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.

This statistic depicts the maternal mortality rate (per 100,000 live births) for developed nations in Europe, Australia and North America in 2015. According to the data, the United States had a maternal mortality rate of 26.4, compared to Finland with a maternal mortality rate of just 3.8. The U.S. has by far the highest maternal mortality rate among developed countries.

This statistic shows the 20 countries* with the highest infant mortality rate in 2024. An estimated 101.3 infants per 1,000 live births died in the first year of life in Afghanistan in 2024. Infant and child mortality Infant mortality usually refers to the death of children younger than one year. Child mortality, which is often used synonymously with infant mortality, is the death of children younger than five. Among the main causes are pneumonia, diarrhea – which causes dehydration – and infections in newborns, with malnutrition also posing a severe problem. As can be seen above, most countries with a high infant mortality rate are developing countries or emerging countries, most of which are located in Africa. Good health care and hygiene are crucial in reducing child mortality; among the countries with the lowest infant mortality rate are exclusively developed countries, whose inhabitants usually have access to clean water and comprehensive health care. Access to vaccinations, antibiotics and a balanced nutrition also help reducing child mortality in these regions. In some countries, infants are killed if they turn out to be of a certain gender. India, for example, is known as a country where a lot of girls are aborted or killed right after birth, as they are considered to be too expensive for poorer families, who traditionally have to pay a costly dowry on the girl’s wedding day. Interestingly, the global mortality rate among boys is higher than that for girls, which could be due to the fact that more male infants are actually born than female ones. Other theories include a stronger immune system in girls, or more premature births among boys.

Abstract

The principal objective of the 2006 Nepal Demographic and Health Survey (NDHS) is to provide current and reliable data on fertility and family planning behavior, child mortality, adult and maternal mortality, children’s nutritional status, the utilization of maternal and child health services, and knowledge of HIV/AIDS. For the first time, the 2006 NDHS conducted anemia testing at the household level for the country as a whole to provide information on the prevalence of anemia at the population level. The specific objectives of the survey are to:

• collect data at the national level which will allow the calculation of key demographic rates;
• analyze the direct and indirect factors which determine the level and trends of fertility;
• measure the level of contraceptive knowledge and practice among women and men by method, urban-rural residence and region,
• collect high-quality data on family health including immunization coverage among children, prevalence and treatment of diarrhea and other diseases among children under five, and maternity care indicators including antenatal visits, assistance at delivery, and postnatal care;
• collect data on infant and child mortality, and maternal and adult mortality;
• obtain data on child feeding practices including breastfeeding, and collect anthropometric measures to use in assessing the nutritional status of women and children;
• collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS and evaluate patterns of recent behavior regarding condom use;
• conduct hemoglobin testing on women age 15-49 and children age 6-59 months in the households selected for the survey to provide information on the prevalence of anemia among women in the reproductive ages and young children.

This information is essential for informed policy decisions, planning, monitoring, and evaluation of programs on health in general and reproductive health in particular at both the national and regional levels. A long-term objective of the survey is to strengthen the technical capacity of government organizations to plan, conduct, process, and analyze data from complex national population and health surveys. Moreover, the 2006 NDHS provides national, regional and subregional estimates on population and health that are comparable to data collected in similar surveys in other developing countries. The first Demographic and Health Survey (DHS) in Nepal was the 1996 Nepal Family Health Survey (NFHS) conducted as part of the worldwide DHS program, and was followed five years later by the 2001 Nepal Demographic and Health Survey (NDHS). Data from the 2006 NDHS survey, the third such survey, allow for comparison of information gathered over a longer period of time and add to the vast and growing international database on demographic and health variables.

Wherever possible, the 2006 NDHS data are compared with data from the two earlier DHS surveys—the 2001 NDHS and the 1996 NFHS—which also sampled women age 15-49. Additionally, men age 15-59 were interviewed in the 2001 NDHS and the 2006 NDHS to provide comparable data for men over the last five years.

Geographic coverage

National

Analysis unit

• Household
• Children under five years
• Women age 15-49
• Men age 15-59

Kind of data

Sample survey data

Sampling procedure

The primary focus of the 2006 NDHS was to provide estimates of key population and health indicators, including fertility and mortality rates, for the country as a whole and for urban and rural areas separately. In addition, the sample was designed to provide estimates of most key indicators for the 13 domains obtained by cross-classifying the three ecological zones (mountain, hill and terai) with the five development regions (East, Central, West, Mid-west, and Far-west).

The 2006 NDHS used the sampling frame provided by the list of census enumeration areas with population and household information from the 2001 Population Census. Each of the 75 districts in Nepal is subdivided into Village Development Committees (VDCs), and each VDC into wards. The primary sampling unit (PSU) for the 2006 NDHS is a ward, subward, or group of wards in rural areas, and subwards in urban areas. In rural areas, the ward is small enough in size for a complete household listing, but in urban areas the ward is large. It was therefore necessary to subdivide each urban ward into subwards. Information on the subdivision of the urban wards was obtained from the updated Living Standards Measurement Survey. The sampling frame is representative of 96 percent of the noninstitutional population.

The sample for the survey is based on a two-stage, stratified, nationally representative sample of households. At the first stage of sampling, 260 PSUs (82 in urban areas and 178 in rural areas) were selected using systematic sampling with probability proportional to size. A complete household listing operation was then carried out in all the selected PSUs to provide a sampling frame for the second stage selection of households. At the second stage of sampling, systematic samples of about 30 households per PSU on average in urban areas and about 36 households per PSU on average in rural areas were selected in all the regions, in order to provide statistically reliable estimates of key demographic and health variables. However, since Nepal is predominantly rural, in order to obtain statistically reliable estimates for urban areas, it was necessary to oversample the urban areas. As such, the total sample is weighted and a final weighting procedure was applied to provide estimates for the different domains, and for the urban and rural areas of the country as a whole.

The survey was designed to obtain completed interviews of 8,600 women age 15-49. In addition, males age 15-59 in every second household were interviewed. To take nonresponse into account, a total of 9,036 households nationwide were selected.

Mode of data collection

Face-to-face

Research instrument

Three questionnaires were administered for the 2006 NDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were adapted to reflect the population and health issues relevant to Nepal at a series of meetings with various stakeholders from government ministries and agencies, NGOs and international donors. The final draft of the questionnaires was discussed at a questionnaire design workshop organized by MOHP in September 2005 in Kathmandu. The survey questionnaires were then translated into the three main local languages—Nepali, Bhojpuri and Maithili and pretested from November 16 to December 13, 2005.

The Household Questionnaire was used to list all the usual members and visitors in the selected households and to identify women and men who were eligible for the individual interview. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. For children under age 18, the survival status of the parents was determined. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and ownership of mosquito nets. Additionally, the Household Questionnaire was used to record height, weight, and hemoglobin measurements of women age 15-49 and children age 6-59 months. The Women’s Questionnaire was used to collect information from all women age 15-49.

These women were asked questions on the following topics: - respondent’s characteristics such as education, residential history, media exposure, - pregnancy history, childhood mortality, - knowledge and use of family planning methods, - fertility preferences, - antenatal, delivery, and postnatal care, - breastfeeding and infant feeding practices, - immunization and childhood illnesses, - marriage and sexual activity, - woman’s work and husband’s background characteristics, - awareness and behavior regarding AIDS and other sexually transmitted infections (STIs), and - maternal mortality.

The Men’s Questionnaire was administered to all men age 15-59 living in every second household in the 2006 NDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health or nutrition.

In addition, the Verbal Autopsy Module into the causes of under-five mortality was administered to all women age 15-49 (and anyone else who remembered the circumstances surrounding the reported death) who reported a death or stillbirth in the five years preceding the survey to children under five years of age.

Response rate

A total of 9,036 households were selected, of which 8,742 were found to be occupied during data collection. Of these existing households, 8,707 were successfully interviewed, giving a household response rate of nearly 100 percent.

