Jordan - Demographic and Health Survey - 1998

Publication date: 1998

World Summit for Children Indicators: Jordan 1997 _________________________________________________________________________________________________ Value _________________________________________________________________________________________________ BASIC INDICATORS _________________________________________________________________________________________________ Childhood mortality Infant mortality rate 24 per 1,000 Under-five mortality rate 34 per 1,000 Maternal mortality Maternal mortality ratio 79 per 100,000 Childhood malnutrition Percent stunted 7.8 Percent wasted 1.9 Percent underweight 5.1 Clean water supply Percent of households within 15 minutes of a safe water supply1 99.3 Sanitary excreta disposal Percent of households with flush toilets 91.8 Basic education Percent of women 15-49 with completed primary education 85.8 Percent of men 15-49 with completed primary education 89.9 Percent of girls 6-12 attending school 90.6 Percent of boys 6-12 attending school 90.2 Percent of women 15-49 who are literate 88.9 Children in especially Percent of children who do not live with their natural mother 2.7 difficult situations Percent of children who live in single adult households 1.9 _________________________________________________________________________________________________ SUPPORTING INDICATORS _________________________________________________________________________________________________ Women's Health Birth spacing Percent of births within 24 months of a previous birth 44.2 Safe motherhood Percent of births with medical antenatal care 95.6 Percent of births with antenatal care in first trimester 78.9 Percent of births with medical assistance at delivery 96.6 Percent of births in a medical facility 93.1 Percent of births at high risk 66.9 Family planning Contraceptive prevalence rate (any method, currently married women) 52.6 Percent of currently married women with an unmet need for family planning 14.2 Percent of currently married women with an unmet need for family planning to avoid a high-risk birth 12.2 Nutrition Maternal nutrition Percent of mothers with low BMI 2.3 Low birth weight Percent of births at low birth weight (of those reporting numeric weight) 10.1 Breastfeeding Percent of children under 4 months who are exclusively breastfed 14.8 Child Health Vaccinations Percent of children whose mothers received tetanus toxoid vaccination during pregnancy 39.5 Percent of children 12-23 months with measles vaccination 89.9 Percent of children 12-23 months fully vaccinated (including BCG) 20.5 Percent of children 12-23 months fully vaccinated (excluding BCG) 85.7 Diarrhea control Percent of children with diarrhea in preceding 2 weeks who received oral rehydration therapy (ORS or sugar-salt-water solution) 28.8 Acute respiratory infection Percent of children with acute respiratory infection in preceding 2 weeks who were seen by medical personnel 76.3 _________________________________________________________________________________________________ 1 Piped, well, and bottled water THE HASHEMITE KINGDOM OF JORDAN Jordan Population and Family Health Survey 1997 Department of Statistics Amman, Jordan Macro International Calverton, Maryland USA December 1998 Report prepared by: Dr. Qeis Halawah Dr. Ghassan Fakhoury Dr. Mohamed El-Arabi Dr. Issa Masarwah Fahad Hiyari Abdelhalim Kharabsheh Fathi Nsour Ikhlas Aranki Dr. Mohamed Ayad Dr. Pavalavali Govindasamy Sri Poedjastoeti Dr. Tulshi Saha Editors: Dr. Abdulhadi Alawin Fahad Hiyari Fathi Nsour Ikhlas Aranki Dr. Mohamed Ayad Dr. Pavalavali Govindasamy Dr. Sidney Moore Sri Poedjastoeti The report summarizes the findings of the 1997 Jordan Population and Family Health Survey (JPFHS), which was conducted by the Jordan Department of Statistics (DOS). Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Development. The JPFHS is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information on the Jordan survey may be obtained from the Department of Statistics, P.O. Box 2015, Jubaiha Street, Amman, Jordan (telephone 962-6- 5342171; fax 962-6-5333518). Additional information about the DHS program may be obtained by writing to DHS, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (telephone 301-572-0200; fax 301-572-0999). Recommended citation: Department of Statistics (DOS) [Jordan] and Macro International Inc. (MI). 1998. Jordan Population and Family Health Survey 1997. Calverton, Maryland: DOS and MI. iii CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Map of Jordan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 History, Geography, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Population and Family Planning Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.4 Health Priorities and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.5 Objectives of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.6 Methodology and Organization of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.6.1 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6.2 Updating of Sampling Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6.3 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6.4 Pretest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.6.5 Recruitment and Training of Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.6.6 Main Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.6.7 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.7 Results of the Household and Individual Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2 HOUSEHOLD CHARACTERISTICS AND WOMEN’S SITUATION . . . . . . . . . . . . 7 2.1 Population by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.2 Population by Age From Other Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.3 Household Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.4 Level of Education of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.5 School Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.6 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.7 Presence of Durable Goods in the Household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.8 Respondents’ Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.9 Respondents’ Level of Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.10 Exposure to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.11 Respondents’ Employment Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.11.1 Employment Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.11.2 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.11.3 Employer and Type of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2.11.4 Child Care While Mother is Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 iv Page CHAPTER 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.1 Fertility Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.2 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.3 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.4 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.5 Teenage Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 CHAPTER 4 FERTILITY REGULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 4.1 Knowledge of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 4.2 Ever-Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 4.3 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 4.4 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.5 Knowledge of the Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.6 Contraceptive Effect of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.7 Timing of Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.8 Source of Supply for Modern Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.9 Contraceptive Discontinuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.10 Future Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.11 Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.12 Acceptability of Media Messages on Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.13 Exposure to Family Planning Messages in Print Media . . . . . . . . . . . . . . . . . . . . . . . . 52 4.14 Attitudes toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 CHAPTER 5 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY . . . . . . . . . . . . 55 5.1 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.3 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 5.4 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.5 Postpartum Amenorrhea, Postpartum Abstinence, and Insusceptibility . . . . . . . . . . . . 61 CHAPTER 6 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 6.1 Desire for Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 6.2 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 6.3 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 6.4 Planning Status of Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 CHAPTER 7 INFANT AND CHILD MORALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 7.1 Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 7.2 Differentials in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 7.3 High-risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 v Page CHAPTER 8 REPRODUCTIVE AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 8.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 8.2 Number of Antenatal Care Visits and Stage of Pregnancy . . . . . . . . . . . . . . . . . . . . . . 82 8.3 Tetanus Toxoid Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 8.4 Place of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 8.5 Assistance During Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 8.6 Delivery Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 8.7 Delivery Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 8.8 Vaccinations by Source of Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 8.9 Vaccinations by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 8.10 Vaccination in First Year of Life by Current Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 8.11 Prevalence and Treatment of Acute Respiratory Infection and Prevalence of Fever . . 90 8.12 Knowledge of Diarrhea Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.13 Diarrhea Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 CHAPTER 9 INFANT FEEDING, MATERNAL AND CHILD NUTRITION . . . . . . . . . . . . . . . . . 97 9.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 9.2 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 9.3 Maternal Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 CHAPTER 10 KNOWLEDGE OF AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 10.1 Source of Information About AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 10.2 Knowledge of Ways to Prevent AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 10.3 Women's Perceptions of the Risk of Getting AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 10.4 Knowledge and Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 CHAPTER 11 MATERNAL MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 11.2 The Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 11.3 Indirect Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 A.1 Sample Design and Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 A.2 Sample Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 vi Page APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 APPENDIX D QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 vii TABLES Page Table 1.1 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Table 2.1 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Table 2.2 Population by age from other sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table 2.4 Foster children and orphans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.5.1 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2.5.2 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2.6 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.7 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table 2.8 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 2.9 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.10 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table 2.11 School attendance and reason for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.12 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 2.13 Women's employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.14 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table 2.15 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.16 Decision on use of women's earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.17 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 3.1 Current fertility according to selected surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 3.2 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 3.3 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 3.4 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 3.5 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3.6 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3.7 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 3.8 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 3.9 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 32 Table 3.10 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 4.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 4.2 Knowledge of contraceptive methods by background characteristics . . . . . . . . . . . . . 36 Table 4.3 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 4.4 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 4.5 Trends in contraceptive use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 4.6 Use of contraception in selected countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 4.7 Currrent use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . 41 Table 4.8 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 4.9 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 4.10 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 4.11 Timing of sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.12 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.13 First-year discontinuation rates for contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 4.14 Reasons for discontinuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 4.15 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 4.16 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 4.17 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 viii Page Table 4.18 Exposure to family planning messages on radio or television . . . . . . . . . . . . . . . . . . . 51 Table 4.19 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 4.20 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.21 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.22 Wives' perceptions of their husbands' attitudes toward family planning . . . . . . . . . . . 54 Table 5.1 Ever-married women according to selected surveys . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 5.2 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 5.3 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table 5.4 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 5.5 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 5.6 Presence of husband in the household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 5.7 Postpartum amenorrhea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 61 Table 5.8 Median duration of postpartum amenorrhea, abstinence, and insusceptibility . . . . . . 62 Table 6.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 6.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 6.3 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 6.4 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 6.5 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 6.6 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . 70 Table 6.7 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 6.8 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 7.1 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table 7.2 Infant and child mortality, selected countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 7.3 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . 77 Table 7.4 Infant and child mortality by biodemographic characteristics . . . . . . . . . . . . . . . . . . . 78 Table 7.5 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 8.1 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 8.2 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . 82 Table 8.3 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 8.4 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 8.5 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table 8.6 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . . . . 86 Table 8.7 Delivery complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table 8.8 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 8.9 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 8.10 Vaccinations in first year of life by current age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table 8.11 Prevalence and treatment of acute respiratory infection and prevalence of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Table 8.12 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 8.13 Knowledge of diarrhea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table 8.14 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 8.15 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 9.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Table 9.2 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 9.3 Median duration and frequency of breastfeeding by background characteristics . . . 100 Table 9.4 Foods received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Table 9.5 Nutritional status of children by demographic characteristics . . . . . . . . . . . . . . . . . . 103 ix Page Table 9.6 Nutritional status of children by background characteristics . . . . . . . . . . . . . . . . . . . 104 Table 9.7 Trends in the nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table 9.8 Maternal nutritional status by background characteristics . . . . . . . . . . . . . . . . . . . . . 107 Table 10.1 Knowledge of AIDS and sources of AIDS information . . . . . . . . . . . . . . . . . . . . . . 109 Table 10.2 Knowledge of ways to avoid AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table 10.3 Perception of the risk of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Table 10.4 Knowledge of and use of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 11.1 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 11.2 Mortality data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 11.3 Indirect estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Table A.1 Sample allocation by governorate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table A.2 Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Table B.1 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Table B.2 Sampling errors - National sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Table B.3 Sampling errors - Urban sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table B.4 Sampling errors - Rural sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Table B.5 Sampling errors - North region sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table B.6 Sampling errors - Central region sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table B.7 Sampling errors - South region sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table C.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table C.3 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table C.4 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Table C.5 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Table C.6 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 xi FIGURES Page Figure 2.1 Male and female population by single years of age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Figure 2.2 Population pyramid of Jordan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 2.3 Population by broad age groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Figure 3.1 Age-specific fertility rates from various data sources, 1976-1997 . . . . . . . . . . . . . . . . 26 Figure 3.2 Age-specific fertility rates by urban-rural residence, 1995-1997 . . . . . . . . . . . . . . . . . 27 Figure 4.1 Current use of contraceptive methods, currently married women 15-49 . . . . . . . . . . . . 38 Figure 4.2 Current use of contraception among currently married women, 1976 to 1997 . . . . . . . 39 Figure 4.3 Current use of contraception among currently married women by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Figure 4.4 Sources of family planning methods, current users of modern methods . . . . . . . . . . . . 46 Figure 4.5 Contraceptive discontinuation rates by reason and method . . . . . . . . . . . . . . . . . . . . . . 47 Figure 5.1 Never-married women 15-39 by age, Jordan, 1976-1997 . . . . . . . . . . . . . . . . . . . . . . . 56 Figure 6.1 Fertility preferences of currently married women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . 64 Figure 6.2 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Figure 7.1 Trends in infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Figure 7.2 Trends in infant and child mortality by five-year periods . . . . . . . . . . . . . . . . . . . . . . . 75 Figure 7.3 Infant mortality by selected demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . 79 Figure 8.1 Delivery in a health facility by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 84 Figure 9.1 Malnutrition among children under five by age in months . . . . . . . . . . . . . . . . . . . . . 105 xiii PREFACE The Department of Statistics (DOS) takes pleasure in presenting the principal report for the 1997 Jordan Population and Family Health Survey (JPFHS). This survey was carried out by DOS during the period June 7 through October 31, 1997, in collaboration with Macro International Inc. under the worldwide Demographic and Health Surveys (DHS) program. The U.S. Agency for International Development (USAID)/Amman provided funding for the survey, while Macro furnished technical assistance throughout various stages of the survey. The survey covered a national sample of close to 7,600 households, in which about 5,800 ever- married women ages 15 to 49 were identified. This sample is nationally representative and has been designed to produce estimates at the national level, by urban-rural residence, by region, and for each of the three major governorates—namely Amman, Irbid, and Zarqa. The survey was used to collect information on households—including demographic characteristics, level of education, and household amenities and durables. Information collected from ever-married women covered background characteristics, fertility preferences, family planning, breastfeeding and nutrition, child health care, immunization, morbidity, maternal mortality, husband’s background, women’s employment, and height and weight of children under five and their mother. The Department of Statistics would like to express its thanks and appreciation to all agencies that participated in this survey, whose support brought this work to success—especially USAID; Macro International Inc.