Egypt - Demographic and Health Survey - 2001

Publication date: 2001

2000Demographic andHealth Survey E gypt 2000 D em ographic and H ealth Survey Egypt Egypt Demographic and Health Survey 2000 Fatma El-Zanaty Ann A. Way January 2001 Ministry of Health National Population and Population Council ORC Macro The 2000 Egypt Demographic and Health Survey (2000 EDHS) is part of the worldwide MEASURE DHS+ project that is funded by the United States Agency for International Development (USAID). The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID . Additional information about the 2000 EDHS may be obtained from the National Population Council, P.O. Box 1036, Cairo, Egypt (telephone: 5240425 or 5240505 and fax: 5240219). Additional information about the MEASURE DHS+ pro ject may be obtained from Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999). Suggested citation: El-Zanaty, Fatma and Ann Way. 2001 Egypt Demographic and Health Survey 2000. Calverton, Maryland [USA]: Ministry of Health and Population [Egypt], National Population Council and ORC Macro. Contents * iii CONTENTS Page Tables and Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi Map of Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxviii CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Geography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Socioeconomic Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.3 Changing Population Size and Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.4 Recent Rate of Natural Increase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.5 Population Policy and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6 Health Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.7 Organization and Objectives of the 2000 EDHS . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.8 Implementation of the 2000 EDHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.9 Coverage of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.1 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.2 Education of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.3 Household Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS . . . . . . . . . . . . . 25 3.1 General Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.2 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.3 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3.4 Disposal of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.5 Household Decision-making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.6 Access to Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 3.7 Coverage of Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 CHAPTER 4 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.1 Current Fertility Levels and Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.2 Comparison of Current and Cumulative Fertility Levels . . . . . . . . . . . . . . . . . . 45 4.3 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 iv * Contents Page 4.4 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.5 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.6 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.7 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 CHAPTER 5 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING . . . 57 5.1 Knowledge of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.2 Knowledge of a Source for Family Planning Methods . . . . . . . . . . . . . . . . . . . . 60 5.3 Exposure to Family Planning Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.4 Interpersonal Communication about Family Planning . . . . . . . . . . . . . . . . . . . 64 5.5 Approval of Family Planning Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 5.6 Attitude about Timing of Adoption of Contraception . . . . . . . . . . . . . . . . . . . . 68 5.7 Knowledge of Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5.8 Ever Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 5.9 First Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 CHAPTER 6 CURRENT USE OF FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.1 Level and Differentials in Current Use of Family Planning . . . . . . . . . . . . . . . . 75 6.2 Trends in Current Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.3 Sources for Modern Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . 83 6.4 Pill Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 6.5 Cost of the IUD and Willingness to Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 6.6 Cost of Injectables and Willingness to Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 CHAPTER 7 NONUSE OF FAMILY PLANNING AND INTENTION TO USE . . . . . . . . . 95 7.1 Discontinuation Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 7.2 Reasons for Discontinuation of Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . 96 7.3 Intention to Use Contraception in the Future . . . . . . . . . . . . . . . . . . . . . . . . . . 98 7.4 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 7.5 Preferred Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 7.6 Contact of Nonusers with Outreach Workers or Health Care Providers . . . . . . 100 CHAPTER 8 PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . . . . . 103 8.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 8.2 Consanguinity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 8.3 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 8.4 Postpartum Amenorrhea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . 107 8. 5 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Contents * v Page CHAPTER 9 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 9.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 9.2 Need for Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 9.3 Women with Unmet Need for Family Planning . . . . . . . . . . . . . . . . . . . . . . . . 116 9.4 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 9.5 Unplanned and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 CHAPTER 10 INFANT AND CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 10.1 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 10.2 Levels and Trends in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . 124 10.3 Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 10.4 High-risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 CHAPTER 11 MATERNAL HEALTH CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 11.1 Pregnancy Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 11.2 Content of Pregnancy Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 11.3 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 11.4 Delivery Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 11.5 Postnatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 11.6 Trends in Maternal Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 11.7 Use of Smoking Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 CHAPTER 12 CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 12.1 Immunization of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 12.2 Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 12.3 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 CHAPTER 13 NUTRITIONAL STATUS, PREVALENCE OF ANEMIA, AND MICRONUTRIENT SUPPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . 163 13.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 13.2 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 13.3 Nutritional Status of Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 13.4 Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 13.5 Micronutrient Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 vi * Contents Page CHAPTER 14 FEMALE CIRCUMCISION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 14.1 Prevalence of Female Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 14.2 Circumcision Experience of Daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 14.3 Support for Female Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 14.4 Trends in Circumcision Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 14.5 Reasons for Support of Female Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . 197 14.6 Exposure to Discussion/Information about Circumcision . . . . . . . . . . . . . . . . 200 CHAPTER 15 CHILDREN’S EDUCATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 15.1 Attendance at School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 15.2 Reasons for Not Attending School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 15.3 Absence from School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 15.4 Expenditures on Schooling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 15.5 Attitude about University Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 APPENDIX A SURVEY STAFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 APPENDIX B SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 APPENDIX C SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 APPENDIX D DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Tables and Figures * vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Population of Egypt, 1882-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Table 1.2 Life expectancy, Egypt 1960-2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Table 1.3 Survey timetable, 2000 Egypt DHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Table 1.4 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . 12 Figure 1.1 Trends in the crude birth rate and the crude death rate, Egypt 1986-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS Table 2.1 Household population by age, residence, and sex . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.2 Population by age, 1988, 1992, 1995, and 2000 . . . . . . . . . . . . . . . . . . . . . . . 14 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 2.4.1 Educational level of the male household populatio . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.4.2 Educational level of the female household populat . . . . . . . . . . . . . . . . . . . . . . 17 Table 2.5 School attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 2.6 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table 2.7 Household possessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Figure 2.1 Population pyramid, Egypt 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure 2.2 Current school attendance by age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Figure 2.3 Current school attendance among girls age 6-15 by residence . . . . . . . . . . . . . 20 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 3.2 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 3.3 Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 3.4 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3.5 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 3.6 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 3.7 Share of household expenditures met by earnings by control over earnings . . . 34 Table 3.8 Share of household expenditures met by earnings and control over earnings by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 3.9 Household decision-making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 3.10 Final say in household decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 3.11 Problems women face in accessing health care . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 3.12 Exposure to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Figure 3.1 Occupation among working women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 viii * Tables and Figures Page Figure 3.2 Share of household expenditures met by working women’s earnings . . . . . . . . 33 Figure 3.3 Exposure to mass media weekly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 CHAPTER 4 FERTILITY Table 4.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 4.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 4.3 Trends in fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 4.4 Trends in fertility by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 4.5 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 4.6 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table 4.7 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 4.8 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.9 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 4.10 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Figure 4.1 Total fertility rates (births per woman 15-49) by place of residence . . . . . . . . . 45 Figure 4.2 Trends in total fertility rates by urban-rural residence, 1988-2000 . . . . . . . . . . 49 Figure 4.3 Age-specific fertility rates for five-year periods preceding the survey . . . . . . . . 50 CHAPTER 5 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING Table 5.1 Knowledge of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 5.2 Knowledge of family planning methods by background characteristics . . . . . . . 59 Table 5.3 Knowledge of source for family planning services . . . . . . . . . . . . . . . . . . . . . . . 60 Table 5.4 Exposure to family planning messages on radio and television . . . . . . . . . . . . . 62 Table 5.5 Exposure to family planning messages in print media and at community meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 5.6 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5.7 Discussion of family planning with persons other than husband . . . . . . . . . . . . 67 Table 5.8 Wives’ and husbands’ attitudes toward family planning . . . . . . . . . . . . . . . . . . 68 Table 5.9 Timing of use of family planning by newly married couples . . . . . . . . . . . . . . . 69 Table 5.10 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 5.11 Ever use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 5.12 Trends in ever use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 5.13 Ever use of family planning by background characteristics . . . . . . . . . . . . . . . . 72 Table 5.14 Number of children at first use of family planning . . . . . . . . . . . . . . . . . . . . . . 74 Figure 5.1 Trends in knowledge of norplant and injectables among currently married women, Egypt 1992-2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Figure 5.2 Trends in recent exposure of ever-married women to family planning messages broadcast on radio or television, Egypt 1995 and 2000 . . . . . . . . . . . 63 Figure 5.3 Recent discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . 65 Tables and Figures * ix Page CHAPTER 6 CURRENT USE OF FAMILY PLANNING Table 6.1 Current use of family planning by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table 6.2 Current use of family planning by method . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 6.3 Current use of family planning by governorate . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 6.4 Trends in current use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 6.5 Trends in the family planning method mix . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 6.6 Trends in current use of family planning by residence . . . . . . . . . . . . . . . . . . . 81 Table 6.7 Trends in current use of family planning by governorate . . . . . . . . . . . . . . . . . 82 Table 6.8 Sources for modern family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 6.9 Sources for family planning methods by residence . . . . . . . . . . . . . . . . . . . . . . 86 Table 6.10 Trends in reliance on public sector source for contraceptive method . . . . . . . . 87 Table 6.11 Brand of pill used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table 6.12 Cost of method for pill users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 6.13 Amount users are willing to pay for the pill . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 6.14 Pharmacies as a source for the pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 6.15 Information received at pharmacies about the pill . . . . . . . . . . . . . . . . . . . . . . 89 Table 6.16 Cost of method for IUD users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table 6.17 Amount users are willing to pay for IUD insertion . . . . . . . . . . . . . . . . . . . . . . 91 Table 6.18 Cost of method for injectable users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 6.19 Amount users are willing to pay for injectables . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 6.20 Service assessment indicators for clinical providers . . . . . . . . . . . . . . . . . . . . . 93 Figure 6.1 Current use of family planning by place of residence . . . . . . . . . . . . . . . . . . . . 76 Figure 6.2 Trends in current use of family planning, Egypt 1980-2000 . . . . . . . . . . . . . . . 79 Figure 6.3 Source for family planning methods by method . . . . . . . . . . . . . . . . . . . . . . . . 85 Figure 6.4 Trends in median cost of IUD in Egyptian pounds, by type of provider, Egypt 1995-2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 CHAPTER 7 NONUSE OF FAMILY PLANNING AND INTENTION TO USE Table 7.1 Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table 7.2 Reasons for discontinuing use of family planning . . . . . . . . . . . . . . . . . . . . . . . 97 Table 7.3 Future use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Table 7.4 Reasons for not using family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 7.5 Preferred method of family planning for future use . . . . . . . . . . . . . . . . . . . . 100 Table 7.6 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . . 101 Figure 7.1 Contraceptive discontinuation rates by method and reason for stopping use . . 97 Figure 7.2 Trends in contact with outreach workers among nonusers by residence . . . . . 102 CHAPTER 8 PROXIMATE DETERMINANTS OF FERTILITY Table 8.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 8.2 Consanguinity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 8.3 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 x * Tables and Figures Page Table 8.4 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Table 8.5 Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . 108 Table 8.6 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table 8.7 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . 110 Figure 8.1 Percentage of births for which mothers are still amenorrheic or abstaining . . 108 CHAPTER 9 FERTILITY PREFERENCES Table 9.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . 111 Table 9.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 9.3 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 9.4 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table 9.5 Profile of women with unmet need for family planning . . . . . . . . . . . . . . . . . 116 Table 9.6 Family planning experience and attitudes among women with unmet need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Table 9.7 Exposure to family planning messages or counseling among women with unmet need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Table 9.8 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Table 9.9 Mean ideal number of children by background characteristics . . . . . . . . . . . . 120 Table 9.10 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Table 9.11 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Figure 9.1 Desire for more children among currently married women . . . . . . . . . . . . . . . 112 CHAPTER 10 INFANT AND CHILD MORTALITY Table 10.1 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Table 10.2 Trends in early childhood mortality in Egypt, 1965-2000 . . . . . . . . . . . . . . . 126 Table 10.3 Infant and child mortality by socioeconomic characteristics . . . . . . . . . . . . . 127 Table 10.4 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . 129 Table 10.5 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Figure 10.1 Trends in under-five mortality, Egypt 1967-1998 . . . . . . . . . . . . . . . . . . . . . 126 Figure 10.2 Under-five mortality (deaths per 1,000 births) by place of residence . . . . . . 128 CHAPTER 11 MATERNAL HEALTH CARE Table 11.1 Type of provider for antenatal care, antenatal care source, number of antenatal care visits, and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 133 Table 11.2 Tetanus toxoid injections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 11.3 Other medical care during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Table 11.4 Advice about antenatal care and family planning use . . . . . . . . . . . . . . . . . . 136 Table 11.5 Care during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Tables and Figures * xi Page Table 11.6 Pregnancy care indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Table 11.7 Pregnancy care indicators by background characteristics . . . . . . . . . . . . . . . 139 Table 11.8 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Table 11.9 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table 11.10 Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table 11.11 Delivery complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Table 11.12 Postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Table 11.13 Postnatal care by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 146 Table 11.14 Trends in maternal health indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table 11.15 Use of smoking tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Figure 11.1 Consultation with health provider during pregnancy . . . . . . . . . . . . . . . . . . 135 Figure 11.2 Trends in medically assisted deliveries, Egypt 1988-2000 . . . . . . . . . . . . . . . 148 CHAPTER 12 CHILD HEALTH Table 12.1 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Table 12.2 Trends in vaccination coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Table 12.3 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Table 12.4 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Table 12.5 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Table 12.6 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Table 12.7 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Table 12.8 Hand-washing facilities in households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Table 12.9 Prevalence and treatment of acute respiratory infection (ARI) . . . . . . . . . . . 161 Figure 12.1 Trends in vaccination coverage, Egypt 1988-2000 . . . . . . . . . . . . . . . . . . . . 153 CHAPTER 13 NUTRITIONAL STATUS, PREVALENCE OF ANEMIA, AND MICRONUTRIENT SUPPLEMENTATION Table 13.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Table 13.2 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Table 13.3 Types of food received by children in the preceding 24 hours . . . . . . . . . . . . 167 Table 13.4 Median duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Table 13.5 Frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Table 13.6 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . 173 Table 13.7 Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . 