Eritrea - Demographic and Health Survey - 1997

Publication date: 1997

Eritrea Demographic and Health Survey 1995 ® National Statistics Office Department of Macro Policy and International Economic Cooperation Office of the President ®DHS Demographic and Health Surveys Macro International Inc. World Summit for Children Indicators: Eritrea 1995 Value BASIC INDICATORS Childhood mortality Maternal mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Basic education Children in especially difficult situations Infant mortality rate (adjusted rate) 72 per 1,000 Under-five mortality rate 136 per 1,000 Maternal mortality ratio 985 per 100,000 Percent stunted 38.4 Percent wasted 16.4 Percent underweight 43.7 Percent of households within 15 minutes of a safe water supply I 16.4 Percent of households with flush toilets or VIP latrines 12.8 Percent of women 15-49 with completed primary education 18.5 Percent of men 15-49 with completed primary education 30.7 Percent of girls 6-12 attending school 40.4 Percent of boys 6-12 attending school 45.1 Percent of women 15-49 who are literate 34.8 Percent of children who are orphans (both parents dead) 0.7 Percent of children who do not live with their natural mother 10.0 Percent of children who live in single adult households 11.2 SUPPORTING INDICATORS Women's Health Birth spacing Safe motherhood Family planning Nutrit ion Maternal nutrition Low birth weight Breastfeeding Iodine Child Health Vaccinations Percent of births within 24 months of a previous birth Percent of births with medical prenatal care Percent of births with prenatal care in first trimester Percent of births with medical assistance at delivery Percent of births in a medical facility Percent of births at high risk Contraceptive prevalence rate (any method, currently married women Percent of currently married women with an unmet demand for family planning Percent of currently married women with an unmet need for family planning to avoid a high-risk birth 25.6 48.9 12.0 20.6 17.3 64.6 8.0 27.5 21.8 Percent of mothers with low BMI 40.6 Percent of births at low birth weight (of those reporting numeric weight) 20.7 Percent of children under 4 months who are exclusively breastfed 63.5 Percent of households with iodized salt 0.2 Percent of children whose mothers received tetanus toxoid vaccination during pregnancy Percent of children 12-23 months with measles vaccination Percent of children 12-23 months fully vaccinated Percent of children with diarrhea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) 33.3 51.0 41.4 37.6 Diarrhea control Acute respiratory infection Percent of children with acute respiratory infection in preceding 2 weeks who were seen by medical personnel 37.1 I Piped, well, and bottled water Eritrea Demographic and Health Survey 1995 National Statistics Office Department of Macro Policy and International Economic Cooperation Office of the President Asmara, Eritrea Macro International Inc. Calverton, Maryland USA March 1997 This report summarizes the findings of the 1995 Eritrea Demographic and Health Survey (EDHS) conducted by the National Statistics Office in the Department of Macro Policy and International Economic Cooperation, Office of the President. Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Development. The EDHS is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the Eritrea survey may be obtained from the National Statistics Office, P.O. Box 5838, Asmara, Eritrea (Telephone: 291-1-128034; Fax: 291-1-128034). Additional information about the DHS program may be obtained by writing to: DHS, Macro Inter- national Inc., 11785 Beltsville Drive, Suite 300, Calvertoo, MD 20705 (Telephone 301-572-0200; Fax: 301-572-0999). Recommended citation: National Statistics Office [Eritrea] and Macro International Inc. 1995. Eritrea Demographic and Health Survey, 1995. Calverton, Maryland: National Statistics Office and Macro International Inc. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Eritrea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAt~R 1 1.1 1.2 1.3 1A 1.5 1.6 CHAPTER 2 2.1 2.2 2.3 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography, History and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Historical Health Settings and Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Health Policy Goals, Priorities and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Family Planning Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Objectives and Organization of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.6.1 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.6.2 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.6.3 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.6.4 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.6.5 Response Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . 9 Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.1.1 Age-Sex Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.1.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.1.3 Educational Level of Household Members . . . . . . . . . . . . . . . . . . . . . . 13 2.1.4 School Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.1.5 Employment Status and Occupation of Hou,,ehold Population . . . . . . . . . 17 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 2.2.1 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.3.1 Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.3.2 Characteristics of Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.3.3 Education Level of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . 26 2.3.4 School Attendance and Reasons for Leaving School . . . . . . . . . . . . . . . 28 2.3.5 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2.3.6 Women's Employment Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 iii CHAPTER 3.1 3.2 3.3 3A 3.5 3.6 3.7 CHAPTER 4 Page 2.3.7 Women's Employer and Form of Earnings . . . . . . . . . . . . . . . . . . . . . . 31 2.3.8 Women's and Men's Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2.3.9 Decision on Use of Women's Earnings . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.3.10 Child Care While Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Retrospective Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Adolescent Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 FERTILITY REGULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.1 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.3 Current Use of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 4.4 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . 58 4.5 Knowledge of Contraceptive Effects of Breastfeeding . . . . . . . . . . . . . . . . . . . . 58 4.6 Source of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.7 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . 61 4.8 Reasons for Nonuse of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.9 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . . 63 4.10 Exposure to Family Planning Messages in the Electronic Media . . . . . . . . . . . . . 63 4.11 Acceptability of Use of Electronic Media to Disseminate Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.12 Exposure to Family Planning Messages in Print Media . . . . . . . . . . . . . . . . . . . 66 4.13 Discussion of Family Planning with Husband . . . . . . . . . . . . . . . . . . . . . . . . . . 67 4.14 Attitudes Toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 CHAFFER 6 6.1 6.2 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . 71 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Sexual Relationships Among Unmarried Women . . . . . . . . . . . . . . . . . . . . . . . 72 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Postpartum Amenorrhea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . 81 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Reproductive Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 iv 6.3 6.4 CHAPTER 7.1 7.2 7.3 7.4 7.5 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 8.6 8.7 CHAPTER 9 9.1 9.2 9.3 CHAPTER 10 Page Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Wanted and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 7 EARLY CHILDHOOD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Background and Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Levels and Trends in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . 100 Socioeconomic Differentials in Early Childhood Mortality . . . . . . . . . . . . . . . . 101 Biodemographic Differentials in Early Childhood Mortality . . . . . . . . . . . . . . . 103 High-Risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Medical Care at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Childhood Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 MATERNAL AND CHILD NUTRIT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Breastfeeding and Complementary Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Nutritional Status of Children under Age Three . . . . . . . . . . . . . . . . . . . . . . . 130 Matemal Anthropometric Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 AIDS AND OTHER SEXUALLY TRANSMITI ' I6D DISEASES . . . . . . . . . . . 137 10.1 Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 10.2 Awareness and Prevalence of Sexually Transmitted Diseases Among Men . . . . . 141 10.3 AIDS Knowledge and Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 10.4 Perception of Risk of Getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 10.5 Behavior Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 10.6 Source of Condom Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 10.7 Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 CHAPTER 11 MATERNAL MORTAL ITY AND ADULT MORTAL ITY . . . . . . . . . . . . . . . 161 11.1 The Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 11.2 Direct Estimates of Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 11.3 Direct Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 11.4 Indirect Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 11.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 CHAPTER 12 FEMALE C IRCUMCIS ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 12.1 Practice of Female Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 V Page 12.2 Problems Associated with Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 12.3 Attitudes Toward Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 12.4 Reasons for Attitudes Toward Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . 176 CHAPTER 13 LOCAL AVAILABIL ITY OF FAMILY PLANNING AND HEALTH SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 13.1 Service Availability Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 13.2 Accessibil ity of Rural Clusters to Urban Centers . . . . . . . . . . . . . . . . . . . . . . 181 13.3 Availability of Educational Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 13.4 Availability of Other Facilities and Services . . . . . . . . . . . . . . . . . . . . . . . . . . 185 13.5 Availability of Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 13.6 Availability of Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 13.7 Malaria Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 13.8 Health Campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 A.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 A.2 Sampling Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 A.3 Characteristics of the EDHS Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 A.4 Sample Allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 A.5 Stratification and Systematic Selection of Clusters . . . . . . . . . . . . . . . . . . . . . 202 A.6 Segmentation of Large PSUs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 A.7 Grouping of Small Villages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 A.8 Sampling Probabilities of Selected PSUs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 A.9 Male Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 A.10 New Reporting Domains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 A. I 1 Sample Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 APPENDIX C DATA QUAL ITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 APPENDIX D PERSONS INVOLVED IN THE 1995 ERI?I'REA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 vi Table 1.1 Table 2.1 Table 2.2 Table 2.3 Table 2A Table 2.5.1 Table 2.5.2 Table 2.6 Table 2.7.1 Table 2.7.2 Table 2.8.1 Table 2.8.2 Table 2,9 Table 2.10 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16 Table 2.17 Table 2.18.1 Table 2.18.2 Table 2.19 Table 2.20 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 TABLES Page Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Household population by age, sex and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Population by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Foster children and orphans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . 14 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Employment status: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Employment status: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Occupation of the household population: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Occupation of the household population: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Differential characteristics between spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 School attendance and reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Women's employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Occupation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Employment and occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Decision on use of women's earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Trends in fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 vii Table 3.7 Table 3.8 Table 3.9 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5.1 Table 4.5.2 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8.1 Table 5.8.2 Table 5.9 Page Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Knowledge of contraceptive methods by background characteristics . . . . . . . . . . . . . . 51 Knowledge of contraceptive methods among couples . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Current use of family p°anning: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Current use of family planning: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Current use of family p'anning by background characteristics . . . . . . . . . . . . . . . . . . . 57 Number of children at filst use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Heard about family planning on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Wives' perceptions of their husbands' attitudes toward family planning . . . . . . . . . . . 68 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Spouse's actual and perceived attitudes toward family planning . . . . . . . . . . . . . . . . . 70 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Sexual relationships of unmarried women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Postpartum amenorrhea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . 81 viii Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5.1 Table 6.5.2 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 8.14 Table 9.1 Table 9.2 Table 9.3 Page Median duration of postpartum insusceptibility by background characteristics . . . . . . 82 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . . . . . . . . 88 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . . . . . . . . 89 Need for family planning services: currently married women . . . . . . . . . . . . . . . . . . . 91 Need for family planning services: all women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . 95 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Infant and child mortality by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . 102 Infant and child mortality by biodemographic characteristics . . . . . . . . . . . . . . . . . . . 103 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . 109 Tetanus toxoid vaccinations and antenatal supplementation . . . . . . . . . . . . . . . . . . . . 110 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . . . . 114 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Vaccinations in first year of life by current age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Prevalence and treatment of acute respiratory infection and prevalence of fever . . . . 119 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Knowledge of diarrhea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 ix Table 9A Table 9.5 Table 9.6 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5.1 Table 10.5.2 Table 10.6.1 Table 10.6.2 Table 10.7.1 Table 10.7.2 Table 10.8 Table 10.9 Table 10.10 Table 10.11.1 Table 10.11.2 Table 10.12 Table 10.13 Table 11.1 Table 11.2 Table 11.3 Table I1A Table 12.1 Table 12.2.1 Table 12.2.2 Table 12.3 Table 12A Table 12.5 Table 12.6.1 Page Types of food received by children in the preceding 24 hours . . . . . . . . . . . . . . . . . . 129 Nutritional status of children by background characteristics . . . . . . . . . . . . . . . . . . . . 132 Nutritional status of mothers by background characteristics . . . . . . . . . . . . . . . . . . . . 135 Number of recent sexual partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Person with whom most recent sexual intercourse occurred: men . . . . . . . . . . . . . . . 140 Payment for sexual relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Knowledge of sexually transmitted diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Knowledge of AIDS and sources of AIDS information: women . . . . . . . . . . . . . . . . 143 Knowledge of AIDS and sources of AIDS information: men . . . . . . . . . . . . . . . . . . 144 Knowledge of ways to avoid AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Knowledge of ways to avoid AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Awareness of AIDS-related health issues: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Awareness of AIDS-related health issues: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Perception of the risk of getting AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Perception of the risk of getting AIDS among couples . . . . . . . . . . . . . . . . . . . . . . . . 152 Reason for perception of small/no risk of getting AIDS . . . . . . . . . . . . . . . . . . . . . . . 152 AIDS prevention behavior: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 AIDS prevention behavior: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Knowledge of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Use of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Adult mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Indirect estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Prevalence and type of female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Age at circumcision: eldest daughter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Age at circumcision: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Persons who perform female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Problems associated with circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Source of treatment for problems associated with circumcision . . . . . . . . . . . . . . . . . 170 Attitudes toward female circumcision by circumcision status of respondent and respondent's daughter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Table 12.6.2 Table 12.7.1 Table 12.7.2 Table 12.8 Table 12.9 Table 13.1 Table 13.2 Table 13.3 Table 13.4 Table 13.5 Table 13.6 Table 13.7 Table 13.8 Table 13.9 Table 13.10 Table 13.11 Table 13.12 Table A.1 Table A.2 Table A.3 Table A.4 Table A.5 Table A.6.1 Table A.6.2 Table B. 1 Table B.2 Table B.3 Table B.4 Table B.5 Table B.6 Table B.7 Page Attitudes toward female circumcision according to selected background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Preferred type of circumcision according to circumcision status of respondent and respondent's daughter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Preferred type of female circumcision according to selected background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Reasons for favoring continuation of female circumcision . . . . . . . . . . . . . . . . . . . . . 176 Reasons for favoring discontinuation of female circumcision . . . . . . . . . . . . . . . . . . . 178 Main access route to community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Transportation to nearest town . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Distance to nearest educational facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Distance to various facilities and associations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Distance and time to nearest facility providing delivery care . . . . . . . . . . . . . . . . . . . 186 Antenatal and delivery care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Distance to nearest maternal and child health services for children . . . . . . . . . . . . . . 188 Distance and time to nearest facility providing child immunization . . . . . . . . . . . . . . 189 Distance to nearest source of child health services . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Distance and time to nearest facility providing family planning . . . . . . . . . . . . . . . . . 190 Distance to nearest source for family planning methods . . . . . . . . . . . . . . . . . . . . . . . 191 Health campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Characteristics of the sampling frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Estimated population of Eritrea according to the 1994 sampling frame . . . . . . . . . . . 198 Estimated population of Eritrea according to the FAO . . . . . . . . . . . . . . . . . . . . . . . . 198 Estimated population distribution and sample allocation . . . . . . . . . . . . . . . . . . . . . . 200 Distribution of samples of clusters, women and households . . . . . . . . . . . . . . . . . . . . 