Zambia - Demographic and Health Survey - 2003

Publication date: 2003

Zambia Demographic and Health Survey 2001-2002 Z a m b i a 2 0 0 1 - 2 0 0 2 D e m o g r a p h i c a n d H e a l t h S u r v e y World Summit for Children Indicators, Zambia 2001-2002 Childhood mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Basic education Family planning Antenatal care Delivery care Low birth weight Iodised salt intake Vitamin A supplements Exclusive breastfeeding Continued breastfeeding Timely complementary feeding Vaccinations Oral rehydration therapy (ORT) Home management of diarrhoea Treatment of ARI Treatment of illness Children in especially difficult situations Use of impregnated bednets Malaria treatment HIV/AIDS Infant mortality rate Under-five mortality rate Maternal mortality rate Percent stunted (children under 5 years) Percent wasted (children under 5 years) Percent underweight (children under 5 years) Percent of households with safe water supply1 Percent of households with flush toilets, pit toilet/latrine Proportion of children reaching grade 52 Net primary school attendance rate2 Proportion of children entering primary school2 Contraceptive prevalence rate (any method, currently married women) Contraceptive prevalence rate (any method, all women) Percent of women who received antenatal care from a health professional3 Percent of births in the 5 years preceding the survey attended by a health professional Percent of births in the 5 years preceding the survey at low birth weight4 Percent of households that use iodised salt5 Percent of children age 6-59 months who received a vitamin A dose in the 6 months preceding the survey Percent of women age 15-49 who received a vitamin A dose in the 2 months after delivery3 Percent of youngest children under 6 months who are exclusively breastfed Percent of children age 12-15 months still breastfeeding Percent of children age 20-23 months still breastfeeding Percent of youngest children age 6-9 months receiving breast milk and complementary foods Percent of children age 12-23 months with BCG vaccination Percent of children age 12-23 months with at least 3 DPT vaccinations Percent of children age 12-23 months with at least 3 polio vaccinations Percent of children age 12-23 months with measles vaccination Percent of mothers who received at least 2 tetanus toxoid vaccinations during pregnancy3 Percent of children age 0-59 months with diarrhoea in the 2 weeks preceding the survey who received oral rehydration salts (ORS) Percent of children age 0-59 months with diarrhoea in the 2 weeks preceding the interview who took more fluids than usual and continued eating somewhat less, the same or more food Percent of children age 0-59 months with acute respiratory infection (ARI) in the 2 weeks preceding the survey who were taken to a health provider Percent of children age 0-59 months with diarrhea, fever and/or ARI in the two weeks preceding the survey who were taken to a health provider Percent of children with at least one parent dead2 Percent of children who do not live with either biological parent2 Percentage of children 0-59 months who slept under an impregnated bednet on the previous night6 Percent of children age 0-59 months with a fever in the 2 weeks preceding the survey who were treated with an anti-malarial drug Percent of women age 15-49 who correctly stated 2 ways of avoiding HIV infection7 Percent of women age 15-49 who correctly identified 2 misconceptions about HIV/AIDS8 Percent of women age 15-49 who believe that AIDS can be transmitted from mother to child during pregnancy, delivery and breastfeeding Percent of women age 15-49 who know of a place to get tested for the AIDS virus Percent of women age 15-49 who have been tested for the AIDS virus 95 per 1,000 168 per 1,000 729 per 100,000 46.8 5.0 28.1 51.3 70.2 87.7 67.1 25.7 34.2 24.6 93.4 43.4 10.7 79.8 67.4 27.5 40.1 96.8 55.5 87.4 94.0 80.0 80.2 84.4 26.7 53.2 28.3 69.1 60.3 16.2 15.0 9.8 51.9 66.3 43.3 55.4 64.4 9.4 1Piped water or protected well water 2Based on de jure children 3For the last live birth in the five years preceding the survey 4For children without a reported birth weight, the proportion with low birth weight is assumed to be the same as the proportion with low birth weight in each birth size category among children who have a reported birth weight. 515 parts per million or more 6 Refers to ever-impregnated bednets 7 Having sex with only one partner who has no other partners and using a condom every time they have sex 8They say that AIDS cannot be transmitted through mosquito bites and that a healthy-looking person can have the AIDS virus. Demogra Central Statistical Office Zambia phic and Health Survey 2001-2002 Central Statistical Office Lusaka, Zambia Central Board of Health Lusaka, Zambia ORC Macro Calverton, Maryland, USA February 2003 Central Board of Health ORC Macro This report summarises the findings of the 2001-2002 Zambia Demographic and Health Survey (ZDHS) carried out by the Central Statistical Office in partnership with the Central Board of Health. ORC Macro provided financial and technical assistance for the survey through the USAID-funded MEASURE DHS+ programme, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. Additional funding for the ZDHS was received from the Government of Japan through a trust fund managed by the United Nations Development Programme (UNDP) and through bilateral agreements between the Government of the Republic of Zambia and the United Nations Population Fund (UNFPA) and the Danish International Development Agency (DANIDA). The opinions expressed are those of the authors and do not necessarily reflect the views of USAID, UNDP, UNFPA or DANIDA. Additional information about the ZDHS may be obtained from the Central Statistical Office, P.O. Box 31908, Lusaka, Tel: 260-1-251377/85; fax: 260-1253468. Additional information about the MEASURE DHS+ project may be obtained by contacting: MEASURE DHS+, ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone 301-572-0200; fax 301-572-0999; e-mail: reports@macroint.com; internet: www.measuredhs.com). Suggested citation: Central Statistical Office [Zambia], Central Board of Health [Zambia], and ORC Macro. 2003. Zambia Demographic and Health Survey 2001-2002. Calverton, Maryland, USA: Central Statistical Office, Central Board of Health, and ORC Macro. CONTENTS Page Tables and Figures .xi Preface . xix Summary of Findings . xxi Map of Zambia. xxvi CHAPTER 1 INTRODUCTION Kumbutso Dzekedzeke and Chanda Mulenga 1.1 History, Geography, and Economy .1 1.2 Population.2 1.3 The Population Policy and National Population and Development Programme.3 1.4 Health Priorities and Programmes.4 1.6 Objectives and Organisation of the Survey.5 1.7 Sample Design.6 1.8 Questionnaires .6 1.9 Syphilis and HIV Testing .7 1.10 Pretest Activities, Training, and Fieldwork .8 1.11 Data Processing .10 1.12 Response Rates.10 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Patrick Mumba Chewe 2.1 Population by Age and Sex .11 2.2 Household Composition .13 2.3 Children’s Living Arrangements and Parental Survival .14 2.4 Educational Level of Household Population .15 2.5 Housing Characteristics and Household Possessions.21 2.6 Household Durable Goods .22 2.7 Access to Health Care.23 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S CHARACTERISTICS Sheila S. Mudenda 3.1 Characteristics of Survey Respondents .25 3.2 Educational Attainment.25 3.3 Literacy.29 3.4 Access to Mass Media .31 3.5 Men’s Employment.33 Contents | iii Page 3.6 Women’s Employment .36 3.6.1 Employment Status .36 3.6.2 Occupation .37 3.6.3 Earnings, Type of Employer, and Continuity of Employment .38 3.6.4 Control over Women’s Earnings and Contribution to Household Expenditures.39 3.7 Women’s Empowerment .41 3.7.1 Women’s Participation in Decision-making.41 3.7.2 Attitudes toward Wife Beating .46 3.7.3 Attitudes toward Refusing Sex.49 3.8 Life-style Measures .52 3.8.1 Use of Tobacco .52 CHAPTER 4 FERTILITY Richard Banda and Margaret T. Mwanamwenge 4.1 Fertility Levels and Trends.55 4.1.1 Fertility Levels.55 4.1.2 Differentials in Current and Completed Fertility .57 4.1.3 Trends in Fertility.59 4.2 Children Ever Born and Children Surviving .62 4.3 Birth Intervals .64 4.4 Age at First Birth .65 4.5 Median Age at First Birth by Background Characteristics .66 4.6 Teenage Fertility .67 CHAPTER 5 FERTILITY REGULATION Mika Bwembya and Margaret T. Mwanamwenge 5.1 Knowledge of Contraceptive Methods .69 5.2 Ever Use of Contraception .71 5.3 Current Use of Contraceptive Methods.74 5.4 Current Use of Contraception by Background Characteristics.75 5.5 Trends in the Use of Family Planning .77 5.6 Number of Children at First Use of Contraception .78 5.7 Use of Social Marketing Brand Pills .79 5.8 Knowledge of Fertile Period.79 5.9 Source of Supply .80 iv | Contents Page 5.10 Informed Choice .81 5.11 Future Use of Contraception.82 5.12 Reasons for Not Intending to Use Contraception .83 5.13 Preferred Method of Contraception for Future Use .84 5.14 Exposure to Family Planning Messages.85 5.15 Exposure to Specific Radio and Television Shows on Family Planning and HIV .86 5.16 Contact of Non-users with Family Planning Providers.88 5.17 Discussion about Family Planning with Husband .89 5.18 Attitudes of Couples toward Family Planning .90 CHAPTER 6 OTHER DETERMINANTS OF FERTILITY Anne R. Cross 6.1 Current Marital Status .93 6.2 Polygyny.94 6.3 Age at First Marriage .95 6.4 Age at First Sexual Intercourse .97 6.5 Recent Sexual Activity.99 6.6 Postpartum Amenorrhoea, Abstinence and Insusceptibility . 102 6.7 Menopause . 103 CHAPTER 7 FERTILITY PREFERENCES AND UNMET NEED FOR FAMILY PLANNING Margaret T. Mwanamwenge and Richard Banda 7.1 Desire for More Children. 105 7.2 Desire to Limit Childbearing by Background Characteristics . 107 7.3 Unmet Need for Family Planning. 109 7.4 Ideal Family Size. 111 7.5 Wanted and Unwanted Fertility. 114 CHAPTER 8 INFANT AND CHILD MORTALITY Kumbutso Dzekedzeke 8.1 Introduction . 117 8.2 Levels and Trends in Infant and Child Mortality . 118 8.3 Early Childhood Mortality by Socioeconomic Characteristics. 119 8.4 Early Childhood Mortality Rates by Demographic Characteristics . 121 8.5 Women’s Status and Early Childhood Mortality . 122 8.6 High-Risk Fertility Behaviour. 123 Contents | v Page CHAPTER 9 MATERNAL AND CHILD HEALTH Miriam Chipimo, Elizabeth Mulamfu, Martha Mulenga, and Arlinda Zhuzhuni 9.1 Maternity Care . 127 9.1.1 Antenatal Care. 127 9.1.2 Delivery and Postnatal Care. 132 9.1.3 Trends in Maternity Care Indicators . 137 9.2 Visits by Health Workers and Presence of a Neighbourhood Health Committee . 138 9.3 Women’s Perceptions of Problems in Obtaining Health Care. 141 9.4 Child Immunisation . 143 9.5 Acute Respiratory Infections . 147 9.6 Diarrhoeal Diseases . 149 CHAPTER 10 MALARIA Miriam Chipimo and Richard Banda 10.1 Introduction . 155 10.1.1 Ownership of Mosquito Nets . 155 10.1.1 Use of Bednets by Children and Pregnant Women . 156 10.2 Malaria Diagnosis, Case Management and Treatment . 157 10.2.1 Malaria Prophylaxis during Pregnancy. 157 10.2.2 Prevalence and Management of Childhood Malaria . 158 CHAPTER 11 INFANT FEEDING, NUTRITIONAL PRACTICES, AND NUTRITIONAL STATUS AMONG YOUNG CHILDREN AND WOMEN Bornwell Sikateyo, Agnes Mugala Aongola, and Arlinda Zhuzhuni 11.1 Breastfeeding. 163 11.1.1 Initiation of Breastfeeding . 163 11.1.2 Age Pattern of Breastfeeding . 165 11.2 Complementary Feeding. 169 11.2.1 Types of Complementary Foods. 169 11.2.2 Frequency of Foods Consumed by Children . 171 11.3 Micronutrients . 172 11.3.1 Salt and Sugar Fortification . 172 vi | Contents Page 11.3.2 Micronutrient Intake among Children . 175 11.3.3 Micronutrient Supplementation for Women . 177 11.4 Household Food Security. 178 11.5 Nutritional Status of Children under Age Five. 179 11.5.1 Measures of Nutritional Status in Childhood . 179 11.5.2 Trends in Children’s Nutritional Status . 183 11.6 Nutritional Status of Women . 183 CHAPTER 12 VIOLENCE AGAINST WOMEN Mary Kazunga and Patrick Mumba Chewe 12.1 Introduction . 185 12.2 Characteristics of Respondents. 186 12.3 Experience of Beatings or Physical Mistreatment . 186 12.4 Perpetrators of Physical Violence . 189 12.5 Frequency of Beatings. 189 12.6 Sexual Violence by a Man. 190 12.7 Perpetrators and Frequency of Sexual Violence in the Past 12 Months. 192 12.8 Sexual Intercourse Forced by a Third Party . 194 CHAPTER 13 HIV/AIDS/STI-RELATED KNOWLEDGE AND BEHAVIOUR Margaret T. Mwanamwenge 13.1 Introduction . 195 13.2 Knowledge about AIDS and Ways to Avoid It . 195 13.2.1 Knowledge of Ways to Avoid AIDS . 195 13.2.2 Knowledge of Programmatically Important Ways to Avoid HIV/AIDS . 197 13.3 Knowledge of HIV/AIDS Transmission and its Effects. 199 13.4 Perception of HIV/AIDS. 200 13.4.1 Discussion of HIV/AIDS with Partners . 200 13.4.2 Stigma Associated with HIV/AIDS . 201 13.4.3 Discussions of Condoms in the Media. 203 13.5 Testing for HIV . 205 13.6 Men’s Attitudes Toward Condoms . 208 13.7 Absence from Home and Use of Alcohol . 210 13.7.1 Absence from Home. 210 13.7.2 Alcohol Consumption . 211 13.8 Knowledge of Symptoms of Sexually Transmitted Infections. 213 Contents | vii Page 13.9 Reports of Recent Sexually Transmitted Infections . 216 13.10 Treatment Seeking and Protection of a Partner from STIs . 217 13.11 Sexual Behaviour . 219 13.11.1 Number of Sexual Partners . 219 13.11.2 Knowledge of Condom Sources and Condom Use for Disease Prevention. 221 13.11.3 Payment for Sexual Relations . 224 CHAPTER 14 PREVALENCE OF HIV AND SYPHILIS Kumbutso Dzekedzeke 14.1 Coverage of HIV and Syphilis Testing. 225 14.1.1 Coverage of Syphilis Testing. 225 14.1.2 Coverage of HIV Testing . 226 14.2 Syphilis Prevalence Rates . 229 14.3 HIV Prevalence Rates . 234 14.4 Comparison of ANC Surveillance Estimates and the ZDHS Rates . 238 CHAPTER 15 ADULT MORTALITY Ann A. Way 15.1 Adult Mortality Data . 241 15.1.1 Data Collection Procedures . 241 15.1.2 Data Quality Assessment . 241 15.2 Direct Estimates of Adult Mortality. 242 15.2.1 Levels and Trends in Adult Mortality. 242 15.2.2 Differentials in Adult Mortality Levels. 244 15.3 Estimates of Maternal Mortality . 245 REFERENCES. 247 APPENDIX A SAMPLE DESIGN . 251 A.1 Introduction . 251 A.2 Survey Objectives . 251 A.3 Sample Domains . 251 A.4 Sample Frame . 251 A.5 Stratification . 252 A.6 Sample Allocation. 252 viii | Contents Contents | ix Page A.7 Sample Selection . 254 A.8 Response Rates. 254 APPENDIX B SAMPLING ERRORS . 259 APPENDIX C DATA QUALITY TABLES . 275 APPENDIX D SURVEY PERSONNEL. 281 APPENDIX E QUESTIONNAIRES . 285 TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Demographic characteristics . 2 Table 1.2 Results of the household and individual interviews . 10 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table 2.1 Household population by age, sex, and residence . 11 Table 2.2 Household composition. 13 Table 2.3 Children’s living arrangements and orphanhood . 14 Table 2.4 Educational attainment of household population . 16 Table 2.5 School attendance ratios. 18 Table 2.6 Grade repetition and dropout rates. 20 Table 2.7 Household characteristics . 21 Table 2.8 Household durable goods. 23 Table 2.9 Inability to pay for medical care. 24 Figure 2.1 Population pyramid . 12 Figure 2.2 Distribution of de facto household population by five-year age groups and sex. 13 Figure 2.3 Percent distribution of de facto household population with no education by age and sex . 17 Figure 2.4 Net and gross attendance ratios by sex. 19 Figure 2.5 Trends in percentage of households with electricity by residence, Zambia 1992-2002. 22 Figure 2.6 Trends in percentage of households owning specific durable goods Zambia 1992-2002. 23 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S CHARACTERISTICS Table 3.1 Background characteristics of respondents . 26 Table 3.2 Educational attainment by background characteristics. 28 Table 3.3 Literacy. 30 Table 3.4 Exposure to mass media . 32 Table 3.5 Employment status: men . 33 Table 3.6 Occupation: men . 35 Table 3.7 Type of earnings: men . 36 Table 3.8 Employment status: women. 37 Table 3.9 Occupation: women. 38 Table 3.10 Employment characteristics: women. 39 Tables and Figures | xi Page Table 3.11 Decision on use of earnings and contribution of earnings to household expenditures. 40 Table 3.12 Women’s control over earnings . 41 Table 3.13 Women’s participation in decisionmaking . 42 Table 3.14.1 Women’s participation in decision-making by background characteristics: women . 43 Table 3.14.2 Women’s participation in decision-making by background characteristics: men . 45 Table 3.15.1 Women’s attitudes toward wife beating . 47 Table 3.15.2 Men’s attitudes toward wife beating . 48 Table 3.16.1 Women’s attitudes toward wife refusing sex with husband. 50 Table 3.16.2 Men’s attitudes toward wife refusing sex with husband . 51 Table 3.17.1 Smoking of tobacco: women . 53 Table 3.17.2 Smoking of tobacco: men . 53 Table 3.18 Smoking of tobacco by background characteristics. 54 Figure 3.1 Youth literacy . 31 Figure 3.2 Distribution of unemployed men by current activity . 34 Figure 3.3 Percentage of women and men who agree with specific reasons that a wife is justified in refusing sex with her husband . 52 CHAPTER 4 FERTILITY Table 4.1 Current fertility . 56 Table 4.2 Fertility by background characteristics. 58 Table 4.3 Trends in age-specific and total fertility rates, various sources. 59 Table 4.4 Trends in fertility by background characteristics . 61 Table 4.5 Trends in age-specific fertility rates . 62 Table 4.6 Children ever born and living. 62 Table 4.7 Birth intervals. 64 Table 4.8 Age at first birth . 65 Table 4.9 Median age at first birth by background characteristics. 66 Table 4.10 Teenage pregnancy and motherhood . 67 Figure 4.1 Total fertility rates, selected sub-Saharan countries , 1998-2001 . 57 Figure 4.2 Total fertility rate by education level . 58 Figure 4.3 Total fertility rate by province . 59 Figure 4.4 Trends in age-specific fertility rates 1980 census, 1992 ZDHS, and 2001-2002 ZDHS. 60 Figure 4.5 Trends in the total fertility rates by urban-rural residence, 1992 ZHDS, 1996 ZDHS, and 2001-2002 ZDHS . 61 Figure 4.6 Percent distribution of all men and currently married men by number of children ever born, according to age group. 63 Figure 4.7 Percentage of teenagers who are mothers or pregnant with their first child. 68 CHAPTER 5 FERTILITY REGULATION Table 5.1.1 Knowledge of contraceptive methods: women . 70 Table 5.1.2 Knowledge of contraceptive methods: men . 71 xii | Tables and figures Page Table 5.2 Ever use of contraception: women. 72 Table 5.3 Ever use of contraception: men . 73 Table 5.4 Current use of contraception . 75 Table 5.5 Current use of contraception by background characteristics . 76 Table 5.6 Trends in the use of family planning. 77 Table 5.7 Number of children at first use of contraception . 79 Table 5.8 Use of Safeplan . 79 Table 5.9 Knowledge of fertile period. 80 Table 5.10 Source of contraception. 81 Table 5.11 Informed choice . 81 Table 5.12 Future use of contraception . 82 Table 5.13 Reasons for not intending to use contraception. 83 Table 5.14 Preferred method of contraception for future use . 84 Table 5.15 Exposure to family planning messages. 85 Table 5.16.1 Exposure to specific radio and television shows on family planning and HIV: Women. 87 Table 5.16.2 Exposure to specific radio and television shows on family planning and HIV: Men . 88 Table 5.17 Contact of non-users with family planning providers . 89 Table 5.18 Discussion of family planning with husband. 90 Table 5.19 Attitudes of couples toward family planning. 91 Figure 5.1 Current use of any contraceptive method among currently married women age 15-49, by background characteristics . 77 Figure 5.2 Trends in current use of specific contraceptive methods among currently married women age 15-49, Zambia 1992-2002. 78 CHAPTER 6 OTHER DETERMINANTS OF FERTILITY Table 6.1 Current marital status. 93 Table 6.2 Polygyny. 95 Table 6.3 Age at first marriage . 96 Table 6.4 Median age at first marriage. 97 Table 6.5 Age at first sexual intercourse. 98 Table 6.6 Median age at first sexual intercourse . 99 Table 6.7.1 Recent sexual activity: women. 100 Table 6.7.2 Recent sexual activity: me n . 101 Table 6.8 Postpartum amenorrhoea, abstinence and insusceptibility . 102 Table 6.9 Median duration of postpartum insusceptibility by background characteristics . 103 Table 6.10 Menopause . 103 CHAPTER 7 FERTILITY PREFERENCES AND UNMET NEED FOR FAMILY PLANNING Table 7.1 Fertility preferences by number of living children. 106 Table 7.2 Desire to limit childbearing. 108 Table 7.3 Need for family planning . 110 Table 7.4 Ideal and actual number of children . 112 Table 7.5 Mean ideal number of children by background characteristics . 113 Table 7.6 Fertility planning status . 114 Tables and Figures | xiii Page Table 7.7 Wanted fertility rates . 115 Figure 7.1 Fertility preferences of currently married women 15-49. 105 Figure 7.2 Percentage of married women and men who want no more children by number of living children . 107 Figure 7.3 Percentage of women with three living children who do not want additional children, by background characteristics . 108 Figure 7.4 Unmet need for spacing and limiting by residence and region . 111 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates. 118 Table 8.2 Trends in early childhood mortality rates . 119 Table 8.3 Early childhood mortality by background characteristics. 120 Table 8.4 Trends in early childhood mortality rates by residence and education. 121 Table 8.5 Early childhood mortality by demographic characteristics. 122 Table 8.6 Early childhood mortality by women’s status indicators . 123 Table 8.7 High-risk fertility behaviour. 124 CHAPTER 9 MATERNAL AND CHILD HEALTH Table 9.1 Antenatal care . 128 Table 9.2 Number of antenatal care visits and timing of first visit . 129 Table 9.3 Antenatal care content. 130 Table 9.4 Tetanus toxoid injections . 131 Table 9.5 Place of delivery . 133 Table 9.6 Assistance during delivery . 134 Table 9.7 Delivery characteristics . 135 Table 9.8 Postnatal care . 137 Table 9.9 Visits by health workers . 139 Table 9.10.1 Neighbourhood Health Committee (NHC): women. 140 Table 9.10.2 Neighbourhood Health Committee (NHC): men . 141 Table 9.11 Problems in accessing health care . 142 Table 9.12 Vaccinations by source of information . 143 Table 9.13 Vaccinations by background characteristics. 