Nigeria - Demographic and Health Survey - 1992

Publication date: 1992

Nigeria Nigeria Demographic and Health Survey 1990 Federal Office of Statistics ®DHS Demographic and Health Surveys IRD/Macro International, Inc. Nigeria Demographic and Health Survey 1990 Federal Office of Statistics Lagos, Nigeria IRD/IVlacro International Inc. Columbia, Maryland USA April 1992 This report summarises the findings of the 1990 Nigeria Demographic and Health Survey, conducted by the Federal Office of Statistics of Nigeria. lRD/Macro International provided technical assistance. Funding for the project was provldnd by the U.S. Agency for International Development (Contract No. DP-3023-Z-00.8074-00). The Nigeria DHS survey is part of the worldwide Demographic and Health Surveys Programme, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information on the Nigeria DHS survey may be obtained from the Federal Office of Statistics, P.M.B. 12528, 36/38 Broad Street, Lagos Island, Lagos, Nigeria. Additional information about the DHS programme may be obtained by writing to: DHS, IRD/IVlacm International Inc.,8850 StanfordBoulevard, Suite4000,Columbia, MD 21045,U.S.A. (Telephone410-290-2800;Telex 198116; Fax 410-290-2999). CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Map of Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii 1 INTRODUCTION 1.1 History, Geography, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.4 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.3 Background Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3 FERTILITY 3.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.2 Children Ever Bom and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.3 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.4 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.5 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4 FERTILITY REGULATION 4.1 Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 4.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 4.3 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.4 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.5 Use of Social Marketing Brand Pills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.6 Knowledge of the Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.7 Sources for Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.8 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.9 Approval of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 $ PROXIMATE DETERMINANTS OF FERTILITY 5.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 5.3 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.4 Age at First Sexual Inlercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.5 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.6 Postpartum Amenorrhoea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.7 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 i i i Page 6 FERTILITY PREFERENCES 6.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 6.2 Demand for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 6.3 Ideal and Actual Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 6.4 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 7 INFANT AND CHILD MORTALITY 7.1 Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 7.2 High Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 8 MATERNAL AND CHILD HEALTH 8.1 Antenatal Cam and Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 8.2 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 8.3 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 8.4 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 8.5 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 9 INFANT FEEDING AND CHILDHOOD NUTRITION 9.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 9.2 Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 10 LOCAL AVAILABILITY OF FAMILY PLANNING AND HEALTH SERVICES 10.10rganisat ion of the Family Planning and Health System . . . . . . . . . . . . . . . . . . . . . . . . . . 117 10.2 Nigeria Service Availability Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 10.3 Availability of Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 10.4 Availability of Maternal and Child Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 APPENDICES Appendix A. Appendix B. Appendix C. Appendix D. Appendix E. Persons Involved in the Nigeria Demographic and Health Survey Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Survey Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Estimates of Sampling Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Data Quality Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 iv Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 TABLES Page Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Educational level of the household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . . . . . . 37 Knowledge of modem contraceptive methods and source for methods . . . . . . . . . . . . . 39 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Current use of comraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . . 43 V Page Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Time to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . 49 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Acceptability of the use of mass media for family planning messages . . . . . . . . . . . . . 54 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Number of co-wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Postpartum amenorrheoa, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 65 Median duration of postpartum insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Desire to limit (stop) childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 vi Table 6.6 Table 6.7 Table 6.8 Table 7.1 Table 7.2 T~ble 7.3 Table 7A Table 8.1 Table 8.2 Table 8.3 Table 8A Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 8.14 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Page Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . 74 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 80 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . 82 High risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Tetanus toxoid vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . . . 98 Prevalence and treatment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Knowledge and use of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 B reastfeeding and supplementation by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 vii Page Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Distance to nearest family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Distance to nearest family planning services for users/nonusers . . . . . . . . . . . . . . . . . 120 distance to nearest family planning services by type of facility . . . . . . . . . . . . . . . . . . 121 Time to nearest family planning services by type of facility . . . . . . . . . . . . . . . . . . . . 122 Distance to nearest maternal and child health services . . . . . . . . . . . . . . . . . . . . . . . . 123 Distance to nearest maternal and child health services for children . . . . . . . . . . . . . . 125 Distance to nearest maternal and child health services by type of facility . . . . . . . . . . 126 Time to nearest maternal and child health services by type of facility . . . . . . . . . . . . 126 Appendix B Table B.I Appendix C Table C.I Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Appendix D Table D. 1 Table D.2 Table D.3 Table D.4 Table D.5 Table D.6 Results of the household and individual interviews by residence and region . . . . . . . 138 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Sampling errors - Entire sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Sampling errors - Urban areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Sampling errors - Rural areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Sampling errors - Northeast region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Sampling errors - Northwest region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Sampling errors - Southeast region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Sampling errors - Southwest region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Age distribution o f eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Births by calendar year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 viii Figure 2.1 Figure 2.2 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 6.1 Figure 7.1 Figure 7.2 Figure 7.3 Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4 Figure 8.5 Figure 9.1 Figure 10.1 FIGURES Page Population pyramid of Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 School enrollment by age and place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Trends in the total fertility rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Distribution of children's year of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Percent of teenagers who have begun childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Trends in contraceptive knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Sources of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Fertility preferences among currcntly married women . . . . . . . . . . . . . . . . . . . . . . . . . 69 Trends in infant and under-five mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Infant mortality by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Child mortality by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Number of anmatal care visits and stage of pregnancy at first visit . . . . . . . . . . . . . . . . 87 Assistance during delivery by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Vaccination coverage among children age 12-23 months . . . . . . . . . . . . . . . . . . . . . . . 94 Percemage of children 12-23 months who are fully vaccinated . . . . . . . . . . . . . . . . . . . 96 Percentage of children receiving treatment for diarrhoea by type of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Percemage of children under 5 years who are chronically undernourished . . . . . . . . . 114 Distribution of currently married rural women by nearest source of family planning/health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 ix ACRONYMS DHS DPA EA FHS FMOH FOS GDP IPPF IRD JSS NDHS NDSS NFS NISER NISH NPC PHC PPFN PRS SAC SSS UNFPA UNHSCP UNICEF USAID WFS WHO Demographic and Health Surveys Department of Population Activities Enumeration Area Family Health Services Federal Ministry of Health Federal Office of Statistics Gross Domestic Product International Planned Parenthood Federation (formerly) Institute for Resource Development Junior Secondary School Nigeria Demographic and Health Survey National Demographic Sample Survey Nigeria Fertility Survey Nigeria Institute for Social and Economic Research National Integrated Survey of Households National Population Commission Primary Health Care Planned Parenthood Federation of Nigeria Planning Research and Statistics Survey Advisory Committee Senior Secondary School United Nations Population Fund United Nations Household Survey Capability Programme United Nations Children Fund United States Agency for International Development World Fertility Survey World Health Organisation xi FOREWORD The Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey which was carded out in all states of the Federal Republic of Nigeria. It was designed to provide information on fertility, family planning and health in Nigeria. The survey was conducted by the Federal Office of Statistics (FOS) of Nigeria, and is part of the worldwide Demographic and Health Surveys Programme coordinated by IRD/Macro International, Inc. The data collection phase of the NDHS was conducted in 1990, just two years following the declaration of the Nigeria National Population Policy (Federal Ministry of Health, 1988). The primary motivation for undertaking the survey was to provide reliable statistics on demographic and health practices, the very issues of concern in the National Population Policy. It is expected that the NDHS will provide information to strengthen the design and implementation of programmes aimed at controlling fertility, promoting family planning and improving the health status of the population. The survey will also provide a cross-sectional view of many demographic and health characteristics of the Nigerian population as of 1990. Since Nigeria gained independence in 1960, there has been a paucity of reliable population and health data at the national level. Vital registration data arc virtually nonexistent and, as of this writing, the most recent census data come from the 1963 Population Census, and those data are of questionable accuracy as well as being totally outdated. Lack of data has resulted from the inherent difficulties of data collection in a country so culturally diverse and in which population data are politically sensitive. Notwithstanding such difficulties, a milestone in the collection of demographic data was reached with the 1981 Nigerian Fertility Survey in which the household survey approach was employed to obtain high-quality data from 9,727 female respondents. It was preceded by the National Demographic Sample Survey (NDSS) in 1980 and followed by the Health Module of the National Integrated Survey of Households (NISH) in 1983 (HANSS). The 1990 NDHS represents another milestone for Nigeria in which rigorous procedures were employed to obtain high- quality data with the survey approach. On this occasion an even more detailed set of information was obtained on demographic and maternal and child health practices for 8,781 female respondents. The substantial achievement of completing the NDHS and publishing this volume is due to the contributions of many individuals. First to be thanked is the then Sole Administrator of FOS who gave his solid support to the exercise. The survey was carried out by the Common Services Department of FOS (in collaboration with other departments of FOS), under the directorship of Mr. O.O. Ajayi. The Survey Coordinator was Mr. O.F. Adedeji, who was assisted by the following core FOS staff: Mr. C.F. Adegbulugbe, Miss V.A. Adeyemi, Mr. R.O. Salawu, Mr. Fred Adeoye, Mrs. R.A. Adade, Mr. J.O. Adedire, Mrs. I. Azeez, Mr. Y.I. Ifalomomi, and Mrs. V.T. Ayo. Mrs. M. Oyediran provided assistance in writing this report. Of course, a major acknowledgement is due to the interviewers and respondents who worked together to record the data, one interview at a time. Each interviewing team was supervised by an FOS staff person and the teams in each region were the responsibility of the FOS state and regional officers. All of these individuals worked to overcome considerable logistical and technical problems, frequently under difficult field conditions. Their contributions are deeply appreciated and most gratefully acknowledged. I must not forget the assistance freely rendered during the training of the interviewers by both the Planned Parenthood Federation of Nigeria (PPFN) and UNICEF (Nigeria). Finally, I wish to acknowledge here the immeasurable contributions of several intemational agencies for providing funding and technical assistance for the survey. The Nigerian Family Health Services Project of the U.S. Agency for International Development initiated the idea of the survey, provided funding and, when the need arose during fieldwork, even provided vehicles and drivers for data collection. Their xiii communication facility support is also gratefully acknowledged. The unstinting support of Project Administrator, Dr. Richard Sturgis, is particularly noted. The Demographic and Health Survey Programme provided technical assistance in many staff visits to Nigeria over the course of the survey. DHS staff and consultants who participated are: Jeremiah Sullivan, Thanh Le, Fred A mold, Christopher Scott, Trevor Croft, Elizabeth Britton, David Cantor, Marilyn Wilkinson, Irwin Shorr, Ties Boerma, and Wamucii Njogu. For production of this report thanks are due Luis Hemando Ochoa, Kaye Mitchell, Sidney Moore, and Robert Wolf. Special acknowledgement is due to Kia I. Reinis who made invaluable contributions during data analysis, report preparation, and was the primary person representing DHS throughout all phases of the survey. O. O. Ajayi Ag. Head, Federal Office of Statistics Lagos, Nigeria xiv SUMMARY OF FINDINGS The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Federal Office of Statistics with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal care, vaccination status, breastfeeding, and nutrition. Data collection took place two years after implementation of the National Policy on Population and addresses issues raised by that policy. Fieldwork for the NDHS was conducted in two phases: from April to July 1990 in the southern states and from July to October 1990 in the northern states. Interviewers collected information on the reproductive histories of 8,781 women age 15-49 years and on the health of their 8,113 children under the age of five years. According to the NDHS, fertility remains high in Nigeria; at current fertility levels, Nigerian women will have an average of 6 children by the end of their reproductive years. The total fertility rate may actually be higher than 6.0, due to underestimation of births. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman. One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). These levels, while low, reflect an increase over the past decade: ten years ago just 1 percent of Nigerian women were using a modem family planning method. Periodic abstinence (rhythm method), the pill, IUD, and injection are the most popular methods among married couples: each is used by about 1 percent of currently married women. Knowledge of contraception remains low, with less than half of all women age 15-49 knowing of any method. Certain groups of women are far more likely to use contraception than others. For example, urban women are four times more likely to be using a contraceptive method (15 percent) than rural women (4 percent). Women in the Southwest, those with more education, and those with five or more children are also more likely to be using contraception. Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong: half of women with five children say that they want to have another child. Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children. National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by women's educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20. Teenagers in the North have births at twice the rate of those in the South: 20 births per 1130 women age 15-19 in the North compared to 10 XV birdas per 100 women in the South. Nearly half of teens in the North have already begun childbearing, versus 14 percent in South. This results in substantially lower total fertility rates in the South: women in the South have, on average, one child less than women in the North (5.5 versus 6.6). The survey also provides information related to maternal and child health. The data indicate that nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born, 87 die during their first year of life (infant mortality rate). There has been little improvement in infant and child mortality during the past 15 years. Mortality is higher in rural than urban areas and higher in the North than in the South. Undemutrition may be a factor contributing to childhood mortality levels: NDHS data show that 43 percent of the children under five are chronically undemourished. These problems are more severe in rural areas and in the North. Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one-third of births and over 60 percent of all babies arc born at home. Only one-third of births are assisted by doctors, trained nurses or midwives. A third of the infants are never vaccinated, and only 30 percent are fully immunised against childhood diseases. When they are ill, most young children go untreated. For example, only about one-third of children with diarrhoea were given oral rehydration therapy. Women and children living in rural areas and in the North are much less likely than others to benefit from health services. Almost four times as many births in the North are unassisted as in the South, and only one-third as many children complete their polio and DPT vaccinations. Programmes to educate women about the need for antenatal care, immunisation, and proper treatment for sick children should perhaps be aimed at mothers in these areas, Mothers everywhere need to learn about the proper time to introduce various supplementary foods to breastfeeding babies. Nearly all babies are breastfed, however, almost all breastfeeding infants are given water, formula, or other supplements within the first two months of life, which both jeopardises their nutritional status and increases the risk of infection. xvi NIGERIA NORTHWEST ~#OKO/o • SOKOTO • • NLGER OYO 52 urban EAS and 2 rural EAs in Lagos D U.O~W I ",'A, . - ,, D L • ~m'A BI~NDEL SOUTHWEST ~,/JaRIVERS_ • ~'- • KANO- q el i • • ~0." ~_ ?uo., ; "" .