Tanzania - Demographic and Health Survey - 1993

Publication date: 1993

Tanzania i • " T r • Tanzania Demographic and Health Survey 1991/1992 Sylvester Ngallaba Saidi Hussein Kapiga Ireneus Ruyobya J. Ties Boerma Bureau of Statistics Planning Commission Dares Salaam, Tanzania Macro International Inc. Columbia, Maryland USA June 1993 This report summarises the findings of the 1991/1992 Tanzania Demographic and Health Survey (TDHS) conducted by the Bureau of Statistics, in collaboration with the Ministry of Health. Macro International Inc. provided technical assistance. Core funds for the TDHS were provided by the U.S. Agency for Intemational Development in Washington through the worldwide Demographic and Health Surveys programme. Additional funding was provided by USAIDfl'anzania. The TDHS is part of the worldwide Demographic and Health Surveys (DHS) programme, which is designed to collect data on fertility, family planning, and maternal and child health. Additionalinform ation about the TDHS may be obtained from the Bureau of Statistics, P.O. Box 796, Dares Salaam (Telephone 051-22722/5; Fax 051-36364). Additional information about the DHS programme may be obtained by writing to: DHS, Macro International Inc., 8850 Stanford Boulevard, Suite 4000, Columbia, MD 21045, USA (Telephone 410-290-2800; Fax 410-290-2999). CONTENTS Page TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii ACRONYMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii MAP OF TANZANIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii CHAPTER 1 1.1 1.2 1.3 1.4 1.5 1.6 INTRODUC~ON Geography, History, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . . . . 2 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CHAPTER 2 2.1 2.2 2.3 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 CHAPTER 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Background Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . 17 FERTILITY Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 FERTILITY REGULATION Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Current Use of Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Knowledge of Fert'de Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . 43 Approval of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 iii CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 CHAPTER 6 6.1 6.2 6.3 6.4 CHAPTER 7 7.1 7.2 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 CHAPTER 9 9.1 9.2 9.3 9.4 CHAPTER 10 10.1 10.2 10.3 10.4 10.5 10.6 Page PROXIMATE DETERMINANTS OF FERTILITY Marital Stutus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Polygamy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Age at First Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . . . . 59 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 FERTILITY PREFERENCES Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Demand for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Ideal and Actual Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 INFANT AND CHILD MORTALITY Infant and Child Mort,ality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 MATERNAL AND CHILD HEALTH Antenatal Care and Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 INFANT FEEDING AND CHILDHOOD NUTRITION Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Child Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Mother's Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 RESULTS OF THE MALE SURVEY Background Characteristics of Male Survey Respondents . . . . . . . . . . . . . . . . . . . 113 Fertility Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Nupfiality and Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Fertility Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 iv CHAPTER 11 11.1 11.2 11.3 11.4 11.5 CHAPTER 12 12.1 12.2 12.3 Page AIDS KNOWLEDGE AND SEXUAL PRACTICES AIDS Awareness and Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 AIDS Misconceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Sources of Information about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Attitudes about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Sexual Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 LOCAL AVAILABILITY OF FAMILY PLANNING AND HEALTH SERVICES Services Availability Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 AvailabUity of Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Availability of Maternal and Child Health Services . . . . . . . . . . . . . . . . . . . . . . . . 164 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E PERSONS INVOLVED IN THE TANZANIA DEMOGRAPIHC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 SURVEY DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 V Table 1.1 Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4.1 Table 2.4.2 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 TABLES Page Demographic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Result of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . . . . . . . 31 Knowledge of modem contraceptive methods and source for methods . . . . . . . . . . . . . 33 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Current use of contraception by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . . 36 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 vii Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Page Time to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . 42 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . 45 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Acceptability of the use of mass media for disseminating family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Current marital status by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Number of co-wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Postpartum amenorrhoea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 59 Postpartum amenorrhoea, abstinence and insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Fertility preference by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . . 68 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 73 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . 76 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 viii Table 8.1 Table 8.2 Table 8.3 Table 8.4 "Iable 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8,9 Table 8.10 Table 8,11 Table 8.12 Table 8.13 Table 9.1 Table 9.2 Table 9.3 Table 9A Table 9.5 Table 9.6 Table 9.7 Table 9.8 Table 9.9 Table 9.10 Table 9.11 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Page Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Tetanus toxoid vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . . . . 92 Prevalence and treatment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Knowledge and use of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Feeding practises during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Initial breastfeec ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Breastfeeding and supplementation by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Feeding pattems for children under 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Birth weight data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Mean birth weight and incidence of low birth weight . . . . . . . . . . . . . . . . . . . . . . . . . 106 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Anthropometric indicators of maternal nutritional status . . . . . . . . . . . . . . . . . . . . . . . 111 Differentials in matemal anthropometric indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . . . . . . 117 Knowledge of modem contraceptive methods and source for methods . . . . . . . . . . . . 119 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Current use of contraception by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . 123 ix Table 10.9 Table 10.10 Table 10.11 Table 10.12 Table 10.13 Table 10.14 Table 10.15 Table 10.16 Table 10.17 Table 10.18 Table 10.19 Table 10.20 Table 10.22 Table 10.23 Table 10.24 Table 10.25 Table 10.26 Table 10.27 Table 10.28 Table 10.29 Table 10.30 Table 10.31 Table 10.32 Table 10.33 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Table 11.5 Table 11.6 Table 11.7 Table 11.8 Page Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Time to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . 125 Future use of contraeeption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Acceptability of the use of mass media for disseminating family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Current marital status by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Fertility preference by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Background characteristics of husbands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Age difference between spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Knowledge of methods among married couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Spouse's perception of other spouse's approval of family planning . . . . . . . . . . . . . . 145 Desire for more children among couples by number of living children . . . . . . . . . . . . 145 Ideal number of children according to spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Knowledge of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 AIDS transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Sources of AIDS information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Government and personal action for AIDS patients . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Frequency of intercourse in the four weeks preceding the survey . . . . . . . . . . . . . . . . 155 Usual frequency of intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Number of sexual parmers in the four weeks preceding the survey . . . . . . . . . . . . . . . 157 Condom use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 X Table 11.9 Table 12.1 Table 12.2 Table 12.3 Table 12.4 Table 12.5 Table 12.6 Table 12.7 Table 12.8 Table 12.9 Table 12.10 Table 12.11 Table B. 1 Table B.2 Table B.3 Table B.4 Table B.5 Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Table C.9 Table C.10 Table C.11 Table C. 12 Table C.13 Page Men's perceptions about condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Distance to nearest family planning services according to residence . . . . . . . . . . . . . . 162 Distance to nearest family planning services according to type of facility and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Time to nearest family planning services according to type of facility and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Distance to nearest antenatal care services according to residence . . . . . . . . . . . . . . . 165 Distance to nearest antenatal care services according to type of facility . . . . . . . . . . . 165 Time to nearest antenatal care services according to type of facility . . . . . . . . . . . . . . 166 Time to nearest delivery care services according to type of residence . . . . . . . . . . . . 166 Distance to nearest facility providing delivery care services according to type of facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Time to nearest facility providing delivery assistance according to type of facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Distance to nearest immunisation services according to residence . . . . . . . . . . . . . . . . 168 Time to nearest immunisation services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Results of the household and individual interviews by residence and zone . . . . . . . . . 184 Sample implementation for women according to residence and zone . . . . . . . . . . . . . 185 Sample implementation for women according to region . . . . . . . . . . . . . . . . . . . . . . . 186 Sample implementation for men according to residence and zone . . . . . . . . . . . . . . . . 187 Sample implementation for men according to region . . . . . . . . . . . . . . . . . . . . . . . . . . 188 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Sampling errors, entire sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Sampling errors, urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Sampling errors, rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Sampling errors, Mainland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Sampling errors, Dares Salaam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Sampling errors, other urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Sampling errors, Rural (Mainland) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Sampling errors, Zanzibar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Sampling errors, Coast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Sampling errors, North Highlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Sampling errors, Lake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Sampling errors, Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 xi Table C.14 Table C.15 Table D.1 Table D.2 Table D.3 Table D.4 Table D.5 Table D.6 Page Sampling errors, Southem Highlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sampling errors, South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 xii FIGURES Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 6.1 Figure 7.1 Figure 7.2 Hgure7.3 ~gureS.1 Figure8.2 Egure8.3 ~gureS.4 ~gum8.5 ~gure9.1 Figure 9.2 Figure 10.1 Figure 10.2 Figure 10.3 Figure 10.4 Figure 10.5 Figure 10.6 Page Population pyramid of Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Level of education for men and women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 School enrolment by age and place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Total fertility rate by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Children ever born to women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Current use of modem contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Use of modem contraceptive methods, married women 15-49 . . . . . . . . . . . . . . . . . . . 38 Distribution of current users by source of contraceptive supply . . . . . . . . . . . . . . . . . . . 42 Fertility preferences among currently married women 15-49 . . . . . . . . . . . . . . . . . . . . . 54 Trends in mortality, infants and children under five . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Infant mortality in the ten years preceding the survey by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Child mortality (1-4 years) in the ten years preceding the survey by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Number of antenatal care visits and timing of first visit . . . . . . . . . . . . . . . . . . . . . . . . . 81 Vaccination coverage among children age 12-23 months . . . . . . . . . . . . . . . . . . . . . . . 87 Vaccination coverage among children 12-23 months . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Pementage of children who received DPT1, DPT3, and measles vaccine by 12 months of age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Pementage of children age 1-59 months who received treatment for diarrhoea in the two weeks preceding the survey by type of treatment . . . . . . . . . . . . . . . . . . . . . 97 Nutritional status of children under five years, mean Z-scores by age in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Percentage of cliildmn under five years who are underweight by region . . . . . . . . . . . 110 Contraceptive knowledge among currently married men and women . . . . . . . . . . . . . 118 Current use of contraceptives among currently married men and women . . . . . . . . . . 122 Percentage of men and of women who have ever had sexual intercourse by exact age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Fertility preferences among currently married men 15-60 . . . . . . . . . . . . . . . . . . . . . . 139 Percent nf currently married men who want no more children . . . . . . . . . . . . . . . . . . . 140 Mean ideal number of children among all men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 xiii Figure 10.7 Figure 11.1 Figure 11.2 Page Spouses responses on approval of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 AIDS awareness and knowledge of modes of transmission . . . . . . . . . . . . . . . . . . . . . 149 Sources of information about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 xiv ACRONYMS ARI BCG BMI CBR CCM CDC CDD DHS DPT EA EP1 GDP IEC ISSA IUD MCH~P NACP NCHS NFPP ORS ORT PHC SD TBA TDHS TFR UN UMATI UNFPA UNICEF USAID WHO Acute Respiratory Infections Bacillus Calmette-Guerin (vaccine) Body Mass Index Crude Birth Rate Chama Cha Mapinduzi (political party) Centers for Disease Control Control of Diarrhoeal Diseases Demographic and Health Surveys Diphtheria - Poliomyelitis - Tetanus (vaccine) Enumeration Area Expanded Programme of Immunization Gross Domestic Product Information, Education, and Communication Integrated System for Survey Analysis Intra-Uterine Device Mammal and Child Health/Family Planning National AIDS Control Programme National Center for Health Statistics National Family Planning Programme Oral Rehydration Salts Oral Rehydration Therapy Primary Health Care Standard Deviation Traditional Birth Attendant Tanzania Demographic and Health Survey Total Fertility Rate United Nations Family Planning Association of Tanzania United Nations Population Fund United Nations Children's Fund United States Agency for International Development World Health Organisation XV PREFACE The Tanzania Demographic and Health Survey (TDHS) involved all areas of the country and was a truly representative survey that aimed at collecting data on fertility, mortality, family planning, and health of the Tanzanians. The survey is part of a worldwide undertaking that aims at assessing the changing demographic and health situation in many developing countries. This effort has, for some time, been coordinated and continues to be coordinated by the Demographic and Health Surveys programme of Macro International Inc., of Columbia, Maryland, USA. A decision to join the programme was made sometime in mid-1990; preparations began in July 1990, and the survey was executed between October 1991 and March 1992. The data processing arrangement, particularly the use of the ISSA (Integrated System for Survey Analysis) package, was done simultaneously with the fieldwork, and the tabulations were done a few months after the fieldwork was completed. Tanzania has a long history of census taking which dates as far back as 1910 when the first count was taken. However, the first modem census was not taken until 1948 under the East African Commission; subsequent censuses were undertaken in 1957, 1967, 1978, and 1988. During the period between 1948 and 1988 only one demographic survey was carried out at a national level, in 1973 (the National Demographic Survey). Vital registration, which is a very important source of fertility and mortality information, is more or less nonexistent, though efforts are now being made to expand and improve the system to cover the whole country instead of just a small section of the urban population. Given this background, the Tanzania Demographic and Health Survey represents yet another milestone in an effort to collect high-quality data on the demographic situation, family planning, and health. The successful completion of the TDHS and publication of this volume is due to the contributions of many people. First, I wish to thank the National Family Planning Project staff for their decision to assign the work to the Bureau of Statistics and provide the field interviewers. To the nurses who worked tirelessly throughout the survey period, I acknowledge with gratitude their valuable contributions to the survey. They endured many logistical and technical difficulties while in the field. Likewise, I would also like to extend my sincere appreciation to the Tanzania Food and Nutrition Centre for their valuable assistance in rendering free training services during the training of the interviewers. The great efforts that were made by the Census Office staff in supervising and running the survey are highly commended. At this juncture, I wish to acknowledge here the immeasurable contributions of the following international agencies who participated in one way or another in the operation of the survey. The U.S. Agency for International Development facilitated the work by providing funds for the entire project. The Demographic and Health Surveys division of Macro International Inc. of Columbia, Maryland, initiated the idea of the survey and provided the needed technical as well as material and moral support during the entire period of the survey. Special acknowledgement is due to Ms. Anne Cross for her efforts in convincing the Government of Tanzania to conduct this survey, to Ms. Naomi Rutenberg who acted as the country coordinator, to Ties Boerma who worked tirelessly to put the survey in its present final form, and to all the staff who participated in some way in bringing this work to its successful conclusion. My sincere appreciation is also extended to the UN agencies, UNFPA and UNICEF, which played a very vital role in providing advice, particularly in determining the items to be included in the survey. Last but not least, I wish to convey my sincere thanks to the Party and Government officials at the national, regional, district, ward, and village levels for their vital role in ensuring the smooth and successful completion of the survey fieldwork. The publication of this report is clear evidence of their contributions to the survey. N.K. Mbalilaki GOVERNMENT STATISTICIAN xvii TANZANIA UGANDA RW BL ZAIR IBAR :-As) 5 SAL.AA~ , F_. .