174 Table 13.8 Trends in nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Table 13.9 Anthropometric indicators of maternal nutritional status . . . . . . . . . . . . . . . 176 Table 13.10 Differentials in maternal anthropometric indicators . . . . . . . . . . . . . . . . . . . 178 Table 13.11 Prevalence of anemia in women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Table 13.12 Prevalence of anemia among children 6-59 months . . . . . . . . . . . . . . . . . . . 182 Table 13.13 Prevalence of anemia in children age 11-19 . . . . . . . . . . . . . . . . . . . . . . . . . 184 Table 13.14.1 Prevalence of anemia in boys age 11-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Table 13.14.2 Prevalence of anemia in girls age 11-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 xii * Tables and Figures Page Table 13.15 Vitamin A supplementation among postpartum mothers . . . . . . . . . . . . . . . . 187 Table 13.16 Vitamin A supplementation among children age 12-23 months . . . . . . . . . . . 188 Table 13.17 Iodized salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Figure 13.1 Distribution of children by breastfeeding status according to age . . . . . . . . . 166 Figure 13.2 Level of anemia among children 6-59 months by place of residence . . . . . . . 183 CHAPTER 14 FEMALE CIRCUMCISION Table 14.1 Prevalence of female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Table 14.2 Aspects of daughter’s circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Table 14.3 Daughter’s age at circumcision and person performing circumcision . . . . . . . 194 Table 14.4 Attitudes toward circumcision and perception of men’s attitudes . . . . . . . . . 195 Table 14.5 Trends in circumcision indicators, Egypt 1995-2000 . . . . . . . . . . . . . . . . . . . 197 Table 14.6 Benefits from undergoing and from not undergoing circumcision . . . . . . . . . 198 Table 14.7 Beliefs about female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Table 14.8 Exposure to discussion or information about female circumcision . . . . . . . . . 201 Figure 14.1 Trend in level of support for female circumcision, Egypt 1995-2000 . . . . . . . 196 CHAPTER 15 CHILDREN’S EDUCATION Table 15.1 School attendance pattern and age started or dropped out . . . . . . . . . . . . . . 203 Table 15.2 School attendance by background characteristics . . . . . . . . . . . . . . . . . . . . . 204 Table 15.3 Reasons for never having attended school . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Table 15.4 Reasons for dropping out of school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Table 15.5 Absence from school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Table 15.6 Main reasons for missing school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Table 15.7 Type of school attended . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Table 15.8 Expenditures on schooling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Table 15.9 Median expenditures on schooling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Table 15.10 Opinion about university education for sons or daughters . . . . . . . . . . . . . . 212 Figure 15.1 Percentage of children age 6-15 not currently attending school by gender and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 APPENDIX B SAMPLE DESIGN Table B.1 Sample parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Table B.2 Primary sampling units by governorate, 2000 Egypt . . . . . . . . . . . . . . . . . . . 222 Table B.3 Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Figure B.1.1 Distribution of sampling points, Urban Governorates, 2000 EDHS . . . . . . . . 231 Figure B.1.2 Distribution of sampling points, Lower Egypt, 2000 EDHS . . . . . . . . . . . . . . 232 Tables and Figures * xiii Page Figure B.1.3 Distribution of sampling points, Upper Egypt, 2000 EDHS . . . . . . . . . . . . . . 233 Figure B.1.4 Distribution of sampling points, Frontier Governorates, 2000 EDHS . . . . . . . 234 APPENDIX C SAMPLING ERRORS Table C.1 List of selected variables for sampling errors, 2000 Egypt DHS . . . . . . . . . . . 239 Table C.2 Sampling Errors - National sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Table C.3 Sampling Errors - Urban sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Table C.4 Sampling Errors - Rural sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 Table C.5 Sampling Errors - Urban Governorates sample . . . . . . . . . . . . . . . . . . . . . . . 243 Table C.6 Sampling Errors - Lower Egypt sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 Table C.7.1 Sampling Errors - Lower Egypt Urban sample . . . . . . . . . . . . . . . . . . . . . . . . 245 Table C.7.2 Sampling Errors - Lower Egypt Rural sample . . . . . . . . . . . . . . . . . . . . . . . . 246 Table C.8 Sampling Errors - Upper Egypt sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Table C.9.1 Sampling Errors - Upper Egypt Urban sample . . . . . . . . . . . . . . . . . . . . . . . . 248 Table C.9.2 Sampling Errors - Upper Egypt Rural sample . . . . . . . . . . . . . . . . . . . . . . . . 249 Table C.10 Sampling Errors - Frontier Governorates sample . . . . . . . . . . . . . . . . . . . . . . 250 APPENDIX D DATA QUALITY TABLES Table D.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Table D.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . 252 Table D.3 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Table D.4 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Table D.5 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 Table D.6 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Preface * xvii PREFACE The 2000 Egypt Demographic and Health Survey is the latest round of a series of surveys carried out in Egypt that have provided information on fertility behavior and its determinants, particularly contraceptive use. The EDHS findings are important in monitoring trends for key variables and in understanding the factors that contribute to differentials in fertility and contraceptive use among various population subgroups. The EDHS also provides a wealth of health- related information about mothers and their children. These data are of special importance for understanding the factors that influence the health and survival of infants and young children. This report summarizes the results of more than 18 months of continuous work in preparing and carrying out various activities of the 2000 EDHS, including fieldwork, data processing, and analysis of the findings presented in this report. It includes findings relating to fertility levels, childbearing intentions, and contraceptive use. It also looks at key maternal and health indicators including the extent to which mothers receive medical care during pregnancy and at delivery, immunization coverage, and the prevalence and treatment of diarrheal disease. The challenge that remains is to use the information in this report to improve the efficiency of population and health program in Egypt. Finally, I would like to express my appreciation to all parties who assisted in the implementation of 2000 EDHS. Their dedication and sincere efforts resulted in the successful completion of the field activities and the rapid issuance of this preliminary analysis of the survey results. Prof. Dr. Maher Mahran Secretary General National Population Council Foreword * xix ACKNOWLEDGMENTS The Egypt Demographic and Health Survey represents the continuing commitment in Egypt to efforts to obtain data on fertility behavior and contraceptive practice. The survey also reflects the strong interest in information on key maternal health and child survival issues. The wealth of demographic and health data that the survey provides will be of great use in charting future directions for the population and health programs. This important survey could not have been implemented without the active support and dedicated efforts of a large number of institutions and individuals. The support and approval of H.E. Prof. Dr. Ismail Salam, the Minister of Health and Population, was instrumental in securing the implementation of the survey. Prof. Dr. Maher Mahan, Secretary General of the National Population Council, provided strong continuing support to the project and has shown great interest in the survey results. Funding for the survey was provided by USAID/Cairo through its bilateral health and population projects. Technical assistance came from ORC Macro through the worldwide USAID- supported MEASURE DHS+ project. I am deeply grateful to the Ministry of Health and Population staff who contributed to the successful completion of this project, especially Dr. Moushera El- Shafei, who was First Under- Secretary of the Ministry of Health and Population at the time that the survey was conducted, for her continuous help and support during the survey. Dr. Essmat Mansour, Under-Secretary for Primary Health Care and Head of the Maternal and Child Health Project, deserves special thanks for her help in facilitating the anemia testing component of the survey. The support of Dr. Yahia El- Hadidi, General Director of the Population and Family Planning Sector, was also appreciated especially his effort in providing the information needed for coding the source of family planning methods. Many thanks also are extended to Dr. Khalid Nasr, Deputy Director of the Maternal and Child Health Project, for his role in facilitating the referral of anemic women, children and adolescents to the health units. I also gratefully acknowledge the staff of USAID, especially Mr. Gary Newton, Mr. Chris McDermott, Dr. Nahed Matta, Ms. Shadia Attia, Mr. Tourhan Nouri, and Ms. Amani Selim for their support and valuable comments throughout the survey activities. Dr. Ann Way of ORC Macro, who worked closely with us on all phases of the EDHS, deserves special thanks for all her efforts throughout the survey and during the preparation of this report. My thanks also are extended to Dr. Alfredo Aliaga for his advice and guidance in designing the sample. Dr. Almaz Sharman provided invaluable assistance with the organization of the anemia- testing component of the survey. Ms. Jeanne Cushing deserves my deepest thanks for her assistance in data processing and analysis required for this report. I would like to express my appreciation for all the assistance received from the administrative and financial department of the National Population Council. xx * Acknowledgements This survey could not have been conducted in such a timely fashion without the combined efforts of the senior, office and field staff in the EDHS team. I would like to express my appreciation for the dedication and skill with which they performed their tasks. Finally, I would like to express my appreciation to all households and women who responded in the survey; without their participation this project would have been impossible. Fatma El- Zanaty Technical Director Summary of Findings * xxi SUMMARY OF FINDINGS The 2000 Egypt Demographic and Health Survey (2000 EDHS) interviewed a nationally representative sample of 15,573 ever-married women aged 15-49. The survey is the sixth in a series of Demographic and Health Surveys conducted in Egypt. As in previous surveys, the main purpose of the 2000 EDHS is to provide detailed information on fertility, family plan- ning, infant and child mortality, and maternal and child health and nutrition. In addition, the 2000 EDHS included two special modules, one including questions on female circumcision and the other collecting data on children’s educa- tion. FERTILITY BEHAVIOR Levels and Trends. During the past 20 years, fertility in Egypt has decreased by almost two births, from 5.3 births at the time of the 1980 Egypt Fertility Survey to 3.5 births at the time of the 2000 EDHS. The decline in fertility was not uniform throughout this period, however; the pace of change was very rapid during the 1980s, slowed in the early 1990s, and showed little change during the period between the 1995 and 2000 EDHS surveys. Looking more closely at the period between the 1995 and 2000 surveys, Upper Egypt experi- enced the largest decrease in fertility, from 4.7 births per woman at the time of the 1995 EDHS to 4.2 births at the time of the 2000 survey. The Frontier Governorates had a more modest decline (from 4.0 to 3.8 births per woman), while, in the Urban Governorates and Lower Egypt, fertility levels remained essentially unchanged during the period at a level of around three births per woman. Age at Marriage. One of the factors influencing the on-going fertility decline in Egypt has been the steady increase in the age at which women marry. Currently, the median age at first mar- riage among women age 25-29 is 20.8 years, around three years greater than the median age at first marriage prevailing among women age 45-49. One of the more important effects of the in- crease in the age at first marriage has been a reduction in adolescent fertility. Adolescent childbearing carries higher risks of morbidity and mortality for the mother and child, particularly when the mother is under age 18. At the time of the 2000 EDHS, 6 percent of women 15-19 had given birth and 3 percent were pregnant with their first child. FAMILY PLANNING USE Levels and Trends. The Egyptian government’s commitment to providing widely accessible family planning services has been a very impor- tant factor in the on-going fertility decline. Contraceptive use levels have more than dou- bled in Egypt between 1980 and 2000, from 24 percent to 56 percent. The IUD continues to be by far the most widely used method; 36 percent of married women were relying on the IUD, 10 percent the pill, and 6 percent injectables. Family Planning Knowledge and Approval. Widespread awareness of family methods as well as nearly universal approval of family planning use have been crucial elements in the expansion of family planning use. At the time of the 2000 EDHS, the average currently married woman knew about seven methods. More than eight in ten women were able to name a source for family planning methods. Exposure to broadcast messages about family planning had increased since 1995, particularly in rural Upper Egypt, where nine in ten 2000 EDHS respon- dents had heard a broadcast compared to seven in ten at the time of the 1995 survey. Family planning has broad support among Egyptian couples. Nine in ten non-sterilized currently married women approve of a couple using family planning, and 85 percent believe their husbands also approve. Very few women xxii * Summary of Findings who approve of family planning use (5 percent) think that a newly married couple should use contraception to delay the first birth. However, most women (85 percent) consider it appropri- ate for a couple to begin family planning use after they have their first child. Differentials in Use. Despite nearly universal family planning knowledge and approval, the 2000 EDHS found significant differentials in use. Use rates exceeded 60 percent in the Urban Governorates and in both urban and rural areas in Lower Egypt. In contrast, only around 40 percent of currently married women were using in rural Upper Egypt and the Frontier Governor- ates. Use rates were directly associated with a woman’s educational level, ranging from 52 percent among women with no education to 61 percent among women who completed second- ary school or higher. Discontinuation of Use. A key concern for the family planning program is the rate at which users discontinue use of contraception and their reasons for stopping. Overall, 30 percent of users in Egypt discontinue using a method within 12 months of starting use. The rate of discontinuation during the first year of use is much higher among pill users (48 percent) and injectable users (48 percent) than among IUD users (14 percent). With regard to the reasons for stopping use, users are more likely to dis- continue during the first year of use because they experienced side effects or had health concerns than for other reasons. Provision of Services. Both government health facilities and private sector providers play an important role in the delivery of family plan- ning services. More than half of all IUD users (54 percent) go to Ministry of Health or other governmental providers for their method. This represents an increase from the situation in 1995, when 45 percent of users relied on public sector facilities for their methods. Public sector providers are also the principal source for injectables while eight in ten pill users obtain their method from a pharmacy. The DHS results suggest that family planing providers are not offering women adequate information to enable them to make an in- formed choice about the method best suited to their contraceptive needs. In particular, many users are not offered a choice of methods. Although side effects cause many users to discontinue, many providers also are not coun- selling women about the side effects. For example, only two in five users who ob- tained their method from a clinical provider reported that they had been told about methods other than the one that they adopted or about the side effects that they might experience. There is even less information exchange be- tween pill users and the pharmacists from which they obtain their methods. Fewer than one in seven users who obtained the pill from a pharmacy received information about other methods or about the side effects they might have in using the pill. NEED FOR FAMILY PLANNING Fertility Preferences. Many Egyptian women are having more births than they consider ideal. Overall, 5 percent of births in the five years prior to the survey were reported to be mis- timed, that is, wanted later and 13 percent were unwanted. If Egyptian women were to have the number of children they consider ideal, the total fertility rate would fall from 3.5 births to 2.9 births per woman. Unmet Need for Family Planning. Taking into account both their fertility desire at the time of the survey and their exposure to the risk of pregnancy, more than one in ten currently married women were considered to have an immediate need for family planning. This group includes women who were not using family planning but wanted either to wait two or more years for the next birth (4 percent) or wanted no more children (8 percent). Two-thirds of women defined as having an unmet need for family planning lived in rural areas and a simi- lar proportion had less than a primary educa- tion. Summary of Findings * xxiii Opportunities to provide advice to these women about family planning are being missed in many cases. Almost half of the women in need of family planning had some contact with a family planning worker or health facility in the year before the survey. In the majority of these encounters, however, family planning was not discussed. Overall, less than one in ten women with an unmet need for family planning re- ceived information or advice about family plan- ning during the year before the survey. CHILD MORTALITY Levels and Trends. At the mortality level prevailing in the five-year period before the EDHS, one in twenty Egyptian children will die before their fifth birthday. The level of early childhood mortality has fallen substantially since the 1960s, when around one in four children died before reaching age five. Socioeconomic Differentials. Mortality rates are higher in rural than urban areas. The high- est levels are found in rural Upper Egypt, where rates are roughly double those in the Urban Governorates, which has the lowest mortality. Differentials by the mother's education are also large, with children born to women who never attended school having mortality rates that are more than twice as high as those among chil- dren born to mothers who have at least a sec- ondary education. Demographic Differentials. Mortality risks are especially high for births that occur within too short a period after a prior birth. The risk of dying before the fifth birthday more than triples if births are closely spaced, i.e., if a child is born less than two years after an elder sibling com- pared with children born four or more years after a prior birth. During the five years prior to the EDHS, more than one-quarter of non-first births occurred within 24 months of a previous birth. Breast- feeding practices, especially the early intro- duction of supplemental foods, reduce the time a woman is amenorrheic following a birth and, thus contribute to short birth intervals. Half of Egyptian mothers become exposed to the risk of another pregnancy within four months of giving birth. MATERNAL HEALTH Care During Pregnancy. The care that a woman receives during pregnancy and at child- birth reduces the risks of illness and death for both the mother and the child. Overall, women saw a medical provider for at least some type of care during the pregnancy prior to 85 percent of all births that occurred during the five-year period prior to the 2000 EDHS. Women re- ported that they had antenatal care, i.e., care sought specifically to monitor the pregnancy, in the case of 52 percent of births. They saw a provider for the recommended minimum num- ber of antenatal care visits (four) in the case of 37 percent of births. Tetanus toxoid injections are given during pregnancy for the prevention of neonatal teta- nus, an important cause of death among new- borns. Women had one or more tetanus toxoid injections for 73 percent of births in the five- year period before the survey. Content of Pregnancy Care. The pregnancy care that Egyptian mothers receive often does not include routine screening or advice that is important in detecting and preventing complica- tions. For example, women reported that they had been weighed and their blood pressure monitored in the case of only about 60 percent of the births in which a medical provider was seen for pregnancy care. Urine and blood sam- ples were taken in two in five births, the moth- er’s height was measured in about a third of the births, and iron tablets/syrup were received or bought in around a quarter of the births. Mothers were given advice about potential pregnancy complications in 18 percent of the births and told by the provider where to seek assistance if they experienced problems in the case of 14 percent of the births. Delivery Care and Postnatal Care. Trained medical personnel assisted at six in ten births during the five-year period prior to the 2000 xxiv * Summary of Findings EDHS. Dayas (traditional birth attendants) assisted with most of the remaining deliveries. Slightly less than half of all deliveries took place in a health facility, with delivery care provided somewhat more often at private than govern- mental facilities. Around one in ten deliveries were by Caesarean section. Care following delivery is very important for both the mother and her child, especially if the birth occurs in the home without medical assis- tance. In