Moldova - Demographic and Health Survey - 2006

Publication date: 2006

REPUBLIC OF MOLDOVA Moldova Demographic and Health Survey 2005 National Scientific and Applied Center for Preventive Medicine Ministry of Health and Social Protection Chisinau, Moldova ORC Macro Calverton, Maryland, USA September 2006 This report summarizes the findings of the 2005 Moldova Demographic and Health Survey (MDHS 2005), which was conducted by the National Scientific and Applied Center for Preventive Medicine (NCPM) of the Ministry of Health and Social Protection (MOHSP). Funding for the project was provided by the United States Agency for International Development (USAID) through the worldwide MEASURE DHS project (Contract No. GPO-C-00-03- 00002-00). Additional funding for the MDHS was provided by the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA). ORC Macro provided technical assistance. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or the Government of Moldova. Additional information about the 2005 MDHS may be obtained from the National Scientific and Applied Center for Preventive Medicine of the Ministry of Health and Social Protection, 67 A str. Gh. Asachi, 2028 Chisinau, Republic of Moldova (Telephone: 373 22 57 46 74 or 373 22 72 96 47; Fax: 373 22 72 97 25). Additional information about the MEASURE DHS project may be obtained from ORC Macro, MEASURE DHS, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E- mail: reports@orcmacro.com, Internet: http://www.measuredhs.com. Recommended citation: National Scientific and Applied Center for Preventive Medicine (NCPM) [Moldova] and ORC Macro. 2006. Moldova Demographic and Health Survey 2005. Calverton, Maryland: National Scientific and Applied Center for Preventive Medicine of the Ministry of Health and Social Protection and ORC Macro. Contents | iii CONTENTS TABLES AND FIGURES . vii PREFACE. xv SUMMARY OF FINDINGS . xvii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxv MAP OF MOLDOVA. xxvi CHAPTER 1 INTRODUCTION 1.1 Geography And Population .1 1.2 History .1 1.3 Economy.3 1.4 Characteristics of the Health System.4 1.4.1 Facilities and Human Resources .4 1.4.2 Reforms of the Health System of the Republic of Moldova .5 1.4.3 Specific Health Care Services .6 1.5 Health Information System.10 1.6 Objectives and Organization of the Survey.10 1.6.1 Sample Design and Implementation .11 1.6.2 Questionnaires .11 1.6.3 Field Staff and Fieldwork .13 1.6.4 Data Processing.14 1.6.5 Response Rates .14 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Household Population by Age and Sex.16 2.2 Household Composition .17 2.3 Children’s Living Arrangements .18 2.4 Educational Attainment of Household Members.20 2.5 Housing Characteristics .23 2.6 Household Durable Goods .24 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS 3.1 Background Characteristics of Respondents.27 3.2 Educational Level of Respondents .29 3.3 Exposure to Mass Media .30 3.3.1 Language Preferences for Print Media .32 3.4 Employment .34 3.4.1 Employment Status.34 3.4.2 Occupation.36 iv Ň Contents 3.4.3 Use of Earnings.39 3.5 Women’s Empowerment .41 3.5.1 Women’s Participation in Decisionmaking .41 3.5.2 Women’s and Men’s Attitudes toward Wife Beating.43 3.5.3 Women’s and Men’s Attitudes toward Wife Refusing Sex with Husband .46 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4.1 Introduction.49 4.2 Current Fertility Levels .50 4.3 Fertility Differentials by Background Characteristics.51 4.4 Fertility Trends .52 4.5 Children Ever Born and Living.53 4.6 Birth Intervals.54 4.7 Age at First Birth.56 4.8 Teenage Pregnancy and Motherhood.57 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods.59 5.2 Ever Use of Contraception .60 5.3 Current Use of Contraceptive Methods .61 5.4 Trends in Contraceptive Use .63 5.5 Differentials in Contraceptive Use by Background Characteristics.64 5.6 Current Use of Contraceptives by Women’s Status.65 5.7 Timing of First Use of Contraception .66 5.8 Knowledge of the Fertile Period .66 5.9 Source of Contraception .67 5.10 Informed Choice.68 5.11 Contraceptive Discontinuation .69 5.12 Future Use of Contraception .71 5.13 Reasons for Not Intending to Use .72 5.14 Preferred Method for Future Use .73 5.15 Exposure to Family Planning Messages .73 5.16 Attitudes of Respondents Towards Family Planning .75 CHAPTER 6 ABORTION 6.1 Pregnancy Outcomes .77 6.2 Lifetime Experience with Induced Abortion.79 6.3 Rates of Induced Abortion.80 6.4 Trends in Induced Abortion .82 CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY 7.1 Introduction.85 Contents | v 7.2 Marital Status .85 7.3 Age at First Marriage .86 7.4 Age at First Sexual Intercourse.88 7.5 Recent Sexual Activity .90 7.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility.93 7.7 Termination of Exposure to Pregnancy .94 CHAPTER 8 FERTILITY PREFERENCES 8.1 Desire for More Children .95 8.2 Need for Family Planning Services.98 8.3 Wanted and Unwanted Fertility . 100 CHAPTER 9 INFANT AND CHILD MORTALITY 9.1 Definitions and Methodology . 103 9.2 Assessment of Data Quality . 104 9.3 Levels and Trends in Infant and Child Mortality. 105 9.4 Socioeconomic Differentials in Childhood Mortality. 107 9.5 Demographic Differentials in Childhood Mortality . 108 9.6 Perinatal Mortality. 109 CHAPTER 10 MATERNAL AND CHILD HEALTH 10.1 Antenatal Care . 111 10.2 Delivery Care. 122 10.3 Delivery Characteristics . 124 10.4 Postnatal Care. 126 10.5 Woman’s Perception of Access to Health Care. 127 10.6 Immunization Coverage . 129 10.7 Acute Respiratory Infections and Fever. 112 10.8 Diarrhea . 114 CHAPTER 11 NUTRITION 11.1 Breastfeeding and Supplementation . 139 11.2 Iodine Intake and Vitamin A Consumption. 143 11.3 Micronutrient Intake . 146 11.4 Anemia . 148 11.5 Nutritional Status of Children . 152 11.6 Nutritional Status of Women. 156 CHAPTER 12 ADULT HEALTH 12.1 Health Insurance. 159 12.2 Tobacco Use. 160 12.3 Alcohol Consumption . 163 vi Ň Contents 12.4 Tuberculosis. 166 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13.1 Knowledge of HIV Transmission and Prevention Methods . 174 13.2 Stigma and Attitudes Related to HIV/AIDS. 181 13.3 Higher-Risk Sex. 185 13.4 Testing for HIV. 189 13.5 Reports of Recent Sexually Transmitted Infections . 192 13.6 Injections . 193 13.7 HIV/AIDS-Related Knowledge and Behavior among Youth . 195 13.8 Recent Sexual Activity among Young Women and Men . 199 CHAPTER 14 DOMESTIC VIOLENCE 14.1 Introduction. 205 14.2 Data Collection. 205 14.3 Violence Since Age 15 . 207 14.4 Marital Violence. 209 14.5 Onset of Spousal Violence Against Women. 211 14.6 Physical Consequences of Spousal Violence . 212 14.7 Violence by Spousal Characteristics and Women’s Status Indicators . 213 CHAPTER 15 EMIGRATION 15.1 Households Having at Least One Former Member Living Abroad. 217 15.2 Household Characteristics of Emigrants’ Former Households. 219 15.3 Background Characteristics of Emigrants. 220 15.4 Main Reason for Emigrating. 221 15.5 Trends in Emigration: Current Age and Sex of Emigrants . 222 15.6 Destination Countries. 224 15.7 Children of Emigrants. 226 REFERENCES .229 APPENDIX A SAMPLE DESIGN. 235 APPENDIX B ESTIMATES OF SAMPLING ERRORS. 239 APPENDIX C DATA QUALITY TABLES . 249 APPENDIX D PERSONS INVOLVED IN THE 2005 MOLDOVA DEMOGRAPHIC AND HEALTH SURVEY. 253 APPENDIX E QUESTIONNAIRES . 257 Tables and Figures | vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.2 Results of the household and individual interviews. 14 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence. 16 Table 2.2 Household composition. 18 Table 2.3 Children’s living arrangements and orphanhood . 19 Table 2.4 Parental residence apart from children. 19 Table 2.5 Educational attainment of household population . 22 Table 2.6 Household characteristics . 23 Table 2.7 Household durable goods . 25 Figure 2.1 Population pyramid . 17 Figure 2.2 Living arrangements of mothers and fathers not living in household interviewed. 20 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 Background characteristics of respondents . 28 Table 3.2.1 Educational attainment by background characteristics: women . 29 Table 3.2.2 Educational attainment by background characteristics: men. 30 Table 3.3.1 Exposure to mass media: women. 31 Table 3.3.2 Exposure to mass media: men. 32 Table 3.4 Language preference for printed media. 33 Table 3.5.1 Employment status: women . 35 Table 3.5.2 Employment status: men. 36 Table 3.6.1 Occupation: women. 37 Table 3.6.2 Occupation: men . 38 Table 3.7 Decision on use of earnings . 40 Table 3.8 Women’s participation in decisionmaking. 41 Table 3.9 Women's participation in decisionmaking by background characteristics. 42 Table 3.10.1 Women’s attitudes toward wife beating . 44 Table 3.10.2 Men’s attitudes toward wife beating. 45 Table 3.11.1 Women’s attitude toward a wife refusing sex with husband . 47 Table 3.11.2 Men’s attitude toward a wife refusing sex with husband. 48 Figure 3.1 Percent distribution of women and men who are currently employed, by occupation. 39 viii | Tables and Figures CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Table 4.1 Current fertility . 50 Table 4.2 Fertility by background characteristics . 52 Table 4.3 Trends in age-specific fertility rates. 53 Table 4.4 Children ever born and mean number of living children . 54 Table 4.5 Birth intervals. 55 Table 4.6 Age at first birth . 56 Table 4.7 Median age at first birth by background characteristics. 57 Table 4.8 Pregnancy and motherhood among teenage women. 58 Figure 4.1 Age-specific fertility rates (ASFR), by region . 50 Figure 4.2 Trends in age-specific fertility rates. 53 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods . 59 Table 5.2 Ever use of contraception. 61 Table 5.3 Current use of contraception . 62 Table 5.4 Current use of contraception by background characteristics . 64 Table 5.5 Current use of contraception by women's status. 65 Table 5.6 Number of children at first use of contraception . 66 Table 5.7 Knowledge of fertile period. 67 Table 5.8 Source of contraception. 68 Table 5.9 Informed choice . 69 Table 5.10 First-year contraceptive discontinuation rate . 70 Table 5.11 Reasons for discontinuation . 71 Table 5.12 Future use of contraception . 72 Table 5.13 Reason for not intending to use contraception . 72 Table 5.14 Preferred method of contraception for future use. 73 Table 5.15.1 Exposure to family planning messages: women . 74 Table 5.15.2 Exposure to family planning messages: men. 75 Table 5.16 Men’s attitudes toward contraception . 76 Figure 5.1 Contraceptive use among currently married women . 63 CHAPTER 6 ABORTION Table 6.1 Pregnancy outcome by background characteristics. 78 Table 6.2 Lifetime experience with induced abortion . 79 Table 6.3 Induced abortion rates . 80 Table 6.4 Induced abortion by background characteristics. 81 Table 6.5 Abortion trends. 83 Table 6.6 Use of contraception prior to pregnancy . 84 Figure 6.1 Age-specific fertility rtes (ASFR) and age-specific abortion rates (ASAR). 81 Figure 6.2 Total abortion rate by background characteristics. 82 Figure 6.3 Age-specific abortion rates (ASAR) for three-year periods prior to the 2005 MDHS . 83 Tables and Figures | ix CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 7.1 Current marital status . 86 Table 7.2 Age at first marriage . 87 Table 7.3 Median age at first marriage. 88 Table 7.4 Age at first sexual intercourse . 89 Table 7.5 Median age at first intercourse . 90 Table 7.6.1 Recent sexual activity: women. 91 Table 7.6.2 Recent sexual activity: men. 92 Table 7.7 Postpartum amenorrhea, abstinence, and insusceptibility. 93 Table 7.8 Menopause. 94 CHAPTER 8 FERTILITY PREFERENCES Table 8.1 Fertility preferences by number of living children . 96 Table 8.2 Desire to limit childbearing . 97 Table 8.3 Need for family planning among currently married women. 99 Table 8.4 Fertility planning status. 100 Figure 8.1 Fertility preferences among currently married women and men age 15-49 . 96 Figure 8.2 Distribution of births in the five years preceding the survey by fertility planning status . 101 CHAPTER 9 INFANT AND CHILD MORTALITY Table 9.1 Early childhood mortality rates . 105 Table 9.2 Regional infant mortality rates that correspond closely with the 5-9-year period prior to the 2005 MDHS. 106 Table 9.3 Early childhood mortality rates by socioeconomic characteristics. 107 Table 9.4 Early childhood mortality rates by demographic characteristics. 108 Table 9.5 Perinatal mortality. 109 Figure 9.1 Early childhood mortality rates for three 5-year periods prior to the 2005 MDHS . 106 CHAPTER 10 MATERNAL AND CHILD HEALTH Table 10.1 Antenatal care. 112 Table 10.2 Number of antenatal care visits and timing of first visit . 113 Table 10.3 Means of transport to last antenatal visit . 114 Table 10.4 Antenatal care education received during antenatal visit . 115 Table 10.5 Components of antenatal care . 117 Table 10.6 Tetanus toxoid injections . 120 Table 10.7 Pregnancy complications . 121 Table 10.8 Place of delivery . 123 Table 10.9 Assistance during delivery . 124 Table 10.10 Delivery characteristics . 125 Table 10.11 Problems in accessing health care . 128 x | Tables and Figures Table 10.12 Vaccinations by source of information. 130 Table 10.13 Vaccinations by background characteristics . 132 Table 10.14 Vaccinations in first 15 months of life. 133 Table 10.15 Prevalence and treatment of symptoms of ARI and fever. 134 Table 10.16 Prevalence of diarrhea . 135 Table 10.17 Knowledge of ORS packets . 136 Table 10.18 Feeding practices during diarrhea . 137 Figure 10.1 Proportion of women encouraged to invite a companion to attend the delivery. 116 Figure 10.2 Proportion of costs covered by the government or by an insurance program for antenatal care. 118 Figure 10.3 Proportion of costs covered by the government or by an insurance program for treatment of pregnancy complication. 122 Figure 10.4 Timeliness of postnatal examinations by a trained provider . 126 Figure 10.5 Percentage of children age 15-26 months vaccinated against childhood diseases at any time preceding the survey . 131 Figure 10.6 Proportion of children age 15-26 months who have received recommended vaccines before their first birthday . 131 Figure 10.7 Amount of food and liquid offered to children under five with diarrhea . 137 CHAPTER 11 NUTRITION Table 11.1 Initial breastfeeding. 140 Table 11.2 Breastfeeding status by child’s age. 141 Table 11.3 Foods consumed by children in the day and night preceding the interview . 142 Table 11.4 Iodization of household salt . 143 Table 11.5 Micronutrient intake among children . 146 Table 11.6 Micronutrient intake among mothers . 147 Table 11.7 Prevalence of anemia in children . 148 Table 11.8 Prevalence of anemia in women . 151 Table 11.9 Prevalence of anemia in children by anemia status of mother . 152 Table 11.10 Nutritional status of children . 155 Table 11.11 Nutritional status of women by background characteristics. 157 Figure 11.1 Type of salt used in daily food preparation, reported versus observed use . 144 Figure 11.2 Type of salt used for pickling. 145 Figure 11.3 Percentage of children with anemia, by severity of anemia and age . 150 CHAPTER 12 ADULT HEALTH Table 12.1 Type of health insurance coverage . 160 Table 12.2.1 Use of tobacco: women. 161 Table 12.2.2 Use of tobacco: men . 162 Table 12.3.1 Use of alcohol: women. 164 Table 12.3.2 Use of alcohol: men. 165 Table 12.4 Drinking more alcohol than usual . 166 Table 12.5 Knowledge of tuberculosis and its transmission modes . 168 Table 12.6.1 Knowledge of symptoms of tuberculosis: women . 169 Tables and Figures | xi Table 12.6.2 Knowledge of symptoms of tuberculosis: men. 170 Table 12.7 Knowledge of treatment of tuberculosis and attitude towards those with TB. 171 Figure 12.1 Percentage of cigarette smokers, by age group and sex . 162 Figure 12.2 Average number of alcoholic beverages consumed by females and males on a typical drinking occasion, by residence. 166 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 13.1 Knowledge of AIDS. 174 Table 13.2 Knowledge of ways to avoid HIV/AIDS. 175 Table 13.3 Knowledge of HIV prevention methods. 176 Table 13.4.1 Misconceptions and general knowledge about AIDS: women . 178 Table 13.4.2 Misconceptions and general knowledge about AIDS: men . 179 Table 13.5 Knowledge of prevention of mother-to-child transmission of HIV. 180 Table 13.6.1 Accepting attitudes toward those living with HIV: women. 182 Table 13.6.2 Accepting attitudes toward those living with HIV: men . 183 Table 13.7 Attitudes toward negotiating safer sex with husband. 184 Table 13.8 Adult support of education about condom use to prevent AIDS . 185 Table 13.9.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: women . 186 Table 13.9.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: men . 187 Table 13.10 Payment for sexual intercourse: men . 188 Table 13.11.1 Coverage of HIV testing: women . 189 Table 13.11.2 Coverage of HIV testing: men . 190 Table 13.12 Pregnant women who received information and counseling about HIV/AIDS. 191 Table 13.13 Self-reporting of sexually transmitted infections (STI) and STI symptoms. 193 Table 13.14 Prevalence of injections . 194 Table 13.15 General knowledge about AIDS and knowledge of a source of condoms among youth . 196 Table 13.16 Age at first sex among youth . 197 Table 13.17 Condom use at first sexual intercourse among youth. 198 Table 13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 199 Table 13.19 Higher-risk sex and condom use at last higher-risk sex in the past year among youth . 201 Table 13.20 Age-mixing in sexual relationships. 202 Table 13.21 Drunkenness during sexual intercourse among youth. 203 Table 13.22 Recent HIV tests among youth . 204 Figure 13.1 Reasons for having an HIV test among women and men age 15-49 who have ever been tested. 192 xii | Tables and Figures CHAPTER 14 DOMESTIC VIOLENCE Table 14.1 Experience of physical mistreatment . 208 Table 14.2 Perpetrators of violence . 209 Table 14.3 Marital violence . 210 Table 14.4 Onset of spousal violence . 212 Table 14.5 Physical consequences of spousal violence. 213 Table 14.6 Spousal violence by spousal characteristics and women’s status indicators . 214 Figure 14.1 Percentage of women who have experienced specific forms of spousal violence ever and in the 12 months preceding the survey . 211 CHAPTER 15 EMIGRATION Table 15.1 Households from which former members have emigrated. 218 Table 15.2 Characteristics of households from which former members have emigrated . 219 Table 15.3 Background characteristics of emigrants at time of emigration . 220 Table 15.4 Main reason for emigrating . 221 Table 15.5 Current age and sex of emigrants . 224 Table 15.6 Destination countries of emigrants . 226 Table 15.7 Characteristics of households caring for the children of emigrants . 226 Table 15.8 Children of emigrants left behind . 227 Figure 15.1 Percentage of households with at least one emigrant by wealth quintile . 219 Figure 15.2 Percent distribution of emigrants by year of emigration and sex . 222 Figure 15.3.1 Current age of emigrants from urban areas. 223 Figure 15.3.1 Current age of emigrants from rural areas. 223 Figure 15.4 Destination countries of emigrants . 225 Figure 15.5 Current age of emigrants’ children . 227 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Number of selected households and completed women and children interviews, by residence . 236 Table A.2 Proportional and non-proportional sample allocation. 236 Table A.3 Final recommended sample size . 237 Table A.4 Sample implementation: women . 237 Table A.5 Sample implementation: men. 238 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 241 Table B.2 Sampling errors for national sample . 242 Table B.3 Sampling errors for urban sample. 243 Table B.4 Sampling errors for rural sample. 244 Table B.5 Sampling errors for North sample. 245 Table B.6 Sampling errors for Center sample . 246 Table B.7 Sampling errors for South sample . 247 Tables and Figures | xiii Table B.8 Sampling errors for Chisinau sample . 248 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 249 Table C.2.1 Age distribution of eligible and interviewed women . 250 Table C.2.2 Age distribution of eligible and interviewed men. 250 Table C.3 Completeness of reporting . 251 Table C.4 Births by calendar years . 251 Table C.5 Reporting of age at death in days . 252 Table C.6 Reporting of age at death in months. 252 Preface | xv PREFACE On August 27, 1991, after almost 50 years as a Soviet republic, the Republic of Moldova became an independent country. The first decade of transition to a democratic system and market economy met with many challenges and hardships for the population. In the new millenium, however, there is evidence of trends towards social economic stability and improvement. These developments are due in large part to collaborative efforts between the Government of Moldova, the international community, and non- governmental organizations working together towards common goals. Population-based surveys are useful in quantifying the impact of these efforts because they provide an array of development indicators which reflect the current situation in the country. The 2005 Moldova Demographic and Health Survey (MDHS) provides many indicators for Moldova’s Millenium Development Goals (2004-2015), for example. Information from the 2005 MDHS will be used by policy- makers in various ministries, by program managers for planning purposes, by the international donor community, and by academic institutions and experts conducting in-depth research. Many of the results from the 2005 MDHS will also be used to analyze trends; indicators from this survey can be compared to results from other national surveys conducted previously in Moldova, including the 1997 Reproductive Health Survey and the 2000 Multiple Indicator Survey. Finally, indicators from the MDHS will be compared with those from other countries in the region. This final report, summarizing the demographic and health information collected in the 2005 MDHS, represents a significant undertaking and coordinated efforts of many entities. It was sponsored by the United States Government through the Agency for International Development (USAID) and co- sponsored by the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA). It was carried out by the National Center for Preventive Medicine, of the Moldova Ministry of Health and Social Protection, with technical assistance provided by ORC Macro. Considerable expertise was given by Moldova’s Department of Statistics, the Institute for Scientific Research in Mother and Child Protection, the Centers for Preventive Medicine, and other institutions. It is likewise important to recognize the work of field staff who collected data from over 11,000 households throughout the country, as they are ultimately responsible for the good quality data that were collected. Ion Bahnarel Director, National Scientific and Applied Center for Preventive Medicine, MOHSP Summary of Findings | xvii SUMMARY OF FINDINGS Moldova’s first Demographic and Health Survey (2005 MDHS) is a nationally representa- tive sample survey of 7,440 women age 15-49 and 2,508 men age 15-59 selected from 400 sample points (clusters) throughout Moldova (excluding the Transnistria region). It is designed to provide data to monitor the population and health situation in Moldova; it includes several indicators which follow up on those from the 1997 Moldova Repro- ductive Health Survey (1997 MRHS) and the 2000 Multiple Indicator Cluster Survey (2000 MICS). The 2005 MDHS used a two-stage sample based on the 2004 Population and Housing Census and was designed to produce separate estimates for key indicators for each of the major regions in Moldova, including the North, Center, and South regions and Chisinau Municipality. Unlike the 1997 MRHS and the 2000 MICS surveys, the 2005 MDHS did not cover the region of Transnis- tria. Data collection took place over a two-month period, from June 13 to August 18, 2005. The survey obtained detailed information on fertility levels, abortion levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, adult health, and awareness and behavior regard- ing