Timor-Leste - Demographic and Health Survey - 2010

Publication date: 2009

Timor-Leste Demographic and Health Survey 2009-10 Tim or-Leste 2009-10 D em ographic and H ealth Survey � � � � � � � Timor-Leste Demographic and Health Survey 2009-10 National Statistics Directorate Ministry of Finance Democratic Republic of Timor-Leste Dili, Timor-Leste ICF Macro Calverton, Maryland, U.S.A. December 2010 This report summarizes the findings of the 2009-10 Timor-Leste Demographic and Health Survey (TLDHS) carried out by the National Statistics Directorate of the Ministry of Finance. ICF Macro provided financial and technical assistance for the survey through the USAID-funded MEASURE DHS program, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. Financial support was provided by USAID, the Government of Australia (AusAID), the Government of Ireland (Irish AID), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United Nations Development Fund (UNDP), and the World Health Organization (WHO). UNFPA supported the survey with administrative, logistical, and technical assistance. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID or donor organizations. Additional information about the 2009-2010 TLDHS may be obtained from the National Statistics Directorate, P.O. Box 10, Timor-Leste; Telephone: (977-1) 670-3339527; Internet: www.dne.mof.gov.tl. Additional information about the MEASURE DHS program may be obtained from MEASURE DHS, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, U.S.A.; Telephone: 1-301-572-0200; Fax: 1-301-572-0999; Email: reports@measuredhs.com. Suggested citation: National Statistics Directorate (NSD) [Timor-Leste], Ministry of Finance [Timor-Leste], and ICF Macro. 2010. Timor-Leste Demographic and Health Survey 2009-10. Dili, Timor-Leste: NSD [Timor- Leste] and ICF Macro. Contents | iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xvii ACKNOWLEDGMENTS . xix CONTRIBUTORS TO THE REPORT . xxi SUMMARY OF FINDINGS . xxiii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxxi MAP OF TIMOR-LESTE . xxxii CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy . 1 1.1.1 History. 1 1.1.2 Geography . 2 1.1.3 Economy . 2 1.2 Population . 3 1.3 Population and Reproductive Health Policies and Programs . 3 1.4 Objectives of the Survey . 4 1.5 Organization of the Survey . 5 1.6 Sample Design . 5 1.6.1 Sampling Frame . 5 1.6.2 Sample Selection . 5 1.7 Questionnaires . 6 1.8 Hemoglobin Testing . 7 1.9 Pretest, Training, and Fieldwork . 7 1.9.1 Pretest . 7 1.9.2 Training . 7 1.9.3 Fieldwork . 8 1.10 Data Processing . 8 1.11 Response Rates . 8 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Household Population by Age and Sex . 11 2.2 Household Composition . 12 2.2.1 Children’s Living Arrangements and Orphanhood . 13 2.2.2 School Attendance by Survivorship of Parents . 14 2.3 Educational Attainment of Household Members . 15 2.3.1 Grade Repetition and Dropout Rates . 20 2.4 Housing Characteristics . 22 2.5 Household Durable Goods . 26 2.6 Wealth Quintiles . 27 2.7 Birth Registration . 28 iv | Contents CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents . 31 3.2 Educational Attainment and Literacy . 32 3.3 Access to Mass Media . 36 3.4 Employment . 38 3.4.1 Employment Status . 38 3.4.2 Occupation . 41 3.4.3 Earnings, Employers, and Continuity of Employment . 43 3.5 Knowledge and Attitudes Concerning Tuberculosis . 44 3.6 Use of Tobacco . 46 CHAPTER 4 FERTILITY 4.1 Current Fertility . 49 4.2 Fertility Differentials . 50 4.3 Fertility Trends . 52 4.4 Children Ever Born and Surviving . 54 4.5 Birth Intervals . 55 4.6 Age at First Birth . 56 4.7 Adolescent Pregnancy and Motherhood . 57 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods . 60 5.2 Knowledge of Contraceptive Methods by Background Characteristics . 61 5.3 Ever Use of Contraception . 62 5.4 Current Use of Contraception . 64 5.5 Trend in Current Use of Contraception . 66 5.6 Current Use of Contraception by Background Characteristics . 66 5.7 Number of Children at First Use of Contraception . 68 5.8 Knowledge of Fertile Period . 69 5.9 Timing of Female Sterilization . 70 5.10 Source of Modern Contraception Methods . 70 5.11 Payment of Fees for Modern Contraceptive Methods . 71 5.12 Informed Choice . 71 5.13 Future Use of Contraception . 72 5.14 Reasons for Non-use of Contraception in the Future . 73 5.15 Preferred Method of Contraception for Future Use . 73 5.16 Exposure to Family Planning Messages . 74 5.17 Contact of Non-users with Family Planning Providers . 75 5.18 Husband’s Knowledge of Wife’s Use of Contraception . 76 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status . 79 6.2 Polygyny . 80 6.3 Age at First Marriage . 81 6.4 Age at First Sexual Intercourse . 83 6.5 Recent Sexual Activity . 85 6.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 88 6.7 Menopause . 89 Contents | v CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children . 91 7.2 Desire to Limit Childbearing by Background Characteristics . 92 7.3 Need for Family Planning Services . 94 7.4 Ideal Family Size . 95 7.5 Fertility Planning . 97 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Definition, Data Quality, and Methodology . 99 8.2 Assessment of Data Quality. 99 8.3 Levels and Trends in Infant and Child Mortality . 100 8.4 Socioeconomic Differentials in Mortality . 102 8.5 Demographic Characteristics and Child Mortality . 103 8.6 Perinatal Mortality . 105 8.7 High-Risk Fertility Behavior . 106 CHAPTER 9 ADULT AND MATERNAL MORTALITY 9.1 Data Quality Analysis . 109 9.2 Adult Mortality . 111 9.3 Maternal Mortality . 111 CHAPTER 10 MATERNAL HEALTH 10.1 Antenatal Care . 113 10.2 Number and Timing of Antenatal Visits . 115 10.3 Components of Antenatal Care . 115 10.4 Tetanus Toxoid Vaccination . 117 10.5 Knowledge of Danger Signs During Pregnancy . 118 10.6 Delivery Care . 119 10.6.1 Place of Delivery . 119 10.6.2 Assistance during Delivery . 121 10.7 Newborn Care . 122 10.7.1 Knowledge of Danger Signs for Newborns . 122 10.7.2 Care for Umbilical Cord . 123 10.7.3 Drying and Bathing of Newborns . 125 10.8 Timing of First Postnatal Checkup . 126 10.9 Type of Provider of First Postnatal Checkup . 127 10.10 Problems in Accessing Health Care . 128 CHAPTER 11 CHILD HEALTH 11.1 Child’s Size at Birth . 131 11.2 Vaccination Coverage . 132 11.3 Trends in Vaccination Coverage . 135 11.4 Acute Respiratory Infection . 136 11.5 Fever . 137 vi | Contents 11.6 Diarrheal Disease . 139 11.6.1 Incidence and Treatment of Diarrhea . 139 11.6.2 Feeding Practices . 141 11.7 Knowledge of ORS Packets . 143 11.8 Stool Disposal . 144 CHAPTER 12 NUTRITION OF CHILDREN AND WOMEN 12.1 Nutritional Status of Children . 147 12.1.1 Nutritional Status of Children . 147 12.1.2 Trends in Children’s Nutritional Status . 151 12.2 Initiation of Breastfeeding . 153 12.3 Breastfeeding Status by Age . 154 12.4 Duration and Frequency of Breastfeeding . 156 12.5 Types of Complementary Foods . 157 12.6 Infant and Young Child Feeding (IYCF) Practices . 158 12.7 Anemia in Children . 160 12.8 Micronutrient Intake among Children . 162 12.9 Nutritional Status of Women . 165 12.10 Foods Consumed by Mothers . 166 12.11 Micronutrient Intake among Mothers . 167 12.12 Prevalence of Anemia in Women . 170 CHAPTER 13 MALARIA 13.1 Mosquito Nets . 174 13.1.1 Ownership of Mosquito Nets . 174 13.1.2 Use of Mosquito Nets by Children . 175 13.1.3 Use of Mosquito Nets by Women . 176 13.1.4 Prevalence and Management of Childhood Malaria . 178 CHAPTER 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 14.1 Knowledge of HIV/AIDS and of Transmission and Prevention Methods . 182 14.1.1 Knowledge of AIDS. 182 14.1.2 Knowledge of HIV Prevention Methods . 183 14.1.3 Comprehensive Knowledge of HIV Transmission . 184 14.2 Attitudes toward People Living with HIV/AIDS . 187 14.3 Risky Behaviors . 189 14.3.1 Multiple Sexual Partners and Higher-risk Sexual Intercourse . 189 14.3.2 Paid Sex . 190 14.4 Knowledge of HIV Testing . 191 14.5 Male Circumcision . 193 14.6 Reports of Recent Sexually Transmitted Infections . 193 14.7 Prevalence of Medical Injections . 195 Contents | vii 14.8 HIV/AIDS-related Knowledge and Behavior among Youth . 197 14.8.1 Comprehensive Knowledge about HIV/AIDS and Source for Condoms 197 14.8.2 Age at First Sex and Condom Use at First Sexual Intercourse . 199 14.8.3 Recent Sexual Activity among Never-married Youth . 201 14.8.4 Drunkenness during Sex among Young Adults . 201 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Employment and Form of Earnings. 203 15.2 Control Over and Relative Magnitude of Women’s Earnings . 204 15.3 Control Over Men’s Cash Earnings . 206 15.4 Women’s Participation in Decisionmaking . 208 15.5 Attitudes toward Wife Beating . 213 15.6 Attitudes toward Refusing Sex with Husband . 216 15.7 Current Use of Contraception by Women’s Status . 222 15.8 Ideal Family Size and Unmet Need by Women’s Status . 222 15.9 Reproductive Health Care by Women’s Status . 224 CHAPTER 16 DOMESTIC VIOLENCE 16.1 Measurement of Violence . 226 16.1.1 The Use of Valid Measures of Violence . 226 16.1.2 Ethical Considerations . 227 16.1.3 Special Training for Implementing the Domestic Violence Module . 227 16.1.4 Characteristics of the Sub-sample of Respondents for the Domestic Violence Module . 228 16.2 Experience of Domestic Violence by Women . 228 16.3 Perpetrators of Physical Violence Against Women . 230 16.4 Women’s Experience of Force at Sexual Initiation . 231 16.5 Experience of Sexual Violence and Perpetrators of Sexual Violence . 231 16.6 Experience of Different Types of Violence . 233 16.7 Violence during Pregnancy . 233 16.8 Marital Control . 234 16.9 Types of Spousal Violence . 236 16.10 Violence by Spousal Characteristics and Empowerment Indicators . 240 16.11 Frequency of Spousal Violence . 241 16.12 Onset of Spousal Violence . 242 16.13 Types of Injuries to Women Resulting from Spousal Violence . 242 16.14 Physical Violence by Women against Their Spouse . 243 16.15 Help-seeking Behavior of Women who Experience Violence . 245 16.16 Family Support for Abused Women in Need . 245 16.17 Social Norms and Values . 247 REFERENCES . 249 APPENDIX A SAMPLE IMPLEMENTATION . 255 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 261 APPENDIX C DATA QUALITY . 281 APPENDIX D SURVEY PERSONNEL . 289 APPENDIX E QUESTIONNAIRES . 293 Tables and Figures | ix TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 8 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . 12 Table 2.2 Household composition . 13 Table 2.3.1 Children’s living arrangements and orphanhood . 14 Table 2.3.2 School attendance by survivorship of parents . 15 Table 2.4.1 Educational attainment of the female household population . 16 Table 2.4.2 Educational attainment of the male household population . 18 Table 2.5 School attendance ratios . 19 Table 2.6 Grade repetition and dropout rates . 21 Table 2.7 Household drinking water . 23 Table 2.8 Household sanitation facilities . 24 Table 2.9 Household characteristics . 25 Table 2.10 Household durable goods . 27 Table 2.11 Wealth quintiles . 28 Table 2.12 Birth registration of children under age five . 29 Figure 2.1 Population Pyramid . 12 Figure 2.2 Percentage of Women and Men with No Education, by Age Group . 17 Figure 2.3 Age-specific Attendance Rates of the de facto Population 5 to 24 Years . 22 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . 32 Table 3.2.1 Educational attainment: Women . 33 Table 3.2.2 Educational attainment: Men . 34 Table 3.3.1 Literacy: Women . 35 Table 3.3.2 Literacy: Men . 36 Table 3.4.1 Exposure to mass media: Women . 37 Table 3.4.2 Exposure to mass media: Men . 38 Table 3.5.1 Employment status: Women . 39 Table 3.5.2 Employment status: Men . 40 Table 3.6.1 Occupation: Women . 41 Table 3.6.2 Occupation: Men . 42 Table 3.7 Type of employment: Women . 43 Table 3.8.1 Knowledge and attitude concerning tuberculosis: Women . 44 Table 3.8.2 Knowledge and attitude concerning tuberculosis: Men . 46 Table 3.9.1 Use of tobacco: Women . 47 Table 3.9.2 Use of tobacco: Men . 48 x | Tables and Figures CHAPTER 4 FERTILITY Table 4.1 Current fertility . 49 Table 4.2 Fertility by background characteristics . 51 Table 4.3 Trends in age-specific fertility rates . 52 Table 4.4 Trends in fertility . 53 Table 4.5 Children ever born and living . 54 Table 4.6 Birth intervals . 55 Table 4.7 Age at first birth . 56 Table 4.8 Median age at first birth . 57 Table 4.9 Teenage pregnancy and motherhood . 58 Figure 4.1 Age-specific Fertility Rates by Urban-Rural Residence . 50 Figure 4.2 Trends in Total Fertility Rates 1995-2010 . 53 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods . 60 Table 5.2 Knowledge of contraceptive methods by background characteristics . 61 Table 5.3.1 Ever use of contraception: Women . 63 Table 5.3.2 Ever use of contraception: Men . 64 Table 5.4 Current use of contraception by age . 65 Table 5.5 Current use of contraception by background characteristics . 67 Table 5.6 Number of children at first use of contraception . 69 Table 5.7 Knowledge of fertile period . 69 Table 5.8 Source of modern contraception methods . 70 Table 5.9 Informed choice . 72 Table 5.10 Future use of contraception . 73 Table 5.11 Reason for not intending to use contraception in the future . 73 Table 5.12 Preferred method of contraception for future use . 74 Table 5.13 Exposure to family planning messages . 75 Table 5.14 Contact of nonusers with family planning providers . 76 Table 5.15 Husband/partner’s knowledge of women’s use of contraception . 77 Figure 5.1 Trends in Use of Contraception among Currently Married Women, 1997-2010 . 66 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status . 79 Table 6.2 Number of co-wives and wives . 80 Table 6.3 Age at first marriage . 81 Table 6.4.1 Median age at first marriage: Women . 82 Table 6.4.2 Median age at first marriage: Men . 83 Table 6.5 Age at first sexual intercourse . 84 Table 6.6 Median age at first intercourse: Men . 85 Table 6.7.1 Recent sexual activity: Women . 86 Table 6.7.2 Recent sexual activity: Men . 87 Table 6.8 Postpartum amenorrhea, abstinence and insusceptibility . 88 Table 6.9 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility . 89 Table 6.10 Menopause . 90 Tables and Figures | xi CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 92 Table 7.2.1 Desire to limit childbearing: Women . 93 Table 7.2.2 Desire to limit childbearing: Men . 93 Table 7.3 Need and demand for family planning among currently married women . 95 Table 7.4 Ideal number of children . 96 Table 7.5 Mean ideal number of children. 97 Table 7.6 Fertility planning status . 98 Table 7.7 Wanted fertility rates . 98 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 101 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 103 Table 8.3 Early childhood mortality rates by demographic characteristics . 104 Table 8.4 Perinatal mortality . 105 Table 8.5 High-risk fertility behavior . 106 Figure 8.1 Mortality Trends . 102 CHAPTER 9 ADULT AND MATERNAL MORTALITY Table 9.1 Completeness of information on siblings . 110 Table 9.2 Year of birth of respondents and siblings . 110 Table 9.3 Sibship size and sex ratio of siblings . 111 Table 9.4 Adult mortality rates . 111 Table 9.5 Direct estimates of maternal mortality . 112 CHAPTER 10 MATERNAL HEALTH Table 10.1 Antenatal care . 114 Table 10.2 Number of antenatal care visits and timing of first visit . 115 Table 10.3 Components of antenatal care . 116 Table 10.4 Tetanus toxoid injections . 117 Table 10.5 Knowledge of danger signs during pregnancy . 119 Table 10.6 Place of delivery . 120 Table 10.7 Assistance during delivery . 121 Table 10.8 Knowledge of danger signs for newborns . 123 Table 10.9 Instruments used to cut the umbilical cord . 124 Table 10.10 Application of material after the umbilical cord was cut . 125 Table 10.11 Drying and bathing of newborns . 126 Table 10.12 Timing of first postnatal checkup. 127 Table 10.13 Type of provider of first postnatal checkup . 128 Table 10.14 Problems in accessing health care . 129 CHAPTER 11 CHILD HEALTH Table 11.1 Child’s weight and size at birth . 132 Table 11.2 Vaccinations by source of information . 133 Table 11.3 Vaccinations by background characteristics . 134 xii | Tables and Figures Table 11.4 Vaccinations in first year of life. 135 Table 11.5 Prevalence and treatment of symptoms of ARI . 137 Table 11.6 Prevalence and treatment of fever . 138 Table 11.7 Prevalence of diarrhea . 139 Table 11.8 Diarrhea treatment . 141 Table 11.9 Feeding practices during diarrhea . 142 Table 11.10 Knowledge of ORS packets or pre-packaged liquids . 143 Table 11.11 Disposal of children’s stools . 144 Figure 11.1 Immunization Coverage of Children 12-23 Months. 133 Figure 11.2 Trends in Children 12-23 Months Fully Immunized . 136 CHAPTER 12 NUTRITION OF CHILDREN AND WOMEN Table 12.1 Nutritional status of children . 149 Table 12.2 Initial breastfeeding . 153 Table 12.3 Breastfeeding status by age . 155 Table 12.4 Median duration and frequency of breastfeeding . 157 Table 12.5 Foods and liquids consumed by children in the day or night preceding the interview . 158 Table 12.6 Infant and young child feeding (IYCF) practices . 160 Table 12.7 Prevalence of anemia in children . 161 Table 12.8 Micronutrient intake and food supplementation among children . 163 Table 12.9 Signs of night blindness among children . 164 Table 12.10 Nutritional status of women . 166 Table 12.11 Foods consumed by mothers in the day or night preceding the interview . 167 Table 12.12 Micronutrient intake among mothers . 169 Table 12.13 Prevalence of anemia in women . 170 Figure 12.1 Nutritional Status of Children by Age . 150 Figure 12.2 Trends in Nutritional Status of Children, 2002-2010 . 152 Figure 12.3 Trends in Nutritional Status of Children, 2007-2010, WHO Child Growth Standards. 152 Figure 12.4 Infant Feeding Practices by Age . 156 Figure 12.5 Infant and Young Child Feeding (IYCF) Practices . 159 CHAPTER 13 MALARIA Table 13.1 Ownership of mosquito nets . 174 Table 13.2 Use of mosquito nets by children . 175 Table 13.3 Use of mosquito nets by women . 176 Table 13.4 Use of mosquito nets by pregnant women . 177 Table 13.5 Prevalence and prompt treatment of fever . 178 Table 13.6 Type and timing of antimalarial drugs . 179 CHAPTER 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 14.1 Knowledge of AIDS. 182 Table 14.2 Knowledge of HIV prevention methods . 184 Table 14.3.1 Comprehensive knowledge about AIDS: Women . 185 Table 14.3.2 Comprehensive knowledge about AIDS: Men . 186 Tables and Figures | xiii Table 14.4.1 Accepting attitudes toward those living with HIV/AIDS: Women . 187 Table 14.4.2 Accepting attitudes toward those living with HIV/AIDS: Men . 188 Table 14.5 Multiple sexual partners in the past 12 months: Men . 190 Table 14.6 Payment for sexual intercourse: Men . 191 Table 14.7 Knowledge of a place to get an HIV test . 192 Table 14.8 Male circumcision . 193 Table 14.9 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms . 194 Table 14.10 Prevalence of medical injections . 196 Table 14.11 Comprehensive knowledge about AIDS and of a source of condoms among youth . 198 Table 14.12 Age at first sexual intercourse among youth . 199 Table 14.13 Condom use at first sexual intercourse among youth . 200 Table 14.14 Premarital sexual intercourse during premarital sexual intercourse among youth . 201 Table 14.15 Drunkenness during sexual intercourse among youth . 202 Figure 14.1 Women and Men Seeking Advice or Treatment for STIs . 195 Figure 14.2 Source of Last Medical Injection . 197 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings of currently married women. 204 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s earnings: Women . 205 Table 15.2.2 Control over men’s cash earnings . 207 Table 15.3 Women’s control over her own earnings and over those of her husband . 208 Table 15.4.1 Women’s participation in decision making . 209 Table 15.4.2 Women’s participation in decision making according to men . 209 Table 15.5.1 Women’s participation in decision making by background characteristics . 211 Table 15.5.2 Men’s attitude toward wives’ participation in decision making . 212 Table 15.6.1 Attitude toward wife beating: Women . 214 Table 15.6.2 Attitude toward wife beating: Men . 215 Table 15.7.1 Attitude toward refusing sexual intercourse with husband: Women . 217 Table 15.7.2 Attitude toward refusing sexual intercourse with husband: Men . 218 Table 15.7.3 Men’s attitude toward a husband’s rights when his wife refuses to have sexual intercourse . 219 Table 15.8 Indicators of women’s empowerment . 221 Table 15.9 Current use of contraception by women’s status . 222 Table 15.10 Women’s empowerment and ideal number of children and unmet need for family planning . 223 Table 15.11 Reproductive health care by women’s empowerment . 224 Figure 15.1 Number of Household Decisions in Which Women Participate . 210 CHAPTER 16 DOMESTIC VIOLENCE Table 16.1 Experience of physical violence . 229 Table 16.2 Persons committing physical violence . 230 Table 16.3 Force at sexual initiation . 231 xiv | Tables and Figures Table 16.4 Experience of sexual violence . 232 Table 16.5 Experience of different forms of violence . 233 Table 16.6 Violence during pregnancy . 234 Table 16.7 Degree of marital control exercised by husbands . 235 Table 16.8 Forms of spousal violence . 237 Table 16.9 Spousal violence by background characteristics. 238 Table 16.10 Spousal violence by husband’s characteristics and empowerment indicators . 241 Table 16.11 Frequency of spousal violence among those who report violence . 242 Table 16.12 Onset of marital violence . 243 Table 16.13 Injuries to women due to spousal violence . 245 Table 16.14 Violence by women against their spouse . 246 Table 16.15 Help seeking to stop violence . 248 Figure 16.1 Percentage of Ever-married Women Who Have Experienced Specific Forms of Physical and Sexual Violence Committed by Their Husband/Partner . 238 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample allocation of clusters and households according to district and by type of residence, Timor-Leste 2009-10 . 256 Table A.2 Sample allocation of expected number of completed women and men interviews according to district and by type of residence, Timor-Leste 2009-10 . 256 Table A.3 Sample implementation: Women . 258 Table A.4 Sample implementation: Men . 259 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Timor-Leste 2009-10 . 263 Table B.2 Sampling errors for National sample, Timor-Leste 2009-10 . 264 Table B.3 Sampling errors for Urban sample, Timor-Leste 2009-10 . 265 Table B.4 Sampling errors for Rural sample, Timor-Leste 2009-10 . 266 Table B.5 Sampling errors for Aileu sample, Timor-Leste 2009-10 . 267 Table B.6 Sampling errors for Ainaro sample, Timor-Leste 2009-10 . 268 Table B.7 Sampling errors for Baucau sample, Timor-Leste 2009-10 . 269 Table B.8 Sampling errors for Bobonaro sample, Timor-Leste 2009-10 . 270 Table B.9 Sampling errors for Covalima sample, Timor-Leste 2009-10 . 271 Table B.10 Sampling errors for Dili sample, Timor-Leste 2009-10 . 272 Table B.11 Sampling errors for Ermera sample, Timor-Leste 2009-10 . 273 Table B.12 Sampling errors for Lautem sample, Timor-Leste 2009-10. 274 Table B.13 Sampling errors for Liquiçá sample, Timor-Leste 2009-10 . 275 Table B.14 Sampling errors for Manatuto sample, Timor-Leste 2009-10 . 276 Table B.15 Sampling errors for Manufahi sample, Timor-Leste 2009-10 . 277 Table B.16 Sampling errors for Oecussi sample, Timor-Leste 2009-10 . 278 Table B.17 Sampling errors for Viqueque sample, Timor-Leste 2009-10 . 279 APPENDIX C DATA QUALITY Table C.1 Household age distribution . 281 Table C.2.1 Age distribution of eligible and interviewed women . 282 Table C.2.2 Age distribution of eligible and interviewed men . 