Uganda - Demographic and Health Survey - 2012

Publication date: 2012

Uganda U ganda 2011 D em ographic and H ealth Survey Demographic and Health Survey 2011 THE REPUBLIC OF UGANDA Uganda Demographic and Health Survey 2011 Uganda Bureau of Statistics Kampala, Uganda MEASURE DHS ICF International Calverton, Maryland, USA August 2012 The 2011 Uganda Demographic and Health Survey (2011 UDHS) was implemented by the Uganda Bureau of Statistics from May through December 2011. The funding for the 2011 UDHS was provided by the government of Uganda, USAID, UNFPA, UNICEF, WHO, Irish Aid, and the UK government. ICF International provided technical assistance to the project through the MEASURE DHS project, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. Additional information about the 2011 UDHS may be obtained from the Uganda Bureau of Statistics (UBOS), Plot 9 Collville Street, P.O Box 7186, Kampala, Uganda; Telephone: (256-41) 706000; Fax: (256-41) 237553/230370; Email: ubos@ubos.org; Internet: http://www.ubos.org. Information about the MEASURE DHS project may be obtained from ICF International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200; Fax: 301-572-0999; E-mail: reports@measuredhs.com; Internet: http://www.measuredhs.com. Recommended citation: Uganda Bureau of Statistics (UBOS) and ICF International Inc. 2012. Uganda Demographic and Health Survey 2011. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc. Contents • iii CONTENTS TABLES AND FIGURES . xix PREFACE . xvii MILLENNIUM DEVELOPMENT GOALS . xix MAP OF UGANDA . xx CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy . 1 1.2 Population . 2 1.3 Population and Health Policies . 3 1.4 Objectives of the 2011 UDHS Survey . 4 1.5 Organization of the Survey . 5 1.6 Sample Design . 5 1.7 Questionnaires . 7 1.8 Anthropometry, Anaemia, and Vitamin A Testing . 8 1.9 Listing, Pretest, Main Training, Fieldwork, and Data Processing . 9 1.10 Response Rates . 10 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2.1 Household Environment . 11 2.1.1 Drinking Water . 11 2.1.2 Household Sanitation Facilities . 13 2.1.3 Housing Characteristics . 13 2.1.4 Household Possessions . 15 2.1.5 Hand Washing . 15 2.2 Wealth Index . 16 2.3 Population by Age and Sex . 17 2.4 Household Composition . 19 2.5 Birth Registration . 19 2.6 Children’s Living Arrangements and Parental Survival . 20 2.7 Education Level of the Household Population . 21 2.7.1 School Attendance by Survivorship of Parents . 21 2.7.2 Educational Attainment . 22 2.7.3 School Attendance Ratios . 24 2.8 Disability . 27 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents . 29 3.2 Educational Attainment by Background Characteristics. 30 3.3 Literacy . 33 3.4 Access to Mass Media . 35 3.5 Employment . 36 3.5.1 Employment Status . 36 3.5.2 Occupation . 40 3.5.3 Type of Women’s Employment . 42 iv • Contents 3.6 Health Insurance . 42 3.7 Use of Tobacco . 44 CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY 4.1 Current Marital Status . 47 4.2 Polygyny . 48 4.3 Age at First Marriage . 50 4.4 Age at First Sexual Intercourse . 52 4.5 Recent Sexual Activity . 54 CHAPTER 5 FERTILITY 5.1 Introduction . 57 5.2 Current Fertility . 57 5.3 Fertility Differentials by Background Characteristics . 58 5.4 Fertility Trends . 60 5.5 Children Ever Born and Living . 61 5.6 Birth Intervals . 62 5.7 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . 64 5.8 Menopause . 65 5.9 Age at First Birth . 65 5.10 Teenage Pregnancy and Motherhood . 67 CHAPTER 6 FERTILITY PREFERENCES 6.1 Desire for More Children . 69 6.2 Desire to Limit Childbearing by Background Characteristics . 70 6.3 Ideal Family Size . 71 6.4 Fertility Planning . 73 6.5 Wanted Fertility Rates. 74 CHAPTER 7 FERTILITY PREFERENCES 7.1 Knowledge of Contraceptive Methods . 78 7.2 Current Use of Contraception . 79 7.3 Current Use of Contraceptive by Background Characteristics . 81 7.4 Trends in Current Use of Family Planning . 83 7.5 Timing of Female Sterilization . 84 7.6 Source of Contraception . 84 7.7 Use of Social Marketing Brands of Pills and Condoms . 85 7.8 Informed Choice . 86 7.9 Contraceptive Discontinuation Rates . 87 7.10 Reasons for Discontinuation of Contraceptive Use . 87 7.11 Knowledge of the Fertile Period . 88 7.12 Need and Demand for Family Planning Services . 89 7.13 Future Use of Contraception . 92 7.14 Exposure to Family Planning Messages . 93 7.15 Contact of Nonusers with Family Planning Providers . 94 7.16 Family Planning Counseling . 95 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Data Quality . 98 8.2 Early Childhood Mortality Rates: Levels and Trends . 98 8.3 Early Childhood Mortality Rates by Socioeconomic Characteristics . 100 Contents • v 8.4 Early Childhood Mortality by Demographic Characteristics . 101 8.5 Perinatal Mortality . 102 8.6 High-risk Fertility Behaviour . 103 CHAPTER 9 REPRODUCTIVE HEALTH 9.1 Antenatal Care . 105 9.1.1 Number and Timing of Antenatal Visits . 107 9.2 Components of Antenatal Care . 107 9.3 Tetanus Toxoid Vaccination . 109 9.4 Place of Delivery . 110 9.5 Assistance during Delivery . 112 9.6 Postnatal Care . 113 9.6.1 Duration of Health Facility Stay and Timing of First Postnatal Checkup 113 9.6.2 Provider of First Postnatal Checkup for Mother . 115 9.7 Newborn Care . 116 9.8 Problems Accessing Health Care . 118 9.9 FEMALE CIRCUMCISION . 119 9.10 Obstetric Fistula . 121 CHAPTER 10 CHILD HEALTH 10.1 Child’s Size at Birth . 123 10.2 Vaccination Coverage . 125 10.3 Trends in Vaccination Coverage . 127 10.4 Acute Respiratory Infection . 129 10.5 Fever . 130 10.6 Diarrhoeal Disease . 132 10.6.1 Prevalence of Diarrhoea . 132 10.6.2 Treatment of Diarrhoea . 133 10.6.3 Feeding Practices during Diarrhoea . 134 10.7 Knowledge of ORS Packets . 137 10.8 Stool Disposal . 137 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS 11.1 Nutritional Status of Children . 140 11.1.1 Measurement of Nutritional Status among Young Children . 140 11.1.2 Data Collection . 141 11.1.3 Measures of Children’s Nutritional Status . 141 11.1.4 Trends in Children’s Nutritional Status . 144 11.2 Breastfeeding and Complementary Feeding . 145 11.2.1 Initiation of Breastfeeding . 145 11.2.2 Breastfeeding Status by Age . 147 11.2.3 Duration of Breastfeeding . 149 11.2.4 Types of Complementary Foods . 150 11.2.5 Infant and Young Child Feeding (IYCF) Practices . 151 11.3 Prevalence of Anaemia in Children . 154 11.4 Micronutrient Intake among Children . 156 11.5 Iodisation of Household Salt . 159 vi • Contents 11.6 Nutritional Status of Women and Men . 159 11.7 Prevalence of Anaemia in Women . 162 11.8 Micronutrient Intake among Mothers . 164 CHAPTER 12 MALARIA 12.1 Introduction . 167 12.2 Ownership of Mosquito Nets . 168 12.3 Indoor Residual Spraying . 169 12.4 Access to Insecticide-treated Nets . 170 12.5 Use of Mosquito Nets. 172 12.5.1 Overall Use of Mosquito Nets . 172 12.5.2 Use of Mosquito Nets by Children under Age 5 . 174 12.5.3 Use of Mosquito Nets by Pregnant Women . 175 12.6 Preventive Malaria Treatment during Pregnancy . 177 12.7 Fever among Children under Age 5 . 178 12.7.1 Prevalence and Treatment of Fever among Children . 178 12.7.2 Type and Timing of Antimalarial Drugs . 180 12.8 Anaemia Prevalence among Children Age 6-59 Months . 181 CHAPTER 13 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13.1 Introduction . 183 13.2 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 184 13.2.1 Awareness of HIV/AIDS . 184 13.2.2 Knowledge of HIV Prevention . 185 13.2.3 Rejection of Misconceptions about HIV/AIDS . 186 13.2.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 189 13.3 Accepting Attitudes towards People Living with Aids . 191 13.4 Attitudes towards Refusing to Have Sex and Negotiating Safer Sex . 193 13.5 Adult Support of Education about Condoms for Children Age 12-14 . 195 13.6 High-risk Sex . 195 13.6.1 Multiple Partners and Condom Use . 196 13.6.2 Transactional Sex . 200 13.7 Coverage of HIV Counseling and Testing . 200 13.7.1 HIV Testing During Antenatal Care . 203 13.8 Male Circumcision . 205 13.9 Self-reporting of Sexually Transmitted Infections . 205 13.10 Treatment of Sexually Transmitted Infections . 207 13.11 Prevalence of Medical Injections . 207 13.12 HIV/AIDS Knowledge and Sexual Behaviour among Young Adults . 209 13.12.1 HIV/AIDS-related Knowledge among Young Adults . 209 13.12.2 Age at First Sexual Intercourse . 210 13.12.3 Abstinence and Premarital Sex . 212 13.12.4 Multiple Partnerships among Young Adults . 213 13.12.5 Age-mixing in Sexual Relationships . 214 13.12.6 Recent HIV Testing among Youth . 215 Contents • vii CHAPTER 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 14.1 Employment and Form of Earnings . 217 14.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s and Their Husband’s Earnings . 218 14.3 Women’s Control over Husbands’ Earnings . 220 14.4 Women’s Empowerment . 222 14.4.1 Ownership of Assets . 222 14.4.2 Women’s Participation in Household Decision Making . 224 14.4.3 Attitudes towards Wife Beating . 228 14.4.4 Women’s Empowerment Indicators . 231 14.5 Current Use of Contraception by Women’s Empowerment Status . 232 14.6 Ideal Family Size and Unmet Need by Women’s Status . 233 14.7 Women’s Status and Reproductive Health Care . 234 CHAPTER 15 ADULT AND MATERNAL MORTALITY 15.1 Assessment of Data Quality . 235 15.2 Estimates of Adult Mortality . 236 15.3 Estimates of Maternal Mortality . 237 CHAPTER 16 DOMESTIC VIOLENCE 16.1 Measurement of Violence . 239 16.1.1 Use of Valid Measures of Violence . 239 16.1.2 Ethical Considerations in the 2011 UDHS . 241 16.1.3 Subsample for the Violence Module . 241 16.2 Experience of Physical Violence . 241 16.3 Perpetrators of Physical Violence . 245 16.4 Experience of Sexual Violence . 245 16.5 Perpetrators of Sexual Violence . 248 16.6 Age at First Experience of Non-Spousal Sexual Violence . 248 16.7 Experience of Different Forms of Violence . 249 16.8 Violence during Pregnancy . 250 16.9 Marital Control by Spouse . 252 16.10 Forms of Spousal Violence . 255 16.11 Spousal Violence by Background Characteristics . 258 16.12 Violence by Spousal Characteristics and Women’s Empowerment Indicators . 261 16.13 Frequency of Spousal Violence . 263 16.14 Onset of Spousal Violence . 265 16.15 Physical Consequences of Spousal Violence . 265 16.16 Violence by Women/Men against Their Spouse . 266 16.17 Violence Against the Spouse by Spousal Characteristics and Women’s Empowerment Indicators . 269 16.18 Help-seeking Behaviour by Women Who Experience Violence . 270 viii • Contents REFERENCES . 275 APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION . 279 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 287 APPENDIX C DATA QUALITY TABLES . 305 APPENDIX D PERSONS INVOLVED IN THE 2011 UGANDA DEMOGRAPHIC AND HEALTH SURVEY . 311 APPENDIX E QUESTIONNAIRES . 317 Tables and Figures • ix TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators . 3 Table 1.2 Results of the household and individual interviews . 10 Figure 1.1 Map of Uganda DHS clusters . 6 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION Table 2.1 Household drinking water . 12 Table 2.2 Household sanitation facilities . 13 Table 2.3 Household characteristics . 14 Table 2.4 Household possessions . 15 Table 2.5 Hand washing . 16 Table 2.6 Wealth quintiles . 17 Table 2.7 Household population by age, sex, and residence . 18 Table 2.8 Household composition . 19 Table 2.9 Birth registration of children under age 5 . 20 Table 2.10 Children's living arrangements and orphanhood . 21 Table 2.11 School attendance by survivorship of parents . 22 Table 2.12.1 Educational attainment of the female household population . 23 Table 2.12.2 Educational attainment of the male household population . 24 Table 2.13 School attendance ratios . 26 Table 2.14 Disability by functional area and age . 28 Figure 2.1 Population pyramid . 18 Figure 2.2 Age-specific attendance rates of the de facto population age 5-24. 27 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . 30 Table 3.2.1 Educational attainment: Women . 31 Table 3.2.2 Educational attainment: Men . 32 Table 3.3.1 Literacy: Women . 33 Table 3.3.2 Literacy: Men . 34 Table 3.4.1 Exposure to mass media: Women . 35 Table 3.4.2 Exposure to mass media: Men . 36 Table 3.5.1 Employment status: Women . 37 Table 3.5.2 Employment status: Men . 39 Table 3.6.1 Occupation: Women . 40 Table 3.6.2 Occupation: Men . 41 Table 3.7 Type of employment: Women . 42 Table 3.8.1 Health insurance coverage: Women . 43 Table 3.8.2 Health insurance coverage: Men . 44 Table 3.9.1 Use of tobacco: Women . 45 Table 3.9.2 Use of tobacco: Men . 46 Figure 3.1 Women's employment status in the past 12 months . 38 x • Tables and Figures CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY Table 4.1.1 Current marital status . 48 Table 4.1.2 Current marital status and type of marriage . 48 Table 4.2.1 Number of women's co-wives . 49 Table 4.2.2 Number of men's wives . 50 Table 4.3 Age at first marriage . 51 Table 4.4 Median age at first marriage by background characteristics . 52 Table 4.5 Age at first sexual intercourse . 53 Table 4.6 Median age at first sexual intercourse by background characteristics . 54 Table 4.7.1 Recent sexual activity: Women . 55 Table 4.7.2 Recent sexual activity: Men . 56 CHAPTER 5 FERTILITY Table 5.1 Current fertility . 57 Table 5.2 Fertility by background characteristics . 59 Table 5.3.1 Trends in age-specific fertility rates . 60 Table 5.3.2 Trends in age-specific and total fertility rates, Uganda 2000-01, 2006, 2011 . 60 Table 5.4 Children ever born and living . 62 Table 5.5 Birth intervals . 63 Table 5.6 Postpartum amenorrhoea, abstinence and insusceptibility . 64 Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility . 65 Table 5.8 Menopause . 65 Table 5.9 Age at first birth . 66 Table 5.10 Median age at first birth . 66 Table 5.11 Teenage pregnancy and motherhood . 67 Figure 5.1 TFR in eastern and southern Africa, DHS surveys . 58 Figure 5.2 Trends in fertility . 61 CHAPTER 6 FERTILITY PREFERENCES Table 6.1 Fertility preferences by number of living children . 70 Table 6.2 Desire to limit childbearing: Women . 71 Table 6.3 Ideal number of children by number of living children . 72 Table 6.4 Mean ideal number of children . 73 Table 6.5 Fertility planning status . 74 Table 6.6 Wanted fertility rates . 75 CHAPTER 7 FAMILY PLANNING Table 7.1 Knowledge of contraceptive methods . 78 Table 7.2 Current use of contraception by age . 80 Table 7.3 Current use of contraception by background characteristics . 82 Table 7.4 Trends in the current use of contraception . 83 Table 7.5 Source of modern contraception methods . 85 Table 7.6 Use of social marketing brand pills and condoms . 85 Table 7.7 Informed choice . 86 Table 7.8 12-month contraceptive discontinuation rates . 87 Table 7.9 Reasons for discontinuation . 88 Table 7.10 Knowledge of fertile period . 88 Table 7.11 Need and demand for family planning among currently married women . 91 Table 7.12 Future use of contraception . 92 Tables and Figures • xi Table 7.13 Exposure to family planning messages . 93 Table 7.14 Contact of nonusers with family planning providers . 94 Table 7.15 Family planning counseling . 95 Figure 7.1 Trends in contraceptive use among currently married women . 84 Figure 7.2 Trends in unmet need for family planning, Uganda 2000-2011 . 92 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 99 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 100 Table 8.3 Early childhood mortality rates by demographic characteristics . 101 Table 8.4 Perinatal mortality . 102 Table 8.5 High-risk fertility behaviour . 103 Figure 8.1 Trends in childhood mortality . 99 CHAPTER 9 REPRODUCTIVE HEALTH Table 9.1 Antenatal care . 106 Table 9.2 Number of antenatal care visits and timing of first visit . 107 Table 9.3 Components of antenatal care . 108 Table 9.4 Doses of drugs for intestinal worms . 109 Table 9.5 Tetanus toxoid injections . 110 Table 9.6 Place of delivery . 111 Table 9.7 Assistance during delivery . 113 Table 9.8 Timing of first postnatal checkup . 115 Table 9.9 Type of provider of first postnatal checkup for the mother . 116 Table 9.10 Timing of first postnatal checkup for the newborn . 117 Table 9.11 Type of provider of first postnatal checkup for the newborn . 118 Table 9.12 Problems accessing health care . 119 Table 9.13 Female circumcision . 120 Table 9.14 Obstetric fistula . 121 Figure 9.1 Mother’s duration of stay in the health facility after giving birth . 114 CHAPTER 10 CHILD HEALTH Table 10.1 Child's weight and size at birth . 124 Table 10.2 Vaccinations by source of information . 126 Table 10.3 Vaccinations by background characteristics . 127 Table 10.4 Vaccinations in first year of life . 128 Table 10.5 Prevalence and treatment of symptoms of ARI . 129 Table 10.6 Prevalence and treatment of fever . 131 Table 10.7 Prevalence of diarrhoea . 132 Table 10.8 Diarrhoea treatment . 134 Table 10.9 Feeding practices during diarrhoea . 136 Table 10.10 Knowledge of ORS packets . 137 Table 10.11 Disposal of children's stools . 138 Figure 10.1 Trends in vaccination coverage during the first year of life among children 12-23 months . 128 xii • Tables and Figures CHAPTER 11 NUTRITION OF CHILDREN AND WOMEN Table 11.1 Nutritional status of children . 143 Table 11.2 Initial breastfeeding . 146 Table 11.3 Breastfeeding status by age . 148 Table 11.4 Median duration of breastfeeding . 150 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 151 Table 11.6 Infant and young child feeding (IYCF) practices . 153 Table 11.7 Prevalence of anaemia in children . 155 Table 11.8 Micronutrient intake among children . 158 Table 11.9 Presence of iodized salt in household . 159 Table 11.10.1 Nutritional status of women . 160 Table 11.10.2 Nutritional status of men . 162 Table 11.11 Prevalence of anaemia in women . 163 Table 11.12 Micronutrient intake among mothers . 165 Figure 11.1 Nutritional status of children by age . 144 Figure 11.2 Trends in nutritional status of children under 5 years . 145 Figure 11.3 Infant feeding practices by age . 147 Figure 11.4 IYCF indicators on breastfeeding status . 149 Figure 11.5 IYCF indicators on minimum acceptable diet . 154 Figure 11.6 Trends in anaemia status among children under 5 years . 156 Figure 11.7 Trends in nutritional status among women 15-49 years . 161 Figure 11.8 Trends in anaemia status among women age 15-49 years . 164 CHAPTER 12 MALARIA Table 12.1 Household possession of mosquito nets . 169 Table 12.2 Indoor residual spraying against mosquitoes . 170 Table 12.3 Access to an insecticide-treated net (ITN) . 171 Table 12.4 Use of mosquito nets by persons in the household . 173 Figure 12.2 Ownership of, access to, and use of ITNs . 174 Table 12.5 Use of mosquito nets by children . 175 Table 12.6 Use of mosquito nets by pregnant women . 176 Table 12.7 Prophylactic use of antimalarial drugs and use of intermittent preventive treatment (IPTp) by women during pregnancy . 178 Table 12.8 Prevalence, diagnosis, and prompt treatment of children with fever . 179 Table 12.9 Type and timing of antimalarial drugs used . 181 Table 12.10 Haemoglobin <8.0 g/dl in children . 182 Figure 12.1 Percentage of the de facto household population with access to an insecticide-treated net . 172 CHAPTER 13 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 13.1 Knowledge of AIDS . 184 Table 13.2 Knowledge of HIV prevention methods . 185 Table 13.3.1 Comprehensive knowledge about AIDS: Women . 187 Table 13.3.2 Comprehensive knowledge about AIDS: Men . 188 Table 13.4 Knowledge of prevention of mother to child transmission of HIV . 190 Table 13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 191 Table 13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 192 Table 13.6 Attitudes toward negotiating safer sexual relations with husband . 194 Table 13.7 Adult support of education about condom use to prevent AIDS . 195 Table 13.8.1 Multiple sexual partners: Women. 196 Tables and Figures • xiii Table 13.8.2 Multiple sexual partners: Men . 197 Table 13.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 199 Table 13.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 200 Table 13.11.1 Coverage of prior HIV testing: Women . 201 Table 13.11.2 Coverage of prior HIV testing: Men . 202 Table 13.12 Pregnant women counseled and tested for HIV . 204 Table 13.13 Male circumcision . 205 Table 13.14 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms . 206 Table 13.15 Prevalence of medical injections . 208 Table 13.16 Comprehensive knowledge about AIDS and of a source of condoms among young people . 209 Table 13.17 Age at first sexual intercourse among young people . 211 Table 13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among young people . 212 Table 13.19 Multiple sexual partners in the past 12 months among young people . 213 Table 13.20 Age-mixing in sexual relationships among women age 15 19 . 214 Table 13.21 Recent HIV tests among young people . 215 Figure 13.2 Trends in age at first sexual intercourse . 212 Figure 13.1 Women and men seeking advice or treatment for STIs . 207 CHAPTER 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 14.1 Employment and cash earnings of currently married women and men . 218 Table 14.2.1 Control over women's cash earnings and relative magnitude of women's cash earnings: Women . 219 Table 14.2.2 Control over men's cash earnings . 221 Table 14.3 Women's control over their own earnings and over those of their husbands . 222 Table 14.4.1 Ownership of assets: Women . 223 Table 14.4.2 Ownership of assets; Men . 224 Table 14.5 Participation in decision making . 225 Table 14.6.1 Women's participation in decision making by background characteristics . 226 Table 14.6.2 Men's participation in decision making by background characteristics . 228 Table 14.7.1 Attitude toward wife beating: Women . 229 Table 14.7.2 Attitude toward wife beating: Men . 231 Table 14.8 Indicators of women's empowerment . 232 Table 14.9 Current use of contraception by women's empowerment . 233 Table 14.10 Women's empowerment and ideal number of children and unmet need for family planning . 233 Table 14.11 Reproductive health care by women's empowerment . 234 Figure 14.1 Number of decisions in which currently married women participate . 227 CHAPTER 15 ADULT AND MATERNAL MORTALITY Table 15.1 Adult mortality rates . 236 Table 15.2 Adult mortality probabilities . 237 Table 15.3 Maternal mortality . 237 Figure 15.1 Maternal mortality ratio (MMR) for the seven years preceding the 2000-01, 2006, and 2011 Uganda DHS with confidence intervals . 238 xiv • Tables and Figures CHAPTER 16 DOMESTIC VIOLENCE Table 16.1.1 Experience of physical violence: women . 243 Table 16.1.2 Experience of physical violence: men . 244 Table 16.2.2 Persons committing physical violence: men . 245 Table 16.2.1 Persons committing physical violence: women . 245 Table 16.3.1 Experience of sexual violence: women . 246 Table 16.3.2 Experience of sexual violence: men . 247 Table 16.4.1 Persons committing sexual violence: women . 248 Table 16.4.2 Persons committing sexual violence: men . 248 Table 16.5.1 Age at first experience of non-spousal sexual violence: women . 