Namibia - Demographic and Health Survey - 2014

Publication date: 2014

Namibia 2013Demographic and Health Survey N am ibia 2013 D em ographic and H ealth Survey REPUBLIC OF NAMIBIA Namibia Demographic and Health Survey 2013 Ministry of Health and Social Services Windhoek, Namibia Namibia Statistics Agency Windhoek, Namibia September 2014 This report summarizes the findings of the 2013 Nambia Demographic and Health Survey (NDHS) implemented by the Ministry of Health and Social Services (MoHSS) in collaboration with the Namibia Statistics Agency (NSA) and the National Institute of Pathology (NIP). Technical support was provided by ICF International with financial support from the Government of Namibia, the United States Agency for International Development (USAID), and the Global Fund (GFATM). Information about the 2013 NDHS may be obtained from the Ministry of Health and Social Services (MoHSS), Private Bag 13198, Windhoek, Namibia; Telephone: (264-61) 203-2500/2; Fax: (264-61) 222-558; Email: pro@mhss.gov.na; Internet: www.mhss.gov.na. Information about The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850-5971, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; Email: reports@DHSprogram.com; Internet: www.DHSprogram.com. Cover photo: “Sunset behind a baobab.” ©2006 Ian Beatty [www.flickr.com/photos/ibeatty/351180675/in/set- 72157594468704452]. Used under Creative Commons license. Suggested citation: The Nambia Ministry of Health and Social Services (MoHSS) and ICF International. 2014. The Namibia Demographic and Health Survey 2013. Windhoek, Namibia, and Rockville, Maryland, USA: MoHSS and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xvii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xix MAP OF NAMIBIA . xx 1 INTRODUCTION . 1 1.1 Geography, History, and Economy . 1 1.1.1 Geography . 1 1.1.2 History . 1 1.1.3 Economy . 2 1.2 Population . 2 1.3 Health Services and Programmes . 3 1.4 Survey Objectives . 4 1.5 Organisation of the Survey . 4 1.6 Survey Implementation. 4 1.6.1 Sample Design . 4 1.6.2 Questionnaires . 5 1.6.3 Anaemia and HIV Testing . 6 1.6.4 Blood Glucose and Blood Pressure Testing . 7 1.6.5 Pretest. 8 1.6.6 Household Listing . 8 1.6.7 Training of Field Staff . 8 1.6.8 Data Collection . 8 1.6.9 Data Processing . 9 1.7 Response Rates . 9 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 2.1 Household Characteristics . 11 2.1.1 Drinking Water . 11 2.1.2 Sanitation Facilities and Waste Disposal . 13 2.1.3 Housing Characteristics . 14 2.1.4 Household Possessions . 15 2.2 Household Wealth . 16 2.3 Hand Washing . 17 2.4 Household Population by Age, Sex, and Residence . 18 2.5 Household Composition . 20 2.6 Birth Registration . 20 2.7 Children’s Living Arrangements and Parental Survival . 21 2.8 Education of the Household Population . 22 2.8.1 Educational Attainment . 22 2.8.2 School Attendance Ratios . 24 2.9 Utilisation of Health Services and Out-of-Pocket Expenditure for Health Care . 26 3 CHARACTERISTICS OF SURVEY RESPONDENTS . 29 3.1 Characteristics of Survey Respondents . 29 3.2 Educational Attainment by Background Characteristics . 31 3.3 Literacy . 33 iv • Contents 3.4 Exposure to Mass Media . 35 3.5 Employment . 37 3.5.1 Employment Status . 37 3.5.2 Occupation . 40 3.5.3 Earnings, Employers, and Continuity of Employment for Women . 42 4 MARRIAGE AND SEXUAL ACTIVITY . 45 4.1 Marital Status . 45 4.2 Polygyny . 46 4.3 Age at First Marriage . 48 4.4 Age at First Sexual Intercourse . 49 4.5 Recent Sexual Activity . 51 5 FERTILITY . 55 5.1 Current Fertility . 55 5.2 Fertility by Background Characteristics . 56 5.3 Fertility Trends . 57 5.4 Children Ever Born and Living . 58 5.5 Birth Intervals . 59 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . 60 5.7 Median Duration of Postpartum Insusceptibility by Background Characteristics . 61 5.8 Menopause . 62 5.9 Age at First Birth . 62 5.10 Median Age at First Birth by Background Characteristics . 63 5.11 Teenage Pregnancy and Motherhood . 63 6 FERTILITY PREFERENCES . 65 6.1 Fertility Preferences by Number of Living Children . 65 6.2 Desire to Limit Childbearing by Background Characteristics . 66 6.3 Ideal Number of Children . 67 6.4 Mean Ideal Number of Children by Background Characteristics . 69 6.5 Fertility Planning Status . 69 6.6 Wanted Fertility Rates . 70 7 FAMILY PLANNING . 71 7.1 Knowledge of Contraceptive Methods . 71 7.2 Current Use of Contraception . 72 7.3 Current Use of Contraception by Background Characteristics . 74 7.4 Source of Modern Contraceptive Methods . 76 7.5 Informed Choice . 77 7.6 Rates of Discontinuing Contraceptive Methods . 78 7.7 Reasons for Discontinuing Contraceptive Methods . 79 7.8 Knowledge of the Fertile Period . 80 7.9 Need and Demand for Family Planning . 80 7.10 Future Use of Contraception . 82 7.11 Exposure to Family Planning Messages in the Media . 82 7.12 Contact of Nonusers with Family Planning Providers . 83 8 INFANT AND CHILD MORTALITY . 85 8.1 Background and Assessment of Data Quality . 85 8.2 Infant and Child Mortality Levels and Trends . 87 8.3 Socioeconomic Differentials in Early Childhood Mortality . 88 8.4 Demographic Differentials in Early Childhood Mortality . 89 Contents • v 8.5 Perinatal Mortality . 90 8.6 High-Risk Fertility Behaviour . 91 9 ADULT AND MATERNAL MORTALITY . 93 9.1 Assessment of Data Quality . 94 9.2 Estimates of Adult Mortality . 95 9.3 Estimates of Maternal Mortality . 95 10 MATERNAL HEALTH CARE . 99 10.1 Antenatal Care . 100 10.2 Number and Timing of Antenatal Care Visits . 101 10.3 Components of Antenatal care . 102 10.4 Tetanus Toxoid . 104 10.5 Place of Delivery . 104 10.6 Assistance during Delivery . 106 10.7 Postnatal Care . 108 10.7.1 Postnatal Checkup for the Mother . 108 10.7.2 Postnatal Care for the Newborn . 111 10.8 Problems in Accessing Health Care . 113 11 CHILD HEALTH . 115 11.1 Child’s Weight and Size at Birth . 115 11.2 Vaccination of Children . 117 11.2.1 Sources of Information . 117 11.2.2 Vaccination Coverage . 117 11.2.3 Trends in Vaccination Coverage . 119 11.3 Prevalence and Treatment of Acute Respiratory Infection . 120 11.4 Prevalence and Treatment of Fever . 120 11.5 Diarrhoeal Disease . 122 11.5.1 Prevalence of Diarrhoea . 122 11.5.2 Treatment of Diarrhoea . 122 11.5.3 Feeding Practices during Diarrhoea . 124 11.6 Knowledge of ORS Packets . 124 11.7 Disposal of Children’s Stools . 126 12 NUTRITION OF CHILDREN AND ADULTS . 129 12.1 Nutritional Status of Children . 130 12.1.1 Measurement of Nutritional Status among Young Children . 130 12.1.2 Data Collection . 131 12.1.3 Levels of Child Malnutrition . 131 12.1.4 Trends in Child Malnutrition . 133 12.2 Initiation of Breastfeeding . 134 12.3 Breastfeeding Status by Age . 135 12.4 Duration of Breastfeeding . 138 12.5 Types of Complementary Foods . 138 12.6 Infant and Young Child Feeding Practices . 139 12.7 Prevalence of Anaemia in Children . 142 12.8 Micronutrient Intake and Supplementation among Children . 143 12.9 Presence of Iodised Salt in Households . 146 12.10 Adult Nutritional Status . 146 12.10.1 Nutritional Status of Women . 146 12.10.2 Nutritional Status of Men . 148 12.10.3 Anaemia in Women . 149 12.10.4 Anaemia in Men . 150 12.11 Micronutrient Intake among Mothers . 150 vi • Contents 13 MALARIA . 153 13.1 Ownership of Mosquito Nets . 153 13.2 Indoor Residual Spraying . 156 13.3 Access to an Insecticide-Treated Net . 157 13.4 Use of Mosquito Nets . 158 13.4.1 Use of Mosquito Nets by Persons in the Household . 158 13.4.2 Use of Existing Mosquito Nets . 160 13.4.3 Use of Mosquito Nets by Children under Age 5 . 160 13.4.4 Use of Mosquito Nets by Pregnant Women . 161 13.5 Use of Intermittent Preventive Treatment of Malaria During Pregnancy . 163 13.6 Prevalence, Diagnosis, and Prompt Treatment of Children with Fever . 163 13.7 Prevalence of Low Haemoglobin in Children . 166 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 169 14.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 170 14.1.1 Knowledge of AIDS . 170 14.1.2 Knowledge of HIV Prevention . 171 14.1.3 Comprehensive Knowledge about HIV/AIDS . 173 14.2 Knowledge about Mother-to-Child Transmission . 176 14.3 Attitudes toward People Living with HIV/AIDS . 178 14.4 Attitudes toward Negotiating Safer Sexual Relations with Husbands . 180 14.5 Attitudes toward Condom Education for Young People . 182 14.6 Higher-Risk Sex . 183 14.6.1 Multiple Sexual Partners . 183 14.6.2 Point Prevalence and Cumulative Prevalence of Concurrent Sexual Partners . 186 14.7 Paid Sex . 187 14.8 Male Circumcision . 189 14.9 Self-Reporting of Sexually Transmitted Infections . 192 14.10 Injections . 193 14.11 HIV/AIDS-Related Knowledge and Behaviour among Young People . 195 14.11.1 Knowledge about HIV/AIDS and Source for Condoms . 195 14.11.2 First Sex . 196 14.11.3 Premarital Sex . 198 14.11.4 Multiple Sexual Partners among Youth . 199 14.11.5 Age Mixing in Sexual Relationships . 201 15 HIV PREVALENCE . 203 15.1 Participation Rates for HIV Testing . 204 15.2 HIV Prevalence . 208 15.2.1 HIV Prevalence by Age . 208 15.2.2 HIV Prevalence by Socioeconomic Characteristics . 209 15.2.3 HIV Prevalence by Demographic and Health Characteristics . 211 15.2.4 HIV Prevalence by Sexual Risk Behaviour . 213 15.3 HIV Prevalence among Young People . 216 15.4 HIV Prevalence by Other Characteristics Related to HIV Risk . 217 15.5 HIV Prevalence among Couples . 219 16 SELF-REPORTED PRIOR HIV TESTING AND TREATMENT . 221 16.1 Coverage of HIV Testing Services . 221 16.2 HIV Testing among Youth . 224 16.3 Couple Counselling and Testing . 225 16.4 Place of Last HIV Test . 229 16.5 HIV Prevalence by Prior HIV Test Results . 229 Contents • vii 16.6 Self-Reported Use of Antiretroviral Medications (ARVs) . 232 16.7 HIV Testing during Pregnancy . 233 16.8 Early Infant Diagnosis . 235 17 BLOOD PRESSURE AND BLOOD GLUCOSE . 237 17.1 Coverage Rates for Blood Pressure and Blood Glucose Measurement . 237 17.2 High Blood Pressure . 238 17.2.1 History and Treatment of High Blood Pressure . 239 17.2.2 Prevalence of High Blood Pressure . 241 17.3 Diabetes . 247 17.3.1 History of Diabetes . 248 17.3.2 Prevalence and Treatment of Diabetes . 250 18 OTHER HEALTH ISSUES. 253 18.1 Knowledge of and Attitudes toward Tuberculosis . 253 18.2 Cancer Screening . 255 18.2.1 Breast Cancer and Cervical Cancer Screening . 255 18.2.2 Prostate Cancer Screening . 257 18.3 Use of Tobacco . 258 18.4 Alcohol Consumption . 261 18.5 Use of Seatbelts . 264 18.6 Physical Activity . 266 18.7 Consumption of Water, Fruits, and Vegetables . 269 18.8 Mental Health . 271 18.9 Health Insurance . 274 19 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 277 19.1 Women’s and Men’s Employment . 277 19.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s Earnings . 278 19.3 Women’s Ownership of Assets . 282 19.4 Women’s and Men’s Participation in Decision Making . 284 19.5 Attitudes toward Wife Beating . 288 19.6 Women’s Empowerment Indicators . 291 19.7 Current Use of Contraception by Women’s Empowerment . 291 19.8 Ideal Family Size and Unmet Need by Women’s Empowerment . 292 19.9 Women’s Empowerment and Reproductive Health Care . 293 20 DOMESTIC VIOLENCE . 295 20.1 Valid Measures of Domestic Violence . 295 20.1.1 Use of Valid Measures of Violence . 295 20.1.2 Ethical Considerations for the Domestic Violence Module in the 2013 NDHS . 296 20.1.3 Subsample for the Violence Module . 297 20.2 Experience of Physical Violence . 297 20.3 Perpetrators of Physical Violence . 299 20.4 Experience of Sexual Violence . 299 20.5 Perpetrators of Sexual Violence . 301 20.6 Experience of Different Forms of Violence . 301 20.7 Violence during Pregnancy . 302 20.8 Marital Control by Husband . 303 20.9 Forms of Spousal Violence . 305 20.10 Spousal Violence by Background Characteristics . 306 viii • Contents 20.11 Violence by Spousal Characteristics and Women’s Empowerment Indicators . 308 20.12 Recent Spousal Violence . 310 20.13 Onset of Spousal Violence . 310 20.14 Physical Consequences of Spousal Violence . 311 20.15 Women’s Violence Against Their Husbands . 312 20.16 Help-Seeking Behaviour by Women Who Experience Violence . 315 20.17 Sources of Help to Stop Violence . 316 REFERENCES . 317 APPENDIX A SAMPLE SELECTION . 323 A.1 Introduction . 323 A.2 Sampling Frame . 323 A.3 Sampling Procedure and Sample Allocation . 324 A.4 Sampling Probabilities . 326 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 335 APPENDIX C DATA QUALITY TABLES . 355 APPENDIX D PARTICIPANTS IN THE 2013 NAMIBIA DEMOGRAPHIC AND HEALTH SURVEY . 361 APPENDIX E QUESTIONNAIRES . 367 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Basic demographic indicators, Namibia 1991, 2001, and 2011 . 2 Table 1.2 Results of the household and individual interviews . 9 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 Table 2.1 Household drinking water . 12 Table 2.2 Household sanitation facilities . 13 Table 2.3 Household characteristics . 14 Table 2.4 Household possessions . 15 Table 2.5 Wealth quintiles . 17 Table 2.6 Hand washing . 18 Table 2.7 Household population by age, sex, and residence . 19 Table 2.8 Household composition . 20 Table 2.9 Birth registration of children under age 5 . 21 Table 2.10 Children’s living arrangements and orphanhood . 22 Table 2.11.1 Educational attainment of the female household population . 23 Table 2.11.2 Educational attainment of the male household population . 24 Table 2.12 School attendance ratios . 25 Table 2.13.1 Health expenditure: Inpatient visits . 27 Table 2.13.2 Health expenditure: Outpatient visits . 28 Figure 2.1 Population pyramid . 19 Figure 2.2 Age-specific attendance rates . 26 3 CHARACTERISTICS OF SURVEY RESPONDENTS . 29 Table 3.1 Background characteristics of respondents . 30 Table 3.2.1 Educational attainment: Women . 32 Table 3.2.2 Educational attainment: Men . 33 Table 3.3.1 Literacy: Women . 34 Table 3.3.2 Literacy: Men . 35 Table 3.4.1 Exposure to mass media: Women . 36 Table 3.4.2 Exposure to mass media: Men . 37 Table 3.5.1 Employment status: Women . 38 Table 3.5.2 Employment status: Men . 39 Table 3.6.1 Occupation: Women . 41 Table 3.6.2 Occupation: Men . 42 Table 3.7 Type of employment . 43 Figure 3.1 Women’s employment status in the past 12 months . 40 4 MARRIAGE AND SEXUAL ACTIVITY . 45 Table 4.1 Current marital status . 46 Table 4.2.1 Number of women’s co-wives . 47 Table 4.2.2 Number of men’s wives . 48 Table 4.3 Age at first marriage . 49 Table 4.4 Age at first sexual intercourse . 50 Table 4.5 Median age at first sexual intercourse by background characteristics . 50 x • Tables and Figures Table 4.6.1 Recent sexual activity: Women . 51 Table 4.6.2 Recent sexual activity: Men . 53 5 FERTILITY . 55 Table 5.1 Current fertility . 55 Table 5.2 Fertility by background characteristics . 56 Table 5.3.1 Trends in age-specific fertility rates . 57 Table 5.3.2 Trends in fertility . 57 Table 5.4 Children ever born and living . 58 Table 5.5 Birth intervals . 59 Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility . 60 Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility . 61 Table 5.8 Menopause . 62 Table 5.9 Age at first birth . 62 Table 5.10 Median age at first birth . 63 Table 5.11 Teenage pregnancy and motherhood . 64 Figure 5.1 Trends in fertility . 58 6 FERTILITY PREFERENCES . 65 Table 6.1 Fertility preferences by number of living children . 66 Table 6.2 Desire to limit childbearing: Women . 67 Table 6.3 Ideal number of children by number of living children . 68 Table 6.4 Mean ideal number of children . 69 Table 6.5 Fertility planning status . 70 Table 6.6 Wanted fertility rates . 70 7 FAMILY PLANNING . 71 Table 7.1 Knowledge of contraceptive methods . 72 Table 7.2.1 Current use of contraception by age . 73 Table 7.2.2 Current use of contraception by background characteristics . 75 Table 7.3 Trends in contraceptive use . 76 Table 7.4 Source of modern contraception methods . 77 Table 7.5 Informed choice . 78 Table 7.6 Twelve-month contraceptive discontinuation rates . 79 Table 7.7 Reasons for discontinuation . 79 Table 7.8 Need and demand for family planning for all women . 81 Table 7.9 Future use of contraception . 82 Table 7.10 Exposure to family planning messages . 83 Table 7.11 Contact of nonusers with family planning providers . 84 Figure 7.1 Trends in contraceptive use among all women age 15-49, Namibia 1992-2013 . 76 8 INFANT AND CHILD MORTALITY . 85 Table 8.1 Early childhood mortality rates . 87 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 88 Table 8.3 Early childhood mortality rates by demographic characteristics . 89 Table 8.4 Perinatal mortality . 91 Table 8.5 High-risk fertility behaviour . 92 Figure 8.1 Trends in childhood mortality, 1987-2012 . 88 Tables and Figures • xi 9 ADULT AND MATERNAL MORTALITY . 93 Table 9.1 Adult mortality rates . 95 Table 9.2 Adult mortality probabilities . 95 Table 9.3 Maternal mortality . 96 Figure 9.1 Maternal mortality ratios with confidence intervals for the 10 years preceding the 1992, 2000, 2006-07, and 2013 NDHS surveys (per 100,000 live births) . 97 10 MATERNAL HEALTH CARE . 99 Table 10.1 Antenatal care . 101 Table 10.2 Number of antenatal care visits and timing of first visit . 102 Table 10.3 Components of antenatal care . 103 Table 10.4 Tetanus toxoid injections . 104 Table 10.5 Place of delivery . 105 Table 10.6 Reasons for not delivering in a health facility . 106 Table 10.7 Assistance during delivery . 107 Table 10.8 Timing of first postnatal checkup . 109 Table 10.9 Type of provider of first postnatal checkup for the mother . 110 Table 10.10 Timing of first postnatal checkup for the newborn . 112 Table 10.11 Type of provider of first postnatal checkup for the newborn . 113 Table 10.12 Problems in accessing health care . 114 Figure 10.1 Mother’s duration of stay in the health facility after giving birth . 111 11 CHILD HEALTH . 115 Table 11.1 Child’s size and weight at birth. 116 Table 11.2 Vaccinations by source of information . 117 Table 11.3 Vaccinations by background characteristics . 118 Table 11.4 Vaccinations in first year of life . 119 Table 11.5 Prevalence and treatment of symptoms of ARI . 120 Table 11.6 Prevalence and treatment of fever . 121 Table 11.7 Prevalence of diarrhoea . 122 Table 11.8 Diarrhoea treatment . 123 Table 11.9 Feeding practices during diarrhoea . 125 Table 11.10 Disposal of children’s stools . 126 Figure 11.1 Trends in vaccination coverage during the first year of life among children age 12-23 months . 119 12 NUTRITION OF CHILDREN AND ADULTS . 129 Table 12.1 Nutritional status of children . 132 Table 12.2 Initial breastfeeding . 135 Table 12.3 Breastfeeding status by age . 136 Table 12.4 Median duration of breastfeeding . 138 Table 12.5 Foods and liquids consumed by children in the day or night preceding the interview . 139 Table 12.6 Infant and young child feeding (IYCF) practices . 141 Table 12.7 Prevalence of anaemia in children . 143 Table 12.8 Micronutrient intake among children . 145 Table 12.9 Presence of iodised salt in household . 146 Table 12.10.1 Nutritional status of women . 147 Table 12.10.2 Nutritional status of men . 148 xii • Tables and Figures Table 12.11.1 Prevalence of anaemia in women . 149 Table 12.11.2 Prevalence of anaemia in men . 150 Table 12.12 Micronutrient intake among mothers . 151 Figure 12.1 Nutritional status of children by age . 133 Figure 12.2 Trends in nutritional status of children under age 5 by period . 134 Figure 12.3 Infant feeding practices by age . 137 Figure 12.4 IYCF indicators on breastfeeding status . 137 Figure 12.5 IYCF indicators on minimum acceptable diet . 142 13 MALARIA . 153 Table 13.1 Household possession of mosquito nets . 155 Table 13.2 Indoor residual spraying against mosquitoes . 156 Table 13.3 Access to an insecticide-treated net (ITN) . 157 Table 13.4 Use of mosquito nets by persons in the household . 159 Table 13.5 Use of existing ITNs . 160 Table 13.6 Use of mosquito nets by children . 161 Table 13.7 Use of mosquito nets by pregnant women . 162 Table 13.8 Use of Intermittent Preventive Treatment (IPTp) by women during pregnancy . 163 Table 13.9 Prevalence, diagnosis, and prompt treatment of children with fever . 165 Table 13.10 Source of advice or treatment for children with fever . 166 Table 13.11 Haemoglobin <8.0 g/dl in children . 167 Figure 13.1 Percentage of the de facto population with access to an ITN in the household . 158 Figure 13.2 Ownership, access, and use of ITNs . 160 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 169 Table 14.1 Knowledge of AIDS . 171 Table 14.2 Knowledge of HIV prevention methods . 172 Table 14.3.1 Comprehensive knowledge about AIDS: Women . 174 Table 14.3.2 Comprehensive knowledge about AIDS: Men . 175 Table 14.4 Knowledge of prevention of mother-to-child transmission of HIV . 177 Table 14.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 179 Table 14.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 180 Table 14.6 Attitudes toward negotiating safer sexual relations with husband . 181 Table 14.7 Adult support of education about condom use to prevent AIDS . 182 Table 14.8.1 Multiple sexual partners: Women . 184 Table 14.8.2 Multiple sexual partners: Men . 185 Table 14.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 187 Table 14.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 188 Table 14.11 Male circumcision . 189 Table 14.12 Provider and place of circumcision . 189 Table 14.13 Attitudes toward male circumcision . 190 Table 14.14 Benefits of male circumcision . 191 Table 14.15 Specific benefits of male circumcision . 191 Table 14.16 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 192 Table 14.17 Prevalence of medical injections . 194 Table 14.18 Comprehensive knowledge about AIDS and of a source of condoms among youth . 196 Tables and Figures • xiii Table 14.19 Age at first sexual intercourse among young people . 197 Table 14.20 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 199 Table 14.21.1 Multiple sexual partners in the past 12 months among young people: Women . 200 Table 14.21.2 Multiple sexual partners in the past 12 months among young people: Men . 201 Table 14.22 Age mixing in sexual relationships among women and men age 15-19 . 202 Figure 14.1 Women and men seeking advice for treatment of STIs . 193 Figure 14.2 Trends in age at first sexual intercourse . 198 15 HIV PREVALENCE . 203 Table 15.1.1 Coverage of HIV testing by background characteristics: Respondents age 15-49 . 205 Table 15.1.2 Coverage of HIV testing by background characteristics: Respondents age 50-64 . 207 Table 15.2 HIV prevalence by age . 209 Table 15.3.1 HIV prevalence by socioeconomic characteristics: Respondents age 15-49 . 210 Table 15.3.2 HIV prevalence by socioeconomic characteristics: Respondents age 50-64 . 211 Table 15.4.1 HIV prevalence by demographic characteristics: Respondents age 15-49 . 212 Table 15.4.2 HIV prevalence by demographic characteristics: Respondents age 50-64 . 213 Table 15.5.1 HIV prevalence by sexual behaviour: Respondents age 15-49 . 214 Table 15.5.2 HIV prevalence by sexual behaviour: Respondents age 50-64 . 215 Table 15.6 HIV prevalence among young people by background characteristics . 216 Table 15.7 HIV prevalence among young people by sexual behaviour . 217 Table 15.8 HIV prevalence by other characteristics: Respondents age 15-64 . 218 Table 15.9 HIV prevalence by male circumcision . 219 Table 15.10 HIV prevalence among couples . 