Nigeria - Demographic and Health Survey -2000

Publication date: 2000

Nigeria Demographic and Health Survey 1999 N ig eria D em o g rap h ic an d H ealth Su rvey 1 9 9 9 National Population Commission Nigeria Demographic and Health Survey 1999 National Population Commission Abuja, Nigeria December 2000 National Population Commission United Nations Population Fund U.S. Agency for International Development This report presents results from the 1999 Nigeria Demographic and Health Survey (NDHS) which was undertaken by the National Population Commission. Financial assistance for the survey was provided by the the United Nations Population Fund (UNFPA) and the U.S. Agency for International Development (USAID). ORC/Macro provided limited technical support in data processing, analysis, and report writing after the data were collected. Additional information about the NDHS may be obtained from the main office of the National Population Commission, Lukazlu Street, Wuse Zone 3, Private Mall Bag 0281, Abuja (09-523-0773 or 09- 523-1026). Recommended citation: National Population Commission [Nigeria]. 2000. Nigeria Demographic andHealth Survey 1999. Calverton, Maryland: National Population Commission and ORC/Macro. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xili Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvli Map of Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER 1 1.1 1.2 1.3 1.4 1.5 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography, History, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Population and Health Policies and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Objectives, Organisation and Design of the NDHS . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2 2.1 2.2 2.3 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . 11 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Current Fertility Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 CHAPTER 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 FERT IL ITY REGULAT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Current Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Number of Children at First Use of Family Planning Methods . . . . . . . . . . . . . . . . . . 57 Knowledge of the Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Conlr aceptive Effect of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 iii 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 Page Intention to Use Family Planning Among Non-Users . . . . . . . . . . . . . . . . . . . . . . . . . 61 Reasons For Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Exposure to Family Planning Messages in Electronic Media . . . . . . . . . . . . . . . . . . . 63 Acceptability of Media Messages on Family Planning . . . . . . . . . . . . . . . . . . . . . . . . 65 Exposure to Family Planning Messages through the Print Media . . . . . . . . . . . . . . . 65 Contact of Nonusers with FamilyPlanning Providers . . . . . . . . . . . . . . . . . . . . . . . . 67 Couples' Communication and Attitudes Towards Family Planning Use . . . . . . . . . . . 68 CHAPTER 5 5.1 5.2 5.3 5.5 5.6 5.7 5.8 5.9 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . 73 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Age at First Marr iage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . . . . . . 83 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 CHAPTER 6 6.1 6.2 6.3 6.4 FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Planning Status of Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 7.6 INFANT AND CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Levels of Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Socioeconomic Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Demographic Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 8.6 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Childhood Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Acute Respiratory Infection and Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 iv CHAPTER9 9.1 9.2 9.3 Page MATERNAL AND CHILD NUTRITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Nutritional Status of Children Under Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Nutritional Status of Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 CHAPTER 10 10.1 10.2 10.3 10.4 FEMALE GENITAL CUTT ING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Prevalence of Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Age at Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Person Who Performed Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Attitudes toward Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 CHAPTER 11 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 SEXUAL ACT IV ITY AND KNOWLEDGE OF SEXUALLY TRANSMITTED DISEASES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Awareness and Knowledge of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Perceptions of the Risk of Getting HIWAIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Behaviour Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Knowledge of Condom Use to Protect against Disease . . . . . . . . . . . . . . . . . . . . . . 154 Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Payment for Sexual Relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Awareness of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Prevalence of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 CHAPTER 12 12.1 12,2 12.3 12.4 12.5 AVAILABIL ITY OF HEALTH AND FAMILY PLANNING SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Organisation of Health and Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . 161 Community Char acteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Distance and Time to Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Contraceptive Use by Distance to Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 CHAPTER 13 13.1 13.2 POLICY IMPLICATIONS OF DATA FROM THE NDHS . . . . . . . . . . . . . . . 169 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Assessing the Goals of the National Population Policy (NPP . . . . . . . . . . . . . . . . . . 169 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 V Page APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 APPENDIX C ANALYSIS OF DATA QUALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 APPENDIX D PERSONS INVOLVED IN THE 1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 vi 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 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16.1 Table 2.16.2 Table 2.17 Table 2.18 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 4.1 Table 4.2 Table 4.3 Table 4.4.1 Table 4.4.2 Table 4.5.1 Table 4.5.2 Table 4.6.1 Table 4.6.2 Table 4.7 Table 4.8 Table 4.9 Table 4.10 TABLES Page Household population by age, sex, and residence . . . . . . . . . . . . . . . . . . . . . . 11 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Educational attainment of household population . . . . . . . . . . . . . . . . . . . . . . . 16 School attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Differential characteristics between spouses . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Educational attainment by background characteristics . . . . . . . . . . . . . . . . . . . 24 Reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Occupation: women . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Decision on use of earnings and contribution of earnings to household expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Fertility trends by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . 42 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of contraceptive methods by background characteristics . . . . . . . . 46 Couples' knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . 47 Ever use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Ever use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Current use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Current use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Current use of contraception by background characteristics: women . . . . . . . . 55 Current use of contraception by background characteristics: men . . . . . . . . . . 56 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . 57 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . 59 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . 60 vii Table4.11 T~4.12 Tab~4.13 T~4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8.1 Table 5.8.2 Table 5.9 Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 7.1 Table 7.2 T~7.3 Table 7.4 Table 8.1 Table 8.2 Table 8.3 Page Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Reasons for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . . . 61 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . 63 Exposure to family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . 66 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Contact of non-users with family planning providers disseminating family planning information . . . . . . . . . . . . . . . . . . . . 68 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Spouse's perception of spouse's approval of family planning . . . . . . . . . . . . . 72 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Number of wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Median age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Postpartum amenorrhoea, abstinence, and insusceptibility. . . . . . . . . . . . . . . 84 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . 87 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . 90 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . 91 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Mean ideal number of children by background characteristics . . . . . . . . . . . . . 96 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Rates of early childhood mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Neonatal, postneonatal, infant, child, and under-five mortality by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Neonatal, postneonatal, infant, child, and under-five mortality by biodemographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . 107 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 viii Table 8.4 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 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 11.1.1 Table 11.1.2 Table 11.2.1 Table 11.2.2 Table 11.3.1 Table 11.3.2 Table 11.4 Table 11.5 Table 11.6 Table 11.7 Table 11.8.1 Table 11.8.2 Table 11.9 Table 11.10.1 Table 11.10.2 Table 11.11 Table 11.12 Table 12.1 Table 12.2 Table 12.3 Table 12.4 Page Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . 112 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 116 Prevalence and treatment of acute respiratory infection and fever . . . . . . . . . 117 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Breastfeeding status by child's age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . 127 Foods received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . 128 Nutritional status of children by demographic characteristics . . . . . . . . . . . . 130 Nutritional status of children by background characteristics . . . . . . . . . . . . . 131 Nutritional status of women by background characteristics . . . . . . . . . . . . . . 133 Prevalence of female genital cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Age at genital cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Attitudes toward female genital cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Reasons for supporting female genital cutting . . . . . . . . . . . . . . . . . . . . . . . . 139 Reasons for not supporting female genital cutting . . . . . . . . . . . . . . . . . . . . . 140 Genital cutting of daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Knowledge of HIV/AIDS and sources of HIV/AIDS information: women . 142 Knowledge of HIV/AIDS and sources of HIV/AIDS information: men . . . . . 143 Knowledge of ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . 144 Knowledge of ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . 145 HIV/AIDS-related knowledge: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 HIV/AIDS-related knowledge: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Perception of risk of getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Perception of the risk of getting HIV/AIDS among couples . . . . . . . . . . . . . 151 Reasons for perception of smaU/no risk of getting HIV/AIDS . . . . . . . . . . . . 151 Reasons for perception of moderate/great risk of getting HIV/AIDS . . . . . . 151 HIV/AIDS prevention behaviour: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 HIV/AIDS prevention behaviour: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Knowledge of condom use to protect against HIV/AIDS and STIs . . . . . . . . 154 Use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Payment for sexual relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Knowledge of sexually transmitted infectious . . . . . . . . . . . . . . . . . . . . . . . . 158 Distance to urban areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Main access route to rural communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Transportation to nearest town . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Distance to various services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 ix Table 12.5 Table 12.6 Table 12.7 Table 12.8 Table A . I . I Table A. 1.2 'Iable B.1 Table B.2 'I able B.3 'I able B.4 ' lable B.5 Table B.6 "I able B.7 Table B.8 Table B.9 T~ble C.1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Page Distance to health facilities by type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Distance to health facility by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Distance to specific health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Contraceptive use and distance to family planning services . . . . . . . . . . . . . . 167 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . 190 Sampling errors: National sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Sampling errors: Urban sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Sampling errors: Rural sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Sampling errors: Northeast region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Sampling errors: Northwest region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Sampling errors: Southeast region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Sampling errors: Southwest region sample . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Sampling errors: Central region sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . 203 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Births by calendar year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Childhood mortality rates for the late 1980s . . . . . . . . . . . . . . . . . . . . . . . . . 211 Trends in childhood mortality by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 X FIGURES Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 2.5 Figure 2.6 Figure 3.1 Figure 3.2 Figure 4. I Figure 4.2 Ngure4.3 N~re4 .4 Figure5.1 Ngure5.2 Ngure5.3 ngure6.1 ~gure6.2 Figure 6.3 Figure 8.1 Figure 8.2 Page Population Pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Distribution of De Facto Household Population by Single Year of Age and Sex . . . . . . 13 Percentage of Males and Females Who Have No Education by Age Group . . . . . . . . . . 17 Percentage in School by Age and Urban-Rural Residence . . . . . . . . . . . . . . . . . . . . . . . 18 Percentage of Households with Specific Amenities, by Urban-Rural Residence . . . . . . . 20 Percentage of Women and Men with Access to Mass Media . . . . . . . . . . . . . . . . . . . . . 27 Total Fertility Rates by Selected Background Characteristics . . . . . . . . . . . . . . . . . . . . 37 Trends in Total Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Trends in Contraceptive Knowledge among Married Women 15-49, 1990 and 1999 . . . 48 Current Use of Contraceptive Methods among Currently Married Women, 1990 and 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Use of Family Planning Among Marrid Women, by Background Characteristics . . . . . . 57 Source of Family Planning Methods among Current Users of Modem Methods . . . . . . . 60 Percentage of Currently Married Women and Men in Polygynous Unions by Age . . . . . 75 Median Age at First Sexual Intercourse among Women Age 25-49 and Men Age 30-64 by Residence, Region, and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Postpartum Amenorrhoea, Abstinence, and Insusceptibility by Number of Months since Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Fe~lity Preferences of Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . 88 Desire to Limit Childbearing among Currently Married Women and Men, by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Trends in Unmet Need, Met Need, and Percentage of Demand for Family Planning that is Satisfied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Antenatal Care, Tetanus Vaccinations, Place of Delivery, and Delivery Assistance . . . 106 Vaccinafion Coverage among Children Age 12-23 Months . . . . . . . . . . . . . . . . . . . . . 115 xi Figure 10.1 Figure 10.2 Figure C.1 Figure C.2 Page Prevalence of Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Provider of Female Genital Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Percent Distribution of Women 15-49 by Age Group, Nigeria 1990 and 1999 . . . . . . . 203 Births per Calendar Year, Nigeria DHS 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 xii FOREWORD The National Population Commission's programme of demographic data production is continuously developed in response to the requirements to provide veritable indicators to facilitate the execution of government policies and programmes such as: the 1988 Population Policy and the current Poverty Alleviation Programme of the Federal Government of Nigeria. It is in recognition of this statutory responsibility that the 1999 NDHS was conducted in all states of the Federation and the Federal Capital Territory. The main objectives of the NDHS are to collect and analyse information on reproductive health including family planning and infant and child mortality, as well as to measure the nutritional status of mothers and children. Compared with the 1990 NDHS, the current survey was expanded in scope to include questions on housing facilities and on awareness and behavionr with regard to the HIV/AIDS pandemic. The 1999 NDHS provides relevant details on these issues and updates the indicators derived from the 1990 survey. Coming at the beginning of the new civilian administration, they constitute benchmark data on which subsequent policy interventions in the social sectors will be evaluated in the future. I would like to acknowledge the assistance of the UNFPA and USAID for providing the funding and technical assistance for the data collection, processing, analysis and report preparation, and the various stakeholders who participated in the series of preparatory seminars and workshops prior to the survey and the preliminary report writing stage. Lastly, the individual and collective contributions of all the principal professional staff of the National Population Commission, the erstwhile Chairman, Lt. Col. Chris Ugokwe (rtd) and members of the Commission are highly commendable. It is my strong belief that this report wiU be of immense benefit to researchers and programme officers by filling the existing gaps in health and demographic statistics in the country, Dr Akintobi A. Kadejo Director-General August 2000 xiii ACKNOWLEDGMENTS Between July 1994 and September 2000, a great number of people participated in activities culminating in the implementation of the Nigeria Demographic and Health Survey (NDHS). These people spent time designing the survey, executing the field operations, processing and analysing the data and producing this report. We would like to mention Dr. Akintobi Kadejo, who in 1994 as the Director, Population Statistics Depa~nent of the National Population Commission (NPC) and more recently as Director-General of the Commission, provided technical guidance and moral support. Others include members of the erstwhile Board of the Commission and the Census Technical Group. Particular mention must be made of the core project team--Mr. Samuel Alaneme, Mr. Inuwa Jalingo, Mr. DoRm Atobasire, and Dr. Samuel Kahi--who, with the Survey Director, were involved in all stages of administration of the project. Successful implementation of a data-gathering exercise such as the NDHS in a country as vast as Nigeria depends on many institutions and individuals. Financial assistance for the project came from the United Nations Population Fund (UNFPA), while the U.S. Agency for International Development (USAID) financed the techncial support for data processing and report writing through their contract with Macro International Inc. The survey benefitted from the interest and experience of UNFPA, which included the project as one of the major activities in their 4 th Country Programme. The 1999 NDHS became the cornerstone of UNFPA sub-project NIR/P38-40 98-2001. The invaluable contributions of UNFPA Chief Technical Adviser, Dr. Gabriel Fosu, to the project are commendable. Dr. Bunmi Dosumu, a Senior Program Manager with USAID/Nigeria, facilitated the support received from both USAID and Macro International Inc. Her commitment to the success of the survey is exemplary. The technical assistance of Macro staff in data processing and report writing is gratefully acknowledged. Many of them took exceptional interest in the NDHS. In this regard, the role of Ms. Annie Cross, Ms. Elizabeth Britton, Ms. Jeanne Cushing, Dr. Jeremiah Sullivan, and Dr. Shea Rutstein deserve special mention. The survey also benefitted from the experience, intellectual guidance, and reviews of the draft report by Dr. Jacob Adetunji, a consultant for Macro International Inc. Many colleagues in the National Population Commission provided valuable inputs into this report. Comments on the first draft of the report received from Professors Tola Atinmo, Olukunle Adegbola, Chris Oyeka, F.A.Oyekanmi, Drs. A.B. Sulalman, A. O. Ketiku, A.A. Adeyemo, Uche Isiugo-Abanihe, Jude Edochie, and representatives of the World Health Organisation, Federal Office of Statistics, UNICEF, Family Health International, the National AIDS Control and Prevention Programme, the Planned Parenthood Federation of Nigeria, the Department of Community Development and Population Activities of the Federal Ministry of Health, and the Women's Health Organisation of Nigeria, among others, enriched