145 Table 9.14 Prevalence of injections .147 Table 9.15 Prevalence and treatment of symptoms of acute respiratory infection (ARI).148 Table 9.16 Prevalence of diarrhoea .149 Table 9.17 Knowledge of ORS packets .150 Table 9.18 Diarrhoea treatment .151 Table 9.19 Feeding practices during diarrhoea .152 Table 9.20 Household knowledge and usage of Clorin .153 Figure 9.1 Trends in maternity care indicators, Zambia 1992-2002 .138 Figure 9.2 Trends in vaccination coverage among children 12-23 months .146 CHAPTER 10 MALARIA Table 10.1 Ownership of mosquito nets. 155 Table 10.2 Use of mosquito nets by children. 156 xiv | Tables and figures Page Table 10.3 Use of mosquito nets by women. 157 Table 10.4 Use of antimalarial drugs during pregnancy. 158 Table 10.5 Prevalence and treatment of fever/convulsions in children . 159 Table 10.6 Drugs taken for fever . 160 Table 10.7 Treatment in children with fever/convulsions . 161 CHAPTER 11 INFANT FEEDING, NUTRITIONAL PRACTICES, AND NUTRITIONAL STATUS AMONG YOUNG CHILDREN AND WOMEN Table 11.1 Initial breastfeeding .164 Table 11.2 Breastfeeding status by child’s age .166 Table 11.3 Median duration of breastfeeding .168 Table 11.4 Foods consumed by children in the day or night preceding the interview .170 Table 11.5 Frequency of foods consumed by children in the day or night preceding the interview .171 Table 11.6 Iodisation of household salt .173 Table 11.7 Presence of sugar in household.174 Table 11.8 Household consumption of sugar.174 Table 11.9 Micronutrient intake among children .176 Table 11.10 Micronutrient intake among mothers .178 Table 11.11 Household food security.179 Table 11.12 Nutritional status of children.181 Table 11.13 Nutritional status of women by background characteristics.184 Figure 11.1 Median duration of breastfeeding by background characteristics. 167 Figure 11.2 Nutritional status of children under five years by province . 182 CHAPTER 12 VIOLENCE AGAINST WOMEN Table 12.1 Background characteristics of respondents who were asked questions about domestic violence.186 Table 12.2 Experience of beatings or physical mistreatment .187 Table 12.3 Perpetrators of physical violence.188 Table 12.4 Frequency of beatings.190 Table 12.5 Experience of sexual violence .191 Table 12.6 Perpetrators of sexual violence.193 Figure 12.1 Experience of sexual violence among ever-married women .192 Figure 12.2 Frequency of sexual violence in the past year, among women who report having ever experienced sexual violence .193 CHAPTER 13 AIDS/HIV/STI-RELATED KNOWLEDGE AND BEHAVIOUR Table 13.1 Knowledge of HIV/AIDS . 196 Table 13.2 Knowledge of ways to avoid HIV/AIDS . 197 Table 13.3 Knowledge of programmatically important ways to avoid HIV/AIDS. 198 Table 13.4 Knowledge of HIV/AIDS-related issues. 200 Tables and Figures | xv Page Table 13.5 Discussion of HIV/AIDS with partner . 201 Table 13.6 Social aspects of HIV/AIDS . 202 Table 13.7 Discussion of condoms in the media. 204 Table 13.8 Knowledge of “Trendsetters” newspaper. 205 Table 13.9.1 Testing for the AIDS virus: women. 206 Table 13.9.2 Testing for the AIDS virus: men. 208 Table 13.10 Men's attitudes toward condoms. 209 Table 13.11 Frequency and length of travel away from home . 210 Table 13.12.1 Alcohol consumption: women. 211 Table 13.12.2 Alcohol consumption: men. 212 Table 13.13 Alcohol consumption by background characteristics . 213 Table 13.14.1 Knowledge of symptoms of STDs: women . 214 Table 13.14.2 Knowledge of symptoms of STDs: men. 215 Table 13.15 Self-reporting of sexually transmitted infections and STI symptoms. 216 Table 13.16 Source of treatment of STIs . 217 Table 13.17 Efforts to protect partners from infection among women and men with STI . 218 Table 13.18 Number of extramarital sexual partners: married women and men. 219 Table 13.19 Number of sexual partners: unmarried women and men . 220 Table 13.20 Knowledge of source for male condoms, and access to condoms. 222 Table 13.21 Use of condoms by type of partner . 223 Table 13.22 Commercial sexual activity and condom use during last commercial sex. 224 Figure 13.1 Unmet need for HIV testing by education level. 207 Figure 13.2 Percentage of men and women with an STI, discharge, genital sore, or ulcer. 217 Figure 13.3 Percentage of unmarried women and men with at least two partners. 221 CHAPTER 14 PREVALENCE OF HIV AND SYPHILIS Table 14.1 Coverage for syphilis testing by urban-rural residence (unweighted) . 225 Table 14.2 Coverage of syphilis testing by province (unweighted) . 226 Table 14.3 Coverage for HIV testing by urban-rural residence (unweighted) . 227 Table 14.4 Coverage of HIV testing by province (unweighted). 228 Table 14.5 Percentage of respondents tested for HIV . 229 Table 14.6 Syphilis testing by age . 231 Table 14.7 Syphilis prevalence by background characteristics. 232 Table 14.8 Syphilis prevalence by age, sex, and urban-rural residence . 233 Table 14.9 Syphilis prevalence by reproductive and sexual activity characteristics . 234 Table 14.10 Syphilis prevention and treatment experience. 235 Table 14.11 HIV prevalence by background characteristics . 236 Table 14.12 HIV prevalence by age, sex, and urban-rural residence. 238 Figure 14.1 Percentage of respondents 15-49 tested for HIV in the 2001-2002 ZDHS, by age group. 230 Figure 14.2 HIV prevalence by sex and age. 237 Figure 14.3 HIV prevalence among women by age and residence . 239 Figure 14.4 HIV prevalence among men by age and residence. 239 xvi | Tables and figures Tables and Figures | xvii Page CHAPTER 15 ADULT MORTALITY Table 15.1 Completeness of reporting on siblings . 242 Table 15.2 Adult mortality rates . 243 Table 15.3 Adult mortality rates by residence and province. 244 Table 15.4 Direct estimates of maternal mortality. 245 Figure 15.1 Trends in Age-specific Mortality among Adults 15-49. 244 APPENDIX A SAMPLE DESIGN Table A.1 Proportional allocation and squared root allocation of 320 clusters by province . 252 Table A.2 Expected number of selected households to reach the target of completed interviews by province . 253 Table A.3 Final allocation of women 15-49 with completed interviews and clusters in each province by urban and rural residence . 253 Table A.4 Sample implementation: women's sample . 256 Table A.5 Sample implementation: women's sample . 257 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 261 Table B.2 Sampling errors for selected variables, total sample, Zambia . 262 Table B.3 Sampling errors for selected variables, urban sample. 263 Table B.4 Sampling errors for selected variables, rural sample. 264 Table B.5 Sampling errors for selected variables, Central province . 265 Table B.6 Sampling errors for selected variables, Copperbelt province. 266 Table B.7 Sampling errors for selected variables, Eastern province . 267 Table B.8 Sampling errors for selected variables, Luapula province. 268 Table B.9 Sampling errors for selected variables, Lusaka province. 269 Table B.10 Sampling errors for selected variables, Northern province . 270 Table B.11 Sampling errors for selected variables, North-Western province . 271 Table B.12 Sampling errors for selected variables, Southern province . 272 Table B.13 Sampling errors for selected variables, Western province . 273 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution. 275 Table C.2.1 Age distribution of eligible and interviewed women. 276 Table C.2.2 Age distribution of eligible and interviewed men . 276 Table C.3 Completeness of reporting . 277 Table C.4 Births by calendar years . 277 Table C.5 Reporting of age at death in days . 278 Table C.6 Reporting of age at death in months . 279 PREFACE The Zambia Demographic and Health Surveys is an important part of the surveillance system providing indicators for the strategic management and monitoring of the health sector in Zambia. Indicators from the surveys show the current status and trends in important areas of health care delivery such as environmental health, reproductive health, maternal health, child health, sexually transmitted infections and HIV/AIDS. The surveys are also a major source of information about health seeking behaviour regarding individuals and communities. Fertility and mortality indicators, which gauge the overall health status of the population are also provided by the surveys. Three Demographic and Health Surveys have been carried out in Zambia, the first in 1992, the second in 1996, and the most recent in 2001-2002. Institutional collaboration has been the hallmark of the implementation of these surveys. As in the previous surveys, the Central Board of Health mobilised resources for the 2001-2002 ZDHS while the Central Statistical Office played the key role in the implementation of the survey. Other participating institutions were the Tropical Diseases Research Centre, which was in charge of syphilis and HIV testing; the University Teaching Hospital, which made important contributions towards the development of the syphilis and HIV testing protocol; the National Food and Nutrition Commission, which was responsible for the nutrition components; and the University of Zambia Demography Division, which assisted with the training of field staff. Key people in the implementation of the 2001-2002 ZDHS were Mr David Diangamo, Director of Census and Statistics; Dr Musonda Rosemary Sunkutu, Director of Public Health and Research in the Central Board of Health; Mr Bornwell Sikateyo, Manager for Health Management Information Systems in the Central Board of Health; Mr Kumbutso Dzekedzeke, Survey Co-ordinator from the Central Statistical Office; Mr Patrick Mumba Chewe, Assistant Survey Co-ordinator from the Central Statistical Office; Dr Rosemary Musonda, Deputy Director at the Tropical Diseases Research Centre; and Ms Arlinda Zhuzhuni, Project Manager from ORC Macro. A number of donors contributed towards the survey costs. The Government of Japan provided vehicles for the survey teams in addition to providing financial support for other components of the survey. Part of the support from the Government of Japan was channelled through the United Nations Development Programme. Other donors who contributed were the U.S. Agency for International Development, which provided financial and technical support through ORC Macro, the United Nations Population Fund, and the Danish Agency for International Development. We owe an immense gratitude to the Field Coordinators, Interviewers, Nurse/Nurse Counsellors, Laboratory Technicians, Supervisors, Field Editors, Provincial Statistical Officers, and Drivers for their hard work and dedication. We have printed a list of names in Appendix D as a sign of our appreciation for their help and kindness. We are also grateful to all the respondents for their patience and generosity with their time. It will only be worth the effort to have compiled all the indicators in this report if stakeholders in the health sector use them to improve health care delivery and efforts to prevent the spread of HIV and other infectious diseases in Zambia. Dr. Ben U. Chirwa Director General Central Board of Health Preface | xix SUMMARY OF FINDINGS A drop in urban childbearing is the principal reason for overall decline in fertility levels. Between the 1992 and 2001-2002 surveys, the urban TFR fell by 1.5 births, from a rate of 5.8 to 4.3 births per woman. In contrast, the rural TFR remained essen- tially stable over this period (7.1 and 6.9 births per woman, respectively). Women who have at least some secondary education experienced a steady de- cline in fertility, with the TFR for such women dropping by one birth over the period covered by the three ZDHS surveys. The 2001-2002 Zambia Demographic and Health Survey (ZDHS) was carried out by the Central Statistical Office and the Central Board of Health. It is a nationally representative sample of 7,658 women age 15-49 and 2,145 men age 15-59. The principal objective of the survey was to provide data to policymakers and planners on the population and health situation in Zambia. Most of the information collected in the 2001-2002 ZDHS represents updated esti- mates of basic demographic and health indica- tors covered in the 1992 ZDHS and 1996 ZDHS surveys. Specifically, the 2001-2002 ZDHS col- lected detailed information on fertility and fam- ily planning, child mortality and maternal mor- tality, maternal and child health and nutritional status, and knowledge, awareness and behaviour regarding HIV/AIDS and other sexually trans- mitted infections. New features of the 2001- 2002 ZDHS include the collection of informa- tion on violence against women and testing of individuals for HIV and syphilis. The length of the interval between births in- fluences the overall fertility level, as well as the health status of the mother and child. There is now a new international consensus that the optimal interval between births is at least 36 months. In Zambia, 41 percent of births occur at least 36 months after a previous birth. Although 16 percent of births occur less than 24 months after a previous birth, this is an improvement from 1996 when almost one in five births (19 percent) occurred less than two years after a previous birth. The median birth interval is 33 months, 3 months shorter than the “safe” birth interval. This represents a one-month increase from the 1996 ZDHS median birth interval (32 months). FERTILITY Survey results indicate that the total fer- tility rate (TFR) in Zambia is 5.9. This means that at current fertility levels, the average Zam- bian woman who is at the beginning of her childbearing years will give birth to 5.9 children by the end of her reproductive period. Results from the 2001-2002 ZDHS show that fertility is highest in Northern province (6.9 births per woman) and lowest in Lusaka (4.3 births per woman). Education has a marked effect on fer- tility, with uneducated women having three and one-half more births than women with at least some secondary education (7.4 births versus 3.9 births). Childbearing begins early in Zambia. By age 18 almost half of women age 45-49 have had their first birth. Most women typically become mothers before the age of 20, with 60 to 70 percent of women in all age groups having given birth by that age. The median age at first birth for women age 25-49 is 18.7 years. Three in ten teenage women (age 15-19) have begun childbearing, with 26 percent having had a child and 6 percent pregnant with their first child. A comparison of the data from the 1996 and 2001-2002 ZDHS surveys indicates that there has been an increase in the median duration of postpar- tum amenorrhoea from 11.5 months to 13.3 months. There has been little change in the median duration of sexual abstinence or insusceptibility to the risk of pregnancy following childbirth. Zambia’s fertility continues to decline although comparatively slowly. The TFR has declined from a level of 6.5 births per woman in 1992 and 6.1 births per woman in 1996 to the current level of 5.9. Despite the decline, fertility in Zambia remains one of the highest in sub- Saharan Africa. Summary of Findings | xxi FAMILY PLANNING Knowledge of contraceptive methods is almost universal in Zambia, with 98 percent of all women and men knowing at least one method of family planning. The male condom and the pill are the most widely known methods among both women and men. Knowledge of family planning methods has increased steadily over the last decade. For example, knowledge of at least one contraceptive method has increased among women from 89 percent in 1992 to 96 percent in 1996 to the current level of 98 percent. Since 1996, the mean number of family planning methods known has increased from 5.3 to 6.8 for women and from 5.0 to 6.1 for men. Mass media are important sources of information on family planning. Almost half of women (49 percent) and six in ten men (62 per- cent) have heard or seen a family planning mes- sage on the radio, television or in a newspa- per/magazine. Radio is the most frequent source of family planning messages for both women (46 percent) and men (57 percent). The 2001-2002 ZDHS data indicate that 70 percent of currently married women and 81 percent of currently married men have used a family planning method at least once in their lifetime. There is a noticeable discrepancy be- tween ever use and current use, with slightly more than one-third of currently married women (34 percent) currently using some method of contraception. Modern methods of contraception are more commonly used than traditional meth- ods; almost one-fourth of currently married women use modern methods (23 percent) com- pared with about one in ten who use traditional methods (12 percent). The pill is the most widely used modern method (12 percent), while withdrawal is the most popular traditional method (5 percent). Six in ten women currently using mod- ern methods obtain their method from the public sector (61 percent), 20 percent from the private medical sector, and 17 percent from other sources such as shops and community-based agents. Contraceptive use in Zambia has in- creased over the past decade from 15 percent in 1992 to 26 percent in 1996 and 34 percent in 2001- 2002. Considering specific methods, the largest gains in use during the ten-year period are observed for contraceptive pills and injectables. The large majority of currently married women who know of family planning approve of its use (87 percent). Moreover, two-thirds of married women who know of a contraception method believe their husband approves of family planning. The majority of currently married women (71 percent) and currently married men (58 percent) either want to space their next child or want no more children, and thus have a potential need for family planning. In Zambia, almost one in three currently married women has an unmet need for family plan- ning (27 percent) – 17 percent for spacing their next birth and 11 percent for limiting births. If the unmet need for family planning of all currently married women who say they want to space or limit their births were met, the contraceptive prevalence rate in Zambia would increase from 34 to 62 percent. MATERNAL HEALTH Use of professional maternity care is com- mon in Zambia: more than nine in ten mothers who had a live birth in the five years preceding the survey received antenatal care from a health professional; only 2 percent received antenatal care from a tradi- tional birth attendant or other person. Almost three- quarters of these women had four or more antenatal care visits during their pregnancy (72 percent). Among mothers who received antenatal care, over three-fourths were given at least one teta- nus toxoid injection during pregnancy for their most recent birth (75 percent). Over the past 10 years, there has been a decrease in the proportion of women who received at least one tetanus toxoid in- jection during their most recent pregnancy, from 81 percent in 1992 and 85 percent in 1996 to the cur- rent level of 75 percent. The 2001-2002 ZDHS data show that seven in ten mothers receive iron tablets, syrup or folic acid during pregnancy. Ninety-four percent of mothers have their height measured dur- ing antenatal care visits, while 25 percent are weighed. Eighty-seven percent of mothers had their blood pressure measured during their antenatal care, and urine and blood sampling was done for 25 and 44 percent of mothers, respectively. xxii | Summary of Findings The 2001-2002 ZDHS results show that slightly more than four in ten births are deliv- ered in a health facility. A similar proportion are delivered by a health professional: 39 percent by a nurse/midwife and the remaining 5 percent by a doctor or clinical officer. Almost four in ten births are delivered with assistance from a rela- tive or friend. A comparison between the three ZDHS surveys shows a steady decline in the proportion of births that are delivered in a health facility, from 51 percent in 1992 and 47 percent in 1996 to the current level of 44 percent. Postnatal care is not common in Zambia. Less than one in four women who deliver out- side a health facility receive postnatal care (23 percent). The 2001-2002 ZDHS collected data allowing measurement of maternal mortality. The maternal mortality ratio during the seven- year period prior to the 2001-2002 ZDHS was estimated at 729 maternal deaths per 100,000 live births. This represents a rise from 649 ma- ternal deaths per 1000,000 live births estimated from the 1996 ZDHS. CHILD HEALTH At current mortality levels, one in six Zambian children die before the fifth birthday, (under-five mortality rate of 168 deaths per 1,000 birth), with slightly more than half of these deaths occurring during the first year of life (infant mortality rate of 95 deaths per 1,000 births). A comparison of the three ZDHS sur- veys, however, shows that mortality among young children has declined from the fairly sta- ble levels observed in the late 1980s and early to mid-1990s. Infant mortality, which had shown a modest increase from 107 to 109 deaths per 1,000 births between the 1992 and 1996 surveys, fell to 95 deaths per 1,000 births in the 2001- 2002 ZDHS. Under-five mortality is 15 percent lower now than it was five to nine years ago, with the pace of decline very similar to the de- cline in infant mortality over the same time pe- riod (13 percent). Early childhood mortality is consistently lower in urban areas than in rural areas. Mater- nal education is strongly correlated with child- hood mortality. Infant mortality is 32 percent lower and under-five mortality 48 percent lower among mothers with some secondary education than among uneducated mothers. Survival of children is strongly associated with proper immunisation and treatment of child- hood illnesses. According to the World Health Or- ganization, a child is considered fully vaccinated if he or she has received a BCG vaccine, three doses of DPT vaccine, at least three doses of polio vaccine, and one dose of measles vaccine. Only 57 percent of Zambian children are fully vaccinated by 12 months of age; however, 70 percent of children 12-23 months are fully vaccinated, with only 3 percent of children not having received any vaccine. Looking at coverage for specific vaccines, 94 percent of children 12-23 months received the BCG vaccine, 84 percent received measles vaccine, and 80 percent received the recommended three doses of DPT and polio vaccines. Comparing the three ZDHS surveys, there was a substantial rise in vaccination coverage in the early to mid-1990s. In contrast, between 1996 and 2001-2002, there was an 11 percent decline in the proportion of children 12-23 months who are fully immunised. Vitamin A is a micronutrient found in very small quantities in some foods. It is considered es- sential for normal sight, growth, and development. Zambia has recently introduced a programme of vi- tamin A supplementation