Egypt, postnatal care was reported in the case of less than 1 in 10 deliveries that took place outside of a health facility. Differentials in Coverage. A woman’s resi- dence and education status are strongly associ- ated with the receipt of maternity care. For example, the percentage of urban births in which the mother received regular antenatal care is more than twice the proportion of rural births (54 percent and 26 percent, respectively). Coverage of maternity care services is especially low in rural Upper Egypt, where regular antena- tal care is received for slightly less than a fifth of births and slightly less than two-fifths of deliveries are medically assisted. Mothers with a secondary or higher education are more than three times as likely to have regular antenatal care and more than twice as likely to have been assisted at delivery by trained medical person- nel as mothers who never attended school. Trends in Coverage. Coverage of maternity care services has improved since the late 1980s. The six-fold increase in tetanus toxoid coverage during the period—from 11 percent at the time of the 1988 EDHS to 72 percent at the time of the 2000 survey—is particularly notable. Medi- cally assisted deliveries also have risen consider- ably, from a level of 35 percent in 1988 to 61 percent in 2000. CHILD HEALTH Childhood Vaccination Coverage. One of the primary means for improving survival during childhood is increasing the proportion of chil- dren vaccinated against the major preventable diseases. The 2000 EDHS results show that 92 percent of children 12-23 months are fully immunized against the six major preventable childhood illnesses (tuberculosis, diphtheria, whooping cough, tetanus, polio and measles). This represents a substantial improvement over the level at the 1995 EDHS, where 79 percent of children were fully immunized. In addition, more than 90 percent of young children also have the recommended three doses of the hepatitis vaccine. Prevalence and Treatment of Childhood Illnesses. The 2000 EDHS provided data on the prevalence and treatment of two common childhood illnesses, diarrhea and acute respira- tory illness. Seven percent of children under five were reported to have had diarrhea in the two weeks preceding the survey. Medical advice was sought in treating about around half of these cases. Use of ORS packets (34 percent) or a homemade solution of sugar, salt and water (5 percent) to combat the dehydration was com- mon. Altogether some form of ORT or increased fluids was used in treating around one in two of the children suffering from diarrhea. During the two weeks preceding the survey, 10 percent of children had a cough accompanied by short, rapid breathing, which are symptoms of acute respiratory illness. A provider was consulted about the illness in the case of two- thirds of the children with these symptoms, and mothers reported that antibiotics were given to three-fourths of the children. NUTRITION INDICATORS FOR CHILDREN AND WOMEN Infant Feeding Practices. Breastfeeding is nearly universal in Egypt, and the average length of time that a child is breastfed is rela- tively long (18.4 months). Breastfeeding prac- tices for very young children are not however optimal. More than half of all infants receive prelacteal feeds (i.e., they are given some type of liquid until the mother’s breast milk flows freely) during the first three days following Summary of Findings * xxv birth. About one-third of children are exclu- sively breastfed throughout the first 4-6 months of life. Exclusive breastfeeding (i.e., without any food or liquid) is recommended because it provides all the necessary nutrients and avoids exposure to disease agents. Nutritional Status of Children. Anthropo- metric data collected for children in the 2000 EDHS indicate that 19 percent of Egyptian children show evidence of chronic malnutrition or stunting, and 3 percent are acutely malnour- ished. The trend in anthropometric indicators from EDHS surveys between 1992 and 2000 shows that the nutritional status of children under age five has improved from the situation prevailing during the first half of the 1990s, when 25-30 percent of children were found to be stunted. Large differentials in children’s nutritional status continue to be observed, however, particularly by residence. For exam- ple, the percentage stunted among children in rural Upper Egypt is 27 percent, three times the level found in the Urban Governorates. Anemia Levels. Anemia, a condition character- ized by a decrease in the concentration of hemoglobin in the blood, is associated with increased morbidity and mortality risks. The 2000 EDHS included hemoglobin testing (the primary method of anemia diagnosis) in a subsample of one-half of all EDHS households for three groups: ever-married women 15-49, children under age five and never-married boys and girls 11-19 years old. The results of the hemoglobin testing for women indicated that around three in ten EDHS respondents have some degree of anemia. Most of these women were found to be mildly ane- mic, 5 percent moderately anemic and only a few women (less than one percent) were found to be severely anemic. Anemia during preg- nancy increases the risks of maternal and infant death, premature delivery, and low birth weight. The 2000 EDHS survey found propor- tion anemic to be considerably higher for preg- nant women (45 percent) and breastfeeding women (32 percent) than for women who were neither pregnant or breastfeeding (26 percent). Looking at the situation among young children, the proportion considered to be at least mildly anemic was similar to that observed among ever-married women (30 percent). However, young children were classified as moderately anemic more often than women. Overall, one in nine children under age five was at least moderately anemic. The overall levels of anemia among never- married boys and girls age 11-19 years (30 percent and 29 percent, respectively) were similar to that found for women and young children. Virtually all of these boys and girls were only mildly anemic; less than two percent were classified as moderately or severely ane- mic. Vitamin A Supplementation. Vitamin A is a micronutrient found in very small quantities in some foods. It is considered essential for normal sight, growth, and development. Egypt has recently introduced a program of vitamin A supplementation for new mothers and for children beginning at age nine months. The 2000 EDHS results suggest that the coverage of that program is still limited. Mothers reported receiving a vitamin A capsule in the case of 1 in 9 births. Around a fifth of Egyptian children 12-23 months had received a Vitamin A capsule. Iodization of Salt. Iodine is another important micronutrient. Egypt has adopted a program of fortifying salt with iodine to prevent iodine deficiency. Overall, 56 percent of households were found to be using salt containing some iodine. FEMALE CIRCUMCISION Level and Trends. Results from the 2000 EDHS confirm the 1995 EDHS finding that the prac- tice of female circumcision is virtually universal among women of reproductive age in Egypt; 97 percent of EDHS respondents had been circum- cised. Attitudes about circumcision appear to be changing. There is some evidence that support xxvi * Summary of Findings for the practice is gradually changing. Just over eight in ten women with daughters (81 percent) reported in 2000 that they had a daughter who was already circumcised or that they intended to have a daughter circumcised in the future. This represented a decrease over the proportion of women with daughters who said in 1995 that they had or planned to have a daughter circum- cised (87 percent). A somewhat smaller propor- tion of women also supported continuation of the practice at the time of the 2000 EDHS (75 percent) than in 1995 (82 percent). Beliefs about Circumcision. The majority of ever-married women 15-49 (73 percent) believe that circumcision is an important part of reli- gious tradition. Two-thirds of the women feel that the husband prefers the wife to be circum- cised, and half of women think that circumci- sion prevents adultery. Fewer women believe that the practice has any adverse consequences, with the most widely recognized problem being the lessening of sexual satisfaction (37 percent). CHILDREN’S EDUCATION School Attendance. Information from a chil- dren’s education module is useful in looking at several important aspects of school attendance among Egyptian children. While most children 6-15 years of age were currently going to school, 16 percent had either never attended school or had attended but dropped out of school at some point prior to the survey. Among those ever attending school, 14 percent had repeated at least one grade. Gender Differences. The proportions never having attended school are nearly identical for boys and girls living in urban areas while there are marked differences between the level among boys (9 percent) and that among girls (19 percent) in rural areas. By place of resi- dence, the proportions never having attended school are highest for both boys and girls in rural Upper Egypt and in the Frontier Gover- norates. The reasons that mothers give for children never having attended school also vary by the child’s gender. Mothers are much more likely to say that a girl did not attend school because it was too costly or because of custom or tradition than they are to offer those reasons when a boy has never have attended school. Expenditures on Schooling. The average Egyptian household spends around 25 pounds per child during the school year on registration and tuition fees, 70 pounds per child on cloth- ing and bags, 33 pounds per child on textbooks and supplies, and 10 pounds per child for tutoring or special classes. Expenditures per child are higher in urban areas than in rural areas for all items. The urban-rural differences in expenditures may in part be due to the fact that more urban than rural children attend private secular schools, where costs are substan- tially higher than in public or religious schools. Attitude about University Education. The children’s education module looked for evidence of son bias in educational expectations by asking all EDHS respondents about who should be sent to the university—the son or the daughter—if parents could afford the costs for only one child. Slightly more than half of the women felt that the decision should be made based on the child’s capabilities. Among the remaining women, however, most believed parents should send the son rather than the daughter. Altogether almost 2 in 5 women felt the parents should send the son to the univer- sity if they could afford to send only one child compared to 7 percent who felt that the daugh- ter should be sent. Introduction * 1 INTRODUCTION 1 1.1 GEOGRAPHY Egypt, one of the oldest societies in the world, is located on the northeast corner of the African continent, bounded on the north by the Mediterranean Sea, on the south by Sudan, on the east by the Red Sea, and on the west by Libya. Egypt has the largest, most densely settled population among the Arab countries. The total area of the country covers approximately one million square kilometers. However, much of the land is desert, and only 6 percent of Egypt’s area is inhabited (CAPMAS 1999). Recently, the Egyptian government adopted a policy of land reclamation and fostering of new settlements in the desert. Despite these efforts, the majority of Egyptians live either in the Nile Delta located in the north of the country or in the narrow Nile Valley south of Cairo. Administratively, Egypt is divided into 26 governorates (see map) and Luxor City. The four Urban Governorates (Cairo, Alexandria, Port Said, and Suez) have no rural population. Each of the other 22 governorates is subdivided into urban and rural areas. Nine of these governorates are located in the Nile Delta (Lower Egypt), eight are located in the Nile Valley (Upper Egypt), and the remaining five Frontier Governorates are located on the eastern and western boundaries of Egypt. 1.2 SOCIOECONOMIC INDICATORS The government of Egypt has adopted various strategies for fostering economic development during the latter half of the twentieth century, moving from a closed economy during the 1960s to an open-market approach in the mid-1970s. The economy expanded rapidly during the 1990s, with the gross national product (GNP) almost doubling between 1993 and 1997, from US$660 to US$1,200 per capita, and the inflation rate decreasing to 3.6 percent (UNDP 2000). The recent economic growth has been accompanied by improvements in a number of human development indicators, including the following: C The proportion of households with access to piped water increased from 70 percent in 1986 to 83 percent in 1996. C School enrolment levels have improved over time, and literacy levels have risen. In 1997, for example, the enrolment ratio at the primary level was 95.2, and adult literacy was 53 percent. C Of particular note are the advances in the education of women. Female enrolment at the primary level rose from 57 percent in 1970 to 91 percent in 1997. At the secondary level, female enrolment also expanded rapidly, from 23 percent in 1970 to 70 percent in 1997 (INP 1998). 2 * Introduction Although many indicators have been improved over time, gaps remain evident for a number of subgroups: C Although women have made gains in education and employment, significant gender gaps still exist. For example, the female literacy rate is only about two-thirds the male rate, and female participation in the labor force is 18 percent of male participation. C Indicators for the rural population continue to be significantly lower than those for urban households. For example, the proportion of the rural population with piped water is 73 percent of the urban population with piped water. The urban-rural gap in access to sanitation facilities is even greater. The proportion of the rural population with access to sanitation facilities is 23 percent of the urban population with access to sanitation facilities. C The urban population is considerably better educated than the rural population. Overall, the literate population in rural areas is two-thirds the literate population in urban areas (INP 1998). 1.3 CHANGING POPULATION SIZE AND STRUCTURE The latest population census in Egypt was carried out in November 1996. According to the results, Egypt has a de facto population of 59.3 million. This number excludes the roughly 2.2 million Egyptians who are living abroad. The overall population density was estimated to exceed 1,685 persons per square kilometer of inhabited area (CAPMAS 1999). This figure varied widely by governorate, from a high of 31,750 persons per square kilometer in Cairo to 34 persons per square kilometer in Suez. Table 1.1 presents the trend over roughly the last century in the size of the Egyp- tian population and in the distribution of the population by urban-rural residence. The table shows that Egypt’s population more than dou- bled during the 45-year period between 1882 and 1927. Growth accelerated at that point, with the population more than quadrupling between 1927 and 1996 (from 14 to 59 mil- lion). Population projections based on the 1996 census results indicate that Egypt’s population will continue to grow rapidly, reaching 77.4 million in the year 2010. Table 1.1 also shows that the Egyptian population became steadily more urbanized during the past century. The proportion urban rose from 17 percent in 1907 to 40 percent in 1966. At that point, the pace of urbanization slowed. In 1996, the urban population repre- sented 43 percent of the total population. Table 1.1 Population of Egypt, 1882-1996 Total population in Egypt and percentage living in urban and rural areas, 1882-1996 ____________________________________________ Total Residence population _______________ Census year (millions) Urban Rural _____________________________________________ 1882 6,712 u u 1897 9,669 u u 1907 11,190 17.2 82.8 1917 12,718 u u 1927 14,178 26.8 73.1 1937 15,921 28.2 71.8 1947 18,967 33.5 66.5 1960 26,085 38.2 61.8 1966 30,076 40.0 58.8 1976 36,626 43.8 56.2 1986 48,254 44.0 56.0 1996 59,313 43.0 57.0 ____________________________________________ Note: Figures exclude Egyptians living abroad. u = Unknown (not available) Source: CAPMAS 2000, Table 1.3 1 A third factor influencing population growth is migration, which is not taken into account in Figure 1.1. Introduction * 3 1.4 RECENT RATE OF NATURAL INCREASE The rate of natural increase represents the difference between the level of births and deaths in a population. It indicates how fast a population will grow, taking into account these two natural events.1 Figure 1.1 shows that the rate of natural increase has been declining in Egypt since 1986. Most of the decline in the rate of natural increase since 1986 is the result of changes in fertility behavior. The crude birth rate (CBR) dropped from a level of 39 per thousand population in 1986 to 28 per thousand by 1994. As Figure 1.1 shows, the decline appears to have leveled off in the mid-1990s, with the CBR fluctuating around a level of 27 births per thousand during the period 1994-1998. The crude death rate decreased from a level of 9.2 per thousand in 1986 to a level of 6.5 per thousand in 1998. Declining mortality has had a demonstrable effect on increas- ing the life expectancy of the Egyptian population. The life expectancy at birth represents the average number of years a child born in a specific year may be expected to live during his/her lifetime. Table 1.2 documents gains in life expectancy for both males and females in Egypt during the period 1960- 2001. Life expectancy increased somewhat faster for females than for males during the period. Table 1.2 Life expectancy, Egypt 1960-2001 Life expectancy at birth by sex, Egypt 1960-2001 ______________________________ Year Male Female ______________________________ 1960 51.6 53.8 1976 52.7 57.7 1986 60.5 63.5 1991 62.8 66.4 1996 65.1 69.0 2001 67.1 71.5 _______________________________ Source: CAPMAS 2000, Table 1.16 4 * Introduction 1.5 POPULATION POLICY AND PROGRAMS Concerns about the population problem were expressed clearly in the National Charter that was issued in the 1960s. In that document, rapid population growth was identified as hindering efforts to raise the living standard of the Egyptian people. An official national family planning program also was established. The program, which was set up within the Ministry of Health, aimed to reduce fertility and thus population growth. The first national population policy statement, initially issued in 1973 and further articulated in 1975, recognized the simultaneous importance of four inter-related dimensions of Egypt’s population problem: growth, spatial distribution, characteristics, and structure. The adoption of the population policy in the 1970s was accompanied by increased governmental activities related to family planning. The Ministry of Health established a department of family planning, and government personnel received training in family planning program management. An information, education, and communication (IEC) project undertaken by a newly established center in the State Information Service was aimed at increasing public awareness about family planning. A revised population policy was issued in 1980, which placed greater emphasis on face-to- face communication and community-based activities to promote family planning. The third (and current) national population policy statement was formulated after the establishment of the National Population Council in the mid-1980s. It again emphasized the seriousness of population problems and recognized the interaction between population and development. Finally, based on the recommendations of the International Conference on Population and Development (ICPD) held in Cairo in 1994, the strategy for achieving Egypt’s population objectives has been broadened to support the expanded availability of reproductive health services and community development efforts of nongovernmental organizations. The new strategy also stresses female education and calls for increased employment opportunities for women to reduce the gender gap. In January 1996, the Ministry of Health became the Ministry of Health and Population (MOHP), reflecting its increased responsibility for population sector activities. Responding to the concerns of the Cairo conference declaration, the MOHP has merged family planning and maternal and child health services into a broad-based women’s health program. It has expanded family planning services, particularly to low-income populations and to rural Upper Egypt. As part of these efforts, the MOHP has renovated most of its clinics and added more than 300 mobile family planning clinics to improve access to services. In addition, the National Women’s Council was established early in the new millennium. The main objective of the council is to increase the role of women in Egyptian society and to decrease the gap between men and women in all areas (education, employment, etc.). 1.6 HEALTH POLICIES AND PROGRAMS During the 1990s, the MOHP had the continuing objective “health for all by the year 2000.” Within that broad mandate, the Government of Egypt placed priority on meeting children’s health needs, with President Mubarak declaring that the 1989-1999 period would be a decade focused on the protection and development of the Egyptian child. A National Council of Childhood and Motherhood, co-chaired by the Prime Minister and the First Lady, was formed at that time to coordinate activities between ministries implementing programs affecting children and mothers. 2 The 2000 EDHS is the fourth full-scale Demographic and Health Survey to be implemented in Egypt; the earlier surveys were conducted in 1988, 1992, and 1995. Two additional interim DHS surveys were carried out in 1997 and 1998. Other national-level surveys for which results are shown in this report include the 1980 Egyptian Fertility Survey (EFS), the 1984 Egypt Contraceptive Prevalence Survey (ECPS), and the 1991 Egypt Maternal and Child Health Survey (EMCHS). Introduction * 5 To improve child health, the MOHP has focused on national programs to control diarrhea and acute respiratory infections and an expanded childhood immunization program. Targets were set to eradicate poliomyelitis and to eliminate neonatal tetanus before the year 2000. The MOHP also directed attention to reducing neonatal mortality by improving the quality of care given to newborns at home and in health facilities through postnatal care. Following the merger of the health and population services described above, the MOHP also has stressed the importance of integrating family planning and maternal and child health. A policy reform agenda was developed to expand health insurance to more beneficiaries and to introduce changes designed to enhance the quality of health services. Attention has been paid to improving health manpower distribution and the compensation provided to health workers. The importance of strengthening the information system to collect, analyze, and facilitate the use of health information at all levels was recognized, and steps have been taken to address this task. All these health reform plans are expected to have a positive effect on the health of women and children. 