~) "IA INDIAN OCEAN MOZAMBIQUE • - - Enumeraf ion Area xviii CHAPTER1 INTRODUCTION 1.1 History, Geography, and Economy Geography The United Republic of Tanzania is the largest country in East Africa, covering 940,000 square kilometers, 60,000 of which is inland water. Tanzania lies south of the Equator and shares borders with eight countries: Kenya and Uganda to the north; Rwanda, Burnndi, Zaire, and Zambia to the west; and Malawi and Mozambique to the South. Tanzania has an abundance of inland water with several large lakes and rivers. Lake Tanganyika runs along the westem border and is Africa's deepest and longest freshwater lake, and the world's second deepest lake. Lake Victoria is the world's second largest lake and drains into the Nile river. The Rufiji is Tanzania's largest river and drains into the Indian Ocean south of Dares Salaam. Of all the rivers in Tanzania, only the Rufiji and the Kagera are navigable by anything larger than a canoe. One of Tanzania's most distinctive geological features is the Great Rift Valley, which was caused by faulting throughout eastern Africa and is associated with volcanic activity in the North-Eastern regions of the country. Two branches of the Rift Valley run through Tanzania. The western branch holds Lakes Tanganyika, Rukwa, and Nyasa; the eastem branch ends in northern Tanzania and includes Lakes Natron, Manyara, and Eyasi. Except for a narrow belt of 900 square kilometres along the coast, most of Tanzania lies above 200 metres in altitude, and much of the country is higher than 1000 metres above sea level. In the north, Mount Kilimanjaro rises to over 5000 metres with the highest peak, Kibo, reaching 5,895 metres. This is the highest point in Africa. Tanzania has a diversity of landscape. The main climatic feature for most of the country is the long dry spell from May to October, followed by a period of rainfall during November/December. The main rainy season along the coast and the areas around Mt. Kilimanjaro is from March to May, with short rains between October and December. In the western part of the country, around lake Victoria, rainfall is well distributed throughout the year, with the peak between March and May. Administratively, Tanzania mainland is divided into 20 regions, and Zanzibar into five. The regions are subdivided into districts. History Tanganyika became an independent nation from British rule on December 9th, 1961. One year later, on December 9th, 1962, it became a republic, severing all links with the British crown except for its membership in the Commonwealth. Zanzibar became independent on January 12th, 1964, after the overthrow of the rule of the Sultanate. On April 26th, 1964, Tanganyika and Zanzibar joined to form the United Republic of Tanzania. Economy Tanzania has a mixed economy in which agriculture plays a key role. Agriculture, which comprises crop, animal husbandry, forestry, fishery, and hunting subsectors, contributes the largest share of any sector to the Gross Domestic Product (GDP). The GDP increased by 3.8 percent in 1991 compared to 3.6 percent in 1990 and 3.3 percent in 1989. Economic growth in the last 5 years follows the implementation of structural adjusmaent policies over the last 7-8 years. The economic growth rate attained in 1991 is higher than the annual population growth rate of 2.8 percent. However, as in the previous years, it is lower than the targeted growth rates of 4.5 and 5.0 percent as envisioned in the Second Economic Recovery Programme and the Second Five-Year Development Plan, respectively. 1.2 Population The 1967 Tanzania census reported a total population of 12.3 million. According to the 1988 census the population had increased to 23.1 million (see Table 1.1). Tanzania is stir sparsely populated, though the population density is high in some parts of the country and has been increasing over time. In 1967, the average population density was 14 persons per square kilometer, by 1988 it had increased to 26 persons per square kilometer. Although the population is still predominantly rural, the proportion of urban residents has been increasing steadily, increasing from 6 percent in 1967 to 18 percent in 1988. Life expectancy rose from 41 years in 1967 to48 years in 1988. The intercensal growth rate between 1978 and 1988 was 2.8 percent, compared to 3.2 percent between 1967 and 1978. Table 1.1 Demographic indicators T Tanz~tia~ 1967~ 1978, and 1988 Census Indicator 1967 1978 1988 Population (milfions) 12.3 17.5 23.1 Density (pop./sq.km) 14 20 26 Percent urban 6.39 13.78 18.33 Crude birth rate 47 49 46 Crude death rate 24.4 19.0 15.0 Total fertility rate 6.6 6.9 6.5 Infant mortality rate (per 1000) 155 137 115 Life expectancy at birth 41 44 48 Source: Bureau of Statistics, 1967; 1978; 1988 1.3 Population and Family Planning Policies and Programmes Population Policy The population of Tanzania has trebled from 7.7 million in 1948 to 23.1 million in 1988. At this rate of growth, it is estimated that by the year 2000 the population will be about 33 million. However, the national economy did not grow significantly in the last decade due to various constraints, and the resources available per head declined by between 7.5-10 percent during 1980-1985 and increased by 1.0 percent per annum between 1985 and 1991. As in other countries in sub-Saharan Africa, rapid population growth has been associated with poor economic performance. The consequences of rapid population growth are felt acutely and visibly in the public budgets for health, education, and related fields of human resource development. It is obvious that expansion of and improvements in the quality of these services is unlikely to happen without first controlling the rapid population growth. It is against this background that Tanzania formulated the 1992 National Population Policy. The major objective of this policy is to reinforce national development by developing available resources in order to improve the quality of life of the people. The main emphasis is regulation of population growth and improvement of the health and welfare of women and children. With specific reference to family planning, the goals of the policy arc to lower the annual population growth rate through a reduction in the numbers of births and an increase in voluntary fertility regulation. Other specific objectives related to population regulation include making family planning services available to all who want them, encouraging every family to space births at least two years apart, and supporting family life education programmes for youth and family planning for men as well as women. Family Planning The Family Planning Association of Tanzania (UMATI) introduced family planning services to Tanzania in 1959. During the early years most services were concentrated in the urban areas. With the expansion of UMATI in the early seventies, services were extended to cover all regions in the country. The government became actively involved in service provision in 1974 following the launching of the integrated Maternal and Child Health (MCH) programme. Although family planning services were provided as part of the integrated programme, contraceptive use continued to be low in the country. In 1984, the government started a National Childspacing Programme with support from the United Nations Population Fund (UNFPA). Evaluation of the National Childspaeing Programme in 1987 indicated only a slight increase in contraceptive prevalence and identified lack of trained service providers and poor logistic support as the major constraints to expansion of services. The findings and recommendations from this evaluation were used to plan a five-year National Family Planning Programme (NFFP). The implementation of this programme began in 1989 with the broad objective of raising the contraceptive acceptance rate from about 7 to 25 percent by 1993. Other specific objectives of the programme arc to: Improve the quality of family planning services through training of service providers, improvement of supervision, and upgrading of the logistic system, Improve accessibility of family planning services by increasing the proportion of health units providing family planning services, Improve general health of mothers and children, and Raise awareness and demand for family planning services. 1.4 Health Priorities and Programmes The government of Tanzania emphasises equity in the distribution of health services and views access to services as a basic human right. In response to the worldwide efforts to attain the social goal of "Health for All" by the year 2000, Tanzania's health strategy focuses on the delivery of primary health care services. In 1991 a new primary health care (PHC) strategy was developed by the Ministry of Health. As the primary objectives, the PHC strategy focuses on strengthening district management capacity, multiseetoral collaboration, and community involvement. At the central, regional, and district level, PHC steering committees have been established. About 60 percent of health services arc provided by the government and the remainder are provided by nongovernmental organisations. Tanzania has an extensive network of health facilities. At the national level there are four major referral hospitals, one of which is the university teaching hospital. Most regions have a regional hospital and there are a total of 152 hospitals in 106 districts. At the divisional level there are about 273 rural health centres and at the ward level there are about 3000 dispensaries. At the village level there are village health posts staffed by two village health workers. It is estimated that there are currently around 5550 village health workers in the country. 1.5 Objectives and Organisation of the Survey The Tanzania Demographic and Health Survey (TDHS) is a national sample survey of women of reproductive ages (15-49) and men aged 15 to 60. The survey was designed to collect data on socio- economic characteristics, marriage patterns, birth history, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during times of illness, and the nutritional status of children and their mothers. The TDHS is part of a worldwide programme that is being funded by the United States Agency for International Development (USAID). The primary objectives of the TDHS were to: Collect data for the evaluation of family planning and health programmes, Determine the contraceptive prevalence rate, which will help in the design of future national family planning programmes, and Assess the demographic situation of the country. The TDHS involved various institutions and individuals. The Bureau of Statistics had the responsibility of running the project and the Ministry of Health provided technical advice and logistical support. Local UNFPA and UNICEF offices provided advisory and logistic support. Financial support was provided by USAID and administered by Macro International. The funds were used to meet expenses related to salaries, allowances for survey personnel, data processing, anthropometric equipment, printing of questionnaires, maintenance of vehicles, fuel, and publication of reports. The Bureau of Statistics provided ten vehicles for the fieldwork and its supervision. The entire work was under the supervision of the survey director who was closely assisted by survey statisticians and the field teams. The supervisors were recruited from both the Bureau of Statistics and the Planning Commission. The Ministry of Health provided male and female nurses who worked as field interviewers. The Census Office prepared the sample frame in conjunction with a sampling expert from Macro International. The questionnaire design and translation (into Kiswahili), the pretest, and the training for the main survey were carried out by the survey statisticians. 1.6 Fieldwork The TDHS field staff consisted of eight teams, each composed of six female interviewers and one male interviewer, a field editor, a supervisor and a driver. Interviewers were recruited from the Ministry of Health and all of them were trained nurses. The fieldwork was conducted during the rainy season (between October 1991 and March 1992). The persons involved in the survey are listed in Appendix A, and a detailed account of the fieldwork is presented in Appendix B. Table 1.2 shows the results of the household and individual interviews. Out of the 9282 households selected for interview, 8561 households could be located and 8327 were actually interviewed. The shortfall between selected and interviewed households was largely due to the fact that many dwellings were either vacant or destroyed or no competent respondents were present at the time of the interview. A total of 9647 eligible women (i.e., women age 15-49 who spent the night before the interview in a sampled household) 4 were identified for interview, and 9238 women were actually interviewed (96 percent response rate). The main reason for non-interview was absence from the home or incapacitation. The TDHS male survey covered men aged between 15 and 60 years who were l iving in selected households (every fourth household of the female survey). The results of the survey show that 2392 eligible men were identified and 2114 men were interviewed (88 percent response rate). Men were generally not interviewed because they were either incapacitated or not at home during the time of the survey. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, end response rates, Tanzania 1991/92 Result Total Household Interviews Households sampled 9282 Households found 8561 Households interviewed 8327 Household response rate 97.3 Individual Interviews Number of eligible women 9647 Number of eligible women interviewed 9238 Eligible women response rate 95.8 Number of eligible men 2392 Number of eligible men inte~iewed 2114 Eligible men response rate 88.3 5 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Information on the background characteristics of the households interviewed in the survey and the individual survey respondents is essential for the interpretation of survey findings, and provides a rough measure of the representativeness of the survey. This chapter presents this information in three sections: Characteristics of the household population, Housing characteristics, and Background characteristics of survey respondents. 2.1 Characteristics of the Household Population The TDHS collected information on all usual residents and visitors who spent the previous night in the household. A household was def'med as a person or a group of persons l iving together and sharing a common source of food. Age The age distribution of the household population in the TDHS is shown in Table 2.1 and Figure 2.1 by five-year age groups. This distribution conforms to the pattern typical of high-fertility populations, i.e., a much higher proportion of the population is in the younger age groups than in the older age groups. Table 2.1 Household population by age T residence~ and sex Percent distribution of the de facto household population by five-year age group, according to orban,rural residence and sex, Tanzania 1991/92 Age group Urban Rural Total Male Female Total Male Female Total Male Female Total 0-4 17.0 14.6 15.8 5-9 13.4 14.0 13.7 10-14 13.8 12.0 12.9 15-19 12.6 13.0 12.8 20-24 8.1 10.8 9.4 25-29 7.0 9.0 8.0 30-34 5.7 6.5 6.1 35-39 4.1 4.5 4.3 40-44 4.2 2.9 3.6 45~.9 4.1 3.1 3.6 50-54 3.1 3.4 3.3 55-59 2.3 1.7 2.0 60-64 2.3 1.9 2.1 65-69 0.9 1.0 1.0 70-74 0.5 0.7 0.6 75-79 0.3 0.4 0.4 80 + 0.3 0.4 0.4 Missing/Don't know 0.2 0.0 0.1 Total 100.0 100.0 100.0 Number 4732 4717 9449 18.6 17.6 18.1 18.2 16.9 17.6 16.2 15.0 15.6 15.6 14.8 15.2 14.8 13.9 14.3 14.5 13.5 14.0 10.8 9.6 10.2 11.2 10.3 10.8 6.5 8.2 7.4 6.8 8.7 7.8 5.6 7.0 6.3 5.9 7.4 6.7 5.0 5.1 5.1 5.2 5.4 5.3 3.9 4.5 4.2 3.9 4.5 4.2 3.3 3.4 3.3 3.5 3.3 3.4 2.8 3.2 3.0 3.1 3.2 3.1 2.5 3.7 3.1 2.6 3.7 3.2 2.5 2.9 2.7 2.5 2.7 2.6 2.2 2.1 2.2 2.2 2.1 2.1 1.9 1.6 1.7 1.7 1.4 1.6 1.5 0.9 1.2 1.3 0.9 1.1 0.7 0.6 0.6 0.6 0.5 0.6 1.0 0.6 0.8 0.8 0.6 0.7 0.2 0.1 0.l 0.2 0.1 0.1 100.0 100.0 1~.0 1~.0 1~.0 1~.0 16439 17540 33~8 21170 22257 434~ 7 Age 50+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 10 Figure 2.1 Population Pyramid of Tanzania 9 0 5 10 Percent TDHS 1991/92 Table 2.2 shows that the population age structure found in the TDHS is very similar to that in the 1967, 1978, and 1988 population censuses. Dependency ratios are also shown. The age dependency ratio is the ratio of the number of persons age 0 to 14 and 65 and over divided by the number of persons age 15 to 64. It is an indicator of the dependency responsibility of adults in their productive years. Table 2.2 Population by age from selected sources Percent disu'ibution of the population by age group, selected sources, Tanzania 1991/92 Census TDHS Age group 1967 1978 1988 1991/92 Less than 15 43.9 46.1 45.8 46.8 15-64 50.5 49.7 49.9 49.2 65+ 5.6 4.0 4.2 3.9 Total 100.0 100.0 100.0 100.0 Median age 1.03 - - - 16.4 Dependency ratio 1.00 1.01 0.97 The dependency ratios in Tanzania are typical of those found in other African countries. With Source: Bureau of Statistics, 1967; 1978; 1988 approximately 47 percent of the population below age 15 and approximately 4 percent above 64, there is roughly one dependent person for each adult in the population. However, old age dependency is minimal compared to child dependency. 8 Household Composit ion Table 2.3 presents the percent distribution of households by sex of head of household, size, and relationship structure and indicates whether the household includes fostered children, according to urban/rural residence. According to the TDHS data, the large majority of households in Tanzania are headed by males (81 percent), which is somewhat higher than the 1988 census figure (70 percent; Bureau of Statistics, 1992). Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, relationship structure, and presence of foster children, according to urban-rural residence and region, Tanzania 1991/92 Mainland Dares Other Characteristic Total Salaam urban Rural Zanzibar Total Household headship Male 75.5 82.9 81.5 83.0 77.6 81.4 Female 24.5 17.1 18.5 17.0 22.4 18.6 Number of usual members 1 13.0 7.2 9.0 18.9 9.0 9.0 2 12.9 9.6 10.4 13.1 11.7 10.5 3 14.4 12.2 12.6 12.2 15.1 12.7 4 12.0 14.5 14.0 13.4 12.4 13.9 5 12.2 13.2 13.0 11.9 15.8 13.1 6 7.1 11.9 10.8 9.0 12.5 10.9 7 8.3 10.9 10.0 5.2 8.7 10.0 8 7.5 6.6 6.8 6.4 6.2 6.7 9+ 12.7 13.9 13.4 9.8 8.7 13.2 Mean size 4.9 5.5 5.3 4.4 4.8 5.3 Relationship structure One adult 19.2 12.4 14.3 22.6 18.0 14.5 Two related adults: Of opposite sex 28.6 37.7 35.5 29.3 41.5 35.7 Of same sex 8.3 3.4 4.6 7.5 4.3 4.6 Three or more related adults 39.5 43.8 42.5 36.2 32.7 42.2 Other 4.0 2.6 3.0 4.4 3.5 3.0 Foster children I 23.3 23.2 22.8 16.7 31.5 23.1 Note: Table is based on de jure members, i.e., usual residents. IFoster children are those under age 15 living in households with neither their mother nor their father present. The average household size for the country is 5.3 persons per household. Rural households are generally larger than urban households (5.5 versus 4.4 for Dares Salaam and 4.9 for other urban areas). The proportion of single-person households was relatively higher in Dar es Salaam and other urban areas than in the rural areas. About 23 percent of households include one or more children under age 15 who have neither their natural mother nor father living with them (i.e., foster children). The highest proportion of households with foster children (32 percent) is found in Zanzibar and the lowest (17 percent) in rural areas. Education In the three decades since independence, the education sector has expanded to reach most parts of the country and phenomenal growth has been recorded in both student enrolment and the number of new institutions. In 1970 a nationwide mass literacy program was launched and in 1975 a national policy of Universal Primary Education was adopted which gave every child the right to free primary education. Primary education, which includes seven years of schooling, was made compulsory for all children 7 to 14 years of age in 1978. There are six years of secondary education. Entry into the fifth year of secondary education (Form V) is based on open competitive examination results. In Zanzibar, although education also incorporates two stages, it differs slightly from the mainland system. Primary education is entered at age 6-8 years and takes 8 years to complete. It is followed by two three-year cycles of secondary school. In the TDHS, information on educational attainment was collected for every member of the household. Tables 2.4.1 and 2.4.2 show the percent distribution of the de facto male and female household population age 5 and over, respectively, by highest level of education attended according to age, residence, and region. It appears that 37 percent of males and 48 percent of females have never been to school (see also Figure 2.2). Fifty-eight percent of males and 49 percent of females have attended only primary school, and 4 percent of males and 2 percent of females have attended secondary school. A very small proportion of males and females (less than 1 percent) have received higher education. The levels of education by age show a pronounced increase in levels of education during the past decades. Progress in eradicating illiteracy in Tanzania would probably be even greater if nonformal education programmes (adult literacy programmes) were taken into account. The proportion of both males and females with no education is highest in Zanzibar, followed by rural areas, However, Zanzibar also has the highest proportion of people with completed primary education. At the regional level, Kilimanjaro has the lowest proportion of people with no education and the highest percentage with primary education. 