Zimbabwe - Demographic and Health Survey - 2007

Publication date: 2007

Zimbabwe Demographic and Health Survey Z im b ab w e 2005-06 D em o g rap h ic an d H ealth S u rvey 2005-06 Zimbabwe Demographic and Health Survey 2005-2006 Central Statistical Office Harare, Zimbabwe Macro International Inc. Calverton, Maryland USA March 2007 The 2005-2006 Zimbabwe Demographic and Health Survey (2005-06 ZDHS) was implemented by the Central Statistical Office (CSO) from August 2005 to March 2006. The 2005-06 ZDHS is one of a series of surveys undertaken by the CSO as part of the Zimbabwe National Household Survey Capability Programme (ZNHSCP). Macro International Inc. provided technical assistance and funding through the MEASURE DHS project, a USAID- funded project providing support for the implementation of population and health surveys in countries worldwide. The Ministry of Health and Child Welfare (MOH&CW), the Zimbabwe Family Planning Council (ZNFPC) and the Musasa Project contributed significantly to the design, implementation, and analysis of the ZDHS results. Other agencies and organizations facilitating the successful implementation of the survey through technical and/or financial support include the Government of Zimbabwe, the National Microbiology Reference Laboratory (NMRL), the USAID/Zimbabwe Mission, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), the United Nations Children’s Fund (UNICEF), the Centers for Disease Control and Prevention (CDC), and the United Kingdom Department for International Development (DFID). This publication was made possible through support provided by the U.S. Agency for International Development under the terms of Contract No. GPO-C-00-03-00002-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. Additional information about the 2005-06 ZDHS may be obtained from the Central Statistical Office, P. O. Box CY 342, Causeway, Harare, Zimbabwe (Telephone: (263-4) 793-971/2 and 797-756/7; Fax: (263-4) 794-757; E-mail: census@mweb.co.zw). Information about the DHS programme may be obtained from the MEASURE DHS Project, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: reports@orcmacro.com, Internet: http://www.measuredhs.com. Recommended citation: Central Statistical Office (CSO) [Zimbabwe] and Macro International Inc. 2007. Zimbabwe Demographic and Health Survey 2005-06. Calverton, Maryland: CSO and Macro International Inc. Contents | iii CONTENTS TABLES AND FIGURES . ix PREFACE . xvii SUMMARY OF FINDINGS . xix MAP OF ZIMBABWE . xxiv CHAPTER 1 INTRODUCTION 1.1 Geography and Economy.1 1.2 Population .2 1.3 Objectives of the Survey .2 1.4 Organisation of the Survey .3 1.4.1 Sample.3 1.4.2 Questionnaires .3 1.4.3 Anaemia and HIV Testing Protocol .4 1.4.4 Training and Fieldwork.6 1.4.5 Data Processing.7 1.4.6 Response Rates .7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Household Population by Age, Sex, and Residence.9 2.2 Household Composition .11 2.3 Education of the Household Population .11 2.3.1 Educational Attainment .11 2.3.2 School Attendance Ratios .14 2.3.3 Repetition and Dropout Rates .16 2.4 Household Characteristics .18 2.4.1 Drinking Water .18 2.4.2 Sanitation Facilities and Waste Disposal .19 2.4.3 Other Household Characteristics .20 2.4.4 Household Durable Goods.21 2.5 Household Wealth.22 2.6 Birth Registration.24 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents.25 3.2 Educational Attainment by Background Characteristics.27 3.3 Literacy Assessment.30 3.4 Exposure to Mass Media .31 3.5 Employment Status .34 iv │ Contents 3.6 Occupation.37 3.7 Type of Employment.39 3.8 Health Insurance Coverage .40 3.9 Knowledge and Attitudes Concerning Tuberculosis .41 3.10 Use of Tobacco.44 CHAPTER 4 FERTILITY 4.1 Current Fertility.47 4.2 Fertility by Background Characteristics .48 4.3 Fertility Trends .49 4.4 Children Ever Born and Living.51 4.5 Birth Intervals.52 4.6 Age at First Birth.53 4.7 Median Age at First Birth by Background Characteristics.53 4.8 Teenage Pregnancy and Motherhood.54 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods.57 5.2 Knowledge of Contraceptive Methods by Background Characteristics .58 5.3 Ever Use of Contraception .60 5.4 Current Use of Contraception .63 5.5 Current Use of Contraception by Background Characteristics .66 5.6 Number of Children at First Use of Contraception.68 5.7 Use of Social Marketing Brand Pills .69 5.8 Use of Social Marketing Brand Condoms .70 5.9 Knowledge of the Fertile Period .71 5.10 Timing of Sterilisation.72 5.11 Source of Supply.72 5.12 Informed Choice.73 5.13 Reasons for Discontinuing Contraceptive Methods .74 5.14 Future Use of Contraception .75 5.15 Reasons for Not Intending to Use Contraception in the Future .76 5.16 Preferred Method of Contraception for Future Use .76 5.17 Exposure to Family Planning Messages in the Media.77 5.18 Contact of Nonusers with Family Planning Providers .79 5.19 Husband or Partner’s Knowledge of Woman’s Use of Contraception.80 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Marital Status .83 6.2 Polygyny .84 6.3 Age at First Marriage .86 6.4 Median Age at First Marriage.87 6.5 Age at First Sexual Intercourse.89 6.6 Median Age at First Sexual Intercourse .90 Contents | v 6.7 Recent Sexual Activity .91 6.8 Postpartum Amenorrhoea, Abstinence, and Insusceptibility.94 6.9 Median Duration of Postpartum Insusceptibility by Background Characteristics .95 6.10 Menopause.96 CHAPTER 7 FERTILITY PREFERENCES 7.1 Fertility Preferences by Number of Living Children.97 7.2 Desire to Limit Childbearing by Background Characteristics .98 7.3 Need and Demand for Family Planning. 100 7.4 Ideal Number of Children . 104 7.5 Mean Ideal Number of Children by Background Characteristics . 106 7.6 Fertility Planning Status . 106 7.7 Wanted Fertility Rates . 107 CHAPTER 8 EARLY CHILDHOOD MORTALITY 8.1 Background and Assessment of Data Quality. 109 8.2 Infant and Child Mortality Levels and Trends. 110 8.3 Socioeconomic Differentials in Early Childhood Mortality . 112 8.4 Biodemographic Differentials in Early Childhood Mortality. 113 8.5 Perinatal Mortality. 114 8.6 High-Risk Fertility Behaviour . 116 CHAPTER 9 MATERNAL HEALTH CARE 9.1 Antenatal Care . 119 9.2 Number and Timing of Antenatal Visits . 121 9.3 Components of Antenatal Care . 121 9.4 Tetanus Toxoid . 124 9.5 Place of Delivery. 124 9.6 Assistance during Delivery. 127 9.7 Postnatal Care. 129 9.8 Postnatal Care Providers. 131 9.9 Problems in Accessing Health Care . 132 CHAPTER 10 CHILD HEALTH 10.1 Child’s Weight and Size at Birth . 135 10.2 Vaccination of Children. 137 10.3 Prevalence and Treatment of Acute Respiratory Infection. 140 10.4 Prevalence and Treatment of Fever . 142 10.5 Prevalence and Treatment of Diarrhoea . 144 10.6 Disposal of Children’s Stools . 147 vi │ Contents CHAPTER 11 NUTRITIONAL STATUS 11.1 Breastfeeding . 149 11.1.1 Breastfeeding Initiation . 149 11.1.2 Breastfeeding Status by the Child’s Age . 151 11.1.3 Median Duration and Frequency of Breastfeeding. 151 11.2 Dietary Diversity among Young Children and Women . 153 11.2.1 Foods and Liquids Consumed by Infants and Young Children . 153 11.2.2 Infant and Young Child Feeding (IYCF) Practices . 154 11.2.3 Foods and Liquids Consumed by Mothers. 157 11.3 Anaemia Prevalence. 159 11.4 Micronutrient Intake and Supplementation . 163 11.4.1 Micronutrient Intake and Supplementation among Children . 163 11.4.2 Micronutrient Intake among Mothers . 165 11.5 Nutritional Status of Children . 167 11.5.1 Measurement of Nutritional Status among Young Children. 167 11.5.2 Results of Data Collection . 168 11.5.3 Levels of Child Malnutrition . 168 11.5.4 Trends in Child Malnutrition . 170 11.6 Women’s Nutritional Status. 171 CHAPTER 12 MALARIA 12.1 Ownership of Mosquito Nets . 173 12.2 Use of Mosquito Nets . 174 12.2.1 Children under Age Five . 174 12.2.2 Women Age 15-49 . 175 12.3 Use of Antimalarial Drugs during Pregnancy. 176 12.4 Prevalence and Prompt Treatment of Fever among Young Children . 178 12.5 Indoor Residual Spraying. 180 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 183 13.2 Knowledge about Mother-to-Child Transmission . 189 13.3 Attitudes towards People Living with HIV/AIDS . 191 13.4 Attitudes towards Negotiating for Safer Sexual Relations with Husbands. 193 13.5 Attitudes towards Condom Education for Youth . 195 13.6 Higher-risk Sex. 195 13.7 Paid Sex. 198 13.8 Coverage of HIV Testing Services . 200 13.9 Self-reporting of Sexually Transmitted Infections. 203 13.10 Injections . 205 13.11 HIV/AIDS-related Knowledge and Behaviour among Youth . 207 13.11.1 Knowledge about HIV/AIDS and Source for Condoms . 207 13.11.2 First Sex . 208 13.11.3 Premarital Sex. 211 Contents | vii 13.11.4 Higher-risk Sex. 212 13.11.5 Age-mixing in Sexual Relationships . 215 13.11.6 Drunkenness during Sexual Intercourse. 215 13.11.7 Coverage of HIV Testing Services . 217 CHAPTER 14 HIV PREVALENCE 14.1 Coverage Rates for the HIV Testing . 219 14.2 HIV Prevalence . 222 14.2.1 HIV Prevalence by Age and Sex . 222 14.2.2 HIV Prevalence by Other Socioeconomic Characteristics . 223 14.2.3 HIV Prevalence by Other Sociodemographic and Health Characteristics. 225 14.2.4 HIV Prevalence by Sexual Risk Behaviour . 226 14.2.5 HIV Prevalence by Other Characteristics Related to HIV Risk . 228 14.3 HIV Prevalence among Young People . 229 14.4 Male Circumcision and HIV Prevalence . 231 14.4.1 Male Circumcision among ZDHS Respondents . 232 14.4.2 Male Circumcision and HIV Status . 233 14.5 HIV Prevalence among Couples . 233 CHAPTER 15 ADULT AND MATERNAL MORTALITY 15.1 Data. 235 15.2 Direct Estimates of Adult Mortality . 236 15.2.1 Levels of Adult Mortality . 237 15.2.2 Trends in Adult Mortality . 237 15.3 Direct Estimates of Maternal Mortality. 239 CHAPTER 16 WOMEN’S STATUS AND HEALTH OUTCOMES 16.1 Employment and Form of Earnings . 241 16.2 Control over and Relative Magnitude of Women’s Earnings. 242 16.3 Woman’s Participation in Decisionmaking . 244 16.4 Attitude towards Wife Beating. 247 16.5 Attitude towards Refusing Sex with Husband. 251 16.6 Current Use of Contraception by Women’s Status. 255 16.7 Widows Dispossessed of Property . 256 CHAPTER 17 DOMESTIC VIOLENCE 17.1 Women Experiencing Physical Violence . 260 17.2 Perpetrators of Physical Violence. 262 17.3 Force at Sexual Initiation. 263 17.4 Experience of Sexual Violence . 263 17.5 Experience of Different Forms of Violence . 266 17.6 Violence during Pregnancy. 267 viii │ Contents 17.7 Marital Control by Husband or Partner. 269 17.8 Forms of Spousal Violence . 271 17.9 Violence by Spousal Characteristics and Women’s Indicators . 275 17.10 Frequency of Spousal Violence . 276 17.11 Onset of Spousal Violence . 277 17.12 Types of Injuries to Women due to Spousal Violence . 278 17.13 Violence by Women against Their Spouse. 279 17.14 Women Who Experienced Violence and Sought Help . 281 CHAPTER 18 ORPHANS AND VULNERABLE CHILDREN 18.1 Orphans and Vulnerable Children. 285 18.1.1 Children’s Living Arrangements and Orphanhood . 285 18.1.2 Orphaned and Vulnerable Children . 286 18.2 Social and Economic Situation of Orphaned and Vulnerable Children. 288 18.2.1 School Attendance. 288 18.2.2 Basic Material Needs. 289 18.2.3 Orphans Living with Siblings . 291 18.2.4 Nutritional Status . 291 18.2.5 Sex before Age 15. 292 18.3 Care and Support for OVCs . 293 18.3.1 Succession Planning . 293 18.3.2 External Support for Households with OVCs . 295 REFERENCES .297 APPENDIX A SAMPLE IMPLEMENTATION . 299 APPENDIX B ESTIMATES OF SAMPLING ERRORS. 301 APPENDIX C DATA QUALITY TABLES . 319 APPENDIX D PERSONS INVOLVED IN THE 2005-06 ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY. 325 APPENDIX E QUESTIONNAIRES . 329 Tables and Figures | ix TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Population size and growth rate .2 Table 1.2 Demographic indicators .2 Table 1.3 Results of the household and individual interviews.7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence.10 Table 2.2 Household composition .11 Table 2.3 Educational attainment of household population.12 Table 2.4 School attendance ratios .15 Table 2.5 Grade repetition and dropout rates .17 Table 2.6 Household drinking water .19 Table 2.7 Household sanitation facilities .20 Table 2.8 Household characteristics.21 Table 2.9 Household possessions.22 Table 2.10 Wealth quintiles.23 Table 2.11 Birth registration of children under age five .24 Figure 2.1 Population pyramid.10 Figure 2.2 Age-specific attendance rates .18 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .26 Table 3.2.1 Educational attainment: women.28 Table 3.2.2 Educational attainment: men .29 Table 3.3.1 Literacy: women .30 Table 3.3.2 Literacy: men.31 Table 3.4.1 Exposure to mass media: women .32 Table 3.4.2 Exposure to mass media: men.33 Table 3.5.1 Employment status: women .35 Table 3.5.2 Employment status: men.36 Table 3.6.1 Occupation: women.37 Table 3.6.2 Occupation: men.38 Table 3.7.1 Type of employment: women .39 Table 3.7.2 Type of employment: men.40 Table 3.8 Health insurance coverage .41 Table 3.9.1 Knowledge and attitude concerning tuberculosis: women .42 Table 3.9.2 Knowledge and attitude concerning tuberculosis: men.43 Table 3.10.1 Use of tobacco: women.44 x │ Tables and Figures Table 3.10.2 Use of tobacco: men.45 CHAPTER 4 FERTILITY Table 4.1 Current fertility.47 Table 4.2 Fertility by background characteristics .48 Table 4.3 Trends in age-specific fertility rates.49 Table 4.4 Trends in current fertility rates.50 Table 4.5 Children ever born and living .51 Table 4.6 Birth intervals .52 Table 4.7 Age at first birth.53 Table 4.8 Median age at first birth by background characteristics .54 Table 4.9 Teenage pregnancy and motherhood.55 Figure 4.1 Total fertility rate by background characteristics .49 Figure 4.2 Trends in current fertility rates, Zimbabwe 1984-2006 .50 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods.58 Table 5.2 Knowledge of contraceptive methods by background characteristics .59 Table 5.3 Trends in knowledge of contraceptive methods.60 Table 5.4.1 Ever use of contraception: women .61 Table 5.4.2 Ever use of contraception: men.62 Table 5.5 Current use of contraception by age.64 Table 5.6 Trends in current use of contraceptive .66 Table 5.7.1 Current use of contraception by background characteristics: women .67 Table 5.7.2 Current use of contraception by background characteristics: men .68 Table 5.8 Number of children at first use of contraception.69 Table 5.9 Use of social marketing brand pills .70 Table 5.10 Use of social marketing brand condoms .71 Table 5.11 Knowledge of fertile period .71 Table 5.12 Source of modern contraceptive methods .73 Table 5.13 Informed choice.74 Table 5.14 Reasons for discontinuation.75 Table 5.15 Future use of contraception .76 Table 5.16 Reason for not intending to use contraception in the future .76 Table 5.17 Preferred method of contraception for future use.77 Table 5.18 Exposure to family planning messages .78 Table 5.19 Contact of nonusers with family planning providers.80 Table 5.20 Husband/partner's knowledge of woman's use of contraception .81 Figure 5.1 Use of specific contraceptive methods among currently married women.65 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status .84 Table 6.2 Number of co-wives and wives .85 Tables and Figures | xi Table 6.3 Age at first marriage .86 Table 6.4.1 Median age at first marriage: women .87 Table 6.4.2 Median age at first marriage: men .88 Table 6.5 Age at first sexual intercourse .89 Table 6.6.1 Median age at first intercourse: women.90 Table 6.6.2 Median age at first intercourse: men .91 Table 6.7.1 Recent sexual activity: women .92 Table 6.7.2 Recent sexual activity: men.93 Table 6.8 Postpartum amenorrhoea, abstinence, and insusceptibility .94 Table 6.9 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility .95 Table 6.10 Menopause.96 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children .98 Table 7.2.1 Desire to limit childbearing: women .99 Table 7.2.2 Desire to limit childbearing: men . 100 Table 7.3.1 Need and demand for family planning among currently married women . 101 Table 7.3.2 Need and demand for family planning for all women and for women who are not currently married. 102 Table 7.4 Ideal number of children. 105 Table 7.5 Mean ideal number of children. 106 Table 7.6 Fertility planning status. 107 Table 7.7 Wanted fertility rates. 108 CHAPTER 8 EARLY CHILDHOOD MORTALITY Table 8.1 Early childhood mortality rates . 111 Table 8.2 Trends in early childhood mortality . 111 Table 8.3 Early childhood mortality rates by socioeconomic characteristics . 112 Table 8.4 Early childhood mortality rates by demographic characteristics. 113 Table 8.5 Perinatal mortality . 115 Table 8.6 High-risk fertility behaviour . 117 CHAPTER 9 MATERNAL HEALTH CARE Table 9.1 Antenatal care. 120 Table 9.2 Number of antenatal care visits and timing of first visit . 121 Table 9.3 Components of antenatal care. 123 Table 9.4 Tetanus toxoid injections. 124 Table 9.5 Place of delivery. 125 Table 9.6 Assistance during delivery . 128 Table 9.7 Timing of first postnatal checkup. 130 Table 9.8 Type of provider of first postnatal checkup. 131 Table 9.9 Problems in accessing health care . 133 Figure 9.1 Delivery in health facility by wealth quintile . 126 xii │ Tables and Figures CHAPTER 10 CHILD HEALTH Table 10.1 Child's weight and size at birth . 136 Table 10.2 Vaccinations by source of information. 137 Table 10.3 Vaccinations by background characteristics . 138 Table 10.4 Trends in vaccination coverage . 140 Table 10.5 Prevalence and treatment of symptoms of acute respiratory infection. 141 Table 10.6 Prevalence and treatment of fever. 143 Table 10.7 Prevalence of diarrhoea . 144 Table 10.8 Diarrhoea treatment. 145 Table 10.9 Feeding practices during diarrhoea. 146 Table 10.10 Disposal of children's stools . 147 CHAPTER 11 NUTRITIONAL STATUS Table 11.1 Initial breastfeeding. 150 Table 11.2 Breastfeeding status by age. 151 Table 11.3 Median duration and frequency of breastfeeding . 152 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview. 154 Table 11.5 Infant and young child feeding (IYCF) practices . 156 Table 11.6 Foods consumed by mothers in the day or night preceding the interview. 158 Table 11.7 Prevalence of anaemia in children. 160 Table 11.8 Prevalence of anaemia in women . 161 Table 11.9 Prevalence of anaemia in men . 162 Table 11.10 Micronutrient intake among children . 164 Table 11.11 Micronutrient intake among mothers . 166 Table 11.12 Nutritional status of children . 169 Table 11.13 Nutritional status of women . 172 Figure 11.1 Infants and Young Child Feeding (IYCF) Practices . 157 Figure 11.2 Trends in the nutritional status of children under age three, Zimbabwe 1994-2006 . 171 CHAPTER 12 MALARIA Table 12.1 Ownership of mosquito nets . 173 Table 12.2 Use of mosquito nets by children . 174 Table 12.3 Use of mosquito nets by women . 176 Table 12.4 Prophylactic use of antimalarial drugs and use of intermittent-preventive treatment (IPT) by women during pregnancy. 177 Table 12.5 Prevalence and prompt treatment of fever . 179 Table 12.6 Type and timing of antimalarial drugs taken by children with fever. 180 Table 12.7 Interior walls of dwelling sprayed against mosquitoes . 181 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 13.1 Knowledge of HIV or AIDS. 184 Tables and Figures | xiii Table 13.2 Knowledge of HIV prevention methods. 185 Table 13.3.1 Comprehensive knowledge about HIV/AIDS: women . 187 Table 13.3.2 Comprehensive knowledge about HIV/AIDS: men . 188 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV . 190 Table 13.5.1 Accepting attitudes towards those living with HIV/AIDS: women. 192 Table 13.5.2 Accepting attitudes towards those living with HIV/AIDS: men. 193 Table 13.6 Attitudes towards negotiating safer sexual relations with husband. 194 Table 13.7 Adult support of education about condom use to prevent HIV . 195 Table 13.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: women. 196 Table 13.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: men . 197 Table 13.9 Payment for sexual intercourse and condom use at last paid sexual intercourse: men. 199 Table 13.10.1 Coverage of HIV testing services: women. 201 Table 13.10.2 Coverage of HIV testing services: men. 202 Table 13.11 Pregnant women counselled and tested for HIV. 203 Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms. 204 Table 13.13 Prevalence of injections . 206 Table 13.14 Comprehensive knowledge about HIV/AIDS and of a source of condoms among youth. 208 Table 13.15 Age at first sexual intercourse among youth. 209 Table 13.16 Condom use at first sexual intercourse among youth . 210 Table 13.17 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth. 211 Table 13.18.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: women . 213 Table 13.18.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: men . 214 Table 13.19 Drunkenness during sexual intercourse among youth . 216 Table 13.20 Coverage of HIV testing services among youth . 217 Figure 13.1 Source for treatment or advice for STI or STI symptoms. 205 CHAPTER 14 HIV PREVALENCE Table 14.1 Coverage of HIV testing by residence and province. 220 Table 14.2 Coverage of HIV testing by selected background characteristics. 221 Table 14.3 HIV prevalence by age . 222 Table 14.4 HIV prevalence by socioeconomic characteristics. 224 Table 14.5 HIV prevalence by demographic characteristics. 225 Table 14.6 HIV prevalence by sexual behaviour . 227 Table 14.7 HIV prevalence by other characteristics. 228 Table 14.8 Prior HIV testing by HIV status . 229 Table 14.9 HIV prevalence among young people by background characteristics . 230 Table 14.10 HIV prevalence among young people by sexual behaviour. 231 Table 14.11 Male circumcision prevalence . 232 xiv │ Tables and Figures Table 14.12 HIV prevalence by male circumcision . 233 Table 14.13 HIV prevalence among couples. 234 Figure 14.1 HIV prevalence by age and sex . 223 CHAPTER 15 ADULT AND MATERNAL MORTALITY Table 15.1 Data on siblings. 236 Table 15.2 Adult mortality rates . 237 Table 15.3 Trends in adult mortality rates . 237 Table 15.4 Maternal mortality. 239 Figure 15.1 Trends in age-specific mortality among women 15-49, Zimbabwe 1985-2006. 238 Figure 15.2 Trends in age-specific mortality among men 15-49, Zimbabwe 1985-2006. 238 CHAPTER 16 WOMEN’S STATUS AND HEALTH OUTCOMES Table 16.1 Employment and cash earnings of currently married women and men . 241 Table 16.2.1 Control over women's cash earnings and relative magnitude of women's earnings. 243 Table 16.2.2 Woman's control over her own earnings and over those of her husband/partner. 244 Table 16.3.1 Women's participation in decisionmaking . 245 Table 16.3.2 Women's participation in decisionmaking by background characteristics . 246 Table 16.4.1 Attitude towards wife beating: women. 249 Table 16.4.2 Attitude towards wife beating: men. 250 Table 16.5.1 Attitude towards refusing sexual intercourse with husband: women . 252 Table 16.5.2 Attitude towards refusing sexual intercourse with husband: men . 253 Table 16.5.3 Men's attitude towards a husband's rights when his wife refuses to have sexual intercourse . 254 Table 16.6 Current use of contraception by women's status . 255 Table 16.7 Widows dispossessed of property. 256 Figure 16.1 Number of household decisions in which currently married women participate. 247 CHAPTER 17 DOMESTIC VIOLENCE Table 17.1 Experience of physical violence. 261 Table 17.2 Persons committing physical violence. 262 Table 17.3 Force at sexual initiation . 263 Table 17.4 Experience of sexual violence. 