282 Tables and Figures | xv Table C.3 Completeness of reporting . 283 Table C.4 Births by calendar years . 283 Table C.5 Reporting of age at death in days . 284 Table C.6 Reporting of age at death in months . 285 Table C.7 Nutritional status of children . 286 Table C.8 Completeness of information on siblings . 287 Table C.9 Indicators on data quality . 287 Table C.10 Sibship size and sex ratio of siblings . 287 Foreword | xvii FOREWORD The 2009-10 Timor-Leste Demographic and Health Survey (TLDHS) is the first national level population and health survey conducted as part of the global Demographic and Health Surveys (DHS) program supported by USAID, but the second Demographic and Health survey in the country. The first DHS was done in 2003 under the guidance of ACIL Australia Pty Ltd, University of Newcastle and the Australian National University. The TLDHS 2009-10 is implemented by the National Statistics Directorate of the General Directorate for Policy Analysis and Research of the Ministry of Finance, under the aegis of the Ministry of Health. The 2009-10 TLDHS supplements and complements the information collected through the censuses, updates the available information on population and health issues, and provides guidance in planning, implementing, monitoring and evaluating Timor-Leste’s health programs. Further, the results of the survey assist in monitoring the progress made towards meeting the Millennium Development Goals (MDGs) and other international initiatives. The 2009-10 TLDHS includes topics related to fertility levels and determinants; family planning; fertility preferences; infant, child, adult and maternal mortality; maternal and child health; nutrition; malaria; domestic violence; knowledge of HIV/AIDS and women’s empowerment. The 2009-10 TLDHS for the first time also includes anemia testing among women age 15-49 and children age 6-59 months. As well as providing national estimates, the survey also provides disaggregated data at the level of various domains such as administrative district, as well as for urban and rural areas. This being the third survey of its kind in the country (after the 2002 MICS and the 2003 DHS), there is considerable trend information on demographic and reproductive health indicators. This survey is the result of concerted effort on the part of various individuals and institutions, and it is with great pleasure that we would like to acknowledge the work put in to produce this very important and useful document. The participation and cooperation that was extended by the members of the Steering Committee in the different phases of the survey is greatly appreciated. On behalf of the Government of Timor-Leste, we the Ministers of Finance and of Health, would like to extend our appreciation for the technical support by ICF Macro International and financial support from our development partners namely; the United States Agency for International Development (USAID), the Government of Australia (AusAID), the Government of Ireland (Irish Aid), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United Nations Development Fund (UNDP) and the World Health Organization (WHO). This report contains enormous valuable information that when used correctly and consistently will undoubtedly improve the lives of many of our people. It is now time for program managers and policy makers to use the information to enable us to achieve our health and social targets as set by the Government. Acknowledgments | xix ACKNOWLEDGMENTS The 2009-10 Timor-Leste Demographic and Health Survey (TLDHS) with the main objective to generate demographic, health and social indicators, was conducted between August 2009 and January 2010. It is the second DHS to be carried out in the country since independence. Preliminary results were launched in April 2010. This report is the main output from the DHS project and will be followed by other thematic analyses depending on the program needs of the country. The 2009-10 TLDHS is a classic example of a project involving many interested groups; the Ministry of Health as the main users, the National Statistics Directorate as the implementer and a consortium of development partners who have provided both technical and financial/administrative support to implement the survey. As a result of the huge demand for data from the TLDHS, its success was accomplished through the concerted efforts of many organizations, institutions, government ministries and individuals who assisted in a variety of ways to plan, prepare, collect, process, analyze and publish the results. The Government through the Director of National Statistics Directorate under the General Directorate of Policy Analysis and Research in Ministry of Finance wishes to thank them all for their inputs into this noble process. We express our deep sense of appreciation to the technical experts from ICF Macro, the National Statistics Directorate staff who worked on the project, UNFPA for mobilizing the resources to cover local costs and administrative support; and to members of the Steering Committee who provided critical inputs at all levels. Additionally, we would like to thank the various technical experts in the fields of population and health for their valuable input in the various phases of the survey. Their expertise was invaluable during the finalization of the questionnaires, training of field staff, reviewing the draft tables and finalizing the report. Our gratitude goes to the national staff who worked during data collection, data capture and cleaning. More importantly, all the Timorese who provided the data during interviews deserve special thanks for their patience and willingness to provide the requisite information. The Government extends sincere gratitude to the development partners for their financial contributions to this project, particularly the United States Agency for International Development (USAID), the Government of Australia (AusAID), the Government of Ireland (Irish Aid), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United Nations Development Fund (UNDP), and the World Health Organization (WHO). We sincerely hope that the information in this report will be fully utilized in the national development planning process by all stakeholders for the welfare of the Timorese people. Antonío Freitas Director General, Analysis and Research Ministry of Finance Contributors to the Report | xxi CONTRIBUTORS TO THE REPORT Elias dos Santos Ferreira, National Statistics Directorate Americo Soares, National Statistics Directorate Lourenco Soares, National Statistics Directorate Juselina Corte-Real, National Statistics Directorate Cesar Melito dos Santos Martins, National Statistics Directorate Isabel Gomes, Maternal and Child Health, Ministry of Health Aurea Celina Martins, Family Planning Section, Ministry of Health Misliza Vital, Child Health, Ministry of Health Jose Lima, Immunization Section, Ministry of Health Fatima Isabel C. Guzmao, Maternal and Reproductive Health, Ministry of Health Dirce Maria Soares, Nutrition Section, Ministry of Health Feliciano, Nutrition Section, Ministry of Health Maria do Rosario de Fatima Mota, Malaria Program, Ministry of Health Elizabeth Dos Reis, HIV/AIDS Section, Ministry of Health Teresa d.j. Vaz Cabral, University of Timor-Leste Dominique Freire, Health Alliance International Beth Elson, Health Alliance International Kiyoe Narita, Health Alliance International Melanie M. Soares, Health Alliance International Ruhul Amin, TAIS/USAID Brett Sutton, TAIS/USAID Asecelina J.M., Family Planning Unit, TAIS/USAID Fredrick Otieno Okwayo, UNFPA Anusara Singhkamarwang, World Food Program Crystal Karakochuk, UNICEF Faraja Chiwile, UNICEF Christine Chan, SEPI Pav Govindasamy, ICF Macro Anjushree Pradhan, ICF Macro Consultant Joy Fishel, ICF Macro Lyndsey Wilson-Williams, ICF Macro Velma Lopez, ICF Macro Summary of Findings | xxiii SUMMARY OF FINDINGS The 2009-10 Timor-Leste Demographic and Health Survey (TLDHS) is the second national- level population and health survey conducted in Timor-Leste and the first conducted as part of the global Demographic and Health Surveys (DHS) program. The sample for the survey was selected independently in every stratum, through a two- stage selection process, to provide estimates for each of the 13 districts and for both urban and rural areas of the country. The 2009-10 TLDHS was designed to cover a nationally representative sample of residential households, taking into account nonresponse; to obtain completed inter- views of women age 15-49 in every selected household; and to obtain completed interviews of men age 15-49 in every third selected household. Each household selected for the TLDHS was eligible for interview with the Household Questionnaire, and a total of 11,463 households were interviewed. All eligible women age 15-49 in the selected households and all eligible men age 15-49 in every third household were inter- viewed with the Women’s and Men’s Question- naires, respectively. A total of 13,137 women age 15-49 and 4,076 men age 15-49 were interviewed. Data collection took place over a six-month period, from early August 2009 to early February 2010. The survey obtained detailed information on fertility, fertility preferences, marriage, sexual activity, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, awareness and behavior regarding HIV and AIDS, and other sexually transmitted infections (STIs). In addition, the 2009-10 TLDHS collected informa- tion on domestic violence, malaria and use of mosquito nets, and anemia testing and anthropo- metric measurements for women and children. The survey was implemented by the National Statistics Directorate of the Directorate General for Analysis and Research of the Ministry of Finance, under the aegis of the Ministry of Health (MOH) of Timor-Leste. Technical support was provided by ICF Macro, and financial support was provided by USAID, the Government of Australia (AusAID), the Government of Ireland (Irish AID), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United Nations Development Fund (UNDP), and the World Health Organization (WHO). UNFPA supported the survey with administrative, logistical, and technical assistance. A steering committee was formed to be responsible for coordination, oversight, advice, and decision- making on all major aspects of the survey. The steering committee was composed of representatives from various ministries and key stakeholders, including the MOH, National Statistics Directorate, USAID, and international nongovernmental organizations (INGOs). FERTILITY Fertility Levels and Trends. The total fertility rate for Timor-Leste for the three years preceding the survey is 5.7 births per woman and is the highest in South East Asia and in Asia (together with Afghanistan) (PRB, 2010) but below the levels of Africa. At this level, it is estimated that the population will increase from its current size of 1.2 million to 1.9 million by the year 2025 and to 3.2 million by the year 2050. Fertility Differentials. As expected, fertility is considerably higher in rural areas than in urban areas. Rural women have on average about one child more than urban women (6.0 compared with 4.9 births per woman). As the age-specific fertility rates (ASFRs) show, the pattern of high rural fertility is prevalent in all age groups. The rural-urban difference in fertility is most pro- nounced for women age 20-24 (236 births per 1,000 women in rural areas versus 187 births per 1,000 women in urban areas). There are considerable differentials in fertility among districts, with fertility ranging from a low of 4.4 births per woman in Covalima to a high of 7.2 births per woman in Ainaro. The level of fertility is inversely related to women’s educational attainment, decreasing rapidly from 6.1 births among women with no education to 2.9 births among women with more than secondary education. Fertility is also inversely associated with wealth quintile. Women in the lowest wealth quintile have an average of 7.3 births, xxiv | Summary of Findings about three children more than women in the highest quintile (4.2 births). Unplanned Fertility. Despite a marked increase in the level of contraceptive use over the past eight years, the 2009-10 TLDHS data indicate that unplanned pregnancies are not uncommon. Overall, 86 percent of births are wanted, 12 percent of births in the country are mistimed (wanted later), and 2 percent are unwanted. Data from the 2003 DHS show that there has been little change in the status of planning for children, with 86 percent of births in the five years preceding the survey planned and 11 percent mistimed. Unwanted births declined from 4 percent in 2003 to 2 percent in 2009-10. Fertility Preferences. There is considerable desire among currently married Timorese to control the timing and number of births. Thirty- five percent of currently married women would like to wait two or more years before the next birth, and 36 percent do not want to have another child, or are sterilized. About one in ten (9 percent) of currently married women would like to have a child soon (within two years). In addition, 17 percent are undecided about whether to have a child or not. The proportion of currently married women who want no more children more than doubled in the last seven years, from 17 percent as reported in the 2003 DHS to 36 percent in the 2009-10 TLDHS. Currently married women and men prefer about six children. Data from the 2003 DHS show that the ideal number of children preferred by currently married women has changed little over the last seven years. FAMILY PLANNING Knowledge of Contraception. Findings from the 2009-10 TLDHS show that 78 percent of currently married women and 66 percent of currently married men in Timor-Leste know of at least one modern method of family planning. The most widely known modern contraceptive methods among currently married women are injectables (70 percent) and the pill (58 percent). Currently, married men are most likely to know of the male condom (54 percent) and injectables (46 percent). Twenty-seven percent of currently married men mentioned knowledge of a tradi- tional method compared with 22 percent of currently married women. Over the past seven years there has been a considerable increase in the overall knowledge of contraceptive methods in the country. Use of Contraception. More than one in five currently married women (22 percent) is using a method of family planning, with 21 percent using a modern contraceptive method. This indicates that modern contraceptive methods are highly favored over either natural family planning methods or other traditional methods. One percent of women report currently using a traditional method. The rhythm method is slightly more popular than withdrawal. Injectables are by far the most popular modern method, and they are used by 16 percent of currently married women. Two percent of women use the pill, and about 1 percent of women each use the IUD or implants, or they are sterilized. Most women who are sterilized are over age 30. Injectables are popular among women age 20-44. Trends in Contraceptive Use. There has been a marked increase in the use of contra- ception by currently married women since 2002. Use of modern methods doubled in the five years between 2002 and 2007 and rose by nearly 50 percent in the three years between 2007 and the 2010. The increase in use of modern methods contributed to a three-fold increase in overall contraceptive use, from 7 percent to 21 percent, in a matter of 7 to 8 years. Differentials in Contraceptive Use. Women in urban areas (30 percent) are more likely to use a family planning method than rural women (20 percent), reflecting wider availability and easier access to methods in urban than in rural areas. Contraceptive use varies by district with much of the difference due to the use of injectables. Use of a modern method among currently married women is highest in Covalima (43 percent) and lowest in Baucau (8 percent). Current use varies markedly between women who have some education and those who have none, however, there is little variation among educated women by specific level of education. Wealth has a positive effect on women’s contraceptive use, with modern contraceptive use increasing markedly as household wealth increases, from 15 percent among currently married women in the lowest wealth quintile to 32 percent among those in the highest wealth quintile. Summary of Findings | xxv Source of Modern Methods. Forty-five percent of all users are served by community health centers, 20 percent by health posts, 17 percent by government and referral hospitals, 3 percent by integrated community health services (SISCa), and 2 percent by mobile clinics. In the private medical sector, most users are served by private hospitals/clinics (8 percent of all users). Most contraceptives sold in private hospitals/ clinics are provided through the Timor-Leste Contraceptive Retail Sales Company. Unmet Need for Family Planning. About one in three currently married women has an unmet need for family planning, with 21 percent having an unmet need for spacing and 10 percent having an unmet need for limiting. Twenty-two percent of women have a met need for family planning. If all currently married women who say they want to space or limit their children were to use a family planning method, the contraceptive prevalence rate would increase to 53 percent from the current 22 percent. Currently, only 42 percent of the family planning needs of currently married women are being met. MATERNAL HEALTH Antenatal Care. Antenatal care from a skilled birth attendant, that is, from a doctor, nurse, midwife, or assistant nurse, is very common in Timor-Leste, with 86 percent of women reporting receipt of such care. The majority of women received care from a nurse or midwife (80 percent). Four percent of women received care from a doctor, and less than 2 percent received care from an assistant nurse. One percent of women received care from a traditional birth attendant. Thirteen percent of women did not receive care from a health provider for their last birth in the five years preceding the survey. Antenatal care from a skilled provider is lowest in Ermera (71 percent) and highest in Dili (96 percent). There has been a significant improvement in the proportion of women receiving antenatal care from a skilled provider—an increase of 41 percent, from 61 percent in the 2003 DHS to 86 percent in the 2009-10 TLDHS. Neonatal tetanus is a leading cause of neonatal death in developing countries where a high proportion of deliveries occur at home or in places where hygienic conditions may be poor. Tetanus toxoid (TT) vaccinations are given to pregnant women to prevent neonatal tetanus. The survey results show that three-quarters of mothers with a live birth in the five years preceding the survey received two or more tetanus toxoid injections during their last preg- nancy, and four-fifths were protected for their last birth. Mothers in Manatuto are most likely to have received two or more tetanus toxoid injections (92 percent) and to have had their last birth protected against neonatal tetanus (95 percent) compared with mothers in all other districts; tetanus toxoid coverage is lowest among mothers in Ermera and Ainaro. With regard to antimalarial indicators, the results show that overall, 39 percent of all women and 45 percent of pregnant women slept under some sort of net the night before the interview. Thirty-seven percent of all women and 43 percent of pregnant women slept under an ever-treated net, and 34 percent and 41 percent, respectively, slept under an ITN. In households that own at least one ITN, a substantially larger proportion of women slept under an ITN the night before the survey (77 percent of all women and 84 percent of pregnant women). Delivery Care. Just over one in five births are delivered in a health facility, with the vast majority delivered in a public (21 percent) rather than in a private (1 percent) facility. The majority of births (78 percent) are delivered at home. Delivery in a health facility is most common among young mothers (25 percent), mothers of first-order births (31 percent), and mothers who have had at least four antenatal visits (31 percent). Half (53 percent) of the children in urban areas are born in a health facility, compared with only 12 percent in rural areas. Delivery in a health facility also varies by district, with facility delivery in Dili being much more likely than in any other district (63 percent). Less than 10 percent of births in Ermera, Oecussi, and Ainaro are delivered in a health facility. Thirty percent of births are delivered by a skilled provider (doctor, nurse, assistant nurse, or midwife), with a nurse or midwife being the most common skilled provider. Three percent of deliveries are performed by a doctor, and less than 1 percent are performed by an assistant nurse. Nearly one-fifth of deliveries are carried out by traditional birth attendants (18 percent). Women receive assistance from a relative or some other person for nearly one in two births (49 percent), while 3 percent of births take place without any type of assistance at all. xxvi | Summary of Findings Postnatal Care. The majority of women (68 percent) did not receive a postnatal check. Among those who received postnatal care, 16 percent received it in less than four hours after delivery, 5 percent received care within 4 to 23 hours, and 3 percent received care within the first two days. Seven percent received postnatal care 3 to 41 days following delivery. Maternal Mortality. Maternal mortality in Timor-Leste is high relative to many developed countries. Respondents reported 120 maternal deaths in the seven years preceding the survey. The maternal mortality rate, which is the annual number of maternal deaths per 1,000 women age 15-49, for the period zero to six years preceding the survey, is 0.96. Maternal deaths accounted for 42 percent of all deaths to women age 15-49; in other words, more than two in five Timorese women who died in the seven years preceding the survey died from pregnancy or pregnancy- related causes. The maternal mortality ratio, which measures the obstetric risk associated with each live birth for the seven years preceding the survey is 557 deaths per 100,000 live births (or alternatively, about 6 deaths per 1,000 live births). The 95 percent confidence interval places the true MMR for 2009-10 anywhere between 408 and 706. CHILD HEALTH Childhood Mortality. Under-5 mortality for the most recent period (0-4 years before the survey or, roughly, during the calendar years 2005-2009) is 64 deaths per 1,000 live births. This means that 1 in 16 children born in Timor- Leste dies before the fifth birthday. Seventy percent of deaths among children under age 5 occur during the first year of life: infant mortality is 45 deaths per 1,000 live births. During infancy, the risk of neonatal deaths and postneonatal deaths is 22 and 23 per 1,000 live births, respectively. Data from the TLDHS for the three five-year periods preceding the survey indicate a decline in childhood mortality. This is consistent with comparison of the TLDHS 2009-10 mortality data with the 2003 DHS survey results, which shows a substantial (23 percent) improvement in child survival. For example, under-5 mortality declined from 83 per 1,000 live births during the period 1999-2003 to 64 per 1,000 live births during the period 2005-2009. This decline is caused principally by a decrease in the infant mortality rate, from 60 deaths per 1,000 for the zero to four years preceding the 2003 DHS to 45 per 1,000 during the same period prior to the 2009-10 TLDHS. Childhood Vaccination Coverage. Fifty- three percent of