Rwanda: Demographic and Health Survey 2019-20

Publication date: 2021

Rwanda Demographic and Health Survey 2019-20 R w anda 2019-20 D em ographic and H ealth S urvey Republic of Rwanda Rwanda Demographic and Health Survey 2019-20 Final Report National Institute of Statistics of Rwanda Kigali, Rwanda Ministry of Health Kigali, Rwanda The DHS Program ICF Rockville, Maryland, USA September 2021 The 2019-20 Rwanda Demographic and Health Survey (2019-20 RDHS) was implemented by the National Institute of Statistics of Rwanda (NISR) in collaboration with the Ministry of Health (MOH). The funding for the 2019-20 RDHS was provided by the Government of Rwanda, United States Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), Enabel (Belgian Development Agency), UNWOMEN, and the Centers for Disease Control and Prevention (CDC). ICF provided technical assistance through The DHS Program, a USAID-funded project that provides support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2019-20 RDHS may be obtained from the National Institute of Statistics of Rwanda, 6139 Kigali, Rwanda; telephone: +250 788 383 103; email: info@statistics.gov.rw; website: www.statistics.gov.rw. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; telephone: +1-301-407-6500; fax: +1-301-407-6501; email: info@DHSprogram.com; internet: www.DHSprogram.com. The contents of this report are the sole responsibility of NISR and ICF and do not necessarily reflect the views of USAID, the United States Government, or other donor agencies. Recommended citation: National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], and ICF. 2021. Rwanda Demographic and Health Survey 2019-20 Final Report. Kigali, Rwanda, and Rockville, Maryland, USA: NISR and ICF. ISBN: 978-99977-43-07-7 http://www.dhsprogram.com/ Contents • iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xix ACKNOWLEDGMENTS . xxi READING AND UNDERSTANDING TABLES FROM THE 2019-20 RWANDA DEMOGRAPHIC AND HEALTH SURVEY (RDHS) . xxiii SUSTAINABLE DEVELOPMENT GOAL INDICATORS . xxix MAP OF RWANDA . xxx 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Survey Objectives . 1 1.2 Sample Design . 2 1.3 Questionnaires . 3 1.4 Anthropometry, Anemia, Malaria, HIV, and Micronutrient Testing . 4 1.4.1 Anthropometry . 4 1.4.2 Anemia Testing . 4 1.4.3 Malaria Testing . 5 1.4.4 HIV Testing . 5 1.4.5 Micronutrient Testing . 6 1.5 Pretest . 8 1.6 Training of Field Staff . 8 1.7 Fieldwork . 9 1.8 Data Processing . 10 1.9 Response Rates . 10 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 13 2.1 Drinking Water Sources and Treatment . 13 2.2 Sanitation . 14 2.3 Exposure to Smoke inside the Home . 15 2.4 Household Wealth . 15 2.4.1 Household Durable Goods . 15 2.4.2 Wealth Index . 16 2.5 Handwashing . 16 2.6 Household Population and Composition . 16 2.7 Children’s Living Arrangements and Parental Survival . 17 2.8 Birth Registration . 18 2.9 Education . 18 2.9.1 Educational Attainment . 18 2.9.2 School Attendance . 19 2.10 Household Bank Account and Health Insurance . 20 3 CHARACTERISTICS OF RESPONDENTS . 37 3.1 Basic Characteristics of Survey Respondents . 37 3.2 Education and Literacy . 38 3.3 Mass Media Exposure . 39 3.4 Internet Usage . 40 3.5 Employment . 40 3.6 Occupation . 41 3.7 Health Insurance Coverage . 42 3.8 Tobacco Use . 42 iv • Contents 4 MARRIAGE AND SEXUAL ACTIVITY . 61 4.1 Marital Status . 61 4.2 Polygyny . 62 4.3 Age at First Marriage . 62 4.4 Age at First Sexual Intercourse . 63 4.5 Recent Sexual Activity . 64 5 FERTILITY . 73 5.1 Current Fertility . 73 5.2 Children Ever Born and Living . 75 5.3 Birth Intervals . 75 5.4 Insusceptibility to Pregnancy . 76 5.5 Age at First Birth . 77 5.6 Teenage Childbearing . 77 6 FERTILITY PREFERENCES . 87 6.1 Desire for Another Child . 87 6.2 Ideal Family Size . 88 6.3 Fertility Planning Status . 89 6.4 Wanted Fertility Rates . 90 7 FAMILY PLANNING . 99 7.1 Contraceptive Knowledge and Use . 99 7.2 Source of Modern Contraceptive Methods . 101 7.3 Informed Choice . 102 7.4 Discontinuation of Contraceptives . 102 7.5 Demand for Family Planning . 103 7.6 Contact of Nonusers with Family Planning Providers . 106 8 INFANT AND CHILD MORTALITY . 121 8.1 Infant and Child Mortality . 122 8.2 Biodemographic Risk Factors . 123 8.3 Perinatal Mortality . 124 8.4 High-risk Fertility Behavior . 125 9 MATERNAL HEALTH CARE . 131 9.1 Antenatal Care Coverage and Content . 131 9.1.1 Skilled Providers . 131 9.1.2 Timing and Number of ANC Visits . 132 9.2 Components of ANC Visits . 133 9.3 Protection against Neonatal Tetanus . 133 9.4 Delivery Services . 134 9.4.1 Institutional Deliveries . 134 9.4.2 Skilled Assistance during Delivery . 135 9.4.3 Thermal Care for Newborns . 135 9.4.4 Delivery by Cesarean . 136 9.5 Postnatal Care . 136 9.5.1 Postnatal Health Check for Mothers . 136 9.5.2 Postnatal Health Check for Newborns . 137 9.6 Problems in Accessing Health Care . 138 Contents • v 10 CHILD HEALTH . 151 10.1 Birth Weight . 151 10.2 Vaccination of Children . 152 10.3 Symptoms of Acute Respiratory Infection . 154 10.4 Fever . 155 10.5 Diarrheal Disease . 155 10.5.1 Prevalence of Diarrhea and Treatment-seeking Behavior . 155 10.5.2 Feeding Practices . 156 10.5.3 Oral Rehydration Therapy and Other Treatments . 156 10.5.4 Knowledge of ORS Packets . 157 10.6 Treatment of Childhood Illness . 158 10.7 Disposal of Children’s Stools . 158 11 NUTRITION OF CHILDREN AND WOMEN . 173 11.1 Nutritional Status of Children . 173 11.1.1 Anthropometry Training and Data Collection . 174 11.1.2 Levels of Child Malnutrition . 175 11.2 Infant and Young Child Feeding Practices . 176 11.2.1 Early Initiation of Breastfeeding . 176 11.2.2 Exclusive Breastfeeding and Continued Breastfeeding . 177 11.2.3 Median Duration of Breastfeeding . 178 11.2.4 Bottle Feeding . 178 11.2.5 Introduction of Complementary Foods . 178 11.2.6 Minimum Dietary Diversity, Minimum Meal Frequency, and Minimum Acceptable Diet . 179 11.3 Anemia Prevalence in Children . 180 11.4 Micronutrient Intake and Supplementation among Children . 181 11.5 Women’s Nutritional Status . 182 11.6 Anemia Prevalence in Women . 183 11.7 Micronutrient Supplementation and Deworming during Pregnancy . 183 11.8 Forthcoming Micronutrient and Related Data . 184 12 MALARIA . 197 12.1 Ownership of Insecticide-treated Nets . 197 12.2 Household Access to and Use of ITNs . 199 12.3 Use of ITNs by Children and Pregnant Women . 200 12.4 Case Management of Malaria in Children . 201 12.4.1 Source of Advice or Treatment for Children with Fever . 202 12.4.2 Type of Antimalarial Drugs Used . 202 12.5 Prevalence of Low Hemoglobin in Children . 202 12.6 Prevalence of Malaria in Children . 202 12.7 Prevalence of Malaria in Women . 203 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 219 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 220 13.2 Knowledge about Mother-to-Child Transmission . 222 13.3 Discriminatory Attitudes towards People Living with HIV . 223 13.4 Multiple Sexual Partners . 223 13.5 Paid Sex . 224 13.6 Coverage of HIV Testing Services . 224 13.6.1 Awareness of HIV Testing Services and Experience with HIV Testing . 224 13.6.2 HIV Testing of Pregnant Women . 225 13.7 Male Circumcision . 225 vi • Contents 13.8 Self-reporting of Sexually Transmitted Infections . 226 13.9 HIV/AIDS-related Knowledge and Behavior among Young People . 226 13.9.1 Comprehensive Knowledge . 226 13.9.2 First Sex . 226 13.9.3 Premarital Sex . 227 13.9.4 Multiple Sexual Partners . 227 13.9.5 Coverage of HIV Testing Services . 227 13.10 Coverage of HIV Self-Testing . 228 13.11 Specific Accepting Attitudes toward a Family Member with HIV/AIDS and Teaching Teenagers to Use Condoms . 228 14 ADULT AND MATERNAL MORTALITY . 249 14.1 Data . 249 14.2 Direct Estimates of Adult Mortality . 250 14.3 Adult Mortality . 251 14.4 Direct Estimates of Maternal Mortality . 251 14.5 Pregnancy-Related Mortality . 252 15 WOMEN’S EMPOWERMENT . 255 15.1 Married Women’s and Men’s Employment . 256 15.2 Control over Women’s Earnings . 257 15.3 Control over Men’s Earnings . 257 15.4 Women’s Control over Their Own Earnings and over Those of Their Husbands . 258 15.5 Women’s and Men’s Ownership of Assets . 258 15.6 Possession of Title or Deed for a House or Land . 258 15.7 Ownership and Use of Bank Accounts and Mobile Phones . 259 15.8 Women’s Participation in Decision Making . 259 15.9 Attitudes toward Wife Beating . 260 15.10 Negotiating Sexual Relations . 261 15.11 Women’s Empowerment and Demographic and Health Outcomes . 262 16 DOMESTIC VIOLENCE . 285 16.1 Measurement of Violence . 286 16.2 Experience of Physical Violence . 287 16.2.1 Prevalence of Physical Violence . 287 16.2.2 Perpetrators of Physical Violence . 287 16.3 Experience of Sexual Violence . 288 16.3.1 Prevalence of Sexual Violence . 288 16.3.2 Perpetrators of Sexual Violence . 288 16.4 Experience of Different Forms of Violence . 288 16.5 Marital Control by Spouse . 289 16.6 Forms of Spousal Violence . 290 16.6.1 Prevalence of Spousal Violence . 290 16.6.2 Onset of Spousal Violence . 292 16.7 Injuries due to Spousal Violence . 293 16.8 Violence Initiated by Respondents against Spouses . 293 16.9 Help Seeking among Women Who Have Experienced Violence . 294 17 DISABILITY . 325 17.1 Disability by Domain and Age . 325 17.2 Disability among Adults by Other Background Characteristics . 326 Contents • vii 18 EARLY CHILD DEVELOPMENT . 331 18.1 Early Childhood Education . 331 18.2 Childhood Learning . 332 18.2.1 Support for Learning . 332 18.2.2 Children’s Books and Playthings . 333 18.3 Adequate Care for Young Children . 334 18.4 Developmentally on Track . 334 19 TUBERCULOSIS . 341 19.1 Knowledge of Tuberculosis . 341 19.2 Signs and Symptoms Suggestive of Tuberculosis Disease and Treatment . 342 REFERENCES . 349 APPENDIX A SAMPLE DESIGN . 353 A.1 Introduction . 353 A.2 Sampling Frame . 353 A.3 Structure of the Sample and Sampling Procedure . 356 A.4 Selection Probabilities and Sampling Weights . 358 A.5 Survey Implementation. 360 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 363 APPENDIX C DATA QUALITY TABLES . 375 APPENDIX D DISTRICT TABLES . 385 APPENDIX E PERSONS INVOLVED IN THE 2019-20 RWANDA DEMOGRAPHIC AND HEALTH SURVEY . 395 APPENDIX F QUESTIONNAIRES . 401 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 11 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 13 Table 2.1.1 Household drinking water . 21 Table 2.1.2 Drinking water according to province and wealth . 22 Table 2.1.3 Treatment of household drinking water . 22 Table 2.2.1 Household sanitation facilities . 23 Table 2.2.2 Sanitation facility type according to province and wealth . 24 Table 2.3 Household characteristics . 25 Table 2.4 Household possessions . 26 Table 2.5 Wealth quintiles . 27 Table 2.6 Handwashing . 27 Table 2.7 Household population by age, sex, and residence . 28 Table 2.8 Household composition . 29 Table 2.9 Children’s living arrangements and orphanhood . 30 Table 2.10 Birth registration of children under age 5 . 31 Table 2.11.1 Educational attainment of the female household population . 32 Table 2.11.2 Educational attainment of the male household population . 33 Table 2.12 School attendance ratios . 34 Table 2.13 Household bank account and health insurance . 35 Figure 2.1 Household drinking water by residence . 13 Figure 2.2 Household toilet facilities by residence . 14 Figure 2.3 Household wealth by residence . 16 Figure 2.4 Population pyramid . 17 Figure 2.5 Birth registration by household wealth . 18 Figure 2.6 Secondary school attendance by household wealth . 19 3 CHARACTERISTICS OF RESPONDENTS . 37 Table 3.1 Background characteristics of respondents . 44 Table 3.2.1 Educational attainment: Women . 45 Table 3.2.2 Educational attainment: Men . 45 Table 3.3.1 Literacy: Women . 46 Table 3.3.2 Literacy: Men . 46 Table 3.4.1 Exposure to mass media: Women . 47 Table 3.4.2 Exposure to mass media: Men . 47 Table 3.5.1 Internet usage: Women . 48 Table 3.5.2 Internet usage: Men . 49 Table 3.6.1 Employment status: Women . 50 Table 3.6.2 Employment status: Men. 51 Table 3.7.1 Occupation: Women . 52 Table 3.7.2 Occupation: Men . 53 Table 3.8 Type of employment: Women . 54 Table 3.9.1 Health insurance coverage: Women . 55 Table 3.9.2 Health insurance coverage: Men . 56 x • Tables and Figures Table 3.10.1 Tobacco smoking: Women . 57 Table 3.10.2 Tobacco smoking: Men . 58 Table 3.11 Average number of cigarettes smoked daily: Men . 59 Table 3.12 Smokeless tobacco use and any tobacco use . 59 Figure 3.1 Education of survey respondents . 38 Figure 3.2 Secondary education by household wealth . 38 Figure 3.3 Secondary education among women, by province . 39 Figure 3.4 Exposure to mass media . 39 Figure 3.5 Employment status by household wealth . 41 Figure 3.6 Occupation . 41 4 MARRIAGE AND SEXUAL ACTIVITY . 61 Table 4.1 Current marital status . 65 Table 4.2.1 Number of women’s co-wives . 66 Table 4.2.2 Number of men’s wives . 67 Table 4.3 Age at first marriage . 68 Table 4.4 Median age at first marriage by background characteristics . 68 Table 4.5 Age at first sexual intercourse . 69 Table 4.6 Median age at first sexual intercourse according to background characteristics . 70 Table 4.7.1 Recent sexual activity: Women . 71 Table 4.7.2 Recent sexual activity: Men . 72 Figure 4.1 Marital status . 61 Figure 4.2 Trends in polygyny . 62 Figure 4.3 Women’s median age at marriage by wealth . 63 Figure 4.4 Median age at first sex and first marriage . 63 Figure 4.5 Trends in early sexual intercourse . 64 5 FERTILITY . 73 Table 5.1 Current fertility . 79 Table 5.2 Fertility by background characteristics . 79 Table 5.3 Trends in age-specific fertility rates . 80 Table 5.4 Children ever born and living . 80 Table 5.5 Birth intervals . 81 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 82 Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 83 Table 5.8 Menopause . 84 Table 5.9 Age at first birth . 84 Table 5.10 Median age at first birth . 85 Table 5.11 Teenage pregnancy and motherhood . 86 Table 5.12 Sexual and reproductive health behaviors before age 15 . 86 Figure 5.1 Trends in fertility by residence . 74 Figure 5.2 Trends in age-specific fertility . 74 Figure 5.3 Fertility by province . 74 Figure 5.4 Fertility by mother’s education . 75 Figure 5.5 Birth intervals . 75 Tables and Figures • xi 6 FERTILITY PREFERENCES . 87 Table 6.1 Fertility preferences by number of living children . 92 Table 6.2.1 Desire to limit childbearing: Women . 93 Table 6.2.2 Desire to limit childbearing: Men . 94 Table 6.3 Ideal number of children by number of living children . 95 Table 6.4 Mean ideal number of children . 96 Table 6.5 Fertility planning status . 96 Table 6.6 Wanted fertility rates . 97 Figure 6.1 Trends in desire to limit childbearing by number of living children . 88 Figure 6.2 Desire to limit childbearing by number of living children . 88 Figure 6.3 Ideal family size . 89 Figure 6.4 Ideal family size by number of living children . 89 Figure 6.5 Fertility planning status . 90 Figure 6.6 Trends in wanted and actual fertility . 90 7 FAMILY PLANNING . 99 Table 7.1 Knowledge of contraceptive methods . 107 Table 7.2 Knowledge of contraceptive methods according to background characteristics . 108 Table 7.3 Current use of contraception by age . 109 Table 7.4 Current use of contraception according to background characteristics . 110 Table 7.5 Knowledge of fertile period . 111 Table 7.6 Knowledge of fertile period by age . 111 Table 7.7 Timing of sterilization . 111 Table 7.8 Source of modern contraception methods . 112 Table 7.9 Use of social marketing brand pills and condoms . 113 Table 7.10 Informed choice . 114 Table 7.11 Twelve-month contraceptive discontinuation rates . 114 Table 7.12 Reasons for discontinuation . 115 Table 7.13.1 Need and demand for family planning among currently married women . 115 Table 7.13.2 Need and demand for family planning for all women and for sexually active unmarried women . 116 Table 7.14 Decision making about family planning . 117 Table 7.15 Future use of contraception . 117 Table 7.16 Exposure to family planning messages . 118 Table 7.17 Contact of nonusers with family planning providers . 119 Figure 7.1 Contraceptive use . 100 Figure 7.2 Trends in contraceptive use . 100 Figure 7.3 Use of modern methods by education . 101 Figure 7.4 Source of modern contraceptive methods . 101 Figure 7.5 Contraceptive discontinuation rates . 103 Figure 7.6 Demand for family planning . 104 Figure 7.7 Trends in demand for family planning . 104 Figure 7.8 Unmet need for family planning by province . 105 8 INFANT AND CHILD MORTALITY . 121 Table 8.1 Early childhood mortality rates . 126 Table 8.2 Five-year early childhood mortality rates according to background characteristics . 126 Table 8.3 Ten-year early childhood mortality rates according to additional characteristics . 127 xii • Tables and Figures Table 8.4 Perinatal mortality . 128 Table 8.5 High-risk fertility behavior . 129 Figure 8.1 Trends in early childhood mortality rates . 122 Figure 8.2 Under-5 mortality by province . 123 Figure 8.3 Under-5 mortality by mother’s education . 123 Figure 8.4 Childhood mortality by previous birth interval . 124 Figure 8.5 Perinatal mortality by mother’s education . 124 9 MATERNAL HEALTH CARE . 131 Table 9.1 Antenatal care . 139 Table 9.2 Number of antenatal care visits and timing of first visit . 140 Table 9.3 Components of antenatal care . 140 Table 9.4 Tetanus toxoid injections . 141 Table 9.5 Place of delivery . 142 Table 9.6 Assistance during delivery . 143 Table 9.7 Cesarean section . 144 Table 9.8 Duration of stay in health facility after birth . 144 Table 9.9 Timing of first postnatal check for the mother . 145 Table 9.10 Type of provider of first postnatal check for the mother . 146 Table 9.11 Timing of first postnatal check for the newborn . 147 Table 9.12 Type of provider of first postnatal check for the newborn . 148 Table 9.13 Content of postnatal care for newborns . 149 Table 9.14 Problems in accessing health care . 150 Figure 9.1 Trends in antenatal care coverage . 132 Figure 9.2 Components of antenatal care . 133 Figure 9.3 Trends in place of birth . 134 Figure 9.4 Health facility births by mother’s education . 134 Figure 9.5 Assistance during delivery . 135 Figure 9.6 Skilled assistance at delivery by household wealth . 135 Figure 9.7 Postnatal care by place of delivery . 137 10 CHILD HEALTH . 151 Table 10.1 Child’s size and weight at birth . 160 Table 10.2 Vaccinations by source of information . 161 Table 10.3 Vaccinations by background characteristics . 162 Table 10.4 Possession and observation of vaccination cards, according to background characteristics . 163 Table 10.5 Prevalence and treatment of symptoms of ARI. 164 Table 10.6 Source of advice or treatment for children with symptoms of ARI . 165 Table 10.7 Prevalence and treatment of fever . 166 Table 10.8 Prevalence and treatment of diarrhea . 167 Table 10.9 Feeding practices during diarrhea . 168 Table 10.10 Oral rehydration therapy, zinc, and other treatments for diarrhea . 169 Table 10.11 Source of advice or treatment for children with diarrhea . 170 Table 10.12 Knowledge of ORS packets or pre-packaged liquids . 171 Table 10.13 Disposal of children’s stools . 172 Tables and Figures • xiii Figure 10.1 Childhood vaccinations . 153 Figure 10.2 Trends in childhood vaccinations . 153 Figure 10.3 Vaccination coverage by household wealth . 154 Figure 10.4 Feeding practices during diarrhea . 156 Figure 10.5 Treatment of diarrhea . 157 Figure 10.6 Prevalence and treatment of childhood illness . 158 11 NUTRITION OF CHILDREN AND WOMEN . 173 Table 11.1 Nutritional status of children . 185 Table 11.2 Initial breastfeeding . 186 Table 11.3 Breastfeeding status by age . 187 Table 11.4 Infant and young child feeding (IYCF) indicators on breastfeeding status . 187 Table 11.5 Median duration of breastfeeding . 188 Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview . 189 Table 11.7 Minimum acceptable diet . 190 Table 11.8 Prevalence of anemia in children . 191 Table 11.9 Micronutrient intake among children . 192 Table 11.10 Nutritional status of women . 193 Table 11.11 Prevalence of anemia in women . 194 Table 11.12 Micronutrient intake among mothers . 195 Figure 11.1 Stunting in children by mother’s education . 175 Figure 11.2 Stunting in children by province . 176 Figure 11.3 Breastfeeding practices by age . 177 Figure 11.4 IYCF indicators on minimum acceptable diet . 180 Figure 11.5 Childhood anemia by residence . 181 12 MALARIA . 197 Table 12.1 Household possession of mosquito nets . 205 Table 12.2 Source of mosquito nets . 205 Table 12.3 Access to an insecticide-treated net (ITN) . 206 Table 12.4 Access to an ITN according to background characteristics . 206 Table 12.5 Use of mosquito nets by persons in the household . 207 Table 12.6 Use of existing ITNs . 207 Table 12.7 Use of mosquito nets by children . 208 Table 12.8 Use of mosquito nets by pregnant women . 209 Table 12.9 Prevalence, diagnosis, and prompt treatment of children with fever . 210 Table 12.10 Source of advice or treatment for children with fever . 211 Table 12.11 Type of antimalarial drugs used . 212 Table 12.12 Coverage of testing for anemia and malaria in children. 213 Table 12.13 Hemoglobin <8.0 g/dl in children . 214 Table 12.14 Prevalence of malaria in children . 215 Table 12.15 Coverage of testing for malaria in women . 216 Table 12.16 Prevalence of malaria in women . 217 Figure 12.1 Household ownership of ITNs . 198 Figure 12.2 Trends in household ownership of ITNs . 198 Figure 12.3 ITN ownership by household wealth . 198 Figure 12.4 Source of ITNs . 199 Figure 12.5 Access to and use of ITNs by residence . 200 Figure 12.6 Trends in use of ITNs by pregnant women and children . 200 xiv • Tables and Figures 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 219 Table 13.1 Knowledge of HIV prevention methods . 230 Table 13.2 Comprehensive knowledge about HIV . 231 Table 13.3 Knowledge of prevention of mother-to-child transmission of HIV . 232 Table 13.4 Discriminatory attitudes towards people living with HIV . 233 Table 13.5.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women . 234 Table 13.5.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men . 235 Table 13.6 Payment for sexual intercourse and condom use at last paid sexual intercourse . 236 Table 13.7.1 Coverage of prior HIV testing: Women . 237 Table 13.7.2 Coverage of prior HIV testing: Men . 238 Table 13.8 Pregnant women counseled and tested for HIV . 239 Table 13.9 Male circumcision . 240 Table 13.10 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 241 Table 13.11 Women and men seeking treatment for STIs . 241 Table 13.12 Comprehensive knowledge about HIV among young people . 242 Table 13.13 Age at first sexual intercourse among young people . 242 Table 13.14 Premarital sexual intercourse among young people . 243 Table 13.15.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months among young people: Women . 243 Table 13.15.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months among young people: Men . 244 Table 13.16 Recent HIV tests among young people . 244 Table 13.17 Knowledge and coverage of self-testing for HIV . 245 Table 13.18 HIV testing for prenuptial purposes and as a couple . 246 Table 13.19 Specific accepting attitudes toward a family member living with HIV/AIDS and teaching teenagers to use condoms to prevent HIV infection . 