201 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Sampling errors - National sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Sampling errors - Urban sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 Sampling errors - Asmara sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Sampling errors - Other town sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 Sampling errors - Rural sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Sampling errors - Southern Red Sea Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 xi Table B.8 Table B.9 Table B.10 Table B.11 Table B.12 Table C.1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Page Sampling errors - Northern Red Sea Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Sampling errors - Anseba Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 Sampling errols - Gash-Barka Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Sampling errors - Southern Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Sampling error s - Central Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Age distribution of eligible and interviewed women and men . . . . . . . . . . . . . . . . . . 230 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 xii Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 5.1 Figure 6.1 Figure 6.2 Figure 6.3 Figure 6.4 Figure 7.1 Figure 7.2 Figure 8.1 Figure 8.2 FIGURES Page Distribution of the household population by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Distribution of the de facto household population by single year of age and sex . . . . ! 1 Percentage of the population age 6-24 enrolled in school by age and sex . . . . . . . . . 16 Housing characteristics by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Age-specific fertility rates by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Total fertility rates by selected background characteristics . . . . . . . . . . . . . . . . . . . . 41 Adolescent childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Current use of family planning, selected countries in Southern and East Africa, 1992-95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Contraceptive use by currently married women 15-49 according to background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Distribution of current users of modem contraceptive methods by source of supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Percentage of married women in a polygynous union by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Fertility preferences of currently married women 15-49 . . . . . . . . . . . . . . . . . . . . . . 86 Fertility preferences of married women by number of living children . . . . . . . . . . . . 87 Percentage of currently married women and men who want no more children by residence and education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Currently married women with unmet need and met need for family planning services by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Trends in infant and under-five mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Under-five mortality by selected demographic characteristics . . . . . . . . . . . . . . . . . 104 Percent distribution of births by antenatal care and delivery characteristics . . . . . . 108 Percentage of children age 12-23 months who have received all vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 xiii Figure 8.3 Figure 9.1 Figure 9.2 Figure 10.1 Figure 10.2 Figure 12.1 Figure 12.2 Figure 12.3 Figure 13.1 Figure 13.2 Page Prevalence of respiratory illness and diarrhea in the two weeks preceding survey by age of child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Prevalence of stunting by age of child and length of birth interval . . . . . . . . . . . . . 133 Nutritional status of children under three years, mean z-scores by age in months . . 134 Changes in sexual behavior after hearing about HIV/AIDS, by sex . . . . . . . . . . . . . 156 Percentage of women who do not know a source for condoms among women 15-49 who have heard of AIDS and who have had sexual intercourse . . . . . . . . . . . 158 Percentage of circumcised women who had problems during sex or at delivery by type of circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Support for female circumcision by background characteristics . . . . . . . . . . . . . . . 173 Reasons for opposing female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Percent distribution of rural sampling points by distance to the nearest town . . . . . 182 Percent distribution of women by distance to the nearest facility for malaria treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 xiv PREFACE The National Statistics Office (NSO) conducted the first Demographic and Health Survey (EDHS) between September and December 1995. The EDHS is the first comprehensive survey carried out by the NSO since its formation in late 1992. A preliminary report of the EDHS was distributed in April 1996. This report presents the major findings of the 1995 EDHS in greater detail. Eritrea as a newly independent country did not inherit a functional National Statistical System and as such the country lacks most of the crucial information that is vital to the enhancement of its development programmes. Attempts are underway to fill the information gap in earnest. The EDHS is one of those attempts and will no doubt benefit broad users. The main objective of the EDHS is to provide policymakers and programme formulators in population and health with adequate and reliable information. The EDHS collected information on demographic characteristics, fertility, infant and child mortality, maternal mortality, nuptiality, fertility preferences, family planning and health-related matters such as breastfeeding practices, antenatal care, children's immunization, childhood disease, nutritional status of mothers and young children and awareness and behaviour regarding sexually transmitted diseases including AIDS. The NSO extends its acknowledgment and gratitude to the various institutions and individuals in the government, cooperation partners and the public for their support in facilitating the successful implementation of the survey. However, special mention is due to the following: Department of Macro Policy and International Economic Co-operation for the follow-up of the programme. The Ministry of Local Government and the City Administrations for crucial assistance all the way down to the village/mimhidar level to enhance smooth field operations. The Ministry of Defence for facilitation of field operation in remote areas. The Ministry of Health for close cooperation in the whole operation, and for the signifi- cant technical and logistical inputs. United States Agency for International Development (USAID) for funding assistance. Macro International Inc. (Maryland USA) for technical assistance. The UNDP, UNFPA and UNICEF for logistics and financial support. All the EDHS field personnel for commitment to high-quality work in difficult working conditions. The EDHS respondents for patience and cooperation in supplying the necessary information and Last but not least the NSO staff, few as they are but who made the survey successful through commitment and a spirit of team work. February 1997 National Statistics Office P.O. Box 5838 Asmara XV SUMMARY OF FINDINGS The Eritrea Demographic and Health Survey (EDHS) is a nationally-representative survey of 5,054 women age 15-49 and 1,114 men age 15-59. The EDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, maternal and child health, maternal mortality, and female circumcision. Fieldwork for the EDHS took place from mid-September 1995 to mid-January 1996. FERTILITY Fertility Levels. EDHS data indicate that fertility in Eritrea is high. The total fertility rate is 6.1 births per woman, the crude birth rate for the period 1992-94 was 37.5 live births per 1,000 population, and the general fertility rate for the three-year period was 198 births per 1,000 women. Fertility Differentials. Fertility is substantially lower among women in Asmara, who have only 3.7 children per woman on average, and women in urban areas (4.2 children per woman on average) than among rural women (7.0 children). Moreover, women who have received some secondary education have the lowest level of fertility, with a total fertility rate of 3.0, compared with a rate of around 7 children per woman for those with no education, a difference of four children. Age at First Birth. Compared with most countries in sub-Saharan Africa, childbearing begins late in Eritrea, with just under half of women becoming mothers by the time they reach age 21, This is tme for both urban and rural areas. Teenage childbearing is not common among women in Asmara and other towns but is fairly common among women in mral areas in Eritrea. Overall, less than one-quarter of teenage women (age 15-19) have begun childbearing, with 19 percent having had a child already and 4 percent carrying their first child. One-third of rural teenagers have either become mothers or are on their way to becoming mothers, compared with only 7 percent of urban teenagers. Teenage pregnancy is a challenge to policymakers since EDHS data show that children born to young mothers suffer higher rates of morbidity and mortality. Birth Intervals. The majority of Eritrean children (74 percent) are born after a "safe" birth interval (24 or more months), with more than one-third born at least 36 months after a prior birth. Nevertheless, one in four non-first births occurs less than 24 months after the preceding birth, with 11 percent occurring less than 18 months since the previous birth. The overall median birth interval is 31 months. The median birth intervals in urban and rural areas are practically the same. Fertility Preferences. Survey data indicate that Eritrean women and men desire large families. Among those with seven or more children, 29 percent of married women and 42 percent of married men want to have more children. Overall, women report a mean ideal number of children of 6.0, compared with 6.9 children for men; ideal family size is higher among currently married women and men (6.6 and 7.8, respectively). Only 4 percent of women regard a two-child family as ideal. Men are more pronatalist than women: 23 percent of men desire 10 or more children compared with 12 percent of women. Unplanned Fertility. Despite the low level of contraceptive use, unplanned pregnancies are not common due to high ideal family size and moderate birth intervals. Overall, 18 percent of current pregnancies and births in the three years prior to the survey were reported to be unplanned; most were xvii mistimed (wanted later), although 5 percent were unwanted. If unwanted births could be eliminated alto- gether, the total fertility rate in Eritrea would be 5.7 births per woman instead of the actual level of 6.1. FAMILY PLANNING Knowledge of Contraceptive Methods. Only about two-thirds of women and four-fifths of men know of at least one modem method of family planning. Among both currently married women and men, the pill is the best known method, while injectables and condoms are also well known. Use of Contraception. The contraceptive prevalence rate in Eritrea is only 8 percent. Three percent of currently married women reported using breastfeeding to prevent pregnancy, 2 percent use the pill, and less than 1 percent use any other method. Differentials in Family Planning Use. Differentials in current use of family planning by residence are large. One-quarter of married women in Asmara are contraceptive users, compared with 11 percent of women in other towns and 5 percent in rural areas. Use of any method is highest in the Central Zone (21 percent) and lowest in the Anseba and Gash-Barka Zones. There are large differentials in current use by level of education. Four percent of currently married women with no formal education are currently using a method, compared with 40 percent of those with some secondary education. Source of Contraception. Four in five current users of modem methods obtain their methods from public sector sources, while 17 percent use private sector medical sources and 5 percent use other private sources. The predominant source of contraceptives in the public sector is the Planned Parenthood Association of Eritrea, providing contraceptives to 40 percent of current users of modem methods. Family Planning Messages. Almost 4 in 10 women and men interviewed reported that they had heard a family planning message on radio and/or television in the few months prior to the survey. Women and men in the Gash-Barka Zone were least exposed to family planning messages, with only 14 percent of women and 22 percent of men having heard a family planning message, compared with over two-thirds of women and men in the Central Zone. Unmet Need for Family Planning. There is a considerable unmet need for family planning services in Eritrea. Overall, slightly more than 27 percent of currently married women are in need of services--21 percent for spacing their next birth and 6 percent for limiting births. If all currently married women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 8 to 35 percent. Currently, 22 percent of the "total demand" for family planning is being met. Availability of Family Planning Services. Family planning services are not widely available in Eritrea. Only one-third of married women live within 5 kilometers of a source of family planning, and only one-quarter of married women can reach the nearest facility providing family planning services within 30 minutes. MATERNAL AND CHILD HEALTH High Childhood Mortality. Childhood mortality in Eritrea is high, but there is evidence of a decline in recent years. Currently, the direct estimate of the infant mortality rate for 0-4 years before the survey is 72 deaths per 1,000 births (adjusted for age at death heaping); under-five mortality is 136 deaths per 1,000 births. This means that one in seven children born in Eritrea dies before reaching her/his fifth birthday. xviii Childhood Vaccination Coverage. The EDHS results show that 41 percent of children age 12-23 months are fully vaccinated and 38 percent have not received any vaccinations. The proportion of children age 12-23 months who were fully vaccinated before their first birthday is 30 percent. This is an improvement from 19 percent of children 24-35 months who were estimated to have been fully vaccinated during their first year of life. While four-fifths of children 12-23 months in urban areas are fully vaccinated, less than one-third of children 12-23 months in rural areas are fully vaccinated, and a large proportion have not received any vaccination. Childhood Health. EDHS data point to relatively high levels of childhood illness. Approximately one in four children under age three had a respiratory illness during the two weeks before the survey. Of these, 37 percent were taken to a health facility or provider for treatment. More than four in ten children under age three were reported to have had a fever and one-fourth were reported to have had diarrhea in the two weeks preceding the survey. About two-thirds of the children with diarrhea received some sort of oral rehydration therapy (a solution prepared from packets of oral rehydration salts (ORS), a homemade sugar-salt-water solution, or increased fluids). Sixty-four percent of mothers know about the use of ORS packets, yet when asked about specific eating and drinking regimes for sick children, only half say that a child who is sick with diarrhea should be given more to drink than usual, and more than half say a child with diarrhea should be given less to eat than usual. Breastfeeding Practices. Breastfeeding is almost universally practiced in Eritrea, with a median duration of 22 months. Since breastfeeding has beneficial effects for both the child and the mother, it is encouraging to note that complements to breast milk start relatively late in Eritrea. In the first two months, only 14 percent of children receive supplements other than water and breast milk. At age 4-5 months, 29 percent of children are given some form of food supplementation. Also encouraging is the fact that the use of infant formula and bottle feeding are not common. However, only three-fourths of children who are breastfed receive complementary foods or drinks at the recommended age of 7-9 months. Childhood Nutritional Status. Overall, 38 percent of Eritrean children under age three are classified as stunted (low height-for-age) including 18 percent who are severely stunted. About 15 percent of children under three in Eritrea are wasted (low weight-for-height); 3 percent are severely wasted. Rural children are more likely to be malnourished than urban children. Maternal Health Care. EDHS data point to several areas of maternal and child health care in which improvements could be made. For births in the three years before the survey just half of Eritrean mothers received antenatal care. Of these, half received care from a doctor and half from a nurse or trained midwife. For 30 percent of births mothers received iron tablets and for 33 percent they received multivitamin tablets. Tetanus toxoid coverage is not high in Eritrea; mothers received two or more tetanus toxoid injections during pregnancy for less than one-fourth of births in the three years before the survey. Only 17 percent of births are delivered in a health facility while 21 percent of births are assisted by trained medical personnel. Maternal health care in rural areas is much poorer than in urban areas. Proper medical attention during pregnancy and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness for the mother or the newborn. Female Circumcision. Female circumcision is almost universal in Eritrea, with 95 percent of women having been circumcised. Younger women (age 15-19) and women living in the Southern and Central Zones are slightly less likely to be circumcised than other women. Of circumcised women, 6 in 10 had clitoridectomy, one in three received infibulation, and 4 percent had excision. One in five circumcised women had a problem during sexual relations or during delivery; 9 percent had both types of problems. The majority of women (three-fourths) with these problems did not seek any outside treatment. Fifty-seven percent of women and 46 percent of men interviewed support continuation of the xix practice, whereas 38 percent of women and 42 percent of men think that the practice of female circumcision should be discontinued. AIDS. Seventy-two percent of women and 89 percent of men know about AIDS. Radio and friends and relatives are the main sources for knowledge of AIDS among both women and men. Forty-seven percent of women and 41 percent of men say that limiting the number of sexual partners or having only one partner can prevent the spread of the disease. About 35 percent of men and women say that using condoms is a way to avoid AIDS. However, knowledge of ways to avoid AIDS is related to respondents' education. Safe patterns of sexual behavior are less commonly reported by respondents who have little or no education than those with more education. Overall, 93 percent of women and 99 percent of men believe that they have little or no chance of being infected with AIDS. Availability of Health Services. Roughly half of women in Eritrea live within 5 km of a facility providing antenatal care and delivery care, and 40 percent of children under three live within 5 km of a facility providing immunization services. However, children whose mothers received both antenatal and delivery care are more likely to live within 5 km of a facility providing maternal and child health (MCH) services (60 percent) than those whose mothers received neither antenatal nor delivery care (20 percent). XX ERITREA \ SAUDI ARABIA X Anseba Barentu Gash-Barka Northern _ Red Sea Centra l •nere• Li . . . . . ~ ~ a . (3 T • h, ! , .