Ukraine - Demographic and Health Survey - 2008

Publication date: 2008

Ukraine Demographic and Health Survey 2007 U kraine 2007 D em ographic and H ealth Survey UKRAINE DEMOGRAPHIC AND HEALTH SURVEY 2007 Ukrainian Center for Social Reforms Kyiv, Ukraine State Statistical Committee Kyiv, Ukraine Ministry of Health Kyiv, Ukraine Macro International Inc. Calverton, Maryland, U.S.A. September 2008 This report summarizes the findings of the 2007 Ukraine Demographic and Health Survey (UDHS) carried out by the Ukrainian Center for Social Reforms and the State Statistical Committee of Ukraine. Macro International Inc. provided technical assistance through the MEASURE DHS project and the United States Agency for International Development (USAID) provided funding under the terms of contract number GPO-C-00-03-00002-00. The views expressed in this report are those of the authors and do not necessarily reflect the views of the United States Agency for International Development or the United States Government or the Government of Ukraine. The 2007 UDHS is part of the worldwide Demographic and Health Surveys program, which is designed to assist developing countries to collect data on fertility, reproductive health, maternal and child health, nutrition, and HIV/AIDS. Additional information about the survey may be obtained from: Ukrainian Center for Social Reforms, 26, Panasa Myrnogo Street, Kyiv, 01011, Ukraine, (Telephone/Fax: +380-44-280-8210; E-mail: ucsr@mail.ru) and from the State Statistical Committee of Ukraine, 3, Shota Rustavely Street, Kyiv- 23,01023, Ukraine (Telephone: +380-287-24-33, Fax: +380-235-37-39; E-mail: office@ukrstat.gov.ua). Additional information about the MEASURE DHS project may be obtained from: Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (Telephone: 1-301-572-0200; Fax: 1-301-572-0999; Email: reports@macrointernational.com; Internet: www.measuredhs.com). Cover photo: The Kyivan Cave Monastery (Kyievo-Pecherska Lavra) is an Orthodox monastery founded in the mid-11th century on the hilly banks of the Dnieper River in Kiev. It is part of an architectural complex that includes eight churches. It figures prominently in the history of the Ukrainian people and is one of the most important spiritual and cultural sites in Ukraine. Recommended citation: Ukrainian Center for Social Reforms (UCSR), State Statistical Committee (SSC) [Ukraine], Ministry of Health (MOH) [Ukraine], and Macro International Inc. 2008. Ukraine Demographic and Health Survey 2007. Calverton, Maryland, USA: UCSR and Macro International. Contents | iii CONTENTS TABLES AND FIGURES . ix PREFACE . xv ACKNOWLEDGEMENTS. xvii SUMMARY OF FINDINGS . xix MAP OF UKRAINE . xxvi CHAPTER 1 INTRODUCTION 1.1 Geography and Population .1 1.2 Characteristics of the Health System of Ukraine .2 1.2.1 Network of Health Institutions, System of Management and Funding, and Basic Problems of the Health System .2 1.2.2 Specific Health Care Services and selected Programs .3 1.3 Systems for Collecting Demographic and Health Data .5 1.4 Objectives and Organization of the Survey .5 1.4.1 Sample Design and Implementation .6 1.4.2 Questionnaires .6 1.4.3 Training of Field Staff .7 1.4.4 Fieldwork and Data Processing .7 1.5 Response Rates.8 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Characteristics of the Population.9 2.1.1 Age-Sex Structure .9 2.1.2 Children’s Living Arrangements and Orphanhood.11 2.1.3 Household Composition .12 2.1.4 Education .12 2.2 Housing Characteristics.15 2.3 Wealth Quintiles .19 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3.1 Background Characteristics of Respondents .21 3.2 Educational Level of Respondents.22 3.3 Exposure to Mass Media .24 3.4 Employment .25 3.5 Occupation .29 3.6 Employment Characteristics .30 3.7 Male Circumcision.31 CHAPTER 4 FERTILITY 4.1 Current Fertility .33 4.2 Fertility Differentials by Background Characteristics .34 4.3 Fertility Trends.36 4.4 Children Ever Born and Living .36 4.5 Birth Intervals .37 iv | Contents 4.6 Age at First Birth .39 4.7 Teenage Pregnancy and Motherhood .41 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods .43 5.2 Ever Use of Contraception .44 5.3 Current Use of Contraception.46 5.4 Current Use of Contraception by Background Characteristics.47 5.5 Trends in Current Use of Family Planning .48 5.6 Number of Children at First Use of Contraception .49 5.7 Knowledge of Fertile Period.49 5.8 Source of Contraception.50 5.9 Payment of Fees for Modern Contraceptive Methods.51 5.10 Informed Choice .51 5.11 Contraceptive Discontinuation.52 5.12 Future Contraception.53 5.13 Reasons for Nonuse of Contraception .54 5.14 Preferred Method of Contraception for Future Use .54 5.15 Exposure to Family Planning Messages.55 5.16 Contact of Nonusers with Family Planning Providers.56 5.17 Husband’s Knowledge of Wife’s Use of Contraception .57 CHAPTER 6 ABORTION 6.1 Pregnancies Ending in Induced Abortion.59 6.2 Lifetime Experience with Induced Abortion .60 6.3 Rates of Induced Abortion .61 6.4 Use of Contraceptive Methods Before Abortion .63 CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY 7.1 Current Marital Status .65 7.2 Age at First Marriage .66 7.3 Age at First Sexual Intercourse .68 7.4 Recent Sexual Activity.69 7.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility .72 7.6 Menopause .72 CHAPTER 8 FERTILITY PREFERENCES 8.1 Desire for More Children.73 8.2 Desire to Limit Childbearing by Background Characteristics .74 8.3 Need for Family Planning Services .74 8.4 Ideal Family Size.76 8.5 Fertility Planning .77 8.6 Circumstances Under Which a Woman Should Not Become Pregnant .78 8.7 Attitudes Toward Adopting a Child .80 Contents | v CHAPTER 9 INFANT AND CHILD MORTALITY 9.1 Definitions and Methodology.83 9.2 Assessment of Data Quality.83 9.3 Levels and Trends in Infant and Child Mortality .84 9.4 Socioeconomic Differentials in Childhood Mortality .85 9.5 Perinatal Mortality .86 CHAPTER 10 ANTENATAL CARE, POSTNATAL CARE, AND INFANT AND YOUNG CHILD FEEDING 10.1 Antenatal Care.87 10.1.1 Antenatal Care Provider.87 10.1.2 Number and Timing of ANC Visits .87 10.1.3 Antenatal Care Content .89 10.2 Assistance and Medical Care at Delivery .91 10.2.1 Place of Delivery .91 10.2.2 Attended Deliveries .91 10.2.3 Caesarean Section Delivery .92 10.3 Postnatal Care .92 10.4 Child Nutrition .93 10.4.1 Initiation of Breastfeeding .93 10.4.2 Breastfeeding Patterns by Age .95 10.4.3 Supplemental Foods .96 CHAPTER 11 ADULT HEALTH 11.1 Tuberculosis .99 11.1.1 Knowledge about Tuberculosis and How Tuberculosis Spreads. 100 11.1.2 Knowledge that Tuberculosis is Curable . 101 11.1.3 Willingness to Keep Secret a Family Member’s Tuberculosis Status . 102 11.1.4 Knowledge about Tuberculosis Symptoms . 102 11.1.5 Misconceptions about the Way Tuberculosis Spreads . 104 11.1.6 Self-reporting of Tuberculosis Diagnosis and Treatment . 106 11.2 High Blood Pressure . 106 11.3 Use of Tobacco . 110 11.3.1 Smoking Cigarettes . 110 11.3.2 Age at First Smoking . 112 11.3.3 Attitudes About Smoking . 113 11.4 Alcohol Consumption . 114 11.4.1 Use of Alcohol . 115 11.4.2 Age at First Alcoholic Drink. 117 11.5 Illicit Drug Use. 117 CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 12.1 Knowledge of HIV/AIDS and of Transmission and Prevention Methods . 119 12.1.1 Awareness of AIDS . 119 12.1.2 Knowledge of Ways to Reduce HIV/AIDS Transmission. 120 12.2 Comprehensive Knowledge about HIV/AIDS . 121 12.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV. 123 12.4 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS . 124 12.5 Attitudes Toward Negotiating Safer Sex. 127 vi | Contents 12.6 Attitudes Toward Condom Education for Youth and Beliefs about Abstinence and Faithfulness. 128 12.7 Higher-Risk Sex . 130 12.7.1 Multiple Sexual Partners, Higher-Risk Sex, and Condom Use. 130 12.7.2 Paid Sex . 133 12.8 Coverage of HIV Counseling and Testing . 134 12.8.1 HIV Testing and Counseling for Pregnant Women . 137 12.8.2 Self-Reporting of Sexually Transmitted Infections (STIs) . 137 12.8.3 Prevalence of Medical Injections. 139 12.8.4 Comprehensive HIV/AIDS Knowledge and Source of Condoms among Youth . 140 12.8.5 Trends in Age at First Sex. 141 12.8.6 Condom Use at First Sex. 142 12.8.7 Abstinence and Premarital Sex. 143 12.8.8 Higher-Risk Sex and Condom Use among Young Adults . 145 12.8.9 Cross-generational Sexual Partners. 146 12.8.10 Drunkenness During Sex Among Young Adults . 147 12.8.11 Voluntary HIV Counseling and Testing among Young Adults . 148 CHAPTER 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 13.1 Employment and Cash Earnings . 151 13.2 Use of Earnings . 152 13.3 Household Decisionmaking . 155 13.4 Attitudes toward Wife Beating . 158 13.5 Attitudes toward Refusing Sexual Intercourse . 160 CHAPTER 14 DOMESTIC VIOLENCE 14.1 Women Experiencing Physical Violence. 166 14.2 Perpetrators of Physical Violence Against Women. 167 14.3 Force at Sexual Initiation . 168 14.4 Experience of Sexual Violence and Perpetrators of Sexual Violence . 169 14.5 Experience of Different Types of Violence . 170 14.6 Violence during Pregnancy . 170 14.7 Marital Control by Husband or Partner . 171 14.8 Types of Spousal Violence . 174 14.8.1 Women’s reports of spousal violence. 174 14.8.2 Men’s reports of spousal violence . 176 14.8.3 Differentials in reported levels of violence. 177 14.9 Violence by Spousal Characteristics and Women’s Indicators. 179 14.10 Frequency of Spousal Violence by Husbands . 180 14.11 Onset of Spousal Violence . 181 14.12 Types of Injuries to Women Resulting from Spousal Violence . 182 14.13 Physical Violence by Women Against their Spouse. 183 14.14 Women Who Experienced Violence and Sought Help . 185 14.15 Men Experiencing Physical Violence . 187 14.16 Perpetrators of Physical Violence Against Men . 187 14.17 Location of Physical Violence Against Men . 188 Contents | vii CHAPTER 15 HUMAN TRAFFICKING 15.1 Working Abroad . 189 15.2 Awareness and Experience of Human Trafficking. 191 15.3 Intention to Work Abroad and the Risk of Human Trafficking . 194 REFERENCES . 199 APPENDIX A SAMPLE DESIGN . 203 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 211 APPENDIX C DATA QUALITY TABLES . 223 APPENDIX D PERSONS INVOLVED IN THE 2007 UKRAINE DEMOGRAPHIC AND HEALTH SURVEY . 227 APPENDIX E QUESTIONNAIRES Household Questionnaire. 231 Woman’s Questionnaire . 247 Man’s Questionnaire . 305 Tables and Figures | ix TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 8 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . 10 Table 2.2 Children’s living arrangements and orphanhood . 11 Table 2.3 Household composition . 12 Table 2.4.1 Educational attainment of the female household population . 14 Table 2.4.2 Educational attainment of the male household population . 14 Table 2.5 Household drinking water . 16 Table 2.6 Household sanitation facilities . 17 Table 2.7 Household characteristics . 18 Table 2.8 Household possessions . 19 Table 2.9 Wealth quintiles . 20 Figure 2.1 Population pyramid . 10 Figure 2.2 Age-specific school attendance rates . 15 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . 22 Table 3.2.1 Educational attainment: women . 23 Table 3.2.2 Educational attainment: men . 23 Table 3.3.1 Exposure to mass media: women . 24 Table 3.3.2 Exposure to mass media: men . 25 Table 3.4.1 Employment status: women . 27 Table 3.4.2 Employment status: men . 28 Table 3.5.1 Occupation: women. 29 Table 3.5.2 Occupation: men . 30 Table 3.6 Type of employment: women . 31 Figure 3.1 Employment status of women and men age 15-49 . 26 Figure 3.2 Percentage of women and men age 15-49 who are currently employed, by background characteristics . 28 Figure 3.3 Male circumcision by region . 32 CHAPTER 4 FERTILITY Table 4.1 Current fertility . 33 Table 4.2 Fertility by background characteristics . 35 Table 4.3 Trends in age-specific fertility rates . 36 Table 4.4 Children ever born and living . 37 Table 4.5 Birth intervals . 38 Table 4.6 Age at first birth . 40 Table 4.7 Median age at first birth . 40 Table 4.8 Teenage pregnancy and motherhood . 41 x | Tables and Figures Figure 4.1 Age-specific fertility rates by urban-rural residence . 34 Figure 4.2 Total fertility rates for the three-year period preceding survey . 35 Figure 4.3 Percentage of births occurring after a short birth interval (less than 24 months after a prior birth) . 39 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods . 44 Table 5.2.1 Ever use of contraception: women . 45 Table 5.2.2 Ever use of contraception: men . 46 Table 5.3 Current use of contraception by age . 47 Table 5.4 Current use of contraception by background characteristics . 48 Table 5.5 Number of children at first use of contraception . 49 Table 5.6 Knowledge of fertile period . 49 Table 5.7 Source of modern contraception methods . 50 Table 5.8 Cost of modern contraceptive methods . 51 Table 5.9 Informed choice . 52 Table 5.10 First-year contraceptive discontinuation rates . 52 Table 5.11 Reasons for discontinuation . 53 Table 5.12 Future use of contraception . 54 Table 5.13 Reason for not intending to use contraception in the future . 54 Table 5.14 Preferred method of contraception for future use . 55 Table 5.15 Exposure to family planning messages . 55 Table 5.16 Contact of nonusers with family planning providers . 57 Table 5.17 Husband/partner’s knowledge of women’s use of contraception . 58 CHAPTER 6 ABORTION Table 6.1 Pregnancy outcome by background characteristics . 59 Table 6.2 Lifetime experience with induced abortion . 60 Table 6.3 Induced abortion rates . 61 Table 6.4 Induced abortion rates by background characteristics . 63 Table 6.5 Use of contraception before pregnancy . 64 Figure 6.1 Age-specific fertility rates (ASFR) and age-specific abortion rates (ASAR) . 62 Figure 6.2 Use of contraception before abortion . 64 CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 7.1 Current marital status . 65 Table 7.2 Age at first marriage . 66 Table 7.3.1 Median age at first marriage: women . 67 Table 7.3.2 Median age at first marriage: men . 67 Table 7.4 Age at first sexual intercourse . 68 Table 7.5.1 Median age at first intercourse: women . 69 Table 7.5.2 Median age at first intercourse: men . 69 Table 7.6.1 Recent sexual activity: women . 70 Table 7.6.2 Recent sexual activity: men . 71 Table 7.7 Postpartum amenorrhea, abstinence, and insusceptibility . 72 Table 7.8 Menopause . 72 Tables and Figures | xi CHAPTER 8 FERTILITY PREFERENCES Table 8.1 Fertility preferences by number of living children . 73 Table 8.2 Desire to limit childbearing . 74 Table 8.3 Need and demand for family planning among currently married women . 75 Table 8.4 Ideal number of children . 76 Table 8.5 Fertility planning status . 77 Table 8.6 Wanted fertility rates . 78 Table 8.7 Perceived any circumstances under which a woman should not become pregnant . 79 Table 8.8 Circumstances under which a woman should not become pregnant . 79 Table 8.9 Attitudes about what a woman should do if she becomes pregnant under circumstances when she should not be pregnant . 80 Table 8.10 Attitudes about what a woman should do when a child is born as a result of a pregnancy that should not have occurred . 80 Table 8.11 Attitudes towards adopting a child . 81 Table 8.12 Circumstances for considering an adoption . 81 Table 8.13 Finding care for child . 82 CHAPTER 9 INFANT AND CHILD MORTALITY Table 9.1 Early childhood mortality rates . 84 Table 9.2 Early childhood mortality rates by background characteristics . 85 Table 9.3 Perinatal mortality . 86 Figure 9.1 Infant mortality rate estimates from registration system, 2007 UDHS, and 1999 URHS (with confidence intervals) . 85 CHAPTER 10 ANTENATAL CARE, POSTNATAL CARE, AND INFANT AND YOUNG CHILD FEEDING Table 10.1 Antenatal care . 88 Table 10.2 Number of antenatal care visits and timing of first visit . 89 Table 10.3 Components of antenatal care . 90 Table 10.4 Place of delivery . 91 Table 10.5 Assistance during delivery . 92 Table 10.6 Timing of first postnatal checkup. 93 Table 10.7 Initial breastfeeding . 94 Table 10.8 Breastfeeding status by age . 95 Table 10.9 Foods and liquids consumed by children in the day and night preceding the interview . 97 Figure 10.1 Median duration of breastfeeding . 96 CHAPTER 11 ADULT HEALTH Table 11.1.1 Knowledge and attitude concerning tuberculosis: women . 100 Table 11.1.2 Knowledge and attitude concerning tuberculosis: men . 101 Table 11.2.1 Knowledge of symptoms of tuberculosis: women . 103 Table 11.2.2 Knowledge of symptoms of tuberculosis: men . 103 Table 11.3 Misconception about tuberculosis transmission . 105 Table 11.4.1 Levels of hypertension: women . 108 Table 11.4.2 Levels of hypertension: men . 109 xii | Tables and Figures Table 11.5.1 Use of tobacco: women . 111 Table 11.5.2 Use of tobacco: men . 112 Table 11.6 Age at first smoking . 112 Table 11.7 Smoking inside home and attitudes about smoking at work and in public places . 114 Table 11.8.1 Use of alcohol: women . 116 Table 11.8.2 Use of alcohol: men . 116 Table 11.9 Age at first alcoholic drink . 117 Table 11.10 Ever use of narcotics . 118 Figure 11.1 Knowledge and misconceptions about how tuberculosis is transmitted . 106 Figure 11.2 Awareness of hypertension and treatment status among hypertensive women and men age 15-49 . 110 CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 12.1 Knowledge of AIDS. 119 Table 12.2 Knowledge of HIV prevention methods . 120 Table 12.3.1 Comprehensive knowledge about AIDS: women . 121 Table 12.3.2 Comprehensive knowledge about AIDS: men . 122 Table 12.4 Knowledge of prevention of mother to child transmission of HIV . 124 Table 12.5.1 Accepting attitudes toward those living with HIV/AIDS: women . 126 Table 12.5.2 Accepting attitudes toward those living with HIV/AIDS: men . 127 Table 12.6 Attitudes toward negotiating safer sexual relations with husband . 128 Table 12.7 Adult support of education about condom use to prevent AIDS . 129 Table 12.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: women . 132 Table 12.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: men . 133 Table 12.9 Payment for sexual intercourse: men . 134 Table 12.10.1 Coverage of prior HIV testing: women . 135 Table 12.10.2 Coverage of prior HIV testing: men . 136 Table 12.11 Pregnant women counseled and tested for HIV . 137 Table 12.12 Self-reported prevalence of sexually transmitted infections (STIs) and STIs symptoms . 138 Table 12.13 Prevalence of medical injections . 139 Table 12.14 Comprehensive knowledge about AIDS and of a source of condoms among youth . 140 Table 12.15 Age at first sexual intercourse among youth . 142 Table 12.16 Condom use at first sexual intercourse among youth . 143 Table 12.17 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 144 Table 12.18.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: women . 145 Table 12.18.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: men . 146 Table 12.19 Age-mixing in sexual relationships among women age 15-19 and 15-24 . 147 Table 12.20 Drunkenness during sexual intercourse among youth . 148 Table 12.21 Recent HIV tests among youth . 149 Figure 12.1 Perceptions and beliefs about abstinence and faithfulness . 130 Tables and Figures | xiii CHAPTER 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 13.1 Employment and cash earnings of currently married women and men . 152 Table 13.2.1 Control over women’s cash earnings and relative magnitude of women’s earnings: women . 153 Table 13.2.2 Control over men’s cash earnings . 154 Table 13.3 Women’s control over their own earnings and over those of their husband . 155 Table 13.4.1 Women’s participation in decisionmaking . 155 Table 13.4.2 Women’s participation in decisionmaking according to men . 156 Table 13.5.1 Women’s participation in decisionmaking by background characteristics . 157 Table 13.5.2 Men’s attitudes toward wife’s participation in decisionmaking . 158 Table 13.6.1 Attitudes toward wife beating: women . 159 Table 13.6.2 Attitudes toward wife beating: men . 160 Table 13.7.1 Attitudes toward wife refusing sexual intercourse with husband: women . 161 Table 13.7.2 Attitudes toward wife refusing sexual intercourse with husband: men . 162 Table 13.7.3 Men’s attitudes toward a husband’s rights when his wife refuses to have sexual intercourse . 163 Figure 13.1 Number of decisions in which currently married women participate . 156 CHAPTER 14 DOMESTIC VIOLENCE Table 14.1 Women’s experience of physical violence . 167 Table 14.2 Persons committing physical violence . 168 Table 14.3 Force at sexual initiation . 168 Table 14.4 Experience of sexual violence . 169 Table 14.5 Persons committing sexual violence . 170 Table 14.6 Experience of different types of violence . 170 Table 14.7 Violence during pregnancy . 171 Table 14.8.1 Degree of marital control exercised by husbands according to women’s reports . 172 Table 14.8.2 Degree of marital control exercised by husbands according to men’s reports . 173 Table 14.9.1 Women’s experience of spousal violence according to women’s reports . 174 Table 14.9.2 Women’s experience of spousal violence according to men’s reports . 176 Table 14.10 Spousal violence according to women’s reports by background characteristics 177 Table 14.11 Spousal violence by husband’s characteristics and empowerment indicators . 180 Table 14.12 Frequency of spousal violence among women who reported violence . 181 Table 14.13 Onset of marital violence . 182 Table 14.14 Injuries to women as a result of spousal violence . 182 Table 14.15.1a Violence by women against their spouse according to women’s reports . 183 Table 14.15.1b Violence by women against their spouse according to women’s reports (continuation) . 184 Table 14.15.2 Violence by women against their spouse according to men’s reports . 185 Table 14.16 Help seeking to stop violence . 186 Table 14.17 Sources where help was sought . 186 Table 14.18 Men’s experience of physical violence . 187 Table 14.19 Persons committing nonspousal physical violence . 188 Figure 14.1 Percentage of ever-married women who have experienced specific types of physical or sexual violence committed by their current or most recent husband/partner, ever and during the past 12 months . 175 Figure 14.2 Spousal violence reported by ever-married women and men age 15-49 . 178 xiv | Tables and Figures Figure 14.3 Spousal violence by husbands against wives according to whether respondent’s father had a history of beating respondent’s mother, as reported by women and men . 179 Figure 14.4 Location where nonspousal physical violence was committed against men in the past 12 months . 188 CHAPTER 15 HUMAN TRAFFICKING Table 15.1 Household members working abroad . 190 Table 15.2 Prevalence of household members working abroad . 190 Table 15.3 Legal working permits . 191 Table 15.4 Awareness of human trafficking . 192 Table 15.5 Prevalence of human trafficking . 193 Table 15.6 Intention to work abroad . 194 Table 15.7 Perception of risk of human trafficking . 195 Table 15.8 Perception of risk of human trafficking over time . 196 Table 15.9 Reasons for perceiving lower risk of human trafficking . 197 Table 15.10 Reasons for perceiving higher risk of human trafficking . 198 APPENDIX A SAMPLE DESIGN Table A.1 Population distribution in Ukraine by administrative regions and by type of residence, based on 2001 population census . 204 Table A.2 Sample allocation of clusters and households according to geographical/ administrative regions and by type of residence . 205 Table A.3 Sample allocation of expected number of completed women and men interviews according to geographical/administrative regions and by type of residence . 206 Table A.4.1 Sample implementation: women . 208 Table A.4.2 Sample implementation: men . 209 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 213 Table B.2 Sampling errors for National sample . 214 Table B.3 Sampling errors for Urban sample . 215 Table B.4 Sampling errors for Rural sample . 216 Table B.5 Sampling errors for North sample . 217 Table B.6 Sampling errors for Central sample . 218 Table B.7 Sampling errors for East sample . 