percent of women relied on withdrawal, and about 3 percent on periodic abstinence or female sterilization. Less than 1 percent of women uses other contraceptive methods such as injectables, implants, female condoms, coils and vaginal foams / jelly, or LAM. In urban areas, contraception is used by 64.1 percent of married or in union women, while in rural areas the figure is 59.9 percent. Use of different contraceptive methods is the highest in Minsk City (reported by about 75 percent of women who were married or in union). In other regions, this proportion varies from 59 to 63 percent. It should be noted that more than one-half of married (or in union) women with children uses contraception (63.4 percent of women with one child; 70.8 percent with two children; 66.6 percent REPRODUCTIVE HEALTH 82 MICS4, Republic of Belarus. Final Report with three children, and 57.5 percent with four or more children). The overall proportion of childless women who were married or in union and were using a contraceptive method was 27.6 percent. More than a half (51.2 percent) of the women who were married or in union reported using modern contraceptive methods, 11.9 percent reported using traditional contraceptive methods, and 36.9 percent of women reported not currently using any contraceptive method (Figure RH.1 ). Figure RH.1. Contraceptive methods used by women age 15-49 years currently married or in union, Republic of Belarus, 2012 Traditional contraceptive methods 11.9% Not using any method 36.9% Modern contraceptive methods 51.2% The choice of a contraceptive method varies by a level of the woman’s education. Modern contraceptive methods are used by 46.3 percent of married or in union women with general basic education, and by 55.2 percent of women with higher education. Conversely, a traditional contraceptive method is used by only 9.9 percent of currently married /in union women with higher education and by more than 24 percent of women with general basic education. Unmet Need for Contraception Unmet need for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth (spacing births) or who wish to stop childbearing altogether (limiting births). Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Table RH.3 shows the levels of met need for contraception, unmet need, and the demand for contraception satisfied. REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 83 Unmet need for spacing is defined as the percentage of women who are not using a method of contraception AND: • are not pregnant and not postpartum amenorrheic1 and are fecund2 and say they want to wait two or more years for their next birth OR • are not pregnant and not postpartum amenorrheic and are fecund and unsure whether they want another child OR • are pregnant and say that pregnancy was mistimed: would have wanted to wait OR • are postpartum amenorrheic and say that the birth was mistimed: would have wanted to wait. Unmet need for limiting is defined as percentage of women who are not using a method of contraception AND: • are not pregnant and not postpartum amenorrheic and are fecund and say they do not want any more children OR • are pregnant and say they did not want to have a child OR • are postpartum amenorrheic and say that they did not want the birth. Total unmet need for contraception is the sum of unmet need for spacing and unmet need for limiting. According to the survey findings, 7 percent of women in the Republic of Belarus have unmet need for contraception, i.e., are facing different degrees of limitations in their actions to plan a pregnancy or wanted birth. Thus, 3.8 percent of women have unmet need for spacing, and 3.2 percent for limiting. The total unmet need for contraception varies by region, from 4.8 percent in Minsk City to 9.8 percent in Vitebsk Region. The total unmet need for contraception decreases with a woman’s age, from 15.1 percent for women age 15-19 years to only 4 percent among women age 40 years and above. As stated above, Table RH.3 presents the indicators of met need for contraception (including by spacing births and by limiting births). Met need for contraception for spacing births is calculated for women, who use a birth control method and who want to have another child or are undecided whether to have another child. Met need for contraception for limiting births indicator includes: • women using a contraceptive method who do not want to have another child; • women using male or female sterilization as a contraceptive method; • women who declare themselves as infecund. Total met need for contraception is calculated as the sum of met need for spacing and met need for limiting. 1 A woman is postpartum amenorrheic if she had a birth in last two years and is not currently pregnant, and her menstrual period has not returned since the birth of the last child. 