249 Table 16.5.2 Age at first experience of non-spousal sexual violence: men . 249 Table 16.6.1 Experience of different forms of violence: women . 250 Table 16.6.2 Experience of different forms of violence: men . 250 Table 16.7 Experience of violence during pregnancy . 251 Table 16.8.1 Marital control exercised by husbands . 253 Table 16.8.2 Marital control exercised by wives . 254 Table 16.9.1 Forms of spousal violence: women . 256 Table 16.9.2 Forms of spousal violence: men . 258 Table 16.10.1 Spousal violence by background characteristics: women . 259 Table 16.10.2 Spousal violence by background characteristics: men . 260 Table 16.11.1 Spousal violence by husband's characteristics and empowerment indicators: women . 261 Table 16.11.2 Spousal violence by wife's characteristics and empowerment indicators: men . 262 Table 16.12.1 Frequency of physical or sexual violence: women . 263 Table 16.12.2 Frequency of physical or sexual violence: men . 264 Table 16.13.1 Experience of spousal violence by duration of marriage: women . 265 Table 16.13.2 Experience of spousal violence by duration of marriage: men . 265 Table 16.14.1 Injuries to women due to spousal violence: women . 266 Table 16.14.2 Injuries to men due to spousal violence: men . 266 Table 16.15.1 Violence by women against their spouse by background characteristics . 267 Table 16.15.2 Men's violence against their spouse by background characteristics . 268 Table 16.16.1 Violence by women against their spouse by spouse's characteristics and empowerment indicators . 269 Table 16.16.2 Men's violence against their spouse by wife's characteristics and empowerment indicators . 270 Table 16.17.1 Help seeking to stop violence: women . 271 Table 16.17.2 Help seeking to stop violence: men . 272 Table 16.18.1 Sources for help to stop the violence: women . 273 Table 16.18.2 Sources for help to stop the violence: men . 273 Figure 16.1 Percentage of ever-married women age 15-49 who have experienced specific types of spousal physical and sexual violence by the current or most recent husband/partner . 257 Tables and Figures • xv APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION Table A.1 Enumeration areas and households . 280 Table A.2 Population . 280 Table A.3 Sample allocation of clusters and households . 281 Table A.4 Sample allocation of completed interviews with women and men . 281 Table A.5 Sample implementation . 282 Table A.6 Sample implementation: Men . 283 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, 2011 Uganda. 289 Table B.2 Sampling errors for national sample, Uganda 2011 . 290 Table B.3 Sampling errors for urban sample, Uganda 2011 . 291 Table B.4 Sampling errors for rural sample, Uganda 2011 . 292 Table B.5 Sampling errors for Kampala region, Uganda 2011 . 293 Table B.6 Sampling errors for Central 1 region, Uganda 2011 . 294 Table B.7 Sampling errors for Central 2 region, Uganda 2011 . 295 Table B.8 Sampling errors for East Central region, Uganda 2011 . 296 Table B.9 Sampling errors for Eastern region, Uganda 2011 . 297 Table B.10 Sampling errors for Karamoja region, Uganda 2011 . 298 Table B.11 Sampling errors for North region, Uganda 2011 . 299 Table B.12 Sampling errors for North region, Uganda 2011 . 300 Table B.13 Sampling errors for Western region, Uganda 2011 . 301 Table B.14 Sampling errors for Southwest region, Uganda 2011 . 302 Table B.15 Sampling errors for adult and maternal mortality rates for the seven-year period preceding the survey, Uganda 2011 . 303 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 305 Table C.2.1 Age distribution of eligible and interviewed women . 306 Table C.2.2 Age distribution of eligible and interviewed men . 306 Table C.3 Completeness of reporting . 307 Table C.4 Births by calendar years . 307 Table C.5 Reporting of age at death in days . 308 Table C.6 Reporting of age at death in months . 308 Table C.7 Nutritional status of children . 309 Table C.8 Completeness of information on siblings . 310 Table C.9 Sibship size and sex ratio of siblings . 310 Preface • xvii he 2011 Uganda Demographic and Health Survey (2011 UDHS) was designed as a follow-up to the 1988/89, 1995, 2000-01, and 2006 Uganda DHS surveys. The main objective of the 2011 UDHS was to obtain current statistical data on the Ugandan population’s demographic characteristics, family planning efforts, maternal mortality, and infant and child mortality. Another objective was to collect information on health care services and activities, antenatal, delivery, and postnatal care, children’s immunisations, and management of childhood diseases. In addition, the survey was designed to evaluate the nutritional status of mothers and children, to measure the prevalence of anaemia among women and children, to assess the level of knowledge about HIV and AIDS among men and women, and to determine the extent of interpersonal violence. The findings of the 2011 UDHS are critical to measurement of the achievements of family planning and other health programmes. To better understand and utilise these findings, the results will be widely disseminated at different planning levels using diverse dissemination techniques to reach the various segments of society. The Uganda Bureau of Statistics would like to acknowledge the efforts of a number of organisations and individuals who contributed immensely to the success of the survey. The Ministry of Health (MOH) chaired the Technical Working Committee, which offered guidance on the implementation of the survey. The Makerere University School of Public Health (MakSPH) and the Makerere University Department of Biochemistry and Sports Science under the College of Natural Sciences conducted the Quality Control and the laboratory testing for vitamin A deficiency respectively. ICF International is greatly appreciated for providing important technical support. Financial assistance was provided by the government of Uganda, USAID/Uganda, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the World Health Organisation (WHO), the UK Government and Irish Aid-the Government of Ireland. We are grateful for the efforts of officials at national and local government levels who supported the survey. Finally, we highly appreciate all the hard work of field staff and, most important, the contributions of survey respondents whose participation was critical to the successful completion of this survey. John B. Male-Mukasa Executive Director Uganda Bureau of Statistics PREFACE T Millennium Development Goal Indicators • xix MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Uganda 2011 Indicator Sex Total Female Male 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under five years of age 12.7 14.9 13.8 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 81.0 81.1 81.0 2.3 Literacy rate of 15-24 year olds2 75.2a 77.1 76.1 b 3. Promote gender equality and empower women 3.1a Ratio of girls to boys in primary education3 na na 1.0 3.1b Ratio of girls to boys in secondary education3 na na 1.1 3.1c Ratio of girls to boys in tertiary education3 na na 0.7 4. Reduce child mortality 4.1 Under five mortality rate4 98 114 90 4.2 Infant mortality rate4 59 70 54 4.3 Proportion of 1 year-old children immunized against measles 76.6 74.8 75.8 5. Improve maternal health 5.1 Maternal mortality ratio5 na na 438 5.2 Percentage of births attended by skilled health personnel6 na na 58.0 5.3 Contraceptive prevalence rate7 30.0 na na 5.4 Adolescent birth rate8 134.5 na na 5.5a Antenatal care coverage: at least 1 visit by a skilled health professional 94.9 na na 5.5b Antenatal care coverage: four or more visits by any provider 47.6 na na 5.6 Unmet need for family planning 34.3 na na 6. Combat HIV/AIDS, malaria and other diseases 6.2 Condom use at last high-risk sex9 51.0 a 61.1 56.1 b 6.3 Percentage of the population age 15-24 years with comprehensive correct knowledge of HIV/AIDS10 38.1 a 39.5 38.8 b 6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years 0.92 0.83 0.87 6.7 Percentage of children under 5 sleeping under insecticide treated bednets 44.0 41.6 42.8 6.8 Percentage of children under 5 with fever who are treated with appropriate antimalarial drugs11 66.7 62.1 64.5 Residence Total Urban Rural 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source12 89.6 66.6 70.0 7.9 Percentage of population with access to improved sanitation13 26.3 17.4 18.7 na = Not applicable 1 The rate is based on reported attendance, not enrollment, in primary education among primary school age children (6-12 year-olds). The rate also includes children of primary school age enrolled in secondary education. This is proxy for MDG indicator 2.1, Net enrollment ratio. 2 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence 3 Based on reported net attendance, not gross enrollment, among 6-12 year-olds for primary, 13-18 year-olds for secondary and 19-24 year- olds for tertiary education 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. The difference in the reference periods explains the apparent inconsistency between the sex-specific and total mortality rates. 5 Expressed in terms of maternal deaths per 100,000 live births in the 7-year period preceding the survey 6 Among births in the five years preceding the survey 7 Percentage of currently married women age 15-49 using any method of contraception 8 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year preceding the survey, expressed in terms of births per 1,000 women age 15-19 9 Higher-risk sex refers to sexual intercourse with a non-marital, non-cohabitating partner. Expressed as a percentage of men and women age 15-24 who had higher-risk sex in the past 12 months. 10 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 11 Measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and received any anti-malarial drug 12 Percentage of de-jure population whose main source of drinking water is a household connection (piped), private and public tap, boreholes, protected /dug well or spring, rain and bottled water 13 Percentage of de-jure population whose household has a flush toilet, ventilated improved pit latrine, pit latrine with a slab, composting toilet, or Ecosan and does not share this facility with other households a Restricted to men in sub-sample of households selected for the male interview b The total is calculated as the simple arithmetic mean of the percentages in the columns for male and females xx • Map of Uganda Introduction • 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY History ganda’s first elections were held on 1 March 1961 and the country obtained independence from Britain in 1962. Uganda became a republic in 1963 and maintained its British Commonwealth membership. There was conflict between supporters of a centralized state and supporters of a loose federation and a strong role of the tribally-based local kingdoms. In February 1966, the Prime Minister Milton Obote suspended the constitution, removed the president and the vice president, and abolished traditional kingdoms. In 1963, a new constitution proclaimed Uganda a republic and gave President Obote greater power. In 1971, a military coup led by armed forces commander Idi Amin Dada overthrew President Obote's government. Amin became the President, dissolved the parliament, and amended the constitution to give himself absolute power. During Amin’s rule, there was economic decline, social disintegration, and open human rights and ethnic violations. The Ugandan army attacked Tanzania because of a border dispute involving Ugandan exiles who had a camp close to the Ugandan border of Mutukula. In 1978, the Tanzanian armed forces fought against Amin's troops that invaded the Tanzanian territory. In return, the Tanzanian army, helped by Ugandans in exile, started a war against Amin's troops and in April 1979 captured Kampala and forced Amin and his remaining forces to flee to Libya. After Amin's removal, there was a succession of leaders before the return of President Milton Obote in 1980. The security forces of Uganda had one of the world's worst human rights records under President Obote. He ruled until July 1985, when an army brigade took over and proclaimed a military government. Obote fled to exile in Zambia. The new government was headed by the former defense force commander General Tito Okello. The Okello government carried out a brutal counterinsurgency in an attempt to destroy the support for the National Resistance Army (NRA) led by Yoweri Kaguta Museveni. Despite negotiations between the Okello government and the NRA and an agreement to a cease- fire in late 1985, the NRA continued the resistance and seized Kampala and the country in late January 1986, forcing Okello's forces to flee to Sudan. The NRA organized a government and proclaimed U Key Findings  The 2011 Uganda Demographic and Health Survey (UDHS) is a nationally representative survey of 10,086 households with 9,247 women age 15-49 and 2,573 men age 15-54.  The 2011 UDHS is the fifth comprehensive survey conducted in Uganda as part of the worldwide Demographic and Health Surveys project.  The primary purpose of the UDHS is to furnish policymakers and planners with detailed information on fertility and family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections.  In all selected households, women age 15-49 and children age 6-59 months were tested for anaemia and for vitamin A deficiency. 2 • Introduction Museveni as president. The new government ended human rights abuses of earlier governments in Uganda, instituted broad economic reforms, and started political liberalization and freedom of the press. The armed resistance against the government has continued since 1986 in northern areas of the country, such as Acholiland. Some of the rebel groups include the Uganda People's Democratic Army, the Holy Spirit Movement, and the Lord's Resistance Army, headed by Joseph Kony, which carried out widespread abduction of children to serve as soldiers or sex slaves. Peace has however started returning to the Northern region and people originally living in internally displaced peoples camps have started settling in their villages. Geography The republic of Uganda is located in East Africa and lies astride the equator. It is a landlocked country that borders Kenya to the east, Tanzania to the south, Rwanda to the southwest, the Democratic Republic of Congo to the west, and South Sudan to the north. The country has an area of 241,039 square kilometres and is administratively divided into 112 districts. Uganda has a decentralized system of governance and several functions have been ceded to the local governments. However, the central government retains the role of formulating policy, setting and supervising standards, and providing national security. Uganda has a favourable climate because of its relatively high altitude. The Central, Eastern, and Western regions of the country have two rainy seasons per year, with relatively heavy rains from March through May and light rains from September through December. The level of rainfall decreases as one travels northward, turning into just one rainy season a year. The soil fertility varies accordingly, being generally fertile in the Central and Western regions and becoming less fertile as one moves to the east and the north. Because climate varies, Uganda’s topography ranges from tropical rain forest vegetation in the south to savannah woodlands and semi-arid vegetation in the north. Climate determines the agricultural potential and thus the land’s capacity to sustain human population; population densities are high in the Central and Western regions and decline towards the north. Economy The economy is predominantly agricultural, with the majority of the population dependent on subsistence farming and light agro-based industries. The country is self-sufficient in food, although its distribution is uneven over all areas. Coffee remains the main foreign exchange earner for the country. During the period immediately following independence, from 1962 to 1970, Uganda had a flourishing economy with a 5 percent growth Gross Domestic Product (GDP) per annum; this contrasted with a population growth rate of 2.6 percent per annum. In the 1970s through the early 1980s, Uganda faced a period of civil and military unrest, resulting in the destruction of the economic and social infrastructure. The growth of the economy and the provision of social services such as education and health care were seriously affected. Since 1986, however, the government has introduced and implemented several reform programmes that have steadily reversed prior setbacks and aimed the country towards economic prosperity. Between 2006 and 2011, the country’s growth in GDP varied between 5.6 percent and 7.1 percent a year (UBOS, 2006a). 1.2 POPULATION In the past, most demographic statistics in Uganda were derived from population censuses, which began in 1948. Subsequent censuses have been held in 1959, 1969, 1980, 1991, and 2002. In addition, Demographic and Health Surveys have been conducted in 1988-1989, 1995, 2000-2001, 2006, and most recently in 2011, the subject of the present report. Additional demographic data have been obtained from other surveys devoted to specific subjects. Introduction • 3 Civil registration was made compulsory in Uganda in 1973. However, its coverage is incomplete, and it is therefore not viable as a source of demographic statistics. Efforts to streamline the system were made between 1974 and 1978, but the achievements from this effort were later frustrated by the economic and civil instability. Table 1.1 presents several demographic indices compiled from the population censuses of 1969 through 2002. Over that period, the population has increased as a result of high fertility and declining mortality. The annual population growth rate between 1969 and 1980 was 2.7 percent, which decreased to 2.5 percent between 1980 and 1991. Instability in Uganda during the early 1980s may have contributed to this decline. The annual population growth rate increased to 3.2 percent between the 1991 census and the 2002 census. The level of urbanization is still low but has been increasing over time. In 2002, a little more than 12 percent of the population lived in urban areas (UBOS, 2006a). Table 1.1 Basic demographic indicators Selected demographic indicators, Uganda 1969-2002 Indicator 1969 1980 1991 2002 Population (thousands) 9,535.1 12,632.2 16,672.7 24,227.3 Intercensal growth rate (percent) 3.9 2.7 2.5 3.2 Density (population/kilometre2) 48 64 85 124 Percent urban 6.6a 6.7 9.9 12.3 Life expectancy Male 46.0 u 45.7 48.8 Female 47.0 u 50.5 52.0 Total 46.5 u 48.1 50.4 u = Unknown (not available) a The 1969 data are based on a different definition of urban Source: UBOS, 2006b 1.3 POPULATION AND HEALTH POLICIES National Population Policy Uganda’s first explicit National Population Policy was promulgated by the government in 1995. That policy elaborated clear strategies with an overall goal of contributing to the improvement of the quality of life of the people of Uganda. Since its foundation, a number of lessons have been learnt. Some important targets were achieved, but others were not. There have also been some major challenges and opportunities at local, regional, and international levels, which need to be taken into account as the country moves forward. It is against this backdrop that the government began to revise the National Population Policy to accommodate new and emerging challenges. The revised policy is a clarion call to plan for and invest in the increasing population, so that the country’s human capital develops to its full potential. Only then can Ugandans hope to benefit from an increasing population as a demographic ‘bonus’ instead of a demographic ‘burden’ (POPSEC, 2008). A National Population Action Plan was also developed and rolled out at the subnational level. Health Policy The first Health Sector Strategic Plan (HSSP I) for Uganda covered the period 2000/01 to 2004/05. The plan helped to guide the government of Uganda in its health sector investments, which were led by the Ministry of Health, health development partners (HDPs), and other stakeholders over this period. Continuous monitoring through quarterly and mid-term reviews helped to assess key achievements and challenges during the implementation of HSSP I and formed the basis for the development of HSSP II for the period 2005/06 to 2009/10. HSSP II was completed in June 2010. 4 • Introduction The government of Uganda, with the stewardship of the Ministry of Health (MOH), developed the second National Health Policy (NHP II) to cover a ten-year period from 2010/11 to 2019/20. The third Health Sector Strategic Plan (HSSP III) was developed to operationalize the NHP II and the health sector component of the National Development Plan (NDP) 2010/11-2014/15, which is the overall development plan for Uganda. The HSSP III provides an overall framework for the health sector. Its major aim is to contribute towards the overall development goal of the government of Uganda by accelerating economic growth to reduce poverty. 1.4 OBJECTIVES OF THE 2011 UDHS SURVEY The 2011 Uganda Demographic and Health Survey (UDHS) was designed to provide information on demographic, health, and family planning status and trends in the country. Specifically, the UDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, breastfeeding practices, and awareness and use of family planning methods. In addition, data were collected on the nutritional status of mothers and young children; infant, child, adult, and maternal mortality; maternal and child health; awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections; and levels of anaemia and vitamin A deficiency. The 2011 UDHS is a follow-up to the 1988-1989, 1995, 2000-2001, and 2006 UDHS surveys, which were implemented by the Statistics Department of Ministry of Finance and Planning, and later by the Uganda Bureau of Statistics (UBOS). The specific objectives of the 2011 UDHS were as follows:  To provide data at the national and subnational level that would allow the calculation of demographic rates, particularly fertility and infant mortality rates  To analyse the direct and indirect factors that determine the level of and trends in fertility and mortality  To measure the level of contraceptive knowledge and practice of women and men by method, by urban-rural residence, and by region  To collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS, and to evaluate patterns of recent behaviour regarding condom use  To assess the nutritional status of children under age 5 and women by means of anthropometric measurements (weight and height), and to assess child feeding practices  To collect data on family health, including antenatal visits, assistance at delivery, breastfeeding, immunizations, and prevalence and treatment of diarrhoea and other diseases among children under age 5  To measure vitamin A deficiency in women and children, and to measure anaemia in women, men, and children  To measure key education indicators, including school attendance ratios and primary school grade repetition and dropout rates  To collect information on the extent of disability  To collect information on the extent of gender-based violence Introduction • 5 This information is essential for informed policy-making and planning, monitoring, and evaluation of health programmes in general and reproductive health programmes in particular, at both the national and regional levels. A long-term objective of the survey was to strengthen the technical capacity of the National Statistics Office to plan, conduct, process, and analyse data from complex national population and health surveys. The 2011 UDHS provides national and regional estimates on population and health that are comparable to data collected in Uganda’s four previous DHS surveys and similar surveys in other developing countries. Data collected in the 2011 UDHS add to the large and growing international database of demographic and health indicators. 