~,~-Dahlak Archipelago .,~ ~. :o ETHIOPIA N 1 = * . . "4 10 . . . % . . I . J Red Sea Zuqur Hanish Archipelago Aseb DJIBOUTI REPUBLIC OF YEMEN CHAPTER 1 INTRODUCTION 1.1 Geography, History and Economy Geography Eritrea, shaped like a hatchet, lies north of the equator and just north of the Horn of Africa. It is bounded in the northwest by the Sudan, in the south by Ethiopia, and in the southeast by Djibouti. Its longest border, the "handle" of the hatchet, is in the east on the Red Sea. The country has a coastline of more than 1,000 kilometers (625 miles) and its territory includes more than 350 islands. Eritrea's proximity to the Red Sea together with its physical features account for its varied climate and rainfall. The highlands have a cool temperate climate while the lowlands are characterized by a hot and humid climate, especially along the coast. Eritrea is in the Saharan rainfall zone and receives its heaviest rains from the southwest monsoons. In normal years, rainfall varies from an annual average of 400 mm to 650 mm in the highlands and from 200 mm to 300 mm in the lowlands. History On 1 January 1890, Italy set the boundaries of Eritrea and ruled it as a colony until 1941 when the British defeated the Italians in the African theater and took over the administration of Eritrea. During World War II, the British made Eritrea into an important center for British and American operations in the region. With Italy's defeat in the Second World War, the question of the disposal of its colonies was raised in the United Nations (UN). The UN sent several multinational investigative teams to Eritrea to conduct local surveys on the wishes of the people. Different teams came up with different solutions, including dividing Eritrea into various portions and awarding them to Britain, France and Ethiopia; maintaining the protectorate for 10 years and then conducting a referendum; and granting full independence. After some years of deliberation, the UN adopted a resolution federating Eritrea with Ethiopia, but guaranteeing Eritreans some democratic rights and autonomy. However, during the federation with Ethiopia, Emperor Halle Selassie's government systematically violated the rights granted by the UN. In 1961, an armed struggle for independence began after years of peaceful protest against Ethiopian infringements on Eritrean democratic rights and autonomy produced no improvement in a deteriorating situation. The Emperor's transgressions culminated in the unilateral dissolution of the Eritrean parliament and annexation of Eritrea as Ethiopia's fourteenth province in 1962. In May 1991, 30 years after the struggle for independence began, the Eritrean People's Liberation Front (EPLF) liberated the entire country and established the Provisional Government of Eritrea (PGE). At the same time, the Ethiopian People's Revolutionary Democratic Front overthrew the Dergue, the Ethiopian Military junta, and instituted a Transitional Govemment in Ethiopia (TGE). In July 1991, at a national conference in Addis Ababa held to deliberate on the future of the country, the TGE endorsed the EPLF's decision to settle the Eritrean question in a referendum to be held two years hence, in which only Eritreans would participate. In April 1993, the PGE conducted an internationally supervised referendum in which 98.5 percent of the population participated; 99.8 percent voted for independence. The head of the UN observer mission said the referendum was "free and fair at every stage." Other observer groups confirmed this. After Eritreans celebrated their official independence on 24 May 1993, the Government was enlarged and reorganized, and a timetable of four years was set to accomplish the drafting of a constitution, development of political pluralism, and the establishment of an elected government (Ministry of Foreign Affairs, 1995). Economy Economically, the thirty-year war of liberation caused decades of lost development as well as the destruction of economic and social infrastructures. In 1995, Eritrea was a low-income developing country with a per capita income of less than US $200 per year. Over 70 percent of Eritrea's people depend for their livelihood on traditional subsistence agriculture including crop farming, livestock raising and fishing, although commercial agriculture and fishing have recently been revived. Eritrea's industrial base is extremely backward and narrow as it is made up of small- and medium-scale consumer-goods producing industries (food, beverages, leather goods, textiles, etc.) whose technology is largely out of date as a result of neglect of investment during the long war. Eritrea has, however, ample natural resources including over 2 million hectares of potentially arable land and the vast Red Sea continental shelf. The Red Sea fishing grounds are estimated to be capable of sustaining a production level of around 70,000 tons of fish per annum, while the current production level is less than 5,000 tons per year. As far as mineral resources are concerned, studies indicate the existence of base metals (gold, copper, zinc, lead, silver etc.) in several parts of the country but the commercial viability of the deposits has yet to be established. In fact, several companies have recently applied and received licenses to undertake exploration and prospecting work for base metals in the promising areas of the country. The potential for extracting petroleum from the Red Sea is also considered to be good and one company has already been granted an exploration license. Government development efforts since independence have concentrated on rehabilitating and rebuilding the war-damaged and destroyed economic and social infra- structures, creating and strengthening the institutions of a new state, and laying down the policy and legisla- tive groundwork for development. In November 1994, the government issued a Macro-Policy statement which spells out the broad goals and strategies of development for the next twenty years. According to the Macro-Policy, "The creation of a modem technologically advanced and internationally competitive economy within the next two decades is an overriding national development objective." The key strategies envisaged in realizing this objective are ". human capital formation with education and health as key inputs, export oriented development both in industry and agriculture, infrastructure development to remove critical bottlenecks, environmental restoration and protection, and the promotion of the private sector." 1.2 Population Since there has not been any survey or census conducted in the country before or after independence, the population size is not known with any degree of precision. Some rough professional estimates put the country' s population in the range of 2.5 to 3.5 million. Estimates of the number of Eritreans living abroad range between 700,000 and 1,000,000. The population is culturally and linguistically diverse, consisting of nine ethnic groups, namely: Tigre, Tigrigna, Saho, Hedarib, Bilen, Kunama, Nara, Afar and Rashaida. 1.3 Historical Health Settings and Problems At the end of the 19th century the Italians introduced a medical service into Eritrea, initially designed purely to protect the settlers from the tropical diseases they encountered. They established a hospital at Asmara, and set up clinics in the areas of Italian settlement. Later, the post-war Labor government during the British occupation opened a network of dispensaries, and although some facilities, such as the hospital at Zula, were dismantled when the British left, Eritrea had a relatively advanced health service by the beginning of the federal period. This health system initially prospered under the Eritrean Administration. Mother and Child Health clinics were established and hospitals renovated (Firebrace and Holland, 1987). But since colonization, little had been done to teach the rural population about the causes and spread of disease. Sanitation and hygiene were rudimentary. In the late 1950s Halle Selassie's regime began to cut Eritrea's health budget, which by 1965 had fallen to a third of its 1955 level (Firebrace and Holland, 1987). As the Eritrean liberation movement become more active, the Ethiopians began to close and destroy clinics. In the rural areas, where the limited health services provided by successive colonial authorities had minimal impact, traditional healers were still consulted and commanded respect. The Eritrean Peoples Liberation Front (EPLF) set up clinics in the settled areas and served the nomadic zones and the contested areas with mobile teams. The EPLF health service started in 1970 with a single mobile clinic only competent to treat malaria and give basic first aid. Training of the first group of 25 "barefoot doctors" began in 1972, but it was not until the period 1975-78 that the health service really became effective. During these years hundreds of skilled Eritreans, including doctors, nurses and paramedical staff, fled the towns and joined the EPLF. Health services were rendered to both combatants and civilians (Firebrace and Holland, 1987). The major health problems in Eritrea are communicable and nutritional deficiency diseases. Among the communicable diseases are diarrhea, acute respiratory infections, tuberculosis, malaria, HIV/AIDS, and parasitic infections. Vaccine preventable diseases are still common among children. 1.4 Health Policy Goals, Priorities and Programs The national health policy is based on the concept and principles of primary health care (PHC), and is designed and developed in such a way that it serves the interest of the majority of the population (Ministry of Health, 1993). The key element of the concept is to promote a holistic approach to health with the active participation of the community. It is also to move away from the medical model of health delivery to a much broader notion of well-being, made possible through more accessible health services provided by the community-based health services system. The main components of PHC include maternal and child health (MCH) services, family planning, health and nutritional education, expanded program on immunization, control of communicable diseases, water and sanitation, provision of basic and essential preventive and curative care, and provision of essential drugs. All such programs and activities are integrated and are provided in almost all health facilities at different levels. Since liberation in 1991, the Ministry of Health (MOH) has made significant progress in ensuring access to health care services through the restoration of health facilities which were damaged by war or were in a state of decay because of inadequate maintenance; the provision of an adequate supply of essential drugs, supplies and equipment for effective provision of health services; and the expansion of available health services to populations which lacked health care, through the construction of new facilities. Currently, the MOH is operating 20 hospitals, 43 health centers and 136 health stations, most of which are government owned (Ministry of Health, 1995). Moreover, the last few years have seen an expansion of the water and sanitation program as a strategy to control diarrheal diseases; the expansion of the immunization program for children under five and expectant mothers aimed at improving the health status of mothers and children; the provision of health care service for nominal fees to the majority of the population; and the training of traditional birth attendants in order to improve the quality of care for mothers who do not deliver at health facilities. The supplementary feeding programs for children under five and 3 expectant mothers in drought-stricken areas has improved the health status of "at-risk groups." One of the greatest achievements of the MOH is in the development of human resources. Training of human power needed to staff health institutions is being carried out at a reasonable pace. A large number of nurses, midwives and health assistants have been trained. Moreover, the skills of ex-fighters who have had basic training in various fields of health--nurses, X-ray technicians, laboratory technicians, pharmacy technicians, dental clinicians, ophthalmic officers, assistant physiotherapists, anesthetists etc.--have been upgraded. A few health workers are also being trained abroad. Additionally, refresher courses and modular training on different program activities and management have been conducted. 1.5 Family Planning Policies and Programs Family planning (FP) services in Eritrea were started as a branch of the Family Guidance Association of Ethiopia (FGAE), which has been in place since 1972. The Association had limited activities, and these were confined to urban areas of the country during the war of liberation (IPPF Africa Region, 1996). Soon after liberation in 1991, one of the areas of concern for the MOH was to identify health problems related to mothers and children. Although it was not a well-structured survey, the maternal mortality ratio in Eritrea was estimated to be at least 700 per 100,000 live births (Ministry of Health, 1995). The total fertility rate was estimated to be 5.8, and in 1992, the MOH estimated that 19 percent of pregnant women received antenatal care and that 6 percent of all deliveries were attended by trained health workers. Tetanus toxoid coverage was estimated from administrative reports to be 13 percent in 1995. The availability and quality of family planning services are poor in many regions of the country and the medical consequences of unsafe abortions are frequently seen. These data suggest that reproductive health is a major public health problem in Eritrea. With these facts in mind, the MOH created a section of MCH/FP under the PHC division. Family planning services were provided in areas where MCH services were delivered. Additionally, the Planned Parenthood Association of Eritrea (PPAE) was established in 1992. Its main concern is to complement the government's efforts in the integration of family planning education and services into developing programs and to promote reproductive health rights and services among the marginalized rural population, youth, women and refugees (IPPF Africa Region, 1996). In spite of these efforts, family planning services were not as they were expected to be, and the MOH is in the process of restructuring itself. Family planning services will be handled through the Sexual and Reproductive Health Program, which will: Cover all men and women of reproductive age as the primary target groups for family planning services; Improve the accessibility, acceptability and quality of family planning and health services through greater involvement of the community, increased use of the private sector, improved quality of provider-client transactions, and improved program management and evaluation; Offer consumers a range of appropriate, safe, and effective contraceptive methods combined with comprehensive information and counseling; Emphasize information and services for women whose health or whose children's health would suffer from pregnancy and childbirth. This means a national campaign to: 4 Reduce pregnancies among younger and older/high parity women; Encourage spacing of children; Decrease unwanted pregnancy and unsafe abortion; Educate and inform policymakers, opinion leaders, communities, families and individuals' about the health benefits of family planning, utilizing a range of culturally appropriate communication measures; Improve provider competence through clinical training and careful attention to better communication skills, including greater sensitivity to clients' perceptions and beliefs; Improve client-provider relations through better selection, training and deployment of field workers and continuous supportive supervision; Develop mechanisms to ensure constant availability of services to encourage continued contraceptive use; and Create an appropriate constellation of services that are both acceptable and convenient to clients, and are linked to primary health care and reproductive health services. 1.6 Objectives and Organization of the Survey The Eritrea Demographic and Health Survey (EDHS) is the first survey ever undertaken by the National Statistics Office (NSO) of the Department of Macro Policy and International Economic Cooperation, Office of the President. It was implemented through the worldwide Demographic and Health Surveys (DHS) program of Macro International Inc. The EDHS was funded by the U.S. Agency for International Development (USAID), and technical assistance was provided by Macro International Inc. of Calverton, Maryland, U.S.A. through its contract with USAID. The UNFPA and UNICEF also provided some financial assistance. The objectives of the EDHS are to: Collect data at the national level which will allow the calculation of demographic rates, particularly fertility and childhood mortality rates; • Analyze the direct and indirect factors which determine levels and trends of fertility; Measure the level of contraceptive knowledge and practice (women and men) by urban-rural residence; Collect reliable data on maternal and child health indicators: immunizations, prevalence and treatment of diarrhea and diseases among children under age three, antenatal care visits, assistance at delivery, and breastfeeding; Assess the nutritional status of children under age three, and their mothers, by means of anthropometric measurements (height and weight ) and analysis of child feeding practices; and Assess the prevailing level of specific knowledge and attitudes regarding AIDS and to evaluate patterns of recent behavior regarding condom use, among women and men. 5 1.6.1 Sample Design and Implementation The EDHS employed a nationally representative, multi-stage probability sample of women between the ages of 15 and 49. The five main reporting domains are: the country as a whole, all urban areas, the capital Asmara, other urban areas outside Asmara, and rural areas. Estimates of selected variables were also produced for each of the six administrative zones j in the country. Since there has been no national census, the sampling frame used for the survey was constructed from a combination of data sources. In rural areas, the sampling frame consisted of a list of villages with population figures collected by the Ministry of Local Government and the sampling units were villages. In urban areas, data on zobas (administrative units) and mimihidars (smaller units within zobas) collected by the NSO between August 1994 and January 1995 were used in the selection of mimihidars as sampling units. In the capital, Asmara, the sampling units were also mimihidars; however, since reliable data on population size did not exist for these mimihidars, the measure of size used for sample selection was the number of registered voters. From this, the number of households and the population size were estimated. A mapping and household listing operation was implemented to update the population size of the sampling units prior to selecting the households for the survey. The sample for the EDHS was selected in two stages. First, 108 villages and 100 mimihidars were selected with probability proportional to size. When villages and mimihidars were very large (in population size), they were segmented and only one segment was selected for the survey, so that each cluster (sample point) corresponded generally to a village, a mimihidar, or part of a village or mimihidar. A complete listing of the households residing in the selected clusters was carried out. The list of households obtained was used as the frame for second-stage sampling, the selection of households to be visited by the EDHS survey teams during the main fieldwork. Women in these households between the ages of 15 and 49 were identified and interviewed. In one-third of the households selected for the survey, men between the ages of 15 and 59 were also interviewed. On average, 25 households were selected in each urban cluster and 35 in each rural cluster. It was expected that the sample would yield interviews with approximately 5,000 women age 15 to 49 and 1,400 men age 15 to 59. Because of the non-proportional distribution of the sample in the 10 provinces that existed at the time of the sample design, sampling weights were applied to the data in this report. Details concerning the EDHS sample design are provided in Appendix A; estimations of sampling errors for selected variables are included in Appendix B. 1.6.2 Questionnaires Four types of questionnaires were used in the Eritrea Demographic and Health Survey: the Household Questionnaire, the Women's Questionnaire, the Men's Questionnaire, and the Service Availability Questionnaire. The Service Availability Questionnaire was based on the model questionnaire used in many recent DHS surveys, while the other questionnaires were based on the DHS Model B Questionnaire for Low Contraceptive Prevalence Countries. After a meeting with potential data users all the questionnaires were modified slightly to adapt them to the situation in Eritrea. The Household Questionnaire was used to list the names and background characteristics of all usual members and visitors to a selected household. The Women's Questionnaire was used to collect information from women age 15-49. In addition, interviewing teams measured the height and weight of mothers and their children under age three. The EDHS survey also See Appendix A, section A.10. included three modules in the women's and the men's questionnaire, namely, maternal mortality, awareness of AIDS, and female circumcision. Information from a sub-sample of men age 15-59 was collected using a Men's Questionnaire. The Service Availability Questionnaire was used to collect information on the health, family planning services and other social services in the sampled clusters. All the questionnaires were first translated from English into Tigrigna. In addition, the Women's and Men's Questionnaires were also translated into Tigre, Kunama, and Afar. Appendix E contains the English version of all questionnaires. 1.6.3 Training and Fieldwork Pretest training and field testing took place in April 1995. For the first three weeks, 7 female and 2 male interviewers were trained to carry out the pretest. Following the training, the pretest fieldwork was conducted over a three-week period during which approximately 250 interviews were completed. Debriefing sessions were held with the pretest field staff and necessary modifications to questionnaires were made based on the experience of the pretest exercise. Training of the field staff for the main survey was conducted during a one-month period in August, 1995. The training course consisted of instructions regarding interviewing techniques and field procedures, a detailed review of items on the questionnaire, instruction and practice in weighing and measuring children and women and mock interviews with men and women of eligible age in areas outside the EDHS sample points. Within the constraint of ensuring that there was an adequate number of interviewers for each of the four local languages, interviewers were selected on the basis of overall performance in class, scores on the tests given in class, and performance during field practice interviews. From among those selected, candidates suitable as field editors and supervisors were identified. The supervisors, field editors, and male interviewers/team leaders were given additional training in coordination of fieldwork, methods of field editing, and data quality control procedures. The EDHS fieldwork was carried out by eight teams, each consisting of one male interviewer/team leader, one female supervisor, one female field editor, four female interviewers, and driver. Five field survey coordinators, three permanent professional staff from the National Statistics Office, and two persons selected from among the trainees were assigned to oversee the teams, facilitate fieldwork activities, and monitor data quality. Data collection took place over a four-month period from mid-September 1995 to mid-January 1996. However, most data collection was completed by end of 1995. The persons involved in the EDHS are listed in Appendix D. 1.6.4 Data Processing All questionnaires for the EDHS were returned to the NSO for data processing, which consisted of office editing, coding of open-ended questions, data entry, and secondary editing (editing computer identified errors). The data were processed by a team consisting of four entry clerks and a data entry supervisor. The head of the data processing unit at the NSO provided overall supervision. Data entry and editing were accomplished using the computer program ISSA (Integrated System for Survey Analysis). Data processing commenced on 11 September 1995 and was completed on 9 March 1996. 