—in particular Dr. Mohamed Ayad, Miss Sri Poedjastoeti, Dr. Alfredo Aliaga, and Noureddine Abderrahim; the Ministry of Health and Health Care (Jordan); and the Jordan Family Planning and Protection Association (JFPPA). Thanks are also due to all households that cooperated with the DOS enumerators by providing the required information. Special thanks are also due to the local and international expert researchers who drafted the present report. I hope that the data in this report will be useful to those interested in policy formulation and decisionmaking in the various health and population areas. Dr. Abdulhadi Alawin Director General of Statistics xv SUMMARY AND RECOMMENDATIONS The 1997 Jordan Population and Family Health Survey (JPFHS) is a nationally representative survey in which 7,335 households and a total of 5,548 ever-married women between the ages of 15 and 49 were successfully interviewed. The survey was fielded between June and October 1997. This survey is the second in a series of Demographic and Health Surveys (DHS) survey in Jordan carried out by the Department of Statistics. The DHS project of Macro International Inc. provided technical assistance under a contract funded by the United States Agency for International Development (USAID). The JPFHS was designed to provide information on levels and trends of fertility, infant and child mortality, and family planning. The survey also gathered information on breastfeeding, maternal and child health care, the nutritional status of children under five, as well as the characteristics of households and household members. Survey results are presented at the national level, by urban and rural residence, and for each of the three regions in the country. Results of this survey can be compared with those of previous demographic surveys, including the 1976 Jordan Fertility Survey, the 1983 Jordan Fertility and Family Health Survey and the 1990 JPFHS. CURRENT STATUS AND PROGRESS Fertility • The JPFHS indicates that fertility continues to decline in Jordan. The total fertility rate for the five-year period prior to the survey indicates that on average, women have 4.4 children by the end of their reproductive years, three children less than 20 years ago, when the total fertility rate was 7.4 in the 1975-1976 period. The decline in fertility has accelerated over time. It was 11 percent in the mid-1970s through the early 1980s, 15 percent in the 1980s, and 21 percent in the early 1990s. • Fertility levels vary across regions. The total fertility rate in the Central region is 4.1 births per woman, while women in the North and South regions have an average of 4.8 children or more. • There are large differences in fertility by educational attainment of women. Women who have attended higher than secondary education have 3.7 children in their lifetime, while women with less education have 4.5 or more children. In recent years, the gap in fertility by women’s education has narrowed. The corresponding figures in 1990 were 4.1 children and 6.9 children, respectively. • Further decline in fertility can be expected in the future. More than half (51 percent) of currently married women in Jordan do not want any more children or have been sterilized, and 27 percent want to delay their next birth for at least two years. If women's desired family size were achieved, the fertility rate would be only 2.9 children per woman, which is 34 percent lower than the observed rate. There has been a decline in the number of children wanted since 1990, when the desired family size was 3.9 children. Family Planning • Increased use of family planning, especially modern methods, has played a major role in fertility decline. Widespread knowledge of family planning is also supportive of further fertility decline. xvi Virtually all currently married women know a method of contraception. Women generally feel it is acceptable to have family planning messages broadcast on radio and television. • In 1997, 53 percent of currently married women were using a method of family planning, and most of these women (38 percent of currently married women) were using a modern contraceptive method. The most popular modern methods are the IUD (23 percent), the pill (7 percent), and female sterilization (4 percent). Fifteen percent of married women are using traditional methods, including 2 percent who are using prolonged breastfeeding. • Women age 35-44, women with 2 or more living children, and better educated women as well as urban women are more likely than other women to use a family planning method. Contraceptive prevalence is highest in the Central region (55 percent) compared with the North region (50 percent), and the South region (43 percent). • Contraceptive use increases with parity; half of women who have 2 children and almost two- thirds of women who have three or more children are using family planning. Other Fertility Determinants • The 1997 JPFHS data suggest that although marriage remains universal among women in Jordan, a growing proportion of women remain single longer. The median age at first marriage for women 25-49 has increased from 19.6 years in 1990 to 21.5 years in 1997. • There are slight regional differences in the age at which women marry; however, staying in school appears to be a motivation for delaying marriage. Women who have higher than secondary education marry almost 6 years later than women with the least education. • In addition to marriage patterns, the risk of pregnancy is affected by postpartum amenorrhea, the period after childbirth when menstruation has not yet returned and postpartum abstinence, the period when sexual activity has not yet been resumed. On average, women start menstruating again 4 months after childbirth and resumed sexual relations a little less than 2 months after childbirth. Future Use of Family Planning • Two in three married women who are not currently using contraception say that they intend to adopt a family planning method some time in the future, most of them (48 percent) in the 12 months following the survey. • Half of the women who expressed an intention to use contraception in the future said they would prefer to use the IUD, the same proportion as in 1990. Maternal and Child Health • In Jordan, maternal and child care is widespread, and there is little variation across subgroups. For virtually all births in the past five years, the mothers received at least one pregnancy checkup from a health professional, 90 percent from a doctor and 5 percent from a nurse or midwife. xvii • Almost all births in Jordan were assisted by health personnel during delivery, and 93 percent of the deliveries took place in a health facility. • Forty percent of the births in the five years preceding the survey were to women who received at least one dose of tetanus toxoid vaccine during pregnancy. The same level was shown in 1990. • In the 1997 JPFHS, mother’s nutritional status was measured using two indices, height and body mass index (BMI). The mean height of mothers measured in the survey was 158 centimeters; only 1 percent of mothers were shorter than 145 centimeters. • In Jordan, virtually all infants 12-23 months have been fully immunized against DPT and polio, and nine in ten have received the vaccine against measles. While BCG is recommended by the Ministry of Health to be given at school entry, one in four infants age 12-23 months has already received the vaccine against tuberculosis. • Immunization coverage varies across regions. While nine in ten infants 12-23 months in the North region have received vaccinations against measles, diphtheria, pertussis, tetanus, and polio, the proportion in the South region is 79 percent, and in Central region 84 percent. • In the two weeks preceding the survey, 10 percent of children under five had a cough with rapid breathing, and 18 percent had diarrhea. Among children with diarrhea, half were taken to a health facility and one in four was given oral rehydration therapy in the form of a solution prepared from ORS packets. • In the JPFHS, all children born since January 1992 were weighed and measured. Two percent of children under five are thin for their height (wasted), 8 percent are short for their age (stunted), and 5 percent are underweight according to their age. Infant and Child Mortality • Twenty-nine of 1,000 infants born in the five years prior to the survey (1992-97) will not survive to their first birthday. For the same period, 34 children will not live to be 5 years old. • Childhood mortality varies significantly by mother's residence and education. Infants in the South region have at least 50 percent higher mortality risks than those in the Central and North regions. Children of mothers with no education have twice the risk of dying of infants whose mothers have secondary education (54 deaths per 1,000 births compared with 27 deaths per 1,000 births). CONTINUING CHALLENGES • Despite the increased use of family planning methods, the increase in age at first marriage, and the apparent decline in fertility, the 1997 Jordan Population and Family Health Survey reveals a number of continuing challenges. While fertility levels are declining, 20 percent of births in the five years preceding the survey were mistimed, and 17 percent were not wanted at all. If these unwanted births had been prevented, women would have had an average of 2.9 births, instead of 4.4 births. xviii • Although it is encouraging to note that the level of unmet need for family planning services in 1997 was lower than that in the 1990 JPFHS, many women want to stop childbearing or delay the next birth for at least two years, but are not using a contraceptive method. • Two in three births in the five years preceding the survey were high-risk births either because the interval since the previous birth was too short (less than two years), the mother was too young (under age 18), too old (age 35 and over), or had too many prior births (3 or more). • Breastfeeding in Jordan is universal. However, the practice of breastfeeding is characterized by supplementation at an early age, and widespread use of a bottle and a nipple. RECOMMENDATIONS The results of the 1997 JPFHS reinforce findings from previous surveys that coverage of maternal and child health (MCH) programs in Jordan continues to improve. This is demonstrated by increased use of MCH services, along with knowledge and use of family planning. However, the survey data also note that: • Information, education and communication programs on the benefits of adopting family planning for the purpose of delaying or limiting childbearing need to be strengthened. These programs should be specifically directed toward women with the most need for family planning, particularly less educated women, women with high parity, and women in the South region. • Potential users of family planning should be counseled on the most appropriate method for their age, fertility desires, and personal situation. • Emphasis should be placed on the health benefits for mothers and children of smaller families and longer birth intervals, which may be achieved by the correct use of traditional methods of family planning including periodic abstinence and prolonged breastfeeding. JORDAN SYRIA IRAQ PALESTINE REGIONS North Central South Aqaba Ma'an Tafielah Karak Madaba Amman Zarqa Balqa Irbid Mafrag Jarash Ajloun Dead Sea SAUDI ARABIA 1 CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy Jordan was part of the Ottoman Empire until 1921, when it gained its independence. It was declared a political entity and became known as “Transjordan” in 1923. In 1950, Transjordan and the West Bank were united and assumed the current name of the Hashemite Kingdom of Jordan. In 1967, the occupation of the West Bank and the Gaza Strip by Israeli forces caused a massive influx of migrants to the East Bank. In 1988, in accordance with the desires of the Arab states and the Palestinian National Authority, the West Bank was administratively disengaged from the Kingdom to facilitate the establishment of the Palestinian state. Jordan, one of the most modern countries in the Middle East, is almost entirely land-locked. The port of Aqaba in the far south is Jordan’s only outlet to the sea. Palestine separates Jordan from the Mediterranean; Saudi Arabia lies to the south and east, Iraq is to the northeast, and Syria is to the north. The total area of the country is about 89,000 square kilometers. The country is divided into 12 governorates, which are grouped into three regions—the North region (Irbid, Jarash, Ajloun, and Mafraq), the Central region (Amman, Zarqa, Balqa, and Madaba), and the South region (Karak, Tafielah, Ma’an, and Aqaba). The major cities are Amman (the capital), Zarqa, and Irbid. There are three agricultural-development regions that run from north to south. They are the Jordan Valley, the highlands, and the Badia (semi-desert). Historically, rural-urban migration, as well as the influx of migrants from outside the country, have contributed to rapid urban growth (Hiyari, 1991). The urban population increased by about 10 percentage points between 1980 and 1994 (from 70 percent to 79 percent). Although the national government still controls most community services, Jordan is moving towards a free-market economy. There has been a slight shift in the economic sectoral shares of gross domestic product (GDP) in favor of the service sector. The share of agriculture in GDP dropped from 8.1 percent in 1990 to 5.5 percent in 1997. Similarly, the contribution of manufacturing to GDP declined from 21.3 percent to 19.7 percent during the same period (Department of Statistics, 1994). Per capita income rose from US$1,172 in 1990 to US$1,723 in 1997 (Central Bank of Jordan, 1995, 1998). The cost of living index increased by 20 percent in 1997 (1992=100). The balance of trade deficit rose sharply by 74 percent in 1996 from its level in 1990. However, the rate of economic growth was as low as 1.0 percent in 1997. As a result of the worldwide economic recession, the Jordanian economy has suffered from structural disparities in recent years. To restructure economic activities in the country, the government launched a reformation program (1991-1997). Currently, the government is encouraging the privatization of certain community services as part of the program of restructuring. 2 1.2 Population The first population census in Jordan was carried out in 1961. The population then totaled 901,000. As a result of the Arab-Israeli wars in 1948 and 1967, and the subsequent Israeli occupation of the West Bank and the Gaza Strip, a large number of Palestinians have moved into the East Bank. In 1979, the population numbered 2.13 million; it nearly doubled to 4.14 million in 1994. As of 1997, the population was estimated at 4.6 million. It is expected to reach 5.9 million in the year 2005 (Adlakha and Fowler, 1998). Population growth averaged 4.8 percent during the period 1961-1979 (Hiyari, 1984), and 4.4 percent between 1979 and 1994. The high rates of growth were caused by the influx of immigrants to the East Bank from the West Bank and the Gaza Strip in the late 1960s, the inflow of large numbers of guest workers, the high rate of natural increase (Hiyari, 1991), and the return of about 300,000 Jordanian nationals as a result of the 1990 Gulf War. The sudden increases in population have created several problems for the country—namely, shortages in food, housing, and employment opportunities and strains on the education system and the urban infrastructure. Results of the 1994 census indicate that the age structure of the population has changed considerably since 1979—primarily as a result of changes in fertility, mortality, and migration. The proportion of the population under 15 years of age declined from 51 percent in 1979 to 41 percent in 1994, while the proportion age 65 and over remained about the same (2.7 percent and 2.8 percent in 1979 and 1994, respectively). Eighty-one percent of schools are run by governmental agencies (Department of Statistics, 1996). The illiteracy rate among the population 15 years old and over has dropped by 56 percent (from 35.5 percent in 1979 to 14.8 percent in 1994) (Department of Statistics, 1983, 1997). In addition, almost one-third of Jordan's population is currently enrolled at various educational levels. Fertility has been declining in Jordan since the mid-1970s. Studies have found that the total fertility rate declined from 7.4 children per woman in 1976 to 5.6 in 1990, and to 4.6 in 1994. These figures indicate a decline of about three children, or 38 percent between 1976 and 1994. This decline was caused by the decrease in the crude birth rate, which dropped from 50 per thousand in 1972 to 35 in 1990, and to 30 in 1994. Mortality has also been declining in Jordan, even faster than fertility. The crude death rate, estimated at 18 per thousand in the early 1960s, had declined to 12 in the early 1980s (Hiyari,1984). In 1990, the crude death rate was estimated at seven per thousand; by 1994 it had dropped to five. The infant mortality rate also declined from 82 per thousand in 1976 to 34 in 1990, to 32 in 1994. In 1994, life expectancy was estimated at 68.2 years for both sexes, 67.2 for males and 69.1 for females (Adlakha and Fowler, 1998). 1.3 Population and Family Planning Policies and Programs Until recently, Jordan had no explicit and official population policy. In 1973, the National Population Commission (NPC) was established, with the mandate to formulate and implement a national population policy and to address all population-related activities (Hiyari,1985). However, the designing of a satisfactory population policy was controversial. Because of the sensitive nature of the problem, the NPC took no distinct actions or steps. The commission was revitalized in the late 1980s to represent several agencies working in the population field. During that period, and prior to 1993, both the public and private sectors have made efforts to provide family planning services. The Ministry of Health and Health Care (MOHHC), through its Maternal and Child Health Centers (MCH), provided optional and predominantly free family planning services as an unofficial and indirect intervention in the population policy (Hiyari, 1985). The efforts made by the Jordan Family Planning and Protection Association (JFPPA), as well as by some voluntary nongovernmental organizations, were invaluable in this regard. 3 In 1991, the NPC adopted the Birth Spacing National Program (originally launched by the MOHHC), prepared an integrated proposal, and submitted the proposal to the government and to the public as a suggested population policy (Hiyari and Saleh, 1996). This program was discussed nationwide, and in 1993 the government approved the program as an official population policy, taking into consideration the religious, social, national, and free-choice dimensions of Jordanian society. 1.4 Health Priorities and Programs The MOHHC is committed to making health services available, accessible, and acceptable in all communities, and seeks to ensure equitable distribution of these services. The government has given priority to the health sector and has developed a national health strategy. This strategy is aimed at creating a comprehensive health care system, utilizing both public and private service providers, and covering all levels of care, from preventive care to tertiary and rehabilitative care. The MOHHC developed short-term and long-term plans to improve the health care system and the delivery of services to the population. The plans focused on the following areas: 1. Coordination of primary, secondary, and tertiary health service delivery, in order to improve the efficiency of the health system and to avoid duplication among health providers and waste of resources. 2. Health manpower development to raise standards in all health manpower categories and to maintain quality standards throughout the system. 3. Facility development by upgrading the existing health centers and hospitals, and building new facilities as needed. 1.5 Objectives of the Survey The 1997 Jordan Population and Family Health Survey (JPFHS) is a national sample survey carried out by the Department of Statistics (DOS) as part of its National Household Surveys Program (NHSP). The JPFHS was specifically aimed at providing information on fertility, family planning, and infant and child mortality. Information was also gathered on breastfeeding, on maternal and child health care and nutritional status, and on the characteristics of households and household members. The survey will provide policymakers and planners with important information for use in formulating informed programs and policies on reproductive behavior and health. 1.6 Methodology and Organization of the Survey The JPFHS is designed to collect data on ever-married women of reproductive age. The areas covered include demographic and socioeconomic characteristics, marriage and reproduction, antenatal care, breastfeeding and child care, fertility preferences, and nutritional status of children under five years of age. The survey was funded primarily by the U.S. Agency for International Development (USAID) as part of the worldwide DHS program. Macro International Inc. assisted in the sample and questionnaire design, the training activities, the computer processing of survey data, and the preparation of reports. A national advisory committee, headed by the Director General of Statistics, was established to provide guidelines for the planning and implementation stages of the survey. The committee consisted of representatives from various government and nongovernment agencies involved in population and health issues. The survey was executed in three stages; the first was the preparatory stage, which involved mapping, listing of housing units, and design and implementation of sampling procedures. At the same time, the 4 survey questionnaires and instruction manuals were developed, pretested, and finalized. All of these activities were completed in April 1997. The second stage encompassed interviewing and collection of data. This was carried out by eight teams, each consisting of one supervisor, one field editor, and three interviewers. Data collection took place from June through October 1997. The next stage involved data entry, which started soon after the beginning of fieldwork and continued until November 1997. Data entry was followed by data cleaning, evaluation, and analysis. 