2 A woman is considered infecund if she is neither pregnant nor postpartum amenorrheic, and (1a) has not had menstruation for at least six months, or (1b) never menstruated, or (1c) her last menstruation occurred before her last birth, or (1d) in menopause/has had hysterectomy OR (2) She declares that she has had hysterectomy, or that she has never menstruated or that she is menopausal, or that she has been trying to get pregnant for 2 or more years without result in response to questions on why she thinks she is not physically able to get pregnant at the time of survey OR (3) She declares she cannot get pregnant when asked about desire for future birth OR (4) She has not had a birth in the preceding 5 years, is currently not using contraception and is currently married and was continuously married during the last 5 years preceding the survey. REPRODUCTIVE HEALTH 84 MICS4, Republic of Belarus. Final Report According to the survey findings, the total met need for contraception among women who are married or in union is 63.1 percent, including 38.9 percent for limiting, and 24.2 percent for spacing. The indicator values for the total met need for contraception vary by area, from 64.1 percent in urban areas (37.5 percent for limiting, and 26.6 percent for spacing) to 59.9 percent in rural areas (42.9 percent for limiting and 17 percent for spacing). In general, it can be observed that the total met need for contraception is considerably higher than the total unmet need for contraception In addition to the above indicators, the percentage of demand for contraception satisfied can also be estimated from the MICS data on the use of contraception and unmet need for contraception. This is defined as the proportion of women currently married or in union who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing and limiting), plus those who are currently using contraception. According to the survey findings, the total met need for contraception is 90.1 percent (90.8 percent among urban and 87.8 percent among rural women). It is highest among the residents of Minsk City (94 percent), and varies from 86.4 percent in Mogilev Region to 92.4 percent in Grodno Region. Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of therapeutic and preventive interventions that may be vital to their and their infants’ health and well-being. Better understanding of foetal growth and development and its relationship to the mother's health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks at delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply women with information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women's nutritional status and prevent infections during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: • blood pressure measurement; • urine testing for bacteriuria and proteinuria; • blood testing to detect syphilis and severe anaemia; • weight / height measurement (optional). REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 85 Table RH.4 shows the percent distribution of women age 15-49 years who gave birth in the two years preceding the survey by the type of personnel providing antenatal care during pregnancy. In the Republic of Belarus, women and children are guaranteed access to medical care by the Constitution, and the laws «On Health», «On the Rights of the Child», the Marriage and Family Code, and other laws and regulations. According to the Law of the Republic of Belarus «On Health», a pregnant woman is entitled to receive antenatal care in a public health facility, inpatient care during and after childbirth, and medical assistance and care for the newborn. In addition, pregnant women who register with an antenatal care provider within 12 weeks of gestation and comply with all of the doctor’s recommendations are entitled to a financial premium. Nearly all women in the Republic of Belarus benefit from the right to receive antenatal care guaranteed by the state: 99.7 percent of women receive antenatal care from a skilled health provider. Coverage of pregnant women by antenatal care is universal across all regions of the country. Generally, antenatal care is provided by medical doctors (99.3 percent). Only a small proportion of women receive antenatal care from nurses and midwives (0.4 percent), and doctor’s assistants (feldshers) (0.1 percent). Practically all (99.7 percent) pregnant women in the Republic of Belarus were seen by skilled medical personnel at least 4 times during pregnancy (Table RH.5). All pregnant women are covered by antenatal care and receive all relevant preventive interventions for protection of reproductive health, including passing all the recommended tests (blood pressure, blood sample and urine specimen)1. Assistance at Delivery Globally three quarters of all maternal deaths occur during delivery and the immediate post- partum period. The single most