10 Table 2.4.1 Educational level of the female household population Percent distribution of the de facto female household populations age five and over by highest level of education attended, according to selected background characteristics, Tanzania 1991/92 No Some Don't Number Median Background educa- Primary Completed secondary/ know/ of number characteristic tio~ incomplete primary Higher Missing Total persons of years Age 5-9 83.2 16.5 0.0 0.0 0.3 100.0 3300 0.0 10-14 22.3 77.5 0.2 0.0 0.0 100.0 3013 3.2 15-19 14.8 78.9 6.3 0.0 0.0 100.0 2297 7.2 20-24 16.4 75.9 7.6 0.0 0.1 100.0 1939 7.3 25-29 28.1 67.6 3.4 0.6 0.2 100.0 1653 7.1 30-34 43.7 51.3 4.0 0.7 0.3 100.0 1206 3.5 35-39 55.9 41.7 2.1 0.2 0.1 100.0 1012 0.0 40-44 60.4 38.0 1.3 0.2 0.0 100.0 727 0.0 45-49 73.1 26.2 0.2 0.0 0.6 100.0 701 0.0 50-54 82.7 15.9 0.2 0.0 1.2 100.0 818 0.0 55-59 85.7 13.5 0.1 0.0 0.7 100.0 591 0.0 60-64 91.2 8.5 0.0 0.0 0.3 100.0 458 0.0 65+ 91.4 7.7 0.0 0.0 0.9 100.0 760 0.0 Missing/Don't lmow 73,8 0.0 0.0 0,0 26.2 100.0 12 0,0 Residence Mainland 47.9 49.7 2.0 0.1 0.3 100.0 17937 1.4 Dares Salaam 32.2 60.8 6.5 0.2 0.3 100.0 965 5.4 Other urban 35.9 57.8 5.7 0.5 0.2 100.0 3022 4.2 Rural 51.6 47.1 0.9 0.1 0.3 1G0.0 13949 0.0 Z~zibar 53.9 33.0 13.1 0.0 0.0 100.0 550 0.0 Region Dodoma 49.6 49.2 1.1 0.0 0.1 100.0 1271 1.0 Arusha 43.4 48.1 6.0 1.0 1.5 100.0 1090 2.4 Kilimanjaro 26.0 68.2 5.5 0.2 0.0 I00.0 1053 4.8 Tanga 41.2 57.2 1.2 0.0 0.4 100.0 987 2.6 Morogom 50.5 48.2 1.2 0.1 0.0 100.0 942 0.0 Coast 56.9 41.4 1.2 0.2 0.3 100.0 376 0.0 Lindi 55.4 43.4 0.2 0.6 0.4 100.0 515 0.0 Mtwara 60.3 39.5 0.0 0.2 0.0 100.0 725 0.0 Ruvuma 36.3 62.6 0.7 0.2 0.2 100.0 688 3.5 Iringa 52.0 45.9 1.3 0.0 0.8 100.0 1067 0.0 Mbeya 45.8 53.5 0.5 0.0 0.2 100.0 914 1.9 Singida 48.0 49.3 2.5 0.0 0.2 100.0 715 1.5 Tabora 57.3 41.3 1.2 0.0 0.1 100.0 566 0.0 Rukwa 55.8 43.4 0.6 0.0 0.2 100.0 414 0.0 Kigoma 54.1 45.3 0.3 0.0 0.3 100.0 806 0.0 Shinyanga 59.5 39.1 1.3 0.0 0.1 100.0 1494 0.0 Kagera 49.1 47.3 3.3 0.0 0.2 100.0 1284 1.0 Mwanza 49.9 48.5 1.4 0.0 0.2 100.0 1238 1.0 Mara 46.8 52.6 0.4 0.0 0,2 100.0 829 1.7 Total 48.1 49.2 2.4 0.1 0.3 100.0 18487 1.4 11 Table 2.4.2 Educational level of the male household populat ion Percent distribution of the de facto male household populations age five and over by highest level of education attended, according to selected background characteristics, Tanzania 1991/92 No Some Don't Number Median Background educa- Primary Completed secondauc/ know/ of number characteristic tion incomplete primary Higher Missing Total persons of years Age 5-9 87.0 12,8 0.0 0.0 0.2 100.0 3294 0.0 10-14 22.6 77,2 0.2 0.0 0.0 100.0 3077 2.8 15-19 11.1 83.1 5.7 0.0 0.1 100,0 2376 7.1 20-24 9.7 80.7 9.4 0.1 0.1 100.0 1449 7.4 25-29 9.8 83.0 6.8 0.3 0.1 100.0 1258 7,4 30-34 16.9 72.8 9.4 0,3 0.7 100.0 1094 7.3 35-39 27.7 62.6 8.0 1.4 0.3 100.0 827 5.7 40-44 29.3 63,8 6.2 0.5 0.2 100.0 746 4,6 45-49 35.8 57.2 5.4 1,1 0,5 100.0 660 4.2 50-54 41.3 50.9 7.0 0.7 0.2 100.0 556 3.9 55-59 50.7 43.0 4.7 0.1 1.6 100.0 525 0.0 60-64 60.0 37.1 1.5 0.2 1.2 100.0 472 0.0 65+ 71.3 26.9 0.9 0.1 0.8 I00.0 934 0.0 Missing/Don't know 45.7 34.9 1.6 0.0 17.7 100.0 44 0.9 Residence Mainland 37.0 58,8 3.6 0.2 0.3 100.0 16826 3.6 Dares Salaam 21.8 65.4 11.9 0.6 0.2 100,0 1046 7.1 Other urban 29.9 62.6 7,0 0.4 0.2 100.0 2891 4.6 Rural 39.8 57.5 2.2 0.1 0,4 100.0 12889 3.0 Zanzibar 41.2 41.5 17.1 0.3 0.0 100.0 486 2.9 Region Dodoma 42.6 56.3 1.2 0.0 0.0 100.0 1200 2.4 Arusha 43.0 50.5 4.5 0.5 1.5 100.0 1060 2.9 Kilimanjaro 21.1 72.7 5.3 0.5 0.3 100.0 942 5.3 Tanga 30.5 66.3 3.1 0.0 0.0 100.0 872 4.1 Morogoro 35.8 61.1 3.1 0.0 0.0 100.0 872 3.5 Coast 45.2 52.0 2.1 0.1 0.6 100.0 343 2.1 Lindi 47.8 49.5 1.6 0.0 1.0 100.0 469 1.6 Mtwara 39.6 59.8 0.4 0.2 0.0 100.0 728 3.1 Ruvuma 29.0 68.1 2.1 0.7 0.2 100.0 575 4.5 Ifinga 36.2 60.4 2,7 0.0 0.7 100.0 954 3.5 Mbeya 32.2 63.5 4.1 0.0 0.1 100.0 847 4.3 Singida 41.8 54.8 3.2 0.1 0.1 100.0 654 2.6 Tabora 41.6 56.0 2.4 0.0 0.1 100.0 560 2.7 Rukwa 42.1 55.2 2.4 0.1 0.2 100.0 438 2.4 Kigoma 44.0 54.1 1.6 0.3 0,0 100.0 690 2.4 Shinyanga 44.0 52.9 2.2 0.3 0.7 100.0 1442 2.4 Kagera 35.1 57.9 6.7 0.1 0.2 100.0 1211 3.7 Mwanza 39.4 56.8 3.4 0.2 0.3 1OO.0 1204 3.0 Mara 37.6 59.3 2.9 0.1 0.2 100.0 720 3.3 Total 37.1 58.4 4.0 0.2 0.3 100.0 17312 3.6 12 Figure 2.2 Level of Education for Men and Women Percent 80 60 40 20 No Education Pr imary Secondary/Higher TDHS 1991/92 Table 2.5 and Figure 2.3 present the percentage of the de facto household population 6-24 years of age enrolled in schools by age, sex, and residence. Forty-seven percent of children aged 6-15 years are enmled. However, enrolment for children aged 11-15 is comparatively high (71 percent) suggesting that many children start primary education aider age 6 or 7. In the age group 6-15 there is a slight difference in enmlment between rural and urban, with rural accounting for about 46 percent and urban about 52 percent. Enrolment after age 15 drops sharply, with only 18 percent of those 16-20 years old and 2 percent of those in their early 20s still in school. Table 2.5 School er.rolment Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban/rural residence, Tanzania 1991/92 Age group Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-10 31.6 22.6 24.4 33.3 26.6 27.9 32.5 24.6 26.2 11-15 74.9 71.6 72.4 71.0 68.6 69.0 73.1 70.1 70.8 6-15 53.6 45.7 47.4 50.8 45.7 46.7 52.3 45.7 47.0 16-20 29.3 23.7 25.1 14.6 10.5 11.6 21.4 17.0 18.1 21-24 8.6 1.8 3.7 3.4 0.7 1.4 5.7 1.2 2.4 13 Percent 8O 7O 60 5O 4O 3O 20 10 0 Figure 2.3 School Enrolment by Age and Place of Residence 6-10 11-15 16-20 21-24 Age In Years TDHS 1991/92 2.2 Housing Characteristics In order to assess the economic and environmental conditions in which the respondents live, women were asked to give specific information about their household environment. Table 2.6 presents the percent distribution of households by housing characteristics according to residence. The source of drinking water and its distance from the household, type of sanitation facilities, and type of flooring materials are important determinants of the health status of household members. Overall, only 7 percent of households in Tanzania have electricity. Dares Salaam has the highest proportion of households with electricity (28 percent). In the rural areas only 1 percent of households have electricity. Sources of drinking water differ considerably by area of residence. The three primary sources of drinking water for the Mainland are public wells, public taps, and rivers or streams. In Dar es Salaam, 70 percent of the households have piped water in their homes and 20 percent obtain water from public taps. In other urban centres, 46 percent of households obtain water from a public tap and about 27 percent have piped water in their houses. Major sources of water in Zanzibar are public wells (34 percent) and public taps (32 percent). In rural areas, only 2 percent of the households have piped water in their houses. The majority get water from a public well (33 percent), rivers or streams (24 percent), public taps (16 percent), and springs (12 percent). 14 Table 2.6 Housing characteristics Percent distribution of households with eligible women by housing characteristics, according to urban/rural residence and region, Tanzania 1991/92 Mainland Dares Other Characteristic Total Salaam urban Rural Zanzibar Total Electricity Yes 6.6 28.2 20.4 1.3 12.7 6.8 No 92.5 71.4 78.3 97.8 86.9 92.3 Missing 0.9 0.4 1.3 0.9 0.4 0.9 Source of drinking water Piped into residence 10.9 69.9 26.9 1.8 22.3 11.3 Public tap 21.8 20.1 45.8 16.1 31.8 22.2 Well in residence 1.2 1.8 1.1 1.1 3.3 1.2 Public well 28.1 5.7 14.7 33.3 33.8 28.3 Spring 9.2 0.2 1.6 11.9 7.4 9.1 River, stream 18.5 0.0 4.4 23.6 1.0 17.9 Pond, lake 3.8 0.0 2.3 4.5 0.0 3.7 Dam 1.8 0.0 0.0 2.4 0.2 1.8 Rainwater 0.2 0.0 0.0 0.3 0.0 0.2 Tanker 0.1 1.3 0.0 0.0 0.0 0.1 Other 3.0 0.0 1.9 3.5 0.1 2.9 Missing 1.4 1.0 1.3 1.4 0.0 1.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Sanitation facility Own flush toilet 0.9 2.6 3.2 0.2 1.1 0.9 Shared flush toilet 0.4 0.8 1.5 0.1 0.2 0.4 Traditional pit latrine 84.2 92.1 88.8 82.4 41.3 82.8 Improved pit latrine 1.3 1.9 3.4 0.7 1.3 1.3 No facility, bush 12.3 1.8 2.2 15.7 56.2 13.7 Missing/Don't know 0.9 0.8 0.9 0,9 0.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring Earth, sand 80.2 24.3 57.0 90.9 69.2 79.8 Wood planks 0.1 0.2 0.0 0.1 0.0 0.1 Parquet, polished wood 0.0 0.2 0.0 0.0 0.0 0.0 Ceramic tiles 0.2 0.9 0.8 0.0 0.0 0.2 Cement 18.2 74.0 41.1 7.6 30.8 18.6 Other 0.1 0,0 0.0 0.2 0.0 0.1 Missing/Don' t know 1.1 0.5 1.2 1.2 0.0 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Persons per sleeping room 1-2 54.0 60.1 61.4 51.6 66.1 54.4 3-4 32.3 30.2 29.3 33.3 25.9 32.1 5-6 8.4 6.2 6.5 9.1 6.3 8.4 7 + 3,1 2.5 0.9 3,7 1.2 3.0 Missing/Don't know 2.1 1.0 1.9 2.3 0.5 2.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Mean persons per room 2.8 2,5 2.5 2.9 2.5 2.8 Number of households 8057 537 1476 6044 269 8327 15 Modem sanitation facilities are not yet available to large proportions of the population. The use of traditional pit toilets is common in both urban and rural areas, accounting for about 83 percent of all households. An additional 14 percent of the households have no toilet facilities. This pattern is similar in most parts of the country except for Dares Salaam and Zanzibar. In Dar es Salaam, 92 percent of the households use traditional pit toilets and 2 percent have no toilet facilities. In Zanzibar, 41 percent of the households use traditional pit toilets and 56 percent of the households have no toilets. Eighty percent of the households have floors made of earth or sand and only 19 percent are made of cement. These percentages vary greatly. For example, in Dares Salaam only 24 percent of the households have floors made of earth/sand and 74 percent use cement. Earth or sand flooring is used extensively in rural areas (91 percent), other urban centres (57 percent), and Zanzibar (69 percent). Other forms of floor materials, e.g., wood planks, parquet, and polished wood, are rarely used. Information on the number of rooms that a household used for sleeping was collected with the intent of determining the extent of crowding. More than half of the households averaged one to two people per sleeping room and a third had three to four people sharing a sleeping room. There is very little diversity among the different geographical areas. Household Durable Goods Respondents were asked about ownership of particular bousehold goods (e.g., radio and television to assess access to media, refrigerator to assess food storage) and modes of transportation (bicycle, motorcycle, car). The results presented in Table 2.7 indicate that 33 percent of households own a radio, with ownership being highest in Dares Salaam (70 percen0 and lowest in rural areas (25 percen0. Less than 1 percent of households in Tanzania possess a television set. Since the Mainland does not have a television station, the percent of households with a television set is lower than in Zanzibar, where there is a television station. Refrigerators are not very common and are mainly found in urban areas. Table 2.7 Household durable goods Percentage of households with eligible women possessing various durable consumer goods, by urban/rural residence and region, Tanzania 1991/92 Mainland Dares Other Possession Total Sa laam urban Rural Zanzibar Total Radio 32.5 69.6 51.5 24.6 48.9 33.1 Television 0.4 2.0 0.9 0.l 4.7 0.5 Refrigerator 1.1 7.8 1.9 0.3 3.1 1.2 Bicycle 21.2 10.5 23.7 21.5 32.8 21.5 Motorcycle 0.7 1.2 1.2 0.6 1.6 0.8 Private car 1.3 3.7 2.3 0.9 1.5 1.3 Number of households 8057 537 1476 6044 269 8327 16 Bicycles are the most common means of transport owned by households. Twenty- two percent of rural households, 11 percent of households in Dares Salaam, and 33 percent of households in Zanzibar own a bicycle. Only 1 percent of surveyed households owns an automobile, and most of them are located in Dar es Salaam and other urban areas. 2.3 Background Characteristics of Survey Respondents General Characteristics Table 2.8 shows the percent distribu- tion of women by age, marital status, ur- ban/rural residence, region, religion, and level of education. Eligible women were asked two questions to determine their ages, "In what month and year were you born?" and "How old were you at your last birthday?" Inter- viewers were trained in probing techniques for situations in which respondents did not know their age or date of birth, and as a last resort, interviewers were instructed to record their best estimate of the respondent's age. Data on marital status of the women at the time of the survey show that 25 percent had never married, 65 percent were in unions (47 percent in monogamous unions and 18 percent in polygamous unions), and 10 per- cent were divorced, separated, or widowed. The vast majority of women live on the mainland (97 percent), with only 3 per- cent living on Zanzibar. One-quarter of wom- en live in urban areas on the mainland, and al- most three quarters in rural areas. One-third of respondents had never attended school. Forty-two percent had com- pleted primary school and only 5 percent of women had gone beyond the primary educa- tion level. Table 2.8 Background characteristics of respondents Percent distribution of women by selected background characteristics, Tanzania 1991/92 Number of women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 23.6 2183 2229 20-24 20.4 1882 1849 25-29 17.3 1599 1573 30-34 12.6 1165 1121 35-39 10.8 I000 1010 40-44 7.7 715 757 45-49 7.5 695 699 Marital status Never married 24.5 2261 2188 Married, monogamous 47.4 4379 4381 Married, polygamous 18.0 1659 1710 Widowed/Divorced/Sep. 10.2 939 959 Educatlon No education 33.9 3128 3259 Primary incomplete 19.8 1825 1887 Completed primary 41.6 3841 3653 Secondary/Higher 4.8 444 439 Residence Mainland 97.2 8978 8718 Dar es Salaam 6.3 585 505 Other urban 18.3 1686 1178 Rural 72.6 6707 7035 Zanzibar 2.8 260 520 Reglon I Dodoma 7.0 649 341 Arusha 6.2 573 367 Kilimanj art 5.6 516 438 Tanga 5.1 471 383 Morogoro 5.5 512 486 Coast 1.7 159 377 Lindi 2.3 217 347 Mtwara 3.9 363 343 Ruvuma 3.5 320 455 Ifinga 5.1 475 378 Mbeya 4.9 449 304 Singida 3.8 355 409 Tabora 2.9 271 414 Rukwa 2.4 217 496 Kigoma 4.1 375 496 Shinyanga 8.6 793 614 Kagera 6.6 608 384 Mwanza 7.2 666 590 Mara 4.4 403 591 Religion Muslim 30.7 2834 3202 Catholic 30.1 2777 2694 Protestant 25.0 2308 2049 None 13.8 1271 1242 Other religion 0.0 0 1 Missing 0.5 47 50 All woman 100.0 9238 9238 1Excludes Dares Salaam and Zanzibar. 17 The three major religions reported by women were Islam (31 percent), Catholicism (30 percent), and Protestantism (25 percent). Fourteen percent of all women either adhere to traditional religions or have no religion. Differentials in Education Table 2.9 shows the percent distribution of women by highest level of education attained according to age, residence, and region. Education is inversely related to age; older women are generally less educated than younger women. The survey results show that 74 percent of women age 45-49 have had no formal education in contrast to 15 percent of women age 15-19. The percentage of women with no education increases with age while the proportion of women with completed primary or secondary/higher education decreases with age, indicating recent improvements in educational attainments. Urban women fare better than rural women in education. While 38 percent of rural women have never been to school, only 20 percent of women in other urban areas and 19 percent in Dares Salaam have never been to school. Zanzibar has a much higher proportion of women with no education (41 percent) than Mainland (34 percent). Generally, only a small proportion of women continue education beyond the primary level. The situation is worst in rural areas where only 2 percent of women have secondary or higher education. Due to the difference in the secondary education system between the Mainland and Zanzibar, 28 percent of women in Zanzibar have secondary education compared to 4 percent in Mainland. A comparison among regions shows that only 9 percent of the women in Kilimanjaro have no education. On the other hand, about half of the women in Shinyanga have never been to school. The Amsha and Kilimanjaro regions have the highest proportion of women with secondary or higher education (13 and 12 percent, respectively). Mtwam, Kigoma, Mbeya, and Mara have the lowest levels of post-primary education (less than 1 percent have secondary or higher education). Access to Media Women were asked if they usually listen to a radio or watch television at least once a week. This information is important to programme planners seeking to reach women with family planning and health messages through the media. Table 2.10 shows that one quarter of women read newspapers and 46 percent listen to the radio. Only 3 percent watch television. Access to the media is somewhat higher among younger women (under 30 years): half of these women listen to the radio at least once a week and about 30 percent read newspapers. Educated women have more access to the media than those with less education and the proportion of women with access to media is higher in urban than in rural areas. 18 Table 2.9 Leval of education Percent distribution of women by highest level of education attended, according to selected background characteristics, Tanzania 1991/92 Level of education No Pr imary Corn- Number Background educa- incom- pleted Secondary/ of characteristic tion plet~ primary Higher Total women Age 15-19 15.3 23.0 55.3 6.4 100,0 2183 20-24 16.2 12.2 63.4 8.1 100.0 1882 25-29 27.9 15.7 52,4 4.0 100,0 1599 30-34 44.9 20.6 30.0 4.5 100.0 1165 35-39 56.5 24.4 16.9 2.3 100.0 1000 40-44 61,6 28.6 8.2 1.6 100.0 715 45-49 74.2 22.0 3.7 0.1 1{30.0 695 Residence Mainland 33.7 20.0 42.3 4.1 100.0 8978 Dares Salaam 18.7 15.2 56.7 9.5 1{30.0 585 Other urban 20.3 18.4 50.6 10.7 100.0 1686 Rural 38.3 20.8 38.9 2.0 100.0 6707 Zanzibar 41.0 12.9 18.1 28,0 100.0 260 Region Dodoma 35.6 16.5 45.8 2.2 100.0 649 Arusha 31.7 15.3 39.9 13.1 100.0 573 Kilimmaj~o 8.5 19.2 60.9 11.5 100.0 516 Tanga 26.1 18.9 53.5 1.6 100.0 471 Morogoro 35.1 21.6 40.3 3.0 100,0 512 Coast 40.6 19.8 36.8 2.7 10O.0 159 L'mdi 33.9 26.2 38.5 1.4 100.0 217 Mtwara 45,3 21.5 33.0 0.2 100.0 363 Ruvuma 19.9 30.2 48.2 1.7 100.0 320 Iringa 42.3 11.6 43.3 2.9 100.0 475 Mbeya 32.7 16,6 49.8 0.9 100.0 449 Singida 29.0 24.4 40.8 5.8 100.0 355 Tabora 47.0 23,1 27.7 2.1 100.0 271 Rukwa 46.1 22,0 30,8 1.1 100.0 217 Kigoma 38.9 17.5 43.0 0.6 100.0 375 Shinyanga 51.7 17.3 28.8 2.1 100.0 793 Kagera 30.7 24,3 37.7 7.4 100.0 608 Mwanza 36.7 22.9 37.8 2.6 100.0 666 Mara 30.2 28.9 40.3 0.6 100.0 403 Total 33.9 19,8 41.6 4.8 100.0 9238 19 Table 2.10 Access to mass media Percentage of women who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by selected background characteristics, Tanzania 1991/92 Read Watch Listen to Number Background newspaper television radio of characteristic weekly weekly weekly women Age 15-19 31.1 4.3 50.1 2183 20-24 34.2 4.5 53.3 1882 25-29 26.6 3.1 49.0 1599 30-34 21.1 3.1 46.4 1165 35-39 16.4 2.2 37.6 1000 40-44 12.4 2.7 35.1 715 45-49 8.5 1.6 32.4 695 Education No education 0.5 1.5 25.6 3128 Primary incomplete 22.3 1.7 41.4 1825 Completed primary 40.1 4.1 59.9 3841 Secondary/Higher 76.8 18.7 93.4 444 Residence Mainland 24.6 3.1 45.3 8978 Dares Salaam 71.8 12.0 89.8 585 Other urban 47.3 7.2 71.2 1686 Rural 14.8 1.3 35.0 6707 Zanzibar 37.6 14.6 77.0 260 Region Dodoma 18.6 0.3 34.7 649 Arusha 37.5 5.1 63.8 573 Kilimanj aro 46.1 5.5 72.7 516 Tanga 25.1 1.7 39.4 471 Morogoro 26.1 3.7 42.3 512 Coast 38.6 7.5 65.5 159 Lindi 17.7 3.1 42.2 217 Mtwara 11.2 3.0 26.2 363 Ruvuma 17.3 2.0 43.8 320 Iringa 18.4 3.1 30.8 475 Mbeya 15.8 0.3 45.9 449 Singida 27.8 5.5 43.2 355 Tabora 8.9 0.7 28.7 271 Rukwa 13.9 1.2 31.7 217 Kigoma 15.6 0.8 41.6 375 Shinyanga 12.4 1.3 29.5 793 Kagera 13.7 2.3 35.5 608 Mwanza 19.0 2.4 44.6 666 Maxa 21.8 0.8 47.6 403 Total 24.9 3.4 46.2 9238 20 CHAPTER 3 FERTILITY The fertility measures presented in this chapter are based on the reported birth histories of women between 15 and 49 years old who were interviewed in the TDHS. Every woman was asked the number of sons and daughters who either were living with her, were living elsewhere, or had died. Also, she was asked for a history of her births, including the month and year each child was born; the name and sex; if deceased, the age at death; and if alive, the current age and whether the child was living with the mother. The information obtained from these questions was used to calculate measures of current and completed fertility, i.e., the number of children ever bom. 3.1 Current Fertility The current level of fertility is presented in this chapter because it has a direct relevance to population policies and programmes. Three- year age-specific fertility rates are presented in Table 3.1. The purpose of calculating three-year rates is to reduce errors that emanate from the size of the sample and to avoid problems caused by the displacement of births from five years preceding the survey to six. This latter practise is often done by the interviewer in order to reduce the amount of work that would have to be done. The sum of the age-specific fertility rates is called the total fertility rate (TFR), which can be defined as the number of children a woman would have by the end of her childbearing years if she were to pass through the years bearing children at the currently observed age-specific fertility rates. As shown in Table 3.1, the total fertility rate is 6.3. The crude birth rate, also presented in Table 3.1, stands at 43 per thousand over the three years prior to the survey. This estimate is close to the 46 per 1,000 that was estimated from the 1988 Population Census. Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by urban-rural residence and region, Tanzania 1991/92 Age group Urban Rural Total 15-19 131 149 144 20-24 236 297 282 25 -29 229 284 270 30-34 198 242 231 35-39 139 187 177 40-44 75 117 108 45-49 19 42 37 TFR 15-49 5.14 6.59 6.25 TFR 15-44 5.04 6.38 6.06 GFR 179 222 212 CBR 42.1 43.0 42.8 TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of women 15-44). expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Note: Rates ere for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. The age-specific fertility rates derived from the TDHS can be compared with data from the 1988 census (Figure 3.1). Except for the two youngest age groups, fertility rates are lower in the TDHS than in the census. The fertility decline appears to he greatest among women aged 25-39. 