the final report. The contributions of the Project Accountants--Mr. A. Ozoilo and Mrs. Endurance Emefiele,--and the secretariat staff--Mrs. Yemi Ohi, Mrs. Akpambang and other staff of the Census and Surveys Department--are gratefully acknowledged. The report uses data and ideas from past research studies on the theme of the survey, many of which are acknowledged in the references. Osamwonyi Osagie Project Director August 2000 XV EXECUTIVE SUMMARY The 1999 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey of 8,199 women age 15-49 and 3,082 men age 15-64, designed to provide information on levels and trends of fe~Jlity, family planning practice, maternal and child health, infant and child mortality, and maternal mortality, as well as awareness of HIV/AIDS and other sexually transmitted diseases (STDs) and female circumcision. Fieldwork for the survey took place between March and May 1999. Fertility The total fertility rate during the five years before the survey is 5.2 births per woman. This shows a drop from the level of 6.0 births per woman as reported in the 1990 NDHS and 5.4 from the 1994 Sentinel Survey. The total fertility rate may, however be higher due to evidence that some births were probably omitted in the data. Fertility is substantially higher in the Northeast and Northwest regions and lower in the Southeast, Southwest, and Central regions. Fertility rates are also lower for more educated women. Childbearing begins early in Nigeria, with about half of women 25 years and above becoming mothers before reaching the age of 20. The median age at first birth is 20. The level of teenage childbearing has declined somewhat, with the proportion of girls age 15-19 who have either given birth or are pregnant with their first child declining from 28 percent in 1990 to 22 percent in 1999. Teenage childbearing is higher in rural than urban areas and for those with no education than those with education. The data from the survey indicate that there is a strong desire for children and a preference for large families with 66 percent of married women and 71 percent of married men indicating a desire to have more children. Even among those with six or more children, 30 percent of married women and 55 percent of married men want to have more children. This indicates a decline for women from the 35 percent reported in the 1990 NDHS. Overall, women report a mean ideal number of children of 6.2, compared with 7.8 children for men. Despite the increasing level of contraceptive use, the 1999 NDHS data show that unplanned pregnancies are common, with almost one in five births reported to be unplanned. Most of these (16 percent of births) are mistimed (wanted later), while 3 percent were unwanted at all. Family Planning Knowledge about family planning methods is increasing in Nigeria, with about 65 percent of all women and 82 percent of all men having heard of at least one method of contraception. Among women, the pill is the best known method (53 percent) while among men, the condom is the best known method (70 percent). Radio is a main source of information about family planning, with 35 percent of women and 61 percent of men reporting that they heard a family planning message on the radio in the few months before interview. The proportions of women and men who have seen a television message are 23 and 40 percent, respectively. Only 17 percent of women had seen a family planning message in the print media. The contraceptive prevalence rate in Nigeria has also increased, with 15 percent of married women and 32 percent of married men now using some method of family planning. The use of modem methods is xvii lower at 9 percent for married women and 14 percent for men. Although traditional contraceptive methods are not actively promoted, their use is relatively high with about 6 percent of married women and 17 percent of married men reporting that they are using periodic abstinence or withdrawal. In 1990, only 6 percent of married women were using any method, with only 4 percent using a modern method. There are significant differentials in levels of family planning use. Urban women and men are much more likely to be using a method than rural respondents. Current use among married women is higher in the Southwest regions (26 percent), Southeast (24 percent), and Central (18 percent) regions than in the Northwest and Northeast (3 percent each). The largest differences occur by educational attainment. Only 6 percent of married women with no education are using a method of contraception, compared with 45 percent of those with more than secondary school. Users of modern contraception are almost as likely to obtain their methods from government as private sources. Forty-three percent of users obtain their methods from the public sector--mostly government hospitals and health centres--while 43 percent use private medical sources such as pharmacies and private hospitals and clinics; 8 percent get their methods from other private sources like friends, relatives, shops and non-governmental organisations. Maternal Health The results of the survey show that antenatal care is not uncommon in Nigeria, with mothers receiving antenatal check-ups from either a doctor, nurse or midwife for two out of three births in the three years preceding the survey. However, the content of antenatal care visits appears to be lacking in at least one respect: survey data indicate deficiencies in tetanus toxoid coverage during pregnancy. Mothers reported receiving the recommended two doses of tetanus toxoid for only 44 percent of births and one dose for I 1 percent of births. Almost 40 percent of births occurred without the benefit of a tetanus vaccination. In Nigeria, home deliveries are still very common, with almost three in five births delivered at home. Compared with 1990, the proportion of home deliveries has declined, with more births now taking place in health facilities. Increasing the proportion of births occurring in facilities is important since they can be attended by medically trained personnel which can result in fewer maternal deaths and delivery complications. Currently, 42 percent of births are attended by doctors, nurses or midwives. The 1999 NDHS data show that about one in four Nigerian women age 15-49 reported being circumcised. The practice of female genital cutting is more prevalent in the south and central parts of the country and is almost non-existent in the north. Child Health The 1999 NDHS data indicate a decline in childhood vaccination coverage, with the proportion of children fully immunised dropping from 30 percent of children age 12-23 months in 1990 to only 17 percent in 1999. Only a little over half of young children receive the BCG vaccine and the first doses of DPT and polio vaccines. Almost 40 percent of children have not received any vaccination. Diarrhoea and respiratory illness are common causes of childhood death. In the two weeks before the survey, 11 percent of children under three years of age were ill with acute respiratory infections (ARI) and 15 percent had diarrhoea. Half of children with ARI and 37,percent of those with diarrhoea were taken to a health facility for treatment. Of all the children with diarrhoea, 34 percent were given fluid prepared from packets of oral rehydralion salts (ORS) and 38 percent received a home-made sugar-salt solution. xviii The infant mortality rate for the five-year period before the survey (early 1994 to early 1999) is 75 per thousand live births. The under-five mortality is 140 deaths per 1,000 births, which means that one in seven children born in Nigeria dies before reaching his/her fifth birthday. However, both these figures are probably considerably higher in reality since an in-depth examination of the data from the birth histories reported by women in the NDHS shows evidence of omission of births and deaths. For this reason, the dramatic decline observed in childhood mortality between the 1990 and 1999 NDHS surveys needs to be viewed with considerably skepticism. Based on the reported birth history information, the infant mortality rate fell from 87 to 75 deaths per 1,000 births, while the under-five mortality rate dropped from 192 to 140. Problems with the overall levels of reported mortality are unlikely to severely affect differentials in childhood mortality. As expected, mother's level of education has a major effect on infant and child mortality. Whereas the lowest infant mortality rate was reported among children of mothers with post- secondary education (41 per thousand live births), the corresponding figure among infants of mothers with no schooling is 77 per thousand live births. Data were also collected in the NDHS on the availability of various health services. The data indicate that the vast majority of Nigerian households live within five kilometres of a health facility, with health centres being the closest, followed by clinics and hospitals. Breasffeeding and Nutrition Breastfeeding is widely practiced in Nigeria, with 96 percent of children being breastfed. The median duration of breastfeeding is 19 months. Although it is recommended that children be exclusively breastfed with no supplements for the first 4 to 6 months, only 20 percent of children 0-3 months are exclusively breasffed, as are 8 percent of children 4-6 months. Two-thirds of children 4-6 months are being given supplements in addition to breast milk. In the NDHS, interviewers weighed and measured children under three born to women who were interviewed. Unfortunately, data were either missing or implausible for more than half of these children. Of the half with plausible data, 46 percent of children under 3 are classified as stunted (low height-for-age), 12 percent are wasted (low weight-for-height) and 27 percent are underweight (low weight-for-age). The 1999 NDHS also collected information on the nutritional status of women who had a birth in the three years prior to the survey. Sixteen percent of these women are considered to be too thin, with a body mass index of less than 18.5. Women of short stature (height less than 145 cm) comprise 7 percent of the women measured. HIV/AIDS and Other Sexually Transmitted Diseases Survey data indicate that awareness of HIWAIDS is becoming more widespread. Three-quarters of women and 90 percent of men in Nigeria have heard of AIDS. The radio and relatives and friends are the most commonly cited sources of information about HIV/AIDS among both women and men. However, knowledge of ways to avoid HIV/AIDS is not so widespread. More than a quarter of women and 14 percent of men say they do not know of any way to avoid HIV/AIDS and 6 percent of women and 3 percent of men say there is no way to avoid it. Only 14 percent of women and 29 percent of men say that using condoms is a means of avoiding the disease. On the other hand, three in five men and women who have heard of AIDS know that ahealthy-looking person can be infected with the AIDS virus and over 80 percent know that AIDS is a fatal disease that cannot be cured. xix Two-thirds of Nigerian women and men believe that they have no chance of contracting HIV/AIDS, while almost all the rest believe their chances are small. Perhaps one reason is that many Nigerians say they have changed their sexual behavior to avoid getting AIDS. For example, 37 percent of women and 42 percent of men say they restrict themselves to only one pamler; one-fourth of the women say they asked their partners to remain faithful. Condoms are acknowledged by a large majority of respondents to be a way of preventing HIV/AIDS and other sexually-transmitted diseases. Men are almost twice as likely (38 percent) as women (20 percent) to have ever used condoms either for family planning or disease prevention. However, only 7 percent of women and 15 percent of men reported having used a condom the last time they had sexual intercourse. The most widely known sexually transmitted disease apart from AIDS is gonorrhoea. XX NIGERIA Northeast )guI Region xxii CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy Geography Nigeria lies on the west coast of Africa between 4 and 14 degrees north latitude and between 2 and 15 degrees east longitude. It occupies approximately 923,768 square kilometres of land, stretching from the Gulf of Guinea on the Atlantic coast in the south to the fringes of the Sahara Desert in the north. The territorial boundaries are defined by the Republics of Niger and Chad in the north, the Cameroon Republic on the east, and the Republic of Benin in the west. The Gulf of Guinea delimits the southern boundary. Nigeriais topographically characterised by two main land forms: lowlands andhighlands. Lowlands predominate in the Niger-Benue valley in the south, the Sokoto-Rimabasin in the northwest, and in the Chad basin in the northeast. Highlands are found mainly in the north and central areas, where they rise to a high at Jos Plateau; they are also found in the southeast, where they rise to a high at Obudu in Cross River State. As with land forms, two main wind systems define the climatic conditions in Nigeria. The southwest monsoon wind blows from the Atlantic Ocean towards the hinterland between bringing rainfall April and September. The northeast trade wind, which is hot, dry, and dust-laden, blows from the Sahara Desert between October and March, having a cooling effect on the entire country. The intensity of both of these winds diminishes inland. The mean temperature oscillates between 25 and 40 centigrade, while the rainfall ranges from 2,650 mm in the southeast to less than 600 mm in some parts of the north, mainly on the fringes of the Sahara Desert. The vegetation that results from these climatic differences consists of mangrove swamp forest in the Niger Delta and Sahel grassland in the. north. With a wide range of climatic, vegetational, and soil conditions, Nigeria possesses potential for a wide range of agricultural production. History Nigeria is a federal republic consisting of 36 states and a Federal Capital Territory. The states are subdivided into 774 administrative units of unequal size called Local Government Areas (LGAs). In some states, especially in the far north, these LGAs are grouped into emirates, districts, or traditional council areas. The 36 states are also grouped into six geopolitical zones that reflect ethnic identity in most cases. The history of the people of Nigeria goes back to antiquity. Evidence of art Iron Age culture was found in relics left behind by the peoples that lived in the Niger-Benue valley. These historical artifacts are known to have been made by the Nok culture. The growth of the Nigerian nation-state, however, can be traced to 1914 when the British colonial administration merged the North and South protectorates and the colony of Lagos into one administrative unit. Nigeria became an independent nation in 1960 and since then, has had different administrative structures. Within the boundaries of Nigeria are found many social groups with distinct but similar cultural traits, which are reflected in the diverse behaviour of the people. There are about 374 identifiable ethnic groups, but the Igbos, Hausas, and Yorubas are the major groups. Economy Nigeria is one of Africa's most endowed economies, with an abundance of both natural and human resources. Its citizens are noted for their high degree of resourcefulness and entrepreneurial skills. Ironically, the country's per capita income of U.S.$350 in 1999 is one of the lowest in the world. The economy is largely agricultural. Sectoral contributions to the gross domestic product may give a distorted picture ofreality since more than 50 percent ofthepopulationis engagedin agriculture. The structure and growth of the economy is therefore not easy to categorise. The main feature of the economy has always been that a high proportion of the national income is derived from the export of a wide range of mineral and agricultural products, with crude oil ctu~ently taking the lead. Since 1980, crude oil production has accounted for more than two-thirds of the gross domestic product and more than 80 percent of total government revenue. There exists vast industrial and commercial concerns that are largely dominated by state enterprises. There are also large, multinational companies, as well as poorly organised small-scale enterprises. All these economic features have combined to create a diverse private sector. The lack of a broad economic base and political instability have recently led to a large-scale 'brain drain' of skilled manpower. Inflation and unemployment are relatively high. The economy has fluctuated between growth and decline within the past two decades. Between 1980 and 1985, it registered negative growth of 3.4 percent per annum; however, between 1987 and 1995, it grew at 3.5 percent per annum. The main economic indicators in the years preceding the survey are less than satisfactory. In 1999, the growth of the gross domestic product was estimated at 2.7 percent, up from 2.4 percent achieved in 1998. However, it fell below the minimum 3.0 percent target for the year. The aggregate index of agricultural production increased by 3.7 percent in 1999, compared with 3.5 percent in 1998, while industrial production feU by 1.4 percent from the 1998 level The average industriai- capacity ntilisation in the same year stood at 31 percent, representing a marginal increase of 2 percent over the 1998 figure. Inflation was estimated at 8.0 percent in December 1999. The Central Bank recently reported that the country's balance of payments improved markedly in 1999 as a result of the rise in global oil prices; however, the performance of non-oil exports remained tmimpressive. Since the onset of democratic administration in 1999, economic policies have become more favourable to investment. Bold steps have been taken to privatise the government's equity in major manufacturing, oil, and service companies. 1.2 Population The total population of Nigeria as reported in the 1991 census was 88,992,220 (Table 1. I). Using a growth rate of 2.9 percent per annum, the National Population Commission (NPC) estimates the current population of Nigeria to be about 115 million. The spatial distribution of the population is uneven. Extensive areas in the Chad basin, the middle Niger valley, the grass plains, and the Niger delta, among others, are sparsely populated. In contrast, there are large areas of densely populated rural districts, which support more than 400 persons per ldlometre occur in parts of Akwa lbom, Imo, Anambra, and Enugu States, as well as around Kano, Katsina, and Sokoto States. However, the average population density of the country in 1991 was 96 persons per kilometre. The most densely populated states are Lagos, Anambra, Imo, and Akwa Ibom. Except for Lagos, all the states 2 Table 1.1 Demographic indicators Demographic indicators from various sources, Nigeria 1963-91 NFS 1981-82 Census and NDHS Census Indicator 1963 NDSS 1980 1990 1991 Population (millions) 55.7 84.7 U 88.9 Density (pop./sq. km) 60 92 U 96.0 Percentage urban 19 23 24 36.3 Crude birth rate (CBR) 66 46 39 44.6 a Crude death rate ((;DR) 27 16 U 14 Total fertility rata (TFR) U 6.3 6.0 5.9 a Infant mortality rate (IMP,) U 85 87 93 Life expectancy at birth 36 48 U 53.2 U = Unknown (not available) a From the post-enumeration survey Sources: National Population Commission, 1998; Federal Office of Statistics, 1990 with high population densities are located in the southeast of Nigeria. Kano State, with an average density of 281 persons per square kilometre is by far the most densely populated state in the north. Other states in the north with a population density of more than 100 persons per square kilometre are Katsina (140 per square kilometre) and Jigawa (127 per square kilometre). The population of Nigeria is predominantly rural, with about 36 percent living in urban areas. The states with a predominantly urban population are Lagos (94 percent), eye (69 percent), and Anambra (62 percent). The states with small urban populations are Jigawa (7 percent), Taraba (10 percent), Akwa Ibom (12 percent), Kebbi (12 percent) and Sokoto (14 percent). 1.3 Population and Health Policies and Programmes Population Policies and Programmes In the light of the perceived high population growth rate and its adverse effect on national development, the federal government adopted a National Policy on Population for Development, Unity, Progress and Self-Reliance (NPP) in 1998. The policy was designed to enable Nigeria to balance the rate of population growth with the available resources. The four main goals of the NPP are as follows: 1. To improve the living standards and the quality of life of the people . To promote their health and welfare, especially through preventing premature deaths and illness among the high-risk groups . To achieve lower population growth rates, through reduction of birth rates by voluntary fertility regulation methods that are compatible with the attainment of the economic and social goals of the nation . To achieve a more even distribution of the population between urban and rural areas (Federal Ministry of Health, 1988). 