1.5 ORGANIZATION OF THE SURVEY The Uganda Bureau of Statistics (UBOS) was the major implementer of the survey. Other agencies and organizations that facilitated the successful implementation of the survey through their technical support include the Ministry of Health, Makerere University School of Public Health, and the Biochemistry Department of Makerere University. A multi-sect oral Technical Working Committee was also constituted to provide technical backstopping. The same team was also responsible for questionnaire design, training, and report writing. Financial assistance was provided by the government of Uganda, USAID/Uganda, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the UK Government and Irish Aid-the Government of Ireland. In addition, ICF International provided limited technical assistance in data processing and report production through the MEASURE DHS project, a USAID-funded program supporting the implementation of population and health surveys in countries worldwide. The UDHS Technical Working Committee, composed of members drawn from the Ministry of Health, the Population Secretariat, and various development partners, oversaw technical issues related to the survey, such as questionnaire design, training, and report writing. 1.6 SAMPLE DESIGN The sample for the 2011 UDHS was designed to provide population and health indicator estimates for the country as a whole and for urban and rural areas separately. Estimates were also reported for the 10 regions of Uganda shown in Figure 1.1. 6 • Introduction Figure 1.1 Map of Uganda DHS clusters Introduction • 7 A representative sample of 10,086 households was selected for the 2011 UDHS. The sample was selected in two stages. In the first stage, 404 enumeration areas (EAs) were selected from among a list of clusters sampled for the 2009/10 Uganda National Household Survey (2010 UNHS). This matching of samples was done to allow linking of the 2011 UDHS health indicators to poverty data from the 2010 UNHS. The clusters in the UNHS were selected from the 2002 Population Census sample frame. In the second stage of sampling, households in each cluster were selected from a complete listing of households, which was updated prior to the survey. Households were purposively selected from those listed. All households in the 2010 UNHS that were in the 404 EAs were included in the UDHS sample. All women age 15-49 who were either permanent residents of the households or visitors who slept in the households the night before the survey were eligible to be interviewed. In addition, in a subsample of one-third of households selected for the survey, all men age 15-54 were eligible to be interviewed if they were either permanent residents or visitors who slept in the household on the night before the survey. Details about the sample design are presented in Appendix A. An additional sample was selected for administration of the Maternal Mortality Module. 1.7 QUESTIONNAIRES Four types of questionnaires were used in the 2011 UDHS: the Household Questionnaire, the Woman’s Questionnaire, the Maternal Mortality Questionnaire, and the Man’s Questionnaire. These questionnaires were adapted from model survey instruments developed by ICF for the MEASURE DHS project and by UNICEF for the Multiple Indicator Cluster Survey (MICS) project. The intent was to reflect the population and health issues relevant to Uganda. Questionnaires were discussed at a series of meetings with various stakeholders, ranging from government ministries and agencies to nongovernmental organizations (NGOs) and development partners. The questionnaires were translated into seven major languages: Ateso, Ngakarimojong, Luganda, Lugbara, Luo, Runyankole-Rukiga, and Runyoro-Rutoro. The Household Questionnaire was used to list all the usual members and visitors who spent the previous night in the selected households. Basic information was collected on the characteristics of each person listed, including his or her age, sex, education, relationship to the head of the household, and disability status. For children under age 18, survival status of the parents was determined. Data on the age and sex of household members were used to identify women and men eligible for an individual interview. In addition, the Household Questionnaire 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 and use of mosquito bednets. The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. The eligible women were asked questions on the following topics:  Background characteristics (age, education, 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 behaviour regarding AIDS and other sexually transmitted infections (STIs) 8 • Introduction  Adult mortality, including maternal mortality  Knowledge of tuberculosis and other health issues  Gender-based violence The Maternal Mortality Questionnaire was administered to all eligible women age 15-49 in 35 additional households in 394 out of 404 EAs. It collected data on maternal mortality using the Sibling Survival Module (commonly referred to as the ‘Maternal Mortality Module’). The Man’s Questionnaire was administered to all eligible men age 15-54 years in every third household in the 2011 UDHS sample. The Man’s Questionnaire collected information similar to that in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health. 1.8 ANTHROPOMETRY, ANAEMIA, AND VITAMIN A TESTING The 2011 UDHS included height and weight measurements, testing for anaemia, and blood sample collection on filter paper cards for vitamin A testing in the laboratory. The protocol for anaemia testing and for the blood specimen collection for vitamin A testing was similar to that used in the 2006 UDHS. Height and Weight Measurement Height and weight measurements were carried out on eligible women age 15-49 and children under age 5 in all selected households, and eligible men age 15-54 in one-third of the households. Weight measurements were obtained using lightweight, SECA mother-infant scales with a digital screen that were designed and manufactured under the guidance of UNICEF. Height measurements were carried out using a measuring board. Children younger than 24 months were measured for height while lying down, and older children were measured while standing. Anaemia Testing Blood specimens were collected to test for anaemia in all children age 6-59 months, women age 15-49 years, and men age 15-54 years who voluntarily consented to the testing. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of young children with small fingers) and collected in a microcuvette. Haemoglobin analysis was carried out on site using a battery-operated portable HemoCue analyzer. Results were given verbally and in writing. Parents of children with a haemoglobin level under 7 grams per decilitre (g/dl) were instructed to take the child to a health facility for follow-up care. Likewise, non-pregnant women, pregnant women, and men were referred for follow-up care if their haemoglobin level was below 7 g/dl, 9 g/dl, and 9 g/dl, respectively. All households in which testing was conducted were given a brochure explaining the causes and prevention of anaemia. Resulting data were adjusted for altitude prior to being tabulated. Vitamin A Testing Blood specimens were collected by the health technicians to test for vitamin A in all women age 15-49 who consented and all children age 6-59 months whose parent or responsible adult consented. The protocol for the blood specimen collection and analysis was based on the anonymous linked protocol developed for the MEASURE DHS project. This protocol allows the merging of the vitamin A test results with the socio-demographic data collected from the individual questionnaires (after removal of all identifying information). Introduction • 9 The health technicians explained the procedure, the confidentiality of the data, and the fact that the vitamin A test results would not be made available to the respondent. If a respondent consented to the vitamin A testing, a maximum of three blood drops from the finger prick were collected on a filter paper card to which a barcode label unique to the respondent was affixed. Respondents were asked whether they consented to having the laboratory store their blood sample for future unspecified testing. If the respondent did not consent to additional testing using their sample, the words ‘no additional testing’ were written on the filter paper card. Each dried blood spot sample was given a unique barcode label in triplicate. The first copy was affixed to the filter paper card. The second copy was attached to the biomarker data collection page of the Household Questionnaire. The third copy of the barcode label was attached to the blood sample transmittal form to track the blood samples as they moved from the field to the laboratory. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected from the field and transported to the laboratory at the biochemistry department of Makerere University in Kampala to be logged in, checked, and stored. The vitamin A test results are shown in a separate report. 1.9 LISTING, PRETEST, MAIN TRAINING, FIELDWORK, AND DATA PROCESSING Listing A household listing operation was conducted in the 404 selected clusters and 10 regions for about three months, starting in April 2011. For this purpose, 18 listing staff were recruited from the UBOS head office to carry out the household listing and prepare the sketch map for each selected EA. A manual of instructions that described the listing and mapping procedures was prepared as a guideline, and the training involved both classroom demonstrations and field practice. Instructions were given on the use of global positioning system (GPS) units to obtain location coordinates for the selected clusters. The listing was performed by organizing the listing staff into six teams, with two listers per team. Six supervisors were also assigned from the UBOS offices to perform quality checks and handle all administrative and technical aspects of the listing operation. Rounds of supervision were also carried out to assess the quality of the field operation and to ensure proper listing. Pretest Before the start of fieldwork, the questionnaires were pretested in all seven local languages to make sure that the questions were clear and could be understood by the respondents. Thirty field workers, comprising of women and men were hired to conduct the pretest. They were trained from August 30, 2010, to September 14, 2010, on how to administer the UDHS survey questionnaires. Seven days of fieldwork and one day of interviewer debriefing and examination followed. Pretest fieldwork was conducted in two clusters each (one urban and one rural) in seven districts. The majority of pretest participants attended the 2011 UDHS training and served as field editors and team leaders in the survey. A second pretest was undertaken to test the management and implementation of the computer- assisted field data editing (CAFE) program and, more specifically, to develop data editing guidelines for the 2011 UDHS. The 2011 UDHS marked the first time tablet computers were used to collect data from the field. The data file transfer process was tested using the internet file streaming system (IFSS) developed by the DHS programme, through which data from the field could be transferred to the UBOS main office via the internet. Main Training UBOS recruited and trained 146 field workers to serve as team supervisors, field editors, male and female interviewers, and reserve interviewers for the main survey. The training, which was conducted from 2 May 2011 to 1 June 2011, consisted of instruction regarding interviewing techniques and field procedures, a detailed review of questionnaires, tests, and instruction and practice in weighing and 10 • Introduction measuring children. The training also included mock interviews and role plays among participants in the classroom and in the neighbouring villages. Team supervisors and editors were further trained in data quality control procedures and fieldwork coordination. The training mainly used the English questionnaires, while the translated versions were simultaneously checked against the English questionnaires to ensure accurate translation. Fieldwork Sixteen data collection teams were formed, each comprised of a team supervisor, a field editor, three female interviewers, one male interviewer, one health technician, and a driver. UBOS staff coordinated and supervised fieldwork activities. USAID/Uganda technical staff also participated in the fieldwork monitoring. A data validation team was formed for each of the 10 regions. Each data validation team included a field supervisor and three interviewers. An independent quality control team that was looking at survey protocol issues also visited the data collection teams. Data collection took place over a six-month period, from end of June 2011 to early December 2011. Fieldwork was carried out in six separate field trips. Between trips, all teams met in Kampala to discuss problems with fieldwork logistics or data collection and to receive feedback and training reinforcement from UBOS staff. Data Processing As mentioned above, questionnaire data were entered in the field by the field editors on each team and the files were periodically sent to the UBOS office by internet. All the paper questionnaires were also returned to UBOS headquarters in Kampala for data processing, which consisted of office editing, coding of open-ended questions, a second data entry, and finally, editing computer-identified errors. The data were processed by a team of eight data entry operators, two office editors, and one data entry supervisor. Data entry and editing were accomplished using CSPro software. The processing of data was initiated in August 2011 and completed in January 2012. 1.10 RESPONSE RATES Table 1.2 shows household and individual response rates for the 2011 UDHS. A total of 10,086 households were selected for the sample, of which 9,480 were found to be occupied during data collection. Of these, 9,033 households were successfully interviewed, giving a household response rate of 95 percent. Of the 9,247 eligible women identified in the selected households, interviews were completed with 8,674 women, yielding a response rate of 94 percent for women. Of the 2,573 eligible men identified in the selected subsample of households for men, 2,295 were successfully interviewed, yielding a response rate of 89 percent for men. Response rates were higher in rural than in urban areas, with the rural-urban difference being more pronounced among men (92 and 82 percent, respectively) than among women (95 and 91 percent, respectively). Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Uganda 2011 Result Residence Total Urban Rural Household interviews Households selected 2,977 7,109 10,086 Households occupied 2,794 6,686 9,480 Households interviewed 2,551 6,482 9,033 Household response rate1 91.3 96.9 95.3 Interviews with women age 15-49 Number of eligible women 2,805 6,442 9,247 Number of eligible women interviewed 2,562 6,112 8,674 Eligible women response rate2 91.3 94.9 93.8 Interviews with men age 15-54 Number of eligible men 772 1,801 2,573 Number of eligible men interviewed 631 1,664 2,295 Eligible men response rate2 81.7 92.4 89.2 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter summarizes demographic and socioeconomic characteristics of the households selected in the 2011 UDHS. Information was collected from both usual residents of a selected household (the de jure population) and persons who had stayed in the selected household the night before the interview (the de facto population). This chapter provides information on the conditions of the households in which the survey population lives, including the source of drinking water, availability of electricity, sanitation facilities, building materials, and possession of household durable goods. Also addressed are specific findings on birth registration of children under age 5, household living arrangements, orphanhood status, school attendance, educational attainment, and disability status. The background information presented in this chapter is intended to facilitate the interpretation of the demographic, socioeconomic, and health indices presented in later chapters. 2.1 HOUSEHOLD ENVIRONMENT The characteristics of a household determine the socioeconomic and health status of its members. The household is where all decisions about health, education, and general welfare are made and acted upon. The 2011 UDHS asked respondents about their household environment, including the source of drinking water, type of sanitation facility, access to electricity, type of material used for roofing, flooring, and walls, and number of rooms used for sleeping in the dwelling. 2.1.1 Drinking Water Increasing access to improved drinking water is one of the targets of the National Development Plan. Access to improved drinking water is also one of the Millennium Development Goals that Uganda has adopted. Unimproved water sources increase the prevalence of waterborne disease and the burden of service delivery through increased demand for health care. Table 2.1 presents indicators useful in monitoring household access to improved drinking water. Improved water sources include piped water into the dwelling, yard, or plot; a public tap/stand pipe or borehole; a protected well or protected spring water, and rainwater. Lack of easy access to an improved water source may limit the quantity of suitable drinking water that is available to a household as well as increase the risk of illness. Access to improved sources of drinking water has increased from 67 percent in T Key Findings  More than half of the population of Uganda is age 15 or younger.  Seventy percent of households use an improved source of drinking water.  Fifty-eight percent of the population take more than 30 minutes roundtrip to fetch water.  Only 16 percent of households have an improved sanitation facility.  About one in every seven households (15 percent) has electricity.  Three out of every ten children under age 5 have their birth registered.  Twelve percent of children under age 18 are orphans.  About three in ten households are headed by a woman. 12 • Housing Characteristics and Household Population 2006 to 70 percent of households in 2011. Nine in ten households in urban areas use improved water sources compared with only two in three households in rural areas. Access to improved water sources in rural areas increased from 63 percent to 67 percent during the same period. The most common source of improved drinking water in urban areas is piped water, used by 67 percent of households. In contrast, only 10 percent of rural households have access to piped water. A large proportion of rural households (44 percent) get their drinking water from a borehole. Ten percent of rural households get their drinking water from a protected spring or well. If water needs to be fetched from a source that is not immediately accessible to the household, it may get contaminated during transportation or storage even if the water is obtained from an improved source. Another factor that influences access to a water source is the burden of fetching water, which often falls disproportionately on female members of the household. Table 2.1 shows that, on average, 6 percent of the households have water on their premises. Urban households are more likely than rural households to have a water source in their house or yard (28 percent and 2 percent, respectively). Households that did not have water on their premises were asked how long it took to fetch water round trip. Thirty-three percent of all households (43 percent in urban areas and 31 percent in rural areas) take less than 30 minutes to fetch drinking water. More than half of all households (54 percent) travel 30 minutes or more to fetch their drinking water: 17 percent in urban areas and 62 percent in rural areas travel this length of time. The 2011 UDHS asked all households whether they treat their water to ensure that it is safe for drinking. Forty-four percent of households boil their drinking water. Urban households (71 percent) are more likely than rural households (38 percent) to boil the water. Six in ten households (59 percent) in rural areas do not treat their drinking water. Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Uganda 2011 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 90.6 65.6 70.3 89.6 66.6 70.0 Piped into dwelling/yard/plot 27.9 1.5 6.4 28.4 1.3 5.3 Public tap/standpipe 38.9 8.2 13.9 34.9 7.8 11.7 Borehole 11.8 43.9 37.9 16.1 45.9 41.6 Protected well/spring 6.9 10.2 9.6 7.6 10.2 9.8 Rain water 0.5 1.4 1.3 0.4 1.3 1.2 Bottled water 4.6 0.4 1.2 2.1 0.1 0.4 Non-improved source 8.9 33.6 29.0 10.1 32.8 29.5 Unprotected well/spring 5.6 18.2 15.8 7.0 17.6 16.1 Tanker truck/vendor 2.2 0.9 1.1 1.6 0.6 0.8 Surface water 1.0 14.6 12.0 1.4 14.5 12.6 Other source 0.6 0.8 0.7 0.3 0.6 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 90.6 65.6 70.3 89.6 66.6 70.0 Time to obtain drinking water (round trip) Water on premises 40.1 6.2 12.5 37.4 5.4 10.0 Less than 30 minutes 42.8 31.1 33.3 41.5 29.7 31.4 30 minutes or longer 16.6 62.0 53.5 20.7 64.3 57.9 Don't know/missing 0.5 0.7 0.7 0.4 0.6 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 70.6 37.7 43.9 68.8 34.8 39.8 Added water guard 3.3 2.7 2.8 3.6 2.6 2.8 Bleach/chlorine added 0.1 0.2 0.2 0.1 0.2 0.2 Strained through cloth 0.8 1.4 1.3 1.0 1.6 1.5 Ceramic, sand, or other filter 0.5 0.5 0.5 0.5 0.5 0.5 Solar disinfection 0.0 0.2 0.2 0.1 0.2 0.1 Let it stand and settle 0.3 0.6 0.5 0.4 0.5 0.5 Other 0.5 0.4 0.4 0.5 0.4 0.4 No treatment 26.7 58.9 52.8 27.8 61.6 56.6 Percentage using an appropriate treatment method2 72.8 40.8 46.8 71.6 38.0 43.0 Number 1,691 7,342 9,033 6,468 37,782 44,250 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, adding waterguard, bleaching, straining, filtering, and solar disinfecting. Housing Characteristics and Household Population • 13 2.1.2 Household Sanitation Facilities Ensuring adequate sanitation facilities is good public health practice. At the household level, the availability of hygienic sanitation facilities reduces the risk of exposure to illnesses and further lightens the burden on the public health delivery system. Appropriate sanitation facilities include an improved toilet and method of waste disposal that separates waste from human contact. A household is classified as having an improved toilet if the toilet is used only by household members (that is, the toilet is not shared) and if the toilet separates the waste from human contact (WHO and UNICEF, 2010). Flush/pour toilets that flush to a piped sewer system, and ventilated improved pit (VIP) latrines, pit latrines with a slab, and composting toilets (which separate solid waste from water) are also classified as improved toilets. Table 2.2 shows that 16 percent of households in Uganda use improved toilet facilities that are not shared with other households (21 percent in urban areas and 15 percent in rural areas). Overall, 19 percent of households have improved facilities but shared toilet facilities− 52 percent in urban areas and 11 percent in rural areas. Two in three households use non-improved toilet facilities (73 percent in rural areas and 28 percent in urban areas). The most common type of toilet in urban areas is a pit latrine with a slab (34 percent), while in rural areas the most common type of toilet is a pit latrine without a slab (62 percent). Ten percent of the households, mainly in rural areas, have no toilet facilities. This proportion has declined over time, from 17 percent in 2000-01 to 12 percent in 2006 and to 10 percent in 2011 (UBOS and ORC Macro, 2001; UBOS and Macro International, Inc., 2007). Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Uganda 2011 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility 20.9 15.3 16.4 26.3 17.4 18.7 Flush/pour flush to piped sewer system 8.6 0.2 1.8 9.4 0.1 1.5 Ventilated improved pit (VIP) latrine 3.7 2.0 2.3 4.8 2.1 2.5 Pit latrine with slab 8.4 12.8 12.0 12.1 14.8 14.4 Composting toilet/Ecosan 0.1 0.3 0.3 0.1 0.4 0.3 Shared facility1 51.6 11.3 18.8 43.6 8.0 13.2 Flush/pour flush to piped sewer system 2.7 0.1 0.6 2.0 0.1 0.3 Ventilated improved pit (VIP) latrine 14.9 2.2 4.6 12.3 1.5 3.1 Pit latrine with slab 33.8 8.9 13.5 29.1 6.4 9.7 Composting toilet/Ecosan 0.2 0.1 0.1 0.2 0.1 0.1 Non-improved facility 27.5 73.4 64.8 30.1 74.7 68.1 Pit latrine without slab/open pit 25.2 61.7 54.9 28.0 63.6 58.4 No facility/bush/field 1.8 11.5 9.7 1.8 10.9 9.6 Other 0.5 0.2 0.3 0.2 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,691 7,342 9,033 6,468 37,782 44,250 1 Facilities that would be considered improved if they were not shared by two or more households 2.1.3 Housing Characteristics Housing characteristics reflect the household’s socioeconomic status in society. The availability or lack of adequate housing facilities determines the magnitude of exposure to risks associated with air pollution and ill health. Table 2.3 shows that only 15 percent of the households in Uganda have electricity, and there is a very large disparity between urban and rural households (55 percent versus 5 percent). The proportion of households with access to electricity has increased since 2006. In urban areas, the proportion of households with electricity rose from 42 percent in 2006 to 55 percent in 2011. In rural areas, the percentage increased from less than 3 percent in 2006 to 5 percent in 2011. The quality of housing for most Ugandans is still inadequate. More than two thirds (69 percent) of households have either earth, sand, or dung floors. Rural houses (81 percent) are more likely than urban 14 • Housing Characteristics and Household Population houses (19 percent) to have this type of floor. Urban houses are more likely to have floors made of cement than rural houses (76 percent versus 18 percent, respectively). The number of rooms used for sleeping in relation to the number of household members is an indicator of the extent of crowding, which in turn increases the risk of contracting communicable diseases. Overall, 46 percent of the households use one room for sleeping, 29 percent use two rooms, and 25 percent use three or more rooms for sleeping. Urban households are more likely to use one room for sleeping than rural households, implying that overcrowding is more rampant in urban than rural households. More than half of the households in Uganda (58 percent) cook in a building separate from the house, while about one-third (28 percent) cook outdoors. In urban areas, one in five households (22 percent) cooks indoors. Cooking and heating with solid fuels can lead to high levels of indoor smoke, which consists of a complex mix of pollutants that can increase the risk of contracting respiratory infections. Uganda is predominantly agriculture based, and the use of solid fuels is widespread. Solid fuels include charcoal, wood, straw, shrubs, grass, agricultural crops, and animal dung. The use of solid fuel in Uganda is almost universal, with 96 percent of households using solid fuel for cooking. The practice is nearly universal in rural households at 98 percent and very common in urban households (85 percent). Wood is the main type of fuel used for cooking in rural areas (85 percent), while charcoal is the most used cooking fuel in urban areas (68 percent). The 2011 UDHS collected information on the frequency of smoking tobacco in the home. Smoking increases the risk of non- communicable diseases, not only for smokers but also for passive smokers. Table 2.3 shows that 16 percent of households are exposed to daily smoking, and 3 percent are exposed weekly. Rural households (17 percent) are almost twice as likely to be exposed to daily smoking as urban households (10 percent). Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Uganda 2011 Housing characteristic Residence Total Urban Rural Electricity Yes 55.4 5.3 14.6 No 44.6 94.7 85.4 Total 100.0 100.0 100.0 Flooring material Earth/sand 13.0 47.5 41.0 Earth and dung 5.5 33.1 27.9 Parquet or polished wood 0.1 0.1 0.1 Mosaic or tiles 3.2 0.1 0.7 Bricks 0.4 0.3 0.3 Cement 76.1 17.9 28.8 Stones 1.2 0.6 0.7 Other 0.4 0.4 0.4 Total 100.0 100.0 100.0 Rooms used for sleeping One 62.3 42.0 45.8 Two 21.9 30.2 28.7 Three or more 15.1 27.2 24.9 Missing 0.7 0.6 0.6 Total 100.0 100.0 100.0 Place for cooking In the house 22.3 8.8 11.3 In a separate building 22.3 66.6 58.3 Outdoors 48.8 23.0 27.8 No food cooked in household 6.4 1.5 2.4 Other 0.2 0.1 0.1 Total 100.0 100.0 100.0 Percentage using a separate room as a kitchen within the house 9.5 2.5 3.8 Cooking fuel Electricity 1.3 0.1 0.3 LPG/natural gas/biogas 3.3 0.0 0.6 Kerosene 4.3 0.3 1.1 Charcoal 67.8 12.4 22.8 Wood 16.9 85.3 72.5 Straw/shrubs/grass 0.0 0.2 0.2 No food cooked in household 6.4 1.5 2.4 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 84.7 98.0 95.5 Frequency of smoking in the home Daily 9.7 17.1 15.7 Weekly 2.4 3.6 3.4 Monthly 0.9 1.4 1.3 Less than monthly 2.0 3.5 3.2 Never 85.0 74.4 76.4 Total 100.0 100.0 100.0 Number 1,691 7,342 9,033 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood/straw/shrubs/grass, agricultural crops, and animal dung Housing Characteristics and Household Population • 15 2.1.4 Household Possessions The availability of durable consumer goods is an indicator of a household’s welfare status. Moreover, particular goods have specific benefits. For instance, a radio, a mobile phone, or a television can be a source of information and new ideas for household members; a refrigerator prolongs the wholesomeness of foods; and a means of transport can increase access to many services that are beyond walking distance. Table 2.4 shows that two-thirds of Ugandan households have radios, 59 percent have mobile telephones, 12 percent have televisions, and 5 percent have refrigerators. There is a significant increase in the level of penetration of the mobile phone industry into rural areas. Between 2006 and 2011, the percentage of rural households owning mobile phones increased more than fivefold, from 10 percent to 53 percent. In urban areas, the percentage of households with mobile phones increased from 53 percent to 87 percent, representing a growth of 64 percent over the same period. Televisions and refrigerators continue to be available mainly in urban households. More than one-third of the households possess a bicycle as a means of transport, with rural households being more likely to possess bicycles (41 percent) than urban households (20 percent). Ownership of motorcycles and cars increased between 2006 and 2011. Eight percent of the households own a motorcycle in 2011 compared with 3 percent in 2006. The proportion of households owning cars/trucks has increased slightly, from 2 percent to 3 percent, during the same period. In 2011, 72 percent of households owned farming land and 62 percent owned farm animals. Urban households are less likely than rural households to own land and farm animals. For example, 36 percent of urban households own farm animals compared with 68 percent of rural households. 2.1.5 Hand Washing Observance and promotion of basic hygiene is fundamental good public health. Hand washing with a detergent ensures that the transmission of germs is restricted, especially among children who are more prone than adults to diarrhoea and other childhood illnesses. Respondents were asked if they had a place for washing hands after using the toilet. Table 2.6 shows that three in ten households (29 percent) had such a place where washing of hands was observed. More than one in four households (27 percent) have both water and soap. Another 27 percent have only water available. Hand washing with water and soap is practiced most in households in Kampala, Central 1, and Western regions. On the other hand, Karamoja and West Nile regions are on the other extreme end with more than 80 percent of households not having any of the hand washing facilities (water/soap/detergents). Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land and livestock/farm animals by residence, Uganda 2011 Possession Residence Total Urban Rural Household effects Radio 71.8 64.6 66.0 Television 45.0 4.9 12.4 Mobile telephone 86.8 53.1 59.4 Non-mobile telephone 4.8 0.7 1.5 Refrigerator 19.7 1.7 5.1 Means of transport Bicycle 19.5 41.1 37.1 Animal drawn cart 0.3 0.8 0.7 Motorcycle/scooter 11.4 7.1 7.9 Car/truck 10.1 1.6 3.2 Boat with a motor 0.1 0.4 0.4 Boat without a motor 0.2 1.0 0.9 Ownership of agricultural land 44.2 78.8 72.3 Ownership of farm animals1 35.7 67.7 61.7 Local cattle 14.5 23.2 21.6 Exotic/cross cattle 3.9 3.7 3.7 Horses/donkeys/mules 0.1 0.4 0.4 Goats 17.6 39.8 35.7 Sheep 2.2 8.6 7.4 Pigs 7.1 20.1 17.7 Chickens 23.7 51.2 46.0 Number 1,691 7,342 9,033 1 Cattle, cows, bulls, horses, donkeys, mules, goats, sheep, pigs, or chicken 16 • Housing Characteristics and Household Population Table 2.5 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Uganda 2011 Background characteristic Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed Number of households with place for hand washing observed Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Total Residence Urban 34.9 1,691 37.7 0.0 30.0 2.1 0.0 30.2 100.0 589 Rural 27.6 7,342 23.9 0.5 25.9 3.0 0.7 45.8 100.0 2,026 Region Kampala 39.0 797 41.7 0.0 30.2 1.2 0.0 26.9 100.0 311 Central 1 50.1 1,140 45.2 0.0 17.6 3.9 1.2 32.0 100.0 571 Central 2 45.1 1,038 26.5 0.7 18.1 3.9 1.5 49.4 100.0 468 East Central 30.6 904 11.9 0.0 42.9 1.8 0.0 43.3 100.0 277 Eastern 25.2 1,226 9.3 0.9 29.9 3.2 0.0 56.8 100.0 309 Karamoja 12.5 306 1.6 0.0 10.1 0.2 0.0 88.2 100.0 38 North 7.2 757 10.3 7.7 19.0 2.3 0.0 60.7 100.0 55 West Nile 16.4 508 4.5 1.0 9.9 0.7 0.0 84.0 100.0 84 Western 22.1 1,228 31.8 0.0 51.1 3.4 0.0 13.7 100.0 272 Southwest 20.5 1,128 15.6 0.0 22.2 1.8 0.0 60.4 100.0 232 Wealth quintile Lowest 17.0 1,719 11.9 0.8 17.2 0.4 0.8 68.9 100.0 292 Second 23.7 1,767 12.4 0.8 26.3 3.9 1.0 55.6 100.0 418 Middle 28.5 1,672 15.0 0.3 31.5 2.5 0.4 50.3 100.0 476 Fourth 32.4 1,723 26.8 0.4 28.0 2.7 1.0 40.8 100.0 559 Highest 40.4 2,152 45.7 0.2 27.1 3.4 0.0 23.5 100.0 870 Total 29.0 9,033 27.0 0.4 26.9 2.8 0.5 42.3 100.0 2,615 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent 2.2 WEALTH INDEX Household income or expenditure is usually regarded as the gold standard for measuring welfare and overall standard of living. However, studies have shown that the wealth index is a good proxy for measuring wealth of households. It serves as an indicator of level of wealth that is consistent with expenditure and income measures (Rutstein, 1999). The wealth index was constructed using household asset data via principal components analysis. In its current form, which takes better account of urban-rural differences in scores and indicators of wealth, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. Categorical variables to be used are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators. The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. This three-step procedure permits greater adaptability of the wealth index in both urban and rural areas. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are obtained by assigning the household score to each de jure household member, ranking each person in the population by his or her score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Table 2.6 shows that in urban areas three-quarters of the population is in the highest wealth quintile, in sharp contrast to the rural areas, where only one in nine persons are in the highest wealth quintile. The wealth quintile distribution varies greatly across regions. Over 90 percent of the population in Kampala is in the highest wealth quintile, while in other regions the proportion is 35 percent or lower. In Housing Characteristics and Household Population • 17 Karamoja, eight in ten households are in the lowest quintile. In North, West Nile, and Eastern regions, 33 percent or more of the households are in the lowest quintile. This finding is consistent with the results of Uganda National Household survey, which showed that poverty is more concentrated in the northern region (UBOS, 2010). Table 2.6 further shows the Gini Coefficient of wealth in Uganda, with 0 representing equal distribution (everyone having the same amount of wealth) and 1 representing a totally unequal distribution (one person having all the wealth). The overall Gini Coefficient for Uganda is 0.4. The coefficient is higher in rural areas (0.3) than in urban areas (0.2), indicating a more unequal distribution of wealth in the rural than in the urban population. The lowest Gini Coefficient is in Kampala (0.1), where over 90 percent of the population is in the highest wealth quintile. Table 2.6 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Uganda 2011 Residence/region Wealth quintile Total Number of persons Gini Coefficient Lowest Second Middle Fourth Highest Residence Urban 1.9 3.1 4.5 15.5 74.9 100.0 6,468 0.19 Rural 23.1 22.9 22.7 20.8 10.6 100.0 37,782 0.32 Region Kampala 0.0 0.1 1.2 7.6 91.0 100.0 2,770 0.12 Central 1 6.0 9.8 18.6 30.9 34.8 100.0 4,823 0.30 Central 2 8.4 12.8 19.7 29.4 29.7 100.0 4,656 0.34 East Central 12.1 21.0 21.2 29.8 15.9 100.0 4,697 0.31 Eastern 32.8 25.2 20.7 15.0 6.3 100.0 6,790 0.35 Karamoja 79.2 6.2 6.7 5.2 2.7 100.0 1,628 0.56 North 40.7 34.6 12.4 7.0 5.3 100.0 4,117 0.34 West Nile 41.2 31.2 14.3 8.0 5.2 100.0 2,810 0.31 Western 14.1 21.4 28.1 21.8 14.7 100.0 6,402 0.35 Southwest 6.3 23.3 32.5 24.5 13.4 100.0 5,555 0.28 Total 20.0 20.0 20.0 20.0 20.0 100.0 44,250 0.39 2.3 POPULATION BY AGE AND SEX Age and sex are important variables that are the primary basis for demographic classification in vital statistics, censuses, and surveys. They are also important variables for the study of mortality, fertility, and marriage. Table 2.7 shows the distribution of the household population in the 2011 UDHS by five-year age groups, urban-rural residence, and sex. The total population in the survey is 43,508, with females slightly outnumbering males (22,285 compared with 21,223). There is no variation in sex composition across rural- urban residence. The overall sex ratio is 95 (or 95 males per 100 females). The sex ratio is higher in rural than in urban areas (96 compared with 92 males per 100 females). The broad base of the population pyramid in Figure 2.1 shows the large number of children under age 15, which characterizes a population with high fertility. Children under age 15 account for more than half (52 percent) of the total population. 18 • Housing Characteristics and Household Population Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Uganda 2011 Age Urban Rural Total Male Female Total Male Female Total Male Female Total <5 17.1 16.1 16.6 19.9 19.0 19.4 19.5 18.5 19.0 5-9 14.6 12.4 13.4 18.7 17.7 18.2 18.1 16.9 17.5 10-14 10.7 11.2 11.0 16.8 15.1 15.9 15.9 14.6 15.2 15-19 9.8 12.0 11.0 10.5 9.4 10.0 10.4 9.8 10.1 20-24 11.2 13.1 12.2 5.3 6.7 6.1 6.2 7.7 7.0 25-29 11.1 11.5 11.3 5.7 6.8 6.2 6.5 7.5 7.0 30-34 6.8 7.1 7.0 4.7 4.8 4.8 5.0 5.1 5.1 35-39 7.1 5.3 6.2 4.3 4.6 4.5 4.7 4.7 4.7 40-44 3.4 3.1 3.3 3.4 3.4 3.4 3.4 3.4 3.4 45-49 2.7 2.1 2.4 2.7 2.9 2.8 2.7 2.8 2.7 50-54 2.1 2.2 2.2 2.2 2.5 2.4 2.2 2.5 2.3 55-59 1.3 1.3 1.3 1.5 1.8 1.6 1.5 1.7 1.6 60-64 0.9 0.9 0.9 1.2 1.5 1.4 1.2 1.4 1.3 65-69 0.4 0.5 0.5 1.0 1.2 1.1 0.9 1.1 1.0 70-74 0.4 0.4 0.4 0.8 0.9 0.9 0.7 0.8 0.8 75-79 0.2 0.2 0.2 0.6 0.6 0.6 0.5 0.6 0.5 80 + 0.3 0.5 0.4 0.7 1.0 0.8 0.6 0.9 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,058 3,325 6,383 18,166 18,960 37,125 21,223 22,285 43,508 Figure 2.1 Population pyramid UDHS 2011 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 Male Female Percentage Housing Characteristics and Household Population • 19 2.4 HOUSEHOLD COMPOSITION Table 2.8 shows that three in ten households are headed by women, the same proportion as in the 2006 UDHS. This is consistent between rural and urban residence. The average household size is 4.9 persons, which is slightly less than the average of 5.0 persons per household reported in 2006. The average household size is smaller in urban areas than in rural areas (3.8 compared with 5.1 persons). The average household size in urban areas declined from 4.1 in 2006 to 3.8 in 2011, while it remained the same in rural areas over the same time period. Single-person households are more common in urban areas (19 percent) than in rural areas (10 percent). In fact, more than half of the urban households have three or fewer household members. On the other hand, 56 percent of rural households have five or more members. All persons below age 18 are defined as children. The 2011 UDHS collected information on the presence of foster children and orphans in households. Foster children are 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 neglected or exploited if no parent is present. Close to one third of households have foster children; rural households are more likely to have foster children than urban households (30 percent and 24 percent, respectively). Eighteen percent of households have orphans. There are more households with a single orphan (14 percent) than double orphans (4 percent). There is little difference between rural and urban areas in the distribution of orphans. 2.5 BIRTH REGISTRATION Registration of births ought to be universally practised. It is a human right for a child to know who its parents are and to acquire a nationality through registration. The registration system in Uganda aims to ensure that all children are registered. A collaborative effort involving UNICEF, the Ministry of Justice and Constitutional Affairs, Plan International, and UBOS, among others, is spearheading the exercise in over 54 districts in Uganda. Apart from being the first legal acknowledgment of a child’s existence, the registration of births is fundamental to the realisation of a number of rights and practical needs, including but not limited to provision of access to health care and immunisation, education, and other social services. Table 2.9 shows that three in ten children are registered in Uganda. This represents an increase of 9 percentage points from the 2006 UDHS (21 percent). Children age 2-4 are more likely to be registered than children below age 2 (32 percent and 26 percent, respectively). Similarly, children in urban areas are more likely to be registered than children in rural areas (38 percent compared with 29 percent). Registration coverage is highest in Kampala (45 percent), Central 1 (42 percent), and Western (36 percent) regions. On the other hand, Karamoja and Southwest regions have the lowest coverage. The highest Table 2.8 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 age 18, according to residence, Uganda 2011 Characteristic Residence Total Urban Rural Household headship Male 69.0 70.8 70.5 Female 31.0 29.2 29.5 Total 100.0 100.0 100.0 Number of usual members 0 0.1 0.1 0.1 1 19.0 9.7 11.5 2 16.1 8.4 9.8 3 17.7 12.3 13.3 4 13.6 13.7 13.7 5 11.7 13.5 13.2 6 7.9 13.1 12.1 7 5.1 9.9 9.0 8 3.5 7.6 6.8 9+ 5.2 11.7 10.5 Total 100.0 100.0 100.0 Mean size of households 3.8 5.1 4.9 Percentage of households with orphans and foster children under 18 years of age Foster children1 23.8 29.7 28.6 Double orphans 2.9 3.8 3.6 Single orphans2 10.3 14.8 14.0 Foster and/or orphan children 26.2 34.4 32.9 Number of households 1,691 7,342 9,033 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent. 20 • Housing Characteristics and Household Population proportion of registered births is found in the highest wealth quintile (44 percent) whereas the lowest percentage is found in the second lowest quintile (26 percent). Table 2.9 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, Uganda 2011 Background characteristic Children whose births are registered Number of children Percentage who had a birth certificate Percentage who did not have birth certificate Percentage registered Age <2 15.3 11.0 26.3 3,301 2-4 19.2 13.0 32.2 5,060 Sex Male 17.3 12.6 29.9 4,182 Female 18.0 11.9 29.9 4,179 Residence Urban 25.5 12.5 38.0 1,068 Rural 16.5 12.2 28.7 7,293 Region Kampala 27.5 17.0 44.5 440 Central 1 22.6 19.8 42.3 866 Central 2 25.5 7.7 33.3 873 East Central 21.9 4.6 26.4 924 Eastern 16.2 16.6 32.8 1,390 Karamoja 7.9 3.2 11.1 314 North 18.7 13.1 31.8 749 West Nile 9.3 8.6 17.8 530 Western 16.1 19.3 35.5 1,230 Southwest 9.3 4.1 13.5 1,047 Wealth quintile Lowest 14.1 13.1 27.2 1,864 Second 14.9 10.8 25.7 1,790 Middle 15.8 11.1 26.9 1,726 Fourth 19.6 8.2 27.8 1,513 Highest 25.7 18.3 44.0 1,467 Total 17.7 12.2 29.9 8,361 2.6 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Table 2.10 presents data on children’s living arrangements and orphanhood in Uganda. Fifty- five percent of children under age 18 live with both parents; 20 percent live with their mothers but not their father (whether alive or dead); 5 percent live with their fathers but not with mother (whether alive or dead); and 19 percent live with neither of their natural parents. The proportion of children living with both parents decreases with age. Although 72 percent of children under age 2 live with both parents, by age 10-14 only 46 percent of children live with their father and mother. The proportion of children living with both parents varies little by the child’s sex. Rural children are more likely to live with both parents than urban children (56 percent versus 49 percent). Regions with the highest proportion of children living with both parents are Eastern (63 percent), North (62 percent) and Southwest (61 percent), while the region with the lowest is Karamoja (49 percent). In general, the percentage of children living with both parents tends to decrease with an increase in household wealth. Housing Characteristics and Household Population • 21 Table 2.10 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, Uganda 2011 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 Total Percent- age not living with a biolo- gical parent Percent- age 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 Missing informa- tion on father/ mother Age 0-4 68.0 18.4 2.2 1.7 0.1 7.8 0.4 0.6 0.3 0.4 100.0 9.1 3.7 8,361 <2 72.2 21.7 1.9 0.7 0.0 2.8 0.1 0.1 0.2 0.3 100.0 3.2 2.4 3,301 2-4 65.2 16.3 2.4 2.4 0.2 11.0 0.7 1.0 0.4 0.4 100.0 13.0 4.6 5,060 5-9 55.7 15.2 4.1 4.8 0.7 13.3 1.6 2.6 1.4 0.7 100.0 18.9 10.4 7,688 10-14 45.5 13.9 6.4 6.6 1.6 15.6 2.3 4.2 3.2 0.7 100.0 25.3 17.9 6,659 15-17 39.7 13.2 8.6 6.0 1.9 17.9 2.5 4.8 4.4 0.9 100.0 29.7 22.4 2,875 Sex Male 56.2 15.4 4.4 5.1 0.9 11.6 1.5 2.4 1.9 0.6 100.0 17.4 11.2 12,947 Female 54.2 16.1 4.9 3.6 0.8 13.7 1.6 2.9 1.7 0.6 100.0 19.8 11.9 12,636 Residence Urban 48.9 18.9 3.3 5.1 0.6 15.1 1.8 3.7 1.9 0.5 100.0 22.5 11.5 3,058 Rural 56.1 15.3 4.8 4.3 0.9 12.3 1.5 2.5 1.8 0.6 100.0 18.1 11.5 22,525 Region Kampala 50.5 19.0 3.5 5.2 0.9 13.7 1.7 3.5 1.3 0.7 100.0 20.2 11.0 1,106 Central 1 49.5 15.9 3.7 6.8 1.5 16.5 1.6 2.6 1.3 0.6 100.0 21.9 10.8 2,722 Central 2 52.6 14.2 3.3 5.6 0.4 17.0 1.6 3.0 1.9 0.4 100.0 23.5 10.3 2,696 East Central 52.6 17.9 3.2 4.7 0.7 15.3 1.5 2.1 1.5 0.6 100.0 20.4 9.1 2,890 Eastern 62.5 12.4 3.8 4.4 1.1 10.5 1.1 2.4 1.2 0.6 100.0 15.2 9.8 4,086 Karamoja 48.9 23.6 6.8 1.2 1.6 7.5 2.6 2.7 4.9 0.1 100.0 17.7 18.7 999 North 61.5 9.0 6.9 3.1 1.1 8.8 1.2 3.8 4.0 0.6 100.0 17.8 17.1 2,476 West Nile 55.3 13.6 4.0 6.2 0.6 14.0 0.9 4.0 0.8 0.4 100.0 19.8 10.5 1,607 Western 49.5 21.4 6.0 4.8 0.5 11.0 2.4 2.1 1.6 0.8 100.0 17.0 12.5 3,822 Southwest 61.3 14.8 5.3 1.3 0.6 11.3 1.2 1.6 1.8 0.8 100.0 15.8 10.6 3,179 Wealth quintile Lowest 56.3 16.0 7.8 3.1 1.0 8.9 1.2 2.4 2.6 0.9 100.0 15.0 15.0 5,449 Second 58.4 14.3 4.9 3.9 0.5 11.3 2.1 2.3 1.7 0.5 100.0 17.4 11.6 5,291 Middle 56.5 15.3 4.5 4.4 0.8 12.0 1.5 2.7 1.6 0.7 100.0 17.8 11.1 5,287 Fourth 53.4 15.6 3.0 5.5 1.4 15.4 1.3 2.6 1.5 0.4 100.0 20.8 9.8 5,197 Highest 50.8 17.6 2.3 5.3 0.7 16.3 1.4 3.3 1.8 0.5 100.0 22.8 9.6 4,359 Total <15 57.2 16.0 4.1 4.2 0.7 11.9 1.4 2.3 1.5 0.6 100.0 17.2 10.1 22,707 Total <18 55.2 15.7 4.6 4.4 0.9 12.6 1.5 2.6 1.8 0.6 100.0 18.6 11.5 25,583 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. 