1.7 ORGANIZATION AND OBJECTIVES OF THE 2000 EDHS The Egypt Demographic and Health Survey (2000 EDHS) is the latest in a series of a nationally representative population and health surveys conducted in Egypt.2 The 2000 EDHS was conducted under the auspices of the Ministry of Health and Population (MOHP) and National Population Council (NPC). Technical support for the 2000 EDHS was provided by ORC Macro through MEASURE DHS+, a project sponsored by the U.S. Agency for International Development (USAID) to assist countries worldwide in conducting surveys to obtain information on key population and health indicators. USAID/Cairo, under the Population/Family Planning IV Project, provided funding for the survey. The 2000 EDHS was designed to provide estimates for key indicators such as fertility, contraceptive use, infant and child mortality, immunization levels, coverage of antenatal and delivery care, and maternal and child health and nutrition. The survey results are intended to assist policymakers and planners in assessing the current health and population programs and in designing new strategies for improving reproductive health and health services in Egypt. 1.8 IMPLEMENTATION OF THE 2000 EDHS TIMETABLE The 2000 EDHS was executed in four stages. The first stage involved preparatory activities, including designing the sample and updating the frame. At the same time, the survey questionnaires were developed, pretested, and finalized. The preparatory stage was initiated in January 1999, and all of the activities were completed by December 1999. The second stage, which took place from January 2000 through April 2000, involved training field staff and interviewing eligible households and individual respondents. The third stage involved all of the data processing activities necessary to produce a clean data file, including editing, coding, entering and verifying the data as well as checking it for consistency. This stage started soon after the beginning of the fieldwork and lasted 6 * Introduction through late May 2000. The focus of the final stage of the survey was analyzing the data and preparing the report. This phase began in June 2000 with the publication of the preliminary report, which presented the main findings from the survey. The activities involved in each of the stages are described in more detail below. The survey timetable is presented in Table 1.3. SAMPLE DESIGN The primary objective of the sample design for the 2000 EDHS was to provide estimates of key population and health indicators including fertility and child mortality rates for the country as a whole and for six major administrative regions (the Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt, and the Frontier Governorates). In the Urban Governorates, Lower Egypt, and Upper Egypt, the design allowed for governorate-level estimates of most of the key variables, with the exception of the fertility and mortality rates. In the Frontier Governorates, the sample size was not sufficiently large to provide separate estimates for the individual governorates. To meet the survey objectives, the number of households selected in the 2000 EDHS sample from each governorate was not proportional to the size of the population in the governorate. As a result, the 2000 EDHS sample is not self-weighting at the national level, and weights have to be applied to the data to obtain the national-level estimates presented in this report. A more detailed description of the 2000 EDHS sample design is included in Appendix B. Sampling errors for selected variables are presented in Appendix C. Table 1.3 Survey timetable, 2000 Egypt DHS _______________________________________________________________________ Activity Starting date Duration _______________________________________________________________________ Updating the sample frame January 1999 1 month Mapping February 1999 1 month Quick-count operation March 1999 3 months Pretest I May 1999 2 weeks Recruitment and training of listing staff September 1999 2 weeks Listing and relisting September 1999 2 months Sample selection November 1999 2 months Questionnaire design March 1999 3 months Preparation of training materials September 1999 2 months Pretest II October 1999 2 months Finalization of questionnaires December 1999 1 month Training of data collection staff January 2000 5 weeks Printing survey materials February 2000 1 month Fieldwork February 2000 2 months Reinterviews April 2000 1 month Office editing and coding March 2000 3 months Data entry March 2000 3 months Computer editing April 2000 3 months Preliminary report June 2000 3 weeks Detailed tabulations June 2000 1 month Final report preparation July 2000 7 months Introduction * 7 SAMPLE SELECTION The sample for the 2000 EDHS was selected in three stages. The first stage included selecting the primary sampling units. The units of selection were shiakhas/towns in urban areas and villages in rural areas. Information from the 1996 census was used in constructing the frame from which the primary sampling units (PSUs) were selected. Prior to selecting the PSUs, the frame was updated to take into account administrative changes that had occurred since 1996. The updating process included both office work and field visits during a three-month period. After it was completed, urban and rural units were stratified by geographical location in a serpentine order from the northwest corner to the southeast corner within each governorate. During this process, shiakhas or villages with a population less than 2,500 were grouped with contiguous shiakhas or villages (usually within the same kism or marquez) to form units with a population of at least 5,000. After the frame was ordered, a total of 500 primary sampling units (228 shiakhas/towns and 272 villages) were selected. The second stage of selection involved several steps. First, detailed maps of the PSUs chosen during the first stage were obtained and divided into parts of roughly equal population size (about 5,000). In shiakhas/towns or villages with a population of 20,000 or more, two parts were selected. In the remaining smaller shiakhas/towns or villages, only one part was selected. Overall, a total of 735 parts were selected from the shiakhas/towns and villages in the 2000 EDHS sample. A quick count was then carried out to provide an estimate of the number of households in each part. This information was needed to divide each part into standard segments of about 200 households. A group of 37 experienced field workers participated in the quick count operation. They were organized into 13 teams, each consisting of 1 supervisor, 1 cartographer and 1 or 2 counters. A one-week training course conducted prior to the quick count included both classroom sessions and field practice in a shiakha/town and a village not covered in the survey. The quick- count operation took place between late March and May 1999. As a quality control measure, the quick count was repeated in 10 percent of the parts. If the difference between the results of the first and second quick count was less than 2 percent, then the first count was accepted. No major discrepancies were found between the two counts in most of the areas for which the count was repeated. After the quick count, a total of 1,000 segments were chosen from the parts in each shiakha/ town and village in the 2000 EDHS sample (i.e., two segments were selected from each of the 500 PSUs). A household listing operation was then implemented in each of the selected segments. To conduct this operation, 12 supervisors and 24 listers were organized into 12 teams. Generally, each listing team consisted of a supervisor and two listers. A one-week training course for the listing staff was held in mid-September 1999. The training involved classroom lectures and two days of field practice in three urban and rural locations not covered in the survey. The listing operation began at the end of September and continued for about 40 days. About 10 percent of the segments were relisted. Two criteria were used to select segments for relisting. First, segments were relisted when the number of households in the listing differed markedly from that expected according to the quick count information. Second, a number of segments were randomly selected to be relisted as an additional quality control test. Overall, few major discrepancies were found in comparisons of the listings. However, a third visit to the field was necessary in a few segments in the Cairo and Aswan governorates because of significant discrepancies between the results of the original listing and the relisting operation. 8 * Introduction The third stage involved selecting the household sample. Using the household lists for each segment, a systematic random sample of households was selected for the 2000 EDHS sample. All ever-married women 15-49 who were usual residents or who were present in the sampled households on the night before the interview were eligible for the EDHS. QUESTIONN AIRE DEVELOPMENT The 2000 EDHS involved two questionnaires: a household questionnaire and an individual questionnaire. The household and individual questionnaires were based on the model survey instruments developed by MEASURE DHS+ for countries with high contraceptive prevalence. Questions on a number of topics not covered in the DHS model questionnaires were also included in the 2000 EDHS questionnaires. In some cases, those items were drawn from the questionnaires used for earlier rounds of the DHS in Egypt. In other cases, the questions were intended to collect information on topics not covered in the earlier surveys (e.g., schooling of children). The household questionnaire consisted of three parts: a household schedule, a series of questions related to the socioeconomic status of the household, and height and weight measure- ment and anemia testing. The household schedule was used to list all usual household members and visitors and to identify those present in the household during the night before the interviewer’s visit. For each of the individuals included in the schedule, information was collected on the relationship to the household head, age, sex, marital status (for those 15 years and older), educational attainment, repetition and dropout (for those 6-24 years), and work status (for those 6 years and older). The second part of the household questionnaire obtained information on characteristics of the physical and social environment of the household (e.g., type of dwelling, availability of electricity, source of drinking water, household possessions, and the type of salt the household used for cooking). Height and weight measurements were obtained and recorded in the last part of the household questionnaire for all ever-married women age 15-49 years and all children born since January 1995 who were listed in the household schedule. In a subsample of households, all eligible women, all children born since January 1995, and all children age 11-19 years were eligible for anemia testing. The individual questionnaire was administered to all ever-married women age 15-49 who were usual residents or who were present in the household during the night before the interviewer’s visit. It obtained information on the following topics: C Respondent’s background C Reproduction C Contraceptive knowledge and use C Fertility preferences and attitudes about family planning C Pregnancy and breastfeeding C Immunization and health C Schooling of children and child labor C Female circumcision C Marriage and husband’s background C Woman’s work and residence. The individual questionnaire included a monthly calendar, which was used to record a history of the respondent’s fertility, contraceptive use (including the source where the method was obtained and the reason for discontinuation for each segment of use), and marriage status during each month of around a five-year period beginning in January 1995. Introduction * 9 PRETEST Two pretests were conducted during the preparation for the 2000 EDHS. After a ten-day training course, the household and individual questionnaires were pretested first in May 1999 in a small number of households. Two supervisors, two field editors, and eight interviewers participated in the first pretest. The pretest was conducted in two Upper Egypt governorates (Beni Suef and Fayoum) and two Lower Egypt governorates (Gharbia and Menoufia). A total of 276 household and 273 individual interviews were completed during the pretest. A larger-scale pretest was conducted in October 1999, including height and weight measurements as well as anemia testing. A three-week training course was conducted prior to the data collection for this pretest. Using six teams, the second pretest was conducted in all the governorates (excluding the Frontier Governorates). A total of 6 supervisors, 6 field editors, and 22 interviewers shared in the data collection with the health technicians who were responsible for the height and weight data collection and anemia testing in a subsample of households. The data collection took about two weeks, and approximately 3,000 households were interviewed. The questionnaires for the 2000 EDHS were finalized after the second pretest. Both comments from interviewers and tabulations of the pretest results were reviewed during the process of finalizing the questionnaires. English versions of the final Arabic language questionnaires are included in Appendix E. DATA COLLECTION ACTIVITIES Staff recruitment. To recruit interviewers and field editors, a list was obtained from the Ministry of Social Affairs (MOSA) of female personnel who were working to fulfill the one-year period of governmental public service that is mandatory for university graduates. All candidates nominated by MOSA for the field staff positions were interviewed, and only those who were qualified were accepted into the training program. All candidates for the interviewer and field editor positions were recent university graduates. Another basic qualification was a willingness to work in any of the governorates covered in the survey. With a few exceptions, interviewers who had previous experience in surveys were not accepted into the training program. This decision was made to reduce any bias that might result from previous survey experience and to ensure that all trainees had a similar background. However, previous survey experience was a basic qualification for the candidates for the positions of supervisor. All of the staff recruited for the anemia testing were required to have a medical background. Some were assigned by the MOHP, and others were recruited from among newly graduated physicians. Training materials. A variety of materials were developed for use in training personnel involved in the fieldwork. A lengthy interviewer’s manual, including general guidelines for conducting an interview as well as specific instructions for asking each of the questions in the EDHS questionnaires, was prepared and given to all field staff. In addition, a chart for converting months from the Islamic calendar to the Gregorian calendar was designed for the 74 months before the 2000 EDHS and distributed to all field staff. 10 * Introduction Other training materials, including special manuals describing the duties of the team supervisor and the rules for field editing, were prepared. Instructions for anthropometric data collection were included in a manual for the staff trained to collect height and weight data. A special manual covering the procedures to be followed in the anemia testing was also prepared. Training for supervisors and interviewers. A special training program for supervisors was conducted during a three-day period prior to the main fieldwork training. This training focused specifically on the supervisor’s duties, but it also covered the 2000 EDHS questionnaires in order to give supervisors a basic understanding of the content of the survey prior to the main training program. Training for interviewers for the 2000 EDHS data collection began in mid-January 2000. Twenty supervisors, 88 interviewers, and 34 anemia-testing and anthropometric-data-collection staff participated in the training program. This five-week training program, which was held in Cairo, included the following: C Lectures related to basic interview techniques and to specific survey topics (e.g., fertility and family planning, maternal and child health, and female circumcision) C Sessions on how to fill out the questionnaire, using visual aids C Role playing and mock interviews C Four days of field practice in areas not covered in the survey C Nine quizzes. Trainees who failed to show interest in the survey, who did not attend the training program on a regular basis, or who failed the first three quizzes were terminated immediately. At the beginning of the third week of training, a list was prepared of the 17 trainees who had performed best during both the classroom and field practices. These trainees were further examined to select 13 field editors. A special training session was held for the field editors after their selection. By the end of the training course, 63 of the 88 candidates originally recruited for interviewer training had been selected to work as interviewers or field editors in the EDHS fieldwork. Training for anthropometric-data-collection and anemia-testing staff. Thirty-four personnel were selected for training in anthropometric data collection and anemia testing. The training included both classroom lectures and practice measurement and blood testing in a nursery school, in health facilities, and in households. At the end of the program, the 26 most-qualified trainees were selected for the anthropometric data collection and anemia testing. As discussed earlier, all of the personnel involved in the anemia testing had a medical background. Most were medical school graduates. Fieldwork. Fieldwork for the 2000 EDHS began on February 23, 2000 and was completed in late April 2000. A total of 105 staff members, including 1 fieldwork coordinator, 2 assistant fieldwork coordinators, 13 supervisors, 13 field editors, and 50 interviewers were responsible for the data collection. In addition, 26 staff members were responsible for the anthropometric measurement and anemia testing. All supervisors were males, while the field editors and interviewers were females. One male and one female staff member were involved in the anthropometric measurement and the anemia testing. Introduction * 11 The field staff was divided into 13 teams; each team had 1 supervisor, 1 field editor, 3 to 4 interviewers, and 2 staff members assigned to height and weight measurement and anemia testing. During the fieldwork, the 13 field teams worked in separate governorates; the number of governorates assigned to an individual team varied from one to three, according to the sample size in the governorates. As soon as the main data collection was completed in the first group of governorates, a random sample of up to 10 percent of the households was selected for reinterview as a quality control measure. Shorter versions of the 2000 EDHS questionnaires were prepared and used for the reinterviews. The visits to PSUs to conduct reinterviews also afforded an opportunity to make callbacks to complete interviews with households or individuals who were not available at the time of the original visit by the 2000 EDHS interviewers. Household or individual questionnaires in which there were significant errors that could not be corrected in the office were also assigned for callbacks. Special teams were organized to handle callbacks and reinterviews. During this phase of the survey, interviewers were not allowed to work in the governorate in which they had worked in the initial fieldwork. Callbacks and reinterviews began on April 15, 2000 and were completed by May 15, 2000. DATA PROCESSING ACTIVITIES Office editing. Staff from the central office were responsible for collecting questionnaires from the teams as soon as a cluster was completed. Office editors reviewed questionnaires for consistency and completeness, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to report any problems detected while editing the questionnaires, which were reviewed by the senior staff. If serious errors were found in one or more questionnaires from a cluster, the supervisor of the team working in that cluster was notified and advised of the steps to be taken to avoid these problems in the future. Machine entry and editing. Machine entry and editing began while interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Integrated System for Survey Analysis (ISSA), a software package developed especially for the Demographic and Health Surveys program. Eleven data entry personnel used ten microcomputers to process the 2000 EDHS survey data. During the machine entry, 100 percent of each segment was reentered for verification. By working one shift six days per week, the data processing staff completed the entry and editing of data by the end of May 2000. 1.9 COVERAGE OF THE SURVEY Table 1.4 summarizes the outcome of the fieldwork for the 2000 EDHS by place of residence. The table shows that, during the main fieldwork and callback phases of the survey, out of 17,521 households selected for the 2000 EDHS, 17,103 households were found, and 16,957 households were successfully interviewed which represents a response rate of 99 percent. A total of 15,649 women were identified as eligible to be interviewed. Questionnaires were completed for 15,573 of those women, which represents a response rate of 99.5 percent. The household response rate exceeded 98 percent in all residential categories, and the response rate for eligible women exceeded 99 percent in all areas. 