Tanzania - Demographic and Health Survey - 2000

Publication date: 2000

Tanzania 1999Reproductive and ChildHealth Survey National Bureau of Statistics MEASURE DHS+ Macro International Inc. Tanzania Reproductive and Child Health Survey 1999 National Bureau of Statistics Dar es Salaam, Tanzania Macro International Inc. Calverton, Maryland, U.S.A. November 2000 National Bureau of Statistics United Nations Children’s Fund U.S. Agency for United Nations Population Fund International Development This report presents results from the 1999 Tanzania Reproductive and Child Health Survey (TRCHS) which was undertaken by the National Bureau of Statistics in collaboration with the Reproductive and Child Health Section of the Ministry of Health. Financial assistance for the survey was provided by the U.S. Agency for International Development (USAID/Tanzania), UNICEF/Tanzania, and the United Nations Population Fund (UNFPA/Tanzania). The TRCHS is part of the worldwide MEASURE Demographic and Health Surveys (DHS+) project which is designed to collect, analyse and disseminate data on fertility, family planning, maternal and child health, and HIV/AIDS. Additional information about the TRCHS may be obtained free of charge from the National Bureau of Statistics, P.O. Box 796, Dar es Salaam (telephone: 135-602; fax: 135-601). Information about the MEASURE DHS+ project may be obtained from Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999). Suggested citation: National Bureau of Statistics [Tanzania] and Macro International Inc. 2000. Tanzania Reproductive and Child Health Survey 1999. Calverton, Maryland: National Bureau of Statistics and Macro International Inc. Contents * iii CONTENTS Page Tables and Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Map of Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Geography, History, and the Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Demographic Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . 2 1.4 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . 9 2.1 Population by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3 Fosterhood and Orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.4 Education Level of Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.5 School Attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.6 Child Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.7 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.8 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.9 Educational Level of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.10 Access to Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.11 Employment and Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 CHAPTER 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.2 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 3.3 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.4 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.5 Births Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.6 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 3.7 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 iv * Contents Page CHAPTER 4 FERTILITY REGULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.1 Knowledge of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 Trends in Contraceptive Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.3 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.4 Current Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.5 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.6 Contact of Nonusers with Family Planning Providers . . . . . . . . . . . . . . . . . . . . 52 4.7 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . 54 4.8 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.9 Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.10 Exposure to Reproductive and Child Health Dramas . . . . . . . . . . . . . . . . . . . . . 56 4.11 Knowledge of Family Planning Logo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.12 Knowledge of Salama Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.13 Attitudes towards Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . 65 5.1 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.2 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.3 Age at First Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 5.4 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5.5 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . 73 5.6 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 CHAPTER 6 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.1 Reproductive Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.2 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 6.3 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 6.4 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 CHAPTER 7 INFANT AND CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 7.1 Definitions, Methodology, and Assessment of Data Quality . . . . . . . . . . . . . . . . 85 7.2 Childhood Mortality Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 7.3 Childhood Mortality Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 7.4 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Contents * v Page CHAPTER 8 REPRODUCTIVE AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.2 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 8.3 Postnatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 8.4 Birth Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 8.5 Childhood Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 8.6 Acute Respiratory Infection and Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 8.7 Use of Bednets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 8.8 Prevalence and Treatment of Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 8.9 Knowledge of Signs of Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 CHAPTER 9 INFANT FEEDING AND CHILDHOOD NUTRITION . . . . . . . . . . . . . . . . . 115 9.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 9.2 Nutritional Status in Early Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 9.3 Vitamin A Supplementation among Children . . . . . . . . . . . . . . . . . . . . . . . . . . 123 CHAPTER 10 KNOWLEDGE OF AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.2 Knowledge of AIDS Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.3 Perceptions of Personal Risk of Getting AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . 128 10.4 Knowledge and Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 10.5 Acceptability of Condom Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 10.6 Number of Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 10.7 AIDS Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 10.8 Knowledge of Condom’s Dual Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 APPENDIX A SAMPLE IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 APPENDIX B ESTIMATES OF SAMPLING ERROR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 APPENDIX D 1999 TRCHS HOUSEHOLD SURVEY STAFF . . . . . . . . . . . . . . . . . . . . . . 171 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Tables and Figures * vii TABLE AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Table 1.2 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table 2.1 Household population by age, residence, and sex . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.2 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.4 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2.5.1 Educational level of the female household population . . . . . . . . . . . . . . . . . . 13 Table 2.5.2 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . 14 Table 2.6 Early childhood education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.7 School attendance ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table 2.8 Child labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.9 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 2.10 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.11 Iodised salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.12 Background characteristics of children under five . . . . . . . . . . . . . . . . . . . . . 21 Table 2.13 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.14.1 Level of education: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.14.2 Level of education: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.15 Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 2.16 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 2.17 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 2.18 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 2.19.1 Occupation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 2.19.2 Occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Figure 2.1 Population pyramid, Tanzania 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Figure 2.2 Level of education for women and men, Tanzania 1999 . . . . . . . . . . . . . . . . 15 Figure 2.3 Percentage of children age 7-13 attending primary school, by sex and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 CHAPTER 3 FERTILITY Table 3.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 3.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 3.3 Trends in fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 3.4 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 viii * Tables and Figures Page Table 3.5 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 3.6 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 3.7 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 3.8 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . 38 Table 3.9 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Figure 3.1 Age-specific fertility rates by urban-rural residence . . . . . . . . . . . . . . . . . . . . 32 Figure 3.2 Total fertility rates by background characteristics . . . . . . . . . . . . . . . . . . . . . 33 Figure 3.3 Pregnancy and childbearing among women age 15-19 . . . . . . . . . . . . . . . . . 39 CHAPTER 4 FERTILITY REGULATION Table 4.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 4.2 Couples’ knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 4.3.1 Ever use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.3.2 Ever use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 4.4.1 Current use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 4.4.2 Current use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 4.5.1 Current use of contraception by background characteristics: women . . . . . . 49 Table 4.5.2 Current use of contraception by background characteristics: men . . . . . . . . 51 Table 4.6 Source of supply for contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.7 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . 54 Table 4.8 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 4.9 Reasons for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . . 56 Table 4.10.1 Heard family planning message: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table 4.10.2 Heard family planning message: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 4.11 Exposure to family planning dramas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 4.12.1 Green Star logo family planning symbol: women . . . . . . . . . . . . . . . . . . . . . . 60 Table 4.12.2 Green Star logo family planning symbol: men . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 4.13 Knowledge of Salama condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 4.14 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 4.15 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 4.16 Spouse’s perception of their spouse’s approval of family planning . . . . . . . . . 64 Figure 4.1 Trends in contraceptive knowledge among women age 15-49, 1991-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Figure 4.2 Contraceptive use among all women age 15-49 by residence and education . . . . . . . . . . . . . . . . . . . . . . . . 50 Figure 4.3 Trends in contraceptive use among all women age 15-49, 1991-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Tables and Figures * ix Page CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY Table 5.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5.2 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 5.3 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 5.4 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 5.5 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 5.6.1 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 5.6.2 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 5.7 Postpartum amenorrhoea, abstinence, and insusceptibility . . . . . . . . . . . . . . 73 Table 5.8 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table 5.9 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 CHAPTER 6 FERTILITY PREFERENCES Table 6.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . 75 Table 6.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 6.3 Desire to stop childbearing by background characteristics . . . . . . . . . . . . . . . 78 Table 6.4 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 6.5 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 6.6 Mean ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 6.7 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 6.8 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Figure 6.1 Fertility preferences of women age 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Figure 6.2 Desire to stop childbearing among women age 15-49, by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Figure 6.3 Trends in mean ideal family size among women and men, 1991-1999 . . . . . 82 CHAPTER 7 INFANT AND CHILD MORTALITY Table 7.1 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 7.2 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . 87 Table 7.3 Infant and child mortality by biodemographic characteristics . . . . . . . . . . . . 89 Table 7.4 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Figure 7.1 Under-five mortality by selected background characteristics . . . . . . . . . . . . . 88 CHAPTER 8 REPRODUCTIVE AND CHILD HEALTH Table 8.1 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 8.2 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . 95 Table 8.3 Antenatal care content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 x * Tables and Figures Page Table 8.4 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table 8.5 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 8.6 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 8.7 Delivery characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Table 8.8 Postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Table 8.9 Postpartum vitamin A supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Table 8.10 Birth registration coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 8.11 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table 8.12 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 107 Table 8.13 Prevalence and treatment of acute respiratory infection and prevalence of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table 8.14 Use of bednets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table 8.15 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table 8.16 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Table 8.17 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 8.18 Knowledge of health complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 8.19 Knowledge of pregnancy complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Figure 8.1 Antenatal and delivery care indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Figure 8.2 Percentage of children age 12-23 months with specific vaccinations according to vaccination cards and mothers’ reports . . . . . . . . . . . . . . . . . . 106 CHAPTER 9 INFANT FEEDING AND CHILDHOOD NUTRITION Table 9.1 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 9.2 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . 117 Table 9.3 Infant feeding indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Table 9.4 Ideal duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Table 9.5 Nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Table 9.6 Trends in nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table 9.7 Vitamin A supplementation among children . . . . . . . . . . . . . . . . . . . . . . . . . 124 CHAPTER 10 KNOWLEDGE OF AIDS Table 10.1 Knowledge of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Table 10.2.1 Knowledge of specific ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . 127 Table 10.2.2 Knowledge of specific ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . 128 Table 10.3 Knowledge (prompted) of the main ways to avoid HIV/AIDS . . . . . . . . . . . . 129 Table 10.4 Misconceptions about HIV/AIDS transmission . . . . . . . . . . . . . . . . . . . . . . . 130 Table 10.5.1 Knowledge and perception of HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . 131 Table 10.5.2 Knowledge and perception of HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . 132 Table 10.6 Knowledge of mother-child transmission of HIV/AIDS . . . . . . . . . . . . . . . . . 133 Table 10.7 Perception of the risk of getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 10.8 Reasons for perception of small/no risk of getting HIV/AIDS . . . . . . . . . . . 135 Tables and Figures * xi Page Table 10.9 Reasons for perception of moderate/great risk of getting HIV/AIDS . . . . . . 135 Table 10.10 Knowledge of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table 10.11.1 Use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table 10.11.2 Use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Table 10.12 Acceptability of women prompting use of condoms . . . . . . . . . . . . . . . . . . . 139 Table 10.13.1 Number of sexual partners: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Table 10.13.2 Number of sexual partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Table 10.14.1 Testing for HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table 10.14.2 Testing for HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table 10.15 Knowledge of dual protection of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . 144 APPENDIX A SAMPLE IMPLEMENTATION Table A.1.1 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table A.1.2 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 APPENDIX B ESTIMATES OF SAMPLING ERROR Table B.1 List of selected variables for sampling errors, Tanzania 1999 . . . . . . . . . . . 152 Table B.2 Sampling errors for women - Total sample: Tanzania 1999 . . . . . . . . . . . . 153 Table B.3 Sampling errors for women - Urban sample: Tanzania 1999 . . . . . . . . . . . . 154 Table B.4 Sampling errors for women - Rural sample: Tanzania 1999 . . . . . . . . . . . . 155 Table B.5 Sampling errors for women - Mainland sample: Tanzania 1999 . . . . . . . . . 156 Table B.6 Sampling errors for women - Zanzibar sample: Tanzania 1999 . . . . . . . . . 157 Table B.7 Sampling errors for women - Pemba sample: Tanzania 1999 . . . . . . . . . . . 158 Table B.8 Sampling errors for women - Unguja sample: Tanzania 1999 . . . . . . . . . . . 159 Table B.9 Sampling errors for men - Total sample: Tanzania 1999 . . . . . . . . . . . . . . . 160 Table B10 Sampling errors for men - Urban sample: Tanzania 1999 . . . . . . . . . . . . . . 160 Table B.11 Sampling errors for men - Rural sample: Tanzania 1999 . . . . . . . . . . . . . . . 161 Table B.12 Sampling errors for men - Mainland sample: Tanzania 1999 . . . . . . . . . . . 161 Table B.13 Sampling errors for men - Zanzibar sample: Tanzania 1999 . . . . . . . . . . . . 162 Table B.14 Sampling errors for men - Pemba sample: Tanzania 1999 . . . . . . . . . . . . . . 162 Table B.15 Sampling errors for men - Unguja sample: Tanzania 1999 . . . . . . . . . . . . . 163 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Table C.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . 166 Table C.3 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Table C.4 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Table C.5 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Table C.6 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Foreward * xiii FOREWORD The National Bureau of Statistics takes pleasure in presenting this report on the 1999 Reproductive and Child Health Survey (TRCHS). The 1999 TRCHS is the latest in a series of periodic surveys to measure levels, patterns, and trends in demographic and health indicators, the first having been the 1991-92 Tanzania Demographic and Health Survey (TDHS). This report contains findings from the 1999 TRCHS regarding data from the households visited. The tables and text cover the most important indicators and should be of use to policy makers and program administrators who need up-to-date data for evaluating their activities and planning future directions. Findings from the survey covering health facilities will be produced in a separate report. The successful completion of the 1999 TRCHS was made possible by the joint effort of a number of organisations and individuals, whose participation we would like to acknowledge with gratitude. First, is the U.S. Agency for International Development (USAID)/Tanzania which has long supported the collection and utilisation of data to evaluate the family planning and health programmes in Tanzania and which initiated planning for this survey and provided the bulk of the funding to implement it. UNICEF/Tanzania and UNFPA/Tanzania also contributed substantially to both the survey design and the funding for the survey. Many other organisations contributed to the questionnaire content and/or the field staff training, including the Reproductive and Child Health Unit at the Ministry of Health, the Tanzania Food and Nutrition Centre, and the National AIDS Control Programme and Mount Meru Hospital. We would also like to thank the Demographic and Health Surveys program of Macro International Inc. in Calverton, Maryland, U.S.A. for providing technical assistance in all phases of the project. The survey would not have gotten off the ground without the exemplary and tireless efforts of the staff at the National Bureau of Statistics. Their many long days of overtime work have served to make this survey effort a success. Similarly, the nurses who acted as interviewers for the survey deserve our heartfelt thanks. Finally, we are ever more grateful to the survey respondents who contributed generously part of their time to enable us to gather crucial data for our country’s future planning. Cletus P.B. Mkai Director General National Bureau of Statistics Dar es Salaam, Tanzania Summary of Findings * xv SUMMARY OF FINDINGS The 1999 Tanzania Reproductive and Child Health Survey (TRCHS) is a nationally- representative sample survey covering 4,029 women age 15-49 and 3,542 men age 15-59. The TRCHS was designed to provide informa- tion on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and indicators of maternal and child health and nutrition. Fieldwork for the TRCHS took place from early September to late-No- vember 1999. Survey data generally confirm patterns observed in the 1996 Tanzania Demographic and Health Survey (TDHS), showing increas- ing contraceptive use and more widespread knowledge about HIV/AIDS; however, results show that many challenges still exist. FERTILITY Fertility Decline. The TRCHS data indicate that there has been a small decline in fertility since the 1996 survey. The total fertil- ity rate has dropped from 5.8 births per woman in the period 1994-96 to 5.6 births for the period 1997-99. The rate of decline may be slowing somewhat, however, and the level of fertility is still high. Large Fertility Differentials. Signifi- cant differences in fertility levels are evident from survey data. For example, the total fertility rate among rural women is twice that of urban women (6.5 versus 3.2). Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 6.5 children in their lifetime, compared with 4.9 for women who have com- pleted primary school. Unplanned Fertility. One reason for the relatively high fertility levels is that un- planned pregnancies are still common. Over- all, more than one in five births in the three years prior to the survey were reported to be unplanned; 11 percent were mistimed (wanted later) and 11 percent were unwanted. Un- wanted births are disproportionately high among older women who already have several children, the very women who are at higher risk of fertility-related illness and higher child mortality. If unwanted births could be elimi- nated altogether, the total fertility rate in Tanzania would be 4.8 births per woman instead of the actual level of 5.6. Ideal Family Size. Although a reduc- tion in the number of unplanned births would reduce fertility substantially, Tanzanian women and men still want to have large families. Even those who have two children or fewer say they would ideally like to have al- most five children on average. FAMILY PLANNING Increasing Use of Contraception. A major cause of the declining fertility in Tanza- nia has been the slow but steady increase in contraceptive use over the last decade. The contraceptive prevalence rate has doubled since 1991-92, from 10 to 22 percent of all women. Use of modern methods has grown from 6 to 16 percent of all women. Overall, there has been a steady growth in the contra- ceptive prevalence rate with an average in- crease of one and a half percentage points a year. Method Mix. In terms of “method mix,” the dominant change over the last 8 years has been the large increase in the num- ber of women using injectable contraception. The proportion of women relying on injectables increased from less than half a percent in 1991-92 to over 5 percent in 1999 and the injectable now accounts for one- quarter of all contraceptive use. Use of condoms, periodic abstinence and withdrawal have also increased somewhat over the past few years. A levelling off in pill use may indicate that some women are switch- xvi * Summary of Findings ing from the pill to injectables. The low level of use of permanent methods such as sterilisa- tion and implants is of concern, given the high level of unplanned births among high-parity, older women. Differentials in Family Planning Use. Differentials in current use of family planning are large. Urban women are almost twice as likely as rural women to be using a contra- ceptive method (33 versus 18 percent). Women in the Mainland are more likely to use than those on Zanzibar. However, the largest differences are found by education—contra- ceptive use among women with some second- ary education is three times higher than among those with no education. Knowledge of Contraception. The proportion of women and men who know of at least one contraceptive method has been over 75 percent for some time and the TRCHS results indicate that the proportion has in- creased to over 90 percent. Moreover, the mean number of methods that women and men say they have heard of has grown from 4 in 1996 to 6 in 1999. Knowing about more methods provides a basis for wider choice. Unmet Need for Family Planning. Unmet need for family planning has declined slightly since 1996. Data from the 1996 TDHS show that 19 percent of all women were in need of services, compared with 17 percent in the 1999 TRCHS. Two-thirds of the unmet need is comprised of women who want to space their next birth, while just one third is for women who do not want any more chil- dren (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 22 percent to 40 percent of all women. Currently, 56 percent of this “total demand” for family planning is being met. Family Planning Messages. Survey data show that family planning messages are continuing to get through to couples. As in 1996, just over 40 percent of women have heard a family planning message on the radio in the six months prior to the survey, while 5 percent have seen a message on the television and one-fifth have seen a poster. Taking all sources into account, two-thirds of women and 70 percent of men say they have seen or heard a family planning message in the last six months. The proportion of women and men who say they have seen or heard specific pro- grams such as Zinduka! and Twende na Wakati has also increased since 1996. MATERNAL AND CHILD HEALTH Maternal Health Care. TRCHS data point to several areas regarding maternal health care in which improvements could be made. Although the proportion of Tanzanian mothers who receive antenatal care from a doctor, nurse, midwife or medical aide has remained steady at just over 90 percent since 1991-92, there has been a shift in providers from nurses and midwives to the less well- trained health aides. The proportion of preg- nant women receiving at least one tetanus toxoid injection has declined from 92 percent in 1996 to 83 in 1999. The data also show a disturbingly steady decline in the proportion of births that occur in a health facility—from 53 percent in 1991-92 to 47 percent in 1996 to 44 percent in 1999. Because of this decline, the proportion of births assisted by trained medical personnel (doctors, nurses, midwives) has declined from 44 percent in 1991-92 to 36 percent in 1999. Less than one in five of those who deliver at home go to a health facility for a postnatal check-up within a month after delivery. Possible Leveling Off of Childhood Mortality Decline. Survey results imply that the decline in childhood mortality documented in the 1996 TDHS may be stagnating or even increasing slightly. The TRCHS rates show that almost 1 in 7 children born in Tanzania dies before reaching the fifth birthday, an indication that there is still much improvement to be made. The under-five mortality rate measured in the survey is 147 deaths per 1,000 births; the infant mortality rate is 99 per 1,000. Summary of Findings * xvii Childhood Vaccination Coverage. The 1999 TRCHS results show that 68 percent of children age 12-23 months are fully vacci- nated, close to the 71 percent in 1996. Childhood Health. The TRCHS pro- vides data on some of the more common childhood illness and their treatment. Just over 1 in 3 children under age five had a fever and 14 percent had respiratory illness in the two weeks before the survey. Of these, two- thirds were taken to a health facility for treat- ment. Twelve percent of children under five were reported to have had diarrhoea in the two weeks preceeding the survey. The fact that two-thirds of children with diarrhoea received some type of oral rehydration therapy (fluid made from an ORS packet or increased fluids) is encouraging. Breastfeeding Practices. The TRCHS results document a relatively long duration of breastfeeding, with a median duration of 21 months. Although breastfeeding has beneficial effects on both the child and the mother, TRCHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in Tanzania. For example, among newborns less than four months of age, 60 percent are already receiving comple- mentary foods or liquids. Nutritional Status of Children. Re- sults show no appreciable change in the nutri- tional status of children in Tanzania. Over 40 percent of children under five show evidence of chronic malnutrition or stunting, while 5 percent are acutely malnourished (wasted). Vitamin A Supplementation. Over the past decade, several studies have proved the importance of adequate vitamin A in mitigat- ing the severity of maternal and childhood illnesses and thereby reducing mortality. Supplementing young children and post- partum women with a capsule containing a high dose of vitamin A is an easy way to en- sure adequate intake. However, survey data show that only 14 percent of children aged 6- 59 months received a high-dose vitamin A supplement in the six months prior to the survey. Vitamin A supplementation for postpartum women has about the same cover- age; 12 percent of women received a supple- ment within 2 months after delivering. HIV/AIDS-RELATED INDICATORS Awareness of AIDS. The TRCHS results confirm the fact that 97 percent of women and 99 percent of men have heard of HIV/AIDS. They also indicate an improvement in knowledge about how the disease is spread, which is reflected in an increase in the propor- tion of women and men who can list most of the major ways to avoid getting the illness. Around three-quarters or more of respondents know that HIV can be passed from a mother to her child and that a healthy-looking person can be infected. Condom Use. One of the main objec- tives of the Tanzanian AIDS control program- me is to encourage consistent use of condoms, especially with partners who may be exposed to HIV with other partners or through other risky behaviour. TRCHS data show that con- dom use with extramarital partners has in- creased since 1996 for women but not for men. Almost one in four women and 34 per- cent of men who had sex with someone other than a husband or wife in the previous 12 months said they used a condom the last time. Half of the respondents feel it is acceptable for a woman to ask a man to use a condom, while almost 60 percent say that if a man has a sexually transmitted disease, it is acceptable for his wife to ask him to use condoms or to refuse to have sex with him. HIV Testing. TRCHS data show that 7 percent of women and 12 percent of men have been tested for HIV, which represents a slight increase from 1996 (4 and 11 percent, respec- tively). As before, about two-thirds of those not tested say they would like to be. Major reasons for not getting tested are not knowing where to go and not having the time to go. Introduction * 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND THE ECONOMY GEOGRAPHY The United Republic of Tanzania is the largest country in East Africa, covering 940,000 square kilometres, 60,000 of which are inland water. Tanzania lies south of the equator and shares borders with eight countries: Kenya and Uganda to the north; Rwanda, Burundi, Democratic Republic of Congo, and Zambia to the west; and Malawi and Mozambique to the south. Tanzania has an abundance of inland water, with several lakes and rivers. Lake Tanganyika runs along the western 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 and then to the Mediterranean Sea. The Rufiji River is Tanzania’s largest river and drains into the Indian Ocean south of Dar es Salaam. Although there are many rivers, only the Rufiji and 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 geologic faulting throughout eastern Africa and is associated with volcanic activity in the northeastern regions of the country. Two branches of the Great Rift Valley run through Tanzania. The western branch holds Lakes Tanganyika, Rukwa, and Nyasa, while the eastern 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 200 metres or more above sea level and much of the country is higher than 1,000 metres. In the north, Mount Kilimanjaro rises to 5,895 metres—the highest point in Africa. The main climatic feature for most of the country is the long dry spell from May to October, followed by a period of rainfall between November and April. The main rainy season along the coast and the areas around Mount 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 period between March and May. HISTORY Tanzania (then Tanganyika) became independent of British colonial rule in December 1961. One year later, on December 9, 1962, it became a republic, severing all links with the British crown except for its membership in the Commonwealth. The off-shore island of Zanzibar became independent on January 12, 1964, after the overthrow of the rule of the Sultanate. On April 26, 1964, Tanganyika and Zanzibar united to form the United Republic of Tanzania. Administratively, the Mainland of Tanzania is divided into 20 regions and Zanzibar is divided into five regions. Each region is subdivided into districts. 2 * Introduction Table 1.1 Demographic characteristics Selected demographic indicators, Tanzania: 1967-1996 _____________________________________________________ Year _____________________________ Index 1967 1978 1988 1996 ____________________________________________________ Population (millions) 12.3 17.5 23.1 U Intercensal growth rate 2.6 3.2 2.8 U Sex ratio 95.2 96.2 94.2 93.2 Crude birth rate 47 49 46 41 Total fertility rate 6.6 6.9 6.5 5.8 Crude death rate 24 19 15 U Infant mortality rate 155 137 115 88 Percent urban 6.4 13.8 18.3 19.8 Density (pop/km2) 14 20 26 U ______________________________________________________ U = Unknown (not available) Source: Bureau of Statistics, 1967; 1978; 1988; Bureau of Statistics and Macro International, 1997 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 4.8 percent in 1999 according to the constant 1992 prices, compared with 4.0 percent recorded in 1998. However, this growth did not reach the target of 5.8 percent, which was predicted in the 1995-96 to 1997-98 Economic Recovery Programmes. The economic growth rate attained in 1999 is higher than the predicted population growth rate of 2.8 percent. 1.2 DEMOGRAPHIC STATISTICS Table 1.1 gives the demographic indices as compiled from the censuses since 1967. The 1967 population cen- sus of Tanzania reported a total popula- tion of 12.3 million. According to the 1988 census, the population had in- creased to 23.1 million. Tanzania is still sparsely populated, although the popu- lation density is high in some parts of the country and has been increasing over time. In 1967, the average popula- tion density was 14 persons per square kilometre; by 1988, it had increased to 26 persons per square kilometre. Al- though the population is still predomi- nantly rural, the proportion of urban residents has been increasing steadily, from 6 percent in 1967 to 18 percent in 1988. While the crude death rate in Tanzania has been decreasing for some time, the total fertility rate—among the highest in Africa—is only now beginning to decline. Although many small-scale surveys have been conducted in the country, censuses and the 1991-92 and 1996 Tanzania Demographic and Health Surveys have been the only sources of demographic statistics in Tanzania. Civil registration has never been used as a source of demographic statistics because its coverage is incomplete. 1.3 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMMES The population size of Tanzania has trebled from 7.7 million in 1948 to 23.1 million in 1988. It is estimated that the annual population increase is now more than 600,000 persons per year. It is projected that the population is now about 33 million. However, the national economy did not grow significantly in the past decade, owing to various constraints; therefore, the resources available per head increased by about 1 percent per annum between 1992 and 1999. During that period the economy grew at an average of 3.8 percent, while the per capita income increased by 0.38 percent. However, the population continued to grow at a high rate, the consequences of which are felt acutely and visibly in the public budgets for health, education, and related fields of human resource Introduction * 3 development. It is evident, therefore, that improvement in the quality and expansion of these services is unlikely to happen without controlling rapid population growth and strengthening the national economy. It is against this background that Tanzania adopted the 1992 National Population Policy. The principal objective of the policy is to reinforce national development through developing available resources to improve the quality of life of the people. Special emphasis is put on regulating the population growth rate, enhancing population quality, and improving the health and welfare of women and children. The primary concerns of the Population Policy are to safeguard, as much as possible, the satisfaction of the basic needs of the vulnerable groups in the population, and to develop human resources for current and future national socioeconomic progress. Since Tanzania was concerned with population and development issues before the adoption of an explicit population policy, the country has a tradition of taking into account population issues in its development plans. With specific reference to family planning, the goals of the policy are to strengthen family planning services to promote the health and welfare of the family, the community, and the nation and eventually to reduce the rate of population growth. 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 and women. The Family Planning Association of Tanzania (UMATI) introduced family planning services to Tanzania in 1959. During the early years the services were mostly provided in a few urban areas with little support from the government. With the expansion of UMATI in the early 70s, services were extended to cover more areas in the country. The government became actively involved in providing family planning services following the launch of the integrated Maternal and Child Health programme in 1974. At the 1994 International Conference for Population and Development in Cairo, Tanzania endorsed the comprehensive approach toward reproductive health. The government now aims at providing universal access to high-quality, affordable reproductive health services, including family planning. Currently, reproductive health services are provided by both governmental and nongovernmental organisations under the coordination of the Reproductive and Child Health Section of the Ministry of Health. Clinical services are complemented by community- based services. There have been various national efforts to control the spread of HIV/AIDS since 1985. Initial efforts were mainly implemented by the Ministry of Health through the National AIDS Control Programme. Over time, involvement of other public sector, nongovernmental, and community-based organisations has occurred. Population Services International operates a social marketing programme in Tanzania. Its purpose is to provide low-cost reproductive health, family planning, and child health products and services to low income people. The objective of the program, which has been in place since 1994, is to reduce disease and deaths by making health products accessible and affordable to low income Tanzanians, providing information, creating awareness, and promoting behaviour change through social marketing techniques. Social marketing of Salama condoms started in 1993 as part of the larger nationwide AIDS/STD control programme; social marketing of Care female condoms started in 1998. Social marketing of mosquito bednets and insecticide started in 1998. 1 Data collection for the survey of health facilities was carried out as a separate but integrated operation, and the data will appear in a separate report. 4 * Introduction 1.4 HEALTH PRIORITIES AND PROGRAMMES The Tanzanian government emphasises equity in the distribution of health services and views access to services as a basic human right. To respond to the worldwide efforts to attain the social goal of “Health to 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. The main objective of the PHC programme is to strengthen district management capacity, multisectoral collaboration and community involvement. More than 60 percent of health services are provided by the government and the remainder are provided by nongovernmental organisations. With an extensive network of health facilities in the country, at the national level there are four consultant hospitals and two special hospitals, one of which is the university teaching hospital. Most regions have a regional hospital and there are a total of 195 hospitals in the country. There are 302 health centres and about 3,500 dispensaries. At the village level, village health posts have been established staffed with at least two village health workers. There are more than 5,550 village health workers in the country. Private institutions are increasingly playing an important role in the provision of health care, especially in urban areas. Recently, the government has undertaken a health sector reform programme, which emphasises decentralisation from the national to the regional and district levels. 