219 Table B.8 Sampling errors for South sample . 220 Table B.9 Sampling errors for West sample . 221 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 223 Table C.2.1 Age distribution of eligible and interviewed women . 224 Table C.2.2 Age distribution of eligible and interviewed men . 224 Table C.3 Completeness of reporting . 225 Table C.4 Births by calendar years . 225 Table C.5 Reporting of age at death in days . 226 Table C.6 Reporting of age at death in months . 226 Preface | xv PREFACE The many critical demographic and social problems facing Ukraine today call for the development of an efficient and flexible social and demographic policy to meet the country’s needs. The development of this policy requires the implementation of special surveys to provide information on the demographic situation in Ukraine and the state of the national health care system. The results of the 2007 Ukraine Demographic and Health Survey (UDHS) allow analysis of a wide range of data on fertility and fertility-related variables that cannot be obtained from current Ukrainian statistics. Of particular interest are data on the number of births in different subgroups of the population by wealth quintiles, the mean number of children ever born, the length of birth intervals, and other proximate determinants of fertility. The experience of retrospective national sample surveys like the 2007 UDHS that focus on marriage, family characteristics, and attitudes toward childbearing, has proved useful for many countries, and indicates that the use of demographic and health surveys is completely justified as a method of social and demographic inquiry. In particular, the 2007 UDHS provides valuable information on attitudes toward childbearing and family building, such as: desired and ideal number of children, intention to limit or space the births of children in the family, and the demand for family planning services in different subgroups of the population. The 2007 UDHS is also a source of extensive information linked to gender, such as factors related to women’s autonomy in decisionmaking, particularly financial decisionmaking in the household, respondents’ attitudes toward sexual relations between spouses, and the problem of domestic violence. In terms of the preservation of women’s health, the chapter on abortion is of considerable importance. In particular, this chapter shows the improvement in the abortion situation since 1999 as a result of the increased use of modern family planning methods. The survey uncovered an important association between induced abortion rates and the number of pregnancies and the number of living children a woman has. Discovering this association would not have been possible using the existing data from current statistics. Information from the UDHS on antenatal care and population awareness of tuberculosis and HIV/AIDS is crucial for developing a well-informed national health care policy. The 2007 UDHS findings include a large body of information on knowledge and use of contraception by various residential and social subgroups in Ukraine. This information will be useful in expanding awareness of modern contraceptive methods to different population strata and in identifying the factors influencing the choice of contraceptive methods and their use. Therefore, the 2007 UDHS results presented in this report will be useful to a large body of experts who focus on the Ukrainian demographic situation and the status of the national health care system as well as to program managers developing strategic activities aimed at overcoming the crisis phenomena existing in these fields. Nataliya Vlasenko Deputy Chairperson State Statistics Committee of Ukraine Acknowledgments | xvii ACKNOWLEDGMENTS The Ukrainian Center for Social Reforms is grateful to all those involved in the implementation of the 2007 Ukraine Demographic and Health Survey (UDHS) and the preparation of this final report. Implementation of the 2007 UDHS was made possible by the generous financial support provided by the United States Agency for International Development (USAID). Particular thanks go to the USAID/Kyiv office representatives, Leslie Perry and Stephan Solat, who have been unfailingly cooperative and supportive. A special expression of gratitude is addressed to our colleagues from Macro International Inc. for providing valuable technical support during the survey design, staff training, data processing, and analysis of the data collected. Additionally, much of this report was prepared by the team of highly qualified and experienced specialists at Macro International Inc. We especially want to acknowledge the cooperation of Bernard Barrere, Gulnara Semenov, Alexander Izmukhambetov, and Sherrell Goggin, who visited Ukraine to assist the national project staff in implementation of the 2007 UDHS. Throughout all stages of the survey, we were assisted and encouraged by the incredibly strong organizational and methodological support received from the State Statistical Committee of Ukraine. We deeply appreciate the positive and professional cooperation of Nataliya Vlasenko, SSC Deputy Chairperson, Lyubov Stelmakh, Director of the Department of Population, and other SSC employees whose devoted work contributed so much to the completion of this ambitious survey in Ukraine. The contributions and comments received from specialists at the Ministry of Health of Ukraine were important to the development of the survey instrument and preparation of both the preliminary and final reports. We are grateful to Tetyana Tatarchuk and Valentyna Kolomeychuk for their participation in the finalization of the report. We also benefited from comments on the UDHS questionnaire design from a number of government institutions and NGOs. It seems unfair to single out a few for particular thanks. We were pleased that many organizations in Ukraine were interested in contributing to the contents of the questionnaires, and we are grateful for the feedback they provided, which allowed us to estimate needed demographic and health indicators. We also want to thank the people who ensured the successful completion of the 2007 UDHS by carrying out their day-to-day work. With great pleasure we acknowledge the devoted and committed work of the national UDHS team, made up not only of managers at headquarters and specialists, but also the numerous teams of interviewers, listers, and data processing operators. The names of these people are listed in Appendix D in this report. We would like to thank you, dear reader, for the attention paid to this report. We hope that the analysis presented herein will help you to answer your questions about the complex new challenges facing Ukraine. The ultimate reward for us will be to see the UDHS data used to good purpose in Ukraine, to develop new strategies and programs to improve the demographic and health situation throughout the country. We believe that the UDHS data are comprehensive and of such quality as to provide a solid base on which to build demographic and health care policy in Ukraine for many years to come. Ella Libanova, Doctor of Economics, Professor National Director, 2007 Ukraine DHS Director, Ukrainian Center for Social Reforms Summary of Findings � xix SUMMARY OF FINDINGS The Ukraine Demographic and Health Survey (UDHS) is a nationally representative survey of 6,841 women age 15-49 and 3,178 men age 15-49. Survey fieldwork was conducted during the period July through November 2007. The UDHS was conducted by the Ukrainian Cen- ter for Social Reforms in close collaboration with the State Statistical Committee of Ukraine. The MEASURE DHS Project provided technical sup- port for the survey. The U.S. Agency for Interna- tional Development/Kyiv Regional Mission to Ukraine, Moldova, and Belarus provided funding. CHARACTERISTICS OF RESPONDENTS The majority, slightly more than 70 percent of the UDHS respondents, live in urban areas. Around one-third of respondents live in the East Region. All households in Ukraine have electricity. Nearly all use improved water sources and improved toi- lets, but only two-thirds of households have water piped into the residence and just over half have a flush toilet. Two-thirds of urban households (76 percent have a flush or pour flush toilet, while the majority of rural households (80 percent) have a pit latrine with a slab. Nearly all households have a finished floor, a color television, and a refrigera- tor; one-fourth have a car or truck, and one-fifth of households have a computer. Women and men in Ukraine are universally well educated. All have attained at least some second- ary or higher education; about one-quarter of women and men in the sample have a technikum education, and nearly one-third have attended uni- versity (33 percent of women and 27 of percent men). Seventy-four percent of women and 81 per- cent of men were employed in the 12 months pre- ceding the survey. FERTILITY Fertility rates. A useful index of the level of fer- tility is the total fertility rate (TFR), which indi- cates the number of children a woman would have if she passed through the childbearing ages at the current age-specific fertility rates (ASFR). The TFR, estimated for the three-year period preceding the survey, is 1.2 children per woman. This is be- low replacement level. The survey found that the TFR is lower in urban areas (1.0 children per woman) than in rural areas (1.5 children per woman). This urban-rural differ- ence in childbearing rates can be attributed almost exclusively to fertility differences in the younger age groups. Age-specific fertility rates indicate that fertility peaks at age 20-24 in both urban and rural areas, but the urban rate (85 births per 1,000 women) is much lower than the rural rate (122 births per 1,000 women), a difference of 37 births per 1,000 women. Trends in fertility. The total fertility rate of 1.2 children per woman (estimated for the three-year period preceding the survey) suggests there has been a small decrease from the rate of 1.4 children observed in the 1999 Ukraine Reproductive Health Survey. Age at first birth. Research has shown that child- bearing in the teenage years is associated with in- creased social and health problems for both the mother and her child. The UDHS found that only 3 percent of women age 15-19 had given birth. Moreover, almost all births among teenage women occurred at ages 18 and 19. Thus, the median age at initiation of childbearing in Ukraine is about 22 years. Birth intervals. Research has shown that children born soon after a previous birth, especially those born within two years of a previous birth, have an increased risk of illness and death. In Ukraine, on- ly 13 percent of second and higher order births occur after a birth interval of less than two years. The proportion of closely spaced births is highest among women in lowest wealth quintile (28 per- cent). Fertility preferences. Among currently married women, 58 percent reported that they either wanted no more children or were sterilized. Another 24 percent want another child, and 18 percent are infecund (unable to conceive) or unde- cided about having another child. xx | Summary of Findings CONTRACEPTION Knowledge and ever use. Knowledge of contra- ception is widespread in Ukraine. Among married women, knowledge of at least one method is uni- versal (99 percent). On average, married women reported knowledge of seven methods of contra- ception. Eighty-nine percent of married women have used a method of contraception at some time. Current use. Two-thirds (67 percent) of married women reported that they were currently using a contraceptive method: 48 percent were using mod- ern methods and 19 percent were using traditional methods. By far, the most commonly used method is the male condom (24 percent). The second most common method—the IUD—is used by 18 per- cent, and 10 percent of currently married women use withdrawal. Overall, levels of contraceptive use are similar for women in urban and rural areas, and similar across educational categories and wealth quintiles (be- tween 62 and 71 percent). Nevertheless, urban women and women with higher education show distinctive behavior patterns by relying more on modern methods and less on traditional methods. Among married women, the proportion using modern methods increases with household wealth status (wealth quintile). Current use of any modern contraceptive method is highest among sexually active unmarried wom- en (79 percent); these women rely primarily on the male condom (59 percent). Trends in current use. Overall, use of contracep- tion has changed little in the past five years, with 68 percent of married women age 15-44 reporting use of a method in the 1999 Ukraine Reproductive Health Survey (URHS) and 70 percent reporting use of a method in the 2007 UDHS.1 However, a closer look at the findings shows that the UDHS results indicate a decrease in the use of traditional methods, particularly withdrawal, and an increase in the use of modern methods, particularly the male condom. Method failure. A woman may discontinue use of contraception for many reasons including the de- sire to have more children, method failure, health 1 The base female population in the UDHS is women age 15-49; in the 1999 URHS the base is women age 15-44. To compare contraceptive use in the two sur- veys, the UDHS data on contraceptive use were com- puted for married women age 15-44. concerns, or lack of exposure to the risk of preg- nancy. In Ukraine, the most common reason for contraceptive discontinuation is the desire for a more effective method (14 percent). Another 12 percent of women discontinued use because of method failure, i.e., becoming pregnant while us- ing a method. The most commonly used traditional method, withdrawal, has the second highest failure rate after periodic abstinence (rhythm). Thirty-six percent of women practicing withdrawal expe- rience a contraceptive failure within 12 months of beginning use. Future use. Among married women who were not using contraception, 19 percent reported that they intended to use in the future. When asked which method they preferred, almost one-third (29 per- cent) of nonusers said they preferred the male condom, followed by the IUD (26 percent) and the pill (10 percent). Just 9 percent of women reported withdrawal as their preferred method and 7 percent reported periodic abstinence (rhythm). Source of supply. Most users of modern methods reported that they obtained their methods either through the pharmacy (49 percent) or the public medical sector (28 percent)—primarily women’s consultations, hospitals, and polyclinics. Two per- cent obtained their contraceptive supplies from the private medical sector, and 20 percent obtained them from other sources, primarily friends, rela- tives, and neighbors. INDUCED ABORTION In Ukraine, as in all of the former Soviet Union, induced abortion has been the primary means of fertility control for many years. Abortion rates. The use of abortion can be meas- ured by the total abortion rate (TAR), which indi- cates the number of abortions a woman would have in her lifetime if she passed through her childbearing years at the current age-specific abor- tion rates. The UDHS estimate of the TAR indi- cates that a woman in Ukraine will have an aver- age of 0.4 abortions during her lifetime. This rate is considerably lower than the comparable rate in the 1999 Ukraine Reproductive Health Survey (URHS) of 1.6. Despite this decline, among preg- nancies ending in the three years preceding the survey, one in four pregnancies (25 percent) ended in an induced abortion. Abortion differentials. Abortion rates are slightly higher among women in rural areas (0.6) than in urban areas (0.4). By region, the TAR ranges from Summary of Findings � xxi 0.3 in the West Region to 0.6 in the Central Re- gion. There is only a slight difference in the TAR by education. Women in the lowest wealth quintile have the highest TAR (0.7) while women in the two highest wealth quintiles have the lowest TAR (0.3). Contraceptive failure and abortion. When for- mulating policies designed to improve the repro- ductive health of women, it is useful to know the contraceptive behavior of women who use abor- tion as a means of fertility control. Two-thirds (66 percent) of all abortions took place among women who were using contraception and experienced method failure. A large proportion of women (42 percent) were using a traditional method, particu- larly withdrawal (28 percent). Greater access to and use of reliable contraceptive methods would reduce the abortion rate. Attitudes toward abortion. In the UDHS, women and men were asked a series of questions on atti- tudes related to abortion. Forty-five percent of women and 59 percent of men age 15-49 who think there are circumstances in which a woman should not become pregnant, reported that they think a pregnancy conceived under such circums- tances should be terminated or aborted. Only18 percent of women and 12 percent of men reported that they think such a pregnancy should be contin- ued. On the other hand, 32 percent of women and 22 percent of men said that it is up to the woman to decide about the pregnancy. Attitudes toward adoption. In the UDHS, all women and men were asked if they would ever consider adopting a child. Overall, women and men in Ukraine are not generally supportive of adopting children. Only 15 percent of both women and men said they would consider adopting a child. The major reasons for considering an adoption would be if the individual or their spouse had fer- tility problems, if the child was a family member, or out of compassion for orphans. In addition, 29 percent of women and 15 percent of men said that they would consider an adoption if they had enough money to afford it. All women and men in the UDHS were asked what they considered to be the best thing to do for a child whose parents could no longer care for the child. The majority of women (68 percent) and men (59 percent) said that help should be sought from other family members of the child. Placing a child in an orphanage was cited by only 2 percent of women and 9 percent of men. MATERNAL AND CHILD HEALTH Antenatal care. Ukraine has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. Overall, the levels of antenatal care and delivery assistance are high. Virtually all mothers receive antenatal care from professional health providers (doctors, nurses, and midwives) with negligible differences between urban and rural areas. Seven- ty-five percent of pregnant women have six or more antenatal care visits; 27 percent have 15 or more ANC visits. The percentage is slightly higher in rural areas than in urban areas (78 percent com- pared with 73 percent). However, a smaller pro- portion of rural women than urban women have 15 or more antenatal care visits (23 percent and 29 percent, respectively). In terms of content of care, virtually all women said they were weighed, had their blood pressure taken, and gave blood and urine specimens; how- ever, only slightly more than one-third of these women said that they were informed about preg- nancy complications (38 percent). In the UDHS, information was collected on the use of iron supplementation during pregnancy for live births in the five years preceding the survey: i.e., the number of days that pregnant women took iron supplementation in the form of tablets or syrup. Slightly more than half of the women took some form of iron supplements during their most recent pregnancy that ended in a live birth. Older women, urban residents, women living in the East Region, and those in the two highest wealth quintiles were most likely to use iron supplements. Delivery care. Virtually all births (99 percent) are delivered under the supervision of a trained medi- cal professional and take place at a health facility (99 percent). Most of these deliveries are attended by a doctor (91 percent), with a nurse-midwife delivering 8 percent of births. The East Region has the highest proportion of births assisted by nurses and midwives (13 percent). Breastfeeding. Ninety-six percent of children born in the five years preceding the survey were breastfed for a period of time. Although the me- dian duration of breastfeeding is 10 months, the duration of exclusive and predominant breastfeed- ing (breastfeeding plus plain water) is short: less than one month and two months, respectively. xxii | Summary of Findings Bottle-feeding. Bottle-feeding is fairly widespread in Ukraine. Among children age 0-3 months living with their mother, more than half (56 percent) of infants are fed with a bottle with a nipple. This proportion increases to 88 percent for children age 6-11 months, before declining. Infant and Young Child Feeding (IYCF). Ap- propriate infant and young child feeding (IYCF) practices include the introduction of sol- id/semisolid foods beginning at age 6 months and increasing the amount of foods and frequency of feeding as the child gets older while maintaining frequent breastfeeding. Although the World Health Organization recom- mends that breastfeeding children under age 6 months not receive supplemental foods, the UDHS indicates that approximately one in five breast- feeding children under age 6 months receives solid or semisolid foods. Almost all children age 6-23 months receive solid or semisolid food. The pro- portion consuming various foods is generally higher among nonbreastfeeding children age 6-23 months than among breastfeeding children the same age. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS The currently low level of HIV infection in Ukraine provides a unique window of opportunity for early targeted interventions to prevent further spread of the disease. However, the increases in the cumulative incidence of HIV infection suggest that this window of opportunity is rapidly closing. Knowledge and attitudes. Virtually all women and men reported that they have heard of HIV/AIDS and roughly 83 to 92 percent of women and men know about the three main ways to re- duce its transmission, namely, abstinence, being faithful to one uninfected partner, and using con- doms. Forty-six percent of women and 45 percent of men in Ukraine have comprehensive knowledge of HIV/AIDS prevention and transmission, i.e., they know that using condoms consistently and having one faithful partner can reduce the risk of contracting HIV and that a healthy-looking person can have the AIDS virus, and they reject the two most common local misconceptions—that a person can become infected with the AIDS virus by kiss- ing someone who is infected, and by sharing food and utensils with someone who has the AIDS vi- rus. Stigma surrounding AIDS is widespread in Ukraine. Only 5 percent of women and 7 percent of men said that they would not want to keep se- cret that a family member was infected with the AIDS virus. At the same time, 75 percent of wom- en and 73 percent of men said they would be will- ing to care for a family member with the AIDS virus in their home. The proportion of respondents who said that an HIV-positive teacher should be allowed to continue teaching is higher among women than men (42 and 32 percent, respective- ly). However, smaller proportions of women and men said that they would buy fresh food from a shopkeeper with AIDS (22 and 11 percent, respec- tively). The percentage expressing accepting atti- tudes on all four measures is low: 1 percent among men and less than 1 percent among women. Sexual behavior. Among respondents who had sexual intercourse in the 12 months preceding the survey, 15 percent of men and 3 percent of women reported having had more than one sexual partner, and 43 percent of men and 22 percent of women reported having higher-risk sex (i.e., sexual inter- course with a nonmarital, noncohabiting partner). Condom use. Almost two-thirds of men (62 per- cent) and slightly more than half of women (52 percent) reported using a condom during the most recent instance of higher-risk sex. These propor- tions are slightly higher among male and female youth age 15-24 (71 and 68 percent, respectively). Almost all of male youth (98 percent) and 96 per- cent of female youth age 15-24 said they knew a place where they could obtain a condom. ADULT HEALTH The major causes of death in Ukraine are similar to those in industrialized countries (cardiovascular diseases, cancer, and accidents), but there is also a rising incidence of certain infectious diseases, such as multidrug-resistant tuberculosis. Tuberculosis. Awareness about tuberculosis is virtually universal; almost all men and women have heard of tuberculosis. Ninety-five percent of female respondents and 94 percent of male res- pondents correctly identified the mode of tubercu- losis transmission (through the air when cough- ing). Hypertension. The UDHS included measurement of blood pressure for consenting adults age 15-49. The results indicate that about 25 percent of wom- en and 32 percent of men can be classified as hypertensive. Over half of men and women age 45 Summary of Findings � xxiii and older have some degree of hypertension, which confirms that hypertension is a serious health problem in Ukraine. Forty-nine percent of women and 77 percent of men with high blood pressure are unaware that they are hypertensive. Smoking. Survey data show that smoking is less prevalent among women than men: 15 percent of women and 52 percent men reported that they cur- rently smoke cigarettes. Among male smokers, 89 percent reported that they smoked 10 or more cig- arettes during the past 24 hours. The likelihood that a man smokes increases with age. Seventy-eight percent of women and 56 percent of men think that smoking should be banned from public places. Alcohol intake. Sixty-two percent of women and 77 percent of men age 15-49 consumed at least one alcoholic beverage in the month prior to the interview. Among men, consumption of at least one alcoholic beverage in the past month is highest in the East Region (90 percent); the proportion is about 70 percent for men in the other regions. Males consume alcohol with greater frequency than females. Twenty-nine percent of men con- sume alcohol 1-2 times per week, and 6 percent drink alcohol daily or almost daily, compared with 9 percent and 2 percent of women, respectively. WOMEN’S STATUS Sixty-four percent of married women make deci- sions on their own about their own health care, 33 percent decide jointly with their husband/partner, and 1 percent say that their husband or someone else is the primary decisionmaker about the wom- an’s own health care. The UDHS gathered information on women’s and men’s attitudes toward wife beating—a proxy for women’s perception of their status. Women and men were asked whether a husband is justified in beating his wife under a series of specific circums- tances: if the wife burns the food, argues with him, goes out without telling him, neglects the children, or refuses sexual relations. Men are more likely than women to agree with at least one of the rea- sons justifying a husband beating his wife (11 per- cent of men compared with 4 percent of women). The UDHS included questions on whether the res- pondent thinks that a wife is justified in refusing to have sexual intercourse with her husband under three specific circumstances: she knows her hus- band has a sexually transmitted disease (STD); she knows her husband has sexual intercourse with other women; and she is tired or not in the mood. Overall, 83 percent of women agree that a woman is justified in refusing to have sex with her hus- band for all three of the specified reasons; only 2 percent of women do not agree with any of the reasons. Men are less likely than women to agree with all three of the specified reasons for a wife to refuse to have sex with her husband (68 percent). DOMESTIC VIOLENCE Overall, 17 percent of women age 15-49 expe- rienced some type of physical violence between age 15 and the time of the survey. Nine percent of all women experienced at least one episode of vi- olence in the 12 months preceding the survey. One percent of the women said they had often been subjected to violent physical acts during the past year. Overall, the data indicate that husbands are the main perpetrators of physical violence against women. Twenty-four percent of ever-married women re- port some type of emotional, physical, or sexual violence. More than one in ten (13 percent) ever- married women age 15-49 report having expe- rienced physical violence by their current or most recent husband/partner. Three percent report sex- ual violence, and 22 percent report emotional vi- olence. Among ever-married women who have ever suf- fered any type of spousal violence, women whose husbands do not drink are the least likely to report physical violence (2 percent), while women whose husbands get drunk frequently are the most likely to report violence (56 percent). Slightly more than one-third of women (38 per- cent) have ever sought help from any source for physical violence committed against them. HUMAN TRAFFICKING The UDHS collected information on respondents’ awareness of human trafficking in Ukraine and, if applicable, knowledge about any household mem- bers who had been the victim of human trafficking during the three years preceding the survey. More than half (52 percent) of respondents to the household questionnaire reported that they had heard of a person experiencing this problem and 10 percent reported that they knew personally someone who had experienced human trafficking. xxiv | Summary of Findings Less than 1 percent of households had a member who had ever experienced this problem. Overall, 8 percent of household members who worked abroad in the three years before the survey experienced problems with human trafficking. Among this group, households in the South Re- gion (18 percent) and households in the lowest wealth quintile (13 percent) were the most likely to report that household members had experienced trafficking. xxvi | Map of Ukraine Black Sea UKRAINE 0 250125 Kilometers Russia Poland Belarus Romania Hungary Moldova Slovakia West North Central South EastKyiv Sevastopol Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY AND POPULATION Ukraine is located in Eastern Europe and is bordered by the Black Sea and the Sea of Azov on the south, by Russia on the east and north, by Belarus on the north; by Poland, Slovakia, Hungary and Romania on the west, and by Moldova on the southwest. The territory of Ukraine is 603.5 thousand square kilometers (SSC 2007a). Ukraine has 27 administrative divisions: 24 regions (oblasts), the Autonomous Republic of Crimea, and two cities with special status: Kyiv and Sevastopol. The capital of Ukraine is Kyiv. Ukraine extends across the Eastern European plain and includes three vegetation zones: pine and mixed forest, forest-steppe, and steppe. More than 60 percent of the land is fertile black land (chernozem). Ukraine is an agro-industrial country rich in natural resources. Most important among these are iron ore, coal, rock salt, cement, gypsum, uranium, and various metals. In general, Ukraine is able to provide most of the country’s resource needs, although some are still imported. Oil and gas are imported from Russia and Turkmenistan because the oil and gas deposits in Ukraine are not sufficient to meet the country’s energy needs. Currently, Ukraine’s industrial structure is focused on heavy industry, especially the iron, steel, and coal industries, and machine-building. The chemical industry, food industry, and various light industries also play important roles. In 1991, Ukraine gained the status of an independent state. The state structure is defined in the Constitution of Ukraine. In 1996, a new constitution was adopted; runaway inflation, which was endemic in the former Soviet Union, was curbed; and the national currency (Hryvna) was launched. Since then, Ukraine has achieved macroeconomic stability; prices and domestic and foreign trade have been liberalized; and an austere monetary policy has been introduced. Tax and budget systems are being reformed and a two-tiered banking structure has been established: the National Bank of Ukraine and all other types of commercial banks. Ukraine has a republican form of government. State power is subdivided into Legislative, Executive, and Judicial branches, each with ascribed functions within the country. Ukraine foreign policy focuses on broad, long-term cooperation with other countries as the way to solve both economic and political problems. In 2007, the gross domestic product (GDP) of Ukraine reached 712,945 billion Hryvna (UAH) or 142,589 billion USD (at current rates) (National Bank of Ukraine, 2008). The per capita GDP in 2007 was 15,329 UAH or 3,065 USD (at current rates). According to the 2001 census, the population of Ukraine is 48.5 million (SSC, 2003a). This makes Ukraine the fifth largest country in Europe (after Germany, Italy, Great Britain, and France). About one-third (32 percent) of the population is rural. The average population density in 2006 (SSC, 2007a) was 77 people per square kilometer, ranging from 36 per square kilometer in Chernyhiv oblast to 173 per square kilometer in Donets’k oblast. Ukrainians make up the largest part of the population (77.8 percent); Russians are the second largest group (17.3 percent); and other ethnic/linguistic groups each constitute 1 percent or less of the population (SSC, 2003a). The population of Ukraine reached a peak (52.2 million) in 1992-1993; since then, the population has been decreasing steadily. At the beginning of 2007, the SSC estimated (SSC, 2008) that the country had a population of 46.3 million, which represents a decline of almost six million. The decline is a result of negative population growth, a nationwide phenomenon since 1991. 2 | Introduction The greater proportion of deaths over births in countries today is not an unusual. More than one-third of European countries have experienced some degree of negative population growth. However, Ukraine is unusual because of the rapid pace of the population decline. At the beginning of the year 2000, the country was losing an average of 350,000 persons annually (calculated by the Institute for Demography and Social Studies from the PRB World Population Data Sheet) (PRB, 2008). In 2005, natural population loss in Ukraine was the highest in Europe. At the same time, however, deteriorating health conditions, low life expectancy, and high rates of mortality (especially among able-bodied men) were seen as contributing factors to the demographic trends in Ukraine. The health status of a population is an indicator of a country’s level of development and quality of life. The social transformation that took place in Ukraine in the 1990s was accompanied by a social and economic crisis that negatively affected the overall health of the population. The situation was further aggravated by the catastrophe at the Chernobyl Nuclear Power Plant, and substantial man- made pollution had a negative effect on the environment and health status of the Ukrainian population. In 1990, the health care system in Ukraine experienced many negative changes that resulted in increased morbidity (especially among children) and decreased life expectancy. 1.2 CHARACTERISTICS OF THE HEALTH SYSTEM OF UKRAINE 1.2.1 Network of Health Institutions, System of Management and Funding, and Basic Problems of the Health System According to the Constitution of Ukraine, every person has a right to health care, medical aid, and medical insurance. The health system is provided by public (state) funding. The state and municipal health institutions provide free medical services. The network of the health system in Ukraine consists of 10.9 thousand medical institutions. In 2006, the number of doctors (all specialties) was 225 thousand, or 48.4 per 10,000 population; the number of paramedical workers was 106.1 per 10,000 population; and the number of inpatient hospital beds was 95.6 per 10,000 population (SSC 2007a). The health system in Ukraine is made up of state, municipal, and private facilities. The first level of service (nonspecialized services) is provided by polyclinics, ambulatories, rural medical- obstetric centers, and antenatal clinics. There is no clear division between primary and secondary (specialized) medical services in Ukraine, so patients can seek out medical experts by themselves without referral by a doctor. Specialized medical services are an important part of the public health system in Ukraine. These are the second and the third levels of medical assistance. The second level includes specialized branches in polyclinics, hospitals, and inpatient clinics. The third level consists of highly specialized services at specialized clinics. It also includes the research institutes of the Academy of Medical Sciences of Ukraine, where the most expensive equipment is located and the most advanced medical technologies are applied. The organizational principles and system of management of the public health system in Ukraine were put in place when the country was part of the Soviet Union. Since independence, efforts have been made to implement changes to the system but the basic features of the Soviet system have been retained. Preservation of the old system in the new social and economic environment reduces efficiency and has a negative effect on the quality and availability of medical services. Another problem is lack of qualified health personnel, particularly in rural medical facilities. The lack of staff is a result of the low level of wages in rural facilities compared with urban facilities—wages at rural facilities are about 60 percent of wages earned in Ukraine as a whole. In Introduction | 3 rural areas, the problem of low wages is compounded by the poor living conditions and limited social infrastructure. Because the current funding system is inadequate to maintain the Ukraine public health system, the country has begun a discussion of the possibility of introducing some type of the mandatory state medical insurance. Recently, the government accepted many documents relating to changes to the public health services. In 2007, the Government of Ukraine approved the National Plan of Development of Public Health Services, which runs through 2010. It suggests improvements to promote financial maintenance of the health system, coordination between funding scales and the amount of state guarantees of free medical assistance, and optimization of public health institutions. A transition from the administrative-command model to the contract model of health services management is suggested, as well as introduction of the mechanism of strategic purchases of medical services on a contractual basis and transition from the line-item budgets of medical institutions to payment-for-services funding based on the scales and structure of specific services. One of the development priorities of the Ukraine public health services is improvements in the primary level of medicine, in particular, the creation of “family medicine.” The process of introducing family medicine in Ukraine started in 1987; training of family doctors in educational institutions began in 1995. Chairs of general practice/family medicine have been opened at all 17 medical institutions of higher education. The primary medical institutions have been charged with creating conditions for the introduction of family medicine. Toward this end, the Ministry of Health of Ukraine has developed a package of normative documents for regulating technologies for the introduction of family medicine. Development of family medicine in Ukraine is patterned after European models defined in the WHO strategy, “Health for All: The Policy Framework for the WHO European Region.” In cooperation with the European Union, a modern model of family medicine was introduced into several regions in Ukraine, including the Autonomous Republic of Crimea, and Zaporizhzhia and Khmelnytskiy oblasts. Public health policy in Ukraine is formulated by the Verkhovna Rada (Parliament). The Ministry of Health is the central executive authority that implements health policy by setting targets, developing health programs and utilizing other mechanisms designed to improve the health of the Ukrainian people. 1.2.2 Specific Health Care Services and Selected Programs The Ministry of Health is implementing more than 25 state target programs and other efforts to improve health care services in Ukraine; these were approved by Decrees of the President, Decisions of the Government. In 2007, the government approved the “State Program of Creation of Uniform System of Granting of Emergency Medical Aid,” which will run through 2010. The program is designed to create conditions that will increase the availability and quality of emergency medical care. The aim is to reduce the levels of physical disability and death caused by accidents, injury, poisonings, and acute clinical conditions attributed to cardiovascular and other diseases. Mother and Child Health Care and Family Planning Mother and child health care is among the most important priorities of the Government of Ukraine. Health services for mothers and children are provided by a network of women’s consultations, medical-genetic consultations, children’s polyclinics and hospitals, family planning centers, and maternity hospitals. To improve public health services for children and mothers, the following national programs have been implemented: 4 | Introduction • “Children of Ukraine” (1995-2000) • National plan of action on improvement of the position of women and increase of their role in a society (1997-2000) • Long-term program of support of women and families • National program “Family planning” (1995-2000) • National program “Reproductive Health” (2001-2005) The complex of measures in the national program, “Reproductive Health” (2001-2005), promoted the following positive changes: • Creation of family planning services • Increased population awareness of the healthy way of life • Safe sexual relations • Responsible paternity • Methods to prevent an unwanted pregnancy • Use of modern contraceptive methods The need for further efforts to improve reproductive health resulted in the implementation of a new national program, “Reproductive Health of the Nation,” which runs through 2015. Beginning January 1, 2007, Ukraine adopted the WHO criteria for live and non-live births and the perinatal period. This prompted requests for increased attention and responsibility of state authorities in the organization, implementation, and maintenance of mother and child health care. In addition to health services, Ukrainian legislation provides many benefits and privileges to families with children. Women receive paid maternity leave of up to 126 days. When the child is born, a lump-sum benefit of 22 subsistence minimums is paid. There is also a benefit for children under age three. A woman’s job is reserved for her during this period. Programs Combating HIV/AIDS and Tuberculosis Combating HIV/AIDS and tuberculosis is a priority of national policy in Ukraine. To provide coordination on policy, programs, and efforts to combat HIV/AIDS and tuberculosis in Ukraine, the National Council of Counteraction to Tuberculosis and HIV-infection/AIDS and the Committee on Combating HIV-infection/AIDS and Other Socially Dangerous Diseases, were created. The fifth national program on prevention of HIV transmission and provision of care and support services (CSS) to people with HIV/AIDS was implemented 2004-2008. It will be replaced by a new national program on prevention of HIV transmission and provision of care and support to people with HIV/AIDS, 2009-2013. Its purpose is to stabilize the epidemiological situation, decrease the rate of HIV transmission, and reduce deaths caused by AIDS. Since 2001, national programs in Ukraine have dealt with the problem of the transmission of HIV from mother to child during pregnancy and delivery. In 1999, a program to monitor pregnant women to prevent the vertical transmission of HIV was introduced. The program includes consultations with pregnant women; prepatrimonial and intranatal HIV testing; administration of �RV drugs during labor or delivery for HIV-positive women; and consultation with HIV-positive women on feeding practices for the child. Tuberculosis is a serious public health problem in Ukraine and the World Health Organization’s DOTS strategy was introduced in pilot regions (Donetsk oblast and Kyiv city) in 2001. Since 2006, the DOTS strategy has been implemented in all regions of Ukraine. Introduction | 5 In 2006, the Government of Ukraine approved the National Program of Counteraction to Tuberculosis. The program, which utilizes international standards of control for tuberculosis, extends through 2011. Sanitary and Epidemiologic Services and Immunoprophylaxis According to the Constitution of Ukraine (Article 49), the state provides for the sanitary and epidemiologic well-being of the population. Basic activities carried out by the government include disease prevention and creation of healthy environments (work, home, and food related). Implementation of these tasks is the responsibility of the State Sanitary and Epidemiologic Service (SES) of Ukraine. This immunoprophylaxis program (2002-2006) was completed in 2006 and resulted in a reduction in the prevalence of infections. A draft of the next immunoprophylaxis program (through 2015) is being prepared. 1.3 SYSTEMS FOR COLLECTING DEMOGRAPHIC AND HEALTH DATA The State Statistical Committee of Ukraine (SSC) is responsible for conducting censuses and for using data from the national registration system to provide information about current registration of population. The last census in Ukraine was conducted in 2001, with the results published in 2002- 2004; the next census is scheduled for 2011. Births, deaths, marriages, and divorces are registered at the local administrative level by the civil registry departments of the Ministry of Justice, while population migration within the country and abroad, by the relevant subdivisions of the Ministry of the Interior, and aggregated statistics are forwarded through the territorial statistical offices to the SSC. The SSC compiles and analyzes these data and issues annual reports entitled, “Population of Ukraine,” and other reports. Health information is collected by staff at health facilities and by the medical statistic services of the Ministry of Health and is sent through the territorial statistical offices to the SSC. The SSC compiles and analyzes these data for the country as a whole and issues annual reports as well as various analytical publications. Based on compiled health data, the Ministry of Health issues annual thematic reports and bi-annual report entitled, “Health indicators of the population and usage of health care resources in Ukraine.” The national data are available at the WHO website, Health for All Database. 1.4 OBJECTIVES AND ORGANIZATION OF THE SURVEY The 2007 Ukraine Demographic and Health Survey (UDHS) is a nationally representative sample survey designed to provide information on population and health issues in Ukraine. The primary goal of the survey was to develop a single integrated set of demographic and health data for the population of the Ukraine. The UDHS was conducted from July to November 2007 by the Ukrainian Center for Social Reforms (UCSR) in close collaboration with the State Statistical Committee (SSC) of Ukraine, which provided organizational and methodological support. Macro International Inc. provided technical assistance for the survey through the MEASURE DHS project. USAID/Kyiv Regional Mission to Ukraine, Moldova and Belarus provided funding for the survey through the MEASURE DHS project. MEASURE DHS is sponsored by the United States Agency for International Development (USAID) to assist countries worldwide in obtaining information on key population and health indicators. The 2007 UDHS collected national- and regional-level data on fertility and contraceptive use, maternal health, adult health and life style, infant and child mortality, tuberculosis, and HIV/AIDS and other sexually transmitted diseases. The survey obtained detailed information on these issues from women of reproductive age and, on certain topics, from men as well. The results of the 2007 UDHS are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving the health of Ukrainians and 6 | Introduction health services for the people of Ukraine. The 2007 UDHS also contributes to the growing international database on demographic and health-related variables. 