According to a 2020 survey of Millennials in India, **** percent of respondents with a professional higher education or vocational college course background preferred to get married between the ages of 26 and 30 years old. A smaller share of respondents in this cohort, **** percent preferred to get married between the ages of ** and **.

Taichung City, the number of first marriage by gender, age and educational attainment, as well as the median age at first marriage (by date of occurrence).

IntroductionGlobally in 2024, 1 in 5 women aged 20–24 years worldwide had been married before the age of 18 years. One reason for this persistent prevalence of underage marriage may be the slow change in social norms relating to education levels and women's marriage age. However, we know little about how norms change, and whether they vary by socio-demographic characteristics. We aimed to investigate changes in social norms across generations in rural Maharashtra, India.MethodsTo understand the status quo, we identified education levels and marriage ages typical of contemporary young adults in rural Maharashtra using the National Family Health Survey. To see if norms have shifted across generations, we analysed data on education and marriage age in 659 parent-adolescent dyads from the Pune Maternal Nutrition Study (PMNS) in rural Maharashtra. To ascertain if norms might shift in the future, we investigated adolescents' aspirations for their future hypothetical children's education and marriage, and classified adolescents as wanting (a) their children to decide themselves, (b) more education and later marriage age, or (c) the status quo. We assessed whether these aspirations differed by socio-demographic characteristics.ResultsCompared to the status quo and PMNS adults, PMNS adolescents had substantially more education, and girls were marrying slightly later. About 70% of the adolescents wanted their children to themselves decide their schooling. The remainder of both sexes wanted their children to have the same education as them (15 years). Only 10% of adolescent girls and 14% of boys wanted their child to decide their own marriage age. Most adolescents wanted a later marriage age for their children than their own experience. Lower educated and early married girls aspired for greater education for their children. More educated boys aspired for later marriage for their children.DiscussionEducation norms have changed by a larger magnitude than marriage age norms. Adolescents are already attaining their education aspirations, but aspire for later marriage of their children, more so for their hypothetical sons than daughters. Since senior household members remain influential in marriage decisions, it may take time before adolescents' aspirations for their children become a new norm.

in 2023, on average, women in Germany got married sometime after turning 32 years old. The graph confirms that marriage took place later and later every year. Various reasons may contribute to this development. Life today Women can simply afford, in various senses of the word, to marry later than before. Being unmarried, regardless of age, has mostly ceased to be stigmatized or unusual for women in Germany. This does not exclude pressure, attention or curiosity from others about the topic, or a woman’s relationship status. It also does not exclude the desire of women to get married. However, in general, attitudes have relaxed significantly in recent decades, nor are there any legal restrictions for unmarried women in terms of education, employment, healthcare, renting or owning property. Women’s life expectancy at birth has increased steadily in Germany, with the latest figures citing 83.2 years. It is also not unusual for Germans to have children outside of a marriage. In fact, figures have been climbing annually since the 1990s and in 2023, around a third of children born, were born outside a marriage. Whether this happens due to a decision made mutually, individually or other circumstances, a woman being shunned for having a child out of wedlock is definitely a thing of the past. Changing demographics Marrying at a later age than in the 1990s, when women got married in their mid to late twenties, is also part of a general demographic shift in Germany, such as the increase in single households (though it does not necessarily mean that the person is unmarried, they might be in a long-distance marriage, for example). Women may also still be studying or traveling before their thirties, preferring to concentrate on concluding these chapters in their lives before proceeding to marriage, especially if they do not yet have a full-time job.

Men and women in Japan are getting married increasingly later than previous generations. In 2023, the average age of women who marry for the first time was about **** years, while men were on average **** years old when they first got married. Social integration of women The rising age at first marriage was partly explained by a common theory that holds the growing number of “parasite singles” accountable for the trend. The term refers to young working people aged between 28 and 40 years who decide to keep living comfortably in their parents' homes to save money. An alternative explanation is the more active participation of Japanese women in society. Increasingly more women in Japan obtain higher education degrees and focus on their career paths. With a rising income, they are financially less dependent, and marriage is no longer essential to afford the life they pursue. Delayed family planning The overall number of newly registered marriages has also declined in the past decade. The reported number of marriages was around ******* in 2023, representing the sixth consecutive years below *******. These developments concerning marriages have also impacted the mean age of childbearing, which has risen considerably since the *****.

IntroductionGlobally in 2024, 1 in 5 women aged 20–24 years worldwide had been married before the age of 18 years. One reason for this persistent prevalence of underage marriage may be the slow change in social norms relating to education levels and women's marriage age. However, we know little about how norms change, and whether they vary by socio-demographic characteristics. We aimed to investigate changes in social norms across generations in rural Maharashtra, India.MethodsTo understand the status quo, we identified education levels and marriage ages typical of contemporary young adults in rural Maharashtra using the National Family Health Survey. To see if norms have shifted across generations, we analysed data on education and marriage age in 659 parent-adolescent dyads from the Pune Maternal Nutrition Study (PMNS) in rural Maharashtra. To ascertain if norms might shift in the future, we investigated adolescents' aspirations for their future hypothetical children's education and marriage, and classified adolescents as wanting (a) their children to decide themselves, (b) more education and later marriage age, or (c) the status quo. We assessed whether these aspirations differed by socio-demographic characteristics.ResultsCompared to the status quo and PMNS adults, PMNS adolescents had substantially more education, and girls were marrying slightly later. About 70% of the adolescents wanted their children to themselves decide their schooling. The remainder of both sexes wanted their children to have the same education as them (15 years). Only 10% of adolescent girls and 14% of boys wanted their child to decide their own marriage age. Most adolescents wanted a later marriage age for their children than their own experience. Lower educated and early married girls aspired for greater education for their children. More educated boys aspired for later marriage for their children.DiscussionEducation norms have changed by a larger magnitude than marriage age norms. Adolescents are already attaining their education aspirations, but aspire for later marriage of their children, more so for their hypothetical sons than daughters. Since senior household members remain influential in marriage decisions, it may take time before adolescents' aspirations for their children become a new norm.

Abstract

The 1993 National Demographic Survey (NDS) is a nationally representative sample survey of women age 15-49 designed to collect information on fertility; family planning; infant, child and maternal mortality; and maternal and child health. The survey was conducted between April and June 1993. The 1993 NDS was carried out by the National Statistics Office in collaboration with the Department of Health, the University of the Philippines Population Institute, and other agencies concerned with population, health and family planning issues. Funding for the 1993 NDS was provided by the U.S. Agency for International Development through the Demographic and Health Surveys Program.

Close to 13,000 households throughout the country were visited during the survey and more than 15,000 women age 15-49 were interviewed. The results show that fertility in the Philippines continues its gradual decline. At current levels, Filipino women will give birth on average to 4.1 children during their reproductive years, 0.2 children less than that recorded in 1988. However, the total fertility rate in the Philippines remains high in comparison to the level achieved in the neighboring Southeast Asian countries.

The primary objective of the 1993 NDS is to provide up-to-date inform ation on fertility and mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programs and strategies for improving health and family planning services in 'the country.

MAIN RESULTS

Fertility varies significantly by region and socioeconomic characteristics. Urban women have on average 1.3 children less than rural women, and uneducated women have one child more than women with college education. Women in Bicol have on average 3 more children than women living in Metropolitan Manila.

Virtually all women know of a family planning method; the pill, female sterilization, IUD and condom are known to over 90 percent of women. Four in 10 married women are currently using contraception. The most popular method is female sterilization ( 12 percent), followed by the piU (9 percent), and natural family planning and withdrawal, both used by 7 percent of married women.

Contraceptive use is highest in Northern Mindanao, Central Visayas and Southern Mindanao, in urban areas, and among women with higher than secondary education. The contraceptive prevalence rate in the Philippines is markedly lower than in the neighboring Southeast Asian countries; the percentage of married women who were using family planning in Thailand was 66 percent in 1987, and 50 percent in Indonesia in 199l.

The majority of contraceptive users obtain their methods from a public service provider (70 percent). Government health facilities mainly provide permanent methods, while barangay health stations or health centers are the main sources for the pill, IUD and condom.

Although Filipino women already marry at a relatively higher age, they continue to delay the age at which they first married. Half of Filipino women marry at age 21.6. Most women have their first sexual intercourse after marriage.

Half of married women say that they want no more children, and 12 percent have been sterilized. An additional 19 percent want to wait at least two years before having another child. Almost two thirds of women in the Philippines express a preference for having 3 or less children. Results from the survey indicate that if all unwanted births were avoided, the total fertility rate would be 2.9 children, which is almost 30 percent less than the observed rate,

More than one quarter of married women in the Philippines are not using any contraceptive method, but want to delay their next birth for two years or more (12 percent), or want to stop childbearing (14 percent). If the potential demand for family planning is satisfied, the contraceptive prevalence rate could increase to 69 percent. The demand for stopping childbearing is about twice the level for spacing (45 and 23 percent, respectively).

Information on various aspects of maternal and child health---antenatal care, vaccination, breastfeeding and food supplementation, and illness was collected in the 1993 NDS on births in the five years preceding the survey. The findings show that 8 in 10 children under five were bom to mothers who received antenatal care from either midwives or nurses (45 percent) or doctors (38 percent). Delivery by a medical personnel is received by more than half of children born in the five years preceding the survey. However, the majority of deliveries occurred at home.

Tetanus, a leading cause of infant deaths, can be prevented by immunization of the mother during pregnancy. In the Philippines, two thirds of bitlhs in the five years preceding the survey were to mothers who received a tetanus toxoid injection during pregnancy.

