Peru - Demographic and Health Survey - 2015

Publication date: 2015

Egypt Demographic and Health Survey 2014Dem ographic and H ealth Survey Egypt 2014 Egypt Demographic and Health Survey 2014 Ministry of Health and Population Cairo, Egypt El-Zanaty and Associates Cairo, Egypt The DHS Program ICF International Rockville, Maryland, USA May 2015 El-Zanaty and Associates Ministry of Health and Population The 2014 Egypt Demographic and Health Survey (2014 EDHS) was conducted on behalf of the Ministry of Health and Population by El-Zanaty and Associates. The 2014 EDHS is part of The DHS Program, which is funded by the United States Agency for International Development (USAID). USAID/Cairo was the main contributor of funding for the survey. Support for the survey also was provided by The United Nations Children’s Fund (UNICEF) and The United Nations Population Fund (UNFPA). The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID, UNICEF, or UNFPA. Additional information about the 2014 EDHS may be obtained from the Ministry of Health and Population, Magles El Shaab Street, Cairo, Egypt; Telephone: 20-2-27948555; Fax: 20-2-27924156. Information about DHS surveys may be obtained from The DHS Program, ICF International, 530 Gaither Road, Suite 500, Rockville, MD USA; Telephone: 1-301-407-6500; Fax: 1-301-407-6501; E-mail: reports@dhsprogram.com; Internet: http://www. dhsprogram.com. Recommended citation: Ministry of Health and Population [Egypt], El-Zanaty and Associates [Egypt], and ICF International. 2015. Egypt Demographic and Health Survey 2014. Cairo, Egypt and Rockville, Maryland, USA: Ministry of Health and Population and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . vii PREFACE . xv ACKNOWLEDGMENTS . xvii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xix MAP OF EGYPT . xx 1 INTRODUCTION . 1 1.1 Geography . 1 1.2 Population Size and Structure . 1 1.3 Recent Rate of Natural Increase . 1 1.4 Organization of the 2014 EDHS . 2 1.4.1 2014 EDHS Timetable . 3 1.4.2 Sample Design . 4 1.4.3 Sample Selection . 4 1.4.4 Questionnaire Development . 5 1.4.5 Pretest . 6 1.4.6 Data Collection Activities . 6 1.4.7 Data Processing Activities . 8 1.5 Survey Coverage . 8 2 CHARACTERISTICS OF HOUSEHOLDS . 11 2.1 Housing Characteristics . 12 2.1.1 Drinking Water Access and Treatment . 12 2.1.2 Sanitation Facilities and Waste Disposal . 14 2.1.3 Other Dwelling Characteristics . 16 2.2 Household Possessions . 17 2.3 Household Wealth . 19 2.4 Hand Washing . 20 2.5 Characteristics of the Household Population . 21 2.5.1 Age and Sex Composition . 21 2.5.2 Household Composition . 23 2.6 Education of the Household Population . 23 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS . 27 3.1 Background Characteristics of Ever-married Women . 27 3.2 Educational Attainment by Background Characteristics . 29 3.3 Literacy . 30 3.4 Exposure to Broadcast, Print, and Digital Media . 31 3.5 Employment Status . 34 3.5.1 Current Employment . 34 3.5.2 Occupation . 35 3.5.3 Type of Employment . 37 4 FERTILITY . 39 4.1 Current Fertility Levels . 39 4.2 Differentials in Current and Cumulative Fertility . 41 4.3 Fertility Trends . 42 4.3.1 Retrospective Data . 42 4.3.2 Comparison with Previous Surveys . 43 4.4 Children Ever Born and Living . 45 4.5 Birth Intervals . 46 4.5.1 Intervals between Births . 46 4.5.2 Attitudes about the Ideal Birth Interval . 48 4.6 Age at First Birth . 49 4.7 Teenage Pregnancy and Motherhood . 50 iv • Contents 5 FERTILITY PREFERENCES . 53 5.1 Desire for More Children . 53 5.2 Ideal Number of Children . 56 5.3 Unplanned and Unwanted Fertility . 58 6 FAMILY PLANNING . 61 6.1 Knowledge of Family Planning Methods . 61 6.2 Knowledge of Fertile Period . 62 6.3 Knowledge of Breastfeeding as a Family Planning Method . 62 6.4 Attitudes toward Timing of Use of Family Planning . 65 6.5 Current Use of Family Planning . 65 6.5.1 Differentials in Current Use of Family Planning by Residence . 66 6.5.2 Demographic and Socioeconomic Differentials . 67 6.6 Trends in Current Use of Family Planning . 69 6.6.1 Trends in Current Use Since 1980 . 69 6.6.2 Trends in Method Mix . 70 6.6.3 Trends by Residence . 71 6.7 Sources for Modern Family Planning Methods . 71 6.7.1 Sources by Method . 71 6.7.2 Sources by Method and Residence . 72 6.7.3 Trends in Sources of Modern Methods . 74 6.8 Pill Brands . 74 6.9 Participation in Family Planning Decision Making . 75 6.10 Informed Choice . 77 6.11 Contraceptive Discontinuation Rates . 79 6.12 Reasons for Discontinuation of Contraceptive Use . 80 6.13 Unmet Need for Family Planning . 81 6.14 Reasons for Nonuse . 83 6.15 Intention to Use Contraception in the Future and Preferred Method . 84 6.16 Contact of Nonusers with Outreach Workers/Health Care Providers . 85 6.17 Exposure to Family Planning Messages . 86 7 PROXIMATE DETERMINANTS OF FERTILITY . 89 7.1 Marital Status . 90 7.2 Consanguinity . 91 7.3 Age at First Marriage . 92 7.4 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 94 7.5 Termination of Exposure to Pregnancy . 97 8 INFANT AND CHILD MORTALITY . 99 8.1 Assessment of Data Quality . 99 8.2 Levels and Trends in Early Childhood Mortality . 100 8.2.1 Levels of Mortality . 101 8.2.2 Trends in Mortality Based on Retrospective Data . 101 8.2.3 Trends in Mortality Based on Data from Multiple Surveys . 101 8.3 Differentials in Mortality . 102 8.3.1 Socioeconomic Differentials . 103 8.3.2 Demographic Differentials . 104 8.4 Perinatal Mortality . 105 8.5 High-Risk Fertility Behavior. 106 9 MATERNAL HEALTH . 109 9.1 Antenatal Care . 109 9.1.1 Antenatal Care Coverage . 109 9.1.2 Tetanus Toxoid Coverage . 112 9.1.3 Content of Pregnancy Care . 113 9.2 Delivery Care . 115 9.2.1 Place of Delivery . 115 9.2.2 Assistance at Delivery . 117 9.2.3 Caesarean Deliveries . 119 9.3 Trends in Antenatal and Delivery Care . 119 Contents • v 9.4 Postnatal Care . 121 9.4.1 Postnatal Checkup for the Mother . 121 9.4.2 Postnatal Checkup for the Baby . 124 10 OTHER HEALTH ISSUES . 129 10.1 Women’s Access to Health Care . 129 10.2 Health Insurance Coverage . 131 10.3 Sexually Transmitted Infections . 132 10.4 Knowledge of HIV/AIDS . 133 10.5 Knowledge of Mother-to-Child Transmission of HIV . 136 10.6 Accepting Attitudes towards People Living with AIDS . 137 10.7 Knowledge of a Source for HIV Testing . 138 10.8 Sources of Information about AIDS . 139 11 CHILD HEALTH . 141 11.1 Child Size and Weight at Birth . 141 11.2 Immunization of Children . 142 11.2.1 Collection of Immunization Data in the 2014 EDHS . 143 11.2.2 Routine Immunization against Common Childhood Illnesses . 143 11.3 Acute Respiratory Infection . 146 11.3.1 Prevalence of ARI . 146 11.3.2 Consultation, Treatment, and Feeding Practices . 147 11.3.3 Differentials in ARI Prevalence and Responses to the Illness . 148 11.4 Fever . 149 11.5 Diarrhea . 150 11.5.1 Prevalence of Diarrhea. 151 11.5.2 Consultation, Treatment, and Feeding Practices . 151 11.5.3 Differentials in Feeding and Treatment Practices during Diarrheal Episodes . 153 11.6 Disposal of Children’s Stools. 156 12 NUTRITION OF CHILDREN, YOUTH, AND WOMEN . 157 12.1 Breastfeeding and Supplementation . 157 12.1.1 Initiation of Breastfeeding . 158 12.1.2 Introduction of Complementary Feeding . 160 12.1.3 Median Durations and Frequency of Breastfeeding . 163 12.2 Dietary Diversity among Children . 163 12.2.1 Foods and Liquids Consumed by Infants and Young Children . 164 12.2.2 Appropriate Infant and Young Child Feeding . 165 12.3 Micronutrient Supplementation among Young Children . 167 12.3.1 Use of Iodized Salt . 167 12.3.2 Micronutrient Intake among Young Children . 168 12.3.3 Micronutrient Intake among Mothers . 171 12.4 Nutritional Status of Young Children, Youth, and Women . 172 12.4.1 Nutritional Status among Young Children. 173 12.4.2 Nutritional Status among Children Age 5-19 Years . 176 12.4.3 Nutritional Status among Ever-married Women Age 15-49 . 179 12.5 Anemia Status of Young Children, Youth, and Women . 180 12.5.1 Anemia Levels among Children Age 6-59 Months . 180 12.5.2 Anemia Levels among Children Age 5-19 Years . 182 12.5.3 Anemia Levels among Ever-married Women Age 15-49 . 183 13 FEMALE CIRCUMCISION . 185 13.1 Prevalence of Female Circumcision among Ever-Married Women . 185 13.2 Women’s Circumcision Experience . 186 13.3 Prevalence of Circumcision among Daughters . 187 13.4 Circumcision Experience among Daughters . 191 13.5 Support for the Continuation of Female Circumcision . 192 13.6 Attitudes about Female Circumcision . 193 13.7 Exposure to Information about Circumcision . 195 vi • Contents 14 CHILD WELFARE . 197 14.1 Birth Registration . 197 14.2 Children’s Living Arrangements and Orphanhood . 198 14.3 Injuries and Accidents and Disabilities among Young Children . 199 14.4 Education . 201 14.4.1 Early Childhood Education . 201 14.4.2 Primary and Secondary School Education . 202 14.5 Child Labor . 204 14.6 Child Discipline . 210 14.7 Child Care Arrangements . 212 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 215 15.1 Employment and Form of Earnings . 215 15.2 Control over Cash Earnings and Relative Magnitude of Earnings . 216 15.2.1 Women’s Control over Her Cash Earnings . 216 15.2.2 Control over Husband’s Cash Earnings . 217 15.2.3 Women’s Earnings Relative to Their Husband’s Earnings . 218 15.3 Women’s Ownership of Selected Assets . 219 15.4 Women’s Participation in Decision-making . 220 15.5 Attitude towards Wife Beating . 222 15.6 Women’s Empowerment Indicators . 224 15.7 Current Use of Contraception by Women’s Status . 224 15.8 Ideal Family Size and Unmet Need by Women’s Status . 225 15.9 Reproductive Health Care and Women’s Empowerment . 226 16 DOMESTIC VIOLENCE . 229 16.1 Factors Associated with Domestic Violence . 230 16.2 Spousal Violence . 233 16.2.1 Levels of Spousal Violence . 233 16.2.2 Spousal Violence by Background Characteristics . 235 16.3 Recent Experience of Spousal Violence . 239 16.4 Onset of Spousal Violence . 240 16.5 Injuries Resulting from Marital Violence . 240 16.6 Physical Violence Involving Any Perpetrator . 241 16.6.1 Prevalence of Physical Violence . 241 16.6.2 Perpetrators of Physical Violence . 242 16.7 Violence during Pregnancy . 243 16.8 Help-seeking Behavior . 243 REFERENCES . 247 APPENDIX A GOVERNORATE TABLES . 251 APPENDIX B SAMPLE DESIGN . 287 B.1 Introduction . 287 B.2 Sampling Frame . 287 B.3 Sample Design and Selection . 288 B.4 Sample Implementation . 293 B.5 Sampling Weights . 295 APPENDIX C ESTIMATES OF SAMPLING ERRORS . 297 APPENDIX D DATA QUALITY TABLES . 337 APPENDIX E PERSONS INVOLVED IN THE 2014 EGYPT DEMOGRAPHIC AND HEALTH SURVEY . 345 APPENDIX F QUESTIONNAIRES . 349 Tables and Figures • vii TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Population of Egypt, 1996-2013. 1 Table 1.2 Life expectancy, Egypt 1976-2014 . 2 Table 1.3 Survey timetable, 2014 Egypt DHS . 3 Table 1.4 Results of the household and individual interviews . 9 Figure 1.1 Trends in crude birth and death rates, Egypt 2000-2013 . 2 2 CHARACTERISTICS OF HOUSEHOLDS . 11 Table 2.1 Household drinking water . 13 Table 2.2 Household sanitation facilities and waste disposal practices . 15 Table 2.3 Household characteristics . 16 Table 2.4 Household possessions . 18 Table 2.5 Wealth quintiles . 20 Table 2.6 Hand washing . 21 Table 2.7 Household population by age, sex, and residence . 22 Table 2.8 Household composition . 23 Table 2.9.1 Educational attainment of the female household population . 24 Table 2.9.2 Educational attainment of the male household population . 25 Figure 2.1 Population pyramid . 22 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS . 27 Table 3.1 Background characteristics of respondents . 28 Table 3.2 Educational attainment . 30 Table 3.3 Literacy . 31 Table 3.4 Exposure to broadcast and print media . 32 Table 3.5 Use of computers and digital media . 33 Table 3.6 Employment status . 35 Table 3.7 Occupation . 36 Table 3.8 Type of employment . 38 Figure 3.1 Occupation among working women . 37 4 FERTILITY . 39 Table 4.1 Current fertility . 40 Table 4.2 Fertility by background characteristics. 41 Table 4.3 Trends in age-specific fertility rates . 43 Table 4.4 Trends in fertility . 43 Table 4.5 Trends in fertility by residence . 45 Table 4.6 Children ever born and living . 46 Table 4.7 Birth intervals . 47 Table 4.8 Ideal birth interval by residence . 48 Table 4.9 Age at first birth . 49 Table 4.10 Median age at first birth . 49 Table 4.11 Teenage pregnancy and motherhood . 51 Figure 4.1 Trends in age-specific fertility, Egypt 2008-2014 . 44 Figure 4.2 Trends in fertility by residence, Egypt 2008-2014 . 45 viii • Tables and Figures 5 FERTILITY PREFERENCES . 53 Table 5.1 Fertility preferences by number of living children . 54 Table 5.2 Desire to limit childbearing . 55 Table 5.3 Ideal number of children by number of living children . 57 Table 5.4 Mean ideal number of children . 57 Table 5.5 Husband’s fertility preference by wife’s ideal number of children . 58 Table 5.6 Fertility planning status . 59 Table 5.7 Wanted fertility rates . 59 Figure 5.1 Desire for more children among currently married women . 54 6 FAMILY PLANNING . 61 Table 6.1 Knowledge of family planning methods . 62 Table 6.2 Knowledge of fertile period . 62 Table 6.3 Belief that breastfeeding reduces chances of pregnancy . 63 Table 6.4 Beliefs concerning breastfeeding and a woman’s protection from pregnancy . 64 Table 6.5 Attitudes toward timing of use of family planning among newly married couples . 65 Table 6.6 Current use of family planning methods by residence . 67 Table 6.7 Current use of family planning methods by selected demographic and social characteristics . 68 Table 6.8 Trends in current use of family planning . 70 Table 6.9 Trends in family planning method mix . 70 Table 6.10 Trends in family planning use by residence . 71 Table 6.11 Source of modern family planning methods . 72 Table 6.12 Source of modern family planning methods by residence . 73 Table 6.13 Trends in reliance on public sector sources for modern family planning methods . 74 Table 6.14 Brand of pill . 75 Table 6.15 Knowledge of pill brand suitable for breastfeeding women . 75 Table 6.16 Family planning decision-making . 76 Table 6.17 Informed choice . 78 Table 6.18 Twelve-month contraceptive discontinuation rates . 80 Table 6.19 Reasons for discontinuation . 81 Table 6.20 Need and demand for family planning among currently married women . 83 Table 6.21 Reasons for not using family planning . 84 Table 6.22 Future use of family planning . 84 Table 6.23 Preferred family planning method . 85 Table 6.24 Contact of currently married nonusers with family planning providers . 86 Table 6.25 Exposure to family planning messages . 87 Figure 6.1 Current use by method . 66 Figure 6.2 Trends in current use of family planning, Egypt 1980-2014 . 69 Figure 6.3 Trends in exposure to family planning messages, Egypt 2005-2014 . 88 7 PROXIMATE DETERMINANTS OF FERTILITY . 89 Table 7.1 Current marital status . 90 Table 7.2 Number of co-wives . 91 Table 7.3 Consanguinity. 92 Table 7.4 Age at first marriage . 93 Table 7.5 Median age at first marriage by background characteristics . 93 Table 7.6 Postpartum amenorrhea, abstinence, and insusceptibility . 95 Table 7.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 96 Table 7.8 Menopause . 97 Tables and Figures • ix Figure 7.1 Percentage of births whose mothers are amenorrheic, abstaining, or insusceptible to the risk of pregnancy . 95 8 INFANT AND CHILD MORTALITY . 99 Table 8.1 Early childhood mortality rates . 101 Table 8.2 Trends in early childhood mortality . 102 Table 8.3 Early childhood mortality rates by socioeconomic characteristics . 103 Table 8.4 Early childhood mortality rates by demographic characteristics . 105 Table 8.5 Perinatal mortality . 106 Table 8.6 High-risk fertility behavior . 107 Figure 8.1 Trends in under-five mortality, Egypt 1967-2012 . 102 Figure 8.2 Under-five mortality by place of residence . 104 9 MATERNAL HEALTH . 109 Table 9.1 Antenatal care . 110 Table 9.2 Antenatal care by background characteristics . 111 Table 9.3 Tetanus toxoid injections . 112 Table 9.4 Components of antenatal care . 114 Table 9.5 Place of delivery . 116 Table 9.6 Time spent in health facility following delivery. 117 Table 9.7 Assistance during delivery . 118 Table 9.8 Caesarean deliveries . 119 Table 9.9 Trends in maternal health indicators by residence . 120 Table 9.10 Timing of first postnatal checkup for the mother . 123 Table 9.11 Type of provider of first postnatal checkup for the mother . 124 Table 9.12 Timing of first postnatal checkup for the newborn . 125 Table 9.13 Type of provider of first postnatal checkup for the newborn . 126 Table 9.14 Blood sample taken from newborn’s heel . 127 Figure 9.1 Trends in maternal health indicators, Egypt 2008-2014 . 121 10 OTHER HEALTH ISSUES . 129 Table 10.1 Problems in accessing health care . 130 Table 10.2 Health insurance coverage . 131 Table 10.3 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms . 133 Table 10.4 Knowledge of AIDS . 135 Table 10.5 Knowledge of prevention of mother-to-child transmission of HIV. 136 Table 10.6 Accepting attitudes toward those living with HIV . 137 Table 10.7 Knowledge of a place where HIV testing is available . 138 Table 10.8 Sources of information about AIDS . 139 11 CHILD HEALTH . 141 Table 11.1 Child’s size and weight at birth . 142 Table 11.2 Vaccinations by source of information . 143 Table 11.3 Vaccinations by background characteristics . 145 Table 11.4 Prevalence of cough . 146 Table 11.5 Consultation about ARI episode . 147 Table 11.6 Treatment and feeding practices for children ill with ARI symptoms . 147 Table 11.7 Prevalence and treatment of ARI symptoms by background characteristics . 148 Table 11.8 Prevalence and treatment of fever . 150 Table 11.9 Prevalence of diarrhea . 151 Table 11.10 Consultation about and treatment practices during a diarrheal episode . 152 Table 11.11 Treatment and feeding practices for children ill with diarrhea . 152 Table 11.12 Consultation with provider and treatment of diarrhea by background characteristics . 154 Table 11.13 Feeding practices during diarrhea by background characteristics . 155 Table 11.14 Disposal of children’s stools . 156 x • Tables and Figures Figure 11.1 Treatment practices among children ill with diarrhea . 153 12 NUTRITION OF CHILDREN, YOUTH, AND WOMEN . 157 Table 12.1 Initial breastfeeding . 159 Table 12.2 Breastfeeding status by age . 161 Table 12.3 Median duration of breastfeeding . 163 Table 12.4 Foods and liquids consumed by children in the day or night preceding the interview 164 Table 12.5 Infant and young child feeding (IYCF) practices . 166 Table 12.6 Presence of iodized salt in households . 168 Table 12.7 Micronutrient intake among children . 169 Table 12.8 Micronutrient intake among mothers . 172 Table 12.9 Nutritional status of children . 175 Table 12.10.1 Nutritional status of girls age 5-19 . 177 Table 12.10.2 Nutritional status of boys age 5-19 . 178 Table 12.11 Nutritional status of women . 179 Table 12.12 Prevalence of anemia in children age 6-59 months . 181 Table 12.13.1 Prevalence of anemia in girls age 5-19 . 182 Table 12.13.2 Prevalence of anemia in boys age 5-19 . 183 Table 12.14 Prevalence of anemia in ever-married women . 184 Figure 12.1 Infant feeding practices by age . 161 Figure 12.2 IYCF indicators on breastfeeding status . 162 Figure 12.3 IYCF indicators on minimum acceptable diet . 167 Figure 12.4 Nutritional status of children by age . 174 Figure 12.5 Trends in nutritional status of children under age 5, Egypt 2000-2014 . 176 13 FEMALE CIRCUMCISION . 185 Table 13.1 Prevalence of female circumcision among ever-married women age 15-49 . 186 Table 13.2 Age at circumcision among ever-married women age 15-49 by residence . 187 Table 13.3 Person performing circumcision among ever-married women by residence . 187 Table 13.4 Current and expected prevalence of female circumcision among daughters . 188 Table 13.5 Current and expected prevalence of female circumcision among daughters by background characteristics . 189 Table 13.6 Age at circumcision among daughters age 0-19 by residence . 191 Table 13.7 Person performing circumcision among daughters by residence . 191 Table 13.8 Attitude about continuation of female circumcision . 192 Table 13.9 Beliefs about female circumcision . 194 Table 13.10 Exposure to information regarding female circumcision . 195 Figure 13.1 Trends in percentage circumcised among daughters age 0-17 years, Egypt 2005-2014 . 190 Figure 13.2 Trends in attitudes toward female circumcision among ever-married women age 15-49, Egypt 1995-2014 . 193 14 CHILD WELFARE . 197 Table 14.1 Birth registration of children under age five . 198 Table 14.2 Children’s living arrangements and orphanhood . 199 Table 14.3 Injuries and accidents . 200 Table 14.4 Early childhood education . 201 Table 14.5 School attendance ratios . 203 Table 14.6 Children’s involvement in economic activities . 206 Table 14.7 Children’s involvement in household chores . 207 Table 14.8 Child labor . 209 Table 14.9 Child discipline . 210 Table 14.10 Child discipline by background characteristics . 211 Table 14.11 Child care arrangements . 213 Tables and Figures • xi Figure 14.1 Age-specific attendance rates of the de-facto population 6 to 24 years . 204 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 215 Table 15.1 Employment and cash earnings of currently married women . 216 Table 15.2 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 217 Table 15.3 Control over husband’s cash earnings . 218 Table 15.4 Women’s control over their earnings and over those of their husbands . 219 Table 15.5 Ownership of assets . 220 Table 15.6 Participation in decision making . 221 Table 15.7 Women’s participation in decision making by background characteristics . 222 Table 15.8 Attitude toward wife beating . 223 Table 15.9 Indicators of women’s empowerment . 224 Table 15.10 Current use of contraception by women’s empowerment . 225 Table 15.11 Ideal number of children and unmet need for family planning by women’s empowerment . 226 Table 15.12 Reproductive health care by women’s empowerment . 227 Figure 15.1 Number of decisions in which currently married women participate . 221 16 DOMESTIC VIOLENCE . 229 Table 16.1 Factors associated with spousal violence . 231 Table 16.2 Marital control exercised by husbands . 232 Table 16.3 Forms of spousal violence . 233 Table 16.4 Spousal violence by background characteristics . 236 Table 16.5 Spousal violence by husband’s characteristics and empowerment indicators . 238 Table 16.6 Recent experience of physical or sexual violence . 239 Table 16.7 Experience of spousal violence by duration of marriage . 240 Table 16.8 Injuries to women due to spousal violence . 240 Table 16.9 Experience of physical violence since age 15 . 241 Table 16.10 Persons committing physical violence . 242 Table 16.11 Experience of violence during pregnancy . 243 Table 16.12 Help seeking to stop violence . 244 Table 16.13 Sources for help to stop the violence . 245 Figure 16.1 Percentage of ever-married women age 15-49 who have experienced various forms of violence ever or in the 12 months preceding the survey, committed by their current (last) husband . 234 APPENDIX A GOVERNORATE TABLES . 227 Table A-2.1 Improved drinking water and toilet facilities, frequency of exposure to smoke in the home, and availability of soap and water at hand-washing location . 251 Table A-2.2 Wealth quintiles . 252 Table A-3.1 Educational attainment . 253 Table A-3.2 Exposure to traditional mass media . 254 Table A-3.3 Use of digital media . 255 Table A-3.4 Employment status . 256 Table A-4.1 Fertility . 257 Table A-4.2 Birth intervals . 258 Table A-4.3 Median age at first birth . 259 Table A-4.4 Teenage pregnancy and motherhood . 260 Table A-5.1 Fertility preferences . 261 Table A-5.2 Wanted fertility rates . 262 Table A-6.1 Current use of family planning methods . 263 Table A-6.2 Trends in current use of family planning methods . 