247 Figure 13.1 Knowledge of mother-to-child transmission (MTCT) of HIV . 222 Figure 13.2 Trends in knowledge of mother-to-child transmission (MTCT) of HIV. 222 Figure 13.3 Discriminatory attitudes towards people living with HIV by education . 223 14 ADULT AND MATERNAL MORTALITY . 249 Table 14.1 Completeness of information on siblings . 253 Table 14.2 Adult mortality rates . 253 Table 14.3 Adult mortality probabilities . 253 Table 14.4 Maternal mortality rate . 254 Table 14.5 Maternal mortality ratio . 254 Figure 14.1 Adult mortality rates by age . 250 15 WOMEN’S EMPOWERMENT . 255 Table 15.1 Employment and cash earnings of currently married women and men . 264 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 265 Table 15.2.2 Control over men’s cash earnings . 266 Table 15.3 Women’s control over their own earnings and over those of their husbands . 267 Tables and Figures • xv Table 15.4.1 Ownership of assets: Women . 268 Table 15.4.2 Ownership of assets: Men . 269 Table 15.5.1 Ownership of title or deed for house: Women . 270 Table 15.5.2 Ownership of title or deed for house: Men . 271 Table 15.6.1 Ownership of title or deed for land: Women . 272 Table 15.6.2 Ownership of title or deed for land: Men . 273 Table 15.7.1 Ownership and use of bank accounts and mobile phones: Women . 274 Table 15.7.2 Ownership and use of bank accounts and mobile phones: Men . 275 Table 15.8 Participation in decision making . 275 Table 15.9.1 Women’s participation in decision making by background characteristics . 276 Table 15.9.2 Men’s participation in decision making by background characteristics. 277 Table 15.10.1 Attitude toward wife beating: Women . 278 Table 15.10.2 Attitude toward wife beating: Men . 279 Table 15.11 Attitudes toward negotiating safer sexual relations with husband . 280 Table 15.12 Ability to negotiate sexual relations with husband . 281 Table 15.13 Indicators of women’s empowerment . 281 Table 15.14 Current use of contraception by women’s empowerment . 282 Table 15.15 Ideal number of children and unmet need for family planning by women’s empowerment . 282 Table 15.16 Reproductive health care by women’s empowerment . 283 Table 15.17 Early childhood mortality rates by women’s status . 283 Figure 15.1 Employment by age . 256 Figure 15.2 Control over women’s earnings . 257 Figure 15.3 Ownership of assets . 258 Figure 15.4 Women’s participation in decision making . 260 Figure 15.5 Attitudes towards wife beating . 261 16 DOMESTIC VIOLENCE . 285 Table 16.1.1 Experience of physical violence: Women . 296 Table 16.1.2 Experience of physical violence: Men . 297 Table 16.2.1 Persons committing physical violence: Women . 298 Table 16.2.2 Persons committing physical violence: Men . 298 Table 16.3.1 Experience of sexual violence: Women . 299 Table 16.3.2 Experience of sexual violence: Men . 300 Table 16.4.1 Persons committing sexual violence: Women. 301 Table 16.4.2 Persons committing sexual violence: Men . 301 Table 16.5.1 Age at first experience of sexual violence: Women . 302 Table 16.5.2 Age at first experience of sexual violence: Men . 302 Table 16.6.1 Experience of different forms of violence: Women . 303 Table 16.6.2 Experience of different forms of violence: Men . 303 Table 16.7 Experience of violence during pregnancy . 304 Table 16.8.1 Marital control exercised by husbands . 305 Table 16.8.2 Marital control exercised by wives . 306 Table 16.9.1 Forms of spousal violence: Women . 307 Table 16.9.2 Forms of spousal violence: Men . 308 Table 16.10.1 Spousal violence by background characteristics: Women . 309 Table 16.10.2 Spousal violence by background characteristics: Men . 310 Table 16.11.1 Spousal violence by husband’s characteristics and empowerment indicators . 311 Table 16.11.2 Spousal violence by wife’s characteristics and empowerment indicators . 312 xvi • Tables and Figures Table 16.12.1 Violence by any husband/partner in the last 12 months . 313 Table 16.12.2 Violence by any wife/partner in the last 12 months . 314 Table 16.13.1 Experience of spousal violence by duration of marriage: Women . 315 Table 16.13.2 Experience of spousal violence by duration of marriage: Men . 315 Table 16.14.1 Injuries to women due to spousal violence . 316 Table 16.14.2 Injuries to men due to spousal violence . 316 Table 16.15.1 Violence by women against their husband by women’s background characteristics . 317 Table 16.15.2 Violence by men against their wife by men’s background characteristics . 318 Table 16.16.1 Violence by women against their husband by husband’s characteristics and empowerment indicators . 319 Table 16.16.2 Violence by men against their wife by wife’s characteristics and empowerment indicators . 320 Table 16.17.1 Help seeking to stop violence: Women . 321 Table 16.17.2 Help seeking to stop violence: Men . 322 Table 16.18.1 Sources for help to stop the violence: Women . 323 Table 16.18.2 Sources for help to stop the violence: Men . 323 Figure 16.1 Experience of violence by marital status . 287 Figure 16.2.1 Forms of spousal violence (women) . 290 Figure 16.2.2 Forms of spousal violence (men) . 291 Figure 16.3 Trends in experience of spousal violence . 291 Figure 16.4 Spousal violence by spouse’s alcohol consumption . 292 Figure 16.5 Help seeking by type of violence experienced . 294 17 DISABILITY . 325 Table 17.1 Disability by domain and age . 328 Table 17.2.1 Disability among adults according to background characteristics: Women . 329 Table 17.2.2 Disability among adults according to background characteristics: Men . 330 Figure 17.1 Degree of difficulty . 326 Figure 17.2 Level of difficulty in at least one domain . 326 18 EARLY CHILD DEVELOPMENT . 331 Table 18.1 Early childhood education . 336 Table 18.2 Support for learning . 337 Table 18.3 Learning materials . 338 Table 18.4 Inadequate care . 339 Table 18.5 Early child development index . 340 Figure 18.1 Early childhood education by mother’s education . 332 Figure 18.2 Inadequate care by mother’s education . 334 Figure 18.3 Developmentally on track by household wealth . 335 19 TUBERCULOSIS . 341 Table 19.1 Knowledge of tuberculosis transmission . 344 Table 19.2 Risk of having tuberculosis and care seeking . 345 Table 19.3 Knowledge of tuberculosis signs and symptoms . 346 Table 19.4.1 Signs and symptoms suggestive of tuberculosis: Women . 347 Table 19.4.2 Signs and symptoms suggestive of tuberculosis: Men . 347 Table 19.5 Prevalence and treatment of suggestive tuberculosis signs/symptoms . 348 Table 19.6 Source of care or help for adults with suggestive signs/symptoms of tuberculosis . 348 Tables and Figures • xvii APPENDIX A SAMPLE DESIGN . 353 Table A.1 Population by province and by district within province, according to type of residence . 354 Table A.2 Distribution of residential households by province and by district within province, according to type of residence . 355 Table A.3 Distribution of EAs and their average size in number of households by province and by district within province, according to type of residence . 356 Table A.4 Sample allocation of EAs and households by province and by district within province, according to type of residence . 357 Table A.5 Sample allocation of expected number of interviews by province and by district within province, according to type of residence . 358 Table A.6 Sample implementation: Women . 360 Table A.7 Sample implementation: Men . 361 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 363 Table B.1 List of selected variables for sampling errors, Rwanda DHS 2019-20 . 365 Table B.2 Sampling errors: Total sample, Rwanda DHS 2019-20 . 367 Table B.3 Sampling errors: Urban sample, Rwanda DHS 2019-20 . 368 Table B.4 Sampling errors: Rural sample, Rwanda DHS 2019-20 . 369 Table B.5 Sampling errors: City of Kigali sample, Rwanda DHS 2019-20 . 370 Table B.6 Sampling errors: South sample, Rwanda DHS 2019-20 . 371 Table B.7 Sampling errors: West sample, Rwanda DHS 2019-20 . 372 Table B.8 Sampling errors: North sample, Rwanda DHS 2019-20 . 373 Table B.9 Sampling errors: East sample, Rwanda DHS 2019-20 . 374 APPENDIX C DATA QUALITY TABLES . 375 Table C.1 Household age distribution . 375 Table C.2.1 Age distribution of eligible and interviewed women . 375 Table C.2.2 Age distribution of eligible and interviewed men . 376 Table C.3 Completeness of reporting . 376 Table C.4 Births by calendar years . 377 Table C.5 Reporting of age at death in days . 377 Table C.6 Reporting of age at death in months. 378 Table C.7 Standardization exercise results from anthropometry training . 379 Table C.8 Height and weight data completeness and quality for children . 380 Table C.9 Height measurements from random sub-sample of measured children . 382 Table C.10 Number of enumeration areas completed by month, according to province, Rwanda DHS 2019-20 . 383 Table C.11 Completeness of information on siblings . 383 Table C.12 Sibship size and sex ratio of siblings . 383 Table C.13 Pregnancy-related mortality . 384 Table C.14 Pregnancy-related mortality . 384 APPENDIX D DISTRICT TABLES . 385 Table D.1 Birth registration of children under age 5 . 385 Table D.2 Household bank account and health insurance . 386 Table D.3 Fertility . 387 Table D.4 Current use of contraception according to background characteristics . 388 Table D.5 Ten-year early childhood mortality rates according to additional characteristics . 389 Table D.6 Nutritional status of children . 390 Table D.7 Median duration of breastfeeding . 391 Table D.8 Micronutrient intake among children . 392 Table D.9 Use of mosquito nets by children . 393 Table D.10 Nutritional status of women . 394 Foreword • xix FOREWORD he Government of Rwanda conducted the 2019-20 Rwanda Demographic and Health Survey (RDHS) to collect up-to-date information for monitoring progress on healthcare programs and policies in Rwanda, including the First National Strategy for Transformation (NST1 2017-2024) and the Sustainable Development Goals (SDGs). The 2019-20 RDHS is a follow-up to the previous five RDHS surveys. Each survey provides data on background characteristics of the respondents, and demographic and health indicators. The target groups in these surveys were women aged 15-49 and men aged 15-59 who were randomly selected from households across the country. Information about children aged 5 and under also was collected, including the height and weight of the children. The 2019-20 RDHS was implemented by the National Institute of Statistics of Rwanda (NISR) in partnership with the Ministry of Health (MOH). The Rwanda Biomedical Center (RBC), and in particular the HIV, Malaria, and National Reference Laboratory (NRL) Divisions, collaborated on several aspects of the survey, especially the biomarkers. ICF International provided technical assistance in implementation of the survey. Funding for the 2019-20 RDHS was provided by the Government of Rwanda, the United States Agency for International Development (USAID), the One United Nations (ONE UN), the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), Enabel, and the United Nations Entity for Gender Equality and the Empowerment of Women (UN WOMEN). Results of the 2019-20 RDHS has shown significant improvement for some indicators and slight decrease in others. This report is therefore an important tool that addresses health concerns, informs policy makers, other stakeholders of priority areas for intervention, and future planning, and resource allocation process. It provides only a snapshot, however, and it is our sincere hope that researchers will deepen our understanding of the topics covered in the survey by undertaking further analysis of the RDHS datasets. Last but not least, we urge all stakeholders, both individuals and organizations, to play an active role in using this valuable information to contribute to a better quality of life for the Rwandan population. Dr. NGAMIJE M. Daniel Minister of Health T Acknowledgments • xxi ACKNOWLEDGMENTS his report has been prepared with the participation of a large number of individuals and organizations. We would like to express our gratitude to all of them. First, we sincerely acknowledge the men and women who generously agreed to respond to all questions they were asked. The response rate was high. We also present our sincere thanks to the Ministry of Local Government and to the local government authorities for their assistance and contributions to the smooth implementation of the survey. We would like to express our sincere appreciation to the Ministry of Health for close collaboration with the National Institute of Statistics of Rwanda (NISR) during preparation and implementation of the survey. The orientation and directives given by the steering committee members are appreciated. We also express our gratitude to many international organizations for their vital financial assistance. Contributions from the United States Agency for International Development (USAID), the One United Nations (ONE UN), the Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), Enabel, and the United Nations Entity for Gender Equality and the Empowerment of Women (UNWOMEN) were of immense importance to the effective accomplishment of the survey. We express our profound gratitude to the team from ICF International, and in particular to Dr. Rathavuth Hong and his colleagues. Their technical assistance contributed to the success of the survey. We thank the technical staff from the Ministry of Health (MOH), RBC-IHDPC, and NISR, for their unfailing participation in all activities of the survey, which were coordinated by NDAKIZE R. Michel and his assistants, in particular MUKANYONGA Apolline (who retired) for her valuable contribution to the last five RDHSs. We congratulate the supervisors, cartographers, listers, team leaders, interviewers, and biomarkers technicians for their valuable efforts, and also the drivers who were able to overcome the fatigue and other challenges inherent in this type of operation. We also thank the Information and Communication Technology team led by HARERIMAMA Massoud for its contribution to the completion of the survey. We appreciate the valuable support provided by administrative and financial departments of the NISR. Their interventions allowed this RDHS to be carried out smoothly and under good conditions. Thank you, MURANGWA Yusuf, Director General of NISR T Reading and Understanding Tables from the 2019-20 RDHS • xxiii READING AND UNDERSTANDING TABLES FROM THE 2019-20 RWANDA DEMOGRAPHIC AND HEALTH SURVEY (RDHS) he 2019-20 Rwanda DHS final report is based on approximately 200 tables of data. For quick reference, they are located at the end of each chapter and can be accessed through links in the pertinent text (electronic version). Additionally, this more reader-friendly version features about 90 figures that clearly highlight trends, subnational patterns, and background characteristics. Large colorful maps display breakdowns by province in Rwanda. The text has been simplified to highlight key points in bullets and to clearly identify indicator definitions in boxes. While the text and figures featured in each chapter highlight some of the most important findings from the tables, not every finding can be discussed or displayed graphically. For this reason, RDHS data users should be comfortable reading and interpreting tables. The following pages provide an introduction to the organization of RDHS tables, the presentation of background characteristics, and a brief overview of denominators. In addition, this section provides some exercises for users as they practice their new skills in interpreting RDHS tables. T xxiv • Reading and Understanding Tables from the 2019-20 RDHS Example 1: Exposure to Mass Media: Women A Question Asked of All Survey Respondents Step 1: Read the title and subtitle, highlighted in orange in the table above. They tell you the topic and the specific population group being described. In this case, the table is about women age 15-49 and their exposure to different types of media. All eligible female respondents age 15-49 were asked these questions. Step 2: Scan the column headings—highlighted in green in Example 1. They describe how the information is categorized. In this table, the first three columns of data show different types of media that women access at least once a week. The fourth column shows women who access all three types of media, while the fifth column shows women who do not access any of the three types of media on a weekly basis. The last column lists the number of women age 15-49 interviewed in the survey. Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the different ways the data are divided into categories based on population characteristics. In this case, the table presents women’s exposure to media by age, urban-rural residence, province, level of education, and wealth quintile. Most of the tables in the RDHS report will be divided into these same categories. Step 4: Look at the row at the bottom of the table highlighted in pink. These percentages represent the totals of all women age 15-49 and their weekly access to different types of media. In this case, 8.6%* of women age 15-49 read a newspaper at least once a week, 19.6% watch television at least weekly, and 62.2% listen to the radio on a weekly basis. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Rwanda DHS 2019-20 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 11.8 22.1 66.7 3.1 28.5 3,258 20-24 10.1 22.5 69.0 4.6 27.7 2,414 25-29 10.0 21.2 63.6 5.7 33.6 2,073 30-34 7.9 17.9 58.7 4.3 38.5 2,118 35-39 5.7 15.8 56.4 3.1 40.4 2,072 40-44 5.5 18.7 59.0 2.8 38.3 1,488 45-49 5.3 14.7 54.2 1.7 42.8 1,211 Residence Urban 16.1 51.1 77.3 11.0 16.0 2,909 Rural 6.8 11.8 58.5 1.9 39.0 11,725 Province City of Kigali 15.5 53.0 76.4 11.0 15.2 2,166 South 7.4 12.1 56.5 2.6 41.0 3,065 West 5.2 14.7 56.3 1.5 41.1 3,174 North 8.4 9.5 57.6 2.3 40.3 2,226 East 8.7 16.8 66.1 3.2 31.3 4,003 Education No education 0.2 5.6 36.2 0.0 62.2 1,377 Primary 4.2 12.4 57.0 0.7 40.0 8,529 Secondary 15.0 30.9 78.1 6.6 18.0 4,086 More than secondary 45.3 73.2 86.1 33.8 4.7 642 Wealth quintile Lowest 2.7 2.3 26.0 0.1 71.9 2,741 Second 4.5 2.7 49.4 0.2 48.9 2,756 Middle 6.0 4.3 66.5 0.6 32.0 2,757 Fourth 8.2 13.3 78.0 1.6 19.5 2,966 Highest 19.2 64.9 84.6 13.9 7.6 3,414 Total 8.6 19.6 62.2 3.7 34.4 14,634 1 2 3 4 5 Reading and Understanding Tables from the 2019-20 RDHS • xxv Step 5: To find out what percentage of women in City of Kigali access all three media at least weekly, draw two imaginary lines, as shown on the table. This shows that 11.0% of women in City of Kigali access all three media once a week. By looking at patterns by background characteristics, we can see how exposure to mass media varies across Rwanda. Mass media are often used to communicate health messages. Knowing how mass media exposure varies among different groups can help program planners and policymakers determine how to most effectively reach their target populations. *For the purpose of this document, data are presented exactly as they appear in the table, including decimal places. However, the text in the remainder of this report rounds data to the nearest whole percentage point. Practice: Use the table in Example 1 to answer the following questions: a) What percentage of women in Rwanda do not access any of the three media at least once a week? b) Which age group has the highest percentage of women who watch television at least once a week? c) Compare women in urban areas to women in rural areas—which group has a higher percentage of women who read a newspaper at least once a week? d) What are the lowest and highest percentages (range) of women who access all three media at least once a week by province? e) Is there a clear relationship in exposure to newspapers on a weekly basis by educational level? f) Is there a clear relationship in exposure to television on a weekly basis by wealth quintile? Answers: a) 34.4% of women in Rwanda do not access any of the three media at least once a week. b) Weekly television access is highest among women age 20-24 (22.5%). c) Weekly newspaper reading is higher among women in urban areas (16.1%) than women in rural areas (6.8%). d) Women’s access to all three media ranges from a low of 1.5% in West to a high of 11.0% in City of Kigali. e) Women’s weekly exposure to newspapers increases with increasing education, from 0.2% among women with no education to 45.3% among those with more than a secondary education. f) Women’s weekly exposure to television increases with increasing household wealth, from 2.3% among women living in the poorest households to 64.9% among those living in the wealthiest households. xxvi • Reading and Understanding Tables from the 2019-20 RDHS Example 2: Prevalence and Treatment of Symptoms of ARI A Question Asked of a Subgroup of Survey Respondents Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age 5, percentage who had symptoms of acute respiratory infection (ARI) in the 2 weeks preceding the survey, and among children with symptoms of ARI in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought, according to background characteristics, Rwanda DHS 2019-20 Among children under age 5: Among children under age 5 with symptoms of ARI: Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought2 Percentage for whom treatment was sought same or next day Number of children Age in months <6 2.4 791 * * 19 6-11 2.4 836 * * 20 12-23 2.3 1,633 (79.1) (39.4) 37 24-35 1.4 1,631 * * 23 36-47 1.3 1,594 * * 21 48-59 1.0 1,535 * * 16 Sex Male 1.8 4,046 66.7 29.4 74 Female 1.6 3,974 79.7 36.3 62 Mother’s smoking status Smokes cigarettes/ tobacco (5.1) 37 * * 2 Does not smoke 1.7 7,983 72.3 32.4 135 Cooking fuel Electricity or gas 0.3 238 * * 1 Charcoal 1.2 1,466 * * 18 Wood/straw3 1.9 6,308 73.8 31.0 118 Residence Urban 1.0 1,411 * * 14 Rural 1.9 6,608 71.1 27.1 123 Province City of Kigali 1.2 1,133 * * 13 South 1.2 1,610 * * 19 West 2.6 1,940 67.2 40.3 51 North 1.6 1,214 * * 19 East 1.6 2,123 (82.2) (20.5) 34 Mother’s education No education 2.1 913 * * 19 Primary 1.9 5,197 69.0 26.4 99 Secondary 1.0 1,555 * * 16 More than secondary 0.9 354 * * 3 Wealth quintile Lowest 2.1 1,866 (66.8) (35.7) 40 Second 2.5 1,542 (63.8) (29.2) 38 Middle 1.9 1,560 * * 30 Fourth 0.9 1,560 * * 13 Highest 1.0 1,491 * * 15 Total 1.7 8,020 72.7 32.5 137 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Symptoms of ARI include short, rapid breathing that is chest-related and/or difficult breathing that is chest-related. 2 Excludes advice or treatment from a traditional practitioner 3 Includes grass, shrubs, and crop residues Step 1: Read the title and subtitle. In this case, the table is about two separate groups of children: all children under age 5 (a) and children under age 5 with symptoms of acute respiratory infection (ARI) in the 2 weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to all children under age 5 (a), and then isolate the columns that refer only to children under age 5 with symptoms of ARI in the 2 weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under age 5 had symptoms of ARI in the 2 weeks before the survey? It’s 1.7%. Now look at the second panel. How many children under age 5 are 1 2 3 4 a b Reading and Understanding Tables from the 2019-20 RDHS • xxvii there who had symptoms of ARI in the 2 weeks before the survey? It’s 137 children, or 1.7% of the 8,020 children under age 5 (with rounding). The second panel is a subset of the first panel. Step 4: Only 1.7% of children under age 5 had symptoms of ARI in the 2 weeks before the survey. Once these children are further divided into the background characteristic categories, there may be too few cases for the percentages to be reliable.  