A flexible model to reconstruct education-specific fertility rates: Sub-saharan Africa case study

The fertility rates are consistent with the United Nation World Population Prospects (UN WPP) 2022 fertility rates.

The Bayesian model developed to reconstruct the fertility rates using Demographic and Health Surveys and the UN WPP is published in a working paper.

Abstract

The future world population growth and size will be largely determined by the pace of fertility decline in sub-Saharan Africa. Correct estimates of education-specific fertility rates are crucial for projecting the future population. Yet, consistent cross-country comparable estimates of education-specific fertility for sub-Saharan African countries are still lacking. We propose a flexible Bayesian hierarchical model to reconstruct education-specific fertility rates by using the patchy Demographic and Health Surveys (DHS) data and the United Nations’ (UN) reliable estimates of total fertility rates (TFR). Our model produces estimates that match the UN TFR to different extents (in other words, estimates of varying levels of consistency with the UN). We present three model specifications: consistent but not identical with the UN, fully-consistent (nearly identical) with the UN, and consistent with the DHS. Further, we provide a full time series of education-specific TFR estimates covering five-year periods between 1980 and 2014 for 36 sub-Saharan African countries. The results show that the DHS-consistent estimates are usually higher than the UN-fully-consistent ones. The differences between the three model estimates vary substantially in size across countries, yielding 1980-2014 fertility trends that differ from each other mostly in level only but in some cases also in direction.

Funding

The data set are part of the BayesEdu Project at Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna) funded from the “Innovation Fund Research, Science and Society” by the Austrian Academy of Sciences (ÖAW).

We provide education-specific total fertility rates (ESTFR) from three model specifications: (1) estimated TFR consistent but not identical with the TFR estimated by the UN (“Main model (UN-consistent)”; (2) estimated TFR fully consistent (nearly identical) with the TFR estimated by the UN ( “UN-fully -consistent”, and (3) estimated TFR consistent only with the TFR estimated by the DHS ( “DHS-consistent”).

For education- and age-specific fertility rates that are UN-fully consistent, please see https://doi.org/10.5281/zenodo.8182960

Variables

Country: Country names

Education: Four education levels, No Education, Primary Education, Secondary Education and Higher Education.

Year: Five-year periods between 1980 and 2015.

ESTFR: Median education-specific total fertility rate estimate

sd: Standard deviation

Upp50: 50% Upper Credible Interval

Lwr50: 50% Lower Credible Interval

Upp80: 80% Upper Credible Interval

Lwr80: 80% Lower Credible Interval

Model: Three model specifications as explained above and in the working paper. DHS-consistent, Main model (UN-consistent) and UN-fully consistent.

List of countries:

Angola, Benin, Burkina Faso, Burundi, Cote D'Ivoire, Cameroon, Central African Republic, Chad, Comoros, Congo, Democratic Republic of Congo, Eswatini, Ethiopia, Gabon, Gambia, Ghana, Guinea, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Africa, Tanzania, Togo, Uganda, Zambia, Zimbabwe