1.6.1 Sample Design and Implementation The 1997 JPFHS sample was designed to produce reliable estimates of major survey variables for the country as a whole, for urban and rural areas, for the three regions (each composed of a group of governorates), and for the three major governorates, Amman, Irbid, and Zarqa. The 1997 JPFHS sample is a subsample of the master sample that was designed using the frame obtained from the 1994 Population and Housing Census. A two-stage sampling procedure was employed. First, primary sampling units (PSUs) were selected with probability proportional to the number of housing units in the PSU. A total of 300 PSUs were selected at this stage. In the second stage, in each selected PSU, occupied housing units were selected with probability inversely proportional to the number of housing units in the PSU. This design maintains a self-weighted sampling fraction within each governorate. The sample design is described in Appendix A; the sampling errors are presented in Appendix B. 1.6.2 Updating of Sampling Frame Prior to the main fieldwork, mapping operations were carried out and the sample units/blocks were selected and then identified and located in the field. The selected blocks were delineated and the outer boundaries were demarcated with special signs. During this process, the numbers on buildings and housing units were updated, listed and documented, along with the name of the owner/tenant of the unit or household and the name of the household head. These activities took place between January 7 and February 28, 1997. 1.6.3 Questionnaires The 1997 JPFHS used two questionnaires, one for the household interview and the other for eligible women (see Appendix D). Both questionnaires were developed in English and then translated into Arabic. The household questionnaire was used to list all members of the sampled households, including usual residents as well as visitors. For each member of the household, basic demographic and social characteristics were recorded and women eligible for the individual interview were identified. The individual questionnaire was developed utilizing the experience gained from previous surveys, in particular the 1983 and 1990 Jordan Fertility and Family Health Surveys (JFFHS). 5 The 1997 JPFHS individual questionnaire consists of 10 sections: - Respondent’s background - Marriage - Reproduction (birth history) - Contraception - Pregnancy, breastfeeding, health and immunization - Fertility preferences - Husband’s background, woman’s work and residence - Knowledge of AIDS - Maternal mortality - Height and weight of children and mothers. 1.6.4 Pretest The household and individual questionnaires were pretested in April and March 1997 in a number of urban and rural clusters outside of those selected for the actual survey. All senior staff members of the survey participated in this activity. The field staff for the pretest consisted of highly qualified and experienced female interviewers. Pretest training, which lasted three weeks, included class discussions, role playing, and field practice. Staff from the MOHHC and the JFPPA were invited to give lectures on their respective areas of expertise. In addition, the pretest teams were trained to carry out supervisory tasks, since they were expected to act as supervisors or field editors during the main fieldwork. The pretest revealed some minor phrasing problems in the questionnaire, which were corrected. 1.6.5 Recruitment and Training of Staff Different supervisory and executive levels of survey staff members were recruited, according to certain criteria such as experience, educational and personal qualifications, and familiarity with geographic areas. Fieldworkers for the main survey were recruited from among those who participated in the 1994 census as well as those who took part in other demographic surveys conducted by the DOS. The interviewers were all highly qualified females. Supervisors and field editors were selected from those who participated in the pretest. They were retained by the DOS after the pretest to assist in sampling activities. The training of interviewers, field editors, and supervisors for both the household and the individual questionnaires lasted three weeks, from May 10 to June 5, 1997. Six staff members versed in specific aspects pertaining to family planning, maternal health, child health, and AIDS, participated in this activity. Much of the training consisted of lectures on how to conduct the interviews and how to fill out the questionnaires. Practice interviewing was done in the third week of training. Staff from the MOHHC and the JFPPA were invited to speak on issues related to their activities. 1.6.6 Main Fieldwork The survey fieldwork was organized in such a way as to ensure control over field logistics by DOS field offices all over the country. The workload, the dispersion of sample units, and transportation facilities served as criteria for identifying the number of field staff in each area. Field staff consisted of five controllers (males), eight supervisors, eight field editors, and eight teams of five interviewers each. Fieldwork was carried out between June 7 and October 31, 1997. To facilitate data collection, each interviewing team was assigned a number of blocks in the sample 6 Table 1.1 Results of the household and individual interviews Number of households, number of interviews and response rates, Jordan 1997 _____________________________________________________________ Residence _______________ Result Urban Rural Total _____________________________________________________________ Household interviews Households sampled Households found Households interviewed Household response rate Individual interviews Number of eligible women (EW) Number of EW interviewed Eligible woman response rate 6,281 1,643 7,924 6,029 1,563 7,592 5,811 1,524 7,335 96.4 97.5 96.6 4,604 1,161 5,765 4,417 1,131 5,548 95.9 97.4 96.2 area. Each supervisor divided his team so as to ensure that all adjacent sampled households were completed by one interviewer. To ensure good data quality, interviewers were asked to conduct fewer interviews during the first three days of data collection. The questionnaires were spot-checked by the field editor and/or the supervisor. Errors were corrected by the interviewers, discussions with the editor or, in some cases, by callbacks to the respective households. To maintain consistency, information on common errors or unusual cases were passed to all supervisors in the area. The field editor and/or the supervisor conducted spot-checks by randomly visiting some sampled households and completing some parts of the same questionnaire (previously filled in by the interviewer). Both questionnaires were then matched and any differences were discussed. Interviewers made repeated attempts by calling back to interview eligible respondents who were not home at the time of the first visit or to persuade eligible women who were reluctant to be interviewed. 1.6.7 Data Processing Fieldwork and data processing activities overlapped. After a week of data collection, and after field editing of questionnaires for completeness and consistency, the questionnaires for each cluster were packaged together and sent to the central office in Amman where they were registered and stored. Special teams were formed to carry out office editing and coding. Data entry started after a week of office data processing. The process of data entry, editing, and cleaning was done by means of the ISSA (Integrated System for Survey Analysis) program DHS has developed especially for such surveys. The ISSA program allows data to be edited while being entered. Data entry was completed on November 14, 1997. A data processing specialist from Macro made a trip to Jordan in November and December 1997 to identify problems in data entry, editing, and cleaning, and to work on tabulations for both the preliminary and final reports. 1.7 Results of the Household and Individual Interviews Table 1.1 is a summary of the results from both the household and the individual interviews. A total of 7,924 occupied housing units were selected for the survey; from among those, 7,592 households were found. Of the occupied households, 7,335 (97 percent) were successfully interviewed. In those households, 5,765 eligible women were identified, and complete interviews were obtained with 5,548 of them (96 percent of all eligible women). Thus, the overall response rate of the 1997 JPFHS was 93 percent. The principal reason for nonresponse among the women was the failure of interviewers to find them at home despite repeated callbacks. 7 CHAPTER 2 HOUSEHOLD CHARACTERISTICS AND WOMEN’S SITUATION This chapter describes the general characteristics of the sample population, including composition by age and sex, residence, education, housing facilities, and exposure to mass media. The data are presented for various subgroups of the population. Another purpose of this chapter is to provide a brief description of the situation of children and women of reproductive age. The main background characteristics, which are highlighted in this chapter, are those that particularly influence nuptiality, fertility, contraceptive behavior, maternal care, and child morbidity and mortality. In addition, information is also provided on women’s employment, work status, child care, domestic living arrangements, and reasons for leaving school. The questionnaire for the 1997 Jordan Population and Family Health Survey (JPFHS) included two questions distinguishing between the de jure population (persons who usually live in the selected household) and the de facto population (persons who spent the night before the interview in the household). It was found, however, that the difference between them was small, and since sample selection for the JPFHS was based on the de facto population, as it had been in past demographic surveys, tabulations for the JPFHS household data were carried out on the basis of the de facto population only. 2.1 Population by Age and Sex In many developing countries, data on age are affected by errors such as misstatement and preference for or avoidance of certain digits. In general, that was not the case in Jordan. The survey results indicated that not only age, but month and year of birth, are widely recognized. Also, the distribution of the population by single years of age (see Figure 2.1) indicates that although there is some preference for ages ending in 0 or 5, the problem is limited. Figure 2.1 Male and Female Population by Single Years of Age JPFHS 1997 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Age 0 100 200 300 400 500 600 700 800 Number of Persons Male Female 8 Table 2.1 Household population by age, residence and sex Percent distribution of the de facto household population by five-year age groups, according to sex and urban-rural residence, Jordan 1997 _________________________________________________________________________ Urban Rural Total Age ___________________ ___________________ ___________________ group Male Female Total Male Female Total Male Female Total _________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Missing/ don't know Total Number 14.5 14.3 14.4 16.7 14.9 15.8 14.9 14.4 14.7 13.5 13.0 13.2 14.2 14.7 14.4 13.6 13.3 13.5 12.7 12.7 12.7 14.5 13.3 13.9 13.0 12.8 12.9 12.1 11.8 12.0 13.3 12.2 12.8 12.3 11.9 12.1 10.4 10.0 10.2 9.2 9.9 9.6 10.2 9.9 10.1 8.8 8.9 8.8 7.6 8.6 8.1 8.6 8.8 8.7 6.5 6.9 6.7 5.7 6.3 6.0 6.4 6.8 6.6 4.7 5.1 4.9 4.0 4.7 4.3 4.6 5.0 4.8 3.6 4.0 4.8 3.1 3.0 3.0 3.5 3.8 3.7 2.8 2.9 2.9 2.5 2.8 2.7 2.8 2.9 2.8 3.1 3.2 3.1 2.2 2.6 2.4 2.9 3.1 3.0 2.4 2.3 2.4 2.0 2.0 2.0 2.3 2.2 2.3 2.0 1.9 1.9 1.8 1.4 1.6 1.9 1.8 1.9 1.2 1.1 1.2 1.2 1.5 1.4 1.2 1.2 1.2 0.8 0.7 0.8 0.8 0.8 0.8 0.8 0.7 0.8 0.4 0.5 0.5 0.6 0.7 0.6 0.5 0.5 0.5 0.5 0.8 0.6 0.8 0.8 0.8 0.6 0.8 0.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 18,027 17,620 35,647 3,878 3,727 7,606 21,906 21,347 43,253 Table 2.1 shows the percent distribution of the population by age and sex, according to urban-rural residence. The table serves two purposes. The first is to show the effects of past demographic trends on the population and to give an indication of future trends. The second is to describe the context in which various demographic processes are operating. The figures in Table 2.1 show that 41 percent of the population is under 15 years of age, an indicator of high fertility (see Figure 2.2). The proportion is higher in rural (44 percent ) than in urban areas (40 percent). The percentage of the population in the younger age groups (less than 20 years old) is higher in rural than in urban areas. The opposite is true in the broad age category of 20-44 years old (35 percent and 31 percent in urban and rural areas, respectively). The latter difference is due to rural-urban migration, especially of males, as well as the influx of migrants from abroad, to urban areas in search of employment. As in many other countries, there are more males than females in Jordan. The overall ratio is 103 males for every 100 females. The sex ratio varies by age. In the younger and older age groups (under 25 years and 60 years and older), the overall sex ratio ranges between 104 and 106. In the middle age groups (25-59 years old), however, the sex ratio drops far below 100 (for example, 94 in the age group 35-44 years). The low ratio reflects the emigration of Jordanian males to the Gulf states and Saudi Arabia during the past three decades. 9 Table 2.2 Population by age from other sources Percent distribution of the population by broad age groups at different dates, Jordan 1976-1997 ___________________________________________________________ 1976 1983 1990 1997 Age group JFS JFFHS JPFHS JPFHS ___________________________________________________________ <15 15-59 60+ Total 52.0 51.2 44.0 41.0 43.4 44.8 51.6 54.0 4.5 4.0 4.3 5.0 100.0 100.0 100.0 100.0 2.2 Population by Age From Other Sources The percentage of the population under 15 years of age declined substantially from 52 percent in 1976 to 41 percent in 1997, with a resultant increase in the 15-59 age group (Table 2.2 and Figure 2.3). That pattern is typical of populations that are experiencing a fertility decline. The change in the age structure is favorable in economic terms. The dependency ratio, calculated as the ratio of persons in the "dependent" ages (under 15, and 60 and over) to those in the working-age category (15-59) on the basis of those figures, fell from 130 in 1976 to 94 in 1990, and to 85 in 1997. Figure 2.2 Population Pyramid of Jordan JPFHS 1997 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Age 02468 0 2 4 6 8 Percent Male Female 10 Table 2.3 Household composition Percent distribution of households by sex of head of household and household size, according to urban-rural residence, Jordan 1997____________________________________________ Residence______________ Characteristic Urban Rural Total____________________________________________ Household headship Male Female Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size 90.3 91.0 90.4 9.7 9.0 9.6 4.1 7.1 4.6 8.3 7.2 8.2 9.0 9.8 9.1 12.9 9.9 12.4 14.2 10.7 13.6 12.7 10.8 12.4 11.3 9.8 11.1 8.7 9.6 8.8 18.4 24.7 19.4 100.0 100.0 100.0 5.9 6.3 6.0 2.3 Household Size Table 2.3 provides information on the size of the sampled households. Household characteristics affect the social and economic well-being of the members of the household. Large household size may be associated with crowding, which can lead to unfavorable health conditions. Single-parent families, especially if they are headed by females, usually have limited financial resources. Large households are common in Jordan. The average number of members (usual residents) in a household is six. Household size is slightly smaller in urban areas (5.9) than in rural areas (6.3). Nineteen percent of households, on average, are composed of nine or more persons. The figure is higher in rural areas (25 percent) than in urban areas (18 percent). The table shows that 10 percent of households in urban areas are headed by females, compared with 9 percent in rural areas. Figure 2.3 Population by Broad Age Groups 1976-1997 52 51 44 4143 45 52 54 5 4 4 5 1976 JFS 1983 JFFHS 1990 JPFHS !997 JPFHS 0 10 20 30 40 50 60 0-14 15-59 60+ 11 Table 2.4 Foster children and orphans Percent distribution of de jure children under age 15 by survival status of parents and child's living arrangements, according to selected background characteristics, Jordan 1997________________________________________________________________________________________________________ Living with mother Living with father Living but not father but not mother Living with _________________ __________________ with Number both Father Father Mother Mother neither of Characteristic parents alive dead alive dead parent Total children________________________________________________________________________________________________________ Age <2 3-5 6-9 10-14 Sex Male Female Residence Urban Rural Region North Central South Total 97.8 1.4 0.4 0.3 0.1 0.1 100.0 3,668 95.5 2.3 1.0 0.4 0.3 0.5 100.0 3,678 93.6 2.6 2.0 0.8 0.2 0.7 100.0 4,567 90.9 3.2 3.2 1.0 0.8 0.8 100.0 5,529 94.2 2.4 1.9 0.6 0.3 0.5 100.0 8,964 93.9 2.6 1.8 0.7 0.4 0.6 100.0 8,478 93.8 2.8 1.7 0.8 0.4 0.6 100.0 14,105 95.0 1.2 2.6 0.3 0.5 0.5 100.0 3,337 93.6 3.2 2.1 0.4 0.0 0.6 100.0 5,106 94.2 2.3 1.7 0.8 0.5 0.5 100.0 11,061 94.4 1.1 2.5 0.6 0.8 0.7 100.0 1,274 94.1 2.5 1.8 0.7 0.4 0.5 100.0 17,442 Results shown in Table 2.4 indicate that the majority of children under 15 years of age (94 percent) are living with both parents. The range is between 98 percent for children age 0-2 years and 91 percent for children 10-14 years. The overall proportion holds true regardless of sex, urban-rural residence, or region. 2.4 Level of Education of the Household Population Education is an important variable affecting demographic behavior. Higher education is usually associated with greater knowledge and use of health practices and family planning methods. The education system in Jordan has been in place for a long time. Basic education is free and compulsory, starting at age six and lasting for 10 years. A further two-year period, known as the secondary cycle, is virtually free. In the JPFHS, questions on education were asked for persons six years of age and older, to be used to calculate rates of school enrollment. Tables 2.5.1 and 2.5.2 present data on the educational composition of the population reported in the household questionnaire. In the 1997 JPFHS, information on educational attainment refers to the highest level of education attended, and the highest grade completed at that level. An important observation is that women have less education than men. More than 92 percent of males in Jordan have had some schooling; about 85 percent of females have attended school. Furthermore, men are likely to stay in school longer than women. The figures for median number of years of schooling indicate that education has a long history in Jordan. Men age 50-54 have had a median of eight years of education, while women in the same age cohort have had less than one year. Among persons age 40-44, the median for men is more than eight years of education, compared with about seven years for females. For persons age 25-34, the gap has narrowed; it finally disappears for persons under 25 years of age. 12 Table 2.5.1 Educational level of the male household population Percent distribution of the de facto male household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Jordan 1997____________________________________________________________________________________________ Don't Median Background No edu- know/ years of characteristic cation Primary Secondary Higher Missing Total Number schooling _____________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region North Central South Total 15.1 84.8 0.1 0.0 0.0 100.0 2,409 1.3 0.6 54.7 44.6 0.0 0.0 100.0 2,859 5.7 1.1 7.6 86.4 4.8 0.1 100.0 2,695 9.6 2.4 8.8 54.6 33.9 0.2 100.0 2,230 10.6 4.6 7.4 53.8 34.0 0.3 100.0 1,878 8.5 5.3 8.7 52.9 32.8 0.3 100.0 1,399 8.4 6.0 12.5 44.1 37.3 0.1 100.0 1,000 8.4 5.8 19.9 39.6 34.5 0.2 100.0 762 8.3 9.4 19.2 41.3 30.0 0.2 100.0 603 8.1 10.1 25.8 35.0 28.9 0.3 100.0 635 7.8 17.3 30.2 29.0 23.3 0.2 100.0 510 6.3 27.9 39.6 22.0 10.3 0.3 100.0 427 4.1 49.9 33.4 10.5 5.5 0.7 100.0 662 0.0 6.9 29.2 44.5 19.2 0.2 100.0 14,949 7.6 11.5 32.3 46.1 9.8 0.2 100.0 3,120 6.7 8.8 31.3 45.0 14.8 0.1 100.0 4,849 7.1 6.9 28.7 45.0 19.3 0.2 100.0 12,051 7.7 11.5 33.5 42.7 11.7 0.6 100.0 1,169 6.6 7.7 29.7 44.8 17.6 0.2 100.0 18,069 7.5 Table 2.5.2 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Jordan 1997 ____________________________________________________________________________________________ Don't Median Background No edu- know/ years of characteristic cation Primary Secondary Higher Missing Total Number schooling _____________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region North Central South Total 14.1 85.8 0.1 0.0 0.0 100.0 2,218 1.5 0.8 55.4 43.8 0.0 0.0 100.0 2,726 5.7 1.1 6.3 85.2 7.3 0.1 100.0 2,537 9.8 1.5 6.6 56.6 35.2 0.1 100.0 2,124 11.0 3.8 7.9 54.1 34.1 0.1 100.0 1,884 8.4 5.8 13.0 49.9 31.3 0.1 100.0 1,451 8.2 10.3 18.0 47.2 24.2 0.2 100.0 1,075 7.8 18.7 27.1 35.6 18.6 0.0 100.0 819 6.6 30.6 27.0 27.9 14.1 0.4 100.0 617 5.2 52.1 24.9 17.1 5.8 0.1 100.0 668 0.0 68.9 17.1 11.1 2.9 0.0 100.0 478 0.0 78.0 11.3 8.9 1.5 0.3 100.0 378 0.0 88.1 9.2 2.0 0.6 0.2 100.0 678 0.0 13.1 27.4 43.3 16.1 0.1 100.0 14,605 7.2 21.8 32.1 38.2 7.8 0.0 100.0 3,049 5.5 17.9 28.4 41.2 12.5 0.0 100.0 4,842 6.4 12.7 28.0 43.3 15.9 0.1 100.0 11,700 7.2 20.0 30.2 38.4 11.3 0.1 100.0 1,113 5.9 14.6 28.2 42.4 14.7 0.1 100.0 17,654 6.9 13 Table 2.6 School enrollment Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban- rural residence, Jordan 1997 ___________________________________________________________________________________________ Male Female Total ______________________ ______________________ ______________________ Age group Urban Rural Total Urban Rural Total Urban Rural Total ___________________________________________________________________________________________ 6-10 11-15 6-15 16-20 21-24 87.5 88.1 87.6 88.6 85.6 88.1 88.0 86.9 87.8 94.1 95.4 94.4 94.9 92.4 94.5 94.5 94.0 94.4 90.7 91.7 90.9 91.8 88.8 91.2 91.2 90.3 91.0 57.2 53.9 56.6 60.7 53.2 59.3 58.9 53.5 57.9 17.0 13.6 16.5 11.0 9.2 10.7 14.1 11.5 13.7 The level of education is closely associated with residence. In urban areas and in the Central region (Amman, Zarqa, Balqa, and Madaba), a greater proportion of the population has attained higher education than in the rest of the country. Furthermore, Tables 2.5.1 and 2.5.2 show that 62 percent of males and 57 percent of females have attended secondary education or higher. The median number of years of schooling is 7.5 years for males and 6.9 years for females. 