What percentage of children under age 5 with symptoms of ARI in the 2 weeks before the survey in East had treatment or advice sought? It’s 82.2%. This percentage is in parentheses because there are between 25 and 49 children (unweighted) in this category. Readers should use this number with caution—it may not be reliable.  What percentage of children under age 5 with symptoms of ARI in the 2 weeks before the survey in City of Kigali had treatment or advice sought? There is no number in this cell—only an asterisk. This is because fewer than 25 children under age 5 had recent symptoms of ARI in City of Kigali. Results for this group are not reported. The subgroup is too small, and therefore the data are not reliable. Note: When parentheses or asterisks are used in a table, the explanation will be noted under the table. If there are no parentheses or asterisks in a table, you can proceed with confidence that enough cases were included in all categories that the data are reliable. Sustainable Development Goals Indicators • xxix SUSTAINABLE DEVELOPMENT GOAL INDICATORS Sustainable Development Goal Indicators—Rwanda DHS 2019-20 Sex Total DHS table number Indicator Male Female 2. Zero hunger 2.2.1 Prevalence of stunting among children under 5 years of age 37.0 29.2 33.1 11.1 2.2.2 Prevalence of malnutrition among children under 5 years of age 6.7 6.8 6.7 na a) Prevalence of wasting among children under 5 years of age 0.9 1.4 1.1 11.1 b) Prevalence of overweight among children under 5 years of age 5.8 5.4 5.6 11.1 3. Good health and well-being 3.1.1 Maternal mortality ratio1 na na 203 14.5 3.1.2 Proportion of births attended by skilled health personnel na na 94.2 9.6 3.2.1 Under-five mortality rate2 47 43 45 8.2 3.2.2 Neonatal mortality rate2 21 17 19 8.2 3.7.1 Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods na 73.7 na 7.13.1 3.7.2 Adolescent birth rates per 1,000 women a) Girls aged 10-14 years3 na 03 na 5.1 b) Women aged 15-19 years4 na 324 na 5.1 3.a.1 Age-standardized prevalence of current tobacco use among persons aged 15 years and older5 7.0 0.9 3.9a 3.10.1, 3.10.2 3.b.1 Proportion of the target population covered by all vaccines included in their national program a) Coverage of DPT containing vaccine (3rd dose)6 98.7 99.3 99.0 10.3 b) Coverage of measles containing vaccine (2nd dose)7 93.1 94.5 93.8 10.3 c) Coverage of pneumococcal conjugate vaccine (last dose in schedule)8 98.5 99.2 98.8 10.3 5. Gender equality 5.2.1 Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months9,10 na 30.0 na 16.9.1 a) Physical violence na 19.7 na 16.9.1 b) Sexual violence na 10.3 na 16.9.1 c) Psychological violence na 23.6 na 16.9.1 5.3.1 Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18 a) Before age 15 na 0.3 na 4.3 b) Before age 18 na 5.5 na 4.3 5.6.1 Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care11 na 63.1 na na 5.b.1 Proportion of individuals who own a mobile telephone12 61.6 47.9 54.8a 15.7.1, 15.7.2 Residence Total DHS table number Urban Rural 7. Affordable clean energy 7.1.1 Proportion of population with access to electricity 86.4 38.4 46.6 2.3 7.1.2 Proportion of population with primary reliance on clean fuels and technology13 16.3 1.0 3.6 2.3 Sex Total DHS table number Male Female 8. Decent work and economic growth 8.10.2 Proportion of adults (15 years and older) with an account at a bank or other financial institution or with a mobile-money-service provider14 36.4 21.3 28.8a 15.7.1, 15.7.2 16. Peace, justice, and strong institutions 16.9.1 Proportion of children under 5 years of age whose births have been registered with a civil authority 85.8 85.4 85.6a 2.10 17. Partnerships for the goals 17.8.1 Proportion of individuals using the Internet15 23.0 12.3 17.6a 3.5.1, 3.5.2 na = Not applicable 1 Expressed in terms of maternal deaths per 100,000 live births in the 5-year period preceding the survey 2 Expressed in terms of deaths per 1,000 live births for the 5-year period preceding the survey 3 Equivalent to the age-specific fertility rate for girls age 10-14 for the 3-year period preceding the survey, expressed in terms of births per 1,000 girls age 10-14 4 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 5 Data are not age-standardized and are available for women and men age 15-49 only. 6 The percentage of children age 12-23 months who received three doses of pentavalent (DPT-HepB-Hib) 7 The percentage of children age 24-35 months who received two doses of measles and rubella 8 The percentage of children age 12-23 months who received three doses of pneumococcal conjugate vaccine 9 Data are available for women age 15-49 who have ever been in union only. 10 In the DHS, psychological violence is termed emotional violence. 11 Data are available for currently married women who are not pregnant only. 12 Data are available for women and men age 15-49 only. 13 Measured as the percentage of the population using clean fuel for cooking 14 Data are available for women and men age 15-49 who have and use an account at a bank or other financial institution; information on use of a mobile-money-service provider is not available. 15 Data are available for women and men age 15-49 who have used the internet in the past 12 months. a The total is calculated as the simple arithmetic mean of the percentages in the columns for males and females. xxx • Map of Rwanda Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2019-20 Rwanda Demographic and Health Survey (RDHS) is the sixth Demographic and Health Survey (DHS) conducted in Rwanda, following those implemented in 1992, 2000, 2005, 2010, and 2014-15. The National Institute of Statistics of Rwanda (NISR), in collaboration with the Ministry of Health (MOH), implemented the survey. Data collection took place from November 9, 2019, to July 20, 2020. The data collection was interrupted for more than 2 months from March 21 to June 7, 2020, due to the nationwide lockdown for the coronavirus disease (COVID-19) pandemic. Funding for the 2019-20 RDHS was provided by the government of Rwanda, the United States Agency for International Development (USAID), the One United Nations (ONE UN), the Centers for Disease Control and Prevention (CDC), the United Nations Children Fund (UNICEF), the United Nations Population Fund (UNFPA), the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women), and Enabel. ICF provided technical assistance through The DHS Program, which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs. 1.1 SURVEY OBJECTIVES The primary objective of the 2019-20 RDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the 2019-20 RDHS:  collected data on fertility levels and preferences; contraceptive use; maternal and child health; infant, child, and neonatal mortality levels; maternal mortality; gender; nutrition; awareness about HIV/AIDS; self-reported sexually transmitted infections (STIs); and other health issues relevant to the achievement of the Sustainable Development Goals (SDGs)  obtained information on the availability of, access to, and use of mosquito nets as part of the National Malaria Control Program  gathered information on other health issues such as injections, tobacco use, and health insurance  collected data on women’s empowerment and domestic violence  tested household salt for iodine levels  obtained data on child feeding practices, including breastfeeding, and conducted anthropometric measurements to assess the nutritional status of children under age 5 and women age 15-49  conducted anemia testing of women age 15-49 and children age 6-59 months  conducted malaria testing of women age 15-49 and children age 6-59 months  conducted HIV testing of women age 15-49 and men age 15-59  conducted micronutrient testing of women age 15-49 and children age 6-59 months The information collected through the 2019-20 RDHS is intended to assist policymakers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population. T 2 • Introduction and Survey Methodology 1.2 SAMPLE DESIGN The sampling frame used for the 2019-20 RDHS is the fourth Rwanda Population and Housing Census (RPHC), which was conducted in 2012 by the National Institute of Statistics of Rwanda (NISR). The sampling frame is a complete list of enumeration areas (EAs) covering the whole country provided by the National Institute of Statistics, the implementing agency for the RDHS. An EA is a natural village or part of a village created for the 2012 RPHC; these areas served as the counting units for the census. The 2019-20 RDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as for urban and rural areas, five provinces, and each of Rwanda’s 30 districts for some limited indicators. The first stage involved selecting sample points (clusters) consisting of EAs delineated for the 2012 RPHC. A total of 500 clusters were selected, 112 in urban areas and 388 in rural areas. The second stage involved systematic sampling of households. A household listing operation was undertaken in all selected EAs from June to August 2019, and households to be included in the survey were randomly selected from these lists. Twenty-six households were selected from each sample point, for a total sample size of 13,000 households. Because of the approximately equal sample sizes in each district, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In half of the households, all men age 15-59 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In the subsample of households selected for the male survey, height and weight measurements, anemia testing, and malaria testing were performed among eligible women who consented to being tested and children less than age 5 with the parent’s or guardian’s consent. In the same subsample, blood samples were collected for testing of HIV from eligible women and men who consented. The domestic violence module for men was implemented in one-half of the households selected for the male survey (25% of the entire sample), and the domestic violence module for women was implemented in the other one-half of households selected for that survey (25% of the entire sample). In one-half of subsample households not selected for the male survey (25% of the entire sample), venous blood samples were collected for micronutrient testing among children age 0-5 and women age 15-49. In this micronutrient subsample, height and weight measurements, anemia testing, and malaria testing (rapid test only) for children and women were also performed. Introduction and Survey Methodology • 3 1.3 QUESTIONNAIRES Five questionnaires were used for the 2019-20 RDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaires, and the Fieldworker Questionnaire. These questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Rwanda. Comments were solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and development partners. The survey protocol was reviewed and approved by the Rwanda National Ethics Committee (RNEC) and the ICF Institutional Review Board. After all questionnaires were finalized in English, they were translated into Kinyarwanda. The 2019-20 RDHS used computer-assisted personal interviewing (CAPI) for data collection. The Household Questionnaire listed all members of and visitors to selected households. Basic demographic information was collected on each person listed, including age, sex, marital status, education, and relationship to the head of the household. For children under age 18, survival status of parents was determined. Data on age, sex, and marital status of household members were used to identify women and men who were eligible for individual interviews. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as source of drinking water; type of toilet facilities; materials used for flooring, external walls, and roofing; ownership of various durable goods; and ownership of mosquito nets. In addition, a disability module was added into this questionnaire. The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics:  Background characteristics (including age, education, and media exposure)  Birth history and child mortality  Knowledge, use, and source of family planning methods  Antenatal, delivery, and postnatal care  Vaccinations and childhood illnesses  Breastfeeding and infant feeding practices  Women’s minimum dietary diversity  Marriage and sexual activity  Fertility preferences (including desire for more children and ideal number of children)  Women’s work and husbands’ background characteristics  Knowledge, awareness, and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs)  Knowledge, attitudes, and behavior related to other health issues (e.g., smoking)  Early childhood development  Adult and maternal mortality  Domestic violence The Man’s Questionnaire was administered to all men age 15-59 in the subsample of households selected for the men’s survey. The Man’s Questionnaire collected much of the same information as the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health. The first Biomarker Questionnaire was used to record the results of anthropometry measurements and other biomarkers (anemia, malaria, and HIV) for women, men, and children. This questionnaire was administered only to the subsamples selected for the men’s survey. 4 • Introduction and Survey Methodology The second Biomarker Questionnaire was used to record the results of anthropometry measurements and other biomarkers (anemia, malaria, and micronutrient) for women and children. This questionnaire was administered only to the subsamples of seven households per cluster. The Fieldworker Questionnaire recorded background information from the interviewers that will serve as a tool in conducting analyses of data quality. Each interviewer completed the self-administered questionnaire after the final selection of interviewers and before the fieldworkers entered the field. No personal identifiers were attached to the 2019-20 RDHS fieldworkers’ data file. The interviewers used tablet computers for data collection. The tablet computers were equipped with Bluetooth® technology to enable remote electronic transfer of files, such as assignments from the team supervisor to the interviewers, individual questionnaires to survey team members, and completed questionnaires from interviewers to team supervisors. The computer-assisted personal interviewing (CAPI) data collection system employed in the 2019-20 RDHS was developed by The DHS Program with the mobile version of CSPro. 1.4 ANTHROPOMETRY, ANEMIA, MALARIA, HIV, AND MICRONUTRIENT TESTING In the half of the households selected for the male survey, the 2019-20 RDHS implemented anthropometry measurements, anemia testing, and malaria testing for children and women and HIV testing for adults. 1.4.1 Anthropometry Height and weight measurements were recorded for children age 0-5 and women age 15-49. The 2019-20 RDHS included quality assurance procedures to improve anthropometry data quality. These procedures, undertaken in real time during data collection, included re-measurement of all children with data outside of pre-specified flagged values on a subsequent day and re-measurement of the height and weight of a random selection of children (10%) on a subsequent day. 1.4.2 Anemia Testing Blood specimens for hemoglobin measurement were collected from women age 15-49 and from all children age 6 months to age 5 for whom consent was obtained from their parents or the adult responsible for the children. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-11 months) and collected in a microcuvette. Hemoglobin analysis was carried out on-site using a battery-operated portable HemoCue 201+ analyzer. Results were provided verbally and in writing. Parents of children with a hemoglobin level under 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, nonpregnant women and pregnant women were referred for follow-up care if their hemoglobin levels were below 7 g/dl and 9 g/dl, respectively. Introduction and Survey Methodology • 5 1.4.3 Malaria Testing Malaria diagnostic tests, including a rapid diagnostic test (RDT) and a test using thick and thin blood smears, were conducted for eligible women and children in the 2019-20 RDHS. For the RDT, a drop of blood was obtained via a prick at the end of the finger, usually at the same time as anemia testing. Results from the RDTs were recorded on the Biomarker Questionnaire and entered into the computer tablet the same day. The RDT results were used to diagnose malaria and guide treatment of parasitemic children during the survey. Parents or guardians of children with a positive RDT were provided with written results, and children were offered a full course of treatment according to the standard procedures in Rwanda if they did not have a severe case of malaria (diagnosed through symptoms or the presence of severe anemia), were not currently on treatment, and had not completed a full course of artemisinin-based combination therapy (ACT) during the preceding 2 weeks. Women with a positive RDT were referred to the nearest health center for treatment. An informed consent form was read to eligible women or the parents of or adults responsible for children or unmarried young adults age 15-17. The anemia brochure also contained information on malaria and was given to all households in which malaria testing was conducted. Thin and thick blood smears were also collected from participants who agreed to malaria testing. These blood smears were dried and packed carefully in the field, assigned barcode labels corresponding to the Biomarker Questionnaire, and then transported to a malaria laboratory at the district/province level, where they were stained. Microscopic examination to determine malaria infection was carried out at the National Reference Laboratory (NRL). The laboratory malaria testing was not complete at the time this report was prepared. 1.4.4 HIV Testing In the subsample selected for the men’s survey, women and men interviewed on the individual questionnaire were eligible for HIV testing. The survey featured a parallel system for HIV testing. RDTs were performed in the household according to a national HIV testing algorithm for respondents who wished to be informed of their status, while dried blood spot (DBS) specimens were collected and transported to a central lab for anonymized testing. HIV prevalence for the survey will be based on the laboratory test results. The Rwanda HIV rapid testing algorithm applies two tests in sequence: First Alere Combo (Alere HIV Combo/Alere HIV-1/2 Ag/Ab Combo) followed by HIV Stat Pak (Chembio | HIV 1/2 STAT-PAK® Assay). Individuals with a non-reactive result on the first test are reported as HIV-negative. Individuals with a reactive first test result undergo subsequent testing with STAT-PAK. Those with a reactive result on both screening tests are classified as HIV-positive for the purposes of the survey but are referred to a nearby health facility for verification testing, and subsequent enrollment into care, as required by the national testing algorithm. Individuals with a reactive first test result followed by a non-reactive second test result are classified as indeterminate and referred for retesting in 4 weeks as per the national guidelines. Dedicated nurse counselors who provided pre- and post-test counseling conducted HIV rapid testing. Pretest counseling included an explanation of HIV infection and transmission, the meaning of test results, risks associated with sexual behaviors, and how to prevent and treat HIV and other sexually transmitted infections. Post-test counseling messages were tailored to participants’ HIV results and risk profiles. The testing and delivery of results at home were done after creating conditions that would guarantee the confidentiality of the respondents. All participants with HIV-seropositive or indeterminate results were referred to the nearest health facility for further care and treatment. 6 • Introduction and Survey Methodology For HIV testing using DBS samples, at the time of collection of the blood sample, a unique and random barcoded identification number was assigned to each participant who consented to testing. Sheets of peel- off labels with unique barcodes were pre-printed for use in the field. Matching barcode labels were affixed to the Biomarker Questionnaire, a fresh filter paper card, and a blood sample transmittal sheet. Approximately every 2 weeks, or more frequently, all DBS samples and transmittal sheets from the same clusters were picked up from teams in the field by central office supervisors and transported to the National Reference Laboratory (NRL) for processing and registration. Each specimen was then assigned a unique serial laboratory number during the registration process at the lab before being stored in a freezer for preservation. The DBS laboratory testing was scheduled to be conducted at the NRL from the fourth quarter of 2020 to the first quarter of 2021. Interviewers collected finger-prick DBS specimens for laboratory testing of HIV from women age 15-49 and men age 15-59 who consented to be tested. The protocol for DBS collection and analysis was based on the anonymous linked protocol developed for The DHS Program. This protocol allows for merging of HIV test results with the data on background characteristics and other information collected in the individual questionnaires after removal of all information that could potentially identify an individual. Interviewers explained the procedure, the confidentiality of the data, and the RDT test results would be made available to the respondent. If consent was given for HIV testing, five blood spots from the finger prick were collected on a filter paper card to which a barcode label unique to the respondent was affixed. A duplicate label was attached to the Biomarker Data Collection Form. A third copy of the same barcode was affixed to the DBS Transmittal Sheet to track the blood samples from the field to the laboratory. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected from the field and transported to the National Reference Laboratory in City of Kigali. Upon arrival at the NRL, each blood sample was logged into the CSPro HIV Test Tracking System database and stored at -20°C until tested. 