In the selected households, 10,973 women were identified as eligible for the individual interview. Interviews were completed for 10,793 women, yielding a response rate of 98 percent. Of the 4,582 eligible men identified in the selected subsample of households, 4,397 were successfully interviewed, giving a 96 percent response rate. Response rates were higher in rural than urban areas, especially for eligible men.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2)

Objectives: To identify and map all trials in maternal health conducted in low- and middle-income countries (LMIC) over the 10-year period 2010-2019, to identify geographical and thematic trends, as well as compare to global causes of maternal death and pre-identified priority areas. Design: Systematic scoping review. Primary and secondary outcome measures: Extracted data included location, study characteristics and whether trials corresponded to causes of mortality and identified research priority topics. Results: Our search identified 7,269 articles, 874 of which were included for analysis. Between 2010 and 2019, maternal health trials conducted in LMICs more than doubled (50 to 114). Trials were conducted in 61 countries – 231 trials (26.4%) were conducted in Iran. Only 225 trials (25.7%) were aligned with a cause of maternal mortality. Within these trials, pre-existing medical conditions, embolism, obstructed labour, and sepsis were all under-represented when compared with number of maternal deaths globally. Large numbers of studies were conducted on priority topics such as labour and delivery, obstetric haemorrhage, and antenatal care. Hypertensive disorders of pregnancy, diabetes, and health systems and policy – despite being high-priority topics – had relatively few trials. Conclusion: Despite trials conducted in LMICs increasing from 2010 to 2019, there were significant gaps in geographical distribution, alignment with causes of maternal mortality, and known research priority topics. The research gaps identified provide guidance and insight for future research conducted in low-resource settings. Methods With support from an information specialist, a search strategy was devised to capture eligible studies (Supplemental Table 1). Search terms for maternal and perinatal health were derived from search strategies used by Cochrane Pregnancy and Childbirth to maintain and update their specialised register. We consulted the search filters developed by Cochrane EPOC to identify search terms relating to LMICs. The search strategy was applied to the Cochrane Central Register of Controlled Trials (CENTRAL), which retrieves records from PubMed/MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO’s International Clinical Trials Registry Platform (ICTRP), KoreaMed, Cochrane Review Group’s Specialised Registers, and hand-searched biomedical sources. Searching CENTRAL directly had the benefit of restricting search results to trials only, keeping the volume of citations to screen to a manageable level. Trial register records from ClinicalTrials.gov and WHO ICTRP were not included in the records retrieved from CENTRAL. The search was conducted on 1 May 2020. Citation management, identification of duplicates, and screening articles for eligibility were conducted using EndNote and Covidence. Two reviewers independently screened titles and abstracts of all retrieved citations to identify those that were potentially eligible. Full texts for these articles were accessed and assessed by two independent reviewers according to the eligibility criteria. At both steps, any disagreements were resolved through discussion or consulting a third author. Data collection and analysis For each included trial we extracted information on title, author, year of publication, location where the trial was conducted (country and SDG region), unit of randomisation (individual or cluster), category of intervention, intervention level (public health, community, primary care, hospital, and health system), and category of the primary outcome(s). The intervention and outcome categories were adapted from Cochrane’s list of ‘higher-level categories for interventions and outcomes’. For trials with more than one primary outcome, we identified a single, most appropriate outcome category through discussion and consensus amongst review authors. The level of intervention was determined based on the level of the healthcare system that the trial was primarily targeting – for example, trials recruiting women at an antenatal clinic were classified as primary care level. Public health and preventative care were defined as interventions for those in the community who were well, while home; and community care was defined as interventions for those in the community who were unwell. Based on the trial’s primary objective, we tagged each trial to one of 35 maternal health topics, as well as classified them by relevance to a cause of maternal death identified by Say et al in their global systematic analysis (Box 1). Included trials were additionally categorised into global research priority topics identified by Souza et al and Chapman et al. The research priorities identified by Souza et al were ranked based on the distribution of maternal health themes across the 190 priority research questions – i.e., the theme with the most research questions was considered the highest-ranked priority topic. This mirrored the process used by Chapman et al, where research topics with the greatest representation within the 100 research questions, based on percentage, were given the highest rank. For each trial identified in our review, we used the variables extracted to classify it according to priority topics identified in Souza et al or Chapman et al, where possible (Box 1). All data were extracted by two independent reviewers, with results compared to ensure consistency and any disputes resolved through discussion or consultation with a third author. As this was a scoping review, we did not perform quality assessments on individual trials. We conducted descriptive analyses using Excel to determine frequencies of extracted variables and used line graphs to explore trends. We assessed trends over time using proportions of each variable within studies available for a given year. While we initially planned to look at trends in individual countries and interventions, many had few or no data points.

This statistic shows the 20 countries * with the lowest infant mortality rate in 2024. An estimated 1.5 out of 1,000 live births died in the first year of life in Slovenia and Singapore in 2024. Infant mortality Infant mortality rates are often used as an indicator of the health and well-being of a nation. Monaco, Iceland, and Japan are among the top three countries with the lowest infant mortality rates with around 2 infant deaths per 1,000 infants within their first year of life. Generally, the countries with the lowest infant mortality also have some of the highest average life expectancy figures. Additionally, the countries with the highest density of physicians and doctors also generally report low infant mortality. Yet, many different factors contribute to differing rates, including the overall income of a country, health spending per capita, a mother’s level of education, environmental conditions, and medical infrastructure, to name a few. This creates a lot of variation concerning the level of childbirth and infant care around the world. The countries with the highest rates of infant mortality include Afghanistan, Mali, and Somalia. These countries experience around 100 infant deaths per 1,000 infants in their first year of life. While the reasons for high rates of infant mortality are numerous, the leading causes of death for children under the year five around the world are Pneumonia, Diarrhea, and Prematurity.

Abstract

The 2019 Pakistan Maternal Mortality Survey (2019 PMMS) was the first stand-alone maternal mortality survey conducted in Pakistan. A nationally representative sample of 1,396 primary sampling units were randomly selected. The survey was expected to result in about 14,000 interviews with ever-married women age 15-49.

The primary objective of the 2019 PMMS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the survey was designed and carried out with the purpose of assessing where Pakistan stands on maternal health indicators and how well the country is moving toward these targets. Overall aims of the 2019 PMMS were as follows: - To estimate national and regional levels of maternal mortality for the 3 years preceding the survey and determine whether the MMR has declined substantially since 2006-07 - To identify medical causes of maternal deaths and the biological and sociodemographic risk factors associated with maternal mortality - To assess the impact of maternal and newborn health services, including antenatal and postnatal care and skilled birth attendance, on prevention of maternal mortality and morbidity - To estimate the prevalence and determinants of common obstetric complications and morbidities among women of reproductive age during the 3 years preceding the survey

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Woman age 15-49
• Community

Kind of data

Sample survey data [ssd]

Sampling procedure

The 2019 PMMS used a multistage and multiphase cluster sampling methodology based on updated sampling frames derived from the 6th Population and Housing Census, which was conducted in 2017 by the Pakistan Bureau of Statistics (PBS). The sampling universe consisted of urban and rural areas of the four provinces of Pakistan (Punjab, Sindh, Khyber Pakhtunkhwa, and Balochistan), Azad Jammu and Kashmir (AJK), Gilgit Baltistan (GB), Federally Administered Tribal Areas (FATA), and the Islamabad Capital Territory (ICT). A total of 153,560 households (81,400 rural and 72,160 urban) were selected using a two-stage and two-phase stratified systematic sampling approach. The survey was designed to provide representative results for most of the survey indicators in 11 domains: four provinces (by urban and rural areas with Islamabad combined with Punjab and FATA combined with Khyber Pakhtunkhwa), Azad Jammu and Kashmir (urban and rural), and Gilgit Baltistan. Restricted military and protected areas were excluded from the sample.