Timorese children age 12-23 months are fully immunized, and 23 percent received no vaccinations. Forty-seven percent of children age 12-23 months are fully vaccinated by 12 months of age. The percentage of children fully vaccinated nearly tripled from 18 percent in 2003. Seventy-seven percent of children received the BCG vaccination, 75 percent received the first DPT dose, and 75 percent received the first polio dose. Coverage for all three vaccinations declines with subsequent doses; 66 percent of children received the recommended three doses of DPT, and 56 percent received three doses of polio. These figures reflect dropout rates (which represent the proportion of children who received the first dose of a vaccine but who did not get the third dose) of 12 percent for DPT and 25 percent for polio, respectively. This is a huge improve- ment from 2003 when the dropout rates for DPT and polio were 45 and 62 percent, respectively. Sixty-eight percent of children received the measles vaccine. Hepatitis B coverage varies slightly from DPT coverage, although they have been given together in a tetravalent vaccine since 2007. This difference is likely due to the inclusion of a small number of children who received the DPT vaccine before the tetravalent vaccine was introduced. Childhood Illness and Treatment. Among children under 5 years of age, 2 percent had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Seven in ten children with symptoms of ARI (71 percent) were taken to a health facility or provider, and 45 percent were prescribed antibiotics. One-fifth of children (19 percent) under 5 years of age were reported to have had fever in the past two weeks. Seventy-three percent of children with a fever were taken to a health facility or provider for treatment. Six percent of children under age 5 with fever in the two weeks preceding the survey were given antimalarial drugs, and 36 percent received antibiotics. Sixteen percent of all children under the age of 5 had diarrhea in the two weeks before the survey, and 1 percent had diarrhea with blood. Overall, 72 percent of children with diarrhea were taken to a health provider for treatment of diarrhea. Seventy-eight percent of children with Summary of Findings | xxvii diarrhea were treated either with oral rehydration salts (ORS) (71 percent) or recommended home fluids (RHF) (40 percent). Ten percent of children were given increased fluids. Overall, 79 percent of children under age 5 with diarrhea were treated with ORS, RHF, or increased fluids. Six percent of children with diarrhea were treated with antibiotics, home remedies were given to 18 percent of children with diarrhea, and 13 percent of children with diarrhea were given no treatment at all. Six percent of children with diarrhea received zinc only. NUTRITION Nutritional Status of Children. Fifty-eight percent of children under age 5 are stunted, and 33 percent are severely stunted. Nineteen percent of children under age 5 are wasted, and 7 percent are severely wasted. The weight-for-age indicator shows that 45 percent of children under age 5 are underweight, and 15 percent are severely underweight. In addition, 5 percent of Timorese children under age 5 are overweight. There has been a slight rise in the level of stunting, wasting, and underweight over the past 6 years. Stunting increased from 49 percent to 53 percent, wasting increased from 12 percent to 17 percent, and underweight increased from 46 percent to 52 percent. Breastfeeding Practices. Breastfeeding is nearly universal in Timor-Leste, with 97 percent of children born in the five years preceding the survey having been breastfed at some time. On average, four in five children are breastfed within the first hour of birth (82 percent), and 96 percent are breastfed within one day of birth. Thirteen percent of children are given a pre- lacteal feed, that is, something other than breast milk, during the first three days of life. The percentage of children who are breastfed early has increased in the past six years, the increase being more pronounced for children breastfed within one hour of birth. There has been a rise in the percentage of children breastfed within one hour of birth by about 74 percent, from 47 percent in the 2003 DHS to 82 percent in 2009- 10 TLDHS. Contrary to WHO’s recommendations, how- ever, only about half (52 percent) of children under age 6 months are exclusively breastfed in Timor-Leste. The 2009-10 TLDHS results also indicate that the proportion of children receiving complementary foods in a timely fashion is encouraging, with 78 percent of children age 6-8 months receiving complementary foods. The practice of bottle-feeding with a nipple is not widespread in Timor-Leste. Intake of Vitamin A. Ensuring that children age 6-59 months receive enough vitamin A may be the single most effective child survival intervention. Deficiencies in this micronutrient can cause blindness and can increase the severity of infections such as measles and diarrhoea. Nearly four-fifths (79 percent) of last-born children age 6-35 months consumed vitamin A- rich foods, and 52 percent of young children consumed foods rich in iron in the 24-hour period before the survey. One in two children (51 percent) age 6-59 months received a vitamin A supplement in the six months before the survey. This is an improvement over the last five years. Along with vitamin A deficiency, the preva- lence of worm infestation has been high in Timor-Leste. Thirty-five percent of children age 6-59 months received deworming tablets in the six months preceding the survey. Prevalence of anemia. Iron-deficiency anemia is a major threat to maternal health and child health. More than one in three (38 percent) Timorese children age 6-59 months old are anemic, with 25 percent mildly anemic, 13 percent moderately anemic, and less than 1 percent severely anemic. Children in Manatuto district have the highest prevalence of anemia (68 percent), and children in Ermera district have the lowest prevalence (15 percent). Nutritional Status of Women. Overall, 15 percent of women are shorter than 145 cm. Women in rural areas are much shorter on average than women in urban areas, with 17 percent falling below the 145 cm cutoff compared with only 9 percent of women in urban areas. Women living in Dili are least likely to be below 145 cm (7 percent), while women in Ermera are most likely (31 percent). Twenty-seven percent of women were found to be malnourished with BMI <18.5 indicating that malnutrition among women is a serious public health concern in Timor-Leste. About 5 percent of Timorese women are overweight or obese. Women’s nutritional status has improved over the years. The proportion of malnourished women (BMI <18.5) has decreased by 29 percent in the past decade, from 38 percent in the 2003 DHS to 27 percent in the 2009-10 TLDHS. xxviii | Summary of Findings However, the level of chronic energy deficiency among nonpregnant women is still high, with more than one-quarter of women having a BMI less than 18.5. The mean BMI has increased only slightly over the years from 19.5 in the 2003 DHS to 20.2 in the 2009-10 TLDHS. A mother’s nutritional status during preg- nancy is important both for the child’s intra- uterine development and for protection against maternal morbidity and mortality. Night blind- ness is an indicator of severe vitamin A deficiency, and pregnant women are especially prone to experience it. More than nine in ten mothers (94 percent) consumed vitamin A-rich foods, and more than one-half (53 percent) consumed iron-rich foods in the 24 hours preced- ing the survey. Fifty-five percent of women received vitamin A postpartum, an improvement from the 23 percent of women who received vitamin A postpartum reported in the 2003 TLDHS. Iron supplementation during pregnancy has been a key health initiative in Timor-Leste since 2003. The proportion of women who took iron supplements during pregnancy has risen from 43 percent in 2003 to 61 percent in 2009-10. However, 37 percent of women did not take any iron supplements during their most recent preg- nancy. Further, only 16 percent of women took the recommended dose of iron supplements for 90 days or more during their pregnancy. In addition, 13 percent of women received deworming medication during pregnancy, 31 percent received supplementary food while pregnant with their last birth, and 29 percent received supplementary food while breastfeeding their last-born child. Thirteen percent of mothers reported having difficulty seeing at night but, when this figure is adjusted to include only those mothers who had no difficulty seeing in the daytime, only 2 percent of mothers suffered from night blindness during their most recent pregnancy in the last five years. This is a decrease from the 13 percent of mothers reported with night blindness in the DHS 2003 survey. Iron deficiency anemia is one of the most common nutritional problems in Timor-Leste. Overall 21 percent of Timorese women age 15- 49 are anemic, with 18 percent mildly anemic, 4 percent moderately anemic, and less than 1 percent severely anemic. However, pregnant women are more likely to be anemic (28 percent) than women who are breastfeeding (25 percent) and women who are neither pregnant nor breast- feeding (19 percent). HIV AND AIDS Knowledge of HIV and AIDS. Forty-four percent of women and 61 percent of men have heard of HIV and AIDS. Women are most aware that the chances of getting the HIV virus can be reduced by limiting sex to one uninfected partner who has no other partners (36 percent). In addition, 26 percent mention that abstaining from sexual intercourse will prevent the transmission of HIV. Among men, the most commonly known prevention method is also limiting sex to one uninfected partner who has no other partners (49 percent). Knowledge of condoms and the role that they can play in preventing the transmission of HIV is much less common among women than among men (30 percent versus 45 percent). Fewer women and men (27 percent and 42 percent, respectively) are also aware that both using condoms and limiting sex to one uninfected partner can reduce the risk of getting the HIV virus. Many Timorese adults lack accurate knowledge about the ways in which the HIV virus can and cannot be transmitted, with women being much less knowledgeable than men. Only 33 percent of women and 46 percent of men know that a healthy-looking person can have the HIV virus. One in four women and two in five men know that HIV cannot be transmitted by mosquito bites, or that a person cannot become infected by sharing food with a person who has HIV or sharing clothes with a person who has HIV. About twice as many men as women (28 percent and 15 percent, respectively) say that a healthy looking person can have the virus and reject the two most common local misconcep- tions (that HIV can be transmitted by mosquito bites and by sharing food). Attitudes towards People Living with HIV and AIDS. Knowledge and beliefs affect how people treat those they know to be living with HIV or AIDS. In the 2009-10 TLDHS, a number of questions were posed to respondents to measure their attitudes towards people living with HIV or AIDS (PLWA). Twice as many women as men (55 percent and 26 percent, respectively) state that they would be willing to care for a family member with the AIDS virus in their home. Eighty-four percent of women and 87 percent of men say that they would not want to keep secret that a family member was infected with the AIDS virus, while 44 percent of women Summary of Findings | xxix and 28 percent of men say that a female teacher with AIDS should be allowed to continue teaching. A relatively lower proportion of women and men (34 percent and 22 percent, respectively) say they would buy fresh vege- tables from a shopkeeper with AIDS. The percentage expressing accepting attitudes on all four measures is low: 11 percent among women and 3 percent among men. HIV-Related Behavioral Indicators. Just over 1 percent of men age 15-49 reported having had two or more sexual partners during the 12 months prior to the survey, with men reporting a mean number of just under two partners in their lifetime. Among men with two or more partners in the 12 months preceding the survey, 19 percent used a condom at last sex. Five percent of men reported that they had engaged in paid sex in the year before the survey, and among those who paid for sex, only 26 percent reported using a condom the last time they paid for sex. DOMESTIC VIOLENCE The 2009-10 TLDHS included a series of questions that focus on specific aspects of domestic and interpersonal violence, including acts of physical, sexual, and emotional violence. Due to ethical considerations, only one woman was administered the domestic violence module in each selected household, and the violence module was not administered if privacy could not be obtained. Approximately one-third of women (38 percent) have experienced physical violence since age 15. One percent of women experienced physical violence often, while 28 percent experienced physical violence sometimes in the past 12 months. Urban women are more likely than rural women to have experienced physical violence since the age of 15 (49 percent compared with 35 percent). This is corroborated by the fact that more than half of the women in Dili district, which is primarily urban, reported experiencing physical violence since the age of 15 years. Women in Manufahi (76 percent) are most likely to report having ever experienced physical violence. Experience of physical violence in the past 12 months is highest among women in Manufahi (65 percent) and lowest in Ainaro (8 percent). Among ever-married women who have ever experienced physical violence, 74 percent reported that a current husband or partner committed the physical violence against them, while 6 percent reported that they experienced physical violence by a former husband/partner. Other perpetrators commonly reported by ever- married women were mother/stepmother (34 percent) and father/stepfather (26 percent), sisters and brothers (11 percent), and other relatives (6 percent). About 3 percent of women have experienced sexual violence, with the proportion of women who have experienced sexual violence ranging from less than 1 percent in Viqueque to 7 percent in Baucau, Lautem, and Aileu. For 16 percent of women who ever experienced sexual violence, the first experience of such violence occurred at age 15-19; 6 percent first experienced sexual violence at age 10-14; and less than 1 percent first experienced sexual violence before age 10. One in ten women who experienced sexual violence first experienced it at age 20-49. The main perpetrators of sexual violence against ever-married women are current husbands/ partners (71 percent) or former husbands/partners (9 percent). The findings from the survey also indicate that overall, 4 percent of women in Timor-Leste experienced physical violence during pregnancy. Violence by husbands against wives is not the only form of spousal violence; women may sometimes be the perpetrators of violence. Six percent of married women report that they have initiated physical violence against their current or most recent husbands, while 5 percent say that they have committed such violence in the 12 months preceding the survey. About one in five women (24 percent) who experience violence seek help. Women who experience both physical and sexual violence (50 percent) are most likely to seek help. Seven percent of women who experienced violence in Manufahi sought help, compared with one in two women in Covalima (51 percent). Millennium Development Goal Indicators | xxxi MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Timor-Leste 2009-10 Indicator Sex Total Male Female 1.8 Prevalence of underweight children under five years of age 45.5 43.8 44.7 2.1 Net attendance ratio in primary school1 70.3 77.4 71.1 2.3 Literacy rate of 15-24 year-olds 86.1 84.1 na 3.1 Ratio of girls to boys in primary, secondary and tertiary education na na 93.3 4.1 Under five mortality rate2 85 76 64 4.2 Infant mortality rate2 59 53 45 4.3 Percentage of 1 year old children immunized against measles 69.0 66.5 67.8 5.1 Maternal mortality ratio3 na na 557 5.2 Percentage of births attended by skilled health personnel na na 29.9 5.3 Contraceptive prevalence rate4 na 22.3 na 5.4 Adolescent birth rate5 na 51 na 5.5 Antenatal care coverage At least one visit na 87.5 na Four or more visits na 55.1 na 5.6 Unmet need for family planning na 30.8 na 6.2 Condom use at last high-risk sex6 13.2 * na 6.3 Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS 19.7 12.2 na 6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years 0.82 0.68 0.75 6.7 Percentage of children under five sleeping under ITN 40.7 41.4 41.0 6.8 Percentage of children under five with fever treated with appropriate antimalarial drugs 6.4 5.1 5.7 Urban Rural Total 7.8 Percentage of population with sustainable access to an improved water source 88.2 56.6 64.0 7.9 Percentage of population with access to improved sanitation 65.9 35.8 43.0 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Net attendance ratio measured in the TLDHS approximates MDG indicator 2.1, Net enrollment ratio. 2 Expressed in terms of deaths per 1,000 live births 3 Expressed in terms of maternal deaths per 100,000 live births 4 Percentage of currently married women using any method of contraception 5 Equivalent to the age-specific fertility rate for women age 15-19, expressed in terms of births per 1,000 women age 15-19. 6 High-risk sex is defined as sexual intercourse with a non-marital, non-cohabiting partner. Expressed as a percentage of men and women age 15-24 who had high-risk sex in the past 12 months. xxxii | Map of Timor-Leste Introduction | 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY 1.1.1 History Timor-Leste is a small country in Southeast Asia. It occupies primarily the eastern half of the island of Timor, with West Timor being part of the Republic of Indonesia. Timor-Leste includes the nearby islands of Ataúro and Jaco, and also Oecussi, an exclave in Indonesian West Timor. The first inhabitants are thought to be descended from Australoid and Melanesian people. Contact between the Portuguese and the island of Timor began in the early 16th century, with trade and eventual colonization occurring in the middle of the century. In 1859, the western portion of the island was ceded to the Dutch. During World War II, Japan occupied Timor-Leste from 1942 to 1945. Portugal resumed colonial authority after the Japanese defeat. The country declared independence from Portuguese rule on November 28, 1975, but was invaded and occupied by Indonesian forces just nine days later on December 7, 1975. It was incorporated into Indonesia in July 1976 as a province known as Timor-Timur. Between 1974 and 1999, there were an estimated 102,800 conflict-related deaths (approximately 18,600 killings and 84,200 “excess” deaths from hunger and illness), the majority of which occurred during the Indonesian occupation (UNESCO, 2009). On August 30, 1999, in a UN-sponsored referendum, an overwhelming majority of the Timorese people voted for independence from Indonesia. Immediately following the referendum, however, anti-independence Timorese militias organized with support from the Indonesian military and began a punitive “scorched-earth” campaign. The majority of the country’s infrastructure was destroyed, including homes, irrigation and water supply systems, schools, and nearly all of the country’s electrical grid. The militias killed approximately 1,400 Timorese and forcibly pushed 300,000 people into West Timor as refugees (CIA, 2010). On September 20, 1999, the International Force for East Timor (INTERFET) began deploying to the country and brought the violence to an end. Following a transitional period administered by the United Nations under the United Nations administration in East Timor (UNTAET), Timor-Leste was internationally recognized as an independent country on May 20, 2002. The country became officially known as the Democratic Republic of Timor-Leste. Kay Rala Xanana Gusmão became the first president, and Mari Alkatiri assumed the role of first prime minister. The relationship between the armed forces and the police remained fragile, and the authority of the state faced multiple challenges. In early 2006, following claims of discrimination within the military of Timor-Leste, nearly 600 military personnel deserted their barracks and were eventually relieved of duty. In April, riots broke out in Dili among rival groups within the military and police. Renewed fighting between the pro-government troops and disaffected Falentil troops broke out in May 2006 and resulted in further destruction of property. Forty people were reported as killed, and more than 20,000 residents fled their homes to internally displaced persons camps outside of the city (Head, 2006). In July 2006, after calls for his resignation, Prime Minister Alkatiri stepped down and was replaced by Jose Ramos-Horta. Following the most recent presidential elections held in April 2007, Jose Ramos-Horta became the president on May 20, 2007 and Kay Rala Xanana Gusmão was sworn in as the Prime Minister on August 8, 2007 (Wikipedia, 2010). 2 | Introduction 1.1.2 Geography Timor-Leste is variously known as Timor-Timur, timur meaning “east” in Malay; Timor- Leste, leste meaning “east” in Portuguese; and Timor Lorosa’e, Lorosa’e meaning “rising sun” in Tetum. The island of Timor is part of the Malay Archipelago and is the largest and easternmost of the Lesser Sunda Islands. To the north of the mountainous island are the Ombai Strait and Wetar Strait, to the south is the Timor Sea, which separates the island from Australia, and to the west lies the Indonesian province of East Nusa Tenggara. The highest point of Timor-Leste is Mount Tatamailau at 2,963 meters. The island of Timor is located at coordinates between 8°50′S and 125°55′E, and the country covers a total area of 14,919 square kilometers (National Statistics Directorate, 2006). The local climate is tropical and generally hot and humid, characterized by distinct rainy and dry seasons. Timor-Leste is divided into 13 administrative districts, 65 sub-districts, and 442 Sucos and 2,225 aldeias. The 13 districts are Ainaro, Alieu, Baucau, Bobonaro, Covalima, Dili, Ermera, Lautem, Liquiçá, Manatuto, Manufahi, Oecussi, and Viqueque. Thirty percent of the population lives in the urban areas, and the rest live in rural areas (NSD, 2010). Dili is the capital. It is the largest city and the main port. The second-largest city is the eastern town of Baucau. Dili has the only functioning international airport, though there is also an airstrip in Baucau that is used for domestic flights. Several languages are spoken in the country. Tetum is the most common language in Timor- Leste and is the first official national language. Portuguese, spoken by fewer people, is the other official language. English and Indonesian are working languages. 