1.6.5 Response Rate Table 1.1 shows response rates for the EDHS. A total of 6,258 households were selected in the sample, of which 5,642 were occupied at the time of the survey ("found"). The shortfall was largely because some households no longer existed in the sampled clusters at the time of interview. Of the 5,642 households that existed at the time of the survey, 5,469 were interviewed, yielding a household response rate of 97 percent. 7 Table 1.1 Results of the household and individual interviews Number of households, number of interviews and response rates, Eritrea 1995 Residence Other Sample/response rate Urban Asmara town Rural Total WOMEN Household interviews Households sampled 2,564 1,265 1,299 3,694 6,258 Households found 2,384 1,223 1,161 3,258 5,642 Households interviewed 2,350 1,208 1,142 3,119 5,469 Household response rate 98.6 98.8 98.4 95.7 96.9 Individual interviews Number of eligible women 2,600 1,509 1,091 2,650 5,250 Number of eligible women interviewed 2,520 1,446 1,074 2,534 5,054 Eligible woman response rate 96.9 95.8 98.4 95.6 96.3 MEN Household interviews Households sampled 853 419 434 1,212 2,065 Households found 798 405 393 1,069 1,867 Households interviewed 784 398 386 1,038 1,822 Household response rate 98,2 98.3 98.2 97.1 97.6 Individual interviews Number of eligible men 620 Number of eligible men interviewed 562 Eligible man response rate 90.6 353 267 647 1,267 316 246 552 1,114 89.5 92.1 85.3 87.9 In the interviewed households 5,250 eligible women were identified of whom 5,054 were interviewed, yielding a response rate of 96 percent. In one-third of the households 1,267 eligible men were identified of which 1,114 were successfully interviewed (88 percent response). The lower response rate for men was due to frequent and longer absences of men for seasonal work. Urban response rates were higher than rural response rates, the difference being especially pronounced for the men's survey. In urban areas, 91 percent of eligible men were interviewed, compared with 85 percent of men in rural areas. The sample implementation results are presented in Table A.6.1 for women and Table A.6.2. for men (in Appendix A) by urban-rural residence and zone. CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter presents information on selected socioeconomic characteristics of the household population and the individual survey respondents including age, sex, education, and place of residence. The chapter also considers the conditions surrounding the households in which the survey population live, including source of drinking water, availability of electricity, sanitation facilities, housing materials, and housing congestion. The conclusions drawn from the survey will be related to these socioeconomic characteristics and environmental conditions. The characteristics of individual survey respondents, that is, women age 15 to 49 and men age 15 to 59, are discussed in Section 2.3. This background information is useful for understanding the factors which affect reproductive and contraceptive use behavior. 2.1 Household Population The EDHS Household Questionnaire was used to collect data on the demographic and social characteristics of all usual residents of the sampled household, and visitors who had spent the previous night in the household? 2.1.1 Age-Sex Composition The distribution of the EDHS household population is shown in Table 2.1, by five-year age groups, according to sex and residence. The EDHS households constitute a population of 23,327 persons and the sample is 27 percent urban. Fifty-three percent of the sample population are females and 47 percent are males. There are larger numbers of the population in the younger age groups than in the older age groups of each sex in both urban and rural areas. The age-sex structure of the population is shown by use of a population pyramid in Figure 2.1. The pyramid is wide-based, a pattern that is typical of high-fertility populations. There is a dearth of men age 15-64 as can also be observed in the low sex ratios for age groups 15-19 to 55-59 (see last colunm of Table 2.1). The low sex ratios may be partly due to war casualties and partly due to migration. However, it appears that male interviewers, who were mainly responsible for completing the Household Questionnaire, also shifted some men age 15-19 to a lower age group or omitted listing eligible male respondents (see Table C.1 in Appendix C). The number of males under five is slightly more than the number age 5-9 years, whereas the number of females is almost the same. Overall, the number of children age 0-4 is greater than in age group 5-9, a finding that is consistent with almost no fertility decline (see Chapter 3). Figure 2.2 shows the distribution of the male and female household population by single year of age (see also Appendix Table C. 1). The data indicate there is a preference for reported ages that end in zero or, to a lesser extent, five (age "heaping" or digit preference). This pattern is commonly found in countries where individual age is not known well. Additionally, there is avoidance of digits that end in one or nine. There 1 A househoM refers to a person or group of related and/or unrelated persons who live together in the same dwelling unit, who acknowledge one adult male or female as head of household, who share the same housekeeping (cooking) arrangements, and are considered as one unit. A member of the household is any person who usually lives in the household and a visitor is someone who is not a usual member of the household but had slept in the household the night before the interview date. The household population presented in this chapter includes, unless otherwise stated, all usual members of the household who slept in the household the night before the survey and visitors (de facto population). Table 2.1 Household population by age~ sex and residence Percent distribution of the de facto household population by five-year age groups, according to sex and urban-rural residence, Eritrea 1995 Urban Rural Total Age Sex Sex Sex group Male Female Total ratio I Male Female Total ratio I Male Female Total ratio t 0-4 15.0 10.3 12.5 120.2 19.4 16.8 18.1 103.8 18.2 15.0 16.5 107.0 5-9 15.0 12.5 13.6 98.7 17.5 16.4 16.9 96.5 16.9 15.3 16.0 97.0 10-14 17.0 14.5 15.6 96.6 16.6 13.7 15.1 108.8 16.7 13.9 15.2 105.2 15-19 12.3 12.8 12.6 79.4 8.1 7.8 7.9 93.9 9.2 9.2 9.2 88.2 20-24 6.6 8.1 7.4 67.6 4.1 6.2 5.2 59.6 4.8 6.7 5.8 62.3 25-29 5.5 6.3 5.9 72.6 4.2 5.7 5.0 66.4 4.5 5.9 5.2 68.2 30-34 3.4 5.0 4.3 56.7 2.9 5.3 4.1 49.3 3.0 5.2 4.2 51.3 35-39 2.8 5.6 4.3 41.2 3.2 4.3 3.8 67.3 3.1 4.7 3.9 58.5 40-44 4.0 5.0 4.6 66.5 4.0 4.7 4.4 75.5 4.0 4.8 4.4 72.9 45-49 3.9 4.2 4.1 78.3 3.5 4.0 3.8 79.3 3.6 4.1 3.9 79.0 50-54 3.2 3.8 3.5 68.9 2.6 3.7 3.2 65.0 2.8 3.7 3.3 66.1 55-59 2.6 3,2 2.9 66.7 3.0 2.9 3.0 95.6 2.9 2.9 2.9 86.8 60-64 2.6 2.7 2.7 79.4 3.6 2.6 3.1 123.6 3.4 2.7 3.0 110.8 65-69 2.4 2.2 2.3 90.0 2.2 2.1 2.1 93.7 2.2 2.1 2.2 92.6 70-74 1.7 1.7 1.7 87.3 2.2 1.9 2.0 106.9 2.1 1.8 2.0 101.9 75-79 0.9 1.0 0.9 77.9 1.2 0.8 1.0 128.9 1.1 0.9 1.0 113.1 80+ 1.0 1.1 1.1 73.8 1.6 l. l 1.3 127.5 1.4 1.1 1.3 112.5 Total 100.0 100.0 100.0 83.0 100.0 100.0 100.0 90.0 100.0 100.0 100.0 88.0 Number 2,882 3,487 6,375 8,021 8,903 16,952 10,903 12,391 23,327 Note: Total includes a small number of people with age or sex not known. t Sex ratio is the number of males per 100 females. Ag~ 80+ 75-79 70-74 65-69 6O-64 55-59 50-54 45-49 4O-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 10 Figure 2.1 Distribution of the Household Population by Age 5 0 Percent 10 EDHS 1995 10 Figure 2.2 Distribution of the De Facto Household Population by Single Year of Age and Sex Percent 4 I I I I I I 0 10 20 30 40 50 60 70 + Single Year of Age l - - Female Male I EDHS1995 is a relative dearth of men age 20, 22, and 23 and an excess of men age 13 and 14, relative to women. This pattern is almost certainly due to male interviewers intentionally omitting or push- ing men outside the eligible age range established for the survey. The distribution of the de jure population s by broad age groups in Table 2.2 shows that children under 15 years of age and the population in age group 15-64 each account for 47 per- cent of the population, with the remaining population over 65 years of age. The population has a low median age of 16.5 years. The dependency ratio 3 is 114 which means that there are 114 persons under 15 years or over 64 years in Eritrea for every 100 persons age 15-64 years. In the de facto population, the distribu- tion of population is similar. Table 2.2 Population by age Percent distribution of the de jure and de facto population by age group, Eritrea 1995 Age De jure De facto group population population <15 46.8 47.8 15-64 46.7 45.8 65+ 6.6 6.4 Total 100.0 100.0 Median age 16,5 15.9 Dependency ratio 114 118 2 Seven percent of the usual residents were temporarily absent, while there were only 2 percent visitors (same proportion in male and female populations) in the de facto population. A slightly higher percentage of females were temporarily absent than the proportion of visitors, but 12 percent of males were temporarily absent from their household. Some of this difference is due to men working away from home in harvesting or in other jobs at the time the survey was conducted (data not shown). 3 The dependency ratio is deft ned as the sum of all persons under 15 years or over 64 years divided by the number of persons age 15-64, multiplied by 100. 11 2.1.2 Household Composition Table 2.3 shows that about one in three Efitrean households is headed by a woman. There is a larger proportion of female-headed households in urban areas (44 percent) than in rural areas (26 percent). Ten percent of households consist of only one person; single member households are more common in other towns (urban areas other than Asmara) than in Asmara or rural areas. The households with two to five members constitute 60 percent of households. One in 9 households has at least eight members and large households are more common in Asmara (1 in 7) than in rural areas (1 in 10). The average household size is 4.4 persons in the country as whole, as well as in rural and urban areas, however, the households in Asmara are slightly larger (4.6 persons) than those in other towns (4.2 persons). Foster children are those persons under 15 years of age who are not living with either of their biological parents. One in 10 households has foster children; urban households are slightly more likely to have foster children. Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and percentage of households with foster children, according to residence, Eritrea 1995 Residence Other Characteristic Urban Asmara towns Rural Total Household headship Male 55.8 55.4 56.4 74.1 69.2 Female 44.2 44.6 43.6 25.9 30.8 Number of usual members 1 12.1 10.4 14.4 9.6 10,2 2 14.3 13.4 15.5 13.7 13.8 3 15.3 15.1 15.6 16.2 16.0 4 14.1 14.2 14.1 15.8 15.4 5 13.4 14.6 11.8 13.8 13.7 6 8.7 8.4 9.3 11.8 11.0 7 8.3 8.7 7.9 8.9 8.8 8 5.9 6.5 5.0 5.6 5.7 9+ 7.6 8.6 6.1 4.6 5.4 Total 100.0 100.0 100.0 100.0 100.0 Mean size 4.4 4.6 4.2 4.4 4.4 Percentage of households with foster children 10.9 11.0 10.7 9.5 9.8 Note: Table is based on de jure members, i.e., usual residents of household. Information regarding foster children and orphans under 15 years of age is presented in Table 2.4. More than 7 in 10 children under 15 years of age live with both parents, 12 percent live with their mothers (but not their living fathers), 1 percent live with their fathers (but not their living mothers), and 3 percent live with neither parent although both are alive. Nine percent of children live with only one parent because the other parent is dead. The percentage of children not living with both parents increases with increasing age of the child. Children are more likely to live with both parents in rural than in urban areas. The proportion living with both parents varies little by sex or by zone except in the Anseba Zone where children are more likely to live with their parents. 12 Table 2.4 Foster children and orphans Percent distribution of de jure children under age 15 by survival status of parents and child's living arrangements, according to child's age, sex, residence, and zone, Eritrea 1995 Living Living with mother with father Not living with Living but not father but not mother either parent Missing with Father Mother info. on Number both Father Father Mother Mother Both only only Both father/ of Characteristic parents alive dead alive dead alive alive alive dead mother Total children Age <2 78.8 17.8 0.9 0.3 0.5 0.9 0.5 0.0 -- 0.3 100.0 2,422 3-5 76.4 12.7 3.9 1.3 2.0 1.7 0.7 0.5 0.3 0.4 100.0 2,182 6-8 72.4 10.0 6.6 1.1 3.2 2.9 0.9 1.I 0.8 1.0 100.0 2,425 9-11 66.6 9.1 10.3 1.5 3.9 3.5 2.2 1.0 1.1 0.8 100.0 2,076 12+ 63.6 8.5 11.1 0.9 4.1 5.1 1.4 1.4 1.5 2.4 100.0 2,164 Sex Male 71.8 11.4 6.3 1.3 2.6 3.0 0.9 0.7 0.9 1.0 100.0 5,731 Female 71.7 12.1 6.5 0.7 2.8 2.5 1.3 0.9 0.5 0.9 100.0 5,509 Residence Urban 65.0 17.1 6.9 1.3 1.4 4.3 0.9 0.9 0.5 1.7 100.0 2,659 Asmara 66.0 16.8 5.5 1.4 1.4 4.5 0.7 1.0 0.5 2.2 100.0 1,487 Other towns 63.6 17.6 8.7 1.1 1.4 4.1 1.1 0.8 0.4 1.1 100.0 1,171 Rural 73.9 10.1 6.2 0.9 3.1 2.3 1.2 0.7 0.8 0.7 100.0 8,610 Zone Southern Red Sea 71.2 9.7 5.8 1.3 2.2 5.8 1.3 0.4 0.8 1.7 100.0 253 Northern Red Sea 73.4 12.9 5.7 1.7 2.2 1.8 0.6 0.7 0.6 0.4 100.0 1,328 Anseba 76.3 9.1 6.8 0.8 3.0 1.4 0.8 1.2 0.6 0.2 100.0 1,511 Gash-Barka 70.5 8.5 6.5 0.8 6.0 1.6 2.5 0.7 1.3 1.5 100.0 2,173 Southern 71.8 12.3 7.4 0.9 1.7 3.1 0.9 0.7 0.6 0.7 100.0 3,720 Central 69.2 15.4 4.8 1.1 1.2 4.5 0.7 0.9 0.6 1.6 100.0 2,282 Total 71.8 11.8 6.4 1.0 2.7 2.8 1,1 0.8 0.7 0.9 100.0 11,269 Note: By convention,foster children are those who are not living with either of their biological parents, This includes orphans, i.e., children with both parents dead. -- Less than 0.05 percent Less than 1 percent of children under 15 have lost both parents. Eleven percent have only one parent alive: 7 percent have lost their fathers and 4 percent have lost their mothers. The loss of one or both parents varies little by sex of the child or residence. However, the proportion of children whose mother is not alive or whose parents are both dead is highest in the Gash-Barka Zone. In that zone, 17 percent, or 1 in 6 children under 15 has lost one or both parents. 2.1.3 Educational Level of Household Members The educational level of household members is an important characteristic because educational attainment affects many areas including reproductive behavior, proper hygienic practices, health of children and the status of women. Eritrea's current formal education is based on a four-tier system, known as the 5-2-4-4 system. In this system primary education consists of five years of schooling, two years of junior secondary education, four years of secondary education, and four years of higher/university education. The current system was adopted after de facto independence in 1991, replacing the four-tier system (6-2-4-4) of Ethiopia in which primary schooling was one year longer than in the current system. Informal education is also provided in Eritrea, e.g., Koranic and church education. Moreover, the Women's Association gives some adult education to its members. The informal education activities promote literacy in certain sectors of the population. 13 Tables 2.5.1 and 2.5.2 show the distribution of female and male household members age six and above by the highest level attended in school and the median number of years of education completed, according to age, residence, and zone. Two-thirds (67 percent) of women have no education, 23 percent have attended primary school, 9 percent secondary school, and less than one-half of one percent have higher education. The proportion of women who have attended school and also the level of education are inversely related to age in the population age 10 and over. The reason a majority (67 percent) of girls in the 6-9 age group have no education is that some girls will start attending school at age 7 or even later, a That educational opportunities are concentrated mainly in urban areas is confirmed by the survey results. The majority of women in urban areas have some education, two-thirds of women in Asmara and over one-half of women in other towns, compared with only one-fifth of women in rural areas. The disparity by residence is not confined only to attending school but also to the level of education attained. Among those who have been to school, a higher proportion have attended secondary or higher level of school in urban than Table 2.5.1 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Eritrea 1995 Don't Number Median Background No know/ of years of characteristic education Primary Secondary Higher missing Total women schooling Age 6-9 66.6 32.4 0.0 0.0 1.0 100.0 1,539 0.0 10-14 40.3 51.9 7.8 0.0 0.1 100.0 1,728 1.3 15.19 39.0 29.5 31.0 0.2 0.3 100.0 1,137 2.9 20~24 54.6 18.8 25.3 0.9 0.4 100,0 834 0.0 25-29 71.4 14.2 13.7 0.6 0.1 100.0 726 0.0 30-34 79.0 11.9 7.7 1.2 0.3 100.0 644 0.0 35-39 77.3 14.8 6.4 1.1 0.4 100.0 579 0.0 40.44 84.7 10.5 3.7 0.7 0.4 100.0 598 0.0 45-49 90.0 7.6 1.6 0.4 0.3 100.0 502 0.0 50-54 93.3 4.6 1.1 0.2 0.8 100.0 459 0.0 55-59 94.0 2.7 0.7 0.2 2.4 100.0 365 0.0 60-64 97.3 1.6 0.0 0.0 1.1 100.0 330 0.0 65+ 96.2 1.0 0.1 0.0 2.7 100.0 736 0.0 Residence Urban 36.6 35.7 26.0 1.2 0.5 100.0 3,055 2.7 Asmara 32.0 34.2 31.8 1.6 0.4 100.0 1,960 3.6 Other towns 44.9 38.4 15.7 0.3 0.7 100.0 1,096 1.0 Rural 80.5 16.9 1.8 0.0 0.8 100.0 7,122 0.0 Zone Southern Red Sea 76.2 11.9 10.2 0.2 1.5 i00.0 252 0.0 Northern Red Sea 81.9 14.7 2.6 0.1 0.7 100.0 1,070 0.0 Anseba 74.4 20.3 4.2 0.1 1.0 100.0 1,264 0.0 Gasb-Barka 87.3 10.3 1.3 0.1 1.0 100.0 1,855 0.0 Southern 73.4 23.0 3.1 0.0 0.4 100.0 3,062 0.0 Central 36.4 35.8 26.0 1.2 0.5 100.0 2,675 2.6 Total 67.3 22.6 9.1 0.4 0.7 100.0 10,178 0.0 Note: Three women for whom the age was not known are included in the table but are not shown separately. 4 From less than 15 percent of children age six years to around 40 percent of children age eight years in Eritrea attend school. The differences between boys and girls are very small. Even at age nine, the proportion with no education (48 percent) is higher than in the age group 10-14 (data not shown). The lower school attendance for younger children may indicate a slight decline in education or that some children start school at age 10 or even later. 14 Table 2.5.2 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, and median number of years of schooling, according to selected background characteristics, Eritrea 1995 Don't Number Median Background No know/ of years of characteristic education Primary Secondary Higher missing Total men schooling Age 6-9 63.8 35.2 0.0 0.0 1.0 100.0 1,467 0.0 10-14 32.4 59.4 7.7 0.0 0.5 100.0 1,818 1.9 15-19 27.2 34.8 37.2 0.7 0.1 100.0 1,003 3.9 20-24 33.4 20.0 40.9 5.3 0.4 100.0 519 5.1 25-29 44.5 22.4 27.5 4.4 1.2 100.0 495 2.4 30-34 59.3 16.8 19.3 3.8 0.8 100.0 330 0.0 35-39 62.3 18.2 14.7 3.9 0.8 100.0 338 0.0 40-44 66.0 18.4 11.1 3.6 1.0 100.0 436 0.0 45-49 66.3 17.1 10.3 3.9 2.5 100.0 397 0.0 50-54 78.4 11.3 8.3 1.1 0.9 100.0 303 0.0 55-59 80.9 12.4 4.9 0.9 0.9 100.0 317 0.0 60-64 85.9 8.6 3.2 0.9 1.4 100.0 366 0.0 65+ 91.7 5.5 1.1 0.9 0.9 100.0 752 0.0 Residence Urban 19.7 39.0 35.5 4.6 1.2 100.0 2,369 4.6 Asmara 14.2 36.5 42.2 6.0 1.1 100.0 1,460 5.7 Other towns 28.6 43.0 24.7 2.2 1.4 100.0 909 2.7 Rural 67.7 26.7 4.6 0.3 0.6 100.0 6,175 0.0 Zone Southern Red Sea 66.3 19.0 12.4 1.5 0.8 100.0 227 0.0 Northern Red Sea 65.9 27.3 5.4 0.7 0.7 100.0 897 0.0 Anseba 64.3 26.1 8.2 0.7 0.8 I00.0 1,048 0.0 Gash-Barka 79.9 16.0 2.7 0.2 1.3 100.0 1,691 0.0 Southern 56.2 36.1 6.6 0.6 0.4 100.0 2,607 0.0 Central 20.2 38.4 35.9 4.5 1.0 100.0 2,073 4.7 Total 54.4 30.1 13.2 1.5 0.8 100.0 8,544 0.0 Note: Four cases for whom the age was not known are included in the table but are not shown separately. in rural areas. Because four-fifths of women in rural areas have not attended school, the median years of schooling completed is zero, whereas for urban women the median is 2.7 years and for women in Asmara 3.6 years or almost one year higher than for urban areas as a whole. In the Central Zone which includes Asmara, only 36 percent of women are uneducated, the same proportion have attended primary school, and more than one-quarter (27 percent) have attended at least secondary school. In contrast, 82 percent of women in the Northern Red Sea Zone and 87 percent in the Gash-Barka Zone have no schooling. Educational attainment is also low in other zones; around three-fourths of women have no education. Interestingly, in the Southem Red Sea Zone, although only one-fourth of women have attended school, more than 4 in 10 of those who have attended school have attended secondary or higher school--a proportion slightly higher than even in the Central Zone where the proportion educated is highest. Educational attainment at each age level is higher for men than women (Table 2.5.2). Almost half (45 percent) of males have attended school versus 32 percent of females. Thirty percent of men have attended primary, 13 percent secondary and 2 percent higher than secondary school. Again, the median years of schooling completed is zero for rural men, but for urban men--those living in Asmara, and other towns--the median years of schooling is 2 years higher than for women living in the same areas. The differentials in education for men by age, residence and zone are very similar to those for women discussed above. 