Ghana - Multiple Indicator Cluster Survey - 2017

Publication date: 2017

Snapshots of key findings Ghana Multiple Indicator Cluster Survey 2017/18 Multiple Indicator Cluster Surveys Snapshots of key findings Ghana Multiple Indicator Cluster Survey 2017/18 CONTENT Preamble .3 Acknowledgements .4 1. SAMPLE & SURVEY CHARACTERISTICS .5 2. MASS MEDIA, COMMUNICATIONS & INTERNET .8 3. CHILD FUNCTIONING .12 4. CHILD MORTALITY .14 5. FERTILITY & FAMILY PLANNING .16 6. ADOLESCENTS .19 7. HIV & SEXUAL BEHAVIOURS .24 8. MATERNAL & NEWBORN HEALTH .28 9. CHILD HEALTH & CARE OF ILLNESS .32 10. INFANT & YOUNG CHILD FEEDING (IYCF) .35 11. NUTRITIONAL STATUS OF CHILDREN .37 12. EARLY CHILDHOOD DEVELOPMENT .39 13. EDUCATION .41 14. PARENTAL INVOLVEMENT IN CHILD’S LEARNING .45 15. BIRTH REGISTRATION .46 16. CHILD DISCIPLINE .48 17. CHILD LABOUR .50 18. CHILD MARRIAGE .52 19. FEMALE GENITAL MUTILATION (FGM) .54 20. DRINKING WATER, SANITATION & HYGIENE - WASH .56 21. GENDER EQUALITY .62 1Ghana Multiple Indicator Cluster Survey 2017/18 2 Ghana Multiple Indicator Cluster Survey 2017/18 Preamble The Multiple Indicator Cluster Survey Six (MICS 6) was conducted in 2017/18 by Ghana Statistical Service in collaboration with the Ministry of Health, Ministry of Education, Ministry of Sanitation and Water Resources, Ministry of Gender, Children and Social Protection, Ghana Health Service and the Ghana Education Service as part of the Global MICS Programme. Technical support was provided by the United Nations Children’s Fund (UNICEF), with government funding and financial support of UNICEF, KOICA, UNDP, USAID and the World Bank through the Statistics for Results Facility – Catalytic Fund (SRF-CF). The Global MICS Programme was developed by UNICEF in the 1990s as an international multi-purpose household survey programme to support countries in collecting internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies, programmes, and national development plans, and to monitor progress towards the Sustainable Development Goals (SDGs) and other internationally agreed upon commitments. In addition, the Ghana MICS 2017/18 specific objectives were to: » (2018-22) goals/targets » Strengthen data and monitoring systems in Ghana » Identify vulnerable groups and disparities, which will inform social inclusion and poverty reduction policies and interventions. The objective of this report is to facilitate the timely dissemination and use of results from the MICS 2017/18. The report contains detailed information on the survey methodology, and summary of most of the standard tables of MICS. For more information on the Global MICS Programme, please go to mics.unicef.org. 3Ghana Multiple Indicator Cluster Survey 2017/18 Report on SDGs and the Ghana Medium-Term National Development Framework Acknowledgements Every great work is achieved with the support of others; thus, it is easy for GSS to conclude how active assistance from many organisations and individuals survey was developed and implemented with inputs from a wide range of stakeholders at International, national, regional and district levels. Ghana Statistical Service is therefore indebted to the United Nations Children’s Fund (UNICEF) for their technical and financial assistance from the planning stage of the survey to the final report including dissemination. Our sincere thanks again go to the Government of Ghana, KOICA, UNDP, USAID, and the World Bank through the Statistics for Results Facility-Catalytic Fund (SRF- CF) for also providing the financial and technical support for the successful completion of this survey. The Ghana Statistical Service wishes to express its deepest gratitude to the Ministry of Health, Ministry of Education, Ministry of Sanitation and Water Resources, Ministry of Gender, Children and Social Protection, Ghana Health Service and the Ghana Education Service for their cooperation and expert advice towards the implementation of this survey. The Service also wishes to acknowledge the immense contribution of the different MICS committees (National Steering Committee, Technical Committee and the Project Implementation Team) in overseeing to the implementation of the survey. We further wish to thank the data collectors/ field staff for their dedication and commitment to the field work and to our respondents who welcomed our field officers and provided them with the required data, and making it possible to complete this survey. Special thanks also go to the team that put this summary report together including Peter Takyi Peprah (Project Coordinator), Yaw Misefa, Emmanuel Boateng, John Foster Agyaho, Dzifa Gwira-Mensah, Solomon Owusu Bempah, Leo Kwamena Arkafra and Felix Adjei all of Ghana Statistical Service and Denis C. Businge, Sylvester Baffoe, Mayeso Zenengeya and the rest of UNICEF Ghana team. We say Ayekoo, we are most grateful. 4 Ghana Multiple Indicator Cluster Survey 2017/18 have positively impacted the execution of this project. The MICS 2017/18 SAMPLE & SURVEY CHARACTERISTICS Multiple Indicator Cluster Surveys Survey Implementation Implementing agency: Ghana Statistical Service Sampling frame: 2010 Population and Housing Census Listing & mapping: June to August 2017 Interviewer training: Fieldwork: October 2017 to January 2018 Questionnaires: Household Women age 15-49 Men age 15-49 Children under 5 Children age 5-17 Water Quality Testing Survey Response Rates Response Rates Household Women age 15-49 Men age 15-49 Children under 5 Children age 5-17 Sampled Occupied Interviewed Eligible for interview Interviewed Eligible for interview Interviewed Eligible for interview Mothers/Caretakers interviewed Eligible for interview Mothers/Caretakers interviewed 99 98 14,609 14,374 13,202 12,960 12,886 97 5,476 5,323 8,903 8,879 100 8,965 8,946 100 1 5Ghana Multiple Indicator Cluster Survey 2017/18 September 2017 Population Characteristics Household Population Age & Sex Distribution Women & Men’s Profile Children’s living arrangements* Children’s Profile Household Composition & Characteristics of Head of household Percent distribution of household population by age group and sex Percent of households by selected characteristics * Figures that are based on fewer than 25 unweighted cases Percent distribution of women and men age 15-49 by background characteristics ( ) Figures that are based on 25-49 unweighted cases (for men only) * Figures that are based on fewer than 25 unweighted cases (for men only) Percent distribution of children age 5-17 and under-five by background characteristics Percent distribution of children age 0-17 years according to living arrangements *Children 0-17 years 6 Ghana Multiple Indicator Cluster Survey 2017/18 Regional distribution of population (percent) Key Messages Region Households Women Men Children under 5 Children 5-17 National 100 100 100 100 100 Western 10.8 9.9 9.8 10.5 10.6 Central 10.4 9.8 8.6 10.4 10.3 Greater Accra 13.2 13.1 12.1 9.7 11.0 Volta 7.7 7.7 8.0 8.0 8.0 Eastern 12.7 12.0 12.8 10.7 12.6 Ashanti 22.4 23.9 24.5 23.8 22.8 Brong Ahafo 9.2 9.2 8.9 9.4 9.5 Northern 7.8 9.2 9.7 11.9 9.3 Upper East 3.4 3.0 3.1 3.2 3.5 Upper West 2.3 2.3 2.6 2.4 2.5 § Ghana MICS 2017/18 had a sample size of 13,202 households with a 99% response rate § The sample size for women 15-49 years was 14,609 with a 98% response rate § The sample size for men 15-49 years was 5,476 with a 97% response rate § The sample size for children under 5 years was 8,903 with a 100% response rate § The sample size for children 5 -17 years was 8,965 with a 100% response rate 7Ghana Multiple Indicator Cluster Survey 2017/18 Key Messages MASS MEDIA, COMMUNICATIONS & INTERNET Multiple Indicator Cluster Surveys Exposure to Mass Media Inequalities in Access to Mass Media Newspaper Women with Access to Newspaper, Radio & Television Weekly Men with Access to Radio, Newspapers & Television Weekly Radio Television All Three 9 6 68 51 63 62 7 4 Women Women Women Women Men Men Men Men Percentage of women & men age 15-49 years who are exposed to specific mass media (newspaper, radio, television) on a weekly basis and percentage of women & men age 15-49 who are exposed to all three on a weekly basis § Nine in every ten of households owned mobile phones, 60% own television sets; 57% radio, 22% had internet at home; 15% had computers and less than 1% owned fixed telephone lines. § Gender disaggregated internet usage in Ghana shows higher usage of the internet by men(35%) as compared to 15% of women. § Though mobile phone usage is high among both men and women, there is more utilization among men when compared to women (88% for men and 82% for women) § There are considerable regional disparities in use of mobile phones. In Greater Accra for instance nine in every ten of women used mobile phones against about half of women in the Upper West Region. § There is relatively less gap in ownership of radios in rural and urban areas. While 59% of urban households in Ghana owned radio, in rural areas, radio ownership is 55%. Percentage of women age 15-49 years who are exposed to newspaper, radio, and television on a weekly basis Percentage of women age 15-49 years who are exposed to newspaper, radio, and television on a weekly basis 2 8 Ghana Multiple Indicator Cluster Survey 2017/18 Household Ownership of a Radio Household Ownership of a Mobile Telephone Households with Internet Household Ownership of a Computer Household Ownership of Information & Communication Technology (ICT) Equipment & Internet at Home Inequalities in Household Ownership of ICT Equipment & Internet at Home Household Population Age & Sex Distribution Region Radio Television Telephone - Fixed line Telephone - Mobile Computer Internet at Home Ghana 57.2 60.4 0.9 92.5 15.0 22.4 Western 56.7 68.5 0.9 92.3 13.3 24.1 Central 51.0 59.2 0.5 88.2 14.5 21.3 Greater Accra 56.1 83.1 2.0 97.8 27.6 37.7 Volta 53.2 45.0 0.5 88.6 7.6 14.2 Eastern 65.3 60.5 0.6 92.7 13.9 16.8 Ashanti 64.9 64.5 1.5 96.4 17.5 27.3 Brong Ahafo 53.7 52.0 0.6 89.2 12.8 18.7 Northern 45.9 44.0 0.1 91.4 6.7 10.2 Upper West 51.2 32.9 0.3 87.0 7.2 14.3 Upper East 47.1 38.3 0.2 79.2 8.2 9.3 Percentage of households which own a radio, television-fixed line, telephone- mobile, computer and that have access to the internet at home Percentage of households with a computer at home Percentage of households with mobile telephone Percentage of households with access to the internet at home Percentage of households with a computer at home 9Ghana Multiple Indicator Cluster Survey 2017/18 Use of Information & Communication Technology Disparities in Use of Information & Communication Technology Computer Use Disparities in Mobile Phone Use among Women Disparities in Internet Use among Women: SDG17.8.1 Disparities in Internet Use among Men: SDG17.8.1 Disparities in Mobile Phone Use among Women Mobile Phone Use Internet Use: SDG17.8.1 21 7 Women Women Women Men Men Men 88 82 35 15 Percentage of women and men age 15-49 years who during the last 3 months used a computer, used a mobile phone and used the internet Percentage of women age 15-49 years who during the last 3 months used a mobile phone Percentage of women age 15-49 years who used the internet in the last 3 months Percentage of men age 15-49 years who used the internet in the last 3 months Percentage of men age 15-49 years who during the last 3 months used a mobile phone 10 Ghana Multiple Indicator Cluster Survey 2017/18 Information & Communication Technology (ICT) Skills Regional Data on ICT Use & Skills Specific Computer Skills Specific Computer Skills Percentage of women and men age 15-49 years who in the last 3 months have carried out specific computer related activities and the percentage who have carried out at least one of these activities Percentage of women and men age 15-49 years who during the last 3 months used a computer, used a mobile phone and used the internet and percentage who performed at least 1 computer-related activity Region Computer Use Mobile Phone Use Internet Use Performed at Least 1 ICT activity Ghana Women Men Women Men Women Men Women Men Western 5.6 17.1 77.7 90.4 12.0 31.8 5.0 16.5 Central 5.0 18.1 86.1 92.5 10.2 28.8 4.1 15.9 Greater Accra 14.3 39.2 91.9 94.0 32.0 58.9 12.2 35.6 Volta 3.6 13.3 73.5 86.6 7.0 20.9 3.2 11.0 Eastern 5.7 27.9 80.7 89.7 15.6 41.5 5.2 24.0 Ashanti 7.5 24.9 86.6 88.1 16.3 42.2 6.8 24.9 Brong Ahafo 6.4 14.7 74.2 84.7 14.8 33.5 5.7 14.3 Northern 2.7 6.9 79.4 82.5 3.4 13.4 2.4 6.2 Upper East 6.0 9.0 76.8 78.5 8.4 13.8 4.7 9.0 Upper West 3.8 5.5 54.7 84.0 4.5 8.7 3.4 5.4 11Ghana Multiple Indicator Cluster Survey 2017/18 CHILD FUNCTIONING Multiple Indicator Cluster Surveys Child Functioning: Levels & Domains Child Functioning Levels by Age-Group Children with disabilities are among the most marginalized groups in society. Facing daily discrimination in the form of negative attitudes, and lack of adequate policies and legislation, children with disabilities are effectively barred from realizing their rights to health, education, and even survival. Children with disabilities are often likely to be among the poorest members of the population and are less likely to attend school, access medical services, or have their voices heard in society. Discrimination against and exclusion of children with disabilities also puts them at a higher risk of physical and emotional abuse or other forms of neglect, violence and exploitation. The Convention on the Rights of the Child (UNICEF, 1989) and the more recent Convention on the Rights of Persons with Disabilities (UN, 2006) explicitly state the rights of children with disabilities on an equal basis with other children. These Conventions focus on the disparities faced by children with disabilities and call for improvements in their access to