HIV infection and other sexually transmitted diseases. Hemoglobin testing was conducted on women and children to detect the presence of anemia. Additional features of the 2005 MDHS include the collection of information on interna- tional emigration, language preference for reading printed media, and domestic violence. The 2005 MDHS was carried out by the National Scientific and Applied Center for Preventive Medicine, hereafter called the National Center for Preventive Medicine (NCPM), of the Ministry of Health and Social Protection. ORC Macro provided technical assistance for the MDHS through the USAID-funded MEASURE DHS project. Local costs of the survey were also supported by USAID, with additional funds from the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and in-kind contributions from the NCPM. CHARACTERISTICS OF RESPONDENTS Ethnicity and Religion. Most women and men in Moldova are of Moldovan ethnicity (77 percent and 76 percent, respectively), followed by Ukrainian (8-9 percent of women and men), Rus- sian (6 percent of women and men), and Gagauzan (4-5 percent of women and men). Romanian and Bulgarian ethnicities account for 2 to 3 percent of women and men. The overwhelming majority of Moldovans, about 95 percent, report Orthodox Christianity as their religion. Residence and Age. The majority of respondents, about 58 percent, live in rural areas. For both sexes, there are proportionally more respondents in age groups 15-19 and 45-49 (and also 45-54 for men), whereas the proportion of respondents in age groups 25-44 is relatively lower. This U-shaped age distribution reflects the aging baby boom cohort following World War II (the youngest of the baby boomers are now in their mid-40s), and their children who are now mostly in their teens and 20s. The smaller proportion of men and women in the middle age groups reflects the smaller cohorts following the baby boom gen- eration and those preceding the generation of baby boomers’ children. To some degree, it also reflects the disproportionately higher emigration of the working-age population. Education. Women and men in Moldova are universally well educated, with virtually 100 percent having at least some secondary or higher education; 79 percent of women and 83 percent of men have only a secondary or secondary special education, and the remainder pursues a higher education. More women (21 percent) than men (16 percent) pursue higher education. xviii | Summary of Findings Language Preference. Among women, preferences for language of reading material are about equal for Moldovan (37 percent) and Rus- sian (35 percent) languages. Among men, prefer- ence for Russian (39 percent) is higher than for Moldovan (25 percent). A substantial percentage of women and men prefer Moldovan and Russian equally (27 percent of women and 32 percent of men). Living Conditions. Access to electricity is almost universal for households in Moldova. Ninety percent of the population has access to safe drinking water, with 86 percent in rural areas and 96 percent in urban areas. Seventy-seven percent of households in Moldova have adequate means of sanitary disposal, with 91 percent of households in urban areas and only 67 percent in rural areas. Children’s Living Arrangements. Com- pared with other countries in the region, Moldova has the highest proportion of children who do not live with their mother and/or father. Only about two-thirds (69 percent) of children under age 15 live with both parents. Fifteen percent live with just their mother although their father is alive, 5 percent live with just their father although their mother is alive, and 7 percent live with neither parent although they are both alive. Compared with living arrangements of children in 2000, the situation appears to have worsened. FERTILITY Fertility Levels and Trends. The total fer- tility rate (TFR) in Moldova is 1.7 births. This means that, on average, a woman in Moldova will give birth to 1.7 children by the end of her repro- ductive period. Overall, fertility rates have de- clined since independence in 1991. However, data indicate that fertility rates may have increased in recent years. For example, women of childbearing age have given birth to, on average, 1.4 children at the end of their childbearing years. This is slightly less than the total fertility rate (1.7), with the dif- ference indicating that fertility in the past three years is slightly higher than the accumulation of births over the past 30 years. Fertility Differentials. The TFR for rural areas (1.8 births) is higher than that for urban areas (1.5 births). Results show that this urban-rural dif- ference in childbearing rates can be attributed almost exclusively to younger age groups. Unplanned Fertility. Twelve percent of births in Moldova are mistimed (wanted later) and almost 9 percent are unwanted. The percentage of births considered to have been unwanted is highest for births of order four and above, almost half of which were reported as not wanted at the time of conception. Similarly, a larger proportion of births to older women are reported as unwanted, com- pared with births to younger women. For example, only 5 percent of births to women age 20-24 are unwanted, compared with 30 percent among women age 35-39. Fertility Preferences. Results show that Moldovan women and men generally want small families. Overall, 64 percent of married women either do not want another child or are sterilized, 28 percent want to have another child—12 percent soon (within two years), 14 percent later, and 3 percent are undecided when—and the remaining 7 percent are either undecided or say they are unable to have another child. Fertility preferences among married men show a similar pattern to women, with an identical proportion (64 percent) either wanting no more children or sterilized. Men are slightly less likely than women to want another child (24 percent) and slightly more likely to be undecided. Furthermore, a large majority of those with two children (83 percent of women and 75 percent of men) say they do not want any more, as do 90 percent of women and 84 percent of men with three children. Even among those with one child, over one-third do not want to have another child. And surprisingly, 9 percent of women and 18 per- cent of men with no children say that they do not want any children. Age at First Birth. MDHS findings indicate that childbearing begins relatively late in Moldova; the majority of women age 20-24 years have never given birth. Between age 30 and 34, however, over 90 percent of women have given birth. The median age at first birth for women age Summary of Findings | xix 25 and older is 21 or 22 years, with little variation between age groups. CONTRACEPTION Knowledge of Contraception. Knowledge of family planning is nearly universal, with 99 per- cent of all women age 15-49 knowing at least one modern method of family planning. Among all women, the male condom, IUD, pills, and with- drawal are the most widely known methods of family planning, with over 80 percent of all women saying they have heard of these methods. Female sterilization is known by two-thirds of women, while periodic abstinence (rhythm meth- od) is recognized by almost six in ten women. Just over half of women have heard of the lactational amenorrhea method (LAM), while 40-50 percent of all women have heard of injectables, male ster- ilization, and foam/jelly. The least widely known methods are emergency contraception, diaphragm, and implants. Use of Contraception. Sixty-eight percent of currently married women are using a family planning method to delay or stop childbearing. Most are using a modern method (44 percent of married women), while 24 percent use a traditional method of contraception. The IUD is the most widely used of the modern methods, being used by 25 percent of married women. The next most widely used method is withdrawal, used by 20 percent of married women. Male condoms are used by about 7 percent of women, especially younger women. Five percent of married women have been sterilized and 4 percent each are using the pill and periodic abstinence (rhythm method). The results show that Moldovan women are adopting family planning at lower parities (i.e., when they have fewer children) than in the past. Among younger women (age 20-24), almost half (49 percent) used contraception before having any children, compared with only 12 percent of women age 45-49. Trends in Contraceptive Use. Contracep- tive use appears to have decreased slightly since 1997, from 74 to 72 percent of married women age 15-44.1 The proportion of women using modern methods has also decreased slightly from 50 to 48 percent. Use of the IUD has dropped considerably, from 38 percent of married women age 15-44 in 1997 to 28 percent of those age 15-44 in 2005. This decline has been partially offset by slight in- creases in use of condoms (from 6 to 9 percent of married women age 15-44), the pill (from 2 to 4 percent), and other methods like LAM and female sterilization. Use of traditional methods has remained steady. Differentials in Contraceptive Use. Although the level of any contraceptive use is about the same for married women in urban and rural areas (67-68 percent), urban women are more likely than rural women to use modern methods (48 and 41 percent, respectively). As expected, contraceptive use increases with level of educa- tion. For example, 72 percent of married women with higher education are using a method of con- traception, compared with 65 percent of women with secondary education. Use also tends to in- crease with the number of living children—from 36 percent among married women with no chil- dren to 74 percent among married women with 3 or 4 children. Although there is almost no difference in use of any contraceptive method by wealth quin- tile, there is a steady rise in use of modern meth- ods as wealth increases. For example, 37 percent of married women in the lowest wealth quintile are using a modern contraceptive method, compared with 51 percent of those in the highest wealth quintile. Source of Modern Methods. Public (gov- ernment) facilities provide contraceptives to more than two in three contraceptive users (69 percent), while 28 percent are supplied through private medical sources, and 3 percent through other pri- vate sources (e.g., shops). 1 The 1997 MRHS data refer to married women age 15-44; consequently, the data from the 2005 MDHS were recalculated for the same age group. Interpretation of trends is also hampered by the fact that the 1997 sur- vey included Transnistria, whereas the 2005 survey did not. xx | Summary of Findings Discontinuation Rates. Overall, more than one-third (38 percent) of family planning users in Moldova discontinue using their method within 12 months of starting its use. Seven percent of users stop using as a result of method failure (i.e., unin- tended pregnancy), while 4 percent discontinue because of a desire to become pregnant, and 18 percent switch to another method. Discontinuation rates are highest for users of LAM (91 percent), presumably because it is only usable immediately after giving birth and its effec- tiveness declines sharply after six months. Discon- tinuation rates are also high for pill users—half of whom stop using within 12 months after starting— and for users of condoms (39 percent), withdrawal (37 percent), and rhythm method (35 percent). On the other hand, very few IUD users (7 percent) discontinue using their method within a year. For all methods, the most common reason for discon- tinuation was to switch to another method. Unmet Need for Family Planning. Seven percent of currently married women in Moldova have an unmet need for family planning, 3 percent for spacing births and 4 percent for limiting. If all these women with unmet need were to join the 68 percent who already are using family planning (met need), the contraceptive prevalence rate could increase from the current level of 68 percent to 75 percent (total demand). In short, 91 percent of the total demand for family planning among married women has been satisfied. ABORTION Reliance on induced abortion was the pri- mary means of fertility control throughout the for- mer Soviet Union, including the former Soviet Republic of Moldova. In the decade after Moldova’s independence in 1991, abortion rates began to decrease as the practice of modern con- traception became more widespread. This decreas- ing trend, however, has stalled since 2000 mainly because older women still rely on abortion to limit childbearing. Thus, abortion is still a key factor in Moldova’s reproductive trends. Pregnancy Outcomes. Slightly more than half of pregnancies in Moldova end in a live birth (55 percent). The majority of pregnancy losses are due to induced abortions (34 percent of pregnan- cies), followed by miscarriages (10 percent) and stillbirths (less than 1 percent). These estimates do not appear to have changed significantly since those in 1997 despite sampling differences (see chapter 6). Lifetime Experience with Abortion. Over- all, more than a third of women (37 percent) of reproductive age have had at least one abortion. This proportion increases rapidly with age, with 61 percent of women age 35 or older having had at least one abortion. The mean number of abortions among women who have had at least one abortion is 2.2. Among women who have ever had an abor- tion, over half have had more than one (59 per- cent). The 2005 MDHS data do not differ signifi- cantly from those in the 1997 MRHS in terms of the percentage of women who reported ever hav- ing had an abortion (37 percent and 39 percent, respectively). Abortion Rates. The lifetime total abortion rate (TAR) for the three-year period prior to the survey is 1.1 abortions per woman. The TAR for married women only, during the same time period, is 1.3 abortions per married woman. Comparing national abortion rates with fer- tility rates, the pattern indicates that fertility rates are significantly higher than abortion rates for women under age 30. The pattern is reversed for older women, with older women more likely to have an abortion than to bear a child. Abortion Differentials. The TAR is slightly higher in urban areas than rural areas (1.3 and 1.0, respectively). TARs do not vary significantly by residence or level of education. The lowest TAR of 0.7 is recorded for women in the poorest wealth quintile, while the highest TAR (1.4) is observed among women in the highest quintile and also for women in Chisinau. Trends in Abortion Rates. On average, women in Moldova who have come to the end of their reproductive years have had an average of 1.5 abortions. Comparing this with the TAR of 1.1—a measure of the current level of induced Summary of Findings | xxi abortion across all age groups—the level of in- duced abortion appears to have decreased over time. However, another more sensitive approach to identifying abortion trends points to stagnation in the TARs for women age 15-44 since the mid- 1990s, and an increase in age-specific abortion rates (ASAR) for women in their 30s since 2003. The general abortion rate (GAR), the number of abortions annually per 1,000 women age 15-44, shows a modest decrease since the late 1990s, but no improvement since 2002. MATERNAL HEALTH Antenatal Care and Delivery Care. Among women with a birth in the five years pre- ceding the survey, almost all reported seeing a health professional at least once for antenatal care during their last pregnancy; nine in ten reported 4 or more antenatal care visits. Seven in ten women had their first antenatal care visit in the first trimester. In addition, virtually all births were deliv- ered by a health professional, in a health facility. Results also show that the vast majority of women have timely checkups after delivering; 89 percent of all women received a medical checkup within two days of the birth, and another 6 percent within six weeks. Components of Antenatal Care. Among women with a birth in the past five years, over 95 percent had their weight measured, their blood pressure taken, and gave a blood and urine sample for analysis during their last pregnancy. Fewer of these mothers, however, benefited from additional preventive care; only 54 percent received iron tab- lets during their last pregnancy and 21 percent received folic acid. Ninety percent had received at least one tetanus toxoid injection at some time in their life. Antenatal Education. Approximately 8 in 10 women with a birth in the five years preceding the survey received information on: smoking and alcohol use during pregnancy; the benefits of breastfeeding; emergency delivery plans; and fam- ily planning. However, given that 61 percent of women experienced some pregnancy complication during their last birth, however, pregnancy care education during antenatal visits could be im- proved. CHILD HEALTH Childhood Mortality. The infant mortality rate for the 5-year period preceding the survey is 13 deaths per 1,000 live births, meaning that about 1 in 76 infants dies before the first birthday. The under-five mortality rate is almost the same with 14 deaths per 1,000 births. The near parity of these rates indicates that most all early childhood deaths take place during the first year of life. Comparison with official estimates of IMRs suggests that this rate has been improving over the past decade. Childhood Vaccination Coverage. Overall, 85 percent of children age 15-26 months are fully vaccinated, and 76 percent of these children were fully vaccinated in their first year of life (or by 15 months for measles, mumps and rubella). These levels show a slight improvement since the 2000 MICS estimates, but more timely coverage is needed so that children benefit from the protective effects of all vaccinations by their first birthday. Similarly, overall coverage levels could be im- proved if children in urban areas, and especially Chisinau, completed all doses of all vaccines required by the National Immunization Program of the Republic of Moldova. Childhood Illness and Treatment. Among children under 5 years of age, 7 percent were re- ported to have had symptoms of acute respiratory illness in the two weeks preceding the survey, while 16 percent had a fever, and 7 percent had diarrhea. Fifty-four percent of children with symp- toms of ARI and/or fever were taken to a health facility or provider for treatment. NUTRITION Breastfeeding Practices. Breastfeeding is nearly universal in Moldova: 97 percent of chil- dren are breastfed. However the duration of breast- feeding is not long, exclusive breastfeeding is not widely practiced, and bottle-feeding is not un- common. In terms of the duration of breastfeeding, xxii | Summary of Findings data show that by age 12-15 months, well over half of children (59 percent) are no longer being breastfed. By age 20-23 months, almost all chil- dren have been weaned. Exclusive breastfeeding is not widely prac- ticed and supplementary feeding begins early: 57 percent of breastfed children less than 4 months are exclusively breastfed, and 46 percent under six months are exclusively breastfeed. The remaining breastfed children also consume plain water, wa- ter-based liquids or juice, other milk in addition to breast milk, and complimentary foods. Bottle-feeding is fairly widespread in Mol- dova; almost one-third (29 percent) of infants un- der 4 months old are fed with a bottle with a nip- ple. Iodine Consumption. Disorders induced by dietary iodine deficiency constitute a major nutri- tional concern in Moldova. Sixty percent of households currently use adequately iodized salt. Improvement in coverage is most needed in rural areas, and especially the South region where only 44 percent of households use iodized salt. Anemia Status of Women and Children. Iron deficient anemia is a health concern that could be addressed with adequate iron supple- ments for women—especially pregnant women— and young children. Twenty-eight percent of women in Moldova have some level of anemia— 40 percent of pregnant women are anemic—and about one-third of children age 6-59 months have mild or moderate anemia. Nutritional Status of Children. At the na- tional level, about 8 percent of children under age five are stunted (low height-for-age), while about 4 percent of children are wasted (low weight-for- height), and 4 percent are underweight (low weight-for-age). Nutritional Status of Women. The mean body mass index (BMI) for women age 15-49 is 25. This is the cutoff point between a normal and overweight BMI. The proportion of overweight or obese women is positively correlated with women’s age. The age group 45-49 has the highest proportion (74 percent) of overweight or obese women, while age group 15-19 has the lowest pro- portion (8 percent). At the national level, the mean height for women is 161 cm, with less than 1 percent of women falling below the cutoff of 145 cm. HIV/AIDS KNOWLEDGE Awareness of HIV/AIDS. Awareness of HIV/AIDS is almost universal among persons of reproductive age. Ninety-seven percent of men and women age 15-49 have heard of HIV/AIDS, but men are slightly better informed than women about specific ways to avoid contracting the dis- ease: 81 percent of women and 89 percent of men indicate that the chances of getting the AIDS virus can be reduced by limiting sex to one faithful partner; 78 percent of women and 87 percent of men are aware that condoms can reduce the risk of contracting HIV during sexual intercourse; and 63 percent of women and 85 percent of men know that abstaining from sex reduces the chances of getting the disease. Seventy-six percent of women and 78 percent of men know that a healthy-looking person can have the AIDS virus. Knowledge patterns between men and women are reversed for mother-to-child transmis- sion of HIV: 68 percent of women compared with 53 percent of men know that HIV can be transmit- ted by breastfeeding; 86 percent of women and 79 percent of men know the disease can be transmit- ted from the mother to the child during pregnancy; and 82 percent of women and 76 percent of men know it can be transmitted during delivery. Attitudes Toward People with HIV. The level of stigma associated with HIV/AIDS is high in Moldova, for both sexes. While most respon- dents age 15-49 would be willing to care for a family member with HIV at home (76 percent of women and 56 percent of men) and would not necessarily want the HIV-positive status of a fam- ily member to remain a secret (61 percent of women and 51 percent of men), far fewer would buy fresh vegetables from a vendor with AIDS (11 percent of both women and men), or believe a fe- male teacher with HIV should be allowed to teach (28 percent of women and 23 percent of men). Summary of Findings | xxiii Only 5 percent of women and 3 percent of men express acceptance on all four measures. HIV-Related Behavioral Indicators. Among respondents who reported having sex in the 12 months preceding the survey, a substan- tially larger proportion of men than women re- ported having had more than one sexual partner (14 percent for men and 2 percent for women). More men than women also reported having had higher-risk sex at some time in the past 12 months (34 and 13 percent, respectively). Only about one- third of women reported using a condom the last time they had sex with a nonmarital, nonco- habiting partner (34 percent), while over half of men did (54 percent). The proportion of women and men age 15-24 that had sex before age 15 is about 1 percent for young women and 9 percent for young men. By age 18, however, 19 percent of young women and 44 percent of young men have had sex. Among sexually active women and men age 15-24, 36 percent and 84 percent, respectively, have had sexual relations with a nonmarital, non- cohabitating partner in the year preceding the sur- vey. Injections. The data show that receiving medical injections is a common practice in Moldova. One-third of women and 28 percent of men received at least one medical injection in the year preceding the survey—women received an average of 6 injections and men received an aver- age of 3.2 injections. Ninety-nine