15 2.1.4 School Enrollment In Table 2.6, school enrollment ratios by age group, sex and residence for the population age 6 to 24 years are presented. A school enrollment ratio is the number of enrolled persons at a specific age group per hundred persons in that age group. Almost half (48 percent) of children age 6-15 are in school; total urban and Asmara enrollments (85 percent and 92 percent, respectively), are at least 50 percentage points higher than rural enrollment (35 percent). Rural children also start attending school at later ages than urban children. For example, in towns and in Asmara, at age 6 and 7, more than one-half and almost 90 percent of children are enrolled in school while 5 and 15 percent of rural children age 6 and 7, respectively, are attending school (data not shown). The absolute and relative differences in urban and rural enrollment are smaller for age groups 16-20 and 21-24 than for age group 6-15. Table 2.6 School enrollment Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and residence, Eritrea 1995 Age group Male Female Total Other Other Other Urban Asmara towns Rural Total Urban Asmara towns Rural Total Urban Asmara towns Rural Total 6-10 11-15 6-15 16-20 21-24 78.9 90.2 66.2 25.8 38.5 78.7 87.5 65.9 21.4 34.8 78.8 88.7 66.1 23.5 36.6 93.9 97.2 88.9 55.9 66.4 89.4 92,0 84.6 44.7 59.3 91.5 94.4 86.8 50.6 62.9 86.4 93.9 76.6 39.3 51.4 84.3 89.9 74.9 30.8 45.5 85.3 91.8 75.8 35.1 48.4 77.2 79.0 73.0 46.3 57.5 54.3 61.0 39.5 14.4 29.1 64.3 68.9 53.7 28.5 41.6 24.4 24.3 24.6 24.8 24.6 13.6 16.9 6.7 2.5 6.6 18.1 20.1 13.9 11.2 13.9 Figure 2.3 and Table 2.6 show that at ages 6-10 and 11-15 the rate of school attendance is only 3 to 7 percentage points lower for girls than for boys. However, at higher ages the gender differences become extremely large. Boys are twice as likely as girls at age 16-20 and four times as likely at age 21-24 to be enrolled in school. The gender disparity in school attendance widens enormously in rural areas at higher ages. 70 60 50 40 30 20 10 0 Percent Figure 2.3 Percentage of the Population Age 6-24 Enrolled in School by Age and Sex I I r i 6-10 11-15 16-20 21-24 Age Group [÷M=, *Fern=, 1 EDHS1995 16 2.1.5 Employment Status and Occupation of Household Population For each member of a household age 10 and over who worked during the month preceding the survey, information was collected on the main occupation and the form of payment received. Information for women is summarized in Table 2.7.1; information for men is in Table 2.7.2. Table 2.7.1 shows that only 17 percent of women age 10-64 and 20 percent of women 15-64 were employed in the month prior to the survey (including 4 percent of women age 10-14 and 14 percent of those 15-19). Between 21 and 28 percent of women age 20-49 were employed, whereas in older age groups the proportion employed decreases from 16 percent among women age 50-54 to 11 percent among those 60-64. Women who work are more likely than men to be paid in cash only (37 percent). More than half of women (53 percent) were not paid either in cash or in kind. Table 2.7.1 Employment status: women Percent distribution of the female household population age 10-64 by employment status and form of earning, according to selected background characteristics, Eritrea 1995 Employment status Not era- Not em- Farm of earning Number ployed, ployed Employed Number of Background in in last in l~t of In Not employed characteristic school month month Missing women Cash kind Both paid Missing women Age 10-14 52.7 37.9 4.4 5.0 1,760 23.1 0.0 0.5 72.3 4.1 78 15-19 39.4 45.9 13.7 1.0 1,171 47.6 6.2 0.0 43.6 2.7 160 20-24 6.3 70.7 22.5 0.6 862 53.9 5.7 0.7 39.4 0.3 194 25-29 0.0 77.8 21.4 0.8 756 51.0 3.9 0.0 42.0 3.0 162 30-34 0.0 77.4 21.5 1.1 664 48.l 9.0 0.7 39.6 2.5 143 35-39 0.0 72.5 26.8 0.7 601 35.6 6.2 0.6 55.9 1.6 161 40-44 0.0 70.8 28.4 0.8 615 26.6 6.0 0.0 61.8 5.6 175 45-49 0.0 71.5 27.8 0.7 537 15.3 8.6 1.9 72.1 2.1 149 50-54 0.0 83.9 15.5 0.6 488 31.5 2.5 0.0 64.3 1.7 76 55-59 0.0 86.1 12.6 1.3 374 (20.1) (6.1) (8.9) (64.8) (0.0) 47 60-64 0.0 88.2 11.1 0.7 344 (20.1) (6.5) (2.6) (69.0) (1.8) 38 Residence Urban 30.0 48.6 19.5 2.0 2,567 78.3 2.6 0.0 17.1 2.0 500 Asmara 32.6 44.2 20.8 2.4 1,640 82.9 2.4 0.0 12.2 2.4 341 Othar towns 25.3 56.3 17.1 1.2 927 68.4 3.1 0.0 27.5 1.0 159 Rural 12.0 70.6 15.7 1.6 5,605 14.3 7.7 1.3 73.9 2.8 883 Zone Southern Red Sea 5.8 75.3 17.2 1.6 205 78.7 6.8 0.0 14.6 0.0 35 Northern Red Sea 8.0 83.0 6.6 2.5 848 63.0 10.7 0.7 24.3 1.3 56 Anseba 11.8 77.3 9.0 1.8 1,027 46.6 6.4 0.0 44.4 2.6 93 Gash-Barka 5.4 80.9 12.2 1.5 1,559 42.8 7.6 3.0 41.9 4.7 190 Southern 19.3 52.9 27.0 0.8 2,342 3.5 6.6 0.9 86.8 2.2 633 Central 32.1 48.1 17.2 2.6 2,191 82.0 2.8 0.0 13.0 2.2 376 Women 10-64 17.7 63.7 16.9 1.7 8,171 37.4 5.8 0.9 53.4 2.5 1,383 Women 15-64 8.0 70.8 20.4 0.8 6,412 38.3 6.2 0.9 52.2 2.4 1,305 Note: Figures in parentheses are based on 25 to 49 women. 17 Table 2.7.2 Employment status: men Percent distribution of the male household population age t 0-64 by employment status and form of earning, according to selected background characteristics, Eritrea 1995 Employment status Not era- Not em- Form of earning Number ployed, ployed Employed Number of Background in in last in last of In Not employed characteristic school month month Missing men Cash kind Both paid Missing men Age 10-14 57.1 26.5 11.2 5.1 1,867 6.3 2.5 1.2 88.5 1.4 210 15-i9 56.9 15.7 26.8 0.6 1,057 18.9 6.0 2.5 69.6 2.9 283 20-24 24.1 23.5 51.9 0.5 557 38.6 3.6 3.5 51.6 2.8 289 25-29 0.0 22.5 77.5 0.0 558 40.3 6.6 2.0 48.1 3.0 432 30-34 0.0 14.4 84.8 0.8 405 37.1 4.1 2.5 53.9 2.5 343 35-39 0.0 8.8 90.5 0.7 399 28.5 4.8 3.6 58.9 4.2 361 40-44 0.0 11.8 88.1 0.1 522 24.1 4,3 3.8 65.4 2.4 459 45-49 0.0 11.2 88.7 0.1 464 24.6 5.0 2.9 64.7 2.8 411 50-54 0.0 18.5 81.5 0.0 380 26.2 2.2 5.1 63.7 2.7 3t0 55-59 0.0 16.6 83.4 0.0 358 18.6 7.2 2.3 70.5 1.3 299 60-64 0.0 27.4 72.3 0.3 409 13.9 5.3 4.6 72.8 3.3 296 Residence Urban 40.4 16.9 41.3 1.4 1,956 73.8 2.1 0.7 20.8 2.6 807 Asmara 41.6 17.3 39,5 1.6 1,232 77.7 0.9 0.4 17.9 3.2 486 Other towns 38.3 16.3 44.3 1.1 724 68.1 4.0 1.0 25.2 1.7 321 Rural 20.2 20.6 57.5 1.7 5,020 13.0 5.5 3.8 74.8 2.8 2,886 Zone Southern Red Sea 12.7 36.4 49.3 1.5 182 41.9 37.8 0.0 19.3 1.1 90 Northern Red Sea 18.7 26.8 52.2 2.3 736 31.7 1.7 8.7 56.5 1.5 385 Anseba 19.8 31.8 46.4 2.1 891 21.1 0.6 0.0 75.1 3.2 413 Gash-Barka 10.0 22.2 66.4 1.4 1,492 14,1 10.6 7.4 64.1 3.9 991 Southern 30.6 11.0 57.1 1.3 1,961 11.5 1.6 0.3 84.9 1.7 1,120 Central 41.8 16.0 40.5 1.7 1,713 65.9 1.6 0.9 28.2 3.4 695 Men 10-64 25.8 19.6 52.9 1.6 6,976 26.3 4.8 3.1 63.0 2.7 3,693 Men 15-64 14.4 17.1 68.2 0.3 5,108 27.5 4.9 3.3 61.5 2.8 3,483 Overall, 53 percent of the men age 10-64 worked in the month before the survey, including 11 percent of children (age 10-14) and 27 percent of young men age 15-19 (see Table 2.7.2). Among men 15-64, the ages which are generally considered economically active, 68 percent worked. Among men over 20, the percentage ranged from 52 percent in age group 20-24 to 91 percent in age group 35-39, before declining steadily to 72 percent in age group 60-64. Men in rural areas are more likely to work and less likely to be paid in cash or kind than their urban counterparts. Employment levels are also higher in the Gash-Barka and Southern Zones and lower in the Central Zone than in other zones. The reason for lower employment among young men, in urban areas, and the Central Zone is that a substantial proportion of those not employed currently attend school. Of men age 10-64 who worked in the month preceding the survey, 34 percent received some kind of payment and 63 percent were not paid at all. One-quarter (26 percent) were paid in cash only, 5 percent were paid in kind only, and 3 percent were paid both in cash and in kind. Tables 2.8.1 and 2.8.2 present information on the occupations of employed persons. Almost 70 percent of employed men age 10-64 work in agriculture and more than half (52 percent) of working women in the same age range are employed in agriculture. The same proportion of men and women are in professional/technical and sales jobs (5 percent each). Men are less likely than women to be service workers (5 percent versus 18 percent) or do government and clerical jobs (2 percent versus 5 percent). 18 Table 2.8.1 Occupation of the household population: women Percent distribution of the employed female household population age 10-64 by current occupation, according to selected background characteristics, Eritrea 1995 Current occupation Profes- Admini- Production sional/ strative/ Govern- and Number Background Tech- Mana- ment/ Agri- related of characteristic nical gerial Clerical Sales Service culture work Missing Total women Age 10-14 0~0 0.0 0.0 0.0 23.1 75.1 0.0 1.8 100.0 78 15-19 1.0 0.0 0.0 2.5 36.7 49.1 9.4 1.3 100.0 160 20-24 9.8 0.0 10.8 5.3 21.9 40.8 I 1.1 0.3 100.0 194 25-29 8.7 0.4 10.2 4.5 18.4 38.4 18.8 0.4 100.0 162 30-34 7.5 0.0 10.4 4.6 21.0 37.2 16.7 2.6 100.0 143 35-39 6.2 0.4 5.4 5.8 14.3 54.1 13.3 0.4 100.0 161 40-44 2.8 0.4 1.2 4.9 12.8 62.3 14.5 1.2 100.0 175 45-49 2.7 0.5 0.9 8.3 4.7 68.3 14.1 0.5 100.0 149 50-54 2.8 0.0 0.9 7.3 8.6 55.1 23.6 1.7 100.0 76 55-59 (0.0) (0.0) (1.3) (12.9) (8.0) (51.8) (25.9) (0.0) 100.0 47 60-64 (0.0) (0.0) (0.0) (11.9) (4.5) (49.3) (34.3) (0.0) 100.0 38 Residence Urban 10.6 0.6 11.3 11.7 40,6 1.6 22.3 1.4 100.0 500 Asmara 11.2 0.8 12.7 10.6 37.8 0.6 24.7 1.6 100.0 341 Other towns 9.3 0.0 8.4 13.9 46.7 3.7 17.0 0.9 100.0 159 Rural 1.5 0.0 1.0 1.9 4.6 80.1 10.3 0.7 100.0 883 Zone Southern Red Sea 5.4 0.0 5.4 2.7 66.5 15.9 4.0 0.0 100.0 35 Northern Red Sea 1.8 0.0 6.6 9.2 33.9 29.8 16.6 2.1 100.0 56 Anseba 6.8 0.0 3.5 6.1 25.2 34.2 23.5 0.7 100.0 93 Gash-Barka 2.7 0.0 3.1 2.3 11.5 43.6 34.8 2.1 100.0 190 Southern 0.9 0.0 0.4 2.9 3.1 90.1 2.2 0.3 100.0 633 Central 12.4 0.7 12.8 10.7 36.2 1.9 23.8 1.5 100.0 376 Women 10-64 4.8 0.2 4.7 5.4 17.6 51.7 14.6 1.0 I00.0 1,383 Women 15-64 5.1 0.2 5.0 5.7 17.3 50.3 15.5 0.9 100.0 1,305 Note: Figures in parentheses are based on 25 to 49 women 19 Table 2.8.2 Occupation of the household population: men Percent distribution of the employed male household population age 10-64 by current occupation, according to selected background characteristics. Eritrea 1995 Currentoccupation Profes- Admini- Production sional/ strative/ Govern- and Number Background Tech- Mana- ment/ Agri- related of characteristic nical gerial Clerical Sales Service culture work Missing Total men Age 10-14 0.0 0.0 0.0 1.0 0.0 98,2 0.7 0.2 100.0 210 15-19 1.1 0.0 0.8 2.0 3.1 83,9 7.3 1.7 100.0 283 20-24 7.4 0.2 4.3 7.8 4.8 53~9 21.5 0.0 100.0 289 25-29 8.5 0,2 2.8 4.6 6.8 53.5 22.0 1.6 100.0 432 30-34 5.2 0.7 2.9 4.4 6.8 60,1 18.7 1.0 100.0 343 35-39 6.2 0.5 2.2 4.7 6.8 6&2 12.9 0.6 100.0 361 40-44 5.0 0.6 2.8 4.6 4.2 69,9 12.4 0.5 100.0 459 45-49 4.5 0.9 1.5 6.3 4.9 66,9 14.0 0.9 100.0 411 50-54 4.9 0.7 2.3 7.5 3.1 69.4 11.7 0.4 100.0 310 55-59 2.3 0.1 1.0 3.0 3.5 76.5 13.5 0.1 100.0 299 60-64 1.2 0.5 0.2 4.8 5.5 80.0 7.9 0.0 100.0 296 Residence Urban 14.7 1.9 8.5 13.2 13.9 8.4 37.9 1.5 100.0 807 Asmara 16.0 1.6 10.7 11.9 12.5 1.6 44.1 1.6 100.0 486 Other towns 12~6 2.4 5.2 15.3 16.0 18.6 28.6 1.3 100.0 321 Rural 1.7 0.0 0.2 2.4 2.2 86.1 6.9 0.5 100.0 2,886 Zone Southern Red Sea 14.3 1.1 1,1 9.0 4.3 46.5 22.7 1.0 100.0 90 Northern Red Sea 3.7 0.4 2.0 6.5 5.9 68.0 12.7 0.8 100.0 385 Anseba 2.9 0.6 0.9 6.8 5,6 76.1 6.9 0.2 100.0 413 Gash-Barka 1.3 0.1 0.3 2.8 3.8 84.3 6.5 1.0 100.0 991 Southern 2.6 0.2 0.3 2.4 2,3 85.9 6.2 0,0 100.0 1,120 Central 12.6 1.3 8.1 8.6 9.0 19.7 39.2 1.5 100.0 695 Men 10-64 4,6 0.4 2.0 4.8 4.8 69.1 13.7 0,7 100.0 3,693 Men 15-64 4.8 0.5 2.2 5.0 5.1 67.4 14.4 0.7 100.0 3,483 2.2 Housing Characteristics The physical characteristics of the household have an important bearing on environmental exposure to disease, as well as reflecting the household's economic condition. Respondents to the Household Questionnaire were asked about a number of char~teristics of their housing. Information was collected on: electricity, source and accessibility of drinking water, toilet facilities, floor materials, total number of rooms and number of rooms used for sleeping, whether farm animals were kept in the living areas, and type of fuel and salt used for cooking in the household. Table 2.9 summarizes this information by residence. Electricity is available almost exclusively in urban areas (see Figure 2.4). Almost all households in Asmara and 58 percent in other towns have electricity. In contrast, only 2 percent of the mral households have electricity. Four in 10 urban households (almost one-half in Asmara and about one-third in other towns) have water piped into the residence, yard, or plot. Three in 10 urban households get water from tanker trucks and 2 in 10 from a public tap. The former source is more common in Asmara and the latter in other towns. Seven percent of urban households (or 16 percent of urban households outside Asmara) obtain water from 20 Table 2.9 Housing characteristics Percent distribution of households by housing characteristics, according to residence, Eritrea 1995 Residence Other Characteristic Urban Asmara towns Rural Total Electricity Yes 80.6 97.2 57.5 2.1 22.9 No 19.4 2.8 42.5 97.8 77.1 Missing/Don't know 0.0 0.0 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 Source of drinking water Piped into residence 40.5 47.0 31.5 0.0 10.7 Public tap 19.1 12.1 29.0 8.1 11.0 Well in residence 0.4 0.1 0.9 0.1 0.2 Public well 6.5 0.2 15.3 40.8 31.8 Spring 0.3 0.0 0.7 26.0 19.2 River/stream 0.3 0.0 0.6 17.5 12.9 Pond/lake 0.2 0.0 0.4 3.1 2.3 Dam 0.0 0.0 0.0 2.6 1.9 Rainwater 0.0 0.0 0.0 0.0 0.0 Tanker truck 30.5 39.7 17.7 1.4 9,1 Bottled water 0.1 0.1 0.1 0.0 0.0 Private individual 1,9 0.7 3.6 0.1 0.6 Other -- 0,0 0.1 0.1 -- Missing/Don't know 0.1 0.1 0.2 0.2 0.2 Total 100.0 100,0 100.0 100.0 100.0 Time to water source (in minutes) <15 minutes 72.6 81.4 60.4 7.2 24.5 Median time to source 0.9 0.8 5.8 60.0 30.7 Normal wait at water source None 70.7 72.0 68.8 66.5 67.6 <5 minutes 0.2 0.1 0.3 0.1 0.1 5-14 minutes 6.5 6.9 6.0 6.5 6,5 15-29 minutes 7.8 6.0 10.3 6,3 6.7 30-34 minutes 8.3 8.2 8.4 7.5 7.7 45-59 minutes 0.8 1,2 0.1 0.8 0.8 60+ minutes 5.5 5.5 5.5 9.1 8.1 Missing 0.2 0.1 0.5 3.3 2.5 Total 100.0 100.0 100.0 100.0 100.0 Sanitation facility Own flush toilet 29.9 43.7 10.8 0.1 8.0 Shared flush toilet 15.2 19.9 8.6 0.0 4.0 Traditional pit toilet 18.2 10.7 28.8 0.7 5.3 Vent. imp. pit latrine 2.7 2.9 2.3 0.1 0.8 No facility/bush 33.9 22.8 49.5 99.0 81.8 Missing/Don't know 0.0 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 Continued. -- Less than 0.05 percent 21 Table 2.9--Continued Residence Other Characteristic Urban Asmara towns Rural Total Floor material Earth/sand 33.7 16.6 57.6 81.2 68.7 Dung 1.2 0.5 2.2 16.2 12.3 Palm/bamboo 0.1 0.1 0.0 0.5 0.3 Parquel/polished wood 0.2 0.2 0.1 0.0 O.1 PVC tiles 34.6 50.6 12.3 0.3 9.3 Cement 30.0 31.7 27.7 1.4 9.0 Carpet 0.2 0.2 0.1 0.0 0.0 Other 0.0 0.0 0.0 0.1 0.1 Missing/Don't know 0.0 0.0 0.0 0.2 0,2 Total 100.0 100.0 100.0 100.0 100.0 Persons per room <2 53.0 55.8 49.1 33.6 38.7 3-4 25.9 24.3 28.1 34.3 32.1 5-6 12.3 11.3 13.7 18.7 17.0 7+ 8.8 8.6 9.0 13.0 11,9 Missing/Don't know 0.0 0,0 0,1 0.4 0.3 Total 100,0 100.0 100.0 100.0 1130.0 Mean number of persons per room 3.0 2.9 3.2 3.8 3.6 Persons per sleeping room <2 46.6 48.9 43.4 28.8 33.5 3-4 29.7 29.1 30.4 34.9 33.5 5-6 13.7 12.4 15,5 21.2 19.2 7 + 9.9 9.4 10.6 14.6 13.4 Missing/Don't know 0.1 0,1 0.1 0.4 0.3 Total 100.0 100.0 100,0 100,0 100.0 Mean number of persons per sleeping room 3.3 3.2 3.4 4.0 3.8 Farm animals in living area Yes 4.9 2,1 8.9 40.8 31.3 Fuel used for cooking Gas 4.8 7.l 1.6 0.4 1.6 Electricity 0.9 1.2 0.3 0,0 0,2 Kerosene 63.9 83.4 36.7 2.2 18.5 Coal/charcoal 5.4 1.0 11,5 1,3 2.4 Wood 23.2 6.1 47.1 76.4 62.3 Animal dung cakes 1.0 0.6 1.6 19,5 14.6 Other 0.8 0.6 1.1 0.0 0.2 Total 100.0 100.0 100.0 100.0 100.0 Salt used for cooking Local salt 97.1 97.0 97.3 99.6 98.9 Packaged salt: iodized 0.7 0.6 0.8 0.0 0.2 Packaged salt: noniodized 1.8 2.2 1,2 0,2 0.6 Salt for animals -- 0.0 0.1 0.1 0.1 Loose salt 0.3 0.2 0.4 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 Number of households 1,446 842 604 4,023 5,469 -- Less than 0.05 percent 22 Figure 2.4 Housing Characteristics by Residence 100 80 60 40 20 0 Percent of Households 81 iiii!ili! 23 Electricity 73 ;:~:',: ' . :1 i i;3!:'i: : . : , . . , . ii ::iiii ~!!.il :.:,~. 25 i?ii:ii:i ~ ii::i::ii ::i::i!i:i r i:i;i;i Source of Water <15 minutes 45 12 Flush Toilet EDHS 1995 a public well or a spring. However, two-thirds of rural households depend on these two sources for water. Twenty-one percent of households in rural areas get water from a river, stream, pond or lake, and only 8 percent from a public tap. No rural household has water piped into the residence. Eight of 10 households in Asmara have easy access to water (i.e,, they are within 15 minutes), compared with 6 of 10 in other towns, and less than 1 in 10 in rural areas. The median time to go to the source of drinking water, get water and come back is one hour in rural areas, 1 minute in Asmara and 6 minutes in other towns. For two-thirds of the households, there is no wait at the water source but 1 in 10 households in rural areas and 1 in 18 in urban areas have to wait more than one hour at the water source. More than one-fifth of households in Asmara, one-half in other towns and almost all rural households have no toilet facility. In urban households, 45 percent either have their own (30 percent) or share a flush toilet (15 percent) with other households (see Figure 2.4) and 21 percent have traditional pit or ventilated pit latrine. Almost two-thirds of households in Asmara use a flush toilet. The most commonly used flooring materials in Eritrea are earth and sand (69 percent) and dung (12 percent). Almost all households in rural areas, 60 percent in other towns, and 17 percent in Asmara have such floors. Most popular in Asmara are PVC tiles (51 percent), followed by cement floors (32 percent)• In contrast, in other towns cement floors (28 percent) are more common than PVC tile floors (12 percent). The EDHS collected data on the total number of rooms and rooms used for sleeping in a household. This information gives measures of household crowding. There are an average of 3.6 persons per room and 3.8 persons per sleeping room. The average number of persons per room and per sleeping room are not very different, indicating that almost all rooms in the dwelling are used for sleeping. Although median household size is the same in urban and rural areas, rural households are more crowded. For example, on average, 4.0 persons sleep in a room in rural households compared with 3.3 persons in urban households• The crowding is further exacerbated in rural areas by keeping animals in the living quarters at night. Forty-one percent of rural households keep animals at night in the same area where they themselves live. 23 Kerosene is the major fuel used for cooking in Asmara (83 percent) and is widely used in other towns (37 percent). A small proportion of households in Asmara use gas (7 percent) or wood (6 percent). However, wood is the main fuel used for cooking in other towns (47 percent) and in rural households (76 percent). Coal or charcoal is used almost exclusively in other towns (12 percent) and animal dung cakes are used almost exclusively in rural areas (20 percent). Almost all households use local salt for cooking because, at the time of the survey, iodized salt was not sold in Eritrea, even in Asmara or other towns. 2.2.1 Household Durable Goods Questions were included in the Household Questionnaire on ownership of durable goods related to access to mass media (radio and television), communication (telephone), food storage (refrigerator), and personal transportation (bicycle, motorcycle, private car, and donkey cart). Like housing characteristics, the availability of durable consumer goods is also a rough measure of household socioeconomic status. Table 2.10 shows the percentage of households owning certain durable goods by residence. In urban households, almost 80 percent have a radio, one-quarter have a television, and 10 percent have a telephone. Fourteen percent have a refrigerator. The proportion of urban households which own means of transport are as follows: bicycle (21 percent), private car (7 percent), donkey cart (1 percent), and motorcycle (less than I percent). Households in Asmara are much more likely to own each durable good espe- cially television, private car and bicycle, compared with households in other towns. Less than 10 percent of households in Asmara do not own any durable good, whereas more than one-third of households in other towns are without any durable goods. In rural areas almost three-quarters Table 2.10 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Eritrea 1995 Residence Other Possessions Urban Asmara towns Rural Total Radio 78.6 89.0 64.2 26.2 40.0 Television 25.2 37.9 7.4 0.1 6.7 Telephone 9.8 14.0 3.9 0.0 2.6 Refrigerator 13.5 16.7 9.1 -- 3.6 Bicycle 21.2 31.5 6.7 2.2 7.2 Motorcycle 0.5 0.7 0.2 0.0 0,1 Private car 7.1 10.8 1.9 0.3 2,1 Donkey can 1.2 1.7 0.5 0.4 0,6 None of the above 19.9 9.2 34.8 73.4 59,2 Number of households 1,446 842 604 4,023 5,469 -- Less than 0.05 percent of household have none of the durable goods mentioned above. Only two durable goods are owned by rural households: one-quarter have a radio and 2 percent have a bicycle. Household ownership of radios by zone differs substantially (data not shown): Southern Red Sea (28 percent), Gash-Barka (18 percent), Northern Red Sea (26 percent), Anseba (28 percent), Southern (36 percent), and Central (83 percent). 