& • t GONGOLA SOUTHEAST BORNO =t NORTHEAST Key • Urban EA • Rural EA State Capital o Natlonal Capital xviii CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy History The many ethnolinguistic groups that make up Nigeria existed as separate and autonomous political entities long before being merged into a British Colonial territory. The establishment and expansion of British influence in both the northern and southern parts of Nigeria and the imposition of British rule resulted in the amalgamation of the protectorates of Northern and Southern Nigeria in 1914. The pattern of government established by the British after the amalgamation was of the crown colony type. The affairs of the colonial administration were conducted by Britons until 1942 when a few Nigerians, for the first time, were appointed non-official members of the executive council. Nigeria became an independent nation on October 1, 1960. Three years later, on October 1, 1963, Nigeria became a republic, severing all links with the British crown, yet retaining membership in the Commonwealth. The first government of independent Nigeria was overthrown in a military coup and replaced by the military administration of Major-General Aguiyi-lronsi on January 15, 1966. This was followed by a series of counter-coups. The government of the Eastern Region seceded on May 30, 1967, igniting a 30-month civil war, which ended in victory for the Federal Government on January 12, 1970. On October 1, 1979, the military administration of General Olusegun Obasanjo voluntarily handed over power to an elected civilian government while a new constitution and democratic form of government were adopted. After four years of civil rule, the military again stepped in on December 31, 1983 with Major- General Buhari as the Head of State. The present military administration of President Ibrahim Babangida came to power on August 27, 1985 after overthrowing Major-General Buhari. The Babangida administration has since embarked on a transition programme of handing over power to a democratically elected civilian government in 1992. Islam and Christianity are the two main religions of the country; the third important religion is the indigenous traditional religion. Muslims reside mostly in the North, while Christians reside mostly in the South. Internal migration, especially from rural to urban areas, has been one of the important demographic themes of modern Nigeria. High rates of migration and natural increase produced an urban population which grew from between 3 and 4 million residents in 1950 to nearly 17 million in 1980. By the latter year, over 20 percent of the population lived in urban areas. Geography The Federal Republic of Nigeria is one of the largest countries in Africa. It is situated on the Gulf of Guinea in West Africa. It is bounded by Niger on the North, Cameroon to the East, and Benin on the West. It covers an area of about 923,768 square kilometres with an estimated population of 112,258,100 persons (National Population Commission), making Nigeria by far the most populous country in Africa. The country has three main rivers: the Niger, Benue and Cross rivers. Rainfall varies greatly, and vegetation ranges from tropical rain forest along the coast to savanna/woodland in the North, with mixed vegetation in between. Temperatures are generally high, and increase from South to North, resulting in widely divergent physical features. The temperature at the coast seldom rises above 32°C but humidity can be as high as 95 percent. The country is influenced by two main wind systems: the moist, relatively cool monsoon wind that brings rain from the Southwest, and the hot, dry, Harmattan wind that sweeps across the country from the Northeast between December and February, bringing dust and high temperatures during the day, and low temperatures at night. On May 27, 1967, a decree was issued by the government of Lieutenant-Colonel Gowon dividing the counU7 into 12 states; the number of states was later increased to 19 in April 1976. In 1988, the present government formed two new states from existing states. Then in 1991 it formed nine more states, increasing the total number to 30 plus Abuja, the Federal Capital Territory. There are about 380 ethnic groups in Nigeria; the major groups are Edo, Efik, Fulani, Hausa, Igbo, Kanuri,Tiv, Urhobo, and Yoruba. Most ethnic groups arc concentrated in different parts of the country. The Hausa, Kanuri, and Fulani live primarily in the North, the Yoruba inhabit the Southwest, the Igbo and Efik are found in the Southeast, the Tiv live in the mid-section of the country, and the Edo and Urhobo reside in the Niger River delta. Economy Nigeria has a mixed economy in which petroleum plays a key role. Nigeria is the sixth largest producer of crude oil in the world, and the second largest in Africa. Economic growth soared in the early 1970s as the country enjoyed the high price ofoil on the world market and experienced a massive inflow of foreign exchange. Petroleum accounted for about 90 percent of exports and 80 percent of government revenue. The boom in oil prices sparked considerable rural to urban migration during the 1970s, resulting in a decline in the agricultural sector. From the beginning of the 1980s, however, there was a downturn in the economy because of falling oil prices, declining sales due to competition in the international oil market, energy conservation strategies adopted by oil purchasing countries, and the worldwide economic recession. The Federal government has since formulated policies to promote economic growth. Industrial policies include increased export of manufactured goods to diversify the nation's foreign exchange base, and strengthening the manufacturing sector through exposure to international competition. Some of the objectives of the agricultural policy focus on (i) increasing production and processing of export crops with a view to increasing their foreign exchange earning capacity, (ii) increasing production of agricultural raw materials to meet the growing needs of the expanding industrial sector, (ili) large scale production of commodities which consume a considerable percentage of Nigeria's foreign exchange, but can be produced locally within the country, (iv) increasing urban to rural migration by increasing opportunities for rural employment and improving the quality of life for persons living in rural areas. In 1988 the agricultural sector represented 36 percent of the GDP while petroleum and industrial sectors contributed 20 percent each. 1.2 Population Table 1.1 Demographic indicators Indicator NFS 1981/82 and National Census NDSS 1980 1963 Population (millions) Density (pop./sq.km.) Percent urban Crude birth rate (per 1,000) Crude death rate (per 1,000) Total fertility rate Infant mortality rate (per 1,000) Life expectancy at birth 84.7 55.7 92 60 23 19 46 66 16 27 6.3 -- 85 -- 48 36 Sources: National Population Bureau and WFS, 1984; National Population Bureau and IRD/Westinghouse, 1988; Federal Office of Statistics, 1963 The 1963 National Census reported a total population of 55.7 million. The National Population Commission (NPC), Lagos, projected the 1963 figure forward at a constant growth rate of 2.5 percent per year to arrive at a 1980 estimate of 84.7 million persons, making Nigeria the most populous country in Africa and among the 15 largest countries in the world. NPC estimated the 1988 population to be 112,258,100 persons, and it is likely that the population is increasing by more than 3 percent per year. In 1963, Nigeria was sparsely settled with a density of 60 persons per square kilometre; this figure has since doubled to 122 persons per square kilometre. The distribution of the population is characterised by areas of high density in the Southeast, Southwest, and North-central parts of the country, while other areas are less densely inhabited. While still predominantly rural, the population has become more urbanised, increasing from 19 percent in 1963 to 23 percent urban in 1980. The crude birth rate decreased from 66 per thousand to about 46 per thousand in 1980 and the crude death rate fell from 27 per thousand to 16 per thousand in the same period. Life expectancy at birth rose from about 36 years in 1963 to about 48 years in 1980. The combination of high birth rates and declining death rates means that the Nigerian population will continue growing at a fast pace for decades to come. 3 1.3 Population and Family Planning Policies and Programmes Population issues have been of great concern to the Government of Nigeria throughout the post- independence period. The population of the country, which stood at 30.4 million in 1952, had by 1963 increased to 55.7 million; the 1988 mid-year estimate was 112 million. In light of the high population growth rate, and its adverse effect on national development and on individual welfare, the Government formulated and launched the National Policy on Population (Federal Ministry of Health, 1988). The policy is predicated on the right of couples and individuals to decide fully the number and spacing of their children, and the right to information, education, and the means to exercise such rights. The objectives of the policy are as follows: (i) To improve the living standards and the quality of life of the people of this country; (ii) To promote their health and welfare, especially through preventing premature deaths and illness among the high risk groups; (iii) To achievelower population growth rates, through reduction of birth rates by voluntary fertility regulation methods that are compatible with the attainment of economic and social goals of the nation; (iv) To achieve a more even distribution of population between urban and rural areas. In order to achieve these objectives and to promote national awareness of the adverse effects of rapid population growth, the following strategies are being vigorously pursued: Establishing fertility regulation and management programmes which make services and facilities accessible and affordable to couples and individuals who want to regulate their fertility; Integrating family planning services into the Primary Health Care Programme; Providing necessary and adequate population information and education to young people, couples and individuals to promote responsible parenthood and to enable them to understand the value of moderate-sized families and the importance of spacing of children; Improving rural living conditions through effective implementation of Integrated Rural Development programmes. Nongovernmental agencies such as the United Nations Population Fund (UNFPA) and the International Planned Parenthood Federation (IPPF) through its Nigerian affiliate, the Planned Parenthood Federation of Nigeria (PPFN) operate family planning clinics in all states, supplementing the efforts of the Federal Ministry of Health (FMOH). 1.4 Health Priorities and Programmes The Federal Government's systematic efforts to develop the health sector over the past three decades have resulted in noticeable improvements in the range of available health care facilities and in the services being provided. The 1981 - 1985 Fourth National Development Plan established a govemment commitment to provide adequate and effective primary health care that is promotive, protective, preventive, restorative and rehabilitative to 80 percent of the population by 1985; and to extend the same to the entire population, within the available resources, by the year 2000. This is with the aim of ensuring socially and economically productive lives for all individuals and communities. Particular emphasis is placed on maternal and child health care, which encompasses family planning, immunisation against major infectious diseases, education regarding the prevention and control of health problems, and environmental sanitation to secure a quality of environment adequate for the health and well- being of all Nigerians. Health services in Nigeria are provided by the Federal, state and local governments as well as nongovermnent organisations. Federal, state and local governments are coordinated in a three-tier health care system: (i) primary health care, which is largely the responsibility of local governments, with the support of the State Ministry of Health, (ii) secondary health care, which provides specialised services to patients referred from the primary health care level, and (iii) tertiary health care, which provides highly specialised referral services to the primary and secondary levels of the health care delivery system. 1.5 Objectives and Organisation of the Survey Objectives The Nigeria Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on socioeconomic characteristics, marriage patterns, history of child bearing, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of children. The primary objectives of the NDHS are: (i) To collect data for the evaluation of family planning and health programmes; (ii) To assess the demographic situation in Nigeria; and (iii) To support dissemination and utilisation of the results in planning and managing family planning and health programmes. Organisation The Nigeria Demographic and Health Survey is a joint project between the Federal Government of Nigeria, represented by the Federal Office of Statistics (FOS), and the U.S, Agency for International Development (USAID). The survey was funded by USAID and the Nigerian Government; it was carried out by the FOS, with technical support from IRD/Macro International Inc. located in Columbia, Maryland. Funds from USAID were administered by IRD/Macro International, and were used for salaries of temporary staff recruited for the survey, allowances of survey personnel, data processing and anthropometric equipment, printing of questionnaires, publication of reports, vehicle maintenance and fuel. Four vehicles were provided to the project by USAID, three were provided by FOS, and four were loaned from USAID's Family Health Services Project (FHS). A Survey Advisory Committee (SAC) was formed, consisting of representatives from FOS, IRD, NPC, FMOH and representatives from the Department of Primary Health Care (PHC), the Depamnent of Planning Research and Statistics (PRS), the Department of Population Activities (DPA), UNICEF, the World Health Organisation (WHO), FHS, PPFN, and the Nigeria Institute for Social and Economic Research (NISER). The committee met periodically, during important phases of the project (e.g., questionnaire design, the pretest and the main survey). The Sole Administrator of FOS appointed the Director of Common Services (FOS) as the Project Director. The Director had overall responsibility for survey implementation. He was assisted by a project coordinator, two FOS senior staff (project statisticians who were fully involved in the project), as well as other FOS staff who participated on a part-time basis. The execution of the project activities was divided between the project statisticians; one was responsible for sampling and the logistics of data collection, while the other was responsible for questionnaire design and translation, the pretest, training for the main survey, and the reinterview subsample. Questionnaires Three questionnaires were used in the main fieldwork for the NDHS: the household questionnaire, the individual questionnaire, and the service availability questionnaire. The first two questionnaires were adapted from the DHS model B questionnaire, which was designed for use in countries with low contraceptive prevalence. The questionnaires were developed in English, and then translated into six of the major Nigerian languages: Efik, Hausa, Igbo, Kanuri, Tiv, and Yoruba. English versions of the questionnaires are reproduced in Appendix E. All usual members and visitors in the selected households were listed on the household questionnaire. For each person listed, information was collected on age, sex, education, and relationship to the head of household. The household questionnaire was used to identify women eligible for the individual questionnaire. The individual questionnaire was administered to women age 15-49 who spent the night preceding the household interview in the selected household. Information in the following areas was obtained during the individual interview: 1. Background characteristics of the respondent 2. Reproductive behaviour and intentions 3. Knowledge and use of contraception 4. Breastfeeding, health, and vaccination status of children 5. Marriage 6. Fertility preferences 7. Husband's background and woman's work 8. Height and weight of children under five. The service availability questionnaire was implemented in the service availability survey (SAS), a separate activity from the main fieldwork. The SAS was designed to assess the availability (or supply) of health and family planning services. Thus, while the individual questionnaire collected information from female respondents pertaining to the demand for health and family planning services, the service availability (SA) questionnaire collected information pertaining to the supply of these services by canvassing health and family planning facilities. The SA questionnaire was administered at the community level (enumeration area), and information was gathered from two sources: groups of four or five knowledgeable informants in the selected community (assembled by the interviewer), and informants interviewed at facilities visited by the interviewer. The results of the service availability survey are presented in Chapter 10. Sample To produce a nationally representative survey, the NDHS sample was drawn from the national master sample for the 1987/1992 National Integrated Survey of Households (N1SH) programme being implemented by the FOS. The 299 sample clusters correspond to the enumeration areas (EA) of the NISH master sample. A sample of about 10,000 households was designed with twofold oversampling of the urban stratum, yielding 132 urban EAs and 167 rural EAs. Thus, the NDHS sample is a weighted sample, and all tables presented in this report are based on weighted data. A more detailed description of the sample design is presented in Appendix B. To ensure data quality, a reidentification and redemarcation of EAs selected for the NDHS sample was conducted by FOS state offices and supervised by state senior staff and FOS staff from Lagos. Then, a household listing operation was carried out in each of the sampling units and a selection of 34 households per EA was made at the FOS headquarters in Lagos. Fieldwork The NDHS field staffconsisted of 25 teams, each composed of four female interviewers, one female editor, and one male or female supervisor. The interviewers and editors were newly recruited for the survey, while supervisors were experienced FOS staff. Fieldwork was conducted from April to October 1990 (April to July in the southern states, and July to October in the northem states). The persons involved in the survey are listed in Appendix A. A more complete description of the fieldwork is presented in Appendix B. Table 1.2 is a summary of results from the household and the individual interviews. A total of 9,998 households were selected; of these, 8,999 were successfully interviewed. The shortfall is largely due to households being absent; for which a predominant cause seemed to be for purposes of planting crops. In the interviewed households 9,200 eligible women were identified and 8,781 were successfully interviewed. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, Nigeria 1990 Result Total Household Interviews Households sampled 9998 Households found 9465 Households interviewed 8999 Individual Interviews Number of eligible women 9200 Number of eligible women interviewed 8781 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Information on the background characteristics of the households interviewed in the survey and the individual survey respondents is essential for the interpretation of survey findings and provides a rough measure of the representativeness of the survey. This chapter presents this information in three sections: characteristics of the household population, housing characteristics, and background characteristics of survey respondents. 2.1 Characteristics of the Household Population The NDHS collected information on all usual residents and visitors who spent the previous night in the household. A household was defined as a person or group of persons living together and sharing a common source of food. Age The age distribution of the household population in the NDHS is shown in Table 2.1 and Figure 2.1 by five-year age groups. The distribution conforms to the pattern characteristic of high fertility populations, Table 2.1 Household population by age, residence and sex Percent distribution of the de facto household population by five-year age group, according to urban-rural residence and sex, Nigeria 1990 Urb~m Rural Total Age group Male Female Total Male Female Total Male Female Total 04 14.6 15.1 14.8 16.9 17.3 17.1 16.4 16.8 16.6 5-9 16.8 16.7 16.7 18.8 17.1 18.0 18.3 17.0 17.7 10-14 13.5 15.7 14.6 13.2 13.4 13.3 13.3 13.9 13.6 15-19 11.0 8.8 9.9 8.8 7.0 7.9 9.4 7.4 8.4 20~4 6.9 8.6 7.8 5.4 7.2 6.3 5.8 7.5 6.7 ~-~ 7.5 8.0 7.7 5.5 7.4 6,5 6.0 7.6 6.8 30-34 6.3 6.2 6.2 5.4 6.4 5.9 5.6 6.3 6.0 35-39 4.9 3.9 4.4 4.2 4.2 4.2 4.4 4.2 4.3 4044 4.5 3.7 4.1 4.0 3.9 4.0 4.1 3.8 4.0 4549 3.0 2.2 2.7 3.4 2.9 3.2 3.3 2.8 3.0 50-54 2.6 4.0 3.3 3.3 4.7 4.0 3.1 4.5 3.8 55-59 1.4 1.9 1.7 2.0 2.8 2.4 1.9 2.6 2.2 60-64 2.2 2.2 2.2 2.8 2.5 2.6 2.6 2.4 2.5 65-69 1.5 0.9 1.2 1.8 1.0 1.4 1.8 1.0 1.4 70-74 1.3 0.9 1.1 1.9 0.9 1.4 1.7 0.9 1.3 75-79 0.5 0.3 0.4 0.7 0.4 0.5 0.7 0.3 0.5 80+ 1.1 0.9 1.0 1.5 0.7 1.1 1.4 0.7 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,799 5,690 11,489 17,651 17,888 35,539 23,450 23,578 47,028 Figure 2.1 Population Pyramid of Nigeria 80+ 75-79 70-74 65-69 60-64 56-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0 -4 20 15 10 5 0 5 10 15 20 Percent NDHS 1990 i.e., a much higher proportion of the population in the younger than in the older age groups. However, the youngest age group (0-4) numbers fewer than the 5-9 year olds; this either results from an undercount of children in the youngest group, or from some 0-4 year olds being reported as age 5-9. Evidence of heaping can also be seen in the female age groups 10-14 and 50-54 years. That heaping does not occur among males in these age groups suggests that some interviewers may have pushed women out of the age range eligible for the individual interview. An assessment of this phenomenon by Rutstein and Bicego (1990), indicates that the effects of misreporting at the upper and lower boundaries (age 15 and 49) are minimal. Table 2.2 compares the population age structure found in the 1990 Nigeria Demographic and Health Survey (NDHS) with that in the 1963 Census (Federal Office of Statistics, 1963), the 1980 National Demographic Sample Survey (NDSS 1980) (National Population Bureau and IRD/Westinghouse, 1988), and the 1981/82 Nigeria Fertility Survey (NFS 1981/82) (National Population Bureau and World Fertility Survey, 1984); dependency ratios are also shown. The age dependency ratio is the ratio of the number of persons age 0 to 14 and 65 and over divided by the number of persons age 15 to 64. It is an indicator of the dependency responsibility of adults in their productive years. 10 Table 2.2 Population by age ~om selected sources Percent distribution of the population by age group, selected sources, Nigeria 1963-1990 Census NDSS NFS NDHS Age group 1963 1980 1981/82 1990 Less thin 15 43.1 47.2 49.5 47.1 15-64 54.9 50.2 48.1 48.5 65+ 2.0 2.8 2,3 4.3 Total I00.0 I00.0 I00.0 I00,0 Median age . . . . 