264 Table A-6.3 Source of modern family planning methods by governorate . 265 xii • Tables and Figures Table A-6.4 Need and demand for family planning among currently married women . 266 Table A-6.5 Contact of nonusers with family planning providers . 267 Table A-6.6 Exposure to family planning messages . 268 Table A-7.1 Consanguinity. 269 Table A-7.2 Median age at first marriage . 270 Table A-8.1 Early childhood mortality rates by governorate . 271 Table A-9.1 Antenatal and delivery care indicators . 272 Table A-9.2 Postnatal care indicators for mothers and newborns by governorate . 273 Table A-10.1 Problems in accessing health care . 274 Table A-10.2 Knowledge of AIDS . 275 Table A-11.1 Vaccinations . 276 Table A-12.1 Nutritional status of ever-married women age 15-49 years . 277 Table A-12.2 Prevalence of anemia in ever-married women by governorate . 278 Table A-13.1 Current and expected prevalence of female circumcision by governorate . 279 Table A-13.2 Attitudes and beliefs about female circumcision by governorate . 280 Table A-14.1 School attendance ratios . 281 Table A-14.2 Child labor . 283 Table A-14.3 Child discipline . 284 Table A-15.1 Women’s participation in decision making . 285 Table A-15.2 Attitude toward wife beating . 286 APPENDIX B SAMPLE DESIGN . 287 Table B.1 Distribution of households by residence . 288 Table B.2 Sample allocation of clusters . 289 Table B.3 Sample allocation of household sample . 290 Table B.4 Sample allocation of women’s interviews . 291 Table B.5 Sampling fractions . 292 Table B.6 Sample implementation by residence . 293 Table B.7 Selected and interviewed households by governorate and residence . 294 Table B.8 Eligible women found and interviewed by governorate and residence . 295 APPENDIX C ESTIMATES OF SAMPLING ERRORS . 297 Table C.1 List of selected variables for sampling errors, Egypt 2014 . 299 Table C.2 Sampling errors for National sample, Egypt 2014 . 300 Table C.3 Sampling errors for Urban sample, Egypt 2014 . 301 Table C.4 Sampling errors for Rural sample, Egypt 2014 . 302 Table C.5 Sampling errors for Urban Governorates sample, Egypt 2014 . 303 Table C.6 Sampling errors for Lower Egypt sample, Egypt 2014 . 304 Table C.7 Sampling errors for Lower Egypt Urban sample, Egypt 2014 . 305 Table C.8 Sampling errors for Lower Egypt Rural sample, Egypt 2014 . 306 Table C.9 Sampling errors for Upper Egypt sample, Egypt 2014 . 307 Table C.10 Sampling errors for Upper Egypt Urban sample, Egypt 2014 . 308 Table C.11 Sampling errors for Upper Egypt Rural sample, Egypt 2014 . 309 Table C.12 Sampling errors for Frontier Governorates sample, Egypt 2014 . 310 Table C.13 Sampling errors for Cairo sample, Egypt 2014 . 311 Table C.14 Sampling errors for Alexandria sample, Egypt 2014 . 312 Table C.15 Sampling errors for Port Said sample, Egypt 2014 . 313 Table C.16 Sampling errors for Suez sample, Egypt 2014 . 314 Table C.17 Sampling errors for Damietta sample, Egypt 2014 . 315 Table C.18 Sampling errors for Dakahlia sample, Egypt 2014 . 316 Table C.19 Sampling errors for Sharkia sample, Egypt 2014 . 317 Table C.20 Sampling errors for Kalyubia sample, Egypt 2014 . 318 Table C.21 Sampling errors for Kafr-El-Sheikh sample, Egypt 2014. 319 Table C.22 Sampling errors for Gharbia sample, Egypt 2014 . 320 Table C.23 Sampling errors for Menoufia sample, Egypt 2014 . 321 Tables and Figures • xiii Table C.24 Sampling errors for Behera sample, Egypt 2014 . 322 Table C.25 Sampling errors for Ismailia sample, Egypt 2014 . 323 Table C.26 Sampling errors for Giza sample, Egypt 2014 . 324 Table C.27 Sampling errors for Beni Suef sample, Egypt 2014 . 325 Table C.28 Sampling errors for Fayoum sample, Egypt 2014 . 326 Table C.29 Sampling errors for Menya sample, Egypt 2014 . 327 Table C.30 Sampling errors for Assuit sample, Egypt 2014 . 328 Table C.31 Sampling errors for Souhag sample, Egypt 2014 . 329 Table C.32 Sampling errors for Qena sample, Egypt 2014 . 330 Table C.33 Sampling errors for Aswan sample, Egypt 2014 . 331 Table C.34 Sampling errors for Luxor sample, Egypt 2014 . 332 Table C.35 Sampling errors for Red Sea sample, Egypt 2014 . 333 Table C.36 Sampling errors for New Valley sample, Egypt 2014 . 334 Table C.37 Sampling errors for Matroh sample, Egypt 2014 . 335 APPENDIX D DATA QUALITY TABLES . 337 Table D.1 Household age distribution . 337 Table D.2 Age distribution of eligible and interviewed women . 338 Table D.3 Completeness of reporting . 339 Table D.4 Births by calendar years . 340 Table D.5 Reporting of age at death in days . 340 Table D.6 Reporting of age at death in months . 341 Table D.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 342 Preface • xv PREFACE ealth for all is the main health objective of the Egyptian government. To monitor and evaluate progress toward the achievement of this goal, reliable data are needed. These data can be obtained from service administration (service-based data) and collected directly from the community (household-based data). The two types of data complement each other in enhancing the information available to monitor progress in the health sector. Since 1980, a number of surveys have been carried out in Egypt to obtain data from the community on the current health situation including the series of Demographic and Health Surveys of which 2014 EDHS is the most recent. The 2014 EDHS is of special importance as it is the first national health survey since 2008. The results of the 2014 EDHS show that key maternal and child health indicators, including antenatal care coverage and medical assistance at delivery, have improved. However, the survey also documents a number of critical challenges, particularly relating to fertility and family planning. The findings of the 2014 EDHS together with the service-based data are very important for measuring the achievements of health and population programs. Based on the above-mentioned considerations, the results of the 2014 EDHS should be widely disseminated at different levels of health management, in the central offices as well as local governments, and to the community at large. Dr. Adel Adawy Minister of Health and Population H Acknowledgments • xvii ACKNOWLEDGMENTS he Egypt Demographic and Health Survey represents the continuing commitment and efforts in Egypt to obtain data on fertility and contraceptive practice. The survey also reflects the strong interest in information on key maternal health and child survival issues. The wealth of demographic and health data that the survey provides will help in charting future directions for Egypt’s population and health programs. This important survey could not have been implemented without the active support and dedicated efforts of a large number of institutions and individuals. The support and approval of the Ministry of Health and Population (MOHP) under the leadership of H.E. Dr. Adel Adawy was instrumental in securing the implementation of the EDHS. USAID/Cairo was the main contributor of funding for the survey. UNICEF and UNFPA also provided financial support. Technical assistance came from the USAID-sponsored DHS Program. I am deeply grateful to the Ministry of Health and Population staff who contributed to the successful completion of this project, especially Dr. Atef El-Shitany, Head of the Population and Family Planning Sector and Dr. Seham El-Sherif, Director of the Information Center for the Population and Family Planning Sector, for their continuous help and support during the survey implementation. I also gratefully acknowledge the Office of Health and Population staff at USAID/Cairo, especially Dr. Nabil Alsoufi, Director, and Ms. Shadia Attia, Senior Monitoring and Evaluation Advisor, for their support and valuable comments throughout the survey activities. I also recognize with gratitude the contributions of Dr. Leonardo Menchini, Chief of Social Policy, Monitoring and Evaluation, and Ms. Manar Soliman, Knowledge Management and Statistics Officer, UNICEF, and Dr. Magdy Khalid, Assistant Representative, UNFPA, in facilitating the successful implementation of the survey. Dr. Ann Way of ICF International, who worked closely with us on all phases of the 2014 EDHS, deserves special thanks for all her efforts throughout the survey and during the preparation of this report. My thanks also are extended to Dr. Mahmoud Elkasabi for his advice and guidance in designing the sample. Ms. Jeanne Cushing deserves my deepest thanks for her assistance in data processing and tabulation required for this report. Ms. Monica Kothari provided invaluable assistance with the training and organization of the anemia-testing and anthropometry component of the survey. I would like to express my appreciation to all the senior office staff at El-Zanaty and Associates for the dedication and skill with which they performed their tasks. Special thanks also go to the EDHS field staff for the efficiency which they performed their work in a sometimes very difficult environment. Finally, I would like to express my appreciation to all households and women who responded in the survey; without their participation this survey would have been impossible. Dr. Fatma El-Zanaty Technical Director T Millennium Development Goal Indicators • xix MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Egypt 2014 Value Total Goal Indicator Male Female 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under five years of age 5.9 5.1 5.5 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 95.8 95.5 95.7 3. Promote gender equality and empower women 3.1a Ratio of girls to boys in primary education2 na na 1.0 3.1b Ratio of girls to boys in secondary education2 na na 1.0 3.1c Ratio of girls to boys in tertiary education2 na na 0.9 4. Reduce child mortality 4.1 Under five mortality rate3 30 30 27 4.2 Infant mortality rate3 25 27 22 4.3 Proportion of children age 18-29 months immunized against measles 95.5 96.2 95.8 5. Improve maternal health 5.2 Percentage of births attended by skilled health personnel4 na na 91.5 5.3 Contraceptive prevalence rate5 na 58.5 na 5.4 Adolescent birth rate6 na 56.5 na 5.5a Antenatal care coverage: at least one visit7 na 90.3 na 5.5b Antenatal care coverage: four or more visits8 na 82.8 na 5.6 Unmet need for family planning na 12.6 na Goal Indicator Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source9 98.7 97.1 97.7 7.9 Percentage of population with access to improved sanitation10 98.9 84.9 90.1 na = Not applicable 1 The ratio is based on reported attendance, not enrollment, in primary education among defacto primary school age children (6-11 year-olds). The rate also includes children of primary school age enrolled in secondary education. This is a proxy for MDG indicator 2.1, Net enrollment ratio. 2 Based on reported net attendance, not gross enrollment, among defacto 6-11 year-olds for primary, 12-17 year-olds for secondary and 18-24 year-olds for tertiary education 3 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. 4 Among births in the five years preceding the survey 5 Percentage of currently married women age 15-49 using any method of contraception 6 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year preceding the survey, expressed in terms of births per 1,000 women age 15-19 7 Percentage of women age 15-49 with live birth in the five years before the survey who received antenatal care at least once from a skilled provider prior to the last birth 8 Percentage of women age 15-49 with live birth in the five years before the survey who had four or more antenatal care visits with any health care provider prior to the last birth 9 Proportion whose main source of drinking water is a household connection (piped), public standpipe, borehole, protected dug well or spring, or bottled water. 10 Improved sanitation technologies are: flush toilet to sewer system, vault (Bayara), or septic tank; ventilated improved pit latrine; traditional pit latrine with a slab; or composting toilet. xx • Map of Egypt MAP OF EGYPT CairoKalyubia Menoufia Alexandria DakahliaKafr El- Sheikh Behera Gharbia Sharkia Damietta Port Said North Sinai South Sinai Suez Ismailia Matrouh Giza ’Menya Beni Suef Fayoum Red Sea Red Sea Assiut Souhag Qena Aswan New Valley Mediterranean Sea Luxor Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY Egypt is located on the northeast corner of the African continent. It is bordered by Libya to the west, Sudan to the south, the Red Sea to the east, and the Mediterranean Sea to the north. Egypt has the largest, most densely settled population among the Arab countries. The total area of the country covers approximately one million square kilometers. However, much of the land is desert, and only 7.7 percent of Egypt’s area is inhabited. The Egyptian government has a policy of land reclamation and fostering of new settlements in the desert. Despite these efforts, the majority of Egyptians live either in the Nile Delta located in the north of the country or in the narrow Nile Valley south of Cairo. Administratively, Egypt is divided into 27 governorates (see map). The four Urban Governorates (Cairo, Alexandria, Port Said, and Suez) have no rural population. Each of the other 23 governorates is subdivided into urban and rural areas. Nine of these governorates are located in the Nile Delta (Lower Egypt), nine are located in the Nile Valley (Upper Egypt), and the remaining five Frontier Governorates are located on the eastern and western boundaries of Egypt. 1.2 POPULATION SIZE AND STRUCTURE Table 1.1 presents the trend between 1996 and 2013 in the size of Egypt’s population and the distribution of the population by urban-rural residence. The latest population census in Egypt was carried out in November 2006. According to the results, Egypt had a de facto population of 72 million. This number excluded the roughly 2.2 million Egyptians who were living abroad. The population continued to increase rapidly following the census, reaching nearly 84 million by 2013. In 2013, the majority (57 percent) of the Egyptian population lived in rural areas. The distribution of the population by urban-rural residence has remained virtually unchanged since the mid-1990s. 1.3 RECENT RATE OF NATURAL INCREASE The rate of natural increase represents the difference between the rates of births and deaths in a population. It indicates how fast a population will grow, taking into account these two natural events. A comparison of the crude birth rates (CBR) and crude death rates (CDR) in Figure 1.1 shows that the rate of natural increase declined in Egypt between 2000 and 2005. The downward trend was reversed in 2006, and the rate of natural increase rose to a peak of 25.5 per thousand in 2012, before declining slightly in 2013. Egypt’s population growth has been mainly influenced by changes in fertility behavior. As Figure 1.1 shows, the CDR remained virtually stable during the period 2000-2013, fluctuating Table 1.1 Population of Egypt, 1996-2013 Total population in Egypt and the percentage living in urban and rural areas, 1996-2013 Total population (thousands) Place of residence Year Urban Rural 1996 58,835 42.6 57.4 1997 60,053 42.6 57.4 1998 61,296 42.6 57.4 1999 62,565 42.5 57.5 2000 63,860 42.5 57.5 2001 65,182 43.1 56.9 2002 66,531 42.9 57.1 2003 67,908 42.9 57.1 2004 69,313 42.8 57.2 2005 70,748 42.7 57.3 2006 72,212 42.5 57.5 2007 73,608 43.1 56.9 2008 75,194 42.9 57.1 2009 76,925 43.0 57.0 2010 78,685 43.0 57.0 2011 80,530 42.8 57.2 2012 82,550 42.9 57.1 2013 83,667 42.8 57.2 Source: CAPMAS 2014, Table 2.3 2 • Introduction between 6.0 and 6.5 per thousand population. At the beginning of the period, the CBR dropped, from 27.4 per thousand population in 2000 to 25.5 per thousand in 2005. At that point, the trend was reversed, and the CBR increased by 25 percent to a level of 31.9 births per thousand in 2012 before declining slightly to 31 births per thousand in 2013. Figure 1.1 Trends in crude birth and death rates, Egypt 2000-2013 The decline in mortality over time in Egypt has had a demonstrable effect on the life expectancy at birth of the Egyptian population. Life expectancy at birth represents the average number of years a child born in a specific year may be expected to live during his/her lifetime. As Table 1.2 shows the life expectancy of the Egyptian population increased from 52.7 years in 1976 to 70.2 years in 2009 for males and from 57.7 years to 74.8 for females. Life expectancy decreased for both males and females in 2010 and then rose again reaching 72.5 years for females and 69.7 years for males by 2014. 1.4 ORGANIZATION OF THE 2014 EDHS The Egypt Demographic and Health Survey is the latest in a series of nationally representative population and health surveys conducted in Egypt.1 The survey was conducted under the auspices of the Ministry of Health and Population (MOHP) and implemented by El-Zanaty & Associates. Technical support for the survey was provided by ICF International through The DHS Program. The DHS Program is sponsored by the United States Agency for International Development (USAID) to assist countries worldwide in conducting surveys to obtain information on key population and health indicators. USAID/Cairo provided the main funding to support the implementation of the survey. The United Nations Children’s Fund (UNICEF) and United Nation Population Fund (UNFPA) also contributed to the funding of the survey. 1 The 2014 EDHS is the seventh full-scale Demographic and Health Survey implemented in Egypt; earlier surveys were conducted in 1988, 1992, 1995, 2000, 2005, and 2008. Three interim DHS surveys were carried out in 1997, 1998, and 2003. Other national-level surveys for which results are shown in this report include the 1980 Egyptian Fertility Survey (EFS), the 1984 Egypt Contraceptive Prevalence Survey (ECPS), and the 1991 Egypt Maternal and Child Health Survey (EMCHS). 27.4 26.7 26.5 26.2 25.7 25.5 25.7 26.5 27.3 28.8 28.7 30.3 31.9 31.0 6.3 6.2 6.4 6.5 6.4 6.4 6.3 6.1 6.1 6.2 6.1 6.1 6.4 6.0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year Crude birth rate Crude death rate Per thousand population Note: Rates are per thousand population. Source: CAPMAS 2014, Table 3.9 Table 1.2 Life expectancy, Egypt 1976-2014 Life expectancy at birth by sex, Egypt 1976-2014 Year Male Female 1976 52.7 57.7 1986 60.5 63.0 1996 65.1 69.0 2000 66.7 71.0 2001 67.1 71.5 2002 67.5 71.9 2003 67.9 72.3 2004 68.4 72.8 2005 68.8 73.5 2006 69.2 73.6 2007 69.5 74.0 2008 69.9 74.4 2009 70.2 74.8 2010 68.2 70.9 2011 68.6 71.4 2012 69.0 71.7 2013 69.4 72.1 2014 69.7 72.5 Source: CAPMAS 2014, Table 3.9 Introduction • 3 The EDHS includes two components: a survey of ever-married women age 15-49 to update key health and population indicators covered in past Egypt DHS surveys and a separate survey of the general population to obtain updated information on other critical health problems facing Egypt including the prevalence of hepatitis B and C and the population’s experience with non- communicable diseases. This report presents findings from the ever-married women component of the EDHS (hereafter referred to as the 2014 EDHS). The results of the Egypt Health Issues Survey which is being implemented in 2015 will be presented in a separate report. The 2014 EDHS was undertaken to provide estimates for key indicators such as fertility, contraceptive use, infant and child mortality, immunization levels, coverage of antenatal and delivery care, nutrition, and prevalence of anemia. In addition, the survey was designed to provide information on the prevalence of female circumcision, domestic violence, and children’s welfare. The survey results are intended to assist policymakers and planners in assessing the current health and population programs and in designing new strategies for improving health services for women and children in Egypt. 1.4.1 2014 EDHS Timetable The 2014 EDHS was executed in four stages. The first stage involved preparatory activities, including designing the sample and updating the sample frame. At the same time, the survey questionnaires were developed, pretested, and finalized. The preparatory stage was initiated in September 2013, and all of the activities were completed by mid-February 2014. The second stage, which took place from March through June 2014, involved training field staff and interviewing eligible households and individual respondents. The third stage encompassed all of the data processing activities necessary to produce a clean data file, including editing, coding, entering and verifying the data as well as checking it for consistency. This stage started soon after the beginning of the fieldwork and lasted until early August 2014. The focus of the final stage of the survey was analyzing the data and preparing the report. This phase began in October 2014 with the publication of the preliminary report, which presented the main findings from the survey. The activities involved in each of the stages are described in more detail below. The survey timetable is presented in Table 1.3. Table 1.3 Survey timetable, 2014 Egypt DHS Activity Starting date Duration Updating the sample frame September 2013 1 month Mapping October 2013 6 weeks Quick-count operation November 2013 3 months Recruitment and training of listing staff January 2014 1 week Listing and re-listing January 2014 6 weeks Sample selection February 2014 6 weeks Questionnaire design December 2013 3 months Preparation of training materials December 2013 2 months Pretest January 2014 2 weeks Finalization of questionnaires February 2014 1 month Training of data collection staff March 2014 5 weeks Printing survey materials April 2014 2 weeks Fieldwork April 2014 3 months Reinterviews June 2014 3 weeks Office editing and coding April 2014 10 weeks Data entry April 2014 10 weeks Computer editing June 2014 2 months Preliminary report September 2014 1 month Detailed tabulations October 2014 2 months Final report preparation October 2014 5 months Final report review and finalization March 2015 2 months 4 • Introduction 1.4.2 Sample Design The sample for the 2014 EDHS was designed to provide estimates of population and health indicators including fertility and mortality rates for the country as a whole and for six major subdivisions (Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt, and the Frontier Governorates). The sample also allows for estimates of most key indicators at the governorate level. In order to allow for separate estimates for the major geographic subdivisions and the governorates, the number of households selected from each of the major subdivisions and each governorate was disproportionate to the size of the population in the units. Thus, the 2014 EDHS sample is not self-weighting at the national level. A more detailed description of the 2014 EDHS sample design is included in Appendix B. Sampling errors for selected variables are presented in Appendix C. 1.4.3 Sample Selection The sample for the 2014 EDHS was selected in four stages. A list of shiakhas/towns constituted the primary sampling frame for urban areas, and a list of villages served as the frame for rural areas. The Central Agency of Public Mobilization and Statistics (CAPMAS) updated these lists, which had been originally prepared for the 2006 census, to reflect the situation in 2013. In order to provide for implicit geographic stratification, the lists of shiakhas/towns and villages in each governorate were arranged in serpentine order according to their location from north to south within the governorate. During the first stage selection, a total of 926 primary sampling units (481 shiakhas/towns and 445 villages) were chosen for the 2014 EDHS sample with probability proportional to size. The second stage of selection involved several steps. First, for each of the primary sampling units (PSU), maps were obtained and divided into parts of roughly equal size, with the number of parts determined by dividing the population in the shiakha or village by 5,000. One to three parts were then selected systematically from each PSU, depending on the size of the shiakha or village. Three parts were selected in shiakhas/villages with a population of 100,000 or more, and two parts were selected in shiakhas/villages with populations between 20,000 and 100,000. In the remaining smaller shiakhas/villages, one part was selected. A quick count was carried out in the selected parts in each PSU to provide the information needed to divide the parts into a number of segments of roughly equal size. Due to security issues, the quick count operation could not be undertaken in North and South Sinai, and, thus, the 42 clusters selected in those governorates were not included in the 2014 Egypt DHS. Because the populations of those governorates comprise less than 1 percent of Egypt’s total population, their exclusion does not affect national estimates. However, because they comprise two of the five Frontier Governorates, information that is presented in this report for the Frontier Governorates is not comparable to results in prior EDHS surveys in which all five Frontier Governorates were surveyed. After the quick count was completed, two to three segments were selected from each PSU. In large shiakhas/towns and villages where there were two or three parts, one segment was chosen from each part. In small shiakhas/towns and villages where only one part had been selected, two segments were chosen from that part. Introduction • 5 A household listing was obtained for each segment. Using the household lists, a systematic random sample of 29,471 households was chosen for the 2014 EDHS. During the survey, usual household members and visitors who were present in the household during the night before the survey visit were identified and listed in the household questionnaire. All ever-married women 15-49 included in that list were eligible for the individual survey interview. A subsample of one-third of all households in each segment was selected for the anemia-testing component. In this subsample, ever- married women age 15-49 and children age 0-19 years were eligible for the testing. One woman in each household in the subsample in which anemia testing was carried out was also selected to be asked questions about domestic violence. 