for children 6 to 72 months through health services and community campaigns. Data from the 2001-2002 ZDHS show that two-thirds of children 6-59 months are reported to have received a vitamin A supplement in the pre- vious 6 months. Fifteen percent of children under five years of age had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Seven out of ten children with ARI symptoms were taken to a health facility or provider for treatment. Forty-three percent of children under five were reported to have been ill with fever and/or con- vulsions in the two-week period preceding the sur- vey. Among these children, more than half took an- timalarial drugs (52 percent) and almost four in ten took antimalarial drugs the same or next day (37 percent). Summary of Findings | xxiii According to mothers’ reports, around 20 percent of children under age five had diar- rhoea at some time in the two weeks before the survey. Slightly more than four in ten children who were ill with diarrhoea were taken to a health facility (43 percent). Mothers reported that almost two-thirds of children with diarrhoea (67 percent) were treated with some form of oral rehydration therapy; more than half (53 percent) were given a solution prepared with oral rehy- dration salts (ORS); and four in ten were given increased fluids. Twenty-one percent of children with diarrhoea did not receive any type of treat- ment. BREASTFEEDING AND NUTRITION Breastfeeding is nearly universal in Zambia: 98 percent of children born in the five years preceding the survey were breastfed. More than half of infants are put to breast within an hour of delivery and 90 percent are breastfed within the first day. The median duration of breastfeeding is 21 months, a slight increase from 1996 (20 months). Despite the high prevalence of breast- feeding in Zambia, the majority of infants are not exclusively breastfed for the first six months of life. Only four in ten infants under 6 months of age are exclusively breastfed in Zambia. Complementary feedings starts early; more than one-third of children under 6 months of age are given complementary foods. According to the 2001-2002 ZDHS find- ings, the level of malnutrition among children under five is significant, with almost half of Zambian children (47 percent) stunted (short for their age), 5 percent wasted (thin for their age), and more than one-fourth underweight (28 per- cent). Generally, children who live in rural areas and children of uneducated mothers are more likely to be malnourished than other children. The nutritional status of women is an- other issue of importance. The mean height of Zambian women is 158 cm. Only 2 percent of women are shorter than the critical height of 145 cm. Fifteen percent of women fall below the cut-off of 18.5 for the body mass index (BMI) - an indicator used to measure the level of chronic energy deficiency among adults. In general, very young women (age 15-19) and rural women are more likely than other women to suffer from chronic energy deficiency. WOMEN’S STATUS AND VIOLENCE AGAINST WOMEN The 2001-2002 ZDHS provides information on the status of women in Zambia, and on physical and sexual violence against women. Overall, more than one in ten women age 15-49 have no education (12 percent) and women are generally less educated than men. Four in ten women in Zambia are illiter- ate. More than half of women were working at the time of the survey (55 percent). Most women work seasonally (53 percent). Agriculture is the pre- dominant sector of the economy, employing 54 per- cent of women in the 12 months preceding the sur- vey. Forty-two percent of all working women in Zambia are either paid in kind or not paid at all. Women working in the non-agricultural sector are more likely to earn cash than women working in ag- riculture. Among currently married women who earn cash for their work, 41 percent report that they alone make decisions about how their earnings will be used and 32 percent report that they decide jointly with their husband. Women in the 2001-2002 ZDHS were asked about their beliefs on wife-beating. A large majority of women (85 percent) believe that a husband is jus- tified in beating his wife for at least one reason. Al- most eight in ten women believe that a husband is justified in beating his wife if she goes out with an- other man. A slightly smaller proportion agree that if a woman neglects her children (61 percent), or ar- gues with her husband (52 percent), then he is justi- fied in beating her. The 2001-2002 ZDHS found that more than half of women report having experienced beatings or physical mistreatment since the age of 15, and al- most one in four women (24 percent) experienced physical violence in the 12 months preceding the survey. Among physically abused women currently in union, almost eight in ten report their current hus- band/partner as a perpetrator of the violence, while among never-married women who experienced physical abuse, the mother or father is the most commonly reported perpetrator (35 percent). xxiv | Summary of Findings Summary of Findings | xxv Overall, 15 percent of women report having experienced sexual violence by a man and 8 percent reported such experience in the 12 months preceding the survey. Among ever- married women who ever experienced sexual violence, the current husband/partner is report- edly the most common perpetrator of such vio- lence (37 percent). More than four in ten never- married women report their current boyfriend as the perpetrator of sexual violence. HIV/AIDS AND STI-RELATED KNOWLEDGE AND BEHAVIOUR General awareness of HIV/AIDS is nearly universal among men and women of re- productive age in Zambia. A large majority of respondents (79 percent of women and 76 per- cent of men) know someone personally who has HIV/AIDS or has died of AIDS. Given the high levels of HIV/AIDS awareness, it is not surprising that 78 percent of women and 86 percent of men know two or more effective ways to avoid HIV infection. More specifically, 72 percent of women and 79 percent of men mention the use of the con- dom as a specific way to avoid HIV infection, while 82 percent of women and 86 percent of men mention limiting the number of sexual part- ners/staying faithful to one partner – all of which are considered to be programmatically important ways of avoiding HIV/AIDS. Respondents who live in urban areas and those with more educa- tion are more likely to know about HIV/AIDS and ways to avoid getting infected with HIV. Knowledge of ways that HIV can be transmitted is important in preventing the spread of the disease in a population. Most women recognize that the HIV virus can be transmitted from a mother to a child during pregnancy (79 percent), during delivery (65 percent), and by breastfeeding (71 percent). Almost eight in ten women and men know that a healthy-looking person can have the AIDS virus. Overall, only 9 percent of women and 14 percent of men have been tested for HIV. The more educated women and men and those living in urban areas are more likely to have been tested for HIV than other respondents. Roughly two-thirds of women and men who have not been tested for AIDS say they want to be tested. One in ten women and men do not know of any sexually transmitted infections (STIs) other than HIV. Only 3 percent of women and 5 percent of men who have ever had sex reported having an STI or symptoms associated with an STI in the 12 months before the survey. More than half of women and men who had an STI in the 12 months preceding the survey sought advice or treatment from a clinic, hospital, or private doctor. Twenty-two percent of women and 32 percent of men with an STI or asso- ciated symptoms did not inform their partner, and one in three women and men with an STI took no action to protect their partner. SYPHILIS AND HIV TESTING The 2001-2002 ZDHS was the first nation- ally representative survey in Zambia to include voluntary syphilis and HIV testing. Syphilis test results were linked to the ZDHS interview data with precautions taken to ensure confidentiality of the respondents. HIV testing was carried out anonymously and the test results could not be linked to the respondent’s individual information, except for age, sex, residence (urban-rural), and province. Overall, 6 percent of women and 8 percent of men age 15-49 in Zambia tested positive for syphilis. The syphilis prevalence rate is slightly higher among urban residents of Copperbelt and Lu- saka than among those living in rural areas and other provinces. Sixty-three percent of men and 28 percent of women who were found to be syphilis positive have used a condom at some time in their life. The 2001-2002 ZDHS data on HIV testing found that of the individuals tested, 16 percent were HIV positive. Women are more likely to be HIV- positive than men (18 percent and 13 percent, re- spectively). Overall, the proportion HIV-positive rises with age from a level of 5 percent among re- spondents 15-19 to 25 percent among those 30-34, before dropping to 17 percent among those age 45- 49. HIV prevalence is more than twice as high in urban areas as in rural areas (23 percent and 11 per- cent, respectively). NORTHERN WESTERN CENTRAL SOUTHERN EASTERN NORTH- WESTERN LUAPULA LUSAKA COPPERBELT Lake Tanganyika Lake Mweru Lake Kariba Lake Bangweulu Mansa Ndola Kabwe Mongu Kasama Lusaka Solwezi Chipata Livingstone Democratic Republic of Congo Angola Namibia Tanzania Mozambique Botswana Zimbabwe Malawi ZAMBIA xxvi | Map of Zambia INTRODUCTION 1 Kumbutso Dzekedzeke and Chanda Mulenga 1.1 HISTORY, GEOGRAPHY, AND ECONOMY History Historical and archaeological evidence indicates that by the year 1500, much of modern Zambia was occupied by Bantu-speaking horticulturalists, farming people who were ancestors of the present inhabitants. In the late nineteenth century, various parts of what was to become Northern Rhodesia were administered by the British South Africa Company. In 1924, the British Colonial Office assumed responsibility for adminis- tering the territory, and in 1953, Northern Rhodesia (Zambia) and Southern Rhodesia (Zimbabwe) joined Nyasaland (Malawi) to form the Central African Federation of Rhodesia and Nyasaland, despite the opposi- tion of Northern Rhodesia’s Africans. The Federation was, however, dissolved in 1963. In October 1964, Zambia gained political independence and adopted a multiparty system of government. In December 1972, Zambia became a one-party state. The current multiparty system was implemented in 1991. Geography Zambia is a land-locked country covering an area of 752,612 square kilometres (about 2.5 percent of Africa). It shares borders with the Democratic Republic of Congo (DRC) and Tanzania in the north; Malawi and Mozambique in the east; Zimbabwe and Botswana in the south; Namibia in the southwest and Angola in the west. Administratively, the country is divided into nine provinces and 72 districts. Of the nine provinces, two are predominantly urban, namely Lusaka and Copperbelt provinces. The remaining provinces—Central, Eastern, Northern, Luapula, North-Western, Western and Southern—are predominantly rural provinces. Four of ten Zambians live in urban areas. Zambia lies between 8 and 18 degrees south latitude and between 20 and 35 degrees east longitude. It has a tropical climate and vegetation with three distinct seasons: the cool dry winter from May to August, a hot dry season during September and October and a warm wet season from November to April. Among the main river water sources in Zambia are the Zambezi, Kafue, Luangwa and Luapula. The country also has major lakes such as Tanganyika, Mweru, Bangweulu and the man-made Kariba. The north- ern part of the country receives the highest rainfall with an annual average ranging from 1,100 mm to over 1,400 mm. The southern and eastern parts of the country have less rainfall, ranging from 600 mm to 1,100 mm annually, which often results in droughts. Economy Zambia has a mixed economy consisting of a modern urban sector that, geographically, follows the rail line and a rural agricultural sector. For a long time, the modern sector has been dominated by parastatal organisations, while private businesses have predominated in construction and agriculture sectors. Since 1991, with the introduction of a liberalised market-oriented economy, the parastatals have been privatised and, in some cases, liquidated. Copper mining is the country’s main economic activity, accounting for 95 percent of export earnings and contributing 45 percent of government revenue during the decade following independence (1965-1975). In the mid-1970s following a sharp decline in copper prices and a sharp increase in oil prices, the country’s economy deteriorated. Attempts were made to minimise dependency on copper exports by diversifying the economy through the creation of import substitution parastatals. This did not achieve the desired results. Introduction | 1 The 1980s marked the start of the first phase of implementing Structural Adjustment Programmes (SAP) amidst a stagnating economy. However, the SAP failed to substantially alter the economy and in- creased the poverty of the majority of Zambians. Currently, around 73 percent of Zambians are classified as poor. Poverty is more prevalent in rural areas than urban areas (83 percent and 56 percent, respectively). Poverty in the Zambian context can be defined as lack of access to income, employment opportunities, enti- tlements for citizens to such things as freely determined consumption of goods and services, shelter and other basic needs of life (MOFNP, 2002). In an effort to halt the economic recession, the Movement for Multiparty Democracy (MMD) Gov- ernment has launched an Economic Recovery Programme (ERP) to turn around the protracted decline of the economy into sustained positive growth, leading to improvement in living standards and the quality of life of the people (Republic of Zambia, 1992). 1.2 POPULATION The 1980, 1990, and 2000 national censuses reported total populations of 5.7 million, 7.8 million and 10.3 million, respectively, with a growth rate of 2.9 percent per annum in 2000 (see Table 1.1). During the 1990-2000 intercensal period, the growth rates varied by province, ranging from 1.3 percent in Copperbelt province to 4.3 percent in Northern province. Table 1.1 Demographic characteristics Selected demographic indicators, Zambia, 1980, 1990, and 2001 Census year Indicator 1980 1990 2000 Population (millions) 5.7 7.8 10.3a Density (pop./sq. km.) 7.5 10.4 13.7 Percent urban 39.9 38 36 Total fertility rate 7.2 6.7 6.0 Completed family size (women age 45-49) 6.6 7.1 6.8 Infant mortality rate 97 123 110 Life expectancy at birth Male 50.4 46.1 47.5 Female 52.5 47.6 51.7 a Adjusted preliminary estimate from the 2000 National Census Sources: Central Statistical Office, 1985a, 1985b, 1995b, and 2002b The population density in Zambia increased from 7.5 people per square kilometre in 1980 to 10.4 in 1990 and 13.7 in 2000. The average density in 2000 ranged from 65 people per square kilometre in Lusaka province to 5 people per square kilometre in North-Western province. In addition to being the most densely populated provinces, Lusaka and Copperbelt are also the most urbanised. The decline in the economy has gradually reduced the proportion of the population in urban areas. The proportion of the population living in urban areas has decreased steadily from 40 percent in 1980 to 38 percent in 1990 and 36 percent in 2000. The proportion of the urban population varies by province, from 91 percent in Copperbelt province to 9 percent in Eastern province (CSO, 2002b). Total fertility rates estimated from the 1969 and 1980 censuses are in the neighbourhood of 7.0 births per woman. The rate declined to 6.7 births per woman in 1990 and to 6.0 in 2000. Life expectancy at birth for males was 50 years in 1980 and was estimated to have declined to 46 years by 1990. In 2000, it increased to 48 years. Zambian women live, on average, 4 years longer than men. Mortality levels are highest in 2 | Introduction Luapula followed by Western and Eastern provinces, with Lusaka, Copperbelt and North-Western provinces experiencing the lowest mortality rates (data not shown). Life expectancy at birth ranged from 44 years in Western Province to 56 years in North-Western province (CSO, 2002b). The overall infant mortality rate de- clined from 141 deaths per 1,000 live births in the mid-1960s (based on the 1969 census) to 99 in the late 1970s, after which it increased to 123 in the late 1980s. In the late 1990s, it declined again to 110 although this level is still higher than that experienced in the late 1970s. 1.3 THE POPULATION POLICY AND NATIONAL POPULATION AND DEVELOPMENT PROGRAMME OF ACTION For the first decade and a half after independence, Zambia did not view the high rate of population growth as a development problem. The results of the 1980 Population and Housing Census exposed the ra- pidity with which the population was expanding and the implied adverse effect on development and individ- ual welfare. This led the government to reappraise the role of population in national development efforts. In 1984, the then National Commission for Development Planning (NCDP) was given a mandate to initiate a draft population policy which would aim at achieving a population growth rate consistent with the growth rate of the economy (NCDP, 1989). The National Population Policy was accepted in May 1989. Since then, the country’s population growth rate has remained high and continues to be a serious impediment to sustainable development. The original population policy was revised in December 1996. New objectives of the policy take ac- count of concerns regarding HIV/AIDS, poverty, and gender issues. Among the objectives of the revised policy are: 1. To ensure that population issues and other development concerns are mutually integrated in the planning and implementation processes so as to attain development; 2 To ensure that all couples and individuals have the basic right to decide freely and responsi- bly the number and spacing of their children and to have the information, education and means to do so in order to enhance the health of families; 3. To contribute to the reduction of maternal, infant and child mortality in order to increase life expectancy; 4. To contribute to the reduction of HIV/AIDS and other sexually transmitted infections so as to improve the general health status of the population; 5. To improve the population’s access to appropriate, affordable and high-quality reproductive health services including family planning and sexual health in order to have a healthy nation; 6. To promote and maintain equal access to education for both sexes at all levels in order to raise literacy levels. The objectives of the policy will be achieved through related policies and strategic frameworks such as the Reproductive Health Policy and the Gender Policy. Institutions from all sectors are involved in imple- menting activities for the strategic frameworks. 1.4 HEALTH PRIORITIES AND PROGRAMMES The Government’s commitment to the objective of improving the quality of life of all Zambians is demonstrated through its efforts to improve health care delivery by reforming the health sector. In 1991, the Government of the Republic of Zambia articulated radical health policy reforms characterised by a move from a strongly centralised health system in which the central structures provided support and national guidance to Introduction | 3 the peripheral structures. An important component of health policy reform is the restructured Primary Health Care (PHC) programme. To ensure that the PHC programme operates efficiently in addressing the main health problems of the individual, the family, and the community, the health service has been decentralised, with the responsibility of planning, implementing, monitoring, and managing PHC programmes falling to the districts. The integrated health plans developed out of the District Health Boards’ Basic Health Programme constitute the PHC pack- age. The reformulated PHC programme aims, among other things, to deal with the main health problems in the community, focusing on the needs of the underserved, high-risk, and vulnerable groups. Thus, atten- tion is paid to the rural and peri-urban areas where the health needs of the people are greatest, with particular emphasis placed on maternal and child care, family planning, nutrition, control of communicable diseases (e.g., diarrhoea, cholera, dysentery, sexually transmitted infections, HIV/AIDS, malaria, etc.), immunisation, and environmental sanitation in order to secure adequate health care for all Zambians. The health reforms established the government’s commitment to improve the health of the population by progress towards the achievement of the following targets by the year 2000: • To reduce the percentage of underweight children (0-5 years) from 23 to 18 percent; • To bring under control 80 percent of tuberculosis cases; • To increase accessibility to and acceptability of family planning services and appropriate use of information in order to increase family planning use; • To improve the quality of, access to and utilisation of maternal and child health services in order to reduce maternal deaths and complications; • To reduce the incidence of sexually transmitted infections (STIs), AIDS, and reproductive tract infections; • To reduce the incidence of induced abortions in order to reduce maternal complications and deaths; • To increase the percentage of the population having adequate sanitation from 66 to 75 per- cent in urban areas and from 37 to 57 percent in rural areas by 1996 (MOH, 1992). The targets were to be achieved through a basic health care services package to be provided at all lev- els of the health care system. 