220 16 SELF-REPORTED PRIOR HIV TESTING AND TREATMENT . 221 Table 16.1.1 Coverage of prior HIV testing: Women . 223 Table 16.1.2 Coverage of prior HIV testing: Men . 224 Table 16.2 Recent HIV tests among youth . 225 Table 16.3.1 Couple counselling and testing . 227 Table 16.3.2 Consideration of couple counselling and testing in the future . 228 Table 16.4 Place of last HIV test . 229 Table 16.5.1 HIV prevalence by self-reported prior HIV testing: Respondents 15-49 . 230 Table 16.5.2 HIV prevalence by self-reported prior HIV testing: Respondents age 50-64 . 230 Table 16.6.1 Prior HIV testing by current HIV status: Respondents 15-49 . 231 Table 16.6.2 Prior HIV testing by current HIV status: Respondents 50-64 . 231 Table 16.7 Self-reported HIV status and ARV use: Women . 232 Table 16.8 Pregnant women counselled and tested for HIV . 234 Table 16.9 Early infant diagnosis . 235 Figure 16.1 Self-reported ARV use and HIV status among HIV-positive women age 15-64 . 233 17 BLOOD PRESSURE AND BLOOD GLUCOSE . 237 Table 17.1 Coverage of testing for blood pressure and fasting blood glucose measurement among women and men age 35-64 . 238 Table 17.2 History of hypertension . 240 Table 17.3 Actions taken or advice received to lower blood pressure . 241 xiv • Tables and Figures Table 17.4.1 Blood pressure status: Women . 243 Table 17.4.2 Blood pressure status: Men . 245 Table 17.5 History of diabetes . 249 Table 17.6 Actions taken or advice received to lower high blood glucose or diabetes . 250 Table 17.7.1 Prevalence of diabetes by background characteristics: Women . 251 Table 17.7.2 Prevalence of diabetes by socioeconomic characteristics: Men . 252 Figure 17.1 Awareness of high blood pressure and treatment status among women and men age 35-64 with high blood pressure. 247 18 OTHER HEALTH ISSUES. 253 Table 18.1.1 Knowledge of and attitudes concerning tuberculosis: Women . 254 Table 18.1.2 Knowledge of and attitudes concerning tuberculosis: Men . 255 Table 18.2 Breast cancer examination and cervical cancer examination or test . 257 Table 18.3 Knowledge of and testing for prostate cancer . 258 Table 18.4.1 Use of tobacco: Women . 259 Table 18.4.2 Use of tobacco: Men . 260 Table 18.5.1 Use of alcohol: Women . 262 Table 18.5.2 Use of alcohol: Men . 263 Table 18.6 Use of seatbelts . 265 Table 18.7.1 Physical activity: Women . 267 Table 18.7.2 Physical activity: Men . 268 Table 18.8.1 Consumption of water, fruits, and vegetables: Women . 270 Table 18.8.2 Consumption of water, fruits, and vegetables: Men . 271 Table 18.9.1 Mental health: Women . 272 Table 18.9.2 Mental health: Men . 273 Table 18.10.1 Health insurance coverage: Women . 275 Table 18.10.2 Health insurance coverage: Men . 276 19 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 277 Table 19.1 Employment and cash earnings of currently married women and men . 278 Table 19.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 279 Table 19.2.2 Control over men’s cash earnings . 281 Table 19.3 Women’s control over their own earnings and over those of their husbands . 282 Table 19.4.1 Ownership of assets: Women . 283 Table 19.4.2 Ownership of assets: Men . 284 Table 19.5 Participation in decision making . 285 Table 19.6.1 Women’s participation in decision making by background characteristics . 286 Table 19.6.2 Men’s participation in decision making by background characteristics . 288 Table 19.7.1 Attitude toward wife beating: Women . 289 Table 19.7.2 Attitude toward wife beating: Men . 290 Table 19.8 Indicators of women’s empowerment . 291 Table 19.9 Current use of contraception by women’s empowerment . 292 Table 19.10 Ideal number of children and unmet need for family planning by women’s empowerment . 293 Table 19.11 Reproductive health care by women’s empowerment . 293 Figure 19.1 Number of decisions in which currently married women participate, Namibia 2013 . 287 Tables and Figures • xv 20 DOMESTIC VIOLENCE . 295 Table 20.1 Experience of physical violence . 298 Table 20.2 Persons committing physical violence . 299 Table 20.3 Experience of sexual violence. 300 Table 20.4 Persons committing sexual violence . 301 Table 20.5 Experience of different forms of violence . 301 Table 20.6 Experience of violence during pregnancy . 302 Table 20.7 Marital control exercised by husbands . 304 Table 20.8 Forms of spousal violence . 305 Table 20.9 Spousal violence by background characteristics . 307 Table 20.10 Spousal violence by husband’s characteristics and empowerment indicators . 309 Table 20.11 Physical or sexual violence in the past 12 months by any husband/partner . 310 Table 20.12 Experience of spousal violence by duration of marriage . 311 Table 20.13 Injuries to women due to spousal violence . 311 Table 20.14 Women’s violence against their spouse . 313 Table 20.15 Women’s violence against their spouse by husband’s characteristics and empowerment indicators . 314 Table 20.16 Help seeking to stop violence . 315 Table 20.17 Sources of help to stop the violence . 316 APPENDIX A SAMPLE SELECTION . 323 Table A.1 Enumeration areas (EAs) and average EA size in the sampling frame . 324 Table A.2 Distribution of households in the sampling frame . 324 Table A.3 Sample allocation of clusters and households . 325 Table A.4 Sample allocation of expected number of interviews with women and men . 325 Table A.5 Sample implementation: Women . 328 Table A.6 Sample implementation: Men . 329 Table A.7 Coverage of HIV testing by social and demographic characteristics: Women . 330 Table A.8 Coverage of HIV testing by social and demographic characteristics: Men . 331 Table A.9 Coverage of HIV testing by sexual behaviour characteristics: Women . 332 Table A.10 Coverage of HIV testing by sexual behaviour characteristics: Men . 333 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 335 Table B.1 List of selected variables for sampling errors, Namibia 2013 . 337 Table B.2 Sampling errors: Total sample, Namibia 2013 . 338 Table B.3 Sampling errors: Urban sample, Namibia 2013 . 339 Table B.4 Sampling errors: Rural sample, Namibia 2013 . 340 Table B.5 Sampling errors: Zambezi sample, Namibia 2013 . 341 Table B.6 Sampling errors: Erongo sample, Namibia 2013 . 342 Table B.7 Sampling errors: Hardap sample, Namibia 2013 . 343 Table B.8 Sampling errors: //Karas sample, Namibia 2013 . 344 Table B.9 Sampling errors: Kavango sample, Namibia 2013 . 345 Table B.10 Sampling errors: Khomas sample, Namibia 2013 . 346 Table B.11 Sampling errors: Kunene sample, Namibia 2013 . 347 Table B.12 Sampling errors: Ohangwena sample, Namibia 2013 . 348 Table B.13 Sampling errors: Omaheke sample, Namibia 2013 . 349 Table B.14 Sampling errors: Omusati sample, Namibia 2013 . 350 Table B.15 Sampling errors: Oshana sample, Namibia 2013 . 351 Table B.16 Sampling errors: Oshikoto sample, Namibia 2013 . 352 Table B.17 Sampling errors: Otjozondjupa sample, Namibia 2013 . 353 Table B.18 Sampling errors for adult and maternal mortality rates, Namibia 2013 . 354 xvi • Tables and Figures APPENDIX C DATA QUALITY TABLES . 355 Table C.1 Household age distribution . 355 Table C.2.1 Age distribution of eligible and interviewed women . 356 Table C.2.2 Age distribution of eligible and interviewed men . 356 Table C.3 Completeness of reporting . 357 Table C.4 Births by calendar years . 357 Table C.5 Reporting of age at death in days . 358 Table C.6 Reporting of age at death in months . 358 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 359 Table C.8 Completeness of information on siblings . 360 Table C.9 Sibship size and sex ratio of siblings . 360 Foreword • xvii FOREWORD he 2013 Namibia Demographic and Health Survey (NDHS) serves as a periodic update of the demographic and health situation in Namibia. This is the fourth comprehensive, national-level population and health survey conducted in Namibia as part of the global Demographic and Health Surveys (DHS) programme. The 2013 NDHS was implemented by the Ministry of Health and Social Services (MoHSS) in collaboration with the Namibia Statistics Agency (NSA) and the National Institute of Pathology (NIP). Technical support was provided by ICF International, with financial support from the Government of Namibia, the United States Agency for International Development (USAID), and the Global Fund. The study was initiated in April 2012, and data collection was carried out from May to September 2013. The overall objective of the survey was to provide demographic, socioeconomic, and health data necessary for policymaking, planning, monitoring, and evaluation at both the national and regional levels. The survey was designed to generate recent and reliable information on fertility, family planning, infant and child mortality, maternal and child health, nutrition, domestic violence, and knowledge and prevalence of HIV/AIDS and other noncommunicable diseases, which allows monitoring progress through time with respect to these issues. In addition, the survey measured the prevalence of anaemia, high blood pressure, and high blood glucose among adult women and men and the prevalence of anaemia among children age 6-59 months; it also collected anthropometric data to assess the nutritional status of women, men, and children. The information provided in this report will aid in assessments of current health- and population- related policies and programmes. It will also be useful in formulating new population and health policies and programmes. A long-term objective of the survey is to strengthen the technical capacity of local organisations to plan, conduct, process, and analyse data from complex national population and health surveys. Moreover, the 2013 NDHS is comparable to similar surveys conducted in other developing countries and therefore affords a national and international comparison. The 2013 NDHS adds to the vast and growing international database on demographic and health-related variables. The Ministry of Health and Social Services would like to extend its appreciation to all development partners for their input to the survey, to ICF International for providing technical support, and, most importantly, to the respondents who provided the information on which this report is based. ANDREW NDISHISHI PERMANENT SECRETARY T Millennium Development Goal Indicators • xix MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Namibia 2013 Sex Total Indicator Male Female 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under age 5 15.3 11.4 13.3 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 89.5 90.8 90.1 2.3 Literacy rate of 15 to 24-year-olds2 92.8a 95.9 94.4b 3. Promote gender equality and empower women 3.1 Ratio of girls to boys in primary, secondary ,and tertiary education 3.1a Ratio of girls to boys in primary education3 na na 1.0 3.1b Ratio of girls to boys in secondary education3 na na 1.2 3.1c Ratio of girls to boys in tertiary education3 na na 1.5 4. Reduce child mortality 4.1 Under-5 mortality rate4 64 54 54 4.2 Infant mortality rate4 44 37 39 4.3 Proportion of 1-year-old children immunized against measles 91.4 87.8 89.5 5. Improve maternal health 5.1 Maternal mortality ratio5 na na 385 5.2 Percentage of births attended by skilled health personnel6 na na 88.2 5.3 Contraceptive prevalence rate7 na 56.1 na 5.4 Adolescent birth rate8 na 82.3 na 5.5a Antenatal care coverage: at least one visit9 na 73.6 na 5.5b Antenatal care coverage: four or more visits10 na 62.5 na 5.6 Unmet need for family planning na 17.5 na 6. Combat HIV/AIDS, malaria, and other diseases 6.2 Condom use at last high-risk sex11 82.0 67.5 74.7 6.3 Percentage of the population age 15-24 with comprehensive correct knowledge of HIV/AIDS12 51.1 61.6 56.3 6.4 Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 1.02 1.01 1.02 6.7 Percentage of children under 5 sleeping under insecticide-treated bed nets 5.9 5.2 5.6 6.8 Percentage of children under 5 with fever who are treated with appropriate antimalarial drugs13 8.8 8.1 8.4 Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source14 97.8 71.9 84.0 7.9 Percentage of population with access to improved sanitation15 53.2 16.7 33.8 na = Not applicable 1 The ratio is based on reported attendance, not enrollment, in primary education among primary school age children age 6-10. The rate also includes children of primary school age enrolled in secondary education. This is a proxy for MDG indicator 2.1, Net enrollment ratio. 2 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence 3 Based on reported net attendance, not gross enrollment, among 6-12-year-olds for primary, 13-17-year-olds for secondary, and 18-22-year- olds for tertiary education 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the five-year period preceding the survey. 5 Expressed in terms of maternal deaths per 100,000 live births in the seven-year period preceding the survey 6 Among births in the five years preceding the survey 7 Percentage of currently married women age 15-49 using any method of contraception 8 Equivalent to the age-specific fertility rate for women age 15-19 for the three years preceding the survey, expressed in terms of births per 1,000 women age 15-19 9 With a skilled provider 10 With any health care provider 11 High-risk sex refers to sexual intercourse with a non-marital, non-cohabitating partner. Expressed as a percentage of men and women age 15- 24 who had higher-risk sex in the past 12 months. 12 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 13 Measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and who received any antimalarial drug 14 Percentage of de jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tubewell or borehole, protected dug well, protected spring, rainwater collection, or bottled water. 15 Percentage of de jure population whose household has a flush toilet, ventilated improved pit latrine, pit latrine with a slab, or composting toilet and does not share its facility with other households a Restricted to men in a subsample of households selected for the male interview b The total calculated as the simple arithmetic mean of the percentages in the columns for male and females xx • Map of Namibia Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND ECONOMY 1.1.1 Geography amibia is a country in south-western Africa that covers approximately 824,000 square kilometres. It is bordered by the Atlantic Ocean in the west, Angola and Zambia in the north, Botswana in the east, and South Africa in the south and east. It lies mostly between 17° and 29° south latitude (a small area is north of 17°) and 11° and 26° east longitude. The name of the country is derived from the Namib Desert, one of the oldest deserts in the world. Its sand dunes, created by the strong onshore winds, are the highest in the world. There is often extremely dense fog in the Namib Desert as a result of its location, where the Atlantic’s cold waters reach Africa. The Namib Desert stretches along the entire west coast of the country, and the Kalahari Desert runs along the south-eastern border with Botswana. The Namibia consists of five geographical areas: the Central Plateau, the Namib Desert, the Great Escarpment, the Bushveld, and the Kalahari Desert. The central, southern, and coastal areas constitute some of the most arid landscapes south of the Sahara. Because of its location between the Namib and Kalahari deserts, Namibia has the least rainfall in sub-Saharan Africa. The climate in Namibia ranges from arid and semi-arid to subtropical, with temperatures between 5°C and 20°C. Fog sometimes occurs along the temperate desert coast. The hottest months of the year are January and February, with average daytime temperatures ranging between 9°C and 30°C. During the winter months, May to September, temperatures can fluctuate from between -6°C and 10°C at night to 20°C in the day. Although frost occurs over large areas of the country during the winter, in general winter days are clear, cloudless, and sunny. Overall, Namibia is a summer rainfall area, with limited showers beginning in October and continuing until April. 1.1.2 History Namibia gained independence from South Africa on March 21, 1990, following the Namibian War of Independence. Independence followed almost a century of colonial rule by Germany and then by South Africa. Namibia became a German Imperial protectorate in 1884 and remained a German colony until the end of World War I. South Africa occupied the colony in 1915, and the League of Nations mandated Namibia to South Africa in 1919. In 1978 the United Nations (UN) Security Council passed UN Resolution 435, which planned the transition toward independence for Namibia. However, it was only in 1985, after internal violence and uprisings, that South Africa established an interim administration in Namibia. Namibia obtained full independence in 1990 with the exception of Walvis Bay and the Penguin Islands, which remained under South African control until 1994. The country has a multi-party system and holds general elections every five years. A bicameral legislature consists of the National Council (two members chosen from each regional council) and the National Assembly. Namibia is a member state of the UN, the Southern African Development Community, the African Union, and the Commonwealth of Nations. Administratively, the country is divided into 13 regions: Zambezi, Kavango, Kunene, Ohangwena, Omusati, Oshana, and Oshikoto in the north; Omaheke, Otjozondjupa, Erongo, and Khomas in central Namibia; and Hardap and //Karas in the south. The capital is Windhoek, located in the Khomas region. N 2 • Introduction 1.1.3 Economy Agriculture, herding, tourism, and the mining industry, including mining for gem diamonds, uranium, gold, silver, and base metals, are the basis of the economy in Namibia. The growth rate of the domestic economy is expected to increase from 4.7 percent in 2013 to 5.0 percent in 2014 (Bank of Namibia, 2013). This economic growth is attributed to the agricultural sector, which recorded a tremendous growth of 42 percent despite the drought experienced in 2013. The drought led to a decrease in the local production of crop farming and, hence, the need to import food items to feed the country’s population. Sectors that have recently performed well include meat processing; manufacturing of other food products, textiles, clothing apparel, and non-metallic mineral products; publishing and printing. The fishing sector declined by 12 percent in 2013, attributed to the ongoing economic crisis in Europe, especially in Spain, which is the largest export market for the Namibian fishing industry. The mining sector also recorded a reduction of 10 percent due to a decline in the value of diamonds (National Planning Commission [NPC], 2013). Namibia is ranked as a middle-income country but has one of the most skewed distributions of income per capita in the world. The disparities in per capita income among the population are the result of the unbalanced development that characterised the Namibian economy in the past. The annual unemployment rate increased from 27 percent in 2012 to 29 percent in 2013 (Namibia Statistics Agency [NSA], 2013a). 1.2 POPULATION Decennial population censuses have been carried out in Namibia since 1991. Table 1.1 provides a summary of the basic demographic indicators for Namibia from 1991, 2001, and 2011census data. According to the 2011 Population and Housing Census, the country’s population stands at 2,113,077, with an increase of 1.5 percent in the last 10 years. Given the presence of the arid Namib Desert, Namibia is one of the least densely populated countries in the world; the population density is estimated to be 2.6 persons per square kilometre. Regional population densities vary substantially, with almost two-thirds of the population living in the four northern regions and less than one-tenth living in the south. Despite rapid urbanisation, Namibia is still mostly rural, with about four in ten people living in urban areas. The percentage of the population residing in urban areas has increased steadily over the last two decades, from 28 percent in 1991 to 43 percent in 2011. Table 1.1 Basic demographic indicators, Namibia 1991, 2001, and 2011 Indicator Census year 19911 20012 20113 Population 1,409,920 1,830,330 2,113,077 Intercensal growth rate (percentage) 3.1 2.9 1.5 Density (population/km2) 1.7 2.1 2.6 Percentage urban 28 33 43 Life expectancy at birth (years)4 Male 59 48 53 Female 63 50 61 1 Central Bureau of Statistics (CBS), 1992 2 CBS, 2003 3 NSA, 2013b 4 NSA, 2013c English is the country’s official language, but there are more than 11 indigenous languages in Namibia. People commonly speak two or three languages, and close to 50 percent of the population speaks Oshiwambo (NSA, 2013b). Introduction • 3 1.3 HEALTH SERVICES AND PROGRAMMES The government of Namibia recognizes that health is a fundamental human right, and it is committed to achieving health for all Namibians. The mandate of the Ministry of Health and Social Services (MoHSS) is derived from Article 95 of the Namibian Constitution, whereby the government is required to support the health and well-being of all people by putting in place legislation that helps provide health care for all and social assistance to the country’s most vulnerable groups (MoHSS, 2012a). Upon gaining independence in 1990, Namibia inherited a health service delivery structure that was segregated along racial lines and based entirely on curative health services. Since then, the MoHSS has adopted a primary health care (PHC) approach for the delivery of health services to the Namibian population. The core functions of the PHC directorate within the MoHSS are organized around four pillars: health promotion, disease prevention, curative services, and rehabilitation services. The PHC programmes were established to reflect the eight core elements of PHC: • Promotion of proper nutrition and an adequate supply of safe water • Maternal and child care, including family spacing • Immunisation of children against the major infectious diseases • Basic housing and sanitation • Prevention and control of locally endemic diseases • Education, awareness, and training on prevention and control of prevailing community health problems • Appropriate treatment for common diseases and injuries • Community participation in health and social matters To implement the national health strategy, the MoHSS has established the following directorates at the national and regional levels (MoHSS, 2007): • Primary Health Care • Special Programmes • Developmental Social Welfare Services • Tertiary Health Care and Clinical Support Services • Policy, Planning and Human Resource Development • Human Resource Management and General Services • Finance and Logistics • 13 Regional Health Directorates The 13 Regional Health Directorates oversee service delivery in 34 health districts. The role of each district is to ensure efficient and effective implementation of regionally directed programmes and projects. Public health services are provided through 30 public district hospitals, 44 health centres, and 269 clinics. Because of the vastness of the country, the sparse distribution of the population, and the lack of access to permanent health facilities in some communities, outreach (mobile clinic) services are provided at about 1,150 outreach points across the country. Three intermediate hospitals (Oshakati Hospital in Oshana, Rundu Hospital in Kavango, and Katutura Hospital in Khomas) and the national referral hospital (Windhoek Central Hospital) provide support to the district hospitals. Intersectoral collaboration has been recognised as an important aspect of health and social care delivery in Namibia, with a number of partners and stakeholders playing a role. Although the government is the main health care and service provider, private and faith-based facilities make an important contribution. The private sector is mainly urban, providing health care through medium-sized hospitals as well as through private pharmacies, doctors’ surgery offices, and nursing homes. Faith-based services are entirely subsidised by the government. 