critical intervention for safe motherhood is to ensure that competent health worker with midwifery skills is present at every birth, and transport is available to a public sector health facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have timely and affordable access to skilled attendance at delivery. The relevant indicators are: • the proportion of births with a skilled attendant; • the proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS4 included a number of questions to assess the proportion of births attended by skilled medical personnel. A skilled attendant includes a doctor, nurse, midwife and feldsher or doctor’s assistant. In the two years preceding the survey, all (100 percent) births in the Republic of Belarus were attended by skilled medical personnel (Table RH.6). No variations were recorded by region, except in 1 Data table not shown in this report. REPRODUCTIVE HEALTH 86 MICS4, Republic of Belarus. Final Report Minsk City, where the figure was 99.8 percent. This proportion did not vary by age, education or level of wealth. Of the total number of institutional deliveries, 96.8 percent were attended by doctors, and 3.1 percent by nurses or midwives. One-quarter (25.3 percent) of deliveries were by a Cesarian section (24.3 percent in urban, and 28.8 percent in rural areas). Among women age 35-49 years, the proportion of such births was 37.9 percent, and among women below age 20 - 14.2 percent, a difference of 2.7 times. Besides, there are variations in this indicator’s value across the regions from a minimum of 16.9 percent in Vitebsk Region to a maximum of 37 percent in Mogilev Region. Place of Delivery Increasing the proportion of births that are delivered in health facilities is an important factor in reducing the health risks to both the mother and the baby. Proper medical attention and hygienic conditions during delivery can reduce the risks of complications and infection that can cause morbidity and mortality to either the mother or the baby. In the Republic of Belarus, practically all (99.9 percent) deliveries occur in a public-sector health facility. No variations are observed by area, level of education or well-being of women. The share of institutional deliveries is close to 100 percent across all regions of the country1. Post-Natal Health Checks The time of birth and immediately after is a critical window of opportunity to deliver lifesaving interventions for both the mother and the newborn. In 2008, the Countdown to 2015 initiative, which monitors progress on maternal, newborn and child health interventions, highlighted the data gap on the post-natal period and care for the mother and newborn, and called not only for post-natal care (PNC) programmes to be strengthened, but also for better data availability and quality2. Following the establishment and discussions of an Inter-Agency Group on PNC and drawing on lessons learned from earlier attempts of collecting PNC data, a new questionnaire module for MICS was developed and validated. Named the Post-natal Health Checks (PNHC) module, the objective is to collect information on newborns’ and mothers’ contact with a provider, not content of care. The rationale for this is that as PNC programmes scale up, it is important to measure the coverage of that scale up and ensure that the platform for providing essential services is in place. Content is considered more difficult to measure, particularly because the respondent is asked to recall services delivered up to two years preceding the interview. In the Republic of Belarus, all women have access to antenatal and postnatal care and all medical personnel employed by antenatal and postnatal care providers have completed medical training in management of pregnancy and childbirth. Safe motherhood programmes have recently increased emphasis on the importance of post- natal care, recommending that all women and newborns receive a health check within two days of 1 Data table not shown in this report. 2 Countdown to 2015: Tracking Progress in Maternal, Newborn & Child Survival, The 2008 Report. UNICEF, New York, 2008. REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 87 delivery. To assess the extent of post-natal care utilization, women who gave birth in the two years preceding the survey were asked: • whether they and their newborn received a health check after the delivery; • the timing of the first check; • the type of health provider after the woman’s last birth (doctor, nurse / midwife, doctor’s assistant or other) According to the survey findings, all women age 15-49 years in the Republic of Belarus, who reported having given birth in a health facility in the two years preceding the survey, stayed 3 days or more in the facility. This proportion does not vary by region, woman’s educational level, or wealth (Table RH.7). Tables RH.8 and