The survey was conducted by the Bureau of Statistics (BOS) and the Ministry of Health (MOH) of Guyana. ICF Macro of Calverton, Maryland, provided technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). Funding to cover technical assistance by ICF Macro and local costs was provided in its entirety by the USAID Mission in Georgetown, Guyana. The primary objective of the 2009 GDHS was to collect information on characteristics of the households and their members, including exposure to malaria and tuberculosis; infant and child mortality; fertility and family planning; pregnancy and postnatal care; childhood immunization, health, and nutrition; marriage and sexual activity; and HIV/AIDS indicators. Other objectives of the 2009 GDHS included (1) supporting the dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country and (2) enhancing the survey capabilities of the institutions involved to facilitate surveys of this type in the future. The 2009 GDHS sampled 5,632 households and completed interviews with 4,996 women age 15-49 and 3,522 men age 15-49. Three questionnaires were used for the 2009 GDHS: the Household Questionnaire, the Women's Questionnaire, and the Men's Questionnaire. The content of these questionnaires was based on the model questionnaires developed by the MEASURE DHS program of ICF Macro. The primary objective of the 2009 GDHS was to collect information on the following topics: Characteristics of households and household members Fertility and reproductive preferences, infant and child mortality, and family planning Health-related matters, such as breastfeeding, antenatal care, children's immunizations, and childhood diseases Marriage, sexual activity, and awareness and behavior regarding HIV and other sexually transmitted infections (STIs) The nutritional status of mothers and children, including anthropometry measurements and anemia testing Other complementary objectives of the 2009 GDHS were: To support dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country To enhance the survey capabilities of the institutions involved to facilitate their use of surveys of this type in the future MAIN RESULTS FERTILITY Fertility Levels and Differentials If fertility were to remain constant in Guyana, women would bear, on average, 2.8 children by the end of their reproductive lifespan. The total fertility rate (TFR) is close to replacement level in urban areas (2.1 children per woman), and higher in the rural areas (3.0 children per woman). The TFR in the Interior area (6.0 children) is more than twice as high as the TFR in the Coastal area (2.4 children per woman) and is three times the fertility in the Georgetown (urban) area (2.0 children). The TFRs for women in the Interior area are significantly higher for all age groups. Fertility Preferences Fifty-six percent of currently married women reported that they don't want to have a/another child, and five percent are already sterilized. The figures for men are 51 and 1 percent, respectively. The desire to stop childbearing increases rapidly as the number of children increases. Among respondents with one child, around one in five wants no more children. Among those with three children, about eight in ten women and seven in ten men want no more children. FAMILY PLANNING Use of Contraception Forty-three percent of women who are currently married or in union are currently using a contraceptive method, mainly a modern method (40 percent). The methods most commonly used by currently married women are the male condom (13 percent), the pill (9 percent), and the IUD (7 percent). Female sterilization and injectables are each used by 5 percent of women. The 2009 GDHS prevalence rate of 43 percent represents an increase of 8 percentage points since the 2005 GAIS (35 percent). Most of the increase was in condom use, injectables, and female sterilization. Unmet Need for Family Planning Twenty-nine percent of currently married women have an unmet need for family planning, mostly for limiting births (19 percent) compared with spacing (10 percent). Because 43 percent of married women are currently using a contraceptive method (met need), the total demand for family planning is estimated at 71 percent of married women (22 percent for spacing, 49 percent for limiting). As a result, only 60 percent of the total demand for family planning is met. MATERNAL HEALTH Antenatal Care Among women who had a birth in the five years preceding the survey, 92 percent received antenatal care (ANC) from a skilled health provider for their most recent birth (51 percent from a nurse/midwife and 35 percent from a doctor). Older mothers (35-49 years) are less likely to receive antenatal care by a skilled health provider than younger mothers. Eighty-six percent of women with no education received ANC from a skilled health provider compared with 95 percent of women with more