1.4.5 Micronutrient Testing In about one-half of the households not selected for the men’s survey (7 households out of 13), the 2019- 20 RDHS implemented micronutrient testing for children and women. This included anthropometry measurements, anemia testing, malaria RDTs, and laboratory testing for various micronutrient markers. Approximately 7 ml of blood and 5 ml of urine (women only) were collected from consenting participants. Although the anthropometry measurements were the same in the micronutrient households as in the households selected for the men’s survey (described above), point-of-care anemia and malaria testing used venous blood collection methods, and the malaria testing did not include thick and thin smears. Below are descriptions of anemia and malaria testing specific to the micronutrient households and laboratory testing for various micronutrient markers. Introduction and Survey Methodology • 7 Anemia Testing Blood specimens for hemoglobin measurement were collected from women age 15-49 and from children age 6 months to age 5 for whom consent was obtained from their parents or the adult responsible for the children. Venous blood samples were collected in a Purple Top vacutainer. Hemoglobin analysis was carried out on-site using a battery-operated portable HemoCue 201+ analyzer. Procedures regarding results and referrals were the same as described for the men’s survey (above). Malaria Testing Malaria rapid diagnostic tests were conducted for eligible women and children. For the RDT for malaria, a drop of whole blood was obtained from a venous collection that had been transferred to a Purple Top vacutainer. Procedures regarding results, treatment, and referrals were the same as described for the men’s survey. Laboratory Testing for Micronutrient Biomarkers and Inflammatory Proteins In the micronutrient subsample, women age 15-49 who were interviewed with the individual questionnaire were eligible for urine collection and venous blood collection, and children age 6 months to age 5 for whom consent was obtained from their parents or the adult responsible for the children participated in venous blood collection. Urine and venous blood were collected according to universal precautions for biospecimen collection and transported in refrigerated cooler boxes with gel packs to satellite clinics equipped with -17°C freezers. The cold chain operated such that time of specimen collection to processing did not exceed 24 hours and time from collection to storage at -80°C did not exceed 7 days. Urine, collected from women, will be assessed for iodine concentrations by the Rwanda Biomedical Center (RBC) to determine the median urinary iodine concentrations for pregnant and nonpregnant women of reproductive age. Venous blood was processed in the field to create three aliquots of serum and a plasma aliquot, and, among women, whole blood lysate samples were prepared so that red blood cell folate could be assessed. Serum retinol, serum ferritin, soluble transferrin receptor, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) will be measured among all women and children with a sufficient volume of serum available for measurement. The RBC is responsible for assessment of retinol using high- performance liquid chromatography methods, and the VitMin laboratory in Germany is responsible for assessment of ferritin, soluble transferrin receptor, CRP, and AGP using an in-house sandwich ELISA (enzyme-linked immunosorbent assay) method. Serum will be stored at -80°C for future assessment of vitamin B12 among women and children. Serum and whole blood lysate samples will be stored at -80°C for future assessment of folate (serum and red blood cell) among women. Plasma samples will be stored as backup samples. Laboratory Testing for Iodine in Salt The seven households per cluster eligible for the micronutrient subsample were asked to provide a 50-g sample of salt from their households, and they were provided replacement salt. The individual household salt samples were stored in airtight (hard plastic) primary packaging with secondary packaging (paper or plastic bag) to prevent cross-contamination. Household salt samples will be tested for the presence or absence of iodine using a rapid test kit. Samples that are positive for iodine will be tested using quantitative titration with sodium thiosulfate methods to determine the concentration of iodine. 8 • Introduction and Survey Methodology 1.5 PRETEST A pretest was conducted from July 29 through August 14, 2019, when 25 candidates (15 women and 10 men) participated in questionnaire training. Additionally, 10 biomarker health technicians participated in biomarker training conducted separately in parallel. The training sessions were conducted in English and Kinyarwanda during the 2 weeks. The training included discussions of the different sections and modules of the questionnaires, mock interviews, role-play, group work, presentations, and in-class practice sessions. Training was conducted by trainers from the NISR and MOH, with technical assistance from ICF International. UNICEF provided training on the early childhood development module. Classroom instruction was provided during the first 3 weeks, and pretest field practice took place over 5 days in three rural villages and two urban villages. Following field practice, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. The CAPI training was conducted by ICF staff with assistance from two NISR data processing coordinators who focused on the technical components of the CAPI data collection system. The training focused on key components of the survey, interview techniques and procedures for completing the RDHS questionnaires, and administration of interviews using the CAPI system. The biomarker training included orientation on collecting height and weight data; testing for anemia, malaria, and HIV; venous blood drawing and processing for micronutrient tests; and standardization procedures for anthropometry. The participants worked in groups using various training techniques, including interactive question-and-answer sessions, case studies, and role-plays. Before starting the fieldwork, the participants were given ample opportunities to practice the questionnaires and to practice collection of biomarkers among women and children. The fieldwork for the pretest was carried out in the Muhanga district and in the clusters that were not selected for the survey sample. Each team carried out the pretest in an urban and a rural location, completing five clusters in total. The participants administered the questionnaires in the field, provided feedback on the content and language of the questionnaires, tested the CAPI software program, commented on the biomarker procedure, and learned various training techniques. Following the fieldwork, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.6 TRAINING OF FIELD STAFF The main training for the 2019-20 Rwanda DHS started on September 30 and ended on November 1, 2019. A total of 160 participants from all over the country were invited to take part in the training. They were chosen based on merit. Eighty-five participants were selected to be interviewers and team leaders, and 51 were selected to be health technicians. The training sessions were held in the main auditorium of the NISR’s training center and were conducted by NISR trainers with support from ICF. Training on biomarkers was provided by trainers from the NRL, with support from ICF and the CDC. Participants were evaluated through in-class exercises, quizzes, and observations made during field practice. By the end of the main training, 17 teams were formed, with each team consisting of 17 team leaders, 17 male interviewers, 51 female interviewers, and 51 health technicians. The team leaders received additional training on how to identify the selected households and different subsamples, data quality control procedures, and fieldwork coordination. Introduction and Survey Methodology • 9 A variety of different learning tools were used in the training. Plenary lectures were held on the technical aspects of biomarker collection, and other tools included video and hands-on demonstrations of the biomarker collection process, instructions on how to fill out the questionnaire and transmittal sheets, and instructions on data quality procedures. In addition, break-out sessions were held daily during which trainees had the opportunity for hands-on practice with both adults and children. A total of three anthropometry standardization exercises were carried out in a community health center. Following the standardization exercises, the results of the exercises were presented. General observations on accuracy (difference between the reference value and the participant’s value) and precision (difference between the first and second readings) were discussed. The field coordinators were trained on the use of the Biomarker Checklist. Also implemented were random re-measurements for quality assurance and re-visitation of households for re-measurements in flagged cases involving children whose Z-score values were less than -3 or greater than 3. A 3-day field practice was conducted. The nurses and laboratory scientists later joined the main team for refresher training before moving on to data collection. 1.7 FIELDWORK Data collection was carried out by 17 field teams. Each team was provided a four-wheel-drive truck with a driver. All blood smears and DBS specimens were transferred to the NISR office every 3-4 days by 10 supervisors from the NISR and NRL who also coordinated and supervised fieldwork activities. Venous blood specimens were processed in the field laboratories set up in the district hospitals, and serum aliquots were stored in mobile freezers (-20°C) before being transferred to the regional laboratories and then the NRL. ICF and the CDC provided technical assistance during the entire data collection period. The fieldwork for the 2019-20 RDHS was carried out under close supervision starting on November 9, 2019, in the clusters in the 17 districts in the North, West, and East provinces. The teams were closely monitored by the field coordinators for quality control. After completion of the fieldwork in these 17 districts, the teams were dispatched to the final 13 districts. However, in the wake of the COVID-19 pandemic, the fieldwork was suspended from April to June 2020. Data collection resumed on June 4 and was completed on July 20, 2020. Fieldwork monitoring was an integral part of the 2019-20 RDHS, and several rounds of monitoring were carried out by the survey coordinators and supervisors of NISR, RBC and ICF. The coordinators were provided with guidelines for overseeing the fieldwork. Weekly field check tables were generated from the completed interviews sent to the central office to monitor fieldwork progress, and feedback was regularly sent out to the teams. 10 • Introduction and Survey Methodology 1.8 DATA PROCESSING The processing of the 2019-20 RDHS data began almost as soon as the fieldwork started. As data collection was completed in each cluster, all electronic data files were transferred via the Internet File Streaming System (IFSS) to the NISR central office in City of Kigali. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted to any inconsistencies and errors. Secondary editing, carried out in the central office, involved resolving inconsistencies and coding the open-ended questions. The NISR data processor coordinated the exercise at the central office. The biomarker paper questionnaires were compared with electronic data files to check for any inconsistencies in data entry. Data entry and editing were carried out using the CSPro software package. The concurrent processing of the data offered a distinct advantage because it maximized the likelihood of the data being error-free and accurate. Timely generation of field check tables allowed for effective monitoring. The secondary editing of the data was completed in the second week of September 2020. Throughout this report, numbers in the tables reflect weighted numbers. Percentages based on 25 to 49 unweighted cases are shown in parentheses, and percentages based on fewer than 25 unweighted cases are suppressed and replaced with an asterisk, to caution readers when interpreting data that a percentage based on fewer than 50 cases may not be statistically reliable. 1.9 RESPONSE RATES Table 1.1 shows response rates for the 2019-20 RDHS. A total of 13,005 households were selected for the sample, of which 12,951 were occupied. All but two occupied households (12,949) were successfully interviewed, yielding a response rate of 100.0%. In the interviewed households, 14,675 women age 15-49 were identified for individual interviews; interviews were completed with 14,634 women, yielding a response rate of 99.7%. In the subsample selected for the male survey, 6,503 households were selected, of which 6,472 were occupied. All but one occupied household (6,471) were successfully interviewed, yielding a response rate of 100.0%. In this subsample, 6,544 men age 15-59 were identified and 6,513 were successfully interviewed, yielding a response rate of 99.5%. In the subsample selected for the micronutrient survey, 3,501 households were selected, of which 3,492 were occupied. All but one of the occupied households (3,491) were successfully interviewed, yielding a response rate of 100.0%. LIST OF TABLES  Table 1.1 Results of the household and individual interviews Introduction and Survey Methodology • 11 Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Rwanda DHS 2019-20 Residence Total Result Urban Rural Household interviews Households selected 2,913 10,092 13,005 Households occupied 2,892 10,059 12,951 Households interviewed 2,892 10,057 12,949 Household response rate1 100.0 100.0 100.0 Interviews with women age 15-49 Number of eligible women 3,564 11,111 14,675 Number of eligible women interviewed 3,551 11,083 14,634 Eligible women response rate2 99.6 99.7 99.7 Household interviews in men’s subsample Households selected 1,456 5,047 6,503 Households occupied 1,441 5,031 6,472 Households interviewed 1,441 5,030 6,471 Household response rate in subsample1 100.0 100.0 100.0 Interviews with men age 15-59 Number of eligible men 1,514 5,030 6,544 Number of eligible men interviewed 1,504 5,009 6,513 Eligible men response rate2 99.3 99.6 99.5 Household interviews in micronutrient subsample Households selected 784 2,717 3,501 Households occupied 784 2,708 3,492 Households interviewed 784 2,707 3,491 Household response rate in subsample1 100.0 100.0 100.0 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 13 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings ▪ Drinking water: In Rwanda, 80% of households have access to an improved water source. ▪ Sanitation: 72% of households have access to improved sanitation. ▪ Electricity: 46% of households have electricity (86% in urban areas and 37% in rural areas). ▪ Household population and composition: The Rwandan population is relatively young; 42% of the population is age 0-14, while only 4% is age 65 or older. nformation on the socioeconomic characteristics of the household population in the 2019-20 RDHS provides a context to interpret demographic and health indicators and can furnish an approximate indication of the representativeness of the survey. In addition, this information sheds light on the living conditions of the population. This chapter presents information on sources of drinking water, sanitation, exposure to smoke inside the home, wealth, handwashing, household population and composition, educational attainment, school attendance, birth registration, and family living arrangements. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells, and bottled water. Sample: Households In Rwanda, 80% of households have access to an improved water source, with urban households having much better access (96%) than rural households (77%) (Table 2.1.1 and Figure 2.1). The most common sources of drinking water in urban households are water piped into the household’s dwelling, yard, plot, or neighbor yard (50%) and public taps or standpipes (26%). Rural households obtain their drinking water mainly from protected wells or springs (36%) and public taps or standpipes (31%). The higher the wealth quintile, the lower the percentage of the population with an unimproved source of drinking water (Table 2.1.2). I Figure 2.1 Household drinking water by residence 15 50 7 30 26 31 2 1 2 31 9 36 3 10 1 20 4 23 Total Urban Rural Percent distribution of households by source of drinking water Unimproved source Other improved (rainwater/tanker/cart/bottle) Protected well or spring Tube well or borehole Public tap/standpipe Piped water into dwelling/ yard/plot/neighbor’s yard 14 • Housing Characteristics and Household Population Fetching drinking water is an additional chore that can be a great burden to household members, depending on the time spent doing so. Eleven percent of urban households and 41% of rural households report having to travel more than 30 minutes (round trip) to obtain drinking water (Table 2.1.1). Trends: The percentage of households using an improved source of drinking water has increased slightly since 2014-15, from 73% to 80%. Basic drinking water service Drinking water from an improved source, provided either water is on the premises or round-trip collection time is 30 minutes or less. Sample: De jure population Limited drinking water service Drinking water from an improved source, and round-trip collection time is more than 30 minutes. Sample: De jure population Table 2.1.2 shows that 55% of the population has basic drinking water service, while 25% has limited drinking water service. Access to basic drinking water service varies widely by province, from a high of 82% in City of Kigali to a low of 43% in the East province. Access to basic drinking water service increases with increasing wealth, from 38% among those in the lowest wealth quintile to 85% among those in the highest quintile. Table 2.1.3 shows that only 35% of households use an appropriate water treatment method (52% in urban areas and 32% in rural areas). Appropriate treatment methods include boiling, bleaching, filtering, and solar disinfecting. 2.2 SANITATION Improved toilet facility Includes flush/pour flush toilets that flush water and waste to a piped sewer system, septic tank, pit latrine, or unknown destination; ventilated improved pit (VIP) latrines; pit latrines with slabs; or composting toilets. Sample: Households Table 2.2.1 and Figure 2.2 provide an overview of the types of sanitation facilities used in the surveyed households at the time of data collection. Nearly three quarters (72%) of households have access to an improved sanitation facility, although access to such facilities is higher in urban (88%) than rural (69%) areas; 25% of households use unimproved sanitation facilities. Nearly two-thirds (64%) of households use a pit latrine with a slab (an improved facility), and 23% use a pit latrine without a slab or an open pit. Nearly all households in Rwanda with a toilet/latrine facility use a facility that is not in their dwelling but is either in the yard/plot of the dwelling (60%) or elsewhere (37%). Figure 2.2 Household toilet facilities by residence 72 88 69 25 11 28 3 1 4 Total Urban Rural Percent distribution of households by type of toilet facilities No facility/ bush/field Unimproved facility Improved facility Housing Characteristics and Household Population • 15 Trends: The percentage of households with an improved sanitation facility increased from 71% in 2014- 15 to 72% in 2019-20. Basic sanitation service Use of improved facilities that are not shared with other households. Sample: De jure population Limited sanitation service Use of improved facilities shared by two or more households. Sample: De jure population In Rwanda, 12% of the household population has limited sanitation service and 61% has basic sanitation service. By residence, 51% of the population in urban areas has basic sanitation service, as compared with 63% of the rural population (Table 2.2.1). The percentage of the household population with basic sanitation service ranges from 51% in City of Kigali to 67% in East Province (Table 2.2.2). On average, 3% of the population engages in open defecation, and this proportion is highest among those in the lowest wealth quintile (9%). 2.3 EXPOSURE TO SMOKE INSIDE THE HOME Exposure to smoke inside the home, from either cooking with solid fuels or smoking tobacco, has potentially harmful health effects. In Rwanda, 22% of households cook inside the house and 95% use solid fuel for cooking; only 5% of households use clean fuel for cooking. Tobacco is smoked in the home daily in 11% of households (Table 2.3). Other Housing Characteristics The 2019-20 RDHS also collected data on access to electricity, flooring materials, and the number of rooms used for sleeping. Slightly less than half of households in Rwanda have access to electricity (46%), and access is more common in urban (86%) than in rural (37%) households. The flooring materials most commonly used are earth or sand (65%) and cement (31%). However, use of these materials varies widely by residence; for example, 68% of urban households use cement, as compared with 22% of rural households (Table 2.3). 2.4 HOUSEHOLD WEALTH 2.4.1 Household Durable Goods Table 2.4 shows information on ownership of various household effects, means of transportation, agricultural land, and livestock/farm animals. Urban households are generally more likely to own various household effects; for example, 41% of urban households own television sets, compared with 8% of rural households. However, rural households are more likely to own agricultural land (67%) and farm animals (54%) than urban households (24% and 19%, respectively). 16 • Housing Characteristics and Household Population 2.4.2 Wealth Index Wealth index Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, and housing characteristics such as source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual (de jure) household member, ranking each person in the household population by her or his score, and then dividing the distribution into five equal categories, each comprising 20% of the population. Sample: Households Table 2.5 presents wealth quintiles according to urban-rural residence and province. The table also includes the Gini coefficient, a measure of disparity in wealth. The Gini coefficient ranges from 0-1, with 0 implying an equal distribution of wealth and 1 implying a totally unequal distribution. By province, South has the highest percentage of the population in the lowest wealth quintile (31%). Three in five people (60%) in City of Kigali are in the highest wealth quintile (Table 2.5). Figure 2.3 shows that 63% of the population in urban areas is in the highest wealth quintile, as compared with 11% of the population in rural areas. Slightly less than half of the rural population is either in the lowest (23%) or second lowest (23%) wealth quintile. 2.5 HANDWASHING To obtain handwashing information, interviewers asked to see the place where members of the household most often wash their hands. A place for handwashing was observed for 84% of the household population; 12% of the population had a fixed place for handwashing (20% in urban areas and 10% in rural areas). However, only 41% of the population for whom a place for handwashing was observed had water available at the time of observation, and only 32% had soap or another cleansing agent available (Table 2.6). 