3 To achieve these goals and to promote national awareness of the adverse effects of rapid population growth, the following objectives were set out: a) Promote awareness among the citizens of population problems and the effects of rapid population growth on development. b) Provide everyone with information and education on the value of reasonable family size to both the individual family and the future of the nation in achieving self-reliance. c) Educate all young people about population matters, sexual relationships, fertility regulations, and family planning before they enter the ages of marriage and childbearing to encourage them to maintain responsible parenthood and reasonable family size to the best of their ability. d) Make family planning services readily available to all couples at an affordable cost at the earliest possible time to enable them to regulate their fertility. e) Provide fertility management programmes that will respond to the needs of sterile or sub- fertile couples to achieve reasonable self-fultillment. f) Improve demographic data collection and analysis on a regular basis and use such data for economic and social-development planning. g) Enhance integrated rural and urban development in order to improve the living conditions in the rural areas and to slow down the rate of rural-urban migration (Federal Ministry of Health, 1988). At the inception of the NPP, the government mobilised resources to implement the population programme. The Population Activities Fund Agency (PAFA) was established to manage a population activities fund with donor and government funds. PAFA was expected to mobilise more funds from other sources. The World Bank discontinued its involvement in 1996 after about three years of operation; therefore, the agency currently relies solely on government funding to promote population programmes in such areas as child and maternal health, advocacy, service delivery, and hospital services. Bilateral and international agencies that have supported the National Population Programme include the United Nations Population Fund (UNFPA), the U.S. Agency for International Development (USAID), and the World Bank. USAID has long been the main provider of contraceptives for the private sector. The British Depamnent for International Development has also continually supported the National Population Programme. The Planned Parenthood Federation of Nigeria (PPFN), an affiliate of the International Planned Parenthood Federation, is the doyen of population activities in the country. The MacArthur Foundation and the Ford Foundation, among others, support various non-governmental organisations. The population policy is widely commended internationally, but its implementation has been dogged by inconsistencies and other problems that are sometimes beyond its control. Chief among these problems are cultural norms that lead to high fertility and religious beliefs about family planning. The low status and level of education of women; poor quality of family planning service delivery; and lack of information, especially in rural areas, are also factors. Poor institutional mechanisms for coordination and implementation of the various population programmes, both private and public, have limited the achievements of the policy in its 12 years of existence. 4 Health Policies and Programmes The federal government has several programmes and policies ainfed at improving health delivery services. The fourth National Development Plan (1981-1985) established a government commitment to provide adequate and effective primary health care that is promotive, protective, preventive, restorative, and rehabilitative to the entire population by the year 2000. A national health policy was consequently adopted in 1988. Its goal is to provide a formal framework for the direction of health management in Nigeria. The objective is to provide the population with access not only to primary health care but also to secondary and tertiary care, as needed, through a tractional referral system. It defines the roles and responsibilities of the three tiers of government, as well as of civil society and non-governmental organisations. In general, the provision of health services is the responsibility of federal, state, and local governments as well as religious organisations and individuals. The services are organised 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 is the responsibility of the state government ili) Tertiary health care, which provides highly specialised referral services to the primary and secondary levels of the health care delivery system and is in the domain of the federal and state governments. The national health policy regards primary health care as the framework to achieve improved health for the population. Primary health care services include health education; adequate nutrition; safe water and sanitation; reproductive health, including family planning; immunisalion against five major infectious diseases; provision of essential drugs; and disease control. The policy document requires that a comprehensive health care system delivered through the primary health centres should include maternal and child health care, including family planning services. The health sector is characterised by wide regional disparities in status, service delivery, and resource availability. More health services are located in the southern states to the disadvantage of the north. The health sector has deteriorated despite Nigeria's high number of medical personnel per capita. The current priorities in the health sector are in the area of childhood immunisation and prevention of HIV/AIDS. 1.4 Objectives, Organisation and Design of the NDHS Objectives The main objective of the 1999 Nigeria Demographic and Health Survey (NDHS) is to provide up-to-date information on real i ty and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programmes and strategies for improving health and family planning services in Nigeria. 5 Organisation The 1999 NDHS is a joint project between the National Population Commission (NPC), the United Nations Population Fund Activities (UNPFA) and the U.S. Agency for International Development (USA/D). The project was fimded by these three orgaulsations, while Macro International Inc., located in Maryland, provided limited technical support in data processing, analysis, and report writing after the data were collected. The NPC set up an NDHS committee to coordinate activities pertaining to the survey. Under the direction of the committee, the Census and Survey Depamnent of the commission conducted the survey. The committee organised seminars and workshops at which the commission's senior demographers gave inputs on the survey instrnments. The DHS Model Questionnaire (which had been sent from Macro International Inc. upon request) was adapted to Nigerian cultural conditions in a symposium held on 11 September 1998. After the workshop, other stakeholders were invited to a two-day workshop in Kaduna on 3 and 4 November 1998. The participants in the workshop included USA/D; UNFPA; Population Activities Fund Agency (PAFA); Family Health International (FHI); the Planned Parenthood Federation of Nigeria (PPFN); the Federal Ministry of Health (MOH); and academics from universities in Lagos, Ibadan, lle-Ife, Sokoto, and Nsukka. The participants expressed their interest in the survey and suggested that specific questions and modules be added to the questionnaire, such as AIDS/STD, a male questionnaire, and maternal mortality. The NDHS committee was responsible for the execution of the project. The project director was in charge of the day-to-day administration of the project with the assistance of the deputy project director. A project coordinator, whose responsibilities included coordinating the state activities, supervising logistics, and ensuring standards, was positioned at the headquarters in Lagos. The seven commission zonal directors acted as zonal coordinators for the survey in their respective zones, while state coordinators were assigned the administration of the survey at the state level. The actual interviews of households and individuals were conducted by teams of seven people, consisting of one supervisor, one field editor, one male interviewer, and four female interviewers. Altogether, there were 34 teams for the 36 states and the Federal Capital Territory. 1.5 Sample Design and Implementation The 1999 Nigeria Demographic and Health Survey (NDHS) was a nationally representative probability sample of women age 10-49 living in households. The sampling frame used for the survey was constructed from the enumeration areas (EAs) into which the country was delineated for the 1991 population census. Currently, the frame contains 212,079 EAs. The sample was stratified into rural and urban areas and was selected in two stages. It was designed to produce reliable estimates of most of the variables for the rural and urban segments of the country as well as each of five statistical regions, namely, the Northeast region, the Northwest region, the Central region, the Southeast region, and the Southwest region. Each of these five regions was treated as a sampling domain. The distribution of the states across these regions is shown fully in Appendix A. The regions used for this survey differ from the six geopolitical zones of the country and the seven administrative zones of the National Population Commission. The primary sampling unit was the EA. Altogether, 400 EAs were selected with equal probability. In all, 119 urban EAs and 281 rural EAs were selected. To ensure data quality, the selection of the EAs was done centrally by trained statisticians at the Liaison Office of the National Population Commission (NPC) in Lagos. The list of selected EAs was sent to the NPC offices in each state to identify the EAs, draw sketch maps, and conduct a listing of all households in each selected EA. NPC's comptrollers at the local govermnent offices thereafter cross-checked the work of the state officers to ensure no omission of any building within the EA. At the second sampling stage, one in every five households listed was selected for interview. The combination of equal probability selection at the first stage and a fixed sampling rate at the second stage yielded a roughly self-weighting sample design. However, while the returns from the rural stratum showed an appreciable level of self-weighting, the returns from the urban stratum showed a significant level of c leviation from self-weighting. The deviation in the urban stratum was due to underlisfing of dwellings in some EAs because of changes in EA boundaries over time. Therefore, in processing and estimating the population parameters, the sample returns were weighted by considering the selection probabilities of the primary sampling units, the expected and eventual field returns, and the differential response rate among the domains. The weights were standardised and entered with the individual data records. Thus, all the tables presented in this report are based on weighted data. In the selected households, all women age 10-49 were eligible for interview with the Women's Questionnaire. In every third household, men age 15-64 were eligible for interview with the Men's Questionnaire. Survey Questionnaires Four questionnaires were used for the main fieldwork: the Service Availability Questionnaire, the Household Questionnaire, the Women's Questionnaire, and the Men's Questionnaire. The Service Availability Questionnaire was implemented at an early stage of the fleldwork and was designed to assess the availability (or supply) of health and family planning services. It was administered at the community level (enumeration area) by interviewing knowledgeable informants in the selected community. All regular members and visitors in the selected household were listed on the Household Questionnaire. For each person listed, information was collected on name, sex, age, and education. The household questionnaire was used to identify both men and women who were eligible for the individual questionnaire and to collect data on housing characteristics. The Women's Questionnaire was administered to all women age 10-49 who were listed on the Household Questionnaire. The decision to interview women age 10-14 was influenced by pretest findings on teenage pregnancy, motherhood, and the age at commencement of sexual activities. Since most of the variables presented in this report are not relevant for the youngest women, the analysis has been restricted to women age 15-49. Women were asked questions on the following topics: Background characteristics (age, education, religion, etc.) Female genital cutting practices Fertility preferences Husband's background and respondent's work Knowledge of AIDS Maternal mortality Height and weight of respondents and their children under three. 7 The Men's Questionnaire was used to interview men age 15-64 living in every third household. It was similar to that for women except that it omitted the sections on antenatal and delivery care, breastfeeding, vaccinations, causes of death, female genital cutting, and height and weight. Training Two levels of training were organised. The first level was the training of trainers, which took place in Lagos between 16 and 20 November 1998. The trainees consisted of zonal and state directors of NPC and selected senior headquarters/liaison office staff who are well versed in survey methodology. Individuals who participated at some of the workshops organised at the planning stages of the survey acted as the facilitators during this level of training. The second stage of training took place for two weeks at the seven zonal headquarters of the i'qPC (namely, Kano, Yola, Port Harcourt, Enugu, Lagos, Ibadan, and Kaduna.) This level of training involved the training of interviewers, supervisors and field editors. Those trained at the first level of training facilitated at this level. Fieldwork Immediately after the training exercise, NDHS field personnel went to the field for data collection. The field staff consisted of 34 teams, each composed of one supervisor, one field editor, four female interviewers, one male interviewer, and a driver. Fieldwork was carried out in 400 EAs nationwide between 29 March 29 and 29 May 1999. The people involved in the f ieldwork and the complete description of the exercise are presented in Appendices D and A. Data Processing The personnel who took part in the processing of NDHS data consisted of 20 data entry operators, two supervisors, and six coders/editors, all of whom are staff of the NPC. Before data processing began, the data entry operators were trained intensively for two weeks by staff from Macro International Inc. (USA). Data were processed on microcomputers and printers that were provided by Macro International Inc., with funding from USAID. The computers were used to establish the nucleus of a demographic laboratory at the NPC. Data were processed using programmes written by Macro International Inc. with the Integrated System for Survey Analysis (ISSA), which was designed for processing DHS data. Response Rate The summary of results from the household and individual interviews is presented in Table 1.2. A total of 7,919 households were sampled, of which 7,736 were determined in the field to be valid households and 7,647 were successfully interviewed, giving a response rate of 99 percent. Of the 8,918 eligible women age 15-49 in these households, 8,199 were interviewed for a response rate of 92 percent. Every third household was selected for coverage with the Men's Questionnaire. Thus, 2,620 households were sampled, of which 2,571 were found and 2,550 were successfully interviewed. In these households, a total of 3,082 men age 15-64 were identified and 2,680 were interviewed for a response rate of 87 percent. Table 1.2 Results of the household and individual interviews Number of households, number of interviews and response rates, according to urban-rural residence, Nigeria 1999 Resldenc~ Result Urban Rural Total FEMALE Household interviews Households sampled 2,600 5,319 7,919 Households found 2,524 5,212 7,736 Households interviewed 2,482 5,165 7,647 Household respo~e rate 983 99.1 98.8 Individual interviews: women Number of eligible women Number of eligible women interviewed Eligible woman response rate MALE 2,984 5,934 8,918 2,697 5,502 8,199 90.4 92.7 91.9 Household interviews Households sampled 849 1,771 2,620 Households found 834 1,737 2,571 Households interviewed 825 1,725 2,550 Household response rate 98.9 99.3 Individual interviews: men Number of eligibleman 1,056 Number of eligiblemen interviewed 882 Eligible man response rate 83.5 99.2 2,026 3,082 1,798 2,680 88.7 87.0 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter presents information on selected socioeconomic characteristics of the household population and the individual survey respondents. These characteristics include age, sex, education and place of residence. The chapter also considers the environmental conditions surrounding the households such as source of drinking water, availability of electricity, sanitation facilities, and housing materials. Examining the characteristics of respondents is useRll in understanding the factors that affect reproductive and contraceptive behaviour. Moreover, the patterns observed in some of these characteristics often provide a quick assessment of the data quality. 2.1 Characteristics of the Household Population The NDHS Household Questionnaire was used to collect data on the demographic and socioeconomic characteristics of all usual residents and any visitors who had spent the previous night in the sampled household. Age-Sex Composition The distribution of the NDHS household population is shown in Table 2.1 by age, sex, and residence. It shows that the proportion of persons in the younger age groups is substantially larger than the proportion in the older age groups for each sex in both urban and rural areas. This pattern is typical of a population with Table 2.1 Household population by age, sex, and residence Percent distribution of tile de facto household population by five-year age group, according to sex and urban-rural residence, Nigeria 1999 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 14.2 14.0 14.1 16.2 15.1 15.7 15.6 14.8 15.2 5-9 15.3 17.5 16.4 17.6 18.8 18.2 16.9 18.4 17.7 10-14 14.2 10.3 12.3 14.0 9.5 I1.8 14.1 9.7 11.9 15-19 11.1 10.5 10.8 9.6 10.2 9.9 10.1 10.3 10.2 20-24 7.6 9.8 8.7 6.2 8.2 7.2 6.6 8.7 7.6 25-29 6.5 8.9 7.7 6.8 8.2 7.5 6.7 8.4 7.6 30-34 6.1 7.2 6.7 5.3 6.3 5.8 5.5 6.6 6.1 35-39 6.1 5.9 6.0 4.6 5.3 5.0 5.0 5.5 5.3 40-44 5.3 4.2 4.7 4.1 3.8 3.9 4.4 3.9 4.2 45-49 3.9 3.0 3.4 3.3 3.3 3.3 3.4 3.2 3.3 50-54 3.3 3.3 3.3 2.9 3.9 3.4 3.0 3.7 3.4 55-59 1.8 1.2 1.5 2.1 2.0 2.0 2.0 1.8 1.9 60-64 1.4 1.5 1.5 2.2 2.1 2.1 2.0 1.9 1.9 65-69 1.3 0.8 1.1 1.8 1.1 1.5 1.7 1.1 1.4 70-74 0.8 0.9 0.9 1.7 1.0 1.3 1.5 0.9 1.2 75-79 0.4 0.3 0.3 0.6 0.4 0.5 0.5 0.4 0.4 80 + 0.5 0.6 0.6 0.9 0.6 0.8 0.8 0.6 0.7 Missing/Don't know 0.2 0.1 0.1 0.1 0.2 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,496 5,472 10,970 13,436 13,210 26,654 I8,932 18,683 37,624 Note: Total includes 10 people whose sex was not stated. 11 high fetXility. Although the proportion under age five is smaller than the proportion age 5-9--which is usually taken as evidence of a recent decline in fertility--at least some of this pattern is due to age misreporting of some ten-year-old girls as age 9 (see below). Overall, there are an equal number of males and females in the population. Figure 2.1 presents a graphic representation of the age and sex structure. The narrowing of the base of the pyramid may result from omission of recent births or displacement of births by age misreporting. Figure 2.1 Population Pyramid, Nigeria 1999 Age 80+ 75-79 70-74 65-69 60-64 55-50 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-0 0-4 I i iiiii i!iii!~i~iiiiiii!!iiii!!iiii~ii iiiiii!iiiii~ii~iiiiiiiiiii!iiiiiiii! ii¸ i iiii~iiiiiii!iii!ii!i!ii!iii~i!ii% ~i! ~ii!!!iiiiiii ~ i i~i !ilii 10 8 6 4 2 0 10 Percent L Female 1 2 4 6 8 NDHS1999 Figure 2.2 shows the distribution of the male and female household population by single year of age. Inspection of the figure reveals several irregularities. Noticeable heaping is observed at ages ending with the digits 0 and 5 and with even numbers, particularly the digits 2 and 8 at the middle and higher ages. The figure further reveals that except for age nine for females, ages ending in odd digits are generally underreported for both sexes. The unexpected heaping at age nine for women is almost certainly due to interviewers reporting younger ages for eligible respondents to lessen their work load, given that women age 10-49 were considered eligible. Age heaping is highly pronounced for age 20 and above among both males and females. It appears to be more pronounced at the younger ages in the rural areas than in the urban areas. Table 2.2 shows the distribution of the population by broad age groups. Children under age 15 account for 45 percent of Nigeria's population, whilethose age 15-64 account for 51 percent. The remaining 4 percent of the population are 64 years and older. Over the past two decades, there has been a very slight decline in the proportion under 15 and a slight increase in the older population. 12 5 4 3 2 1 0 Figure 2.2 Distribution of De Facto Household Population by Single Year of Age and Sex, Nigeria 1999 Percent I I I I I I I I 30 35 40 45 50 55 60 65 70+ Single Year of Age l~-Ma!e +Female I NDHS1999 The population has a low median age of 17.5 years (not shown). This means that half of the population is younger than 17.5 years and the other half is older than 17.5 years. The table also shows that the dependency ratio is 94; that is, there are 94 persons under 15 or over 64 for every 100 persons age 15-64 in Nigeria. In other words, besides taking care of himself/herself, the average Nigerian of working age is also expected to take care of approximately one other person. The decline in the dependency ratio since 1981-82 indicates a lessening of the economic burden of persons in the productive age range who support those of nonproductive ages. Table 2.2 Population by age from selected sources Percent distribution of the population by age group, selected sources, Nigeria 1963-1999 Sentinel Census NDSS NFS NDHS Census survey NDHS Age group 1963 1980 1981-82 1990 1991 1994 1999 <15 43.1 47.2 49.5 47.1 44.9 45.3 44.8 15-64 54.9 50.2 48.1 48.5 51.8 51.3 51.4 65+ 2.0 2.8 2.3 4.3 3.3 3.4 3.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Dependency ratio 82 100 108 106 93 95 94 Sources: I963 Census, 1980 NDSS; 1981-82 NFS; 1990 NDHS; 1991 Census; 1994 Sentinel Survey (SS); 1999 NDHS 13 Household Composition Table 2.3 shows that households in Nigeria are predominantly headed by men (83 percent), with only 17 percent headed by women. The proportion of female-headed households is slightly higher in urban areas (19 percent) than in rural areas (16 percent). There are only small differences in the composition of urban and rural households by number of members. Thus, the mean household size in rural areas (5.1 persons) is only slightly higher than in urban areas (4.8). Fosterhood and Orphanhood Foster children are children under 15 years of age who are not living with either of their biological parents. To measure the prevalence of child fostering and orphanhood, four questions were asked in the NDHS Household Questionnaire on the survival status and residence of the parents of children less than 15 years of age. As shown in Table 2.3, 16 percent of households have foster children. Table 2.4 presents details regarding foster children and orphans under 15 years of age. The data show that almost three-quarters of children under 15 live with both their natural parents, while 8 percent live with their mothers but not their fathers, 4 percent live with only their fathers, and 9 percent live with neither parent (foster children). Information on parents is missing for 7 percent of children. Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and presence of foster children in household, according to urban-rural residence, Nigeria 1999 Residence Chameteristlc Urba~ Rural Total Sex of head of household Male 81.4 83.8 83.0 Female 18.6 16.2 16.9 Total 100.0 100.0 100.0 Number of usual members 1 11.4 11.2 11.3 2 I1.9 11.0 11.3 3 13.7 12.8 13.1 4 14.6 13.8 14.1 5 15.2 12.9 13.6 6 10.8 10.5 10.6 7 7.7 9.2 8.8 8 5.0 5.4 5.3 9+ 9.7 12.8 11.8 Total 100.0 100.0 100.0 Mean size 4.8 5.1 5.0 Percentage witl~ foster children 16.2 16.0 16.1 Note: Table is based on de jure members; i.e., ~sual residents. Foster children are children under age 15 living in households with neither their mother nor their father present. The table also indicates a low level of orphanhood in Nigeria. Although 4 percent of children under 15 have lost their fathers and 3 percent have lost their mothers, less than one percent are orphans, having lost both parents. As expected, the percentage of children who are living with both their natural parents decreases with increasing age of the child. There are no major differences in fosterhood or orphanhood by sex of the child or by urban-rural residence. Most children below age 15 live with both parents in all regions of the country, but the proportion is highest in the two northern regions (81 percent) and lowest in the Southeast (58 percent). 14 i Table 2.4 Fosterhood and orphanhood Percent distribution of dejuro children under ago 15 by survival status of parents and child's living arrangements, according to background characteristics, Nigeria 1999 Living Living with mother with father but not father but not mother Not living with either parent Missing Living informa- with Father Mother tion on Number Background both Father Father Mother Mother Both only only Both father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children A•-• 81.6 8.5 1.1 3-5 77.6 5.5 1.4 6-9 70.8 5.6 2.3 10-14 62.1 5.8 3.5 S~-~ Male 72.8 6.3 2.2 Female 71.3 6.2 2.1 Residence Urban 71.3 7.5 1.7 Rural 72.4 5.7 2.3 Region Northeast 80.9 2.0 0.8 Northwest 81.2 2.7 1.0 Southeast 58.3 9.9 5.2 Southwest 68.8 8.6 1.9 Central 74.6 6.4 1.4 Total 72.1 6.2 2.1 1.1 0.2 1.6 0.I 0.0 0.2 5.7 100.0 3,270 2.1 1.0 5.1 0.2 0.3 0.8 6.0 i00.0 3,878 3.2 1.5 8.2 0.5 1.0 1.1 5.9 100.0 5,323 4.7 2.2 9.8 1.1 1.5 1.2 8.1 100.0 4,566 3.4 1.6 5.7 0.5 0.9 0.7 6.1 100.0 8,904 2.5 1.0 7.7 0.6 0.7 1.0 6.9 100.0 8,129 2.6 1.5 7.8 0.3 0.9 0.5 5.9 i00.0 4,750 3.1 1.3 6.2 0.6 0.7 1.0 6.7 I00.0 12,287 2.8 1.3 4.4 0.3 0.8 0.6 6.2 100.0 3,316 1.8 1.5 3.3 0.5 0.7 0.3 6.8 100.0 2,553 2.5 1.2 10.1 1.1 1.3 1.0 9.2 100.0 3,595 4.1 1.2 8.7 0.4 0.5 0.4 5.4 100.0 3,875 3.2 1.4 5.5 0.2 0.6 1.8 4.9 I00.0 3,697 3.0 1.3 6.7 0.5 0.8 0.9 6.5 100.0 17,037 Note: By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., chlidren with both parents dead. Educational Level of Household Members The educational level of the population is often used as an indicator of the socioeconomic development of the country. Moreover, many phenomena, such as reproductive behaviour, use of contraception, infant and child mortality, morbidity, and proper hygienic habits are affected by education. Education in Nigeria has evolved over a long period of time, with a series of policy changes. As a result there have been increases in the enrolment of children and in the number of educational institutions bothin the public and private sectors. The 1976 National Policy on Universal Primary Education gives every child the right to free primary education. Later, the 6-3-3-4 system was introduced, establishing six years of primary education, followed by three years of junior secondary and three years of senior secondary education. The last segment of four years is for university or polytechnic education. Subsequently, the national literacy programme for adults was launched, followed by the establishment of nomadic education to address the needs of children of migrant cattle herders and fishing people in the riverine areas. In October 1999, Universal Basic Education (UBE) was launched, making it compulsory for every child to be educated free up to the junior secondary school level in an effort to meet the nation's manpower requirement for national development. Table 2.5 presents the distribution of the household population age six years and over by level of education, according to sex, age, place of residence, and region. The table shows that 26 percent of men and 38 percent of women have not received any formal education. Roughly one-third of the population has at least some primary school, but not more, while one-quarter of men and one-fifth of women reached secondary school. Seven percent of men and 4 percent of women have a higher education. 15 Table 2.5 Educational attainment of household population Percent distribution of the de facto male and female household populations age six and over by highest level of education attained, according to selected background characteristics, Nigeria 1999 Level of education Number Median of number Background No Don't know/ women/ of years of characteristic education Primary Secondary Higher missing Total men schooling MALE Age 6-9 30.0 60.5 0.4 0.0 9.1 100.0 2,481 0.2 10-14 16.7 57.5 22.i 0.2 3.5 100.0 2,664 3.6 15-19 13.5 20.7 62.0 1.5 2.3 100.0 1,904 7.4 20-24 16.4 18.5 52.4 9.8 2.9 100.0 1,247 9.2 25-29 18.3 20.i 42.5 15.9 3.3 100.0 1,277 10.0 30-34 22.9 21.7 34.7 16.8 3.9 100.0 1,050 8.3 35-39 20.5 25.6 30.8 18.4 4.7 100.0 954 7.9 40-44 33.7 23.2 20.9 17.7 4.5 100.0 839 5.5 45-49 32.7 29.9 16.0 15.1 6.2 100.0 653 5.3 50-54 41.3 29.0 12.4 11.6 5.7 100.0 569 4.1 55-59 42.1 29.2 12.1 9.6 6.9 100.0 374 2.3 60-64 54.7 23.0 7A 3.9 11.0 100.0 373 0.0 65+ 65.7 17.0 3.9 3.3 10.1 100.0 847 0.0 R~idellce Urban 13.9 33.5 35.4 13.2 4.0 100.0 4,544 6.0 Rural 31.2 35.1 23.2 4.7 5.8 100.0 10,715 3.1 Region Northeazt 50.1 18.6 I6.2 4.5 I0.5 I00,0 2,586 0.0 Northwest 51.6 18.4 13.7 3.5 12.8 100.0 1,970 0.0 Southeast 9.I 50.1 31.6 6.8 2.3 100,0 3,402 5.3 Southwest 12.9 38.8 36.1 9.6 2.6 100,0 3,884 5.8 Central 25.1 35.9 27.2 9.1 2.7 100,0 3,417 4.8 Total 26.1 34.6 26.8 7.2 5.2 100.0 15,259 4.7 FEMALE Age 6-9 32.8 57.8 0.5 0.0 8.8 100.0 2,798 0.2 10-14 20.0 51.7 24.2 0.0 4.2 100.0 1,817 3.8 15-19 22.1 23.0 50.2 1.0 3.7 100.0 1,918 6.1 20-24 28.9 19.3 38.9 7.6 5.3 100~0 1,622 5.9 25-29 31.9 23.0 31.1 8.5 5.6 100.0 1,573 5.6 30-34 39.5 21.7 24.1 8.2 6.5 100,0 1,228 5.1 35-39 44.6 22.3 16.3 9.1 7.7 100.0 1,027 1.7 40-44 56.2 22.3 8.6 5.7 7.2 100.0 728 0.0 45-49 58.0 24.8 4.5 5.2 7.5 100,0 599 0.0 50-54 63.0 15.9 5.2 3.8 12.1 100,0 693 0.0 55-59 72.8 8.2 3.2 2.6 13.2 100.0 331 0.0 60-64 76.6 5.5 1.2 1.5 15.2 I00.0 356 0.0 65+ 83.6 2.8 0.5 1.3 I1.7 100,0 556 0.0 Residence Urban 25.4 32.0 29.9 8.1 4.6 100.0 4,529 5,1 Rural 43.3 29,8 16.7 2.1 8.1 100,0 10,745 0.1 Region Northeast 64.0 14.4 8.0 1.5 12.2 100,0 2,536 0.0 Northwest 64.6 11.5 5.8 0.6 17.6 100.0 1,935 0.0 Southeast 18.8 44.5 29.I 4.1 3.5 100.0 3,645 4.8 Southwest 22.8 36.5 30.4 6.5 3.7 100.0 3,789 5.3 Central 41.0 31.5 18.3 4.4 4.8 100.0 3,369 1.0 Total 38.0 30.5 20.6 3.9 7.1 100.0 15,273 1.7 Note: Total includes 26 men whose age is missing and 28 women whose age is missing 16 MeninNigeriahave adistinct educational advantage over women. Menreceiveroughiy three years more education than women, with a median number of years of schooling of 4.7 for males, compared with only 1.7 years for females. At every age group, there are smaller proportions of men than women with no education (Figure 2.3). Despite reductions over time in the propollion of men and women with no education (evidenced by the fact that younger people are less likely to be uneducated), the gender differential in educational attainment has narrowed little. The proportion of rural males and females with no education is almost double that of urban respondents. The Northwest region has the highest proportion of persons with no education (52 percent of men and 65 percent of women), while the Southeast region has the lowest percentage who have never been to school (9 percent of men and 19 percent of women). The Southwest region has the highest proportion who have attended higher educational institutions (10 percent of men and 7 percent of women). 100 80 60 40 i 20 Figure 2.3 Percentage of Males and Females Who Have No Education by Age Group, Nigeria 1999 Percent 0 6-9 101-14 151-19 20~24 25~29 30~34 35~39 40~44 451-49 50~54 55~59 50~54 65+ Age Group I~-Male -e-Female I NDHS 1999 School Attendance Rates Table 2.6 shows school attendance rates by age group, sex, and residence for the population age 6-24 years. A school enrolment rate is the percentage of children in a specific age group who are currently in school. 17 Table 2.6 School attendance Percent of the de facto household population 6-24 years of age currently in school, by age, sex, and ~esidence, Nigeria 1999 Male Female Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 6-10 72.6 53.4 58.5 68.8 49.5 54.9 70.7 51.4 56.7 11-15 77.2 65.2 68.8 75.5 60.1 64.9 76.4 63.0 67.1 6-15 74.8 58.4 63.0 71.5 53.3 58.6 73.2 56.0 60.9 16-20 58.3 44.7 49.1 41.1 30.9 33.9 49.7 37.2 41.0 21-24 30.8 24.0 26.4 21.3 15.1 17.4 25.5 19.2 21.4 The table shows that 57 percent of children age 6-10 are in school. The percentage enrolled in school increases to 67 in the age group 11-15 years, after which it drops substantially. Only 41 percent of the population age 16-20 are attending school. Among those in their early twenties, only 21 percent are still in school. School attendance is substantially higher for urban than for rural residents (Figure 2.4). In the population as a whole, males are more likely than females to be enrolled in school in all age groups, with the differential being greatest for the 16-20 age group. Figure 2.4 Percentage in School by Age and Urban-Rural Residence, Nigeria 1999 Percent 80 60 40 20 6-15 16.20 21-24 AgeGroup I~Urban IZ3Rural I NDHSI999 18 2.2 Household Facilities In the Household Questionnaire, re- spondents were asked about certain charac- teristics of their households, including availa- bility of electricity, source of drinking water, time to water source, type of toilet facilities, I main floor materials, and persons per room. l These physical characteristics have an important bearing on exposure to disease for household members, particularly children. They are also useful indicators of the socioeconomic status of the household. Table 2.7 summarises this infor- mation by urban-rural residence. ! Overall, 45 percent of households in Nigeria have electricity (Figure 2.5). This represents an improvement over the 27 percent reported in the 1990 NDHS. Electricity is avail- able in four of every live urban households (84 percent), which is three times the proportion in rural areas (28 percent). Access to drinking water and adequate sanitation facilities are important determinants of health conditions. In Nigeria, one in four house- holds has piped water, either piped into their residence or plot or a public tap. More than 40 percent of households use water from a well or borehole, and 25 percent use surface water from a river, pond, or dam. Assuming that water from pipes, private wells, boreholes, and springs are tmcontaminated, slightly more than half of Nigerian households drink safe water. Sources used by households to obtain drinking water differ considerably by area of residence. Twenty-four percent of urban house- holds obtain water from pipes in their residence, yard, or plot, compared with only 4 percent of rural households. In urban areas, 26 percent of households obtain drinking water from public taps, versus 10 percent of rural households. Other sources of water for urban households are private wells and boreholes. In rural areas, one- third (32 percent) of households obtain drinking water from rivers and streams. Other major sources of water for rural dwellers are public wells and wells in the yard or plot. Table 2.7 Housing characteristics Percent distribution of households by housing characteristics, according to residence, Nigeria 1999 Residence Characteristic Urban Rural Total Electricity Yes 84.3 27.9 44.9 No 14.9 70.9 54.0 Missing 0.8 1.2 1.1 Total 100.0 100.0 100.0 Source of drinking water Pipe in residence/yard/plot 24.0 3.7 9.8 Public tap 25.8 9.5 14.4 Well in residence/yard/plot 16.9 15.I 15.7 Public well 9.6 19.8 16.7 Bomhole I2.4 9.1 10.1 S~?ring 1.1 4.0 3.1 Rwer/stmam 3.2 32.2 23.4 Pond/lake 0.5 1.6 1.2 Darn 0.4 0.3 0.3 Rainwater 0.3 0.8 0.6 Tanker truck 1.6 1.1 1.3 Tanker vendor 2.0 1.2 1.4 Bottled water 0.4 0.1 0.2 Other 0.6 0.4 0.5 Missing 1.0 1.0 1.0 Total 100.0 100.0 100.0 Time to water source (in minutes) <15 minutes 74.2 48.5 56.3 Median time to source 0.3 14.1 9.4 Sanitation facility Own water closet 20.7 2.9 8.3 Shared flush toilet (W.C.) 9.9 1.4 3.9 Traditional pit toilet 46.4 56.7 53.6 Ventilated improved pit (VIP) latrine 8.8 5.2 6.3 Bucket toilet 0.3 0.1 0.1 No facility/bu stdfleld/river I2.3 32.1 26.1 Other 0.6 0.1 0.3 Missing 1.2 1.5 1.4 Total 100.0 100.0 100.0 Main floor material Earth/sand 9.8 44.8 34.2 Dung 1.5 4.6 3.7 Wood planks 0.1 0.2 0.2 Palm/bamboo 0.1 0.1 0.1 Vinyl or asphalt strips 0.0 0.2 0.1 Ceramic tiles 1.3 0.1 0.5 Cement 67.1 45.6 52.1 Terazol/Marble 2.0 0.5 0.9 Carpet 16.9 2.8 7.1 Missing 1.2 1.1 I.I Total 100.0 100.0 100.0 Persons per sleeping room 1-2 59.0 67.5 65.0 3-4 25.5 23.3 24.0 5-6 I0.4 5.2 6.8 7+ 3.4 2.0 2.4 Missing/Don't know 1.7 2.0 1.9 Mean 2.7 2.3 2.5 Total 100.0 100.0 100.0 Number of households 2,313 5,334 7,647 19 Figure 2.5 Percentage of Households with Specific Amenities, by Urban-Rural Residence, Nigeria 1999 Percent 100 80 6O 40 2O 0 Electricity piped Drinking Flush Toilet Water IB~Urban lllRural I~Total I NDHS 1999 Proximity to a water source encourages use of more water, which results in better hygiene. Slightly more than half of all Nigerian households are within 15 minutes of a source of water. About three-quarters of urban households (74 percent) are close (within 15 minutes) to a water source, compared with less than half of rural households. The median travel time to th~ source of drinking water is 14 minutes in rural areas, while it is only a fraction of a minute (0.3 minutes) in urban areas. NDHS data (Table 2.7) show that 8 percent of all households have their own water closet, while 4 percent share water closets, 54 percent have traditional pit toilets, and 26 percent have no toilet facility. The use of traditional pit toilets is more common in rural than in urban areas (57 percent versus 46 percent). Twelve percent of urban households have no toilet facility, which is much lower than the proportion in rural areas (32 percent). The most commonly used flooring materials are cement (52 percent) and earth/sand (34 percent). More than three-quarters of urban households and 90 percent of rural households use these two materials for flooring. The NDHS collected data on the total number of rooms that a household uses for sleeping. This information provides a measure of household room density. Table 2.7 shows that 65 percent of households have one or two persons per sleeping room and one-quarter have three to four persons per sleeping room. On average, there are 2.5 persons per sleeping room. 20 Household Durable Goods Besides providing information on the socioeconomic status of households, durable consumer goods have specific benefits for the households. Having access to a radio or tele- vision exposes household members to innovative ideas. A refrigerator prolongs the whole- someness of foods, and transportation allows greater access to many services outside the local area. Table 2.8 shows the availability of selected durable goods by urban-rural residence. Sixty-two percent of households own a radio, 31 percent have an electric fan, 26 percent have a television, 24 percent have an electric iron, and 24 percent have a bicycle. Few households have telephones (2 percent), private cars (8 percent), or gas cookers (5 percent). Table 2.8 Household durable ~oods Percentage of households possessing various durable consumer goods, by residence, Nigeria 1999 Residence Durable consumer goods Urban Rural Total Radio 77.6 55.3 62.1 Television 52.7 13.9 25.6 Telephone 5.3 0.2 1.8 Refrigerator 33.6 7.4 15.3 Bicycle 9.8 30.5 24.2 Motorcycle 13.9 13.3 13.5 Private car 14.9 4.5 7.7 Gas cooker 10.2 2.3 4.7 Electric iron 50.1 13.3 24.4 Electric fan 65.0 16.3 31.0 Donkey/hurse/camel 0.1 4.7 3.3 Canoe/boat/ship 0.2 4.3 3.1 None (radio through ear) 16.4 33.9 28.6 None of the above 13.4 30.2 25.1 Number of households 2,313 5,334 7,647 Ownership of all items inquired about is higher among urban than among rural households, except bicycles, work animals, and boats. For example, the proportion of urban households that own a private car (15 percent) is thrice the proportion of rural households (5 percent). Less than 1 percent of rural households have a telephone, compared with 1 in 20 urban households. Large urban-rural differentials are also observed in ownership of appliances that usually require electricity, such as televisions, refrigerators, irons, and fans. 2.3 Characteristics of Survey Respondents Background Characteristics Data concerning characteristics of the respondents are presented in Table 2.9. As expected, there are many more respondents in the younger age groups than at older ages. Seventy percent of women and 60 percent of men are in union (married or living together), while one-quarter of the women and more than one- third of the men have never married. The proportion divorced, widowed, or separated is generally low in Nigeria. About 70 percent of both maie and female respondents reside in rural areas, a decline from the level of 75 percent in the 1990 NDHS. About 30 percent of respondents are from the Northwest and Northeast regions, while about 48 percent are from the Southwest and Southeast regions. The remaining 22 percent reside in the Central region. 21 Table 2.9 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Nigeria 1999 Number of women Number of men Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted Alg5e- 19 21.6 1,775 1,774 19.1 511 513 20-24 18.5 1,521 1,528 11.9 319 315 25-29 18.5 1,516 1,521 13.6 366 361 30-34 13.9 1,137 1,142 13.0 348 348 35-39 12.I 992 983 10.3 275 278 40-44 8.5 696 689 8.9 239 240 45-49 6.9 568 562 7.4 197 197 50-54 7.6 205 209 55-64 8.2 220 219 Marital status Never married 26.0 2,130 2,118 36.9 988 988 Married 64.6 5,304 5,316 56.7 1,518 1,512 Living together 5.5 453 439 3.5 93 96 Widowed 1.6 134 132 0.7 18 18 Divorced 1.0 83 86 0.9 24 24 Not living together 1.2 102 108 1.4 38 42 Residence Urban 31.0 2,540 2,697 30.7 821 882 Rural 69.0 5,666 5,502 69.3 1,859 1,798 R~o'rt °~ beast 15.7 1,292 1,304 16.3 437 437 Northwest 13.2 1,087 1,162 13.3 356 337 Southeast 23.0 1,886 1,895 22.0 590 602 Southwest 25.4 2,080 2,002 26.0 696 698 Central 22.7 1,861 1,836 22.4 601 606 Education level attained No education 40.5 3,324 3,325 243 663 652 Primary 22.8 1,868 1,850 26.5 710 70g Secondary 30.5 2,506 2,503 36.8 986 988 Higher 6.2 508 521 12.0 32I 332 Religion Catholic 14.6 1,201 1,189 13.1 352 355 Protestant 19.0 1,559 1,558 20.3 543 553 Other Christian 20.4 1,672 1,657 19.1 513 521 Muslim 43.7 3,587 3,620 45.2 1,210 1,190 Traditionalist 1.6 132 120 1.9 52 50 Other 0.7 56 55 0.4 11 11 All women 100.0 8,206 8,199 100.0 2,680 2,680 Educational levels are low in Nigeria and women are at a distinct disadvantage compared with men. The proportion of women age 15-49 who have never been to school is 16 percentage points higher than that of men (41 versus 25 percent). The proportion of male respondents who have attended post-secondary schools (12 percent) is double that of female respondents (6 percent). As regards religion, slightly more than half of the respondents are Christian and slightly less than half are Muslim. Characteristics of Couples Since male respondents were selected from households in which women were also interviewed, it is possible to match married men with their wives to form a sample of couples. Table 2.10 presents information on 1,451 couples. 22 Table 2.10 Differential characteristics between spouses Percent distribution of couples by differences between spouses in age and level of education, Nigeria 1999 Number Percent/ of Characteristic Years couples Wife older 2.0 30 Husband older by: 0-4 years I3.9 201 5-9 years 31.7 460 10-14 years 25.9 375 15 years or more 26.5 385 Mean age difference (years) First wife 10.0 1,264 Second wife 17.5 187 All wives 10.9 1,45I Education (percent) Both husband and wife not educated 35.0 508 Wife educated, husband not 3.7 54 Husband educated, wife not 20.8 301 Both husband and wife educated 40.5 587 Total 100.0 1,451 In Nigeria, it is common for men to marry younger women. In the NDHS, only 2 percent of wives are older than their husbands. The mean age difference between husbands and their wives is 11 years. In polygynous unions, the mean age difference between the husband and his second wife is 18 years. The data also show that educated men are likely to marry educated women (41 percent), and that with no education marry women with no education (35 percent). It is rare for an educated woman to marry a man who is not educated, although 20 percent of educated husbands have wives who had no schooling. Educational Differentials Table 2.11 gives an overview of the relationship between the level of education and other background characteristics of respondents. Of particular importance are possible differences in the educational composition of women from different age groups, urban-rural residence, and regions. Older women and men are generally less educated than younger respondents. For example, 65 percent of women age 45-49 have no formal education, compared with only 26 percent of women age 15-19. The level of education also varies greatly according to residence. Women and men in urban areas are more likely to have obtained higher education than their rural counterparts. The urban-rural difference is more pronounced at the secondary and higher level. Only 3 percent of women and 8 percent of men in rural areas have a higher education, compared with 13 percent of women and 21 percent of men in urban areas. 