12 * Introduction Table 1.4 Results of the household and individual interviews Number of household and eligible women interviewed and response rates by urban-rural residence and place of residence, Egypt DHS 2000 ___________________________________________________________________________________________________________ Place of residence ___________________________________________________________ Urban Lower Egypt Upper Egypt Frontier Interview Gover- ____________________ ______________________ Gover- results Urban Rural norates Total Urban Rural Total Urban Rural norates Total ________________________________________________________________________________________________________ Household interviews Households sampled 9,119 8,402 4,173 6,661 2,354 4,307 5,748 1,968 3,780 939 17,521 Households found 8,810 8,293 4,009 6,520 2,273 4,247 5,654 1,921 3,733 920 17,103 Households interviewed 8,692 8,265 3,939 6,478 2,242 4,236 5,621 1,905 3,716 919 16,957 Household response rate 98.7 99.7 98.3 99.4 98.6 99.7 99.4 99.2 99.5 99.9 99.1 Individual interviews Eligible women 7,211 8,438 3,122 6,135 1,837 4,298 5,441 1,677 3,764 951 15,649 Eligible women interviewed 7,178 8,395 3,102 6,108 1,831 4,277 5,413 1,670 3,743 950 15,573 Eligible woman response rate 99.5 99.5 99.4 99.6 99.7 99.5 99.5 99.6 99.4 99.9 99.5 Characteristics of Households * 13 Table 2.1 Household population by age, residence, and sex Percent distribution of the de facto household population by five-year age groups, according to urban-rural residence and sex, Egypt 2000_______________________________________________________________________________ Urban Rural Total Age ______________________ ______________________ ______________________ group Male Female Total Male Female Total Male Female Total_______________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Total Number 11.3 10.9 11.1 13.8 13.0 13.4 12.7 12.1 12.4 10.1 10.2 10.1 13.0 12.5 12.8 11.8 11.5 11.6 12.2 11.9 12.0 14.5 13.8 14.2 13.5 13.0 13.3 11.6 11.4 11.5 12.5 11.8 12.2 12.1 11.6 11.9 9.4 9.8 9.6 8.4 9.2 8.8 8.9 9.5 9.2 7.3 7.7 7.5 6.6 7.5 7.1 6.9 7.6 7.3 6.4 6.9 6.6 5.7 6.1 5.9 6.0 6.5 6.2 6.7 6.8 6.8 5.9 5.9 5.9 6.2 6.3 6.3 5.5 6.0 5.7 4.3 4.4 4.4 4.8 5.1 4.9 5.4 6.1 5.7 3.9 4.6 4.2 4.5 5.3 4.9 4.4 3.2 3.8 3.2 2.5 2.8 3.7 2.8 3.2 3.1 3.3 3.2 2.3 2.6 2.5 2.7 2.9 2.8 2.8 2.6 2.7 2.2 2.3 2.2 2.4 2.4 2.4 1.7 1.3 1.5 1.6 1.5 1.5 1.7 1.4 1.5 1.2 1.0 1.1 1.1 1.1 1.1 1.2 1.1 1.1 0.5 0.5 0.5 0.6 0.5 0.6 0.6 0.5 0.5 0.4 0.4 0.4 0.5 0.5 0.5 0.4 0.5 0.5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 19,135 19,169 38,305 25,169 24,893 50,062 44,304 44,061 88,367 CHARACTERISTICS OF HOUSEHOLDS 2 The objective of this chapter is to provide a demographic and socioeconomic profile of the 2000 EDHS sample and a descriptive assessment of the environment in which women and children live. This goal is accomplished by examining the general characteristics of the households in the sample. Information is presented on the age, sex, and education of the household population, as well as on housing facilities and household possessions. The profile of the 2000 EDHS households provided in this chapter will help in understanding the results presented in the following chapters. In addition, it may provide useful input for social and economic development planning. 2.1 CHARACTERISTICS OF THE HOUSEHOLD POPULATION The questionnaire for the 2000 EDHS included two questions distinguishing between the de jure population (persons who usually live in selected household) and the de facto population (persons who spent the night before the interview in the household). The differences between these populations are small, and since past surveys and censuses were based on de facto populations, tabulations for the household data presented in this chapter are based on the de facto definition, unless otherwise stated. AGE AND SEX COMPOSITION Table 2.1 presents the percent distribution of the de facto population by age, according to urban-rural residence and sex. The table shows the effects of past demographic trends on the structure of the Egyptian population and indicates the context in which a variety of demographic processes are operating. 14 * Characteristics of Households Table 2.2 Population by age, 1988, 1992, 1995, and 2000 Percent distribution of the de facto population by broad age groups, 1988 EDHS, 1992 EDHS, 1995 EDHS, and 2000 EDHS _________________________________________________ 1988 1992 1995 2000 Age group EDHS EDHS EDHS EDHS _________________________________________________ Less than 15 15-64 65+ Total Median age Dependency ratio 41.2 41.7 40.0 37.3 55.0 54.6 56.3 59.1 3.8 3.7 3.7 3.6 100.0 100.0 100.0 100.0 - 18.8 19.3 20.3 81.8 83.2 77.6 69.2 __________________________________________ Source: El-Zanaty et al., 1996, Table 2.2 The information on sex and age distribution is used to construct a population pyramid describing the 2000 EDHS household population (Figure 2.1). The pyramid has a wide base, with a large concentration (37 percent) of the population under 15 years of age. This pattern is typical of countries that have experienced relatively high fertility in the recent past. The effect of recent fertility declines is evident in the fact that the proportions of children under age 5 and age 5 to 9 are smaller than the proportion age 10 to 14. The proportion under age 15 is greater in the rural population than in the urban population (Table 2.1). The differences in the urban-rural age distributions reflect the lower recent fertility in urban areas compared with rural areas. Table 2.2 presents a comparison of the distribution of the household popula- tion by broad age groups for the four EDHS surveys carried out between 1988 and 2000. The dependency ratio, defined as the ratio of the nonproductive popula- tion (persons under age 15 and age 65 and over) to the population age 15-64, is calcu- lated based on these figures. The depen- dency ratio, which was above 80 at the time of the 1988 survey, had declined to 69 at the time of the 2000 EDHS. The decline reflects a substantial lessening in the burden placed on persons in the pro- ductive ages to support older and younger household members. Characteristics of Households * 15 Table 2.3 Household composition Percent distribution of households by sex of head of household and household size, according to urban-rural residence and place of residence, Egypt 2000 ____________________________________________________________________________________________________ Place of residence _______________________________________________________ Urban Lower Egypt Upper Egypt Frontier Gover- __________________ __________________ Gover- Characteristic Urban Rural norates Total Urban Rural Total Urban Rural norates Total ____________________________________________________________________________________________________ Household headship Male Female Total Number of usual members 0 1 2 3 4 5 6 7 8 9+ Total Mean size Number of households 86.9 89.1 86.3 88.7 86.6 89.7 88.1 88.1 88.1 93.8 88.0 13.1 10.9 13.7 11.3 13.4 10.3 11.9 11.9 11.9 6.2 12.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 0.3 0.0 0.4 0.1 0.0 0.1 0.1 0.2 0.0 0.5 0.1 6.2 3.7 6.8 4.0 6.3 2.9 4.9 5.0 4.8 6.4 5.0 10.1 7.2 10.9 8.1 9.5 7.4 7.9 9.5 7.0 9.1 8.7 14.4 8.8 15.5 11.2 14.0 9.8 9.5 13.3 7.4 8.7 11.6 21.5 13.3 23.6 16.7 21.4 14.4 14.1 17.8 12.0 14.2 17.4 20.2 15.0 20.4 18.8 21.5 17.4 14.4 18.8 12.0 15.1 17.6 13.1 15.7 11.6 15.9 14.2 16.7 14.5 14.5 14.4 12.9 14.4 6.9 11.9 5.3 10.1 7.5 11.4 11.4 9.1 12.7 9.7 9.4 3.6 8.6 2.7 5.8 2.9 7.2 8.8 5.9 10.4 7.6 6.1 3.7 15.6 2.9 9.4 2.7 12.8 14.4 5.9 19.1 15.8 9.7 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 4.5 6.0 4.3 5.3 4.5 5.7 5.7 4.9 6.2 6.0 5.2 8,429 8,528 3,852 7,154 2,380 4,775 5,751 2,066 3,685 200 16,957 ____________________________________________________________________________________________________ Note: Table is based on de jure members, i.e., usual residents. HOUSEHOLD COMPOSITION Table 2.3 presents the distribution of households in the 2000 EDHS sample by sex of the head of the household and by the number of household members. These characteristics are important because they are often associated with socioeconomic differences between households. For example, female-headed households frequently are poorer than households headed by males. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. Unlike earlier tables, Table 2.3 is based on de jure members, i.e. usual residents. The household head is female in 12 percent of households. There is little variation in the proportion of female-headed households by residence, except for the Frontier Governorates, where females head 6 percent of households. 16 * Characteristics of Households Table 2.4.1 Educational level of the male household population Percent distribution of the de facto male household population age six and over by highest level of education attended, according to selected background characteristics, Egypt 2000 __________________________________________________________________________________________________ Median Primary number Primary complete/ Number of years Background No incom- some Secondary of of characteristic education plete secondary complete Higher Total males schooling ___________________________________________________________________________________________________ Age group 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Total 13.8 86.1 0.0 0.0 0.0 100.0 4,089 0.4 4.4 38.0 57.6 0.0 0.0 100.0 5,992 4.3 6.2 8.3 63.5 13.8 8.1 100.0 5,381 8.2 7.6 6.7 22.4 38.8 24.5 100.0 3,923 10.4 12.1 10.4 21.1 38.4 17.9 100.0 3,059 11.2 16.6 12.7 16.9 37.1 16.7 100.0 2,649 11.1 21.8 16.2 15.5 29.1 17.4 100.0 2,766 8.5 24.7 16.9 17.0 24.5 16.9 100.0 2,127 6.5 31.4 16.1 18.1 18.8 15.6 100.0 1,996 5.3 38.4 13.4 18.2 15.0 14.9 100.0 1,633 4.6 44.1 13.2 17.6 11.3 13.8 100.0 1,178 3.2 55.1 11.6 12.1 9.6 11.7 100.0 1,084 0.0 66.9 12.4 10.1 4.9 5.7 100.0 1,684 0.0 12.4 20.5 29.3 19.9 18.1 100.0 16,573 7.1 23.1 26.7 28.5 16.2 5.6 100.0 20,994 4.4 12.0 18.2 29.3 18.8 21.7 100.0 7,346 7.8 19.2 24.5 29.1 18.0 9.2 100.0 16,351 5.1 12.4 22.0 28.6 20.5 16.4 100.0 4,637 6.9 21.9 25.6 29.2 17.0 6.4 100.0 11,714 4.6 20.8 26.5 28.0 17.0 7.6 100.0 13,364 4.7 13.0 22.7 29.0 20.9 14.3 100.0 4,283 6.4 24.5 28.3 27.5 15.2 4.5 100.0 9,081 4.0 19.4 21.5 30.5 19.3 9.4 100.0 506 5.5 18.4 24.0 28.8 17.8 11.1 100.0 37,567 5.4 There are on average 5.2 persons per household. One in four households has fewer than four members, while another quarter of the households has seven or more members. In general, rural households are larger than urban households. For example, fewer than one in ten urban households have eight or more members, compared with nearly one in four rural households. Household size varies from an average of 4.3 persons in the Urban Governorates to 6.2 persons in rural Upper Egypt. 2.2 EDUCATION OF THE HOUSEHOLD POPULATION The educational level of household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and the health of children. Results from household interviews can be used to look at both educational attainment among household members and school attendance among children and young adults. EDUCATIONAL ATTAINMENT Tables 2.4.1 and 2.4.2 present data on the educational level of the household population age 6 and over. Primary education in Egypt starts at age 6 and continues for 5 years. A further three-year period, known as the preparatory stage, is considered basic education and is compulsory. The secondary stage, which includes another three years of schooling, is not compulsory. 1 The method for calculating median years of schooling that was used in the 2000 EDHS differs from the method used for such calculations in earlier DHS surveys. Consequently, the medians for the 2000 EDHS shown in Tables 2.4.1 and 2.4.2 cannot be directly compared with the medians that were calculated in earlier rounds of the DHS surveys and published in the survey reports. Characteristics of Households * 17 Table 2.4.2 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, according to selected background characteristics, Egypt 2000 _____________________________________________________________________________________________________ Median Primary number Primary complete/ Number of years Background No incom- some Secondary of of characteristic education plete secondary complete Higher Total females schooling ____________________________________________________________________________________________________ Age group 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Total 17.4 82.5 0.0 0.0 0.0 100.0 3,918 0.4 13.3 33.2 53.5 0.0 0.0 100.0 5,717 4.2 18.5 7.3 49.7 15.4 9.1 100.0 5,124 8.1 21.9 6.6 18.2 34.5 18.9 100.0 4,171 10.1 32.9 10.1 12.8 31.2 13.0 100.0 3,353 7.9 38.8 12.7 9.8 28.1 10.7 100.0 2,843 4.6 47.5 15.5 8.8 17.9 10.3 100.0 2,774 1.1 48.2 19.8 10.4 13.5 8.1 100.0 2,245 1.0 55.8 16.8 12.3 8.4 6.7 100.0 2,317 0.0 64.2 12.3 11.0 7.6 4.9 100.0 1,233 0.0 69.5 13.0 6.8 5.2 5.5 100.0 1,274 0.0 73.8 12.3 5.8 5.3 2.8 100.0 1,077 0.0 84.8 8.9 4.0 1.5 0.8 100.0 1,537 0.0 21.6 20.7 25.0 19.1 13.6 100.0 16,659 5.5 44.8 23.4 19.2 10.1 2.5 100.0 20,927 0.5 20.9 19.0 25.4 18.5 16.2 100.0 7,331 5.9 34.5 23.3 21.3 15.2 5.7 100.0 16,131 3.0 21.5 22.1 24.0 20.6 11.7 100.0 4,642 5.4 39.7 23.8 20.2 13.1 3.3 100.0 11,489 1.8 41.9 22.7 20.3 10.4 4.8 100.0 13,626 1.3 22.8 22.0 25.3 18.5 11.4 100.0 4,393 5.0 50.9 23.1 17.8 6.5 1.6 100.0 9,233 0.0 37.4 16.8 24.3 15.0 6.5 100.0 497 3.2 34.5 22.2 21.7 14.1 7.4 100.0 37,586 3.1 The results in Tables 2.4.1 and 2.4.2 confirm that there is a gap in educational attainment between males and females. Overall, more than 80 percent of males in the EDHS households have ever attended school, compared with 65 percent of females. The median number of years of schooling for men is 5.4, which is more than 2 years higher than the median level for women (3.1 years).1 18 * Characteristics of Households An examination of the changes in educational indicators over successive cohorts indicates that there have been substantial increases over time in the educational attainment of both men and women. For example, the median number of years of schooling is 10.4 for males age 20-24 years, compared with 6.5 years in the 40-44 age group. Women have experienced substantial improve- ments in education as well. As a result, the differentials in educational attainment between males and females have narrowed among younger cohorts; for example, the gap in the median number of years of schooling is negligible for those under age 25. Urban residents are more likely to have attended school and to have remained in school for a longer period than rural residents. Gender differences in educational attainment also are less evident in urban than in rural areas. The median number of years of schooling is 4.4 years among rural men, compared with 0.5 years among rural women. The difference is much smaller in urban areas, where the median years of schooling is 7.1 years for men, compared with 5.5 years for women. By place of residence, gender differences in the likelihood of attending school are greatest in rural Upper Egypt and least in the Urban Governorates. In rural Upper Egypt, three-quarters of men have ever attended school, compared with about 50 percent of women. In the Urban Governorates, the gap is much smaller, with nearly 80 percent of women having had some education, compared with 88 percent of men. CURRENT SCHO OL ATTENDANCE The 2000 EDHS collected information on current school attendance for the population age 6-24 years. Figure 2.2 presents the percentage of the population in this age range that was attending school at the time of the survey. The comparatively low age-specific attendance rate for children age 6 reflects that some of these children had not had their sixth birthday at the time the school year started and thus were not eligible to attend school. Characteristics of Households * 19 Table 2.5 School attendance Percentage of the de facto household population age 6-24 years who are currently attending school, by age group, sex, urban-rural residence, and place of residence, Egypt 2000 _____________________________________________________________________________________ Place of residence _______________________________________________________ Urban Lower Egypt Upper Egypt Frontier Age Gover- __________________ __________________ Gover- group Urban Rural norates Total Urban Rural Total Urban Rural norates Total _____________________________________________________________________________________ MALE _____________________________________________________________________________________ 6-10 11-15 6-15 16-20 21-24 88.4 87.1 88.8 89.2 89.7 89.0 85.7 86.3 85.5 84.6 87.6 86.7 84.3 86.5 84.8 85.2 84.6 85.2 88.0 84.0 86.7 85.3 87.5 85.6 87.5 86.8 87.3 86.6 85.4 87.2 84.8 85.6 86.3 59.3 45.5 63.2 48.5 58.1 44.9 48.9 54.4 46.6 46.8 51.3 20.4 12.6 23.0 14.0 17.8 12.4 15.1 18.9 12.9 12.8 16.3 _____________________________________________________________________________________ FEMALE _____________________________________________________________________________________ 6-10 11-15 6-15 16-20 21-24 89.8 79.9 89.0 87.1 90.6 85.8 78.5 90.0 74.0 79.9 83.9 89.3 70.8 88.1 82.9 93.3 79.3 69.4 87.6 61.6 70.5 78.2 89.6 75.2 88.5 84.9 92.0 82.4 73.8 88.7 67.6 75.0 80.9 54.5 28.2 57.3 38.9 55.4 32.6 31.8 49.9 22.9 35.8 39.7 14.7 5.4 16.2 7.8 12.9 5.8 8.2 14.7 4.8 5.4 9.6 _____________________________________________________________________________________ TOTAL _____________________________________________________________________________________ 6-10 11-15 6-15 16-20 21-24 89.1 83.7 88.9 88.1 90.2 87.4 82.3 88.1 80.1 82.5 85.8 88.0 77.8 87.3 83.9 89.1 82.1 77.4 87.8 73.0 78.9 81.8 88.5 80.6 88.0 85.9 89.6 84.6 79.8 87.9 76.5 80.7 83.7 56.9 36.9 60.2 43.7 56.8 38.8 40.3 52.0 34.9 40.6 45.5 17.6 8.9 19.7 10.8 15.4 9.0 11.5 16.8 8.7 8.8 12.9 Overall, the majority of children of both sexes age 16 and under were attending school. However, Figure 2.2 shows that school attendance rates are generally higher among boys than among girls. The gender gap in school attendance increases somewhat with age, particularly among the post-primary ages (i.e., 11-24 years). Table 2.5 presents school attendance rates by residence. For boys, under age 15, residential differences in school attendance rates are generally quite small; more than eight in ten boys age 15 and under are in school regardless of the locality in which they reside. At older ages, however, boys living in urban areas, particularly in the Urban Governorates, are more likely to attend school than boys from rural areas. For example, 59 percent of boys age 16-20 are currently attending school in urban areas compared to 46 percent of boys in the same age group in rural areas. 20 * Characteristics of Households Residential differentials in school attendance rates are much more evident for girls than boys at all ages. For example, there is gap of 15 percentage points in the current school attendance rates for girls age 6-15 between urban and rural areas (90 percent and 75 percent, respectively). In general, school attendance rates are lowest for girls living in rural Upper Egypt followed by girls living in the Frontier Governorates. Figure 2.3 shows that the rates of attendance for girls age 6-15 range from 68 percent in rural Upper Egypt to 92 percent in urban Lower Egypt. 2.3 HOUSEHOLD ENVIRONMENT HOUSING CHARACTERISTICS Table 2.6 presents the distribution of households by selected housing characteristics, including the source of drinking water, type of sanitation facilities, type of flooring, and number of rooms in the dwelling. These are important determinants of the health status of household members, particularly children. They can also be used as indicators of the socioeconomic status of households. Characteristics of Households * 21 Table 2.6 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence and place of residence, Egypt 2000____________________________________________________________________________________________________ Place of residence_______________________________________________________ Urban Lower Egypt Upper Egypt Frontier Gover- __________________ __________________ Gover- Characteristic Urban Rural norates Total Urban Rural Total Urban Rural norates Total____________________________________________________________________________________________________ Electricity Yes No Total Source of drinking water Piped water Piped into residence/plot Public tap Open well water Well in residence/plot Public well Covered well water Well in residence/plot Public well Surface water Nile/canal Purchase water Bottled water Buy water from truck Total Time to water source Water within 15 minutes Sanitation facility Modern flush toilet Traditional w/tank flush Traditional w/bucket flush Pit toilet/latrine No facility Total Flooring Ceramic/marble tiles Cement tiles Cement Wall-to-wall carpet Vinyl Parquet/polished wood Wood planks Earth/sand Total Persons per sleeping room 1-2 3-4 5+ Don’t know/missing Total Mean rooms per household Mean persons per room Number of households 99.5 95.9 99.7 98.7 99.6 98.3 95.3 99.0 93.3 89.7 97.7 0.5 4.1 0.3 1.3 0.4 1.7 4.7 1.0 6.7 10.3 2.