2.6 HOUSEHOLD POPULATION AND COMPOSITION Household A person or group of related or unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as the head of the household, who share the same housekeeping arrangements, and who are considered a single unit. De facto population All persons who stayed in the selected households the night before the interview (whether usual residents or visitors). Figure 2.3 Household wealth by residence 5 233 23 6 23 22 20 63 11 Urban Rural Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest Housing Characteristics and Household Population • 17 De jure population All persons who are usual residents of the selected households, whether or not they stayed in the household the night before the interview. How data are calculated All tables are based on the de facto population unless otherwise specified. The 2019-20 RDHS included a total of 55,479 de facto household members, of whom 25,862 were male and 29,618 were female. Table 2.7 shows that 42% of the population is age 0-14, while 55% is age 15-64 and only 4% is age 65 and above. Figure 2.4 shows the de facto household population by 5-year age groups according to sex. The broad base of the pyramid demonstrates that Rwanda’s population is relatively young. This kind of distribution is characteristic of countries with high fertility and low life expectancy. Table 2.8 shows that women head 32% of households in Rwanda. The average household size is 4.3 persons, and the difference between urban households (4.0 persons) and rural households (4.3 persons) is very small. Overall, 22% of households include children who are orphans or not living with either biological parent. Trends: The age composition of the de facto population has remained relatively constant since 2014-15. 2.7 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Orphan A child with one or both parents who are dead. Sample: Children under age 18 Ten percent of children under age 18 are not living with a biological parent, while 7% are orphans (i.e., one or both parents are dead). The percentage of children who are orphans or not living with a biological parent increases with age; among children age 15-17, 15% had lost one or both parents, and 20% were not living with a biological parent (Table 2.9). Trends: The percentage of children under age 18 who do not live with a biological parent has decreased slightly since 2014-15, from 12% to 10%. Figure 2.4 Population pyramid 10 6 2 2 6 10 <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+ Age Percent distribution of the household population Male Female 2610 18 • Housing Characteristics and Household Population 2.8 BIRTH REGISTRATION Registered birth Child has a birth certificate or child does not have a birth certificate, but his/her birth is registered with the civil authorities. Sample: De jure children under age 5 The global concern regarding the need to have all births registered by 2030 is evident in targets 16.9 and 17.19 of the SDGs. This is important given the need to protect all children because a child who is not registered is in danger of being shut out of society—denied the right to an official identity, a recognized name, and a nationality. In addition to preventing child exploitation, birth registration enables a child to receive medical treatment, go to school, inherit property, and find legal work. All of these situations rely on birth registration to prove identity and thus entitlement to basic rights. Table 2.10 presents information on birth registration of children under age 5. At the time of the survey, 86% of children’s births were registered with the civil authorities. The percentage of children whose births are registered is lower among those under age 2 (81%) than among those age 2-4 (89%). By province, the percentage of registered births is highest in North (91%) and lowest in City of Kigali (80%). Figure 2.5 shows that the percentage of children whose births are registered varies by wealth quintile, from 78% in the lowest quintile to 90% in the highest quintile. Trends: The percentage of children under age 5 whose births are registered with the civil authorities has increased over time, from 56% in 2014-15 to 86% in 2019-20. 2.9 EDUCATION 2.9.1 Educational Attainment Median educational attainment Half of the population has completed less than the median number of years of schooling, and half of the population has completed more than the median number of years of schooling. Sample: De facto household population age 6 and older Education is one of the most important aspects of social and economic development. Education improves capabilities and is strongly associated with various socioeconomic variables such as lifestyle, income, and fertility for both individuals and societies. The majority of Rwandans have either no formal education or only some primary education. Specifically, 65% of females and 66% of males age 6 and over have no education (15% and 11%, respectively) or only some primary education (50% and 55%, respectively) (Tables 2.11.1 and 2.11.2). The median number of years of completed education is 3.8 among women and 3.7 among men. Trends: The percentage of females over age 6 with no education has declined slightly since 2014-15, from 19% to 15%; the percentage among males has also declined, from 13% to 11%. The median number of years of schooling has increased from 2.9 to 3.8 among women and from 3.0 to 3.7 among men. Figure 2.5 Birth registration by household wealth 78 87 87 88 90 Lowest Second Middle Fourth Highest Percentage of de jure children under age 5 whose births are registered with the civil authorities Poorest Wealthiest Housing Characteristics and Household Population • 19 Patterns by background characteristics ▪ Rural residents are twice as likely as urban residents to have no education. Sixteen percent of women and 12% of men in rural areas have no education, as compared with 7% of women and 6% of men in urban areas. ▪ Among both women and men, the median number of years of education increases with increasing wealth. 2.9.2 School Attendance Net attendance ratio (NAR) Percentage of the school-age population that attends primary or secondary school. Sample: Children age 7-12 for primary school NAR and children age 13-18 for secondary school NAR Gross attendance ratio (GAR) The total number of children attending primary school divided by the official primary school-age population and the total number of children attending secondary school divided by the official secondary school-age population. Sample: Children age 7-12 for primary school GAR and children age 13-18 for secondary school GAR In Rwanda, the primary school net attendance ratio (NAR) for the population age 7-12 is 92% (92% for girls and 91% for boys). The secondary school NAR drops drastically to 37% (39% for girls and 34% for boys). The variation in the secondary school NAR by residence is large, with a difference of 20 percentage points between urban (54%) and rural (34%) areas (Table 2.12). Figure 2.6 shows the secondary school NAR among children age 13-18 by wealth quintile. Fifty-seven percent of girls in the highest wealth quintile attend secondary school, as compared with 15% of those in the lowest wealth quintile. Boys follow a similar trajectory (59% in the highest quintile and 12% in the lowest quintile). In all wealth quintiles other than the highest quintile, the secondary school NAR is higher among girls. The gross attendance ratio (GAR) is also presented in Table 2.12. A GAR value of more than 100% means that some students are not of the official school age. The GAR is slightly higher for boys than girls at the primary level (138% versus 137%) but is lower for boys at the secondary level (46% versus 51%). Gender parity index (GPI) The ratio of female to male students attending primary school and the ratio of female to male students attending secondary school. The index reflects the magnitude of the gender gap. Sample: Primary school students and secondary school students Figure 2.6 Secondary school attendance by household wealth 15 27 36 54 57 12 19 32 43 59 Lowest Second Middle Fourth Highest Net attendance ratio for secondary school among children age 13-18 Girls Boys WealthiestPoorest 20 • Housing Characteristics and Household Population A GPI of 1 indicates parity or equality between male and female school participation ratios. A GPI lower than 1 indicates a gender disparity in favor of males, with a higher proportion of males than females attending the specified level of schooling. A GPI higher than 1 indicates a gender disparity in favor of females. In Rwanda, the NAR-based GPI is 1.01 for primary school and 1.16 for secondary school. The GAR-based GPI is 0.99 for primary school and 1.12 for secondary school. Patterns by background characteristics ▪ NAR-based and GAR-based GPIs at the primary level vary only minimally by province (1.00 to 1.02 for NAR-based GPIs and 0.97 to 1.01 for GAR-based GPIs). ▪ NAR-based and GAR-based GPIs at the secondary level are highest in South province (1.35 and 1.30, respectively). ▪ There is no clear pattern between wealth and either NAR-based or GAR-based GPIs. 2.10 HOUSEHOLD BANK ACCOUNT AND HEALTH INSURANCE Household bank account Percentage of households with at least one member who has a back account. Sample: All interviewed households Household health insurance Percentage of households with at least one member who has health insurance coverage. Sample: All interviewed households Table 2.13 shows that 50% of Rwandan households have at least one member with a bank account. This proportion is higher among urban households (68%) than rural households (46%). The percentage of households in which at least one member has a bank account increases with increasing wealth, from 21% in the lowest wealth quintile to 89% in the highest wealth quintile. Eighty-six percent of households have at least one member with health insurance coverage. This percentage increases with increasing wealth, from 73% in the lowest wealth quintile to 96% in the highest quintile. LIST OF TABLES For more information on household population and housing characteristics, see the following tables: ▪ Table 2.1.1 Household drinking water ▪ Table 2.1.2 Drinking water according to province and wealth ▪ Table 2.1.3 Treatment of household drinking water ▪ Table 2.2.1 Household sanitation facilities ▪ Table 2.2.2 Sanitation facility according to province and wealth ▪ Table 2.3 Household characteristics ▪ Table 2.4 Household possessions ▪ Table 2.5 Wealth quintiles ▪ Table 2.6 Handwashing ▪ Table 2.7 Household population by age, sex, and residence ▪ Table 2.8 Household composition ▪ Table 2.9 Children’s living arrangements and orphanhood ▪ Table 2.10 Birth registration of children under age 5 ▪ Table 2.11.1 Educational attainment of the female household population ▪ Table 2.11.2 Educational attainment of the male household population ▪ Table 2.12 School attendance ratios ▪ Table 2.13 Household bank account and health insurance Housing Characteristics and Household Population • 21 Table 2.1.1 Household drinking water Percent distribution of households and de jure population by source of drinking water and by time to obtain drinking water, percentage of households and de jure population with basic drinking water service, and percentage with limited drinking water service, according to residence, Rwanda DHS 2019-20 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 95.8 77.0 80.4 95.1 76.4 79.6 Piped into dwelling/yard/plot 39.4 5.1 11.3 39.9 5.4 11.3 Piped to neighbor 10.7 2.1 3.7 8.8 2.0 3.1 Public tap/standpipe 25.5 31.2 30.1 25.7 30.8 29.9 Tube well or borehole 0.8 1.7 1.5 0.9 1.7 1.5 Protected dug well 0.7 3.0 2.5 0.7 2.8 2.4 Protected spring 8.7 32.8 28.4 8.9 32.6 28.5 Rainwater 0.0 0.6 0.5 0.0 0.5 0.5 Tanker truck/cart with small tank 0.2 0.1 0.1 0.2 0.1 0.1 Bottled water 9.9 0.5 2.2 9.9 0.6 2.2 Unimproved source 3.9 23.0 19.5 4.5 23.5 20.3 Unprotected dug well 0.4 1.7 1.5 0.5 1.7 1.5 Unprotected spring 1.6 13.1 11.0 1.8 13.0 11.1 Surface water 1.9 8.2 7.0 2.1 8.8 7.7 Other 0.3 0.1 0.1 0.4 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises1 59.8 8.6 17.9 58.5 8.9 17.3 30 minutes or less 28.8 50.6 46.6 28.5 49.5 45.9 More than 30 minutes 11.2 40.8 35.4 12.9 41.6 36.7 Don’t know 0.2 0.1 0.1 0.1 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage with basic drinking water service2 86.9 48.8 55.8 85.0 48.2 54.5 Percentage with limited drinking water service3 8.9 28.1 24.6 10.1 28.2 25.1 Number of households/ population 2,355 10,594 12,949 9,441 45,928 55,369 1 Includes water piped to a neighbor and those reporting a round-trip collection time of zero minutes 2 Defined as drinking water from an improved source, provided either water is on the premises or round-trip collection time is 30 minutes or less. Includes safely managed drinking water, which is not shown separately. 3 Drinking water from an improved source, and round-trip collection time is more than 30 minutes or is unknown 22 • Housing Characteristics and Household Population Table 2.1.2 Drinking water according to province and wealth Percent distribution of de jure population by drinking water source, percentage of de jure population with basic drinking water service, and percentage with limited drinking water service, according to province and wealth quintile, Rwanda DHS 2019-20 Background characteristic Improved source of drinking water1 Unimproved source of drinking water2 Total Percentage with basic drinking water service2 Percentage with limited drinking water service3 Number of persons Province City of Kigali 97.4 2.6 100.0 81.9 15.4 7,175 South 79.6 20.4 100.0 51.1 28.5 12,262 West 75.6 24.4 100.0 54.8 20.8 12,510 North 83.0 17.0 100.0 56.8 26.2 8,453 East 72.5 27.5 100.0 42.5 30.0 14,970 Wealth quintile Lowest 68.7 31.3 100.0 38.2 30.5 11,076 Second 72.2 27.8 100.0 41.9 30.4 11,074 Middle 78.2 21.8 100.0 47.5 30.7 11,072 Fourth 84.3 15.7 100.0 59.5 24.8 11,073 Highest 94.6 5.4 100.0 85.3 9.3 11,074 Total 79.6 20.4 100.0 54.5 25.1 55,369 1 See Table 2.1.1 for definition of an improved source. 2 See Table 2.1.1 for definition of an unimproved source. 3 Defined as drinking water from an improved source, provided either water is on the premises or round-trip collection time is 30 minutes or less. Includes safely managed drinking water, which is not shown separately. 4 Drinking water from an improved source, and round-trip collection time is more than 30 minutes or is unknown Table 2.1.3 Treatment of household drinking water Percentage of households and de jure population using various methods to treat drinking water, and percentage using an appropriate treatment method, according to residence, Rwanda DHS 2019-20 Households Population Water treatment method Urban Rural Total Urban Rural Total Boil 49.3 29.7 33.3 50.7 29.6 33.2 Bleach/chlorine added 1.8 1.1 1.2 2.1 1.1 1.3 Strain through cloth 0.1 0.2 0.2 0.1 0.2 0.2 Ceramic, sand, or other filter 1.7 1.8 1.8 1.9 1.9 1.9 Solar disinfection 0.0 0.0 0.0 0.0 0.0 0.0 Let stand and settle 0.1 0.1 0.1 0.1 0.1 0.1 Bottled water 1.8 0.1 0.4 1.8 0.1 0.4 Other 0.2 0.0 0.0 0.2 0.0 0.0 No treatment 46.5 68.0 64.1 44.6 67.9 64.0 Percentage using an appropriate treatment method1 51.8 31.8 35.4 53.5 31.9 35.6 Number of households/ population 2,355 10,594 12,949 9,441 45,928 55,369 Note: Respondents may report multiple treatment methods, so the sum of treatment may exceed 100%. 1 Appropriate water treatment methods are boiling, bleaching, filtering, and solar disinfecting. Housing Characteristics and Household Population • 23 Table 2.2.1 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, percent distribution of households and de jure population with a toilet/latrine facility by location of the facility, percentage of households and de jure population with basic sanitation service, and percentage with limited sanitation service, according to residence, Rwanda DHS 2019-20 Type and location of toilet/ latrine facility Households Population Urban Rural Total Urban Rural Total Improved sanitation facility 87.9 68.7 72.2 87.7 69.7 72.8 Flush/pour flush to piped sewer system 5.2 0.4 1.3 6.0 0.5 1.4 Flush/pour flush to septic tank 4.3 0.3 1.0 4.7 0.3 1.0 Flush/pour flush to pit latrine 2.0 0.5 0.8 2.1 0.5 0.8 Flush/pour flush, don’t know where 0.2 0.1 0.1 0.2 0.1 0.1 Ventilated improved pit (VIP) latrine 3.9 4.9 4.7 3.6 4.8 4.6 Pit latrine with slab 72.3 62.4 64.2 71.2 63.4 64.7 Composting toilet 0.1 0.1 0.1 0.1 0.1 0.1 Unimproved sanitation facility 11.1 27.8 24.8 11.3 27.4 24.7 Flush/pour flush not to sewer/septic tank/pit latrine 3.2 1.0 1.4 3.6 1.1 1.5 Pit latrine without slab/open pit 7.9 26.8 23.3 7.7 26.3 23.2 Open defecation (no facility/ bush/field) 1.0 3.5 3.0 1.0 2.9 2.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population 2,355 10,594 12,949 9,441 45,928 55,369 Location of toilet facility In own dwelling 11.5 0.7 2.7 12.7 0.8 2.8 In own yard/plot 75.2 56.7 60.1 74.6 56.8 59.9 Elsewhere 13.3 42.6 37.1 12.7 42.4 37.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population with a toilet/latrine facility 2,331 10,227 12,558 9,351 44,601 53,952 Percentage with basic sanitation service1 44.1 60.0 57.1 51.3 62.7 60.7 Percentage with limited sanitation service2 43.8 8.8 15.1 36.4 7.0 12.0 Number of households/population 2,355 10,594 12,949 9,441 45,928 55,369 1 Defined as use of improved facilities that are not shared with other households. Includes safely managed sanitation service, which is not shown separately. 2 Defined as use of improved facilities shared by 2 or more households 24 • Housing Characteristics and Household Population Table 2.2.2 Sanitation facility type according to province and wealth Percent distribution of de jure population by type of sanitation, percentage of de jure population with basic sanitation service, and percentage with limited sanitation service, according to province and wealth quintile, Rwanda DHS 2019-20 Type of sanitation Total Percentage with basic sanitation service3 Percentage with limited sanitation service4 Number of persons Background characteristic Improved sanitation facility1 Unimproved sanitation facility2 Open defecation Province City of Kigali 92.4 7.0 0.7 100.0 50.5 41.8 7,175 South 64.6 32.2 3.3 100.0 58.2 6.4 12,262 West 74.6 22.9 2.5 100.0 65.1 9.5 12,510 North 60.5 36.9 2.5 100.0 55.2 5.3 8,453 East 75.5 21.6 2.9 100.0 67.2 8.2 14,970 Wealth quintile Lowest 44.1 47.5 8.5 100.0 36.6 7.5 11,076 Second 65.9 31.6 2.5 100.0 59.9 6.1 11,074 Middle 76.5 22.2 1.3 100.0 69.6 6.9 11,072 Fourth 84.8 14.8 0.5 100.0 67.1 17.7 11,073 Highest 92.5 7.4 0.1 100.0 70.5 22.0 11,074 Total 72.8 24.7 2.6 100.0 60.7 12.0 55,369 1 See Table 2.2.1 for definition of an improved facility. 2 See Table 2.2.1 for definition of an unimproved facility. 3 Defined as use of improved facilities that are not shared with other households. Includes safely managed sanitation service, which is not shown separately. 4 Defined as use of improved facilities shared by 2 or more households Housing Characteristics and Household Population • 25 Table 2.3 Household characteristics Percent distribution of households and de jure population by housing characteristics, percentage using solid fuel for cooking, percentage using clean fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Rwanda DHS 2019-20 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 86.4 36.7 45.7 86.4 38.4 46.6 No 13.6 63.3 54.3 13.6 61.6 53.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth/sand 20.2 75.3 65.3 20.3 74.5 65.2 Dung 0.0 0.3 0.2 0.0 0.3 0.2 Bricks without cement 0.6 1.4 1.2 0.7 1.4 1.3 Parquet or polished wood 0.0 0.0 0.0 0.0 0.0 0.0 Vinyl or asphalt strips 0.0 0.0 0.0 0.0 0.0 0.0 Ceramic tiles/coastal brick 11.2 0.7 2.6 13.5 0.8 3.0 Cement 67.8 22.4 30.6 65.3 23.0 30.2 Carpet 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.1 0.0 0.0 0.1 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 29.4 17.2 19.4 17.2 11.1 12.1 Two 30.2 40.4 38.5 30.1 38.4 37.0 Three or more 40.3 42.5 42.1 52.7 50.5 50.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 24.1 21.9 22.3 20.6 19.5 19.7 In a separate building 42.6 61.6 58.2 49.6 65.0 62.3 Outdoors 32.5 16.3 19.2 29.6 15.5 17.9 No food cooked in household 0.8 0.2 0.3 0.2 0.1 0.1 Other 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 0.5 0.1 0.2 0.5 0.1 0.2 LPG/natural gas/biogas 18.2 1.1 4.2 15.8 0.9 3.4 Kerosene 0.1 0.0 0.0 0.0 0.0 0.0 Charcoal 53.9 7.8 16.2 53.8 6.9 14.9 Wood 22.9 70.0 61.4 25.8 71.0 63.3 Straw/shrubs/grass 3.6 20.5 17.4 3.7 20.9 17.9 Agricultural crop 0.0 0.1 0.1 0.0 0.1 0.1 Animal dung 0.0 0.0 0.0 0.0 0.0 0.0 Briquette 0.0 0.0 0.0 0.0 0.0 0.0 Sawdust 0.1 0.0 0.0 0.1 0.0 0.0 Other 0.0 0.0 0.0 0.0 0.0 0.0 No food cooked in household 0.8 0.2 0.3 0.2 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 80.3 98.5 95.2 83.3 98.9 96.2 Percentage using clean fuel for cooking2 18.7 1.3 4.5 16.3 1.0 3.6 Frequency of smoking in the home Daily 7.2 11.6 10.8 6.9 11.7 10.9 Weekly 3.2 3.9 3.8 3.2 3.8 3.7 Monthly 0.7 0.8 0.8 0.7 0.8 0.8 Less than once a month 0.4 0.5 0.5 0.4 0.5 0.5 Never 88.5 83.2 84.2 88.9 83.2 84.