1.1.3 Economy Timor-Leste’s economy is one of the poorest in the world (CIA, 2010). During colonization and even before then, Timor-Leste was best known for its sandalwood. In late 1999, about 70 percent of the economic infrastructure of Timor-Leste was destroyed by Indonesian troops and anti- independence militias. Some 300,000 people fled westward. Over the next three years, a massive international program led by the United Nations and manned by civilian advisers, peacekeepers, and police officers led to substantial reconstruction in the country (CIA, 2010). Timor-Leste still suffers from the aftereffects of the conflict. The country faces great challenges in continuing to rebuild infrastructure and strengthen the civil administration. One promising long-term project has been the joint development with Australia of petroleum and natural gas resources in the southeastern waters off Timor. Following independence, Timor-Leste negotiated the Timor Sea Treaty with Australia. This treaty replaced a previous agreement, the Timor Gap treaty, brokered between Indonesia and Australia in 1989. The Timor Sea Treaty established the Joint Petroleum Development Area (JPDA), which is administered jointly by both countries. Under the terms of the treaty, Timor-Leste receives 90 percent of the revenue from petroleum production in the JPDA, and Australia receives the remaining 10 percent. Agriculture and fishery are the backbone of the Timorese economy, and coffee plantations have been of major significance. In 2007, a poor harvest led to deaths from starvation in several parts of the country, and 11 districts required food supplies through international aid. The 2007 Timor-Leste Survey of Living Standards reported that nearly 50 percent of the Timorese lived below the national poverty line, estimated at $0.88 per capita per day. Based on a recent survey-to-survey imputation calculation, the incidence of poverty in the country is predicted to have declined by 9 percentage points between 2007 and 2009 (MOF, 2010). Timor-Leste’s Human Development Index for 2010 is 0.502—positioning the country at 120 out of 169 countries and areas (UNDP, 2010). This is an increase of 17 percent from 0.428 in 2005. During the same period, Timor- Leste’s life expectancy at birth increased by over 2 years. Introduction | 3 The government of Timor-Leste has laid out the Fourth Constitutional Government Program for 2007-2012 as the country’s development strategy for the current five years. It defines the long- term development goals in terms of reducing poverty and promoting the equitable growth and life of the Timorese population. The Office of the Prime Minister is preparing the Strategic Development Plan to address the national priorities for the country over the period 2011-2030. 1.2 POPULATION The first census following independence was conducted in 2004, and the second census was completed in August 2010. According to the 2004 Census, the population of Timor-Leste is 923,198 and the annual growth rate is 5.3 percent (NSD, 2006). The population increased by 24 percent over the last 15 years, growing from 747,547 in 1990 to 923,198 in 2004 (NSD, 2006). The population is currently estimated at 1,066,582 with an annual growth rate of 2.4 percent between the 2004 Census and the 2010 Census (NSD, 2010). According to the 2004 Census, life expectancy was estimated at 59 years, and increased to 62 years according to the 2010 Census. 1.3 POPULATION AND REPRODUCTIVE HEALTH POLICIES AND PROGRAMS Shortly after the country gained independence, the Ministry of Health initiated the first National Health Policy Framework (NHPF) for 2002-12, which prioritizes the health needs of the Timorese people and emphasizes the importance of understanding the social determinants of health within the local cultural context. The NHFP seeks to “provide quality of health for the East Timorese by establishing and developing a cost-effective and needs-based health system which will specially address the health issues and problems of women, children, and other vulnerable groups, particularly the poor, in a participatory way” (MOH, 2002a). The NHPF serves as the basis for the formulation of the National Health Promotion Strategy (NHPS) and the National Reproductive Health Strategy (NRHS), which is an outcome of the 1994 International Conference on Population and Development (ICPD) held in Cairo (MOH, 2004a). The primary objectives of the NRHS are: • to substantially increase the level of knowledge in the general population on issues related to sexuality and reproductive health; • to promote family planning in order to stabilize the population growth rate and reduce the incidence of unintended, unwanted, and mistimed pregnancies; • to ensure that all women and men have access to basic reproductive health care services, health promotion, and information on issues related to reproduction; • to reduce the level of maternal mortality and morbidity; • to reduce the level of prenatal and neonatal mortality and morbidity; • to reduce the burden of STIs/HIV; • to meet changing reproductive health needs over the life cycle and to improve the health status of people of reproductive age. Family planning is one of the major components of the Timor-Leste planned development activities under the First Development Plan, 2002-2007. The Timor-Leste Family Planning and Maternal and Child Health project (FP/MCH) functions under the Ministry of Health. The Ministry of Health endorsed the National Family Planning Policy for Timor-Leste in March 2004. The primary objective of this policy is to address population growth and provide guidance on the development and implementation of family planning programs and activities in Timor-Leste (MOH, 2004b). The FP/MCH project began in 2002, and since then it has gradually involved all 13 districts of Timor-Leste. Family planning services have become an integral part of government health services. Currently, temporary modern family planning methods (male condoms, contraceptive pills, and injectables) are provided by peripheral health workers and volunteers on a regular basis through national, regional, zonal, and district hospitals; primary health care centers/health centers; and health 4 | Introduction posts and sub-health posts. Services such as implants and IUD insertions are available only at a limited number of hospitals, health centers, and selected health posts where trained personnel are available. Depending on the district, sterilization services are provided at some static sites in the 13 districts through scheduled “seasonal” or mobile outreach services. A number of local nongovernmental organizations (NGOs) and international nongovernmental organizations (INGOs) also are currently involved in the delivery of family planning services at the grass roots level. 1.4 OBJECTIVES OF THE SURVEY The principal objective of the 2009-10 Timor-Leste Demographic and Health Survey (TLDHS) was to provide current and reliable data on fertility and family planning behavior, child mortality, adult and maternal mortality, child nutritional status, the utilization of maternal and child health services, and knowledge of HIV/AIDS. The specific objectives of the survey were to: • collect data at the national level that will allow the calculation of key demographic rates; • analyze the direct and indirect factors that determine the levels and trends in fertility; • measure the level of contraceptive knowledge among women and men, and measure the level of practice among women by method, according to urban or rural residence; • collect quality data on family health, including immunization coverage among children, prevalence and treatment of diarrhea and other diseases among children under age 5, and maternity care indicators, including antenatal visits, assistance at delivery, and postnatal care; • collect data on infant and child mortality and on maternal and adult mortality; • obtain data on child feeding practices, including breastfeeding, and collect anthropometric measures to use in assessing the nutritional status of women and children; • collect information on knowledge of tuberculosis (TB), knowledge of the spread of TB, and attitudes towards people infected with TB among women and men; • collect data on use of treated and untreated mosquito nets, persons who sleep under the nets, use of drugs for malaria during pregnancy, and use of antimalarial drugs for treatment of fever among children under age 5; • collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS, and evaluate patterns of recent behavior regarding condom use; • collect information on the sexual practices of women and men; their number of sexual partners in the past 12 months, and over their lifetime; risky sexual behavior, including condom use at last sexual intercourse; and payment for sex; • conduct hemoglobin testing on women age 15-49 and children age 6-59 months in a sub- sample of households selected for the survey to provide information on the prevalence of anemia among women of reproductive age and young children; • collect information on domestic violence This information is essential for informed policy decisions, planning, monitoring, and evaluation of programs on health in general, and on reproductive health in particular, at both the national and district levels. A long-term objective of the survey is to strengthen the technical capacity of government organizations to plan, conduct, process, and analyze data from complex national population and health surveys. Moreover, the 2009-10 TLDHS provides national and district-level estimates on population and health that are comparable to data collected in similar surveys in other developing countries. The first Demographic and Health Survey (DHS) in Timor-Leste was done in 2003. Unlike the 2003 DHS, however, the 2009-10 TLDHS was conducted under the worldwide MEASURE DHS program, funded by the United States Agency for International Development (USAID) and with technical assistance provided by ICF Macro. Data from the 2009-10 TLDHS allow for comparison of information gathered over a longer period of time and add to the vast and growing international database on demographic and health variables. Introduction | 5 1.5 ORGANIZATION OF THE SURVEY The TLDHS 2009-10 was implemented by the National Statistics Directorate of the Directorate General for Analysis and Research of the Ministry of Finance, under the aegis of the Ministry of Health (MOH) of Timor-Leste. Technical support was provided by ICF Macro, and financial support was provided by USAID, the Government of Australia (AusAID), the Government of Ireland (Irish AID), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United Nations Development Fund (UNDP), and the World Health Organization (WHO). UNFPA supported the survey with administrative, logistical, and technical assistance. A steering committee was formed to be responsible for coordination, oversight, advice, and decision making on all major aspects of the survey. The steering committee was composed of representatives from various ministries and key stakeholders, including the MOH, National Statistics Directorate, USAID, and international NGOs. 1.6 SAMPLE DESIGN The primary focus of the 2009-10 TLDHS was to provide estimates of key population and health indicators, including fertility and mortality rates, for the country as a whole and for urban and rural areas separately. In addition, the sample was designed to provide estimates of most key variables for the 13 districts. 1.6.1 Sampling Frame The TLDHS used the sampling frame provided by the list of census enumeration areas (EAs) with population and household information from the 2004 Population and Housing Census (PHC). Administratively, Timor-Leste is divided into 13 districts. Stratification is achieved by separating each of the 13 districts into urban and rural areas. In total, 26 sampling strata were created. Samples were selected independently in every stratum, through a two-stage selection process. Implicit stratification was achieved at each of the lower administrative levels by sorting the sampling frame before sample selection, both according to administrative units and also by using a probability proportional-to-size selection at the first stage of sampling. The implicit stratification also allowed for the proportional allocation of sample points at each of the lower administrative levels. 1.6.2 Sample Selection At the first stage of sampling, 455 enumeration areas (116 urban areas and 339 rural areas) were selected with probability proportional to the EA size, which is the number of households residing in the EA at the time of the census. A complete household listing operation in all of the selected EAs is the usual procedure to provide a sampling frame for the second-stage selection of households. However, a complete household listing was only carried out in select clusters in Dili, Ermera, and Viqueque, where more than 20 percent of the households had been destroyed. In all other clusters, a complete household listing was not possible because the country does not have written boundary maps for clusters. Instead, using the GPS coordinate locations for structures in each selected cluster as provided for by the 2004 PHC, households were randomly selected using their Geographic Information System (GIS) location identification in the central office. A map for each cluster was then generated, marking the households to be surveyed with their location identification. The maps also contained all the other households, roads, rivers, and major landmarks for easier location of selected households in the field. To provide statistically reliable estimates of key demographic and health variables and to cater for nonresponse, 27 households each were selected. 6 | Introduction The survey was designed to cover a nationally representative sample of 12,285 residential households, taking into account nonresponse; to obtain completed interviews of 11,800 women age 15-49 in every selected household; and to obtain completed interviews of 3,800 men age 15-49 in every third selected household. 1.7 QUESTIONNAIRES Three questionnaires were administered in the TLDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires were adapted from the standard MEASURE DHS core questionnaires to reflect the population and health issues relevant to Timor-Leste based on a series of meetings with various stakeholders from government ministries and agencies, NGOs, and international donors. The final draft of each questionnaire was discussed at a questionnaire design workshop organized by NSD on March 10, 2009, in Dili. These questionnaires were then translated and back translated from English into the two main local languages−Tetum and Bahasa—and pretested prior to the main fieldwork to ensure that the original meanings of the questions were not lost in translation. 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 age, sex, education, and relationship to the head of the household. For children under age 18, survival status of the parents was determined. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and ownership of mosquito nets. Additionally, the Household Questionnaire was used to record height and weight measurements for women age 15-49 and children under age 5, and to list hemoglobin measurements for women age 15-49 and children age 6-59 months. The Woman’s Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following topics: • Background characteristics (education, residential history, media exposure, etc.) • Birth history and childhood mortality • Knowledge and use of family planning methods • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Woman’s work and husband’s background characteristics • Awareness and behavior regarding AIDS and other sexually transmitted infections (STIs) • Maternal mortality • Domestic violence The Man’s Questionnaire was administered to all men age 15-49 living in every third household. The Man’s Questionnaire collected much of the same information found in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health, nutrition, maternal mortality, or domestic violence. Introduction | 7 1.8 HEMOGLOBIN TESTING In one-third of the households selected for the 2009-10 TLDHS, women age 15-49 and children age 6-59 months were tested for anemia. Anemia testing was only carried out if consent was provided by the respondent and, in the case of a minor, by the parent or guardian. The protocol for hemoglobin testing was approved by the Ministry of Health in Timor-Leste. Hemoglobin testing is the primary method for diagnosis of anemia. In the 2009-10 TLDHS, testing was done using the HemoCue system. A consent statement was read to the eligible woman and to the parent or responsible adult of young children and women age 15-17. This statement explained the purpose of the test, informed prospective subjects and/or their caretakers that the results would be made available as soon as the test was completed, and requested permission for the test to be carried out. Before the blood was taken, the finger was wiped with an alcohol prep swab and allowed to air-dry. Then the palm side of the end of one finger was punctured with a sterile, nonreusable, self- retractable lancet. A drop of blood was collected with a HemoCue microcuvette and placed in a HemoCue photometer where the results were displayed. For children age 6-11 months who were particularly undernourished and thin, a heel puncture was made to draw a drop of blood. The results were recorded in the Household Questionnaire, as well as on a brochure, given to each woman, parent, or responsible adult, which explained what the results meant. 1.9 PRETEST, TRAINING, AND FIELDWORK 1.9.1 Pretest For the pretest, 10 interviewers were recruited to interview in the two local languages. The training for the pretest and fieldwork took place from April 27 to May 23, 2009. Both rural and urban households were selected for the pretest in three districts (Bobonaro, Viqueque, and Dili). Based on the findings of the pretest, the Household, the Woman’s, and the Man’s Questionnaires were further refined in both of the local languages. 1.9.2 Training The National Statistics Directorate (NSD), in close coordination with the MOH, recruited and trained 101 persons for the fieldwork to serve as supervisors, field editors, male and female interviewers, quality control staff, and reserves. They participated in the main training held in Dili from July 13 – August 8, 2009. Staff from MOH, NSD, and ICF Macro led the four-week training course, which was conducted mainly in Tetum and included lectures, presentations, practical demonstrations, and practice interviewing in small groups as well as several days of field practice. The participants also received anthropometric training and training in hemoglobin testing. After the training on how to complete the Household, Woman’s, and Man’s Questionnaires was completed, all trainees were given written and oral tests to gauge their understanding of the TLDHS questionnaires and interviewing techniques. On the basis of their scores on the exam and overall performance in the classroom and during field practice, 88 trainees were selected to participate in the main fieldwork. From the group, 10 of the best trainees were selected as quality control staff, 13 of the best male trainees were selected as supervisors, and 13 of the best female interviewers were identified as field editors. The remaining 52 trainees were selected to be interviewers. All selected field staff were trained in anthropometric measurement taking. After completing the interviewers’ training, the field editors and supervisors were trained for an additional three days on how to supervise the fieldwork and edit questionnaires in the field, in order to ensure data quality. The participants also received training on hemoglobin testing. 8 | Introduction 1.9.3 Fieldwork Data collection began on August 10, 2009, by 13 teams consisting of three female interviewers, one male interviewer, a male supervisor, and a female field editor. Fieldwork was completed on February 7, 2010. Fieldwork supervision was coordinated at NSD; 6 quality control teams made up of one male and one female member each, monitored data quality. Additionally, close contact between NSD and the teams was maintained through field visits by senior staff, members of the steering committee, and ICF Macro staff. Regular communication was also maintained through cell phones. 1.10 DATA PROCESSING The processing of the TLDHS results began soon after the start of fieldwork. Completed questionnaires were returned periodically from the field to the NSD data processing center in Dili, where they were entered and edited by 13 data processing personnel who were specially trained for this task. The data processing personnel included a supervisor, a questionnaire administrator, 2 office editors, and 13 data entry operators. The concurrent processing of the data was an advantage because field check tables could be generated to monitor various data quality parameters while the teams were still in the field. As a result, specific feedback was given to the teams to improve performance. The data entry and editing phase of the survey was completed by the end of February 2010. 1.11 RESPONSE RATES Table 1.1 shows household and individual response rates for the 2009-10 TLDHS. A total of 12,128 households were selected for the sample, of which 11,671 were found to be occupied during data collection. Of these existing households, 11,463 were successfully interviewed, giving a household response rate of 98 percent. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Timor-Leste 2009-10 Result Residence Total Urban Rural Household interviews Households selected 3,012 9,116 12,128 Households occupied 2,851 8,820 11,671 Households interviewed 2,745 8,718 11,463 Household response rate1 96.3 98.8 98.2 Interviews with women age 15-49 Number of eligible women 3,625 10,171 13,796 Number of eligible women interviewed 3,233 9,904 13,137 Eligible women response rate2 89.2 97.4 95.2 Interviews with men age 15-49 Number of eligible men 1,183 3,238 4,421 Number of eligible men interviewed 1,015 3,061 4,076 Eligible men response rate2 85.8 94.5 92.2 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Introduction | 9 In these households, 13,796 women were identified as eligible for the individual interview. Interviews were completed with 13,137 women, yielding a response rate of 95 percent. Of the 4,421 eligible men identified in the selected sub-sample of households, 4,076 or 92 percent were successfully interviewed. Response rates were higher in rural than urban areas, with the rural-urban difference in response rates more marked among eligible men than among eligible women. The tabulations in the rest of the report discuss in detail the main demographic and health findings from interviews with these eligible women and men. Household Population and Housing Characteristics | 11 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter presents descriptive summaries of the social, economic, and demographic characteristics of households sampled for the survey. The basic characteristics of the sampled population (i.e., age, sex, education, and place of residence) coupled with the socioeconomic conditions of the households form the basis of the background information used to analyze most key demographic and health indices in this report. This information is crucial for the interpretation of key demographic and health indicators. From these indicators, meaningful policies and programs for interventions are drawn, and the representativeness of the survey is measured. One focus of this chapter is to describe the environment in which men, women, and children live. This description presents the general characteristics of the population, such as the age-sex structure, literacy and education, household arrangements (headship, size), and housing facilities (sources of water supply, sanitation facilities, dwelling characteristics, and household possessions). A distinction is made between urban and rural areas because many of these indicators differ depending on place of residence. In the 2009-10 TLDHS, a household is defined as a person or a group of persons, related or unrelated, who live together in the same house or compound, share the same housekeeping arrange- ments, and eat together as a unit. The Household Questionnaire was used to collect information on all usual residents and visitors who spent the night preceding the survey in the household. This mode of data collection allows the analysis of either the de jure (usual) residents of the household or the de facto household population (all individuals who spent the night preceding the interview in the household, including visitors). Wherever possible, the 2009-10 TLDHS data are compared with data from other surveys conducted in the country, such as the 1997 Indonesia DHS (CBS et al., 1998), the 2002 Multiple Indicator Cluster Survey (MICS) (UNICEF, 2003), the 2003 DHS (MOH et al., 2004), and the 2007 Timor-Leste Survey of Living Standards (TLSLS) (NSD, 2007). However, when comparing the 2009- 10 TLDHS with other surveys, caution should be exercised in interpreting the results because the sample size, design, study population, period of coverage, and methods of estimation of key indicators may differ and therefore not be exactly comparable. 