The sampled households were randomly selected from 1,396 primary sampling units (PSUs) (740 rural and 656 urban) after a complete household listing. In each PSU, 110 randomly selected households were administered the various questionnaires included in the survey. All 110 households in each PSU were asked about births and deaths during the previous 3 years, including deaths among women of reproductive age (15-49 years). Households that reported at least one death of a woman of reproductive age were then visited, and detailed verbal autopsies were conducted to determine the causes and circumstances of these deaths to help identify maternal deaths. In the second phase, 10 households in each PSU were randomly selected from the 110 households selected in the first phase to gather detailed information on women of reproductive age. All eligible ever-married women age 15-49 residing in these 10 households were interviewed to gather detailed information, including a complete pregnancy history.

Note: A detailed description of the sample design is provided in Appendix A of the final report.

Mode of data collection

Face-to-face [f2f]

Research instrument

Six questionnaires were used in the 2019 PMMS: the Short Household Questionnaire, the Long Household Questionnaire, the Woman’s Questionnaire, the Verbal Autopsy Questionnaire, the Community Questionnaire, and the Fieldworker Questionnaire. A Technical Advisory Committee was established to solicit comments on the questionnaires from various stakeholders, including representatives of government ministries and agencies, nongovernmental organisations, and international donors. The survey protocol was reviewed and approved by the National Bioethics Committee, the Pakistan Health Research Council, and the ICF Institutional Review Board. After being finalised in English, the questionnaires were translated into Urdu and Sindhi. The 2019 PMMS used paper-based questionnaires for data collection, while computer-assisted field editing (CAFE) was used to edit questionnaires in the field.

Cleaning operations

The processing of the 2019 PMMS data began simultaneously with the fieldwork. As soon as data collection was completed in each cluster, all electronic data files were transferred via the Internet File Streaming System (IFSS) to the NIPS central office in Islamabad. These data files were registered and checked for inconsistencies, incompleteness, and outliers. A double entry procedure was adopted by NIPS to ensure data accuracy. The field teams were alerted about any inconsistencies and errors. Secondary editing of completed questionnaires, which involved resolving inconsistencies and coding open-ended questions, was carried out in the central office. The survey core team members assisted with secondary editing, and the NIPS data processing manager coordinated the work at the central office. Data entry and editing were carried out using the CSPro software package. The concurrent processing of the data offered a distinct advantage because it maximised the likelihood of the data being error-free and accurate.

Response rate

In the four provinces, the sample contained a total of 116,169 households. All households were visited by the field teams, and 110,483 households were found to be occupied. Of these households, 108,766 were successfully interviewed, yielding a household response rate of 98%. The subsample selected for the Long Household Questionnaire comprised 11,080 households, and interviews were carried out in 10,479 of these households. A total of 12,217 ever-married women age 15-49 were eligible to be interviewed based on the Long Household Questionnaire, and 11,859 of these women were successfully interviewed (a response rate of 97%).

In Azad Jammu and Kashmir, 16,755 households were occupied, and interviews were successfully carried out in 16,588 of these households (99%). A total of 1,707 ever-married women were eligible for individual interviews, of whom 1,666 were successfully interviewed (98%). In Gilgit Baltistan, 11,005 households were occupied, and interviews were conducted in 10,872 households (99%). A total of 1,219 ever-married women were eligible for interviews, of whom 1,178 were successfully interviewed (97%).

A total of 944 verbal autopsy interviews were conducted in Pakistan overall, 150 in Azad Jammu and Kashmir, and 88 in Gilgit Baltistan. The Verbal Autopsy Questionnaire was used in almost all of the interviews, and response rates were nearly 100%.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2019 Pakistan Maternal Mortality Survey (2019 PMMS) to minimise this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2019 PMMS is only one of many samples that could have been selected from the same population, using the same design and sample size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

If the sample of respondents had been selected by simple random sampling, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2019 PMMS sample was the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed using SAS programmes developed by ICF. These programmes use the Taylor linearisation method to estimate variances for survey estimates that are means, proportions, or ratios and use the Jackknife repeated replication method for variance estimation of more complex statistics such as fertility and mortality rates.

A more detailed description of estimates of sampling errors are presented in Appendix B of the survey report.

Data appraisal

Data Quality Tables

- Household age distribution

U.S. infant mortality rate for 2025 is 5.20, a 2.58% decline from 2024.

<ul style='margin-top:20px;'>

<li>U.S. infant mortality rate for 2024 was <strong>5.34</strong>, a <strong>2.87% decline</strong> from 2023.</li>
<li>U.S. infant mortality rate for 2023 was <strong>5.50</strong>, a <strong>0% increase</strong> from 2022.</li>
<li>U.S. infant mortality rate for 2022 was <strong>5.50</strong>, a <strong>0% increase</strong> from 2021.</li>
</ul>Infant mortality rate is the number of infants dying before reaching one year of age, per 1,000 live births in a given year.

Abstract

The 2017 Ghana Maternal Health Survey (2017 GMHS) was designed to produce representative estimates for maternal mortality indicators for the country as a whole, and for each of the three geographical zones, namely Coastal (Western, Central, Greater Accra and Volta), Middle (Eastern, Ashanti and Brong Ahafo) and Northern (Northern, Upper East and Upper West). For other indicators such as maternal care, fertility and child mortality, the survey was designed to produce representative results for the country as whole, for the urban and rural areas, and for each of the country’s 10 administrative regions.

The primary objectives of the 2017 GMHS were as follows: • To collect data at the national level that will allow an assessment of the level of maternal mortality in Ghana for the country as a whole and for three zones: Coastal (Western, Central, Greater Accra, and Volta regions), Middle (Eastern, Ashanti, and Brong Ahafo regions), and Northern (Northern, Upper East, and Upper West regions) • To identify specific causes of maternal and non-maternal deaths, in particular deaths due to abortionrelated causes, among adult women • To collect data on women’s perceptions of and experiences with antenatal, maternity, and emergency obstetrical care, especially with regard to care received before, during, and following the termination or abortion of a pregnancy • To measure indicators of the utilisation of maternal health services, especially post-abortion care services • To allow follow-on studies and surveys that will be used to observe possible reductions in maternal mortality as well as abortion-related mortality

The information collected through the 2017 GMHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Woman age 15-49

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample for the 2017 GMHS was designed to provide estimates of key reproductive health indicators for the country as a whole, for urban and rural areas separately, for three zonal levels (Coastal, Middle, and Northern), and for each of the 10 administrative regions in Ghana (Western, Central, Greater Accra, Volta, Eastern, Ashanti, Brong Ahafo, Northern, Upper East, and Upper West).

The sampling frame used for the 2017 GMHS is the frame of the 2010 Population and Housing Census (PHC) conducted in Ghana. The 2010 PHC frame is maintained by GSS and updated periodically as new information is received from various surveys. The frame is a complete list of all census enumeration areas (EAs) created for the PHC.

The 2017 GMHS sample was stratified and selected from the sampling frame in two stages. Each region was separated into urban and rural areas; this yielded 20 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before the sample selection, according to administrative units at different levels, and by using a probability proportional to size selection at the first stage of sampling.

In the first stage, 900 EAs (466 EAs in urban areas and 434 EAs in rural areas) were selected with probability proportional to EA size and with independent selection in each sampling stratum. A household listing operation was implemented from 25 January to 9 April 2017 in all of the selected EAs. The resulting lists of households then served as a sampling frame for the selection of households in the second stage. The household listing operation included inquiring of each household if there had been any deaths in that household since January 2012 and, if so, the name, sex, and age at time of death of the deceased person(s).