1.4 Strategic Framework to Combat the National HIV/AIDS Epidemic Once the first case of AIDS was diagnosed in Zambia in 1984, the government realised that HIV/AIDS required behavioural interventions as well as care and support. The National AIDS Prevention and Control Programme was formally established in 1986 with assistance from the WHO Global Programme on AIDS. Consistent with the evolving epidemic, three national plans have been developed to respond to the HIV/AIDS epidemic. In 1987, an emergency short-term plan was developed to ensure safe blood and blood product supplies. In 1993, the Second Medium Term plan (1993-1998) was launched. This plan acknowl- edged that the initial response to HIV/AIDS was inadequate to contain a problem that was more than just medical in nature. It further acknowledged that the first plan did not incorporate in its planning process a mechanism for intersectoral coordination and collaboration. It was therefore decided that the cross-cutting and multi-dimensional nature of the HIV/AIDS epidemic needed a broad and multisectoral response. Thus, to ensure a coordinated, nationalised response, the AIDS, STI and TB programmes were integrated. The inte- grated programmes sought to foster political commitment at the highest level, develop intersectoral ap- proaches encompassing all government ministries, the private sector and civil society, increase access to STI care, strengthen condom promotion and distribution, develop effective AIDS impact mitigation strategies, and control TB. 4 | Introduction In the current national Strategic Framework 2001-2003, a combination of interventions are being im- plemented to (National HIV/AIDS/TB Council, 2000): 1. Reduce HIV/AIDS transmission, mainly focussing on children, youth, women and high risk populations; and 2. Reduce the socio-economic impact of HIV/AIDS on individuals and families at the work- place, in the homes and on the whole Zambian society. The interventions include: 1. Information, education and communication to inform the general public about HIV/AIDS; 2. Condom promotion and distribution; 3. Early and effective diagnosis and treatment of sexually transmitted infections; 4. Blood screening; 5. Counselling and testing; 6. Special programmes for orphans, widows and widowers; 7. Support for persons living with AIDS; 8. Advocacy for the introduction of non-discriminatory practices and laws. 1.6 OBJECTIVES AND ORGANISATION OF THE SURVEY Objectives The Zambia Demographic and Health Survey (ZDHS) is a nationally representative sample survey of women and men of reproductive age designed to provide information on fertility, family planning, child sur- vival and health of children. The primary objectives of the ZDHS are: 1. To collect up-to-date information on fertility, infant and child mortality and family plan- ning; 2. To collect information on health-related matters such as breastfeeding, antenatal care, chil- dren’s immunisations and childhood diseases; 3. To assess the nutritional status of mothers and children; 4. To support dissemination and utilisation of the results in planning, managing and improving family planning and health services in the country; 5. To enhance the survey capabilities of the institutions involved in order to facilitate the im- plementation of surveys of this type in the future; and 6. To document current epidemics of sexually transmitted infections and HIV/AIDS through use of specialised modules. Organisation The 2001-2002 ZDHS was conducted by the Central Statistical Office (CSO) and the Central Board of Health (CBoH). ORC Macro of Calverton, Maryland provided technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). Funding for the survey was sup- plied by ORC Macro (from USAID), the Government of Japan through a trust fund managed by the United Nations Development Programme (UNDP) and through bilateral agreements between the Government of the Republic of Zambia and the United Nations Population Fund (UNFPA), and the Danish International Development Agency (DANIDA). 1.7 SAMPLE DESIGN The sample for the 2001-2002 Zambia Demographic and Health Survey covered the population resid- Introduction | 5 ing in private households in the country. A representative probability sample of approximately 8,000 households was selected for the ZDHS. This sample was constructed in such a manner as to allow for sepa- rate estimates for key indicators for each of the 9 provinces in Zambia. As a result, the ZDHS sample is not self-weighting at the national level. A list of Standard Enumeration Areas (SEAs) prepared for the 2000 Population Census constituted the frame for the ZDHS sample selection. A total of 320 clusters (100 urban and 220 rural) were selected from this frame. In general, the ZDHS clusters included only one SEA; however, in order to achieve the minimum cluster size of 85 households, 34 clusters comprised two SEAs. The final stage of selection in- volved the systematic sampling of households from a list of all households that was prepared for each of the selected SEAs. All women age 15-49 who were either permanent residents of the households in the ZDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed in the survey. In addition, in a subsample of one-third of all the households selected for the ZDHS, all men age 15-59 were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey. Finally, all women and men (approximately 2,500 of each) living in the households selected for the men’s survey and eligible for the DHS interview were asked to voluntarily give blood for syphilis and HIV testing. 1.8 QUESTIONNAIRES Three questionnaires were used for the 2001-2002 ZDHS: the Household Questionnaire, the Women’s Questionnaire and the Men’s Questionnaire. The contents of these questionnaires were based on the model questionnaires developed by the MEASURE DHS+ programme for use in countries with low levels of contraceptive use. The questionnaires are reproduced in Appendix E. In consultation with technical institutions, local and international organisations, the CSO modified the DHS model questionnaires to reflect relevant issues in population, family planning and other health issues in Zambia. A series of questionnaire design meetings were organised by the CSO with the assistance of ORC Macro, and the inputs generated in these meetings were used to produce the first draft of the ZDHS question- naires. These questionnaires were translated from English into the seven major languages, namely Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja, and Tonga. The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including his or her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. The Household Questionnaire collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and ownership and use of mosquito nets. The Household Questionnaire was also used to record height and weight measurements of women 15-49 and children under the age of 6, and, where syphilis and HIV testing was conducted, to record the respondents’ consent to the testing. In order to maintain confidentiality, separate forms were used for recording the results of the syphilis and HIV testing. The Women’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: • Background characteristics (education, residential history, media exposure, etc.) • Knowledge and use of family planning methods • Fertility preferences • Antenatal and delivery care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Woman’s work and husband’s background characteristics 6 | Introduction • Infant and child feeding practices • Childhood mortality • Awareness and behaviour regarding AIDS and other sexually transmitted infections (STIs) • Adult mortality including maternal mortality. The Women’s Questionnaire included a series of questions to obtain information on women’s experi- ence of domestic violence. These questions were administered to one woman per household. In households with two or more eligible women, special procedures were followed in order to ensure the random selection of this woman. The Men’s Questionnaire was administered to all men age 15-59 living in every third household in the ZDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a reproductive history or questions on maternal and child health, nutrition, or maternal mortality. 1.9 SYPHILIS AND HIV TESTING In households selected for the male survey, the ZDHS involved the collection of blood specimens from all eligible women and men who voluntarily consented to the syphilis and HIV testing. The initial proto- col for the blood specimen collection and testing as well as modifications made in the protocol during the course of the study were reviewed and approved by both the Institutional Review Board of ORC Macro and the Ethical Review Committee of the University of Zambia which approves research studies on human sub- jects conducted in Zambia. For the syphilis and HIV testing activities, a nurse/nurse counselor and a laboratory technician were added to each of the 12 ZDHS field teams. The nurse/nurse counselors and laboratory technicians were re- cruited from the health facilities under the district health management boards with the assistance of the CBoH and had experience in blood collection and testing, respectively. According to the initial protocol, syphilis testing was done in the field by the laboratory technician, using a qualitative Rapid Plasma Reagin (RPR) as a screening test and the Abbott test strip Determine as the confirmatory test. Those individuals who were found to test positive for syphilis were offered treatment at home with one injection of benzathine penicillin, which is the standard treatment in Zambia. Alternative treatment was given to those allergic to penicillin and to pregnant women (erythromycin capsules for pregnant women and doxycycline capsules for men and non- pregnant women). An emergency kit (epinephrine) was provided to each nurse/nurse counselor for penicillin- allergic cases. Treatment was also offered to the partners of individuals who tested positive. If the respondent tested positive for syphilis and did not want to be treated at home, a referral letter was given for free treatment at the nearest health facility. An effort was also made to ensure follow-up care for respondents (and their partners, whenever possible) who were tested and found to be positive but who were not at home when the nurse/nurse counselor returned to provide treatment. To facilitate the follow-up care, respondents (and their partners, whenever possible) were asked at the time they gave a blood specimen to consent to have their names, contact information, and test results given to the nearest health facility in the event that the subjects were unavailable for treatment during the survey. The syphilis testing protocol was modified in January 2002 at the request of the CBoH. Although the Determine test had shown a high degree of accuracy in other settings, it was not considered appropriate to use as the confirmatory test in the ZDHS because it had not been validated and/or officially approved for use in Zambia. In the revised protocol, RPR was still performed in the field by the lab technician as a screening test for syphilis. The major change was that no confirmatory test was performed in the field. Instead, all RPR- reactive blood samples were collected in cryo vials, frozen in liquid nitrogen tanks and transported to the Tropical Diseases Research Centre (TDRC) in Ndola for syphilis confirmatory testing using Treponema Pal- lidum Haemaglutination Assay (TPHA). Under the revised protocol, respondents testing positive on the RPR test were not treated in the field. Rather, subjects testing positive on the RPR were advised of their status and they (and their partners if the Introduction | 7 subjects agreed) received a referral letter(s) to an appropriate local health facility for follow-up diagnosis and treatment. At the end of the fieldwork for each ZDHS sample point, the nurse/nurse counselor counted up the number of RPR-positive subjects and dropped off a sufficient number of benzathine penicillin doses and sy- ringes at the designated health centre closest to the sample point with instructions to health centre staff to use the supplies to treat ZDHS subjects. Again, as part of the informed consent process, the respondent was asked for his/her consent for the interviewing team to give contact information to a designated health facility for follow-up in case the respondent was not found at home at the time of result notification. To ensure that all confirmed positive cases would be adequately treated, the CBoH asked that the results of the TPHA testing be provided to the District Health Management Teams (DHMTs). The DHMTs and local health centre staff were instructed to conduct follow-ups in such a way as to minimise the loss of subject confidentiality. The HIV testing in the ZDHS was anonymous and unlinked to the other variables collected in the survey except for sex, age and geographical location of the respondent. If a respondent consented to HIV test- ing, the laboratory technician prepared a dried blood spot (DBS) sample on a filter paper card from the venous blood specimen. Each DBS sample was given a serial identification number that was not related to survey identifiers for the respondent. The DBS samples from a cluster were then placed in Ziploc bags and trans- ported to TDRC in Ndola for HIV testing. At TDRC, the DBS samples were first eluted and then screened using the Wellcozyme HIV 1&2 GACELISA. All the positive samples and 10 percent of the negative samples were re-tested using BIONOR HIV 1&2. Any discordant cases were tested with Western Blot. HIV tests vary in their sensitivity, that is, their ability to correctly identify all cases with the virus and specificity, that is, their ability to avoid falsely identifying cases as having the virus when they do not. The DHS protocol employed three tests in order to reduce errors that might be introduced in the results by a single test’s performance in detecting false positive or false negative cases. Specifically, the confirmatory testing with BIONOR (which has a reported sensitivity of nearly 100 percent and a specificity of 98 percent) of all positive samples and of 10 percent of the negative samples was aimed at detecting errors resulting from the initial testing with GACELISA, which has a somewhat lower reported sensitivity (97 percent) and specificity (96 percent). The third step of testing the discordant cases with Western Blot was the final effort to reduce the number of false positive or false negative cases to a minimum. A total of 3,961 samples were collected in the ZDHS, of which 710 tested positive using the GACELISA. When these positive samples were retested using BIONOR, 570 tested positive and 140 tested negative. Western Blot was then performed for the 140 samples for which the results were discordant, i.e., the GACELISA result was positive and the BIONOR result was negative. Only one of the samples was con- firmed as positive and 139 were confirmed as negative with Western Blot. As an additional quality control measure 10 percent of the total number of samples found to be nega- tive with the GACELISA test were also tested with BIONOR. Of the 325 negative samples retested, only two were found to be positive on BIONOR. These discordant cases were then tested with Western Blot and the result was considered as final. Finally, the availability of the serum samples collected for syphilis testing allowed for a comparison of the results of testing using dried blood spots versus testing using serum for the same subjects. In this exer- cise, which was designed to validate the use of the dried blood spot approach, both plasma and dried blood spots samples were tested for HIV for a total of 505 respondents. Discordant results were obtained in only 3 cases; in all the discordant cases, the outcome of the plasma test was negative while the DBS test positive. Overall, 118 samples were positive for HIV on the plasma test and 121 samples were positive on the DBS. The HIV and syphilis test results were entered on special forms by either the field or laboratory per- sonnel involved in the testing. These forms were sent to CSO in Lusaka where the data were entered and processed separately from the DHS questionnaires. The syphilis test results were then linked to the individual DHS records in a special data file. Another data file was created for the HIV test data. Since the HIV testing was anonymous, the HIV testing results could not be linked to DHS interview data. Thus, the HIV data file 8 | Introduction includes information only on the age, sex, and residence (urban-rural and province) for each of the individuals tested. 1.10 PRETEST ACTIVITIES, TRAINING, AND FIELDWORK The ZDHS involved a number of activities to address various methodological and ethical concerns raised by the inclusion of HIV and syphilis testing as well as to pilot the ZDHS questionnaires. A total of three formal pretests were conducted during this phase of the survey. The training and fieldwork for the first pretest took place May 14-25, 2001. In addition to pretesting the survey questionnaires, the pretest included syphilis and HIV testing using a simple finger prick procedure from which blood spots were collected on filter paper. Four medical laboratory technicians, nine female interviewers, seven male interviewers, and six nurse counselors, were trained, forming seven teams, one for each local language. The pretest fieldwork was con- ducted in four areas, three urban and one rural. In total, 65 household questionnaires, 79 women’s question- naires and 106 men’s questionnaires were completed in the course of three days. A total of 81 persons were identified as eligible for the blood collection. Of these, 52 persons voluntarily agreed to give a sample of blood. After the first pretest was completed, it was decided that venous rather than capillary blood samples should be collected to be consistent with existing syphilis testing protocols in Zambia. To pilot all of the test- ing procedures, a second pretest was carried out July 18-24, 2001. Four medical laboratory technicians, five female interviewers and five male interviewers took part in the second pretest. The staff was selected from those individuals who had participated in the first pretest. In the second pretest, 130 questionnaires (38 household, 57 women’s and 35 men’s questionnaires) were administered. Sixty-nine persons were selected for the venous blood collection. Out of these, 67 (32 males and 35 females) agreed to have their blood tested. In the second pretest, RPR was used as the screening test for syphilis and Abbot Determine test strip as the con- firmatory test. The pretest included follow-up treatment or referral for those who tested positive for syphilis. The laboratory technicians also tested the procedures for obtaining dried blood spots from the venous blood samples for later HIV testing. Using the same staff who took part in the second pretest, a third pretest of the HIV/syphilis protocol was conducted July 26 though August 1, 2001. This pretest focused mainly on gaining additional experience with the informed consent statement in a variety of settings. Five areas were covered, three high-density areas (low income earners areas) and two low-density areas (high income earners areas). In the third pretest, 98 households and 286 individuals were covered. More than 85 percent of respondents agreed to HIV and syphi- lis testing. In addition to the three pretests, an additional field exercise was conducted as part of the ZDHS to validate the use of dried blood spots for the HIV testing. In this study, matched DBS and plasma samples were collected and tested. The results of the testing of the matched DBS and plasma samples were similar, leading to the decision to collect DBS samples. A total of 88 interviewers and 36 nurse/nurse counselors and laboratory technicians participated in the main survey training that took place August 20 through September 16, 2001. All participants were trained in interviewing techniques and the contents of the ZDHS questionnaires. The training was conducted following the standard DHS training procedures, including class presentations, mock interviews, and tests using the Women’s Questionnaire. Special training was given to interviewers on the collection of the domestic violence data, especially on issues relating to informed consent and privacy. Male participants were additionally trained on the content of the men’s questionnaire. The nurse/nurse counselors were trained to use the scales and height boards to collect anthropometric measurements of women and young children. All of the inter- viewers were trained in taking height and weight measurements so that they could assist the nurse/nurse coun- selors in performing these tasks. During the last week of the training, the nurse/nurse counselors and laboratory technicians, who al- ready had experience in blood collection and testing, were separated and trained on the specific procedures for drawing blood samples in the field and on syphilis testing using RPR. Additionally, they received training specifically focused on the internationally accepted procedures to minimise risk (“universal precautions”) and Introduction | 9 confidentiality. Finally, in addition to the classroom instruction, the ZDHS training included practice interviews using the questionnaire in English and the participants’ local languages. Data collection for the 2001-2002 ZDHS took place over a seven-month period from November 2001 to May 2002. Twelve interviewing teams carried out data collection. Each team consisted of one team super- visor, one field editor, three to four female interviewers, one male interviewer, one nurse/nurse counselor, one lab technician, and one driver. Six staff assigned from the CSO coordinated and supervised fieldwork activi- ties. They were assisted by staff from the TDRC and the University of Zambia Demography Division. ORC Macro participated in field supervision for interviews, height and weight measurements, and blood collection and testing. 1.11 DATA PROCESSING The processing of the ZDHS results began shortly after the fieldwork commenced. Completed ques- tionnaires were returned periodically from the field to CSO offices in Lusaka, where they were entered and edited by data processing personnel who were specially trained for this task. The concurrent processing of the data was an advantage because CSO was able to advise field teams of problems detected during the data en- try. TDRC provided the results of the syphilis and HIV testing to CSO for entry and editing. The data entry and editing phase of the survey was completed in August 2002. 1.12 RESPONSE RATES Table 1.2 shows response rates for the 2001-2002 ZDHS. Response rates are a source of concern because high non-response may affect the reliability of the results. A total of 8,050 households were selected in the sample, of which 7,260 were found at the time of the fieldwork. The shortfall is largely due to some structures being vacant. Of the 7,260 existing households, 7,126 were successfully inter- viewed, yielding a household response rate of 98 percent. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Zambia 2001-2002 Residence Result Urban Rural Total Household interviews Households selected 2,167 5,883 8,050 Households occupied 2,059 5,201 7,260 Households interviewed 2,013 5,113 7,126 Household response rate 97.8 98.3 98.2 Interviews with women Number of eligible women 2,650 5,294 7,944 Number of eligible women in- terviewed 2,551 5,107 7,658 Eligible woman response rate 96.3 96.5 96.4 Interviews with men Number of eligible men 814 1,604 2,418 Number of eligible men inter- viewed 689 1,456 2,145 Eligible man response rate 84.6 90.8 88.7 In the households interviewed in the survey, a total of 7,944 eligible women were identified; interviews were completed with 7,658 of these women, yielding a response rate of 96 percent. With regard to the male survey results, 2,418 eligible men were identified in the subsample of households selected for the male survey, of which 2,145 were successfully inter- viewed, yielding a response rate of 89 percent. The response rates are lower for the urban than for rural sample, especially for men. Compared with the 1996 ZDHS, there has been a slight decline in response rates. In the 1996 survey, the response rates were 99 percent for households, 97 percent for women, and 91 percent for men (CSO, MOH, and Macro International, 1997). The principal reason for non-response among both eligible men and women was the failure to find indi- viduals at home despite repeated visits to the household. The substantially lower response rate for men reflects 10 | Introduction Introduction | 11 the more frequent and longer absences of men from the household, principally related to their employment and life style. Characteristics of Households and Respondents | 11 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2 Patrick Mumba Chewe The purpose of this chapter is to provide a descriptive summary of some demographic and socio- economic characteristics of the population in the sampled households. Also examined are environmental conditions, such as housing facilities and household characteristics. This information on the characteristics of the households and the individual women and men interviewed is essential for the interpretation of survey findings. In the 2001-2002 ZDHS a household was defined as a person or a group of persons, related or unrelated, who live together in the same dwelling unit and share a common source of food. The Household Questionnaire was used to collect information on all usual residents and visitors who spent the night preceding the survey in the household. This method of data collection allows the analysis of either de jure (usual residents) or de facto (those who are there at the time of the survey) populations. 2.1 POPULATION BY AGE AND SEX Age and sex are important demographic variables and are the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also very important variables in the study of mortality, fertility, and nuptiality. The distribution of the de facto household population in the 2001-2002 ZDHS survey is shown in Table 2.1 by five-year age groups, according to sex and urban-rural residence while Figure 2.1 shows the population pyramid by sex for Zambia. The data show that there are slightly more women than men in Zambia, with women constituting 51 percent and men constituting 49 percent. There is no 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, Zambia 2001–2002 Urban Rural Total Age Male Female Total Male Female Total Male Female Total 0-4 15.7 14.6 15.1 18.9 18.7 18.8 17.8 17.2 17.5 5-9 16.1 17.1 16.6 17.0 15.7 16.3 16.7 16.2 16.4 10-14 14.1 13.8 13.9 14.9 13.9 14.3 14.6 13.8 14.2 15-19 10.5 12.2 11.4 11.2 9.6 10.4 10.9 10.5 10.7 20-24 9.7 11.2 10.4 6.8 8.6 7.8 7.9 9.6 8.7 25-29 9.1 9.4 9.3 6.8 7.0 6.9 7.7 7.9 7.8 30-34 8.1 6.3 7.2 4.8 5.2 5.0 6.0 5.6 5.8 35-39 4.7 4.2 4.5 4.5 4.5 4.5 4.6 4.4 4.5 40-44 3.3 3.5 3.4 3.3 3.5 3.4 3.3 3.5 3.4 45-49 2.7 2.6 2.6 2.4 2.7 2.6 2.5 2.6 2.6 50-54 2.0 1.6 1.8 1.8 2.9 2.4 1.9 2.4 2.2 55-59 1.4 1.2 1.3 1.8 2.2 2.0 1.7 1.8 1.7 60-64 1.1 0.9 1.0 2.0 2.1 2.0 1.6 1.7 1.7 65-69 0.7 0.8 0.7 1.4 1.4 1.4 1.1 1.2 1.2 70-74 0.3 0.4 0.3 1.0 1.0 1.0 0.8 0.8 0.8 75-79 0.2 0.2 0.2 0.7 0.6 0.7 0.5 0.5 0.5 80 + 0.2 0.2 0.2 0.6 0.4 0.5 0.5 0.3 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,416 6,591 13,007 11,395 11,808 23,202 17,811 18,399 36,209 12 | Characteristics of Households and Respondents variation in sex composition of the population by urban-rural residence from what is observed at the national level. The age distribution of the Zambian population is typical of high fertility/high mortality populations which show a higher proportion of younger persons in the overall population (see Figure 2.1). The population under age 15 constitutes 48 percent of the total population, while the older age groups are very small. This type of age structure has a built-in momentum for the growth of the country’s population. The implication is that the population growth rate will remain high for some time because the young population will eventually reach the reproductive age. A feature worth noting in the population distribution is the gap between males and females at age 20-24 in the ZDHS sample (Figure 2.2). The gap indicates that there are more women than men in this age group. 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 0-4 02468101214161820 0 2 4 6 8 10 12 14 16 18 20 ZDHS 2001-2002 Age Male Percent Female Characteristics of Households and Respondents | 13 2.2 HOUSEHOLD COMPOSITION Information about the composition of households, specifically the sex of the head of the household and size of the household, is presented in Table 2.2. These characteristics are important because they are associated with aspects of household welfare. Female-headed households are, for example, typically poorer than male- headed households. Where households are large, there is generally greater crowding, which is associated with unfavourable health conditions. The proportion of female- headed households increased from 1992 (13 percent) to 1996 (20 percent) and has remained the same since 1996. In the 2001-2002 ZDHS, the average household size was 5.2 persons, compared with 5.4 persons in the 1996 ZDHS and 5.6 persons in the 1992 ZDHS. This shows a modest decline over the period. Table 2.2 further shows that the average household size is larger in urban areas (5.5 persons) than in rural areas (5.1 persons). The proportion of households with more than nine persons is higher in urban areas (14 percent) than in rural areas (10 percent). Figure 2.2 Distribution of De Facto Household Population by Five-Year Age Groups and Sex � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age group 0 5 10 15 20 Male Female� � ZDHS 2001-2002 Percent Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Zambia 2001-2002 Residence Characteristic Urban Rural Total Sex of head of household Male 79.8 76.1 77.4 Female 20.2 23.9 22.6 Total 100.0 100.0 100.0 Number of usual members 1 5.9 6.8 6.5 2 8.4 9.6 9.2 3 12.0 13.2 12.8 4 13.7 15.8 15.1 5 14.0 14.9 14.6 6 13.8 12.9 13.2 7 10.1 9.7 9.8 8 8.4 7.1 7.5 9+ 13.8 10.0 11.3 Total 100.0 100.0 100.0 Number of households 2,437 4,689 7,126 Mean size 5.5 5.1 5.2 Note: Table is based on de jure members, i.e., usual residents. 14 | Characteristics of Households and Respondents 2.3 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Table 2.3 takes into account parental survival status in looking at children’s living arrangements. Several aspects of the table are of interest, particularly the extent of orphanhood, i.e., the proportion of children who have lost one or both parents. The AIDS epidemic is a major factor contributing to orphanhood. Table 2.3 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 15 by children's living arrangements and survival status of parents, according to background characteristics, Zambia 2001-2002 Not living with either parent Living with mother but not father Living with father but not mother Background characteristic Living with both parents Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing informa -tion on father/ mother Total Number of children Age 0-1 75.2 20.0 2.4 0.3 0.2 1.1 0.2 0.1 0.1 0.4 100.0 2,737 2-4 70.4 14.7 4.1 1.7 0.6 5.7 0.9 0.8 0.5 0.5 100.0 3,690 5-9 61.1 9.8 6.6 3.5 1.3 8.9 2.1 3.0 3.0 0.8 100.0 6,096 10-14 49.0 7.4 8.9 4.3 1.8 12.4 3.2 5.5 6.1 1.4 100.0 5,265 Sex Male 62.2 11.5 6.3 3.1 1.1 7.2 1.8 2.9 3.0 0.7 100.0 8,878 Female 61.0 11.9 5.9 2.6 1.2 8.9 1.9 2.8 2.9 1.0 100.0 8,910 Residence Urban 60.5 10.1 7.9 3.9 1.2 7.6 1.5 2.8 3.5 1.0 100.0 6,070 Rural 62.2 12.5 5.2 2.4 1.1 8.3 2.1 2.9 2.6 0.8 100.0 11,719 Province Central 58.0 11.7 6.2 2.5 1.2 8.8 2.6 4.7 3.8 0.5 100.0 1,349 Copperbelt 64.3 8.8 7.7 3.3 0.7 7.3 1.6 2.3 3.3 0.8 100.0 3,217 Eastern 65.4 12.2 3.8 1.9 1.0 8.2 1.7 2.1 2.5 1.1 100.0 2,374 Luapula 62.6 10.6 6.5 2.0 1.0 10.3 2.3 2.0 1.8 0.9 100.0 1,400 Lusaka 60.0 9.9 7.7 3.4 1.3 8.6 1.6 3.2 3.4 0.8 100.0 2,315 Northern 67.6 10.7 6.0 1.6 1.4 5.2 1.4 2.3 3.0 0.7 100.0 2,559 North-Western 59.8 13.7 6.4 3.8 1.0 9.0 1.5 1.9 1.9 1.0 100.0 968 Southern 58.0 12.5 4.7 3.0 1.2 10.0 1.8 4.8 3.4 0.6 100.0 2,081 Western 50.7 20.1 5.4 5.2 1.7 7.4 3.1 2.9 2.2 1.3 100.0 1,525 Total 61.6 11.7 6.1 2.9 1.1 8.1 1.9 2.9 2.9 0.9 100.0 17,789 There has not been a measurable change in the proportion of children under the age of 15 living with both their natural parents between the 1996 ZDHS (62 percent) and the 2001-2002 ZDHS (62 percent). Overall, 18 percent of children under the age of 15 live with only their mothers compared with 19 percent in the 1996 ZDHS, 4 percent live with only their fathers compared with 5 percent in the 1996 ZDHS, while 16 percent are fostered or not living with either parent. Results from the 2001-2002 ZDHS show that fathers of 12 percent of the children under the age of 15 are dead, mothers of 6 percent are dead and both parents of 3 percent are dead. Table 2.3 shows that the proportion of children living with both parents declines with age. Three- fourths of children under age two live with both parents, compared with less than half of those age 10-14. Western province has the smallest proportion of children under the age of 15 living with both parents (51 percent), while Northern province has the largest proportion (68 percent). Characteristics of Households and Respondents | 15 2.4 EDUCATIONAL LEVEL OF HOUSEHOLD POPULATION Education is a key determinant of the lifestyle and status an individual enjoys in a society. Studies consistently show that educational attainment has a substantial effect on reproductive behaviour, contraceptive use, fertility, infant and child mortality, morbidity, and attitudes and awareness related to family health and hygiene. Formal education in Zambia is based on a three-tier system: primary education consisting of 7 years, junior secondary school consisting of 2 years, and senior secondary school consisting of 3 years. Upon completion of secondary school, someone may choose to further his/her education by either going to the university for 4 to 7 years, depending on the field of study, and obtain a degree or attending a vocational or technical institute for a two to three-year certificate/diploma course. The main goal is for the nation to meet its human resource requirement in the socio-economic and political sectors thereby leading to national development. The Government of the Republic of Zambia has recently (2002) declared free education for all for grades 1-7 (primary education). This change in policy was motivated by an effort to make free education accessible so that literacy rates will improve. 2.4.1 Educational Attainment of the Household Population During the 2001-2002 ZDHS survey, information on educational attainment was collected for every member of the household age 5 and over. The results are presented in Table 2.4 and Figure 2.3. Data on the educational attainment among youth suggest that there has been progress in achieving the goal of universal education. Table 2.4 shows the percent distribution of the de facto male and female population age 6 and over, by the highest level of education attained, according to selected background characteristics. Overall, more females than males have no education (25 percent and 18 percent, respectively). More than four in ten (42 percent of males and 45 percent of females) have some primary education. The proportion of males who completed primary and secondary education is slightly higher than the respective proportion of females. Figure 2.3 and Table 2.4 show that the proportions of persons with no education are markedly higher among those in the 6-9 age group (many of whom have not yet started school) and among those age 50 and above. There are urban-rural differences in educational attainment. Seven percent of males in urban areas and 2 percent in rural areas have attained more than a secondary level of education, compared with 4 percent of females in urban areas and 1 percent in rural areas. About 32 percent of females and 23 percent of males in rural areas have no education. In urban areas, 13 percent of females and 9 percent of males have no education. Results from past DHS surveys in Zambia indicate that the proportion of children attending school has decreased slightly over the 10-year period between the surveys. In 1992, 11 percent of boys and girls age 10-14 had never attended school; in 1996, 13 percent of males and 12 percent of females had never attended school; and in 2001-2002, 14 percent of males and 15 percent of females age 10-14 had never attended school. 16 | Characteristics of Households and Respondents Table 2.4 Educational attainment of household population Percent distribution of the de facto female and male household population age six and over by highest level of education completed, according to background characteristics, Zambia 2001-2002 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median number of years MALE Age 6-9 55.0 43.9 0.0 0.0 0.0 0.0 1.1 100.0 2,396 0.0 10-14 13.7 79.3 4.3 2.2 0.0 0.0 0.5 100.0 2,597 2.5 15-19 6.3 46.6 18.9 25.8 2.0 0.1 0.2 100.0 1,948 5.8 20-24 5.7 26.3 21.6 28.4 14.2 3.5 0.3 100.0 1,399 6.8 25-29 7.0 24.4 21.8 26.5 13.8 6.3 0.3 100.0 1,365 6.8 30-34 5.5 19.2 22.5 27.5 13.6 11.3 0.4 100.0 1,071 7.5 35-39 6.8 19.0 27.5 27.8 9.8 9.0 0.0 100.0 812 6.9 40-44 5.0 17.0 34.7 24.6 9.5 8.5 0.6 100.0 590 6.8 45-49 6.8 21.1 26.0 29.2 5.3 10.6 1.0 100.0 452 6.8 50-54 11.4 24.3 21.1 26.0 5.7 11.3 0.3 100.0 338 6.6 55-59 16.8 39.0 16.0 15.6 4.5 8.0 0.0 100.0 295 5.2 60-64 22.1 44.0 13.6 11.7 2.8 4.8 1.1 100.0 292 3.7 65+ 36.6 46.0 7.8 5.7 1.1 1.8 1.0 100.0 523 1.9 Residence Urban 8.9 33.0 14.4 24.8 11.2 7.2 0.5 100.0 5,198 6.5 Rural 22.8 46.5 14.8 11.5 2.2 1.6 0.5 100.0 8,878 3.3 Province Central 15.8 44.2 14.7 17.4 3.6 4.0 0.2 100.0 1,056 4.7 Copperbelt 8.8 34.9 15.7 24.1 9.2 7.0 0.2 100.0 2,790 6.4 Eastern 30.2 42.4 11.1 10.1 3.5 1.8 0.8 100.0 1,880 2.1 Luapula 22.8 48.3 14.9 10.7 1.3 2.0 0.0 100.0 1,052 3.3 Lusaka 10.8 33.0 15.7 21.3 11.5 6.9 0.9 100.0 1,997 6.4 Northern 18.3 45.5 16.0 14.4 3.6 1.8 0.4 100.0 1,915 4.1 North-Western 23.1 46.7 9.5 15.8 2.1 2.6 0.2 100.0 669 3.2 Southern 17.5 44.2 18.6 14.4 3.3 1.6 0.4 100.0 1,573 4.1 Western 23.9 48.8 11.2 10.6 3.4 0.8 1.2 100.0 1,145 2.9 Total 17.7 41.5 14.7 16.4 5.5 3.7 0.5 100.0 14,077 4.5 FEMALE Age 6-9 53.2 45.6 0.1 0.0 0.0 0.0 1.1 100.0 2,401 0.0 10-14 15.4 76.7 5.3 2.1 0.0 0.0 0.5 100.0 2,543 2.7 15-19 8.9 41.6 17.8 29.2 2.1 0.1 0.2 100.0 1,938 5.9 20-24 11.8 34.4 19.1 23.5 8.1 2.9 0.1 100.0 1,759 6.2 25-29 10.5 35.0 20.9 23.8 4.3 5.3 0.1 100.0 1,448 6.2 30-34 11.5 35.8 23.3 21.8 2.9 4.5 0.3 100.0 1,022 6.1 35-39 15.8 36.4 24.5 17.7 1.9 3.2 0.5 100.0 811 5.7 40-44 19.2 35.3 25.9 13.8 1.9 4.0 0.0 100.0 644 5.4 45-49 21.9 44.9 18.2 9.2 0.9 4.8 0.2 100.0 487 3.8 50-54 43.1 39.6 6.7 5.3 0.6 3.8 0.8 100.0 444 0.8 55-59 55.3 36.9 3.7 1.6 0.0 1.6 1.0 100.0 330 0.0 60-64 63.9 30.9 1.9 0.8 0.0 1.8 0.7 100.0 307 0.0 65+ 71.1 26.5 1.0 0.2 0.1 0.2 0.9 100.0 518 0.0 Residence Urban 12.9 38.5 17.0 22.4 4.6 4.3 0.3 100.0 5,417 5.8 Rural 31.6 48.9 10.2 7.6 0.7 0.5 0.5 100.0 9,237 2.0 Province Central 21.6 48.5 12.5 13.0 2.1 2.4 0.1 100.0 1,074 3.7 Copperbelt 15.4 38.2 18.5 20.5 3.4 3.6 0.4 100.0 2,824 5.5 Eastern 36.4 45.5 7.0 7.7 1.3 1.3 0.6 100.0 1,940 1.3 Luapula 28.5 55.3 9.1 6.0 0.6 0.4 0.0 100.0 1,147 2.0 Lusaka 15.1 40.4 17.1 18.1 4.3 4.4 0.6 100.0 1,973 5.2 Northern 28.5 48.4 9.9 10.8 1.3 0.5 0.6 100.0 2,033 2.6 North-Western 32.7 47.1 7.6 10.3 1.1 1.0 0.2 100.0 726 1.9 Southern 22.2 46.8 15.9 12.1 1.5 1.0 0.5 100.0 1,621 3.4 Western 33.5 45.7 9.0 9.5 1.2 0.4 0.8 100.0 1,317 1.8 Total 24.7 45.0 12.7 13.0 2.1 1.9 0.5 100.0 14,655 3.2 1 Completed 7th year at the primary level 2 Completed 12th year at the secondary level Characteristics of Households and Respondents | 17 2.4.2 School Attendance Rates The 2001-2002 ZDHS collected information on school attendance among the population 5-24 years that allows calculation of net attendance ratios (NARs) and gross attendance ratios (GARs). The NAR for primary school is the percentage of the primary-school-age (7-13 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (14-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR for primary school is the total number of primary school students, of any age, expressed as the percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students up to an age limit of 24 years, expressed as the percentage of the official secondary-school- age population. The GAR is almost always higher than the NAR because the GAR includes participation by those who are older or younger than the official range for that level. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. Table 2.5 presents the NARs and GARs by urban-rural residence and province, according to sex for primary and secondary school. Results show that the overall NAR for primary schools is 78 percent in urban areas compared with 61 percent in rural areas. The GAR is also higher in urban areas than in rural areas (98 percent versus 87 percent). Figure 2.4 shows that the NAR for males and females is 67 percent while the GAR for males is 97 percent and that of females is 85 percent. At secondary school, the average NAR is 22 percent. The NAR is higher for females than males at secondary school (23 percent for females with 21 percent for males). Figure 2.3 Percent Distribution of De Facto Household Population with No Education by Age and Sex 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Age group 0 20 40 60 80 Percent Male Female ZDHS 2001-2002 18 | Characteristics of Households and Respondents Table 2.5 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population by level of schooling and sex, according to background characteristics, Zambia 2001-2002 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 77.5 78.3 77.9 101.3 95.2 98.2 0.94 Rural 61.6 60.3 60.9 95.2 78.9 87.2 0.83 Province Central 71.9 71.1 71.5 108.3 95.2 102.0 0.88 Copperbelt 78.9 73.0 75.9 102.4 87.2 94.6 0.85 Eastern 53.0 55.7 54.3 77.1 72.8 75.0 0.94 Luapula 56.9 55.7 56.3 85.6 72.0 79.1 0.84 Lusaka 74.3 76.0 75.2 100.7 95.2 97.9 0.94 Northern 63.0 60.8 61.9 102.5 78.0 90.2 0.76 North-Western 75.3 77.5 76.4 117.3 106.3 111.8 0.91 Southern 67.8 72.1 70.0 100.8 88.3 94.4 0.88 Western 60.2 55.8 58.0 90.0 75.6 83.0 0.84 Total 67.2 66.9 67.1 97.4 84.9 91.2 0.87 SECONDARY SCHOOL Residence Urban 36.0 38.1 37.1 61.4 51.8 56.3 0.84 Rural 13.0 12.6 12.8 23.1 17.3 20.4 0.74 Province Central 17.9 19.3 18.6 37.8 26.2 31.7 0.69 Copperbelt 33.8 39.1 36.5 56.1 50.6 53.3 0.90 Eastern 14.9 15.1 15.0 27.5 25.2 26.4 0.92 Luapula 12.1 6.4 9.2 19.5 8.9 14.1 0.46 Lusaka 28.9 25.1 27.0 52.6 35.7 43.8 0.68 Northern 16.4 21.0 18.5 30.3 27.6 29.1 0.91 North-Western 27.6 23.9 25.9 46.5 33.3 40.4 0.72 Southern 14.5 19.4 16.7 23.8 26.2 24.9 1.10 Western 11.5 13.0 12.2 15.3 17.5 16.4 1.14 Total 20.6 22.5 21.5 35.8 30.7 33.3 0.86 1 The NAR for primary school is the percentage of the primary-school age (7-13 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary- school age (14-18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school- age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index is the ratio of the GAR for females to the GAR for males. Characteristics of Households and Respondents | 19 Provincial differentials show low net attendance ratios in Eastern, Luapula, and Western provinces. The NAR is higher for females than males in Eastern, Lusaka, North-Western, and Southern provinces. At secondary school level, the NAR is higher for females than males in all provinces except Luapula, Lusaka, and North-Western provinces. The Gender Parity Index represents the ratio of the GAR for females to the GAR for males. It is presented for both the primary and secondary level and offers a summary measure of the extent to which there are gender differences in attendance rates. A GPI less than 1 indicates that a smaller proportion of females than males attend school. Overall, the Gender Parity Index is less than 1 for both primary school (0.9) and secondary school (0.9). For primary school, the index is 0.9 in urban areas and 0.8 in rural areas, compared with 0.8 and 0.7, respectively, at the secondary level. 