percent of the last injections were administered with an unused syringe from a previously unopened package. HIV Testing. Thirty-six percent of women in Moldova have been tested for HIV at some time, compared with 30 percent of men. Thirty- four percent of women and 27 percent of men were tested and also received the results of their HIV test. DOMESTIC VIOLENCE Violence Since Age 15. MDHS data show that one-quarter of all women (27 percent) have experienced violence since they were age 15 and 13 percent experienced violence in the 12 months preceding the survey. The main perpetrators of violence against women are husbands (69 percent) and, to a lesser extent, fathers/stepfathers (14 per- cent), and mothers/stepmothers (7 percent). Marital Violence. Twenty-three percent of ever-married women report having experienced emotional violence by husbands, 24 percent report physical violence, and 4 percent report sexual vio- lence. Almost one-third (32 percent) of ever- married women report suffering emotional, physi- cal, or sexual violence, while 3 percent have experienced all three forms of violence by their current or most recent husband. The data further show that divorced or sepa- rated women are more than twice as likely as mar- ried women to have been abused emotionally, physically, and sexually, suggesting that the vio- lence might have been a factor in the termination of their marriages. EMIGRATION In Moldova, and in post-Soviet states in gen- eral, large-scale labor emigration is an important demographic phenomenon that has a substantial negative impact on the population growth as well as on the social and economic structure of society. Emigrant Households. Seventeen percent of households in Moldova have at least one former member who emigrated. This percentage is about the same in urban and rural households. The high- est percentage of households with at least one emigrant is in the South region (21 percent) and the lowest is in Chisinau (13 percent). Emigrant Characteristics. A slightly high- er proportion of emigrants are males (52 percent, compared with 48 percent for women). However, in Chisinau and the South region, a slightly higher proportion of emigrants are females. The distribu- tion of emigrants by age at emigration is similar for males and females. The most common age group for emigration is age 20-24 for both sexes. This age group accounts for roughly one-quarter of all emigrants (22 percent of females and 27 per- cent of males). Approximately three-quarters of all emigrants leave the country between age 15 and xxiv | Summary of Findings 39 (73 percent of females and 79 percent of males). More than one-quarter of both males and females living abroad have left behind a wife or husband in their original household. Over half of emigrants are the son or daughter, or son-in-law or daughter-in-law, of the head of the household (55 percent of female emigrants are the daughter or daughter-in-law, 64 percent of male emigrants are the son or son-in-law). Forty-two percent of emigrants left children in Moldova, with 37 percent of emigrants from urban areas and 45 percent from rural areas having left at least one child behind. Among the emi- grants who left children behind, about 2 in 10 left behind two or more children. Main Reason for Emigrating. Not surpris- ingly, labor is overwhelmingly the main reason that people from Moldova emigrate. Household respondents report that for 83 percent of female emigrants and 91 percent of male emigrants, work was the main reason for moving abroad. An addi- tional 7 percent of women and 3 percent of men emigrated to accompany their spouse or family abroad; 3 percent of women and 1 percent of men emigrated in order to marry a foreigner. Five per- cent or less of emigrants left Moldova with their main purpose being to study abroad. Emigration Trends. Data show that emi- gration was negligible prior to the dissolution of the Soviet Union in 1991, and throughout most of the first decade of Moldova’s independence. Emi- gration accelerated in the late 1990s and was con- tinuing to accelerate at the time of the survey. Over half (57 percent) of all emigrants reported in the survey left Moldova between 2001 and mid- 2005. Destination Countries. Given that many Moldovans are ethnic Russian, half of emigrants went to Russia (a total of 54 percent went to some country of the former Soviet Union, including Russia). One-third of all emigrants moved to Western Europe, with Italy as a primary destina- tion (20 percent), followed by Portugal, Greece, and Spain. The remaining emigrant destinations included Turkey, North America, Israel, Romania, and other countries. Millennium Development Goal Indicators | xxv Millennium Development Goal Indicators na = Not applicable 1 Based on children born in the 5 years preceding the survey. For children without a reported birth weight, the proportion with low birth weight is assumed to be the same as the proportion with low birth weight in each birth size category among children who have a reported birth weight. 2 Based on de jure members. Numerator is children age 7-11 currently attending school; denominator is children 7-11 years old. 3 Based on de jure members. This indicator is calculated using rates of promotion, dropout, and repetition for a given school year. These rates are used to project an estimate for the percentage of students attending grade 1 who are expected to reach grade 5, with or without repetition. 4 Numerator is respondents 15-24 years old who can read part of a sentence or the whole sentence; denominator is respondents 15-24 years old. 5 The ratio of girls to boys for primary/secondary/tertiary education is the ratio of the primary/secondary/tertiary education GAR for females to the GAR for males. (The GAR is the total number of primary/secondary/ tertiary education students, expressed as a percentage of the official level of education-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent.) 6 Numerator is all women working in the non-agricultural sector who received payment in cash or kind; denominator is all women. 7 In Moldova, the measles vaccination is given at the age of 12 months (unlike the standard 9 months in many countries). The values presented in the table are for children 12-59 months who have been vaccinated at any time against measles. The prevalence of children vaccinated against measles by age 15 months is significantly lower, however, at 83.4 percent. 8 Skilled health personnel includes: doctor, nurse, midwife, and auxiliary midwife. 9 Higher-risk sex is sexual intercourse with a nonmarital, noncohabiting partner. 10 Respondents with “general knowledge” of AIDS are those who say that using a condom for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, and furthermore say that a healthy-looking person can have the AIDS virus, and who reject the common misconception that HIV can be spread by sharing food with someone with AIDS. 11 Note that these indicators do not take into account children who live outside of households, e.g., in institutions or on the street, because the MDHS includes only households in its sample. 12 Solid fuel includes: wood, straw, crops and other. 13 Improved drinking water sources includes: water from pipe/tap and from protected well. 14 Improved sanitary means of excreta disposal includes: flush toilet, ventilated improved pit latrine, and latrine with a slab. Goal Indicator Value Male Female Total 1. Eradicate extreme poverty and hunger Prevalence of underweight in children under five years of age 1 3.4 5.2 4.3 Male Female Total 2. Achieve universal primary education Net enrollment ratio in primary education2 77.5 78.8 78.2 Percent of pupils starting grade 1 who reach grade 53 99.8 100.0 99.9 Literacy rate of young people age 15-24 years4 99.5 99.7 99.6 3. Promote gender equality and empower women Ratio of girls to boys in primary school5 1.03 Ratio of girls to boys in secondary school5 1.05 Ratio of girls to boys in tertiary education5 1.34 Ratio of literate women to men, age group 15-24 years 1.00 Share of women in wage employment in the nonagricultural sector6 80.2 Male Female Total 4. Reduce child mortality Under-five mortality rate 12.8 14.9 13.6 Infant mortality rate 11.3 14.5 12.8 Percent of children age 15-26 months immunized against measles7 90.8 90.3 90.6 5. Improve maternal health Percent of births attended by skilled health personnel8 99.5 Male Female Total 6. Combat HIV/AIDS, malaria, and other diseases Percentage of current users of contraception who are using condoms (all women) na 20.4 na Condom use at last higher-risk sex9 53.7 33.8 42.4 Percentage of population age 15-24 years with general knowledge about HIV/AIDS10 54.3 41.6 44.3 Contraceptive prevalence rate (all women) 49.8 Contraceptive prevalence rate (married women and women in union) 67.8 Ratio of school attendance of orphans to school attendance of nonorphans age 10-14 years11 0.9 Percent of population in malaria-risk areas using effective malaria prevention and treatment measures na Urban Rural Total 7. Ensure environmental sustainability Percent of population using solid fuels for cooking, urban and rural 12 1.4 24.3 15.1 Percent of population with sustainable access to an improved water source, urban and rural13 96.4 85.5 89.7 Percent of population with access to improved sanitation, urban and rural14 91.1 67.4 76.8 Percent of households with access to secure tenure na na na xxvi | Map of Moldova Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY AND POPULATION The Republic of Moldova is a small, landlocked country in Eastern Europe. It has a surface area of 33,700 square kilometers and shares a border with Romania and Ukraine. The main water arteries are the Dniester River (657 km long) and the Prut River (695 km long). The terrain consists mainly of rolling plains with the highest point in the country measuring an altitude of 430 meters. Moldova became independent from the Soviet Union on August 27, 1991. A new constitution was adopted in 1994. The judicial branch of government is composed of a Supreme Court and a Constitutional Court which reviews legislative acts and governmental decisions. The legislative branch of government is composed of a unicameral Parliament. In the executive branch, the president is elected by Parliament for a four-year term and eligible for a second term. The territory of Moldova is divided into administrative-territorial units. As of January 1, 2006 these units consist of 32 districts (raions), 5 municipalities, 60 towns and 917 villages (communities), and 1,575 rural settlements. There are two territorial units to which special terms of autonomy are attributed: the autonomous territory of Gagauz, and the territory of Transnistria located on the east side of the Dniester River. Moldova’s official population count registered in the population census of October 5, 2004, excluding the districts in the region of Transnistria, was 3.4 million. Moldova has the highest population density of any of the former Soviet Republics; on average, there are about 111 people per square kilometer, and about 1,255 people per square kilometer in Chisinau. Compared with the population count in the 1989 census, Moldova’s population has decreased by approximately 274,000 people. The rate of population decline, determined both by a greater number of deaths than live births, as well as a surplus of emigrants over immigrants, results in a negative population growth estimated to be about -0.5 percent. An aging population is a consequence of a declining population; since 1989, there has been a decrease in the proportion of young people under age 15 and a simultaneous increase in the proportion of working-age and elderly people age 60 and older. The average age registered in the 2004 census was 35.3 years, compared with 32 years in the 1989 census data. The average life expectancy at birth in 2004 was 64.5 years for males and 72.2 years for females. The life expectancy is also higher in urban areas than rural areas—both men and women in urban areas live approximately 3 years longer than those in rural areas. The ethnic composition of Moldova as registered in the 2004 census reveals that the majority of the population is ethnic Moldovan (76 percent), followed by Ukrainian (8 percent), Russian (6 percent), Gagauz (4 percent), Romanian (2 percent) and Bulgarian (2 percent). Other ethnic groups make up about 1 percent of the population. The overwhelming majority of Moldovans are affiliated with the Orthodox religion. 1.2 HISTORY Moldova lies between the Carpathian Mountains, the Black Sea, and the Dniester River. The first communities in this region emerged approximately 300,000 years ago. This territory, lying in the path of numerous migrating tribes and peoples, evolved as a mix of cultures, civilizations, and communities. From the 3rd century B.C. to the 1st century A.D., Geto-Dacian kingdoms emerged in the Carpathian- Balkan region; the strongest of these were the Burebista (82-44 B.C.) and Decebal (87-106 A.D.) king- doms. The domination of the Roman Empire in Dacia (106-275) led to the Romanization of the 2 | Introduction Carpathian-Danube population and of tribes migrating from the east, including Slavs who settled in the region. By the 8th or 9th century, a distinct East-Romanic (Romanian) community had emerged. From the end of the 13th century to the first half of the 14th century, the process of establishing independent states to the east of the Carpathian Mountains accelerated. The medieval state of Moldova dates back to 1359. The territory of Moldova expanded in the second half of the 14th century when, with the liberation of the Carpathian-Danube region from Mongol-Tatar domination, it extended its borders to the Black Sea. The peak of development of the medieval Moldovan state was reached in the second half of the 15th century, during the rule of Stephen the Great; this period saw the consolidation of internal power in Moldova and an increase in its prestige in international relations. In 1538 Moldova fell under the domination of the Ottoman Empire. This lasted three centuries and during that time Moldova lost part of its territory—first the southern part of the country and later other parts were taken from Moldovan jurisdiction and governed directly by the Ottoman and Tatar authorities. The vassalage regime was initially a protective suzerainty but eventually became more restrictive as it laid down its power structures. Moldova, however, remained autonomous in the organi- zation and management of the state’s internal affairs. In the 18th century, Moldova experienced a range of military confrontations with the Ottoman, Russian, and Habsburg Empires; the battles conducted on Moldovan territory resulted in the loss of more territory. Following the Russian-Turkish war (1806-1812), the eastern part of Moldova between the Prut and the Dniester Rivers, called Bessarabia, became part of the Russian Empire. In 1859, the western part of Moldova between the Carpathian Mountains and the Prut River joined with Wallachia to be united as the Kingdom of Romania. On December 2, 1917, Bessarabian authorities proclaimed the independence of the Republic of Moldova. Shortly thereafter, however, on March 27, 1918, Bessarabia united with Romania. After the creation of the Soviet Union in 1922, the Soviet government established the Moldavian Autonomous Soviet Socialist Republic (Moldovan ASSR); on August 2, 1940, the Soviets created the Moldavian Soviet Socialist Republic (Moldavian SSR) by combining the territories of Bessarabia (eastern Moldova) and the Moldovan ASSR. During the 1940s the population inhabiting this region experienced difficult times: thousands of peasants were uprooted or killed, and many villages were devastated as a result of the Soviet invasion (1940), the Romanian-German operations in World War II (1941-1944), and the subsequent forced collectivization and deportations to Siberia and Kazakhstan. An estimated 115,000 peasants died because of the famine in 1946-1947 (Gribincea, 1995; Taran et al., 1993). Post-war development of Moldovan society was characterized by greater integration into the Soviet social, economic, and cultural spheres. An important economic and scientific potential evolved but its development was hampered by an inflexible totalitarian, centralized regime. By the end of the 1980s, the social economic situation deteriorated abruptly, portending the eventual break-down of the Soviet system. Following the collapse of the Soviet Union on August 27, 1991, an independent Republic of Moldova (Moldova) was proclaimed, marking the beginning of a new epoch in the development of the country and its society. Independent Moldova undertook the difficult challenges of transitioning from a totalitarian society, based on a centrally planned economy, to a liberal democratic society, based on a market economy. It confronted complex political, economic, social, and cultural issues. The formation of Moldova as an independent state took place under already difficult social economic conditions, during a tense political situation, and in the face of substantial social and cultural differences within the population. Introduction | 3 The first decade of transition saw a continuous decrease in the value of the gross domestic product (GDP), such that by the end of the decade it was less than 40 percent of that registered in 1990. In 1992, Moldova underwent a short but bloody conflict in the territory situated to the east of the Dniester River (Transnistria). This conflict resulted in over 1,000 deaths and casualties and over 130,000 refugees. The situation remains unresolved today. Now, at the beginning of the 21st century, Moldova is making serious efforts to overcome obstacles and avoid crises. It is seeking ways to optimize reforms in political and economic life such that it continues to become more integrated into the European Community and on its way towards a better future. 1.3 ECONOMY Moldova is an agrarian-industrial country. It enjoys a favorable climate and has an abundance of arable lands. Since Moldova does not have within its borders an important quantity of mineral resources, the economy depends greatly on its agricultural potential. Rich, black soil covers almost three quarters of the territory’s surface, and the favorable climate is conducive to reaping two harvests per year. The main crops are cereals, maize, sugar beet, sunflower, tobacco, vine, vegetables, and fruit. Agricultural products account for approximately 60 percent of the export values. Moldova’s industry is concentrated mainly on processing agricultural raw materials, in particular, the production of wine and cigarettes and the processing of tobacco. This activity is complemented by light industries such as chemical industry, wood processing, machine building, and the manufacturing of some equipment. Heavy industry such as cement works and metallurgy is concentrated in the Transnistria region and has a market in Russia. Some of Moldova’s electrical power is generated at the hydroelectric station on the Dniester River and at thermoelectric power plants. These sources of energy, however, are not sufficient to meet the needs of the country. This circumstance creates a significant dependence on Russia and Ukraine to supply supplemental energy sources, which in turn results in payment issues and ultimately in an increase in Moldova’s external debt. Moldova’s need for energy resources (e.g., petrol, coal, natural gas) are thus only satisfied when supplemental energy is imported, and in particular from Russia. The Government of Moldova has made progress in implementing economic reforms, including the introduction of a stable currency, privatization of enterprises, liberalization of prices and interest rates, etc. Overall, the reforms implemented in recent years have had positive results. For example, the private sector currently contributes over 60 percent of the GDP and the market is functioning with commercial banks, stock exchanges, free economic zones, etc. The distribution of GDP per economic sector is, for agriculture, 48 percent; for industry, 28 percent; and for services, 24 percent. Economic reforms in Moldova have been largely supported by international agencies. Since 1992, when Moldova joined the International Monetary Fund (IMF), the Word Bank (WB), and the European Bank for Reconstruction and Development (EBRD), it has benefited from many investments from international financial banking structures as well as various states such as Romania, Russia, USA, Germany, Japan, and others. Despite attaining some macroeconomic benchmarks, however, the sharp decline of economic activity in the first decade after independence lead to an acute growth of poverty in the 1990s—Moldova went from a country with an overall medium income level to one with an overall low income level. At the end of the 1990s, over 70 percent of the country’s population was considered poor (and approximately 60 percent were considered very poor), the GDP reached in real terms only 34 percent of the 1990 level (Ministry of Economics and Commerce, 2005). Moldova’s social indicators have also been among the 4 | Introduction worst in the region. In 2003, UNDP’s human development indicators ranked Moldova only 117th out of a total of 177 countries, and in last place among all CIS countries except Tajikistan (UNDP, 2005). The crisis related to Moldova’s transition lasted until 2000, when the economy finally started to manifest a sustainable growth. Between 2001 and 2004, Moldova’s economy grew by over 30 percent, while the GDP average annual growth constituted about 7 percent. The economic growth has determined a marked decrease in poverty rates, which, according to estimates, have dropped in 2004 to over a half of the highest levels registered in 1999 (World Bank, 2005). The export of labor force denoted by emigrating Moldovans of working age, and the resulting influx of currency transfers generated by the activity of Moldovans living abroad, represent important social and economic trends in Moldova. The 2004 population census revealed that over 357,000 Moldovans (approximately one-quarter of the total labor force) currently work abroad. Due to the increase in the flow of emigrants, especially between 1999 and 2004, the officially registered currency transfers from abroad have increased from 5 percent to approximately 27 percent of the GDP, thus placing Moldova among world economies that are most dependent on remittances (World Bank, 2005). 1.4 CHARACTERISTICS OF THE HEALTH SYSTEM 1.4.1 Facilities and Human Resources The main goal of Moldova’s health system is the assurance of quality medical services to all citizens. In recent years, the health system has undergone numerous functional and administrative reforms and readjustments. The Ministry of Health and Social Protection has concentrated its efforts on the following objectives: • Establishment of a legislative and normative basis for the implementation of compulsory health insurance; • Consolidation of primary and emergency health care sectors; • Increase in the quality of medical services offered; • Establishment of a network of state pharmaceutical institutions to rationally distribute medical supplies of high quality and low price; • Establishment of an evaluation and accreditation system for sanitary conditions in medical institutions; • Establishment of financial and contractual requirements between payers, suppliers and consumers of medical services; and • Identification of evidence-based clinical protocols for quality management of medical services. The principles of family medicine underpin Moldova’s national health care system. The national health care system promises to offer all citizens an equal opportunity to receive certain medical services free of charge. These services have been stipulated in the United Program of Compulsory Health Insurance (United Program), which is approved annually by the Government of Moldova. The United Program is financed with funds from the National Health Insurance Company. Those insured under the United Program benefit from the following health services: Introduction | 5 • Emergency care at the pre-hospital stage, provided by the district, municipal, or zonal emergency health care services; • Primary care, provided by a family doctor, in a Family Doctor Center or as home-based health care; • Specialized outpatient care, provided by specialized doctors at consulting hospitals and regional medical institutions; • Dental care; • Hospital care at in-patient medical institutions; • Paramedical services of simple or complicated nature; and • Maternal and child health including iron and folic acid for pregnant women, out-patient treatment for children under age 5, and partial or full compensation for medical supplies. Almost all employees in Moldova’s health system—including 10,753 doctors and 23,147 paramedical personnel—are state employees. Approximately 36 doctors per 10,000 persons serve people in urban areas, while about 12 doctors per 10,000 persons serve rural inhabitants. The coverage of paramedical personnel is better and constitutes 66 paramedics per 10,000 people. The average ratio of paramedical personnel per doctor is 2.2 (SACPHHM, 2005). A widespread and persistent problem in Moldova’s health care system is low salaries for medical personnel; the average monthly salary, despite general economic growth experienced in recent years, is about 125 USD for doctors and 70 USD for nurses. 