Some of the selected EAs were very large. To minimise the task of household listing, each large EA selected for the 2017 GMHS was segmented. Only one segment was selected for the survey with probability proportional to segment size. Household listing was conducted only in the selected segment. Thus, in the GMHS, a cluster is either an EA or a segment of an EA. As part of the listing, the field teams updated the necessary maps and recorded the geographic coordinates of each cluster. The listing was conducted by 20 teams that included a supervisor, three listers/mappers, and a driver.

For further details on sample design, see Appendix A of the final report.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were used in the 2017 GMHS: the Household Questionnaire, the Woman’s Questionnaire, and the Verbal Autopsy Questionnaire.

Cleaning operations

All electronic data files for the 2017 GMHS were transferred via the IFSS to the GSS central office in Accra, where they were stored on a password-protected computer. The data processing operation included registering and checking for any inconsistencies and outliers. Data editing and cleaning included structure and consistency checks to ensure completeness of work in the field. The central office also conducted secondary editing, which required resolution of computer-identified inconsistencies and coding of openended questions. The data were processed by five GSS staff members. Data editing was accomplished using CSPro software. Secondary editing and data processing were initiated in June and completed in November 2017.

Response rate

A total of 27,001 households were selected for the sample, of which 26,500 were occupied at the time of fieldwork. Of the occupied households, 26,324 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 25,304 eligible women were identified for individual interviews; interviews were completed with 25,062 women, yielding a response rate of 99%.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2017 Ghana Maternal Health Survey (2017 GMHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2017 GMHS is only one of many samples that could have been selected from the same population, using the same design and sample size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall in. For example, for any given statistic calculated from a sample survey, the true value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

If the sample of respondents had been selected by simple random sampling, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2017 GMHS sample is the result of a multi-stage stratified sampling, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed by SAS programs developed by ICF International. These programs use the Taylor linearization method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

A more detailed description of estimates of sampling errors are presented in Appendix B of the survey final report.

Data appraisal

Data Quality Tables - Household age distribution - Age distribution of eligible and interviewed women - Completeness of reporting - Births by calendar years - Reporting of age at death in days - Reporting of age at death in months - Completeness of information on siblings - Sibship size and sex ratio of siblings - Pregnancy-related mortality trends

See details of the data quality tables in Appendix C of the survey final report.

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

Description of the interaction terms between the year of occurrence of death and age group at the regional and national levels, Brazil, 2020–2021.

BackgroundGlobally around half a million maternal death occurred annually related to labor and delivery of which twenty percent is contributed by post-partum anemia. Postpartum anemia contributes about two percent of total maternal mortality in Ethiopia. Immediate postpartum anemia is a common public health problem in most parts of the globe, being frequent in low and middle-income countries including in the developed world. The previous studies cut off point for immediate postpartum Anemia is 11mg/dl which is the cutoff point of anemia after one week of postpartum, environmental factors like barefoot were not addressed in the previous studies and the previous studies were conducted in a single facility This study aimed to assess the magnitude and associated factors of immediate post-partum anemia among women who gave birth in East Gojjam zone hospitals, Northwest Ethiopia.MethodsInstitutional based cross-sectional study was conducted from October 20-November 20 2020 on immediate post-partum anemia. During the study 467 study participants were included by using systematic random sampling method Data were collected using a structured interviewer-administered questionnaire and a blood sample was used for hemoglobin determination. Data were checked, coded, and entered into Epi-Data Version 4.2 and then exported to SPSS version 25 for analysis. Binary logistic regressions were done to identify predictors of immediate post-partum anemia and a 95% confidence interval of odds ratio at a p-value less than was taken as a significance level.ResultsThe overall magnitude of immediate postpartum anemia among mothers who gave birth in East Gojjam Zone Hospitals were found to be 21.63% (95% CI:18.12%, 25.11%), not having antenatal care follow-up (Adjusted Odds Ratio (AOR) = 2.92;95% CI:1.20,7.06), assisted instrumental delivery (AOR = 2.72; 95% CI:1.08,6.78),mid-upper arm circumferences less than 23cm (AOR = 5.75;95% CI:3.38, 9.79), antepartum hemorrhage (AOR = 4.51; 95% CI:2.42, 8.37), never wearing shoes (AOR = 2.60; 95% CI:1.10, 6.14) were found to be significantly associated with immediate postpartum anemia.ConclusionThis study indicates that immediate postpartum anemia is a moderate public health problem in the study area. A more careful strategy is ideal to increase antenatal care follow-up that sticks to national guideline contact schedule, safe reduction of instrumental and cesarean deliveries to the minimum, quick and timely linkage and treatment of malnourished pregnant mothers to the center where they get adequate health care services, along with a high index of suspicion in mothers diagnosed with antepartum hemorrhage, wise and vigilant advice on consistent use of the shoe for pregnant mothers are recommended to tackle the burden of immediate post-partum anemia.

Abstract

The principal objective of the 2007 Ghana Maternal Health Survey (GMHS) is intended to serve as a source of data on maternal health and maternal death for policymakers and the research community involved in the Reducing Maternal Morbidity and Mortality (R3M) program. Specifically, the data collected in the GMHS is intended to help the Government of Ghana and the consortium of organizations participating in the R3M program to launch a series of collaborative efforts to significantly expand women's access to modern family planning services and comprehensive abortion care (CAC), reduce unwanted fertility, and reduce severe complications and deaths resulting from unsafe abortion. The GMHS collected data from a nationally representative sample of households and women of reproductive age (15-49). The data were collected in two phases. The primary objectives of the 2007 GMHS were: • To collect data at the national level that will allow an assessment of the level of maternal mortality in Ghana for the country as a whole, for the R3M program regions (Greater Accra, Ashanti and Eastern Regions), and for the non-program regions; • To identify specific causes of maternal and non-maternal deaths, and specifically to be able to identify deaths due to abortion-related causes, among adult women; •To collect data on women’s perceptions and experience with antenatal, maternity, and emergency obstetrical care, especially with regard to care received before, during, and after the termination or abortion of a pregnancy; • To measure indicators of the utilization of maternal health services and especially post-abortion care services in Ghana; and • To provide baseline data for the R3M program and for follow-on studies and surveys that will be used to observe possible reductions in maternal mortality as well as reductions in abortion-related mortality.It also contributes to the ever-growing international database on maternal health-related information.

The pregnancy-related mortality ratio (PRMR) for the 7-year period preceding the survey, calculated from the sibling history data, is 451 deaths per 100,000 live births and for the 5-year period preceding the survey is 378 deaths per 100,000 live births.Induced abortion accounts for more than one in ten maternal deaths and the obstetric risk from induced abortion is highest among young women age 15-24. Although almost all women seek antenatal care from a health professional, only one in two women deliver in a health facility, and three in four women seek postnatal care. Despite the emphasis on continuity of care, less than one in two women receive all three maternity care components (antenatal care, delivery care, and postnatal care) from a skilled provider. Clearly, Ghana has a long way to go towards achieving the MDG-5 target.

Geographic coverage

National

Analysis unit

Individual

Universe

1. All women age 12-49 years in households and residents in Ghana

Kind of data

Sample survey data [ssd]

Sampling procedure

To achieve the above-mentioned objectives and to obtain an accurate measure of the causes of maternal mortality at the national level, and for the Reducing Maternal Morbidity and Mortality( R3M) regions (Greater Accra, Ashanti and Eastern regions) and other regions (Western, Central, Volta, Brong Ahafo, Northern, Upper East and Upper West), 1600 primary sampling units were selected (half from the R3M regions and half from the other regions) within the 10 administrative regions of the country, across urban and rural areas. The primary sampling units consisted of wards or subwards drawn from the 2000 Population Census. This sample size was estimated from information in the 2003 Ghana DHS survey; it was expected that each primary sampling unit would yield, on average, 150 households. GSS and GHS enumerators carried out a complete mapping and listing of the 1600 selected clusters. This first phase of data collection yielded a total of 227,715 households.