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/ population 2,355 10,594 12,949 9,441 45,928 55,369 LPG = Liquefied petroleum gas 1 Includes kerosene, charcoal, wood, straw/shrubs/grass, agricultural crop, animal dung, briquette, and sawdust 2 Includes electricity, LPG/natural gas, and biogas 26 • Housing Characteristics and Household Population Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals, by residence, Rwanda DHS 2019-20 Residence Total Possession Urban Rural Household effects Radio 59.1 36.2 40.4 Television 40.5 7.7 13.6 Mobile phone 90.4 66.7 71.0 Computer 17.5 1.7 4.6 Non-mobile phone 0.4 0.2 0.3 Refrigerator 10.4 0.6 2.4 Mattress 93.6 64.3 69.7 Bench/chairs 73.4 84.9 82.8 Bed 67.8 63.6 64.4 Table 75.5 64.5 66.5 Sofa 43.1 9.7 15.8 Traditional improved stove 20.5 25.8 24.8 Stove 8.6 0.7 2.1 Cupboard 32.3 7.3 11.9 Dining table 18.1 6.2 8.4 Iron machine 41.4 10.4 16.0 Laundry machine 0.8 0.1 0.2 Satellite dish 24.8 4.3 8.0 Camera 1.7 0.2 0.5 Means of transport Bicycle 9.7 14.9 13.9 Animal-drawn cart 0.2 0.0 0.1 Motorcycle/scooter 3.6 1.9 2.2 Car/truck 7.1 0.6 1.8 Boat with a motor 0.1 0.0 0.0 Boat without a motor 0.2 0.1 0.2 Ownership of agricultural land 23.5 67.4 59.4 Ownership of farm animals1 18.9 53.7 47.3 Number 2,355 10,594 12,949 1 Cows, bulls, goats, sheep, pigs, rabbits, horses, donkeys, mules, chickens, or other poultry Housing Characteristics and Household Population • 27 Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence and province, Rwanda DHS 2019-20 Residence/ province Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 5.4 3.4 6.1 21.8 63.2 100.0 9,441 0.19 Rural 23.0 23.4 22.8 19.6 11.1 100.0 45,928 0.32 Province City of Kigali 2.5 5.1 7.8 24.7 60.0 100.0 7,175 0.21 South 31.1 21.7 18.2 17.3 11.7 100.0 12,262 0.28 West 22.0 22.7 21.9 18.7 14.7 100.0 12,510 0.26 North 19.9 25.4 24.2 17.4 13.2 100.0 8,453 0.25 East 17.7 20.5 23.4 22.5 15.9 100.0 14,970 0.30 Total 20.0 20.0 20.0 20.0 20.0 100.0 55,369 0.29 Table 2.6 Handwashing Percentage of the de jure population for whom the place most often used for washing hands was observed, by whether the location was fixed or mobile; total percentage of the de jure population for whom the place for handwashing was observed; among the de jure population for whom the place for handwashing was observed, percentage with water available, percentage with soap available, and percentage with a cleansing agent other than soap available; percentage of the de jure population with a basic handwashing facility; and percentage with a limited handwashing facility, according to background characteristics, Rwanda DHS 2019-20 Percentage of de jure population for whom place for washing hands was observed: Number of persons Place for handwashing observed and: Number of persons for whom place for hand- washing was observed Percentage of the de jure population with a basic handwashing facility3 Percentage of the de jure population with a limited handwashing facility4 Number of persons for whom a place for handwashing was observed or with no place for hand- washing in the dwelling, yard, or plot Background characteristic Place for handwashing was a fixed place Place for handwashing was mobile Total Water available Soap available1 Cleansing agent other than soap available2 Residence Urban 20.4 68.8 89.1 9,441 48.4 42.9 0.2 8,415 36.8 52.9 9,380 Rural 10.2 72.7 82.9 45,928 39.2 29.5 0.0 38,056 22.7 60.6 45,679 Province City of Kigali 17.8 70.1 87.8 7,175 46.2 42.7 0.2 6,302 36.0 52.5 7,122 South 11.2 75.2 86.4 12,262 33.4 26.2 0.1 10,590 21.2 65.5 12,221 West 6.7 71.8 78.5 12,510 26.7 19.7 0.0 9,821 12.8 66.1 12,455 North 11.7 67.6 79.2 8,453 47.1 33.0 0.0 6,698 24.5 55.8 8,346 East 14.2 73.1 87.2 14,970 51.7 40.0 0.0 13,060 33.8 53.8 14,914 Wealth quintile Lowest 4.3 74.7 79.0 11,076 30.6 17.7 0.0 8,746 12.4 67.2 10,980 Second 6.8 75.0 81.8 11,074 35.6 25.5 0.0 9,056 19.5 62.9 11,000 Middle 9.6 74.6 84.1 11,072 38.1 30.6 0.0 9,317 23.2 61.3 11,027 Fourth 11.2 73.3 84.5 11,073 40.7 34.2 0.0 9,355 27.1 57.7 11,034 Highest 27.7 62.6 90.3 11,074 57.4 49.3 0.2 9,996 43.3 47.5 11,018 Total 11.9 72.0 83.9 55,369 40.9 31.9 0.1 46,471 25.1 59.3 55,059 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 The availability of a handwashing facility on premises with soap and water 4 The availability of a handwashing facility on premises without soap and/or water 28 • Housing Characteristics and Household Population Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by age groups, according to sex and residence, Rwanda DHS 2019-20 Urban Rural Male Female Total Age Male Female Total Male Female Total <5 15.4 14.1 14.7 16.1 13.7 14.9 16.0 13.8 14.8 5-9 13.8 11.2 12.4 14.7 12.6 13.6 14.6 12.4 13.4 10-14 10.4 10.5 10.4 15.0 12.8 13.8 14.2 12.4 13.2 15-19 10.6 11.4 11.0 11.7 11.0 11.3 11.5 11.0 11.3 20-24 9.9 10.9 10.4 6.7 7.6 7.2 7.3 8.2 7.8 25-29 7.9 9.8 9.0 5.5 6.4 6.0 5.9 7.0 6.5 30-34 8.3 9.1 8.8 6.2 6.8 6.5 6.5 7.2 6.9 35-39 7.0 6.7 6.8 6.2 7.1 6.7 6.3 7.0 6.7 40-44 5.2 4.8 5.0 4.3 5.1 4.7 4.4 5.0 4.7 45-49 3.4 4.0 3.8 3.3 4.1 3.7 3.3 4.1 3.7 50-54 2.9 2.1 2.5 2.5 2.9 2.7 2.5 2.8 2.7 55-59 1.9 1.5 1.7 2.6 2.8 2.7 2.5 2.6 2.5 60-64 1.5 1.4 1.4 2.0 2.6 2.3 1.9 2.4 2.2 65-69 0.8 0.9 0.8 1.3 1.6 1.5 1.3 1.5 1.4 70-74 0.3 0.6 0.5 0.9 1.1 1.0 0.8 1.0 0.9 75-79 0.2 0.4 0.3 0.4 0.7 0.5 0.4 0.6 0.5 80+ 0.4 0.6 0.5 0.7 1.0 0.9 0.6 1.0 0.8 Don’t know/missing 0.0 0.0 0.0 0.0 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 Dependency age groups 0-14 39.6 35.8 37.5 45.8 39.1 42.3 44.8 38.5 41.5 15-64 58.7 61.7 60.3 50.8 56.5 53.8 52.1 57.4 54.9 65+ 1.7 2.5 2.2 3.3 4.4 3.9 3.1 4.1 3.6 Don’t know/missing 0.0 0.0 0.0 0.0 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 Child and adult populations 0-17 45.9 42.4 44.0 53.7 46.6 49.9 52.4 45.9 48.9 18+ 54.1 57.6 56.0 46.3 53.4 50.1 47.6 54.1 51.1 Don’t know/missing 0.0 0.0 0.0 0.0 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 Adolescents 10-19 21.0 21.8 21.4 26.6 23.7 25.1 25.7 23.4 24.5 Number of persons 4,333 5,149 9,482 21,529 24,469 45,998 25,862 29,618 55,479 Housing Characteristics and Household Population • 29 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 children under age 18 who are orphans or not living with a biological parent, according to residence, Rwanda DHS 2019-20 Residence Total Characteristic Urban Rural Household headship Male 65.5 68.7 68.1 Female 34.5 31.3 31.9 Total 100.0 100.0 100.0 Number of usual members 0 0.0 0.0 0.0 1 13.6 6.4 7.7 2 12.8 11.5 11.7 3 16.7 18.1 17.9 4 18.8 19.7 19.6 5 14.9 18.1 17.5 6 11.6 12.8 12.6 7 5.8 7.3 7.0 8 3.1 3.5 3.5 9+ 2.8 2.6 2.6 Total 100.0 100.0 100.0 Mean size of households 4.0 4.3 4.3 Percentage of households with children under age 18 who are orphans or not living with a biological parent Double orphans 0.5 0.7 0.6 Single orphans1 7.1 8.6 8.3 Children not living with a biological parent2 16.0 17.9 17.6 Orphans and/or children not living with a biological parent 19.3 22.6 22.0 Number of households 2,355 10,594 12,949 Note: Table is based on de jure household members, i.e., usual residents. 1 Includes children with one dead parent and an unknown survival status of the other parent 2 Children not living with a biological parent are those under age 18 living in households with neither their mother nor their father present. 30 • Housing Characteristics and Household Population Table 2.9 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, percentage of children not living with a biological parent, and percentage of children with one or both parents dead, according to background characteristics, Rwanda DHS 2019-20 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a biologi- cal parent Percent- age with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing informa- tion on father/ mother Age 0-4 71.4 21.8 1.3 0.5 0.2 3.5 0.3 0.2 0.0 0.8 100.0 4.1 2.0 8,157 <2 74.2 23.5 0.9 0.1 0.0 0.6 0.2 0.1 0.0 0.6 100.0 0.8 1.2 3,220 2-4 69.5 20.6 1.5 0.8 0.2 5.5 0.3 0.3 0.1 1.0 100.0 6.2 2.6 4,938 5-9 64.9 18.6 2.8 1.9 0.6 8.1 0.6 0.6 0.2 1.8 100.0 9.5 4.9 7,420 10-14 60.6 16.2 5.4 2.6 1.1 9.8 0.9 1.4 0.4 1.7 100.0 12.5 9.3 7,325 15-17 53.4 14.2 8.6 1.9 1.3 14.5 1.7 2.4 1.1 0.9 100.0 19.6 15.2 4,066 Sex Male 64.9 18.3 3.9 1.7 0.8 7.3 0.5 0.9 0.4 1.2 100.0 9.1 6.7 13,499 Female 63.0 18.2 3.9 1.6 0.6 9.0 0.9 1.1 0.3 1.4 100.0 11.3 6.9 13,469 Residence Urban 58.1 23.5 2.8 2.5 0.9 8.8 0.8 1.2 0.3 1.0 100.0 11.2 6.1 4,142 Rural 65.0 17.3 4.1 1.5 0.7 8.0 0.7 0.9 0.4 1.4 100.0 10.0 6.9 22,826 Province City of Kigali 60.9 22.7 3.1 2.5 0.7 7.0 0.8 1.1 0.2 1.1 100.0 9.0 5.9 3,143 South 61.8 17.9 4.0 1.7 0.6 9.5 0.5 1.2 0.7 2.0 100.0 11.9 7.2 5,842 West 67.2 16.3 4.4 0.7 0.8 7.2 0.8 1.3 0.3 0.9 100.0 9.6 7.7 6,409 North 68.0 17.0 3.9 0.8 0.5 7.1 0.5 0.7 0.3 1.1 100.0 8.6 6.0 4,054 East 61.9 18.8 3.8 2.6 0.8 8.9 0.9 0.6 0.3 1.3 100.0 10.8 6.6 7,521 Wealth quintile Lowest 55.0 26.1 7.2 1.6 0.7 5.9 0.5 0.8 0.4 1.8 100.0 7.7 9.7 5,806 Second 63.7 17.3 4.8 1.3 0.8 8.4 0.8 0.6 0.3 1.8 100.0 10.2 7.5 5,553 Middle 72.1 14.0 2.8 1.4 0.7 6.5 0.4 0.7 0.4 1.0 100.0 8.0 5.2 5,471 Fourth 67.7 15.9 2.4 1.6 0.6 8.4 0.8 1.0 0.5 1.2 100.0 10.6 5.3 5,344 Highest 61.5 17.2 1.9 2.6 0.7 12.1 1.2 1.8 0.3 0.7 100.0 15.4 5.9 4,794 Total <15 65.8 18.9 3.1 1.6 0.6 7.0 0.6 0.7 0.2 1.4 100.0 8.5 5.3 22,902 Total <18 63.9 18.2 3.9 1.7 0.7 8.1 0.7 1.0 0.4 1.3 100.0 10.2 6.8 26,968 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent Housing Characteristics and Household Population • 31 Table 2.10 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Rwanda DHS 2019-20 Percentage of children whose births are registered and who: Number of children Background characteristic Had a birth certificate Did not have a birth certificate Total percentage of children whose births are registered Age <2 16.8 64.2 81.0 3,220 2-4 16.5 72.1 88.6 4,938 Sex Male 17.2 68.5 85.8 4,111 Female 15.9 69.5 85.4 4,047 Residence Urban 23.4 61.2 84.6 1,389 Rural 15.2 70.6 85.8 6,768 Province City of Kigali 21.6 58.0 79.7 1,085 South 10.4 74.2 84.6 1,664 West 19.4 68.5 87.8 1,974 North 14.7 76.2 90.9 1,239 East 17.3 66.9 84.2 2,195 Wealth quintile Lowest 9.6 68.2 77.8 1,903 Second 12.7 74.2 86.9 1,598 Middle 15.1 72.1 87.2 1,596 Fourth 18.8 69.0 87.8 1,569 Highest 28.9 61.1 90.1 1,490 Total 16.6 69.0 85.6 8,157 32 • Housing Characteristics and Household Population Table 2.11.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Rwanda DHS 2019-20 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 18.0 82.0 0.0 0.0 0.0 0.0 0.0 100.0 2,826 0.5 10-14 1.2 78.4 8.3 12.0 0.0 0.0 0.0 100.0 3,662 3.6 15-19 1.1 31.0 19.7 45.7 2.1 0.4 0.0 100.0 3,269 5.7 20-24 1.6 31.1 17.9 29.8 14.7 4.7 0.1 100.0 2,432 5.9 25-29 6.7 34.5 16.8 19.9 13.8 8.2 0.1 100.0 2,076 5.5 30-34 10.9 47.5 17.3 8.1 8.5 7.7 0.0 100.0 2,127 4.3 35-39 15.4 51.9 19.9 3.7 4.1 4.9 0.0 100.0 2,081 3.6 40-44 17.4 48.6 21.9 5.6 2.9 3.5 0.0 100.0 1,485 4.6 45-49 24.5 55.4 10.0 5.5 2.2 2.4 0.0 100.0 1,218 3.9 50-54 33.5 49.0 10.8 2.6 1.6 2.3 0.2 100.0 822 2.6 55-59 43.8 37.3 14.4 2.0 1.5 0.9 0.0 100.0 767 1.4 60-64 49.4 38.0 9.2 2.3 1.2 0.0 0.0 100.0 716 0.0 65+ 67.6 27.4 3.2 1.1 0.5 0.1 0.1 100.0 1,210 0.0 Don’t know/ missing * * * * * * * 100.0 1 * Residence Urban 7.4 36.8 12.4 22.5 9.9 11.0 0.0 100.0 4,286 5.6 Rural 16.4 53.3 13.4 12.6 3.3 1.0 0.0 100.0 20,405 3.5 Province City of Kigali 6.9 38.5 12.6 21.4 10.1 10.5 0.0 100.0 3,184 5.5 South 16.6 51.8 13.9 13.0 3.1 1.6 0.0 100.0 5,564 3.6 West 17.4 51.8 13.1 12.7 3.7 1.4 0.0 100.0 5,512 3.4 North 15.3 52.3 14.8 11.9 3.9 1.7 0.0 100.0 3,763 3.8 East 14.8 52.8 12.2 14.8 3.7 1.7 0.0 100.0 6,668 3.6 Wealth quintile Lowest 24.8 59.0 10.6 5.2 0.3 0.0 0.0 100.0 4,936 2.1 Second 19.4 57.5 12.2 9.8 1.0 0.1 0.0 100.0 5,012 2.9 Middle 14.4 55.2 14.6 13.6 2.2 0.0 0.1 100.0 4,781 3.7 Fourth 10.4 47.6 16.1 19.7 5.4 0.8 0.0 100.0 4,932 4.6 Highest 5.2 33.3 12.8 23.2 13.0 12.5 0.0 100.0 5,029 6.0 Total 14.8 50.4 13.2 14.3 4.4 2.7 0.0 100.0 24,691 3.8 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school 2 Completed 6th grade at the secondary level Housing Characteristics and Household Population • 33 Table 2.11.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Rwanda DHS 2019-20 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 22.0 77.9 0.0 0.1 0.0 0.0 0.0 100.0 2,958 0.3 10-14 1.9 84.3 5.9 7.8 0.0 0.0 0.0 100.0 3,668 3.1 15-19 1.4 40.6 15.8 40.2 1.8 0.2 0.0 100.0 2,974 5.4 20-24 3.5 36.1 18.9 24.3 13.0 4.3 0.1 100.0 1,878 5.5 25-29 5.5 36.3 15.7 16.6 16.2 9.7 0.0 100.0 1,521 5.5 30-34 10.1 45.5 16.9 8.8 9.7 8.8 0.1 100.0 1,687 4.6 35-39 13.2 45.9 25.2 4.8 3.9 6.8 0.2 100.0 1,631 4.3 40-44 12.9 49.8 22.6 6.1 3.6 4.8 0.2 100.0 1,143 4.9 45-49 14.2 57.8 11.9 7.3 3.5 5.2 0.0 100.0 862 5.0 50-54 21.4 50.9 12.5 4.3 5.7 5.1 0.1 100.0 657 4.3 55-59 26.1 43.7 22.0 3.1 2.0 3.0 0.0 100.0 635 3.1 60-64 30.4 40.4 21.4 3.8 2.2 1.8 0.0 100.0 497 2.7 65+ 35.1 42.4 17.2 2.8 1.6 0.6 0.2 100.0 791 2.3 Don’t know/ missing * * * * * * * 100.0 1 * Residence Urban 6.0 39.6 12.5 19.1 11.3 11.4 0.1 100.0 3,531 5.5 Rural 12.0 58.5 13.6 11.3 3.0 1.5 0.1 100.0 17,373 3.4 Province City of Kigali 6.4 40.4 14.1 17.5 11.3 10.3 0.1 100.0 2,744 5.4 South 12.4 57.8 13.9 11.3 2.3 2.3 0.1 100.0 4,660 3.3 West 11.7 55.2 14.4 12.8 4.2 1.8 0.0 100.0 4,595 3.5 North 10.5 59.0 13.8 10.5 3.4 2.7 0.1 100.0 3,206 3.6 East 11.8 58.5 11.7 12.5 3.5 1.8 0.1 100.0 5,698 3.4 Wealth quintile Lowest 18.8 66.5 9.6 4.4 0.5 0.1 0.0 100.0 3,849 2.0 Second 13.9 63.1 13.3 8.3 1.2 0.2 0.0 100.0 4,094 2.9 Middle 10.8 60.1 15.2 11.5 1.9 0.3 0.1 100.0 4,370 3.5 Fourth 8.1 52.1 16.3 16.9 5.0 1.6 0.0 100.0 4,275 4.4 Highest 4.3 36.5 12.2 21.1 12.8 13.1 0.1 100.0 4,316 5.9 Total 11.0 55.3 13.4 12.6 4.4 3.2 0.1 100.0 20,904 3.7 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school 2 Completed 6th grade at the secondary level 34 • Housing Characteristics and Household Population Table 2.12 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling, and the gender parity index (GPI), according to background characteristics, Rwanda DHS 2019-20 Net attendance ratio 1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 90.9 88.9 89.8 0.98 135.3 125.6 130.2 0.93 Rural 91.3 92.7 92.0 1.01 138.5 138.6 138.6 1.00 Province City of Kigali 89.4 90.2 89.8 1.01 129.7 125.7 127.6 0.97 South 91.5 92.4 91.9 1.01 136.8 133.7 135.3 0.98 West 90.6 90.7 90.7 1.00 131.9 133.0 132.5 1.01 North 93.4 94.0 93.7 1.01 142.7 141.7 142.3 0.99 East 91.2 92.9 92.1 1.02 145.1 143.7 144.4 0.99 Wealth quintile Lowest 86.5 91.5 88.9 1.06 129.7 133.5 131.5 1.03 Second 92.7 93.9 93.3 1.01 142.8 142.6 142.7 1.00 Middle 93.8 94.9 94.3 1.01 143.3 143.5 143.4 1.00 Fourth 93.9 92.0 92.9 0.98 143.8 135.5 139.6 0.94 Highest 89.9 87.4 88.6 0.97 130.5 126.3 128.4 0.97 Total 91.3 92.1 91.7 1.01 138.1 136.6 137.4 0.99 SECONDARY SCHOOL Residence Urban 56.1 52.6 54.2 0.94 77.7 74.6 76.0 0.96 Rural 30.2 36.7 33.5 1.22 40.2 46.8 43.5 1.16 Province City of Kigali 53.2 49.8 51.4 0.94 74.4 69.6 71.8 0.94 South 31.5 42.7 37.2 1.35 41.6 54.1 48.0 1.30 West 33.8 36.5 35.1 1.08 45.3 48.5 46.9 1.07 North 28.3 30.3 29.3 1.07 37.1 40.0 38.6 1.08 East 32.1 39.2 35.8 1.22 43.3 49.8 46.7 1.15 Wealth quintile Lowest 11.9 14.7 13.4 1.23 17.0 17.4 17.2 1.03 Second 19.1 26.8 23.0 1.41 26.1 33.2 29.7 1.27 Middle 31.6 36.4 34.0 1.15 41.1 44.7 42.9 1.09 Fourth 43.3 54.1 48.7 1.25 55.1 69.2 62.1 1.26 Highest 59.3 57.2 58.1 0.96 83.9 81.6 82.6 0.97 Total 33.9 39.2 36.6 1.16 45.6 51.2 48.5 1.12 1 The NAR for primary school is the percentage of the primary school-age (7-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school-age (13-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100.0. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100.0. 3 The gender parity index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The gender parity index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. Housing Characteristics and Household Population • 35 Table 2.13 Household bank account and health insurance Percentage of households in which at least one member has a bank account and is covered by health insurance, according to residence, province, and wealth quintile, Rwanda DHS 2019-20 Background characteristic Percentage of households with at least one member who has a bank account Percentage of households with at least one member covered by health insurance Number of households Residence Urban 68.3 87.2 2,355 Rural 45.8 85.6 10,594 Province City of Kigali 68.3 85.3 1,810 South 49.6 86.1 3,003 West 48.2 85.3 2,770 North 48.4 92.0 2,012 East 42.4 82.7 3,353 Wealth quintile Lowest 20.7 72.9 2,837 Second 34.4 84.1 2,609 Middle 48.6 88.1 2,473 Fourth 62.0 90.6 2,570 Highest 88.5 95.5 2,460 Total 49.9 85.9 12,949 Characteristics of Respondents • 37 CHARACTERISTICS OF RESPONDENTS 3 Key Findings ▪ Education: The percentage of women age 15-49 with no education has decreased since 2014-15, from 12% to 9%. Over the same period, the median number of years of schooling completed has increased from 4.6 to 5.2 years. ▪ Exposure to mass media: The level of exposure to mass media is generally low in Rwanda. Thirty-four percent of women and 16% of men have no access to any of three specified media sources (newspaper, television, and radio) at least once a week. ▪ Internet usage: Urban women and men (40% and 58%, respectively) are more likely than rural women and men (8% and 17%, respectively) to have ever used the internet. ▪ Employment: 66% of women and 87% of men are currently employed. his chapter presents information on the demographic and socioeconomic characteristics of the survey respondents such as age, education, place of residence, marital status, employment, and wealth status. This information is useful for understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviors. 3.1 BASIC CHARACTERISTICS OF SURVEY RESPONDENTS The 2019-20 RDHS interviewed 14,634 women age 15-49 and 6,513 men age 15-59. Table 3.1 shows the percent distribution of women and men age 15-49 by background characteristics. The majority of women and men are under age 30 (53% of women and 55% of men). Nearly all Rwandans are Christians; 97% of women and 95% of men are Catholics, Protestants, Adventists, or Jehovah’s Witnesses. The remaining 3% of women and 5% of men practice other religions (Islam, traditional, etc.) or do not practice any religion. Women are more likely than men to be currently married or living together with a partner (51% and 49%, respectively). Women are less likely than men to have never been married (40% and 49%, respectively). About four in every five Rwandans live in rural areas (80% of women and 81% of men). T 38 • Characteristics of Respondents 3.2 EDUCATION AND LITERACY Literacy Respondents who had attended higher than secondary school were assumed to be literate. All other respondents, shown a typed sentence to read aloud, were considered literate if they could read all or part of the sentence. Sample: Women and men age 15-49 Education is one of the most important determinants of an individual’s knowledge and behavior. Table 3.2.1, Table 3.2.2 and Figure 3.1 show that men and women have relatively similar levels of education. Only 9% of women and 7% of men age 15-49 have no formal education, while nearly one-third of women and men (32% each) have some secondary education or higher. Eighty-five percent of women and 86% of men are literate (Tables 3.3.1 and 3.3.2). Trends: The percentage of women and men who are literate has increased since 2014-15, from 80% to 85% among women and from 84% to 86% among men. The percentage of women and men with no education has decreased over the same period, from 12% to 9% among women and from 9% to 7% among men. The median number of years of schooling completed has increased from 4.6 to 5.2 years among women and from 4.8 to 5.1 years among men. Patterns by background characteristics ▪ Urban women are better educated than rural women; only 5% of urban women have no education, as opposed to 11% of rural women (Table 3.2.1). ▪ Educational attainment among women increases with increasing household wealth (Figure 3.2). For example, only 9% of women in the lowest wealth quintile have a secondary education or higher, as compared with 64% of those in the highest quintile. A similar pattern is observed among men. Figure 3.1 Education of survey respondents Figure 3.2 Secondary education by household wealth 9 7 40 44 18 18 21 19 7 7 4 5 Women Men Percent distribution of women and men age 15-49 by highest level of schooling attended or completed More than secondary Completed secondary Some secondary Completed primary Some primary No education 9 18 24 38 64 9 17 23 37 63 Lowest Second Middle Fourth Highest Percentage of women and men age 15-49 with a secondary education or higher Women Men WealthiestPoorest Characteristics of Respondents • 39 ▪ The percentage of women who have completed secondary education or higher is highest in City of Kigali (29%) and lowest in South province (8%) (Figure 3.3). ▪ Median number of years of education completed is higher among urban residents than rural residents. Urban women have completed a median of 7.3 years of education, while the median among rural women is 4.8 years. The corresponding figures among men are 7.6 years and 4.8 years. ▪ Women and men in the lowest wealth quintile (68% each) are less likely than other women and men to be literate (Table 3.3.1 and Table 3.3.2). 3.3 MASS MEDIA EXPOSURE Exposure to mass media Respondents were asked how often they read a newspaper, listened to the radio, or watched television. Those who responded at least once a week are considered regularly exposed to that form of media. Sample: Women and men age 15-49 Exposure to different mass media is key to information dissemination and expansion of knowledge. Tables 3.4.1 and 3.4.2 show the percentages of women and men who are exposed to different types of media, by background characteristics. The level of exposure to mass media is generally low in Rwanda. Among both women and men, radio is the most frequently accessed form of media: 62% of women and 81% of men listen to the radio. Twenty percent of women watch television, and 9% read newspapers. The corresponding percentages among men are 30% and 15%. Figure 3.4 shows that one-third of female respondents (34%) and 16% of male respondents have no access to any of the three media sources at least once a week. Trends: Women’s and men’s exposure to mass media has changed very little since 2014-15. For example, the proportion of women who listen to the radio at least once a week has remained constant at 62%. Among men, this proportion has increased slightly from 79% to 81%. The proportion of respondents having no access to any of the three sources (newspaper, television, and radio) has decreased slightly, from 36% to 34% among women and from 19% to 16% among men. Patterns by background characteristics ▪ The percentage of women who read a newspaper at least once a week is very low. However, urban women are over two times more likely to read a newspaper than rural women (16% and 7%, Figure 3.3 Secondary education among women, by province Percentage of women who have completed secondary education or higher Figure 3.4 Exposure to mass media 9 20 62 4 34 15 30 81 9 16 Reads news- paper Watches television Listens to radio All three media None of these media Percentage of women and men age 15-49 who are exposed to media on a weekly basis Women Men 40 • Characteristics of Respondents respectively). The urban-rural gap is more evident in television viewing, with 51% of urban women and only 12% of rural women watching television at least once a week. ▪ The percentages of women and men with no access to any of the three media sources are lowest in City of Kigali (15% and 5%, respectively) and among those in the highest wealth quintile (8% and 2%, respectively). Women and men with no formal education are most likely to have no access to any of the three media (62% and 39%, respectively). 3.4 INTERNET USAGE The internet has gradually become an important means of transacting business, sharing information, and interacting through social media, and a number of organizations have adopted it as a way to reach people. There are currently online shopping platforms through which business is transacted on a daily basis in Rwanda. Also, some e-health platforms have started operating in the country. Overall, 14% of women and 25% of men age 15-49 reported that they had ever used the internet. However, only 12% of women and 23% of men had used the internet in the past 12 months (Tables 3.5.1 and 3.5.2). Patterns by background characteristics ▪ Urban women and men (40% and 58%, respectively) are more likely than rural women and men (8% and 17%, respectively) to have ever used the internet. ▪ The percentages of women and men who have ever used the internet are highest in City of Kigali (40% and 56%, respectively). ▪ The proportion of women and men who have ever used the internet increases dramatically by level of wealth. Less than 1% of women and 3% of men in the lowest wealth quintile have ever used the internet, as compared with 45% of women and 63% of men in the highest wealth quintile. 