2.5 School Enrollment Table 2.6 shows the proportion of the household population age 6-24 years enrolled in school, by age, sex, and residence. Although the differentials are small, the data support the association of school enrollment with residence. Urban areas have a slightly higher level of school enrollment than rural areas across all age groups. School enrollment differentials by sex vary according to age. For boys and girls 6-15 years there is virtually no difference in enrollment. In fact, a higher percentage of girls are enrolled in the age group 16-20. Nevertheless, the gap between males and females widens at 21-24 years, where the enrollment rate for females is much lower than that for males. 2.6 Housing Characteristics In the JPFHS, information on housing characteristics was collected in the individual questionnaire rather than in the household questionnaire. Thus, a sampled household is represented by the number of eligible women interviewed in the household. Households for which no individual interview was completed are, therefore, not included in the analysis. Table 2.7 presents the distribution of households by housing characteristics. The figures indicate that all households in urban areas have electricity, compared with 94 percent in rural areas. Piped-in water is widely available—particularly in urban areas (97 percent), but less often (81 percent) in rural areas. About 7 percent of rural dwellings use water that may be unsafe for drinking and other purposes. The problem is further aggravated if households using tankers to obtain water (another 11 percent ) are added. The figures indicate that all households can reach a water source within fifteen minutes, regardless of their place of residence. 14 Table 2.7 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Jordan 1997 _________________________________________________ Residence ________________ Characteristic Urban Rural Total _________________________________________________ Electricity Yes No Total Source of drinking water Piped into residence Public tap Well in residence Public well Spring Rainwater Tanker truck Bottled water Other Total Time to water source (in minutes) <15 minutes Type of salt used for cooking Salt not used Packaged salt, iodized Packaged salt, noniodized Other Total Sanitation facility Own flush toilet Shared flush toilet Traditional pit toilet No facility Total Type of sewage system Public network Dug hole No sewage Missing Total Main floor material Earth/sand Wood planks Vinyl/asphalt strips Ceramic tiles Cement Total Persons per sleeping room 1-2 3-4 5-6 7+ Missing/Don't know Total Mean Number of households 99.8 94.4 98.9 0.2 5.6 1.1 100.0 100.0 100.0 97.1 81.4 94.4 0.0 0.3 0.1 1.1 3.7 1.6 0.0 0.4 0.1 0.0 2.3 0.4 0.3 0.6 0.3 1.0 10.6 2.7 0.3 0.1 0.3 0.1 0.5 0.2 100.0 100.0 100.0 99.9 97.5 99.5 0.1 0.1 0.1 95.8 91.3 95.0 3.8 8.4 4.6 0.2 0.2 0.2 100.0 100.0 100.0 94.0 70.8 90.1 1.6 2.4 1.8 4.2 24.0 7.5 0.1 2.8 0.6 100.0 100.0 100.0 70.5 4.4 59.2 29.3 92.4 40.1 0.1 3.1 0.6 0.1 0.0 0.1 100.0 100.0 100.0 0.1 1.4 0.3 0.0 0.1 0.0 0.6 0.3 0.5 86.2 61.8 82.1 13.1 36.3 17.0 100.0 100.0 100.0 50.4 40.6 48.7 39.1 41.8 39.5 8.4 13.0 9.2 2.1 4.7 2.5 0.1 0.0 0.1 100.0 100.0 100.0 3.0 3.4 3.0 6,086 1,249 7,335 15 Table 2.8 Household durable goods Percentage of households possessing various durable consumer goods, by urban-rural residence, Jordan 1997 __________________________________________ Residence_____________ Possessions Urban Rural Total__________________________________________ Radio Television Telephone Refrigerator Bicycle Motorcycle Private car Video Air conditioning Solar heater None of the above Number of households 84.1 73.0 82.2 93.0 84.7 91.5 41.6 19.7 37.9 87.5 70.8 84.7 9.5 6.3 8.9 0.1 0.4 0.2 25.7 11.9 23.4 28.2 8.4 24.8 4.3 2.2 4.0 21.4 11.7 19.8 2.1 6.4 2.8 6,086 1,249 7,335 Table 2.7 also shows that a large majority of households (95 percent ) use packaged iodized salt for cooking. Ninety percent of households have a flush toilet (with marked differences between urban and rural households). Seventy-one percent of urban households have access to a public sewage network, in contrast with only 4 percent of rural households. About four-fifths of dwellings (82 percent) have floors made of ceramic tile; another 17 percent have cement floors. The proportions differ reciprocally by urban-rural residence; urban households are more likely to have ceramic flooring, while rural households tend to have cement flooring. The large size of households in Jordan is reflected in Table 2.7. The mean number of persons per sleeping room is three for the country as a whole, with little difference between urban and rural areas. Almost two-fifths of the households have 3-4 persons per sleeping room, and one in 10 households has 5-6 persons per sleeping room. Those figures indicate the extent of crowding in the household. 2.7 Presence of Durable Goods in the Household Jordan is a modern society, and most of the population enjoys the convenience of electrical appliances (see Table 2.8). Ninety-two percent of households have television sets, 85 percent have a refrigerator, and 82 percent have a radio. There are some differences between urban and rural areas, particularly regarding the presence of a refrigerator. Eighty-eight percent of households in urban areas have a refrigerator, compared with 71 percent in rural areas. One in four households owns a private car. The proportion in urban areas is more than twofold that in rural areas (26 and 12 percent, respectively). One in five households possesses a solar heater, and about one in 10 owns a bicycle. 2.8 Respondents’ Background Characteristics Table 2.9 presents the distribution of respondents by selected background characteristics, including age, marital status, residence, educational level, and religion. Most respondents know their date of birth (by year and month) because 90 percent of households in Jordan possess a Family Booklet (a record of birth dates, marriages, and birth histories). The distribution of ever- married women shows that 18 percent are under age 25 compared with 22 percent in 1990. Despite the similar proportion of women under age 35 in both years, the proportion of women age 40-49 was slightly lower in 1997 than in 1990. Among ever-married women, the percent distribution by marital status has remained constant since 1976. More than 96 percent are currently married; the rest are either divorced or widowed. The population of Jordan is highly urbanized (see Table 2.9). Eighty-four percent of the sample population reside in urban areas (localities with 5,000 or more). The distribution of the population by region emphasizes the degree of urbanization. Only 6 percent of all ever-married women reside in the governorates of the South region (Karak, Tafielah, Ma’an, and Aqaba), which are largely rural. 16 Table 2.9 Background characteristics of respondents Percent distribution of women by selected background characteristics, Jordan 1997 __________________________________________________ Number of ever-married women __________________ Background Weighted Un- characteristic percent Weighted weighted __________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Married Widowed Divorced Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Currently attending school Yes No Religion Islam Christian Other Missing Total 3.7 207 206 14.3 795 798 21.4 1,185 1,195 20.3 1,126 1,145 16.8 931 923 13.2 734 724 10.3 570 557 96.2 5,337 5,340 2.2 124 122 1.6 87 86 83.6 4,636 4,417 16.4 912 1,131 26.7 1,479 1,490 67.2 3,729 3,303 6.1 340 755 9.1 504 594 15.3 850 866 53.3 2,957 2,885 22.3 1,237 1,203 0.4 24 24 99.5 5,521 5,522 97.0 5,381 5,383 2.8 156 156 0.1 6 5 0.1 5 4 100.0 5,548 5,548 Table 2.9 also presents the weighted and unweighted numbers of women in the sample. The unweighted numbers of women in the Central region (Amman, Zarqa, Balqa, and Madaba ) are smaller than the weighted numbers. The opposite is true in the South region (because of oversampling). For example, in the South region, although the weighted number of women is 340, in reality data were collected from 755 women. The South region was oversampled to obtain enough women to yield statistically reliable estimates. The figures in Table 2.9 also indicate that almost one in 10 ever-married women (9 percent) have never received formal education, whereas three in four (76 percent) ever attended secondary or higher education. Less than half a percent were attending school at the time of the survey. The majority of ever- married women are Moslems (97 percent). 17 Table 2.10 Level of education Percent distribution of ever-married women by the highest level of education attended, according to selected background characteristics, Jordan 1997 ___________________________________________________________________________________ Highest level of education __________________________________________ Number Background No edu- of characteristic cation Primary Secondary Higher Total women ___________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Total 2.9 14.6 82.1 0.5 100.0 207 1.5 7.8 73.7 17.0 100.0 795 2.7 8.0 60.2 29.1 100.0 1,185 5.0 12.8 52.4 29.8 100.0 1,126 9.8 17.1 49.9 23.2 100.0 931 18.1 27.5 36.5 18.0 100.0 734 30.6 27.6 29.0 12.9 100.0 570 6.4 14.4 54.9 24.2 100.0 4,636 22.6 19.8 45.2 12.4 100.0 912 11.7 15.7 51.7 20.9 100.0 1,479 7.0 15.0 54.8 23.2 100.0 3,729 20.6 16.6 44.2 18.6 100.0 340 9.1 15.3 53.3 22.3 100.0 5,548 2.9 Respondents’ Level of Education Table 2.10 shows the relationship between level of education and selected background characteristics. As expected, the percentage of women with no formal education increases with age. Conversely, younger women are likely to be better educated than older women. For example, 82 percent of women age 15-19 have had some secondary education, compared with only 29 percent of women in the age group 45-49. Women in urban areas are more likely to have had higher education than their rural counterparts. There are pronounced regional differences in women's educational attainment. In the Central region, 7 percent of women have no education, whereas in the South region, the proportion is 21 percent. The gap is narrower for higher education. The larger percentage of women with higher education in certain governorates may be due partly to the greater availability of higher education facilities there. Women 15-24 years were also asked whether they were attending school at the time of the survey and, if not, their reason for leaving school (Table 2.11). The survey findings indicate that 98 percent of women are not attending school. More than half (54 percent) reported that they stopped their schooling to get married; 14 percent stopped because they did not like attending school. 18 Table 2.11 School attendance and reasons for leaving school Percent distribution of ever-married women 15-24 by whether they are attending school and, if not, the reason for leaving school, according to highest level of education attended, Jordan 1997 ______________________________________________________________________________________________ School Educational attainment attendance/ ____________________________________________________________ Reason for not Primary Primary Secondary Secondary Higher attending school incomplete complete incomplete complete secondary Total______________________________________________________________________________________________ Still attending school Reason not attending school Got pregnant Got married Take care of younger children Family need help Could not pay school fees Need to earn money Graduated/Enough school Did not pass exams Did not like school School not accessible Repeated failure Parents' refusal Other Don't know/missing Total Number 1.9 (4.0) 1.2 1.1 10.0 2.5 0.0 (0.0) 1.4 1.2 1.8 1.3 10.7 (8.7) 63.9 71.2 20.2 54.3 0.0 (7.8) 1.5 1.2 0.9 1.4 7.0 (4.7) 3.9 2.1 0.0 3.2 4.9 (4.0) 1.5 5.0 2.2 2.6 0.0 (0.0) 0.6 1.0 2.5 0.9 0.0 (0.0) 0.6 4.5 58.7 9.4 0.0 (0.0) 2.1 0.3 0.0 1.2 50.6 (30.0) 14.2 7.7 1.9 14.0 4.6 (17.1) 1.7 1.5 0.0 2.0 11.9 (10.1) 4.8 0.5 0.8 4.0 3.4 (11.8) 1.7 2.6 0.0 2.1 4.3 (1.7) 0.8 0.0 0.0 0.8 0.7 (0.0) 0.2 0.0 0.9 0.3 100.0 100.0 100.0 100.0 100.0 100.0 65 27 556 200 136 985 ______________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. 2.10 Exposure to Mass Media The exposure of women to television, radio, and newspapers is shown in Table 2.12. Eighty-nine percent of women in the sample watch television frequently, 44 percent listen to the radio, and 43 percent read newspapers frequently. Although exposure to mass media varies little across age groups, younger women are slightly less likely to be exposed to mass media than older women. As expected, there is a positive association between education and newspaper reading, a higher proportion of women with at least secondary education read newspapers than those with less education. The relationship holds true for television viewing and listening to the radio. The relationship between residence and exposure to mass media varies depending on the type of media. Women in urban areas are more likely to read the newspaper (46 percent) than women in rural areas (27 percent). The extent to which women listen to the radio or view television does not vary substantially by urban-rural residence or by region. 19 Table 2.12 Access to mass media Percentage of women and men who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by selected background characteristics, Jordan 1997 ___________________________________________________________________________ Mass media ____________________________________ Read Watch Listen to No newspaper television radio All Number Background mass once a once a once a three of characteristic media week week week media women ___________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 6.9 37.9 90.5 39.6 18.7 207 5.3 41.3 90.2 39.7 17.6 795 5.6 42.0 88.8 40.9 19.6 1,185 5.2 44.8 90.1 43.4 23.2 1,126 6.6 46.5 86.5 47.5 25.3 931 7.4 43.1 87.1 50.6 25.9 734 8.4 34.6 87.9 47.2 21.2 570 6.1 45.6 88.9 43.9 23.4 4,636 6.8 26.6 87.4 45.9 14.6 912 6.9 32.0 88.9 40.7 16.4 1,479 5.8 47.3 88.7 45.4 24.5 3,729 8.0 35.5 86.3 46.6 18.2 340 16.0 1.5 79.8 36.2 0.5 504 7.6 20.4 86.0 43.7 10.6 850 5.5 45.0 89.6 44.7 23.8 2,957 3.0 68.5 91.8 46.7 34.0 1,237 6.2 42.5 88.6 44.2 21.9 5,548 2.11 Respondents’ Employment Characteristics In the 1997 JPFHS, respondents were asked a number of questions about their employment, including whether they were currently working and, if not, whether they had worked during the year before the survey. Women who were currently working were then asked a number of questions about the kind of work they were doing and whether or not they were paid in cash. Those who earned cash for their work were asked who made the decision about how their earnings were used. If they had small children, they were asked about the arrangements they had for child care when they were working. 2.11.1 Employment Status The majority of women (86 percent) are not working, nor have they worked during the last 12 months (Table 2.13). Only one in 10 women was employed throughout the year. The proportion of women not working ranges from 98 percent among those age 15-19 to 79 percent among those age 35-39. 20 Table 2.13 Women's employment Percent distribution of women by employment status and continuity of employment, according to selected background characteristics, Jordan 1997 ________________________________________________________________________________________________ Not currently employed Currently employed __________________ ______________________________________ Did not work Worked All year in last in _________________ Number Background 12 last 12 5+ days <5 days Season- Occasion- of characteristic months months per week per week ally ally Total women ________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 97.7 1.1 0.0 0.5 0.0 0.6 100.0 207 93.1 1.7 2.9 0.3 0.4 1.6 100.0 795 86.8 2.5 8.8 0.3 0.6 1.0 100.0 1,185 83.2 1.9 12.1 0.3 1.1 1.4 100.0 1,126 78.9 2.7 15.0 0.1 1.3 1.8 100.0 931 82.8 1.3 11.9 0.6 1.1 2.3 100.0 734 86.9 1.1 8.3 0.1 2.4 1.3 100.0 570 85.4 1.9 10.0 0.3 0.8 1.6 100.0 4,636 86.1 2.3 8.2 0.1 2.3 1.0 100.0 912 84.3 1.8 11.2 0.6 1.5 0.7 100.0 1,479 86.7 1.9 8.5 0.2 0.8 1.9 100.0 3,729 78.8 2.7 16.2 0.0 1.4 0.9 100.0 340 86.8 2.2 5.2 0.5 3.4 1.8 100.0 504 92.5 0.9 2.8 0.1 1.6 2.1 100.0 850 93.2 1.1 3.5 0.3 0.5 1.5 100.0 2,957 62.1 4.6 31.2 0.4 0.8 0.9 100.0 1,237 85.5 1.9 9.7 0.3 1.0 1.5 100.0 5,548 Differentials in employment status by urban-rural residence and region are small; however, women in the South region seem to have better opportunities for continuous work (16 percent are permanently employed) compared with women in other regions. Educational attainment affects the likelihood of a woman's being employed. The percentage of women not working decreases from 93 percent for those with primary and secondary education to 62 percent for those with higher education. The continuity of employment is also affected by level of education. About one in three women (31 percent) with higher education works throughout the year, compared with only 5 percent of women with no education. 21 Table 2.14 Occupation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of non- agricultural employment, according to selected background characteristics, Jordan 1997____________________________________________________________________________________________________________ Agriculture Nonagricultural employment______________________________ _______________________________ Prof. Number Background Own Family Rented Other's tech./ Sales/ Unskilled of characteristic land land land land manag. services manual Other Missing Total women____________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total * * * * * * * * * 100.0 2 (1.1) (2.5) (0.0) (0.0) (46.5) (41.0) (6.1) (0.0) (2.6) 100.0 41 0.9 0.4 0.4 2.9 75.8 11.6 8.1 0.0 0.0 100.0 127 0.0 0.7 0.6 1.2 72.4 20.2 3.3 0.3 1.4 100.0 167 0.8 0.3 1.3 1.9 70.0 16.8 8.6 0.0 0.2 100.0 171 0.0 3.8 0.3 5.3 53.9 25.3 11.4 0.0 0.0 100.0 117 5.2 2.8 1.0 6.0 37.7 29.4 14.6 0.0 3.5 100.0 68 0.2 0.5 0.2 1.7 67.2 21.2 8.0 0.0 1.1 100.0 589 5.0 6.5 3.2 9.0 46.6 19.2 10.2 0.4 0.0 100.0 106 1.4 2.4 1.0 5.7 62.7 17.7 7.5 0.0 1.6 100.0 207 0.3 0.8 0.3 1.2 64.2 23.4 9.1 0.0 0.6 100.0 425 3.9 1.5 2.2 3.5 68.0 14.1 5.6 0.7 0.6 100.0 63 7.5 9.3 5.8 18.4 0.8 31.4 24.5 0.0 2.3 100.0 56 2.3 1.1 1.2 13.0 1.8 47.2 32.8 0.7 0.0 100.0 57 0.6 1.6 0.6 1.0 33.8 49.2 12.7 0.0 0.6 100.0 171 0.0 0.3 0.0 0.0 93.7 4.1 0.9 0.0 0.9 100.0 412 0.9 1.4 0.7 2.8 64.1 20.9 8.3 0.1 0.9 100.0 695 ____________________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk means that the figure is based on less than 25 unweighted cases, and has been suppressed. 2.11.2 Occupation Table 2.14 shows a high proportion of women engaged in professional and technical occupations (64 percent), and one in five employed in sales work. Slightly less than 6 percent of women work in various agricultural activities. The percentages vary considerably by background characteristics of women. For example, older women, women living in rural areas and in less urbanized regions (the North and South regions), and those with less education are more likely to work in the agricultural sector than other women. 22 Table 2.15 Employer and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to selected background characteristics, Jordan 1997________________________________________________________________________________________________ Employed by Employed by Self-employed a nonrelative a relative________________ ________________ _________________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Total women________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total * * * * * * 100.0 2 (30.7) (2.5) (63.1) (0.0) (3.7) (0.0) 100.0 41 12.1 0.7 79.0 3.3 2.1 2.7 100.0 127 10.6 0.8 83.3 0.6 3.3 1.3 100.0 167 11.7 1.5 80.1 0.6 4.4 1.6 100.0 171 17.2 0.0 69.5 0.9 8.1 4.3 100.0 117 20.9 0.8 59.8 2.8 13.0 2.7 100.0 68 14.9 0.8 78.3 0.9 3.8 1.3 100.0 589 12.0 1.4 62.7 3.9 12.4 7.5 100.0 106 11.0 0.0 76.8 1.6 5.8 4.9 100.0 207 17.3 1.1 74.6 1.4 4.7 0.9 100.0 425 6.7 2.4 82.2 0.7 5.7 2.4 100.0 63 24.4 1.0 44.3 3.9 16.3 10.1 100.0 56 35.6 0.0 43.3 6.4 13.6 1.1 100.0 57 31.1 2.7 53.4 2.1 7.4 3.3 100.0 171 3.3 0.3 94.0 0.0 1.5 0.8 100.0 412 14.4 0.9 75.9 1.4 5.1 2.2 100.0 695 ________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk means that the figure is based on less than 25 unweighted cases, and has been suppressed. 2.11.3 Employer and Type of Earnings Table 2.15 shows that 15 percent of working women are self-employed, 7 percent work for a relative, and an overwhelming majority (77 percent) work for someone who is a nonrelative. Most women (95 percent) earn cash for their work. There is no marked difference by age in terms of cash earnings. As expected, urban work is more likely to be compensated with cash than work in rural areas. It is also not surprising that educated women are more likely to receive cash compensation than less educated women. 