Based on reports of mothers and information obtained from health cards, 90 percent of children aged 12-23 months have received shots of the BCG as well as the first doses of DPT and polio, and 81 percent have received immunization from measles. Immunization coverage declines with doses; the drop out rate is 3 to 5 percent for children receiving the full dose series of DPT and polio. Overall, 7 in 10 children age 12-23 months have received immunization against the six principal childhood diseases---polio, diphtheria, ~rtussis, tetanus, measles and tuberculosis.

During the two weeks preceding the survey, 1 in 10 children under 5 had diarrhea. Four in ten of these children were not treated. Among those who were treated, 27 percent were given oral rehydration salts, 36 percent were given recommended home solution or increased fluids.

Breasffeeding is less common in the Philippines than in many other developing countries. Overall, a total of 13 percent of children born in the 5 years preceding the survey were not breastfed at all. On the other hand, bottle feeding, a widely discouraged practice, is relatively common in the Philippines. Children are weaned at an early age; one in four children age 2-3 months were exclusively breastfed, and the mean duration of breastfeeding is less than 3 months.

Infant and child mortality in the Philippines have declined significantly in the past two decades. For every 1,000 live births, 34 infants died before their first birthday. Childhood mortality varies significantly by mother's residence and education. The mortality of urban infants is about 40 percent lower than that of rural infants. The probability of dying among infants whose mother had no formal schooling is twice as high as infants whose mother have secondary or higher education. Children of mothers who are too young or too old when they give birth, have too many prior births, or give birth at short intervals have an elevated mortality risk. Mortality risk is highest for children born to mothers under age 19.

The 1993 NDS also collected information necessary for the calculation of adult and maternal mortality using the sisterhood method. For both males and females, at all ages, male mortality is higher than that of females. Matemal mortality ratio for the 1980-1986 is estimated at 213 per 100,000 births, and for the 1987-1993 period 209 per 100,000 births. However, due to the small number of sibling deaths reported in the survey, age-specific rates should be used with caution.

Information on health and family planning services available to the residents of the 1993 NDS barangay was collected from a group of respondents in each location. Distance and time to reach a family planning service provider has insignificant association with whether a woman uses contraception or the choice of contraception being used. On the other hand, being close to a hospital increases the likelihood that antenatal care and births are to respondents who receive ANC and are delivered by a medical personnel or delivered in a health facility.

Geographic coverage

National. The main objective of the 1993 NDS sample is to allow analysis to be carried out for urban and rural areas separately, for 14 of the 15 regions in the country. Due to the recent formation of the 15th region, Autonomous Region in Muslim Mindanao (ARMM), the sample did not allow for a separate estimate for this region.

Analysis unit

• Household
• Women age 15-49

Universe

The population covered by the 1993 Phillipines NDS is defined as the universe of all females age 15-49 years, who are members of the sample household or visitors present at the time of interview and had slept in the sample households the night prior to the time of interview, regardless of marital status.

Kind of data

Sample survey data

Sampling procedure

The main objective of the 1993 National Demographic Survey (NDS) sample is to provide estimates with an acceptable precision for sociodemographics characteristics, like fertility, family planning, health and mortality variables and to allow analysis to be carried out for urban and rural areas separately, for 14 of the 15 regions in the country. Due to the recent formation of the 15th region, Autonomous Region in Muslim Mindanao (ARMM), the sample did not allow for a separate estimate for this region.

The sample is nationally representative with a total size of about 15,000 women aged 15 to 49. The Integrated Survey of Households (ISH) was used as a frame. The ISH was developed in 1980, and was comprised of samples of primary sampling units (PSUs) systematically selected and with a probability proportional to size in each of the 14 regions. The PSUs were reselected in 1991, using the 1990 Population Census data on

As of 2023, the median age at the time of first marriage in Singapore was 31 years old for men and 29.5 years old for women. While this had remained relatively constant for men since 2014, the median age of marriage for women had been increasing, indicating a trend amongst Singaporean women in delaying marriage. More women delaying marriage and motherhood Women in Singapore are becoming more educated and are increasingly active in the workforce, resulting in many women delaying marriage and motherhood in favor of pursuing a career. This has resulted in a significant proportion of highly-educated and highly-qualified women remaining single for longer. Financial independence delayed marriage for many women Many women preferred to be financially stable before getting married, especially in light of the costs involved in holding a wedding and starting a home. The prospect of losing financial independence and sacrificing career success has also deterred many women from motherhood, leaving Singapore with one of the lowest fertility rates in the world.

Abstract

The Sudan Demographic and Health Survey (SDHS) was conducted in two phases between November 15, 1989 and May 21, 1990 by the Department of Statistics of the Ministry of Economic and National Planning. The survey collected information on fertility levels, marriage patterns, reproductive intentions, knowledge and use of contraception, maternal and child health, maternal mortality, and female circumcision. The survey findings provide the National Population Committee and the Ministry of Health with valuable information for use in evaluating population policy and planning public health programmes.

A total of 5860 ever-married women age 15-49 were interviewed in six regions in northern Sudan; three regions in southern Sudan could not be included in the survey because of civil unrest in that part of the country. The SDHS provides data on fertility and mortality comparable to the 1978-79 Sudan Fertility Survey (SFS) and complements the information collected in the 1983 census.

The primary objective of the SDHS was to provide data on fertility, nuptiality, family planning, fertility preferences, childhood mortality, indicators of maternal health care, and utilization of child health services. Additional information was coUected on educational level, literacy, source of household water, and other housing conditions.

The SDHS is intended to serve as a source of demographic data for comparison with the 1983 census and the Sudan Fertility Survey (SFS) 1978-79, and to provide population and health data for policymakers and researchers. The objectives of the survey are to: - assess the overall demographic situation in Sudan, - assist in the evaluation of population and health programmes, - assist the Department of Statistics in strengthening and improving its technical skills for conducting demographic and health surveys, - enable the National Population Committee (NPC) to develop a population policy for the country, and - measure changes in fertility and contraceptive prevalence, and study the factors which affect these changes, and - examine the basic indicators of maternal and child health in Sudan.

MAIN RESULTS

Fertility levels and trends

Fertility has declined sharply in Sudan, from an average of six children per women in the Sudan Fertility Survey (TFR 6.0) to five children in the Sudan DHS survey flTR 5.0). Women living in urban areas have lower fertility (TFR 4.1) than those in rural areas (5.6), and fertility is lower in the Khartoum and Northern regions than in other regions. The difference in fertility by education is particularly striking; at current rates, women who have attained secondary school education will have an average of 3.3 children compared with 5.9 children for women with no education, a difference of almost three children.

Although fertility in Sudan is low compared with most sub-Saharan countries, the desire for children is strong. One in three currently married women wants to have another child within two years and the same proportion want another child in two or more years; only one in four married women wants to stop childbearing. The proportion of women who want no more children increases with family size and age. The average ideal family size, 5.9 children, exceeds the total fertility rate (5.0) by approximately one child. Older women are more likely to want large families than younger women, and women just beginning their families say they want to have about five children.

Marriage

Almost all Sudanese women marry during their lifetime. At the time of the survey, 55 percent of women 15-49 were currently married and 5 percent were widowed or divorced. Nearly one in five currently married women lives in a polygynous union (i.e., is married to a man who has more than one wife). The prevalence of polygyny is about the same in the SDHS as it was in the Sudan Fertility Survey.

Marriage occurs at a fairly young age, although there is a trend toward later marriage among younger women (especially those with junior secondary or higher level of schooling). The proportion of women 15-49 who have never married is 12 percentage points higher in the SDHS than in the Sudan Fertiliy Survey.

There has been a substantial increase in the average age at first marriage in Sudan. Among SDHS. Since age at first marriage is closely associated with fertility, it is likely that fertility will decrease in the future. With marriages occurring later, women am having their first birth at a later age. While one in three women age 45-49 had her first birth before age 18, only one in six women age 20-24 began childbearing prior to age 18. The women most likely to postpone marriage and childbearing are those who live in urban areas ur in the Khartoum and Northern regions, and women with pest-primary education.

Breastfeeding and postpartum abstinence

Breastfeeding and postpartum abstinence provide substantial protection from pregnancy after the birth uf a child. In addition to the health benefits to the child, breastfeeding prolongs the length of postpartum amenorrhea. In Sudan, almost all women breastfeed their children; 93 percent of children are still being breastfed 10-11 months after birth, and 41 percent continue breastfeeding for 20-21 months. Postpartum abstinence is traditional in Sudan and in the first two months following the birth of a child 90 percent of women were abstaining; this decreases to 32 percent after two months, and to 5 percent at~er one year. The survey results indicate that the combined effects of breastfeeding and postpartum abstinence protect women from pregnancy for an average of 15 months after the birth of a child.

Knowledge and use of contraception

Most currently married women (71 percent) know at least one method of family planning, and 59 percent know a source for a method. The pill (70 percent) is the most widely known method, followed by injection, female sterilisation, and the IUD. Only 39 percent of women knew a traditional method of family planning.

Despite widespread knowledge of family planning, only about one-fourth of ever-married women have ever used a contraceptive method, and among currently married women, only 9 percent were using a method at the time of the survey (6 percent modem methods and 3 percent traditional methods). The level of contraceptive use while still low, has increased from less than 5 percent reported in the Sudan Fertility Survey.

Use of family planning varies by age, residence, and level of education. Current use is less than 4 percent among women 15-19, increases to 10 percent for women 30-44, then decreases to 6 percent for women 45-49. Seventeen percent of urban women practice family planning compared with only 4 percent of rural women; and women with senior secondary education are more likely to practice family planning (26 percent) than women with no education (3 percent).