2.1 HOUSEHOLD POPULATION BY AGE AND SEX Age and sex are important variables in analyzing demographic trends. Table 2.1 and Figure 2.1 present the distribution of the de facto household population in the 2009-10 TLDHS survey by five-year age groups, according to sex and urban-rural residence. The age structure is typical of a young population characterized by high fertility. This type of population structure imposes a heavy burden on the social and economic assets of a country. Although the results of the 2009-10 TLDHS indicate that 45 percent of the population is under age 15, this percentage represents a small improvement over the results of the 2003 survey in which 51 percent of the population was under age 15. About four percent of the population is in the older age groups (age 65 or older), and this percentage has not changed since 2003. 12 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Timor-Leste 2009-10 Age Urban Rural Total Male Female Total Male Female Total Male Female Total <5 14.8 14.7 14.8 15.3 15.0 15.2 15.2 15.0 15.1 5-9 16.1 15.0 15.6 16.3 15.7 16.0 16.3 15.6 15.9 10-14 12.7 13.0 12.8 14.4 13.9 14.1 14.0 13.7 13.8 15-19 11.1 11.0 11.1 10.4 9.7 10.1 10.6 10.0 10.3 20-24 8.4 10.0 9.2 6.2 6.9 6.6 6.8 7.6 7.2 25-29 7.4 7.7 7.6 5.1 5.5 5.3 5.7 6.0 5.8 30-34 5.4 5.7 5.5 4.0 4.6 4.3 4.3 4.8 4.6 35-39 6.2 5.1 5.6 5.1 5.3 5.2 5.4 5.3 5.3 40-44 4.7 4.7 4.7 4.6 4.3 4.4 4.6 4.4 4.5 45-49 3.6 3.4 3.5 4.1 3.6 3.8 3.9 3.6 3.8 50-54 3.2 3.3 3.3 3.4 4.2 3.8 3.3 4.0 3.7 55-59 2.1 1.5 1.8 2.6 2.3 2.5 2.5 2.1 2.3 60-64 1.9 2.0 2.0 4.1 4.6 4.3 3.6 4.0 3.8 65-69 1.1 1.2 1.1 2.3 2.3 2.3 2.0 2.1 2.0 70-74 0.6 0.7 0.6 1.0 1.2 1.1 0.9 1.1 1.0 75-79 0.3 0.2 0.3 0.6 0.4 0.5 0.5 0.4 0.4 80+ 0.3 0.6 0.4 0.5 0.5 0.5 0.4 0.5 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 8,072 7,618 15,689 25,555 25,647 51,202 33,626 33,265 66,891 Figure 2.1 Population Pyramid 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 <5 Age 0246810 0 2 4 6 8 10 Timor-Leste 2009-10 Percent Female Male 2.2 HOUSEHOLD COMPOSITION The size and composition of households and the sex of the head of household are important factors affecting the welfare of the household. Table 2.2 shows the information collected in the 2009- 10 TLDHS on the sex of the head of household and the mean household size. More than four in five (88 percent) households are headed by males, while one-eighth (12 percent) of households are headed by females. The percentage of female-headed households is higher in rural areas (13 percent) than in urban areas (11 percent). The mean household size in Timor-Leste is 5.8 persons, with households in urban areas only marginally larger (5.9 persons) than those in rural areas (5.8 persons). Three percent of all households are single-person households, and the proportion of single-person households does not differ much between urban and rural areas. A sizeable proportion of households (15 percent) have 9 or more usual members, with urban households slightly more likely to be large than rural households. Household Population and Housing Characteristics | 13 Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under 18, according to residence, Timor-Leste 2009-10 Characteristic Residence Total Urban Rural Household headship Male 88.8 87.4 87.7 Female 11.2 12.6 12.3 Total 100.0 100.0 100.0 Number of usual members 0 0.1 0.0 0.0 1 2.9 3.2 3.1 2 6.2 6.8 6.7 3 9.4 9.4 9.4 4 14.4 12.4 12.9 5 16.0 14.6 14.9 6 15.3 15.4 15.4 7 11.1 13.5 13.0 8 8.8 10.2 9.9 9+ 15.8 14.4 14.7 Total 100.0 100.0 100.0 Mean size of households 5.9 5.8 5.8 Percentage of households with orphans and foster children under 18 Foster children1 18.0 17.6 17.7 Double orphans 1.4 1.7 1.6 Single orphans2 7.6 10.1 9.5 Foster and/or orphan children 21.6 23.6 23.1 Number of households 2,695 8,768 11,463 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households where neither their mother nor their father is a de jure resident. 2 Single orphans includes children with one dead parent and an unknown survival status of the other parent. 2.2.1 Children’s Living Arrangements and Orphanhood The 2009-10 TLDHS also collected information on the presence of foster children and orphans in the households. Foster children are defined here as children under age 18 living in households with neither their mother nor their father present; orphans are children with one or both parents dead. Foster children and orphans are of concern because they may be at increased risk of neglect or exploitation when their mothers or fathers are not present to assist them. Table 2.2 also shows that 23 percent of the households have orphans or foster children under age 18. The proportion of households in Timor-Leste with orphans or foster children is high and reflects the political turmoil in the country over the past two decades. Rural households are slightly more likely to have orphans or foster children than urban households. Eighteen percent of households have foster children, 10 percent have at least one single orphan (either parent is dead), and 2 percent have at least one double orphan (both parents are dead). Detailed information on living arrangements and orphanhood for children under age 18 is presented in Table 2.3.1. Of the 34,411 children under age 18 reported in the 2009-10 TLDHS, about 82 percent live with both parents. About 7 percent live with their mother but not their father, with 4 percent living with their mother only even though their father is alive. About 2 percent live with their father but not their mother, with less than 1 percent living with their father even though their mother is alive. Nine percent of children under age 18 live with neither of their natural parents. Table 2.3.1 also provides data on the extent of orphanhood. Less than 1 percent of children under age 18 have lost both parents, while 7 percent have lost either their mother or father. 14 | Household Population and Housing Characteristics The percentage of children not living with a biological parent increases with age from 4 percent of children age 0-4 years to 19 percent of children age 15-17 years. The highest proportion of children not living with a parent is in Bobonaro and Covalima (12 percent each), and the lowest is in Lautem and Oecussi (7 percent each). By wealth status, the proportion of children under age 18 not living with a natural parent rises from 8 percent among those in the lowest two wealth quintiles to 12 percent among those in the highest wealth quintile. Table 2.3.1 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Timor-Leste 2009-10 Background characteristic Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Missing information on father/ mother Total Percentage not living with a biological parent Percentage with one or both parents dead1 Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Age 0-4 88.6 5.5 1.5 0.5 0.3 3.0 0.3 0.2 0.2 0.0 100.0 3.7 2.5 10,075 <2 89.7 6.7 1.3 0.2 0.1 1.6 0.2 0.1 0.1 0.0 100.0 2.0 1.8 3,876 2-4 87.9 4.7 1.6 0.6 0.4 3.9 0.3 0.3 0.2 0.0 100.0 4.7 2.9 6,198 5-9 84.5 3.3 2.5 0.8 1.3 5.9 0.6 0.7 0.5 0.0 100.0 7.6 5.6 10,672 10-14 77.0 2.3 4.7 1.1 2.4 8.9 1.1 1.4 1.0 0.0 100.0 12.4 10.6 9,284 15-17 68.4 2.5 6.3 1.2 2.5 13.0 1.6 2.4 2.0 0.1 100.0 19.1 14.9 4,381 Sex Male 81.7 3.7 3.3 0.8 1.5 6.6 0.8 0.9 0.7 0.0 100.0 9.0 7.2 17,607 Female 81.5 3.4 3.2 0.9 1.4 6.9 0.8 1.0 0.7 0.0 100.0 9.5 7.2 16,804 Residence Urban 81.8 3.2 2.9 1.3 0.9 7.5 0.7 1.0 0.7 0.1 100.0 9.8 6.2 7,890 Rural 81.6 3.7 3.4 0.7 1.6 6.6 0.8 0.9 0.7 0.0 100.0 9.0 7.5 26,521 District Aileu 85.8 1.6 3.3 0.1 1.8 5.4 0.3 1.1 0.6 0.0 100.0 7.5 7.2 1,424 Ainaro 77.2 5.7 3.9 1.3 2.7 6.4 1.2 0.7 0.8 0.0 100.0 9.1 9.4 2,041 Baucau 83.0 2.6 2.7 0.1 1.6 7.2 0.7 1.2 0.7 0.1 100.0 9.9 7.0 3,921 Bobonaro 77.1 3.8 4.4 1.3 1.7 9.0 0.7 1.2 0.8 0.0 100.0 11.7 8.8 3,175 Covalima 77.9 4.8 4.4 0.4 0.8 7.9 1.1 1.2 1.4 0.0 100.0 11.7 8.9 1,981 Dili 85.3 2.0 2.3 1.4 0.8 6.4 0.5 0.8 0.5 0.1 100.0 8.2 4.9 5,279 Ermera 77.4 7.2 3.3 1.5 1.3 6.6 0.9 0.9 0.8 0.0 100.0 9.2 7.3 4,429 Lautem 82.9 3.7 4.4 0.5 1.6 4.9 0.6 0.9 0.5 0.0 100.0 6.9 8.0 2,546 Liquiçá 81.2 3.8 3.0 0.8 1.9 6.9 0.6 1.0 0.7 0.0 100.0 9.3 7.2 2,042 Manatuto 85.0 1.7 2.9 0.5 0.8 7.3 0.4 0.7 0.6 0.0 100.0 9.0 5.5 1,553 Manufahi 80.1 4.5 2.1 1.5 1.2 8.5 1.0 0.5 0.6 0.0 100.0 10.6 5.4 1,305 Oecussi 86.4 1.7 3.2 0.1 1.4 4.4 1.2 0.9 0.6 0.0 100.0 7.1 7.3 2,260 Viqueque 82.3 2.3 3.5 0.1 1.9 7.3 0.6 0.9 1.0 0.0 100.0 9.9 8.0 2,455 Wealth quintile Lowest 82.7 3.3 4.5 0.4 1.5 5.3 0.9 0.5 0.9 0.0 100.0 7.6 8.3 7,204 Second 81.6 3.6 4.0 0.8 2.6 5.3 0.5 1.1 0.7 0.0 100.0 7.5 8.8 6,857 Middle 83.1 4.2 2.8 0.6 1.2 5.5 0.8 1.0 0.8 0.0 100.0 8.1 6.6 6,788 Fourth 79.5 3.7 3.1 1.2 1.2 8.6 1.1 1.0 0.7 0.0 100.0 11.4 7.0 6,772 Highest 81.1 3.2 1.9 1.1 0.8 9.3 0.5 1.2 0.6 0.1 100.0 11.6 5.1 6,790 Total <15 83.6 3.7 2.8 0.8 1.3 5.9 0.6 0.7 0.5 0.0 100.0 7.8 6.1 30,031 Total <18 81.6 3.6 3.3 0.8 1.5 6.8 0.8 1.0 0.7 0.0 100.0 9.2 7.2 34,411 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent. 2.2.2 School Attendance by Survivorship of Parents Children who are orphaned may be at a greater risk of dropping out of school because of lack of financial and psychological support. The TLDHS included information to monitor such situations and collected information on school attendance of children age 10-14 by parental survival, which is presented in Table 2.3.2. The data confirm that children age 10-14 whose parents are both dead are less likely to be attending school (66 percent) than children whose parents are both living, with the child residing with at least one parent (87 percent). The overall ratio of school attendance of the former group to the latter group is 0.75. Further breakdown by background characteristics was not possible due to the low number of orphans. Household Population and Housing Characteristics | 15 Table 2.3.2 School attendance by survivorship of parents For de jure children 10-14 years of age, the percentage attending school by parental survival, according to background characteristics, Timor-Leste 2009-10 Background characteristic Percentage attending school by survivorship of parents Ratio1 Both parents deceased Number Both parents alive and living with at least one parent Number Sex Male 71.4 50 87.5 3,790 0.82 Female (58.8) 40 86.9 3,685 (0.68) Residence Urban (77.8) 20 89.4 1,627 (0.87) Rural 62.3 70 86.6 5,847 0.72 Total 65.8 91 87.2 7,474 0.75 Note: Table is based only on children who usually live in the household. Figures in parentheses are based on 25-49 unweighted cases. 1 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with a parent 2.3 EDUCATIONAL ATTAINMENT OF HOUSEHOLD MEMBERS Timor-Leste is beginning to rebuild itself and move forward as an independent nation following years of unrest and instability created by Indonesian rule, UN governance, and internal conflict. Education is important to this effort because it helps individuals make informed decisions that have a positive impact on their health and well-being. The educational system was completely disrupted from 1999 until 2000, with more than 90 percent of the schools damaged and no longer functional (UNESCO, 2009; Fleischhacker and Uhlin, 2004). Indonesian teachers left the country, and the textbooks and the school curricula were no longer relevant under a new government. Schools were vandalized and destroyed yet again after the 2006 crisis. Renewed efforts have since been under way to reconstruct the educational system in the country. The country has gone through three different systems of education. The Portuguese introduced a western curriculum during the colonial period (1511-1975). Portuguese was the medium of instruction in schools; however, the vast majority of Timorese had limited access to education. Only a few elite Timorese men, primarily those who supported the Portuguese and who carried out administrative functions of the country, were educated (Fleischhacker and Uhlin, 2004). The basic compulsory education comprised nine years in the Portuguese system, with the first cycle (1o Ciclo) lasting four years (age 6 -9), the second cycle (2 o Ciclo) lasting two years (age 10-12), and the third cycle (3 o Ciclo) lasting three years (age 13-15). The first cycle is equivalent to primary education (escolas básicas), while the second and third cycles combined are equivalent to secondary (secundárias) education (AngloINFO, 2010). During the Indonesian occupation, education was made accessible to the public. Indonesian teachers devoted themselves to promoting education in the country, with Bahasa Indonesia as the medium of instruction in schools. The Indonesian education system included six years of primary education, three years of lower secondary education (SMP), and three years of upper secondary education (SMA). In addition, higher education through a university was divided into Sarjana (S1) comprising four years, Pasca Sarjana (S2) comprising 2 years, and PhD (S3) comprising two years. There were also two years of pre-primary education, or kindergarten, known as Taman Kanak-Kanak. The current system of education, which began in October 2008, consists of 6 years of basic or primary education (from age 6-11 for grades 1 through 6; 3 years of pre-secondary education (from age 12-14 for grades 7 through 9); and an additional three years of secondary education (from age 15- 17 for grades 10 through 12). Secondary education is organized through two modalities (1) general secondary education, preparing students for university education, and (2) technical professional secondary education, preparing students for entry into the labor market (UNESCO, 2009). 16 | Household Population and Housing Characteristics The Early Childhood Care and Education (ECCE) is not compulsory in Timor-Leste and is not considered a part of the formal educational system, although the National Education Policy 2007- 2012 recognizes the importance of preschool education (UNESCO, 2009). The impact of these three different systems of formal education in the country is reflected in the educational attainment of women and men interviewed in the 2009-10 TLDHS. Early studies have reported that primary school enrolment among children changed little between 1999 and 2007, growing from 65 percent to 74 percent (UNESCO, 2009). In 2007 only 47 percent of children had completed primary school. The government set as a target the completion of primary school by all children by 2015 (NSD, 2007). Table 2.4.1 shows the percent distribution of the de facto female household population age 6 and older by highest level of education attended or completed and according to background characteristics. Thirty-seven percent of women have never been to school, about 30 percent have some primary education, 5 percent completed only primary school, 26 percent have some secondary education or have completed secondary school, and about 2 percent have more than secondary school education. Table 2.4.1 Educational attainment of the female household population Percent distribution of the de facto female household populations age 6 and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Timor-Leste 2009-10 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 31.7 67.9 0.1 0.2 0.0 0.0 0.1 100.0 4,243 0.2 10-14 9.4 67.8 1.7 21.2 0.0 0.0 0.0 100.0 4,560 3.4 15-19 12.1 15.1 4.1 64.6 3.4 0.6 0.0 100.0 3,329 7.0 20-24 16.0 12.5 7.5 33.1 24.4 6.5 0.0 100.0 2,538 8.6 25-29 25.1 13.5 10.8 20.6 24.9 5.0 0.0 100.0 2,000 6.3 30-34 31.2 13.2 13.9 17.6 18.9 5.1 0.0 100.0 1,601 5.4 35-39 37.4 15.8 12.3 17.1 14.9 2.5 0.0 100.0 1,751 4.4 40-44 55.5 15.2 7.5 8.9 10.8 2.0 0.0 100.0 1,451 0.0 45-49 68.5 15.9 5.2 4.8 3.4 2.1 0.2 100.0 1,186 0.0 50-54 86.8 8.3 1.5 1.7 1.1 0.5 0.1 100.0 1,334 0.0 55-59 89.4 6.5 1.0 1.6 0.7 0.3 0.5 100.0 701 0.0 60-64 96.4 2.2 0.8 0.1 0.3 0.0 0.2 100.0 1,325 0.0 65+ 97.6 1.7 0.1 0.2 0.2 0.0 0.2 100.0 1,325 0.0 Residence Urban 21.9 28.4 4.1 24.1 15.6 5.8 0.2 100.0 6,259 4.9 Rural 42.0 30.3 4.8 17.4 5.0 0.5 0.0 100.0 21,095 1.0 District Aileu 36.1 32.8 4.6 21.2 4.7 0.4 0.0 100.0 1,140 1.8 Ainaro 47.9 26.9 2.5 16.9 4.9 0.9 0.0 100.0 1,554 0.1 Baucau 38.1 30.4 3.6 20.4 6.7 0.7 0.1 100.0 3,195 1.7 Bobonaro 44.7 29.5 4.9 15.8 4.5 0.7 0.1 100.0 2,687 0.7 Covalima 32.8 31.0 5.5 23.4 6.4 0.8 0.1 100.0 1,701 2.3 Dili 16.1 27.9 4.1 25.0 18.7 7.8 0.3 100.0 4,239 5.9 Ermera 51.9 28.2 3.4 13.3 3.1 0.1 0.0 100.0 3,331 0.0 Lautem 30.3 33.5 6.4 22.2 7.1 0.5 0.0 100.0 1,803 2.7 Liquiçá 42.3 31.2 4.0 16.3 5.7 0.5 0.0 100.0 1,665 1.0 Manatuto 34.2 30.6 5.4 19.9 8.9 1.0 0.0 100.0 1,299 2.3 Manufahi 39.4 29.3 4.0 20.4 6.0 0.7 0.2 100.0 1,100 1.6 Oecussi 45.4 30.6 9.8 11.2 2.6 0.5 0.0 100.0 1,698 0.2 Viqueque 40.2 31.0 4.6 18.0 5.3 0.9 0.0 100.0 1,943 1.4 Wealth quintile Lowest 52.3 31.1 4.4 10.8 1.3 0.1 0.0 100.0 5,397 0.0 Second 46.5 31.6 4.3 14.8 2.7 0.1 0.0 100.0 5,488 0.3 Middle 41.9 29.2 5.1 18.6 4.8 0.4 0.0 100.0 5,564 1.1 Fourth 31.3 29.9 5.2 23.7 8.4 1.5 0.1 100.0 5,500 2.9 Highest 14.8 27.6 4.1 26.7 19.9 6.7 0.2 100.0 5,405 6.2 Total 37.4 29.9 4.6 18.9 7.4 1.7 0.1 100.0 27,354 1.8 Note: Total includes 10 cases with information missing on age. 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level Household Population and Housing Characteristics | 17 The data show that the proportion of women with no education has declined by age, suggesting some improvement in education over the years. During the Portuguese era, the proportion of women who were educated was low. As seen in Figure 2.2, there has been a steady increase in the percentage of the population who has ever attended school in each sequential age cohort. Rapid increases in school attendance among women start in the cohort of women who were age 50-54 at the time of the survey. At the time of the Indonesian invasion in 1975, these women were age 16-20. Figure 2.2 Percentage of Women and Men with No Education, by Age Group 32 9 12 16 25 31 37 56 69 87 89 96 98 35 10 11 14 21 22 22 30 39 56 66 84 89 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+ Age group 0 20 40 60 80 100 Percent Women Men Timor-Leste 2009-10 Increases in secondary education have also been substantial: 10 percent of women age 45-49 have attended any secondary school or higher compared with 69 percent of women age 15-19. It is also important to note that 32 percent of girls age 6-9 have no education; however, many of the girls in this age group may not yet have attained the official age required to start school by the start of the ongoing school year. Education varies by place of residence. The proportion of women with no education is almost twice as high in rural (42 percent) as in urban areas (22 percent). Conversely, three times as many urban women as rural women have completed secondary school (16 percent compared with 5 percent). Women’s educational attainment varies by district. More than half of the female population in Ermera has no education compared with 16 percent in Dili. As expected, women in households belonging to the highest wealth quintile are least likely to be uneducated (15 percent) compared with those in the lowest quintile (52 percent). Table 2.4.2 shows that 30 percent of men have never been to school, 39 percent have had some primary education or have completed primary education, 29 percent have had some secondary or have completed secondary education, and 3 percent have more than secondary education. Men exhibit a trend similar to that for women with regard to the level of educational attainment over the years (Figure 2.2). Differences in educational attainment among men by background characteristics are similar to those discussed for women. 18 | Household Population and Housing Characteristics Table 2.4.2 Educational attainment of the male household population Percent distribution of the de facto male household populations age 6 and older by highest level of schooling attended or completed and median grade completed, according to background characteristics, Timor-Leste 2009-10 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 34.5 65.2 0.1 0.1 0.0 0.0 0.0 100.0 4,532 0.1 10-14 9.5 71.2 1.6 17.7 0.0 0.0 0.0 100.0 4,695 3.1 15-19 10.8 19.6 3.6 62.1 3.1 0.7 0.2 100.0 3,559 6.7 20-24 14.0 12.4 6.2 34.8 25.3 7.3 0.1 100.0 2,276 11.7 25-29 20.5 16.3 7.7 15.1 30.3 10.1 0.0 100.0 1,908 8.1 30-34 21.8 15.0 11.3 12.3 28.5 11.0 0.1 100.0 1,459 7.1 35-39 22.2 16.5 11.7 17.6 23.6 8.0 0.3 100.0 1,807 5.9 40-44 30.4 18.9 8.2 12.9 25.1 4.4 0.1 100.0 1,546 5.1 45-49 39.4 23.9 7.3 10.1 16.2 3.1 0.0 100.0 1,327 2.4 50-54 56.4 26.1 5.0 4.5 6.8 1.3 0.1 100.0 1,117 0.0 55-59 65.9 21.3 5.3 3.4 2.4 1.7 0.0 100.0 843 0.0 60-64 83.6 11.5 2.7 0.8 1.0 0.4 0.1 100.0 1,196 0.0 65+ 89.1 8.8 0.8 0.7 0.4 0.0 0.2 100.0 1,311 0.0 Residence Urban 16.5 31.8 4.2 21.7 17.3 8.3 0.3 100.0 6,629 5.2 Rural 33.8 35.0 4.6 17.3 8.0 1.3 0.0 100.0 20,947 2.0 District Aileu 32.2 35.8 6.2 17.0 7.2 1.5 0.0 100.0 1,182 2.1 Ainaro 38.8 33.2 3.4 17.1 6.5 1.0 0.0 100.0 1,580 1.5 Baucau 29.3 36.8 3.4 18.7 10.3 1.4 0.1 100.0 3,135 2.4 Bobonaro 36.2 34.2 5.1 15.0 8.2 1.3 0.0 100.0 2,572 1.8 Covalima 23.7 36.2 5.9 20.7 11.7 1.8 0.1 100.0 1,731 3.2 Dili 13.0 30.4 4.1 21.8 20.0 10.4 0.3 100.0 4,622 6.0 Ermera 42.9 31.6 4.2 16.2 4.7 0.4 0.0 100.0 3,299 0.9 Lautem 21.5 37.8 4.3 22.4 12.2 1.9 0.0 100.0 1,828 3.4 Liquiçá 31.1 37.6 4.2 17.8 6.9 2.3 0.0 100.0 1,724 2.3 Manatuto 28.6 35.2 4.9 17.9 11.1 2.1 0.1 100.0 1,222 2.9 Manufahi 31.1 30.3 6.2 21.8 8.7 1.6 0.2 100.0 1,153 3.0 Oecussi 42.5 34.5 5.8 11.1 4.3 1.9 0.0 100.0 1,618 0.6 Viqueque 30.2 37.2 3.3 18.2 8.9 2.3 0.0 100.0 1,910 2.3 Wealth quintile Lowest 44.5 34.6 4.4 12.8 3.3 0.5 0.0 100.0 5,391 0.4 Second 37.9 35.3 4.4 16.0 5.8 0.5 0.1 100.0 5,462 1.4 Middle 33.8 34.8 5.3 17.2 7.8 1.1 0.1 100.0 5,448 2.0 Fourth 23.3 34.8 4.7 22.3 12.5 2.4 0.0 100.0 5,479 3.7 Highest 10.1 31.9 3.6 23.0 21.1 10.1 0.2 100.0 5,797 6.4 Total 29.6 34.2 4.5 18.3 10.2 3.0 0.1 100.0 27,576 2.7 Note: Total includes 2 cases with information missing on age. 