264 Table 17.5 Age at first experience of sexual violence . 265 Table 17.6 Persons committing sexual violence . 266 Table 17.7 Experience of different forms of violence. 267 Table 17.8 Violence during pregnancy. 268 Table 17.9 Degree of marital control exercised by husbands. 270 Table 17.10 Forms of spousal violence . 271 Tables and Figures | xv Table 17.11 Spousal violence by background characteristics . 274 Table 17.12 Spousal violence by husband's characteristics and empowerment indicators. 275 Table 17.13 Frequency of spousal violence among those who report violence. 276 Table 17.14 Onset of spousal violence. 277 Table 17.15 Injuries to women due to spousal violence. 278 Table 17.16 Violence by women against their spouse . 279 Table 17.17 Seeking help to stop violence . 282 Table 17.18 Sources from where help was sought. 283 Figure 17.1 Percentage of ever-married women who have experienced violence by their current or last husband (ever and in the past 12 months). 272 CHAPTER 18 ORPHANS AND VULNERABLE CHILDREN Table 18.1 Children’s living arrangements and orphanhood. 286 Table 18.2 Orphans and vulnerable children (OVC) . 287 Table 18.3 School attendance by survivorship of parents and by OVC status . 289 Table 18.4 Possession of basic material needs by orphans and vulnerable children . 290 Table 18.5 Orphans not living with siblings. 291 Table 18.6 Underweight orphans and vulnerable children . 292 Table 18.7 Sexual intercourse before age 15 of orphans and vulnerable children. 293 Table 18.8 Succession planning . 294 Table 18.9 External support for very sick persons. 295 Table 18.10 External support for orphans and vulnerable children. 296 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation: women . 299 Table A.2 Sample implementation: men . 300 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors. 304 Table B.2 Sampling errors for National sample . 305 Table B.3 Sampling errors for Urban sample. 306 Table B.4 Sampling errors for Rural sample . 307 Table B.5 Sampling errors for Manicaland sample . 308 Table B.6 Sampling errors for Mashonaland Central sample . 309 Table B.7 Sampling errors for Mashonaland East sample. 310 Table B.8 Sampling errors for Mashonaland West sample. 311 Table B.9 Sampling errors for Matabeleland North sample . 312 Table B.10 Sampling errors for Matabeleland South sample . 313 Table B.11 Sampling errors for Midlands sample . 314 Table B.12 Sampling errors for Masvingo sample. 315 Table B.13 Sampling errors for Harare sample. 316 Table B.14 Sampling errors for Bulawayo sample . 317 Table B.15 Sampling errors for HIV prevalence rates by sex, urban-rural residence, and province . 318 xvi │ Tables and Figures APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 319 Table C.2.1 Age distribution of eligible and interviewed women . 320 Table C.2.2 Age distribution of eligible and interviewed men. 320 Table C.3 Completeness of reporting . 321 Table C.4 Reporting of age at death in days . 321 Table C.5 Reporting of age at death in months. 322 Table C.6 Births by calendar years . 323 Preface | xvii PREFACE The Central Statistical Office (CSO) conducted the fourth Zimbabwe Demographic and Health Survey (ZDHS) between August 2005 and March 2006. The last ZDHS was fielded in 1999. The 2005-06 ZDHS is one of a series of surveys undertaken by CSO as part of the Zimbabwe National Household Survey Capability Programme (ZNHSCP). The survey is also part of the worldwide Demographic and Health Surveys programme, which has been implemented in Africa, Asia, Latin America, and Europe. This report represents the major findings of the 2005-06 ZDHS; a preliminary report was published in August 2006. While significantly expanded in content, the 2005-06 ZDHS is a follow-on to the 1988, 1994, and 1999 ZDHS surveys and provides updated estimates of basic demographic and health indicators covered in those surveys. The 2005-06 ZDHS collected information on fertility levels; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections. Additionally, the 2005-06 ZDHS collected data on malaria prevention and treatment and domestic violence. The 2005-06 ZDHS is also the first survey in Zimbabwe to provide population-based prevalence estimates for anaemia among men, women and young children and HIV among women and men age 15-49. The Central Statistical Office extends its acknowledgement and gratitude to the various agencies and individuals in the government, the donor community, and the public sector for unrelenting support that facilitated the successful implementation of the survey. Specific mention, however is due to the following: the Ministry of Health and Child Welfare (MOH&CW), the Zimbabwe Family Planning Council (ZNFPC) and the Musasa Project for contributing significantly to the design, implementation, and analysis of the ZDHS results; the Government of Zimbabwe, the National Microbiology Reference Laboratory (NMRL), the United States Agency for International Development (USAID), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), the United Nations Children’s Fund (UNICEF), the Centers for Disease Control and Prevention (CDC), and the United Kingdom Department for International Development (DFID) for facilitating the successful implementation of the survey through technical and donor support; Macro International for providing technical assistance throughout the ZDHS project; all the field personnel engaged during the survey for commitment to high-quality work under difficult conditions; and finally the ZDHS respondents for their patience and cooperation. Moffat Nyoni Acting Director, Census and Statistics Central Statistical Office P.O. Box CY 342 Causeway Harare, Zimbabwe Summary of Findings | xix SUMMARY OF FINDINGS The 2005-06 Zimbabwe Demographic Health Survey (ZDHS) is a nationally representa- tive survey of 8,907 women age 15-49 and 7,175 men age 15-54. The 2005-06 ZDHS is the fourth comprehensive survey conducted in Zimbabwe as part of the Demographic and Health Surveys (DHS) programme. The data are intended to fur- nish programme managers and policymakers with detailed information on levels and trends in fertil- ity; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of moth- ers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/ AIDS and other sexually transmitted infections. The 2005-06 ZDHS is the first ZDHS survey to collect information on malaria prevention and treatment and domestic violence. The 2005-06 ZDHS is also the first survey in Zimbabwe to pro- vide population-based prevalence estimates for anaemia and HIV. Women age 15-49 and men age 15-54 were tested for anaemia and HIV. Children ages 6-59 months were tested for anaemia. FERTILITY The survey results show that Zimbabwe has ex- perienced a decline in fertility of almost 2 births over the past two decades, with the fertility rate falling from 5.4 births per woman at the time of the 1988 ZDHS to 3.8 births at the time of the 2005-06 survey. On average, rural women are hav- ing two children more than urban women (4.6 and 2.6, respectively). The low level of fertility among urban women is also reflected in the lower fertility among women in the urban provinces of Harare and Bulawayo, where women on average are hav- ing 2.5 or fewer children compared with 3.7 or more children in other provinces. Fertility differ- entials by education and wealth are substantial. Women who had no formal education and women in the lowest wealth quintile on average are having more than 5 children, while women with higher than a secondary education and women in the highest wealth quintile are having less than 3 chil- dren. Unplanned pregnancies are common in Zimbabwe. Overall, 13 percent of births are unwanted, while 20 percent are mistimed (wanted later). If all un- wanted births were prevented, women would have an average of 3.3 children, compared with the ac- tual average of 3.8 children. Marriage patterns are an important determinant of fertility levels in a population. The median age at first marriage in Zimbabwe among women age 25-49 is 19.3 years. Urban women marry one year later than rural women (20.1 and 18.8 years, re- spectively). For women age 25-49 with no educa- tion, the median age at first marriage is 17.7 years compared to 22.7 years for women with higher than a secondary education. Men enter into first union at a much later age than women; the median age at first marriage for men age 25-49 is 24.3 years. Only 13 percent of men age 25-49 married by age 20 compared with 57 percent of women. The average man and woman in Zimbabwe initi- ates sexual activity before marriage. Among the population age 25-49, the median age at first sex- ual intercourse is 20.2 years for men and 18.6 years for women. The 2005-06 ZDHS show that 11 percent of cur- rently married women are married to men who are in a polygynous union. Older women, women who live in rural areas, women with no education, and women in the lowest wealth quintiles are more likely than other women to have co-wives. The prevalence of polygyny varies markedly across provinces. Bulawayo has the lowest level (2 per- cent) and Mashonaland Central the highest (18 percent). xx | Summary of Findings FAMILY PLANNING Overall, knowledge of family planning in Zim- babwe has been nearly universal since 1994. In the 2005-06 ZDHS, 98 percent of all women reported knowing about a contraceptive method. The pill, male condoms, and injectables are the most widely known methods. Eighty-seven percent of currently married women have used a family planning method at least once in their lifetime. Sixty percent of currently married women are currently using any contraceptive method, and 58 percent report use of a modern method. The most popular method is the pill, used by more than 4 in 10 currently married women (43 percent). Ten percent of currently married women use injectables, while 1 percent of currently mar- ried women use the male condom. Government-sponsored facilities remain the chief providers of contraceptive methods in Zimbabwe. The distribution of sources of modern method supplies for current users shows that the majority of users (68 percent) obtain their contraceptives from the public sector. The participation of the private medical sector in family planning service delivery has almost doubled between 1994 and 2006 (from 12 to 22 percent). Eight percent of cur- rent users obtain their methods from retail outlets. Unmet need for family planning has remained at around the same level since 1999 (13 percent). If all married women with an unmet need for family planning were to use adopt a contraceptive meth- ods, the contraceptive prevalence rate in Zim- babwe would increase from 58 to 74 percent. Reducing discontinuation is important in address- ing unmet need. Across all family planning meth- ods, a significant proportion of discontinuations are the result of women becoming pregnant while using a method (12 percent) or of the experience of method-related side effects or health concerns (13 percent). CHILD HEALTH Data from the 2005-06 ZDHS indicate that the infant mortality rate was 60 deaths per 1,000 live births, while the under-five mortality rate was 82 per 1,000 live births for the five-year period im- mediately preceding the survey. The neonatal mor- tality rate was 24 per 1,000 births. Thus, approxi- mately three-quarters of childhood deaths occurred during infancy, with more than one-quarter taking place during the first month of life. Child mortality is consistently lower in urban ar- eas than in rural areas. There is also substantial variation in the mortality level across provinces. Under-five and infant mortality rates are highest in Manicaland and lowest in Matabeleland South and Bulawayo. Children whose mothers have more than a secondary education have somewhat lower mortality than children whose mothers have less education. In Zimbabwe, children are considered fully vacci- nated when they receive one dose of BCG vaccine, three doses each of DPT and polio vaccines, and one dose of measles vaccine. Overall, 53 percent of children 12-23 months old had received all vac- cinations at the time of the survey. Seventy-six percent of children had received the BCG vaccina- tion, and 66 percent had been vaccinated against measles. The coverage of the first dose of DPT and polio is relatively high (77 percent each). However, only 62 percent of children received the third dose of DPT and 66 percent received the third dose of polio. Comparison of the 2005-06 ZDHS results with those of the earlier surveys shows there has been a decline in vaccination cov- erage in Zimbabwe, from 80 percent in 1994 to 75 percent in 1999 to the current rate of 53 percent. Six percent of children under age five experienced symptoms of an acute respiratory infection (ARI) within the two weeks before the survey. Treatment from a health facility or provider was sought for one in four children (25 percent). Eight percent of children received antibiotics. Eight percent of children under five were reported to have had fever, a major manifestation of ma- laria, within the two weeks prior to the survey. More than a quarter of children (27 percent) were taken to a health facility or provider for treatment. A small percentage of children with fever received antimalarial drugs (5 percent), while more than twice as many (13 percent) received antibiotics. Summary of Findings | xxi At the time of the survey, diarrhoea was a more prevalent problem among young children than fe- ver; 12 percent of children under age five had diar- rhoea at some time within the two weeks before the survey. A third of children with diarrhoea were taken to a health provider. The majority (70 per- cent) of children were treated with some type of oral rehydration therapy (ORT): 6 percent were treated with solution prepared from an oral rehy- dration salt (ORS) packet; 61 percent were given recommended home fluids (RHF) prepared at home; and 32 percent were given increased fluids. A quarter of children with diarrhoea did not re- ceive any type of treatment at all. MATERNAL HEALTH In Zimbabwe, almost all women who had a live birth in the five years preceding the survey re- ceived antenatal care from health professionals (94 percent); 10 percent from a doctor and 84 percent from a trained nurse or midwife. Only 5 percent of mothers did not receive any antenatal care. Tetanus toxoid injections are given during preg- nancy to prevent neonatal tetanus. Nearly six in ten women (58 percent) who gave birth during the five-year period had had the tetanus toxoid injec- tions required to ensure that their last birth was protected against neonatal tetanus. The majority of births in the five years before the survey were delivered in a health facility (68 per- cent). This figure is slightly lower than that re- corded in the 1999 ZDHS (72 percent) and the 1994 ZDHS (69 percent). Fifty-five percent of births occurred in public health facilities and 13 percent occurred in private health facilities. Nine percent of births were assisted by a doctor and 60 percent by a nurse or midwife, 11 percent by a trained traditional birth attendant, and 16 percent by an untrained traditional birth attendant. Five percent of births were delivered by a Caesarean section. Overall, 54 percent of mothers received a postnatal checkup for the most recent birth in the five years preceding the survey, with 30 percent having the checkup within the critical 48 hours after delivery. BREASTFEEDING AND NUTRITION Among children under five years of age, 98 per- cent were breastfed at some point in their life. The median breastfeeding duration in Zimbabwe is long (18.8 months). Exclusive breastfeeding, on the other hand, is relatively short, with a median duration of less than one month. Only 22 percent of babies are exclusively breastfed throughout the first six months of life. More than three-quarters of children age 6-9 months receive complementary foods, and six in ten children age 18-23 months have been weaned. Bottle feeding is not very common; 3 percent of babies less than six months of age are fed with a bottle, and the proportion bottle-fed peaks at 10 percent among children 12- 17 months. More than half of Zimbabwean children (58 per- cent) age 6-59 months are classified as anaemic, with 28 percent mildly anaemic, 30 percent mod- erately anaemic, and 1 percent severely anaemic. The prevalence of anaemia among women is less pronounced than among children. Thirty-eight percent of women 15-49 are anaemic, with 27 per- cent mildly anaemic, 9 percent moderately anae- mic, and 1 percent severely anaemic. In contrast to the levels among young children and women, anaemia rates among men are quite moderate. Only 11 percent of men are anaemic, with 8 per- cent mildly anaemic, 2 percent moderately anae- mic, and less than 1 percent severely anaemic. Overall, 29 percent of children were stunted (short for their age) at the time of the survey, 6 percent were wasted (thin for their height), and 17 percent were underweight (thin for their age). All of the indices indicate that malnutrition increases with a child’s age, with prevalence peaking in the age range 12-23 months, and declining again as chil- dren approach their fifth birthday. For example, stunting affects nearly half of children 18-23 months, and 20 percent of children in that age range are severely stunted. Nine percent of chil- dren age 12-23 months are wasted and the highest rate of severe acute malnutrition is found in the 12-17 month age group (2 percent). xxii | Summary of Findings Overall, 66 percent of women have a body mass index (BMI) in the normal range. One in four women are overweight, with 7 percent classified as obese. At the other extreme, 9 percent are thin, and 2 percent are severely thin. MALARIA Twenty percent of all households interviewed dur- ing the survey had at least one mosquito net, while 7 percent had more than one. Nine percent of households had a net that had ever been treated with an insecticide. Most of the households own- ing an ever-treated net had at least one net meeting one of the insecticide-treated net (ITN) criteria, i.e., it was a factory-treated net that did not require re-treatment, a pre-treated net obtained within one year of the survey interview, or a net soaked in insecticide at some time during the year before the survey. Usage of bednets is relatively low among young children and pregnant women, groups which are particularly vulnerable to malaria’s effect. On the night before the survey, 4 percent of children un- der age five slept under an ever-treated net and 3 percent slept under an ITN. Three percent of preg- nant women slept under an ever-treated net and another 3 percent slept under an ITN. Fifteen percent of households reported that the interior walls of their dwelling had been sprayed, principally as part of a government programme (11 percent). Among these households, 35 percent reported that it had been less than three months since the walls were sprayed, while 23 percent indicated that it had been at least nine months since the walls had been sprayed. Among women who had their last birth in the two years before the survey, 38 percent took an anti- malarial drug during their pregnancy. Twelve per- cent of all pregnant women took at least one does of SP/Fansidar during their pregnancy. Seven per- cent reported taking two or more doses if SP/Fansidar. Almost all of the women who took SP/Fansidar were given the drug during an antena- tal care visit, and, are thus considered to have had preventive intermittent treatment (IPT). HIV/AIDS AND STIS Knowledge of HIV and AIDS is universal in Zim- babwe. Ninety-eight percent of women age 15-49 and 99 percent of men age 15-49 have heard of HIV or AIDS. However, less than half of women (44 percent) and men (47 percent) have what can be considered comprehensive knowledge about the modes of HIV transmission and prevention. Com- prehensive knowledge means knowing that use of condoms and having just one uninfected, faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission or preven- tion. Eighty percent of women and men know that HIV can be transmitted by breastfeeding. Fifty-seven percent of women and 46 percent of men know that the risk of mother-to-child transmission (MTCT) can be reduced by a mother taking spe- cial drugs during pregnancy. Given that most HIV infections in Zimbabwe are contracted through heterosexual contact, informa- tion on the level of higher-risk sex (i.e., sexual intercourse with a partner who is neither a spouse nor a cohabitating partner) is important for plan- ning prevention programmes. The 2005-06 results indicate that one percent of women and 14 percent of men have had two or more partners during the 12 months preceding the survey, and 11 percent of women and 36 percent of men have had higher- risk sexual intercourse. Among respondents who engaged in higher-risk sexual intercourse, 47 per- cent of women and 71 percent of men reported that they used a condom at the last high-risk sex- ual intercourse. Among the adult population age 15-49, 26 percent of women and 19 percent of men have been tested for HIV at some point in time. Twenty-two per- cent of women and 16 percent of men received their results. Results from the HIV testing component in the 2005-06 ZDHS indicate that 18 percent of Zim- babwean adults age 15-49 are infected with HIV. Among women, the HIV rate is 21 percent com- pared to 15 percent among men. Among women, Summary of Findings | xxiii HIV prevalence peaks at 36 percent in the 30-34 age group, which is six times the rate among women 15-19 and around twice the rate observed among women age 45-49. HIV prevalence in- creases from 3 percent among men in the 15-19 age group to 33 percent in the age group 40-44 and then decreases to 20 percent among men age 50-54. HIV prevalence is similar in urban and ru- ral areas (19 and 18 percent respectively). In gen- eral, the differentials by province also are not ex- tremely large. Matabeleland South had the highest prevalence rate (21 percent), followed closely by Manicaland (20 percent). Masvingo (15 percent) and Midlands (16 percent) had the lowest preva- lence. More than 2,000 cohabiting couples were tested for HIV in the 2005-2006 ZDHS. Results indicate that, among 72 percent of cohabiting couples, both partners tested negative for HIV. Both partners were HIV positive among 15 percent of cohabiting couples while 13 percent were discordant, that is, one partner was infected and the other was not. In 8 percent of couples, the male partner was infected and the woman was not, while in another 5 percent of couples, the woman was infected and the man was not. DOMESTIC VIOLENCE One eligible woman in each household was asked questions on domestic violence. In Zimbabwe, domestic violence occurs across all socioeconomic and cultural backgrounds. Over one-third of all women (36 percent) have experienced physical violence since they were 15, and 17 percent ex- perienced physical violence in the 12 months pre- ceding the survey. Among women who experi- enced violence since age 15, a total of 47 percent reported that their current husband or partner was the perpetrator and 18 percent reported that the perpetrator was a former husband or partner. Twelve percent of all women who have experi- enced physical violence since 15 reported that the perpetrator was their mother or step-mother. Among ever-married women, 57 percent reported that their current husband was the perpetrator. For never-married women, 22 