16.3 Dependency ratio 0.82 1.00 1.08 1.06 Sources: 1963 Census (Federal Office of Statistics, 1963); 1980 National Demographic Sample Survey (National Population Bureau and IRD/Westinghonse, 1988); 1981/82 Nigeria Fertility Survey (National Population Bureau and World Fertility Survey, 1984) The dependency ratios in Nigeria are typical of those found in other African countries. With approximately 47 percent of the population under age 15 and 4 percent over age 64, there is one dependent person for each adult in the population. As in many rapidly growing populations, old age dependency is minimal compared to child dependency. Household Composition While the large majority of households in Nigeria are headed by males (86 percent), there are regional differences (see Table 2.3). About 20 percent of housebolds in the South are headed by women, whereas it is unusual in the North for a household to be headed by a woman (5 percent). There are two characteristics worth noting when comparing urban and rural households. First, fern ale headed households are more common in urban areas (18 percent) than in rural areas (13 percent); and second, single person households are more common in urban areas (16 percen0 than in rural areas (9 percent) and households of nine or more persons are more common in rural areas, 17 percent compared to 11 percent in urban areas. As a result, average household size is larger in rural (5.6) than in urban (4.8) areas. 11 Table 2.3 Household composition Percent dista'ibution of households by sex of head of household, household size, kinship structure, and presence of foster children, according to urban-rural residence and region, Nigeria 1990 Characteristic Residence Region Urban Rural Northeast Northwest Southeast Southwest Total Household headship Male 82.0 87.1 94.3 94.9 77.3 81.2 85.7 Female 18.0 12.9 5.7 5.1 22.7 18.8 14.3 Numberofusualmembers 1 16.2 9.2 7.4 6.7 12.9 15.8 11.1 2 12.7 9.6 10.8 10.8 9.3 11.3 10.5 3 12.9 12.7 13.2 18.1 9.6 12.0 12.8 4 12.2 13.2 14.6 13.3 11.9 12.4 12.9 5 11.1 11.9 11.7 11.7 11.6 11.8 11.7 6 10.4 11.3 10.2 9.9 12.5 10.8 11.0 7 8.1 8.8 7.7 8.9 9.0 8.5 8.6 8 5.5 6.5 5.9 5.3 7.4 5.6 6.2 9+ 11.0 16.8 18.6 15.2 15.6 11.7 15.2 Meanslze 4.8 5.6 5.8 5.4 5.5 4.9 5.4 Relationship structure One adult 22.2 13.5 9.7 8.8 19.9 22.0 15.8 Two related adults of opposite sex 34.8 37.1 40.9 46.6 29.8 32.8 36.5 of same sex 5.2 2.0 1.2 0.6 4.2 4.6 2.9 Three or more related adults 34.6 45.5 45.8 43.3 43.5 37.9 42.6 Other 3.3 1.8 2.4 0.7 2.5 2.7 2.2 With loser children 7.1 6.8 6.2 3.8 8.1 8.6 6.9 Note: Table is based on de jure members; i.e., usual residents. Households are largest, on average, in the Northeast (5.8 persons per household), and smallest in the Southwest (4.9 persons per household). The overall average household size is 5.4 persons, Seven percent of households include one or more children under age 15 who have neither their natural mother nor natural father l iving with them. Educat ion In the three decades since independence, the education sector has recorded phenomenal growth in student enrolments and numbers of institutions, and has expanded to reach all parts of the federation. The national education policy has evolved over the years to meet the needs of the country. In 1976, Nigeria adopted a national policy of Universal Primary Education, which gave every child the right to free primary schooling. The emphasis in education shifted from the standard liberal education to the new more practical 12 6-3-3-4 system. Under the new system, primary education is six years, and secondary education is six years rather than five years (three years junior secondary and three years senior secondary). A graduate of secondary school may then choose to further his or her education by attending a university or polytechnic school for a 4-year course leading to a degree or to the Higher National Diploma. At this level, very few courses last more than four years. The goal is for the nation to meet its manpower requirements in various areas of social, economic and political growth, as well as achieving national development and modernization. A nationwide mass literacy programme was launched in June 1990, although it had been in existence at state and locallevels for over 25 years. The National Commission on Nomadic Education was recently established to address the needs of children of migrant cattle herders and fishing peoples in the riverine areas. In the NDHS, information on educational attainment was collected for every member of the household (see Table 2.4). One-half of the population has received no formal education; 43 percent of males and 58 percent of females have never been to school; 32 percent of males and 26 percent of females have attended only primary school; and 14 percent of males and 9 percent of females have attended secondary school. Only 3 percent of males and 1 percent of females have obtained higher education. The proportion of persons with no education is much higher in the rural areas than in urban areas, and this difference is seen for both males and females. Rural residents are twice as likely to have never attended school (58 percent) as urban residents (29 percent). There are major regional differences in the level of education. The Northwest has the highest proportion of persons with no education (73 percent of males and 86 percent of females); in the Southwest, those who have never been to school are in the minority (18 percent of males and 30 percent of females). 13 Table 2.4 Educational level of the household population Percent distribution of the de facto male and female household populations age five and over by highest level of education attended, according to selected background characteristics, Nigeria 1990 Number Median Background Some Completed S¢~ne Completed of number characteristic None primary primary seconda~ secc~dal 7 Higher Missing Total persons of years MALE Age 5-9 51.0 29.7 0.2 0.0 0.0 0.0 lO-14 21.7 49.9 8.9 7.0 0.0 0.0 15-19 20.6 15.4 21.3 24.8 I~0 0,5 20-~ 23.0 5.0 22.4 12.5 ~.9 4.8 25-~ 31.8 3.9 21.7 6.8 23.9 9.0 30-34 41.1 5.5 22.3 3.1 15.4 8.3 35-39 ~.I 5.0 21.5 2.8 13.2 7.5 40-44 53.6 5.6 22.3 2.8 9.3 4.1 45-49 52.7 9.5 18,4 4.1 8.1 4.4 50-54 72.6 7.3 8.5 1.8 5.3 3,1 55-59 72.3 7.7 8.4 3.0 2.0 2.3 ~4M 80.1 5.0 6.8 1,1 2.2 1.5 ~+ 84.4 5.8 4.7 1.0 1,1 0.9 Reslden~ Urban 22.4 21.2 15.1 ii.I 15.7 6.5 RuN 50.2 18.4 11.6 4.5 5.1 1.4 R~lon No,east 65.5 7.8 8.6 1.8 4.0 1,1 No , west 72.8 10.3 6.2 2.9 3.6 1.3 S~th~st 26.8 27.8 18.4 6.2 8.0 2.3 S~thwcst 17.8 26.4 14.1 13.1 14.6 5.7 T~ 43.3 19.1 IZ5 6.1 7.7 2.6 19.1 I~.0 4293 0.7 12.4 I~.0 3,115 3.6 7.5 I~.0 2,194 6.5 4.5 1~,0 1,362 6.9 2.8 I~.0 1,4~ 6.6 4.2 l~,0 1,320 6.1 3.9 I~.0 I~34 4.0 2.4 1~.0 971 0.9 2.7 1~.0 771 0.9 1,4 1~,0 729 0.7 4.2 1~.0 443 0.7 3.2 1~,0 614 0.6 2.1 1~.0 1,320 0.6 8.1 1~.0 4,848 6.1 8.8 1~.0 14,7~ 0.9 I 1.2 i00.0 4,731 0.7 2.9 I00.0 3,997 0.7 10.5 I00.0 6,148 3.6 8.4 I00.0 4,737 6.0 8.6 100.0 19,613 1.2 FEMALE Age 5-9 54.4 27.9 10-14 34.1 41.7 15-19 33.6 11.0 20-7A 42.0 6.6 25-29 54,2 6.3 30-34 71.1 7.5 35-39 70.4 9.4 40-44 78.9 7.8 45-49 84.7 6.5 5O-54 90.9 3.8 55-59 95.8 1.6 60-64 96.3 2.2 65+ 95.2 1.9 Residence Urban 36.3 21.4 Rural 65.2 15.4 Region Northeast 82.0 4.8 Northwest 86.2 6.6 Southeast 43.1 24.6 Southwest 29.7 27.5 Total 58.2 16.9 0.2 0.0 0.0 0.0 7.4 6.6 0.1 0.0 ~.6 20.0 8.2 0.4 18.6 10.6 17.1 2.3 17.2 5.8 11.7 3.2 10.8 2.7 3.1 2.9 11.9 2.3 3.4 1.1 8.0 1.9 1.1 0.8 5,0 1.9 0.7 0.9 3.2 0.4 0.5 0.3 1.1 0,7 0,1 0.2 0.7 0.I 0.I 0.0 1.9 0.1 0.2 0.1 17.4 I~.0 4,010 0,7 I0.I I~.0 3,288 2.9 6.2 l~.0 IJ49 6.2 3.0 I~.0 1,777 6.0 1.6 I~.0 IJ84 0.9 2.0 I~.0 I~91 0.7 1.6 I~.0 982 0.7 1.6 I~.0 905 0.6 0.3 I~.0 654 0.6 0.9 1~.0 1,072 0.5 0,5 100.0 615 0,5 0,5 I~.0 567 0.5 0,6 I~.0 711 0.5 12.1 10.8 9.9 2.5 7.0 I~.0 4~33 3.0 7.5 3.0 2.0 0.4 6.5 I~,0 14,889 0.7 4.0 0.8 0.7 0.0 7.7 I~.0 4,~8 0.6 3.1 1.4 I.I 0.I 1.5 I~.0 4,~1 0.6 12.5 5.5 4.0 0.8 9.4 1~.0 6,476 1.0 12.8 11.6 9.5 2.7 6.3 I~.0 4,437 3.6 8,6 4.9 3.9 0.9 6.7 1~,0 19,622 0.8 14 Table 2.5 presents enrolment rates by age, sex and residence. Fifty-five percent of children age 6-15 years are enrolled in school. As shown in Figure 2.2, enrolment is higher in urban areas (about three-quarters of children are enrolled) than in rural areas (one-half are enrolled); and boys are more likely to be enrolled than girls (59 percent versus 51 percent). Enrolment after age 15 drops significantly; only one-quarter of older teens are still in school and only 11 percent of those in their early twenties are still in school; the urban/rural differences are not as great at these ages, but male/female differences are greater because women are much less likely than men to go on for higher schooling. Table 2.5 School artrolmont Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban- rural residence, Nigeria 1990 Age group Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-I0 74,1 49.9 55.4 69.4 43.0 49.4 71.7 46.6 52,5 11-15 75,8 60.9 64.9 70.2 48.0 54.0 73,0 54.6 59,5 6-15 74.8 54.1 59.1 69.7 45.0 51.2 72.3 49.7 55.3 16-20 37.6 32.4 33.9 30,0 16.9 20.5 33.9 24.6 27,2 21-24 18.0 16,6 17.1 10.1 4.1 6.0 13.6 9.4 10.8 80 70 60 50 40 30 20 10 Percent 0-- 6-15 Figure 2.2 School Enrollment by Age and Place of Residence 16-20 21-24 I "Urban mRural i NDHS 1990 15 2.2 Hous ing Character i s t i cs In order to assess the socioeconomic conditions under which respondents live, women were asked to give specific information about their household environment. Table 2.6 presents this information for all households in which women were interviewed. (Although the questions on household characteristics were asked in the individual questionnaire, Table 2.6 has been tabulated to represent households; i.e., households with more than one eligible woman are still counted only once). Table 2.6 Housing characteristics Percent distribution of households with eligible women by housing characteristics, according to urban-rural residence and region, Nigeria 1990 Characteristic Residence Region Urban Rural Northeast Northwest Southeast Southwest Total Electricity 82.4 8.6 Source of drinking water Piped into residence 1.5 Piped into yard Public tap Well with hand pump Well without hand pump 14.8 River, spring, surface water 4.9 Tanker truck/other vendor 8.9 Rainwater 0.3 Other 0.4 Total 100.0 I00.0 Sanitation facility Flush 29.9 2.1 Bucket 1.5 0.3 Pit 60.4 62.2 No facilities 8.1 35.5 Total 100.0 100.0 Flooring Parquetc~olished wood 2.0 0.2 Vinyl/asphalt strips 0.9 0.3 Ceramic tiles 3.3 0.7 Wood planks O.5 0.1 Cement 72.6 46.9 Animal dung 0.5 1.1 Earth/sand 7.1 50.6 Other 12.9 0.1 Total 100.0 100.0 Persons per sleeping room 1-2 43.4 50.2 3~l 35.6 33.6 5-6 14.7 10.3 7 + 6.2 5.6 Missing/Don't know 0.l 0.4 Total 100.0 100.0 Mean persons per room 3.4 3.2 Number of households 1,649 4,844 11.0 13.0 22.4 65.4 27.3 17.3 4.8 5.1 2.7 10.3 5.5 13.8 1.8 3.4 4.1 3.7 8.6 4.8 32.2 8.4 11.3 4.1 17.3 24.5 14.4 7.4 6.8 15.3 4.8 2.4 7.2 7.0 28.1 31.9 49.1 9.5 13.2 ~.7 51.9 30.5 32.1 62.0 27.4 40.0 0.7 1.6 0.5 1.5 8.1 2.8 0.7 1.2 0.1 0.8 0.3 0.6 0.0 0.0 0.0 0.0 0.4 0.1 1~.0 100.0 l~.0 1~.0 100.0 0.5 1.7 7.7 27.7 9.1 0.1 0.1 0.6 1.4 0.6 74.9 66.7 57.8 48.8 61.7 24.5 31.5 33.9 22.1 28.5 lO0.O 100.0 100.0 100.0 100.0 0.2 0.3 0.2 2.0 0.6 0.3 0.3 0.6 0.7 0.5 0.2 0.9 0.9 3.8 1.4 0.4 0.2 0.0 0.4 0.2 32.4 54.5 58.8 66.0 53.4 1.5 0.4 0.5 1.4 0.9 ~.7 43.3 38.9 11.3 39.5 0.3 0.2 0.0 14.3 3.4 l~.O i~ .0 1~,0 100.0 1~.0 54.9 47.0 50.0 41.5 48.5 31.8 38.0 31.2 36.2 34.1 7.8 11.0 11.9 14.8 11.4 4.8 3.5 6.8 7.5 5.7 0.7 0.5 0.1 0.0 0.3 100.0 100.0 100.0 100.0 100.0 3.0 3.1 3.2 3.5 3.2 1,471 1,529 2,025 1,468 6,493 16 Overall, 27 percent of households in Nigeria have electricity. While electricity is available to the majority of eligible women in urban areas (82 percent) it is available to only a small minority in rural areas (9 percent). Two-thirds of households in the Southwest have electricity, compared to 11 percent in the Northeast. Sources used by households to obtain drinking water differ considerably by area of residence. In urban areas, piped water is the primary source of drinking water: 32 percent obtain water from a public tap and another 31 percent have water piped into their residence or yard. In rural areas, water from rivers and springs is the main source of drinking water (52 percent) and another 28 percent obtain water from a well without a hand pump. Modem sanitation facilities are not available to large segments of the population. The use of pit toilets is common in both urban and rural areas (60 and 62 percent respectively); in urban areas, most of the rest of the population use flush toilets (30 percent), and in rural areas, most of the rest of the population have no facilities (36 percen0. The flooring material of dwelling units is usually cement (53 percent) or earth (40 percent). Cement flooring is most common in urban areas (73 percent). Of the remaining urban households, most have carpet or tile flooring (coded in the "other" category). Households in rural areas also have cement flooring (47 percent) but are equally likely to have an earth or sand floor (51 percent). Information was collected on the number of rooms households use for sleeping (as a measure of crowding). There was not much diversity according to residence and region. In about one-third of households three or four persons share a room for sleeping; however, in almost half of the households the average is one or two persons. Household Durable Goods Respondents were asked about ownership of particular household goods (radio and television, to assess access to media; refrigerator, to assess food storage) and modes of transportation (bicycle, motorcycle, car). The results presented in Table 2.7 indicate that 55 percent of households own a radio (80 percent in urban areas, 47 percent in rural areas) and 19 percent own a television (54 percent in urban areas, 7 percent in rural areas). Televisions and refrigerators are mostly restricted to the urban areas due to lack of electricity in rural areas. Many rural households (37 percent) own a bicycle whereas only 17 percent of urban households have a bicycle. Seventeen percent of urban households own an automobile. 17 Table 2.7 Household durable goods Percentage of households with eligible women possessing various durable consumer goods, by urban-rural residence end region, Nigeria 1990 Possession Residence Region Urban Rural Northeast Northwest Southeast Southwest Total Radio 79.6 46.6 39.1 53.1 55.9 71.5 54.9 Television 53.7 7.1 6.3 8.1 16.5 46.0 18.9 Refrigerator 32.9 3.1 4.1 4.6 8.9 26.0 10.7 Bicycle 16.6 36.9 26.4 30.8 46.4 17.7 31.7 Motorcycle 17.5 16.3 10.0 19.0 19.0 17.3 16.6 Auto 16.6 4.4 3.2 4.9 6.7 15.5 7.5 Number of households 1,649 4,844 1,471 1,529 2,025 1,468 6,493 2.3 Background Characteristics of Survey Respondents General Characteristics Women were asked two questions in the individual interview to assess their age: "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained in probing techniques for situations in which respondents did not know their age or date of birth; and as a last resort, interviewers were instructed to record their best estimate of the respendent's age. The five-year age distribution is shown in Table 2.8. The proportion of women age 15-19 ( 18 percent) is slightly smaller than the proportion age 20-24 (19 percent), which is not what would be expected in an expanding population. It is also smaller than the proportion of women age 15-19 in the NFS (21.6 percent). The proportion of women 20-24 was larger in the NDHS than in the NFS (17.6 percent). The data in Table 2.8 indicate that 78 percent of NDHS respondents are currently in a union (either married or living together), 17 percent have never been married, and 4 percent are either widowed, divorced or separated. The percentage of women who are currently married is quite high; the NFS also reported a high percentage of currently married women (80 percent). Marriage patterns are discussed in detail in Chapter 5. 18 Table 2.8 Background characteristics of respondents Percent distribution of women by selected background characteristics, Nigeria 1990 Number of women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 18.4 1,611.6 1,678 20-24 19.1 1,676.2 1,682 25-29 19.0 1,669.3 1,658 30-34 16.1 1,409.5 1,386 35-39 10.9 954.0 948 4044 9.5 836.1 827 45 -49 7.1 624.3 602 Marital status Never married 17.2 1,513.1 1,701 Married 70.9 6,229.8 6,097 Living together 7.4 650.3 599 Widowed 2,4 213.7 201 Divorced 1,1 94.7 85 Separated 0,9 79.4 98 Education No education 57.2 5,019.9 4,540 Some primary 9.0 794.1 742 Completed primary 14.8 1,299.8 1,366 Some secondary 8.7 764.8 918 Completed secondary/higher 10.2 893.9 1,207 Residence Urban 24.9 2,187.2 3.530 Rural 75.1 6,593.8 5,251 Region Northeast 22.8 1,999.5 2,038 Northwest 23.9 2,098.1 1,699 Southeast 31.5 2,768.5 2,324 Southwest 21.8 1,914.9 2,720 Religion Protestantism 33.7 2,963.2 2,942 Catholicism 13.9 1,222.9 1.210 Islam 47.5 4,174.1 4,269 Traditional religion 2.4 207.5 188 No Religion 2.4 213.3 172 All women 100.0 8,781.0 8,781 The majority of respondents have never attended school (57 percent), 15 percent have completed only primary school, and 10 percent have completed secondary school (2 percent of these women have gone for schooling beyond the secondary level). 19 Although urbanization is increasing, the population is still predominantly rural; three-quarters of respondents live in rural areas. The data indicate that 32 percent of respondents live in the Southeast; the Northeast, Northwest and Southwest each account for 21-24 percent of the women interviewed. Most women report themselves to be either Moslem or Christian, and the population is evenly divided between the two, (48 percent Muslim, 48 percent Christian). Those who adhere to traditional religions and those who report no religion each account for 2 percent of the population. Differentials in Education Table 2.9 shows the distribution of the surveyed women by education, according to selected characteristics. Education is inversely related to age; that is, older women are generally less educated than younger women. For example, 85 percent of women age 45-49 have had no formal education, whereas only 34 percent of women age 15-19 have never been to school. Table 2.9 Level of education Percent distribution of women by the highest level of education attended, according to selected background characteristics, Nigeria 1990 Level of education Completed Number Background Some Completed Some secondary/ of characteristic None primary primary secondary Higher Total women Age 15-19 33.8 12.0 20.4 23.1 10.5 100.0 1,612 20-24 42.1 7.9 18.9 11.6 19.5 100.0 1,676 25-29 54.3 6.9 16.9 6.8 15.0 100.0 1,669 30-34 70.0 10.2 11.5 2.5 5.6 100.0 1,410 35-39 72.6 9.6 10.6 2.6 4.7 100.0 954 40-44 78.2 8.8 9.1 2.0 2.0 100.0 836 45-49 84.9 7.2 5.1 1.4 1.4 100.0 624 Residence Urban 31.2 7.3 19.4 16.6 25.5 100.0 2,187 Rural 65.8 9.6 13.3 6.1 5.1 100.0 6,594 Region Northeast 83.7 4.7 7.1 2.4 2.0 100.0 2,000 Northwest 87.8 2.9 5.0 2.1 2.2 100.0 2,098 Southeast 36.2 16.8 23.7 11.2 11.8 100.0 2,769 Southwest 26.1 9.1 20.7 18.9 25.1 100.0 1,915 Total 57.2 9.0 14.8 8.7 10.2 100.0 8,781 Twice as many urban women have received some education as rural women (69 percent versus 34 percent). Only a small proportion of rural women (11 percent) go on for secondary schooling compared to urban residents (42 percent). 20 Table 2.9 provides information on women's level of education by region. The northern regions have a much higher proportion of uneducated women (86 percent) than the southern regions (36 percent in the Southeast, 26 pereent in the Southwest). The proportion of women who have had some secondary education is ten times higher in the Southwest than in either of the Northern regions. Access to Media Women were asked if they usually listen to a radio or watch television at least once a week. This information is important to programme planners seeking to reach women with family planning and health messages through the media. Overall, one-quarter of women watch television weekly and one-half listen 1o the radio weekly (see Table 2.10). Media access is higher among younger women, one-third of whom watch television at least once a week and over one-half listen to the radio once a week, Most media access is among the urban population, although 44 percent of the rural population does listen to the radio. A much higher proportion of educated women, women in urban areas, and women in the Southwest watch television and listen to the radio. Table 2.10 Access to mass media Percentage of women who usually watch television once a week, or listen to radio once a week, by selected background characteristics, Nigeria 1990 Watch Listen to Number Background television radio of characteristic weekly weekly women Age 15-19 33.8 58.0 1,612 20-24 28.5 55.8 1,676 25-29 28.0 55.9 1,669 30-34 19.5 52.3 1,410 35-39 21.5 52.9 954 40-44 20.0 45.4 836 45-49 16.6 40.6 624 Education No education 9.3 39.7 5,020 Some primary 23.6 56.6 794 Completed primary 39.8 69.0 1,300 Some secondary 56.4 73.6 765 Completed secondary/higher 71.3 86.3 894 Residence Urban 67.4 82.1 2,187 Rural 11.7 43.7 6,594 Region Northeast 8.4 35.5 2,000 Northwest 11.5 47.8 2,098 Southeast 25.6 53.8 2,769 Southwest 58.8 77.1 1,915 Total 25.5 53.3 8,781 21 CHAPTER 3 FERTILITY The fertility measures presented in this chapter are based on the reported reproductive histories of women age 15-49 interviewed in the NDHS. Each woman was asked the number of sons and daughters living with her, the number living elsewhere, and the number who had died. She was then asked for a history of all her births, including the month and year each was born, the name, the sex, and if deceased, the age at death, and if alive, the current age and whether he/she was living with the mother. Based on this information, measures of completed fertility (number of children ever born) and current fertility (age-specific rates) are examined. These measures are also analyzed in connection with various background characteristics. 3.1 Current Fertility The current level of fertility is the most important topic in this chapter because of its direct relevance to population policies and programmes. Three-year age-specific fertility rates are presented in Table 3.1. Three-year rates are calculated as a compromise between three criteria: to provide the most current information, to reduce sampling error, and to avoid problems noted in previous surveys of the displacement of births from five years preceding the survey to six years. Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding die survey, by urben-ruxal residence mad region, Nigeria 1990 Age group Residence Region Urban Rural Northeast Northwest Southeast Southwest Total 15-19 0.093 0.166 0.224 0.194 0.106 0.074 0.146 20-24 0.199 0.280 0.280 0.281 0.256 0.210 0.258 25-29 0.255 0.265 0.237 0.274 0.268 0.270 0.263 30-34 0.223 0.219 0.221 0.229 0.220 0.211 0.220 35-39 0.145 0.164 0.140 0.156 0.162 0.176 0.159 4044 0.057 0.100 0.129 0.134 0.053 0.078 0.092 45-49 0.034 0.071 0.075 0.061 0.050 0.073 0.064 TFR 15-49 5.033 6.326 6.532 6.645 5.573 5.461 6.011 TFR 15-44 4.865 5.970 6.155 6.339 5.322 5.095 5.691 GFR 0,172 0.213 0,223 0.229 0.188 0,173 0,203 CBR 34 40 39 46 37 32 39 TFR: GFR: CBR: Note: Total fertility rate expressed per woman General fertility rate (births divided by number of women 15-44), expressed per 1,000 women Crude birth rate, expressed per 1,000 population Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. 23 Numerators of the age-specific fertility rates in Table 3.1 are calculated by isolating live births which occurred in the 1-36 months preceding the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of birth (determined from the date of birth of the mother). The denominators of the rates are the number of woman- years lived in each of the specified five-year age groups during the 1-36 months preceding the survey. There are two regionally distinct patterns of fertility: that of the North and that of the South. During the central childbearing years (25-39), women tend to bear children at about the same rates in the North and the South. It is during the early and late childbearing years that differences are evident. In the teenage years, women in the North have children at twice the rate of women in the South (on average, each year, 1,000 women age 15-19 in the South will give birth to 100 babies, while 1,000 women age 15-19 in the North will give birth to 200 babies). Women in the North achieve their peak fertility in their early twenties, while women in the South reach their highest fertility in their late twenties. In their early 40s, women in the North continue bearing children at twice the rate of women in the South. The sum of the age-specific fertility rates, i.e., the total fertility rate (TFR), is used to summarise the current level of fertility. It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. If fertility were to remain constant at current levels, a Nigerian woman would give birth to an average of six children. The higher fertility of women in the North results in a total fertility rate which is one child greater than that of women in the South (6.6 versus 5.5). The crude birth rate (CBR) presented in Table 3.1 is the annual number of births in a population per 1,0t30 persons. The CBR can be estimated from the birth history data and the age-sex distribution of the household population. Overall, there were about 39 births per thousand population over the last three years, according to the NDHS. 24 Fertility trends can be analyzed in two ways. One is to compare NDHS data with previous surveys. The last national estimates of total fertility can be calculated from data collected in the 1981/82 Nigeria Fertility Survey (NFS). Table 3.2 compares three-year total fertility rates as estimated by the NDHS and NFS t. The two surveys, nearly a decade apart, yield almost the same total fertility rates (5.9 for the NFS and 6.0 for the NDHS); however, estimates vary greatly for subgroups of the population. Further analysis would be required before concluding whether differences are due to real trends or simply the result of differential data quality. Both surveys do indicate that the fertility of uneducated women is fifty percent higher than the fertility of the most educated women. Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey end mean number of children ever born to women age 40-49, by selected background characteristics, Nigeria 1990 Background ch~acterlstie NDHS NFS Mean number Mean number of children of children Total ever born Total ever born fertility to women fertility to women rate I age 40-49 rate I age 40-49 Residence Urban 5.03 6.01 5.79 4.81 Rural 6.33 6.61 5.98 5.56 Region Northeast 6.53 5.75 5.95 4.34 Northwest 6.64 6.21 6.38 4.49 Southeast 5.57 6.99 5.72 6,53 Southwest 5.46 6.84 6.25 5.30 Education No education 6.50 6.41 6.14 5.45 Some primary 7.17 7,38 6.81 5,99 Completed primary 5.57 6.54 7.59 5.71 Some secondary 5.07 6.44 3.90 4.31 Completed secondary~igher 4.18 5.82 NA NA Total 6.01 6.49 5.94 5.41 NA = Not applicable IRate for women age 15-49 years 1 The NFS report presented a five-year total fertility rate of 6.34; a three-year rate is presented here for purposes of comparability with the NDHS estimate. (The five-year rate estimated for the NDHS is 6.27). 25 Fertility trends can also be estimated based on NDHS data alone. Table 3.3 shows the age-specific fertility rates for four-year periods preceding the survey. Four-year periods were used instead of the customary five-year periods in order to avoid the effects of displacement of births from five to six years preceding the survey. Table 3.3 Age-specific fertility rates Age-specific fertility rates (per thousand women) for four-year periods preceding the survey, by mother's age at the time of birth, Nigeria 1990 Number of years preceding the survey Mother's age 0-3 4-7 8-11 12-15 16-19 15-19 144 178 166 179 168 20-24 267 297 321 288 250 25-29 274 316 326 309 [286] 30-34 228 261 287 284 [280] 35-39 162 210 [237] [253] 40-44 95 [119] [188] 45-49 [67] [110] -- Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are mmcated. The data in Table 3.3 along with similar data from the NFS are plotted in Figure 3.1. Figure 3.1 shows the trends in the total fertility rate based on estimates from the NFS and the NDHS. These are four- year rates, for several periods preceding each survey. There are three points worth noting: i) the NDHS and NFS estimates for 1976 coincide almost exactly, lending confidence to these estimates, ii) given the NDHS estimate for 1980, it appears likely that the NFS estimate for that year is low, and ili) the NDHS estimate repeats the NFS pattern of declining fertility in the four years immediately preceding the survey. 26 Figure 3.1 Trends in the Total Fertility Rate Women 15-34, NFS and NDHS Surveys No. of children 6 5 4 3 i i i i ~ I 1968 1972 1976 1980 1984 1988 1992 Note: The points shown are the mid-points of four-year periods, . . . . NFS - - '~- -NDH8 Is the fertility decline real, or has there been an undercount of births in the years preceding the survey? If there has been no change in fertility over time, the number of births (and woman-years of exposure) would be expected to increase because of the larger cohorts of women moving into the childbearing years (due to the past high fertility). If fertility is fairing, the number of births would be expected to increase over time, but at a slower rate. Figure 3.2 shows the number of births reported in each calendar year. The curve shows a five-year moving average of the numbers. It can be seen from the curve that the number of births in the five years preceding the survey levels offsharply instead of continuing to rise gradually. It appears, therefore, that the number of births in the five years preceding the survey has been underestimated. Both the NFS and the NDHS encountered a pattern of declining births in the years immediately preceding the survey, which lends weight to the diagnosis of underreport'mg. (Although not shown here, the woman- years of exposure increase steadily over time, as expected, indicating that there has been no decline and/or underestimation of the number of women.) So, the question becomes: if births have been underestimated, has there been any fertility decline at all, and if so, how much? The answer to this question requires further investigation, including an analysis of the proximate determinants of fertility, to see whether other behaviours have changed to a degree that would be commensurate with a decline in fertility. 27 Figure 3.2 Distribution of Children's Year of Birth Percent of total births 6 4 2 0 55 60 65 70 75 80 85 90 Year of Birth Births in one year 5 yr. moving average NDH8 1990 Table 3.4 Fertility by marital duration Fertility rates for ever-married women by duration since first marriage in years for four-year periods preceding the survey, Nigeria 1990 Marriage Number of years preceding the survey duration at birth 0-3 4-7 8-11 12-15 16-19 0-4 328 340 326 307 287 5-9 292 340 349 325 292 10-14 259 299 312 299 257 15-19 217 244 250 243 [239] 20-24 141 181 [203] [1861 25-29 72 [87] [95] -- Note: Duratlon-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated Table 3.4 presents fertility rates for ever-married women by duration since first marriage for four-year periods preceding the survey. Fertility early in marriage often remains resilient to change, even when fertility is declining, because fertility decline usually begins at the older ages (when women start to limit the number of blahs), and not by young couples postponing births. However, Table 3.4 shows a recent decline in 28 fertility, even for marriages of short duration. This may be a real decline, or may reflect an undercount of recent births, as noted earlier. 3.2 Ch i ld ren Ever Born and Living The distribution of women by number of children ever born is presented in Table 3.5 for all women and for currently married women. In the NDHS questionnaire, the total number of children ever born was ascertained by a sequence of questions designed to maximize recall. The mean number of children ever born Table 3.5 Children ever born and living Percent disqxibution of all women and of currently married women by number of children ever born (CEB) and mean number ever born m~d living, according to five-year age groups and regions, Nigeria 1990 Number of children ever born (CEB) 0 I 2 3 4 5 6 7 8 9 Number Mean Mean no. of no. of living 10+ Total women CEIl children ALL WOMEN Age 15-19 76.5 17.3 5.0 0.8 0.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,612 0.3 0.3 20-24 32.3 24.7 21,9 11.4 7.9 1.1 0.6 0.2 0.0 0.0 0.0 I00.0 1,676 1.4 1.2 25-29 11.3 12.9 17.8 20.3 15.3 13.1 6.5 1.8 0.6 0.2 0.3 I00.0 1,669 3.0 2.4 30-34 4.1 5.2 9.7 12.6 16.6 16.9 14.4 10.7 6.2 2.8 0.8 100.0 1,410 4.6 3.7 35-39 4.5 2.7 6.7 7.2 14.0 12.5 14.5 13.9 11.3 6.1 6.5 100.0 954 5.5 4.3 40~4 4.6 3.9 4.2 7.7 7.9 9.5 11.3 13.0 14.9 9.4 13.6 100.0 836 6.3 4.8 45-49 4.0 3.9 3.9 6.1 5.9 8.9 9.4 12.4 14.0 10.8 20,6 I00.0 624 6.8 5.1 Reglon Nollheast 18.6 14.9 13.9 12.5 10.4 7.5 6.2 5.0 4.0 3.1 4.0 100.0 2,000 3.3 2.5 No~hwest 16.4 14.6 13.5 12.5 11.2 8.2 6.3 7.7 4.6 1.9 3.1 I00.0 2,098 3.4 2.6 Southeast 29.0 9.2 10.0 8.4 8.4 8.7 7.9 5.7 5.0 3.7 3.9 100,0 2,769 3.3 2.8 Southwest 31.9 10.8 8.6 7.7 9.8 8.6 7.1 4.3 5.5 2.1 3.6 100.0 1,915 3.1 2.5 To~al 24.2 12.1 11.4 10.2 9.8 8.3 7.0 5.7 4.8 2.8 3.6 100.0 8,781 3.3 2.6 CURRENTLY MARRIED WOMEN Age 15-19 41.4 42.1 13.4 2.3 0.8 0.0 0.0 0.0 0.0 0.0 0.0 I00.0 597 0.8 0.7 20-24 15.6 29.6 27,8 14.7 10.1 1.3 0.8 0.2 0.0 0.0 0.0 I00.0 1,279 1.8 1.5 25-29 5.3 12.7 19.0 22.3 16.3 14.2 7.2 2.0 0.7 0.2 0.2 I00,0 1,492 3.2 2.6 30-34 3.5 5.1 9.8 12.4 16.5 16.7 14.6 11.2 6.4 2.9 0.8 I00.0 1,348 4.6 3.8 35-39 3.9 2.5 7.0 7.6 14.0 12.0 14.8 14.1 II.3 6.3 6.5 100.0 892 5.6 4.4 40-44 4.7 4.2 3.9 7.9 7.8 8.7 11.1 13.6 14.7 9.4 14.0 I00.0 731 6.3 4.8 45-49 4.4 3.9 3.7 5.9 6.0 8.7 8.2 13.2 14,2 9.9 21.9 I00.0 543 6.8 5.1 Region Northeast 13.9 15.6 14.8 13.2 11.2 8.0 6.5 5.4 4.2 3.1 4.1 100.0 1,849 3.5 2.7 Northwest II.I 15.6 14.0 13.3 II.9 8.8 6.8 8.3 4.9 2,1 3.4 I00.0 1,944 3.7 2.8 Southeast 6.4 10.7 14.6 12.0 10.9 11.2 10.6 7.9 6.3 4.7 4.9 100.0 1,801 4.4 3.7 Southwest 5.8 13.9 12.0 10.9 14.0 11.9 10.0 6.2 7.7 3.0 4,8 100.0 1,287 4.3 3.5 Total 9.7 14.0 14.0 12.5 11.8 9.8 8.3 7.0 5.6 3.2 4.2 100.0 6,880 3.9 3.1 29 for all women increases rapidly with age, so that by the end of her childbearing years, a woman has given birth to almost seven children. The distribution of women by number of births indicates that alraost one- quarter of teens have already Ix)me a child, and nearly one-third of women age 45 and over have borne nine or more children. The results for younger women who are currently married differ from those for the sample as a whole because of the large number of unmarried women with minimal fertility. Differences at older ages, though minimal, generally reflect the impact of marital dissolution. The parity distribution for older, currently married women also provides a measure of primary infertility. Voluntary childlessness is rare in West Africa, anti married women with no live births are most likely unable to bear children. The NDHS results suggest that about 4 to 5 percent of Nigerian women are unable to bear children. 3.3 Birth Intervals There has been a fair amount of research to indicate that short birth intervals are deleterious to the health of babies. This is particularly true for babies born at intervals of less than 24 months. Table 3.6 shows the percent distribution of births in the five years preceding the survey by the number of months since the previous birth. Over one-quarter of births were born after an interval of less than 24 months. The median birth interval length (30 months) is only six months longer than the minimum considered safe. The unusual aspect of these results is that birth interval length is one of the very few behaviours examined in this report which is invariant to regional and educatlonal characteristics of the mother. Although the table indicates that a high proportion of births to teens were preceded by short intervals, this does not reflect the actual situation of most teen births because the table excludes first births (which are the majority of teen births). 30 Table 3.6 Birth intervals Percent distribution of births in the five yeurs preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Nigeria 1990 Number of months since previous binh Characteristic 7-17 18-23 24-35 36-47 48+ Median number of Number months since of Total previous birth births Age of mother 15-19 16.8 28.4 38.4 10.4 6.1 100.0 25.2 120 20-29 11.5 19.9 42.0 15.1 11.5 100.0 28.6 3,031 30-39 8.2 16.3 42.0 16.3 17.3 100.0 30.9 2,761 40 + 6.8 12.7 32.0 17.6 30.9 100.0 36.4 813 Birth order 2-3 9.5 18.9 41.6 15.1 14.9 100.0 29.4 2,534 4-6 9.5 17.5 40.0 16.5 16.6 100.0 30.7 2,709 7 + 10.3 16.1 40.5 15.8 17.4 100.0 30.7 1,481 Sex of prior birth Male 9.6 18.1 41.1 15.6 15.8 100.0 29.7 3,332 Female 9.7 17.4 40.4 16.0 16.5 100.0 30.6 3,393 Survival of prior birth Living 8.7 16.9 40.8 16.6 17.1 100.0 30.9 5,808 Dead 15.8 22.6 40.4 10.9 10.2 100.0 26.9 916 Residence Urban 8.8 16.9 42.3 16.5 15.4 100.0 30.4 1,392 Rural 9.9 17.9 40.3 15.6 16.3 I00.0 30,1 5,333 Region Northeast 9.4 17.2 37.4 17.0 19.0 100.0 31.1 1,576 Northwest 9.5 17.5 40.7 16.8 15.5 100.0 30.8 1,847 Southeast 11.7 18,7 43.9 12.9 12.8 100.0 28.6 2,049 Southwest 6.8 17.0 39.6 17.7 18.9 100,0 31.5 1,252 Education No education 9.1 16.9 38.8 16.6 18.6 100.0 31.2 4,445 Some primary 10.3 18.1 45.6 15.8 10.1 100.0 29.0 692 Completed primary 9.4 19.1 44.7 15.2 11.7 100.0 29.1 941 Some se.condm T 14.5 18.7 45.6 9.3 12,0 100.0 27.2 319 Completed secondary/higher 11.9 21.8 40.8 13.2 12.3 100.0 29.2 322 Total 9.6 17.7 40.7 15.8 16.1 100,0 30.2 6,724 Note: First-ordur births arc excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 3.4 Age at First Birth The age at which childbearing begins has important demographic consequences as well as important consequences for the mother and child. In many countries, postponement of first births, reflecting an increase in the age at marriage, has contributed greatly to overall fertility decline. Table 3.7 presents the distribution of Nigerian women by age at first birth, according to their current age. One-half of women became mothers before the age of 20, of which 10 to 12 percent gave birth before age 15, and 21 to 28 percent gave birth between age 15 and 17. There has been little change in the median age at first birth, although there is some evidence of a decline among younger women. 31 Table 3.7 Age at first biTth Percent disuibufion of women 15-49 by age at first birth, according to current age. Nigeria 1990 Current age Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-2l 22-24 25+ Total women birth 15-19 76.5 5.6 14.7 3.1 NA NA NA 100.0 1,612 a 20-24 32.3 12.1 22.8 18.6 10.3 3.9 NA 100.0 1,676 19.7 25-29 11.3 9.6 25.5 18.8 16.0 15.1 3.8 100.0 1,669 19.6 30-34 4.1 12.3 27.6 17.5 14.1 14.2 10.2 100.0 1,409 19.1 35-39 4.5 9.4 23.4 16.3 17.0 12,4 17.1 100.0 954 20.1 40~4 4.6 12.1 22.9 14.1 14.5 14.0 17.8 100.0 836 20.1 45-49 4.0 9.5 21.2 18.0 13.1 13.3 21.0 100.0 624 20.1 NA = Not applicable aLess than 50 percent of the women in the age group x to x+4 have had a birth by age x Table 3.8 summarizes the median age at first birlh for different cohorts and compares the entry age into parenthood for different subgroups of the population. (Medians for cohort 15 - 19 could not be determined because half the women have not yet had a birth.) Findings for older women should be interpreted with caution. For example, the higher medians for older women in the North may reflect omission or misdating of early births, rather than a genuine trend. Overall, the findings point to a possible decline in age at first birth in the North, and an increase in the South. The median age in the Northeast (18.8) is nearly two years below that in the Southwest (20.5). 32 Table 3.8 Median age st first birth Median age at first birth among women age 20-49 years, by current age and selected background characteristics, Nigeria 1990 Current age Background Ages Ages characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban a 20.8 19.9 20.4 20.8 20.4 a 20.4 Rural 19.1 19.3 18.8 20.0 19.8 20.0 19.3 19.4 Region Northeast 17,5 18.0 17.6 19,9 20.7 22.4 18.3 18,8 Northwest 18.5 19.2 19.4 20.1 20.4 19.4 19.3 19.5 Southeast a 20.0 19.5 19.9 18.6 19.4 19.9 19.6 Southwest a 21.3 19.6 20.4 20.6 20.6 a 20.5 Education No education 17.8 18.2 18.5 20.0 20.2 20.0 18.8 19.1 Some primary 19.0 19.3 18.9 19.1 19.8 19.8 19.3 19.3 Completed primary 19.7 20.2 20.2 20.6 19.6 20.8 a 20.3 Some secondary a 20.6 20.6 22.4 20.4 21.4 a 20.8 Completed secondary/higher a a 23,3 21.3 22.1 23.3 a 24,5 Total 19.7 19.6 19.1 20.1 20.1 20.1 19.7 19.7 Note: The medians for cohort 15-19 could not be determined because half the women have not yet had a birth. aMediarts were not calculated for these cohorts because less than 50 percent of women in the age group x to x+4 have had a birth by age x. 3.5 Teenage Pregnancy and Motherhood One of the targets outlined in the National Policy on Population is: "to reduce pregnancy to mothers below 18 years and above 35 years of age by 50 percent by 1995 and by 90 percent by the year 2000." Table 3.9 shows the percentage of women age 15-19 who are mothers or pregnant with their first child. About 40 percent of teenagers 18 years of age have already begun childbearing (have already given birth, or are pregnant with their first child), and 30 percent of teens 17 years of age. Attempts to reduce early childbearing need to target women in the North, where 48 percent of teens have begun childbearing, compared with 14 percent in the South. 33 Table 3.9 Teenage pregnancy and motherhood Percentage of teenagers 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Nigeria 1990 Percentage who are: Percentage who have Pregnant begun Number Background with f'tr st child- of characteristic Mothers child bearing teenagers Age 15 9.3 3.9 13.1 373 16 14.9 5.9 20.8 322 17 24.7 5.5 30.2 326 18 34.4 5.0 39.3 333 19 39.0 3.8 42.8 259 Residence Urban 14.6 2.8 17.4 462 Rural 27.0 5.6 32.7 1,150 Education No education 43.4 8.6 52.1 545 Some primary 19.2 7.4 26.6 193 Completed primary 18.1 3.1 21.2 329 Some secondary 7.0 1.2 8.2 372 Completed secondary/higher 11.2 1.0 12.2 169 Region Northeast 39.5 10.7 50.2 352 Northwest 40.7 5.6 46.2 308 Southeast 13.9 2.9 16.7 570 Southwest 9.1 1.6 10.8 381 Total 23.5 4.8 28.3 1,612 Figure 3.3 shows the percentage of teenagers who have begun childbearing (have already given birth, or are pregnant with their first child), by region. The differences between regions are great: four times as many women age 17 in the Northeast have begun childbearing as in the Southeast. 