than secondary education. Delivery Care Overall, 92 percent of births in the five years preceding the survey were assisted by a skilled birth provider, mainly by a nurse or midwife (56 percent), followed by a doctor (31 percent). Births to mothers under age 35 and lower order births are more likely to have assistance at delivery by a skilled provider than births to older mothers and higher order births. By residence, births in Urban areas are more likely than those in Rural areas, and births in the Coastal area are more likely than births in the Interior area, to be assisted by a skilled health provider. The percentage of births assisted by a skilled provider ranges from a low of 57 percent in Region 9 to a high of 98 percent in Region 4. Births to mothers who have more education and births in the higher wealth quintiles are more likely to be assisted by a skilled provider than other births. Almost all births to mothers with more than secondary education (98 percent) are assisted by a skilled provider compared with 71 percent of births to mothers with no education. Caesarean section One in eight births (13 percent) in the five years preceding the survey was delivered by caesarean section. The prevalence of C-section delivery increases steadily with mother's age and decreases with birth order. Regions 1, 6, 7, and 9 have the lowest levels of deliveries by C-section (2-5 percent) and Region 3 has the highest level (23 percent). The percentage of births delivered by C-section increases with a mother's education and generally increases with her wealth. CHILD HEALTH Infant and Child Mortality Childhood mortality rates in Guyana are relatively low. For every 1,000 live births, 38 children die during the first year of life (infant mortality), and 40 children die during the first five years (under-age 5 mortality). Almost two-thirds of deaths in the first five years (25 deaths per 1,000 live births) take place during the neonatal period (the first month of life). The mortality rate after the first year of life up to age 5 (child mortality) is also very low at 3 deaths per 1,000 live births. The 2009 GDHS mortality data do not show any clear trends over time. However, mortality data have to be interpreted with caution because sampling errors associated with mortality estimates are large. Vaccination Coverage Overall, 63 percent of Guyanese children age 18-29 months are fully immunized, and only 5 percent of the children received no vaccinations at all. Looking at coverage for specific vaccines, 94 percent of children received the BCG vaccination, 92 percent received the first dose of pentavalent vaccine, and 78 percent received the first polio dose (Polio 1). Coverage for the pentavalent and polio vaccinations declines with subsequent doses; 85 percent of children received the recommended three doses of pentavalent vaccine, and 70 percent received three doses of polio. These figures reflect dropout rates of 8 percent for the pentavalent vaccine and 11 percent for polio; the dropout rate represents the proportion of children who received the first dose of a vaccine but who did not get the third dose. Eighty-two percent of children are vaccinated against measles, and 79 percent of children have been vaccinated against yellow fever. Illnesses and Treatment Acute Respiratory Infections (ARI) Five percent of children under age 5 had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Among children with symptoms of ARI, advice or treatment was sought from a health facility or provider for 65 percent, and antibiotics were prescribed as treatment for 18 percent (data not shown). Fever Fever was found to be moderately frequent in children under age 5 in Guyana (20 percent), ranging from 17 percent in children under 6 months to about 26 percent in children 12-17 months.. Most of the children under age 5 with fever (59 percent) were taken to a health facility or a health provider for their most recent episode of fever. Overall, about one in five children with fever (21 percent) received antibiotics, and 6 percent received antimalarial drugs. Diarrhea Overall, about 10 percent of children were reported to have diarrhea in the two weeks immediately before the survey, with just 1 percent reporting bloody diarrhea. Overall, about six in ten children under age 5 with diarrhea (59 percent) were taken to a health facility or health provider for advice or treatment. Male children (55 percent) are less likely than female children (63 percent) to be taken for treatment or advice to a health facility or provider. Additionally, children living in the Coastal area are much less likely to be taken for treatment or advice (50 percent) than children in the Interior area (79 percent). NUTRITION OF CHILDREN Height and Weight Almost one in five children (18 percent) under age 5 is short for age or stunted, and one in twenty (5