1.5 OBJECTIVES AND ORGANISATION OF THE SURVEY The 1999 Tanzania Reproductive and Child Health Survey (TRCHS) is the fourth in a series of national sample surveys. The first was the 1991-92 Tanzania Demographic and Health Survey (TDHS), which was followed by the Tanzania Knowledge, Attitudes and Practices Survey (TKAP) in 1994 and then by the 1996 Tanzania Demographic and Health Survey (TDHS). The primary objective of the 1999 TRCHS was to collect data at the national level (with breakdowns by urban-rural and Mainland-Zanzibar residence wherever warranted) on fertility levels and preferences, family planning use, maternal and child health, breastfeeding practices, nutritional status of young children, childhood mortality levels, knowledge and behaviour regarding HIV/AIDS, and the availability of specific health services within the community.1 Related objectives were to produce these results in a timely manner and to ensure that the data were disseminated to a wide audience of potential users in governmental and nongovernmental organisations within and outside Tanzania. The ultimate intent is to use the information to evaluate current programmes and to design new strategies for improving health and family planning services for the people of Tanzania. The survey was undertaken by the National Bureau of Statistics in collaboration with the Reproductive and Child Health Section of the Ministry of Health. The survey was initiated and jointly funded by the U.S. Agency for International Development (USAID/Tanzania), UNICEF/Tanzania, and the United Nations Population Fund (UNFPA/Tanzania). Technical assistance was provided by Macro International Inc. as part of the worldwide MEASURE Demographic and Health Surveys (DHS+) project, which is designed to collect, analyse, and disseminate data on fertility, family planning, maternal and child health, and HIV/AIDS. Introduction * 5 SAMPLE DESIGN The TRCHS used a three-stage sample design. Overall, 176 census enumeration areas were selected (146 on the Mainland and 30 in Zanzibar) with probability proportional to size on an approximately self-weighting basis on the Mainland, but with oversampling of urban areas and Zanzibar. To reduce costs and maximise the ability to identify trends over time, these enumeration areas were selected from the 357 sample points that were used in the 1996 TDHS, which in turn were selected from the 1988 census frame of enumeration in a two-stage process (first wards/branches and then enumeration areas within wards/branches). Before the data collection, fieldwork teams visited the selected enumeration areas to list all the households. From these lists, households were selected to be interviewed. The sample was designed to provide estimates for the whole country, for urban and rural areas separately, and for Zanzibar and, in some cases, Unguja and Pemba separately. The health facilities component of the TRCHS involved visiting hospitals, health centres, and pharmacies located in areas around the households interviewed. In this way, the data from the two components can be linked and a richer dataset produced. QUESTIONNAIRES The household survey component of the TRCHS involved three questionnaires: 1) a Household Questionnaire, 2) a Women’s Questionnaire for all individual women age 15-49 in the selected households, and 3) a Men’s Questionnaire for all men age 15-59. The health facilities survey involved six questionnaires: 1) a Community Questionnaire administered to men and women in each selected enumeration area; 2) a Facility Questionnaire; 3) a Facility Inventory; 4) a Service Provider Questionnaire; 5) a Pharmacy Inventory Questionnaire; and 6) a questionnaire for the District Medical Officers. All these instruments were based on model questionnaires developed for the MEASURE programme, as well as on the questionnaires used in the 1991-92 TDHS, the 1994 TKAP, and the 1996 TDHS. These model questionnaires were adapted for use in Tanzania during meetings with representatives from the Ministry of Health, the University of Dar es Salaam, the Tanzania Food and Nutrition Centre, USAID/Tanzania, UNICEF/Tanzania, UNFPA/Tanzania, and other potential data users. The questionnaires and manual were developed in English and then translated into and printed in Kiswahili. The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for individual interview and children under five who were to be weighed and measured. Information was also collected about the dwelling itself, such as the source of water, type of toilet facilities, materials used to construct the house, ownership of various consumer goods, and use of iodised salt. Finally, the Household Questionnaire was used to collect some rudimentary information about the extent of child labour. The Women’s Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following topics: C Background characteristics (age, education, religion, type of employment) C Birth history C Knowledge and use of family planning methods C Antenatal, delivery, and postnatal care C Breastfeeding and weaning practices C Vaccinations, birth registration, and health of children under age five C Marriage and recent sexual activity 6 * Introduction C Fertility preferences C Knowledge and behaviour concerning HIV/AIDS. The Men’s Questionnaire covered most of these same issues, except that it omitted the sections on the detailed reproductive history, maternal health, and child health. The final versions of the English questionnaires are provided in Appendix E. Before the questionnaires could be finalised, a pretest was done in July 1999 in Kibaha District to assess the viability of the questions, the flow and logical sequence of the skip pattern, and the field organisation. Modifications to the questionnaires, including wording and translations, were made based on lessons drawn from the exercise. TRAINING AND FIELDWORK Competency was the guiding factor in recruiting interviewers. As with 1991-92, 1994, and 1996 surveys, the Ministry of Health was requested to secure the services of trained nurses to be interviewers in the 1999 TRCHS. A similar request was made to the Zanzibar Ministry of Health to provide nurses to serve as interviewers. The training of field staff for the main survey was conducted over a three-week period from mid-August to the first week of September 1999, at the Golden Rose Hotel in Arusha Municipality. A total of 100 nurses were recruited and trained by experienced statisticians and demographers from the National Bureau of Statistics, with support from staff at Macro International Inc. and guest lecturers from the Arusha Regional Hospital and staff from the Tanzania Food and Nutrition Centre. Trial interviews were conducted in the nearby villages and in some parts of Arusha Municipality. Trainees also visited day care centres to gain experience in measuring children. Data processing staff participated in the training to acquaint themselves with the questionnaires. The training course consisted of instructions in interviewing techniques and field procedures, as well as a detailed review of items on the questionnaires. It also covered use of salt testing kits, weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in and around Arusha Municipality. During training, a series of assessment tests were given to the class. These tests were graded, and the results were used to select interviewers. Those who showed a high level of understanding of the questionnaires and were also able to detect errors in completed questionnaires were later chosen to be field editors. Supervisors and editors participated in further training to discuss their duties and responsibilities. Ensuring data quality was emphasised. The supervisor was required to act as the leader of the field team and to be responsible for the well-being and safety of team members, as well as the completion of the assigned workload and the maintenance of data quality. Responsibilities of the editor included monitoring interviewer performance and checking all questionnaires for completeness and consistency. Close supervision of the interviewers and editing of completed questionnaires was emphasised to ensure accurate and complete data collection. The fieldwork began the first week of September and continued until the third week of November 1999. Data collection for the 1999 TRCHS was implemented by ten teams, nine of which were composed of six female interviewers, one male interviewer, a field editor, a supervisor, and a driver. The tenth team was for quality control and was composed of a supervisor, two interviewers, and a driver. The list of persons who were involved in the survey is presented in Appendix D. The quality control team visited all the teams to check the quality of their work by reviewing Introduction * 7 Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, by urban-rural residence, Tanzania 1999 ________________________________________________________ Residence _________________ Result Urban Rural Total ________________________________________________________ Household interviews Households sampled 1,304 2,522 3,826 Households occupied 1,233 2,444 3,677 Households interviewed 1,192 2,423 3,615 Household response rate 96.7 99.1 98.3 Individual interviews: women Number of eligible women 1,446 2,672 4,118 Number of eligible women interviewed 1,418 2,611 4,029 Eligible woman response rate 98.1 97.7 97.8 Individual interviews: men Number of eligible men 1,367 2,425 3,792 Number of eligible men interviewed 1,250 2,292 3,542 Eligible man response rate 91.4 94.5 93.4 completed questionnaires, observing interviews, and reinterviewing a subsample of households to check that the original interviews were completed and all eligible respondents were correctly identified. Problems found in one team were immediately communicated to other teams through the head office. DATA PROCESSING All the questionnaires for the TDHS were returned to the National Bureau of Statistics for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing of computer-identified errors. All data were processed on microcomputers and a software programme developed for DHS surveys, called the Integrated System for Survey Analysis (ISSA). The data processing staff for the survey consisted of eight data entry operators, one editor and two supervisors who were staff of the National Bureau of Statistics. Data entry was 100 percent verified. Office editing and data processing activities were initiated immediately after the beginning of fieldwork and were completed in mid-January 2000. RESPONSE RATES A summary of response rates from the household and individual interviews is shown in Table 1.2. In all, 3,826 households were selected for the sample, out of which 3,677 were occupied. Of the households found, 3,615 were interviewed, representing a response rate of 98 percent. The shortfall is primarily due to dwellings that were vacant or in which the inhabitants were not at home despite of several callbacks. In the interviewed house- holds, a total of 4,118 eligible women (i.e., women age 15-49) were identified for the individual interview, and 4,029 women were actually interviewed, yielding a re- sponse rate of 98 percent. A total of 3,792 eligible men (i.e., men age 15- 59), were identified for the individ- ual interview, of whom 3,542 were interviewed, representing a response rate of 93 percent. The principal rea- son for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. The lower response rate among men than women was due to the more frequent and longer absences of men. The response rates are lower in urban areas due to longer absence of respondents from their homes. One-member households are more common in urban areas and are more difficult to 8 * Introduction interview because they keep their houses locked most of the time. In urban settings, neighbours often do not know the whereabouts of such people. Introduction * 9 Characteristics of Households * 9 Table 2.1 Household population by age, residence, and sex Percent distribution of the de facto household population by five-year age group, according to urban-rural residence and sex, Tanzania 1999 __________________________________________________________________________________________________ Urban Rural Total _______________________ _______________________ _______________________ Age group Male Female Total Male Female Total Male Female Total __________________________________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Total Number 14.7 12.9 13.7 19.0 17.2 18.0 18.0 16.2 17.1 14.6 13.9 14.2 18.0 15.6 16.7 17.3 15.2 16.2 12.6 10.9 11.7 14.8 13.4 14.1 14.3 12.8 13.5 11.3 10.5 10.9 9.3 10.0 9.7 9.8 10.1 9.9 8.9 12.7 10.9 6.3 8.0 7.2 6.8 9.1 8.0 8.9 11.1 10.1 6.0 7.2 6.6 6.7 8.1 7.4 6.5 6.2 6.4 4.1 5.3 4.7 4.6 5.5 5.1 6.3 6.0 6.1 5.0 4.8 4.9 5.3 5.1 5.2 4.0 3.6 3.8 2.4 3.0 2.7 2.8 3.1 2.9 3.3 3.5 3.4 3.2 3.3 3.2 3.2 3.3 3.3 3.3 2.1 2.7 2.4 3.6 3.0 2.6 3.3 2.9 1.7 1.7 1.7 2.1 2.6 2.3 2.0 2.4 2.2 2.0 2.2 2.1 1.9 2.3 2.1 1.9 2.3 2.1 0.7 1.0 0.9 2.6 1.7 2.1 2.2 1.6 1.9 0.7 0.6 0.7 1.3 0.9 1.1 1.2 0.8 1.0 0.4 0.5 0.4 0.9 0.5 0.7 0.8 0.5 0.6 0.2 0.5 0.3 0.7 0.8 0.7 0.6 0.7 0.7 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,822 2,122 3,944 6,544 7,120 13,665 8,366 9,242 17,609 2CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS The purpose of this chapter is to provide a short descriptive summary of some demographic and socioeconomic characteristics of the population in the sampled households and the individual respondents interviewed, such as age, sex, residence, and educational level. Also examined are environmental conditions such as housing facilities and household characteristics. This information on the characteristics of the households and the individual women and men interviewed is essential for the interpretation of survey findings and can provide an approximate indication of the representativeness of the survey. For the purposes of the 1999 TRCHS, a household was defined as a person or a group of persons who live together and share a common source of food. The Household Questionnaire (see Appendix E) was used to collect information on all usual residents and visitors who spent the night preceding the interview in the household. This method of data collection allows the calculation of either de jure (usual residents) or de facto (those there at the time of the survey) populations. 2.1 POPULATION BY AGE AND SEX The distribution of the household population in the TRCHS is shown in Table 2.1 by five-year age groups, according to sex and urban-rural residence. Because of relatively high levels of fertility in the past, Tanzania has a larger proportion of its population in the younger age groups than in the older age groups (Figure 2.1). This pattern is similar to the one observed in the censuses and the 1991-92 and 1996 TDHS surveys, except that the pattern is smoother in 1999. Most notable is the 10 * Characteristics of Households Figure 2.1 Population Pyramid, Tanzania 1999 80+ 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 0246810 0 2 4 6 8 10 Percent Male Female TRCHS 1999 absence of the heaping of women’s ages on 14 and 50 that was seen in the earlier surveys, which probably resulted from a deliberate tactic of interviewers to reduce their workload (see Table C.1). Table 2.2 shows that the population structure by broad age groups is similar to that found in the 1967, 1978, and 1988 censuses as well as that observed in the 1991-92 and 1996 TDHS surveys. Just under half of the population is below age 15, with most of the other half in the 15-64 age group; the remaining 4 percent are age 65 and over. The population has a low median age of 16 years. Table 2.2 also shows the age dependency ratio, which is an indicator of the dependency responsibility of adults in their productive years. It is defined as the ratio of the total number of persons below age 15 and above age 65 divided by the number of persons age 15 to 64. In 1999, the dependency ratio was 104, which implies that there are 104 dependents for every 100 persons in the productive ages. 2.2 HOUSEHOLD COMPOSITION Information about the composition of households by sex of the head of the household and size of the household is presented in Table 2.3. This table also shows the percentage of households with foster children. The data shows that men head 77 percent of households in Tanzania, similar to the level observed in the1996 TDHS (78 percent). Female-headed households are more common in urban (27 percent) than rural areas (22 percent). The average household size in Tanzania is 5 persons. Rural households are larger than urban households; the mean household size is 5.3 in rural areas and 4.3 in urban areas. Characteristics of Households * 11 Table 2.2 Population by age from selected sources Percent distribution of the population by age group, according to selected sources, Tanzania 1967-1999 ______________________________________________________________________ 1967 1978 1988 1991-92 1994 1996 1999 Age group Census Census Census TDHS TKAPS TDHS TRCHS ______________________________________________________________________ <15 43.9 46.1 45.8 46.8 49.3 47.2 46.8 15-64 50.5 49.9 49.9 49.3 46.4 48.5 49.1 65+ 5.6 4.0 4.3 3.9 4.3 4.3 4.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Median age U U U 16.4 15.4 16.4 16.4 Dependency ratio 98 100 100 103 115 106 104 ______________________________________________________________________ Sources: Bureau of Statistics, 1967-1999 U = Unknown (not available) Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and presence of foster children, according to urban-rural residence, Tanzania 1999 ___________________________________________________ Residence ______________ Characteristic Urban Rural Total ___________________________________________________ Household headship Male Female Total Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size Percentage of households with foster children 73.0 78.3 76.9 .27.0 21.7 23.1 100.0 100.0 100.0 15.4 7.1 9.2 14.0 10.0 11.1 14.7 13.3 13.7 14.9 15.5 15.3 13.2 14.7 14.3 9.2 13.2 12.1 7.0 7.9 7.7 5.2 6.1 5.9 6.4 12.2 10.7 100.0 100.0 100.0 4.3 5.3 5.0 20.0 22.5 21.8 ___________________________________________________ Note: Table is based on de jure members, i.e., usual residents. By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. More than one-fifth (22 percent) of households have foster children, that is, children under age 15 living in a household with neither their biological mother nor father present. The high proportion of households with foster children certainly intensifies the economic burden on these households. With the current high preva- lence of AIDS, the percentage of households with foster children in Tanzania is likely to rise. 2.3 FOSTERHOOD AND ORPHANHOOD Information regarding fosterhood and orphanhood of children under age 15 is presented in Table 2.4. The table shows that 63 percent of children under 15 are living with both their biological parents, while 17 percent are living with their mothers (but not with their fathers), 5 percent are living with their fathers (but not with their moth- ers) and 14 percent are living with neither of their natural parents. The table also provides data on the extent of orphanhood, that is, the proportion of children whose biological parents have both died. Of children under 15 years, 6 percent have lost their fathers and 3 percent have lost their mothers. One percent of children have lost both their natural parents (orphaned). 12 * Characteristics of Households Table 2.4 Fosterhood and orphanhood Percent distribution of de jure children under age 15 by survival status of parents and child's living arrangements, according to selected background characteristics, Tanzania 1999 ________________________________________________________________________________________________________ Living Living with mother with father Not living with but not father but not mother either parent Missing Living ____________ _____________ ___________________________ informa- with Father Mother tion on Number Background both Father Father Mother Mother Both only only Both father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children ________________________________________________________________________________________________________ Age <2 3-5 6-9 10-14 Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 75.2 19.9 1.4 0.3 0.2 2.4 0.2 0.0 0.0 0.4 100.0 1,862 70.1 13.0 2.3 2.7 0.1 9.2 0.8 0.8 0.3 0.7 100.0 1,725 58.4 12.5 3.6 5.8 1.2 11.5 1.7 2.4 1.4 1.5 100.0 2,319 51.4 11.2 5.6 7.0 1.9 12.9 2.1 3.7 2.1 2.1 100.0 2,388 63.0 13.6 3.2 4.8 0.8 8.6 1.3 1.9 1.4 1.4 100.0 4,204 62.2 14.1 3.6 3.7 1.1 10.1 1.2 1.9 0.7 1.2 100.0 4,091 55.8 16.3 3.3 6.5 1.1 10.7 1.7 2.1 1.0 1.6 100.0 1,598 64.2 13.3 3.4 3.8 0.9 9.1 1.2 1.9 1.1 1.2 100.0 6,697 62.6 13.9 3.4 4.3 1.0 9.3 1.3 1.9 1.1 1.3 100.0 8,071 55.5 16.4 3.2 6.6 1.1 10.7 1.7 2.1 1.0 1.6 100.0 1,536 64.2 13.3 3.5 3.8 1.0 9.0 1.2 1.9 1.1 1.2 100.0 6,534 64.1 14.2 2.7 3.2 0.0 11.2 0.8 1.8 0.4 1.5 100.0 224 67.7 12.7 3.1 4.0 0.1 8.9 0.5 2.0 0.4 0.7 100.0 110 60.7 15.6 2.4 2.5 0.0 13.4 1.2 1.6 0.4 2.2 100.0 114 62.6 13.9 3.4 4.3 1.0 9.4 1.3 1.9 1.1 1.3 100.0 8,294 ________________________________________________________________________________________________________ Note: By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. Differentials in fosterhood and orphanhood are not large. Obviously, younger children are more likely than older children to be living with one or both parents, and their parents are more likely to be living. Also, children in Zanzibar are less likely to be orphaned than children in the Mainland. 