1.4.1 Sample Design and Implementation The sample was designed to allow detailed analysis of indicators—including the estimation of fertility, abortion and infant/child mortality rates at the national level and for urban and rural areas. Many indicators can also be estimated for the following five domains or geographical areas: North, Central, South, East, and West. Each domain consists of a few administrative divisions out of the total 27 administrative regions existing in Ukraine (24 regions, the capital city Kyiv, the city of Sevastopol, and the Autonomous Republic of Crimea), except for the clusters affected by the Chernobyl disaster and are uninhabitable.1 • North: the city of Kyiv, and the regions of Kyiv, Zhytomyr, Sumy and Chernihiv; • Central: the regions of Cherkasy, Poltava, Kirovohrad and Vinnytsia; • South: the Autonomous Republic of Crimea, the city of Sevastopol’ and the regions of Odesa, Mykolaiv and Kherson; • East: the regions of Dnipropetrovs’k, Donets’k, Zaporizhzhia, Luhans’k, and Kharkiv; • West: the regions of Ivano-Frankivs’k, Khmel’nyts’kyi, Chernivtsi, L’viv, Rivne, Ternopil’, Volyn’ and Zakarpattia. A representative sample of households was selected for the 2007 UDHS. The sample was selected in two stages. In the first stage, 500 clusters were selected in Kyiv and the 26 other administrative divisions from the list of enumeration areas in the master sample frame of the 2001 Ukraine Population Census (SSC 2003a). In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected from each cluster for participation in the survey. This design resulted in a final sample of 15,004 households selected. All women age 15-49 who were either permanent residents of the selected households or visitors present in the household the night before the survey were eligible to be interviewed. In addition, all men age 15-49 in one-half of the selected households were eligible to be interviewed if they were either permanent residents or visitors present in the household the night before the survey. Interviews were completed for 6,841 women and 3,178 men. 1.4.2 Questionnaires Three questionnaires were used in the UDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The questionnaires were based on the model survey instruments developed by the MEASURE DHS project. The model questionnaires were adapted for use in Ukraine by experts from the UCSR, the SSC, the Ministry of Family Youth and Sports Affairs (MFYSA), the Ministry of Health (MOH) and Macro International Inc. Input was also sought from a number of nongovernmental organizations. Additionally, a module on human trafficking was developed for pilot testing during the 2007 UDHS. The questionnaires were prepared in English and translated into Ukrainian and Russian. The questionnaires were pretested in March 2007. The Household Questionnaire was used to list all usual members and visitors to the household and to collect information on the socioeconomic status of the household. The first part of the Household Questionnaire collected information on age, sex, educational attainment, and the relationship of each household member or visitor to the household head. This information provided basic demographic data on Ukrainian households, and was used to identify the women and men who were eligible for the individual interview (i.e., women and men age 15-49), and to randomly select one man or one woman age 15-49 per household to be interviewed with the domestic violence module. The second part of the Household Questionnaire included questions on housing 1 One cluster was originally selected from the Chernobyl area and was replaced. Introduction | 7 characteristics (e.g., flooring material, source of water and type of toilet facilities), ownership of a variety of consumer goods, and other questions on the socioeconomic status of the household. The Household Questionnaire was also used to obtain information on human trafficking. The Women’s Questionnaire obtained information from women age 15-49 on the following topics: • Background characteristics • Pregnancy history • Abortion history • Antenatal, delivery, and postnatal care • Knowledge, attitudes, and use of contraception • Reproductive and adult health • Breastfeeding and weaning practices • Marriage and recent sexual activity • Fertility preferences • Attitudes towards unwanted pregnancies, abortion and adoption • Knowledge of and attitudes toward AIDS and other sexually transmitted diseases • Knowledge of and attitudes toward tuberculosis • High blood pressure and medical injections • Smoking, alcohol and narcotics consumption • Domestic violence The Men’s Questionnaire, administered to men age 15-49, focused on the following topics: • Background characteristics • Reproductive health • Knowledge, attitudes, and use of contraception • Attitudes toward and use of condoms • Marriage and recent sexual activity • Fertility preferences • Attitudes towards unwanted pregnancies, abortion and adoption • Employment and gender roles • Attitudes toward women’s status • Knowledge of and attitudes toward AIDS and other sexually transmitted diseases • Knowledge of and attitudes toward tuberculosis • High blood pressure and medical injections • Smoking, alcohol and narcotics consumption • Domestic violence In addition, blood pressure measurements for adult women and men were recorded in their individual questionnaires. 1.4.3 Training of Field Staff The main survey training was conducted by the Ukrainian Center for Social Reforms and the State Statistical Committee during a two-week period in July 2007, and was attended by all supervisors, field editors, interviewers, and quality control personnel. The training included lectures, demonstrations, practice interviewing in small groups, examinations and practicing blood pressure measurement using a digital monitor. All field staff participated in one day of field practice. 8 | Introduction 1.4.4 Fieldwork and Data Processing The survey data was collected by twenty-seven teams, each consisting of one or two female interviewers, a male interviewer, and a female team supervisor/editor. Fieldwork began in late July 2007 and was completed in November 2007. Senior DHS technical staff visited teams regularly to review the work and monitor data quality. Data processing of the UDHS began shortly after the beginning of fieldwork. Completed questionnaires were returned regularly from the field to UCSR headquarters in Kyiv, where they were entered and edited by specially trained data processing personnel. Data processing personnel included a supervisor, a questionnaire administrator, several office editors, 20 data entry operators, and a secondary editor. Concurrent data processing allowed the survey technical staff to be able to advise fieldwork teams of problems detected during the data entry. Tables generated to check various data quality parameters were used for this purpose. As a result, specific feedback was given to the teams to improve performance. The data entry and editing phase of the survey was completed in late January 2008. 1.5 RESPONSE RATES Table 1.1 presents household and individual response rates for the survey. A total of 15,004 households were selected for the sample, of which 14,069 were found at the time of fieldwork. The main reason for the difference is that some of the dwelling units that were occupied during the household listing operation were either vacant or the residents were away for an extended period at the time of interview. Of the households that were found, 95 percent were successfully interviewed. In these households, 7,437 women were identified as eligible for the individual interview. Interviews were completed with 92 percent of these women. Of the 3,523 eligible men identified, 90 percent were successfully interviewed. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Ukraine 2007 Result Residence Total Urban Rural Household interviews Households selected 9,317 5,687 15,004 Households occupied 8,739 5,330 14,069 Households interviewed 8,124 5,255 13,379 Household response rate 93.0 98.6 95.1 Individual interviews: women Number of eligible women 4,679 2,758 7,437 Number of eligible women interviewed 4,291 2,550 6,841 Eligible woman response rate 91.7 92.5 92.0 Individual interviews: men Number of eligible men 2,200 1,323 3,523 Number of eligible men interviewed 1,993 1,185 3,178 Eligible man response rate 90.6 89.6 90.2 Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter presents a summary of the demographic and socioeconomic characteristics of the household population in the 2007 Ukraine Demographic and Health Survey (UDHS), including age, sex, place of residence, and educational status. The chapter also presents information on household ownership of various durable goods, key characteristics of the dwelling in which the household re- sides, and a wealth index derived from the household asset data. Information collected on the socio- economic characteristics of the UDHS households and respondents is important in understanding and interpreting the findings of the survey and also provides some indication of the representativeness of the survey. A household is defined as a person or group of related and unrelated persons who live togeth- er in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as head of the household, and who have common arrangements for cooking and eating their food. The ques- tionnaire for the 2007 UDHS distinguishes between the de jure population (persons who usually live in a selected household) and the de facto population (persons who stayed the night before the inter- view in the household). According to the 2007 UDHS data, the differences between these populations are small. Tabulations for the household data presented in this chapter are primarily based on the de facto population. Throughout the report, the numbers in the tables reflect weighted numbers (see Ap- pendix A for discussion of the sample design). To ensure statistical reliability, percentages based on 25 to 49 unweighted cases are shown within parentheses, and percentages based on fewer than 25 un- weighted cases are suppressed. 2.1 CHARACTERISTICS OF THE POPULATION 2.1.1 Age-Sex Structure Age and sex are important demographic variables and form the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. Table 2.1 presents the percent distribution of the de facto popula- tion by five-year age groups, according to urban-rural residence and sex. The information is used to construct the population pyramid shown in Figure 2.1. Table 2.1 shows that the total de facto population was 32,377 and there are more women (17,556) than men (14,816), with women constituting 54 percent of the population. The data show that the gender disparity is concentrated among the population age 50 and older (Figure 2.1). About two-thirds of the population is in the 15-64 age group, also referred to as the economi- cally active population. The proportion of the population falling within this age group is higher in ur- ban areas (70 percent) than in rural areas (61 percent). This difference may be largely attributed to rural-to-urban migration, especially among the young in search of jobs and higher education. 10 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Ukraine 2007 Age Urban Rural Total Male Female Total Male Female Total Male Female Total <5 4.1 3.4 3.7 4.9 3.7 4.3 4.4 3.5 3.9 5-9 4.7 3.4 4.0 6.0 4.1 5.0 5.1 3.6 4.3 10-14 5.6 4.3 4.9 7.4 6.5 6.9 6.2 5.0 5.5 15-19 6.4 4.5 5.4 7.1 5.3 6.1 6.6 4.8 5.6 20-24 7.9 6.5 7.2 6.1 4.7 5.4 7.3 6.0 6.6 25-29 8.0 6.6 7.2 5.9 4.7 5.2 7.3 6.0 6.6 30-34 7.7 6.2 6.9 6.1 5.7 5.9 7.2 6.0 6.6 35-39 6.8 6.5 6.6 7.4 5.9 6.6 7.0 6.3 6.6 40-44 6.4 6.1 6.2 6.6 5.1 5.8 6.5 5.8 6.1 45-49 7.7 6.8 7.2 7.4 6.1 6.7 7.6 6.6 7.0 50-54 8.5 10.3 9.5 7.7 7.9 7.8 8.2 9.5 9.0 55-59 8.0 9.0 8.5 6.8 6.9 6.8 7.6 8.3 8.0 60-64 4.6 5.4 5.0 4.0 5.1 4.6 4.4 5.3 4.9 65-69 5.4 7.0 6.3 5.8 8.8 7.5 5.5 7.6 6.7 70-74 4.0 5.7 4.9 4.7 6.9 5.9 4.3 6.0 5.2 75-79 2.5 4.2 3.4 3.8 6.4 5.2 3.0 4.8 4.0 80 + 1.8 4.2 3.1 2.1 6.2 4.3 1.9 4.9 3.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 10,129 12,027 22,162 4,686 5,529 10,215 14,816 17,556 32,377 Note: Total includes 3 persons whose sex was not recorded. Figure 2.1 Population pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 <5 Age 0123456 0 1 2 3 4 5 6 UDHS 2007 Percent Males Females The remainder of the population that is not economically active, including the younger popu- lation under age 15 and the elderly population age 65 and older, constitutes the economically depen- dent population. The data further indicate that 14 percent of the population are less than 15 years of age. The proportion under 15 is larger in the rural areas than in the urban areas (16 and 13 percent, respectively). The percentage age 10-19 years is larger than the percentage age 0-9, suggesting that fertility has fallen over the ten-year period before the survey. Elderly people age 65 and older make up 19 percent of the population. The disproportionately low percentage of the population age 60-64 years is probably a result of low levels of fertility during World War II (Figure 2.1). Household Population and Housing Characteristics | 11 2.1.2 Children’s Living Arrangements and Orphanhood Detailed information on living arrangements and parental survivorship for children under 18 years of age is presented in Table 2.2. Among the 5,524 children under age 18, two in three live with both parents, 24 percent live with their mother only, 2 percent live with their father only, and 3 per- cent live with neither of their natural parents. The table also provides data on the extent of fosterhood and orphanhood among children un- der age 18. Three percent of children are fostered, meaning they are not living with either parent even though one or both parents are still alive. Six percent of children are orphaned, that is, the child has lost one or both parents. Five percent of children under 18 years have lost their fathers, but fewer children have lost their mothers (2 percent) or both parents (less than 1 percent). Table 2.2 Children’s living arrangements and orphanhood Percent distribution of de jure children under 18 years of age 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, Ukraine 2007 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 Percentage not living with a biological parent Percentage with one or both parents dead 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 or mother Age 0-4 75.0 18.5 1.8 1.0 0.9 0.9 0.0 0.1 0.0 1.8 100.0 1.0 2.8 1,245 <2 79.4 16.5 1.3 0.9 0.2 0.7 0.0 0.0 0.0 0.9 100.0 0.7 1.5 454 2-4 72.6 19.6 2.1 1.1 1.2 0.9 0.0 0.2 0.0 2.2 100.0 1.1 3.5 791 5-9 69.2 22.4 2.5 0.9 0.6 2.1 0.0 0.1 0.2 2.1 100.0 2.4 3.4 1,376 10-14 65.0 20.2 5.0 1.4 1.8 2.2 0.4 0.1 0.4 3.5 100.0 3.0 7.7 1,768 15-17 59.7 20.4 6.4 0.7 1.5 3.0 1.0 0.4 0.6 6.2 100.0 5.0 10.0 1,136 Sex Male 67.9 20.2 4.2 1.1 1.5 1.8 0.1 0.1 0.3 2.8 100.0 2.3 6.2 2,893 Female 66.4 20.7 3.7 1.0 1.0 2.3 0.6 0.2 0.3 3.8 100.0 3.4 5.8 2,627 Residence Urban 65.3 22.1 3.9 0.9 1.3 2.2 0.4 0.2 0.3 3.5 100.0 3.0 5.9 3,468 Rural 70.5 17.5 4.1 1.3 1.2 1.7 0.3 0.1 0.4 2.9 100.0 2.4 6.2 2,056 Region North 71.8 15.4 4.0 1.1 1.5 2.3 0.3 0.1 0.2 3.3 100.0 2.9 6.1 1,038 Central 67.7 21.8 2.8 0.8 0.8 2.5 0.0 0.1 0.0 3.5 100.0 2.6 3.7 638 East 59.5 27.8 5.3 0.8 1.8 0.9 0.5 0.3 0.1 3.0 100.0 1.8 8.0 1,428 South 67.0 18.1 4.5 0.7 0.8 3.0 0.6 0.0 0.6 4.7 100.0 4.2 6.6 883 West 71.3 17.7 2.8 1.6 0.9 2.0 0.2 0.2 0.5 2.7 100.0 3.0 4.7 1,537 Wealth quintile Lowest 64.5 20.0 4.7 1.7 2.0 2.4 0.1 0.0 0.7 3.8 100.0 3.2 7.6 923 Second 71.9 17.3 3.8 0.7 0.9 1.5 0.2 0.3 0.1 3.4 100.0 2.0 5.2 1,311 Middle 67.6 19.5 3.7 1.3 1.0 3.2 0.7 0.1 0.1 2.7 100.0 4.1 5.7 1,061 Fourth 60.3 25.5 5.5 0.7 1.0 2.1 0.5 0.3 0.4 3.8 100.0 3.2 7.6 1,046 Highest 70.0 20.5 2.5 1.0 1.4 1.2 0.3 0.1 0.3 2.8 100.0 1.8 4.6 1,182 Total <15 69.2 20.4 3.3 1.2 1.2 1.8 0.2 0.1 0.2 2.5 100.0 2.2 5.0 4,388 Total <18 67.2 20.4 4.0 1.1 1.2 2.0 0.3 0.2 0.3 3.3 100.0 2.8 6.0 5,524 Note: Table is based on de jure members, i.e., usual residents. Total includes 3 persons whose sex was not recorded. Differentials in fosterhood and orphanhood by background characteristics are not large. As expected, older children are most likely to be fostered and orphaned. Small differences in living ar- rangements are found between rural and urban children. The North region has the highest proportion of children living with both parents (72 percent) and the East region has the lowest (60 percent). Children’s living arrangements have no specific pattern according to the household wealth index. Table 2.2 also presents the extent of fosterhood and orphanhood among children under age 15 to allow comparison with children under age 18. Differences in living arrangements and parental sur- vivorship between children under age 15 and under age 18 are negligible. 12 | Household Population and Housing Characteristics 2.1.3 Household Composition Table 2.3 shows the percent distribution of households in the 2007 UDHS sample by sex of the head of the household and household size. It also presents the mean household size for urban and rural areas. These characteristics are important because they are often associated with differences in household socioeconomic levels. For example, female-headed households are frequently poorer than households headed by males. In addition, the size and composition of the household affects the alloca- tion of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. Women and men head nearly equal proportions of Ukrainian households. The average house- hold size in Ukraine is 2.5 persons. The average household size in rural areas is slightly larger than in urban areas (2.6 compared with 2.4 members). More than one in four households has only one mem- ber. Information on the proportion of households with foster children or orphan children is also presented in Table 2.3. Less than 2 percent of households include one or more foster children. Or- phans are included in 2 percent of households. Table 2.3 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under 18 years of age, according to residence, Ukraine 2007 Characteristic Residence Total Urban Rural Household headship Male 49.9 52.1 50.5 Female 50.1 47.9 49.4 Total 100.0 100.0 100.0 Number of usual members 1 27.2 29.3 27.8 2 32.3 28.1 31.1 3 21.7 16.1 20.0 4 12.7 14.1 13.1 5 3.9 7.2 4.9 6+ 1.9 5.1 2.8 Total1 100.0 100.0 100.0 Mean size of households 2.4 2.6 2.5 Percentage of households with orphans and foster children under 18 years of age Foster children2 1.4 1.4 1.4 Double orphans 0.1 0.1 0.1 Single orphans 1.7 2.1 1.9 Foster and/or orphan children 3.0 3.4 3.1 Number of households 9,364 4,015 13,379 Note: Table is based on de jure household members, i.e., usual residents. 1 Includes households (0.2 %) with no de jure members, because the UDHS 2007 field work coincided with summer vacation period and in some cases all members of a household slept last night in the household, but were not usual members of that household, for example in rented summer house. 2 Foster children are those under 18 years of age living in households with neither their mother nor their father present. 2.1.4 Education The educational attainment of household members is an important determinant of their oppor- tunities and behaviors. Many phenomena such as use of health facilities, reproductive behavior, health of children, and proper hygienic habits are associated with the educational level of household mem- bers, especially women. Household Population and Housing Characteristics | 13 The educational system of Ukraine has undergone several recent reforms, making it challeng- ing to analyze education data across a wide range of ages. Since 2005, a 12-year school system has been implemented: primary education takes four years to complete and middle education takes five years to complete (from classes [grades] 5 to 9). There are then three years of what are commonly called senior classes 10-12. PTU, or “Professionalnoe Tekhnicheskoye Uchilische,” is a vocational school that accepts students who have completed grade 9 of secondary school. It combines secondary education with ad- ditional training on manual or basic skill occupations. “Tekhnicum,” also known as a “secondary- special” education in the former Soviet Union educational system, is technical training in a specific field such as nursing, agriculture, and construction. Currently in Ukraine, tekhnicum is considered an initial level of higher education (I-II levels of state accreditation at higher education institutions). University, or similar institutions of III-IV levels of state accreditation at higher education in- stitutions, and postgraduate education prepares higher level specialists. Students who have completed secondary education or the equivalent, or who have completed tekhnicum, may enroll in university. In subsequent tables, these educational categories are collapsed into two categories: “second- ary or less,” which includes no education, primary level, secondary level, and PTU, and “higher than secondary,” which includes tekhnicum and university or similar higher education. Tables 2.4.1 and 2.4.2 present information on the educational attainment of female and male Ukrainians age six and over. Virtually all Ukrainians have gone to school. The proportion of the population with no education is low (1 percent or less), except among those age 6-9 (reflecting some who have not yet started school) and females age 65 years and older (2 percent). The median number of years of schooling is 10.7 years for women and 10.9 years for men. The median is higher among the populations living in urban areas and in the North and East, and it is positively associated with wealth status. Individuals residing in urban areas are much more likely to have attained a university education than those in rural areas. Wealth status also has a strong positive relationship with universi- ty education; 39 percent of women in the highest wealth quintile have at least some university educa- tion, compared with 6 percent in the lowest quintile. The corresponding proportions for men are 39 percent and 5 percent, respectively. 