21 Figure 3,1 Age-Specific Fertility Rates 1988 Census and 1991/92 TDHS Births per 1,000 Women 300 250 200 1507 100 5O i i i i 5-19 20-24 25-29 30-34 35-39 40-44 45-49 Age The total fertility rates by level of education and by place of residence can be summarized in Table 3.2 and Figure 3.2. Due to small sample sizes for some categories, the data should be viewed with caution. Dar es Salaam has considerably lower fertility than other urban and rural areas in Tanzania. In TDHS an attempt was made to compare fertility estimates by region. Due to the small numbers of women, the ability to make regional comparisons was seriously compromised. To avoid this problem, regions were grouped into six "zones," mainly based on geographic and ecologic characteristics. This strategy enhanced the power to make the necessary geographical comparisons by distributing relatively large numbers of women in each zone. However, it should be noted that these zones do not conform to the administrative zones of the United Republic of Tanzania. The classification of regions into the zones is shown below: Coastal zone: Northem Highlands zone: Lake zone: Central zone: Southem Highlands zone: Southern zone: Tanga, Morogoro, Coast, Dares Salaam and Zanzibar Arusha and Kilimanjaro Tabora, Kigoma, Shinyanga, Kagera, Mwanza, and Mara Dodoma and Singida Iringa, Mbeya, and Rukwa Lindi, Mtwara, and Ruvuma Total fertility rotes are lowest in the Southern regions and Coastal zone (5.1 and 5.7 children per woman, respectively). Lake and Central regions have the highest levels of fertility (6.9 and 7.1 children per woman, respectively). Women with secondary education have a total fertility rate of 4.2 children per woman, which is considerably less than all other women. Women who have only completed a primary education have a total fertility of 6.0; women with incomplete primary education and women with no formal education have total fertility rates of 6.4 and 6.5, respectively. 22 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40- 49, by selected background characteristics, Tanzama 1991/92 Mean number of children Total ever born Background fertility to women characteristic rate- age 40-49 Residence Mainland 6.2 6.9 Dares Salaam 4.0 6.1 Other urban 5.6 6.4 Rural 6.6 7.1 Zanzibar 6.4 6.9 Zone Coastal 5.7 6.8 Northern Highlands 6.0 7.3 Lake 6.9 7.3 Central 7.1 6.2 Southern Highlands 6.3 7.1 South 5.1 6.4 Education No education 6.5 6.9 Primary incomplete 6.4 7.1 Completed primary 6.0 6.5 Secondary/Higher 4.2 4.8 Total 6.3 6.9 IRate for women age 15-49 years by Main land Dar ee Salaam Other Urban Rural Zanz ibar Coastal Northern Highlands Lake Centra l South Highlands South No Education Incomplete Pr imary Completed Pr imary Secondary/Higher Figure 3.2 Total Fertility Rate Background Characteristics 2 4 6 TDHS 1991/92 23 Fertility trends can be analysed in two ways. One way is to compare TDHS data with previous censuses. As has been observed (see Table 1.1), the 1978 and 1988 censuses reveal that fertility declined over time, from 6.9 to 6.5 to 6.3 according to the TDHS. A second way to analyse fertility trends is by using the TDHS data alone. Table 3.3 shows the age- specific fertility rates for four-year periods preceding the survey. Four-year periods were used instead of the usual five-year periods in order to avoid the effects of shifting births from five to six years preceding the survey. According to the table, there has been a gradual decline in fertility during the last 20 years, e.g., the cumulative fertility of women age 15-34 decreased from 5.7 to 4.6 during this period. Table 3.3 Al~e-specifie fertility rates Age-specific fertility rates (per thousand women) for four-year periods preceding the surcey, by mother's age at the free of birth, Tanzania 1991/92 Number of years ineceding the survey Mother's age 0-3 4-7 8-11 12-15 16-19 15-19 139 146 158 185 209 20-24 281 285 289 316 309 25-29 266 269 289 311 297 30-34 226 268 275 269 [320] 35-39 176 185 202 [257] 40-44 110 [115] [176] 45-49 [40] [34] Note: Age-specific fertility rates are per 1,000 women. Estinmtes enclosed in brackets are tsuncated. A similar pattern is observed in Table 3.4 which shows the fertility rates for ever-married women by duration since first marriage. For the same marriage duration, fertility has declined over time. Table 3.4 Fertility by marital duration Fertility rates for ever-married women by duration since fi~t marriage in years, for four-year periods preceding the survey, Tanzama 1991/92 Marriage Number of years pr¢ceding the survey duration at birth 0-3 4-7 8-11 12-15 16-19 0-4 332 339 344 361 354 5-9 284 307 325 328 321 10-14 258 272 284 317 299 15-19 211 232 254 248 [258] 20-24 150 192 193 [212] 25-29 89 107 [171] Note: Duratlon-specific fertility rates are per 1,000 women, Estimates enclosed in brackets are ta'uncated. 24 3.2 Children Ever Born and Living The distribution of all women by number of children ever born is presented in Table 3.5 for all women and currently married women. The mean number of children ever born increases with age; at the end of her reproductive period, the Tanzanlan woman has given birth to about 7 children. About three percent of women 40 years and older are childless. Currently married women at the end of their childbearing years have given birth to an average of seven children (7.2). Among currently married women aged 40-49 only two percent are childless. Data on children ever born from the TDHS and the 1988 Census can be compared in Figure 3.3. Up to about age 40 the two data sets exhibit remarkably similar results, which suggests good data quality in each. Table 3.5 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Tanzania 1991/92 Number of children ever born (CEB) Number Mean no. Mean no. Age of of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN Age 15-19 76.8 19.7 3.4 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2183 0.27 0.24 20-24 24.3 30.5 28.6 12.1 3.9 0.5 0.0 0.0 0.0 0.0 0.0 100.0 1882 1.42 1.24 15-29 6.4 12.7 21.3 24.7 18.7 11.2 3.6 1.0 0.4 0.1 0.0 100.0 1599 2.92 2.48 30-34 4.3 5.9 8.2 12 .5 16,4 20.9 16.9 10.2 2.6 1.5 0.7 100.0 1165 4.43 3.75 35-39 1.9 4.1 3.2 8.4 8.7 15.5 17.8 14,6 13.2 7.5 5.1 100.0 10O0 5.83 4.80 40-44 2.6 3.7 4.5 3.2 6.0 8.1 12,8 15.6 12.6 11.9 18.9 100.0 715 6.90 5.65 45-49 4.1 3.7 2.5 4.4 7.5 8.5 9.2 13.3 13.8 11.7 21.4 100.0 695 6.94 5.43 Total 25.5 14.8 12,2 9.8 8.1 7.6 6.4 5.2 3.8 2.8 3.7 100.0 9238 3.11 2.58 CURRENTLY MARRIED WOMEN Age 15-19 42.1 48.4 9.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 558 0.68 0.60 20-24 10.9 31.3 35.8 16.2 5.2 0.7 0.1 0.0 0.0 0.0 0.0 100.0 1283 1.76 1.53 15-29 3.5 10 .3 19.3 27.3 20.7 12.8 4.3 1.2 0.5 0.0 0.0 100.0 1274 3.16 2.70 30-34 1.4 4.8 8.1 12 .8 17.1 21.2 17.6 11.2 3.0 1.8 0.9 100.0 935 4.67 3.96 35-39 1.4 4.1 2.7 7.4 7.8 15.4 19.0 15.5 13.6 7.8 5.5 100.0 841 5.98 4.92 40-44 2.3 3.1 3.8 2.0 6.0 8.0 13.0 16.2 13.5 12.2 19.8 100.0 603 7.09 5.82 45-49 2.3 4.5 1,7 4.2 6.1 7.4 10.1 13 .3 14.6 12.6 23.2 100.0 545 7.2A 5.67 Total 7.8 15.3 14.7 12.8 10.4 9.7 8.5 7.0 5.1 3.7 5.0 100.0 6038 4.02 3.34 25 9 7 6 5 4 3 2 1 o; Figure 3.3 Children Ever Born to Women 15-49 1988 Census and 1991/92 TDHS i i i i i 15-19 20-24 25-29 30-34 35-39 40-44 45-49 "Census 1988 ")I~'rDHS 1991/92 ~ l m 3.3 Birth Intervals The timing of births has implications for both fertility and mortality. A woman who has births spaced closely together most likely will complete her childbearing years with more children than one who spaces her births farther apart. Babies who are bom within a short interval are subject to poor health and thus are more exposed to the risks of dying than those who are born after longer birth intervals. Table 3.6 shows the percent distribution of births in the five years before the survey by interval since previous birth by demographic and background characteristics. Half of all births occurred after an interval of 33 months, 18 percent of all births occurred less than 24 months after a previous birth, 63 percent occurred at an interval between 24 and 47 months, and 19 percent of the births occurred at an interval of four years or more. In general, there are only small differences in median birth interval length between subgroups. However, if the previous child is deceased, birth intervals are about 6 months shorter than if the previous child is surviving. Younger women also have shorter birth intervals than older women. 26 Table 3.6 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Tanzania 1991/92 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-~7 48+ Total Median number of Number months since of previom birth births Age of mother 15-19 18.3 20.4 49.8 9.2 2.2 100.0 25.4 78 20-29 6.4 14.1 49.1 17.1 13,4 100.0 30.9 3046 30-39 5.1 10.5 40.0 20.6 23.8 100.0 35.0 2430 40 + 3.7 7.5 34.5 25.9 28.4 100.0 38.1 743 Blrlh order 2-3 6.1 13,1 45.8 17.5 17.5 100.0 32.1 2604 4-6 4.7 11.2 44.8 18.8 20.5 100,0 33.6 2295 7 + 6.7 11.2 38.8 23.7 19.6 100.0 34.5 1398 Sex of prior birth Male 5.8 11.5 44.0 19.1 19.6 100.0 33.4 3178 Female 5,6 12.5 43.7 19.7 18.5 100.0 33.1 3119 Survival of prior birth Living 3.3 11.3 45.4 20.7 19.3 100.0 33.9 5339 Dead 19.2 16.2 35.4 11.7 17.5 100.0 28.3 958 Residence Mainland 5.6 11.9 43.9 19.5 19.1 100.0 33.3 6108 Dar es Salaam 5.3 6.5 44.7 22.4 21.1 100.0 34.7 270 Other urban 4.7 12.4 39.8 19,8 23.3 100.0 34,4 934 Rural 5.7 12.1 44.7 19.3 18.2 100.0 33.1 4904 Zanzibar 11.1 15.4 42.1 14.4 17.0 100.0 30.4 189 Zone Coastal 6.2 10.0 41.2 20.9 21.6 100.0 34.6 1238 Northvrn Highlands 6.5 16.5 34.8 15.8 26.4 100.0 33.5 714 Lake 6.8 14.4 48.5 16.2 14.1 100.0 30.7 2317 Central 4.0 9.5 48.4 23.3 14.8 100.0 33.2 723 Southern Highlands 3.8 9.5 40.4 23.3 23.0 100.0 36.1 805 South 3.9 7.1 41.3 22.9 24.8 100.0 36.3 501 Region Dodoma 4.0 7.3 49.9 25.3 13.5 100.0 33.3 500 Arusha 6.0 17.2 33.7 14,7 28.5 100.0 33,8 427 Kilimanjaro 7.3 15.5 36.4 17.5 23.4 100.0 32.9 287 Tanga 5.9 11.8 37.6 18.9 25.8 100.0 34.8 323 Morogoro 5.3 8,7 39.6 24.6 21.8 100.0 35.5 365 Coast 3.7 7.5 48.6 22.8 17.4 100.0 33.6 91 Lindi 5.1 6.8 34.8 27.0 26.2 100.0 37.8 140 Mtwara 3.3 4.4 37.3 20.5 34.6 100.0 38.3 152 Ruvuma 3,5 9.2 48.6 21.9 16.9 100.0 34.5 209 Iringa 2.6 7.0 37.9 27.8 24.7 100.0 37.7 352 Mbeya 4.3 11.7 39.5 20.9 23.6 100.0 35.4 283 Singida 4.1 14.5 45.0 18.9 17.6 100.0 32,8 223 Tabora 4.9 8.6 42.1 26.6 17.8 100,0 34.9 186 Rukwa 5.6 11.0 47.0 18.1 18.4 100.0 33.6 171 Kigoma 6.7 15.0 53.5 14.3 10.4 100.0 30.2 296 Shinyanga 7.3 13.8 49.0 15,5 14.4 100.0 30.5 633 Kagera 8.4 17.1 45.6 15.2 13.6 100.0 30.8 445 Mwanza 6.5 13.3 52.3 15.8 12.1 100.0 29.7 466 Mara 5.0 16.5 44.5 15.4 18.5 100.0 31.3 292 Education No education 5.4 11.5 40.8 21.4 20.9 100.0 34.5 2574 Primary incomplete 5.0 10.5 45.6 19.0 19.9 100.0 33.3 1288 Completed primary 5.9 13.7 47.0 17.4 16.0 100.0 32.0 2277 Secondary/Higher 14.1 8.2 34.7 17.6 25.4 100.0 34.1 158 Total 5.7 12.0 43.9 19.4 19.0 100.0 33.3 6297 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live I~a'th. 27 3.4 Age at FirstBirth The age at which childbearing begins has important demographic consequences and also consequences for the mother and child. A rise in the age at first birth is usually a reflection of the increase of age at first marriage, though the opposite may not be true. In many countries, postponement of first births, reflecting an increase in age at marriage, has contributed greatly to overall fertility decline. Table 3.7 shows the percent distribution of women by age at first birth according to current age of the mother. While 10 percent of older women (45-49) had their first birth before age 15, only 4 percent of the younger women (20- 24) had their first birth before reaching age 15. Among older women (45-49), 60 percent had their first birth before reaching age 20, whereas 57 percent of the young women had their first birth before age 20. The median age at first birth has increased by about one year across cohorts age 40-44 to 20-24. Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Tanzania 1991/92 Current ago Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 76.8 0.9 13.9 8.4 NA NA NA 10~.0 2183 a 20-24 24.3 4.0 24.3 28.5 14.7 4.2 NA 100.0 1882 19,5 25-29 6.4 5.6 26.1 24.7 19.3 12.6 5,4 100.0 1599 19,5 30-34 4.3 9.2 35.6 20.8 14.6 10,4 5.1 100.0 1165 18.5 35-39 1.9 8,0 36.8 22.0 13.6 10,1 7.4 100.0 1000 18.4 40-44 2.6 9.7 34.4 21.2 13,6 11.0 7.5 100.0 715 18.5 45-49 4.1 9.7 31,3 19.1 14,5 10.5 10.9 100.0 695 18.8 NA = Not applicable aLess than 50 percent of the women in the age group x to x+4 have had a birth by age x 28 Table 3.8 presents the median age at first birth by place of residence and education. There is no variation in age at first birth by place of residence, but there is a substantial increase in the age at first birth with increasing levels of education, Table 3.8 Median age at first birth Median age at ftrst birth among women age 20-49 years, by current age and ~elected background characteristics, Tanzania 1991/92 Current age Background Ages Ages characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Mainland 19.5 19.5 18.5 18.4 18.5 18.8 19,0 18.8 Dar es Salaam a 20.1 18.8 (17.8) (18.2) (17.4) 19.4 18.7 Other urban 20.0 19,7 17.7 17.7 18.5 18.3 18.9 18,5 Rural 19.3 19.4 18.7 18.7 18.5 19.0 19.0 18.9 Zanzibar 19,7 19.5 18,3 (17.3) (17.8) (18.9) 18.8 18.4 Education No education 18.3 17.9 18.1 18.3 18.4 18.9 18,3 18.3 Primary incomplete 18.4 18.6 17.2 17.9 18.3 18.6 18.1 18.1 Completed primary 19.7 20.2 19.6 19.5 20.0 19.3 19.8 20,0 Secondary/Higher a 23,9 23.1 * * * a 23.4 Total 19.5 19.5 18.5 18.4 18.5 18.8 19.0 18.8 Note: The medians for cohort 15-19 could not be determined because half the women have not yet had a birth. Rates shown in parentheses are b~ed on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. aMediens were not calculated for these cohorts because less than 50 percent of women in the age group x to x+4 have had a birth by age x. 3.5 Teenage Pregnancy and Motherhood The issue of fertility among women aged 15-19 is vital because teenage mothers and their children are at high risk for social and health problems. Children born to young mothers are more prone to illness and higher mortality during childhood than children born to older mothers. Table 3.9 presents the percentage of teenagers aged 15-19 who are mothers or are pregnant with their first child by background characteristics. Overall, 29 percent of teenagers covered by this survey have already begun childbearing (i.e,, they have given birth or had their first pregnancy at the time of the survey). Among those age 15, three percent have begun childbearing and among those age 19, almost 60 percent have a a birth or are pregnant. 29 Table 3.9 Teenage pregnancy and motherhood Percentage of teenagers 15-19 who are mothers or pregnant with their first child by selected background characteristics, Tanzania 1991/92 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing teenagers 0.5 2.7 3.2 392 16 6.0 4.1 10.1 474 17 18.2 9.3 27.6 387 18 33.7 6.5 40.2 457 19 53.3 6.2 59.4 474 Residence Mah-dand 23.2 5.8 29.0 2114 Dares Salaam 15.5 6.2 21.7 162 Other urban 25.7 4.8 30.5 421 Rural 23.3 6.1 29.4 1531 Zanzibar 23.9 2.2 26.1 69 Zone Coastal 24.1 5.2 29.4 480 Northern Highlands 11.8 2.0 13.8 228 Lake 22.4 5.6 28.0 813 Central 26.2 7.7 34.0 235 Southern Highlands 27.3 7.0 34.4 219 South 29.2 7.9 37.1 208 Education No education 29.1 6.4 35.5 333 Primary incomplete 16.4 4.0 20.4 503 Completed primary 26.8 6.7 33.5 1207 Secondary/Higher 3.1 1.5 4.6 139 Total 23.2 5.7 29.0 2183 Although most teenagers who have begun childbearing have given birth only once, a small proportion of them have given birth twice. Table 3.10 shows the percent distribution of teenagers 15-19 by number of children ever born according to single years of age. Twenty percent of teenagers have given birth to one child and 4 percent have had 2 or more children. The mean number of children ever born among teenagers is 0.3. Table 3.10 Children born to teenagers Percent distribution of teenagers 15-19 by number of children ever bern (CEB), Tanzania 1991/92 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB teenagers 15 99.5 0.5 0.0 100.0 0.00 392 16 94.0 5.8 0.2 100.0 0.06 474 17 81.8 16.0 2.2 100.0 0.20 387 18 66.3 28.1 5.7 100.0 0.40 457 19 46.7 44.4 8.9 100.0 0.62 474 Total 76.8 19.7 3.6 100.0 0.27 2183 30 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Contraception Knowing about contraceptives is an important step needed before one can actually use contraceptives. Information on an individual's contraceptive knowledge was obtained at the interview by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. I f the respondent failed to mention a particular method spontaneously, the interviewer mentioned and described the method and asked i f the respondent knew it. The following modem methods were described: pills, IUD, injections, barrier methods (diaphragm, foam, and jelly), condoms, and female and male sterilisation. Three traditional methods were also described--periodic abstinence (rhythm method), mucus method, and withdrawal. For each method recognised, the respondent was asked if she knew where it could be obtained. I f she reported knowing about the rhythm method, she was asked i f she knew where a person could obtain advice on how to use the method. The results are presented in Table 4.1. Table 4.1 Knowledge of contraceptive methods and source for methods Percentage of all women and currently married women who know specific contraceptive methods and who know a source (for information or services), by specific methods, Tanzania 1991/92 Know method Know a source Currently Currently Contraceptive All married All married method women women women women Any method 74.4 80.2 65.5 71.4 Any modern method 72.2 77.6 65.1 71.1 Modern method Pill 68.9 74.6 59.5 65.6 IUD 31.3 35.0 29.1 32.7 Injection 39.6 44.0 36.5 40.7 Diaphragm/foam/jelly 19.5 22.2 17.9 20.4 Condom 51.3 55.0 44.8 48.3 Female sterilisation 49.5 54.6 46.0 50.8 Male sterilisation 10.1 11.3 9.3 10.5 Any traditional method 44.1 48.9 NA NA Periodic abstinence 23.3 24.7 19.1 20.7 Mucus method 9.3 9.8 NA NA Withdrawal 23.9 27.1 NA NA Other 21.2 24.6 NA NA Number of women 9238 6038 9238 6038 NA = Not applicable 31 Of all Tanzanian women aged 15-49 years who were interviewed in the survey, 74 percent knew at least one method of family planning. The level of knowledge was slightly higher (80 percent) among currently married women. A majority of all women interviewed (72 percent) knew at least one modem contraceptive method, while less than half (44 percent) reported knowing at least one traditional method. Currently married women were relatively more likely to know of modem contraceptive methods (78 percent) and traditional methods (49 percent). Since currently married women are regarded to be at highest risk of getting pregnant, the remaining sections of this chapter will focus on them. However, in interpreting the results it is recommended that readers take into consideration that out of 9238 women interviewed, 6038 (65 percent) were currently married. Hence, currently married women constitute two thirds of all women covered by this study. The modem contraceptive methods most frequently reported by currently married women were pills (75 percent), condom (55 percent) and female sterilization (55 percent). Other methods commonly reported were injections (44 percent), IUD (35 percent), and barrier methods (22 percent). Male sterilization was the least known modem method of contraception. As for the traditional methods, 25 percent of married women knew periodic abstinence, while 27 percent knew withdrawal. Only 10 percent of currently married women knew the mucus method. Overall, the level of knowledge of both modem and traditional contraceptive methods was slightly lower among all women when compared to currently married women, suggesting that women not currently married were less likely to be aware of contraceptive methods. Results of several other studies in Tanzania (Kapiga et al., 1993; Ministry of Health, 1992) showed widespread knowledge of modem contraceptive methods, with pills being the best known. The high level of knowledge of the pill may be due to its wide availability in most family planning service delivery points and for the fact that it is the most used method in Tanzania. Data presented in the subsequent sections of this chapter support this observation. The observed high level of knowledge of condoms has been reported in several other studies (NACP, 1992; Ministry of Health, 1992) and has been associated with the ongoing HIV/AIDS campaign in which condom use is promoted as a preventive measure. Only 12 percent of currently married women who knew of pills were not aware of a place where they could obtain this method, and 7 percent of currently married women who knew female sterilization did not know where this procedure was done. As for other modem contraceptive methods, a majority of women were not aware of the place where these methods could be obtained. In general, about 92 percent of currently married women who know a modem method also are aware of where it can be obtained. The association between age, education, and region where respondents were residing at the time of the survey, knowledge of family planning methods, and sources where such methods could be obtained was assessed in Table 4.2. Knowledge of at least one method of contraception among currently married women is low in the extreme age groups (15-19 years and 45-49 years). The level of knowledge increases with age, reaches a peak at 30-34 years, and then decreases to reach the lowest level at 45-49 years. A similar pattern was observed for knowledge of modem contraceptives and a source where the methods could be obtained. Overall, the levelof knowledge of contraceptive methods and of a place where they could be obtained is lower on the Tanzania mainland than in Zanzibar. However, due to the small number of currently married women interviewed in Zanzibar (only 168), comparisons with mainland Tanzania should be regarded cautiously. Within mainland Tanzania, the level of knowledge is lower in rural areas than in urban areas. 