2.4 EDUCATION LEVEL OF HOUSEHOLD POPULATION Education is a key determinant of the life style and status an individual enjoys in a society. It affects many aspects of human life, including demographic and health behaviour. Studies have consistently shown that educational attainment has strong effects on reproductive behaviour, contraceptive use, fertility, infant and child mortality, morbidity, and issues related to family health and hygiene. In the 1999 TRCHS, information on educational attainment was collected for every member of the household. Tables 2.5.1 and 2.5.2 show the percent distribution of the de facto female and male population ages six and older, by the highest level of education attended and the median of years of schooling completed, according to selected background characteristics. Characteristics of Households * 13 Table 2.5.1 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Tanzania 1999 __________________________________________________________________________________________ Level of education _____________________________________________ Some Median Number Background No Primary Completed secondary years of of characteristic education incomplete primary or higher Total schooling females __________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 64.1 35.3 0.0 0.5 100.0 0.0 1,118 25.6 72.8 1.3 0.2 100.0 1.3 1,185 19.7 35.9 38.9 5.4 100.0 5.2 931 17.0 15.8 60.9 6.3 100.0 6.3 838 17.0 13.4 63.0 6.6 100.0 6.3 749 21.5 16.7 55.1 6.7 100.0 6.2 511 39.6 16.9 40.0 3.6 100.0 3.7 468 52.3 17.2 25.3 5.2 100.0 0.0 287 64.6 24.8 7.2 3.3 100.0 0.0 310 75.4 18.9 4.9 0.8 100.0 0.0 302 76.8 15.3 2.5 5.3 100.0 0.0 219 85.9 9.4 1.6 3.0 100.0 0.0 211 87.8 8.0 1.8 2.4 100.0 0.0 331 22.7 31.0 37.0 9.3 100.0 4.7 1,792 45.5 29.9 22.8 1.7 100.0 0.0 5,669 40.1 30.1 26.6 3.2 100.0 1.1 7,266 22.7 30.9 37.9 8.5 100.0 4.8 1,731 45.5 29.8 23.1 1.5 100.0 0.0 5,535 37.8 34.4 10.1 17.7 100.0 1.2 195 44.8 35.1 7.8 12.3 100.0 0.0 87 32.2 33.8 11.9 22.1 100.0 2.5 107 40.1 30.2 26.2 3.6 100.0 1.1 7,461 There is a strong differential in educational attainment between the sexes, especially as age increases. Overall, 40 percent of women in Tanzania have never been to school, compared with 31 percent of men (Figure 2.2). The proportion with no education increases with age. For example, the proportion of women who have never attended any formal schooling increases from 17 percent in age group 20-24 to 88 percent among those age 65 and older. For men, the proportion increases from 11 percent (age group 15-19) to 66 percent (age group 65 and older). Thirty percent of women and 34 percent of men have completed primary school, with just under 5 percent having attended some secondary school. The median number of years of schooling is 1.1 for women and 2.6 for men. Overall, educational attainment is higher in urban areas than in rural areas. The proportion of women and men with no education in urban areas is half that of rural areas. Conversely, the percentage with primary and secondary education is higher for urban than for rural women and men. 14 * Characteristics of Households Table 2.5.2 Educational level of the male household population Percent distribution of the de facto male household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Tanzania 1999 __________________________________________________________________________________________ Level of education _____________________________________________ Some Median Number Background No Primary Completed secondary years of of characteristic education incomplete primary or higher Total schooling males __________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 72.8 26.4 0.0 0.7 100.0 0.0 1,171 24.6 73.7 1.3 0.4 100.0 1.0 1,197 11.4 41.0 42.9 4.7 100.0 5.3 818 11.3 17.5 62.3 8.9 100.0 6.3 571 10.1 14.9 67.1 7.9 100.0 6.4 557 9.3 15.4 65.0 10.3 100.0 6.4 385 10.7 15.0 62.8 11.5 100.0 6.4 443 22.1 27.0 40.2 10.6 100.0 6.0 231 28.6 36.1 29.5 5.7 100.0 3.5 267 25.9 42.3 25.0 6.8 100.0 3.6 217 33.1 53.4 10.9 2.6 100.0 3.3 167 45.3 43.7 6.8 4.3 100.0 1.1 161 65.6 25.0 6.9 2.5 100.0 0.0 398 16.4 36.1 34.9 12.6 100.0 4.7 1,508 34.9 35.5 27.2 2.4 100.0 1.9 5,074 30.7 35.5 29.4 4.4 100.0 2.6 6,416 16.4 36.0 35.6 12.0 100.0 4.7 1,456 34.9 35.3 27.6 2.2 100.0 1.9 4,960 28.8 41.3 11.6 18.3 100.0 2.4 166 34.9 43.3 7.7 14.0 100.0 1.0 74 23.8 39.7 14.8 21.7 100.0 3.7 92 30.7 35.6 29.0 4.7 100.0 2.6 6,582 Educational attainment is higher in Zanzibar than in the Mainland. For example, although the proportions of both women and men with no education are only slightly lower in Zanzibar than in the Mainland, the proportions with at least some secondary school are far higher in Zanzibar than in the Mainland. This difference in educational attainment is because compulsory education in Zanzibar incorporates three years of secondary education. 2.5 SCHOOL ATTENDANCE The 1999 TRCHS collected more detailed information about school attendance than previous surveys. The survey also included information about early childhood education programs. Table 2.6 presents data on the proportion of children age 3 and 4 years listed on the Household Questionnaire who are attending some form of early childhood education (nursery school, kindergarten). Less than 3 percent of children age 36-59 months were reported to be attending some sort of school. As might be expected, pre-school education coverage is higher among Characteristics of Households * 15 Figure 2.2 Level of Education for Women and Men, Tanzania 1999 TRCHS 1999 40 30 26 4 31 36 29 5 No Education Primary Incomplete Primary Complete Secondary/ Higher 0 10 20 30 40 50 Percent Women Men urban children, among children age 4, and among children whose mothers have some secondary education. Table 2.7 and Figure 2.3 present the percentage of the primary-school-age population (ages 7-13) who are currently attending primary school by age, sex, and urban-rural residence. These percentages are also referred to as net attendance ratios. As shown in the table, attendance ratios are low in Tanzania, with only slightly more than half of primary-school-age children attending primary school. Girls are more likely than boys to be attending school (56 versus 51 percent), which shows that the overall low attendance rate is not due to keeping girls out of school. Attendance is higher for children in Zanzibar than for those in the Mainland (67 versus 53 percent). It is also higher for urban than for rural children and for older children. That attendance ratios are substantially higher at ages 11-13 than at 7-10 implies that many children start school late. 2.6 CHILD LABOUR In many societies, poor families cannot afford to send their children to school because the child’s labour is a valuable asset to the family. Despite policies and sometimes laws designed to eliminate child labour, the practice continues in many countries. In order to measure the extent of child labour in Tanzania, the 1999 TRCHS asked a series of questions about all children age 5-14. Questions included whether the child was doing any kind of work for pay, whether he/she regularly did unpaid family work on the farm or in a family business, and whether the child regularly helped with household chores at home, like cleaning, caring for animals, or cooking. The results are shown in Table 2.8. Caution should be used in interpreting these data, as the rather lengthy questions usually recommended by labour experts could not be accommodated in this particular survey. It is encouraging to note that only a tiny fraction (less than 2 percent) of Tanzanian children age 5-14 are working for pay. However, more than one in five children are doing unpaid work in a family business, and almost four out of five regularly help out with domestic chores. One-quarter 16 * Characteristics of Households Table 2.6 Early childhood education Percentage of de facto children age 36-59 months who are attending some form of organised early childhood education (ECE), by selected background characteristics, Tanzania 1999 ___________________________________________ Percentage Number Background attending ECE of characteristic programme children ___________________________________________ Child’s age 36-47 months 48-59 months Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Missing Total 0.9 560 3.9 588 1.8 554 3.1 594 10.1 197 0.8 952 2.4 1,116 10.4 188 0.8 928 3.0 32 2.3 16 3.6 16 0.0 287 0.5 153 3.3 477 (18.6) 27 3.0 204 2.4 1,148 ___________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases of children spend four or more hours a day in domes- tic chores. As expected, older children, rural children and, to a lesser extent, male children are more likely to be working. Children in Zanzibar are far less likely than children in the Mainland to be working, especially doing unpaid family work or domestic chores. 2.7 HOUSING CHARACTERISTICS Socioeconomic conditions in Tanzania were assessed by asking respondents about their house- hold environment, e.g., their access to electricity, sources of drinking water, time to water sources, type of toilet facilities, and floor materials. This information is summarised in Table 2.9. As the table shows, only 8 percent of house- holds in Tanzania have electricity. Electricity is much more common in urban areas; 27 percent of urban households have electricity, compared with only 1 percent of rural households. The source of drinking water is important because waterborne diseases, including diarrhoea and dysentery, are prevalent in the country. Sources of water expected to be relatively free of these diseases are piped water, protected wells, tube wells, and protected springs. Other sources, like unpro- tected wells, rivers and streams, and ponds and lakes, are more likely to carry the bacteria that cause these diseases. Table 2.9 shows that about two-thirds of Tanzanian households have safe drinking water; 38 percent of all households have access to piped water, while 28 percent get their drinking water from other relatively safe sources—protected dug wells, tube wells, or protected springs. One-third of all households rely on sources of drinking water that are less safe, such as unprotected wells and springs and surface water from ponds and rivers. As expected, a far greater proportion of urban than rural households have safe sources of drinking water (92 versus 56 percent). In urban areas, 62 percent of the households have access to water within 15 minutes, compared with 26 percent of rural households. Modern sanitation facilities are not yet available to a large proportion of Tanzanian households. The use of traditional pit toilets is still common in both urban and rural areas, accounting for 86 percent of all households. Households with no toilet facilities are more exposed to the risk of diseases such as dysentery, diarrhoea, and typhoid fever. Overall, about 12 percent of the households in Tanzania have no toilet facilities. This problem is more common in rural areas, where 16 percent of the households have no toilet facilities, compared with 1 percent of households in urban areas. Characteristics of Households * 17 Table 2.7 School attendance ratios Percentage of de facto children of primary school age (7-13) attending primary school, by selected background characteristics, Tanzania 1999 ________________________________________________________________________________ Males Females Total Background _________________ _________________ ________________ characteristic Attending Number Attending Number Attending Number ________________________________________________________________________________ Age 7-8 years 9-10 years 11-12 years 13 years Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 27.0 581 34.8 582 30.9 1,163 48.1 521 54.5 528 51.3 1,050 72.6 487 73.4 495 73.0 982 72.2 269 71.2 250 71.7 519 71.0 336 71.3 367 71.1 703 47.1 1,522 51.7 1,488 49.4 3,010 51.0 1,809 55.2 1,801 53.1 3,610 70.6 323 70.8 352 70.7 675 46.8 1,486 51.4 1,449 49.1 2,935 65.5 49 68.1 54 66.9 103 63.2 27 61.8 26 62.5 53 68.5 21 73.8 28 71.5 50 51.4 1,858 55.6 1,855 53.5 3,713 Figure 2.3 Percentage of Children Age 7-13 Attending Primary School, by Sex and Residence 56 71 5251 71 47 Total Urban Rural 0 20 40 60 80 Percent Female Male TRCHS 1999 18 * Characteristics of Households Table 2.8 Child labour Percentage of de facto children 5-14 years of age who are currently working, by selected background characteristics Tanzania 1999 ___________________________________________________________________________ Currently Currently doing doing domestic work for: unpaid ___________________ Currently family Less 4 or doing work on a than more Number Background work farm or 4 hours hours Currently of characteristic for pay business per day per day working1 children ____________________________________________________________________________ Age 5-9 10-14 Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 0.4 8.3 47.1 18.2 24.1 2,850 3.0 38.1 60.1 33.7 60.2 2,382 2.0 23.6 49.6 25.8 42.6 2,643 1.2 20.1 56.6 24.8 38.4 2,589 1.9 12.6 55.3 17.8 28.0 1,023 1.5 24.1 52.5 27.1 43.6 4,209 1.6 22.4 52.9 25.8 41.3 5,086 1.9 13.0 55.0 18.3 28.7 984 1.5 24.7 52.4 27.6 44.3 4,102 3.8 3.4 58.2 8.3 13.4 145 5.0 2.8 57.9 10.7 15.4 74 2.6 4.0 58.4 5.8 11.3 71 1.6 21.9 53.0 25.3 40.5 5,231 _____________________________________________________________________________ 1 “Working“means either doing paid or unpaid work or doing domestic work for four or more hours a day. The type of material used for flooring is an indicator not only of the quality of housing but also of health risk. Overall, 79 percent of all households in Tanzania live in residences with floors made of earth or sand, while 21 percent live in houses with cement floors. Earth flooring is almost universal in rural areas (93 percent). In general, rural households have poorer quality floors than urban households. Respondents were also asked about their household’s ownership of particular durable goods. Besides providing an indicator of socioeconomic status, ownership of these goods provides measures of other aspects of life. Ownership of a radio and a television is a measure of access to mass media; refrigerator ownership indicates a capacity for more hygienic food storage; and ownership of a bicycle, motorcycle, or a private car shows the means of transport available to households. Information on ownership of these items is presented in Table 2.10. Possession of durable goods is not common in Tanzania because many households cannot afford them. Nationally, only 43 percent of households own a radio and only 2 percent of households own a television. Refrigerators are also uncommon; only 2 percent of households have a refrigerator. Bicycles are the most common type of transportation owned by households; almost one-third of households have a bicycle. Ownership of motorised transportation is extremely rare. Only 1 percent of households have a car and even fewer have a motorcycle. As expected, urban 1 Salt that contains at least 15 parts per million of iodine is considered to be adequately iodised. Characteristics of Households * 19 Table 2.9 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Tanzania 1999 ___________________________________________________ Residence _______________ Characteristic Urban Rural Total ___________________________________________________ Electricity No Yes Missing Source of drinking water Piped into residence Piped into yard Public tap Unprotected well Protected dug well Borehole or tube well Protected spring Unprotected spring Pond, river, stream Tanker truck Time to water source (in minutes) <15 minutes (percent) Median time to source Sanitation facilities Flush toilet Traditional pit toilet Vent. imp. pit latrine No facilities/bush Floor material Earth/sand Cement Other Total Number of households 72.6 98.7 91.9 27.3 1.1 8.0 0.1 0.2 0.2 9.0 1.0 3.1 39.2 3.1 12.6 31.9 18.2 21.8 2.2 18.4 14.2 5.2 18.5 15.0 6.0 10.4 9.2 0.8 5.1 4.0 0.9 8.2 6.3 1.9 16.9 13.0 2.7 0.1 0.8 61.7 25.5 35.0 4.1 29.1 19.6 4.1 0.6 1.5 91.5 83.4 85.5 3.2 0.2 1.0 1.1 15.8 12.0 37.2 93.4 78.7 62.6 6.4 21.1 0.2 0.2 0.1 100.0 100.0 100.0 946 2,669 3,615 households are more likely than rural house holds to own all the items listed, except for bicycles. For example, two-thirds of urban households have radios, compared with only one-third of rural households. Half the rural households surveyed do not possess any of the items listed, compared with only 27 percent of urban households. Ownership of radios, televisions, and bicycles has hardly changed since 1996. The only item that shows any appreciable change is the radio; the proportion of households with a radio has increased from 41 to 43 percent. Another household characteristic measured in the TRCHS was the use of io- dised salt. Iodine deficiency in the diet can lead to serious nutritional deficiencies that can result in health problems such as goitre, stunting, mental retardation, and cretinism. The government of Tanzania has emphasised the addition of iodine to salt to prevent these health problems. Interviewers asked house- hold respondents for a teaspoon of salt that was used for cooking. They then tested the salt for iodine content using portable test kits. Interviewers succeeded in testing the salt in 97 percent of households. As shown in Table 2.11, two-thirds of households were found to have an ade- quate level of iodisation, while the salt used by one-third of the households was not iodised.1 Urban households and those in the Mainland are more likely to use iodised salt. Health officials should make efforts to improve the situation in Pemba, where less than 10 percent of households use iodised salt. 2.8 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 2.12 shows the distribution of children under five by selected background characteris- tics. As expected, there are an equal number of boys and girls under five listed in the Household Questionnaire. They have a similar distribution by place of residence as the general population, i.e., 97 percent live in the Mainland and 3 percent live in Zanzibar. However, children under five are somewhat less urbanised than the general population, with less than 20 percent living in urban areas, compared with about 22 percent of the general population. 20 * Characteristics of Households Table 2.10 Household durable goods Percentage of households possessing various durable consumer goods, by urban-rural residence, Tanzania 1999 ___________________________________________________ Residence Durable _______________ good Urban Rural Total ___________________________________________________ Radio Television Refrigerator Bicycle Motorcycle Private car or truck None of the above Number of households 66.9 34.7 43.2 8.5 0.2 2.4 7.1 0.2 2.0 27.3 34.1 32.3 1.5 0.5 0.7 3.6 0.2 1.1 26.9 49.5 43.6 946 2,669 3,615 Table 2.11 Iodised salt Percent distribution of households by whether salt was tested for iodine and, among those tested, percent distribution by iodine content, according to selected background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Among households tested, Salt testing in households percentage with iodine level: ___________________________ ___________________________ Percentage Background Percentage not 0 ppm 50 ppm Number of characteristic tested tested Total (no iodine) 25 ppm or more Total households ____________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 95.3 4.7 100.0 13.9 8.3 77.8 100.0 946 97.0 3.0 100.0 40.0 14.7 45.3 100.0 2,669 96.7 3.3 100.0 32.4 13.2 54.4 100.0 3,526 95.4 4.6 100.0 12.6 8.3 79.0 100.0 920 97.2 2.8 100.0 39.3 14.9 45.8 100.0 2,605 92.2 7.8 100.0 66.5 6.9 26.6 100.0 89 94.3 5.7 100.0 90.9 1.6 7.5 100.0 38 90.7 9.3 100.0 48.0 11.0 41.0 100.0 52 96.6 3.4 100.0 33.2 13.0 53.7 100.0 3,615 _____________________________________________________________________________________________________ ppm = parts per million Table 2.13 shows the distribution of female and male respondents by selected background characteristics. To assess their age, respondents were asked two questions in the individual interview: "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained to probe in situations in which respondents did not know their age or date of birth, and they were instructed to record their best estimate of the respondent’s age as a last resort. Results show the same steep drop-off with age seen in the general population, which is indicative of a high fertility population. As with children under five, the vast majority of women and men live in the Mainland (98 percent), while only 3 percent live in Zanzibar. Twenty-eight percent of women and 27 percent of men live in urban areas. Data on marital status at the time of the survey show that 23 percent of women age 15-49 and 36 percent of men age 15-59 have never married; 66 percent of women and 58 percent of men were currently in unions; and 11 percent of women and 5 percent of men were divorced, separated, or widowed. Characteristics of Households * 21 Table 2.12 Background characteristics of children under five Percent distribution of de facto children under age five by selected background characteristics, Tanzania 1999 ____________________________________________________ Number of children __________________ Background Weighted Un- characteristic percent Weighted weighted _____________________________________________________ Child’s age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Missing Total 11.3 338 339 10.6 318 302 20.0 597 575 19.9 594 584 18.7 559 579 19.5 584 554 50.4 1,506 1,473 49.6 1,484 1,460 17.9 535 750 82.1 2,455 2,183 97.3 2,910 2,183 17.1 513 508 80.2 2,397 1,675 2.7 80 750 1.3 40 339 1.4 41 411 25.5 762 723 14.8 442 456 45.8 1,368 1,126 3.4 101 302 10.6 316 326 100.0 2,990 2,933 The proportion of women who have never attended school is almost twice that of men (27 versus 14 percent). Just under half of women and just over half of men have completed primary education only, while 5 percent of women and 7 percent of men have gone beyond primary education. One-third of women and men are Muslim, an almost equal proportion are Catholic, one-fourth are Protestants, and 13 percent adhere to traditional religions or have no religion. 2.9 EDUCATIONAL LEVEL OF SURVEY RESPONDENTS Tables 2.14.1 and 2.14.2 present the distribution of women and men by level of education, according to selected characteristics. As mentioned earlier, men are generally better educated than women. While 27 percent of women age 15-49 have had no formal education, only 14 percent of men age 15-59 have had no schooling. The proportion of respondents who have had some secondary education is higher among men than among women. Education is inversely related to age; older women and men are generally less educated than younger women and men. The percentage of women with no education rises with age, from 20 percent or less among women in their 20s and early 30s to 67 percent among women in the age group 45-49. This differential in education means that younger women and men have had better educational opportunities than older people. The correlation is also reflected in the higher percentage of women in the age group 20-24 who completed primary education (67 percent), compared with women age 45-49 (9 percent). Urban women and men are much more likely than rural women and men to go to school. Thirty-three percent of rural women have no education, compared with only 13 percent of urban women. Conversely, 69 percent of urban women have completed primary education and 13 percent have been to secondary school, while 45 percent of rural women completed primary education and only 2 percent have been to secondary school. Similar patterns exist for the men. At least in part as a result of the difference in the secondary education system between the Mainland and Zanzibar, a higher proportion of women with some secondary education is observed in Zanzibar (34 percent), compared with the Mainland (5 percent). The proportion of men with some secondary education is also higher in Zanzibar (34 percent) than in the Mainland (7 percent). 