4 • Introduction 1.4 SURVEY OBJECTIVES The 2013 NDHS is part of the worldwide Demographic and Health Surveys (DHS) programme funded by the United States Agency for International Development (USAID). DHS surveys are designed to collect data on fertility, family planning, and maternal and child health; assist countries in monitoring changes in population, health, and nutrition; and provide an international database that can be used by researchers investigating topics related to population, health, and nutrition. The overall objective of the survey is to provide demographic, socioeconomic, and health data necessary for policymaking, planning, monitoring, and evaluation of national health and population programmes. In addition, the survey measured the prevalence of anaemia, HIV, high blood glucose, and high blood pressure among adult women and men; assessed the prevalence of anaemia among children age 6-59 months; and collected anthropometric measurements to assess the nutritional status of women, men, and children. A long-term objective of the survey is to strengthen the technical capacity of local organizations to plan, conduct, and process and analyse data from complex national population and health surveys. At the global level, the 2013 NDHS data are comparable with those from a number of DHS surveys conducted in other developing countries. The 2013 NDHS adds to the vast and growing international database on demographic and health-related variables. 1.5 ORGANISATION OF THE SURVEY The 2013Namibia Demographic and Health Survey is the fourth nationally representative, comprehensive DHS survey conducted in Namibia. The 2013 NDHS was implemented by the Ministry of Health and Social Services in collaboration with the Namibia Statistics Agency and the National Institute of Pathology (NIP). Technical support was provided by ICF International, with financial support from the government of Namibia, the United States Agency for International Development, and the Global Fund. 1.6 SURVEY IMPLEMENTATION 1.6.1 Sample Design The primary focus of the 2013 NDHS was to provide estimates of key population and health indicators, including fertility and mortality rates, for the country as a whole and for urban and rural areas. In addition, the sample was designed to provide estimates of most key variables for the 13 administrative regions. Each of the administrative regions is subdivided into a number of constituencies (with an overall total of 107 constituencies). Each constituency is further subdivided into lower level administrative units. An enumeration area (EA) is the smallest identifiable entity without administrative specification, numbered sequentially within each constituency. Each EA is classified as urban or rural. The sampling frame used for the 2013 NDHS was the preliminary frame of the 2011 Namibia Population and Housing Census (NSA, 2013a). The sampling frame was a complete list of all EAs covering the whole country. Each EA is a geographical area covering an adequate number of households to serve as a counting unit for the population census. In rural areas, an EA is a natural village, part of a large village, or a group of small villages; in urban areas, an EA is usually a city block. The 2011 population census also produced a digitised map for each of the EAs that served as the means of identifying these areas. The sample for the 2013 NDHS was a stratified sample selected in two stages. In the first stage, 554 EAs—269 in urban areas and 285 in rural areas—were selected with a stratified probability proportional to size selection from the sampling frame. The size of an EA is defined according to the Introduction • 5 number of households residing in the EA, as recorded in the 2011 Population and Housing Census. Stratification was achieved by separating every region into urban and rural areas. Therefore, the 13 regions were stratified into 26 sampling strata (13 rural strata and 13 urban strata). Samples were selected independently in every stratum, with a predetermined number of EAs selected. A complete household listing and mapping operation was carried out in all selected clusters. In the second stage, a fixed number of 20 households were selected in every urban and rural cluster according to equal probability systematic sampling. Due to the non-proportional allocation of the sample to the different regions and the possible differences in response rates, sampling weights are required for any analysis using the 2013 NDHS data to ensure the representativeness of the survey results at the national as well as the regional level. Since the 2013 NDHS sample was a two-stage stratified cluster sample, sampling probabilities were calculated separately for each sampling stage and for each cluster. 1.6.2 Questionnaires Three questionnaires were administered in the 2013 NDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires were adapted from the standard DHS6 core questionnaires to reflect the population and health issues relevant to Namibia at a series of meetings with various stakeholders from government ministries and agencies, nongovernmental organisations, and international donors. The final draft of each questionnaire was discussed at a questionnaire design workshop organised by the MoHSS from September 25-28, 2012, in Windhoek. The questionnaires were then translated from English into the six main local languages—Afrikaans, Rukwangali, Oshiwambo, Damara/Nama, Otjiherero, and Silozi—and back translated into English. The questionnaires were finalised after the pretest, which took place from February 11-25, 2013. The Household Questionnaire was used to list all usual household members as well as visitors in the selected households. Basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. In addition, the Household Questionnaire included questions on knowledge of malaria and use of mosquito nets by household members, along with questions regarding health expenditures. The Household Questionnaire was used to identify women and men who were eligible for the individual interview and the interview on domestic violence. The questionnaire also collected information on characteristics of the household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various durable goods. The results of tests assessing iodine levels were recorded as well. In half of the survey households (the same households selected for the male survey), the Household Questionnaire was also used to record information on anthropometry and biomarker data collected from eligible respondents, as follows: • All eligible women and men age 15-64 were measured, weighed, and tested for anaemia and HIV. • All eligible women and men age 35-64 had their blood pressure and blood glucose measured. • All children age 0 to 59 months were measured and weighed. • All children age 6 to 59 months were tested for anaemia. The Woman’s Questionnaire was used to collect information from women age 15-49. Women were asked questions on the following topics: • Background characteristics (e.g., education, residential history, media exposure) • Birth history and childhood mortality • Knowledge and use of family planning methods 6 • Introduction • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Women’s work and husbands’ background characteristics • Awareness and behaviour regarding AIDS and other sexually transmitted infections (STIs) • Other health issues (e.g., knowledge of tuberculosis; tobacco use; alcohol consumption; use of seat belts while seated in a vehicle; physical activity; consumption of water, fruits, and vegetables; knowledge of and testing for breast cancer and cervical cancer; and mental health) • Maternal mortality • Domestic violence The Woman’s Questionnaire was also used to collect information from women age 50-64 living in half of the selected survey households on background characteristics, marriage and sexual activity, women’s work and husbands’ background characteristics, awareness and behaviour regarding AIDS and other STIs, and other health issues. The Man’s Questionnaire was administered to all men age 15-64 living in half of the selected survey households. The Man’s Questionnaire collected much of the same information as the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health or nutrition. In addition to the questionnaires, other technical documents were prepared by the MoHSS in collaboration with DHS programme staff at ICF International, including interviewer and supervisor training manuals and assignment sheets for fieldwork control. 1.6.3 Anaemia and HIV Testing In half of the survey households (the same households selected for the male survey), haemoglobin testing to assess the prevalence of anaemia was conducted on women and men age 15-64 who voluntarily consented to the testing and on children 6-59 months for whom consent was obtained from their parents or the adult responsible for the children. To carry out the testing, a drop of blood was obtained from a finger prick (or a heel prick in the case of children less than 12 months old or young children with thin fingers) and collected in a microcuvette. Haemoglobin analysis was performed on-site using a battery-operated portable HemoCue analyser. Results were given to the adults and to the parents or adults responsible for the children, verbally and in writing. Parents of children with a haemoglobin level under 7 g/dl (considered to be severely anaemic) were instructed to take the child to a health facility for follow-up care. Likewise, non-pregnant women and men were referred for follow-up care if their haemoglobin level was below 7 g/dl. Pregnant women were referred to a health facility for follow-up care if their haemoglobin level was below 9 g/dl. In the same households selected for anaemia (half of the survey households), blood specimens were also collected in the field from men and women age 15-64 for HIV testing in the laboratory. Verbal consent for HIV testing was requested from each respondent following completion of the individual interview. The HIV testing protocol was approved by the MoHSS Biomedical Research Committee, the Institutional Review Board of ICF International, and the U.S. Centers for Disease Control and Prevention. Health technicians collected blood specimens from all women and men who consented. The protocol for blood specimen collection and analysis was based on the anonymous linked protocol developed by the DHS programme. This protocol allows for the merging of HIV test results with socio- Introduction • 7 demographic data collected in the individual questionnaires after all information that can potentially identify an individual has been destroyed. Health technicians explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. If a respondent consented to HIV testing, three to five blood spots from a finger prick were collected on a filter paper card to which a barcode label unique to the respondent was affixed. Respondents were asked whether they would consent to having the laboratory store their blood sample for future unspecified testing. If they did not consent to additional testing using their sample, this was indicated on the Household Questionnaire, and the words “no additional testing” were written on the filter paper card. Each respondent, whether providing consent or not, was given an informational brochure on HIV/AIDS and a list of nearby sites providing voluntary counselling and testing services. A barcode label identical to that placed on the filter paper card was attached to the Household Questionnaire. A third copy of the same barcode was affixed to the dried blood spot (DBS) transmittal form to track the blood samples from the field to the laboratory. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected from the field, along with the completed questionnaires, and transported to be logged in and checked at the MoHSS; the samples were then delivered to the NIP, where HIV testing took place. At the NIP, each blood sample was logged into the CSPro HIV Test Tracking System database, given a laboratory number, and stored at -20˚C. The HIV testing protocol stipulates that testing of blood can be conducted only after questionnaire data entry is completed, verified, and cleaned; all paper questionnaires are destroyed; and all unique identifiers are removed from the questionnaire data file except the anonymous barcode number. The HIV testing algorithm followed in the 2013 NDHS was as follows. First, all samples were screened using the Vironostika® Ag/Ab combination assay (Biomérieux), a highly sensitive fourth- generation enzyme-linked immunoassay (ELISA). A negative result was recorded as negative. All samples that tested positive on the first ELISA and 10 percent of the samples that tested negative were retested with a second highly specific fourth-generation ELISA, the Enzygnost® HIV Integral II assay (Siemens). Positive samples on both tests were recorded as positive. If the results of the first and second ELISAs were discordant, the two ELISAs were repeated. If the results remained discordant, the samples were tested using a third confirmatory test, the Inno-Lia HIV I/II Score line immunoassay (Innogenetics), to resolve the discordance. The final result was recorded as positive if the line immunoassay confirmed it to be positive and negative if the line immunoassay confirmed it to be negative. If the line immunoassay results were indeterminate, the sample result was recorded as indeterminate. The line immunoassay was also used to determine the HIV type of all positive samples. Following laboratory testing, the HIV test results were entered into a spreadsheet with a barcode as the unique identifier. The barcode linked the HIV test results with the data from the individual interviews. 1.6.4 Blood Glucose and Blood Pressure Testing In the 2013 NDHS, blood glucose testing was conducted to estimate the prevalence of diabetes mellitus type 2 among women and men age 35-64. After an overnight fast, a blood sample was obtained from respondents by a finger prick, and the blood was tested using the HemoCue Glucose 201 RT system (HemoCue Ab, Angelholm, Sweden) to determine the blood glucose level. Blood glucose levels were recorded as millimoles per litre (mmol/L) and compared with the World Health Organization’s cutoffs to classify the prevalence of diabetes among adult women and men. Elevated blood pressure, commonly referred to as high blood pressure, is a known risk factor for death from stroke and coronary heart disease. In the 2013 NDHS, blood pressure measurements (systolic 8 • Introduction and diastolic) were carried out among women and men age 35-64 to assess the prevalence of high blood pressure among adults. The measurements were not used for diagnostic purposes. Rather, respondents who had an abnormal measurement were informed of their blood pressure level and advised to visit a health facility for evaluation. Blood pressure was measured using the Life Source UA-767 Plus digital device with automatic upper-arm inflation and automatic pressure release. Interviewers were trained in the use of this device according to the manufacturer’s recommended protocol. Three blood pressure measurements were taken, and the first measurement was discarded. The average of the last two measurements was reported as the blood pressure reading in millimetres of mercury (mmHg). 1.6.5 Pretest Pretest training was held at the Khomas Regional Council Office and the National Training Center in Windhoek. There were 35 trainees, 16 men and 19 women. Trainees included eight individuals who had participated in previous NDHS surveys. The survey instruments were piloted from February 11 to February 24, 2013. The questionnaires were pretested in both urban and rural clusters. About 150 women and 150 men were interviewed during the pilot survey, and the results were used to modify the survey instruments as necessary. 1.6.6 Household Listing Prior to the main survey, a complete listing of households in the selected primary sampling units (PSUs) was carried out. This provided a sampling frame from which 20 households in each PSU were selected for the survey. The listing exercise was carried out by the MoHSS in collaboration with the NSA. 1.6.7 Training of Field Staff The main training for the 2013 NDHS was conducted from April 22 to May 18, 2013. A total of 250 participants were recruited, including 31 nurses who served as health technicians. The interviewers were split into five classrooms. The first three weeks primarily covered classroom instruction, expert presentations on selected topics, mock interviews and quizzes. At the end of the classroom training, all of the interviewers completed a final exam and a structured, scored mock interview; they were also judged according to their performance during field practice. In addition to training on the basic content of the questionnaires, a separate training session was conducted for health technicians from May 6-22 on height and weight measurements, blood pressure and blood glucose measurements, anaemia and HIV testing, and DBS preparation. Also, separate training sessions were held for regional supervisors, team supervisors, and editors on their roles and responsibilities, emphasizing the importance of field editing and data quality. 1.6.8 Data Collection Data collection was carried out by 28 teams, each consisting of a supervisor, a field editor, three female interviewers, one male interviewer, and a health technician. Fieldwork started on May 26, 2013, with all teams initially deployed to complete one selected cluster each in Windhoek to enable intense supervision and technical backstopping. After satisfactory completion of these clusters, the teams were deployed to their respective regions to continue fieldwork. Fieldwork was completed on September 30, 2013. Quality assurance was maintained by national and regional supervisors through close supervision and monitoring during fieldwork. The questionnaires were edited by the field editors in the field and verified by the team supervisor before being transported to the MoHSS central office. In addition, national and regional supervisors ensured quality control through editing of questionnaires and observation of interviewers. Common mistakes and practical solutions were communicated through written notes and discussed with all team members. Introduction • 9 Close contact between the MoHSS central office and the teams was maintained through field visits by senior staff, ICF International staff and representatives of USAID/Namibia. Regular communication was maintained through cell phones. A publicity campaign was implemented during May and June 2013 to provide information to communities about the survey and its objectives. The campaign enlightened the public about survey processes, including interviews, anthropometric measurements and collection of blood samples. Information about the survey was announced in the print media and on television, including the official launch of the survey by the MoHSS. T-shirts and leaflets were also prepared for this purpose. 1.6.9 Data Processing CSPro—a Windows-based integrated census and survey processing system that combines and replaces the ISSA and IMPS packages—was used for entry, editing, and tabulation of the NDHS data. Prior to data entry, a practical training session was provided by ICF International to all data entry staff. A total of 28 data processing personnel, including 17 data entry operators, one questionnaire administrator, two office editors, three secondary editors, two network technicians, two data processing supervisors, and one coordinator, were recruited and trained on administration of questionnaires and coding, data entry and verification, correction of questionnaires and provision of feedback, and secondary editing. NDHS data processing was formally launched during the week of June 22, 2013, at the National Statistics Agency Data Processing Centre in Windhoek. The data entry and editing phase of the survey was completed in January 2014. 1.7 RESPONSE RATES Table 1.2 shows household and indi- vidual response rates for the 2013 NDHS. A total of 11,004 households were selected for the sample, of which 10,165 were found to be oc- cupied during data collection. Of the occupied households, 9,849 were successfully inter- viewed, yielding a household response rate of 97 percent. In these households, 9,940 women age 15-49 were identified as eligible for the individ- ual interview. Interviews were completed with 9,176 women, yielding a response rate of 92 percent. In addition, in half of these households, 842 women age 50-64 were successfully inter- viewed; in this group of women, the response rate was 91 percent. Of the 5,271 eligible men identified in the selected subsample of households, 4,481 (85 percent) were successfully interviewed. Response rates were higher in rural than in urban areas, with the rural-urban difference more marked among men than among women. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Namibia 2013 Result Residence Total Urban Rural Household interviews Households selected 5,343 5,661 11,004 Households occupied 4,975 5,190 10,165 Households interviewed 4,766 5,083 9,849 Household response rate1 95.8 97.9 96.9 Interviews with women age 15-49 Number of eligible women 5,327 4,613 9,940 Number of eligible women interviewed 4,843 4,333 9,176 Eligible women response rate2 90.9 93.9 92.3 Interviews with women age 50-643 Number of eligible women 359 562 921 Number of eligible women interviewed 320 522 842 Eligible women response rate2 89.1 92.9 91.4 Interviews with men age 15-643 Number of eligible men 2,722 2,549 5,271 Number of eligible men interviewed 2,224 2,257 4,481 Eligible men response rate2 81.7 88.5 85.0 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents 3 In 50 percent of selected households Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter presents information on the demographic and socioeconomic characteristics of the household population, including age, sex, education, and place of residence. These descriptive data provide a context for the interpretation of demographic and health indices and can offer an approximate indication of the representativeness of the survey. In the 2013 NDHS, a household was defined as a person or group of related and unrelated persons who lived together in the same dwelling unit(s), who acknowledged one adult male or female as the head of the household, who shared the same housekeeping arrangements, and who were considered a single unit. Information was collected from all of the usual residents of each selected household and visitors who had stayed in the selected household the night before the interview. Those persons who stayed in the selected household the night before the interview (whether usual residents or visitors) represent the de facto population; usual residents alone constitute the de jure population. To maintain comparability with other surveys, all tables in this report refer to the de facto population unless otherwise specified. 