1.4.2 Reforms of the Health System of the Republic of Moldova Throughout the past decade, as a result of the 1995 Health Protection Law and the 1997-2003 Health Sector Strategy, the Government of Moldova has put forth a variety of regulations and statutory acts aimed at addressing structural inefficiencies, streamlining human resources, improving health sector financing and equitable access to services, ensuring implementation and monitoring of national health policies, working out inter-sectoral programs, and involving the community in healthcare related decisions. The following legislative and statutory acts underlie the structural and organizational reforms in the healthcare system, namely: • Reform of primary health care (PHC) through institutionalizing family doctors and promoting the principle of free choice by the patient; institutionalizing per capita financing of PHC; and delegating the management of PHC, hospitals and emergency services to local public administration authorities (1997); • Establishment of the State Sanitary Epidemiologic Service (SSES); • Adoption of a legislative framework to introduce compulsory health insurance in January 2004, based on the taxation of salaries (2 percent from employees and 2 percent from employers); and • Reorganization of health services into a single package, comprising, at the district level, services at a hospital, a PHC service, emergency services, and specialized out-patient services. Although still from separate budgets, they would be managed by a single district Chief Medical Officer. 6 | Introduction A distinctive achievement in the past decade is the establishment of a minimal package of services offered free of charge to the entire population of Moldova.1 Those who are not insured through their work or otherwise insured receive free health care including preventive and primary health care (provided by a family doctor at the pre-hospital stage), inpatient medical care in case of major surgery or a medical emergency, and health care for infectious and chronic diseases such as tuberculosis, cancer, mental disorders, HIV/AIDS, and other diseases. 1.4.3 Specific Health Care Services Emergency Health Care. The National Scientific and Practical Emergency Medicine Center oversees emergency health care in Moldova. Emergency services are administered through 4 regional nodes located in the North, Center, South, and Autonomous Territory of Gagauzia, as well as 43 sub-units and 74 emergency health care posts in rural settlements. Altogether, 497 doctors, 907 paramedical personnel, and 303 ambulance fleets attend to medical emergencies. Primary Health Care Service. The main objectives of primary health services are to promote health and wellness, protect maternal and child health, improve health care coverage in rural areas, develop professional and technological capacity, prevent and control transmissible diseases, and implement a family planning program. Primary health care services are provided by 35 district Family Doctor Centers, 392 Health Centers, and 551 Family Doctor Offices. The number of family doctors in 2005 was 2,066. Hospital and Specialized Out-patient Health Care. Hospital and specialized out-patient health care, including dental care, is provided by specialized consulting sections of district hospitals. A review of hospitals in rural areas concluded that the average number of beds in rural hospitals was too high and thus inefficient from an economic and medical standpoint; Moldova, therefore, worked to streamline the number of beds in hospitals. Overall, the absolute number of beds dropped from 45,665 in 1998 to 20,457 in 2005, due mainly to the liquidation of hospitals in rural settlements that had a capacity of 50-100 beds each. In the same period, the number of hospitals was reduced from 245 to 65. Improvements in hospital indicators have since been observed, for example, the average duration of hospitalization decreased from 17.5 days in 1998 to 9.8 days in 2005, and the use of beds increased from 251 days per year in 2000 to 265 days in 2005. Mother and Child Health Care. Health care provision for mothers and children is a priority for the Ministry of Health and Social Protection. The MOHSP has implemented an array of national and sub- national programs aimed at ensuring access to quality health care for all children and pregnant women in order to reduce the incidence of morbidity, disability, and mortality. Under the United Program, children under age five benefit from subsidized medical supplies for outpatient treatment, while pregnant women are provided free iron and folic acid prophylaxes during pregnancy. The implementation of the “Promotion of Quality Perinatal Services” program and of the Global Initiative “Making Pregnancy Safer” has resulted in strengthening the regionalized system of perinatal care, providing quality health services, and institutionalizing a perinatal supervision system. As a result, the perinatal mortality in the most recent three years has stabilized. The “National Strategy for Reproductive Health” was approved on August 26, 2005 by Government Regulation no. 913. The main objective of the Strategy is to uphold the rights of citizens to achieve their reproductive desires, and to assure women their health in childbearing years. 1 Article 36 of the Constitution of the Republic of Moldova guarantees provision of minimal health care services to the noninsured population, free of charge. Introduction | 7 Since 2000, Moldova has implemented the strategy of “Integrated Management of Childhood Illnesses,” promoted by the World Health Organization (WHO). This strategy aims at improving the quality of the primary health care provided to children, and in particular, it aims to reduce infant mortality and mortality in children under age five. The strategy also contains a communication component designed to improve awareness in families regarding measures they should take to ensure the harmonious development of their children. In order to improve primary health care services to children, two important measures have been conceived: one, directives for standardized care, “Standards of Supervision of Pregnant Women and Infants under Out-patient Conditions”; and two, in order to track child health and immunizations, a “Card of Development of a Healthy Child” is distributed to the child’s parent or caretaker. Specialized care is provided to children at the Institute of Scientific Research in the section of Protection of Maternal and Infant Health. Family Planning Services. The Ministry of Health and Social Protection is in charge of providing family planning services. The priorities in this domain are to provide family planning information, improve sexual and reproductive health of adults and youth, and prevent domestic violence, sexual abuse, and trafficking of women and children. Under the auspices of the “National Program in Family Planning and Protection of Reproductive Health for the years 1999-2003,” the National Strategy in Reproductive Health, and the National Concept of “Friendly Health Services to the Young,” detailed measures are outlined to promote family planning services, information, education, and communication services, and to counsel the population in repro- ductive health issues. Abortions are legal in Moldova provided that the pregnant woman consents and that the abortion is carried out by a licensed health professional at a hospital or another specialized medical institution. Abortions are therefore not allowed to be carried out in private clinics. Abortions in Moldova may be carried out within the first 12 weeks of pregnancy. After this period, abortions may be carried out up to 28 weeks for outstanding medical, social-economic, or personal reasons, and with a special authorization from a board of local doctors. As of 1996, abortions are paid for by women; the costs of an abortion vary between 7.50 USD and 11.00 USD. State Sanitary Epidemiologic Service. As in other countries, prevention of contagious and non- contagious diseases is a key concern in Moldova. The State Sanitary Epidemiologic Service (SSES) carries out functions relevant to these concerns, including: supervising epidemiologic activities all over the country; drafting statutory acts and guidelines relevant to preventive medicine and epidemiologic measures to protect the population; coordinating and conducting scientific research in preventive medicine; working out measures to combat epidemics in the environment and in the workplace; training and educating the population about health issues; regularly monitoring establishments in areas of increased epidemiologic risk; promoting preventive measures against infectious diseases; ensuring immunization coverage of the population; protecting the country’s borders against the emergence and spread of conventional and extremely contagious diseases; ensuring the safety of the population in case of a nuclear disaster; monitoring public hygiene; and promoting a generally healthy lifestyle. Additionally, the functions of the SSES include conducting bacteriological, virological, serological, immunological, and parasitological laboratory tests, including tests for diagnosing contagious diseases and other tests capable of identifying factors that may adversely influence the population’s health. On an annual basis, the SSES laboratories carry out over a million microbiological, virological, immunological, and parasitological tests and over 250,000 sanitary hygienic laboratory tests, radiological measurements, and tests of physical factors of the life environment. 8 | Introduction The SSES comprises the National Scientific and Practical Center for Preventive Medicine, two municipal Centers for Preventive Medicine (Chisinau and Balti), and 34 district Centers for Preventive Medicine. The joint activity of the SSES with other health institutions and with regional and local public administration authorities has contributed to achieving a stable epidemiological oversight in the country. As a result, there have been no widespread crises of cholera, diphtheria, brucellosis, tetanus, pseudo- tuberculosis, anthrax, tularemia, acute poliomyelitis, congenital rubella, hemorrhagic fevers, rabies, epidemic typhus, vernal tick-born encephalitis, hepatitis E, etc. The incidence of rubella, measles, and viral hepatitis has already been greatly reduced; the incidence of typhoid fever, salmonellas, whooping cough, epidemic parotitis, and scarlet fever is likewise dropping. There have been no serious outbreaks of infectious diseases and toxic infections, nor events of extremely contagious diseases. National Program for Combating Tuberculosis. The National Program for Combating Tuberculosis, adopted by the Government of Moldova, is based on the Directly Observed Treatment Short-course (DOTS) strategy that provides guidelines for the diagnosis, treatment, and monitoring of tuberculosis. This strategy, put forth by the World Health Organization, is being successfully applied in many European countries. The major objectives of National Program are achieved by implementing four components based on the DOTS system, namely: 1) establishing a National Network of Tuberculosis Laboratories to diagnose pulmonary infectious tuberculosis; 2) increasing human resources capacity and disease control services within the general health system, in particular emphasizing early detection of infected persons at the primary health care level and follow-up with curative care; 3) improving tuberculosis prevention; and 4) increasing the degree of public awareness about tuberculosis-related problems. Program implementation started on November 1, 2001 in three pilot zones, including Chisinau and the former districts of Lapusna and Orhei. The program will eventually be implemented throughout the country. A significant batch of medical supplies that covers the needs of hospitals across the country has been purchased with international funds. Diagnostic laboratories have also been equipped with state- of-the-art microscopes, allowing for a more reliable and timely detection of the disease. In 2005, the National Program initiated activities for 2006-2010. These activities include launching DOTS-Plus at penitentiaries, monitoring the long-term treatment of patients with multi-drug- resistant forms of tuberculosis, and developing the Automated Informational System for Monitoring and Follow-Up of Tuberculosis Patients. The prevention of tuberculosis in children is ensured by vaccinating newborns with BCG and revaccinating them at the age of 7 years, as well as promoting preventive treatment for children living in contact with tuberculosis patients. National Program for Combating HIV/AIDS. In 2001, the Government of Moldova adopted the 2001-2005 National Program for Combating HIV/AIDS and Sexually Transmitted Infections. The main objectives of the Program are: • To reduce the prevalence and incidence of HIV and sexually transmitted diseases (STD); and • To strengthen national commitment in conducting prevention activities, providing medical, social, psychological, legal, and rehabilitation assistance to infected persons, and coordinat- ing involvement of nongovernmental agencies in implementing the activities. Furthermore, the National Program cites eight priority strategies: • Formulation of a national policy regarding HIV/AIDS and STD; Introduction | 9 • Prevention of sexually transmitted HIV/AIDS and STD; • Prevention of new cases of HIV/AIDS among drug users; • Prevention of HIV/AIDS and STD among youth; • Prevention of perinatal and mother-to-child HIV transmission; • Health care provision and social support to HIV patients and members of their families; • Ensuring the safety of blood transfusions and medical interventions; • Epidemiological surveillance and monitoring of HIV/AIDS and STD. In order to improve treatment of HIV patients, in 2003, the Republican Dermatologic- Venereologic Dispensary opened a special hospital section with 35 beds, including 5 pediatric beds, for HIV patients. This hospital section follows modern protocols of care and examination of HIV patients and provides them with antiretroviral drugs as well as necessary supplies and equipment. On September 5, 2005, Government Regulation no. 948 approved the National Program of Prevention and Control of the HIV/AIDS Infection and STD for the years 2006-2010, in line with requirements of the European Union. Following this, cooperation between the Ministry of Health and Social Protection and the European Network of Epidemiologic Surveillance of HIV/AIDS was initiated. National Immunization Program. The prevention of transmissible diseases by vaccination is among the most important and cost-effective investments in public health. Timely immunization fosters health and reduces the medical, social, and economic setbacks caused by certain preventable diseases. The first National Immunization Program was approved in Moldova for the years 1994-2000. Its implementation has contributed to the abolishment of poliomyelitis, the halting of diphtheria and mumps epidemics, and to a substantial reduction of the incidence of viral hepatitis B, measles, and whooping cough. The implementation of the second National Immunization Program, for 2001-2005, has enforced wide vaccination coverage, guaranteed the distribution of necessary vaccines, improved the quality of immunization services, and has helped Moldova maintain the status of a polio-free country. In addition, the elimination of native cases of diphtheria, measles, rubella and neonatal tetanus has been achieved, the incidence of hepatitis B, whooping cough, and mumps has diminished significantly, and the incidence of tetanus in adults has been reduced to very few cases. These successes are attributed to the committed activity of medical employees, international assistance granted by entities such as UNICEF, WHO, the governments of the United States and Japan, the Global Alliance for Vaccines and Immunization, and the systematic increase of financial support granted by the Government of Moldova. The National Immunization Program for 2006-2010 guarantees children, and others at risk, immunizations free of charge against ten infectious diseases: poliomyelitis, diphtheria, tetanus, whooping cough, hepatitis B, measles, mumps, rubella, tuberculosis, and hemophilus influenza type B. The Program pursues the following objectives: • Ensuring over 95 percent vaccination coverage, at the national level and at the level of each district and municipality; 10 | Introduction • Maintaining Moldova as a poliomyelitis-free country, and a country free of cases of tetanus in newborns and congenital rubella; • Continued progress towards eliminating cases of measles, rubella, and diphtheria; • Reducing the incidence of: tetanus to less than 0.05 cases per 100,000 population; hepatitis B in children to less than 2 cases per 100,000 population; whooping cough to less than 1.5 cases per 100,000 population; and mumps to less than 6 cases per 100,000 population; • Limiting the cases of child tuberculosis to isolated cases; and • Reducing morbidity and mortality from septic meningitis and pneumonia caused by Hib infection in children under age three. 1.5 HEALTH INFORMATION SYSTEM The National Statistics Bureau is in charge of conducting decennial population censuses and maintaining vital registration data on the population, including births, deaths, marriages, and divorce. These statistics are kept updated by local civil registry offices and submitted regularly to regional statistical authorities. The latter transmits all documents to the National Statistics Bureau for automatic processing. Afterwards, aggregate statistical information is provided to users and to the general public. The Ministry of Informational Development is responsible for keeping records on international migration. The Ministry keeps track of international immigration and emigration during the intercensal period. This information is used by the National Statistics Bureau for population projections and other demographic estimates. Health information is collected by means of regional reports that compile health statistics at regular intervals, from which information is transmitted to the Scientific and Practical Center of Public Health and Health Management (SPCPHHM) of the Ministry Health and Social Protection. The SPCPHHM compiles and analyses these data for publication in annual reports entitled “Public Health in Moldova.” These reports contain morbidity data by type of disease, mortality data by cause of death, infant mortality, including perinatal and neonatal mortality, maternal mortality by cause of death, indicators related to maternal and child health, medical institutions, medical personnel, and average time of hospitalization. These data are tabulated at the national level and by regions. In addition, reports on the incidence of infectious diseases and the administration of vaccinations are submitted and analyzed monthly. The State Sanitary Epidemiologic Service (SSES) issues a separate annual report entitled “Sanitary hygienic and epidemiologic situation in the Republic of Moldova according to the statistic reports of SSES authorities and institutions.” The report addresses activities related to disease prevention and the monitoring and supervision (including laboratory supervision) of the spread of infectious diseases. 1.6 OBJECTIVES AND ORGANIZATION OF THE SURVEY This survey, Moldova’s first Demographic and Health Survey (MDHS), was carried out by the National Scientific and Applied Center for Preventive Medicine (NCPM), of the Ministry of Health and Social Protection. ORC Macro provided technical assistance for the MDHS through the USAID-funded MEASURE DHS program. Local costs of the survey were also supported by USAID, with additional local funding received from the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and in-kind contributions from the NSACPM. Introduction | 11 Data collection was conducted from June 13 to August 18, 2005. Data were collected from a nationally representative sample of over 11,000 households. All women age 15-49 in these households and all men age 15-59 in a subsample of one-third of the households were eligible to be individually interviewed. In addition to the data collected through interviews with these women and men, capillary blood samples were collected from all women age 15-49 and all children age 6-59 months for anemia testing. The 2005 MDHS is designed to provide data to monitor the population and health situation in Moldova. Specifically, the 2005 MDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, knowledge and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and awareness and behavior regarding AIDS and other sexually transmitted infections. Additional features of the 2005 MDHS include the collection of information on international emigration, domestic violence, and hemo- globin testing to detect the presence of anemia. The information collected in the 2005 MDHS provides updated estimates of an array of demographic and health indicators that will assist in the development of appropriate policies and programs to address the most important health issues in Moldova. 1.6.1 Sample Design and Implementation The 2005 Moldova Demographic and Health Survey is based on a representative probability sample of over 11,000 households. This sample was designed in such a manner as to allow separate urban and rural estimates for key population and health indicators, e.g., fertility, contraceptive prevalence, and infant mortality for children under five. Transnistria, the semiautonomous region in the eastern part of the country accounting for approximately 15 percent of Moldova’s population, is not included in the sample. The 2005 MDHS utilized a two-stage sample design. The first stage involved selecting a sample of cluster sectors from an updated master sampling frame constructed from the 2004 Moldova Population and Housing Census. A total of 400 clusters in Moldova were selected from the master sampling frame. Clusters for urban and rural domains (233 urban and 167 rural) were selected using systematic sampling with probabilities proportional to their size. The distribution of clusters between urban and rural domains is not proportional to the 2004 census distribution, and consequently neither is the final household distribution. The 2005 MDHS is, therefore, not a self-weighted household sample. A final weighting adjustment procedure was carried out to provide estimates at the national level. A complete household listing operation was carried out from early April to late May 2005 in all of the selected clusters in order to provide a sampling frame for the second stage selection of households. The second stage selection involved the systematic selection of households from a complete listing of all households in each of the 400 clusters. The sample “take” in both urban and rural clusters was 30 households. All women age 15-49 in the total sample of households, and all men age 15-59 in a subsample of one-third of households, who were either usual residents of the households in the MDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed in the survey. 