RH.9 present data on health checks and post-natal care visits of newborns. Data on health checks and post-natal care visits of mothers are shown in Table RH.10. It should be noted, that health checks following birth while in facility or at home refer to checks provided by any health provider regardless of timing (column 1 of Table RH.8). Post-natal care visits refer to a separate visit to check on the health of the newborn and mother and provide preventive care services and therefore do not include health checks following birth while in facility or at home. The indicator «Post-natal health checks» includes any health check after birth received while in the health facility and at home, regardless of timing, as well as PNC visits within two days of delivery.   Table RH.8 presents the percentage of newborns born in the two years preceding the survey who received health checks and post-natal care visits from any health provider after birth. In the Republic of Belarus, all (100 percent) newborns receive a health check following birth, and all are performed by a public sector health provider. This indicator is identical in all regions of the country. With regard to PNC visits of the newborns, the majority take place on the day of discharge from a maternity clinic or on the next day (14.4 and 65.2 percent, respectively). Also, 12 percent of PNC visits occurred on the second day following discharge, and about 6 percent on days 3-6. All PNC visits were made by a public sector health provider. Thus, all newborns were receiving health checks and PNC visits following birth by health providers – and the value of this indicator is 100 percent across all regions of the country, irrespective of the household’s area of residence, wealth, or mother’s level of education. Table RH.9 presents data on the first post-natal care visits for newborns that occurred within one week after discharge from a health facility, by provider and location. As underlined above, post- natal care visit does not include health checks following birth (in facility or at home). The majority (94.1 percent) of the first PNC visits are at home. The value of this indicator is above 90 percent in all regions of the country, except Mogilev Region (87.8 percent). The remaining proportion (5.9 percent) of the PNC visits occurs in the public sector health facilities. Nearly all (97.4 percent) PNC visits for newborns are provided by a doctor, nurse or midwife. The rest of PNC visits are done by a doctor’s assistant (feldsher). As expected, nearly all (99.7 percent) PNC visits in urban areas are provided by a doctor / nurse / midwife, while in rural areas the figure is 89.1 percent. The remaining proportion (0.3 percent in urban and 10.9 percent in rural areas) of newborns receives the PNC visits by doctor’s assistants (feldshers). REPRODUCTIVE HEALTH 88 MICS4, Republic of Belarus. Final Report Table RH.10 presents the percentage of women age 15-49 years who gave birth to a child in the last two years preceding the survey and who received postnatal care and health checks by skilled health providers. As seen from the table, nearly all (99.7 percent) new mothers in the Republic of Belarus received postnatal health checks immediately after birth in a public-sector health facility or at home. The majority of post-natal care visits for mothers occur about one week after giving birth, as the timing of the PNC visit is determined mostly by the normal length of stay in a maternity clinic (Table RH.7). However, nearly 13 percent of women (11.6 percent in urban and 16.9 percent in rural areas) received no post-natal care visits. This proportion is particularly high in Gomel and Vitebsk Regions, exceeding one-quarter of women with no post-natal care visits (29.3 percent and 25.3 percent, respectively). It is also correlated with the level of household’s wealth. Among the poorest women 24 percent received no post-natal care visits, and among richest women the figure was 10.2 percent. In general, post-natal health checks were provided to all women who had given birth. Coverage was universal (100 percent) in all regions of the country, irrespective of the level of education, wealth or area of residence of the mother1. It is necessary to note the differences between the data in Tables RH.8 and RH.10, which refer, respectively, to post-natal health checks of newborns and of mothers. These are related mainly to the frequency of post-natal care visits (somewhat lower for mothers than for children, including visits on the same day of discharge from the maternity hospital, on the next day after discharge, etc.). Likewise, only 0.1 percent of newborns did not receive a post-natal care visit at home, and among mothers the figure was 12.8 percent. In the Republic of Belarus, among women receiving post-natal care visits for mothers within one week of discharge from a maternity hospital about 90 percent receive health checks in a public sector facility, 7.8 percent at home and 3 percent at private sector health facilities1. The majority (95 percent) of post-natal health checks of mothers is provided by a doctor, nurse or midwife. Some 5 percent of post-natal care visits are provided by doctor’s assistants (feldshers). 