34 Figure 3.3 Percentage of Teenagers Who Have Begun Childbearing, by Region Percent 100 80 60 40 20 0 15 I i I 16 17 18 19 Age l --Northeast -~--Northwest --~- Southesst -~ Southwest i NDH8 1990 Whereas most teens who have begun childbearing have given birth only once, a small proportion have given birth twice. Table 3.10 shows the distribution of women age 15-19 by number of children ever born, excluding those who are currently pregnant. Eleven percent of women age 18 have given birth to two children. By giving birth early and presumably with short birth intervals, these women and their children are at a higher risk of dying. The issue of high-risk childbearing is discussed in Chapter 8. Table 3.10 Children bern to teenagers Percent dis~ibution of teenagers 15-19 by number of children ever bern (CEB), Nigeria 1990 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB teenagers 15 90.8 8.4 0.9 100.0 0.1 373 16 85.1 13.6 1.3 1(30.0 0.2 322 17 75.3 17.7 7.0 100.0 0.3 326 18 65.6 23.8 10.6 100.0 0.5 333 19 61.0 25.8 13.2 1(30.0 0.6 259 Total 76.5 17.3 6.2 100.0 0.3 1,612 35 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Contraception Determining the level of knowledge of contraceptive methods and of services was a major objective of the Nigeria DHS survey, since knowledge of specific methods and of the places where they can be obtained is a precondition for use. Information about knowledge of contraceptive methods was collected by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked if she recognised it. Eight modem methods--the pill, IUD, injection, foaming tablets, barrier methods (diaphragm, foam and jelly), condoms, female sterilisation and male sterilisation--were described, as well as two traditional methods--periodic abstinence (rhythm method) and withdrawal. Any other methods mentioned by the respondent, such as herbs or breastfeeding, were also recorded. For each method recognised, the respondent was asked if she knew where a person could obtain the method. If she reported knowing about the rhythm method, she was asked if she knew where a person could obtain advice on how to use the method. Table 4.1 indicates that less than half (46 percent) of all Nigerian women age 15-49 know of at least one method of family planning. Looked at another way, this means that over half of the women reported that Table 4.1 Knowledge of contraceptive methods and source for methods Percentage of all women and currently married women who know specific contraceptive methods and who know a source (for information or services), by specific methods, Nigeria 1990 Know method Know a source Currently Currently Contraceptive All married All married method women women women women Any method 45.7 43.6 34.0 31.9 Modern method 43,5 41.2 33.2 31.2 Pill 35,1 33.8 25.0 24.1 IUD 20,3 19.8 15.9 15.6 Injection 34.2 33.6 25.2 24.8 Foaming tablets 10.7 9.6 8.1 7.1 Diephragm/foam/jelly 7.9 7.3 6.2 5.7 Condom 24.1 21.6 17.7 15.9 Female stedlisation 20.4 19.4 15.7 14.9 Male sterilis atinn 7.5 6.7 5.6 4.9 Any traditional method 25.7 23.6 10.8 8.9 Rhythm 17.3 14.7 10.8 8.9 Withdrawal 14.2 12.4 HA NA Other traditional methods 10.0 10.3 NA NA Number of women 8,781 6,880 8,781 6,880 37 they did not know any method of family planning. Knowledge of methods was slightly lower among currently married women and higher among never-married women than among all women. However, since it is currently married women who are at greatest risk of pregnancy, this chapter focuses primarily on them. Almost twice as many married women reported knowing a modem method (41 percent) as reported knowing a traditional method (24 percent). The most frequently reported methods are the pill and injection, each known by 34 percent of married women. Following these, the condom, IUD, and female sterllisation are the most commonly known methods (about 20 percent of married women). Other modem methods (foaming tablets, diaphragm, and male sterilisation) are less well known. As for traditional methods, about 15 percent of married women know the rhythm method, i.e, periodic abstinence, while 12 percent know withdrawal. Although the level of contraceptive knowledge in Nigeria is low, there has been improvement over time. In the 1981/82 Nigerian Fertility Survey (NFS), only 34 percent of all women ~ reported that they bad heard of any method (National Population Bureau and World Fertility Survey, 1984, Table 7.2). Thus, in the 10 years between the NFS and the NDHS, the level of contraceptive knowledge increased by 35 percent. There were also large increases in the proportion of women who know specific methods (see Figure 4.1). Not all women who know a family planning method know where they can obtain it. One-quarter of the women who have heard of the two most frequently mentioned methods, the pill and injection, do not know a place where they can obtain the methods. The same is true for condoms. Overall, only one-third of Figure 4.1 Trends in Contraceptive Knowledge Women 15-49, NFS and NDHS Surveys Any method Pill IUD Injection Condom Female aterilisation Male sterilisation Rhythm Withdrawal 10 20 30 40 Percent W NFS 1981-82 =aim NDHS 1990 50 Data from the NFS are tabulated for all women, not just currently married women. 38 currently married women know a place where they can obtain some method of family planning. As with knowledge of the methods themselves, knowledge of places where specific methods can be obtained is slightly higher among women who have never been married than among those who are currently married. Table 4.2 indicates that among married women, knowledge of at least one contraceptive method is somewhat higher among women in their late 20s than among younger or older women. This is also true for knowledge of at least one modem method and knowledge of a place to obtain a modem method. Knowledge of contraceptive methods and their sources differs substantially by urban-rural residence. The proportion of Table 4.2 Knowledge of modem contraceptive methods and source for methods Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by selected background characteristics, Nigeria 1990 Know a Know Know source for Number Background any a modem modem of characteristic method method 1 method women Age 15-19 31.7 30.5 23.0 597 20-24 45.4 42.1 31.8 1,279 25-29 49.2 47.2 36.1 1,492 30-34 43.5 41.9 30.1 1.348 35-39 44.4 42.1 34.0 892 4044 43.9 41.4 31.3 731 45-49 35.3 30.2 23.9 543 Residence Urban 70.4 68.5 58.9 1,476 Rural 36.3 33.7 23.7 5,404 Region Northeast 24.0 21.9 17.9 1,849 Northwest 30.3 27.7 15.1 1,944 Southeast 56.6 53.9 40.9 1,801 Southwest 73.6 71.4 61.2 1,287 Education No education 29.1 26.7 18.3 4,610 Some primary 63.1 60.2 43.0 594 Completed primary 67.2 64.5 52.6 911 Some secondary 83.8 82.0 66.0 322 Completed secondary/higher 90.8 89.4 81.9 438 Total 43.6 41.2 31.2 6,880 1Includes pill, IUD, injection, vaginal methods (foaming tablets/diaphragm/ foam/jelly), condom, female stefilisation, and male sterilisation. 39 urban married women who know at least one family planning method (70 percent) is twice that of rural women (36 percent). The same relationship holds for knowledge of a modem method; however, knowledge of a source for a modem method shows an even wider differential, with almost 60 percent of urban women knowing a source, compared to only 24 percent of rural women. This means that, not only are rural women less likely than urban women to know specific contraceptive methods, but even among those who do, a smaller percentage know of a source for these methods. Differences in contraceptive knowledge by region are large. The proportion of married women who have heard of at least one family planning method is three times higher in the Southwest (74 percent) than in the Northeast (24 percent). The level of knowledge in the Southeast (57 percent) is also higher than in the Northwest (30 percent). The same pattern holds for knowledge of modem methods and for knowledge of where these methods can be obtained. There are also large differences in contraceptive knowledge by educational attainment. Fewer than 30 percent of women with no education say that they have heard of any method of family planning, compared to two-thirds of those with primary education and over 80 percent of those with some secondary education. Over 90 percent of respondents who completed secondary school have heard of a family planning method. 4.2 Ever Use of Contraception All women interviewed in the NDHS who said that they had heard of a method of family planning were asked if they had ever used it. Only one in seven Nigerian women (15 percent) has ever used a method of family planning and only one in eleven (9 percent) has ever used a modem method (see Table 4.3). A slightly smaller proportion of currently married women (14 percent) have ever used family planning than among all women (15 percent). Ever-use is lowest for those in the youngest and oldest age groups (15-19 and 45-49 years) and is relatively uniform for those in the intermediate age groups. Ever-use of modem methods among currently married women is only slightly higher than ever-use of traditional methods. The most widely used methods are the pill (5 percent of married women) and rhythm method, i.e., periodic abstinence (4 percent). Three percent of married women have ever used withdrawal, and two percent each have ever used condoms, injection, and the IUD. The level of ever use of family planning appears to remain constant over time, with 14 percent of currently married women in both the 1981/82 NFS and the 1990 NDHS saying they had used a family planning method sometime 2 (London, et al., 1985). However, most of the ever-use reported in the earlier survey consisted of prolonged abstinence, which was not specifically asked about in the NDHS and is not considered a family planning method as such. Ever use of modem methods increased among currently married women from 2 percent in 1981/82 to 8 percent in 1990. Data from the NFS cited here are not strictly comparable to those from the NDHS, since they refer to women age 15-44, instead of 15-49; however, the effect of this discrepancy is minimal. 40 Table 4.3 Ever use of contr~eption Percentage of all women and currently married women who have ever used a contraceptive method, by specific methods and age, Nigeria 1990 Age of woman Background All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Ages ALL WOMEN Any method 8.3 18.0 18.7 14,1 18.3 15.7 12.7 15.2 Modern method 4.0 10.1 11.3 8.0 12.3 11.5 7,1 9.0 Pill 1.8 5.0 6.5 4,5 7.0 5.9 4.6 4.9 IUD 0.2 0.7 1.3 1.8 3.1 3.8 2,0 1.6 Injection 0.5 1.5 1.6 2,0 3.0 3.9 2,2 1.8 Foaming tablets 0.7 0.6 0.6 0.6 1.1 0.8 0.0 0.6 Diaphragm/foam/jelly 0.2 O. 1 0.3 0.2 0.3 0.1 0.0 0.2 Condom 1.6 4.6 3.8 1,9 1.6 1.0 1.0 2.5 Female sterilisation 0.0 0.0 0.1 0.1 0.4 1.3 0.6 0.2 Male sterilisatinn 0.0 O. 1 0.0 O. 1 0.2 0.0 0.0 0.0 Any traditional method 5,9 12.8 11.7 9.0 8.6 6.5 8,0 9.3 Rhythm 3,9 7.7 7.8 4.5 4,5 3.1 3.4 5.4 Withdrawal 1,8 5.0 5.5 3,3 2.6 2.1 1.9 3.5 Other traditional methods 1,3 2.7 1.8 2.5 2.7 2.4 3.7 2,3 Number of women 1,612 1.676 1,669 1,410 954 836 624 8.781 CURRENTLY MARRIED WOMEN Any method 4.4 13,4 16.0 13.7 17.3 16.2 12.1 14.0 Modern method 2,2 7.3 9.6 7.6 11.3 12.1 7.2 8.4 Pill 1.0 4.1 5.6 4.4 6.1 6.4 4.5 4.8 IUD 0.3 0.7 1.2 1.9 2.6 4.1 2.3 1.7 Injection 0.5 1.5 1.3 1.7 3.1 4.0 2.4 1.9 Foaming tablets 0.1 0.2 0.6 0.5 1.2 1.0 0.0 0.5 Diaphragm/foam/jelly 0.0 0.0 0.2 0.2 0.3 0.1 0.0 0.1 Condom 0.7 2,2 3.3 1.8 1.7 1.0 1.0 2.0 Female stefilisation 0.O 0.0 0.1 0.1 0.4 1.4 0.5 0.3 Male sterilisation 0.0 0.0 0.0 O. 1 0.2 0.0 0.0 0.0 Any traditional method 2.9 9.0 9.6 8.7 8.7 6.6 6.9 8.1 Rhythm 1.0 5.0 6.1 4.3 4.8 3.1 2.3 4.3 Withdrawal 1.1 2.5 4.6 3.1 2.5 2.2 1.3 2.8 Other traditional methods 1.2 2.4 1.7 2.4 2.7 2.3 3.7 2.3 Number of women 597 1,279 1,492 1,348 892 731 543 6,880 41 4,3 Current Use of Contraception Only 6 percent of currently married women in Nigeria are using a contraceptive method (see Table 4.4). Contraceptive use among women who are not married is twice as high, 13 percent (not shown). Since it is customary to analyze contraceptive use among currently married women, this chapter focuses primarily on married women. TaMe 4,4 Current use of contraception Percent distribution of all women and of ctuarently married women by contraceptive me~hod currently used, according to age, Nigeria 1990 Ago of woman Method 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-44 15-49 ALL WOMEN Any method 5.9 9.5 8.6 6.5 8.4 7.9 4.2 7.8 7.5 Any modern method 1.9 3.8 3.9 3.6 5.3 5.4 3.3 3,8 3.8 Pill 1.0 1.7 1.7 1.1 1.7 1.1 1.3 1.4 1.4 IUD 0.1 0.3 0.9 1.1 1.2 1.7 0.6 0.7 0.7 Injection 0.1 0.7 0.4 0.9 1.5 1.1 0.6 0.7 0.7 Foanfin 8 tablets 0.3 0.1 0.1 0,2 0.2 0.2 0.0 0.2 0.2 Condom 0.4 1.1 0.8 0.2 0.3 0.1 0.1 0.6 0.5 Female sterilisation 0.0 0.0 0.I 0,1 0.4 1.3 0.6 0.2 0.2 Any traditional method 3.9 5.6 4.6 2.8 3.1 2.5 1.0 4.0 3.8 Rhythm 2.9 3.7 3.3 1.5 1.6 1.0 0.3 2.6 2.4 Withdrawal 0.5 1.2 0.9 0.5 0.6 0.8 0.1 0.8 0.7 Other Ixac~tional methods 0.6 0.8 0.4 0.7 1.0 0.7 0.5 0.7 0.7 Not using 94.1 90.5 91.4 93.5 91.6 92.1 95.8 92.2 92.5 Total 100.0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 100.0 Number of women 1,612 1,676 1,669 1,410 954 836 624 8,157 8,781 CURRENTLY MARRIED WOMEN Any method 1.3 5.1 6.0 6.5 8.6 8.4 4.6 6.1 6.0 Any modern method 0.6 2.7 3.1 3.7 5.4 5.8 3.6 3.5 3.5 PHI 0.2 1.4 1.2 1.1 1.8 1.2 1.5 1.2 1.2 IUD 0.0 0.2 0.7 1.1 1.0 1.9 0.7 0.8 0.8 Injection 0.0 0.6 0.3 0.9 1.6 1.0 0.7 0.8 0.7 F, oarmng tablets 0.0 0.1 0.1 0.2 0.2 0.2 0.0 0.1 0.1 Condom 0.4 0.4 0.6 0.2 0.4 O. 1 O. 1 0.4 0.4 Female sterilisation 0.0 0.0 0.1 0.1 0.4 1.4 0.5 0.3 0.3 Any traditional method 0.7 2.4 3.0 2.7 3.2 2.6 1.0 2.6 2.5 Rhythm 0.2 1.6 2.0 1.4 1.7 1.0 0.4 1.4 1.4 Withckawal 0.3 0.4 0.7 0.6 0.6 0.9 0.0 0.6 0.5 Other traditional methods 0.3 0.4 0.4 0.8 0.9 0.7 0.6 0.6 0.6 Not using 98.7 94.9 94.0 93.5 91.4 91.6 95.4 93.9 94.0 Totsl I00.0 I00.0 I00.0 I00.0 I00.0 I00.0 100.0 I00.0 I00.0 Number of women 597 1,279 1,492 1,348 892 731 543 6,338 6,880 Almost as many married women are using traditional methods (3 percent) as are using modem methods (4 percent). The most popular contraceptive method is the rhythm method, i.e, periodic abstinence, followed by the pill, IUD, and injection, each of which is used by about one percent of married women. Contraceptive use is highest among women in their late 30s and early 40s, and lowest among women age 42 15-19. This pattern is most likely due largely to the fact that younger women are just starting their families, while older women are more likely to have completed their families and to want to stop childbearing altogether. For the same reasons, younger women are more likely to use less effective methods such as withdrawal or rhythm, or temporary methods such as the condom, while older women are more likely to use more effective methods such as the pill, IUD, and injection. As with the data on ever use, it appears at f'Lr St glance that the level of current use of family planning has changed little over time, increasing among married women age 15-44 from 5 percent in 1981/82 (London, et al., 1985) to 6 percent in 1990. However, most of current use in the earlier survey was of traditional methods, almost exclusively prolonged abstinence. Looking just at modem methods, current use increased from I percent to 4 percent among married women age 15-44. While overall use of family planning is quite low, the NDHS data show that some women are more likely to bc using contraception than others (sue Table 4.5 and Figure 4.2). Women most likcly to be using Table 4.5 Curr~t use of cor~aception by backp~otmd cheracteristlcs Percent distribution of curre~ttly married women by contraceptive method curronfly used, according to selected background characteristics, Nigeria 1990 Modem raethoda Traditional metho& Not Any Any Periodic usin 8 Number Background Any modern In'~c- Con- bad. ablti- With- any of characteristic method method Pill IUD don dcfn method nence drawal Other method Total women Realdence Urban 14.8 9.6 3.1 2.5 1.8 1.1 5.2 3.5 1.1 0.6 85.2 100.0 1,476 Rural 3.6 1.9 0.7 0.3 0.4 0.1 1.7 0.8 0.4 0.5 96.4 100.0 5,404 Regina Northeast 2.0 1.3 0.5 0.1 0.5 0.0 0.7 0.0 0.2 0.5 98.0 100.0 1,849 Northwest 1.2 0.7 0.4 0.2 0.0 0.0 0.5 0.0 0.0 0.4 98.8 100.0 1,944 Scuthe.tst 8.8 3.9 0.8 0.9 1.1 0.5 5.0 3.5 1.0 0.5 91.2 100.0 1,801 Southwest 15.0 10.5 4.0 2.5 1.6 1.2 4.5 2.3 1.1 1.1 85.0 100.0 1,287 l~du~Uon No education 2.0 1.3 0.5 0.2 0.3 0.0 0.7 0.1 0.1 0.4 98.0 100.0 4,610 Some pxlnu~ 7.8 3.9 1.3 0.6 1.1 0.0 3.9 1.5 1.4 1.0 92.2 100.0 594 Completedlzlmary 10.5 6.4 2.0 1.9 1.4 0.3 4.1 2.8 0.5 0.8 89.5 100.0 911 Some secondary 17.0 9.7 3.2 1.7 2.8 1.1 7.3 4.1 2.1 1.1 83.0 100.0 322 Completed secondary/higher 28.4 16.7 5.5 4.4 1.6 4.2 11.7 9.0 2.2 0.4 71.6 100.0 438 Number of living children None 4.2 1.6 0.9 0.0 0.3 0.3 2.6 2.0 0.3 0.3 95.8 100.0 802 I 3.5 1.7 0.7 0.1 0.1 0.6 1.8 0.9 0.6 0.3 96.5 100.0 1',154 2 4.1 2.6 0.9 0.3 0.6 0.7 1.6 0.8 0.2 0.5 95.9 100.0 1,172 3 5.1 2.8 0.9 0.8 0.5 0.1 2.3 1.3 0.S 0.5 94.9 100.0 1,051 4 7.0 4.5 LI 1.9 0.9 0.3 2.5 1.5 0.5 0.5 93.0 100.0 894 5ormo~e 9.6 6.2 2.2 1.4 1.5 0.2 3.5 1.7 0.8 1.0 90.4 100.0 1,806 Total 6.0 3.5 1.2 0.8 0.7 0.4 2.5 1.4 0.5 0.6 94.0 100.0 6,880 Note: Total men of modem methods and all methods include usen of fcsmlng tablets (0.1 perce~ ~ women) and female sterilization (0.3 perumt of w~nm). 43 Figure 4.2 Current Use of Contraception Currently Married Women 15-49 RESIDENCE Urban Rural REGION Northeast Northwest Southeaet Southwest EDUCATION No educ. Prim. Incomp. Prim. Comp. Sec. Incomp Sec./Higher ~ 4 2 []1 ~ 8 m 2 8 17 28 O 10 20 30 Percent NDHS 1990 contraception are those in urban areas, those inthe Southwest, those withmore education, and those with five or more children. Urban women are four times more likely to be using family planning (15 percent) than rural women (4 percent). Both urban and rural women rely primarily on the rhythm method, followed by the pill. The proportion of married women using any method of contraception varies widely by region, from 1 percent in the Northwest to 15 percent in the Southwest. In the North, the pill and traditional methods (other than rhythm, i.e., periodic abstinence, and withdrawal) are the most frequently used methods; in the Northeast, injection is also used. In the Southeast, the rhythm method is the most popular method, followed by injection, withdrawal, the IUD, and the pill, all of which have about the same level of use. In the Southwest, the pill, IUD, and rhytlun are the most widely used methods. Greater use of family planning among women with formal education--an association documented in countries around the world--also occurs in Nigeria. Contraceptive use increases steadily with increasing level of education, from 2 percent of women with no education to more than one-quarter (28 percent) of those who have completed secondary education. At all educational levels, traditional methods account for around half or just under half of all use, and the rhythm method is the single most widely used method for all but those with no education. As for modem methods, the pill is the most popular method among all educational groups. Use of condoms is limited to those who have secondary schooling. Contraceptive use varies little according to the number of children a woman has, up to four children. As the number of children increases, use of modem methods becomes more important in the overall method mix. 44 4.4 Number of Children at First Use of Contraception In many cultures, family planning is used only when couples have already had as many children as they want. As the concept of planning families gains acceptance, however, couples may begin to use contraception for spacing births as well as for limiting family size. Moreover, unmarried young women may be particularly motivated to use family planning to avoid an unwanted pregnancy. Table 4.6 shows the number of children a woman had when she first used contraception. For older age cohorts, women generally started using family planning only after they had had five or more children. For younger age cohorts, women were more likely to have started using family planning before they had had any children. For example, roughly the same proportion of women age 45-49 and 20-24 have ever used a contraceptive method (13 percent and 14 percent, respectively). However, while over half of the ever users age 45-49 waited until they had had at least four children, half of the ever users age 20-24 started to use a method before they had had any children at all. This reflects a shift towards use of family planning for spacing puq)oses. Table 4.6 Number of children at First use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Nigeria 1990 Number of living children at time Never of first use of contraception Number Current used of age contraception 0 1 2 3 4 5+ Total women 15-19 95.7 2.4 1.8 0.0 0.0 0.0 0.0 100.0 622 20-24 86.3 6.6 3.7 1.9 1.0 0.2 0.0 100.0 1,312 25-29 84.0 4.7 4.0 2.9 2.3 1.1 1.0 100.0 1,537 30-34 86.2 2.3 2.8 2.4 1.5 1.8 2.8 100.0 1,397 35-39 82.3 2.2 1.1 2.6 1.8 2.7 7.0 100.0 943 40-44 84.3 1.5 1.5 1.2 2.6 2.3 6.1 104).0 834 45-49 87.3 0.9 1.2 0.7 2.7 1.2 5.9 100.0 624 Total 85.9 3.4 2.6 1.9 1.7 1.3 2.9 100.0 7,268 4.5 Use of Social Marketing Brand Pills Several years ago, a social marketing programme was launched to distribute oral contraceptives (the pill) through the private sector. The programme operates by providing a large pharmaceutical company with pills for a price that is just above cost. The company then sells them through its roughly 4000 outlets throughout the country. More recently, the programme was expanded to include condoms and foaming tablets, but this change was too recent to be measured in the NDHS. In order to measure the extent to which the programme has reached the general public, all NDHS respondents who reported that they were currently using the pill (121 women) were asked to show the packet of pills they were using, or, if they could not, to tell the interviewer which brand they were using. Overall, only 4 percent of pUl users were using either of the two social marketing brands, Nordiol and Norquest. The 45 proportion was the same in urban and rural areas (4 percent in urban, 5 percent in rural areas). The social marketing project seems to have made the greatest impact in the Southeast, where 10 percent of pill users are using a social marketing brand; in the Southwest, the proportion is only 3 percent. There were too few pill users in the Northeast and Northwest to tabulate brand used. In fact, even in the two southern regions, the numbers of pill users is small, and, consequently, the data on brands used are subject to relatively high sampling errors. It should be noted that both brands are available through outlets other than those of the social marketing project; however, most users of these brands probably obtained them through project outlets. 