23 Table 2.16 Decision on use of women's earnings Percent distribution of women receiving cash earnings by person who decides how earnings are used, according to selected background characteristics, Jordan 1997 ___________________________________________________________________________________________________ Person who decides how earnings are used__________________________________________________________ Jointly Jointly with with Number Background Husband/ husband/ Someone someone of characteristic Woman partner partner else else Missing Total women___________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Marital status Not married Currently married Total * * * * * * 100.0 2 (51.2) (3.8) (41.9) (0.0) (0.0) (3.2) 100.0 40 27.1 1.8 70.6 0.0 0.4 0.0 100.0 119 32.2 1.9 66.0 0.0 0.0 0.0 100.0 163 34.4 3.0 61.2 0.8 0.6 0.0 100.0 165 39.0 6.8 53.7 0.4 0.0 0.0 100.0 111 54.2 5.8 38.3 0.0 1.7 0.0 100.0 64 38.2 2.7 58.1 0.3 0.5 0.2 100.0 572 24.9 9.2 65.9 0.0 0.0 0.0 100.0 92 27.5 4.3 67.6 0.0 0.6 0.0 100.0 193 42.3 2.8 54.1 0.3 0.3 0.3 100.0 411 23.9 7.3 67.2 0.8 0.8 0.0 100.0 60 59.4 17.2 21.1 0.0 2.3 0.0 100.0 47 56.9 2.1 41.0 0.0 0.0 0.0 100.0 52 49.1 2.8 46.7 1.1 0.3 0.0 100.0 157 26.1 2.6 70.8 0.0 0.3 0.3 100.0 407 92.9 0.0 0.0 1.1 6.0 0.0 100.0 44 32.4 3.9 63.4 0.2 0.0 0.2 100.0 620 36.3 3.6 59.2 0.3 0.4 0.2 100.0 664 ______________________________________________________________________________________________ Note: Figures in parentheses are based on 25 to 49 unweighted cases. An asterisk means that the figure is based on less than 25 unweighted cases, and has been suppressed. Women earning cash for their work were asked who mainly decides how their earnings will be used. Table 2.16 shows that 59 percent of women reported that they and their husband jointly decide on how the money is to be spent, and 36 percent of women stated that it is their sole decision. Older women, women in urban areas, and women who reside in the Central region are more likely than women in other categories to make independent decisions on spending their earnings. Surprisingly, education does not necessarily confer more power in decisionmaking for women, although the percentages should be interpreted with caution because some of the numbers are too small to be statistically meaningful. 24 Table 2.17 Child care while working Percent distribution of currently employed women by whether they have a child under six years of age at home, and the percent distribution of employed mothers who have a child under six by person who cares for child while mother is at work, according to selected background characteristics, Jordan 1997 _________________________________________________________________________________________________ Women with children Child's caretaker while mother is at work 0-6 yr at home _______________________________________________________________________ School/ Not No One Re- Husband/ Other Insti- worked Number Background children or spon- Servant/ rela- tutional since of characteristic home more dent Neighbor tive care birth Other Total women_________________________________________________________________________________________________ Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Employer Relative Nonrelative Self-employed Occupation Agricultural Nonagricultural Employment status All year, full week All year, part week Seasonal Occasional Total 33.6 66.4 16.3 16.7 28.2 37.5 0.9 0.4 100.0 589 32.1 67.9 24.5 22.9 39.3 13.3 0.0 0.0 100.0 106 31.2 68.8 14.6 17.8 30.2 35.1 1.5 0.9 100.0 207 35.3 64.7 19.3 19.0 28.9 32.3 0.5 0.0 100.0 425 27.1 72.9 17.0 9.0 35.2 37.9 0.0 0.9 100.0 63 59.1 40.9 29.0 50.3 15.1 5.6 0.0 0.0 100.0 56 44.9 55.1 51.5 35.5 11.1 0.0 0.0 2.0 100.0 57 37.9 62.1 44.5 16.5 24.9 13.5 0.0 0.6 100.0 171 26.4 73.6 3.9 13.8 34.8 46.4 1.1 0.1 100.0 412 51.8 48.2 60.0 24.3 11.3 4.5 0.0 0.0 100.0 51 31.1 68.9 3.8 18.9 35.3 40.8 0.9 0.3 100.0 537 35.9 64.1 77.0 8.6 7.5 6.0 0.0 0.9 100.0 107 42.9 57.1 33.1 45.0 21.9 0.0 0.0 0.0 100.0 40 32.5 67.5 16.9 16.3 30.0 35.7 0.8 0.4 100.0 648 32.7 67.3 6.3 16.6 33.8 41.9 0.9 0.5 100.0 538 24.5 75.5 27.8 36.7 26.7 8.9 0.0 0.0 100.0 16 38.5 61.5 59.3 20.0 17.5 3.2 0.0 0.0 100.0 56 35.0 65.0 64.4 18.4 13.0 4.3 0.0 0.0 100.0 83 33.4 66.6 17.6 17.6 29.9 33.7 0.7 0.4 100.0 695 _________________________________________________________________________________________________ Note: Total includes six women for whom information on occupation was not available. 2.11.4 Child Care While Mother is Working Table 2.17 presents information on who provides child care for children under age six of working mothers. The data show that one in three employed women sends her young children to school or a day care facility. Thirty percent of women have relatives to mind their children. Among parents, 18 percent of women and 18 percent of their husbands look after their own children. That percentage varies markedly by background characteristics. Institutional care is more popular among women residing in urban areas, women with higher education, women working for a nonrelative, and women working in nonagricultural activities. Self-employed women and women with seasonal or occasional employment usually look after their own children while working. 25 CHAPTER 3 FERTILITY Fertility measures in this chapter are based on the reported birth histories of ever-married women age 15 to 49 who were interviewed in the 1997 Jordan Population and Family Health Survey (JPFHS). Data were collected in two sections. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who had died. Next, for each live birth, she was asked to report the sex, date of birth, whether the birth was single or multiple, and whether the child was living in the household or elsewhere. The survival status of each live birth was also asked. For deceased children, the age at death was recorded. As an indicator of future fertility, information was collected on whether married women were pregnant at the time of the interview. Experience in using birth histories to estimate fertility levels and trends has found that underreporting of children ever born and displacement of children's dates of birth are common in many countries. Underreporting of children affects estimates of fertility levels, whereas misreporting of children's date of birth distorts fertility trends over time. Regarding the latter, one of the characteristics of the 1997 JPFHS is the high quality of age and date reporting. Virtually all women knew their age, their age at marriage and their date of marriage. For children's age and date of birth reporting, both month and year of birth are documented for all births recorded in the birth history (see Table C.3). This information lends confidence to the quality of basic data used in the estimation of fertility measures. Because fertility rates presented in this chapter are based on direct measures derived from the birth history section of the JPFHS, two potential drawbacks require some attention. First, only surviving women were interviewed in the survey. This would bias the rates if mortality of women of childbearing age were high and if fertility of surviving and nonsurviving women differed significantly— neither of which is the case in Jordan. Limiting the survey respondents to ever-married women presents another potential bias. The number of births to single women in Jordan is negligible. Although information on fertility was obtained only from ever-married women, estimates can be made for all women (regardless of marital status) based on information in the household questionnaire; these estimates assume that women who have never been married have had no children. This chapter also analyzes levels of fertility by background characteristics of women, which include age, residence, and education level. Factors related to fertility—including the mean age at birth, birth intervals, and teenage fertility—are also analyzed. 3.1 Fertility Levels and Trends Age-specific fertility rates and total fertility rates (TFR) for the three-year period preceding the survey are shown in Table 3.1, along with data from three previous surveys for comparison—the 1976 Jordan Fertility Survey (JFS), the 1983 Jordan Fertility and Family Health Survey (JFFHS), and the 1990 JPFHS. Data for the 1976 survey are calculated based on the two years preceding the survey (1975-1976), while those for 1983, 1990 and 1997 refer to the three years preceding the survey (1981-1983, 1988-1990, and 1995- 1997, respectively). Comparison of the findings from the four surveys shows the trends in fertility levels over a 22-year period. 26 Table 3.1 Current fertility according to selected surveys Age-specific fertility rates and total fertility rates from selected surveys, Jordan, 1976, 1983, 1990, and 1997 _______________________________________________________ JFS JFFHS JPFHS JPFHS Age group 19761 19832 19902 19972 _______________________________________________________ 15-19 71 49 49 43 20-24 300 228 219 172 25-29 367 335 296 246 30-34 332 305 264 206 35-39 240 233 188 144 40-44 112 127 79 48 45-49 47 40 19 11 TFR 15-49 7.4 6.6 5.6 4.4 TFR 15-44 7.1 6.4 5.5 4.3 _______________________________________________________ TFR: Total fertility rates, expressed per woman 1 Based on the two years preceding the survey 2 Based on the three years preceding the survey The TFR is the sum of the age-specific fertility rates; it represents the average number of children a woman in Jordan would have at the end of her reproductive years if she were subject to the observed age- specific rates. At current levels, a woman would give birth to an average of 4.4 children in her lifetime. That is 40 percent lower than the rate recorded in 1976 (7.4 births per woman). Data in Table 3.1 indicate that the pace of fertility decline has been faster in the more recent period. For example, it was 11 percent between 1976 and 1983 (dropping from 7.4 to 6.6 births per woman), 15 percent between 1983 and 1990 (dropping from 6.6 to 5.6 births per woman), and 21 percent between 1990 and 1997 (dropping from 5.6 to 4.4 births per woman). In comparison with fertility levels in the neighboring countries for which data are available from DHS surveys, the TFR in Jordan is moderate; countries with lower TFR include Turkey (2.7 births in 1991-1993), Morocco (3.3 births in 1993-1995), Egypt (3.6 births in 1993-1995), and Tunisia (3.0 births in 1993-1995). Countries with higher TFR are Pakistan (5.4 births in 1988-1991) and Yemen (7.7 births in 1989-1992). The decline occurred at all ages; however, the most significant decline is observed among teenagers—dropping from 71 births in the 1976 JFS to 43 births per 1,000 women in the 1997 JPFHS. Figure 3.1 shows that most of the decline since 1990 is due to lower age-specific fertility rates for women age 30 and older. At the same time, the age-specific fertility rates in all of the surveys peak in the 25-29 age group. Figure 3.1 Age-Specific Fertility Rates from Various Data Sources, 1976-1997 Births per 1,000 Women 27 Table 3.2 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by urban-rural residence, Jordan 1997 ___________________________________________________ Residence _______________ Age group Urban Rural Total ___________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 TFR 15-44 General fertility rate Crude birth rate 41 48 43 169 187 172 243 259 246 198 245 206 137 184 144 45 62 48 10 15 11 4.22 5.00 4.35 4.17 4.93 4.30 140 160 144 32.5 35.5 33.1 ___________________________________________________ Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Total fertility rate expressed per woman. General fertility rate (births divided by number of women 15-44), expressed per 1,000 women. Crude birth rate expressed per 1,000 population. Table 3.2 and Figure 3.2 present the age- specific fertility rates and cumulative fertility for the three-year period preceding the survey by urban-rural residence. In Table 3.2, the general fertility rate (GFR) is the annual number of live births per 1,000 women age 15-44 in the three years preceding the survey. The crude birth rate (CBR) is the annual number of live births per 1,000 population for the same period. In general, women in rural areas have almost one child more than urban women (5.0 births compared with 4.2 births). The most significant differences are found in the middle of the women's reproductive period (age 30-34), where rural women have an average 0.047 births more than urban women. The fertility differentials according to background characteristics of women are shown in Table 3.3. Column one shows the total fertility rates for the three years preceding the survey (1995-1997); column two, the percentage of married women who were pregnant at the time of the fieldwork; and column three, the mean number of children ever born (CEB) to women age 40-49. CEB is an indicator of cumulative fertility and reflects the fertility of older women who are nearing the end of their reproductive years, representing completed fertility. When fertility remains constant over time, TFR and CEB will be the same or almost the same. In the 1997 JPFHS, however, the fact that the completed fertility rate (6.8 children per woman) is much higher than the total fertility rate (4.4 children per woman) indicates a considerable decline in fertility. 0 1 2 3 Urban Rural JPFHS 1997 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age 28 Table 3.3 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant and mean number of children ever born to women age 40-49, by selected background characteristics, Jordan 1997 ___________________________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant1 age 40-49 ___________________________________________________________________ Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 4.22 7.40 6.54 5.00 7.75 8.33 4.85 8.43 7.73 4.11 6.90 6.37 4.80 9.49 7.81 4.59 5.49 8.09 4.54 7.10 7.77 4.53 7.41 6.39 3.66 8.28 4.15 4.35 7.46 6.81 ___________________________________________________________________ 1 Rate for women age 15-49 years Table 3.4 Age-specific fertility rates Age-specific fertility rates (per 1,000) for five-year periods preceding the survey, by mother's age at the time of birth, Jordan 1997 ___________________________________________ Number of years preceding the survey Mother's _________________________________ age 0-4 5-9 10-14 15-19 ___________________________________________ 15-19 45 50 61 90 20-24 184 209 261 301 25-29 246 282 340 371 30-34 215 251 302 [351] 35-39 146 177 [225] U 40-44 55 [87] U U 45-49 [13] U U U ___________________________________________ Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. U = Unknown (no information ) The TFR is about 4.8 births per woman in the North and South regions, while in the Central region (which comprises the most urbanized areas of the country, including Amman governorate) the TFR is 4.1 births per woman (see Table 3.3). Among women who have had no formal education and those who have had up to secondary education, fertility varies little (about 4.5 children). However, women who have had higher education have 0.7 birth less than other women. These figures suggest that as educational opportunities for women improve above the secondary-school level, the level of fertility declines, and the differentials in fertility will narrow among women according to education. The 1997 JPFHS data show that 7 percent of women of reproductive age were pregnant at the time of the survey. The geographical variation in the proportion of pregnant women follows a pattern similar to that of fertility. Rural women and those living in the South region are more likely to be pregnant than women in other areas. Better educated women are more likely to be pregnant than women with less education. Comparing data from previous surveys is but one means of studying trends in fertility (Table 3.4). Trends can also be investigated by using retrospective data from a single survey. The birth history information collected in the JPFHS is used for this purpose. Figures in brackets represent partial fertility rates caused by truncation; women age 50 and older were not included in the survey. Also, the further back in time that rates are calculated, the more severe the truncation. For example, rates cannot be 29 Table 3.5 Fertility by marital duration Fertility rates by duration since first marriage in years, for five-year periods preceding the survey, Jordan 1997 ___________________________________________ Marriage Number of years preceding the survey duration _________________________________ at birth 0-4 5-9 10-14 15-19 ___________________________________________ 0-4 425 444 478 463 5-9 310 344 393 424 10-14 235 255 329 393 15-19 153 211 284 [375] 20-24 85 141 [241] U 25-29 40 [88] U U ___________________________________________ Note: Fertility rates per 1,000 women. Estimates enclosed in brackets are truncated. U = Unknown (no information ) Table 3.6 Children ever born and living Percent distribution of all women and of currently married women age 15-49 by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Jordan 1997 ____________________________________________________________________________________________________ Mean Mean number Number of children ever born Number number of Age ______________________________________________________________ of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ___________________________________________________________________________________ ALL WOMEN __________________________________________________________________________________________________________ 15-19 96.0 2.6 1.1 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,523 0.06 0.06 20-24 69.2 10.3 12.3 5.9 1.9 0.3 0.0 0.0 0.0 0.0 0.0 100.0 2,050 0.62 0.60 25-29 38.6 8.5 16.7 16.2 11.1 5.1 2.5 1.0 0.3 0.0 0.0 100.0 1,789 1.85 1.78 30-34 23.5 3.8 8.8 14.0 15.0 14.9 8.8 5.5 3.1 2.0 0.6 100.0 1,395 3.38 3.26 35-39 14.6 2.6 4.7 7.8 12.5 13.4 14.1 9.5 7.6 4.9 8.4 100.0 1,036 4.99 4.78 40-44 8.6 1.6 2.3 5.6 8.9 11.4 10.1 11.5 10.9 9.9 19.2 100.0 778 6.51 6.17 45-49 7.1 2.7 2.1 4.9 6.8 8.1 9.1 9.7 11.4 9.0 29.0 100.0 593 7.19 6.72 Total 50.4 5.3 7.7 7.5 6.8 5.7 4.4 3.3 2.7 2.1 4.1 100.0 10,165 2.30 2.25 __________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN __________________________________________________________________________________________________________ 15-19 50.8 31.8 14.2 3.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 203 0.70 0.69 20-24 20.2 26.4 31.9 15.4 5.1 0.9 0.0 0.1 0.0 0.0 0.0 100.0 777 1.62 1.56 25-29 7.1 12.4 25.5 24.6 16.8 7.8 3.9 1.5 0.4 0.0 0.0 100.0 1,168 2.81 2.70 30-34 4.6 4.6 10.9 17.4 18.7 18.8 11.0 6.9 3.9 2.5 0.7 100.0 1,099 4.23 4.09 35-39 4.6 2.2 4.5 8.3 14.0 15.7 16.0 10.7 8.7 5.5 9.8 100.0 880 5.66 5.43 40-44 2.9 1.3 2.1 5.6 9.4 12.0 10.8 12.3 12.0 10.6 20.8 100.0 690 7.00 6.64 45-49 3.0 2.1 2.1 5.2 6.7 7.8 9.5 9.4 11.6 10.2 32.3 100.0 520 7.69 7.19 Total 8.8 9.4 14.3 13.9 12.5 10.6 8.1 6.0 5.0 3.8 7.6 100.0 5,337 4.34 4.14 calculated for women in the age group 45-49 years for the period 5-19 years before the survey, because these women would have been over age 50 at the time of the survey and, thus, were not interviewed. Data in Table 3.4 indicate that the fertility rate has been declining in all age groups. Table 3.5 presents fertility for ever-married women according to the length of time since first marriage for four five-year periods preceding the survey. The table is similar to Table 3.4 except that it is confined to ever-married women and age is replaced by duration of marriage. Data in Table 3.5 confirm the findings presented in Table 3.4: fertility has declined for all marriage durations. 3.2 Children Ever Born Table 3.6 presents the distribution of all women and currently married women by the number of children they have had. In the 1997 JPFHS, since the respondents are ever-married women, information on the reproductive history of never-married women was not collected. However, since almost no births in Jordan take place before marriage, it can be assumed that never-married women have had no births. The data represent the accumulation of births over time. The difference in fertility between all women and currently married 30 Table 3.7 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Jordan 1997 ____________________________________________________________________________________________________ Median number of months Number of months since previous birth since Number Background ______________________________________________ previous of characteristic 7-17 18-23 24-35 36-47 48+ Total birth births ____________________________________________________________________________________________________ Age of mother 15-19 20-29 30-39 40 + Birth order 2-3 4-6 7 + Sex of prior birth Male Female Survival of prior birth Dead Living Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 46.5 39.7 10.7 3.2 0.0 100.0 18.8 40 28.4 29.4 29.8 7.9 4.6 100.0 22.3 2,172 17.3 18.8 29.9 14.0 20.0 100.0 28.5 2,396 9.7 11.5 26.0 15.3 37.6 100.0 37.8 473 29.0 26.8 27.9 8.3 8.0 100.0 22.6 2,234 16.5 20.5 30.3 13.6 19.2 100.0 27.8 1,836 14.3 18.1 30.8 14.5 22.2 100.0 29.9 1,011 20.9 21.7 29.4 11.4 16.6 100.0 26.1 2,620 22.2 24.0 29.2 11.5 13.0 100.0 24.9 2,461 45.8 22.2 16.8 10.7 4.4 100.0 18.8 171 20.7 22.8 29.8 11.5 15.3 100.0 25.8 4,909 21.0 22.4 28.5 11.6 16.5 100.0 25.9 4,087 23.7 24.3 32.9 10.8 8.3 100.0 24.5 994 23.0 25.2 28.9 11.1 11.8 100.0 24.4 1,517 20.9 21.7 29.1 11.6 16.7 100.0 26.3 3,209 20.8 22.3 33.8 11.8 11.3 100.0 25.6 355 16.3 18.4 35.3 15.4 14.6 100.0 27.8 392 19.1 21.2 30.3 11.2 18.2 100.0 26.4 685 22.1 24.0 28.5 10.9 14.5 100.0 25.0 2,884 23.5 22.1 28.9 11.5 14.0 100.0 25.3 1,120 21.5 22.8 29.3 11.4 14.9 100.0 25.5 5,081 ____________________________________________________________________________________________________ Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. women is due to the proportion of women who were not married at the time of the survey (i.e., single, divorced, or widowed). On average, women have given birth to 1.9 children by their late twenties, 5 children by their late thirties, and more than 7 children by the end of their reproductive period. Differences in the mean number of children born and living are notable only after women have reached the age of 40. Caution should be exercised in interpreting the data for women in the oldest age groups because of possible recall problems; older women are more likely to omit a child, particularly if the child died at a young age or is living away from the mother. 3.3 Birth Intervals A birth interval is the period of time between two successive live births. Research has shown that children born soon after a previous birth are at greater risk of illness and death. The percent distribution of births in the five years before the survey is shown in Table 3.7. 