1.6.2 Questionnaires Three questionnaires were used for the 2005 MDHS: the Household Questionnaire, the Women’s Questionnaire and the Men’s Questionnaire. The contents of these questionnaires were based on model questionnaires developed by the MEASURE DHS program. 12 | Introduction Consultations with partners were held in Chisinau to obtain input from various national and international experts on a broad array of issues. Based on these consultations, the DHS model question- naires were modified to reflect issues relevant in Moldova concerning population, women and children’s health, family planning, and other health issues. After approval of the final content by the steering committee, these questionnaires were translated from English into Romanian and Russian. The Household Questionnaire was used to list all the usual members and visitors in the selected households and to identify women and men who were eligible for the individual interview. Basic information was collected on the characteristics of each person listed, including their age, sex, education, and relationship to the head of the household. In addition, a separate listing and basic information on former household members who had emigrated abroad was collected. The Household Questionnaire was also designed to collect information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor and roof of the house, ownership of various durable goods, etc. Finally, height and weight measurements, and the results of hemoglobin measure- ments for consenting women age 15-49 years and children age 6-59 months were recorded in the Household Questionnaire. The Women’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: • background characteristics (education, residential history, media exposure, etc.); • reproductive history; • knowledge and use of family planning methods; • fertility preferences; • antenatal and delivery care; • breastfeeding and infant feeding practices; • vaccinations and childhood illnesses; • marriage and sexual activity; • woman’s work and husband’s background characteristics; • infant and child feeding practices; • childhood mortality; and • awareness and behavior about AIDS and other sexually transmitted infections (STIs). The Women’s Questionnaire had a number of important additions to the DHS model questionnaire. First, a series of questions were incorporated to obtain information on women’s experience of domestic violence. These questions were administered to one woman per household. In households with two or more eligible women, special procedures were followed in order to ensure that there was random selection of the women to be interviewed with these questions. Another addition to the Women’s Questionnaire was a vaccination module for each child under the age of five years to be completed at the local health clinic. According to child health experts, immunization information is more frequently kept at the health clinic than on a health card in the mother’s possession. The purpose of this module was, therefore, to collect information on immunizations from the local health clinic in addition to that collected during the woman’s interview. The vaccination module provides better quality immunization indicators because information gathered during the interview is augmented with information from the local health clinic. Closely related to the Women’s Questionnaire is the caretaker module. This separate module contains the same set of child health questions as those in the Women’s Questionnaire regarding immunizations, childhood illnesses such as fever and diarrhea, and nutrition. The purpose of this module is to gather information on children under age 5 years whose mother does not live in the selected household or is not available to be interviewed. This is important because of the large number of young Introduction | 13 women emigrating and leaving behind a significant number of children to be cared for by another caretaker. The Men’s Questionnaire was administered to all men age 15-59 living in every third household in the MDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain questions on reproductive history, maternal and child health, nutrition, and domestic violence. All aspects of the MDHS data collection were pretested in April 2005. Twenty-six people with medical backgrounds and other specialties were trained for two weeks and then dispatched to conduct interviews in Romanian and Russian, carry out hemoglobin testing, and take height and weight measure- ments. Over 200 households in urban and rural areas were interviewed in the pretest. The lessons learned from the pretest were used to finalize the survey instruments and logistical arrangements. The major changes as a result of the pretest were incorporation of the caretaker module described above and soliciting the assistance of local medical personnel in each cluster to introduce field personnel to selected households. The latter served to improve household response rates, especially in urban areas. 1.6.3 Field Staff and Fieldwork Training of fieldwork staff began on May 16, 2005 in Chisinau and lasted three weeks. A total of 96 training participants were trained as field staff supervisors, editors, and interviewers. In addition, 12 data entry operators and two office editors attended the training. All field staff were also trained as technicians to conduct hemoglobin testing. Most of the participants had a medical background and several had prior experience as interviewers for the UNICEF Multiple Indicator Survey (MICS 2000). Interviewer training was conducted mostly in Romanian by senior staff from NCPM with technical input from ORC Macro. In addition, resource persons from other agencies made presentations on Moldova’s program for family planning, maternal and child health, HIV/AIDS, and gender issues including domestic violence. All participants were trained on interviewing techniques and the contents of the MDHS questionnaires. The training was conducted following the standard DHS training procedures, including class presentations, mock interviews, and written tests. All of the participants were trained on how to complete the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. In addition to in-class training, participants practiced taking anthropometric measures and conducting anemia testing on consenting women and children at local health clinics. They also spent several days in practice field sites interviewing in both languages and carrying out all fieldwork activities. While both female and male interviewers interviewed respondents for the Household Questionnaire, only female interviewers interviewed respondents eligible for the Women’s Questionnaire and only male interviewers for the Men’s Questionnaire. Participants selected as field supervisors and editors were given an additional two days of training on how to supervise fieldwork and edit questionnaires. Fifteen teams were organized for fieldwork. Each team was made up of a field supervisor, an editor, three female interviewers, and one male interviewer. The field staff was selected on the basis of assessments of in-class participation, field practice, fluency in languages, and capacity to conduct interviews as well as anemia testing. The most experienced participants, namely those who had partici- pated in the pretest and those who did very well in the main survey training, were selected to be supervisors and editors. Senior staff from the NCPM coordinated and supervised all aspects of fieldwork activities. ORC Macro followed fieldwork progress by receiving approximately every two weeks a standard set of quality control tables generated from the most recent accumulation of data. Data collection took place for just over two months, from June 13 to August 18, 2005. On average, each team completed one cluster over two full days, taking advantage of early mornings and late evenings to find respondents at home. 14 | Introduction 1.6.4 Data Processing The processing of the MDHS results began shortly after the fieldwork commenced. Completed questionnaires were returned weekly from the field to the NCPM headquarters in Chisinau, where they were entered and edited by data processing personnel who were specially trained for this task. Data were entered using CSPro, a program specially developed for use in DHS surveys. All data were entered twice (100 percent verification). The concurrent processing of the data with ongoing data collection was a distinct advantage for data quality since NCPM had the opportunity to advise field teams of problems detected during the data entry. The data entry and editing phase of the survey was completed in late August 2005. 1.6.5 Response Rates Table 1.1 presents household and individual response rates for the survey. A total of 12,206 households were selected for the sample, of which 11,649 were occupied at the time of fieldwork. The main reason for the difference is that some of the dwelling units that were occupied during the household listing operation were either vacant or the household was away for an extended period at the time of interviewing. Of the occupied households, 95 percent were successfully interviewed. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Moldova 2005 Residence Result Urban Rural Total Household interviews Households selected 7,104 5,102 12,206 Households occupied 6,707 4,942 11,649 Households interviewed 6,227 4,868 11,095 Household response rate 92.8 98.5 95.2 Individual interviews: women Number of eligible women 4,602 3,224 7,826 Number of eligible women interviewed 4,301 3,139 7,440 Eligible women response rate 93.5 97.4 95.1 Individual interviews: men Number of eligible men 1,698 1,199 2,897 Number of eligible men interviewed 1,417 1,091 2,508 Eligible men response rate 83.5 91.0 86.6 In the households interviewed in the survey, a total of 7,826 eligible women age 15-49 were identified; interviews were completed with 7,440 of these women, yielding a response rate of 95 percent. In a subsample of one-third of households in the MDHS sample, a total of 2,897 eligible men were identified and interviews were completed with 2,508 of these men, yielding a male response rate of 87 percent. As is typically found in other surveys, the response rates are lower for the urban than for the rural sample, and lower among men than women. The principal reason for nonresponse among both eligible women and men was the failure to find individuals at home despite repeated visits to the household. Household Population and Housing Characteristics | 15 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter presents information on the social, economic, and demographic characteristics of the household population, focusing mainly on such background characteristics as age, sex, educational attendance and attainment, place of residence, and socioeconomic conditions of households. The information provided is intended to facilitate interpretation of the key findings in the 2005 MDHS as well as to assist in assessing the representativeness of the survey. A household is defined as a person or group of related and/or unrelated persons who live together in the same dwelling unit, or in connected premises, who acknowledge one adult member as head of the household, and who have common arrangements for preparing and eating their food. The questionnaire for the MDHS distinguishes between the de jure population (persons who usually live in a selected household) and the de facto population (persons who stayed in the household the night before the interview). According to the results, however, the difference between these populations is small. Tabulations based on household data presented in this chapter include both de jure and de facto populations, whereas tabulations in the remainder of the chapters are based primarily on the de facto population. Because of how the sample was designed, weighting procedures were used to ensure that results presented throughout the report are nationally representative, and representative for each study domain (see Appendix A). The numbers in the tables, therefore, reflect weighted numbers. However, the statistical precision of results depends on the actual number of cases covered in the survey, or the unweighted number of cases. When unweighted numbers are insufficient to ensure a high degree of statistical reliability, the values calculated from these numbers are flagged: for example, percentages or proportions based on 25 to 49 unweighted cases are shown in parentheses, and percentages based on fewer than 25 unweighted cases are suppressed with an asterisk. One of the background characteristics used throughout many tables in this report is an index of socioeconomic status, presented as a wealth quintile. This index was developed and tested in a large number of countries in relation to inequities in household income, use of health services, and health outcomes (Rutstein et al., 2000). It is an indicator of the level of wealth that is consistent with expenditure and income measures (Rutstein, 1999). The wealth index was constructed by employing a principal components analysis using household asset data. The asset information was collected through the Household Questionnaire of the MDHS and covers information on household ownership of a number of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities, and type of material used for flooring. Each asset was assigned a weight (factor score), generated from the principal components analysis, and the resulting asset scores were standardized in relation to a normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household; individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed for the whole sample; separate indices were not prepared for the urban and rural populations. 16 | Household Population and Housing Characteristics 2.1 HOUSEHOLD POPULATION BY AGE AND SEX Age and sex variables are the primary basis of demographic classification in vital statistics, censuses, and surveys. Table 2.1 presents the distribution of the de facto population by five-year age groups, according to urban-rural residence and sex. The information is used to construct the population pyramid shown in Figure 2.1. The total de facto population in households included in the MDHS is 30,491. The data show that 53 percent of the population is female. In absolute numbers, females outnumber males from age 20 onward, and the gender disparity is most pronounced beginning at age 50. The reasons for this imbalance may be attributed to out-migration of men since the early 1990s (see Chapter 15), as well as higher mortality rates of adult men compared with adult women. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Moldova 2005 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 6.1 4.6 5.3 6.4 5.6 6.0 6.3 5.2 5.7 5-9 5.2 4.2 4.7 7.2 6.5 6.8 6.4 5.6 6.0 10-14 7.0 6.5 6.7 10.4 9.0 9.7 9.1 8.0 8.5 15-19 10.2 8.9 9.5 9.2 8.8 9.0 9.6 8.8 9.2 20-24 9.3 9.1 9.2 6.6 6.0 6.3 7.6 7.2 7.4 25-29 8.6 7.0 7.7 5.7 5.3 5.5 6.8 6.0 6.4 30-34 7.2 6.5 6.8 5.1 5.2 5.2 5.9 5.7 5.8 35-39 6.1 6.1 6.1 5.7 5.0 5.3 5.9 5.4 5.6 40-44 6.7 7.0 6.9 6.3 5.9 6.1 6.4 6.3 6.4 45-49 8.0 7.9 8.0 7.3 6.9 7.1 7.6 7.3 7.4 50-54 7.7 8.9 8.4 7.6 7.9 7.8 7.7 8.3 8.0 55-59 5.5 6.7 6.1 6.2 6.5 6.4 5.9 6.6 6.3 60-64 4.2 4.4 4.3 4.3 4.8 4.6 4.3 4.7 4.5 65-69 3.3 4.5 3.9 4.4 5.5 4.9 3.9 5.1 4.6 70-74 2.2 3.1 2.7 3.6 4.6 4.1 3.1 4.0 3.6 75-79 1.6 2.6 2.2 2.4 3.8 3.2 2.1 3.4 2.8 80 + 1.0 2.0 1.5 1.5 2.6 2.1 1.3 2.4 1.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,417 6,217 11,637 8,861 9,993 18,854 14,278 16,210 30,491 Sixty-seven percent of household members comprise the economically active population (between ages 15 and 64). This proportion is significantly higher in urban areas (73 percent) than in rural areas (63 percent). The disparity is at least partially explained by rural to urban migration of youth in search of higher education and better job prospects in the city. The remainder of the population that is not economically active, including the younger population under age 15 and the elderly population age 65 and older, constitutes the economically dependent population. Children under age 15 make up 20 percent of the population. Lower fertility levels in the cities ultimately result in a smaller share of children in urban areas: only 17 percent of the population in urban areas is under age 15, versus 23 percent under age 15 in rural areas. Elderly people age 65 and older make up 13 percent of the population. Lower mortality rates for women result in a greater share of elderly women than elderly men: 15 percent of women are age 65 and above, versus only 10 percent of men. Household Population and Housing Characteristics | 17 At a glance, Figure 2.1 reveals a couple of noteworthy patterns. First, relatively large proportions of the population are between age 45 and 55, and between age 10 to 19. The older bulge in the pyramid is evidence of the baby boom generation—those people born in the period of economic prosperity in industrialized countries after World War II. The younger bulge in the pyramid represents, for the most part, the children of the baby boomers. The second notable trend is population aging, obvious from the shape of the pyramid. Compared with previous decades, the so-called pyramid reflecting the present population structure has a smaller base and a less tapered top, thus resembling a rectangular form more than a pyramid. This is evidence of population aging, which is the predominant trend in most countries in Europe, especially in Eastern Europe. Given persistently low fertility, below replacement level and, to a lesser extent, increases in average life expectancy,1 it is likely that the proportion of elderly will continue to become larger and eventually surpass the proportion of young people. The effect of out-migration, which is selective of young people in their reproductive years, serves to speed the aging process of the overall population structure still further. 2.2 HOUSEHOLD COMPOSITION Table 2.2 presents the distribution of households by sex of the head of household and by the household size, for urban and rural areas. The characteristics are of interest because they are often associated with differences in household socioeconomic levels. For example, female-headed households are frequently poorer than households headed by males. Indeed, official data from the Moldova State Department of Statistics reports that, in 2004, 76 percent of households headed by men had a good or satisfactory level of living, compared with 67 percent of households headed by women (MSDS, 2005). 1 Official estimates of life expectancy in 2000 were 71 years for women and 64 years for men; in 2004, they were 72 years for women and 65 years for men (MSDS, 2005). Moldova 2005 Figure 2.1 Population Pyramid 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 <5 Age 0246810 0 2 4 6 8 10 Males Females Percent 18 | Household Population and Housing Characteristics Data from the MDHS show that, at the national level, women head 34 percent of Moldovan households; this percentage differs modestly be- tween urban and rural areas (38 percent and 31 percent, respectively). Results further show that the average household size in Moldova is 2.8, and that there is little difference in the average size of urban households and rural households. 2.3 CHILDREN’S LIVING ARRANGEMENTS Children not living with their natural parents are more likely to be disadvantaged compared with those who do live with their parents; they may be at increased risk of impoverishment, deprived of prop- erty rights and other rights, and at increased risk of abuse, neglect, and exploitation. The MDHS col- lected detailed information on children’s living ar- rangements. Table 2.3 shows the percent distribution of children under age 15 by their living arrange- ments and survival status of parents, according to background characteristics. Just over two-thirds (69 percent) of children under age 15 live with both parents. Fifteen percent live with just their mother although their father is alive, 5 percent live with just their father although their mother is alive, and 7 percent live with neither parent although both are alive. These children are “social orphans,” that is, their biological parents are still alive but they have been voluntarily left in the care of another person, or persons.2 Results show that just 3 percent of children under age 15 have lost their father only, 1 percent have lost their mother only, and only a tiny fraction have lost both biological parents. Altogether, 3 percent of children under age 15 have at least one parent who died. 2 These indicators do not take into account children who live outside the household—for example, in institutions or on the street—because the MDHS includes only households in its sample. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Moldova 2005 Residence Characteristic Urban Rural Total Sex of head of household Male 61.8 69.2 66.3 Female 38.1 30.8 33.7 Total 100.0 100.0 100.0 Number of usual members 1 18.7 20.8 20.0 2 27.4 27.0 27.1 3 26.4 19.2 22.0 4 18.8 18.1 18.4 5 5.5 9.2 7.7 6+ 2.7 5.6 4.5 Missing 0.5 0.1 0.3 Total 100.0 100.0 100.0 Number of households 4,444 6,651 11,095 Mean size 2.7 2.9 2.8 Note: Table is based on de jure members, i.e., usual residents. Household Population and Housing Characteristics | 19 Table 2.3 Children's living arrangements and orphanhood Percent distribution of de jure children under age 15 by children's living arrangements and survival status of parents, according to background characteristics, Moldova 2005 Not living with either parent Living with mother but not father Living with father but not mother Background characteristic Living with both parents Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing information on father/ mother Total Number of children Age <2 81.7 13.8 0.2 0.7 0.3 2.7 0.0 0.0 0.0 0.6 100.0 684 2-4 70.3 16.5 0.9 3.0 0.2 7.9 0.1 0.0 0.0 1.0 100.0 1,019 5-9 66.1 16.3 1.8 4.4 0.3 8.3 0.3 0.4 0.1 1.9 100.0 1,817 10-14 66.8 13.8 3.4 6.0 0.6 6.1 0.4 0.6 0.3 2.0 100.0 2,622 Sex Male 67.7 16.2 2.5 5.0 0.6 5.8 0.2 0.1 0.2 1.8 100.0 3,143 Female 70.1 13.7 1.8 3.9 0.2 7.6 0.4 0.6 0.1 1.6 100.0 3,000 Residence Urban 67.0 17.7 2.4 3.9 0.3 5.5 0.1 0.4 0.1 2.5 100.0 2,061 Rural 69.8 13.6 2.0 4.7 0.4 7.3 0.4 0.4 0.2 1.3 100.0 4,082 Region North 68.6 15.7 2.3 4.3 0.2 6.9 0.3 0.5 0.2 1.0 100.0 1,792 Center 69.6 13.1 2.2 4.6 0.8 7.9 0.2 0.2 0.2 1.1 100.0 1,881 South 67.7 14.3 1.8 5.4 0.2 7.1 0.6 0.6 0.1 2.0 100.0 1,334 Chisinau 69.4 17.6 2.0 3.3 0.3 3.7 0.1 0.3 0.1 3.3 100.0 1,135 Wealth quintile Lowest 72.6 14.1 2.3 2.6 1.1 4.9 0.2 0.7 0.2 1.2 100.0 1,322 Second 66.8 14.2 2.5 5.1 0.2 8.4 0.7 0.4 0.2 1.5 100.0 1,241 Middle 67.0 13.9 2.1 6.3 0.1 8.2 0.1 0.4 0.3 1.6 100.0 1,346 Fourth 65.7 16.5 1.9 4.9 0.3 7.9 0.4 0.2 0.1 2.1 100.0 1,193 Highest 72.7 16.6 1.8 3.1 0.1 3.5 0.1 0.2 0.0 2.0 100.0 1,041 Total 68.9 15.0 2.1 4.5 0.4 6.7 0.3 0.4 0.2 1.7 100.0 6,143 Table 2.4 presents information on residence of mothers and fathers who live separately from their children under age 15. Figure 2.2 shows that three-quarters of mothers of children under 15 who are not living in the same household as their child(ren) are living abroad (76 percent). About one-fifth of mothers live in another household in Moldova (19 percent). Figure 2.2 also shows that about half of fathers who are not living in the same household as their child(ren) are living abroad (46 percent), and about the same proportion are living in another household in Moldova. It should be kept in mind, however, that in absolute numbers, almost twice as many fathers as mothers do not live with their children. Therefore, although a smaller proportion of fathers live abroad than mothers, the number of fathers living abroad surpasses the number of mothers living abroad. Table 2.4 Parental residence apart from children Among children under age 15 whose mothers and fathers are alive but not living in the same household, percent distribution by residence of parent, Moldova 2005 Residence Mother Father Abroad 75.9 45.7 In other household in Moldova 19.3 46.4 Institution 0.0 0.9 Don't know 2.2 4.7 Missing 2.6 2.3 Total 100.0 100.0 Number 720 1,341 20 | Household Population and Housing Characteristics Compared to living arrangements of children in 2000, the proportion of children not living with their parents has increased. In 2000, 84 percent of children under age 15 lived with both parents. Ten percent lived with just their mother, although their father was alive; 3 percent lived with just their father, although their mother was alive; and 2 percent lived with neither parent. Altogether, 4 percent of children under age 15 had at least one parent who had died (MICS 2000). Although the values from 2000 were estimated from a sample including the region of Transnistria, the differences are large enough to at least conclude an increase, and probably a substantial one, in the proportion of children not living with their parents. Further research, as well as program development for children in Moldova who are left behind by migrating parents, is under way; because this trend appears to be on the rise, it merits close attention (see, for example, Bacalu, 2004; Dubrovschi, 2004; Ghencea and Gugumac, 2004; Gonta, 2004; and Salaru, 2004). Not only have children’s living arrangements deteriorated since 2000, but they are also among the worst in the region. Compared with estimates from recent Demographic and Health Surveys conducted in other countries in Eastern Europe and Eurasia, fewer children live with both of their parents in Moldova than in other countries in the region: in Armenia (1999), 10 percent of children age 0-15 are not living with both mother and father; in Kazakhstan (1999), 19 percent; in Kyrgyz Republic (1997), 15 percent; in Turkmenistan (2000), 12 percent; and in Uzbekistan, 7 percent (ORC Macro, 2005). 