The Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. The BDHS is intended to serve as a source of population and health data for policymakers and the research community. In general, the objectives of the BDHS are to: assess the overall demographic situation in Bangladesh, assist in the evaluation of the population and health programs in Bangladesh, and advance survey methodology. More specifically, the objective of the BDHS is to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; 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.

The 2007 Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. The BDHS is a nationally representative sample survey designed to provide information on basic national indicators of social progress including fertility, childhood mortality, contraceptive knowledge and use, maternal and child health, nutritional status of mothers and children, awareness of AIDS, and domestic violence. This periodic survey is conducted every three to four years to serve as a source of population and health data for policymakers, program managers, and the research community. In general, the aims of the BDHS are to: Provide information to meet the monitoring and evaluation needs of health and family planning programs, and Provide program managers and policy makers involved in these programs with the information they need to plan and implement future interventions. More specifically, the objectives of the survey are to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; maternal and child health; awareness of HIV/AIDS and other sexually transmitted diseases; knowledge of tuberculosis; and domestic violence. Although improvements and additions have been made to each successive survey, the basic structure and design of the BDHS has been maintained over time in order to measure trends in health and family planning indicators. The 2007 BDHS survey was conducted under the authority of the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. Macro International Inc., a private research firm located in Calverton, Maryland, USA, provided technical assistance to the survey as part of its international Demographic and Health Surveys program. The U.S. Agency for International Development (USAID)/Bangladesh provided financial assistance.

The Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. The BDHS is intended to serve as a source of population and health data for policymakers and the research community. In general, the objectives of the BDHS are to: assess the overall demographic situation in Bangladesh, assist in the evaluation of the population and health programs in Bangladesh, and advance survey methodology. More specifically, the objective of the BDHS is to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; 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.

The 2007 Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. The BDHS is a nationally representative sample survey designed to provide information on basic national indicators of social progress including fertility, childhood mortality, contraceptive knowledge and use, maternal and child health, nutritional status of mothers and children, awareness of AIDS, and domestic violence. This periodic survey is conducted every three to four years to serve as a source of population and health data for policymakers, program managers, and the research community. In general, the aims of the BDHS are to: Provide information to meet the monitoring and evaluation needs of health and family planning programs, and Provide program managers and policy makers involved in these programs with the information they need to plan and implement future interventions. More specifically, the objectives of the survey are to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; maternal and child health; awareness of HIV/AIDS and other sexually transmitted diseases; knowledge of tuberculosis; and domestic violence. Although improvements and additions have been made to each successive survey, the basic structure and design of the BDHS has been maintained over time in order to measure trends in health and family planning indicators. The 2007 BDHS survey was conducted under the authority of the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. Macro International Inc., a private research firm located in Calverton, Maryland, USA, provided technical assistance to the survey as part of its international Demographic and Health Surveys program. The U.S. Agency for International Development (USAID)/Bangladesh provided financial assistance.

Abstract

The Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health.

The BDHS is intended to serve as a source of population and health data for policymakers and the research community. In general, the objectives of the BDHS are to: - assess the overall demographic situation in Bangladesh, - assist in the evaluation of the population and health programs in Bangladesh, and - advance survey methodology.

More specifically, the objective of the BDHS is to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; 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.

Geographic coverage

National

Analysis unit

• Household
• Children under five years
• Women age 10-49
• Men age 15-59

Kind of data

Sample survey data

Sampling procedure

Bangladesh is divided into six administrative divisions, 64 districts (zillas), and 490 thanas. In rural areas, thanas are divided into unions and then mauzas, a land administrative unit. Urban areas are divided into wards and then mahallas. The 1996-97 BDHS employed a nationally-representative, two-stage sample that was selected from the Integrated Multi-Purpose Master Sample (IMPS) maintained by the Bangladesh Bureau of Statistics. Each division was stratified into three groups: 1 ) statistical metropolitan areas (SMAs), 2) municipalities (other urban areas), and 3) rural areas. 3 In the rural areas, the primary sampling unit was the mauza, while in urban areas, it was the mahalla. Because the primary sampling units in the IMPS were selected with probability proportional to size from the 1991 Census frame, the units for the BDHS were sub-selected from the IMPS with equal probability so as to retain the overall probability proportional to size. A total of 316 primary sampling units were utilized for the BDHS (30 in SMAs, 42 in municipalities, and 244 in rural areas). In order to highlight changes in survey indicators over time, the 1996-97 BDHS utilized the same sample points (though not necessarily the same households) that were selected for the 1993-94 BDHS, except for 12 additional sample points in the new division of Sylhet. Fieldwork in three sample points was not possible (one in Dhaka Cantonment and two in the Chittagong Hill Tracts), so a total of 313 points were covered.

Since one objective of the BDHS is to provide separate estimates for each division as well as for urban and rural areas separately, it was necessary to increase the sampling rate for Barisal and Sylhet Divisions and for municipalities relative to the other divisions, SMAs and rural areas. Thus, the BDHS sample is not self-weighting and weighting factors have been applied to the data in this report.