23 Table 2.11 Educational attainment by background characteristics Percent distribution o f women and men by highest level of schooling attained, according to selected background characteristics, Nigeria 1999 Highest level of schooling attained Number of Background No edu- women/ cJaar vet~-istie e~tioa P r imly Se, condaty Higttex Total men WOMEN Age 15-19 25.7 22.1 51.3 0.9 I00.0 1,775 20-24 32.4 20.2 40.0 7.4 100.0 1,521 25-29 36.0 24.7 30.6 8.6 100.0 1,516 30-34 43.9 22.8 25.3 8.0 100.0 1,137 35-39 52.5 23.2 14.9 9.4 100.0 992 4044 63.1 23.4 8.2 5.3 100.0 696 452~9 64.9 ~.7 5.5 4.9 l f~.0 56g Residence Urban 24.9 21.0 41.5 12.5 100.0 2,540 Rural 47.5 23.5 25.6 3.3 100.0 5,666 Region Northeast 76.9 8.9 12.0 2.1 100.0 1,292 Northwest 82.3 8.1 8.3 1.2 I00.0 1,087 Southeast 11.0 36.2 46.2 6.7 100.0 1,886 Southwest 19.8 26.7 43.8 9.7 100.0 2,080 Central 43.9 23.0 25.6 7.5 100.0 1,86I All women 40.5 22.8 30.5 6.2 100.0 8,206 MEN Age 15-19 13.2 20.5 65.4 1.0 100.0 511 20-24 12.6 25.1 53.2 9.1 100.0 319 25-29 I5.6 28.7 38.2 17.5 I00.0 366 30-34 18.5 28.2 34.9 18.3 100.0 348 35-39 25.3 23.7 31.6 19A 100.0 275 40-44 36.2 26.4 19.4 18.1 100.0 239 45-49 36.0 34.9 16.0 13.1 100.0 197 50-54 42.9 32.I 15.2 9.8 100.0 205 55+ 53.9 27.0 11.4 7.7 100.0 220 Re~de~ce Urban 13.4 20.8 45.0 20.7 100.0 82I Rural 29.7 29.0 33.2 8.1 100.0 1,859 Region Northeast 49.5 I8.2 23.7 8.7 100.0 437 Northwest 58.6 21.4 12.6 7.3 100.0 356 Southeast 6.8 37.4 45.2 10.7 100.0 590 Southwest 10.0 25.8 50.0 14.1 100.0 696 Central 21.3 25.7 37.2 15.9 100.0 601 A11 raett 24.7 26,5 36,8 12,0 100.0 2,680 The Northwest region has the highest proportion of uneducated respondents (82 percent of women and 59 percent of men). In the Southeast region, only 11 percent of women and 7 percent of men had no schooling. The proportion of women who have a primary school education in the Southeast region is higher than in the other regions. 24 Reasons for Leaving School Knowledge of the reasons for leaving school can provide guidance for policies aimed at enhancing women's status. Women age 15-24 who had attended school but were not currently attending were asked in the NDHS why they stopped. Table 2.12 shows the percent distribution of women age 15-24 years by current enrolment status in school, that is, whether they are attending school and if not, their reasons for leaving school and level of education attained. Almost half (48 percent) of women age 15-24 who have attended school are still continuing their education. The major reason for leaving school is inability to pay school fees (15 percent). The next most frequently cited reason for stopping schooling is to get married (10 percent). This reason is most common among women who have completed primary school (19 percent). Among those who left higher education institutions, the major reasons for leaving are that they graduated, had enough education needed to earn money, and marriage. The proportion of those leaving school because they did not pass exams is highest amongst those who have completed secondary school (7 percent). It is interesting to note that the least common reason for leaving school is that the school is not accessible. Table 2.12 Reasons for leaving school Percent distribution of women age 15-24 who have ever attended school by current e~ollment status and reason for leaving school, according to highest level of education attended, Nigeria 1999 Highest level of education Reason stopped Primary Primary Secondary Secondary attending school incomplete complete incompIete complete Higher Total Still in school 45.1 11.9 71.0 22.4 67.5 48.0 Got pregnant 4.7 2.6 3.8 1.0 0.7 3.0 Got married 12.8 18.6 5.6 11.1 2.4 9.7 Take care of children 1.0 0.8 0.3 0.8 0.0 0.5 Family needed help 2.9 2.8 0.7 2.5 0.0 1.6 Could not pay school fees 18.6 34.4 8.9 10.2 1.5 14.9 Need to earn money 0,0 3.1 1.1 6,9 4.1 2.6 Graduated, enough 1.9 6.0 2.6 24.3 19.3 7.8 Did not pass exams 1.1 4.0 0.6 6,8 0,0 2.3 Did not like school 7.9 7.0 1.8 1.0 0.0 3.2 School not accessible 0.0 0.4 0.3 0.3 0.0 0.2 Other 2.6 3.7 1.2 7.5 0.0 2.9 Don' t know/misslng 1.4 4.6 2.2 5.3 4.5 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 211 488 1,126 393 129 2,347 Access to Mass Media NDHS respondents were asked if they usually read newspapers, listen to radio, or watch television at least once a week. This information is important because it provides an thdicalion of the level of exposure to the mass media, which are often used to disseminate information on family planning and public health. Table 2.13 and Figure 2.6 show the percentage of female and male respondents exposed to different types 25 Table2.13 Acee~ss tomassmedia Percentage of women and men who usually read a newspaper weekly, watch television weekly, and listen to the radio daily, by selected background characteristics, Nigeria 1999 Number No Reads a Watches Listens to All of news a ar television the radio three women/ Background mass ~Pk~ charaO.eristic media w weekly daily media men WOMEN Alg5e- 19 39.3 27.3 39.4 51.3 17.9 1,775 20-24 37.4 28.9 39.1 54.1 18.1 1,521 25-29 40.1 25.5 36.1 53.7 17.5 1,516 30-34 42.5 21.2 33.4 53.1 i6.5 1,137 35-39 45.8 19.0 31.9 49.4 14.3 992 40-44 49.4 13.2 28.5 43.7 10.3 696 45-49 51.5 11.1 24.3 45.3 8.3 568 Residence Urban 18.7 39.6 66.5 72.2 32.8 2,540 Rural 52.5 I5.7 20.9 41.9 8.4 5,666 Region Northeast 65.I 8.3 14.5 31.5 5.3 1,292 Northwest 57.9 5.6 10.4 40.4 3.0 1,087 Southeast 40.3 26.2 36.3 47.5 15.1 1,886 Southwest 19.7 38.3 58.4 73.2 29.6 2,080 Central 43.4 23.4 36.3 50.5 16.4 1,861 Education No education 66.8 0.2 10.3 31.1 0.1 3,324 Primary 41.1 12.0 33.7 52.1 6.7 1,868 Secondary 17.6 49.5 58.9 70.1 33.1 2,506 Higher 3.7 83.3 84.4 87.1 68.4 508 All women 42.0 23.1 35.0 51.2 15.9 8,206 MEN Alg.' e- I9 18.4 35.0 56.9 73.9 27.7 511 20-24 16.5 45.1 59.9 78.8 35.6 319 25-29 12.3 47.8 53.2 81.1 34.7 366 30-34 14.3 50.4 53.3 83.1 40.3 348 35-39 17.8 44.6 47.4 80.3 34.0 275 40-44 20.I 39.4 47.4 76.5 31.5 239 45-49 19.7 36.6 43.1 80.3 27.2 197 50-54 18.3 37.1 43.5 77.9 30.3 205 55+ 25.7 29.9 34.7 71.6 22.4 220 Residence Urban 6.3 63.1 82.9 89.2 57.5 821 Rural 22.6 31.5 36.3 73.2 20.6 1,859 Region Northeast 30.5 24.8 35.0 66.0 17.5 437 Northwest 32.5 13.3 22.3 65.8 8.7 356 Southeast 18.5 38.0 48.2 75.8 27.4 590 Southwest 6.1 66.9 75.9 90.5 58.6 696 Central 11.9 42.9 51.8 82.3 29.8 601 Education No education 40.2 2.5 18.1 57.0 1.4 663 Pdmarrv 17.2 30.4 41.1 79.4 19.5 710 Secondary 7.8 59.6 68.2 85.9 46.4 986 Higher 1.9 88.1 84.6 95.1 78.0 321 All men 17.6 41.2 50.6 78.1 31.9 2,680 26 Figure 2.6 Percentage of Women and Men with Access to Mass Media, Nigeria 1999 Newspaper Telsvision Radio All Three Media No Access 0 51 ~;~i~i~i~i~ii~i~i~i~iiiili~i~i~i~i~i~il i~iii~i~ili!i~ii!i~!i!i!] 78 i 42 20 40 60 80 100 Percent ]llWomen E~Men] NDHS1999 of mass media by age, residence, region, and level of education. In all, the proportion of men who have access to all three types of mass media is twice that of women (32 versus 16 percent). The table further shows that radio is the more commonly accessed medium, with 51 percent of women and 78 percent of men listening at least once a day. The next most widely used medium is television. Only 23 percent of women and 41 percent of men read a newspaper at least once a week. The proportion of women who have no access to any mass media is more than twice that of men (42 percent compared with 18 percent). Generally, exposure to mass media decreases with age and is higher in urban than in rural areas. Printed material and television are less commonly accessed by people in rural areas, perhaps in part because of their lower socioeconomic status. Exposure to all three media is substantially lower in the northern regions than in the other three regions. Less-educated respondents are also less likely to read newspapers, watch television, and listen to the radio than their better- educated peers. Women's Employment Status The NDHS collected information from women about their current employment status. The results are presented in Table 2.14. About half of women are not currently employed and about a third are employed on a full-time basis. The proportion not currently employed declines with age, while the proportions of those employed on a full-time and part-time basis increase with age. A slightly higher level of unemployment is observed among women in rural areas than in urban areas (54 versus 47 percent). The highest percentage of employed women is in the Southwest (67 percent) and the Southeast (56 percent). Unemployment is highest among women with no education (62 percent). 27 Table 2.14 Employment Percent distribution of women by employment status and continuity of employment, according to selected background characteristics, Nigeria 1999 Not currently employed Did not work Worked Currently employed in last in Number Background 12 last 12 All year All year Season- Occasion- of characteristic months months 5+ days <5 days ally ally Missing Total women Age 15-19 79.1 1.2 9.1 3.2 3.5 3.4 0.5 I00.0 1,775 20-26 62.2 1.5 24.5 3.7 6.1 1.6 0.4 I00.0 1,521 25-29 44.6 1.5 37.9 6.6 6.4 2.2 0.7 100.0 1,516 30-34 35.9 1.2 44.8 6.5 9.0 2.1 0.5 100.0 1,137 35-39 33.1 1.3 46.3 6.3 10.1 2.8 0.2 100.0 992 40-44 30.7 1.2 48.5 6.2 10.2 3.1 0.1 100.0 696 45-49 26.2 1.8 48.2 9.2 11.2 3.2 0.2 100.0 568 Residence Urban 45.4 1.2 42.5 2.9 4.7 2.6 0.5 100.0 2,540 Rural 52.5 1.4 28.4 6.5 8.2 2.5 0.4 100.0 5,666 Region Northeast 78.0 1.0 12.7 2.6 3.4 1.8 0.5 100.0 1,292 Northwest 78.4 1.1 10.4 3.6 4.1 2.4 0.0 100.0 1,087 Southeast 41.3 1.9 30.8 10.7 10.7 3.9 0.6 100.0 1,886 Southwest 29.9 2.0 55.3 4.1 5.6 2.6 0.5 100.0 2,080 Central 46.5 0.6 36.4 4.5 9.9 1.8 0.4 100.0 1,861 Education No education 60.8 1.2 24.1 4.3 7.0 2.3 0.4 100.0 3,324 Primary 32.8 1.7 42.4 9.9 9.9 2.9 0.1 100.0 1,868 Secondary 52.7 1.4 32.6 4.4 5.8 2.8 0.7 100.0 2,506 Higher 34.3 1.4 54.6 1.5 6.1 1.6 0.4 I00.0 508 All women 50.3 1.4 32.7 5.4 7.2 2.6 0.4 100.0 8,206 Women's Employers and Remuneration Table 2.15 shows the percent distribution of employed women by type of employer and form of earnings (remuneration), according to background characteristics. About 70 percent of women who work are self-employed, while 17 percent are employed by relatives and 13 percent are employed by non-relatives. In all cases, most (86 percent) employed women work for cash. Women in mral areas are tvdce as likely as those in urban areas to work for non-cash payments. The Northwest region has the highest proportion of self-employed women (78 percent), followed by the Southeast region (74 percent). The proportion of women who are employed by non-relatives increases with education. 28 Table 2.15 Employer and form of earnings Percent distribution of currently employed women by employer and type of earnings (cash, in kind, no payment), according to background characteristics, Nigeria 1999 Employed by Employed by Self-employed a nonrelative a relative Does Does Does Number Background Earn~ not eeee~n Eam~ not e~n Eam~ not e~n of characteristic cash cash cash cash cash cash Missing Total women Age 15-19 37.5 3.6 9.1 4.6 19.8 24.2 1,3 100.0 340 20-24 60.4 5.5 13.8 2.1 7.5 9.5 1,2 100.0 546 25-29 67.9 3.6 11.3 1.4 10.4 4.0 1,4 100.0 806 30-34 66,9 4.7 13,7 0,2 9,2 4,6 0,6 100,0 710 35-39 65.4 4.8 14.1 0.4 8.6 6.1 0.4 100.0 649 40-44 68.5 5.3 9.7 0.2 10.2 4.9 1,2 100.0 473 45-49 72.9 4.8 9.2 0.2 7.1 5.0 0,7 100.0 408 Residence Urban 64.5 2.8 20.2 1.4 6.6 3.5 1,0 100.0 1,342 Rural 64.1 5.5 7.7 1.0 11.7 9.1 1.0 100.0 2,590 Region Northeast 62.6 2.5 9.3 0.0 11.5 11.6 2,6 100.0 264 Northwest 76.6 1.6 6.5 0.0 11.5 2.1 1,5 100.0 223 Southeast 66.5 7.3 11.9 0.8 5.4 7.0 1,2 100.0 1,060 Southwest 66.5 2.3 13.0 1.7 12.0 3.9 0.7 100.0 1,406 Central 56.1 6.3 12.4 1.2 11.3 12.1 0,6 100.0 978 Education No education 67.8 5.6 2.2 0.2 13.7 9.5 0~9 100.0 1,250 Primary 73.2 5.0 3.9 1.7 9.1 6.3 0.8 100.0 1,223 Secondary 60.8 4.3 16.9 1.6 8.2 7.1 1,0 100.0 1,133 Higher 28.4 0.4 62.3 1.1 4.3 1.9 1,5 100.0 325 All women 64.2 4.6 11.9 1.1 9.9 7.2 1,0 100.0 3,931 1 Includes both women who receive only cash and those who receive cash and in-kind payment. 2 Includes both women who receive in-kind payment and those who receive no payment. Women's and Men's Occupations Tables 2.16.1 and 2.16.2 present information on the current occupation of employed women and men, respectively. Slightly more than one-fifth of working women are employed in agriculture. Of these, most work either on their own or on family-owned land. Many of those not employed in agriculture work in sales and services (56 percent). Almost 10 percent of employed women are in professional, technical, or managerial occupations, while 11 percent work in skilled and unskilled manual services. Generally, women are more likely to be engaged in non-agricultural than in agricultural employment (79 percent versus 21 percent). Women from the Southeast region are the most likely to be employed in agriculture (29 percent), while women from the Northwest region are the least likely (4 percent). As expected, women with higher education are less likely to be employed in agriculture (2 percent) and are more likely to be engaged in professional, technical, or managerial employment (63 percent). About three-fifths of women who have completed primary and secondary education are engaged in sales and services. 29 Table2.16.1 Occupation: women Percent distribution of currently employed women by type of work performed (agricultural and nonagricultural) and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Nigeria 1999 Agricultural work Nonagricultural work ]?roLl Sales Manual labour Number Background Own Family Rented Other Tech./ and of charactetistie land land land land Man~g. sevc~ces Skilled Unskilled Other Missing Total women Age 15-19 3.4 17.8 2,1 1.2 4.3 57.6 9.8 0.0 1.2 2.7 I00.0 340 20-24 3.1 11.9 1.9 1.9 8.8 53.2 16.2 0.5 0.9 1.6 100.0 546 25-29 3.5 8.8 2,1 1.5 11.8 55.1 14.9 0.2 0.6 1.5 100.0 806 30-34 4.5 8.9 2.5 1.4 11.6 59.4 8.4 0.1 2.0 1.1 100.0 710 35-39 4.4 10.7 4,4 1.6 13.6 56.2 8.0 0.0 0.5 0.6 100.0 649 40-44 7.4 11.7 4.4 3.0 7.1 56.4 9.2 0.0 0.4 0.4 100.0 473 45-49 8.0 I3.6 4.5 4.0 6.4 55.9 6.4 0.0 0.5 0.8 100.0 408 Residence Urban 1.6 2.7 0,5 0.9 18.1 61.1 13.4 0.1 0.7 0.9 100.0 1,342 Rural 6.3 15.6 4,3 2.5 5.6 53.7 9.4 0.1 1.0 1.4 100.0 2,590 Region Northeast 2.6 11.8 0.0 1.I 9.6 54.2 15.6 0.0 1.8 3.4 I00.0 264 Northwest 0.4 2.6 0.0 0.7 6.9 70.3 12.0 1.3 2.4 3.4 100.0 223 Southeast 8.8 12.8 4,7 2.5 8.6 53.9 7.4 0.1 0.3 1.0 100.0 1,060 Southwest 1.9 7.0 4.5 2.1 10.7 61.5 10.7 0.1 0.9 0.5 100.0 1,406 Central 5.9 17.2 0.7 1.8 10.8 48.4 12.9 0.I 0.9 1.3 100.0 978 No education 7.5 17.7 4.8 2.6 0.4 55.5 8.6 0.1 1.2 1.5 100.0 1,250 Primary 4.9 11.6 3.4 2.4 1.3 62.9 12.1 0.1 0.7 0.6 100.0 1,223 Secondary 2.6 6.4 1,6 1.2 14.3 59.6 11.9 0.2 0.7 1.4 100.0 1,133 Higher 0.7 0.7 0,0 1.0 63.4 21.9 10.1 0.0 1.1 1.2 100.0 325 All women 4.7 I1.2 3,0 2.0 9.9 56.2 10.8 0.I 0.9 1.2 I00.0 3,931 Note: ProfJTechYManag. includes professional, technical, clerical, and managerial occupations. 30 About three-quarters (76 percent) of the men are currently working. Surprisingly, there is a higher level of unemployment among those who have completed secondary school (44 percent) than among those with no education (6 percent). One-third of all men are working in agricultural occupations, 14 percent are in sales and services, 14 percent are in manual work, and 12 percent are in professional, technical, or managerial employment. Table2.16.2 Occupation: men Percent distribution of type of work performed (agricultural and nonagricultural) and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Nigeria 1999 Agricultural work Nonagricultural work Not currently ProLI Sales Manual labour Number Background era- Own Family Rented Other Tech./ and of characturistle ployed land land land land Manag. services Sldlled Unskilled Other Missing Total men Age 15-19 72.3 1.7 13.6 0.9 1A 1.0 3.8 4.1 0.4 0.5 0.4 100.0 511 20-24 44,4 6.7 12.0 2.6 L9 2.2 12.2 13.9 2,0 1.8 0.3 100.0 319 25-29 19.2 15.3 11.1 3.7 3.6 11.6 16.4 17.2 0.5 1.0 0.3 100.0 366 30-34 2,4 16.4 11.7 4.8 3.5 20.4 16.5 21,3 0.3 1.8 0.9 100.0 348 35-39 4.1 19.1 9.8 4.7 3.1 25.7 14.1 15.8 1.5 1A 0.8 100,0 275 40-44 0.8 29.3 6.6 6.9 3.6 20.6 15.0 14.8 0.9 1.0 0.4 100.0 239 45-49 2.1 25.9 6.6 3.0 3.6 I6.6 21.9 19.2 0.0 1.0 0.0 I00,0 197 50-54 3.0 20.7 10.3 8.0 7.9 13.3 19.I 15.7 0.0 0.5 1,5 100.0 205 55+ 6.7 34.0 7.3 4.0 7.8 12.8 I7.1 7.6 0.0 1.9 0.8 100.0 220 Residence Urban 31.2 3.7 2,3 1.8 1.5 18.9 18.2 19.7 0.6 1.7 0.6 100.0 821 Rural 20.0 21.7 14.2 4.8 4.5 9.6 11.8 11.1 0.7 1.0 0.6 100.0 1,859 Region Northeast 12.9 26.4 14.0 2.7 3.5 11.2 15.9 10.8 0.7 1.6 0.2 100.0 437 Northwest 6.9 40.6 21.8 0.9 2.4 7.9 9.8 7.3 0.9 0.6 0.9 100.0 356 Southeast 29.6 9.8 3,7 4.7 3.3 12.3 18.7 14.2 0.9 1.7 1.1 100,0 590 Southwest 32.5 4.3 9.3 6.9 3.1 13.2 12.5 16.8 0.7 0.3 0.4 100.0 696 Central 24.4 14.4 9.5 2.1 5.1 15.2 11.4 15.6 0.2 1.8 0.3 100.0 601 Edueatioll No education 5.5 40,0 18.2 5.4 7,1 2.3 8.8 11.2 0.5 0.7 0.3 100.0 663 Primary 12.6 14,9 15.1 5.3 4.1 7.4 16.7 21.8 0,6 0.7 0.7 100.0 710 Secondary 44.2 5.6 5.1 2.8 1.3 9.7 16.2 12.0 1.1 1.6 0.5 100.0 986 Higher 20.7 2.4 1,5 0.7 1.9 52.8 10.5 6.5 0.0 1.9 1.0 100.0 321 All men 23.4 16.2 10.5 3,8 3.6 12.4 13,8 13.7 0.7 1.2 0.6 100.0 2,680 Note: Pro~/Tech,/Manag. includes professional, technical, clerical, and managerial occupations, 31 Decision on Use of Earnings Information on who decides how to use the cash earned by employed women can be used as a measure of the status of women. Table 2.17 shows that 70 percent of women who receive cash earnings decide for themselves how to spend their money, 12 percent dec'lde jointly with their husband or partner, while 11 percent report that their husband or partner alone decides how their earnings will be used. Table 2.17 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of women receiv'mg cash earnings by person who decides how earnings are used, according to selected background characteristics, Nigeria 1999 Person who decides how earnings are used Jointly Jointly with Number Background Self with Someone someone of characteristic only Partner partner else else Missing Total women Age 15-19 65.3 4.6 4.1 14.6 7.3 4.1 100.0 226 20-24 74.2 9.6 8.8 2.7 2.1 2.5 100.0 447 25-29 67.9 12.7 I5.2 0.5 0.8 3.0 100.0 724 30-34 69.8 12.7 12.9 0.0 0.9 3.7 100.0 638 35-39 68.6 13.7 13.4 0.4 0.4 3.6 100.0 574 40-44 74.2 10.6 10.4 0.0 0.2 4.6 100.0 420 45-49 70.9 9.3 15.2 0.0 0.9 3.7 I00.0 365 Residence Urban 74.6 8.3 11.6 1.4 1.4 2.7 100.0 1,228 Rural 67.6 13.0 12.7 1.6 1.2 4.0 100.0 2,166 Region Northeast 79.3 3.7 9.7 0.9 0.4 5.8 100.0 220 Northwest 79.9 8.3 5.2 1.3 0.0 5.3 100.0 211 Southeast 59.4 15.5 17.7 1.4 2.0 3.9 100.0 894 Southwest 73.7 8.4 12.4 1.2 1.2 3.1 100.0 1,288 Central 71.1 I4.2 8.5 2.3 1.2 2.6 I00.0 781 Education No education 76.1 11.0 7.4 1.2 0.6 3.7 100.0 1,050 Primary 69.3 11.7 12.8 1.3 1.0 3.8 100.0 1,056 Secondary 67.3 10.6 14.5 2.3 2.5 2.8 100.0 977 Higher 61.3 12.8 20.0 1.1 0.6 4.2 100.0 3I 1 Marital status Not married 84.6 0.8 0.5 7.1 4.9 2.2 100.0 654 Currently married 66.7 13.8 15.1 0.2 0.4 3.8 100.0 2,740 Total 70.1 11.3 12.3 1.5 1.3 3.5 i00.0 3,394 Older, urban women with less than a secondary education and those not currently married are more likely to report that they make their own decisions on how to spend the money they earn. The greatest proportion of women who make their own decisions on spending their earnings is found in the Northwest region (80 percent) and the least in the Southeast region (59 percent). There is an inverse relationship between educational level and decision on use of women's cash income; the higher the level of education, the lower the proportion of women who make their own decision on how to spend their income. The most educated women have the highest proportion who decide on spending jointly with their husband or partner (20 percent) or allow their husband or partner to decide for them (13 percent). Married women have a considerably higher proportion who jointly decide with their husband or partner (15 percent) or allow their husband to decide for them (14 percent) on what to do with the cash they earn. 32 Child Care While Working Table 2.18 shows the percent distribution of employed women by whether or not they have a child under six years of age and for those who do, the percent distribution by type of childminder. Slightly more than half of employed women have a child under six years of age living with them. Four in 10 working mothers report that they care for their children under six themselves. Other caretakers include other relatives ( 13 percent), other female children ( 13 percent), and schools (5 percent). In urban areas, women frequently employ the services of their neighbours (6 percent) and servants or hired help (4 percent). Relatives other than the respondent's own children are an important source of child care for women who have a higher education (20 percent). These mothers are also more likely to place the child in school. More than half of women employed as occasional workers care for their children themselves (59 percent), while women who work full time engage the services of other relatives (13 percent). 33 t.o Table 2.18 Child care while working percent distribution of currently employed women by whether they have a child under six years of age at home, and the percent distribution of employed mothers who have a child under six by person who cares for child while mother is at work, according to selected background characteristics, Nigeria 1999 Child's caretaker while mother is at work One or No child more Not Number under children Re- Neigh- Child Other Other worked of Background six under six spend- Husband/ Other hot/ Hked is in female male sin c~ employed characteristic athome athome ent partner relative Friend help school child child birth Other Missing Total women Residence Urban 49.2 50.8 42.1 1.7 11.4 6.0 3,8 10.3 7.9 1.6 0.9 2.2 12.1 100.0 1,342 Rural 45.2 54.8 40.5 2.4 14.2 4.3 2,3 3.2 15.0 4.2 1.6 2.6 9.8 100.0 2,590 Region Northeast 32.0 68.0 61.8 2.8 4.8 1.0 4,0 3.4 10.1 1.1 0.0 0.0 11.0 100.0 264 Northwest 39.4 60.6 59.7 3.5 4.7 1.3 2,1 0.0 14.1 1.5 0.8 0.0 12.3 100.0 223 Southeast 51.i 48.9 17.8 3.5 19.1 4.8 5,4 . 