3.5 EMPLOYMENT Currently employed Respondents who were employed in the 7 days before the survey. Sample: Women and men age 15-49 In the 2019-20 RDHS, respondents were asked whether they were employed at the time of the survey and, if not, whether they had worked at any time during the 12 months preceding the survey. Tables 3.6.1 and 3.6.2 show that 66% of women and 87% of men are currently employed. Furthermore, 7% of women and 2% of men reported that they had worked in the past 12 months but were not currently employed. Trends: Current employment among women age 15-49 has declined over the past 5 years, from 78% in 2014-15 to 66% in 2019-20. However, the percentage of men who are currently employed has increased slightly from 85% to 87%. Patterns by background characteristics ▪ Divorced, separated, or widowed women (82%) are more likely to be employed than women who are currently married or living together with a partner (77%) and those who have never been married (49%) (Table 3.6.1). Among men, those who are currently married or living with a partner (99%) and those who are divorced, separated, or widowed (93%) are more likely to be employed than those who have never been married (74%) (Table 3.6.2). Characteristics of Respondents • 41 ▪ There are notable variations in the proportion of currently employed women and men by place of residence. Rural women and men (69% and 88%, respectively) are more likely to be employed than urban women and men (57% and 83%, respectively). ▪ The percentage of women who are currently employed decreases with increasing wealth, from 74% among those in the lowest wealth quintile to 56% among those in the highest wealth quintile. A similar pattern is observed among men; 90% of those in the lowest wealth quintile are currently employed, as compared with 83% of those in the highest quintile (Figure 3.5). ▪ There is no linear relationship between current employment and level of education among either female or male respondents. 3.6 OCCUPATION Occupation Categorized as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, agriculture, and other. Sample: Women and men age 15-49 who were currently employed or had worked in the 12 months before the survey Tables 3.7.1 and 3.7.2 show that only small proportions of men and women were employed in professional/technical/managerial occupations in the 12 months before the survey (5% and 4%, respectively). The two most frequently reported occupations in Rwanda are agriculture (46% among women and 39% among men) and unskilled manual labor (28% among women and 31% among men). A higher percentage of women than men are engaged in agricultural work (Figure 3.6). Twenty-three percent of employed women in Rwanda are not paid for their work. Women engaged in agricultural work are much more likely (42%) than those working in nonagricultural occupations (8%) to not be paid for their work. Forty-eight percent of women who worked in the past year are self-employed (Table 3.8). Trends: There has been a substantial decline since 2014-15 in the proportion of women working in agricultural occupations, from 76% to 46%. Among men, the proportion has decreased from 58% to 39%. The proportion of women and men who are engaged in unskilled manual labor has increased dramatically, from 10% to 31% among men and from 2% to 28% among women. Figure 3.5 Employment status by household wealth Figure 3.6 Occupation 74 71 71 62 56 90 88 87 87 83 Lowest Second Middle Fourth Highest Percentage of women and men age 15-49 who are currently employed Women Men 4 1 14 3 28 4 46 5 1 11 12 31 3 39 Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Percentage of women and men age 15-49 employed in the 12 months before the survey by occupation Women Men 42 • Characteristics of Respondents Patterns by background characteristics ▪ Women and men living in rural areas are more likely to be engaged in agriculture (53% and 46%, respectively) than those living in urban areas (14% and 8%, respectively) (Tables 3.7.1 and 3.7.2). ▪ Women and men with more than a secondary education are more likely than those at other educational levels to be engaged in professional/technical/managerial work (48% and 53%, respectively). Women and men with no education are mostly engaged in unskilled manual labor (43% and 46%, respectively). ▪ The percentages of men and women employed in professional/technical/managerial and clerical occupations generally increase with increasing wealth. 3.7 HEALTH INSURANCE COVERAGE Health insurance improves access to health care, thus promoting good health. Reasonable access to health care encourages individuals to seek health maintenance services more regularly than they otherwise would, thereby preventing potentially serious illnesses. Additionally, health insurance protects individuals from financial hardships that may result from large or unexpected medical bills. The 2019-20 RDHS collected information about specific types of insurance coverage and the percentages of women and men with any health insurance according to background characteristics. More than 4 in every 5 Rwandan women and men age 15-49 (83% each) have health insurance. Mutuelle/community health insurance is the most popular type of insurance among both women and men (77% and 78%, respectively) (Table 3.9.1 and Table 3.9.2). Trends: The percentage of women and men who have any form of health insurance has increased since 2014-15, from 74% to 83% among women and from 73% to 83% among men. Patterns by background characteristics ▪ Health insurance coverage increases with increasing wealth. Ninety-one percent of women and 92% of men in the highest wealth quintile have insurance coverage, as compared with 67% of women and 63% of men in the lowest quintile. ▪ Women and men with more than a secondary education are more likely to have Rwandaise d’Assurance Maladie (RAMA) or Rwandan Social Security Board (RSSB) insurance (33% and 37%, respectively) than those with other levels of education. 3.8 TOBACCO USE Table 3.10.1 shows that cigarette smoking and use of any type of tobacco are rare among women (less than 1%). Seven percent of men smoke any type of tobacco (nearly all of whom smoke cigarettes), and 5% smoke daily (Table 3.10.2). Among men who smoke cigarettes daily, about two-thirds (67%) smoke less than 5 cigarettes each day, while 22% smoke 5-9 cigarettes and 10% smoke 10 or more cigarettes each day (Table 3.11). Less than 1 percent of women and men use smokeless tobacco (Table 3.12). Trends: Smoking among women is uncommon in Rwanda; since 2014-15, 1% or less of women have reported that they smoke. The proportion of men who reported smoking any type of tobacco decreased from 12% in 2014-15 to 7% in 2019-20. Patterns by background characteristics ▪ The percentage of men who use any type of tobacco increases from less than 1% among those age 15- 19 to a peak of 16% among those age 40-44 before declining to 15% among those age 45-49. Characteristics of Respondents • 43 ▪ There are variations by province in cigarette smoking among men, from 4% in North and West to 10% in South (Table 3.10.2). ▪ The percentage of men who smoke cigarettes declines with increasing education, from 21% among those with no formal education to 2% among those with more than a secondary education. Similarly, 15% of men in the lowest wealth quintile smoke cigarettes, as compared with only 4% in the highest wealth quintile. LIST OF TABLES For more information on the characteristics of survey respondents, see the following tables: ▪ Table 3.1 Background characteristics of respondents ▪ Table 3.2.1 Educational attainment: Women ▪ Table 3.2.2 Educational attainment: Men ▪ Table 3.3.1 Literacy: Women ▪ Table 3.3.2 Literacy: Men ▪ Table 3.4.1 Exposure to mass media: Women ▪ Table 3.4.2 Exposure to mass media: Men ▪ Table 3.5.1 Internet usage: Women ▪ Table 3.5.2 Internet usage: Men ▪ Table 3.6.1 Employment status: Women ▪ Table 3.6.2 Employment status: Men ▪ Table 3.7.1 Occupation: Women ▪ Table 3.7.2 Occupation: Men ▪ Table 3.8 Type of employment: Women ▪ Table 3.9.1 Health insurance coverage: Women ▪ Table 3.9.2 Health insurance coverage: Men ▪ Table 3.10.1 Tobacco smoking: Women ▪ Table 3.10.2 Tobacco smoking: Men ▪ Table 3.11 Average number of cigarettes smoked daily: Men ▪ Table 3.12 Smokeless tobacco use and any tobacco use 44 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Rwanda DHS 2019-20 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 22.3 3,258 3,308 26.1 1,526 1,534 20-24 16.5 2,414 2,424 16.4 960 954 25-29 14.2 2,073 2,047 12.1 710 735 30-34 14.5 2,118 2,095 14.3 835 816 35-39 14.2 2,072 2,043 13.6 793 784 40-44 10.2 1,488 1,487 9.8 575 570 45-49 8.3 1,211 1,230 7.7 447 440 Religion Catholic 36.7 5,364 5,506 42.0 2,455 2,520 Protestant 47.2 6,905 6,754 40.0 2,340 2,262 Adventist 12.5 1,836 1,842 12.8 748 748 Muslim 1.8 269 287 2.6 153 161 Traditional 0.0 1 1 0.0 0 1 Jehovah’s Witness 0.9 128 114 0.5 30 28 Other 0.2 29 24 0.1 8 6 No religion 0.7 104 106 1.9 112 107 Marital status Never married 40.4 5,914 6,060 49.0 2,867 2,908 Married 32.1 4,703 4,706 30.6 1,786 1,779 Living together 18.4 2,698 2,584 18.4 1,074 1,026 Divorced/separated 6.4 935 906 1.8 105 107 Widowed 2.6 383 378 0.2 14 13 Residence Urban 19.9 2,909 3,551 19.1 1,115 1,366 Rural 80.1 11,725 11,083 80.9 4,731 4,467 Province City of Kigali 14.8 2,166 1,921 15.0 879 766 South 20.9 3,065 3,482 21.2 1,239 1,409 West 21.7 3,174 3,312 21.7 1,268 1,334 North 15.2 2,226 2,294 15.1 886 915 East 27.4 4,003 3,625 26.9 1,574 1,409 Education No education 9.4 1,377 1,352 7.2 420 417 Primary 58.3 8,529 8,500 61.0 3,569 3,522 Secondary 27.9 4,086 4,110 26.7 1,562 1,565 More than secondary 4.4 642 672 5.0 295 329 Wealth quintile Lowest 18.7 2,741 2,844 15.8 924 967 Second 18.8 2,756 2,707 18.4 1,076 1,058 Middle 18.8 2,757 2,709 21.0 1,227 1,182 Fourth 20.3 2,966 2,884 21.9 1,278 1,261 Highest 23.3 3,414 3,490 23.0 1,342 1,365 Total 15-49 100.0 14,634 14,634 100.0 5,846 5,833 50-59 na na na na 667 680 Total 15-59 na na na na 6,513 6,513 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents • 45 Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Rwanda DHS 2019-20 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 1.4 30.9 18.8 39.1 7.6 2.2 100.0 5.8 5,672 15-19 1.0 31.1 19.6 45.9 2.1 0.4 100.0 5.7 3,258 20-24 1.8 30.6 17.9 30.0 15.0 4.7 100.0 5.9 2,414 25-29 6.5 34.9 16.6 19.8 13.8 8.4 100.0 5.5 2,073 30-34 11.3 46.9 16.9 8.3 9.0 7.6 100.0 4.3 2,118 35-39 16.5 51.0 20.1 3.8 3.8 4.8 100.0 3.6 2,072 40-44 18.4 48.4 21.0 5.6 3.2 3.5 100.0 4.5 1,488 45-49 25.6 54.6 10.1 5.3 2.1 2.4 100.0 3.8 1,211 Residence Urban 4.6 23.4 14.9 27.8 14.0 15.2 100.0 7.3 2,909 Rural 10.6 44.6 18.7 18.9 5.5 1.7 100.0 4.8 11,725 Province City of Kigali 3.9 25.5 15.8 26.2 14.1 14.5 100.0 7.1 2,166 South 9.8 43.3 19.0 19.8 5.4 2.7 100.0 5.0 3,065 West 12.4 42.5 18.0 18.5 6.2 2.3 100.0 4.8 3,174 North 9.0 43.8 20.3 17.5 6.6 2.8 100.0 5.0 2,226 East 10.0 42.6 16.8 21.9 6.0 2.7 100.0 5.0 4,003 Wealth quintile Lowest 20.3 54.9 15.5 8.7 0.6 0.0 100.0 3.2 2,741 Second 12.9 51.7 17.9 15.7 1.8 0.1 100.0 4.2 2,756 Middle 8.2 46.7 20.7 20.5 3.8 0.1 100.0 4.9 2,757 Fourth 5.8 34.9 21.0 28.2 8.8 1.3 100.0 5.6 2,966 Highest 2.0 19.2 15.0 28.0 18.3 17.5 100.0 8.3 3,414 Total 9.4 40.4 17.9 20.7 7.2 4.4 100.0 5.2 14,634 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school 2 Completed 6th grade at the secondary level Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Rwanda DHS 2019-20 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 2.0 37.4 17.2 34.4 7.1 2.0 100.0 5.5 2,486 15-19 0.9 39.5 15.9 41.2 2.4 0.1 100.0 5.5 1,526 20-24 3.6 34.1 19.3 23.6 14.5 5.0 100.0 5.6 960 25-29 5.1 37.3 14.4 15.5 16.8 10.8 100.0 5.5 710 30-34 10.0 46.2 15.9 8.6 10.0 9.3 100.0 4.5 835 35-39 12.8 49.9 23.7 4.9 2.7 6.0 100.0 3.9 793 40-44 13.8 52.9 21.2 3.8 3.7 4.7 100.0 4.7 575 45-49 15.7 59.5 11.2 7.9 1.8 3.8 100.0 4.8 447 Residence Urban 3.5 24.4 14.3 25.7 16.1 16.0 100.0 7.6 1,115 Rural 8.1 48.1 18.2 17.9 5.3 2.5 100.0 4.8 4,731 Province City of Kigali 2.8 27.5 16.7 24.3 15.3 13.4 100.0 6.8 879 South 9.0 47.6 17.9 17.4 4.6 3.5 100.0 4.7 1,239 West 7.6 43.5 18.1 19.6 8.2 3.0 100.0 5.1 1,268 North 6.9 46.6 19.7 16.3 5.4 5.2 100.0 5.0 886 East 8.1 47.7 15.9 19.7 5.5 3.2 100.0 4.8 1,574 Wealth quintile Lowest 17.3 60.3 13.6 7.5 1.1 0.2 100.0 3.0 924 Second 9.6 55.2 18.6 13.7 2.6 0.4 100.0 4.2 1,076 Middle 6.9 50.0 20.4 18.7 3.5 0.5 100.0 4.8 1,227 Fourth 3.7 37.8 21.2 25.8 8.6 2.9 100.0 5.5 1,278 Highest 1.9 22.3 13.0 26.7 17.8 18.3 100.0 8.2 1,342 Total 15-49 7.2 43.6 17.5 19.4 7.3 5.0 100.0 5.1 5,846 50-59 24.4 50.8 14.7 3.7 2.9 3.6 100.0 3.3 667 Total 15-59 9.0 44.3 17.2 17.8 6.9 4.9 100.0 5.0 6,513 1 Completed 6th grade (for 6-grade system) and 8th grade (for 8-grade system) at the primary level or were in vocational school 2 Completed 6th grade at the secondary level 46 • Characteristics of Respondents Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Rwanda DHS 2019-20 Higher than primary schooling No schooling, preschool or primary school Total Percentage literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 49.7 36.1 6.8 7.3 0.0 0.1 100.0 92.6 5,672 15-19 49.2 37.6 6.0 7.2 0.0 0.0 100.0 92.8 3,258 20-24 50.3 34.0 7.9 7.5 0.0 0.2 100.0 92.3 2,414 25-29 42.6 38.0 8.0 11.4 0.0 0.0 100.0 88.6 2,073 30-34 25.9 45.9 10.2 18.0 0.0 0.0 100.0 82.0 2,118 35-39 13.0 51.0 12.6 23.3 0.0 0.0 100.0 76.7 2,072 40-44 14.2 54.4 7.7 23.5 0.1 0.1 100.0 76.3 1,488 45-49 13.7 47.7 9.4 28.5 0.0 0.6 100.0 70.9 1,211 Residence Urban 58.4 29.5 5.4 6.6 0.0 0.2 100.0 93.3 2,909 Rural 27.3 46.0 9.4 17.2 0.0 0.1 100.0 82.6 11,725 Province City of Kigali 56.0 33.1 4.5 6.4 0.0 0.0 100.0 93.6 2,166 South 29.7 42.9 11.5 15.8 0.0 0.1 100.0 84.1 3,065 West 28.2 45.4 8.2 18.0 0.0 0.2 100.0 81.8 3,174 North 27.9 48.6 7.5 15.8 0.0 0.2 100.0 84.1 2,226 East 31.3 42.3 9.6 16.7 0.0 0.1 100.0 83.2 4,003 Wealth quintile Lowest 10.0 44.4 13.1 32.3 0.0 0.1 100.0 67.5 2,741 Second 18.3 47.7 13.2 20.7 0.0 0.1 100.0 79.2 2,756 Middle 25.4 52.9 8.3 13.3 0.0 0.1 100.0 86.6 2,757 Fourth 39.6 44.9 6.0 9.4 0.0 0.1 100.0 90.5 2,966 Highest 65.6 27.1 3.9 3.3 0.0 0.1 100.0 96.6 3,414 Total 33.4 42.7 8.6 15.1 0.0 0.1 100.0 84.8 14,634 1 Refers to women who attended schooling higher than the primary level and women who can read a whole sentence or part of a sentence Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Rwanda DHS 2019-20 Higher than primary schooling No schooling, preschool or primary school Total Percentage literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 44.3 37.9 8.3 9.5 0.0 0.0 100.0 90.5 2,486 15-19 44.3 38.4 8.5 8.8 0.0 0.0 100.0 91.2 1,526 20-24 44.3 37.1 8.0 10.7 0.0 0.0 100.0 89.3 960 25-29 43.9 34.9 8.0 13.2 0.0 0.0 100.0 86.8 710 30-34 29.1 44.3 10.4 16.1 0.0 0.0 100.0 83.9 835 35-39 14.7 51.7 12.1 21.5 0.0 0.0 100.0 78.5 793 40-44 16.1 59.1 8.9 15.9 0.0 0.0 100.0 84.1 575 45-49 19.9 52.2 7.1 20.8 0.0 0.0 100.0 79.2 447 Residence Urban 59.8 31.4 3.8 5.0 0.0 0.0 100.0 94.9 1,115 Rural 27.2 46.4 10.3 16.1 0.0 0.0 100.0 83.9 4,731 Province City of Kigali 54.8 37.0 4.1 4.1 0.0 0.0 100.0 95.9 879 South 27.5 41.6 13.5 17.3 0.0 0.0 100.0 82.6 1,239 West 32.6 46.0 6.7 14.7 0.0 0.0 100.0 85.3 1,268 North 28.3 51.3 5.0 15.4 0.0 0.0 100.0 84.6 886 East 29.8 42.2 12.4 15.6 0.0 0.0 100.0 84.4 1,574 Wealth quintile Lowest 9.4 45.0 13.1 32.5 0.0 0.0 100.0 67.5 924 Second 16.9 49.7 14.2 19.2 0.0 0.0 100.0 80.8 1,076 Middle 24.6 51.0 11.2 13.2 0.0 0.0 100.0 86.8 1,227 Fourth 39.1 46.2 6.2 8.6 0.0 0.0 100.0 91.4 1,278 Highest 65.9 28.2 2.9 3.0 0.0 0.0 100.0 97.0 1,342 Total 15-49 33.4 43.5 9.0 14.0 0.0 0.0 100.0 86.0 5,846 50-59 16.3 48.3 9.1 25.8 0.0 0.6 100.0 73.6 667 Total 15-59 31.7 44.0 9.1 15.2 0.0 0.1 100.0 84.7 6,513 1 Refers to men who attended schooling higher than the primary level and men who can read a whole sentence or part of a sentence Characteristics of Respondents • 47 Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Rwanda DHS 2019-20 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 11.8 22.1 66.7 3.1 28.5 3,258 20-24 10.1 22.5 69.0 4.6 27.7 2,414 25-29 10.0 21.2 63.6 5.7 33.6 2,073 30-34 7.9 17.9 58.7 4.3 38.5 2,118 35-39 5.7 15.8 56.4 3.1 40.4 2,072 40-44 5.5 18.7 59.0 2.8 38.3 1,488 45-49 5.3 14.7 54.2 1.7 42.8 1,211 Residence Urban 16.1 51.1 77.3 11.0 16.0 2,909 Rural 6.8 11.8 58.5 1.9 39.0 11,725 Province City of Kigali 15.5 53.0 76.4 11.0 15.2 2,166 South 7.4 12.1 56.5 2.6 41.0 3,065 West 5.2 14.7 56.3 1.5 41.1 3,174 North 8.4 9.5 57.6 2.3 40.3 2,226 East 8.7 16.8 66.1 3.2 31.3 4,003 Education No education 0.2 5.6 36.2 0.0 62.2 1,377 Primary 4.2 12.4 57.0 0.7 40.0 8,529 Secondary 15.0 30.9 78.1 6.6 18.0 4,086 More than secondary 45.3 73.2 86.1 33.8 4.7 642 Wealth quintile Lowest 2.7 2.3 26.0 0.1 71.9 2,741 Second 4.5 2.7 49.4 0.2 48.9 2,756 Middle 6.0 4.3 66.5 0.6 32.0 2,757 Fourth 8.2 13.3 78.0 1.6 19.5 2,966 Highest 19.2 64.9 84.6 13.9 7.6 3,414 Total 8.6 19.6 62.2 3.7 34.4 14,634 Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Rwanda DHS 2019-20 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 men Age 15-19 11.3 33.1 81.9 6.2 14.5 1,526 20-24 18.7 38.7 86.0 11.6 11.2 960 25-29 19.1 30.9 82.3 10.9 15.6 710 30-34 17.3 24.2 77.3 10.5 20.8 835 35-39 11.8 25.3 80.3 7.7 18.4 793 40-44 13.9 28.7 79.2 9.8 19.2 575 45-49 9.3 21.5 77.6 6.2 19.8 447 Residence Urban 34.2 60.8 91.0 25.3 5.2 1,115 Rural 9.8 22.9 78.8 5.0 19.0 4,731 Province City of Kigali 33.0 63.9 91.0 25.9 5.1 879 South 9.0 19.3 76.4 5.1 22.6 1,239 West 15.3 30.4 78.4 7.4 19.0 1,268 North 9.4 20.1 79.6 5.1 17.5 886 East 10.6 25.2 82.5 5.5 15.1 1,574 Education No education 0.3 11.1 59.1 0.3 39.0 420 Primary 6.1 21.7 78.9 2.9 19.1 3,569 Secondary 26.8 46.0 90.0 16.4 6.8 1,562 More than secondary 70.5 74.8 93.5 52.8 1.5 295 Wealth quintile Lowest 3.7 11.9 54.0 1.3 43.2 924 Second 5.3 14.1 73.3 2.0 24.7 1,076 Middle 7.2 16.3 84.4 2.4 13.7 1,227 Fourth 14.8 29.2 90.9 7.0 7.7 1,278 Highest 35.6 69.1 93.9 27.0 2.1 1,342 Total 15-49 14.5 30.1 81.2 8.8 16.4 5,846 50-59 8.7 21.3 72.8 5.9 25.6 667 Total 15-59 13.9 29.2 80.3 8.5 17.3 6,513 48 • Characteristics of Respondents Table 3.5.1 Internet usage: Women Percentage of women age 15-49 who have ever used the internet and percentage who have used the internet in the past 12 months, and among women who have used the internet in the past 12 months, percent distribution by frequency of internet use in the past month, according to background characteristics, Rwanda DHS 2019-20 Ever used the internet Used the internet in the past 12 months Number Among respondents who have used the internet in the past 12 months, percentage who, in the past month, used the internet: Background characteristic Almost every day At least once a week Less than once a week Not at all Missing Total Number Age 15-19 12.3 11.1 3,258 28.8 41.2 17.0 13.1 0.0 100.0 363 20-24 22.4 19.2 2,414 46.8 34.6 6.1 12.6 0.0 100.0 462 25-29 20.5 17.9 2,073 59.0 27.9 6.7 6.4 0.0 100.0 371 30-34 14.5 13.0 2,118 57.6 28.9 5.7 7.7 0.0 100.0 276 35-39 8.9 7.9 2,072 63.2 27.8 5.5 3.5 0.0 100.0 164 40-44 8.1 7.1 1,488 69.8 20.1 5.3 4.8 0.0 100.0 106 45-49 5.4 5.0 1,211 56.2 33.0 9.0 1.7 0.0 100.0 60 Residence Urban 39.8 36.4 2,909 59.8 27.9 6.1 6.1 0.0 100.0 1,058 Rural 7.5 6.4 11,725 37.3 38.1 11.5 13.1 0.0 100.0 745 Province City of Kigali 39.7 36.1 2,166 60.6 26.3 7.7 5.3 0.0 100.0 781 South 9.3 8.0 3,065 42.8 39.3 8.4 9.5 0.0 100.0 245 West 9.3 7.7 3,174 35.7 41.3 10.3 12.7 0.0 100.0 244 North 9.3 8.3 2,226 43.4 29.7 10.0 16.9 0.0 100.0 185 East 9.9 8.7 4,003 47.3 35.1 7.4 10.2 0.0 100.0 347 Education No education 0.1 0.0 1,377 * * * * * * 0 Primary 2.3 1.8 8,529 30.2 44.6 10.8 14.5 0.0 100.0 152 Secondary 29.8 25.9 4,086 38.4 38.0 11.7 11.9 0.0 100.0 1,057 More than secondary 96.8 92.5 642 77.2 18.5 1.8 2.5 0.0 100.0 594 Wealth quintile Lowest 0.5 0.3 2,741 * * * * * * 8 Second 1.8 1.2 2,756 (10.7) (42.8) (9.3) (37.2) (0.0) (100.0) 34 Middle 3.7 2.7 2,757 16.3 44.3 12.4 27.0 0.0 100.0 75 Fourth 12.0 9.6 2,966 27.8 41.6 14.3 16.4 0.0 100.0 285 Highest 44.5 41.0 3,414 58.2 29.3 6.8 5.7 0.0 100.0 1,400 Total 13.9 12.3 14,634 50.5 32.1 8.3 9.0 0.0 100.0 1,803 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Characteristics of Respondents • 49 Table 3.5.2 Internet usage: Men Percentage of men age 15-49 who have ever used the internet and percentage who have used the internet in the past 12 months, and among men who have used the internet in the past 12 months, percent distribution by frequency of internet use in the past month, according to background characteristics, Rwanda DHS 2019-20 Ever used the internet Used the internet in the past 12 months Number Among respondents who have used the internet in the past 12 months, percentage who, in the past month, used the internet: Background characteristic Almost every day At least once a week Less than once a week Not at all Missing Total Number Age 15-19 22.1 20.8 1,526 48.7 30.3 7.9 13.1 0.0 100.0 318 20-24 39.7 37.0 960 57.2 28.2 5.2 9.3 0.0 100.0 355 25-29 35.2 32.7 710 62.9 20.7 4.1 12.3 0.0 100.0 232 30-34 25.1 23.1 835 68.3 19.2 3.6 8.8 0.0 100.0 193 35-39 14.5 14.1 793 71.4 18.9 5.3 4.4 0.0 100.0 112 40-44 17.1 15.7 575 76.8 19.2 1.9 2.1 0.0 100.0 90 45-49 10.7 9.7 447 (66.2) (13.1) (20.7) (0.0) (0.0) (100.0) 43 Residence Urban 58.4 56.3 1,115 74.3 17.1 4.1 4.5 0.0 100.0 627 Rural 16.6 15.1 4,731 48.5 30.5 7.1 13.8 0.0 100.0 715 Province City of Kigali 56.2 54.8 879 81.7 10.5 4.7 3.2 0.0 100.0 482 South 14.3 13.0 1,239 49.1 32.4 9.3 9.2 0.0 100.0 162 West 22.1 20.5 1,268 54.7 28.5 6.4 10.4 0.0 100.0 260 North 20.8 18.5 886 43.1 33.8 3.4 19.6 0.0 100.0 164 East 19.2 17.5 1,574 46.4 33.8 6.1 13.8 0.0 100.0 275 Education No education 1.0 0.7 420 * * * * * * 3 Primary 8.5 7.3 3,569 46.2 33.3 6.2 14.3 0.0 100.0 262 Secondary 54.0 50.8 1,562 55.8 26.4 7.1 10.7 0.0 100.0 793 More than secondary 97.8 96.5 295 86.7 10.2 1.4 1.6 0.0 100.0 285 Wealth quintile Lowest 3.1 2.2 924 * * * * * * 21 Second 9.3 8.1 1,076 26.6 38.3 8.5 26.6 0.0 100.0 87 Middle 11.4 9.9 1,227 33.8 34.6 11.5 20.1 0.0 100.0 122 Fourth 25.8 23.4 1,278 47.8 28.8 9.6 13.8 0.0 100.0 299 Highest 62.5 60.7 1,342 74.0 19.0 3.1 3.9 0.0 100.0 814 Total 15-49 24.6 23.0 5,846 60.6 24.2 5.7 9.5 0.0 100.0 1,343 50-59 7.3 6.6 667 (83.0) (7.3) (2.1) (7.6) (0.0) (100.0) 44 Total 15-59 22.8 21.3 6,513 61.3 23.7 5.6 9.4 0.0 100.0 1,387 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 50 • Characteristics of Respondents Table 3.6.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Rwanda DHS 2019-20 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 38.2 5.1 56.6 100.0 3,258 20-24 61.8 9.6 28.6 100.0 2,414 25-29 73.2 7.9 18.9 100.0 2,073 30-34 76.2 7.5 16.3 100.0 2,118 35-39 79.6 6.3 14.1 100.0 2,072 40-44 80.8 6.3 13.0 100.0 1,488 45-49 81.1 6.5 12.3 100.0 1,211 Marital status Never married 49.4 6.6 44.0 100.0 5,914 Married or living together 76.9 7.3 15.8 100.0 7,401 Divorced/separated/ widowed 82.4 7.0 10.5 100.0 1,318 Number of living children 0 47.0 6.7 46.3 100.0 5,368 1-2 74.0 8.3 17.6 100.0 4,150 3-4 79.8 6.4 13.7 100.0 3,184 5+ 80.9 5.9 13.3 100.0 1,932 Residence Urban 56.7 9.0 34.2 100.0 2,909 Rural 68.7 6.5 24.8 100.0 11,725 Province City of Kigali 54.6 10.7 34.7 100.0 2,166 South 62.7 5.7 31.6 100.0 3,065 West 69.9 7.1 23.0 100.0 3,174 North 71.7 7.4 20.9 100.0 2,226 East 69.5 5.7 24.9 100.0 4,003 Education No education 80.5 6.7 12.8 100.0 1,377 Primary 73.0 6.5 20.5 100.0 8,529 Secondary 48.9 7.6 43.5 100.0 4,086 More than secondary 57.7 9.8 32.5 100.0 642 Wealth quintile Lowest 74.4 6.9 18.7 100.0 2,741 Second 71.0 7.1 21.9 100.0 2,756 Middle 70.9 6.7 22.4 100.0 2,757 Fourth 62.4 7.1 30.5 100.0 2,966 Highest 55.7 7.1 37.2 100.0 3,414 Total 66.3 7.0 26.7 100.0 14,634 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents • 51 Table 3.6.