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 99.0 75.9 99.7 83.8 98.4 76.5 83.9 98.6 75.6 81.6 87.4 97.0 64.9 98.3 76.1 96.1 65.8 75.2 95.3 64.0 77.5 80.8 2.0 11.0 1.4 7.7 1.8 10.6 8.6 3.3 11.6 4.0 6.5 0.2 2.5 0.0 1.5 0.4 2.0 1.6 0.1 2.5 13.7 1.4 0.0 1.3 0.0 0.7 0.1 1.0 1.0 0.1 1.5 3.9 0.7 0.1 1.2 0.0 0.8 0.3 1.0 0.6 0.0 1.0 9.8 0.7 0.3 20.0 0.1 13.0 0.5 19.2 13.9 0.6 21.3 0.8 10.2 0.1 13.1 0.1 7.5 0.1 11.1 10.3 0.4 16.0 0.6 6.7 0.1 6.9 0.0 5.5 0.4 8.1 3.5 0.2 5.4 0.3 3.5 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.5 1.5 0.2 1.7 0.6 2.3 0.5 0.8 0.4 3.9 1.0 0.2 0.0 0.0 0.0 0.0 0.0 0.3 0.8 0.0 0.0 0.1 0.3 1.5 0.2 1.7 0.6 2.3 0.3 0.0 0.4 3.9 0.9 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 99.0 89.8 99.4 92.7 98.7 89.8 93.2 98.7 90.1 89.6 94.4 59.2 7.8 71.6 24.0 52.7 9.7 19.3 44.3 5.4 36.8 33.4 3.4 3.7 2.3 5.0 4.7 5.2 2.7 4.0 1.9 0.7 3.6 36.6 78.1 25.9 69.1 42.0 82.6 64.3 49.4 72.6 52.7 57.5 0.5 5.4 0.0 1.2 0.4 1.5 7.3 1.4 10.5 1.4 3.0 0.3 4.9 0.2 0.7 0.2 1.0 6.4 0.8 9.6 8.4 2.6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 6.8 0.5 9.4 1.4 2.8 0.7 2.6 6.7 0.3 3.1 3.6 70.7 30.4 72.1 46.6 69.7 35.1 40.7 70.0 24.3 48.3 50.4 8.2 31.8 5.2 32.1 12.1 42.1 15.0 8.9 18.5 19.8 20.0 8.7 1.5 9.3 5.5 11.6 2.4 1.5 3.7 0.3 12.0 5.1 0.9 0.0 1.7 0.1 0.4 0.0 0.0 0.0 0.0 0.5 0.5 0.6 0.0 0.8 0.2 0.5 0.0 0.2 0.4 0.0 0.1 0.3 0.1 0.1 0.0 0.2 0.2 0.1 0.0 0.0 0.0 0.0 0.1 4.0 35.6 1.3 13.9 2.7 19.5 39.9 10.1 56.6 16.2 19.9 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 13.1 13.6 15.7 8.8 8.9 8.7 17.8 13.7 20.0 7.0 13.4 74.0 60.4 73.0 68.6 76.7 64.6 61.3 72.7 55.0 68.2 67.1 12.5 25.5 11.0 22.2 13.9 26.3 20.4 13.2 24.4 24.4 19.0 0.4 0.5 0.3 0.4 0.5 0.4 0.5 0.4 0.6 0.4 0.4 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 3.5 3.9 3.4 3.9 3.6 4.0 3.7 3.5 3.7 3.9 3.7 1.4 1.7 1.5 1.5 1.3 1.5 1.8 1.5 1.9 1.6 1.6 8,429 8,528 3,852 7,154 2,380 4,775 5,751 2,066 3,685 200 16,957 22 * Characteristics of Households Almost all EDHS households live in dwellings with electricity, and nearly nine in ten households have access to piped water, mainly within their dwelling or yard. Urban households are somewhat more likely to have access to piped drinking water than rural households. Among urban households, 97 percent have piped water available in the dwelling or yard, and 2 percent obtain water from a public tap. Among rural households, more than three-quarters have access to piped water, primarily at their residence (65 percent). Among the remaining rural households, most use well water. Households in rural Upper Egypt are somewhat more likely to rely on well water than households in rural Lower Egypt (24 percent and 21 percent, respectively). For most households, the source for their drinking water is within their dwelling or yard. Overall, 94 percent of households obtain drinking water in their dwelling or yard or within 15 minutes of their residence. About a third of Egyptian households have modern flush toilets, and 61 percent have traditional flush toilets. There are differences in the type of toilet facilities by both urban-rural residence and place of residence. Urban households are somewhat more likely to have a modern flush toilet (59 percent) than a traditional flush toilet. In comparison, the majority of rural households (78 percent) have traditional toilets with a bucket flush. Only 3 percent have no toilet facilities. Almost all of the households without toilet facilities are found in rural Upper Egypt or the Frontier Governorates. With regard to flooring, about half of the EDHS households live in dwellings with cement tile floors, and 20 percent in dwellings with a cement floor. About another fifth have a dirt (earth/sand) floor in their dwelling. There are substantial differences in the flooring materials in urban and rural dwellings. Among urban households, nearly 80 percent have a cement tile or cement floor, compared with about 60 percent of rural households. Conversely, more than a third of rural households live in dwellings with a dirt floor, compared with 4 percent of urban households. Dirt floors are more common in rural Upper Egypt than in rural Lower Egypt. The 2000 EDHS included a question about the number of rooms that a household had (excluding the bathrooms, kitchen, and hallways). Taken together with the information on the number of persons in the household, the results provide a measure of crowding. Table 2.6 shows that 13 percent of the households have one or two rooms in the dwelling, 67 percent have three or four rooms, and 19 percent have five rooms or more. The mean number of rooms per household is 3.7, and there is an average of 1.6 persons per room. Rural households are more crowded than urban households. The mean number of persons per room is 1.4 in urban areas, compared with 1.7 persons in rural areas. HOUSEHOLD POSSESSIONS Table 2.7 provides information on household ownership of durable goods and other possessions. With regard to durable goods, about nine in ten EDHS households own a television (color or black and white), more than eight in ten households own a washing machine or a radio with a cassette recorder, and about two-thirds own a refrigerator or electric fan. More than a quarter of the households have a telephone. Urban households are more likely to have these items than rural households. For example, 93 percent of households in urban areas own a washing machine, compared with about 74 percent of households in rural areas. Rates of ownership of various household possessions also differ by place of residence, with higher rates of ownership for most items reported among households in the Urban Governorates, Lower Egypt, and the Frontier Governorates than in Upper Egypt. Households in rural Upper Egypt have the lowest rates of ownership for all durable goods. Characteristics of Households * 23 Table 2.7 Household possessions Percentage of households possessing various household effects, means of transportation, property, and farm animals, by urban-rural residence and place of residence, Egypt 2000 ____________________________________________________________________________________________________ Place of residence _______________________________________________________ Urban Lower Egypt Upper Egypt Frontier Gover- __________________ __________________ Gover- Possession Urban Rural norates Total Urban Rural Total Urban Rural norates Total ____________________________________________________________________________________________________ Household effects Radio Television Video Telephone Electric fan Water heater Refrigerator Sewing machine Washing machine Means of transportation Bicycle Private car Motorcycle Property Farm/other land Farm animals Livestock/poultry None of the above Number of households 89.3 74.6 90.3 84.2 90.6 81.1 73.3 85.8 66.3 81.8 81.9 94.5 84.3 95.3 90.6 94.5 88.6 84.2 93.2 79.1 81.2 89.4 22.0 2.3 28.4 6.6 15.1 2.4 8.2 18.8 2.2 9.9 12.1 44.7 11.0 51.0 21.4 39.0 12.6 19.6 39.2 8.7 43.6 27.8 82.4 56.9 82.9 61.9 77.1 54.4 69.9 87.1 60.3 74.5 69.5 56.4 11.6 63.3 26.8 51.9 14.3 23.0 49.2 8.3 33.9 33.9 85.0 44.4 88.4 61.4 83.5 50.4 52.1 80.0 36.5 75.7 64.6 11.0 4.8 10.7 6.6 9.7 5.1 7.5 12.9 4.5 11.4 7.9 92.8 73.5 94.4 86.4 92.5 83.3 71.6 90.3 61.1 77.7 83.1 11.5 16.5 4.0 15.5 14.6 16.0 18.2 20.3 17.0 32.0 14.0 13.1 3.4 17.3 5.1 8.1 3.7 5.7 11.0 2.7 14.6 8.2 1.7 1.9 1.0 2.3 2.3 2.4 1.6 2.2 1.2 2.5 1.8 6.5 35.1 5.2 27.5 7.9 37.2 23.0 7.0 32.0 27.2 20.9 11.4 65.1 4.0 48.8 18.2 64.1 48.3 16.2 66.3 41.7 38.4 1.5 3.6 1.5 1.9 1.4 2.1 4.2 1.6 5.6 3.0 2.6 8,429 8,528 3,852 7,154 2,380 4,775 5,751 2,066 3,685 200 16,957 Table 2.7 also includes information on household ownership of a means of transportation. Overall, 8 percent of households own a car, with the highest rate of ownership in the Urban Governorates (17 percent) and the lowest rate in rural Upper Egypt (3 percent). Relatively few households have a motorcycle, and rates of ownership of bicycles vary from 4 percent in the Urban Governorates to 32 percent in the Frontier Governorates. As expected, households in rural areas are significantly more likely than urban households to own a farm or other land. More than one-third of rural households own a farm or other land, compared with only 7 percent of urban households. There is also considerable variation in the proportion reporting that they own livestock or poultry, from 66 percent of households in rural Upper Egypt to only 4 percent of households in the Urban Governorates. Background Characteristics of Respondents * 25 Table 3.1 Background characteristics of respondents Percent distribution of ever-married women by selected back- ground characteristics, Egypt 2000_____________________________________________________ Number of women__________________ Background Weighted Un- characteristic percent Weighted weighted_____________________________________________________ Marital status Married Widowed Divorced Not living together Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Work status Working for cash Not working for cash All women 92.4 14,382 14,393 5.0 775 748 2.0 309 317 0.7 107 115 4.0 615 595 14.4 2,244 2,246 18.3 2,850 2,844 17.3 2,701 2,701 17.2 2,674 2,688 14.0 2,182 2,223 14.8 2,307 2,276 44.1 6,871 7,178 55.9 8,702 8,395 19.2 2,992 3,102 43.8 6,826 6,108 12.5 1,946 1,831 31.3 4,880 4,277 35.6 5,546 5,413 11.6 1,808 1,670 24.0 3,738 3,743 1.3 209 950 43.2 6,734 6,613 13.2 2,060 2,043 13.0 2,026 2,083 30.5 4,753 4,834 14.6 2,266 2,332 85.4 13,307 13,241 100.0 15,573 15,573 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 This chapter provides a profile of the ever-married women who were interviewed in the 2000 Egypt DHS. First, information is presented on a number of basic characteristics of the EDHS respondents including age, residence, education, and work status. Then the chapter explores in more depth the women’s educational and employment status, their participation in household decision-making, and the problems that they perceive they have in accessing health care for themselves. Finally, the chapter looks at the extent to which women have access to mass media, which is used extensively in Egypt for public education efforts in the areas of reproductive and child health. 3.1 GENERAL CHARACTERISTICS Table 3.1 presents the distribu- tion of eligible women by various back- ground characteristics including age, marital status, urban-rural residence, place of residence, and educational level. As noted in Chapter 1, ever-mar- ried women age 15-49 who were usual residents or present in the household on the night before the interviewer's visit were eligible to be interviewed in the 2000 EDHS. Among the ever-married women in the sample, 92 percent are currently married, 5 percent widowed, and 3 per- cent divorced or separated. Looking at the age distribution in Table 3.1, slightly more than one-third of the 2000 EDHS respondents are under age 30 and more than one-quarter are age 40 and over. There are fewer women in the 15-19 and 20-24 age groups than in the 25-29 cohort. This is because only ever-married women were interviewed and because there has been an increas- ing tendency to delay marriage until older ages in Egypt. These changes in marriage patterns are described in more detail in Chapter 8. 26 * Background Characteristics of Respondents Table 3.2 Level of education Percent distribution of ever-married women by highest level of education attended, according to selected background characteristics, Egypt 2000___________________________________________________________________________________________ Level of education______________________________________ Primary Primary complete/ Secondary Number Median Background No incom- some complete/ of number characteristic education plete secondary higher Total women of years____________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Work status Working for cash Not working for cash Total 37.5 13.1 28.4 21.0 100.0 615 3.9 31.2 8.6 21.2 39.1 100.0 2,244 5.8 35.3 10.3 13.3 41.1 100.0 2,850 7.0 39.7 12.4 9.3 38.7 100.0 2,701 4.5 49.4 14.4 8.6 27.6 100.0 2,674 0.0 49.8 19.2 10.4 20.7 100.0 2,182 0.0 57.2 15.4 12.6 14.8 100.0 2,307 0.0 25.9 12.0 16.3 45.8 100.0 6,871 8.2 57.0 14.2 10.4 18.4 100.0 8,702 0.0 23.9 10.0 19.0 47.1 100.0 2,992 8.6 44.9 13.6 11.3 30.1 100.0 6,826 2.4 26.2 13.0 13.9 46.8 100.0 1,946 8.4 52.4 13.9 10.3 23.4 100.0 4,880 0.0 51.6 14.7 11.7 22.1 100.0 5,546 0.0 28.6 14.5 14.0 42.8 100.0 1,808 5.9 62.7 14.8 10.5 12.0 100.0 3,738 0.0 43.8 7.0 17.7 31.6 100.0 209 4.6 16.9 4.0 4.9 74.2 100.0 2,266 11.7 47.7 14.8 14.4 23.1 100.0 13,307 1.2 43.2 13.2 13.0 30.5 100.0 15,573 3.1 More than half of the women (56 percent) are living in rural areas. Considering place of residence, about one-fifth of the women are from the Urban Governorates, 44 percent live in Lower Egypt, and 36 percent live in Upper Egypt. Only 1 percent was from the Frontier Governorates. The educational level of the 2000 EDHS respondents varies considerably. Slightly more than 40 percent of the women never attended school, while 31 percent had completed the secondary level. Only 15 percent of respondents were working at a job for which they are paid in cash. 3.2 EDUCATION DIFFERENTIALS IN EDUCATIONAL ATTAINMENT An overview of the relationship between women's level of education and other background characteristics is provided in Table 3.2. As expected, the level of education decreases with increasing age among respondents age 25 and over. That women age 25-29 have a higher level of education than women in the 15-19 and 20-24 age groups should not be interpreted as evidence of a recent decline in educational attainment among young women. Instead the explanation lies in the fact that the EDHS sample included only ever-married women. Women who married in their teens are more likely to have left school early than women who married later, and thus women in the 15-19 and 20-24 age groups include a disproportionate number of less-educated women in comparison with older cohorts. Background Characteristics of Respondents * 27 Women in urban areas are more educated than those from rural areas. Among urban women, 46 percent have completed at least secondary school, compared with 18 percent of rural women. Educational levels are lowest in rural Upper Egypt, where 63 percent of the women have never gone to school. The highest levels are found in the Urban Governorates, where only about one-quarter of women have never attended school. Not surprisingly, the majority of women working for cash have completed secondary school or higher. LITERACY ASSESSMENT The 2000 EDHS assessed literacy levels among women who had never been to school or who had attended only the primary level by asking them to read several simple sentences from a card. To avoid possible bias in households where more than one eligible woman was interviewed, the EDHS teams used two cards, each with a different set of sentences. The sentences on the cards were selected from primary school Arabic textbooks. In addition to assessing literacy, information was collected from women with a primary education or less on whether they had ever attended any literacy program, i.e., any program (outside of primary school) that involved learning to read or write. Table 3.3 shows that the majority of respondents asked to read simple sentences during the EDHS interview either were unable to read at all or were able to read only part of the sentences. This is not surprising in view of the relatively large proportion of EDHS respondents who never attended school (43 percent) or have less than a primary education (13 percent). However, even among respondents who completed the primary level, about a quarter were unable to read any of the simple sentences, and 44 percent could read only parts of a sentence. The proportion that is illiterate is somewhat higher among respondents age 15-19 than among those in the 20-24 and 25-29 age groups. This pattern is somewhat unexpected because participation in schooling has been steadily rising among Egyptian women. The explanation lies in the fact that the EDHS sample included only ever-married women. Women in their teens who are married are more likely to have left school early than other women. The strong association between residence and literacy observed in Table 3.3 is clearly a reflection of residential differences in educational levels. Rural women are more than twice as likely as urban women to be unable to read at all. As expected, women working for cash are much more likely to be literate than other women. Literacy programs are one means of increasing the proportion of women who are able to read or write. Table 3.3 shows that 9 percent of women with a primary education or less have ever attended a literacy program. Younger women and women living in urban areas are somewhat more likely than other women to have taken part in a literacy program. Even among these groups, however, only a relatively small proportion participated in a literacy program. 28 * Background Characteristics of Respondents Table 3.3 Literacy Percent distribution of ever-married women by level of literacy, and percentage of women with primary education or less who attended a literacy program, according to selected background characteristics, Egypt 2000_____________________________________________________________________________________________________ Literacy Percent- Number of ______________________________________ age women Able to Able to who with Cannot read only read Preparatory/ Number attended primary Background read parts of whole higher of literacy education characteristic at all sentence sentence education Total women program or less_____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete Work status Working for cash Not working for cash Total 45.1 8.5 3.3 43.1 100.0 615 13.0 350 36.7 7.0 2.8 53.5 100.0 2,244 10.6 1,042 39.9 5.7 2.4 52.0 100.0 2,850 9.3 1,367 44.8 7.0 3.5 44.7 100.0 2,701 9.9 1,493 56.3 7.6 3.6 32.4 100.0 2,674 8.0 1,806 58.8 10.6 6.2 24.3 100.0 2,182 8.0 1,651 65.9 11.0 4.2 18.9 100.0 2,307 5.9 1,872 30.3 10.0 4.5 55.2 100.0 6,871 11.9 3,079 65.2 6.5 3.0 25.3 100.0 8,702 6.9 6,504 26.6 11.1 4.5 57.8 100.0 2,992 12.8 1,261 52.8 6.6 3.3 37.3 100.0 6,826 7.4 4,281 32.3 7.2 5.0 55.5 100.0 1,946 8.8 866 61.0 6.3 2.7 30.0 100.0 4,880 7.0 3,415 58.8 8.2 3.7 29.3 100.0 5,546 8.2 3,920 34.3 11.2 4.1 50.3 100.0 1,808 13.2 898 70.6 6.7 3.5 19.2 100.0 3,738 6.7 3,022 44.2 8.3 4.7 42.8 100.0 209 16.6 120 94.7 4.3 1.0 NA 100.0 6,734 7.1 6,734 57.9 29.7 12.3 NA 100.0 2,060 11.5 2,060 23.6 44.3 32.1 NA 100.0 788 13.1 788 18.8 2.8 1.9 76.6 100.0 2,266 9.8 531 55.1 8.9 4.0 32.0 100.0 13,307 8.4 9,051 49.8 8.0 3.7 38.5 100.0 15,573 8.5 9,582 ___________________________________________________________________________________________________ NA = Not applicable 3.3 EMPLOYMENT In the 2000 EDHS, respondents were asked a number of questions about their employment, including whether they were currently working and, if not, whether they had worked during the year before the survey. Women who were currently working were then asked questions about the kind of work they were doing and whether they were paid in cash or not. CURRENT EMPLOYMENT Table 3.4 shows the percent distribution of 2000 EDHS respondents according to current and past employment. For those women who are working, the table provides information on whether the woman is employed full-time or not. Overall, 17 percent of women are currently engaged in some economic activity. Most of the women who are not working do not report recent work experience; only 1 percent of the respondents not working at the time of EDHS interview had had a job for which they were paid in cash during the 12-month period before the survey. Background Characteristics of Respondents * 29 Table 3.4 Employment Percent distribution of ever-married women by employment status and continuity of employment, according to background characteristics, Egypt 2000 ___________________________________________________________________________________________ Not currently employed ____________________ Did not work Worked Currently employed in last in ________________________ Number Background 12 last 12 All Season- Occasion- of characteristic months months year ally ally Total women ______________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Currently married Widowed/divorced/separated Number of living children 0 1-2 3-4 5+ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Total 96.9 0.4 1.5 0.5 0.6 100.0 615 93.4 0.9 4.2 1.2 0.3 100.0 2,244 84.2 0.7 12.8 1.8 0.3 100.0 2,850 79.2 1.2 16.9 2.1 0.6 100.0 2,701 74.0 1.1 21.9 2.2 0.8 100.0 2,674 77.8 0.7 18.5 2.1 0.8 100.0 2,182 83.0 0.7 14.6 1.4 0.3 100.0 2,307 83.0 0.9 14.0 1.7 0.4 100.0 14,382 74.3 1.1 19.6 3.1 2.0 100.0 1,191 85.6 1.4 11.5 1.3 0.2 100.0 1,428 80.4 0.9 16.8 1.4 0.4 100.0 5,218 78.4 1.0 17.9 2.0 0.7 100.0 5,321 89.7 0.4 7.1 2.2 0.6 100.0 3,606 77.0 1.3 20.5 0.9 0.4 100.0 6,871 86.6 0.6 9.7 2.5 0.6 100.0 8,702 77.2 1.2 20.5 0.6 0.5 100.0 2,992 79.9 0.8 15.8 2.8 0.7 100.0 6,826 75.1 1.3 22.2 1.0 0.4 100.0 1,946 81.8 0.5 13.3 3.5 0.8 100.0 4,880 88.2 0.9 9.4 1.1 0.3 100.0 5,546 79.0 1.4 18.5 1.0 0.2 100.0 1,808 92.7 0.7 5.1 1.1 0.4 100.0 3,738 79.8 0.8 18.5 0.7 0.1 100.0 209 89.7 0.6 5.9 2.9 0.9 100.0 6,734 92.6 0.6 5.2 1.2 0.4 100.0 2,060 93.5 0.4 5.1 0.6 0.4 100.0 2,026 62.7 1.7 34.6 0.8 0.1 100.0 4,753 82.3 0.9 14.5 1.8 0.5 100.0 15,573 30 * Background Characteristics of Respondents Most of the women who work are employed on a full-time basis; only a minority work only seasonally or occasionally. The employment differentials presented in Table 3.4 indicate that women in the 30-44 age group are more likely to be currently employed than older or younger women. The comparatively small proportion of women under age 30 who work may be related to the greater childcare responsibilities. Urban women and highly educated women are much more likely to be involved in work than other women. Overall, 23 percent of urban women are engaged in some economic activity, compared with 13 percent in rural areas. Highly educated women are most likely to report current employment; more than a third of women who completed secondary or higher education are working. OCCUPATION In the EDHS 2000, women who indicated that were working or had worked within the year before the survey were asked about the kind of work that they did. Their response was recorded exactly as they gave it and was the basis for the coding of occupation that occurred after the survey in the central office. As Figure 3.1 shows, the majority of women who are currently working are employed in nonagricultural occupations. About two-thirds of working women are in professional, technical, and managerial positions or in clerical occupations. An additional 12 percent are in sales and services, and 6 percent work in jobs categorized as skilled manual labor. Less than one in five working women is involved in some type of agricultural activity. Women who work in agricultural occupations typically work on land that they or their family own or on rented land, with a relatively small proportion working on someone else’s land. Background Characteristics of Respondents * 31 Table 3.5 Occupation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of non-agricultural employment, according to background characteristics, Egypt 2000 ________________________________________________________________________________________________________ Agricultural Non-agricultural ____________________________ ____________________________ Prof./ Number Background Own Family Rented Other's tech./ Sales/ Skilled of characteristic land land land land manag.1 Clerical services manual Missing Total women ___________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Currently married Widowed/divorced/ separated Number of living children 0 1-2 3-4 5+ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Total * * * * * * * * * * 16 2.3 21.6 5.1 4.0 40.1 11.0 7.5 5.9 2.5 100.0 129 1.4 9.3 3.8 4.3 53.8 12.9 8.9 4.8 0.7 100.0 429 0.9 6.7 2.7 3.9 45.4 22.2 10.9 5.9 1.4 100.0 529 1.6 6.4 2.5 4.3 35.4 32.8 10.0 5.5 1.5 100.0 665 3.1 6.8 3.1 3.1 33.7 29.1 14.3 5.2 1.7 100.0 468 4.2 9.1 3.4 2.3 39.7 20.0 15.6 5.3 0.3 100.0 376 1.6 9.2 3.2 3.0 42.6 24.8 9.3 5.2 1.1 100.0 2,318 6.3 1.6 2.8 9.0 27.4 13.8 28.5 8.4 2.1 100.0 294 1.4 5.9 2.5 1.4 42.7 24.9 8.3 11.3 1.5 100.0 187 1.2 4.9 2.1 1.9 52.3 23.5 8.0 4.8 1.3 100.0 973 1.3 7.8 2.8 4.7 38.5 28.0 10.9 5.0 1.1 100.0 1,095 7.7 20.6 7.4 6.5 16.5 9.5 24.2 6.0 1.7 100.0 357 0.3 0.6 0.2 0.5 50.7 29.8 10.2 6.4 1.2 100.0 1,496 4.6 18.6 7.2 7.9 27.8 15.2 13.1 4.3 1.3 100.0 1,115 0.3 0.3 0.2 0.2 47.7 31.6 11.1 8.4 0.2 100.0 648 3.6 14.0 4.4 6.0 36.5 18.6 11.0 5.1 0.7 100.0 1,321 0.4 1.4 0.0 0.9 54.7 25.9 10.2 6.5 0.0 100.0 460 5.4 20.8 6.7 8.7 26.8 14.7 11.4 4.4 1.1 100.0 861 0.8 4.9 3.9 2.5 42.4 25.2 13.0 3.6 3.7 100.0 602 0.0 0.3 0.4 0.5 50.4 31.2 9.1 3.2 4.9 100.0 355 1.9 11.4 9.0 5.4 31.0 16.5 18.6 4.1 2.0 100.0 248 1.2 0.0 0.6 0.0 53.7 33.4 8.8 1.7 0.5 100.0 40 7.1 27.5 10.0 13.7 6.8 0.0 26.5 7.0 1.3 100.0 656 3.6 19.1 10.2 3.3 9.3 1.7 26.4 25.2 1.3 100.0 140 0.0 5.8 1.1 0.0 11.8 5.4 43.5 32.5 0.0 100.0 124 0.2 0.2 0.1 0.1 58.8 35.9 2.1 1.4 1.3 100.0 1,692 2.1 8.3 3.2 3.7 40.9 23.6 11.5 5.5 1.3 100.0 2,611 ___________________________________________________________________________________________________________ Note: An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 1 Professional, technical, and managerial, occupations Table 3.5 looks at the differences in the occupational profile of working women according to selected background characteristics. As expected, the proportion involved in professional, technical and managerial occupations and the proportion working in clerical positions are much greater among urban women than rural women. These proportions also rise rapidly with the women’s educational level. 