6.4 22.1 8.3 3.7 4.2 4.7 100.0 1,060 Southwest 46.4 53.6 47.9 1.1 9.9 6.8 0,9 8.3 5.7 1.3 0.5 2.6 14.9 100.0 1,406 Central 47.4 52.6 42.1 1.9 17.8 4.2 2,6 2.6 13.9 2.6 0.7 2.1 9.6 100.0 978 Education No education 47.4 52.6 52.6 1.9 6.0 4.5 0.3 0.8 13.9 3.4 0.8 2.0 13.8 100.0 1,250 Primary 44.8 55.2 33.4 2.5 16.3 6.3 1.1 3.7 17.4 5.1 1.5 3.6 9.1 100.0 1,223 Secondary 44.8 55.2 43.1 2.2 16.4 3.4 4.6 7.1 8.5 1.9 1.8 1.7 9.4 100.0 1,133 Higher 56.1 43.9 14.2 1.5 19.8 5.6 I4,4 28.4 3.0 0.6 1.4 3.0 7.9 100.0 325 Work status For family member 47.4 52.6 34.3 0.3 8.8 6.8 2.4 3.0 18.6 4.2 0.9 2.6 18.1 100.0 673 For someone else 60.9 39.1 16.4 3.1 23.4 4.2 9,3 24.7 3.8 2.1 1.5 2.7 8.8 100.0 516 Self-employed 43.6 56.4 46.1 2.5 13.1 4.5 2,0 3.6 12.6 3.3 1.3 2.4 8.7 100.0 2,718 Missing 50.8 49.2 8.5 0.0 0.0 0.0 8.3 0.0 0.0 0.0 17.1 6.6 59.4 100.0 25 Occupation Agricultural 45.5 54.5 26.1 1.8 14.5 6.6 1,1 2.9 24.4 7.6 1.4 4.8 8.8 100.0 822 Nonagricultaral 46.5 53.5 45.0 2.3 13.0 4.4 3,2 6.3 9.5 2.2 1.4 1.8 10.7 100.0 3,028 Employment status All year, full week 45.8 54.2 43.3 1.8 12.7 4.9 3.I 6.2 10.1 3.2 1.0 2.3 11.3 100.0 2,678 All year, part week 45.9 54.1 31.8 2.5 17.1 4.5 1.7 4.5 22.9 3.6 2.2 1.8 7.3 100.0 437 Seasonal 45.8 54.2 33.2 3.4 I5.5 5.1 1.9 4.1 18.9 4.2 2.0 3.8 7.9 I00.0 585 Occasional 57.7 42.3 58.5 3.4 6.6 3.4 3.3 1.9 5.5 2.3 2.3 2.4 10.4 100.0 209 Total 46.6 53.4 41.0 2.2 13.3 4.8 2.8 5.5 12.7 3.3 1.3 2.5 10.6 100.0 3,931 ~ote: Total includes 82 women not stated as to occupation and 22 whose seasonality of employment is not stated. Respondent is currently employed but has not worked since last birth. CHAPTER 3 FERTILITY 3.1 Introduction Retrospective reproductive histories of women age 15-49 years were used to measure the fertility rates presented in this chapter. Each woman was asked to provide information on the number of sons and daughters to whom she had given birth who were living with her, the number living elsewhere, and the number who had died. A summation of the total number of children dead and alive, at home and living elsewhere, and now deceased was used to determine the total number of children each woman had at the time of the interview. Each woman was then asked for a history of all her live births, including information such as name, month and year of birth, sex, and survival status. For children who had died, information on age at death was recorded. The age of each living child and whether or not the child resides with the mother were also determined. The above information is analysed in the following sections to provide fertility levels and trends; fertility differentials by residence, region, and education; information on the length of the interval between births; age at first birth; and the extent of childbearing among adolescents. A brief discussion of the quality of the NDHS fertility data appears in Appendix C. 3.2 Current Fertility Levels One of the most important indicators measured in the 1999 NDHS is the level of fertility currently prevailing in Nigeria. Table 3,1 presents the reportexl age-specific fertility rates for the five-year period preceding the survey per 1,000 women? The sum of the age-specific fertility rates (known as the total rea l i ty rate) is a useful means of summarising the 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 age-specific rates. The general fertility rate represents the annual number of births in a population per 1,000 women age 15-44. The crude biffll rate is the annual number of births in a population per 1,000 people. Both these measures are calculated using the birth history data and the age and sex distribution of the household population. All rates are computed for the five-year period preceding the survey, which is roughly equivalent to the calendar years 1994-98. The total fertility rate indicates that if fertility rates were to remain constant at the level prevailing during the 1994-98 period, a Nigerian woman would bear 5.2 children in her lifetime. The age-specific rates indicate a pattern of late childbearing, with a peak at age group 25-29 and the rate at age group 30-34 being slightly higher than that of the 20-24 age group. The crude birth rate for the 1994-98 period was 38 per 1,000 persons, and the general fertility rate for the same period was 176 per 1,000 women. I Numerators of the age-specific fertility rates are calculated by summing the number of live births that occurred in the period 1-59 months preceding the survey (determinexl by the date of interview and the date of birth of the child) and classifying them by tile age (in five-year groups) of the mother at the time of birth (determined by the mother's date of birth). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-59 months preceding the survey. 35 An assessment of the fertility data in the 1999 NDHS indicates that there was probably some omission of births in thethree-year period immediately prior to the survey. Presumably, interviewers omitted recording some of these births to reduce their workload, since the lengthy health section applied to all births occurring since January 1996. Similar errors have not only been suspected in the 1990 NDHS (FOS, 1992:27), but also in DHS surveys in several other countries (IRD, 1990). The assessment suggests an underreporting of births in the 1999 survey on the order of 14 to 15 percent (see Appendix C). Thus, the true total fertility rate for the five years before the survey is probably closer to 5.9 or 6.0 than to the reported rate of 5.2. Despite the possibility that the level of fertility may have been underreported, there is no reason to believe that underreporfing would substantially alter the findings on differences in fertility across all subpopulafions. For example, it is clear that fertility is higher in rural than in urban areas. With a total fertility rate of 5.4, rural women are bearing almost one child more on average than urban women who have a total fertility rate of 4.5. In all age groups, fertility rates are higher in rural than in urban areas, although the difference is relatively larger among teenagers age 15-19. For example, the age- specific fertility rate for women age 15-19 is 75 in urban areas, compared with 126 in rural areas. Age-specific fertility rates among women age 35- 44 are almost one and a half times higher in rural areas than in urban areas. 3.3 Fertility Differentials Table 3.2 and Figure 3.1 show differentials in fertility by residence, region, and educational level. Fertility in the Northeast and Northwest is substantially--approximately two children--higher than in the other three regions. The northern regions also have the highest percentage of women who were pregnant at the time of the survey. Table 3.1 Currant fertility Age-specific and cumulative fertility rates and the crude birth rote for the five years preceding the survey, by urban-rural residence, Nigeria 1999 Residence Age group Urban Rural Total 15-19 75 126 111 20-24 192 233 220 25-29 231 243 239 30-34 21i 233 226 35-39 114 150 138 40-44 53 78 71 45-49 23 24 24 TFR women 15-49 4.50 5.44 5.15 TFR women 15-44 4.38 5.32 5.03 Genaral fertility rate 154 186 176 Crude birth rote 35.6 38.5 37.7 Note: Rates for age group 45-49 may be slightly biased due to truncation. Total feffdity rate expressed per woman. General fertility rate (births divided by number of women 15-49); exprezsed per 1,000 women. Crude birth rate expressed per 1,000 population. Table 3.2 Fertility by background characteristics Total fertility rate for the five years preceding the survey, percentage currently pregnant and mean number of children ever born to women age 40-49, by selected background characteristics, Nigeria 1999 Mean number of children Total Percentage ever born Background fer til~ty currently to women characteristic rate pregnant age 40-49 Residence Urban 4.50 8.54 5.65 Rural 5.44 10.88 6.32 Region Northeast 6.79 13,51 6.37 Northwest 6.45 13.27 5.64 Southeast 4.64 7,93 6.92 Southwest 4.50 8.54 5.79 Central 4.49 10,08 5.81 Education No education 6.13 11.99 6.06 Primary 5.55 10,72 6.76 Secondary 4.91 7.59 5.70 Higher (2.43) 8,78 4.49 Total 5.15 10A6 6.12 ~wote: Figures in parentheses are based on 500-999 women. omen age 15-49 years 36 Total RESIDENCE U~an Rural REGION Northeast Northwest Southeast Southwest Central EDUCATION No education Primary Secondary Higher* Figure 3.1 Fertility Rates by Selected Background Characteristics, Nigeria 1999 ~ 5 . 4 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: : :; :::: ; ;: : ::~:: ::~:: : . =~.~.~ . ] 6.8 ,, ,,, ~ 6 . 1 ~ ~ ~ 4 ~ 5"6 ~ 2 . 4 1 2 3 4 5 6 Number of Chitdren 7 8 • Unreliable due to small number of women NDH$1999 The level of fertility is negatively associated with educational attainment. Women with no education are bearing children at a rate of more than six children over their lifetime, while women with a primary education have half a child less on average. The differential becomes more apparent at higher educational levels. There is a difference of more than one child between women with a secondary education and those with no education, while the difference between women with a higher education and those with a primary education is more than three children. The table also shows the mean number of children ever born to women age 40-49, which is a measure of completed fertility. This measure can be used to assess differentials in fertility trends over time for population subgroups. The data show a decline in fertility in urban areas, in most regions, and among most education subgroups. An overall comparison of past and present fertility suggests a recent decline of about one child per woman, from 6.1 to 5.2 children. 3.4 Ferti l ity T rends One way to examine fertility trends is to compare the results of the 1999 NDHS with those of other surveys. Figure 3.2 shows the 1999 NDHS results along with those from the 1981-82 Nigeria Fertility Survey (NFS), the 1990 NDHS, the 1991 Post Enumeration Survey (PES), and the baseline report of the 1994 Sentinel Survey. There appears to have been a decline in the total fertility rate in Nigeria from 6.3 in 1981-82 to 5.2 in 1999. The data suggest that on average a Nigerian woman has one child less in 1999 than she would have had in 1981-82. 37 Figure 3.2 Trends in Total Fertility Rates 1981/82 NFS 1990 NDHS 1991PES 1994 Sentinel Survey 1999 NDHS ~ 6 . 3 ::!ii:!ii:!i i !iiiii iiiiigiiiiiiii iiiiii iii iiiii!!iiiiiiii!iiii:!i ! SS : : : : :~: : . : : : : . < ::::::::::::::::::::::::::: : x : : : : : : : .x ~ ~ 5 . 4 ~ 5 . 2 0 1 2 3 4 5 Number of Children Note: Rates refer to the 5-year period preceding the suwey except the 1994 survey, which is based on the S-year period preceding the survey. Source: FOS 1992:25; NPC 1994:40; NPC 1998:226 6 However, the suspicion that recent births were underreported in the 1999 NDHS makes interpretation of trends in fertility more difficult. For example, Table 3.3 shows total fertility rates for the five-year periods prior to the 1990 and 1999 NDHS surveys by region. 2 As mentioned before, at the national level, there has evidently been a decline of about one child over the nine-year period. However, the substantial decline in fertility for the Central region (by 2.6 children) is implausibly steep, especially given the observed level of use of contraception (see Chapter 4). This implausible decline suggests very substantial underreporting of births in the Central region. It also seems unlikely that fertility in the Northeast region has increased by almost one child over the same time period. Table 3.3 Fertilitv trends by region Total fertility rates for the five-year period prior to the 1990 NDHS and the 1999 NDHS by region Percent Region 1990 NDHS 1999 NDHS change Northeast 5.9 6.8 +0.9 Northwest 7.0 6.5 -0.5 Southeast 5.8 4.6 -1.2 Southwest 5.9 4.5 -1.4 Central 7.1 4.5 -2.6 Nigeria 6.3 5.2 - 1.1 2 For this analysis, the data from the 1990 survey are re-daasified into the same five geographic regions used for the 1999 survey. The reclassification of the 21 states and F.C.T. Abuja that existed at the time of the 1990 survey is as follows: Northeast: Bauehi, Borne, Kano Northwest: Kaduna, Katsina, Sokoto Southeast: Anambra, Akwa Ibom, Cross River, Imo, Rivers Southwest: Bendel, Lagos, Ogtm, Ondo, eye Centrah Benue, F.C.T. Abuja, Gongola, Kwara, Niger, Plateau 38 Fertility trends can also be estimated on the basis of NDHS data alone. Table 3.4 shows age- specific fertility rates for five-year periods preceding the 1999 NDHS. As expected, the data show an extremely steep decline in rates for the most recent periods (5-9 to 0-4). How much of this decline is due to a true decline in childbearing and how much is due to omission of births is impossible to say. However, if, as mentioned above, the true fertility rate for the most recent period is about 5.9 or 6.0, then there most probably has been a moderate decline in fertility over the recent 5-10 years. 3.5 Children Ever Born The distribution of all women and currently married women by age and number of children ever Table 3.4 Age-specific fertility rates Age-speCific feztility rates for five-year periods preceding the survey, Nigeria 1999 Number of years preceding the survey Age group 0-4 5-9 10-14 15-19 15-19 111 139 133 159 20-24 220 262 261 257 25-29 239 279 280 301 30-34 226 262 246 [305] 35-39 138 198 [185] 40-44 71 [122] 45-49 [24] Note: Age-spec'ffic fertility rates pet 1,000 women. Esti- mates enclosed in brackets are truncated. born and living is presented in Table 3.5. The table also shows the mean number of children ever born to women in each five-year age group, an indicator of the momentum of childbearing. Table 3.5 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born and mean number of children ever born (CEB) and mean number of living children, according to five-year age groups, Nigeria 1999 Mean Mean num- number Number of children ever born Number ber of Age of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 81.6 12.9 4.6 0.7 0.2 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,775 0.25 0.22 20-24 44.3 23.2 16.4 10.9 3.7 1.0 0.3 0.2 0.0 0.0 0.0 100.0 1,521 1.12 0.98 25-29 18.4 13.9 19.4 19.4 13.4 10.1 3.3 1.5 0.3 0.1 0.1 100.0 1,516 2.51 2.18 30-34 8.7 7.1 10.9 16.0 17.7 15.2 10.8 6.8 4.5 1.4 0.9 100.0 1.137 3.94 3.40 35-39 3.5 3.5 7.4 8.9 17.3 16.4 12.4 11.1 8.9 4.2 6.4 100.0 992 5.24 4.47 40-44 4.2 2.0 4.3 8.2 11.1 13.3 12.9 14.1 12.9 7.1 9.9 100.0 696 5.95 5.10 45-49 3.0 2.7 5.7 7.7 9.4 10.6 12.7 11.9 12.3 8.5 15.6 100.0 568 6.33 5.15 Total 31.4 11.4 10.8 10.3 9.3 8.0 5.6 4.6 3.7 1.9 2.8 100.0 8,206 2.85 2.43 CURRENTLY b/~ARRIED WOMEN 15-19 38.3 41.8 16.9 2.3 0.6 0.0 0.0 0.0 0.0 0.0 0.0 100.0 472 0.85 0.74 20-24 15.2 34.3 25.1 17.1 5.7 1.6 0.6 0.4 0.0 0.0 0.0 100.0 934 1.73 1.52 25-29 7.2 14.9 21.9 22.1 15.8 11.8 3.9 1.8 0.4 0.2 0.2 100.0 1,272 2.89 2.52 30-34 4.1 6.8 11.3 17.4 18.3 16.4 11.5 7.1 4.8 1.6 0.8 100 .0 1,032 4.16 3.60 35-39 2.2 3.2 7.1 9.2 17.7 16.9 12.5 11.2 9.1 4.3 6.7 100.0 925 5.35 4.59 40-44 2.9 2.2 4.4 7.6 10.9 13.2 13.0 13.8 14.1 7.3 10.5 100.0 637 6.09 5.22 45-49 2.7 2.5 4.6 8.3 8.9 10.4 12.9 12.9 12.6 8.5 15.7 100.0 484 6.42 5.25 Total 8.8 14,5 14.3 14.0 12.5 10.9 7.5 6.2 5.0 2.5 3.7 100.0 5,757 3.81 3.27 39 The data show that 18 percent of all women age 15-19 years have given birth to at least one child, which is an indication of early childbearing. The high level of fertility in Nigeria is apparent in the rapid rise in the number of children born by age group of women. On average, women have given birth to one child by their early 20s, four children by their early 30s, and six children by their early 40s. In fact, one-third of women in their 40s have given birth to eight or more children. Figures for currently married women do not differ greatly from those for all women at older ages; however, at younger ages, the percentage of currently married women who have had children is much higher than the percentage among all women. The percentage of women age 45-49 who have never had children provides an indicator of primary infertility---the proportion of women who are unable to bear children. Voluntary childlessness is rare in Nigeria, and it is likely that married women with no births are unable to bear children. The data in Table 3.5 suggest that primary infertility is low, less than 3 percent. It should be noted that this estimate does not include women who may have had one or more children but who are unable to have more (secondary infertility). 3.6 Birth Intervals Information on birth intervals provides insight into birth spacing patterns, which affect fertility as well as infant and childhood mortality. Research has shown that children born too soon after a previous birth are at increased risk of dying at an early age. Table 3.6 shows the percent distribution of births in the five years before the survey by interval since previous birth, according to background characteristics. The data show that birth intervals are generally intermediate in length in Nigeria. More than one- quarter (26 percent) of non-first births occur less than 24 months after the previous birth, which is usually considered to place the child at higher risk of illness and death. More than one-third of births take place 24- 35 months after the previous birth, with 38 percent occurring at least 3 years after the previous birth. The median birth interval is 31 months for Nigerian women, seven months longer than the minimum of 24 months considered safe for mother and child. This is almost identical to the median birth interval of 30 months reported in the 1990 NDHS (FOS, 1992:31). As expected, younger women have shorter birth intervals than older women, presumably because they are more fecund and want to build their families. The median birth interval for women age 15-19 is 27 months, compared with 36 months for women over age 40. However, birth order, sex of previous birth, and place of residence do not seem to have much influence on birth intervals. A shorter median interval also prevails for children whose preceding sibling has died, compared with those whose prior sibling is alive. Among the factors that could be responsible for the shorter birth intervals are earlier resumption of intercourse, shortened or no breastfeeding, and nonuse of contraception. Birth interval length varies according to region. Women in the Southwest and Central regions have a median birth interval of 34 months, which is five months longer than that for women in the other three regions. Birth intervals do not show much variation by level of mother's education. 40 Table 3.6 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth and median length of birth interval, according to selected demographic and socioeconomic charactersfics, Nigeria 1999 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-47 48+ Median number of months Number since of previous Total births birth Age of mother 15-19 12.1 19.3 49.3 12.8 6.5 100.0 112 26.6 20-29 12.1 17.3 40.4 17.3 12.9 100.0 2,110 29.0 30-39 10.9 13.6 32.3 21.5 21.7 100.0 2,223 33.5 40 + 11.9 11.8 25.5 22.4 28.4 100.0 492 36.3 Birth order 2-3 9.5 15.1 38.0 19.5 17.8 100.0 2,061 31.1 4-6 12.1 I5.6 33.8 19.0 19.5 100.0 1,928 31.0 7+ 14.7 14.2 33.5 20.9 I6.8 100.0 948 31.2 Sex of prior birth Male 11.3 14.8 36.6 19.2 18.1 100.0 2,564 31.0 Female 11.8 15.5 34.3 20.0 18.4 100.0 2,374 31.3 Survival ofprlor birth Dead 28.3 20.4 28.3 12.0 11.0 100.0 708 24.5 Living 8.7 14.3 36.7 20.8 19,5 100.0 4,230 32.5 Residence Urban 10.5 13.5 34.9 19,8 21.3 100.0 1,322 32.7 Rural 11.9 15.7 35.7 19.5 17.2 100.0 3,616 30.6 Region Northeast 15.1 15.5 35.9 18.1 15.5 100.0 1,113 29.4 Northwest 13.5 17.4 35.6 17.4 16.0 100.0 882 28.9 Southeast 10.9 I8.4 37.5 18.3 14.9 I00.0 937 29.3 Southwest 8.2 11.7 34.9 21.2 24.0 100.0 1,009 34.2 Central 9,7 13.2 33.7 22.7 20.8 100.0 995 33.8 Education No education 13.2 15.5 33.6 19,3 18.4 100.0 2,560 31.3 Primary 10.2 15.3 37.2 20.0 17.3 100.0 1.238 30.8 Secondary 9.3 14.3 38.2 20.4 17.8 100.0 960 31.0 Higher 8,7 13.9 35,6 I6.5 25,3 100.0 180 32,5 Total 11.5 15.1 35.5 19.6 18,3 100.0 4,938 31.1 Note: First births are excluded. The interval for multiple births is the number of months since the end of the preceding pregnancy that ended in a live birth. 3.7 Age at First Birth The age at which childbearing starts is an important demographic indicator that usually reflects the age at first marriage, even though some births occur outside marital union. It also reflects the level of contraceptive use and the magnitude of adolescent fertility. These have major health and social implications for the society. Table 3.7 presents the distribution of women by age at first birth according to current age. Childbearing begins early in Nigeria, with about half of women 25 years and above becoming mothers before reaching the age of 20. The median age at first birth is 20. The data also show that there has been no significant change in the median age at first birth between older and younger women. 41 Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Nigeria 1999 Current age Women Median with Age at fast birth Number age at no of first births <15 15-17 I8-19 20-21 22-24 25+ Total women birth 15-19 81.6 6.5 9.5 2.4 NA NA NA 100.0 1,775 a 20-24 44.3 8.5 19.2 15.I 9.1 3.7 NA 100.0 1,521 a 25-29 18.4 11.2 18.6 16.7 15.1 14.3 5.8 100.0 1,516 20.4 30-34 8.7 14.6 19.0 15.2 14.6 I6.7 11.3 100.0 1,137 20.2 35-39 3.5 12.9 20.1 17.8 I4.4 12.4 18.9 100.0 992 19.9 40-44 4.2 14.7 24.3 15.5 14.3 12.5 14.6 100.0 696 19.4 45-49 3.0 10.7 22.4 14.5 16.3 13.7 19.3 100.0 568 20.2 •Th A = Not applicable e medians for cohorts 15-19 and 20-24 could not be determined because half of the women had not had a birth before reaching the lowest age of the age group. D i f fe rent ia l s in med ian age at f irst b i r th are shown in Tab le 3.8. The most not iceab le d i f ferent ia ls occur w i th respect to reg ion, w i th women in the northern reg ions start ing to bear ch i ldren ear l ier than those in the Centra l , Southeast , and Southwest regions. Educated women, part icu lar ly those w i th a h igher educat ion, start bear ing ch i ld ren la ter than those wi th a pr imary and secondary educat ion. Table 3.8 Median age at fast birth by background characteristics Median age at first birth among women 25-49, by current age and selected background characteristics, Nigeria 1999 Current age Women Background age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 21.8 21.6 20.3 19.9 20.5 21.0 Rural 19.9 I9.6 19.7 19.2 20.1 19.7 Region Northeast 18.1 18.4 17.8 19.1 19.9 18.2 Northwest 18.4 18.4 19.0 18.5 18.4 18.6 Southeast 22.7 20.7 20.9 19.3 20.1 21.0 Southwest 22.0 21.6 20.8 20.3 20.7 21.1 Central 20.2 19.8 19.6 18.6 20.1 19.8 Education No education 18.4 18.5 18.5 18.7 19.7 18.7 Primary 19.9 19.7 19.7 19.0 20.5 19.8 Secondary 22.9 22.2 22.1 20.8 21.6 22.4 Higher a 25.4 24.2 23.7 23.9 a Total 20.4 20.2 19.9 19.4 20.2 20.1 Note: The medians for cohorts 15-19 and 20-24 could not be determined because half of the ~oman had not had a birth before reaching the lowest age of the age group. The medians could not be determined because half of the women had not had a birth before reaching the lowest age of the age group. 