32 Table 4.2 Knowledge of modem contraceptive methods and source for methods Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by selected background characteristics, Tanzania 1991/92 Know a Know Know source for Number Background any a modem modem of characteristic method method ] method women Age 15-19 70.9 68.7 58.4 558 20-24 81.4 79.6 73.0 1283 25-29 84.5 82.6 76.0 1274 30-34 85.5 83.7 77.5 935 35-39 79.7 76.7 72.2 841 40-44 80.1 76.6 70.0 603 45-49 69.2 62.7 56.3 545 Residence Mainland 79.8 77.1 70.5 5870 Dar es Salaam 91.7 91.1 84.9 349 Other urban 94.2 93.8 89.1 966 Rural 75.8 72.5 65.4 4555 Zanzibar 95.9 95.9 92.5 168 Region Dodoma 94.9 93.1 86.5 445 Arusha 70.3 65.4 58.8 350 Kilimmajaro 94.5 94.5 93.4 258 Tanga 71.1 69.9 67.0 306 Morogoro 93.6 93.0 90.1 334 Coast 90.8 89.4 79.7 98 Lindi 94.4 93.8 81.3 155 Mtwara 81.9 78.9 66.3 249 Ruvuma 9.2.2 91.1 80.1 210 Iringa 70.3 68.6 63.7 338 Mbeya 75.9 70.9 70.6 333 Singida 86.6 84.8 82.5 190 Tabora 79.0 76.1 74.1 174 Rukwa 50.5 47.9 45.7 158 Kigoma 73.8 71.2 65.3 245 Shinyanga 60.9 53.3 40.6 578 Kagera 77.2 76.3 71.0 371 Mwanza 78.6 75.3 63.9 444 M~a 87.3 84.0 75.3 285 Education No education 68.7 64.2 56.2 2505 Primary incomplete 85.6 83.5 76.9 1166 Completed primary 89.2 88.3 83.0 2215 Secondary/Higher 98.9 98.9 98.9 152 Total 80.2 77.6 71.1 6038 1Includes pill, 1UD, injection, vaginal methods (foaming tablets/diephragm/ foam/jelly), condom, female stefilisatlon, and male sterilisatlon. 33 Knowledge of contraceptive methods varies widely by region (Table 4.2). More than 90 percent of currently married women in Zanzibar, Ruvuma, Lindi, Dares Salaam, Morogoro, Kilimanjaro, and Dodoma are aware of at least one modem contraceptive method. Knowledge of modem contraceptive methods is low in Rukwa (48 percent), Shinyanga (53 percent), Arusba (65 percent), Iringa (69 percent), and Tanga (70 percent). The level of education of currently married women is positively associated with knowledge of contraceptive methods and a source where they could be obtained. Knowledge of at least one modem contraceptive method was 64 percent among women with no education, 84 percent among women with incomplete primary education, 88 percent among women who had completed primary education, and 99 percent among women with secondary education or higher. However, only 3 percent of currently married women had secondary education or higher. 4.2 Ever Use of Contraception All women interviewed in the survey who reported knowing a method of family planning were asked if they had ever used that method. The results are presented in Table 4.3. About 23 percent of all women have ever used a method of family planning, and 14 percent have ever used a modem contraceptive method. Table 4.3 Ever use of con~aceptlon Percentage of all women and of currently married women who have ever used any contraceptive method, by specific method and age, Tanzania 1991/92 Age Any modern Any meth- method od Modem methods Traditional methods nia- Female Male Peal- In phragm, steal- steri- Any odic With- Number jec- foam, lisa- lisa- ttad. absti- Mucus draw- of pill IUD tiea jelly Condom tion tion method nence method al Other women ALL WOMEN 15-19 6.7 2.9 1,3 0.0 0.0 0.1 1.8 0.0 0.0 5.0 3.3 0.3 1.7 0.5 2183 20-24 25.0 13.9 9.3 0.4 0.2 0.2 6.2 0.3 0.0 15.9 9.0 0.8 7.6 1.9 1882 25-29 28.2 17.2 14.9 0.9 0.8 0.1 3.7 0.4 0.1 16.6 7.1 1.9 9.9 2.2 1599 30-34 32.5 20.6 17.5 1.6 1.6 0.3 4.8 1.1 0.0 20.5 10.4 1.8 11.1 3.4 1165 35-39 30.4 22.9 18.7 3.6 1.4 0.7 3.7 4.6 0.1 14.7 6.2 2.0 7.3 3.7 1000 404-4 27.0 19.9 14.9 3.3 1.7 0.7 2.6 5.0 0.1 15.0 5.1 1.0 7.9 4.4 715 45-49 21.4 13.1 8.0 1.9 2.4 0.3 0.8 4.0 0.2 13.0 3.6 0.4 7.8 4.0 695 Total 22.7 14.1 10.8 1.2 0.9 0.3 3.6 1.5 0.0 13.6 6.5 1.1 7.0 2.4 9238 CURRENTLY MARRIED WOMEN 15-19 10.9 4.1 2.4 0.0 0.0 0.0 2.1 0.0 0.0 7.3 4.0 0.5 3.1 0.8 558 20-24 26.2 15.2 10,6 0.4 0,1 0.2 6.8 0.3 0.0 16.1 7.2 1.0 8.8 2.2 1283 25-29 26.6 15.4 13.2 0.9 0.4 0.2 2,4 0.3 0.1 16.4 5.7 1.9 10.5 2.3 1274 3034 32.3 19,1 16.1 1.7 1.8 0.2 4.6 1.2 0.0 21.4 11.2 1.9 11.4 3.6 935 35-39 28.3 20.9 16.6 3.0 1,3 0.8 3.5 3.9 0.1 14.2 5.7 1.7 7.6 3.4 841 40-44 26.6 19.8 14.9 3.1 1.9 0.6 2.5 4.9 0.1 15.1 4.9 1.2 7.7 4.2 603 45-49 20.9 12.4 7.6 2.1 2.3 0.1 0.3 3.4 0.2 13.5 4.1 0.5 7.9 4.0 545 Total 25.7 15.8 12.3 1.5 1.0 0.3 3.6 1.6 0.1 15.6 6.5 1.4 8.7 2.8 6038 34 Among currently married women, 26 percent reported having used family planning methods, and 16 percent have ever used modem family planning methods. Ever use of traditional family planning methods was reported by 14 percent of all women and 16 percent of currently married women. The most commonly used methods of family planning by currently married women were pills (l 2 percent), withdrawal (9 percent), and periodic abstinence (7 percent). Generally, ever use of modem family planning methods increases with age up to 35-39 years, after which it decreases. 4.3 Current Use of Contraceptives Table 4.4 presents the distribution of women by family planning method currently used according to age. Only 10 percent of currently married women in Tanzania were using family planning methods at the time of interview. This section focuses primarily on married women, since it is customary to analyse contraceptive use among currently married women. Table 4.4 Cun'ent use of contraception by age Percent distribution of all women and of currently married women by contlaceptive method currently used, according to age, age, Tanzania 1991/92 Age Any modem Any meth- method od Modern methods Traditional methods Die- Fcmaal© Male Ptgi- Not phragm, steri- steri- Any eric With cur- Inje~- foam+ Con- lisa- lisa- trsd. absti- Mucus draw- reraly Pill IUD tion jelly dora ti~'l ti~-t method nerve method Id Other usin 8 Total Number ALL WOMEN 15-19 3.4 1.0 0.6 0.0 0.0 0.0 0.4 0.0 0.0 2.4 1.7 0.0 0.5 0.2 3.4 IC0.0 2183 20-24 9.9 5.7 3.6 0.2 0.1 0.0 1.5 0.3 0.0 4,2 2.1 0.1 1.4 0.5 9.9 100.0 1882 25-29 10.7 5.7 4.6 0.3 0.1 0.0 0.3 0.4 0.0 5.0 2.1 0,2 2.0 0.7 10.7 1(30.0 1599 30-34 14.9 10.5 7.0 0.4 0.8 0.0 1.1 1.1 0.0 4.4 1.9 0.0 1.9 0.7 14.9 1(30.0 1165 35-39 14.2 11.1 3.7 1.0 0.5 0.0 1.2 4.6 0.0 3.1 1.0 0.2 1.4 0.5 14.2 leO.0 1000 40-44 10.7 7.6 0.9 0.5 0.9 0.1 0.2 5.0 0.0 3.1 0.7 0.0 1.8 0.6 10.7 100.0 715 45-49 7.2 5.4 0.1 0.4 0.6 0.1 0.1 4.0 0.2 1.8 0.8 0.0 0.5 0.5 7.2 100.0 695 Total 9.5 5.9 3.0 0.3 0.3 0.0 0.7 1.5 0.0 3.6 1.6 0.1 1.3 0.5 9.5 100.0 9238 CURRENTLY MARRIED WOMEN 15-19 5.2 1.7 1.4 0.0 0.0 0.0 0.2 0.0 0.0 3.6 1.7 0.0 1.4 0.5 5.2 100.0 558 20-24 10.0 5.9 4.3 0.2 0.0 0.0 1.1 0.3 0.0 4.1 1.3 0.1 2.0 0.6 10.0 100.0 1283 25-29 9.9 5.2 4.1 0.4 0.2 0.0 0.3 0.3 0.0 4.8 1.4 0.3 2.5 0.6 9.9 100.0 1274 30-34 13.8 9.1 5.5 0.4 1.0 0.0 l.t 1.2 0.0 4.7 1.8 0.0 2.3 0.6 13.8 100.0 935 35-39 13.3 10.5 3.8 1.0 0.4 0.0 1.3 3.9 0.0 2.8 0.8 0.0 1.6 0.4 13.3 100.0 841 40-44 10.9 7.5 0.8 0.6 0.9 0.1 0.2 4.9 0.0 3.4 0.6 0.0 2.1 0.7 10.9 100.0 603 45-49 7.1 4.8 0.1 0.5 0.5 0.1 0.1 3.4 0.2 2.3 1.0 0.0 0.6 0.7 7.1 I00.0 545 Total 10.4 6.6 3.4 0.4 0.4 0.0 0.7 1.6 0.0 3.9 1.3 0.1 1.9 0.6 10.4 100.0 6038 Use of modem methods was higher (7 percent) than that of traditional methods (4 percent). Pills were used by 3 percent of currently married women, which is about half of all women using modem methods. Other methods commonly used were withdrawal (2 percent), female sterilization (2 percent), and periodic abstinence (1 percent). Use of family planning methods was lowest among younger women (15-19 years) and highest among women between 30-39 years of age. The tendency to use family planning methods was higher among older women, probably due to the fact that they are more likely to have completed their 35 families and hence want to stop childbearing. Similar findings were also observed in Nigeria (Federal Office of Statistics, 1992). To determine the factors associated with current use of family planning methods, use of the methods was assessed by various background characteristics of women, such as urban/rural residence, region, education, and number of living children. The results are presented in Table 4.5 and Figure 4.1. Table 4.5 Current use of contraception by back~rotmd characteristics Percent distribution of currently marr ied women by contraceptive method currently used, according to selected background characteristics, Tanzania 1991/92 Background chatactetlstlc Modem methods Traditional mctho& Femdi¢ Male Any Pod- Any All Vagthdi stexl- stefi- trl,d, cdic With Number meth- rood- Injec- meth- Con- lka- llisa- meth- absti- draw- of od era Pill IUD tion ods dc~n don tion. od hence Mucus al Other women Residence Mainland 10.5 6.6 3.4 0.4 0,4 0.0 0.7 1.6 0.0 4.0 1.3 0.1 2.0 0.6 5870 Dares Salaam 15.7 10.9 5.7 0.5 0.6 0.0 1.9 2.2 0.0 4.8 0.6 0.0 3.5 0.6 349 Other urban 18.7 15.1 9.5 1.3 1.3 0.0 1.4 1.6 0.0 3.6 1,6 0.1 1.1 0.8 966 Rural 8.4 4.4 1.9 0.2 0.1 0.0 0.5 1.6 0.0 4.0 1,3 0.1 2.1 0.6 4555 Zanzibar 7.1 6.6 2.9 0.3 1.1 0.0 0,8 1.5 0,0 0.5 0.5 0.0 0.0 0.0 168 Region Dodoma 9.6 8.3 4.5 0.0 1.6 0.0 2.2 0.0 0.0 1.3 0.5 0.0 0.6 0.2 445 Arusha 17.3 12,3 7.6 0,8 0.4 0.0 1.1 2.5 0.0 5.0 0.8 0.6 3,3 0,2 350 Kilimanjaro 33.1 25.3 8,5 4.8 0,4 0.3 3.4 7.9 0.0 7.8 1.8 0,3 5,6 0.0 258 Tanga 15.8 7.5 4.9 0.0 0.7 0.0 0.3 1.6 0.0 8.3 1.8 0.0 6.5 0.0 306 Morogoro 10.6 4.5 3.3 0.0 0.0 0.0 1.0 0.2 0,0 6.1 2.0 0.0 2.4 1.8 334 Coast 13.6 3.3 1.8 0.0 0.0 0.4 1.1 0.0 0.0 10.3 0.8 0.0 6.7 2.8 98 Lindi 11.5 9.7 4.9 0.0 1.0 0.0 0.6 3.2 0.0 1.8 0.0 0.0 0.2 1.6 155 Mtwara 2.3 1.5 0.4 0.0 0.4 0.0 0.0 0.7 0.0 0.8 0.0 0,0 0.0 0.8 249 Ruvuma 7,8 5.1 1.3 0.0 0.0 0.0 0.3 3.5 0.0 2.7 0,0 0.4 1.3 1.1 210 lringa 11.1 9.0 6.7 0,9 0.2 0.0 0.0 0.8 0.3 2.1 1.2 0.0 0.9 0.0 338 Mbeya 12.1 5.4 2.9 0.9 0.0 0.0 0.0 1.6 0.0 6.7 0.8 0.O 5.9 0.0 333 Singida 14.0 10.7 8.4 0.9 0.0 0.0 0.0 1.4 0.0 3.4 1.5 0.0 1.1 0.7 190 Tabora 9.0 4.1 1.0 0.2 0.0 0,0 0.0 2.9 0.0 5.0 1.6 0.4 1.5 1.4 174 Rukwa 5,6 4.4 2.3 0.0 0.0 0.0 0.5 1.7 0.0 1.2 0.9 0.0 0.1 0.1 158 Kigoma 4.9 2.8 1.3 0.0 0.1 0.0 0.9 0.5 0.0 2.1 0.3 0.0 0,5 1,3 245 Shinyanga 4.2 1.2 0.6 0.0 0.0 0.0 0.3 0.3 0.0 3.0 2,4 0.0 0.0 0,6 578 Kagera 8.4 3.9 0.5 0.0 0.3 0.0 0.0 3.2 0.0 4.4 2,8 0,0 1.3 0.3 371 Mwanza 4.0 2.3 1.5 0.0 0.0 0.0 0.0 0.9 0.0 1.6 0.8 0.0 0.3 0.6 444 Mall 7.9 3.0 0.8 0.2 1.1 0,0 0.0 0.9 0.0 4.9 2.9 0.3 1.1 0.6 285 Education No education 3.7 1.8 0.6 0.0 0.2 0.0 0.1 0.8 0,0 1.9 0.7 0,0 0,8 0.4 2505 Primary incomplete 12.9 8.2 2.3 0.6 1.0 0.0 0.7 3.6 0.0 4.7 0,7 0.2 2.9 0.9 11(6 Completed primary 14.6 9.3 6,1 0.4 0.3 0.O 1.2 1.3 0.0 5.3 1.9 0.1 2.7 0.6 2215 Secondary/Higher 42.4 33.1 17.2 6.6 0.3 0,0 3.9 5.2 0.0 9.3 4.9 0.5 3.0 0.9 152 Number of children 0 1.8 0.6 0.1 0.0 0.0 0.0 0.0 0.5 0.0 1.2 1.2 0.0 0.0 0.0 619 1 9.8 6.3 4.5 0.0 0.1 0.0 0.7 1.0 0.0 3.5 1.4 0.3 1.4 0.4 1058 2 11.6 6.0 4.2 0.4 0.0 0.0 1.2 0.3 0.0 5.6 1.6 0.1 2.9 1.0 1001 3 11.3 7.7 4.8 1.2 0.1 0.0 0.6 1.0 0.0 3.6 1.2 0.1 1.9 0.5 835 4÷ 12.0 8,0 2.9 0.5 0.8 0.1 0.7 2.9 0.0 4.0 1.1 0,0 2.2 0.7 2525 Total 10.4 6.6 3.4 0.4 0.4 0.0 0.7 1.6 0.0 3.9 1.3 0A 1.9 0.6 6038 36 Figure 4.1 Current Use of Modern Contraceptives among Currently Married Women 15-49 RESIDENCE/ MalnlanO ~ Dar es Salaam k ¢ ~ Other urbai3 I~¢~ Rural Zanzibar r~ R E G I O N / Ki l imanjaro ~ Arushe ~ Sin(;Ida ~ L1 n d ) I ~ Ir lnga Dodoma Tangs Mbeye • ,~ Ruvums Moroaoro~ R u'kwe ~ Tabors K a g e r s ~ Coast Mare Mwanzs ~ Mtwara ~ Shinyanga ~ ~a~-~,~p -~ : . 10 20 Percent 30 TDHS 1991/92 The proportion of married women using any method of family planning was higher in the Tanzania mainland (11 percent) than in Zanzibar (7 percent). Within the Tanzania mainland, women in rural areas were less likely to use family planning methods than those in urban areas. However, the prevalence of contraceptive use was slightly lower in Dares Salaam (16 percent) than in other urban areas (19 percent). In both urban and rural areas, the pill was the most used method. The prevalence of use of family planning methods varied widely by region. Regions with the highest proportion of married women using modem methods were Kilimanjaro (25 percent), Arusha (12 percent), Dares Salaam (11 percent), and Singida (11 percent). Lowest prevalence of contraceptive use was found in Shinyanga (1 percent), Mtwara (2 percent), Mwanza (2 percent), and Kigoma (3 percent). Overall, pills were the most popular method in most of the regions. Use of traditional methods was relatively high in Coast (10 percent), Tanga (8 percent), Kilimanj aro (8 percent), and Mbeya (7 percent). In general, withdrawal was the most common traditional method used in all regions. The probability of using family planning methods is associated with level of education. As documented in other countries, a monotonic increase in contraceptive use was found to be associated with increasing level of education. The proportion of married women using any family planning method increased from about 4 percent among women with no formal education to 42 percent among those with secondary education or higher. A similar pattern was observed for both modem and traditional methods. Female sterilisation is the most commonly used method among women with no education and those with incomplete primary education, whereas pills are the most used contraceptive method among women with completed primary education and above. The association between level of education and use of contraception was further explored by relating the proportion of women who had completed primary school and above and current use of contraceptives by 37 region; the results are shown in Figure 4.2. These results indicate that there is a strong relationship between contraceptive use and level of education. The level of education explains 63 percent of the variation in use of modem contraceptives between regions. Kilimanjaro region is an outlier, especially because of its high use of modem contraceptives: the level of use is higher than expected on the basis of its level of education. Dares Salaam, despite having a level of contraceptive use higher than most other regions, has a lower level than expected on the basis of its level of education. :30 Percent Figure 4.2 Use of Modern Contraceptive Methods, Married Women 15-49 25 20 15 10 5 0 • Kilimanjaro 10 20 30 40 50 60 70 80 90 Percent Completed Primary Education or Above 100 TDHS 1991/92 Use of any family planning method was found to increase from about 2 percent among women with no living child to 12 percent among those with at least four living children. Increasing prevalence of modem contraceptive use was also found to be associated with increasing number of living children. Use of specific modem and traditional methods varied little according to the number of living children, except for female sterilization and IUD, which were found to be used mainly by women with at least three living children. In general, these findings indicate that women more likely to be using family planning methods are those on mainland Tanzania, particularly those in urban areas other than Dares Salaam, those residing in the Kilimanjaro region, those who have completed secondary education, and those with at least two living children. 4.4 Number of Children at First Use of Contraception Family planning methods may be used by couples for either limiting family size or spacing births. Family size limiters are likely to start using contraceptives only when they have already had as many children as they want, whereas couples wishing to space their births may start contracepting at a much earlier phase before having many births. In many cultures where acceptance of family planning is not widespread, most couples use contraceptives for limiting family size. As the concept of planning families gains acceptance, 38 however, couples may begin to use contraception for spacing births as well as for limiting family size. To explore the possible motivation for use of contraceptives, a question was posed on the number of living children ever-married women had when they first used contraception; the results are presented in Table 4.6. Table 4.6 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Tanzania 1991/92 Ntmaber of living children at time Never of first use of contraception Number Current used of age contraception 0 1 2 3 4+ Missing Total women 15-19 88.5 6.0 4.7 0.2 0.0 0.0 0.6 100.0 618 20-24 73.6 2.5 17.8 3.7 0.7 0.4 1.3 100.0 1409 25-29 72.3 1.3 12.2 8.3 3.6 1.3 1.0 100.0 1457 30-34 66.9 0.7 10.2 7.1 6.1 7.8 1.3 100.0 1117 35-39 70.7 1.1 6.8 4.7 5.4 10.6 0.7 100.0 976 40-44 73.1 0.8 2.8 3.8 3.7 15.0 0.8 100.0 709 45-49 78.5 0.1 2.6 2.0 3.8 12.0 1.0 100.0 692 Total 73.6 1.7 9.7 4.9 3.4 5.8 1.0 100.0 6977 Overall, only 2 percent of women used contraceptives before they had children. About 37 percent of women who had ever used contraceptives (10 percent of all ever-married women) started using contraceptives when they had one child, suggesting that they were interested in spacing their births. On the other end, about 22 percent of ever users of contraceptives (6 percent of all ever-married women) used contraceptives for the first time when they had at least 4 living children, suggesting that they were interested in limiting family size. When we take into consideration the age of respondents at interview a very interesting pattem can be observed. Among ever users of contraceptives, over half (52 percent) of women below 20 years of age started using contraceptives before they had any living child, while 67 percent of women between 20-24 years started using contraceptives when they had only one child. Among women age 40-49 who reported to have ever used contraceptives, 56 percent had at least 4 living children at the time they started using contraceptives. These results suggests that the major motivation for starting to use contraceptives was prevention of unwanted pregnancies for those below 20 years of age; spacing of births for those between 20-29 years; and limiting family size for those at40 years and above. Thus, they reflect a possible increasing tendency of using family planning methods for prevention of unwanted pregnancies and child spacing rather than of family size limitation. 4.5 Knowledge of the Fertile Period The time between two menstrual bleedings is commonly referred to as a menstrual cycle. Women's ability to conceive tends to vary within the menstrual cycle. Generally, women are said to be "fertile" for a brief period of time at mid-cycle, and relatively "infertile" for the rest of the cycle. Knowledge of this fact is obviously important for successful practice of coital-related methods and periodic abstinence or the rhythm 39 method. To assess this knowledge, women were asked to identify the time within the menstrual cycle when a woman is most likely to conceive. Table 4.7 presents the percent distribution of all women and those who have ever used periodic abstinence by reported knowledge of the fertile period. Of all women interviewed, 42 percent reported that they did not know when a woman is most likely to conceive, and 20 percent said that a woman is most likely to conceive just after her period has ended. Only 13 percent gave the correct response -- that a woman was most likely to conceive in the middle of her menstrual cycle. Ever users of periodic abstinence were more likely to know the time in the cycle when a woman was expected to conceive. Of 598 women who had ever used periodic abstinence, 31 percent correctly identified the mid-cycle as the fertile period, and only 12 percent said they did not know. In general, knowledge of the fertile period was very low, since more than half of all women and those who have ever used periodic abstinence gave wrong answers or reporting that they did not know when a woman was most likely to conceive. Table 4.7 Knowledge of fertile period Percent dgtst~ibution of all women and of women who have ever used periodic abstinence by knowledge of the fertile period during the ovulatory cycle, Tanzania 1991/92 Ever u~ers Perceived All of periodic fertile period women abstinence During menstraal period 0.6 0.6 Right after period has ended 19.5 27.8 In the middle of the cycle 13.0 31.1 Just before period begins 5.7 11.6 Other 0.1 0.3 No particular time 18.2 15.9 Don't know 42.1 12.1 Missing 0.9 0.6 Total 100.0 100.0 Number 9238 598 4.6 Sources for Family Planning Methods All current users of modem contraceptive methods were asked to report the source from which they most recently obtained their methods. Interviewers were instructed to write the name of the source, which was later verified and coded by the supervisors and field editors. The reported sources of contraceptive supplies are summarized in Table 4.8. Public (govemment) facilities were reported by the majority (73 percent) of modem contraceptive users as the source of their most recent contraceptive supplies. Eighteen percent reported obtaining contraceptives from private medical facilities, while only 4 percent obtained their supplies from other private outlets such as shops or friends and relatives. The most common sources of methods were dispensaries for public (government) sector and religious organisation health facilities and private shops for the private sector. 40 Several factors may influence a woman to select a certain facility as a source of contraceptive supplies. One of these factors may be the type of method chosen. Table 4.8 shows the most recent source of supply by the method used by current users of modem contraceptive methods. The majority of users of the pill, IUD, and condom and all users of injectables obtained their supplies from public (govemment) facilities. Among 134 women reporting to have been sterilized, half were performed in public (government) facilities, and one-third were done in a private medical facility. The sources of modem contraceptive methods are summarized in Figure 4.3. Table 4.8 Source of supply for modem contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Tanzania 1991192 Female In jet- sterill- Source of supply Pill IUD tion Condom sadon Total Public sector 86.3 (74.6) (100.0) 54.3 49.4 72.9 Consultant hospital 0.7 (7.0) (9.2) 2.2 12.3 4.5 Regional hospital 6.6 (21.5) (10.3) 4.3 10.2 8.2 District hospitul 18.8 (7.2) (38.1) 12.0 25.6 19.9 Health centre 21.5 (30.3) (16.3) 10.1 0.0 14.9 Dispensary 37.4 (8.6) (21.5) 24.3 0.0 23.9 Parastatal health facility 1.4 (0.0) (4.7) 0.0 1.4 1.3 Village health post/Worker 0.0 (0.0) (0.0) 1.4 0.0 0.2 Medical private sector 9.2 (25.4) (0.0) 18.0 36.3 17.8 Religious org. facility 6.1 (25.4) (0.0) 6.4 33.4 14.0 Private doctor/Hospital/Clinic 0.9 (0.0) (0.0) 4.0 2.8 1.7 Pharmacy/Medical store 2.0 (0.0) (0.0) 7.5 0.0 2.0 UMATI CBD worker 0.1 (0.0) (0.0) 0.0 0.0 0.1 Other private sector 2.4 (0.0) (0.0) 23.1 0.0 4.1 Shop 0.3 (0.0) (0.0) 21.3 0.0 2.8 Friends, relatives 2.1 (0.0) (0.0) 1.9 0.0 1.3 Other 0.0 (0.0) (0.0) 0.5 0.5 0.2 Don't know 0.0 (0.0) (0.0) 4.1 0.0 0.5 Missing 2.1 (0.0) (0.0) 0.0 13.8 4.