There is widespread approval of family planning in Sudan. Almost two-thirds of currently married women who know a family planning method approve of the use of contraception. Husbands generally share their wives's views on family planning. Three-fourths of married women who were not using a contraceptive method at the time of the survey said they did not intend to use a method in the future.

Communication between husbands and wives is important for successful family planning. Less than half of currently married women who know a contraceptive method said they had talked about family planning with their husbands in the year before the survey; one in four women discussed it once or twice; and one in five discussed it more than twice. Younger women and older women were less likely to discuss family planning than those age 20 to 39.

Mortality among children

The neonatal mortality rate in Sudan remained virtually unchanged in the decade between the SDHS and the SFS (44 deaths per 1000 births), but under-five mortality decreased by 14 percent (from 143 deaths per 1000 births to 123 per thousand). Under-five mortality is 19 percent lower in urban areas (117 per 1000 births) than in rural areas (144 per 10(30 births).

The level of mother's education and the length of the preceding birth interval play important roles in child survival. Children of mothers with no education experience nearly twice the level of under-five mortality as children whose mother had attained senior secondary or nigher education. Mortality among children under five is 2.7 times higher among children born after an interval of less than 24 months than among children born after interval of 48 months or more.

Maternal mortality

The maternal mortality rate (maternal deaths per 1000 women years of exposure) has remained nearly constant over the twenty years preceding the survey, while the maternal mortality ratio (number of maternal deaths per 100,000 births), has increased (despite declining fertility). Using the direct method of estimation, the maternal mortality ratio is 352 maternal deaths per 100,000 births for the period 1976-82, and 552 per 100,000 births for the period 1983-89. The indirect estimate for the maternal mortality ratio is 537. The latter estimate is an average of women's experience over an extended period before the survey centred on 1977.

Maternal health care

The health care mothers receive during pregnancy and delivery is important to the survival and well-being of both children and mothers. The SDHS results indicate that most women in Sudan made at least one antenatal visit to a doctor or trained health worker/midwife. Eighty-seven percent of births benefitted from professional antenatal care in urban areas compared with 62 percent in rural areas. Although the proportion of pregnant mothers seen by trained health workers/midwives are similar in urban and rural areas, doctors provided antenatal care for 42 percent and 19 percent of births in urban and rural areas, respectively.

Neonatal tetanus, a major

Descriptive statistics of key variables by region and parental gender (Mean value).

The Pakistan Demographic and Health Survey (PDHS) was fielded on a national basis between the months of December 1990 and May 1991. The survey was carried out by the National Institute of Population Studies with the objective of assisting the Ministry of Population Welfare to evaluate the Population Welfare Programme and maternal and child health services. The PDHS is the latest in a series of surveys, making it possible to evaluate changes in the demographic status of the population and in health conditions nationwide. Earlier surveys include the Pakistan Contraceptive Prevalence Survey of 1984-85 and the Pakistan Fertility Survey of 1975. The primary objective of the Pakistan Demographic and Health Survey (PDHS) was to provide national- and provincial-level data on population and health in Pakistan. The primary emphasis was on the following topics: fertility, nuptiality, family size preferences, knowledge and use of family planning, the potential demand for contraception, the level of unwanted fertility, infant and child mortality, breastfeeding and food supplementation practices, maternal care, child nutrition and health, immunisations and child morbidity. This information is intended to assist policy makers, administrators and researchers in assessing and evaluating population and health programmes and strategies. The PDHS is further intended to serve as a source of demographic data for comparison with earlier surveys, particularly the 1975 Pakistan Fertility Survey (PFS) and the 1984-85 Pakistan Contraceptive Prevalence Survey (PCPS). MAIN RESULTS Until recently, fertility rates had remained high with little evidence of any sustained fertility decline. In recent years, however, fertility has begun to decline due to a rapid increase in the age at marriage and to a modest rise in the prevalence of contraceptive use. The lotal fertility rate is estimated to have fallen from a level of approximately 6.4 children in the early 1980s to 6.0 children in the mid-1980s, to 5.4 children in the late 1980s. The exact magnitude of the change is in dispute and will be the subject of further research. Important differentials of fertility include the degree ofurbanisation and the level of women's education. The total fertility rate is estimated to be nearly one child lower in major cities (4.7) than in rural areas (5.6). Women with at least some secondary schooling have a rate of 3.6, compared to a rate of 5.7 children for women with no formal education. There is a wide disparity between women's knowledge and use of contraceptives in Pakistan. While 78 percent of currently married women report knowing at least one method of contraception, only 21 percent have ever used a method, and only 12 percent are currently doing so. Three-fourths of current users are using a modem method and one-fourth a traditional method. The two most commonly used methods are female sterilisation (4 percent) and the condom (3 percent). Despite the relatively low level of contraceptive use, the gain over time has been significant. Among married non-pregnant women, contraceptive use has almost tripled in 15 years, from 5 percent in 1975 to 14 percent in 1990-91. The contraceptive prevalence among women with secondary education is 38 percent, and among women with no schooling it is only 8 percent. Nearly one-third of women in major cities arc current users of contraception, but contraceptive use is still rare in rural areas (6 percent). The Government of Pakistan plays a major role in providing family planning services. Eighty-five percent of sterilised women and 81 percent of IUD users obtained services from the public sector. Condoms, however, were supplied primarily through the social marketing programme. The use of contraceptives depends on many factors, including the degree of acceptability of the concept of family planning. Among currently married women who know of a contraceptive method, 62 percent approve of family planning. There appears to be a considerable amount of consensus between husbands and wives about family planning use: one-third of female respondents reported that both they and their husbands approve of family planning, while slightly more than one-fifth said they both disapprove. The latter couples constitute a group for which family planning acceptance will require concerted motivational efforts. The educational levels attained by Pakistani women remain low: 79 percent of women have had no formal education, 14 percent have studied at the primary or middle school level, and only 7 percent have attended at least some secondary schooling. The traditional social structure of Pakistan supports a natural fertility pattern in which the majority of women do not use any means of fertility regulation. In such populations, the proximate determinants of fertility (other than contraception) are crucial in determining fertility levels. These include age at marriage, breastfeeding, and the duration of postpartum amenorrhoea and abstinence. The mean age at marriage has risen sharply over the past few decades, from under 17 years in the 1950s to 21.7 years in 1991. Despite this rise, marriage remains virtually universal: among women over the age of 35, only 2 percent have never married. Marriage patterns in Pakistan are characterised by an unusually high degree of consangninity. Half of all women are married to their first cousin and an additional 11 percent are married to their second cousin. Breasffeeding is important because of the natural immune protection it provides to babies, and the protection against pregnancy it gives to mothers. Women in Pakistan breastfeed their children for an average of20months. Themeandurationofpostpartumamenorrhoeais slightly more than 9 months. After tbebirth of a child, women abstain from sexual relations for an average of 5 months. As a result, the mean duration of postpartum insusceptibility (the period immediately following a birth during which the mother is protected from the risk of pregnancy) is 11 months, and the median is 8 months. Because of differentials in the duration of breastfeeding and abstinence, the median duration of insusceptibility varies widely: from 4 months for women with at least some secondary education to 9 months for women with no schooling; and from 5 months for women residing in major cities to 9 months for women in rural areas. In the PDHS, women were asked about their desire for additional sons and daughters. Overall, 40 percent of currently married women do not want to have any more children. This figure increases rapidly depending on the number of children a woman has: from 17 percent for women with two living children, to 52 percent for women with four children, to 71 percent for women with six children. The desire to stop childbearing varies widely across cultural groupings. For example, among women with four living children, the percentage who want no more varies from 47 percent for women with no education to 84 percent for those with at least some secondary education. Gender preference continues to be widespread in Pakistan. Among currently married non-pregnant women who want another child, 49 percent would prefer to have a boy and only 5 percent would prefer a girl, while 46 percent say it would make no difference. The need for family planning services, as measured in the PDHS, takes into account women's statements concerning recent and future intended childbearing and their use of contraceptives. It is estimated that 25 percent of currently married women have a need for family planning to stop childbearing and an additional 12 percent are in need of family planning for spacing children. Thus, the total need for family planning equals 37 percent, while only 12 percent of women are currently using contraception. The result is an unmet need for family planning services consisting of 25 percent of currently married women. This gap presents both an opportunity and a challenge to the Population Welfare Programme. Nearly one-tenth of children in Pakistan die before reaching their first birthday. The infant mortality rate during the six years preceding the survey is estimaled to be 91 per thousand live births; the under-five mortality rate is 117 per thousand. The under-five mortality rates vary from 92 per thousand for major cities to 132 for rural areas; and from 50 per thousand for women with at least some secondary education to 128 for those with no education. The level of infant mortality is influenced by biological factors such as mother's age at birth, birth order and, most importantly, the length of the preceding birth interval. Children born less than two years after their next oldest sibling are subject to an infant mortality rate of 133 per thousand, compared to 65 for those spaced two to three years apart, and 30 for those born at least four years after their older brother or sister. One of the priorities of the Government of Pakistan is to provide medical care during pregnancy and at the time of delivery, both of which are essential for infant and child survival and safe motherhood. Looking at children born in the five years preceding the survey, antenatal care was received during pregnancy for only 30 percent of these births. In rural areas, only 17 percent of births benefited from antenatal care, compared to 71 percent in major cities. Educational differentials in antenatal care are also striking: 22 percent of births of mothers with no education received antenatal care, compared to 85 percent of births of mothers with at least some secondary education. Tetanus, a major cause of neonatal death in Pakistan, can be prevented by immunisation of the mother during pregnancy. For 30 percent of all births in the five years prior to the survey, the mother received a tetanus toxoid vaccination. The differentials are about the same as those for antenatal care generally. Eighty-five percent of the births occurring during the five years preceding the survey were delivered

Abstract

The Uganda Demographic and Health Survey (UDHS) was conducted by the Ministry of Health in 24 districts between September 1988 and February 1989. The sample covered 4730 women aged 15-49. Nine northern districts were not surveyed due to security reasons. The purpose of the survey was to provide planners and policymakers with baseline information regarding fertility, family planning, and maternal and child health. The survey data were also needed by UNFPA and UNICEF- Kampala for planning and evaluation of current projects in Uganda.