2.7 EDUCATION LEVEL OF THE HOUSEHOLD POPULATION Education is a key determinant of an individual’s stock of human capital. Studies have consistently shown that educational attainment strongly affects reproductive behaviour, fertility, infant and child morbidity and mortality, and attitudes and awareness related to family health, use of family planning, and sanitation. The 2011 UDHS collected information on educational attainment of all persons age 3 and older in the selected households. 2.7.1 School Attendance by Survivorship of Parents The survival status of parents has an impact on their children’s school attendance. Table 2.11 shows the percentage of children age 10-14 attending school, by parental survival status (deceased or alive), and the ratio of the percentage attending with both parents deceased to the percentage attending with both parents alive, according to background characteristics. Data show that double orphaned children are less likely to attend school (84 percent) than children who have both parents alive and live with at least one parent (96 percent), resulting in a school attendance ratio of 0.87 between the percentage of children with both parents deceased and the percentage of children with both parents alive and living with a parent. 22 • Housing Characteristics and Household Population Male children with both parents deceased are much less likely than female children in the same situation to attend school (80 percent versus 88 percent). Table 2.11 School attendance by survivorship of parents For de jure children 10-14 years of age, the percentage attending school, by parental survival and the ratio of the percentage attending, by parental survival, according to background characteristics, Uganda 2011 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 80.0 117 96.0 2,290 0.83 Female 87.7 97 95.1 2,101 0.92 Residence Urban (83.8) 22 97.9 419 (0.86) Rural 83.4 192 95.4 3,972 0.87 Region Kampala * 5 97.6 123 0.68 Central 1 * 18 98.2 456 0.86 Central 2 (91.0) 28 97.5 447 0.93 East Central * 18 97.5 511 0.96 Eastern * 21 97.3 742 0.86 Karamoja 49.4 25 60.3 166 0.82 North (93.4) 33 96.9 417 0.96 West Nile * 9 92.1 279 0.78 Western (100.0) 29 96.7 693 1.03 Southwest * 29 97.3 558 0.79 Wealth quintile Lowest 73.1 61 87.4 889 0.84 Second (81.6) 52 95.6 915 0.85 Middle (91.0) 31 97.6 930 0.93 Fourth (90.9) 32 98.9 1,016 0.92 Highest (90.2) 38 98.8 643 0.91 Total 83.5 214 95.6 4,392 0.87 Note: Table is based only on children who usually live in the household. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Ratio of the percentage attending with both parents deceased to the percentage attending with both parents alive and living with at least one parent 2.7.2 Educational Attainment Tables 2.12.1 and 2.12.2 show the percent distribution of the de facto female and male household population age 6 and older by the highest level of education attended or completed, according to background characteristics. The majority of Ugandans have either no formal education or only some primary education. One in five females (20 percent) and 13 percent of males age 6 and older have never had any formal education. Fifty-eight percent of females and 59 percent of males have attained some primary education only, and 7 percent each of females and males have completed primary education, but not continued. A slightly higher percentage of both females (12 percent) and males (14 percent) have attended but did not complete secondary education. Only 4 percent of females and 6 percent of males have completed secondary or higher education. The trends in educational attainment by successive age groups indicate that, despite free universal primary education, 33 percent of girls and 34 percent of boys age 6-9 have never attended school. Studies have attributed the poor school attendance to long distances to and from schools, costs of education beyond tuition, and the fact that children below age 8 are still considered too young to start school by some sections of society in Uganda (UBOS, 2010). The proportion of females and males with no education increases with increasing age. For example, 12 percent of women age 25-29 have never attended school compared with 59 percent of women age 60-64. Housing Characteristics and Household Population • 23 As expected, educational attainment is much higher among the urban population than among the rural population. For example, in urban areas only 8 percent of females and 7 percent of males have no education, compared with 22 percent of females and 14 percent of males in rural areas. At the regional level, Karamoja has the highest proportion of females and males with no education in Uganda. The highest percentage of females and males who have completed secondary or higher education live in Kampala, Central 1 and Central 2 regions and, among men, North region. The most substantial variation in educational attainment occurs across the wealth quintiles. Only 7 to 8 percent of females and males in the wealthiest households have no education, compared with 34 percent of females and 20 percent of males in the poorest households. Table 2.12.1 Educational attainment of the female household population Percent distribution of the de facto female household population age six and over by highest level of schooling attended or completed and median years completed according to background characteristics, Uganda 2011 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 32.6 67.4 0.0 0.0 0.0 0.0 0.0 100.0 3,069 0.0 10-14 4.3 92.8 0.9 2.0 0.0 0.0 0.0 100.0 3,243 2.5 15-19 3.3 56.8 9.0 29.0 0.5 1.4 0.1 100.0 2,191 5.4 20-24 5.6 40.8 13.5 28.7 3.7 7.6 0.1 100.0 1,711 6.2 25-29 11.6 43.9 12.2 21.5 1.2 9.5 0.1 100.0 1,663 5.5 30-34 17.6 48.9 10.6 14.1 1.0 7.7 0.0 100.0 1,145 4.1 35-39 21.8 50.8 9.6 11.1 0.9 5.7 0.0 100.0 1,056 3.4 40-44 27.3 45.7 11.3 12.2 0.7 2.7 0.1 100.0 753 3.2 45-49 30.7 46.1 13.0 5.5 0.4 4.2 0.1 100.0 620 2.6 50-54 42.1 36.8 8.9 7.4 1.9 2.6 0.4 100.0 553 1.4 55-59 47.9 36.6 6.9 5.4 0.4 2.1 0.8 100.0 381 0.0 60-64 59.4 29.2 2.0 5.5 0.0 3.1 0.8 100.0 319 0.0 65+ 72.0 23.3 0.8 1.8 0.1 0.9 1.1 100.0 749 0.0 Residence Urban 8.2 40.9 8.3 27.0 3.2 12.2 0.1 100.0 2,719 6.1 Rural 22.0 60.9 6.2 8.9 0.3 1.5 0.1 100.0 14,739 2.3 Region Kampala 5.3 33.0 9.3 30.0 4.4 17.9 0.1 100.0 1,202 7.1 Central 1 16.0 53.6 9.1 15.4 1.7 4.0 0.1 100.0 1,908 3.8 Central 2 16.8 54.8 8.8 16.4 0.7 2.1 0.3 100.0 1,829 3.5 East Central 17.6 60.0 6.4 13.4 0.5 2.1 0.1 100.0 1,843 3.0 Eastern 14.8 68.4 6.0 8.8 0.4 1.5 0.1 100.0 2,620 2.6 Karamoja 58.1 36.3 1.4 3.1 0.3 0.8 0.0 100.0 677 0.0 North 22.7 66.3 4.6 4.9 0.3 1.1 0.2 100.0 1,583 2.2 West Nile 24.8 64.1 4.6 4.8 0.1 1.2 0.4 100.0 1,047 1.6 Western 21.4 59.8 5.1 11.1 0.2 2.4 0.0 100.0 2,476 2.6 Southwest 23.8 58.2 7.0 8.7 0.3 2.1 0.0 100.0 2,273 2.1 Wealth quintile Lowest 34.0 60.4 3.2 2.2 0.1 0.1 0.2 100.0 3,462 0.7 Second 24.4 64.1 5.4 5.6 0.1 0.3 0.0 100.0 3,309 1.9 Middle 18.8 65.0 7.1 8.0 0.3 0.7 0.0 100.0 3,440 2.5 Fourth 15.7 59.5 7.9 14.9 0.3 1.4 0.3 100.0 3,511 3.4 Highest 7.7 41.5 8.8 26.5 2.9 12.5 0.1 100.0 3,736 6.1 Total 19.9 57.8 6.5 11.7 0.8 3.2 0.1 100.0 17,458 2.7 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level 24 • Housing Characteristics and Household Population Table 2.12.2 Educational attainment of the male household population Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Uganda 2011 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 33.6 66.4 0.0 0.0 0.0 0.0 0.0 100.0 3,049 0.0 10-14 3.6 94.4 0.6 1.4 0.0 0.0 0.1 100.0 3,373 2.2 15-19 2.8 65.1 5.8 24.7 0.6 1.0 0.1 100.0 2,203 5.0 20-24 4.7 36.1 11.6 32.7 4.9 9.2 0.7 100.0 1,315 6.7 25-29 4.3 33.9 15.8 28.2 4.8 12.4 0.5 100.0 1,370 6.7 30-34 7.7 36.9 15.0 24.8 2.9 11.4 1.2 100.0 1,069 6.3 35-39 9.0 42.6 12.6 21.6 3.7 9.0 1.3 100.0 994 5.8 40-44 11.4 40.1 15.7 20.4 2.2 8.9 1.4 100.0 724 5.8 45-49 13.2 40.0 14.5 17.0 2.5 12.2 0.6 100.0 576 5.6 50-54 14.7 42.7 16.5 15.1 1.1 9.0 1.0 100.0 459 5.2 55-59 12.3 42.4 17.5 15.6 1.0 10.7 0.4 100.0 309 5.5 60-64 17.9 42.2 16.0 12.3 1.9 8.1 1.6 100.0 252 4.9 65+ 37.2 46.1 3.9 6.4 0.6 4.7 0.9 100.0 594 1.8 Residence Urban 6.6 37.3 6.8 26.6 6.1 15.8 0.7 100.0 2,442 6.7 Rural 13.5 63.0 7.4 12.1 0.8 2.9 0.4 100.0 13,851 3.1 Region Kampala 4.1 28.1 6.2 30.5 8.4 21.7 1.0 100.0 1,045 9.0 Central 1 15.5 53.9 7.3 16.6 1.5 4.3 1.0 100.0 1,852 3.5 Central 2 12.8 56.1 8.2 16.0 2.2 3.3 1.4 100.0 1,725 3.7 East Central 12.3 61.3 5.9 16.0 1.1 2.9 0.6 100.0 1,708 3.3 Eastern 8.7 68.0 6.7 12.8 0.5 3.2 0.1 100.0 2,451 3.4 Karamoja 45.3 37.2 5.8 8.2 1.2 2.4 0.0 100.0 522 0.0 North 9.3 64.9 9.8 9.9 0.7 5.3 0.2 100.0 1,535 3.7 West Nile 9.9 65.1 8.5 11.3 1.1 3.9 0.3 100.0 1,022 3.3 Western 11.7 63.3 7.0 13.7 0.7 3.3 0.3 100.0 2,419 3.3 Southwest 14.5 63.1 7.5 9.6 1.4 4.0 0.0 100.0 2,013 2.6 Wealth quintile Lowest 20.3 67.3 5.4 5.8 0.0 1.0 0.2 100.0 3,032 2.0 Second 13.1 66.8 8.3 9.3 0.6 1.7 0.2 100.0 3,246 2.9 Middle 12.3 64.5 8.3 12.2 0.5 1.9 0.3 100.0 3,245 3.2 Fourth 10.8 59.5 7.4 17.1 1.2 3.4 0.6 100.0 3,449 3.8 Highest 6.6 38.4 7.1 25.9 5.4 15.7 1.0 100.0 3,321 6.5 Total 12.5 59.1 7.3 14.2 1.6 4.8 0.5 100.0 16,293 3.4 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level 2.7.3 School Attendance Ratios Uganda’s educational system is a three-tier system that consists of seven years of primary education, followed by six years of secondary education (four years of ordinary secondary and two years of advanced secondary), and at least three years of university/tertiary education. The official age ranges for these levels are 6-12 years for primary education, 13-18 years for secondary education, and age 19-24 for university/tertiary education. The official age range for pre-primary education is 3-5 years. Table 2.13 shows data on net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by school level and sex, according to residence, region, and wealth index. The NAR for pre-primary school is the percentage of the pre-primary-school-age population (3-5 years) that attends pre-primary school; the NAR for primary school is the percentage of the primary-school-age population (6-12 years) that attends primary school; and the NAR for secondary school is the percentage of the population of secondary school age (13-18 years) that attends secondary school. The GAR for pre-primary school is the total number of pre-primary school students of any age, expressed as a percentage of the official pre-primary-school-age population (3-5 years); the GAR for primary school is the total number of primary school students of any age, expressed as a percentage of the official primary-school-age population (6-12 years); and the GAR for secondary school is the total number of secondary school students of any age, expressed as a percentage of the official secondary-school-age population (13-18 years). If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. Persons are considered to be currently attending school if they attended formal academic school at any point during the school year. Housing Characteristics and Household Population • 25 Table 2.13 shows that 23 and 24 percent, each, of male and female children of pre-primary school age in Uganda attend pre-primary school. Further, 81 percent each of male and female children of primary school age in Uganda attend primary school. At the same time, only 17 percent of secondary-school age population attend secondary school (16 percent of males and 18 percent of females). At the pre-primary school level, the NAR is substantially lower in rural areas (20 percent) than in urban areas (53 percent). West Nile region has the lowest NAR at the pre-primary school level (5 percent) and Kampala has the highest NAR for pre-primary school (62 percent). The NAR at the pre-primary education level increases from just 7 percent in the lowest wealth quintile to 53 percent in the highest wealth quintile. The pre-primary education GAR is almost the same among males and females (41 and 42 percent, respectively). Similar to the NAR, the GAR for pre-primary education level is higher in urban than rural areas (75 percent versus 37 percent). It is lowest in West Nile (7 percent) and highest in Kampala (82 percent), and it increases from 15 percent in the lowest wealth quintile to 75 percent in the highest wealth quintile. The Gender Parity Index (GPI) measures sex-related differences in school attendance ratios regardless of age. It is the ratio of female-to-male attendance. A GPI of 1 indicates parity, or equality, between the school participation ratios for males and females. A GPI of less than 1 indicates a gender disparity in favour of males. That is, a higher proportion of males than females attend that level of schooling. A GPI that is higher than 1 indicates a gender disparity in favour of females. The GPI for pre- primary school level is 1.02, indicating that there is no gender gap. At the primary level, the GAR is higher among males (124 percent) than among females (119 percent). The same pattern is observed at the secondary level (25 and 22 percent, respectively). The overall GAR of 121 percent shows that there are many overage students attending primary schools, and this applies to pupils in both rural and urban areas. There is a strong relationship between household economic status and schooling at both the primary and secondary levels and among males and females. For example, at the primary education level, the NAR increases from 73 percent in the lowest wealth quintile to 87 percent in the highest wealth quintile. Similarly, at the secondary level the NAR rises from 4 percent in the lowest wealth quintile to 33 percent in the highest wealth quintile. The GPI for primary school level is 0.96, indicating that there is almost no gender gap. At the secondary level, the gender difference is slightly larger (0.89). The disparity in attendance between females and males at primary education is minimal in all regions except in West Nile (0.85) and Karamoja (0.88). However, at secondary school level, the variation widens in the North (0.57), West Nile (0.59), and Kampala (0.57) regions. 26 • Housing Characteristics and Household Population Table 2.13 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, Uganda 2011 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRE-PRIMARY SCHOOL Residence Urban 50.0 55.7 52.8 1.11 72.2 77.0 74.6 1.07 Rural 18.9 20.2 19.5 1.07 37.1 37.0 37.1 1.00 Region Kampala 61.1 62.3 61.7 1.02 79.5 83.4 81.5 1.05 Central 1 31.9 39.6 35.8 1.24 50.4 53.7 52.1 1.07 Central 2 34.3 35.2 34.8 1.03 66.1 69.6 67.8 1.05 East Central 14.7 21.2 17.9 1.44 31.2 34.7 33.0 1.11 Eastern 11.1 14.8 13.0 1.33 23.1 22.3 22.7 0.97 Karamoja 4.4 7.4 6.0 1.66 10.8 15.9 13.5 1.47 North 11.8 10.4 11.2 0.88 18.6 17.9 18.3 0.96 West-Nile 5.4 4.2 4.8 0.79 6.6 6.8 6.7 1.03 Western 24.7 27.8 26.1 1.13 46.4 54.9 50.2 1.18 Southwest 33.0 27.0 30.0 0.82 70.6 56.5 63.4 0.80 Wealth quintile Lowest 5.9 7.6 6.7 1.28 12.5 17.1 14.8 1.37 Second 15.2 15.3 15.3 1.01 32.2 32.6 32.4 1.01 Middle 23.1 20.1 21.6 0.87 44.4 37.4 40.9 0.84 Fourth 26.0 30.4 28.2 1.17 55.2 52.9 54.1 0.96 Highest 50.1 56.3 53.2 1.12 72.0 78.6 75.3 1.09 Total 22.5 24.4 23.4 1.08 41.1 41.7 41.4 1.02 PRIMARY SCHOOL Residence Urban 85.3 84.6 85.0 0.99 114.4 118.1 116.2 1.03 Rural 80.6 80.6 80.6 1.00 125.2 118.7 122.0 0.95 Region Kampala 86.6 83.3 84.9 0.96 107.1 103.3 105.1 0.96 Central 1 85.5 89.2 87.3 1.04 121.7 121.5 121.6 1.00 Central 2 79.0 80.2 79.6 1.01 118.9 116.7 117.8 0.98 East Central 84.0 85.0 84.5 1.01 127.8 123.8 125.9 0.97 Eastern 86.3 89.3 87.7 1.03 136.3 128.6 132.5 0.94 Karamoja 53.9 49.3 51.4 0.91 76.9 67.8 71.9 0.88 North 80.1 77.9 79.0 0.97 131.8 125.5 128.8 0.95 West Nile 81.2 76.7 78.9 0.95 132.8 112.9 122.9 0.85 Western 80.5 78.9 79.7 0.98 124.7 122.4 123.6 0.98 Southwest 78.1 79.2 78.6 1.01 119.8 118.1 118.9 0.99 Wealth quintile Lowest 75.0 71.4 73.2 0.95 114.6 101.0 107.8 0.88 Second 79.6 79.3 79.5 1.00 128.0 118.3 123.3 0.92 Middle 82.6 84.9 83.7 1.03 129.7 125.1 127.4 0.96 Fourth 82.8 85.5 84.1 1.03 129.3 129.1 129.2 1.00 Highest 87.1 85.9 86.5 0.99 117.6 122.4 120.0 1.04 Total 81.1 81.0 81.0 1.00 124.1 118.6 121.4 0.96 SECONDARY SCHOOL Residence Urban 39.7 31.0 34.7 0.78 54.9 36.0 44.0 0.66 Rural 12.6 15.5 14.0 1.23 20.5 19.2 19.9 0.93 Region Kampala 48.6 34.4 39.8 0.71 64.5 36.7 47.4 0.57 Central 1 16.6 30.5 23.7 1.84 26.4 34.6 30.6 1.31 Central 2 19.6 25.2 22.4 1.29 28.1 28.3 28.2 1.01 East Central 19.4 20.7 20.0 1.07 30.6 26.6 28.7 0.87 Eastern 13.4 14.2 13.8 1.06 24.7 17.8 21.4 0.72 Karamoja 7.2 7.5 7.4 1.05 8.1 7.7 7.9 0.95 North 5.8 3.7 4.8 0.64 10.9 6.2 8.6 0.57 West Nile 11.5 7.6 9.7 0.66 20.9 12.3 16.9 0.59 Western 15.7 15.2 15.5 0.96 23.2 18.3 20.8 0.79 Southwest 13.1 16.8 14.9 1.28 19.2 23.6 21.3 1.23 Wealth quintile Lowest 4.7 3.9 4.3 0.81 7.8 4.5 6.2 0.58 Second 8.7 10.6 9.6 1.23 15.8 13.4 14.7 0.85 Middle 11.8 11.5 11.6 0.97 20.2 15.6 18.0 0.78 Fourth 20.0 25.9 23.0 1.30 31.6 31.3 31.5 0.99 Highest 35.1 31.5 33.1 0.90 48.2 37.0 41.8 0.77 Total 15.8 18.0 16.9 1.14 24.6 21.9 23.3 0.89 -1 The NAR for pre-primary school is the percentage of the pre-primary-school-age (3-5 years) population that is attending primary school. The NAR for primary school is the percentage of the primary-school-age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 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. Housing Characteristics and Household Population • 27 Figure 2.2 shows the age-specific attendance rates (ASARs) for the population age 5-24 at primary, secondary, or tertiary/university level in the 2011 school year. In Uganda, the minimum age for schooling is age 6. However, some children start school at age 5. Over 80 percent of boys and girls age 8- 15 attend school. There are some differences in the proportion of males and females attending school. The difference is obvious at age 16 and older, when the proportion of adolescent males attending school is higher than that of adolescent females. Figure 2.2 Age-specific attendance rates of the de facto population age 5-24 UDHS 2011 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 10 20 30 40 50 60 70 80 90 100 Percentage Male Female 2.8 DISABILITY Persons with disabilities are considered vulnerable in Uganda. They are disadvantaged in work places and in other public places. The government of Uganda has developed a National Disability Policy to promote effective service delivery to persons with disabilities. Recently, the Expanding Social Protection Programme (ESP) was developed primarily to incorporate a national social protection system, including direct income support for the poorest and most vulnerable people, a population that includes those with disabilities. In the 2011 UDHS, information was collected on each household member age 5 and older about whether he or she had difficulties with seeing, hearing, communicating, walking or climbing stairs, remembering or concentrating, or performing self-care. Table 2.14 shows that 19 percent of persons age 5 and over have some form of disability. The prevalence of disability increases with age, from 12 percent among children age 5-9 to 67 percent among those age 60 and above. The prevalence of disability is about 12 to 13 percent among persons age 5-29, and starts to rise after age 30. The prevalence increases significantly, from 19 percent among persons age 30-39, to 31 percent at age 40-49, and to 49 percent at age 50-59. Difficulties in seeing and walking or climbing stairs are the most common types of disabilities reported during the survey. 