services, and in their participation in all aspects of life. In order to achieve these goals, there is a need for cross-nationally comparable, reliable data. Key Messages § About one in every five children 2-17 years have a functioning difficulty. § Functional difficulties are more prevalent in the 5-17 years age group when compared to children 2-4 years . § The highest proportions of children with functioning difficulties were found in Volta, Eastern and Upper West regions while the least were reported from Northern and Greater Accra regions. S e e in g H e a ri n g W a lk in g F in e M o to r C o m m u n ic a ti o n Le a rn in g P la yi n g C o n tr o lli n g B e h av io u r S e lf c a re R e m e m b e ri n g C o n c e n tr a ti n g A c c e p ti n g C h a n g e M a k in g F ri e n d s A n x ie ty D e p re ss io n National 2-4 years 0.1 0.1 0.2 0.7 1.9 3.9 0.3 5.3 N/A N/A N/A N/A N/A N/A N/A 5-17 years 0.5 0.3 1.0 N/A 0.7 5.3 N/A 5.6 1.1 4.1 2.0 3.1 2.1 4.2 2.9 2-17 years 0.3 0.2 0.6 N/A N/A N/A N/A NA N/A N/A N/A N/A N/A N/A N/A Percentage of children aged 2–17 years with functional difficulty in at least one domain, by domain of difficulty N/A- Not Applicable 3 12 Ghana Multiple Indicator Cluster Survey 2017/18 Child Functioning: Inequalities Regional Data on Child Functioning Child Functioning & the Use of Assistive Devices Region 2-4 years 5-17 years 2-17 years National 11 21 19 Western 16 21 20 Central 14 18 17 Greater Accra 8 15 13 Volta 13 32 29 Eastern 8 30 26 Ashanti 12 21 19 Brong Ahafo 10 20 18 Northern 6 8 8 Upper East 9 16 15 Upper West 10 22 20 Percentage of children aged 2–17 years with functional difficulty in at least one domain, by region Percentage of children aged 2-17 years who use assistive devices and have functional difficulty within domain of assistive device 13Ghana Multiple Indicator Cluster Survey 2017/18 CHILD MORTALITY Multiple Indicator Cluster Surveys Mortality Rates among Children Under-5 Years preceeding the survey Neonatal mortality rate: SDG 3.2.2 Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-5 mortality rate: SDG 3.2.1 0-4 27 14 41 16 56 5-9 27 18 45 18 62 10-14 32 17 49 24 72 Neonatal mortality (NN): probability of dying within the first month of life Post-neonatal mortality: calculated as difference between infant and neonatal mortality rates Infant mortality (1q0): probability of dying between birth and first birthday Child mortality (4q1): probability of dying between the first and fifth birthday Under-5 mortality (5q0): probability of dying between birth and fifth birthday Key Messages § Under-5 mortality rates continue to reduce from 72 to 56 over the past 14 years preceding the survey. § Infant mortality rates have reduced from 49 to 41 over the past 14 years prior to the survey § Over the past 4 years prior to the survey, reductions in mortality are reported on all forms of mortality except neonatal mortality rates that remained the same. 4 14 Ghana Multiple Indicator Cluster Survey 2017/18 Child Mortality Disparities Under-5 mortality rate by socio-economic characteristics & area Neonatal & under-5 mortality rates by region Trends in under-5 mortality rates Under-5 mortality rate by demographic risk factors Under-five mortality rates for the five year period preceding the survey, by socio-economic characteristics, area and demographic risk factors The source data used in the above graph is taken from the final reports of MICS 2017/18, MIS 2017, DHS 2014, MICS 2011 and DHS 2008, with the exception of IGME (2016) which is downloaded from the UN IGME web portal. Child mortality source data and child mortality estimates are published on www.childmortality.org, the web portal of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Data from the same source may differ between a report and UN IGME web portal as UN IGME recalculates estimates using smaller intervals and/or calendar years (if data are available). Region Neonatal mortality Under-5 mortality National 27 56 Western 12 37 Central 22 46 Greater Accra 19 31 Volta 14 39 Eastern 27 63 Ashanti 52 79 Brong Ahafo 16 39 Northern 19 76 Upper East 21 43 Upper West 28 63 Neonatal mortality and under-5 mortality rates (deaths per 1000 live births) for the five year period preceding the survey, by region 15Ghana Multiple Indicator Cluster Survey 2017/18 FERTILITY & FAMILY PLANNING Multiple Indicator Cluster Surveys Fertility Adolescent Birth Rate: SDG indicator 3.7.2 Age Specific Fertility Rates Total Fertility Rate Age-specific fertility rates (ASFR) are the number of live births in the last 3 years, divided by the average number of women in that age group during the same period, expressed per 1,000 women Age-specific fertility rate for girls age 15-19 years for the three-year period preceding the survey ( ) Figures in parentheses are based on 250 - 499 unweighted cases. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates (ASFRs) calculated for each of the five-year age groups of women, from age 15 through to age 49 Adolescent Birth rate SDG 3.7.2 indicator is under target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes Reducing adolescent fertility and addressing the multiple factors underlying it are essential for improving sexual and reproductive health and the social and economic well-being of adolescents. Preventing births very early in a woman’s life is an important measure to improve maternal health and reduce infant mortality. 5 16 Ghana Multiple Indicator Cluster Survey 2017/18 Early Child Bearing - by Age 18 Family Planning Met Need for Family Planning Trends in Early Child Bearing - by Age 18 Method of Family Planning by Various Characteristics Met Need for Family Planning - Spacing Percentage of women age 20-24 years who have had a live birth before age 18, by background characteristics Percentage of women age 20-24 years who have had a live birth before age 18 24 3 73 72 2 26 73 7 20Higher Primary 69 2 28 77 4 20Urban Rural 73 2 25 76 5 19Richest Poorest 75 3 22 69 2 30 Age 15-19 Age 20 - 24 Type of method* By Woman’s Education By Residence By Wealth Quintile By Age No Method Any Modern Method Any Traditional Method Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method *Modern Methods include female sterilization, male sterilization, IUD, injectables, implants, pills, male condom, Female condom, diaphragm, foam, jelly and contraceptive patch Traditional methods refer to periodic abstinence and withdrawal Percentage of women age 15-49 years currently married or in union with met need for family planning for spacing, by background characteristics Percentage of women age 15-49 years currently married or in union with met need for family planning for limiting, by background characteristics 17Ghana Multiple Indicator Cluster Survey 2017/18 Percentage of Demand for Family Planning Satisfied with Modern Methods - SDG indicator 3.7.1 Regional Data on Fertility & Family Planning The proportion of demand for family planning satisfied with modern methods (SDG indicator 3.7.1) is useful in assessing overall levels of coverage for family planning programmes and services. Access to and use of an effective means to prevent pregnancy helps enable women and their partners to exercise their rights to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so. Meeting demand for family planning with modern methods also contributes to maternal and child health by preventing unintended pregnancies and closely spaced pregnancies , which are at higher risk for poor obstetrical outcomes. # On the woman’s education, the lowest findings was from SSS/SHS/ Secondary level at 32.6 percent Key Messages § Greater Accra region has the lowest fertility rate for adolescent girls 15-19 years at 48 per 1000 adolescent girls of the same age group compared to Volta region with the highest (103 per 1000 adolescent girls). § Northern region has the highest TFR with 5.2 whilst Greater Accra has the lowest TFR 3.2 § Eastern region has the highest percentage (30%) of women age 20-24 years who have had a live birth before age 18, § Women in Northern region have the lowest modern contraceptive use (14%) when compared to the Upper East region (36%) § Two in every five women demanded for family planning and are satisfied with modern methods of family planning. Region Adolescent Birth Rate Total Fertility Rate Child bearing before 15 among 15- 19 years women Child bearing before 18 among 20- 24 years women Contraception Use of modern method among married / in- union women Contraception Use of any method among married / in- union women Demand for family planning & satisfaction with modern methods among married / in- union women National 75 4.4 0.7 18 24 27 42 Western 102 5.0 0.0 25 28 32 43 Central 88 4.7 0.5 18 26 29 40 Greater Accra 48 3.2 0.8 10 20 27 39 Volta 103 4.6 1.3 20 24 24 38 Eastern 100 4.1 1.3 30 27 34 44 Ashanti 58 4.3 0.6 16 24 27 43 Brong Ahafo 75 4.4 0.6 13 29 32 46 Northern 57 5.2 0.4 17 14 14 29 Upper East 64 4.5 0.2 21 36 37 64 Upper West 56 4.7 0.5 14 29 29 54 18 Ghana Multiple Indicator Cluster Survey 2017/18 The Adolescent Population: Age 10-19 Every Adolescent Survives & Thrives This snapshot of adolescent well-being is organized around key priority areas for adolescents: § Every adolescent survives and thrives § Every adolescent learns § Every adolescent is protected from violence and exploitation § Every adolescent lives in a safe and clean environment § Every adolescent has an equitable chance in life Adolescence is by some measures the healthiest period in the life-course, yet it can also mark the first manifestations of issues which can have lifelong effects on health and wellbeing, such as unsafe sexual behaviour, early childbearing and substance misuse. Nevertheless, health interventions during this period are shown to have long-lasting effects. Access to appropriate contraceptive methods is critical to prevent adolescent pregnancy and its related consequences, allowing adolescents to transition into adulthood with the ability to plan their pregnancies and live healthy and productive lives. ADOLESCENTS Multiple Indicator Cluster Surveys Age & Sex Distribution of Household Population Adolescent Birth Rate: SDG 3.7.2 Modern Contraceptive Use, Unmet Need & Demand Satisfied for Modern Methods: SDG 3.7.1 Age-specific fertility rate for girls age 15-19 years: the number of live births in the last 3 years, divided by the average number of women in that age group during the same period, expressed per 1,000 women ( ) Figures that are based on 250 -499 unweighted cases Percentage of girls age 15-19 years who are using (or whose partner is using) a contraceptive method, percentage with an unmet need for contraception and percent of demand for modern methods of family planning satisfied, by marital status 6 19Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent Survives & Thrives Every Adolescent Learns Tobacco* & Alcohol Use Foundational Reading Skills SDG 4.1.1.(a) (i: reading) School Attendance Ratios (Adjusted net attendance ratio) Foundational Numeracy Skills SDG 4.1.1.(a) (ii: numeracy) Information & Communications Technology (ICT) Skills* Girls Boys Percentage of adolescent girls and boys age 15-19 who have ever used tobacco or alcohol Percentage of adolescent girls and boys age 15-19 who have used tobacco or alcohol in the last 1 month *Tobacco use in last month among adolescents is an age disaggregate of SDG 3.a.1 Alcohol and tobacco use typically have their onset in adolescence and are major risk factors for adverse health and social outcomes, as well as for non-communicable diseases later in life. Adolescence is a time of heightened risk-taking, independence seeking and experimentation. Adolescents are at increased risk of substance use due to social, genetic, psychological or cultural reasons. Yet adolescence is also an opportune time for education on the negative consequences of substance use, and promote healthy behaviours that will last into adulthood. Quality education and experiences at school positively affect physical and mental health, safety, civic engagement and social development. Adolescents, however, can also face the risk of school drop-out, early marriage or pregnancy, or being pulled into the workforce prematurely. Data on reading and numeracy skills are collected in MICS through a direct assessment method. The Foundational Learning module captures information on children’s early learning in reading and mathematics at the level of Grade 2 in primary education. MICS indicators LN.22a –22c on Foundational reading and number skills - reading, age 7-14; reading, age for grade 2/3; and reading, attending grade 2/3 ( SDG indicator 4.1.1) . References for detailed literal and inferential questions can be found in the Ghana MICS 2017/18 main report questionnaire 5-17 years, Questions FL10A – FL27 21 11 Percentage of children age 7-14 who can 1) read 90% of words in a story correctly, 2) Answer three literal comprehension questions, 3) Answer two inferential comprehension questions Percentage of children age 7-14 who can successfully perform 1) a number reading task, 2) a number discrimination task, 3) an addition task and 4) a pattern recognition and completion task Adjusted net attendance ratio, by level of education and by gender 7 17 Percentage of girls age 15-19 who can perform at least one of the nine listed computer related activities *Age disaggregate of SDG 4.4.1: Proportion of youth and adults with information and communications technology (ICT) skills Percentage of boys age 15-19 who can perform at least one of the nine listed computer related activities *Age disaggregate of SDG 4.4.1: Proportion of youth and adults with information and communications technology (ICT) skills Note: Tables