Mitra and Associates conducted a household listing operation in all the sample points from 15 September to 15 December 1996. A systematic sample of 9,099 households was then selected from these lists. Every second household was selected for the men's survey, meaning that, in addition to interviewing all ever-married women age 10-49, interviewers also interviewed all currently married men age 15-59. It was expected that the sample would yield interviews with approximately 10,000 ever-married women age 10-49 and 3,000 currently married men age 15-59.

Note: See detailed in APPENDIX A of the survey report.

Mode of data collection

Face-to-face

Research instrument

Four types of questionnaires were used for the BDHS: a Household Questionnaire, a Women's Questionnaire, a Men' s Questionnaire and a Community Questionnaire. The contents of these questionnaires were based on the DHS Model A Questionnaire, which is designed for use in countries with relatively high levels of contraceptive use. These model questionnaires were adapted for use in Bangladesh during a series of meetings with a small Technical Task Force that consisted of representatives from NIPORT, Mitra and Associates, USAID/Bangladesh, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Population Council/Dhaka, and Macro International Inc (see Appendix D for a list of members). Draft questionnaires were then circulated to other interested groups and were reviewed by the BDHS Technical Review Committee (see Appendix D for list of members). The questionnaires were developed in English and then translated into and printed in Bangla (see Appendix E for final version in English).

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

The Women's Questionnaire was used to collect information from ever-married women age 10-49. These women were asked questions on the following topics: - Background characteristics (age, education, religion, etc.), - Reproductive history, - Knowledge and use of family planning methods, - Antenatal and delivery care, - Breastfeeding and weaning practices, - Vaccinations and health of children under age five, - Marriage, - Fertility preferences, - Husband's background and respondent's work, - Knowledge of AIDS, - Height and weight of children under age five and their mothers.

The Men's Questionnaire was used to interview currently married men age 15-59. It was similar to that for women except that it omitted the sections on reproductive history, antenatal and delivery care, breastfeeding, vaccinations, and height and weight. The Community Questionnaire was completed for each sample point and included questions about the existence in the community of income-generating activities and other development organizations and the availability of health and family planning services.

Response rate

A total of 9,099 households were selected for the sample, of which 8,682 were successfully interviewed. The shortfall is primarily due to dwellings that were vacant or in which the inhabitants had left for an extended period at the time they were visited by the interviewing teams. Of the 8,762 households occupied, 99 percent were successfully interviewed. In these households, 9,335 women were identified as eligible for the individual interview (i.e., ever-married and age 10-49) and interviews were completed for 9,127 or 98 percent of them. In the half of the households that were selected for inclusion in the men's survey, 3,611 eligible ever-married men age 15-59 were identified, of whom 3,346 or 93 percent were interviewed.

The principal reason for non-response among eligible women and men was the failure to find them at home despite repeated visits to the household. The refusal rate was low.

Note: See summarized response rates by residence (urban/rural) in Table 1.1 of the survey report.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: (1) non-sampling errors, and (2) sampling errors. Non-sampling 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 BDHS to minimize this type of error, non-sampling 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 BDHS is only one of many samples that could have been selected from the same population, using the same design and expected 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 between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

A 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 percent of all possible samples of identical size and design.

If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the BDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the BDHS is the ISSA Sampling Error Module. This module used the Taylor

Abstract

The 2007 Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health.

The BDHS is a nationally representative sample survey designed to provide information on basic national indicators of social progress including fertility, childhood mortality, contraceptive knowledge and use, maternal and child health, nutritional status of mothers and children, awareness of AIDS, and domestic violence. This periodic survey is conducted every three to four years to serve as a source of population and health data for policymakers, program managers, and the research community.

In general, the aims of the BDHS are to: - Provide information to meet the monitoring and evaluation needs of health and family planning programs, and - Provide program managers and policy makers involved in these programs with the information they need to plan and implement future interventions.

More specifically, the objectives of the survey are to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; maternal and child health; awareness of HIV/AIDS and other sexually transmitted diseases; knowledge of tuberculosis; and domestic violence. Although improvements and additions have been made to each successive survey, the basic structure and design of the BDHS has been maintained over time in order to measure trends in health and family planning indicators.

The 2007 BDHS survey was conducted under the authority of the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. Macro International Inc., a private research firm located in Calverton, Maryland, USA, provided technical assistance to the survey as part of its international Demographic and Health Surveys program. The U.S. Agency for International Development (USAID)/Bangladesh provided financial assistance.

Geographic coverage

National

Analysis unit

• Household
• Children under five years
• Women age 15-49
• Men age 15-54

Universe

The 2007 BDHS covers the entire population residing in private dwelling units in Bangladesh.

Kind of data

Sample survey data

Sampling procedure

The 2007 BDHS employs a nationally representative sample that covers the entire population residing in private dwelling units in Bangladesh. The survey used the sampling frame provided by the list of census enumeration areas (EAs) with population and household information from the 2001 Population Census. Bangladesh is divided into six administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, and Sylthet. In turn, each division is divided into zilas, and each zila into upazilas. Rural areas in an upazila are divided into union parishads (UPs), and UPs are further divided into mouzas. Urban areas in an upazila are divided into wards, and wards are subdivided into mahallas. These divisions allow the country as a whole to be easily divided into rural and urban areas. EAs from the census were used as the Primary Sampling Units (PSUs) for the survey, because they could be easily located with correct geographical boundaries and sketch maps were available for each one. An EA, which consists of about 100 households, on average, is equivalent to a mauza in rural areas and to a mohallah in urban areas.