2.4 EDUCATIONAL ATTAINMENT OF HOUSEHOLD MEMBERS Moldova’s education system, until independence in 1991, followed the same structure as the Soviet educational system. In the past 15 years, however, the system has undergone several reforms, making the analysis of education data across a wide range of ages challenging. Basically, Moldova’s primary and secondary educational system has three components. The first component is primary school and comprises grades 1-4 (usually children age 8 to 11, but some children start younger). The second component is secondary school and comprises grades 5-9 (usually children age 12 to 16, but some children start younger), or grades 5-12. Students who have completed a total of at least 9 grades are considered to have fully completed compulsory education. The third component is secondary special Figure 2.2 Living Arrangements of Mothers and Fathers Not Living in Household Interviewed MDHS 2005 MOTHER FATHER Abroad 76% Missing 3% Other household 19% Don’t know 2% Abroad 46% Institution 1% Missing 2% Don’t know 5% Other household 46% Household Population and Housing Characteristics | 21 education. Secondary special education is an alternative for students who have completed a total of at least 9 years of schooling; at this stage, a student may opt to follow secondary special education that is specialized technical training in a specific field such as nursing, agriculture, construction, etc. Secondary special education usually lasts 2-3 years and, when successfully completed, the student is considered qualified to work in that specific field. Students who have successfully completed a total of 12 years of schooling (primary and secondary education), or who have completed primary schooling plus a secondary special education, are qualified to attend university. Table 2.5 shows the percent distribution of the female and male household population age 7 and older, by highest level of education attained and according to background characteristics. Only a tiny fraction have no education. Furthermore, by age group 15-19, virtually all females and all males have attended or completed secondary or secondary special education. In the oldest age groups, age 65 and above, about one-third have attended or completed only primary education. This finding—that education levels are significantly lower amongst those age 65 and above—provides evidence of the rapid improve- ments in the education system following the Second World War. Overall, relatively more people have opted to pursue secondary education (65 percent of males and 56 percent of females) versus secondary special education (10 percent of males and 15 percent of females). This is especially the case for the age group 15-19, where, for both sexes, 86 percent have reached secondary school versus only about 5 percent who have attended secondary special school. In terms of the highest level of education, the data show that women are slightly more likely than men to attend university. Overall, 13 percent of males and 15 percent of females have at least some university education. This difference is largest in younger generations; for example, for the age group 20-24, 40 percent of women versus 30 percent of men have at least some higher education. 22 | Household Population and Housing Characteristics Table 2.5 Educational attainment of household population Percent distribution of the de facto female and male household population by highest level of education attended or completed, according to background characteristics, Moldova 2005 Background characteristic No education Primary Secondary Secondary special Higher Total Number MALE Age 7-9 1.0 97.6 1.2 0.2 0.0 100.0 382 10-14 1.8 31.3 66.8 0.1 0.0 100.0 1,302 15-19 1.0 2.2 86.2 5.3 5.3 100.0 1,370 20-24 0.4 1.6 61.6 6.8 29.6 100.0 1,090 25-29 0.8 0.2 64.6 9.5 24.8 100.0 976 30-34 0.9 0.4 66.5 15.4 16.5 100.0 842 35-39 0.3 0.1 70.8 14.5 14.1 100.0 836 40-44 0.7 0.3 67.5 15.8 15.3 100.0 921 45-49 0.5 0.4 70.1 15.0 13.9 100.0 1,084 50-54 0.5 0.5 67.3 16.2 15.5 100.0 1,094 55-59 0.3 1.1 65.9 17.8 14.8 100.0 849 60-64 0.6 5.1 63.8 13.6 16.7 100.0 610 65+ 3.0 30.3 49.2 8.1 9.5 100.0 1,486 Residence Urban 0.8 6.3 53.1 14.3 25.5 100.0 4,916 Rural 1.2 13.0 71.9 7.9 5.9 100.0 7,926 Region North 1.4 11.7 66.3 11.5 8.8 100.0 3,913 Center 1.0 11.4 71.9 7.4 8.3 100.0 3,619 South 0.9 12.6 68.6 9.9 8.0 100.0 2,564 Chisinau 0.5 5.3 49.2 13.1 31.7 100.0 2,746 Wealth quintile Lowest 1.8 17.5 76.0 3.5 1.2 100.0 2,607 Second 1.6 13.4 74.7 7.2 3.1 100.0 2,565 Middle 0.9 9.1 70.1 11.1 8.7 100.0 2,575 Fourth 0.5 7.6 57.4 15.8 18.5 100.0 2,550 Highest 0.2 4.3 44.8 14.3 36.1 100.0 2,545 Total1 1.0 10.4 64.7 10.4 13.4 100.0 12,842 FEMALE Age 7-9 0.9 98.8 0.2 0.0 0.0 100.0 376 10-14 0.4 31.7 67.9 0.1 0.0 100.0 1,302 15-19 0.5 0.2 85.9 5.6 7.9 100.0 1,434 20-24 0.4 0.5 49.4 10.0 39.7 100.0 1,166 25-29 0.8 0.5 60.1 13.1 25.3 100.0 968 30-34 0.4 0.7 54.9 23.0 21.0 100.0 926 35-39 0.5 0.4 52.9 27.4 18.7 100.0 878 40-44 0.1 0.4 55.1 25.0 19.3 100.0 1,027 45-49 0.0 0.2 58.5 25.0 16.2 100.0 1,186 50-54 0.6 0.7 61.6 23.4 13.5 100.0 1,339 55-59 0.6 1.6 58.5 23.0 16.1 100.0 1,067 60-64 0.9 10.9 63.6 12.5 12.0 100.0 755 65+ 11.6 39.3 34.1 7.9 6.5 100.0 2,411 Residence Urban 1.5 7.5 46.0 19.4 25.3 100.0 5,790 Rural 2.8 15.9 61.8 11.6 7.8 100.0 9,047 Region North 3.3 15.1 56.3 14.9 10.3 100.0 4,772 Center 2.1 13.8 62.9 12.3 8.9 100.0 3,994 South 2.7 14.2 59.1 13.7 10.1 100.0 2,821 Chisinau 0.8 6.0 42.8 18.1 32.1 100.0 3,250 Wealth quintile Lowest 4.6 21.6 66.9 5.1 1.6 100.0 3,000 Second 3.5 16.8 65.0 10.0 4.5 100.0 3,044 Middle 1.8 11.3 58.4 16.9 11.4 100.0 2,926 Fourth 1.1 7.9 48.8 21.0 21.0 100.0 2,983 Highest 0.3 5.0 38.3 20.7 35.6 100.0 2,884 Total1 2.3 12.6 55.6 14.7 14.6 100.0 14,837 Note: Primary school includes grades 1-4; secondary school includes grades 5-12. 1 Totals include undetermined/missing cases Household Population and Housing Characteristics | 23 2.5 HOUSING CHARACTERISTICS To assess the socioeconomic conditions under which the population lives, respondents were asked to give specific information about their house- hold environment. Some of these characteristics, such as housing construction material, water source, and sanitation facilities, are used to calculate the wealth index (see beginning of this chapter). Table 2.6 presents some of the major household character- istics, by urban and rural residence. Access to electricity is almost universal for households in Moldova. In terms of construction material, the largest share of households in rural and urban areas have polished wooden (parquet) floors, and a further 11 percent in urban areas and one- quarter of households in rural areas have wooden planks on the floor. The next most common floor material is vinyl or asphalt strips in urban households (33 percent) and ceramic tiles or cement in rural households (11 percent). The main roofing material is calamine/cement fiber, followed by cement, which together accounts for 92 percent of all households. The material most often used for walls in urban areas is cement or limestone (80 percent), and almost half of all households in rural areas are constructed using adobe with sod (47 percent). Overcrowding in households does not seem to be a problem in Moldova since 92 percent of households sleep only one or two persons per room. Gas is the main cooking fuel used. About 40 percent of all households use bottled gas and almost as many use natural gas, with urban households using mainly natural gas (75 percent) and rural households using mainly bottled gas (60 percent). Safe drinking water is a basic necessity for good health. Thirty percent of households in Moldova have water piped directly to their household (another 6 percent have water piped to their yard), and about half of households in Moldova obtain water from a protected well (48 percent). Large discrepancies are noted between urban and rural households; two-thirds of urban households have water piped directly into the home, while over two- thirds of rural households have water from a protected well. Table 2.6 Household characteristics Percent distribution of households by household character- istics, according to residence, Moldova 2005 Residence Household characteristic Urban Rural Total Electricity Yes 99.4 98.0 98.6 No 0.5 1.9 1.3 Total1 100.0 100.0 100.0 Main floor material Earth, sand 0.9 8.4 5.4 Wood planks 11.4 24.0 19.0 Parquet, polished wood 46.8 45.3 45.9 Vinyl, asphalt strips 33.3 8.0 18.1 Ceramic tiles/cement 4.1 11.2 8.3 Carpet 3.3 3.0 3.1 Total1 100.0 100.0 100.0 Main roof material Calamine/cement fiber 40.8 87.8 69.0 Cement 54.1 1.9 22.8 Ceramic tiles 2.8 6.6 5.1 Metal 0.9 2.6 1.9 Other 1.1 1.0 1.0 Total1 100.0 100.0 100.0 Main wall material Cement 36.2 2.5 16.0 Stone with lime/cement 43.9 32.3 36.9 Adobe with sod 12.3 46.9 33.1 Bricks 4.7 4.6 4.7 Cement blocks 2.1 11.9 8.0 Other 0.4 9.8 1.2 Total1 100.0 100.0 100.0 Persons per sleeping room 1-2 90.7 92.5 91.8 3-4 8.2 6.3 7.0 5+ 0.5 0.6 0.6 No bedrooms/missing 0.6 0.7 0.7 Total 100.0 100.0 100.0 Mean number of persons per sleeping room 1.4 1.3 1.4 Type of cooking fuel Electricity 5.3 1.2 2.9 Bottled gas (LPG) 18.3 59.7 43.1 Natural gas 74.8 14.9 38.9 Wood 0.8 14.0 8.7 Straw/shrubs/grass 0.2 4.5 2.8 Agricultural crop 0.1 5.0 3.0 Other 0.3 0.8 0.6 Total1 100.0 100.0 100.0 Source of drinking water Piped into dwelling 66.7 4.9 29.6 Protected well 16.3 69.4 48.1 Piped to yard/plot 6.2 6.5 6.4 Unprotected well 0.9 7.3 4.8 Bottled water 5.7 0.4 2.5 Protected spring 1.5 4.3 3.1 Other 2.5 7.3 5.4 Total1 100.0 100.0 100.0 Continued. 24 | Household Population and Housing Characteristics The population accessing safe drinking water is represented by the following sources: piped into the dwelling or yard; protected well; protected spring; and bottled water. Overall, 90 percent of the population has access to safe drinking water, with 86 percent in rural areas and 96 percent in urban areas. About 92 percent of households reported having suf- ficiently available potable water last year. Adequate personal hygiene and disposal of human excreta is associated with less risk of contact- ing certain diseases such as diarrhea and worms. Adequate means of excreta disposal include the following: flush toilets connected to a sewage system or septic tank, other flush toilets, and improved pit latrines (with ventilation and/or a concrete slab). Overall, 77 percent of households in Moldova have adequate means of sanitary disposal, with 91 percent of households in urban areas and only 67 percent in rural areas. Six percent of households share their sanitary facility with another household. As expected, ownership of arable land is more common in rural areas than in urban areas—90 percent of households in rural areas versus 34 percent in urban areas. Among households in urban areas that own land, most own 10 ari or less. In contrast, land owners from rural areas own much larger plots. Households in rural areas are also more likely to own livestock or farm animals (87 percent) than are urban households (23 percent). Twelve percent of households reported hav- ing a bank account, but about four times as many households in urban areas as in rural areas have bank accounts (21 percent and 6 percent, respectively). The distribution of households by wealth quintiles shows that a small share of households in the lowest and second wealth quintile are located in urban areas (7 percent), and an even smaller share of households in rural areas are located in the highest wealth quintile (about 1 percent). 2.6 HOUSEHOLD DURABLE GOODS The possession of durable goods is a rough measure of household socioeconomic status. Table 2.7 shows the percentage of households possessing various durable goods by urban-rural residence. The most commonly possessed items from the list of 18 items are a sofa and armoire (98 percent for both items). Roughly three-quarters of households have a radio (72 percent) and/or refrigerator (76 percent); about two-thirds have a color television (69 percent) and/or fixed telephone (67 percent); and about one- Table 2.6—Continued Residence Household characteristic Urban Rural Total Sufficient potable water last year Yes 92.2 91.4 91.7 No 7.7 8.4 8.1 Water source too far 2.0 4.5 3.5 Costs too much 0.4 0.4 0.4 Limited quantity available/water rationed 4.5 2.7 3.4 Drought 0.1 0.3 0.2 Other 0.7 0.5 0.6 Total1 100.0 100.0 100.0 Sanitation facility Flush - to piped sewer system 70.3 3.8 30.4 Pit latrine - ventilated improved pit (VIP) 11.3 31.2 23.2 Pit latrine - with slab 9.5 32.4 23.2 Pit latrine - without slab / open pit 7.7 21.8 16.1 Composting toilet 0.8 9.7 6.1 Other 0.4 1.2 0.8 Total1 100.0 100.0 100.0 Share toilet with other households Yes 8.0 5.4 6.4 No 91.7 93.3 92.6 Total1 100.0 100.0 100.0 Land usable for agriculture Does not own any land 65.7 10.1 32.4 1-9 ari 18.8 3.1 9.4 10-49 ari 9.8 37.9 26.6 50-99 ari 1.0 12.0 7.6 1-9 hectares 3.9 36.0 23.1 10+ hectares 0.2 0.5 0.4 Total1 100.0 100.0 100.0 Livestock, herds, or farm animals Yes 23.2 87.2 61.6 No 76.7 12.7 38.3 Total1 100.0 100.0 100.0 Bank account Yes 21.0 6.1 12.1 No 78.4 93.4 87.4 Total1 100.0 100.0 100.0 Wealth quintile Lowest 1.8 33.9 21.1 Second 5.6 32.0 21.4 Middle 11.1 22.5 18.0 Fourth 34.3 10.3 19.9 Highest 47.1 1.3 19.6 Total 100.0 100.0 100.0 Number of households 4,444 6,651 11,095 1 Totals include the undetermined cases. Household Population and Housing Characteristics | 25 third (31 percent) have a mobile telephone. Over half of households have a washing machine, while 41 percent have a vacuum cleaner and the same proportion have a bathtub or shower. Roughly one-quarter of households own a VCR/DVD (27 percent), bicycle (27 percent), and/or a car or truck (23 percent). Fewer than 10 percent of households have a computer (7 percent) and a microwave (9 percent), although these percentages are higher in urban areas (15 percent and 13 percent, respectively). The share of households possessing any durable good is almost always higher in urban areas than rural areas, except for black and white television, radio, bicycle, and motorcycle. It is possible that, in lower income households, these items are owned instead of a color television or a car or truck. Fewer than 1 percent of households have none of the items mentioned. Table 2.7 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Moldova 2005 Residence Durable consumer goods Urban Rural Total Radio 70.4 73.0 72.0 Television 86.4 58.1 69.4 Black-white TV 13.1 27.8 21.9 VCR/DVD 37.3 19.6 26.7 Fixed telephone 87.5 52.7 66.7 Mobile telephone 50.7 17.5 30.8 Computer 14.5 2.1 7.0 Refrigerator 91.2 65.0 75.5 Microwave 13.2 6.3 9.0 Vacuum cleaner 67.7 23.3 41.1 Washing machine 72.5 45.6 56.4 Water heat 29.3 6.6 15.7 Bathtub/shower 73.3 20.1 41.4 Sofa 98.9 96.6 97.5 Armoire 98.7 96.7 97.5 Bicycle 25.5 28.3 27.2 Motorcycle 2.7 7.9 5.8 Car/truck 28.2 18.7 22.5 None of the above 0.2 0.7 0.5 Number of households 4,444 6,651 11,095 Characteristics of Respondents | 27 CHARACTERISTICS OF SURVEY RESPONDENTS 3 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Information on the basic characteristics of women and men interviewed in the survey is important for interpreting findings presented later in the report. Background characteristics of the 7,440 women and 2,508 men interviewed in the Moldova Demographic and Health Survey (MDHS) are presented in Table 3.1. For both sexes, there are proportionally more respondents in age groups 15-19 and 45-49 (and also 45-54 for men), whereas there are proportionally fewer respondents in age groups 25-44. This U-shaped distribution of the MDHS sample reflects the aging baby boom cohort following World War II (the youngest of the baby boomers are now in their mid-40s), and their children, who are now mostly in their teens and 20s. The lower proportions of women and men in the middle age groups reflect the smaller cohorts following the baby boom generation and preceding the generation of baby boomer’s children. To some degree, it also reflects the disproportionately higher emigration of the working age population (see Chapter 15). More women and men live in rural areas than urban areas, and there is little difference in the distribution of women and men by urban-rural residence (57 percent of women and 58 percent of men live in rural areas). The smallest proportion of women and men, about one-fifth, are from the South region. Two-thirds of women and men are married or living together (66 percent). Because men tend to marry later in life than women, 29 percent of the surveyed men age 15-59 have never married, compared to a quarter of the women age 15-49. On the other hand, women are more likely than men to be divorced or separated (7 percent versus 4 percent). Very few women (2 percent) and men (1 percent) are widowed. Women and men in Moldova are universally well educated, with virtually 100 percent having at least some secondary or higher education: 79 percent of women and 83 percent of men have only a secondary or secondary special education,1 and the remainder pursue a higher education. More women (21 percent) than men (16 percent) pursue higher education. While most respondents in the MDHS are ethnic Moldovans and follow the Orthodox religion, there is more variation in ethnicity than in religion. Most women and men in Moldova are ethnic Moldovans (77 percent and 76 percent, respectively), followed by Ukrainians (8 percent of women and 9 of percent men), Russians (6 percent of women and men), and Gagauzans (4 percent of women and 5 percent of men). Romanians and Bulgarians account for 2 to 3 percent of women and men. The overwhelming majority of Moldovans, about 95 percent, report Orthodox as their religion. Between 1 and 4 percent of women and men are Jewish, Protestant, or another religion. 1 “Secondary special” education is specialized technical training in a specific field such as nursing, agriculture, construction, etc. 28 | Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men, by selected background characteristics, Moldova 2005 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 19.0 1,417 1,403 16.4 411 411 20-24 15.1 1,124 1,145 11.0 275 287 25-29 13.0 964 964 9.3 234 241 30-34 12.4 924 918 8.9 224 228 35-39 11.5 855 859 9.9 248 247 40-44 13.5 1,007 1,001 9.9 247 242 45-49 15.4 1,149 1,150 13.9 349 340 50-54 na na na 11.8 296 293 55-59 na na na 8.9 224 219 Marital status Never married 25.0 1,862 1,884 29.1 730 745 Married 61.4 4,565 4,486 62.7 1,573 1,561 Living together 5.0 372 406 3.4 85 83 Divorced/separated 6.8 509 532 3.9 98 99 Widowed 1.8 132 132 0.9 22 20 Residence Urban 42.9 3,194 4,301 42.0 1,055 1,417 Rural 57.1 4,246 3,139 58.0 1,453 1,091 Region North 29.7 2,207 2,065 30.2 756 700 Center 27.3 2,033 1,805 28.0 702 633 South 18.9 1,402 1,443 19.8 496 518 Chisinau 24.2 1,798 2,127 22.1 554 657 Education No education/primary 0.6 49 49 0.6 16 14 Secondary 60.9 4,534 4,332 71.3 1,788 1,713 Secondary special 17.8 1,327 1,372 12.0 302 317 Higher 20.6 1,530 1,686 16.1 403 464 Religion Orthodox 94.5 7,030 6,991 93.7 2,351 2,341 Protestant (ex. Evangelical, Baptist, Jehovah witness) 2.9 217 245 1.9 47 48 Jewish 0.5 40 37 3.7 94 100 Other 2.0 152 165 0.7 16 18 Ethnic group Moldovan 77.0 5,727 5,515 75.6 1,896 1,830 Romanian 2.2 167 178 2.5 62 74 Ukrainian 7.9 586 597 8.5 212 207 Russian 6.1 457 563 5.6 140 168 Gagauzan 3.8 283 329 4.5 114 134 Bulgarian 1.9 144 166 2.1 53 62 Other 1.0 77 92 1.1 29 33 Total 100.0 7,440 7,440 100.0 2,508 2,508 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents | 29 3.2 EDUCATIONAL LEVEL OF RESPONDENTS Tables 3.2.1 and 3.2.2 present the distributions of female and male respondents, respectively, by the highest level of education attended, according to age, urban-rural residence, region, and wealth quintile. Virtually 100 percent of men and women interviewed have attended secondary school. The great majority of women and men have only attended secondary or secondary special schools (79 percent of women and 83 percent of men); however, secondary special education has become a much less popular option for the youngest respondents (age 15-24). The youngest respondents are also more likely to attend university than respondents in older cohorts: in age group 20-24, 40 percent of women and 32 percent of men have at least some university education, compared with 12 to 25 percent for respondents in every other age category. Table 3.2.1 Educational attainment by background characteristics: women Percent distribution of women by highest level of schooling attended or completed, and median number of years of schooling completed, according to background characteristics, Moldova 2005 Educational attainment Background characteristic No education Primary Secondary Secondary special Higher Total Number Median years of schooling Age 15-19 0.1 0.2 86.7 5.4 7.7 100.0 1,417 9.3 20-24 0.1 0.5 49.6 9.4 40.4 100.0 1,124 11.0 25-29 0.5 0.5 60.3 13.7 25.0 100.0 964 10.6 30-34 0.1 1.1 54.0 23.8 21.1 100.0 924 11.0 35-39 0.2 0.2 52.9 27.9 18.9 100.0 855 11.0 40-44 0.5 0.5 55.0 25.5 18.6 100.0 1,007 10.7 45-49 0.3 0.2 57.5 26.1 16.0 100.0 1,149 10.3 Residence Urban 0.3 0.4 47.1 20.2 32.0 100.0 3,194 11.4 Rural 0.2 0.5 71.4 16.1 11.9 100.0 4,246 9.8 Region North 0.5 0.4 62.7 20.2 16.2 100.0 2,207 10.2 Center 0.2 0.5 71.1 14.9 13.2 100.0 2,033 9.8 South 0.1 0.4 66.3 18.9 14.3 100.0 1,402 10.0 Chisinau 0.1 0.3 43.1 17.4 39.1 100.0 1,798 11.8 Wealth quintile Lowest 0.3 0.8 88.6 7.5 2.8 100.0 1,243 9.2 Second 0.4 0.7 77.6 14.2 7.1 100.0 1,234 9.6 Middle 0.4 0.2 64.0 20.2 15.2 100.0 1,511 10.2 Fourth 0.1 0.4 50.0 23.3 26.2 100.0 1,672 11.2 Highest 0.0 0.2 37.7 20.5 41.5 100.0 1,780 12.2 Total 0.2 0.4 60.9 17.8 20.6 100.0 7,440 10.3 In general, respondents of either sex who opted to attend secondary school are mostly from rural areas, while those who attended secondary special school are mostly from urban areas. Roughly three times as many urban than rural respondents have attended university and at least 40 percent of those from households in the wealthiest quintile have attended university (42 percent of women and 40 percent of men). 