22 * Characteristics of Households Table 2.13 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Tanzania 1999 _________________________________________________________________________________ Women Men ____________________________ __________________________ Number of women Number of men _________________________________ Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted __________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Marital status Never married Married Living together Widowed Divorced Not living together Education No education Primary incomplete Primary complete Secondary+ Religion Muslim Catholic Protestant Traditional or no religion Other Total 22.6 909 933 22.3 790 803 20.1 811 773 15.2 540 550 18.6 749 751 15.4 546 530 12.2 490 491 10.5 371 367 11.3 456 491 12.6 445 451 7.4 299 301 6.2 219 250 7.8 315 289 7.3 259 249 NA NA NA 5.7 201 185 NA NA NA 4.8 171 157 27.9 1,122 1,418 26.6 941 1,250 72.1 2,907 2,611 73.4 2,601 2,292 97.5 3,929 3,060 97.5 3,452 2,673 27.0 1,088 1,036 25.7 909 898 70.5 2,841 2,024 71.8 2,543 1,775 2.5 100 969 2.5 90 869 1.1 44 396 1.0 36 316 1.4 56 573 1.5 55 553 23.4 943 977 36.4 1,289 1,344 58.5 2,357 2,369 54.6 1,936 1,874 7.3 295 239 3.6 128 124 3.2 128 126 0.8 29 29 3.5 140 185 1.8 64 71 4.1 165 133 2.7 97 100 27.1 1,093 1,026 14.0 495 479 21.2 854 821 28.2 1,000 966 46.3 1,866 1,640 50.6 1,791 1,566 5.3 215 542 7.2 256 531 32.6 1,315 1,940 32.6 1,153 1,710 30.0 1,208 974 31.1 1,103 892 24.2 975 759 22.1 784 578 12.9 520 344 13.4 475 336 0.3 11 12 0.7 27 26 100.0 4,029 4,029 100.0 3,542 3,542 ___________________________________________________________________________________ NA = Not applicable Characteristics of Households * 23 Table 2.14.1 Level of education: women Percent distribution of women by the highest level of education attended, according to selected background characteristics, Tanzania 1999 _________________________________________________________________________________ Level of education: women ______________________________________________ Number Background No edu- Primary Primary Secon- of characteristic cation incomplete complete dary+ Total women __________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 20.8 35.0 39.1 5.1 100.0 909 17.3 15.8 60.7 6.3 100.0 811 16.1 14.5 62.3 7.1 100.0 749 20.0 16.9 56.9 6.3 100.0 490 38.9 18.8 39.1 3.2 100.0 456 53.1 18.3 24.3 4.3 100.0 299 66.5 24.5 7.1 1.9 100.0 315 13.2 17.4 56.1 13.3 100.0 1,122 32.5 22.7 42.5 2.3 100.0 2,907 27.1 21.2 47.1 4.6 100.0 3,929 13.2 17.4 57.3 12.0 100.0 1,088 32.4 22.7 43.1 1.8 100.0 2,841 28.4 20.3 17.5 33.8 100.0 100 39.3 23.3 14.3 23.2 100.0 44 19.8 18.0 20.1 42.1 100.0 56 27.1 21.2 46.3 5.3 100.0 4,029 Table 2.14.2 Level of education: men Percent distribution of men by the highest level of education attended, according to selected background characteristics, Tanzania 1999 _________________________________________________________________________________ Level of education: men ______________________________________________ Number Background No edu- Primary Primary Secon- of characteristic cation incomplete complete dary+ Total men __________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 11.6 42.8 41.1 4.5 100.0 790 11.0 19.1 62.6 7.4 100.0 540 8.7 16.1 65.5 9.7 100.0 546 9.6 14.8 66.6 8.9 100.0 371 10.4 16.0 63.1 10.5 100.0 445 16.8 28.8 43.0 11.5 100.0 219 26.7 35.4 34.1 3.8 100.0 259 27.0 46.6 21.4 4.9 100.0 201 32.3 56.5 9.8 1.4 100.0 171 7.0 21.8 54.1 17.0 100.0 941 16.5 30.5 49.3 3.7 100.0 2,601 13.9 28.2 51.4 6.5 100.0 3,452 7.0 21.9 55.2 15.9 100.0 909 16.4 30.5 50.0 3.2 100.0 2,543 17.6 28.6 19.6 34.2 100.0 90 26.2 29.6 13.5 30.6 100.0 36 11.9 28.0 23.6 36.5 100.0 55 14.0 28.2 50.6 7.2 100.0 3,542 24 * Characteristics of Households Table 2.15 Literacy Percent distribution of women and men by literacy level, according to selected background characteristics, Tanzania 1999 ________________________________________________________________________________________________________ Women Men _______________________________________ ________________________________________ Can Can Can Can read read read read Cannot part of whole Number Cannot part of whole Number Background read sen- sen- of read sen- sen- of characteristic at all tence tence Refused Total women at all tence tence Refused Total men ________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 31.1 6.5 62.2 0.1 100.0 909 25.2 10.8 63.6 0.4 100.0 790 27.3 5.0 67.6 0.1 100.0 811 20.7 5.4 72.2 1.7 100.0 540 25.9 7.5 66.6 0.0 100.0 749 21.2 5.4 73.3 0.0 100.0 546 29.8 7.0 63.1 0.1 100.0 490 16.9 4.4 78.5 0.2 100.0 371 46.9 7.7 45.3 0.1 100.0 456 16.4 4.3 79.4 0.0 100.0 445 56.3 8.8 33.3 1.6 100.0 299 18.9 5.5 75.5 0.0 100.0 219 69.4 7.0 23.2 0.4 100.0 315 27.0 6.8 66.1 0.0 100.0 259 NA NA NA NA NA NA 26.1 8.2 64.6 1.1 100.0 201 NA NA NA NA NA NA 32.7 11.3 55.9 0.1 100.0 171 19.3 5.0 75.3 0.5 100.0 1,122 11.1 3.4 84.3 1.2 100.0 941 42.3 7.5 50.1 0.1 100.0 2,907 26.0 8.2 65.6 0.2 100.0 2,601 36.0 6.8 57.0 0.2 100.0 3,929 22.2 6.8 70.6 0.4 100.0 3,452 19.4 5.0 75.1 0.4 100.0 1,088 11.1 3.3 84.4 1.2 100.0 909 42.3 7.5 50.1 0.1 100.0 2,841 26.1 8.1 65.6 0.1 100.0 2,543 30.9 7.1 60.7 1.3 100.0 100 18.8 10.4 69.2 1.7 100.0 90 42.6 9.2 46.9 1.3 100.0 44 23.8 13.5 61.3 1.4 100.0 36 21.8 5.5 71.4 1.3 100.0 56 15.5 8.4 74.2 1.9 100.0 55 95.9 1.3 2.7 0.0 100.0 1,093 86.1 4.1 9.7 0.1 100.0 495 31.1 15.5 52.6 0.8 100.0 854 24.4 14.1 60.6 0.9 100.0 1,000 7.0 6.8 86.1 0.1 100.0 1,866 6.2 4.7 88.8 0.3 100.0 1,791 0.0 0.0 100.0 0.0 100.0 215 0.0 0.0 100.0 0.0 100.0 256 35.9 6.8 57.1 0.2 100.0 4,029 22.1 6.9 70.6 0.4 100.0 3,542 ________________________________________________________________________________________________________ Note: Respondents who reached secondary school were not tested but were assumed to be able to read the whole sentence. NA = Not applicable The level of literacy is often viewed as an indicator of the basic level of socioeconomic development of a country. In the TRCHS, women age 15-49 and men age 15-59 who were interviewed individually were asked to read a simple sentence in Swahili. Interviewers then coded their reading ability on the questionnaire. This small literacy test marks a departure from previous surveys in which respondents were asked whether they could read. Table 2.15 shows the percent distribution of both women and men by level of literacy according to background characteristics. Illiteracy is high among women, compared with men. Thirty-six percent of all women respondents are illiterate, compared with only 22 percent of men. Seven percent of all women could read only part of the sentence and 57 percent of all women could read the whole sentence. Among men, 7 percent could read part of the sentence and 71 percent could read the whole sentence. As expected, illiteracy rates are higher in rural than in urban areas and among the less educated population. For both sexes, illiteracy is slightly higher in the Mainland than in Zanzibar. Characteristics of Households * 25 Table 2.16 Access to mass media Percentage of women and men who usually read a newspaper once a week, watch television once a week, or listen to the radio weekly, by selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Women Men ________________________________________________________________________________ Read Watch Read Watch No news- tele- Listen to All Number No news- tele- Listen to All Number Background mass paper vision radio three of mass paper vision radio three of characteristic media weekly weekly weekly media women media weekly weekly weekly media men _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 72.4 4.1 4.1 23.4 0.3 909 58.4 7.3 9.2 36.4 2.0 790 67.4 5.8 5.6 30.3 2.0 811 44.0 14.4 14.4 50.6 4.5 540 66.4 8.1 4.7 29.9 1.6 749 45.2 19.5 7.4 50.4 3.3 546 69.7 4.2 4.0 27.1 0.2 490 46.1 16.9 8.3 48.5 4.8 371 68.3 5.1 3.3 30.8 0.8 456 43.9 17.0 9.0 51.7 6.3 445 71.1 4.2 4.1 26.7 1.6 299 48.6 17.2 15.8 47.6 9.5 219 75.0 2.5 2.2 23.3 0.7 315 56.5 11.2 7.5 39.2 3.0 259 NA NA NA NA NA NA 55.7 12.0 9.1 41.8 5.2 201 NA NA NA NA NA NA 58.9 5.2 1.8 39.1 0.4 171 47.2 14.2 12.4 45.1 3.1 1,122 29.3 34.3 24.9 60.1 13.0 941 78.2 1.7 1.1 20.7 0.3 2,907 57.7 6.1 3.9 39.8 0.8 2,601 70.3 5.2 3.8 26.9 1.0 3,929 50.8 13.5 8.8 44.8 4.0 3,452 47.9 14.2 11.3 44.7 3.0 1,088 29.7 34.4 23.9 60.0 12.9 909 78.9 1.7 0.9 20.1 0.3 2,841 58.4 6.0 3.4 39.4 0.7 2,543 41.0 6.8 24.4 51.0 3.4 100 25.9 16.5 35.6 61.9 8.1 90 52.6 4.1 12.7 43.2 2.0 44 29.3 11.6 21.2 64.3 4.5 36 32.0 8.9 33.5 57.0 4.4 56 23.8 19.7 45.1 60.3 10.4 55 84.7 0.0 0.8 14.8 0.0 1,093 72.3 2.1 3.7 26.9 0.9 495 74.1 2.7 1.9 22.7 0.1 854 57.1 6.4 8.1 39.3 2.2 1,000 63.6 6.9 4.5 33.3 1.2 1,866 46.0 16.0 9.1 48.2 3.8 1,791 27.1 26.9 29.3 60.7 9.0 215 9.7 46.8 29.4 83.1 18.9 256 69.6 5.2 4.3 27.5 1.1 4,029 50.2 13.6 9.5 45.2 4.1 3,542 _______________________________________________________________________________________________________ NA = Not applicable 2.10 ACCESS TO MEDIA Female and male respondents were asked in the survey if they usually read a newspaper, listen to the radio, or watch television at least once a week. This information is of use in planning the dissemination of family planning and health messages. Table 2.16 shows the percentage of female and male respondents exposed to different types of mass media by age, residence, and level of education. Results show that 5 percent of women and 14 percent of men read a newspaper or magazine weekly, while 28 percent of women and 45 percent of men listen to the radio at least once a week. Only 4 percent of women and 10 percent of men watch television at least once a week. The vast majority of respondents do not use any of these media (70 percent of women and 50 percent of men). 26 * Characteristics of Households Access to mass media is somewhat higher among younger respondents and among those living in urban rather than rural areas. It is also higher among residents of Zanzibar than among residents of the Mainland. As expected, educated persons are more likely to read newspapers or magazines, watch television, and listen to the radio than less-educated persons. Overall, data indicate that of the three media, radio is by far the most widespread compared with the other two. It is interesting to note that access to mass media appears to have fallen considerably over recent years. For example, the proportion of women who read newspapers weekly increased from 25 percent in 1991-92 to 31 percent in 1994, then declined to 13 percent in 1996 and further to 5 percent in 1999. A similar pattern exists for television viewing and radio listening habits. While some of the trend may be real, most is probably due to changes in the wording of the questions in the 1996 survey and again in the 1999 survey. For example, while the two earlier surveys asked if the respondent usually reads a newspaper at least once a week, the 1996 TDHS asked an open- ended question (“How often do you read a newspaper?”) with a set of six possible codes from which the interviewer was to choose the closest to the respondent’s answer. In the 1999 TRCHS, the question was: “Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?” While the simpler yes-no question that was used in the first two surveys might have lead the respondent to answer affirmatively, it is not apparent why the wordings of the questions used in the 1996 and 1999 surveys would have lead to an apparent decline in coverage. 2.11 EMPLOYMENT AND OCCUPATION In the 1999 TRCHS, information was collected about current employment, earnings, and occupation for women age 15-49 and men age 15-59. Although data were collected from female and male respondents, the analysis in this section concentrates on women. Women were asked several questions designed to elicit whether or not they were working. First, they were asked if they were doing any work other than their own housework. If the answer was negative, they were asked a more probing question, suggesting that some women may sell things, have a small business or work on the family farm or business. Data in Table 2.17 indicate that 24 percent of women report being unemployed. The proportion not working is higher among younger women and those residing in urban areas. The proportion of women not working is also higher in Zanzibar and surprisingly, among the better educated. Most women who work do so on a seasonal basis; just under one-half of all women work part of the year, while one-quarter work throughout the year. The proportion of women who are not currently working seems to have declined over time, from 46 percent in 1996 to 24 percent in 1999; however, the questions asked differed in the two surveys. Therefore, much of the decline is probably spurious. Women who reported themselves as employed at the time of the survey were asked whether they worked for a member of their family, worked for someone else, or were self-employed. They were also asked if they earned cash for their work (Table 2.18). Thirty-seven percent of working women are self-employed, while 9 percent work for others and 54 percent work in a family business. Most working women (73 percent) earn cash for their work. Rural working women are more likely to work in a family business, while urban women are more likely to work for others or for themselves. Urban women who work are also more likely than rural women to receive cash earnings (88 vs. 68 percent). Women in Zanzibar who work are more likely to be self-employed or to work for an employer and less likely to work in family businesses than women in the Mainland. Characteristics of Households * 27 Table 2.17 Employment Percentage of women in various employment categories, according to selected background characteristics, Tanzania 1999 _____________________________________________________________________________________ Not currently employed Currently employed ________________ _____________________ No work Worked Number Background for last 12 last 12 All Season- Occa- of characteristic months months year ally sionally Missing Total women ____________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 38.6 5.1 15.6 37.4 3.3 0.0 100.0 909 18.1 6.6 24.0 46.0 5.2 0.2 100.0 811 16.6 5.2 26.3 46.1 5.7 0.1 100.0 749 11.7 5.0 27.5 54.1 1.7 0.0 100.0 490 11.7 3.1 29.9 52.9 1.5 0.9 100.0 456 6.9 2.0 34.2 55.5 1.5 0.0 100.0 299 11.1 4.0 26.0 55.2 3.3 0.3 100.0 315 26.9 6.9 34.6 26.4 5.2 0.0 100.0 1,122 16.8 4.0 20.7 55.3 3.0 0.3 100.0 2,907 19.3 4.8 24.6 47.6 3.5 0.2 100.0 3,929 26.7 6.9 34.5 26.5 5.3 0.0 100.0 1,088 16.5 4.0 20.7 55.7 2.9 0.2 100.0 2,841 30.4 7.3 23.1 32.7 6.0 0.4 100.0 100 29.9 6.8 9.6 46.4 7.2 0.2 100.0 44 30.9 7.7 33.7 22.0 5.1 0.6 100.0 56 16.3 3.7 19.3 58.2 2.2 0.3 100.0 1,093 28.7 4.7 22.1 39.6 4.9 0.0 100.0 854 15.7 5.6 26.8 47.8 3.8 0.2 100.0 1,866 33.5 5.0 41.1 16.7 3.7 0.0 100.0 215 19.6 4.8 24.5 47.2 3.6 0.2 100.0 4,029 Table 2.19.1 indicates the type of occupation in which working women are engaged. Seventy- two percent of employed women are involved in agricultural activities, mostly working on their own or family-owned land. Twenty percent of working women are involved in unskilled manual jobs. Only 2 percent of women are doing professional, managerial, or technical jobs. Table 2.19.2 presents similar data for men. It shows that only 11 percent of men are not currently employed. Sixty-two percent of all men 15-59 work in agriculture, mostly on their own or family land. Four percent have professional, technical, or managerial jobs, while 21 percent work as manual laborers. Among both women and men, agricultural jobs are more common in rural than in urban areas. Educated women and men are more likely to be employed in professional and technical occupations. 28 * Characteristics of Households Table 2.18 Employer and form of earnings Percent distribution of employed women by employer and form of earnings, according to background characteristics, Tanzania 1999 ___________________________________________________________________________________________ Employed by Employed by Self-employed a nonrelative a relative _______________ _______________ ______________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women ____________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 20.8 2.0 9.2 0.2 33.5 34.1 0.2 100.0 511 36.3 4.3 10.1 0.2 30.1 18.8 0.2 100.0 611 36.8 6.8 7.5 0.0 32.5 16.3 0.0 100.0 586 32.5 6.2 4.8 0.0 33.3 23.2 0.0 100.0 408 28.3 7.5 10.3 0.0 34.9 18.3 0.7 100.0 388 30.2 4.4 10.9 0.0 32.3 22.1 0.0 100.0 273 35.3 7.6 4.7 0.0 33.3 19.1 0.0 100.0 266 47.2 3.0 28.0 0.0 12.8 9.0 0.0 100.0 743 26.6 6.1 2.0 0.1 39.1 25.8 0.2 100.0 2,300 31.3 5.0 8.3 0.1 33.2 22.0 0.2 100.0 2,981 46.7 2.9 28.1 0.0 13.1 9.2 0.0 100.0 722 26.4 5.7 1.9 0.1 39.7 26.1 0.2 100.0 2,260 49.7 22.4 13.9 0.3 5.0 8.7 0.0 100.0 62 35.4 33.7 10.2 0.0 5.9 14.7 0.0 100.0 28 61.2 13.3 16.9 0.5 4.3 3.8 0.0 100.0 34 23.8 7.2 3.2 0.1 38.6 26.9 0.2 100.0 874 32.8 5.1 5.9 0.0 33.8 22.4 0.0 100.0 569 35.3 4.6 9.6 0.1 30.1 20.0 0.2 100.0 1,468 37.7 2.7 39.4 0.1 16.3 3.8 0.0 100.0 132 31.6 5.3 8.4 0.1 32.7 21.7 0.2 100.0 3,043 Characteristics of Households * 29 Table 2.19.1 Occupation: women Percent distribution of employed women by current occupation and type of agricultural land worked or type of nonagricultural employment, according to selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Agricultural Nonagricultural ____________________________ ______________________________________ Pro- Number Background Own Family Rented Other’s fessional/ Sales/ Skilled Unskilled of characteristic land land land land technical service manual manual Other Total women _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 12.2 64.1 0.1 0.7 0.2 2.2 1.4 17.1 2.0 100.0 511 23.3 39.9 1.5 1.2 1.2 4.1 1.0 22.8 5.1 100.0 611 25.8 39.4 0.0 0.3 2.9 1.7 1.1 26.4 2.4 100.0 586 28.7 41.8 0.2 0.7 2.5 1.4 1.9 19.9 2.8 100.0 408 27.8 38.7 0.8 1.6 2.7 3.5 1.1 22.2 1.6 100.0 388 33.4 42.2 0.3 1.2 6.9 0.3 0.6 15.1 0.1 100.0 273 39.8 41.4 2.6 0.5 2.5 0.8 0.4 10.4 1.6 100.0 266 9.6 14.2 1.0 0.5 7.0 6.6 2.4 50.6 8.1 100.0 743 30.7 54.0 0.6 1.0 0.8 0.8 0.7 10.5 0.8 100.0 2,300 25.5 45.1 0.7 0.7 2.2 2.3 0.9 20.0 2.6 100.0 2,981 9.8 14.6 1.1 0.4 6.7 6.7 2.1 50.4 8.3 100.0 722 30.6 54.8 0.6 0.8 0.8 0.8 0.5 10.3 0.8 100.0 2,260 28.2 6.7 0.3 7.2 7.4 1.8 14.0 32.6 1.8 100.0 62 42.2 10.2 0.6 12.4 4.9 0.3 10.3 18.7 0.3 100.0 28 16.9 3.9 0.0 3.0 9.3 3.0 17.0 43.7 3.1 100.0 34 29.4 56.1 0.4 1.3 0.5 0.5 0.4 10.8 0.6 100.0 874 24.6 49.5 1.6 0.8 0.4 0.6 0.7 17.2 4.5 100.0 569 25.6 38.2 0.6 0.6 2.0 3.2 1.2 25.6 3.0 100.0 1,468 4.5 11.3 0.1 1.1 27.0 10.3 6.9 37.2 1.7 100.0 132 25.6 44.3 0.7 0.9 2.3 2.2 1.1 20.3 2.6 100.0 3,043 30 * Characteristics of Households Table 2.19.2 Occupation: men Percent distribution of men by current occupation and type of nonagricultural employment, according to selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Not Agricultural Nonagricultural curr- ________________________ _________________________________ ently Pro- Number Background em- Own Family Rented Other’s fessional/ Sales/ Skilled Unskilled of characteristic ployed land land land land technical service manual manual Other Total men _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 31.7 12.5 31.3 0.5 3.8 0.9 2.7 2.2 13.8 0.6 100.0 790 9.3 23.4 28.1 2.5 5.1 1.0 3.5 7.6 18.9 0.5 100.0 540 3.5 29.1 26.7 3.0 4.9 2.5 3.1 9.1 17.9 0.1 100.0 546 3.0 32.3 22.7 6.6 4.1 4.5 2.9 8.3 14.8 0.9 100.0 371 2.1 23.1 32.0 3.2 4.4 8.0 1.9 7.8 17.3 0.3 100.0 445 5.2 33.0 25.7 2.4 6.4 10.4 1.0 5.5 9.9 0.4 100.0 219 3.8 45.1 24.4 1.0 3.8 6.6 0.7 7.2 7.2 0.0 100.0 259 2.8 29.5 33.8 0.8 4.4 10.6 0.2 6.3 11.4 0.1 100.0 201 6.1 51.0 26.4 2.8 2.3 0.3 5.1 1.7 4.2 0.1 100.0 171 13.9 7.9 8.7 2.5 2.9 9.3 6.5 15.3 31.8 1.1 100.0 941 9.5 33.4 35.5 2.5 4.9 2.0 1.1 2.9 8.1 0.1 100.0 2,601 10.6 26.8 29.0 2.5 4.1 3.8 2.5 6.1 14.2 0.4 100.0 3,452 14.0 8.1 9.0 2.6 2.9 8.9 6.5 15.3 31.7 1.1 100.0 909 9.4 33.6 36.1 2.5 4.6 2.0 1.0 2.8 7.9 0.1 100.0 2,543 12.3 17.2 4.8 0.7 14.2 10.3 5.3 9.0 24.7 1.5 100.0 90 13.7 24.0 6.0 1.3 15.6 9.4 3.7 7.8 17.3 1.3 100.0 36 11.4 12.7 4.0 0.4 13.3 11.0 6.3 9.8 29.5 1.7 100.0 55 6.1 34.3 38.1 2.5 5.7 0.5 1.6 1.9 9.3 0.1 100.0 495 17.9 27.5 28.7 2.2 4.0 0.6 2.1 4.4 12.0 0.7 100.0 1,000 6.6 27.1 28.2 2.6 4.3 3.7 2.8 7.6 16.6 0.3 100.0 1,791 19.7 4.2 8.9 2.5 3.8 25.9 3.9 12.1 18.4 0.6 100.0 256 10.7 26.6 28.3 2.5 4.4 4.0 2.5 6.2 14.4 0.4 100.0 3,542 Fertility * 31 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the five years preceding the survey, by urban-rural residence, Tanzania 1999____________________________________________________ Residence______________ Age group Urban Rural Total____________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR women 15-49 TFR women 15-44 General fertility rate Crude birth rate 95 154 138 199 301 268 170 269 240 93 262 213 58 165 138 17 96 78 0 49 37 3.16 6.48 5.55 3.16 6.24 5.37 128 223 195 34.4 43.5 41.4 ____________________________________________________ Note: Rates are for the period 1-59 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Total fertility rate expressed per woman. General fertility rate (births divided by number of women 15-49), expressed per 1,000 women. Crude birth rate expressed per 1,000 population. FERTILITY 3 The fertility measures presented in this chapter are based on the reported birth histories of women age 15-49 who were interviewed in the 1999 Tanzania Reproductive and Child Health Survey (TRCHS). Estimates of fertility are based on carefully gathered survey data. Each woman was first asked about the number of sons and daughters who were living with her, were living elsewhere, or had died. Each woman was also 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 those questions was used to calculate measures of current and completed fertility, i.e., the number of children ever born. 3.1 CURRENT FERTILITY Table 3.1 presents age-specific fertility rates and other summary indica- tors calculated from survey data such as the total fertility rate, the general fertility rate, and the crude birth rate. The age- specific fertility rate is defined as the number of live births during a specified period to women in a particular age group divided by the number of woman- years lived in that age group during the specified period. It is a valuable measure of the current childbearing performance of women. The total fertility rate (TFR) is the number of children a woman would have from age 15 to age 49 if she were to bear children at the prevailing age-spe- cific rates (or the average number of children a woman would have if she experienced a given set of age-specific fertility rates through her lifetime). It is obtained by summing the age-specific fertility rates and multiplying by five. It is a useful summary measure of age-specific fertility rates. The general fertility rate is the number of live births occurring during a specified period per 1,000 women of reproductive age (in this case,15-49). Finally, the crude birth rate is the number of births per 1,000 population. Measures of current fertility are estimated for the three-year period preceding the survey, which corresponds roughly to 1997-1999. The choice of the reference period is a compromise between providing the most recent information, avoiding problems of omission or displacement of births due to recall lapse for older women, and obtaining enough cases to reduce the sampling errors. 