31 Table 3.8 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Jordan 1997 ___________________________________________________________________________________________________ Women Median with Age at first birth Number age at no _____________________________________________ of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth ___________________________________________________________________________________________________ 15-19 96.0 0.2 2.8 1.0 NA NA NA 100.0 2,523 a 20-24 69.2 0.1 5.9 10.8 9.8 4.1 NA 100.0 2,050 a 25-29 38.6 0.1 6.6 10.5 15.0 19.7 9.5 100.0 1,789 24.7 30-34 23.5 0.2 9.0 14.1 15.0 18.9 19.3 100.0 1,395 23.9 35-39 14.6 1.1 15.0 14.8 14.4 17.3 22.9 100.0 1,036 22.7 40-44 8.6 1.4 17.5 18.9 18.0 18.6 17.1 100.0 778 21.3 45-49 7.1 1.2 16.3 20.3 22.4 15.2 17.6 100.0 593 21.1___________________________________________________________________________________________________ NA = Not applicablea Omitted because less than 50 percent of the women in the age group x to x+4 have had a birth by age x. Women in Jordan favor relatively long birth intervals: the median birth interval among children born in the five years preceding the survey is 25.5 months—1.5 months longer than that recorded in the 1990 JPFHS. More than half of all children (56 percent) are born at least two years after their siblings, and one in four is born after an interval of three years or longer. As expected, children born to younger women and low-parity women have shorter birth intervals than those born to older women and high-parity women. The birth interval following a child who has died is shorter than the interval following the birth of a surviving child (19 months, compared with 26 months). The length of birth intervals varies little according to urban- rural residence and region. However, there is a negative association between women’s education and length of birth interval; better educated women have shorter intervals between births—presumably in part because they marry later. Since these women are starting their families later, they may have shorter birth intervals to “catch up” with women who started childbearing earlier. Another reason may be the length of breastfeeding; educated women breastfeed their children for a shorter duration than uneducated women (see Table 9.3). 3.4 Age at First Birth The onset of childbearing is an important indicator of fertility. In Jordan, the postponement of first births (reflecting a later age at first marriage) has made a large contribution to the overall decline in fertility. Table 3.8 shows the distribution of women by age at first birth. Women under age 25 were not included in the calculation of median age at first birth because most had not given birth. Figures in the last column suggest an increase across age cohorts. Women age 25-29 give birth for the first time two years after women age 35-39, and 3.6 years later than women age 45-49. Table 3.9 presents the differentials in age at first birth among women age 25-49 by background characteristics. Overall, the median age at first birth is 23.2 years. Urban women begin childbearing more than a year later than rural women (23.3 years compared with 22.2 years). There are no significant differences in the median age at first birth by region. Differentials by education are more marked and follow an unusual pattern. Women with secondary education have the highest median age at first birth (21.9 years), followed by women with no education. The lowest median age at first birth is for women who have attended primary school (20.7 years). 32 Table 3.9 Median age at first birth by background characteristics Median age at first birth among women 25-49, by current age and selected background characteristics, Jordan 1997 ________________________________________________________________________________ Current age Women Background ___________________________________________ age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 ________________________________________________________________________________ Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 24.8 24.1 23.1 21.5 21.2 23.3 24.3 22.8 21.0 20.6 20.8 22.2 24.1 24.2 23.1 20.8 20.7 23.1 25.0 23.8 22.7 21.5 21.3 23.2 24.8 23.3 21.7 20.7 20.5 22.7 a 25.0 21.0 20.3 20.6 21.3 23.6 20.9 20.8 19.9 20.2 20.7 22.8 22.1 21.3 20.7 21.0 21.9 a 25.8 26.2 25.4 25.8 a 24.7 23.9 22.7 21.3 21.1 23.2 _________________________________________________________________________________ Note: The medians for cohort 15-24 could not be determined because some women may still have a birth before reaching age 45. a Omitted because less than 50 percent of the women in the age group x to x+4 have had a birth by age x. 3.5 Teenage Fertility Table 3.10 examines the extent of fertility among women age 15-19. This issue is a major social and health concern because teenage mothers and their children usually have higher risk of illness and death. At the same time, women who become mothers in their teens are more likely to curtail their education. Data from this survey indicate that more than half of women age 15-19 said that they left school to get married. Among teenagers in Jordan, the level of fertility is low. Only 6 percent of women began childbearing during their teens. Levels of teenage pregnancy vary little by place of residence; the most significant differentials are age and education. At age 15, only 1 percent of women have started childbearing. By age 19, one in seven will have become a mother or will be pregnant with her first child. Women’s education plays an important part in determining the onset of childbearing. The proportion bearing their first child at a young age declines as women’s level of education increases—from 13 percent among women with primary schooling to less than 1 percent among women with higher education. 33 Table 3.10 Teenage pregnancy and motherhood Percentage of teenagers 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Jordan 1997 ____________________________________________________________________________ Percentage of teenagers who are: Percentage ______________________ who have Pregnant begun Number Background Already with first child- of characteristic mothers child bearing teenagers ____________________________________________________________________________ Age 15 16 17 18 19 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 0.5 0.5 1.0 531 1.7 0.3 2.0 507 2.4 1.8 4.2 513 5.9 2.5 8.5 500 10.1 3.8 13.9 472 3.9 1.9 5.7 2,070 4.6 1.3 5.9 452 4.5 1.6 6.1 681 3.9 1.8 5.7 1,689 3.0 1.8 4.8 153 * * * 25 7.8 4.8 12.7 158 3.9 1.7 5.6 2,154 0.6 0.0 0.6 181 4.0 1.8 5.7 2,523 ____________________________________________________________________________ Note: An asterisk means that the figure is based on fewer than 25 unweighted cases, and has been suppressed. 1 Jordan, Egypt, and Yemen were the only three Arab countries to include prolonged breastfeeding as a family planning method in the knowledge section of the DHS questionnaire. 35 CHAPTER 4 FERTILITY REGULATION The National Population Commission (NPC) prepared a National Population Strategy for Jordan, which the cabinet approved in 1993. One of the principal elements of the strategy is “the reinforcement of the right of families to have the appropriate number of children and to have access to information and family planning methods in order to make their decisions freely, albeit in line with religious and cultural values.” Through the Ministry of Health and Health Care, the Jordan Family Planning and Protection Association, civil and voluntary organizations, and rural development projects, women are receiving information about family health, breastfeeding, and child spacing. This chapter considers a number of indicators from the 1997 Jordan Population and Family Health Survey (JPFHS) relating to knowledge, attitudes, and use of family planning. This chapter also presents information on intended future use of contraception and exposure to mass media messages about family planning. Whenever possible, comparison is made with the results of other DHS or PAPCHILD surveys carried out in other Arab countries; time trends are examined by comparing the JPFHS findings with those of three earlier surveys: the 1976 Jordan Fertility Survey (JFS) (Department of Statistics, 1979), the 1983 Jordan Fertility and Family Health Survey (JFFHS) (Department of Statistics, 1984), and the 1990 Jordan Population and Family Health Survey (JPFHS) (Zou’bi et al., 1992). 4.1 Knowledge of Family Planning Methods Determining the level of knowledge of contraceptive methods was a major objective of the 1997 JPFHS, since knowledge of specific methods is a precondition for using them. Information about women's knowledge of contraceptive methods was collected by first asking the respondents an open-ended question about which contraceptive methods they had heard of. All methods named in response to this question were recorded as spontaneous knowledge. When a respondent failed to mention any of the listed methods, the interviewer would describe a method and ask whether the respondent had heard of it. All methods recognized by the respondent after hearing a description of it were recorded as probed knowledge. Information on knowledge was collected for eight modern methods: the pill, the IUD, injectables, implants, vaginal methods (foam, jelly, sponge, or diaphragm), the condom, female sterilization, and male sterilization, and three traditional methods: periodic abstinence, withdrawal, and prolonged breastfeeding).1 In addition, provision was made in the questionnaire to record any other methods that respondents named without any prompting. In this analysis, only the overall levels of knowledge are presented—that is, respondents are classified as knowing a method regardless of whether they named it spontaneously or after probing. It should be noted that knowledge of a family planning method in the JPFHS and all DHS surveys is defined simply as having heard of a method. No questions were asked to elicit depth of knowledge, such as how a specific method is used. 2Since implants are a new method in Jordan, the use of implants is still very limited (0.1 percent). 36 Table 4.1 Knowledge of contraceptive methods Percentage of all women and of currently married women who know specific contraceptive methods, Jordan 1997__________________________________________ Ever- Currently Contraceptive married married method women women__________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Condom Female sterilization Male sterilization Implants Any traditional method Periodic abstinence Withdrawal Prolonged breastfeeding Other methods Number of respondents Mean number of methods 100.0 100.0 100.0 100.0 99.8 99.8 99.9 99.9 91.5 91.9 71.0 71.5 83.5 84.4 96.2 96.2 30.8 30.9 31.3 31.8 99.2 99.3 90.4 90.7 89.7 90.2 97.4 97.5 5.3 5.3 5,548 5,337 8.9 8.9 Table 4.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women who know at least one contraceptive method and at least one modern method by selected background characteristics, Jordan 1997 ____________________________________________________ Knows Knows Number Background any modern of characteristic method method women ____________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-45 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 100.0 100.0 203 100.0 100.0 777 100.0 100.0 1,168 100.0 100.0 1,099 99.9 99.9 880 100.0 100.0 690 99.8 99.8 520 100.0 100.0 4,469 99.8 99.8 868 100.0 100.0 1,428 100.0 100.0 3,582 99.6 99.6 327 99.7 99.7 467 99.9 99.9 804 100.0 100.0 2,866 100.0 100.0 1,200 100.0 100.0 5,337 The JPFHS results indicate that all married women in Jordan know at least one method of family planning (see Table 4.1). Among modern methods, the pill and IUD are the best known (100 percent), followed by female sterili- zation (96 percent). Knowledge of the condom, vaginal methods, and injectables ranges from 72 percent to 92 percent. The least recognized methods, male sterilization and implants, are known to only 31 percent and 32 percent of married women, respectively. As expected, prolonged breastfeeding is known to nearly all married women. Periodic abstinence and withdrawal are also well known (91 percent and 90 percent, respectively). Since knowledge of any family planning method or any modern method is universal, there is almost no variation among subgroups on the basis of background characteristics (Table 4.2). 4.2 Ever Use of Contraception All ever-married women interviewed in the JPFHS who said they had heard of a method of family planning were asked whether they ever used it. Table 4.3 shows the percentage of wom- en who have ever used a contraceptive method. Almost eight in 10 ever-married women (78 percent) reported that they had used a contra- ceptive method at some time, including 15 percent who had used prolonged breastfeeding. Ever use among married women (79 percent) is almost the same as for ever-married women. Modern methods are used by two-thirds of married ever-users (66 percent). The IUD is the most popular method (46 percent), followed by the pill (41 percent). The percentage reporting ever use of other modern methods, with the exception of implants,2 varies from 3 percent for injectables to 16 percent for condoms. 37 Table 4.3 Ever use of contraception Percentage of all women and of currently married women who have ever used any contraceptive method, by specific method, according to age, Jordan 1997____________________________________________________________________________________________________________ Modern method Traditional method________________________________________________________ ____________________________ Dia- Female Any In- phragm/ steri- Any Periodic Prolonged Number Any modern ject- Foam/ Con- liza- Im- trad. absti- With- breast- Other of Age method method Pill IUD ables Jelly dom tion plants method nence drawal feeding methods women____________________________________________________________________________________________________________ ALL WOMEN____________________________________________________________________________________________________________ 15-19 32.9 19.1 12.8 7.3 1.2 0.5 3.6 0.0 0.0 20.5 5.3 15.0 3.8 0.2 207 20-24 61.4 40.8 20.2 22.9 1.1 2.9 11.1 0.0 0.1 40.9 16.5 25.4 10.4 0.4 795 25-29 80.4 63.2 36.8 41.4 1.6 4.4 15.7 0.4 0.0 51.5 24.9 31.9 14.6 0.6 1,185 30-34 83.6 73.4 44.1 55.9 3.1 7.7 18.1 2.1 0.3 53.8 28.6 33.9 17.4 0.6 1,126 35-39 83.1 75.7 47.9 55.0 3.2 9.3 17.7 6.3 0.0 51.0 29.0 31.6 16.3 0.9 931 40-44 84.7 77.4 49.9 58.0 3.6 13.1 15.7 9.2 0.2 49.5 28.2 29.1 16.1 1.6 734 45-49 82.5 71.3 54.4 43.1 4.6 14.8 14.7 13.5 0.0 51.1 26.3 28.3 18.5 2.9 570 Total 77.8 65.2 40.4 45.1 2.7 7.8 15.3 4.2 0.1 48.9 25.0 29.9 15.0 1.0 5,548____________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN____________________________________________________________________________________________________________ 15-19 33.2 19.0 12.5 7.4 1.3 0.5 3.7 0.0 0.0 21.0 5.4 15.4 3.9 0.2 203 20-24 62.0 41.3 20.3 23.5 1.1 3.0 11.4 0.0 0.1 41.3 16.7 25.7 10.5 0.4 777 25-29 80.8 63.4 36.9 41.6 1.7 4.4 15.8 0.4 0.0 52.1 25.2 32.3 14.8 0.6 1,168 30-34 84.4 74.1 44.7 56.4 3.2 7.9 18.5 2.1 0.3 54.4 29.0 34.2 17.5 0.7 1,099 35-39 84.5 77.2 48.7 56.8 3.4 9.6 18.5 6.3 0.0 52.4 29.7 32.4 16.9 1.0 880 40-44 87.0 79.5 51.3 60.1 3.8 13.8 16.3 9.7 0.2 51.4 29.3 30.3 16.7 1.7 690 45-49 83.5 72.2 55.3 44.8 4.6 15.3 14.7 14.0 0.0 52.5 27.1 29.1 19.1 2.8 520 Total 78.7 65.9 40.8 45.9 2.7 7.9 15.6 4.2 0.1 49.8 25.5 30.5 15.3 1.0 5,337 The level of ever use of traditional contraceptive methods is fairly high in Jordan. Withdrawal, the most frequently adopted traditional method, has been used by 31 percent of currently married women, followed by periodic abstinence (26 percent) and prolonged breastfeeding (15 percent). Compared with the findings of the 1976 JFS and the 1990 JPFHS, the level of ever use among ever- married women increased by 68 percent between 1976 and 1997, and by 23 percent between 1990 and 1997. The overall increase in ever use of modern methods between the last two surveys is slightly higher (28 percent) than the increase for all methods. 4.3 Current Use of Contraception The level of current use of contraception is one of the indicators most frequently used to assess the success of family planning activities. It is also widely used as a measure in analyzing the determinants of fertility. Results from the 1997 JPFHS indicate that 53 percent of married women are using a contraceptive method, including 2 percent of women who are using prolonged breastfeeding (see Table 4.4 and Figure 4.1). Nearly four in ten current users rely on modern methods. The IUD is the most widely adopted modern method (23 percent), followed by the pill (7 percent) and female sterilization (4 percent). Less than 4 percent rely on other modern methods, such as the condom, vaginal methods, and injectables. Fifteen percent of currently married women are using a traditional method, principally withdrawal (8 percent) and periodic abstinence (5 percent). Prolonged breastfeeding is practiced by 2 percent of married women. 3 To maintain comparability with data from previous surveys, prolonged breastfeeding is not included as a family planning method. 38 Table 4.4 Current use of contraception Percentage of currently married women who are using a contraceptive method, by specific method, according to age, Jordan 1997 ___________________________________________________________________________________________________________ Modern method Traditional method________________________________________________________ ___________________________________ Dia- Female Pro- Any In- phragm/ steri- Any Periodic longed Not Number Any modern ject- Foam/ Con- liza- Im- trad. absti- With- breast- Other currently of Age method method Pill IUD ables Jelly dom tion plants method nence drawal feeding methods using Total women __________________________________________________________________________________ 15-19 19.0 12.4 6.0 5.2 0.6 0.0 0.5 0.0 0.0 6.7 0.5 5.3 0.8 0.0 81.0 100.0 203 20-24 36.6 23.7 4.9 15.7 0.1 0.4 2.4 0.0 0.1 12.8 2.2 7.6 3.0 0.1 63.4 100.0 777 25-29 51.9 34.9 7.6 23.1 0.7 0.6 2.6 0.4 0.0 16.9 3.9 9.3 3.6 0.1 48.1 100.0 1,168 30-34 57.9 43.2 8.1 27.8 1.2 0.3 3.3 2.1 0.3 14.7 4.8 7.0 2.9 0.0 42.1 100.0 1,099 35-39 62.6 47.0 7.4 29.2 0.9 0.5 2.7 6.3 0.0 15.5 6.8 6.9 1.8 0.1 37.4 100.0 880 40-44 63.6 48.3 5.5 29.1 1.0 0.9 1.8 9.7 0.2 15.1 7.4 7.0 0.7 0.2 36.4 100.0 690 45-49 48.4 33.2 3.5 13.4 0.2 0.7 1.4 14.0 0.0 14.7 6.9 7.5 0.4 0.4 51.6 100.0 520 Total 52.6 37.7 6.5 23.1 0.7 0.5 2.4 4.2 0.1 14.8 4.9 7.6 2.3 0.1 47.4 100.0 5,337 Overall, the level of contraceptive use has increased substantially in the last 20 years, from 23 percent in the 1976 JFS survey to 35 percent in the 1990 JPFHS survey, and to 50 percent in the 1997 JPFHS survey3 (Table 4.5 and Figure 4.2). The relative increase in use during the seven years preceding the 1997 JPFHS is more than 44 percent for all methods, and 40 percent for all modern methods. Figure 4.1 Current Use of Contraceptive Methods Currently Married Women 15-49 39 Table 4.5 Trends in contraceptive use Percentage of currently married women who are using specific contraceptive methods, Jordan, 1976 JFS, 1983 JFFHS, 1990 JPFHS, and 1997 JPFHS ________________________________________________________ Contraceptive JFS JFFHS JPFHS JPFHS method 1976 1983 1990 1997 ________________________________________________________ Any method 22.8 26.0 35.0 50.3 Any modern method 17.3 20.8 26.9 37.7 Pill 11.9 7.8 4.6 6.5 IUD 2.0 8.3 15.3 23.1 Injection U 0.2 0.0 0.7 Vaginal methods 0.1 0.1 0.6 0.5 Condom 1.4 0.6 0.8 2.4 Female sterilization 1.9 3.8 5.6 4.2 Any traditional method a 5.4 5.3 8.1b 12.5b Periodic abstinence 2.1 2.9 3.9 4.9 Withdrawal 3.3 2.4 4.0 7.6 Number of women 3,445 3,735 6,184 5,337 ________________________________________________________ U = Unknown (not available) a Other methods are excluded because of non-comparability among the four surveys.b Prolonged breastfeeding is excluded as a contraceptive method because no question was asked about this method in the two earlier surveys. Source: Department of Statistics (1979; 1984); and Zou’bi et al., 1992 * Excludes prolonged breastfeeding 23 26 35 50 40 Table 4.6 Use of contraception in selected countries Use of contraception among currently married women, selected DHS and PAPCHILD surveys, 1992-1997_____________________________________________________ Any Any modern Traditional Country method method method_____________________________________________________ Algeria 1992 (PAPCHILD) 46.6 42.9 3.7 Egypt 1995 (DHS) 46.9 45.5 1.4 Jordan 1997 (DHS) 50.3 37.7 12.5 Morocco 1995 (DHS) 50.3 42.4 7.9 Syria 1994 (PAPCHILD) 36.1 28.3 7.8 Tunisia 1994-95 (PAPCHILD) 59.7 49.4 10.3_____________________________________________________ Note: Prolonged breastfeeding is excluded from data for all countries. Source: Farid, 1996; El-Zanaty et al., 1996; Azelmat et al., 1996 Comparing specific methods, there was considerable change in the use of specific contraceptive methods in the period between 1976 and 1997. Most noticeable is the shift from the pill to the IUD. Whereas 12 percent and 8 percent of married women were using the pill in 1976 and 1983 respectively, only 5 percent were using it in 1990 and 7 percent in 1997. On the other hand, IUD use increased from 2 percent in 1976 to 15 percent in 1990, and to 23 percent in 1997. Use of female sterilization also increased substantially between 1976 and 1990; it then declined by 25 percent during the past seven years. The JPFHS findings on use of contraception are among the highest in the countries in which DHS or PAPCHILD surveys have been conducted, and in countries with well-established family planning activities. The findings from Jordan are most similar to those from Algeria, Egypt, and Morocco (Table 4.6). Use of contraceptive methods differs according to basic characteristics. With regard to age patterns, the use of contraception increases steadily up to age 40-44 and declines thereafter (Table 4.4); use among currently married women is lowest among those age 15-19 (19 percent), peaks among women age 40-44 (64 percent), then declines sharply among those age 45-49 (48 percent). Most women in the younger cohorts use contraception for spacing births, relying on the pill, the IUD, and traditional methods. Women age 40-49 are more likely to use female sterilization in order to limit (stop) childbearing. The level of contraceptive use is higher by 20 percent among women living in urban areas (54 percent) than among women in rural areas (45 percent). The percentage using modern methods among women living in urban areas is 27 percent higher than the percentage among those living in rural areas (39 percent and 31 percent, respectively) (Table 4.7 and Figure 4.3). There is also regional variation in current use of family planning. The Central region (which includes the capital, Amman) has the highest level of contraceptive use (55 percent), followed by the North region (50 percent). The lowest level is the South region (43 percent). Differentials in the use of modern methods are similar to those for the use of any method. Current use of contraception varies primarily between women who have received formal education and those with no education. Differences among the three levels of education are relatively small. This pattern also holds for the current use of modern methods. It should be noted, however, that use of the IUD increases with level of education, while use of female sterilization is negatively correlated with level of educational attainment. Those correlations could be due in part to the fact that women with no education tend to be older and have more children than women who have received formal education, and thus the former are more likely to want to stop childbearing altogether. The use of traditional methods also increases with level of education. Use of contraception increases with the number of living children, from 1 percent among currently married women with no children to 64 percent among women with four or more children. 