1 Data table not shown in this report. REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 89 Table RH.1. Knowledge of contraceptive methods Percentage of women age 15-49 years, percentage of women age 15-49 years who are currently married or in union, and percentage of sexually active women age 15-49 years currently not married or in union who have heard of contraception, Republic of Belarus, 2012 All Women who are currently married or in union Sexually active women who are currently not married or in union* Any method 99.9 100.0 100.0 Any modern method 99.9 100.0 100.0 Female sterilization 90.9 93.3 87.6 Male sterilization 78.4 80.8 75.8 Contraceptive pills 98.9 99.2 99.1 Intrauterine device 98.1 99.6 96.9 Contraceptive injections 75.5 76.9 77.0 Contraceptive implants 52.7 53.1 59.6 Male condoms 99.9 100.0 100.0 Female condoms 66.8 67.6 67.8 Diaphragm 49.5 50.8 53.4 Foam / jelly 58.5 59.5 65.0 Urgent contraception 65.1 67.3 67.3 Any traditional method 98.4 99.1 99.2 Periodic abstention 94.0 95.6 93.4 Withdrawal 97.4 98.1 98.6 Other 69.3 74.4 61.8 Mean number of methods known to women 10.9 11.1 11.0 Number of women 5745 3985 667 * Had sex in the last month preceding the survey. Table RH.2. Use of contraception Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Republic of Belarus, 2012 Percentage of women currently married or in union who are using a contraceptive method: Percentage of women currently married or in union not using any contraceptive method F e m a l e s t e r i l i z a t i o n M a l e s t e r i l i z a t i o n I U D ( i n t r a u t e r i n e d e v i c e ) I n j e c t a b l e s I m p l a n t s P i l l s M a l e c o n d o m F e m a l e c o n d o m D i a p h r a g m / f o a m / j e l l y L a c t a t i o n a l a m e n o r r h o e a m e t h o d P e r i o d i c a b s t i n e n c e W i t h d r a w a l O t h e r A n y m o d e r n m e t h o d A n y t r a d i t i o n a l m e t h o d A n y m e t h o d 1 Number of women currently married or in union age 15-49 years Region Brest 38.9 4.3 0.0 18.3 0.0 0.0 6.1 25.1 0.0 0.0 0.6 2.4 4.3 0.0 53.8 7.3 61.1 650 Vitebsk 37.3 2.2 0.0 15.0 0.1 0.8 7.9 22.0 0.0 0.0 1.4 6.2 7.0 0.0 48.1 14.6 62.7 503 Gomel 40.6 2.4 0.0 9.0 0.0 0.0 8.4 23.2 0.0 0.0 1.4 2.0 12.7 0.2 43.1 16.3 59.4 589 Grodno 41.0 0.3 0.0 24.1 0.0 0.0 6.7 16.1 0.4 0.0 0.3 2.1 9.0 0.0 47.6 11.4 59.0 439 Minsk City 25.3 1.4 0.0 11.4 0.3 0.0 20.6 29.7 0.1 0.0 1.1 1.0 8.5 0.6 63.5 11.2 74.7 778 Minsk 40.1 7.7 0.0 14.3 0.1 0.0 8.7 17.0 0.1 0.7 0.6 4.2 6.6 0.1 48.5 11.4 59.9 599 Mogilev 41.1 3.8 0.0 17.2 0.0 0.0 8.8 17.2 0.0 0.0 0.2 4.4 5.8 1.5 46.9 11.9 58.9 427 Area Urban 35.9 2.4 0.0 14.5 0.1 0.1 11.1 23.9 0.1 0.1 0.9 2.8 7.7 0.4 52.4 11.7 64.1 2958 Rural 40.1 5.7 0.0 16.7 0.0 0.0 7.8 17.4 0.0 0.0 0.7 3.8 7.8 0.0 47.6 12.3 59.9 1027 Age 15-19 (42.0) (0.0) (0.0) (11.5) (0.0) (0.0) (6.4) (30.5) (0.0) (0.0) (2.1) (0.8) (6.7) (0.0) (48.4) (9.6) (58.0) 37 20-24 43.9 0.3 0.0 4.7 0.1 0.5 10.8 28.9 0.3 0.0 1.0 2.2 7.5 0.0 45.5 10.7 56.1 399 25-29 36.8 0.7 0.0 10.9 0.4 0.0 11.5 28.2 0.3 0.1 2.2 1.4 7.0 0.5 52.0 11.2 63.2 729 30-34 35.1 2.5 0.0 15.1 0.0 0.0 10.9 25.2 0.0 0.0 1.3 1.9 7.7 0.3 53.7 11.2 64.9 761 35-39 24.3 4.5 0.0 22.4 0.0 0.3 14.4 21.8 0.0 0.5 0.2 3.4 7.3 0.9 63.8 11.8 75.7 730 40-44 32.3 5.2 0.0 22.5 0.0 0.0 8,4 19.3 0.0 0.0 0.1 3.9 8.3 0.0 55.4 12.4 67.7 631 45-49 52.2 5.3 0.0 11.3 0.0 0.0 5.5 11.9 0.0 0.0 0.1 5.3 8.4 0.0 34.0 13.8 47.8 698 Table continued Percentage of women currently married or in union who are using a contraceptive method: Percentage of women currently married or in union not using any contraceptive method F e m a l e s t e r i l i z a t i o n M a l e s t e r i l i z a t i o n I U D ( i n t r a u t e r i n e d e v i c e ) I n j e c t a b l e s I m p l a n t s P i l l s M a l e c o n d o m F e m a l e c o n d o m D i a p h r a g m / f o a m / j e l l y L a c t a t i o n a l a m e n o r r h o e a m e t h o d P e r i o d i c a b s t i n e n c e W i t h d r a w a l O t h e r A n y m o d e r n m e t h o d A n y t r a d i t i o n a l m e t h o d A n y m e t h o d 1 Number of women currently married or in union age 15-49 years Number of living children No 72.4 0.5 0.0 1.0 0.0 0.0 7.7 14.9 0.0 0.0 0.0 0.5 3.0 0.0 24.0 3.5 27.6 397 1 36.6 0.5 0.0 12.7 0.2 0.1 11.7 25.4 0.2 0.0 0.5 3.1 8.5 0.5 50.8 12.6 63.4 1542 2 29.2 4.6 0.0 20.3 0.0 0.1 10.6 21.6 0.0 0.2 1.2 3.9 8.1 0.2 57.5 13.3 70.8 1668 3 33.4 9.1 0.0 17.3 0.0 0.0 6.3 21.7 0.0 0.1 1.2 1.1 9.4 0.2 54.7 11.9 66.6 301 4 + 42.5 