The primary objective of the UDHS was to provide data on fertility, family planning, childhood mortality and basic indicators of maternal and child health. Additional information was collected on educational level, literacy, sources of household water and housing conditions. The available demographic data were incomplete and hardly any recent information concerning family planning or other health and social indicators existed at the national level.

A more specific objective was to provide baseline data for the South West region and the area in Central region known as the Luwero Triangle, where the Uganda government and UNICEF are currently supporting a primary health care project. In order to effectively plan strategies and to evaluate progress in meeting the project goals and objectives, there was a need to collect data on the health of the target population.

Another important goal of UDHS was to enhance the skills of those participating in the project so that they could conduct high-quality surveys in the future. Finally, the contribution of Ugandan data to an expanding international data set was an objective of the UDHS.

SUMMARY OF FINDINGS

The UDHS data indicate that fertility is high in Uganda, with women having an average of seven births by the time they reach the end of their childbearing years. Overall, fertility in Uganda has remained the same, that is, just over seven children per woman during the last 15 years. Women in urban areas, especially Kampala, have fewer children than women in rural areas. A significant finding is that fertility is linked to education: women with higher education have an average of 5 births, compared with 7 births for women with primary education. Childbearing begins at an early age, with 60 percent of Ugandan women having their first birth before the age of 20. Less than 3 percent of women have their first birth at age 25 or older.

A major factor contributing to high fertility is age at first marriage; 54 percent of women marry before they reach 18 years of age and only 2 percent remain unmarried throughout their entire life. However, with increasing levels of education among women, there is evidence of a trend toward later marriage. The median age at first union has risen from 17 for older women to 18 for those age 20-24. Urban women marry 2 years later on average than rural women, while women with middle and higher education marry 4 years later than women with no education. Polygyny is common in Uganda, with 33 percent of currently married women reporting that their husband has other wives. The practice declines with higher levels of education.

Breastfeeding and postpartum abstinence provide some protection from pregnancy after the birth of a child. In Uganda, babies are breastfed for an average of 19 months and postpartum amenorrhoea lasts an average of 13 months. However, sexual abstinence after a birth is short, with an average duration of only 4 months. UDHS data show a decline in duration of breastfeeding and postpartum abstinence, especially among younger, urban, and educated women.

The low level of contraceptive use in Uganda is one of the leading factors contributing to high fertility, as evidenced by the UDHS data. Although 84 percent of currently married Ugandan women know at least one contraceptive method and 77 percent know of a source for a contraceptive method, only 22 percent have ever used a method; and only 5 percent are currently using a method. Low rates of use are due partially to the desire of women to have many children. However, access to family planning services may also be a factor since most clinics are in urban areas, while 89 percent of women live in rural areas.

Among currently married women using contraception, periodic abstinence is the most common method used (1.6 percent), followed by pill (1.1 percent) and female sterilisation (0.8 percen0. Contraceptive use is higher among women with more children and women who reside in urban areas, especially Kampala. There are strong differentials in family planning use by education level. The level of use among women with higher education is eighteen times the rate for women with no education. Forty-two percent of users of modern methods obtained their method from government hospitals, while 33 percent reported Family Planning Association of Uganda (FPAU) clinics as the source. Ten percent of users rely on private sources such as private doctors and clinics. The most common reasons for nonuse of contraception cited by women who are exposed to the risk of pregnancy, but do not want to get pregnant immediately are: fear of side effects, prohibition by religion, lack of knowledge, and disapproval by parmer.

Despite the low level of contraceptive use in Uganda, the UDHS indicates that the potential need for family planning is great. Although 39 percent of the currently married women want another child soon (within 2 years), 33 percent want to space their pregnancies for at least two years and another 19 percent want no more children. This means that 52 percent of currently married women in the surveyed area are potentially in need of family planning services either to limit or to space their births. Furthermore, 35 percent of the women who had a birth in the 12 months prior to the survey indicated that their last birth was either unwanted or mistimed.

UDHS data indicate that infant and childhood mortality remain high. For every thousand live births, 100 children die before reaching their first birthday and 180 children die before reaching age five. While these rates indicate high levels of mortality, there is some evidence that rates have declined in the five years before the survey. Forty-four percent of children under five with health cards have been fully immunised against the major vaccine-preventable diseases. This percentage is higher if children without health cards who have been immunised are included.

UDHS data further indicated high levels of prevalence of certain illnesses. Of children under five, 24 percent had diarrhea in the two weeks before the survey. Forty-one percent of children under five were reported to have had a fever in the previous four weeks and 22 percent had an episode of severe cough with difficult or rapid breathing in the four weeks preceding the interview. Various types of treatment including antibiotics and antimalarials were used to treat the illnesses.

The nutritional status of children in Uganda was assessed from UDHS data. Overall, 45 percent of the children age 0-60 months were found to be stunted, that is, two or more standard deviations below the mean reference population for height-for-age. These children are defined as chronically undernourished.

Geographic coverage

The Uganda Demographic and Health Survey (UDHS) was conductedin 24 districts. Nine northern districts were not surveyed due to security reasons.

Analysis unit

• Household
• Women age 15-49

Universe

The population covered by the 1988 UDHS is defined as the universe of all women age 15-49 in Uganda and all men age 15-54 living in the household. But due to security problems at the time of sample selection, 9 districts, containing an estimated 20 percent of the country's population, were excluded from the sample frame

Kind of data

Sample survey data

Sampling procedure

The UDHS used a stratified, weighted probability sample of women aged 15-49 selected from 206 clusters. Due to security problems at the time of sample selection, 9 districts, containing an estimated 20 percent of the country's population, were excluded from the sample frame. Primary sampling units in rural areas were sub-parishes, which, in the absence of a more reliable sampling frame, were selected with a probability proportional to the number of registered taxpayers in the sub-parish. Teams visited each selected sub-parish and listed all the households by name of the household head. Individual households were then selected for interview from this list.

Because Ugandans often pay taxes in rural areas or in their place of work instead of their place of residence, it was not possible to use taxpayer rolls as a sampling frame in urban areas. Consequently, a complete list of all administrative urban areas known as Resistance Council Ones (RCls) was compiled, and a sampling frame was created by systematically selecting 200 of these units with equal probability. The households in these RCls were listed, and 50 RCls were selected with probability proportional to size. Finally, 20 households were then systematically selected in each of the 50 RCls for a total of 1,000 urban households.

SAMPLE DESIGN

The sample used for the Uganda Demographic and Health Survey was a stratified, weighted probability sample of women aged 15-49 selected from 206 clusters. Due to security problems at the time of sample selection, 9 of the country's 34 districts, containing an estimated 20 percent of the population, were excluded from the sample frame. Primary sampling units in rural areas were sub-parishes, which, in the absence of a more reliable sampling frame, were selected with a probability proportional to the number of registered taxpayers in the sup-parish.

The South West region and

Estimates of the average ages at marriage in 1990 for different education levels.