1.4.4 Questionnaire Development The 2014 EDHS involved two questionnaires: a household questionnaire and an individual questionnaire. The questionnaires were based on the model survey instruments developed by the MEASURE DHS Phase III project. Questions on a number of topics not covered in the DHS model questionnaires were also included in the 2014 EDHS questionnaires. In some cases, those items were drawn from the questionnaires used for earlier rounds of the DHS in Egypt. In other cases, the questions were intended to collect information on new topics recommended by data users. The EDHS household questionnaire was used to enumerate all usual members of and visitors to the selected households and to collect information on the socioeconomic status of the households as well as on the nutritional status and anemia levels among women and children. The first part of the household questionnaire collected information on the age, sex, marital status, educational attainment, and relationship to the household head of each household member or visitor. These questions were included in order to provide basic demographic data for the EDHS households. They also served to identify the women who were eligible for the individual interview and the women and children who were eligible for anthropometric measurement and anemia testing. In the second part of the household questionnaire, there were questions on housing characteristics (e.g., the number of rooms, the flooring material, the source of water, and the type of toilet facilities) and on ownership of a variety of consumer goods. Special modules collecting information relating to child labor and discipline were also administered in the household questionnaire. Finally, the height and weight measurements and the results of anemia testing among women and children were recorded in the household questionnaire. The individual questionnaire was administered to all ever-married women age 15-49 who were usual residents or who were present in the household during the night before the interviewer’s visit. It obtained information on the following topics: • Respondent’s background • Reproduction • Contraceptive knowledge and use • Fertility preferences and attitudes about family planning • Pregnancy and breastfeeding • Child immunization and health • Child nutrition • Husband’s background, women’s work, and health care • Female circumcision • HIV/AIDS and other sexually transmitted infections 6 • Introduction In addition, a domestic violence section was administered to women in the subsample of households selected for the anemia testing. One eligible woman was selected randomly from each of the households in the subsample to be asked the domestic violence section. The individual questionnaire also included a monthly calendar covering the period between January 2009 and the interview. A history of the respondent’s marital, fertility, and contraceptive use status during each month in the period was recorded in the calendar. If the respondent reported discontinuing a segment of contraceptive use during a month, the main reason for the discontinuation was noted in the calendar. 1.4.5 Pretest A pretest was conducted during the preparation for the 2014 EDHS. After a two-week training course, the household and individual questionnaires were pretested in January 2014. Two supervisors, two field editors, and 8 interviewers participated in the pretest. In addition, two health staff (technicians/ nurses) collected the height and weight measures and conducted the anemia testing. The pretest was carried out in one Upper Egypt governorate (Beni Suef) and one Lower Egypt governorate (Menoufia). A sample of 250 households was selected for the pretest: 125 households in each governorate. The data collection took about five days. A total of 249 household and 181 individual interviews were completed during the pretest. The questionnaires for the 2014 EDHS were finalized after the pretest. Both comments from interviewers and tabulations of the pretest results were reviewed during the process of finalizing the questionnaires. English versions of the final Arabic language questionnaires are included in Appendix F. 1.4.6 Data Collection Activities Staff recruitment. To recruit interviewers and field editors, a list was obtained from the Ministry of Social Solidarity (MOSS) of female personnel who were working to fulfill the one-year period of governmental public service that is mandatory for university graduates. All candidates nominated for the field staff positions were interviewed, and only those who were qualified were accepted into the training program. All candidates for the interviewer and field editor positions were recent university graduates. Another basic qualification was willingness to work in any of the governorates covered in the survey. Previous survey experience was a basic qualification for the candidates for the positions of supervisor with a few exceptions; however, interviewers who had previous experience in surveys were not accepted into the training program. This decision was made to reduce any bias that might be introduced from the prior survey experience and to ensure that all trainees had a similar background. All of the staff recruited for the anemia testing had a medical background, and some had worked in previous EDHS surveys. Training materials. A variety of materials were developed for use in training personnel involved in the fieldwork. A lengthy interviewer’s manual, including general guidelines for conducting an interview as well as specific instructions for asking each of the questions in the EDHS questionnaires, was prepared and given to all field staff. In addition, a chart for converting months from the Islamic calendar to the Gregorian calendar was designed for the 60 months before the 2014 EDHS and distributed to all field staff along with a calendar of well-known worldwide or local events. Introduction • 7 Other training materials, including special manuals describing the duties of the team supervisor and the rules for field editing, were prepared. Instructions for anthropometric data collection were included in a manual for the staff trained to collect height and weight data. A special manual covering the procedures to be followed in the anemia testing was also prepared. Main survey training. Training for the 16 candidates for the team supervisor positions was conducted during a one-day period prior to the main fieldwork training. This training focused specifically on the supervisor’s duties, but it also covered the 2014 EDHS questionnaires in order to give supervisors a basic understanding of the content of the survey prior to the main training program. Training for 103 candidates for interviewers for the 2014 EDHS data collection began by the beginning of the second week of March 2014. This five-week training program, which was held in Cairo, included the following: • Lectures related to basic interview techniques and to specific survey topics (e.g., fertility and family planning, maternal and child health, and child immunization) • Sessions on how to fill out the questionnaire, using visual aids • Role playing and mock interviews • Five days of field practice in areas not covered in the survey • Four quizzes Trainees who failed to show interest in the survey, who did not attend the training program on a regular basis, or who failed the first two quizzes were terminated immediately. Before the fourth field practice, a list was prepared of the 20 trainees who had performed best during both the classroom and field practices. Following the fourth field practice, 14 of these trainees were chosen to be field editors. A special training session was held for the field editors after their selection. By the end of the training course, 67 of the 103 candidates originally recruited for interviewer positions training were selected to work as interviewers or field editors in the EDHS fieldwork. Training for health technician staff. Thirty-six personnel were recruited for the health technician training. The training included both classroom lectures and practice measurement and blood testing in a nursery school and in households contacted during field practice sessions. At the end of the program, the 28 most-qualified trainees (11 males and 17 females) were selected for the anthropometric data collection and anemia testing. As discussed earlier, most of the personnel involved in the anemia testing had a medical background. Fieldwork. Fieldwork for the 2014 EDHS began on April 10, 2014 and was completed in late June 2014. The field staff was divided into 14 teams; each team had 1 supervisor, 1 field editor, 3 to 4 interviewers, and 2 health technicians assigned to height and weight measurement and anemia testing. All supervisors were males, while the field editors and interviewers were females. At least one of the two health technicians on each team was female. During the fieldwork, the 14 field teams worked in separate governorates; the number of governorates assigned to a team varied from one to three, according to the sample size in the governorates. As a quality control measure, field editors regularly conducted re-interviews using a shortened version of the EDHS questionnaire during the fieldwork. The results of the re-interview were compared to the responses in the original interviews and errors were discussed with the interviewer. The teams were closely supervised throughout the fieldwork by a fieldwork coordinator, two assistant fieldwork coordinators, two anthropometric consultants, and other senior staff. Finally, the results of special tabulations, i.e., field check tables, prepared on a weekly basis throughout the data entry and editing of the questionnaires helped to 8 • Introduction identify field staff whose performance was below expectation. They were the target of immediate feedback and more intensive monitoring. As a further quality control measure, after the main data collection was completed, a random sample of around 10 percent of the households was selected for re-interview using the shortened version of the questionnaire. The visits to PSUs to conduct re-interviews also afforded an opportunity to make callbacks to complete interviews with households or individuals who were not available at the time of the original visit by the 2014 EDHS interviewers. Household or individual questionnaires in which there were significant errors that could not be corrected in the office were also assigned for callbacks. Special teams including staff who had worked in the main survey were organized to handle the callbacks and re-interviews. During this phase of the survey, interviewers were not allowed to work in the governorate in which they had worked in the initial fieldwork. Callbacks and re-interviews began in early June 2014 and took more than three weeks to complete. 1.4.7 Data Processing Activities Office editing. Staff from the central office were responsible for collecting questionnaires from the teams as soon as interviewing in a cluster was completed. Limited office editing took place by office editors for consistency and completeness, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to note any problems detected while editing the questionnaires; the problems were reviewed by the senior staff and communicated to the field staff. If serious errors were found in one or more questionnaires from a cluster, the supervisor of the team working in that cluster was notified and advised of the steps to be taken to avoid these problems in the future. Machine entry and editing. Machine entry and editing began while interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Census and Survey Processing System (CSPro), a software package for entering, editing, tabulating, and disseminating data from censuses and surveys. Fifteen data entry personnel used twelve microcomputers to process the 2014 EDHS survey data. During the data processing, questionnaires were entered twice and the entries were compared to detect and correct keying errors. The data processing staff completed the entry and editing of data by the end of July 2014. 1.5 SURVEY COVERAGE Table 1.4 summarizes the outcome of the fieldwork for the 2014 EDHS by place of residence. The table shows that, during the main fieldwork and callback phases of the survey, out of 29,471 households selected for the 2014 EDHS, 28,630 households were found. Among those households, 28,175 were successfully interviewed, which represents a response rate of 98.4 percent. A total of 21,903 women were identified as eligible to be interviewed in 2014 EDHS. Out of these women 21,762 were successfully interviewed, which represents a response rate of 99.4 percent. The household response rate exceeded 97 percent in all residential categories, and the response rate for eligible women exceeded 98 percent in all areas. Introduction • 9 Table 1.4 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to urban-rural residence and place of residence (unweighted), Egypt 2014 Result Urban Rural Urban Gover- norates Lower Egypt Upper Egypt Frontier Gover- norates1 Total Total Urban Rural Total Urban Rural Household interviews Households selected 14,893 14,578 6,068 10,903 3,735 7,168 10,845 3,966 6,879 1,655 29,471 Households occupied 14,305 14,325 5,796 10,643 3,597 7,046 10,552 3,800 6,752 1,639 28,630 Households interviewed 13,962 14,213 5,639 10,533 3,523 7,010 10,373 3,691 6,682 1,630 28,175 Household response rate2 97.6 99.2 97.3 99.0 97.9 99.5 98.3 97.1 99.0 99.5 98.4 Interviews with women age 15-49 Number of eligible women 9,711 12,192 3,702 8,413 2,504 5,909 8,436 2,612 5,824 1,352 21,903 Number of eligible women interviewed 9,628 12,134 3,667 8,384 2,492 5,892 8,376 2,593 5,783 1,335 21,762 Eligible women response rate3 99.1 99.5 99.1 99.7 99.5 99.7 99.3 99.3 99.3 98.7 99.4 1 Does not include North and South Sinai governorates 2 Households interviewed/households occupied 3 Respondents interviewed/eligible respondents Characteristics of Households • 11 CHARACTERISTICS OF HOUSEHOLDS 2 he chapter uses information from the 2014 EDHS sample to provide a demographic and socioeconomic profile of Egyptian households. Information is presented on housing facilities and household possessions, as well as the age, sex, and education of the household population. The profile of the households provided in this chapter will help in understanding the results of the 2014 EDHS presented in the following chapters. In addition, it may provide useful input for social and economic development planning. In reviewing the information presented for the household population in the chapter, distinctions will sometimes be made between de jure and de facto populations. The de jure household population refers to all persons who usually live in the household while the de facto population refers to the persons who spent the night before the interview in the household. The de facto population includes any visitor(s) who may have spent the night before the interview in the household, and it excludes any usual household members who may have been away on the night before the survey. Differences between the de jure and the de facto household populations are small, and past surveys and censuses have generally been reported for de facto populations. Therefore, the tabulations of the EDHS household and individual data presented in this report are based on the de facto definition, unless otherwise stated. T Key Findings: • Almost all households (98 percent) in Egypt obtain drinking water from an improved source. The source for most households is a piped connection in the dwelling or plot (91 percent). • Overall, 16 percent of households do something to treat the water they drink, and 11 percent use an appropriate method, primarily filtering the water. • Ninety-one percent of Egyptian households have sole use of an improved toilet, i.e., a toilet that flushes into a sewer, bayara or septic system. • More than 9 in 10 Egyptian households own a television connected to a satellite dish, a cell phone, and a refrigerator. Around one-third of households own a computer, and 9 percent own a car, van or truck. • Around two-thirds of the population in the Urban Governorates is in the highest wealth quintile compared with 12 percent of the population in Lower Egypt and 14 percent in Upper Egypt. • The population in rural Upper Egypt is especially concentrated at the lower end of the wealth index, with 41 percent falling into the lowest wealth quintile. In rural Lower Egypt, in contrast, 22 percent of the population falls in the lowest wealth quintile. • Most households are headed by males; the head is female in only 13 percent of households. • Overall, 86 percent of Egyptian males age 6 and over have attended school compared to 75 percent of females. Among men and women under age 25, however, there is virtually no difference in educational attainment. 12 • Characteristics of Households 2.1 HOUSING CHARACTERISTICS The 2014 EDHS survey collected information on a range of housing characteristics. These data are presented for households and for the total de jure household population. The results for households are further disaggregated by residence. 2.1.1 Drinking Water Access and Treatment Increasing access to improved drinking water is one of the Millennium Development Goals (MDG) that Egypt along with other nations worldwide adopted (United Nations General Assembly 2001). Improved sources are defined as those sources which are likely to provide safe drinking water (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2014). Improved sources include a piped source within the dwelling, a public tap, a tube hole or borehole, a protected well or spring1, and bottled water. Table 2.1 shows the proportions obtaining drinking water from improved and non-improved sources for both households and the de jure household population. The proportions of households and of the household population with access to an improved drinking water source are virtually identical. The discussion in this section of the report focuses on the information for households in keeping with the chapter’s purpose of describing the characteristics of the households in the 2014 EDHS sample. The information for the household population included in the table is useful for reporting on the MDG indictor on use of an improved water source which is population-based. Table 2.1 shows that the vast majority (98 percent of households) in Egypt have access to drinking water from an improved source. In most cases, the source is a piped connection in the dwelling itself or the plot (91 percent). Households in the three Frontier Governorates that were covered in the survey are least likely to obtain water from an improved source (85 percent) while households in the Urban Governorates and urban Upper Egypt have almost universal access to an improved drinking water source. Appendix Table A-2.1 provides information on governorate-level variation in household access to an improved drinking water source. Few Egyptian households are far from the source from which they obtain drinking water. Most households (93 percent) obtain the water from a source on premises. The majority of households fetching drinking water from a source outside the dwelling or plot were within 30 minutes of this source. Table 2.1 also provides information on the extent to which Egyptian households treat the water they use for drinking. More than 8 in 10 households do nothing to treat their drinking water. Households that treat their water generally use an appropriate method. Overall, 16 percent of households report using one or more methods to treat the water they drink. Eleven percent of households employ an appropriate treatment method, primarily filtering the water. Households in the three Frontier Governorates and urban Lower Egypt are most likely to report using appropriate treatment methods (19 percent and 17 percent, respectively). 1 A well or spring which is covered or otherwise ‘protected’ from contamination from surface water or animals. C ha ra ct er is tic s of H ou se ho ld s • 1 3 Ta bl e 2. 1 H ou se ho ld d rin ki ng w at er P er ce nt d is tri bu tio n of h ou se ho ld s by s ou rc e of d rin ki ng w at er , tim e to o bt ai n dr in ki ng w at er , an d tre at m en t of d rin ki ng w at er , ac co rd in g to u rb an -r ur al r es id en ce a nd p la ce o f re si de nc e an d pe rc en t di st rib ut io n of d e ju re p op ul at io n by s ou rc e of d rin ki ng w at er , t im e to o bt ai n dr in ki ng w at er , a nd tr ea tm en t o f d rin ki ng w at er , a cc or di ng to u rb an -r ur al re si de nc e, E gy pt 2 01 4 H ou se ho ld s P op ul at io n C ha ra ct er is tic U rb an R ur al U rb an G ov er - no ra te s Lo w er E gy pt U pp er E gy pt Fr on tie r G ov er - no ra te s1 To ta l U rb an R ur al To ta l To ta l U rb an R ur al To ta l U rb an R ur al So ur ce o f d rin ki ng w at er Im pr ov ed s ou rc e 98 .8 97 .1 99 .9 96 .4 96 .5 96 .4 99 .0 99 .9 98 .5 85 .0 97 .8 98 .7 97 .1 97 .7 P ip ed in to d w el lin g/ ya rd /p lo t 96 .0 87 .6 98 .3 87 .0 91 .7 85 .4 93 .5 98 .2 91 .0 69 .0 91 .0 96 .0 87 .8 90 .9 P ub lic ta p/ st an dp ip e 0. 7 4. 6 0. 1 4. 4 1. 4 5. 4 2. 5 0. 7 3. 5 4. 0 3. 0 0. 8 4. 4 3. 1 Tu be w el l o r b or eh ol e 0. 1 0. 8 0. 0 0. 6 0. 1 0. 8 0. 4 0. 0 0. 7 1. 9 0. 5 0. 1 0. 8 0. 5 P ro te ct ed d ug w el l 0. 0 0. 9 0. 0 0. 9 0. 1 1. 2 0. 3 0. 0 0. 4 0. 3 0. 5 0. 0 0. 8 0. 5 P ro te ct ed s pr in g 0. 0 0. 1 0. 0 0. 2 0. 1 0. 2 0. 0 0. 1 0. 0 0. 0 0. 1 0. 0 0. 2 0. 1 B ot tle d w at er 2. 0 3. 2 1. 5 3. 3 3. 1 3. 4 2. 3 0. 9 3. 0 9. 8 2. 7 1. 8 3. 1 2. 6 N on -im pr ov ed s ou rc e 1. 1 2. 3 0. 1 3. 4 3. 4 3. 3 0. 5 0. 0 0. 7 5. 4 1. 8 1. 1 2. 4 1. 9 Ta nk er tr uc k/ ca rt w ith d ru m 1. 1 2. 