18.1 0.0 14.0 0.0 0.0 3.0 14.0 0.0 0.0 1.9 1.3 2.8 2.4 49.1 8.3 57.5 77 Education General basic 29.6 9.8 0.0 12.2 0.0 0.0 3.3 21.0 0.0 0.0 1.2 5.2 17.6 0.0 46.3 24.1 70.4 75 General secondary 41.7 3.4 0.0 14.8 0.1 0.0 10.3 20.2 0.0 0.0 0.2 1.7 7.3 0.3 48.7 9.6 58.3 543 Vocational-technical / Secondary specialized 37.4 3.8 0.0 15.6 0.0 0.1 7.4 22.0 0.0 0.1 0.8 4.1 8.6 0.1 49.0 13.6 62.6 1910 Higher 34.9 2.1 0.0 14.7 0.2 0.1 14.3 23.4 0.2 0.2 1.1 1.9 6.2 0.7 55.2 9.9 65.1 1457 Wealth index quintile Poorest 44.8 5.7 0.0 14.9 0.0 0.0 5.2 17.9 0.0 0.0 1.1 3.6 6.7 0.0 43.8 11.4 55.2 530 Second 37.6 4.8 0.0 15.8 0.0 0.0 9.6 20.2 0.1 0.1 0.6 3.6 7.8 0.0 50.4 12.0 62.4 752 Middle 38.8 2.3 0.0 13.1 0.1 0.2 10.7 22.4 0.2 0.0 0.2 2.9 9.0 0.1 49.0 12.2 61.2 776 Fourth 36.2 2.1 0.0 15.7 0.0 0.0 8.2 25.7 0.0 0.0 0.4 3.1 8.2 0.4 51.7 12.1 63.8 858 Richest 31.8 2.5 0.0 15.6 0.2 0.2 14.6 23.0 0.1 0.3 1.7 2.3 6.9 0.8 56.5 11.7 68.2 1069 Total 36.9 3.2 0.0 15.1 0.1 0.1 10.3 22.3 0.1 0.1 0.8 3.0 7.7 0.3 51.2 11.9 63.1 3985 1 MICS indicator 5.3; MDG indicator 5.3. ( ) – Figures that are based on 25-49 unweighted cases. REPRODUCTIVE HEALTH 92 MICS4, Republic of Belarus. Final Report Table RH.3. Unmet need for contraception Percentage of women age 15-49 years currently married or in union with an unmet need for family planning and percentage of demand for contraception satisfied, Republic of Belarus, 2012 Met need for contraception Unmet need for contraception Fo r s pa ci ng Fo r l im iti ng To ta l Fo r s pa ci ng Fo r l im iti ng To ta l1 N um be r o f w om en cu rre nt ly m ar rie d or in u ni on Pe rc en ta ge o f d em an d fo r c on tra ce pt io n sa tis fie d N um be r o f w om en cu rre nt ly m ar rie d or in u ni on w ith n ee d fo r c on tra ce pt io n Region Brest 24.8 36.3 61.1 5.4 2.6 8.0 650 88.5 449 Vitebsk 24.7 38.0 62.7 4.8 5.0 9.8 503 86.5 364 Gomel 23.5 35.9 59.4 2.1 2.9 5.0 589 92.2 380 Grodno 13.1 45.9 59.0 2.1 2.8 4.9 439 92.4 281 Minsk City 35.7 39.0 74.7 2.8 2.0 4.8 778 94.0 618 Minsk 21.0 38.9 59.9 4.3 3.9 8.1 599 88.1 408 Mogilev 18.1 40.8 58.9 5.1 4.2 9.2 427 86.4 290 Area Urban 26.6 37.5 64.1 3.6 2.9 6.5 2958 90.8 2089 Rural 17.0 42.9 59.9 4.3 4.1 8.3 1027 87.8 701 Age 15-19 (57.3) (0.7) (58.0) (15.1) (0.0) (15.1) 37 (79.3) 27 20-24 50.7 5.4 56.1 12.5 1.7 14.2 399 79.8 281 25-29 48.1 15.1 63.2 6.1 3.2 9.2 729 87.2 528 30-34 32.4 32.4 64.9 4.8 3.5 8.3 761 88.6 557 35-39 15.8 59.9 75.7 1.3 2.7 4.0 730 95.0 581 40-44 3.9 63.8 67.7 0.0 4.2 4.2 631 94.1 454 45-49 0.4 47.4 47.8 0.6 3.5 4.1 698 92.1 362 Education General basic 18.7 51.7 70.4 1.3 5.9 7.2 75 90.7 59 General secondary 17.9 40.3 58.3 4.4 4.8 9.2 543 86.4 366 Vocational-technical / Secondary specialized 18.5 44.1 62.6 3.2 3.5 6.7 1910 90.3 1323 Higher 34.2 30.9 65.1 4.4 2.1 6.5 1457 91.0 1042 Wealth index quintile Poorest 16.2 39.1 55.2 4.7 5.9 10.6 530 83.9 349 Second 22.1 40.3 62.4 3.5 3.1 6.6 752 90.4 519 Middle 23.4 37.9 61.2 3.3 4.4 7.7 776 88.8 535 Fourth 27.3 36.5 63.8 4.3 2.7 7.0 858 90.1 607 Richest 27.7 40.5 68.2 3.4 1.4 4.8 1069 93.4 780 Total 24.2 38.9 63.1 3.8 3.2 7.0 3985 90.1 2790 1 MICS indicator 5.4; MDG indicator 5.6. ( ) – Figures that are based on 25-49 unweighted cases. REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 93 Table RH.4. Antenatal care coverage Percent distribution of women age 15-49 years who gave live birth in the two years preceding the survey by type of personnel providing antenatal care during the pregnancy for the last birth, Republic of Belarus, 2012 Person providing antenatal care Doctor Nurse / midwife Doctor’s assistans (feldsher) No antenatal care provided received Total Any skilled personnel1 Number of women who had a live birth in the preceding two years Area Urban 99.8 0.2 0.0 0.0 100.0 100.0 571 Rural 97.3 1.1 0.5 1.2 100.0 98.8 159 Education General basic (87.5) (5.9) (6.6) (0.0) 100.0 (100.0) 11 General secondary 98.0 0.3 0.0 1.7 100.0 98.3 111 Vocational-technical / Secondary specialized 99.6 0.4 0.0 0.0 100.0 100.0 281 Higher 99.9 0.1 0.0 0.0 100.0 100.0 327 Wealth index quintile Poorest 97.3 0.5 0.0 2.2 100.0 97.8 83 Second 98.7 0.7 0.6 0.0 100.0 100.0 123 Middle 99.5 0.5 0.0 0.0 100.0 100.0 139 Fourth 99.6 0.4 0.0 0.0 100.0 100.0 156 Richest 100.0 0.0 0.0 0.0 100.0 100.0 229 Total 99.3 0.4 0.1 0.3 100.0 99.7 730 1 MICS indicator 5.5a; MDG indicator 5.5. ( ) – Figures that are based on 25-49 unweighted cases. Table RH.5. Number of antenatal care visits Percent distribution of women who had a live birth during the two years preceding the survey by number of antenatal care visits, Republic of Belarus, 2012 Percentage of women who had: No antenatal care visits 4 or more visits1 Missing / DK Total Number of women who had a live birth in the preceding two years Area Urban 0.0 99.9 0.1 100.0 571 Rural 1.2 98.6 0.2 100.0 159 Wealth index quintile Poorest 2.2 