Abstract

The 1998 Kenya Demographic and Health Survey (KDHS) is a nationally representative survey of 7,881 wo 881 women age 15-49 and 3,407 men age 15-54. The KDHS was implemented by the National Council for Population and Development (NCPD) and the Central Bureau of Statistics (CBS), with significant technical and logistical support provided by the Ministry of Health and various other governmental and nongovernmental organizations in Kenya. Macro International Inc. of Calverton, Maryland (U.S.A.) provided technical assistance throughout the course of the project in the context of the worldwide Demographic and Health Surveys (DHS) programme, while financial assistance was provided by the U.S. Agency for International Development (USAID/Nairobi) and the Department for International Development (DFID/U.K.). Data collection for the KDHS was conducted from February to July 1998. Like the previous KDHS surveys conducted in 1989 and 1993, the 1998 KDHS was designed to provide information on levels and trends in fertility, family planning knowledge and use, infant and child mortality, and other maternal and child health indicators. However, the 1998 KDHS went further to collect more in-depth data on knowledge and behaviours related to AIDS and other sexually transmitted diseases (STDs), detailed “calendar” data that allows estimation of contraceptive discontinuation rates, and information related to the practice of female circumcision. Further, unlike earlier surveys, the 1998 KDHS provides a national estimate of the level of maternal mortality (i.e. related to pregnancy and childbearing).The KDHS data are intended for use by programme managers and policymakers to evaluate and improve health and family planning programmes in Kenya. Fertility. The survey results demonstrate a continuation of the fertility transition in Kenya. At current fertility levels, a Kenyan women will bear 4.7 children in her life, down 30 percent from the 1989 KDHS when the total fertility rate (TFR) was 6.7 children, and 42 percent since the 1977/78 Kenya Fertility Survey (KFS) when the TFR was 8.1 children per woman. A rural woman can expect to have 5.2 children, around two children more than an urban women (3.1 children). Fertility differentials by women's education level are even more remarkable; women with no education will bear an average of 5.8 children, compared to 3.5 children for women with secondary school education. Marriage. The age at which women and men first marry has risen slowly over the past 20 years. Currently, women marry for the first time at an average age of 20 years, compared with 25 years for men. Women with a secondary education marry five years later (22) than women with no education (17).The KDHS data indicate that the practice of polygyny continues to decline in Kenya. Sixteen percent of currently married women are in a polygynous union (i.e., their husband has at least one other wife), compared with 19 percent of women in the 1993 KDHS, 23 percent in the 1989 KDHS, and 30 percent in the 1977/78 KFS. While men first marry an average of 5 years later than women, men become sexual active about onehalf of a year earlier than women; in the youngest age cohort for which estimates are available (age 20-24), first sex occurs at age 16.8 for women and 16.2 for men. Fertility Preferences. Fifty-three percent of women and 46 percent of men in Kenya do not want to have any more children. Another 25 percent of women and 27 percent of men would like to delay their next child for two years or longer. Thus, about three-quarters of women and men either want to limit or to space their births. The survey results show that, of all births in the last three years, 1 in 10 was unwanted and 1 in 3 was mistimed. If all unwanted births were avoided, the fertility rate in Kenya would fall from 4.7 to 3.5 children per woman. Family Planning. Knowledge and use of family planning in Kenya has continued to rise over the last several years. The 1998 KDHS shows that virtually all married women (98 percent) and men (99 percent) were able to cite at least one modern method of contraception. The pill, condoms, injectables, and female sterlisation are the most widely known methods. Overall, 39 percent of currently married women are using a method of contraception. Use of modern methods has increased from 27 in the 1993 KDHS to 32 percent in the 1998 KDHS. Currently, the most widely used methods are contraceptive injectables (12 percent of married women), the pill (9 percent), female sterilisation (6 percent), and periodic abstinence (6 percent). Three percent of married women are using the IUD, while over 1 percent report using the condom and 1 percent use of contraceptive implants (Norplant). The rapid increase in use of injectables (from 7 to 12 percent between 1993 and 1998) to become the predominant method, plus small rises in the use of implants, condoms and female sterilisation have more than offset small decreases in pill and IUD use. Thus, both new acceptance of contraception and method switching have characterised the 1993-1998 intersurvey period. Contraceptive use varies widely among geographic and socioeconomic subgroups. More than half of currently married women in Central Province (61 percent) and Nairobi Province (56 percent) are currently using a method, compared with 28 percent in Nyanza Province and 22 percent in Coast Province. Just 23 percent of women with no education use contraception versus 57 percent of women with at least some secondary education. Government facilities provide contraceptives to 58 percent of users, while 33 percent are supplied by private medical sources, 5 percent through other private sources, and 3 percent through community-based distribution (CBD) agents. This represents a significant shift in sourcing away from public outlets, a decline from 68 percent estimated in the 1993 KDHS. While the government continues to provide about two-thirds of IUD insertions and female sterilisations, the percentage of pills and injectables supplied out of government facilities has dropped from over 70 percent in 1993 to 53 percent for pills and 64 percent for injectables in 1998. Supply of condoms through public sector facilities has also declined: from 37 to 21 percent between 1993 and 1998. The survey results indicate that 24 percent of married women have an unmet need for family planning (either for spacing or limiting births). This group comprises married women who are not using a method of family planning but either want to wait two year or more for their next birth (14 percent) or do not want any more children (10 percent). While encouraging that unmet need at the national level has declined (from 34 to 24 percent) since 1993, there are parts of the country where the need for contraception remains high. For example, the level of unmet need is higher in Western Province (32 percent) and Coast Province (30 province) than elsewhere in Kenya. Early Childhood Mortality. One of the main objectives of the KDHS was to document current levels and trends in mortality among children under age 5. Results from the 1998 KDHS data make clear that childhood mortality conditions have worsened in the early-mid 1990s; this after a period of steadily improving child survival prospects through the mid-to-late 1980s. Under-five mortality, the probability of dying before the fifth birthday, stands at 112 deaths per 1000 live births which represents a 24 percent increase over the last decade. Survival chances during age 1-4 years suffered disproportionately: rising 38 percent over the same period. Survey results show that childhood mortality is especially high when associated with two factors: a short preceding birth interval and a low level of maternal education. The risk of dying in the first year of life is more than doubled when the child is born after an interval of less than 24 months. Children of women with no education experience an under-five mortality rate that is two times higher than children of women who attended secondary school or higher. Provincial differentials in childhood mortality are striking; under-five mortality ranges from a low of 34 deaths per 1000 live births in Central Province to a high of 199 per 1000 in Nyanza Province. Maternal Health. Utilisation of antenatal services is high in Kenya; in the three years before the survey, mothers received antenatal care for 92 percent of births (Note: These data do not speak to the quality of those antenatal services). The median number of antenatal visits per pregnancy was 3.7. Most antenatal care is provided by nurses and trained midwives (64 percent), but the percentage provided by doctors (28 percent) has risen in recent years. Still, over one-third of women who do receive care, start during the third trimester of pregnancy-too late to receive the optimum benefits of antenatal care. Mothers reported receiving at least one tetanus toxoid injection during pregnancy for 90 percent of births in the three years before the survey. Tetanus toxoid is a powerful weapon in the fight against neonatal tetanus, a deadly disease that attacks young infants. Forty-two percent of births take place in health facilities; however, this figure varies from around three-quarters of births in Nairobi to around one-quarter of births in Western Province. It is important for the health of both the mother and child that trained medical personnel are available in cases of prolonged labour or obstructed delivery, which are major causes of maternal morbidity and mortality. The 1998 KDHS collected information that allows estimation of mortality related to pregnancy and childbearing. For the 10-year period before the survey, the maternal mortality ratio was estimated to be 590 deaths per 100,000 live births. Bearing on average 4.7 children, a Kenyan woman has a 1 in 36 chance of dying from maternal causes during her lifetime. Childhood Immunisation. The KDHS

Abstract

The 1996 Nepal Family Health Survey (NFHS) is a nationally representative survey of 8,429 ever- married women age 15-49. The survey is the fifth in a series of demographic and health surveys conducted in Nepal since 1976. The main purpose of the NFHS was to provide detailed information on fertility, family planning, infant and child mortality, and matemal and child health and nutrition. In addition, the NFHS included a series of questions on knowledge of AIDS.

The primary objective of the Nepal Family Health Survey (NFHS) is to provide national level estimates of fertility and child mortality. The survey also provides information on nuptiality, contraceptive knowledge and behaviour, the potential demand for contraception, other proximate determinants of fertility, family size preferences, utilization of antenatal services, breastfeeding and food supplementation practices, child nutrition and health, immunizations, and knowledge about Acquired Immune Deficiency Syndrome (AIDS). This information will assist policy-makers, administrators and researchers to assess and evaluate population and health programmes and strategies. The NFHS is comparable to Demographic and Health Surveys (DHS) conducted in other developing countries.

MAIN RESULTS

FERTILITY

Survey results indicate that fertility in Nepal has declined steadily from over 6 births per woman in the mid-1970s to 4.6 births per woman during the period of 1994-1996. Differentials in fertility by place of residence are marked, with the total fertility rate (TFR) for urban Nepal (2.9 births per woman) about two children less than for rural Nepal (4.8 births per woman). The TFR in the Mountains (5.6 births per woman) is about one child higher than the TFR in the Hills and Terai (4.5 and 4.6 births per woman, respectively). By development region, the highest TFR is observed in the Mid-western region (5.5 births per woman) and the lowest TFR in the Eastern region (4.1 births per woman).

Fertility decline in Nepal has been influenced in part by a steady increase in age at marriage over the past 25 years. The median age at first marriage has risen from 15.5 years among women age 45-49 to 17.1 years among women age 20-24. This trend towards later marriage is supported by the fact that the proportion of women married by age 15 has declined from 41 percent among women age 45-49 to 14 percent among women age 15-19. There is a strong relationship between female education and age at marriage. The median age at first marriage for women with no formal education is 16 years, compared with 19.8 years for women with some secondary education.

Despite the trend towards later age at marriage, childbearing begins early for many Nepalese women. One in four women age 15-19 is already a mother or pregnant with her first child, with teenage childbearing more common among rural women (24 percent) than urban women (20 percent). Nearly one in three adolescent women residing in the Terai has begun childbearing, compared with one in five living in the Mountains and 17 percent living in the Hills. Regionally, the highest level of adolescent childbearing is observed in the Central development region while the lowest is found in the Western region.

Short birth intervals are also common in Nepal, with one in four births occurring within 24 months of a previous birth. This is partly due to the relatively short period of insusceptibility, which averages 14 months, during which women are not exposed to the risk of pregnancy either because they are amenorrhoeic or abstaining. By 12-13 months after a birth, mothers of the majority of births (57 percent) are susceptible to the risk of pregnancy. Early childbearing and short birth intervals remain a challenge to policy-makers. NFHS data show that children born to young mothers and those born after short birth intervals suffer higher rates of morbidity and mortality.

Despite the decline in fertility, Nepalese women continue to have more children than they consider ideal. At current fertility levels, the average woman in Nepal is having almost 60 percent more births than she wants--the total wanted fertility rate is 2.9 births per woman, compared with the actual total fertility rate of 4.6 births per woman. Unplanned and unwanted births are often associated with increased mortality risks. More than half(56 percent) of all births in the five-year period before the survey had an increased risk of dying because the mother was too young (under 18 years) or too old (more than 34 years), or the birth was of order 3 or higher, or the birth occurred within 24 months of a previous birth.

Nevertheless, the percentage of women who want to stop childbearing in Nepal has increased substantially, from 40 percent in 1981 to 52 percent in 1991 and to 59 percent in 1996. According to the NFHS, 41 percent of currently married women age 15-49 say they do not want any more children, and an additional 18 percent have been sterilized. Furthermore, 21 percent of married women want to wait at least two years for their next child and only 13 percent want to have a child soon, that is, within two years.