SR.9.4W and SR.9.4M in the main report provide details on the nine computer related activities 20 Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent is Protected from Violence & Exploitation Child Marriage: SDG 5.3.1 Female Genital Mutilation: SDG 5.3.2 Age Disaggregate Child Discipline Only non-violent Physical punishment Psychological aggression Any violent discipline* Attitudes towards Female Genital Mutilation Adolescence is a period of heightened risk to certain forms of violence and exploitation. The onset of puberty marks an important transition in girls’ and boys’ lives whereby gender, sexuality and sexual identity begin to assume greater importance, increasing vulnerability to particular forms of violence, particularly for adolescent girls. Certain harmful traditional practices, such as female genital mutilation/cutting and child marriage, often take place at the onset of puberty. At the same time, as children enter adolescence, they begin to spend more time outside their homes and interact more intimately with a wider range of people, including peers and romantic partners. This change in social worlds is beneficial in many respects, but also exposes adolescents to new forms of violence. Percentage of women aged 20 to 24 years who were first married or in union before age 15 and before age 18, by area Percentage of girls age 15 to 19 years who have undergone FGM/C, by age group *Age disaggregate of SDG 5.3.2: Prevalence of FGM/C among women age 15-49 Percentage of children age 1 to 14 years who experienced any discipline in the past month, by type *Age disaggregate of SDG 16.2.1 Percentage of boys and girls age 15-19 who have heard about FGM/C, by their attitudes on if the practice should continue 3 Severe17 Other types 76 89 94 21Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent is Protected from Violence & Exploitation Every Adolescent Lives in a Safe & Clean Environment Child Labour: SDG 8.7.1* Water, Sanitation & Clean Fuel Use Percentage of adolescents age 5-17 years engaged in child labour, by type of activity and by age *Estimates from MICS of child labour are different from those in the SDG database for SDG 8.7.1, as the database excludes hazardous work & applies a threshold of 21 hours for household chores for children age 5-14 and no threshold for household chores for children age 15-17 Definition of Child Labour Age 5-11 years: At least 1 hour of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 12-14 years: At least 14 hours of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 15-17 years: At least 43 hours of economic or unpaid household services per week or hazardous working conditions. Economic activities include paid or unpaid work for someone who is not a member of the household, work for a family farm or business. Household chores include activities such as cooking, cleaning or caring for children, as well as collecting firewood or fetching water. The data presented here are at the household level. Evidence suggests that adolescent access to these services are comparable to household-level data. Basic Drinking Water SDG 1.4: Drinking water from an improved source, provided collection time is not more than 30 minutes for a roundtrip including queuing. Improved drinking water sources are those that have the potential to deliver safe water by nature of their design and construction, and include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water Basic Sanitation Services SDG 1.4.1/6.2.1 : Use of improved facilities which are not shared with other households. Improved sanitation facilities are those designed to hygienically separate excreta from human contact, and include: flush/pour flush to piped sewer system, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs Clean Fuels SDG 7.2.1: Primary reliance on clean fuels and technologies for cooking, space heating and lighting 22 Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent has an Equitable Chance in Life Functioning Difficulties in Adolescents Achieving sustainable progress and results with regard to equity demands a human rights-based approach. At the core of international human rights legal framework is the principle of non-discrimination, with instruments to combat specific forms of discrimination, including against women, indigenous peoples, migrants, minorities, people with disabilities, and discrimination based on race and religion, or sexual orientation and gender identity. As adolescents begin to form more of an individual identity, discrimination can often become more pronounced, taking form in harassment, bullying, or exclusion from certain activities. At the same time, research has shown that discrimination during adolescence has a particularly strong effect on stress hormones, potentially leading to life-long mental or physical health side effects. Children and adolescents with disabilities are one of the most marginalized groups in society. Facing daily discrimination in the form of negative attitudes, lack of adequate policies and legislation, adolescents with disabilities are effectively barred from realizing their rights to health, education, and even survival. Percentage of adolescents who have a functioning difficulty, by domain and age Key Messages § The unmet need for family planning is highest among unmarried adolescents while modern use of family planning methods is higher among marrieds than unmarried adolescents. § More than a third of married adolescents compared to one in every ten unmarried adolescents reported demand for modern methods of family planning satisfied. § Adolescent girls in rural areas and those among the poorest and less educated are at a higher risk of early child bearing. § One in every five women age 20-24 years were first married before age 18 years. This remains lower at one in every 20 women of the same age group married for the first time before age 15 years. § Female genital mutilation is of very rare occurrence in Ghana and almost all respondents do not support this practice. § Almost all of children aged 1 to 14 years were reported experiencing any form of violent discipline. Among age groups, any physical punishment is highest among children 3-4 years and lowest among children 10-14 years. § Three in every ten children 5-17 years is involved in child labour § Child labour is mostly practiced in rural areas, among the poorest and those not attending school. There were no huge disparities related to sex of the child. § One in every five of the children 5-17 years are engaged in hazardous working conditions. This is more than their engagement with household chores and economic activities. § Close to one third of children 15-17 years are engaged in hazardous working conditions and this reduces with lower age groups. § One in every five adolescents has ever used alcohol. Alcohol use is more prevalent among adolescents when compared to tobacco. Adolescent boys are more prone to tobacco and alcohol use than the girls. § The adjusted net attendance ratio for education is highest among primary school adolescents when compared to junior and upper secondary school adolescents. It is also highest among female adolescents except for those in upper secondary school (SSS/ SHS/Secondary) level. § Learning, controlling behaviour, anxiety and depression are the highest forms of functioning difficulty faced by adolescents 23Ghana Multiple Indicator Cluster Survey 2017/18 HIV & SEXUAL BEHAVIOURS HIV indicators Women Men Multiple Indicator Cluster Surveys Comprehensive Knowledge Percent who know of the two ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy looking person can be HIV-positive, and who reject the two most common misconceptions, and any other local misconception Stigma Percent of those who report discriminatory attitudes towards people living with HIV, including 1) would not buy fresh vegetables from a shopkeeper or vendor who is HIV-positive and 2) think children living with HIV should not be allowed to attend school with children who do not have HIV Testing Percent who have been tested for HIV in the last 12 months and know the result Testing during Antenatal Care Percent of women who during their antenatal care for their last pregnancy were offered an HIV test, accepted and received results, and received post-test health information or counselling related to HIV Key Messages § Overall, there is low HIV comprehensive knowledge. However, men aged 15-49 years are more knowledgeable (23%) when compared to 14% women of the same age group. § Additionally, low HIV comprehensive knowledge exists among adolescents and young people (only 20% of males and 17% of females aged 15-24 years). § About eight in every ten women reported discriminatory attitudes towards people living with HIV, and this was lower for men at 74% § HIV testing is low among adults 15-49 years in the last 12 months prior to the survey (about one in every ten had tested), however, uptake of HIV testing is twice higher among females when compared to males. § A third of pregnant women were offered an HIV test, accepted, received results and post-test health information or counselling related to HIV during their last pregnancy. 17 14 Age 15-49 Age 15-24 20 23 Age 15-49 Age 15-24 82 80 Age 15-49 Age 15-24 79 74 Age 15-49 Age 15-24 11 15Age 15-49 Age 15-24 3 7Age 15-49 Age 15-24 30 33 Age 15-49 Age 15-24 7 24 Ghana Multiple Indicator Cluster Survey 2017/18 HIV Indicators by Key Characteristics Knowledge among Adolescent Girls & Young Women (15-24)* Tested for HIV in last 12 months Regional Data on HIV Testing Knowledge among Adolescent Boys & Young Men (15-24)* *Percent age 15-24 who know two ways of HIV prevention, who know that a healthy looking person can be HIV-positive, and who reject two most common misconceptions. Percent age 15-49 who have been tested for HIV in the last 12 months and know the result Key Messages § Among adolescent girls and young women (15-24 years), having a post secondary (higher) education offers a ten-fold increment of having comprehensive knowledge of HIV when compared to women with Pre-Primary Education or none § Variations exist in the uptake of HIV testing across regions, gender, age groups and pregnancy status. Across all regions, HIV testing is higher for women than men § For women and men among age groups, HIV testing is highest among adults 25-29 years and lowest in the 15-19 years age group § In the Northern Region only 3% of men aged 15-49 years reported having been tested in the last 12 months prior to the survey, in contrast to 10% in Eastern region and 8% in Greater Accra § For pregnant women attending ANC, HIV testing is lowest in Volta Region (18%) and highest in Greater Accra at 43% National / Regional Tested in last 12 months and know their results Women testing at ANCMen Women National 7 15 33 Western 4 12 32 Central 8 12 28 Greater Accra 8 17 43 Volta 8 13 18 Eastern 10 16 33 Ashanti 6 17 38 Brong Ahafo 5 15 39 Northern 3 8 20 Upper East 8 15 42 Upper West 7 15 34 Tested in last 12 months: percent age 15-49 who have been tested in the last 12 months and know the result HIV testing during ANC: percent of women age 15-49 who during their last antenatal care for their last pregnancy were offered an HIV test, accepted and received results, and received post-test health information or counselling related to HIV 25Ghana Multiple Indicator Cluster Survey 2017/18 Sexual Behaviour by Key Characteristics Sexually Active Multiple Partners Adolescent boys & young men 15-24 years Adolescent girls & young women 15-24 years Young People who had Sex Before Age 15 Girls 15-19 who Report Sex with Partner 10 years or Older Condom Use Percent of women and men age 15-49 and 15-24 years who had sexual intercourse within the last 12 months Percent of women and men age 15-49 and 15-24 years who had sex with more than one partner in last 12 months Percent of women and men age 15-24 who had sex before age 15 Percent of women and men age 15-24 and 15-49 who had more than one sexual partner in the last 12 months reporting that a condom was used the last time they had sex Percent of adolescent girls age 15-19 who had sex in the last 12 months who report having had sex with a man 10 or more years older in the last 12 months In many settings, sexual behaviour can be considered a risk factor for health and social issues. These include reproductive health, HIV and other sexually transmitted infections, and gender equality and empowerment. An understanding of the population’s sexual behavior patterns can inform both disease prevention and health promotion programmes. 