30 | Characteristics of Respondents Table 3.2.2 Educational attainment by background characteristics: men Percent distribution of men by highest level of schooling attended or completed, and median number of years of schooling completed, according to background characteristics, Moldova 2005 Educational attainment Background characteristic No education Primary Secondary Secondary special Higher Total Number Median years of schooling Age 15-19 0.0 1.7 86.7 4.9 6.7 100.0 411 9.1 20-24 0.0 0.0 61.7 6.4 31.9 100.0 275 10.4 25-29 0.0 0.0 63.8 10.5 25.7 100.0 234 10.8 30-34 0.3 0.4 68.6 16.9 13.8 100.0 224 10.7 35-39 0.0 0.0 73.3 10.9 15.8 100.0 248 10.2 40-44 0.6 0.6 66.7 16.4 15.6 100.0 247 10.8 45-49 0.3 0.5 73.6 13.1 12.4 100.0 349 10.0 50-54 0.0 0.2 69.7 16.7 13.5 100.0 296 10.2 55-59 0.0 0.5 66.4 17.3 15.7 100.0 224 10.0 Residence Urban 0.1 0.3 56.1 14.8 28.8 100.0 1,055 11.0 Rural 0.2 0.7 82.3 10.0 6.8 100.0 1,453 9.7 Region North 0.1 0.5 76.2 12.8 10.5 100.0 756 9.9 Center 0.2 1.0 78.9 9.4 10.5 100.0 702 9.7 South 0.2 0.2 76.6 13.0 10.0 100.0 496 9.8 Chisinau 0.0 0.1 50.2 13.5 36.1 100.0 554 11.4 Wealth quintile Lowest 0.7 2.1 91.4 4.8 0.9 100.0 450 9.3 Second 0.0 0.0 87.1 9.2 3.7 100.0 470 9.6 Middle 0.0 0.4 78.5 13.1 8.0 100.0 464 10.0 Fourth 0.0 0.3 62.9 15.5 21.4 100.0 561 10.6 Highest 0.0 0.0 44.4 15.8 39.8 100.0 563 11.8 Total 0.1 0.5 71.3 12.0 16.1 100.0 2,508 10.0 The median number of years of school completed for women and men in Moldova is 10 years. Respondents from urban areas and Chisinau have an additional year of schooling, and respondents from the wealthiest households have the greatest educational advantage, with a median of 12 years of schooling. 3.3 EXPOSURE TO MASS MEDIA Access to information is essential in increasing people’s knowledge and awareness of what is taking place around them, and may eventually affect their perceptions and behavior. In the survey, exposure to media was assessed by asking respondents how often they read a newspaper, watched television, or listened to the radio. Knowing the types of persons who are more or less likely to be reached by the media is important for purposes of planning programs intended to spread information about health or other issues related to the general welfare of the population. Tables 3.3.1 and 3.3.2 show the percentage of female and male respondents, respectively, with access to the various media by age, urban-rural resi- dence, region, educational levels, and wealth quintile. Characteristics of Respondents | 31 Table 3.3.1 Exposure to mass media: women Percentage of women who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Moldova 2005 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media No media Number Age 15-19 60.5 92.9 84.4 52.2 1.9 1,417 20-24 58.0 93.0 80.0 48.3 1.9 1,124 25-29 53.5 93.1 75.1 43.0 3.1 964 30-34 59.4 92.1 74.1 47.8 4.1 924 35-39 57.3 91.9 74.3 47.0 4.1 855 40-44 54.7 91.8 71.5 43.5 4.6 1,007 45-49 50.0 89.6 70.3 38.7 5.4 1,149 Residence Urban 64.9 95.6 76.4 52.5 1.6 3,194 Rural 49.8 89.4 76.0 41.1 4.9 4,246 Region North 55.1 92.6 76.5 43.9 2.6 2,207 Center 48.4 88.2 75.0 41.2 6.3 2,033 South 55.8 90.9 74.7 45.3 4.4 1,402 Chisinau 67.0 96.8 78.3 54.6 0.8 1,798 Education No education/primary (22.7) (74.0) (57.2) (17.0) (19.6) 49 Secondary 45.3 89.1 73.3 36.1 5.0 4,534 Secondary special 68.3 96.6 79.1 56.7 1.4 1,327 Higher 79.5 97.6 82.7 67.2 0.3 1,530 Wealth quintile Lowest 36.0 77.8 68.4 26.9 11.6 1,243 Second 44.2 88.8 75.1 35.5 4.1 1,234 Middle 56.8 95.6 77.1 47.2 2.3 1,511 Fourth 63.7 95.3 78.2 53.3 1.5 1,672 Highest 71.5 98.3 79.7 58.8 0.4 1,780 Total 56.3 92.1 76.2 46.0 3.5 7,440 Note: Figures in parentheses are based on 25-49 unweighted cases. About 95 percent of women and men in Moldova have exposure to media at least once a week. Television is the most popular media source and more than 90 percent of women and men watch it at least weekly. About an equal share of women and men listen to the radio, which is the second most popular media source (76 and 79 percent, respectively). Women, however, are more likely than men to read a newspaper once a week (56 and 41 percent, respectively). Overall, women have more exposure to media: 46 percent access all three sources at least once a week, versus 35 percent of men. 32 | Characteristics of Respondents Table 3.3.2 Exposure to mass media: men Percentage of men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Moldova 2005 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media No media Number Age 15-19 36.1 95.5 84.7 31.6 1.3 411 20-24 40.1 94.1 86.3 37.6 3.3 275 25-29 42.8 92.3 78.2 36.8 4.4 234 30-34 42.7 89.2 82.7 36.8 3.2 224 35-39 50.0 90.6 85.6 45.6 3.0 248 40-44 46.3 93.8 77.3 41.1 5.6 247 45-49 37.1 86.0 72.3 28.4 5.9 349 50-54 39.7 86.2 77.4 32.8 5.3 296 55-59 35.6 83.1 66.6 29.2 11.5 224 Residence Urban 52.2 95.7 81.5 45.2 1.4 1,055 Rural 32.2 86.4 77.6 27.6 6.9 1,453 Region North 34.0 91.3 78.1 28.6 3.9 756 Center 35.0 86.0 78.3 30.9 6.0 702 South 36.7 86.8 75.2 30.7 8.1 496 Chisinau 60.3 97.6 85.7 53.0 0.5 554 Education No education/primary * * * * * 16 Secondary 30.0 88.0 75.9 24.9 5.7 1,788 Secondary special 56.2 97.1 86.1 48.3 0.6 302 Higher 77.7 97.4 90.0 71.1 0.9 403 Wealth quintile Lowest 18.8 71.1 68.2 14.3 14.0 450 Second 28.9 86.0 75.2 23.8 7.6 470 Middle 36.0 96.2 79.0 30.6 2.0 464 Fourth 46.6 96.0 84.8 41.6 0.9 561 Highest 65.8 98.8 86.1 58.0 0.3 563 Total 40.6 90.3 79.3 35.0 4.6 2,508 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 3.3.1 Language Preferences for Print Media In addition to observing trends in exposure to various types of media, it is interesting to consider the language in which respondents prefer to access information in print. A very brief background on language evolution in Moldova should help to interpret the results presented in Table 3.4. The Moldovan language is a Romanian dialect that is native to the region. The main difference between the Moldovan and Romanian languages is that the former includes more words of Slavic origin because of the influence of a Russian- speaking population that has dominated much of the region for very long periods (United States Library of Congress, 1995). Moldovan was written in the Latin alphabet from the mid-19th century until 1940 when the script was changed to the Cyrillic alphabet. In 1989, the Moldovan Soviet Socialist Republic designated Moldovan as the state language of Moldova and changed the script back to the Latin Characteristics of Respondents | 33 alphabet. Russian was maintained as the language of interethnic communication. After independence, the 1994 Moldovan Constitution also designated Moldovan, written in the Latin script, as the state language (Article 13.1). The Constitution further recognizes and protects the right to maintain and develop Russian, and other languages, as functional languages of the state (Article 13.2). Table 3.4 presents language preferences for printed material, among women and men who read a newspaper at least once a week, according to background characteristics. Among women, preferences for language of reading material are about equal for Moldovan in the Latin alphabet (37 percent) and Russian (35 percent) languages. Among men, preference for Russian language (39 percent) is higher than for Moldovan in the Latin alphabet (25 percent). A substantial percentage of women and men reported equally preferring both Moldovan and Russian languages (27 and 32 percent, respectively). Preference for reading Moldovan in the Cyrillic alphabet is low (2 percent for women and 4 percent for men), but would no doubt be higher if the autonomous region of Transnistria were included in the sample.2 Table 3.4 Language preference for printed media Among men and women who read a newspaper at least once a week, percent distribution by preferred language of newspaper, according to background characteristics, Moldova 2005 Women Men Background characteristic Moldovan/ Latin charac. Moldovan/ Cyrillic charac. Russian Moldovan and Russian Other Total Number Moldovan/ Latin charac. Moldovan/ Cyrillic charac. Russian Moldovan and Russian Other Total Number Age 15-19 57.4 0.6 23.0 18.7 0.2 100.0 857 51.2 2.1 24.6 22.0 0.0 100.0 148 20-24 43.3 0.5 29.0 27.2 0.0 100.0 652 39.0 0.7 32.7 27.6 0.0 100.0 110 25-29 34.4 0.6 37.5 27.4 0.1 100.0 516 19.8 0.9 43.0 36.4 0.0 100.0 100 30-34 27.2 2.0 38.6 31.7 0.4 100.0 549 19.9 0.0 40.6 38.8 0.7 100.0 96 35-39 27.3 3.3 36.6 31.8 0.9 100.0 490 18.6 6.0 39.0 34.5 1.9 100.0 124 40-44 27.5 3.8 41.9 26.6 0.1 100.0 551 12.4 3.8 46.5 37.3 0.0 100.0 114 45-49 24.6 3.7 43.1 28.1 0.5 100.0 575 8.8 8.0 50.0 31.5 1.8 100.0 129 50-54 na na na na na na na 19.7 6.5 37.4 36.4 0.0 100.0 117 55-59 na na na na na na na 26.4 1.5 37.6 30.8 3.7 100.0 80 Residence Urban 27.6 1.0 48.3 22.8 0.3 100.0 2,073 19.3 3.5 47.4 29.6 0.3 100.0 551 Rural 45.2 2.9 21.1 30.4 0.4 100.0 2,115 30.8 3.6 28.5 35.7 1.5 100.0 469 Region North 34.1 2.4 35.5 27.8 0.1 100.0 1,216 27.3 2.3 39.8 30.6 0.0 100.0 257 Center 53.1 2.7 15.5 28.2 0.5 100.0 985 29.5 4.4 24.9 39.8 1.3 100.0 246 South 28.6 1.9 40.2 28.7 0.6 100.0 783 16.7 2.8 40.3 37.4 2.8 100.0 182 Chisinau 30.4 0.9 45.6 23.0 0.1 100.0 1,205 23.1 4.2 47.1 25.6 0.0 100.0 335 Education No education/ primary * * * * * * 11 * * * * * * 1 Secondary 40.9 3.1 30.3 25.4 0.3 100.0 2,054 24.7 5.4 39.1 30.0 0.9 100.0 536 Secondary special 30.7 1.2 40.0 27.9 0.2 100.0 906 23.6 3.2 38.2 34.6 0.4 100.0 170 Higher 33.5 0.6 37.4 28.2 0.4 100.0 1,216 24.5 0.6 38.5 35.5 0.9 100.0 313 Wealth quintile Lowest 52.9 5.5 12.4 28.9 0.3 100.0 447 38.6 4.9 21.5 35.0 0.0 100.0 85 Second 49.1 2.6 18.5 29.8 0.0 100.0 545 29.6 2.8 32.8 34.0 0.9 100.0 136 Middle 40.2 2.1 28.5 28.8 0.4 100.0 859 27.5 3.3 31.3 35.9 2.0 100.0 167 Fourth 33.5 1.3 34.9 29.8 0.5 100.0 1,065 22.9 4.5 36.8 34.4 1.5 100.0 261 Highest 25.3 0.9 53.1 20.5 0.2 100.0 1,272 19.4 2.9 49.5 28.3 0.0 100.0 371 Total 36.5 1.9 34.6 26.7 0.3 100.0 4,189 24.6 3.5 38.7 32.4 0.8 100.0 1,019 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 2 In the autonomous region of Transnistria, the Moldovan language is still written in the Cyrillic alphabet. It is a co- official language, along with Ukrainian and Russian. 34 | Characteristics of Respondents Compared with older respondents, those in the youngest age group show a marked increase in the preference for reading in Moldovan in the Latin alphabet, and a simultaneous decrease in the preference for reading in Russian. This trend corresponds with the period following independence, when the Moldovan language was designated the official national language. From age 25 on the largest share of female and male respondents in every age group prefers to read in the Russian language. The preference for reading in Russian, or an equal preference for reading in Russian or Moldovan, is higher for men than women in all age groups. The latter may be explained by their military training, which was carried out in Russian and, during the Soviet period, was obligatory for males. By place of residence and region, similar patterns are noted for women and men. Respondents in rural areas, of both sexes, prefer reading Moldovan in the Latin alphabet about one and a half times more than those in urban areas, while respondents in urban areas have a preference as strong or stronger for reading in Russian; for example, more than twice as many females in urban areas prefer to read in Russian than females in rural areas. Females and males in rural areas are more likely than those in urban areas to prefer both Moldovan and Russian equally. By region, the strongest preference for Russian is in Chisinau, while Russian language is least preferred in the Center region (outside of Chisinau). The relationship between language preference and educational attainment is less clear than for other background characteristics, and the pattern differs by sex. For example, women who attained secondary education prefer to read the Moldovan language in the Latin alphabet and those who attained secondary special or higher education prefer Russian. There is no such pattern for men. In terms of wealth quintiles, for both women and men there is a monotonic increase for a preference in Russian language from the lowest to the highest wealth quintile, and a simultaneous decrease in a preference for Moldovan language. An equal preference for both languages does not vary substantially by quintile, but overall a larger proportion of men than women have an equal preference for the two languages. 3.4 EMPLOYMENT 3.4.1 Employment Status The MDHS asked respondents whether they were employed at the time of the survey and, if not, whether they were employed at all in the 12 months preceding the survey. Tables 3.5.1 and 3.5.2 show the distribution of women and men by employment status, respectively, by background characteristics. Fifty- one percent of women and 58 percent of men are currently employed, and a further 4 percent and 8 percent, respectively, were employed in the 12 months preceding the survey but were no longer employed at the time of the survey. For women, the data show a strong positive association between percent currently employed and age, and between percent currently employed and wealth quintile; for men, the relationship is also positive, but with some exceptions. For example, men in age groups 50-54 and 55-59 are less likely than men age 25-49 to be employed. Men in the older age groups (and probably women also, although data were not collected for women over age 49) are likely to have been the most dramatically affected by economic upheavals during the transition period. These cohorts would have been middle-aged in the 1990s, and probably less likely than their younger counterparts to adapt their career to the new and quickly changing postsocialist economic environment. Characteristics of Respondents | 35 Men who are married are most likely to be employed (70 percent), while among women, the women who were previously married (that is, separated, divorced and widowed women) are the most likely to be employed (67 percent). Since previously married women are likely to be single mothers, they, along with married men, may represent heads of households and be the main income earner in the family. Respondents are more likely to be employed if they live in Chisinau or other urban areas, and are least likely to be employed if they live in the Center region (outside of Chisinau). Current employment is higher for respondents who attained secondary special or higher education (over 60 percent) versus those who attended secondary education. Table 3.5.1 Employment status: women Percent distribution of women by employment status, according to background characteristics, Moldova 2005 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Age 15-19 14.6 2.8 82.6 0.0 100.0 1,417 20-24 38.2 5.0 56.7 0.0 100.0 1,124 25-29 52.2 4.7 43.1 0.0 100.0 964 30-34 62.9 4.9 32.1 0.1 100.0 924 35-39 68.3 3.6 27.9 0.2 100.0 855 40-44 70.4 4.3 25.1 0.2 100.0 1,007 45-49 70.9 3.1 25.9 0.1 100.0 1,149 Marital status Never married 23.4 3.2 73.3 0.0 100.0 1,862 Married or living together 59.9 4.0 36.0 0.1 100.0 4,937 Divorced/separated/ widowed 67.4 6.3 26.1 0.2 100.0 641 Number of living children 0 30.8 4.1 65.1 0.0 100.0 2,456 1-2 62.1 4.0 33.9 0.0 100.0 3,918 3-4 60.8 3.7 35.1 0.4 100.0 965 5+ 50.3 4.1 45.6 0.0 100.0 101 Residence Urban 59.3 3.7 37.0 0.1 100.0 3,194 Rural 45.5 4.2 50.2 0.1 100.0 4,246 Region North 48.9 3.9 47.2 0.0 100.0 2,207 Center 44.8 3.9 51.1 0.1 100.0 2,033 South 51.0 4.0 44.9 0.1 100.0 1,402 Chisinau 62.4 4.1 33.4 0.0 100.0 1,798 Education No education/primary (32.8) (0.0) (67.2) (0.0) (100.0) 49 Secondary 44.0 4.4 51.5 0.1 100.0 4,534 Secondary special 65.2 3.4 31.3 0.1 100.0 1,327 Higher 62.1 3.3 34.6 0.0 100.0 1,530 Wealth quintile Lowest 43.6 5.3 50.8 0.2 100.0 1,243 Second 44.3 4.4 51.3 0.0 100.0 1,234 Middle 47.4 3.5 49.0 0.1 100.0 1,511 Fourth 54.3 3.3 42.3 0.1 100.0 1,672 Highest 62.6 3.8 33.6 0.0 100.0 1,780 Total 51.4 4.0 44.5 0.1 100.0 7,440 Note: Figures in parentheses are based on 25-49 unweighted cases. 36 | Characteristics of Respondents Table 3.5.2 Employment status: men Percent distribution of men by employment status, according to background characteristics, Moldova 2005 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Age 15-19 14.7 6.2 77.4 1.7 100.0 411 20-24 47.9 12.1 40.0 0.0 100.0 275 25-29 71.2 11.9 16.6 0.3 100.0 234 30-34 71.6 10.1 18.3 0.0 100.0 224 35-39 76.1 5.5 18.5 0.0 100.0 248 40-44 73.7 8.8 17.5 0.0 100.0 247 45-49 71.8 7.3 20.9 0.0 100.0 349 50-54 60.7 7.1 32.2 0.0 100.0 296 55-59 55.5 7.0 37.5 0.0 100.0 224 Marital status Never married 30.0 7.4 61.8 0.8 100.0 730 Married or living together 69.9 8.3 21.8 0.1 100.0 1,657 Divorced/separated/ widowed 55.6 12.8 31.6 0.0 100.0 120 Residence Urban 61.4 7.0 31.1 0.4 100.0 1,055 Rural 54.8 9.1 35.9 0.2 100.0 1,453 Region North 55.2 6.7 37.9 0.1 100.0 756 Center 53.0 9.8 37.0 0.1 100.0 702 South 59.3 9.6 30.9 0.3 100.0 496 Chisinau 65.1 7.1 27.0 0.8 100.0 554 Education No education/primary * * * * * 16 Secondary 54.3 9.0 36.4 0.3 100.0 1,788 Secondary special 66.1 8.5 25.1 0.3 100.0 302 Higher 66.4 4.7 28.7 0.2 100.0 403 Wealth quintile Lowest 52.7 8.5 38.8 0.0 100.0 450 Second 52.4 9.8 37.7 0.2 100.0 470 Middle 60.9 8.6 30.0 0.5 100.0 464 Fourth 54.7 7.9 36.9 0.5 100.0 561 Highest 65.9 6.8 27.0 0.3 100.0 563 Total 57.6 8.2 33.9 0.3 100.0 2,508 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 3.4.2 Occupation The distributions of women and men employed in the 12 months preceding the survey, by occupation and other background characteristics, are shown in Tables 3.6.1 and 3.6.2, and Figure 3.1. About one-fifth of women (20 percent) and men (23 percent) work in the agricultural sector. There are substantial differences between women and men’s occupations outside of agriculture, however. For example, more than 50 percent of females are engaged in professional/technical/managerial work and sales and services (33 percent and 24 percent, respectively), while another 18 percent are engaged in skilled manual labor. In contrast, the majority of men are engaged in manual labor—45 percent in skilled manual labor and 8 percent in unskilled manual labor. Clerical and domestic occupations represent minor occupational options in Moldova. Characteristics of Respondents | 37 Table 3.6.1 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics, Moldova 2005 Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agricul- ture Missing Total Number of women Age 15-19 9.1 3.4 40.5 23.5 0.0 2.6 20.0 1.1 100.0 217 20-24 31.8 6.1 27.2 21.0 0.5 2.0 10.8 0.6 100.0 473 25-29 34.7 3.3 26.5 16.8 0.5 1.0 16.6 0.6 100.0 546 30-34 36.5 3.5 23.0 19.6 0.0 0.7 16.6 0.0 100.0 627 35-39 34.1 2.9 23.6 17.4 0.0 1.7 20.1 0.1 100.0 615 40-44 35.1 2.4 22.5 14.9 0.3 1.3 23.2 0.5 100.0 752 45-49 33.3 2.2 19.5 17.2 0.4 0.8 26.1 0.5 100.0 848 Marital status Never married 31.8 6.5 29.7 18.1 0.0 1.3 12.2 0.5 100.0 459 Married or living together 33.6 2.7 23.2 17.1 0.3 1.4 21.3 0.5 100.0 3,147 Divorced/separated/ widowed 29.9 3.2 25.4 22.7 0.5 0.9 17.5 0.0 100.0 471 Number of living children 0 34.5 5.2 28.4 18.0 0.4 1.0 12.0 0.4 100.0 814 1-2 36.3 3.3 24.5 18.5 0.1 1.3 15.7 0.3 100.0 2,585 3-4 19.6 0.6 18.0 15.7 0.6 1.8 43.3 0.4 100.0 622 5+ (5.7) (0.0) (16.2) (9.8) (0.0) (1.5) (62.9) (3.9) (100.0) 55 Residence Urban 40.6 5.2 30.0 21.3 0.3 1.1 1.2 0.3 100.0 1,969 Rural 25.8 1.4 18.7 14.7 0.2 1.5 37.2 0.5 100.0 2,108 Region North 29.1 1.7 23.7 15.6 0.2 0.8 28.6 0.3 100.0 1,163 Center 28.0 2.4 21.9 18.1 0.3 1.8 27.2 0.4 100.0 991 South 29.9 2.7 20.7 17.9 0.4 2.2 25.5 0.8 100.0 770 Chisinau 43.2 5.8 28.9 19.9 0.2 0.7 0.9 0.3 100.0 1,153 Education No education/primary * * * * * * * * * 16 Secondary 5.5 1.9 30.9 25.8 0.4 2.1 32.9 0.5 100.0 2,174 Secondary special 50.9 3.6 20.6 15.0 0.2 0.8 8.6 0.4 100.0 906 Higher 77.4 5.8 12.6 3.2 0.0 0.0 0.7 0.3 100.0 980 Wealth quintile Lowest 8.4 0.2 13.3 9.6 0.5 2.0 65.4 0.5 100.0 608 Second 17.9 1.4 20.6 17.6 0.3 1.1 40.8 0.4 100.0 600 Middle 31.7 2.8 24.0 22.4 0.2 1.8 16.7 0.3 100.0 768 Fourth 40.8 3.9 28.9 21.1 0.1 1.2 3.5 0.5 100.0 950 Highest 48.2 5.4 28.0 16.7 0.3 0.7 0.3 0.3 100.0 1,150 Total 33.0 3.2 24.2 17.9 0.3 1.3 19.8 0.4 100.0 4,077 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 38 | Characteristics of Respondents Table 3.6.2 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Moldova 2005 Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agricul- ture Missing Total Number of men Age 15-19 2.2 0.0 7.4 58.4 10.0 0.0 20.5 1.4 100.0 77 20-24 9.5 1.4 11.6 56.2 8.1 0.8 11.7 0.7 100.0 162 25-29 16.5 2.4 12.7 45.2 6.0 0.0 17.2 0.0 100.0 195 30-34 13.1 0.6 15.1 46.1 7.1 0.0 17.2 0.8 100.0 183 35-39 9.3 0.8 12.5 45.1 3.1 0.0 28.7 0.5 100.0 202 40-44 12.9 0.3 7.8 47.7 9.2 0.0 22.1 0.0 100.0 204 45-49 12.4 0.0 5.6 42.0 6.8 0.0 32.7 0.5 100.0 276 50-54 20.0 0.3 5.8 35.3 15.0 0.0 23.7 0.0 100.0 200 55-59 20.1 1.3 2.9 37.6 11.7 0.0 25.1 1.4 100.0 140 Marital status Never married 8.6 1.6 9.4 52.5 9.5 0.5 16.9 1.0 100.0 264 Married or living together 14.6 0.7 9.5 42.8 7.7 0.0 24.4 0.4 100.0 1,292 Divorced/separated/ widowed 11.7 0.0 2.3 54.2 12.5 0.0 19.3 0.0 100.0 82 Residence Urban 22.2 1.3 13.8 52.5 7.4 0.2 2.2 0.4 100.0 710 Rural 6.8 0.4 5.5 39.1 8.9 0.0 38.7 0.5 100.0 929 Region North 10.4 0.5 8.3 41.6 10.3 0.0 28.4 0.4 100.0 468 Center 7.9 0.2 8.6 47.1 6.5 0.0 29.0 0.8 100.0 441 South 10.5 0.7 5.0 41.5 10.9 0.0 31.4 0.0 100.0 341 Chisinau 26.0 1.8 14.3 49.4 5.6 0.3 1.9 0.7 100.0 388 Education No education/primary * * * * * * * * * 9 Secondary 2.4 0.1 5.5 51.7 10.5 0.1 29.1 0.5 100.0 1,124 Secondary special 16.5 1.9 13.0 48.6 5.1 0.0 14.4 0.4 100.0 224 Higher 55.4 2.5 20.4 15.9 2.1 0.0 3.4 0.5 100.0 282 Wealth quintile Lowest 1.5 0.0 1.7 30.0 13.3 0.0 52.8 0.6 100.0 275 Second 4.8 0.5 4.9 40.3 8.9 0.0 40.5 0.1 100.0 292 Middle 7.3 1.1 6.2 50.3 8.9 0.0 25.1 1.1 100.0 322 Fourth 16.9 0.4 13.1 53.6 8.3 0.0 7.8 0.0 100.0 350 Highest 30.0 1.6 16.1 46.6 3.9 0.3 0.9 0.7 100.0 399 Total 13.5 0.8 9.1 44.9 8.3 0.1 22.9 0.5 100.0 1,639 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. A closer examination of respondents engaged in agricultural occupations shows little difference between background characteristics by sex. For example, 20 to 33 percent of employed women and men in age groups 35-39 and over work in agriculture. Agricultural workers are most likely to have the following characteristics: to live in rural areas, to have a secondary education (versus secondary special or higher education), and to come from households in the lowest two wealth quintiles. Outside of Chisinau region, a roughly equal proportion of employed respondents in North, South, and Center regions are engaged in agricultural occupations. Characteristics of Respondents | 39 The greatest share of women who are currently employed work in a professional/technical/ managerial jobs (33 percent). There is little variation in the percentage of professional women from each age group over 15-19. Not surprisingly, relatively more professional women live in urban areas, have attended secondary special school or university, and come from households in the two upper wealth quintiles. The second largest share of women is engaged in sales and services activities (24 percent). Unlike professional women, a relatively larger percentage of women in sales and service are from the youngest age group (15-19) and have attended secondary school. The greatest percentage of male respondents earn their living doing skilled manual labor (45 percent). A relatively larger percentage of these men are in younger age groups, 15-19 and 20-24, live in an urban area, and come from households in the middle or fourth wealth quintiles. In contrast, among the 14 percent of males who are engaged in professional/technical/managerial livelihoods, a greater share of them are in older age groups, 50-54 and 