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level Males are more likely to be educated than females at all levels of education, with the exception of completion of primary education where there is little difference. The median number of years of schooling completed is about one year higher for males (2.7 years) than females (1.8 years). There has been improvement in the proportion of the population with no education since the 2003 DHS survey. The proportion of females with no education decreased from 47 percent in 2003 to 37 percent in 2009-10. Similarly, the proportion of males with no education decreased from 37 to 30 percent. The male-female gap in educational attainment has narrowed slightly over the years. The 2009-10 TLDHS collected information on school attendance for the population age 5-24 that allows the calculation of net attendance ratios (NARs) and gross attendance ratios (GARs) (see Table 2.5). The NAR for primary school is the percentage of the primary-school-age (age 6-11) population that is attending primary school. The NAR for secondary school is the measure of the secondary-school-age (age 12-17) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR however, measures participation at each level of schooling among persons age 5-24. The GAR is almost always higher than the NAR for the same level because the GAR includes participation by those who may be older (because they may have started school late, repeated one or more grades, or dropped out and returned) or may be younger than the official age range for that level. Household Population and Housing Characteristics | 19 Table 2.5 presents data on the NAR and GAR for the de facto household population by level of schooling and sex, according to place of residence, region, and wealth quintile. Seventy-one percent of children age 6-11, who should be attending primary school, are currently doing so. The net enrolment rate for primary school was reported to be 77 percent in the 2007 TLSLS. Table 2.5 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the gender parity index (GPI), according to background characteristics, Timor-Leste 2009-10 Background characteristic Net attendance ratio Gross attendance ratio Male Female Total Gender Parity Index Male Female Total Gender Parity Index PRIMARY SCHOOL Residence Urban 77.1 79.8 78.3 1.04 100.9 101.5 101.2 1.01 Rural 68.3 69.9 69.1 1.02 100.6 99.3 99.9 0.99 District Aileu 72.0 76.0 73.9 1.06 113.8 119.6 116.6 1.05 Ainaro 64.3 67.2 65.7 1.04 103.9 94.5 99.3 0.91 Baucau 72.8 73.4 73.1 1.01 103.3 101.6 102.5 0.98 Bobonaro 71.2 74.0 72.6 1.04 102.9 98.7 100.8 0.96 Covalima 82.6 83.5 83.0 1.01 113.7 108.7 111.3 0.96 Dili 75.0 76.8 75.8 1.02 91.5 93.9 92.6 1.03 Ermera 56.4 57.2 56.8 1.01 89.2 88.4 88.8 0.99 Lautem 80.0 80.9 80.4 1.01 108.1 115.0 111.2 1.06 Liquiçá 62.7 65.1 63.8 1.04 105.5 101.2 103.5 0.96 Manatuto 77.5 79.9 78.7 1.03 103.8 104.1 104.0 1.00 Manufahi 75.6 76.1 75.8 1.01 108.4 102.4 105.4 0.95 Oecussi 58.5 63.6 60.9 1.09 87.0 93.5 90.1 1.07 Viqueque 71.4 74.6 72.9 1.04 105.5 102.1 103.9 0.97 Wealth quintile Lowest 56.9 62.2 59.4 1.09 90.2 94.4 92.2 1.05 Second 68.2 67.7 67.9 0.99 103.9 100.6 102.3 0.97 Middle 69.7 72.1 70.9 1.03 105.1 102.5 103.9 0.98 Fourth 75.9 77.6 76.7 1.02 105.3 102.9 104.1 0.98 Highest 82.0 82.1 82.0 1.00 100.2 98.7 99.5 0.98 Total 70.3 72.1 71.1 1.03 100.6 99.8 100.2 0.99 SECONDARY SCHOOL Residence Urban 57.7 61.2 59.4 1.06 89.6 94.5 92.0 1.05 Rural 38.6 43.6 41.0 1.13 62.0 62.6 62.3 1.01 District Aileu 32.3 46.4 39.8 1.44 61.6 69.5 65.8 1.13 Ainaro 38.9 48.0 43.2 1.23 57.2 64.1 60.5 1.12 Baucau 44.4 50.6 47.4 1.14 69.0 68.2 68.6 0.99 Bobonaro 36.1 42.3 39.2 1.17 60.8 65.5 63.2 1.08 Covalima 48.6 62.0 55.0 1.28 78.7 91.8 85.0 1.17 Dili 59.3 64.3 61.7 1.08 90.2 97.3 93.7 1.08 Ermera 33.4 29.7 31.6 0.89 59.6 47.5 53.7 0.80 Lautem 53.6 49.5 51.6 0.92 78.3 72.3 75.5 0.92 Liquiçá 35.4 37.1 36.2 1.05 59.1 57.8 58.5 0.98 Manatuto 48.7 57.4 53.4 1.18 73.5 71.8 72.5 0.98 Manufahi 48.1 53.6 50.7 1.12 74.5 77.7 76.0 1.04 Oecussi 25.0 26.5 25.8 1.06 38.9 44.1 41.6 1.13 Viqueque 41.4 48.1 44.6 1.16 65.6 69.2 67.3 1.05 Wealth quintile Lowest 27.8 28.5 28.1 1.03 45.2 41.3 43.3 0.91 Second 32.4 35.9 34.1 1.11 56.3 54.1 55.3 0.96 Middle 38.4 46.1 42.3 1.20 63.5 66.9 65.2 1.05 Fourth 52.2 57.0 54.6 1.09 83.6 83.9 83.8 1.00 Highest 63.5 70.3 66.7 1.11 92.6 102.7 97.4 1.11 Total 43.0 47.5 45.2 1.10 68.4 69.7 69.1 1.02 1 The NAR for primary school is the percentage of the primary-school age (6-11 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school age (12-17 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR(GAR) for females to the NAR(GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR(GAR) for females to the NAR(GAR) for males. 20 | Household Population and Housing Characteristics The GAR at the primary school level is 100 percent. The distribution shows that both the NAR and GAR are much lower at the secondary school level: 45 percent of students age 12-17 who should be attending secondary school are in school (NAR). The GAR for secondary school is 69 percent. A UNESCO report in 2008 estimated that the GER (gross enrollment ratio) in secondary school in 2005 was 53 percent (UNESCO, 2009). The results show that the NARs for females and males are similar in primary school. In secondary school, the NAR for females (48 percent) is only slightly higher than for males (43 percent), suggesting that there is not much of a gender gap in school attendance in Timor-Leste. The GAR at primary level is slightly higher for males than females, however, indicating relatively higher over-age or under-age attendance among males compared with attendance among females. School attendance ratios at both the primary and secondary levels are lower in rural than in urban areas. For instance, the NAR at the primary school level in rural areas is 69 percent compared with 78 percent in urban areas. Similarly, the GAR at the secondary school level is 62 percent in rural areas, compared with 92 percent in urban areas. Regional differences are obvious for the NAR and GAR at the primary school levels, with attendance ratios being notably lower in Ermera and Oecussi compared with all other districts. The GAR at the secondary school level is especially low for Oecussi (42 percent). There is a strong relationship between household economic status and school attendance that can be seen at both the primary and secondary levels and among males and females. For example, the NAR for primary school increases from 59 percent among students from poorer households (lowest wealth quintile) to 82 percent among pupils from richer households (highest wealth quintile). The Gender Parity Index (GPI) represents the ratio of the NAR (or GAR) for females to the NAR (or GAR) for males. It is presented in Table 2.5 at both the primary and secondary levels and offers a summary measure of gender differences in school attendance rates. A GPI of less than 1 indicates that a smaller proportion of females than males attends school. In Timor-Leste, the GPI for the GAR is almost 1 (0.99) for primary school attendance and slightly higher than 1 (1.02) for secondary school attendance, indicating the virtual non-existence of a gender gap in education in the country. 2.3.1 Grade Repetition and Dropout Rates According to UNESCO, 16 percent of children in Timor-Leste repeat grades, 25 percent drop out, and only 46 percent reach Grade 6 (UNESCO, 2009). At the pre-secondary level the completion rate is 49 percent, and among all children age 12 to 14 years in the country, only 28 percent of them complete the pre-secondary level, indicating a considerable number of dropouts. The 2009-10 TLDHS also assessed grade repetition and dropout rates. Table 2.6 presents these rates for the de facto household population age 5-24 who attended primary school in the previous school year. Repetition and drop-out rates describe the flow of pupils through the educational system. Repetition rates indicate the percentage of pupils who attended a particular class during the previous school year who are repeating that grade in the current school year; that is, they attended the same grade during the 2009-10 academic year as they had attended during the 2008-09 year1. Dropout rates show the percentage of pupils who attended class during the 2008-09 academic year but who did not attend school the following year. Repetition and dropout rates approach zero when pupils nearly always progress to the next grade at the end of the school year. They often vary across grades, indicating points in the school system where pupils are not regularly promoted to the next grade or they decide to drop out of school. 1 The TLDHS covered the academic years 2007-08 as previous and 2008-09 as current for households interviewed in academic year 2008-09. Similarly, for households interviewed in 2009-10 the current academic year was considered as 2009-10 and the previous as 2008-09. The tabulation takes this into account. Household Population and Housing Characteristics | 21 Table 2.6 Grade repetition and dropout rates Repetition and dropout rates, for the de facto household population age 5-24 who attended primary school in the previous school year, by school grade, according to background characteristics, Timor-Leste 2009-10 Background characteristic School grade 1 2 3 4 5 6 REPETITION RATE1 Sex Male 2.0 0.6 0.4 0.7 0.5 0.2 Female 1.4 0.7 0.3 0.3 0.6 0.1 Residence Urban 2.4 0.6 0.1 0.8 1.6 0.3 Rural 1.6 0.7 0.4 0.4 0.2 0.1 District Aileu 0.8 0.8 0.6 0.0 0.0 0.9 Ainaro 1.0 0.0 0.0 0.8 0.0 0.0 Baucau 0.5 0.0 1.4 0.0 0.0 0.0 Bobonaro 1.7 1.1 0.7 0.9 0.0 0.0 Covalima 2.3 0.5 0.0 0.0 0.4 0.0 Dili 1.7 0.5 0.0 0.7 2.1 0.0 Ermera 2.9 1.1 0.7 0.0 1.3 0.0 Lautem 2.5 1.9 0.3 1.6 0.0 0.0 Liquiçá 2.6 0.3 0.0 2.3 0.5 1.9 Manatuto 0.0 0.6 0.0 0.0 0.0 0.0 Manufahi 0.5 0.0 0.0 0.0 0.0 0.0 Oecussi 2.1 0.7 0.0 0.0 0.0 0.0 Viqueque 1.6 0.5 0.0 0.0 0.0 0.0 Wealth quintile Lowest 1.2 0.2 0.8 0.3 0.5 0.3 Second 1.4 0.7 0.0 0.3 0.0 0.0 Middle 2.4 0.5 0.7 1.0 0.4 0.0 Fourth 2.2 1.4 0.0 0.4 0.0 0.2 Highest 1.5 0.5 0.3 0.6 1.6 0.2 Total 1.7 0.6 0.4 0.5 0.5 0.1 DROPOUT RATE2 Sex Male 1.1 1.0 2.2 2.4 2.6 4.1 Female 1.4 2.0 2.2 2.2 2.2 4.4 Residence Urban 3.5 1.1 3.3 6.2 3.4 10.1 Rural 0.6 1.6 1.9 1.2 2.2 2.4 District Aileu 0.4 0.0 0.0 0.0 0.6 0.9 Ainaro 0.0 0.4 0.0 0.0 1.4 0.7 Baucau 0.0 0.5 0.0 0.0 0.0 1.1 Bobonaro 0.0 0.0 0.3 0.0 0.0 0.0 Covalima 2.5 1.6 3.8 3.5 3.3 8.8 Dili 7.2 8.9 12.2 13.7 14.6 15.9 Ermera 0.0 0.0 0.0 0.0 0.0 0.0 Lautem 0.0 0.0 0.0 0.0 0.0 2.8 Liquiçá 0.0 0.0 0.9 0.0 0.0 0.0 Manatuto 0.8 0.8 0.6 0.0 0.0 0.8 Manufahi 1.1 0.0 0.7 0.7 0.0 2.6 Oecussi 0.0 0.0 0.0 0.0 0.7 2.2 Viqueque 0.0 0.5 0.0 0.8 0.7 0.5 Wealth quintile Lowest 0.5 0.2 0.9 1.3 0.7 2.5 Second 0.1 0.6 0.2 0.4 1.2 1.4 Middle 0.6 0.8 0.6 0.0 0.4 1.2 Fourth 1.5 1.4 2.5 1.6 3.0 5.3 Highest 3.6 4.9 6.5 8.2 6.6 8.7 Total 1.2 1.5 2.2 2.3 2.4 4.3 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who no longer attend school. For both sexes the repetition rate is higher in grade 1 than in grades 2 through 6. In grade 1 the repetition rate is 2 percent for males, compared with 1 percent for females, but in grade 2 the repetition rate for females is slightly higher than that for males. There are small variations by urban- rural residence in almost all grades, except in grade 5 where urban residents have a higher repetition 22 | Household Population and Housing Characteristics rate (2 percent) than their rural counterparts (0.2 percent). Larger differentials are observed by districts, especially in grade 1. While as high as 3 percent of pupils in the Ermera, Lautem, and Liquiçá districts, respectively, repeat grade 1, there is no grade repetition in grade 1 in Manatuto. In grade 6 only, pupils in Liquiçá (2 percent) and Aileu (1 percent) repeat the grade. In general, dropout rates are higher than repetition rates for all grades. Dropout rates across grades are similar (1 to 2 percent), except for grade 6 (4 percent). Males and females have similar dropout rates for almost all grades. It is interesting to note that the dropout rates are higher at all levels in urban areas than in rural areas, except for grade 2. There are wide regional variations in dropout rates. Dropout rates are markedly higher in Dili than in all other districts, and this may be attributed to the displacement of the population, particularly in Dili, due to the political strife and subsequent instability in years 2006-2008. Figure 2.3 shows the age-specific attendance rates (ASAR) for the de facto household population, age 5-24, by sex. The ASAR shows participation in schooling at any level, from primary through higher education. The closer the ASAR is to 100, the higher the participation of a given age population at that level. A little more than 66 percent of children who are age 7 attend school. School attendance rises markedly up to age 12, remains high up to age 13, and then gradually declines. There are no marked differences in the proportion of males and females attending school up to age 18, after which there are substantially higher proportions of males than females attending school. Figure 2.3 Age-specific Attendance Rates of the de facto Population 5 to 24 Years 13 42 67 80 83 88 87 89 86 82 81 73 73 60 48 38 27 16 15 7 11 35 69 76 85 85 89 89 86 84 79 75 71 62 58 44 41 32 16 13 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age (years) 0 20 40 60 80 100 Percent Female Male Timor-Leste 2009-10 2.4 HOUSING CHARACTERISTICS There is a strong correlation between the socioeconomic condition of households and the vulnerability of their members, especially children, to common diseases. The amenities and assets available to households are important in determining the general socioeconomic status of the population. The 2009-10 TLDHS included questions on household access to electricity, sources of drinking water, types of sanitation facilities, flooring materials, and ownership of durable goods. The availability of and accessibility to improved drinking water may, to a large extent, minimize the prevalence of waterborne diseases among household members, especially young children. The source of drinking water is important because potentially fatal diarrheal diseases, such as typhoid, cholera, and dysentery, are common in Timor-Leste. Table 2.7 shows the percent Household Population and Housing Characteristics | 23 distribution of households by main source of drinking water, time taken to collect drinking water, person in the household who usually collects drinking water, and treatment of water, according to residence. Table 2.7 Household drinking water Percent distribution of households and de jure population by source, time to collect, and person who usually collects drinking water; and percentage of households and the de jure population by treatment of drinking water, according to residence, Timor-Leste 2009-10 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source Piped water into dwelling/yard/plot 38.1 11.7 17.9 38.8 12.2 18.5 Public tap/standpipe 25.1 27.1 26.6 24.5 28.1 27.3 Tube well or borehole 10.3 3.2 4.9 10.6 3.1 4.9 Protected dug well 3.1 4.9 4.5 3.1 4.6 4.3 Protected spring 4.1 8.4 7.4 4.2 8.4 7.4 Rainwater 0.0 0.2 0.1 0.0 0.1 0.1 Non-improved source Unprotected dug well 4.6 7.0 6.5 4.9 6.7 6.3 Unprotected spring 5.8 32.6 26.3 5.7 32.1 25.8 Tanker truck/cart with small tank 0.2 0.5 0.5 0.3 0.5 0.5 Surface water 0.7 3.3 2.7 0.7 3.2 2.6 Bottled water, improved source for cooking/washing1 7.7 0.1 1.9 6.9 0.1 1.7 Bottled water, non-improved source for cooking/washing1 0.1 0.0 0.0 0.1 0.0 0.0 Other 0.2 1.0 0.8 0.2 0.9 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 88.4 55.6 63.3 88.2 56.6 64.0 Time to obtain drinking water (round trip) Water on premises 78.3 38.1 47.5 78.8 38.6 48.1 Less than 30 minutes 13.7 26.3 23.3 13.0 26.1 23.0 30 minutes or longer 7.4 34.4 28.1 7.4 34.2 27.9 Don’t know/missing 0.7 1.2 1.1 0.8 1.1 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 13.4 42.3 35.5 13.1 41.8 35.0 Adult male 15+ 3.7 7.4 6.5 3.0 6.5 5.7 Female child under age 15 3.2 8.5 7.2 3.7 9.4 8.0 Male child under age 15 0.8 2.5 2.1 1.1 2.6 2.2 Other 0.5 1.3 1.1 0.3 1.1 0.9 Water on premises 78.3 38.1 47.5 78.8 38.6 48.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 74.9 84.0 81.9 75.8 85.3 83.0 Bleach/chlorine 4.4 1.9 2.5 5.2 2.0 2.8 Strained through cloth 58.0 62.0 61.0 58.6 62.6 61.6 Ceramic, sand, or other filter 0.1 0.2 0.2 0.1 0.2 0.2 Solar disinfection 0.0 0.1 0.0 0.0 0.0 0.0 Other 9.8 6.4 7.2 8.1 6.1 6.6 No treatment 22.2 15.1 16.8 21.6 13.9 15.7 Percentage using an appropriate treatment method3 77.4 84.5 82.8 78.1 85.8 84.0 Number 2,695 8,768 11,463 15,852 51,134 66,985 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source, according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Overall, 63 percent of households obtain their drinking water from an improved source. Eighteen percent of households have access to piped water in their dwelling, yard, or plot, while 27 percent access drinking water from a public tap. Nine percent of households get their drinking water from a tube well or borehole or a protected dug well, and 7 percent have access to protected spring 24 | Household Population and Housing Characteristics water. Thirty-six percent of households use non-improved sources of drinking water. There is a big difference between urban and rural households in access to improved sources of drinking water (88 and 56 percent, respectively). The major source of drinking water for rural households is unprotected springs (33 percent). Twenty-seven percent of rural households use a public tap or standpipe as their main source of drinking water. Access to piped drinking water has increased since 2003 when 38 percent of the households had access to it compared with 45 percent in 2009-10. Nearly one in two households has access to drinking water on the premises, just under one in four takes less than 30 minutes, and three in ten take 30 minutes or longer to get to and return from their nearest source of drinking water. Not surprisingly most urban households have water on their premises or take less than 30 minutes to access their water source. Table 2.7 also provides information on the person who usually collects drinking water. Adult females age 15 and older are most likely to collect drinking water for the household if it is not on the premises (36 percent), followed by female children and adult men (7 percent each). Seventeen percent of households do not treat their water prior to drinking. The most common treatment methods are boiling (82 percent) and straining through cloth (61 percent). In the 2009-10 TLDHS, it was possible for households to report more than one method of treatment. An improved toilet facility is considered the most efficient and hygienic method of human waste disposal. Table 2.8 shows the percent distribution of households by type of toilet facility, according to residence. Overall, 41 percent of households use improved, not shared, toilet facilities. There are marked differences by urban-rural residence. Sixty-five percent of urban households and 34 percent of rural households use improved toilet facilities that are not shared with other households. However, 37 percent of households have no toilet facilities, a situation that is more common in rural areas (45 percent) than in urban areas (14 percent). Table 2.8 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Timor- Leste 2009-10 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility 65.3 33.9 41.3 65.9 35.8 43.0 Flush/pour flush to piped sewer system 14.7 6.9 8.7 15.6 7.3 9.3 Flush/pour flush to septic tank 33.6 4.5 11.4 31.5 4.9 11.2 Flush/pour flush to pit latrine 9.4 8.8 9.0 10.4 8.8 9.2 Ventilated improved pit (VIP) latrine 4.1 2.8 3.1 4.7 3.0 3.4 Pit latrine with slab 3.3 10.1 8.5 3.5 11.0 9.2 Composting toilet 0.2 0.8 0.6 0.2 0.8 0.7 Non-improved facility 34.7 66.1 58.6 34.2 64.2 57.1 Any facility shared with other households 16.7 6.2 8.6 17.0 6.2 8.7 Flush/pour flush not to sewer/ septic tank/pit latrine 0.6 0.5 0.5 0.6 0.5 0.5 Pit latrine without slab/open pit 1.1 2.4 2.1 1.0 2.6 2.3 Bucket 0.6 0.4 0.4 0.6 0.4 0.5 Hanging toilet/hanging latrine 0.2 0.1 0.1 0.2 0.1 0.1 No facility/bush/field 13.5 44.7 37.4 12.7 43.0 35.8 Other 2.0 11.8 9.5 2.1 11.4 9.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,695 8,768 11,463 15,852 51,134 66,985 Household Population and Housing Characteristics | 25 Table 2.9 presents the distribution of households by household characteristics, according to residence. Overall, 38 percent of households in Timor-Leste have electricity; four-fifths (83 percent) of households in urban areas have electricity, compared with about one in four (24 percent) households in rural areas. The 2009-10 TLDHS findings show that the proportion of households with electricity has increased over the past five years, growing from 26 percent in 2003. Table 2.9 Household characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking; and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Timor-Leste 2009-10 Housing characteristic Households Population Urban Rural Total Urban Rural Total Electricity Yes 83.4 24.0 38.0 84.4 24.8 38.9 No 16.6 76.0 62.0 15.6 75.2 61.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth, sand 27.1 70.4 60.2 26.1 69.2 59.0 Dung 0.5 0.7 0.7 0.5 0.7 0.7 Wood/planks 1.4 1.6 1.5 1.5 1.4 1.4 Palm/bamboo 1.5 2.1 1.9 1.4 1.8 1.7 Parquet or polished wood 0.2 0.1 0.2 0.2 0.1 0.1 Vinyl or asphalt strips 0.0 0.0 0.0 0.0 0.0 0.0 Ceramic tiles 14.8 1.2 4.4 13.6 1.3 4.2 Cement 53.9 23.7 30.8 56.1 25.3 32.6 Carpet 0.2 0.1 0.1 0.3 0.1 0.1 Other 0.3 0.1 0.1 0.3 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 11.9 16.2 15.2 8.6 12.6 11.7 Two 31.7 35.3 34.5 28.8 32.8 31.8 Three or more 56.2 47.9 49.8 62.4 54.1 56.1 Missing 0.3 0.6 0.5 0.2 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 13.5 10.4 11.1 12.8 8.8 9.7 In a separate building 78.9 85.8 84.2 80.0 87.7 85.9 Outdoors 7.4 3.8 4.6 6.9 3.5 4.3 Other 0.0 0.0 0.0 0.0 0.0 0.0 Missing 0.1 0.0 0.0 0.2 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 8.2 0.3 2.2 7.1 0.3 1.9 LPG/natural gas/biogas 1.7 0.1 0.5 1.2 0.0 0.3 Kerosene 8.9 0.5 2.5 8.0 0.4 2.2 Coal/lignite 0.0 0.0 0.0 0.0 0.0 0.0 Charcoal 0.3 0.3 0.3 0.4 0.3 0.3 Wood 80.7 98.8 94.5 83.0 98.9 95.2 Straw/shrubs/grass 0.2 0.1 0.1 0.3 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 81.2 99.1 94.9 83.7 99.3 95.6 Number of households 2,695 8,768 11,463 15,852 51,134 66,985 Type of fire/stove among households using solid fuel1 Closed stove with chimney 1.0 0.2 0.3 0.9 0.1 0.3 Open fire/stove with chimney 0.6 0.4 0.4 0.7 0.4 0.4 Open fire/stove with hood 14.9 14.1 14.2 16.0 15.4 15.6 Open fire/stove without chimney or hood 83.0 83.4 83.3 82.0 82.2 82.2 Other 0.5 1.9 1.6 0.5 1.8 1.5 Missing 0.0 0.1 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population using solid fuel 2,189 8,691 10,880 13,268 50,773 64,041 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood/straw/shrubs/grass, agricultural crops, and animal dung 26 | Household Population and Housing Characteristics The type of flooring material used in dwellings is a proxy indicator of the socioeconomic status of a household as well as a potential source of exposure to disease-causing agents. Most households in Timor-Leste have rudimentary or natural flooring made of earth, sand, or mud mixed with dung. Finished floors made of tiles, cement, polished wood, and carpet are seen in just over one in three households (36 percent). However, over the past five years there has been a small increase in the percentage of households with finished floors, (28 percent in 2003 compared with 36 percent in 2009-10). Rural households are much more likely to have earth and sand floors (70 percent) than urban households (27 percent). The second most common flooring material in rural areas is cement (24 percent). About 15 percent of urban households have ceramic floors, and less than 2 percent have palm/bamboo floors. The number of rooms used for sleeping indicates the extent of crowding in households. Overcrowding increases the risk of contracting infectious diseases like acute respiratory infections and skin diseases, which particularly affect children. In the 2009-10 TLDHS, about half of the households had three or more rooms for sleeping; 35 percent had two rooms, and 15 percent had one room. Households in rural areas are less likely than those in urban areas to have three or more rooms for sleeping (48 and 56 percent, respectively). The presence and extent of indoor pollution is dependent on whether food is cooked inside the house, the type of fuel used for cooking, and whether households have a chimney or hood to ventilate cooking fumes. One in ten households (11 percent) cooks inside the house, 84 percent cook in a separate building, and 5 percent cook outdoors. This pattern was observed in both urban and rural areas. The majority of households in Timor-Leste use solid fuels (primarily wood) for cooking (95 percent). Although nearly all households in rural areas use wood for cooking (99 percent), 81 percent of urban households use wood. Urban households are also much more likely to use kerosene (9 percent) and electricity (8 percent) for cooking. The data also indicate that among households that use solid fuel for cooking, more than four in five do not use a chimney or hood (83 percent), and there is no marked difference between urban and rural areas. A closed fire or stove with a chimney is used by less than 1 percent of households in Timor-Leste. 