7 11 11 § One in every ten of adolescent girls and young women aged 15-24 years began having sex before their 15th birthday. This is lower at 7% for adolescent boys in the same age group. § One in every ten of adolescent girls aged 15-19 years who had sex in the last 12 months reported having sex with a man who was ten or more years older. § Sex debut before 15 years among young girls is more reported in the Western, Eastern, Volta, Northern, Upper East & Upper West Regions with regional figures above the national average § Girls with no education or Pre-Primary education, residing in rural areas and from poorest households are far more likely to begin having sex before age 15 than girls with secondary education and from wealthier urban settings § Urban girls/boys and young men/women aged 15-24 years with multiple sexual partners in the last 12 months reported more condom use during their last sexual encounter than rural young people of the same age group Key Messages 26 Ghana Multiple Indicator Cluster Survey 2017/18 Sexual Behavior by Key Characteristics Condom Use among Young People Sex before Age 15 among Adolescent Girls & Young Women 15-24 Regional Data on Sexual Behaviour Adolescent boys and young men age 15-24 Adolescent girls and young women age 15-24 Condom use among Young People (with non-marital/ cohabiting partner) Percent of adolescents and young people age 15-24 who had more than one sexual partner in the last 12 months reporting that a condom was used the last time they had sex Percent of adolescent girls and young women age 15-24 who had sex before age 15 Percentage of adolescents 15-24 years reporting the use of a condom during the last sexual intercourse with a non-marital, non-cohabiting partner in the last 12 months # young women age 15-24 Primary level was the lowest with 15.4 percent Adolescent boys 15-19 Young men 20-24 Adolescent girls 15-19 Young women 20-24 28 24 (50) (35) Region Men 15-24 Women 15-24 Sex before 15 Sex before 15 National 7 11 Western 2 12 Central 7 9 Greater Accra 9 5 Volta 5 17 Eastern 11 15 Ashanti 11 9 Brong Ahafo 2 8 Northern 2 17 Upper East 4 13 Upper West 3 12 ( ) Figures that are based on 25-49 unweighted cases 27Ghana Multiple Indicator Cluster Survey 2017/18 MATERNAL & NEWBORN HEALTH Key Elements of Maternal & Newborn Health Multiple Indicator Cluster Surveys Maternal & Newborn Health Cascade by Area Content & Coverage of Antenatal Care ServicesTiming of First Antenatal Care Visit Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth at least once by skilled health personnel or at least four times by any provider, who were attended by skilled health personnel during their most recent live birth (SDG 3.1.2), whose most recent live birth was delivered in a health facility, who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live and percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery, by area Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples, were given neonatal tetanus protection, took three or more doses of SP/Fansidar to prevent malaria, reported that during an ANC visit they received information or counselling on HIV, and reported that they were offered and accepted an HIV test during antenatal care and received their results during the last pregnancy that led to a live birth Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth at least once by skilled health personnel, by the timing of first ANC visit 7 1 3 < 4 months 4-5 months 6-7 months 8+ months No ANC 6227 8 28 Ghana Multiple Indicator Cluster Survey 2017/18 Coverage of Skilled Attendance at Birth & Institutional Delivery by Area Coverage of Antenatal Care by Various Characteristics Skilled Attendance at Birth Institutional Delivery Skilled attendant Unskilled attendant No attendant Institutional Non-institutional Percentage of women age 15-49 years with a live birth in the last 2 years who were attended to during their last pregnancy that led to a live birth at least once by skilled health personnel or at least four times by any provider 79 12 9 71 16 13 90 6 4 Total Total Rural Rural Urban Urban 78 22 69 31 90 10 Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth and percentage whose most recent live birth was delivered in a health facility (institutional delivery) by area 29Ghana Multiple Indicator Cluster Survey 2017/18 Caesarian Section by Various Characteristics Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered by caesarean section by various characteristics Percentage of women age 15-49 years with a live birth in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live and percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery, by various characteristics Among the last live-birth in the last 2 years, percentage who were dried after birth; percentage who were given skin to skin contact; percentage who were bathed after 24 hours of birth; percentage where the umbilical cord was cut with a new blade or boiled instrument; percentage where nothing harmful was applied to the cord; percentage where the newborn received a least 2 postnatal signal care functions within 2 days after birth; and percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth, by various characteristics Postnatal Care within 2 Days of Birth by Various Characteristics Coverage of Newborn Care 30 Ghana Multiple Indicator Cluster Survey 2017/18 Regional Data on Maternal and Newborn Cascade Region ANC: At least 1 visit (skilled provider) ANC: At least 4 visits (any provider) Skilled Attendance at Birth Institutional Delivery Postnatal Care for Mother within 2 days Postnatal Care for Newborn within 2 days National 97 85 79 78 85 91 Western 98 88 80 78 86 90 Central 97 85 73 74 81 87 Greater Accra 97 90 93 92 93 93 Volta 96 75 69 67 81 88 Eastern 94 81 79 78 88 93 Ashanti 99 87 82 82 86 94 Brong Ahafo 96 86 86 86 85 91 Northern 97 82 60 57 75 86 Upper East 100 95 94 94 91 93 Upper West 97 85 83 80 81 88 For indicator definitions, please see earlier charts § Antenatal care (4+ visit) is high among women in urban areas (90%) compared to women in rural areas (81%) § Six in every ten of pregnant women attend first antenatal visit in during the first 4 months of pregnancy § Eight in every ten pregnant women are attended to by skilled personnel during child birth § There is high coverage of both postnatal care for mothers within 2 days and newborns (about nine in every ten) Key Messages § While some interventions such as checking of blood pressure, urine and blood tests are provided for more than nine in every ten of pregnant women, about half of pregnant women do not receive IPT for malaria and do not receive HIV counselling nor testing § A third of pregnant women do not receive vaccination to prevent neonatal tetanus. § One in every ten pregnant women gave birth through caesarean section. Birth through caesarean section was more than double in urban than in rural areas, and it increases with wealth and education of pregnant woman. § One quarter of newborns received skin to skin contact immediately after birth § Bathing was delayed for nearly a quarter of the newborns, and less than half received cord care without application of harmful substances. 31Ghana Multiple Indicator Cluster Survey 2017/18 CHILD HEALTH & CARE OF ILLNESS Diarrhoea Multiple Indicator Cluster Surveys Care-seeking for Diarrhoea Feeding during Diarrhoea ORS Treatment for Diarrhoea ORS + Zinc Treatment for Diarrhoea ORT + Continued Feeding for Diarrhoea Disparities in Care-seeking for Diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought by source of provider Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought at a health facility or provider # On wealth quintiles, the Middle quintile was the lowest with 25 percent ## On Mother’s Education, Primary level was lowest with 32 percent 50 27 39 Percentage of children age 0-59 months with diarrhoea in the last two weeks prior to the interview treated with oral rehydration salt solution (ORS) Percentage of children age 0-59 months with diarrhoea in the last two weeks prior to the interview treated with oral rehydration salt solution (ORS) and zinc Percentage of children age 0-59 months with diarrhoea in the last two weeks prior to the interview who were given oral rehydration therapy (ORT) with continued feeding 9 32 Ghana Multiple Indicator Cluster Survey 2017/18 Malaria Household Availability of Insecticide Treated Nets (ITNs) Care-seeking during Fever Malaria Diagnosis Usage ACT Treatment among Children who Received Treatment Disparities in Care-seeking during Fever Children Under-Five who slept under an ITN 57 49 Percentage of households with at least one insecticide- treated net (ITN) Percentage of children age 0-59 months with fever in the last two weeks for whom advice or treatment was sought, by source of advice or treatment Percentage of children age 0-59 months with fever in the last two weeks for whom advice or treatment was sought at a health facility or provider Percentage of children age 0-59 months who slept under an ITN last night 32 10 Percentage of children with fever who had blood taken from a finger or heel for testing Among children with fever who received anti-malarial treatment, percent treated with Artemisinin-based Combination Therapy (ACT) 33Ghana Multiple Indicator Cluster Survey 2017/18 Symptoms of Acute Respiratory Infection (ARI) Regional Data on Care-Seeking for Childhood Illness Care-seeking for Symptoms of ARI Disparities in Care-seeking for Symptoms of ARI Percentage of children age 0-59 months with symptoms of ARI in the last two weeks for whom advice or treatment was sought, by source of advice or treatment * Figures that are fewer than 25 unweighted cases and have been suppressed () Figures in parentheses are based on 25-49 unweighted cases. Percentage of children age 0-59 months with symptoms of ARI in the last two weeks for whom advice or treatment was sought at a health facility or provider ( ) Figures in parentheses are based on 25-49 unweighted cases. § Overall, more than a third of children 0-59 months who had diarrhea sought treatment from a health facility or provider while at the same time findings indicate more care seeking for malaria at seven in every ten children. § Among regions, more than half (59%) of children in Upper West region who had diarrhea received care from a health facility or provider compared to 18% in Greater Accra region as the lowest finding. § Eighty nine percent of children who had fever in the Upper East region received care from a health facility or provider when compared to 62% in the Central region (the lowest finding among regions). Key MessagesRegion Care-Seeking at a health facility or provider for: Diarrhoea Fever Symptoms of ARI National 36 69 56 Western 37 66 * Central 32 62 * Greater Accra 18 81 * Volta 38 68 (19) Eastern 36 75 (54) Ashanti 30 67 (79) Brong Ahafo 51 68 * Northern 39 68 56 Upper East 51 89 * Upper West 59 73 * 34 Ghana Multiple Indicator Cluster Survey 2017/18 INFANT & YOUNG CHILD FEEDING (IYCF) Infant & Young Child Feeding Multiple Indicator Cluster Surveys breastmilk; Introduction to solids: percentage of infants aged 6-8 months receiving solid or semi-solid food; Minimum diet diversity: percentage of children aged 6-23 months receiving 5 of the 8 recommended food groups; Minimum meal frequency: percentage of children aged 6-23 months receiving the recommended minimum number of solid/liquid feeds as per the age of child; Minimum acceptable diet: percentage of children aged 6-23 months receiving the minimum diversity of foods and minimum number of feeds; Continued breastfeeding at 1 year: percentage of children aged 12-15 months who continue to receive breastmilk; Continued breastfeeding at 2 years: percentage of children aged 20-23 months who continue to receive breastmilk. § Half of newborns are put to breast within 1 hour of birth. § Early initiation of breast feeding is more practiced among mothers who gave birth through vaginal means and those who gave birth from a health facility than those with a caesarean section or home birth § About two in every five babies are exclusively breastfed § One in every five babies are not introduced to solid or semi-solid foods from 6 - 8 Key Messages months and this contributes to slow growth in babies § Young children 6-23 months are not fed often enough and their diet lacks variety. Only 12 percent of these children meet the recommended minimum acceptable diet § Nine in every ten babies continue with breast feeding at 1 year while only four in every ten do the same at 2 years § Early initiation of breast feeding is practiced most in Central Region and least in the Eastern region. § Disparities on minimum diet diversity exist and are highest among the richest, most educated and urban babies than they are among the poorest, least educated and rural babies. § Minimum diet diversity is highest in the Central Region and lowest in the Upper West Region 10 35Ghana Multiple Indicator Cluster Survey 2017/18 Early initiation: percentage of newborns put to breast within 1 hour of birth; Exclusive breastfeeding: percentage of infants aged 0-5months receiving only IYCF: Equity Regional Data Early Initiation of Breastfeeding Minimum Diet Diversity Percent of newborns put to the breast within one hour of birth, by background characteristics Percent of children aged 6-23 months that were fed food from at least 5 out of 8 food groups, by background characteristics Region Early Initiation of breastfeeding Minimum Diet Diversity National 52 Western 51 Central 65 Greater Accra 46 Volta 47 Eastern 40 Ashanti 49 Brong Ahafo 60 Northern 58 Upper East 56 Upper West 62 Percent of newborns put to the breast within one hour of birth, and per cent of children aged 6-23months that were fed food from at least 5 out of 8 food groups by geographic region 36 Ghana Multiple Indicator Cluster Survey 2017/18 23 23 30 28 14 18 30 15 21 19 13 Stunting: SDG 2.2.1 Wasting: SDG 2.2.2 Overweight: SDG 2.2.2 Anthropometric Malnutrition Indicators by Age Underweight NUTRITIONAL STATUS OF CHILDREN Anthropometric Malnutrition Indicators Multiple Indicator Cluster Surveys Stunting refers to a child who is too short for his or her age. Stunting is the failure to grow both physically and cognitively and is the result of chronic or recurrent malnutrition. Wasting refers to a child who is too thin for his or her height. Wasting, or acute malnutrition, is the result of recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death, but treatment is possible. Overweight refers to a child who is too heavy for his or her height. This form of malnutrition results from expending too few calories for the amount consumed from food and drinks and increases the risk of noncommunicable diseases later in life. Underweight is a composite form of undernutrition that can include elements of stunting and wasting (i.e. an underweight child can have a reduced weight for their age due to being too short for their age and/or being too thin for their height). 