In the United States in 2021, the death rate was highest among those aged 85 and over, with about 17,190.5 men and 14,914.5 women per 100,000 of the population passing away. For all ages, the death rate was at 1,118.2 per 100,000 of the population for males, and 970.8 per 100,000 of the population for women. The death rate Death rates generally are counted as the number of deaths per 1,000 or 100,000 of the population and include both deaths of natural and unnatural causes. The death rate in the United States had pretty much held steady since 1990 until it started to increase over the last decade, with the highest death rates recorded in recent years. While the birth rate in the United States has been decreasing, it is still currently higher than the death rate. Causes of death There are a myriad number of causes of death in the United States, but the most recent data shows the top three leading causes of death to be heart disease, cancers, and accidents. Heart disease was also the leading cause of death worldwide.

This table contains 2394 series, with data for years 1991 -1991 (not all combinations necessarily have data for all years). This table contains data described by the following dimensions (Not all combinations are available): Geography (1 items: Canada ...), Population group (19 items: Entire cohort; Income adequacy quintile 1 (lowest);Income adequacy quintile 3;Income adequacy quintile 2 ...), Age (14 items: At 25 years; At 30 years; At 35 years; At 40 years ...), Sex (3 items: Both sexes; Females; Males ...), Characteristics (3 items: Probability of survival; Low 95% confidence interval; life expectancy; High 95% confidence interval; life expectancy ...).

In 2023, the age-specific death rate for men aged 90 or over in England and Wales was 248.1 per one thousand population, and 215.1 for women. Except for infants that were under the age of one, younger age groups had the lowest death rate, with the death rate getting progressively higher in older age groups.

Number of deaths and mortality rates, by age group, sex, and place of residence, 1991 to most recent year.

Annual data on death registrations by single year of age for the UK (1974 onwards) and England and Wales (1963 onwards).

Rank, number of deaths, percentage of deaths, and age-specific mortality rates for the leading causes of death, by age group and sex, 2000 to most recent year.

Maternal mortality rates can vary significantly around the world. For example, in 2022, Estonia had a maternal mortality rate of zero per 100,000 live births, while Mexico reported a rate of 38 deaths per 100,000 live births. However, the regions with the highest number of maternal deaths are Sub-Saharan Africa and Southern Asia, with differences between countries and regions often reflecting inequalities in health care services and access. Most causes of maternal mortality are preventable and treatable with the most common causes including severe bleeding, infections, complications during delivery, high blood pressure during pregnancy, and unsafe abortion. Maternal mortality in the United States In 2022, there were a total of 817 maternal deaths in the United States. Women aged 25 to 39 years accounted for 578 of these deaths, however, rates of maternal mortality are much higher among women aged 40 years and older. In 2022, the rate of maternal mortality among women aged 40 years and older in the U.S. was 87 per 100,000 live births, compared to a rate of 21 among women aged 25 to 39 years. The rate of maternal mortality in the U.S. has risen in recent years among all age groups. Differences in maternal mortality in the U.S. by race/ethnicity Sadly, there are great disparities in maternal mortality in the United States among different races and ethnicities. In 2022, the rate of maternal mortality among non-Hispanic white women was about 19 per 100,000 live births, while non-Hispanic Black women died from maternal causes at a rate of almost 50 per 100,000 live births. Rates of maternal mortality have risen for white and Hispanic women in recent years, but Black women have by far seen the largest increase in maternal mortality. In 2022, around 253 Black women died from maternal causes in the United States.

BackgroundAlthough less studied than other types of familial losses, the loss of a sibling could be a potential trigger of stroke as it represents a stressful life event. We studied the association between loss of a sibling and fatal stroke up to 18 years since bereavement. Methodology/Principal FindingsWe conducted a follow-up study between 1981 and 2002, based on register data covering the total population of Swedes aged 40–69 years (n = 1,617,010). An increased risk of fatal stroke (1.31 CI: 1.05, 1.62) was found among women who had experienced the loss of a sibling. No increase in the overall mortality risk was found in men (1.11 CI: 0.92, 1.33). An elevated risk in the short term (during the second and third half-year after the death) was found among both men and women, whereas longer-term elevation in risk was found primarily for women. Both external (1.47 CI: 1.00, 2.17) and not external (1.26 CI: 1.00, 1.60) causes of sibling death showed associations among women. In men, an association was found only if the sibling also died from stroke (1.78 CI: 1.00, 3.17). However, among women, we found an increased risk of stroke mortality if the sibling died from causes other than stroke (1.30 CI: 1.04, 1.62). Conclusions/SignificanceThe findings suggest an increased risk of dying from stroke mortality after the death of a sibling, and that bereavement affects particularly women. It is important for health care workers to follow bereaved siblings and recognize potential changes of stress-levels and health related behaviours that could lead to risk of stroke.