2.5 HOUSEHOLD DURABLE GOODS Information was collected in the 2009-10 TLDHS on the availability of household durable goods, such as household effects, means of transportation, and ownership of agricultural land and farm animals. Table 2.10 shows that 40 percent of households own a mobile telephone, 35 percent own a radio, 23 percent own a television, and 9 percent own a refrigerator. Urban households are much more likely than rural households to own these goods. For example, 49 percent of urban households own a radio, compared with 30 percent of rural households. Mobile telephones are available in 74 percent of households in urban areas and 30 percent of rural households, while 60 percent of urban households have a television and only 11 percent of households in rural areas have a television. The most common means of transportation in the country is a motorcycle or scooter, owned by 13 percent of households, and another 11 percent of households own a bicycle, 9 percent own an animal-drawn cart, and 4 percent own a car or truck. Less than 1 percent of households own a boat with a motor. In general, urban households are much more likely to own a means of transport than rural households. Household Population and Housing Characteristics | 27 Table 2.10 Household durable goods Percentage of households and de jure population possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Timor-Leste 2009-10 Possession Households Population Urban Rural Total Urban Rural Total Household effects Radio 49.0 30.1 34.5 49.6 32.1 36.2 Television 60.4 10.9 22.5 62.1 12.1 23.9 Mobile telephone 73.5 29.8 40.1 75.6 33.3 43.3 Non-mobile telephone 1.5 0.3 0.6 1.8 0.4 0.7 Refrigerator 30.6 2.2 8.9 29.7 2.5 8.9 Means of transport Bicycle 24.1 6.9 11.0 26.2 7.7 12.0 Animal drawn cart 15.2 7.6 9.4 16.9 8.4 10.4 Motorcycle/scooter 32.4 7.5 13.4 33.5 8.5 14.4 Car/truck 12.3 1.4 3.9 11.8 1.5 4.0 Boat with a motor 0.6 0.7 0.7 0.8 0.7 0.7 Ownership of agricultural land 42.7 91.6 80.1 45.4 92.0 81.0 Ownership of farm animals1 70.6 93.4 88.1 74.3 94.1 89.4 Number 2,695 8,768 11,463 15,852 51,134 66,985 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, or chickens Four in five households (80 percent) own agricultural land, and 88 percent have farm animals. Table 2.10 shows that rural households are more than two times as likely to own agricultural land as urban households (92 and 43 percent, respectively). Similarly, 93 percent of rural households own farm animals, compared with only 71 percent of urban households. 2.6 WEALTH QUINTILES The wealth quintile provides information on the economic status of households in a surveyed country. Wealth quintiles provide a consistent measure of combined indicators of household income and expenditures. The wealth quintile, as constructed, uses information on household ownership of various consumer items, ranging from household assets like a television, means of transport like a bicycle, and ownership of land and farm animals, to dwelling characteristics, such as source of drinking water, sanitation facilities, and type of building materials used in the construction of houses. Each asset is assigned a weight (factor score) generated through principal components analysis, and the resulting asset scores are standardized in relation to a normal distribution with a mean of zero and standard deviation of one. Each household is then assigned a score for each asset, and the scores are summed for each household; individuals are ranked according to the total score of the household in which they reside. The sample is then divided into quintiles from one (lowest) to five (highest). A single asset index is developed for the whole sample; separate indices are not prepared for the urban and rural populations. The 2009-10 TLDHS provides an opportunity to examine the distribution of the population in Timor-Leste by household economic status. Table 2.11 shows the percent distribution of the de jure population by wealth quintiles, according to residence and districts. Fifty-eight percent of the urban population is in the highest wealth quintile, compared with only 9 percent of the rural population. The rural population is more likely to be in the lowest three lowest quintiles. Dili is by far the wealthiest district in the country, with 71 percent of its population in the highest quintile. Nearly one in two households in Oecussi is in the poorest wealth quintile, and more than three in five households in Ainaro, Oecussi, and Viqueque are in the lowest two quintiles. 28 | Household Population and Housing Characteristics Table 2.11 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, according to residence and region, Timor-Leste 2009-10 Residence/ region Wealth quintile Total Number of population Lowest Second Middle Fourth Highest Residence Urban 4.5 6.1 9.3 22.2 57.8 100.0 15,852 Rural 24.6 24.2 23.3 19.2 8.7 100.0 51,134 District Aileu 20.6 27.9 25.1 18.2 8.2 100.0 2,785 Ainaro 30.9 32.2 19.7 12.1 5.2 100.0 3,830 Baucau 26.9 28.9 19.3 13.4 11.5 100.0 7,590 Bobonaro 15.2 19.7 26.1 27.8 11.1 100.0 6,323 Covalima 17.2 17.7 23.1 25.1 16.8 100.0 3,993 Dili 0.4 2.1 6.5 20.1 71.0 100.0 10,905 Ermera 9.8 30.2 31.9 21.5 6.6 100.0 8,132 Lautem 28.0 16.7 20.4 24.5 10.4 100.0 4,547 Liquiçá 15.7 18.8 25.3 25.1 15.2 100.0 4,082 Manatuto 22.2 10.9 22.5 27.7 16.8 100.0 3,088 Manufahi 28.3 25.1 18.1 16.6 12.0 100.0 2,699 Oecussi 46.6 17.1 14.4 14.2 7.6 100.0 4,281 Viqueque 35.3 25.5 17.4 13.0 8.7 100.0 4,730 Total 19.9 19.9 20.0 19.9 20.3 100.0 66,985 2.7 BIRTH REGISTRATION Birth registration by definition means ensuring that the birth of a child is officially registered with the state (UNICEF, 2007). The Convention on the Rights of the Child (UN General Assembly, 1989) states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Parents are required to give their children a name and to register the child because the child has a right to know who his or her parents are and to have a nationality through registration in accordance with national laws and international standards. Studies have shown that in Timor-Leste, parents preferred to register the name and identity of their children through baptism (UNICEF, 2007). Although there was an attempt to register vital events, such as births, deaths, and marriages, prior to 1999, the ensuing violence and destruction left little record of such registration. Since Timor-Leste has gained independence, UNICEF and Plan International have been instrumental in promoting birth registration in Timor-Leste. In 2000, the United Nations Transitional Administration in East Timor (UNTAET) set up the first civil registration administration in Timor- Leste. This was followed by the establishment of the Central Civil Registry within the Ministry of Internal Affairs, whereby births, marriages, and deaths were registered. The responsibility of vital registration was then shifted to the Ministry of Justice under the Division of Civil Registry and Notary in 2002. Since 2003 UNICEF has supported the efforts of the Ministry of Justice to run mobile registration campaigns in the districts (UNICEF, 2005). Further, Plan International has collaborated with UNICEF in two districts to promote universal birth registration and by 2007 had facilitated birth registration of about 90,000 children in Timor-Leste (Plan, 2009; Cody, 2009). The 2009-10 TLDHS collected information on the percentage of children under age 5 whose births were officially registered with the civil authority. Excluded were registrations with the church during baptism. Table 2.12 shows the percentage of children under age 5 whose births were officially registered and the percentage with a birth certificate at the time of the survey, by background characteristics. Not all children reported as registered had a birth certificate at the time of the survey, so some certificates may have been lost or never issued. The births of 55 percent of children under age 5 have been registered: 41 percent have a birth certificate, and 15 percent do not have a birth certificate. Data from the 2003 DHS showed that 53 Household Population and Housing Characteristics | 29 percent of children under age 5 were reported to have been registered (hospital record, village record, proof of birth, and birth certificate), but only 9 percent had a birth certificate. The significant increase in the number of children with a birth certificate is probably due to the mobile registration campaigns launched by the Ministry of Justice in the districts. Nearly two-thirds of children age 2-4 years have been registered (65 percent), compared with two-fifths of children below age 2 (40 percent). About 14-16 percent of all these children do not have a birth certificate. There is no substantial variation in birth registration by sex of child. Rural children are more likely to be registered (57 percent) than urban children (50 percent). Most children in Manufahi are registered (91 percent), in contrast with children living in Viqueque, Covalima, Dili, and Liquiçá, where 40 percent or fewer are registered. The percentage of children registered ranges from a low of 50 percent among those in the lowest wealth quintile to a high of 59 percent among those in the middle wealth quintile. Table 2.12 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Timor-Leste 2009-10 Background characteristic Percentage of children whose births are registered Number of children Had a birth certificate Did not have a birth certificate Total registered Age <2 26.7 13.5 40.1 3,876 2-4 49.1 15.5 64.6 6,198 Sex Male 40.5 14.4 54.8 5,112 Female 40.5 15.0 55.5 4,962 Residence Urban 37.7 12.0 49.7 2,341 Rural 41.3 15.5 56.8 7,734 District Aileu 50.7 18.4 69.1 370 Ainaro 33.0 26.9 59.9 596 Baucau 46.5 20.4 66.9 1,057 Bobonaro 55.9 4.1 60.0 954 Covalima 30.9 5.8 36.7 471 Dili 31.4 8.9 40.3 1,615 Ermera 63.4 3.4 66.8 1,279 Lautem 37.1 9.3 46.3 801 Liquiçá 27.9 12.4 40.3 583 Manatuto 45.8 22.1 67.8 460 Manufahi 43.7 47.6 91.3 384 Oecussi 26.9 33.3 60.2 789 Viqueque 21.6 12.6 34.3 715 Wealth quintile Lowest 30.9 19.1 50.0 2,164 Second 40.3 14.0 54.3 2,006 Middle 44.4 14.4 58.9 2,048 Fourth 43.9 13.1 56.9 1,961 Highest 43.8 12.4 56.1 1,895 Total 40.5 14.7 55.2 10,075 Characteristics of Respondents | 31 CHARACTERISTICS OF RESPONDENTS 3 This chapter describes the demographic and socioeconomic profile of respondents interviewed in the 2009-10 TLDHS. This information is useful in the interpretation of findings and in understanding the results presented later in the report. The survey collected basic information on respondents’ age, level of education, marital status, religion, ethnicity, and wealth status. In addition, information was collected on respondents’ exposure to mass media and literacy status, employment status, occupation, and type of earnings. Additional information collected includes knowledge and attitudes concerning tuberculosis and use of tobacco. For the first time, the 2009-10 TLDHS gathered information from all women and men irrespective of their marital status, in contrast with the 2003 DHS, which sampled only ever-married women and men. The discussion in this report therefore refers to both unmarried and married women and men. In addition, tables in this report show detailed information for men age 15-49, so that characteristics associated with women in the same age group may be compared. Throughout this report, numbers in the tables reflect weighted numbers. In most cases, percentages based on 25 to 49 unweighted cases are shown in parentheses. Percentages based on fewer than 25 unweighted cases are suppressed and replaced with an asterisk to caution readers when interpreting data that a percentage based on fewer than 50 cases may not be statistically reliable1. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS A description of the background characteristics of the 13,137 women age 15-49 and 4,076 men age 15-49 interviewed in the 2009-10 TLDHS is shown in Table 3.1. More than half of the respondents (56 percent of women and 55 percent of men) are under age 30. In general, the proportion of women and men in each age group declines as age increases (with the exception of women and men in the age group 35-39), reflecting the comparatively young age structure of the population in Timor-Leste. Three-fifths of women (60 percent) and just over half of men (53 percent) are currently married or living together. Thirty-six percent of women in the sample have never married compared with 46 percent of men. On the other hand, women are more likely to be divorced, separated, or widowed than men (4 percent compared with 1 percent). The place of residence is a background characteristic that determines access to services and exposure to information pertaining to reproductive health and other aspects of life. The majority of respondents reside in rural areas: nearly one in five respondents lives in Dili, and about one in ten lives in Baucau and Ermera. Respondents are least likely to reside in Manufahi. Women are disadvantaged in terms of educational attainment. This is observed at all levels of education. The male-female difference is especially obvious among those with no education and those with secondary or higher levels of education. Nearly three in ten women have no education compared with one in five men. Similarly, 48 percent of women have secondary or higher levels of education compared with 55 percent of men. The vast majority of respondents are Roman Catholic (98 percent), while 1 to 2 percent of women and men are Protestant. 1 For mortality rates, parentheses are used if based on 250 to 499 children exposed to the risk of mortality in any of the component rates, and suppressed if based on fewer than 250 children exposed to the risk of mortality in any of the component rates. 32 | Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Timor-Leste 2009-10 Background characteristic Women Men Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 23.9 3,144 3,243 24.4 994 1,009 20-24 17.8 2,343 2,323 15.8 643 643 25-29 14.4 1,897 1,877 14.4 586 575 30-34 11.7 1,534 1,478 10.8 439 437 35-39 12.8 1,684 1,722 13.6 553 544 40-44 10.6 1,388 1,358 11.3 462 460 45-49 8.7 1,146 1,136 9.8 400 408 Marital status Never married 35.6 4,675 4,706 45.8 1,865 1,869 Married 57.8 7,588 7,548 48.8 1,988 1,993 Living together 2.4 318 329 4.2 170 159 Divorced/separated 1.8 231 219 0.4 18 18 Widowed 2.5 325 335 0.8 35 37 Residence Urban 26.2 3,439 3,233 27.0 1,102 1,015 Rural 73.8 9,698 9,904 73.0 2,974 3,061 District Aileu 4.2 554 1,036 4.4 181 298 Ainaro 4.7 619 841 5.3 217 296 Baucau 10.7 1,408 1,007 10.2 415 297 Bobonaro 9.6 1,262 1,062 8.7 357 319 Covalima 5.9 781 989 5.8 236 297 Dili 18.8 2,466 1,227 19.5 797 403 Ermera 11.7 1,542 1,082 12.1 491 355 Lautem 6.6 864 1,023 7.6 308 366 Liquiçá 6.1 801 1,069 6.2 252 315 Manatuto 4.6 603 1,135 4.7 190 366 Manufahi 3.6 470 791 3.4 137 228 Oecussi 6.7 884 1,000 5.8 235 271 Viqueque 6.7 882 875 6.4 260 265 Education No education 29.3 3,854 3,922 19.4 791 798 Primary 22.9 3,005 3,112 25.7 1,046 1,070 Secondary 44.4 5,829 5,804 49.3 2,009 2,025 More than secondary 3.4 449 299 5.7 230 183 Religion Roman Catholic 97.7 12,840 12,833 98.2 4,003 4,006 Muslim 0.2 22 20 0.3 14 5 Protestant 1.9 253 264 1.3 53 56 Hindu 0.2 21 18 0.1 4 6 Other 0.0 1 2 0.1 3 3 Total 15-49 100.0 13,137 13,137 100.0 4,076 4,076 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 3.2 EDUCATIONAL ATTAINMENT AND LITERACY Tables 3.2.1 and 3.2.2 show the distribution of respondents by educational attainment, according to background characteristics. Twenty-nine percent of women age 15-49 have never been to school, 14 percent have some primary education, 9 percent have completed primary education, 29 percent have some secondary education, and 19 percent have completed secondary or a higher level of education. Older women and those who reside in rural areas are most likely to have no education. The urban-rural difference in the level of education is pronounced among those who have completed secondary or higher levels of schooling. For example, women in urban areas are more than three times as likely as those in rural areas to have completed secondary education or a higher level of education (39 percent and 12 percent, respectively). Characteristics of Respondents | 33 Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Timor-Leste 2009-10 Background characteristic Highest level of schooling Total Median years completed Number of women No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 13.4 13.3 6.9 47.8 15.5 3.0 100.0 7.7 5,487 15-19 11.8 13.4 6.5 61.6 6.4 0.3 100.0 7.4 3,144 20-24 15.6 13.2 7.6 29.3 27.8 6.5 100.0 8.6 2,343 25-29 24.7 13.3 11.5 19.9 25.4 5.3 100.0 6.3 1,897 30-34 30.5 13.4 13.4 17.9 19.3 5.4 100.0 5.5 1,534 35-39 37.9 15.2 12.3 16.9 15.0 2.7 100.0 4.4 1,684 40-44 54.8 15.1 7.2 9.9 10.6 2.4 100.0 a 1,388 45-49 68.3 16.2 4.7 5.0 3.9 1.9 100.0 a 1,146 Residence Urban 14.5 10.1 5.8 30.6 28.8 10.2 100.0 11.2 3,439 Rural 34.6 15.4 10.0 27.9 11.2 1.0 100.0 5.0 9,698 District Aileu 31.4 15.3 9.6 32.6 10.3 0.8 100.0 5.3 554 Ainaro 39.9 10.7 5.9 28.5 13.4 1.7 100.0 4.8 619 Baucau 27.1 15.6 7.0 31.5 17.4 1.5 100.0 6.0 1,408 Bobonaro 39.6 14.6 10.1 24.3 10.1 1.3 100.0 4.1 1,262 Covalima 21.7 15.1 10.5 36.4 14.6 1.7 100.0 6.6 781 Dili 10.5 9.8 5.2 29.5 31.7 13.3 100.0 12.5 2,466 Ermera 49.3 12.9 8.2 21.6 7.6 0.2 100.0 1.2 1,542 Lautem 20.2 13.6 12.8 38.2 14.2 1.0 100.0 6.5 864 Liquiçá 33.5 19.1 7.9 27.1 11.6 0.8 100.0 4.5 801 Manatuto 24.5 15.9 8.9 30.5 18.9 1.4 100.0 6.0 603 Manufahi 27.2 14.4 8.1 34.3 14.5 1.5 100.0 6.0 470 Oecussi 41.0 17.6 18.4 16.6 5.5 0.9 100.0 3.4 884 Viqueque 32.1 15.4 9.5 29.7 11.8 1.6 100.0 5.2 882 Wealth quintile Lowest 49.0 19.1 10.3 18.0 3.4 0.1 100.0 0.9 2,314 Second 40.8 17.8 9.8 24.6 6.8 0.2 100.0 3.3 2,468 Middle 33.2 14.5 10.4 30.4 10.8 0.7 100.0 5.2 2,590 Fourth 22.7 13.1 9.2 34.4 17.5 3.0 100.0 7.0 2,687 Highest 8.0 7.4 5.4 33.0 35.1 11.1 100.0 13.1 3,077 Total 29.3 14.0 8.9 28.6 15.8 3.4 100.0 5.7 13,137 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level a = Omitted because less than 50 percent of women had any education before reaching the beginning of the age group. Educational attainment is directly related to the economic status of respondents. An analysis of education by wealth quintile indicates that women in the highest wealth quintile are most likely to complete secondary or a higher level of education. For example, nearly one in two women in the highest wealth quintile has completed secondary or higher education, compared with less than 4 percent of women in the lowest wealth quintile. A similar pattern in educational attainment is found among men (Table 3.2.2). However, men are more educated than women in all categories. One in five men has never had formal schooling, one in five has some primary education, one in thirteen has completed primary school, three in ten have some secondary education, and more than one in four men has completed secondary or higher education. Women have completed a median of 6 years of schooling compared with 7 years for men. 34 | Characteristics of Respondents Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Timor-Leste 2009-10 Background characteristic Highest level of schooling Total Median years completed Number of men No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 11.7 13.9 6.6 48.7 16.9 2.1 100.0 7.6 1,636 15-19 10.8 15.7 7.1 59.7 6.3 0.5 100.0 7.3 994 20-24 13.2 11.2 5.9 31.8 33.3 4.6 100.0 12.2 643 25-29 20.4 19.9 6.9 12.4 31.3 9.2 100.0 7.7 586 30-34 19.1 18.6 9.1 16.3 28.5 8.4 100.0 7.6 439 35-39 20.0 17.2 12.7 17.9 20.8 11.5 100.0 6.1 553 40-44 29.2 18.2 8.9 13.2 24.7 5.9 100.0 5.3 462 45-49 37.5 27.0 8.3 10.2 13.3 3.8 100.0 2.3 400 Residence Urban 9.3 11.4 5.9 27.6 31.0 14.9 100.0 13.1 1,102 Rural 23.2 19.7 9.0 28.2 17.7 2.2 100.0 5.7 2,974 District Aileu 17.9 17.7 11.1 31.2 19.7 2.4 100.0 6.6 181 Ainaro 29.7 16.7 7.0 31.0 14.0 1.6 100.0 5.4 217 Baucau 15.7 22.7 7.4 27.3 24.6 2.3 100.0 7.1 415 Bobonaro 28.9 16.8 8.5 25.2 18.2 2.4 100.0 5.5 357 Covalima 12.5 14.7 12.7 32.4 23.0 4.7 100.0 7.9 236 Dili 7.1 10.7 6.0 24.5 34.3 17.4 100.0 13.9 797 Ermera 37.1 20.9 6.9 23.4 11.0 0.7 100.0 3.7 491 Lautem 11.0 9.2 9.0 42.0 24.3 4.6 100.0 8.3 308 Liquiçá 17.5 24.4 6.6 30.5 18.1 2.9 100.0 6.0 252 Manatuto 17.8 20.1 8.2 28.0 23.1 2.8 100.0 6.6 190 Manufahi 20.0 14.3 7.9 37.7 16.6 3.6 100.0 6.9 137 Oecussi 29.1 27.3 13.7 18.2 7.9 3.7 100.0 4.0 235 Viqueque 19.0 21.7 8.4 28.7 18.1 4.1 100.0 6.0 260 Wealth quintile Lowest 32.3 22.0 10.7 26.2 8.2 0.5 100.0 4.2 728 Second 26.6 21.8 10.6 26.4 14.2 0.4 100.0 5.1 781 Middle 23.3 20.3 9.5 29.6 15.2 2.0 100.0 5.6 786 Fourth 15.0 17.5 5.8 30.2 27.4 4.1 100.0 8.1 849 Highest 4.0 8.0 5.2 27.4 36.9 18.5 100.0 14.1 932 Total 15-49 19.4 17.5 8.2 28.0 21.3 5.7 100.0 7.1 4,076 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level Literacy is widely acknowledged as benefiting the individual and the society and is associated with a number of positive outcomes for health, nutrition, and the overall well-being of both men and women. In the 2009-10 TLDHS, literacy was determined by the respondents’ ability to read all or part of a sentence. During data collection, interviewers carried a set of cards on which simple sentences were printed in five of the major languages. These cards were used to test a respondent’s reading ability. Only those who had never been to school and those who had not completed the primary level were asked to read the cards in the language they were most likely able to read. Those who had attended secondary school or received higher education were assumed to be literate. Table 3.3.1 indicates that more than two-thirds of women in Timor-Leste (68 percent) are literate. The literacy status varies by place of residence. Four-fifths of women residing in urban areas are literate compared with three-fifths of their rural counterparts. The level of literacy by age shows a consistent decrease with increasing age. This suggests that the younger generations have had more opportunity to learn to read than the older generations. Eighty-six percent of women age 15-19 are literate compared with 29 percent of women age 45-49. Characteristics of Respondents | 35 Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Timor-Leste 2009-10 Background characteristic Pre- secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Age 15-19 68.3 11.2 6.6 13.9 0.0 0.0 0.0 100.0 86.1 3,144 20-24 63.6 9.5 8.3 18.5 0.0 0.1 0.0 100.0 81.4 2,343 25-29 50.6 10.9 10.3 27.9 0.1 0.2 0.0 100.0 71.8 1,897 30-34 42.7 14.3 10.1 32.8 0.0 0.1 0.0 100.0 67.1 1,534 35-39 34.6 12.0 12.5 40.9 0.1 0.0 0.0 100.0 59.0 1,684 40-44 22.9 9.6 10.3 56.8 0.1 0.2 0.0 100.0 42.8 1,388 45-49 10.8 8.9 9.5 70.3 0.0 0.3 0.1 100.0 29.3 1,146 Residence Urban 69.6 8.0 6.1 16.1 0.0 0.1 0.0 100.0 83.8 3,439 Rural 40.0 12.0 10.4 37.4 0.1 0.1 0.0 100.0 62.4 9,698 District Aileu 43.6 11.6 9.8 35.0 0.0 0.0 0.0 100.0 65.0 554 Ainaro 43.5 5.1 9.2 42.2 0.0 0.0 0.1 100.0 57.8 619 Baucau 50.4 12.1 6.9 30.7 0.0 0.0 0.0 100.0 69.3 1,408 Bobonaro 35.6 10.8 11.6 41.4 0.1 0.4 0.0 100.0 58.0 1,262 Covalima 52.7 10.6 10.9 25.6 0.0 0.1 0.1 100.0 74.2 781 Dili 74.5 7.9 6.7 10.7 0.0 0.1 0.0 100.0 89.2 2,466 Ermera 29.5 5.5 12.2 52.5 0.2 0.1 0.0 100.0 47.2 1,542 Lautem 53.4 14.4 10.3 21.8 0.0 0.1 0.0 100.0 78.1 864 Liquiçá 39.5 11.0 12.3 37.1 0.0 0.0 0.1 100.0 62.8 801 Manatuto 50.8 14.5 8.4 26.3 0.0 0.0 0.0 100.0 73.7 603 Manufahi 50.3 11.6 8.4 29.6 0.0 0.1 0.0 100.0 70.3 470 Oecussi 23.0 20.6 8.0 48.3 0.0 0.1 0.0 100.0 51.6 884 Viqueque 43.1 15.3 8.2 33.1 0.1 0.1 0.0 100.0 66.6 882 Wealth quintile Lowest 21.6 14.9 10.0 53.2 0.1 0.2 0.0 100.0 46.5 2,314 Second 31.6 11.2 12.2 44.9 0.1 0.0 0.0 100.0 55.1 2,468 Middle 41.9 11.8 10.4 35.6 0.1 0.1 0.0 100.0 64.2 2,590 Fourth 55.0 10.5 9.3 25.2 0.0 0.1 0.0 100.0 74.7 2,687 Highest 79.1 7.4 5.2 8.1 0.0 0.1 0.1 100.0 91.8 3,077 Total 47.8 10.9 9.2 31.9 0.0 0.1 0.0 100.0 68.0 13,137 1 Refers to women who attended pre-secondary school or higher and women who can read a whole sentence or part of a sentence Not surprisingly, literacy is highest in Dili, the most urban district in the country, with nine in ten women being literate. Less than one in two women in Ermera is literate, however. There is also a significant difference in literacy levels by women’s wealth status, with literacy rising from a low of 47 percent among women in the lowest wealth quintile to a high of 92 percent among women in the highest wealth quintile. This reaffirms the positive association between economic status and literacy. Men are more likely to be literate than women (Table 3.3.2). Four-fifths of Timorese men age 15-49 are literate. The gap in urban-rural literacy among men is smaller than the gap among women, suggesting that men in rural areas are better able to access learning than women. The level of literacy ranges from a low of 56 percent of men in Oecussi to a high of 92 percent of men in Dili. Nearly all men (95 percent) in the highest wealth quintile are literate. 