A short household questionnaire was administered to identify deaths that occurred in the five years preceding the survey to women age 12-49 in each household listed in the selected cluster. In the second phase of data collection a verbal autopsy questionnaire was administered in all households identified in the first phase as having experienced the death of a woman age 12-49. This yielded a total of 4,203 completed verbal autopsy questionnaires.

In the second phase of fieldwork, 400 clusters were randomly selected from the 1600 clusters identified in the first phase. Households with women age 15-49 were selected from these 400 clusters (half from the R3M regions and half from the other regions) and were stratified by region and urban-rural residence to yield 10,858 completed household interviews and 10,370 individual women's interviews. These households were selected randomly and independently from the households identified in the first phase as having experienced a female death.

Institutional populations (those in hospitals, army barracks, etc.) and households residing in refugee camps were excluded from the GMHS sample.

Sampling deviation

No deviation of the original sample design was made

Mode of data collection

Face-to-face [f2f]

Research instrument

The GMHS used four questionnaires: (1) a Phase I short household questionnaire administered at the time of listing; (2) a Phase II verbal autopsy questionnaire administered in households identified at listing as having experienced the death of a female household member age 12-49; (3) a Phase II long-form household questionnaire administered in independently selected households chosen for the individual woman’s interview, and (4) a Phase II questionnaire for individual women age 15-49 in the same phase two selected households. The primary purpose of the short household questionnaire administered at the time of listing during Phase I was to identify deaths to women age 12-49, for administering the verbal autopsy questionnaire on the causes of female deaths, particularly maternal deaths and abortion-related deaths. Unique identifiers for households in phase one and households in phase two were not maintained; therefore households cannot be matched across both phases of the survey. During the first phase of the survey, all households in each selected cluster were listed and administered the short household questionnaire. This questionnaire was administered to identify households that experienced the death of a female [regular] household member in the five years preceding the survey. The verbal autopsy questionnaire (VAQ) was administered during the second phase of fieldwork in those households in which thefemale who died was age 12-49. The VAQ was designed to collect as much information as possible on the causes of all female deaths, to inform the subsequent categorization of maternal deaths, and facilitate specific identification of abortion-related deaths. During the second phase of fieldwork, a longer household questionnaire was administered in the independent subsample of households, to identify eligible women age 15- 49 for the individual woman’s questionnaire and to obtain some background information on the socioeconomic status of these women. The individual questionnaire included the maternal mortality module, which allows for the calculation of direct estimates of pregnancy-related mortality rates and ratios based on the sibling history. The individual questionnaire also gathered information on abortions and miscarriages, the utilization of maternal health services and post-abortion care, women’s knowledge of the legality of abortion in Ghana, the services they have utilized for abortion and if not, the reasons they have not been able to access professional health care for abortions, the places that offer abortion-related care, the persons offering such services, and other related questions. During the design of these questionnaires, input was sought from a variety of organizations that are expected to use the resulting data. After preparation of the questionnaires in English, they were translated into three languages: Akan, Ga, and Ewe. Back translations into English were carried out by people other than the initial translators to verify the accuracy of the translations in the three languages to be used. All problems arising during the translations were resolved before the pretest. The translated questionnaires were pretested to detect any problems in the translations or the flow of the questionnaire, as well as to gauge the length of time required for interviews. GSS and GHS engaged 20 interviewers for approximately two weeks for the pretest (with proficiency in each of the local languages used in the survey). All the pretest interviewers were trained for two weeks. The pretest interviewing took about one week to complete, during which approximately 30 women were interviewed in each of the local languages. The pretest results were used to modify the survey instruments as necessary. All changes in the questionnaire after the pretest were agreed to by GSS, GHS, and Macro. GSS and GHS were responsible for producing a sufficient number of the various questionnaires for the main fieldwork. During the pretest and main survey training, experts in the areas of health and family planning were identified by GSS and GHS to provide guidance in the presentation of topics in their fields, as they relate to the GMHS questionnaires. Other technical documents that were finalized include: • Household listing manual, listing forms and cartographic materials; • Interviewer’s manual; • Supervisor’s manual; • Interviewer and Supervisor’s

Abstract

The 2017 Ghana Maternal Health Survey (GMHS) was implemented by the Ghana Statistical Service (GSS). Data collection took place from 15 June to 12 October 2017. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. Financial support for the 2017 GMHS was provided by the Government of Ghana through the Ministry of Health (MOH) and by USAID, the European Union (EU) delegation to Ghana, and the United Nations Population Fund (UNFPA).

SURVEY OBJECTIVES The primary objectives of the 2017 GMHS were as follows: - To collect data at the national level that will allow an assessment of the level of maternal mortality in Ghana for the country as a whole and for three zones: Coastal (Western, Central, Greater Accra, and Volta regions), Middle (Eastern, Ashanti, and Brong Ahafo regions), and Northern (Northern, Upper East, and Upper West regions) - To identify specific causes of maternal and non-maternal deaths, in particular deaths due to abortionrelated causes, among adult women - To collect data on women’s perceptions of and experiences with antenatal, maternity, and emergency obstetrical care, especially with regard to care received before, during, and following the termination or abortion of a pregnancy - To measure indicators of the utilisation of maternal health services, especially post-abortion care services - To allow follow-on studies and surveys that will be used to observe possible reductions in maternal mortality as well as abortion-related mortality

The information collected through the 2017 GMHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

Household Woman

Universe

the survey covered all household members, all women aged 15-49 and for autopsy questionnaire women aged 12-49.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample for the 2017 GMHS was designed to provide estimates of key reproductive health indicators for the country as a whole, for urban and rural areas separately, for three zonal levels (Coastal, Middle, and Northern), and for each of the 10 administrative regions in Ghana (Western, Central, Greater Accra, Volta, Eastern, Ashanti, Brong Ahafo, Northern, Upper East, and Upper West).

The sampling frame used for the 2017 GMHS is the frame of the 2010 Population and Housing Census (PHC) conducted in Ghana. The 2010 PHC frame is maintained by GSS and updated periodically as new information is received from various surveys. The frame is a complete list of all census enumeration areas (EAs) created for the PHC. An EA is a geographic area that covers an average of 161 households (per updates to the PHC frame from the 2014 Ghana Demographic and Health Survey [GDHS]). Individual EA size is the number of residential households in the EA according to the 2010 PHC. The average size of urban EAs (185 households) is slightly larger than the average size of rural EAs (114 households). The sampling frame contains information about the EA’s location, type of residence (urban or rural), and estimated number of residential households.

The 2017 GMHS sample was stratified and selected from the sampling frame in two stages. Each region was separated into urban and rural areas; this yielded 20 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before the sample selection, according to administrative units at different levels, and by using a probability proportional to size selection at the first stage of sampling.

In the first stage, 900 EAs (466 EAs in urban areas and 434 EAs in rural areas) were selected with probability proportional to EA size and with independent selection in each sampling stratum. A household listing operation was implemented from 25 January to 9 April 2017 in all of the selected EAs. The resulting lists of households then served as a sampling frame for the selection of households in the second stage. The household listing operation included inquiring of each household if there had been any deaths in that household since January 2012 and, if so, the name, sex, and age at time of death of the deceased person(s).

Some of the selected EAs were very large. To minimise the task of household listing, each large EA selected for the 2017 GMHS was segmented. Only one segment was selected for the survey with probability proportional to segment size. Household listing was conducted only in the selected segment. Thus, in the GMHS, a cluster is either an EA or a segment of an EA. As part of the listing, the field teams updated the necessary maps and recorded the geographic coordinates of each cluster. The listing was conducted by 20 teams that included a supervisor, three listers/mappers, and a driver.

The second stage of selection provided two outputs: the list of households selected for the main survey (Household Questionnaire and Woman’s Questionnaire) and the list of households selected for the verbal autopsy survey (Verbal Autopsy Questionnaire).