percent reported that a teacher was the perpetrator and 21 percent re- ported that their mother or step-mother was the perpetrator. Overall, 25 percent of women reported that they have experienced sexual violence at some point in their lives. Among women who have ever had sexual intercourse, 21 percent reported that their first sexual intercourse was forced against their will. The majority (65 percent) of women reported that their current or former husband, partner, or boyfriend committed the act of sexual violence. It is important to highlight that among women who were less than 15 years old when their first experi- ence of sexual violence occurred, 7 percent re- ported that the perpetrators were a relative, 7 per- cent reported that the person was a family friend, and 4 percent reported that the person was a step father. ORPHANS AND VULNERABLE CHILDREN Six in ten Zimbabwean children under age 18 in the households sampled for the ZDHS surveyed were not living with both parents. More than one- quarter of children were not living with either par- ent. Just under one-quarter of children under age 18 were orphaned, that is, one or both parents were dead. A comparison of the results from the 1994 and 2005-2006 surveys for this age group indicates that there has been a dramatic increase in orphanhood. The proportion of children orphaned, i.e., with one or both parents dead, more than dou- bled between the two surveys, from 9 percent to 22 percent. The proportion of paternal orphans, i.e., those whose father had died, increased from 7 percent to 19 percent during period while the pro- portion that were maternal orphans rose from 3 to 9 percent between the 1994 ZDHS and the 2005- 2006 survey. The proportion of children with both parents dead doubled, from less than one percent to 6 percent. Overall, 1 in 10 children under age 18 was consid- ered as vulnerable, i.e., they lived in a household in which at least one adult had been chronically ill during the year before the survey or they had at least a parent living in the household or elsewhere who had suffered from a chronic illness. Three in ten children are considered orphaned or vulner- able. xxiv | Map of Zimbabwe Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY AND ECONOMY Zimbabwe lies just north of the Tropic of Capricorn between the Limpopo and Zambezi rivers. The country is landlocked, bordered by Mozambique on the east, South Africa on the south, Botswana on the west, and Zambia on the north and northwest. It is part of a great plateau, which constitutes the major feature of the geology of southern Africa. Almost the entire surface area of Zimbabwe is more than 300 metres above sea level, with nearly 80 percent of the land lying more than 900 metres above sea level and about 5 percent lying more than 1,500 metres above sea level. About 70 percent of the surface rock in Zimbabwe is granite, schist, or igneous, and it is rich in mineral wealth. Soil types range from clay or sandy loam in the high veldt to Kalahari sands in the hot and dry western part of the country. The climate of Zimbabwe is a blend of cool, dry, sunny winters and warm, wet summers. Average annual precipitation totals increase with increasing altitude; however, temperature drops with increasing altitude. The Eastern Highlands of the country are therefore associated with cool and wet conditions, while the Sabi, Limpopo, and Zambezi valleys are hot and dry. Mining and agriculture are the backbone of the country’s economy, even though the country is richly endowed with some of the world’s most impressive manmade and natural tourist attractions, such as the Great Zimbabwe Ruins and Victoria Falls. Zimbabwe has abundant natural resources, including 8.6 million hectares of potentially arable land and more than 5 million hectares of forests, national parks, and wildlife estates. There are adequate supplies of surface and ground water that could be harnessed for generation of electric power, irrigation of crops, and domestic and industrial use. Mineral resources are varied and extensive, including platinum, gold, asbestos, coal, nickel, iron, copper, lithium, and precious stones such as emeralds. The economy is diversified but biased toward agriculture and mining, which are by far the country’s major foreign-currency earning sectors. Besides mineral processing, major industries include food processing, construction, chemicals, textiles, wood and furniture, and production transport equipment. The main agricultural export products are tobacco, maize, cotton, sugar, and groundnuts. The agriculture sector has well-developed commercial and communal farming systems. The communal sector’s contribution towards the production of industrial raw materials and food products has increased substantially since 1980, despite its poor physical and socioeconomic infrastructure. In 1996-2000, the government of Zimbabwe implemented a five-year economic development programme, the Zimbabwe Programme for Economic and Social Transformation (ZIMPREST). It was envisaged that the government of Zimbabwe would implement ZIMPREST with financial support from the World Bank, the International Monetary Fund, and other international organisations. However, the financial aid was not received in a timely manner. ZIMPREST advocated adequate and sustainable economic growth and social development to reduce poverty and create a basis for all of Zimbabwe’s citizens to provide a better life for themselves and their children. 2 | Introduction 1.2 POPULATION In the 2002 census, the population of Zimbabwe was 11.6 mil- lion. Estimates, rather than actual counts, of the total population are available from the beginning of the century through 1951, when the census began to include non-Africans. Table 1.1 presents population growth rates for several years compiled from the population censuses. The average annual growth in the population reached a peak of 3.5 per- cent in 1951 and 1961, and then dropped to 3 percent between 1982 and 1992. The annual population growth rate between 1992 and 2002 was 1.1 percent. Table 1.2 shows that the population of people of African descent was 99 percent in 2002. The population of European, Asian, and Coloured descendants made up the remaining 1 percent in 2002. The 2002 census estimated the crude birth rate (CBR) and the crude death rate (CDR) to be about 30 births per thousand population and 17 deaths per thousand population, respectively. Forty-one percent of the population of Zimbabwe was below 15 years of age, 55 percent was between the ages of 15 and 64 years, and a very small proportion (4 percent) was 65 years of age or more. 1.3 OBJECTIVES OF THE SURVEY The 2005-2006 Zimbabwe Demographic and Health Survey (2005-06 ZDHS) is one of a series of surveys undertaken by the Central Statistical Office (CSO) as part of the Zimbabwe National Household Survey Capability Programme (ZNHSCP) and the worldwide MEASURE DHS programme. The Ministry of Health and Child Welfare (MOH&CW), Zimbabwe National Family Planning Council (ZNFPC), and the Musasa Project contributed significantly to the design, implementation, and analysis of the 2005-06 ZDHS results. Financial support for the 2005-06 ZDHS was provided by the government of Zimbabwe, the United States Agency for International Development (USAID), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United Kingdom Department for International Development (DFID), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), and the Centres for Disease Control and Prevention (CDC). The Demographic and Health Research Division of Macro International Inc. (Macro) provided technical assistance during all phases of the survey. While significantly expanded in content, the 2005- 06 ZDHS is a follow-on to the 1988, 1994, and 1999 ZDHS and provides updated estimates of basic demo- Table 1.1 Population size and growth rate Population size and annual rate of increase in the population, Zimbabwe 1901-2002 Year Population (‘000) Annual growth rate (percent) 1901 713 - 1911 907 2.4 1921 1,147 2.4 1931 1,464 2.5 1941 2,006 3.2 1951 2,829 3.5 1961 3,969 3.5 1969 5,134 3.3 1982 7,608 3.0 1992 10,412 3.1 2002 11,632 1.1 Source: Central Statistical Office, 2002 Table 1.2 Demographic indicators Selected demographic indicators, Zimbabwe 1992 and 2002 Indicator 1992 Census 2002 Census Total population (thousands) 10,412 11,632 Distribution by ethnic group (percent) African 98.8 99.3 European 0.8 0.4 Coloured 0.3 0.2 Asian 0.1 0.1 Distribution by age group (percent) 0-14 45.1 40.6 15-64 51.3 55.0 65+ 3.3 4.0 Not stated 0.3 0.4 Crude birth rate (CBR) Births per 1,000 population 34.5 30.3 Crude death rate (CDR) Births per 1,000 population 9.5 17.2 Number of males per 100 females in the total population 95 94 Life expectancy at birth 61.0 45.0 Source: Central Statistical Office, 2002 Introduction | 3 graphic and health indicators covered in the earlier surveys. In addition, data on malaria prevention and treatment, domestic violence, anaemia, and HIV/AIDS were also collected in the 2005-06 ZDHS. The primary objectives of the 2005-06 ZDHS project are to provide up-to-date information on fertility levels; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness, behaviour, and prevalence regarding HIV/AIDS and other sexually transmitted infections (STIs). 1.4 ORGANISATION OF THE SURVEY 1.4.1 Sample The sample for the 2005-06 ZDHS was designed to provide population and health indicator estimates at the national and provincial levels. The sample design allowed for specific indicators, such as contraceptive use, to be calculated for each of the 10 provinces (Manicaland, Mashonaland Central, Mashonaland East, Mashonaland West, Matabeleland North, Matabeleland South, Midlands, Masvingo, Harare, and Bulawayo). The sampling frame used for the 2005-06 ZDHS was the 2002 Zimbabwe Master Sample (ZMS02) developed by CSO after the 2002 population census. With the exception of Harare and Bulawayo, each of the other eight provinces was stratified into four strata according to land use: communal lands, large-scale commercial farming areas (LSCFA), urban and semi-urban areas, small- scale commercial farming areas (SSCFA), and resettlement areas. Only one urban stratum was formed each for Harare and Bulawayo, providing a total of 34 strata. A representative probability sample of 10,800 households was selected for the 2005-06 ZDHS. The sample was selected in two stages with enumeration areas (EAs) as the first stage and households as the second stage sampling units. In total 1,200 EAs were selected with probability proportional to size (PPS), the size being the number of households enumerated in the 2002 census. The selection of the EAs was a systematic, one-stage operation carried out independently for each of the 34 strata. The 1,200 ZMS02 EAs were divided into three replicates of 400 EAs each. One of the replicates consisting of 400 EAs was used for the 2005-06 ZDHS. In the second stage, a complete listing of households and mapping exercise was carried out for each cluster in January 2005. The list of households obtained was used as the frame for the second stage random selection of households. The listing excluded people living in institutional households (army barracks, hospitals, police camps, boarding schools, etc.). CSO provincial supervisors also trained provincial CSO officers to use global positioning system (GPS) receivers to take the coordinates of the 2005-06 ZDHS sample clusters. All women age 15-49 and all men age 15-54 who were either permanent residents of the households in the 2005-06 ZDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. Anaemia and HIV testing was performed in each household among eligible women and men who consented to either or both tests. With the parent’s or guardian’s consent, children age 6-59 months were tested for anaemia in each household. In addition, a sub-sample of one eligible woman in each household was randomly selected to be asked additional questions about domestic violence. 1.4.2 Questionnaires Three questionnaires were used for the 2005-06 ZDHS: a Household Questionnaire, a Women’s Questionnaire, and a Men’s Questionnaire. These questionnaires were adapted to reflect the population and health issues relevant to Zimbabwe at a series of meetings with various stakeholders from 4 | Introduction government ministries and agencies, nongovernmental organizations, and international donors. Three language versions of the questionnaires were produced: Shona, Ndebele, and English. The Household Questionnaire was used to list all the usual members and visitors of 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. For children under age 18, survival status of the parents was determined. If a child in the household had a parent who was sick for more than three consecutive months in the 12 months preceding the survey or a parent who had died, additional questions related to support for orphans and vulnerable children were asked. Additionally, if an adult in the household was sick for more than three consecutive months in the 12 months preceding the survey or an adult in the household died, questions were asked related to support for sick people or people who have died. The Household Questionnaire was also used to identify women and men who were eligible for the individual interview. Additionally, 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, weight, and haemoglobin measurements for children age 6-59 months. 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.) • Birth history and childhood mortality • Knowledge and use of family planning methods • Fertility preferences • Antenatal, delivery and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Women’s work and husband’s background characteristics • Women’s and children’s nutritional status • Domestic violence • Awareness and behaviour regarding AIDS and other sexually transmitted infections (STIs) • Adult mortality including maternal mortality. As in the 1999 ZDHS, a “calendar” was used in the 2005-06 ZDHS to collect information on the respondent’s reproductive history since January 2000 concerning contraceptive method use, sources of contraception, reasons for contraceptive discontinuation, and marital unions. In addition, interviewing teams measured the height and weight of all children under the age of five years and of all women age 15-49. The Men’s Questionnaire was administered to all men age 15-54 in each household in the 2005- 06 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 detailed reproductive history or questions on maternal and child health or nutrition. 1.4.3 Anaemia and HIV Testing Protocol In each household selected for the 2005-06 ZDHS, women age 15-49, men age 15-54, and children age 6-59 months were tested for anaemia. In addition, all eligible women and men were tested Introduction | 5 for HIV. Anaemia and HIV testing were only carried out if consent was provided by the respondents and, in the case of an unmarried minor age 15-17, by the parent or guardian. Additionally, respondents were asked if they would consent to anonymous storage of their dried blood spot (DBS) sample to be used for further research at a later date. Consent for HIV, anaemia, and additional testing were obtained separately. The protocol for haemoglobin and HIV testing was approved by the Medical Research Council of Zimbabwe in Harare, Zimbabwe; the ORC Macro Institutional Review Board in Calverton, Maryland, USA; and the CDC in Atlanta, Georgia, USA. Anaemia Testing Haemoglobin testing is the primary method of anaemia diagnosis. In the 2005-06 ZDHS, testing was performed using the HemoCue system. A consent statement was read to the eligible woman and to the parent or responsible adult of young children and unmarried women and men age 15-17. This statement explained the purpose of the test, informed prospective subjects tested and/or their caretakers that the results would be made available as soon as the test was completed, and requested permission for the test to be carried out. The statement also requested consent to refer respondents to a local health facility if their haemoglobin level indicated severe anaemia. The MOH&CW provided anaemia tablets to the health facilities serving the clusters included in the 2005-06 ZDHS sample. Before the blood was taken, the finger was wiped with an alcohol prep pad and allowed to air dry. Then the finger was punctured with a sterile, nonreusable, self-retractable lancet and a drop of blood was collected on a HemoCue microcuvette and placed in a HemoCue photometer which displayed the result. For children 6-11 months who were particularly undernourished or thin, a heel puncture was performed to draw a drop of blood. For children 6-59 months of age, the results were recorded in the Household Questionnaire. For adult women age 15-49 years and men age 15-54 years, the results were recorded in the Women’s and Men’s Questionnaire, respectively. For each person whose haemoglobin level was severe and who agreed to have the condition reported, a referral was given to the respondent to be taken to a health facility. HIV Testing Eligible women and men selected for HIV testing who were interviewed were asked to voluntarily provide five drops of blood for HIV testing. The protocol for the blood specimen collection and analysis was based on the anonymous linked protocol developed for MEASURE DHS. The protocol allows for the merging of the HIV results to the sociodemographic data collected in the individual questionnaires, provided that information that could potentially identify an individual is destroyed before the linking takes place. Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the subject. They also explained the option of DBS storage for use in additional testing. If a respondent consented to the HIV testing, five blood spots from the finger prick were collected on a filter paper card to which a bar code label unique to the respondent was affixed. If the respondent did not consent to additional testing using their sample, the words “no further testing” were written on the filter paper card. Each household, whether individuals consented to HIV testing or not, was given an information brochure on HIV/AIDS and a list of fixed sites, grouped by province, providing voluntary counselling and testing (VCT) services. Each DBS sample was given a bar code label, and a duplicate label was attached to the Individual Questionnaire. A third copy of the same bar code was affixed to the Blood Sample Transmittal Form to track the blood samples from the field to the laboratory. DBS samples were dried overnight and packaged for storage the following morning. Samples were periodically collected in the field along with the 6 | Introduction completed questionnaires and transported to CSO in Harare to be logged in, checked, and transported to the National Microbiology Reference Laboratory (NMRL) for testing. The processing of DBS samples for HIV testing at NMRL was handled by two laboratory scientists. The DBS samples were logged into the Census and Survey Processing System (CSPro) HIV Test Tracking System (CHTTS) database, each given a laboratory number, and stored at -20˚C until tested. All samples were tested on the first assay test, an enzyme-linked immunosorbent assay (ELISA), Vironostika® HIV Uni-Form II Plus O, bioMerieux. A negative result was considered negative. All positives were subjected to a second ELISA test by AniLab Systems, Finland, compatible with ELISYS 2 (a fully automated ELISA analyzer manufactured by Human of Germany). Positive samples on the second test were considered positive. If the first and second tests were discrepant, the sample was retested with tests 1 and 2. If on repeat of tests 1 and 2 both were negative, the sample was rendered negative. If both were positive, the sample was rendered positive. If there was still a discrepancy in the results after repeating tests 1 and 2, a third confirmatory test, Genetic Systems New LAV Blot I (a Western Blot by Bio-Rad France), was administered. The final result was rendered positive if the tests showed inconsistent results on the repeat ELISAs. The final result was also rendered positive if the Western Blot confirmed the result to be positive, and rendered negative if the Western Blot confirmed it to be negative. If the results were still discordant, the sample was rendered indeterminate. The HIV test results for the 2005-06 ZDHS were entered into a spreadsheet with a barcode as the unique identifier to the result. 1.4.4 Training and Fieldwork CSO staff and a variety of experts from government ministries, nongovernmental organizations (NGOs), and donor organizations participated in a three-day training of trainers (TOT) conducted in April 2005. Immediately following the TOT, the pretest training and fieldwork took place in April and May 2005. The pretest fieldwork was conducted in Gweru and surrounding areas, where both Shona and Ndebele households could easily be identified. For two weeks, 16 qualified nurses and Advanced-Level graduates were trained to administer the questionnaires, take anthropometric measurements, and collect blood samples for anaemia and HIV testing. Representatives from the NMRL and CDC/Zimbabwe assisted in training participants on the finger prick for blood collection, and proper handling and storage of the DBS samples for HIV testing. The pretest fieldwork was conducted in two separate six-day phases, covering approximately 200 households. Debriefing sessions were held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. Pretest interviewers were retained to serve as field editors and team supervisors during the main survey. Training of field staff for the main survey was conducted during a four-week period in July 2005. Permanent CSO staff, as well as staff of MOH&CW, ZNFPC, the Musasa Project, and Macro International Inc. trained 130 interviewer trainees, most of whom were trained nurses or Advanced-Level graduates. The training course consisted of instruction regarding interviewing techniques and field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children, collecting blood samples for anaemia and HIV testing, mock interviews between participants in the classroom, and practice interviews with real respondents in areas outside the 2005-06 ZDHS sample points. Trainees who performed satisfactorily in the training programme were selected as interviewers, while the remainder were retained to assist in office operations. During this period, field editors and team supervisors were provided with additional training in methods of field editing, data quality control procedures, and fieldwork coordination. Introduction | 7 Fourteen interviewing teams carried out the fieldwork for the 2005-06 ZDHS. Each team consisted of one team supervisor, one field editor, three or four female interviewers, two or three male interviewers, and one driver. In total, there were 14 team supervisors, 14 field editors, 44 female interviewers, 43 male interviewers, 24 data capture clerks, and 14 drivers. Nine permanent senior CSO staff coordinated and supervised fieldwork activities. Data collection took place over a seven-month period, from August 2005 to February 2006. 