2.4.3 Grade Repetition and Dropout Rates By asking about the grade or standard that primary school age children were attending during the previous school year, it is possible to calculate dropout rates and repetition rates (see Table 2.6). Repetition and dropout rates are important in assessing how students are progressing through the primary system. The repetition rate represents the percentage of children reported to have been in a given grade during the prior school year who are in the same grade during the current school year, i.e., the percentage of students who are repeating the grade. The dropout rate represents the percentage of children reported to have been in school during the prior school year who are not currently attending school. Overall, repetition and dropping out of school is high in Zambia at grade 7. Table 2.6 shows that repetition is highest at grade 7 and grade 1 (7 percent). Repetition rate at grade seven is higher in rural areas (11 percent) than in urban areas (4 percent). The highest dropout rate is 17 percent for grade 7, compared with 5 percent for grade 6 and 4 percent for grade 4 and grade 5. This is understandable, since grade 7 marks the end of primary school. Figure 2.4 Net and Gross Attendance Ratios by Sex 67 21 97 36 67 23 84 31 67 22 91 33 Primary School Secondary School Primary School Secondary School 0 20 40 60 80 100 Percent Male Female Total ZDHS 2001-2002 Net Attendance Ratio Gross Attendance Ratio 20 | Characteristics of Households and Respondents Provincial differentials indicate that Luapula province has the highest repetition rate for all primary school grades (1-7) followed by Northern province. The high repetition rate in Luapula province may explain the low dropout rate in this province. Table 2.6 Grade repetition and dropout rates Repetition and dropout rates for the de jure household population age 5-24 years by school grade, according to background characteristics, Zambia 2001-2002 School grade Background characteristic 1 2 3 4 5 6 7 REPETITION RATE1 Sex Male 6.1 6.1 5.7 5.1 2.7 3.6 9.0 Female 7.8 6.5 2.6 2.5 3.5 5.0 4.7 Residence Urban 1.8 3.4 2.2 0.9 1.2 1.0 3.6 Rural 9.6 8.0 5.6 5.8 4.7 7.2 10.5 Province Central 4.3 5.1 2.9 3.6 5.7 3.8 12.9 Copperbelt 1.4 1.9 0.8 0.8 0.8 0.9 2.8 Eastern 8.1 7.7 4.1 0.0 0.0 (5.6) (4.2) Luapula 27.7 18.9 17.6 (24.5) (10.8) (23.5) * Lusaka 2.0 4.5 0.8 1.0 0.0 1.1 5.5 Northern 14.8 13.9 11.1 11.8 10.9 13.3 12.3 North-Western 5.6 8.1 7.8 2.4 4.5 3.1 4.2 Southern 0.7 1.7 0.0 0.0 2.0 0.0 5.5 Western 3.5 1.2 2.4 0.0 (0.0) (0.0) * Total 6.9 6.3 4.3 3.9 3.1 4.2 6.9 DROPOUT RATE2 Sex Male 1.2 3.7 2.1 3.2 4.3 3.9 18.7 Female 3.2 2.4 3.5 4.9 2.9 5.8 15.1 Residence Urban 1.5 1.9 1.8 3.9 2.0 4.2 13.4 Rural 2.4 3.8 3.3 4.1 5.1 5.2 20.7 Province Central 0.6 0.0 0.0 3.6 4.1 1.9 12.9 Copperbelt 6.1 7.6 4.9 7.3 5.8 6.8 19.8 Eastern 2.0 5.6 4.1 6.0 2.6 (5.6) (12.5) Luapula 0.0 0.0 0.0 (0.0) (0.0) (0.0) * Lusaka 2.0 1.5 2.5 3.0 0.9 3.4 17.8 Northern 1.3 1.1 1.9 2.1 1.7 4.8 15.1 North-Western 0.5 0.0 1.2 0.8 0.0 1.0 1.4 Southern 1.4 2.6 4.7 6.1 9.1 7.7 (29.1) Western 0.9 1.2 1.2 0.0 (2.2) (2.4) * Total 2.1 3.1 2.8 4.0 3.7 4.7 17.0 Note: Figures in parentheses are based on 25-49 unweighted cases; an asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. Characteristics of Households and Respondents | 21 2.5 HOUSING CHARACTERISTICS AND HOUSEHOLD POSSESSIONS The physical characteristics of households are important in assessing the general socioeconomic status of the population. ZDHS respondents were asked about their household environment, including access to electricity, sources of drinking water, time to water sources, type of toilet facilities and floor materials, and possession of various durable goods. This information is summarised in Tables 2.7 and 2.8. The proportion of households with electricity is 45 percent in urban areas and 3 percent in rural areas with a combined proportion of 17 percent nationwide (Figure 2.5). The data show that there has been no improvement in electrification during the 1990s, with less than one in five households having electricity. There has been some increase in urban areas, from 39 to 45 percent of households between 1992 and 2001-2002. Source of Drinking Water Water quality has a strong impact on the health of household members, especially young children. A household’s source of drinking water is important because potentially fatal diseases, including typhoid, cholera, and dysentery, are prevalent in unprotected sources. Sources of water expected to be relatively free of these diseases are piped water and water drawn from protected wells and deep boreholes. Other sources, like unprotected wells and surface water (rivers, streams, ponds, and lakes), are more likely to carry disease- causing agents. The most common sources of drinking water for Zambian households are open wells, protected wells, public taps, rivers and streams. In urban areas most drinking water comes from piped sources. In rural areas most of the water comes from public wells, rivers, and streams. This pattern is similar to findings from the 1992 and 1996 ZDHS surveys. On average, households in urban areas take less than 2 minutes to reach their source of water, compared with 10 minutes for rural households. Seventy-eight percent of households in urban areas take less than 15 minutes to reach their source of drinking water compared with 50 percent of households in rural areas. Table 2.7 Household characteristics Percent distribution of households by household characteristics, according to residence, Zambia 2001–2002 Residence Household characteristic Urban Rural Total Electricity Yes 45.1 2.9 17.4 No 54.9 97.0 82.6 Total 100.0 100.0 100.0 Source of drinking water Piped into dwelling 19.3 1.0 7.3 Piped into yard/plot 22.8 1.3 8.6 Communal tap 38.2 4.2 15.8 Piped to neighbour 1.3 0.0 0.5 Open well in yard/plot 2.9 3.3 3.1 Open public well 4.8 36.2 25.5 Open well at neighbour 0.5 0.2 0.3 Protected well in yard/plot 2.9 2.2 2.5 Protected public well 5.2 22.5 16.6 Spring 0.0 2.1 1.4 River/Stream 0.9 23.2 15.6 Pond/Lake/Dam 0.7 3.5 2.6 Rainwater 0.0 0.1 0.1 Tanker truck 0.1 0.0 0.0 Bottled water 0.1 0.0 0.0 Other 0.3 0.1 0.1 Total 100.0 100.0 100.0 Time to water source Percentage <15 minutes 78.4 49.9 59.7 Median time to source (minutes) 1.3 9.9 9.4 Sanitation facilities Flush toilet 42.3 1.9 15.7 Traditional pit latrine 49.9 54.6 53.0 Ventilated improved pit latrine 2.5 1.0 1.5 No facility/Bush/Field 4.9 42.5 29.6 Other 0.1 0.0 0.0 Missing 0.3 0.0 0.1 Total 100.0 100.0 100.0 Flooring material Earth/Mud/Dung 18.0 86.4 63.0 Wood planks 0.1 0.1 0.1 Parquet/Wood tiles 0.3 0.0 0.1 Brick 0.1 0.1 0.1 Terrazzo/Ceramic tiles 1.3 0.1 0.5 Concrete/Cement 71.2 12.8 32.8 Carpet 5.7 0.3 2.2 Other 3.3 0.1 1.2 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number of households 2,437 4,689 7,126 22 | Characteristics of Households and Respondents Sanitation Facilities Most households in Zambia (53 percent) use traditional pit latrines: 50 percent in urban areas and 55 percent in rural areas. Flush toilets are mainly found in urban areas and are used by 42 percent of households compared with 2 percent in rural areas. Overall, one in three households in Zambia have no toilet facilities. This problem is more common in rural areas (43 percent) than in urban areas (5 percent). Type of Flooring The type of material used for flooring is a proxy indicator of the economic level of the household as well as an indicator of potential exposure to disease-causing agents. Households in rural areas have poorer quality floors than those in urban areas as can be seen from Table 2.7. Results show that more households in rural areas have floors made of earth/mud/dung (86 percent) than in urban areas (18 percent), while more households in urban areas have floors made of concrete or cement (71 percent) than in rural areas (13 percent). 2.6 HOUSEHOLD DURABLE GOODS Respondents were asked about ownership of particular household goods such as radios and television sets (to assess access to media), refrigerators (to assess food storage), telephones or cellular phones (to assess other means of communication), and modes of transport (bicycle, motorcycle, car). Ownership of these items is also indicative of the household’s social and economic well-being. Results from Table 2.8 show that 42 percent of households own a radio, (61 percent in urban areas and 31 percent in rural areas) and 19 percent own a television (48 percent in urban areas and 4 percent in rural areas). Four percent own a telephone or cell phone (10 percent in urban areas and less than 1 percent in rural areas). Ten percent of households own a refrigerator. Televisions, refrigerators, and telephones or cell phones are mostly restricted to urban areas, presumably due to lack of electricity and/or financial resources in rural areas. Figure 2.5 Trends in Percentage of Households with Electricity by Residence, Zambia 1992-2002 39 3 19 44 2 17 45 3 17 Urban Rural Total 0 10 20 30 40 50 Percent 1992 1996 2001-2002 Residence Characteristics of Households and Respondents | 23 Thirty percent of households own a bicycle (20 per- cent in urban areas and 34 percent in rural areas), while only 3 percent own a car and less than one percent own a motor- cycle. Among the household possessions listed above, the bicycle is the only possession that is more common in rural areas than in urban areas. It is striking that more than four in ten households possess none of the items asked about. Figure 2.6 shows that possession of television and bicycle has been increasing over time, while possession of a radio and motorcycle declined between 1996 and 2001 and owning a car/truck remained at the same level between 1996 and 2001. 2.7 ACCESS TO HEALTH CARE The 2001-2002 ZDHS included two questions to ascertain difficulties in accessing medical care due to financial constraints. As part of the Household Questionnaire, respondents were asked if, in the last 12 months, any member had been denied care from a health facility because they could not pay and whether any member was unable to obtain prescribed medicine because they could not pay. Table 2.9 shows the percentage of households answering these questions affirmatively, by selected background characteristics. According to this table, 21 percent of households reported that a household member was denied care from a health facility because they were unable to pay (22 percent in urban areas and 20 percent in rural areas). Table 2.8 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Zambia 2001–2002 Residence Durable consumer goods Urban Rural Total Radio 60.8 31.4 41.5 Television 48.3 3.8 19.0 Telephone or cell phone 10.2 0.4 3.8 Refrigerator 26.0 1.3 9.7 Bicycle 20.4 34.2 29.5 Motorcycle 0.4 0.3 0.4 Car/truck 6.5 0.8 2.7 None of the above 28.2 52.0 43.9 Number of households 2,437 4,689 7,126 Figure 2.6 Trends in Percentage of Households Owning Specific Durable Goods, Zambia 1992-2002 39 8 7 19 1 4 44 17 7 25 1 3 42 19 10 30 0 3 Radio Television Refrigerator Bicycle Motorcycle Car/Truck 0 10 20 30 40 50 Percent 1992 1996 2001-2002 Durable Goods 24 | Characteristics of Households and Respondents Table 2.9 Inability to pay for medical care Percentage of households in which members were denied medical care or did not get prescribed medicine due to inability to pay, by background characteristics, Zambia 2001- 2002 ––––––––––––––––––––––––––––––––––––––––––––––––– Denied Number care from Could not of Background a health afford house- characteristic facility medicine holds ––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 22.1 32.5 2,437 Rural 20.0 17.2 4,689 Province Central 15.2 23.0 490 Copperbelt 23.5 27.7 1,221 Eastern 22.9 19.0 999 Luapula 17.8 19.8 652 Lusaka 23.2 39.8 976 Northern 15.6 12.8 1,028 North-Western 17.6 11.2 371 Southern 19.2 17.9 734 Western 26.7 21.0 656 Total 20.7 22.5 7,126 Western province (27 percent), Copperbelt (24 percent), and Lusaka province (23 percent) have the highest percentage of households where members were denied care from a health facility because they could not pay. Central province (15 percent) has the lowest proportion of such households. In 23 percent of all households, members could not obtain medicine because they could not afford to pay (33 percent in urban areas and 17 percent in rural areas). The highest proportion of households where members could not afford to pay for medicine is found in Lusaka (40 percent), followed by Copperbelt (28 percent) and Central province (23 percent). The lowest proportion is found in North-Western province (11 percent). CHARACTERISTICS OF RESPONDENTS AND WOMEN’S CHARACTERISTICS 3 Sheila S. Mudenda The objective of this chapter is to provide a demographic and socioeconomic profile of respon- dents in the 2001-2002 Zambia DHS. Information on the basic characteristics of women and men inter- viewed in the survey is essential for the interpretation of findings presented later in the report and can provide an approximate indication of the representativeness of the survey. The chapter begins by describing basic background characteristics, including age, marital status, educational level, and residential characteristics. This is followed by more detailed information on educa- tion, literacy, and exposure to mass media. Next, data on the employment and earnings of women, deci- sion making in the household and attitudes on women's position in relation to others in the household are presented. Last, data on tobacco use are provided as a lifestyle measure. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS The percent distributions of women age 15-49 and of men age 15-59 interviewed in the 2001- 2002 ZDHS by key background characteristics, including age, marital status, urban-rural residence, place of residence, and educational level, are presented in Table 3.1. A high proportion of the respondents are youths (i.e., 15-24 years). The proportion in each age group tends to decrease with increasing age. Table 3.1 shows that most of the respondents were married, although the proportion of married women is higher than that of men by almost 3 percentage points. Not surprisingly, about a quarter of fe- male respondents had never been married compared with over a third (36 percent) of male respondents. Data in chapter 6 of this report affirm that men marry later (23 years) than women (18 years). Table 3.1 also shows that the proportion of female respondents who are divorced/separated at the time of the survey is higher than for male respondents (9 and 4 percent, respectively), presumably because men are more likely to remarry than women. The majority (60 percent) of both women and men interviewed live in rural areas. The largest share of both female and male respondents is from the Copperbelt province (20 and 21 percent, respec- tively), with the smallest share recorded in North-Western province (5 percent and 4 percent, respec- tively). Table 3.1 further shows that there are more educated men than women. For both sexes, the major- ity of those who have been to school have only completed primary school (58 percent of women and 51 percent of men). Only 5 percent of men report no education versus 12 percent of women. Forty-four percent of men have had at least some secondary education versus only 30 percent of women. Table 3.1 also shows that the majority of women (75 percent) and men (72 percent) are Protes- tant, followed by Catholic (23 percent and 24 percent, respectively). The most common ethnic group among both women (36 percent) and men (35 percent) is Bemba, followed by Nyanja (17 percent each). 3.2 EDUCATIONAL ATTAINMENT Educational attainment is generally one of the key indicators of the status of women. As stated in an International Labour Organisation (ILO) briefing kit, large educational differentials between men and women tend to sustain a perpetual gender inequality within the family and in society at large. Data on Characteristics of Respondents │ 25 Table 3.1 Background characteristics of respondents 26 │ Charac Percent distribution of women 15-49 and men 15-59 by background characteristics, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men ––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––– Background Weighted Weighted Unweighted Weighted Weighted Unweighted characteristic percent number number percent number number –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 23.7 1,811 1,806 21.4 459 475 20-24 21.7 1,664 1,648 16.1 346 346 25-29 18.0 1,376 1,361 16.8 361 353 30-34 12.7 972 972 13.1 281 277 35-39 10.0 766 778 11.2 241 244 40-44 7.9 601 606 8.1 174 170 45-49 6.1 467 487 5.3 113 113 50-54 na na na 4.6 100 94 55-59 na na na 3.3 71 73 Marital status Never married 24.8 1,897 1,851 36.4 782 787 Married 60.5 4,636 4,675 57.8 1,240 1,239 Living together 0.8 58 56 0.4 8 10 Divorced/separated 9.3 709 724 4.4 94 89 Widowed 4.7 358 352 1.0 21 20 Residence Urban 40.1 3,073 2,551 39.7 851 689 Rural 59.9 4,585 5,107 60.3 1,294 1,456 Province Central 7.3 562 891 7.7 165 276 Copperbelt 20.2 1,544 939 20.8 447 266 Eastern 12.1 926 894 12.5 268 256 Luapula 8.1 622 626 7.7 166 181 Lusaka 14.8 1,132 896 14.6 314 239 Northern 13.6 1,040 1,171 13.6 292 327 North-Western 4.6 354 881 4.3 93 238 Southern 10.6 814 707 10.8 232 205 Western 8.7 663 653 7.9 169 157 Education No education 12.1 925 1,002 5.0 108 116 Primary 58.0 4,439 4,534 51.3 1,100 1,161 Secondary 26.9 2,061 1,916 37.7 808 754 Higher 3.1 234 206 6.0 129 114 Religion Catholic 22.9 1,755 1,735 24.3 522 510 Protestant 75.1 5,750 5,748 72.0 1,545 1,551 Muslim 0.3 20 17 0.5 10 8 Other 1.5 116 143 2.9 63 70 Ethnic group Bemba 36.0 2,754 2,553 35.2 755 709 Tonga 14.9 1,138 1,088 15.0 321 316 North-Western 10.7 820 1,243 11.2 240 352 Baroste 7.8 601 587 7.7 166 154 Nyanja 16.6 1,268 1,163 16.5 354 325 Mambwe 6.0 461 446 6.3 136 127 Tumbuka 5.4 411 361 5.5 118 106 Other 2.7 205 216 2.5 54 55 Total 100 7,658 7,658 100.0 2,145 2,145 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Education categories refer to the highest level of education attended, whether or not that level was com- pleted. Readers should note that the table includes information on both the weighted and unweighted numbers. Weighting was necessary because the sample was not allocated by province according to the actual distribution of the population; instead the sample was allocated in such a fashion as to provide a sufficient number of respondents for each province to allow provincial estimates to be calculated for most survey variables. It also is important to note that some subgroups shown include comparatively small numbers of respondents. In subsequent tabulations, figures will be not be shown for a subgroup if the unweighted number of cases for the subgroup falls below 25. na = Not applicable teristics of Respondents enrolment ratios suggest that education attainment is largely conditioned by a society’s level of socio- economic development and that larger gender gaps in schooling are observed in regions with lower over- all educational levels (ILO, 1995). Table 3.2 provides an overview of the relationship between the respondents’ level of education and other background characteristics. The data show that younger respondents, especially women, are more likely to have attended school than the older ones (92 and 89 percent of women age 15-19 and 20-24, respectively, compared with 78 percent of those age 45-49). Table 3.2 shows that in contrast to women, higher proportions of male respondents complete sec- ondary school, particularly at ages 20-24 and 25-29 years (22 and 23 percent of males compared with 11 and 10 percent of women, respectively). High dropouts of girls at primary and secondary levels may explain some of the differences in educational attainment between women and men. Measures to enhance retention of girls in school have been considered by the Zambian government. One such measure allows girls who drop out of school due to pregnancy to continue with their education after they have delivered. Table 3.2 also shows that education attainment varies greatly with type of residence. Given the different socio-economic situations, respondents in rural areas have substantially lower educational at- tainment compared with their urban counterparts. For example, half of women in urban areas have at- tended or completed secondary school, compared with only 16 percent of rural women. At the provincial level, rural provinces1 have the highest proportion of respondents with no schooling, with Eastern province leading for both females and males (23 and 13 percent, respectively). The gender gap (the difference in percentage points between women and men) in the proportion reporting no schooling is 10 percent in Eastern province versus only 1 percent and 4 percent in Copperbelt and Lu- saka provinces. 1 This refers to all provinces of Zambia with the exception of Copperbelt and Lusaka. Characteristics of Respondents │ 27 Table 3.2 Educational attainment by background characteristics Percent distribution of women and men by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Zambia 2001-2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended or completed ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Some Median Background No Some Completed secon- Completed years of characteristic education primary primary1 dary secondary2 Higher Total Number schooling –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 8.0 41.6 16.6 31.4 2.4 0.0 100.0 1,811 6.0 20-24 11.5 35.2 18.2 24.1 7.9 3.2 100.0 1,664 6.2 25-29 10.5 36.6 19.9 23.2 4.1 5.6 100.0 1,376 6.1 30-34 11.4 37.3 22.1 22.1 2.9 4.2 100.0 972 6.1 35-39 15.9 37.9 23.6 18.1 1.8 2.6 100.0 766 5.5 40-44 17.6 36.9 26.0 13.6 2.0 3.9 100.0 601 5.6 45-49 22.5 45.5 17.0 10.0 0.9 4.1 100.0 467 3.7 Residence Urban 3.7 21.9 24.0 36.6 7.5 6.3 100.0 3,073 7.0 Rural 17.7 49.2 16.8 14.1 1.3 0.9 100.0 4,585 4.2 Province Central 8.0 42.4 20.2 22.0 3.6 3.8 100.0 562 6 Copperbelt 3.3 23.2 26.3 35.7 6.0 5.5 100.0 1,544 6.8 Eastern 22.7 45.7 11.2 15.4 2.6 2.3 100.0 926 3.7 Luapula 14.7 58.6 14.2 10.7 1.1 0.6 100.0 622 3.7 Lusaka 7.6 24.9 25.8 28.6 6.7 6.5 100.0 1,132 6.7 Northern 14.4 46.9 15.8 19.6 2.4 0.9 100.0 1,040 5.0 North-Western 17.5 45.9 13.7 19.4 1.8 1.7 100.0 354 4.6 Southern 12.3 38.5 23.1 22.2 3.0 1.0 100.0 814 6.0 Western 19.4 45.2 15.8 16.8 2.1 0.6 100.0 663 4.0 Total 12.1 38.3 19.7 23.1 3.8 3.1 100.0 7,658 6.0 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 4.0 45.5 18.4 28.0 4.0 0.0 100.0 459 6.0 20-24 3.9 26.9 16.3 30.8 19.5 2.5 100.0 346 7.5 25-29 6.5 25.9 20.8 23.7 16.2 6.9 100.0 361 6.8 30-34 6.0 24.0 22.1 28.2 8.8 11.0 100.0 281 6.9 35-39 6.7 19.5 25.3 30.1 8.3 10.1 100.0 241 6.9 40-44 2.8 19.8 39.5 24.1 6.1 7.8 100.0 174 6.7 45-49 3.1 18.8 25.5 38.8 3.5 10.3 100.0 113 7.6 50-54 6.9 29.5 25.5 21.3 6.0 10.7 100.0 100 6.5 55-59 5.9 50.6 10.5 20.9 5.8 6.3 100.0 71 5.3 Residence Urban 1.6 12.4 19.8 36.7 18.6 10.9 100.0 851 8.6 Rural 7.3 40.6 23.3 21.8 4.3 2.8 100.0 1,294 6.1 Province Central 5.1 35.1 19.2 27.9 6.9 5.8 100.0 165 6.5 Copperbelt 1.9 8.3 21.8 39.1 16.9 12.0 100.0 447 8.7 Eastern 12.5 34.0 21.1 21.9 5.1 5.5 100.0 268 6.2 Luapula 4.4 45.9 26.5 18.8 1.7 2.8 100.0 166 6.0 Lusaka 3.8 17.2 20.5 31.0 19.2 8.4 100.0 314 8.4 Northern 3.1 38.8 25.1 25.1 5.2 2.8 100.0 292 6.3 North-Western 7.1 42.4 13.0 28.6 4.2 4.6 100.0 93 6.0 Southern 2.9 34.6 26.8 25.4 7.3 2.9 100.0 232 6.5 Western 9.6 48.4 16.6 16.6 8.3 0.6 100.0 169 4.9 Total 5.0 29.4 21.9 27.7 10.0 6.0 100.0 2,145 6.7 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed 7th grade at the primary level 2 Completed 12th grade at the secondary level 28 │ Characteristics of Respondents 3.3 LITERACY The ability to read is an important personal asset allowing women and men increased opportuni- ties in life. Knowing the distribution of the literate population can help programme planners, especially for health and family planning programmes, know how to best reach women and men with their mes- sages. In the 2001-2002 ZDHS, literacy was established by a respondent’s ability to read all or part of a simple sentence in any of the seven major language groups of Zambia.2 The test on literacy was only ap- plied to respondents who had less than secondary education. Table 3.3 shows that literacy levels are higher for men than women throughout all age groups. Over one-third (38 percent) of women and close to a fifth (18 percent) of men are illiterate. As expected, urban respondents have higher literacy levels (79 percent for women and 91 percent for men) than those in rural areas (48 percent for women and 76 percent for men). Figure 3.1 indicates the extent to which those who are close to school age (15-24) are literate. It shows that literacy levels for youth are higher for males than for females. While almost six in ten women in both age groups are literate, the literacy level for men is higher for both age groups (71 percent for men age 15-19 and 83 percent for men age 20-24). 