32 * Background Characteristics of Respondents Table 3.6 Employer and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to background characteristics, Egypt 2000____________________________________________________________________________________________________ Employed by Employed by Self-employed a non-relative a relative_______________ _______________ _______________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Works in agriculture Agricultural Non-agricultural Total * * * * * * * 100.0 16 8.4 2.0 65.7 1.9 0.8 21.1 0.0 100.0 129 6.2 1.7 76.6 1.3 3.2 10.9 0.1 100.0 429 7.7 1.0 76.4 2.3 2.6 9.5 0.5 100.0 529 11.6 2.1 75.7 1.7 1.2 7.3 0.3 100.0 665 10.9 3.8 73.5 0.9 3.0 7.3 0.5 100.0 468 14.5 1.7 70.7 0.3 2.9 9.9 0.0 100.0 376 5.9 0.4 89.9 0.2 1.5 1.8 0.4 100.0 1,496 15.7 4.5 52.9 3.1 3.5 20.2 0.1 100.0 1,115 5.9 0.6 89.4 0.0 1.7 2.0 0.5 100.0 648 11.9 3.1 64.1 2.5 3.1 15.1 0.2 100.0 1,321 7.2 0.3 88.1 0.3 1.4 2.5 0.3 100.0 460 14.4 4.7 51.2 3.7 4.0 21.8 0.1 100.0 861 10.9 1.6 78.5 0.6 1.3 6.7 0.3 100.0 602 4.3 0.0 92.9 0.3 1.3 0.7 0.5 100.0 355 20.4 3.9 57.8 1.0 1.4 15.4 0.0 100.0 248 5.1 1.5 89.7 0.0 2.4 1.3 0.0 100.0 40 25.3 6.2 28.2 4.6 5.0 30.7 0.0 100.0 656 28.5 7.7 35.3 3.1 1.5 23.9 0.0 100.0 140 22.2 1.7 63.8 0.0 3.5 8.9 0.0 100.0 124 1.8 0.1 95.8 0.2 1.3 0.4 0.4 100.0 1,692 7.4 8.9 21.8 7.1 5.8 49.0 0.0 100.0 451 10.6 0.7 85.0 0.2 1.6 1.5 0.3 100.0 2,161 10.1 2.1 74.1 1.4 2.3 9.7 0.3 100.0 2,611 ____________________________________________________________________________________________________ Note: An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. EMPLOYER AND FORM O F EARNINGS Table 3.6 shows that, among working women, 12 percent are self-employed, a roughly similar percentage work for relatives, while the majority (76 percent) work for someone other than a relative. Rural women, particularly from Upper Egypt, are more likely to be self-employed or to work for a relative than urban women. Similarly, women with less than a secondary education are more likely to be self-employed or to work for a relative than highly educated women. For example, among employed women who never attended school, about two-thirds are either self-employed (32 percent) or work for a relative (36 percent). In contrast, only 4 percent of working women with at least a secondary education are self-employed or work for a relative. Background Characteristics of Respondents * 33 Table 3.6 also shows that, among women who work, 87 percent earn cash for the work they do. As discussed earlier, women who are working and earning cash represent 15 percent of all ever- married women interviewed in the survey. Finally, the results in Table 3.6 confirm that as expected, the proportion earning cash varies markedly according to the type of employer. Women employed by a non-relative almost always earn cash, and the majority of self-employed women receive cash for the work they do. However, the majority of women working for relatives are not paid in cash. Thus, women who receive cash for the work they do are disproportionately found in groups where the proportion of women working for an employer other than a relative is highest, i.e., among urban women, well-educated women, and women working in non-agricultural occupations. 3.4 DISPOSAL OF EARNINGS EDHS respondents who earned cash were asked about the share of household expenditures that were paid with their earnings and about the person(s) who mainly made the decisions about how their earnings would be spent. Figure 3.2 shows that women’s earnings are used to meet household expenses in most cases. Only 13 percent of the women with cash earnings contribute nothing or almost nothing to meeting household expenses. Table 3.7 shows that almost all of the women who work for cash are involved in deciding how their earnings would be spent. Two in five women say they alone are mainly responsible for making decisions on how their earnings are spent. Among the remaining women, the majority make these decisions jointly (primarily with the husband); only 4 percent say that the husband or someone else alone is mainly responsible for decisions about how the respondent’s earnings are to be spent. The extent to which women report that they mainly are responsible for deciding how to spend their earnings is related to the degree to which the household is dependent on the women’s earnings to meet expenses. Women at the two extremes—those whose earnings are not used to 34 * Background Characteristics of Respondents Table 3.7 hare of household expenditures met by earnings by control over earnings Percent distribution of women receiving cash earnings by the person(s) deciding about how earnings will be used, according to the share of household expenditures met by earnings, Egypt 2000 ___________________________________________________________________________________________ Person(s) deciding about how earnings will be spent ________________________________________________ Share of Jointly household Jointly with Number expenditures Respon- with someone Someone of met by earnings dent husband else Husband else Total women ______________________________________________________________________________________________ None/almost none 56.9 35.4 2.1 4.0 1.6 100.0 299 Less than half 35.1 60.7 0.7 3.3 0.2 100.0 861 Half or more 31.3 63.4 1.6 3.5 0.1 100.0 734 All 65.8 28.9 1.6 3.1 0.6 100.0 369 Total 41.7 53.0 1.3 3.4 0.5 100.0 2,266 ______________________________________________________________________________________________ Note: Total includes three women for whom information on the contribution to household expenditures was missing. meet expenses at all and those whose earnings cover all household expenses—are more likely than other women to report that they alone are responsible for making decisions about how their earnings will be spent. Table 3.8 presents differentials in the two measures related to the disposal of women’s earnings. With regard to the extent to which their earnings contribute to meeting household expenses, women under age 30 and those with no living children generally report paying a smaller proportion of household expenses than older and higher parity women. There are several possible reasons for this pattern. Women may have less need to contribute to meeting household expenses before the family has children. Younger women may also have lower earnings relative to the earnings of their husband. In the case of older women, the husband is more likely to have retired (or died) so that the woman’s earnings may represent a more significant proportion of the household budget. Table 3.8 shows that almost all women who are widowed, divorced, or separated say they alone are responsible for deciding how to use their earnings. Among currently married women, only one-third report that they make the decisions about how their earnings are used themselves, while 60 percent say that the decisions are made jointly with their husband. In general, the residential differentials in the share of household expenses paid for by women’s earnings are not large, nor is there great variation by educational level. With respect to control over how their earnings are spent, urban women are somewhat more likely than rural women to report that they themselves mainly make decisions about how the money they earn will be spent. By place of residence, the proportion reporting that they themselves make spending decisions varies from a high of 56 percent among women in urban Upper Egypt to 28 percent in the Frontier Governorates. With respect to educational differentials, women with less than a secondary education are more likely than those who have completed secondary school or higher to report that they decide for themselves how to spend the money they earn. In all subgroups, the majority of the women who do not make decisions about how to spend earnings themselves report that they make these decisions jointly with their husband. Background Characteristics of Respondents * 35 Table 3.8 Share of household expenditures met by earnings and control over earnings by background characteristics Percent distribution of women receiving cash earnings by share of household expenditures met by earnings and the person deciding about how earnings will be spent, according to selected background characteristics, Egypt 2000_______________________________________________________________________________________________________________________ Share of household expenditures by Person(s) deciding about respondent’s earnings how earnings will be spent____________________________ ____________________________________ Jointly Jointly with None/ Less Number with some- Some- Number Background almost than Half or of Respon- hus- one Hus- one of characteristic none half more All Total women dent band else band else Total women________________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Currently married Widowed/divorced/ separated Number of living children 0 1-2 3-4 5+ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary compl./ some secondary Secondary complete/higher Total * * * * 100.0 6 * * * * * 100.0 6 24.7 44.4 22.2 7.7 100.0 96 26.8 59.5 0.9 9.7 3.1 100.0 96 19.7 43.1 30.6 6.6 100.0 369 36.1 55.5 1.1 6.3 1.0 100.0 369 16.2 39.9 34.3 9.4 100.0 461 34.5 60.9 1.7 2.5 0.3 100.0 461 8.3 36.8 33.8 20.8 100.0 591 43.8 53.0 0.2 2.5 0.2 100.0 591 10.7 36.0 33.2 20.1 100.0 411 46.4 49.7 1.8 1.9 0.2 100.0 411 8.9 32.8 31.9 26.4 100.0 331 53.0 41.6 2.4 2.9 0.1 100.0 331 14.0 41.5 34.7 9.6 100.0 1,990 35.0 60.4 0.3 3.9 0.5 100.0 1,990 7.6 12.2 15.7 64.0 100.0 276 90.3 0.0 8.7 0.0 0.5 100.0 276 25.7 31.6 32.7 10.0 100.0 168 46.4 47.1 2.2 3.7 0.6 100.0 168 14.6 40.0 31.7 13.5 100.0 900 42.9 52.5 1.2 2.6 0.7 100.0 900 10.8 38.5 33.3 17.1 100.0 960 40.3 55.0 0.9 3.3 0.3 100.0 960 8.6 32.6 31.2 27.7 100.0 238 39.3 51.0 2.5 7.1 0.0 100.0 238 13.1 37.7 35.2 13.9 100.0 1,462 45.7 50.3 1.3 2.5 0.2 100.0 1,462 13.4 38.4 27.3 20.5 100.0 805 34.4 58.0 1.4 5.1 1.0 100.0 805 12.7 38.2 32.9 16.3 100.0 631 49.5 44.8 2.3 3.3 0.0 100.0 631 12.1 35.7 32.2 19.7 100.0 1,047 33.4 61.5 1.1 3.3 0.5 100.0 1,047 11.8 35.0 38.2 14.8 100.0 446 33.7 63.3 0.6 2.1 0.0 100.0 446 12.4 36.1 27.8 23.3 100.0 601 33.2 60.2 1.4 4.2 0.8 100.0 601 16.1 42.8 30.4 10.7 100.0 549 49.5 45.0 0.7 3.9 0.9 100.0 549 15.7 41.2 33.5 9.6 100.0 351 55.7 41.5 0.3 1.8 0.6 100.0 351 16.9 45.5 24.9 12.7 100.0 197 38.4 51.1 1.3 7.7 1.5 100.0 197 9.8 29.6 57.1 3.5 100.0 39 28.3 69.2 0.7 1.8 0.0 100.0 39 13.4 29.9 20.8 35.3 100.0 384 46.8 41.7 3.1 6.9 1.2 100.0 384 13.8 33.1 21.5 31.6 100.0 91 52.2 43.3 0.0 4.5 0.0 100.0 91 4.4 37.5 28.0 29.7 100.0 111 55.8 35.3 0.9 6.8 0.7 100.0 111 13.7 40.1 36.0 10.2 100.0 1,681 39.1 57.3 1.0 2.4 0.3 100.0 1,681 13.2 38.0 32.4 16.3 100.0 2,266 41.7 53.0 1.3 3.4 0.5 100.0 2,266 __________________________________________________________________________________________________________________________ Note: An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 3.5 HOUSEHOLD DECISION-MAKING To assess women’s role in household decision-making, 2000 EDHS respondents were asked questions about who in the household (respondent, husband, both, other) has the final say in decisions related to the following five specific areas: the woman’s own health care, large household purchases, everyday household purchases, visits to friends or relatives, and what food to cook each day. Table 3.9 shows that women are more likely to make the final decision in the case of recurring household decisions (i.e., what to cook or everyday purchases). Joint decision-making is most common in the case of visits to family or relatives, while women most often say that the husband 36 * Background Characteristics of Respondents Table 3.9 Household decision-making Percent distribution of ever-married women 15-49 by person who makes specific household decisions, according to type of decision, Egypt 2000 ___________________________________________________________________________________________ Person(s) who make(s) household decision ____________________________________________ Jointly Jointly with Someone Number Household Self with someone Husband else of decision only husband else only only Total women ______________________________________________________________________________________________ Own health care 36.4 22.9 1.0 38.0 1.8 100.0 15,573 Large household purchases 10.0 31.0 1.3 53.5 4.2 100.0 15,573 Everyday household purchases 47.6 18.4 4.2 22.4 7.3 100.0 15,573 Visits to family or relatives 16.8 53.6 3.5 23.8 2.3 100.0 15,573 What food to cook each day 66.3 13.7 9.8 4.3 5.9 100.0 15,573 makes final decisions about large household purchases. With regard to decisions about the woman’s own health care, about a third of the women say that final decisions in this area are their own. The remaining women are more likely to report that their husband makes the final decisions about the woman’s own health care than to say that the decisions are made jointly. Table 3.10 presents differentials in the proportions of women who report that they alone or jointly have the final say with respect to various decisions. The table shows that 31 percent of the respondents are involved either alone or jointly in all five decision areas. Only 4 percent have no involvement in making any of the decisions. The results in Table 3.10 indicate that widowed, divorced, and separated women have greater involvement in various decisions than currently married women. Women’s involvement in household decision-making increases with the age of the woman and with parity up to four children. Rural women, and women from the Frontier Governorates are generally less likely than women to report that they make decisions alone or jointly. Participation in household decision- making appears to be more limited for women living in rural Upper Egypt and the Frontier Governorates than for women from other areas. For example, slightly less than half of women from rural Upper Egypt and the Frontier Governorates say they alone or jointly have the final say in decisions relating to their own health care compared with 75 percent of women in the Urban Governorates. There are also relatively large differentials in the proportions having a final say in decisions about major and daily household purchases between women from rural Upper Egypt and the Frontier Governorates and other women. A woman’s education level is directly related to her degree of involvement in making the various household decisions, with 40 percent of women who completed at least the secondary level of education saying that they have the final say either alone or jointly in all of the decisions, compared with slightly more than a quarter of the women with no education. Women working for cash are also much more likely than other women to report having a say in the various decisions. Background Characteristics of Respondents * 37 Table 3.10 Final say in household decisions Percentage of ever-married women who say that they alone or jointly have the final say in specific household decisions, according to background characteristics, Egypt 2000_____________________________________________________________________________________________________ Alone or jointly has final say in: ________________________________________________________________ Visits to Own Making Making family, What food All None of Number Background health large daily relatives, to cook specified specified of characteristic care purchases purchases friends daily decisions decisions women_____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Currently married Widowed/divorced/ separated Number of living children 0 1-2 3-4 5+ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Work status Working for cash Not working for cash Total 48.1 33.2 52.7 63.4 74.1 19.6 11.3 615 53.8 36.7 61.5 69.1 83.7 24.8 7.1 2,244 59.2 39.7 68.8 72.2 88.2 28.1 5.0 2,850 62.0 42.1 72.7 75.4 90.9 31.4 3.8 2,701 60.5 43.0 73.3 74.5 92.9 32.0 3.1 2,674 64.4 48.0 74.3 75.8 93.9 36.3 2.7 2,182 64.8 47.7 75.0 78.6 93.2 38.3 2.2 2,307 57.8 39.1 69.0 72.5 89.8 27.5 4.3 14,382 89.3 81.8 84.9 89.5 90.4 75.6 4.4 1,191 57.2 41.4 61.8 72.3 82.6 28.9 8.0 1,428 62.8 43.9 69.8 75.0 88.0 33.0 4.8 5,218 62.9 45.0 74.7 75.8 92.6 33.3 2.8 5,321 53.8 36.5 67.7 69.7 91.0 26.4 4.3 3,606 68.0 47.6 76.2 78.8 93.2 36.2 2.3 6,871 54.2 38.2 65.6 69.9 87.1 27.2 5.8 8,702 74.5 50.2 79.3 77.0 91.9 40.6 2.4 2,992 63.3 47.2 75.5 76.6 89.8 35.6 3.6 6,826 70.8 51.8 79.9 82.5 94.3 40.6 1.8 1,946 60.3 45.3 73.7 74.3 88.0 33.5 4.4 4,880 49.3 32.6 59.9 68.7 88.8 21.2 5.8 5,546 54.8 39.3 68.4 77.3 94.2 25.0 2.5 1,808 46.7 29.4 55.8 64.6 86.2 19.3 7.4 3,738 46.3 29.9 44.7 72.2 88.9 19.9 10.4 209 52.5 35.5 66.0 68.0 87.7 25.8 6.0 6,734 58.3 40.6 72.0 70.5 90.5 28.5 3.6 2,060 60.5 43.0 67.5 73.3 88.4 30.4 4.4 2,026 72.0 52.5 76.7 83.7 93.1 40.3 2.0 4,753 80.2 63.5 82.6 88.1 95.5 52.0 1.1 2,266 56.9 38.7 68.2 71.4 88.8 27.7 4.8 13,307 60.3 42.3 70.3 73.8 89.8 31.2 4.3 15,573 3.6 ACCESS TO HEALTH CARE As part of the effort to explore women’s ability to obtain health services, the 2000 EDHS looked at the extent to which women perceive that they face significant problems in accessing health care for themselves. To obtain this information, EDHS respondents were asked whether each of the following factors would be a big problem for them in obtaining health services: knowing where to go, getting permission to go, getting money for treatment, the distance to the health facility, concern about going alone to the facility, and lack of a female health care provider. Table 3.11 shows that in general, a minority of women think each of the specific potential barriers to accessing care is actually a big problem for them. However, slightly more than half of the women identify at least one obstacle to getting health care that they consider to be a major problem. 38 * Background Characteristics of Respondents Table 3.11 Problems women face in accessing health care Percentage of ever-married women 15-49 who reported that various factors pose a big problem in accessing health care for themselves by selected background characteristics, Egypt 2000 ____________________________________________________________________________________________________ At least one Getting Distance Not Lack of specified Knowing Getting money to Have to wanting female factor Number Background where permission for health take to go health is a big of characteristic to go to go treatment facility transport alone provider problem women ____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Currently married Widowed/divorced/ separated Number of living children 0 1-2 3-4 5+ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Works status Working for cash Not-working for cash Total 15.8 39.0 32.4 15.2 16.7 32.9 28.2 61.6 615 10.4 32.8 26.2 12.8 14.2 25.5 23.8 56.0 2,244 8.7 29.1 25.2 13.1 14.2 21.4 20.3 51.7 2,850 8.6 27.4 27.1 14.1 14.7 20.1 20.3 52.3 2,701 9.8 28.3 28.9 13.5 14.6 21.2 20.5 51.4 2,674 9.3 22.6 25.7 12.5 14.0 18.0 17.5 48.3 2,182 9.1 23.3 25.9 14.2 15.6 20.5 19.0 49.5 2,307 9.6 29.2 26.6 13.2 14.4 21.5 20.6 52.5 14,382 9.3 11.0 28.8 16.1 17.4 22.3 19.5 45.5 1,191 12.5 29.4 22.0 12.6 13.8 28.0 23.2 53.0 1,428 8.0 25.3 22.0 11.3 12.7 20.1 18.8 47.1 5,218 8.2 26.2 25.7 13.5 14.5 19.7 20.2 50.5 5,321 12.6 33.1 37.2 16.8 18.0 24.1 22.6 60.7 3,606 5.4 19.7 18.0 8.5 9.6 16.2 16.7 41.3 6,871 12.8 34.2 33.7 17.4 18.6 25.9 23.6 60.4 8,702 3.6 16.5 14.0 6.3 8.1 15.5 16.0 36.3 2,992 9.8 29.4 24.6 15.4 16.4 20.1 20.8 53.4 6,826 6.4 23.8 18.6 11.6 11.6 16.2 16.7 45.2 1,946 11.2 31.6 27.0 16.9 18.3 21.7 22.4 56.7 4,880 11.9 31.0 36.1 14.6 15.8 26.1 22.6 58.0 5,546 6.9 19.4 23.6 8.8 10.1 16.3 18.2 44.2 1,808 14.3 36.6 42.2 17.5 18.5 30.8 24.7 64.7 3,738 23.9 52.3 33.1 20.7 22.0 40.0 25.1 65.4 209 13.6 36.0 38.6 18.4 19.7 26.8 25.3 63.6 6,734 10.3 29.5 31.0 14.6 15.4 22.7 20.4 57.2 2,060 7.5 25.1 22.1 10.9 11.6 21.3 20.7 49.0 2,026 4.4 16.6 10.2 7.1 8.4 13.9 13.9 34.4 4,753 4.9 15.6 13.4 9.2 11.0 12.0 11.5 34.3 2,266 10.3 29.9 29.1 14.2 15.3 23.2 22.1 55.0 13,307 9.6 27.8 26.8 13.5 14.6 21.6 20.6 51.9 15,573 Background Characteristics of Respondents * 39 Table 3.11 also provides some insights into the specific problems women perceive as major obstacles in getting health care. Getting permission to go and getting the money to pay are most frequently cited as posing big problems (28 percent and 27 percent, respectively), followed by desire to have someone accompany them to the provider, and the lack of female providers (22 per- cent and 21 percent, respectively). Fifteen percent or less of women mention the need to arrange for transport, the distance to the provider, or their lack of knowledge of where to go as big problems in obtaining health care for themselves. There are marked differences by urban-rural residence and place of residence in the extent to which women perceive that they face major obstacle(s) to getting health care (Table 3.11). Sixty percent of rural women report at least one potential obstacle, compared with a little more than 40 percent of urban women. Women from Upper Egypt and the Frontier Governorates are more likely than those from Lower Egypt and the Urban Governorates to mention at least one potential obstacle. As expected, highly educated women and women who work for cash are less likely than other women to report that anything is a big problem for them in accessing health care. There also are differences by background characteristics, particularly residence and education, in the types of specific obstacles that women regard as big problems in accessing health care. For example, women in rural Upper Egypt and especially in the Frontier Governorates were more likely than other women to say that lack of knowledge of where to go to obtain health care services posed a big problem for them. Getting permission to go and not wanting to go alone were acknowledged much more often as potential obstacles by women from the Frontier Governorates than by women in other residential categories. Concerns about obtaining the money to pay for care and finding transport are more common among rural women and women from the Frontier Governorates than other women. Looking at women’s education, the largest differential was found with respect to the proportion of women indicating that money was a problem in accessing health care. Women with no education were nearly four times as likely to say that getting money for treatment was potentially an issue for them compared to women with a secondary or higher education. Educational differentials were smallest in the case of knowing where to go. 3.7 COVERAGE OF MASS MEDIA The 2000 EDHS collected information on the exposure of women to both broadcast and print media. These data are important because they provide some indication of the extent to which Egyptian women are regularly exposed to the mass media, which are extensively used in Egypt to convey family planning and health messages to the population. The level of exposure of EDHS respondents to television, radio, and newspapers or maga- zines is shown in Figure 3.3. More than 90 percent usually watch television weekly, about three- quarters listen to radio, and one-quarter read a newspaper or magazine. Slightly more than one in five women report exposure to all three media, and only 5 percent have no exposure to print or broadcast media. 