2.3 Characteristics of Survey Respondents 2.3.1 Background Characteristics Background characteristics of the 5,054 women and 1,114 men interviewed in the EDHS are presented in Table 2.11. The proportion of respondents declines with increasing age for both sexes except that men's age pattern is interrupted by a lower proportion in age group 30-34 than in age group 35-39. The distributions of men and women by age are not comparable because of a higher upper age limit for eligible men. However, 54 percent of the women and 45 percent of the men are under 30; 24 percent of women and 20 percent of men are in their thirties. Twenty-two percent of women and 21 percent of men are in the age range 40-49 and 13 percent of men interviewed are age 50 or over. 24 Table 2.11 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Eritrea 1995 Women Men Number of women Number of men Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted Age 15-19 22.3 1,129 1,137 21.3 237 251 20-24 16.3 823 844 12.7 142 140 25-29 15.5 782 773 t l .4 127 136 30-34 12.6 638 652 9.2 102 99 35-39 l l . l 562 576 l l .2 125 I I I 40-44 I 1.9 603 592 10.5 117 114 45-49 10.2 518 480 10.2 113 110 50-54 NA NA NA 6.9 77 84 55-59 NA NA NA 6.6 73 69 Residence Urban 32.6 1,648 2,520 31.9 356 562 Asmara 20.9 1,059 1,446 20.5 229 316 Other towns l 1.7 589 1,074 11.4 127 246 Rural 67.4 3,406 2,534 68. l 758 552 Zone Soutbem Red Sea 2.8 139 273 3.5 39 72 Northern Red Sea l l .0 556 803 9.9 l l0 164 Anseba 12.7 642 559 12.0 133 114 Gash-Barka 18.9 957 834 20.9 233 187 Southern 27.5 1,392 852 25.6 286 186 Central 27.1 1,368 1,733 28.0 312 391 Marital status Never married 20.0 1,009 1,204 35.0 390 439 Married 61.4 3,102 2,864 59.6 664 615 Living together 5.3 270 280 1.0 l 1 15 Widowed 4.8 240 239 1.5 16 15 Divorced 6.8 345 360 1.9 21 20 Not living together 1.7 88 107 1.1 12 10 Education No education 65.9 3,332 2,924 46.7 520 429 Primary incomplete 15.6 786 861 21.9 243 220 Primary complete 8.6 435 566 12.2 136 154 Secondary+ 9.9 501 703 19.3 215 311 Religion Orthodox 56.7 2,866 2,652 56.9 633 600 Catholic 4.2 211 210 3.4 38 39 Protestant 1.1 56 74 0.8 9 13 Muslim 37.5 1,893 2,094 38.9 433 462 Traditional believer 0.5 24 18 0.0 0 0 Other/missing 0.1 5 6 0.0 0 0 Ethnicity Afar 2.5 126 239 2.7 30 52 Bilen 2.6 130 121 3.3 37 39 Hedarib 2.3 118 107 2.9 33 25 Kunama 1.2 62 71 1.2 13 12 Nara 2.7 138 108 2.8 31 22 Rashaida 0.1 4 6 0.1 1 2 Saho 4.8 241 I98 3.8 43 38 Tigre 21.0 1,060 1,167 21.9 244 259 Tigrigna 62.0 3,133 2,962 60.4 673 649 Ethiopia 0.7 35 69 0.0 0 0 Other 0.1 3 4 0.7 8 16 Total 100.0 5,054 5,054 100.0 l.114 1,114 NA -- Not applicable 25 The same proportion of males and females are in urban areas (about one-third). This is unexpected since men are more likely to migrate to cities and towns in search of work. For both sexes, the largest proportion of respondents is in the Southern Zone (26-27 percent) and the Central Zone (27-28 percent) while the lowest proportion is in the Southern Red Sea Zone (around 3 percent). Around 60 percent of women and men are currently married. Male respondents are much more likely than female respondents to have never married because men tend to marry later than women. On the other hand, more women than men report their current marital status as widowed or divorced. The proportion of women who have never been to school is 19 percentage points or nearly forty percent higher than that of men (66 percent versus 47 percent). Men are also over 40 percent more likely than women to complete primary school and twice as likely to attend secondary school or higher levels of education. 2.3.2 Characteristics of Couples Because the men who were interviewed indi- vidually in the EDHS were selected from households in which women were interviewed, it is possible to match married men with their wives to form a sample of couples. Table 2.12 presents data on 564 couples. In Eritrea, as in most countries, men marry women young- er than they are. In less than 2 percent of couples, the wife was older than her husband; among the remaining couples, the husband was almost equally likely to be 0-9 years and 10 years or more older than his wife (see Table 2.12). The mean age difference between spouses is 10 years. Both wife and husband are educated in only 1 in 6 couples. In 1 in 5 couples, an educated husband has an uneducated wife, and in only 2 percent of couples, the woman is educated and her husband is not. Sixty- two percent of couples have no education. 2.3.3 Education Level of Survey Respondents Table 2.12 Differential characteristics between spouses Percent distribution of couples by differences between spouses in age and level of education, Eritrea 1995 Number Percent/ of Characteristic Years couples Wife older 1.5 8 Husband older by: 0-4 years 16.8 95 5-9 years 32.0 181 10-14 years 32.2 182 15 years or more 17.5 99 Mean age difference (years) All wives 9.7 564 Education (percent) Both husband and wife not educated 61.6 Wife educated, husband not 2.3 Husband educated, wife not 19.8 Both husband and wife educated 16.0 347 15 111 91 Total 100.0 564 Table 2.13 shows the percent distributions of female and male respondents by the highest level of education attended, according to age, residence, and zone. Youngerpeoplehaveattendedhigherlevelsofeducationthanolder people. The majority ofurbanmen and almost 3 in 10 urban women have attended secondary school while the overwhelming majority of rural women (83 percent) and a majority of rural men (63 percent) have no education. In contrast, almost the same proportion of men (61 percent) in Asmara have secondary or higher education. Among the zones, the Central Zone stands out in educational attainment. It has higher proportions than any other zone of men and women who have attended secondary school (50 percent and 30 percent, respectively). Forty-five percent of men in the Southern Zone and a majority of men (59-82 percent) and women (71-89 percent) in other zones have no education. Interestingly, the men and women who enter school in the Southern Red Sea Zone are almost as likely to reach at least secondary level of schooling as those who attend school in the Central Zone. 26 Table 2.13 Level of education Percent distribution of women and men by the highest level of education attended, according to selected background characteristics, Edtrea 1995 Highest level of education Number Background No edu- Primary Primary of characteristic cation incomplete complete Secondary+ Total respondents WOMEN Age 15-19 38.1 24.5 21.6 15.7 100.0 1,129 20-24 53.5 18.0 8.8 19.6 100.0 823 25-29 71.2 13.5 5.7 9.6 100.0 782 30-34 77.6 11.6 4.4 6.4 100.0 638 35-39 78.7 13.2 3,1 5.0 100.0 562 40-44 83.9 10,6 3.5 2.0 100.0 603 45-49 89.2 8.2 1.3 1.4 100.0 518 Residence Urban 29,9 22.7 19.0 28.4 100.0 1,648 Asmara 22.9 20,8 19.8 36.4 100.0 1,059 Other towns 42.6 26,1 17.4 13.9 100.0 589 Rural 83.3 12. l 3.6 1.0 100.0 3,406 Zone Southern Red Sea 71.4 8.1 10,2 10.2 100.0 139 Northern Red Sea 84.6 8.6 4.4 2.4 100.0 556 Anseba 73.2 16.3 7.3 3.2 100.0 642 Gash-Barka 88.5 7.7 2.7 1.1 100.0 957 Southern 76.2 17.1 3.9 2.8 100.0 1,392 Central 28.2 22.7 19.6 29.5 100.0 1,368 Total 65.9 15.6 8,6 9.9 100.0 5,054 MEN Age 15-19 17.8 32.5 21.5 28.2 100.0 237 20-24 26.2 17.6 16.5 39.7 100.0 142 25-29 42.7 19.7 12.7 24.9 100.0 127 30-34 53.1 16.9 11.5 18.5 100.0 102 35-39 60.2 20.1 10.0 9.7 100.0 125 40-44 63.8 22.5 7.0 6.7 100.0 117 45-49 57.0 24,9 5.0 13.1 100.0 113 50-54 72,7 16.5 3.3 7.5 100.0 77 55-59 84.1 9.1 5.7 1.0 100.0 73 Residence Urban 11.6 18.0 19.1 51.3 10010 356 Asmara 6.6 12.3 20.3 60.8 I00.0 229 Other towns 20.4 28.2 17.0 34.4 100.0 127 Rural 63. l 23.7 8.9 4.3 100.0 758 Zone Southern Red Sea 61.8 6.5 10.2 21.5 100.0 39 Northern Red Sea 59.0 23.8 9.9 7.3 100.0 110 Anseba 62.0 16.8 13.0 8.2 100.0 133 Oash-Barka 81.5 10.8 3.1 4.5 100.0 233 Southern 45.3 38.8 8.4 7.5 100.0 286 Central 9.2 18.0 23.0 49.8 100.0 312 Total 46.7 21,9 12.2 19.3 100.0 1,114 27 2.3.4 School Attendance and Reasons for Leaving School Women age 15 to 24 years who had attended school and were not currently attending school were asked in the EDHS why they had stopped attending school. One of the most important determinants of a woman's social and economic status is her level of education. Knowledge of the reasons why women leave school can provide guidance for policies designed to enhance women's status. Table 2.14 shows the percent distribution of women age 15 to 24 years by current enrollment in school whether they are attending school and, if not, their reasons for leaving school, according to highest level of education attended. A majority of women age 15 to 24 years in Eritrea who have attended school are continuing their education. The proportion currently attending school is highest amongst those who have completed primary but as yet not completed secondary school. After completing secondary school, the women are most likely to discontinue studying in school. Table 2.14 School attendance and reasons for leaving school Percent distribution of women 15 to 24 by current school attendance and percent distribution of women not currently attending school by reason for leaving school, according to highest level of education attended, Eritrea 1995 School Educational attainment attendance/ Reason for not Primary Primary Secondary attending school incomplete complete incomplete Secondary+ Total School attendance Currently attending 36.9 62.4 71.4 29.3 51.0 Not attending 63.1 37.6 28.6 70.7 49.0 Total 100.0 100.0 100.0 100.0 100.0 Reason not attending school Got pregnant 3.5 6.5 13.3 2.0 5.2 Got married 43.2 31.7 26.6 3.0 32.8 Take care of younger children 4.3 7.1 1.1 1.6 4.2 Family need help 13.0 5.2 4.3 1.2 8.5 Could not pay school fees 5.1 4.5 3.3 0.0 4.0 Need to earn money 6.8 7.0 5.5 5.7 6.5 Graduated/Enough school 0.0 0.0 1.1 30.5 4.5 Did not pass exams 1.8 6.1 21.2 48.9 11.9 Did not like school 2.6 8.8 6.4 0.0 4.1 School not accessible 5.8 5.0 2.4 0.0 4.4 Due to war 3.8 2.3 1.1 0.0 2.6 Due to health problem 5.5 11.1 7.8 2.7 6.6 Other 1.0 2.1 1.1 1.0 1.3 Don't know/missing 3.7 2.6 4.7 3.3 3.5 Total 100.0 100.0 100.0 100.0 100.0 Number not attending school 269 119 66 76 530 One-third of women who were currently not in school reported that they left because they got married, and another 5 percent said that getting pregnant was the reason for their leaving school. The proportion mentioning these two reasons combined is higher among those have not completed either primary or secondary school than those who have. Only 5 percent of women who have completed secondary school mentioned these two reasons. The next most frequently cited reason is "did not pass examination" (12 percent) which is mentioned by one-fifth of women who have not completed secondary school and almost half of those who have. Nine percent of women who left school mentioned that their family needed money 28 and 7 percent said that they needed to earn money. Health problems caused 7 percent to leave school. Two reasons account for 84 percent of all women leaving school after completing secondary school: "did not pass examination" and "graduated/had enough schooling." 2.3.5 Access to Mass Media Table 2.15 shows the percentage of female and male respondents exposed to different types of mass media by age, residence, zone, and level of education. It is important to know which types of persons are more/less likely to be reached by the media for purposes of planning programs intended to spread information about health and family planning. Men have more access to all mass media than women do. Twenty percent of women and 39 percent of men read newspapers or magazines at least once a week, 18 percent of women and 27 percent of men watch television at least once a week, and 53 percent of women and 70 percent of men listen to the radio at least once a week. Eleven percent of women and 23 percent of men have access (at least once a week) to all three media. Forty-six percent and 29 percent of the females and males, respectively, have no access to mass media. As expected, access to all three mass media is higher for women and for men in urban areas than in rural areas. Access to at least one type of mass media is almost universal for men and around 90 percent for women in urban areas, compared with only 60 percent and 38 percent for men and women in rural areas, respectively. Printed material and television are less accessible to people in rural areas because of lower education and limited electrification. Young women under 25 years, men under 40 years, and educated men and women, are more likely to read newspapers, watch television and listen to the radio than other men and women. Men and women in the Central Zone are more exposed to media than those in other zones. In the Central Zone, the exposure of men to all media is high and to radio it is almost universal. In comparison with men, for women exposure to radio is slightly lower, for television moderately lower and much lower for newspapers. Less than half of women have access to any mass media except in the Central and Southern Zones. 2.3.6 Women's Employment Status The EDHS collected information from women regarding their current employment situation.5 Table 2.16 shows that about three-fourths of women are not currently employed. Fifteen percent of women are employed all year (12 percent full-time), 8 percent seasonally, and 1 percent occasionally. The highest percentage employed among women is in the Southem Zone (48 percent), followed by women in Asmara, those 45 and over, and those with secondary school or higher education (almost one-third in each group). Seventy to 92 percent of women in all other categories shown in the table did not work in the 12 months preceding the survey. In Asmara and other towns women are more likely to report year-round employment (26 and 18 percent, respectively) than women in rural areas (11 percent). Regular, year-round employment is also more common in the Central and Southern Red Sea Zones. Similarly, regular full-time work tends to increase and seasonal work decrease with increasing level of education. On the other hand, seasonal work is most common in the Southern Zone, and more common among older women (13 percent among women 45-49) than younger women, in rural areas (11 percent) than in urban areas. 5 Employment is defined as receiving payment in cash or in kind for work. 29 Table 2.15 Access to mass media Percentage of women and men who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by selected background characteristics, Eritrea 1995 Background characteristic Mass media Read Watch Listen to Number No newspaper television radio All of mass once a once a once a three women/ media week week week media men WOMEN Age 15-19 29.9 35.6 27.8 66.6 19.7 1,129 20-24 38.6 27.3 22.0 59.4 14.6 823 25-29 52.2 16.3 14.2 46,4 9.1 782 30-34 54.0 14.8 11.8 45.8 7.9 638 35-39 50.8 12.8 12.2 47.8 6.6 562 40-44 55.2 10.4 12.3 42.8 5.3 603 45-49 53.1 7.5 I 1,7 45.9 4.8 518 Residence Urban 11.5 49.6 50.3 84.5 33.0 1,648 Asmara 4.8 59.1 67.3 91.0 45.6 1,059 Other towns 23.6 32.7 19.7 72.8 10.3 589 Rural 62.0 6.0 1.7 37.2 0.4 3,406 Zone Southern Red Sea 69.8 16.6 16.2 24.9 8.8 139 Northern Red Sea 66.4 7.9 5.6 33.1 2.6 556 Anseba 59.3 11.0 4.3 39.2 2.3 642 Gash-Barka 72.1 6.2 0.6 26.8 0.1 957 Southern 46,4 10.5 4.1 52.6 1.6 1,392 Central 8.6 49.6 54.1 87.8 36.1 1,368 Education No education 64.5 1.0 4.5 34.8 0.4 3,332 Primary incomplete 16.1 41.0 20.2 78.9 12.0 786 Primary complete 4.1 61.7 48.0 91.5 35.2 435 Secondary+ 1.4 79.3 73.1 96.5 59.2 501 Total 45.5 20.2 17.5 52.6 I 1.0 5,054 MEN Age 15-19 23.8 52.8 39.3 74.0 33.2 237 20-24 12.4 56.1 40,4 86.6 35.9 142 25-29 20.6 43.2 29.3 78.7 27.9 127 30-34 28.1 38.2 22.0 69.4 20.1 102 35-39 30.8 30.3 21.2 69.2 20.4 125 40-44 39,6 34.3 14.7 59.4 10.9 117 45-49 37.3 29.3 19.1 60.2 16.7 113 50-54 40.5 23.0 15.5 57.3 12.6 77 55-59 41.4 14.4 17.9 55.9 9.9 73 Residence Urban 3.6 78.5 67.5 95.0 59.0 356 Asmara 0.6 85.8 82.3 98.4 73.4 229 Other towns 8.8 65.5 40.8 88.9 33.1 127 Rural 40.2 21.0 8.0 58.1 6.6 758 Zone Southern Red Sea 51.9 26.7 22.7 46.9 18.8 39 Northern Red Sea 37.9 34.9 18.0 59.9 14.8 110 Anseba 33.6 27.4 3.0 65.2 2.5 133 Gash-Barka 61.0 15.5 5.7 38.4 5.1 233 Southern 22.6 23.1 10.3 74.0 6.8 286 Central 1.2 80.3 72.0 98.1 64.4 312 Education No education 55.3 5.5 3.5 44.0 1.3 520 Primary incomplete 8.9 47.0 20.9 87.9 16.9 243 Primary complete 5.3 72.2 47.1 92.0 40.7 136 Secondary+ 0.5 91.9 78.0 98.3 72.7 215 Total 28.5 39.3 27.0 69.9 23.3 1,114 30 Table 2.16 Women's employment Percent distribution of women by employment status and continuity of employment, according to selected background characteristics, Eritrea 1995 Not currently employed Currently employed Did not work Worked All year in last in Number Background 12 last 12 5+ days <5 days Season- Occasion- of characteristic months months per week per week ally ally Missing Total women Age 15-i9 81.5 1.4 8.1 0.9 6.9 1.2 0.0 100.0 1,129 20-24 71.3 2.1 13.5 4.3 7.0 1.6 0.2 100.0 823 25-29 71.6 2.2 13.0 4.1 7.7 1.1 0.3 100.0 782 30-34 71.1 2.6 13.4 3.4 8.2 1.0 0.2 100.0 638 35-39 71.3 1.4 12. I 4.8 8.1 2.2 0.0 100.0 562 40-44 69.7 1.9 13.9 3.1 9.7 1.4 0.3 100.0 603 45-49 67.8 1.4 14.1 1.9 13.3 1.6 0.0 100.0 518 Residence Urban 69.0 2.7 22.2 0.8 2.4 2.7 0.2 100.0 1,648 Asmara 66.4 2.6 25.4 0.6 2.2 2.5 0.2 100.0 1,059 Other towns 73.6 3.0 16.3 1.2 2.7 3.1 0.1 100.0 589 Rural 75.0 1.4 7.3 4.1 11.2 0.8 0.1 100.0 3,406 Zone Southern Red Sea 79.8 1.4 12.7 1.1 2.1 2.9 0.0 100.0 139 Northern Red Sea 87.4 1.9 6.0 0.3 3.5 0.9 0.0 100.0 556 Anseba 92.0 0.4 5.3 0.0 0.9 1.4 0.0 100.0 642 Gash-Barka 86.7 1.6 4.0 1.1 5.3 0.8 0.5 100.0 957 Southern 49.3 2.3 15.6 9.5 22.2 1.1 0.0 100.0 1,392 Central 72.2 2.3 20.1 0.6 2.4 2.2 0.2 100.0 1,368 Education No education 73.2 1.6 8.8 4.2 10.8 1.3 0.2 100.0 3,332 Primary incomplete 73.8 2.5 15.0 1.7 4.8 1.9 0.2 100.0 786 Primary complete 79.3 1.6 14.4 0.5 2.6 1.6 0.0 100.0 435 Secondary+ 65.5 2.5 28.2 0.2 2.4 1.1 0.0 100.0 501 Total 73.0 1.8 12.2 3.1 8.3 1.4 0.1 100.0 5,054 2.3.7 Women's Employer and Form of Earnings Table 2.17 shows the percent distribution of employed women by type of employer and form of earnings, according to background characteristics. About 32 percent of the women are self-employed, almost the same proportion are employed by relatives, and in both cases the majority do not earn cash. Thirty-seven percent are employed by nonrelatives, the overwhelming majority of whom earn cash. Overall, just over 40 percent of employed women are paid in cash. Ninety percent of urban women who work work for cash. On the other hand, mral women generally do not get paid in cash for their work and are as likely to work for themselves as for relatives (around 40 percent). The Southern Zone has the highest proportion of women who are self-employed and not receiving cash (45 percent) and the highest proportion of women employed by relatives without getting money (42 percent). Women are more likely to work for relatives in the Gash-Barka Zone than in any other zone: 20 percent earning cash and 29 percent not getting paid in cash. In other zones, most jobs are provided by 31 Table 2.17 Employer and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to selected background characteristics, Eritrea 1995 Employed by Employed by Self-employed a nonrelative a relative Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women Age 15-19 3.9 7.7 39.1 3.0 2.0 44.3 0.0 100.0 194 20-24 4.5 21.0 41.2 5.0 4.3 24.0 0.0 100.0 218 25-29 5.5 33.1 36.3 1.9 3.2 19.3 0.7 100.0 204 30-34 2.2 31.4 35.3 7,7 4.5 18.9 0.0 100.0 166 35-39 6.0 30.8 28.8 5,8 6.9 21.6 0.0 100.0 153 40-44 7.2 28.9 24.6 5,9 5,3 27.3 0.8 100.0 170 45-49 6.2 39.5 17.8 3,7 4.4 28.5 0.0 100.0 160 Residence Urban 10.6 2.5 72.4 3,7 6.7 4.1 0.0 100.0 463 Asmara 8.1 2.0 79.1 2.5 4.7 3.6 0.0 100.0 326 Other towns 16.5 3.6 56.6 6.6 11.4 5.3 0.0 100.0 138 Rural 1.8 41.0 9.6 5.1 2.8 39.3 0.3 100.0 802 Zone Southern Red Sea 7.8 5.8 80.8 5.6 0.0 0.0 0.0 100.0 26 Northern Red Sea 15.7 13.0 39.6 19.9 1.8 9.9 0.0 100.0 59 Anseba 1 1.5 0.0 72.5 4.1 1.4 10.5 0.0 100.0 49 Gash-Barka 10.8 16.7 18.7 3.0 19.9 28.5 2.5 1000 110 Southern 1.2 45.4 5.5 4.4 1.9 41.5 0.0 100.0 673 Central 7.6 1.9 79.2 2.9 5.0 3.4 0.0 1130.0 347 Education No education 3.5 38.6 15.1 5.0 3.6 33.8 0.3 100.0 838 Primary incomplete 8.9 7.2 52.8 6.2 6.4 18.5 0.0 100.0 184 Primary complete 11.7 0.9 73.2 3.1 6.2 4.9 0.0 100.0 83 Secondary+ 5.2 1.9 79.9 1.4 4.1 7.6 0.0 100.0 160 Total 5.0 26.9 32.6 4.6 4.3 26.4 0.2 100.0 1.265 nonrelatives and pay is in cash--from 40 percent of employed women in the Northern Red Sea Zone to around 80 percent in the Central and Southern Red Sea Zones. Three-fourths of uneducated women do not earn cash for their work: 39 percent work for themselves, 34 percent work for relatives and 5 percent work for others. The proportion of women who are employed by nonrelatives and earn cash increases with education, from 15 percent of women who have had no education to three-fourths of women who completed at least primary school. On the other hand, there is a negative relationship between educational level and working for a relative and not receiving any remuneration. 2.3.8 Women's and Men's Occupation Information on the current occupation of employed women and men is shown in Tables 2.18.1. and 2.18.2, respectively. A majority of working women (55 percent) have agricultural occupations; 44 percent work on their own land, 6 percent work for others, and 5 percent work on family land. Women who are not working in agriculture range from 9 percent in sales/services to 13 percent working as household and domestic workers. One in 10 employed women has a professional, technical, or managerial occupation. 32 Table 2.18.1 Occupation: women Percent distribution of currently employed women by occupation and type of agricultural land worked or type of non- agricultural employment, according to selected background characteristics, Eritrea 1995 Agricultural Nonagricultural ProL Household Number Background Own Family Rented Other's techJ Sales/ Skilled and of characteristic land land land land manag, services manual domestic Missing Total women Age 15-19 19.6 24.0 0.0 9.3 1.3 4.9 10.4 30.6 0.0 100.0 194 20-24 37.1 4.1 0.0 6.6 17.3 11.7 9.2 14.0 0.0 100.0 218 25-29 45.8 2.9 1.5 4.7 14.2 9.5 10.7 9.7 1.0 100.0 204 30-34 44.9 0.0 0.0 6.8 18.4 6.4 14.4 9.1 0.0 100.0 166 35-39 49.3 0.7 0,0 3.9 10.7 8.8 15.7 10.9 0.0 100.0 153 40-44 49.7 3.5 0.0 7.1 3.9 8.5 15.2 11.3 0.8 100.0 170 45-49 65.7 0.0 0.0 4.2 3.6 11.6 10.6 4.4 0.0 100.0 I60 Residence Urban 0.6 0.0 0.0 0.9 24.7 19.4 23.8 30.5 0.2 100.0 463 Asmara 0.7 0.0 0.0 0.2 26.1 15.5 26.3 31.0 0.2 109.0 326 Other towns 0.6 0.0 0.0 2.4 21.3 28.5 17.7 29.4 0.0 100.0 138 Rural 68.5 8.5 0.4 9,2 1.8 2.7 5.3 3.2 0.3 100.0 802 Zone Southern Red Sea 0.0 0.0 0.0 0.0 15.0 9.4 11.7 63.9 0.0 100.0 26 Northern Red Sea 20.6 0.0 0.0 7.9 9.9 13.1 25.2 23.4 0.0 100.0 59 Anseba 0.0 0.0 0.0 19.6 23.0 10.4 27.0 20.0 0.0 100.0 49 Gash-Barka 40.1 3.5 0.0 2.2 5.5 16.8 18.3 11.i 2.5 100.0 110 Southern 73.3 9.6 0.4 8.8 1.3 3.7 1.7 1.1 0.0 100.0 673 Central 0,6 0.0 0.0 0.5 26.6 15.2 25.9 30.9 0.2 100.0 347 Education No education 63.5 5.2 0.4 7.1 0,2 4.7 8.6 10.0 0.3 100.0 838 Primary incomplete 10.8 11.8 0.0 7.8 2.9 17.1 22.6 27.0 0.0 109.0 184 Primary complete 0.0 0.0 0.0 3.6 21.5 18.4 25.0 31.5 0.0 100.0 83 Secondary+ 0.0 1.9 0.0 0,5 64,9 15.9 11.4 5.0 0.5 100.0 160 Total 43,6 5.4 0.2 6.2 10.2 8.8 12.1 13.2 0.3 1130.0 1,265 Note: Professional, technical, managerial includes professional, technical, clerical and managerial occupations. Not surprisingly, 87 percent of employed mral women and 76 percent of uneducated women are in agricultural jobs. Working women who live in urban areas or have completed primary education are almost exclusively employed in nonagricultural occupations. Almost one-third of urban women workers are household and domestic workers and 24 percent do skilled manual work. On the other hand, over 90 percent of women in the Southern Zone and slightly less than half of women in the Gash-Barka Zone are in agricultural occupations, whereas in other zones agriculture is not so dominant. Almost all women who have completed at least primary level of school are in nonagricultural jobs. It is surprising that one-third of employed women who have completed primary school but have not attended secondary school do household and domestic work. Eighty-one percent of women with at least some secondary education hold professional, technical, or managerial jobs (65 percent) or work in occupations related to sales and services (16 percent). Women who have only completed primary school are half as likely to have these occupations as those who have some secondary education. 