97.4 0.4 100.0 83 Second 0.0 100.0 0.0 100.0 123 Middle 0.0 99.8 0.2 100.0 139 Fourth 0.0 100.0 0.0 100.0 156 Richest 0.0 100.0 0.0 100.0 229 Total 0.3 99.7 0.1 100.0 730 1 MICS indicator 5.5b; MDG indicator 5.5. REPRODUCTIVE HEALTH 94 MICS4, Republic of Belarus. Final Report Table RH.6. Assistance during delivery Percent distribution of women age 15-49 years who had a live birth in the two years preceding the survey by person assisting at delivery and percentage of births delivered by C-section, Republic of Belarus, 2012 Person assisting at delivery Doctor Nurse / midwife Relative / Friend Total Delivery assisted by any skilled attendant1 Percent delivered by C-section2 Number of women who had a live birth in the preceding two years Region Brest 99.6 0.4 0.0 100.0 100.0 25.6 126 Vitebsk 98.9 1.1 0.0 100.0 100.0 16.9 89 Gomel 97.6 2.4 0.0 100.0 100.0 29.4 91 Grodno 96.8 3.2 0.0 100.0 100.0 19.0 57 Minsk City 92.4 7.4 0.2 100.0 99.8 24.7 207 Minsk 100.0 0.0 0.0 100.0 100.0 25.6 96 Mogilev 96.6 3.4 0.0 100.0 100.0 37.0 64 Area Urban 96.6 3.3 0.1 100.0 99.9 24.3 571 Rural 97.6 2.4 0.0 100.0 100.0 28.8 159 Mother’s age at birth Less than 20 97.8 2.2 0.0 100.0 100.0 14.2 38 20-34 96.7 3.3 0.1 100.0 99.9 24.8 634 35-49 97.7 2.3 0.0 100.0 100.0 37.9 58 Education General basic (97.9) (2.1) (0.0) 100.0 (100.0) (30.9) 11 General secondary 94.1 5.9 0.0 100.0 100.0 27.9 111 Vocational-technical / Secondary specialized 98.4 1.5 0.1 100.0 99.9 29.1 281 Higher 96.4 3.6 0.0 100.0 100.0 20.8 327 Wealth index quintile Poorest 97.9 2.1 0.0 100.0 100.0 32.4 83 Second 97.5 2.5 0.0 100.0 100.0 23.6 123 Middle 96.7 3.1 0.2 100.0 99.8 22.4 139 Fourth 95.6 4.4 0.0 100.0 100.0 24.8 156 Richest 96.9 3.1 0.0 100.0 100.0 25.6 229 Total 96.8 3.1 0.0 100.0 100.0 25.3 730 1 MICS indicator 5.7; MDG indicator 5.2. 2 MICS indicator 5.9. ( ) – Figures that are based on 25-49 unweighted cases. REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 95 Table RH.7. Post-partum stay in health facility Percent distribution of women age 15-49 years who gave birth in a health facility in the two years preceding the survey by duration of stay in health facility following their last live birth, Republic of Belarus, 20121 Duration of stay in health facility 3-6 days 7 days and more Total Number of women who gave birth in a health facility in the preceding two years Region Brest 61.3 38.7 100.0 126 Vitebsk 57.0 43.0 100.0 89 Gomel 55.5 44.5 100.0 91 Grodno 47.0 53.0 100.0 57 Minsk City 80.2 19.8 100.0 206 Minsk 67.2 32.8 100.0 96 Mogilev 62.4 37.6 100.0 64 Area Urban 68.4 31.6 100.0 570 Rural 53.5 46.5 100.0 159 Mother’s age at birth Less than 20 54.1 45.9 100.0 38 20-34 66.1 33.9 100.0 633 35-49 62.7 37.3 100.0 58 Education General basic (62.6) (37.4) 100.0 11 General secondary 59.9 40.1 100.0 111 Vocational-technical / Secondary specialized 60.7 39.3 100.0 280 Higher 70.9 29.1 100.0 327 Wealth index quintile Poorest 47.8 52.2 100.0 83 Second 71.3 28.7 100.0 123 Middle 62.7 37.3 100.0 139 Fourth 68.2 31.8 100.0 155 Richest 67.7 32.3 100.0 229 Total 65.2 34.8 100.0 729 ( ) – Figures that are based on 25-49 unweighted cases. Table RH.8. Post-natal health checks of newborns Percentage of newborns born in the last two years preceding the survey who received health checks and post-natal care (PNC) visits from any health provider after birth, Republic of Belarus, 2012  PNC visit (time after birth) PNC visit (time after discharge from health facility) Health check following birth while in facility or at home S a m e d a y 3 - 6 d a y s f o l l o w i n g b i r t h A f t e r t h e f i r s t w e e k f o l l o w i n g b i r t h N o p o s t - n a t a l c a r e v i s i t M i s s i n g / D K T o t a l S a m e d a y 1 d a y f o l l o w i n g d i s c h a r g e 2 d a y s f o l l o w i n g d i s c h a r g e 3 - 6 d a y s f o l l o w i n g d i s c h a r g e A f t e r t h e f i r s t w e e k f o l l o w i n g d i s c h a r g e N o p o s t - n a t a l c a r e v i s i t M i s s i n g / D K T o t a l P o s t - n a t a l h e a l t h c h e c k f o r t h e n e w b o r n 1 Number of last births in the two years preceding the survey Region Brest 100.0 0.0 29.9 70.1 0.0 0.0 100.0 20.9 55.6 13.1 4.9 5.5 0.0 0.0 100.0 100.0 126 Vitebsk 100.0 0.0 36.7 62.8 0.3 0.3 100.0 6.4 75.8 7.0 7.1 3.2 0.3 0.3 100.0 100.0 89 Gomel 100.0 0.0 31.8 67.7 0.4 0.0 100.0 13.1 55.7 18.4 10.6 1.7 0.4 0.0 100.0 100.0 91 Grodno 100.0 0.0 18.4 81.6 0.0 0.0 100.0 4.3 73.0 14.9 6.6 1.2 0.0 0.0 100.0 100.0 57 Minsk City 99.8 0.2 64.3 35.5 0.0 0.0 100.0 19.0 68.3 9.5 1.7 1.4 0.0 0.2 100.0 100.0 207 Minsk 100.0 0.0 37.7 62.3 0.0 0.0 100.0 12.9 64.4 13.2 7.7 1.8 0.0 0.0 100.0 100.0 96 Mogilev 100.0 0.0 29.1 68.8 0.0 2.1 100.0 10.6 67.1 11.5 6.0 2.8 0.0 2.1 100.0 100.0 64 Area Urban 99.9 0.1 43.7 55.9 0.1 0.2 100.0 14.0 67.8 11.0 4.9 1.9 0.1 0.3 100.0 100.0 571 Rural 100.0 0.0 