14 | Household Population and Housing Characteristics Table 2.4.1 Educational attainment of the female household population Percent distribution of the de facto female household populations age six and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Ukraine 2007 Background characteristic No education Primary Secondary PTU Tekhnicum University1 Total Number Median years completed Age 6-9 22.4 76.8 0.9 0.0 0.0 0.0 100.0 518 1.1 10-14 0.4 19.3 80.2 0.1 0.0 0.0 100.0 870 5.6 15-19 0.1 0.2 61.7 4.9 12.2 20.9 100.0 835 10.4 20-24 0.3 0.2 20.7 11.9 17.6 49.3 100.0 1,048 14.5 25-29 0.7 0.4 25.1 9.5 25.6 38.7 100.0 1,053 15.0 30-34 0.1 0.1 25.9 13.5 28.2 32.0 100.0 1,060 14.6 35-39 0.2 0.2 25.3 12.2 30.7 31.5 100.0 1,111 14.6 40-44 0.0 0.0 26.1 12.8 31.7 29.4 100.0 1,015 14.6 45-49 0.2 0.2 25.0 11.1 35.8 27.7 100.0 1,158 14.7 50-54 0.4 0.3 35.3 9.6 32.5 22.0 100.0 1,675 14.2 55-59 0.3 0.3 40.8 7.9 30.6 20.2 100.0 1,459 13.5 60-64 0.1 1.6 51.7 9.2 23.1 14.2 100.0 929 10.2 65+ 1.6 23.4 50.0 4.2 12.1 8.6 100.0 4,100 7.5 Residence Urban 1.1 6.4 32.0 9.0 25.5 25.8 100.0 11,545 13.1 Rural 1.7 15.5 53.5 5.6 13.0 10.8 100.0 5,286 9.4 Region North 1.4 7.1 35.9 7.3 23.2 25.0 100.0 3,077 11.6 Central 1.3 10.3 41.6 9.4 18.9 18.5 100.0 2,067 9.9 East 0.9 7.2 35.6 9.2 25.0 22.0 100.0 5,390 11.5 South 1.0 8.7 41.5 7.7 20.2 20.9 100.0 2,549 10.5 West 1.8 13.9 42.2 6.0 17.7 18.3 100.0 3,749 9.9 Wealth quintile Lowest 1.7 20.0 55.4 5.5 11.7 5.7 100.0 3,549 9.0 Second 1.8 9.2 46.5 7.8 20.3 14.4 100.0 3,289 10.0 Middle 1.0 7.6 38.1 8.2 24.5 20.5 100.0 3,380 11.0 Fourth 0.9 4.3 30.4 9.9 26.7 27.7 100.0 3,428 14.0 Highest 0.9 4.6 21.9 8.4 25.4 38.8 100.0 3,185 14.9 Total 1.3 9.3 38.8 8.0 21.6 21.1 100.0 16,831 10.7 1 Or similar institutions with levels III-IV of state accreditation for institutions of higher education Table 2.4.2 Educational attainment of the male household population Percent distribution of the de facto male household populations age six and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Ukraine 2007 Background characteristic No education Primary Secondary PTU Tekhnicum University1 Total Number Median years completed Age 6-9 26.9 73.0 0.1 0.0 0.0 0.0 100.0 605 0.9 10-14 0.4 18.2 81.2 0.0 0.2 0.0 100.0 913 5.5 15-19 0.8 0.1 63.0 8.1 12.8 15.2 100.0 982 10.3 20-24 0.4 0.5 22.0 15.9 20.1 41.0 100.0 1,085 14.3 25-29 0.1 0.2 24.4 17.2 22.5 35.7 100.0 1,085 14.7 30-34 0.4 0.2 29.7 18.8 22.1 28.6 100.0 1,067 13.4 35-39 0.6 0.1 29.6 19.2 24.0 26.2 100.0 1,036 12.7 40-44 0.2 0.2 32.5 18.2 27.7 21.2 100.0 956 11.9 45-49 0.2 0.1 33.4 18.1 27.2 21.0 100.0 1,123 11.8 50-54 0.1 0.4 37.7 14.8 28.1 18.8 100.0 1,222 11.7 55-59 0.2 0.2 40.5 12.1 29.0 18.0 100.0 1,123 11.6 60-64 0.1 1.9 44.1 15.1 20.5 18.1 100.0 653 10.9 65+ 0.8 73.0 0.1 8.3 13.9 13.8 100.0 2,165 9.3 Residence Urban 1.4 5.3 30.5 13.9 23.4 25.5 100.0 9,611 11.9 Rural 1.9 10.2 56.8 10.7 11.3 9.1 100.0 4,406 9.6 Region North 1.6 6.6 35.5 12.2 18.8 25.3 100.0 2,559 11.3 Central 1.1 7.0 43.2 14.5 17.3 16.8 100.0 1,658 10.3 East 1.5 5.0 34.8 13.8 23.1 21.7 100.0 4,465 11.5 South 1.5 6.3 40.5 11.8 19.7 20.1 100.0 2,125 10.8 West 1.8 9.8 43.3 12.2 16.6 16.3 100.0 3,210 10.2 Wealth quintile Lowest 1.6 11.6 59.5 12.0 10.6 4.7 100.0 2,700 9.4 Second 1.7 8.0 48.3 12.8 17.1 12.1 100.0 2,828 10.0 Middle 1.8 5.3 38.2 13.3 23.1 18.2 100.0 2,780 11.1 Fourth 1.6 4.6 29.0 14.7 23.9 26.2 100.0 2,788 12.1 Highest 1.1 4.9 20.1 11.8 23.0 39.1 100.0 2,922 14.7 Total 1.5 6.8 38.7 12.9 19.6 20.3 100.0 14,017 10.9 1 Or similar institutions with levels III-IV of state accreditation for institutions of higher education Household Population and Housing Characteristics | 15 Figure 2.2 presents the age-specific attendance ratios (ASAR) for the population age 6-24 by sex. The ASAR indicates participation in schooling at any level, from primary through higher educa- tion. The closer the ASAR is to 100 percent, the higher the proportion of a given age attending school. In Ukraine, almost all youths of basic secondary age and higher (age 6-17) attend school and there are no significant differences by gender. After age 18, attendance ratios begin to decline and females at- tending school outnumber males. Figure 2.2 Age-specific school attendance rates UDHS 2007 0 9 81 98 98 100 98 99 98 100 96 98 93 78 69 56 49 46 22 13 0 6 87 96 99 100 98 100 99 98 99 100 96 76 72 59 56 46 26 14 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percent Male Female 2.2 HOUSING CHARACTERISTICS To assess the socioeconomic conditions under which the population lives, respondents were asked to give specific information about their household environment. Type of water source, sanita- tion facilities, and floor material are characteristics that affect the health status of household members and particularly of children. They also indicate the socioeconomic status of households. Tables 2.5 to 2.8 present major housing characteristics by urban-rural residence. Table 2.5 provides information on the source of drinking water for both households and the de jure population living in those households. 16 | Household Population and Housing Characteristics Table 2.5 Household drinking water Percent distribution of households and de jure population by source of drinking water, according to residence, Ukraine 2007 Source of drinking water Households Population Urban Rural Total Urban Rural Total Improved source 93.5 95.4 94.1 93.4 95.7 94.1 Piped water into dwelling/yard/plot 80.1 30.5 65.2 80.1 32.0 64.9 Public tap/standpipe 2.0 3.6 2.5 1.8 3.5 2.4 Tube well or borehole 3.5 5.4 4.0 3.6 5.5 4.2 Protected dug well 7.8 54.9 22.0 7.7 53.4 22.2 Protected spring 0.1 1.0 0.4 0.1 1.3 0.5 Nonimproved source 0.5 4.3 1.7 0.5 4.0 1.6 Unprotected dug well 0.2 2.9 1.0 0.2 2.6 1.0 Unprotected spring 0.1 0.1 0.1 0.1 0.1 0.1 Tanker truck/cart with small tank 0.2 1.3 0.6 0.2 1.3 0.6 Bottled water, improved source for cooking/washing1 5.7 0.1 4.0 5.8 0.1 4.0 Bottled water, nonimproved source for cooking/washing1 0.2 0.0 0.1 0.2 0.0 0.1 Other 0.1 0.1 0.1 0.1 0.1 0.1 Missing 0.0 0.1 0.0 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 99.2 95.5 98.1 99.2 95.8 98.1 Number 9,364 4,015 13,379 22,406 10,403 32,809 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or nonimproved source according to their water source for cooking and washing. Table 2.5 shows that 98 percent of the households use improved sources for drinking water.1 Two-thirds of households in Ukraine have their drinking water piped directly into the house, yard, or plot. Urban households are much more likely than rural households to have piped water in their house, yard, or plot (80 percent and 31 percent, respectively). More than half of rural households (55 percent) get water from protected dug wells, compared with 8 percent of urban households. Poor sanitation coupled with unsafe water sources increases the risk of water-borne diseases and illnesses due to poor hygiene. Table 2.6 shows the proportion of households and of the de jure population having access to hygienic sanitation facilities. A household’s toilet/latrine facility is classi- fied as hygienic if it is used only by household members (i.e., not shared) and the type of facility ef- fectively separates human waste from human contact. The types of facilities that are most likely to accomplish this are flush or pour flush into a piped sewer system/septic tank and ventilated and im- proved pit latrine with a slab. 1 Improved water sources include piped water, public tap, tube well or borehole, protected dug well, or protected spring. Households using bottled water for drinking are classified as using an improved or nonimproved source according to their water source for cooking and washing. Household Population and Housing Characteristics | 17 Table 2.6 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Ukraine 2007 Type of toilet/ latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 68.8 5.7 49.9 67.8 5.9 48.2 Flush/pour flush to septic tank 1.4 2.1 1.6 1.7 2.2 1.9 Flush/pour flush to pit latrine 6.1 6.0 6.1 7.0 6.9 7.0 Pit latrine with slab 18.6 79.6 36.9 19.0 79.4 38.1 Composting toilet 0.4 1.1 0.6 0.3 1.0 0.5 Nonimproved facility Any facility shared with other households 3.4 1.6 2.8 3.1 1.4 2.5 Flush/pour flush not to sewer/ septic tank/pit latrine 0.0 0.1 0.1 0.0 0.1 0.1 Pit latrine without slab/open pit 0.7 2.5 1.3 0.6 2.0 1.0 Bucket 0.1 1.0 0.4 0.1 0.9 0.3 No facility/bush/field 0.0 0.1 0.1 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 9,364 4,015 13,379 22,406 10,403 32,809 Ninety-five percent of households in Ukraine use improved sanitation facilities that are not shared with another household (Table 2.6). Half of households in Ukraine use a flush toilet connected to a piped sewer system and more than one-third use a pit latrine with slab. Flush toilets are wide- spread in urban areas (76 percent), while pit latrines with slab are the most common type of facility in rural areas (80 percent). Five percent of households use a nonimproved toilet. Overall, most of the respondents in urban areas live in environments with more adequate sani- tary conditions (Table 2.7). Almost all households in Ukraine have electricity. The majority of rural households have wood/plank floors (63 percent), while linoleum (39 percent) is widely used in urban areas as floor material, followed by wood/planks (28 percent). Parquet or polished wood floors are about equally common in urban and rural areas (20 percent and 18 percent, respectively). In Ukraine, just under one-third of households (31 percent) have one room used for sleeping while close to half of households (45 percent) have two rooms for sleeping. Among households using one or two rooms for sleeping, a slightly higher proportion of households in urban areas use two rooms for sleeping than those in rural areas. Smoke from solid fuels used for cooking, such as charcoal, wood, and other biomass fuels, is a major cause of respiratory infections. The type of fuel used for cooking, the location where food is cooked, and the type of stove used are all related to indoor air quality and the degree to which house- hold members are exposed to risk of respiratory infections and other diseases. Overall, more than eight in ten households cook in the house. For more than 90 percent of urban households, the place for cooking is inside the house while rural households are less likely to cook in the house (66 percent). Cooking fuel also affects the air quality for household members. The main cooking fuel used in Ukraine is liquid petroleum gas (LPG)/natural gas/biogas for 88 percent of all households, regardless of place of residence. Reducing the proportion of the population relying on solid fuels is a Millennium Development Goal, and in Ukraine, this proportion is only 4 percent (2 percent in urban and 8 percent in rural). 18 | Household Population and Housing Characteristics Table 2.7 Household characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking; and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Ukraine 2007 Housing characteristic Households Population Urban Rural Total Urban Rural Total Electricity Yes 99.9 99.6 99.8 99.9 99.7 99.8 No 0.1 0.3 0.1 0.0 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth/sand/dung 0.1 0.9 0.3 0.0 0.7 0.3 Wood/planks 28.3 63.0 38.7 27.4 59.7 37.7 Parquet or polished wood 19.9 18.1 19.3 20.7 19.5 20.3 Ceramic tiles 0.2 0.2 0.2 0.3 0.2 0.2 Concrete 0.7 0.8 0.7 0.8 0.9 0.8 Carpet 7.6 5.0 6.8 7.7 6.1 7.2 Laminate 3.3 0.5 2.5 3.6 0.6 2.6 Linoleum 38.8 10.5 30.3 38.4 11.2 29.7 Other 0.8 0.9 0.8 0.8 0.9 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 32.4 29.1 31.4 21.5 16.2 19.8 Two 46.1 42.2 45.0 48.4 43.2 46.8 Three or more 20.1 27.3 22.3 28.7 39.1 32.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 91.4 66.2 83.9 90.5 64.7 82.3 In a separate building 7.7 33.0 15.3 8.8 34.7 17.0 Outdoors 0.1 0.2 0.1 0.1 0.2 0.1 Other 0.0 0.1 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 9.9 3.3 8.0 9.7 2.8 7.5 LPG/natural gas/biogas 87.6 87.8 87.7 88.2 88.9 88.4 Coal/lignite 1.8 0.9 1.5 1.5 0.7 1.3 Charcoal 0.1 0.2 0.1 0.0 0.2 0.1 Wood 0.4 7.6 2.5 0.3 7.4 2.6 No food cooked in household 0.1 0.1 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 2.2 8.7 4.2 1.9 8.3 3.9 Number of households 9,364 4,015 13,379 22,406 10,403 32,809 Note: Total includes missing cases LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal and wood The availability of durable goods is a proximate measure of household socioeconomic status. Moreover, particular goods have specific benefits. For example, having access to a radio or a televi- sion exposes household members to innovative ideas; a refrigerator prolongs the wholesomeness of foods; and a means of transport allows greater access to many services away from the local area. Ta- ble 2.8 provides information on household ownership of durable goods (radios, televisions, tele- phones, and refrigerators) and modes of transportation (bicycles, motorcycles, and automobiles). Household Population and Housing Characteristics | 19 Table 2.8 Household possessions Percentage of households and de jure population possessing various household effects, means of transportation, agricultural land and livestock/farm animals by residence, Ukraine 2007 Possession Households Population Urban Rural Total Urban Rural Total Household effects Radio 73.0 67.1 71.2 73.1 67.5 71.3 Television 98.2 94.9 97.2 98.8 96.7 98.2 Mobile telephone 73.4 56.3 68.2 82.4 69.8 78.4 Non-mobile telephone 68.3 31.3 57.2 70.4 36.0 59.5 Refrigerator 97.8 88.4 95.0 98.5 91.9 96.4 DVD 38.6 20.4 33.1 47.6 29.0 41.7 Air conditioner 5.3 0.6 3.9 6.2 0.8 4.5 Satellite dish 9.4 8.8 9.2 11.7 12.1 11.8 Computer 25.0 8.1 19.9 31.8 11.4 25.3 Washing machine 83.3 72.7 80.1 87.3 79.3 84.8 Means of transport Bicycle 32.3 59.2 40.4 38.3 68.4 47.8 Animal drawn cart 0.2 6.6 2.1 0.3 8.5 2.9 Motorcycle/scooter 7.0 13.1 8.9 8.9 16.7 11.3 Car/truck 28.1 22.3 26.4 33.8 29.7 32.5 Boat with a motor 1.5 0.8 1.3 1.6 0.9 1.4 Ownership of agricultural land 31.2 86.8 47.9 33.3 88.0 50.6 Ownership of farm animals1 14.0 79.5 33.7 15.5 83.7 37.1 Number 9,364 4,015 13,379 22,406 10,403 32,809 1 Cows, bulls, horses, donkeys, goats, sheep, pigs, rabbits, nutria, geese, turkeys or chickens The results indicate that urban households are slightly more likely than rural households to own durable goods. Overall, 97 percent of Ukrainian households have a television, 95 percent have a refrigerator, 80 percent have a washing machine, 71 percent have a radio, and 68 percent have a mo- bile telephone. Both mobile and nonmobile telephones are much more common in urban areas than in rural areas. Urban households are much more likely than rural households to have a computer (25 per- cent and 8 percent, respectively). More than one in four households in Ukraine have a car or truck, and 40 percent have a bi- cycle. Bicycles are more common in rural areas than in urban areas (59 percent and 32 percent, re- spectively). Rural households are more likely than urban households to own an animal drawn cart or motorcycle/scooter. Forty-eight percent of Ukrainian households own agricultural land; the proportion is unders- tandably higher in rural than urban areas (87 percent and 31 percent, respectively). Thirty-four percent of Ukrainian households own farm animals (80 percent in rural and 14 percent in urban areas). 2.3 WEALTH QUINTILES The wealth index was developed and tested in a number of countries as a tool for assessing inequities in household income and relating those inequities to use of health services and health out- comes (Rutstein and Johnston, 2004; Rutstein et al., 2000). The wealth index is constructed by assign- ing a weight or factor score to each household asset through principal components analysis. These scores are summed by household, and individuals are ranked according to the total score of the house- hold in which they reside. The sample is then divided into population quintiles—five groups with an equal number of individuals in each group. At the national level, approximately 20 percent of the population is in each wealth quintile. 20 | Household Population and Housing Characteristics Table 2.9 Wealth quintiles Percent distribution of the jure population by wealth quintiles, according to residence and region, Ukraine 2007 Residence/region Wealth quintile Total Number of population Lowest Second Middle Fourth Highest Residence Urban 8.0 12.5 22.4 28.1 28.9 100.0 22,406 Rural 45.8 36.1 14.8 2.7 0.6 100.0 10,403 Region North 17.6 15.4 17.0 19.5 30.4 100.0 5,994 Central 26.6 27.0 17.2 15.9 13.3 100.0 3,897 East 14.4 15.2 21.5 23.1 25.8 100.0 10,349 South 17.8 23.3 23.2 21.4 14.3 100.0 4,981 West 27.5 24.5 19.7 17.4 10.8 100.0 7,588 Total 20.0 20.0 20.0 20.0 20.0 100.0 32,809 Table 2.9 shows the distribution of the population across the five wealth quintiles by urban-rural residence and region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas. The findings indicate that wealth in Ukraine is concen- trated in urban areas. Among the population in urban areas, 29 percent is in the highest wealth quintile and 28 percent is in the fourth quintile, compared with a total of only 3 percent of the household population in rural areas. Marked differentials in welfare levels are also observed between regions. For example, about half of the population in the North and East regions is in the highest two wealth quintiles. In contrast, in the Central and West regions, more than half of the household population falls into the lowest two wealth quintiles. Background Characteristics of Respondents | 21 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 The purpose of this chapter is to provide a demographic and socioeconomic profile of the 2007 Ukraine Demographic and Health Survey (UDHS) sample. Information on the basic characteris- tics of women and men interviewed in the survey is essential for the interpretation of findings pre- sented later in the report and also can provide an indication of the representativeness of the survey. For tables in this report that relate to the general adult population, the base population includes wom- en and men age 15-49. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 presents the percent distribution of interviewed women and men age 15-49 by background characteristics including age, marital status, educational level, place of residence, and region. As noted in Chapter 1, all women age 15-49 who were usual residents or present in the house- hold on the night before the interviewer’s visit were eligible to be interviewed in the 2007 UDHS. Men age 15-49 meeting the same criteria were interviewed in one-half of the selected households. In order not to double count respondents, the tables in this report are based on the de facto population, that is, those who stayed in the household the previous night. For the most part, the male and female populations represented in the sample are fairly evenly distributed by age; however, there are somewhat greater proportions of women and men in their mid- to late forties than in younger age groups. This distribution is quite similar to the age distribution in the 2001 Ukraine Population Census (SSC, 2003b). The majority of both women and men are married or living together, with a slightly greater proportion of married women (55 percent) versus married men (51 percent). Fourteen percent of women are divorced or separated and 3 percent are widowed, compared with 9 percent and 1 percent of men, respectively. Twenty-three percent of women and 33 percent of men have never been married. Slightly more than 70 percent of UDHS respondents live in urban areas. Around one-third of respondents live in the East. Roughly 20 percent live in the North, a similar percentage live in the West, 15 percent are from the South, and 11 percent reside in the Central region. Women and men in Ukraine are universally well educated, with almost all having at least some secondary or higher education. Eleven percent of women and 17 percent of men have attended Professionalnoe Tekhnicheskoye Uchilische (PTU). Twenty-seven percent of women have attended a tekhnicum, as have 22 percent of men. Similarly, more women (33 percent) than men (27 percent) have higher education. Slightly more than one-fourth of women and men (27 percent) are living in households ranked in the highest wealth quintile, and 12 percent of women and 14 percent of men live in households ranked in the lowest wealth quintile. The majority of women (81 percent) and men (64 percent) report Orthodox Christianity as their religion. Eleven percent of women and almost three in ten men (29 percent) report no religion. 22 | Background Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 according to selected background characteristics, Ukraine 2007 Background characteristic Women Men Weighted percentage Weighted number Unweighted number Weighted percentage Weighted number Unweighted number Age 15-19 11.4 782 830 14.0 444 451 20-24 14.7 1,006 977 14.4 459 459 25-29 14.6 998 953 13.7 436 420 30-34 14.4 984 1,002 15.1 479 483 35-39 15.3 1,049 1,051 14.1 449 461 40-44 13.7 936 946 12.6 399 393 45-49 15.9 1,085 1,082 16.1 512 511 Religion Christian Orthodox 81.0 5,541 5,556 64.2 2,041 2,129 Christian Catholic 5.0 345 373 3.9 123 128 Christian Protestant 1.2 80 78 0.8 25 27 Islam 0.9 63 98 1.1 33 46 Judaism 0.1 5 3 0.3 11 6 No religion 11.2 769 692 29.0 920 817 Other/missing 0.6 37 41 0.7 24 25 Marital status Never married 22.6 1,544 1,520 32.9 1,044 1,058 Married 55.3 3,781 3,882 50.7 1,611 1,645 Living together 4.9 335 313 5.9 188 158 Divorced/separated 13.8 945 897 9.1 290 278 Widowed 3.4 236 229 1.4 45 39 Residence Urban 71.4 4,887 4,291 71.7 2,277 1,993 Rural 28.6 1,954 2,550 28.3 901 1,185 Region North 19.7 1,345 1,277 19.4 616 590 Central 11.9 817 1,334 11.1 354 565 East 31.0 2,120 1,117 33.4 1,060 590 South 15.3 1,049 1,488 15.5 493 725 West 22.1 1,509 1,625 20.6 654 708 Education No education 0.0 2 2 0.1 2 2 Primary 0.1 7 10 0.1 2 3 Secondary 28.7 1,966 2,170 33.5 1,063 1,133 PTU 11.0 754 761 17.2 548 561 Tekhnicum 26.8 1,831 1,737 21.7 691 666 University1 33.3 2,281 2,161 27.4 872 813 Wealth quintile Lowest 12.4 847 1,004 13.6 432 508 Second 21.0 1,437 1,711 20.5 651 783 Middle 18.6 1,276 1,391 19.6 622 661 Fourth 21.2 1,451 1,266 19.6 623 549 Highest 26.8 1,831 1,469 26.7 849 677 Total 100.0 6,841 6,841 100.0 3,178 3,178 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 1 University or similar institutions of levels III-IV of state accreditation for higher education institutions 3.2 EDUCATIONAL LEVEL OF RESPONDENTS Tables 3.2.1 and 3.2.2 show the educational level of female and male respondents by selected background characteristics. The results reflect the fact that education has been almost universal in Ukraine for some time. Overall, a negligible percentage of respondents have never attended school, and the majority have attained at least a secondary or higher education. The median years of schooling for women is 14.2 years and for men is 11.9 years. Background Characteristics of Respondents | 23 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, Ukraine 2007 Background characteristic Highest level of schooling Total Median years completed Number of women No education Primary Secondary PTU Tekhnicum University1 Age 15-24 0.0 0.1 38.6 9.0 15.0 37.2 100.0 12.3 1,788 15-19 0.0 0.2 61.9 5.1 12.4 20.4 100.0 10.3 782 20-24 0.0 0.1 20.5 12.1 17.0 50.4 100.0 14.6 1,006 25-29 0.1 0.1 25.4 9.7 25.5 39.3 100.0 15.0 998 30-34 0.0 0.1 26.6 12.2 29.1 32.0 100.0 14.6 984 35-39 0.0 0.1 24.5 12.5 31.2 31.7 100.0 14.7 1,049 40-44 0.0 0.1 24.6 13.1 33.0 29.2 100.0 14.6 936 45-49 0.1 0.1 25.1 11.2 35.6 27.8 100.0 14.7 1,085 Residence Urban 0.0 0.1 20.4 11.4 29.1 39.0 100.0 14.8 4,887 Rural 0.1 0.1 49.5 10.1 21.0 19.3 100.0 10.8 1,954 Region North 0.0 0.0 25.7 9.3 25.1 39.9 100.0 14.4 1,345 Central 0.0 0.2 30.2 14.2 25.3 30.1 100.0 13.6 817 East 0.0 0.0 22.4 12.5 32.7 32.3 100.0 14.6 2,120 South 0.0 0.4 33.0 9.9 24.9 31.9 100.0 13.8 1,049 West 0.1 0.1 36.5 9.6 21.9 31.7 100.0 13.2 1,509 Wealth quintile Lowest 0.1 0.2 55.4 11.7 20.8 11.8 100.0 10.4 847 Second 0.0 0.2 41.0 11.3 26.3 21.2 100.0 11.7 1,437 Middle 0.0 0.1 27.8 11.5 28.5 32.2 100.0 14.1 1,276 Fourth 0.1 0.0 19.5 11.2 30.4 38.8 100.0 14.8 1,451 Highest 0.0 0.1 14.8 10.0 25.8 49.3 100.0 15.4 1,831 Total 0.0 0.1 28.7 11.0 26.8 33.3 100.0 14.2 6,841 1 University or similar institutions of levels III-IV of state accreditation for higher education institutions 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, accord- ing to background characteristics, Ukraine 2007 Background characteristic Highest level of schooling Total Median years completed Number of men No education Primary Secondary PTU Tekhnicum University1 Age 15-24 0.1 0.1 42.1 11.4 17.2 29.1 100.0 11.5 903 15-19 0.0 0.1 65.3 6.8 13.7 14.1 100.0 10.3 444 20-24 0.3 0.0 19.7 15.9 20.6 43.5 100.0 14.5 459 25-29 0.0 0.0 24.4 18.9 22.2 34.5 100.0 14.7 436 30-34 0.0 0.2 30.7 20.0 20.9 28.2 100.0 11.9 479 35-39 0.2 0.0 26.0 24.5 21.4 27.9 100.0 12.0 449 40-44 0.0 0.0 31.4 16.2 28.6 23.9 100.0 14.2 399 45-49 0.0 0.1 36.7 17.9 25.2 20.1 100.0 11.6 512 Residence Urban 0.1 0.0 26.4 16.9 23.5 33.2 100.0 14.2 2,277 Rural 0.1 0.2 51.4 18.2 17.3 12.8 100.0 10.6 901 Region North 0.2 0.0 28.2 17.3 19.5 34.9 100.0 13.4 616 Central 0.0 0.0 37.2 22.6 19.5 20.7 100.0 11.2 354 East 0.0 0.0 32.6 16.0 24.6 26.8 100.0 12.9 1,060 South 0.0 0.2 37.3 13.5 21.5 27.6 100.0 11.9 493 West 0.1 0.2 35.0 19.1 20.7 25.0 100.0 11.7 654 Wealth quintile Lowest 0.2 0.5 54.0 25.4 13.6 6.3 100.0 10.4 432 Second 0.0 0.0 46.3 17.8 22.2 13.7 100.0 10.9 651 Middle 0.0 0.0 34.6 17.2 24.4 23.8 100.0 11.9 622 Fourth 0.0 0.0 23.4 18.6 24.4 33.6 100.0 14.4 623 Highest 0.1 0.0 19.8 11.6 21.6 46.8 100.0 15.2 849 Total 0.1 0.1 33.5 17.2 21.7 27.4 100.0 11.9 3,178 1 University or similar institutions of levels III-IV of state accreditation for higher education institutions 24 | Background Characteristics of Respondents Although virtually all female respondents had attended secondary school, there are marked differences across subgroups of the population in the proportions who have gone beyond that level. For example, Table 3.2.1 shows that 39 percent of urban women have university education, compared with only 19 percent of rural women. There also is some variation by region, with the largest propor- tion of university-educated women living in the North region (40 percent) and the smallest proportion in the Central region (30 percent). Attainment of a higher education is closely related to wealth status; 49 percent of women in the highest wealth quintile have at least some university education, compared with 12 percent of women in the lowest quintile. Overall, the median number of years of schooling varies from 10.4 years among women in the lowest wealth quintile to 15.4 years among those in the highest quintile. As Table 3.2.2 shows, the pattern of educational attainment among men is similar to that of women. Thirty-three percent of urban men have some university-level education, compared with 13 percent of rural men. Residents in the North region seem to have an educational advantage over the rest of the country: 35 percent of men in the North region are university-educated, compared with 21 percent in the Central region. Wealth status is positively associated with education; while 6 percent of men in the lowest wealth quintile have higher education, the corresponding proportion for men in the highest wealth quintile is 47 percent. Like women, men living in the wealthiest households have, on average, almost five additional years of schooling compared with men in the poorest households (15.2 and 10.4 years, respectively). 