3 0. 1 3. 3 3. 4 3. 3 0. 4 0. 0 0. 7 5. 4 1. 8 1. 1 2. 3 1. 9 O th er 0. 1 0. 5 0. 0 0. 2 0. 1 0. 2 0. 5 0. 1 0. 8 9. 7 0. 4 0. 2 0. 6 0. 4 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 Ti m e to o bt ai n dr in ki ng w at er (r ou nd tr ip )2 W at er o n pr em is es 96 .8 89 .9 98 .5 89 .7 93 .6 88 .4 94 .3 98 .3 92 .2 82 .9 92 .7 96 .9 90 .2 92 .7 Le ss th an 3 0 m in ut es 2. 6 7. 1 1. 4 7. 6 5. 2 8. 4 3. 8 1. 3 5. 2 11 .8 5. 3 2. 6 6. 9 5. 3 30 m in ut es o r l on ge r 0. 5 2. 8 0. 2 2. 5 1. 0 3. 0 1. 8 0. 3 2. 5 5. 1 1. 9 0. 5 2. 8 2. 0 D on ’t kn ow /m is si ng 0. 1 0. 1 0. 0 0. 1 0. 1 0. 1 0. 1 0. 0 0. 1 0. 1 0. 1 0. 1 0. 1 0. 1 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 W at er tr ea tm en t p rio r t o dr in ki ng 2, 3 B oi le d 0. 7 0. 5 1. 0 0. 7 1. 0 0. 7 0. 3 0. 2 0. 3 0. 1 0. 6 0. 7 0. 5 0. 6 B le ac h/ ch lo rin e ad de d 0. 0 0. 0 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 S tra in ed th ro ug h cl ot h 0. 4 0. 3 0. 3 0. 6 1. 0 0. 4 0. 0 0. 0 0. 0 0. 0 0. 3 0. 5 0. 3 0. 3 C er am ic , s an d or o th er fi lte r 13 .7 7. 4 13 .4 10 .8 16 .4 9. 0 7. 1 11 .0 5. 1 19 .0 10 .0 13 .8 7. 4 9. 7 S ol ar d is in fe ct io n 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 Le t i t s ta nd a nd s et tle 2. 6 7. 1 0. 9 5. 8 3. 2 6. 6 6. 6 4. 3 7. 8 1. 9 5. 2 2. 7 7. 3 5. 6 O th er 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 N o tre at m en t 82 .9 85 .0 84 .6 82 .4 78 .8 83 .6 86 .2 84 .9 86 .9 79 .0 84 .1 82 .6 84 .9 84 .1 P er ce nt ag e us in g an a pp ro pr ia te tre at m en t m et ho d4 14 .4 8. 0 14 .3 11 .6 17 .2 9. 7 7. 4 11 .2 5. 4 19 .1 10 .6 14 .5 7. 9 10 .3 N um be r 11 ,5 14 16 ,6 61 4, 59 9 13 ,2 43 3, 29 3 9, 95 0 10 ,1 01 3, 48 0 6, 62 1 23 1 28 ,1 75 43 ,3 25 73 ,0 22 11 6, 34 7 1 D oe s no t i nc lu de N or th a nd S ou th S in ai g ov er no ra te s 2 I nc lu de s ho us eh ol ds o bt ai ni ng d rin ki ng w at er fr om im pr ov ed a nd n on -im pr ov ed s ou rc es 3 R es po nd en ts w er e ab le to re po rt m or e th an o ne tr ea tm en t m et ho d so th e su m o f t he p er ce nt ag es in th e va rio us tr ea tm en t c at eg or ie s m ay e xc ee d 10 0 pe rc en t. 4 A pp ro pr ia te w at er tr ea tm en t m et ho ds in cl ud e bo ili ng , b le ac hi ng , f ilt er in g, a nd s ol ar d is in fe ct in g. Characteristics of Households • 13 14 • Characteristics of Households 2.1.2 Sanitation Facilities and Waste Disposal Ensuring adequate sanitation facilities is another Millennium Development Goal. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2014). Table 2.2 provides information on access to improved sanitation facilities for both households and the de jure household population. As was the case with access to an improved water source, there is virtually no difference between the proportions of households and of the household population with access to an improved, not shared toilet. The discussion of the results in Table 2.2 below reviews the information relating to households since the focus of the chapter is on the characteristics of the households in the EDHS sample. The information for the household population included in the table is useful for reporting on the MDG indicator on use of improved, not shared sanitation facilities which is population-based. Table 2.2 shows that 91 percent of the Egyptian households have access to an improved, not shared toilet facility, that is, they have sole use of a toilet that flushes or pour flushes into a sewer, bayara (vault), or a septic system. Considering residential differentials, the proportion of households who have sole use of an improved facility is lowest in rural Lower Egypt (80 percent). Information on the governorate-level variation in the proportion of households using improved, not shared toilet facilities is presented in Appendix Table A-2.1. Table 2.2 also presents information on waste disposal practices. More than half of households (54 percent) report kitchen waste or trash is collected, either at the dwelling or from a container in the street (i.e., a container shared with others). Thirty-seven percent of households dump waste or trash into the street, an empty plot or a canal or drainage ditch, 8 percent burn waste or trash, and less than one percent feed it to animals. Dumping or burning waste or trash is much more common in rural than in urban areas (54 percent and 33 percent, respectively). Around 7 in 10 households in rural Upper Egypt dispose of trash by dumping (45 percent) or burning (24 percent). C ha ra ct er is tic s of H ou se ho ld s • 1 5 Ta bl e 2. 2 H ou se ho ld s an ita tio n fa ci lit ie s an d w as te d is po sa l p ra ct ic es P er ce nt d is tri bu tio n of h ou se ho ld s by ty pe o f t oi le t/l at rin e fa ci lit ie s an d m et ho d of d is po sa l o f k itc he n w as te a nd tr as h, a cc or di ng to u rb an -r ur al re si de nc e an d pl ac e of re si de nc e, a nd p er ce nt d is tri bu tio n of d e ju re po pu la tio n by ty pe o f t oi le t/ la tri ne fa ci lit ie s an d m et ho d of d is po sa l o f k itc he n w as te a nd tr as h, a cc or di ng to u rb an -r ur al re si de nc e, E gy pt 2 01 4 H ou se ho ld s P op ul at io n C ha ra ct er is tic U rb an R ur al U rb an G ov er - no ra te s Lo w er E gy pt U pp er E gy pt Fr on tie r G ov er - no ra te s To ta l U rb an R ur al To ta l To ta l U rb an R ur al To ta l U rb an ru ra l Ty pe o f t oi le t f ac ili tie s Im pr ov ed , n ot s ha re d fa ci lit y 98 .8 84 .8 98 .7 84 .4 99 .0 79 .6 94 .6 98 .7 92 .5 99 .1 90 .5 98 .9 84 .9 90 .1 Fl us h/ po ur fl us h to p ip ed se w er s ys te m 92 .0 36 .6 97 .0 62 .5 95 .9 51 .5 37 .8 82 .5 14 .3 52 .4 59 .2 90 .9 34 .3 55 .4 Fl us h/ po ur fl us h to v au lt (b ay ar a) 4. 4 20 .4 1. 0 0. 8 0. 0 1. 1 36 .5 12 .5 49 .1 32 .7 13 .9 5. 4 22 .5 16 .2 Fl us h/ po ur fl us h to s ep tic ta nk 2. 3 27 .9 0. 7 21 .0 3. 0 27 .0 20 .3 3. 7 29 .1 13 .9 17 .4 2. 5 28 .1 18 .6 S ha re d fa ci lit y2 1. 0 2. 8 1. 2 1. 3 0. 6 1. 5 3. 5 1. 3 4. 7 0. 0 2. 1 0. 9 2. 8 2. 1 Fl us h/ po ur fl us h to p ip ed se w er s ys te m 0. 8 0. 7 1. 2 0. 8 0. 6 0. 8 0. 5 0. 7 0. 4 0. 0 0. 7 0. 7 0. 6 0. 7 Fl us h/ po ur fl us h to v au lt (b ay ar a) 0. 1 1. 3 0. 0 0. 0 0. 0 0. 0 2. 3 0. 5 3. 2 0. 0 0. 8 0. 2 1. 4 1. 0 Fl us h/ po ur fl us h to s ep tic ta nk 0. 0 0. 8 0. 0 0. 5 0. 0 0. 7 0. 7 0. 1 1. 0 0. 0 0. 5 0. 0 0. 8 0. 5 N on -im pr ov ed fa ci lit y 0. 2 12 .4 0. 2 14 .3 0. 4 18 .9 1. 9 0. 0 2. 8 0. 8 7. 4 0. 2 12 .3 7. 8 Fl us h/ po ur fl us h no t t o se w er /v au lt (b ay ar a) / se pt ic ta nk 0. 1 12 .1 0. 1 14 .1 0. 3 18 .7 1. 6 0. 0 2. 4 0. 2 7. 2 0. 1 12 .0 7. 6 P it la tri ne w ith ou t s la b/ op en p it 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 B uc ke t 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 N o fa ci lit y/ bu sh /fi el d 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 2 0. 6 0. 1 0. 0 0. 1 0. 1 O th er 0. 0 0. 1 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 M is si ng 0. 0 0. 1 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 D is po sa l o f k itc he n w as te an d tr as h C ol le ct ed 67 .0 44 .2 69 .1 57 .5 64 .5 55 .2 41 .1 66 .2 27 .9 56 .2 53 .5 65 .8 42 .0 50 .9 Fr om h om e 39 .4 39 .8 37 .0 50 .8 45 .1 52 .6 26 .9 38 .3 20 .9 12 .9 39 .6 38 .3 37 .8 38 .0 Fr om c on ta in er in s tre et 27 .6 4. 4 32 .1 6. 7 19 .3 2. 6 14 .2 27 .9 7. 0 43 .3 13 .9 27 .5 4. 2 12 .9 D um pe d in to 32 .0 40 .2 30 .7 36 .3 35 .0 36 .7 40 .3 31 .1 45 .1 42 .7 36 .9 33 .0 40 .9 37 .9 S tre et /e m pt y pl ot 29 .8 24 .3 30 .0 22 .3 32 .7 18 .8 30 .3 27 .2 31 .9 42 .7 26 .6 30 .7 24 .8 27 .0 C an al /d ra in ag e 2. 1 15 .9 0. 7 14 .0 2. 3 17 .9 10 .0 3. 9 13 .2 0. 0 10 .3 2. 2 16 .1 11 .0 B ur ne d 0. 9 13 .6 0. 1 5. 3 0. 3 6. 9 16 .3 2. 3 23 .7 0. 9 8. 4 1. 0 14 .9 9. 8 Fe d to a ni m al s 0. 1 1. 0 0. 0 0. 5 0. 1 0. 6 1. 1 0. 2 1. 6 0. 2 0. 6 0. 1 1. 1 0. 7 O th er 0. 1 1. 0 0. 0 0. 4 0. 1 0. 5 1. 2 0. 1 1. 7 0. 0 0. 6 0. 1 1. 0 0. 6 M is si ng 0. 0 0. 1 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 1 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r 11 ,5 14 16 ,6 61 4, 59 9 13 ,2 43 3, 29 3 9, 95 0 10 ,1 01 3, 48 0 6, 62 1 23 1 28 ,1 75 43 ,3 25 73 ,0 22 11 6, 34 7 1 D oe s no t i nc lu de N or th a nd S ou th S in ai g ov er no ra te s 2 I nc lu de s fa ci lit ie s th at w ou ld b e co ns id er ed im pr ov ed e xc ep t t he y ar e sh ar ed b y tw o or m or e ho us eh ol ds Characteristics of Households • 15 16 • Characteristics of Households 2.1.3 Other Dwelling Characteristics Table 2.3 shows the distribution of households according to other dwelling characteristics for which information was obtained in the 2014 EDHS. The results confirm that virtually all Egyptian households have electricity. With regard to flooring, more than nine in ten households (94 percent) live in dwellings with ceramic tile or cement floors. Only 5 percent have dirt (earth/sand) floors in their dwellings. Rural households are more likely than urban households to live in dwellings with a dirt floor (7 percent and less than 1 percent, respectively). Dirt floors are more common in rural Upper Egypt than in rural Lower Egypt (14 percent and 3 percent, respectively). Table 2.3 also shows that 22 percent of Egyptian households have only one room that is used for sleeping in their dwelling, 60 percent live in a dwelling with 2 rooms for sleeping, and 18 percent had three rooms or more in which members of the household sleep. Table 2.3 Household characteristics Percent distribution of households by housing characteristics and by frequency of smoking in the home, according to urban-rural residence and place of residence, Egypt 2014 Housing characteristic Urban Rural Urban Gover- norates Lower Egypt Upper Egypt Frontier Gover- norates1 Total Total Urban Rural Total Urban Rural Electricity Yes 99.9 99.8 100.0 99.9 100.0 99.8 99.7 99.7 99.6 99.9 99.8 No 0.1 0.2 0.0 0.1 0.0 0.2 0.3 0.2 0.4 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth/sand 0.8 7.3 0.2 2.1 0.5 2.6 10.1 1.8 14.4 4.4 4.7 Wood/planks 0.2 0.0 0.3 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.1 Parquet/polished wood 0.6 0.0 0.7 0.1 0.3 0.0 0.3 0.8 0.0 0.1 0.3 Vinyl/asphalt strips 0.2 0.0 0.2 0.1 0.2 0.1 0.0 0.1 0.0 0.0 0.1 Ceramic tiles 44.7 27.4 47.7 37.6 45.9 34.9 23.8 38.6 16.1 50.3 34.4 Cement tiles 47.3 33.7 47.2 37.5 45.7 34.7 38.2 49.9 32.0 29.3 39.2 Cement 5.7 30.8 3.1 21.6 6.4 26.7 27.1 8.4 37.0 15.6 20.5 Carpet 0.4 0.3 0.3 0.4 0.7 0.4 0.2 0.2 0.2 0.2 0.3 Other 0.1 0.2 0.1 0.3 0.1 0.4 0.0 0.0 0.0 0.1 0.2 Missing 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.0 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 21.5 22.3 24.2 17.0 16.2 17.2 27.4 22.7 29.9 24.5 21.9 Two 61.8 58.9 59.8 65.1 67.2 64.4 53.8 59.6 50.8 49.3 60.1 Three or more 16.7 18.9 15.9 18.0 16.6 18.4 18.7 17.7 19.3 26.2 18.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Frequency of smoking in the home Daily 43.3 45.3 42.6 44.4 42.0 45.2 45.6 45.3 45.8 41.3 44.5 Weekly 0.9 1.5 0.7 1.5 0.8 1.7 1.1 1.0 1.1 0.8 1.2 Monthly 0.3 0.8 0.3 0.6 0.5 0.7 0.7 0.2 1.0 0.7 0.6 Less than monthly 0.1 0.3 0.1 0.2 0.2 0.2 0.3 0.1 0.4 0.1 0.2 Never 55.4 52.0 56.2 53.2 56.4 52.2 52.2 53.4 51.6 57.1 53.4 Missing 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 11,514 16,661 4,599 13,243 3,293 9,950 10,101 3,480 6,621 231 28,175 1 Does not include North and South Sinai governorates Characteristics of Households • 17 Finally, Table 2.3 includes information on the frequency of smoking in the home. This information is included to assess the extent to which household members are exposed to secondhand smoke (SHS). Secondhand smoke represents health risks for children and adults who do not smoke (WHO 2013). For example, children who are exposed to SHS are at increased risk for ear infections, respiratory illnesses, and poor lung development (US Department of Health and Human Services 2006). Table 2.3 shows that exposure to SHS is common in Egyptian households. Household members are exposed to SHS on a daily basis in more than 4 in 10 households. Only minor differences are observed in the level of daily SHS exposure by urban-rural residence and place of residence. Governorate-level variation in SHS exposure is shown in Appendix Table A-2.1. 2.2 HOUSEHOLD POSSESSIONS Table 2.4 provides information on household ownership of durable goods and other possessions. Ninety-eight percent of EDHS households own a television (color or black and white). Ninety-seven percent of households are connected to a satellite dish, with most households owning the dish. With regard to other electronic equipment, 31 percent own a radio with a cassette player, and 3 percent of households have a video or DVD player. Around one-third of households own a computer. Ninety-two percent of households have a phone; most (90 percent) own cell phones, with only 20 percent saying they have a traditional landline phone. Twenty percent of households own smart phones, a device that allows the owner access to a range of uses beyond basic phone calls, including potential access to the internet. The majority of Egyptian households own most basic appliances. Ninety-seven percent of households have an electric fan and a refrigerator, and 96 percent own washing machine. More than half own a water heater. Much smaller proportions of households possess the other appliances and electric goods in Table 2.4; 10 percent have a freezer, 7 percent have an air conditioner, and less than one percent owns a dishwasher Considering household furnishings, almost all households own a bed (99 percent), 91 percent own a sofa, and more than 8 in 10 households own a table and a chair. More than 6 in 10 households have a hanging lamp and 56 percent own a tablia. In around two-thirds of the households, at least one household member owns a watch. Rates of ownership are higher in urban than in rural areas for many household effects. Notably, however, rural households are almost as likely as urban households to have a phone, a television, a satellite dish, refrigerator, washing machine, and electric fan. Rates of ownership of various household effects also differ by place of residence, with households in the Urban Governorates, Lower Egypt, and the three surveyed Frontier Governorates more likely than households in Upper Egypt to own most items. In general, households in rural Upper Egypt have the lowest rates of ownership of the items in Table 2.4. Table 2.4 also includes information on household ownership of a means of transportation. Overall, 9 percent of households own a car, van, or truck, with the highest rate of ownership in the Frontier Governorates (20 percent) and Urban Governorates (16 percent) and the lowest rate in rural Upper Egypt (4 percent). Rates of ownership of motorcycles vary from 2 percent in the Urban Governorates to 12 percent in rural Lower Egypt. The bicycle ownership rate is also highest in rural Lower Egypt (8 percent). As expected, rural households more often own an animal cart than urban households (8 percent and less than 1 percent, respectively). 18 • Characteristics of Households Table 2.4 Household possessions Percentage of households possessing various household effects and means of transportation, percentage owning agricultural land, livestock/farm animals, and poultry/birds, and percentage in which a member has a bank/savings account by urban-rural residence and place of residence, Egypt 2014 Possession Urban Rural Urban Gover- norates Lower Egypt Upper Egypt Frontier Gover- norates1 Total Total Urban Rural Total Urban Rural Household effects Radio with cassette recorder 31.9 30.6 25.4 39.2 40.1 38.9 23.6 33.3 18.4 13.2 31.1 Any television 98.7 96.6 99.1 98.0 98.8 97.7 96.1 98.3 95.0 98.2 97.5 Black and white television 0.7 1.6 0.6 1.2 0.6 1.4 1.6 0.9 1.9 0.2 1.2 Color television 98.4 95.8 98.7 97.5 98.5 97.1 95.3 97.9 93.9 98.1 96.9 Video/DVD player 4.2 1.7 4.8 2.3 4.0 1.8 2.2 3.6 1.5 2.1 2.7 Any telephone 93.6 90.2 93.6 91.8 93.6 91.2 90.3 93.5 88.7 93.6 91.6 Landline telephone 30.2 12.8 34.0 20.1 32.2 16.1 13.2 23.7 7.7 21.7 19.9 Any mobile telephone 91.9 89.1 92.1 90.3 91.9 89.8 89.3 91.6 88.1 92.5 90.3 Smart phone 30.2 12.6 31.6 17.1 28.6 13.3 17.6 29.1 11.6 31.6 19.8 Other cell phone 86.6 87.1 84.8 87.7 87.8 87.6 86.8 87.5 86.3 89.7 86.9 Satellite dish 98.3 95.4 98.6 97.6 98.3 97.3 94.3 98.0 92.4 97.7 96.6 Owns satellite dish 97.3 94.0 97.7 95.8 96.6 95.6 93.5 97.3 91.6 97.6 95.3 Connected only 1.1 1.4 0.9 1.7 1.7 1.8 0.8 0.7 0.8 0.1 1.3 Computer 46.8 22.9 49.4 32.3 48.5 27.0 25.3 41.5 16.7 40.2 32.6 Sewing machine 4.2 4.4 2.4 5.2 6.3 4.9 3.9 4.6 3.6 1.8 4.3 Electric fan 97.4 96.4 96.6 96.6 97.3 96.3 97.2 98.6 96.5 96.3 96.8 Air conditioner 12.7 2.3 13.8 3.1 8.6 1.3 7.4 14.3 3.8 23.8 6.6 Refrigerator 98.6 95.7 98.9 97.6 98.4 97.4 95.0 98.4 93.3 97.5 96.9 Freezer 12.7 7.4 11.2 11.9 17.4 10.0 5.9 10.3 3.5 7.0 9.6 Water heater 75.2 39.4 80.8 52.0 72.9 45.0 44.4 69.9 31.0 59.8 54.0 Dishwasher 1.5 0.3 2.2 0.5 1.0 0.3 0.5 1.0 0.2 0.8 0.8 Any washing machine 97.4 94.9 97.7 96.9 97.7 96.7 93.8 96.9 92.2 92.9 95.9 Automatic washing machine 50.8 18.1 58.1 29.0 47.9 22.8 22.5 44.1 11.1 36.3 31.5 Other washing machine 56.7 83.6 48.8 77.5 61.6 82.8 77.1 62.3 84.8 68.8 72.6 Bed 99.4 98.5 99.5 99.6 99.6 99.5 97.7 98.9 97.0 99.1 98.9 Sofa 94.2 88.0 94.8 89.4 95.2 87.5 90.4 92.9 89.0 81.8 90.6 Hanging lamp 48.9 70.1 47.5 66.5 53.6 70.7 61.1 45.7 69.2 67.7 61.5 Table 93.0 81.1 95.1 85.7 92.2 83.6 82.1 91.1 77.4 83.4 86.0 Tablia 36.8 69.5 25.8 62.1 44.7 67.8 62.3 43.8 72.0 50.8 56.1 Chair 93.7 79.7 96.1 87.0 93.8 84.7 78.5 90.6 72.2 86.2 85.4 Kolla/zeer 4.8 23.8 2.2 16.9 5.7 20.6 21.4 7.5 28.7 8.8 16.1 Watch 76.8 57.8 81.2 71.2 78.9 68.7 51.2 69.2 41.7 59.6 65.6 Means of transport Bicycle 4.1 7.4 1.4 7.5 6.2 8.0 6.3 5.8 6.6 3.6 6.1 Motorcycle/scooter 4.4 10.7 1.9 9.9 5.3 11.5 8.6 7.0 9.4 8.0 8.1 Animal drawn cart 0.7 7.6 0.3 7.5 1.2 9.6 3.3 0.8 4.6 0.5 4.8 Car/truck 13.7 5.2 16.3 7.6 12.8 5.9 6.3 10.8 4.0 20.2 8.7 Ownership of agricultural land 2.7 20.4 0.8 16.8 4.6 20.9 14.0 3.3 19.7 12.3 13.2 Ownership of farm animals2 1.3 17.2 0.4 12.2 1.5 15.7 13.5 2.1 19.5 8.9 10.7 Ownership of poultry/birds 6.5 37.1 2.0 31.6 11.1 38.4 25.9 8.2 35.3 12.5 24.6 Bank/savings account 12.4 5.1 13.2 7.7 12.9 6.0 6.0 10.2 3.8 17.0 8.1 Number 11,514 16,661 4,599 13,243 3,293 9,950 10,101 3,480 6,621 231 28,175 1 Does not include North and South Sinai governorates 2 Cattle, milk cows/bulls, horses/donkeys/mules, goats, and sheep Characteristics of Households • 19 Households in rural areas are more likely than urban households to own agricultural land. Twenty percent of rural households own agricultural land, compared with only 3 percent of urban households. There is considerable variation in the proportion of households reporting that they own farm animals, from a high of 20 percent of households in rural Upper Egypt to less than 1 percent of households in the Urban Governorates. The proportion of households owning poultry or birds ranges from 2 percent in the Urban Governorates to 38 percent in rural Lower Egypt. Overall, 11 percent of Egyptian households own farm animals, and one-quarter own poultry or birds. Table 2.4 also shows that comparatively few Egyptian households have at least one member with a bank/savings account (8 percent). Urban households are more than two times as likely as rural households to have an account. 2.3 HOUSEHOLD WEALTH Although the 2014 EDHS did not collect data on consumption or income, the detailed information on dwelling and household characteristics and household assets that was collected in the survey was used to create a wealth index. The wealth index assesses the long-term standard of living of the household (Rutstein and Johnson 2004). It has been shown to be consistent with measures of household wealth based on income and expenditure data (Filmer and Prichett 2001; Rutstein 1999). In prior EDHS surveys, data on housing characteristics and household assets were also used to create a wealth index. However, the approach taken in creating the wealth index in the 2014 EDHS differs somewhat from the procedure used in earlier surveys in that the index is created in three steps in order to better take into account urban-rural differences in household and dwelling characteristic and asset measures (Rutstein 2008). The first step in the creation of the wealth index from the 2014 EDHS data employed a subset of indicators common to both urban and rural areas to create wealth scores for households in both areas. In that process, categorical variables were transformed into separate dichotomous (0-1) indicators. Those indicators and indicators that were continuous were then analyzed using principal components analysis to produce a common factor score for each household. In a second step, separate factor scores were produced for households in urban and in rural areas using the area-specific indicators. The third step combined the separate area-specific factor scores to produce a nationally applicable wealth index by adjusting the area-specific score through regression on the common factor scores. The resulting combined wealth index had a mean of zero and a standard deviation of one. After the wealth index was finalized, each member of a household was assigned the score for their household. The de jure household population was then divided into five equal parts, from quintile one (lowest-poorest) to quintile five (highest-wealthiest). Table 2.5 shows the distribution of the de jure EDHS household population by wealth quintile and urban-rural and place of residence. Appendix Table A-2.2 shows the wealth index distribution of the household population according to governorate. Also included in Table 2.5 and Appendix Table A-2.2 are Gini coefficients, which provide a measure of the level of concentration of wealth. A Gini coefficient of 0 indicates an equal distribution of wealth and a coefficient of 1, a totally unequal distribution. In other words, if every person in the country owns the same amount of wealth, the Gini coefficient would be 0. If one person in the country owns all of the wealth, then the Gini coefficient would be 1. Because of its nature, smaller areas are more likely to have lower values of the Gini coefficient because they are more likely to be homogeneous than are larger areas. Thus, the values of the coefficient for residential categories are often lower than the value of the nation as a whole. 20 • Characteristics of Households Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to urban-rural residence and place of residence, Egypt 2014 Wealth quintile Total Number of persons Gini coefficientResidence Lowest Second Middle Fourth Highest Urban-rural residence Urban 3.1 2.8 4.6 35.8 53.7 100.0 43,325 0.06 Rural 30.0 30.2 29.2 10.6 0.0 100.0 73,022 0.17 Place of residence Urban Governorates 0.5 1.1 2.1 31.5 64.8 100.0 16,262 0.02 Lower Egypt 17.5 21.1 29.2 20.4 11.8 100.0 54,210 0.13 Urban 2.7 2.5 4.4 39.6 50.8 100.0 12,563 0.07 Rural 22.0 26.7 36.7 14.6 0.0 100.0 41,648 0.15 Upper Egypt 30.0 25.6 15.5 15.4 13.5 100.0 44,864 0.15 Urban 6.1 5.2 7.7 37.6 43.4 100.0 13,945 0.10 Rural 40.8 34.8 19.0 5.4 0.0 100.0 30,919 0.20 Frontier Governorates1 21.9 18.3 13.7 17.7 28.5 100.0 1,010 0.17 Total 20.0 20.0 20.0 20.0 20.0 100.0 116,347 0.13 1 Does not include North and South Sinai governorates As expected, the results in Table 2.5 document considerable differences in the wealth index distributions by residence. For example, a much larger proportion of the urban population than the rural population in Egypt is found in the two highest wealth quintiles (90 percent and 11 percent, respectively). In turn, more of the rural than urban population are in the two lowest wealth index groups (60 percent and 6 percent, respectively). Considering place of residence, there are also marked differences. Around two-thirds (65 percent) of the population in the Urban Governorates is in the highest wealth quintile compared with 14 percent of the population in Upper Egypt and 12 percent in Lower Egypt. The population in rural Upper Egypt is especially concentrated at the lower end of the wealth index, with 41 percent falling into the lowest wealth quintile. In rural Lower Egypt, in contrast, 22 percent of the population falls in the lowest wealth quintile. With regard to the concentration of wealth, an examination of the Gini coefficients in Table 2.5 indicates that wealth inequality is greater in rural than in urban areas (17 percent and 6 percent, respectively). Inequality in the distribution of wealth is greatest in rural Upper Egypt (20 percent). 