42 3.8 Teenage Pregnancy and Motherhood Early childbearing, particularly among teenagers (those under 20 years of age) has negative demographic, socioeconomic, and sociocultural consequences. Teenage mothers are more likely to suffer from severe complications during delivery, which result in higher morbidity and mortality for both themselves and their children. In addition, the socioeconomic advancement ofteenagemothersinthe areas of educational attainment and accessibility to job opportunities may be curtailed. Table 3.9 shows the percentage of women age 15-19 who are mothers or pregnant with their first child, by background characteristics. Eighteen percent of teenage women in Nigeria are mothers, while another 4 percent are pregnant with their first child. In other words, 22 percent have begun childbearing. There has been a sharp decline in this percentage, from 28 percent of teenagers in 1990 to 22 percentin 1999 (FOS, 1992:34), suggest- ing a reduction in the incidence of teen- age pregnancy over the years. As expected, the proportion of women who have begun childbearing rises rapidly with age, from 11 percent of 15-year-old women to 34 percent of 19- year-old women (see Table 3.9). The table also shows significant residential, educational and regional differentials in teenage childbearing. The level of teen- age pregnancy and motherhood in rural areas (26 percent) is more than twice the level in urban areas (12 percent). More than 50 percent of teenagers in the North- east and Northwest regions have begun childbearing, compared with only 8 per- cent in the Southwest and the Southeast and 18 percent in the Central region. Education is strongly related to early childbearing. Girls with no educa- tion are far more likely to have begun childbearing than those with primary and Table 3.9 Teenage pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their ftrst child, by selected background characteristics, Nigeria 1999 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 7.9 2.8 10.8 412 16 7.8 1.7 9.4 328 17 20.3 6.I 26.4 328 18 27.8 2.7 30.5 414 19 29.8 4.5 34.3 294 Residence Urban 9.5 2.5 12.1 532 Rural 22.3 3.9 26.1 1,243 Region Northeast 43.3 8.1 51.3 269 Northwest 47.1 7.6 54.7 200 Southeast 7.3 1.0 8.3 482 Southwest 6.1 1.9 7.9 449 Central 14.5 3.1 17.6 374 Education No education 50.1 7.6 57.7 456 Primary 16.2 4.4 20.6 392 Secondary 3.9 1.1 5.0 911 Higher * * * 16 Total 18.4 3.5 21.9 1,775 Note: An asterisk indicates a figure is based on fewer than 25 cases and ha~ been suppressed. especially those with some secondary education. Fifty-eight percent of teenage women with no education have begun childbearing, compared with only 21 percent of those with a primary education and 5 percent of those with some secondary education. 43 CHAPTER4 FERTILITY REGULATION 4.1 Knowledge of Contraceptive Methods Knowledge of contraceptive methods is an important variable in any discussion of fertility regulation and in the evaluation of family planning programmes. The practice of contraception depends on knowledge of methods and the places where they can be obtained. Information on knowledge of contraceptive methods was assessed through a series of questions combining spontaneous recall and prompting procedures. Women and men were first asked to name the ways or methods by which a couple could delay or avoid pregnancy. Interviewers then asked about specific methods not mentioned spontaneously by the respondent. In all, information was sought about eight modem methods--the pill, the intrauterine device (IUD), injectables, implants, barrier methods (diaphragm, foam, and jelly), condom, and female and male sterilisation--as well as two traditional methods--periodic abstinence (safe period or rhythm method), and withdrawal. Other methods mentioned by the respondent, such as herbs or breasffeeding, were also recorded. The ability to name or recognise the name of a family planning method is a nominal test of respondents' knowledge and not a measure of how much they might know about the method. Table 4.1 presents information on women's and men's knowledge of contraceptive methods. Two- thirds (65 percent) of women age 15-49 and 82 percent of men age 15-59 know of at least one contraceptive method. The proportions of currently married respondents who have heard of a contraceptive method Table 4.1 Knowledge of contraceptive methods Percentage of all women and men, of currently married women and men, and of sexually active unmarried women and men, and women with no sexual experience who know specific contraceptive methods, Nigeria 1999 Women Men Sexually Sexually Currently active No Currently active Contraceptive All married unmarried sexual All married unmarried method women women women experience men men men Any method 65.4 64.4 91.1 53.5 82.3 83.4 98.2 Any modern method 63.1 61.9 89.1 52.5 78.7 77.9 97.8 Pill 53.4 55.1 77.7 34.9 57.4 60.7 74.4 IUD 34.2 37.6 48.3 14.6 23.8 27.7 35.2 Injectables 49.2 51.8 67.8 28.2 51.0 56.2 61.8 Diaphragm/Foam/Jelly 14.3 15.1 23.6 6.5 17.1 18.0 26.9 Condom 48.1 44.6 84.9 43.8 70.1 66.8 95.6 Female sterilisation 27.9 29.3 34.4 18.1 36.0 40.8 37.5 Male sterilisalion 10.8 11.4 17.0 5.5 18.4 20.0 24.6 Implants 11.4 12.2 17.3 5.1 10.3 12.3 14.4 Any traditional method 40.2 40.4 66.8 24.9 61.7 68.7 82.4 Periodic abstinence 31.6 30.9 58.1 20.7 47.3 54.1 62.7 Withdrawal 26.1 26.6 45.0 13.3 50.0 54.9 75.1 Traditional charms 3.7 4.6 2.0 1.6 5.9 8.1 1.4 Traditional medications 0.9 1.0 1.0 0.3 5.5 6.9 9.2 Other methods 5.2 5.4 8.8 2.0 2.4 2.6 2.7 Number of respondents 8,206 5,757 367 1,324 2,680 1,612 228 Mean number of methods 3.2 3.3 4.9 1.9 4.0 4.3 5.2 45 are almost the same as among all women and men, being only slightly lower for women and slightly higher for men. However, knowledge of contraceptive methods is considerably higher among sexually active unmarried women and men than among married and total respondents. For example, 98 percent of sexually active unmarried men have heard of a contraceptive method. Knowledge of modern methods is higher than traditional methods for all groups. Among married women, the methods most frequently recognised are the pill (55 percent) and injectables (52 percent), followed by condoms (45 percent), IUD (38 percent), periodic abstinence (31 percent), female sterilisation (29 percent), and withdrawal (27 percent). Other methods such as male sterilisation, implants, diaphragms, foam, and jelly are less known (less than 20 percent). Among sexually active unmarried women and among men, the most commonly reported method is the condom, followed by the pill and injectables. In general, men are more likely than women to have heard of the male-oriented methods such as condoms, male 8terilisation, and withdrawal. Contraceptive knowledge varies considerably, as shown in Table 4.2. The proportions of women and men who know of any method increases with age and peaks at 30-34 years for women and 45-49 years among men. The same pattern is observed for women interviewed in the 1990 Nigeria Demographic and Health Survey. Table 4.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and men who know at least one method of contraception, by selected background characteristics, Nigeria 1999 Women Men Knows Knows Number Knows Knows Number Background any modem of any modem of characteristic method method women method method men Age 15-19 37.5 36.3 472 50.3 50.3 I2 20-24 60.8 58.8 934 71.3 63.0 46 25-29 68.2 66.0 1,272 79.3 76.9 202 30-34 70.9 68.3 1,032 85.9 83.0 284 35-39 68.0 66.1 925 86.4 81.2 248 40-44 64.4 6I .0 637 85.5 80.7 222 45-49 66.5 6I .7 484 89.0 81.4 191 50-54 NA NA NA 80.6 74.5 196 55-64 NA NA NA 80.0 70.0 210 Residence Urban 83.3 82.0 1,670 93.0 90.I 460 Rural 56.7 53.7 4,087 79.5 73.0 1,152 Region Northeast 35.4 34.6 1,137 61.4 57.2 307 Northwest 42.2 39.1 986 72.0 65.2 285 Southeast 81.6 79.0 946 93.4 88.4 303 Southwest 87.2 83.7 1,367 93.8 90.4 387 Central 70.0 67.7 1,321 92.1 83.9 330 Education No education 43.6 40.5 3,032 65.9 55.7 545 Primary 80.2 77.5 1,298 86.6 80.9 476 Secondary 92.9 91.9 1,123 95.7 94.6 373 Higher 99.0 97.8 303 98.7 98.2 217 Total 64.4 61.9 5,757 83.4 77.9 1,612 NA = Not applicable 46 Urban residents are much more l ikely than rural residents to have heard of contraceptive methods. For example, 83 percent of married urban women have heard of a method, compared with only 57 percent of rural women. Knowledge is also considerably higher among southerners than among those living in the north; the proport ion of married women who know of at least one method is more than twice as high in the Southeast and Southwest regions than in the Northeast and Northwest regions. As expected, educated women and men are much more likely to know about family planning methods than those with no education. Virtually all respondents with a higher education have heard of at least one method, compared with only 44 percent of uneducated women. Because both women and men in the same households were interviewed in the 1999 NDHS, it is possible to l ink married men with their wives and analyse data for married couples. Table 4.3 shows data comparing contraceptive knowledge of wives and husbands for the 1,451 couples that could be linked. The data show a rather low level of jo int knowledge of methods. Even for the best-known methods like the pill, condoms, and injectables, in only about one-third of couples do both the husband and wife know the method. When only one partner knows a method, it is more likely to be the husband than the wife who knows it, especially if it is a male-oriented method. The only method that wives are more likely than their husbands to know about is the IUD. Table 4.3 Couples' knowledge of contraceptlve methods Percent distribution of couples by knowledge of speCtfic contraceptive methods, Nigeria 1999 Husband Wife knows knows Both method, method, Neither Background know wife husband knows characteristic method doesn't doesn't method Total Any method 55.6 25.4 5.4 13.6 100.0 Any modern method 51.6 23.9 7.3 17.2 100.0 Pill 36.9 20.2 15.5 27.4 100.0 IUD 14.8 10.0 20.3 54.9 100.0 Injectables 33.5 21.4 15.9 29.2 100.0 Diaphragm/Foam/Jelly 4.4 12.5 8.8 74.3 100.0 Condom 36.3 26.3 5.7 31.7 100.0 Female sterilisation 15.4 25.0 13.1 46.4 I00.0 Male stedlisation 4.0 14.3 7.2 74.5 100.0 Implants 2.6 8.1 7.7 81.5 100.0 Any traditional method 28.1 33.4 5.6 32.9 100.0 Periodic abstinence 21.6 27.6 6.4 44.4 100.0 Withdrawal 18.4 33.7 6.6 41.4 100.0 Note: Table is based on 1,451 couples. Knowledge of contraceptive methods has increased dramatically in Nigeria over the past nine years. In 1990, only 44 percent of married women knew any method of contraception; by 1999, this proportion had grown to 64 percent (Figure 4.1). Knowledge of the pill, IUD, iujectables, and condom all increased by about 18 to 23 percentage points. 47 Figure 4.1 Trends in Contraceptive Knowledge among Married Women 15-49, 1990 and 1999 Any method Pil l njec ab es DiaphragnVfoanY]elly ~. 7.:;:~;:; Condom Female stedlisation Male sterillsatfon ~:7 .= 1 Periodic abstinence Withdrawal ~ . 1 Source: FOS 1992:37 44 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 52 ~q';t 15 ~: J~%- : , : :> : , 29 11 :::::::::::::::::::::::::::::::::::::::::::::::::: ~7 10 20 30 40 50 60 70 80 Percent 1~m1990 NDHS ~1999 NDHS I NDHS1999 4.2 Ever Use of Family Planning Methods Ever use of contraception is defined as the use of a contraceptive method at any time during a woman's reproductive years. In collecting this information, respondents were asked whether they ever used any of the methods that they indicated they know. Results showed that use lags considerably behind knowledge. Among all women, about a quarter (27 percent) have ever used a method and less than a fifth (17 percent) have used a modern method (Table 4.4.1). Ever use is slightly higher among married women than among all women (29 vs. 27 percent). Ever use of contraceptive methods among sexually active unmarried women (66 percent) is more than double that among those who are currently married. The percentage of married women who ever used a contraceptive method is highest among the 30-34 age group (36 percent) and lowest among the 15-19 age group (7 percent). For thelatter finding, the outcome is not unexpected since women in that age group are young and may want to start families. The most commonly used method is periodic abstinence (10 percent), even though more women know about the pill, IUD, condoms and injectables. The next most widely used methods among married women are the pill (9 percent), injectables (6 percent), and condoms (6 percent). Periodic abstinence is the most commonly ever-used method among married women in most age groups, although younger women also have used the pill and condoms, while older women have used the IUD and sometimes injectables. The level of ever use has increased significantly since 1990. In 1990, only 14 percent of married women reported having ever used a contraceptive method; by 1999, this proportion had doubled to 29 percent. 48 4~ ~o Table4.4.1 Ever use of contraception: women Percentage of all women, of currently married women, and of sexually active unmarried women who have ever used a contraceptive method, by method and age, Nigeria 1999 Modvra method Traditional method Any Tradi- Any Diaphragm/ Female tradi- periodic Tradi- tioaal Number Any modem Inject- Foa~/ sterili- Ira- tioral absti- With- tioaal medica- Other of Age method method Pill IUD ables Jelly Condom safioa plant method nence draw~l charms tions methods women ALL WOMEN 15-19 9.2 5.9 2.8 0.1 0.5 0.0 3.5 0.0 0.0 5.0 3.4 1.5 0.0 0.1 0.8 1,775 20-24 26.4 17.1 7.5 0.8 2.0 0.1 10.4 0.0 0.0 14.7 10.4 5.5 0.3 0.1 1.9 1,521 25-29 31.5 20.4 10.5 2.0 4.6 0.6 9.7 0.0 0.0 t7.4 11.7 6.5 0.4 0.2 2.2 1,516 30-34 37.3 25.7 13.4 5.4 8.9 1.0 8.8 0.2 0.5 19.9 13.3 7.6 0.7 0.4 1.6 1,137 35-39 35.6 24.6 12.2 7.3 7.9 0.8 6.6 0.8 0.3 18.0 11.3 7.1 0.8 0.3 2.4 992 40-44 31.7 20.8 9.5 7.8 7.7 0.3 3.3 0.1 0.4 16.0 9.7 3.5 1.6 0.4 2.9 696 45-49 30.9 17.7 6.6 7.3 6.6 0.9 2.3 0.9 0.2 18.5 12.1 4.6 1.3 0.2 2.5 568 Total 27.0 17.8 8.5 3.3 4.6 0.4 6.9 0.2 0.2 14.6 9.7 5.1 0.6 0.2 1.9 8,206 CURRENTLY MARRIED WOMEN 15-19 7.2 4.8 3.4 0.0 0.9 0.0 1.4 0.0 0.0 3.8 2.6 1.2 0.0 0.0 0.4 472 20-24 20.5 12.1 5.9 0.6 2.0 0.1 6.1 0.0 0.0 11.8 8.0 3.9 0.4 0.1 1.8 934 25-29 29.0 18.1 10.0 1.9 4.4 0.6 7.2 0.0 0.0 16.3 10.5 6.3 0.5 0.2 2.0 1,272 30-34 36.0 23.7 12.7 5.1 8.8 0.7 7.2 0.2 0.4 19.8 12.8 7.7 0.8 0.3 1.8 1,032 35-39 35.3 24.3 12.0 7.0 8.0 0.8 6.2 0.9 0.2 18.1 11.5 7.1 0.9 0.2 2.0 925 40-44 32.0 21.1 9.3 8.1 7.7 0.3 3.4 0.2 0.5 16.2 10.I 3.8 1.3 0.3 2.7 637 45-49 32.4 19.4 7.3 7.9 6.7 1.1 2.5 0.8 0.2 19.3 13.0 5.2 1.3 0.2 2.1 484 Total 28.7 18.5 9.3 4.1 5.7 0.5 5.6 0.3 0.2 15.7 10.2 5.5 0.7 0.2 1.9 5,757 UNMARRIED SEXUALLY ACITv'E WOMEN 15-I9 53.0 29.6 13.2 0.0 3.1 0.0 21.6 0.0 0.0 34.0 19.8 11.1 0.0 0.0 12.1 103 20-24 74.l 54.4 23.3 3.9 5.8 0.0 36.3 0.0 0.0 40.4 31.2 19.0 0.8 0.0 3.5 135 25+ 69.0 59.1 25.9 11.4 10.4 4.0 38.5 0.0 0.0 28.6 21.7 11.3 0.0 1.2 3.8 130 Total 66.4 49.1 21.4 5.5 6.7 1.4 33.0 0.0 0.0 34.4 24.6 14.1 0.3 0.4 6.0 367 L~ Table 4.4.2 Ever use of contraception: men Percentage of all men, of currently married men, and of sexually active unmarried men who have ever used a contraceptive method, by method and age, Nigeria 1999 Modern method Traditional method Any Tradi- Any Diaphragm/ Female Male tradi- periodic Tradi- tional Number Any modem Inject- Foam/ sterili- sterili- Ira- tional absti- With- tionaI medica- Other of Age method method Pill IUD ables Jelly Condom sation sation plant method nenee drawal charms tions methods men ALL MEN I5-19 13.9 10.9 1.7 0.0 0.2 0.0 10.1 0.0 0.0 0.2 6.0 2.9 4.0 0.0 0.0 0.6 511 20-24 36.4 30.1 2.5 0.3 0.6 1.2 29.4 0.0 0.0 0.0 19.1 12.I i l l 0.0 0.0 1.1 319 25-29 44.7 35.6 6.1 0.3 4.5 0.8 32.0 0.3 0.3 0.0 25.8 17.4 i5.8 0.6 0.3 0.6 366 30-34 50.1 31.1 5.9 0.7 5.1 0.0 26.7 0.0 0.0 0.0 34.1 26.4 19.2 0.6 0.5 0.6 348 35-39 45.1 29.1 7.9 2.4 5.5 0.2 24.3 0.4 0.0 0.2 33.8 27.7 16.5 0.6 0.4 1.9 275 40-44 47.6 26.1 9.0 0.7 9.1 0.4 18.5 1.3 0.0 0.0 35.2 27.1 18.1 1.3 0.9 0.4 239 45-49 48.0 23.0 8.2 1.0 5.2 1.5 17.9 1.0 0.5 0.0 39.4 33.1 17.2 1.5 0.5 1.0 197 50-54 52.6 28.9 6.9 2.7 6.5 1.8 20.5 2.4 0.3 0.0 40.9 37.4 16.4 0.0 1.7 0.8 205 55+ 46.3 16.3 7.1 2.9 2.6 0.5 11.3 0.9 0.5 0.0 38.9 33.8 9.0 2.7 4.6 0.9 220 Total 39.8 25.1 5.6 1.0 3.9 0.6 21.2 0.5 0.1 0.1 27.2 21.1 13.3 0.7 0.8 0.8 2,680 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * 12 20-24 (26.7) (18.1) (4.6) (0.0) (0.0) (0.0) (15.6) (0.0) (0.0) (0.0) (19.9) (15.3) (11.3) (0.0) (0.0) (0.0) 46 25-29 35.6 25.4 7.6 0.0 3.5 0.4 20.2 0.5 0.5 0.0 23.8 17.8 14.2 0.6 0.5 0.5 202 30-34 47.3 27.2 6.2 0.8 4.6 0.0 22.2 0.0 0.0 0.0 35.6 28.0 19.4 0.4 0.6 0.4 284 35-39 42.3 25.7 7.6 2.7 5.6 0.3 20.5 0.4 0.0 0.3 32.4 26.7 15.2 0.7 0.4 2.1 248 40-44 48.3 26.0 8.8 0.8 9.5 0.5 18.3 1.4 0.0 0.0 36,2 27.9 19.0 1.4 0.9 0.4 222 45-49 47.9 22.6 8.0 1.0 4.9 1.6 17.9 1.1 0.6 0.0 39.6 33.1 I7.2 1.6 0.0 1.0 191 50-54 53.0 29.8 7.3 2.9 6.8 1.9 21.0 2.5 0.3 0.0 41.2 37.4 17.1 0.0 1.8 0.9 196 55+ 46.1 15.7 7.0 3.0 2.7 0.5 i0.4 0.9 0.5 0.0 39.4 34.4 8.4 2.3 3.9 1.0 210 Total 45.1 24.5 7.3 1.5 5.2 0.6 18.7 0.9 0.2 0.1 34.8 28.7 15.8 0.9 1.1 0,9 1,612 UNMARRIED SEXUALLY AC£1NE MEN 15-19 (61.4) (52.4) (11.0) (0.0) (2.6) (0,0) (50.3) (0.0) (0.0) (0.0) (30.1) (16.4) (22.7) (0.0) (0.0) (2.6) 43 20-24 77.7 67.3 6.4 1.2 2.3 5.0 67.3 0.0 0.0 0.0 44.9 25.1 31.1 0.0 0.0 1.6 77 25+ 84.4 74.9 7.8 0.0 13.1 0.0 73.2 0.0 0.0 0.0 44.0 28.9 31.2 0.0 0.9 0.0 107 Total 77.8 68.0 7.9 0.4 7.4 1.7 66.8 0,0 0.0 0.0 41.6 25.2 29.6 0.0 0.4 1.0 228 Note: Figures in parentheses ~xe based on 25-49 cases. An asterisk indicates a figure is based on fewer than 25 cases and has been suppressed. As is the case for women, married men are somewhat more likely than all men to have used a contraceptive method (45 vs, 40 percent), whereas sexually active unmarried men are by far the most likely to have used a method (78 percent). As shown in Table 4.4.2, periodic abstinence is also the most commonly used method among married men (29 percent) as well as women. This method is followed by condoms (19 percent), withdrawal (16 percent), and then the pill (7 percent). 4.3 Current Use of Family Planning Methods Current use of family planning methods refers to the use of contraceptive methods at the time of the survey. Analysis of current use of family planning methods is conventionally based on women who are currently married, since they are the most likely to be regularly exposed to the risk of pregnancy. Only 15 percent of married women are currently using any method, while only 9 percent are using a modern method (Table 4.5.1). Although the percentage is low even for the sub-Saharan region, there has been an improvement since 1990, when only 6 percent of married women were reported to be using any method and only 4 percent were reported to be using a modern method (FOS, 1992: 42- -see Figure 4.2). The most commonly used method is periodic abstinence (rhythm method), which is used by 5 percent of married women. This method is followed by pills, injectables, and the IUD, which are used by 2 percent of married women each. Contraceptive use is highest among married women in their 30s and early 40s (about 20 percent) and lowest among the 15-19 age group (4 percent). This finding is expected since younger women are more likely than older women to want another child soon. While periodic abstinence is the most widely used method for all age groups, younger women are the next most likely to use either injectables or the pill, while older women are more likely to use IUDs. One-third of married men report that they are currently using a family planning method (Table 4.5.2). As among married women, married men report periodic abstinence as the major method (used by 15 percent). However, the next most commonly used method among men is condoms (6 percent). That use of periodic abstinence as reported by married men is considerably higher than as reported by married women has been found in other DHS surveys, and one theory is that men may mistake periodic abstinence for long-term abstinence. 51 L~ to Table 4.5.1 Current use of contraception: women Percentage of all women, of currently married women, and of sexually active unmarried women who are currently using a contraceptive method, by method and age, Nigeria 1999 Modem method Traditional method Any Any I)iaphr agm/ Female tradl- Periodic Iqot /qtmther Any modem Inject- Foam/ sterili- tioaal absti- With- Other currently of Age method method Pill IUD ables Jelly Condom sation Implant method neltee drawal methods using Total women ALL WOMEN 15-19 6.6 3.2 1.3 0.0 0.1 0.0 1.8 0.0 0.0 2.9 2.2 0.7 0.5 93.4 100.0 1,775 20-24 16.0 7.9 3.i 0.4 0.4 0.1 3.9 0.0 0.0 7.0 5.2 1.8 1.1 84.0 I00.0 1,521 25-29 17.2 8.8 2.8 1.1 2.0 0.2 2.7 0.0 0.0 7.3 5.7 1.5 1.2 82.8 I00.0 1,516 30-34 20.8 13.6 4.0 1.9 4.5 0.3 2.6 0.2 0.1 6.6 5.0 1.6 0.6 79.2 100.0 1,137 35-39 20.5 13.3 3.5 4.2 3.4 0.2 1.1 0.8 0.1 6.6 5.3 1.4 0.6 79.5 100.0 992 40-44 19.8 11.7 1.9 4.5 3.6 0.0 1.2 0.1 0.3 5.6 4.8 0.8 2.5 80.2 1130.0 696 45-49 I&9 8.7 1.7 3.5 1.8 0.2 0.7 0.9 0.0 5.2 4.7 0.5 0.9 85.1 100.0 568 Total 15.7 8.9 2.6 1.7 1.9 0.1 2.3 0.2 0.0 5.8 4.6 1.2 1.0 84.3 I00.0 8,206 CURRENTLY MARRIED WOMEN 15-19 4.2 1.2 1.0 0.0 0.0 0.0 0.2 0.0 0.0 2.5 2.0 0.5 0.4 95.8 100.0 472 20-24 8.2 2.6 1.1 0.1 0.2 0.1 1.0 0.0 0.0 4.7 3.5 1.2 0.9 91.8 100.0 934 25-29 13.9 6.7 2.2 0.9 1.9 0.2 1.6 0.0 0.0 6.1 4.6 1.5 t.1 86.1 100.0 1,272 30-34 20.1 I2.7 4.0 1.8 4.5 0.2 1.9 0.2 0.1 6.7 5.0 1.6 0.7 79.9 I00.0 1,032 35-39 20.7 13.3 3.6 3.7 3.6 0.2 1.2 0.9 0.1 7.1 5.7 1.5 0.3 79.3 100.0 925 40~14 20.5 12.1 2.1 4.8 3.6 0.0 1.2 0.2 0.3 5.9 5.1 0.8 2.4 79.5 100.0 637 45-49 16.5 9.4 1.9 4.I 1.8 0.2 0.6 0.8 0.0 6.2 5.5 0.6 0.9 83.5 160.0 484 Total 15.3 8.6 2.4 2.0 2.4 0.2 1.2 0.3 0.1 5.8 4.6 1.2 0.9 84.7 100.0 5,757 S ExzrALLY ACITqE UNMARRIED WOMEN" 15-19 46.6 23.0 6.9 0.0 1.0 0.0 15.I (tO 0.0 17.5 12.2 5.3 6.1 53.4 100.0 103 20-24 68.3 40.4 17.7 3.1 2.3 0.0 I7.3 0.0 0.0 25.1 19.2 5.9 2.8 31.7 I00.0 135 25+ 58.0 40.2 12.2 8.2 4.4 0.8 I4.6 0.0 0.0 14.2 11.7 2.5 3.6 42.0 100.0 130 Total 58.6 35.4 12.7 4.0 2.7 0.3 15.7 0.0 0.0 19.1 14.6 4.5 4.0 41.4 1O0.0 367 t~ Table 4.5.2 Current use of contraception: men Percentage of all men, of currently married men, and of sexually active unmarried men who are ettrrently using a contraceptive method, by method and age, Nigeria 1999 Modem method Traditional method Any Any modem inject- Age method method Pill IUD ables ALL MEN Any Diaphragm/ Female tradl- Peliodie Not Nura~r Foam/ sterili- tional abstl- With- Other currently of Jelly Cc~adom satloa method hence drawal methods using Total mesa 15-19 9.2 6.4 1.1 0.0 0.0 0.0 5.3 0.0 2.4 1.6 0.8 0.4 90.8 100.0 511 20-24 21.2 14.9 1.3 0.0 0.4 0.3 12.9 0.0 5.6 4.1 1.5 0.7 78.8 100.0 319 25-29 27.5 19.8 2.8 0.0 2.5 0.0 14.5 0.0 7.8 6.5 1.3 0.0 72.5 100.0 366 30-34 33.6 17.1 3.3 0.3 2.1 0.0 11.4 0.0 15.9 12.7 3.2 0.6 66.4 100.0 348 35-39 32.0 16.3 5.4 1.1 2.0 0.0 7.8 0.0 15.4 12.1 3.2 0.3 68.0 100.0 275 40-44 33.9 16.3 5.2 0.0 4.8 0.0 5.9 0.4 16.7 13.8 2.9 0.8 66.1 100.0 239 45-49 35.3 13.5 4.0 0.5 2.1 0.0 6.3 0.5 21.2 18.6 2.6 0.6 64.7 100.0 197 50-54 39.6 19.1 3.4 1.9 4.1 0.5 7.9 1.4 19.5 18.0 1.5 0.9 60.4 100.0 205 55+ 30.8 8.6 3.1 1.7 0.9 0.0 2.0 0.9 19.1 19.1 0.0 2.1 69.2 100.0 220 Total 26.9 14.2 3.0 0.5 1.8 0.1 8.6 0.2 11.9 10.1 1.8 0.7 73.1 100.0 2,680 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * * 12 20-24 (6.2) (2.0) (0.0) (0.0) (0.0) (0.0) (2.0) (0.0) (4.3) (4,3) (0.0) (0.0) (93.8) 100.0 46 25-29 24.4 14.5 3.6 0.0 2.6 0.0 8.3 0.0 9.9 8.4 1.5 0.0 75.6 100.0 202 30-34 31.6 14.2 3.7 0.4 1.7 0.0 8.3 0.0 17.0 13.0 4.0 0.4 68.4 100.0 284 35-39 29.8 14.3 4.9 1.2 2.0 0.0 6.2 0.0 15.2 11.6 3.6 0.3 70.2 100.0 248 40~ 35.2 16.3 5.1 0.0 4.9 0.0 5.9 0.4 18.0 14.8 3.2 0.9 64.8 100.0 222 45-49 35.9 13.9 4.2 0.5 2.2 0.0 6.5 0.5 21.4 18.7 2.7 0.6 64.1 1G0.0 191 50-54 41.3 20.0 3.6 2.0 4.2 0.5 8.2 1.4 20.4 18.8 1.6 1.0 58.7 100.0 196 55+ 31.4 8.5 3.3 1.7 1.0 0.0 1.6 0.9 20.1 20.1 0.0 2.9 68.6 100.0 210 Total 31.8 I4.1 3.9 0.8 2.5 0.1 6.4 0.4 16.9 14.5 2.4 1.7 68.2 100.0 1,612 SEXUALLY ACTIVE UNMARRIED MEN 15-19 (39.4) (27.7) (5.9) (0.0) (0.0) (0.0) (21.9) (0.0) (9.0) (9.0) (0.0) (2.6) (60.6) 100.0 43 20-24 50.3 38.6 4.2 0.0 1.6 i.I 31.7 0.0 11.7 6.9 4.8 0.0 49.7 100.0 77 25+ 57.4 47.4 4.0 0.0 5.9 0.0 37.4 0.0 10.0 9.1 1.0 0.0 42.6 100.0 107 Total 51.6 40.7 4.4 0.0 3.3 0.4 32~5 0.0 10.4 8.3 2.1 0.5 48.4 100.0 228 Note: Figures in parentheses ambased oa 25-49 cases. Anastefiskinthcates afigur~isbased on fewer thaa 25 cases andhasbeensuppressed. Figure 4.2 Current Use of Contraceptive Methods among Currently Married Women, 1990 and 1999 Percent Any Method Any Current Method II~INDHS 1990 I~NDHS 19991 NDHS1999 Contraceptiveuseis far from uniform across all sub-groups ofthepopulation. Tables4.6.1 and 4.6.2 show differentials in contraceptive use among married women and men, respectively. Among married women, use is almost twice as high in urban than in rural areas (23 versus 12 percent--see Figure 4.3). The proportion of married women using any method is about eight times higher in the two southern regions than in the two northern regions (24 to 26 percent versus 3 percent); it is intermediate in the Central region (18 percent). Women in the south are much more likely than those in the north to use traditional methods. The proportion of womenusing contraceptives also varies with educational level. Thehigher the level of education, the higher the proportion of women using a method. Contraceptive use rises from 6 percent for women with no education to 45 percent for women with a higher education. A similar pattern is observed with specific methods, whether modern or traditional. As expected, contraceptive use increases with the number of living children, from 3 percent of married women with no children to 21 percent of women with four or more children. Differentials in use among married men are similar to those for married women (Table 4.6.2). Use is higher among urban men, those in the south, men with more education, and those with more children. 