2 The major language groups were Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja, and Tonga. Characteristics of Respondents │ 29 Table 3.3 Literacy Percent distribution of women and men by level of schooling attended and by level of literacy, and percent literate, accord- ing to background characteristics, Zambia 2001-2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No schooling or primary school –––––––––––––––––––––––––––––––––––––––––––– Secon- No card dary Can read Can read Cannot with Don't Background school whole part of read required know/ Percent characteristic or higher sentence sentence at all language missing Total Number literate1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 33.8 14.6 10.3 40.1 0.8 0.4 100.0 1,811 58.7 20-24 35.1 16.1 8.0 39.1 1.3 0.4 100.0 1,664 59.2 25-29 33.0 20.7 9.5 35.7 1.1 0.0 100.0 1,376 63.2 30-34 29.2 24.0 10.3 35.2 1.1 0.1 100.0 972 63.6 35-39 22.5 27.5 9.4 39.2 1.3 0.0 100.0 766 59.5 40-44 19.5 33.7 9.7 35.8 0.5 0.7 100.0 601 63.0 45-49 14.9 32.8 10.1 41.1 0.8 0.2 100.0 467 57.8 Residence Urban 50.4 19.3 9.2 19.4 1.4 0.3 100.0 3,073 78.8 Rural 16.3 22.4 9.7 50.7 0.8 0.2 100.0 4,585 48.4 Province Central 29.4 27.3 8.0 34.9 0.4 0.0 100.0 562 64.6 Copperbelt 47.2 22.7 8.8 19.3 1.8 0.2 100.0 1,544 78.7 Eastern 20.4 16.0 11.4 52.0 0.2 0.0 100.0 926 47.8 Luapula 12.5 23.5 5.3 58.6 0.0 0.2 100.0 622 41.2 Lusaka 41.7 17.9 10.7 26.6 2.6 0.6 100.0 1,132 70.3 Northern 22.9 17.9 12.4 46.5 0.1 0.3 100.0 1,040 53.2 North-Western 22.9 18.3 12.1 46.2 0.1 0.3 100.0 354 53.3 Southern 26.2 24.9 10.5 36.1 1.7 0.7 100.0 814 61.5 Western 19.6 24.7 4.6 51.0 0.2 0.0 100.0 663 48.9 Total 30.0 21.1 9.5 38.1 1.0 0.3 100.0 7,658 60.6 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 32.0 22.1 16.6 28.7 0.4 0.2 100.0 459 70.7 20-24 52.9 18.7 11.4 17.0 0.0 0.0 100.0 346 83.0 25-29 46.7 19.6 13.5 19.9 0.0 0.3 100.0 361 79.8 30-34 47.9 27.0 10.9 14.2 0.0 0.0 100.0 281 85.8 35-39 48.5 28.7 6.6 15.2 0.0 1.0 100.0 241 83.8 40-44 37.9 39.8 12.3 9.4 0.7 0.0 100.0 174 89.9 45-49 52.6 32.2 6.7 8.6 0.0 0.0 100.0 113 91.4 50-54 38.1 29.7 18.7 13.5 0.0 0.0 100.0 100 86.5 55-59 33.0 44.1 9.8 13.0 0.0 0.0 100.0 71 87.0 Residence Urban 66.2 15.5 8.7 9.4 0.0 0.2 100.0 851 90.5 Rural 28.8 32.2 14.7 23.8 0.2 0.2 100.0 1,294 75.7 Province Central 40.6 25.4 18.5 15.6 0.0 0.0 100.0 165 84.4 Copperbelt 68.0 13.9 9.4 8.3 0.4 0.0 100.0 447 91.4 Eastern 32.4 23.0 17.2 27.3 0.0 0.0 100.0 268 72.7 Luapula 23.2 44.2 8.3 24.3 0.0 0.0 100.0 166 75.7 Lusaka 58.6 16.3 12.1 12.6 0.0 0.4 100.0 314 87.0 Northern 33.0 32.7 15.6 18.3 0.0 0.3 100.0 292 81.3 North-Western 37.4 31.9 10.9 19.7 0.0 0.0 100.0 93 80.3 Southern 35.6 33.2 10.7 19.5 0.5 0.5 100.0 232 79.5 Western 25.5 33.1 8.3 32.5 0.0 0.6 100.0 169 66.9 Total 43.7 25.6 12.4 18.1 0.1 0.2 100.0 2,145 81.6 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Refers to women/men who attended secondary school and women/men who can read a whole sentence or part of a sen- tence 30 │ Characteristics of Respondents Figure 3.1 Youth Literacy 59 59 71 83 15-19 20-24 0 20 40 60 80 100 Percentage literate Women Men ZDHS 2001-2002 Age group 3.4 ACCESS TO MASS MEDIA The 2001-2002 ZDHS collected information on the exposure of respondents to the various com- mon print and electronic media. Respondents were asked how often they read a newspaper, listened to the radio, or watched television in a week. This information is useful in determining the media channels to use in disseminating family planning and health services to target audiences. Table 3.4 shows distinct patterns of exposure to different forms of mass media. The highest pro- portion of respondents (44 percent of women and 65 percent of men) listen to the radio at least once a week, followed by one in four women and one in three men who watch television once a week. It is ap- parent that print media is least utilised by both women and men. This is particularly true for women (11 percent) compared with men (24 percent). Comparison between the 1996 ZDHS and 2001-2002 ZDHS reveals a general decline in media use for both women and men. The decline is more pronounced for the print media, which could be ex- plained by the declining economic situation in the country. The Living Conditions Monitoring Survey (LCMS) data for 1998 indicate that poverty levels have remained high (with 73 percent of the population being poor), indicating a possible squeeze on the respondents’ purchasing power. Chances are that with less money, a larger proportion of expenditures are directed towards food-related purchases. Table 3.4 indicates that more than half of women have no access to any type of media, compared with about one-third of men. Women and men in rural areas have substantially lower access to all forms of media (less than 3 percent for both) than their urban counterparts (16 percent and 39 percent, respec- tively). It is apparent from Table 3.4 that education has a major impact on access to any of the specified media. For instance, weekly reading of a newspaper by women increases from a negligible proportion (under 1 percent) among those with no education to 65 percent among women with higher education. A similar pattern prevails for men, although, with generally higher proportions than women at all education levels. Characteristics of Respondents │ 31 32 │ Characteristics of Res Table 3.4 Exposure to mass media Percentage of women and men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure ––––––––––––––––––––––––––––––––– Reads a Watches Listens to newspaper television the radio Number at least at least at least All No of Background once once once three mass women/ characteristic a week a week a week media media men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 10.7 28.2 44.2 7.2 49.5 1,811 20-24 11.3 25.9 45.2 7.3 49.3 1,664 25-29 12.7 25.7 44.3 8.0 49.5 1,376 30-34 10.8 27.2 47.0 8.4 48.8 972 35-39 8.9 21.0 41.3 5.4 54.9 766 40-44 8.8 21.0 40.2 6.5 55.7 601 45-49 6.4 13.5 32.6 3.8 63.8 467 Residence Urban 21.1 55.0 65.1 16.2 24.8 3,073 Rural 3.6 4.8 29.0 0.9 69.0 4,585 Province Central 8.9 22.4 44.1 5.6 51.4 562 Copperbelt 16.5 52.3 62.1 11.8 26.4 1,544 Eastern 5.5 6.5 31.2 2.5 67.0 926 Luapula 1.6 1.8 22.8 0.0 75.7 622 Lusaka 26.6 60.4 70.5 21.8 21.2 1,132 Northern 6.1 9.2 33.3 3.2 64.2 1,040 North-Western 3.1 5.4 34.8 0.6 62.9 354 Southern 5.7 9.2 35.5 1.8 60.7 814 Western 4.1 4.7 20.2 1.1 77.2 663 Education No education 0.1 3.8 19.3 0.0 80.1 925 Primary 3.6 16.1 36.3 1.8 59.5 4,439 Secondary 24.3 47.6 65.2 16.6 25.8 2,061 Higher 65.3 75.6 83.8 50.2 4.3 234 Total 10.6 24.9 43.5 7.1 51.3 7,658 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 14.7 33.7 56.0 11.3 39.0 459 20-24 30.3 40.6 73.2 22.3 22.5 346 25-29 26.6 29.2 67.2 17.6 27.2 361 30-34 29.8 38.3 69.5 24.9 27.8 281 35-39 25.8 31.1 65.7 17.9 30.4 241 40-44 21.1 31.2 61.9 14.8 34.5 174 45-49 22.7 35.5 60.1 15.8 33.0 113 50-54 20.4 31.0 66.2 13.1 28.9 100 55-59 7.9 18.1 52.7 4.2 43.1 71 Residence Urban 49.2 69.4 82.2 38.5 9.6 851 Rural 6.5 10.1 53.0 2.9 44.9 1,294 Province Central 23.2 32.2 75.4 13.0 20.3 165 Copperbelt 47.7 70.3 84.2 38.3 9.0 447 Eastern 5.5 7.4 50.0 1.2 49.2 268 Luapula 3.3 4.4 60.8 0.6 38.7 166 Lusaka 52.7 71.1 81.2 41.8 7.9 314 Northern 5.5 10.4 51.4 3.1 46.2 292 North-Western 8.4 8.8 53.8 2.5 44.1 93 Southern 11.7 22.9 51.2 7.3 43.4 232 Western 8.9 7.0 45.2 5.1 54.1 169 Education No education 0.0 10.7 37.4 0.0 56.1 108 Primary 6.2 17.9 53.3 3.8 43.7 1,100 Secondary 42.0 51.8 79.2 29.9 14.4 808 Higher 73.6 72.3 92.4 63.4 4.5 129 Total 23.5 33.6 64.6 17.0 30.9 2,145 pondents 3.5 MEN’S EMPLOYMENT Male respondents were asked a number of questions to elicit their employment status at the time of the survey, the continuity of their employment in the 12 months prior to the survey and, if they were not employed at all in the prior 12 months, the principal activity in which they were involved during the period. Table 3.5 presents information relating to men’s employment during the 12 month period prior to the survey. In all, 79 percent of men were employed in the last 12 months while 21 percent were unem- ployed. Younger men are markedly less likely to be employed than men age 25 and older. This reflects the fact that many are still in school as well as problems youth may have in finding work. Employment levels of men in rural areas are higher (82 percent) than those of their urban counterparts (75 percent). The men most likely to have been employed in the last 12 months are divorced, separated or widowed men (83 percent), and those who have never been to school (91 percent). Among educated men, the like- lihood of having been employed in the last 12 months is highest for those with higher education (88 per- cent). One in ten men were unemployed at the time of the survey, although they were employed in the 12 months prior to the survey. Table 3.5 Employment status: men Percent distribution of men by employment status, according to background characteristics, Zambia 2001- 2002 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in the 12 months preceding the survey Not –––––––––––––––––– employed Not in the Number Background Currently currently last 12 Missing/ of characteristic employed employed months don't know Total men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 26.3 6.9 66.1 0.7 100.0 459 20-24 61.1 16.5 22.4 0.0 100.0 346 25-29 80.6 13.5 5.9 0.0 100.0 361 30-34 89.8 7.7 2.5 0.0 100.0 281 35-39 82.6 12.2 5.2 0.0 100.0 241 40-44 86.8 10.7 2.6 0.0 100.0 174 45-49 80.6 13.1 6.3 0.0 100.0 113 50-54 85.5 7.5 7.0 0.0 100.0 100 55-59 78.8 11.4 9.8 0.0 100.0 71 Marital status Never married 63.0 8.8 28.1 0.2 100.0 589 Married or living together 69.0 12.5 18.3 0.1 100.0 1,325 Divorced/separated/widowed 74.3 8.3 16.8 0.5 100.0 231 Residence Urban 61.4 13.7 24.7 0.1 100.0 851 Rural 72.2 9.3 18.3 0.2 100.0 1,294 Province Central 68.8 5.1 26.1 0.0 100.0 165 Copperbelt 59.0 16.9 24.1 0.0 100.0 447 Eastern 78.1 5.5 16.4 0.0 100.0 268 Luapula 85.6 1.1 13.3 0.0 100.0 166 Lusaka 66.1 7.9 25.9 0.0 100.0 314 Northern 77.7 2.4 19.3 0.6 100.0 292 North-Western 53.4 13.0 33.2 0.4 100.0 93 Southern 53.7 35.6 10.2 0.5 100.0 232 Western 71.3 5.7 22.9 0.0 100.0 169 Education No education 84.4 6.3 9.3 0.0 100.0 108 Primary 70.2 10.9 18.6 0.3 100.0 1,100 Secondary 60.8 12.3 26.9 0.0 100.0 808 Higher 80.1 8.1 11.8 0.0 100.0 129 Total 67.9 11.0 20.9 0.2 100.0 2,145 Characteristics of Respondents │ 33 Figure 3.2 shows the distribution of men not employed in the 12 months prior to the survey by current activity. Of the unemployed, two in three are students, while the rest are mostly looking for work or are simply inactive (15 and 14 percent, respectively). Figure 3.2 Distribution of Unemployed Men by Current Activity ZDHS 2001-2002 Going to school/ studying 66% Looking for work 15% Inactive 14% Could not work/ handicapped 3% Other 2% Men who reported being employed during the 12-month period prior to the survey were asked about the principal occupation and the type of earnings (i.e., cash, kind or unpaid) that they received. Ta- ble 3.6 looks at the main occupation among men who were employed during the 12-month period before the survey. It shows that over half (51 percent) of working men were employed in the agricultural sector, 18 percent in sales and services, and 16 percent in skilled manual jobs. The rest work mostly in domestic service and professional/technical/managerial jobs (6 percent each). As expected, Table 3.6 shows that the majority of employed men in rural areas work in agricul- ture, whereas those in urban areas are mostly in non-agricultural occupations of sales and services (34 percent) and skilled manual work (32 percent). This pattern is also distinct amongst the provinces, with more men engaged in agriculture occupations in rural provinces: Luapula (79 percent), Northern (77 percent), Eastern (75 percent) and Western (74 percent). Lusaka province has the highest proportion (12 percent) of professional, technical and managerial workers as well as of domestic servants. The data indicate that education has a strong impact on one’s occupation. Men with no or primary education are engaged more in agricultural activities and those with higher education take up more professional/ managerial jobs. 34 │ Characteristics of Respondents Table 3.6 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteris- tics, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Don’t Number technical/ and Skilled skilled Domestic Agri- know/ of Background characteristic managerial Clerical services manual manual service culture missing Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.0 0.0 23.9 11.1 0.4 4.1 54.5 6.1 100.0 152 20-24 0.9 1.0 32.2 9.0 1.9 9.4 43.7 1.8 100.0 268 25-29 4.5 0.4 19.7 16.4 1.4 8.4 49.3 0.0 100.0 339 30-34 7.0 1.7 14.9 18.1 3.5 6.8 47.3 0.8 100.0 274 35-39 7.3 1.0 13.7 18.8 1.1 4.3 53.0 0.7 100.0 229 40-44 9.4 0.4 13.6 16.3 0.0 5.1 55.2 0.0 100.0 169 45-49 10.8 0.0 11.6 21.6 0.0 3.3 51.7 1.1 100.0 106 50-54 9.6 1.2 6.6 22.4 0.0 3.6 56.6 0.0 100.0 93 55-59 5.2 0.0 5.5 19.4 0.0 1.4 68.5 0.0 100.0 64 Marital status Never married 2.4 0.6 31.6 10.5 2.0 8.2 41.1 3.6 100.0 389 Married or living together 6.8 0.8 12.4 17.7 1.2 5.5 55.2 0.4 100.0 1,203 Divorced/separated/widowed 1.3 1.1 34.4 18.1 0.9 6.2 37.4 0.6 100.0 102 Residence Urban 9.2 1.3 33.7 31.8 3.1 13.1 7.2 0.6 100.0 640 Rural 3.3 0.4 8.7 6.6 0.3 1.9 77.4 1.4 100.0 1,055 Province Central 3.9 0.5 26.0 8.3 2.0 7.4 45.6 6.4 100.0 122 Copperbelt 5.9 0.5 28.7 32.2 4.5 7.9 19.8 0.5 100.0 339 Eastern 6.1 1.4 7.0 7.5 0.0 2.3 74.8 0.9 100.0 224 Luapula 4.5 0.0 8.3 4.5 0.6 1.9 79.0 1.3 100.0 144 Lusaka 12.4 2.3 35.6 25.4 1.1 15.8 7.3 0.0 100.0 232 Northern 1.9 0.0 9.2 7.6 0.4 3.1 77.1 0.8 100.0 234 North-Western 5.7 0.0 9.5 10.8 1.3 3.8 68.4 0.6 100.0 62 Southern 3.8 1.1 14.2 16.4 0.0 3.8 59.0 1.6 100.0 207 Western 2.5 0.0 8.3 9.9 0.0 5.0 74.4 0.0 100.0 130 Education No education 0.0 0.0 18.3 6.7 0.0 0.0 75.0 0.0 100.0 98 Primary 0.5 0.0 16.1 11.5 0.8 3.6 65.8 1.7 100.0 892 Secondary 3.7 1.5 23.5 23.8 2.6 11.0 33.1 0.7 100.0 590 Higher 58.4 3.5 5.7 20.2 0.3 5.9 5.9 0.0 100.0 114 Total 5.5 0.8 18.1 16.1 1.3 6.2 50.9 1.1 100.0 1,694 Table 3.7 looks at the form of earnings received by men who were employed during the 12-month period before the survey, according to whether the work they performed was in the agricultural or non- agricultural sector. Among employed men in agriculture, over half (56 percent) report that they are not paid, reflecting the fact that many are self-employed. More than eight in ten (84 percent) employed men in non-agricultural occupations receive cash payment for their work. Characteristics of Respondents │ 35 Table 3.7 Type of earnings: men Percent distribution of men employed in the 12 months preceding the survey by type of earnings, according to type of employment (agricultural or non-agricultural), Zambia 2001-2002 –––––––––––––––––––––––––––––––––––––––––––– Non- Agri- agri- cultural cultural Type of earnings work work Total –––––––––––––––––––––––––––––––––––––––––– Cash only 9.7 83.9 45.4 Cash and in-kind 26.7 5.9 16.4 In-kind only 7.4 1.6 4.5 Not paid 56.2 8.5 33.2 Missing 0.0 0.1 0.5 Total 100.0 100.0 100 Number of men 862 813 1,694 –––––––––––––––––––––––––––––––––––––––––– Note: Total includes 19 men with missing informa- tion on type of employment who are not shown separately 3.6 WOMEN’S EMPLOYMENT The 2001-2002 ZDHS also collected information relating to women’s employment. The meas- urement of women’s employment is particularly 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, the ZDHS asked women several questions to ascertain their employment status. First women were asked, “Aside from your own housework, are you currently working?” 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. Are you currently doing any of these things or any other work?” It should, however, be recognised that major obstacles standing in the way of women’s gaining access to employment with the same opportunities as men are caused by a number of factors, the “most significant being inequality in respect of access to education, discrimination in employment and occupa- tion, which leads to categorisation of jobs according to gender, national laws and regulations, inequality in respect of access to factors of production, the low level of women's participation in decision-making and social control bodies and finally, social attitudes” (ILO, 1995). Information on women’s participation in decision-making also was collected in the 2001-2002 and is presented later in this chapter. 3.6.1 Employment Status Table 3.8 shows the percent distribution of women by employment status during the 12 months preceding the survey. Fifty-seven percent of women were employed in the 12 months preceding the sur- vey, compared with 79 percent of men (Table 3.5). Employment levels in the last 12 months are higher for women in rural areas than for their urban counterparts (63 percent and 49 percent, respectively). This pattern is also generally true for employed men, although their proportions for men in both rural and ur- ban areas are higher than those for women. Table 3.8 shows that the proportion of women employed in the last 12 months tends to increase with age and number of living children. The data indicate that women who are divorced, separated, or widowed have the highest em- ployment rates, followed by those in marital union (72 percent versus 62 percent). Although never- married women and men are the least likely to be employed, the proportion for women is much lower (37 percent) than for men (72 percent) (Table 3.5). 36 │ Characteristics of Respondents Table 3.8 Employment status: women Percent distribution of women by employment status, according to background characteristics, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in the 12 months preceding the survey Not –––––––––––––––––– employed Not in the Number Currently currently last 12 Missing/ of 3.6.2 O Ta before the survey. As in agricul- ture. This e in ten in domestic s l occupa- tions (5 pe Background characteristic employed employed months don't know Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 32.7 2.5 64.8 0.0 100.0 1,811 20-24 49.9 3.4 46.6 0.1 100.0 1,664 25-29 62.3 3.1 34.7 0.0 100.0 1,376 30-34 65.6 2.4 32.0 0.0 100.0 972 35-39 70.5 2.3 27.2 0.0 100.0 766 40-44 66.3 2.1 31.6 0.0 100.0 601 45-49 68.6 2.1 29.3 0.0 100.0 467 Marital status Never married 33.8 2.8 63.4 0.0 100.0 1,897 Married or living together 60.0 2.4 37.6 0.0 100.0 4,694 Divorced/separated/widowed 67.6 3.9 28.5 0.0 100.0 1,067 Number of living children 0 36.2 3.0 60.8 0.0 100.0 2,067 1-2 57.1 2.7 40.2 0.0 100.0 2,431 3-4 63.6 2.5 33.9 0.1 100.0 1,578 5+ 65.6 2.6 31.8 0.0 100.0 1,582 Residence Urban 45.9 3.1 51.0 0.0 100.0 3,073 Rural 60.3 2.4 37.2 0.0 100.0 4,585 Province Central 70.0 1.0 29.0 0.0 100.0 562 Copperbelt 44.9 3.4 51.7 0.0 100.0 1,544 Eastern 20.8 1.6 77.6 0.0 100.0 926 Luapula 91.1 1.1 7.8 0.0 100.0 622 Lusaka 49.1 3.7 47.2 0.0 100.0 1,132 Northern 73.5 0.9 25.5 0.1 100.0 1,040 North-Western 42.7 15.7 41.7 0.0 100.0 354 Southern 39.0 1.1 59.8 0.0 100.0 814 Western 81.5 1.8 16.7 0.0 100.0 663 Education No education 57.6 2.0 40.3 0.0 100.0 925 Primary 57.9 2.6 39.4 0.0 100.0 4,439 Secondary 43.4 3.2 53.4 0.0 100.0 2,061 Higher 76.5 2.5 21.0 0.0 100.0 234 Total 54.5 2.7 42.7 0.0 100.0 7,658 ccupation ble 3.9 shows the occupations reported by women employed in the 12-month period observed with employed men, the majority of employed women (54 percent) work is followed by one-fourth who are employed in sales and services occupations and on ervices. A major difference is observed amongst women and men in skilled manua rcent and 16 percent, respectively). Characteristics of Respondents │ 37 Table 3.9 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Don’t Number technical/ and Skilled skilled Domestic Agri- know/ of Background characteristic managerial Clerical services manual manual service culture missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.8 0.5 25.4 1.9 0.0 5.9 65.1 0.5 100.0 638 20-24 2.1 1.6 27.2 3.8 0.7 11.5 52.3 0.7 100.0 887 25-29 6.4 2.5 27.6 6.3 0.0 12.1 44.8 0.3 100.0 899 30-34 5.6 1.9 22.8 5.5 0.8 11.7 50.5 1.2 100.0 661 35-39 3.6 0.9 24.1 4.7 0.0 9.9 56.1 0.7 100.0 557 40-44 3.7 2.5 22.5 5.7 0.3 8.2 56.7 0.5 100.0 412 45-49 6.5 0.9 20.1 3.3 0.2 10.3 58.1 0.6 100.0 330 Marital status Never married 6.6 2.7 31.2 3.4 0.5 8.5 46.6 0.5 100.0 694 Married or living together 3.3 1.3 22.0 5.1 0.3 9.7 57.7 0.6 100.0 2,927 Divorced/separated/widowed 4.1 1.8 30.6 3.6 0.2 14.0 44.8 0.8 100.0 763 Number of living children 0 5.3 3.1 26.1 4.4 0.6 9.2 50.2 1.1 100.0 810 1-2 5.1 1.3 27.3 4.5 0.2 10.8 50.4 0.4 100.0 1,452 3-4 2.3 1.7 24.9 4.8 0.3 10.6 55.1 0.2 100.0 1,042 5+ 3.1 0.7 21.1 4.6 0.3 10.0 59.3 0.8 100.0 1,079 Residence Urban 7.9 4.5 42.4 7.4 0.6 22.6 13.3 1.3 100.0 1,504 Rural 1.9 0.1 15.9 3.1 0.1 3.8 74.8 0.3 100.0 2,879 Province Central 4.1 1.4 21.8 4.3 0.2 5.4 62.4 0.5 100.0 400 Copperbelt 7.7 2.2 30.6 3.5 0.4 26.7 28.2 0.7 100.0 746 Eastern 13.5 1.0 35.5 7.5 1.0 8.0 33.5 0.0 100.0 207 Luapula 0.9 0.0 5.2 2.4 0.0 1.7 89.8 0.0 100.0 573 Lusaka 6.3 6.3 53.3 10.1 0.6 18.8 2.3 2.1 100.0 597 Northern 0.8 0.3 7.7 1.3 0.0 4.4 85.0 0.6 100.0 774 North-Western 2.9 0.2 11.7 2.3 0.0 3.7 78.8 0.4 100.0 207 Southern 4.6 1.1 38.7 8.8 0.7 10.2 35.6 0.4 100.0 327 Western 0.6 0.4 26.7 4.2 0.2 2.8 65.1 0.2 100.0 553 Education No education 0.2 0.0 19.3 1.6 0.0 3.1 75.6 0.2 100.0 552 Primary 0.3 0.3 24.2 3.8 0.2 8.4 62.0 0.7 100.0 2,687 Secondary 5.2 3.6 33.8 8.7 0.7 19.9 27.4 0.7 100.0 960 Higher 62.6 15.5 6.7 3.0 0.0 8.1 4.1 0.0 100.0 185 Total 4.0 1.6 25.0 4.6 0.3 10.3 53.7 0.6 100.0 4,384 Table 3.9 further shows that most working women (75 percent) in rural areas are engaged in agri- cultural activities compared with 13 percent in urban areas. A large majority (85 percent) of women in urban areas work in non-agricultural activities with 42 percent in sales and services followed by those in domestic service who constitute 23 percent. It is apparent from Table 3.9 that the likelihood of women’s participation in professional, technical or managerial jobs, sales and services, and clerical increases with rising education levels. 