2.1 HOUSEHOLD CHARACTERISTICS The physical characteristics of households and the availability and accessibility of basic household facilities are important in assessing the general welfare and socioeconomic condition of the population. The 2013 NDHS collected information on a range of housing characteristics, including source of drinking water, time taken to fetch water, type of sanitation facility, access to electricity, type of flooring, and number of rooms used for sleeping. Questions were asked about sources of energy for cooking fuel and lighting, household effects, hand washing, school attendance, and educational attainment as well as health insurance and health expenditures. These data are presented for households and are further disaggregated by residence (rural and urban) and region. 2.1.1 Drinking Water The source of drinking water is an indicator of its suitability for drinking. Sources that are more likely to provide water suitable for drinking are identified in Table 2.1 as improved sources. These include T Key Findings • Eighty-seven percent of Namibian households use an improved source of drinking water. • Only 34 percent of households in Namibia use improved toilet facilities that are not shared with other households; 46 percent of households have no toilet facility at all. • Forty-seven percent of households have access to electricity. • Fifty-three percent of households use solid fuel for cooking. • Ownership of mobile phones has risen dramatically; 89 percent of households reported owning a mobile phone in the current survey, as compared with 52 percent in the 2006-07 NDHS. • Eighty-seven percent of children under age 5 have been registered with civil authorities and 63 percent have a birth certificate. • Approximately 14 percent of children under age 18 are orphaned (that is, one or both parents are not living). • Twelve percent of females and 14 percent of males age 6 and older have never attended school. 12 • Housing Characteristics and Household Population a piped source within the dwelling, yard, or plot; a public tap, tube well, or borehole; a hand pump/protected well or protected spring; and rainwater or bottled water.1 Lack of ready access to a water source may limit the quantity of suitable drinking water that is available to a household. Even if the water is obtained from an improved source, it may be contaminated during transportation or storage if it is fetched from a source that is not immediately accessible to the household. Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Namibia 2013 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 97.5 75.5 86.9 97.8 71.9 84.0 Piped into dwelling 52.8 19.4 36.8 54.9 18.5 35.5 Piped to yard/plot 14.6 13.6 14.2 15.5 12.5 13.9 Public tap/standpipe 28.7 23.3 26.1 26.3 22.8 24.4 Tube well or borehole 0.3 15.3 7.5 0.4 13.9 7.6 Protected well 0.0 3.0 1.5 0.0 3.4 1.8 Protected spring 0.0 0.6 0.3 0.0 0.6 0.3 Rainwater 0.0 0.1 0.1 0.0 0.1 0.1 Bottled water 1.1 0.1 0.6 0.7 0.0 0.4 Non-improved source 0.3 13.2 6.5 0.3 15.5 8.4 Unprotected well 0.2 11.2 5.5 0.3 13.6 7.4 Unprotected spring 0.0 0.8 0.4 0.0 0.7 0.4 Tanker truck/cart with drum 0.0 1.1 0.6 0.1 1.3 0.7 Other 2.1 3.0 2.6 1.7 2.4 2.1 Missing 0.1 8.3 4.0 0.1 10.1 5.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 68.0 37.3 53.3 70.9 34.9 51.7 Less than 30 minutes 26.2 35.5 30.7 23.3 34.9 29.5 30 minutes or longer 4.9 25.5 14.8 5.1 28.6 17.6 Don’t know/missing 0.8 1.7 1.2 0.8 1.6 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 9.1 2.3 5.9 9.4 2.3 5.6 Bleach/chlorine added 0.3 4.2 2.2 0.3 5.1 2.9 Strained through cloth 0.0 0.3 0.2 0.0 0.3 0.2 Ceramic, sand, or other filter 1.5 0.2 0.9 1.5 0.2 0.8 Other 0.6 0.6 0.6 0.5 0.5 0.5 No treatment 88.5 92.6 90.5 88.4 92.0 90.3 Percentage using an appropriate treatment method2 10.7 6.4 8.7 11.0 7.3 9.0 Number 5,121 4,728 9,849 19,458 22,207 41,665 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Source of drinking water is important because waterborne diseases such as diarrhoea are prevalent in Namibia. Sources of water expected to be relatively free of the agents responsible for these diseases are piped water, hand pumps/protected wells, protected springs, rainwater, and bottled water. Other sources such as unprotected wells, unprotected springs, and tanker trucks/carts with drums are more likely to carry disease-causing agents. Table 2.1 indicates that a majority of Namibian households (87 percent) have access to improved water sources: 37 percent from piped water into the dwelling, 14 percent from water piped to the yard, and 26 percent from a public tap. Households in urban areas (98 percent) are more likely than those in rural areas (76 percent) to have access to an improved source of water. In the 2006-07 NDHS, 97 percent of urban households and 80 percent of rural households were reported to use improved sources of water. 1 The categorisation into improved and non-improved categories follows that proposed by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (WHO and UNICEF, 2012a). Housing Characteristics and Household Population • 13 The table further shows that 53 percent of households in Namibia have a source of drinking water on their premises, with a large difference between urban and rural households (68 percent and 37 percent, respectively). A comparison with the findings from the 2006-07 NDHS shows that there has been a significant drop in the proportion of urban households with water on the premises (from 81 percent to 68 percent), while the percentage of rural households with water on the premises has increased slightly from 32 percent to 37 percent . Thirty-one percent of households take less than 30 minutes to obtain drinking water, while 15 percent take 30 minutes or longer. Nine percent of households treat their drinking water. Six percent boil their water and 2 percent use bleach/chlorine prior to drinking. Ninety-three percent of rural households and 89 percent of urban households do not treat their drinking water. 2.1.2 Sanitation Facilities and Waste Disposal A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates waste from human contact (WHO and UNICEF, 2012b). The types of facilities considered improved are toilets that flush or pour flush into a piped sewer system, septic tank, or pit latrine; ventilated improved pit (VIP) latrines; and pit latrines with a slab. Table 2.2 shows that only 34 percent of households in Namibia use improved toilet facilities that are not shared with other households, and 15 percent use facilities that would be considered improved if they were not shared. Forty-nine percent of households in urban areas have improved toilet facilities that are not shared, as compared with 17 percent of households in rural areas. Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Namibia 2013 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 44.0 7.4 26.4 48.0 5.2 25.2 Flush/pour flush to septic tank 0.9 0.8 0.9 0.9 0.6 0.8 Flush/pour flush to pit latrine 1.3 1.5 1.4 1.7 1.4 1.5 Ventilated improved pit (VIP) latrine 1.9 5.4 3.6 2.2 7.0 4.8 Pit latrine with slab 0.3 1.9 1.0 0.4 2.2 1.3 Composting toilet 0.1 0.2 0.1 0.1 0.2 0.1 Total 48.5 17.2 33.5 53.2 16.7 33.8 Shared facility1 Flush/pour flush to piped sewer system 19.0 2.0 10.9 15.4 0.9 7.7 Flush/pour flush to septic tank 0.2 0.4 0.3 0.1 0.2 0.2 Flush/pour flush to pit latrine 1.9 0.5 1.3 1.5 0.2 0.8 Ventilated improved pit (VIP) latrine 3.2 2.1 2.6 2.8 1.7 2.2 Pit latrine with slab 0.2 0.5 0.4 0.2 0.3 0.2 Composting toilet 0.0 0.1 0.0 0.0 0.1 0.0 Total 24.6 5.5 15.4 20.1 3.3 11.2 Non-improved facility Flush/pour flush not to sewer/septic tank/pit latrine 1.8 0.7 1.2 1.7 0.4 1.0 Pit latrine without slab/open pit 2.7 2.3 2.5 3.4 2.7 3.0 Bucket 0.6 0.6 0.6 0.6 0.4 0.5 Hanging toilet/hanging latrine 0.1 0.1 0.1 0.1 0.1 0.1 No facility/bush/field 21.1 73.6 46.3 20.0 76.4 50.0 Other 0.5 0.0 0.3 0.7 0.0 0.3 Missing 0.1 0.1 0.1 0.1 0.1 0.1 Total 26.9 77.3 51.1 26.7 80.0 55.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,121 4,728 9,849 19,458 22,207 41,665 1 Facilities that would be considered improved if they were not shared by 2 or more households More than half of Namibian households (51 percent) have non-improved toilet facilities. Forty-six percent of households have no toilet facility at all, as compared with 49 percent in the 2006-07 NDHS 14 • Housing Characteristics and Household Population survey. Twenty-one percent of households in urban areas and 74 percent of households in rural areas lack any toilet facility. The proportion of urban households without a toilet facility increased by 6 percentage points over the last six years from 15 percent to 21 percent. On the other hand, the proportion of rural households with no toilet facility decreased by 4 percentage points over the same period (78 percent versus 74 percent). 2.1.3 Housing Characteristics Table 2.3 presents information on the characteristics of household dwellings. In addition to reflecting the household’s socioeconomic situation, these character- istics show the environmental conditions in which the household lives. Access to electricity usually goes hand in hand with improved housing structures and a better standard of living. In Namibia, only 47 percent of households have electricity. There is a large difference in access to electricity between urban and rural households (72 percent and 21 percent, respectively). The percentage of households with electricity has risen since the 2006-07 NDHS survey, when only 44 percent of households had electricity. This gain, however, has been in rural households only, in which the percentage of households with electricity rose from 15 percent to 21 percent. Access to electricity in urban households however, declined from 78 percent to 72 percent over the same period. The type of material used for flooring is also an indicator of socio- economic status and, to some extent, deter- mines the household’s vulnerability to disease-causing agents. Forty percent of Namibian households have earthen floors (made of earth/sand, dung, or mud/clay), while 34 percent have cement floors. One in five households have ceramic floors. Differences exist between rural and urban households; earth/sand flooring is most common in rural areas (44 percent), while cement and ceramic tiles are most common in urban areas (35 percent and 33 percent, respectively). Overall, 31 percent of Namibian households use one room for sleeping, 26 percent use two rooms, and 43 percent use three or more rooms. Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Namibia 2013 Housing characteristic Residence Total Urban Rural Electricity Yes 72.2 20.5 47.4 No 27.8 79.5 52.6 Total 100.0 100.0 100.0 Flooring material Earth/sand 17.7 44.1 30.4 Dung 0.5 2.7 1.6 Mud/clay 1.9 13.8 7.6 Wood planks 0.4 0.1 0.3 Palm/bamboo 0.2 0.0 0.1 Parquet or polished wood 0.6 0.1 0.4 Vinyl or asphalt strips 1.4 0.3 0.9 Ceramic tiles 33.4 3.7 19.1 Cement 34.5 33.7 34.1 Carpet 8.3 1.3 4.9 Other 0.8 0.1 0.5 Missing 0.3 0.1 0.2 Total 100.0 100.0 100.0 Rooms used for sleeping One 35.3 26.0 30.8 Two 29.3 21.8 25.7 Three or more 35.0 51.7 43.0 Missing 0.5 0.5 0.5 Total 100.0 100.0 100.0 Place for cooking In the house 77.5 52.8 65.6 In a separate building 5.8 10.8 8.2 Outdoors 16.2 36.2 25.8 No food cooked in household 0.4 0.1 0.3 Other 0.1 0.1 0.1 Total 100.0 100.0 100.0 Cooking fuel Electricity 58.0 7.4 33.7 LPG/natural gas/biogas 16.3 3.4 10.1 Kerosene 5.0 0.1 2.6 Charcoal 0.2 0.4 0.3 Wood 19.9 87.4 52.3 Animal dung 0.0 1.0 0.5 Other 0.1 0.0 0.1 No food cooked in household 0.4 0.1 0.3 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 20.1 88.9 53.1 Frequency of smoking in the home Daily 19.5 22.4 20.9 Weekly 2.2 2.4 2.3 Monthly 0.4 0.2 0.3 Less than monthly 0.5 0.6 0.5 Never 77.3 74.4 75.9 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Number 5,121 4,728 9,849 LPG = Liquid petroleum gas 1 Includes charcoal, wood, and animal dung Housing Characteristics and Household Population • 15 The potential for exposure to harmful effects of smoke from using solid fuels for cooking increases if cooking occurs within the house itself rather than outdoors or in a separate building. Sixty-six percent of households in Namibia cook in the house, 8 percent cook in a separate building, and 26 percent cook outdoors. Seventy-eight percent of urban households cook in the house, as compared with 53 percent of rural households. Cooking and heating with solid fuels can lead to high levels of indoor smoke, a complex mix of health-damaging pollutants that can increase the risk of contracting diseases (WHO, 2011). Solid fuels include charcoal, wood, and animal dung. In the 2013 NDHS, households were asked about their primary source of fuel for cooking. The results show that 52 percent of households use wood for cooking, while only 34 percent use electricity. There are large differences in use of fuel for cooking between urban and rural areas. Eighty-seven percent of households in rural areas use wood as their primary source of fuel for cooking, while 58 percent of urban households use electricity as their main source of cooking fuel. Information on frequency of smoking inside the home was obtained to assess the percentage of households in which there is exposure to secondhand smoke, which causes health risks in children and adults who do not smoke. Pregnant women who are exposed to secondhand smoke have a higher risk of delivering a low birth weight baby (Windham et al., 1999), and children exposed to secondhand smoke are at increased risk for respiratory and ear infections and poor lung development (U.S. Department of Health and Human Services, 2006). Twenty-one percent of Namibian households reported that someone smokes in the home daily. In 76 percent of households, smoking never occurs in the home. 2.1.4 Household Possessions Possession of durable goods is an indicator of a household’s socioeconomic status. Moreover, each particular item has specific benefits. For instance, having access to a radio or a television exposes household members to innovative ideas, a refrigerator prolongs the wholesomeness of foods, and a means of transport allows greater access to services away from the local area. Table 2.4 shows data on ownership of selected household possessions by residence. The most commonly owned items by households are mobile telephones (89 percent), radios (68 percent), televisions (44 percent), and refrigerators (42 percent). With the exception of the radio, all of these proportions are higher than those recorded in the 2006-07 NDHS. Most notably, household ownership of mobile phones has risen from 52 percent to 89 percent, a 71 percent increase. Urban households are more likely than rural households to own each of these items. With regard to a means of transportation, 14 percent of households own a bicycle, while 27 percent own a car or truck. Urban households are twice as likely to own a car or truck as rural households. Farming of agricultural land and ownership of farm animals are common in Namibia, with about 48 percent of households owning farm animals. Not surprisingly, the proportions of households in rural areas that own agricultural land (70 percent) and farm animals (75 percent) are much higher than the corresponding proportions of urban households (20 percent and 22 percent, respectively). Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Namibia 2013 Possession Residence Total Urban Rural Household effects Radio 73.3 63.0 68.4 Television 66.6 18.5 43.6 Mobile telephone 95.0 81.4 88.5 Non-mobile telephone 15.0 2.6 9.0 Refrigerator 64.9 16.7 41.8 Means of transport Bicycle 15.2 11.8 13.5 Animal-drawn cart 2.0 12.4 7.0 Motorcycle/scooter 2.5 1.1 1.8 Car/truck 35.0 17.6 26.7 Boat with a motor 0.8 0.2 0.5 Ownership of agricultural land 19.7 70.3 44.0 Ownership of farm animals1 22.3 74.8 47.5 Number 5,121 4,728 9,849 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, or chickens 16 • Housing Characteristics and Household Population 2.2 HOUSEHOLD WEALTH Information on household assets was used to create an index that is used throughout this report to represent the wealth of the households interviewed in the 2013 NDHS. This method for calculating a country-specific wealth index was developed and tested in a large number of countries in relation to inequalities in household income, use of health services, and health outcomes (Rutstein and Johnson, 2004). It has been shown to be consistent with expenditure and income measures. The wealth index is constructed using household asset data, including ownership 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 flooring material. In its current form, which takes account of urban-rural differences in these items and characteristics, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. For purposes of creating scores, categorical variables are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators (Rutstein, 2008). The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are formed by assigning the household score to each de jure household member, ranking each person in the population by that score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Thus, throughout this report, wealth quintiles are expressed in terms of quintiles of individuals in the overall population rather than quintiles of individuals at risk for any one health or population indicator. For example, quintile rates for infant mortality refer to infant mortality rates per 1,000 live births among all people in the population quintile concerned, as distinct from quintiles of live births or newly born infants, who constitute the only members of the population at risk of mortality during infancy. Table 2.5 presents wealth quintiles by residence and region. Also included in the table is the Gini coefficient, which indicates the level of concentration of wealth (0 being an equal distribution and 1 a totally unequal distribution). The table shows that wealth in Namibia is unevenly distributed by residence and region. Forty percent of the urban population is in the highest wealth quintile, as compared with 2 percent of the rural population. In contrast, 36 percent of the rural population is in the lowest wealth quintile, compared with 2 percent of the urban population. The distribution of the population by wealth quintile among regions shows large variations. In Khomas and Erongo, half of the population is in the highest wealth quintile (50 percent and 48 percent, respectively). In Ohangwena and Kavango, on the other hand, half of the population is in the lowest wealth quintile. The overall Gini coefficient in Namibia is 0.42. It is higher in rural (0.45) than in urban (0.24) areas, indicating a more unequal distribution of wealth in the rural population than in the urban population. The lowest Gini coefficient is seen in Erongo (0.18), where nearly one in two persons are in the highest wealth quintile. The highest Gini coefficient—that is, the least equitable distribution of wealth—is observed in Kavango (0.51). Housing Characteristics and Household Population • 17 Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence and region, Namibia 2013 Residence/region Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 1.7 11.0 17.5 29.5 40.3 100.0 19,458 0.24 Rural 36.1 27.8 22.3 11.6 2.2 100.0 22,207 0.45 Region Zambezi 36.3 23.8 19.7 11.4 8.8 100.0 2,181 0.44 Erongo 0.5 8.0 12.1 31.3 48.1 100.0 3,083 0.18 Hardap 3.4 11.3 19.0 34.9 31.3 100.0 1,451 0.30 //Karas 3.8 10.7 22.5 31.9 31.0 100.0 1,482 0.28 Kavango 48.9 22.0 15.6 10.5 3.1 100.0 4,308 0.51 Khomas 0.5 10.4 14.9 23.7 50.4 100.0 7,697 0.21 Kunene 17.7 28.3 22.3 19.3 12.5 100.0 1,288 0.41 Ohangwena 49.2 26.2 13.6 8.7 2.2 100.0 4,861 0.47 Omaheke 10.6 27.1 30.2 21.4 10.7 100.0 1,144 0.44 Omusati 23.1 30.5 32.8 10.8 2.8 100.0 4,829 0.37 Oshana 10.6 24.3 29.2 22.7 13.2 100.0 3,306 0.38 Oshikoto 26.8 26.6 20.9 17.2 8.5 100.0 3,483 0.48 Otjozondjupa 5.5 13.2 21.1 41.9 18.3 100.0 2,553 0.30 Total 20.0 20.0 20.0 20.0 20.0 100.0 41,665 0.42 2.3 HAND WASHING To obtain hand washing information, interviewers asked to see the place where members of the household most often washed their hands. Information on the availability of water, cleansing agents, or both was recorded only for households where a hand washing place was observed. Interviewers observed a place for hand washing in 87 percent of households (Table 2.6). Among households where a place for washing hands was observed, 54 percent had soap and water, 21 percent had only water, and 21 percent had no water, soap, or any other cleansing agent. Not surprisingly, households in urban areas were much more likely to have soap and water for hand washing. Three in four households in Otjozondjupa and //Karas (76 percent and 74 percent, respectively) had soap and water for hand washing. On the other hand, four in ten households in Omusati (43 percent) had no water, no soap, and no cleansing agent for washing hands. The percentage of households with soap and water for hand washing increases with increasing wealth, from 22 percent among the poorest households to 85 percent among the wealthiest households. 