3.3 EXPOSURE TO MASS MEDIA The 2007 UDHS collected information on the exposure of women and men to both broadcast and print media. This information is important because it can help program managers plan the disse- mination of information on health, family planning, nutrition, and other programs. The results are pre- sented in Tables 3.3.1 and 3.3.2. Table 3.3.1 Exposure to mass media: women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characte- ristics, Ukraine 2007 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 68.9 98.0 69.4 50.9 0.8 782 20-24 74.8 98.1 72.4 57.6 1.2 1,006 25-29 76.7 98.1 68.0 57.7 1.1 998 30-34 73.7 97.7 66.1 53.5 1.1 984 35-39 76.2 97.7 65.7 54.6 1.0 1,049 40-44 75.5 97.7 62.1 52.0 1.1 936 45-49 75.0 96.3 64.3 52.5 1.8 1,085 Residence Urban 78.5 98.0 70.8 59.2 0.9 4,887 Rural 64.9 96.8 56.8 41.8 1.8 1,954 Region North 71.9 98.0 70.4 54.9 0.6 1,345 Central 71.7 96.4 66.1 46.0 0.8 817 East 86.8 98.5 73.7 68.1 0.8 2,120 South 64.0 95.1 61.0 44.7 3.4 1,049 West 68.8 98.4 58.1 45.3 1.0 1,509 Education Secondary or less 61.8 96.9 60.8 42.7 1.7 2,729 Higher 83.1 98.1 70.8 61.9 0.8 4,112 Wealth quintile Lowest 61.5 95.5 50.5 35.8 2.9 847 Second 70.9 97.2 61.2 48.5 1.5 1,437 Middle 73.4 97.6 64.8 52.0 1.2 1,276 Fourth 77.0 97.6 68.9 55.3 0.9 1,451 Highest 82.4 99.0 78.3 68.0 0.4 1,831 Total 74.6 97.6 66.8 54.2 1.2 6,841 Background Characteristics of Respondents | 25 Nearly all Ukrainian women (98 percent) watch television at least once a week, 75 percent read a newspaper, and 67 percent listen to the radio (Table 3.3.1). Only 1 percent do not regularly have exposure to any of the three media, compared with 54 percent who are exposed to all three me- dia on a weekly basis. Women age 20-29 are somewhat more likely than older women to report exposure to all three types of media. Exposure to all forms of media is clearly associated with residence, education, and wealth. Fifty-nine percent of urban women are exposed to television, radio, and newspapers, com- pared with 42 percent of rural women. Women from the East are markedly more likely to be exposed to all of the media (68 percent) than women from other regions. Sixty-two percent of women with a higher education are exposed to all three media, compared with 43 percent of women with secondary or lower level education. Sixty-eight percent of women in the highest wealth quintile are exposed to all three media, compared with 36 percent of women in the lowest wealth quintile. Compared with women, a higher proportion of men listen to the radio at least once a week (76 percent) and a smaller proportion read a newspaper at least once a week (68 percent). Overall, howev- er, the proportion of men exposed to all three types of media (54 percent) is identical to the rate ob- served among women (Table 3.3.2) and, as is the case among women, only 1 percent of men are not regularly exposed to mass media. Table 3.3.2 also shows that, for men, the relationships between ex- posure to mass media and background characteristics are generally similar to those observed among women. Table 3.3.2 Exposure to mass media: men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteris- tics, Ukraine 2007 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of men Age 15-19 52.1 98.5 74.7 40.6 1.2 444 20-24 66.2 97.1 77.6 54.1 2.3 459 25-29 71.7 97.8 79.1 59.4 0.5 436 30-34 69.6 94.8 78.1 56.5 2.0 479 35-39 73.3 97.9 76.4 58.4 0.9 449 40-44 72.2 98.2 70.5 54.4 0.5 399 45-49 70.4 96.4 74.4 56.2 1.2 512 Residence Urban 71.8 97.3 79.6 59.4 1.1 2,277 Rural 58.1 96.9 66.7 41.3 1.8 901 Region North 78.7 97.2 74.7 63.6 1.0 616 Central 56.2 96.8 63.0 37.4 1.8 354 East 74.1 97.9 83.5 63.3 0.7 1,060 South 52.5 94.9 72.6 39.3 2.2 493 West 65.8 97.9 74.2 51.2 1.3 654 Education Secondary or less 55.8 96.2 70.3 41.0 1.9 1,615 Higher 80.4 98.2 81.7 68.1 0.6 1,563 Wealth quintile Lowest 53.2 95.0 55.3 32.6 3.1 432 Second 59.9 97.3 72.1 44.1 1.1 651 Middle 66.3 97.0 75.3 51.6 1.6 622 Fourth 71.2 97.9 78.6 58.8 0.2 623 Highest 80.4 97.8 87.8 71.7 1.0 849 Total 67.9 97.2 75.9 54.3 1.3 3,178 3.4 EMPLOYMENT In the 2007 UDHS, respondents were asked about their employment status at the time of the survey and, if they were not currently employed, about any work they may have done in the 12 26 | Background Characteristics of Respondents months prior to the survey1. All employed respondents were asked additional questions about their occupation; whether they were paid in cash, in kind, or not at all; and for whom they worked. Tables 3.4.1 and 3.4.2 show the percent distribution of female and male respondents by em- ployment status according to background characteristics. A high proportion of women (72 percent) reported being currently employed, 2 percent were employed in the 12 months preceding the survey but not working at the time of the survey, and 26 percent were not employed in the 12 months preced- ing the survey (Figure 3.1). Figure 3.1 Employment status of women and men age 15-49 UDHS 2007 Currently employed 72% Not currently employed 2% No work past 12 months 26% Currently employed 78% Not currently employed 3% No work past 12 months 19% Women Men A slightly higher proportion of men (78 percent) than women reported being currently em- ployed. Three percent of men reported that they were employed in the 12 months preceding the survey but not working at the time of the survey, and 19 percent reported that they were not employed during the 12 months preceding the survey. Looking at the differentials, employment among women and men generally increases with age. Women with three or more living children are less likely to be currently employed compared with those with one or two living children. However, the lowest proportion of currently employed women is among those with no living children, which is usually associated with young age. Women and men who are currently or formerly married are more likely than their never-married counterparts to be employed at the time of the survey. Women and men in urban areas are more likely to be currently employed than their rural counterparts. Employment among women and men is highest in the East region (79 and 82 percent, respectively), and lowest in the West region (61 and 71 percent, respectively). The likelihood that a 1 The measurement of women’s employment can be especially difficult because some of the activities that women do, especially work on family farms, family businesses, or in the informal sector, are often not perceived by women themselves as employment and hence are not reported as such. To avoid underestimating women’s employment, therefore, the questions relating to employment in the Women’s Questionnaire encouraged women to report such activities. First, women were asked, “Aside from your own housework, have you done any work in the last seven days?” Women who answered “No” to this question were then asked, “As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business, or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?” Background Characteristics of Respondents | 27 woman is currently employed increases with both her education level and the wealth status of her household. Among men, the employment rate also tends to increase with education and wealth status, although the relationships are not as uniform as among women (Figure 3.2). Table 3.4.1 Employment status: women Percent distribution of women age 15-49 by employment status, according to background characteristics, Ukraine 2007 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Currently employed1 Not currently employed Age 15-19 11.6 2.3 86.0 100.0 782 20-24 58.1 3.2 38.7 100.0 1,006 25-29 80.3 1.0 18.6 100.0 998 30-34 85.4 1.7 12.9 100.0 984 35-39 83.4 2.3 14.0 100.0 1,049 40-44 85.4 1.0 13.6 100.0 936 45-49 83.5 2.2 14.2 100.0 1,085 Marital status Never married 41.3 2.3 56.3 100.0 1,544 Married or living together 78.2 1.9 19.8 100.0 4,116 Divorced/separated/widowed 88.4 1.5 10.1 100.0 1,181 Number of living children 0 51.7 2.3 45.9 100.0 2,098 1-2 81.9 1.7 16.4 100.0 4,379 3+ 62.8 3.3 33.7 100.0 364 Residence Urban 76.3 1.6 22.0 100.0 4,887 Rural 59.8 3.0 37.2 100.0 1,954 Region North 77.8 1.7 20.5 100.0 1,345 Central 66.4 2.2 31.3 100.0 817 East 78.7 1.1 20.1 100.0 2,120 South 68.4 2.7 28.9 100.0 1,049 West 61.2 2.7 36.0 100.0 1,509 Education Secondary or less 60.4 2.5 37.0 100.0 2,729 Higher 79.1 1.6 19.3 100.0 4,112 Wealth quintile Lowest 56.9 3.6 39.4 100.0 847 Second 63.7 2.6 33.7 100.0 1,437 Middle 70.4 1.7 27.9 100.0 1,276 Fourth 77.6 1.4 20.8 100.0 1,451 Highest 80.7 1.4 18.0 100.0 1,831 Total 71.6 2.0 26.4 100.0 6,841 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, vaca- tion, or any other such reason. 28 | Background Characteristics of Respondents Table 3.4.2 Employment status: men Percent distribution of men age 15-49 by employment status, according to background characteristics, Ukraine 2007 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 17.5 3.7 78.7 100.0 444 20-24 69.4 4.2 26.3 100.0 459 25-29 93.5 1.5 5.0 100.0 436 30-34 93.0 2.5 4.5 100.0 479 35-39 93.5 1.4 5.1 100.0 449 40-44 93.0 2.2 4.9 100.0 399 45-49 87.4 4.8 7.7 100.0 512 Marital status Never married 49.5 3.7 46.7 100.0 1,044 Married or living together 93.0 2.6 4.4 100.0 1,799 Divorced/separated/widowed 89.2 2.3 8.5 100.0 334 Residence Urban 80.5 2.6 16.9 100.0 2,277 Rural 72.6 3.9 23.4 100.0 901 Region North 78.7 1.7 19.4 100.0 616 Central 78.1 4.1 17.8 100.0 354 East 82.4 3.3 14.3 100.0 1,060 South 79.1 4.0 16.8 100.0 493 West 70.7 2.1 27.1 100.0 654 Education Secondary or less 74.8 3.4 21.7 100.0 1,615 Higher 81.8 2.5 15.6 100.0 1,563 Wealth quintile Lowest 73.1 4.9 22.0 100.0 432 Second 74.0 3.3 22.6 100.0 651 Middle 79.4 4.6 16.0 100.0 622 Fourth 81.1 1.1 17.8 100.0 623 Highest 81.3 1.9 16.7 100.0 849 Total 78.3 2.9 18.7 100.0 3,178 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, vaca- tion, or any other such reason. Figure 3.2 Percentage of women and men age 15-49 who are currently employed, by background characteristics UDHS 2007 81 73 75 82 73 74 79 81 81 76 60 60 79 57 64 70 78 81 RESIDENCE Urban Rural MOTHER’S EDUCATION Secondary or less Higher WEALTH QUINTILE Lowest Second Middle Fourth Highest 0 10 20 30 40 50 60 70 80 90 100 Percentage currently employed Men Women Background Characteristics of Respondents | 29 3.5 OCCUPATION Information on a woman’s occupation not only allows an evaluation of the woman’s source of income but also has implications for her empowerment. To obtain information on occupation in the survey, respondents who indicated that they were currently working or had been employed in the 12- month period prior to the survey were asked about the kind of work they did. Their responses were recorded verbatim and served as the basis for the coding of occupation that occurred in the central office. Table 3.5.1 Occupation: women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background cha- racteristics, Ukraine 2007 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 3.3 14.8 46.7 11.7 12.6 3.4 7.6 100.0 108 20-24 22.6 20.9 40.9 7.0 4.2 0.6 3.7 100.0 617 25-29 33.3 20.6 31.0 6.4 6.5 1.0 1.2 100.0 812 30-34 29.6 20.0 31.7 8.3 7.0 2.6 0.8 100.0 858 35-39 26.4 19.7 34.1 9.8 7.4 2.4 0.1 100.0 899 40-44 30.5 19.3 30.9 8.6 8.2 2.0 0.4 100.0 808 45-49 30.4 16.7 28.3 10.6 9.9 2.7 1.3 100.0 931 Marital status Never married 26.7 19.9 35.4 8.8 6.4 0.5 2.3 100.0 673 Married or living together 29.3 19.6 31.6 8.8 7.4 2.2 1.2 100.0 3,298 Divorced/separated/widowed 27.2 18.2 34.5 8.2 8.5 2.4 1.0 100.0 1,062 Number of living children 0 30.8 21.2 33.0 7.1 4.6 1.1 2.2 100.0 1,134 1-2 28.5 19.4 32.3 9.0 7.9 2.0 1.0 100.0 3,658 3+ 18.2 8.4 38.0 10.9 15.1 7.2 2.2 100.0 241 Residence Urban 30.5 20.4 32.6 9.0 5.7 0.3 1.5 100.0 3,807 Rural 22.4 15.9 33.2 7.4 13.1 7.3 0.6 100.0 1,226 Region North 34.4 20.3 28.9 7.5 6.5 1.5 1.0 100.0 1,070 Central 24.4 22.4 33.1 6.7 9.7 3.2 0.4 100.0 561 East 27.1 18.6 32.8 11.7 7.1 1.4 1.3 100.0 1,692 South 28.4 19.1 35.2 6.4 8.4 2.1 0.5 100.0 746 West 26.8 17.8 34.6 7.5 7.4 3.1 2.7 100.0 965 Education Secondary or less 4.7 9.8 47.7 16.0 15.7 4.7 1.6 100.0 1,717 Higher 40.8 24.2 25.0 4.9 3.3 0.7 1.1 100.0 3,316 Wealth quintile Lowest 15.5 12.9 34.4 9.5 18.0 8.6 1.1 100.0 512 Second 23.6 18.5 35.0 9.4 8.7 4.2 0.7 100.0 953 Middle 25.1 20.7 34.1 9.2 8.0 1.6 1.2 100.0 920 Fourth 31.2 19.3 32.3 9.8 6.1 0.1 1.2 100.0 1,146 Highest 36.1 21.1 30.2 6.7 4.0 0.1 1.8 100.0 1,502 Total 28.5 19.3 32.7 8.7 7.5 2.0 1.3 100.0 5,033 Table 3.5.1 shows the percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics. One-third of employed women are in sales and services; 29 percent are employed in professional, technical, or managerial positions; and 19 percent are employed in clerical positions. Only 2 percent of women work in agriculture. Thirty-one percent of urban women, 41 percent of women with higher education, and more than one-third of women living in households in the highest wealth quintile hold professional, tech- nical, or managerial jobs. The proportions working in sales and services and in skilled and unskilled manual occupations are markedly higher among women with secondary or less education than among other women. 30 | Background Characteristics of Respondents Table 3.5.2 shows that among employed men, 20 percent hold professional, technical, or ma- nagerial positions; 28 percent are employed in sales and services; 38 percent work as skilled manual laborers; and only 2 percent work in agriculture. The variations across subgroups in the occupational profile among employed men are generally similar to those observed among women, with the excep- tion of similar proportions of men working in sales and services in each category of education. Table 3.5.2 Occupation: men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characte- ristics, Ukraine 2007 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 5.8 1.7 14.3 27.2 41.1 1.9 8.0 100.0 94 20-24 15.8 4.8 30.2 35.7 9.1 1.0 3.4 100.0 338 25-29 24.4 3.7 31.3 33.5 4.6 1.8 0.7 100.0 415 30-34 22.4 2.3 27.3 37.9 8.0 1.6 0.5 100.0 458 35-39 21.1 2.4 25.9 40.6 6.0 3.5 0.4 100.0 426 40-44 20.3 1.9 27.6 40.7 6.4 2.4 0.6 100.0 380 45-49 17.6 1.3 27.0 42.8 8.2 2.0 1.1 100.0 472 Marital status Never married 15.9 3.9 29.9 32.3 13.5 1.9 2.6 100.0 556 Married or living together 21.1 2.1 28.7 38.9 6.1 2.1 1.0 100.0 1,720 Divorced/separated/widowed 20.2 3.0 17.1 45.7 11.2 2.4 0.5 100.0 306 Residence Urban 23.0 2.7 29.3 36.1 7.3 0.5 1.2 100.0 1,892 Rural 11.2 2.4 23.0 44.3 11.1 6.5 1.4 100.0 689 Region North 26.4 3.7 28.9 32.7 7.0 0.6 0.7 100.0 496 Central 13.5 3.6 30.9 37.3 12.1 2.4 0.2 100.0 291 East 19.5 1.5 25.4 42.0 9.0 1.1 1.4 100.0 908 South 17.8 3.1 29.1 36.2 8.9 3.2 1.6 100.0 410 West 19.4 2.5 27.1 39.2 5.5 4.3 2.0 100.0 477 Education Secondary or less 3.0 1.5 26.9 50.6 14.0 2.9 1.0 100.0 1,263 Higher 36.0 3.6 28.3 26.4 2.8 1.3 1.5 100.0 1,318 Wealth quintile Lowest 8.3 1.5 14.3 53.6 14.6 6.4 1.2 100.0 337 Second 9.5 2.7 29.6 42.4 10.4 4.3 1.1 100.0 503 Middle 19.3 2.1 27.3 39.4 10.0 1.3 0.7 100.0 523 Fourth 24.0 3.4 29.9 36.0 4.9 0.6 1.2 100.0 512 Highest 30.1 2.8 31.2 28.9 5.0 0.0 2.0 100.0 706 Total 19.9 2.6 27.6 38.3 8.3 2.1 1.3 100.0 2,582 3.6 EMPLOYMENT CHARACTERISTICS Women who were employed in the 12 months preceding the survey were asked about the type of earnings they received, that is, whether they were paid in cash, in kind, or not at all. They were also asked about whether they were employed by a relative, a nonrelative, or were self-employed. Addi- tionally, women were asked whether they worked continuously throughout the year or seasonally. Table 3.6 presents the results of these questions according to the type of employment (agricultural or nonagricultural). Background Characteristics of Respondents | 31 Table 3.6 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), Ukraine 2007 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 55.0 97.4 96.3 Cash and in-kind 32.2 1.8 2.4 In-kind only 1.6 0.1 0.2 Not paid 9.4 0.5 0.8 Missing 1.8 0.2 0.4 Total 100.0 100.0 100.0 Type of employer Employed by family member 4.5 1.8 2.0 Employed by nonfamily member 75.0 90.6 90.0 Self-employed 20.5 7.4 7.6 Missing 0.0 0.2 0.4 Total 100.0 100.0 100.0 Continuity of employment All year 73.2 94.3 93.6 Seasonal 23.6 3.6 4.0 Occasional 3.2 1.8 1.9 Missing 0.0 0.4 0.5 Total 100.0 100.0 100.0 Number of women employed during the past 12 months 102 4,866 5,033 Note: Total includes women with information missing on type of employment who are not shown separately. Overall, 96 percent of employed women earn cash only, 2 percent are paid in cash and in kind, and 1 percent receive either in-kind payment or no payment at all. One in ten women who work in agriculture do not receive payment, and 55 percent are paid in cash only. Ninety-seven percent who work in nonagricultural jobs are paid in cash only. Table 3.6 shows that 90 percent of women who work are employed by a nonrelative, 2 per- cent are employed by a family member, and 8 percent are self-employed. The proportion self- employed among women working in agricultural jobs is 21 percent, compared with 7 percent of those employed in nonagricultural jobs. With regard to continuity of employment, the data show that more than nine in ten employed women work all year (94 percent). As expected, nearly one-fourth (24 percent) of women who work in agriculture work seasonally, while most of those who work in nonagricultural jobs typically work all year (94 percent). 3.7 MALE CIRCUMCISION Male circumcision has been shown to lower the risk to men of contracting sexually transmit- ted infections, including HIV. In the Ukraine, male circumcision is religiously practiced by the fol- lowers of Judaism and Islam. Figure 3.3 shows the percentage of men who report that they have been circumcised, by region. In general, only 2 percent of all men reported that they have been circumcised. The highest percentage of circumcision was observed in the South region (8 percent), which includes the Auto- nomous Republic of Crimea with a relatively large Muslim population of Crimean Tatars. 32 | Background Characteristics of Respondents Figure 3.3 Male circumcision by region UDHS 2007 2.3 1.2 1.6 1.9 8 0 Ukraine North Central East South West 0 2 4 6 8 10 Percent Fertility | 33 FERTILITY 4 Fertility is one of the three principal components of population dynamics, the others being mortality and migration. This chapter looks at a number of fertility indicators including levels, pat- terns, and trends in current and cumulative fertility; the length of birth intervals; the age at which women initiate childbearing; and teenage fertility. All women who were interviewed in the 2007 Ukraine Demographic and Health Survey (UDHS) were asked to give their complete reproductive history. In collecting these histories, each woman was first asked about the total number of pregnancies ending in live births, stillbirths, miscar- riages, and induced abortions. After obtaining these aggregate data, an event-by-event pregnancy his- tory was collected. For each pregnancy, the duration, the month and year the pregnancy ended, and the pregnancy outcome were recorded. Information was collected about the most recent completed pregnancy, then the next-to-last, etc. For each pregnancy ending in a live birth, information was col- lected on the sex of the child, survival status, and age (for living children) or age at death (for dead children). 4.1 CURRENT FERTILITY The data collected in the reproductive history were used to calculate two of the most widely used measures of current fertility: the total fertility rate (TFR) and its component age-specific fertility rates (ASFR). The TFR is interpreted as the number of children a woman would bear in her lifetime if she experienced the currently observed age-specific rates throughout her reproductive years. The fer- tility rates refer to the three-year period before the survey (i.e., approximately from August-November 2004 to August-November 2007). Rather than a longer or a shorter period, the three- year period was chosen for calculating these rates to pro- vide the most current information, to reduce sampling er- ror, and to avoid problems of the displacement of births. ASFRs are expressed by the number of births to women of a given age interval per 1,000 women in that age interval. In this survey, the ASFR for any specific five-year age in- terval is calculated by dividing the number of births of women in the age interval during the period 1 to 36 months preceding the survey by the number of years lived by women in that age interval during the same period of 1 to 36 months. According to the results of the 2007 UDHS, the TFR is 1.2 children per woman (Table 4.1). This means that, on average, a woman in Ukraine who is at the begin- ning of her childbearing years would give birth to 1.2 children by the end of her reproductive period if fertility levels were to remain constant at the level observed in the three-year period before the 2007 UDHS. This is far below the replacement-level fertility of slightly more than 2.0 births. The TFR for rural areas (1.5 births per woman) is higher than for urban areas (1.0 birth per woman). Figure 4.1 shows that this urban-rural difference in childbearing rates is more pronounced Table 4.1 Current fertility Age-specific and total fertility rate, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Ukraine 2007 Age group Residence Total Urban Rural 15-19 16 43 24 20-24 85 122 94 25-29 56 79 62 30-34 36 41 38 35-39 12 16 13 40-44 4 1 3 45-49 0 2 0 TFR (15-49) 1.0 1.5 1.2 GFR 36 48 39 CBR 7.1 8.3 7.5 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population 34 | Fertility among women under age 30 than among older women. Fertility peaks at age 20-24 in both urban and rural areas. The greatest absolute urban-rural difference in ASFR (37 births per 1,000 women) is also found in this age group. Table 4.1 presents two other summary measures of fertility: the crude birth rate (CBR) and the general fertility rate (GFR). The survey results indicate that the crude birth rate is 7.5 births per 1,000 population, which is below the rate reported by the State Statistical Committee of Ukraine (SSC) (9.8 per 1,000 population) for the year 2006 (SSC, 2007c). Urban-rural differentials are also observed in the CBR and the GFR. Figure 4.1 Age-specific fertility rates by urban-rural residence � � � � � � � � � � � � � � 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group 0 20 40 60 80 100 120 140 Births per 1,000 women Rural Urban Total� � UDHS 2007 Compared with recent fertility estimates from Demographic and Health Surveys conducted in other countries in the region, fertility in Ukraine in 2007 was lower than in Azerbaijan (2.0 births per women in 2006), Moldova (1.7 births per woman in 2005), and Armenia (1.7 births per woman in 2005) (SSC [Azerbaijan] and Macro International, 2008; NCPM [Moldova] and ORC Macro, 2006; NSS, MOH [Armenia], and ORC Macro, 2006). 