1.4.5 Data Processing All questionnaires for the 2005-06 ZDHS were returned to the CSO for data processing, which consisted of office editing, coding of open-ended questions, data entry, and secondary editing of computer-identified errors. The secondary editing involved checking and, if necessary, resolving inconsistencies in the data identified by the editing program. The data were processed in two shifts by a team of 24 data entry clerks, 2 data editors, 2 data entry supervisors, and administrators to receive and check the blood samples from the field. Data entry and editing was accomplished using the software package CSPro. Fourteen microcomputers were used for data processing. These were networked via a local area network connection to allow greater control by supervisors over the data entry process and to increase the security of the data. This also facilitated updating data entry software from a single location without interrupting data entry, and the ability to perform automatic daily backups of the data files. Twelve computers were used for data entry, while the other two computers were reserved for supervisory duties. Supervisor computers were used for the allocation of batches to operators, secondary editing, and scanning of DBS barcodes. Data processing commenced in September 2005 and, after data collection was completed in February 2006, a second shift comprising 12 operators and 2 supervisors (drawn from field interviewers/ editors with computer experience) was introduced to speed up data entry. There was 100 percent verifi- cation (re-entry) of all questionnaires so as to maxi- mize the quality of the data and to reduce the secondary editing process. Secondary editing was completed in March 2006. The final data cleaning was performed for two weeks in May 2006, after which the tables for preliminary results were generated from the imputed raw data. 1.4.6 Response Rates Table 1.3 shows response rates for the 2005-06 ZDHS. A total of 10,752 households were selected for the sample, of which 9,778 were currently occupied. The shortfall was largely due to some households no longer existing in the sampled clusters at the time of the interview. Of the 9,778 existing households, 9,285 were successfully interviewed, yielding a household response rate of 95 percent. In the interviewed households, 9,870 eligible women were identified and, of these, 8,907 were interviewed, yielding a response rate of 90 percent. Of the 8,761 eligible men identified, 7,175 were successfully interviewed (82 percent response rate). The principal reason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the households. The lower response rate among men than among women was due to the more frequent and longer absences of men from the households. Table 1.3 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Zimbabwe 2005-2006 Residence Result Urban Rural Total Household interviews Households selected 3,455 7,297 10,752 Households occupied 3,248 6,530 9,778 Households interviewed 3,056 6,229 9,285 Household response rate 94.1 95.4 95.0 Interviews with women Number of eligible women 3,763 6,107 9,870 Number of eligible women interviewed 3,203 5,704 8,907 Eligible women response rate 85.1 93.4 90.2 Interviews with men Number of eligible men 3,421 5,340 8,761 Number of eligible men interviewed 2,459 4,716 7,175 Eligible men response rate 71.9 88.3 81.9 Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter presents information on some socioeconomic characteristics of the household population and the individual survey respondents, such as age, sex, education, and place of residence. The environmental profile of households in the 2005-06 ZDHS sample is also examined. Taken together, these descriptive data provide a context for the interpretation of demographic and health indices and can furnish an approximate indication of the representativeness of the survey. The 2005-06 ZDHS collected information from all usual residents of a selected household (the de jure population) and persons who had stayed in the selected household the night before the interview (the de facto population). Because the difference between these two populations is small, to maintain comparability with other surveys, all tables in this report refer to the de facto population unless otherwise specified. 2.1 HOUSEHOLD POPULATION BY AGE, SEX, AND RESIDENCE The 2005-06 ZDHS Household Questionnaire was used to collect data on the demographic and social characteristics of all usual residents of the sampled household and on visitors who had spent the previous night in the household.1 Table 2.1 shows the distribution of the 2005-06 ZDHS household population by five-year age groups, according to sex and urban-rural residence. The ZDHS households constitute a population of 40,805 individuals; 52 percent of the population are female and 48 percent are male. There are larger numbers of the population in the younger age groups than in the older age groups of each sex, particularly in rural areas. The age-sex structure of the population is shown by use of a population pyramid in Figure 2.1. The pyramid has a wide but tapering base, a pattern that is consistent with a population experiencing a decline in fertility. The number of children under five is less than the number age five to nine years, a finding that is consistent with a recent fertility decline. The proportion of children under 15 years of age was around 44 percent in 2005-06, while that of persons over 65 years of age was about 5 percent. 1 A household refers to a person or group of related and unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as head of household, who share the same housekeeping arrangements, and who are considered one unit. A member of the household is any person who usually lives in the household, and a visitor is someone who is not a usual member of the household but had slept in the household the night before the interview date. The household population presented in this chapter includes, unless otherwise stated, all usual members of the household who slept in the household the night before the survey and visitors (de facto population). 10 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Zimbabwe 2005-2006 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 12.0 11.8 11.9 16.4 14.1 15.2 15.0 13.4 14.1 5-9 12.7 11.2 11.9 18.3 15.2 16.6 16.5 13.9 15.1 10-14 11.5 11.0 11.2 17.3 15.6 16.4 15.5 14.2 14.8 15-19 10.4 13.7 12.1 11.9 9.7 10.7 11.4 10.9 11.2 20-24 12.6 14.1 13.4 7.2 8.1 7.7 9.0 10.0 9.5 25-29 9.7 9.9 9.8 5.5 6.7 6.1 6.8 7.7 7.3 30-34 8.3 7.5 7.9 4.4 5.8 5.1 5.7 6.3 6.0 35-39 6.3 6.1 6.2 3.4 3.7 3.6 4.3 4.5 4.4 40-44 3.9 4.4 4.1 2.4 3.2 2.8 2.9 3.6 3.2 45-49 3.3 2.8 3.0 2.3 3.1 2.7 2.6 3.0 2.8 50-54 3.0 2.9 3.0 1.6 3.8 2.7 2.0 3.5 2.8 55-59 2.2 1.3 1.8 2.3 3.0 2.7 2.3 2.4 2.4 60-64 1.5 1.3 1.4 1.8 2.1 1.9 1.7 1.8 1.7 65-69 1.2 0.7 0.9 1.8 1.8 1.8 1.6 1.4 1.5 70-74 0.6 0.6 0.6 1.4 1.5 1.4 1.1 1.2 1.2 75-79 0.3 0.3 0.3 1.0 1.0 1.0 0.8 0.8 0.8 80+ 0.6 0.4 0.5 1.1 1.7 1.4 0.9 1.3 1.1 Number 6,226 6,688 12,914 13,215 14,674 27,891 19,441 21,361 40,805 ZDHS 2005-2006 Figure 2.1 Population Pyramid 80 + 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 <5 Age 0246810 0 2 4 6 8 10 Male Female Percent Household Population and Housing Characteristics | 11 2.2 HOUSEHOLD COMPOSITION Table 2.2 shows that a female heads more than one in three households in Zimbabwe (38 per- cent). The proportion of female-headed households has increased slightly from 34 percent in the 1999 ZDHS to 38 percent 2005-06 ZDHS. The proportion of female-headed households also increased in urban areas (23 to 29 percent) and rural areas (39 to 43 per- cent) for the same time period. The average house- hold size has increased slightly from 4.2 people in 1999 to 4.5 people in 2005-06. Urban households are, on average, slightly smaller (4.1 people) than rural households (4.6 people). Overall, 35 percent of households have foster children, as do 25 percent of urban households and 40 percent of rural households. This is an increase since 1999 when 21 percent of households had foster children with 11 percent in urban areas and 27 percent in rural areas. Foster children are those individuals under 15 years of age who have no natural parent in the household. The total number of households interviewed was 9,285 of which 66 percent and 34 percent were in rural and urban areas, respectively. 2.3 EDUCATION OF THE HOUSEHOLD POPULATION 2.3.1 EDUCATIONAL ATTAINMENT The educational level of household members is among the most important characteristics of the household because it is associated with many phenomena that have a significant impact on health-seeking behaviour, reproductive behaviour, use of contraception, and the health of children. Table 2.3 shows the distribution of female and male household members age 6 years and above by the highest level of education ever attended (even if they did not complete that level) and the median number of years of education completed, according to age, urban-rural residence, province, and wealth quintile. Survey results show that the majority of Zimbabweans have attained some form of education. Generally, educational attainment is slightly higher for males than for females, with 91 percent of males having attended school versus 88 percent of females. However, in Zimbabwe there is very little difference by sex among other educational attainment indices. The percentage for males and females who had only some primary education is similar (42 percent for males and 43 percent for females). Likewise, 7 percent of males and 6 percent of females completed primary school but did not go on to the secondary level. Thirty-seven percent of males had some secondary schooling, compared with 36 percent of females. A relatively small amount of males (2 percent) and females (1 percent) completed secondary school and did not go on to attain any post-secondary education. The percentage of males (4 percent) and females (2 percent) in the 2005-06 ZDHS who had more than a secondary education remained the same as what was observed in the 1994 ZDHS. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size; and mean size of household, according to residence, Zimbabwe 2005-2006 Residence Characteristic Urban Rural Total Household headship Male 71.5 57.4 62.3 Female 28.5 42.6 37.7 Number of usual members 0 0.2 0.1 0.1 1 11.0 9.7 10.1 2 13.1 10.3 11.3 3 18.4 15.2 16.3 4 20.5 16.9 18.1 5 13.9 16.3 15.5 6 9.8 11.1 10.6 7 6.4 8.1 7.5 8 3.5 5.1 4.5 9+ 3.3 7.3 5.9 Percentage with foster children 25.1 39.7 34.6 Mean size of households 4.1 4.6 4.5 Number of households 3,201 6,084 9,285 Note: Table is based on de jure members, i.e., usual residents. 12 | Household Population and Housing Characteristics Table 2.3 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 attended or completed, according to background characteristics, Zimbabwe 2005-2006 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Number Median number of years FEMALE Age 6-9 28.7 70.6 0.0 0.3 0.0 0.0 0.4 2,372 0.5 10-14 1.1 69.8 17.9 10.7 0.0 0.0 0.4 3,024 4.7 15-19 0.8 23.2 4.9 69.8 0.8 0.3 0.1 2,335 7.6 20-24 1.0 20.3 3.8 69.4 2.7 2.9 0.0 2,134 9.1 25-29 1.1 24.1 5.0 64.2 0.8 4.6 0.2 1,639 8.5 30-34 3.2 26.9 3.8 59.7 1.2 4.7 0.6 1,348 7.9 35-39 4.1 29.8 3.5 56.5 0.9 4.9 0.3 954 7.8 40-44 17.0 42.2 6.9 27.5 0.7 5.5 0.3 765 6.2 45-49 20.0 52.2 6.4 16.5 0.5 3.7 0.7 649 4.9 50-54 22.7 51.8 7.2 14.9 0.3 1.7 1.5 751 4.3 55-59 30.2 48.8 5.5 13.9 0.1 1.0 0.4 522 3.2 60-64 34.9 46.0 6.1 7.7 0.2 2.7 2.3 389 2.5 65+ 53.8 36.2 3.0 3.3 0.3 1.0 2.5 1,008 0.0 Residence Urban 4.8 28.2 4.2 55.6 2.0 4.6 0.7 5,746 7.8 Rural 15.2 49.6 7.4 26.4 0.1 0.8 0.5 12,154 5.1 Province Manicaland 11.2 49.5 6.7 30.5 0.5 1.4 0.3 2,238 5.8 Mashonaland Central 19.8 44.6 8.2 25.9 0.3 1.1 0.2 1,781 4.8 Mashonaland East 14.0 43.6 7.0 32.9 0.2 1.6 0.7 1,710 5.8 Mashonaland West 14.9 44.2 6.1 31.5 0.4 1.8 1.1 1,679 5.6 Matabeleland North 17.7 50.9 6.0 23.6 0.4 1.2 0.1 1,275 5.1 Matabeleland South 12.2 47.9 7.3 28.4 0.7 2.7 0.9 1,042 5.8 Midlands 10.5 45.1 7.2 34.2 0.4 2.3 0.4 2,476 6.1 Masvingo 11.6 49.2 8.1 29.7 0.3 0.6 0.5 2,098 5.6 Harare 5.2 26.0 3.1 59.1 1.8 4.2 0.6 2,412 8.2 Bulawayo 4.5 28.3 3.6 56.6 2.7 3.3 1.0 1,187 7.8 Wealth quintile Lowest 22.2 53.8 7.6 15.9 0.0 0.0 0.3 3,443 3.9 Second 16.2 50.7 7.9 24.6 0.0 0.1 0.4 3,508 4.8 Middle 11.4 48.3 7.4 31.8 0.1 0.3 0.7 3,749 5.6 Fourth 6.5 37.0 5.4 47.8 0.5 2.1 0.5 3,368 6.8 Highest 3.8 25.1 3.5 57.1 2.8 7.1 0.7 3,832 8.8 Total 11.9 42.7 6.3 35.8 0.7 2.0 0.5 17,900 6.1 Continued. Household Population and Housing Characteristics | 13 Table 2.3—Continued Percent distribution of the de facto female and male household population age six and over by highest level of education attended or completed, according to background characteristics, Zimbabwe 2005-2006 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Number Median number of years MALE Age 6-9 31.4 67.8 0.2 0.1 0.0 0.0 0.5 2,552 0.4 10-14 1.2 73.6 16.7 7.9 0.0 0.0 0.6 3,007 4.2 15-19 0.6 24.2 6.9 66.3 1.2 0.4 0.3 2,219 7.3 20-24 0.8 17.1 4.1 65.3 6.7 5.7 0.2 1,742 9.2 25-29 1.1 18.5 3.2 64.8 4.0 8.3 0.1 1,329 9.2 30-34 1.2 16.0 2.9 68.2 2.8 8.9 0.1 1,106 9.2 35-39 1.5 14.4 1.7 69.1 2.7 10.6 0.1 844 9.3 40-44 4.6 31.5 4.8 46.3 0.7 12.0 0.0 556 7.6 45-49 8.0 43.1 8.7 32.2 0.6 6.7 0.6 504 6.6 50-54 7.1 44.9 6.3 34.4 1.3 5.4 0.6 397 6.4 55-59 13.3 38.6 10.3 30.5 1.0 4.2 2.1 445 6.1 60-64 18.5 41.4 8.0 27.1 0.6 4.2 0.2 325 5.6 65+ 28.3 47.7 8.4 11.2 0.0 2.8 1.6 856 3.3 Residence Urban 4.3 26.2 4.0 53.4 3.9 7.7 0.6 5,310 8.8 Rural 10.7 49.4 8.0 29.2 0.6 1.7 0.4 10,574 5.5 Province Manicaland 8.6 43.8 9.5 32.6 1.4 3.7 0.4 1,925 6.0 Mashonaland Central 12.3 46.0 7.3 30.9 1.2 2.1 0.3 1,628 5.4 Mashonaland East 9.5 42.5 7.1 37.1 0.7 2.7 0.5 1,508 6.2 Mashonaland West 10.0 43.5 6.2 36.3 1.2 1.8 1.0 1,568 6.1 Matabeleland North 12.6 54.9 7.8 22.2 0.1 2.3 0.0 1,137 5.3 Matabeleland South 9.6 50.4 7.4 26.7 1.4 3.9 0.6 831 6.0 Midlands 9.0 44.0 6.4 35.6 1.5 3.1 0.4 2,207 6.1 Masvingo 7.2 48.3 7.5 33.8 1.0 2.1 0.2 1,797 6.0 Harare 4.3 24.0 4.1 55.5 3.8 7.7 0.4 2,248 9.1 Bulawayo 4.6 26.6 3.7 53.0 4.4 6.6 1.1 1,034 7.9 Wealth quintile Lowest 15.4 57.6 8.8 17.9 0.2 0.0 0.2 2,951 4.1 Second 11.4 51.0 8.1 28.4 0.2 0.5 0.4 3,051 5.3 Middle 8.3 46.0 7.7 35.3 1.0 1.1 0.6 3,113 6.0 Fourth 5.2 32.4 5.5 50.0 1.8 4.6 0.5 3,520 7.2 Highest 3.8 24.0 3.8 51.4 5.0 11.4 0.6 3,248 9.1 Total 8.6 41.6 6.7 37.3 1.7 3.7 0.5 15,883 6.3 Note: In Zimbabwe, primary level is referred to as grades 1-7. Secondary level is referred to as forms 1-6. With the primary and secondary levels combined, there is a total of 13 years of schooling. 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level The median number of years of educational attainment is six for both males and females. As expected, educational attainment is higher for all indicators in urban areas and among the population in the highest wealth quintile. 14 | Household Population and Housing Characteristics 2.3.2 School Attendance Ratios In Table 2.4, school attendance ratios by level of schooling, sex, residence, province, and wealth quintile for the population age 6 to 24 years are presented. The net attendance ratio (NAR) is an indicator of participation in schooling among children of official school age, and the gross attendance ratio (GAR) indicates the participation at each level of schooling among all children between the ages of 7 and 18 years. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level.2 Data in Table 2.4 show that, among children age 7 to 12 years, 91 percent attended primary school, and 45 percent of children age 13 to 18 years attended secondary school. For primary education, nine in ten males and females were enrolled in school. For secondary education, among persons 13 to 18 years, males and females were almost equally likely to be in school (44 percent for males and 45 percent for females). At the primary and secondary level, NARs in urban areas were higher than in rural areas. Consistent with this finding, attendance in primary education in the urban provinces (Harare and Bulawayo) is slightly higher than in other provinces, and the trend is the same for secondary education. Attendance is the highest among the wealthy households compared with the poor at both primary and secondary levels. While wealth is not a significant factor for attendance at the primary level, it has a greater impact on attendance at the secondary level. Among children age 7 to 12 years, no less than nine in ten children attended school at the primary level for all wealth quintiles. However, the data show that differentials vary greatly by wealth quintile at the secondary level. Only 24 percent of children age 13 to 18 attended secondary school in the lowest wealth quintile compared with 63 percent in the highest wealth quintile. With reference to the GAR, the ratios are much higher than 100 for primary education, indicating that a large proportion of children over the age of 12 years are still attending primary school. For secondary education, the percentages are much lower than 100, indicating that many children age 13 to 18 years are not currently attending secondary school. The gender parity index (GPI), or the ratio of the female to the male GAR at the primary and secondary levels, indicates the magnitude of the gender gap in attendance ratios. It is presented at both the primary and secondary levels and offers a summary measure of gender differences in school attendance rates. A GPI less than one indicates that a smaller proportion of females than males attend school. The GPI at the primary and secondary school levels are nearly equal (0.97 and 0.98, respectively). At the secondary level, there are marked differences in the GPI by place of residence and province. Table 2.4 also indicates that in the highest wealth quintile the gender gap is the widest (0.85), in contrast to children in the lowest wealth quintile (1.09) where more girls than boys attended secondary school. 2 Students who are over age for a given level of schooling may have started school over age, may have repeated one or more grades in school, or may have dropped out of school and later returned. Household Population and Housing Characteristics | 15 Table 2.4 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population by level of schooling and sex; and gender parity index, according to background characteristics, Zimbabwe 2005-2006 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 93.9 93.4 93.7 119.1 114.3 116.6 0.96 Rural 90.4 91.1 90.7 123.6 119.7 121.7 0.97 Province Manicaland 87.8 92.9 90.4 119.7 118.6 119.1 0.99 Mashonaland Central 88.3 84.5 86.5 121.2 125.0 123.0 1.03 Mashonaland East 93.4 94.1 93.7 129.4 124.7 127.2 0.96 Mashonaland West 88.5 83.9 86.3 122.9 110.5 116.9 0.90 Matabeleland North 89.5 94.0 91.6 116.8 118.6 117.7 1.02 Matabeleland South 92.5 91.3 91.9 118.7 114.6 116.5 0.97 Midlands 91.6 93.6 92.7 121.8 116.5 119.0 0.96 Masvingo 94.4 92.7 93.6 130.3 121.3 126.0 0.93 Harare 95.4 95.1 95.3 118.0 114.0 115.9 0.97 Bulawayo 93.9 94.5 94.2 124.8 119.9 122.3 0.96 Wealth quintile Lowest 88.9 90.1 89.5 122.0 117.4 119.8 0.96 Second 91.8 89.6 90.7 124.0 118.9 121.4 0.96 Middle 91.1 92.8 91.9 123.0 121.3 122.2 0.99 Fourth 90.9 91.8 91.3 123.6 115.8 119.8 0.94 Highest 94.8 95.0 94.9 119.6 117.3 118.4 0.98 Total 91.3 91.6 91.4 122.5 118.3 120.4 0.97 SECONDARY SCHOOL Residence Urban 63.4 55.8 59.2 71.9 63.0 67.0 0.88 Rural 37.4 39.7 38.5 42.9 43.0 42.9 1.00 Province Manicaland 47.1 42.9 45.1 54.8 47.3 51.3 0.86 Mashonaland Central 33.2 31.2 32.1 41.0 32.9 36.7 0.80 Mashonaland East 44.7 45.4 45.0 50.2 49.9 50.1 0.99 Mashonaland West 35.5 37.7 36.6 41.8 44.8 43.3 1.07 Matabeleland North 27.0 35.2 31.2 32.9 38.5 35.8 1.17 Matabeleland South 40.4 47.6 44.0 45.6 52.4 49.0 1.15 Midlands 42.4 50.7 46.4 48.3 53.3 50.7 1.10 Masvingo 45.8 41.9 43.9 51.4 45.7 48.6 0.89 Harare 62.1 55.2 58.3 67.7 61.2 64.2 0.90 Bulawayo 66.8 61.5 63.7 73.3 71.0 72.0 0.97 Wealth quintile Lowest 22.2 26.2 24.1 25.4 27.7 26.5 1.09 Second 37.0 36.3 36.6 42.0 38.6 40.3 0.92 Middle 47.8 49.7 48.7 52.1 54.2 53.1 1.04 Fourth 49.2 50.4 49.8 58.5 55.2 56.8 0.94 Highest 68.2 58.5 62.7 79.3 67.4 72.5 0.85 Total 44.1 44.8 44.5 50.4 49.3 49.9 0.98 1 The NAR for primary school is the percentage of the primary-school-age (7-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The gender parity index for primary school is the ratio of the primary school GAR for females to the GAR for males. The gender parity index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. 16 | Household Population and Housing Characteristics 2.3.3 Repetition and Dropout Rates Repetition and dropout rates describe the flow of students through the school system. Table 2.5 shows the repetition and dropout rates of the de facto household population age 5 to 24 years who attended school in the previous school year by grade and form, according to sex and residence. The repetition rate is defined as the percentage of students in a given grade the previous year who repeated that same grade in the current school year. The dropout rate refers to the percentage of students in a given grade the previous school year who do not attend school in the current school year. Repetition rates are highest in grade 1 (6 percent) and grade 7 (4 percent) and vary by place of residence, province, and wealth quintile. Repetition rates are generally higher among males than females. Table 2.5 also shows that repetition rates are higher for children in rural areas than they are in urban areas, except for grades 4 and 5. The repetitions rates in Mashonaland East are the highest for each grade level, except for grades 1 and 2 where the province has, respectively, the second and third highest percentage of repetition. The lowest and second lowest wealth quintiles have the highest percentages of repetition. Table 2.5 indicates that the dropout rates increase with each grade level, culminating at a national rate of 18 percent for grade 7. Overall, dropout rates in grade 7 are high for both males and females throughout the country. In general, the rates are higher in rural than in urban areas. Mashonaland Central and Matabeleland North have the highest dropout rates for grade 7 (33 percent each). School dropouts at grade 7 are highest in poorest households (34 percent) and lowest in the wealthiest households (2 per- cent). The age-specific attendance rates (ASARs) for the population age 5 to 24 years are presented in Figure 2.2 by age and sex. The ASAR indicates participation in schooling at any level, from primary to higher levels of education. The trends are the same for males and females. Approximately half of children attend school by age 6. For ages 8 to 12, nine out of ten children attend school. At age 13, attendance rates begin to decline as age increases. Household Population and Housing Characteristics | 17 Table 2.5 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, Zimbabwe 2005-2006 School grade Background characteristic 1 2 3 4 5 6 7 REPETITION RATE1 Sex Male 6.6 3.8 2.1 2.5 2.1 2.4 5.1 Female 6.1 1.1 2.8 1.6 1.5 2.2 2.8 Residence Urban 2.3 1.6 0.6 2.3 1.8 1.2 2.0 Rural 7.6 2.7 3.0 2.0 1.8 2.6 4.7 Province Manicaland 4.1 4.7 2.9 0.2 3.1 0.0 4.6 Mashonaland Central 11.6 2.5 0.0 2.3 0.0 1.3 1.0 Mashonaland East 11.2 4.4 6.4 6.3 5.8 6.5 9.3 Mashonaland West 3.4 0.3 5.9 0.7 0.9 0.7 2.0 Matabeleland North 4.4 1.1 1.6 2.0 0.8 4.1 7.0 Matabeleland South 3.6 2.3 1.8 3.3 1.4 0.8 1.3 Midlands 7.2 1.9 2.0 1.7 1.9 3.0 0.0 Masvingo 10.4 4.9 1.9 0.6 0.0 3.7 7.0 Harare 1.7 0.0 1.4 1.9 2.3 0.0 3.7 Bulawayo 0.0 0.0 0.0 4.8 1.1 1.7 2.3 Wealth quintile Lowest 10.1 3.4 2.8 2.3 1.2 3.7 4.1 Second 6.3 3.6 4.2 2.5 3.2 2.1 8.7 Middle 7.6 1.1 2.3 1.4 1.2 2.1 1.9 Fourth 2.8 2.9 0.9 0.7 1.3 1.3 2.7 Highest 1.6 0.8 1.0 3.3 1.8 1.9 2.2 Total 6.4 2.4 2.5 2.1 1.8 2.3 3.9 DROPOUT RATE2 Sex Male 2.7 2.6 2.0 3.4 5.9 5.2 18.6 Female 1.8 4.0 4.7 3.4 3.5 4.9 17.5 Residence Urban 2.7 1.0 1.4 2.3 1.8 2.9 9.4 Rural 2.1 4.0 3.9 3.7 5.6 5.7 21.5 Province Manicaland 6.1 3.6 4.1 4.0 4.8 5.3 16.9 Mashonaland Central 4.4 10.6 9.5 6.4 12.8 4.8 33.3 Mashonaland East 0.0 0.8 0.9 2.6 0.7 1.1 13.5 Mashonaland West 1.9 4.1 5.6 1.7 7.1 7.7 21.5 Matabeleland North 0.5 2.5 0.0 2.8 4.3 4.7 33.0 Matabeleland South 4.2 1.7 3.1 3.7 4.4 6.3 18.4 Midlands 2.0 4.0 3.0 3.2 3.1 5.6 17.0 Masvingo 2.3 0.6 3.8 5.6 5.6 8.6 15.1 Harare 0.0 0.5 0.0 0.0 0.8 1.4 8.6 Bulawayo 0.0 1.4 0.0 1.3 0.0 1.9 5.9 Wealth quintile Lowest 2.9 4.1 4.2 5.9 8.9 9.2 33.6 Second 2.1 5.0 4.7 3.0 4.0 4.2 20.0 Middle 1.4 3.4 2.5 2.4 4.4 3.9 16.4 Fourth 3.7 2.5 3.8 4.3 3.3 5.1 16.6 Highest 1.1 0.4 0.4 0.8 1.6 2.1 2.4 Total 2.2 3.3 3.3 3.4 4.6 5.1 18.1 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. 