The survey is based on a two-stage stratified sample of households. At the first stage of sampling, 361 PSUs were selected. Figure 1.1 shows the geographical distribution of the 361 clusters visited in the 2007 BDHS. The selection of PSUs was done independently for each stratum and with probability proportional to PSU size, in terms of number of households. The distribution of the sample over different parts of the country was not proportional, because that would have allocated the two smallest divisions, Barisal and Sylhet, too small a sample for statistical precision. Because only a small proportion of Bangladesh's population lives in urban areas, urban areas also had to be over-sampled to achieve statistical precision comparable to that of rural areas. Therefore, it was necessary to divide the country into strata, with different probabilities of selection calculated for the various strata. Stratification of the sample was achieved by separating the sample into divisions and, within divisions, into urban and rural areas. The urban areas of each division were further subdivided into three strata: statistical metropolitan areas (SMAs), municipality areas, and other urban areas. In all, the sample consisted of 22 strata, because Barisal and Sylhet do not have SMAs.

The 361 PSUs selected in the first stage of sampling included 227 rural PSUs and 134 urban PSUs. A household listing operation was carried out in all selected PSUs from January to March 2007. The resulting lists of households were used as the sampling frame for the selection of households in the second stage of sampling. On average, 30 households were selected from each PSU, using an equal probability systematic sampling technique. In this way, 10,819 households were selected for the sample. However, some of the PSUs were large and contained more than 300 households. Large PSUs were segmented, and only one segment was selected for the survey, with probability proportional to segment size. Households in the selected segments were then listed prior to their selection. Thus, a 2007 BDHS sample cluster is either an EA or a segment of an EA.

The survey was designed to obtain 11,485 completed interviews with ever-married women age 10-49. According to the sample design, 4,360 interviews were allocated to urban areas and 7,125 to rural areas. All ever-married women age 10-49 in selected households were eligible respondents for the women's questionnaire. In addition, ever-married men age 15-54 in every second household were eligible to be interviewed.

Note: See detailed in APPENDIX A of the survey report.

Sampling deviation

The 2007 BDHS sampled all ever-married women age 10-49. The number of eligible women age 10-49 was 11,234, of whom 11,051 were interviewed for a response rate of 98.4 percent. However, there were very few ever-married women age 10-14 (55 unweighted cases or less than one percent). These women have been removed from the data set and weights recalculated for the 15-49 age group. The tables in the survey report discuss only women age 15-49.

Mode of data collection

Face-to-face

Research instrument

The 2007 BDHS used five questionnaires: a Household Questionnaire, a Women’s Questionnaire, a Men’s Questionnaire, a Community Questionnaire, and a Facility Questionnaire. Their contents were based on the MEASURE DHS Model Questionnaires. These model questionnaires were adapted for use in Bangladesh during a series of meetings with a Technical Task Force (TTF) that included representatives from NIPORT, Mitra and Associates, ICDDRB: Knowledge for Global Lifesaving Solutions, the Bangladesh Rural Advancement Committee (BRAC), USAID/Dhaka, and Macro International. Draft questionnaires were then circulated to other interested groups and reviewed by the BDHS Technical Review Committee. The questionnaires were developed in English and then translated and printed in Bangla.

The Household Questionnaire was used to list all the usual members of and visitors to selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for individual interviews. In addition, the questionnaire collected information about the dwelling unit, such as the source of water, type of toilet facilities, flooring and roofing materials, and ownership of various consumer goods. The Household Questionnaire was also used to record height and weight measurements of all women age 10-49 and all children below six years of age.

The Women’s Questionnaire was used to collect information from ever-married women age 10-49. Women were asked questions on the following topics: - Background characteristics, including age, residential history, education, religion, and media exposure, - Reproductive history, - Knowledge and use of family planning methods, - Antenatal, delivery, postnatal, and newborn care, - Breastfeeding and infant feeding practices, - Vaccinations and childhood illnesses, - Marriage, - Fertility preferences, - Husband’s background and respondent’s work, - Awareness of AIDS and other sexually transmitted diseases, - Knowledge of tuberculosis, and - Domestic violence.

The Men’s Questionnaire was used to collect information from ever-married men age 15-54. Men were asked questions on the following topics: - Background characteristics, including respondent’s work, - Marriage, - Fertility preferences, - Participation in reproductive health care, - Awareness of AIDS and other sexually transmitted diseases, - Knowledge of tuberculosis, injuries, and tobacco consumption, and - Domestic violence

Questions on domestic violence (which were included in both the Women’s and Men’s Questionnaires) were administered to only one eligible respondent per household, whether female or male. In households with two or more eligible respondents, special procedures were followed to ensure that