Since the 1950s, the suicide rate in the United States has been significantly higher among men than women. In 2022, the suicide rate among men was almost four times higher than that of women. However, the rate of suicide for both men and women has increased gradually over the past couple of decades. Facts on suicide in the United States In 2022, the rate of suicide death in the United States was around 14 per 100,000 population. The suicide rate in the U.S. has generally increased since the year 2000, with the highest rates ever recorded in the years 2018 and 2022. In the United States, death rates from suicide are highest among those aged 45 to 64 years and lowest among younger adults aged 15 to 24. The states with the highest rates of suicide are Montana, Alaska, and Wyoming, while New Jersey and Massachusetts have the lowest rates. Suicide among men In 2023, around 4.5 percent of men in the United States reported having serious thoughts of suicide in the past year. Although this rate is lower than that of women, men still have a higher rate of suicide death than women. One reason for this may have to do with the method of suicide. Although firearms account for the largest share of suicide deaths among both men and women, firearms account for almost 60 percent of all suicides among men and just 35 percent among women. Suffocation and poisoning are the other most common methods of suicide among women, with the chances of surviving a suicide attempt from these methods being much higher than surviving an attempt by firearm. The age group with the highest rate of suicide death among men is by far those aged 75 years and over.

The suicide rate among females in the United States is highest for those aged 45 to 64 years and lowest among girls aged 10 to 14 and elderly women 75 and over. Although the suicide rate among women remains over three times lower than that of men, rates of suicide among women have gradually increased over the past couple decades. Suicide among women in the United States In 2021, there were around six suicide deaths per 100,000 women in the United States. In comparison, the rate of suicide among women in the year 2000 was about four per 100,000. Suicide rates among women are by far the highest among American Indians or Alaska Natives and lowest among Hispanic and Black or African American women. Although firearms are involved in the highest share of suicide deaths among both men and women, they account for a much smaller share among women. In 2020, the firearm suicide rate among women was 1.8 per 100,000 population, while the rates of suicide for suffocation and poisoning were 1.7 and 1.5 per 100,000, respectively. Suicidal ideation among women Although not everyone who experiences suicidal ideation, or suicidal thoughts, will attempt suicide, suicidal thoughts are a risk factor for suicide. In 2022, just over five percent of women in the United States reported having serious thoughts of suicide in the past year. Suicidal thoughts are more common among women than men even though men have much higher rates of death from suicide than women. This is because men are more likely to use more lethal methods of suicide such as firearms. Women who suffer from substance use disorder are significantly more likely to have serious thoughts of suicide than women without substance use disorder.

In the United States, the leading causes of death among women are heart disease and cancer. Heart disease and cancer are similarly the leading causes of death among U.S. men. In 2022, heart disease accounted for **** percent of all deaths among women in the United States, while cancer accounted for **** percent of deaths. COVID-19 was the third leading cause of death among both men and women in 2020 and 2021, and the fourth leading cause in 2022. Cancer among women in the U.S. The most common types of cancer among U.S. women are breast, lung and bronchus, and colon and rectum. In 2025, there were around ******* new breast cancer cases among women, compared to ******* new cases of lung and bronchus cancer. Although breast cancer is the most common form of cancer among women in the United States, lung and bronchus cancer causes the highest number of cancer deaths. In 2025, around ****** women were expected to die from lung and bronchus cancer, compared to ****** from breast cancer. Breast cancer Although breast cancer is the second most deadly form of cancer among women, rates of death have decreased over the past few decades. This decrease is possibly due to early detection, progress in therapy, and increasing awareness of risk factors. In 2023, the death rate due to breast cancer was **** per 100,000 population, compared to a rate of **** per 100,000 in the year 1990. The state with the highest rate of deaths due to breast cancer is Oklahoma, while South Dakota had the lowest rates.

In 2022, the life expectancy at birth for women born in the UK was 82.57 years, compared with 78.57 years for men. By age 65 men had a life expectancy of 18.25 years, compared with 20.76 years for women.