FAMILY PLANNING

Knowledge of family planning is virtually universal in Nepal, with 98 percent of currently married women having heard of at least one method of family planning. This is a five-fold increase over the last two decades (1976-1996). Much of this knowledge comes from media exposure. Fifty-three percent of ever-married women had been exposed to family planning messages on the radio and/or the television and 23 percent have been exposed to messages through the print media. In addition, about one in four women has heard at least one of three specific family planning programmes on the radio.

There has been a steady increase in the level of ever use of modern contraceptive method over the past 20 years, from 4 percent of currently married women in 1976, to 27 percent in 1991 and 35 percent in 1996. Among ever-users, female sterilization and male sterilization are the most popular methods (37 percent), indicating that contraceptive methods have been used more for limiting than for spacing births.

The contraceptive prevalence rate among currently married women is 29 percent, with the majority of women using modern methods (26 percent). Again, the most widely used method is sterilization (18 percent, male and female combined), followed by injectables (5 percent). Although current use of modern contraceptive methods has risen steadily over the last two decades, the pace of change has been slowest in the most recent years (1991-1996). Current use among currently married non-pregnant women increased from 3 percent in 1976 to 15 percent in 1986 to 24 percent in 1991 and to 29 percent in 1996. While female sterilization increased by only 3 percent from 45 percent of modern methods in 1986 to 46 percent in 1996, male sterilization declined by almost 50 percent from 41 percent to 21 percent over the same period.

The level of current use is nearly twice as high in the urban areas (50 percent) as in rural areas (27 percent). Only 18 percent of currently married women residing in the Mountains are currently using contraception, compared with 30 percent and 29 percent living in the Hills and Terai regions, respectively. There is a notable difference in current contraceptive use between the Far-western region (21 percent) and all the other regions, especially the Central and Eastern regions (31 percent each). Educational differences in current use are large, with 26 percent of women with no education currently using contraception, compared with 52 percent of women who have completed their School Leaving Certificate (SLC). In general, as women's level of education rises, they are more likely to use modem spacing methods.

The public sector figures prominently as a source of modem contraceptives. Seventy-nine percent of modem method users obtained their methods from a public source, especially hospitals and district clinics (32 percent) and mobile camps (28 percent). The public sector is the predominant source of sterilizations, 1UDs, injectables, and Norplant, and both the public and private sectors are equally important sources of the pill and condoms. Nevertheless, the public sector's share of the market has fallen over the last five years from 93 percent of current users in 1991 to 79 percent in 1996.

There is considerable potential for increased family planning use in Nepal. Overall, one in three women has an unmet need for family planning--14 percent for spacing and 17 percent for limiting. The total demand for family planning, including those women who are currently using contraception, is 60 percent. Currently, the family planning needs of only one in two women is being met. While the increase in unmet need between 1991 (28 percent) and 1996 (31 percent) was small, there was a 14 percent increase in the percentage of women using any method of family planning and, over the same period, a corresponding increase of 18 percent in the demand for family planning.

MATERNAL AND CHILD HEALTH

At current mortality levels, one of every 8 children born in Nepal will die before the fifth birthday, with two of three deaths occurring during the first year of life. Nevertheless, NFHS data show that mortality levels have been declining rapidly in Nepal since the eighties. Under-five mortality in the period 0-4 years before the survey is 40 percent lower than it was 10-14 years before the survey, with child mortality declining faster (45 percent) than infant mortality (38 percent).

Mortality is consistently lower in urban than in rural areas, with children in the Mountains faring much worse than children living in the Hills and Terai. Mortality is also far worse in the Far-western and Mid-western development regions than in the other regions. Maternal education is strongly related to mortality, and children of highly

The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Federal Office of Statistics with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal care, vaccination status, breastfeeding, and nutrition. Data collection took place two years after implementation of the National Policy on Population and addresses issues raised by that policy. Fieldwork for the NDHS was conducted in two phases: from April to July 1990 in the southern states and from July to October 1990 in the northern states. Interviewers collected information on the reproductive histories of 8,781 women age 15-49 years and on the health of their 8,113 children under the age of five years. OBJECTIVES The Nigeria Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on socioeconomic characteristics, marriage patterns, history of child bearing, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of children. The primary objectives of the NDHS are: (i) To collect data for the evaluation of family planning and health programmes; (ii) To assess the demographic situation in Nigeria; and (iii) To support dissemination and utilisation of the results in planning and managing family planning and health programmes. MAIN RESULTS According to the NDHS, fertility remains high in Nigeria; at current fertility levels, Nigerian women will have an average of 6 children by the end of their reproductive years. The total fertility rate may actually be higher than 6.0, due to underestimation of births. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman. One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). These levels, while low, reflect an increase over the past decade: ten years ago just 1 percent of Nigerian women were using a modem family planning method. Periodic abstinence (rhythm method), the pill, IUD, and injection are the most popular methods among married couples: each is used by about 1 percent of currently married women. Knowledge of contraception remains low, with less than half of all women age 15-49 knowing of any method. Certain groups of women are far more likely to use contraception than others. For example, urban women are four times more likely to be using a contraceptive method (15 percent) than rural women (4 percent). Women in the Southwest, those with more education, and those with five or more children are also more likely to be using contraception. Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong: half of women with five children say that they want to have another child. Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children. National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by women's educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20. Teenagers in the North have births at twice the rate of those in the South: 20 births per 1130 women age 15-19 in the North compared to 10 birdas per 100 women in the South. Nearly half of teens in the North have already begun childbearing, versus 14 percent in South. This results in substantially lower total fertility rates in the South: women in the South have, on average, one child less than women in the North (5.5 versus 6.6). The survey also provides information related to maternal and child health. The data indicate that nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born, 87 die during their first year of life (infant mortality rate). There has been little improvement in infant and child mortality during the past 15 years. Mortality is higher in rural than urban areas and higher in the North than in the South. Undemutrition may be a factor contributing to childhood mortality levels: NDHS data show that 43 percent of the children under five are chronically undemourished. These problems are more severe in rural areas and in the North. Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one-third of births and over 60 percent of all babies arc born at home. Only one-third of births are assisted by doctors, trained nurses or midwives. A third of the infants are never vaccinated, and only 30 percent are fully immunised against childhood diseases. When they are ill, most young children go untreated. For example, only about one-third of children with diarrhoea were given oral rehydration therapy. Women and children living in rural areas and in the North are much less likely than others to benefit from health services. Almost four times as many births in the North are unassisted as in the South, and only one-third as many children complete their polio and DPT vaccinations. Programmes to educate women about the need for antenatal care, immunisation, and proper treatment for sick children should perhaps be aimed at mothers in these areas, Mothers everywhere need to learn about the proper time to introduce various supplementary foods to breastfeeding babies. Nearly all babies are breastfed, however, almost all breastfeeding infants are given water, formula, or other supplements within the first two months of life, which both jeopardises their nutritional status and increases the risk of infection.

This map shows the average number of children born to a woman during her lifetime. Data from Population Reference Bureau's 2017 World Population Data Sheet. The world's total fertility rate reported in 2017 was 2.5 as a whole. Replacement-Level fertility is widely recognized as 2.0 children per woman, so as to "replace" each parent in the next generation. Countries depicted in pink have a total fertility rate below replacement level whereas countries depicted in teal have a total fertility rate above replacement level. In countries with very high child mortality rates, a replacement level of 2.1 could be used, since not every child will survive into their reproductive years. Determinants of Total Fertility Rate include: women's education levels and opportunities, marriage rates among women of childbearing age (generally defined as 15-49), contraceptive usage and method mix/effectiveness, infant & child mortality rates, share of population living in urban areas, the importance of children as part of the labor force (or cost/penalty to women's labor force options that having children poses), and religious and cultural norms, among many other factors. This map was made using the Global Population and Maternal Health Indicators layer.