18 | Household Population and Housing Characteristics 2.4 HOUSEHOLD CHARACTERISTICS The physical characteristics and availability and accessibility of basic household facilities are important in assessing the general welfare and socioeconomic condition of the population. The 2005-06 ZDHS survey collected information on a range of housing characteristics. These data are presented for households and for the total de jure household population. The results are further disaggregated by residence. 2.4.1 Drinking Water Table 2.6 shows information on drinking water. The source of drinking water is an indicator of the quality of the water. Sources that are likely to be of suitable quality are listed under “improved source,” while sources not of suitable quality are listed under “non-improved source.” The majority of households in Zimbabwe (78 percent) have access to an improved source of water (99 percent in urban areas and 67 percent in rural areas). Overall, 36 percent of households have water piped into the dwelling, yard, or plot, while 5 percent of households use a public tap or standpipe. In rural areas, boreholes are the main source of drinking water (38 percent), followed by unprotected and protected dug wells (18 percent and 17 percent, respectively). Most households (87 percent) do not treat their drinking water. Of the selected urban households, 78 percent do not treat their water, compared with 91 percent in rural areas. Ten percent of households boil their water and 2 percent use bleach or chlorine. Figure 2.2 Age-specific Attendance Rates 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 10 20 30 40 50 60 70 80 90 100 Percent Male Female ZDHS 2005-2006Note: Figure shows percentage of the de jure household population age 5-24 years attending school. Household Population and Housing Characteristics | 19 Table 2.6 Household drinking water Percent distribution of households by source, time to collect, and person who usually collects drinking water, according to residence; the percent distribution of the de jure population by source, time to collect, and person who usually collects drinking water; the percentage of households by treatment of drinking water, according to residence; and the percentage of the de jure population by treatment of drinking water, Zimbabwe 2005-2006 Residence Urban Rural Total De jure population Source of drinking water Improved source 99.4 67.1 78.2 75.8 Piped water into dwelling/ yard/plot 92.7 6.1 36.0 32.9 Public tap/standpipe 4.5 5.7 5.3 4.1 Tube well or borehole 0.9 37.5 24.9 26.6 Protected dug well 1.3 17.1 11.6 11.8 Protected spring 0.0 0.7 0.4 0.5 Rainwater 0.0 0.0 0.0 0.0 Non-improved source 0.6 32.9 21.8 24.1 Unprotected dug well 0.4 18.1 12.0 13.5 Unprotected spring 0.0 3.4 2.2 2.4 Tanker truck/cart with small tank 0.2 0.4 0.3 0.3 Surface water na 11.0 7.2 7.9 Total 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 95.1 20.6 46.3 43.1 Less than 30 minutes 4.0 38.4 26.5 26.9 30 minutes or longer 0.8 40.4 26.8 29.4 Don't know/missing na 0.6 0.4 0.5 Total 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 3.5 62.6 42.2 47.4 Adult male 15+ 1.3 11.0 7.6 5.1 Female child under age 15 0.1 4.2 2.8 3.2 Male child under age 15 0.0 1.3 0.8 0.9 Other 0.0 0.2 0.2 0.2 Water on premises 95.1 20.6 46.3 43.1 Missing na 0.2 0.1 0.1 Total 100.0 100.0 100.0 100.0 Treatment of drinking water1 Boiled 20.3 5.2 10.4 10.5 Bleach/chlorine 1.1 2.0 1.7 1.6 Strained through cloth na 0.3 0.2 0.2 Ceramic, sand, or other filter 0.1 0.2 0.2 0.2 Other 0.5 1.6 1.2 1.3 No treatment 78.1 91.1 86.6 86.6 Number 3,201 6,084 9,285 41,323 na = Not applicable 1 Respondents may report multiple treatment methods so the sum may exceed 100 percent. 2.4.2 Sanitation Facilities and Waste Disposal Table 2.7 presents information on the proportion of households that have access to hygienic sanitation facilities by type of toilet/latrine. Hygienic status is determined on the basis of type of facility and whether it is used by only one household (improved) or shared with other households (unimproved). Forty percent of households in Zimbabwe have improved toilet facilities that are not shared with other households, of which 19 percent flush to a piped sewer system, 2 percent flush to a septic tank, and 20 | Household Population and Housing Characteristics less than 1 percent flush to a pit latrine. Nineteen percent of households use some type of a latrine that is not shared with other households. Most households with improved facilities in urban areas (57 percent) have flush toilets. In rural areas, the most common improved, non-shared toilet is either the ventilated improved pit (VIP) latrine or the Blair toilet (22 percent). The most common unimproved facilities in urban households are toilets shared by more than one household (39 percent). More than four in ten households in rural areas have no toilet facility. This proportion increased from 40 percent in the 1999 ZDHS to 45 percent in 2005-06 ZDHS. Table 2.7 Household sanitation facilities Percent distribution of households by type of toilet/latrine facilities, according to residence, and the percent distribution of the de jure population by type of toilet facilities, Zimbabwe 2005-2006 Residence Type of toilet/ latrine facility Urban Rural Total De jure population Improved, not shared 58.5 30.5 40.1 42.0 Flush/pour flush to piped sewer system 52.1 1.2 18.8 19.0 Flush/pour flush to septic tank 4.0 0.8 1.9 1.9 Flush/pour flush to pit latrine 0.7 0.1 0.3 0.3 Ventilated improved pit (VIP) latrine/Blair toilet 1.3 21.6 14.6 15.8 Pit latrine with slab 0.4 6.5 4.4 4.9 Composting toilet na 0.1 0.1 0.1 Not improved 41.4 69.6 59.8 58.0 Any facility shared with other households 38.8 17.0 24.5 19.7 Flush/pour flush not to sewer/ septic tank/pit latrine 1.2 0.0 0.4 0.3 Pit latrine without slab/open pit 0.3 7.3 4.9 5.6 Bucket 0.3 0.1 0.2 0.2 No facility/bush/field 0.2 44.9 29.5 31.9 Other 0.2 0.1 0.1 0.1 Missing 0.4 0.2 0.2 0.2 Total 100.0 100.0 100.0 100.0 Number 3,201 6,084 9,285 41,323 na = Not applicable 2.4.3 Other Household Characteristics Information on household characteristics such as availability of electricity, type of flooring material, number of rooms for sleeping, type of fuel used for cooking, place for cooking, fuel, and type of fire/stove among households using biomass fuel are shown in Table 2.8. The physical characteristics of the household reflect the household’s economic condition and have an important bearing on environ- mental exposure to disease. Thirty-seven percent of households in Zimbabwe have access to electricity. There is a significant difference in access to electricity between urban and rural areas. In urban areas, 91 percent of households have electricity versus 9 percent in rural areas. The most commonly used flooring material is cement (65 percent), followed by earth, sand, or dung (31 percent). In urban areas, 90 percent of households have cement floors, compared with 52 per- cent in rural areas. Earth, sand, or dung floors are found in 48 percent of rural households. Household Population and Housing Characteristics | 21 Data were collected on the num- ber of sleeping rooms per household. Thirty-seven percent of households have one room used for sleeping, while 36 per- cent have two rooms and 26 percent have three or more rooms. The number of rooms used for sleeping does not vary much by place of residence. The most common fuels used for cooking are wood (66 percent), followed by electricity (33 percent). In rural areas, 95 percent of households use wood for cooking, compared with 11 percent in urban areas. The most common cooking fuel used among urban households is electricity (88 percent); only 4 percent of rural households use electricity for cook- ing. Forty-three percent of house- holds in Zimbabwe cook in the house, 48 percent cook in a separate building, and 9 percent cook outdoors. Eighty percent of urban households cook in the house, compared with 23 percent of rural households. On the other hand, 68 per- cent of rural households cook in a sepa- rate building, versus 10 percent of urban households. More than six out of ten house- holds in Zimbabwe use biomass fuel (67 percent). The majority (97 percent) of those households use an open fire or stove that does not have a chimney or hood. 2.4.4 Household Durable Goods Information on ownership of durable goods and other possessions is presented in Table 2.9 by residence. In general, ownership of household effects, means of transportation, and agricultural land and farm animals is a rough measure of a household’s socioeconomic status. Table 2.8 Household characteristics Percent distribution of households by household characteristics, according to residence, and percent distribution of the de jure population by household characteristics, Zimbabwe 2005-2006 Residence Household characteristic Urban Rural Total De jure population Electricity Yes 91.4 8.7 37.2 33.8 No 8.6 91.2 62.7 66.0 Total 100.0 100.0 100.0 100.0 Flooring material Earth, sand, dung 0.2 47.7 31.3 34.3 Wood planks 0.3 na 0.1 0.2 Parquet, polished wood 1.3 na 0.5 0.5 Vinyl, asphalt strips 0.2 na 0.1 0.1 Ceramic tiles 2.7 0.1 1.0 1.0 Cement 90.2 51.7 64.9 61.8 Carpet 4.8 0.4 1.9 1.9 Total 100.0 100.0 100.0 100.0 Rooms used for sleeping One 37.2 37.4 37.4 25.1 Two 34.8 36.8 36.1 38.3 Three or more 27.3 25.2 25.9 35.9 Missing 0.7 0.5 0.6 0.6 Total 100.0 100.0 100.0 100.0 Type of dwelling unit Traditional na 49.7 32.6 35.1 Mixed 0.3 34.8 22.9 25.5 Detached 57.1 9.2 25.8 23.3 Semi-detached 34.0 4.2 14.5 12.8 Flat/town home 7.4 1.5 3.5 2.9 Shack 0.7 0.3 0.4 0.3 Other 0.3 0.1 0.2 0.1 Total 100.0 100.0 100.0 100.0 Any windows 98.0 86.7 90.6 90.4 Windows with glass 96.3 42.8 61.2 58.6 Windows with screens 44.1 22.2 29.8 28.9 Windows with curtains/ shutters 82.7 37.4 53.0 51.0 Cooking fuel Electricity 87.9 3.5 32.6 29.7 Paraffin/kerosene 0.6 na 0.2 0.1 Coal, lignite na 0.2 0.1 0.1 Charcoal na 0.2 0.1 0.1 Wood 11.2 95.3 66.3 69.3 Straw/shrubs/grass 0.1 0.6 0.4 0.5 Animal dung na 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 Place for cooking In the house 80.3 22.7 42.6 40.9 In a separate building 10.2 67.8 47.9 50.8 Outdoors 9.3 9.4 9.3 8.2 Total 100.0 100.0 100.0 100.0 Number of households 3,201 6,084 9,285 41,323 Type of fire/stove among households using solid fuel1 Closed stove with chimney 0.6 0.1 0.1 0.1 Open fire/stove with chimney 5.6 2.8 3.0 2.7 Open fire/stove without chimney or hood 92.6 96.9 96.6 97.1 Other 1.0 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 Number of households using biomass fuel 383 5,866 6,249 29,039 1 Includes kerosene, coal/lignite, charcoal, wood/straw/shrubs/grass, and animal dung na = Not applicable 22 | Household Population and Housing Characteristics Table 2.9 shows that among household effects, 48 percent of households have a radio, 31 percent have a television, 14 percent have a mobile telephone, and 8 percent have a non-mobile phone. With reference to means of transportation, 25 percent of households have a bicycle, 18 percent have an animal- drawn cart, 1 percent have a motorcycle or scooter, 6 percent have a car or truck, and less than 1 percent have a boat with a motor. Sixty-seven percent of households own agricultural land and 60 percent own farm animals. The proportion of households with durable goods varies by urban-rural residence. Urban households are more likely than rural households to own modern conveniences powered by electricity, such as a radio (78 percent and 33 percent, respectively) and a television (70 percent and 10 percent, respectively). The most common means of transportation owned by households in both urban and rural areas is the bicycle (29 percent in urban areas compared with 23 percent in rural areas). Urban households own more modern means of transportation than rural households, such as a car or truck (14 percent compared with 2 percent, respectively) and a motorcycle or scooter (2 percent compared with 1 percent, respectively). Among urban households, 28 percent own agricultural land compared with 88 percent in rural areas. In Zimbabwe, 35 percent of households have a bank account. Households in urban areas are almost four times as likely than households in rural areas to have a bank account (67 percent compared with 18 percent). Table 2.9 Household possessions Percentage of households possessing various durable consumer goods, by residence, Zimbabwe 2005-2006 Residence Possessions Urban Rural Total De jure population Household effects Radio 77.5 32.9 48.3 49.1 Television 70.4 10.4 31.1 31.6 Mobile telephone 34.5 2.7 13.7 13.9 Non-mobile telephone 22.2 1.0 8.3 8.5 Means of transportation Bicycle 28.5 23.4 25.1 28.0 Animal-drawn cart 4.8 24.4 17.7 21.7 Motorcycle/scooter 1.7 0.8 1.1 1.2 Car/truck 14.1 2.1 6.3 6.8 Boat with a motor 0.8 0.2 0.4 0.4 Wheelbarrow 19.8 38.2 31.9 35.8 Ownership of agricultural land 27.6 87.7 67.0 71.9 Ownership of farm animals1 22.4 80.1 60.2 66.5 Ownership of bank account 67.2 18.3 35.2 33.9 Number of households 3,201 6,084 9,285 41,323 1 Cattle, horses, donkeys, goats, sheep, or chickens 2.5 HOUSEHOLD WEALTH One of the background characteristics used throughout this report is a wealth index. Information on household assets was used to create an index representing the wealth of the households interviewed in the 2005-06 ZDHS. The wealth index was developed and tested in a large number of countries in relation to inequalities in household income, use of health services, and health outcomes (Rutstein et al., 2000). It Household Population and Housing Characteristics | 23 is an index of wealth that is consistent with expenditure and income measures (Rutstein, 1999). The economic index was constructed using household asset data including ownership of a number of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities, and type of flooring material. Each asset was assigned a weight or factor score generated through principal components analysis. The resulting asset scores were standardized in relation to a normal distribution with a mean of zero and a standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household. Individuals were ranked according to the score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed on the basis of data from the entire country sample and used in all the tabulations presented. Wealth quintiles are expressed in terms of quintiles of individuals in the population, rather than quintiles of individuals at risk for any one health or population indicator. For example, the quintile rates for infant mortality refer to the infant mortality rates per 1,000 live births among all people in the population quintile concerned, as distinct from quintiles of live births or newly born infants, who constitute the only members of the population at risk of mortality during infancy. Table 2.10 presents the wealth quintiles by residence and province. Almost all of the urban population is represented in the fourth and highest quintiles (98 percent) while about six in ten households in rural areas are in the lowest and second wealth quintiles. Sixty-one percent of the population in urban areas is in the highest wealth quintile, in contrast to 1 percent in the rural areas. The wealth quintile distribution among provinces shows large variations. As expected, the two urban provinces, Bulawayo and Harare, have the largest proportions in the highest wealth quintile (67 and 63 percent, respectively). In contrast, Matabeleland North and Masvingo have the largest proportions in the lowest wealth quintile (56 and 32 percent, respectively). Table 2.10 Wealth quintiles Percent distribution of the jure population by wealth quintiles, according to residence and province, Zimbabwe 2005-2006 Wealth quintile Residence/ province Lowest Second Middle Fourth Highest Total Number Residence Urban na na 1.5 37.9 60.5 100.0 13,087 Rural 29.3 29.3 28.5 11.7 1.2 100.0 28,236 Province Manicaland 16.4 21.6 31.2 22.0 8.7 100.0 5,166 Mashonaland Central 23.4 32.7 25.8 13.2 4.9 100.0 4,329 Mashonaland East 9.8 22.4 34.6 23.2 9.9 100.0 3,772 Mashonaland West 21.7 23.4 18.5 21.8 14.7 100.0 4,140 Matabeleland North 55.6 24.0 8.1 7.7 4.6 100.0 3,043 Matabeleland South 20.2 24.9 32.2 12.7 10.0 100.0 2,205 Midlands 25.6 21.4 22.1 15.4 15.4 100.0 5,731 Masvingo 31.7 29.4 22.7 12.7 3.5 100.0 4,818 Harare na na 2.5 34.4 63.1 100.0 5,577 Bulawayo na na na 33.5 66.5 100.0 2,540 Total 20.0 20.0 20.0 20.0 20.0 100.0 41,323 na = Not applicable 24 | Household Population and Housing Characteristics 2.6 BIRTH REGISTRATION The registration of births is the inscription of the facts of each birth into an official log kept at the registrar’s office. Information on the registration of births was collected in the household interview, where respondents were asked if their child under age five had a birth certificate. If they responded that the child did not have a birth certificate, an additional ques- tion was posed to ascertain if the child’s birth had ever been registered with the municipal or local authorities. Table 2.11 shows the percentage of children less than five years of age whose births were offici- ally registered, and the percentage who had a birth certificate at the time of the survey. The total proportion of children whose births were registered was 74 per- cent. Thirty-eight percent had a birth cer- tificate and 36 percent did not. There is little variation by age or sex. Urban resi- dents are more likely to register the births of their children (83 percent) than rural residents (71 percent). Children in Mid- lands (83 percent), Masvingo (83 percent), Harare (82 percent), Bulawayo (81 per- cent), and Manicaland (81 percent) had the highest proportion of registered births. Children in Mashonaland East were least likely to have their births registered (58 percent). Households in the highest wealth quintile were most likely to register their children’s births, and households in the lowest quintile were the least likely (85 percent compared with 67 percent). Table 2.11 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, according to background characteristics, Zimbabwe 2005-2006 Percentage of children whose births are registered Background characteristic Has a birth certificate Did not have a birth certificate Total registered Number of children Age <2 27.2 46.0 73.2 2,265 2-4 44.3 30.1 74.4 3,544 Sex Male 38.5 35.5 73.9 2,911 Female 36.8 37.1 74.0 2,898 Residence Urban 57.1 25.6 82.7 1,557 Rural 30.5 40.2 70.7 4,251 Province Manicaland 30.5 50.2 80.7 753 Mashonaland Central 40.0 23.6 63.7 664 Mashonaland East 40.3 17.9 58.1 483 Mashonaland West 32.7 29.7 62.4 604 Matabeleland North 40.2 29.0 69.1 432 Matabeleland South 40.1 23.9 64.0 307 Midlands 32.0 51.0 83.0 867 Masvingo 23.6 59.1 82.7 747 Harare 58.0 23.5 81.6 679 Bulawayo 56.9 24.0 80.9 272 Wealth quintile Lowest 20.5 46.3 66.8 1,383 Second 31.7 39.3 70.9 1,303 Middle 35.1 38.0 73.1 1,119 Fourth 46.1 32.1 78.2 1,097 Highest 65.2 19.8 85.0 907 Total 37.7 36.3 73.9 5,809 Characteristics of Respondents | 25 CHARACTERISTICS OF RESPONDENTS 3 This chapter presents information on demographic and socioeconomic characteristics of the survey respondents, such as age, education, place of residence, and marital, employment, and wealth status. These characteristics are for men age 15-54 years and women age 15-49 years. This information is useful for understanding the factors that affect reproductive and contraceptive use and other health behaviours, as they provide a context for the interpretation of the demographic and health indices. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Background characteristics of the 8,907 women and 7,175 men interviewed in the 2005-06 ZDHS are presented in Table 3.1. The distribution of the respondents according to age shows a similar pattern for men and women. The proportion of respondents in each age group declines with increasing age for both sexes. Forty-six percent of women and 47 percent of men are in the 15-24 years age group, and 30 percent of women and 27 percent of men are 25-34 years. Fifty-six percent of women compared with 45 percent of men are currently married. Male respondents were much more likely than female respondents to have never married (48 percent for men and 27 percent for women). Eight percent of female respondents and 1 percent of male respondents stated that they were widowed. Men are also less likely to be divorced than women, as 8 percent of women reported that they were divorced, compared with 4 percent of men. The proportion of men in urban areas (41 percent) does not vary much from that of women (39 percent). The largest proportion of both male and female respondents (18 percent and 17 percent, respectively) is in Harare. Following Harare is Midlands, which is where 13 percent of women and 14 percent of men reside. Matabeleland South has the smallest proportions of both male and female respondents (5 percent each). Education is an important factor influencing an individual’s attitude and outlook on various aspects of life. Generally, educational attainment in Zimbabwe is high; 71 percent of men and 63 percent of women attended secondary school or higher. Around one-quarter of men and one-third of women have attended only primary school. Two percent of men and 4 percent of women have no education. The majority of the respondents (66 percent of men and 89 percent of women) are Christians. Men (25 percent) were more likely than women (8 percent) to report no religion. Men are also more likely to be traditionalist than women (8 percent compared with 2 percent). 