2.4 HAND WASHING Hand washing with water and soap is one of the most effective health interventions to reduce the incidence of illness especially among children. Monitoring correct hand washing behavior is challenging. The 2014 EDHS assessed the potential for correct hand washing behavior to take place by observing if a household had a specific place where people most often wash their hands and observing if water and soap (or other local cleansing materials) were present at a specific place for hand washing. Table 2.6 presents the hand washing results by urban-rural residence and place of residence and Appendix Table A-2.1 shows the results by governorate. Characteristics of Households • 21 Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap and other cleansing agents, according to urban-rural residence, place of residence, and wealth quintile, Egypt 2014 Percent- age of house- holds where place for washing hands was observed Number of house- holds Among households where place for hand washing was observed, percentage with: Number of house- holds with place for hand washing observed Background characteristic Soap and water1 Water and cleans- ing agent2 other than soap only Water only Soap but no water3 Cleans- ing agent other than soap only2 No water, no soap, no other cleans- ing agent Missing Total Urban-rural residence Urban 96.0 11,514 94.5 0.1 4.0 1.0 0.0 0.4 0.0 100.0 11,052 Rural 96.3 16,661 86.4 0.1 11.1 1.2 0.0 1.3 0.0 100.0 16,050 Place of residence Urban Governorates 95.4 4,599 95.1 0.1 3.2 1.4 0.0 0.2 0.1 100.0 4,388 Lower Egypt 96.0 13,243 92.7 0.0 5.1 1.2 0.0 1.0 0.0 100.0 12,716 Urban 96.4 3,293 95.1 0.0 3.6 0.7 0.0 0.6 0.0 100.0 3,175 Rural 95.9 9,950 92.0 0.0 5.6 1.3 0.0 1.1 0.0 100.0 9,541 Upper Egypt 96.9 10,101 83.2 0.2 14.5 0.8 0.0 1.2 0.0 100.0 9,788 Urban 96.7 3,480 93.0 0.2 5.5 0.7 0.0 0.6 0.0 100.0 3,366 Rural 97.0 6,621 78.1 0.1 19.3 0.9 0.0 1.6 0.0 100.0 6,422 Frontier Governorates4 90.8 231 91.4 0.0 6.0 0.6 0.0 2.1 0.0 100.0 210 Wealth quintile Lowest 96.8 4,685 74.8 0.1 21.5 1.2 0.0 2.4 0.0 100.0 4,534 Second 96.6 5,324 84.3 0.1 13.0 1.2 0.0 1.4 0.0 100.0 5,144 Middle 96.0 5,682 92.8 0.1 5.3 1.0 0.0 0.7 0.0 100.0 5,457 Fourth 95.3 6,163 94.2 0.1 4.0 1.2 0.0 0.5 0.0 100.0 5,877 Highest 96.4 6,321 98.1 0.1 0.9 0.8 0.0 0.1 0.0 100.0 6,091 Total 96.2 28,175 89.7 0.1 8.2 1.1 0.0 0.9 0.0 100.0 27,102 1 Soap includes soap or detergent in bar, liquid, powder or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud or sand 3 Includes households with soap only as well as those with soap and another cleansing agent 4 Does not include North and South Sinai governorates Overall, the EDHS interviewers were able to observe the place where hands were usually washed in the case of 96 percent of the survey households. Ninety percent of these households had soap and water available at the observed hand washing location. Households from rural areas, Upper Egypt, and the two lowest quintiles were least likely to have soap and water in the place where hand washing occurs. 2.5 CHARACTERISTICS OF THE HOUSEHOLD POPULATION 2.5.1 Age and Sex Composition Table 2.7 presents the percent distribution of the de facto household population by age, according to urban-rural residence and sex. The table describes the demographic context in which behaviors examined later in the report occur. The population spending the night before the interview in the households selected for the survey included 114,428 individuals, with females slightly outnumbering men. The age structure of the de facto household population reflects the effects of past demographic trends in Egypt, particularly high fertility. The majority of the household population (53 percent) was less than 25 years old, and 35 percent were less than 15 years old. The proportion under age 15 was greater in the rural 22 • Characteristics of Households population (38 percent) than in the urban population (31 percent). This difference is an outcome of lower fertility over the past several decades in urban areas compared with rural areas. Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and urban-rural residence, Egypt 2014 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 11.7 10.3 11.0 15.6 14.0 14.8 14.1 12.6 13.4 5-9 10.7 10.2 10.4 13.0 11.7 12.3 12.1 11.1 11.6 10-14 10.1 9.1 9.6 11.1 10.4 10.7 10.7 9.9 10.3 15-19 8.8 8.6 8.7 9.3 9.3 9.3 9.1 9.0 9.1 20-24 8.0 8.0 8.0 7.7 9.0 8.4 7.8 8.6 8.2 25-29 8.4 9.0 8.7 8.0 9.6 8.8 8.2 9.4 8.8 30-34 7.2 7.6 7.4 6.9 7.7 7.3 7.0 7.7 7.3 35-39 5.9 6.6 6.3 5.8 5.9 5.9 5.9 6.2 6.0 40-44 5.1 5.5 5.3 4.7 4.8 4.7 4.8 5.1 4.9 45-49 5.2 5.3 5.2 4.5 4.3 4.4 4.7 4.7 4.7 50-54 4.9 5.5 5.2 3.8 4.0 3.9 4.2 4.5 4.4 55-59 4.1 4.9 4.5 2.9 2.9 2.9 3.4 3.7 3.5 60-64 4.3 4.2 4.3 2.8 2.8 2.8 3.4 3.3 3.4 65-69 2.6 2.6 2.6 1.6 1.4 1.5 2.0 1.9 1.9 70-74 1.6 1.5 1.6 1.2 1.1 1.2 1.4 1.3 1.3 75-79 0.6 0.6 0.6 0.6 0.4 0.5 0.6 0.5 0.5 80 + 0.6 0.6 0.6 0.5 0.7 0.6 0.5 0.6 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 21,709 21,671 43,380 35,217 35,830 71,048 56,926 57,501 114,428 The population pyramid shown in Figure 2.1 was constructed using the sex and age distribution of the 2014 EDHS household population. The pyramid has a wide base. This pattern is typical of countries that have experienced relatively high fertility in the recent past. Figure 2.1 Population pyramid -8 -6 -4 -2 0 2 4 6 8 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Percent Age Male Female EDHS 2014 8 6 4 2 Characteristics of Households • 23 2.5.2 Household Composition Table 2.8 presents information from the 2014 EDHS on the distribution of households by sex of the head of the household and by the number of de jure household members. These characteristics are important because they are often associated with socioeconomic differences between households. For example, female-headed households frequently are poorer than households headed by males. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. The EDHS results show that most Egyptian households are headed by males; the head is female in only 13 percent of the households. Female-headed households are somewhat more common in urban than in rural areas; 16 percent of urban households have a female head compared with 11 percent of the rural households. The average household has 4.1 members. Thirty-seven percent of the households had three or fewer members, while 8 percent of the households have seven or more members. In general, rural households are larger than urban households. For example, only 5 percent of urban households have seven or more members, compared with 11 percent of rural households. The average urban household has 3.8 persons compared with 4.4 persons in rural areas. The EDHS data also can be used to look at the extent to which Egyptian households are caring for orphan and foster children. Children with one parent who has died are classified as single orphans while double orphans are defined as children who have lost both parents. Foster children include children whose parents are alive but the child is not living with either parent. Overall, Table 2.8 shows that 4 percent of households in Egypt include orphan and/or foster children, with most of these households caring for single orphans. 2.6 EDUCATION OF THE HOUSEHOLD POPULATION The educational level of household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and children’s health. Primary education in Egypt starts at age 6 and consists of six Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of households, and percentage of households with orphans and foster children under 18 years of age, according to urban-rural residence, Egypt 2014 Characteristic Urban Rural Total Household headship Male 83.6 89.5 87.1 Female 16.4 10.5 12.9 Total 100.0 100.0 100.0 Number of usual members 1 9.6 4.3 6.5 2 16.2 12.8 14.2 3 17.1 15.6 16.2 4 23.7 22.1 22.8 5 19.4 21.0 20.3 6 9.2 13.3 11.6 7 3.0 6.1 4.8 8 1.0 2.4 1.9 9+ 0.6 2.4 1.7 Total 100.0 100.0 100.0 Mean size of households 3.8 4.4 4.1 Percentage of households with orphans and foster children under 18 years of age Foster children1 0.9 1.6 1.3 Double orphans 0.1 0.1 0.1 Single orphans2 3.3 3.3 3.3 Foster and/or orphan children 4.0 4.7 4.4 Number of households 11,514 16,661 28,175 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent. 24 • Characteristics of Households years of is schooling.2 Secondary education currently involves six years of schooling of which the first three years—the preparatory level—are considered basic education and are compulsory. The final three years of secondary education is not compulsory. During the 2014 EDHS household interviews, questions were included on the highest level of schooling completed for all household members age six and older and on recent school attendance for household members age 6-24 years. The information collected in response to the questions on the educational attainment is presented for female and male household members in Tables 2.9.1 and 2.9.2, respectively. A comparison of Tables 2.9.1 and 2.9.2 highlights the gap in educational attainment between males and females in Egypt, particularly at the older ages. Overall, 86 percent of males had ever attended school, compared with 75 percent of females. The median number of years of schooling for men is 7.4, which is 1.6 years higher than the median for women (5.8 years). Table 2.9.1 Educational attainment of the female household population Percent distribution of the de facto female household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Egypt 2014 Background characteristic No education Some primary Completed primary1 Some secondary Completed secon- dary2 More than secondary Total Number Median years completed Age 6-93 16.0 83.9 0.0 0.1 0.0 0.0 100.0 4,889 0.5 10-14 2.0 53.6 1.6 42.8 0.0 0.0 100.0 5,683 4.7 15-19 3.9 4.6 2.5 71.4 9.4 8.1 100.0 5,189 8.9 20-24 9.1 2.7 2.8 15.6 41.0 28.7 100.0 4,974 10.8 25-29 15.8 3.7 2.7 11.4 43.8 22.5 100.0 5,384 10.4 30-34 20.7 6.5 5.6 9.8 38.8 18.6 100.0 4,408 10.2 35-39 25.8 7.1 6.2 12.0 34.9 14.0 100.0 3,549 8.8 40-44 36.3 8.1 2.4 11.4 31.6 10.0 100.0 2,907 7.4 45-49 45.2 9.7 4.2 5.8 25.6 9.5 100.0 2,700 3.1 50-54 51.7 12.1 5.3 4.8 15.9 10.2 100.0 2,600 0.0 55-59 55.3 11.2 8.1 3.4 12.3 9.8 100.0 2,103 0.0 60-64 64.6 9.6 6.8 3.1 7.9 7.9 100.0 1,903 0.0 65+ 73.8 9.6 5.8 2.4 4.5 3.8 100.0 2,446 0.0 Residence Urban 17.3 17.3 4.3 18.5 23.4 19.1 100.0 18,918 8.2 Rural 29.5 21.6 3.1 19.1 19.9 6.8 100.0 29,818 4.6 Place of residence Urban Governorates 16.7 16.4 5.4 18.1 22.2 21.2 100.0 7,291 8.4 Lower Egypt 23.6 20.5 3.0 18.2 23.5 11.2 100.0 22,575 5.9 Urban 15.8 18.3 3.2 18.0 24.9 19.9 100.0 5,466 8.9 Rural 26.1 21.2 3.0 18.2 23.1 8.4 100.0 17,110 5.3 Upper Egypt 29.3 20.8 3.4 20.0 18.3 8.2 100.0 18,464 4.8 Urban 19.5 17.7 3.9 19.3 23.6 16.0 100.0 5,941 7.5 Rural 34.0 22.3 3.2 20.4 15.7 4.5 100.0 12,523 3.4 Frontier Governorates4 23.5 18.1 6.1 20.0 20.0 12.3 100.0 406 6.0 Wealth quintile Lowest 40.2 22.0 2.9 20.1 11.8 3.0 100.0 9,684 2.1 Second 34.5 23.0 3.4 19.8 15.9 3.4 100.0 9,862 3.3 Middle 21.4 21.3 3.4 18.5 27.1 8.3 100.0 9,256 6.2 Fourth 19.4 19.5 4.4 19.1 25.1 12.4 100.0 9,689 7.0 Highest 8.9 14.4 3.7 17.0 26.5 29.6 100.0 10,246 10.7 Total 24.7 20.0 3.6 18.9 21.3 11.6 100.0 48,737 5.8 Note: Total includes one case for whom age is missing. 1 The population age 22-36 years completed 5 years at the primary level; all others completed 6 years at the primary level. 2 Completed 6 years at the secondary level 3 Includes some children were not eligible to attend school because their 6th birthday fell after the start of the 2014-2015 school year. 4 Does not include North and South Sinai governorates 2 Between 1989 and 2004, primary education was five years. Characteristics of Households • 25 Table 2.9.2 Educational attainment of the male household population Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Egypt 2014 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number Median years completed Age 6-93 16.0 84.0 0.0 0.0 0.0 0.0 100.0 5,313 0.4 10-14 1.5 54.3 2.0 42.2 0.0 0.0 100.0 6,111 4.7 15-19 2.6 7.1 2.2 72.3 8.7 7.0 100.0 5,187 8.9 20-24 4.1 5.0 3.8 17.4 40.2 29.5 100.0 4,437 10.8 25-29 7.5 5.0 5.0 12.3 45.2 25.1 100.0 4,657 10.5 30-34 10.0 7.5 5.2 11.4 44.8 21.1 100.0 3,967 10.4 35-39 10.9 8.5 7.2 12.8 41.7 18.9 100.0 3,338 10.7 40-44 16.0 9.7 4.9 16.1 37.6 15.8 100.0 2,752 11.1 45-49 19.9 11.2 5.7 11.3 37.8 14.1 100.0 2,699 11.1 50-54 25.7 11.1 6.8 8.5 29.8 18.1 100.0 2,417 8.7 55-59 31.9 12.7 8.1 8.5 21.7 17.0 100.0 1,929 5.6 60-64 37.5 10.7 9.3 7.1 18.0 17.4 100.0 1,938 5.2 65+ 51.8 9.7 8.8 5.0 12.8 11.9 100.0 2,562 0.0 Residence Urban 10.4 19.1 5.0 19.6 24.5 21.4 100.0 18,676 9.2 Rural 16.4 25.0 4.1 21.9 23.7 8.9 100.0 28,632 6.2 Place of residence Urban Governorates 9.7 17.1 6.6 19.7 24.3 22.5 100.0 7,211 9.6 Lower Egypt 14.0 23.4 4.1 20.9 24.4 13.1 100.0 22,292 7.3 Urban 10.3 20.1 3.7 19.5 24.2 22.2 100.0 5,383 9.5 Rural 15.2 24.4 4.2 21.4 24.5 10.2 100.0 16,909 6.7 Upper Egypt 15.8 24.2 3.9 21.6 23.4 11.1 100.0 17,387 6.5 Urban 11.3 20.7 4.1 19.7 24.8 19.4 100.0 5,848 8.7 Rural 18.1 25.9 3.8 22.6 22.7 6.9 100.0 11,539 5.7 Frontier Governorates4 13.9 19.1 5.5 19.5 27.0 14.9 100.0 418 7.9 Wealth quintile Lowest 22.8 26.4 4.6 22.8 18.8 4.7 100.0 9,485 4.9 Second 19.2 26.0 4.2 22.9 21.7 5.9 100.0 9,279 5.5 Middle 11.7 24.5 4.3 20.7 27.6 11.2 100.0 8,970 7.6 Fourth 11.9 21.6 5.5 20.8 26.7 13.5 100.0 9,451 7.8 Highest 5.2 15.5 3.7 17.9 25.5 32.2 100.0 10,123 11.0 Total 14.0 22.7 4.4 21.0 24.1 13.8 100.0 47,308 7.4 Note: Total includes one case for whom age is missing. 1 The population age 22-36 years completed 5 years at the primary level; all others completed 6 years at the primary level 2 Completed 6 years at the secondary level 3 Includes some children were not eligible to attend school because their 6th birthday fell after the start of the 2014-2015 school year. 4 Does not include North and South Sinai governorates An examination of the education distributions for successive cohorts indicates that there have been changes over time in the educational attainment of both men and women. For example, the median number of years of schooling is 10.8 for males age 20-24 years, nearly double the median for males in the 55-59 age group (5.6 years). The improvement in educational attainment has been even more striking for females; the median number of years of schooling is 10.8 for females age 20-24 years, more than three times the median for females in the age group 45-49 (3.1 years). As a result of the gains in female education, the gap in the educational attainment between males and females has almost disappeared among younger cohorts. For example, there is almost no differential in the median number of years of schooling between men and women who are under age 25. Urban residents are more likely to have attended school and to have remained in school for a longer period than rural residents. The results in Tables 2.9.1 and 2.9.2 also show that gender differences in educational attainment are less evident in urban than in rural areas. For example, the median number of years of schooling is 6.2 years among rural men, 1.6 years greater than the median 26 • Characteristics of Households among rural women (4.6 years). The difference is smaller in urban areas, where the median number of years of schooling is 9.2 years for men, compared with 8.2 years for women. By place of residence, gender differences in the likelihood of attending school are most evident in rural Upper Egypt where 82 percent of men have ever attended school, compared with 66 percent of women. The gender gap is least apparent in urban Lower Egypt where 84 percent of women have some education, compared with 90 percent of men. Educational attainment is associated with wealth index, with the largest differentials between males and females observed in the lowest two wealth quintiles. For example, the median number of years of schooling among males in the lowest wealth quintile is more than double the median years among females (4.9 years and 2.1 years, respectively). In contrast, the difference in the median years of schooling is only 0.3 years between males and females in the highest wealth quintiles (11 years and 10.7 years, respectively). Background Characteristics of Respondents • 27 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 his chapter provides a detailed profile of the ever-married women who were interviewed in the 2014 Egypt DHS. First, the chapter presents information on a number of basic characteristics of the EDHS respondents including age, residence, education, and work status. Next the chapter explores in more depth the women’s educational background and literacy status. The chapter then presents information on the women’s exposure to traditional mass media and use of computers and digital media. Finally, the chapter looks further at the women’s employment status. The background characteristics presented in this chapter are expected to help in understanding the findings in the chapters that follow. 3.1 BACKGROUND CHARACTERISTICS OF EVER-MARRIED WOMEN All ever-married women age 15-49 who were usual residents or present in the EDHS sample households on the night before the interviewer’s visit were eligible for a detailed interview that was designed to obtain information on a range of key demographic and health indicators. Table 3.1 presents the distribution of the women interviewed in the EDHS by marital status, age, urban-rural residence, place of residence, educational level, work status, and wealth quintile. Among the ever-married women in the EDHS sample, 94 percent were currently married, 3 percent widowed, and 3 percent divorced or separated. Looking at the age distribution in Table 3.1, around two-fifths of the women were under age 30, and slightly more than one-quarter were age 40 and over. There were fewer women in the 15-19 and 20-24 age groups than in the 25-29 cohort. This pattern is the result of the inclusion of only ever-married women in the sample and the tendency to delay marriage until older ages in Egypt. More information is presented on marriage patterns in Chapter 7. T Key Findings: • Around two-fifths of the 2014 EDHS respondents were under age 30 and slightly more than one-quarter were age 40 and over. • The majority of respondents (65 percent) were living in rural areas. • Around one-quarter of the respondents never attended school, while slightly more than half of the women completed at least the secondary level. • One-third of rural respondents were unable to read at all, around twice the level among urban respondents. • The vast majority of respondents (97 percent) watch television at least once a week, 17 percent listen to radio on a weekly basis, and only 6 percent read a newspaper or magazine regularly. • Fourteen percent of respondents use a computer, 8 percent surf the Internet, and 9 percent use social media at least once per week. • Overall, 16 percent of respondents were engaged in some economic activity in the 12 months prior to the survey. • Among employed respondents, more than half were employed in professional, technical, and managerial positions or in clerical occupations, and 21 percent worked in sales and services. 28 • Background Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of ever-married women age 15-49 by selected background characteristics, Egypt 2014 Background characteristic Weighted percent Weighted number Unweighted number Age 15-19 3.5 764 738 20-24 14.0 3,055 3,051 25-29 21.8 4,753 4,718 30-34 19.0 4,127 4,133 35-39 16.1 3,495 3,473 40-44 13.2 2,864 2,902 45-49 12.4 2,705 2,747 Marital status Married 94.0 20,460 20,430 Divorced/separated 2.9 633 662 Widowed 3.1 669 670 Urban-rural residence Urban 35.0 7,623 9,628 Rural 65.0 14,139 12,134 Place of residence Urban Governorates 12.7 2,774 3,667 Lower Egypt 49.0 10,664 8,384 Urban 10.7 2,319 2,492 Rural 38.3 8,346 5,892 Upper Egypt 37.4 8,130 8,376 Urban 11.1 2,421 2,593 Rural 26.2 5,708 5,783 Frontier Governorates1 0.9 194 1,335 Governorates Urban Governorates Cairo 8.3 1,811 1,189 Alexandria 3.9 857 737 Port Said 0.4 86 800 Suez 0.1 19 941 Lower Egypt Damietta 2.0 433 986 Dakahlia 8.0 1,740 955 Sharkia 9.0 1,956 1,011 Kalyubia 4.7 1,033 850 Kafr El-Sheikh 4.4 957 945 Gharbia 6.3 1,370 835 Menoufia 4.8 1,045 855 Behera 9.0 1,959 1,088 Ismailia 0.8 172 859 Upper Egypt Giza 9.4 2,040 1,076 Beni Suef 3.5 770 875 Fayoum 3.3 721 843 Menya 5.1 1,107 858 Assuit 5.0 1,085 965 Souhag 4.8 1,039 913 Qena 3.6 776 1,055 Aswan 1.7 368 886 Luxor 1.0 224 905 Frontier Governorates Red Sea 0.4 83 387 New Valley 0.2 54 443 Matroh 0.3 58 505 Education No education 24.0 5,232 4,861 Some primary 6.1 1,334 1,239 Primary complete/some secondary 17.4 3,796 3,875 Secondary complete/higher 52.4 11,400 11,787 Work status Working for cash 13.6 2,964 3,064 Not working for cash 86.4 18,798 18,698 (Continued…) Background Characteristics of Respondents • 29 Table 3.1—Continued Background characteristic Weighted percent Weighted number Unweighted number Wealth quintile Lowest 17.9 3,887 3,960 Second 19.7 4,277 4,011 Middle 22.2 4,839 4,048 Fourth 20.9 4,542 4,482 Highest 19.4 4,217 5,261 Total 15-49 100.0 21,762 21,762 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 1 Does not include North and South Sinai governorates The majority of the ever-married women in the EDHS 2014 (65 percent) were living in rural areas. Considering place of residence, 13 percent of the women were from the Urban Governorates, 49 percent from Lower Egypt, 37 percent from Upper Egypt, and 1 percent from the three Frontier Governorates covered in the survey. The largest percentages of respondents come from Giza, Behera, and Sharkia governorates each with 9 percent, and Cairo and Dakahlia, each with 8 percent. Port Said, Suez, Ismailia, Luxor, Red Sea, New Valley, and Matroh governorates each have 1 percent or less of respondents. The educational level of the 2014 EDHS respondents varied considerably. Around one- quarter of the women never attended school, while slightly more than half of the women completed at least the secondary level. Table 3.1 shows that 14 percent of ever-married women were working for cash at the time of the survey. Looking at the wealth quintiles, the women were fairly evenly distributed across the wealth quintiles. The smallest percentage was found in the lowest wealth quintile (18 percent) and the highest percentage was found in the middle quintile (22 percent). 