54 Table4.6.1 Curmntuseofcontraceplionbybackgroundcharacturistics: women Percent distribution of currently married women by contraceptive method currently used, according to selected background characteristics, Nigeria 1999 Modem method Traditional method Any Any Diaphragm/ Female tradi- Periodic Background Any modem Inject- Foam/ sterili- tional absti- characteristic method method Pill IUD ables Jelly Condom sation Implant method nenee Not With- Other currently drawal methods using Residence Uth~m 23.4 15.7 5.5 4.0 3.0 0.4 2.5 0.2 0.2 6.4 Rural 12.0 5.6 1.2 1.2 2.1 0.1 0.7 0.3 0.0 5.6 Total N~bcr of womcIl Education No education 6.0 3.I 0.7 0.7 1.1 0.0 0.3 0.2 0.0 2.3 2.1 0.2 0.6 94.0 100.0 3,032 Primary 19.9 10.1 3.3 2.5 2.6 0.1 1.5 0.2 0.0 8.5 6.6 1.9 1.3 80.1 I00.0 1,298 Secondary 27.1 16.2 5.0 3.1 4.7 0.4 2.6 0.3 0.2 9.6 7.3 2.3 1.3 7Z9 100.0 1,123 Higher 44.8 28.0 6.6 8.7 5.8 1.0 4.6 0.7 0.7 15.9 10.6 5.3 1.0 55.2 100.0 303 No. of living children 0 3.3 1.3 0.7 0.0 0.1 0.0 0.5 0.0 0.0 1.9 1.2 0.8 0.0 96.7 100.0 585 1 8.0 3.5 1.5 0.2 0.4 0.3 1.1 0.0 0.0 3.9 2.9 1.0 0.6 92.0 100.0 944 2 14.3 7.8 2.8 1.2 1.1 0.0 2.3 0.2 0.2 5,9 4.9 0.9 0.0 85.7 100.0 931 3 I8.0 8.7 2.8 2.5 1.9 0.1 1.2 0.1 0.1 7.8 5.8 2.0 1.5 82.0 100.0 886 4+ 20.5 12.5 3.0 3.3 4.4 0.2 1.1 0.5 0.0 6.8 5.5 1.3 1.2 79.5 100.0 2,412 Total 15.3 8.6 2.4 2.0 2.4 0.2 1.2 0.3 0.1 5.8 4.6 1.2 0.9 84.7 100.0 5,757 Region Northeast 3.1 2.2 1A 0.1 0.7 0.0 0.1 0.0 0.0 0.7 0.5 0.3 0.1 96.9 100.0 1,137 Noithwest 3.2 2.5 1.I 0.2 0.9 0.0 0.1 0.I 0.0 0.2 0.1 0.1 0.6 96.8 100.0 986 Southeast 23.5 9.1 1.9 1.5 3.1 0.2 1.9 0.5 0,0 12.9 9,4 3.4 1,5 76.5 100,0 946 Southwest 26.2 15.5 4.2 5.2 2.6 0.3 2.9 0.2 0.2 9.I 7.1 1.9 1.6 73.8 100.0 1,367 Central 17.8 10.9 2.9 2.1 4.2 0.2 1.0 0.5 0.1 6.0 5.4 0.6 0.9 82.2 100.0 1,321 4.6 1.9 1.2 76.6 100.0 1,670 4.6 1.0 0.8 88.0 100.0 4,087 L/I OX Table 4.6.2 Current use of contraceptiou b 7 background characteristics: men Percent distribution of currently married men by contraceptive method currently used, according to selected background characteristics, Nigeria 1999 Modea-a method Traaition~l meXhod Any Tradi- Any Diaphragm/ Female tradi- Periodic Tradi- tioual Not Number Background Any modem Inject- Foam/ sterili- tional abstl- With- tional medl- Otlmr catrtentiy of characteristic method method Pill IUD ables J~lly Condom safion method neaee drawal ehmxns cations methods using Total men Residence Urban 39.3 24.4 8.4 1.3 2.7 0.2 11.5 0.2 14.6 11.8 2.8 0.2 0.2 0.0 60,7 100.0 460 Rural 28.9 10.0 2.1 0.6 2.4 0.0 4.4 0.5 17.9 15.6 2.2 03 0.4 0.2 71.1 160.0 1,152 Region Northeast 7.2 5.2 2.9 0.0 0.6 0.0 1.7 0.0 1.9 1.3 0.7 0.0 0.0 0.0 92,8 100.0 307 Northwest 3.0 1.5 0.3 0.0 0.9 0.0 ().3 0.0 0.0 0.i) 0.6 1.t 0.4 0.0 97,0 100.0 285 Southeast 53.3 14.3 2.6 1.0 4.0 0.0 4.9 1.8 38.6 34.7 4.0 0.0 0.0 0.3 46.7 100.0 303 Southwest 533 24.9 4.3 1.7 2.6 0.2 16.0 0.0 26.7 22.0 4.7 0.4 1.0 0.3 46,7 100.0 387 Central 34.9 20.5 8.7 0.9 4.3 0.0 6.3 0.3 l&2 12.2 1.9 0.0 0.3 0.0 65,1 100.0 330 Education No vducation 12.0 2.3 1.2 0.2 0.4 0.0 0.5 0.0 8.8 8.6 0.2 0.3 0.6 0.0 88,0 100.0 545 Primary 38.2 13.5 3.9 0.8 2.1 0.0 5.7 1.0 23.4 21.1 2.4 0.4 0.4 0.4 61,8 100.0 476 Secondary 40.2 21.6 5.3 0.8 3.2 0.0 12.1 0.2 18.0 14.1 4.0 0.3 0.2 0.0 59,8 100.0 373 Higher 53.4 32.4 8.4 2.2 7.5 0.4 13.4 0.5 21.0 15.8 5.2 0.0 0.0 0.0 46,6 100.0 217 No. of living children 0 14.3 9.4 0.8 0.0 0.8 0.0 7.8 0.0 4.9 4.9 0.0 0.0 0.0 0.0 85,7 100.0 145 1 26.0 10.9 3.2 0.6 0.6 0.0 6.4 0.0 15.1 10.8 4.3 0.0 0.0 0.0 74,0 100.0 181 2 31.4 13.2 3.2 1.0 1.5 0.0 Z4 0.0 18.2 13.5 4.7 0.0 0,0 0.0 68,6 1G0.0 198 3 34.3 16.5 4.1 0.0 3.5 0.0 8.9 0.0 16.9 14.3 2.7 0.4 0.5 0.0 65.7 100.0 223 4+ 35.5 15.2 4.7 1.1 3.2 0.I 5.4 0.8 19.0 17.2 1.8 0.5 0.6 0.2 64.5 100.0 865 Total 31.8 14.1 3.9 0.8 2.5 0.1 6.4 0.4 16.9 14.5 2.4 0.3 0.4 0.1 68.2 i00.0 1,612 Figure 4.3 Use of Family Planning Among Married Women, by Background Characteristics, Nigeria 1999 RESIDENCE Urban :.:.x.:-:-:.:.123 Rural 12 REGION Northeast Northwest Southeast Southwest Central EDUCATION NO ettucat/on i Primary [ Secondary ! Higher 0 10 20 30 40 50 Percent ImModarn Methods E3Tradhional Methods I 60 NDHS19gg 4.4 Number of Children at First Use of Family Planning Methods The NDHS included a question for all women who had ever used a method as to how many living children they had when they first used a method. Table 4.7 shows the distribution of ever-married women by the number of living children they had when they first used a method, according to f ive-year age group. These data enable the examination of both periodic and cohort changes in the timing of the initiation of contraceptive use during the family building process. Table 4.7 Number of children at first use of contraception Percent distribution of ever-marrled women by number of living children at the time of first use of contraception, according to current age, Nigeria 1999 Never used Number of living children at time of first use of contraception Number contra- of Current age ception 0 1 2 3 4+ Missing Total women 15-19 93.0 3.7 1.9 0.6 0.2 0.0 0.6 100.0 489 20-24 79.1 9.9 6.7 2.6 0.9 0.1 0.6 100.0 966 25-29 70.8 8.8 10.3 4.8 2.5 2.7 0.2 100.0 1,319 30-34 63.5 6.5 11.0 6.9 5£ 6.1 0.4 I00.0 1,079 35-39 64.2 5.5 7.6 5.5 4.5 12.1 0.6 100.0 974 40-44 68.0 4.5 5.2 3.5 3.5 14.8 0.6 100.0 687 45-49 68.8 4.5 8.6 2.6 1.4 13.5 0.7 100.0 562 Total 71.0 6.7 8.0 4.2 2.9 6.5 0.5 100.0 6,076 Overall, 19 percent of women initiated contraceptive use when they had fewer than three living children, with 7 percent initiating use before having the first child, 8 percent after having the first child, and 4 percent after having the second child. Younger cohorts of women have a tendency to initiate family planning use at lower parities than older cohorts. For example, while less than 16 percent of 57 women age 40 and older initiated family planning use before having three children, the proportion rises with younger cohorts, reaching 24 percent among women age 25-34 years. This pattern probably reflects the fact that young women are more likely to use family planning to space births, while older women are more likely to use family planning to l imit births. The trend toward initiating family planning use at lower parities can also be seen by comparing data from the 1990 and 1999 NDHS surveys. For example, in 1990, only 8 percent of women reported initiating contraceptive use when they had fewer than three children, compared with 19 percent in 1999. 4.5 Knowledge of the Fertile Period Table 4.8 presents the distribution of all women and those who have ever used per iodic abstinence in relation to their reported knowledge of the fertile period in the menstrual cycle. The most common response given by the women was "don't know" (45 percent). Only 14 percent of women correctly identified the middle of the menstrual cycle as the time a woman is most likely to get pregnant. When compared with the results from the 1990 NDHS (20 percent), the 1999 data show a decline. Knowledge of the fertile period is somewhat better among women who say they are using periodic Table 4.8 Knowledge of fertile period Percent distribution of users of periodic abstinence and of all women by knowledge of the fertile period during the ovulatory cycle, Nigeria 1999 Users of Perceived perloffxc All fertile period abstinence women During menstrtlal period 0.3 0.6 Right after period has ended 29.4 19.2 Halfway between periods 27.3 13.6 Just before period begins 3.0 2.1 At any time 13.5 18.7 Other 0.6 0.4 Don't know 25.2 44.6 Missing 0.7 0.8 Total 100.0 100.0 Number 375 8,206 abstinence as a method of family planning. However, even among these women, only 27 percent gave the correct answer ("halfway between periods" or "the middle of the cycle"), while 25 percent said they didn't know when a woman is most likely to get pregnant, and 14 percent said a woman can get pregnant any time. 4.6 Contraceptive Effect of Breastfeeding Breastfeeding is an important variable because of its effect on fecundity, spacing of births, and conception. It has been proved scientifically that exclusive hreastfeeding does prolong the period of postpartum infecundity. And for many years, women themselves in various cultures have recognised that prolonged breastfeeding lengthens the period of postpartum infecundity and birth intervals. Thus, hreastfeeding, if exclusively practised immediately after birth, can be an effective method of family planning. Table 4.9 presents the distribution of women by knowledge of the effects of breastfeeding on the risk of pregnancy by background characteristics. Half (51 percent) of the women believe that breastfeeding has no influence on the risk of pregnancy. However, 29 percent indicate that breastfeeding influences the risk of conception, with 5 percent saying that it increases the risk of pregnancy, 13 percent saying that it decreases the risk of pregnancy, and 10 percent saying it depends. Twenty percent of women do not know whether hreastfeeding increases or decreases the risk of pregnancy. Knowledge of the contraceptive effect of breastfeeding is higher in the Southeast (25 percent) and Southwest regions (18 percent) than in the other regions. The nigher the level of education, the more likely a woman will know that breastfeeding can decrease the risk of pregnancy. 58 Table 4.9 Perceived contraceptive effect of breastfeedlng Percent distribution of currently married women by perceived risk of pregnancy associated with breasffeeding and percentage of currently married women who previously relied and who currently rely on breastfeeding to avoid pregnancy and percentage who meet laetational amenorrhoeic method (LAM) criteria, according to selected background characteristics, Nigeria 1999 Perceived risk of pregnancy associated with breastfeeding Reliance on breastfeeding to avoid pregnancy Meet Number Background Un- In- De- Don't Previ- Cur- LAM of characteristic changed creased creased Depends know Missing Total ously rently criteria women Age 15-19 45.7 4.4 6.3 5.3 38.2 0.2 100.0 2.4 1.8' 7.9 472 20-24 53.7 5.8 10.3 8.0 21.7 0.5 100.0 6.5 3.3 6.1 934 25-29 50.7 5.2 12.7 11.2 19.5 0.8 100.0 8.0 4.0 5.1 1,272 30-34 53.7 4.5 14.1 10.3 17.1 0.2 I00.0 9.3 5.8 3.5 1,032 35-39 48.7 5.3 16.0 12.1 17.6 0.3 100.0 10.1 3.7 3.9 925 40-44 48.1 4.4 16.4 11.1 19.0 1.0 100.0 10.1 3.9 1.8 637 45-49 50.0 5.8 15.2 11.5 16.6 1.0 100.0 9.6 1.7 0.4 484 Residence Urban 49.1 5.1 15.9 10.4 18.8 0.7 100.0 9.3 4.0 3.5 1,670 Rural 51.3 5.1 12.0 10.1 21.0 0.5 100.0 7.8 3.7 4.6 4,087 Region Northeast 50.8 3.7 6.4 10.8 27.4 0.9 100.0 4.1 2.8 6.2 1,137 Northwest 62.6 5.0 9.9 4.7 17.5 0.2 100.0 6.9 3.9 5.1 986 Southeast 41.1 5.6 25.2 10.3 17.2 0.6 100.0 18.0 6.6 2.7 946 Southwest 46.8 7.5 18.0 12.3 14.7 0.7 100.0 8.3 4.0 3.4 1,367 Central 52.3 3.5 7.8 11.5 24.5 0.4 100.0 5.7 2.4 4.1 1,321 Education No education 53.7 4.3 8.7 8.9 23.7 0.7 100.0 5.5 2.9 4.5 3,032 Ptimary 47.6 5.3 15.8 11.8 19.1 0.5 100.0 11.4 5.2 4.2 1,298 Secondary 47.3 7.0 18.3 11.4 15.7 0.4 100.0 11.2 4.9 4.7 1,123 Higher 45.3 5.0 27.1 12.0 10.0 0.6 100.0 10.9 2.7 0.9 303 Tot~ 50.6 5.1 13.2 10.2 20.4 0.6 100.0 8.2 3.8 4.3 5,757 The last few columns in Table 4.9 show that 8 percent of women say they have used breastfeeding as a means to delay a pregnancy and 4 percent say they are currently doing so. Using data from other questions in the NDHS on duration since last birth and current breastfeeding status, 4 percent of respondents can be said to meet the criteria for using lactational amenorrhoea; that is, they are currently breastfeeding a child who is less than six months of age and they are not supplementing the breast milk with any other food or liquid. Curiously, although women in the Southeast region are by far the most likely to say they have used breastfeeding as a contraceptive and that they are currently doing so, they are the least likely to fit the criteria for effective use. 4.7 Sources of Family Planning Methods Information on sources of modern contraceptives is useful for family planning programme managers and implementors. In the 1999 NDHS, women who reported using a modern method of contraception at the t ime of the survey were asked where they most recently obtained the method. Table 4.10 and Figure 4.4 show that equal proportions of users obtain their methods from public sector (government) sources (43 percent) and private medical sources (43 percent). The main sources of contraceptives in the public sector are government hospitals (23 percent), health centres (12 percent), and public family planning clinics (7 percent). Among the private medical sources, pharmacies and patent medical stores account for the largest proportion (32 percent). Other private sources, such as shops and friends and relatives, account for 8 percent of current users. 59 Table 4.10 Source of supply for modem contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Nigeria 1999 An Inject- modern 1 Source of supply Pill IUD ables Condom methods Public sector 29.1 74.4 68.6 12.9 42.9 Government hospital 16.0 48.3 28.0 3.8 23.0 Government health centre 4.7 19.1 26.0 5.9 12.2 Family planning clinic 6.8 6.3 12.1 2.5 6.5 Moblie clinic 0.0 0.0 0.6 0.6 0.3 Community health worker 1.0 0.7 1.2 0.0 0.7 Other public 0.5 0.0 0.6 0.0 0.3 Private medical sector 53.1 19.5 27.0 62.7 42.9 Private hospitaYclinic 4.3 17.4 I4.4 5.6 10.0 Pharmacy/patent reed. store 47.4 1.5 9.3 56.5 31.5 Private doctor 0.0 0.6 2.5 0.6 0.8 Private mobile clinic 0.5 0.0 0.0 0.0 0.2 Private community health worker 0.0 0.0 0.7 0.0 0.2 Other private medical 0.9 0.0 0.0 0.0 0.3 Other private 11.8 1.6 1.9 15.4 8.4 Shop 2.3 0.0 0.7 4.8 2.1 Church 0.4 0.0 0.6 0.0 0.4 Friends/relatives 5.6 0.0 0.7 9.4 4.2 Nongovemment organizatinn 0.0 0.8 0.0 0.0 0.2 Other 3.5 0.8 0.0 1.1 1.5 DoJa't know/missing 6.0 4.5 2.5 9.1 5.8 Total 100.0 100.0 100.0 100.0 100.0 Number of women 216 137 159 186 728 Note: Totals include 10 users of diaphragm/foam/jelly, 16 users of female sterilisation, ] and 4 users of implants. Figure 4.4 Source of Family Planning Methods among Current Users of Modern Methods, Nigeria 1999 Private medical 43% Other 8% know/Missing 7% NDHS1999 60 Overall, public sector sources supply three-quarters of IUD users and more than two-thirds of injectable users. Users of pills and condoms, however, on the other hand, are more l ikely to go to private medical sources, especially pharmacies. 4.8 Intention to Use Family Planning Among Non-Users An important indicator of the changing demand for family planning is the extent to which non- users of contraception plan to use family planning in the future. Women and men who were not using contraception at the time of the survey were asked about their intention to use family planning in the future. The results are presented in Table 4.11. Among both women and men, 23 percent of currently married non-users say they intend to use family planning in the future, with slightly more than half saying they intend to use in the next 12 months. Sixty percent of married women and 57 percent of married men say they do not intend to use family planning, while 15 percent of women and men are unsure as to whether they will use or not. Among women, the intent to use in the next 12 months increases somewhat with the number of l iving children. Table 4.11 Future use of contraception Percent distribution of currently married women and men who are not using a contraceptive method by intention to use a method in the future, according to number of living children (women), Nigeria 1999 Future use of contracoptlon Number of living children 1 0 1 2 3 4+ women men Intend to use in next 12 months 2.9 10.8 14.4 14.8 16.3 13.7 11.8 Intend to use later 10,2 11.8 10.2 8.3 5.7 8.3 10.1 Unsure as to 6ruing 0,6 0.8 0.9 0.3 0.8 0.7 0.9 Unsure as to intention 19,8 17.5 16.4 15.7 12.9 15.3 14.8 Do not intend to use 65.5 57.6 56.7 59.1 62.2 60.3 56.8 Don't know/Missing 0.9 1.5 1.4 1.8 2.3 1.8 5.7 Total 100,0 100,0 100.0 100.0 I00.0 100.0 100,0 Number of woman/men 395 880 802 747 2,051 4,875 1,098 1 Includes current pregnancy 4.9 Reasons For Nonuse To better inform programmes aimed at contraceptive education and encouragement of use, the NDHS included questions about why respondents do not intend to use family planning in the future. The main reasons for not using family planning given by currently married nonusers who do not intend to use a contraceptive method in the future are presented in Table 4.12. The important reasons given by women are a desire for more children, opposition to family planning, lack of knowledge about methods, and religious prohibitions about using. Younger women are more likely to say that they want more children, while a larger proportion of older women say they do not intend to use because they are menopausal or they have had a hysterectomy. 61 Table 4.12 Reasons for not intending to use contraception Percent distribution of currently married women and men who are not using a contraceptive method and who do not intend to use in the future, by main reason for not intending to use, according to age (women), Nigeria 1999 Age Reason for not intending Total Total to use contraception <30 30-49 women men Not married 0.1 0.1 0.1 0.2 Infrequent sex 0.5 3.7 2.2 1.8 Menopausal, hysterectomy 0.1 9.2 5.1 4.8 Subfecund, infe~und 0.7 2.4 1.7 2.5 Wants more children 34.1 22.8 27.9 37.5 Respondent opposed 15.1 16.4 15.8 I3.1 Spouse opposed 8.3 5.9 7.0 0.2 Others opposed 0.1 0.2 0.1 0.3 Religious prohibitlon 11.5 10.4 10.9 21.8 Knows no method 15.6 14.3 14.8 9.0 Knows no source 3.0 2.8 2.9 2.6 Health concerns 1.3 1.5 1.4 0.4 Fear side effects 4.5 3.8 4.1 1.9 Lack of access 0.1 0.1 0.1 0.2 Costs too much 0.0 0.1 0.1 0.0 Inconvenient to use 0.1 0.5 0.3 0.0 Interferes with body processes 0.5 1.6 1.1 0.2 Up to woman to use 0.0 0.0 0.0 0.2 Other 2.2 2.9 2.6 2.4 Don't know 1.6 1.1 1.3 0.7 Missing 0.7 0.1 0.4 0.2 Total 100.0 100.0 100.0 100.0 Number of women/man 1,333 1,604 2,937 624 The men that were interviewed gave such reasons as wanting more children (38 percent), religious restrictions (22 percent), and opposition to use (13 percent). It is also interesting to note reasons that are not commonly cited. For example, very few respondents say they do not intend to use because of health concerns or fear of side effects. Similarly, lack of access and excessive costs do not seem to be barriers to use. 4.10 Preferred Method of Contraception for Future Use Future demand for specific methods was assessed by asking nonusers who said they intended to use family planning in the future which method they preferred to use. Table 4.13 presents information on the preferred method of currently married women who are not using a contraceptive method but who intend to use one in the future. The largest share of these women (27 percent) say they intend to use injectables, while 19 percent say they would prefer to use the pill, and 10 percent say they intend to use periodic abstinence. Women who intend to use family planning in the next 12 months have method preferences similar to women who intend to use later. 62 Table 4.13 Preferred method o f 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, Nigeria I999 Timing of intended use In next After 12 12 Preferred method months months Total Pill 17.9 22.0 19.2 IUD 9.4 7.6 8.6 Injectables 27.2 28.3 27.2 Diaphragm/foam/jelly 0.3 0.0 0.2 Condom 6.7 3.8 5.8 Female sterilisatlon 1.8 3.7 2.5 Implants 0.9 1.0 0.9 Periodic abstinence 10.2 10.2 10.4 Withdrawal 3.2 2.7 2.9 Folk method 5.0 4.5 5.1 Other 1.1 0.5 0.8 Don't know 0.7 0.0 0.4 Missing 15.5 15.6 15.9 Total 100.0 100.0 100.0 Nttmber of women 667 404 1,105 Note: Total inc

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