4.6 Knowledge of the Fertile Period A basic knowledge of reproductive physiology is useful for successful practice of coital-related methods such as withdrawal, the condom, or barrier methods, but it is especially important for users of periodic abstinence or the rhythm method. The successful practice of periodic abstinence depends on an understanding of when during the ovulatory cycle a woman is most likely to conceive. Table 4.7 presents the percent distribution of all respondents and those who have ever used periodic abstinence by reported knowledge of the fertile period in the ovulatory cycle. Table 4.7 Knowledge of fertile period Percent disa'ibution of all women and of women who have ever used periodic abstinence by knowledge of the fertile period during the ovulatory cycle, Nigeria 1990 Ever users Perceived All of periodic fertile period women abstinence During menstrual period 2.3 3.7 Right after period has ended 30.2 34.1 In the middle of the cycle 20.0 42.6 Just before period begins 2.7 3.1 At any time 9.4 8.4 Don't know 35.1 7.9 Total 100.0 100.0 Number 8,781 474 Thirty-five pement of the women interviewed said they did not know when a woman is most likely to conceive and 30 percent said that a woman is most likely to conceive just after her period has ended. Only 20 percent gave the "correct" response: that a woman is most likely to conceive in the middle of her ovulatory cycle. Ever-users of periodic abstinence are more knowledgeable about the ovulatory cycle than women in general. Forty-three percent identified the fertile time as occurring in the middle of the cycle, and only 8 percent said they did not know when it occurred. It should be noted that the precoded response categories for this question are only one way of dividing the cycle into distinct periods. Women may actually have a more accurate understanding of their fertility cycles than is reflected by these categories. However, it appears that almost half of all women and one-fifth of those who have used periodic abstinence do not 46 understand the ovulatory process, since they either reported that they did not know when a woman is most likely to get pregnant or they gave answers such as "during her period" or "at any time." 4.7 Sources for Family Planning Methods All current users of modem methods of family planning were asked to report the source from which they most recently obtained their methods. Because women often do not know exactly which category the source they use falls into (e.g., govemment hospital, private health centre, etc.), interviewers were instructed to write the name of the source. Supervisors and field editors were to verify that the name and the type of source were consistent, asking cluster informants for the names of local family planning sources if necessary. This practice was designed to improve the reporting of data on sources of family planning. Table 4.8 indicates that 37 percent of modem method users last obtained their methods from public (government) sources, while 47 percent relied on private sources, and 4 percent used outlets of the Planned Parenthood Federation of Nigeria. Government hospitals were the single most frequently cited source, 26 percent of users. In fact, one-half of users obtained their methods from hospitals or health cemres, whether public or private. Table 4.8 Source of supply for modern contraceptive methods Percent distribudon of current users of modem contraceptive methods by source of supply or information, according m specific method, Nigeria 1990 most recent DUreX/ Source Pill IUD Injection Condom Total I Total government 29.0 61.0 44.9 (13.4) 36.7 Govc~'nrnent hospital 19.5 41.2 31.9 (7.2) 25.9 Government health centre 8.2 19.8 10.9 (6,2) I0.0 Government doctor 1.3 0.0 2. I (0.0) 0.9 PPFM 2.3 7.8 3.6 (3.6) 4.3 Total prlvate 62.1 20.0 48.5 (54.9) 47.2 Private doctor 1.5 0.7 8.3 (0.2) 2.2 Private hospital/health centre 4.1 18.6 35.6 (4.0) 13.2 Private pharmacy 23.9 0.0 0.0 (14.2) 11,7 Private patient medical office 28.8 0.0 3.0 (30,7) 17.3 Private market 2.0 0.0 0.0 (4.1) 1.3 Private place of work 1.8 0.8 1.6 (1.7) 1.3 Total other sources 5.9 11.1 3.0 (11.7) 8.8 Mission 1.5 10.1 1.6 (0.0) 5.0 Friends#elatives 4.4 1.0 1.3 (11.3) 3.7 Don't know/Missing 0.7 0.0 0.0 (16.4) 2.9 Total 100.0 I00.0 I00.0 I00.0 100.0 Number of users 121 65 61 46 329 IUsers of foaming tablets (0.2 percent) and female stcrilisadon (0.2 percent) are excluded because there are fewer than 25 ceaes for each category. 47 Which source a woman uses depends on many things, one of which is the type of method she has chosen. Most pill users obtain supplies from private sources, one-quarter from pharmacies and one-quarter from patent medicine shops. Conversely, the IUD is obtained largely from govemment facilities, approximately two-fifths from government hospitals and one-fifth from govemment health centres. Injections are obtained about equally from govemment and private sources. Most condoms are purchased from patent medicine shops and pharmacies, and the condom is the method most likely to be obtained from friends or relatives. Overall, government sources supply 30 percent of pill users, 61 percent of IUD users, 45 percent of injection users, and 13 percent of condom users. Private sources supply 62 percent of pill users, 20 percent of IUD users, 49 percent of injection users, and 55 percent of condom users. Figure 4.3 summarises the sources for current users of all modem methods combined. Figure 4.3 Sources of Family Planning Methods Current Users of Modern Methods Other 9 =, Don't Know/ Missing 3% :e 47% Government 37% FN 4% NDHS 1990 Women who are currently using a modem contraceptive method were asked how long it takes to travel from their home to the place where they obtain the method. Nonusers were asked if they knew a place where they could obtain a modem method and, if so, how long it would take to travel there. The results are shown in Table 4.9. Looking f irst at women who are currently using a modem method, 34 percent are within 30 minutes of the place to which they go to get their method, while 30 percent are 30 minutes to one hour from their source. Only 22 percent of users of modem methods are one hour or more from their source of supply. As expected, urban users are generally closer than rural users to their supply sources. 48 Table 4.9 Time to somce of supply for modem contraceptive methods Percent distribution of women who are currently using a modem contraceptive method, of women who are not using a modern method, and of women who know a method, by time to reach a source of supply, according to urban-rural residence, Nigeria 1990 Women who are currently using a modem method Women who are not using a modem method Women who know a contraceptive method Minutes to source Urban Rural Total Urban Rural Total Urban Rural Total 0-14 22.2 9.1 17.1 12.1 2.9 5.0 15.5 6.9 10.2 15-29 17.4 16.8 17.1 11.5 1.8 4.0 14.2 4.8 8.4 30-59 31.1 28.3 30.0 16.5 5.4 7.9 21.2 12.6 15.9 60 or more 17.0 30.6 22.3 9.5 13.7 12.7 12.1 28.0 21.9 Does not know time 11.4 14.4 12.6 3.8 1.6 2.1 4.8 4.1 4.3 Does not know source 1.0 0.8 0.9 45.9 73.7 67.5 20.9 35.0 29.6 Not stated 0.0 0.0 0.0 0.6 0.9 0.8 11.3 8.5 9.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Median time to source 30.2 30.8 30.4 30.1 60.4 40.6 30.1 60.2 30.9 Number of women 200 129 329 1,821 6,296 8,117 1,542 2,475 4,017 Among women who are not currently using a modem method, two-thirds (68 percent) do not know a source for a modem contraceptive method. Since this question was asked of all nonusers and includes women who do not know a method, it is not surprising that so many do not know a source. The final panel of Table 4.9 is based on all women who know a method. Since women who were using a traditional method were not asked the questions on distance to a source of family planning, they are categorized as "not stated" in this panel. Even among women who know of at least one family planning method, 30 percent say they do not know of a place to get a modem method, and fewer than 20 percent are within 30 minutes of a source for a modem method. Among those who know a source, in urban areas there is no difference in the median distance (time) to a source between users and nonusers of modem methods; however, in rural areas, women who do not use are on average twice as far away from a source. 4.8 Intention to Use Family Planning Among Nonusers Women who were not using a contraceptive method at the time of the survey were asked if they thought they would do something to keep from getting pregnant at any time in the future. Among currently married nonusers, a large majority (68 percent) said they do not intend to use family planning in the future (see Table 4.10). About one in five nonusers (22 percent) said they did intend to use in the future; just over half of these women said they planned to use a method within the next 12 months. Intention to use family planning is closely related to the number of children a woman has. While only 9 percent of childless nonusers said they intended to use family planning in the future, 26 percent of nonusers with four or more children said they intended to use. Perhaps because contraceptive use is so low in Nigeria, the majority of those who say they intend to use contraception in the future are women who have never used. Those who used in the past but are not currently using make up less than nne-quarter of those who intend to use in future. 49 Table 4.10 Future use of contraception Petr, ent distribution of currently married women who are not using a contraceptive method by past experience with contraception and intention to use in the future, according to number of living children, Nigeria 1990 Past experience with contraception and future intentions Number of living children I 0 1 2 3 4+ Toml Never used contraception Intends to use in next 12 months 1.4 6.2 7.2 7.4 13.1 8.9 Intends to use later 4.9 9.4 7.9 8.3 7.0 7.6 Unsure as to intention 12.9 9.0 9.3 8.2 9.7 9.5 Does not intend to use 76.4 68.1 67.5 67,9 60.1 65.5 Previously used contraception Intends to use in next 12 months 0.6 2.0 2.6 3.9 4.6 3.3 Intends to use later 2.0 2.7 1.9 1.7 1.3 1.8 Unsure as to intention 0.2 0.7 0.9 0.4 0.6 0.6 Does not intend to use 1.6 1.9 2.6 2.2 3.4 2.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 All currently married nonusers Intends to use in next 12 months 2.0 8.1 9.7 11.3 17.7 12.2 Intends to use later 6.9 12.1 9.9 10.0 8.3 9.4 Unsure as to intention 13.1 9.7 10.2 8.6 10.3 10.2 Does not intend to use 78.0 70.1 70.1 70.2 63.6 68.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 578 1,127 1,095 1,058 2,606 6,465 lincludes current pregneney Table 4.11 presents the reasons for not using contraception given by women who do not intend to use a method. Of the 68 percent of married nonusers who say they do not intend to use family planning in the future, almost half say they do not intend to use because they want children (47 percent). Other reasons given are "religion" (12 percent), lack of knowledge (12 percent), and "fatalism" (6 percent), which encompasses responses that imply that there is nothing the woman can do about the number of children she will have. Women under age 30 are more likely to say that they do not intend to use because they want children, while those age 30 and over are more likely to cite reasons such as being menopausal or infecund ("difficult to get pregnant"), or lack of knowledge. 50 Table 4.11 Reasons for not using contraception Percent distribution of women who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Nigeria 1990 ~e Reason for not using contraception 15-29 30-49 Total Wants ch'ddren 57.7 37.6 47.1 Lack of knowledge 9.3 14.0 11.7 Fatalistic 5,3 6.0 5.7 Costs too much 0.2 0.5 0,4 Side effects 2.2 3.5 2.9 Health concerns 0.7 1.4 1.1 Hard to get methods 0.6 0.4 0.5 Religion 12.1 12.3 12.2 Opposed to family planning 3.4 4.4 3.9 Partner opposes family planning 2.8 2.2 2.5 Others oppose family planning 0.5 0.2 0.4 Infrequent sex 0.4 1.3 0.9 Difficult to get pregnant 1.9 6.3 4.2 Menopausal/hysterectomy 0.0 6.0 3.2 Inconvenient 0.6 1.0 0.8 Other reasons 0.4 0.6 0.5 Don't know 2.1 1.9 2.0 Total 100.0 100.0 100.0 Number of women 2,092 2,315 4,408 Nonusers who said that they d/d intend to use family planning in the future were asked which method they preferred to use (see Table 4.12). Most of these women said they preferred to use either the pill (30 percent) or injection (24 percent), while almost one-quarter (23 percent) were unsure which method they might use. Women who intend to use in the next 12 months are more likely to know which method they prefer to use and strongly favour the pill, while women who intend to use after 12 months are more likely to say they are unsure of which method they might use. 51 Table 4.12 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Nigeria 1990 Intend to use In next After Preferred method 12 12 of contraception months months Total Pill 34.0 24.2 29.7 IUD 6.2 4.4 5.5 Injection 26.7 21.2 24.3 Foaming tablets 0.3 0.3 0.3 Diaphragm/foam/jelly 1.1 0.8 1.0 Durex/Condom 1.7 2.6 2.0 Female sterilisation 4.2 3.6 3.9 Rhythm 5.2 5.6 5.4 Withdrawal 1.8 2.2 2.0 Other 2.8 3.1 3.0 Unsure/Don't know 16.1 31.9 23.0 Total 100.0 100.0 100.0 Number of women 790 607 1.397 4.9 Approval of Family Planning All respondents in the NDHS were asked if they had heard a message about family planning on radio or television in the month preceding the survey. One in four women said they had heard a message, while three-quarters had not (see Table 4.13). The proportion of women who had heard family planning messages varied widely by background characteristics. One-half of women who live in urban areas or in the Southwest had heard messages, compared to less than 20 percent of women living in rural areas or in regions other than the Southwest. More educated women were also much more likely to have heard a family planning message on radio or television than their less educated counterparts. 52 Table 4.13 Family planning messages on radio and television Percent disuributinn of all women by whether they have heard a family planning message on radio or on television in the month preceding the survey, according to selected background characteristics, Nigeria 1990 Heard family planning message on radio or on television Number Background of characteristic No Yes Total women Residence Urban 50.2 49.8 100.0 2,187 Rural 83.8 16.2 t00.0 6,594 Region Northeast 84.7 15.3 100.0 2,000 Northwest 80.1 19.9 100.0 2,098 Southeast 79.5 20.5 100.0 2,769 Southwest 54.5 45.5 100.0 1,915 Education No education 84.5 15.5 100.0 5,020 Some primary 78.8 21.2 100.0 794 Completed primary 66.8 33.2 100.0 1,300 Some secondary 58.8 41.2 100.0 765 Completed secondasy/higher 48.2 51.8 100.0 894 Total 75.4 24.6 100.0 8,781 Table 4.14 presents results from a question on whether women believe it acceptable or not acceptable to air family planning messages over radio or television. Just over half the women interviewed said that such messages are acceptable to them. 3 The proportion of women who think family planning messages are acceptable varies little according to the age group of the woman; only those age 45 -49 are slightly less likely to find such messages acceptable. However, there are strong differences in the acceptability of family planning messages by background characteristics. Women living in urban areas or in the Southwest, as well as more educated women are much more likely to accept family planning messages on radio or television than other women. Although not shown in Table 4.14, 30 percent said that it was not acceptable and 14 percent had no opinion. 53 Table 4,14 Acceptability of the use of mass media for disseminating family planning messages Pen~entage of women who believe that it is acceptable to have messages about family planning on radio or television, by age and selected background characteristics, Nigeria 1990 Age of woman Background ~:hasacteristie 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 74.0 81.4 80.9 75.1 74.6 71.8 63.7 76.4 Rural 49.3 50.5 51.7 47.4 48.8 52.1 43.1 49.4 Region Northeast 37.4 38.4 38.1 35.6 39.2 38.4 24.7 36.7 Northwest 32.6 40.1 42.6 37.6 29.5 37.8 31.0 37.2 Southeast 67.4 71.3 72.6 67.5 61.2 64.2 59.0 67.4 Southwest 76.6 86.0 85.0 78.3 81.2 81.2 72.2 80.8 Education No education 28.9 31.9 39.9 42.9 42.8 47.2 40.9 39.6 Some primary 56.9 69.0 66.3 75.9 78.1 88.8 78.2 70.3 Completed primary 64.7 69.1 76.3 75.9 86.2 84.6 80.9 72.9 Some secondary 75.3 83.5 91.6 84.5 94.0 96.6 100.0 81.6 Completed secondary/higher 85.4 89.4 91.1 93.1 97.9 94.4 73.5 89.8 Total 56.4 59.1 59.1 53.9 54.7 56.2 46.9 56.1 An indication of the acceptability of family planning is the extent to which couples discuss the topic with each other. Table 4.15 indicates that 41 percent of married women who know a contraceptive method had discussed family planning with their husbands in the previous year. Most of these women had discussed Table 4.15 Discussion of family planning by couples Percent distribution of currently married women who know a contraceptive method by the number of times family planning was discussed with husband in the year preceding the survey, according to current age, Nigeria 1990 Age Number of times family planning discussed Number Once or Three Not of Never twice or more ascenained Total women 15-19 69.7 22.4 6.9 0.9 100.0 189 20-24 62.0 26.4 11.4 0.3 100.0 580 25-29 57.9 25.0 16.6 0.5 100.0 735 30-34 55.2 25.2 19.2 0.5 100.0 587 35-39 54.4 23.4 20.9 1.3 100.0 397 40-44 53.0 20.2 23.6 3.2 100.0 32l 45-49 60.7 18.0 19.1 2.2 100.0 191 Total 58.1 24.0 17.0 1.0 100.0 2,999 54 the topic only once or twice with their husbands, but a substantial proportion had discussed family planning more often. Older women---except those age 45-49--are more likely to have discussed family planning with their husbands in the previous year than am younger women. To obtain more direct information about the acceptability of family planning, respondents were asked if they approved or disapproved of couples using a method to avoid pregnancy. Although all women were asked this question, the data presented here is restricted to currently married women and excludes those women who had never heard of a contraceptive method. Currently married women were also asked if they thought that their husbands approved of the use of family planning. It should bc noted that wives' opinions of their husbands' attitudes may bc incorrect, either bccanse they have misconstrued their husbands' truc attitudes, or because of a tendency to report their husbands' attitudes as similar to their own. Table 4.16 presents results from these two questions. Table 4.16 Attitudes of couples toward family plarming Among currently married women who know a conU'aceptive method, the percentage who approve of family plmming, by their perception of their husband's attitude and selected background characteristics, Nigeria 1990 Respondent approves mid: Both Husband's Number Background Respondent partners Husband attitude of characteristic aplxoves approve disapproves is unknown women Age 15-19 57.4 30.4 11.0 16.1 189 20-24 67.8 42.6 11.7 13.3 580 25-29 72.5 45.8 10.7 15.5 735 30-34 74.6 45.4 13.8 14.8 587 35-39 73.5 45.3 15.0 12.5 397 40M4 70.9 36.5 16.5 14.8 321 45-49 69.4 46.2 8.5 12.5 191 Residence Urbea 77.5 51.2 12.8 12.7 1,039 Rural 67.2 38.8 12.4 15.2 1,961 Region Northeast 62.6 39.0 10.9 I 1.8 444 Northwest 54.2 34.5 6.2 13.4 589 Southeast 75.3 43.8 12.4 18.1 1,020 Southwest 80.1 49.6 17.5 12.0 947 Education No education 59.4 32.3 11.7 14.7 1,344 Some primary 71.0 38.4 14.7 16.5 375 Completed primary 77.4 49.6 12.7 14.3 612 Some seonndm7 83.6 51.3 16.3 15.0 269 Completed second~/higher 89.9 68.3 10.7 10.5 398 Total 70.8 43.1 12.6 14.3 2,999 55 Overall, 71 percent of married women who know a contraceptive method approve of family planning. Forty-three percent of women say that their husbands also approve of family planning; only 13 percent say that they approve of family planning and their husbands do not. Approval of family planning by married women shows little variation by age of the woman, except that women age 15-19 are less likely to approve than older women. Married women (as well as their husbands) who live in urban areas, in the Southwest or the Southeast, and those who are better educated, are more likely than other women to approve of the use of family planning. 56 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY This chapter addresses the principal factors, other than contraception, which affect a woman's risk of becoming pregnant: nuptiality and sexual intercourse, postpartum amenorrhoea and abstinence from sexual relations, and secondary infertility. While it is by no means exact, marriage is an indicator of exposure of women to the risk of pregnancy, and is therefore important for the understanding of fertility. Populations in which age at marriage is low also tend to experience early childbearing and high fertility; hence the motivation to examine trends in age at marriage. This chapter also includes more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Measures of other proximate determinants of fertility are the durations of postpartum amenorrhoea and postpartum abstinence and the level of secondary infertility. 5.1 Marital Status Current marital status at the time of the survey is shown in Table 5.1. The term "married" refers to legal or formal marriage, while "living together" refers to informal unions. In subsequent tables, these two categories are combined and referred to collectively as "currently married" or "currently in union." Women who are widowed, divorced, and not living together (separated) make up the remainder of the "ever-married" or "ever in union" category. Table 5.1 Current marital status Percent distribution of women by current marital status, according to age, Nigeria 1990 Marital status Number Never Living Not living of Age married Married together Widowed Divorced together Total women 15-19 61.4 34.0 3.0 0.3 0.7 0.6 100.0 1,612 20-24 21.7 70.8 5.5 0.5 0.7 0.8 100.0 1,676 25-29 7.9 81.5 7.9 1.0 0.7 0.9 100.0 1,669 30-34 0.9 84.9 10.8 1.4 1.4 0.7 100.0 1,410 35-39 1.2 83.7 9.8 3.7 0.5 1.1 100.0 954 40-44 0.3 77.7 9.8 7.8 2.8 1.7 100.0 836 45-49 0.1 78.7 8.2 10.3 1.8 0.8 100.0 624 Total 17.2 70.9 7.4 2.4 1.1 0.9 100.0 8,781 57 Most women are currently in a union (78 percent). The NFS, which also defined marriage to include both formal and informal unions, reported a similar figure (80 percent of women were in a union at the time of the survey). Although the great majority of women are in a union, a fair proportion enter their twenties having never been married (22 percent of women age 20-24 years). As expected, the proportion of women who are widowed increases with age, reaching 10 percent among those 45-49 years. Two percent of women are divorced or separated. 5.2 Polygyny Since polygyny is common in Nigeria, married women were asked whether their husbands had other wives, and if so, how many. Overall, 41 percent of currently married women are in a polygynous union. 1 Table 5.2 indicates that polygyny exists in all regions and among all socioeconomic groups, although prevalence varies. Rural women and women in the North are more likely than urban women and women in the South to be in such unions. Nearly one-half of women who have no education are in a polygynous union, compared to 17 percent of those who have completed secondary school. Table 5.2 Polygyny Percentage of currently married women in a polygynous union, by age and selected background characteristics, Nigeria 1990 Age of woman Background All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 ages Residence Urban 22.6 26,0 27.4 34.5 39.3 51.5 45.6 33.6 Rural 27.8 35.8 38.2 51.1 49.6 45.5 55.1 42.9 Region Northeast 25,8 34.5 46.5 51.1 50.8 52.5 54.3 43.6 Northwest 31,0 44.1 43.8 62,3 57,0 50.4 65.8 49.7 Southeast 24.3 26.0 21.7 34.0 36.1 38,8 37.6 30.4 Southwest 21.4 23.6 28.7 40.0 50,1 45.4 57,1 38.4 Education No education 32.0 42.0 43.8 54.0 53.0 48.8 56.3 47.8 Some primary 27,1 34.8 40.4 32.3 28,4 43.4 26.6 34.1 Completed primary 11.5 26.8 21.7 34.6 33,5 35,1 49,5 27.0 Some secondary 22.5 20.5 31.3 25.8 42.5 49.6 20,5 26.8 Completed secondary/higher 0.6 15.0 11.9 23.7 26.6 33.8 36.3 16.9 Total 27.0 33.7 35.6 47.3 47.3 46.8 53.4 40.9 ~ The NFS also reported a high incidence of polygyny: 43 percent of currently married women reported themselves to be in a polygynous union. 