4.2 FERTILITY DIFFERENTIALS BY BACKGROUND CHARACTERISTICS Table 4.2 and Figure 4.2 show the total fertility rate by background characteristics. Fertility is lowest in the East region (0.9 births per woman) and highest in the South and West regions (1.4 births per woman). The TFR is 1.4 births among women with secondary or lower levels of education, com- pared with 1.0 births among women with higher education. There is a negative association between fertility and wealth; women living in the poorest households have the highest fertility (1.7 births per woman). Fertility | 35 Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Ukraine 2007 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 1.0 3.0 1.6 Rural 1.5 2.3 2.0 Region North 1.1 3.4 1.6 Central 1.2 2.2 1.8 East 0.9 2.1 1.5 South 1.4 3.5 1.8 West 1.4 3.1 2.0 Education Secondary or less 1.4 2.9 1.9 Higher 1.0 2.7 1.6 Wealth quintile Lowest 1.7 2.7 2.1 Second 1.3 2.4 1.8 Middle 1.3 3.1 1.7 Fourth 0.9 2.1 1.6 Highest 1.0 3.4 1.5 Total 1.2 2.8 1.7 Note: Total fertility rates are for the period 1-36 months prior to interview. Figure 4.2 Total fertility rates for the three-year period preceding survey 1.2 1.0 1.5 1.4 1.0 1.7 1.3 1.3 0.9 1.0 Ukraine RESIDENCE Urban Rural MOTHER’S EDUCATION Secondary or less Higher WEALTH QUINTILE Lowest Second Middle Fourth Highest 0.0 1.0 2.0 3.0 Total fertility rate (children per woman) UDHS 2007 The percentage of women who reported being pregnant at the time of the survey is 2.8. This is likely to be an underestimate because women in the early stages of pregnancy may be unaware or un- sure that they are pregnant, and some may be reluctant to report that they are pregnant. Small differ- ences are found in this percentage across subgroups of women. 36 | Fertility The last column in Table 4.2 shows the mean number of children ever born to women age 40-49. This is an indicator of cumulative fertility; it reflects the fertility performance of older women who are nearing the end of their reproductive period and thus represents completed fertility. If fertility had remained stable over time, the mean number of children ever born to women age 40-49 would be similar to the TFR. In fact, the UDHS found that the mean number of children ever born to women age 40-49 (1.7 children per woman) is higher than the TFR for the three years preceding the survey (1.2 children per woman), indicating that fertility has declined over the past 30 years. The decline in fertility implied by a comparison of the TFR with completed fertility appears to have been shared by all subgroups. 4.3 FERTILITY TRENDS The 2007 UDHS data also allow for a direct examination of fertility trends over the 20 years pre- ceding the survey. One method for directly assessing fertility trends is to examine the age-specific fertility rates over time. Table 4.3 presents age-specific fertility rates for five-year periods preceding the survey using data on live births from respondents’ pregnancy histo- ries. Because women age 50 and older were not inter- viewed in the survey, the rates are successively trun- cated as the number of years before the survey increases. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years or more prior to the survey because women in that age group would have been 50 or older at the time of the survey. Data in this table indicate that fertility has declined in the past 20 years. The decline is partic- ularly evident among women in the young age groups. For example, age-specific fertility among women age 15-19 declined from 55 births per 1,000 women in the period 10-14 years before the sur- vey to 29 births per 1,000 women in the period 0-4 years before the survey, a nearly 50 percent de- crease. The pace of the decline was more rapid at the beginning of the period than during the five-year period preceding the UDHS, reflecting the fact that women had already achieved very low fertility levels by the beginning of the latter period. Another method that is useful in determining the fertility trend is to compare the TFR for the three-year period preceding the UDHS with the rates found from other data sources for earlier periods. The 1999 Reproductive Health Survey (RHS) estimated the TFR among women age 15-44 for the two-year period preceding the survey to be 1.4 (1.3 in urban areas and 1.8 in rural areas) (KIIS, CDC, and USAID, 2001). A comparison of the RHS rate with the TFR of 1.2 estimated from the 2007 UDHS indicates that fertility has slightly decreased in recent years. Fertility estimates from other sources, mainly from the government registration system, also confirmed that fertility has declined steadily throughout the 1990s and into the present decade, from a TFR of 1.8 in 1990 to 1.3 in 2006 among women age 15-49 (SSC, 2007c). 4.4 CHILDREN EVER BORN AND LIVING Table 4.4 shows the distribution of all women and of currently married women by the total number of children ever born and by mean number of living children. Data on the number of children ever born reflect the accumulation of births to women over their entire reproductive years and there- fore have limited reference to current fertility levels, particularly when the country has experienced a decline in fertility. However, the information is useful in looking at how average family size varies across age groups and for looking at the level of primary infertility. Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preced- ing the survey, by mother’s age at the time of the birth, Ukraine 2007 Mother’s age at birth Number of years preceding survey 0-4 5-9 10-14 15-19 15-19 29 39 55 56 20-24 100 112 132 146 25-29 61 62 78 89 30-34 36 26 31 [48] 35-39 11 9 [13] 40-44 3 [1] 45-49 [0] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. Fertility | 37 Table 4.4 shows that women in Ukraine have given birth to an average of 1.12 children, near- ly all of whom (1.09 children) are still alive. The mean number of children women have increases with age, reflecting the natural family-building process. On average, women in Ukraine have given birth to nearly one child by their late twenties. However, even in the oldest age groups, the mean number of children ever born is less than two. Almost no women age 15-19 (3 percent) have given birth. This proportion declines rapidly to 16 percent among women in their early thirties and to 5 per- cent among those in their forties. As expected, currently married women have had more births than all women in all age groups. The largest difference between the data on children ever born for currently married women and all women is in the young age groups, because a large number of unmarried young women are not exposed to the risk of pregnancy. Differences at older ages reflect the impact of marital dissolution (divorce or widowhood). Among currently married women, 43 percent have had only one live-born child, 37 percent have had two children, 6 percent have had three children, and less than 2 percent of women have had four or more children. Voluntary childlessness is rare in Ukraine, and most married women tend to have at least one child. Thus, the proportion childless among women age 45-49 is an indirect indicator of primary infertility. In total, only 4 percent of currently married women age 45-49 have never had a live birth. Table 4.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Ukraine 2007 Age Number of children ever born Total Number of women Mean number of children ever born Mean number of living children 0 1 2 3 4 5 6 7 8 9 ALL WOMEN 15-19 97.4 2.3 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 782 0.03 0.03 20-24 66.2 29.1 4.2 0.4 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,006 0.39 0.39 25-29 30.6 51.0 16.1 1.9 0.2 0.1 0.1 0.0 0.0 0.0 100.0 998 0.91 0.90 30-34 15.9 44.6 33.2 4.9 0.8 0.3 0.2 0.1 0.0 0.0 100.0 984 1.32 1.29 35-39 8.5 42.9 40.8 6.0 1.4 0.2 0.1 0.0 0.1 0.1 100.0 1,049 1.51 1.47 40-44 5.4 41.2 43.1 7.8 1.8 0.3 0.2 0.0 0.1 0.1 100.0 936 1.62 1.58 45-49 4.9 33.3 47.5 10.8 2.0 0.7 0.6 0.3 0.0 0.0 100.0 1,085 1.77 1.70 Total 30.4 35.9 27.5 4.8 0.9 0.2 0.2 0.1 0.0 0.0 100.0 6,841 1.12 1.09 CURRENTLY MARRIED WOMEN 15-19 62.0 31.1 6.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 45 0.45 0.45 20-24 39.6 51.4 8.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 472 0.70 0.70 25-29 18.3 57.4 21.2 2.5 0.3 0.2 0.1 0.0 0.0 0.0 100.0 691 1.10 1.08 30-34 7.5 44.9 39.8 6.1 1.1 0.3 0.2 0.1 0.0 0.0 100.0 709 1.51 1.48 35-39 4.3 40.7 45.5 7.5 1.5 0.1 0.1 0.0 0.1 0.0 100.0 770 1.63 1.59 40-44 4.3 36.9 47.8 8.3 2.0 0.2 0.2 0.0 0.1 0.1 100.0 680 1.70 1.66 45-49 3.5 31.2 51.0 10.8 2.4 0.5 0.3 0.2 0.0 0.0 100.0 750 1.82 1.76 Total 11.7 43.0 37.1 6.3 1.3 0.2 0.2 0.1 0.0 0.0 100.0 4,116 1.45 1.42 4.5 BIRTH INTERVALS A birth interval is defined as the length of time between two live births. Research has shown that short birth intervals may adversely affect maternal health and children’s chances of survival (Rutstein, 2005; WHO, 2006a). Children born too close to a previous birth, especially if the interval between the births is less than two years, are at increased risk of health problems and dying at an early age. The occurrence of closely spaced births gives the mother insufficient time to restore her health, which may limit her ability to take care of her children. The duration of breastfeeding for the older child may also be shortened if the mother becomes pregnant. Longer birth intervals, on the other hand, contribute to the improved health status of both mother and child. 38 | Fertility Table 4.5 shows the percent distribution of second and higher-order births in the five years prior to the survey by the number of months since the previous birth. The overall median birth interval is 66.4 months. Only 13 percent of non-first births occur within 24 months of the previous birth, which is considered a short birth interval. Short birth intervals are as high as 40 percent among fourth or higher order births, 28 percent among births to women in the lowest wealth quintile, and 21 percent among rural births (Figure 4.3). In general, younger women have shorter birth intervals than older women. While 19 percent of births among women age 20-29 are spaced less than 24 months apart, the corresponding figure is 9 percent for births among women age 30-39. Table 4.5 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Ukraine 2007 Background characteristic Months since preceding birth Total Number of non-first births Median number of months since preceding birth 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 * * * * * * * 3 * 20-29 11.0 7.8 23.1 14.5 13.7 29.8 100.0 193 41.9 30-39 4.6 4.7 4.7 4.9 7.5 73.6 100.0 282 92.1 40-49 (0.0) (0.0) (2.5) (3.8) (2.9) (90.8) 100.0 24 * Sex of preceding birth Male 8.7 6.9 12.6 12.0 6.9 52.9 100.0 258 63.1 Female 5.2 4.9 10.9 4.8 12.5 61.7 100.0 244 80.0 Birth order 2-3 5.4 5.0 12.0 8.4 10.3 58.9 100.0 460 69.6 4+ 23.9 16.5 9.2 9.9 1.7 38.9 100.0 42 36.3 Residence Urban 2.1 3.7 10.1 8.6 10.4 65.1 100.0 274 79.7 Rural 12.8 8.6 13.8 8.4 8.6 47.7 100.0 229 57.9 Region North 3.2 6.4 9.4 5.3 9.1 66.6 100.0 96 82.9 Central 4.5 7.5 10.1 8.6 11.2 58.0 100.0 57 65.7 East 4.7 1.2 3.7 7.9 11.9 70.6 100.0 100 87.2 South 4.5 6.1 15.2 8.2 5.6 60.4 100.0 86 79.6 West 12.7 7.9 16.9 10.8 10.1 41.6 100.0 164 49.6 Education Secondary or less 10.7 6.0 13.7 9.4 8.3 51.9 100.0 263 62.5 Higher 2.9 5.8 9.7 7.5 11.0 63.1 100.0 240 75.7 Wealth quintile Lowest 15.9 11.9 13.4 8.5 6.8 43.6 100.0 102 50.7 Second 8.8 4.3 14.7 10.6 11.6 50.0 100.0 140 61.0 Middle 2.3 2.2 13.4 7.7 12.1 62.3 100.0 97 81.6 Fourth 1.1 7.0 8.0 9.6 8.4 65.8 100.0 69 82.5 Highest 3.8 4.9 6.8 5.4 7.9 71.2 100.0 94 83.7 Total 7.0 5.9 11.8 8.5 9.6 57.2 100.0 503 66.4 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding preg- nancy that ended in a live birth. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25 to 49 unweighted cases. Fertility | 39 Figure 4.3 Percentage of births occurring after a short birth interval (less than 24 months after a prior birth) Note: Data are for non-first births in the five years preceding the survey 16 10 6 21 17 9 28 13 5 8 9 SEX OF CHILD Male Female RESIDENCE Urban Rural MOTHER’S EDUCATION Secondary or less Higher WEALTH QUINTILE Lowest Second Middle Fourth Highest 0 5 10 15 20 25 30 Percentage of births UDHS 2007 The median number of months since the preceding birth is shorter for children born in rural areas (57.9 months) than those born in urban areas (79.7 months). Among regions, children born in the West region have the shortest interval (49.6 months), and those born in the East region have the longest birth interval (87.2 months). With regard to wealth status, births to women in the lower wealth quintiles have shorter intervals compared with births to women in the higher wealth quintiles. 4.6 AGE AT FIRST BIRTH Age at first birth is an important determinant of fertility. It has significant demographic con- sequences for society as a whole, as well as for the health and welfare of mothers and children. Early initiation into childbearing lengthens the reproductive period and subsequently increases fertility. Conversely, a late start in childbearing shortens the reproductive period and thus decreases fertility. Table 4.6 shows the percentage of women age 15-49 who have given birth by specific exact ages, ac- cording to current age. For women age 25 and older, the median age at first birth is presented in the last column of the table. 40 | Fertility Table 4.6 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Ukraine 2007 Current age Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth 15 18 20 22 25 15-19 0.1 na na na na 97.4 782 a 20-24 0.0 3.2 12.6 na na 66.2 1,006 a 25-29 0.1 5.0 20.0 39.4 62.5 30.6 998 23.1 30-34 0.1 7.3 27.8 52.3 71.3 15.9 984 21.8 35-39 0.0 4.9 26.3 52.1 74.9 8.5 1,049 21.8 40-44 0.2 3.0 21.7 49.8 76.5 5.4 936 22.0 45-49 0.0 1.9 16.2 42.5 73.3 4.9 1,085 22.6 25-49 0.1 4.4 22.3 47.2 71.7 12.9 5,053 22.3 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the be- ginning of the age group The 2007 UDHS findings indicate that childbearing among women begins relatively late. Two-thirds of women age 20-24 (66 percent) have never given birth. The median age at first birth among women age 25 and older is 22.3. Although the trend across age cohorts is not uniform, the me- dian age at first birth among women 25-29 years is 23.1 years, which is higher than the median ages at which older cohorts first gave birth (21.8 to 22.6 years). Table 4.7 shows the differential patterns in the median age at first birth among women cur- rently age 25-49, by background characteristics. The measures are presented beginning with age group 25-49 to ensure that at least half of the women in the age group have already had a birth. Wom- en in urban areas generally have a higher median age at first birth than women in rural areas (22.6 and 21.4 years, respectively). The median age at first birth varies only slightly by region, ranging from 21.8 years in the West region to 22.6 years in the North region. The median age at first birth is 21.4 years among women with secondary or less education and 22.8 among women with higher education. Although not uniform, the median age at first birth increases with wealth quintile. Table 4.7 Median age at first birth Median age at first birth among women age 25-49 years, by current age, according to background characteristics, Ukraine 2007 Background characteristic Current age Women age 25-49 25-29 30-34 35-39 40-44 45-49 Residence Urban 23.7 22.4 22.2 22.1 22.8 22.6 Rural 21.5 20.7 21.1 21.7 22.0 21.4 Region North 23.7 22.2 22.5 21.6 23.0 22.6 Central 22.9 21.9 21.2 21.7 22.0 21.9 East 23.2 21.8 21.8 22.3 22.7 22.4 South 23.7 22.0 21.8 22.2 22.6 22.5 West 22.0 21.2 21.7 21.9 22.3 21.8 Education Secondary or less 21.7 20.9 21.0 21.4 22.0 21.4 Higher 23.9 22.5 22.3 22.4 22.9 22.8 Wealth quintile Lowest 22.8 21.0 21.4 21.9 22.2 21.8 Second 21.4 21.3 21.0 21.8 22.1 21.6 Middle 22.6 21.5 21.8 21.7 22.0 21.9 Fourth 23.0 21.6 22.5 22.1 23.2 22.5 Highest a 22.9 22.2 22.3 23.0 23.0 Total 23.1 21.8 21.8 22.0 22.6 22.3 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group Fertility | 41 4.7 TEENAGE PREGNANCY AND MOTHERHOOD It is well known that adolescent pregnancy, early childbearing, and mother- hood have negative socioeconomic and health consequences. Adolescent mothers are more likely to have complications during labor, which results in higher morbidity and mortal- ity for themselves and their children. Moreo- ver, childbearing during the teenage years frequently has adverse social consequences, particularly on female educational attainment, because women who become mothers in their teens are more likely to curtail education1. Table 4.8 shows the percentage of women age 15-19 (teenagers) who are moth- ers or pregnant with their first child, by back- ground characteristics. Overall, 4 percent of teenagers in Ukraine have begun childbear- ing. No respondents age 15 and 16 have be- gun childbearing, but starting from age 17, the proportion of young women who have begun childbearing increases with age, from 4 percent among women age 17 to 9 percent of women age 19. Although teenage fertility does not vary significantly by residence (4 percent in urban areas compared with 5 percent in rural areas), it varies significantly across regions, ranging from 1 percent in the East region to 8 percent in the South region. The proportion of early childbearing does not vary by education. The proportion who have begun childbearing is markedly lower among teenagers in the highest wealth quintile compared with those in the other wealth quintiles. 1 The legal age at marriage in Ukraine is 18 for men and 17 for women. Table 4.8 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child and percentage who have begun childbearing, by background characteristics, Ukraine 2007 Background characteristic Percentage who: Percentage who have begun child- bearing Number of women Have had a live birth Are pregnant with first child Age 15 0.0 0.0 0.0 141 16 0.0 0.0 0.0 166 17 1.6 2.6 4.2 178 18 6.2 1.7 7.9 136 19 5.9 3.3 9.2 161 Residence Urban 1.7 2.1 3.8 508 Rural 4.4 0.6 4.9 274 Region North 2.3 1.4 3.8 136 Central 2.2 2.3 4.4 106 East 0.0 1.0 1.0 212 South 4.6 2.9 7.5 125 West 4.6 1.1 5.7 204 Education Secondary or less 2.3 1.9 4.2 526 Higher 3.4 0.8 4.2 256 Wealth quintile Lowest 5.7 1.9 7.7 135 Second 1.5 0.9 2.4 191 Middle 4.0 4.7 8.7 142 Fourth 2.0 0.9 2.9 152 Highest 0.8 0.0 0.8 161 Total 2.6 1.6 4.2 782 Family Planning | 43 FAMILY PLANNING 5 The network of family planning institutions established in Ukraine is effective because of the successful implementation of the “Family Planning” and “Reproductive Health 2001-2005” programs. There has been a noticeable improvement in the awareness of contraceptive methods and in the timing of desired pregnancies. In the process of implementing these programs, there has been a 25 percent decrease in induced abortion rates over the past four years (SSC, 2007a). The government program, “Reproductive Health of the Nation for the Period Until 2015,” aims to improve reproductive health as an important component of overall health and is currently the main programmatic document used to make decisions on many reproductive health issues. With implementation of the program, the government has, for the first time, supported the purchase of contraceptive supplies that will be provided at no cost to women who should avoid pregnancy or childbirth for health reasons. This chapter presents results from the 2007 Ukraine Demographic and Health Survey (UDHS) on knowledge of contraceptive methods and contraceptive prevalence rates past and present. The chapter then considers a number of other topics that are of practical use to policy and program administrators in formulating effective family planning strategies. These topics include sources of contraceptive methods, costs of modern methods, informed choice among users, reasons for discontinuation of a method, and plans for future use of contraceptive methods. The chapter also contains information on exposure to family planning messages through the media and contact of nonusers with family planning providers. Because men play an important role in the realization of reproductive goals, results from the male survey are also presented, wherever possible. In addition, when possible, comparisons are made with findings from the 1999 Ukraine Reproductive Health Survey (URHS) to evaluate changes in family planning in the Ukraine over time. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Knowledge of contraceptive methods is an important precursor to use. Information on knowledge of contraception was collected by first asking a respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a specific method spontaneously, the interviewer described the method and asked whether the respondent recognized it. The ability to spontaneously name or recognize a family planning method when it is described should be regarded as a simple test of the awareness of a method but not necessarily as an indication of the extent of a respondent’s knowledge of the method. The UDHS collected information on eight modern family planning methods—female and male sterilization, the pill, IUD, injectables, implants, male condoms, and emergency contraception—and two traditional methods—rhythm and withdrawal. Folk methods, such as the use of plants and herbs, if mentioned spontaneously by respondents were also noted. In Table 5.1, information about knowledge of contraceptive methods is presented for all women and men as well as for currently married and unmarried but sexually active women and men, by specific methods. The results show that knowledge of at least one modern method of family planning in Ukraine is universal among both women and men, regardless of marital status. A slightly greater proportion of women and men reported having heard of a modern than a traditional method. Knowledge of any traditional method is at or above 90 percent in all of the marital status categories. These results are similar to the findings of the 1999 URHS, indicating that contraceptive knowledge has remained consistently high in Ukraine. 