18 Percentage children under-5 who are stunted Percentage children under-5 who are wasted Percentage children under-5 who are underweightPercentage children under-5 who are overweight 1 7 13 Percentage children who are underweight, stunted, wasted and overweight, by age in months § Close to one in every five children under 5 years is stunted while one in every ten children under 5 is underweight § Close to one in every ten children (7%) experiences wasting while the proportion of overweight children is low at 1% § Stunting is highest in the Northern Region and lowest in Greater Accra region § Large disparities exist between the poorest / least educated on one hand, and the richest / most educated with the former presenting the highest stunted children. § Less disparities exist among wasted children except for the 0-5 months age group that present more wasting compared to the 48-59 months age group. Key Messages 11 37Ghana Multiple Indicator Cluster Survey 2017/18 Nutritional Status of Children: Disaggregates Regional Data on Stunting, Overweight & Wasting Stunting: SDG 2.2.1 Wasting: SDG 2.2.2 Percentage of under 5 children who are stunted, by background characteristics Percentage of under 5 children who are wasted, by background characteristics National / Regional Stunting: SDG 2.2.1 Overweight: SDG 2.2.2 Wasting % stunted (moderate and severe) % overweight (moderate and severe) % wasted (moderate and severe, SDG 2.2.2) % wasted (severe) National 18 1 7 1 Western 16 1 7 2 Central 18 1 7 1 Greater Accra 13 2 6 1 Volta 21 1 8 3 Eastern 16 2 5 0 Ashanti 16 1 6 0 Brong Ahafo 14 2 7 1 Northern 29 1 9 2 Upper East 18 1 7 3 Upper West 15 1 6 1 38 Ghana Multiple Indicator Cluster Survey 2017/18 Early Stimulation & Responsive Care EARLY CHILDHOOD DEVELOPMENT Support for Learning Multiple Indicator Cluster Surveys Early childhood, which spans the period up to 8 years of age, is critical for cognitive, social, emotional and physical development. During these years, a child’s newly developing brain is highly plastic and responsive to change. Optimal early childhood development requires a stimulating and nurturing environment, access to books and learning materials, interactions with responsive and attentive caregivers, adequate nutrients, access to good quality early childhood education, and safety and protection. All these aspects of the environment contribute to developmental outcomes for children. Children facing a broad range of risk factors including poverty; poor health; high levels of family and environmental stress and exposure to violence, abuse, neglect and exploitation; and inadequate care and learning opportunities face inequalities and may fail to reach their developmental potential. Investing in the early years is one of the most critical and cost-effective ways countries can reduce gaps that often place children with low social and economic status at a disadvantage. Percentage of children age 2-4 years with whom the father, mother or adult household members engaged in activities that promote learning and school readiness during the last three days Note: Activities include: reading books to the child; telling stories to the child; singing songs to the child; taking the child outside the home; playing with the child; and naming, counting or drawing things with the child Percentage of children aged 36-59 months attending an early childhood education programme, by background characteristics Attendance at Early Childhood Education Programmes § Overall, seven in every ten children 36-59 months attend early childhood education programs § Mothers play a more critical role compared to fathers in engaging children on learning and readiness activities (11% vs 3% respectively); and this is much higher (34%) when other adult household members are involved § Less than half of the poorest population have their children attending early Key Messages childhood programmes when compared to nearly all children from the richest quintile. § More proportions of children in urban areas attend early childhood education when compared to those from rural areas. There were no large disparities when comparing sex of the child § Ghana’s Early Childhood Development Index (ECDI) indicates that nearly seven out of every ten children - age 3-4 years - are developmentally on track in literacy-numeracy, physical, social- emotional, and learning domains. § ECDI varies, and is higher among girls, children born to an educated mother, belonging to a rich household, living in an urban area and those attending early childhood education. § Early childhood education is highest in Greater Accra region and lowest in Northern Region 12 39Ghana Multiple Indicator Cluster Survey 2017/18 Access to Play & Learning Materials ECDI: Total Score & Domains, SDG 4.2.1 ECDI: Disaggregates Inadequate supervision of children Learning Materials & Child Supervision Early Childhood Development Index (ECDI) Percentage of children under age five according to their access to play and learning materials ECDI: Early Childhood Development Index; percentage of children age 3-4 years who are developmentally on track in literacy-numeracy, physical, social-emotional, and learning domains ECDI by various characteristics ECE = early childhood education Region Left in inadequate supervision National 30 Western 30 Central 28 Greater Accra 21 Volta 26 Eastern 25 Ashanti 27 Brong Ahafo 26 Northern 53 Upper East 35 Upper West 35 40 Ghana Multiple Indicator Cluster Survey 2017/18 School Net Attendance Rates (adjusted) Net Attendance Rate for Early Childhood Education Participation Rate in Organized Learning (1 Year Prior to Primary Entry Age): SDG 4.2.2 EDUCATION Attendance Rates & Inequalities Inequalities in Attendance in Early Childhood Education & Participation in Organized Learning Multiple Indicator Cluster Surveys Percentage of children age 36-59 months who are attending early childhood education Percentage of children attending an early childhood education programme, or primary education (adjusted net attendance ratio), who are one year younger than the official primary school entry age at the beginning of the school year 13 41Ghana Multiple Indicator Cluster Survey 2017/18 Adjusted Primary School Net Attendance Rate Adjusted Junior Secondary (JSS/JHS/Middle) School Net Attendance Rate Adjusted Senior Secondary School (SSS/SHS/Secondary) Net Attendance Rate Inequalities in Attendance Rates Regional Data for Net Attendance Rates (adjusted) Percentage of children of primary school age (as of the beginning of school year) who are attending primary or secondary school Percentage of children of Junior secondary school age (as of the beginning of the current or most recent school year) who are attending junior secondary school or higher Percentage of children of senior secondary school age (as of the beginning of the current or most recent school year) who are attending senior secondary school or higher Region Early Childhood Education Participation rate in organized learning Primary Junior Secondary (JSS/JHS/ Middle) Senior Secondary (SSS/SHS/ Secondary) National 71 88 81 40 20 Western 75 90 81 42 18 Central 86 95 82 41 16 Greater Accra 86 95 89 57 30 Volta 50 79 75 27 13 Eastern 74 89 84 44 24 Ashanti 81 96 86 49 27 Brong Ahafo 63 84 78 36 14 Northern 46 72 67 24 12 Upper East 65 86 81 25 9 Upper West 63 71 76 23 4 § Attendance rates for early childhood and pre-primary education are high (71%); and every four out of every five children of five years of age are attending early childhood or primary education (organized learning). § Similar rates of attendance are maintained at the primary level (81%). However, there is a sharp decrease at JHS where only two out of every five children continue to attend. Key Messages § Net attendance rate further shrinks at SHS, where only 1 out of 5 children attend. § Girls’ net attendance rates are marginally higher than boys’ at primary and JHS levels but SHS. § School attendance rates vary significantly according to wealth and residence, and children most likely to attend through the levels of education are those who belong to richer households and live in urban areas. § While attendance rates vary across regions, Volta, Brong Ahafo, Northern, Upper East and Upper West regions are consistently represented in the bottom five – across all levels of education. § Greater Accra has the highest attendance rates in primary, JHS and SHS with 89%, 57% and 30% respectively. 42 Ghana Multiple Indicator Cluster Survey 2017/18 Primary School Junior Secondary Senior Secondary (SSS/SHS/Secondary) Inequalities in Completion Rates Regional Data in Completion Rates Completion Rates Percentage of children age 3 to 5 years above the intended age for the last grade of primary school who have completed primary education Percentage of children age 3 to 5 years above the intended age for the last grade of junior secondary school who have completed junior secondary education Percentage of children or youth age 3 to 5 years above the intended age for the last grade of upper secondary school who have completed senior secondary education Region Primary Junior Secondary (JSS/JHS/Middle) Senior Secondary (SSS/SHS/Secondary) National 71 47 Western 74 46 Central 76 41 Greater Accra 77 71 Volta 63 27 Eastern 74 47 Ashanti 79 49 Brong Ahafo 68 46 Northern 54 39 Upper East 55 37 Upper West 53 43 43Ghana Multiple Indicator Cluster Survey 2017/18 47 45 47 66 30 54 59 45 29 31 15 (JSS/JHS/Middle) Out of School Rates Out of School Dimensions for Levels of Education SDG Summary for Education Dimension 1: Children not attending an early childhood education programme or primary education Dimension 2: Children of primary school age who are not in primary or secondary school Dimension 3: Children of junior secondary school age who are not in primary or secondary school Dimension 4: Children who are in primary school but at risk of dropping out (overage by 2 or more years) Dimension 5: Children who are in junior secondary school but at risk of dropping out (overage by 2 or more years) SDG MICS Indicator Definition & Notes Values 4.1.4 LN.8 a,b,c Completion rate (primary education, Junior secondary, Senior secondary education) 4.1.5 LN.6 a,b,c Out-of-school rate (primary education, Junior and Senior secondary education) 19%, 7%, 25% 4.1.6 LN.10 a,b, Percentage of children over-age for grade (primary education, Junior secondary education) 16%, 35% 4.5.1 LN.5 a Parity indices (female/male, rural/urban, bottom/top wealth quintiles) for primary adjusted net attendance rate 1.0, 0.9, 0.7 4.5.1 LN.5 b Parity indices (female/male, rural/urban, bottom/top wealth quintiles) for junior/lower secondary (JSS/JHS/Middle) adjusted net attendance rate 1.2, 0.7, 0.3 § Less than half of children complete higher secondary education. § Disparities continue to persist across all levels of education by wealth quintile and residence; completion Key Messages rate is higher for urban dwellers and the rich as compared to their rural and poor counterparts respectively. § Girls perform better than boys on completion at primary and JHS. § About eight in every ten of children in Ashanti region have completed primary school while this is lowest in Upper West at about half. § Out-of-school children of primary school age remains high at 19 percent and relatively lower in JHS at 7 percent. It is highest in SHS at 25 percent. 44 Ghana Multiple Indicator Cluster Survey 2017/18 § Completion rate at primary school (71%) is higher than upper schooling levels 71.