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 279 31 29 69 134 545 UMATI = Family Planning Association of Tanzania 41 Figure 4.3 Distribution of Current Users by Source of Contraceptive Supply Mission Facility 14% Pharmacy/Shop Other 5'~ Don't Know/Missing 5% " 1 Centre 15% Dispensary 24% Government Hospital 33% TDHS 1991/92 Other factors that may influence a woman to select a certain source of supplies is the distance from home to the facility. To assess the distance involved, current users of modem contraceptive methods were asked how long it takes to travel from their home to the place where they obtain the method. Nonusers were asked if they knew a place where they could obtain a modem method and, i f so, how long it would take to travel there. The results are shown in Table 4.9. Table 4.9 Time to source of supply for modem contraceptive methods Percent distribution of women who are currently using a modem contraceptive method, of women who are not using a modem method, and of women who know a method, by time to reach a source of supply, according to urban/rural residence, Tanzania 1991/92 Women who are currently using a modem method Women who are not using a modem method Women who know a eontxaceptive method Minutes to source Urban Rural Total Urban Rural Total Urban Rural Total 0-14 16.7 10.4 13.4 10.2 3.8 5.3 12.3 5.4 7.4 15-29 22.5 6.9 14.4 11.4 3.1 5.0 14.4 4.5 7.3 30-59 22.1 14.1 18.0 22.7 8.7 12.0 25.8 12.4 16.3 60 or more 31.2 61.6 47.0 22.3 34.0 31.2 26.3 47.7 41.5 Does not know time 1.4 1.9 1.6 0.5 0.6 0.6 0.6 0.9 0.8 Does not know source 0.7 0.3 0.5 31.8 49.1 45.0 19.0 27.8 25.3 Not stated 5.4 4.8 5.1 1.1 0.7 0.8 1.7 1.2 1.4 Total 100.0 100.0 10O.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 262 282 545 2032 6661 8693 1991 4885 6876 42 Among women currently using modem contraceptive methods, 28 percent reported living less than 30 minutes from the source of contraceptives, while 18 percent took 30 minutes to one hour to reach the source of contraceptives. Almost half (47 percent) of current users reported taking one hour or more to reach the source. As expected, women in rural areas were more likely to live farther from their source of contraceptives than their urban counterparts. Among women who are not currently using modem contraceptive methods, 45 percent did not know a source for contraceptive methods. This finding may be due to the fact that all women were asked this question, including those who do not know any method. However, even among those women who knew a family planning method, 25 percent said they did not know a place to get modem methods. 1 This suggests that lack of knowledge of a source of contraceptive supply is not necessarily due to not knowing about family planning methods. Among those who knew a source of contraceptives, the time to a source of contraceptives was similar in users and nonusers in urban and rural areas. For instance, the proportion more than 60 minutes away from the source is highest among rural women who use (62 percent), followed by women who know a method (48 percent) and non-users (34 percent). These findings partly suggest that travel time to the source of contraceptive supply may not be an important determinant of contraceptive use in urban and rural areas. However, the large proportion of non-users who do not know a source complicates the picture: these may be women who live far from a source. In that case, travel time is an important determinant of use. 4.7 Intention to use Family Planning Among Nonusers Currently married women who were not using contraceptive methods at the time of survey were asked if they intended to use family planning methods in future. The results are presented in Table 4.10. Over half of women (56 percent) said they did not intend to use family planning methods in the future, whereas 17 percent were not sure. In general, women with no living children were more likely to report that they do not intend to use family planning methods. Nineteen percent of nonusers said they were intending to use family planning methods within 12 months, 7 percent said they intended to use after 12 months, and about 2 percent indicated their intention to use contraceptives in the future, although they were not sure of the timing. Thus, the majority of women intending to use family planning methods in the future reported that they were planning to do so within the next 12 months. These results are not entirely consistent with the results presented in Table 4.1, where, based on a different question, it was shown that 89 percent of women who know a method know a source. No explanation for this difference can be given. 43 Table 4.10 Future use of contraception Percent dis~butlon of currently married women who a~ not using a contraceptive method by past experience with contraception and intention to use in the future, according to number of living children, Tanzania 1991/92 Past experience with contraception and future intentions Number of living children I 0 1 2 3 4+ Total Never used contraception Intends to use in next 12 months 2.3 10.6 11.5 13.0 14,0 11,9 Intends to use later 5.2 5.6 6.5 3.8 2,9 4.3 Unsure as to liming 0.9 0.8 1.2 1.2 1.0 1.0 Unsure as to intention 17.3 19.7 18.5 12.7 12,3 15.1 Does not intend to use 68.8 51.8 46.6 48.3 48,5 50,5 Missing 0.0 0.3 0.3 0.0 0.3 0,2 Previously used contraception Intends to use in next 12 months 0.6 3.5 8,2 10,1 8.3 7.1 Intends to use later 1.2 2.4 1.8 2.4 2.7 2.3 Unsure as to timing 0.0 0.0 0.3 2.1 0.6 0.6 Unsure as to intention 1.2 2.0 0.7 1.5 1.7 1.5 Does not intend to use 2,4 3.1 4.3 4.8 7.6 5.5 Missing 0.0 0.0 0.0 0.1 0.1 0.1 Total 100.0 100.0 100.0 100,0 100.0 100.0 All currently married nonusers Intends to use in next 12 months 2.9 14.1 19.7 23.2 22.4 19.0 Intends to use later 6.4 8.0 8.3 6.2 5.6 6.6 Unsure as to timin~ 0.9 0.8 1.5 3.2 1.6 1.6 Unsure as to intenlaon 18.4 21.7 19.2 14.1 13.9 16.5 Does not intend to use 71,3 54.9 51.0 53.1 56.2 55.9 Missing 0,0 0,3 0.3 0.2 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100,0 Number of women 461 927 897 796 2327 5409 1Includes cun-ent pregnancy Women who said they do not intend to use family planning methods were asked to give their reasons for nonuse. Out of the 3025 respondents, 36 percent said they do not intend to use family planning methods in the future because they want children (see Table 4.11). Other reasons given were difficulty in conceiving (12 percent), infecundity (post-menopausal/had hysterectomy) (11 percent), lack of knowledge of methods (9 percent), and opposition to family planning (8 percent). Women below 30 years of age were more likely to report that they do not intend to use contraceptives because they want children, whereas those age 30 years or more were more likely to say that they were infecund or menopausal and therefore no longer at risk of getting pregnant. Nonusers who indicated their willingness to use family planning methods in the future were asked to mention the method they preferred to use. A majority of these women (53 percent) said they preferred to use pills (see Table 4.12). Other preferred methods were injections (12 percent), female sterilization (9 percent), and IUD (5 percent). Women who intend to use in the next 12 months have similar method preference as women who intend to use after 12 months. However, women who were not sure of the timing of future use were more likely to prefer the withdrawal method. 44 Table 4.11 Reasons for not using contraception Percent distribution of women who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Tanzania 1991/92 Age Reason for not using contraception <30 30+ Total Wants children 52.2 23.9 36.4 Lack of knowledge 10.8 7.6 9.0 Partner opposed 4.1 2.4 3.1 Costs too much 0.0 0.1 0.1 Side effects 3.6 3.1 3.4 Health concerns 0.8 1.9 1.4 Hard to get methods 2.5 1,8 2.1 Religion 0.5 0.6 0.5 FOPpeSod to family planning 7.7 7.6 7.7 atalistic 3.8 6.2 5.2 Other people opposed 0.1 0.2 0.1 Infrequent sex 1.3 2.1 1.8 Difficult to be pregnant 4.7 17.8 12.0 Menopausal, had hysterectomy 0.0 20.2 11.3 Inconvenient 1.1 1.3 1.2 Not married 0.4 0.4 0.4 Other 0.6 0.7 0.7 Don't know 5.5 2.0 3.5 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number 1331 1694 3025 Table 4.12 Preferred method of eontracoption for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Tanzania 1991/92 Intend to use In next After Unsure Preferred method 12 12 as to of contraception months months timing Total 1 Pill 53.1 54,3 54.5 53.4 IUD 5.6 3,3 0.0 4.7 Injection 13.7 10,2 3.6 12.2 Diaphragm/Foam/Jelly 1.0 2.1 0.0 1.2 Condom 1.5 1,2 0.0 1.4 Female sterilisation 8.9 7,0 9.6 8.5 Male sterilisation 0.2 0,4 0.0 0.3 Periodic absfinenco 3.5 4.0 5.8 3.8 Mucus method 0.2 0.3 0.0 0.2 Withdrawal 1.6 2.0 12.5 2.4 Other 3.4 5.6 6.2 4.1 Missing 7.3 9.4 7.8 8.0 Total 100.0 100.0 100.0 100.0 Number 1026 359 88 1475 1Includes 3 missing cases 45 4.8 Approval of Family Planning Radio and television are the major potential sources of information about family planning. To assess the effectiveness of such messages, all respondents were asked if they had heard a message about family planning on radio or television in the month preceding the survey. A large majority of respondents (76 percent) said they bad not heard any message, whereas only 23 percent reported that they did (see Table 4.13). Women in Zanzibar were more likely to have heard family planning messages on radio and television than their counterparts on the mainland. It should be noted that although the question was asked for both radio and television for the mainland, radio is the only source of information, since no public television system is in place there. This may account for the differences observed between Zanzibar and the Tanzania mainland. Table 4.13 Family pbmning messages on radio and television Percent distribution of all women by whether they have heard a family planning message on radio or on television in the month preceding the suiwey, according to selected background characteristics, Tmazania 1991/92 Heard family planning message on radio or on television Background Radio Television characteristic Neither only only Both Missing Total Number Residence Mainland 77.5 21.5 0.3 0.3 0.4 100.0 8978 Dares Salaam 43.8 53.1 0.9 2.2 0.0 100.0 585 Other urban 62.4 36.8 0.4 0.4 0.0 100.0 1686 Rural 84.2 14.9 0.3 0.2 0.5 100.0 6707 Zanzibar 33.0 55.4 0.4 11.0 0.2 100.0 260 Region Dodoma 84.7 14.5 0.5 0.0 0.3 100.0 649 Arusha 63.9 35.7 0.0 0.3 0.1 100.0 573 Kilimanjaro 73.0 26.5 0.4 0.2 0.0 100.0 516 Tanga 86.2 12.5 0.0 0.4 0.9 100.0 471 Morogoro 76.7 22.6 0.5 0.1 0.1 100.0 512 Coast 65.4 32.9 1.0 0.8 0.0 100.0 159 Lindi 86.3 13.7 0.0 0.0 0.0 100.0 217 Mtwara 93.3 6.7 0.0 0.0 0.0 100.0 363 Ruvuma 91.2 8.6 0.2 0.0 0.0 100.0 320 Iringa 77.9 19.6 0.0 0.3 2.3 100.0 475 Mbeya 79.9 19.4 0.0 0.2 0.4 100.0 449 Singida 80.3 19.2 0.5 0.0 0.0 100.0 355 Tabora 83.8 15.5 0.2 0.2 0.3 100.0 271 Rukwa 78.3 21.1 0.2 0.2 0.2 100.0 217 Kigoma 74.6 25.3 0.0 0.2 0.0 100.0 375 Shinyanga 88.5 10.8 0.0 0.0 0.7 100.0 793 Kagera 78.0 19.0 1.4 0.9 0.7 100.0 608 Mwanza 77.0 22.1 0.5 0.2 0.2 100.0 666 Mara 75.6 24.0 0.0 0.3 0.1 100.0 403 Education No education 86.7 12.2 0.2 0.2 0.6 100.0 3128 Primary incomplete 77.8 21.3 0.1 0.4 0.4 100.0 1825 Completed primary 70.3 28.5 0.4 0.6 0.2 100.0 3841 Secondary/Higher 46.4 46.6 1.7 5.0 0.2 100.0 444 Total 76.2 22.4 0.3 0.6 0.4 100.0 9238 On the Tanzania mainland, radio messages on family planning were more likely to have been heard by women in urban areas than those in rural areas and the proportion varied widely across regions. Over half of respondents in Zanzibar (67 percent) and Dares Salaam (56 percent) have heard family planning messages 46 on radio compared to less than 12 percent of respondents in Mtwara, Ruvuma, and Shinyanga. More educated women were also more likely to have heard a family planning message on radio or television than their less educated counterparts. Women were asked whether they thought it was acceptable or not acceptable for family planning information to be provided on radio or television. Overall, a majority of women interviewed (71 percent) reported that it was acceptable to use radio or television for family planning information (Table 4.14). Table 4.14 Acceptability of the use of mass media for disseminating family planning messages Percentage of women who believe that it is acceptable to have messages about family planning on radio or television, by selected background characteristics, Tanzania 1991/92 Not Background Accept- accept- characteristic able able Missing Total Number A15.19ge 57.9 13.5 28.7 100.0 2183 20-24 79.4 10.2 10.4 100.0 1882 25-29 77.4 11.2 11.3 100.0 1599 30-34 79.7 11.2 9.1 100.0 1165 35-39 68.9 17.7 13.4 100.0 1000 40-44 67.7 16.7 15.7 100.0 715 45-49 60.4 15.4 24.2 100.0 695 Residence Mainland 70.5 12.7 16.8 100.0 8978 Dares Salaam 79.4 15.9 4.7 100.0 585 Other urban 82.1 8.4 9.5 100.0 1686 Rural 66.8 13.4 19.7 100.0 6707 Zanzibar 71.2 24.3 4.6 100.0 260 Region Dodoma 73.7 13.8 12.5 100.0 649 Arusha 77.3 11.1 11.6 100.0 573 Kilimanj axo 84.6 4.6 10.8 100.0 516 Tanga 78.5 6.8 14.7 100.0 471 Morogoro 73.8 13.4 12.9 100.0 512 Coast 61.7 28.2 10.0 100.0 159 Lindi 74.2 14.1 11.7 100.0 217 Mtwara 56.4 13.8 29.8 100.0 363 Ruvuma 69.4 15.6 15.0 100.0 320 Iringa 55.8 15.4 28.8 100.0 475 Mbeya 62.7 7.9 29.4 100.0 449 Singida 69.7 10.8 19.5 100.0 355 Tabora 75.1 9.4 15.5 100.0 271 Rukwa 51.9 11.3 36.8 100.0 217 Kigoma 68.3 15.0 16.7 100.0 375 Shinyanga 66.6 10.2 23.3 100.0 793 Kagera 71.5 15.7 12.8 100.0 608 Mwanza 69.3 13.4 17.2 100.0 666 Mara 70.1 17.9 12.0 100.0 403 Education No education 57.0 19.3 23.6 100.0 3128 Some primary 70.8 11.6 17.6 100.0 1825 Completed primary 79.3 9.3 11.4 100.0 3841 Secondary/Higher 88.5 5.7 5.7 100.0 444 Total 70.5 13.0 16.5 100.0 9238 47 Acceptability of radio and television as a source of information was relatively low among women below 20 years and above 44 years, while the proportion of women reporting these channels to be unacceptable was relatively higher among women above 34 years of age. Women in Zanzibar were twice as likely as their counterparts in Tanzania mainland to say that radio and television were unacceptable media for family planning information. Within the Tanzania mainland, women in Dares Salaam and rural areas were more likely to report that radio and television were unacceptable than women in other urban areas. Acceptability of radio and television for dissemination of family planning messages varied across regions. Less than 10 percent of women in Kilimanjaro, Tanga, Mbeya, and Tabora reported that radio and television were unacceptable for dissemination of family planning messages, compared to more than twenty percent of women in Coast and Zanzibar. More educated women were much more likely to accept family planning messages on radio or television than less educated women. TO assess the acceptability of family planning among married women who know family planning methods, the TDHS included a question about the extent to which couples discuss the topic with each other. Table 4.15 indicates that 56 percent of respondents had not discussed family planning with their husbands during the previous year. Among those who have discussed family planning with their husbands, most had discussed the topic only once or twice. Women below 20 years of age and those above 39 years of age were more likely not to have discussed family planning with their husbands than their counterparts age 20-39 years. Table 4.15 Discussion of family planning by couples Percent distribution of currently married women who know a contraceptive method by the number of times family planning was discussed with husband in the year preceding the survey, eccording to current age, Tanzania 1991/92 Number of times family planning discussed Number Three Once or or more Don't know/ of Age Never twice times Missing Total women 15-19 66.1 26.2 7.3 0.3 100.0 396 20-24 51.1 29.3 19.4 0.2 100.0 1040 25-29 52.9 28.2 18.6 0.3 100.0 1073 30-34 49.0 29.0 21.8 0.2 100.0 788 35-39 58.1 19.9 21.2 0.8 100.0 637 40-44 61.3 22.5 16.1 0.0 100.0 453 45-49 72.9 13.4 13.2 0.5 100.0 358 Total 56.0 25.6 18.1 0.3 100.0 4746 TO obtain more direct information about the acceptability of family planning, respondents were asked if they approved or disapproved of couples using family planning methods. Although all women were asked this question, the data presented here are restricted to currently married women and exclude those women who had never heard of a contraceptive method. Currently married women were also asked if they thought that their husbands approved of the use of family planning. The results are shown in Table 4.16. 48 Table 4.16 Attitudes of couples toward family planning Among curranfly married non-stefilised women who know a contraceptive method, the percentage who approve of family planning, by their perception of their husband's attitude and selected background characteristics, Tanzania 1991/92 Respondent Respondent approves disapproves Unsure Unsure Number Background Both Husband of Husband of Both of characteristic approve disapproves husband approves husband disapprove Missing Total women Age 15-19 35.5 15.2 30.9 0.7 6.4 10.7 0.5 100.0 396 20-24 50.0 11.6 25.7 1.2 4.9 6.2 0.4 100.0 1040 25-29 45.1 19.0 21.2 1.7 6.1 6.8 0.1 100.0 1073 30-34 46.2 18.6 21.7 1.4 5.3 6.6 0.1 100.0 788 35-39 42.2 17.8 21.4 1.4 7.6 8.8 0.8 100.0 637 40~14 37.0 21.0 23.6 1.2 9.5 7.7 0.0 100.0 453 45-49 34.3 16.2 29.9 1.1 9.9 7.8 0.8 100.0 358 Residence Mainland 44.2 16.2 24.5 1.3 6.4 7.0 0.4 10O.0 4587 Dar as Salaam 60.1 13.5 17.2 1.5 1.7 6.0 0.0 100.0 313 Other urban 59.1 18.6 14.3 0.9 2.9 4.1 0.1 100.0 895 Rural 38.8 15.9 27.8 1.4 7.8 7.8 0.4 100.0 3379 Zanzibar 26.1 32.8 11.1 1.7 9.7 18.4 0.3 100.0 159 Region Dodoma 43.5 19.6 23.9 0.0 9.1 3.8 0.2 100.0 422 Arusha 56.8 18.8 11.3 1.8 5.3 6.0 0.0 100.0 237 Killmanjaro 73.5 12.1 13.0 0.0 0.4 1.0 0.0 100.0 223 Tanga 56.4 17.5 22.4 0.0 3.2 0.5 0.0 100.0 213 Morogoro 49.9 18.9 16.6 1.0 4.3 8.4 0.9 100.0 312 Coast 39.6 20.2 15.3 3.3 8.2 12.9 0.5 100.0 89 Lindi 34.7 17.4 21.0 3.5 6.2 16.4 0.8 100.0 141 Mtwara 21.8 9.0 38.8 3.7 12.4 13.3 1.0 100.0 202 Ruvuma 30.5 23.5 24.7 1.3 7.7 12.2 0.2 100.0 187 Iringa 43.3 20.4 14.2 4.4 4.8 11.8 1.1 100.0 233 Mbeya 43.5 16.1 31.2 1.1 4.1 4.0 0.0 100.0 247 Singida 46.3 17.4 29.9 0.5 2.8 3.2 0.0 100.0 162 Tabura 36.8 11.2 39.5 0.4 7.8 4.0 0.3 100.0 132 Rukwa 49.8 10.4 26.0 0.3 6.9 5.2 1.4 100.0 77 Kigoma 54.5 9.8 20.7 1.2 9.6 4.2 0.0 100.0 179 Shinyanga 23.4 10.9 46.5 2.0 10.5 6.6 0.0 100.0 350 Kagera 52.9 8.1 20.8 0.4 8.3 8,6 0.9 I00.0 274 Mwanza 28.1 20.9 33.6 0.2 9.6 7.5 0.0 I00.0 345 Mara 41.4 24.1 16.5 2.0 4.5 10.5 0.9 100.0 246 Education No education 27.4 18.3 29.7 1.6 11.3 11.2 0.4 100.0 1699 Primary incomplete 41,8 21,9 21.1 0,9 5.6 8.1 0,5 I00,0 956 Completed primary 56.1 13.4 21.6 1.3 3.2 4.1 0.2 100.0 1948 Secondary/Higher 76.7 11.1 7.5 0.3 2.0 2.4 0.0 100.0 142 Total 43.6 16.8 24.0 1.3 6.6 7.4 0.3 I00.0 4746 49 Overall, 84 percent of married women who know of a method approve of couples using family planning methods. Half of these women (44 percent) reported that their husbands also approved of family planning. However, about 17 percent of women said that they appmve of family planning but their husbands do not. Seven percent of the respondents said that both they and their husbands disapproved of family planning. Only 1 percent of respondents reported that they disapproved of family planning, but their husbands approved. Women in Zanzibar were more likely than women in the mainland to disapprove of family planning methods, as were their spouses. Husbands of respondents approving family planning methods in Zanzibar were more likely to disapprove family planning than those in other parts of Tanzania. Approval of family planning methods by both respondents and husbands was found to increase with increasing women's education, while disapproval of family planning methods was found to decrease with increasing education. These findings underscore the importance of education in changing women's attitudes towards use of family planning methods. 50 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY This chapter concerns the principal factors other than contraception that affect a woman's risk of becoming pregnant, namely nuptiality and sexual intercourse, postpartum amenorrhoea and abstinence from sexual relations, and secondary infertility. Marriage is the primary indicator of exposure of women to the risk of pregnancy and therefore is important for the understanding of fertility. Populations in which age at marriage is low tend to experience early childbearing and subsequently high fertility. This situation necessitates an examination of trends in age at marriage. This chapter also includes more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Measures of other proximate determinants of fertility are the durations of postpartum amenorrhoea and postpartum abstinence and the level of secondary fertility. 