32 * Fertility The TFR in Tanzania is 5.6 births per woman. The TFR in rural areas is 6.5, compared with 3.2 in urban areas. In other words, rural women will have on average three more children than their urban counterparts. The crude birth rate in Tanzania is 41 births per 1,000 population. As with the TFR, there is a clear differential in this rate by residence: 44 in rural areas and 34 in urban areas. The general fertility rate in Tanzania is 195 per 1,000 women, with the rate being much higher in rural areas (223) than in urban areas (128). The age-specific fertility rates calculated on the basis of the three years preceding the survey indicate that Tanzanian women have a broad-peaked fertility pattern (age-specific fertility rates in age groups 20-24 and 25-29 differ only slightly), as shown in Figure 3.1. However, fertility declines sharply after the mid-30s, with the age-specific fertility rates being only 37 births per 1,000 women at age group 45-49. 3.2 FERTILITY DIFFERENTIALS Table 3.2 and Figure 3.2 present fertility differentials according to urban-rural residence, for Mainland/Zanzibar, and by level of education. The large urban-rural differentials in fertility measures have already been noted. Looking at differences between the Mainland and Zanzibar, the results show almost identical total fertility rates of 5.6 each. However, the data indicate large differences in fertility rates by level of education. Women who completed primary school have a total fertility rate of 4.9 children per woman, which is lower than the rates for women with incomplete primary education (5.1) and women with no education (6.5). Fertility * 33 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and mean number of children ever born to women age 40-49, by selected background characteristics, Tanzania 1999___________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant age 40-49___________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Education No education Incomplete primary Complete primary+ Total 3.16 5.8 5.33 6.48 10.8 7.11 5.55 9.4 6.67 3.12 5.7 5.30 6.48 10.8 7.10 5.59 9.4 7.32 6.53 8.4 7.04 5.13 9.1 6.91 4.85 10.0 5.29 5.55 9.4 6.69 ___________________________________________________ 1 Women age 15-49 years Table 3.2 also shows the mean number of live births for women age 40- 49. This figure is an indicator of com- pleted fertility or cumulative fertility for women who are approaching the end of their childbearing years. A comparison of the total fertility rate (5.6) and the cumu- lative fertility rate (6.7) gives an indica- tion of fertility trends over time. For all women, the mean number of live births has been decreasing in Tanzania, and this pattern is true for all groups. Nine percent of interviewed women reported that they were pregnant at the time of interview. Variations in this proportion are minimal except that urban women are far less likely than rural women to be pregnant. 3.3 FERTILITY TRENDS Fertility trends can be analysed in two ways. One is to compare the 1999 TRCHS data with previous data, namely the 1988 population census and the 1991-92 and 1996 TDHS surveys. 34 * Fertility Table 3.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates for 1988 Census and selected surveys, Tanzania 1988-1999 _____________________________________________________________ Census TDHS TDHS TRCHS Age group 1988 1991-92 1996 1999_____________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR women age 15-49 106 144 135 138 280 282 260 268 310 270 255 240 272 231 217 213 206 177 167 138 105 108 87 78 17 37 42 37 6.5 6.3 5.8 5.6 _____________________________________________________________ Note: Rates refer to the three-year period preceding the survey. Rates for the age group 45-49 may be slightly biased due to truncation. Source: Bureau of Statistics and Macro International, 1997:31 Table 3.4 Age-specific fertility rates Age-specific fertility rates for 5-year periods preceding the survey, Tanzania 1999 ______________________________________________ Number of years preceding the survey Age _________________________________ group 0-4 5-9 10-14 15-19 ______________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 137 139 159 167 271 280 272 310 233 270 250 278 210 231 272 [234] 148 191 [168] - 89 [134] - - [32] - - - ______________________________________________ Note: Age-specific fertility rates per 1,000 women. Esti- mates enclosed in brackets are truncated. Table 3.3 reveals that fer- tility has declined gradually but steadily over time, from 6.5 chil- dren per woman in the 1988 cen- sus to 5.6 children per woman in the 1999 TRCHS. For women in the two youngest age groups, the trend is erratic: first rising, then falling, then rising slightly again. However, for women age 25-44, the trend in age-specific rates is generally a steady decline. Rates for the oldest age group are again erratic, which could be due to the small sample size, which is subject to high sampling errors. A second way of analysing fertility trends is using TRCHS data alone. Because women age 50 and above were not interviewed in the survey, the rates are successively truncated as the number of years before the survey increases (see Table 3.4). The data also indicate a gradual decline in fertility in Tanzania during the past 20 years. 3.4 CHILDREN EVER BORN Table 3.5 shows the distribution of all women and currently married women by age and number of children ever born. The table also shows the mean number of children ever born to women in each age group, an indicator of the momentum of childbearing. Data on the number of children ever born reflect the accu- mulation of births over the past 30 years and therefore have limited relevance to current fertility levels, especially if the country has experienced a decline in fertility. The data indicate that one-fifth (20 percent) of all women age 15-19 years have given birth. On average, women have given birth to almost three children by their late 20s, five children by their late 30s, and seven children by the end of their childbearing years. As expected, currently married women have had more births than all women in all age groups. The reason is undoubtedly that currently married women are more consistently exposed to the risk of pregnancy. The percentage of women in their 40s who have never had children provides an indicator of the level of primary infertility—the proportion of women who are unable to bear children at all. Since voluntary childlessness is rare in Tanzania, it is likely that married women with no births are unable to bear children. The TRCHS results suggest that primary infertility is low, less than 2 percent. It should be noted that this estimate of primary infertility does not include women who may have had one or more births but who are unable to have more (secondary infertility). Fertility * 35 Table 3.5 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born and mean number of children ever born (CEB) and mean number of living children, according to five-year age groups, Tanzania 1999 ______________________________________________________________________________________________________ Mean Mean number Number of children ever born Number number of Age __________________________________________________________ of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ______________________________________________________________________________________________________ ALL WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 80.3 17.2 2.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 909 0.23 0.19 21.6 35.9 27.1 12.4 2.3 0.7 0.0 0.0 0.0 0.0 0.0 100.0 811 1.40 1.18 8.0 15.1 20.9 25.7 18.2 8.2 2.9 0.9 0.0 0.0 0.0 100.0 749 2.72 2.30 5.6 6.6 8.2 13.9 20.5 19.7 15.1 5.9 2.7 1.7 0.0 100.0 490 4.15 3.52 3.3 5.2 9.8 10.5 18.7 10.5 11.8 11.4 10.9 3.6 4.3 100.0 456 4.98 4.04 1.9 4.8 4.8 4.6 8.0 14.1 12.0 11.9 14.1 9.8 13.9 100.0 299 6.40 5.15 0.6 5.7 2.8 5.9 5.8 9.5 13.7 8.6 14.2 15.2 18.0 100.0 315 6.96 5.57 25.2 16.1 12.5 11.0 9.5 7.0 5.7 3.7 3.7 2.5 2.9 100.0 4,029 2.93 2.41 ______________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 46.4 44.5 7.3 1.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 227 0.64 0.53 10.1 35.6 35.7 14.2 3.5 1.0 0.0 0.0 0.0 0.0 0.0 100.0 550 1.68 1.45 5.7 11.6 20.9 28.3 19.9 9.3 3.3 1.1 0.0 0.0 0.0 100.0 615 2.92 2.48 3.8 5.6 7.5 10.6 21.5 21.2 17.3 7.2 3.2 2.0 0.0 100.0 407 4.43 3.80 2.5 4.2 7.9 10.5 19.6 8.8 12.6 11.5 12.6 4.5 5.4 100.0 364 5.26 4.24 2.0 2.1 2.2 5.0 6.7 15.8 12.6 12.4 14.0 11.9 15.4 100.0 239 6.78 5.43 0.0 6.0 3.5 3.5 6.4 9.9 11.8 8.9 16.1 14.8 19.1 100.0 251 7.10 5.72 8.5 16.1 15.6 13.5 12.5 9.2 7.4 4.9 5.0 3.4 3.9 100.0 2,653 3.77 3.11 3.5 BIRTHS INTERVALS A birth interval is defined as the length of time between two successive live births. Research has shown that short birth intervals adversely affect the health of mothers and their children's chances of survival. Table 3.6 shows the percent distribution of non-first births that occurred in the five years before the TRCHS by the number of months since the previous birth. The data show that most Tanzanian children are born after a “safe” interval of two or more years (83 percent). Fewer than one in five births (17 percent) occurs after an interval of less than 24 months. The median birth interval is 33 months. Birth interval length has not changed since 1991-92 nor since 1996. As expected, younger women have shorter birth intervals than older women, presumably because younger women are more fecund and want to build their families. The median birth interval for women age 15-19 is 25 months, compared with 37 months for women over age 40. A shorter median interval also prevails for children whose preceding sibling has died, compared with those whose preceding sibling is living. The overall median birth interval is about 7 months shorter for children whose preceding sibling died compared with children whose preceding sibling survived. This pattern presumably reflects a shortened breastfeeding period due to the death of the preceding sibling, as well as minimal use of contraceptives. 36 * Fertility Table 3.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth and median length of birth interval, according to selected demographic and socioeconomic characteristics, Tanzania 1999 _____________________________________________________________________________________________________ Median number of months Number of months since previous birth Number since ____________________________________________ of previous Characteristic 7-17 18-23 24-35 36-47 48+ Total births birth ______________________________________________________________________________________________________ Age of mother 15-19 20-29 30-39 40 + Birth order 2-3 4-6 7 + Sex of prior birth Male Female Survival of prior birth Dead Living Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Total (40.8) (6.9) (43.6) (1.4) (7.3) 100.0 26 24.5 7.1 13.4 45.3 19.8 14.5 100.0 1,287 31.2 2.8 8.8 36.3 25.1 27.1 100.0 931 36.4 1.7 11.4 34.8 22.3 29.8 100.0 267 37.3 8.0 12.4 38.5 22.0 19.1 100.0 1,099 32.6 3.2 10.7 43.2 19.7 23.2 100.0 933 33.3 3.1 10.5 41.3 25.4 19.6 100.0 480 34.4 5.7 11.4 39.7 22.2 21.1 100.0 1,314 33.6 4.8 11.5 42.0 21.4 20.2 100.0 1,198 33.0 19.0 17.7 31.8 13.6 18.0 100.0 404 27.3 2.7 10.2 42.5 23.4 21.2 100.0 2,108 34.1 4.3 6.3 23.9 22.6 42.9 100.0 387 43.2 5.5 12.3 43.9 21.7 16.7 100.0 2,125 32.2 5.2 11.3 40.9 21.8 20.8 100.0 2,439 33.4 4.2 5.8 23.3 22.8 43.9 100.0 369 43.7 5.4 12.3 44.0 21.7 16.7 100.0 2,070 32.2 8.6 15.1 38.5 21.1 16.7 100.0 73 31.6 11.0 17.1 39.5 20.3 12.1 100.0 37 30.1 6.1 13.1 37.4 21.9 21.5 100.0 36 33.6 4.7 11.6 40.5 22.8 20.4 100.0 759 33.7 5.7 12.0 39.2 23.5 19.5 100.0 420 33.3 5.5 11.0 41.9 20.6 20.9 100.0 1,263 33.0 4.8 13.1 33.2 22.2 26.8 100.0 70 35.1 5.3 11.4 40.8 21.8 20.7 100.0 2,512 33.3 ____________________________________________________________________________________________________ Note: The interval for multiple births is the number of months since the end of the preceding pregnancy that ended in a live birth. Numbers in parentheses are based on 25 to 49 respondents (unweighted). The median birth interval is 11 months longer in urban than in rural areas. Eleven percent of births in urban areas occur at intervals of less than 24 months, compared with 18 percent of rural births. By region, the results show that about 17 percent of births in the Mainland versus 24 percent of births in Zanzibar occur after intervals of less than 24 months. Birth intervals vary little by mother’s education. Fertility * 37 Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth and median age at first birth, according to current age, Tanzania 1999 ____________________________________________________________________________________________________ Women Median with Age at first birth Number age at no _____________________________________________ of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth ____________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 80.3 1.2 11.7 6.8 NA NA NA 100.0 909 a 21.6 3.1 23.3 29.8 17.9 4.3 NA 100.0 811 19.6 8.0 3.3 26.6 26.3 21.9 11.1 2.8 100.0 749 19.5 5.6 5.7 29.2 27.6 15.8 9.0 7.1 100.0 490 19.1 3.3 7.2 28.1 24.0 16.1 13.2 8.0 100.0 456 18.9 1.9 7.4 43.7 21.6 11.2 7.5 6.7 100.0 299 17.9 0.6 6.3 36.6 18.7 16.9 12.0 9.0 100.0 315 18.9 ____________________________________________________________________________________________________ NA = Not applicablea Omitted because less than 50 percent of women in the age group had a birth before entering the age group. 3.6 AGE AT FIRST BIRTH The age at which childbearing begins influences the number of children a woman bears throughout her reproductive period in the absence of any active control. Table 3.7 shows the percent distribution of women by age at first birth, according to age at the time of the survey. For women age 20 and older, the median age at first birth is presented in the last column of the table. The results confirm findings from the 1991-92 and 1996 TDHS which show that childbearing begins early in Tanzania, with most women becoming mothers before they reach the age of 20. The median age at first birth is between 18 and 20. The data show that the median age at first birth has increased slightly from around 18 or 19 for older women to over 19 for women in their early 20s. This slight change to later age at first birth is reflected in the smaller proportion of younger women whose first births occurred before age 15; about 6-7 percent of women in their 30s and 40s report having had their first birth before age 15, compared with only 1 percent of women age 15-19. Table 3.8 shows the median age at first birth among women aged 20-49 years by current age and selected background characteristics. There is not much variation in age at first birth by place of residence, with urban women having only slightly higher ages at first birth than rural women. The median age at first birth shows an inverse relationship with educational attainment: as low as 18 years for women with no education or incomplete primary education and increasing to 23 years for women with at least some secondary education. 3.7 TEENAGE PREGNANCY AND MOTHERHOOD Early childbearing, particularly among teenagers (those under 20 years of age) has negative demographic, socioeconomic, and sociocultural consequences. Teenage mothers are more likely to suffer from severe complications during delivery, which result in higher morbidity and mortality for both themselves and their children. In addition, the socioeconomic advancement of teenage mothers in the areas of educational attainment and accessibility to job opportunities may be curtailed. 38 * Fertility Table 3.8 Median age at first birth by background characteristics Median age at first birth among women 20-49, by current age and selected background characteristics, Tanzania 1999_____________________________________________________________________________________________________ Current age Women Women Background ____________________________________________________ age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49_____________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Education No education Incomplete primary Complete primary Secondary+ Total 20.5 19.8 19.9 20.1 17.7 18.8 19.8 19.5 19.3 19.3 18.9 18.7 18.1 18.9 19.0 18.9 19.6 19.5 19.1 18.9 17.9 18.9 19.2 19.0 a 19.8 19.9 20.2 17.7 18.8 19.8 19.5 19.3 19.3 18.9 18.7 18.1 19.0 19.0 18.9 a 19.6 19.7 18.3 17.0 15.7 19.0 18.7 18.6 19.2 17.7 18.0 17.5 19.1 18.2 18.1 18.7 18.9 17.4 19.5 18.4 18.1 18.5 18.4 19.8 19.3 19.5 20.2 18.0 19.2 19.6 19.5 a 23.5 23.5 23.0 20.4 23.2 a 23.4 19.6 19.5 19.1 18.9 17.9 18.9 19.2 19.0 _____________________________________________________________________________________________________ a Omitted because less than 50 percent of women in the age group had a birth before entering the age group. Table 3.9 Teenage pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Tanzania 1999_______________________________________________________________ Percentage who are: Percentage_________________ who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women_______________________________________________________________ Age 15 16 17 18 19 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Total 2.0 0.6 2.6 217 5.8 4.7 10.5 210 16.9 7.5 24.4 182 39.1 6.9 46.0 137 47.9 6.0 53.9 163 20.4 2.6 23.1 217 19.4 5.5 25.0 692 19.9 4.9 24.7 884 20.7 2.7 23.4 208 19.6 5.5 25.1 676 12.8 4.5 17.2 25 8.9 6.8 15.7 12 16.3 2.3 18.6 13 23.9 8.8 32.7 189 15.9 0.8 16.8 318 22.2 6.5 28.7 356 8.5 3.8 12.3 46 19.7 4.9 24.5 909 Table 3.9 shows the percentage of women age 15-19 years who are mothers or pregnant with their first child by background characteristics. One in five teenage women in Tanzania is a mother and another 5 percent are pregnant with their first child. Thus, 25 percent of teen- age women have begun child- bearing. There has been a slight decline in this proportion since the 1996 TDHS, which indicated that 26 percent of women age 15-19 had begun childbearing (21 percent had delivered a child and 5 percent were pregnant with their first child) (Bureau of Statistics and Macro International Inc., 1997:38). As expected, the propor- tion of women who have begun childbearing rises rapidly with age, from 3 percent of those age 15 to 54 percent of those age 19 (see Figure 3.3). Those residing in the Mainland and especially those with no education are also more likely than others to have begun childbearing. Fertility * 39 Fertility Regulation * 41 FERTILITY REGULATION 4 Knowledge of family planning methods and where they can be obtained is necessary in deciding whether to adopt a contraceptive method and which method to choose. This chapter presents information on contraceptive knowledge, attitudes, behaviour, and sources. In presenting the findings on fertility regulation, the primary focus is on women of reproductive age, with some analogous survey results from men, who play an important role in the realisation of reproductive goals. 