According to the World Health Organization, from 2010 to 2014, there were around 55 million abortions worldwide, 45% of which were unsafe. In Brazil, data on abortion and its complications are incomplete. Health care data are only available for the public sector and mortality data depend on investigations of deaths. This study sought to describe the situation of abortion in the country using public data available in the different Information Systems - SIM (mortality), SINASC (live births) and SIH (hospitalization). From 2008 to 2015, there were around 200,000 hospitalizations/year for procedures related to abortion, 1,600 of which for medical and legal reasons. From 2006 to 2015, we found 770 maternal deaths in SIM whose underlying cause was abortion. There was a discreet reduction in the number of deaths from abortion in the period, with regional variation. This number could be increased by around 29% per year if deaths with mentions of abortion and declared with a different underlying cause were considered. Among the deaths reported as resulting from abortion, 1% were abortions due to medical and legal reasons and 56.5% were non-specified abortions. The proportion of deaths from abortion identified in SIH, in relation to the total number of deaths from abortion identified in SIM, varied between 47.4% in 2008 and 72.2% in 2015. Although official health data do not allow us to estimate the number of abortions in Brazil, we were able to establish the profile of women at higher risk for death from abortion: black and indigenous women, with low educational levels, under 14 and over 40 years of age, living in the North Northeast and Central regions, without a partner.

BackgroundRandomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM. Methods and FindingsThe Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4–3.8, p<0.001) than men (2.3: 2.0–2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, p<0.001) in men and 2.7 (2.2–3.4, p<0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ≥40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA1c of <7% and 37% had very poor (≥9%) glycaemic control. Among those aged ≥40, 37% had blood pressures above even conservative targets (≥140/90 mmHg) and 39% of those ≥40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used. ConclusionsAlthough the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed. Please see later in the article for the Editors' Summary

BackgroundEndometrial cancer is the sixth leading cause of cancer among females and about 97,000 global deaths of endometrial cancer. The changes in the trends of obesity, fertility rates and other risk factors in South Africa (SA) may impact the endometrial cancer trends. The aim of this study was to utilise the age period cohort and join point regression modelling to evaluate the national and ethnic trends in endometrial cancer mortality in South Africa over a 20year period (1999–2018).MethodsData from Statistics South Africa was obtained to calculate the annual number of deaths, and annual crude and age standardised mortality rates (ASMR) of endometrial cancer from 1999–2018. The overall and ethnic trends of endometrial cancer mortality was assessed using the Join point regression model, while Age-period-cohort (APC) regression modelling was conducted to estimate the effect of age, calendar period and birth cohort.ResultsDuring the period 1999–2018, 4,877 deaths were due to endometrial cancer which constituted about 3.6% of breast and gynecological cancer deaths (3.62%, 95% CI: 3.52%–3.72%) in South Africa. The ASMR of endometrial cancer doubled from 0.76 deaths per 100,000 women in 1999 to 1.5 deaths per 100,000 women in 2018, with an average annual rise of 3.6% per annum. (Average Annual Percentage change (AAPC): 3.6%, 95%CI:2.7–4.4, P-value < 0.001). In 2018, the overall mean age at death for endometrial cancer was was 67.40 ± 11.04 years and, the ASMR of endometrial cancer among Indian/Asians (1.69 per 100,000 women), Blacks (1.63 per 100,000 women) and Coloreds (1.39 per 100,000 women) was more than doubled the rates among Whites (0.66 deaths per 100,000 women). Indian/Asians had stable rates while other ethnic groups had increased rates. The Cohort mortality risk ratio (RR) of endometrial cancer increased with successive birth cohort from 1924 to 1963 (RR increased from 0.2 to 1.00), and subsequently declined among successive cohorts from 1963 to 1998 (1.00 to 0.09). There was strong age and cohort but not period effect among the South African women. Ethnic disparity showed that there was age effect among all the ethnic groups; Cohort effect among Blacks and Coloureds only, while Period effect occurred only among Blacks.ConclusionsThe mortality rates of endometrial cancer doubled over a twenty-year period in South Africa from 1999–2018. There was strong ethnic disparity, with age and cohort effect on endometrial cancer trends. Thus, targeted efforts geared towards prevention and prompt treatment of endometrial cancer among the high-risk groups should be pursued by stake holders.

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.

Women 40 years and over have the highest rates of maternal mortality in the United States. In 2023, the rate of maternal mortality among this age group was around 60 per 100,000 live births. This statistic presents maternal mortality rates in the United States from 2018 to 2023, by age group.

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

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 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 wantsthe 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 planning14 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 educated mothers are least likely to die young. For example, infant mortality is nearly