Selection for Main Survey In the second stage of selection for the main survey, a fixed number of 30 households were selected from each cluster, resulting in a total sample size of 27,000 households. Replacement of nonresponding households was not allowed. Due to the non-proportional allocation of the sample to the different regions and the possible differences in response rates, sampling weights are required for any analysis that uses the 2017 GMHS data. This ensures the representativeness of the survey results at the national and regional levels. Results shown in this report have been weighted to account for the complex sample design.

All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed.

Selection for Verbal Autopsy Survey In the second stage of selection for the verbal autopsy survey, all households in which a female resident age 10-54 died in 2012 or later were selected to be visited by an interviewer. However, only the deaths of female residents who were age 12-49 at the time of death were eligible to be included in the survey. A wider age range was used for the initial selection in case of minor inaccuracies on the part of the person who provided information during the household listing operation; the first questions in the Verbal Autopsy Questionnaire established true eligibility, and interviews ended if the deceased woman was discovered to have died before age 12, after age 49, or before 2012.

There is a chance that some households were both purposively selected for the verbal autopsy survey and randomly selected for the main survey.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were used in the 2017 GMHS: the Household Questionnaire, the Woman’s Questionnaire, and the Verbal Autopsy Questionnaire. The survey protocol was reviewed and approved by the ICF Institutional Review Board.

The Household Questionnaire and the Woman’s Questionnaire were adapted from The DHS Program’s standard Demographic and Health Survey questionnaires and the questionnaires used in the 2007 GMHS to reflect the specific interests and data needs of this survey. The Verbal Autopsy Questionnaire was adapted from the recent 2016 World Health Organization (WHO) verbal autopsy instrument.

For all questionnaires, input was solicited from stakeholders representing government ministries and development partners. After the finalization of the questionnaires in English, they were translated into three major languages: Akan, Ga, and Ewe. The Household and Woman’s Questionnaires were programmed into tablet computers to facilitate computer-assisted personal interviewing (CAPI) for data collection purposes, with the capability to choose any of the four languages for either of the questionnaires.

The Verbal Autopsy Questionnaire was filled out on paper during data collection and entered into the CAPI system afterwards. The tablet computers were equipped with Bluetooth® technology to enable remote electronic transfer of files, such as assignments from the team supervisor to the interviewers, individual questionnaires among survey team members, and completed questionnaires from interviewers to team supervisors. The CAPI data collection system employed in the 2017 GMHS was developed by The DHS Program using the mobile version of CSPro. The CSPro software was developed jointly by the U.S. Census Bureau, The DHS Program, and Serpro S.A.

Household Questionnaire The Household Questionnaire was used to list all members of and visitors to selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women who were eligible for individual interviews. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the dwelling unit, and ownership of various

Abstract

The 2017 Ghana Maternal Health Survey (GMHS) was implemented by the Ghana Statistical Service (GSS). Data collection took place from 15 June to 12 October 2017. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. Financial support for the 2017 GMHS was provided by the Government of Ghana through the Ministry of Health (MOH) and by USAID, the European Union (EU) delegation to Ghana, and the United Nations Population Fund (UNFPA).

SURVEY OBJECTIVES The primary objectives of the 2017 GMHS were as follows: - To collect data at the national level that will allow an assessment of the level of maternal mortality in Ghana for the country as a whole and for three zones: Coastal (Western, Central, Greater Accra, and Volta regions), Middle (Eastern, Ashanti, and Brong Ahafo regions), and Northern (Northern, Upper East, and Upper West regions) - To identify specific causes of maternal and non-maternal deaths, in particular deaths due to abortionrelated causes, among adult women - To collect data on women’s perceptions of and experiences with antenatal, maternity, and emergency obstetrical care, especially with regard to care received before, during, and following the termination or abortion of a pregnancy - To measure indicators of the utilisation of maternal health services, especially post-abortion care services - To allow follow-on studies and surveys that will be used to observe possible reductions in maternal mortality as well as abortion-related mortality

The information collected through the 2017 GMHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

Household Woman

Universe

the survey covered all household members, all women aged 15-49 and for autopsy questionnaire women aged 12-49.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample for the 2017 GMHS was designed to provide estimates of key reproductive health indicators for the country as a whole, for urban and rural areas separately, for three zonal levels (Coastal, Middle, and Northern), and for each of the 10 administrative regions in Ghana (Western, Central, Greater Accra, Volta, Eastern, Ashanti, Brong Ahafo, Northern, Upper East, and Upper West).

The sampling frame used for the 2017 GMHS is the frame of the 2010 Population and Housing Census (PHC) conducted in Ghana. The 2010 PHC frame is maintained by GSS and updated periodically as new information is received from various surveys. The frame is a complete list of all census enumeration areas (EAs) created for the PHC. An EA is a geographic area that covers an average of 161 households (per updates to the PHC frame from the 2014 Ghana Demographic and Health Survey [GDHS]). Individual EA size is the number of residential households in the EA according to the 2010 PHC. The average size of urban EAs (185 households) is slightly larger than the average size of rural EAs (114 households). The sampling frame contains information about the EA’s location, type of residence (urban or rural), and estimated number of residential households.

The 2017 GMHS sample was stratified and selected from the sampling frame in two stages. Each region was separated into urban and rural areas; this yielded 20 sampling strata. Samples of EAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before the sample selection, according to administrative units at different levels, and by using a probability proportional to size selection at the first stage of sampling.

In the first stage, 900 EAs (466 EAs in urban areas and 434 EAs in rural areas) were selected with probability proportional to EA size and with independent selection in each sampling stratum. A household listing operation was implemented from 25 January to 9 April 2017 in all of the selected EAs. The resulting lists of households then served as a sampling frame for the selection of households in the second stage. The household listing operation included inquiring of each household if there had been any deaths in that household since January 2012 and, if so, the name, sex, and age at time of death of the deceased person(s).

Some of the selected EAs were very large. To minimise the task of household listing, each large EA selected for the 2017 GMHS was segmented. Only one segment was selected for the survey with probability proportional to segment size. Household listing was conducted only in the selected segment. Thus, in the GMHS, a cluster is either an EA or a segment of an EA. As part of the listing, the field teams updated the necessary maps and recorded the geographic coordinates of each cluster. The listing was conducted by 20 teams that included a supervisor, three listers/mappers, and a driver.

The second stage of selection provided two outputs: the list of households selected for the main survey (Household Questionnaire and Woman’s Questionnaire) and the list of households selected for the verbal autopsy survey (Verbal Autopsy Questionnaire).

Selection for Main Survey In the second stage of selection for the main survey, a fixed number of 30 households were selected from each cluster, resulting in a total sample size of 27,000 households. Replacement of nonresponding households was not allowed. Due to the non-proportional allocation of the sample to the different regions and the possible differences in response rates, sampling weights are required for any analysis that uses the 2017 GMHS data. This ensures the representativeness of the survey results at the national and regional levels. Results shown in this report have been weighted to account for the complex sample design.

All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed.

Selection for Verbal Autopsy Survey In the second stage of selection for the verbal autopsy survey, all households in which a female resident age 10-54 died in 2012 or later were selected to be visited by an interviewer. However, only the deaths of female residents who were age 12-49 at the time of death were eligible to be included in the survey. A wider age range was used for the initial selection in case of minor inaccuracies on the part of the person who provided information during the household listing operation; the first questions in the Verbal Autopsy Questionnaire established true eligibility, and interviews ended if the deceased woman was discovered to have died before age 12, after age 49, or before 2012.

There is a chance that some households were both purposively selected for the verbal autopsy survey and randomly selected for the main survey.

Mode of data collection

Face-to-face [f2f]

Research instrument

Three questionnaires were used in the 2017 GMHS: the Household Questionnaire, the Woman’s Questionnaire, and the Verbal Autopsy Questionnaire. The survey protocol was reviewed and approved by the ICF Institutional Review Board.