36 | Characteristics of Respondents Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Timor-Leste 2009-10 Background characteristic Pre- secondary school or higher No schooling or primary school Total Percentage literate1 Number of men Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-19 66.4 13.4 6.9 13.2 0.2 0.0 100.0 86.6 994 20-24 69.7 8.8 6.8 14.6 0.0 0.0 100.0 85.4 643 25-29 52.8 12.8 12.9 21.3 0.0 0.1 100.0 78.6 586 30-34 53.2 16.6 10.7 19.5 0.0 0.0 100.0 80.5 439 35-39 50.2 17.3 9.1 23.4 0.0 0.0 100.0 76.6 553 40-44 43.7 14.2 11.7 30.1 0.0 0.3 100.0 69.6 462 45-49 27.2 20.0 12.2 40.6 0.0 0.0 100.0 59.4 400 Residence Urban 73.4 9.6 5.5 11.2 0.2 0.1 100.0 88.6 1,102 Rural 48.1 15.9 11.0 25.0 0.0 0.1 100.0 75.0 2,974 District Aileu 53.3 9.0 13.1 24.6 0.0 0.0 100.0 75.4 181 Ainaro 46.6 14.7 8.4 29.6 0.0 0.7 100.0 69.7 217 Baucau 54.2 20.8 8.1 17.0 0.0 0.0 100.0 83.0 415 Bobonaro 45.8 19.5 14.4 20.2 0.0 0.0 100.0 79.8 357 Covalima 60.0 4.6 17.1 18.3 0.0 0.0 100.0 81.7 236 Dili 76.2 9.5 5.8 8.2 0.2 0.0 100.0 91.6 797 Ermera 35.0 6.8 18.0 40.1 0.0 0.0 100.0 59.9 491 Lautem 70.8 14.2 3.5 11.5 0.0 0.0 100.0 88.5 308 Liquiçá 51.5 19.5 4.9 24.1 0.0 0.0 100.0 75.9 252 Manatuto 53.9 25.8 1.4 18.9 0.0 0.0 100.0 81.1 190 Manufahi 57.8 8.9 8.5 24.7 0.0 0.0 100.0 75.3 137 Oecussi 29.9 22.7 3.3 43.8 0.0 0.2 100.0 55.9 235 Viqueque 50.9 18.2 15.1 15.8 0.0 0.0 100.0 84.2 260 Wealth quintile Lowest 35.0 18.2 11.0 35.8 0.0 0.0 100.0 64.2 728 Second 41.1 16.7 13.0 29.1 0.0 0.2 100.0 70.7 781 Middle 46.9 16.5 12.7 23.9 0.0 0.0 100.0 76.1 786 Fourth 61.6 13.5 7.5 17.3 0.0 0.1 100.0 82.6 849 Highest 82.8 7.7 4.6 4.7 0.2 0.0 100.0 95.1 932 Total 15-49 54.9 14.2 9.5 21.3 0.0 0.1 100.0 78.6 4,076 1 Refers to men who attended pre-secondary school or higher and men who can read a whole sentence or part of a sentence 3.3 ACCESS TO MASS MEDIA Access to information through the media is essential to increasing people’s knowledge and awareness of what is taking place around them, which may eventually affect their perceptions and behavior. In the 2009-10 TLDHS, exposure to media was assessed by asking respondents if they listened to a radio, watched television, or read newspapers or magazines at least once a week. This information is useful for program managers and planners engaged in determining which media may be most effective for disseminating health information to targeted audiences. The detailed results are presented in Tables 3.4.1 and 3.4.2 by background characteristics. Media exposure in Timor-Leste is relatively low, with just over one in ten women and men exposed to all three specified types of mass media. Just over one-third of women are exposed to the radio, and a similar proportion is exposed to television at least once a week. Exposure to the radio and television is slightly higher among men, with two-fifths of men exposed to the radio and the television. Just over one-fifth of women and men read a newspaper at least once a week. Media exposure declines with age among women, but the relationship is less clear among men. Young women under 24 years of age are more likely to be exposed to the mass media than older women, presumably in part because of their higher level of education. There is also a wide gap in exposure to mass media by place of residence. For example, the proportion of newspaper readers is Characteristics of Respondents | 37 Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Timor-Leste 2009-10 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 32.7 40.5 40.0 15.5 38.5 3,144 20-24 27.0 40.2 41.9 15.2 41.8 2,343 25-29 21.8 38.6 39.3 12.7 44.9 1,897 30-34 18.3 38.5 34.5 11.7 49.5 1,534 35-39 15.3 30.6 30.6 7.8 55.2 1,684 40-44 11.9 31.0 29.5 7.1 56.4 1,388 45-49 7.3 24.3 23.1 5.1 65.8 1,146 Residence Urban 36.7 76.4 59.5 27.5 15.4 3,439 Rural 16.5 22.0 27.4 6.3 59.2 9,698 District Aileu 20.5 15.3 31.3 5.1 57.8 554 Ainaro 11.9 10.7 18.3 3.4 74.3 619 Baucau 16.4 23.7 31.2 8.0 57.4 1,408 Bobonaro 17.1 29.6 32.7 8.6 51.1 1,262 Covalima 23.5 36.1 43.3 8.6 38.3 781 Dili 42.2 87.9 67.8 33.3 6.6 2,466 Ermera 17.3 10.5 19.1 2.7 67.5 1,542 Lautem 12.0 29.0 21.9 4.2 60.8 864 Liquiçá 22.9 29.4 42.0 11.5 45.1 801 Manatuto 26.7 36.3 32.4 16.7 52.3 603 Manufahi 24.9 30.0 50.1 10.2 37.6 470 Oecussi 7.8 29.2 18.4 4.9 63.7 884 Viqueque 11.6 21.6 15.8 3.6 67.1 882 Education No education 0.4 13.2 16.0 0.1 76.5 3,854 Primary 12.5 27.1 28.1 3.8 55.6 3,005 Secondary 37.2 52.0 49.8 20.3 28.0 5,829 More than secondary 67.1 91.0 74.7 55.6 4.3 449 Wealth quintile Lowest 7.1 8.3 10.3 1.4 81.6 2,314 Second 12.3 10.6 17.3 2.2 71.1 2,468 Middle 16.2 16.5 29.9 4.2 57.9 2,590 Fourth 22.3 42.1 43.4 10.1 35.6 2,687 Highest 44.7 89.4 68.2 35.3 5.6 3,077 Total 21.8 36.3 35.8 11.8 47.7 13,137 significantly higher among urban women (37 percent) than among their rural counterparts (17 percent). About one in three women and men in Dili are exposed to all three media sources at least once a week. Media exposure among women is lowest in Ermera where less than 3 percent of women are exposed to all three media sources at least once a week. Men in Liquiçá, Ermera, and Bobonaro are least likely to be exposed to all three sources of media at least once a week. Not surprisingly, media exposure is highly related to the educational level as well as the economic status of the respondent. Exposure to mass media is highest among women with secondary or a higher level of education and among those who are in the highest wealth quintile. The lower level of exposure to media among poor respondents may be because they are less likely to own a radio or television and, therefore, are less likely to be consistently exposed to these media sources. A similar relationship is observed between media exposure among men and their education and wealth. 38 | Characteristics of Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Timor-Leste 2009-10 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of men Age 15-19 18.0 45.7 42.0 9.2 38.7 994 20-24 22.3 48.8 52.3 15.0 32.6 643 25-29 24.5 43.6 47.8 13.4 35.7 586 30-34 24.4 40.4 43.2 12.5 39.9 439 35-39 22.9 39.6 40.5 14.9 44.5 553 40-44 21.7 34.4 41.9 12.9 46.5 462 45-49 12.1 27.3 34.9 4.9 51.1 400 Residence Urban 36.8 74.0 59.4 25.9 13.9 1,102 Rural 14.9 29.3 37.8 6.6 50.1 2,974 District Aileu 21.8 27.7 46.5 10.2 42.6 181 Ainaro 13.6 16.3 32.5 4.7 58.5 217 Baucau 29.0 35.3 40.5 9.0 36.2 415 Bobonaro 10.1 32.7 43.9 3.9 42.8 357 Covalima 12.0 35.7 43.3 7.0 43.6 236 Dili 43.0 80.4 62.3 31.0 9.7 797 Ermera 12.0 10.7 22.0 3.6 70.5 491 Lautem 10.5 36.8 26.2 4.6 53.0 308 Liquiçá 7.2 38.0 39.8 4.1 47.6 252 Manatuto 11.1 53.5 83.2 8.8 14.2 190 Manufahi 18.3 46.5 60.3 8.9 29.1 137 Oecussi 23.7 43.8 46.4 15.2 40.4 235 Viqueque 15.5 32.2 24.2 12.5 63.5 260 Education No education 0.2 15.8 21.1 0.0 71.1 791 Primary 10.6 28.9 35.5 4.2 51.9 1,046 Secondary 28.9 53.4 54.0 16.4 26.1 2,009 More than secondary 67.3 80.9 67.5 47.2 6.5 230 Wealth quintile Lowest 9.3 19.4 21.2 3.1 67.3 728 Second 12.1 18.4 30.1 2.9 59.0 781 Middle 12.3 23.8 39.8 4.9 49.2 786 Fourth 21.9 45.3 50.9 9.7 31.0 849 Highest 43.2 89.0 69.3 34.0 4.6 932 Total 15-49 20.8 41.4 43.7 11.9 40.3 4,076 3.4 EMPLOYMENT 3.4.1 Employment Status The 2009-10 TLDHS asked respondents a number of questions regarding their employment status, including whether they were working in the seven days preceding the survey and, if not, whether they had worked in the 12 months before the survey. The results for women and men are presented in Tables 3.5.1 and 3.5.2. At the time of the survey, about two-fifths of women were currently employed, and less than one percent was not employed but had worked sometime during the past 12 months. The proportion of women currently employed increases with age. Current employment is lowest among women age 15-19 (23 percent) and highest among those age 45-49 (58 percent). Women who are divorced, separated, or widowed are more likely to be currently employed than other women. Women who have three or more children are more likely to be currently employed than those with two or fewer children. Less than one-third of women in urban areas were currently working compared with two-fifths of women in rural areas. The higher rural rate of employment reflects the importance of farm work and perhaps a shortage of income, but the distinction between paid and Characteristics of Respondents | 39 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Timor-Leste 2009-10 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Currently employed1 Not currently employed Age 15-19 22.7 0.3 77.0 100.0 3,144 20-24 31.1 0.5 68.4 100.0 2,343 25-29 38.2 0.7 61.1 100.0 1,897 30-34 44.3 0.5 55.0 100.0 1,534 35-39 48.6 0.4 50.9 100.0 1,684 40-44 56.7 0.9 42.2 100.0 1,388 45-49 58.1 0.5 41.2 100.0 1,146 Marital status Never married 28.7 0.4 70.9 100.0 4,675 Married or living together 43.1 0.6 56.2 100.0 7,906 Divorced/separated/widowed 65.2 1.0 33.8 100.0 556 Number of living children 0 30.3 0.4 69.2 100.0 5,178 1-2 38.8 0.4 60.7 100.0 2,350 3-4 45.8 0.6 53.3 100.0 2,554 5+ 47.9 0.7 51.4 100.0 3,055 Residence Urban 30.2 0.8 68.8 100.0 3,439 Rural 42.0 0.4 57.5 100.0 9,698 District Aileu 66.0 0.6 33.4 100.0 554 Ainaro 29.7 0.0 70.3 100.0 619 Baucau 26.1 0.2 73.7 100.0 1,408 Bobonaro 44.1 0.1 55.8 100.0 1,262 Covalima 41.6 0.2 58.2 100.0 781 Dili 28.8 1.2 69.8 100.0 2,466 Ermera 43.3 0.1 56.6 100.0 1,542 Lautem 17.5 0.5 82.0 100.0 864 Liquiçá 37.4 0.2 62.4 100.0 801 Manatuto 36.4 0.2 63.4 100.0 603 Manufahi 47.7 0.1 52.0 100.0 470 Oecussi 84.9 2.0 13.1 100.0 884 Viqueque 33.3 0.4 66.0 100.0 882 Education No education 51.6 0.6 47.8 100.0 3,854 Primary 43.6 0.5 55.9 100.0 3,005 Secondary 27.9 0.4 71.6 100.0 5,829 More than secondary 42.7 1.2 56.0 100.0 449 Wealth quintile Lowest 49.1 0.5 50.3 100.0 2,314 Second 42.0 0.5 57.4 100.0 2,468 Middle 41.1 0.5 58.4 100.0 2,590 Fourth 33.7 0.7 65.7 100.0 2,687 Highest 31.6 0.6 67.6 100.0 3,077 Total 38.9 0.5 60.5 100.0 13,137 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. unpaid work may not be especially meaningful in a society with high rates of subsistence living. Current employment rises from 18 percent among women in Lautem to 85 percent among women in Oecussi. Current employment is highest among women with no education and lowest among women with secondary education. Current employment varies inversely with wealth quintile, rising from 32 percent among women in the wealthiest households to 49 percent among women in the poorest households. 40 | Characteristics of Respondents Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Timor-Leste 2009-10 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Currently employed1 Not currently employed Age 15-19 65.7 2.8 31.6 100.0 994 20-24 78.8 2.9 18.3 100.0 643 25-29 88.6 3.1 8.3 100.0 586 30-34 95.2 1.4 3.4 100.0 439 35-39 95.6 1.2 3.2 100.0 553 40-44 94.9 2.3 2.8 100.0 462 45-49 95.7 1.2 3.1 100.0 400 Marital status Never married 71.4 3.1 25.5 100.0 1,865 Married or living together 95.7 1.6 2.7 100.0 2,158 Divorced/separated/widowed 90.3 0.0 9.7 100.0 53 Number of living children 0 73.0 3.0 24.0 100.0 2,009 1-2 95.8 1.5 2.7 100.0 638 3-4 96.1 1.6 2.4 100.0 720 5+ 95.3 1.7 3.0 100.0 709 Residence Urban 65.4 4.4 30.2 100.0 1,102 Rural 91.6 1.5 6.9 100.0 2,974 District Aileu 84.5 0.4 15.1 100.0 181 Ainaro 86.7 1.5 11.8 100.0 217 Baucau 94.7 0.9 4.4 100.0 415 Bobonaro 85.6 5.2 9.2 100.0 357 Covalima 90.3 0.8 8.9 100.0 236 Dili 60.3 4.3 35.3 100.0 797 Ermera 99.4 0.1 0.5 100.0 491 Lautem 89.2 1.9 8.9 100.0 308 Liquiçá 91.3 5.5 3.2 100.0 252 Manatuto 95.1 2.4 2.5 100.0 190 Manufahi 74.9 1.2 23.9 100.0 137 Oecussi 95.8 0.4 3.8 100.0 235 Viqueque 81.0 1.2 17.9 100.0 260 Education No education 95.1 1.3 3.7 100.0 791 Primary 90.2 2.1 7.7 100.0 1,046 Secondary 77.9 2.9 19.2 100.0 2,009 More than secondary 80.9 0.9 18.3 100.0 230 Wealth quintile Lowest 91.8 0.9 7.3 100.0 728 Second 92.8 1.1 6.1 100.0 781 Middle 90.0 1.9 8.1 100.0 786 Fourth 82.6 2.9 14.5 100.0 849 Highest 69.1 4.1 26.8 100.0 932 Total 15-49 84.5 2.3 13.2 100.0 4,076 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. The proportion currently employed is much higher among men than women (Table 3.5.2). The majority of men age 15-49 (85 percent) were employed at the time of survey. The percentage of currently employed men rises with age, from 66 percent among men age 15-19 to 96 percent among men age 45-49. Never-married men, men with no children, urban men, those living in Dili, those with a secondary education, and those in the highest wealth quintile are least likely to be currently employed. Characteristics of Respondents | 41 3.4.2 Occupation Respondents who were currently employed or who had worked in the 12 months preceding the survey were asked further about their occupation. The results are presented in Tables 3.6.1 and 3.6.2, which show data on employed women and men, respectively, by occupation and according to background characteristics. Agriculture is the dominant sector of the economy of Timor-Leste, and most employed persons work in the agricultural sector. Specifically, 61 percent of employed women and 67 percent of employed men are engaged in agricultural jobs. Tables 3.6.1 and 3.6.2 further show that 22 percent of women and 14 percent of men are employed in sales and service. The survey indicates that 6 percent of employed women are manual workers (skilled and unskilled), while 7 percent are engaged in the professional, technical, and managerial fields. The type of occupation varies greatly by gender. Women are less likely than men to be highly educated or to have attended vocational or technical schools. Therefore, their employment in the professional, technical, and managerial sector is somewhat low compared with that of men (7 percent compared with 11 percent). Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Timor-Leste 2009-10 Background characteristic Professional/ technical/ managerial Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of women Age 15-19 1.5 14.6 0.3 5.5 6.3 71.3 0.5 100.0 725 20-24 5.8 22.8 0.0 7.2 4.4 58.9 1.0 100.0 740 25-29 8.5 26.7 0.2 6.7 4.9 52.0 1.0 100.0 737 30-34 8.5 25.9 0.5 6.7 4.2 52.8 1.5 100.0 687 35-39 7.1 22.4 0.4 5.3 3.5 60.5 0.8 100.0 826 40-44 8.3 21.1 0.2 5.5 2.4 62.1 0.4 100.0 800 45-49 5.6 19.3 0.2 4.9 1.6 68.4 0.1 100.0 671 Marital status Never married 5.7 18.2 0.0 6.4 4.1 64.4 1.3 100.0 1,360 Married or living together 6.8 23.4 0.3 5.9 4.2 58.7 0.6 100.0 3,458 Divorced/separated/ widowed 6.5 21.0 0.5 4.2 0.3 67.4 0.0 100.0 368 Number of living children 0 6.0 18.4 0.0 6.6 4.4 63.4 1.2 100.0 1,592 1-2 7.5 26.6 0.4 6.9 3.4 55.0 0.2 100.0 922 3-4 8.4 26.0 0.3 6.1 4.3 53.9 1.0 100.0 1,187 5+ 4.9 19.3 0.3 4.5 3.4 67.1 0.4 100.0 1,484 Residence Urban 15.2 44.8 0.2 10.2 7.5 19.2 2.9 100.0 1,067 Rural 4.3 15.9 0.3 4.9 2.9 71.6 0.2 100.0 4,119 District Aileu 3.2 7.5 0.0 2.4 6.9 79.8 0.1 100.0 369 Ainaro 9.4 10.2 0.0 3.2 2.6 74.6 0.0 100.0 184 Baucau 7.8 26.1 0.4 6.7 3.0 54.6 1.3 100.0 370 Bobonaro 3.4 18.0 0.2 14.3 0.3 63.6 0.1 100.0 558 Covalima 7.6 24.3 0.0 4.0 0.0 64.1 0.0 100.0 326 Dili 17.6 48.6 0.5 12.3 5.4 11.7 4.0 100.0 740 Ermera 3.8 3.8 0.5 2.1 0.6 89.3 0.0 100.0 670 Lautem 12.7 24.8 0.0 5.7 0.3 55.5 1.0 100.0 155 Liquiçá 4.6 19.7 0.3 4.0 0.8 70.3 0.3 100.0 301 Manatuto 5.2 24.4 0.0 10.2 3.0 56.9 0.2 100.0 221 Manufahi 4.8 22.9 0.0 3.6 0.6 68.1 0.0 100.0 225 Oecussi 1.4 24.7 0.0 1.4 12.9 59.5 0.0 100.0 769 Viqueque 4.4 10.3 0.7 2.8 1.6 79.8 0.4 100.0 298 Education No education 0.6 14.7 0.3 4.6 2.2 77.3 0.3 100.0 2,012 Primary 1.2 19.8 0.1 4.8 4.6 68.6 0.9 100.0 1,326 Secondary 13.4 30.3 0.3 8.0 5.5 41.7 0.9 100.0 1,651 More than secondary 45.6 36.9 0.0 10.3 3.2 1.3 2.7 100.0 197 Wealth quintile Lowest 1.3 12.3 0.2 3.5 3.7 78.8 0.2 100.0 1,149 Second 1.9 13.5 0.0 3.5 2.2 78.6 0.4 100.0 1,049 Middle 3.1 13.9 0.5 4.9 3.4 73.9 0.2 100.0 1,077 Fourth 6.8 26.0 0.3 6.9 4.8 54.7 0.6 100.0 922 Highest 20.9 46.6 0.2 11.6 5.5 12.7 2.5 100.0 990 Total 6.5 21.8 0.2 5.9 3.9 60.8 0.8 100.0 5,186 42 | Characteristics of Respondents Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Timor-Leste 2009-10 Background characteristic Professional/ technical/ managerial Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of men Age 15-19 3.6 5.4 1.1 2.8 1.0 85.7 0.4 100.0 680 20-24 8.3 10.6 1.8 4.6 1.1 72.6 1.1 100.0 525 25-29 12.4 18.8 1.6 5.9 0.2 58.4 2.7 100.0 537 30-34 13.0 22.2 3.3 4.9 0.1 56.1 0.4 100.0 424 35-39 14.2 19.5 1.8 4.9 0.1 58.8 0.7 100.0 535 40-44 15.6 14.5 0.9 6.4 0.0 61.5 1.1 100.0 449 45-49 11.8 13.7 1.3 0.1 0.0 71.8 1.4 100.0 387 Marital status Never married 8.2 8.5 1.3 4.2 0.9 76.2 0.7 100.0 1,390 Married or living together 12.6 18.5 1.9 4.3 0.1 61.3 1.4 100.0 2,101 Divorced/separated/ widowed 4.9 5.1 2.1 5.0 0.0 82.9 0.0 100.0 47 Number of living children 0 8.8 9.4 1.3 4.2 0.8 74.6 1.0 100.0 1,527 1-2 10.3 20.4 2.6 4.7 0.4 59.1 2.5 100.0 621 3-4 13.1 22.1 1.2 5.4 0.0 57.4 0.7 100.0 703 5+ 13.3 12.3 2.0 2.8 0.0 69.2 0.4 100.0 688 Residence Urban 19.5 36.0 1.6 10.1 0.6 29.2 2.9 100.0 769 Rural 8.4 8.4 1.7 2.6 0.4 78.0 0.6 100.0 2,769 District Aileu 10.9 3.6 0.0 0.8 0.0 84.3 0.4 100.0 154 Ainaro 4.5 6.7 0.0 0.8 2.7 85.3 0.0 100.0 192 Baucau 5.4 13.4 2.9 3.7 0.0 72.2 2.4 100.0 396 Bobonaro 6.4 10.5 0.8 1.8 0.0 80.1 0.4 100.0 324 Covalima 15.1 11.9 3.0 3.3 0.0 66.6 0.0 100.0 215 Dili 24.3 45.9 2.4 11.9 0.4 10.9 4.2 100.0 515 Ermera 3.4 3.4 0.3 0.7 0.0 92.1 0.0 100.0 489 Lautem 7.2 8.2 1.5 3.9 1.5 77.7 0.0 100.0 280 Liquiçá 12.3 12.3 4.3 6.6 0.0 63.6 0.9 100.0 244 Manatuto 8.0 21.9 4.1 5.1 1.3 58.8 0.9 100.0 185 Manufahi 19.9 8.4 0.0 3.1 0.0 68.6 0.0 100.0 105 Oecussi 8.4 6.2 0.2 0.9 0.4 83.8 0.0 100.0 226 Viqueque 16.3 4.5 0.5 6.3 0.0 71.9 0.5 100.0 214 Education No education 4.2 6.4 1.7 0.9 0.0 86.7 0.1 100.0 762 Primary 8.1 9.8 2.5 2.8 0.2 76.2 0.3 100.0 965 Secondary 12.1 18.8 1.3 6.0 0.7 59.6 1.5 100.0 1,623 More than secondary 40.0 32.7 0.0 10.3 0.7 11.3 5.0 100.0 188 Wealth quintile Lowest 4.2 2.3 1.0 2.0 0.3 90.1 0.2 100.0 675 Second 5.2 5.2 1.2 2.0 0.3 85.4 0.8 100.0 733 Middle 8.0 6.4 2.4 2.0 0.4 80.2 0.6 100.0 722 Fourth 14.7 17.9 1.1 5.7 0.4 58.9 1.2 100.0 726 Highest 22.1 41.1 2.5 9.9 0.6 21.1 2.7 100.0 682 Total 15-49 10.8 14.4 1.6 4.3 0.4 67.4 1.1 100.0 3,538 The relationship between occupation and age is mixed. One notable finding is the relatively higher percentages of women age 25-34 employed in sales and services and engaged in professional, technical, and managerial occupations. Residence has a significant effect on the type of occupation. As expected, a high proportion of respondents in rural areas—seven in ten employed women, and eight in ten employed men—are engaged in agricultural work. Urban women are most likely to be engaged in sales and services compared with other occupations. Women and men in Dili are much more likely to be engaged in sales and services and in professional, technical, and managerial occupations, and are least likely to be engaged in agriculture. On the other hand, women and men in Ermera are most likely to be engaged in agriculture and least likely to be engaged in sales and services. Characteristics of Respondents | 43 3.4.3 Earnings, Employers, and Continuity of Employment Table 3.7 shows the percent distribution of women by type of earnings and employment characteristics. These tables also present data on whether respondents are involved in agricultural or nonagricultural occupations because all of the employment variables shown in the tables are strongly influenced by the sector of employment. Table 3.7 Type of employment Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Timor-Leste 2009-10 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 2.3 45.6 19.3 Cash and in-kind 0.3 2.1 1.0 In-kind only 1.1 0.5 0.9 Not paid 96.2 51.7 78.8 Missing 0.0 0.1 0.0 Total 100.0 100.0 100.0 Type of employer Employed by family member 19.3 11.1 16.1 Employed by nonfamily member 1.3 37.8 15.6 Self-employed 79.5 51.2 68.4 Total 100.0 100.0 100.0 Continuity of employment All year 26.9 68.0 42.9 Seasonal 57.0 22.7 43.7 Occasional 16.1 9.2 13.5 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 3,154 1,992 5,186 Note: Total includes 40 women with missing information on type of employment who are not shown separately. Four-fifths of working women are not paid for their work. This is because the vast majority of women (96 percent) engaged in agricultural work are unpaid workers, most likely employed by family members at the peak of the agricultural season. On the other hand, almost one in two women employed in nonagricultural work will receive cash earnings. More than two-thirds of women are self-employed, with self-employment much higher in the agricultural (80 percent) than in the nonagricultural sector (51 percent). Women are as likely to be employed by a family member as by a nonfamily member (16 percent each). One in five women working in the agricultural sector is working for a family member compared with only 11 percent of women working in the nonagricultural sector. In addition, the proportion of women employed by someone outside the family is higher among those working in the nonagricultural sector than among those working in the agricultural sector (38 percent versus 1 percent). About two in five women work all year. A similar proportion works seasonally, while one in seven works occasionally. Continuity of employment also varies by sector. The majority of women employed in the agricultural sector are seasonal workers (57 percent), compared with only one in

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