The 1993 National Demographic Survey (NDS) is a nationally representative sample survey of women age 15-49 designed to collect information on fertility; family planning; infant, child and maternal mortality; and maternal and child health. The survey was conducted between April and June 1993. The 1993 NDS was carried out by the National Statistics Office in collaboration with the Department of Health, the University of the Philippines Population Institute, and other agencies concerned with population, health and family planning issues. Funding for the 1993 NDS was provided by the U.S. Agency for International Development through the Demographic and Health Surveys Program. Close to 13,000 households throughout the country were visited during the survey and more than 15,000 women age 15-49 were interviewed. The results show that fertility in the Philippines continues its gradual decline. At current levels, Filipino women will give birth on average to 4.1 children during their reproductive years, 0.2 children less than that recorded in 1988. However, the total fertility rate in the Philippines remains high in comparison to the level achieved in the neighboring Southeast Asian countries. The primary objective of the 1993 NDS is to provide up-to-date inform ation on fertility and mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programs and strategies for improving health and family planning services in 'the country. MAIN RESULTS Fertility varies significantly by region and socioeconomic characteristics. Urban women have on average 1.3 children less than rural women, and uneducated women have one child more than women with college education. Women in Bicol have on average 3 more children than women living in Metropolitan Manila. Virtually all women know of a family planning method; the pill, female sterilization, IUD and condom are known to over 90 percent of women. Four in 10 married women are currently using contraception. The most popular method is female sterilization ( 12 percent), followed by the piU (9 percent), and natural family planning and withdrawal, both used by 7 percent of married women. Contraceptive use is highest in Northern Mindanao, Central Visayas and Southern Mindanao, in urban areas, and among women with higher than secondary education. The contraceptive prevalence rate in the Philippines is markedly lower than in the neighboring Southeast Asian countries; the percentage of married women who were using family planning in Thailand was 66 percent in 1987, and 50 percent in Indonesia in 199l. The majority of contraceptive users obtain their methods from a public service provider (70 percent). Government health facilities mainly provide permanent methods, while barangay health stations or health centers are the main sources for the pill, IUD and condom. Although Filipino women already marry at a relatively higher age, they continue to delay the age at which they first married. Half of Filipino women marry at age 21.6. Most women have their first sexual intercourse after marriage. Half of married women say that they want no more children, and 12 percent have been sterilized. An additional 19 percent want to wait at least two years before having another child. Almost two thirds of women in the Philippines express a preference for having 3 or less children. Results from the survey indicate that if all unwanted births were avoided, the total fertility rate would be 2.9 children, which is almost 30 percent less than the observed rate, More than one quarter of married women in the Philippines are not using any contraceptive method, but want to delay their next birth for two years or more (12 percent), or want to stop childbearing (14 percent). If the potential demand for family planning is satisfied, the contraceptive prevalence rate could increase to 69 percent. The demand for stopping childbearing is about twice the level for spacing (45 and 23 percent, respectively). Information on various aspects of maternal and child health-antenatal care, vaccination, breastfeeding and food supplementation, and illness was collected in the 1993 NDS on births in the five years preceding the survey. The findings show that 8 in 10 children under five were bom to mothers who received antenatal care from either midwives or nurses (45 percent) or doctors (38 percent). Delivery by a medical personnel is received by more than half of children born in the five years preceding the survey. However, the majority of deliveries occurred at home. Tetanus, a leading cause of infant deaths, can be prevented by immunization of the mother during pregnancy. In the Philippines, two thirds of bitlhs in the five years preceding the survey were to mothers who received a tetanus toxoid injection during pregnancy. Based on reports of mothers and information obtained from health cards, 90 percent of children aged 12-23 months have received shots of the BCG as well as the first doses of DPT and polio, and 81 percent have received immunization from measles. Immunization coverage declines with doses; the drop out rate is 3 to 5 percent for children receiving the full dose series of DPT and polio. Overall, 7 in 10 children age 12-23 months have received immunization against the six principal childhood diseases-polio, diphtheria, ~rtussis, tetanus, measles and tuberculosis. During the two weeks preceding the survey, 1 in 10 children under 5 had diarrhea. Four in ten of these children were not treated. Among those who were treated, 27 percent were given oral rehydration salts, 36 percent were given recommended home solution or increased fluids. Breasffeeding is less common in the Philippines than in many other developing countries. Overall, a total of 13 percent of children born in the 5 years preceding the survey were not breastfed at all. On the other hand, bottle feeding, a widely discouraged practice, is relatively common in the Philippines. Children are weaned at an early age; one in four children age 2-3 months were exclusively breastfed, and the mean duration of breastfeeding is less than 3 months. Infant and child mortality in the Philippines have declined significantly in the past two decades. For every 1,000 live births, 34 infants died before their first birthday. Childhood mortality varies significantly by mother's residence and education. The mortality of urban infants is about 40 percent lower than that of rural infants. The probability of dying among infants whose mother had no formal schooling is twice as high as infants whose mother have secondary or higher education. Children of mothers who are too young or too old when they give birth, have too many prior births, or give birth at short intervals have an elevated mortality risk. Mortality risk is highest for children born to mothers under age 19. The 1993 NDS also collected information necessary for the calculation of adult and maternal mortality using the sisterhood method. For both males and females, at all ages, male mortality is higher than that of females. Matemal mortality ratio for the 1980-1986 is estimated at 213 per 100,000 births, and for the 1987-1993 period 209 per 100,000 births. However, due to the small number of sibling deaths reported in the survey, age-specific rates should be used with caution. Information on health and family planning services available to the residents of the 1993 NDS barangay was collected from a group of respondents in each location. Distance and time to reach a family planning service provider has insignificant association with whether a woman uses contraception or the choice of contraception being used. On the other hand, being close to a hospital increases the likelihood that antenatal care and births are to respondents who receive ANC and are delivered by a medical personnel or delivered in a health facility.

Abstract

The 1992 Zambia Demographic and Health Survey (ZDHS) was a nationally representative sample survey of women age 15-49. The survey was designed to provide information onlevels and trends of fertility, infant and child mortality, family planning knowledge and use, and maternal and child health. The ZDHS was carried out by the University of Zambia in collaboration with Central Statistical Office and the Ministry of Health. Fieldwork was conducted from mid-January to mid-May 1992, during which time, over 6000 households and 7000 women were interviewed.

The primary objectives of the ZDHS are: - To collect up-to-date information on fertility, infant and child mortality and family planning; - To collect information on health-related matters such as breastfeeding, antenatal care, children's immunizations and childhood diseases; - To assess the nutritional status of mothers and children; - To support dissemination and utilisation of the results in planning, managing and improving family planning and health services in the country; and - To enhance the survey capabilities of the institutions Involved in order to facilitate the implementation of surveys of this type in the future.

MAIN RESULTS

• Results imply that fertility in Zambia has been declining over the past decade or so; at current levels, Zambian women will give birth to an average of 6.5 children during their reproductive years.

• Contraceptive knowledge is nearly universal in Zambia; over 90 percent of married women reported knowing about at least one modern contraceptive method.Over half of women using modern methods obtained them from government sources.

• Women in Zambia am marrying somewhat later than they did previously. The median age at marriage has increased from 17 years or under among women now in their 30s and 40s to 18 years or older among women in their 20s. Women with secondary education marry three years later (19.9) than women with no education (16.7).

• Over one-fifth (22 percent) of currently married women do not want to have any more children.

• One of the most striking findings from the ZDHS is the high level of child mortality and its apparent increase in recent years.

• Information on various aspects of maternal and child healtlr--antenatal care, vaccinations, bmastfeeding and food supplementation, and illness---was collected in the ZDHS on births in the five years preceding the survey.

• ZDHS data indic ate that haft of the births in Zambia are delivered at home and half in health facilities.

• Based on information obtained from health cards and mothers' reports, 95 percent of children age 12- 23 months are vaccinated against tuberculosis, 94 percent have received at least one dose of DPT and polio vaccines, and 77 percent have been vaccinated against measles. Sixty-seven percent of children age 12-23 months have been fully immunised and only 4 percent have not received any immuhisations.

• Almost all children in Zambia (98 percent) are breastfed. The median duration of breasffeeding is relatively long (19 months), but supplemental liquids and foods are introduced at an early age. By age 2-3 months, half of all children are being given supplementary food or liquid.

• ZDHS data indicate that undemutrition is an obstacle to improving child health; 40 percent of children under age five are stunted or short for their age, compared to an international reference population. Five percent of children are wasted or thin for their height and 25 percent are underweight for their age.

• The ZDHS included several questions about knowledge of AIDS. Almost all respondents (99 percent) had heard of AIDS and the vast majority (90 percent) knew that AIDS is transmitted through sexual intercourse.

The implementation of all these aspects of the PHC programmes requires multi-sectoral action and close collaboration among the various govemment institutions. The Govemment has therefore set up multi- sectoral PHC committees as an integral part of the PHC basic supportive manpower and inter-sectoral collaboration with other ministries has been given prominence.

Geographic coverage

The 1992 Zambia Demographic and Health Survey (ZDHS) is a nationally representative sample survey, also representative at the level of the nine provinces.

Analysis unit

• Household
• women age 15-49
• Children under five years

Universe

All women of reproductive age, age 15-49 in the total sample of households.

Kind of data

Sample survey data

Sampling procedure

Zambia is divided administratively into 9 provinces and 57 districts. In preparation for the 1990 Census of Population, Housing and Agriculture, the entire country was demarcated into Census Supervisory Areas (CSAs). Each CSA was in turn divided into Standard Enumeration Areas (SEAs) of roughly equal size. The measure of size used for selecting the ZDHS sample was the number of households obtained during a quick count operation carried out in 1987. The frame of 4240 CSAs was stratified into urban anti rural areas within each province, with the districts ordered geographically within provinces, thus providing further implicit stratification.

The ZDHS sample was selected from this frame in three stages. First, 262 CSAs (149 in urban areas and 113 in rural areas) were selected from this frame with probability proportional to size (the number of households from the quick count). One SEA was then selected from within each sampled CSA, again with probability proportion to size. The Central Statistical Office (CSO) then organised a household listing operation, in which all structures in the selected SEAs were numbered (on doors), the names of the heads of households were listed and the households were marked by number on sketch maps of the SEAs. These household lists were used to select a systematic sample of households for the third and final stage of sampling. Initially, the objective of the ZDHS sample design was to be able to produce estimates at the national level, for urban and rural areas separately, and for the larger provinces. Since Zambia's population is almost equally divided by urban and rural residence, a self weighting sample was originally designed. Later, it was decided that it would be desirable to be able to produce separate estimates for all nine provinces. To achieve this objective, additional rural CSAs (and SEAs) were selected inLuapula, North- eastern and Western Provinces and the sample take (number of households) in each rural SEA in these provinces was reduced from 42 to 35 in order to minimise the total sample size increase (the sample take was 20 households in urban areas). As a result of this oversampling in Luapula, North-Western and Western Provinces, the ZDHS sample is not self-weighting at the national level.

Mode of data collection

Face-to-face

Research instrument

Two types of questionnaires were used for the ZDHS: (a) the Household Questionnaire and (b) the Individual Questionnaire.