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Table 3.2 provides information on the relationship between the educational level of EDHS respondents and selected background characteristics. Additional information on the differentials in women’s educational attainment by governorate is available in Appendix Table A-3.1. Overall, more than half of respondents have completed the secondary level or higher, reflecting the long-term trend toward increasing educational attainment among women in Egypt. As expected, the level of education decreases with increasing age among women age 25 and over. However, the table also shows that respondents age 15-19 had an average of only 8.6 years of schooling, much lower than the average among women age 20-29 years (10.4 years). The explanation lies in the fact that women who marry early typically leave school at a younger age than women who marry later. The lower educational attainment of ever-married women age 15-19 should be kept in mind when looking at the differences between respondents age 15-19 and older respondents throughout the report. Urban respondents were more highly educated than those from rural areas. Among urban women, 65 percent had completed secondary school or higher, compared with 46 percent of rural women. On the other hand, rural women were more than twice as likely as urban women to have never attended school. Educational levels were lowest in rural Upper Egypt, where 39 percent of the women had never attended school. The highest educational levels were found in urban Lower Egypt 30 • Background Characteristics of Respondents and the Urban Governorates; only 12 percent of EDHS respondents from these areas had never attended school, and 25 percent of women had more than secondary education. Educational attainment rises with the wealth quintile. More than eight in ten women in the highest wealth quintile had completed secondary school or higher, while about half of the women in the lowest quintile had never attended school. Table 3.2 Educational attainment Percent distribution of ever-married women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Egypt 2014 Highest level of schooling Total Median years completed Number of ever- married women Background characteristic No education Some primary Com- pleted primary1 Some secon- dary Com- pleted secon- dary2 More than secon- dary Age 15-24 10.9 4.2 3.8 25.7 45.2 10.2 100.0 10.3 3,819 15-19 8.7 8.3 5.5 50.0 26.5 0.9 100.0 8.6 764 20-24 11.5 3.2 3.4 19.7 49.8 12.5 100.0 10.4 3,055 25-29 16.5 3.7 2.8 12.4 45.8 18.9 100.0 10.4 4,753 30-34 21.2 6.6 5.4 9.8 39.7 17.3 100.0 10.2 4,127 35-39 25.9 6.7 6.2 12.1 35.2 13.8 100.0 8.9 3,495 40-44 35.7 8.3 2.4 11.7 31.9 9.8 100.0 7.5 2,864 45-49 45.3 9.3 4.2 6.0 25.7 9.4 100.0 3.1 2,705 Urban-rural residence Urban 13.8 4.6 4.6 12.2 42.1 22.7 100.0 10.7 7,623 Rural 29.6 7.0 3.9 13.9 36.6 9.1 100.0 8.2 14,139 Place of residence Urban Governorates 11.9 5.2 5.7 13.5 39.1 24.5 100.0 10.7 2,774 Lower Egypt 20.8 6.3 3.7 11.8 43.2 14.3 100.0 10.3 10,664 Urban 11.9 3.9 3.8 10.2 45.5 24.7 100.0 10.9 2,319 Rural 23.3 6.9 3.7 12.2 42.5 11.4 100.0 10.2 8,346 Upper Egypt 32.4 6.3 4.1 15.3 32.3 9.6 100.0 7.5 8,130 Urban 17.8 4.6 4.0 12.5 42.4 18.7 100.0 10.5 2,421 Rural 38.6 7.1 4.1 16.5 28.0 5.7 100.0 5.5 5,708 Frontier Governorates3 22.9 4.2 7.3 12.3 35.0 18.4 100.0 10.2 194 Wealth quintile Lowest 47.7 8.6 4.3 13.8 22.7 3.0 100.0 1.5 3,887 Second 37.4 8.9 4.9 14.8 30.4 3.6 100.0 5.2 4,277 Middle 18.9 6.1 3.7 14.6 46.5 10.2 100.0 10.2 4,839 Fourth 14.0 5.1 5.0 13.8 44.8 17.3 100.0 10.5 4,542 Highest 5.4 2.3 2.8 9.4 45.3 34.8 100.0 11.6 4,217 Total 24.0 6.1 4.1 13.3 38.5 13.9 100.0 10.1 21,762 1 Women age 22-36 years completed 5 years at the primary level; all other women completed 6 years at the primary level. 2 Completed 6 years at the secondary level 3 Does not include North and South Sinai governorates 3.3 LITERACY In the 2014 EDHS, respondents who had some secondary or higher education were assumed to be able to read. Among the remaining women i.e., those who had never been to school or who had attended only the primary level, literacy was directly assessed by asking the women to read two simple sentences from a card. To avoid possible bias within the same household where more than one eligible woman was interviewed, the EDHS teams used four cards, each with a different set of sentences. The sentences on the cards were selected from primary school Arabic text books. Table 3.3 presents literacy rates among ever-married women age 15-49 based on the combination of educational attainment and the literacy assessment. Very few women who had less Background Characteristics of Respondents • 31 than a preparatory education were able to read. Overall, the EDHS results indicate that more than one- quarter of ever-married women cannot read at all. The proportion of EDHS respondents who were unable to read increased with age, reflecting the lower educational attainment of older women. The strong association between residence and literacy is also clearly related to residential differences in educational levels. Rural respondents were more than twice as likely as urban women to be unable to read at all. The proportion of women unable to read at all was highest in rural Upper Egypt (41 percent). Table 3.3 also shows that the level of illiteracy decreased with increasing wealth. Six percent of women in the highest wealth quintile were not able to read at all compared to 51 percent of women in the lowest quintile. Table 3.3 Literacy Percent distribution of ever-married women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Egypt 2014 Secon- dary school or higher No schooling or primary school Total Percent- age literate1 Number of ever- married women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Missing Age 15-24 81.1 2.2 3.2 13.4 0.0 0.0 100.0 86.5 3,819 15-19 77.4 3.4 4.3 14.9 0.0 0.0 100.0 85.1 764 20-24 82.0 1.9 2.9 13.1 0.1 0.0 100.0 86.8 3,055 25-29 77.1 1.8 3.7 17.4 0.0 0.0 100.0 82.6 4,753 30-34 66.7 3.6 5.2 24.3 0.1 0.0 100.0 75.5 4,127 35-39 61.2 2.9 6.0 29.8 0.1 0.1 100.0 70.1 3,495 40-44 53.5 2.9 4.8 38.7 0.1 0.0 100.0 61.2 2,864 45-49 41.2 3.2 6.6 48.9 0.1 0.0 100.0 50.9 2,705 Urban-rural residence Urban 77.0 2.6 4.6 15.7 0.0 0.0 100.0 84.3 7,623 Rural 59.6 2.8 4.9 32.7 0.1 0.0 100.0 67.2 14,139 Place of residence Urban Governorates 77.1 3.2 5.6 14.0 0.0 0.1 100.0 85.9 2,774 Lower Egypt 69.2 2.3 4.3 24.1 0.1 0.1 100.0 75.8 10,664 Urban 80.4 2.1 3.9 13.5 0.1 0.0 100.0 86.4 2,319 Rural 66.1 2.3 4.4 27.0 0.1 0.1 100.0 72.9 8,346 Upper Egypt 57.2 3.1 5.1 34.6 0.1 0.0 100.0 65.3 8,130 Urban 73.6 2.3 4.2 19.9 0.0 0.0 100.0 80.1 2,421 Rural 50.2 3.4 5.4 40.8 0.1 0.0 100.0 59.1 5,708 Frontier Governorates2 65.7 3.0 6.1 25.2 0.0 0.0 100.0 74.8 194 Wealth quintile Lowest 39.4 3.5 5.9 50.9 0.2 0.1 100.0 48.8 3,887 Second 48.8 3.2 6.1 41.7 0.1 0.0 100.0 58.1 4,277 Middle 71.3 2.4 4.3 21.8 0.1 0.0 100.0 78.1 4,839 Fourth 75.9 2.7 5.2 16.3 0.0 0.0 100.0 83.7 4,542 Highest 89.6 1.8 2.5 6.1 0.0 0.0 100.0 93.9 4,217 Total 65.7 2.7 4.8 26.7 0.1 0.0 100.0 73.2 21,762 1 Includes women who had some secondary education or higher and women who had never been to school or attended only the primary level who were able to read all or part of a sentence 2 Does not include North and South Sinai governorates 3.4 EXPOSURE TO BROADCAST, PRINT, AND DIGITAL MEDIA The 2014 EDHS collected information on exposure to broadcast and print media. These data are important because they provide some indication of the extent to which Egyptian women are regularly exposed to the mass media that have been traditionally used to convey family planning and 32 • Background Characteristics of Respondents health messages to the population. In addition, a series of questions were asked in the EDHS to assess exposure to digital media, which are increasingly seen as an alternative path for communication messages. Table 3.4 presents the proportions of ever-married women age 15-49 that reported they watch television, listen to the radio, or read a newspaper or magazine regularly by background characteristics. The table also includes information on the proportions of women accessing all three media at least once per week and the proportion not exposed to any media on a weekly basis. Appendix Table A-3.2 shows the governorate-level variations in these indicators. Television is clearly the dominant medium. The vast majority of ever-married women (97 percent) watch television at least once a week, 17 percent listen to radio at least once a week, and only 6 percent read a newspaper or magazine at least once a week. Two percent of women report regular exposure to all three media, and 3 percent have no exposure to broadcast or print media. Table 3.4 Exposure to broadcast and print media Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Egypt 2014 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of ever- married women Age 15-19 2.5 96.5 11.4 0.6 3.0 764 20-24 3.4 97.2 13.6 0.9 2.2 3,055 25-29 5.6 96.8 16.2 2.5 2.6 4,753 30-34 6.0 96.6 16.8 2.3 2.8 4,127 35-39 6.4 96.4 16.0 2.6 3.0 3,495 40-44 7.4 96.9 19.0 3.0 2.5 2,864 45-49 6.8 95.7 19.3 3.3 3.6 2,705 Urban-rural residence Urban 9.5 97.2 15.1 3.9 2.3 7,623 Rural 3.8 96.3 17.2 1.5 3.0 14,139 Place of residence Urban Governorates 12.3 98.2 16.1 5.5 1.4 2,774 Lower Egypt 6.2 96.6 23.2 2.6 2.5 10,664 Urban 10.1 95.8 21.0 4.1 3.3 2,319 Rural 5.1 96.8 23.8 2.2 2.3 8,346 Upper Egypt 3.1 96.1 8.0 1.0 3.6 8,130 Urban 5.7 97.2 8.7 1.9 2.5 2,421 Rural 2.0 95.6 7.7 0.5 4.0 5,708 Frontier Governorates1 4.6 96.1 6.8 1.2 3.5 194 Education No education 0.2 95.1 12.1 0.1 4.5 5,232 Some primary 1.1 95.7 15.0 0.3 3.7 1,334 Primary complete/some secondary 3.3 97.2 13.6 1.0 2.4 3,796 Secondary complete/higher 9.7 97.2 19.7 4.1 2.0 11,400 Wealth quintile Lowest 1.7 93.8 13.3 0.6 5.4 3,887 Second 2.7 96.8 13.5 0.6 2.8 4,277 Middle 4.3 96.9 19.5 1.8 2.2 4,839 Fourth 6.2 97.3 16.6 2.6 2.2 4,542 Highest 13.9 97.9 18.9 6.0 1.6 4,217 Total 5.8 96.6 16.5 2.3 2.8 21,762 1 Does not include North and South Sinai governorates Considering differentials in Table 3.4, there is almost no variation in the percentage of women who watch television. Considering print media, urban women, especially those living in the Urban Governorates and urban Lower Egypt, women with a secondary or higher education, and Background Characteristics of Respondents • 33 women in the highest wealth quintile were most likely to report reading a newspaper or magazine on a weekly basis. Regular exposure to radio broadcasts was highest in Lower Egypt and lowest in Upper Egypt and the three Frontier Governorates included in the survey. Table 3.5 presents information on the variation in use of computers and exposure to digital media among ever-married women age 15-49. Governorate-level differences in these indicators are presented in Appendix Table A-3.3. Overall, 14 percent of ever-married women use a computer, 8 percent go on the Internet, and 9 percent use social media at least once per week. Seven percent of women report regular exposure to all three digital media, and 85 percent have no exposure to any digital media. Women living in urban areas are much more likely to use a computer at least once per week than rural women (23 percent and 9 percent, respectively). They are also more likely than rural women to regularly access the Internet (14 percent and 4 percent, respectively) and social media (17 percent and 5 percent respectively). Table 3.5 Use of computers and digital media Percentage of ever-married women age 15-49 who use a computer, the Internet, and social media on a weekly basis, by background characteristics, Egypt 2014 Background characteristic Uses a computer at least once a week Uses Internet at least once a week Uses social media at least once a week Uses all three digital media at least once a week Uses none of the three digital media at least once a week Number of ever- married women Age 15-19 7.7 2.5 3.7 1.8 90.9 764 20-24 14.2 8.3 10.5 7.6 84.7 3,055 25-29 17.0 9.9 11.9 8.6 81.6 4,753 30-34 16.2 8.8 10.8 8.3 82.9 4,127 35-39 13.7 6.9 9.0 6.5 85.7 3,495 40-44 11.7 5.5 7.9 5.3 87.9 2,864 45-49 8.4 4.3 5.7 4.0 91.3 2,705 Urban-rural residence Urban 22.9 14.1 17.1 13.3 76.0 7,623 Rural 8.9 3.9 5.3 3.3 90.3 14,139 Place of residence Urban Governorates 25.7 17.2 19.6 16.7 73.8 2,774 Lower Egypt 13.7 6.7 8.8 5.9 85.2 10,664 Urban 23.4 14.0 17.8 12.7 74.7 2,319 Rural 11.0 4.7 6.3 4.1 88.2 8,346 Upper Egypt 9.8 5.0 6.8 4.6 89.5 8,130 Urban 19.0 10.6 13.5 9.9 80.1 2,421 Rural 6.0 2.6 3.9 2.3 93.4 5,708 Frontier Governorates1 19.8 10.8 14.0 10.2 79.2 194 Education No education 0.5 0.1 0.4 0.1 99.1 5,232 Some primary 1.7 0.3 0.8 0.3 98.0 1,334 Primary complete/some secondary 5.8 1.9 2.5 1.6 93.8 3,796 Secondary complete/higher 24.0 13.5 16.9 12.4 74.6 11,400 Wealth quintile Lowest 2.6 0.9 1.7 0.7 96.8 3,887 Second 4.4 1.5 2.3 1.3 95.1 4,277 Middle 10.2 4.0 5.9 3.5 89.1 4,839 Fourth 16.4 8.4 10.2 7.5 82.5 4,542 Highest 35.1 22.4 26.9 21.2 63.5 4,217 Total 13.8 7.5 9.4 6.8 85.3 21,762 1 Does not include North and South Sinai governorates 34 • Background Characteristics of Respondents Slightly more than one-quarter of women from Urban Governorates and almost one-fifth of women in the three Frontier Governorates surveyed in the EDHS use a computer at least once a week compared to 14 percent among women from Lower Egypt and 10 percent among women in Upper Egypt. Similar patterns are observed with respect to the use of the Internet and social media. A woman’s education level is related to the likelihood of computer use and also to her level of exposure to digital media, with a clear divide between women who completed secondary school or higher and other women. There also is a strong association between wealth and use of a computer and exposure to digital media. Looking at women reporting use of all three media, for example, 21 percent of women in the highest wealth quintile report used all three media at least once a week compared with 1 percent among women in the lowest two wealth quintiles. 3.5 EMPLOYMENT STATUS Like education, employment can be a source of empowerment for women, especially if it puts them in control of income. The measurement of women’s employment, however, can be difficult. The difficulty arises largely because some of the work that women do, especially work on family farms, family businesses or in the informal sector is often not perceived by women themselves as employment, and hence not reported as such. To avoid underestimating women’s employment, the 2014 EDHS interviewers asked respondents several questions to ensure complete coverage of employment in both the formal or informal sectors. Respondents also were asked a number of questions about their current employment status and employment in the 12 months prior to the survey. For women who were currently employed or had worked in the 12 months before the survey, additional information was obtained on the type of work women were doing, whether they worked continuously throughout the year, whom they worked for, and the form in which they received their earnings (cash or in kind). 3.5.1 Current Employment Table 3.6 shows the percent distribution of 2014 EDHS respondents according to current and recent employment. Appendix Table A-3.4 presents these results by governorate. Overall, 16 percent of women were currently engaged in some economic activity. The rate is the same as the percentage of ever-married women age 15-49 reported as currently employed in the 2008 EDHS. Most of the women who were not working at the time of the survey did not report recent work experience; only 1 percent of the respondents were not working at the time of EDHS interview but had had a job during the 12-month period before the survey. Table 3.6 shows that the proportion of women who were currently employed increased with age, peaking in the 45-49 age group. With regard to the other employment differentials presented in Table 3.6, women living in urban Lower Egypt, women who completed secondary school or higher, and women in the highest wealth quintile were much more likely to be currently employed than other women. Background Characteristics of Respondents • 35 Table 3.6 Employment status Percent distribution of ever-married women age 15-49 by employment status, according to background characteristics, Egypt 2014 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Don’t know/ missing Total Number of ever- married women Background characteristic Currently employed1 Not currently employed Age 15-19 3.1 0.5 96.4 0.0 100.0 764 20-24 5.1 0.4 94.5 0.0 100.0 3,055 25-29 12.5 0.9 86.6 0.0 100.0 4,753 30-34 17.1 0.5 82.3 0.0 100.0 4,127 35-39 20.0 0.6 79.4 0.0 100.0 3,495 40-44 20.3 0.6 79.1 0.0 100.0 2,864 45-49 22.8 0.6 76.6 0.0 100.0 2,705 Marital status Married 14.9 0.6 84.6 0.0 100.0 20,460 Divorced/separated/widowed 25.8 1.4 72.8 0.0 100.0 1,302 Number of living children 0 10.4 1.2 88.5 0.0 100.0 1,948 1-2 14.8 0.5 84.7 0.0 100.0 8,848 3-4 17.9 0.7 81.4 0.0 100.0 8,673 5+ 13.6 0.3 86.1 0.0 100.0 2,293 Urban-rural residence Urban 18.4 0.6 81.0 0.0 100.0 7,623 Rural 14.0 0.6 85.4 0.0 100.0 14,139 Place of residence Urban Governorates 16.2 0.4 83.4 0.0 100.0 2,774 Lower Egypt 17.6 0.8 81.6 0.0 100.0 10,664 Urban 22.1 0.7 77.1 0.1 100.0 2,319 Rural 16.3 0.9 82.8 0.0 100.0 8,346 Upper Egypt 12.5 0.4 87.1 0.0 100.0 8,130 Urban 17.2 0.6 82.2 0.0 100.0 2,421 Rural 10.6 0.3 89.1 0.0 100.0 5,708 Frontier Governorates2 16.8 1.7 81.4 0.0 100.0 194 Education No education 11.2 0.6 88.2 0.0 100.0 5,232 Some primary 12.9 1.3 85.8 0.0 100.0 1,334 Primary complete/some secondary 7.5 0.6 91.9 0.0 100.0 3,796 Secondary complete/higher 20.5 0.6 78.9 0.0 100.0 11,400 Wealth quintile Lowest 13.2 0.6 86.2 0.0 100.0 3,887 Second 11.8 0.8 87.4 0.0 100.0 4,277 Middle 14.0 0.5 85.5 0.0 100.0 4,839 Fourth 16.4 0.7 82.9 0.0 100.0 4,542 Highest 22.2 0.6 77.2 0.0 100.0 4,217 Total 15.5 0.6 83.9 0.0 100.0 21,762 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 2 Does not include North and South Sinai governorates 3.5.2 Occupation During the 2014 EDHS, women who indicated that they were working or had worked within the year before the survey were asked about the kind of work that they did. Their response was recorded exactly as they gave it and was the basis for the coding of occupation that occurred after the survey in the central office. Table 3.7 looks at the differences in the occupational profile among women who were employed at any time during the 12 months before the survey. The majority of women who worked were employed in non-agricultural occupations (Figure 3.1). More than half of the working women were occupied in professional, technical, and managerial positions or in clerical occupations. An 36 • Background Characteristics of Respondents additional 21 percent were employed in sales and services, and 7 percent worked in jobs categorized as skilled manual labor. Sixteen percent of working women were involved in some type of agricultural activity. Table 3.7 Occupation Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Egypt 2014 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agri- culture Mis- sing Total Number of ever- married women employed during the last 12 months Age 15-19 * * * * * * * 100.0 28 20-24 34.5 5.2 15.6 14.3 0.0 30.1 0.3 100.0 167 25-29 52.6 6.2 19.8 6.9 0.4 14.1 0.0 100.0 639 30-34 48.8 9.1 22.3 5.7 0.5 13.5 0.0 100.0 729 35-39 45.8 7.7 21.5 6.0 1.7 17.1 0.2 100.0 720 40-44 45.4 8.1 21.7 7.4 1.8 15.6 0.0 100.0 598 45-49 37.8 16.7 22.9 6.1 1.6 14.9 0.0 100.0 632 Marital status Married 46.6 9.1 20.0 6.2 1.2 16.7 0.1 100.0 3,158 Divorced/separated/ widowed 33.2 9.9 33.5 12.4 0.8 10.0 0.1 100.0 355 Number of living children 0 48.3 7.9 20.2 14.0 0.9 8.7 0.0 100.0 225 1-2 52.4 10.0 18.6 7.3 0.9 10.8 0.0 100.0 1,354 3-4 42.8 9.0 22.8 5.2 1.4 18.7 0.1 100.0 1,615 5+ 25.3 8.3 26.9 7.8 1.4 30.2 0.0 100.0 319 Urban-rural residence Urban 54.6 13.0 21.9 7.9 1.7 0.8 0.1 100.0 1,446 Rural 38.8 6.6 21.0 6.1 0.8 26.7 0.0 100.0 2,067 Place of residence Urban Governorates 46.7 11.9 26.6 10.6 3.8 0.0 0.4 100.0 460 Lower Egypt 44.5 9.1 20.1 6.0 0.9 19.4 0.0 100.0 1,965 Urban 58.7 14.4 17.2 7.2 0.7 1.9 0.0 100.0 529 Rural 39.3 7.1 21.2 5.6 0.9 25.8 0.0 100.0 1,435 Upper Egypt 45.7 8.4 21.3 6.8 0.6 17.2 0.0 100.0 1,053 Urban 57.7 12.6 22.5 6.1 0.6 0.4 0.0 100.0 432 Rural 37.3 5.4 20.5 7.2 0.6 28.9 0.0 100.0 621 Frontier Governorates1 57.1 7.8 23.6 3.7 0.1 7.7 0.0 100.0 36 Education No education 5.2 0.3 32.1 8.8 5.0 48.6 0.0 100.0 618 Some primary 8.7 0.0 35.7 15.8 1.3 38.2 0.4 100.0 190 Primary complete/some secondary 7.1 1.8 37.6 19.4 2.4 31.2 0.5 100.0 304 Secondary complete/higher 63.3 13.2 15.4 4.0 0.0 4.0 0.0 100.0 2,401 Wealth quintile Lowest 13.6 3.9 13.0 4.7 0.9 63.9 0.0 100.0 536 Second 26.6 5.9 28.6 8.3 2.4 28.1 0.1 100.0 540 Middle 47.4 8.5 26.6 7.4 1.0 9.0 0.0 100.0 700 Fourth 54.9 10.8 24.3 7.4 1.8 0.7 0.0 100.0 776 Highest 64.1 13.3 15.8 6.3 0.2 0.2 0.2 100.0 961 Total 45.3 9.2 21.4 6.8 1.2 16.1 0.1 100.0 3,513 Note: An asterisk indicates a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Does not include North and South Sinai governorates Background Characteristics of Respondents • 37 As expected, the proportion involved in professional, technical and managerial occupations and in clerical positions is higher among urban women than rural women. These proportions also rise rapidly with both education and wealth. Overall, more than three-quarters of working women who have attained a secondary or higher education or fall in the highest wealth quintile are employed in professional, technical, managerial or clerical occupations. Figure 3.1 Occupation among working women 3.5.3 Type of Employment Table 3.8 examines several aspects of women’s employment according to the type of occupation (agricultural or non-agricultural). The table shows that the majority of employed women (88 percent) were paid in cash or in cash and kind. Seven in 10 of the women worked for someone other than a relative, 13 percent worked for a family member while 17 percent were self-employed. Most of the women (87 percent) worked year-round, 10 percent were employed seasonally, and 3 percent worked only occasionally. The employment parameters in Table 3.8 varied according to whether a woman worked in an agricultural occupation or not. Women working in agricultural occupations were much more likely than other working women not to be paid for the work they do (56 percent and 4 percent, respectively). This can be explained by the fact that more than half of the women who are employed in agricultural occupations are working for a family member compared with 5 percent of working women who are involved in non-agricultural occupations. As expected, seasonal work is more common among women working in agricultural occupations than among women employed in non- agricultural occupations (38 percent and 5 percent, respectively). Unskilled manual 1.2% Skilled manual 6.8% Agricultural 16.1% Sales and service 21.4% Clerical 9.2% Professional/ technical/ managerial 45.3% EDHS 2014 38 • Background Characteristics of Respondents Table 3.8 Type of employment Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Egypt 2014 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 34.2 94.8 85.1 Cash and in-kind 7.9 1.3 2.4 In-kind only 2.4 0.3 0.6 Not paid 55.5 3.5 11.9 Missing 0.0 0.1 0.0 Total 100.0 100.0 100.0 Type of employer Employed by family member 53.5 4.7 12.6 Employed by nonfamily member 33.8 77.3 70.3 Self-employed 12.7 17.8 17.0 Missing 0.0 0.2 0.1 Total 100.0 100.0 100.0 Continuity of employment All year 56.1 92.8 86.9 Seasonal 38.0 4.6 9.9 Occasional 5.9 2.6 3.1 Missing 0.0 0.1 0.0 Total 100.0 100.0 100.0 Number of ever-married women employed during the last 12 months 564 2,946 3,513 Note: Total includes women with missing information on type of employment who are not shown separately. Fertility • 39 FERTILITY 4 his chapter investigates a number of fertility indicators including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women initiate childbearing. Information on current and cumulative fertility is essential in monitoring the progress and evaluating the impact of the population program in Egypt. The data on birth intervals are important since short intervals are strongly associated with childhood mortality. The age at which childbearing begins also has a major impact on the health and well-being of both the child and the mother. Data on childbearing patterns were collected in the 2014 EDHS in several ways. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who may have died. Next, a complete history of all of the woman’s births was obtained, including the name, sex, month and year of birth, age, and survival status for each of the births. For living children, a question was asked about whether the child was living in the household or away. For dead children, the age at death was recorded. Finally, information was collected on current pregnancies. 