%, 47%, 47% PARENTAL INVOLVEMENT IN CHILD’S LEARNING Multiple Indicator Cluster Surveys 14 Children with 3 or more books to read at home Children who read books or are read to at home Children who receive help with homework Parental Involvement: Learning Environment at Home Parental Involvement: Support for learning at School 45Ghana Multiple Indicator Cluster Survey 2017/18 BIRTH REGISTRATION Birth Registration Levels Multiple Indicator Cluster Surveys Birth registration for Children Under-Five: SDG 16.9.1 Birth registration by Age § Seven in every ten children under 5 years had their births registered § More male than female children are registered § Among age groups, children 0-11 months (over half) have the lowest registered proportions § Birth registration proportions are highest in Upper East , Greater Accra and Ashanti regions while the lowest are reported from Brong Ahafo and Eastern region § Birth registration increases with level of education and wealth and is more prevalent in urban than rural areas. Key Messages Percentage of children under age 5 whose births are registered, by whether or not they have a birth certificate and by sex Percentage of children under age 5 whose births are registered, by age in months 15 46 Ghana Multiple Indicator Cluster Survey 2017/18 Birth Registration: Inequalities Regional Data on Birth Registration Mother’s (or Caregiver’s) Knowledge of How to Register Region Total registered National 71 Western 69 Central 74 Greater Accra 79 Volta 67 Eastern 60 Ashanti 75 Brong Ahafo 58 Northern 71 Upper East 81 Upper West 74 Unregistered children whose mothers do not know how to register them Unregistered children whose mothers know how to register them Percentage of children under age 5 whose births are not registered, by mother’s (or caregiver’s) knowledge of how to register a child Percentage of children under age 5 whose births are registered, by region 47Ghana Multiple Indicator Cluster Survey 2017/18 CHILD DISCIPLINE Child Discipline Multiple Indicator Cluster Surveys Types of Child Discipline Violent Discipline: Inequalities Only non-violent Physical punishment Psychological aggression Any violent discipline: SDG 16.2.1 3 Severe 17 Other types 76 89 94 Percentage of children age 1 to 14 years who experienced any discipline in the past month, by type Percentage of children aged 1 to 14 years who experienced any violent discipline in the past month, by background characteristics Physical punishment: Shaking, hitting or slapping a child on the hand/arm/ leg, hitting on the bottom or elsewhere on the body with a hard object, spanking or hitting on the bottom with a bare hand, hitting or slapping on the face, head or ears, and hitting or beating hard and repeatedly. Severe physical punishment: Hitting or slapping a child on the face, head or ears, and hitting or beating a child hard and repeatedly. Psychological aggression: Shouting, yelling or screaming at a child, as well as calling a child offensive names such as ‘dumb’ or ‘lazy’ Violent discipline: Any physical punishment and/or psychological aggression. § Almost all of children (94%) aged 1 to 14 years were reported to experience any form of violent discipline. § Among age groups, any physical punishment is highest among children 3-4 years and lowest among children 10-14 years. Key Messages § There were no large differences in coverage or disparities in relation to violent discipline and residence, sex, wealth or education of mother or child. § Less males (less than half) compared to six in every ten females feel that physical punishment is necessary in bringing up a child. Additionally, the more educated respondents are, the less they feel or think that physical punishment is necessary to raise or educate children 16 48 Ghana Multiple Indicator Cluster Survey 2017/18 Violent Discipline: Age Patterns Attitudes to Physical Punishment Physical Punishment: Attitudes & Experiences Percentage of children age 1 to 14 years who experienced any violent discipline in the past month, by type and by age Percentage of respondents to the child discipline module who think that physical punishment is necessary to raise or educate children, by their background characteristics 49Ghana Multiple Indicator Cluster Survey 2017/18 CHILD LABOUR Child Labour: Levels & Disaggregates Multiple Indicator Cluster Surveys Child Labour for Age 5-17 years: SDG 8.7.1* Types of Child Labour Percentage of children age 5 to 17 years engaged in child labour, by background characteristics *Estimates from MICS of child labour are different from those in the SDG database for indicator 8.7.1, as the database excludes the hazardous work component and applies a threshold of 21 hours for household chores for children age 5-14 and no threshold for household chores for children age 15-17 Percentage of children age 5 to 17 years engaged in child labour, by type of activity and by age Note: These data reflect the proportions of children engaged in the activities at or above the age specific thresholds outlined in the definitions box. Definition of Child Labour Age 5 to 11 years: At least 1 hour of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 12 to 14 years: At least 14 hours of economic work, 28 hours of unpaid household services per week or hazardous working conditions. Age 15 to 17 years: At least 43 hours of economic or unpaid household services per week or hazardous working conditions. Economic activities include paid or unpaid work for someone who is not a member of the household, work for a family farm or business. Household chores include activities such as cooking, cleaning or caring for children, as well as collecting firewood or fetching water. Key Messages § About one in every three children age 5 to 17 years is engaged in child labour. § One in every five children 5-17 years is engaged in hazardous working conditions. § Children 5-17 years are more engaged in economic activities than household chores, particularly the 5-11 years age group. § Children 5-17 years involved in hazardous working conditions are mostly found in rural areas, among the poorest and among those not attending school. There were no huge disparities related to sex of the child. § Northern, Upper West and Upper East Regions had the highest proportions of children involved in child labour while the least were found in Greater Accra and Ashanti regions. 17 50 Ghana Multiple Indicator Cluster Survey 2017/18 Inequalities in Child Labour & Hazardous Conditions Regional Data on Child Labour Child Labour Inequalities Hazardous Conditions Inequalities Percentage of children age 5 to 17 years engaged in child labour, by type of activity and by sex Percentage of children age 5 to 17 years working under hazardous conditions, by background characteristics Region Total Child Labour National 30 Western 28 Central 30 Greater Accra 11 Volta 32 Eastern 30 Ashanti 22 Brong Ahafo 34 Northern 54 Upper East 42 Upper West 45 Percentage of children age 5 to 17 years engaged in child labour, by region 51Ghana Multiple Indicator Cluster Survey 2017/18 CHILD MARRIAGE Child Marriage: Levels & Disaggregates Multiple Indicator Cluster Surveys Marriage before Age 15 & Age 18: SDG 5.3.1 Disaggregates in Marriage before Age 18 Percentage of women age 20-24 years who were first married or in union before age 15 and before age 18*, by residence Percentage of women age 20-24 years who were first married or in union before age 18, by wealth quintile and education Key Messages § One in every five women age 20-24 years were first married before age 18 years. This remains lower, at one in every 20 women for the same age group, married for the first time before age 15 years. § Marriage before age 15 and 18 years is lowest among the age cohort 20-24 years § Among the different age cohorts, marriage before ages 18 and 15 years is highest among the 35-39 and 40-44 years age groups respectively. § More proportions of persons in rural than urban areas practice child marriage § Child Marriage is highest in Northern, Upper East and Volta regions, and lowest in Greater Accra, Ashanti and Brong-Ahafo regions § Child marriage increases with less wealth and less education. 18 52 Ghana Multiple Indicator Cluster Survey 2017/18 Regional Data on Child Marriage Trends in Child Marriage Percentage of women aged 20 to 24 years who were first married or in union before age 18, by region Percentage of women age 20-49 years who were first married or in union before age 15 and before age 18, by age cohort Region Marriage by age 18 National 19 Western 23 Central 22 Greater Accra 8 Volta 24 Eastern 23 Ashanti 17 Brong Ahafo 17 Northern 28 Upper East 28 Upper West 22 53Ghana Multiple Indicator Cluster Survey 2017/18 FEMALE GENITAL MUTILATION (FGM) Female Genital Mutilation Multiple Indicator Cluster Surveys Level & Disaggregates of FGM Among Women 15-49 Disaggregates of FGM Among Daughters 0-14 years Percentage of girls and women age 15 to 49 years who have undergone FGM/C*, by residence and wealth quintile *SDG 5.3.2 Percentage of daughters age 0 to 14 years who have undergone FGM/C (as reported by their mothers), by residence, mother’s education and wealth quintile Female genital mutilation (FGM) refers to “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.”1 FGM is a violation of girls’ and women’s human rights and is condemned by many international treaties and conventions, as well as by national legislation in many countries. Yet, where it is practised FGM is performed in line with tradition and social norms to ensure that girls are socially accepted and marriageable, and to uphold their status and honour and that of the entire family. UNICEF works with government and civil society partners towards the elimination of FGM in countries where it is still practised. 1. World Health Organization, Eliminating Female Genital Mutilation: An interagency statement, WHO, UNFPA, UNICEF, UNIFEM, OHCHR, UNHCR, UNECA, UNESCO, UNDP, UNAIDS, WHO, Geneva, 2008, p. 4. § Overall, the practice of female genital mutilation (FGM) is low in the country, however women in the rural areas (3.6%) perform FGM 3 times more than women in urban areas (1.2%). § Similarly, women in the poorest quintile perform FGM 7 times more compared to women in the richest quintile. § Female genital mutilation decreases with age, and the most common type of Key Messages FGM reported was one that involved the removal of flesh. § More than nine in every ten of those who have heard about FGM do not agree with the continuity of this practice. § NOTE: Prevalence data for girls aged 0 to 14 reflect their current, but not final, FGM/C status since some girls who have not been mutilated may still be at risk of experiencing the practice once they reach the customary age for cutting. Therefore, the data on prevalence for girls under age 15 is actually an underestimation of the true extent of the practice. Since age at cutting varies among settings, the amount of underestimation also varies and this should be kept in mind when interpreting all FGM/C prevalence data for this age group. 19 54 Ghana Multiple Indicator Cluster Survey 2017/18 Female Genital Mutilation Attitudes to FGM Trends in FGM Type of FGM Percentage of girls and women age 15 to 49 years who have undergone FGM/C, by age cohort Percentage distribution of girls and women age 15 to 49 years who have heard about FGM/C, by their attitudes about whether the practice should continue Percentage distribution of girls and women age 15 to 49 years who have undergone FGM/C, by type Percentage of girls and women age 15 to 49 years who have heard about FGM and think the practice should continue, by wealth quintile, education, residence and age 55Ghana Multiple Indicator Cluster Survey 2017/18 DRINKING WATER, SANITATION & HYGIENE - WASH Basic Drinking Water, Sanitation & Hygiene Services Multiple Indicator Cluster Surveys Basic drinking water Basic sanitation Basic hygiene (hand washing) Percent of population by drinking water, sanitation and hygiene coverage Drinking water ladder: Basic service (at least basic drinking water services) - (SDG 1.4.1) refer to an improved source, provided collection time is not more than 30 minutes for a roundtrip including queuing. Improved drinking water sources are those that have the potential to deliver safe water by nature of their design and construction, and include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water. Limited refers to an improved source more than 30 minutes roundtrip. Unimproved sources include unprotected dug wells and unprotected springs. Surface Water (No service) refers to the direct collection of water from surface waters such as rivers, lakes or irrigation channels. Sanitation ladder: At least basic (Basic Service) sanitation services (SDG 1.4.1) refer to the use of improved facilities which are not shared with other households. Improved sanitation facilities are those designed to hygienically separate excreta from human contact, and include: flush/pour flush to piped sewer system, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs. Limited sanitation service refers to an improved facility shared with other households. Unimproved sanitation facilities include flush/pour flush to an open drain, pit latrines without a slab, hanging latrines and bucket latrines. Open defecation refers to No service . Hygiene ladder: A basic hygiene service (SDG 1.4.1 & SDG 6.2.1) refers to the availability of a handwashing facility on premises with soap and water. Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent, and soapy water but does not include ash, soil, sand or other handwashing agents. Limited hygiene service refers to a facility lacking water and/or soap. No facility means there is no handwashing facility on the household’s premises. § Eight in every ten household populations are using basic drinking water services § Regions that are hydrologically challenged, such as the Northern, Upper East and Upper West regions, are now clearly noticeable as having lower than national average access to basic water (improved water within 30 minutes). § E-coli is highest in household drinking water than at source. Close to eight in every ten households had E-coli in their drinking water while close to half of water sources were affected Key Messages § There is a clear wealth disparity on basic water access, with the wealthy nearly twice as likely to have access than the poor. Additionally, urban dwellers are more likely to have basic access than those from rural areas § Only one in every five households in Ghana have an improved sanitation facility for their household § More than one in every five still practice open defecation § Nearly half of the poorest quintile household population practices open defecation and this practice significantly decreases with increase in wealth. Open defecation is more prevalent in rural areas § Sharing of sanitation remains prevalent, and one in every four household populations use public facilities § Nearly half of the population have access to a handwashing with soap facility (mobile or fixed) with soap and water present § About one in every five of the women feel excluded from social activities during menstruation 20 56 Ghana Multiple Indicator Cluster Survey 2017/18 WASH: Inequalities in Basic Services Basic drinking water Basic Sanitation Basic Hygiene (Hand washing) Regional Data on Basic Services Percent of population using basic drinking water services by background characteristics Percent of population using basic sanitation services by background characteristics # The highest disparity on Education was found among the JSS/JHS/Middle level at 27.4% Percent of population using basic drinking water, sanitation and hygiene services by region Percent of population using