26 | Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Zimbabwe 2005-2006 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 24.2 2,152 2,130 26.5 1,899 1,978 20-24 21.9 1,952 1,945 20.3 1,459 1,435 25-29 16.5 1,466 1,439 15.1 1,082 1,035 30-34 13.6 1,216 1,212 12.3 882 878 35-39 9.4 834 843 9.2 663 645 40-44 7.8 699 719 6.5 469 451 45-49 6.6 589 619 5.7 409 427 50-54 0.0 0.0 0.0 4.3 312 326 Marital status Never married 27.0 2,404 2,452 47.5 3,406 3,455 Married 56.3 5,016 4,979 45.1 3,236 3,178 Living together 1.4 127 139 2.6 184 189 Divorced/separated 7.7 689 677 3.5 250 255 Widowed 7.5 671 660 1.4 100 98 Residence Urban 39.3 3,502 3,203 40.5 2,904 2,459 Rural 60.7 5,405 5,704 59.5 4,271 4,716 Province Manicaland 11.7 1,043 1,039 11.6 829 790 Mashonaland Central 9.3 825 751 9.8 702 721 Mashonaland East 8.0 714 696 8.3 598 578 Mashonaland West 9.3 829 777 10.1 726 668 Matabeleland North 6.0 536 672 6.1 434 547 Matabeleland South 4.9 439 630 4.5 325 464 Midlands 13.4 1,193 1,128 14.0 1,003 956 Masvingo 12.8 1,137 974 11.1 800 779 Harare 16.8 1,492 1,395 17.8 1,274 1,032 Bulawayo 7.8 697 845 6.7 483 640 Education No education 4.3 380 380 1.5 111 124 Primary 32.6 2,902 2,971 27.3 1,956 2,113 Secondary 60.1 5,355 5,297 65.3 4,687 4,541 More than secondary 3.0 270 259 5.9 422 397 Religion Traditional 2.1 186 205 7.5 535 579 Roman Catholic 10.2 913 920 10.4 749 744 Protestant 25.6 2,283 2,257 17.0 1,219 1,218 Pentecostal 17.8 1,581 1,535 13.0 932 913 Apostolic Sect 29.9 2,659 2,672 22.4 1,605 1,603 Other Christian 5.5 494 486 3.6 255 243 Muslim 0.7 62 59 1.1 76 61 None 8.0 713 758 25.0 1,792 1,802 Other 0.2 15 15 0.2 11 12 Wealth quintile Lowest 17.4 1,552 1,623 15.3 1,099 1,242 Second 16.8 1,500 1,614 16.6 1,193 1,359 Middle 17.4 1,546 1,618 17.2 1,235 1,312 Fourth 22.5 2,006 1,905 27.4 1,969 1,795 Highest 25.9 2,304 2,147 23.4 1,680 1,467 Total 100.0 8,907 8,907 100.0 7,175 7,175 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Characteristics of Respondents | 27 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Overall, the level of education in Zimbabwe is high, and men are more educated than women. Presented in Tables 3.2.1 and 3.2.2 are the percent distributions of female and male respondents by highest level of education attained, according to age, urban-rural residence, and province. Younger people are more likely to be educated and to reach higher levels of education than older people. The proportion of women without education ranges from less than 1 percent for women age 15-19 years to 21 percent for women age 45-49. These proportions range from less than 1 percent for men age 15-19 years to 9 percent for men 45-49 years. The majority of women age 45-49 (62 percent) attended primary school; on the other hand, the majority of women age 15-19 attended secondary school (71 percent). This pattern is similar for men: 53 percent of men age 45-49 attended primary school and 71 percent of men age 15-19 went to secondary school. Rural people are less educated than their urban counterparts. About 6 percent of rural women do not have any education, compared with 1 percent of urban women. The corresponding figures are 2 percent and less than 1 percent for rural and urban men, respectively. Similarly, only 49 percent of rural women have a secondary education or higher, and 85 percent of urban women have a secondary or higher education. The improvement in levels of education reflects the significant expansion and improved accessibility to the educational system after independence in 1980. The distribution of education is fairly similar across provinces with the exceptions of Harare and Bulawayo, which are urban centres. Mashonaland Central, Mashonaland West, Matabeleland North, and Masvingo have the highest proportions of women with no education (10 percent, 8 percent, 7 percent, and 5 percent, respectively). In all provinces, the majority of men have gone to secondary school. Higher wealth status is associated with a greater level of educational attainment. Eleven percent of women in the lowest wealth quintile have no education compared with less than 1 percent of women in the highest wealth quintile. Among men, 4 percent in the lowest quintile have no education compared with less than 1 percent in the two highest quintiles. 28 | Characteristics of Respondents Table 3.2.1 Educational attainment: women Percent distribution of women 15-49 by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Zimbabwe 2005-2006 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of women Median number of years of schooling Age 15-19 0.4 22.5 5.7 70.0 1.1 0.3 100.0 2,152 7.7 20-24 0.6 19.6 4.5 70.2 2.4 2.7 100.0 1,952 9.0 25-29 0.8 24.9 6.0 63.1 0.4 4.7 100.0 1,466 8.2 30-34 3.4 26.6 4.8 59.8 0.7 4.7 100.0 1,216 7.8 35-39 5.7 28.8 4.4 55.7 0.9 4.5 100.0 834 7.6 40-44 19.5 43.4 6.6 25.7 0.3 4.6 100.0 699 6.1 45-49 21.2 54.8 7.0 14.5 0.2 2.4 100.0 589 4.7 Residence Urban 1.0 12.7 1.7 76.6 2.3 5.7 100.0 3,502 9.2 Rural 6.4 36.6 7.8 47.7 0.3 1.3 100.0 5,405 6.7 Province Manicaland 4.4 33.4 4.7 54.2 0.8 2.4 100.0 1,043 7.2 Mashonaland Central 9.8 32.3 8.9 46.7 0.3 1.9 100.0 825 6.7 Mashonaland East 3.0 28.4 5.4 60.0 0.4 2.7 100.0 714 7.7 Mashonaland West 7.5 30.1 6.5 52.8 0.4 2.8 100.0 829 7.0 Matabeleland North 6.8 40.2 5.8 44.4 0.6 2.1 100.0 536 6.7 Matabeleland South 3.6 34.3 4.7 51.5 1.1 4.9 100.0 439 7.1 Midlands 3.4 26.3 5.8 60.4 0.9 3.2 100.0 1,193 7.5 Masvingo 5.0 38.6 10.5 44.6 0.4 0.9 100.0 1,137 6.6 Harare 0.5 11.2 0.9 80.4 2.0 5.0 100.0 1,492 9.2 Bulawayo 1.7 9.8 1.7 78.7 3.8 4.3 100.0 697 9.2 Wealth quintile Lowest 10.5 48.6 10.7 30.1 0.0 0.0 100.0 1,552 6.2 Second 6.1 38.7 9.3 45.9 0.0 0.1 100.0 1,500 6.6 Middle 4.7 29.2 5.6 59.5 0.3 0.6 100.0 1,546 7.2 Fourth 1.9 21.5 3.4 69.9 0.7 2.6 100.0 2,006 8.3 Highest 0.7 8.8 0.9 77.3 3.3 9.0 100.0 2,304 9.3 Total 4.3 27.2 5.4 59.0 1.1 3.0 100.0 8,907 7.6 Note: In Zimbabwe, primary level is referred to as grades 1-7. Secondary level is referred to as forms 1-6. With the primary and secondary levels combined, there is a total of 13 years of schooling. 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level Characteristics of Respondents | 29 Table 3.2.2 Educational attainment: men Percent distribution of men 15-49 by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Zimbabwe 2005-2006 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of men Median number of years of schooling Age 15-19 0.3 22.5 6.3 68.9 1.6 0.4 100.0 1,899 7.4 20-24 0.3 16.2 4.7 65.2 7.5 6.1 100.0 1,459 9.2 25-29 0.8 19.5 3.3 64.9 3.7 7.8 100.0 1,082 9.2 30-34 0.6 16.4 4.2 67.2 2.9 8.9 100.0 882 9.2 35-39 1.0 14.5 2.0 71.0 1.6 10.0 100.0 663 9.3 40-44 4.5 32.5 4.9 45.7 0.6 11.8 100.0 469 7.4 45-49 9.0 43.9 9.3 31.8 0.2 5.8 100.0 409 6.5 Residence Urban 0.1 8.2 1.1 74.8 6.1 9.8 100.0 2,767 9.4 Rural 2.1 29.8 7.5 56.1 1.3 3.3 100.0 4,096 7.1 Province Manicaland 1.5 22.7 8.3 57.8 2.9 6.8 100.0 793 8.0 Mashonaland Central 1.8 28.2 9.0 55.7 1.9 3.4 100.0 681 7.3 Mashonaland East 1.3 17.1 3.0 72.9 1.6 4.1 100.0 570 8.9 Mashonaland West 1.3 23.2 5.4 64.8 2.4 2.9 100.0 691 8.3 Matabeleland North 3.6 40.6 7.0 43.5 0.3 4.9 100.0 416 6.8 Matabeleland South 1.5 30.2 5.7 52.9 3.5 6.2 100.0 306 7.5 Midlands 1.2 24.3 4.7 61.6 3.1 5.1 100.0 956 8.0 Masvingo 2.1 26.5 6.1 59.6 2.1 3.7 100.0 771 7.5 Harare 0.0 6.6 0.8 77.1 5.7 9.8 100.0 1,219 9.4 Bulawayo 0.1 8.7 1.1 73.3 6.7 10.2 100.0 460 9.3 Wealth quintile Lowest 3.6 45.3 10.7 39.8 0.5 0.1 100.0 1,042 6.5 Second 1.9 31.3 8.2 57.3 0.6 0.7 100.0 1,137 7.0 Middle 1.1 22.6 6.1 65.8 2.2 2.3 100.0 1,194 7.8 Fourth 0.8 14.7 2.5 72.2 2.9 6.9 100.0 1,892 9.1 Highest 0.1 4.5 0.6 72.1 7.8 14.9 100.0 1,599 9.5 Total 15-49 1.3 21.1 4.9 63.7 3.2 5.9 100.0 6,863 8.6 Total 15-54 1.5 22.3 5.0 62.2 3.1 5.9 100.0 7,175 8.4 Note: In Zimbabwe, primary level is referred to as grades 1-7. Secondary level is referred to as forms 1-6. With the primary and secondary levels combined, there is a total of 13 years of schooling. 1 Completed 7th grade at the primary level 2 Completed 6th grade at the secondary level 30 | Characteristics of Respondents 3.3 LITERACY ASSESSMENT Literacy is widely acknowledged as benefiting individuals and society. It is also associated with a number of positive health outcomes. In the 2005-06 ZDHS, literacy status was determined based on the respondents’ ability to read all or part of a sentence. Tables 3.3.1 and 3.3.2 show the percent distribution of women and men by level of schooling attended and by level of literacy, and percent literate, according to background characteristics. Literacy rates in Zimbabwe are very high. Overall, 91 percent of women and 95 percent of men are literate. Variations in literacy by age show that literacy decreases as age increases for both women and men. The percent literate is almost the same for both women and men ages 15-29, while men ages 30-49 have higher literacy rates than women. Women and men in urban areas have higher literacy rates (98 percent and 99 percent, respectively) than their rural counterparts (87 percent of women and 93 percent of men). Variations in literacy by province show that both Bulawayo and Harare have the highest literacy rate for women (98 percent) and men (99 percent). Mashonaland Central has the lowest literacy rate for women (83 percent), while Matabeleland North has the lowest literacy rates for men (90 percent). As with educational attainment, literacy is directly associated with wealth status. Table 3.3.1 Literacy: women Percent distribution of women 15-49 by level of schooling attended and by level of literacy, and percent literate, according to background characteristics, Zimbabwe 2005-2006 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Number of women Percent literate1 Age 15-19 71.4 16.6 7.2 3.8 0.1 0.0 0.7 100.0 2,152 95.3 20-24 75.3 12.2 9.1 2.9 0.2 0.0 0.2 100.0 1,952 96.7 25-29 68.3 17.3 10.2 3.6 0.1 0.0 0.4 100.0 1,466 95.8 30-34 65.2 16.3 10.9 7.4 0.1 0.0 0.2 100.0 1,216 92.3 35-39 61.1 18.2 10.7 10.0 0.0 0.0 0.0 100.0 834 90.0 40-44 30.5 24.4 16.1 27.4 0.7 0.1 0.7 100.0 699 71.0 45-49 17.1 33.9 19.3 29.3 0.2 0.0 0.3 100.0 589 70.3 Residence Urban 84.6 8.7 4.3 1.9 0.1 0.0 0.4 100.0 3,502 97.6 Rural 49.3 23.4 14.4 12.3 0.2 0.0 0.4 100.0 5,405 87.1 Province Manicaland 57.5 18.8 15.2 8.0 0.0 0.0 0.6 100.0 1,043 91.5 Mashonaland Central 48.9 20.1 13.7 16.9 0.0 0.1 0.2 100.0 825 82.8 Mashonaland East 63.2 15.3 12.2 9.1 0.0 0.0 0.2 100.0 714 90.7 Mashonaland West 56.0 10.8 17.8 14.0 0.3 0.0 1.1 100.0 829 84.6 Matabeleland North 47.2 19.0 22.0 11.5 0.0 0.0 0.3 100.0 536 88.3 Matabeleland South 57.5 29.2 6.1 6.0 0.9 0.2 0.2 100.0 439 92.8 Midlands 64.5 21.9 7.1 5.5 0.5 0.0 0.5 100.0 1,193 93.6 Masvingo 45.9 30.9 10.7 12.2 0.0 0.0 0.3 100.0 1,137 87.5 Harare 87.4 7.6 2.9 1.6 0.2 0.0 0.3 100.0 1,492 97.9 Bulawayo 86.8 7.3 4.1 1.7 0.0 0.0 0.0 100.0 697 98.3 Wealth quintile Lowest 30.2 30.8 19.5 18.7 0.3 0.0 0.5 100.0 1,552 80.4 Second 46.0 25.4 14.7 13.5 0.1 0.1 0.2 100.0 1,500 86.1 Middle 60.5 19.6 10.8 8.5 0.2 0.0 0.5 100.0 1,546 90.9 Fourth 73.2 14.0 8.4 3.9 0.2 0.0 0.3 100.0 2,006 95.6 Highest 89.6 5.6 3.2 1.2 0.0 0.0 0.4 100.0 2,304 98.3 Total 63.1 17.6 10.5 8.2 0.2 0.0 0.4 100.0 8,907 91.2 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Characteristics of Respondents | 31 Table 3.3.2 Literacy: men Percent distribution of men 15-49 by level of schooling attended and by level of literacy, and percent literate, according to background characteristics, Zimbabwe 2005-2006 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Number of men Percent literate1 Age 15-19 70.9 15.5 8.6 3.7 0.2 0.0 1.1 100.0 1,899 95.0 20-24 78.9 11.1 6.6 2.6 0.2 0.0 0.6 100.0 1,459 96.6 25-29 76.4 14.7 5.0 3.4 0.1 0.0 0.3 100.0 1,082 96.1 30-34 78.9 11.8 7.1 1.6 0.0 0.0 0.6 100.0 882 97.9 35-39 82.6 8.5 5.3 2.7 0.4 0.0 0.4 100.0 663 96.4 40-44 58.1 19.5 14.2 7.5 0.0 0.0 0.7 100.0 469 91.8 45-49 37.8 35.2 14.5 11.6 0.6 0.0 0.4 100.0 409 87.4 Residence Urban 90.7 5.7 2.6 0.5 0.1 0.0 0.4 100.0 2,767 99.0 Rural 60.7 20.9 11.4 6.0 0.2 0.0 0.8 100.0 4,096 92.9 Province Manicaland 67.5 18.9 6.7 5.0 0.8 0.0 1.1 100.0 793 93.1 Mashonaland Central 61.0 27.6 4.1 6.4 0.3 0.0 0.7 100.0 681 92.7 Mashonaland East 78.6 10.0 7.6 2.9 0.0 0.0 1.0 100.0 570 96.1 Mashonaland West 70.1 10.6 14.2 3.9 0.2 0.0 1.0 100.0 691 94.9 Matabeleland North 48.8 20.5 20.2 9.9 0.0 0.0 0.6 100.0 416 89.5 Matabeleland South 62.6 20.8 13.7 2.1 0.4 0.0 0.4 100.0 306 97.1 Midlands 69.9 16.8 8.2 4.6 0.0 0.0 0.6 100.0 956 94.8 Masvingo 65.4 19.5 9.7 4.5 0.0 0.0 0.9 100.0 771 94.6 Harare 92.6 5.4 1.4 0.3 0.1 0.0 0.2 100.0 1,219 99.4 Bulawayo 90.1 4.2 4.6 0.8 0.0 0.0 0.3 100.0 460 98.8 Wealth quintile Lowest 40.4 30.7 18.0 9.6 0.3 0.0 1.0 100.0 1,042 89.1 Second 58.7 21.8 12.9 5.8 0.1 0.0 0.8 100.0 1,137 93.3 Middle 70.3 16.0 8.1 4.0 0.4 0.0 1.3 100.0 1,194 94.3 Fourth 82.0 10.5 4.6 2.3 0.2 0.0 0.4 100.0 1,892 97.2 Highest 94.8 3.4 1.4 0.2 0.0 0.0 0.2 100.0 1,599 99.6 Total 15-49 72.8 14.7 7.9 3.8 0.2 0.0 0.7 100.0 6,863 95.4 Total 15-54 71.2 15.6 8.3 4.0 0.2 0.0 0.7 100.0 7,175 95.1 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 3.4 EXPOSURE TO MASS MEDIA Exposure to mass media provides the opportunity to experience new ideas and knowledge that is useful in various aspects of everyday life. It is also important to know which types of persons are more likely to be reached by the media for planning programmes intended to spread information about health and family planning. Tables 3.4.1 and 3.4.2 show the percentage of female and male respondents who were exposed to different types of mass media by age, urban-rural residence, province, level of education, and wealth quintile. Twenty-five percent of women and 40 percent of men read newspapers at least once a week, 36 percent of women and 44 percent of men watch television at least once a week, and 48 percent of women and 64 percent of men listen to the radio at least once a week. 32 | Characteristics of Respondents Table 3.4.1 Exposure to mass media: women Percentage of women 15-49 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, Zimbabwe 2005-2006 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 28.4 38.2 50.6 18.2 40.0 2,152 20-24 27.5 40.2 52.3 18.7 38.6 1,952 25-29 24.6 34.7 49.7 16.2 42.8 1,466 30-34 22.8 35.8 45.6 16.1 46.6 1,216 35-39 23.1 36.9 46.8 14.5 44.7 834 40-44 17.1 33.0 41.2 12.5 50.6 699 45-49 13.5 23.8 34.5 8.6 61.2 589 Residence Urban 48.9 77.9 77.4 37.8 8.8 3,502 Rural 8.6 9.2 28.9 2.3 66.4 5,405 Province Manicaland 19.3 25.5 39.1 13.4 55.6 1,043 Mashonaland Central 8.4 15.4 39.1 3.7 56.9 825 Mashonaland East 14.3 23.7 38.1 8.7 57.2 714 Mashonaland West 14.7 33.3 45.6 8.6 45.3 829 Matabeleland North 19.7 12.1 18.8 4.1 66.8 536 Matabeleland South 22.9 24.8 39.7 7.2 45.5 439 Midlands 18.2 28.5 44.2 12.6 50.4 1,193 Masvingo 7.6 10.6 28.7 2.3 66.3 1,137 Harare 50.2 79.1 80.3 38.5 7.6 1,492 Bulawayo 60.9 82.7 81.3 48.6 5.0 697 Education No education 0.9 6.8 21.0 0.4 77.3 380 Primary 6.2 14.9 30.0 2.4 65.1 2,902 Secondary 33.5 47.7 58.4 23.0 31.7 5,355 More than secondary 73.0 81.1 73.6 53.1 5.2 270 Wealth quintile Lowest 4.8 1.3 13.7 0.3 83.1 1,552 Second 5.7 3.7 23.1 0.7 73.5 1,500 Middle 9.4 8.8 32.8 1.9 62.3 1,546 Fourth 28.4 44.6 63.6 15.3 23.9 2,006 Highest 56.6 92.1 83.8 47.7 2.6 2,304 Total 24.5 36.3 48.0 16.3 43.7 8,907 It is important to note that there are differentials by sex and residence in exposure to different forms of mass media. Generally, urban residents and men are more likely to be exposed to all forms of mass media than rural residents and women. Sixty-six percent of rural women, 9 percent of urban women, 42 percent of rural men, and 5 percent of urban men reported having no exposure to any form of mass media at least once a week. Men age 35-39 and women age 20-24 years, those who are better educated, and persons living in Harare and Bulawayo are more likely to read newspapers, watch television, and listen to the radio. Characteristics of Respondents | 33 Table 3.4.2 Exposure to mass media: men Percentage of men 15-49 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, Zimbabwe 2005-2006 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of men Age 15-19 31.7 38.5 60.7 20.3 32.4 1,899 20-24 46.0 46.8 69.1 31.0 22.2 1,459 25-29 42.9 45.3 65.5 28.8 24.1 1,082 30-34 44.3 44.1 65.9 29.6 24.7 882 35-39 48.9 48.6 66.8 33.9 23.5 663 40-44 41.9 46.2 62.5 28.8 27.8 469 45-49 30.5 43.0 63.0 23.5 30.9 409 Residence Urban 71.9 81.0 83.8 56.2 4.5 2,767 Rural 19.2 18.7 51.9 7.6 41.6 4,096 Province Manicaland 37.2 37.6 64.2 21.8 27.3 793 Mashonaland Central 27.2 34.1 73.9 15.7 20.2 681 Mashonaland East 31.3 32.3 60.8 19.5 33.1 570 Mashonaland West 27.1 38.0 57.6 19.1 35.3 691 Matabeleland North 38.2 16.1 38.3 8.5 42.3 416 Matabeleland South 38.1 29.0 45.8 24.9 47.6 306 Midlands 28.0 33.9 61.9 19.0 33.6 956 Masvingo 17.4 23.9 50.5 9.9 43.1 771 Harare 73.8 82.4 85.3 59.3 4.1 1,219 Bulawayo 76.3 78.5 79.9 54.6 4.2 460 Education No education 3.9 7.5 31.5 3.9 67.1 88 Primary 12.3 18.6 49.1 4.9 45.9 1,782 Secondary 48.1 51.5 69.9 33.2 20.3 4,588 More than secondary 85.4 75.9 82.3 63.3 5.3 405 Wealth quintile Lowest 10.9 5.8 33.8 1.6 60.3 1,042 Second 15.6 12.6 50.3 3.9 43.8 1,137 Middle 20.4 20.4 54.3 7.8 38.5 1,194 Fourth 51.8 57.7 77.8 34.0 11.5 1,892 Highest 78.8 91.8 87.7 66.9 1.7 1,599 Total 15-49 40.4 43.8 64.8 27.2 26.7 6,863 Total 15-54 40.0 43.6 64.3 27.0 27.2 7,175 Media exposure among women and men is also affected by wealth status. More than half of women (57 percent) in the highest wealth quintile read a newspaper at least once a week, compared with 5 percent of women in the lowest wealth quintile. Seventy-nine percent of men in the highest wealth quintile read a newspaper at least once a week, compared with 11 percent of men in the lowest wealth quintile. The majority of women and men in the highest wealth quintile (92 percent of women and men) watch television at least once a week, in contrast to 1 percent of women and 6 percent of men in the lowest wealth quintile. Compared with reading a newspaper and watching television, the differentials between wealth quintiles are less when it comes to listening to the radio once a week. Eighty-four percent of women and 88 percent of men in the highest wealth quintile listen to the radio once a week, compared with 14 percent of women and 34 percent of men in the lowest wealth quintile. 34 | Characteristics of Respondents 3.5 EMPLOYMENT STATUS The 2005-06 ZDHS collected information from women and men about their current employment status. Tables 3.5.1 and 3.5.2 present information on whether respondents were working in the seven days preceding the survey and, if not, whether they had worked in the 12 months before the survey. Overall, 56 percent of women and 30 percent of men reported that they were not employed in the 12 months preceding the survey. Women and men in the age group 15-19 years are less likely to be employed than their counterparts in older age groups. Women who are divorced, separated, or widowed are more likely to be currently employed (50 percent) than other women. Men who are currently in union are more likely to be currently employed (83 percent) than men who have never been married or are divorced, separated, or widowed. Women and men with no children are least likely to be employed. This may be due to their younger age. Variations by place of residence show that a higher percentage of women and men in urban areas (40 percent and 65 percent, respectively) are employed compared with their rural counterparts (35 percent and 61 percent, respectively). Substantial provincial variations exist in women’s and men’s employment characteristics. Women in Matabeleland North, Mashonaland East, and Bulawayo are much more likely than women in other provinces to report not having been employed in the past 12 months, while men in Matabeleland North, Matabeleland South, and Manicaland are much more likely than men in other provinces to report not having been employed in the past 12 months. Women and men with more than secondary education accounted for the highest percentage of those currently employed (76 percent of women and 83 percent of men). For both women and men, unemployment decreases as the level of education increases. Among women, the proportion who were not employed in the past 12 months also declined as the wealth quintile increased. Among men, a similar tendency is observed although the pattern is not uniform. At least half of women in each wealth quintile were not employed in the 12 months preceding the survey. For men in the same category, the range is from 24 percent in the fourth wealth quintile to 36 percent in the middle wealth quintile. Characteristics of Respondents | 35 Table 3.5.1 Employment status: women Percent distribution of women 15-49 by employment status, according to background characteristics, Zimbabwe 2005-2006 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Age 15-19 21.4 4.2 74.2 0.2 100.0 2,152 20-24 35.0 8.8 56.2 0.0 100.0 1,952 25-29 40.6 8.0 51.4 0.0 100.0 1,466 30-34 46.2 7.2 46.5 0.1 100.0 1,216 35-39 48.0 6.7 45.3 0.0 100.0 834 40-44 47.4 5.7 46.9 0.0 100.0 699 45-49 42.5 4.7 52.8 0.0 100.0 589 Marital status Never married 27.4 4.9 67.4 0.2 100.0 2,404 Married or living together 37.8 7.0 55.2 0.0 100.0 5,143 Divorced/separated/ widowed 49.9 8.5 41.6 0.0 100.0 1,360 Number of living children 0 28.5 5.5 65.8 0.2 100.0 2,724 1-2 40.7 7.6 51.6 0.0 100.0 3,295 3-4 41.4 6.3 52.2 0.0 100.0 1,775 5+ 38.5 6.9 54.6 0.0 100.0 1,113 Residence Urban 40.0 7.3 52.7 0.0 100.0 3,502 Rural 34.9 6.2 58.9 0.1 100.0 5,405 Province Manicaland 31.8 8.1 60.1 0.0 100.0 1,043 Mashonaland Central 36.3 10.0 53.7 0.0 100.0 825 Mashonaland East 25.1 2.5 72.4 0.0 100.0 714 Mashonaland West 42.7 4.3 53.0 0.0 100.0 829 Matabeleland North 16.0 2.5 81.6 0.0 100.0 536 Matabeleland South 27.4 8.7 63.9 0.0 100.0 439 Midlands 62.2 9.2 28.2 0.3 100.0 1,193 Masvingo 30.2 6.4 63.4 0.0 100.0 1,137 Harare 41.8 8.2 49.9 0.1 100.0 1,492 Bulawayo 29.1 1.9 68.9 0.0 100.0 697 Education No education 33.3 6.8 59.9 0.0 100.0 380 Primary 34.5 6.5 58.9 0.0 100.0 2,902 Secondary 36.4 6.6 56.9 0.1 100.0 5,355 More than secondary 75.8 8.3 15.9 0.0 100.0 270 Wealth quintile Lowest 29.8 6.0 64.2 0.0 100.0 1,552 Second 33.8 6.3 59.8 0.1 100.0 1,500 Middle 34.7 7.2 58.0 0.2 100.0 1,546 Fourth 38.4 7.9 53.6 0.0 100.0 2,006 Highest 43.7 5.8 50.4 0.0 100.0 2,304 Total 36.9 6.6 56.4 0.1 100.0 8,907 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 36 | Characteristics of Respondents Table 3.5.2 Employment status: men Percent distribution of men 15-49 by employment status, according to background characteristics, Zimbabwe 2005-2006 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Age 15-19 28.3 3.9 66.8 0.9 100.0 1,899 20-24 64.0 9.4 26.6 0.0 100.0 1,459 25-29 78.8 7.9 13.3 0.0 100.0 1,082 30-34 82.3 7.8 10.0 0.0 100.0 882 35-39 80.0 8.3 11.7 0.0 100.0 663 40-44 84.3 5.0 10.7 0.0 100.0 469 45-49 78.2 8.4 13.3 0.0 100.0 409 Marital status Never married 43.3 6.1 50.1 0.5 100.0 3,404 Married or living together 82.6 7.5 9.9 0.0 100.0 3,132 Divorced/separated/ widowed 71.9 11.6 16.5 0.0 100.0 327 Number of living children 0 45.8 6.5 47.2 0.5 100.0 3,685 1-2 82.6 7.6 9.8 0.0 100.0 1,675 3-4 83.4 6.8 9.8 0.0 100.0 944 5+ 78.2 8.4 13.4 0.0 100.0 560 Residence Urban 65.4 7.0 27.3 0.3 100.0 2,767 Rural 60.7 6.9 32.1 0.3 100.0 4,096 Province Manicaland 44.5 11.2 44.1 0.1 100.0 793 Mashonaland Central 80.3 2.3 16.1 1.3 100.0 681 Mashonaland East 69.1 2.4 28.6 0.0 100.0 570 Mashonaland West 75.2 5.1 19.6 0.1 100.0 691 Matabeleland North 41.0 9.3 49.8 0.0 100.0 416 Matabeleland South 33.8 6.5 59.7 0.0 100.0 306 Midlands 67.9 7.0 24.8 0.3 100.0 956 Masvingo 61.9 7.3 30.8 0.0 100.0 771 Harare 65.5 9.2 25.0 0.2 100.0 1,219 Bulawayo 61.6 6.7 31.0 0.6 100.0 460 Education No education 55.8 9.3 34.9 0.0 100.0 88 Primary 62.6 9.1 28.4 0.0 100.0 1,782 Secondary 61.0 6.5 32.2 0.4 100.0 4,588 More than secondary 82.6 3.2 14.2 0.0 100.0 405 Wealth quintile Lowest 56.2 9.4 34.3 0.1 100.0 1,042 Second 60.3 8.2 31.1 0.4 100.0 1,137 Middle 58.0 6.0 35.7 0.2 100.0 1,194 Fourth 70.2 5.4 24.2 0.2 100.0 1,892 Highest 62.8 7.2 29.7 0.4 100.0 1,599 Total 15-49 62.6 7.0 30.2 0.3 100.0 6,863 Total 15-54 63.1 7.1 29.5 0.3 100.0 7,175 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents | 37 3.6 OCCUPATION Respondents who were currently employed or had worked in the 12 months preceding the survey were further asked to specify their occupation. Information on current occupation of employed