4.1 CURRENT FERTILITY LEVELS The level of current fertility is one of the most important topics in this report because of its direct relevance to population policies and programs. A number of measures of current fertility are discussed including age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate. The rates are generally presented for the three-year period preceding the survey, a period covering portions of the calendar years 2011 through 2014. The three-year period was chosen for calculating these rates (rather than a longer or a shorter period) to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births. T Key Findings: • The total fertility rate for the three years prior to the 2014 EDHS is 3.5 births. • In rural areas, the total fertility rate is 3.8 births per woman, around 30 percent higher than the rate in urban areas (2.9 births). • Reversing a more than 25-year pattern of declining fertility, the total fertility rate rose substantially during the six-year period between the 2008 and 2014 surveys, from a level of 3.0 births per woman to 3.5 births per woman. • All geographic areas shared in the rise in fertility that occurred between the 2008 and 2014 EDHS surveys except the Urban Governorates where the rate dropped from 2.6 births in 2008 to 2.5 births in 2014. • One-fifth of non-first births were born within 24 months of a prior birth, an interval which has been shown to place a child at higher risk of mortality. • Childbearing begins early for many Egyptian women; more than one- quarter of women age 25-49 had their first birth by age 20, and 45 percent gave birth by age 22. • Seven percent of adolescents are already mothers, and 4 percent are pregnant with their first child. 40 • Fertility Age-specific fertility rates are useful in understanding the age pattern of fertility. Numerators of age-specific fertility rates are calculated by identifying live births that occurred in the period 1-36 months prior to the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of the child’s birth. The denominators of these rates are the number of woman-years lived in each of the specified five-year age groups in the period 1-36 months prior to the survey. Although information on fertility was obtained only for ever-married women, the age-specific rates are presented for all women regardless of marital status. Data from the household questionnaire on the age structure of the population of never-married women were used to calculate the all-women rates. This procedure assumes that women who have never been married have had no children. The total fertility rate (TFR) is a useful measure for examining the overall level of fertility. It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. The TFR is calculated by summing the age-specific fertility rates for women age 15-49. The general fertility rate (GFR) represents the annual number of births in a population per 1,000 women age 15-44. The crude birth rate (CBR) is the annual number of births in a population per 1,000 persons. Both measures are based on the birth history data for the three-year period before the survey and the age-sex distribution of the household population. Table 4.1 presents estimates of current fertility levels by residence. The total fertility rate indicates that if fertility rates were to remain constant at the level prevailing during the three-year period before the 2014 EDHS (approximately May 2011 to April 2014), an Egyptian woman would bear 3.5 children during her lifetime. In rural areas, the TFR is 3.8 births per woman, around 30 percent higher than the rate in urban areas (2.9 births). Table 4.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Egypt 2014 Age group Urban Rural Urban Governorates Lower Egypt Upper Egypt Frontier Governorates1 Total Total Urban Rural Total Urban Rural 15-19 24 75 23 58 19 71 65 28 79 62 56 20-24 160 243 130 230 174 246 222 176 240 213 213 25-29 182 211 156 205 208 205 210 191 219 230 200 30-34 126 139 111 123 120 125 155 146 160 165 134 35-39 70 68 72 56 60 56 85 77 88 83 69 40-44 18 16 13 11 14 10 25 26 25 27 17 45-49 3 4 2 2 2 3 6 4 7 0 4 TFR(15-49) 2.9 3.8 2.5 3.4 3.0 3.6 3.8 3.2 4.1 3.9 3.5 GFR 103 142 90 128 104 135 139 114 151 141 127 CBR 23.3 32.7 20.2 29.0 23.7 30.7 32.5 26.3 35.4 33.0 29.1 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population 1 Does not include North and South Sinai governorates Looking at the differentials across the place of residence, the highest TFR is observed in rural Upper Egypt (4.1 births per woman), followed by the rates in the three Frontier Governorates covered in the survey (3.9 births per woman) and rural Lower Egypt (3.6 births per woman). The TFR rates in urban Lower Egypt and urban Upper Egypt (3.0 and 3.2 births per woman, respectively) are lower than the TFR for the country as a whole. The TFR in the Urban Governorates (2.5 births per woman) is almost 40 percent lower than the rate in rural Upper Egypt. Fertility • 41 According to the age-specific fertility rates shown in Table 4.1, fertility is concentrated among women age 20-34 years, with the highest rate observed in the 20-24 age group (213 births per thousand). Fertility peaks later among urban women than rural women; the highest age-specific fertility among urban women is in the 25-29 age group (182 births per thousand) while fertility peaks among rural women in the age group 20-24 (243 births per thousand). Urban-rural differences in age- specific fertility are particularly marked among women in their teens. The age-specific fertility rate among rural women age 15-19 years is 75 per thousand, more than three times the rate among urban women age 15-19 years. Estimates of the crude birth rate and the general fertility rate also are presented in Table 4.1. For the period 2011-2014, the crude birth rate was 29 births per thousand population, and the general fertility rate was 127 births per thousand women. Variations are observed in both the CBR and GFR by residence. In general, there is a wide gap between urban and rural areas, with women in rural areas tending to have a much higher CBR and GBR than women in urban areas. By far the lowest rates are found in the Urban Governorates, where the CBR was 20 births per thousand population and the GFR was 90 births per thousand women. The highest rates were observed in rural Upper Egypt where the CBR was 35 births per thousand population, and the GFR was 151 births per thousand women. 4.2 DIFFERENTIALS IN CURRENT AND CUMULATIVE FERTILITY Table 4.2 presents differentials by selected background characteristics in the TFR and two additional fertility measures—the percentage currently pregnant and the mean number of children ever born to women age 40-49. Appendix Table A- 4.1 provides information on governorate-level differences in these fertility measures. The percentage of women who were pregnant at the time of the survey provides a measure of current fertility, although it is subject to some degree of error as women may not recognize or report all first trimester pregnancies. The mean number of children ever born (CEB) among women 40-49 serves as a measure of cumulative fertility, taking into account the past fertility behavior of women who are nearing the end of the reproductive period. If fertility is stable over time in a population, the TFR and the mean CEB for women 40-49 will be similar. The differentials in the fertility measures in Table 4.2 further Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Egypt 2014 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Urban-rural residence Urban 2.9 5.9 3.3 Rural 3.8 8.3 4.2 Place of residence Urban Governorates 2.5 5.2 2.9 Lower Egypt 3.4 7.0 3.6 Urban 3.0 5.7 3.2 Rural 3.6 7.4 3.7 Upper Egypt 3.8 8.6 4.5 Urban 3.2 6.8 3.7 Rural 4.1 9.5 4.9 Frontier Governorates1 3.9 9.3 4.0 Education No education 3.8 5.9 4.3 Some primary 3.5 6.4 4.2 Primary complete/some secondary 3.5 6.3 3.8 Secondary complete/higher 3.5 8.6 3.2 Wealth quintile Lowest 3.6 6.4 4.7 Second 3.6 7.6 4.1 Middle 3.9 8.5 3.7 Fourth 3.5 8.3 3.4 Highest 2.8 6.1 2.9 Total 3.5 7.4 3.8 Note: Total fertility rates are for the period 1-36 months prior to interview. 1 Does not include North and South Sinai governorates 42 • Fertility document the strong influence of residence on fertility in Egypt. For example, the mean CEB among women age 40-49 varies from 2.9 births in the Urban Governorates to 4.9 births in rural Upper Egypt. The current fertility measures in Table 4.2 vary only modestly with education. For example, the TFR decreases from 3.8 children among women with no education to 3.5 among women with some primary education and remains at that level among women with higher education. The variation in completed fertility across educational groups is more pronounced; the mean number of children ever born is 4.3 among women age 40-49 with no education, compared with 3.2 among women who have completed secondary school. The fertility measures in Table 4.2 vary markedly by wealth quintile. The TFR deceases from a level of 3.6 births among women in the lowest wealth quintile to 2.8 births among women in the highest wealth quintile. The highest TFR was reported among women in the middle wealth quintile (3.9 children). The mean number of children ever born among women 40-49 also decreases with wealth, from 4.7 in the lowest quintile to 2.9 in the highest quintile. A comparison of TFR and the mean CEB among women age 40-49 provides an indication of the magnitude and direction of fertility change over the past several decades in Egypt. The recent increase in current fertility has reduced the gap between these two measures. Women age 40-49 had an average of 3.8 births over their lifetime, only 0.3 births more than the current TFR. Considering the patterns for subgroups, the largest difference between current and cumulative fertility is observed in the lowest wealth quintile, where the TFR is 1.1 births lower than the mean number of children ever born to women 40-49. Notably, among women with secondary or higher education, the current TFR is higher than the mean CEB among women age 40-49. A similar pattern is observed among women in middle and fourth wealth quintiles. Among women in the highest wealth quintile, the TFR is only slightly lower than the mean CEB among women age 40-49, suggesting that fertility has remained virtually stable among women in the quintile over the past several decades. Finally, Table 4.2 shows that 7 percent of the 2014 EDHS respondents were pregnant at the time of the survey. Looking at residential differentials, the highest percentage currently pregnant (10 percent) was observed in rural Upper Egypt, while the percentage was lowest in the Urban Governorates (5 percent). Surprisingly, the percentage of women who were pregnant was higher among women with a secondary or higher education than among less educated women. This is due at least in part to the fact that, on average, highly-educated women married at older ages than women in the other education categories and, thus, they were more likely to be in the family-building stage at the time of the survey than less educated women. 4.3 FERTILITY TRENDS 4.3.1 Retrospective Data Table 4.3 uses information from the retrospective birth histories obtained from EDHS respondents to examine trends in age-specific fertility rates for successive five-year periods before the survey. To calculate these rates, births were classified according to the period of time in which the birth occurred and the mother’s age at the time of birth. Because women 50 years and over were not interviewed in the 2014 EDHS, the rates for older age groups become progressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the periods 5-9 years and more prior to the survey, because these women were 50 years or older at the time of the EDHS and, thus, were not interviewed in the survey. Fertility • 43 Overall, the results document a marked decline in age-specific fertility over the 20-year period for which the rates are presented. However, most of the changes occurred at the beginning of the period. Only very modest changes were recorded in the past decade, and age-specific rates for the 20-24 and 25-29 age groups actually rose slightly during the period. 4.3.2 Comparison with Previous Surveys Table 4.4 shows TFR estimates from a series of surveys conducted in Egypt during the period 1979 through 2014. The surveys vary in the timeframes for which the TFR estimates are available. For example, the rates from the EFS, ECPS and the EMCHS are based on births in a one-year period before the survey, while the rates for the DHS surveys are based on a three-year period before the interview date. In general, three-year rates are subject to less sampling variability than one-year rates. The size of the sample covered in a specific survey is another factor related to sampling variability. In general, rates from surveys with comparatively large samples are subject to less sampling variability than rates from surveys with smaller samples. Thus, the TFR for the 2003 Interim DHS has a somewhat greater margin of error than the full scale DHS surveys (i.e., the surveys conducted in 1988, 1992, 1995, 2000, 2005, 2008 and 2014). Sampling errors for the TFRs derived from the 2014 EDHS are presented in Appendix C. As Table 4.4 shows, the results from the various surveys indicate that fertility levels declined almost continuously in Egypt between the 1980 EFS and the 2008 EDHS. The decline in fertility was especially rapid during the period between the mid-1980s and the mid-1990s. During the period between the 1995 and 2008 EDHS surveys, the downward trend in the TFR continued but at a much slower pace, especially in the period between the 2003 and 2008 EDHS surveys. Reversing the long- term pattern of declining fertility, the TFR rose substantially during the six-year period between the 2008 and 2014 surveys, from a level of 3.0 births per woman to 3.5 births per woman. Table 4.4 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates, Egypt 1980-2014 Age EFS ECPS 1988 EDHS 1991 EMCHS 1992 EDHS 1995 EDHS 2000 EDHS 2003 Interim EDHS 2005 EDHS 2008 EDHS 2014 EDHS 1979- 19801 1983- 19841 1986- 19882 1990- 19911 1990- 19922 1993- 19952 1997- 20002 2000- 20032 2002- 20052 2005- 20082 2011- 20142 15-19 78 73 72 73 63 61 51 47 48 50 56 20-24 256 205 220 207 208 200 196 185 175 169 213 25-29 280 265 243 235 222 210 208 190 194 185 200 30-34 239 223 182 158 155 140 147 128 125 122 134 35-39 139 151 118 97 89 81 75 62 63 59 69 40-44 53 42 41 41 43 27 24 19 19 17 17 45-49 12 13 6 14 6 7 4 6 2 2 4 TFR 15-49 5.3 4.9 4.4 4.1 3.9 3.6 3.5 3.2 3.1 3.0 3.5 Note: Rates for the age group 45-49 may be slightly biased due to truncation. Source: El-Zanaty and Way, 2009, Table 4.4 1 Rates are for the 12-month period preceding the survey. 2 Rates are for the 36-month period preceding the survey. Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother’s age at the time of the birth, Egypt 2014 Number of years preceding survey Mother’s age at birth 0-4 5-9 10-14 15-19 15-19 57 58 59 69 20-24 204 201 201 206 25-29 198 197 206 224 30-34 130 131 141 [163] 35-39 66 68 [88] - 40-44 17 [26] - - 45-49 [3] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 44 • Fertility Figure 4.1 highlights that all age groups shared in the recent rise in fertility rates except women age 40-49 years. The increase was highest among women in the 20-24 age group; fertility rose by 26 percent in this age group between the 2008 EDHS and the 2014 EDHS. As a result of the differences in the pace of fertility change across various age groups, childbearing has become somewhat more concentrated among women under age 30. Currently, a woman will have an average of 2.3 births by her 30th birthday, roughly two-thirds of her lifetime births. Figure 4.1 Trends in age-specific fertility, Egypt 2008-2014 Table 4.5 highlights the trends in fertility by residence between the 1988 EDHS and the 2014 EDHS.1 Urban fertility declined between the 1988 and 1992 surveys, from 3.5 to 2.9 births. The decline levelled off early in the 1990s, with the urban TFR fluctuating around three births throughout the remainder of the decade, before falling to a level of 2.6 births in 2003. During the period between the 2003 and 2014 EDHS surveys, urban fertility increased to 2.9 births, a level last recorded in the urban areas more than 20 years earlier in the 1992 EDHS. In rural areas, fertility levels declined from 5.4 births per woman at the time of the 1988 EDHS to 3.2 births per woman at the time of the 2008 EDHS before increasing by 19 percent to 3.8 births per woman in 2014. The absolute increase in the rural TFR between 2008 and 2014 was three times that observed in urban areas during the period (0.6 births per woman and 0.2 births per woman, respectively). Looking at variations by the place of residence, declines in fertility were observed in all areas between the 1988 and 2008 surveys. Figure 4.2 shows that all areas shared in the rise in fertility that occurred between the 2008 and 2014 EDHS surveys except the Urban Governorates where the TFR decreased slightly from 2.6 births in 2008 to 2.5 births in 2014. The largest absolute increases in the TFR were observed in the three surveyed Frontier Governorates and rural Lower Egypt. 1 Residential differentials in the TFR are not available for the 1980 EFS and the 1984 ECPS surveys. 0 50 100 150 200 250 15-19 20-24 25-29 30-34 35-39 40-44 45-49 2008 2014 Births per 1,000 women Age (years) Fertility • 45 Table 4.5 Trends in fertility by residence Total fertility rates by urban-rural residence and place of residence, Egypt 1988-2014 Residence 1988 EDHS 1991 EMCHS 1992 EDHS 1995 EDHS 2000 EDHS 2003 Interim EDHS 2005 EDHS 2008 EDHS 2014 EDHS 1986- 19882 1990- 19911 1990- 19922 1993- 19952 1997- 20002 2000- 20032 2002- 20052 2005- 20082 2011- 20142 Urban-rural residence Urban 3.5 3.3 2.9 3.0 3.1 2.6 2.7 2.7 2.9 Rural 5.4 5.6 4.9 4.2 3.9 3.6 3.4 3.2 3.8 Place of residence Urban Governorates 3.0 2.9 2.7 2.8 2.9 2.3 2.5 2.6 2.5 Lower Egypt 4.5 U 3.7 3.2 3.2 3.1 2.9 2.9 3.4 Urban 3.8 3.5 2.8 2.7 3.1 2.8 2.7 2.6 3.0 Rural 4.7 4.9 4.1 3.5 3.3 3.2 3.0 3.0 3.6 Upper Egypt 5.4 U 5.2 4.7 4.2 3.8 3.7 3.4 3.8 Urban 4.2 3.9 3.6 3.8 3.4 2.9 3.1 3.0 3.2 Rural 6.2 6.7 6.0 5.2 4.7 4.2 3.9 3.6 4.1 Frontier Governorates3 U U U 4.1 3.9 U 3.3 3.2 3.9 TFR 15-49 4.4 4.1 3.9 3.6 3.5 3.2 3.1 3.0 3.5 Note: Rates for the age group 45-49 may be slightly biased due to truncation. U = Unavailable Source: El-Zanaty and Way, 2009, Table 4.5 1 Rates are for the 12-month period preceding the survey. 2 Rates are for the 36-month period preceding the survey. 3 Does not include North and South Sinai governorates Figure 4.2 Trends in fertility by residence, Egypt 2008-2014 4.4 CHILDREN EVER BORN AND LIVING Table 4.6 presents the distributions of all women and currently married women by the total number of children ever born. These distributions reflect the accumulation of births among EDHS respondents over the past 30 years and, therefore, their relevance to the current situation is limited. However, the information is useful in looking at how the average family size varies across age groups and for looking at the level of primary infertility. Since only ever-married women were interviewed in the 2014 EDHS, information on the reproductive histories of never-married women is not available. However, virtually all births in Egypt 3.0 2.6 2.9 2.6 3.0 3.4 3.0 3.63.5 2.5 3.4 3.0 3.6 3.8 3.2 4.1 Total Egypt Urban Governorates Total Urban Rural Total Urban Rrual Births per woman 2008 EDHS 2014 EDHS EDHS 2014 Lower Egypt Upper Egypt 46 • Fertility occur within marriage; thus, in calculating these fertility measures for all women, never-married women were assumed to have had no births. The marked differences between the results for currently married women and for all women at the younger ages are due to the comparatively large numbers of never-married women in those age groups who, as noted, are assumed to have had no births. Table 4.6 indicates that the average Egyptian woman has given birth to 2 children. Out of that number, 1.9 children are still alive, indicating that around 5 percent of the children ever born to EDHS respondents have died. Reflecting the natural family-building process, the number of children that women have borne increases directly with age from an average of less than one child among women age 20-24 to an average of 4.0 births among women 45-49. As expected, the likelihood that at least one of a woman’s children has died also increases with the woman’s age. Out of the average of 4.0 children born to women 45-49, an average of 0.3 children or 8 percent are no longer alive. Table 4.6 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Egypt 2014 Number of children ever born Total Number of women Mean number of children ever born Mean number of living childrenAge 0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN 15-19 93.3 5.8 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 5,185 0.08 0.07 20-24 50.9 24.5 19.2 4.4 1.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 5,003 0.80 0.78 25-29 19.8 16.6 35.1 20.7 6.1 1.5 0.2 0.0 0.0 0.0 0.0 100.0 5,455 1.82 1.77 30-34 11.0 6.9 24.4 33.0 16.2 6.1 1.8 0.5 0.1 0.1 0.0 100.0 4,429 2.66 2.57 35-39 6.0 4.1 18.4 30.5 23.0 10.7 4.6 1.9 0.5 0.3 0.1 100.0 3,605 3.26 3.13 40-44 5.3 4.1 14.2 27.2 24.2 13.1 6.0 3.0 1.5 1.1 0.5 100.0 2,921 3.59 3.40 45-49 5.5 3.2 12.6 21.6 22.2 15.4 7.3 5.8 3.6 1.6 1.1 100.0 2,751 4.00 3.69 Total 32.3 10.6 18.5 18.1 11.1 5.3 2.2 1.2 0.6 0.3 0.2 100.0 29,349 2.02 1.93 CURRENTLY MARRIED WOMEN 15-19 53.8 39.9 6.