41 Table 4.7 Current use of contraception by background characteristics Percent distribution of currently married women by contraceptive method currently used, according to selected background characteristics, Jordan 1997 ________________________________________________________________________________________________________________ Modern method Traditional method __________________________________________________________________________ Pro- Dia- Female longed Not Any Any In- phragm/ steri- Any Periodic breast- Other cur- Number Background meth- modern ject- Foam/ Con- liza- trad. absti- With- feed- meth- rently of characteristic od method Pill IUD ables Jelly dom tion method nence drawal ing ods using Total women ________________________________________________________________________________________________________________ Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher No. of living children 0 1 2 3 4+ Total 54.0 39.0 6.4 24.5 0.6 0.5 2.6 4.2 14.8 5.2 7.6 2.0 0.1 46.0 100.0 4,469 45.3 30.7 7.1 15.9 1.2 0.5 1.7 4.2 14.4 3.5 7.4 3.5 0.2 54.7 100.0 868 49.5 33.6 5.3 20.1 0.8 0.6 2.3 4.5 15.8 4.1 8.5 3.3 0.1 50.5 100.0 1,428 54.6 39.9 7.1 24.9 0.6 0.5 2.6 4.0 14.6 5.5 7.3 1.8 0.1 45.4 100.0 3,582 43.4 31.1 5.6 17.1 1.8 0.3 1.4 4.9 12.1 2.8 6.2 3.0 0.3 56.6 100.0 327 37.0 26.2 4.2 12.2 1.6 0.6 1.0 6.7 10.2 1.9 5.5 2.9 0.5 63.0 100.0 467 49.0 36.9 5.9 19.3 0.5 1.1 1.0 8.9 11.9 2.7 8.0 1.2 0.2 51.0 100.0 804 53.7 39.1 7.1 24.7 0.7 0.4 2.5 3.5 14.6 4.6 7.5 2.5 0.0 46.3 100.0 2,866 58.3 39.2 6.5 26.2 0.6 0.4 3.7 1.6 19.0 8.4 8.3 2.3 0.1 41.7 100.0 1,200 1.3 0.6 0.0 0.1 0.0 0.3 0.0 0.3 0.7 0.0 0.7 0.0 0.0 98.7 100.0 479 26.6 10.4 4.3 3.5 0.5 0.0 2.1 0.0 16.3 4.1 9.5 2.7 0.0 73.4 100.0 538 51.6 36.1 9.0 23.3 0.3 0.6 2.9 0.0 15.2 3.3 9.7 2.2 0.2 48.4 100.0 777 62.2 44.9 8.8 30.9 0.7 0.5 3.4 0.6 17.4 6.8 7.3 3.3 0.0 37.8 100.0 749 64.1 47.8 6.8 28.7 1.0 0.7 2.5 7.8 16.1 5.9 7.9 2.3 0.2 35.9 100.0 2,793 52.6 37.7 6.5 23.1 0.7 0.5 2.4 4.2 14.8 4.9 7.6 2.3 0.1 47.4 100.0 5,337 Figure 4.3 Current Use of Contraception among Currently Married Women by Background Characteristics 54 45 50 55 43 37 49 54 58 42 Table 4.8 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception according to current age, Jordan 1997 _________________________________________________________________________________________ Never Number of living children at time used of first use of contraception Number contra- _________________________________________________ of Current age ception 0 1 2 3 4+ Missing Total women _________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 67.1 8.0 21.4 3.5 0.0 0.0 0.4 100.0 207 38.6 5.9 34.6 16.2 4.1 0.6 0.7 100.0 795 19.6 3.9 41.7 20.8 9.3 4.6 0.9 100.0 1,185 16.4 2.9 31.5 21.9 13.0 14.3 1.3 100.0 1,126 16.9 1.7 23.5 17.9 13.6 26.3 1.9 100.0 931 15.3 1.5 23.2 16.6 8.8 34.6 2.1 100.0 734 17.5 2.3 19.6 14.8 10.2 35.5 2.4 100.0 570 22.2 3.3 30.1 18.1 9.7 16.6 1.3 100.0 5,548 4.4 Number of Children at First Use of Contraception Table 4.8 shows the number of living children at the time of first use of contraception by age among ever-married women. With the increasing adoption of family planning—particularly among younger women—the average parity of women at first use of contraception has been declining. Just under half of women age 40-49 used any family planning method before having four or more children, compared with about 75 percent of women age 25-29. Women are adopting family planning fairly early in the family building process. The proportion who started using contraception after marriage to delay the first birth has increased from 2 percent among women age 45-49 to 8 percent among those age 15-19. Overall, 30 percent of ever-married women (39 percent of ever-users), began using a contraceptive method when they had one child, and another 18 percent began after they had had two children. When the Jordan findings were compared with those of the two Arab countries in which a DHS survey had been conducted during the prior three years (Egypt and Morocco), it was found that parity at first use of contraception in Jordan was lower than in Egypt (El-Zanaty et al., 1996), but higher than in Morocco (Azelmat et al., 1996). 4.5 Knowledge of the Fertile Period A basic knowledge of reproductive physiology provides a useful background for the successful practice of coitus-dependent methods (such as withdrawal, condom, or barrier methods), and even more so for the practice of periodic abstinence, or the safe-period method. As noted earlier, periodic abstinence has been used by 25 percent of currently married women at some time, and it is currently being used by 5 percent of recently surveyed women. Since the failure rate for using the safe period method is high, it is important to find out if women who are practicing the method know when during the ovulatory cycle they should avoid having sexual intercourse. Table 4.9 presents the distribution of ever-married women who are currently using periodic abstinence, categorized by the time during the ovulatory cycle when they think a woman is most likely to get pregnant (perceived fertile period). To obtain these data, the respondents were asked when during the monthly cycle a woman has the greatest chance of becoming pregnant. The results indicate that the 4The slight discrepancy between data in this section and data in sections 4.2 and 4.3 is due to the fact that data on contraceptive effect of breastfeeding come from questions 440-441, and data on ever use and current use come from questions 403 and 408 (see questionnaire in Appendix D). No adjustment was made to the data to make these figures consistent. 43 Table 4.9 Knowledge of fertile period Percent distribution of all women and of women who have ever used periodic abstinence by knowledge of the fertile period during the ovulatory cycle, Jordan 1997___________________________________________________ Ever users Perceived of periodic Calendar/ All fertile period abstinence rhythm women___________________________________________________ During period * * * After period ends 10.9 10.6 19.8 Middle of the cycle 86.8 86.9 66.3 Before period begins 1.4 1.5 1.6 At any time 0.9 1.0 2.6 Don't know 0.0 0.0 9.5 Total 100.0 100.0 100.0 Number1 263 240 5,548___________________________________________________ Note: An asterisk indicates that the figure is based on less than 25 unweighted cases, and has been suppressed. 1 Includes 7 women who use the sympto-thermal method. ovulatory cycle is well known to ever-married women, as well as to women who have used the safe period method. Two-thirds of ever-married women can correctly identify the safe period. Among women using periodic abstinence, 87 per- cent answered correctly, while 11 percent gave the response “after the period ended.” Despite the relatively large proportion of women who can correctly identify the fertile period, it should be noted that one-third of ever- married women said they did not know the fertile period or gave the wrong answer. Since periodic abstinence is being used by a substantial number of women, family planning workers need to provide more information on the physiology of reproduction, with emphasis on the ovulatory cycle. 4.6 Contraceptive Effect of Breastfeeding Knowledge of the effect of breastfeeding on the risk of pregnancy is important for postpartum contraceptive programs that promote the use of the lactational amenorrheic method (LAM). The effective use of breastfeeding as a contraceptive method depends on a number of criteria: that the woman be postpartum amenorrheic (menstruation has not returned since the last birth); that she be exclusively or almost exclusively breastfeeding; and that less than six months have passed since the birth. To satisfy all the requirements for use of LAM, a woman should also know that if any of the preceding criteria no longer hold, she is at an increased risk of pregnancy and should no longer rely on breastfeeding for contraception. Table 4.10 shows that almost half of currently married women (45 percent) believe that breastfeeding decreases the risk of pregnancy; 24 percent of women believe that breastfeeding has no effect; and 28 percent of women say that it depends on how breastfeeding is practiced. Only 1 percent of women believe that breastfeeding increases the risk of pregnancy. There are no significant differences by background characteristics in the perceived effect of breastfeeding on the risk of pregnancy. Although almost 15 percent of currently married women have at some time relied on breastfeeding to avoid pregnancy, less than 3 percent were using breastfeeding as a contraceptive method at the time of the survey,4 and less than 2 percent meet the LAM criteria. 5 The median is calculated for women under 40 years of age in order to minimize problems of censoring. 44 Table 4.10 Perceived contraceptive effect of breastfeeding Percent distribution of currently married women by perceived risk of pregnancy associated with breastfeeding and percentage of currently married women who previously relied and who currently rely on breastfeeding to avoid pregnancy and percentage who meet lactational amenorrheic method (LAM) criteria, according to selected background characteristics, Jordan 1997 ____________________________________________________________________________________________________ Reliance on Perceived risk of pregnancy breastfeeding associated with breastfeeding to avoid pregnancy _________________________________________ ________________ Don't Meet Number Background Un- In- De- know/ Previ- Cur- LAM of characteristic changed creased creased Depends Missing Total ously rently criteria1 women ____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 19.0 3.0 45.9 19.5 12.7 100.0 3.4 1.4 2.3 203 21.5 2.0 46.2 27.5 2.8 100.0 9.9 3.9 2.2 777 22.1 0.7 48.4 27.0 1.9 100.0 14.7 4.1 3.2 1,168 24.3 1.1 45.3 28.0 1.3 100.0 17.7 3.2 0.9 1,099 25.9 1.6 43.7 27.3 1.5 100.0 16.3 2.2 0.6 880 25.4 1.2 39.8 30.3 3.2 100.0 15.3 0.8 0.6 690 25.3 1.3 43.1 27.8 2.6 100.0 17.8 0.7 0.1 520 24.6 1.4 44.3 27.4 2.2 100.0 14.5 2.4 1.3 4,469 19.2 0.9 48.0 28.1 3.8 100.0 16.4 4.5 2.4 868 18.7 0.7 48.3 29.6 2.6 100.0 18.4 3.9 1.7 1,428 25.7 1.6 44.0 26.4 2.3 100.0 13.4 2.2 1.3 3,582 23.3 1.1 41.1 30.8 3.7 100.0 14.3 3.3 2.3 327 25.2 1.1 39.9 28.9 4.8 100.0 19.4 3.0 1.0 467 22.7 1.6 44.5 27.3 3.8 100.0 15.3 1.4 1.1 804 23.6 1.6 45.7 26.9 2.3 100.0 14.1 2.9 1.7 2,866 24.0 0.7 45.5 28.6 1.2 100.0 14.5 3.2 1.5 1,200 23.7 1.3 44.9 27.5 2.5 100.0 14.8 2.7 1.5 5,337 ____________________________________________________________________________________________________ 1 Includes women who are breastfeeding a child under 6 months of age, are still postpartum amenorrheic, and are not feeding the child anything but breast milk and plain water. 4.7 Timing of Sterilization Although current use of female sterilization decreased between 1990 and 1997, it still represents more than 11 percent among users of modern methods; therefore, the age at which the operation takes place is of particular interest to family planning officials (Table 4.11). Overall, women's age at sterilization remained about the same in Jordan between 1990 and 1997; the median age for women under age 40 is age 35.5 Women who were sterilized when they were less than 30 years of age are more likely to have had the operation performed in the distant past; older women (age 40 and over) tend to have had the operation more recently. 45 Table 4.11 Timing of sterilization Percent distribution of sterilized women by age at the time of sterilization, according to the number of years since the operation, Jordan 1997 ____________________________________________________________________________________________________ Age at time of sterilization Number Years since _____________________________________________________ of Median operation <25 25-29 30-34 35-39 40-44 45-49 Total women age1 ____________________________________________________________________________________________________ <2 2.1 9.7 27.4 34.2 23.0 3.6 100.0 61 34.8 2-3 0.0 5.7 26.5 40.5 24.5 2.8 100.0 45 35.7 4-5 (0.0) (8.0) (16.3) (53.9) (20.3) (1.4) 100.0 30 36.9 6-7 (0.0) (6.6) (24.4) (44.6) (24.4) (0.0) 100.0 29 35.4 8-9 (2.3) (11.2) (25.0) (57.3) (4.1) (0.0) 100.0 27 35.8 10+ (3.1) (20.3) (47.4) (29.1) (0.0) (0.0) 100.0 40 a Total 1.4 10.4 28.7 41.0 16.9 1.7 100.0 231 35.0 ____________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases1 Median age was calculated only for women less than 40 years of age to avoid problems of censoringa Not calculated due to censoring Table 4.12 Source of supply for modern contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply, according to specific methods, Jordan 1997 _________________________________________________________________________________ Female Injec- Vaginal Con- sterili- Source of supply Pill IUD tion methods dom zation Total_________________________________________________________________________________ Public Government hospital Government health center Government MCH Univerisity hospital, clinic Royal medical services Medical private Private hospital Private doctor Pharmacy JFPPA UN HCR Other nongovernment org. Other private Other private Friends/relatives Total Number of women1 21.2 24.3 (29.5) (6.3) 29.1 59.2 28.1 0.7 2.7 (7.0) (0.0) 1.0 40.7 6.9 8.7 7.1 (2.8) (3.9) 10.9 0.0 6.7 10.9 12.9 (9.3) (2.4) 17.2 0.0 11.1 0.4 0.3 (3.3) (0.0) 0.0 1.4 0.5 0.5 1.3 (7.1) (0.0) 0.0 17.1 3.0 78.4 75.6 (70.5) (3.7) 70.9 40.8 71.7 2.2 5.5 (0.0) (0.0) 0.0 34.8 7.7 12.1 26.2 (20.0) (20.4) 0.0 0.0 18.8 51.9 1.1 (16.7) (58.6) 51.5 0.0 14.1 5.4 35.7 (31.1) (10.7) 7.5 0.0 24.0 5.6 3.3 (0.0) (3.9) 11.2 0.0 3.8 0.4 2.5 (2.7) (0.0) 0.0 0.0 1.7 0.8 1.4 (0.0) (0.0) 0.8 5.9 1.7 0.4 0.1 (0.0) (0.0) 0.0 0.0 0.1 0.4 0.1 (0.0) (0.0) 0.0 0.0 0.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 349 1,235 39 28 130 231 2,019 _________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes 5 women who are using implants 4.8 Source of Supply for Modern Methods In addition to information about the level of contraceptive use, program officials need to know where users obtain their methods. As in the 1990 JPFHS, the 1997 survey included a question for current users of modern methods regarding the source of their method. Family planning clinics, private doctors, and pharmacies are the major private sources of supply for modern contraceptive methods (Table 4.12 and Figure 4.4). Together, those sources serve almost three-fourths of current users (72 percent), almost the same level as in 1990. 6 Discontinuation rates presented in Table 4.13 refer to all episodes of contraceptive use in the period of time covered by the calendar, not just the episodes that began during the period. They are cumulative one-year discontinuation rates that represent the proportion of users discontinuing a method by 12 months after the start of use. The rates are calculated by dividing the number of discontinuations for each reason at each duration of use in single months by the number of months of exposure at that duration. The single-month rates are then cumulated to produce a one-year rate. The reasons for discontinuation are treated as competing risks (net rates). 46 The sources relied on by users vary by method used. Pharmacies are the primary source for users of methods that require resupply, including the pill (52 percent), vaginal methods (59 percent), and condoms (52 percent). Family planning clinics (JFPPA) are the primary source for IUDs (36 percent) and injections (31 percent). In the public sector, government hospitals are the major source for most female sterilizations (41 percent). 4.9 Contraceptive Discontinuation A key concern of family planning officials is the extent to which women discontinue use of contraceptive methods, and their reasons for doing so. Life-table discontinuation rates based on information collected in the calendar are presented in Table 4.13. Discontinuation rates were calculated for each method based on use during the first 12 months after beginning the method. The reasons for discontinuation were examined, then classified into three main categories: method failure, desire to become pregnant, and other reasons (including problems related to the use of a particular method, husband's disapproval, and absence of need to use a family planning method). Fourteen percent of users stopped using before the end of the first year because the method failed; 8 percent said they stopped because they wanted to become pregnant; and 11 percent stopped because of side effects and health concerns.6 These rates are similar to those found in the 1990 JPFHS. 47 Table 4.13 First-year discontinuation rates for contraception First-year contraceptive discontinuation rates due to method failure, desire for pregnancy, health reasons, or other reasons, according to specific method, Jordan 1997 ______________________________________________________________________ Reason for discontinuing contraception __________________________________ Side Desire effects/ All Contraceptive Method to become health other method failure pregnant reasons reasons Total ______________________________________________________________________ Pill 9.6 7.6 31.5 19.2 67.9 IUD 2.2 3.5 9.2 2.7 17.7 Diaphragm/Foam/Jelly 25.0 3.2 26.6 27.6 82.4 Condom 21.0 6.7 5.3 34.5 67.6 Periodic abstinence 30.3 13.1 0.9 18.1 62.4 Withdrawal 23.1 12.0 0.9 20.2 56.3 Prolonged breastfeeding 17.1 6.8 1.3 26.2 51.3 Total 14.2 7.6 10.7 16.3 48.9 ______________________________________________________________________ Note: Figures are based on life-table calculations. First-year discontinuation rates due to method failure are highest for periodic abstinence and vaginal methods (Figure 4.5). Three of ten women who used periodic abstinence and 25 percent of women who used a vaginal method (diaphragm, foam, or jelly) became pregnant while using the method. Discontinuation rates due to method failure are also high for withdrawal (23 percent) and condoms (21 percent). Percent 48 Table 4.14 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the last five years by main reason for discontinuation, according to specific method, Jordan 1997 ____________________________________________________________________________________________________ Diaphragm/ Periodic Reason for Injec- Foam/ absti- With- Absti- discontinuation Pill IUD tion Jelly Condom nence drawal nence Total ____________________________________________________________________________________________________ Became pregnant 15.9 10.5 (2.8) 33.1 32.8 50.2 39.3 32.4 26.6 To become pregnant 16.2 33.4 (2.3) 5.6 16.8 24.4 27.3 16.9 23.2 Husband disapproved 1.2 0.7 (0.0) 6.1 21.2 1.4 9.8 0.0 3.8 Side effects 31.6 27.9 (37.3) 21.0 6.1 0.2 1.6 0.5 15.9 Health concerns 11.1 12.4 (15.1) 8.3 0.5 0.9 1.4 2.9 6.7 Access/Availability 0.1 0.0 (0.0) 0.9 0.0 0.3 0.0 0.0 0.1 More effective method 3.7 1.4 (10.1) 12.2 9.6 15.0 12.8 21.8 8.9 Inconvenient to use 3.8 3.2 (12.0) 7.2 4.8 0.8 0.8 0.3 2.5 Infrequent sex 9.3 2.7 (5.2) 3.7 3.8 3.5 2.6 0.0 4.2 Cost 0.0 0.0 (0.0) 0.0 1.1 0.0 0.0 0.0 0.1 Fatalistic 0.2 0.0 (2.8) 0.0 0.0 0.0 0.1 0.0 0.1 Menopause 0.7 0.1 (1.5) 0.0 0.0 0.3 0.6 0.2 0.4 Marital dissolution 0.2 0.2 (0.0) 0.0 0.0 0.1 0.0 0.1 0.1 Other 2.8 4.0 (11.0) 0.9 3.0 1.8 2.4 15.7 4.3 Period returned 0.2 0.0 (0.0) 0.0 0.0 0.4 0.3 9.0 1.1 Rest 3.1 3.4 (0.0) 1.1 0.3 0.7 0.8 0.2 1.9 Don't know 0.0 0.1 (0.0) 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,330 1,327 45 118 331 783 952 575 5,477 ____________________________________________________________________________________________________ Note: Includes 18 women who had used prolonged breastfeeding. Figures in parentheses are based on 25-49 unweighted cases. Table 4.14 provides information about women's reasons for discontinuing contraception. The table includes all discontinuations in the five years before the survey, regardless of whether they occurred during the first 12 months of use or later. The reason given most frequently for discontinuation was method failure (27 percent), followed by desire to get pregnant (23 percent), and side effects or health concerns (23 percent). The other reasons women cited for discontinuation were the desire to have a more effective method (9 percent) and infrequent sexual relations or menopause (5 percent). Opposition to family planning by the husband represents less than 4 percent. Discontinuation due to method failure is particularly high for traditional methods: periodic abstinence (50 percent) and withdrawal (39 percent). Among modern methods, method failure was the main reason given for discontinuation of vaginal methods and condoms (33 percent each), both coitus-dependent methods. Side effects and health concerns were especially evident among women who had been relying on injectables (52 percent), the pill (43 percent), and the IUD (40 percent). 