basic hygiene services by background characteristics # The highest disparity on Education was found among the SSS/SHS/Senior level at 65.3% Region Basic Drinking Water Basic Sanitation Basic Hygiene National 79 21 48 Western 77 21 58 Central 88 19 58 Greater Accra 98 25 50 Volta 59 14 37 Eastern 78 30 65 Ashanti 89 23 52 Brong Ahafo 84 20 39 Northern 50 12 31 Upper East 71 8 34 Upper West 76 15 26 57Ghana Multiple Indicator Cluster Survey 2017/18 Accessibility of Water & Sanitation Facilities Time Spent Each Day Collecting Water Sanitation Accessibility & Privacy Open Defecation Who Primarily Collects Water for the Household Percent of population by mean time person primarily responsible for water collection spends collecting water each day in households without water on premises Percent of the population sharing improved sanitation facilities, by location of sanitation facility Percent of the population practising open defecation, by background characteristics Percent of population by gender and age of person primarily responsible for collecting drinking water in households without water on premises 58 Ghana Multiple Indicator Cluster Survey 2017/18 Safely Managed Drinking Water Services: SDG 6.1.1 Improved, basic & safely managed drinking water Drinking water coverage: National, urban & rural Drinking Water Quality at Source & Home Availability of Drinking Water Percent of population using improved, basic and safely managed drinking water services Safely managed (SDG 6.1) are improved sources: accessible on premises, available when needed, free from contamination Percent of population using drinking water sources with E. coli (orange) and proportion with E. coli in glass of drinking water in household drinking water (teal) Water Quality Testing response rates for Household and Source testing are 97.5% and 95.8% respectively Percent of population by drinking water coverage Percentage of household population with drinking water available in sufficient quantities 59Ghana Multiple Indicator Cluster Survey 2017/18 Safely Managed Sanitation Services: SDG 6.2.1 Management of Sanitation Services Types of Sanitation Facility Disposal of excreta Types of Sanitation Facility by Region Percent of population by type of sanitation facility, grouped by type of disposal Percent of population using sewer connections, onsite sanitation and open defecation , by region Percent of population using onsite improved sanitation facilities, by final disposal of excreta Safely managed sanitation services represents an ambitious new level of service during the SDGs and is the indicator for target 6.2. Safely managed sanitation services are improved facilities that are not shared with other households and where excreta are safely disposed of in situ or transported and treated offsite. The MICS survey collected information on the management of excreta from onsite facilities. For households where excreta are transported offsite (sewer connection, removal for treatment), further information is needed on the transport and treatment of excreta to calculate the proportion that are safely managed. Region Sewer connection Safe disposal in situ of excreta from on-site sanitation facilities Open defecation National 2 43 22 Western 1 50 16 Central 1 47 17 Greater Accra 9 21 8 Volta 1 37 38 Eastern 3 62 7 Ashanti 4 48 11 Brong Ahafo 0 63 17 Northern 0 24 57 Upper East 0 19 67 Upper West 0 24 52 60 Ghana Multiple Indicator Cluster Survey 2017/18 Menstrual Hygiene Management Exclusion from Activities during Menstruation Exclusion from Activities during Menstruation by Various Characteristics Inequities in Access to Appropriate Materials & Private Place to Wash & Change at Home 94 13 92 Women with a private place to wash & change at home Women using reusable materials Women with appropriate materials & a private place to wash & change at home Denominator for all 3 indicators: women age 15-49 who reported menstruating in the last 12 months Percent of women who did not participate in social activities, school or work due to their last menstruation in the last 12 months, by age, among women reporting menstruating in the last 12 months Percent of women who did not participate in social activities, school or work due to their last menstruation in the last 12 months, by residence, wealth quintile, education and region, among women reporting menstruating in the last 12 months # Among wealth quintiles, the highest proportions were reported from the Second and Middle quintiles at 23.5% and 19.2% Percent of women age 15-49 using appropriate menstrual hygiene materials with a private place to wash and change while at home, among women reporting menstruating in the last 12 months 61Ghana Multiple Indicator Cluster Survey 2017/18 GENDER EQUALITY Every Girl & Boy Survives & Thrives: The First Decade of Life Mortality Rates among Children Under-5, SDG 3.2.1 Sex Disaggregate Malnutrition: Wasting (Moderate & Severe) among Children Under-5, SDG 2.2.2 Malnutrition: Overweight (Moderate & Severe) among Children Under-5, SDG 2.2.2 Malnutrition: Stunting (Moderate & Severe) among Children Under-5, SDG 2.2.1 Gender equality means that girls and boys, women and men, enjoy the same rights, resources, opportunities and protections. Investments in gender equality contribute to lifelong positive outcomes for children and their communities and have considerable inter-generational payoffs because children’s rights and well-being often depend on women’s rights and well-being. This snapshot shows key dimensions of gender equality during the lifecycle. It is organized around: 1) the first decade of life (0-9 years of age) when gender disparities are often small, particularly in early childhood; 2) the second decade of childhood (10-19 years of age) when gender disparities become more pronounced with the onset of puberty and the consolidation of gender norms; and 3) adulthood, when gender disparities impacts both the wellbeing of women and girls and boys. Nutrition and a supportive environment in early childhood are among the key determinants of the health and survival of children and their physical and cognitive development. Generally, girls tend to have better biological endowments than boys for survival to age five, and thus higher survival chances under natural circumstances. However, gender discrimination against girls can affect survival, resulting in higher than expected female mortality. Similarly, stunting rates are typically lower among girls than boys, potentially due to the higher risk for preterm birth among boys, which is inextricably linked with lower birth weight. However, children with mothers who gave birth at a young age or who have no education may be more likely to be malnourished. Children with restricted cognitive development during early life are at risk for later neuropsychological problems, poor school achievement, early school drop-out, low-skilled employment, and poor care of their own children. Stimulation and interaction with parents and caregivers can jumpstart brain development and promote well-being in early childhood. This is also the period of development when gender socialization, or the process of learning cultural roles according to one’s sex, manifests. Caregivers, particularly fathers, may respond to, and interact with, sons and daughters differently. Infant mortality: probability of dying between birth and the first birthday Under-five mortality: the probability of dying between birth and the fifth birthday Wasting refers to a child who is too thin for his or her height Overweight refers to a child who is too heavy for his or her height Stunting refers to a child too short for his or her age 21 62 Ghana Multiple Indicator Cluster Survey 2017/18 Every Girl & Boy Survives & Thrives: The First Decade of Life Every Girl & Boy Is Protected From Violence & Exploitation: The First Decade of Life Registering children at birth is the first step in securing their recognition before the law, safeguarding their rights, and ensuring that any violation of these rights does not go unnoticed. While vitally important for both girls and boys, the implications of low birth registration rates for girls are significant, rendering them more vulnerable to certain forms of exploitation they are at greater risk of, including child marriage and international trafficking. Although average birth registration rates are similar for girls and boys, children with mothers who have no education may be less likely to have their births registered. While girls and boys face similar risks of experiencing violent discipline -which includes physical punishment and psychological aggression- by caregivers in the home, gender inequality and domestic violence are among the factors associated with an elevated risk of violence against both girls and boys. Early Stimulation & Responsive Care by Adults Birth Registration, SDG 16.9.1 Sex Disaggregate Violent Discipline, SDG 16.2.1 Sex & Age Disaggregate Early Childhood Development Index, SDG 4.2.1 Percentage of children age 2-4 years with whom adult household members engaged in activities that promote learning and school readiness during the last three days, by person interacting with child and sex of child. Note: Activities include: reading books to the child; telling stories to the child; singing songs to the child; taking the child outside the home; playing with the child; and naming, counting or drawing things with the child Percentage of children age 3-4 years who are developmentally on track in at least 3 of the following 4 domains: literacy-numeracy, physical, social-emotional, and learning domains, by sex Percentage of children under age 5 whose births are registered, by sex and maternal education level Percentage of children age 1-14 years who experienced violent discipline in the past month, by sex Note: The age group 1-14 spans the first and second decades of life. 72 65 Girls Boys 63Ghana Multiple Indicator Cluster Survey 2017/18 Percentage of children of primary school age not attending either primary or secondary school, by wealth quintile and area Percentage of children who age 3 to 5 years above the intended age for the last grade of primary school who have completed primary education, by sex Every Girl & Boy Learns: The First Decade of Life Participation Rate in Organized Learning, SDG 4.2.2 Children of Primary School Age Out of School Primary Completion Primary School Attendance Investment in good quality early childhood education services prior to entering school improves learning outcomes for children. It also enhances the efficiency of the school system by reducing repetition and drop- out and improving achievement, especially among girls and marginalized groups. Primary education provides the foundation for a lifetime of learning. Considerable progress has been made in achieving universal education and closing the gender gap but gender disparities to the disadvantage of girls still exist in some countries. Further, girls still comprise the majority of the world’s out-of-school population. Note: Because children of primary school age range from 6-14 years, these indicators include some children in their second decade of life. Percent distribution of children age one year younger than the official primary school entry age at the beginning of the school year, by attendance to education, and attendance to an early childhood education programme or primary education (adjusted net attendance ratio), by sex Percentage of children of primary school age attending primary or secondary school (adjusted net attendance ratio), by wealth quintile and urban/rural residence. § While more girls than boys live to celebrate their first birthday (39 and 42 deaths per 1000 livebirths respectively), more boys live to celebrate their fifth birthday than girls (54 and 58 deaths per 1000 livebirths). § The percentage of boys who are too short for their ages (stunted) is higher than that of their girls counterparts (20% and 16% respectively). Key Messages § Percentage of children age 3-4 years who are developmentally on track in at least 3 of the following 4 domains: literacy-numeracy, physical, social- emotional, and learning domains is more for girls (73%) than (65%). § The probability of suffering psychological aggression, physical and violent discipline is higher for boys than girls. § There are more girls than boys attending (82 % and 80% respectively) and completing (73% and 69% respectively) Primary education than their boys counterparts. 