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Rwanda DHS 2019-20 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 61.9 4.6 33.6 100.0 1,526 20-24 89.0 2.0 9.0 100.0 960 25-29 94.2 2.2 3.5 100.0 710 30-34 98.2 1.1 0.7 100.0 835 35-39 98.6 0.7 0.7 100.0 793 40-44 98.1 0.8 1.1 100.0 575 45-49 97.5 1.4 1.0 100.0 447 Marital status Never married 74.3 3.7 22.0 100.0 2,867 Married or living together 98.9 0.8 0.3 100.0 2,860 Divorced/separated/ widowed 92.8 2.2 5.1 100.0 119 Number of living children 0 74.9 3.7 21.4 100.0 2,936 1-2 98.3 1.2 0.5 100.0 1,229 3-4 98.8 0.6 0.6 100.0 1,051 5+ 99.0 0.4 0.6 100.0 630 Residence Urban 83.0 4.0 13.1 100.0 1,115 Rural 87.6 1.8 10.6 100.0 4,731 Province City of Kigali 80.4 3.5 16.1 100.0 879 South 83.9 1.4 14.7 100.0 1,239 West 87.5 3.8 8.7 100.0 1,268 North 92.7 1.7 5.6 100.0 886 East 88.4 1.2 10.4 100.0 1,574 Education No education 97.9 0.8 1.4 100.0 420 Primary 90.8 1.6 7.7 100.0 3,569 Secondary 74.5 3.7 21.8 100.0 1,562 More than secondary 86.5 4.7 8.8 100.0 295 Wealth quintile Lowest 89.5 1.8 8.6 100.0 924 Second 88.4 1.3 10.4 100.0 1,076 Middle 87.1 2.2 10.7 100.0 1,227 Fourth 87.0 2.0 10.9 100.0 1,278 Highest 82.8 3.5 13.7 100.0 1,342 Total 15-49 86.7 2.2 11.0 100.0 5,846 50-59 96.0 1.2 2.9 100.0 667 Total 15-59 87.7 2.1 10.2 100.0 6,513 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 52 • Characteristics of Respondents Table 3.7.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Rwanda DHS 2019-20 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Total Number of women Age 15-19 0.4 0.2 11.5 3.0 32.3 11.8 40.8 100.0 1,413 20-24 2.7 1.6 17.8 4.3 26.4 8.6 38.6 100.0 1,722 25-29 4.2 2.4 18.3 3.6 28.6 3.8 39.1 100.0 1,680 30-34 5.5 1.3 16.0 3.5 26.3 2.4 45.0 100.0 1,773 35-39 4.0 0.4 12.9 2.5 28.1 1.1 51.0 100.0 1,780 40-44 3.7 0.8 12.1 2.3 25.3 1.3 54.6 100.0 1,295 45-49 3.8 0.0 9.0 2.1 26.6 1.1 57.2 100.0 1,062 Marital status Never married 3.2 1.7 16.3 3.7 27.3 11.6 36.2 100.0 3,312 Married or living together 4.1 0.9 13.5 3.1 26.0 0.9 51.6 100.0 6,234 Divorced/separated/ widowed 1.5 0.1 13.8 1.9 37.8 2.4 42.5 100.0 1,179 Number of living children 0 3.6 2.1 15.9 4.5 25.8 11.1 37.1 100.0 2,884 1-2 4.3 1.1 16.6 3.2 28.1 3.1 43.6 100.0 3,419 3-4 4.0 0.3 12.9 2.8 28.2 1.2 50.6 100.0 2,747 5+ 1.1 0.5 9.5 1.3 29.2 0.6 57.8 100.0 1,676 Residence Urban 9.4 4.1 35.7 5.8 15.5 15.8 13.7 100.0 1,914 Rural 2.3 0.4 9.7 2.6 30.3 1.9 52.9 100.0 8,812 Province City of Kigali 9.3 4.1 36.2 6.5 13.1 16.1 14.6 100.0 1,414 South 3.2 0.4 8.6 2.5 30.2 3.0 52.0 100.0 2,097 West 2.1 0.8 15.2 2.6 34.2 2.7 42.4 100.0 2,445 North 2.7 0.7 10.2 2.9 29.1 2.3 52.1 100.0 1,761 East 2.7 0.4 9.9 2.6 26.7 2.3 55.4 100.0 3,008 Education No education 0.0 0.0 6.8 0.6 43.3 1.6 47.7 100.0 1,200 Primary 0.1 0.1 10.6 2.7 29.6 4.3 52.5 100.0 6,784 Secondary 7.1 2.0 26.6 6.1 18.6 6.4 33.2 100.0 2,308 More than secondary 47.5 13.0 29.6 1.5 1.9 1.7 4.8 100.0 433 Wealth quintile Lowest 0.0 0.0 3.4 0.8 49.4 0.7 45.6 100.0 2,227 Second 0.0 0.0 7.1 1.2 37.2 1.1 53.4 100.0 2,154 Middle 0.7 0.1 9.1 2.8 27.0 1.1 59.3 100.0 2,140 Fourth 2.3 0.6 20.1 5.0 17.1 2.6 52.3 100.0 2,061 Highest 14.8 4.5 32.7 6.2 6.5 16.4 19.0 100.0 2,144 Total 3.5 1.0 14.4 3.1 27.7 4.4 45.9 100.0 10,726 Characteristics of Respondents • 53 Table 3.7.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Rwanda DHS 2019-20 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Total Number of men Age 15-19 0.6 0.0 11.9 4.3 40.8 5.3 37.1 100.0 1,014 20-24 3.7 0.6 13.2 12.3 32.9 5.8 31.6 100.0 873 25-29 5.3 1.4 11.4 13.1 31.9 3.0 33.9 100.0 685 30-34 7.8 1.5 8.6 15.3 28.9 0.8 37.1 100.0 829 35-39 5.6 0.5 7.9 15.2 25.6 0.7 44.5 100.0 787 40-44 5.5 0.4 10.4 13.7 26.1 0.5 43.4 100.0 569 45-49 5.7 0.0 9.3 9.9 20.5 0.3 54.2 100.0 443 Marital status Never married 4.3 0.7 13.3 9.3 34.8 5.5 32.0 100.0 2,237 Married or living together 5.0 0.6 8.5 13.6 26.9 0.5 44.9 100.0 2,850 Divorced/separated/ widowed 0.7 0.0 8.0 11.8 50.1 1.9 27.6 100.0 113 Number of living children 0 4.4 0.7 13.1 8.7 34.7 5.3 33.1 100.0 2,307 1-2 6.1 1.1 8.5 16.1 30.8 1.3 36.2 100.0 1,223 3-4 4.5 0.1 7.9 13.9 26.6 0.2 46.6 100.0 1,044 5+ 2.6 0.2 9.6 10.4 23.3 0.1 53.7 100.0 626 Residence Urban 13.0 1.8 25.5 24.1 20.3 7.3 8.1 100.0 969 Rural 2.7 0.4 7.1 8.9 33.2 1.7 46.1 100.0 4,231 Province City of Kigali 11.3 1.5 23.0 29.0 17.8 8.4 8.9 100.0 738 South 3.4 0.4 7.5 9.8 34.6 2.0 42.3 100.0 1,057 West 3.4 0.8 12.1 10.2 31.5 1.2 40.8 100.0 1,158 North 5.0 0.3 6.6 7.1 34.2 1.2 45.5 100.0 836 East 2.7 0.4 7.3 8.0 32.1 2.4 47.0 100.0 1,411 Education No education 0.4 0.0 2.9 5.0 46.1 1.7 43.9 100.0 415 Primary 0.4 0.0 8.2 10.5 33.4 2.6 44.8 100.0 3,295 Secondary 6.7 1.0 18.5 17.0 24.4 3.9 28.6 100.0 1,222 More than secondary 53.4 7.2 14.8 12.1 4.0 0.5 8.0 100.0 269 Wealth quintile Lowest 0.0 0.1 3.1 3.9 55.0 0.5 37.4 100.0 844 Second 0.1 0.0 5.8 4.1 36.0 0.5 53.5 100.0 964 Middle 0.7 0.1 6.3 7.3 30.9 0.6 54.2 100.0 1,095 Fourth 3.3 0.5 11.3 17.5 26.4 1.8 39.2 100.0 1,139 Highest 16.7 2.2 23.2 22.2 12.9 9.2 13.7 100.0 1,158 Total 15-49 4.6 0.6 10.5 11.7 30.8 2.7 39.0 100.0 5,200 50-59 5.1 0.4 6.1 10.4 18.1 0.2 59.7 100.0 648 Total 15-59 4.7 0.6 10.0 11.6 29.4 2.4 41.3 100.0 5,848 54 • Characteristics of Respondents Table 3.8 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Rwanda DHS 2019-20 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 14.4 69.5 44.2 Cash and in-kind 32.8 21.2 26.5 In-kind only 11.4 1.3 5.9 Not paid 41.5 8.0 23.3 Total 100.0 100.0 100.0 Type of employer Employed by family member 14.8 6.1 10.0 Employed by non-family member 21.9 59.7 42.4 Self-employed 63.3 34.3 47.6 Total 100.0 100.0 100.0 Continuity of employment All year 58.7 48.1 53.0 Seasonal 8.6 8.4 8.5 Occasional 32.7 43.5 38.5 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 4,918 5,807 10,726 Note: Total includes women with missing information on type of employment who are not shown separately. Characteristics of Respondents • 55 Table 3.9.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, and percentage with any health insurance, according to background characteristics, Rwanda DHS 2019-20 Background characteristic RAMA1/ RSSB2 Employer Mutuelle/ community health insurance Private insurance company MMI3 None Any health insurance Number of women Age 15-19 2.3 0.2 78.5 0.4 0.8 17.9 82.1 3,258 20-24 2.1 0.0 81.4 0.5 0.4 15.6 84.4 2,414 25-29 4.1 0.1 77.8 0.8 0.8 16.6 83.4 2,073 30-34 5.6 0.1 73.6 1.0 1.8 18.0 82.0 2,118 35-39 4.5 0.1 74.7 0.7 2.2 18.1 81.9 2,072 40-44 4.3 0.1 74.5 0.7 2.4 18.3 81.7 1,488 45-49 3.7 0.1 77.8 0.7 0.6 17.2 82.8 1,211 Residence Urban 7.4 0.2 70.7 2.3 2.8 16.8 83.2 2,909 Rural 2.7 0.1 78.8 0.2 0.8 17.5 82.5 11,725 Province City of Kigali 5.7 0.2 69.8 2.6 2.7 19.2 80.8 2,166 South 3.0 0.0 80.2 0.3 0.5 15.9 84.1 3,065 West 3.4 0.0 76.4 0.2 0.7 19.3 80.7 3,174 North 3.8 0.0 84.5 0.4 1.2 10.3 89.7 2,226 East 3.0 0.2 75.3 0.4 1.4 19.9 80.1 4,003 Education No education 0.0 0.1 71.4 0.0 0.2 28.3 71.7 1,377 Primary 0.6 0.0 79.3 0.1 0.6 19.3 80.7 8,529 Secondary 6.5 0.1 78.9 0.8 2.3 11.6 88.4 4,086 More than secondary 32.6 0.7 49.5 8.2 4.9 4.2 95.8 642 Wealth quintile Lowest 0.0 0.0 67.3 0.0 0.0 32.7 67.3 2,741 Second 0.2 0.1 79.9 0.0 0.0 19.7 80.3 2,756 Middle 0.5 0.0 83.8 0.1 0.1 15.6 84.4 2,757 Fourth 3.3 0.2 83.0 0.3 0.8 12.5 87.5 2,966 Highest 12.1 0.2 72.5 2.4 4.4 8.8 91.2 3,414 Total 3.6 0.1 77.2 0.6 1.2 17.4 82.6 14,634 1 RAMA: Rwandaise d’Assurance Maladie 2 RSSB: Rwandan Social Security Board 3 MMI: Military Medical Insurance 56 • Characteristics of Respondents Table 3.9.2 Health insurance coverage: Men Percentage of men age 15-49 with specific types of health insurance coverage, and percentage with any health insurance, according to background characteristics, Rwanda DHS 2019-20 Background characteristic RAMA1/ RSSB2 Employer Mutuelle/ community health insurance Private insurance company MMI3 Other None Any health insurance Number of men Age 15-19 3.0 0.1 80.7 0.5 0.8 0.0 15.2 84.8 1,526 20-24 2.6 0.5 80.5 0.7 0.8 0.1 15.4 84.6 960 25-29 3.4 0.5 76.3 1.2 0.5 0.0 18.5 81.5 710 30-34 7.1 0.2 75.2 1.1 0.5 0.1 16.1 83.9 835 35-39 4.9 0.0 74.3 0.7 0.5 0.0 20.0 80.0 793 40-44 6.0 0.6 73.7 0.6 1.5 0.0 18.1 81.9 575 45-49 4.4 0.0 76.8 1.0 1.1 0.0 16.7 83.3 447 Residence Urban 9.6 1.1 70.0 2.7 2.7 0.1 14.6 85.4 1,115 Rural 3.0 0.1 79.3 0.3 0.3 0.0 17.3 82.7 4,731 Province City of Kigali 6.9 1.1 71.1 2.7 3.2 0.1 15.7 84.3 879 South 3.1 0.1 78.1 0.3 0.2 0.0 18.4 81.6 1,239 West 4.1 0.0 77.4 0.4 0.3 0.0 17.9 82.1 1,268 North 5.1 0.3 83.8 0.4 0.6 0.0 10.1 89.9 886 East 3.2 0.1 77.1 0.5 0.3 0.0 19.0 81.0 1,574 Education No education 0.0 0.0 69.5 0.0 0.0 0.0 30.5 69.5 420 Primary 0.8 0.1 79.3 0.1 0.4 0.0 19.5 80.5 3,569 Secondary 7.0 0.2 81.8 0.9 1.5 0.1 9.2 90.8 1,562 More than secondary 36.9 3.5 44.7 9.9 3.0 0.0 5.1 94.9 295 Wealth quintile Lowest 0.1 0.0 63.3 0.1 0.0 0.0 36.6 63.4 924 Second 0.6 0.0 78.4 0.0 0.0 0.0 21.0 79.0 1,076 Middle 0.3 0.1 87.0 0.1 0.0 0.0 12.6 87.4 1,227 Fourth 3.5 0.1 83.9 0.3 0.4 0.0 11.9 88.1 1,278 Highest 14.2 0.9 71.8 3.0 3.0 0.1 8.2 91.8 1,342 Total 15-49 4.2 0.3 77.5 0.8 0.8 0.0 16.8 83.2 5,846 50-59 4.6 0.0 78.7 0.5 0.5 0.0 15.8 84.2 667 Total 15-59 4.3 0.2 77.6 0.7 0.7 0.0 16.7 83.3 6,513 1 RAMA: Rwandaise d’Assurance Maladie 2 RSSB: Rwandan Social Security Board 3 MMI: Military Medical Insurance Characteristics of Respondents • 57 Table 3.10.1 Tobacco smoking: Women Percentage of women age 15-49 who smoke various tobacco products, according to background characteristics, Rwanda DHS 2019-20 Percentage who smoke:1 Number of women Background characteristic Cigarettes2 Other type of tobacco3 Any type of tobacco Age 15-19 0.5 0.0 0.5 3,258 20-24 0.2 0.0 0.2 2,414 25-29 0.3 0.0 0.3 2,073 30-34 0.3 0.0 0.3 2,118 35-39 0.5 0.2 0.7 2,072 40-44 1.5 0.9 2.2 1,488 45-49 2.1 1.8 3.6 1,211 Residence Urban 0.7 0.0 0.7 2,909 Rural 0.6 0.3 0.9 11,725 Province City of Kigali 0.8 0.0 0.8 2,166 South 0.9 0.1 0.9 3,065 West 0.7 0.0 0.7 3,174 North 0.5 0.6 0.9 2,226 East 0.4 0.6 0.9 4,003 Education No education 2.3 1.5 3.6 1,377 Primary 0.6 0.2 0.8 8,529 Secondary 0.2 0.0 0.2 4,086 More than secondary 0.5 0.0 0.5 642 Wealth quintile Lowest 1.0 0.7 1.6 2,741 Second 0.9 0.4 1.2 2,756 Middle 0.4 0.2 0.6 2,757 Fourth 0.5 0.1 0.6 2,966 Highest 0.5 0.0 0.5 3,414 Total 0.6 0.3 0.9 14,634 1 Includes daily and occasional (less than daily) use 2 Cigarettes include kreteks. 3 Includes pipes full of tobacco, cigars, cheroots, cigarillos, and water pipes 58 • Characteristics of Respondents Table 3.10.2 Tobacco smoking: Men Percentage of men age 15-49 who smoke various tobacco products, and percent distribution of men by smoking frequency, according to background characteristics, Rwanda DHS 2019-20 Percentage who smoke: 1 Smoking frequency Total Number of men Background characteristic Cigarettes2 Other type of tobacco3 Any type of tobacco Daily smoker Occasional smoker4 Non- smoker Age 15-19 0.3 0.0 0.3 0.2 0.1 99.7 100.0 1,526 20-24 1.7 0.3 1.8 0.9 1.0 98.1 100.0 960 25-29 6.8 0.1 6.8 3.3 3.5 93.2 100.0 710 30-34 9.4 0.4 9.4 7.4 2.1 90.6 100.0 835 35-39 12.9 0.2 12.9 9.6 3.3 87.1 100.0 793 40-44 15.5 0.2 15.5 11.2 4.3 84.5 100.0 575 45-49 15.0 0.3 15.3 11.4 3.9 84.7 100.0 447 Residence Urban 6.8 0.2 6.9 4.7 2.2 93.0 100.0 1,115 Rural 7.0 0.2 7.0 5.0 2.0 93.0 100.0 4,731 Province City of Kigali 7.5 0.2 7.5 5.8 1.7 92.5 100.0 879 South 9.6 0.2 9.6 7.4 2.2 90.4 100.0 1,239 West 4.4 0.0 4.4 2.6 1.9 95.6 100.0 1,268 North 4.3 0.3 4.5 2.4 2.3 95.4 100.0 886 East 8.0 0.2 8.0 5.8 2.2 92.0 100.0 1,574 Education No education 21.3 1.4 21.3 14.9 6.4 78.7 100.0 420 Primary 7.4 0.1 7.4 5.5 2.0 92.6 100.0 3,569 Secondary 3.0 0.0 3.0 1.8 1.3 97.0 100.0 1,562 More than secondary 1.7 0.0 1.7 0.6 1.4 98.0 100.0 295 Wealth quintile Lowest 15.2 0.4 15.4 10.9 4.5 84.6 100.0 924 Second 8.2 0.3 8.2 5.9 2.3 91.8 100.0 1,076 Middle 5.1 0.2 5.1 3.6 1.6 94.9 100.0 1,227 Fourth 5.1 0.1 5.1 3.7 1.4 94.9 100.0 1,278 Highest 3.6 0.1 3.6 2.4 1.3 96.3 100.0 1,342 Total 15-49 6.9 0.2 7.0 4.9 2.1 93.0 100.0 5,846 50-59 23.1 2.0 24.6 20.4 4.2 75.4 100.0 667 Total 15-59 8.6 0.4 8.8 6.5 2.3 91.2 100.0 6,513 1 Includes daily and occasional (less than daily) use 2 Includes manufactured cigarettes, hand-rolled cigarettes, and kreteks 3 Includes pipes, cigars, cheroots, cigarillos, and water pipes 4 Occasional refers to less often than daily use. Characteristics of Respondents • 59 Table 3.11 Average number of cigarettes smoked daily: Men Among men age 15-49 who smoke cigarettes daily, percent distribution by average number of cigarettes smoked per day, according to background characteristics, Rwanda DHS 2019-20 Average number of cigarettes smoked per day1 Total Number of respondents who smoke cigarettes daily1 Background characteristic <5 5-9 10-14 15-24 ≥25 Don’t know/ missing Age 15-19 * * * * * * * 3 20-24 * * * * * * * 8 25-29 * * * * * * * 23 30-34 65.2 17.9 9.2 7.7 0.0 0.0 100.0 62 35-39 68.9 25.7 3.3 2.0 0.0 0.0 100.0 76 40-44 72.5 18.6 8.9 0.0 0.0 0.0 100.0 64 45-49 (62.4) (22.6) (3.7) (8.4) (3.0) (0.0) (100.0) 51 Residence Urban 71.2 12.8 13.4 2.6 0.0 0.0 100.0 52 Rural 66.6 24.2 4.2 4.3 0.6 0.0 100.0 235 Province City of Kigali (70.8) (11.4) (13.5) (4.3) (0.0) (0.0) (100.0) 51 South 73.6 21.8 3.0 1.6 0.0 0.0 100.0 92 West (64.1) (30.2) (5.7) (0.0) (0.0) (0.0) (100.0) 32 North * * * * * * * 21 East 58.1 25.8 6.0 8.5 1.6 0.0 100.0 92 Education No education 67.9 18.9 9.3 4.0 0.0 0.0 100.0 62 Primary 66.4 23.7 5.2 3.9 0.8 0.0 100.0 196 Secondary (75.1) (20.1) (0.0) (4.8) (0.0) (0.0) (100.0) 28 More than secondary * * * * * * * 2 Wealth quintile Lowest 75.3 20.3 2.1 2.4 0.0 0.0 100.0 101 Second 66.7 23.3 3.4 6.7 0.0 0.0 100.0 64 Middle (60.2) (33.7) (6.0) (0.0) (0.0) (0.0) (100.0) 43 Fourth (58.1) (19.4) (18.3) (4.2) (0.0) (0.0) (100.0) 48 Highest (67.5) (14.7) (4.2) (8.8) (4.7) (0.0) (100.0) 32 Total 15-49 67.4 22.2 5.9 4.0 0.5 0.0 100.0 287 50-59 72.1 22.5 5.3 0.0 0.0 0.0 100.0 126 Total 15-59 68.9 22.3 5.7 2.8 0.4 0.0 100.0 413 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes manufactured cigarettes, hand-rolled cigarettes, and kreteks Table 3.12 Smokeless tobacco use and any tobacco use Percentage of women and men age 15-49 who currently use smokeless tobacco, according to type of tobacco product, and percentage who use any type of tobacco, Rwanda DHS 2019-20 Tobacco product Women Men Snuff, by mouth 0.4 0.0 Snuff, by nose 0.0 0.1 Chewing tobacco 0.4 0.0 Any type of smokeless tobacco1 0.8 0.1 Any type of tobacco2 1.5 7.0 Number 14,634 5,846 Note: Table includes women and men who use smokeless tobacco daily or occasionally (less than daily). 1 Includes snuff by mouth, snuff by nose, chewing tobacco, and betel quid with tobacco 2 Includes all types of smokeless tobacco shown in this table along with cigarettes, kreteks, pipes, cigars, cheroots, cigarillos, and water pipes Marriage and Sexual Activity • 61 MARRIAGE AND SEXUAL ACTIVITY 4 Key Findings ▪ Current marital status: 51% of women and 49% of men age 15-49 are currently in union. ▪ Polygyny: 8% of currently married women report that their husband has multiple wives. ▪ Age at first marriage: The median age at first marriage among women age 25-49 is 22.8 years. Men marry later than women, with the median age at first marriage among men age 30-59 being 25.8 years. ▪ Sexual initiation: The median age at first sexual intercourse among women age 25-49 is 20.7 years, while the median age among men age 25-59 is 22.2 years. arriage and sexual activity help determine the extent to which women are exposed to the risk of pregnancy. Thus, they are important determinants of fertility levels. However, the timing and circumstances of marriage and sexual activity also have profound consequences for women’s and men’s lives. 4.1 MARITAL STATUS Currently married Women and men who report being married or living together with a partner as though married at the time of the survey. Sample: Women and men age 15-49 Fifty-one percent of women and 49% of men are currently married or living together with a partner. By age 45-49, only 6% of women and 2% of men have never been married (Table 4.1 and Figure 4.1). Overall, women are more likely than men to be divorced, separated, or widowed. Women are less likely to be single; 40% of women and 49% of men have never been married. Figure 4.1 Marital status Percent distribution of women and men age 15-49 Never married 40% Married or living together 51% Divorced/ separated 6% Widowed 3% Women Never married 49% Married or living together 49% Divorced/ separated 2% Widowed <1% Men M 62 • Marriage and Sexual Activity Trends: Overall, the percentage of women and men who are currently in union is consistent with the percentage in 2014-15, when 52% of women and 50% of men were in union. 4.2 POLYGYNY Polygyny Women who report that their husband or partner has other wives are considered to be in a polygynous marriage. Sample: Currently married women age 15-49 Eight percent of women age 15-49 reported that their husband or partner has other wives, while 3% of men age 15-49 reported having more than one wife (Table 4.2.1 and Table 4.2.2). Trends: Eight percent of currently married women are in a polygynous union, as compared with 14% in 1992 and 7% in 2014-15 (Figure 4.2). Patterns by background characteristics ▪ Eight percent of rural women have one or more co-wives, compared with 6% of urban women (Table 4.2.1). ▪ By province, the percentage of women with one or more co-wives is highest in South and East (9% each) and lowest in North (4%) (Table 4.2.1). ▪ Women with no education are much more likely to have co-wives (12%) than women who have more than a secondary education (2%). ▪ Twelve percent of women in the lowest wealth quintile report that they have one or more co-wives, as compared with 5% of women in the highest quintile. ▪ The percentage of men with two or more wives is higher in City of Kigali (4%) than in the other provinces (Table 4.2.2). ▪ Men with no education or a primary education are more likely to have two or more wives (3% each) than men with more than a secondary education (0%). 4.3 AGE AT FIRST MARRIAGE Median age at first marriage Age by which half of respondents have been married. Sample: Women age 20-49, 25-49, and 30-49 and men age 20-49, 25-49, 30- 49, 20-59, 25-59, and 30-59 Median ages at first marriage are 22.8 years and 22.5 years among women age 25-49 and 30-49, respectively. The median age at first marriage is 25.6 years among men age 30-49, while the median age is 25.8 years among men age 30-59. These findings corroborate the fact that women tend to marry earlier than men. Nine percent of women age 25-49 and only 3% of men age 30-49 marry before their 18th birthday (Table 4.3). Figure 4.2 Trends in polygyny 14 12 11 8 7 8 1992 RDHS 2000 RDHS 2005 RDHS 2010 RDHS 2014-15 RDHS 2019-20 RDHS Percentage of married women age 15-49 in a polygynous union Marriage and Sexual Activity • 63 Trends: The median age at first marriage among women age 25-49 has increased slightly since 2014-15, from 21.9 years to 22.8 years. Within the same age group, the percentage of women marrying before age 18 has declined from 14% to 9%. The percentage of men age 30-49 marrying before age 18 has not changed since 2014-15 (3%). Patterns by background characteristics ▪ Rural women age 25-49 marry at younger ages than their urban counterparts (22.5 years versus 24.8 years) (Table 4.4). ▪ Women in City of Kigali marry at a much later age (24.9 years) than women in East (21.9 years). ▪ Women in the lowest wealth quintile marry 3 years earlier than women in the highest quintile (21.9 years versus 24.9 years) (Figure 4.3). 4.4 AGE AT FIRST SEXUAL INTERCOURSE Median age at first sexual intercourse Age by which half of respondents have had sexual intercourse. Sample: Women age 20-49, 25-49, and 30-49 and men age 20-49, 25-49, 30- 49, 20-59, 25-59, and 30-59 The median age at first sexual intercourse among women age 30-49 in Rwanda is 20.6 years, while the median age among men is 22.5 years. On average, women initiate sexual intercourse 1.9 years earlier than men (Table 4.5). The median age at first sexual intercourse is 3.1 years earlier than the median age at first marriage among men age 30-49, while the median age at first sexual intercourse is 1.9 years earlier than the median age at first marriage among women (Figure 4.4). This indicates that the gap between age at initiation of sexual intercourse and age at first marriage is longer among men than among women. Two percent of women age 25-49 initiate sexual intercourse by age 15 and 20% by age 18. By age 20, 42% of women have had sexual intercourse (Table 4.5). Three percent of men age 25-49 have their first sexual intercourse by age 15, and 31% of men have had sexual intercourse by age 20. Figure 4.3 Women’s median age at marriage by wealth Figure 4.4 Median age at first sex and first marriage 21.9 22.4 22.2 22.9 24.9 Lowest Second Middle Fourth Highest Median age at first marriage among women age 25-49 Poorest Wealthiest 20.7 22.822.5 25.6 Median age at first sex Median age at first marriage Median age in years Women age 25-49 Men age 30-49 64 • Marriage and Sexual Activity Trends: The percentage of women age 25-49 who have had sexual intercourse by age 18 has changed only minimally since 2014-15 (19% versus 20%), and the percentage among men has not changed (14%) (Figure 4.5). The median age at first sexual intercourse among women age 25-49 has decreased since 2014-15 from 21.8 years to 20.7 years. Patterns by background characteristics ▪ There are only minimal differences by residence in median age at first sexual intercourse. Rural women age 25-49 initiate sexual intercourse 0.3 years earlier than urban women. In contrast, urban men age 25-59 initiate sexual intercourse 0.5 years earlier than their rural counterparts (Table 4.6). ▪ There is very little variation by province in the median age at first sexual intercourse among either women or men. ▪ Women with no education engage in sexual intercourse earlier than women with more than a secondary education (19.1 years versus 24.8 years). ▪ Women in the lowest wealth quintile initiate sexual intercourse earlier than women in the highest quintile (19.7 years versus 22.0 years). 4.5 RECENT SEXUAL ACTIVITY The survey collected data on recent sexual activity. Overall, nearly half of women and men age 15-49 (48% and 49%, respectively) reported having sexual intercourse during the 4 weeks before the survey. Twenty-seven percent of women and 30% of men reported that they have not had sexual intercourse. For more information on recent sexual activity, see Tables 4.7.1 and 4.7.2. LIST OF TABLES For more information on marriage and sexual activity, see the following tables: ▪ Table 4.1 Current marital status ▪ Table 4.2.1 Number of women’s co-wives ▪ Table 4.2.2 Number of men’s wives ▪ Table 4.3 Age at first marriage ▪ Table 4.4 Median age at first marriage by background characteristics ▪ Table 4.5 Age at first sexual intercourse ▪ Table 4.6 Median age at first sexual intercourse according to background characteristics ▪ Table 4.7.1 Recent sexual activity: Women ▪ Table 4.7.2 Recent sexual activity: Men Figure 4.5 Trends in early sexual intercourse 27 25 23 21 19 20 19 20 16 14 14 1992 RDHS 2000 RDHS 2005 RDHS 2010 RDHS 2014-15 RDHS 2019-20 RDHS Percentage who had first sexual intercourse by age 18 Women age 25-49 Men age 25-49 Marriage and Sexual Activity • 65 Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Rwanda DHS 2019-20 Marital status Total Percent- age of respond- ents currently in union Number of respond- ents Age Never married Married Living together Divorced Separated Widowed WOMEN 15-19 97.4 0.0 2.2 0.1 0.2 0.0 100.0 2.3 3,258 20-24 64.5 7.6 23.4 1.2 3.0 0.2 100.0 31.1 2,414 25-29 29.1 29.3 3

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