The contents of these questionnaires were based on the DHS Model B Questionnaire, which is designed for use in countries with low levels of contraceptive use. Additions and modifications to the model questionnaires were made after consultation with members of the Department of Social Development Studies of the University of Zambia, the Central Statistical Office (CSO), the Ministry of Health, the Planned Parenthood Association of Zambia (PPAZ), and the National Commission for Development Planning. The questionnaires were developed in English and then translated into and printed in seven of the most widely spoken languages (Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja and Tonga).

a) The Household Questionnaire was used to list all the usual members and visitors of a selected household. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women who were eligible for the individual interview. In addition, information was collected on the household itself, such as the source of water, type of toilet facilities, material used for the floor of the house, and ownership of various consumer goods.

b) The Individual Questionnaire was used to collect information from women age 15-49 about the following topics: Background characteristics (education, religion, etc.); Reproductive history; Knowledge and use of family planning methods; Antenatal and delivery care; Breastfeeding and weaning practices; Vaccinations and health of children under age five; Marriage; Fertility preferences; Husband's background and respondent's work; and Awareness of AIDS.

In addition, interviewing teams measured the height and weight of all children under age five and their mothers.

Cleaning operations

All questionnaires for the ZDHS were returned to the University of Zambia for data processing. The processing operation consisted of office editing, coding of open-ended questions, data entry, and editing errors found by the computer programs. Two programmers (one from the CSO and one from the University), one questionnaire administrator, two office editors, and three data entry operators were responsible for the data processing operation. The data were processed on four microcomputers owned by the Department of Social Development Studies at the University of Zambia. The ZDHS data entry and editing programs were written in ISSA (Integrated System for Survey Analysis) and followed the standard DHS consistency checks and editing procedures. Simple range and skip errors were corrected at the data entry stage. Secondary machine editing of the

The second National Family Health Survey (NFHS-2), conducted in 1998-99, provides information on fertility, mortality, family planning, and important aspects of nutrition, health, and health care. The International Institute for Population Sciences (IIPS) coordinated the survey, which collected information from a nationally representative sample of more than 90,000 ever-married women age 15-49. The NFHS-2 sample covers 99 percent of India's population living in all 26 states. This report is based on the survey data for 25 of the 26 states, however, since data collection in Tripura was delayed due to local problems in the state. IIPS also coordinated the first National Family Health Survey (NFHS-1) in 1992-93. Most of the types of information collected in NFHS-2 were also collected in the earlier survey, making it possible to identify trends over the intervening period of six and one-half years. In addition, the NFHS-2 questionnaire covered a number of new or expanded topics with important policy implications, such as reproductive health, women's autonomy, domestic violence, women's nutrition, anaemia, and salt iodization. The NFHS-2 survey was carried out in two phases. Ten states were surveyed in the first phase which began in November 1998 and the remaining states (except Tripura) were surveyed in the second phase which began in March 1999. The field staff collected information from 91,196 households in these 25 states and interviewed 89,199 eligible women in these households. In addition, the survey collected information on 32,393 children born in the three years preceding the survey. One health investigator on each survey team measured the height and weight of eligible women and children and took blood samples to assess the prevalence of anaemia. SUMMARY OF FINDINGS POPULATION CHARACTERISTICS Three-quarters (73 percent) of the population lives in rural areas. The age distribution is typical of populations that have recently experienced a fertility decline, with relatively low proportions in the younger and older age groups. Thirty-six percent of the population is below age 15, and 5 percent is age 65 and above. The sex ratio is 957 females for every 1,000 males in rural areas but only 928 females for every 1,000 males in urban areas, suggesting that more men than women have migrated to urban areas. The survey provides a variety of demographic and socioeconomic background information. In the country as a whole, 82 percent of household heads are Hindu, 12 percent are Muslim, 3 percent are Christian, and 2 percent are Sikh. Muslims live disproportionately in urban areas, where they comprise 15 percent of household heads. Nineteen percent of household heads belong to scheduled castes, 9 percent belong to scheduled tribes, and 32 percent belong to other backward classes (OBCs). Two-fifths of household heads do not belong to any of these groups. Questions about housing conditions and the standard of living of households indicate some improvements since the time of NFHS-1. Sixty percent of households in India now have electricity and 39 percent have piped drinking water compared with 51 percent and 33 percent, respectively, at the time of NFHS-1. Sixty-four percent of households have no toilet facility compared with 70 percent at the time of NFHS-1. About three-fourths (75 percent) of males and half (51 percent) of females age six and above are literate, an increase of 6-8 percentage points from literacy rates at the time of NFHS-1. The percentage of illiterate males varies from 6-7 percent in Mizoram and Kerala to 37 percent in Bihar and the percentage of illiterate females varies from 11 percent in Mizoram and 15 percent in Kerala to 65 percent in Bihar. Seventy-nine percent of children age 6-14 are attending school, up from 68 percent in NFHS-1. The proportion of children attending school has increased for all ages, particularly for girls, but girls continue to lag behind boys in school attendance. Moreover, the disparity in school attendance by sex grows with increasing age of children. At age 6-10, 85 percent of boys attend school compared with 78 percent of girls. By age 15-17, 58 percent of boys attend school compared with 40 percent of girls. The percentage of girls 6-17 attending school varies from 51 percent in Bihar and 56 percent in Rajasthan to over 90 percent in Himachal Pradesh and Kerala. Women in India tend to marry at an early age. Thirty-four percent of women age 15-19 are already married including 4 percent who are married but gauna has yet to be performed. These proportions are even higher in the rural areas. Older women are more likely than younger women to have married at an early age: 39 percent of women currently age 45-49 married before age 15 compared with 14 percent of women currently age 15-19. Although this indicates that the proportion of women who marry young is declining rapidly, half the women even in the age group 20-24 have married before reaching the legal minimum age of 18 years. On average, women are five years younger than the men they marry. The median age at marriage varies from about 15 years in Madhya Pradesh, Bihar, Uttar Pradesh, Rajasthan, and Andhra Pradesh to 23 years in Goa. As part of an increasing emphasis on gender issues, NFHS-2 asked women about their participation in household decisionmaking. In India, 91 percent of women are involved in decision-making on at least one of four selected topics. A much lower proportion (52 percent), however, are involved in making decisions about their own health care. There are large variations among states in India with regard to women's involvement in household decisionmaking. More than three out of four women are involved in decisions about their own health care in Himachal Pradesh, Meghalaya, and Punjab compared with about two out of five or less in Madhya Pradesh, Orissa, and Rajasthan. Thirty-nine percent of women do work other than housework, and more than two-thirds of these women work for cash. Only 41 percent of women who earn cash can decide independently how to spend the money that they earn. Forty-three percent of working women report that their earnings constitute at least half of total family earnings, including 18 percent who report that the family is entirely dependent on their earnings. Women's work-participation rates vary from 9 percent in Punjab and 13 percent in Haryana to 60-70 percent in Manipur, Nagaland, and Arunachal Pradesh. FERTILITY AND FAMILY PLANNING Fertility continues to decline in India. At current fertility levels, women will have an average of 2.9 children each throughout their childbearing years. The total fertility rate (TFR) is down from 3.4 children per woman at the time of NFHS-1, but is still well above the replacement level of just over two children per woman. There are large variations in fertility among the states in India. Goa and Kerala have attained below replacement level fertility and Karnataka, Himachal Pradesh, Tamil Nadu, and Punjab are at or close to replacement level fertility. By contrast, fertility is 3.3 or more children per woman in Meghalaya, Uttar Pradesh, Rajasthan, Nagaland, Bihar, and Madhya Pradesh. More than one-third to less than half of all births in these latter states are fourth or higher-order births compared with 7-9 percent of births in Kerala, Goa, and Tamil Nadu. Efforts to encourage the trend towards lower fertility might usefully focus on groups within the population that have higher fertility than average. In India, rural women and women from scheduled tribes and scheduled castes have somewhat higher fertility than other women, but fertility is particularly high for illiterate women, poor women, and Muslim women. Another striking feature is the high level of childbearing among young women. More than half of women age 20-49 had their first birth before reaching age 20, and women age 15-19 account for almost one-fifth of total fertility. Studies in India and elsewhere have shown that health and mortality risks increase when women give birth at such young ages?both for the women themselves and for their children. Family planning programmes focusing on women in this age group could make a significant impact on maternal and child health and help to reduce fertility. INFANT AND CHILD MORTALITY NFHS-2 provides estimates of infant and child mortality and examines factors associated with the survival of young children. During the five years preceding the survey, the infant mortality rate was 68 deaths at age 0-11 months per 1,000 live births, substantially lower than 79 per 1,000 in the five years preceding the NFHS-1 survey. The child mortality rate, 29 deaths at age 1-4 years per 1,000 children reaching age one, also declined from the corresponding rate of 33 per 1,000 in NFHS-1. Ninety-five children out of 1,000 born do not live to age five years. Expressed differently, 1 in 15 children die in the first year of life, and 1 in 11 die before reaching age five. Child-survival programmes might usefully focus on specific groups of children with particularly high infant and child mortality rates, such as children who live in rural areas, children whose mothers are illiterate, children belonging to scheduled castes or scheduled tribes, and children from poor households. Infant mortality rates are more than two and one-half times as high for women who did not receive any of the recommended types of maternity related medical care than for mothers who did receive all recommended types of care. HEALTH, HEALTH CARE, AND NUTRITION Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. One goal is for each pregnant woman to receive at least three antenatal check-ups plus two tetanus toxoid injections and a full course of iron and folic acid supplementation. In India, mothers of 65 percent of the children born in the three years preceding NFHS-2 received at least one antenatal