women and men is shown in Tables 3.6.1 and 3.6.2. Nationally, agriculture employs the largest percentage of Zimbabweans: 34 percent of both women and men. After agriculture, sales and services (31 percent of women) and skilled manual labour (22 percent of men) have the second highest percentage of all employed women and men, respectively. Table 3.6.1 Occupation: women Percent distribution of women 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Zimbabwe 2005-2006 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agricul- ture Missing Total Number of women Age 15-19 1.6 2.7 23.4 4.6 2.2 25.4 38.1 2.0 100.0 551 20-24 6.1 7.2 34.4 8.1 0.7 11.6 30.2 1.6 100.0 856 25-29 8.0 6.2 35.0 10.1 1.4 6.4 32.0 1.1 100.0 713 30-34 8.0 3.3 33.7 9.8 1.4 9.9 32.1 1.7 100.0 649 35-39 10.2 2.6 32.2 12.7 1.3 6.7 32.9 1.4 100.0 457 40-44 10.7 2.6 25.1 13.0 0.8 6.8 40.7 0.4 100.0 371 45-49 9.2 1.7 19.9 13.3 0.8 9.0 45.6 0.3 100.0 278 Marital status Never married 7.8 8.0 28.5 6.8 2.1 24.8 19.8 2.2 100.0 778 Married or living together 7.1 3.5 30.0 10.6 1.1 5.8 40.6 1.3 100.0 2,303 Divorced/separated/ widowed 7.4 3.2 34.7 9.8 0.7 13.0 30.7 0.5 100.0 794 Number of living children 0 7.2 7.1 28.0 8.1 1.9 22.1 23.8 1.7 100.0 928 1-2 8.9 5.2 35.4 9.3 0.8 8.5 30.4 1.4 100.0 1,593 3-4 6.8 1.8 29.5 12.2 1.0 6.5 41.0 1.2 100.0 848 5+ 3.4 0.7 22.3 9.2 1.7 6.7 55.4 0.5 100.0 505 Residence Urban 11.1 8.6 45.6 12.0 0.5 13.7 6.2 2.2 100.0 1,656 Rural 4.4 1.2 19.5 7.9 1.8 9.1 55.5 0.7 100.0 2,218 Province Manicaland 7.2 3.5 29.6 13.4 2.5 10.3 32.2 1.2 100.0 416 Mashonaland Central 5.9 1.3 27.4 7.2 1.2 10.3 45.9 0.8 100.0 382 Mashonaland East 10.5 4.5 26.2 12.0 1.4 10.2 33.6 1.5 100.0 197 Mashonaland West 6.3 2.6 25.8 11.6 0.0 12.0 39.4 2.3 100.0 390 Matabeleland North 13.5 2.1 54.4 5.6 1.0 14.6 8.1 0.7 100.0 99 Matabeleland South 11.4 3.7 38.0 10.8 3.6 22.4 8.9 1.1 100.0 159 Midlands 3.8 3.1 14.8 4.1 0.4 7.5 65.0 1.3 100.0 853 Masvingo 4.8 0.3 26.1 5.8 3.5 10.9 48.0 0.6 100.0 416 Harare 9.3 9.0 48.7 14.7 0.7 12.2 3.7 1.7 100.0 747 Bulawayo 14.1 12.6 43.8 14.0 0.0 14.0 0.4 1.0 100.0 217 Education No education 0.6 0.0 17.4 5.7 0.5 8.5 66.4 1.0 100.0 152 Primary 1.3 0.5 22.6 8.6 1.4 14.1 50.9 0.6 100.0 1,192 Secondary 6.0 5.6 36.9 11.0 1.2 10.8 26.8 1.8 100.0 2,303 More than secondary 56.5 14.4 18.4 4.5 1.3 0.0 3.9 1.0 100.0 227 Wealth quintile Lowest 1.2 0.4 14.7 8.9 3.1 7.3 63.8 0.7 100.0 555 Second 1.2 0.5 19.5 7.3 1.9 9.2 60.0 0.5 100.0 602 Middle 2.7 1.3 22.7 6.7 1.6 8.5 56.0 0.6 100.0 646 Fourth 8.2 3.1 42.0 11.9 0.4 11.4 21.2 1.7 100.0 930 Highest 15.3 11.1 39.5 11.1 0.4 15.2 5.2 2.2 100.0 1,142 Total 7.3 4.4 30.6 9.6 1.2 11.1 34.4 1.3 100.0 3,874 38 | Characteristics of Respondents Table 3.6.2 Occupation: men Percent distribution of men 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Zimbabwe 2005-2006 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agricul- ture Missing Total Number of men Age 15-19 2.1 0.2 8.9 10.1 10.6 18.1 47.9 2.0 100.0 613 20-24 6.5 1.5 18.3 21.7 8.4 9.5 32.1 2.0 100.0 1,071 25-29 8.9 2.6 19.3 22.2 8.6 6.4 31.0 1.1 100.0 938 30-34 8.9 3.0 16.6 25.4 7.3 3.8 33.4 1.6 100.0 794 35-39 12.3 5.2 16.5 22.6 7.1 4.0 30.7 1.6 100.0 586 40-44 15.4 4.2 11.2 23.3 6.9 5.6 31.2 2.1 100.0 418 45-49 12.8 0.8 10.2 26.0 6.6 7.2 35.6 0.8 100.0 355 Marital status Never married 6.6 1.4 15.4 16.4 9.6 12.1 35.9 2.5 100.0 1,680 Married or living together 10.4 3.3 15.3 24.2 7.2 5.3 33.2 1.2 100.0 2,821 Divorced/separated/ widowed 5.6 0.6 19.1 24.8 8.3 8.4 33.1 0.2 100.0 273 Number of living children 0 7.3 1.3 15.6 17.4 9.6 11.8 34.8 2.1 100.0 1,928 1-2 9.7 4.0 18.9 25.4 6.4 5.2 28.9 1.4 100.0 1,510 3-4 12.4 3.1 13.3 23.8 7.6 5.7 32.9 1.2 100.0 851 5+ 5.4 1.2 8.5 21.5 8.3 4.2 49.8 1.1 100.0 484 Residence Urban 14.0 5.0 25.8 33.5 9.6 6.2 3.0 2.9 100.0 2,003 Rural 5.0 0.6 8.1 12.8 7.0 9.1 56.6 0.7 100.0 2,772 Province Manicaland 10.0 0.5 18.5 18.3 11.4 8.0 31.2 2.1 100.0 442 Mashonaland Central 3.4 1.2 7.6 13.3 10.4 11.4 51.7 1.0 100.0 562 Mashonaland East 6.3 0.9 16.2 12.9 5.9 8.6 48.7 0.3 100.0 408 Mashonaland West 5.7 2.1 11.3 21.4 6.0 6.5 45.3 1.8 100.0 555 Matabeleland North 9.9 1.1 17.6 25.6 7.4 15.1 22.2 1.1 100.0 209 Matabeleland South 14.5 3.5 8.7 32.8 8.8 12.8 16.2 2.8 100.0 123 Midlands 5.6 2.7 8.0 21.9 6.8 4.2 49.1 1.8 100.0 716 Masvingo 6.8 0.7 8.3 9.0 6.3 10.6 57.4 1.0 100.0 533 Harare 14.1 6.3 28.1 33.2 9.3 5.0 2.6 1.5 100.0 912 Bulawayo 17.5 1.9 26.5 30.9 8.8 8.4 1.5 4.5 100.0 315 Education No education 0.0 0.0 11.8 9.2 7.7 13.5 56.5 1.3 100.0 57 Primary 1.5 0.4 8.5 17.3 9.3 13.9 47.9 1.1 100.0 1,276 Secondary 7.0 3.0 18.9 23.8 8.2 6.1 31.3 1.7 100.0 3,094 More than secondary 52.8 5.5 12.2 18.3 2.5 0.6 5.4 2.7 100.0 347 Wealth quintile Lowest 0.2 0.1 3.8 15.3 9.1 5.7 65.1 0.7 100.0 683 Second 1.7 0.6 5.7 12.6 8.3 8.5 62.2 0.4 100.0 779 Middle 3.4 0.6 9.9 9.6 6.7 11.5 57.9 0.5 100.0 765 Fourth 9.7 2.5 23.3 29.1 8.9 9.7 15.2 1.6 100.0 1,430 Highest 21.4 6.4 23.5 29.9 7.2 4.0 3.7 3.9 100.0 1,118 Total 15-49 8.8 2.5 15.5 21.5 8.1 7.9 34.1 1.6 100.0 4,774 Total 15-54 8.9 2.4 15.3 21.6 7.8 7.8 34.5 1.7 100.0 5,038 Among urban men, the most common occupations are skilled manual labour (34 percent) and sales and services (26 percent). Urban women are most often employed in sales and services (46 percent). In rural areas, more than half of women (56 percent) and men (57 percent) are employed in agriculture. Variations by province show that Midlands has the highest percentage of both women and men in agricultural occupations (65 percent and 49 percent, respectively). Matabeleland North has the highest percentage of women in sales and services (54 percent), and Harare has the highest percentage of men in sales and services (28 percent). Harare and Matabeleland South have the highest percentage of men in Characteristics of Respondents | 39 skilled manual labour occupations (33 percent each). Bulawayo has the highest percentage of both women and men in the professional, technical, and managerial occupations (14 percent of women and 18 percent of men). Employment by level of education shows that 57 percent of women and 53 percent of men with more than a secondary education are in professional, technical, and managerial occupations. The majority of women and men with no education work in the agricultural sector (66 percent of women and 57 percent of men). 3.7 TYPE OF EMPLOYMENT Table 3.7.1 shows the percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural). Fifty-five percent of all the women employed in agricultural work are not paid for their work, while 84 percent of the women in nonagricultural work are given their earnings as cash only. Sixty-four percent of women employed in agricultural work and 50 percent of women in nonagricultural work are self-employed. Differentials by continuity of employ- ment show that 76 percent of all women in agricultural work are seasonally employed, whereas 63 percent of women in nonagricultural work are employed all year. Table 3.7.1 Type of employment: women Percent distribution of women 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Zimbabwe 2005-2006 Employment characteristic Agricultural work Nonagri- cultural work Total Type of earnings Cash only 26.9 84.1 64.0 Cash and in-kind 15.7 7.7 10.6 In-kind only 2.8 1.3 1.8 Not paid 54.7 6.8 23.5 Missing 0.0 0.2 0.2 Total 100.0 100.0 100.0 Type of employer Employed by family member 20.2 8.7 12.7 Employed by non-family member 15.4 40.9 32.0 Self-employed 64.1 50.0 55.0 Missing 0.2 0.5 0.4 Total 100.0 100.0 100.0 Continuity of employment All year 18.8 62.6 47.5 Seasonal 76.0 19.2 38.8 Occasional 5.2 18.1 13.6 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Number of women 1,333 2,489 3,874 Note: Total includes women with missing information on type of employment who are not shown separately. 40 | Characteristics of Respondents Table 3.7.2 shows the percent distribution of men employed in the 12 months preceding the survey by type of earnings, and whether employment is in the agricultural or nonagricultural sector. Overall, 66 percent of men were paid in cash only, 21 percent were not paid, 11 percent received cash and in-kind payment, and 2 percent received in-kind payment only. Among men working in the agricultural sector, 53 percent were not paid, 27 percent were paid in cash only, 16 percent received cash and in-kind payment, and 4 percent received in-kind payment only. In contrast, among men working in the nonagricultural sector, 86 percent received cash only, 8 percent received a combination of cash and in-kind payment, 4 percent did not receive any payment, and less than 1 percent received in-kind payment only. Table 3.7.2 Type of employment: men Percent distribution of men 15-49 employed in the 12 months preceding the survey by type of earnings, according to type of employment (agricultural or nonagricultural), Zimbabwe 2005- 2006 Employment characteristic Agricultural work Nonagri- cultural work Total Type of earnings Cash only 26.5 86.4 65.5 Cash and in-kind 16.2 7.8 10.7 In-kind only 4.2 0.6 1.9 Not paid 53.0 4.4 21.4 Missing 0.0 0.8 0.5 Total 100.0 100.0 100.0 Number of men 1,740 3,212 5,038 Note: Total includes men with missing information on type of employment who are not shown separately. 3.8 HEALTH INSURANCE COVERAGE The 2005-06 ZDHS collected data on women’s health insurance coverage. The majority of women (91 percent) do not have health insurance. Among the 9 percent of women with health insurance, 4 percent have insurance through their employer, 3 percent are covered under a privately purchased commercial plan, and the remaining 2 percent are covered through some other mechanism. As expected, women who reside in urban areas and women in the highest wealth quintile are the most likely to have health insurance coverage. Education is strongly associated with health care coverage. Sixty percent of women with more than a secondary education have health insurance, compared with 1 percent of women with no education, 3 percent with only a primary education, and 10 percent with a secondary education. Characteristics of Respondents | 41 Table 3.8 Health insurance coverage Percent distribution of women by type of health insurance coverage, according to background characteristics, Zimbabwe 2005-2006 Background characteristic Other employer- based insurance Privately purchased commercial insurance Other None Total Number of women Age 15-19 1.7 2.1 1.4 94.7 100.0 2,152 20-24 3.0 2.5 2.3 92.2 100.0 1,952 25-29 4.1 3.0 2.5 90.4 100.0 1,466 30-34 5.6 3.3 3.1 88.1 100.0 1,216 35-39 5.5 3.2 3.6 87.7 100.0 834 40-44 7.6 2.9 2.6 86.8 100.0 699 45-49 4.1 1.9 2.4 91.6 100.0 589 Residence Urban 7.1 5.3 5.0 82.5 100.0 3,502 Rural 1.8 0.9 0.6 96.6 100.0 5,405 Province Manicaland 3.0 2.9 0.6 93.6 100.0 1,043 Mashonaland Central 1.6 1.3 1.0 96.1 100.0 825 Mashonaland East 3.4 1.0 2.8 92.7 100.0 714 Mashonaland West 1.1 3.4 3.1 92.4 100.0 829 Matabeleland North 3.5 1.2 0.4 94.9 100.0 536 Matabeleland South 4.2 1.5 1.4 92.9 100.0 439 Midlands 5.2 1.4 0.6 92.9 100.0 1,193 Masvingo 2.9 0.6 0.9 95.6 100.0 1,137 Harare 6.9 5.7 6.1 81.3 100.0 1,492 Bulawayo 5.2 5.6 4.8 84.4 100.0 697 Education No education 0.4 0.7 0.2 98.7 100.0 380 Primary 1.7 0.5 0.5 97.2 100.0 2,902 Secondary 4.2 3.4 2.7 89.8 100.0 5,355 More than secondary 26.6 14.1 19.3 40.0 100.0 270 Wealth quintile Lowest 0.7 0.3 0.1 98.9 100.0 1,552 Second 0.6 0.2 0.1 99.1 100.0 1,500 Middle 1.7 0.7 0.4 97.2 100.0 1,546 Fourth 4.1 2.3 2.1 91.5 100.0 2,006 Highest 9.5 7.5 7.0 76.0 100.0 2,304 Total 3.9 2.7 2.4 91.1 100.0 8,907 3.9 KNOWLEDGE AND ATTITUDES CONCERNING TUBERCULOSIS The 2005-06 ZDHS collected data on women’s and men’s knowledge and attitudes concerning tuberculosis (TB). Tables 3.9.1 and 3.9.2 show the percentage of women and men who have heard of TB, and among those who have heard of TB, the percentage who know that TB is spread through air by coughing, the percentage who believe that TB can be cured, and the percentage who would want to keep it a secret if a family member had TB, by background characteristics. Ninety-four percent of women and 96 percent of men reported that they have heard of TB. Women and men who live in urban areas, reside in Bulawayo province, and have more than a secondary education were more likely to have heard of TB than their counterparts in other categories. 42 | Characteristics of Respondents Table 3.9.1 Knowledge and attitude concerning tuberculosis: women Percentage of women 15-49 who have heard of tuberculosis (TB), and among women who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would want to keep secret that a family member has TB, by background characteristics, Zimbabwe 2005-2006 Among women who have heard of TB Among all women Background characteristic Percentage who have heard of TB Number Percentage who report that TB is spread through the air by coughing Percentage who believe that TB can be cured Percentage who would want a family member's TB kept secret Number of women Age 15-19 91.3 2,152 67.1 82.7 56.8 1,964 20-24 93.6 1,952 70.7 89.0 67.8 1,828 25-29 95.8 1,466 72.6 91.6 70.2 1,404 30-34 95.2 1,216 73.6 92.4 69.1 1,157 35-39 96.4 834 73.8 93.3 70.4 804 40-44 93.4 699 69.5 92.2 64.2 653 45-49 94.8 589 68.2 89.3 61.1 558 Residence Urban 97.0 3,503 78.6 92.8 71.3 3,398 Rural 92.0 5,405 65.2 86.6 61.2 4,970 Province Manicaland 92.1 1,043 62.4 89.7 73.7 960 Mashonaland Central 87.9 825 65.1 87.1 67.7 725 Mashonaland East 91.6 714 59.0 83.7 72.6 654 Mashonaland West 90.6 829 67.0 88.6 75.6 751 Matabeleland North 98.4 536 66.3 85.4 15.8 528 Matabeleland South 85.7 439 52.7 89.3 27.7 377 Midlands 96.4 1,193 88.3 89.8 86.6 1,150 Masvingo 97.6 1,137 65.4 87.8 54.9 1,110 Harare 95.2 1,492 73.3 92.8 80.4 1,421 Bulawayo 99.3 697 88.9 92.1 41.8 693 Education No education 87.6 380 51.5 80.4 54.3 333 Primary 89.9 2,903 60.0 85.5 57.3 2,610 Secondary 96.3 5,355 76.0 91.0 69.7 5,155 More than secondary 100.0 270 92.9 98.0 73.7 270 Wealth quintile Lowest 90.0 1,552 61.6 84.1 50.8 1,397 Second 90.5 1,500 64.7 85.6 60.5 1,357 Middle 93.4 1,546 65.2 87.2 66.9 1,445 Fourth 95.9 2,006 73.4 91.9 69.4 1,923 Highest 97.5 2,304 80.8 93.2 72.7 2,247 Total 93.9 8,907 70.6 89.1 65.3 8,368 Among women and men who have heard of TB, 71 percent reported that TB is spread through the air by coughing. Women and men in the age groups 15-19 years and 45-49 years; respondents residing in rural areas; women in Matabeleland South; men in Matabeleland North; and those with a primary education or less had the lowest percentage of people who reported that TB is spread through coughing. Eighty-nine percent of all respondents who have heard of TB believe that TB can be cured. Among provinces, the percentage of people who believe that TB can be cured ranges from 84 percent of women in Mashonaland East and 81 percent of men in Mashonaland West to 93 percent of women in Harare and 95 percent of men in Bulawayo. Among those who have heard of TB, 65 percent of women and 70 percent of men indicated that they would want knowledge of a family member’s TB to be kept secret. Characteristics of Respondents | 43 Table 3.9.2 Knowledge and attitude concerning tuberculosis: men Percentage of men 15-49 who have heard of tuberculosis (TB), and among men who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would want to keep secret that a family member has TB, by background characteristics, Zimbabwe 2005-2006 Among men who have heard of TB Among all men Background characteristic Percentage who have heard of TB Number Percentage who report that TB is spread through the air by coughing Percentage who believe that TB can be cured Percentage who would want a family member's TB kept secret Number Age 15-19 91.8 1,899 67.8 82.1 58.5 1,743 20-24 96.0 1,459 70.6 87.2 69.3 1,400 25-29 97.1 1,082 72.5 91.2 73.6 1,050 30-34 97.9 882 73.2 92.9 75.9 863 35-39 97.6 663 77.1 93.5 77.5 648 40-44 96.6 469 71.9 92.4 75.6 453 45-49 97.1 409 66.7 90.0 72.3 398 Residence Urban 97.8 2,767 80.0 93.2 72.9 2,706 Rural 94.0 4,096 64.6 85.0 67.0 3,848 Province Manicaland 91.3 793 59.6 86.7 69.7 724 Mashonaland Central 94.0 681 71.0 86.0 73.7 640 Mashonaland East 89.4 570 73.8 85.6 83.3 510 Mashonaland West 96.0 691 59.4 81.0 76.7 663 Matabeleland North 96.1 416 55.2 82.0 30.9 400 Matabeleland South 96.9 306 85.0 90.8 18.0 297 Midlands 97.4 956 79.0 89.3 81.3 931 Masvingo 96.9 771 62.4 90.1 71.8 747 Harare 97.5 1,219 79.5 93.4 88.5 1,189 Bulawayo 98.7 460 83.3 94.8 26.2 454 Education No education 90.3 88 59.8 74.3 48.9 79 Primary 91.0 1,782 57.4 80.2 59.7 1,621 Secondary 97.1 4,588 74.5 90.9 72.5 4,454 More than secondary 98.8 405 89.0 96.5 78.9 400 Wealth quintile Lowest 93.7 1,042 57.9 81.4 58.3 977 Second 93.5 1,137 66.9 83.7 68.2 1,062 Middle 93.9 1,194 65.4 86.3 68.3 1,121 Fourth 96.0 1,892 73.9 90.6 72.5 1,816 Highest 98.7 1,599 82.5 94.7 74.5 1,578 Total 15-49 95.5 6,863 71.0 88.4 69.4 6,554 Total 15-54 95.6 7,175 70.9 88.6 69.6 6,861 44 | Characteristics of Respondents 3.10 USE OF TOBACCO The 2005-06 ZDHS collected information on women’s and men’s tobacco use. Tables 3.10.1 and 3.10.2 present the percent of women and men who smoke cigarettes, a pipe, or use other tobacco products, and the percent distribution of cigarette smokers by number of cigarettes smoked in the 24 hours before the interview, according to background characteristics. Table 3.10.1 also includes data on women’s tobacco use by maternity status. Table 3.10.1 Use of tobacco: women Percentage of women 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics and maternity status, Zimbabwe 2005-2006 Tobacco use Number of cigarettes in the past 24 hours1 Background characteristic Cigarettes Pipe Other tobacco Does not use tobacco Number of women 1-2 3-5 6-9 10+ Don't know/ missing Total Number of cigarette smokers Age 15-19 0.2 0.1 0.1 99.7 2,152 * * * * * 100.0 5 20-24 0.0 0.0 0.2 99.7 1,952 * * * * * 100.0 1 25-29 0.1 0.1 0.1 99.7 1,466 * * * * * 100.0 1 30-34 0.3 0.0 0.6 99.2 1,216 * * * * * 100.0 4 35-39 0.3 0.0 0.6 99.0 834 * * * * * 100.0 3 40-44 0.5 0.2 1.8 97.6 699 * * * * * 100.0 4 45-49 3.0 1.8 3.2 94.0 589 * * * * * 100.0 17 Residence Urban 0.4 0.1 0.3 99.2 3,503 * * * * * 100.0 15 Rural 0.3 0.2 0.7 98.9 5,405 * * * * * 100.0 18 Province Manicaland 0.2 0.1 0.3 99.3 1,043 * * * * * 100.0 2 Mashonaland Central 1.2 0.9 0.4 98.5 825 * * * * * 100.0 10 Mashonaland East 0.1 0.0 0.4 99.4 714 * * * * * 100.0 1 Mashonaland West 0.2 0.2 1.6 98.2 829 * * * * * 100.0 2 Matabeleland North 0.4 0.5 0.7 98.3 536 * * * * * 100.0 2 Matabeleland South 0.4 0.0 1.6 98.4 439 * * * * * 100.0 2 Midlands 0.4 0.1 0.5 99.3 1,193 * * * * * 100.0 5 Masvingo 0.0 0.0 0.4 99.6 1,137 * * * * * 100.0 0 Harare 0.6 0.0 0.4 98.9 1,492 * * * * * 100.0 9 Bulawayo 0.1 0.0 0.2 99.7 697 * * * * * 100.0 1 Education No education 3.6 3.0 2.8 93.8 380 * * * * * 100.0 14 Primary 0.2 0.0 1.1 98.7 2,903 * * * * * 100.0 7 Secondary 0.2 0.1 0.1 99.6 5,355 * * * * * 100.0 11 More than secondary 0.7 0.0 0.8 98.9 270 * * * * * 100.0 2 Maternity status Pregnant 0.0 0.4 0.1 99.4 589 * * * * * 100.0 0 Breastfeeding (not pregnant) 0.0 0.0 0.1 99.9 1,699 * * * * * 100.0 0 Neither 0.5 0.2 0.7 98.8 6,619 * * * * * 100.0 33 Wealth quintile Lowest 0.4 0.2 1.2 98.4 1,552 * * * * * 100.0 6 Second 0.2 0.0 0.6 99.3 1,500 * * * * * 100.0 2 Middle 0.7 0.6 0.4 98.8 1,546 * * * * * 100.0 11 Fourth 0.1 0.1 0.6 99.3 2,006 * * * * * 100.0 3 Highest 0.5 0.0 0.2 99.2 2,304 * * * * * 100.0 12 Total 0.4 0.2 0.6 99.0 8,907 (18.3) (14.2) (3.1) (18.8) (45.6) 100.0 33 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 All female smokers had smoked at least 1 cigarette in the past 24 hours. Characteristics of Respondents | 45 The majority of women (99 percent) reported that they do not use tobacco. Only 33 women reported smoking cigarettes so that it is not possible to look at the pattern of cigarette use among women. Thirty percent of men age 15-49 reported using cigarettes, a pipe, or other tobacco products. Most of the male respondents smoke cigarettes (21 percent). The largest number of cigarette smokers is in the 20-24 year age group (357 cigarette smokers). There is not much variance by urban-rural residence. Among men who smoke, 33 percent smoked three to five cigarettes within 24 hours prior to the interview and 27 percent smoked 10 or more cigarettes during the same time period. Table 3.10.2 Use of tobacco: men Percentage of men 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics , Zimbabwe 2005-2006 Tobacco use Number of cigarettes in the past 24 hours Background characteristic Cigarettes Pipe Other tobacco Does not use tobacco Number of men 0 1-2 3-5 6-9 10+ Don't know/ missing Total Number of cigarette smokers Age 15-19 4.7 0.4 1.9 94.5 1,899 9.9 36.7 24.0 7.3 18.2 3.9 100.0 89 20-24 24.5 3.4 5.8 74.6 1,459 5.7 25.9 34.7 14.6 16.8 2.2 100.0 357 25-29 27.9 4.1 7.1 70.0 1,082 5.4 16.1 33.4 15.4 27.2 2.4 100.0 301 30-34 23.5 3.2 6.3 74.8 882 2.5 14.8 34.2 15.3 31.9 1.4 100.0 207 35-39 28.6 4.4 7.1 68.7 663 6.0 16.9 34.5 15.7 25.3 1.6 100.0 190 40-44 32.9 4.8 6.9 65.0 469 5.1 8.7 32.0 18.8 33.0 2.4 100.0 154 45-49 40.0 5.6 7.3 58.7 409 3.7 12.5 30.2 11.2 41.2 1.2 100.0 164 Residence Urban 19.5 1.7 4.7 78.9 2,767 3.8 19.0 30.3 14.9 29.2 2.8 100.0 541 Rural 22.5 3.9 5.6 76.1 4,096 6.0 18.1 34.4 14.5 25.3 1.6 100.0 921 Province Manicaland 21.8 2.5 4.9 77.4 793 4.0 15.5 39.2 16.9 23.5 0.9 100.0 173 Mashonaland Central 27.1 1.8 8.3 72.5 681 5.5 15.7 29.0 15.1 34.2 0.5 100.0 185 Mashonaland East 22.3 13.2 0.7 77.6 570 0.9 19.5 34.9 12.8 30.3 1.6 100.0 127 Mashonaland West 26.3 3.8 9.0 71.2 691 1.7 17.9 31.5 17.0 30.6 1.3 100.0 182 Matabeleland North 18.9 8.2 4.9 77.9 416 0.7 17.9 36.8 21.8 16.6 6.3 100.0 79 Matabeleland South 12.0 2.5 5.5 87.1 306 5.1 14.0 40.6 12.2 28.0 0.0 100.0 37 Midlands 18.8 1.3 4.8 79.1 956 12.7 24.1 35.1 7.8 18.7 1.5 100.0 179 Masvingo 19.3 0.1 3.3 79.5 771 13.1 15.4 30.9 15.0 22.8 2.7 100.0 149 Harare 23.1 1.0 5.3 74.9 1,219 3.2 18.4 30.6 16.0 28.0 3.8 100.0 281 Bulawayo 15.5 0.7 6.0 83.8 460 1.4 28.3 27.0 9.2 33.0 1.1 100.0 71 Education No education 52.8 13.5 7.4 45.6 88 6.5 (11.3) (36.6) (8.8) (32.6) (4.2) 100.0 46 Primary 25.4 4.5 7.1 72.4 1,782 5.7 15.9 31.6 18.2 26.7 1.7 100.0 452 Secondary 19.9 2.3 4.7 78.9 4,588 4.9 20.8 33.3 13.1 25.8 2.1 100.0 912 More than secondary 12.7 1.4 2.6 86.0 405 4.5 (6.7) (34.0) (15.7) (37.5) (1.6) 100.0 52 Wealth quintile Lowest 25.3 4.1 6.0 73.3 1,042 7.8 17.2 34.5 16.7 21.9 1.8 100.0 264 Second 22.7 4.0 6.9 75.4 1,137 6.5 17.1 30.9 14.3 30.6 0.5 100.0 259 Middle 22.6 3.9 5.6 76.2 1,194 4.6 22.7 34.8 14.6 20.7 2.6 100.0 270 Fourth 22.4 2.7 4.6 76.1 1,892 5.5 14.4 34.3 13.5 28.6 3.6 100.0 423 Highest 15.4 1.1 4.2 83.2 1,599 1.1 23.6 28.7 14.7 31.1 0.7 100.0 247 Total 15-49 21.3 3.0 5.3 77.2 6,863 5.2 18.5 32.9 14.6 26.7 2.1 100.0 1,462 Total men 15-54 22.1 3.1 5.5 76.3 7,175 5.1 17.9 32.6 15.2 27.3 2.0 100.0 1,587 Note: Figures in parentheses are based on 25-49 unweighted cases. Fertility | 47 FERTILITY 4 In the 2005-06 ZDHS, data were collected on current and completed fertility. Drawing from the birth histories of women interviewed in the survey, the chapter begins with a description of current fertility, followed by differentials in fertility. Attention is next focused on trends in fertility, including examination of age-specific fertility rates in time periods going back 15 to 20 years. The chapter concludes with a presentation of information on age of women at their first birth and patterns of adolescent childbearing. The fertility indicators presented in this chapter are based on reports provided by women age 15- 49 years regarding their reproductive histories. As in the previous ZDHS surveys, each woman was asked to provide information on the total number of sons and daughters to whom she had given birth who were living with her, the number living elsewhere, and the number who had died, in order to obtain the total number of live births. In the birth history, women reported on the detailed history of each live birth separately, including such information as name, month and year of birth, sex, and survival status. For children who had died, information on age at death was collected. 