3.6.3 Earnings, Type of Employer, and Continuity of Employment It is commonly acknowledged that women’s reproductive and domestic role (housework, food preparation, and caring for the young, old and disabled family members) is generally perceived to be their primary function, restricting their time and mobility for productive work (ILO, 1995). Most women are thus constrained to choose income-earning activities, which can be combined with child care and house- hold work. Table 3.10 presents information on women’s employment status, the form of earnings and the continuity of employment. The table takes into account whether women are involved in agricultural or 38 │ Characteristics of Respondents non-agricultural occupations, since all of the em- ployment variables shown in the table are strongly influenced by the sector in which a woman is em- ployed. Table 3.10 Employment characteristics: women Percent distribution of women employed in the 12 months pre- ceding the survey by type of earnings, type of employer, and con- tinuity of employment, according to type of employment (agricul- tural or non-agricultural), Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Non- Agri- agri- cultural cultural Employment characteristic work work Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of earnings Cash only 18.7 81.3 47.7 Cash and in-kind 16.0 4.4 10.6 In-kind only 2.2 1.1 1.7 Not paid 63.1 13.2 40.0 Total 100.0 100.0 100.0 Type of employer Employed by family member 20.0 7.2 14.1 Employed by nonfamily member 2.1 29.5 14.8 Self-employed 77.8 63.2 71.1 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Continuity of employment Throughout the year 16.0 59.3 35.8 Seasonal/part of year 81.7 20.3 53.3 Once in a while 2.3 20.3 10.8 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Number of women 2,354 2,003 4,384 –––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 27 women with missing information on type of employment who are not shown separately According to the data in Table 3.10, most women engaged in agricultural work are self- employed (78 percent), work seasonally or part of the year (82 percent) and receive no payment for their work (63 percent). Table 3.10 further shows that a majority of women in non-agricultural activi- ties earn cash only (81 percent), 63 percent work for themselves, and 59 percent work throughout the year. 3.6.4 Control over Women’s Earnings and Contribution to Household Expenditures In the 2001-2002 ZDHS, employed women who earn cash were asked about who the main de- cision-maker is with regard to the use of their earn- ings. Further, they were asked about the proportion of household expenditures met by their earnings. Their answers to these questions provide some in- sight into the extent to which women have auton- omy over their earnings and the relative importance of women’s earnings. The latter information also has implications for the empowerment of women. It is expected that employment and earnings are more likely to empower women if they perceive their earnings as important for meeting the needs of their household. Table 3.11 shows the percent distribution of 2001-2002 ZDHS respondents who earn cash for the work they do by the degree of control over the use of their earnings and the extent to which their earnings meet household expenditures. Almost six out of ten women decide by themselves how their earnings are to be spent. Close to one in every four working women said that the decisions are made jointly with someone else, whereas one in five reported that this decision is fully made by someone else. Independent decision-making by women is more pronounced in urban (72 percent) than rural ar- eas (39 percent) and notably increases with age: 49 percent of women age 15-19 compared with 59 per- cent of women age 45-49. Education has an impact on decision-making of women on the use of their earnings: 38 percent of women with no education decide independently on how earnings are to be used compared with 64 percent of women with higher education. In rural areas, decisions on the use of women’s earnings are almost equally divided, with more than one-third made by the woman herself (39 percent), one-third made jointly (29 percent), and one-third by someone else (31 percent). At the pro- vincial level, the highest proportions of women who decide for themselves how their earnings are spent are in Lusaka (77 percent) and Copperbelt (65 percent) and the lowest are in North-Western and Northern (35 percent each). Regarding the use of women’s earnings, Table 3.11 shows that a similar proportion of women re- ported that their earnings constitute “less than half” (39 percent) and “half or more” (38 percent) of household expenditures. Almost one in five women who work for cash say their earnings provide the entire household expenditure. Characteristics of Respondents │ 39 Table 3.11 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earn- ings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Zambia 2001- 2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Person who decides how Proportion of household expenditures earnings are used met by earnings –––––––––––––––––––––––––– –––––––––––––––––––––––––––––––– 40 │ Ch Someone Almost Less Half Number Background Self else none/ than or of characteristic only Jointly1 only2 Total none half more All Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 48.9 15.3 35.8 100.0 12.8 40.0 30.0 17.2 100.0 278 20-24 53.8 21.0 25.0 100.0 6.8 41.7 37.9 13.3 100.0 538 25-29 56.3 22.5 21.1 100.0 4.7 37.9 41.8 15.5 100.0 591 30-34 58.5 26.0 15.5 100.0 4.1 40.2 38.5 17.2 100.0 389 35-39 55.8 25.3 19.0 100.0 3.6 32.9 43.1 20.5 100.0 341 40-44 56.8 27.8 15.1 100.0 1.3 38.7 37.9 21.3 100.0 231 45-49 59.3 24.7 16.0 100.0 3.4 39.1 32.4 25.1 100.0 186 Marital status Never married 73.4 6.5 20.1 100.0 11.9 42.9 31.2 13.7 100.0 370 Married or living together 40.7 32.4 26.8 100.0 4.6 39.3 40.5 15.4 100.0 1,692 Divorced/separated/widowed 93.0 2.8 4.0 100.0 3.1 34.1 36.1 26.7 100.0 492 Number of living children 0 63.5 12.1 24.4 100.0 11.9 40.2 34.7 13.2 100.0 433 1-2 54.2 23.2 22.4 100.0 4.4 39.0 39.3 17.2 100.0 892 3-4 55.9 24.7 19.5 100.0 4.0 36.8 42.2 16.9 100.0 622 5+ 51.3 28.6 20.0 100.0 3.6 39.6 35.6 21.0 100.0 607 Residence Urban 71.8 16.7 11.4 100.0 6.5 41.3 40.3 11.9 100.0 1,266 Rural 39.4 29.1 31.4 100.0 4.3 36.3 36.4 22.7 100.0 1,287 Province Central 50.3 13.5 36.2 100.0 5.4 40.6 36.7 17.3 100.0 247 Copperbelt 65.4 19.8 14.8 100.0 4.1 39.9 45.0 11.0 100.0 523 Eastern 53.7 22.2 24.1 100.0 4.9 19.1 41.4 34.6 100.0 168 Luapula 43.8 26.6 29.7 100.0 10.2 50.8 30.5 8.6 100.0 127 Lusaka 76.9 13.2 9.8 100.0 7.1 45.1 37.6 10.3 100.0 591 Northern 34.5 37.9 27.1 100.0 5.6 24.0 34.5 35.2 100.0 363 North-Western 35.4 45.1 19.5 100.0 7.0 29.8 34.5 28.7 100.0 144 Southern 44.8 30.0 25.1 100.0 1.0 51.7 38.9 8.4 100.0 234 Western 44.4 17.0 37.9 100.0 4.6 43.1 35.9 15.7 100.0 155 Education No education 38.0 27.5 34.4 100.0 7.1 34.6 34.5 23.5 100.0 255 Primary 53.7 21.7 24.5 100.0 4.8 41.1 36.7 17.4 100.0 1,417 Secondary 63.3 21.8 14.8 100.0 6.4 37.9 40.3 15.1 100.0 703 Higher 64.3 31.1 4.6 100.0 3.5 30.5 48.4 17.6 100.0 178 Total 55.5 22.9 21.4 100.0 5.4 38.8 38.3 17.4 100.0 2,553 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 With husband or someone else 2 Includes husband Table 3.12 presents data on how decisions on use of women’s earnings are made and the contri- bution of these earnings to household expenditures based on marital status. As expected, married women are less likely to make exclusive decisions on how to spend their earnings, compared with unmarried women (41 and 85 percent, respectively). Thirty-one percent of married women decide jointly with their husbands. It is notable that one in four married women who earn cash for their work say that their hus- bands alone decide how to spend their earnings. aracteristics of Respondents Table 3.12 Women’s control over earnings Percent distribution of women who received cash earnings for work in the past 12 months by person who decides how earnings are used and marital status, according to proportion of household expenditures met by earnings, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married or living together Not married1 ––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––– Jointly Jointly Jointly Some- Contribution with with Hus- Someone Number with one Number to household Self hus- someone band else of Self someone else of expenditures only band else only only Total women only else only Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Almost none/none 57.4 20.1 1.6 17.6 3.2 100.0 78 83.8 6.8 9.4 100.0 59 Less than half 47.2 25.6 1.2 25.4 0.5 100.0 664 83.1 2.7 13.9 100.0 326 Half or more 37.1 31.7 1.3 29.7 0.3 100.0 686 85.9 3.9 10.3 100.0 293 All 28.9 47.4 0.3 22.8 0.2 100.0 261 86.0 7.5 6.5 100.0 182 Total 40.7 31.3 1.1 26.3 0.5 100.0 1,692 84.6 4.4 10.9 100.0 862 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table excludes 4 women missing information on contribution to household expenditures. 1 Never-married, divorced, separated, or widowed women Table 3.12 further shows that among married women, the less their earnings provide toward household expenditures, the more likely they are to decide by themselves how to use their earnings. As the importance of their earnings increases, so does the likelihood that they make decisions jointly with their husbands. A majority of unmarried women make their own decisions, regardless of the degree of contribution to household expenditure. 3.7 WOMEN’S EMPOWERMENT In addition to information on women’s education, employment status, and control over earnings, the 2001-2002 ZDHS obtained information from both women and men on other measures of women’s status and empowerment. In particular, questions were asked on women’s roles in making household de- cisions, on acceptance of wife beating, and on opinions about when a wife should be able to refuse sex with her husband. These questions are used to define three different indicators of women’s empowerment: (1) women’s participation in decision-making, (2) degree of acceptance of wife beating, and (3) degree of acceptance of a wife’s right to refuse sex with her husband. The first measure—women’s participation in decision-making—requires little explanation since the ability to make decisions about one’s own life is of obvious importance to women’s empowerment. The other two measures derive from the notion that gender equity is essential to empowerment. One of Zambia’s policy measures to address women’s participation in decision-making is to “encourage efforts by non-governmental organisations, trade unions and the private sector to achieve equality between women and men in their ranks, including equal participation in their decision-making bodies and in nego- tiations at all times” (GIDD, 2000) Responses that indicate a view that the beating of wives by husbands is justified reflect a low status of women. Although such attitudes do not necessarily signify approval of men beating their wives, they do signify acceptance of norms that give men the right to discipline women with force. Similarly, beliefs about whether and when a woman can refuse sex with her husband reflect issues of gender equity regarding sexual rights and bodily integrity. Besides yielding an important measure of empowerment, in- formation about women’s attitudes toward sexual rights is useful for improving and monitoring reproduc- tive health programmes that depend on women’s willingness and ability to control their own sexual lives. 3.7.1 Women’s Participation in Decision-making Table 3.13 shows the percent distribution of women by the person that the woman says usually has the final say in making decisions in four areas: (1) the woman’s own health care, (2) large household Characteristics of Respondents │ 41 purchases, (3) visits to family/friends, and (4) how many children to have and when. The results are pre- sented by marital status. Women are considered to participate in decision-making if they make decisions alone or jointly with their husband or someone else. Table 3.13 indicates that for married women, decision-making is highly dominated by husbands. Women report that husbands alone are responsible for decisions, particularly for making large household purchases (62 percent), visits to family/friends (56 percent), number of children to have and when (50 percent), and even the wife's own health care (47 percent). In contrast, the proportion of women who report that they alone have decision-making responsibility in these areas is much lower: own health care (30 percent), visits to family/friends (17 percent), large household purchases (11 percent), and number and timing of children (10 percent). As expected, unmarried women are more likely than married women to make decisions by themselves. However, because unmarried women tend to be younger than married women and are often living with their parents or other relatives, decisions are often made by others. Table 3.13 Women’s participation in decisionmaking Percent distribution of women by person who has the final say in making specific decisions and marital status, according to type of decision, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married or living together Not married1 ––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––– Decision Decision Jointly Jointly not made/ Jointly Some- not with with Hus- Someone not with one made/Not Self hus- someone band else appli- Self someone else appli- Type of decision only band else only only cable Total only else only cable Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Own health care 30.1 11.0 0.5 46.5 11.8 0.2 100.0 42.5 3.7 53.1 0.8 100.0 Large household purchases 11.3 25.1 0.1 61.7 1.6 0.2 100.0 29.8 3.6 60.8 5.7 100.0 Visits to family/friends 16.8 25.7 0.0 56.1 1.1 0.2 100.0 41.9 3.7 51.9 2.5 100.0 How many children to have and when 9.6 35.8 0.4 49.8 0.4 4.0 100.0 46.8 3.2 11.2 38.7 100.0 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Results are based on 4,694 women currently married or living together and 2,964 not married women. 1 Never-married, divorced, separated, or widowed women Table 3.14.1 presents information on the proportion of women involved alone or jointly in mak- ing the above-mentioned four decisions according to background characteristics. In addition, the table includes two summary indicators: (1) the proportion of women involved in making decisions in all four areas and (2) the proportion of women not involved in making any of the decisions. Table 3.14.1 shows that less than a fifth of women report taking part in decisions concerning all of the specified areas. It is apparent that women are most likely to report participating in decisions on the number of children to have and when to have them (47 percent), visits to family/friends (44 percent), their own health care (43 percent), and least likely to report participating in decisions in making large pur- chases (35 percent). Never-married women are least likely to report being involved in decision-making, particularly concerning making large purchases (13 percent) and visiting family/friends (27 percent). As mentioned earlier, this is probably because they are young and still live with parents/guardians who make most of the decisions. Women with no children are also less likely than those with children to participate in any or all of the specified decisions. One might expect higher educational status to give women greater decision-making power within their households. However, Table 3.14.1 indicates that women with no education report having some- what more say (21 percent) in all the specified decisions compared with women with primary and secon- dary schooling (16 and 17 percent, respectively). Women with higher education are the most likely to report having a say in all the specified decisions (37 percent), along with those who earn cash for their work (26 percent). However, participation in decision-making for women with higher education varies with the type of decision, whereas there is little distinction for those earning cash for their work. 42 │ Characteristics of Respondents Table 3.14.1 Women’s participation in decision-making by background characteristics: women Percentage of women who say that they alone or jointly have the final say in specific decisions, by background characteristics, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Alone or jointly has final say in: ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Visits to None Own Making family, Number All of the Number Background health large relatives, of children specified specified of characteristic care purchases friends and when decisions decisions women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 26.8 11.6 23.2 33.9 4.9 45.7 1,811 20-24 41.6 28.7 39.8 46.9 13.5 28.8 1,664 25-29 45.7 42.4 49.2 53.7 19.4 21.8 1,376 30-34 49.5 47.4 51.5 54.6 24.1 21.9 972 35-39 57.2 51.2 55.3 54.4 29.1 21.4 766 40-44 54.9 52.1 60.6 52.2 29.2 21.1 601 45-49 55.4 57.7 63.6 51.3 30.7 20.1 467 Marital status Never married 33.4 12.9 26.7 38.2 8.0 40.9 1,897 Married or living together 41.5 36.5 42.5 45.8 15.6 29.0 4,694 Divorced/separated/widowed 68.8 69.9 79.1 70.9 44.5 6.0 1,067 Number of living children 0 30.9 16.2 27.3 35.6 7.0 41.4 2,067 1-2 46.3 38.1 46.8 52.2 18.7 23.9 2,431 3-4 47.6 43.4 50.0 51.4 22.5 25.0 1,578 5+ 50.5 48.1 54.1 51.6 25.4 23.7 1,582 Residence Urban 46.8 37.2 47.2 48.4 17.3 23.8 3,073 Rural 40.9 34.1 41.4 46.8 18.0 32.1 4,585 Province Central 25.0 27.5 35.7 42.4 7.2 31.5 562 Copperbelt 34.7 34.9 46.2 44.5 13.2 30.4 1,544 Eastern 31.8 26.8 31.5 35.0 15.9 48.2 926 Luapula 30.7 23.6 38.0 40.1 9.1 36.1 622 Lusaka 58.7 37.8 45.4 45.8 18.2 19.4 1,132 Northern 52.1 37.1 48.4 56.6 23.5 22.6 1,040 North-Western 60.3 50.5 64.9 72.6 39.3 15.6 354 Southern 33.1 45.0 28.9 48.8 20.7 34.9 814 Western 70.0 38.7 63.4 56.0 22.8 13.9 663 Education No education 47.4 38.6 47.4 46.1 21.0 29.1 925 Primary 40.9 33.3 41.7 45.1 16.3 31.0 4,439 Secondary 42.9 35.1 43.1 50.8 17.2 26.6 2,061 Higher 75.3 63.6 71.3 68.3 36.6 4.7 234 Employment Not employed 36.6 26.3 35.2 42.0 13.2 36.0 3,476 Employed for cash 54.4 51.3 56.5 55.3 26.1 17.7 2,401 Employed not for cash 41.3 31.3 43.0 47.6 15.4 29.5 1,775 Total 43.3 35.3 43.7 47.4 17.7 28.8 7,658 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The total includes 6 women with missing data for employment. Characteristics of Respondents │ 43 The 2001-2002 ZDHS also sought men’s opinions concerning women’s participation in decision- making in the four specified areas. Table 3.14.2 shows the percent distribution of men who say that their wife or partner alone or jointly should have the greater say in making specific decisions. Table 3.14.2 shows that one in four men are of the opinion that wives alone or jointly should not have the greater say in any of the specified decisions. The proportion of men who feel that women should have a say in none of the specified decisions is higher in rural than urban areas (32 percent and 15 per- cent, respectively). More than half of men are of the view that a wife or partner should decide by herself or jointly about the number of children to have and when to have them. Fewer men say that wives should have the greater say in decisions related to large household purchases and visits to family and friends (43 percent each). As presented in Table 3.14.2, according to male respondents, the importance of the wife’s role in decision-making increases with the level of the man’s education. For instance, 37 percent of men with no education and 93 percent of those with higher education said a wife or partner should have a greater say in how she spends her own money. Amongst the provinces, the highest proportion of men who say wives should have the greater say in all specified decisions is in Eastern province (31 percent), while men in Luapula province are least likely to believe so (9 percent). Eastern province has the highest proportion of men (along with Western province) who say that women should have the final say in none of the specified decisions. 44 │ Characteristics of Respondents Table 3.14.2 Women’s participation in decision-making by background characteristics: men Percentage of men who say that their wife alone or jointly should have the final say in specific decisions, by background characteristics, Zambia 2001-2002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wife alone or jointly should have the greater say in: ––––––––––––––––––––––––––––––––––––––––––– Visits to How None Making family, Number wife spends All of the Number Background large relatives, of children her specified specified of characteristic purchases friends and when money decisions decisions men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 33.9 36.9 48.9 46.9 15.6 27.4 459 20-24 39.2 38.9 52.7 52.0 19.2 25.9 346 25-29 42.8 41.3 53.5 45.0 18.6 26.8 361 30-34 48.8 49.9 59.0 55.9 26.0 21.6 281 35-39 46.6 48.9 54.6 50.4 25.2 24.8 241 40-44 53.2 47.1 62.3 54.9 29.2 21.9 174 45-49 48.2 52.8 63.2 54.4 28.0 20.0 113 50-54 43.6 40.9 48.5 47.9 24.4 33.8 100 55-59 44.9 42.7 45.0 48.9 14.5 23.5 71 Marital status Never married 38.7 40.5 53.3 51.1 19.1 24.3 782 Married or living together 46.2 45.0 55.2 50.6 23.3 25.5 1,248 Divorced/separated/widowed 33.1 39.3 44.8 38.9 13.9 31.1 116 Number of living children 0 37.9 39.5 52.1 50.2 18.7 26.0 861 1-2 43.4 45.3 53.0 49.4 20.7 24.5 447 3-4 51.0 48.9 56.5 52.3 26.4 24.0 336 5+ 45.0 43.3 56.2 49.2 22.8 25.9 501 Residence Urban 52.0 52.4 64.2 61.5 28.8 14.7 851 Rural 36.7 36.9 47.2 42.6 16.3 32.3 1,294 Province Central 56.2 46.0 67.8 64.5 26.8 12.3 165 Copperbelt 45.9 52.3 64.3 52.6 25.9 15.4 447 Eastern 38.3 41.0 46.9 44.5 30.9 43.0 268 Luapula 28.2 38.1 49.7 49.2 8.8 26.5 166 Lusaka 55.6 47.7 59.8 68.6 27.2 13.8 314 Northern 39.4 40.1 47.1 44.0 15.9 26.6 292 North-Western 23.1 35.7 51.3 43.7 13.4 37.0 93 Southern 47.3 41.5 44.9 37.1 14.1 29.3 232 Western 29.3 26.8 43.3 36.9 12.7 42.7 169 Education No education 29.1 31.9 34.7 37.3 15.2 42.3 108 Primary 32.9 32.4 41.4 37.8 11.6 34.0 1,100 Secondary 50.8 52.0 67.7 61.8 27.9 1

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