28 • Housing Characteristics and Household Population Table 2.14 Disability by functional area and age Percent distribution of de facto household population age five and over by the degree of difficulty according to the functional area, and percent distribution by the highest degree of difficulty in at least one functional area by age, Uganda 2011 Functional area and age Degree of difficulty Some difficulty, a lot of difficulty, or can't do at all Number of individuals Can't do at all A lot of difficulty Some difficulty No difficulty Don't know/ missing Total Functional area Difficulty seeing 0.1 1.6 7.7 90.5 0.1 100.0 9.4 35,226 Difficulty hearing 0.1 0.8 4.5 94.5 0.1 100.0 5.4 35,226 Difficulty walking or climbing stairs 0.1 1.7 5.4 92.6 0.1 100.0 7.2 35,226 Difficulty remembering or concentrating 0.1 1.3 4.8 93.6 0.1 100.0 6.2 35,226 Difficulty with self-care 0.3 0.4 1.6 97.6 0.1 100.0 2.3 35,226 Difficulty communicating 0.1 0.3 1.0 98.4 0.1 100.0 1.5 35,226 Difficulty in at least one functional area 5-9 1.0 1.8 8.7 88.3 0.2 100.0 11.5 7,602 10-14 0.4 2.4 9.5 87.6 0.1 100.0 12.3 6,616 15-19 0.4 2.2 9.7 87.6 0.1 100.0 12.3 4,394 20-29 0.3 2.1 10.4 87.1 0.1 100.0 12.8 6,059 30-39 0.1 3.2 15.2 81.4 0.0 100.0 18.5 4,265 40-49 0.5 6.0 24.9 68.6 0.0 100.0 31.4 2,672 50-59 0.6 11.6 36.6 51.2 0.0 100.0 48.8 1,703 60+ 3.4 24.8 38.6 33.0 0.2 100.0 66.8 1,914 Total age 10 and over 0.6 4.9 15.8 78.7 0.1 100.0 21.3 27,624 Total age 15 and over 0.6 5.7 17.8 75.9 0.1 100.0 24.1 21,007 Total 0.7 4.2 14.3 80.8 0.1 100.0 19.2 35,226 Characteristics of Respondents • 29 CHARACTERISTICS OF RESPONDENTS 3 he purpose of this chapter is to create a demographic and socioeconomic profile of individual female and male respondents. This information helps to interpret findings presented later in the report and indicates the representativeness of the survey. The chapter begins by describing basic background characteristics, including age, marital status, religion, ethnicity, and wealth. It then provides more detailed information on education, media exposure, employment, health insurance, and tobacco use. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS The basic characteristics of the 8,674 women and 2,191 men age 15-49 interviewed in the 2011 UDHS are presented in Table 3.1. Relatively high proportions of both female and male respondents are in the younger age groups, with more than half of the respondents (61 percent of women and 57 percent of men) under age 30. In general, the proportion of women and men in each group declines as age increases, reflecting the comparatively young age structure of the population in Uganda, which results from previous high fertility levels. The majority of women and men are Catholic (41 percent and 44 percent), 30 percent of women and 32 percent of men are Protestant, and 13 percent of women and 12 percent of men are Muslim. In addition, 13 percent of women and 9 percent of men are Pentecostal, and 2 percent of each sex are Seventh-day Adventists (SDA). In general the percentages for various religions are consistent across males and females. More than one-fifth of women (24 percent) and more than one-third of men (38 percent) have never married. The majority of women (36 percent) and men (41 percent) are currently married, and 27 percent of women and 15 percent of men live together. Nine percent of women and 5 percent of men are divorced or separated. Four percent of women and very few men are widowed. Eight in ten respondents reside in rural areas. Across the ten regions, the Eastern and Western regions have the largest populations, while Karamoja has the smallest population for both men and women. T Key Findings  Thirteen percent of women and 4 percent of men age 15-49 have no education. However, the percentage of women and men with at least some secondary education has increased by 30 percent and 18 percent, respectively, in the past five years.  Twenty-one percent of women and 11 percent of men age 15-49 are not exposed to any source of mass media.  Less than 1 percent of women and 2 percent of men are covered by health insurance.  Sixty-nine percent of women were employed in the 12 months preceding the survey, with the majority (57 percent) employed in the agricultural sector.  Twenty-six percent of working women are not paid for their work, and 79 percent of women in nonagricultural work are paid by cash only. 30 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Uganda 2011 Background characteristic Women Men Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 23.6 2,048 2,026 25.5 554 562 20-24 18.8 1,629 1,666 14.6 318 340 25-29 18.1 1,569 1,618 16.6 361 365 30-34 12.5 1,086 1,101 14.9 323 310 35-39 11.8 1,026 992 12.3 268 284 40-44 8.4 729 709 8.8 191 179 45-49 6.8 587 562 7.2 157 151 Religion Catholic 40.6 3,524 3,731 43.8 952 994 Protestant 30.0 2,601 2,463 32.0 695 678 Muslim 13.0 1,124 1,173 12.4 269 287 Pentecostal 13.3 1,154 1,079 8.5 185 169 SDA 1.9 168 149 1.8 39 34 Marital status Never married 24.4 2,118 2,208 38.4 834 872 Married 35.6 3,087 3,071 41.4 899 878 Living together 26.9 2,331 2,281 15.1 329 326 Divorced/separated 9.3 805 790 4.7 103 107 Widowed 3.8 328 319 0.3 8 8 Residence Urban 19.8 1,717 2,562 20.2 439 614 Rural 80.2 6,957 6,112 79.8 1,734 1,577 Region Kampala 9.7 839 1,039 10.2 221 238 Central 1 11.0 956 767 9.6 209 178 Central 2 10.4 902 830 10.8 236 221 East Central 10.0 869 875 10.8 236 244 Eastern 14.6 1,267 943 13.3 289 234 Karamoja 3.3 289 659 2.5 55 116 North 8.5 735 823 9.2 199 222 West Nile 5.8 500 910 6.1 133 236 Western 14.1 1,221 919 14.8 322 280 Southwest 12.7 1,097 909 12.6 273 222 Education No education 12.9 1,120 1,332 4.1 90 112 Primary 59.4 5,152 4,820 60.2 1,309 1,250 Secondary+ 27.7 2,402 2,522 35.6 774 829 Wealth quintile Lowest 17.5 1,519 1,755 15.9 345 382 Second 18.2 1,579 1,433 19.5 423 400 Middle 18.5 1,608 1,404 18.5 402 361 Fourth 19.9 1,726 1,542 22.3 486 459 Highest 25.8 2,242 2,540 23.8 517 589 Total 15-49 100.0 8,674 8,674 100.0 2,173 2,191 50-54 na na na na 122 104 Total 15-54 na na na na 2,295 2,295 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable SDA = Seventh-day Adventist 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Education affects many aspects of life, including individual demographics and health behaviours. Studies have shown that educational level is strongly associated with contraceptive use, fertility, general health status, morbidity, and mortality of children. Tables 3.2.1 and 3.2.2 show the distribution of respondents by educational attainment, according to background characteristics. Table 3.2.1 shows that 13 percent of women age 15-49 have never been to school, 48 percent have only some primary education, 11 percent have completed only primary school, and 21 percent have some secondary education. One percent of women stopped after completing secondary Characteristics of Respondents • 31 school, and 5 percent have higher than secondary education. Older women and those who reside in rural areas are most likely to have no education. The advantage of urban residents over rural residents in education is pronounced for those who have completed secondary school. For example, women in urban areas are much more likely than those in rural areas to have completed secondary or more than secondary education (20 percent and 3 percent, respectively). Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median grade completed, according to background characteristics, Uganda 2011 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 3.8 48.7 11.7 29.7 1.7 4.4 100.0 5.9 3,677 15-19 2.9 54.1 10.7 30.2 0.6 1.5 100.0 5.6 2,048 20-24 4.9 41.8 12.9 29.2 3.2 8.0 100.0 6.2 1,629 25-29 11.2 45.4 12.2 21.5 1.4 8.4 100.0 5.5 1,569 30-34 16.9 49.6 10.5 15.1 1.3 6.4 100.0 4.0 1,086 35-39 22.6 51.4 9.0 11.6 0.5 4.9 100.0 3.3 1,026 40-44 27.3 46.6 10.3 12.4 0.5 2.8 100.0 3.2 729 45-49 32.3 45.2 13.1 5.7 0.1 3.5 100.0 2.5 587 Residence Urban 3.5 26.5 11.1 38.7 4.1 16.1 100.0 8.0 1,717 Rural 15.2 53.4 11.3 16.9 0.6 2.5 100.0 4.6 6,957 Region Kampala 1.4 22.5 12.0 39.0 4.6 20.6 100.0 8.7 839 Central 1 9.2 39.3 15.0 28.2 2.4 5.9 100.0 6.1 956 Central 2 8.9 41.7 15.5 28.7 1.3 3.9 100.0 6.0 902 East Central 9.0 50.3 10.7 25.1 0.9 4.0 100.0 5.4 869 Eastern 9.1 60.6 10.6 16.5 0.6 2.6 100.0 4.6 1,267 Karamoja 57.9 29.8 2.5 7.4 0.7 1.7 100.0 0.0 289 North 15.7 64.4 8.3 9.2 0.5 1.9 100.0 4.0 735 West Nile 19.3 61.7 8.1 8.5 0.3 2.1 100.0 3.6 500 Western 16.0 48.8 9.7 20.8 0.7 4.0 100.0 5.0 1,221 Southwest 15.7 51.3 13.0 15.4 0.6 3.9 100.0 4.4 1,097 Wealth quintile Lowest 29.5 59.9 6.0 4.4 0.1 0.1 100.0 2.5 1,519 Second 17.3 61.8 9.6 10.5 0.2 0.5 100.0 4.0 1,579 Middle 11.4 57.7 13.5 15.6 0.9 0.9 100.0 4.8 1,608 Fourth 9.1 46.5 13.8 27.7 0.6 2.4 100.0 5.6 1,726 Highest 2.7 24.7 12.6 39.1 3.7 17.2 100.0 8.1 2,242 Total 12.9 48.1 11.3 21.2 1.3 5.2 100.0 5.2 8,674 1 Completed grade 7 at the primary level 2 Completed grade 6 at the secondary level Women in the Kampala, Central 1, Central 2, East Central, Western, and Southwest regions are more likely than those in the other regions to have more than a secondary level education (4 percent or higher), while more than half of the women in the Karamoja region have no education at all. The respondent’s educational attainment relates directly to her or his economic status. An examination of education by wealth quintile indicates that 30 percent of women from the poorest households have never attended school, compared with 3 percent of those from the wealthiest households. Women in the highest wealth quintile are most likely to have a secondary education or higher. For example, 21 percent of women in the highest wealth quintile have completed secondary school or have more than a secondary education compared with less than 1 percent of women in the lowest wealth quintile. At the national level, women have completed a median of 5.2 years of school. The median for urban women is 8.0 years, which compares with 4.6 years for rural women. The median number of years of schooling completed is highest among women in Kampala (8.7) and lowest among women in the Karamoja region (0.0). There is a large difference in median number of years completed by wealth quintile (8.1 in the highest quintile versus 2.5 in the lowest quintile). 32 • 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 grade completed, according to background characteristics, Uganda 2011 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 1.5 53.8 7.7 29.5 2.5 4.9 100.0 5.7 872 15-19 1.0 62.4 5.8 27.8 1.1 1.8 100.0 5.2 554 20-24 2.4 39.0 11.0 32.4 5.0 10.3 100.0 6.8 318 25-29 3.0 41.9 13.9 25.0 3.5 12.7 100.0 6.3 361 30-34 4.5 46.9 11.2 23.4 2.3 11.7 100.0 5.9 323 35-39 8.3 50.6 9.2 19.5 1.9 10.5 100.0 5.4 268 40-44 8.5 47.0 13.4 21.5 1.2 8.3 100.0 5.5 191 45-49 7.9 47.4 20.8 14.7 1.9 7.3 100.0 5.3 157 Residence Urban 1.0 23.8 9.1 35.2 7.9 23.1 100.0 9.1 439 Rural 4.9 55.8 11.3 22.2 1.0 4.6 100.0 5.3 1,734 Region Kampala 0.4 21.9 10.2 37.1 6.5 24.0 100.0 9.3 221 Central 1 6.0 50.8 12.5 23.2 1.5 6.1 100.0 5.5 209 Central 2 4.4 44.9 11.1 29.6 5.2 4.8 100.0 6.1 236 East Central 3.7 51.8 5.9 31.7 2.2 4.7 100.0 5.7 236 Eastern 4.6 58.6 9.7 20.4 0.7 5.9 100.0 5.2 289 Karamoja 29.5 20.7 20.1 26.6 1.2 1.8 100.0 6.0 55 North 0.0 55.8 14.6 19.2 0.5 10.0 100.0 5.8 199 West Nile 3.7 45.7 11.5 30.6 1.9 6.6 100.0 6.0 133 Western 4.2 54.7 11.0 20.8 0.5 8.8 100.0 5.1 322 Southwest 3.4 59.1 10.6 16.5 3.5 6.9 100.0 5.2 273 Wealth quintile Lowest 11.2 58.8 11.9 16.1 0.0 1.9 100.0 4.6 345 Second 4.8 63.5 12.8 15.8 0.7 2.4 100.0 5.0 423 Middle 4.2 58.5 12.2 19.7 1.6 3.8 100.0 5.1 402 Fourth 1.7 49.0 8.6 32.9 1.7 6.1 100.0 6.0 486 Highest 1.1 24.6 9.8 34.4 6.7 23.3 100.0 8.8 517 Total 15-49 4.1 49.3 10.9 24.8 2.4 8.4 100.0 5.8 2,173 50-54 11.7 43.7 16.2 18.7 1.0 8.7 100.0 5.3 122 Total 15-54 4.5 49.0 11.2 24.5 2.3 8.4 100.0 5.7 2,295 1 Completed 7 grade at the primary level 2 Completed 6 grade at the secondary level A similar educational attainment pattern is found among men (Table 3.2.2). Men are more educated than women in all categories. At the national level, 4 percent of men age 15-49 have no education, but almost half (49 percent) have some primary education only. Twenty-five percent of men have only some secondary schooling, and 11 percent have a secondary education or higher. Men age 40-44 are more likely to have no education (9 percent) than men age 15-24 (2 percent). Men in urban areas have higher levels of educational attainment than their rural counterparts. One percent of urban men have no formal education compared with 5 percent of rural men. Three in ten men (31 percent) in urban areas have completed secondary or have more than a secondary education, compared with only (6 percent) in rural areas. Overall, men age 15-49 have completed a median of 5.8 years of schooling. It is also worth noting that the percentage of women and men attending or who have completed primary education is higher in rural than urban areas, while for secondary higher and education, the reverse is true. The likelihood of attending school and reaching higher levels of education increases dramatically as wealth increases. Differences by wealth are large among men; 11 percent of men from the poorest households have no schooling compared with 1 percent from the wealthiest households. At the other end of the spectrum, 64 percent of men from the wealthiest households have attended secondary school or higher compared with 18 to 41 percent for men in the lower quintiles. Looking at trends over time, the percentage of women who attended secondary education or higher education has increased by 30 percent, from 21 percent in 2006 to 28 percent in 2011. A smaller increase (18 percent) was seen among men, from 30 percent in 2006 to 36 percent in 2011. Characteristics of Respondents • 33 3.3 LITERACY The ability to read and write empowers women and men. Literacy statistics are important for policymakers and program managers to assess the ability of the population to absorb information on health and nutrition from printed materials. In the 2011 UDHS, literacy was determined by the respondent’s ability to read all or part of a simple sentence. During data collection, interviewers carried a set of cards on which simple sentences were printed in all the major languages spoken in Uganda. Only women and men who had never been to school and women and men who had only a primary education were asked to read the cards in the language they were most familiar with. Those with a secondary education or higher were assumed to be literate. Table 3.3.1 indicates that two-thirds of women age 15-49 in Uganda (64 percent) are literate, which represents an increase from the 2006 figure of 56 percent. The level of literacy is much higher among women age 15-19 than among women in other age groups. This suggests that younger women have had more opportunity to learn than older women. Literacy varies by place of residence; 86 percent of urban women are literate compared with 59 percent of rural women. 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, Uganda 2011 Background characteristic Secondary school or higher No schooling or primary school Total Percent- age 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 Age 15-24 35.9 24.2 15.2 23.7 1.1 0.0 100.0 75.2 3,677 15-19 32.3 28.7 17.4 20.8 0.8 0.0 100.0 78.4 2,048 20-24 40.4 18.5 12.3 27.3 1.5 0.0 100.0 71.2 1,629 25-29 31.3 20.5 11.5 35.1 1.6 0.0 100.0 63.2 1,569 30-34 22.9 18.2 14.7 41.8 2.4 0.0 100.0 55.8 1,086 35-39 17.0 20.2 13.4 47.0 1.9 0.4 100.0 50.6 1,026 40-44 15.8 27.3 11.0 43.4 2.3 0.1 100.0 54.1 729 45-49 9.4 28.5 11.9 47.4 2.2 0.7 100.0 49.7 587 Residence Urban 58.9 17.7 9.4 12.9 1.2 0.0 100.0 86.0 1,717 Rural 20.0 24.1 14.7 39.3 1.8 0.1 100.0 58.8 6,957 Region Kampala 64.2 16.0 10.5 7.8 1.5 0.0 100.0 90.6 839 Central 1 36.5 27.0 16.2 20.0 0.1 0.2 100.0 79.6 956 Central 2 34.0 25.1 15.5 23.5 1.9 0.0 100.0 74.5 902 East Central 29.9 16.0 11.8 41.3 1.0 0.1 100.0 57.7 869 Eastern 19.7 17.2 12.1 48.3 2.5 0.1 100.0 49.0 1,267 Karamoja 9.8 5.5 7.4 72.9 4.3 0.0 100.0 22.8 289 North 11.6 18.8 18.4 50.9 0.0 0.2 100.0 48.8 735 West Nile 10.9 17.0 17.3 54.0 0.7 0.2 100.0 45.1 500 Western 25.5 28.9 8.9 33.0 3.4 0.2 100.0 63.3 1,221 Southwest 20.0 37.7 17.7 23.3 1.2 0.0 100.0 75.5 1,097 Wealth quintile Lowest 4.7 14.9 12.5 64.5 3.4 0.0 100.0 32.0 1,519 Second 11.2 22.4 16.0 48.0 2.1 0.3 100.0 49.6 1,579 Middle 17.4 30.6 17.3 33.2 1.2 0.3 100.0 65.3 1,608 Fourth 30.6 27.3 13.9 26.8 1.3 0.0 100.0 71.8 1,726 Highest 60.0 19.6 10.0 9.7 0.7 0.0 100.0 89.6 2,242 Total 27.7 22.8 13.7 34.0 1.7 0.1 100.0 64.2 8,674 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 34 • Characteristics of Respondents Regional differences in literacy are marked, with literacy levels highest among women in predominantly urban Kampala (91 percent) and lowest in the Karamoja region (23 percent). There is a significant difference in literacy by household wealth, with the literacy rate ranging from 32 percent among women in the lowest wealth quintile to 90 percent among women in the highest quintile. This reinforces the positive association between economic status and literacy. Men are more likely to be literate than women (Table 3.3.2). Seventy-eight percent of Ugandan men age 15-49 are literate, a decline from 83 percent in 2006. The pattern of male literacy is similar to the pattern among women. However, there are marked differences between men and women across age groups. Seventy-nine percent of men age 45-49 are literate compared with 50 percent of women in the same age group. The gap in urban-rural literacy among men is smaller than that among women, suggesting that men in rural areas have better access to learning than women. Men in Kampala, North, Central 2, and West Nile regions are more likely to be literate than those in other regions. Men in the highest wealth quintile have the highest literacy level (90 percent). 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, Uganda 2011 Background characteristic Secondary school or higher No schooling or primary school Total Percent- age 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 Missing Age 15-24 36.9 22.1 18.1 21.2 1.7 0.0 0.1 100.0 77.1 872 15-19 30.8 26.9 20.6 20.1 1.6 0.0 0.0 100.0 78.3 554 20-24 47.6 13.7 13.6 23.0 1.8 0.0 0.2 100.0 74.9 318 25-29 41.1 19.5 19.0 18.8 1.5 0.0 0.2 100.0 79.6 361 30-34 37.4 23.2 15.2 23.5 0.7 0.0 0.0 100.0 75.8 323 35-39 31.9 32.2 13.7 20.7 1.5 0.0 0.0 100.0 77.8 268 40-44 31.1 30.8 14.9 20.5 2.7 0.0 0.0 100.0 76.8 191 45-49 23.8 37.7 17.9 17.6 3.0 0.0 0.0 100.0 79.4 157 Residence Urban 66.2 12.9 12.0 7.7 1.1 0.0 0.1 100.0 91.1 439 Rural 27.9 28.0 18.2 24.0 1.8 0.0 0.0 100.0 74.1 1,734 Region Kampala 67.6 10.6 13.5 6.5 1.9 0.0 0.0 100.0 91.6 221 Central 1 30.7 23.7 19.3 25.3 1.0 0.0 0.0 100.0 73.8 209 Central 2 39.7 13.5 30.8 14.4 1.6 0.0 0.0 100.0 84.0 236 East Central 38.6 16.6 16.9 27.5 0.4 0.0 0.0 100.0 72.1 236 Eastern 27.0 25.1 15.1 30.1 2.7 0.0 0.0 100.0 67.2 289 Karamoja 29.7 18.5 14.7 35.4 1.8 0.0 0.0 100.0 62.8 55 North 29.6 50.0 5.2 14.7 0.5 0.0 0.0 100.0 84.8 199 West Nile 39.1 13.9 29.5 15.7 1.3 0.0 0.5 100.0 82.5 133 Western 30.1 28.7 15.8 21.6 3.6 0.0 0.2 100.0 74.6 322 Southwest 26.9 38.4 12.4 21.5 0.8 0.0 0.0 100.0 77.7 273 Wealth quintile Lowest 18.1 25.0 21.5 32.8 2.5 0.0 0.0 100.0 64.6 345 Second 18.9 33.0 19.5 26.9 1.6 0.0 0.2 100.0 71.4 423 Middle 25.1 29.8 17.5 26.6 1.1 0.0 0.0 100.0 72.3 402 Fourth 40.7 24.3 17.8 15.3 1.9 0.0 0.0 100.0 82.8 486 Highest 64.4 15.2 10.6 8.2 1.4 0.0 0.1 100.0 90.2 517 Total 15-49 35.6 25.0 17.0 20.7 1.7 0.0 0.1 100.0 77.5 2,173 50-54 28.5 29.2 19.3 20.5 0.0 2.5 0.0 100.0 77.0 122 Total 15-54 35.2 25.2 17.1 20.7 1.6 0.1 0.1 100.0 77.5 2,295 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence Characteristics of Respondents • 35 3.4 ACCESS TO MASS MEDIA Exposure to information on television and radio and in print can increase an individual’s knowledge and awareness of new ideas, social changes, and opportunities, which in turn can affect the individual’s perceptions and behaviour, including those related to health. In the 2011 UDHS, exposure to media was assessed by asking respondents how often they listened to a radio, watched television, or read newspapers or magazines. Media exposure in Uganda is higher among men than women; 14 percent of men and 6 percent of women are exposed to all three media at least once a week (Table 3.4.1 and Table 3.4.2). Seventy-four percent of women and 86 percent of men listen to the radio at least once a week, and 20 percent of women and 30 percent of men watch television at least once a week. 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, Uganda 2011 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 23.3 24.0 75.2 7.6 18.3 2,048 20-24 16.8 23.6 77.1 9.2 18.6 1,629 25-29 12.3 21.2 74.1 6.0 20.3 1,569 30-34 13.1 16.8 72.1 5.2 22.4 1,086 35-39 10.1 14.6 69.4 3.8 27.0 1,026 40-44 10.9 12.9 74.6 4.1 22.4 729 45-49 10.4 12.9 73.9 5.8 24.9 587 Residence Urban 36.9 59.7 78.0 23.0 8.4 1,717 Rural 10.0 9.8 73.2 2.3 24.2 6,957 Region Kampala 41.1 77.4 73.5 29.6 6.2 839 Central 1 21.6 27.6 79.0 9.0 14.8 956 Central 2 26.8 20.0 79.7 8.3 15.3 902 East Central 11.0 14.4 77.2 4.1 20.1 869 Eastern 8.7 6.6 58.0 1.6 38.5 1,267 Karamoja 4.8 3.7 28.3 0.6 69.3 289 North 6.2 5.4 82.2 1.8 16.3 735 West Nile 9.5 8.2 77.9 1.6 20.4 500 Western 9.5 16.9 80.4 3.2 17.4 1,221 Southwest 10.0 10.0 80.0 2.7 18.0 1,097 Education No education 0.1 6.6 60.0 0.1 39.0 1,120 Primary 8.5 12.5 73.5 2.0 23.0 5,152 Secondary+ 37.1 41.2 82.1 18.9 8.6 2,402 Wealth quintile Lowest 2.8 3.2 49.4 0.1 48.8 1,519 Second 5.6 4.6 72.5 0.5 25.7 1,579 Middle 8.6 5.6 79.6 0.8 18.3 1,608 Fourth 15.0 12.8 83.8 2.8 13.7 1,726 Highest 35.8 57.0 80.7 21.7 6.6 2,242 Total 15.3 19.7 74.1 6.4 21.0 8,674 Women and men under age 30 are more likely to be exposed to the mass media than older women and men, presumably in part because of their higher level of education. There is a wide gap in exposure to mass media by place of residence. For example, the proportion of newspaper readers is notably higher among urban women (37 percent) and men (60 percent) than among their rural counterparts (10 percent and 16 percent, respectively). Not surprisingly, media exposure is closely related to the respondent’s educational level as well as economic status. Although 19 percent of women and 30 percent of men with secondary and higher levels of education access all three media at least once a week, less than 1 percent of women and men with no education access all three media sources. Likewise, 22 percent of women and 44 36 • Characteristics of Respondents percent of men from the highest wealth quintile access all three media at least once a week compared with less than 1 percent of women and men from the lowest quintile. Women and men in Kampala are more likely to be exposed to all three media on a weekly basis than those in other regions. Forty-one percent of women and 58 percent of men in Kampala read a newspaper on a weekly basis. The patterns of exposure to mass media are similar among men and women. 