4.1 KNOWLEDGE OF FAMILY PLANNING METHODS As in the 1996 TDHS, information about knowledge of family planning methods among women and men was collected in two ways in the 1999 TRCHS. First, respondents were asked to name methods or ways couples can use to prevent or delay pregnancy. When a respondent failed to mention a method spontaneously, the interviewer described the method and then asked if the respondent knew it. Using this approach, information was collected for nine modern family planning methods: female and male sterilisation, the pill, IUD, injectables, implants, male condom, female condom, and vaginal methods (foam/jelly/diaphragm). Information was also collected on three traditional methods: the calendar (rhythm) method, lactational amenorrhoea, and withdrawal. Provision was also made in the questionnaire to record any other methods named spontaneously by respondents. Both prompted and unprompted knowledge are combined in this report. Table 4.1 shows the level of knowledge of specific contraceptives among all women and men, currently married women and men, sexually active unmarried women and men, and women with no sexual experience. The level of knowledge of any contraceptive method among all women age 15-49 years is high; almost all women (91 percent) have heard of at least one contraceptive method. Almost all of the women who have heard of any contraceptive method have heard of a modern method (91 percent), while slightly more than a half (58 percent) of the women have heard of a traditional contraceptive method. The results show that contraceptive knowledge is higher among currently married women (95 percent) than sexually active unmarried women (92 percent) and women with no sexual experience (65 percent). The most commonly recognised contraceptive methods among all women age 15-49 in Tanzania are the pill (86 percent), male condoms (83 percent), injectables (81 percent), female sterilisation (63 percent), the IUD (54 percent), female condoms (41 percent), and implants (40 percent). About a quarter of women (27 percent) know about male sterilisation, and about a fifth (21 percent) know about vaginal contraceptives (diaphragm/foam/jelly). Concerning the traditional methods, a substantial number of women know about withdrawal (39 percent) and periodic abstinence (37 percent), and one-quarter (25 percent) have heard about lactational amenorrhoea. Knowledge of other methods was found to be generally low (18 percent). Men are slightly more likely than women to have heard of at least one family planning method (93 versus 91 percent). As expected, men are more likely than women to know about male- oriented methods and less likely to know about female methods. For example, 90 percent of men compared with 83 percent of women know about the male condom and 33 percent of men compared with 27 percent of women know about male sterilisation. Men are also more knowledgeable of some traditional contraceptive methods; 47 percent of men compared with 42 * Fertility Regulation Table 4.1 Knowledge of contraceptive methods Percentage of all women 15-49 and men 15-59, of currently married women and men, of sexually active unmarried women and men, and of women with no sexual experience who know specific contraceptive methods, Tanzania 1999_______________________________________________________________________________________________ Women Men_______________________________________ ________________________ Sexually Sexually Currently active No Currently active Contraceptive All married unmarried sexual All married unmarried method women women women experience men men men_______________________________________________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Male condom Female condom Female sterilisation Male sterilisation Implants Any traditional method Periodic abstinence Withdrawal LAM Other Number of respondents Mean number of methods 90.9 95.3 91.6 65.4 92.8 97.1 96.1 90.5 94.9 90.7 65.3 92.0 96.0 95.8 86.3 93.0 86.4 48.0 78.9 89.2 80.3 53.8 59.5 60.6 17.0 39.7 51.3 30.4 80.9 87.7 81.7 41.5 67.7 80.3 65.6 20.6 22.7 30.2 2.6 14.9 19.1 12.4 83.2 87.2 86.6 57.7 90.4 94.4 95.4 41.4 45.5 51.6 10.9 44.8 53.3 40.5 62.5 69.1 64.3 24.9 63.1 75.7 57.9 27.3 29.5 32.9 7.9 32.8 40.0 30.3 40.3 44.7 46.4 9.4 21.7 28.2 16.5 58.4 66.2 67.4 14.0 61.7 76.4 51.2 36.6 40.0 47.1 11.0 43.0 53.2 34.1 39.2 45.6 45.8 4.8 46.9 59.2 41.2 24.6 28.1 27.1 5.0 20.7 28.4 13.0 18.4 22.4 17.4 1.2 14.4 20.5 7.4 4,029 2,653 366 496 3,542 2,063 551 6.2 6.7 6.8 2.4 5.8 6.9 5.3 ______________________________________________________________________________________________ LAM = Lactational amenorrhoea method 39 percent of women know about withdrawal and 43 percent of men as compared with 37 percent of women know about periodic abstinence. However, men are much less likely than women to have heard about female-oriented methods, especially the IUD, injectables, implants, and the pill. On average, all women and men know about six contraceptive methods, whereas married women and men know about seven methods. Table 4.2 shows the correspondence in contraceptive knowledge between husbands and wives for the 1,820 couples interviewed in the 1999 TRCHS sample. Knowledge of at least one contraceptive method by both spouses was found to be high (95 percent). For couples in which only one partner knows of a method, husbands are more likely to know about methods in which they take part, such as male condoms, male sterilisation, periodic abstinence, and withdrawal, while wives are more likely to know about methods like the pill, IUD, injectables, vaginal methods, and implants. Surprisingly, however, husbands are more likely than their wives to have heard of female sterilisation, the female condom, and lactational amenorrheoa. Some methods were not recognised by either the husband or the wife, the most notable being vaginal methods, male sterilisation, and implants, which were unknown to 65 percent, 48 percent, and 46 percent of the couples, respectively. Fertility Regulation * 43 Table 4.2 Couples’ knowledge of contraceptive methods Percent distribution of couples by knowledge of specific contraceptive methods, Tanzania 1999___________________________________________________________________ Wife Husband knows Both knows method, Neither Contraceptive know method, husband knows method method wife doesn’t doesn’t method Total ___________________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Male condom Female condom Female sterilisation Male sterilisation Implants Any traditional method Periodic abstinence Withdrawal LAM Other 94.5 3.0 1.7 0.9 100.0 93.5 2.9 2.3 1.3 100.0 86.0 3.4 7.8 2.8 100.0 38.5 13.8 21.3 26.4 100.0 73.0 7.3 15.0 4.6 100.0 6.1 13.1 16.2 64.6 100.0 85.8 8.9 2.6 2.7 100.0 29.7 24.8 15.0 30.5 100.0 57.0 19.5 12.9 10.6 100.0 16.6 23.5 12.1 47.8 100.0 18.7 9.5 25.3 46.4 100.0 56.3 20.1 10.3 13.4 100.0 26.6 26.9 12.3 34.2 100.0 35.8 24.0 11.6 28.6 100.0 11.7 17.2 16.0 55.0 100.0 6.4 13.6 15.5 64.4 100.0 __________________________________________________________________ Note: Table is based on 1,820 couples LAM = Lactational amenorrhoea method 44 * Fertility Regulation Figure 4.1 Trends in Contraceptive Knowledge Among Women Age 15-49, 1991-1999 74 72 44 84 84 47 91 91 58 Any Method Any Modern Method Any Traditional Method 0 20 40 60 80 100 Percent 1991-92 TDHS 1996 TDHS 1999 TRCHS 4.2 TRENDS IN CONTRACEPTIVE KNOWLEDGE There has been a substantial increase over time in the proportion of women and men who are aware of contraceptive methods. The proportion of all women who have heard of at least one contraceptive method has increased from 74 percent in 1991-92 to 84 percent in 1996 to 91 percent in 1999 (see Figure 4.1). Knowledge of specific contraceptive methods has increased more dramatically. In 1991-92, only 40 percent of women had heard of the injectable contraceptive; by 1999, this figure had increased to 81 percent. Similarly, the proportion of women who know of male condoms grew from 51 percent among all women to 83 percent in 1999. Generally, the level of knowledge among all women has increased since 1996 for all methods except vaginal contraceptives (diaphragm/foam/jelly), which declined from 31 percent in 1996 to 21 percent in 1999. The largest increases in knowledge among women over the three-year period between 1996 and 1999 occurred for implants (from 24 percent to 40 percent), male condoms (from 72 percent to 83 percent), and injectables (from 71 percent to 81 percent). For men, the increase in the proportion who have heard of any method has been less steep than for women—from 89 percent in 1996 to 93 percent in 1999. Still, the level of knowledge has increased since 1996 for all methods except vaginal contraceptives (which declined from 35 to 15 percent of all men) and male sterilisation (which declined from 35 to 33 percent). Both women and men registered a substantial level of knowledge of the female condom, which was not asked about in prior surveys. 4.3 EVER USE OF FAMILY PLANNING METHODS All women and men interviewed in the 1999 TRCHS who said that they had heard of a contraceptive method were asked if they had ever used that method. In this context, ever use refers Fertility Regulation * 45 to the use of a contraceptive method at any time with no distinction between past and current use. Tables 4.3.1 and 4.3.2 show the percentage of women and men who have ever used contraceptive methods, according to method, age, and marital status. The results show that 41 percent of women 15-49 have used a contraceptive method at some time in their lives. Women have used modern methods more frequently (30 percent) than traditional methods (21 percent). The modern contraceptive methods commonly used by women are the pill (16 percent), injectables (12 percent), and male condoms (11 percent); while the traditional methods commonly used by women are withdrawal (11 percent), periodic abstinence (8 percent) and lactational amenorrhoea (4 percent). Ever use of any contraceptive method is higher for sexually active unmarried women (52 percent) than for currently married women (47 percent). With regard to men (Table 4.3.2), the results show that almost half (48 percent) of all men have used a method at some time, with modern methods having been used more frequently (38 percent) than traditional methods (26 percent). The modern contraceptive methods commonly used by men are the male condom (28 percent), the pill (12 percent), and injectables (7 percent); while the traditional methods commonly used by men are withdrawal (15 percent) and periodic abstinence (14 percent). As opposed to what is observed among women, ever use of any contraceptive is higher for currently married men (60 percent) than sexually active unmarried men (48 percent). However, the order is reversed for ever use of any modern contraceptive, which is slightly higher among sexually active unmarried men (46 percent) than among currently married men (44 percent). 46 * Fertility Regulation Table 4.3.1 Ever use of contraception: women Percentage of all women, of currently married women, and of sexually active unmarried women who have ever used a contraceptive method, by method and age, Tanzania 1999 _____________________________________________________________________________________________________________________ Modern method Traditional method ____________________________________________________ _______________________________ Any Any Female tradi- Periodic Number Any modern Inject- Male Female sterili- Im- tional absti- With- Other of Age method method Pill IUD ables condom condom sation plant method nence drawal LAM methods women _____________________________________________________________________________________________________________________ ALL WOMEN ____________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 13.3 10.1 1.8 0.0 1.7 7.6 0.3 0.0 0.0 5.2 3.0 1.8 0.6 0.3 909 46.1 35.9 18.3 0.7 11.8 17.1 0.1 0.1 0.2 21.7 10.1 11.8 2.8 1.1 811 52.3 39.8 23.6 2.9 19.2 13.6 0.3 1.0 0.8 25.4 10.6 14.1 5.6 3.3 749 51.5 37.2 24.4 2.7 16.4 9.1 0.0 1.7 0.8 25.9 8.3 13.3 5.2 6.9 490 50.0 35.0 19.9 1.6 14.8 12.5 0.0 2.0 0.3 30.0 7.8 17.7 10.1 4.8 456 50.6 35.3 21.2 2.1 15.0 6.0 0.0 5.9 0.7 30.7 11.4 16.3 4.2 6.8 299 36.6 24.4 14.6 4.7 10.3 1.8 0.0 6.0 0.0 18.8 8.2 7.9 2.9 3.3 315 40.5 29.9 16.4 1.7 11.9 10.8 0.1 1.5 0.4 20.6 8.1 10.9 4.1 3.1 4,029 _____________________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ____________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 24.5 15.5 5.3 0.2 3.6 8.8 0.0 0.0 0.0 11.8 6.5 4.4 1.6 0.3 227 45.0 32.6 17.9 0.5 11.8 12.5 0.0 0.1 0.0 22.1 8.0 13.1 3.8 1.4 550 52.1 38.6 23.1 2.8 18.7 12.7 0.1 1.3 0.9 24.5 9.7 14.3 5.6 3.2 615 52.8 37.4 24.0 2.4 16.5 7.5 0.0 2.0 0.9 26.9 8.3 14.7 4.8 7.4 407 50.6 33.4 19.8 1.0 14.9 11.0 0.0 1.6 0.0 33.4 8.4 19.8 11.6 5.4 364 48.8 31.8 18.5 1.2 16.3 5.0 0.0 5.4 0.9 29.7 9.4 18.9 3.8 5.3 239 40.3 26.8 14.8 5.5 11.3 1.3 0.0 7.1 0.0 20.6 9.3 9.0 2.3 3.6 251 46.7 32.7 19.0 1.9 14.2 9.5 0.0 2.0 0.4 24.6 8.6 13.9 5.1 3.8 2,653 ___________________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED WOMEN ___________________________________________________________________________________________________________________ Total 51.9 44.4 24.8 1.8 13.3 25.9 0.7 0.1 0.4 27.1 12.9 10.5 2.5 4.9 366 _____________________________________________________________________________________________________________________ Note: Less than one-half of one percent of women reported ever using diaphragm/foam/jelly. LAM = Lactational amenorrhoea method There has been a gradual increase in the level of ever use of modern contraceptives among women and men in recent years. In 1991-92, 14 percent of all women had used a modern method at some time, compared with 21 percent in 1994, 23 percent in 1996, and 30 percent in 1999. Absolute increases in ever use were greatest for injectables. Among men, ever use of a modern contraceptive method increased from 20 percent in 1991-92 to 24 percent in 1994, 26 percent in 1996, and to 38 percent in 1999. The increase in ever use was greatest for the male condom. 4.4 CURRENT USE OF FAMILY PLANNING METHODS Level of Contraceptive Use The level of current use of contraceptive methods is one of the indicators most frequently used to assess the success of family planning programme activities. It is also widely used as a measure in analysing the determinants of fertility. This section focuses on the levels and differentials in current use of family planning with particular emphasis on the method mix among users. Trends in contraceptive use in Tanzania are also described. Fertility Regulation * 47 Table 4.3.2 Ever use of contraception: men Percentage of all men, of currently married men, and of sexually active unmarried men who have ever used a contraceptive method, by method and age, Tanzania 1999 ____________________________________________________________________________________________________________________ Modern method Traditional method ______________________________________________________ ______________________________ Any Any Female tradi- Periodic Number Any modern Inject- Male Female sterili- Im- tional absti- With- Other of Age method method Pill IUD ables condom condom sation plant method nence drawal LAM methods men _____________________________________________________________________________________________________________________ ALL MEN ____________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 17.8 16.5 1.4 0.0 0.4 16.0 0.3 0.0 0.1 5.3 2.6 3.3 0.0 0.2 790 48.7 44.2 4.9 0.0 1.9 42.0 1.4 0.1 0.4 17.9 8.6 11.1 0.2 0.5 540 63.9 53.8 18.9 0.5 12.4 41.4 1.6 0.0 0.1 30.5 16.0 16.2 5.5 2.3 546 54.3 41.4 14.9 2.0 8.2 31.3 1.3 0.4 0.0 31.5 17.8 20.1 3.8 3.8 371 66.5 50.7 18.2 1.4 12.4 36.5 0.3 1.6 0.7 40.1 21.4 24.3 8.8 3.3 445 59.5 43.0 25.0 2.2 9.0 23.6 0.3 5.2 0.0 44.0 24.4 23.3 10.1 7.4 219 52.6 35.6 16.6 1.1 13.2 17.5 0.0 3.7 0.0 39.5 20.2 25.2 4.1 4.7 259 53.7 35.6 13.7 5.1 8.8 12.9 0.0 5.9 1.1 37.6 16.9 18.4 3.8 11.0 201 47.9 20.0 10.2 0.2 7.2 4.4 0.0 5.0 0.0 35.8 17.3 12.0 10.5 7.2 171 48.2 37.7 11.9 1.0 7.1 27.9 0.7 1.4 0.3 26.4 13.7 15.0 4.0 3.1 3,542 ____________________________________________________________________________________________________________________ CURRENTLY MARRIED MEN1 ____________________________________________________________________________________________________________________ 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 55.9 45.8 10.0 0.0 3.9 40.2 1.5 0.0 1.0 25.3 12.3 15.9 0.7 1.6 158 65.1 52.4 21.4 0.7 14.0 36.6 1.5 0.0 0.1 35.3 18.1 18.6 7.0 2.9 401 55.5 41.7 15.8 2.2 9.1 30.5 1.5 0.4 0.0 32.1 17.8 19.7 3.9 4.2 334 69.3 52.4 18.7 1.2 14.4 36.5 0.3 1.8 0.8 43.2 23.7 26.6 10.0 2.9 381 62.8 44.1 27.4 1.9 9.1 22.1 0.0 6.0 0.0 47.7 26.8 24.8 11.1 8.4 193 53.2 35.5 16.3 1.0 14.2 16.3 0.0 4.1 0.1 41.6 21.4 25.9 4.4 4.9 236 56.4 37.3 14.6 5.5 9.4 12.8 0.0 6.3 1.1 40.1 18.2 19.5 4.1 11.8 187 52.1 21.9 11.3 0.3 8.0 4.6 0.0 5.5 0.0 38.8 18.4 12.7 11.6 7.9 154 60.0 43.5 17.5 1.5 11.1 27.5 0.7 2.4 0.4 37.9 19.9 21.0 6.7 4.9 2,063 _____________________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED MEN _____________________________________________________________________________________________________________________ Total 48.4 45.9 8.1 0.5 1.8 44.0 1.4 0.1 0.1 16.0 6.3 11.4 0.7 0.5 551 ____________________________________________________________________________________________________________________ Note: One-tenth of one percent of men reported ever using diaphragm/foam/jelly. LAM = Lactational amenorrhoea method 1There are too few married men age 15-19 to show separately. Overall, 22 percent of all women in Tanzania are currently using a contraceptive method, with 16 percent using modern methods (Table 4.4.1). The most widely used methods are injectables (5 percent), the pill (5 percent), and the male condom (4 percent). Less than 2 percent of women have been sterilised. Seven percent of women are currently using traditional methods, the most popular among these being withdrawal (3 percent). Contraceptive use is lowest among teenagers (15-19 years) and older women (45-49 years); at all other age groups, use is surprisingly constant at 26-29 percent of women. The lower levels of contraceptive use among younger women may reflect lower levels of sexual activity or a desire to start their families, while the drop in contraceptive use among older women may reflect declining fecundity or lower levels of sexual activity. Male condoms are the most popular contraceptives currently used by teenage women (15-19 years), while the pill and injectables are the most widely used methods among women 20-39 years. Among women in their early 40s, 48 * Fertility Regulation Table 4.4.1 Current use of contraception: women Percent distribution of all women, of currently married women, and of sexually active unmarried women by contraceptive method currently used, according to age, Tanzania 1999 _____________________________________________________________________________________________________________ Modern method Traditional method ______________________________________ ______________________________ Any Any Female tradi- Periodic Not Number Any modern Inject- Male sterili- tional absti- With- Other currently of Age method method Pill IUD ables condom sation method nence drawal LAM methods using Total women _____________________________________________________________________________________________________________ ALL WOMEN _____________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 7.7 5.8 1.1 0.0 0.7 3.7 0.0 1.9 1.2 0.4 0.3 0.3 92.3 100.0 909 29.4 22.0 8.2 0.3 7.2 6.0 0.1 7.4 2.9 2.8 1.7 0.2 70.6 100.0 811 26.0 18.3 5.4 0.7 7.5 3.5 1.0 7.7 1.9 3.3 1.3 1.4 74.0 100.0 749 27.5 17.8 7.7 0.7 6.6 0.7 1.7 9.7 3.4 3.3 2.2 1.2 72.5 100.0 490 27.5 19.0 5.5 0.3 5.9 5.3 2.0 8.4 1.5 3.5 2.5 0.9 72.5 100.0 456 28.7 16.1 1.3 0.2 8.0 0.7 5.9 12.6 4.2 5.0 1.0 2.4 71.3 100.0 299 15.4 12.3 0.5 1.6 3.5 0.7 6.0 3.1 1.4 0.6 0.3 0.9 84.6 100.0 315 22.3 15.6 4.6 0.5 5.4 3.5 1.5 6.7 2.2 2.5 1.3 0.9 77.7 100.0 4,029 _____________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ____________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 10.6 6.5 2.9 0.0 2.1 1.4 0.0 4.1 1.3 1.7 1.1 0.0 89.4 100.0 227 28.4 20.4 8.4 0.3 6.8 4.9 0.1 8.0 2.6 3.0 2.4 0.0 71.6 100.0 550 24.9 16.4 4.1 0.3 7.6 3.1 1.3 8.5 1.6 4.0 1.5 1.5 75.1 100.0 615 29.5 19.1 8.9 0.9 6.2 0.5 2.0 10.4 3.5 3.9 2.2 1.2 70.5 100.0 407 28.4 18.5 5.9 0.0 5.6 5.3 1.6 10.0 1.7 4.4 3.1 0.8 71.6 100.0 364 30.7 17.2 1.3 0.0 9.8 0.7 5.4 13.6 3.6 6.3 1.2 2.5 69.3 100.0 239 16.9 13.5 0.6 2.1 3.3 0.3 7.1 3.5 1.3 0.7 0.3 1.1 83.1 100.0 251 25.4 16.9 5.3 0.4 6.3 2.7 2.0 8.5 2.2 3.5 1.9 1.0 74.6 100.0 2,653 ____________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED WOMEN _____________________________________________________________________________________________________________ Total 33.0 26.1 9.3 0.7 5.5 9.5 0.1 7.0 4.9 0.6 0.5 2.0 67.0 100.0 366 ___________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method injectables are clearly the most popular method, whereas women in their late 40s are more likely to have been sterilised. Current use of contraception among men is slightly higher than among women. Twenty- nine percent of all men age 15-59 in Tanzania are currently using a contraceptive method, with 21 percent using modern methods and 9 percent using traditional methods (Table 4.4.2). The contraceptive methods most widely used by men are the male condom (12 percent), periodic abstinence (4 percent), and the pill (4 percent). The major difference in current use among women and men is the proportionally higher use of male condoms and periodic abstinence by men. Among women, current use of any contraceptive method is higher among married women (25 percent) than among all women (22 percent), but it is highest among unmarried sexually active women, 33 percent of whom are using some method. Among men, married men are the Fertility Regulation * 49 Table 4.4.2 Current use of contraception: men Percent distribution of all men, of currently married men, and of sexually active unmarried men by contraceptive method currently used, according to age, Tanzania 1999 ____________________________________________________________________________________________________________ Modern method Traditional method ______________________________________ _______________________________ Any Any Female tradi- Periodic Not Number Any modern Inject- Male sterili- tional absti- With- Other currently of Age method method Pill IUD ables condom sation method nence drawal LAM methods using Total men ____________________________________________________________________________________________________________ ALL MEN ____________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 11.8 11.0 0.2 0.0 0.1 10.6 0.0 0.8 0.6 0.3 0.0 0.0 88.2 100.0 790 25.7 23.5 1.9 0.0 0.5 20.9 0.1 2.2 1.9 0.3 0.0 0.2 74.3 100.0 540 40.1 28.4 7.2 0.0 4.9 16.0 0.0 11.7 5.6 2.6 3.5 0.3 59.9 100.0 546 32.9 22.1 7.7 0.9 3.3 9.7 0.4 10.8 5.3 4.2 0.9 0.5 67.1 100.0 371 40.6 27.5 6.4 0.4 4.7 14.6 1.3 13.1 3.7 5.8 2.6 1.0 59.4 100.0 445 43.6 25.8 7.3 0.4 4.5 8.3 5.2 17.7 7.8 3.9 4.9 1.1 56.4 100.0 219 36.4 20.2 3.6 0.0 7.0 5.8 3.7 16.2 9.7 4.6 1.5 0.5 63.6 100.0 259 27.1 17.2 2.3 1.5 4.8 2.9 5.7 9.9 5.0 1.2 1.8 1.8 72.9 100.0 201 24.0 12.5 2.4 0.0 5.1 0.0 5.0 11.5 5.9 2.3 3.3 0.0 76.0 100.0 171 29.3 20.8 4.0 0.3 3.1 12.0 1.4 8.5 4.1 2.4 1.6 0.5 70.7 100.0 3,542 ___________________________________________________________________________________________________________ CURRENTLY MARRIED MEN1 ____________________________________________________________________________________________________________ 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 22.7 17.7 4.9 0.0 1.5 11.3 0.0 5.0 4.9 0.0 0.0 0.0 77.3 100.0 158 41.7 26.1 8.6 0.0 6.2 11.0 0.0 15.6 7.2 3.5 4.8 0.5 58.3 100.0 401 34.9 23.0 8.6 1.0 3.7 9.3 0.4 11.9 5.8 4.6 1.0 0.5 65.1 100.0 334 43.8 28.5 7.3 0.5 5.5 13.7 1.5 15.3 4.3 6.7 3.1 1.2 56.2 100.0 381 47.2 27.0 8.3 0.5 5.1 7.1 6.0 20.2 8.9 4.5 5.6 1.2 52.8 100.0 193 37.9 20.1 3.7 0.0 7.7 4.6 4.0 17.9 10.6 5.1 1.6 0.6 62.1 100.0 236 29.0 18.4 2.4 1.6 5.1 3.1 6.1 10.6 5.4 1.3 2.0 1.9 71.0 100.0 187 25.7 13.9 2.7 0.0 5.7 0.0 5.5 11.9 6.3 2.0 3.6 0.0 74.3 100.0 154 37.0 23.0 6.4 0.4 5.2 8.6 2.3 14.0 6.6 3.9 2.8 0.8 63.0 100.0 2,063 ____________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED MEN ____________________________________________________________________________________________________________ Total 30.5 29.5 1.7 0.0 0.3 27.2 0.1 1.0 0.3 0.7 0.0 0.2 69.5 100.0 551 ____________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method 1 There are too few married men age 15-19 to show separately most likely to be using a method (37 percent), while unmarried sexually active men are only slightly more likely than all men to be using a method (31 versus 29 percent). The male condom is the overwhelming choice among unmarried sexually active men (27 percent) and it is more popular than the pill among unmarried sexually active women. This preference for the male condom among unmarried women and men suggests that it is a popular method for premarital sex because of the dual protection it offers: protection from pregnancy and protection from sexually transmitted diseases. 