18 • Housing Characteristics and Household Population Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Namibia 2013 Background characteristic Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed, percentage with: Number of households with place for hand washing observed Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Missing Total Residence Urban 89.1 5,121 68.3 0.0 14.9 4.6 0.0 12.1 0.1 100.0 4,561 Rural 84.0 4,728 37.4 0.4 28.0 3.5 0.2 30.4 0.0 100.0 3,970 Region Zambezi 79.6 541 42.2 0.8 37.9 1.1 0.0 18.0 0.0 100.0 431 Erongo 89.4 930 63.0 0.1 16.3 4.2 0.0 16.4 0.0 100.0 832 Hardap 91.5 381 60.2 0.0 20.6 0.8 0.0 18.4 0.0 100.0 349 //Karas 63.3 406 73.8 0.2 14.8 2.5 0.0 8.5 0.2 100.0 257 Kavango 58.9 737 36.7 0.0 35.1 5.7 0.2 22.4 0.0 100.0 435 Khomas 89.7 2,015 68.0 0.0 18.4 3.2 0.0 10.1 0.3 100.0 1,807 Kunene 87.5 354 69.4 2.5 15.5 1.7 0.0 10.9 0.0 100.0 310 Ohangwena 83.7 900 25.1 0.0 28.5 4.7 0.9 40.9 0.0 100.0 754 Omaheke 80.7 335 66.7 0.0 21.0 0.8 0.2 11.2 0.0 100.0 270 Omusati 90.0 949 27.2 0.0 26.5 3.6 0.0 42.7 0.0 100.0 855 Oshana 99.2 831 58.2 0.1 7.0 11.2 0.0 23.4 0.1 100.0 824 Oshikoto 97.2 817 43.3 0.1 25.7 2.2 0.0 28.6 0.0 100.0 794 Otjozondjupa 94.1 652 75.6 0.7 14.4 5.8 0.0 3.5 0.0 100.0 614 Wealth quintile Lowest 77.0 1,737 21.6 0.5 35.2 3.3 0.3 39.1 0.1 100.0 1,338 Second 84.8 1,910 38.2 0.4 25.8 3.6 0.2 31.8 0.0 100.0 1,620 Middle 88.4 1,954 46.1 0.1 22.9 5.6 0.1 25.1 0.1 100.0 1,728 Fourth 90.2 2,136 65.6 0.1 18.5 4.8 0.0 10.9 0.0 100.0 1,927 Highest 90.8 2,111 84.9 0.0 7.8 3.1 0.0 4.0 0.2 100.0 1,918 Total 86.6 9,849 53.9 0.2 21.0 4.1 0.1 20.6 0.1 100.0 8,530 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent 2.4 HOUSEHOLD POPULATION BY AGE, SEX, AND RESIDENCE Age and sex are important demographic variables and are the primary basis for demographic classifications in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and marriage. The distribution of the de facto household population in the 2013 NDHS is shown in Table 2.7 by five-year age groups, according to sex and residence. A total of 41,396 individuals resided in the 9,849 households successfully interviewed; 21,774 were female, and 19,621 were male. The age-sex structure of the population is shown in the population pyramid in Figure 2.1. The broad base of the pyramid indicates that Namibia’s population is mostly young. The proportion of persons under age 15 was 38 percent in 2013, while the proportion of individuals age 65 and older was 5 percent. After a steady decline from 16 percent in the 1992 NDHS to 14 percent in the 2000 NDHS and 13 percent in the 2006–07 NDHS, the proportion of the population less than age 5 increased slightly to 14 percent in the current survey. Housing Characteristics and Household Population • 19 Table 2.7 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, Namibia 2013 Age Urban Rural Male Female Total Male Female Total Male Female Total <5 11.7 11.5 11.6 16.4 15.1 15.7 14.2 13.4 13.8 5-9 10.6 10.5 10.5 15.6 13.5 14.5 13.3 12.1 12.7 10-14 9.8 9.1 9.4 14.6 13.4 14.0 12.4 11.4 11.9 15-19 8.8 9.8 9.4 12.4 9.9 11.1 10.8 9.9 10.3 20-24 11.8 12.5 12.2 7.8 6.7 7.2 9.6 9.4 9.5 25-29 10.3 10.4 10.4 5.5 5.7 5.6 7.8 7.9 7.9 30-34 9.0 8.6 8.8 4.9 5.0 4.9 6.8 6.7 6.7 35-39 7.4 7.3 7.4 4.6 4.8 4.7 5.9 6.0 5.9 40-44 6.5 5.9 6.2 3.2 3.9 3.6 4.8 4.8 4.8 45-49 5.0 4.0 4.5 2.7 3.5 3.2 3.8 3.8 3.8 50-54 3.2 3.6 3.4 2.4 3.9 3.2 2.7 3.8 3.3 55-59 2.0 2.3 2.1 1.8 2.7 2.2 1.9 2.5 2.2 60-64 1.4 1.5 1.5 1.9 2.8 2.4 1.7 2.2 2.0 65-69 1.0 1.1 1.0 1.9 2.3 2.1 1.5 1.7 1.6 70-74 0.7 0.7 0.7 1.6 2.0 1.8 1.2 1.4 1.3 75-79 0.3 0.5 0.4 0.9 1.3 1.1 0.6 0.9 0.8 80+ 0.2 0.5 0.4 1.6 3.4 2.5 1.0 2.0 1.5 Don’t know/missing 0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 9,116 10,174 19,291 10,505 11,599 22,106 19,621 21,774 41,396 Figure 2.1 Population pyramid 8 6 4 2 0 2 4 6 8 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Percent Age Male Female NDHS 2013 8 6 4 2 20 • Housing Characteristics and Household Population 2.5 HOUSEHOLD COMPOSITION Information on the composition of households, including the sex of the head of the household and the size of the household, is presented in Table 2.8. These characteristics are important because they are associated with the welfare of the household. In larger households, economic resources are often more limited. Moreover, when the household size is large, crowding can lead to health problems. Table 2.8 shows that 44 percent of the households in Namibia are headed by women. Households with one and two members constitute 17 percent and 16 percent of all households, respectively. The average household size is 4.2 persons, as compared with 4.5 in the 2006-07 NDHS survey. On average, rural households are larger (4.7 persons) than urban households (3.8 persons). Information was also collected on the living arrangements of all children under age 18 residing in the sample households and on the survival status of their parents. This information can be used to assess the extent to which households face a need to care for orphaned or foster children. Orphans include children whose mother or father has died (single orphans) as well as children who have lost both parents (double orphans). In the case of foster children, both parents are alive but the children are living in a household where neither their natural mother nor their natural father resides. Overall, 35 percent of households in Namibia are caring for foster and/or orphaned children. 2.6 BIRTH REGISTRATION Birth registration is the inscription of the facts of each birth into an official log kept at the registrar’s office. A birth certificate is issued as proof of the registration of the birth. Birth registration is basic to ensuring a child’s legal status and, thus, fundamental rights and services (UNICEF, 2006; United Nations General Assembly, 2002). Information on registration of births was collected in the household interview. Respondents were asked whether children under age 5 residing in the household had a birth certificate. Table 2.9 shows the percentage of de jure children under age 5 whose births are registered with the civil authorities. Eighty-seven percent of children under five are registered with the civil authorities—63 percent have a birth certificate, 23 percent have a hospital card and less than 1 percent are registered but do not have a birth certificate. Children less than age 2 are less likely to have a birth certificate (56 percent) than children age 2-4 (68 percent Male children are slightly more likely to have a birth certificate than female children (65 percent versus 62 percent). Children in urban households are more likely to have a birth certificate than children in rural households (77 percent and 54 percent, respectively). By region, the proportion of children with birth certificates is highest in //Karas (89 percent) and lowest in Kavango (47 percent). The percentage of children with birth certificates correlates positively with wealth, ranging from 42 percent among children in the lowest wealth quintile to 90 percent among children in the highest quintile. Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size, mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Namibia 2013 Characteristic Residence Total Urban Rural Household headship Male 59.5 52.3 56.1 Female 40.5 47.7 43.9 Total 100.0 100.0 100.0 Number of usual members 0 0.2 0.2 0.2 1 18.6 16.1 17.4 2 18.1 13.4 15.8 3 15.2 12.6 13.9 4 15.7 11.7 13.8 5 11.5 12.0 11.7 6 8.3 9.3 8.8 7 4.8 7.4 6.0 8 2.7 5.0 3.8 9+ 5.1 12.2 8.5 Total 100.0 100.0 100.0 Mean size of households 3.8 4.7 4.2 Percentage of households with orphans and foster children under age 18 Foster children1 18.4 46.4 31.9 Double orphans 2.0 3.5 2.7 Single orphans2 9.5 19.9 14.5 Foster and/or orphan children 22.1 49.6 35.3 Number of households 5,121 4,728 9,849 Note: Table is based on de jure household members (i.e., usual residents). 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent Housing Characteristics and Household Population • 21 Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Namibia 2013 Background characteristic Children whose births are registered Number of children Percentage with a birth certificate Percentage without a birth certificate Percentage with only a hospital card Percentage registered Age <2 55.5 0.4 29.3 85.3 2,288 2-4 68.4 0.9 19.1 88.4 3,390 Sex Male 64.7 0.7 22.2 87.6 2,776 Female 61.8 0.7 24.2 86.7 2,900 Residence Urban 77.2 0.8 10.9 88.9 2,214 Rural 54.3 0.6 31.0 86.0 3,464 Region Zambezi 49.1 1.1 41.9 92.1 352 Erongo 79.7 0.5 10.6 90.8 310 Hardap 84.7 0.0 7.8 92.5 195 //Karas 88.8 3.0 5.1 97.0 175 Kavango 46.5 0.4 23.4 70.2 688 Khomas 78.1 0.6 10.6 89.3 769 Kunene 52.2 3.4 20.9 76.4 221 Ohangwena 54.4 0.3 36.5 91.2 836 Omaheke 60.4 1.4 22.9 84.6 180 Omusati 64.3 0.1 24.8 89.2 672 Oshana 63.2 1.1 17.3 81.6 398 Oshikoto 59.1 0.2 37.6 96.9 504 Otjozondjupa 70.7 1.0 14.2 86.0 379 Wealth quintile Lowest 42.2 0.6 40.2 83.1 1,420 Second 55.6 0.6 28.2 84.5 1,306 Middle 68.2 0.8 19.4 88.4 1,181 Fourth 76.1 1.1 12.8 90.1 1,009 Highest 90.4 0.4 2.5 93.3 762 Total 63.2 0.7 23.2 87.1 5,678 Note: Total includes 1 child with missing information on sex. 2.7 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Information was collected on the living arrangements and parental survival status of all children under age 18 residing in the sample households to assess the potential burden on households in terms of the need to provide for orphaned or foster children. The information was also used to assess the situation from the perspective of the children themselves. Table 2.10 presents the proportion of children under age 18 who are not living with one or both parents, either because the parent(s) died or for other reasons. Two percent of Namibian children under age 18 have lost both parents. Eight percent are not living with either parent. Twenty-eight percent of children are not living with either parent although both are alive. Fourteen percent of children under age 18 are orphaned (that is, one or both parents are dead). The percentage of orphaned children increases rapidly with age, from 4 percent among children under age 5 to 27 percent among children age 15-17. Rural children are more likely to be orphaned than urban children (15 percent and 12 percent, respectively). Otjozondjupa and Erongo (9 percent each) have the lowest proportion of orphaned children, and Oshana has the highest (18 percent). The percentage of children with one or both parents dead varies little by wealth. Thirty-seven percent of children are not living with their biological parents. Twenty-one percent of children from households in the highest wealth quintile are not living with a biological parent, and 43 and 44 percent of children from households in the second and middle wealth quintiles, respectively, are not living with a biological parent. The vast majority (97) percent) of children with no parents are attending school, while 95 percent of children with at least one living parent are attending school (data not shown). 22 • Housing Characteristics and Household Population Table 2.10 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Namibia 2013 Background characteristic Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a biolo- gical parent Percent- age with one or both parents dead1 Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing infor- mation on father/ mother Age 0-4 29.8 40.6 2.1 2.3 0.1 22.6 0.5 0.8 0.4 0.9 100.0 24.3 4.0 5,678 <2 31.9 53.4 2.2 0.6 0.0 10.7 0.3 0.1 0.2 0.7 100.0 11.3 2.8 2,288 2-4 28.4 32.0 2.0 3.4 0.2 30.5 0.7 1.3 0.6 1.0 100.0 33.1 4.8 3,390 5-9 25.2 25.2 3.6 4.7 0.4 33.7 1.8 2.9 1.2 1.3 100.0 39.6 10.0 5,267 10-14 20.8 21.3 6.4 4.4 0.9 30.0 4.4 6.6 3.3 1.9 100.0 44.3 21.9 4,919 15-17 20.3 17.3 8.5 3.7 1.2 26.7 5.9 6.5 4.2 5.7 100.0 43.2 26.8 2,528 Sex Male 24.8 27.4 4.6 4.2 0.6 28.4 2.5 3.6 2.0 2.0 100.0 36.5 13.5 9,148 Female 24.7 28.3 4.5 3.3 0.5 28.3 2.8 3.9 1.9 1.9 100.0 36.8 13.8 9,243 Residence Urban 34.9 30.5 4.8 5.0 0.8 15.9 1.8 2.1 2.1 2.1 100.0 22.0 11.8 7,087 Rural 18.4 26.2 4.4 2.9 0.4 36.1 3.2 4.8 1.8 1.8 100.0 45.8 14.8 11,305 Region Zambezi 34.1 27.2 5.9 3.1 1.2 17.3 2.8 3.3 3.5 1.7 100.0 26.8 16.7 987 Erongo 38.4 28.5 3.7 5.3 0.6 17.3 2.7 1.5 0.2 1.9 100.0 21.7 9.0 1,053 Hardap 33.1 30.8 3.0 3.8 0.5 20.0 2.2 1.9 3.3 1.4 100.0 27.4 11.1 581 //Karas 31.6 29.5 6.9 5.8 0.9 15.5 2.0 1.6 4.0 2.3 100.0 23.0 15.8 574 Kavango 29.5 29.6 4.7 3.1 0.3 22.8 2.7 3.2 1.9 2.2 100.0 30.7 12.9 2,268 Khomas 39.1 30.4 5.6 5.8 1.0 11.5 1.3 1.8 1.9 1.8 100.0 16.5 11.7 2,482 Kunene 23.6 29.2 4.3 4.2 0.2 29.9 1.3 2.2 1.2 3.9 100.0 34.7 9.5 568 Ohangwena 13.4 25.5 3.7 3.8 0.4 42.5 3.3 5.2 1.2 1.0 100.0 52.2 14.1 2,755 Omaheke 32.2 23.9 5.5 3.3 1.2 25.8 2.2 1.4 2.5 2.1 100.0 31.9 12.7 465 Omusati 12.6 26.4 4.8 2.5 0.4 40.0 3.1 5.7 2.4 2.1 100.0 51.2 16.6 2,498 Oshana 14.3 27.0 4.9 3.5 0.1 34.6 4.0 6.3 2.5 2.8 100.0 47.4 18.1 1,426 Oshikoto 16.6 27.7 3.5 2.4 0.4 37.3 3.8 5.4 1.3 1.5 100.0 47.8 14.8 1,637 Otjozondjupa 32.4 27.1 3.8 3.5 0.6 25.6 1.1 1.4 1.9 2.6 100.0 30.0 8.9 1,098 Wealth quintile Lowest 22.6 28.6 5.5 2.5 0.4 30.5 2.7 3.9 1.9 1.5 100.0 39.0 14.5 4,520 Second 19.7 28.2 4.1 2.9 0.4 32.8 3.4 4.8 1.9 1.9 100.0 42.8 14.7 3,967 Middle 20.1 25.5 4.3 4.2 0.6 34.6 2.7 4.5 1.7 1.9 100.0 43.5 14.1 3,677 Fourth 23.2 33.0 4.3 3.9 0.8 24.1 2.8 3.1 2.3 2.5 100.0 32.4 13.7 3,347 Highest 42.9 23.2 4.4 6.1 0.5 15.6 1.4 1.8 1.9 2.1 100.0 20.7 10.2 2,882 Total <15 25.5 29.5 3.9 3.7 0.4 28.6 2.2 3.3 1.6 1.3 100.0 35.6 11.6 15,864 Total <18 24.8 27.8 4.6 3.7 0.5 28.3 2.7 3.7 1.9 1.9 100.0 36.6 13.6 18,392 Note: Table is based on de jure household members (i.e., usual residents). Total includes 1 child with missing information on sex. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on the survival status of the other parent 2.8 EDUCATION OF THE HOUSEHOLD POPULATION The educational level of household members is among the most important characteristics of a household because it is associated with many factors that have a significant impact on health-seeking behaviours, reproductive behaviours, use of contraception, and the health of children. Results from the 2013 NDHS can be used to look at educational attainment among household members and school attendance as well as dropout rates among youth. 2.8.1 Educational Attainment Tables 2.11.1 and 2.11.2 show the distribution of female and male household members age 6 and above by the highest level of schooling ever attended (even if they did not complete that level) and the median number of years of education completed according to age, residence, region, and wealth quintile. A comparison of the two tables reveals that there is a gap in educational attainment between females and males. Although the majority of the household population age 6 and older has some education, 12 percent of females have never attended school, as compared with 14 percent of males. Females have completed a median of 6.6 years of schooling, which is 0.6 years more than the median for males (6.0 years). Housing Characteristics and Household Population • 23 Table 2.11.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Namibia 2013 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 31.9 67.0 0.0 0.0 0.0 0.0 1.1 100.0 2,111 0.0 10-14 2.2 83.0 5.7 8.5 0.1 0.0 0.5 100.0 2,481 3.8 15-19 2.0 15.5 10.9 60.7 7.4 3.5 0.1 100.0 2,148 7.7 20-24 3.2 6.8 4.2 48.5 22.6 14.4 0.3 100.0 2,052 9.7 25-29 4.6 9.0 5.2 49.0 21.0 10.7 0.4 100.0 1,725 9.4 30-34 6.0 11.6 6.2 45.5 20.0 10.4 0.2 100.0 1,454 9.3 35-39 6.9 16.1 5.2 41.3 20.7 9.0 0.9 100.0 1,298 9.2 40-44 7.0 19.2 5.5 37.4 19.7 10.5 0.6 100.0 1,055 9.2 45-49 12.3 24.5 7.0 29.8 12.9 12.3 1.2 100.0 820 7.8 50-54 14.8 33.6 7.2 23.0 9.2 10.8 1.4 100.0 825 6.1 55-59 23.3 33.5 8.3 20.7 5.0 8.8 0.3 100.0 545 4.9 60-64 28.8 35.7 5.9 16.6 5.4 6.4 1.3 100.0 475 3.8 65+ 43.3 36.5 4.6 7.9 2.3 3.2 2.1 100.0 1,331 1.0 Residence Urban 7.1 24.1 4.4 34.5 17.9 11.5 0.6 100.0 8,805 8.9 Rural 16.9 40.8 6.7 27.7 4.7 2.5 0.8 100.0 9,528 4.8 Region Zambezi 13.3 31.5 4.4 36.2 9.5 4.6 0.6 100.0 911 6.7 Erongo 5.2 25.8 3.6 39.1 18.5 7.5 0.3 100.0 1,311 8.9 Hardap 7.5 34.4 5.8 35.5 12.0 4.6 0.3 100.0 633 7.1 //Karas 7.5 29.7 6.9 38.3 12.9 4.5 0.3 100.0 646 7.5 Kavango 18.7 44.6 8.1 21.3 4.2 1.8 1.3 100.0 1,848 4.1 Khomas 4.5 19.4 3.8 31.4 21.7 18.4 0.8 100.0 3,561 9.6 Kunene 31.7 29.3 2.7 25.7 6.2 3.5 0.9 100.0 522 3.5 Ohangwena 18.7 41.2 5.3 28.1 4.1 2.0 0.5 100.0 2,119 4.5 Omaheke 25.8 29.3 7.0 26.8 6.1 4.2 0.8 100.0 440 4.6 Omusati 14.3 41.4 7.6 29.6 3.6 2.9 0.6 100.0 2,268 5.2 Oshana 6.6 33.1 3.0 35.7 13.5 7.5 0.6 100.0 1,527 7.5 Oshikoto 11.4 35.9 7.1 31.6 9.4 3.9 0.7 100.0 1,501 6.3 Otjozondjupa 16.6 30.2 8.0 29.8 10.2 3.8 1.3 100.0 1,048 6.3 Wealth quintile Lowest 23.0 45.2 7.9 21.1 1.8 0.1 1.0 100.0 3,560 3.4 Second 17.1 40.0 6.4 31.3 4.0 0.7 0.6 100.0 3,459 5.0 Middle 11.9 34.4 5.8 36.2 8.6 2.2 0.9 100.0 3,523 6.4 Fourth 7.3 27.4 5.4 35.9 15.5 8.0 0.5 100.0 3,784 8.2 Highest 3.2 19.0 2.8 30.2 23.3 20.9 0.7 100.0 4,007 9.9 Total 12.2 32.7 5.6 31.0 11.0 6.8 0.7 100.0 18,333 6.6 Note: Total includes 13 children with missing information on age. 1 Completed 7 grades at the primary level 2 Completed 5 grades at the secondary level The percentage of females who have no education decreases from 43 percent among those age 65 and over to 2 percent among those age 10-19. Similarly, the percentage of males who have never been to school decreases from 39 percent in the oldest age group to 3 percent among those age 10-19, indicating that there has been a gradual improvement in the level of education in Namibia over the last few decades. Educational attainment also differs markedly among regions. For example, the largest proportion of the female and male household population over age 6 that has never been to school is found in Kunene (32 percent and 35 percent, respectively). The region with the lowest proportion of household members who have never attended school is Khomas and Erongo for females (5 percent each) and Khomas for males (7 percent). The percentage of males and females who have no education decreases steadily with increasing wealth. 24 • Housing Characteristics and Household Population Table 2.11.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Namibia 2013 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 34.0 64.9 0.0 0.1 0.0 0.0 0.9 100.0 2,035 0.0 10-14 3.4 88.0 3.7 4.4 0.0 0.0 0.5 100.0 2,426 3.4 15-19 3.1 27.3 10.9 53.0 3.6 1.6 0.5 100.0 2,111 7.0 20-24 6.6 12.5 5.8 44.5 20.0 10.1 0.5 100.0 1,892 9.2 25-29 9.7 12.5 5.2 40.4 19.1 12.6 0.5 100.0 1,525 9.3 30-34 9.9 14.8 5.9 35.8 20.6 11.5 1.4 100.0 1,340 9.2 35-39 10.1 17.7 7.1 34.2 18.4 11.5 1.1 100.0 1,160 9.1 40-44 14.0 21.3 5.6 28.9 17.0 12.2 1.1 100.0 933 8.4 45-49 14.7 20.3 7.6 24.5 17.7 13.5 1.7 100.0 747 8.0 50-54 17.2 25.4 7.4 24.3 10.4 14.1 1.2 100.0 538 6.9 55-59 22.1 29.3 4.5 21.9 10.3 11.1 0.8 100.0 364 5.6 60-64 27.6 31.5 5.6 19.1 5.6 8.5 2.2 100.0 334 4.3 65+ 39.4 35.0 2.8 10.2 5.7 4.8 2.1 100.0 834 1.5 Residence Urban 8.7 26.0 4.4 32.0 16.6 11.5 0.9 100.0 7,840 8.5 Rural 18.1 45.4 6.4 22.3 4.6 2.4 1.0 100.0 8,414 4.0 Region Zambezi 8.5 37.3 4.5 30.5 13.5 4.8 0.9 100.0 846 6.6 Erongo 7.6 25.7 4.2 35.8 17.5 8.6 0.5 100.0 1,333 8.4 Hardap 11.4 34.6 6.3 29.9 13.5 3.6 0.6 100.0 587 6.5 //Karas 10.1 29.6 8.3 33.0 12.1 6.5 0.3 100.0 610 7.2 Kavango 19.4 44.3 6.2 20.6 5.1 2.8 1.5 100.0 1,595 3.5 Khomas 6.9 21.6 4.3 30.4 18.7 16.9 1.3 100.0 3,183 9.3 Kunene 34.7 31.0 3.1 21.2 5.2 4.2 0.6 100.0 477 2.8 Ohangwena 19.0 49.3 4.2 21.3 3.0 1.9 1.3 100.0 1,725 3.5 Omaheke 27.0 33.2 6.0 21.8 7.5 3.8 0.8 100.0 493 3.9 Omusati 14.0 49.7 7.8 21.7 3.4 3.0 0.5 100.0 1,757 4.4 Oshana 7.5 39.8 4.1 29.4 11.1 7.9 0.2 100.0 1,311 6.3 Oshikoto 14.5 41.5 7.5 25.4 6.5 3.9 0.9 100.0 1,364 5.0 Otjozondjupa 20.6 30.6 5.2 29.0 10.3 2.8 1.6 100.0 972 5.6 Wealth quintile Lowest 23.8 48.7 6.0 17.6 2.1 0.3 1.4 100.0 3,011 2.8 Second 18.8 43.9 6.0 25.1 4.7 0.8 0.8 100.0 3,257 4.1 Middle 13.4 38.0 6.6 30.4 7.9 2.5 1.2 100.0 3,374 5.7 Fourth 8.7 31.7 5.5 32.4 14.0 7.1 0.6 100.0 3,246 7.4 Highest 4.2 19.3 2.9 28.3 22.2 22.4 0.7 100.0 3,367 9.9 Total 13.5 36.0 5.4 26.9 10.4 6.8 0.9 100.0 16,254 6.0 Note: Total includes 16 children with missing information on age. 1 Completed 7 grades at the primary level 2 Completed 5 grades at the secondary level 2.8.2 School Attendance Ratios The net attendance ratio (NAR) indicates participation in primary schooling for the population age 6-12 and secondary schooling for the population age 13-17. The gross attendance ratio (GAR) measures participation at each level of schooling among those of any age from 5 to 24 years. The GAR is almost always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level. An NAR of 100 percent would indicate that all of those in the official age range for a given level are attending at that level. The GAR can exceed 100 percent if there is significant overage or underage participation at a given level of schooling. Table 2.12 provides data on net attendance ratios and gross attendance ratios by sex and level of schooling, according to residence, region, and wealth quintile. The NAR is 90 percent at the primary level and 50 percent at the secondary level. The rural primary school NAR is 88 percent, as compared with 93 percent in urban areas. The NAR is highest in Erongo (96 percent). In general, the NAR at the primary level increases with increasing wealth, from 85 percent in the lowest wealth quintile to 94-95 percent in the highest two quintiles. There have been only very small changes in the NAR and GAR since 2006-07. Housing Characteristics and Household Population • 25 Table 2.12 School attendance ratios Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by sex and level of schooling, and the gender parity index (GPI), according to background characteristics, Namibia 2013 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender parity index3 Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 92.7 93.8 93.3 1.01 128.9 124.5 126.6 0.97 Rural 87.7 88.8 88.2 1.01 135.7 126.9 131.4 0.94 Region Zambezi 94.7 94.2 94.4 0.99 144.2 137.0 140.8 0.95 Erongo 94.7 97.7 96.3 1.03 130.5 124.1 127.2 0.95 Hardap 92.8 96.1 94.5 1.04 124.2 117.7 120.9 0.95 //Karas 92.3 92.0 92.1 1.00 127.5 114.8 120.7 0.90 Kavango 86.0 89.6 87.8 1.04 135.8 135.1 135.4 0.99 Khomas 93.4 94.4 93.9 1.01 123.5 127.3 125.4 1.03 Kunene 66.2 77.6 71.9 1.17 99.9 105.0 102.4 1.05 Ohangwena 87.4 88.6 88.0 1.01 135.4 128.0 131.9 0.95 Omaheke 83.1 83.9 83.5 1.01 111.8 115.4 113.3 1.03 Omusati 90.9 88.1 89.4 0.97 143.1 121.5 131.9 0.85 Oshana 96.4 92.5 94.4 0.96 153.4 122.3 137.5 0.80 Oshikoto 88.4 91.9 90.2 1.04 136.5 135.1 135.8 0.99 Otjozondjupa 84.0 87.9 86.0 1.05 109.6 117.9 114.0 1.08 Wealth quintile Lowest 83.0 87.1 85.0 1.05 132.2 131.3 131.8 0.99 Second 88.5 88.0 88.3 0.99 138.2 124.7 131.7 0.90 Middle 90.5 91.3 90.9 1.01 136.7 124.1 130.4 0.91 Fourth 95.6 94.4 95.0 0.99 133.1 126.1 129.5 0.95 Highest 93.3 94.8 94.1 1.02 123.4 122.1 122.7 0.99 Total 89.5 90.8 90.1 1.01 133.2 126.0 129.6 0.95 SECONDARY SCHOOL Residence Urban 55.3 56.0 55.7 1.01 66.6 67.0 66.8 1.01 Rural 40.2 51.5 45.6 1.28 51.5 61.6 56.4 1.20 Region Zambezi 45.0 55.7 50.7 1.24 70.2 71.6 71.0 1.02 Erongo 51.4 60.1 55.9 1.17 58.0 67.5 62.9 1.16 Hardap 44.2 47.0 45.6 1.06 44.9 50.6 47.7 1.13 //Karas 56.1 63.6 59.5 1.14 66.7 77.8 71.7 1.17 Kavango 33.8 31.9 32.8 0.94 50.0 40.5 45.0 0.81 Khomas 62.6 58.5 60.3 0.93 75.1 70.5 72.5 0.94 Kunene 22.5 38.1 30.0 1.69 33.0 41.2 37.0 1.25 Ohangwena 40.6 49.9 45.1 1.23 52.2 62.7 57.3 1.20 Omaheke 37.9 30.6 34.2 0.81 40.4 31.9 36.2 0.79 Omusati 45.4 62.4 53.5 1.37 57.3 74.4 65.5 1.30 Oshana 50.2 61.4 55.3 1.22 59.3 75.6 66.8 1.28 Oshikoto 41.6 57.5 49.7 1.38 52.8 66.3 59.6 1.26 Otjozondjupa 46.1 49.8 48.2 1.08 49.7 53.5 51.8 1.08 Wealth quintile Lowest 30.9 41.5 36.3 1.34 44.0 49.8 46.9 1.13 Second 36.2 44.9 40.3 1.24 44.9 60.2 52.0 1.34 Middle 47.2 56.0 51.3 1.19 60.0 65.0 62.3 1.08 Fourth 53.5 53.7 53.6 1.00 63.9 65.0 64.5 1.02 Highest 69.0 70.6 69.9 1.02 80.8 79.6 80.1 0.99 Total 45.8 53.4 49.6 1.17 57.1 63.9 60.5 1.12 1 The NAR for primary school is the percentage of the primary school age (A-B years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school age (C-D years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students expressed as a percentage of the official primary school age population. The GAR for secondary school is the total number of secondary school students expressed as a percentage of the official secondary 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. 3 The gender parity index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The gender parity index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. The GAR at the primary school level is 130 percent. This figure exceeds the primary school NAR (90 percent) by 40 percentage points, indicating that a large number of children outside the official school age population are attending primary school. At the secondary level, the GAR (61 percent) is somewhat closer to the NAR (50 percent), indicating that fewer youth outside of the official school age population are attending secondary school than is the case for primary school. 