40 * Background Characteristics of Respondents According to the results presented in Table 3.12, women living in urban areas are somewhat more likely to be exposed to the mass media channels, particularly newspapers or magazines and the radio, than rural women. Overall, a third of urban women are exposed to all three media week- ly, compared with 11 percent of rural women. Considering place of residence, a majority of women in every residential category watches television or listens to the radio weekly. The percentage that reads a newspaper or magazine weekly varies considerably, from 11 percent in rural Upper Egypt to 45 percent in the Urban Governorates. Lack of exposure to any of the three media varies from 2 percent of women in the Urban Gover- norates and urban Lower Egypt to 13 percent of women in the Frontier Governorates. There is a strong association between the level of education and exposure to mass media; as the education level of respondents increases, the percentages that report exposure to each of the three mass media increase. Background Characteristics of Respondents * 41 Table 3.12 Exposure to mass media Percentage of ever-married women who usually watch television weekly, listen to the radio weekly, or read a newspaper or magazine weekly, by selected background characteristics, Egypt 2000 ____________________________________________________________________________________ Read Watch Listen to newspaper All No Number Background television radio or magazine three media of characteristic weekly weekly weekly media exposure women ____________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Work status Working for cash Not working for cash Total 93.3 67.1 18.9 15.8 3.7 615 93.8 72.6 25.8 20.7 3.3 2,244 94.3 73.2 29.2 25.1 3.6 2,850 93.0 73.4 29.8 25.4 4.3 2,701 91.9 70.1 24.7 20.6 5.2 2,674 91.1 71.6 22.8 19.0 5.7 2,182 91.0 70.1 19.7 16.6 6.3 2,307 95.9 78.5 41.3 34.9 1.9 6,871 90.0 66.3 12.7 10.5 6.8 8,702 96.2 81.1 45.4 39.1 1.7 2,992 93.9 76.8 21.2 17.9 3.2 6,826 95.9 81.2 39.3 33.6 1.7 1,946 93.1 75.1 14.0 11.7 3.8 4,880 89.6 60.8 19.7 16.0 7.7 5,546 95.3 72.4 37.3 30.1 2.6 1,808 86.8 55.2 11.2 9.1 10.2 3,738 77.7 58.2 22.6 16.7 13.3 209 87.8 62.8 1.1 0.8 8.7 6,734 93.9 69.1 7.6 6.7 4.0 2,060 96.0 78.4 28.8 23.9 1.7 2,026 97.4 82.6 65.8 55.5 0.5 4,753 94.6 77.8 61.3 51.3 3.0 2,266 92.2 70.6 19.2 16.2 4.9 13,307 92.6 71.7 25.3 21.3 4.7 15,573 Fertility * 43 FERTILITY 4 This chapter looks at a number of fertility indicators including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women initiate childbearing. Information on current and cumulative fertility is essential in monitoring the progress and evaluating the impact of the population program in Egypt. The data on birth intervals are important since short intervals are strongly associated with childhood mortality. The age at which childbearing begins can also have a major impact on the health and well-being of both the child and the mother. Data on childbearing patterns were collected in the 2000 EDHS in several ways. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who may have died. Next, a complete history of all of the woman’s births was obtained, including the name, sex, month and year of birth, age, and survival status for each of the births. For living children, a question was asked about whether the child was living in the household or away. For dead children, the age at death was recorded. Finally, information was collected on whether currently married women were pregnant at the time of the survey. 4.1 CURRENT FERTILITY LEVELS AND DIFFERENTIALS The level of current fertility is one of the most important topics in this report because of its direct relevance to population policies and programs. Measures of current fertility presented in this chapter include age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate. These rates are generally presented for the three-year period preceding the survey, a period covering portions of the calendar years 1997 through 2000. The three-year period was chosen for calculating these rates (rather than a longer or a shorter period) to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births. Age-specific fertility rates are useful in understanding the age pattern of fertility. Numerators of age-specific fertility rates are calculated by identifying live births that occurred in the 1 to 36 months preceding the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of the child’s birth. The denominators of these rates are the number of woman-years lived in each of the specified five-year age groups during the 1 to 36 months preceding the survey. Although information on fertility was obtained only for ever-married women, the age-specific rates are presented for all women regardless of marital status. Data from the household questionnaire on the age structure of the population of never-married women were used to calculate the all-women rates. This procedure assumes that women who have never been married have had no children. The total fertility rate (TFR) is a useful measure for examining the overall level of fertility. It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. The TFR is calculated by summing the age-specific fertility rates. It is presented for women age 15-44 and women 15-49 to facilitate comparisons with other surveys in which the age range of interviewed women may differ from that in the 2000 EDHS. 44 * Fertility Table 4.1 Current fertility Age-specific and total fertility rates and the crude birth rate and general fertility rate for the three years preceding the survey, by urban-rural residence and place of residence, Egypt 2000 ____________________________________________________________________________________________________ Place of residence _____________________________________________________________ Urban Lower Egypt Upper Egypt Frontier Gover- ____________________ ____________________ Gover- Age group Urban Rural norates Total Urban Rural Total Urban Rural norates Total ____________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 TFR 15-44 GFR CBR 34 65 31 50 29 57 64 35 77 38 51 152 231 136 208 175 220 217 152 250 172 196 194 218 187 197 194 199 232 205 246 216 208 148 146 141 125 144 117 177 161 185 191 147 66 83 60 50 53 49 113 90 125 95 75 20 28 19 15 12 17 39 31 44 30 24 4 4 5 3 3 3 5 3 6 18 4 3.09 3.88 2.89 3.24 3.05 3.31 4.24 3.39 4.66 3.80 3.53 3.07 3.86 2.87 3.23 3.03 3.29 4.21 3.37 4.63 3.71 3.51 102 135 95 114 100 119 142 110 157 125 120 24.8 30.1 23.2 26.9 25.1 27.5 31.3 26.3 33.4 29.9 27.8 ____________________________________________________________________________________________________ Note: Rates are for the period 1-36 months preceding the survey (approximately March 1997-February 2000). Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population The general fertility rate (GFR) represents the annual number of births in a population per 1,000 women age 15-44. The crude birth rate (CBR) is the annual number of births in a population per 1,000 persons. Both measures are based on the birth history data for the three-year period before the survey and the age-sex distribution of the household population. Current estimates of fertility levels are presented in Table 4.1 by residence. The total fertility rate indicates that if fertility rates were to remain constant at the level prevailing during the three- year period before the 2000 EDHS (approximately March 1997 to February 2000), an Egyptian woman would bear 3.5 children during her lifetime. In rural areas, the TFR is 3.9 births per woman, a little less than one birth higher than the rate in urban areas. Considering the variation by place of residence, the TFR for rural Lower Egypt (3.3 births per woman) is similar to the rate for urban Upper Egypt (3.4 births per woman) and 1.4 births lower than the TFR for rural Upper Egypt. The TFR for the Frontier Governorates is 3.8 births, a rate that is higher than any other area except rural Upper Egypt (Figure 4.1). The lowest TFR is 2.9 births per woman in the Urban Governorates, almost two children lower than the rate in rural Upper Egypt. Egyptian women are having children early in the childbearing period. According to the age- specific fertility rates shown in Table 4.1, the average Egyptian woman will give birth to 1.2 children by age 25 and 2.3 children by age 30. The age pattern of fertility shows little variation by urban-rural residence, except that urban fertility peaks in the age group 25-29 (194 births per thousand women), while rural fertility is highest in age group 20-24 (231 births per thousand women). Looking at place of residence, the age-specific rates are much higher in rural Upper Egypt than in the other areas in every age group except the 45-49 age group. Fertility * 45 Estimates of the crude birth rate and the general fertility rate are also presented in Table 4.1. For the period 1997-2000, the crude birth rate was 27.8 births per thousand population, and the general fertility rate was 120 births per thousand women. There are substantial differences by residence in both the CBR and the GFR. The lowest rates are found in the Urban Governorates, where the CBR was 23 births per thousand population and the GFR was 95 births per thousand women. In contrast, in rural Upper Egypt where the rates are highest, the CBR was estimated to be 33 births per thousand population, and the GFR was 157 births per thousand women. 4.2 COMPARISON OF CURRENT AND CUMULATIVE FERTILITY LEVELS Using the 2000 EDHS data, the trend in fertility in Egypt can be assessed in several ways. One approach is to compare the total fertility rate at the time of the survey with the mean number of children ever born (CEB) among women 40-49. The latter indicator takes into account the fertility behavior of older women who are nearing the end of their reproductive period and thus serves as a measure of cumulative fertility. If fertility is stable over time in a population, the TFR and the mean CEB for women 40-49 will be similar. If fertility levels have been falling, the TFR will be substantially lower than the mean CEB among women age 40-49. The comparison of the TFR with the mean CEB among women 40-49 in Table 4.2 suggests that fertility has fallen sharply in Egypt over the past several decades. Women age 40-49 had an average of 5.2 births during their lifetime, about one and a half births more than women bearing children at the current rates will have. The decline in fertility implied by a comparison of the TFR with completed fertility has been greater in rural than in urban areas. The largest implied decline in fertility by place of residence is observed in rural Lower Egypt, where the TFR was 2.2 births lower than the mean number of children ever born to women 40-49. 46 * Fertility Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and the mean number of children ever born to women age 40-49, by selected background character- istics, Egypt 2000 ______________________________________________________ Mean number Percent- of children Total age ever born Background fertility currently to women characteristic rate1 pregnant age 40-49 ______________________________________________________ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates Education No education Primary incomplete Primary complete/ some secondary Secondary complete/higher Work status Working for cash Not working for cash Total 3.09 4.7 4.32 3.88 6.7 6.03 2.89 3.9 3.87 3.24 5.7 5.15 3.05 4.8 4.39 3.31 6.0 5.50 4.24 6.9 6.03 3.39 5.7 4.93 4.66 7.6 6.73 3.80 6.7 5.60 4.09 5.8 6.01 3.78 5.1 5.14 3.36 4.2 4.53 3.22 6.9 3.01 2.65 4.4 3.67 3.66 6.0 5.45 3.53 5.8 5.15 ______________________________________________________ 1 Women age 15-49 years Table 4.2 also highlights mark- ed differences in fertility levels and trends by education. The TFR de- creases rapidly with increasing educa- tional level, from 4.1 births among women with no education to 3.2 births among women who had completed secondary or higher. The differentials in completed fertility across educa- tional groups are even more striking. The mean number of children ever born is 6.0 among women age 40-49 with no education, compared with 3.0 among women who have completed secondary school or higher. With re- gard to the trend in fertility, the de- cline in fertility implied by a compari- son of the TFR with the mean CEB is substantial for women with less than a secondary education. However, the TFR for women with a secondary or higher education is slightly higher than the mean number of children ever born among women age 40-49 with at least a secondary education. This pattern suggests that fertility levels among highly educated women may be in- creasing slightly after remaining rela- tively stable for several decades. The TFR is about one birth lower among women who are working for cash than among other women. Cumulative fertility is also lower among women who work in the cash economy than among other women. The decline in fertility implied by a comparison of the TFR with the mean CEB is greater among women who are not working or who do not receive cash for their work than among women who are employed in jobs for which they are paid in cash. Another indicator of current fertility, the percentage of women who are currently pregnant, is included in Table 4.2. Overall, 6 percent of the 2000 EDHS respondents were pregnant at the time of the survey. Women in rural Upper Egypt have the highest percentage currently pregnant (8 percent), while the percentage is lowest in the Urban Governorates (4 percent). Surprisingly, the percentage of women who were pregnant is higher for women with a secondary or higher education than for other women. This may be due at least in part to the fact that, on average, highly-educated women are younger than women in the other education categories and thus more likely to be in the family-building stage than other women. Fertility * 47 Table 4.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates, Egypt 1979-2000 _____________________________________________________________________________________________________ 1997 1998 1980 1984 1988 1991 1992 1995 Interim Interim 2000 EFS ECPS EDHS EMCHS EDHS EDHS EDHS EDHS EDHS ______ ________ ________ _________ ________ ________ _______ ________ ________ 1979- 1983- 1986- 1990- 1990- 1993- 1995- 1996- 1997- Age group 19801 19841 19882 19911 19922 19952 1997 19982 20002 _____________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 78 73 72 73 63 61 52 64 51 256 205 220 207 208 200 186 192 196 280 265 243 235 222 210 189 194 208 239 223 182 158 155 140 135 135 147 139 151 118 97 89 81 65 73 75 53 42 41 41 43 27 18 22 24 12 13 6 14 6 7 5 1 4 5.3 4.9 4.4 4.1 3.9 3.6 3.3 3.4 3.5 _____________________________________________________________________________________________________ 1 Rates are for the 12-month period preceding the survey 2 Rates are for the 36-month period preceding the survey Source: El-Zanaty et al., 1996, Table 3.2 El-Zanaty and Associates and Macro International Inc., 1998, Table 2.1 El-Zanaty and Associates and Macro International Inc., 1999, Table 2.1 4.3 FERTILITY TRENDS Trends in fertility can be assessed in several other ways. TFR estimates from the 2000 EDHS can be compared with estimates obtained in earlier surveys. Fertility changes can also be examined by using data from the birth histories obtained from the 2000 EDHS respondents to look at the trend in age-specific fertility rates for successive five-year periods before the survey. COMPARISON WITH PREVIOU S SURVEYS Table 4.3 shows the TFR estimates from a series of surveys conducted in Egypt during the period 1979 through 2000. The surveys vary in the timeframes for which the TFR estimates are available. For example, the rates from the EFS, ECPS and the EMCHS are based on births in a one- year period before the survey, while the rates for the DHS surveys are based on a three-year period before the interview date. In general, three-year rates are subject to less sampling variability than one-year rates. The size of the sample covered in a specific survey is another factor related to sampling variability. In general, rates from surveys with comparatively large samples are subject to less sampling variability than rates from surveys with smaller samples. Thus, the rates for the 1997 and 1998 Interim DHS surveys have somewhat greater margins of error than the standard DHS surveys (i.e., the surveys conducted in 1988, 1992, 1995, and 2000). Sampling errors for the TFRs derived from the 2000 EDHS are presented in Appendix C. As Table 4.3 shows, fertility levels have declined almost continuously in Egypt over the past two decades, from a level of 5.3 births per woman at the time of the 1980 EFS to 3.5 births per woman at the time of the 2000 EDHS. The decline in fertility was especially rapid during the period between the mid-1980s and the mid-1990s. The TFR reached a level of 3.3 births per woman at the time of the 1997 Interim DHS before rising to the level of 3.5 births per woman recorded in the 2000 EDHS. The sampling errors associated with the TFR estimates for the Interim DHS surveys are sufficiently large that the trend in the TFR estimates between the 1997 EDHS and 2000 EDHS 1 Residential differentials in the TFR are not available for the 1980 and the 1984 surveys. Because of the greater sampling variability, rates are not shown for the 1997 and 1998 Interim EDHS surveys. 48 * Fertility Table 4.4 Trends in fertility by residence Total fertility rates for the three years preceding the survey, by residence, Egypt 1986-2000 _____________________________________________________________________________ 1988 1991 1992 1995 2000 EDHS EMCHS EDHS EDHS EDHS ________ _________ ________ ________ _______ 1986- 1990- 1990- 1993- 1997- Residence 19881 19912 19921 19951 20001 _____________________________________________________________________________ Urban-rural residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt Urban Rural Frontier Governorates TFR 15-49 3.5 3.3 2.9 3.0 3.1 5.4 5.6 4.9 4.2 3.9 3.0 2.9 2.7 2.8 2.9 4.5 u 3.7 3.2 3.2 3.8 3.5 2.8 2.7 3.1 4.7 4.9 4.1 3.5 3.3 5.4 u 5.2 4.7 4.2 4.2 3.9 3.6 3.8 3.4 6.2 6.7 6.0 5.2 4.7 u u u 4.0 3.8 4.4 4.1 3.9 3.6 3.5 _____________________________________________________________________________ u = Unknown (not available) 1 Rates are for the 36-month period preceding the survey. 2 Rates are for the 12-month period preceding the survey Source: El-Zanaty et al., 1996, Table 3.4 surveys cannot be considered significant. However, the rise in the TFR observed in the DHS results is similar to the trend observed in crude birth rate estimates derived from the vital registration system (see Figure 1.1) during the period, suggesting that fertility levels in Egypt may in fact have risen slightly in the latter half of the 1990s before falling back to the level observed in the middle of the decade. The results in Table 4.3 indicate that all age groups have shared in the decline in fertility rates. However, the decline has been more rapid among older women than among younger women. Age-specific fertility rates among women age 30 and over fell by more than 40 percent between the 1980 EFS and the 2000 EDHS. In contrast, fertility rates among women under age 30 declined by only about 25 percent during this period. As a result of the differences in the pace of fertility change across various age groups, childbearing has become somewhat more concentrated among women under age 30. Currently, a woman will have an average of 2.3 births by her 30th birthday, roughly two-thirds of her lifetime births. This pattern is typical of countries like Egypt in which fertility levels are declining. The trend in fertility by residence is presented in Table 4.4 for the period between the 1988 EDHS and the 2000 EDHS.1 Urban fertility declined between the 1988 and 1992 surveys, from 3.5 to 2.9 births (Figure 4.2). The decline leveled off early in the 1990s, with the urban TFR fluctuating around three births throughout the rest of the 1990s. In rural areas, however, fertility levels declined continuously, from 5.4 births per woman at the time of the 1988 EDHS to 3.9 births per woman at the time of the 2000 EDHS. Fertility * 49 Table 4.5 Age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother’s age, Egypt 2000 ____________________________________________ Number of years preceding the survey Mother’s ________________________________ age 0-4 5-9 10-14 15-19 ____________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 53 72 106 123 195 220 267 280 208 223 270 294 145 157 203 237 72 91 [133] - 25 [44] - - [4] - - - ____________________________________________ Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. Place of residence was related to the pattern of fertility decline. Women in rural Upper Egypt experienced the greatest absolute change in fertility levels during the period, with the TFR dropping from 6.2 to 4.7 births per woman. The TFR in rural Lower Egypt was 4.7 births at the time of the 1988 survey (the level reached in 2000 in rural Upper Egypt) and dropped to 3.3 births at the time of the 2000 EDHS. RETROSPECTIVE DATA Fertility trends can also be investigated using retrospective data from the birth histories collected from respondents in a single survey. The age-specific fertility rates shown in Table 4.5 and in Figure 4.3 were generated from the birth history data collected in the 2000 EDHS. The numerators of the rates are c

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