55-59, also live in an urban area, and come from the highest wealth quintile. Figure 3.1 Percent Distribution of Women and Men Who Are Currently Employed, by Occupation WOMEN MEN Note: Totals may not add to 100 because of rounding. MDHS 2005 Agriculture 20% Domestic service/ clerical 5% Skilled manual 18% Sales and services 24% Professional/ technical managerial 33% Professional/ technical managerial 14% Agriculture 23% Domestic service/ clerical 1% Unskilled manual 8% Skilled manual 45% Sales and services 9% 3.4.3 Use of Earnings Married women who are employed and receive cash earnings were asked who the primary decisionmaker is regarding how their earnings are spent. This information allows for the assessment of women’s control over their own earnings. Table 3.7 shows how women’s control over their earnings varies by background characteristics. Among women receiving cash earnings, about two-thirds decide jointly with their husband or with someone else how to use their income (62 percent), almost a third (30 percent) decide by themselves, and for a small minority (2 percent), someone else makes decisions about how their earnings are used. 40 | Characteristics of Respondents There is not a lot of variation by background characteristics for the type of decision made, independently or jointly. In general, however, women who make independent decisions about their earnings are more likely to be in the oldest age group, from urban areas especially Chisinau, and from households in the highest wealth quintile. In contrast, women who make joint decisions with their spouse or someone else are more likely in the youngest age groups, from rural areas, from the South region, and from households in the lowest wealth quintile. Table 3.7 Decision on use of earnings Percent distribution of married women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used, according to background characteristics, Moldova 2005 Person who decides how earnings are used Background characteristic Self only Jointly1 Someone else only2 Missing Total Number of women Age 15-19 (25.3) (72.7) (2.0) (0.0) (100.0) 33 20-24 24.1 72.0 3.3 0.6 100.0 252 25-29 27.0 70.3 2.4 0.4 100.0 387 30-34 27.4 70.3 1.8 0.5 100.0 488 35-39 28.9 68.3 2.8 0.0 100.0 478 40-44 30.4 67.8 1.7 0.1 100.0 552 45-49 35.5 61.9 2.0 0.5 100.0 596 Number of living children 0 33.4 62.3 3.8 0.5 100.0 284 1-2 29.8 67.9 2.0 0.3 100.0 2,026 3-4 27.3 70.3 2.3 0.1 100.0 441 5+ (19.4) (79.2) (1.4) (0.0) (100.0) 34 Residence Urban 34.3 62.9 2.4 0.4 100.0 1,414 Rural 24.8 73.0 2.0 0.2 100.0 1,371 Region North 28.2 69.5 1.9 0.4 100.0 775 Center 27.2 70.3 2.4 0.1 100.0 663 South 23.2 74.6 2.1 0.1 100.0 543 Chisinau 37.3 59.7 2.5 0.6 100.0 804 Education No education/primary * * * * * 12 Secondary 29.9 66.8 2.9 0.4 100.0 1,362 Secondary special 27.6 70.2 2.0 0.2 100.0 693 Higher 31.2 67.5 1.1 0.2 100.0 717 Wealth quintile Lowest 23.2 73.1 3.2 0.5 100.0 294 Second 25.6 71.9 2.3 0.2 100.0 380 Middle 27.5 70.0 2.2 0.3 100.0 575 Fourth 29.9 67.6 2.3 0.2 100.0 705 Highest 34.9 62.9 1.8 0.4 100.0 832 Total 29.6 67.8 2.2 0.3 100.0 2,785 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 With husband or someone else 2 Includes husband Characteristics of Respondents | 41 3.5 WOMEN’S EMPOWERMENT In addition to information on women’s education, employment status, and control over earnings, the MDHS collected information from both women and men on other measures of women’s autonomy and status. In particular, questions were asked about women’s roles in making household decisions, on tolerance of wife beating, and on their opinions about when a wife is justified in refusing to have sex with her husband. Such information provides insight into women’s control over their environment as well as attitudes toward gender roles. 3.5.1 Women’s Participation in Decisionmaking To assess women’s decisionmaking authority, the MDHS collected information on married women’s participation in four different types of household decisions: on the respondents’ own health care; on making large household purchases; on making household purchases for daily needs; and on visits to family or relatives. Table 3.8 shows the percent distribution of married women according to who usually has the final say in each of these decisions. The autonomy of women in this case would be gauged by either their making such decisions independently or jointly. Table 3.8 Women's participation in decisionmaking Percent distribution of currently married women by person who has the final say in making specific decisions, according to type of decision, Moldova 2005 Currently married or living together Decision Self only Jointly with husband Husband only Someone else only Missing/ other Total Number of women Own health care 51.6 45.4 2.4 0.3 0.4 100.0 4,937 Large household purchases 19.0 76.8 3.4 0.4 0.4 100.0 4,937 Daily household purchases 64.0 32.5 2.7 0.5 0.3 100.0 4,937 Visits to family or relatives 19.8 77.1 2.3 0.3 0.4 100.0 4,937 Among currently married women, independence in making decisions ranges from one-fifth for making large household purchases and visiting family or relatives, to 64 percent for making daily household purchases. Husbands (or partners) rarely make any of these decisions without their wife’s input; decisions that are not made solely by the woman are most likely to be made jointly by the woman and her husband. Overall, married women in Moldova have a lot of say in specific household decisions, and Table 3.9 shows that participation in decisionmaking varies little by background characteristics. In all four types of decisions, 96 to 97 percent of married women are influential in making specific decisions, either by themselves or jointly. Ninety-two percent reported having a say in all four decisions, and only among the youngest women (age 15-19) did substantially fewer (81 percent) have a say in all four decisions. Women with five or more children and women employed but not for cash had a slight advantage over other women in having a say in final decisions (96 percent). 42 | Characteristics of Respondents Table 3.9 Women's participation in decisionmaking by background characteristics Percentage of currently married women who say that they alone or jointly have the final say in specific decisions, by background characteristics, Moldova 2005 Alone or jointly has final say in: Background characteristic Own health care Making large purchases Making daily purchases Visits to family or relatives All specified decisions None of the specified decisions Number of women Age 15-19 92.7 92.6 90.1 89.7 80.7 2.6 136 20-24 95.5 93.7 95.6 95.7 88.2 1.2 629 25-29 97.0 95.6 96.3 96.6 89.9 0.7 794 30-34 97.7 96.3 96.5 97.1 91.6 0.6 810 35-39 98.1 96.4 97.7 98.4 93.1 0.4 746 40-44 97.1 96.9 98.0 98.3 93.3 0.7 869 45-49 97.4 97.0 96.8 97.5 93.6 0.9 953 Number of living children 0 93.5 94.0 93.4 94.9 86.5 1.8 534 1-2 97.4 96.0 97.0 97.4 91.4 0.6 3,435 3-4 98.0 97.0 97.3 97.4 94.4 0.7 875 5+ 96.1 96.1 97.1 97.1 96.1 2.9 93 Residence Urban 96.4 94.5 95.0 96.6 88.6 1.0 2,045 Rural 97.5 97.0 97.8 97.4 93.6 0.6 2,892 Region North 97.8 97.1 97.6 97.6 93.3 0.6 1,515 Center 96.4 95.9 96.4 96.7 91.3 1.0 1,336 South 98.1 97.6 98.6 97.7 93.9 0.2 958 Chisinau 95.9 93.4 94.2 96.4 87.4 1.4 1,127 Education No education/primary (86.1) (82.0) (82.0) (82.6) (80.5) (13.9) 41 Secondary 97.1 96.7 96.9 96.9 92.1 0.8 2,884 Secondary special 97.7 95.9 97.8 98.6 93.1 0.3 1,046 Higher 96.8 94.6 95.3 96.8 88.5 0.7 966 Employment Not employed 96.7 94.9 95.9 95.6 89.9 1.2 1,965 Employed for cash 97.2 96.5 96.9 98.0 92.2 0.6 2,644 Employed not for cash 98.4 99.0 99.7 98.8 96.4 0.0 313 Wealth quintile Lowest 97.1 95.6 96.8 96.2 92.4 1.4 839 Second 97.8 97.4 97.8 96.8 93.8 0.6 834 Middle 97.2 97.3 97.7 97.7 93.3 0.5 1,029 Fourth 96.6 95.9 96.5 98.4 91.1 0.6 1,081 Highest 96.8 94.3 95.0 96.3 88.0 0.9 1,154 Total 97.1 96.0 96.7 97.1 91.5 0.8 4,937 Note: Figures in parentheses are based on 25-49 unweighted cases. Characteristics of Respondents | 43 3.5.2 Women’s and Men’s Attitudes toward Wife Beating Violence against women is an area increasingly being recognized as a serious human rights issue. If violence against women is tolerated in society, eradicating it is made more difficult. To gauge the acceptability of domestic violence, women and men interviewed in the MDHS were asked whether they thought a husband would be justified in hitting or beating his wife in each of the following five situations: if she burns the food; if she argues with him; if she goes out without telling him; if she neglects the children; and if she refuses to have sex with him.3 Tables 3.10.1 and 3.10.2 show that women and men think there is little justification for a husband to beat his wife. Although 21 percent of women and 22 percent of men agree with at least one specified reason for wife beating, results show that neglecting the children is the only widely accepted reason, cited by 18 percent of both women and men. Fewer than 10 percent feel that wife beating is justified for any of the other reasons asked about. A relatively large proportion of men and women who agree with at least one specified reason for beating a wife are from households in the two lowest wealth quintiles, are among those employed not for cash, and are among those who attended secondary school (versus secondary special or higher). In addition, women with three or more children were more likely to agree with at least one reason that a husband is justified in hitting or beating his wife. 3 The MDHS also included questions on the actual prevalence of gender violence (see Chapter 14). 44 | Characteristics of Respondents Table 3.10.1 Women's attitudes toward wife beating Percentage of women who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Moldova 2005 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Agrees with at least one specified reason Number Age 15-19 4.1 4.9 6.7 20.8 2.9 23.7 1,417 20-24 4.2 4.1 5.4 16.6 1.7 18.6 1,124 25-29 4.0 5.6 7.1 17.4 2.3 20.1 964 30-34 4.3 3.8 6.7 17.2 3.5 20.4 924 35-39 4.5 5.6 8.0 17.6 4.0 20.3 855 40-44 3.9 5.1 8.8 17.9 3.8 21.2 1,007 45-49 4.7 6.5 8.5 16.9 3.1 20.4 1,149 Marital status Never married 3.3 3.6 4.8 17.3 2.2 19.6 1,862 Married or living together 4.6 5.7 8.3 18.2 3.4 21.4 4,937 Divorced/separated/ widowed 4.7 4.4 6.4 17.8 2.3 19.5 641 Number of living children 0 3.6 4.0 5.8 16.9 2.4 19.6 2,456 1-2 3.6 4.6 6.3 16.6 2.6 19.2 3,918 3-4 8.5 9.5 14.2 25.5 6.2 29.3 965 5+ 4.1 9.2 14.3 24.6 4.6 30.6 101 Residence Urban 1.9 2.7 3.1 12.0 1.7 13.8 3,194 Rural 6.0 6.9 10.4 22.3 4.0 26.1 4,246 Region North 5.5 5.8 8.3 21.0 4.0 24.4 2,207 Center 4.9 5.9 9.1 20.6 3.2 23.6 2,033 South 3.8 5.4 8.2 17.5 2.5 20.5 1,402 Chisinau 2.3 3.0 3.2 11.3 2.0 13.5 1,798 Education No education/primary (12.2) (22.4) (20.4) (30.6) (16.3) (36.7) 49 Secondary 5.8 7.0 10.2 23.7 4.1 27.5 4,534 Secondary special 2.1 2.7 3.5 11.0 1.6 13.3 1,327 Higher 1.3 1.0 1.5 6.3 0.7 7.0 1,530 Employment Not employed 4.6 5.5 7.8 19.6 3.0 22.5 3,598 Employed for cash 3.6 4.3 5.9 15.0 2.6 17.9 3,439 Employed not for cash 5.7 7.9 13.6 27.4 6.6 31.1 382 Wealth quintile Lowest 11.0 10.1 16.8 32.9 6.7 38.2 1,243 Second 5.2 7.8 10.3 23.8 4.1 27.3 1,234 Middle 3.5 5.3 7.4 17.1 2.7 20.0 1,511 Fourth 2.3 2.9 3.5 12.8 1.6 14.9 1,672 Highest 1.3 1.5 2.0 8.9 1.3 10.4 1,780 Total 4.2 5.1 7.3 17.9 3.0 20.8 7,440 Note: Figures in parentheses are based on 25-49 unweighted cases. Characteristics of Respondents | 45 Table 3.10.2 Men's attitudes toward wife beating Percentage of men who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Moldova 2005 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Agrees with at least one specified reason Number Age 15-19 3.4 9.2 9.1 20.6 5.1 24.7 411 20-24 3.8 6.8 7.9 21.2 2.1 23.8 275 25-29 0.5 5.7 8.6 13.6 2.1 15.4 234 30-34 2.8 5.2 8.6 19.5 3.3 21.8 224 35-39 3.2 8.4 11.1 21.0 4.9 24.7 248 40-44 0.7 6.2 7.9 18.5 2.8 22.4 247 45-49 3.2 9.8 15.1 15.0 3.7 23.9 349 50-54 1.8 7.0 9.1 12.6 4.5 18.7 296 55-59 3.5 6.7 8.2 14.9 3.9 16.5 224 Marital status Never married 3.0 8.1 8.8 22.0 3.6 25.2 730 Married or living together 2.2 7.0 9.4 14.8 3.5 19.3 1,657 Divorced/separated/ widowed 6.5 11.2 19.0 27.6 7.0 34.4 120 Residence Urban 2.1 5.1 4.7 12.4 2.5 15.0 1,055 Rural 3.0 9.2 13.4 21.2 4.6 26.5 1,453 Region North 2.2 6.5 9.5 16.0 3.0 19.5 756 Center 2.9 9.7 11.6 19.5 3.6 25.3 702 South 2.5 8.8 13.6 19.7 5.5 24.8 496 Chisinau 2.9 4.8 4.1 15.1 3.1 17.4 554 Education No education/primary * * * * * * 16 Secondary 3.3 9.3 12.0 20.9 4.8 25.7 1,788 Secondary special 0.2 3.3 6.5 11.7 0.8 14.9 302 Higher 0.9 2.0 2.1 6.5 0.5 8.8 403 Employment Not employed 2.9 7.9 10.4 17.9 4.0 22.6 1,351 Employed for cash 2.2 7.0 8.4 16.6 2.7 19.7 1,031 Employed not for cash 2.8 7.3 13.7 22.1 8.6 28.6 122 Wealth quintile Lowest 4.0 11.1 15.9 23.9 6.0 31.9 450 Second 3.7 10.2 16.5 22.4 4.6 27.3 470 Middle 2.1 8.6 7.7 18.6 4.1 22.5 464 Fourth 2.1 5.7 7.9 14.0 2.7 16.9 561 Highest 1.6 3.2 2.6 11.0 1.7 13.0 563 Total 2.6 7.5 9.7 17.5 3.7 21.7 2,508 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 46 | Characteristics of Respondents 3.5.3 Women’s and Men’s Attitudes toward Wife Refusing Sex with Husband The MDHS asked women and men respondents whether they thought a wife is justified in refusing to have sex with her husband in the following three circumstances: when she knows that her husband has a sexually transmitted disease; when she knows that her husband has sex with other women; and when she is tired or not in the mood. Tables 3.11.1 and 3.11.2 show the responses of women and men, respectively. Overall, women’s sexual autonomy is high in Moldova. Seventy-one percent of women and 68 percent of men agree that all of the above reasons are rational justifications for a woman to refuse to have sexual relations with her husband. Only 7 percent of both women and men agree with none of the reasons. The most accepted reason for refusing to have sex, for both sexes, is if the wife knows that the husband has a sexually transmitted disease (91 percent of both women and men). Seventy-seven percent of both women and men think that a woman’s being tired or not in the mood justifies not having sex. The largest disparity between women and men’s attitudes is when a woman knows that her husband has sex with other woman: 85 percent of women believe this is justification to refuse sex, while only 76 percent of men believe this is a justifiable reason. The tables also show attitudes towards refusing to have sex by background characteristics. The differences are not large, but there is a distinct pattern that is similar for both men and women. That is, the percentages of those who do not agree with any specified reason for refusing sex are higher for the youngest age groups (15-19), for those never married, for those who show a higher tolerance for wife beating, and for those in the lowest wealth quintiles. The percentage is also higher for women who have five or more children. Characteristics of Respondents | 47 Table 3.11.1 Women's attitudes toward a wife refusing sex with husband Percentage of women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Moldova 2005 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Is tired or not in the mood Agrees with all of the specified reasons Agrees with none of the specified reasons Number Age 15-19 85.3 80.2 73.2 68.2 12.2 1,417 20-24 93.0 88.1 79.6 74.1 4.7 1,124 25-29 93.6 88.6 79.5 74.4 4.1 964 30-34 93.2 86.3 77.8 71.9 4.8 924 35-39 93.9 87.2 79.3 73.0 3.5 855 40-44 91.7 84.6 77.3 71.5 6.2 1,007 45-49 88.4 80.1 75.0 67.8 9.3 1,149 Marital status Never married 87.2 81.6 73.5 68.4 10.6 1,862 Married or living together 92.5 86.0 78.8 72.6 5.2 4,937 Divorced/separated/ widowed 89.1 82.5 74.7 69.3 8.7 641 Number of living children 0 88.5 82.9 74.6 69.2 9.0 2,456 1-2 93.0 86.8 79.7 73.5 4.8 3,918 3-4 89.2 81.1 74.5 68.9 8.8 965 5+ 80.1 75.2 62.3 57.4 16.2 101 Residence Urban 93.0 86.6 78.8 72.8 4.8 3,194 Rural 89.2 83.1 75.8 70.1 8.4 4,246 Region North 92.3 85.6 77.9 72.0 5.7 2,207 Center 88.3 82.7 75.5 69.9 9.2 2,033 South 91.0 85.5 77.7 73.1 6.6 1,402 Chisinau 91.9 84.9 77.4 70.6 5.6 1,798 Education No education/primary (73.1) (59.7) (51.9) (43.4) (22.3) 49 Secondary 88.4 82.8 76.0 70.5 8.9 4,534 Secondary special 94.8 87.4 81.2 74.9 3.6 1,327 Higher 95.3 88.3 77.6 71.3 3.0 1,530 Employment Not employed 89.6 83.7 77.3 71.3 8.1 3,598 Employed for cash 92.0 85.7 76.7 71.0 5.5 3,439 Employed not for cash 92.7 84.0 78.3 73.6 6.5 382 Number of reasons wife beating is justified 0 91.6 85.3 78.1 72.5 6.4 5,891 1-2 91.0 84.4 76.3 69.7 5.5 1,205 3-4 80.7 76.4 63.0 58.0 15.5 271 5 66.6 62.4 58.2 47.2 29.3 73 Wealth quintile Lowest 86.4 80.6 73.3 68.5 10.9 1,243 Second 87.9 81.8 76.5 70.9 10.2 1,234 Middle 91.6 86.0 78.4 73.3 6.3 1,511 Fourth 92.2 85.3 76.6 69.7 5.4 1,672 Highest 94.2 87.6 79.6 73.3 3.4 1,780 Total 90.8 84.6 77.1 71.3 6.8 7,440 Note: Figures in parentheses are based on 25-49 unweighted cases. 48 | Characteristics of Respondents Table 3.11.2 Men's attitudes toward a wife refusing sex with husband Percentage of men who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Moldova 2005 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Is tired or not in the mood Agrees with all of the specified reasons Agrees with none of the specified reasons Number Age 15-19 85.6 70.7 70.9 58.7 10.4 411 20-24 94.0 78.5 77.2 70.7 4.6 275 25-29 93.3 75.7 75.6 67.6 5.4 234 30-34 91.4 75.1 80.9 68.0 5.2 224 35-39 94.5 81.7 83.3 74.1 3.2 248 40-44 88.9 73.5 81.6 70.6 8.4 247 45-49 93.2 77.3 78.7 68.9 5.0 349 50-54 92.8 75.2 77.2 68.0 4.7 296 55-59 88.3 74.6 75.2 69.9 10.1 224 Marital status Never married 87.5 70.7 71.4 60.4 9.4 730 Married or living together 93.0 78.0 80.3 71.5 4.9 1,657 Divorced/separated/ widowed 87.7 71.8 74.3 63.6 11.3 120 Residence Urban 93.0 77.1 78.1 69.1 5.4 1,055 Rural 89.8 74.4 76.9 67.0 7.3 1,453 Region North 91.0 79.3 79.8 71.8 5.9 756 Center 92.9 72.8 75.5 67.0 6.4 702 South 89.2 75.2 77.6 65.3 6.2 496 Chisinau 90.7 74.3 76.5 65.9 7.6 554 Education No education/primary * * * * * 16 Secondary 89.4 73.6 75.1 65.1 7.6 1,788 Secondary special 97.0 79.5 84.1 75.7 2.6 302 Higher 96.0 82.9 83.7 75.8 3.2 403 Employment Not employed 91.7 74.4 77.2 67.0 5.9 1,351 Employed for cash 90.5 76.9 77.2 68.6 7.4 1,031 Employed not for cash 89.5 77.4 82.2 72.3 5.3 122 Number of reasons wife beating is justified 0 91.3 76.1 78.6 68.6 6.2 1,929 1-2 90.5 74.7 75.1 66.4 7.4 457 3-4 87.1 68.4 66.3 59.8 9.7 94 5 (100.0) (74.2) (75.1) (69.6) (0.0) 27 Wealth quintile Lowest 84.9 68.8 70.1 60.6 10.9 450 Second 87.5 72.8 76.2 65.3 9.0 470 Middle 94.6 80.0 81.0 73.0 3.9 464 Fourth 94.0 78.6 79.8 70.5 3.8 561 Highest 93.3 76.6 79.1 69.1 5.6 563 Total 91.1 75.6 77.4 67.9 6.5 2,508 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility, Levels, Trends, and Differentials | 49 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4 4.1 INTRODUCTION Fertility is one of the three principal components of population dynamics, the others being mortality and migration (United Nations, 1973). The factors that determine fertility can be placed into two major categories—biological and social. The biological component refers to the capacity to reproduce, usually called “fecundity.” A woman’s fecundity varies with age; her fecundity begins to increase from menarche (the onset of menstruation), peaks in her twenties, and then declines to menopause (the time when a woman ceases to ovulate and menstruate). The biological component is necessary but is not on its own a sufficient condition for fertility. Given the capacity to reproduce, the social environment in which people live largely determines whether couples will actually have children, and if so, how many and with what degree of spacing. Demographers use the term “fertility” to refer to the actual production of live offspring or live births. The definition of a live birth was developed by the World Health Organization in 1950: “The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached (WHO, 1992).” The MDHS data are used to calculate several measures of fertility. Age-specific fertility rates (ASFRs) are expressed by the number of births to women of a given age interval per 1,000 women in that age interval. In this survey, the ASFR for any specific 5-year age interval is calculated by dividing the number of births of women in the age interval during the period 1 to 36 months preceding the survey by the number of years lived by women in that age interval during the same period of 1 to 36 months. The total fertility rate (TFR) is based on the ASFRs and is one of the most commonly used summary indicators of fertility. The TFR is interpreted as the average number of children that would be born to a woman during her lifetime if she were to experience the currently observed age-specific fertility rates throughout her reproductive years. The TFR is calculated by adding the current age-specific fertility rates, multiplying by 5 (because five-year age groups of women are used), then dividing by 1,000. An important property of the total fertility rate is that it is not affected by the age distribution of the population. All women who were interviewed in the MDHS were asked to give a complete reproductive history. In collecting these histories, each woman was first asked about the total number of pregnancies that had ended in live births, induced abortions, miscarriages, and stillbirths. After obtaining these aggregate data, an event-by-event pregnancy history was collected. For each pregnancy, the duration, the month and year of termination, and the result of the pregnancy were recorded. The result of each pregnancy was classified as a live birth, stillbirth, miscarriage, or induced abortion. Information was collected about the most recent completed pregnancy, then the next-to-last, etc. For each live birth, information was collected on the sex of the child, survival status, and age (for surviving children) or age at death (for deceased children). 50 | Fertility Levels, Trends, and Differentials From the information collected in the reproductive histories, it is possible to estimate current fertility levels and trends, fertility differentials, number of children ever born and living, birth intervals, age at first birth, teenage pregnancy, and motherhood. 4.2 CURRENT FERTILITY LEVELS Table 4.1 and Figure 4.1 present the ASFRs and the TFRs for the three years preceding the survey, which corre- sponds to the period mid-2002 to mid-2005. The three-year period, rather than a longer or shorter period, was chosen for calculating these rates in order to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births.1 Table 4.1 shows a TFR of 1.7 children per woman for the three-year period preceding the 2005 MDHS. (The corresponding 95% confidence interval is 1.6 and 1.8.) This means that, on average, a woman in Moldova who is at the beginning of her childbearing years will give birth to 1.7 children by the end of her reproductive period if fertility levels remain constant at the level observed in the three-year period. This level is below replacement level fertility (which is slightly higher than 2.0). 1 The displacement of births is a potential bias introduced into the data when, during data collection, some inter- viewers displace a child’s date of birth from the true age of under five years to some age older than five years old. Interviewers may illicitly do this in order to avoid having to fill the lengthy questionnaire section on the health of children under age five and thus complete the interview more quickly. Table 4.1 Current fertility Age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Moldova 2005 Residence Age group Urban Rural Total 15-19 26 39 34 20-24 110 153 132 25-29 91 98 95 30-34 54 59 57 35-39 17 16 17 40-44 2 4 3 45-49 0 0 0 TFR 1.5 1.8 1.7 GFR 51 59 55 CBR 12.5 11.7 12.0 ASFR: Age-specific fertility rate (number of births to women in a specific age group divided by the number of woman-years lived during a given period) TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population � � � � � � � � � �

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