58 It is not uncommon for a woman to have two or more co-wives (see Table 5.3). In fact, in the Southeast, although most women are in a monogamous union (70 percent), more women have two or more co-wives (20 percent) than have one co-wife (10 percent.) The likelihood of having two or more co-wives increases with age, as more time passes in which the husband may acquire a younger wife. Women who are more educated are less likely to have a co-wife; 28 percent of women with no education have one co-wife, compared to 8 percent of those who have completed secondary or higher education. Table 5.3 Number of co-wives Percont distribution of currently married woman by number of co-wives, according to selected background characteristics, Nigeria 1990 Number of co-wives Number Background of characteristic 0 1 2+ Total women Age 15-19 73.0 15.7 11.3 100.0 597 20-24 66.3 22.5 11.1 100.0 1,279 25-29 64.4 21.4 14.1 100.0 1,492 30-34 52.7 28.5 18.8 100.0 1,348 35-39 52.7 22.0 25.3 100.0 892 40-44 53.2 23.1 23.3 100.0 731 45-49 46.6 26.3 27.1 100.0 543 Residence Urban 66.4 20.0 13.4 100.0 1,476 Rural 57.1 24.0 18.9 100.0 5,404 Region Northeast 56.4 26.0 17.6 100.0 1,849 Northwest 50.3 33.3 16.3 100.0 1,944 Southeast 69.6 10.2 20.1 100.0 1,801 Southwest 61.6 21.8 16.6 100.0 1,287 Educatlon No education 52.2 28.0 19.8 100.0 4,610 Some primary 65.9 16.0 18.0 100.0 594 Completed primary 73.0 14.4 12.6 100.0 911 Some secondary 73.2 12.6 14.2 100.0 322 Completed secondary/higher 83.1 7.9 8.4 100.0 438 Total 59.1 23.1 17.7 100.0 6,880 5.3 Age at First Marriage The National Policy on Population states that "Families shall be dissuaded from giving away their daughters in marriage before the age of 18 years." However, the NDHS indicates that half the women in Nigeria have married by age 17 (the median age nationally) and, except for the youngest cohorts, this pattern has remained stable over time (see Table 5.4). 59 Table 5.4 Age at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage, according to currant age, Nigeria 1990 Percentage of women who were first married by exact age: Current age 15 18 20 22 Percentage Median who had Number age at never of first 25 married women marriage 15-19 20.1 NA NA NA NA 61.4 1612 a 20-24 26.7 51.9 67.6 NA NA 21.7 1676 17.8 25-29 29.8 55.0 68.8 78.6 88.6 7.9 1669 17.2 30-34 29.8 62.5 76.0 85.7 93.7 0.9 1410 16.3 35-39 25.4 56.4 70.1 82.8 90.3 1.2 954 17.3 40-44 29.9 57.6 70.6 85.9 92.7 0.3 836 16.8 45-49 24.0 56.5 71.9 83.5 91.6 0.1 624 17.3 20-49 28.0 56.4 70.6 81.2 88.2 7.3 7169 17.1 25-49 28.4 57.7 71.5 82.8 91.2 2.9 5493 16.9 NA = Not applicable SOmitted because less than 50 percent of the women in the age group x to x+4 were first married by age x Cohort trends in age at marriage can also be described by comparing the cumulative distribution for successive age groups, as shown in Table 5.4. (For each cohort the accumulated percentages stop at the lower age boundary of the cohort to avoid censoring problems. For instance, for the cohort currently aged 20-24, accumulation stops with the percentage married by exact age 20). On a national scale, age at marriage has not changed appreciably over time. Only among the youngest women (15-24) has there been a slight shift from marrying during the mid-teen years to the later teen years. Whereas about 30 percent of women have typically married by age 15, only 20 percent of those currently age 15-19 years have married by age 15. Thus, the median age at marriage has increased by about one-half a year. The national picture masks quite variable marriage behaviour pattems; Table 5.5 gives a more detailed picture of the trends in the median age at marriage. It can be seen that the slight change observed at the national level has been achieved primarily through changes in the behaviour of women in the South. In the Southeast, the median age at marriage has increased by two years between the cohorts of women age 20-29 and 40-49; a similar increase appears to be taking place in the Southwest. There has been no clear change in behaviour among women in the North. Education is closely related to age at first marriage. The median age at first marriage increases steadily with education, from 15.7 among women with no education, to 20 for women with secondary schooling. 60 Table 5.5 Median age at first marriage Median age at first marriage among women age 20-49 years, by current age and selected background characteristics, Nigeria 1990 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban a 19.9 18.l 18.7 18.9 19.1 19.4 19.0 Rural 16.7 16.3 15.9 16.8 16.4 16.9 16.4 16,3 Region Northeast 14.8 14.9 15.1 15.4 15.3 15.7 15.2 15,2 Northwest 15.7 15.4 15.4 15.2 15.2 15.7 15.4 15.4 Southeast 19.4 19.3 18.2 18.1 17.3 17.4 18.5 18.3 Southwest a 20.5 18.6 19.7 20.1 19.5 a 19.7 Education No education 15.2 15.3 15.6 16.1 16.0 16.8 15.7 15.8 Some primary 17.3 16.7 17.3 18.2 18.9 18.8 17.8 18.0 Completed primary 18.0 18.8 19.1 19.5 19.2 20.1 18.7 19.1 Some secondary 19.8 20.3 19.6 20.5 19.2 20.6 20.0 20.2 Completed secondary/higher a 24.9 22.9 21.1 22.2 23.4 a 23.9 Total 17.8 17.2 16.3 17.3 16.8 17.3 17.1 16.9 Note: Medians are not shown for women 15-19 because less than 50 percent have married by age 15 in all subgroups shown in the table. aOmitted because less than 50 percent of the women in the age group were first married by age 20. 5.4 Age at First Sexual Intercourse While age at first marriage is commonly used as a proxy for exposure to intercourse, the two events do not coincide exactly. Women may engage in sexual relations prior to marriage, especially if they are postponing the age at which they marry. The NDHS asked women to state the age at which they first had sexual intercourse (see Tables 5.6 and 5.7). (Note that the information on age at first sexual intercourse in Tables 5.6 and 5.7 parallels the information on age at first marriage in Tables 5.4 and 5.5.) In many cases sexual activity precedes marriage (see Table 5.6). For example, by age 18, 63 percent of women have had intercourse, whereas only 56 percent have married; by age 20, 80 percent have had intercourse, while 72 percent have married. Overall, the median age at first sexual intercourse is just over 16 years, which is about three-quarters of a year earlier than the median age at marriage. Comparing cohorts, there has been little change over time. 61 Table 5.6 Age at first sexual intercourse Percentage of women who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at f'trst intercourse, according to current age, Nigeria 1990 Current age 15 18 20 22 Percentage of women who had Percentage Median first intercourse by exact age: who Number age at never had of first 25 intercourse women intercourse 15-19 24.4 NA NA NA NA 45.6 1,612 a 20-24 29.7 63.0 82.5 NA NA 7.5 1,676 16.6 25-29 31.2 62.1 80.4 89.6 96.7 1.5 1,669 16.4 30-34 32.8 67.4 82.6 91.9 97.4 0.4 1,410 15.9 35-39 27.8 63.0 75.3 87.5 93.3 0.2 954 16.5 404-4 31.1 61.1 77.5 89.9 94.2 0.0 836 16.4 45-49 27.6 62.3 78.7 88.3 94.2 0.0 624 16.5 20-49 30.4 63.4 80.2 89.9 94.8 2.2 7,169 16.3 25-49 30.6 63.5 79.4 89.7 95.6 0.6 5,493 16.2 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 had had intercourse by age x I f women do not wait for marriage to become sexually active, has the increasing age at marriage in the Southeast and Southwest and among women with increasing education had any effect on reducing exposure to intercourse? Table 5.7 shows that while women in the Southeast and Southwest do indeed initiate sexual activity two to three years later than women in the Northeast and Northwest, they have been doing so for several decades. While age at marriage has been increasing, the age of initiating sexual relations has remained unchanged in the Southeast and Southwest. However, women with more education do tend to marry later (the median age at first marriage for the most educated women is eight years later than that of women with no education); but they do not delay sexual relations to the same degree that they delay marriage (the median among the most educated is 3,5 years later than for the least educated women). An urban-rural comparison shows similar results: while urban women have a median age at marriage three years later than rural women, their median age at first intercourse is only two years later. 62 Table 5.7 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 years, by current age and selected background characteristics, Nigeria 1990 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 17.9 17.8 17.4 17.6 17.8 18.3 17.8 17.7 Rural 16.0 15.9 15.7 16.1 16.1 16.0 15.9 15.9 Region Northeast 14.7 15.0 15.0 15.4 15.3 15.5 15.1 15.2 Northwest 15.5 15.3 15.3 15.1 15.3 14.9 15.3 15.2 Southeast 17.8 17.9 17.6 17.4 16.6 17.1 17.6 17.5 Southwest 18.4 18.5 17.9 18.7 18.9 18.4 18.4 18.5 Education No education 15.0 15.2 15.4 15.8 15.9 15.9 15.5 15.6 Some primary 16.6 16.3 16.8 17.8 18.3 18.3 17.1 17.3 Completed primary 17.3 18.2 18.3 18.5 17.9 18.9 18.0 18.2 Some secondary 18.1 18.1 19.1 18.5 17.8 20.1 18.3 18.4 Completed secondary/higher 18.9 19.0 20.0 19.2 18.5 20.0 19.0 19.2 Total 16.6 16.4 15.9 16.5 16.4 16.5 16.3 16.2 Note: Medians were not shown for women 15-19 because less than 50 percent had had intercourse by age 15 in all subgroups shown in the table. 5.5 Recent Sexual Activity In the absence of contraception, the probability of pregnancy is related to the frequency of intercourse. Thus, information on sexual activity can be used to refine measures of exposure to pregnancy. Only l0 percent of women interviewed in the NDHS had never had sexual intercourse. But not all women who have ever had intercourse are currently sexually active. Table 5.8 presents data on sexual activity, by background characteristics; the distributions are shown for women who have ever had intercourse. Women are considered to be sexually active if they had intercourse at least once in the four weeks prior to the survey. Women who arc not sexually active may be abstaining in the period following a birth, ormaybe abstaining forvariousother rcasons. Among women who have had sexualintercourse, 61 percent were sexually active in the month prior to the survey. Women who have never been in a union are just as likely to be sexually active as those who are in a union; however, they are not as likely to be postpartum abstaining (the main reason women in a union may not be sexually active). Approximately one-fifth of women in the South who have ever had sexual intercourse are currently abstaining for reasons other than being postpartum; this number is double that for women in the North. Compared to the Northeast (where three-quarters of women who have had intercourse are currently sexually active), only half of the women in the South are currently sexually active. As expected, women who arc using a method of family planning are more likely to be sexually active than those who are not. 63 Table 5.8 Recent sexual activity Percent distribution of women who have ever had sexual intercourse by sexual activity in the four weeks preceding the survey and the duration of abstinence by whether or not postpartum, according to selected background characteristics, Nigeria 1990 Not sexually active in last 4 weeks Sexually Abstaining Absta/ming active (postpartum) (not postpartum) Number Background in last of characteristic 4 weeks 0-1 years 2+ years 0-1 years 2+ years Missing Total women Age of mother 15-19 66.3 16.7 1.7 13.8 0.8 0.7 100.0 877 20-24 65.8 19.8 1.0 12,4 0.8 0.2 100.0 1,551 25-29 58.7 25.7 3.0 10.9 1.3 0.4 100.0 1,646 30-34 61.1 21.2 4.2 12.1 1.2 0.2 100.0 1,404 35-39 57.7 20.4 4.7 13.7 3.3 0.1 100.0 952 40-44 56.8 10.8 6.4 17.2 8.6 0.2 100.0 836 45-49 52.5 8.1 1.6 22.0 15.9 0.0 100.0 624 Duration of union 0-4 59.3 29.0 1.7 9.0 0.3 0.7 100.0 1,377 5-9 62.8 24.9 2.8 9.1 0.3 0.2 100.0 1,405 10-14 63.0 20.1 4.7 10.9 1.3 0.0 100.0 1,374 15-19 60.5 21.5 3.4 12.0 2.4 0.2 100.0 1,261 20-24 58.7 16.0 5.3 14.9 5.1 0.0 100.0 847 25+ 58.9 5.6 2.7 18.9 13.5 0.3 100.0 1,003 Never in union 58.5 3.1 0.9 33.0 4.0 0.6 100.0 623 Residence Urban 58.0 18.2 2.5 17.6 3.5 0.2 100.0 1,881 Rural 61.4 19.4 3.3 12.4 3.2 0.3 100.0 6,010 Region Northeast 74.6 14.8 1.7 7.5 1.1 0.4 100.0 1,920 Northwest 66.3 20.1 3.1 8.3 2.1 0.2 100.0 1,990 Southeast 52.0 19.9 3.7 18.8 5.5 0.2 100.0 2,349 Southwest 49.4 21.9 4.1 20.0 4.2 0.4 100.0 1,632 Education No education 63.1 18.0 3.8 11.1 3.7 0.2 100.0 4,878 Some primary 52.4 27.0 3.7 13.3 3.4 0.1 100.0 680 Completed primary 55.6 22.4 2.9 16.4 2.5 0.3 100.0 1,093 Some secondary 57.5 20.3 0.4 19.9 2.0 0.0 100.0 487 Completed secondary/higher 60.8 13.7 0.2 22.1 2.3 0.8 100.0 745 Current contraceptive No method 59.0 20.6 3.4 13.3 3.5 0.2 100.0 7,228 Pill 79.6 2.4 0.0 16.4 1.1 0.5 100.0 121 IUD 85.1 0.7 1.6 11.2 1.4 0.0 100.0 65 Injection 84.7 3.8 0.0 11.5 0.0 0.0 100.0 61 Durex]Condom (81.6) (2.6) (0.0) (15.7) (0.0) (0.0) 100.0 46 Other modern (76.3) (4.5) (3.1) (12.7) (3.3) (0.0) 100.0 37 Other 74.1 3.8 0.2 20.4 0.4 1.1 100.0 331 Total 60.6 19.1 3.1 13.6 3.3 0.3 100.0 7,891 64 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility Postpartum protection from conception can be prolonged by breastfeeding, which can lengthen the duration of amenorrhoea (the period following a birth, but prior to the return of menses). Protection can also be prolonged by delaying the resumption of sexual relations. Table 5.9 presents the percentage of births whose mothers are postpartum amenorrboeic and abstaining, as well as the percentage of births whose mothers are defined as still postpartum insusceptible for either reason, by time since the last birth. Table 5.9 Postpartum amenorrhoea) abstinence mad insusceptibility Percentage of births whose mothers are postpartum amanorrhoeic, abstaining and insusceptible, by number of months since birth, and median and mean durations, Nigeria 1990 Number Months Amenor- Imus- of since birth rhoeie Abstaining ceptible births <2 93.7 95.9 98.5 267 2-3 89.2 89.5 95.8 283 4-5 82.8 74.7 93.3 307 6-7 76.8 61.2 85.7 352 8-9 72.6 58.4 84.6 303 10-11 64,0 51.3 74.8 210 12-13 57.4 44.4 73.0 317 14-15 44.6 33.4 58.1 294 16-17 48.9 40.7 59.8 295 18-19 41.0 31.4 52.2 232 20-21 27,0 30.0 45.2 216 22-23 22.6 21.7 32.0 168 24-25 12.1 17.9 26.0 315 26-27 7.9 10.4 14.9 300 28-29 8.6 9.3 13.0 265 30-31 7.4 8.8 13.7 245 32-33 4.2 10.8 12.8 212 34-35 14.2 16.4 20,0 222 Total 45.3 40.9 55.2 4,802 Median 14.6 10.8 19.0 Mean 15.8 14.4 19.3 Prevalence/Incidence Mean 16.1 14.5 19.6 Three-quarters of Nigerian women remain amenorrhoeic for at least six months following a birth; most women abstain from sexual relations during this time. However, about 12 months later (about 18 months al~er birth), fewer than half the women are still amenorrhoeic (41 percent), and fewer than one-third (31 percent) are still abstaining. Overall, 50 percent of women become susceptible to pregnancy within 19 months of giving birth. 65 Table 5.10 shows the median durations of insusceptibility by background characteristics of the mothers. As will be seen in Chapter 8, duration of breastfeeding (which is linked to amenorrhoea) decreases as the education level of the mother increases. As a result, the duration of amenorrhoea for educated women is shorter too. Whereas the median for women with no education is one and a half years, it is less than nine months for women with secondary or more schooling. Women are more similar to each other in their durations of abstaining than their durations of amenorrhoea. The median duration of abstinence is between 10 and 11 months. Table 5.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum umenorrhoea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Nigeria 1990 Postpartum Number Background Postpartum Postpartum insuscep- of characteristic amenorrhoea abstinence tibility women Age <30 13.8 9.5 17.3 2,856 30+ 16.2 11.5 21.0 1,946 Residence Urban 12.0 11.6 15.1 998 Rural 16.4 10.6 19.9 3,804 Region Northeast 19.5 10.9 21.2 1,214 Northwest 17.1 7.8 19.9 1,311 Southeast 12.0 11.0 15.9 1,395 Southwest 13.2 12.7 17.0 883 Education No education 18.2 10.6 21.0 2,972 Some primary 15.1 12.7 20.0 495 Completed primary 12.1 10.9 15.2 728 Some secondary 7.9 8.5 16.3 279 Completed secondary/higher 8.5 8.3 10.2 323 Total 14.6 10.8 19.0 4,802 Note: Medians ere based on current status. 5.7 Termination of Exposure to Pregnancy Later in life, the risk of pregnancy begins to decline with age, typically beginning around age 30. While the onset of infecundity is difficult to determine for any individual woman, there are ways of estimating it for a population. Table 5.11 presents indicators of decreasing exposure to the risk of pregnancy for women age 30 and above. 66 The first indicator, menopause, includes women who are neither pregnant nor postpartum amenorrhoeic, but have not had a menstrual period in the six months preceding the survey. Forty-one percent of the oldest women interviewed are menopausal. The second indicator of infecundity is obtained from a demonstrated lack of fertility. If a woman was continuously married for the five years preceding the survey, did not use contraception, and did not give birth in that time (nor is currently pregnant), she is considered terminally infertile. By the early forties, about half the women appear to be terminally infertile. The last indicator is long-term abstinence, which is the percentage of currently married women who did not have intercourse in the last three years. This percentage is fairly low, except among the oldest women. Table 5.11 Termination of exposure to the risk of pregnancy Indicators of menopause, terminal infertility and long-term abstinence among currently married women age 30-49, by age, Nigeria 1990 Terminal Long-term Age Menopause I infertility 2 abstinence 3 30-34 2.3 16.1 1.4 35-39 3.1 26.5 2.7 40-41 12.2 49.9 4.8 42-43 11.6 46.9 4.7 44~15 24.5 59.3 6.0 46-47 19.3 67.5 5,1 48-49 40.7 83.1 l 1.9 Women 30-49 10.6 33.7 3.4 1Percentage of non-pregnant, non-amenorrhoeic currently married women whose last menstraal period occurred six or more months preceding the survey or who report that they are menopausal. 2percentage of currently married women in their first onion of five or more years who have never used contraception and who did not have a birth in the five years preceding the survey and who are not pregnant. 3Percentage of currently married women who did not have intercourse in the three years preceding the survey. 67 CHAPTER 6 FERTILITY PREFERENCES In the NDHS several questions were asked to ascertain womens' fertility preferences: their desire to have another child, the length of time they wanted to wait before having that child, and the number of children they considered to be ideal. These data make the quantification of fertility preferences possible, and in combination with information on contraceptive use allows us to estimate the demand for family planning, either to space or to limit births. These questions were asked of nonsterilised, currently married women; and the question to ascertain ideal family size was asked of all women. 6.1 Desire for More Children Women were asked: "Would you like to have mother child or would you prefer not to have any more children?" If they did indeed want another child, they were asked: "How long would you like to wait from now before the birth of another child?" These questions were appropriately phrased if the woman had not yet had any children, and if the woman was pregnant, she was asked about her desire after the baby she was expecting. Figure 6.1 shows the percent distribution of currently married women by their fertiIity preferences and Table 6.1 shows the distribution according to the number of living children. Overall, 64 percent of women want another child, but 33 percent want to wait two or more years before having that child. Fifteen percent do not want any more children at all. Not surprisingly, the desire for more children declines Figure 6.1 Fertility Preferences among Currently Married Women 15-19 Want Ch i ld Wi th in 2 yre 31% Undecided 14% Want No More 15~ Mis_ . . . _. Infecund 4% NDHS1990 69 Table 6.1 Fertility preference by number of living children Percent distribution of currently married women by desire for more children, according to number of living children, Nigeria 1990 Desire for Number of living children l children 0 1 2 3 4 5 6+ Total Have another soon 2 60.4 38.9 37.9 30.1 23.5 21.1 15.2 31.2 Have another later ~ 8.3 45.1 40.1 39.5 35.2 30.5 19.3 32.8 Have another, undecided when 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Undecided 14.5 7.9 11.0 14.0 17.1 17.2 16.0 13.6 Wants no more 1.4 3.2 5.0 8.6 16.7 23.6 43.4 15.1 Sterilised 0.0 0.1 0.1 0.2 0.2 0.4 0.9 0.3 Declared Infeeund 11.8 2.8 3.8 4.1 4.0 4.0 3.6 4.4 Missing 3.5 2.0 2.1 3.4 3.3 3.1 1.5 2.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 612 1,168 1,144 1,113 928 735 1,181 6,880 llncludes current pregnancy 2Wants next birth within 2 years ~Wanls to delay next birth for 2 or more years Table 6.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, according to age, Nigeria 1990 Desire for Age of woman children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon 1 38.3 39.6 32.8 30.0 29.4 23.l 15.7 31.2 Have another later 2 47.7 43.9 42.9 31.7 23.8 12.5 7.1 32.8 Have another, undecided when 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Undecided I0.3 9.8 12.6 17.6 15.4 17.6 11.0 13.6 Wants no more 1.4 2.7 6.9 14.5 23.4 32.7 45.9 15.1 Sterilised 0.0 0.0 0.1 0.1 0.4 1.4 0.5 0.3 Declared Infecund 0.6 1.2 1.5 2.8 5.3 11.6 17.0 4.4 Missing 1.7 2.7 3.2 3.3 2.3 1.1 2.8 2.6 Total 100.0 100.0 I00.0 100.0 100.0 100.0 I00.0 100.0 Number 597 1.279 1,492 1,348 892 731 543 6,880 lWants next birth within 2 years ZWants to delay next birth for 2 or more years noticeably as the number of living children increases. Thus, 60 percent of women with no living children want to have a child soon (within the next two years), whereas only 15 percent of women with 6 or more living children want a child soon. Conversely, among women with no living children, only one percent declare not wanting any children, and 43 percent of women who have six or more children no longer want any more. This indicates a considerable interest in controlling fertility, and therefore a potential demand for family planning services, among women with many children. In the category of women with six or more children, those who either want to space or to limit their births total more than 60 percent. 