33 Lo Table 2,18.2 Employment and occupation: men Percent distribution of men by employment status and percent distribution of currently employed men by occupation and type of agricultural land worked or type of non- agricultural employment, according to selected background characteristics, Eritrea 1995 Wedc status Agricultural Nonagricultural Not Prof. Household Background currently Currently Own Family Rented Other's techJ Sales/ Skilled and Number characteristic employed employed land land land land manag, services manual dorne~ric Missing Total of men Age 15-19 74.7 25.3 5.8 47.9 1.2 17.4 0.5 2.6 21.0 2.3 1.2 100.0 237 20-24 32.3 67.7 18.8 30.6 0.0 0.7 8.2 11.4 26.0 4.3 0.0 100.0 142 25-29 10.3 89.7 35.2 12.3 0.0 7.8 12.2 8.0 22.2 1.5 0.8 100.0 127 30-34 5.5 94.5 51.7 6.5 0.7 6.4 13.8 5.7 13.2 1.8 0.0 100.0 102 35-39 3.9 96.1 59.6 2.7 0.9 5.4 6.6 9.4 13.6 1.8 0.0 100.0 125 40~14 9.9 90.1 59.2 3.9 0.0 4.9 8.6 8.6 13.4 1.4 0.0 100.0 117 45-49 4.3 95.7 54.5 5.8 0.8 3.2 10.0 9.2 13.2 3.3 0.0 100.0 113 50-54 6.2 93.8 62.9 0.0 0.0 9.0 7.2 9.0 11.0 0.9 0.0 100.0 77 55-59 14.4 85.6 67.4 3.7 0.0 5.3 2.1 7.9 11.5 2.1 0.0 100.0 73 Residence Urban 34.1 65.9 5.3 2.3 0.6 2.0 25.1 18.3 38.5 7.5 0.3 100.0 356 Asmara 37.0 63.0 0.5 0.5 1.0 0.5 30.2 15.6 44.7 6.5 0.5 100.0 229 Other towns 29.0 71.0 12.9 5,1 0.0 4.3 17.t 22.7 28.7 9.1 0.0 100.0 127 Rural 20.7 79.3 63.2 14.8 0.3 7.8 1.8 4.3 7.5 0.1 0.1 100.0 758 Zolle Southern Red Sea 29.6 70.4 0.0 6,0 0.0 33.8 7.8 12.4 37.9 2.1 0.0 100.0 39 Northern Red Sea 22.1 77.9 41.5 8~5 1.0 12.5 3.9 13.3 14.8 3.4 1.0 100.0 110 Anseba 20.5 79.5 52.7 11.4 0.0 10.4 6.1 11.0 5.3 3.1 0.0 1130.0 133 Gash-Barka 12.2 87.8 70.6 7,3 0.0 5.6 3.1 5.7 7.5 0.3 0.0 100.0 233 Southern 23.6 76.4 62.1 22.3 0.0 3.2 2.2 3.3 6.3 0.6 0.0 100.0 286 Central 38.2 61.8 I0.8 5.0 1.3 1.0 24.2 12.2 40.3 4.9 0.4 100.0 312 EducaUon No education 9.7 90.3 67.3 11.8 0.2 9.4 0.7 3.2 5.8 1.5 0.2 100.0 520 Primary incomplete 28.5 71.5 37.4 14.3 1.I 2.2 1.6 14.8 25.2 3.3 0.0 100.0 243 Primary complete 39.3 60.7 13.0 16.1 0.0 0.7 12.1 16.7 36.9 3.5 0.9 100.0 136 Secondary+ 48.9 51.1 0.7 0.7 0.7 2.5 48.8 13.2 31.3 2.2 0.0 100.0 215 Total 25.0 75.0 47.0 11.3 0.4 6.1 8.4 8.3 16.2 2.2 0.2 100.0 1,114 Note: Professional, technical, managerial includes professional, technical, clerical and managerial occupations. Among men 15-59, 75 percent are currently working and among those 25-59 the proportion working ranges from 86 to 95 percent (see Table 2.18.2). Unemployment is higher in urban areas. Only one-fifth of men in rural areas are not currently employed, compared with 37 and 29 percent of men in Asmara and other towns, respectively. Higher unemployment in urban areas may be partly due to some young persons still pursuing their higher educational goals and not entering the labor force. Among working men, 65 percent are in the agriculture sector and the remainder have other occupations--16 percent skilled manual, 8 percent professional/technical/managerial, 8 percent sales or services and 2 percent household and domestic. 2.3.9 Decision on Use of Women's Earnings Information on who decides how to use the cash earned by employed women can be used as a measure of the status of women. Table 2.19 shows that 72 percent of women who receive cash earnings decide for themselves how to spend their money, 15 percent decide jointly with their husband/partner and 11 percent decide jointly with someone other than their husband/partner. Less than one half of one percent Table 2.19 Decision on use of women's earnings Percent distribution of women receiving cash earnings by person who decides how earnings are used, according to selected background characteristics, Eritrea 1995 Person who decides how earnings are used Jointly Jointly with with Number Background Husband/ husband/ Someone someone of characteristic Woman partner partner else else Missing Total women Age 15-19 80.2 0.0 0.0 4.8 14.2 0.8 100.0 87 20-24 70.7 1.3 9.3 4. I 14.6 0.0 100.0 109 25-29 72.9 0.0 13. I 0.0 14.0 0.0 100.0 92 30-34 68.1 0.0 26.9 0.0 4.9 0.0 10O.0 70 35-39 72.4 0.0 20.2 0.1) 5.7 1.7 100.0 64 40-44 67.2 1.2 23.8 0.0 6.7 1.2 1130.0 63 45-49 63.6 0.0 27.1 0.0 9.3 0.0 100.0 45 Residence Urban 75.6 0.5 13.8 1.6 8.1 0.4 100.0 416 Asmara 74.3 0.5 15.2 1.0 8.6 0.5 100.0 299 Other towns 78.8 0.6 10.3 3.2 7.0 0.0 100.0 116 Rural 56.6 0.0 20.8 1.7 20.0 0.9 100.0 I 15 Zone Southern Red Sea (85.2) (0.0) (2. I) (2. I) (10.6) (0.0) 100.0 23 Northern Red Sea 66.4 2.1 14.2 0.0 17.2 0.0 1GO.0 34 Anseba (92.6) (0.0) (4.8) (0.0) (0.0) (2.6) 100.0 42 Gash-Barka 56.9 0.0 17.2 1.1 24.8 0.0 100.0 54 Southern 50.7 0.0 32.8 7.9 8.6 0.0 100.0 58 Central 74.5 0.5 14.2 0.9 9.4 0.5 100.0 319 Education No education 72.0 0.4 17.1 0.6 9.0 1.0 100.0 186 Primary incomplete 74.6 0.0 12.6 2.7 10.2 0.0 100.0 126 Primary complete 76.1 0.0 8.1 3.7 I 1.2 1.0 100.0 76 Secondary+ 65.7 1.0 19.2 1.0 13.1 0.0 100.0 143 Marital status Currently married 48.3 1.3 46.3 0.4 3.6 0.0 100.0 174 Not married 82.8 NA NA 2.2 14.1 0.7 100.0 357 Total 71.5 0.4 15.3 1.6 10.7 0.5 100.0 530 Note: Figures in parentheses are based on 25 to 49 women. NA = Not applicable 35 of women who earn cash reported that their husband alone decides how their earnings will be used. Younger women (probably because they are not married), urban women, those with less than secondary schooling, and unmarried women are more likely to report that they make their own decisions on how to spend the money they earn. Three-fourths of women earning cash in urban areas make their own decision on how to use the money they earn, compared with 57 percent of employed women in rural areas. Three-quarters of women in the Central Zone and 85 percent and 93 percent in the Southern Red Sea Zone and the Northern Red Sea Zone, respectively, report that only they decide what to do with the cash they earn. In the Gash-Barka Zone over 40 percent decide jointly with their husband (17 percent) or someone other than their husband (25 percent), whereas in the Southern Zone 49 percent of women depend on others to decide how to spend the cash they earn. In the Southern Zone, one-third decide jointly with their husband, and 7-8 percent each do so jointly with someone else or have only someone else decide for them. There is an unexpected relationship between level of education and decisions on use of a woman's cash income. About three-fourths of women with no education or primary education report that they alone make decisions about the money they earn, compared with two-thirds of women who have attended secondary school. The most educated group of women has the highest proportion deciding on spending jointly with their partners (19 percent) or with someone else (13 percent). Slightly less than one-half of currently married women make the decision to spend their money themselves and one-half do so with their partner (46 percent) or with someone other than their partner. Only 17 percent of unmarried women do not make the decision themselves. 2.3.10 Child Care While Working Table 2.20 shows the percent distribution of employed women by whether they have a child under six years of age and, for those who do, the percent distribution by type of child minder (caretaker) used by the mother while working. Slightly over half (53 percent) of employed women have a child under six years of age. Almost 90 percent of employed mothers report that children under six are cared for by themselves, their children, and other relatives: respondent (50 percent), female child (17 percent), male child (4 percent), and other relatives (18 percent). Five percent of mothers say that neighbors provide child care and 4 percent report that they depend on servants and hired help. Mothers in Asmara are least likely to mind children while working ( 14 percent) because they depend to a considerable extent on relatives other than their children (32 percent) and on servants and hired help (26 percent). Their own children, especially female children, are also an important source of child care: female child (19 percent) and male child (4 percent). In other towns, the mother herself is the most important source of child care (37 percent), followed closely by other relatives (33 percent) and older children (13 percent). Rural mothers have less help from other relatives and have no hired help for child care. In rural areas, most mothers themselves provide child care (56 percent), whereas their older children play as important a role as they do for mothers living in urban areas. By type of child care providers, mothers are undoubtedly the most important source of child care. Relatives other than respondents' own children are an especially important source of child care for women who have completed primary education (60 percent) and for those living in the Anseba Zone (61 percent). Relatives are also fairly important in urban areas, the Central Zone, for women with secondary education, and for those who work for someone else or work only occasionally. Children are as important providers of child care as mothers in the Northern Red Sea Zone. Servants and hired help are used in urban areas (26 percent in Asmara), and are the only nonmaternal child care providers used in the Southern Red Sea Zone (50 percent). Hired help and other relatives are equally important for women with some secondary education (35 percent and 37 percent, respectively). 36 Table 2.20 Child care whi le work ing Percent distribution of currently employed women by whether they have a child under six years of age at home, and the percent distribution of employed mothers who have a child under six by person who cares for child whi le mother is at work, according to selected background characteristics, Eritrea 1995 Background characteristic Employed women with: One or more No chil- Child's caretaker while mother is at work child dren Number Not under under of era- Re- Other Neigh- Child Other Other worked six at six at ployed spond- rein- her/ Hired is in female male since home home women ent tire Friend help school child child birth I Other Missing Total Residence Urban 73.8 Asmara 74.8 Other towns 71.2 Rural 31.3 Zone Southern Red Sea 96.2 Northern Red Sea 47.4 Anseba 70.3 Gash-Barka 55.6 Southern 27.3 Central 74.8 Education No education 36.5 Primary incomplete 65.4 Primary complete 68.5 Secondary+ 68.6 Work status For family member 40.0 For someone else 69.6 Self-employed 26.9 Occupation Agricultural 27.1 Nonagdcaltural 71.6 Employment status All year, full week 55.9 All year, part week 19.9 Seasonal 39.0 Occasional 72.7 Total 46.8 26.2 463 21.6 32.4 4.0 19.9 0.6 16.8 2.4 0.6 0.5 1.2 100.0 25.2 326 14.3 32.1 3.6 25.9 0.9 18.7 3.6 0.9 0.0 0.0 100.0 28.8 138 36.7 33.0 4.9 7.4 0.0 12.6 0.0 0.0 1.7 3.7 100.0 68.7 802 56.1 14.6 4.9 0.0 0.0 17.4 4.1 0.9 0.2 1.9 100.0 3.8 26 50.0 * * * * * * * * * 100.0 52.6 59 (38.5) (8.5) (8.1) (4.7) (0.0) (37.3) (0.0) (0.0) (2.9) (0.0) 100.0 29.7 49 * * * * * * * * * * 100.0 44.4 110 (52.5) (21.4) (1.3) (0.0) (0.0) (21.2) (0.0) (0.0) (0.0) (3.6) 100.0 72.7 673 57.4 14.2 5.0 0.1 0.0 15.7 4.7 1.0 0.0 2.0 100.0 25.2 347 14.6 32.6 4.6 24.3 0.8 18.8 3.4 0.8 0.0 0.0 100.0 63.5 838 55.6 13.7 4.9 0.1 0.0 19.0 3.9 0.6 0.2 2.1 100.0 34.6 184 51.4 19.4 4.9 5.6 0.0 10.9 4.2 3.1 0.0 0.5 100.0 31.5 83 9.5 60.2 0.0 8.4 0.0 8.2 8.4 2.8 2.6 0.0 100.0 31.4 160 8.7 37.3 5.0 35.0 1.5 11.7 0.0 0.0 0.0 0.8 100.0 60.0 388 60.6 15.7 1.3 0.6 0.0 14.7 4.7 1.3 0.0 1.2 100.0 30.4 471 15.5 33.1 4.5 13.3 0.5 22.3 6.9 1.9 0.5 1.6 100.0 73.1 404 58.4 12.2 7,5 1.2 0.0 16.9 1.7 0.0 0.3 1.8 100.0 72.9 701 57.4 14.4 4.7 0.0 0.0 16.6 4.5 0.6 0.2 1.7 IGO.O 28.4 560 26.3 29.1 4.9 14.7 0.5 19.7 1.8 1.7 0.4 0.9 I00.0 44.1 615 41.2 21.6 5.4 8.4 0.0 17.3 3.6 1.0 0.2 1.3 100,0 80.1 155 53.8 l l . l 4.8 0.0 0.0 23.0 4.8 0.0 0.0 2.4 I00.0 61.0 421 58.2 16.7 4.2 0.6 0.0 13.8 3.9 1.2 0.0 1.5 I00.0 27.3 71 38.9 24.2 1.5 0.0 3.8 27.0 0.0 0.0 4.6 0.0 100.0 53.2 1,265 49.9 17.8 4.7 3.6 0.1 17.3 3.8 0.8 0.2 1.7 100.0 Note: Total includes two women for whom information on employment status was not available. Figures in parentheses are based on 25 to 49 women; an asterisk indicates that a figure is based on fewer than 25 women and has been suppressed. I Respondent is currently employed but has not worked since last birth. 37 CHAPTER 3 FERTILITY The measurement of fertility levels, differentials and determinants is a maj or objective of the EDHS. In the survey, data were collected on current and completed fertility. The chapter begins with a description of current fertility, followed by differentials in fertility. Attention is next focused on trends in fertility; an examination of age-specific fertility rates for time periods going back 15 to 20 years. Sections 3.4 and 3.5 present information on children ever born and birth intervals. The chapter concludes with a presentation of information regarding age of women at first birth and patterns of adolescent childbearing. The fertility indicators presented in this chapter are based on reports provided by women age 15-49. Each woman in the EDHS was asked to provide information on the total number of sons and daughters to whom she had given birth who were living with her, the number living elsewhere, and the number who had died. Each woman was also asked for a history of all births she had had in her lifetime. In the birth history, women reported on the detailed history of each live birth separately, including such information as: name, month and year of birth, sex, and current survival slams. For children who had died, information on age at death was collected. 3.1 Current Fertility The most widely used measures of current fertility are the total fertility rate (TFR) and its component age-specific fertility rates (ASFR). The TFR is defined as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific rates. Age-specific and aggregate fertility measures (total fertility rate, general fertility rate, and crude birth rate) for the three years before the survey, are shown in Table 3.1 for all of Eritrea, and for urban and rural areas. The age-specific fertility rates by residence are shown also in Figure 3.1. Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by residence, Eritrea 1995 Residence Age group Urban Rural Total 15-19 52 171 125 20-24 161 282 245 25-29 215 290 269 30-34 200 267 245 35-39 115 224 189 40-44 83 121 110 45-49 21 45 37 TFR 15-49 4.23 6.99 6.10 TFR 15-44 4.12 6.77 5.91 GFR 128 231 198 CBR 29.3 40.3 37.5 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. 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 Numerators for the age-specific fertility rates are calculated by summing the number of live births that occurred 1-36 months preceding the survey (determined by the date of interview and birth date of the child), and classifying them by age (in five-year groups) of the mother at the time of birth (determined by the mother's birth date). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-36 months preceding the survey. 39 Figure 3.1 Age-Specific Fertility Rates By Urban-Rural Residence Births per 1,000 Women 3OO 25O lOO 50 o 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Group [+Urban -l-Rural =~,Total I EDH8 1995 The total fertility rate (TFR) for Eritrea is 6.1 children per woman. Peak childbearing occurs during a fairly long span, between age 20 and 34, dropping thereafter. This is true for both urban and rural areas but the drop is more pronounced in urban areas. Fertility among urban women is substantially lower (4.2 children per woman) than among rural women (7.0 children per woman) which means that under the present age schedule of fertility, a woman living in an urban area will have, on average, almost three fewer children (or about 40 percent fewer children) during her childbearing years than a woman living in a rural area. This pattern of lower urban fertility is evident in every age group (Fig- ure 3.1). 3.2 Fertility Differentials Table 3.2 and Figure 3.2 show differ- entials in fertility by residence and level of education. The urban-rural differentials have already been discussed. However, the table shows that fertility of women in Asmara Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey. percentage currently pregnant and mean number of children ever born to women age 40-49, by selected background characteristics, Eritrea 1995 Mean number of children Percentage ever born Background Total currently to women characteristic fertility rate I pregnant I age 40-49 Residence Urban 4.23 5,3 5.38 Asmara 3.72 4,1 5.26 Other towns 5.14 7,5 5.59 Rural 6.99 11.2 6.60 Education No education 6.87 11.0 6.34 Primary incomplete (5.52) 8.4 5.80 Primary complete (4.33) 4.0 5.66 Secondary+ (3.04) 3.4 4.15 Total 6.10 9.2 6.23 Note: Total fertility rates in parentheses are based on 500-999 women age 15-49. i Women age 15-49 years 40 Figure 3.2 Total Fertility Rates by Selected Background Characteristics ERITREA RESIDENCE Urban Asmata Other Towns Rural EDUCATION No Education primary Incomplete Primary Complete Secondary + 6.1 4,2 3.7 7.0 ~i;iiii~ii~i~ii!i::::!~:!:iiiiii::i:~iii::i::i;!~i;i~i;iiii:~i:~:i:i:i::!iii!~!~i~!~!~!!::i:~iiii:i:i:i::i;i:;ii~ 6.9 !!:~i~!:~!~:~:~:i~iiiii~i~:~.:i~iii;iiiiiiii~iiii:~i~i~i~iiiiiiiiii:~ 4.z iii::i::i::i::i::iii~i;i!::!::::i::i::iiiii~::i::i::i::;:::i:il 3.o 0.0 2.0 4.0 6.0 8.0 ~lFe~i l~Rate EDHS1995 (3.7 children per woman) is lower than women in other towns (5.1 children per woman) and is slightly more than half the rate for the women in rural areas. Educational attainment is closely linked to a woman's fer- tility; the'l'l~R for women with no formal education is 6.9 children per woman, versus 5.5 children for women who attended school but did not complete the primary level, 4.3 for women who had completed primary education, and 3.0 for women with at least some secondary education. Table 3.2 also allows a general assessment of trends in fertility over time among population subgroups. The mean number of children ever born to women age 40-49 is a measure of fertility in the past. A comparison of current (total) fertility with past (completed) fertility shows that fertility has declined considerably in Asmara and among women with higher education. There has been slight decline in other towns and among women who have attended school but have not completed the primary level. However, fertility may have actually increased in rural areas and among uneducated women. Overall, the comparison of past and present fertility indicators suggests that there has not been any substantial decline in fertility over the past years in Eritrea, especially compared with many African and Near Eastern countries. At the time of the survey, over 9 percent of interviewed women reported that they were pregnant. This could possibly be an underestimate of the number of women pregnant because many women in the early stages of pregnancy are not yet certain that they are pregnant and some may not want to declare that they are expecting a child. 3.3 Fertility Trends Table 3.3 gives the age-specific fertility rates for five-year periods preceding the survey, using data from respondents' birth histories. Figures in brackets represent partial fertility rates due to truncation. (Women 50 years of age and older were not included in the survey and the further back into time rates are 41 calculated, the more severe is the truncation. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years before the sur- vey because those women would have been over age 50 at the time of the survey and were not interviewed.) It should also be noted that misre- porting of the date of birth of children can result in the appearance of false trends in fertility. Evidence from the table suggests that there have been declines in fertility over the last 15 years in all age groups with the exception of the two youngest (i,e., 15-19 and 20-24) which show almost no change or only a slight increase for the period 10-14 to 5-9 years prior to the survey. During the most recent five-year period (5-9 to 0-4 years) prior to the survey the decline is highest for age group 30-34 (16 percent) and slightly less for age group 35-39 (12 percent). Table 3.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by women's age, Eritrea 1995 Number of years preceding the survey Women's age 0-4 5-9 10-14 15-19 15-19 116 122 120 101 20-24 240 247 243 215 25-29 267 297 298 266 30-34 245 293 308 [278] 35-39 207 234 [279] 40-44 113 [165] 45-49 [41 ] Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. Fertility rates for ever-married women by number of years since first marriage for five-year periods preceding the survey are shown in Table 3.4. This table is analogous to Table 3.3, but is confined to ever-married women and replaces age with number of years since first marriage. For the most recent 5-year period (from 5-9 to 0-4 years preceding the survey) fertility has remained virtually unchanged for the 0-4 year marriage duration. During the same period, the decline starting for marriage duration 5-9 years steadily increases with longer marriage durations. Table 3.4 Trends in fertility by marital duration Fertility rates for ever-married women by number of years since first marriage, for five-year periods preceding the survey, Eritrea 1995 Marriage duration Number of years preceding the survey at birth (years) 0-4 5-9 10-14 15-19 0-4 260 258 241 189 5-9 294 305 298 271 10-14 260 300 310 285 15-19 236 289 324 [272] 20-24 179 231 [266] 25 -29 105 [ 170] Note: Fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. 