4.10 Future Use of Family Planning To obtain information about potential demand for family planning services, all currently married women who were not using contraception at the time of the survey were asked about their intention to use family planning in the future. Those who responded in the affirmative were also asked which method they would prefer to use and whether they intended to use that method during the next 12 months. Table 4.15 presents the distribution of currently married women who were not using contraception, by intention to use in the future, according to number of living children. Nearly two-thirds of nonusers (65 percent) said that they intend to use family planning in the future—most of them within the next 12 months 49 Table 4.15 Future use of contraception Percent distribution of currently married women who are not currently using any contraceptive method by intention to use in the future, according to number of living children, Jordan 1997 ________________________________________________________________________________________ Number of living children1 _________________________________________ Future intentions 0 1 2 3 4+ Total ________________________________________________________________________________________ Intend to use in next 12 months Intend to use later Unsure as to timing Unsure as to intention Do not intend to use Missing Total Number of women 14.0 44.2 63.3 61.0 50.4 48.1 41.4 28.7 18.5 13.6 6.9 17.3 4.1 4.2 1.9 1.9 1.5 2.4 10.2 4.2 1.5 3.2 2.9 3.9 30.3 18.7 14.6 19.9 38.3 28.3 0.0 0.0 0.2 0.4 0.0 0.1 100.0 100.0 100.0 100.0 100.0 100.0 326 386 381 336 1,101 2,531 ________________________________________________________________________________________ 1 Includes current pregnancy Table 4.16 Reasons for not using contraception Percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future, by main reason for not intending to use, according to age, Jordan 1997 _________________________________________________ Age Reason for not ________________ using contraception 15-29 30-49 Total _________________________________________________ Formerly married Infrequent sex Menopausal, hysterectomy Subfecund, infecund Wants more children Husband sick, subfecund Respondent opposed Husband opposed Religious prohibition Rumors Knows no source Health concerns Fear side effects Inconvenient to use Interfere with body God's will Other Don't know Total Number 0.0 0.2 0.1 1.1 6.2 5.5 0.0 13.9 12.0 9.3 21.9 20.2 50.6 20.7 24.7 1.0 6.8 6.0 5.0 2.4 2.8 7.8 4.8 5.2 1.6 0.9 1.0 1.0 0.0 0.1 0.0 0.2 0.2 4.8 6.6 6.3 13.4 7.1 8.0 0.4 0.4 0.4 0.0 0.4 0.3 0.4 2.5 2.2 3.6 4.9 4.7 0.0 0.2 0.1 100.0 100.0 100.0 97 618 716 (48 percent). Only 28 percent of nonusers said they do not intend to use in the future. In the 1990 JPFHS, the proportion of women who did not plan to do anything to avoid a pregnancy in the future was 43 percent. Intention to use contraception in the future appears not to have a strong positive association with the number of living children a woman has; women with two children are more likely to want to use contraception in the future than those with fewer or more children. Specifically, 82 percent of women with two children said they intend to use a method of family planning, compared with 55 percent of childless women and 57 percent of women with four or more children. The reasons women choose not to use family planning are of particular interest to family planning program officials. Table 4.16 gives the dis- tribution of women who are not using contraception by their reason for not using. The primary reason given is infecundity or menopause; 32 percent of women say it is difficult for them to get pregnant. The next most common reason for not using is the desire to get pregnant; 25 percent of nonusers say they are not using because they want to have children. Other reasons mentioned are health concerns or fear of side effects (14 percent), and infrequent sexual relations or husband’s sickness (12 percent). Another 8 percent mention husband’s or respondent’s disapproval of contraception. In the 1990 JPFHS, 13 percent of nonusers who did not intend to use contraception cited factors related to religious concerns or fatalism such as “God’s will.” In the 1997 JPFHS, only 3 percent of women mentioned religion or fatalism as reasons for nonuse. 50 Table 4.17 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contra- ceptive method but who intend to use in the future by preferred method, according to timing of intended use, Jordan 1997____________________________________________________________ Timing of intended use __________________________ In next After Preferred method 12 12 Unsure All of contraception months months when women____________________________________________________________ Pill IUD Injection Diaphragm/Foam/Jelly Condom Female sterilization Male sterilization Implants Periodic abstinence Withdrawal Prolonged breastfeeding Depends on the body Depends on doctor Missing Total Number of women 17.1 19.4 15.3 17.6 48.3 48.7 38.7 48.1 4.8 3.0 3.9 4.3 0.4 0.3 0.0 0.4 1.5 1.0 0.0 1.3 5.0 1.8 0.0 4.0 0.2 0.0 0.0 0.1 0.6 1.2 0.0 0.7 4.4 7.3 5.0 5.2 7.0 4.6 7.5 6.4 1.8 1.8 1.8 1.8 1.1 1.2 2.1 1.1 2.0 1.0 4.6 1.8 5.7 8.7 21.1 7.0 100.0 100.0 100.0 100.0 1,218 438 60 1,715 Women under age 30 are more likely than older women to mention the desire to have children, while infecundity and menopause are more often reported by older women. Husband’s or respondent’s disapproval of contraception is mentioned more often by younger women than by women age 30 and over. Fear of side effects is also cited more often by younger women than older women. An important indicator of the changing demand for family planning is the extent to which nonusers of contraception plan to use contraception in the future. Married women who were not using contraception at the time of the survey were asked if they intended to use a family planning method in the future. The results are shown in Table 4.17. The majority of women (76 percent) say they want to use a modern method of contraception; slightly less than 14 percent want to use a traditional method. Half of the women who intend to use contraception say they want to use the IUD—the same propor- tion as in 1990. After the IUD, the most popular modern methods are the pill (18 percent) and female sterilization (4 percent). The levels for 1997 are similar to those in 1990, except for female sterilization. There were more women in the 1990 JPFHS than in the 1997 JPFHS who said they intended to use female sterilization in the future (7 percent compared with 4 percent). Method preferences are almost identical for women who intend to use contraception during the next 12 months as for those who intend to use after 12 months. Some programmatic implica- tions can be drawn from the data in Table 4.17. Because of the popularity of the IUD, the pill, and female steriliza- tion, several issues need to be considered in anticipation of women’s carrying out their intentions to use those methods. First, the supply of pills must be adequate to meet the needs of women who want to use that method; second, for women who want to use the IUD or female sterilization, trained personnel must be available to provide the services. 4.11 Exposure to Family Planning Messages Radio and television are the major sources of information about family planning in the media. To assess the effectiveness of those media for disseminating family planning information, all ever-married women were asked if they had heard or seen messages about family planning on the radio or television during the 6 months prior to the survey. The results indicate that, overall, 92 percent of ever-married women are exposed to family planning messages on radio and television, the major electronic media (Table 4.18). Television is by far the more prominent of the two. Differentials in access to family planning messages by age, place of residence, and region are generally minimal. There is somewhat greater variability by educa- tional level: 79 percent of women with no education were reached through electronic media in the previous month, compared with 93 percent of women with secondary education. 51 Table 4.18 Exposure to family planning messages on radio or television Percent distribution of women by whether they have heard a message about family planning on radio or television in the few months prior to the interview, according to selected background characteristics, Jordan 1997 _________________________________________________________________________________ Heard a message about family planning on radio or television __________________________________ Heard Tele- Both message Number Background Radio vision radio on of characteristic only only and TV neither Total women _________________________________________________________________________________ Age group 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 2.5 51.0 36.2 10.3 100.0 207 0.9 37.8 53.1 8.3 100.0 795 1.5 38.8 54.7 5.0 100.0 1,185 1.4 36.4 56.3 5.9 100.0 1,126 2.4 33.8 54.5 9.2 100.0 931 1.9 30.0 56.7 11.4 100.0 734 1.9 26.9 56.0 15.3 100.0 570 1.6 35.7 55.0 7.7 100.0 4,636 2.0 33.9 51.8 12.2 100.0 912 1.6 43.3 46.5 8.6 100.0 1,479 1.7 32.4 57.5 8.3 100.0 3,729 1.5 33.9 55.3 9.3 100.0 340 2.9 31.9 44.4 20.8 100.0 504 2.0 35.2 51.1 11.6 100.0 850 1.5 35.6 56.0 6.9 100.0 2,957 1.2 36.5 57.3 5.0 100.0 1,237 1.7 35.4 54.5 8.5 100.0 5,548 4.12 Acceptability of Media Messages on Family Planning To determine the level of acceptability of disseminating family planning information through the media, all ever-married women were asked if they thought it was acceptable for family planning information to be provided on the radio or television. The results indicate that almost all respondents (96 percent) consider it acceptable for mass media to carry programs on family planning issues (Table 4.19). In 1990, the proportion was 84 percent. Acceptance of the dissemination of family planning messages is uniformly high among all subgroups; it varies from 91 percent among women with no education to 97 percent among women with secondary education. 52 Table 4.19 Acceptability of media messages on family planning Percent distribution of women by acceptability of messages about family planning on the radio and television, by selected background characteristics, Jordan 1997 ______________________________________________________________________ Acceptability of family planning messages on radio or television _____________________________ Number Background Accept- Not of characteristic able acceptable Unsure Total women ______________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 93.3 6.2 0.5 100.0 207 96.7 2.9 0.4 100.0 795 96.3 3.5 0.2 100.0 1,185 97.2 2.5 0.2 100.0 1,126 95.8 3.9 0.3 100.0 931 94.2 5.5 0.3 100.0 734 92.3 6.6 1.1 100.0 570 96.0 3.7 0.3 100.0 4,636 93.8 5.2 1.0 100.0 912 94.0 5.4 0.7 100.0 1,479 96.4 3.4 0.2 100.0 3,729 95.2 3.8 1.0 100.0 340 91.3 7.3 1.4 100.0 504 94.1 5.2 0.7 100.0 850 97.1 2.7 0.2 100.0 2,957 95.1 4.7 0.2 100.0 1,237 95.7 4.0 0.4 100.0 5,548 4.13 Exposure to Family Planning Messages in Print Media Female respondents were asked if they had been exposed to a family planning message through a newspaper or magazine article, a poster, or a leaflet during the 6 months prior to the interview. The results in Table 4.20 show that 65 percent of women reported that they had been exposed to family planning information via print media. The most commonly reported source of a family planning message in the print media is posters (47 percent), followed by newspapers/magazines (41 percent), and leaflets (33 percent). Younger women are more likely to have been exposed to family planning messages through print media than older women; for example, 71 percent of women age 20-24 have been reached through print, compared with 47 percent of women age 45-49. The level of exposure to family planning messages through print varies between urban and rural areas (68 percent vs. 54 percent). Women living in the Central region are more likely to have seen a family planning message in print than women in the other two regions. The proportion of women exposed to messages in any print media increases directly with educational level— from 21 percent among women with no formal education to 82 percent among women with higher education. 53 Table 4.20 Family planning messages in print Percentage of women who received a message about family planning through the print media in the few months prior to the interview, according to selected background characteristics, Jordan 1997 ______________________________________________________________________ Type of print media containing family planning message ____________________________________ News- Any Number Background Leaflet/ paper/ print of characteristic brochure Poster magazine media women ______________________________________________________________________ Age group 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 25.3 48.2 32.0 65.4 207 38.2 54.3 43.9 70.9 795 35.4 51.7 45.4 71.3 1,185 38.2 52.2 45.3 72.8 1,126 34.1 45.3 40.8 64.5 931 24.1 39.6 37.1 54.0 734 19.2 30.5 31.3 47.2 570 34.3 48.3 44.3 67.6 4,636 24.1 41.4 26.5 54.3 912 26.0 45.8 31.8 60.0 1,479 35.5 48.4 45.6 68.4 3,729 30.3 39.9 36.0 56.1 340 3.6 18.5 2.3 20.9 504 19.2 35.7 21.8 46.9 850 36.1 51.0 45.7 71.4 2,957 45.2 57.7 60.3 82.0 1,237 32.6 47.2 41.3 65.4 5,548 Table 4.21 Discussion of family planning by couples Percent distribution of currently married non-sterilized women who know a contraceptive method by the number of times family planning was discussed with husband in the year preceding the survey, according to current age, Jordan 1997 _______________________________________________________________________________ Number of times family planning discussed with husband ___________________________________ Not Number Once or More applicable of Current age Never twice often Missing/ Total women _______________________________________________________________________________ 15-19 29.2 28.8 42.1 0.0 100.0 203 20-24 19.9 26.6 53.1 0.4 100.0 777 25-29 18.9 27.2 53.8 0.1 100.0 1,163 30-34 22.5 29.6 47.5 0.3 100.0 1,075 35-39 31.2 25.7 42.7 0.3 100.0 824 40-44 45.0 23.0 31.6 0.4 100.0 623 45-49 65.4 14.7 18.0 1.9 100.0 447 Total 29.5 25.8 44.3 0.4 100.0 5,111 4.14 Attitudes toward Family Planning An indication of the acceptability of family planning is the extent to which couples discuss the topic. Although husband-wife discussion of family planning is not a precondition for adoption of a method, evidence of such discussion is an indication of interest in the subject on the part of the couple, which is presumed to precede use. Table 4.21 indicates that three out of ten women who know a contraceptive method have never talked about family planning with their husband. Twenty-six percent of women have 54 Table 4.22 Wives' perceptions of their husbands' attitudes toward family planning Percent distribution of currently married non-sterilized women who know a contraceptive method by wife's attitude toward family planning and wife's perception of her husband's attitude toward family planning, according to selected background characteristics, Jordan 1997 _____________________________________________________________________________________________________ Wife approves __________________ Husband Husband's Number Background Both disap- attitude Wife Wife Husband of characteristic approve proves unknown unsure Missing Total approves approves women _____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 74.9 8.0 5.7 3.4 8.0 100.0 88.6 74.9 203 82.3 11.0 2.9 0.5 3.3 100.0 96.2 82.3 777 85.6 8.6 2.2 0.2 3.3 100.0 96.5 85.6 1,163 84.0 10.5 1.8 0.4 3.2 100.0 96.3 84.0 1,075 79.9 13.7 1.9 0.9 3.7 100.0 95.4 79.9 824 76.6 15.0 2.9 0.9 4.5 100.0 94.5 76.6 623 71.4 12.4 4.7 1.9 9.6 100.0 88.5 71.4 447 81.7 11.2 2.4 0.6 4.2 100.0 95.2 81.7 4,281 77.9 11.9 3.8 1.6 4.7 100.0 93.6 77.9 830 79.4 11.7 3.2 1.7 4.0 100.0 94.3 79.4 1,363 81.9 10.9 2.4 0.4 4.2 100.0 95.3 81.9 3,439 79.1 13.0 1.8 0.6 5.5 100.0 93.9 79.1 310 58.2 20.1 5.6 3.4 12.7 100.0 83.9 58.2 434 72.6 16.0 3.4 1.4 6.6 100.0 92.0 72.6 732 83.3 10.9 2.3 0.4 3.1 100.0 96.5 83.3 2,765 89.6 6.0 1.8 0.2 2.4 100.0 97.4 89.6 1,181 81.1 11.3 2.6 0.8 4.2 100.0 95.0 81.1 5,111 talked with their husband about the subject once or twice during the 12 months before the survey, and 44 percent of women reported having had at least three conversations with their husband during the period. As expected, husband-wife discussion of family planning is more prevalent among younger women (age 20-34) than older women. To obtain more direct information about the acceptability of family planning, respondents were asked if they approved or disapproved of couples using a method to avoid pregnancy. The data presented in Table 4.22 indicate that, overall, 95 percent of currently married women who know a contraceptive method approve of family planning. More than four of five women say that their husband also approves of family planning; 11 percent of women say that they approve of family planning but their husband does not. Approval of family planning by married women varies little by age, except that women age 45-49 are less likely to approve than the younger cohorts. Married women who live in rural areas and those who have no formal education are also less likely than other women to approve of the use of family planning. 55 Table 5.1 Ever-married women according to selected surveys Percentage of women 15-49 who have ever married by age, Jordan, 1976, 1983, 1990, and 1997 ___________________________________________________ JFS JFFHS JPFHS JPFHS Age group 1976 1983 1990 1997 ___________________________________________________ 15-19 19.5 9.4 10.6 8.2 20-24 64.1 42.0 45.2 38.8 25-29 87.4 76.3 73.7 66.2 30-34 95.3 90.1 89.1 80.7 35-39 92.4 94.9 94.6 89.9 40-44 98.0 96.8 97.3 94.4 45-49 98.3 97.1 98.0 96.0 Total 65.7 56.0 56.2 54.6 CHAPTER 5 NUPTIALITY AND EXPOSURE TO THE RISK OF PREGNANCY This chapter addresses the principal factors, other than contraception, that affect a woman's risk of becoming pregnant: nuptiality, postpartum amenorrhea, and secondary infertility. The questionnaire used in the Jordan Population and Family Health Survey (JPFHS) differs from the DHS core questionnaire in that questions on recent sexual activity were not included, owing to the awkwardness in addressing such questions to women in the Jordanian cultural context. However, information on sexual activity was replaced with proxy questions pertaining to whether the respondent's husband lives in the same household and the amount of time he spent in the household during the month before the survey. Information on nuptiality is of particular interest because marriage is a primary indicator of the exposure of women to the risk of pregnancy. Marriage patterns are important for an understanding of fertility. Early age at first marriage is associated with early childbearing and high fertility. In this survey and for all data collection in Jordan, the term marriage refers to a legal or formal union. 5.1 Current Marital Status Table 5.1 compares data on ever-married women from the 1997 JPFHS with the 1976 Jordan Fertility Survey (JFS), the 1983 Jordan Fertility and Family Health Survey (JFFHS), and the 1990 Jordan Population and Family Health Survey (JPFHS). During the 21 years between 1976 and 1997, the percentage of women ever married decreased from 66 to 55 percent, a drop of 17 percent. However, the decline appears to have occurred during the first 7 years, since the percentages remained nearly unchanged after 1983. In Jordan, marriage is almost universal. In 1997, only 4 percent of women have not married by the end of their reproductive years (see Figure 5.1). However, the percentage never married has increased over the years. For example, in 1976, less than 5 percent of women age 30-34 had never married. That increased to about 10 percent between 1983 and 1990, and almost doubled in 1997, rising to 19 percent. The pattern is similar for women in the younger age groups. Nevertheless, much of the decline in the age at marriage took place between 1976 and 1983. 56 Table 5.2 Current marital status Percent distribution of women by current marital status, according to age, Jordan 1997 _____________________________________________________________________ Marital status ____________________________________ Number Never of Age married Married Divorced Widowed Total women _____________________________________________________________________ 15-19 91.8 8.0 0.2 0.0 100.0 2,523 20-24 61.2 37.9 0.7 0.2 100.0 2,050 25-29 33.8 65.3 0.6 0.3 100.0 1,789 30-34 19.3 78.8 1.2 0.7 100.0 1,395 35-39 10.2 84.9 2.2 2.8 100.0 1,036 40-44 5.7 88.7 1.4 4.3 100.0 778 45-49 3.9 87.7 1.3 7.0 100.0 593 Total 45.4 52.5 0.9 1.2 100.0 10,165 Table 5.2 presents the distribution of women by current marital status. Of the 10,165 women age 15-49 listed in the household schedule, 45 percent had never married, 53 percent were currently married, and the remaining 2 percent were either divorced or widowed. Figure 5.1 Never-married Women 15-39 by Age Jordan, 1976-1997 15-19 20-24 25-29 30-34 35-39 0 20 40 60 80 100 1976 JFS 1983 JFFHS 1990 JPFHS 1997 JPFHS 80 91 89 92 36 58 55 61 13 24 26 39 5 10 11 19 8 5 5 10 57 Table 5.3 Polygyny Percentage of currently married women age 15-49 in a polygynous union, by age and selected background characteristics, Jordan 1997 _________________________________________________________________________________________ Current age Background __________________________________________________________ characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total _________________________________________________________________________________________ Residence Urban Rural Region North Central South Educational level attended No education Primary Secondary Higher Total 2.4 2.0 3.3 6.3 9.0 9.3 8.3 5.9 2.0 3.8 8.7 12.5 9.5 14.8 12.7 9.6 0.0 1.2 4.7 8.0 6.9 10.9 9.9 6.3 3.2 2.6 3.9 7.0 10.1 9.9 8.5 6.6 4.3 4.2 5.3 7.2 7.1 8.3 12.2 6.8 0.0 4.0 27.7 20.6 20.8 18.5 18.8 19.3 8.3 8.0 10.4 14.2 14.7 12.0 8.7 11.7 1.4 2.1 4.1 7.1 7.7 6.9 1.7 4.8 0.0 0.9 0.5 2.3 3.2 5.3 3.8 2.2 2.3 2.4 4.2 7.3 9.1 10.1 9.1 6.5 The proportion currently married increases steadily from 8 percent among women age 15-19 to 89 percent among those age 40-44, then declines slightly to 88 percent for women in the oldest age group. As expected, the proportion widowed increases with age, reaching 7 percent for women age 45-49. Less than 1 percent of women in Jordan are divorced. 5.2 Polygyny Marital unions are predominantly of two types—those that are monogamous and those that are polygynous. The distinction has social significance and possible implications for fertility, although the relationship

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