The 1998 Philippines National Demographic and Health Survey (NDHS). is a nationally-representative survey of 13,983 women age 15-49. The NDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. It was implemented by the National Statistics Office in collaboration with the Department of Health (DOH). Macro International Inc. of Calverton, Maryland provided technical assistance to the project, while financial assistance was provided by the U.S. Agency for International Development (USAID) and the DOH. Fieldwork for the NDHS took place from early March to early May 1998. The primary objective of the NDHS is to Provide up-to-date information on fertility levels; determinants of fertility; fertility preferences; infant and childhood mortality levels; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving health and family planning services in the country. MAIN RESULTS Survey data generally confirm patterns observed in the 1993 National Demographic Survey (NDS), showing increasing contraceptive use and declining fertility. FERTILITY Fertility Decline. The NDHS data indicate that fertility continues to decline gradually but steadily. At current levels, women will give birth an average of 3.7 children per woman during their reproductive years, a decline from the level of 4.1 recorded in the 1993 NDS. A total fertility rate of 3.7, however, is still considerably higher than the rates prevailing in neighboring Southeast Asian countries. Fertility Differentials. Survey data show that the large differential between urban and rural fertility levels is widening even further. While the total fertility rate in urban areas declined by about 15 percent over the last five years (from 3.5 to 3.0), the rate among rural women barely declined at all (from 4.8 to 4.7). Consequently, rural women give birth to almost two children more than urban women. Significant differences in fertility levels by region still exist. For example, fertility is more than twice as high in Eastern Visayas and Bicol Regions (with total fertility rates well over 5 births per woman) than in Metro Manila (with a rate of 2.5 births per woman). Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 5.0 children in their lifetime, compared to 2.9 for women with at least some college education. Women with either elementary or high school education have intermediate fertility rates. Family Size Norms. One reason that fertility has not fallen more rapidly is that women in the Philippines still want moderately large families. Only one-third of women say they would ideally like to have one or two children, while another third state a desire for three children. The remaining third say they would choose four or more children. Overall, the mean ideal family size among all women is 3.2 children, identical to the mean found in 1993. Unplanned Fertility. Another reason for the relatively high fertility level is that unplanned pregnancies are still common in the Philippines. Overall, 45 percent of births in the five years prior to the survey were reported to be unplanned; 27 percent were mistimed (wanted later) and 18 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in the Philippines would be 2.7 births per woman instead of the actual level of 3.7. Age at First Birth. Fertility rates would be even higher if Filipino women did not have a pattem of late childbearing. The median age at first birth is 23 years in the Philippines, considerably higher than in most other countries. Another factor that holds down the overall level of fertility is the fact that about 9 or 10 percent of women never give birth, higher than the level of 3-4 percent found in most developing countries. FAMILY PLANNING Increasing Use of Contraception. A major cause of declining fertility in the Philippines has been the gradual but fairly steady increase in contraceptive use over the last three decades. The contraceptive prevalence rate has tripled since 1968, from 15 to 47 percent of married women. Although contraceptive use has increased since the 1993 NDS (from 40 to 47 percent of married women), comparison with the series of nationally representative Family Planning Surveys indicates that there has been a levelling-off in family planning use in recent years. Method Mix. Use of traditional methods of family planning has always accounted for a relatively high proportion of overall use in the Philippines, and data from the 1998 NDHS show the proportion holding steady at about 40 percent. The dominant changes in the "method mix" since 1993 have been an increase in use of injectables and traditional methods such as calendar rhythm and withdrawal and a decline in the proportions using female sterilization. Despite the decline in the latter, female sterilization still is the most widely used method, followed by the pill. Differentials in Family Planning Use. Differentials in current use of family planning in the 16 administrative regions of the country are large, ranging from 16 percent of married women in ARMM to 55 percent of those in Southern Mindanao and Central Luzon. Contraceptive use varies considerably by education of women. Only 15 percent of married women with no formal education are using a method, compared to half of those with some secondary school. The urban-rural gap in contraceptive use is moderate (51 vs. 42 percent, respectively). Knowledge of Contraception. Knowledge of contraceptive methods and supply sources has been almost universal in the Philippines for some time and the NDHS results indicate that 99 percent of currently married women age 15-49 have heard of at least one method of family planning. More than 9 in 10 married women know the pill, IUD, condom, and female sterilization, while about 8 in 10 have heard of injectables, male sterilization, rhythm, and withdrawal. Knowledge of injectables has increased far more than any other method, from 54 percent of married women in 1993 to 89 percent in 1998. Unmet Need for Family Planning. Unmet need for family planning services has declined since I993. Data from the 1993 NDS show that 26 percent of currently married women were in need of services, compared with 20 percent in the 1998 NDHS. A little under half of the unmet need is comprised of women who want to space their next birth, while just over half is for women who do not want any more children (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 47 percent to 70 percent of married women. Currently, about three-quarters of this "total demand" for family planning is being met. Discontinuation Rates. One challenge for the family planning program is to reduce the high levels of contraceptive discontinuation. NDHS data indicate that about 40 percent of contraceptive users in the Philippines stop using within 12 months of starting, almost one-third of whom stop because of an unwanted pregnancy (i.e., contraceptive failure). Discontinuation rates vary by method. Not surprisingly, the rates for the condom (60 percent), withdrawal (46 percent), and the pill (44 percent) are considerably higher than for the 1UD (14 percent). However, discontinuation rates for injectables are relatively high, considering that one dose is usually effective for three months. Fifty-two percent of injection users discontinue within one year of starting, a rate that is higher than for the pill. MATERNAL AND CHILD HEALTH Childhood Mortality. Survey results show that although the infant mortality rate remains unchanged, overall mortality of children under five has declined somewhat in recent years. Under-five mortality declined from 54 deaths per 1,000 births in 1988-92 to 48 for the period 1993-97. The infant mortality rate remained stable at about 35 per 1,000 births. Childhood Vaccination Coverage. The 1998 NDHS results show that 73 percent of children 12- 23 months are fully vaccinated by the date of the interview, almost identical to the level of 72 percent recorded in the 1993 NDS. When the data are restricted to vaccines received before the child's first birthday, however, only 65 percent of children age 12-23 months can be considered to be fully vaccinated. Childhood Health. The NDHS provides some data on childhood illness and treatment. Approximately one in four children under age five had a fever and 13 percent had respiratory illness in the two weeks before the survey. Of these, 58 percent were taken to a health facility for treatment. Seven percent of children under five were reported to have had diarrhea in the two weeks preceeding the survey. The fact that four-fifths of children with diarrhea received some type of oral rehydration therapy (fluid made from an ORS packet, recommended homemade fluid, or increased fluids) is encouraging. Breastfeeding Practices. Almost all Filipino babies (88 percent) are breastfed for some time, with a median duration of breastfeeding of 13 months. Although breastfeeding has beneficial effects on both the child and the mother, NDHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in the Philippines. For example, among newborns less than two months of age, 19 percent were already receiving supplemental foods or liquids other than water. Maternal Health Care. NDHS data point to several areas regarding maternal health care in which improvements could be made. Although most Filipino mothers (86 percent) receive prenatal care from a doctor, nurse, or midwife, tetanus toxoid coverage is far from universal and