70 The percent distribution of currently married women by desire for children, according to age is shown in Table 6.2. The desire to limit bi~as increases rapidly with age; only one percent of women age 15-19 want no more children, while 46 percent of those age 45-49 years want to stop childbearing. The desire to stop childbearing varies greatly by background characteristics of the respondent (see Table 6.3). Overall, the percentage of women who want no more children is twice as high in the Southeast and Southwest (22 and 23 percent) as it is in the Northeast and Northwest (9 and 10 percen0. The percentage of women wanting no more children is positively associated with education. Among women with four children, the desire to stop having children is much more common for women with the highest level of education (37 percent) than for women with no education (15 percent). Table 6.3 Desire to limit (stop) childbearing Percentage of currently married women who want no more children, by number of living children and selected background characteristics, Nigeria 1990 Number of living children 1 Background cheraeteristic 0 1 2 3 4 5 6+ Total Residence Urban 0.0 2.7 5,5 11.4 27.5 32.8 51.8 20,5 Rural 1.8 3.4 4.9 8.1 13,6 21.4 42.1 14.0 Region Northeast 2.3 3.6 4,5 4.3 10.0 17.6 31.5 9.2 Northwest 1.2 2.8 5,8 11.0 11.5 21.0 24.1 10.1 Southeast 0.6 4.2 4.5 10.4 19.3 26.6 52.8 21.8 Southwest 0.0 2.4 5.5 9.6 27.8 29.6 60.1 23.4 Education No education 1.8 3.8 4.1 8.3 14.8 19.9 37.4 13.9 Some primary 0.0 2.9 4.3 3.8 16.0 22.0 55.6 20.6 Completed primary 1.0 0.5 9.6 11.9 19.2 35.9 63.0 20.0 Some secondary 0.0 4.5 1.8 5.5 15.3 45.2 56.3 11.9 Completed secondarflhigher 0.2 3.4 6.3 16.9 37.4 54.9 97.4 17.6 Total 1.4 3.3 5.1 8.8 16.9 24.0 44.3 15.4 Note: Women who have been sterilised are considered to want no more children. llncludes current pregnancy 6.2 Demand for Family Planning Services Women who are currently married, and who declare either that they do not want to have any more children (they want to limit their childbearing) or that they want to wait two or more years before having another child (they want to space their births), but are not currently using contraception, have an unmet need for family planning. 1 Women with unmet need and those currently using contraception constitute the total demand for family planning (see Table 6.4). 1 The calculation of unmet need, being a current status measure, is further refined by excluding women who are currently amenorrheeic (nearly 30 percent of women) and, therefore, not in need of family planning at this point in time. For an exact description of the calculation, see footnote 1, Table 6.4. 71 Fertility desires are high in Nigeria, so the total demand for family planning is relatively low, 27 percent of currently married women. Table 6.4 indicates that the demand for family planning is highest among the most educated women: 47 percent 0f those who have completed secondary school have a demand for family planning. Demand is greater in urban areas (37 percent) than in rural areas (24 percent); but only 40 percent of the demand in urban areas is satisfied. Table 6.4 Need for family' planning services Percentage of currently naarried women with unmet need for family planning, met need for family planning, and the total demand for far~ly planning services, by selected background characteristics, Nigeria 1990 Met need for Unmet need for family planning Total demand for Percentage farrfily planning ~ (currently using) 2 family planning of demand Background For For For For For For satis- characteristic spacing lirr~ting Total spacing lircfiting Total spacing limiting Total fled Age 15-19 15.7 0.3 16.0 1.3 0.0 1.3 17.0 0.3 17.3 7.7 20-24 13,6 1.0 14.6 4.7 0.4 5.1 18.3 1.4 19.7 26.0 25-29 13.2 2.9 16.1 5.3 0.7 6.0 18.5 3.6 22.1 27.3 30 34 12.1 6.0 18.1 3.7 2.8 6.5 15.8 8.8 24.6 26.5 35-39 11,2 12.7 23.9 2.9 5.8 8.7 14.1 18.4 32.6 26.8 40 44 6.1 23.7 29.7 0,8 7.6 8.4 6.9 31.2 38.1 22.0 45-49 4.1 39.3 43.4 0.4 4.2 4,6 4.5 43.4 47.9 9.6 Residence Urban 12.3 9.7 22.0 8.5 6.4 14.9 20.8 16.1 36.9 40.4 Rural 11.3 9.2 20.5 2.0 1.6 3.6 13.3 10.8 24.1 15.0 Re81on Northeast 14.4 6.5 20.9 1.0 1.0 2.0 15.4 7.5 22.9 8.8 Northwest 8.0 6.2 14.2 0.7 0.6 1.2 8.6 6.8 15.4 7.9 Southeast 13.1 13.2 26.3 5,1 3.8 9.0 18.2 17.0 35.3 25.4 Southwest 10.6 12.4 23.0 8.4 6.6 15.0 19.0 19.0 38.0 39.5 Education No education 10.0 9.8 19.8 1.0 1.0 2.0 11.0 10.7 21.8 9.1 Some primary 15.4 10.4 25.7 3.2 4.6 7.8 18.6 14.9 33.5 23.3 Completed prima~ 12.8 9.7 22.5 4.1 6.5 10.6 17.0 16.2 33.1 32.1 Some secondary 21.0 4.4 25.4 12.6 4.4 17.0 33.6 8.8 42.4 40.2 Completed secondary/higher 13.0 4.9 18.0 19.7 9.0 28.7 32.7 13.9 46.7 61.5 Total 11.5 9.3 20.8 3.4 2.7 6.0 14.9 11.9 26.8 22.5 IUnmet need for spacing refers to pregnant women whose pregnancy was mistimed, amenorrhoeic women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who say they want to wait two or more years for their next birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and to women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. Also excluded are menopausal and infecund women, defined in Footnotes 1 and 2 in Table 5.11. 2Using for spacing refers to women who are using some method of family planning and who say they want to wait two or more years for their next child, Using for limiting refers to women who are using and who want no more children. 72 For the great majority of women, the need for family planning is not fulfilled (more than three- quarters of the total demand is unsatisfied). Although the unmet need for spacing and for limiting purposes is very low (12 and 9 percent of currently married women), younger women are more likely to need family planning for spacing purposes (16 percent), and older women for limiting purposes (39 percent). The data show that even the moderate demand for family planning that currently exists in Nigeria remains mostly unfulfilled. Large differences in need for family planning exist between regions. Even the low demand extant in the Northeast (23 percent) and Northwest (15 percent), is not fulfilled (less than 10 percent of demand is satisfied). In the Southeast and Southwest, 35 and 38 percent of demand is satisfied, respectively. The most educated women have the highest proportion of demand satisfied (62 percent). 6.3 Ideal and Actual Number of Children In order to ascertain what women consider to be the ideal number of children, they were asked: "If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?" Table 6.5 indicates that the idea of conscious reproductive choice is largely unknown to a large proportion of women. Sixty-one percent of women gave non-numeric responses. Such a high proportion of non-numerical responses is unusual, even for African countries. 2 In most cases, women indicated that the number of children they would have is "up to God." Table 6.5 Ideal number of chil&en Pereant distribution of all women by ideal number of children and mean ideal number of children for all women and for eurrantiy married women, according to number of living children, Nigeria 1990 Number of living children I Ideal number of children None 1 2 3 4 5 6+ Total 0 0.0 0.1 0.0 0.1 0.0 0.0 0.1 0.0 1 0.3 0.5 0.1 0.0 0.0 0.0 0.0 0.1 2 1.4 0.5 1.1 0.2 0.4 0.6 0.5 0.8 3 3.8 2.9 1.0 1.2 0.5 0.9 0.8 1.9 4 18.6 10.3 11.4 5.6 9.6 3.0 2.9 10.0 5 13.4 6.9 8.8 7.4 8.2 8.9 2.8 8.5 6+ 15.3 14.3 12.9 17.0 19.2 23.7 26.2 17.8 Non-numeric response 47.2 64.6 64.7 68.5 61.9 62.8 66.8 60.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2,083 1,290 1,194 1,166 986 784 1,278 8,781 Mean ideal number 5.0 5.5 5.7 6.1 6.1 7.0 7.2 5.8 Number of women 1101 457 422 367 375 292 425 3438 Mean for women in union 5.5 5.6 5.7 6.1 6.0 7.1 7.2 6.2 Number of women in union 157 381 401 348 345 265 385 2,284 Note: The means exclude women who gave non-numeric responses. 1Includes eu~ent pregnancy 2 For instance, in Liberia, Mali and Morocco, countries which show the highest proportions of non-numeric responses in DHS sma, eys, at most one-quarter of all women gave this type of response. 73 Because the majority of women gave a non-numeric response, the means shown in Table 6.5 should be interpreted with caution. They do not represent the preferences of all women, but only of those that gave a numeric answer (39 percent of women). Given that urban and more educated women are more likely to give numeric answers, it is probable that these means are biased downwards and, as a result, the ideal number of children for all women is underestimated. Table 6.5 shows an association between the ideal number of children and the number of living children. The ideal number is 5 among childless women and 7 among women with 5 or more children. The reason for this is twofold. On the one hand, women may successfully attain their desired family size, and consequently those who want more children have more. On the other hand, women may rationalize and adjust their ideal number of children to the actual number of children they have had. Table 6.6 presents the mean ideal number of children by age and selected background characteristics of the respondents. Typically, urban and more educated women have a smaller ideal family size. Thus, among women with no education the mean ideal number of children is 6.9, and gradually decreases to 4.6 among the highest educated women. In urban areas, the mean ideal number of children is 5, compared to 6.3 in rural areas. The difference between regions is also significant, the ideal family size being about one child larger in the Northem regions than in the Southern regions. Table 6.6 Mean ideal number of children by background characteristics Mean ideal number of children for all women, by age and selected background characteristics, Nigeria 1990 Age of woman Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 4.7 4.6 4.9 5~7 5.4 6.2 6.2 5.0 Rural 5.6 5.8 6.2 6.8 6.5 7.3 7.3 6.3 Region Northeast 6.2 6.5 6.8 7.0 6.6 6.7 7.0 6.6 Northwest 5.5 6.5 6.8 7.4 5.6 7.0 10.1 6.7 Southeast 5.3 5.3 5.7 6.3 6.5 7.6 6.8 5.9 Southwest 4.7 4.6 4.6 5.9 5.5 6.2 6.0 5.0 Education No education 6.0 7.1 6.9 7.1 6.5 7.4 7.3 6.9 Some primary 5.9 5.5 5.4 6.5 6.1 7.2 5.8 6.1 Completed primary 5.4 5.5 5.8 6.4 6.0 6.7 6.7 5.8 Some secondary 4.9 4.8 5.5 5.3 4.9 5.8 5.5 5.0 Completed secondary/higher 4.8 4.5 4.6 4.7 5.1 5.0 5.4 4.6 Total 5.3 5.3 5.7 6.5 6.1 7.0 7.0 5.8 74 6.4 Fertility Planning Since the issue of mistimed and unwanted fertility is an important one, the NDHS asked whether each birth in the five years preceding the survey was planned (wanted then), unplanned (wanted later), or not wanted at all (wanted no more). The responses give an indication of the degree to which couples are successfully controlling their fertility. These data are likely to be underestimates because women with unplanned or unwanted births may rationalize such births anti declare them as wanted once they are bom. Table 6.7 shows that 87 percent of births in the last 5 years were wanted at the time they were conceived, while 8 percent were wanted later, and only 2 percent were not wanted at all. Four percent of the fourth or higher order births were not wanted, and 9 percent of births of this order were wanted, but at a later time. The proportion of births that were not wanted increases with mother's age at the time of the birth. Less than one percent of births to the youngest women were not wanted, compared to 14 percent of births to women age 45-49. Table 6.7 Fertility planning status Percent dislxibutinn of births in the five yeecs preceding the survey by fertility planning status, according to birth order and mother's age, Nigeria 1990 Planning status of birth Birth order Wanted Number and mother's Wanted Wanted no of age then later more Missing Total births Birth order 1 84.1 6.2 0.8 8.9 100.0 1,797 2 92.0 6.3 0.5 1.1 100.0 1,480 3 89.8 8.5 0.5 1.1 100.0 1,410 4+ 84.8 9.2 4.0 2.1 100.0 4,669 Age at birth <19 90.3 8.3 0.5 0.8 100.0 1,460 20-24 90.2 8.3 0.9 0.6 100.0 2.508 25-29 90.1 7.6 1.6 0.6 100.0 2,507 30-34 86.4 9.5 2.2 1.8 100,0 1,423 35-39 81.9 8.7 7.7 1.8 100.0 832 40-44 82,8 5.9 10.6 0,7 100.0 335 45-49 78.8 6.3 14.2 0.7 100.0 88 Total 86.6 8.1 2.3 3.1 100.0 9,356 Note: Birth order includes current pregnancy. The potential demographic impact of avoiding unwanted births can be estimated by calculating the wanted fertility rate. The wanted fertility rate is calculated in the same manner as the total fertility rate, but unwanted births arc excluded from the numerator. For this calculation, unwanted births are defined as those which exceed the number considered ideal by the respondent. (Women who did not report an ideal family size were assumed to want all their births.) This rate represents the level of fertility that would have prevailed in the three years preceding the survey if all unwanted births had been prevented. A comparison of the total wanted fertility rate and the actual total fertility rate suggests the potential demographic impact of the elimination of unwanted births. 75 Table 6.8 presents the total wanted fertility rate and the total fertility rate by background characteristics. In the first column, women who did not report an ideal family size are assumed to want all their births. Given the small proportion of unwanted births in Nigeria, the difference between the total wanted fertility rate (column 1) and the actual total fertility rate (column 3) is small. The actual total fertility rate is only three percent higher than the wanted rate (6.0 versus 5.8). This means that even if Nigerian women effectively controlled their childbearing, fertility rates would remain high, either because women still prefer large families, or because they are not familiar with the idea of conscious reproductive choice. However, since a large proportion of women gave nonnumerical responses to the question on ideal family size (nearly 60 percent of respondents said the number of children they would have is "up to God"), it is useful to look at the total wanted fertility rate for women who did specify an ideal family size (column 2). The total wanted fertility rate for women who did specify an ideal family size is 5 children. Table 6.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Nigeria 1990 Total Total wanted wanted Total Background fertility fertility fertility characteristic rate rate 1 rate Residence Urban 4.8 4.3 5.0 Rural 6.1 5.5 6.3 Region Northe~t 6.2 6.4 6.5 Northwest 6.6 5.9 6.6 Southeast 5.2 4.8 5.6 Southwest 5.2 4.4 5.5 Education No education 6.3 6.1 6.5 Some primary 6.7 6.6 7.2 Completed primary 5.3 5.0 5.6 Some secondary 4.7 4.5 5.1 Completed secondary/higher 4.0 3.0 4.2 To~ 5.8 5.0 6.0 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey, The total fertility rates are the same as those presented in Table 3.1. ITFR among those women who reported an ideal family size. Excludes women who gave non-numerical responses to question on ideal family size. 76 CHAPTER 7 INFANT AND CHILD MORTALITY A demographic assessment of Nigeria's population would be incomplete without analysis of infant and child mortality rates. Such analysis can form the basis for informed decisions on health, as well as population, policies and programmes. This chapter presents information on levels, trends and differentials in neonatal, postneonatal, infant and child mortality. This information can be used for population projections and as a means of identifying those sectors of the child population that are at high risk. Information about infant and child mortality is also necessary for economic and health planning. Mortality estimates are calculated from information that was collected in the birth history section of the individual questionnaire. The section began with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live in the household, who live elsewhere, and who died). These questions were followed by a retrospective birth history in which data were obtained on sex, date of birth, survivorship status, and current age or age at death of each of the respondents' live births. The rates presented here are defined as follows: Neonatal mortality: Postneonatal mortality: Infant mortality: Child mortality: Under-five mortality: the probability of dying within the first month of life; the difference between infant and neonatal mortality; the probability of dying before the first birthday; the probability of dying between the first and fifth birthday; the probability of dying before the fifth birthday. The reliability of the mortality estimates is affected by the completeness of reporting deaths, the degree of differential displacement of birth dates of surviving and dead children, and the extent to which age at death is accurately reported. Heaping of age at death at 12 months in the NDHS was fairly common (see Appendix D, Table D.6). Also, interviewers at times recorded deaths at "1 year," even though instructions required them to record deaths under two years of age in months. An unknown fraction of these deaths may have actually occurred before the first birthday. Thus, the infant mortality rate may be biased downward somewhat and child mortality biased upward; under-five mortality would be unaffected. Yet, earlier simulation studies using DHS data from other countries indicate that while age at death misreporting is troublesome, the type and magnitude of that observed in the NDHS is unlikely to result in biases of more than 5 percent (Sullivan et al., 1990). The rates presented here are thus unadjusted; that is, all deaths reported at 12 months or "1 year" are assigned to the post-infant age period. It is seldom possible to establish, with confidence, mortality levels for a period more than 15 years before a survey? Even in the recent 15-year period considered here, apparent trends in mortality should be interpreted with caution. First, there may exist differences in the completeness of death reporting related to the length of time preceding the survey. Second, the accuracy of reports of age at death and of date of birth may deteriorate with time. Thus, without a detailed evaluation of the quality of birth history data (which is not attempted in this report), conclusions regarding changes in mortality should be considered preliminary. 1 Due to limitations of the data, rates for periods earlier than 15 years preceding the survey do not adequately represent all births. 77 7.1 Infant and Child Mortality In the five years preceding the survey, nearly 1 in 5 children died before their fifth birthday. Neonatal, postneonatal, infant, child and under-five mortality rates are shown in Table 7.1 for five-year periods in the 15 years preceding the survey. Under-five mortality over this period has fallen slowly from 201 deaths to 192 deaths per thousand live births. The small decline is largely attributable to a drop in the neonatal rate from 52 to 42 deaths per thousand live births; mortality between 1 and 59 months of age has shown no improvement over the period. The latter finding may reflect the offsetting effects of improved health services on the one hand, and the deteriorating economic position of the average Nigerian household, on the other. Overall, 87 of every 1,000 children born die before their first birthday, and 115 of every 1,000 children alive at age one year die before their fifth birthday. Table 7.1 Infant and child mortality Infant and child mortality rates by five-year periods preceding the survey. Nigeria 1990 Years preceding survey Neonatal Postneonatal Infant Child Under-five mortality mortality mortality mortality mortality (NN) (PNN) (lqo) (4ql) (sqo) 04 42.1 45.2 87.2 115.2 192.4 5-9 48.7 47.0 95.7 103.3 189.1 10-14 51.9 46.7 98.6 113.5 200.9 A comparison of NDHS and NFS data is given in Figure 7.1. Estimates for the overlapping period centred around 1977 suggests serious underreporting of deaths in the NFS, especially for children age 1-5 years. In sum, child survival has improved very little over the decade of the 1980s in Nigeria; the only encouraging sign is a small decline in mortality during the first month of life. An important finding of the NDHS involves the age pattem of under-five mortality. In most countries of the world, mortality during the first year of life exceeds that during the subsequent four years. However, this is not the case in Nigeria: child mortality (115/1000) is substantially higher than infant mortality (87/1000) in the 5-year period preceding the survey. The higher level of child mortality, relative to infant mortality, is a pattern found in other West African countries such as Mall and Senegal. 78 Figure 7.1 Trends In Infant and Under-five Mortality, NFS and NDHS Surveys Deaths per 1,000 b i r ths 25O 200 150 100 50 0 1962 i i J I i 1967 1972 1977 1982 1987 1991 . Inftnt mort. NFS -~-- Under-five NFS Note: The points shown ere the mid-points of five-year periods. Infant mort. NDH8 Under-five NDH8 79 Table 7.2 Infant and child mortality by background characteristics Infant and child mortality rates for the ten-year period preceding the survey, by selected background characteristics, Nigeria 1990 Neonatal Postneonatal Infant Child Under-five Background mortality mortality mortality mortality mortality characteristic (NN) (PNN) (lqo) (4ql) (sqo) Residence Urban 40,4 35.1 75.4 58.9 129.8 Rural 46,7 49.1 95.8 123.8 207.7 Region Northeast 39.2 48.5 87.7 139.2 214.6 Northwest 57.8 52.0 109,8 151.2 244.4 Southeast 38.6 44.1 82,7 66.5 143.7 Southwest 46.3 38.3 84,6 90.3 167.2 Education No education 48.4 47.5 95,9 126.4 210.1 Some primary 43.4 54.1 97,5 103.7 191.1 Completed primary 38.5 41.2 79,8 63.0 137.7 Some secondary 42.7 50.2 92,9 62.9 149.8 Completed secondary/higher 30.0 18.7 48.6 30.2 77.3 Medical maternity care No antenatal/delivery care 43.2 58.0 101.2 184.7 267,2 Either antenatal or delivery 34.5 37.2 71.7 106.4 170,4 Both antenatal & delivery 46.5 34.5 81.0 68.4 143,8 45.3 46.1 91.4 109.6 191,0 Total Table 7.2 presents neonatal, postoeonatal, infant, child and under-five mortality rates by selected background characteristics for the 10-year period (1981-1990) preceding the survey. A ten-year reference period is used to allow for adequate numbers of events in each population subgroup. Figures 7.2 and 7.3 show infant and child mortality rates by selected characteristics. The pattern of higher child mortali

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