The Household Questionnaire and the Woman’s Questionnaire were adapted from The DHS Program’s standard Demographic and Health Survey questionnaires and the questionnaires used in the 2007 GMHS to reflect the specific interests and data needs of this survey. The Verbal Autopsy Questionnaire was adapted from the recent 2016 World Health Organization (WHO) verbal autopsy instrument.

For all questionnaires, input was solicited from stakeholders representing government ministries and development partners. After the finalization of the questionnaires in English, they were translated into three major languages: Akan, Ga, and Ewe. The Household and Woman’s Questionnaires were programmed into tablet computers to facilitate computer-assisted personal interviewing (CAPI) for data collection purposes, with the capability to choose any of the four languages for either of the questionnaires.

The Verbal Autopsy Questionnaire was filled out on paper during data collection and entered into the CAPI system afterwards. The tablet computers were equipped with Bluetooth® technology to enable remote electronic transfer of files, such as assignments from the team supervisor to the interviewers, individual questionnaires among survey team members, and completed questionnaires from interviewers to team supervisors. The CAPI data collection system employed in the 2017 GMHS was developed by The DHS Program using the mobile version of CSPro. The CSPro software was developed jointly by the U.S. Census Bureau, The DHS Program, and Serpro S.A.

Household Questionnaire The Household Questionnaire was used to list all members of and visitors to selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women who were eligible for individual interviews. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the dwelling unit, and ownership of various

【リソース】Delayed registrations for Japanese in Japan - Natality_1_Delayed registrations of live births, by sex and year of birth:Japan, each prefecture and 21 major cities / Delayed registrations for Japanese in Japan - General mortality_1_Delayed registrations of deaths, by sex and year of death:Japan, each prefecture and 21 major cities / Foreigners in Japan - Natality_1_Live births born in wedlock by nationality of father and mother / Foreigners in Japan - Natality_2_Live births by sex, month of occurrence and nationality of mother / Foreigners in Japan - Natality_3_Live births born in wedlock by nationality of father, each prefecture and 21 major cities / Foreigners in Japan - Natality_4_Live births by nationality of mother, each prefecture and 21 major cities / Foreigners in Japan - Natality_5_Live births, mean age of mother, by nationality and age of mother / Foreigners in Japan - General mortality_1_Deaths by sex, month of occurrence and nationality / Foreigners in Japan - General mortality_2_Deaths by sex, place of occurrence and nationality / Foreigners in Japan - General mortality_3_Deaths by nationality, each prefecture and 21 major cities / Foreigners in Japan - General mortality_4_Deaths by sex, age and nationality / Foreigners in Japan - Infant mortality_1_Infant deaths (under 1 year) by sex, month of occurrence and nationality / Foreigners in Japan - Foetal mortality_1_Foetal deaths by month of occurrence, sex and nationality of mother / Foreigners in Japan - Foetal mortality_2_Foetal deaths by type of extraction, age of mother and specified period of gestation / Foreigners in Japan - Marriages and divorces_1_Marriages by nationality of bride and groom / Foreigners in Japan - Marriages and divorces_2_Mean ages, marriages and their percent distribution, of bride and groom (for first marriages and remarriages performed and registered in 2018) / Foreigners in Japan - Marriages and divorces_3_Divorces and their percent distribution, by legal type / Foreigners in Japan - Marriages and divorces_4_Divorces by nationality of wife and husband / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_1_Live births, deaths and infant deaths (under 1 year), by sex and month of occurrence / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_2_Mean ages, marriages and their percent distribution, of bride and groom (for first marriages and remarriages performed and registered in 2018) / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_3_Divorces and their percent distribution, by legal type / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_4_Deaths by sex and age / Delayed registrations for foreigners in Japan_1_Live births, deaths, infant deaths (under 1 year) and foetal deaths, by sex, year of occurrence and nationality_(1) Live births and deaths / Delayed registrations for foreigners in Japan_1_Live births, deaths, infant deaths (under 1 year) and foetal deaths, by sex, year of occurrence and nationality_(2) Infant deaths and foetal deaths / Delayed registrations for Japanese in foreign countries_1_Live births, deaths and infant deaths (under 1 year), by sex and year of occurrence / Foreigners in Japan, Japanese in foreign countries (Causes of death)_1_Deaths of foreigners in Japan, nationality and of Japanese in foreign countries, by sex and causes (the condensed list of causes of death for Japan) / Foreigners in Japan, Japanese in foreign countries (Causes of death)_2_Infant deaths (under 1 year) of foreigners in Japan, nationality and of Japanese in foreign countries, by sex and causes (the list of causes of infant death) / Vital Statistics_Vital statistics of Japan_Final data_Other_Yearly_2018 / Delayed registrations for Japanese in Japan - Natality_1_Delayed registrations of live births, by sex and year of birth:Japan, each prefecture and 21 major cities,Delayed registrations for Japanese in Japan - General mortality_1_Delayed registrations of deaths, by sex and year of death:Japan, each prefecture and 21 major cities,Foreigners in Japan - Natality_1_Live births born in wedlock by nationality of father and mother,Foreigners in Japan - Natality_2_Live births by sex, month of occurrence and nationality of mother,Foreigners in Japan - Natality_3_Live births born in wedlock by nationality of father, each prefecture and 21 major cities,Foreigners in Japan - Natality_4_Live births by nationality of mother, each prefecture and 21 major cities,Foreigners in Japan - Natality_5_Live births, mean age of mother, by nationality and age of mother,Foreigners in Japan - General mortality_1_Deaths by sex, month of occurrence and nationality,Foreigners in Japan - General mortality_2_Deaths by sex, place of occurrence and nationality,Foreigners in Japan - General mortality_3_Deaths by nationality, each prefecture and 21 major cities

In 2022, the infant mortality rate in the United States was 5.4 out of every 1,000 live births. This is a significant decrease from 1960, when infant mortality was at around 26 deaths out of every 1,000 live births. What is infant mortality? The infant mortality rate is the number of deaths of babies under the age of one per 1,000 live births. There are many causes for infant mortality, which include birth defects, low birth weight, pregnancy complications, and sudden infant death syndrome. In order to decrease the high rates of infant mortality, there needs to be an increase in education and medicine so babies and mothers can receive the proper treatment needed. Maternal mortality is also related to infant mortality. If mothers can attend more prenatal visits and have more access to healthcare facilities, maternal mortality can decrease, and babies have a better chance of surviving in their first year. Worldwide infant mortality rates Infant mortality rates vary worldwide; however, some areas are more affected than others. Afghanistan suffered from the highest infant mortality rate in 2024, and the following 19 countries all came from Africa, with the exception of Pakistan. On the other hand, Slovenia had the lowest infant mortality rate that year. High infant mortality rates can be attributed to lack of sanitation, technological advancements, and proper natal care. In the United States, Massachusetts had the lowest infant mortality rate, while Mississippi had the highest in 2022. Overall, the number of neonatal and post neonatal deaths in the United States has been steadily decreasing since 1995.