3.4 Retrospective Fertility Measures of lifetime fertility reflect the accumulation of births over the past 30 years or so, and therefore, have little relevance for current fertility levels. Information on lifetime fertility is useful for examining average family size across age groups as well as estimating levels of primary infertility. Lifetime fertility is also useful in understanding changes that have taken place in the age pattem of current fertility. The percent distribution of women by the number of children ever born is presented in Table 3,5 (for all women and for currently married women). The table also shows the mean number of children ever born (CEB) to women in each five-year age group, an indicator of the momentum of childbearing. Women of childbearing age in Eritrea have borne an average of three children and have an average of 2.5 currently living children. On average, women in their early twenties have given birth to about one child, in their late twenties to 2.5 children, by their early thirties to nearly four children, and by their late thirties to around five children. The women currently at the end of their childbearing years have had well over six children. Of the 6.5 children ever born to women age 45-49, only five have survived. 42 Table 3.5 Children ever born and living Percent distribution of all women and of currently married women age 15-49 by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Eritrea 1995 Number of children ever born (CEB) Number Mean no. Mean no. Age of of of living group 0 1 2 3 4 5 6 7 8 9 I0+ Total women CEB children ALL WOMEN 15-19 81.2 16.0 2.7 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,129 0.22 0.20 20-24 35.4 30.8 21.9 8.5 2.9 0,4 0.0 0.0 0.0 0.0 0.0 100.0 823 1.14 1.03 25-29 15.9 I6.5 19.7 23.0 13.9 7.0 3.0 0.9 0.1 0.0 0.0 100.0 782 2.41 2.06 30-34 9.4 9.0 11.6 15.4 17.1 15.5 I2.1 5.1 3.8 0.7 0.3 I00.0 638 3.72 3.13 35-39 4.5 5.6 6.4 12.0 14.4 14.2 13.8 14.3 8.8 3.8 2.3 100.0 562 4.94 4.11 40-44 5.0 2.9 5.7 6.5 6.3 13.3 13.9 13.5 14.2 10.0 8.7 100,0 603 6.00 4.75 45-49 2.2 4.1 6.9 6.1 6.9 9.5 11,5 11.I 12.6 12.2 16.9 100.0 518 6.50 5.00 Total 28.9 13.6 10.8 9.6 7.9 7.3 6.4 5.1 4.5 2.9 3.1 100.0 5,054 3.0I 2.46 CURRENTLY MARRIED WOMEN 15-19 51.9 39.7 8.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 366 0,57 0.52 20-24 18.5 34.5 30.1 12.0 4.2 0,6 0.0 0.0 0.0 0.0 0.0 100.0 571 1,51 1.36 25-29 8.0 15.6 21.3 25.1 16.8 8.3 3.7 1.1 0.1 0.0 0.0 100.0 637 2,73 2.34 30-34 4.8 6.8 9.5 16.9 17.9 18.1 13,9 6.4 4.6 0.8 0.4 100,0 513 4,14 3.50 35-39 1.i 3.0 4.4 l l . l 14.4 14.4 16.5 16.8 10.8 4.8 2.8 100.0 450 5.50 4.60 40-44 1.5 1.6 2.7 5.2 6.2 13.4 15.5 15.2 17.2 11.8 9.7 I00.0 472 6.62 5.26 45-49 1.1 2.1 2.6 3.1 6.5 8.6 10.8 11.1 15.8 15.7 22.6 100.0 362 7,38 5.64 Total 11.5 15.0 12.7 11.9 10.1 9.2 8.3 6.7 6,3 4.1 4,2 100.0 3,371 3.92 3.22 Only 19 percent of all women in the 15-19 age group have ever had a child, implying that early childbearing is not very common in Eritrea. The results for women who are currently married differ from those for all women, especially at younger ages, because of the large number of young unmarried women with minimal fertility. Differences at older ages generally reflect the impact of marital dissolution (either divorce or widowhood). Only 1 percent of currently married women age 45-49 have never had a child. Under the proposition that desire for children is universal in Eritrea, this 1 percent is a rough measure of primary infertility or the inability to bear children. 3.5 Birth Intervals Information on the length of birth intervals provides insight into birth spacing patterns. Research has shown that children born too soon after a previous birth are at increased risk of poor health, and at high risk of dying at an early age, particularly when the interval is less than 24 months. Table 3.6 shows the distribution of births in the five-year period before the survey by the interval since the previous birth, according to various demographic and socioeconomic variables. As in Kenya (NCPD et al., 1994), in Eritrea 1 in 4 births takes place after "too short" an interval (less than 24 months). Almost 4 in 10 births (39 percent) occur 24-35 months after a prior birth, and more than one-third occur three years or more after the previous birth. The median birth interval is 31 months for all births. There is no substantial difference in the length of the birth interval by age of mother, sex of prior birth, place of residence, or birth order. A shorter median interval (28 months) prevails for children whose preceding sibling has died compared to those whose preceding sibling is alive. This pattern presumably 43 Table 3.6 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Eritrea 1995 Median number of months Demographic/ Number of months since previous birth since Number Socioeconomic previous of characteristic 7-17 18-23 24-35 36-47 48+ TotaJ birth births Age of mother 15-19 (24.3) (21.1) (34.5) (16.0) (4.2) 100.0 27.2 33 20-29 12.0 15.5 42.8 18.2 11.5 100.0 30.2 1,184 30-39 9.9 13.5 37.5 22.6 16.5 100.0 32.3 1,387 40 + 10.7 15.1 35.6 19.8 18.9 100.0 31.8 692 Birth order 2-3 12.0 15.0 34.6 21.0 17.4 100.0 31.7 1,281 4-6 8.8 11.5 43.7 20.8 15.3 100.0 32.2 1,263 7 + 12.8 19.2 38.6 18.5 10.9 100.0 29.1 752 Sex of prior birth Male 11,0 14.8 39.0 20.8 14.4 100.0 31.2 1,712 Female 10.9 14.4 39.0 19.9 15.8 100.0 31.3 1,584 Survival status of prior birth Living 8.8 14.7 40.3 21.3 15.0 100.0 31.7 2,845 Dead 24.9 14.1 30.8 14.3 15.8 100.0 27.7 450 Residence Urban 11.4 16.3 32.8 18.2 21.2 100.0 31.6 667 Asmara 12.9 14.4 29.5 19.5 23.6 100.0 32.8 335 Other towns 10.0 18.1 36.2 16.9 18.8 100.0 30.3 333 Rural 10.9 14.2 40.5 20.9 13.5 100.0 31.2 2,628 Education No education 10.6 14.4 39.9 20.9 14.2 100.0 31.2 2,735 Primary incomplete 11.5 16.7 35.3 17.1 19.3 100.0 31.7 354 Primary complete 11.8 8.6 40.2 19.4 20.0 100.0 31.6 116 Secondary+ 17.9 20.0 25.0 17.4 19.7 100.0 27.3 90 Total 11.0 14.6 39.0 20.3 15.1 100.0 31.3 3,296 Note: First births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Figures in parentheses are based on 25 to 49 births. reflects early resumption of sexual intercourse, a shortened breastfeeding period, and minimal use of contraception (perhaps due to the desire to replace the deceased child, as soon as possible). There is no difference in the length of the birth interval for births to women with less than secondary education. However, women with secondary education tend to have more closely spaced births than women with less education. 3.6 Age at First Birth The age at first birth is a cmcial demographic indicator that usually reflects age at first marriage, level of contraceptive use, and premarital sexual exposure. Early initiation of childbearing is a major determinant of large family size and rapid population growth, particularly in countries where family planning is not widely practiced. Moreover, bearing children at a young age involves substantial risks to the health of both the mother and child. Early childbearing also tends to restrict educational and economic opportunities for women. 44 Table 3.7 presents the percent distribution of women by age at first birth, according to current age. Childbearing tends to begin late in Eritrea, with the majority of women becoming mothers after age 20. The median age at first birth is around 21 years for most age groups with the exception of women age 35-39 and 40-44, for whom it is 22 years. Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Eritrea 1995 Women Median with Age at first birth Number age at no of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 81.2 1.8 12.7 4.3 NA NA NA 100.0 1,129 a 20-24 35.4 3.7 23.3 20.4 12.5 4.6 NA 100,0 823 a 25-29 15.9 2.7 17.9 20.1 17.6 18.1 7.7 100.0 782 20.9 30-34 9.4 3.0 20.1 20.3 14.1 17.0 16.1 100.0 638 20.8 35-39 4.5 4.9 13.7 14.6 16.1 23.1 23.1 100.0 562 22.1 40-44 5.0 3.7 15.7 15.3 15.2 18.1 27.0 I00.0 603 22.0 45-49 2.2 4.2 21.8 15.6 14.4 15.1 26.6 100.0 518 21.1 NA = Not applicable a Omitted because less than 50 percent of the women in age group x to x+4 have had a birth by age x Differentials in median age at first birth for women 25-49 are shown in Table 3.8. There is little difference among medians by background characteristics; the median age is between 21 years and 22 years for all groups. For women 25-49, the median age at first birth is 21.4 years, which is higher than reported for many sub-Saharan countries in which DHS surveys have been conducted. For example, the median age at first birth is around 19 years in Kenya (NCPD et al., 1994) Malawi (NSO and MI, 1994) Uganda (SD and Table 3.8 Median age at first birth Median age at first birth among women age 25-49 years, by current age and selected background characteristics, Eritrea 1995 Current age Background Ages characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 22.8 21.6 21.5 21.8 21.2 21.9 Asmara 24.6 22.6 21.8 21.4 20.3 22.1 Other towns 21.0 20.7 21.2 22.4 23.1 21.5 Rural 20.4 20.6 22.2 22.1 21.1 21.2 Zone Southern Red Sea 20.1 (20.7) (22.8) (20.9) * 21.0 Northern Red Sea 20.9 21.5 22.7 23.2 22.5 21.8 Anseba 22.3 20.5 21.3 22.6 (22.6) 21.8 Gash-Barka 21.0 20.8 21.8 21.2 20.7 21.2 Southern 19.9 19.8 22.3 22.6 21.2 21.0 Central 23.0 21.8 21.9 21.2 20.2 21.6 Education No education 20.3 20.5 22.2 22.1 21.3 21.2 Primary incomplete 22.0 21.2 21.4 21.1 19.9 21.2 Primary complete 21.6 (21.5) * (19.6) * 21.0 Secondary+ a 27.1 (22.7) * * a Total 20.9 20.8 22.1 22.0 21.1 21.4 Note: The medians for cohorts 15-19 and 20-24 could not be determined because half the women have not yet had a birth. Figures in parentheses are based on 25 to 49 women; an asterisk indicates that a figure is based on fewer than 25 women and has been suppressed. a Omitted because less than 50 percent of the women with secondary or higher education in the age groups 25-29 and 25-49 have had a birth by age 25 45 MI, 1996), and Zambia (Gaisie et al., 1993). The median age at first birth in Zimbabwe is 19.6 years (CSO and MI, 1995) and 21 years in Namibia (Katjiuanjo et al., 1993). 3.7 Adolescent Fertility Pregnancy is physically demanding for women at any age but it poses a special health risk for teenagers. Adolescent mothers are more likely to suffer complications during delivery. Similarly, children born to very young mothers are at increased risk of sickness and death. Early pregnancy also has diverse negative demographic, socioeconomic and sociocultural consequences for young girls. Their socioeconomic advancement, such as educational attainment and accessibility to better job opportunities, may be curtailed by early pregnancy. Also, if a young girl is pregnant and unmarried, she is likely to be relegated to less respectable position in society. Table 3.9 shows the percent distribution of women age 15-19 who were mothers or were pregnant with their first child at the time of the survey, according to selected background characteristics. Nineteen percent of adolescents are already mothers and another 4 percent are currently pregnant. The proportion of adolescents already on the pathway to family formation rises rapidly with age, from less than 3 percent at age 15 to 50 percent at age 19 (see Figure 3.3). Rural adolescents and those with less education tend to start childbearing earlier. The negative relationship between educational level and early childbearing seems strong, however it should be pointed out that cause and effect can go either way. It may be that girls who have never attended school or who leave school early are also more likely to begin childbearing early. On the other hand, getting mamed and/or becoming pregnant may also be a cause of girls leaving school early (see Table 2.14). Table 3.9 Teenage pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Eritrea 1995 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 1.5 1.0 2.5 300 16 10.4 2.7 13.1 218 17 12.5 9.2 21.7 191 18 34.3 5.5 39.8 276 19 46,0 4.2 50.2 145 Residence Urban 6,1 1.1 7.2 448 Asmara 3.5 0.7 4.2 3 l 1 Other towns I 1.9 1.9 13.8 137 Rural 27.2 6.3 33.4 680 Education No education 33.5 8.1 41.7 431 Primary incomplete 17.5 3.1 20.7 277 Primary complete 6.6 1.3 7.9 244 Secondary+ 1.7 0.4 2.1 177 Total 18.8 4,2 23.0 1,129 46 Figure 3.3 Adolescent Childbearing Percent 100 80 60 40 20 0 5O 22 15 16 17 18 19 Age in Years ~E~Already Mothers ~Pregnant (1st child) ] EDHS1995 47 CHAPTER4 FERTILITY REGULATION This chapter presents the EDHS results regarding various aspects of contraceptive knowledge, attitudes, and behavior. While the focus is placed on women, some results from the male survey will also be presented because men play an important role in the realization of reproductive goals. To get an indication of interspousal communication and agreement in the attitudes and knowledge of couples regarding family planning, the responses of men are, where possible, paired with responses obtained from their spouses in the same household. Family planning methods are grouped into three principal types in the following presentation: modem methods (pill, IUD, injectables, vaginal methods~iaphragm, foam, jelly, and foaming tablets---condom, and female and male sterilization), traditional methods (periodic abstinence, withdrawal, and breastfeeding), and folk methods. 4.1 Knowledge of Contraceptive Methods Women and men who are adequately informed about their options regarding methods of contracep- tion are better able to develop a rational approach to planning their families. Information on knowledge of contraception was collected by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the inter- viewer described the method and asked if the respondent recognized it. As married men and women have the greatest level of exposure to the risk of pregnancy, the following presentation places emphasis on these subgroups. Table 4.1 shows the percentage of all women and men, currently married women and men, and sexually active unmarried women and men, and women with no sexual experience who know specific contraceptive methods. Knowledge of family planning methods is not high; only about two-thirds of women age 15-49 and four-fifths of men age 15-59 know of at least one modem method of family planning. Knowledge of contraceptive methods is slightly more extensive, on average, among men than women. Married women and men know an average of 2.4 and 3.7 methods, respectively. Among both currently married women and men, the pill is the best known method of family planning, while injectables and condoms are also well known. Condoms tend to be much better known among men. Vaginal methods (diaphragm, foam, jelly, and foaming tablets) and male sterilization are not commonly known among either female or male respondents. Traditional methods are also not well known by women. Only one-third of currently married women have heard of at least one traditional method. Less than one-fifth of currently married women know about periodic abstinence (rhythm method) and the same proportion mentioned breastfeeding as a family planning method, although breastfeeding was not included in the list of methods in the questionnaire. Less than one-tenth of women know of withdrawal. Knowledge of all methods except breastfeeding is higher among all women than among currently married women. The difference was substantial for condoms and less than three percentage points for other methods. Only 1 percent of men mentioned breastfeeding as a family planning method. Knowledge of other methods, especially other traditional methods, is much higher among men than women. Sixty-five percent 49 Table 4.1 Knowledge of contraceptive methods Percentage of all women, of currently married women, of sexually active unmarried women and of women with no sexual experience and the percentage of all men, of currently married men, and of sexually active unmarried men who know specific contraceptive methods, Eritrea 1995 Marital and sexual activity status: women Marital and sexual activity status: men Sexually Sexually Currently active No Currently active Contraceptive All married unmarried sexual All married unmarried method women women women experience men men men Any method 68.0 63.9 (89.3) 77.0 81.7 81.7 (98.3) Any modern method 66.3 62.0 (89.3) 76.9 78.9 78.1 (98.3) Pill 62.7 59.9 (89.3) 69.8 71.5 73.3 (94.7) IUD 18.2 16.7 (33.7) 20.5 25.0 25.6 (48.9) Injectables 51.9 51.3 (81.2) 50.7 60.0 62.3 (86.8) Diaphragm/Foam/Jelly 7.5 6.5 (14.8) 11.3 11.5 9.1 (27.6) Condom 43.1 34.9 (77.6) 66.6 71.3 68.3 (93.0) Female sterilization 24.8 24.0 (50.7) 28.1 29.8 29.9 (56.7) Male sterilization 6.5 5.6 (12.0) 9.7 7.6 7.3 (12.8) Any traditional method 34.0 33.4 (55.4) 32.3 60.2 65.8 (88.7) Periodic abstinence 20.5 17.8 (34.9) 27.0 58.7 64.6 (86.5) Withdrawal 7.8 7.0 (16.4) 9.5 26.2 26.1 (72.3) Breast feeding 16.0 18.2 (21.6) 7.3 0.8 1.1 (0.0) Any folk method 0.3 0.1 (0.0) 1.1 1.0 1.2 (0.0) Any traditional/folk method 34.0 33.4 (55.4) 32.4 60.4 66.1 (88.7) Number of respondents 5,054 3,371 26 981 1,114 675 34 Mean number of methods 2.6 2.4 4.3 3.0 3,6 3.7 5.8 Note: Figures in parentheses are based on 25 to 49 respondents. and 26 percent of currently married men know of periodic abstinence and withdrawal, respectively, compared with 18 percent and 7 percent of currently married women. Knowledge of modem methods varies little by age for currently married women, but for men knowledge peaks at age 30-34 and then declines as age increases (see Table 4.2). The level of knowledge of at least one modem method is very high in urban areas for both women and men (92 percent and 96 percent, respectively) but is low in mral areas where around half of women and three-fourths of men are aware of modem methods. By zone, the level of knowledge differs more among women than among men. The Gash-Barka Zone has the lowest and the Central Zone the highest level of knowledge for both men and women. Knowledge is also high in the Southern Zone. Only 4 in 10 women in the Northern Red Sea and Anseba Zones know any modem method. Men are more likely than women to know about contraceptive methods in every zone except in the Southern Zone. The difference in knowledge is most notable in the Anseba Zone where currently married men are more than twice as likely to know a modem method as women. 50 Table 4.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and men who know at least one contraceptive method and at least one modem method, by selected background characteristics, Eritrea 1995 Knowledge of contraception: women Knowledge of contraception: men Know Know Number Know Know Number Contraceptive any modern of any modem of method method method women method method men Age 15-19 62.9 62.1 366 * * 3 20-24 66.7 65.8 571 (83,8) (83.8) 43 25-29 64.7 62.5 637 84.1 84.1 77 30-34 61.8 59.7 513 89.4 80.0 86 35-39 64.8 63.0 450 82.0 78. I 116 40-45 62.8 60.8 472 79.6 79.6 104 45-49 62.6 58.9 362 81.0 77.3 107 50-54 NA NA NA 80.8 75.1 70 55-59 NA NA NA 73.8 68.0 68 Residence Urban 91.9 91.6 768 96.5 95.8 165 Asmara 96.6 96.6 451 97.8 97.8 98 Other towns 85.3 84.5 317 94.6 93,0 67 Rural 55.7 53.3 2,604 77.0 72.3 510 Zone Southern Red Sea 52.3 52.3 87 (68.9) (68.9) 20 Northern Red Sea 43.9 40.8 447 78.3 73.1 74 Anseba 40.9 40.3 441 95.8 91.0 90 Gash-Barka 35.4 33.7 735 65.8 59.3 169 Southern 85.9 82.6 1,025 80.3 77,3 188 Central 93.0 93.0 636 98.4 98.4 133 Education No education 55.7 53.2 2,636 72.2 66.4 418 Primary incomplete 90.8 90.8 445 95.2 94.9 139 Primary complete 95.7 95.7 136 98.9 98.9 55 Secondary+ 99.5 99.5 154 100.0 100.0 63 Total 63.9 62.0 3,371 81.7 78.1 675 Note: Figures in parentheses are based on 25 to 49 men. An asterisk indicates a figure is based on fewer than 25 men and has been suppressed. NA = Not applicable Knowledge of methods is related to whether women and men have attended school. Fifty-three and 66 percent of currently married women and men with no schooling know a modem method compared with over 90 percent of women and men who have attended school. Table 4.3 shows the correspondence between the contraceptive knowledge of husbands and wives (564 couples). In 5 of 10 couples, both the husband and wife know of the pill, in 4 of 10 both know about injectables, and in 3 of 10 both know of condoms. It is interesting to note that for all methods except male sterilization, the proportion of couples in which the husband knows the method while the wife does not exceeds the proportion in which the wife knows the method while the husband does not. The most well- 51 Table 4.3 Knowledge of contraceptive methods among couples Percent distribution of couples by contraceptive knowledge, according to specific methods, Eritrea 1995 Husband Wife Both knows, knows, Neither Contraceptive know wife husband knows method method not not method Total Any method 56.6 25.7 8.2 9.4 100.0 Any modern method 55.7 23.0 8.4 12.9 100.0 Pill 51.0 23.1 9.2 16.6 100.0 IUD 10.3 13.5 5.2 70.9 100.0 lnjectables 39.8 23.2 15.2 21.8 100.0 Diaphragm/Foam/Jelly 2.7 4.6 4.5 88.2 100.0 Condom 31.5 36.0 2.6 29.9 100.0 Female sterilization 10.7 18.1 13.5 57.6 100.0 Male sterilization 0.8 4.7 5.1 89.3 100.0 Any traditional method 25.7 40.5 5.0 28.8 100.0 Periodic abstinence 14,3 50.5 2.4 32.8 100.0 Withdrawal 3.2 22.4 3.9 70.5 100.0 Breastfeeding 0.1 1.0 16.8 82.1 100.0 Any folk method 0.0 1.4 0.0 98.6 100.0 Any traditional/folk method 25.7 40.8 5.0 28.5 100.0 Note: Table is based on 564 couples. known methods among couples, when either one or both know the method, are the pill (83 percent), injectables (78 percent), and condoms (70 percent). 4.2 Ever Use of Contraception All men and women interviewed in the EDHS who said that they had heard of a method of family planning were asked if they had ever used that method. Table 4.4 shows the percentage of women who have ever used family planning, according to method type and age. The table also shows ever use of methods for men. Twelve percent of all women and 15 percent of currently married women reported having used a method of family planning at some time; among currently married women 9 percent have used a modem method and 9 percent have used a traditional method. The methods most commonly used by currently married women are the pill (7 percent), breastfeeding (6 percent), periodic abstinence (3 pe

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