50 * Fertility Regulation Table 4.5.1 Current use of contraception by background characteristics: women Percentage distribution of all women by contraceptive method currently used, according to selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________________ Modern method Traditional method _____________________________________ ____________________________ Any Any Female tradi- Periodic Not Number Background Any modern Inject- Male sterili- tional absti- With- Other currently of characteristic method method Pill IUD ables condom sation method nence drawal LAM methods using Total women _______________________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + No. of living children None 1 2 3 4 5 6+ Total 33.0 28.9 8.9 1.2 9.9 6.7 1.8 4.1 2.8 0.8 0.0 0.9 67.0 100.0 1,122 18.2 10.5 3.0 0.2 3.6 2.2 1.4 7.7 2.0 3.1 1.8 0.9 81.8 100.0 2,907 22.5 15.7 4.6 0.5 5.4 3.5 1.6 6.8 2.2 2.5 1.3 0.9 77.5 100.0 3,929 33.4 29.3 8.9 1.2 10.0 6.9 1.8 4.1 2.9 0.8 0.0 0.9 66.6 100.0 1,088 18.3 10.6 2.9 0.2 3.6 2.3 1.5 7.8 2.0 3.2 1.8 0.9 81.7 100.0 2,841 13.6 10.9 4.8 0.6 3.9 1.1 0.7 2.7 1.2 0.9 0.4 0.2 86.4 100.0 100 6.8 4.9 1.1 0.2 2.5 0.0 1.1 2.0 1.0 0.8 0.2 0.0 93.2 100.0 44 18.9 15.6 7.6 0.8 4.9 2.0 0.3 3.3 1.4 0.9 0.5 0.4 81.1 100.0 56 14.0 6.8 1.8 0.2 2.5 1.3 1.0 7.2 1.4 3.2 1.7 0.9 86.0 100.0 1,093 17.8 11.7 3.8 0.3 3.2 2.0 2.2 6.1 2.5 1.6 1.3 0.9 82.2 100.0 854 26.8 20.5 6.4 0.3 7.9 4.5 1.3 6.3 2.0 2.5 1.2 0.8 73.2 100.0 1,866 42.8 33.5 6.3 3.9 6.7 12.0 3.5 9.2 6.3 2.4 0.0 1.6 57.2 100.0 215 7.3 5.9 1.7 0.0 0.1 3.9 0.0 1.4 1.4 0.0 0.0 0.3 92.7 100.0 1,104 28.0 20.8 6.6 1.0 6.2 5.6 1.2 7.2 2.9 3.0 1.2 0.3 72.0 100.0 733 26.4 19.7 6.4 0.6 9.4 1.9 1.1 6.7 2.3 2.0 1.9 0.8 73.6 100.0 618 29.1 21.5 4.9 0.6 6.6 6.4 2.6 7.6 2.7 2.8 1.2 1.2 70.9 100.0 427 25.6 18.2 6.1 0.0 7.1 3.4 1.6 7.4 1.1 2.6 2.0 1.7 74.4 100.0 381 28.5 18.0 7.8 0.1 8.2 0.5 1.4 10.5 2.0 6.6 1.1 0.8 71.5 100.0 276 30.3 16.2 2.7 1.1 6.8 0.5 5.1 14.1 3.4 5.2 3.2 2.2 69.7 100.0 489 22.3 15.6 4.6 0.5 5.4 3.5 1.5 6.7 2.2 2.5 1.3 0.9 77.7 100.0 4,029 _______________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method Differentials in Contraceptive Use Some women are more likely to use contraceptive methods than others (Table 4.5.1 and Figure 4.2). The proportion of women currently using contraceptives in urban areas (33 percent) is almost double that of rural areas (18 percent). Among both rural and urban women, injectables are the most popular method, followed by the pill. The third most used contraceptive method is the condom among urban women and withdrawal among rural women. There are differences in the levels of current use between the Mainland and Zanzibar. Women who live in the Mainland are more likely to use a contraceptive method (23 percent) than women who live in Zanzibar (14 percent). Contraceptive use is particularly low in Pemba (7 percent), in comparison with Unguja (19 percent). Compared with the 1996 TDHS, contraceptive use has increased in all areas except Pemba, where it has remained unchanged. Education is clearly related to the use of contraceptive methods. Only 14 percent of women with no formal education are currently using any contraceptive, compared with 18 percent of women with incomplete primary school, 27 percent of women who have completed primary school, and 43 percent of women with at least some secondary education. Women with no education are Fertility Regulation * 51 Table 4.5.2 Current use of contraception by background characteristics: men Percentage distribution of all men by contraceptive method currently used, according to selected background characteristics, Tanzania 1999 ______________________________________________________________________________________________________________ Modern method Traditional method __________________________________ _____________________________ Any Any Female tradi- Periodic Not Number Background Any modern Inject- Male sterili- tional absti- With- Other currently of characteristic method method Pill IUD ables condom sation method nence drawal LAM methods using Total men _______________________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + No. of living children None 1 2 3 4 5 6+ Total 38.5 31.8 6.8 0.6 3.9 19.0 1.2 6.7 4.1 1.4 1.2 0.2 61.5 100.0 941 26.0 16.8 3.0 0.1 2.8 9.5 1.4 9.2 4.1 2.8 1.8 0.6 74.0 100.0 2,601 29.7 21.1 4.0 0.3 3.1 12.2 1.4 8.6 4.1 2.4 1.7 0.5 70.3 100.0 3,452 39.0 32.3 6.9 0.6 4.0 19.4 1.3 6.7 4.1 1.4 1.2 0.2 61.0 100.0 909 26.3 17.0 3.0 0.1 2.9 9.6 1.4 9.3 4.1 2.8 1.8 0.6 73.7 100.0 2,543 16.4 11.3 4.3 0.2 1.4 5.2 0.2 5.1 2.8 1.7 0.5 0.0 83.6 100.0 90 9.9 3.7 1.4 0.3 0.5 1.0 0.6 6.2 3.6 1.7 0.8 0.0 90.1 100.0 36 20.7 16.3 6.2 0.2 2.0 8.0 0.0 4.4 2.3 1.8 0.3 0.0 79.3 100.0 55 14.9 8.6 1.7 0.0 1.6 2.8 2.5 6.3 3.0 1.5 1.5 0.3 85.1 100.0 495 22.7 15.1 3.3 0.4 2.2 7.3 1.8 7.7 3.7 2.2 1.2 0.6 77.3 100.0 1,000 34.5 24.8 4.6 0.0 3.7 15.8 0.7 9.6 4.5 2.8 2.0 0.3 65.5 100.0 1,791 46.8 38.8 7.5 2.0 5.0 21.6 1.8 8.1 4.6 2.1 0.7 1.4 53.2 100.0 256 16.1 15.5 0.8 0.0 0.2 14.4 0.0 0.6 0.4 0.2 0.0 0.1 83.9 100.0 1,482 36.8 28.4 7.3 0.5 5.3 14.8 0.3 8.4 6.5 1.3 0.6 0.3 63.2 100.0 395 39.5 26.0 7.9 0.0 2.6 14.9 0.7 13.5 7.0 2.3 3.6 0.5 60.5 100.0 369 43.4 28.7 6.0 0.9 5.4 14.3 2.1 14.7 5.3 5.5 3.3 0.6 56.6 100.0 314 35.7 21.9 3.8 0.0 4.1 12.5 1.3 13.8 3.5 7.3 2.3 0.7 64.3 100.0 213 38.1 22.7 11.0 0.0 7.3 3.0 1.4 15.4 5.2 7.7 1.9 0.6 61.9 100.0 194 38.7 20.6 4.3 0.7 6.5 3.5 5.6 18.2 9.2 3.6 4.0 1.4 61.3 100.0 574 29.3 20.8 4.0 0.3 3.1 12.0 1.4 8.5 4.1 2.4 1.6 0.5 70.7 100.0 3,542 _______________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method relatively more likely to rely on traditional methods such as withdrawal, while those with some education favour modern contraceptives such as injectables and pills. Women with some secondary education are most likely to use condoms, followed by injectables and periodic abstinence. As expected, current contraceptive use rises with the number of living children. The percentage of women using any contraceptive increases rapidly from 7 percent among women with no living children to 28 percent among those with one child and only rises gradually to 30 percent among those with six or more children. Almost the same trend is observed for the current use of modern and traditional contraceptive methods. Differentials in contraceptive use among men follow patterns similar to those that among women (Table 4.5.2). Trends in Contraceptive Use 52 * Fertility Regulation Figure 4.2 Contraceptive Use among All Women Age 15-49 by Residence and Education 33 18 23 14 14 18 27 43 RESIDENCE Urban Rural MAINLAND/ZANZIBAR Mainland Zanzibar EDUCATION No Education Primary Incomplete Primary Complete Secondary+ 0 10 20 30 40 50 Percent of Women Modern Traditional TRCHS 1999 Contraceptive use has substantially increased over the past decade. In 1991-92, only 10 percent of all women were using any contraceptive method; that proportion has more than doubled to 22 percent (Figure 4.3). On the other hand, in 1991-92, current use of any modern contraceptive method among all women was at 6 percent, and the percentage has almost tripled to 16 percent in 1999. Focusing on specific methods, most notable is the steady rise in use of injectables, from less than 1 percent of women in 1991-92 to 5 percent in 1999. Use of male condoms has also increased from less than 1 percent of women in 1991-92 to about 4 percent in 1999. Two trends are of special note: & Use of female sterilisation. In spite of the sizeable proportion of women who say that they do not want to have any more children, the proportion of women who have been sterilised has changed little. & Use of traditional methods. Current use of traditional methods has increased from about 4 percent in 1991-92 to 7 percent in 1999, despite the increased knowledge of modern contraceptive methods since 1991-92. Fertility Regulation * 53 Figure 4.3 Trends in Contraceptive Use among All Women Age 15-49, 1991-1999 10 6 16 12 22 16 Any Method Any Modern Method 0 5 10 15 20 25 Percent 1991-92 TDHS 1996 TDHS 1999 TRCHS 4.5 SOURCES OF FAMILY PLANNING METHODS Women who reported using a modern contraceptive method at the time of the survey were then asked where they obtained the method the last time. It is likely that some women may have misreported the type of place where they obtained the method, since the distinction between hospitals, clinics, and sometimes between public and private sources may not be clear to them. Table 4.6 shows that current users of modern contraceptives in Tanzania are more likely to obtain their supplies from the public (government) sector (67 percent) than the private medical sector (22 percent) or other private sources (11 percent). These results show that the public sector is the source of modern contraceptives to seven of every ten current users. Public sources include dispensaries which supply the bulk (27 percent) of the users, followed by government health centres (18 percent), district hospitals (13 percent), and regional hospitals (8 percent). About two in ten current users get their supplies from the private medical sector. The prominent institutions among this source are pharmacies (10 percent), religious/mission hospitals (5 percent), and private doctors and clinics/hospitals (4 percent). The type of source varies greatly by method. Those using methods requiring medical expertise like sterilisation and injectables are more likely to get them from the public sector. As expected, the majority of condom users obtain their supplies from private sources such as pharmacies and shops. There has been some shift from public to private sources of contraception since 1991-92. However, the public sector has remained a dominant source of contraceptives, supplying almost all of the injectables (88 percent), pills (79 percent), and female sterilisations (70 percent). 54 * Fertility Regulation Table 4.6 Source of supply for contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply or information, according to specific method, Tanzania 1999_____________________________________________________________________________ Female All Inject- Male sterili- modern Source of supply Pill ables condom sation methods1_____________________________________________________________________________ Public sector Regional hospital District hospital Government health centre Dispensary Village health worker Private medical Mission hospital Private hospital/clinic Pharmacy CBD worker Other private Shop Friends/relatives Health education/bar girls Other Don’t know Missing Total Number 79.4 88.1 18.1 69.8 67.2 2.3 5.1 0.5 41.1 7.6 12.6 15.9 4.0 24.8 13.1 27.7 26.7 3.2 0.0 18.3 34.1 40.5 7.8 3.9 26.9 2.6 0.0 2.5 0.0 1.3 17.7 11.9 38.8 26.9 21.8 3.7 4.3 0.0 25.4 5.3 0.3 6.7 3.0 1.5 3.8 8.1 0.0 33.8 0.0 10.1 5.6 1.0 1.9 0.0 2.5 2.9 0.0 42.2 0.0 10.5 0.2 0.0 27.2 0.0 6.3 2.5 0.0 14.6 0.0 4.0 0.0 0.0 0.4 0.0 0.1 0.2 0.0 0.0 0.0 0.1 0.0 0.0 1.0 0.0 0.2 0.0 0.0 0.0 3.3 0.3 100.0 100.0 100.0 100.0 100.0 186 216 140 62 630 _____________________________________________________________________________ CBD = Community-based distribution 1Total includes 19 IUD users, 4 implant users, and 3 female condom users 4.6 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Family planning fieldworkers who are largely based in rural areas are expected to visit women and men of reproductive age, especially those who are not using any modern contraceptive method. One of the objectives of such visits is to discuss the options and, when indicated, motivate the nonusers to adopt a method of family planning. Health facility and extension workers are also expected to visit or discuss and motivate families for family planning while providing other health services. To get an indication of the frequency of such visits or discussions, women were asked whether a family planning fieldworker had visited them within the previous 12 months. Table 4.7 shows that not much has changed since the 1996 TDHS, with only 5 percent of nonusers having been visited by a family planning fieldworker during the 12 months preceding the survey. In the 12 months preceding the survey, more than half (53 percent) of nonusers visited a health facility; however, only 14 percent of nonusers (or 27 percent of those who visited a facility) said that someone at the facility spoke to them about family planning. This finding gives insight into the level of missed opportunities (contacts between nonusers and health workers that were not used to motivate nonusers to adopt family planning). No one at the health facility spoke to three-quarters of the nonusers about family planning. About eight in ten (81 percent) nonusers were neither visited by a family planning worker Fertility Regulation * 55 Table 4.7 Contact of nonusers with family planning providers Percent distribution of nonusers by whether they were visited by a family planning (FP) worker or spoke with a health facility staff member about family planning methods during the 12 months prior to interview, according to selected background characteristics, Tanzania 1999_____________________________________________________________________________________________________ Visited by family Not visited by family planning fieldworker planning fieldworker ______________________ _______________________ Visited Visited health facility health facility No FP ______________ Did not ______________ Did not services Dis- Did not visit Dis- Did not visit or infor- Number Background cussed discuss health cussed discuss health mation of characteristic FP FP facility FP FP facility Missing provided Total nonusers _____________________________________________________________________________________________________ Age 15-19 20-24 25-59 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + Total 0.8 0.3 1.1 5.3 29.6 62.9 0.1 92.4 100.0 839 2.1 0.7 0.6 21.9 36.9 37.6 0.3 74.5 100.0 572 6.0 1.3 0.6 20.9 39.1 32.1 0.0 71.2 100.0 554 2.5 1.4 1.6 20.2 36.7 37.7 0.0 74.4 100.0 355 1.9 3.4 1.1 15.8 38.3 39.5 0.0 77.8 100.0 331 3.8 0.9 1.9 13.2 34.7 44.9 0.6 79.6 100.0 213 2.3 0.7 1.9 5.2 31.8 57.3 0.9 89.1 100.0 267 5.8 3.1 3.2 13.2 37.7 36.9 0.1 74.6 100.0 752 1.6 0.4 0.4 14.8 34.0 48.6 0.2 82.6 100.0 2,379 2.6 1.0 1.1 14.4 34.4 46.4 0.2 80.7 100.0 3,044 5.9 3.1 3.2 13.1 37.0 37.6 0.1 74.6 100.0 724 1.5 0.4 0.4 14.8 33.5 49.1 0.2 82.7 100.0 2,320 2.8 2.1 1.4 16.2 52.9 24.2 0.4 77.1 100.0 86 1.5 0.8 1.1 14.5 55.2 26.1 0.8 81.3 100.0 41 4.0 3.3 1.6 17.7 50.9 22.5 0.0 73.4 100.0 46 1.2 0.1 0.5 12.1 34.1 51.6 0.4 85.7 100.0 940 2.2 0.8 0.6 11.3 30.2 54.6 0.2 84.9 100.0 702 3.7 1.3 1.6 17.5 37.5 38.4 0.0 76.0 100.0 1,365 3.3 7.6 3.1 15.5 37.9 32.1 0.5 70.0 100.0 123 2.6 1.1 1.1 14.4 34.9 45.8 0.2 80.6 100.0 3,131 nor spoken to about family planning when they visited a health facility. This lack of contact with family planning providers actually represents a slight improvement from the 1996 TDHS level of 87 percent. However, it still indicates there is a large pool of potential users of family planning that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises. 4.7 INTENTION TO USE FAMILY PLANNING AMONG NONUSERS An important indicator of changing demand for contraception is the extent to which nonusers of contraception intend to use family planning services in the future. During the 1999 TRCHS, respondents who were not using contraception at the time of the survey were asked whether they intended to use a contraceptive method in the next 12 months. Table 4.8 shows that 35 percent of women and 31 percent of men who were not using a 56 * Fertility Regulation Table 4.8 Future use of contraception Percent distribution of all women and men who are not using a contraceptive method by intention to use a method in the next 12 months, according to number of living children, Tanzania 1999 ___________________________________________________________________________________________ Number of living children1_________________________________________ Total Total Future use of contraception 0 1 2 3 4+ women men__________________________________________________________________________________________ Intend to use in next 12 months Unsure as to intention Do not intend to use in next 12 months Don’t know/Missing Total Number of women/men 17.8 43.7 45.3 43.6 39.0 34.9 31.3 19.3 5.2 5.3 5.6 4.9 9.4 12.5 62.2 50.7 49.4 50.3 55.6 55.3 55.5 0.7 0.4 0.1 0.5 0.5 0.5 0.6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 934 544 453 329 871 3,131 2,503 ___________________________________________________________________________________________ 1 Includes current pregnancy contraceptive reported that they intended to use one some time in the next 12 months. Intention to use among women seems to be related to the number of living children; it is lower among those without children and then rises with an increase in the number of children. 4.8 REASONS FOR NONUSE Respondents who were not currently using any contraception and said they did not intend to use any method in the next 12 months were asked about their reasons for nonuse. Table 4.9 presents data on the main reasons for not using contraceptives given by both women and men. A desire to have more children was the most prominent reason for nonuse among women (23 percent) and was commonly cited by men as well (22 percent). Among men, however, the most common reason for nonuse is not being married (33 percent). Other common reasons for nonuse among women and men are that the respondent is opposed to contraceptive use or that the respondent is not sexually active. The desire for children has been the major reason for nonuse of contraception among women since 1991-92. Menopause or hysterectomy are also common reasons for nonuse, especially among women and men age 30 and older. 4.9 EXPOSURE TO FAMILY PLANNING MESSAGES The media, especially radio and television, are the major potential sources of information about family planning. To asses the effectiveness of such media for the dissemination of family planning information, all female and male respondents in the survey were asked if they had heard or seen messages about family planning on the radio, television, or in various print media during the six months before the interview. Tables 4.10.1 and 4.10.2 show that, as in the 1996 TDHS, a higher proportion of men than women are exposed to family planning messages. Seven in ten men (70 percent) and 66 percent of women reported that they had heard or seen a family planning message in the past six months. Radio remains the most dominant of the media; less than 10 percent of respondents had seen a family planning message on television. Medical professionals are an important source of family planning information, especially among women (49 percent). Among women, the next most effective media are billboards, posters, and live dramas. Among men, the most important sources Fertility Regulation * 57 Table 4.9 Reasons for not intending to use contraception Percent distribution of all women and men who are not using a contraceptive method and who do not intend to use in the future, by main reason for not intending to use, according to age, Tanzania 1999 _______________________________________________________________________________ Women Men ________________________ ______________________ Age Age Reason for not intending ______________ Total ______________ Total to use contraception <30 30-49 women <30 30-49 men_______________________________________________________________________________ Not married No sex Infrequent sex Menopausal/hysterectomy Subfecund/infecund Postpartum/amenorrheic Breastfeeding Wants more children Respondent opposed Partner opposed Others opposed Religious prohibition Knows no method Knows no source Health concerns Fear side effects Lack of access Costs too much Inconvenient to use Interferes with body processes Methods not reliable Other Don't know Number of women/men 28.3 2.2 16.6 54.5 8.3 32.6 19.2 6.3 13.4 16.3 3.2 10.1 3.1 6.9 4.8 5.3 5.2 5.3 0.6 18.8 8.8 0.0 16.1 7.6 1.4 5.1 3.1 0.0 2.8 1.3 1.5 3.8 2.5 0.6 2.5 1.5 4.4 1.6 3.2 0.6 1.5 1.0 22.0 23.2 22.6 16.3 27.4 21.6 19.7 22.0 20.7 12.7 24.3 18.2 9.8 8.0 9.0 0.8 4.0 2.3 0.6 0.7 0.7 0.0 0.8 0.4 1.3 2.3 1.7 3.1 5.3 4.2 7.2 3.4 5.5 10.0 5.9 8.1 2.2 0.7 1.5 5.6 4.0 4.9 0.7 3.7 2.0 0.6 1.8 1.2 7.4 7.5 7.5 2.9 7.1 4.9 0.4 0.5 0.4 0.0 0.0 0.0 0.1 0.3 0.2 0.4 0.1 0.3 0.4 0.6 0.5 4.2 0.3 2.3 1.3 2.8 2.0 0.6 2.7 1.6 4.1 2.7 3.5 0.0 0.0 0.0 5.1 6.3 5.6 2.5 3.1 2.8 2.6 0.4 1.6 1.8 1.0 1.4 954

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