64 Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent Girl & Boy Survives & Thrives: The Second Decade of Life Contraceptive Use & Demand Satisfied Early Childbearing - by Age 18 Tobacco* & Alcohol UseComprehensive Knowledge of HIV While adolescence carries new health risks for both girls and boys, girls often face gender- specific vulnerabilities, with lifelong consequences. Complications related to pregnancy and childbirth are among the leading causes of death worldwide for adolescent girls age 15 to 19. Preventing adolescent pregnancy not only improves the health of adolescent girls, but also provides them with opportunities to continue their education, preparing them for jobs and livelihoods, increasing their self-esteem and giving them more say in decisions that affect their lives. Yet, too often, adolescent girls lack access to appropriate sexual and reproductive health services, including modern methods of contraception. Additionally, despite having a higher risk of contracting HIV due to both greater physiological vulnerabilities and gender inequalities, adolescent girls are often less knowledgeable than adolescent boys about how HIV is transmitted. However, gender norms adversely impact adolescent boys as well. For example, norms around masculinity that encourage risk taking may heighten adolescent boys’ use of alcohol and tobacco, increasing their likelihood of developing noncommunicable diseases later in life. Contraceptive use and demand for family planning satisfied by modern methods among adolescent girls age 15-19, by marital status Percent of girls and boys age 15-19 who know of the two ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy looking person can be HIV- positive, and who reject the two most common misconceptions, and any other local misconception. Tobacco and alcohol use among adolescents age 15-19, by sex *Includes an age and sex disaggregate of SDG 3.a.1: use of tobacco Percentage of women age 20-24 years who had a live birth by age 18, by urban/rural residence 65Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent Girl & Boy is Protected from Violence & Exploitation: The Second Decade of Life Adolescence presents unique vulnerabilities to violence and exploitation for girls. In many countries, marriage before the age of 18 is a reality for girls due to the interaction of several factors that place a girl at risk, including poverty, social norms, customary or religious laws that condone the practice, an inadequate legislative framework and the state of a country’s civil registration system. Child marriage often compromises a girl’s development by resulting in early pregnancy and social isolation, interrupting her schooling, and limiting her opportunities for career and vocational advancement. It also often involves a substantial age difference between the girl and her partner, thus further disempowering her and putting her at greater risk of partner violence, sexually transmitted diseases and lack of agency. Attitudes about wife beating serve as a marker for the social acceptability of intimate partner violence. Acceptance of wife beating among adolescent girls and boys suggests that it can be difficult for married girls who experience violence to seek assistance and for unmarried girls to identify and negotiate healthy and equitable relationships. Female genital mutilation is a human rights issue that also affects girls and women. Adolescence, in particular, is a vulnerable period for girls who have undergone FGM because they may experience heightened consequences of the procedure as they become sexually active and begin childbearing. Gender-based discrimination may be one of the most ubiquitous forms of discrimination adolescent girls face, and it has long-lasting and far-reaching effects on their personal trajectories as well as on all aspects of social and economic development. While in most regions, girls and boys are equally likely to be involved in child labour, gender is a determinant of the types of activities boys and girls engage in, with girls more likely to be involved in domestic work. Child Marriage, SDG 5.3.1 Attitudes toward Domestic Violence Spousal Age Difference Percentage of women aged 20-24 years who were first married or in union before age 15 and before age 18*, by residence Percentage of adolescents age 15-19 years who justify wife beating for any of the following reasons: she goes out without telling him; she neglects the children; she argues with him; she refuses sex with him; she burns the food, by sex and age group # Proportions based on data for boys 15-19 years Percent distribution of adolescent girls age 15-19 currently married or in union by age difference with their partner education level and wealth quintile () Figures in parentheses are based on 25-49 unweighted cases. * Figures that are fewer than 25 unweighted cases and have been suppressed *** Under Education, figures for SSS/SHS/Secondary and Higher could not be reported as they were fewer than 25 unweighted cases and have been suppressed. Therefore only JSS/JHS/Middle could be shared. 66 Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent Girl & Boy is Protected from Violence & Exploitation: The Second Decade of Life Life satisfaction measures an individual’s perceived level of well-being or how an individual feels about their life as a whole. Measuring adolescent girls’ and boy’s satisfaction with their lives can provide important insights into their mental health during a stage of life when gender norms consolidate and girls and boys experience different risk factors for mental health disorders. Female Genital Mutilation (FGM), SDG 5.3.2 Age Disaggregate Life Satisfaction Every Adolescent Girl & Boy has an Equitable Chance in Life: The Second Decade of Life Child Labour, SDG 8.7.1 a Percentage of girls age 10-14 whose mothers report they have undergone FGM b Percentage of adolescent girls age 15-19 who report having undergone FGM FGM refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Among adolescents age 15-19, average life satisfaction score on a scale of 0 to 10, by sex and age group Percentage of children age 5 to 17 years engaged in child labour, by sex, age group and type of activity * Note: Indicator includes children in the first & second decade of life **Estimates from MICS of child labour are different from those in the SDG database for indicator 8.7.1, as the database excludes the hazardous work component and applies a threshold of 21 hours for household chores for children aged 5-14 and no threshold for household chores for children aged 15-17 67Ghana Multiple Indicator Cluster Survey 2017/18 While participation in secondary education is expanding, progress lags behind primary education. Gender disparities disadvantaging girls are also wider and occur in more countries at the secondary level than at the primary level. Yet, advancing girls’ secondary education is one of the most transformative development strategies countries can invest in. Completion of secondary education brings significant positive benefits to girls and societies – from increased lifetime earnings and national growth rates, to reductions in child marriage, stunting, and child and maternal mortality. Every Adolescent Girl & Boy Learns: The Second Decade of Life Lower/Junior Secondary Attendance Net Attendance Rate Junior / Lower Secondary Completion Senior / Upper Secondary Completion Senior / upper Secondary Attendance Net Attendance Rate Percentage of children of lower/Junior secondary school age attending Junior secondary school or higher (adjusted net attendance ratio), by sex, wealth quintile and area Percentage of children who age 3 to 5 years above the intended age for the last grade of junior / lower secondary school who have completed lower secondary education, by sex Percentage of children or youth who age 3 to 5 years above the intended age for the last grade of Senior / upper secondary school who have completed upper secondary education, by sex Percentage of children of senior/upper secondary school age attending Senior secondary school or higher (adjusted net attendance ratio), by sex, wealth quintile and area 68 Ghana Multiple Indicator Cluster Survey 2017/18 Every Adolescent Girl & Boy Learns: The Second Decade of Life Every Adolescent Girl & Boy Lives in a Safe & Clean Environment: The Second Decade of Life Children of Lower Secondary School Age Out of School Menstrual Hygiene Management Percentage of children of lower /junior secondary age not attending either primary or secondary school, by wealth quintile and area The ability of adolescent girls to safely manage their monthly menstrual cycle in privacy and with dignity is fundamental to their health, psychosocial well-being and mobility. Girls in low-resource and emergency contexts without access to adequate menstrual hygiene management facilities and supplies experience stigma and social exclusion while also forgoing important educational, social and economic opportunities. Menstrual Hygiene Management: Among adolescent girls age 15-19 who reported menstruating in the last 12 months, percentage using appropriate menstrual hygiene materials with a private place to wash and change while at home Exclusion from Activities during Menstruation: Among adolescent girls age 15-19 who reported menstruating in the last 12 months, percentage of women who did not participate in social activities, school or work due to their last menstruation in the last 12 months § Child bearing among young women by age 18 years is higher for rural (23%) than urban (13%) folks. § Only 15 percent and 17 percent of adolescent girls and boys respectively have comprehensive knowledge of HIV. § While the proportion of adolescents 15-19 years who have ever-used tobacco is 1% and 6% among girls and boys respectively; those who have ever-used alcohol is higher at 19% and 22% for girls and boys respectively. Key Messages § One out of every five young women 20-24 years was married before age 18 while this is much higher at one out of every four among rural dwellers and one out of every three among those in the poorest quintile. § Close to one in every five for adolescent girls age 15-19 years currently married or in union has a spouse that is 10 years or older § Child labour on household activities is higher among girls than boys (79% and 69% respectively) while child labour in economic activities is higher among boys than girls (21% and 18% respectively). § Nine out of every ten adolescent girls use appropriate menstrual hygiene materials with a private place to wash and change at home; 1 out of every 5 however did not participate in social activities, school or work due to their last menstruation. 69Ghana Multiple Indicator Cluster Survey 2017/18 To survive and thrive, all children require care and support from women and men. Care and support can be substantively improved by fostering gender equality, an important goal in its own right, and by reducing the gender-related barriers. Gender- related barriers include women’s and girls’ disproportionate lack of information, knowledge and technology, resources, and safety and mobility, as well as the gender division of labour and gender norms. For example, a mother’s lack of mobility, due to prohibitive norms or lack of transportation, may impede birth registration, nutrition, and other child outcomes. The internalization of gender norms around masculine and feminine expectations and behaviours may influence women’s and men’s attitudes toward intimate partner violence and physical punishment of children as well as self-perceptions of well-being, including life satisfaction and expectations for the future. Gender Equality in Adulthood Access to Knowledge, Information & Technology Access to Resources Time on Household Chores: Water Collection Literacy Mobile Phone Ownership, SDG 5.b.1 Who collects water? Time spent on water collection Health Insurance Coverage Media Access Internet Use: SDG17.8.1 Percentage of adults age 15-49 who are literate, by sex Percentage of adults age 15-49 who own a mobile phone, by sex, wealth quintile and area Percentage of adults age 15-49 with health insurance,, by sex, wealth quintile and area Percent distribution of household members without drinking water on premises by person usually collecting drinking water used in the household Percent distribution of average amount of time spent collecting water per day by sex of person primarily responsible for water collection in households without drinking water on premises Percentage of adults age 15-49 who read a newspaper, listen to the radio, or watch television (any media) at least once a week Percentage of adults age 15-49 using the internet at least once in the past 3 months, by sex 65 79 Women Men 77 84 Women Men 15 35 Women Men 70 Ghana Multiple Indicator Cluster Survey 2017/18 Gender Equality in Adulthood Feminine & masculine attitudes & expectations Life satisfaction Perceptions of a better life Attitudes toward domestic violence Attitudes toward physical punishment Percentage of adults age 15-49 who justify wife beating for any of the following reasons: she goes out without telling him; she neglects the children; she argues with him; she refuses sex with him; she burns the food, by sex, wealth quintile and area Among adults age 15-49, average life satisfaction score on a scale of 0 to 10, by sex, wealth quintile and marital status. Higher scores indicate higher satisfaction levels. Percentage of adults age 15-49 who expect that their lives will get better in one year, by sex, wealth quintile and marital status Percentage of caretakers who believe that physical punishment is needed to bring up, raise, or educate a child properly, by sex of caretaker 59 48 Women Men § Literacy rate for men is higher than women (79% and 65% respectively). § While one out of every three men uses the internet, one out of every seven women uses it. § Percentage of men with access to mass media (84%) is higher than that of women (77%). Key Messages § Among the poorest, richest, urban and rural households, there are more men who own a mobile phone than women; 79 percent and 68 percent of men and women respectively own a mobile phone. § Among the poorest, richest, urban and rural households, there are more women with health insurance than men; 56 percent and 40 percent of women and men respectively have health insurance. 71Ghana Multiple Indicator Cluster Survey 2017/18 The Ghana Multiple Indicator Cluster Survey (MICS) was conducted in 2017/18 by the Ghana Statistical Service (GSS) as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF, Government of Ghana, World Bank, USAID, KOICA and UNDP provided financial support. Statistical snapshots and the Survey Findings Report for this and other surveys are available on mics.unicef.org/surveys. 72 Ghana Multiple Indicator Cluster Survey 2017/18 Multiple Indicator Cluster Surveys

View the publication