26 • Housing Characteristics and Household Population At the primary school level, the GPI is more than 1 for the NAR and 0.95 for the GAR, but both are more than 1 at the secondary school level. This means that there is a greater gender disparity in favour of females in secondary school than in primary school. This parity difference is especially pronounced between urban and rural areas. The GPI associated with the secondary school NAR in rural areas is 1.28, as compared with 1.01 in urban areas; the GPI associated with the secondary school GAR is 1.20 and 1.01 in rural areas and urban areas, respectively. Large differences in GPI are also observed by region. The difference in the GPI for both the NAR and GAR by wealth quintile is more pronounced at the secondary level. Age-specific attendance rates (ASARs) for the population age 5 to 24—that is, the percentage of a given age cohort that attends school, regardless of the level attended (primary, secondary, or higher)—are shown in Figure 2.2. Up to age 14, a higher percentage of females than males attend school. From age 15- 20, a higher percentage of males than females attend school. Beyond age 20, females are more likely to be in school than males. Figure 2.2 Age-specific attendance rates 2.9 UTILISATION OF HEALTH SERVICES AND OUT-OF-POCKET EXPENDITURE FOR HEALTH CARE The 2013 NDHS collected data in the Household Questionnaire on utilisation of health services by household members. Information on inpatient visits was collected for each household from just a single member who was admitted for an overnight stay at a health facility in the six months preceding the survey. This information included place of admission, the cost of treatment and services received during the most recent visit (including the cost of laboratory tests, drugs, and other items), the main reason for seeking care, and the total number of times the individual stayed overnight at a health facility in the preceding six months. Information on outpatient visits was also collected from a single household member who consulted a health care facility, provider, pharmacy, or traditional healer for health care in the four weeks preceding the survey without staying overnight. Information on outpatient care included the place where care was most recently received, the cost of treatment and services received (including the cost of consulting fees and expenses, as well as other items such as drugs and tests), the main reason for seeking care, and the number of times the individual received care in the last four weeks without staying overnight. 0 10 20 30 40 50 60 70 80 90 100 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percent Age (years) Male Female NDHS 2013 Housing Characteristics and Household Population • 27 Caution should be exercised when interpreting the data collected on inpatient and outpatient health care visits since this information refers to only one person from each household who was not selected at random, but rather selected on the basis of the most recent visit during the reference period (six months for inpatient care and four weeks for outpatient care). These data cannot be extrapolated to provide information on the number of annual outpatient visits per capita among women and men in Namibia, nor can they provide the annual number of inpatient admissions. The information is meant to simply provide insight into the general level of out-of-pocket expenditure on inpatient and outpatient visits. Table 2.13.1 shows that 14 percent of households had a member who stayed overnight at a health facility in the past six months. Inpatient visits were most common in households in Kavango (20 percent) and least common in Omaheke (10 percent). The average expenditure for the most recent visit was 798 Namibian dollars (NAD) (about US$75) for men and 817 NAD (about US$77) for women. Men had an average of 3.6 inpatient stays, as compared with women’s average of 2.9 inpatient stays. Not surprisingly, men and women in urban areas and in the highest wealth quintile paid much more on average for inpatient visits than men and women in rural areas or in the other wealth quintiles. Table 2.13.1 Health expenditure: Inpatient visits Percentage of households with a member who was admitted to stay overnight at a health facility in the last six months, average cost of health care (in Namibia dollars) during the most recent overnight stay, and average number of inpatient visits for this particular household member (unweighted), Namibia 2013 Background characteristic Percentage of households with a member who stayed overnight in a health facility in the past 6 months Number of households Men Women Average health expenditure for the most recent visit Average number of inpatient visits Number of households Average health expenditure for the most recent visit Average number of inpatient visits Number of households Age <5 na 211 291 3.3 120 185 3.4 91 5-14 na 84 (827) (2.0) 52 (258) (3.6) 32 15-24 na 185 (651) (3.5) 37 85 2.0 148 25-34 na 301 820 4.9 82 1,460 2.1 218 35-44 na 203 361 4.4 77 299 2.1 126 45-54 na 122 (1,730) (2.8) 45 2,670 4.1 77 55-64 na 96 (1,154) (2.6) 41 1,021 6.2 54 65+ na 149 1,290 3.6 81 149 3.4 67 Residence Urban 13.6 5,121 1,424 2.7 249 1,076 2.7 447 Rural 14.0 4,728 259 4.3 289 501 3.0 366 Region Zambezi 15.4 541 (57) (1.8) 31 51 1.3 51 Erongo 13.0 930 (1,294) (2.1) 39 971 1.5 81 Hardap 12.4 381 * * 12 1,315 2.9 35 //Karas 13.0 406 (1,943) (2.2) 22 1,648 3.4 30 Kavango 20.2 737 252 7.6 62 53 5.4 80 Khomas 12.3 2,015 (1,975) (3.7) 91 1,843 2.0 156 Kunene 12.5 354 (92) (4.5) 16 148 2.1 28 Ohangwena 13.7 900 (33) (5.9) 55 (54) (4.0) 68 Omaheke 9.5 335 (529) (1.5) 16 (111) (1.4) 15 Omusati 15.3 949 181 2.9 75 664 3.5 70 Oshana 12.8 831 (1,848) (2.2) 34 833 2.0 72 Oshikoto 13.1 817 (292) (2.0) 38 527 2.8 69 Otjozondjupa 15.4 652 790 2.3 45 765 4.5 56 Wealth quintile Lowest 14.7 1,737 82 4.3 126 42 4.2 124 Second 14.2 1,910 209 4.6 108 75 2.7 161 Middle 12.7 1,954 195 3.6 86 51 2.5 161 Fourth 14.7 2,136 476 2.8 116 431 3.0 196 Highest 12.9 2,111 3,180 2.5 102 3,258 2.2 170 Total 13.8 9,849 798 3.6 538 817 2.9 813 Note: Total includes 1 man with missing information on age. 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. na = Not applicable Table 2.13.2 shows that 36 percent of households reported a member who had sought care from a health provider, pharmacy, or traditional healer without staying overnight in the four weeks preceding the survey. Outpatient visits are more common in rural (39 percent) than urban areas (33 percent) and most common in Omusati (51 percent). Differences by wealth quintile are small. Outpatient visits are less 28 • Housing Characteristics and Household Population expensive than inpatient visits. Men paid an average of 99 NAD (about US$10) and women an average of 161 NAD (about US$15) for an outpatient visit. There is only a minimal difference in the average number of outpatient visits by men (1.6) and women (1.5). Both men and women incurred costs for an average of 1.2 outpatient visits. Outpatient visits were most expensive for men in Hardap and least expensive for men in Omusati. On the other hand, women in Otjozondjupa paid the most for an outpatient visit and women in Ohangwena paid the least. Among both men and women, outpatient visits were much more expensive in urban than rural areas and for households in the highest wealth quintile. Table 2.13.2 Health expenditure: Outpatient visits Percentage of households with a member who received care from a health provider, a pharmacy, or a traditional healer without staying overnight in the last four weeks, average cost of health care (in Namibia dollars) during the most recent visit, average number of outpatient visits for this particular household member, and average number of outpatient visits for which money was spent (unweighted), Namibia 2013 Background characteristic Percentage of households with a member who had an outpatient visit in the past 4 weeks Number of households Men Women Average health expenditure for the most recent visit Average number of outpatient visits Average number of outpatient visits for which money was spent Number of households Average health expenditure for the most recent visit Average number of outpatient visits Average number of outpatient visits for which money was spent Number of households Age <5 na 594 39 1.4 1.2 316 44 1.5 1.3 278 5-14 na 312 42 1.6 1.2 143 46 1.3 1.1 169 15-24 na 402 79 1.4 1.2 167 63 1.7 1.4 235 25-34 na 527 50 1.7 1.2 196 65 1.5 1.2 331 35-44 na 498 148 1.7 1.4 207 467 1.4 1.2 291 45-54 na 422 184 1.7 1.3 156 365 1.7 1.5 266 55-64 na 296 158 1.6 1.3 126 42 1.5 1.1 170 65+ na 457 156 1.4 0.9 156 107 1.5 0.9 300 Residence Urban 32.5 5,121 149 1.6 1.3 715 284 1.6 1.3 945 Rural 39.1 4,728 51 1.5 1.1 751 55 1.5 1.2 1,099 Region Zambezi 42.8 541 31 1.8 1.4 106 84 1.9 1.4 126 Erongo 31.2 930 112 1.5 1.3 146 67 1.5 1.2 145 Hardap 24.6 381 538 1.3 0.9 37 65 1.1 0.8 57 //Karas 35.8 406 95 1.5 1.0 62 80 1.4 1.2 82 Kavango 37.5 737 26 1.7 1.3 110 22 1.6 1.2 166 Khomas 28.9 2,015 241 1.8 1.5 229 447 1.6 1.3 348 Kunene 20.9 354 97 1.2 1.1 26 129 1.4 1.2 48 Ohangwena 45.0 900 12 1.4 1.0 164 11 1.4 0.9 241 Omaheke 34.0 335 160 1.5 1.4 57 210 1.5 1.1 56 Omusati 50.5 949 7 1.5 1.1 171 15 1.5 1.3 308 Oshana 36.3 831 59 1.4 1.2 137 68 1.5 1.4 163 Oshikoto 37.5 817 32 1.7 1.1 122 113 1.2 1.1 185 Otjozondjupa 33.3 652 148 1.3 1.1 99 689 1.9 1.4 118 Wealth quintile Lowest 37.4 1,737 12 1.6 1.2 256 8 1.5 1.1 394 Second 34.5 1,910 21 1.7 1.2 278 305 1.5 1.1 381 Middle 36.5 1,954 16 1.6 1.2 308 70 1.5 1.2 406 Fourth 33.1 2,136 92 1.6 1.4 296 86 1.6 1.3 409 Highest 37.3 2,111 316 1.4 1.1 328 322 1.5 1.3 454 Total 35.7 9,849 99 1.6 1.2 1,466 161 1.5 1.2 2,044 Note. Total includes 3 women with missing information on age. na = Not applicable Characteristics of Survey Respondents • 29 CHARACTERISTICS OF SURVEY RESPONDENTS 3 his chapter presents information on key demographic and socioeconomic characteristics of the survey respondents, including age, religion, marital status, residence, education, literacy, and media access. The chapter also explores adult employment status, occupation, and earnings. The information contained in this chapter provides a useful context within which the demographic and health indices discussed in the remainder of the report should be understood. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 shows the background characteristics of the 9,176 women and 3,950 men age 15-49 interviewed in the 2013 NDHS. In addition, as explained in Chapter 1, interviews on selected sections of the questionnaires were conducted with 842 women and 531 men age 50-64 in a subsample of half of the households selected for the male survey. Overall, 57 percent of women and 59 percent of men are below the age of 30. The highest proportions of respondents however, fall in the 15-19 age group with 21 percent of women and 23 percent of men falling within this age group. These percentages decrease steadily to reach 8 percent and 7 percent, respectively, in the 45-49 age group. The Namibian population is predominantly Christian. The majority (44 percent of women and 43 percent of men) belong to the Evangelical Lutheran Church in Namibia (ELCIN). Twenty percent of women and 26 percent of men reported being Roman Catholic while 21 percent of women and 13 percent of men reported being Protestant or Anglican. A large majority of respondents age 15-49 (60 percent of women and 68 percent of men) have never been married. Thirty-four percent of women and 29 percent of men are currently married or living together with a partner as if married, while 7 percent and 3 percent, respectively, are divorced, separated, or widowed. T Key Findings • A total of 9,176 women and 3,950 men age 15-49 were interviewed as part of the 2013 NDHS. • In half of the households selected for the male survey, partial interviews were conducted with 842 women and 531 men age 50-64. • Five percent of women and 8 percent of men age 15-49 have no education. The majority of respondents (76 percent of women and 69 percent of men) have a secondary education or higher. • Literacy rates are high in Namibia: 93 percent of women and 91 percent of men are literate. • Forty-three percent of women and 56 percent of men age 15-49 are currently employed. • Among women who were employed in the past 12 months, the majority work in sales and services (58 percent). Men are most likely to be employed in skilled manual work (33 percent) and sales and services (30 percent). • Three percent of women and 9 percent of men work in agriculture. • Thirty-six percent of women who work in agriculture are not paid for their work. 30 • Characteristics of Respondents Fifty-seven percent of the respondents reside in urban areas, while 43 percent reside in rural areas. By region, Khomas (where Windhoek, the capital city, is located) had the highest proportion of both female and male respondents (24 percent and 25 percent, respectively), whereas Kunene, Omaheke, Hardap, and //Karas had the lowest proportions of respondents (3-4 percent). Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Namibia 2013 Background characteristic Women Men Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 20.8 1,906 1,857 22.9 922 883 20-24 19.5 1,786 1,720 20.1 808 771 25-29 16.2 1,489 1,495 16.4 658 613 30-34 13.7 1,260 1,262 12.9 520 516 35-39 12.1 1,110 1,146 11.1 448 454 40-44 10.0 917 942 9.3 376 404 45-49 7.7 708 754 7.2 289 309 Religion Roman Catholic 19.6 1,802 1,892 25.9 1,041 1,031 Protestant/Anglican 21.2 1,947 2,049 12.7 511 511 ELCIN 44.0 4,035 3,783 43.4 1,745 1,571 Seventh-Day Adventist 4.8 436 522 4.0 161 192 No religion 1.1 105 129 1.8 72 100 Other 9.0 827 779 12.0 483 537 Missing 0.3 23 22 0.2 9 8 Marital status Never married 59.5 5,458 5,188 68.3 2,745 2,577 Married 17.9 1,644 1,779 15.1 609 657 Living together 16.1 1,476 1,587 13.7 551 587 Divorced/separated 4.4 408 429 2.6 106 118 Widowed 2.1 189 193 0.2 10 11 Residence Urban 56.6 5,190 4,843 56.8 2,282 1,998 Rural 43.4 3,986 4,333 43.2 1,739 1,952 Region Zambezi 5.0 457 647 5.4 218 291 Erongo 8.4 771 858 9.3 372 421 Hardap 3.3 304 595 3.8 152 299 //Karas 3.7 343 782 3.8 151 333 Kavango 9.1 835 743 7.9 316 281 Khomas 24.0 2,202 986 25.4 1,023 415 Kunene 2.8 258 584 2.6 104 252 Ohangwena 9.7 894 695 8.2 328 255 Omaheke 2.5 225 535 2.6 103 256 Omusati 9.6 884 725 8.5 342 262 Oshana 8.2 755 671 8.3 335 274 Oshikoto 7.7 707 656 8.3 335 302 Otjozondjupa 5.9 540 699 6.0 241 309 Education No education 4.6 419 551 7.7 310 379 Primary 19.6 1,798 1,914 23.5 944 978 Secondary 65.7 6,029 6,019 59.7 2,400 2,307 More than secondary 10.1 930 692 9.1 368 286 Wealth quintile Lowest 15.6 1,429 1,461 14.8 594 605 Second 17.7 1,625 1,661 19.1 769 768 Middle 19.6 1,795 1,903 22.0 886 897 Fourth 23.1 2,116 2,162 22.8 917 913 Highest 24.1 2,211 1,989 21.3 855 767 Total 15-49 100.0 9,176 9,176 100.0 4,021 3,950 50-64 0.0 797 842 0.0 460 531 Total 15-64 0.0 9,973 10,018 0.0 4,481 4,481 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. ELCIN = Evangelical Lutheran Church in Namibia Education is an important determinant of the other demographic and health characteristics of individuals and the societies to which they belong. The proportion of respondents with no education is low (5 percent of women and 8 percent of men). The majority of respondents (76 percent of women and 69 percent of men) have a secondary education or higher. Characteristics of Survey Respondents • 31 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Tables 3.2.1 and 3.2.2 show the educational attainment of women and men age 15-49, respectively, by background characteristics. As mentioned above, the level of education in Namibia is high, with only 5 percent of women and 8 percent of men having no formal education. As expected, the proportion of respondents with no education increases with age, from 2 percent among women and men age 15-19 to 12 percent among women age 45-49 and 13 percent among men age 40-44. Respondents in rural areas are less likely to be educated than their urban counterparts; 7 percent of women and 11 percent of men in rural areas have no education, as compared with 3 percent and 5 percent, respectively, of women and men in urban areas. The proportion of women and men with no education is highest in Kunene (22 percent and 30 percent, respectively) and lowest in Erongo and Oshana among women (1 percent each) and Oshana among men (2 percent). The percentage of women and men with no education decreases with increasing wealth. Ten percent of women and 15 percent of men in the lowest wealth quintile have no education, as compared with less than 1 percent each among respondents in the highest wealth quintile. Women are more likely to reach higher levels of education than men. For example, 48 percent of women have some secondary education, compared with 44 percent of men. Tables 3.2.1 and 3.2.2 further show that women have a median of 9.1 years of schooling while men have a median of 8.7 years of schooling. Median number of years of schooling is higher among women and men age 20-29, those residing in urban areas and in Khomas, and those in the wealthiest quintile than among their counterparts in the other groups. Overall, the results show that there have been improvements in educational attainment since the 2006-07 NDHS. For example, median number of years of schooling completed has increased from 8.5 to 9.1 among women and from 7.2 to 8.7 among men. 32 • Characteristics of Respondents Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Namibia 2013 Background characteristic Highest level of schooling Total Median years completed Number of women No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 1.8 10.5 6.8 55.5 15.5 10.0 100.0 8.9 3,691 15-19 1.6 14.3 9.1 62.4 8.0 4.6 100.0 8.1 1,906 20-24 2.0 6.5 4.2 48.2 23.4 15.7 100.0 9.7 1,786 25-29 4.2 10.3 4.7 48.2 21.8 10.9 100.0 9.4 1,489 30-34 5.9 11.6 6.2 46.4 20.0 9.9 100.0 9.3 1,260 35-39 6.1 16.3 5.8 42.9 19.9 9.1 100.0 9.1 1,110 40-44 7.2 19.8 5.3 38.3 19.6 9.8 100.0 9.1 917 45-49 11.6 26.2 7.4 30.5 12.3 12.0 100.0 7.8 708 Residence Urban 3.1 8.3 4.3 44.7 24.4 15.2 100.0 9.7 5,190 Rural 6.5 20.2 8.5 52.1 9.3 3.5 100.0 8.0 3,986 Region Zambezi 5.0 12.6 4.6 57.8 15.0 5.0 100.0 8.7 457 Erongo 1.0 9.1 4.2 51.7 24.6 9.4 100.0 9.6 771 Hardap 3.2 12.8 7.1 54.8 16.9 5.2 100.0 9.0 304 //Karas 1.7 12.1 6.6 55.0 18.1 6.6 100.0 9.1 343 Kavango 6.6 31.4 10.8 36.0 12.5 2.7 100.0 7.1 835 Khomas 2.0 5.4 3.3 37.6 27.2 24.4 100.0 11.1 2,202 Kunene 21.9 18.1 4.1 42.7 9.3 3.9 100.0 7.6 258 Ohangwena 4.8 21.6 7.7 54.2 8.3 3.3 100.0 7.9 894 Omaheke 17.2 16.0 7.8 45.2 9.7 4.1 100.0 7.8 225 Omusati 4.4 14.7 9.8 59.2 7.9 3.9 100.0 8.2 884 Oshana 0.9 8.9 2.7 53.8 22.8 10.9 100.0 9.5 755 Oshikoto 5.2 12.8 7.5 52.3 15.9 6.3 100.0 8.7 707 Otjozondjupa 9.5 15.1 8.3 46.5 15.6 4.9 100.0 8.6 540 Wealth quintile Lowest 10.3 30.0 11.3 43.8 4.3 0.2 100.0 6.7 1,429 Second 7.5 20.3 9.1 55.2 7.1 0.9 100.0 7.8 1,625 Middle 4.7 13.4 6.5 56.3 15.3 3.9 100.0 8.8 1,795 Fourth 2.5 8.3 4.7 49.9 25.0 9.6 100.0 9.6 2,116 Highest 0.5 2.8 1.8 36.3 29.6 29.0 100.0 11.3 2,211 Total 4.6 13.5 6.1 47.9 17.8 10.1 100.0 9.1 9,176 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level Characteristics of Survey Respondents • 33 Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Namibia 2013 Background characteristic Highest level of schooling Total Median years completed Number of men No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 3.6 16.2 7.4 53.5 13.5 5.8 100.0 8.3 1,730 15-19 1.8 21.5 9.0 58.9 6.9 1.9 100.0 7.5 922 20-24 5.7 10.1 5.7 47.3 21.0 10.2 100.0 9.3 808 25-29 9.6 11.4 5.5 42.4 19.2 11.8 100.0 9.3 658 30-34 10.3 15.9 6.4 36.4 19.4 11.5 100.0 9.2 520 35-39 10.3 18.6 5.7 36.9 18.5 9.9 100.0 9.1 448 40-44 13.2 21.1 5.8 30.2 15.9 13.9 100.0 8.5 376 45-49 12.0 22.5 11.3 28.1 14.6 11.4 100.0 7.5 289 Residence Urban 4.9 9.8 4.5 45.7 22.1 13.1 100.0 9.5 2,282 Rural 11.4 25.4 10.1 40.9 8.2 4.0 100.0 7.0 1,739 Region Zambezi 4.5 19.7 4.6 40.7 24.8 5.7 100.0 9.2 218 Erongo 4.8 9.4 5.7 48.6 21.4 10.0 100.0 9.4 372 Hardap 5.4 18.8 6.8 48.4 17.1 3.5 100.0 9.0 152 //Karas 3.0 13.9 7.8 49.3 18.2 7.7 100.0 9.0 151 Kavango 12.1 21.5 8.0 42.8 9.7 5.9 100.0 7.3 316 Khomas 4.1 8.5 4.7 40.7 24.5 17.5 100.0 9.8 1,023 Kunene 30.2 17.8 7.4 30.0 8.7 5.9 100.0 6.2 104 Ohangwena 13.6 24.3 5.4 47.7 5.6 3.5 100.0 6.8 328 Omaheke 19.2 24.6 7.3 34.6 8.9 5.5 100.0 6.8 103 Omusati 3.5 25.2 16.2 44.4 6.1 4.7 100.0 7.2 342 Oshana 2.1 17.2 6.6 47.2 15.4 11.5 100.0 9.1 335 Oshikoto 13.7 25.6 7.9 39.7 7.5 5.6 100.0 7.1 335 Otjozondjupa 11.7 12.8 5.9 49.1 17.7 2.7 100.0 8.6 241 Wealth quintile Lowest 15.3 32.2 10.7 35.8 6.0 0.0 100.0 6.2 594 Second 13.1 24.8 9.1 43.8 8.1 1.1 100.0 7.0 769 Middle 8.9 19.7 9.2 47.8 9.7 4.7 100.0 7.9 886 Fourth 3.5 9.6 5.4 49.6 20.5 11.4 100.0 9.4 917 Highest 0.8 2.4 1.6 38.2 32.0 24.9 100.0 11.2 855 Total 15-49 7.7 16.5 6.9 43.6 16.1 9.1 100.0 8.7 4,021 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level 3.3 LITERACY The ability to read and write is an important personal asset, enhancing people’s ability to access information and connect with opportunities for enhancing their socioeconomic well-being. In addition, knowledge of the literacy level of the population can help health and development workers determine how to package and communicate their messages. In the 2013 NDHS, the literacy status of respondents who had not attended school or had attended only primary school was determined by assessing their ability to read all or part of a sentence. Respondents with a secondary education or higher were assumed to be literate. Tables 3.3.1 and 3.3.2 show the percent distributions of women and men, respectively, by level of schooling attended and level of literacy, as well as the percentage of respondents who are literate, according to background characteristics. The literacy rate in Namibia is generally high, with more than nine in ten respondents being literate (93 percent of women and 91 percent of men). Literacy level tends to decrease with age, especially among women. Ninety-six percent of women age 15-24 are literate, as compared with 86 percent of women age 45-49. Women and men in urban areas (96 percent and 95 percent, respectively) are more likely to be literate than those in rural areas (90 percent and 85 percent, respectively). Variations also exist by region. The literacy rate among women ranges from 77 percent in Kunene and Omaheke to 98 percent in Erongo and Oshana. Among men, literacy rate is highest in Khomas (97 percent) and lowest in Kunene and Omaheke (71 percent each). Literacy increases with increasing wealth among both women and men. For 34 • Characteristics of Respondents example, 86 percent of women in the lowest wealth quintile are literate, as compared with 99 percent of those in the highest wealth quintile. The corresponding percentages for men are 79 percent and 99 percent, respectively. Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Namibia 2013 Background characteristic Secondary school or higher No schooling or primary school Percent- age literate1 Number of women Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/visually impaired Total Age 15-24 80.9 11.7 3.3 3.0 0.7 0.0 100.0 95.9 3,691 15-19 75.0 17.2 3.6 2.9 1.1 0.1 100.0 95.7 1,906 20-24 87.3 5.9 2.9 3.1 0.3 0.0 100.0 96.2 1,786 25-29 80.8 9.0 4.1 5.0 0.7 0.0 100.0 93.9 1,489 30-34 76.3 12.9 3.7 6.0 0.6 0.1 100.0 92.9 1,260 35-39 71.9 14.7 4.4 7.5 0.9 0.0 100.0 91.0 1,110 40-44 67.7 17.0 7.0 5.4 2.4 0.0 100.0 91.7 917 45-49 54.8 22.8 8.6 11.4 1.8 0.3 100.0 86.2 708 Residence Urban 84.3 8.8 2.9 3.1 0.5 0.0 100.0 95.9 5,190 Rural 64.8 19.0 6.4 7.9 1.5 0.1 100.0 90.2 3,986 Region Zambezi 77.8 8.2 6.0 7.7 0.2 0.0 100.0 92.1 457 Erongo 85.7 9.3 2.5 2.1 0.0 0.0 100.0 97.6 771 Hardap 76.9 12.7 5.9 4.1 0.1 0.0 100.0 95.4 304 //Karas 79.6 11.2 5.1 2.0 1.6 0.1 100.0 95.9 343 Kavango 51.1 23.1 16.0 8.9 0.5 0.1 100.0 90.3 835 Khomas 89.2 5.4 1.8 2.4 0.6 0.0 100.0 96.5 2,202 Kunene 55.9 15.5 5.1 22.5 0.4 0.0 100.0 76.5 258 Ohangwena 65.9 21.5 4.2 3.2 4.8 0.2 100.0 91.6 894 Omaheke 59.0 10.3 7.9 20.9 1.5 0.0 100.0 77.2 225 Omusati 71.0 19.9 2.9 5.5 0.0 0.0 100.0 93.9 884 Oshana 87.5 10.1 0.4 1.9 0.0 0.0 100.0 98.0 755 Oshikoto 74.5 17.4 3.0 4.7 0.2 0.0 100.0 94.9 707 Otjozondjupa 67.0 14.9 5.4 9.3 2.8 0.2 100.0 87.3 540 Wealth quintile Lowest 48.4 26.0 11.2 11.5 2.4 0.2 100.0 85.6 1,429 Second 63.2 19.4 6.4 9.1 1.4 0.0 100.0 89.0 1,625 Middle 75.5 14.0 3.8 5.5 0.9 0.0 100.0 93.2 1,795 Fourth 84.5 9.3 2.5 2.7 0.4 0.0 100.0 96.3 2,116 Highest 94.9 3.4 0.9 0.5 0.3 0.0 100.0 99.2 2,211 Total 75.8 13.2 4.4 5.2 1.0 0.0 100.0 93.4 9,176 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Characteristics of Survey Respondents • 35 Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Namibia 2013 Background characteristic Secondary school or higher No schooling or primary school Percentage literate1 Number of men Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Total Age 15-24 72.8 14.8 5.3 5.9 0.7 0.0 100.0 92.8 1,730 15-19 67.7 21.5 4.7 4.7 0.8 0.0 100.0 93.9 922 20-24 78.5 7.1 6.0 7.3 0.7 0.0 100.0 91.6 808 25-29 73.5 7.3 9.2 9.8 0.3 0.0 100.0 89.9 658 30-34 67.4 11.9 8.4 11.4 0.3 0.0 100.0 87.7 520 35-39 65.4 10.0 14.7 8.3 0.9 0.0 100.0 90.2 448 40-44 59.9 13.8 12.4 12.5 0.6 0.5 100.0 86.1 376 45-49 54.2 21.4 13.5 10.3 0.5 0.2 100.0 89.0 289 Residence Urban 80.8 7.8 6.1 4.3 0.5 0.0 100.0 94.7 2,282 Rural 53.1 19.9 12.0 13.9 0.7 0.1 100.0 84.9 1,739 Region Zambezi 71.2 9.1 8.0 9.6 0.5 0.0 100.0 88.3 218 Erongo 80.1 9.6 5.8 3.5 0.6 0.0 100.0 95.4 372 Hardap 69.0 10.6 11.0 6.8 2.1 0.4 100.0 90.6 152 //Karas 75.3 15.0 3.4 3.9 0.7 0.3 100.0 93.7 151 Kavango 58.4 12.2 11.3 14.1 2.5 0.4 100.0 82.0 316 Khomas 82.7 6.4 7.5 2.9 0.4 0.0 100.0 96.6 1,023 Kunene 44.6 11.8 14.7 27.9 0.4 0.1 100.0 71.2 104 Ohangwena 56.8 16.7 9.1 17.4 0.0 0.0 100.0 82.6 328 Omaheke 48.9 5.0 17.2 26.3 2.1 0.0 100.0 71.1 103 Omusati 55.2 25.5 13.9 5.4 0.0 0.0 100.0 94.6 342 Oshana 74.1 21.4 0.3 3.5 0.0 0.0 100.0 95.8 335 Oshikoto 52.8 19.5 13.5 13.9 0.3 0.0 100.0 85.8 335 Otjozondjupa 69.6 11.7 7.3 10.3 0.2 0.0 100.0 88.6 241 Wealth quintile Lowest 41.8 22.1 14.7 19.3 1.6 0.2 100.0 78.6 594 Second 53.0 18.7 12.4 14.3 0.8 0.0 100.0 84.1 769 Middle 62.2 16.3 11.1 9.3 0.8 0.0 100.0 89.6 886 Fourth 81.4 8.8 6.0 2.9 0.1 0.1 100.0 96.3 917 Highest 95.2 2.7 1.3 0.7 0.0 0.0 100.0 99.2 855 Total 15-49 68.8 13.0 8.6 8.4 0.6 0.1 100.0 90.5 4,021 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 3.4 EXPOSURE TO MASS MEDIA The 2013 NDHS collected information on respondents’ exposure to common print and electronic media. Respondents were asked how often they read a newspaper,1 listened to the radio, or watched television. The mass media in Namibia serve as an important channel for conveying messages on family planning, malaria, HIV/AIDS awareness, and other health-related issues. Tables 3.4.1 and 3.4.2 show the percentages of women and men, respectively, who were exposed to the different types of mass media by age, residence, region, level of education, and wealth quintile. Radio is the most commonly used type of mass media among both men and women, with 58 percent and 60 percent, respectively, listening to the radio at least once a week. More than four in ten women and men (42 percent and 44 percent, respectively) watch television at least once a week. Thirty-nine percent of women read a newspaper at least once a week. Overall, 21 percent of women have access to all three media (radio, television, and newspaper) at least once per week. Urban women are substantially more likely to be exposed to all three media (33 percent) than rural women (6 percent). There exist wide regional variations with respect to media exposure. About four in ten women in Khomas (41 percent), Hardap (40 percent), and Erongo (38 percent) 1 Data for men who read a newspaper at least once a week are not shown due to a problem in the data entry programme. The responses from men with a secondary education or higher were not entered, resulting in a gross underestimate of men’s exposure to this type of media. 36 • Characteristics of Respondents are exposed to all three media, as compared with only 2 percent of women in Omusati and 5 percent of those in Kavango. Women’s exposure to all three media increases notably with increasing education and wealth. Among men, 34 percent have access to both media (radio and television) at least once per week (as noted, data for men who read a newspaper at least once a week are not shown). Similar to women, urban men (51 percent) are much more likely to be exposed to both of these types of media than rural men (11 percent). Access to the two specified media ranges from 8 percent among men in Omusati to 74 percent among those in Erongo. Men’s exposure to both radio and television increases steadily as their education and wealth increase. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Namibia 2013 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 36.0 40.2 52.5 17.9 30.6 1,906 20-24 43.7 47.0 56.9 24.1 24.4 1,786 25-29 40.8 45.8 57.3 21.8 25.6 1,489 30-34 40.1 40.6 59.7 21.2 25.6 1,260 35-39 35.6 38.1 60.7 21.4 28.4 1,110 40-44 38.7 37.8 60.7 21.7 26.5 917 45-49 35.4 36.8 62.3 21.8 29.0 708 Residence Urban 55.4 61.9 63.9 33.2 15.0 5,190 Rural 17.7 15.5 49.6 5.8 42.8 3,986 Region Zambezi 17.9 36.2 58.4 10.6 30.7 457 Erongo 60.4 65.3 66.4 38.4 11.5 771 Hardap 56.5 68.7 73.4 39.5 11.7 304 //Karas 34.0 51.8 53.4 17.5 23.7 343 Kavango 10.3 21.6 33.8 4.8 54.8 835 Khomas 69.8 67.2 67.3 40.9 8.6 2,202 Kunene 23.2 42.7 58.3 13.4 31.5 258 Ohangwena 15.7 15.4 58.4 5.6 35.6 894 Omaheke 22.3 33.9 66.4 10.7 23.9 225 Omusati 15.2 6.1 36.6 2.2 55.8 884 Oshana 41.3 33.4 61.4 19.8 27.2 755 Oshikoto 33.1 29.0 60.9 12.5 26.4 707 Otjozondjupa 35.5 51.7 56.4 22.8 28.3 540 Education No education 2.1 15.5 44.0 0.9 51.3 419 Primary 13.8 18.0 46.8 5.7 45.3 1,798 Secondary 43.4 45.1 61.0 23.3 23.0 6,029 More than secondary 76.0 77.8 63.3 47.5 7.2 930 Wealth quintile Lowest 9.9 4.0 40.5 1.4 55.4 1,429 Second 18.3 8.3 49.2 4.0 45.0 1,625 Middle 31.7 23.4 59.6 8.8 28.7 1,795 Fourth 48.1 65.8 63.5 30.0 14.5 2,116 Highest 70.4 82.6 68.0 48.6 6.4 2,211 Total 39.0 41.8 57.7 21.3 27.1 9,176 Characteristics of Survey Respondents • 37 Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Namibia 2013 Background characteristic Watches television at least once a week Listens to the radio at least once a week Accesses both media at least once a week Accesses neither of the two media at least once a week Number of men Age 15-19 41.0 54.0 29.8 34.8 922 20-24 42.3 55.9 30.0 31.7 808 25-29 43.7 64.1 34.1 26.2 658 30-34 47.4 63.0 36.7 26.3 520 35-39 44.1 66.1 35.9 25.6 448 40-44 45.8 59.8 39.4 33.8 376 45-49 48.5 72.6 44.3 23.2 289 Residence Urban 63.9 68.3 51.3 19.1 2,282 Rural 17.7 50.1 11.4 43.7 1,739 Region Zambezi 29.2 49.1 19.7 41.4 218 Erongo 80.7 85.8 74.1 7.6 372 Hardap 52.2 49.1 27.4 26.1 152 //Karas 64.4 71.3 51.3 15.6 151 Kavango 22.9 40.6 14.3 50.8 316 Khomas 68.9 74.4 55.9 12.6 1,023 Kunene 38.2 54.5 28.9 36.3 104 Ohangwena 17.6 56.1 11.4 37.7 328 Omaheke 22.8 57.3 18.1 38.0 103 Omusati 15.1 41.1 7.8 51.6 342 Oshana 24.2 38.0 11.7 49.4 335 Oshikoto 20.0 63.7 14.6 30.9 335 Otjozondjupa 52.1 62.2 46.7 32.4 241 Education No education 13.7 51.1 12.8 48.1 310 Primary 25.0 52.4 18.6 41.2 944 Secondary 50.2 63.8 39.2 25.2 2,400 More than secondary 76.4 66.8 57.9 14.7 368 Wealth quintile Lowest 7.2 40.7 3.9 56.0 594 Second 14.7 57.5 10.9 38.8 769 Middle 27.7 55.7 20.2 36.8 886 Fourth 70.4 68.1 55.7 17.2 917 Highest 84.0 73.5 66.9 9.4 855 Total 15-49 43.9 60.4 34.0 29.7 4,021 Note: Data on men who read a newspaper at least once a week are not shown due to a problem in the data entry programme. The responses from men with a secondary education or higher were not entered, resulting in a gross underestimate of men’s exposure to this type of media. 3.5 EMPLOYMENT 3.5.1 Employment Status The 2013 NDHS asked respondents a number of questions regarding their employment status, including whether they were working in the seven days preceding the survey and, if not, whether they had worked in the 12 months preceding the survey. The results for women and men are presented in Tables 3.5.1 and 3.5.2, respectively. At the time of the survey, 43 percent of women were employed and 3 percent were not employed but had worked sometime during the past 12 months (Table 3.5.1 and Figure 3.1). Fifty-six percent of men were employed at the time of the survey, and 6 percent were employed at some point during the 12 months before the survey (Table 3.5.2). The proportion of currently employed respondents is considerably lower among younger women and men, especially those age 15-19 (8 percent of women and 14 percent of men), probably because many are still in school. Also, never-married women and men are less likely to be working than those currently or formerly married. For example, 36 percent of women who have never been married are employed, as compared with 52 percent of those who are married or cohabiting and 57 percent of those who are divorced, separated, or widowed. Women and men with no children are less likely to be employed than respondents who have children. 38 • Characteristics of Respondents The proportion of women and men who are employed is higher in urban areas (53 percent and 66 percent, respectively) than in rural areas (30 percent and 43 percent, respectively). By region, employment among women ranges from 25 percent in Zambezi to 56 percent each in Erongo and //Karas. Among men, employment is lowest in Omusati (28 percent) and highest in Hardap (73 percent). In the case of women, there is a linear inverse relationship between level of education and unemployment. Three in ten women with no education (30 percent) are employed, as compared with more than six in ten (62 percent) women with more than a secondary education. Among men, those with more than a secondary education (77 percent) are more likely to be employed than men with less education or no education (53-59 percent). However, the patterns by education are not linear. Employment increases steadily with increasing wealth among both women and men. Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Namibia 2013 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Currently employed1 Not currently employed Age 15-19 8.3 1.7 90.0 100.0 1,906 20-24 31.0 5.7 63.3 100.0 1,786 25-29 54.2 3.2 42.6 100.0 1,489 30-34 61.2 2.6 36.0 100.0 1,260 35-39 58.0 2.8 39.0 100.0 1,110 40-44 62.7 1.8 35.5 100.0 917 45-49 58.1 1.2 40.8 100.0 708 Marital status Never married 36.0 3.2 60.8 100.0 5,458 Married or living together 51.7 2.2 46.0 100.0 3,121 Divorced/separated/widowed 57.0 4.9 38.0 100.0 597 Number of living children 0 24.1 2.9 73.0 100.0 3,034 1-2 52.7 3.7 43.6 100.0 3,606 3-4 55.5 1.6 42.7 100.0 1,750 5+ 39.8 2.8 57.3 100.0 785 Residence Urban 52.8 3.8 43.2 100.0 5,190 Rural 29.5 1.8 68.7 100.0 3,986 Region Zambezi 25.0 1.0 74.1 100.0 457 Erongo 56.3 3.5 40.1 100.0 771 Hardap 44.3 1.9 53.8 100.0 304 //Karas 56.1 6.5 37.4 100.0 343 Kavango 28.0 1.0 71.0 100.0 835 Khomas 54.2 4.5 41.2 100.0 2,202 Kunene 33.9 0.9 65.2 100.0 258 Ohangwena 34.9 1.5 63.6 100.0 894 Omaheke 35.5 4.8 59.7 100.0 225 Omusati 25.8 0.0 74.0 100.0 884 Oshana 44.8 1.6 53.6 100.0 755 Oshikoto 47.0 6.0 47.0 100.0 707 Otjozondjupa 44.1 4.2 51.6 100.0 540 Education No education 29.5 3.4 66.8 100.0 419 Primary 31.8 2.0 66.2 100.0 1,798 Secondary 43.9 3.2 52.8 100.0 6,029 More than secondary 62.0 2.8 35.0 100.0 930 Wealth quintile Lowest 21.8 1.7 76.5 100.0 1,429 Second 32.2 2.7 65.0 100.0 1,625 Middle 42.9 2.6 54.4 100.0 1,795 Fourth 52.0 3.8 44.2 100.0 2,116 Highest 54.8 3.5 41.6 100.0 2,211 Total 42.7 3.0 54.3 100.0 9,176 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Survey Respondents • 39 Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Namibia 2013 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 14.3 5.6 80.1 100.0 922 20-24 56.0 5.6 38.4 100.0 808 25-29 70.1 7.7 21.9 100.0 658 30-34 72.8 5.9 21.2 100.0 520 35-39 77.5 4.3 18.1 100.0 448 40-44 72.4 3.9 23.7 100.0 376 45-49 70.8 3.9 25.2 100.0 289 Marital status Never married 44.9 6.5 48.5 100.0 2,745 Married or living together 80.3 3.2 16.5 100.0 1,160 Divorced/separated/widowed 72.7 7.3 20.1 100.0 116 Number of living children 0 38.5 6.2 55.3 100.0 2,094 1-2 73.7 5.5 20.6 100.0 1,077 3-4 79.9 3.8 16.3 100.0 544 5+ 70.0 4.1 25.8 100.0 305 Residence Urban 65.5 4.9 29.6 100.0 2,282 Rural 43.3 6.5 50.1 100.0 1,739 Region Zambezi 52.6 5.6 41.8 100.0 218 Erongo 71.7 3.3 25.0 100.0 372 Hardap 72.6 2.6 24.7 100.0 152 //Karas 69.5 4.4 25.8 100.0 151 Kavango 46.3 7.6 46.0 100.0 316 Khomas 69.3 5.9 24.8 100.0 1,023 Kunene 58.3 1.3 40.4 100.0 104 Ohangwena 28.6 9.7 61.3 100.0 328 Omaheke 67.1 4.2 28.7 100.0 103 Omusati 28.1 4.4 67.6 100.0 342 Oshana 54.2 6.4 39.5 100.0 335 Oshikoto 47.8 8.7 43.5 100.0 335 Otjozondjupa 56.1 0.3 43.6 100.0 241 Education No education 58.8 3.2 38.0 100.0 310 Primary 52.5 5.3 42.2 100.0 944 Secondary 53.7 6.1 40.1 100.0 2,400 More than secondary 76.9 4.4 18.8 100.0 368 Wealth quintile Lowest 40.9 7.0 52.0 100.0 594 Second 50.6 5.9 43.6 100.0 769 Middle 57.1 5.0 37.9 100.0 886 Fourth 61.7 4.3 34.0 100.0 917 Highest 63.9 6.2 29.9 100.0 855 Total 15-49 55.9 5.6 38.5 100.0 4,021 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 40 • Characteristics of Respondents Figure 3.1 Women’s employment status in the past 12 months 3.5.2 Occupation Respondents who are employed or had worked in the 12 months preceding the survey were asked to specify their occupation. The results for women and men are presented in Table 3.6.1 and Table 3.6.2, respectively, according to background characteristics. In Namibia, women are most likely to be employed in sales and services (58 percent), followed by professional, technical, or managerial jobs (19 percent) and clerical jobs (12 percent). By contrast, men are most likely to be employed in skilled manual work (33 percent), followed closely by sales and services (30 percent). Sixteen percent of men are engaged in professional, technical, or managerial jobs. Three percent of women and 9 percent of men work in agriculture. Urban-rural residence influences the type of work that men do but does not have a notable effect on women’s occupations. Men who live in urban areas are most likely to be employed in skilled manual labour (39 percent), followed by sales and services (25 percent) and professional, technical, or managerial jobs (20 percent). Among rural men, the leading occupations are sales and services (38 percent), skilled manual labour (23 percent), and agriculture (21 percent). There are no major variations by region. Women and men with more than a secondary education are more likely to be employed in professional, technical, or managerial occupations, while those with no education or a primary education are more likely to be employed in sales and services. Currently employed 43% Not currently employed but worked in last 12 months 3% Did not work in last 12 months 54% NDHS 2013 Characteristics of Survey Respondents • 41 Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Namibia 2013 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 8.6 9.5 68.7 1.7 2.3 7.0 2.2 100.0 190 20-24 13.8 17.5 59.7 2.0 3.0 3.2 0.8 100.0 655 25-29 18.4 13.1 57.4 5.1 3.2 2.2 0.6 100.0 855 30-34 20.2 11.7 59.3 3.0 2.6 2.8 0.5 100.0 804 35-39 20.5 8.1 57.1 5.7 4.1 3.7 0.7 100.0 675 40-44 21.1 11.4 55.4 5.1 3.0 3.9 0.1 100.0 591 45-49 29.2 7.9 49.1 5.8 3.5 2.8 1.8 100.0 420 Marital status Never married 14.2 12.4 62.4 4.1 3.3 2.9 0.8 100.0 2,138 Married or living together 25.9 11.6 50.5 4.4 3.2 3.8 0.6 100.0 1,681 Divorced/separated/widowed 19.6 9.2 61.0 4.4 2.2 2.5 1.1 100.0 370 Number of living children 0 22.2 18.2 48.8 3.8 2.7 3.0 1.3 100.0 820 1-2 20.9 13.1 56.2 3.6 3.5 2.4 0.4 100.0 2,034 3-4 17.8 7.1 63.0 5.1 3.2 2.9 0.8 100.0 1,001 5+ 7.9 2.4 70.0 6.3 1.8 10.0 1.7 100.0 335 Residence Urban 21.9 14.8 53.4 4.3 3.6 1.3 0.7 100.0 2,941 Rural 13.4 4.7 67.1 4.0 2.0 7.9 0.9 100.0 1,248 Region Zambezi 14.6 8.3 60.7 6.7 4.2 4.9 0.6 100.0 118 Erongo 14.8 14.2 53.4 4.6 10.9 1.4 0.6 100.0 461 Hardap 18.7 18.4 56.5 2.5 1.4 2.4 0.0 100.0 140 //Karas 13.7 14.8 45.4 3.0 12.4 9.8 0.9 100.0 215 Kavango 14.3 5.8 64.9 3.1 0.5 9.8 1.6 100.0 242 Khomas 29.2 14.4 49.3 4.1 1.9 0.4 0.6 100.0 1,292 Kunene 20.0 9.3 57.8 6.9 2.3 3.3 0.5 100.0 90 Ohangwena 12.3 5.6 72.1 6.3 1.3 1.4 0.9 100.0 326 Omaheke 14.8 12.2 63.2 6.9 0.3 2.6 0.0 100.0 91 Omusati 18.8 3.0 71.4 5.2 0.0 1.6 0.0 100.0 228 Oshana 16.7 11.9 65.0 4.3 0.6 0.7 0.8 100.0 351 Oshikoto 11.9 11.1 60.4 2.2 1.6 11.0 1.8 100.0 374 Otjozondjupa 15.3 13.1 60.4 3.5 2.6 4.4 0.6 100.0 261 Education No education 1.5 0.0 83.3 3.4 3.6 6.1 2.1 100.0 138 Primary 2.4 0.7 84.0 3.6 2.1 6.9 0.3 100.0 607 Secondary 13.8 14.3 59.6 4.8 3.8 2.8 0.8 100.0 2,842 More than secondary 66.9 14.0 14.7 2.2 1.1 0.7 0.6 100.0 602 Wealth quintile Lowest 5.6 0.8 72.6 5.9 2.0 11.2 1.9 100.0 336 Second 5.2 4.4 76.6 3.4 2.2 7.2 1.1 100.0 567 Middle 9.0 7.8 70.7 5.7 2.9 3.6 0.4 100.0 817 Fourth 16.1 13.1 59.1 4.8 4.9 1.6 0.5 100.0 1,181 Highest 38.8 19.3 35.2 2.7 2.5 0.7 0.8 100.0 1,289 Total 19.4 11.8 57.5 4.2 3.2 3.2 0.8 100.0 4,189 42 • Characteristics of Respondents Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Namibia 2013 Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 6.9 4.8 33.1 31.2 13.0 10.1 0.9 100.0 184 20-24 11.6 5.5 32.0 33.6 8.7 8.4 0.3 100.0 498 25-29 16.8 3.1 32.2 33.3 7.5 6.9 0.3 100.0 512 30-34 16.4 3.9 27.9 34.4 7.0 9.4 1.0 100.0 410 35-39 19.6 2.3 25.9 35.8 7.6 8.0 0.8 100.0 367 40-44 20.3 3.4 28.1 29.0 7.8 10.7 0.7 100.0 287 45-49 22.7 2.1 27.5 32.4 5.0 9.9 0.3 100.0 216 Marital status Never married 13.6 4.2 31.3 34.9 7.8 7.6 0.6 100.0 1,411 Married or living together 19.3 3.2 27.2 31.1 8.4 10.3 0.5 100.0 968 Divorced/separated/ widowed 26.1 0.6 31.0 28.2 4.6 8.8 0.6 100.0 93 Number of living children 0 15.5 4.5 31.7 30.5 9.0 8.3 0.5 100.0 937 1-2 17.5 3.7 27.7 35.0 7.1 8.4 0.6 100.0 854 3-4 17.9 2.9 29.7 30.6 8.2 10.2 0.6 100.0 456 5+ 11.9 2.0 28.7 42.4 6.0 8.4 0.7 100.0 226 Residence Urban 20.3 5.2 25.0 38.9 8.0 2.0 0.5 100.0 1,607 Rural 8.8 0.9 38.3 22.5 7.7 21.1 0.7 100.0 866 Region Zambezi 12.0 1.5 44.0 25.6 10.2 6.3 0.4 100.0 127 Erongo 18.7 3.3 18.8 42.0 10.9 4.7 1.6 100.0 279 Hardap 12.7 3.8 18.8 25.2 5.0 33.1 1.4 100.0 115 //Karas 13.6 2.4 23.1 25.1 19.6 16.0 0.3 100.0 112 Kavango 7.7 1.3 50.5 22.6 8.3 8.3 1.3 100.0 171 Khomas 22.8 6.4 21.6 41.7 5.5 1.9 0.1 100.0 769 Kunene 11.7 2.4 26.2 19.7 9.8 29.3 1.1 100.0 62 Ohangwena 10.1 1.8 38.5 34.3 13.6 1.7 0.0 100.0 126 Omaheke 7.4 1.7 27.8 19.6 9.8 33.0 0.8 100.0 74 Omusati 13.0 0.0 38.3 34.0 7.2 6.3 1.1 100.0 111 Oshana 20.2 3.3 31.0 40.2 3.3 2.0 0.0 100.0 203 Oshikoto 11.8 3.5 46.2 19.5 5.8 13.2 0.0 100.0 189 Otjozondjupa 10.0 2.0 35.6 21.1 8.8 20.7 1.8 100.0 136 Education No education 1.4 0.0 40.6 21.2 11.3 24.9 0.7 100.0 192 Primary 3.7 0.6 35.7 35.7 7.0 16.7 0.6 100.0 545 Secondary 13.3 4.9 29.3 37.9 9.2 4.9 0.5 100.0 1,437 More than secondary 63.4 5.5 13.8 13.5 1.3 1.9 0.6 100.0 299 Wealth quintile Lowest 1.6 1.2 53.0 23.8 6.1 14.3 0.0 100.0 284 Second 6.3 0.1 36.3 30.9 8.6 16.8 0.9 100.0 434 Middle 9.5 1.5 25.6 40.7 11.8 10.4 0.5 100.0 550 Fourth 17.9 6.1 25.9 35.6 8.8 5.1 0.6 100.0 605 Highest 35.2 7.0 21.4 29.8 3.8 2.1 0.7 100.0 599 Total 16.3 3.7 29.7 33.2 7.9 8.7 0.6 100.0 2,472 3.5.3 Earnings, Employers, and Continuity of Employment for Women Table 3.7 shows the percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, continuity of employment, and type of employment (agricultural or nonagricultural). The financial sector in Namibia is well developed by African standards, and the economy is largely monetised. Fifty-four percent of women engaged in agricultural work are paid in cash only, while 9 percent are paid in-kind. More than one-third (36 percent) of women who work in agriculture are not paid at all for their work. By contrast, 89 percent of women engaged in nonagricultural work are paid in cash, and only 7 percent are not paid at all. Characteristics of Survey Respondents • 43 Fifty-three percent of women who work in agriculture are employed by non-family members, 32 percent are employed by family members, and 16 percent are self-employed. Among women engaged in nonagricultural work, 70 percent are employed by non-family members, 23 percent are self-employed, and 7 percent are employed by family members. With regard to continuity of employment, 77 percent of employed women work all year, 14 percent are seasonal workers, and 9 percent are considered occasional workers. Seventy-eight percent of women who work in the nonagricultural sector are employed all year, as compared with 43 percent of those who work in agriculture. On the other hand, 51 percent of women who work in agriculture are seasonal workers, compared with only 12 percent of those who do nonagricultural work. Table 3.7 Type of employment Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Namibia 2013 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 53.9 89.3 88.0 Cash and in-kind 9.0 3.2 3.4 In-kind only 1.6 0.7 0.7 Not paid 35.5 6.6 7.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 31.6 7.4 8.3 Employed by non-family member 52.9 69.7 68.9 Self-employed 15.5 22.6 22.4 Total 100.0 100.0 100.0 Continuity of employment All year 42.7 78.4 77.1 Seasonal 51.2 12.3 13.6 Occasional 6.1 9.2 9.1 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 135 4,023 4,189 Note: Total includes women with missing information on type of employment who are not shown separately. Marriage and Sexual Activity • 45 MARRIAGE AND SEXUAL ACTIVITY 4 arriage is a primary indication of the exposure of women to the risk of pregnancy and, therefore, is important for an understanding of fertility. Populations in which women marry at a young age tend to initiate childbearing early and have high fertility. More direct measures of the beginning of exposure to pregnancy are age at first sexual intercourse and frequency of sexual intercourse. Fertility is more closely linked to age at first sexual intercourse than to age at marriage in countries such as Namibia, where sexual initiation often occurs before marriage. This chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant. These factors include marriage, polygyny, and sexual activity. 