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, Uganda 2011 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 21.3 32.3 83.7 10.5 12.3 554 20-24 29.3 37.4 85.6 19.0 11.3 318 25-29 29.5 36.4 90.7 19.5 6.9 361 30-34 28.3 28.5 85.4 16.4 10.4 323 35-39 21.9 25.4 82.4 13.7 14.4 268 40-44 20.3 16.9 86.7 7.5 12.5 191 45-49 22.5 16.1 84.0 10.6 15.0 157 Residence Urban 60.3 77.3 87.7 49.2 4.3 439 Rural 16.0 17.7 85.0 5.4 13.2 1,734 Region Kampala 57.7 88.7 86.1 49.2 3.3 221 Central 1 23.1 31.0 92.3 12.9 5.5 209 Central 2 29.6 34.3 88.5 18.1 8.6 236 East Central 19.7 34.4 88.1 11.8 9.4 236 Eastern 19.6 13.9 74.4 4.7 22.7 289 Karamoja 14.7 16.1 73.7 5.1 23.6 55 North 7.7 7.5 81.6 2.2 17.1 199 West Nile 25.6 8.0 76.9 5.2 18.9 133 Western 25.9 29.2 88.1 14.4 10.2 322 Southwest 19.3 20.4 93.5 10.8 6.1 273 Education No education 2.2 10.5 69.9 0.0 27.9 90 Primary 12.1 22.5 83.7 5.7 14.0 1,309 Secondary + 49.3 44.3 90.4 30.4 5.2 774 Wealth quintile Lowest 8.7 10.9 62.9 0.6 30.7 345 Second 12.7 12.7 87.6 2.1 11.2 423 Middle 13.8 13.4 87.9 4.6 11.5 402 Fourth 22.5 27.9 92.6 10.4 6.1 486 Highest 56.8 70.8 90.5 44.4 3.7 517 Total 15-49 25.0 29.8 85.5 14.3 11.4 2,173 50-54 17.3 21.2 87.6 8.6 11.8 122 Total 15-54 24.6 29.3 85.6 14.0 11.5 2,295 3.5 EMPLOYMENT 3.5.1 Employment Status The 2011 UDHS asked respondents a number of questions regarding their employment status, including whether they worked 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, 69 percent of the women were currently employed, 4 percent were not employed but had worked sometime during the preceding 12 months, and 26 percent were not employed (Table 3.5.1 and Figure 3.1). Characteristics of Respondents • 37 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Uganda 2011 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Currently employed1 Not currently employed Age 15-19 47.3 4.1 48.5 0.0 100.0 2,048 20-24 64.6 5.3 30.0 0.1 100.0 1,629 25-29 75.1 4.9 19.9 0.1 100.0 1,569 30-34 78.8 4.0 17.1 0.1 100.0 1,086 35-39 84.1 3.2 12.7 0.0 100.0 1,026 40-44 82.7 4.0 13.1 0.2 100.0 729 45-49 82.6 2.6 14.7 0.0 100.0 587 Marital status Never married 47.5 4.2 48.2 0.0 100.0 2,118 Married or living together 75.0 4.3 20.7 0.0 100.0 5,418 Divorced/separated/widowed 82.8 4.1 13.0 0.0 100.0 1,134 Number of living children 0 49.1 4.0 46.8 0.0 100.0 2,279 1-2 70.9 5.0 24.0 0.2 100.0 2,099 3-4 76.1 5.0 18.9 0.0 100.0 1,832 5+ 81.4 3.3 15.2 0.1 100.0 2,464 Residence Urban 64.3 3.9 31.7 0.1 100.0 1,717 Rural 70.5 4.3 25.2 0.1 100.0 6,957 Region Kampala 63.2 3.1 33.7 0.0 100.0 839 Central 1 56.2 5.1 38.7 0.0 100.0 956 Central 2 71.4 3.4 25.2 0.0 100.0 902 East Central 72.3 4.8 22.5 0.5 100.0 869 Eastern 63.5 3.1 33.5 0.0 100.0 1,267 Karamoja 85.3 6.8 8.0 0.0 100.0 289 North 53.0 10.3 36.6 0.0 100.0 735 West Nile 71.1 4.2 24.7 0.0 100.0 500 Western 79.5 1.4 19.0 0.1 100.0 1,221 Southwest 82.2 4.4 13.4 0.0 100.0 1,097 Education No education 77.8 4.0 18.2 0.0 100.0 1,120 Primary 70.8 4.4 24.7 0.1 100.0 5,152 Secondary + 62.0 4.0 33.9 0.0 100.0 2,402 Wealth quintile Lowest 73.9 4.1 22.0 0.0 100.0 1,519 Second 71.3 5.7 23.0 0.0 100.0 1,579 Middle 71.3 4.2 24.4 0.1 100.0 1,608 Fourth 68.0 4.4 27.4 0.1 100.0 1,726 Highest 64.2 3.2 32.6 0.0 100.0 2,242 Total 69.3 4.2 26.4 0.1 100.0 8,674 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. 38 • Characteristics of Respondents Figure 3.1 Women's employment status in the past 12 months Uganda 2011 DHS Currently employed 70% Not currently employed 4% Did not work in last 1 26% Currently employed 69% Not currently employed, but worked in last 12 months 4% Did not work in last 12 months 26% The proportion of women currently employed increases with age. Current employment is lowest among women age 15-19 (47 percent) and highest among those age 35-49 (83 percent, or higher). Women who are divorced, separated, or widowed are more likely to be currently employed than other women (83 percent versus 75 percent or lower). Women who have five or more children are more likely to be employed (81 percent) than those with no children (49 percent). The proportion of women currently employed varies by place of residence and region. Rural women are more likely to be currently employed than urban women (71 percent versus 64 percent). Women in Karamoja, Southwest, and Western regions are more likely to be employed (85 percent, 82 percent, and 80 percent, respectively) than women in other regions. The proportion of women currently employed decreases with level of education. For example, 78 percent of women with no education are employed, compared with 62 percent of women with a secondary or higher level of education. Women living in the poorest households are much more likely to be employed (74 percent) than women in the wealthiest households (64 percent). The proportion of currently employed men (91 percent) is higher than that of women (Table 3.5.2). The percentage of currently employed men increases with age, from 75 percent among men age 15- 19 to 99 percent among men age 30-34, and then declines to 97 percent among men age 45-49. Men who have never married (79 percent), men with no living children (81 percent), and urban men (87 percent) are less likely to be employed than other men. Characteristics of Respondents • 39 Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Uganda 2011 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 75.1 7.4 17.5 100.0 554 20-24 89.1 4.4 6.5 100.0 318 25-29 97.4 0.9 1.7 100.0 361 30-34 99.0 0.6 0.4 100.0 323 35-39 97.9 0.8 1.4 100.0 268 40-44 96.1 2.0 1.9 100.0 191 45-49 96.7 1.7 1.6 100.0 157 Marital status Never married 79.2 6.3 14.5 100.0 834 Married or living together 97.7 1.3 1.0 100.0 1,228 Divorced/separated/widowed 98.1 0.0 1.9 100.0 111 Number of living children 0 80.8 5.8 13.4 100.0 902 1-2 96.6 1.9 1.5 100.0 386 3-4 98.9 0.9 0.2 100.0 339 5+ 97.5 1.1 1.4 100.0 546 Residence Urban 86.8 3.5 9.7 100.0 439 Rural 91.6 3.1 5.3 100.0 1,734 Region Kampala 82.7 4.4 12.9 100.0 221 Central 1 96.7 0.2 3.0 100.0 209 Central 2 96.0 1.6 2.3 100.0 236 East Central 84.4 8.3 7.3 100.0 236 Eastern 91.1 1.1 7.8 100.0 289 Karamoja 88.7 4.1 7.2 100.0 55 North 90.0 8.0 2.0 100.0 199 West Nile 90.0 5.6 4.4 100.0 133 Western 89.8 0.0 10.2 100.0 322 Southwest 94.7 2.4 3.0 100.0 273 Education No education 93.9 2.1 4.0 100.0 90 Primary 91.3 3.4 5.3 100.0 1,309 Secondary + 89.1 2.9 8.1 100.0 774 Wealth quintile Lowest 95.1 2.3 2.5 100.0 345 Second 91.2 4.3 4.5 100.0 423 Middle 93.1 1.6 5.3 100.0 402 Fourth 90.3 2.7 7.0 100.0 486 Highest 85.6 4.5 10.0 100.0 517 Total 15-49 90.6 3.2 6.2 100.0 2,173 50-54 94.2 0.8 4.9 100.0 122 Total 15-54 90.8 3.0 6.1 100.0 2,295 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. There is no clear pattern in the variation of men’s employment by level of education. By wealth status, current employment among men decreases from 95 percent in the poorest households to 86 percent in the wealthiest households. Current employment among women age 15-49 has decreased from 81 percent in 2006 to 69 percent in 2011, and employment among men has decreased from 94 percent in 2006 to 91 percent in 2011. 40 • Characteristics of Respondents 3.5.2 Occupation Respondents who were currently employed or who had worked in the 12 months preceding the survey were asked to specify their occupation. The results are presented in Table 3.6.1 and Table 3.6.2. 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, Uganda 2011 Background characteristic Professional/ managerial/ technical/ assistant professional Clerical Sales and services Skilled agriculture, forestry, and fishery workers Craft and related trade workers Plant and machine operators and assemblers Elementary occupations Total Number of women Age 15-19 0.8 0.2 13.2 60.2 5.7 0.0 19.9 100.0 1,054 20-24 6.1 0.5 18.8 52.2 7.3 0.0 15.2 100.0 1,138 25-29 9.1 0.4 19.9 52.1 6.0 0.2 12.4 100.0 1,255 30-34 6.3 0.4 16.5 56.3 7.9 0.0 12.5 100.0 899 35-39 4.7 0.4 15.9 61.1 4.7 0.0 13.2 100.0 896 40-44 4.7 0.0 15.3 63.5 6.7 0.0 9.7 100.0 632 45-49 3.2 0.1 13.9 63.4 7.6 0.0 11.9 100.0 500 Marital status Never married 7.4 0.7 16.1 49.4 6.1 0.0 20.3 100.0 1,096 Married or living together 5.4 0.3 15.0 61.3 6.5 0.0 11.4 100.0 4,293 Divorced/separated/widowed 2.4 0.2 24.2 48.8 6.6 0.0 17.8 100.0 986 Number of living children 0 6.4 0.7 16.2 50.4 7.2 0.0 19.1 100.0 1,211 1-2 8.6 0.4 21.2 48.6 6.7 0.0 14.5 100.0 1,592 3-4 5.7 0.2 18.7 56.1 6.3 0.1 12.9 100.0 1,485 5+ 1.8 0.1 11.9 68.9 6.0 0.0 11.3 100.0 2,087 Residence Urban 13.8 1.4 40.7 13.6 7.8 0.0 22.7 100.0 1,173 Rural 3.4 0.1 11.2 67.2 6.1 0.0 12.0 100.0 5,202 Region Kampala 14.2 2.0 45.5 2.4 7.6 0.0 28.4 100.0 557 Central 1 8.0 0.0 28.2 39.0 5.6 0.0 19.1 100.0 586 Central 2 6.1 0.2 21.8 54.0 5.9 0.0 12.0 100.0 674 East Central 5.0 0.4 15.1 64.1 4.0 0.0 11.4 100.0 669 Eastern 3.8 0.1 8.3 71.3 3.3 0.2 13.0 100.0 843 Karamoja 1.8 0.0 2.6 50.6 13.6 0.2 31.2 100.0 266 North 1.4 0.0 11.5 52.5 15.9 0.0 18.7 100.0 466 West Nile 1.9 0.1 24.4 41.1 17.9 0.0 14.6 100.0 376 Western 4.8 0.3 10.9 71.7 4.5 0.0 7.8 100.0 988 Southwest 3.9 0.0 6.8 81.8 2.1 0.0 5.3 100.0 951 Education No education 0.0 0.0 5.7 74.6 7.0 0.0 12.6 100.0 916 Primary 0.1 0.0 14.3 64.2 6.5 0.1 14.9 100.0 3,873 Secondary + 21.1 1.3 28.7 30.7 6.0 0.0 12.3 100.0 1,586 Wealth quintile Lowest 0.1 0.0 6.2 70.5 7.0 0.0 16.2 100.0 1,185 Second 1.2 0.0 8.0 71.8 8.9 0.0 10.1 100.0 1,216 Middle 1.8 0.0 9.6 72.5 5.5 0.1 10.3 100.0 1,213 Fourth 4.3 0.0 17.5 60.3 5.7 0.0 12.2 100.0 1,250 Highest 16.2 1.3 36.7 20.7 5.4 0.0 19.6 100.0 1,511 Total 5.3 0.3 16.6 57.3 6.4 0.0 13.9 100.0 6,375 In Uganda, the agricultural sector remains the main employer, with 57 percent of women and 55 percent of men age 15-49 engaged in work in agriculture, forestry and fishery. These figures are lower than those in the 2006 UDHS, when 75 percent of women and 68 percent of men were employed in agricultural occupations. The survey indicates that 17 percent of women work in sales and services, an increase from 13 percent in 2006. Five percent of women work in professional, technical, and managerial fields. Among men, 11 percent work in sales and services, and 5 percent have professional, technical, and managerial positions, similar to the 2006 UDHS findings. Fourteen percent of women and 15 percent of men work in elementary occupations (i.e., cleaners and helpers). Characteristics of Respondents • 41 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, Uganda 2011 Background characteristic Professional/ managerial/ technical/ assistant professional Clerical Sales and services Skilled agriculture forestry and fishery workers Craft and related trade workers Plant and machine operators, and assemblers Elementary occupations Total Number of men Age 15-19 1.2 0.2 6.4 66.9 7.1 0.7 17.6 100.0 457 20-24 3.1 0.5 15.9 45.3 12.8 4.9 17.5 100.0 298 25-29 6.0 0.2 13.1 43.6 7.7 10.5 18.9 100.0 355 30-34 9.1 0.7 10.1 52.8 9.1 7.2 11.1 100.0 322 35-39 7.3 0.9 8.3 57.1 7.2 5.8 13.3 100.0 265 40-44 5.7 0.0 12.5 62.9 5.8 1.1 12.0 100.0 187 45-49 6.2 0.0 11.3 60.9 5.6 1.6 14.3 100.0 154 Marital status Never married 3.5 0.4 9.5 55.9 9.6 2.4 18.7 100.0 713 Married or living together 6.2 0.4 11.6 55.8 7.1 5.8 13.2 100.0 1,216 Divorced/separated/widowed 4.4 0.0 9.0 46.9 10.9 9.6 19.2 100.0 109 Number of living children 0 4.1 0.4 10.0 55.7 9.2 2.1 18.6 100.0 782 1-2 9.0 0.5 12.3 44.9 9.0 9.4 15.0 100.0 380 3-4 7.0 0.2 11.4 49.1 9.6 8.8 13.9 100.0 338 5+ 2.9 0.4 10.2 66.2 5.2 3.0 12.1 100.0 539 Residence Urban 14.8 1.9 22.7 10.1 17.3 12.0 21.2 100.0 396 Rural 2.8 0.0 7.8 66.3 6.0 3.1 14.1 100.0 1,642 Region Kampala 16.0 1.2 26.7 2.3 18.0 11.6 24.2 100.0 193 Central 1 5.9 0.0 10.8 53.1 6.9 7.4 16.0 100.0 203 Central 2 3.5 1.0 11.8 54.3 9.3 4.6 15.4 100.0 230 East Central 3.1 0.0 9.7 54.3 10.5 3.7 18.7 100.0 218 Eastern 2.7 0.0 8.7 72.7 5.1 3.7 7.2 100.0 266 Karamoja 2.9 1.5 19.3 34.3 11.3 0.0 30.7 100.0 51 North 5.0 0.0 6.0 73.2 3.4 0.7 11.6 100.0 195 West Nile 5.1 0.0 7.4 74.6 7.5 1.2 4.1 100.0 127 Western 5.9 0.8 4.7 66.8 4.3 6.1 11.4 100.0 289 Southwest 2.0 0.0 11.1 49.2 9.6 4.3 24.0 100.0 265 Education No education 2.3 0.0 9.8 66.5 3.8 0.4 17.3 100.0 86 Primary 1.0 0.0 8.7 63.2 6.8 3.8 16.6 100.0 1,240 Secondary + 12.8 1.1 14.4 40.3 11.1 7.2 13.2 100.0 712 Wealth quintile Lowest 0.8 0.0 5.7 77.6 4.4 0.6 10.9 100.0 336 Second 1.7 0.0 6.0 71.7 6.4 1.2 13.0 100.0 404 Middle 1.6 0.0 8.4 65.3 6.1 3.1 15.5 100.0 381 Fourth 2.7 0.3 13.0 53.6 5.3 6.5 18.6 100.0 452 Highest 16.5 1.3 18.2 18.6 16.9 10.8 17.7 100.0 466 Total 15-49 5.2 0.4 10.7 55.4 8.2 4.8 15.4 100.0 2,038 50-54 5.1 0.0 4.9 64.0 12.5 1.8 11.6 100.0 116 Total 15-54 5.1 0.4 10.4 55.8 8.4 4.6 15.2 100.0 2,154 As expected, place of residence has a significant effect on type of occupation. In rural areas, two of three employed men and women (66 percent and 67 percent, respectively) are engaged in agricultural work. Employment outside the agricultural sector is highest among women and men with more than secondary education and those in the highest wealth quintile. Women in the Southwest, Western, and Eastern regions are more likely than other women to be involved in agriculture, forestry, or fisheries (71 percent or higher). Seventy-two percent or more of men in Eastern, North, and West Nile regions work in agricultural fields. However, since 2006, employment in agriculture has declined and shifted to other occupations, especially sales and services. The lowest proportion of women and men engaged in the agricultural sector live in Kampala region. There is a positive relationship between women’s education and their involvement in sales and services. For example, 29 percent of women with secondary or higher education are involved in this sector, compared with 6 to 14 percent of women with less education. A similar pattern is found among men. Seventy-one percent of employed women in the lowest wealth quintile work in agriculture compared with 42 • Characteristics of Respondents 21 percent of women in the highest wealth quintile. Agricultural work is also less common among men with some secondary or higher education and men in the highest wealth quintile. The proportion of respondents in elementary occupations, such as cleaners and helpers, decreases with age and is highest among the never-married, respondents with no living children, urban respondents, and those with no education or primary education. 3.5.3 Type of Women’s Employment Table 3.7 presents the percent distribution of employed women age 15-49 by type of earnings, employer characteristics, and continuity of employment, according to type of employment (agricultural or nonagricultural). About half (49 percent) of women who were employed in the 12 months preceding the survey received cash payment only; with 35 percent in the agricultural sector versus 79 percent in the nonagricultural sector. Women working in agriculture are more likely not to be paid than those working in nonagricultural work (36 percent compared with 4 percent). Five percent of women employed in the agricultural sector are paid in-kind only. Two in three women, in both agriculture and nonagricultural sectors, are self-employed. Women who work in agriculture are more likely to be employed by a family member (22 percent), whereas those who work in a nonagricultural sector are more likely to be employed by a nonfamily member (28 percent). Table 3.7 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Uganda 2011 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 35.1 78.9 49.1 Cash and in-kind 23.6 14.5 20.7 In-kind only 5.4 2.2 4.4 Not paid 35.8 4.4 25.8 Total 100.0 100.0 100.0 Type of employer Employed by family member 22.0 7.7 17.4 Employed by nonfamily member 11.4 27.5 16.5 Self-employed 66.6 64.7 66.0 Total 100.0 100.0 100.0 Continuity of employment All year 54.1 72.2 59.9 Seasonal 36.5 13.1 29.1 Occasional 9.4 14.6 11.1 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 4,339 2,034 6,375 Note: Total includes women with missing information on type of employment who are not shown separately. Six in ten employed women work all year, 54 percent of those who work in the agricultural sector and 72 percent of those in the non-agricultural sector. Three in ten women are employed seasonally. Women in the agricultural sector are three times more likely to work seasonally than those who work in the nonagricultural sector (37 percent and 13 percent, respectively). 3.6 HEALTH INSURANCE Over the last two decades, interest has grown in the potential of social health insurance (SHI) as a health financing mechanism for low- and middle-income countries. Like many other African countries, Uganda is currently trying to find an efficient, equitable, and sustainable health financing mechanism that Characteristics of Respondents • 43 will raise a substantial amount of funds for the health sector. A National Health Insurance scheme (NHIS) has been introduced in a phased manner, with the objective of obtaining additional funding for the health sector and promoting financial risk protection. The scheme is expected to bring additional resources for the health sector and improve equity in access to health services. In the 2011 UDHS, respondents were asked whether they have any type of health insurance. The health insurance may be obtained through a mutual health organization or community-based program, or privately purchased from a commercial provider. Tables 3.8.1 and 3.8.2 show that only 1 percent of women and less than 2 percent of men are covered by health insurance. Urban women, women who live in Kampala, those with secondary or higher education, and those from the wealthiest households are the most likely to be covered by some type of health insurance. Men show the same pattern as women. Table 3.8.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Uganda 2011 Background characteristic Mutual health organization/ community- based insurance Privately purchased commercial insurance Other None Number of women Age 15-19 0.3 0.5 0.0 99.2 2,048 20-24 0.4 0.9 0.0 98.7 1,629 25-29 0.2 1.3 0.2 98.4 1,569 30-34 0.1 1.3 0.0 98.6 1,086 35-39 0.1 0.7 0.1 99.1 1,026 40-44 0.4 1.0 0.1 98.4 729 45-49 0.3 0.5 0.0 99.2 587 Residence Urban 0.3 3.4 0.2 96.0 1,717 Rural 0.2 0.3 0.0 99.5 6,957 Region Kampala 0.1 4.6 0.2 95.1 839 Central 1 0.2 0.7 0.2 98.9 956 Central 2 0.0 0.6 0.0 99.4 902 East Central 0.2 0.6 0.0 99.1 869 Eastern 0.1 0.2 0.1 99.6 1,267 Karamoja 0.0 0.3 0.0 99.7 289 North 0.2 0.1 0.0 99.8 735 West Nile 0.0 0.1 0.0 99.9 500 Western 0.1 0.7 0.0 99.2 1,221 Southwest 1.3 0.8 0.0 98.0 1,097 Education No education 0.3 0.1 0.1 99.5 1,120 Primary 0.2 0.2 0.0 99.6 5,152 Secondary + 0.4 2.8 0.1 96.6 2,402 Wealth quintile Lowest 0.1 0.0 0.1 99.8 1,519 Second 0.2 0.2 0.0 99.7 1,579 Middle 0.2 0.2 0.0 99.6 1,608 Fourth 0.1 0.3 0.1 99.5 1,726 Highest 0.5 3.0 0.1 96.4 2,242 Total 0.3 0.9 0.1 98.8 8,674 44 • Characteristics of Respondents Table 3.8.2 Health insurance coverage: Men Percentage of men age 15-49 with specific types of health insurance coverage, according to background characteristics, Uganda 2011 Background characteristic Mutual health organization/ community based insurance Privately purchased commercial insurance Other None Number of men Age 15-19 0.0 0.4 0.0 99.6 554 20-24 0.3 2.0 0.0 97.7 318 25-29 0.8 1.9 0.0 97.3 361 30-34 0.9 3.1 0.0 96.0 323 35-39 0.1 0.7 0.0 99.3 268 40-44 0.0 0.1 0.0 99.9 191 45-49 0.6 1.5 0.3 97.6 157 Residence Urban 0.3 5.2 0.1 94.4 439 Rural 0.4 0.4 0.0 99.2 1,734 Region Kampala 0.2 7.3 0.0 92.4 221 Central 1 0.0 0.6 0.2 99.2 209 Central 2 0.4 0.4 0.0 99.2 236 East Central 0.0 0.6 0.0 99.4 236 Eastern 0.9 0.5 0.0 98.6 289 Karamoja 0.0 0.8 0.0 99.2 55 North 0.0 1.0 0.0 99.0 199 West Nile 0.2 0.0 0.0 99.8 133 Western 0.0 1.3 0.0 98.7 322 Southwest 1.3 0.9 0.0 97.8 273 Education No education 0.0 1.6 0.0 98.4 90 Primary 0.5 0.2 0.0 99.3 1,309 Secondary + 0.2 3.4 0.1 96.4 774 Wealth quintile Lowest 0.8 0.3 0.0 98.9 345 Second 0.0 0.2 0.0 99.8 423 Middle 0.7 0.2 0.0 99.1 402 Fourth 0.2 0.9 0.0 98.9 486 Highest 0.3 4.4 0.1 95.2 517 Total 15-49 0.4 1.4 0.0 98.2 2,173 50-54 0.0 1.2 0.0 98.8 122 Total 15-54 0.4 1.4 0.0 98.3 2,295 3.7 USE OF TOBACCO Smoking and using other forms of tobacco can cause a wide variety of diseases and lead to death. Smoking is a risk factor for cardiovascular disease, lung cancer, and other forms of cancer, and contributes to the severity of pneumonia, emphysema, and chronic bronchitis. Further, secondhand smoke may adversely affect health and aggravate illnesses. In the 2011 UDHS, women and men age 15-49 were asked whether they currently smoke cigarettes and, if so, how many cigarettes they had smoked in the past 24 hours. Those who were not currently smoking cigarettes were asked whether they used any other forms of tobacco, such as a pipe, chewing tobacco, or snuff. Results are shown in Tables 3.9.1 and 3.9.2 for women and men, respectively. Characteristics of Respondents • 45 Table 3.9.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity status, Uganda 2011 Background characteristic Uses tobacco Does not use tobacco Number of women Cigarettes Pipe Other tobacco Age 15-19 0.0 0.0 0.5 99.5 2,048 20-24 0.4 0.1 1.1 98.5 1,629 25-29 0.7 0.2 2.1 96.8 1,569 30-34 0.5 0.3 2.2 97.0 1,086 35-39 1.1 1.1 2.4 95.5 1,026 40-44 1.0 1.2 2.8 95.4 729 45-49 2.4 0.7 5.1 92.8 587 Maternity status Pregnant 0.2 0.0 1.9 97.7 1,011 Breastfeeding (not pregnant) 0.6 0.2 2.3 96.9 2,500 Neither 0.7 0.5 1.6 97.3 5,163 Residence Urban 0.3 0.6 0.2 98.8 1,717 Rural 0.7 0.3 2.2 96.8 6,957 Region Kampala 0.2 0.9 0.2 98.8 839 Central 1 0.5 1.3 0.8 97.5 956 Central 2 0.2 0.5 0.2 99.2 902 East Central 0.3 0.0 0.0 99.1 869 Eastern 0.0 0.0 0.0 100.0 1,267 Karamoja 0.3 0.0 35.4 64.4 289 North 0.0 0.0 0.0 100.0 735 West Nile 1.6 0.3 2.6 95.7 500 Western 1.8 0.2 0.9 97.4 1,221 Southwest 1.2 0.4 1.9 96.7 1,097 Education No education 2.1 0.5 9.0 89.1 1,120 Primary 0.5 0.5 1.1 97.9 5,152 Secondary + 0.1 0.1 0.1 99.5 2,402 Wealth quintile Lowest 1.4 0.0 7.7 91.4 1,519 Second 0.9 0.4 0.7 98.1 1,579 Middle 0.6 0.6 0.8 98.0 1,608 Fourth 0.5 0.3 0.8 98.4 1,726 Highest 0.1 0.5 0.2 99.0 2,242 Total 0.6 0.4 1.8 97.2 8,674 46 • Characteristics of Respondents Table 3.9.2 Use of tobacco: Men Percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Uganda 2011 Background characteristic Uses tobacco Does not use tobacco Number of men Cigarettes Pipe Other tobacco Age 15-19 1.2 0.4 0.2 98.3 554 20-24 6.5 0.0 3.0 92.4 318 25-29 12.0 0.9 4.7 84.7 361 30-34 19.2 1.3 5.0 77.6 323 35-39 20.9 1.1 8.6 75.7 268 40-44 18.2 1.4 6.1 78.1 191 45-49 28.3 0.0 11.7 67.2 157 Residence Urban 7.9 0.0 0.7 91.8 439 Rural 13.4 0.9 5.4 83.6 1,734 Region Kampala 8.2 0.0 0.0 91.7 221 Central 1 12.6 2.0 3.8 84.9 209 Central 2 9.4 1.6 2.0 87.4 236 East Central 6.1 1.3 0.4 92.7 236 Eastern 11.2 0.1 1.4 88.4 289 Karamoja 5.1 1.6 42.2 53.8 55 North 18.9 0.0 12.1 80.0 199 West Nile 31.1 0.0 16.3 66.3 133 Western 14.3 0.0 1.7 85.0 322 Southwest 9.8 1.1 1.7 88.6 273 Education No education 12.4 2.0 12.5 75.8 90 Primary 15.6 0.8 5.5 81.6 1,309 Secondary + 6.7 0.3 1.8 92.6 774 Wealth quintile Lowest 24.6 0.3 15.4 68.4 345 Second 17.1 0.9 5.7 80.6 423 Middle 11.1 1.2 2.5 87.3 402 Fourth 8.0 0.8 1.7 90.0 486 Highest 5.2 0.3 0.1 94.4 517 Total 15-49 12.3 0.7 4.4 85.3 2,173 50-54 25.1 4.0 9.1 66.1 122 Total 15-54 13.0 0.9 4.7 84.3 2,295 Tables 3.9.1 and 3.9.2 show that tobacco use is more common among Ugandan men than women (15 percent compared with 3 percent). Twelve percent of men age 15-49 smoke cigarettes, while 1 percent smoke pipes, and 4 percent consume other forms of tobacco. Use of tobacco is most common among older men, men living in rural areas, and those with no education. The highest tobacco use is found among men in the lowest wealth quintile (32 percent). Cigarette smoking among men is most prevalent in West Nile region (31 percent), while Karamoja has the highest proportion of men who use other types of tobacco (42 percent). Karamoja also accounts for a large proportion of the women who use tobacco. Among women age 15-49 who smoke cigarettes, 18 percent smoked 3 to 5 cigarettes, and 18 percent smoked 10 or more cigarettes in the previous 24 hours (data not shown). Among men who smoked cigarettes, 28 percent smoked 1 to 2 cigarettes, 32 percent smoked 3 to 5 cigarettes, and 20 percent smoked 10 or more cigarettes in the 24 hours prior to the survey (data not shown). Marriage and Sexual Activity • 47 MARRIAGE AND SEXUAL ACTIVITY 4 his chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant. These factors are marriage, polygyny, and sexual activity. 