【リソース】Delayed registrations for Japanese in Japan - Natality_1_Delayed registrations of live births, by sex and year of birth:Japan, each prefecture and 21 major cities / Delayed registrations for Japanese in Japan - General mortality_1_Delayed registrations of deaths, by sex and year of death:Japan, each prefecture and 21 major cities / Foreigners in Japan - Natality_1_Live births born in wedlock by nationality of father and mother / Foreigners in Japan - Natality_2_Live births by sex, month of occurrence and nationality of mother / Foreigners in Japan - Natality_3_Live births born in wedlock by nationality of father, each prefecture and 21 major cities / Foreigners in Japan - Natality_4_Live births by nationality of mother, each prefecture and 21 major cities / Foreigners in Japan - Natality_5_Live births, mean age of mother, by nationality and age of mother / Foreigners in Japan - General mortality_1_Deaths by sex, month of occurrence and nationality / Foreigners in Japan - General mortality_2_Deaths by sex, place of occurrence and nationality / Foreigners in Japan - General mortality_3_Deaths by nationality, each prefecture and 21 major cities / Foreigners in Japan - General mortality_4_Deaths by sex, age and nationality / Foreigners in Japan - Infant mortality_1_Infant deaths (under 1 year) by sex, month of occurrence and nationality / Foreigners in Japan - Foetal mortality_1_Foetal deaths by month of occurrence, sex and nationality of mother / Foreigners in Japan - Foetal mortality_2_Foetal deaths by type of extraction, age of mother and period of gestation / Foreigners in Japan - Marriages and divorces_1_Marriages by nationality of bride and groom / Foreigners in Japan - Marriages and divorces_2_Mean ages, marriages and their percent distribution, of bride and groom (for first marriages and remarriages performed and registered in 2013) / Foreigners in Japan - Marriages and divorces_3_Divorces and their percent distribution, by legal type / Foreigners in Japan - Marriages and divorces_4_Divorces by nationality of wife and husband / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_1_Live births, deaths and infant deaths (under 1 year), by sex and month of occurrence / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_2_Mean ages, marriages and their percent distribution, of bride and groom (for first marriages and remarriages performed and registered in 2013) / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_3_Divorces and their percent distribution, by legal type / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_4_Deaths by sex and age / Delayed registrations for foreigners in Japan_1_Live births, deaths, infant deaths (under 1 year) and foetal deaths, by sex, year of occurrence and nationality_(1) Live births and deaths / Delayed registrations for foreigners in Japan_1_Live births, deaths, infant deaths (under 1 year) and foetal deaths, by sex, year of occurrence and nationality_(2) Infant deaths and foetal deaths / Delayed registrations for Japanese in foreign countries_1_Live births, deaths and infant deaths (under 1 year), by sex and year of occurrence / Foreigners in Japan, Japanese in foreign countries (Causes of death)_1_Deaths of foreigners in Japan, nationality and of Japanese in foreign countries, by sex and causes (the condensed list of causes of death for Japan) / Foreigners in Japan, Japanese in foreign countries (Causes of death)_2_Infant deaths (under 1 year) of foreigners in Japan, nationality and of Japanese in foreign countries, by sex and causes (the list of causes of infant death) / Vital Statistics_Vital statistics of Japan_Final data_Other_Yearly_2013 / Delayed registrations for Japanese in Japan - Natality_1_Delayed registrations of live births, by sex and year of birth:Japan, each prefecture and 21 major cities,Delayed registrations for Japanese in Japan - General mortality_1_Delayed registrations of deaths, by sex and year of death:Japan, each prefecture and 21 major cities,Foreigners in Japan - Natality_1_Live births born in wedlock by nationality of father and mother,Foreigners in Japan - Natality_2_Live births by sex, month of occurrence and nationality of mother,Foreigners in Japan - Natality_3_Live births born in wedlock by nationality of father, each prefecture and 21 major cities,Foreigners in Japan - Natality_4_Live births by nationality of mother, each prefecture and 21 major cities,Foreigners in Japan - Natality_5_Live births, mean age of mother, by nationality and age of mother,Foreigners in Japan - General mortality_1_Deaths by sex, month of occurrence and nationality,Foreigners in Japan - General mortality_2_Deaths by sex, place of occurrence and nationality,Foreigners in Japan - General mortality_3_Deaths by nationality, each prefecture and 21 major cities,Foreigner

【リソース】Delayed registrations for Japanese in Japan - Natality_1_Delayed registrations of live births, by sex and year of birth:Japan, each prefecture and 21 major cities / Delayed registrations for Japanese in Japan - General mortality_1_Delayed registrations of deaths, by sex and year of death:Japan, each prefecture and 21 major cities / Foreigners in Japan - Natality_1_Live births born in wedlock by nationality of father and mother / Foreigners in Japan - Natality_2_Live births by sex, month of occurrence and nationality of mother / Foreigners in Japan - Natality_3_Live births born in wedlock by nationality of father, each prefecture and 21 major cities / Foreigners in Japan - Natality_4_Live births by nationality of mother, each prefecture and 21 major cities / Foreigners in Japan - Natality_5_Live births, mean age of mother, by nationality and age of mother / Foreigners in Japan - General mortality_1_Deaths by sex, month of occurrence and nationality / Foreigners in Japan - General mortality_2_Deaths by sex, place of occurrence and nationality / Foreigners in Japan - General mortality_3_Deaths by nationality, each prefecture and 21 major cities / Foreigners in Japan - General mortality_4_Deaths by sex, age and nationality / Foreigners in Japan - Infant mortality_1_Infant deaths (under 1 year) by sex, month of occurrence and nationality / Foreigners in Japan - Foetal mortality_1_Foetal deaths by month of occurrence, sex and nationality of mother / Foreigners in Japan - Foetal mortality_2_Foetal deaths by type of extraction, age of mother and specified period of gestation / Foreigners in Japan - Marriages and divorces_1_Marriages by nationality of bride and groom / Foreigners in Japan - Marriages and divorces_2_Mean ages, marriages and their percent distribution, of bride and groom (for first marriages and remarriages performed and registered in 2016) / Foreigners in Japan - Marriages and divorces_3_Divorces and their percent distribution, by legal type / Foreigners in Japan - Marriages and divorces_4_Divorces by nationality of wife and husband / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_1_Live births, deaths and infant deaths (under 1 year), by sex and month of occurrence / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_2_Mean ages, marriages and their percent distribution, of bride and groom (for first marriages and remarriages performed and registered in 2016) / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_3_Divorces and their percent distribution, by legal type / Japanese in foreign countries - natality,general mortality,infant mortality,marriages and divorces_4_Deaths by sex and age / Delayed registrations for foreigners in Japan_1_Live births, deaths, infant deaths (under 1 year) and foetal deaths, by sex, year of occurrence and nationality_(1) Live births and deaths / Delayed registrations for foreigners in Japan_1_Live births, deaths, infant deaths (under 1 year) and foetal deaths, by sex, year of occurrence and nationality_(2) Infant deaths and foetal deaths / Delayed registrations for Japanese in foreign countries_1_Live births, deaths and infant deaths (under 1 year), by sex and year of occurrence / Foreigners in Japan, Japanese in foreign countries (Causes of death)_1_Deaths of foreigners in Japan, nationality and of Japanese in foreign countries, by sex and causes (the condensed list of causes of death for Japan) / Foreigners in Japan, Japanese in foreign countries (Causes of death)_2_Infant deaths (under 1 year) of foreigners in Japan, nationality and of Japanese in foreign countries, by sex and causes (the list of causes of infant death) / Vital Statistics_Vital statistics of Japan_Final data_Other_Yearly_2016 / Delayed registrations for Japanese in Japan - Natality_1_Delayed registrations of live births, by sex and year of birth:Japan, each prefecture and 21 major cities,Delayed registrations for Japanese in Japan - General mortality_1_Delayed registrations of deaths, by sex and year of death:Japan, each prefecture and 21 major cities,Foreigners in Japan - Natality_1_Live births born in wedlock by nationality of father and mother,Foreigners in Japan - Natality_2_Live births by sex, month of occurrence and nationality of mother,Foreigners in Japan - Natality_3_Live births born in wedlock by nationality of father, each prefecture and 21 major cities,Foreigners in Japan - Natality_4_Live births by nationality of mother, each prefecture and 21 major cities,Foreigners in Japan - Natality_5_Live births, mean age of mother, by nationality and age of mother,Foreigners in Japan - General mortality_1_Deaths by sex, month of occurrence and nationality,Foreigners in Japan - General mortality_2_Deaths by sex, place of occurrence and nationality,Foreigners in Japan - General mortality_3_Deaths by nationality, each prefecture and 21 major cities

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