5.1 Marital Status The demographic significance of marriage patterns derives from the fact that formal or informal unions am primary indicators of exposure to the risk of pregnancy. Current marital status of eligible women at the time of the survey is shown in Table 5.1. Here, "marriage" refers to civil, religious, or traditional marriage, as well as "living together." Divorced (including separated) and widowed make up the remainder of the "ever married" category. Table 5.1 Current marital status by age Percent distribution of women by current marital status, according to age, Tanzania 1991/92 Marital status Number Never Living of Age married Married together Widowed Divorced Total women 15-19 71.8 21.2 4.3 0.2 2.6 100.0 2180 20-24 25.1 55.9 12.2 0.7 6.0 100.0 1880 25-29 8.9 58.0 21.6 1.8 9.7 t00.0 1597 30-34 4.1 55.7 24.6 4.2 11.4 100.0 1165 35-39 2.4 55.7 28.4 5.0 8.5 100.0 1000 40-44 0.9 53.8 30.5 6.8 8.1 100.0 714 45-49 0.4 49.4 29.0 10.4 10.7 100.0 695 Total 24.5 47.4 18.0 2.9 7.3 100.0 9233 About 65 percent of the eligible women are currently married. This is virtually the same proportion as observed in the 1988 population census (66 percent currently married). As expected, most of the single (never married) women are in the young age groups, that is below 25 years. 51 5.2 Polygyny According to Table 5.2, polygyny is fairly common in Tanzania: slightly more than one in four currently married women said their husbands had other wives (28 percent). Twenty-nine percent of rural currently married women have co-wives compared to 12 percent in Dares Salaam. Polygynous unions exist in all the regions and among women of different education. Mara and Shinyanga regions have the highest percentages of married women in polygynous union, and Kilimanjaro and Dares Salaam the smallest. More than one-third of women with no education are in polygynous unions compared to 14 percent of those with secondary or higher education. Table 5.2 Polygyny Percentage of currently married women in a polygynous union, by age end selected background characteristics, Tanzania 1991/92 Age of women Background All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 ages Residence Mainland 16.6 18.0 27.2 30.7 33.8 36.1 37.2 27.5 Dares Salaam (0.0) 6.2 13.3 (11.2) (23.3) (23.2) * 12.4 Other urban 6.5 15.6 21.9 28.9 31.0 37.6 35.8 24.1 Rural 20.4 19.6 29.4 32.7 35.1 36.7 38.0 29.4 Zanzibar (19.9) 16.3 25.6 (25.8) (31.9) (36.6) (27.8) 25.2 Region Dodoma * (15.5) (15.4) (13.0) (16.5) * * 18.8 Arusha * 19.4 27.8 (33.3) (33.0) (42.1) * 31.1 Kilimanjaro * (2.1) (10.6) (10.9) (17.0) (29.4) (6.1) 12.2 Tanga * 13.6 (18.1) (42.6) (34.4) (33.2) (48.4) 28.5 Morogoro (4.8) 12.5 21.3 (27.5) 31.9 (27.4) (34.3) 22.5 Coast (12.8) 12.0 23.6 32.1 31.0 * (20.4) 22.3 Lindi (6.6) (15.0) (8.7) (33.8) (49.1) (65.1) (49.6) 33.1 Mtwara (14.5) (15.0) (15.6) (21.2) (42.2) (42.4) (38.5) 26.5 Ruvuma (26.6) 14.5 34.6 (27.4) (35.6) (31.4) (42.0) 29.8 Iringa * 17.7 38.0 37.3 (53.8) (36.4) (34.3) 34.8 Mbeya * 11.8 (26.5) (45.1) (31.1) (45.7) * 26.6 Singida * 16.3 (29.8) (36.0) (42.4) * * 28.2 Tabora (14.2) (22.5) 32.1 (18.1) (35.5) (22.5) (26.9) 25.2 Rukwa (14.6) 15.2 33.8 21.9 (31.7) (28.0) * 23.3 Kigoma (8.9) 11.6 25.0 34.0 (36.4) (69.1) (47.1) 30.2 Shinyanga 22.2 35.9 41.0 44.9 36.7 (36.8) (51.9) 38.0 Kagera (8.7) 19.2 19.0 (12.4) (29.1) (25.0) (26.1) 19.7 Mwanza 12.1 22.0 33.5 42.8 (37.0) (36.4) (45.4) 31.2 Mara 42.2 29.8 52.4 52.9 56.9 (62.2) * 48.9 Education No education 20.0 27.4 36.4 36.3 34.7 40.8 39.8 35.4 Some primary 18.3 22.3 25.7 27.2 33.4 31.7 29.9 27.5 Completed primary 14.8 14.4 23.3 24.3 31.0 24.4 24.1 19.4 Some secondary * (8.0) (4.1) (25.4) * * * 14.2 Total 16.7 17.9 27.1 30.6 33.8 36.2 37.0 27.5 Note: Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. 52 Table 5.3 shows that 73 percent of currently married women have no other co-wives while 16 percent have one co-wife, and 11 percent have two or more co-wives. Mara, Kigoma, and Zanzibar have the highest proportion of currently married women with more than one co-wife. Not only is polygyny more common among less educated women, but the propensity for those in polygynous unions to have more than one co- wife is more common among less educated women. Table 5,3 Number of co-wives Percent distribution of currently married women by number of co-wives, according to selected background characteristics, Tartzania 1991D2 Number of co-wives Number Background of characteristic 0 1 2+ Missing Total women A15_19ge 83.3 11.0 5.5 0.2 100.0 558 20-24 82.1 10.6 6,3 1.0 100.0 1283 25-29 72.9 17.6 9.0 0.5 100.0 1274 30-34 69.4 18.0 11.7 0.9 100,0 935 35-39 66.2 17.2 15.9 0.6 100.0 841 40-44 63.8 19.7 16.2 0.3 100.0 603 45-49 63.0 19.9 16.5 0.5 100.0 545 Residence Mainland 72.5 16.2 10.8 0.6 100.0 5870 Dares Salaam 87.6 7.5 4.9 0.0 100.0 349 Other urban 75.9 15.9 7.3 0,8 100.0 966 Rural 70.6 16.9 11.9 0.6 100.0 4555 Zanzibar 74.8 7.8 16.0 1.4 100.0 168 Region Dodoma 81.2 15.6 3.2 0.0 100.0 445 Arusha 68.9 16.2 14.0 0.9 100.0 350 Kilimanjaro 87.8 9.1 2.8 0.4 100.0 258 Tanga 71.5 15.5 12.2 0.8 100.0 306 Morogoro 77.5 15,4 7.0 0.1 100.0 334 Coast 77.7 13.2 9.2 0.0 100.0 98 Lindi 66.9 23.1 10.0 0.0 100.0 155 Mtwara 73.5 18.4 8.1 0.0 100.0 249 Ruvuma 70.2 18.2 11.6 0,0 100.0 210 Iringa 65.2 17.5 14.1 3,2 100.0 338 Mbe~a 73.4 13.3 11.4 1,8 100.0 333 Singlda 71.8 18.7 9.2 0.3 100.0 190 Tabora 74.8 15.5 8.7 0.9 100.0 174 Rukwa 76.7 12.2 10.5 0.6 100.0 158 Ki~oma 69.8 13.2 16.3 0.6 100.0 245 Shmyanga 62.0 26.7 10.7 0.7 100.0 578 Kagera 80.3 6.9 12.1 0.6 100.0 371 Mwanza 68.8 18.4 12.8 0.0 100.0 444 Mara 51.1 22.2 26.5 0.3 10O.0 285 Education No education 64.6 19.1 15.7 0.6 100.0 2505 Primary incomplete 72.5 16.7 10.3 0.5 100.0 1166 Completed primary 80.6 12.5 6.2 0.7 100.0 2215 Secondary/Higher 85.8 9,0 4.8 0.4 100.0 152 Total 72.5 16.0 10.9 0.6 100.0 6038 53 5.3 Age at FirstMarriage According to the 1971 Marriage Act, the minimum legal age for a woman to get married is 18 years. The TDHS results show that the median age at first marriage is about 18 years (see Table 5.4). Age at marriage appears to be rising from about 17 years among women in their fourties, to 19 years among women in their twenties. Among women age 20-49, 15 percent were married by age 15, almost half by age 18 and two-thirds by age 20. Table 5.4 Age at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage, according to current age, Tanzania 1991192 Current age 15 18 20 22 Percentage of women who were Percentage Median first married by exact age: who had Number age at never of tin'st 25 married women marriage 15-19 3.7 NA NA NA NA 71.7 2183 a 20-24 7.2 36.6 61.0 NA NA 25.1 1882 19.0 25-29 10.9 39.7 59.1 74.0 85.9 8.9 1599 19.0 30-34 19.2 53.2 69.5 80.2 88.9 4.1 1165 17.7 35-39 19.0 55.0 74.3 83.7 91.3 2.4 1000 17.5 40-44 23.7 58.9 76.2 84.3 92.5 0.9 715 17.2 45-49 27.2 59.4 76.1 86.8 94.3 0.4 695 17.2 20-49 15.4 47.2 66.9 78.1 85.7 9.9 7055 18.3 25-49 18.3 51.0 69.0 80.4 89.7 4.3 5174 17.9 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 were first married by age x Table 5.5 shows that Zanzibar has a lower median age at first marriage (16 years) than that observed on the Mainland (18 years). Rural women are married slightly earlier than urban women. Differences by education are more pronounced. Women with secondary or higher education have the highest median age at first marriage (23 years), compared to women with completed primary education (20 years), and incomplete primary education and no education (17 years). 54 Table 5.5 Median age at first marriage Median age at first marriage among women age 20-49 years, by current age and selected background cheraetedstics, Tanzania 1991/92 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40.44 45-49 20-49 25-49 Residence Mainland 19.1 19.0 17.7 17.6 17.2 17.2 18.3 18.0 Der es Salaam 19.6 19.5 17.6 17.8 16.8 15.8 18.9 18.3 Other urban a 20.2 17.4 18.0 17.5 18.2 19.0 18.4 Rural 18.7 18.7 17.8 17.5 17.1 17.1 18.1 17.8 Zanzibar 18.3 17.4 16.5 15.3 15.8 15.8 16.8 16.4 Education No education 17.0 16.7 16.6 16.9 16.5 16.7 16.7 16.7 Primary incomplete 17.8 18.1 16.5 17.1 17.4 17.9 17.5 17.4 Completed primary 19.4 20.1 19.5 19.6 19.9 18.3 19.6 19.9 Secondary/Higher a (23,0) (23.5) * * * a 23.0 Total 19.0 19.0 17.7 17.5 17.2 17.2 18.3 17.9 Note: Medians ere not shown for women 15-19 because less than 50 percent have married by age 15 in all subgroups shown in the table. Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. aOmitted because less than 50 percent of the women in the age group were first married by age 20. 55 5.4 Age at First Intercourse Though age at first marriage is widely used as a proxy for exposure to sexual intercourse, this is not useful in Tanzania because many women engage in sexual activities before they are married. As Table 5.6 shows, the median age at first intercourse (16.8 years) is one and a half years lower than the median age at first marriage (18.3 years, Table 5.5). By age 15, 23 percent of women had had sexual intercourse and by age 18, the legal age at marriage, 65 percent of women had had sexual intercourse, whereas only half had married by this age. By age 20, 83 percent of women had had sexual intercourse but only 67 percent were married. Table 5.6 also shows that there is a moderate increase of the age at first sexual intercourse from 16.4 years among women 30-49 years to 17.3 years among women 20-24 years. Table 5.6 Age at first sexual intercourse Percentage of women who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at first intercourse, according to current age, Tanzania 1991/92 Cttrtent age 15 Percentage of women who had Percentage Median first intercourse by exact age: who Number age at never had of first 18 20 22 25 intercourse women intercourse 15-19 11.2 NA NA NA NA 48.7 2183 a 20-24 16.6 60.1 82.6 NA NA 8.4 1882 I7.3 25-29 19.3 59.8 79.5 89.4 94.7 1.5 1599 17.2 30-34 28.1 68.5 82.5 90.8 94.9 1.2 1165 16.4 35-39 25.5 70.0 86.3 93.2 96.6 0.4 1000 16.4 40~-4 27.3 71.1 86.0 92.2 96.1 0.2 715 16.3 4549 30.6 67.1 81.0 91.8 95.4 0.0 695 16.4 20~19 22.8 64.6 82.6 90.8 94.2 2.9 7055 16.8 25-49 25.1 66.3 82.6 91.1 95.4 0.8 5174 16.6 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 had had intercourse by age x Overall, women become sexually active at almost the same age regardless of the geographical area, though with minor differences (Table 5.7). However, the relationship between education and sexual activity is quite strong. The median age at first sexual intercourse among women with secondary or higher education is 20 years, 18 years among women who have completed primary education, and about 16 years for women with incomplete primary education or no education. 5.5 Recent Sexual Activity In a situation where contraception is not practiced, the probability of pregnancy is closely related to the frequency of sexual intercourse. Therefore, such information is very useful as a measure of exposure to pregnancy. Table 5.6 shows that all but 3 percent of women 20-49 in the TDHS had sexual intercourse. However, not all women who ever had sexual intercourse are currently sexually active. 56 Table 5.7 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 years, by current age and selected background characteristics, Tanzania 1991/92 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Malnla_nd 17.3 17.2 16.4 16.4 16.3 16.4 16.8 16.6 Dares Salaam 17.8 17.7 16.9 (16.7) (16.4) (15.8) 17.2 16.8 Other urban 17.8 17.9 16.2 16.3 16.5 16.7 17.0 16.7 Rural 17.0 17.0 16.5 16.4 16.2 16.4 16.7 16.6 Zanzibar 18.3 17.3 16.6 (15.3) (15.8) (16.0) 16.8 16.4 Education No education Primary incomplete Completed primary Secondary/Higher 16.1 15.6 15.7 15.9 15.9 16.2 15.9 15.8 16.3 16.3 15.8 16.3 16.4 17.o 16.3 16.3 17.6 18.1 17.6 18.1 18.4 17.8 17.8 18.0 a 20.5 20.4 * * * a 20.4 Total 17.3 17.2 16.4 16.4 16.3 16.4 16.8 16.6 Note: Medians were not shown for women 15-19 because less than 50 percent had had intercourse by ago 15 in all subgroups shown in the table. Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. Table 5.8 shows the percent distribution of women who have ever had sexual intercourse by sexual activity in the four weeks prior to the survey and duration of abstinence by whether or not postpartum. Women are considered to be sexually active if they had sexual intercourse at least once in the four weeks prior to the survey. Women who are not sexually active may be abstaining for various reasons, such as having given birth. Overall, 61 percent of women were sexually active during the 4 weeks period before the survey, 18 percent were postpartum abstaining, and 21 percent were abstaining for reasons other than having recently given birth. The proportion of sexually active women varies very little by age of the woman. Women who have ever had sexual intercourse but have never been in union are also sexually active (43 percent), but less so than ever-married women. Twenty-two percent of single women who ever had sexual intercourse were postpartum abstaining and 35 percent were abstaining for other reasons. There appears to be no appreciable decline in the proportion of women sexually active according to duration since first marriage, except among those married for 25 years or more. Regional data show that sexual activity was highest in Mwanza, Zanzibar and Shinyanga (over 70 percent had intercourse in the last 4 weeks), and lowest in Iringa and Ruvuma (below 50 percent). The latter two regions had the highest proportion of women in the period of postpartum abstinence. The proportion sexually active decreases slightly with increasing levels of education. Women with secondary or higher education had markedly higher levels of abstinence for reasons other than giving birth. This may be due to the fact that the better educated women are more likely to be younger and single. As expected, women who are using a family planning method are more likely to be sexually active than those who are not using any method. Among users of a family planning method, the proportion of women sexually active varies according to the method used: the highest level of sexual activity was found among users of the pill. 57 Table 5.8 Recent sexual activity Percent distribution of women who have ever had sexual intercourse by sexual activity in the four weeks preceding the survey and the duration of abstinence by whether or not postpartum, according to selected background characteristics, Tanzania 1991/92 Not sexually active in last 4 weeks Sexually Abstaining Abstaining active (postpartum) (not postpartum) Number Background in last of characteristic 4 weeks 0-1 years 2+ years 0-1 years 2+ years Missing Total women Age of mother 15-19 57.8 18.1 0.9 21.7 1.5 0.0 100.0 1121 20-24 59.9 19.9 1.8 17.1 1.2 0.1 100.0 1724 25-29 61.2 20.8 2.5 14.3 1.1 0.1 100.0 1576 30-34 63.8 16.4 2.2 15.8 1.8 0.1 100.0 1151 35-39 63.3 13.6 2.7 18.2 2.0 0.3 100.0 997 40-44 64.7 8.3 1.6 18.6 6.6 0.1 100.0 714 45-49 56.8 3.7 2.2 22.2 14.5 0,6 100.0 695 Duration of union 0-4 64.6 20.5 0.7 13.8 0.4 0.0 100.0 1752 5-9 63.9 19.9 1.5 14.1 0.5 0.0 100.0 1409 10-14 65.0 18.4 1.3 14.4 0.9 0.0 100.0 986 15-19 62.5 13.7 2.6 18.7 2.3 0.1 100.0 975 20-24 65.4 12.5 2.1 16.2 3.0 0.8 100.0 809 25+ 60.0 5.7 1.9 20.2 12.1 0.2 100.0 1047 Never in union 42.8 16.8 4.9 30.5 4.7 0.2 100.0 1000 Residence Mainland 60.7 16.3 2.0 17.7 3.1 0.1 100.0 7776 Dares Salaam 69.3 12.2 1.2 13.4 3.9 0.0 100.0 500 Other urban 56.5 15.3 1.3 23.1 3.6 0.1 100.0 1451 Rural 61.0 16.9 2.3 16.8 2.9 0.2 100.0 5825 Zanzibar 73.3 6.6 0.2 16.8 2.5 0.7 100,0 202 Region Dodoma 56.4 20,7 L4 17.6 3.9 0.0 100.0 606 Arusha 51.2 24.6 3.8 17.4 2.5 0.5 100.0 507 Kilin~anjaro 58,0 11.3 2.9 22.7 5.1 0.0 100.0 371 Tanga 63.1 11.1 1.4 22.8 1.6 0.0 100.0 393 Morogoro 56.1 16.9 3.3 20.7 2.8 0.2 100.0 472 Coast 58.1 17.8 1.7 18.9 3.2 0.4 100.0 142 Lindi 51.0 25.1 2.7 18.5 2.8 0.0 100.0 205 Mtwara 59.4 21.7 2.4 14.8 1.7 0.0 100.0 335 Ruvuma 47.4 28.6 3.2 18.9 1.9 0.0 100.0 288 lringa 40.7 31.7 7.0 15.8 4.4 0.4 100.0 429 Mbeya 62.3 15.8 1.2 16.6 4.0 0.0 100.0 388 Singida 52.4 18.2 2.2 22.5 4.1 0.6 100.0 291 Tabora 60.3 16.0 1.7 20.1 1.9 0.0 100.0 247 Rukwa 60.0 20.8 1.0 16.8 1.4 0.0 100.0 196 Kigoma 65.0 10.3 2.2 18.2 4.3 0.0 100.0 289 Shinyanga 71,9 10.3 0.0 16.6 1.2 0.0 100.0 685 Kagera 67.2 8.3 1,4 17,2 5.7 0.2 100.0 480 Mwanza 74.8 9.0 0,6 14.2 1.5 0.0 100.0 596 Mara 66.4 10.9 0.9 17.7 3.5 0.5 100.0 356 Education No education 62.7 14.0 1.7 17.0 4.3 0.2 100.0 2991 Primary incomplete 63.6 13.8 2.4 16.6 3.6 0.1 100.0 1499 Completed primary 58.7 19.5 2.1 17.8 1.7 0.1 100.0 3209 Secondary/l ligher 55.1 10.5 1.0 30.6 2.8 0.0 100.0 278 Current contraceptive No method 59.5 17.4 2.1 17.6 3.2 0.1 100.0 7106 Pill 80.1 1.4 0.4 17.4 0.0 0.6 100.0 279 IUD (76.3) (0.0) (0.0) (23.7) (0.0) 0.0 100.0 31 Sterilisatlon 59.3 7.5 1.2 20.7 11.2 0.0 100.0 134 Periodic abstinence 63.1 7.4 1.3 26.2 2.0 0.0 100.0 152 Other 77.7 7.6 1.0 13.7 0.0 0.0 100.0 275 Total 61.0 16.1 2.0 17.7 3.1 0.1 100.0 7978 Note: Rates shown in paxenthese are based on 25-19 women. 58 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility For women who are not using contraception, exposure to the risk of pregnancy in the period following birth is influenced by two factors, namely breastfeeding and sexual abstinence. Breastfeeding can prolong postpartum protection from conception by lengthening the duration of amenorthoea (the period following a birth, but prior to return of menses) and by delaying the resumption of sexual relations. Table 5.9 shows the percentage of births whose mothers are postpartum amenorrhoeic, abstaining, and postpartum insusceptible by the number of months since birth. Women who are insusceptible are defined as those who are either amenorrhoeic or abstaining following a birth and, thus, are not exposed to the risk of pregnancy. The data refer to whether or not the woman was amenorrhoeic or abstaining at the time of the survey. Table 5.9 Postpartum amcnorrhoea) abstinenc% and insuscepfibflit), Percentage of births whose mothers are postp~tum amenorrhoeie, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Tanzania 1991/92 Number Months Amanor- Insus- of since birth rhoeie Abstaining ceptible births < 2 97.0 91.8 100.0 242 2-3 85.5 72.1 91.6 283 4-5 86.1 53.4 90.8 337 6-7 68.0 49.3 80.3 289 8-9 71.4 46.6 80.3 276 10-11 61.4 30.6 69.4 287 12-13 54.2 30.5 61.1 306 14-15 45.4 28.4 55.7 296 16-17 33.6 24.0 46.6 304 18-19 26.8 24.5 36.9 291 20-21 21.9 18.8 31.3 252 22-23 15.9 15.9 24.6 299 24-25 9.7 12.8 21.4 268 26-27 5.4 7.9 11.5 256 28-29 1.6 4.3 5.9 292 30-31 4.1 5.3 9.5 266 32-33 3.9 2.4 5.5 279 34-35 2.5 3.8 5.5 230 Total 39.4 29.3 46.9 Median 13.3 6.5 15.6 Mean 14.2 10.7 16.8 Prevalence/Incidence mean 14.0 10.4 16.7 5051 About 8-9 months after giving birth, 71 percent of women in Tanzania remain amenorrhoeic, 47 percent are abstaining from sexual relations, and only 20 percent are susceptible to pregnancy. At 18-19 months postpartum, 27 percent remain amenorrhoeic, 25 percent are still abstaining and 63 percent are susceptible to pregnancy. At 24 months, only 10 percent are amenorrhoeic and 13 percent are still abstaining 59 from sexual relations, while 79 percent are susceptible to pregnancy. The median duration of postpartum amenorrhoea is 13.3 months and of postpartum sexual abstinence 6.5 months, resulting in a postpartum insusceptible period of 15.6 months. Table 5.10 shows the median durations of postpartum insusceptibility by background characteristics of the mothers. Older women have longer periods of insusceptibility mainly because they are amenorrhoeic for a longer period. Women in Dar-es-Salaam have very short periods of postpartum amenorrhoea (median 6 months), whereas women in Zanzibar practice postpartum abstinence only for a short period (3 months). Differences by education are small, except that women with more education have short durations of amenorrhoea. Table 5.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Tanz~mia 1991/92 Postpartum Number Background Postpartum Postpartum insuseep- of characteristic amenorrhoea abstinence tibility women Age <30 12,3 6.2 14.5 3271 30+ 15.4 7.1 17.3 1780 Residence Mainland 13.4 6.8 15.8 4906 Dares Salaam 6.1 7.1 9.5 226 Other urban 10.9 9.8 13.2 843 Rural 14.2 6.1 16.1 3837 Zanzibar 11.1 3.2 11.6 146 Education No education 14.3 5.9 17.5 1693 Primary incomplete 15.1 4.7 16.2 932 Completed primary 12.2 7.4 14.5 2271 Secondary/Higher 6.6 7.2 11.0 156 Total 13.3 6.5 15.6 5051 Note: Medians are based on current status. 5.7 Termination of Exposure to Pregnancy The onset of infertility with increasing age reduces the proportion of women who are exposed to the risk of pregnancy. Three measures of decreasing exposure--menopause, terminal infertility, and long-term abstinence--are shown in Table 5.11. For this analysis women are considered to be menopausal if they are neither pregnant nor postpartum amenorrhoeic, but have not had a menstrual period in the six months preceding the survey. The proportion of women who are menopausal rises with age, particularly after age 40, and reaches 38 percent in the oldest age group (48-49). 60 Table 5.11 Termination of exposure to the risk of pregnancy Indicators of menopause, terminal infertility and long-term abst'mence among currently married women age 30-49, by age, Tanzania 1991/92 Long-term Menopause I abstinence 2 Age Percent Number Percent Number 30-34 2.0 548 0.9 935 35-39 5.8 529 0.9 841 40-41 9.2 224 1.3 308 42-43 15.6 179 2.6 224 44-45 24.4 199 5.1 235 46-47 28.7 171 4.2 191 48-49 38.1 173 4.2 189 Total 12.6 2024 1.8 2923 tPercentage of non-pregnant, non-arnenorrhoeic currently married women whose last menstrual period occurred six or more months preceding the survey or who report that they are menopausal. 2Percentage of eta'rently married women who did not have intercourse in the three years preceding the survey. The second indicator ofinfecundity is obtained from a demonstrated lack of fertility. I f a woman was married at least five years before the survey, has never used contraception, did not give birth in the five years before the survey, and is not currently pregnant, she is considered terminally infertile. By their mid-fourties, almost 60 percent appear to be terminally infertile and by their late fourties, three quarters are infertile. The last indicator is long-term abstinence, which is the percentage of currently married women who did not have sexual intercourse in the three years preceding the survey. This percentage is quite low even among older women (about 4-5 percent). 