4.1 CURRENT FERTILITY Measures of current fertility presented in this chapter include age-specific fertility rates (ASFRs), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR). These rates are generally presented for the three- year period preceding the survey, a period covering portions of the calendar years 2002 through 2005. The three-year period was chosen for calculating these rates (rather than a longer or a shorter period) to provide the most current information, to reduce sampling error, and to avoid problems of the displace- ment of births. Age-specific fertility rates are useful in understanding the age pattern of fertility. Numerators of ASFRs are calculated by identifying live births that occurred in the period 1-36 months prior to the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year groups) of the mother at the time of the child’s birth. The denominators of these rates are the number of woman-years lived in each of the specified five- year age groups in the period 1-36 months prior to the survey. The total fertility rate is a common measure of current fertility and is defined as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific rates. The general fertility rate is the number of live births occurring during a specified period per 1,000 women age 15-44. The crude birth rate is the number of births per 1,000 population during a specified period. Table 4.1 Current fertility Age-specific and total fertility rate, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Zimbabwe 2005-2006 Residence Age group Urban Rural Total 15-19 70 120 99 20-24 147 248 205 25-29 130 198 172 30-34 112 164 144 35-39 51 111 86 40-44 6 59 42 45-49 0 17 13 TFR 15-49 2.6 4.6 3.8 TFR 15-44 2.6 4.5 3.7 GFR 98 163 137 CBR 28.5 32.0 31.0 Note: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population 48 | Fertility Table 4.1 shows the age-specific and aggregate fertility measures calculated from the 2005-06 ZDHS data. The total fertility rate for Zimbabwe is 3.8 children per woman. Peak childbearing occurs during ages 20-24 and 25-29 years, dropping sharply after age 34. Fertility among urban women is substantially lower (2.6 children per woman) than among rural women (4.6 children per woman). This pattern of lower fertility in urban areas is evident in every age group. 4.2 FERTILITY BY BACKGROUND CHARACTERISTICS Table 4.2 and Figure 4.1 show differentials in fertility by urban-rural residence, province, level of education, and wealth quintile. The TFR ranges from about two births per woman in the urban provinces of Harare (2.5) and Bulawayo (2.3) to 4.9 births per woman in Masvingo. Educational attainment is closely linked to a woman’s fertility; the TFR for women with no formal education and women with a primary education is four or more children per woman, while that for women with at least some secondary educa- tion is three or fewer children per woman. Table 4.2 also allows for a general assess- ment of differential trends in fertility over time among population subgroups. The mean number of children ever born to women age 40-49 years is a measure of fertility in the past. The mean number of children ever born to older women who are nearing the end of their reproductive period is an indicator of average completed fertility of women who began childbearing during the three decades preceding the survey. If fertility remained constant over time and the reported data on both children ever born and births during the three years preceding the survey are reasonably accurate, the TFR and the mean number of children ever born for women 40-49 years would be similar. When fertility levels have been falling, the TFR will be substantially lower than the mean number of children ever born among women age 40-49. A comparison of current (total) fertility with past (completed) fertility shows that there have been substantial and roughly equivalent declines in both urban and rural areas and within all provincial and education categories. Overall, the comparison of past and present fertility indicators suggests a decline from 5.2 to 3.8 children per woman. At the time of the survey, 7 percent of interviewed women reported that they were pregnant. This percentage is an underestimate of the true percent pregnant because many women at early durations of pregnancy will not yet know for sure that they are pregnant and some women may not want to declare that they are pregnant. Differentials in pregnancy status closely parallel differentials in current fertility. Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Zimbabwe 2005-2006 Background characteristic Total fertility rate Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Residence Urban 2.6 4.4 4.0 Rural 4.6 8.0 5.8 Province Manicaland 4.2 7.4 5.5 Mashonaland Central 4.6 8.6 5.1 Mashonaland East 3.7 7.7 5.1 Mashonaland West 3.7 6.7 5.3 Matabeleland North 4.2 6.1 5.9 Matabeleland South 4.0 5.3 5.0 Midlands 4.2 7.3 5.7 Masvingo 4.9 8.0 6.5 Harare 2.5 5.3 4.1 Bulawayo 2.3 2.4 3.6 Education No education 5.8 2.0 6.1 Primary 4.5 7.9 5.5 Secondary 3.3 6.3 4.0 More than secondary 2.7 5.0 2.9 Wealth quintile Lowest 5.5 8.0 6.4 Second 4.8 10.0 6.1 Middle 4.0 7.1 5.5 Fourth 3.2 6.3 4.5 Highest 2.3 3.5 3.8 Total 3.8 6.6 5.2 1 Women age 15-49 years Fertility | 49 4.3 FERTILITY TRENDS The data in Table 4.3 provide further evi- dence of a substantial fertility decline in Zimbabwe. This table uses information from the retrospective birth histories obtained from ZDHS respondents to examine trends in age-specific fertility rates for successive five-year periods before the survey. To calculate these rates, births were classified according to the period of time in which the birth occurred and the mother’s age at the time of birth. Because women age 50 and above were not interviewed in the survey, the rates are successively truncated for periods more distant from the survey date. For example, rates can- not be calculated for women age 35-39 for the period 15-19 years before the survey because these women would have been over the age of 50 at the time of the survey and were not interviewed. Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Zimbabwe 2005-2006 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 101 114 117 113 20-24 205 211 225 242 25-29 179 200 223 243 30-34 143 163 191 [224] 35-39 90 113 [152] - 40-44 46 [65] - - 45-49 [12] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 2.6 4.6 4.2 4.6 3.7 3.7 4.2 4.0 4.2 4.9 2.5 2.3 5.8 4.5 3.3 2.7 5.5 4.8 4.0 3.2 2.3 3.8 RESIDENCE Urban Rural PROVINCE Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Harare Bulawayo EDUCATION No education Primary Secondary More than secondary WEALTH QUINTILE Lowest Second Middle Fourth Highest ZIMBABWE 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 Births per woman Figure 4.1 Total Fertility Rate by Background Characteristics ZDHS 2005-06 50 | Fertility Fertility has fallen among all age groups over the past two decades. Among women under age 35, substantial and sustained declines in age-specific fertility rates were observed from 15 to 19 years before the survey to 0 to 4 years before the survey. Fertility decline is steepest among women 25-34 years of age. Table 4.4 and Figure 4.2 show trends in current fertility rates based on successive ZDHS surveys. Fertility declined by 1.7 births between the 1988 and 2005-06 surveys. Table 4.4 Trends in current fertility rates Age-specific fertility rates and total fertility rates, Zimbabwe 1984-2006 Age group 1988 ZDHS (1984-88) 1994 ZDHS (1991-94) 1999 ZDHS (1996-99) 2005-06 ZDHS (2004-05-2005-06) 15-19 103 99 112 99 20-24 247 210 199 205 25-29 247 194 180 172 30-34 219 172 135 144 35-39 160 117 108 86 40-44 86 52 46 42 45-49 36 14 15 13 TFR 15-49 5.5 4.3 4.0 3.8 ( ( ( ( ( ( ( , , , , , , , ' ' ' ' ' ' ' 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group 0 50 100 150 200 250 300 Births per 1,000 women 1988 ZDHS 1994 ZDHS 1999 ZDHS 2005-06 ZDHS' , ( Figure 4.2 Trends in Current Fertility Rates, Zimbabwe 1984-2006 Fertility | 51 4.4 CHILDREN EVER BORN AND LIVING The distribution of women by the number of children ever born is presented in Table 4.5 for all women and for currently married women. The table also shows the mean number of children ever born to women in each five-year age group. These distributions reflect the accumulation of births among ZDHS respondents over the past 30 years and, therefore, their relevance to the current situation is limited. However, the information on children ever born is useful for observing how average family size varies across age groups, and for observing the level of primary infertility. On average, women in their early twenties have given birth to about one child, women in their early thirties have had three children, and women currently at the end of their childbearing years have had more than five children. Of the 5.7 chil- dren ever born to women age 45-49, 5.1 survived to the time of the survey. Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Zimbabwe 2005-2006 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 84.2 14.0 1.7 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2,152 0.2 0.2 20-24 30.9 39.7 21.8 6.2 1.2 0.1 0.0 0.0 0.0 0.0 0.0 1,952 1.1 1.0 25-29 8.7 20.7 36.7 22.1 7.7 3.5 0.4 0.2 0.0 0.0 0.0 1,466 2.1 2.0 30-34 2.5 10.4 25.9 26.0 17.4 11.2 5.2 0.8 0.6 0.1 0.0 1,216 3.1 2.9 35-39 2.8 8.3 16.7 19.4 23.0 13.6 7.8 5.2 2.2 0.4 0.6 834 3.7 3.5 40-44 2.4 5.2 7.2 12.0 20.5 16.1 12.8 10.8 5.9 4.5 2.5 699 4.9 4.5 45-49 2.6 4.0 5.7 9.0 9.9 15.1 15.7 12.5 12.6 5.0 7.9 589 5.7 5.1 Total 29.5 18.4 17.3 11.9 8.3 5.7 3.6 2.3 1.6 0.7 0.8 8,907 2.2 2.0 CURRENTLY MARRIED WOMEN 15-19 46.2 46.3 7.1 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 448 0.6 0.6 20-24 12.0 47.4 30.2 8.5 1.8 0.2 0.0 0.0 0.0 0.0 0.0 1,200 1.4 1.3 25-29 3.3 17.9 39.8 25.2 8.6 4.3 0.5 0.2 0.0 0.0 0.0 1,125 2.3 2.2 30-34 1.2 6.6 24.2 27.8 19.5 12.6 6.0 1.1 0.7 0.1 0.1 933 3.3 3.1 35-39 2.2 5.3 15.0 18.7 22.0 17.0 9.1 6.5 3.1 0.5 0.7 556 4.0 3.7 40-44 1.7 3.3 6.7 9.8 21.2 14.5 14.3 13.2 6.5 5.4 3.4 485 5.2 4.8 45-49 1.4 3.5 3.8 6.9 9.4 13.8 16.0 16.1 14.6 5.1 9.2 396 6.1 5.5 Total 8.3 21.4 23.3 16.1 10.9 7.5 4.8 3.4 2.2 1.0 1.1 5,143 2.9 2.7 Results at younger ages for currently married women differ from those for the sample as a whole because of the large number of unmarried women with minimal fertility. Differences at older ages generally reflect the impact of marital dissolution (either divorce or widowhood). About 1 percent of married women age 45-49 have never had a child. Under the proposition that desire for children is universal in Zimbabwe, this percentage represents a rough measure of primary infertility or the inability to bear children. 52 | Fertility 4.5 BIRTH INTERVALS Information on the length of birth intervals provides insight into birth spacing patterns, which affect fertility as well as infant and child mortality. Research has shown that children born too soon after a previous birth are at increased risk of poor health, particularly when the interval is less than 24 months. Table 4.6 shows the distribution of births in the five years before the survey by the interval since the previous birth, according to various background and demographic characteristics. Table 4.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, according to background characteristics, Zimbabwe 2005-2006 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-54 55-59 60+ Total Number of non-first births Median number of months since preceding birth Age 15-19 (25.4) (14.3) (46.1) (8.5) (3.4) (2.3) (0.0) 100.0 38 29.0 20-29 4.2 7.4 32.1 26.1 10.6 5.5 14.2 100.0 1,817 38.2 30-39 2.8 5.2 20.6 21.9 11.2 5.6 32.7 100.0 1,390 47.8 40-49 2.4 7.4 21.5 20.3 6.3 5.2 36.8 100.0 323 47.0 Birth order 2-3 3.6 5.8 27.7 23.7 10.9 5.3 23.0 100.0 2,198 41.5 4-6 3.4 7.3 25.1 22.3 10.4 6.6 24.9 100.0 1,086 42.6 7+ 4.9 10.3 26.3 29.8 6.4 2.9 19.3 100.0 283 40.0 Sex of preceding birth Male 3.5 6.4 25.8 24.6 11.4 5.2 23.2 100.0 1,865 41.9 Female 3.8 6.9 28.0 22.8 9.3 5.8 23.4 100.0 1,702 41.2 Survival of preceding birth Living 2.0 5.8 26.6 24.6 10.8 5.9 24.5 100.0 3,290 42.6 Dead 23.9 16.7 29.5 13.6 5.9 0.9 9.4 100.0 277 27.5 Residence Urban 3.4 6.4 22.6 18.5 8.4 6.8 33.9 100.0 885 47.1 Rural 3.8 6.7 28.2 25.5 11.0 5.1 19.8 100.0 2,682 40.4 Province Manicaland 6.1 8.6 30.9 19.7 8.9 5.4 20.5 100.0 473 38.4 Mashonaland Central 2.7 2.8 24.2 28.0 14.1 6.9 21.3 100.0 437 44.5 Mashonaland East 2.1 6.2 21.7 22.0 13.1 6.7 28.2 100.0 247 46.2 Mashonaland West 3.2 6.1 27.4 25.8 7.8 4.7 24.9 100.0 361 41.0 Matabeleland North 3.3 5.2 35.0 24.5 8.1 3.4 20.5 100.0 233 38.5 Matabeleland South 2.6 7.2 31.4 24.6 7.3 3.2 23.7 100.0 185 38.8 Midlands 4.8 6.4 26.6 24.9 11.3 5.4 20.6 100.0 542 41.4 Masvingo 3.8 9.1 26.1 24.6 12.3 4.3 19.9 100.0 558 41.0 Harare 2.8 6.0 22.7 21.8 8.0 7.4 31.3 100.0 386 45.8 Bulawayo 2.3 8.1 24.5 17.0 9.0 7.5 31.7 100.0 146 45.8 Education No education 1.7 9.0 21.5 28.4 6.0 8.1 25.2 100.0 202 42.5 Primary 3.8 7.5 27.2 26.0 10.1 4.7 20.8 100.0 1,480 40.4 Secondary 3.8 5.6 27.2 21.9 11.3 5.8 24.4 100.0 1,806 42.7 More than secondary 2.7 9.2 24.6 11.2 5.5 5.6 41.2 100.0 80 48.7 Wealth quintile Lowest 3.2 7.7 32.4 25.1 11.2 5.1 15.2 100.0 982 38.2 Second 3.7 7.0 29.2 25.4 11.2 6.0 17.5 100.0 799 40.5 Middle 5.3 5.6 24.7 27.0 9.6 4.0 23.8 100.0 621 41.9 Fourth 2.5 6.6 23.3 20.6 10.7 6.4 30.0 100.0 658 45.6 Highest 4.0 5.1 19.2 18.7 8.1 5.9 38.9 100.0 507 51.0 Total 3.7 6.6 26.8 23.7 10.4 5.5 23.3 100.0 3,567 41.6 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Figures in parentheses are based on 25-49 unweighted cases. Fertility | 53 The median birth interval in Zimbabwe is 41.6 months. About one in ten children are born after too short an interval (less than 24 months). The median interval length is shorter among births to women under age 30 than among births to older mothers. The median birth interval length is 27.5 months among children whose older sibling did not survive compared with 42.6 months among children whose older sibling is still alive. The median birth interval in urban areas (47.1 months) is somewhat higher than in rural areas (40.4 months). Of all the provinces, the longest birth interval is observed in Mashonaland East (46.2 months) and the shortest in Manicaland (38.4 months). By education, those with more than secondary education have the longest birth interval (48.7 months). 4.6 AGE AT FIRST BIRTH The age at which childbearing begins has an impact on the health and welfare of a mother and her children. In many countries, the postponement of first births has contributed to an overall fertility decline. Table 4.7 shows the distribution of women by age at first birth, according to their current age. The median age at first birth in Zimbabwe is around 20 for most age groups. Although this broad measure has not changed since the 1999 ZDHS, more detailed analysis of trends in age at first birth does reveal a decline in early childbearing. For example, whereas about 26 percent of women age 35-39 had a birth at age 18, only 21 percent of women currently age 20-24 had their first birth at age 18. This slow but steady trend reflects positively on efforts to keep girls and women in school through more advanced levels to improve their social and economic status. Table 4.7 Age at first birth Among all women, percentage who gave birth by exact ages, percentage who have never given birth, and median age at first birth, by current age, Zimbabwe 2005-2006 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 1.3 na na na na 84.2 2,152 a 20-24 1.5 20.8 46.9 na na 30.9 1,952 a 25-29 2.9 21.4 48.7 70.0 86.3 8.7 1,466 20.1 30-34 5.1 25.3 47.4 70.5 87.0 2.5 1,216 20.2 35-39 4.2 26.1 48.3 66.9 83.7 2.8 834 20.2 40-44 3.9 26.3 56.6 75.0 89.0 2.4 699 19.5 45-49 4.9 28.5 54.1 76.5 88.5 2.6 589 19.7 a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group na = Not applicable 4.7 MEDIAN AGE AT FIRST BIRTH BY BACKGROUND CHARACTERISTICS Table 4.8 summarises the median age at first birth for different age cohorts across residential and educational subgroups. For all age groups, the median age at first birth is higher in urban areas than in rural areas. Similarly, age at first birth increases markedly with increasing level of education; for example, within the cohort age 25-29 years, women without any education have their first birth at 18.2 years, compared with 24 years for women with more than secondary education. This is a difference of 5.8 years. 54 | Fertility Table 4.8 Median age at first birth by background characteristics Median age at first birth among women age 20-49 years, by current age and background characteristics, Zimbabwe 2005- 2006 Age Background characteristic 20-24 25-29 30-34 35-39 40-44 45-49 Women age 20-49 Women age 25-49 Residence Urban 22.3 21.1 21.2 20.4 19.9 19.8 21.0 20.7 Rural 19.5 19.6 19.6 20.0 19.2 19.7 19.6 19.6 Province Manicaland a 20.4 19.7 20.0 18.7 20.9 20.0 20.0 Mashonaland Central 19.1 19.1 19.2 19.8 20.0 18.8 19.2 19.4 Mashonaland East 20.0 19.4 20.2 20.8 19.6 19.4 19.9 19.8 Mashonaland West 19.4 19.7 20.4 19.8 18.7 20.1 19.7 19.8 Matabeleland North 19.8 19.6 19.1 19.2 19.2 19.4 19.4 19.3 Matabeleland South a 19.3 20.3 20.3 19.2 19.6 19.9 19.7 Midlands 19.9 19.9 20.1 20.5 20.1 19.3 20.0 20.0 Masvingo a 19.9 19.4 19.9 19.3 19.7 19.8 19.7 Harare a 21.3 21.3 20.5 20.3 19.6 a 20.8 Bulawayo a 21.1 21.7 20.4 19.9 19.9 a 20.8 Education No education * * (18.7) (18.4) 18.8 19.0 18.8 18.8 Primary 18.5 18.9 18.7 18.6 19.1 19.9 18.9 19.0 Secondary a 20.7 20.7 21.0 20.2 19.8 a 20.7 More than secondary a 24.0 23.0 (25.1) (22.7) * a 23.7 Wealth quintile Lowest 19.0 19.3 18.9 19.1 19.5 19.4 19.2 19.2 Second 19.2 19.1 19.2 20.4 18.9 19.9 19.3 19.4 Middle a 20.1 20.4 20.3 18.8 19.6 a 19.9 Fourth a 20.7 20.6 19.8 19.7 19.7 a 20.3 Highest a 21.3 21.2 20.8 20.3 20.0 a 20.9 Total a 20.1 20.2 20.2 19.5 19.7 a 20.0 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. a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group 4.8 TEENAGE PREGNANCY AND MOTHERHOOD The issue of adolescent fertility is important on both health and social grounds. Children born to very young mothers are at increased risk of sickness and death. Adolescent mothers are more likely to experience adverse pregnancy outcomes and are also more constrained in their ability to pursue educational opportunities than young women who delay childbearing. Table 4.9 shows the percent distribution of women age 15-19 years who have given birth or were pregnant with their first child at the time of the survey, according to selected background characteristics. Overall, 21 percent of women age 15-19 have begun childbearing. The proportion of adolescents already on the path to family formation rises rapidly with age, from 2 percent at age 15 to 41 percent at age 19. Rural adolescents and those with less education tend to start childbearing earlier. Fertility | 55 Table 4.9 Teenage pregnancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child, and percentage who have begun childbearing, by background characteristics, Zimbabwe 2005-2006 Percentage who: Background characteristic Have had a live birth Are pregnant with first child Percentage who have begun childbearing Number of women Age 15 1.5 0.8 2.4 347 16 4.3 3.8 8.1 502 17 10.0 7.5 17.4 385 18 25.2 8.1 33.3 472 19 34.8 6.4 41.2 447 Residence Urban 10.2 3.2 13.4 849 Rural 19.4 7.0 26.4 1,303 Province Manicaland 16.5 7.2 23.7 230 Mashonaland Central 19.9 10.2 30.1 201 Mashonaland East 16.5 7.2 23.7 153 Mashonaland West 22.8 3.6 26.4 174 Matabeleland North 27.9 4.3 32.1 143 Matabeleland South 10.1 3.9 13.9 122 Midlands 12.4 6.1 18.5 280 Masvingo 19.1 6.2 25.3 315 Harare 11.5 3.8 15.3 350 Bulawayo 5.3 1.2 6.5 183 Education No education * * * 8 Primary 25.1 9.0 34.1 607 Secondary 12.0 4.0 16.0 1,530 More than secondary * * * 7 Wealth quintile Lowest 26.3 5.8 32.1 354 Second 19.6 11.6 31.1 357 Middle 17.3 5.8 23.1 406 Fourth 16.0 6.6 22.7 435 Highest 6.1 0.5 6.6 600 Total 15.8 5.5 21.2 2,152 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Family Planning | 57 FAMILY PLANNING 5 This chapter focuses on women who are sexually active because these women have the greatest risk of exposure to pregnancy and need for regulating their fertility. However, the results of interviews with men are presented alongside those with women because men play an equally important role in the realisation of reproductive health and family planning decision behaviour. Family planning methods are grouped into two broad categories, namely modern methods and traditional methods. Modern family planning methods are further categorised into three subgroups, that is, short-term methods (oral contraceptive pills, condoms, the lactational amenorrhoea method [LAM], and emergency contraception), long-term methods (injectables, implants, and intrauterine devices or IUDs), and permanent methods (female and male sterilisation). Traditional methods consist of periodic abstinence, withdrawal, and various folk methods such as strings and herbs. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Information on the knowledge of contraceptive methods was collected by asking respondents to name the various methods that a couple can use to delay or avoid a pregnancy. A respondent who could not name any method(s) spontaneously was prompted by the interviewer mentioning and describing each of the methods that had not been mentioned spontaneously and asking whether the respondent had ever heard about it. Knowledge of family planning methods is almost universal in Zimbabwe, meaning that men and women in the country have information about the options available for regulating births and planning their families (Table 5.1). The level of knowledge of at least one modern method of family planning among all women age 15-49 years is also almost universal at 98 percent, and for currently married women it is 99 percent. Similarly, the level of knowledge of at least one modern method of family planning is very high among all men aged 15-49 years (99 percent). Virtually all currently married men know at least one method of family planning (100 percent). Virtually all sexually active women and 99 percent of sexually active men know of at least one method of family planning. Women in Zimbabwe know an average of seven family planning methods, the same as in 1999. Oral contraceptives, injectables, and condoms are the family planning methods most widely known by women in Zimbabwe. For all women age 15-49 years, the proportion who know about the pill is 95 percent, 94 percent know about the male condom, and 89 percent know about injectables. Knowledge of the female condom among women increased by 12 percentage points from 57 percent in 1999 to 69 percent in 2006. However, knowledge of implants registered the highest increase of 19 percentage points from almost 25 perc

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