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 746 0.53 0.51 20-24 19.3 40.0 31.9 7.0 1.7 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,980 1.32 1.28 25-29 7.7 18.5 40.6 24.2 7.1 1.7 0.2 0.0 0.0 0.0 0.0 100.0 4,610 2.11 2.05 30-34 3.9 6.5 26.2 35.9 17.8 6.7 2.0 0.6 0.1 0.1 0.0 100.0 3,981 2.90 2.80 35-39 2.5 3.4 18.2 32.3 24.3 11.5 4.9 2.1 0.6 0.3 0.1 100.0 3,282 3.43 3.29 40-44 3.0 2.8 13.7 28.4 25.3 14.0 6.4 3.1 1.6 1.1 0.5 100.0 2,579 3.75 3.56 45-49 3.6 2.2 12.6 22.3 22.4 16.0 8.0 5.9 4.1 1.8 1.2 100.0 2,282 4.15 3.82 Total 8.5 13.9 25.2 24.7 14.9 7.1 2.9 1.5 0.8 0.4 0.2 100.0 20,460 2.74 2.61 4.5 BIRTH INTERVALS 4.5.1 Intervals between Births A child’s health status is closely related to the length of preceding birth interval. Research has shown that children born too soon after a previous birth (i.e., within 24 months) are at greater risk of illness and death than those born after a longer interval. In addition, short birth intervals may have consequences for other children in the family. The occurrence of closely spaced births gives the mother insufficient time to restore her health, which may limit her ability to take care of her children. The duration of breastfeeding for the older child may also be shortened if the mother becomes pregnant. Table 4.7 shows the percent distributions of second order and higher (non-first) births in the five years preceding the survey by length of the previous birth interval according to selected Fertility • 47 background characteristics. Information on the length of birth intervals is also presented by governorate in Appendix Table A-4.2. Table 4.7 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Egypt 2014 Months since preceding birth Total Number of non-first births Median number of months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 43.4 25.1 27.4 3.7 0.4 0.0 100.0 49 18.8 20-29 11.4 14.9 36.6 21.6 9.2 6.3 100.0 5,271 31.7 30-39 5.2 8.5 22.0 17.8 14.9 31.6 100.0 4,783 45.4 40-49 1.1 3.4 11.0 13.1 9.1 62.4 100.0 604 75.8 Sex of preceding birth Male 7.6 11.4 27.7 19.1 11.6 22.5 100.0 5,473 37.5 Female 8.9 11.4 29.5 19.6 11.8 18.8 100.0 5,233 36.1 Survival of preceding birth Living 7.4 11.2 28.7 19.6 11.9 21.1 100.0 10,333 37.1 Dead 30.7 17.2 24.6 11.8 7.5 8.2 100.0 373 24.4 Birth order 2-3 9.6 12.4 31.4 19.7 11.1 15.8 100.0 7,731 34.7 4-6 4.6 9.0 21.2 18.2 13.5 33.5 100.0 2,731 45.7 7+ 5.8 6.9 21.4 20.9 12.8 32.3 100.0 245 45.3 Urban-rural residence Urban 7.7 10.1 26.6 19.1 12.2 24.2 100.0 3,289 38.6 Rural 8.4 12.0 29.5 19.5 11.5 19.1 100.0 7,417 36.0 Place of residence Urban Governorates 7.8 9.8 26.0 20.0 13.0 23.5 100.0 1,059 38.8 Lower Egypt 6.9 10.7 29.2 19.9 11.8 21.5 100.0 4,898 37.3 Urban 7.5 8.9 28.8 18.3 12.2 24.3 100.0 952 38.1 Rural 6.7 11.1 29.3 20.3 11.7 20.8 100.0 3,946 37.0 Upper Egypt 9.6 12.4 28.5 18.7 11.4 19.3 100.0 4,642 35.7 Urban 7.7 11.2 25.2 19.0 11.8 25.1 100.0 1,224 39.0 Rural 10.3 12.9 29.7 18.6 11.3 17.3 100.0 3,418 34.9 Frontier Governorates1 12.1 15.5 27.5 17.9 9.6 17.3 100.0 107 34.1 Education No education 7.5 9.9 27.7 19.1 11.3 24.6 100.0 2,291 38.5 Some primary 7.9 8.9 22.9 18.8 14.7 26.7 100.0 581 42.7 Primary complete/some secondary 9.8 12.0 27.0 20.1 11.5 19.7 100.0 1,872 36.5 Secondary complete/higher 8.0 12.1 30.0 19.3 11.7 18.9 100.0 5,963 36.0 Work status Working for cash 7.4 9.8 25.9 20.4 11.5 25.1 100.0 1,206 39.3 Not working for cash 8.3 11.6 28.9 19.2 11.7 20.1 100.0 9,500 36.5 Wealth quintile Lowest 9.9 13.0 27.3 19.3 11.1 19.3 100.0 2,128 35.9 Second 9.0 10.2 28.3 19.9 12.9 19.8 100.0 2,259 37.3 Middle 6.8 11.8 31.1 19.0 11.7 19.6 100.0 2,589 36.1 Fourth 7.8 11.5 28.8 19.6 10.4 22.0 100.0 2,085 36.8 Highest 7.7 10.4 26.6 18.8 12.7 23.8 100.0 1,644 38.4 Total 8.2 11.4 28.6 19.4 11.7 20.7 100.0 10,706 36.7 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 1 Does not include North and South Sinai governorates Birth intervals during the period were relatively long. About four-fifths of births took place at least two years after a prior birth and more than half of the births took place at least 3 years after a 48 • Fertility prior birth. The median interval was 36.7 months, which was slightly shorter than the median interval observed at the time of the 2008 EDHS (37.5 months). Overall, one-fifth of non-first births were born too soon after a prior birth, i.e., within 24 months of a previous birth. Table 4.7 shows that younger women have shorter birth intervals than older women. The median interval varied from 18.8 months among the small number of births to women age 15-19 to 75.8 months among births to women age 40-49. The median birth interval was almost 13 months longer in cases where the prior birth was alive than when that child had died (37.1 months and 24.4 months, respectively). The median birth interval in urban areas was 38.6 months, compared with 36 months in rural areas. Birth intervals were longer in urban Upper Egypt (39 months) than in Urban Governorates and urban Lower Egypt (38.8 and 38.1 months, respectively). In rural areas, the median birth interval was longer in Lower Egypt (37 months) than in Upper Egypt (34.9 months). The median birth interval was shortest in the three surveyed Frontier Governorates (34.1 months). No clear association is observed between the woman’s educational level and the average birth interval. However, intervals are longer for births to women who were working for cash than for births to other women (39.3 months and 36.5 months, respectively). Also, the median birth interval among women in the highest wealth quintile was around 2 months longer than that observed among women in the lowest quintile. 4.5.2 Attitudes about the Ideal Birth Interval Ever-married women were asked about the ideal length of time that a woman should wait between births. The responses for this question are presented in Table 4.8. Almost six in ten women believe a woman should wait three or more years between births and 14 percent think that ideally a woman should wait at least four years before having another child. Although these attitudes are encouraging, it also must be noted that around two-fifths of the women think that the ideal spacing between births should be less than three years. Women in urban areas, particularly in the Urban Governorates, are much less likely than rural women to think births should be spaced less than three years apart. Table 4.8 Ideal birth interval by residence Percentage distribution of ever-married women age 15-49 by the length of time that a woman should wait between births by urban-rural residence and place of residence, Egypt 2014 Ideal interval between births Urban Rural Urban Gover- norates Lower Egypt Upper Egypt Frontier Gover- norates1 Total Total Urban Rural Total Urban Rural 1 year 1.8 3.3 1.4 1.9 1.4 2.0 4.3 2.4 5.1 7.0 2.8 2 years 33.3 40.9 31.8 37.6 32.6 39.0 40.9 34.9 43.4 56.0 38.3 3 years 47.3 42.7 47.7 47.0 49.4 46.3 40.1 45.5 37.8 24.6 44.3 4 years 11.8 8.7 12.7 9.2 11.4 8.6 9.6 11.4 8.8 6.9 9.8 5 years 5.2 3.4 5.8 3.7 4.6 3.5 3.9 5.1 3.4 3.5 4.0 Don’t know 0.5 0.8 0.5 0.5 0.5 0.5 1.0 0.4 1.3 2.1 0.7 Missing 0.1 0.1 0.1 0.1 0.0 0.2 0.2 0.3 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of ever- married women 7,623 14,139 2,774 10,664 2,319 8,346 8,130 2,421 5,708 194 21,762 1 Does not include North and South Sinai governorates Fertility • 49 4.6 AGE AT FIRST BIRTH The age at which childbearing begins has important demographic consequences for society as a whole as well as for the health and welfare of mother and child. In many countries, postponement of first births has contributed greatly to overall fertility decline. Table 4.9 presents the distribution of women by age at first birth, according to their current age. For women under age 25, the median age at first birth is not shown because less than 50 percent of women in those ages had given birth at the time of the survey. Table 4.9 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Egypt 2014 Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth Current age 15 18 20 22 25 15-19 0.3 na na na na 93.3 5,185 a 20-24 0.5 6.7 24.4 na na 50.9 5,003 a 25-29 0.8 7.6 23.4 43.5 69.4 19.8 5,455 22.7 30-34 1.2 10.5 24.9 43.4 67.4 11.0 4,429 22.7 35-39 1.5 11.3 26.6 45.1 68.4 6.0 3,605 22.6 40-44 1.7 11.9 27.6 47.2 69.3 5.3 2,921 22.3 45-49 1.9 14.6 31.3 48.6 70.1 5.5 2,751 22.2 20-49 1.1 9.8 25.8 na na 19.2 24,164 a 25-49 1.3 10.6 26.1 45.0 68.8 10.9 19,161 22.6 na = Not applicable due to censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group The results in Table 4.9 indicate that childbearing begins early for many Egyptian women. More than one- quarter of women age 25-49 had their first birth by age 20 and 45 percent gave birth by age 22. Women in younger cohorts are less likely than older women to have given birth to their first child while they were in their teens. For example, among women age 45-49, 31 percent had become a mother by age 20, while only 24 percent of women age 20-24 had given birth to their first child by age 20. Overall, Table 4.9 shows that the median age at first birth ranges from a low of 22.2 years among women age 45-49 to 22.7 years among women age 25-29. These cohort changes parallel increases in the median age at first marriage during the same period (see Chapter 7). Table 4.10 presents differentials in the median age at first birth across age cohorts for key background characteristics. Governorate-level differentials are presented in Appendix Table A-4.3. The measures are presented for women age 25-49 years to ensure that half of the women have already had a birth. Overall, the median age at first birth is 22.6 years for women 25-49. However, there are large differences in the age at which women first gave birth among the various subgroups. Urban women started childbearing 2.3 years later than their Table 4.10 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Egypt 2014 Background characteristic Women age 25-49 Urban-rural residence Urban 24.0 Rural 21.7 Place of residence Urban Governorates 24.6 Lower Egypt 22.4 Urban 23.6 Rural 22.1 Upper Egypt 21.8 Urban 23.5 Rural 21.1 Frontier Governorates1 22.9 Education No education 20.7 Some primary 20.7 Primary complete/some secondary 21.1 Secondary complete/higher 23.8 Wealth quintile Lowest 21.0 Second 21.4 Middle 22.1 Fourth 23.1 Highest 24.7 Total 22.6 1 Does not include North and South Sinai governorates 50 • Fertility rural counterparts. On average, women in rural Upper Egypt had their first birth one year earlier than women in rural Lower Egypt and 3.5 years earlier than women in the Urban Governorates. There is a clear association between women’s education and age at which they start childbearing. Women who have a secondary or higher education had their first birth an average of about three years later than women with no education. The median age at first birth is also is strongly associated with the wealth quintile. There is a difference of 3.7 years in the median age at first birth between women in the highest wealth quintile and women in the lowest wealth quintile. 4.7 TEENAGE PREGNANCY AND MOTHERHOOD Teenage fertility is a major health concern because teenage mothers and their children are at high risk of illness and death. Childbearing during the teenage years also frequently has other adverse social consequences, particularly for female educational attainment, as women who become mothers in their teens are more likely to curtail education. Table 4.11 highlights the percentage of women age 15-19 who are mothers or who are pregnant with their first child. Information on governorate-level variation in the level of teenage pregnancy and motherhood are shown in Appendix Table A-4.4. The overall level of teenage childbearing is 11 percent. Comparing the 2014 data with results from the previous EDHS surveys, a slow but steady upward trend is observed, from 9 percent in 2005 to 10 percent in 2008 and finally 11 percent in 2014. Table 4.11 shows that the proportion of women who have begun childbearing rises rapidly throughout the teenage years, from less one percent among 15-year-olds to 8 percent among 17-year- olds, 16 percent among 18-year-olds, and 27 percent among 19-year-olds. There are significant residential differences in the level of teenage childbearing. In rural areas, the level of teenage fertility (14 percent) is almost three times the level in urban areas (5 percent). Considering place of residence, the highest levels of teenage childbearing are found in rural Lower Egypt and rural Upper Egypt (14 percent each) and the lowest in the Urban Governorates (4 percent). The level of teenage fertility does not vary in a consistent direction with education or wealth. Fertility • 51 Table 4.11 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child, and percentage who have begun childbearing, by background characteristics, Egypt 2014 Percentage of women age 15-19 who: Percentage who have begun childbearing Number of women Background characteristic Have had a live birth Are pregnant with first child Age 15 0.6 0.7 1.3 1,055 16 1.6 1.6 3.2 1,069 17 4.7 3.3 7.9 1,043 18 9.5 6.8 16.3 1,045 19 18.3 9.1 27.4 973 Urban-rural residence Urban 2.9 2.1 5.0 1,905 Rural 8.9 5.4 14.3 3,304 Place of residence Urban Governorates 2.0 1.5 3.6 689 Lower Egypt 7.6 4.8 12.4 2,338 Urban 3.6 2.9 6.5 573 Rural 8.9 5.4 14.3 1,763 Upper Egypt 7.3 4.4 11.6 2,131 Urban 3.1 1.9 5.1 618 Rural 8.9 5.4 14.2 1,523 Frontier Governorates1 6.5 4.5 11.0 44 Education No education 11.7 6.4 18.1 204 Some primary 12.2 4.3 16.5 270 Primary complete/some secondary 5.3 3.1 8.4 3,817 Secondary complete/higher 10.2 8.5 18.7 886 Wealth quintile Lowest 6.8 2.4 9.2 1,203 Second 6.3 4.5 10.8 1,107 Middle 11.5 7.5 19.0 873 Fourth 8.0 5.1 13.1 1,005 Highest 1.8 2.2 4.0 1,004 Total 6.7 4.2 10.9 5,185 1 Does not include North and South Sinai governorates Fertility Preferences • 53 FERTILITY PREFERENCES 5 etailed investigation of the fertility desires in a population is important, both for estimating the potential unmet need for family planning and for predicting future fertility. This chapter presents data from the 2014 EDHS on the fertility intentions and desired family size among Egyptian women. Also, the chapter considers the potential effect on fertility if unwanted pregnancies were prevented. 5.1 DESIRE FOR MORE CHILDREN The 2014 EDHS obtained information on fertility preference by asking non-sterilized currently married women the question: “Would you like to have (a/another) child or would you prefer not to have any (more) children?” For pregnant women, the question was prefaced by the wording, “After the child you are expecting. . . .” Women who wanted more children were then asked how long they would like to wait before the birth of their next child. Sterilized women were considered to want no more children for the purposes of the fertility preference tabulations presented in this chapter. Table 5.1 and Figure 5.1 show the reproductive intentions of currently married women interviewed in the 2014 EDHS. The majority of married women did not want any more children (59 percent) or were sterilized (1 percent). Almost all of the remaining women (33 percent) wanted another child. Among those wanting another child, the majority—18 percent of all currently married women—either wanted to wait two years or more to have the next birth or were unsure of when they wanted another child. Less than half of the women who wanted another child—15 percent of all currently married women—wanted a child soon (within two years). The fertility preferences of the 2014 EDHS respondents are not very different from the preferences expressed at the time of the 2008 EDHS when 62 percent of currently married women did not want another child or were sterilized, 17 percent wanted to delay the next birth, and 14 wanted another child soon. D Key Findings: • Six in ten currently married women do not want another birth or are sterilized, and 17 percent would like to delay the next birth for at least two years. • The average married woman considers a three-child family to be ideal. • More than one-fifth of married women believe their husband wants more children than they do. • One in 6 births in the five-year period before the EDHS was either not wanted at the time or not wanted at all. • The total wanted fertility (2.8 births per woman) is lower than the current TFR (3.5 births per woman) but higher than the wanted fertility rate at the time of the 2008 EDHS (2.4 births per woman). 54 • Fertility Preferences Table 5.1 Fertility preferences by number of living children Percent distribution of currently married women 15-49 by desire for children, according to number of living children, Egypt 2014 Number of living children1 Total 15-49 Desire for children 0 1 2 3 4 5 6+ Have another soon2 90.4 31.0 13.5 5.0 2.3 1.9 0.4 14.9 Have another later3 0.5 57.3 23.2 6.6 2.4 1.4 1.5 17.1 Have another, undecided when 1.0 3.8 1.8 0.7 0.2 0.3 0.0 1.3 Undecided 0.4 1.4 7.2 4.5 2.8 1.7 1.2 4.0 Want no more 0.9 5.3 52.5 79.9 86.4 88.0 87.4 59.1 Sterilized 0.0 0.0 0.2 1.0 2.9 3.5 4.9 1.2 Declared infecund 6.7 1.2 1.5 2.2 3.0 3.1 4.5 2.4 Missing 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,089 3,056 5,465 5,469 3,132 1,364 885 20,460 1 The number of living children includes the current pregnancy. 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years As expected, Table 5.1 shows that the desire for a child is strongly related to the number of living children the woman already had. There was very little interest in spacing the first birth. Nine in ten women who had not yet begun childbearing at the time of the survey wanted a birth soon. More than 9 in 10 women who had one child expressed a desire to have another child. However, the majority (57 percent) of women with one child wanted to wait two years or more to have the next birth. Among women with more than one child, the desire to cease childbearing increased rapidly with the number of children, from 53 percent among women with two children to 80 percent among women with three children. Figure 5.1 Desire for more children among currently married women Want another later 17.1% Want another soon 14.9% Want another, unsure about timing 1.3% Undecided 4.0% Declared infecund 2.4% Want no more/sterilized 60.3% Egypt 2014 Fertility Preferences • 55 Table 5.2 presents the variation in the percentage of currently married women who wanted no more children or who were sterilized with the number of living children (including any current pregnancy) for various subgroups. Governorate-level variations in the percentage of women wanting no more children are found in Appendix Table A-5.1. Table 5.2 Desire to limit childbearing Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Egypt 2014 Number of living children1 Total Background characteristic 0 1 2 3 4 5 6+ Urban-rural residence Urban 1.6 7.7 60.9 85.4 92.5 91.3 94.9 63.6 Rural 0.5 4.1 47.4 78.3 87.8 91.6 91.8 58.6 Place of residence Urban Governorates 1.0 8.0 68.8 88.3 95.0 93.0 (82.5) 64.9 Lower Egypt 1.2 5.6 58.2 87.3 92.8 93.3 92.2 63.8 Urban 3.3 9.2 61.5 86.8 92.8 88.7 (97.8) 65.0 Rural 0.6 4.7 57.2 87.5 92.8 94.2 91.2 63.5 Upper Egypt 0.6 3.9 34.4 66.6 83.9 90.4 92.9 54.3 Urban 1.0 6.0 48.8 81.0 90.2 91.4 97.8 61.3 Rural 0.4 3.1 26.3 58.4 81.7 90.1 92.0 51.3 Frontier Governorates2 0.0 4.4 40.4 75.1 86.0 85.2 87.1 54.0 Education No education 1.8 11.4 57.5 79.5 87.5 90.8 91.5 72.0 Some primary 0.0 6.2 51.1 81.2 88.2 91.5 91.8 68.8 Primary complete/some secondary 0.2 3.4 49.2 79.3 90.6 91.3 91.9 55.4 Secondary complete/higher 0.9 4.8 52.7 82.0 90.2 92.8 97.1 55.9 Work status Working for cash 1.5 9.6 60.2 84.2 91.6 95.8 98.5 67.9 Not working 0.8 4.8 51.6 80.3 88.9 91.0 91.8 59.2 Wealth quintile Lowest 1.5 5.2 42.7 73.3 86.4 93.1 90.6 64.4 Second 0.1 4.4 43.7 77.7 86.5 90.2 93.7 61.4 Middle 0.8 3.8 49.9 80.9 90.7 90.0 94.0 57.3 Fourth 1.2 4.8 56.5 83.0 91.3 89.6 96.5 57.9 Highest 0.8 8.2 63.1 87.5 93.4 95.6 90.3 61.7 Total 0.9 5.3 52.8 80.9 89.2 91.5 92.4 60.3 Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases. 1 The number of living children includes the current pregnancy 2 Does not include North and South Sinai governorates Table 5.2 shows that urban women express a desire to limit family size at lower parities than rural women. For example, 61 percent of urban women with two children wanted to stop childbearing, compared with 47 percent of rural women with two children. The urban-rural differential in the desire for children narrows at higher parities; more than 90 percent of urban and rural residents with five or more children wanted no more children. Looking at the differentials by place of residence, married women living in rural Upper Egypt and the Frontier Governorates were generally the least likely to want to limit childbearing. For example, more than 8 in 10 married women with three children in the Urban Governorates and in both urban and rural areas in Lower Egypt wanted no more children (or were sterilized). In contrast, 58 percent of married women with three children in rural Upper Egypt and 75 percent in the three Frontier Governorates wanted to limit childbearing. Results also show that, overall, the proportion wanting no more children generally declined as the woman’s educational level increased. To some extent, this pattern reflects the interrelationships between a woman’s age, education level and her fertility preferences; educational levels are higher 56 • Fertility Preferences among younger women than older women and younger women are more likely to want another child than older women. Women who were working for cash were slightly more likely to want to limit childbearing than other women, regardless of the number of children the woman had. The desire to limit childbearing was positively related to wealth among women who had between two and four children. At higher parities, 90 percent or more of women wanted no more children, regardless of the wealth quintile. 5.2 IDEAL NUMBER OF CHILDREN The discussion of fertility preferences earlier in this chapter focused on the respondent’s wishes for the future. A woman’s preferences obviously are influenced by the number of children she already has. The 2014 EDHS attempted to obtain a measure of fertility preferences that was less dependent on the woman’s current family size by asking about the respondent’s ideal number of children. The question about ideal family size required a woman to perform the difficult task of considering the number of children she would choose to have in her whole life regardless of the number (if any) that she had already borne. Four percent of women gave a nonnumeric response to the question about ideal family size, reflecting the difficulty that these respondents had with the abstract nature of the question. Table 5.3 shows the distribution of ever-married women by their ideal number of children, according to number of living children. In considering the results in Table 5.3, it is important to remember that for several reasons, the ideal number of children tends to be fairly closely associated with the actual number of children a woman has. First, women who want a large family tend to have more children than other women. Second, women may rationalize their ideal family size so that as the actual number of children increases, their preferred family size also increases. Furthermore, women with a larger family—being on average older than women with small families—may prefer a larger ideal family size because of attitudes that they acquired 20 to 30 years ago. Table 5.3 shows that 37 percent of ever-married women wanted a two-child family, while 29 percent considered a three-child family ideal and another 19 percent expressed their preference for a four-child family. Relatively few women wanted five or more children. As expected, higher parity women showed a preference for more children; the mean ideal number of children ranged from 2.7 children among women with one child to 4.4 children among women with six or more children. Overall, the mean ideal family size was 3.0 children, which is slightly higher than the average ideal number of children reported at the time of the 2008 Egypt DHS (2.9 children). The results in Table 5.3 also indicate that many higher-parity women have had more children than they would now prefer. For example, 46 percent of EDHS respondents with four children said that they would have preferred to have three or fewer children. About two-thirds of the women with five children considered a smaller family ideal. Fertility Preferences • 57 Table 5.3 Ideal number of children by number of living children Percent distribution of ever-married women 15-49 by ideal number of children, and mean ideal number of children for ever-married women and for currently married women, according to the number of living children, Egypt 2014 Number of living children1 Total Ideal number of children 0 1 2 3 4 5 6+ 0 0.7 0.2 0.6 0.3 0.5 0.3 0.6 0.4 1 11.8 3.1 1.9 1.6 0.7 0.4 0.6 2.2 2 44.3 51.2 52.1 29.2 24.2 17.2 9.0 37.0 3 18.2 28.0 26.8 42.7 20.9 23.2 18.1 29.1 4 14.8 11.0 13.2 17.5 38.7 26.0 26.0 19.4 5 3.0 1.5 1.6 2.9 5.5 15.6 11.0 4.0 6+ 2.8 2.4 1.5 2.2 4.8 9.3 21.4 3.8 Non-numeric responses 4.3 2.7 2.3 3.6 4.7 7.9 13.4 4.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of ever-married women 1,242 3,330 5,755 5,727 3,314 1,444 949 21,762 Mean ideal number of children for:2 Ever-married women 2.6 2.7 2.6 3.0 3.5 3.8 4.4 3.0 Number of ever-married women 1,189 3,241 5,623 5,520 3,158 1,330 822 20,883 Currently married women 2.7 2.7 2.7 3.0 3.5 3.8 4.4 3.0 Number of currently married women 1,046 2,977 5,340 5,281 2,988 1,255 763 19,651 1 The number of living children includes any current pregnancy. 2 Means are calculated excluding respondents who gave non-numeric responses. The mean ideal number of children is presented by background characteristics in Table 5.4 and by governorate in Appendix Table A-5.1. As expected, there is a positive association between the ideal number of children and women’s age. The mean ideal number of children increases from 2.8 children among women younger than 30 years old to 3.3 children among women in the age cohort 45-49. The mean ideal number of children is higher among women in rural areas

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