61 CHAPTER 6 FERTILITY PREFERENCES In the TDHS several questions were asked to all women in order to determine their fertility preferences: their desire to have a(nother) child; i f so, how long they would prefer to wait before the next child; and i f they could start afresh, how many children they would want. The responses obtained from these questions provided information that was used to classify women by their preferences according to age as well as other background characteristics. 6.1 Des i re fo r More Ch i ld ren In Tanzania, where contraceptive prevalence is still low and where cultural as well as husbands' influences on reproductive decisions are still strong, the desire for children is widespread. Table 6.1 and Figure 6.1 show the percent distribution of currently married women by their fertility preferences. One- quarter of currently married women indicated that they wanted another child soon, 42 percent wanted another child later, and 23 percent wanted no more children (including 2 percent who have been sterilised). The proportion of currently married women who want another child soon decreases rapidly with the increasing numberof l iv ing children. For example, 35 percent of currently married women with one l iving child wanted another child soon compared to only 8 percent of women with 6 children or more. A similar pattern can be observed with the proportion of women who wanted another child later, at least among women with 2 or more children. However, the proportion of currently married women who wanted no more children increased with the increasing number of l iving children. More than half of women with at least six children did not want any more children. Table 6.1 Fertility preference by number of living children Percent distribution of currently married women by desire for more children, according to number of living children, Tanzania 1991/92 Number of living children 1 Desire for children 0 1 2 3 4 5 6+ Total Have another soon 2 79.9 34.5 25.1 22.9 22.0 18.5 8.4 26.1 Have another later 3 5.1 57.7 59.5 57.6 45.1 34.8 18.6 41.7 Have another, undecided when 3.3 1.8 0.9 1.0 1.2 1.2 0.7 1.3 Undecided 0.7 0.5 1.7 2.7 2.7 4.8 5.3 2.8 Wants no more 1.2 1.7 8.2 11.1 23.5 33.3 55.5 21.4 Sterilised 0.6 1.1 0.3 0.9 1.7 1.7 4.1 1.7 Declared infecund 8.6 2.5 3.8 3.4 3.6 5.3 7.3 4.8 Missing 0.7 0.1 0.4 0.5 0.3 0.4 0.2 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 472 1031 1014 890 738 598 1294 6038 1Includes current pregnancy 2Wents next birth within 2 years 3Wants to delay next birth for 2 or more years 63 Figure 6.1 Fertility Preferences among Currently Married Women 15-49 Want Child Later 42% (>2 years) Child Soon 26% '<2 years) Infecund 5% Undecided 4% 40 More 23% (Includes sterilisstion) TDHS 1991/92 The percent distribution of currently married women by desire for children according to age is shown in Table 6.2. Older women are much more likely than younger women to want no more children. The desire to l imit births increases rapidly with age. Only 2 percent of currently married women 15-19 years want no more children, but the proportion increases to 49 percent for women 40-44. Table 6.2 Fertility preferences by age Percent distiibudon of currently married women by desire for more children, according to age, Tanzania 1991/92 Desire for Age of woman children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon I 36.8 26.1 28.4 27.0 24.7 22.5 14.1 26.1 Have another later 2 58.1 64.9 55.1 41.9 23.4 8.7 3.4 41.7 Have another, undecided when 2.0 1.3 1.2 1.2 1.1 1.1 1.5 1.3 Undecided 0.6 1.3 2.4 3.7 5.9 3.5 2.2 2.8 Wmats no more 2.1 5.3 12.2 22.6 36.2 48.9 45.8 21.4 Sterilised 0.0 0.3 0.3 1.2 3.9 4.9 3.6 1.7 Declared infectmd 0.3 0.6 0.3 2.4 4.1 10.3 28.8 4.8 Missing 0.2 0.3 0.3 0.2 0.7 0.1 0.6 0.3 Total 100.0 100,0 100.0 100.0 100.0 100.0 100.0 100.0 Number 558 1283 1274 935 841 603 545 6038 IWmats next birth within 2 years 2Wants to delay next birth for 2 or more years 64 The desire to have no more children varies by background characteristics of the women. Table 6.3 shows that there is only limited variation by urbalVroral residence or between Zanzibar and Mainland Tanzania. However, there is considerable regionalvariation. InKilimanjaro almosthalfofcurrentlymarried women did not want another child (47 percent). Singida and Arusha follow with almost one-third of women wanting no more children. In eight regions, less than 20 percent of currently married women wanted no more children, including Shinyanga as the lowest with 14 percent. At the regional level, there was no clear relationship between percent wanting no more children and respondent's level of education. Table 6.3 Desire to limit childbearing Percentage of currently married women who want no more children, by nttmber of living children and selected background characteristics, Tanzania 1991/92 Number of living children I Background characteristic 0 1 2 3 4 5 6+ Total Residence Mainland 1.6 2.8 8.5 12.0 25.5 34.9 59.8 23.1 Dares Salaam (0.0) 7.3 26.0 (20.3) (47.6) * (72.0) 27.9 Other urban 3.4 1.7 18.5 11.8 37.4 41.2 73.2 27.3 Rural 1.6 2.7 5.3 11.4 21.3 33.0 56.9 21.9 Zanzibar (5.8) 2.6 8.1 (12.3) 15.7 (34.8) 53.6 22.1 Education No education 1.0 3.3 6.1 12.9 22.3 30.9 52.6 26.6 Primary incomplete 4.7 5.2 3.4 13.5 27.7 44.6 71.6 33.6 Completed primary 1.3 2.1 10.0 10.1 26.4 33.0 67.6 13.6 Secondary/Higher * (0.9) 24.2 (20.9) * * * 23.6 Total 1.7 2.8 8.5 12.0 25.2 34.9 59.6 23.1 Note: Women who have been sterilised are considered to want no more children. Rates shown in parentheses arc based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. llnchides current pregnancy 6.2 Demand for Fami ly P lanning Services Women who are currently married, and who indicate that they either want no more children or want to wait for two or more years before having another child, but are not using contraception, are considered to have an unmet need for family planning. Women with unmet need and those currently using contraception (met need) constitute the total demand for family planning. Table 6.4 shows the percentage of currently married women with unmet need and met need and the total demand for family planning services by background characteristics. Forty-one percent of currently married women can be considered to constitute total demand for family planning, of which 24 percent is a demand for spacing purposes and 17 percent is a demand for limiting purposes. The demand for family planning services appears to be highest among currently married women living in urban areas (Dar-es-Salaam or other urban areas, about 50 percent), among women with secondary or higher education (62 percent, mostly more demand for spacing) and in selected regions. In Kilimanjaro, Arusha, and Morogoro, the total demand exceeds 50 percent. 65 Table 6.4 Need for family planning seawiees Percentage of currently mamed women with unmet need f~ family planning, met need for fanfily planning, and the total demand for farnily planning services, by selected background characteristics, Tanzania 1991/92 Met need for Unrnet need for family planning Total demand for Percentage fan~y planning I (currently using) 2 family planning of demand Number For For For For For For saris- of spacing limiting Total spacing limiting Total spacing limiting Total fled women Background charactefisfc Age 15-19 17.5 3.0 20-24 24.8 3.1 25-29 25.4 6.5 30-34 21.9 10.4 35-39 11.3 20.8 40-44 5.9 27.8 45-49 2.5 27.6 Residence Mainland 17.7 12.1 Dares Salaam 19.9 13.8 Other urban 18.6 14.8 Rural 17.4 11.4 Zanzibar 27.2 10.9 Region Dodoma 20.9 9.6 Arusha 21.7 Kilimanjaro 17.5 Tanga 21.4 Morogoro 24.6 Coast 17.8 Lindi 17.6 Mtwara 14.7 Ruvuma 20.7 Idnga 15.4 Mbeya 20.9 Singida 15.9 Tabora 12.4 Rukwa 20.9 Kigoma 15.2 Shinyanga 14.0 Kagera 12.3 Mwanza 16.0 Mara 15.5 Education No education 14.6 Primary incomplete 14.5 Completed primary 24.0 Secondary/Higher 14.3 Total 18.0 20.5 5.2 0.0 5.2 22.8 3.0 25.8 20.3 558 27.8 9.1 0.9 10.0 33.9 3.9 37.8 26.3 1283 31.9 8.3 1.6 9.9 33.7 8.1 41.8 23.8 1274 32.2 7.9 6.0 13.8 29.7 16.3 46.0 30.0 935 32.1 3.2 10.1 13.3 14.5 30.9 45.4 29.3 841 33.7 0.8 10.1 10.9 6.7 37.9 44.6 24.5 603 30.1 0.1 7.0 7.1 2.6 34.6 37.2 19.0 545 29.8 6.0 4.5 10.5 23.7 16.6 40.4 26.1 5870 33.7 7.3 8.5 15.7 27.2 22.3 49.5 31.8 349 33.4 11.0 7.7 18.7 29.6 22.5 52.1 36.0 966 28.8 4.8 3.5 8.4 22.2 14.9 37.2 22.5 4555 38.1 3.1 4.0 7.1 30.3 14.9 45.2 15.7 168 30.5 4.5 5.1 9.6 25.4 14.7 40.1 24.0 445 13.3 35.0 11.9 5.5 17.3 33.6 18.8 52.3 33.1 350 19.8 37.3 15.0 18.1 33.1 32.5 37.8 70.3 47.0 258 12.0 33.4 10.3 5.5 15.8 31.7 17.6 49.2 32.1 306 15.4 40.1 6.7 3.9 10.6 31.3 19.3 50.6 20.9 334 9.9 27.7 9.3 4.3 13.6 27.1 14.2 41.3 33.0 98 13.3 30.9 6.0 5.6 11.5 23.6 18.9 42.5 27.1 155 12.6 27.4 1.6 0.7 2.3 16.4 13.4 29.7 7.9 249 10.8 31.6 2.3 5.6 7.8 23.0 16.4 39.4 19.8 210 9.2 24.6 8.2 2.9 11.1 23.6 12.1 35.7 31.1 338 11.0 31.9 9.0 3.1 12.1 29.9 14.1 44.0 27.6 333 14.4 30.3 7.9 6.1 14.0 23.8 20.5 44.4 31.7 190 17.1 29.5 4.0 5.0 9.0 16.4 22.1 38.5 23.4 174 11.0 31.9 3.3 2.3 5.6 24.2 13.3 37.5 14.9 158 9.1 24.3 3.8 1.1 4.9 19.0 10.2 29.2 16.7 245 10.9 24.9 3.6 0.7 4.2 17.6 11.6 29.2 14.6 578 10.8 23.1 2.9 5.5 8.4 15.2 16.3 31.5 26.5 371 11.2 27.1 1.8 2.2 4.0 17.7 13.4 31.1 12.8 444 11.0 26.5 4.3 3.6 7.9 19.8 14.6 34.4 22.9 285' 15.0 29.6 1.3 2.4 3.7 15.9 17.4 33.3 I1.1 2505 17.9 32.4 5.1 7.8 12.9 19.6 25.7 45.2 28.5 1166 6.1 30.1 10.0 4.5 14.6 34.0 10.6 44.6 32.6 2215 5.2 19.5 28.6 13.8 42.4 42.9 19.0 62.0 68.5 152 12.1 30.1 5.9 4.5 10.4 23.9 16.6 40.5 25.7 6038 tUnmet need for spacing includes pregnant women whose pregnancy was mistimed, amenocthoeic women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and say they want to wait 2 or more yeats for their next birth.Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsme when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, an~enorrhoeic women whose last child w~ unwanted and women who axe neither pregnant nor amenorrhoeio and who are not using any method of family planning and who want no more children. 2Using for spacing is defined as women who ale using sorr~ method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who axe using and who want no more children. Note that the specific methods used are not taken into account here. 66 The need for family p la~ing is not fulfilled for the majority of t-he women. About one quarter of the total demand is satisfied: 30 percent of married women have an unmet need for family planning services. The lowest proportions of demand satisfied can be observed among women under 20 years and 45-49 years, among women in Zanzibar (16 percent of the demand satisfied), and among women with no education. The highest proportion of demand satisfied occurs among women with secondary or higher education (69 percent) and in Kilimanjam region (47 percent). It appears that educated women are much more successful than other women in meeting their family planning needs. 6.3 Ideal and Actual Number of Children In addition to the actual number of children that women have, the TDHS examined the ideal number of children that women desired. The question required the respondent to consider abstractly and independently of her family size and give the number of children she would like to have if she could start all over again. Table 6.5 shows the percent distribution of all women by ideal number of children and mean ideal number of children for all women and currently married women, according to the number of living children. About 14 percent of women gave a non-numeric response, such as "up to God" or "as many as possible." Table 6.5 Ideal number of children Percent distribution of all women by ideal number of children and mean ideal number of children for all women and for currently married women, according to number of living children, Tanzania 1991/92 Number of living children t Ideal number of children 0 1 2 3 4 5 6+ Total 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1 0.4 0.3 0.1 0.1 0.0 0.3 0.1 0.2 2 4.5 3.0 3.3 1.0 0.6 0.8 0.9 2.5 3 7.7 10,6 6.6 4.5 2.2 1.6 1.2 5.7 4 24.9 27,4 20.1 18.3 13.8 6.9 11.6 19.4 5 16.2 16.9 19.2 12.8 12.5 14.6 6.1 14.3 6+ 31.8 34,1 40.5 50.2 57.4 58.8 59.7 44.3 Non-numeric response 14.6 7.8 10.2 13.1 13.4 17.1 20.3 13.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2345 1545 1275 1043 870 694 1466 9238 Mean ideal number 5.4 5.4 5.8 6.1 6.5 7.1 7.4 6.1 Number of women 2002 1425 1145 907 753 575 1168 7976 Mean for women in union 5.8 5.6 5.9 6.2 6.6 7.2 7.4 6.4 Number of women in union 403 935 901 775 639 496 1032 5181 Note: The means exclude women who gave non-numeric responses. llncindes current pregnancy The mean ideal family size among all women was 6.1 children and among currently married women 6.4 children. There is a correlation between the actual and ideal family size. The mean ideal number of children increases from 5.4 among childless women to 7.4 among women with 6 or more living children. 67 The reason for this is twofold. First, to the extent that women implement their preferences, those who want larger families will tend to achieve larger families. Secondly, women may adjust their ideal family size upwards as the actual number increases. Forty-four percent of all women want at least six children, 59 percent at least five, and 78 percent at least four. Only 8 percent of respondents considered three children or fewer an ideal family size. This proportion is slightly higher among women with none or one child: 13 percent of women with no child or with one child wanted three children or less. Despite the pronatalist attitudes of most women, there is some evidence of unwanted fertility; 10 percent of women with 5 children and 20 percent of those with 6 or more children reported ideal numbers of children that were less than the actual number of children they have. Table 6.6 presents the mean ideal number of children for all women by age and selected background characteristics. Women with secondary or higher education and women in Kilimanjaro region wanted fewer than five children (means of 4.2 and 4.3, respectively). Women with no education have the largest mean ideal number of children (7.3). Women in Zanzibar want more children on average (6.8) than women on mainland Tanzania (6.0). Table 6.6 Mean ideal number of children by background characteristics Mean ideal number of children for all women, by age and selected background characteristics, Tanzania 1991/92 Age of woman Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Mainland 5.5 5.4 5.8 6.4 7.0 7.2 7.5 6.0 Dares Salaam 4.5 4.6 5.3 5.6 (6.1) (7.2) * 5.2 Other urban 4.8 4.6 5.2 5.9 6.7 6.1 7.2 5.4 Rural 5.8 5.7 5.9 6.6 7.1 7.5 7.6 6.3 Zanzibar 6.0 5.9 7.2 7.7 (6.9) (7.6) (9.4) 6.8 Region Dodoma 5.7 5.1 6.1 (6.7) (8.3) (7.1) (7.3) 6.3 Arusha 4.9 4.8 5.2 (5.6) (6.6) (6.0) (6.9) 5.4 Kilimanj aro 3.8 4.0 4.1 (4.8) 4.8 (5.6) (4.4) 4.3 Tanga 4.8 4.8 5.6 6.3 (5.8) (6.3) (6,3) 5.5 Morogoro 5,4 5.8 5.8 6.4 8.1 (8.6) (8.1) 6.5 Coast 5.2 5.6 (6.6) (7.3) (8.1) (9.2) (9,9) 6.8 Lindi 4.9 5.5 5.4 (5.7) (7.0) (7.2) (7,8) 6.0 Mtwara 4.9 5.7 5.1 (6.6) (6.7) (7.0) (7,6) 6.0 Ruvurna 4.8 4.9 5.9 6.3 6.7 (6.4) (6,6) 5.7 Iringa (5.0) 4.6 4.8 6.0 6.4 * (8,2) 5.5 Mbe:ca 5.5 5.1 5.3 (6.2) (7.4) * * 5.8 Sing~da 5.7 5.6 6.2 (6.6) (6.6) (7,7) (8.9) 6.4 Tabora 6.5 6.4 5.6 6.2 (7.4) 7.4 (7,6) 6.6 Rukwa 5.8 5.6 6.5 6.6 6.7 (8.4) (6,3) 6,3 Ki~oma 6.2 6.4 7.0 7.0 8.3 (8.0) (9,5) 6.9 Shmyanga 6.5 6.5 6.7 6.8 7.9 (7.9) (9,0) 6.9 Kagera 5.9 6.0 5.9 6.5 6.9 (8.1) (7,9) 6.3 Mwanza 6.4 6.1 6.8 7.1 (7.4) (7.4) (7,9) 6.7 Mara 5.7 5.9 6.0 7.0 7.3 7.1 (8,3) 6.4 Education No education 6.3 6.6 6.9 7.0 7.7 7.8 8,0 7.3 Primary incomplete 5.7 6.3 5.9 6.6 6.9 6.7 6.4 6.3 Completed primary 5.4 5.1 5.4 5.7 5.2 6.3 5.5 5.3 Secondary/Higher 4.3 4.2 3.8 4.7 * * * 4.2 Total 5.5 5.4 5.8 6.4 7.0 7.2 7.5 6.1 Note: Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. 68 6.4 Fertility Planning In the TDHS, women were asked questions for each child born in the preceding five years and any pregnancy to determine whether the pregnancy was planned (wanted then), wanted but at a later time, or unwanted (wanted no more). The answers indicate the degree to which couples are successfully controlling fertility. However, it must be noted that these questions required the respondent to accurately recall her wishes at one or more points in the last five years and to report them honestly. Here, the danger of rationalization is present since an unwanted conception may become a cherished child. Therefore, the values presented here are likely to be underestimates of the proportion of couples successfully controlling their fertility. Table 6.7 shows the percent distribution of births in the five years preceding the survey by planned fertility status, according to birth order and mother's age at birth. Three-quarters of births in the last five years were wanted at the time they were conceived, 15 percent were wanted later, and 8 percent were not wanted at all. These proportions vary according to birth order. Eleven percent of the fourth or higher order births were not wanted, 18 percent were wanted at a later time, and 70 percent were wanted at that time. The proportion of births that were not wanted at all generally increases with age of the mother. On the other hand, the older the women, the lower the proportion of births that were wanted at the time they were conceived. The proportion of births wanted later is low at the youngest age group, reaches a peak among age 25-29, and then decreases. Table 6.7 Fertility planning status Percent distxibution of births in the five years preceding the survey by fertility planning status, according to birth order and mother's age, Tanzania 1991D2 Planning status of birth 1 Birth order Wanted Number and mother's Wanted Wanted no of age then later more Missing Total bkths Birth order 1 84,2 6.4 8.4 0.9 100.0 2005 2 78,4 17.1 4.1 0.5 100,0 1669 3 76,3 18,2 4.1 1.4 100.0 1284 4+ 69.7 17.9 10.8 1.6 100.0 4106 Age at birth <19 80.4 9.9 8.9 0.9 100.0 1627 20-24 78,4 16.1 4,7 0.8 100.0 2656 25-29 73.2 20.1 5.5 1.3 100.0 2148 30-34 73.5 16.7 7.9 1.9 100.0 1299 35-39 71.6 12.2 14,4 1.7 100,0 874 40-44 65.2 8,5 24.9 1.4 100.0 381 45-49 60.0 7.8 26.8 5,4 100.0 79 Total 75.5 15.2 8.1 1.2 100.0 9065 llncludes current pregnancy. 69 The potential demographic impact of avoiding unwanted births can be estimated by calculating the wanted fertility rate. This calculation proceeds in the same way as the total fertility rate, but the unwanted births are excluded from the numerator. In this context unwanted births are defined as births that exceed the number considered ideal by the respondent. The rate that is obtained from these calculations represents the level of fertility that woul~d have prevailed during the three years preceding the survey if all unwanted births were prevented. Comparison of actual rates with wanted rates indicates the potential demographic impact of the elimination of unwanted births. Table 6.8 shows the wanted total fertility rate and the actual total fertility rate for the three years preceding the survey by selected background characteristics. Overall, the wanted total fertility rate is 11 percent lower than the actual total fertility rate. Thus, if the unwanted births were eliminated, the total fertility rate in Tanzania would be 5.6 children born per woman. The differences between actual and wanted fertility rates are fairly similar by urban/rural residence and level of education (less than 1 child). The one exception is among women in the northern highlands, where the wanted total fertility rate (4.6) is more than one child less than the actual total fertility rate (6.0). However, in general, even if women in Tanzania were to control their childbearing, fertility rates would remain high, either because women still prefer large families or they are not familiar with the idea of conscious reproductive choice. Hence, the demographic impact of family planning can be increased by promoting a desire for smaller families. Table 6.8 Wanted fe~lity rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Tanzania 1991/92 Total wanted Total Background fertility fertility characteristic rate rate Residence Mainland 5.57 6.24 Dares Salaam 3.72 4.04 Other urban 4.77 5.56 Rural 5.91 6.58 Zanzibar 5.73 6.38 Zone Coastal 5.06 5.66 Northern Highlands 4.63 6.01 Lake 6.18 6.88 Central 6.65 7.06 Southern Highlands 5.81 6.25 South 4.55 5.11 Education No education 5.93 6.50 Primary incomplete 5.47 6.44 Completed primary 5.32 5.99 Secondary/Higher 3.69 4.22 Total 5.57 6.25 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 3.2. 70 CHAPTER 7 INFANT AND CHILD MORTALITY Including an estimation of infant and child mortality rates in the demographic assessment of Tanzania is important because mortality levels in children below the age of five may have profound impact on a number of demographic parameters. Childhood mortality data are also useful in assessing the impact of child survival programmes and identifying child populations that are at high risk. Mortality estimates were calculated from information collected in the birth history section of the individual questionnaire. The section began with questions about the overall childbearing experience of respondents (i.e., the number of sons and daughters who live in the household, those who live elsewhere, and those who have died). These questions were followed by a retrospective bi~h history in which data were obtained on sex, date of birth, survivorship status, and current age or age at death of each of the respondents' live births. The rates presented in this chapter are defined as follows: Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the difference between infant and neonatal mortality Infant mortality: the probability of dying before the first birth

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