44 | Family Planning Looking at knowledge of specific methods among currently married women, the most widely known modern contraceptive methods are male condoms (99 percent) and the IUD and the pill (96 and 94 percent, respectively). Seventy-four percent of married women know about female sterilization, 65 percent have heard of male sterilization, 50 percent mentioned knowing about emergency contraception, 47 percent cited injectables, and 23 percent were aware of implants. Considering traditional methods, 96 percent of married women know about withdrawal, 90 percent have heard of rhythm, and 16 percent could name a folk method. Although the patterns are not completely uniform, levels of knowledge of specific methods among sexually active unmarried women are generally similar to those found among married women. It is notable, however, that unmarried sexually active women are more aware of pills and substantially more aware of emergency contraception compared with other women. Contraceptive knowledge among currently married men is similar to that of women except that fewer men know about injectables, implants, and emergency contraception, and just 1 percent know about folk methods. Because of the nearly universal knowledge of contraceptives in Ukraine, there is almost no difference in the percentage of respondents who have heard of at least one method of contraception by background characteristics (data not shown). Table 5.1 Knowledge of contraceptive methods Percentage of all respondents, currently married respondents and sexually active unmarried respondents age 15-49 who know any contraceptive method, by specific method, Ukraine 2007 Method Women Men All women Currently married women Sexually active unmarried women1 All men Currently married men Sexually active unmarried men1 Any method 99.1 99.3 100.0 99.5 99.7 100.0 Any modern method 99.1 99.2 100.0 99.4 99.7 100.0 Female sterilization 69.5 74.3 70.6 63.5 70.7 63.9 Male sterilization 60.3 65.3 59.0 57.3 64.4 56.8 Pill 93.5 94.3 97.2 87.9 92.6 87.6 IUD 94.0 96.1 96.3 82.5 89.0 85.9 Injectables 43.7 47.0 40.3 34.6 37.9 34.9 Implants 21.1 23.0 15.3 13.6 13.9 14.8 Male condom 98.8 98.8 100.0 99.3 99.6 100.0 Emergency contraception 48.5 49.6 57.9 31.7 33.6 37.1 Any traditional method 93.8 97.3 98.3 89.7 95.0 93.1 Rhythm 85.4 89.6 91.0 73.7 84.7 71.4 Withdrawal 91.4 96.0 96.6 86.7 92.0 90.6 Folk method 14.8 16.1 27.2 1.0 1.3 0.5 Mean number of methods known by respondents 7.2 7.5 7.5 6.3 6.8 6.4 Number of respondents 6,841 4,116 637 3,178 1,799 683 1 Had last sexual intercourse within past 30 days 5.2 EVER USE OF CONTRACEPTION In the 2007 UDHS, respondents who had heard of a method of family planning were asked if they had ever used a method. Ever use refers to use of a method at any time, with no distinction between past and present use. Data on ever use of contraception has special significance because it reveals the cumulative success of the family planning program in Ukraine in promoting the use of contraception among couples. Table 5.2.1 shows the percentage of all women, currently married women, and sexually active unmarried women who have ever used a specific family planning method by age. Looking first at the patterns for currently married women, 89 percent have ever used any method of contraception and 78 percent have used a modern method. Two in three married women have ever used a male condom, making it the most commonly used modern method. About one in three has ever used an IUD, more than one in six has used the pill, and 4 percent have used emergency contraception. The majority of Family Planning | 45 married women (72 percent) report use of traditional methods, with withdrawal being used more often than the rhythm method. Although the difference is not large, Table 5.2.1 also shows that sexually active unmarried women are more likely than married women to have ever used a method. Ever use of any method among the former group of women is 96 percent, and use of a modern method is 95 percent. In addition to the information on women’s use of contraception, the 2007 UDHS collected information from men on the ever use of four male methods: male sterilization, condoms, rhythm method, and withdrawal. Table 5.2.2 shows that 95 percent of currently married men age 15-49 have ever used one of these methods. Looking at specific methods, currently married men are most likely to have used condoms (89 percent), followed by use of withdrawal (77 percent) and rhythm (59 percent). Less than 1 percent of married men reported having been sterilized. As in the case of women, sexually active unmarried men are more likely to have ever used a method than currently married men. Finally, given the near universality of ever use of contraception, it is not surprising that there are relatively small differences across age groups in ever use rates in Tables 5.2.1 and 5.2.2. The largest age differentials are among married women, with the ever-use rate increasing from 66 percent among women age 15-19 to a peak of 91 percent among women in their late thirties. Table 5.2.1 Ever use of contraception: women Percentage of all women, currently married women, and sexually active unmarried women age 15-49 who have ever used any contraceptive method by method, according to age, Ukraine 2007 Age Any method Any modern method Modern method Any traditional method Traditional method Number of women Female steriliza- tion Male steriliza- tion Pill IUD Inject- ables Implants Male condom Emer- gency contra- ception Rhythm With- drawal Folk method ALL WOMEN 15-19 14.7 14.2 0.0 0.3 0.5 0.0 0.1 0.0 13.9 0.8 7.6 1.7 6.3 1.2 782 20-24 65.4 59.8 0.0 0.2 11.8 4.0 0.2 0.0 56.7 10.2 42.0 18.6 34.6 5.6 1,006 25-29 83.6 75.5 0.2 0.2 17.3 13.0 0.4 0.0 68.0 5.8 61.5 35.9 51.0 6.0 998 30-34 88.4 78.2 0.8 0.1 19.3 25.1 0.2 0.0 70.3 7.3 72.7 46.9 62.0 10.1 984 35-39 90.3 81.9 1.2 0.0 20.2 39.1 0.6 0.0 70.4 3.1 75.5 51.1 65.6 10.4 1,049 40-44 89.1 79.6 0.7 0.3 17.6 48.6 0.6 0.4 68.8 3.1 77.7 53.8 66.9 14.0 936 45-49 87.9 78.0 0.5 0.8 18.7 50.3 0.2 0.0 63.1 3.5 75.8 53.5 67.5 10.3 1,085 Total 76.2 68.5 0.5 0.3 15.6 26.7 0.3 0.1 60.2 4.9 60.7 38.6 52.1 8.4 6,841 CURRENTLY MARRIED WOMEN 15-19 66.4 60.5 0.0 0.0 1.1 0.0 0.0 0.0 60.5 9.4 37.0 11.5 28.7 8.1 45 20-24 78.6 67.1 0.0 0.4 15.4 7.5 0.0 0.0 62.0 8.1 56.3 26.2 45.2 6.3 472 25-29 88.1 77.1 0.2 0.3 17.0 16.1 0.5 0.0 68.1 4.4 66.9 40.6 55.9 5.7 691 30-34 90.7 79.4 1.1 0.1 19.2 28.8 0.2 0.0 71.6 6.8 76.2 49.8 63.3 11.3 709 35-39 91.3 82.1 1.3 0.0 20.3 42.8 0.8 0.0 68.5 2.5 75.8 52.1 66.7 10.6 770 40-44 90.5 80.6 0.6 0.4 17.2 50.5 0.8 0.5 70.3 1.7 78.7 54.7 68.4 12.4 680 45-49 90.3 79.2 0.5 1.0 17.5 53.4 0.3 0.0 63.7 2.8 76.9 53.7 68.9 10.0 750 Total 88.6 78.1 0.6 0.3 17.8 34.6 0.5 0.1 67.6 4.2 72.4 47.1 62.1 9.6 4,116 SEXUALLY ACTIVE UNMARRIED WOMEN1 15-19 98.0 94.9 0.0 1.0 4.7 0.0 1.2 0.0 94.9 2.5 54.2 8.4 45.4 7.6 59 20-24 97.3 96.9 0.0 0.0 17.9 1.2 0.4 0.0 96.0 26.3 57.9 24.5 49.3 11.2 221 25-29 92.5 90.7 1.1 0.0 20.2 11.7 0.0 0.0 83.5 11.7 63.2 34.3 52.3 16.7 112 30-34 96.4 93.7 0.0 0.0 23.3 19.0 0.0 0.0 84.5 15.4 81.3 59.6 74.2 18.9 70 35-39 95.0 95.0 0.0 0.0 25.0 42.2 0.0 0.0 91.2 10.2 84.6 65.1 68.7 25.1 76 40-44 (96.0) (93.5) (0.0) (0.0) (30.0) (64.8) (0.0) (0.0) (87.7) (4.9) (89.0) (57.5) (72.8) (49.2) 63 45-49 (98.2) (93.5) (0.0) (0.0) (27.5) (70.1) (0.0) (0.0) (73.1) (2.9) (80.7) (60.5) (70.2) (22.7) 36 Total 96.1 94.5 0.2 0.1 20.3 20.0 0.2 0.0 89.7 15.0 68.6 38.7 58.0 18.7 637 Note: Figures in parentheses are based on 25 to 49 unweighted cases. 1 Women who had sexual intercourse within past 30 days 46 | Family Planning Table 5.2.2 Ever use of contraception: men Percentage of all men, currently married men, and sexually active unmarried men age 15-49 who have ever used any contraceptive method by method, according to age, Ukraine 2007 Age Any method Modern method Traditional method Number of men Any modern method Male steriliza- tion Male condom Any traditional method Rhythm With- drawal ALL MEN 15-19 32.2 29.3 0.4 29.0 15.3 4.1 14.4 444 20-24 89.1 87.5 0.5 87.5 61.6 19.9 57.4 459 25-29 95.1 92.4 0.8 92.4 79.8 40.9 70.8 436 30-34 94.7 89.4 0.2 89.4 83.8 49.4 78.5 479 35-39 94.1 87.8 0.6 87.8 83.0 56.2 77.7 449 40-44 94.4 84.5 0.7 84.5 86.7 58.6 80.4 399 45-49 93.5 88.3 0.3 88.3 83.3 57.6 76.7 512 Total 84.9 80.1 0.5 80.1 70.6 41.1 65.3 3,178 CURRENTLY MARRIED MEN 15-19 92.5 85.3 0.0 85.3 69.8 69.8 44.8 13 20-24 93.3 90.6 0.0 90.6 72.7 44.3 61.5 104 25-29 95.0 92.7 0.9 92.7 84.0 53.0 73.2 263 30-34 96.8 90.3 0.0 90.3 86.1 56.2 80.3 331 35-39 94.1 87.1 0.7 87.1 83.9 64.3 78.1 351 40-44 94.8 84.2 0.8 84.2 87.3 62.5 80.9 317 45-49 93.9 88.3 0.2 88.3 84.8 59.6 77.7 420 Total 94.7 88.5 0.5 88.5 84.4 58.6 77.0 1,799 SEXUALLY ACTIVE UNMARRIED MEN1 15-19 90.8 86.5 0.8 86.5 42.8 3.1 42.8 75 20-24 98.2 97.5 0.8 97.5 66.6 14.8 63.9 253 25-29 99.3 96.8 0.6 96.8 78.4 21.5 72.2 132 30-34 99.0 97.4 1.2 97.4 86.2 39.8 81.7 98 35-39 (98.2) (98.2) (0.0) (98.2) (86.3) (28.0) (79.9) 54 40-44 (93.5) (93.5) (0.0) (93.5) (86.5) (43.3) (82.1) 36 45-49 (94.5) (94.5) (0.0) (94.5) (80.6) (63.1) (73.0) 35 Total 97.3 95.8 0.7 95.8 72.4 23.4 68.4 683 Note: Figures in parentheses are based on 25 to 49 unweighted cases. 1 Men who had sexual intercourse within past 30 days 5.3 CURRENT USE OF CONTRACEPTION Current use of contraception is defined as the proportion of women who reported the use of a family planning method at the time of interview. The level of current use—usually calculated among currently married women—is the most widely used and valuable measure of the success of family planning programs. Table 5.3 shows the percent distribution of all women, currently married women, and sexually active unmarried women who are currently using specific family planning methods by age. Similar information on current use was not collected for men. Table 5.3 shows that nearly two in three currently married women (67 percent) are using a method of family planning, with 48 percent using a modern contraceptive method. The most popular modern methods are the condom (24 percent), followed by the IUD (18 percent) and the pill (5 percent). Other modern methods are currently used by less than 1 percent of currently married women. One in five women are currently using traditional methods, with withdrawal slightly more popular (10 percent) than rhythm (7 percent). The pattern of current use among sexually active unmarried women is similar to that among currently married women, except that current use is reported to be much higher among the former than the latter group. Eighty-seven percent of sexually active unmarried women report current use of any method, with 79 percent currently using a modern method. Condom use among sexually active unmarried women is nearly two and a half times higher than condom use among currently married women. On the other hand, currently married women are much more likely to be using an IUD than sexually active unmarried women. Family Planning | 47 Current contraceptive use varies by age. Use is lower among younger women, presumably because they are in the early stage of family building, and among older women, some of whom may no longer be fecund, than among those at intermediate ages. For example, current use of a modern contraceptive method is 43 percent among currently married women age 15-19, increases to 58 percent among women age 35-39, and then drops sharply to 33 percent at age 45-49. A similar pattern is seen in IUD use. However, condom use, which is most popular among the youngest group of women, falls steadily as age increases, from 37 percent to 14 percent. Table 5.3 Current use of contraception by age Percent distribution of all women, currently married women, and sexually active unmarried women age 15-49 by contraceptive method currently used, according to age, Ukraine 2007 Age Any method Any modern method Modern method Any tradi- tional method Traditional method Not currently using Total Number of women Female steriliza- tion Pill IUD Male condom Foam/ jelly Rhythm With- drawal Folk method ALL WOMEN 15-19 11.0 10.4 0.0 0.3 0.0 9.5 0.5 0.6 0.0 0.6 0.0 89.0 100.0 782 20-24 51.9 42.6 0.0 5.0 3.5 32.7 1.4 9.3 2.0 6.0 1.4 48.1 100.0 1,006 25-29 58.2 44.3 0.2 6.2 9.5 28.0 0.4 13.9 4.7 8.5 0.7 41.8 100.0 998 30-34 62.3 47.6 0.8 6.3 14.2 25.6 0.6 14.7 5.6 7.4 1.7 37.7 100.0 984 35-39 65.6 49.9 1.2 3.8 22.7 21.5 0.6 15.7 6.5 8.0 1.2 34.4 100.0 1,049 40-44 60.3 42.1 0.7 2.1 21.2 17.5 0.7 18.1 8.5 8.7 1.0 39.7 100.0 936 45-49 39.4 25.9 0.5 1.9 11.4 11.8 0.2 13.4 5.4 7.0 1.0 60.6 100.0 1,085 Total 50.9 38.3 0.5 3.7 12.1 21.2 0.6 12.6 4.8 6.8 1.0 49.1 100.0 6,841 CURRENTLY MARRIED WOMEN 15-19 48.3 42.7 0.0 0.0 0.0 37.0 5.6 5.6 0.0 5.6 0.0 51.7 100.0 45 20-24 62.7 45.0 0.0 6.6 6.5 31.0 0.9 17.7 3.9 11.1 2.8 37.3 100.0 472 25-29 64.5 46.1 0.2 6.5 11.9 27.2 0.3 18.4 6.3 11.1 1.1 35.5 100.0 691 30-34 73.6 55.1 1.1 7.2 18.2 28.1 0.3 18.5 7.2 9.1 2.2 26.4 100.0 709 35-39 78.0 58.1 1.3 4.6 26.8 24.8 0.7 19.9 8.0 10.1 1.7 22.0 100.0 770 40-44 70.3 47.4 0.6 2.8 24.3 19.0 0.6 22.9 10.3 11.4 1.1 29.7 100.0 680 45-49 50.7 32.9 0.5 2.4 15.5 14.2 0.2 17.8 6.6 9.8 1.4 49.3 100.0 750 Total 66.7 47.5 0.6 4.8 17.7 23.8 0.5 19.1 7.2 10.3 1.6 33.3 100.0 4,116 SEXUALLY ACTIVE UNMARRIED WOMEN1 15-19 85.9 81.8 0.0 2.3 0.0 76.6 2.9 4.1 0.0 4.1 0.0 14.1 100.0 59 20-24 91.6 87.8 0.0 8.2 0.9 73.8 4.5 3.7 0.8 2.7 0.3 8.4 100.0 221 25-29 87.8 80.7 1.1 9.8 8.5 59.9 1.3 7.2 0.6 6.6 0.0 12.2 100.0 112 30-34 84.1 71.7 0.0 6.4 8.5 52.3 4.4 12.4 3.7 8.7 0.0 15.9 100.0 70 35-39 86.4 74.4 0.0 5.3 29.5 37.5 2.0 12.0 7.2 4.8 0.0 13.6 100.0 76 40-44 (83.1) (72.9) (0.0) (0.0) (31.9) (37.4) (3.6) (10.2) (4.6) (3.2) (2.4) (16.9) 100.0 63 45-49 (77.6) (55.5) (0.0) (6.1) (14.7) (32.7) (2.0) (22.1) (13.6) (7.0) (1.4) (22.4) 100.0 36 Total 87.3 79.3 0.2 6.5 10.2 59.0 3.2 8.0 2.9 4.7 0.4 12.7 100.0 637 Note: If more than one method is used, only the most effective method is considered in this tabulation. Figures in parentheses are based on 25 to 49 unweighted cases. 1 Women who had sexual intercourse within past 30 days 5.4 CURRENT USE OF CONTRACEPTION BY BACKGROUND CHARACTERISTICS The study of differentials in current use of contraception is important because it helps identify subgroups of the population to target for family planning services. Table 5.4 shows the percent distribution of currently married women by their current use of family planning methods, according to background characteristics. This table allows comparison of levels of current contraceptive use among major population groups. It also permits an examination of differences in the method mix among current users within the various subgroups. There are noticeable differences in the use of contraceptive methods among subgroups of currently married women. Women in urban areas are more likely to use a family planning method than rural women, perhaps reflecting wider availability and easier access to methods in urban than in rural areas. The contraceptive prevalence rate for modern methods is 50 percent in urban areas, compared with 42 percent in rural areas. Most of that difference is owed to more widespread use of male condoms among urban than rural couples. 48 | Family Planning Table 5.4 Current use of contraception by background characteristics Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Ukraine 2007 Background characteristic Any method Any modern method Modern method Any tradi- tional method Traditional method Not currently using Total Number of women Female sterili- zation Pill IUD Male condom Foam/ jelly Rhythm With- drawal Folk method Residence Urban 68.5 50.0 0.6 5.5 17.0 26.1 0.7 18.5 7.4 9.1 2.0 31.5 100.0 2,858 Rural 62.3 41.9 0.7 3.4 19.3 18.3 0.2 20.4 6.5 13.2 0.7 37.7 100.0 1,258 Number of living children 0 39.5 31.8 0.0 6.2 1.4 23.1 1.0 7.7 2.1 4.9 0.8 60.5 100.0 491 1-2 71.0 50.8 0.6 4.8 20.6 24.2 0.5 20.1 7.6 10.7 1.8 29.0 100.0 3,330 3+ 62.9 36.4 2.1 2.9 12.1 19.4 0.0 26.5 10.2 15.3 1.0 37.1 100.0 295 Region North 72.6 44.9 0.4 6.1 11.4 26.8 0.3 27.6 15.8 8.9 2.9 27.4 100.0 861 Central 68.5 51.2 0.6 7.8 24.6 18.0 0.2 17.4 8.1 8.0 1.2 31.5 100.0 508 East 70.4 58.2 0.4 4.4 23.9 28.2 1.3 12.2 2.3 8.7 1.3 29.6 100.0 1,182 South 64.8 53.6 1.2 4.5 15.5 31.8 0.4 11.2 3.9 4.4 2.8 35.2 100.0 650 West 56.5 29.9 0.9 2.9 13.5 12.6 0.0 26.6 7.0 19.3 0.3 43.5 100.0 914 Education Secondary or less 63.3 43.2 0.6 3.4 17.3 21.6 0.3 20.1 6.2 11.9 2.0 36.7 100.0 1,609 Higher 68.8 50.3 0.7 5.7 18.0 25.1 0.7 18.5 7.8 9.3 1.4 31.2 100.0 2,507 Wealth quintile Lowest 62.4 36.0 0.3 3.5 14.2 17.8 0.1 26.4 7.3 17.1 1.9 37.6 100.0 508 Second 63.7 45.1 0.9 4.0 19.9 20.0 0.3 18.6 6.2 10.9 1.4 36.3 100.0 903 Middle 64.2 47.2 0.6 5.8 19.8 20.4 0.5 17.0 6.1 9.9 1.1 35.8 100.0 793 Fourth 69.5 50.7 0.8 4.6 16.2 28.9 0.2 18.8 7.6 9.2 2.1 30.5 100.0 776 Highest 70.7 52.7 0.5 5.7 17.2 28.2 1.1 18.0 8.3 7.9 1.8 29.3 100.0 1,136 Total 15-44 70.2 50.8 0.7 5.4 18.2 25.9 0.6 19.4 7.3 10.4 1.7 29.8 100.0 3,366 Total 15-49 66.7 47.5 0.6 4.8 17.7 23.8 0.5 19.1 7.2 10.3 1.6 33.3 100.0 4,116 Note: If more than one method is used, only the most effective method is considered in this tabulation. Use of modern methods increases from 32 percent among women with no living children to 51 percent among women with one or two living children, and then decreases to 36 percent among women with three or more children. IUD use peaks among women with 1-2 children, and the pill is most popular among women who have not yet had a child. There is little variation in condom use by the number of living children. Use of traditional methods increases as the number of living children increases. Contraceptive use varies by region, with current use of modern methods twice as high in the East region (58 percent) as in the West region (30 percent). Use of the pill is highest in the Central region (8 percent), and use of the IUD is highest in the Central and Eastern regions (25 and 24 percent, respectively). Condom use is highest in the South region (32 percent). Use of traditional methods is highest in the North and West regions, with the rhythm method being the most popular traditional method in the North region (16 percent) and withdrawal being the most popular traditional method in the West region (19 percent). Women with more than secondary education (69 percent) are more likely to use contraception than women with secondary or less education (63 percent). Considering the method mix, women who have higher than secondary education are somewhat more likely to use the pill and condom and less likely to use withdrawal than women with secondary or less education. Wealth has a positive effect on women’s contraceptive use; modern contraceptive use increases markedly as household wealth increases, from 36 percent among married women in the lowest wealth quintile to 53 percent among those in the highest wealth quintile. 5.5 TRENDS IN CURRENT USE OF FAMILY PLANNING The base female population in the UDHS is women age 15-49, while in the 1999 URHS it is women age 15-44. To analyze trends in contraceptive prevalence rates in Ukraine between the 1999 URHS and the 2007 UDHS, the UDHS data were computed for women age 15-44 to be comparable Family Planning | 49 with the 1999 URHS data. Current use of any method of contraception (70 percent among married women age 15-44 in the 2007 UDHS) has changed little since the 1999 URHS, when overall use was 68 percent (KIIS et al., 2001). However, there has been a 34 percent increase in the use of modern methods over the eight years, from 38 to 51 percent, and a corresponding decrease in the use of traditional methods, from 30 to 19 percent over the period. The increase in the use of modern methods occurred primarily because of the increase in the use of the male condom, from 14 to 26 percent. Smaller increases were seen in the use of the pill, while use of the IUD decreased slightly over the period. 5.6 NUMBER OF CHILDREN AT FIRST USE OF CONTRACEPTION To examine the timing of initial family planning use during the family building process, the 2007 UDHS asked all women about the number of living children they had when they first used contraception. Table 5.5, which presents this information by age group, allows an analysis of cohort changes in parity at first use of contraception. Table 5.5 Number of children at first use of contraception Percent distribution of women age 15-49 by number of living children at time of first use of contraception, according to current age, Ukraine 2007 Current age Never used Number of living children at time of first use of contraception Total Number of women 0 1 2 3 4+ Missing 15-19 85.3 13.8 0.6 0.1 0.0 0.0 0.2 100.0 782 20-24 34.6 52.6 11.8 0.9 0.0 0.0 0.2 100.0 1,006 25-29 16.4 50.5 29.2 3.1 0.6 0.2 0.1 100.0 998 30-34 11.6 43.5 36.9 6.3 0.6 0.7 0.3 100.0 984 35-39 9.7 38.2 40.9 8.7 1.8 0.4 0.2 100.0 1,049 40-44 10.9 33.0 40.8 13.1 1.0 0.8 0.4 100.0 936 45-49 12.1 28.9 43.3 12.6 1.9 0.7 0.5 100.0 1,085 Total 23.8 37.9 30.1 6.6 0.9 0.4 0.3 100.0 6,841 More than one in three Ukrainian women first used a method of family planning before they had any children, 30 percent first adopted a method when they had one child, and 7 percent adopted a method when they had two children. Younger women report first use of contraception at lower parities than older women. For example, 53 percent of women age 20-24 began using contraception before having any children, compared with 44 percent of women age 30-34. 5.7 KNOWLEDGE OF FERTILE PERIOD An elementary knowledge of repro- ductive physiology provides a useful back- ground for the successful practice of the rhythm method. As shown in Tables 5.1, 5.2.1, and 5.3, respectively, 85 percent of all women have heard of the rhythm method, 39 percent have used it in the past, and 5 percent are currently using the method. Table 5.6 shows respondents’ knowledge about the time during the menstrual cycle when a woman is most likely to get pregnant. Overall, 64 percent of women cor- rectly reported the most fertile time as being halfway between two menstrual periods. Among users of the rhythm method, a large majority (81 percent) were able to correctly identify when during a woman’s cycle she is Table 5.6 Knowledge of fertile period Percent distribution of women age 15-49 by knowledge of the fertile period during the ovulatory cycle, according to current use of the rhythm method, Ukraine 2007 Perceived fertile period Users of rhythm method Nonusers of rhythm method All women Just before her menstrual period begins 9.2 4.3 4.5 During her menstrual period 0.0 0.9 0.9 Right after her menstrual period has ended 8.2 7.8 7.8 Halfway between two menstrual periods 81.1 63.4 64.3 Other 0.3 1.0 0.9 No specific time 0.0 2.9 2.8 Don’t know 0.9 19.3 18.4 Missing 0.3 0.3 0.3 Total 100.0 100.0 100.0 Number of women 328 6,513 6,841 50 | Family Planning most likely to get pregnant, with only 8 percent incorrectly reporting that a woman’s most fertile period is right after menstruation has ended. Knowledge among women not using the rhythm method is also relatively high; 63 percent of these women knew when the most fertile period is, about one- fifth did not know when a woman’s fertile period is, and 8 percent stated that a woman is most susceptible to pregnancy just after her period has ended. 5.8 SOURCE OF CONTRACEPTION Table 5.7 shows the main sources of contraception for users of different modern methods. Information on where women obtain their method is important in designing policies and programs to expand and improve family planning service delivery. To obtain these data, all current users of modern contraceptive methods were asked the most recent source of their methods. The pharmacy is the major source of contraceptive methods in Ukraine, with nearly half of all users getting their method from pharmacies. The public medical sector remains the second major source, providing contraceptives to almost three in ten current users of modern methods. Less than 2 percent of users get their methods from the private medical sector, and 20 percent get their methods from other sources, primarily from friends, relatives, or neighbors. Table 5.7 Source of modern contraception methods Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method, Ukraine 2007 Source Pill IUD Male condom Total Public Sector 4.1 76.1 3.4 27.8 Hospital/mate

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