4.1 CURRENT MARITAL STATUS For most women in Uganda, marriage marks the onset of regular exposure to the risk of pregnancy. Therefore, information on age at first marriage is important for understanding fertility. Populations in which age at first marriage is low tend to have early childbearing and high fertility. Table 4.1.1 presents the percent distribution of women and men by current marital status, according to age group. The term ‘married’ refers to legal or formal marriage, while the term ‘living together’ designates an informal union in which a man and a woman live together but a formal civil or religious ceremony has not taken place. In later tables that do not list ‘living together’ as a separate category, these respondents are included in the ‘currently married’ group. Respondents who are currently married, widowed, divorced, or separated are referred to as ‘ever married’. Table 4.1.1 shows that the proportion of women currently in union (married or cohabiting) is 63 percent, the same as in the 2006 UDHS, and a reduction from 67 percent in the 2000-2001 UDHS. Notable, however, is the decrease in the proportion of married women, from 49 percent in 2006 to 36 percent in 2011, and the increase in the proportion of those living together, from 14 percent to 27 percent during the same period. One in four women (24 percent) has never been married, while about 13 percent are divorced, widowed, or separated. The proportion of women who have never married declines sharply with age, and by age 30, almost all women have married. The proportion of women in a formal union increases with age and peaks at age 35-39. The decline after age 40 is the result of widowhood, divorce, and separation. As expected, older women are more likely to be widowed or divorced than younger women. Men age 15-49 are more likely to have never been married (38 percent) than women (24 percent). The proportion of men age 15-49 who are married has declined since the previous survey, from 50 percent in 2006 to 41 percent in 2011. This decline is noticeable among men under 25. Among the ever-married, men are less likely than women to be widowed or separated. This is partly due to remarriage and polygyny. T Key Findings  The median age at marriage for men age 25-49 is 22.3 years, four years older than the median age for women in the same age range, at 17.9 years.  The percentage of women who were first married by age 15 has declined from 19 percent among women currently age 45-49 to 3 percent among women age 15-19.  For Ugandan women, the median age at first sex is about one year less than the median age at first marriage. In contrast, men typically initiate sexual intercourse four years before their first marriage.  Overall, 25 percent of married women in Uganda are in a polygynous union. The percentage of women who are in a polygynous union has declined steadily over the past decade from 32 percent in the 2000-01 to 25 percent in 2011. 48 • Marriage and Sexual Activity Table 4.1.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Uganda 2011 Age Marital status Percentage of respondents currently in union Number of respondents Never married Married Living together Divorced Separated Widowed Total WOMEN 15-19 77.3 8.6 11.4 0.1 2.6 0.1 100.0 20.0 2,048 20-24 23.9 31.8 35.5 0.5 7.2 1.0 100.0 67.3 1,629 25-29 5.6 44.6 37.9 0.6 9.9 1.3 100.0 82.5 1,569 30-34 2.3 48.2 32.9 0.9 12.1 3.6 100.0 81.1 1,086 35-39 1.5 51.3 28.6 0.4 11.9 6.3 100.0 79.9 1,026 40-44 0.8 50.8 25.0 1.7 10.6 10.9 100.0 75.8 729 45-49 2.2 46.2 15.8 1.8 15.5 18.5 100.0 62.0 587 Total 24.4 35.6 26.9 0.7 8.6 3.8 100.0 62.5 8,674 MEN 15-19 96.9 0.6 1.2 0.0 1.2 0.0 100.0 1.9 554 20-24 63.4 16.1 15.7 0.4 4.4 0.0 100.0 31.9 318 25-29 19.9 50.6 24.1 1.1 4.0 0.3 100.0 74.6 361 30-34 6.0 61.3 25.9 1.7 4.8 0.4 100.0 87.2 323 35-39 0.9 72.5 17.9 1.0 5.9 1.9 100.0 90.4 268 40-44 0.6 76.2 17.7 1.7 3.9 0.0 100.0 93.8 191 45-49 0.6 78.4 12.7 4.6 3.7 0.0 100.0 91.1 157 Total 15-49 38.4 41.4 15.1 1.1 3.7 0.3 100.0 56.5 2,173 50-54 0.0 75.5 14.4 1.9 7.5 0.7 100.0 89.9 122 Total 15-54 36.3 43.2 15.1 1.1 3.9 0.4 100.0 58.3 2,295 Table 4.1.2 shows the current marital status and type of marriage among women and men age 15-49. One in four women (25 percent) and about one in three men (32 percent) have had a customary marriage, 27 percent of women and 15 percent of men are cohabiting, and 9 percent of women and 8 percent of men 15-49 have had a religious marriage. Just 1 percent, each, of women and men have had a civil marriage. Table 4.1.2 Current marital status and type of marriage Percent distribution of women and men age 15-49 by current marital status and type of marriage, according to age, Uganda 2011 Age Marital status an type of marriage Percentage of respondents currently in union Number of respondents Marriage Living together Never married/ previously married Total Civil marriage Customary marriage Religious marriage WOMEN 15-19 0.2 7.7 0.7 11.4 80.0 100.0 20.0 2,048 20-24 0.9 27.0 4.0 35.5 32.6 100.0 67.3 1,629 25-29 1.3 33.3 10.0 37.9 17.3 100.0 82.5 1,569 30-34 1.7 32.4 14.1 32.9 18.9 100.0 81.1 1,086 35-39 1.4 34.9 15.0 28.6 20.0 100.0 79.9 1,026 40-44 1.4 30.3 19.2 25.0 24.0 100.0 75.8 729 45-49 1.6 26.6 18.1 15.8 38.0 100.0 62.0 587 Total 1.1 25.4 9.1 26.9 37.5 100.0 62.5 8,674 MEN 15-19 0.0 0.4 0.2 1.2 98.1 100.0 1.9 554 20-24 1.0 12.9 2.2 15.7 68.1 100.0 31.9 318 25-29 2.1 42.3 6.2 24.1 25.4 100.0 74.6 361 30-34 0.4 52.1 8.8 25.9 12.8 100.0 87.2 323 35-39 1.7 57.4 13.5 17.9 9.6 100.0 90.4 268 40-44 1.3 53.5 21.4 17.7 6.2 100.0 93.8 191 45-49 1.8 50.4 26.2 12.7 8.9 100.0 91.1 157 Total 15-49 1.0 32.2 8.2 15.1 43.5 100.0 56.5 2,173 50-54 0.9 54.2 20.4 14.4 10.1 100.0 89.9 122 Total 15-54 1.0 33.4 8.8 15.1 41.7 100.0 58.3 2,295 4.2 POLYGYNY Marital unions are predominantly of two types: monogamous and polygynous. The distinction has social significance and probable fertility implications, although the association between union type and fertility is complex and not well understood. Polygyny, the practice of having more than one wife, has Marriage and Sexual Activity • 49 implications for the frequency of sexual intercourse and thus an effect on fertility. The extent of polygyny is ascertained by asking currently married women whether their husband or partner has other wives and, if so, how many. Similarly, interviewers ask currently married men how many wives or partners they have. Tables 4.2.1 and 4.2.2 show the proportion of currently married women and men, respectively, who are in polygynous unions, by background characteristics. Overall, 25 percent of married women in Uganda are in a polygynous union. In the 2011 UDHS, 5 percent of women are in a polygynous union with two or more co-wives, compared with 7 percent in 2006. The extent of polygyny reported by women has declined steadily over the last decade from 32 percent in the 2000-01 UDHS to 28 percent in the 2006 UDHS and to 25 percent in 2011. The prevalence of polygynous unions generally increases with age; young women are more likely to be in a monogamous marriage than older women. Eighty-two percent of married women age 15-19 are in a monogamous union as compared with 69 percent of women age 45-49. Rural women are more likely to be in polygynous unions (26 percent) than urban women (20 percent). The regional distribution also shows substantial variation. The prevalence of polygyny is lowest in Central 1 (17 percent) and highest in Karamoja (51 percent). Polygyny also is relatively common in East Central (39 percent), West Nile (31 percent), and Central 2 (27 percent) regions. There is an inverse relationship between education and polygyny. The proportion of currently married women in a polygynous union decreases from 33 percent among women with no education to 20 percent among women with more than secondary education. The relationship between wealth quintile of the household and polygyny is not clear. Data on polygynous unions among currently married men are shown in Table 4.2.2. Seventeen percent of men age 15-54 report having two or more wives. Like women, older men, men living in rural areas, and those with little or no education are more likely to be in polygynous unions than other men. Polygyny is higher among men in Karamoja (27 percent), North (26 percent) and East Central (23 percent) regions. The level of polygyny reported by men age 15-54 has remained constant over the past five years at 17 percent. Table 4.2.1 Number of women's co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Uganda 2011 Background characteristic Number of co-wives Total Number of women 0 1 2+ Don't know Missing Age 15-19 82.4 11.1 2.6 3.9 0.0 100.0 409 20-24 80.2 14.3 1.5 4.0 0.0 100.0 1,097 25-29 72.6 19.7 3.7 4.0 0.0 100.0 1,295 30-34 67.4 22.5 6.9 3.0 0.2 100.0 880 35-39 64.7 23.9 8.6 2.8 0.1 100.0 820 40-44 65.1 21.1 10.1 3.7 0.0 100.0 553 45-49 68.7 20.0 9.1 2.2 0.0 100.0 364 Residence Urban 73.5 15.5 4.7 6.3 0.0 100.0 892 Rural 71.5 19.9 5.6 3.0 0.1 100.0 4,526 Region Kampala 73.3 14.9 2.7 9.1 0.0 100.0 397 Central 1 75.9 14.6 2.7 6.8 0.0 100.0 559 Central 2 64.4 20.3 6.4 9.0 0.0 100.0 565 East Central 58.3 27.6 11.1 3.0 0.0 100.0 580 Eastern 80.0 14.4 3.8 1.8 0.0 100.0 859 Karamoja 48.4 33.5 17.8 0.3 0.0 100.0 215 North 74.7 22.4 2.7 0.2 0.0 100.0 487 West Nile 67.7 24.3 7.0 0.4 0.5 100.0 330 Western 74.2 17.4 6.3 2.0 0.2 100.0 743 Southwest 79.5 16.2 2.3 2.1 0.0 100.0 681 Education No education 65.4 23.3 9.3 1.9 0.1 100.0 877 Primary 71.8 19.3 5.1 3.7 0.1 100.0 3,313 Secondary + 76.4 15.9 3.6 4.1 0.0 100.0 1,227 Wealth quintile Lowest 71.1 20.9 5.9 2.2 0.0 100.0 1,063 Second 75.5 17.9 4.3 2.3 0.1 100.0 1,101 Middle 73.3 18.9 5.0 2.8 0.1 100.0 1,042 Fourth 67.5 20.8 7.7 4.0 0.0 100.0 997 Highest 71.4 17.8 4.7 6.0 0.1 100.0 1,215 Total 71.8 19.2 5.4 3.5 0.1 100.0 5,418 50 • Marriage and Sexual Activity Table 4.2.2 Number of men's wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, Uganda 2011 Background characteristic Number of wives Total Number of men 1 2+ Age 15-19 * * 100.0 10 20-24 94.7 5.3 100.0 101 25-29 90.7 9.3 100.0 270 30-34 83.0 17.0 100.0 282 35-39 85.4 14.6 100.0 242 40-44 76.8 23.2 100.0 179 45-49 73.5 26.5 100.0 143 Residence Urban 90.5 9.5 100.0 215 Rural 82.9 17.1 100.0 1,014 Region Kampala 94.9 5.1 100.0 96 Central 1 84.9 15.1 100.0 120 Central 2 85.3 14.7 100.0 127 East Central 77.3 22.7 100.0 122 Eastern 85.9 14.1 100.0 199 Karamoja 73.1 26.9 100.0 40 North 73.9 26.1 100.0 117 West Nile 83.6 16.4 100.0 77 Western 86.0 14.0 100.0 183 Southwest 88.9 11.1 100.0 147 Education No education 67.0 33.0 100.0 73 Primary 83.6 16.4 100.0 754 Secondary + 88.7 11.3 100.0 402 Wealth quintile Lowest 80.5 19.5 100.0 243 Second 86.1 13.9 100.0 257 Middle 80.6 19.4 100.0 233 Fourth 83.5 16.5 100.0 247 Highest 90.3 9.7 100.0 248 Total 15-49 84.3 15.7 100.0 1,228 50-54 71.0 29.0 100.0 109 Total 15-54 83.2 16.8 100.0 1,338 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 4.3 AGE AT FIRST MARRIAGE Marriage is the leading social and demographic indicator of exposure of women to the risk of pregnancy, especially in the case of low levels of contraceptive use. Early marriages in the Ugandan context, where use of family planning is limited, lead to early childbearing and a longer period of exposure of women to reproductive risks, which lead to high cumulative fertility levels. Table 4.3 shows the percentage of women and men who have married by specific exact ages, according to current age. Although the minimum legal age for a woman to get married is 18 years in Uganda, marriage among young girls is a common practice. Among women age 20-49, 15 percent were married by age 15, and 49 percent were married by age 18. The median age at first marriage among women age 25-49 is 17.9 years and has been fairly stable for the past 30 years. However, the trend has shifted toward fewer women marrying at very young ages. The proportion of women married by age 15 has declined over time, from 19 percent among women currently age 45-49 to 3 percent among women currently age 15-19. Men tend to marry at much older ages than women. Among men age 25-49, only 9 percent were married by age 18, and 25 percent by age 20. The median age at marriage for men age 25-49 is 22.3 years, four years older than the median age for women in the same age range, at 17.9 years. The median age at marriage for men age 25-49 has remained the same in the last five years. Marriage and Sexual Activity • 51 Table 4.3 Age at first marriage Percentage of women and men age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Uganda 2011 Current age Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage 15 18 20 22 25 WOMEN 15-19 3.2 na na na na 77.3 2,048 a 20-24 9.9 39.7 61.2 na na 23.9 1,629 18.9 25-29 14.0 48.0 66.8 79.7 90.7 5.6 1,569 18.2 30-34 18.1 52.4 71.8 83.0 91.6 2.3 1,086 17.8 35-39 16.5 52.9 73.4 84.0 91.4 1.5 1,026 17.7 40-44 21.9 55.6 73.1 84.2 93.2 0.8 729 17.6 45-49 19.3 51.3 70.4 79.5 87.9 2.2 587 17.9 20-49 15.4 48.6 68.3 na na 8.1 6,626 18.1 25-49 17.2 51.5 70.6 82.0 91.1 2.9 4,997 17.9 MEN 15-19 0.0 na na na na 96.9 554 a 20-24 0.8 5.5 16.6 na na 63.4 318 a 25-29 0.6 8.0 24.0 47.6 67.6 19.9 361 22.4 30-34 0.3 12.7 27.3 48.7 68.2 6.0 323 22.2 35-39 0.4 6.9 25.4 46.7 67.3 0.9 268 22.4 40-44 0.0 5.2 23.5 48.5 74.7 0.6 191 22.1 45-49 1.0 7.6 26.7 44.0 61.7 0.6 157 23.0 20-49 0.5 7.9 23.6 na na 18.4 1,619 a 25-49 0.4 8.5 25.4 47.4 68.0 7.4 1,301 22.3 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women or men began living with their spouse or partner for the first time before reaching the beginning of the age group Table 4.4 shows the median age at first marriage for women age 20-49 and age 25-49, and for men age 25-54 by background characteristics. Data for women age 15-19 and for men age 15-24 have been omitted because of the small number of married respondents in these age groups. Women age 25-49 living in urban areas marry about two years later than rural women (20 years compared with 17.6 years). The median age at first marriage is highest in Kampala (20.7 years) and lowest in North region at 16.7 years. The median age at first marriage for women age 25-49 is higher among the better educated and the wealthier. Variations by background characteristics among men age 25-54 display a pattern like that among women but are not as pronounced. 52 • Marriage and Sexual Activity Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, and median age at first marriage among men age 25-54, according to background characteristics, Uganda 2011 Background characteristic Women age Men age 20-49 25-49 25-54 Residence Urban a 20.0 a Rural 17.8 17.6 21.9 Region Kampala a 20.7 a Central 1 18.2 17.7 23.0 Central 2 17.8 17.6 22.9 East Central 17.3 17.0 22.5 Eastern 17.6 17.5 21.7 Karamoja 18.4 18.6 20.8 North 16.9 16.7 21.4 West Nile 18.1 17.9 22.3 Western 18.1 17.9 21.9 Southwest 18.9 18.6 22.8 Education No education 16.9 16.9 22.3 Primary 17.4 17.4 21.6 Secondary + a 20.8 24.5 Wealth quintile Lowest 17.5 17.5 21.6 Second 17.5 17.4 21.3 Middle 17.8 17.5 22.2 Fourth 17.8 17.5 21.9 Highest a 19.7 a Total 18.1 17.9 22.5 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner a = Omitted because less than 50 percent of the respondents began living with their spouse/partners for the first time before reaching the beginning of the age group 4.4 AGE AT FIRST SEXUAL INTERCOURSE Although age at first marriage is often used as a proxy for first exposure to sexual intercourse, the two events do not necessarily coincide. In the 2011 UDHS interviewers asked women and men how old they were when they first had sexual intercourse. Table 4.5 shows the percentages of women and men who first had sexual intercourse by specific exact ages. Among women age 25-49, 23 percent first had sexual intercourse before age 15, 64 percent before age 18, and by age 25 the majority of Ugandan women (90 percent) had had sexual intercourse. The median age at first sexual intercourse for women age 25-49 is 16.8 years compared with the median age at first marriage of 17.9 years. This suggests that Ugandan women generally begin sexual intercourse about a year earlier than their first marriage. The median age at first sexual intercourse has increased over the past two decades, from 16.8 years for women currently age 45-49 to 17.5 years for women currently age 20-24. As is the case with age at first marriage, men tend to initiate sexual activity later in life than women. The median age at first sex for men age 25-49 years is 18.6 years, about two years later than for women. The median ages at first intercourse among the different age cohorts suggest no significant change in age at first sexual intercourse for men over the past 30 years. The median age at first sexual intercourse for men age 25-49 years, at 18.6 years, is about four years lower than the median age at first marriage, at 22.3 years. Marriage and Sexual Activity • 53 Table 4.5 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Uganda 2011 Current age Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number of respondents Median age at first intercourse 15 18 20 22 25 WOMEN 15-19 12.2 na na na na 54.9 2,048 a 20-24 16.1 57.9 77.1 na na 8.2 1,629 17.5 25-29 19.6 61.7 77.9 86.6 91.1 0.8 1,569 17.0 30-34 23.7 64.2 81.0 88.4 90.8 0.8 1,086 16.8 35-39 22.7 65.4 80.8 86.9 89.5 0.2 1,026 16.7 40-44 27.2 63.2 79.5 84.7 88.2 0.0 729 16.7 45-49 27.5 64.1 81.7 86.1 89.9 0.0 587 16.8 20-49 21.4 62.1 79.2 na na 2.4 6,626 17.0 25-49 23.1 63.5 79.8 86.7 90.1 0.4 4,997 16.8 15-24 13.9 na na na na 34.2 3,677 a MEN 15-19 17.9 na na na na 59.9 554 a 20-24 12.8 42.9 69.5 na na 14.5 318 18.4 25-29 8.8 37.6 65.2 79.5 89.7 3.3 361 18.8 30-34 7.7 39.4 70.6 84.4 91.4 1.1 323 18.5 35-39 8.8 40.2 67.7 81.3 89.8 0.3 268 18.5 40-44 6.2 35.3 66.6 84.1 89.7 0.0 191 18.6 45-49 6.6 39.5 69.8 83.9 90.4 0.0 157 18.5 20-49 8.8 39.3 68.2 na na 3.9 1,619 18.5 25-49 7.9 38.5 67.8 82.3 90.2 1.3 1,301 18.6 15-24 16.0 na na na na 43.3 872 a 20-54 8.7 39.6 67.9 na na 3.6 1,741 18.5 25-54 7.8 38.8 67.5 82.4 90.2 1.2 1,423 18.6 na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Table 4.6 shows the median age at first sexual intercourse for women and men by current age and background characteristics. Urban women have their first sexual experience at somewhat older ages than rural women. Examination by region reveals that women of the Eastern and East Central regions engage in sexual relations earliest (16.3 and 16.2 years respectively), while their counterparts in the Southwest region initiate sex about two years later, at age 18.7 years. Women with at least some secondary education start sexual relations almost two years later than less educated women. The relationship between the level of household wealth and the initiation of sexual intercourse is not strong. For men age 25-54, the differences in the median age at first sexual intercourse by background characteristics are minimal. The largest differences are observed by region. Men in the West Nile region and the Southwest region start sexual intercourse later than men in other regions (19.3 and 20.0 years, respectively). 54 • Marriage and Sexual Activity Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 20-49 and age 25-49, and median age at first sexual intercourse among men age 20-54 and 25-54, according to background characteristics, Uganda 2011 Background characteristic Women age Men age 20-49 25-49 20-54 25-54 Residence Urban 17.6 17.4 18.4 18.6 Rural 16.8 16.7 18.6 18.5 Region Kampala 17.8 17.6 18.4 18.4 Central 1 16.5 16.3 18.2 18.4 Central 2 16.6 16.5 18.4 18.4 East Central 16.2 15.9 18.4 18.5 Eastern 16.3 16.2 18.4 18.4 Karamoja 17.8 17.9 18.9 19.0 North 16.7 16.6 18.0 18.1 West Nile 17.8 17.6 19.3 19.3 Western 16.9 16.8 18.4 18.3 Southwest 18.7 18.4 a 20.0 Education No education 16.4 16.3 17.9 18.0 Primary 16.6 16.5 18.5 18.5 Secondary + 18.2 18.2 18.8 18.9 Wealth quintile Lowest 16.6 16.6 18.4 18.4 Second 16.9 16.8 18.4 18.4 Middle 16.9 16.6 18.6 18.6 Fourth 16.7 16.5 18.6 18.6 Highest 17.6 17.4 18.6 18.7 Total 17.0 16.8 18.5 18.6 a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group 4.5 RECENT SEXUAL ACTIVITY In societies with low use of contraception, the probability of a woman becoming pregnant is closely related to the exposure to and frequency of sexual intercourse. Therefore, information on sexual activity can be used to refine measures of exposure to pregnancy. Interviewers asked women and men how long ago their last sexual activity occurred, recording whether they had had a sexual encounter in the preceding four weeks. Tables 4.7.1 and 4.7.2 show the percent distributions of women and men by recent sexual activity. Fifty-one percent of all women age 15-49 were sexually active in the four weeks before the survey, 22 percent had been sexually active in the year before the survey but not in the four weeks prior to the interview, and 13 percent had been sexually active at some time in their lives but not for the past one or more years. Fifteen percent of the women had never had sexual intercourse. The highest level of recent sexual activity is observed among women age 25-34 (65 to 67 percent). The proportion of women who are sexually active gradually declines after age 34. The proportion sexually active in the four weeks preceding the survey among women in marital union declines slightly with the number of years in union, from 78 percent among women married for less than five years to 72 percent for women married 25 years or more. Women who were married in the past or who have never been married are less likely to have had sex in the recent past. As expected, women who are currently in union are much more likely to have been sexually active in the four weeks preceding the survey (76 percent) than women who were formerly married (14 percent) or who have never been married (8 percent). Marriage and Sexual Activity • 55 Rural women were more likely to be recently sexually active (52 percent) than urban women (48 percent). Women residing in the North region (56 percent), Western (55 percent), and Central 1 (53 percent) were more likely than women in other regions to have been sexually active in the past four weeks, while women in West Nile (42 percent) were least likely. Women with no education (59 percent) were substantially more sexually active in the recent past than women with some education (46 to 52 percent). Among wealth quintiles the richest women were the least likely to report being sexually active in the past four weeks (49 percent). Table 4.7.1 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Uganda 2011 Background characteristic Timi

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