4.1 MARITAL STATUS Table 4.1 presents data on the current marital status of women and men age 15-49 interviewed in the survey. In this table, the term “married” is intended to mean legal, traditional, or formal marriage, while “living together” describes persons who live together in an informal union as husband and wife. Thirty-four percent of women of childbearing age are in a union; that is, they are either married or living with a man as if married. Sixty percent of women of childbearing age have never been married. The proportion of women who have never been married declines with age, from 94 percent among those age 15-19 to 24 percent among those age 45-49. Seven percent of women of childbearing age are divorced, separated, or widowed. The proportion of formerly married women increases with age. As expected, the proportion of women who are widowed is highest in the oldest age group 45-49 (12 percent). Men tend to marry at a later age than women. Overall, 29 percent of men are either married or living with a woman as if married. Sixty-eight percent of men have never married. The proportion of men who have never married (or lived with a woman) declines with age, from 99 percent among those age 15-19 to 19 percent among those age 45-49. Three percent of men are divorced, separated, or widowed. As with women, the proportion of formerly married men increases with age. M Key Findings • Thirty-four percent of women age 15-49 and 29 percent of men age 15-49 are either married or living together with a partner. • Six percent of currently married women age 15-49 report being married to men who are in a polygynous union, while 2 percent of currently married men age 15-49 report having two or more wives. • The median age at first sexual intercourse is 19 years among women and 18 years among men age 25-49. • About four in ten women and men age 15-49 reported having had sexual intercourse in the past four weeks. 46 • Marriage and Sexual Activity Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Namibia 2013 Marital status Total Percentage of respondents currently in union Number of respondents Age Never married Married Living together Divorced Separated Widowed WOMEN 15-19 94.1 0.6 4.8 0.0 0.5 0.0 100.0 5.4 1,906 20-24 77.9 5.0 14.6 0.1 2.3 0.1 100.0 19.5 1,786 25-29 57.8 13.8 23.7 0.3 4.1 0.4 100.0 37.5 1,489 30-34 44.2 27.1 23.3 0.9 3.9 0.7 100.0 50.3 1,260 35-39 36.5 32.1 21.3 1.8 5.5 2.8 100.0 53.4 1,110 40-44 30.6 38.1 16.2 3.2 5.9 6.0 100.0 54.2 917 45-49 24.1 41.4 13.1 3.5 5.6 12.3 100.0 54.5 708 Total 15-49 59.5 17.9 16.1 1.0 3.4 2.1 100.0 34.0 9,176 MEN 15-19 99.3 0.0 0.7 0.0 0.0 0.0 100.0 0.7 922 20-24 90.0 1.2 8.2 0.0 0.6 0.0 100.0 9.4 808 25-29 72.1 8.1 16.9 0.3 2.6 0.0 100.0 25.0 658 30-34 53.4 17.6 25.6 0.6 2.8 0.0 100.0 43.2 520 35-39 40.9 30.6 24.0 0.8 3.1 0.6 100.0 54.6 448 40-44 30.2 45.0 18.4 1.7 3.7 1.1 100.0 63.4 376 45-49 18.6 51.2 19.8 6.1 3.2 1.1 100.0 71.0 289 Total 15-49 68.3 15.1 13.7 0.8 1.8 0.2 100.0 28.8 4,021 4.2 POLYGYNY Polygyny (the practice of having more than one wife) has implications for frequency of exposure to sexual activity and, therefore, fertility. The extent of polygyny in Namibia was measured by asking all women currently married or living with a man the following question: “Does your husband/partner have other wives, or does he live with other women as if married?” If the answer was yes, the woman was asked “Including yourself, in total, how many wives or live-in partners does he have?” Currently married men or men living with a woman were asked “Do you have other wives, or do you live with other women as if married?” If the answer was yes, the man was asked “Altogether, how many wives or live-in partners do you have?” Table 4.2.1 shows the distribution of currently married women by number of co-wives, according to selected background characteristics. Seventy-six percent of married women report that their husband or partner has no other wife, a decrease from the figure reported in the 2006-07 NDHS (81 percent). Six percent of women report that their husbands have more than one wife. Rural women are more likely to live in a polygynous union than urban women (9 percent versus 4 percent). Ten percent or more of women in Zambezi, Kunene, Kavango, and Ohangwena are in a polygynous union, as compared with less than 1 percent of women in Hardap. The proportion of women in a polygynous relationship declines with increasing education and, in general, with increasing household wealth. Marriage and Sexual Activity • 47 Table 4.2.1 Number of women’s co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Namibia 2013 Number of co-wives Total Number of women Background characteristic 0 1 2+ Don’t know/ missing Age 15-19 78.0 2.0 0.0 20.0 100.0 103 20-24 81.9 2.8 0.3 15.0 100.0 349 25-29 77.3 4.1 1.0 17.7 100.0 558 30-34 76.3 4.2 0.3 19.1 100.0 634 35-39 76.4 5.3 1.2 17.0 100.0 593 40-44 73.1 6.1 2.2 18.6 100.0 497 45-49 73.6 6.5 1.9 18.0 100.0 386 Residence Urban 74.0 2.8 0.9 22.3 100.0 1,819 Rural 79.6 7.4 1.4 11.6 100.0 1,301 Region Zambezi 85.1 10.0 1.3 3.5 100.0 204 Erongo 73.3 3.6 1.3 21.8 100.0 305 Hardap 91.9 0.9 0.0 7.2 100.0 131 //Karas 82.5 1.9 0.7 14.9 100.0 133 Kavango 85.5 9.5 0.6 4.4 100.0 429 Khomas 67.3 1.8 0.9 30.0 100.0 727 Kunene 78.6 7.2 3.4 10.8 100.0 108 Ohangwena 84.6 9.8 0.0 5.6 100.0 184 Omaheke 77.8 3.7 1.3 17.1 100.0 110 Omusati 67.3 7.0 1.2 24.5 100.0 187 Oshana 76.5 4.3 0.7 18.6 100.0 164 Oshikoto 79.8 2.0 3.4 14.7 100.0 208 Otjozondjupa 67.3 2.1 0.8 29.8 100.0 231 Education No education 75.5 7.6 1.8 15.1 100.0 233 Primary 77.8 7.8 1.7 12.8 100.0 718 Secondary 75.8 4.0 0.8 19.4 100.0 1,808 More than secondary 76.9 0.8 0.8 21.5 100.0 362 Wealth quintile Lowest 80.9 10.0 1.3 7.8 100.0 558 Second 77.8 5.4 2.2 14.6 100.0 539 Middle 71.7 5.8 1.4 21.1 100.0 598 Fourth 75.1 2.5 0.7 21.7 100.0 623 Highest 76.5 1.6 0.4 21.5 100.0 802 Total 15-49 76.3 4.8 1.1 17.8 100.0 3,121 Table 4.2.2 presents the distribution of currently married men age 15-49 by number of wives, according to background characteristics. The vast majority of men (98 percent) report having only one wife. Two percent of married men report having two or more wives, as compared with 6 percent of women who reported having co-wives. Men in Kunene (8 percent), those with no education (4 percent), and men living in households in the second and fourth wealth quintiles (4 percent each) are most likely to report having more than one wife. 48 • Marriage and Sexual Activity Table 4.2.2 Number of men’s wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, Namibia 2013 Background characteristic Number of wives Total Number of men 1 2+ Age 15-19 * * 100.0 7 20-24 98.9 1.1 100.0 76 25-29 97.8 2.2 100.0 165 30-34 96.4 3.6 100.0 225 35-39 96.8 3.2 100.0 245 40-44 99.3 0.7 100.0 238 45-49 98.4 1.6 100.0 205 Residence Urban 98.2 1.8 100.0 745 Rural 97.1 2.9 100.0 415 Region Zambezi 95.4 4.6 100.0 78 Erongo 98.4 1.6 100.0 137 Hardap 100.0 0.0 100.0 63 //Karas 97.3 2.7 100.0 53 Kavango 99.0 1.0 100.0 126 Khomas 97.9 2.1 100.0 307 Kunene 92.5 7.5 100.0 39 Ohangwena (97.0) (3.0) 100.0 42 Omaheke 100.0 0.0 100.0 37 Omusati (96.8) (3.2) 100.0 45 Oshana (100.0) (0.0) 100.0 50 Oshikoto 98.2 1.8 100.0 66 Otjozondjupa 96.8 3.2 100.0 117 Education No education 95.6 4.4 100.0 122 Primary 98.0 2.0 100.0 252 Secondary 97.9 2.1 100.0 635 More than secondary 98.8 1.2 100.0 151 Wealth quintile Lowest 98.0 2.0 100.0 175 Second 96.3 3.7 100.0 196 Middle 99.1 0.9 100.0 226 Fourth 96.5 3.5 100.0 285 Highest 99.1 0.9 100.0 277 Total 15-49 97.8 2.2 100.0 1,160 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 unweighted cases and has been suppressed. 4.3 AGE AT FIRST MARRIAGE Age at first marriage has a major effect on childbearing. Women who marry early will, on average, have longer exposure to pregnancy and a greater number of lifetime births. Information on age at first marriage was obtained by asking all ever-married respondents the month and year they started living together with their first spouse. Table 4.3 presents the percentages of both women and men age 15-49 who first married by specific exact ages. Fourteen percent of women age 25-49 married by age 20, as compared with 17 percent in the 2006-07 NDHS. Among men, 5 percent were married by age 20, same as the figure reported in the 2006-07 NDHS survey. The median age at first marriage among women and men age 20-49 or 25-49 cannot be calculated since less than 50 percent of women and men began living with their spouses or partners for the first time before reaching the beginning of the age group. Similarly, median age at first marriage by background characteristics is not shown separately because, for most subgroups of women and men, less than 50 percent began living with their spouses or partners for the first time before reaching the beginning of the age group. Marriage and Sexual Activity • 49 Table 4.3 Age at first marriage Percentage of women and men age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Namibia 2013 Percentage first married by exact age: Percentage never married Number Median age at first marriage Current age 15 18 20 22 25 WOMEN 15-19 0.9 na na na na 94.1 1,906 a 20-24 1.6 6.9 13.0 na na 77.9 1,786 a 25-29 2.0 7.8 14.3 21.6 33.0 57.8 1,489 a 30-34 1.2 7.3 12.6 18.3 28.7 44.2 1,260 a 35-39 2.2 8.6 15.3 20.7 30.9 36.5 1,110 30.4 40-44 1.9 8.7 13.9 20.7 31.3 30.6 917 30.7 45-49 2.2 8.9 16.6 25.8 39.1 24.1 708 28.9 20-49 1.8 7.8 14.0 na na 50.4 7,270 a 25-49 1.8 8.1 14.3 21.1 32.1 41.5 5,485 a MEN 15-19 0.0 na na na na 99.3 922 a 20-24 0.0 1.4 3.9 na na 90.0 808 a 25-29 0.0 2.4 5.5 10.5 20.4 72.1 658 a 30-34 0.0 1.7 4.6 10.1 19.6 53.4 520 a 35-39 0.0 2.6 5.0 9.8 19.8 40.9 448 34.1 40-44 0.0 2.3 5.5 9.3 19.5 30.2 376 33.5 45-49 0.0 3.0 5.7 9.4 19.1 18.6 289 34.7 20-49 0.0 2.1 4.9 na na 59.0 3,099 a 25-49 0.0 2.4 5.2 9.9 19.8 48.1 2,291 a Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of women or men began living with their spouse or partner for the first time before reaching the beginning of the age group 4.4 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage can be used as a proxy for the beginning of exposure to the risk of pregnancy. However, because some women are sexually active before marriage, the age at which women initiate sexual intercourse more precisely marks the beginning of their exposure to reproductive risks. The 2013 NDHS asked women and men how old they were when they first had sexual intercourse. Table 4.4 presents the percentages of women and men who had sexual intercourse by specific exact ages and the median ages at first sexual intercourse. The results show that men initiate sex at an earlier age than women. The median age at first intercourse is 19.0 years among women age 25-49 and 18.2 years among men the same age. Five percent of women and 10 percent of men age 25-49 reported that they had sexual intercourse by age 15. The majority of women and men age 25-49 (62 percent and 74 percent, respectively) reported having had sexual intercourse by age 20. Table 4.5 presents the median age at first sexual intercourse among women and men by background characteristics. Among women age 25-49, median age at first sexual intercourse ranges from a low of 17.0 years in Kavango to a high of 20.3 years in Omusati. Median age at first sexual intercourse increases with increasing education and wealth. For example, the median age is more than three years lower among women with no education than among women with more than a secondary education. There are smaller differences among men by residence, education, and wealth. However, there are noteworthy differences by region, with median age at first sexual intercourse ranging from 16.6 years in Kunene to 18.4 years in Omusati. 50 • Marriage and Sexual Activity Table 4.4 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Namibia 2013 Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number Median age at first intercourse Current age 15 18 20 22 25 WOMEN 15-19 6.8 na na na na 54.9 1,906 a 20-24 3.9 39.7 72.5 na na 9.2 1,786 18.6 25-29 6.1 36.8 63.7 79.3 88.5 1.8 1,489 18.8 30-34 5.2 39.3 63.2 77.7 86.1 1.1 1,260 18.7 35-39 4.5 34.6 59.1 74.3 82.2 0.8 1,110 19.2 40-44 4.1 30.6 52.3 68.6 79.1 1.1 917 19.7 45-49 4.2 28.5 50.2 65.3 77.4 0.8 708 20.0 20-49 4.7 36.0 62.3 na na 3.2 7,270 a 25-49 5.0 34.8 59.0 na na 1.2 5,485 19.0 15-24 5.4 na na na na 32.8 3,691 19.0 MEN 15-19 13.4 na na na na 56.6 922 a 20-24 12.7 55.2 82.6 na na 7.6 808 17.7 25-29 13.9 53.0 77.6 92.1 95.9 2.3 658 17.7 30-34 8.5 46.2 73.5 88.4 92.2 0.3 520 18.2 35-39 10.8 48.6 69.9 85.5 89.3 1.3 448 18.1 40-44 6.1 36.3 63.6 79.8 86.5 1.3 376 18.6 45-49 8.0 38.1 65.8 82.4 90.4 0.4 289 18.6 20-49 10.7 48.4 74.3 na na 2.9 3,099 a 25-49 10.1 46.0 71.4 na na 1.2 2,291 18.2 15-24 13.1 na na na na 33.7 1,730 18.3 na = Not applicable due to censoring a = Omitted because less than 50 percent of respondents had sexual intercourse for the first time before reaching the beginning of the age group Table 4.5 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women and men age 25-49, according to background characteristics, Namibia 2013 Background characteristic Women age 25-49 Men age 25-49 Residence Urban 19.1 18.3 Rural 18.6 18.2 Region Zambezi 18.1 18.1 Erongo 18.9 18.2 Hardap 19.1 18.4 //Karas 19.0 18.1 Kavango 17.0 18.1 Khomas 19.5 18.2 Kunene 17.8 16.8 Ohangwena 18.6 18.1 Omaheke 18.2 18.1 Omusati 20.3 18.4 Oshana 19.9 18.3 Oshikoto 19.5 18.4 Otjozondjupa 18.5 18.4 Education No education 17.3 18.4 Primary 17.9 18.4 Secondary 19.2 18.1 More than secondary 20.7 18.1 Wealth quintile Lowest 17.9 18.3 Second 18.6 18.2 Middle 18.9 18.2 Fourth 19.1 18.2 Highest 19.8 18.3 Total 19.0 18.2 Marriage and Sexual Activity • 51 4.5 RECENT SEXUAL ACTIVITY In the absence of effective contraception, the probability of pregnancy depends highly upon the frequency of intercourse. Information on sexual activity, therefore, can be used to refine measures of exposure to pregnancy. All women and men were asked how long ago they most recently had sexual intercourse. Tables 4.6.1 and 4.6.2 present the distribution of women and men by recent sexual activity, according to background characteristics. Table 4.6.1 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Namibia 2013 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 13.7 24.0 7.0 0.4 54.9 100.0 1,906 20-24 36.6 41.9 11.6 0.8 9.2 100.0 1,786 25-29 49.8 36.8 10.6 1.1 1.8 100.0 1,489 30-34 54.5 32.3 11.4 0.5 1.1 100.0 1,260 35-39 53.2 29.1 15.8 1.1 0.8 100.0 1,110 40-44 52.5 26.8 18.5 1.1 1.1 100.0 917 45-49 46.2 23.5 27.5 2.1 0.8 100.0 708 Marital status Never married 23.5 37.4 15.0 0.7 23.4 100.0 5,458 Married or living together 74.0 21.4 3.3 1.3 0.0 100.0 3,121 Divorced/separated/ widowed 24.7 31.8 43.1 0.4 0.0 100.0 597 Marital duration2 0-4 years 74.6 22.0 2.2 1.2 0.0 100.0 958 5-9 years 75.6 20.7 2.8 1.0 0.0 100.0 679 10-14 years 70.4 23.9 4.5 1.3 0.0 100.0 464 15-19 years 73.1 20.5 4.0 2.4 0.0 100.0 310 20-24 years 74.9 19.6 4.8 0.7 0.0 100.0 224 25+ years 73.5 18.5 6.0 2.0 0.0 100.0 131 Married more than once 74.8 20.6 3.6 1.0 0.0 100.0 354 Residence Urban 45.4 29.6 11.4 1.3 12.4 100.0 5,190 Rural 34.8 34.2 14.8 0.3 15.9 100.0 3,986 Region Zambezi 45.7 33.9 12.6 1.0 6.8 100.0 457 Erongo 48.3 27.7 11.3 1.1 11.7 100.0 771 Hardap 47.1 23.6 15.2 1.2 12.9 100.0 304 //Karas 46.2 31.1 10.2 1.2 11.3 100.0 343 Kavango 40.3 29.8 22.4 0.3 7.2 100.0 835 Khomas 47.0 29.1 9.2 1.8 12.9 100.0 2,202 Kunene 49.1 35.8 11.1 0.0 4.1 100.0 258 Ohangwena 27.9 36.4 15.5 0.3 19.9 100.0 894 Omaheke 51.5 28.9 11.4 0.7 7.5 100.0 225 Omusati 30.2 33.1 12.4 0.4 23.9 100.0 884 Oshana 29.9 40.6 13.0 0.1 16.4 100.0 755 Oshikoto 34.2 35.0 13.1 0.2 17.5 100.0 707 Otjozondjupa 48.4 24.0 13.3 1.8 12.5 100.0 540 Education No education 54.8 26.4 15.5 0.2 3.1 100.0 419 Primary 40.7 28.3 16.7 0.4 14.0 100.0 1,798 Secondary 38.6 33.0 12.5 0.8 15.2 100.0 6,029 More than secondary 48.7 30.9 6.9 3.1 10.5 100.0 930 Wealth quintile Lowest 36.7 34.2 14.8 0.3 13.9 100.0 1,429 Second 38.5 33.6 14.7 0.2 13.0 100.0 1,625 Middle 41.6 32.6 13.2 0.5 12.0 100.0 1,795 Fourth 41.9 32.3 12.9 0.6 12.3 100.0 2,116 Highest 43.3 26.8 10.0 2.3 17.6 100.0 2,211 Total 15-49 40.8 31.6 12.9 0.9 13.9 100.0 9,176 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married Table 4.6.1 shows that 41 percent of women age 15-49 were sexually active within the four weeks preceding the survey, 32 percent were sexually active within the past year, and 13 percent were sexually active one or more years prior to the survey. Fourteen percent of women reported never having had sexual intercourse. The proportion of women who were sexually active in the past four weeks increases with age, 52 • Marriage and Sexual Activity from 14 percent at age 15-19 to 55 percent at age 30-34, before decreasing gradually to reach 46 percent at age 45-49. Women who are married or living together with a partner are most likely to have recently engaged in sexual intercourse (74 percent), while women who are divorced, separated, or widowed are only slightly more likely to be sexually active than those who have never been married (25 percent versus 24 percent). Among married women, those married for 10-14 years are least likely than other women to have recently engaged in sexual intercourse (70 percent). Recent sexual activity is relatively lower among women in rural areas (35 percent) than among women in urban areas (45 percent). More than half of the women in Omaheke (52 percent) were sexually active in the last four weeks, compared with 28 percent in Ohangwena. Women with no education and those with more than a secondary education are more likely to have recently engaged in sexual intercourse than women with a primary or secondary education. The percentage of women who have recently been sexually active increases with increasing wealth. Table 4.6.2 indicates that a slightly higher proportion of men than women age 15-49 have recently engaged in sexual intercourse (44 percent versus 41 percent). Thirty percent of men have been sexually active within the past year and 10 percent within one or more years. There has been a small increase in recent sexual activity over the last six years, with the 2006-07 NDHS reporting that 40 percent of men and 38 percent of women had recently been sexually active. Fifteen percent of men reported that they have never had sex. Men who are married or living together with a partner are more likely to be sexually active (76 percent) than men who have never been married (31 percent) and men who are divorced, separated, or widowed (40 percent). Men who have been married more than once are most sexually active (80 percent). As with women, men in urban areas (50 percent) are more likely to have engaged in recent sexual activity than men in rural areas (37 percent). About half of men in Zambezi, Erongo, Hardap, Kavango, Khomas, Kunene, and Omaheke have recently been sexually active. Recent sexual activity is highest among men with more than a secondary education (61 percent) and those in the highest wealth quintile (55 percent). Marriage and Sexual Activity • 53 Table 4.6.2 Recent sexual activity: Men Percent distribution of men age 15-49 by timing of last sexual intercourse, according to background characteristics, Namibia 2013 Timing of last sexual intercourse Never had sexual intercourse Total Number of men Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 11.6 21.4 10.2 0.2 56.6 100.0 922 20-24 40.1 38.9 13.1 0.3 7.6 100.0 808 25-29 52.4 35.5 8.4 1.5 2.3 100.0 658 30-34 61.5 27.5 10.5 0.2 0.3 100.0 520 35-39 56.7 32.1 8.8 1.1 1.3 100.0 448 40-44 60.7 28.2 7.5 2.3 1.3 100.0 376 45-49 67.0 19.8 10.3 2.5 0.4 100.0 289 Marital status Never married 30.8 33.4 13.3 0.4 22.3 100.0 2,745 Married or living together 75.9 20.2 1.9 2.0 0.0 100.0 1,160 Divorced/separated/ widowed 39.7 38.7 19.2 2.4 0.0 100.0 116 Marital duration2 0-4 years 76.8 21.0 1.5 0.7 0.0 100.0 362 5-9 years 74.1 21.1 2.2 2.6 0.0 100.0 250 10-14 years 77.5 17.7 1.2 3.5 0.0 100.0 202 15-19 years 71.9 22.3 2.5 3.2 0.0 100.0 124 20-24 years 73.4 18.8 5.3 2.4 0.0 100.0 76 25+ years (79.4) (20.6) (0.0) (0.0) (0.0) 100.0 27 Married more than once 79.6 19.0 0.7 0.6 0.0 100.0 118 Residence Urban 49.5 28.2 9.8 1.5 10.9 100.0 2,282 Rural 36.8 31.7 10.5 0.1 20.8 100.0 1,739 Region Zambezi 56.4 26.4 11.2 0.0 5.9 100.0 218 Erongo 53.2 25.7 8.5 0.3 12.3 100.0 372 Hardap 49.9 28.1 6.0 1.3 14.8 100.0 152 //Karas 39.9 28.4 11.3 1.1 19.3 100.0 151 Kavango 50.8 30.0 6.6 1.1 11.5 100.0 316 Khomas 50.6 27.4 11.9 1.6 8.5 100.0 1,023 Kunene 51.4 27.0 12.3 0.4 8.8 100.0 104 Ohangwena 30.4 37.0 8.3 0.0 24.4 100.0 328 Omaheke 49.0 32.4 9.0 0.0 9.6 100.0 103 Omusati 29.5 25.5 7.3 0.0 37.8 100.0 342 Oshana 30.8 39.3 8.2 1.5 20.2 100.0 335 Oshikoto 35.0 34.0 16.5 0.2 14.3 100.0 335 Otjozondjupa 46.2 27.1 10.4 2.3 13.9 100.0 241 Education No education 47.6 36.6 10.3 0.1 5.4 100.0 310 Primary 37.1 29.3 11.8 0.3 21.4 100.0 944 Secondary 43.7 29.6 10.1 1.0 15.7 100.0 2,400 More than secondary 61.4 25.7 6.0 2.5 4.4 100.0 368 Wealth quintile Lowest 38.0 32.9 11.9 0.4 16.9 100.0 594 Second 37.0 31.0 12.8 0.5 18.8 100.0 769 Middle 41.6 32.4 11.0 0.1 14.9 100.0 886 Fourth 46.6 31.0 7.6 0.7 14.2 100.0 917 Highest 54.5 22.3 8.4 2.8 12.2 100.0 855 Total 15-49 44.0 29.7 10.1 0.9 15.2 100.0 4,021 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Excludes men who had sexual intercourse within the last 4 weeks 2 Excludes men who are not currently married Fertility • 55 FERTILITY 5 Fertility is one of the three principal components of population dynamics that determine the size, structure, and composition of the population in any country. This chapter focuses on a number of fertility indicators including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women begin childbearing. Birth intervals are important because short intervals are associated with high childhood mortality. The age at which childbearing begins can also have a major impact on the health and well-being of both the mother and the child. Measures of several proximate determinants of fertility that influence exposure to the risk of pregnancy are presented as well, including duration of postpartum amenorrhoea, postpartum abstinence, and menopause. The fertility indicators presented in this chapter are based on reports of reproductive histories provided by women age 15-49. As in the previous NDHS surveys, each woman was asked to provide information on the total number of sons and daughters to whom she had given birth and who were living with her, the number living elsewhere, and the number who had died, in order to obtain the total number of live births. In the birth history, women reported the details of each live birth separately, including such information as name, month and year of birth, sex, and survival status. For children who had died, age at death was recorded. 5.1 CURRENT FERTILITY Measures of current fertility are presented in Table 5.1 for the three-year period preceding the survey, corresponding to the calendar period 2011-2013. A three-year period was chosen for calculating these rates to provide the most current information while also allowing the rates to be calculated for a sufficient number of cases so Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Namibia 2013 Residence Total Age group Urban Rural 15-19 66 101 82 20-24 134 226 168 25-29 144 207 168 30-34 122 187 149 35-39 84 144 110 40-44 29 59 42 45-49 8 12 10 TFR (15-49) 2.9 4.7 3.6 GFR 103 156 125 CBR 30.0 29.3 29.5 Note:

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