30.4 69.5 0.0 0.1 100.0 15.7 55.9 15.5 8.1 4.7 0.0 0.1 100.0 100.0 159 Mother’s age at birth Less than 20 100.0 0.0 25.5 73.9 0.0 0.6 100.0 13.6 56.1 19.0 9.1 1.6 0.0 0.6 100.0 100.0 38 20-34 99.9 0.1 41.6 58.0 0.1 0.2 100.0 13.7 66.2 11.7 5.7 2.3 0.1 0.3 100.0 100.0 634 35-49 100.0 0.0 41.5 58.1 0.4 0.0 100.0 22.5 59.6 10.3 2.1 5.2 0.4 0.0 100.0 100.0 58 Education General basic (100.0) (0.0) (36.6) (63.7) (0.0) (0.0) 100.0 (16.2) (60.9) (12.7) (10.3) (0.0) (0.0) (0.0) 100.0 (100.0) 11 General secondary 100.0 0.0 37.8 61.8 0.0 0.4 100.0 12.3 67.1 14.1 4.0 2.0 0.0 0.4 100.0 100.0 111 Vocational-technical / Secondary specialized 99.9 0.1 33.2 66.3 0.1 0.2 100.0 13.8 63.7 12.9 5.2 3.9 0.1 0.4 100.0 100.0 281 Higher 100.0 0.0 48.5 51.3 0.1 0.1 100.0 15.5 66.0 10.4 6.3 1.6 0.1 0.1 100.0 100.0 327 Wealth index quintile Poorest 100.0 0.0 25.6 74.1 0.0 0.3 100.0 13.2 61.4 16.4 6.8 1.9 0.0 0.3 100.0 100.0 83 Second 100.0 0.0 48.1 51.7 0.0 0.2 100.0 15.7 59.6 15.5 4.5 4.4 0.0 0.2 100.0 100.0 123 Middle 99.8 0.2 38.1 61.2 0.0 0.5 100.0 13.9 65.8 10.1 6.9 2.5 0.0 0.7 100.0 100.0 139 Fourth 100.0 0.0 40.2 59.3 0.3 0.3 100.0 14.7 66.3 11.1 5.1 2.3 0.3 0.3 100.0 100.0 156 Richest 100.0 0.0 44.5 55.4 0.1 0.0 100.0 14.1 68.4 10.3 5,2 1.9 0.1 0.0 100.0 100.0 229 Total 100.0 0.0 40.8 58.9 0.1 0.2 100.0 14.4 65.2 12.0 5.6 2.5 0.1 0.3 100.0 100.0 730 1 MICS indicator 5.11. ( ) – Figures that are based on 25-49 unweighted cases. REPRODUCTIVE HEALTH MICS4, Republic of Belarus. Final Report 97 Table RH.9. Post-natal care (PNC) visits for newborns within one week after discharge1 Percentage of newborns who were born in the last two years preceding the survey and received post-natal care visits within one week after discharge by location and provider of the first PNC visit, Republic of Belarus, 2012 Location of first PNC visit Provider of first PNC visit A t h om e P ub lic h ea lth fa ci lit y To ta l D oc to r / n ur se / m id w ife D oc to r’s a ss is ta nt (fe ld sh er ) To ta l Number of newborns born in the two years preceding the survey with a PNC visit within the first week after discharge Region Brest 93.5 6.5 100.0 96.9 3.1 100.0 119 Vitebsk 92.0 8.0 100.0 97.7 2.3 100.0 86 Gomel 92.2 7.8 100.0 93.4 6.6 100.0 89 Grodno 99.3 0.7 100.0 98.7 1.3 100.0 56 Minsk City 96.1 3.9 100.0 99.1 0.9 100.0 204 Minsk 95.2 4.8 100.0 96.3 3.7 100.0 94 Mogilev 87.8 12.2 100.0 98.9 1.1 100.0 61 Area Urban 94.7 5.3 100.0 99.7 0.3 100.0 558 Rural 91.7 8.3 100.0 89.1 10.9 100.0 151 Mother’s age at birth Less than 20 98.3 1.7 100.0 91.6 8.4 100.0 37 20-34 94.5 5.5 100.0 97.6 2.4 100.0 617 35-49 86.4 13.6 100.0 99.6 0.4 100.0 55 Education General basic (96.1) (3.9) 100.0 (88.4) (11.6) 100.0 11 General secondary 93.9 6.1 100.0 95.9 4.1 100.0 109 Vocational-technical / Secondary specialized 92.9 7.1 100.0 97.5 2.5 100.0 268 Higher 95.1 4.9 100.0 98.2 1.8 100.0 321 Wealth index quintile Poorest 94.8 5.2 100.0 87.7 12.3 100.0 81 Second 92.3 7.7 100.0 94.4 5.6 100.0 117 Middle 90.7 9.3 100.0 98.9 1.1 100.0 135 Fourth 93.0 7.0 100.0 100.0 0.0 100.0 151 Richest 97.5 2.5 100.0 99.8 0.2 100.0 225 Total 94.1 5.9 100.0 97.4 2.6 100.0 709 1 Table RH.9 has been customized to reflect the situation of Belarus where about two thirds of mothers stay in the health facility 3-6 days following birth (see Table RH.7). The same length of stay in the health facility was used for both the mother and the newborn child (since only information on the duration of stay of the mother was collected) ( ) – Figures that are based on 25-49 unweighted cases. Table RH.10. Post-natal health checks for mothers Percentage of women age 15-49 years who gave birth in the 2 years preceding the survey who received health checks and post-natal care (PNC) visits from any health provider in relation to time after birth and time after discharge from the health facility, Republic of Belarus, 2012   PNC visit (time after birth) PNC visit (time after discharge from health facility) Health check following birth while in facility or at home S a m e d a y 1 d a y f o l l o w i n g b i r t h 2 d a y s f o l l o w i n g b i r t h 3 - 6 d a y s f o l l o w i n g b i r t h A f t e r t h e f i r s t w e e k f o l l o w i n g b i r t h N o p o s t - n a t a l c a r e v i s i t M i s s i n g / D K T o t a l S a m e d a y 1 d a y a f t e r d i s c h a r g e 2 d a y s a f t e r d i s c h a r g e 3 - 6 d a y s a f t e r d i s c h a r g e A t l e a s t o n e w e e k a f t e r d i s c h a r g e N o p o s t - n a t a l c a r e v i s i t M i s s i n g / D K T o t a l P o s t - n a t a l h e a l t h c h e c k f o r t h e m o t h e r 1 Number of women who gave birth in the two years preceding the survey Region Brest 100.0 0.0 0.0 0.0 1.7 91.7 5.9 0.7 100.0 0.6 1.8 1.9 3.8 83.6 5.9 2.4 100.0 100.0 126 Vitebsk 99.7 0.4 0.7 0.0

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