United States US: Fertility Rate: Total: Births per Woman data was reported at 1.800 Ratio in 2016. This records a decrease from the previous number of 1.843 Ratio for 2015. United States US: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 2.002 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 3.654 Ratio in 1960 and a record low of 1.738 Ratio in 1976. United States US: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s USA – Table US.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Moldova's first Demographic and Health Survey (2005 MDHS) is a nationally representative sample survey of 7,440 women age 15-49 and 2,508 men age 15-59 selected from 400 sample points (clusters) throughout Moldova (excluding the Transnistria region). It is designed to provide data to monitor the population and health situation in Moldova; it includes several indicators which follow up on those from the 1997 Moldova Reproductive Health Survey (1997 MRHS) and the 2000 Multiple Indicator Cluster Survey (2000 MICS). The 2005 MDHS used a two-stage sample based on the 2004 Population and Housing Census and was designed to produce separate estimates for key indicators for each of the major regions in Moldova, including the North, Center, and South regions and Chisinau Municipality. Unlike the 1997 MRHS and the 2000 MICS surveys, the 2005 MDHS did not cover the region of Transnistria. Data collection took place over a two-month period, from June 13 to August 18, 2005. The survey obtained detailed information on fertility levels, abortion levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, adult health, and awareness and behavior regarding HIV infection and other sexually transmitted diseases. Hemoglobin testing was conducted on women and children to detect the presence of anemia. Additional features of the 2005 MDHS include the collection of information on international emigration, language preference for reading printed media, and domestic violence. The 2005 MDHS was carried out by the National Scientific and Applied Center for Preventive Medicine, hereafter called the National Center for Preventive Medicine (NCPM), of the Ministry of Health and Social Protection. ORC Macro provided technical assistance for the MDHS through the USAID-funded MEASURE DHS project. Local costs of the survey were also supported by USAID, with additional funds from the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), and in-kind contributions from the NCPM. MAIN RESULTS CHARACTERISTICS OF RESPONDENTS Ethnicity and Religion. Most women and men in Moldova are of Moldovan ethnicity (77 percent and 76 percent, respectively), followed by Ukrainian (8-9 percent of women and men), Russian (6 percent of women and men), and Gagauzan (4-5 percent of women and men). Romanian and Bulgarian ethnicities account for 2 to 3 percent of women and men. The overwhelming majority of Moldovans, about 95 percent, report Orthodox Christianity as their religion. Residence and Age. The majority of respondents, about 58 percent, live in rural areas. For both sexes, there are proportionally more respondents in age groups 15-19 and 45-49 (and also 45-54 for men), whereas the proportion of respondents in age groups 25-44 is relatively lower. This U-shaped age distribution reflects the aging baby boom cohort following World War II (the youngest of the baby boomers are now in their mid-40s), and their children who are now mostly in their teens and 20s. The smaller proportion of men and women in the middle age groups reflects the smaller cohorts following the baby boom generation and those preceding the generation of baby boomers' children. To some degree, it also reflects the disproportionately higher emigration of the working-age population. Education. Women and men in Moldova are universally well educated, with virtually 100 percent having at least some secondary or higher education; 79 percent of women and 83 percent of men have only a secondary or secondary special education, and the remainder pursues a higher education. More women (21 percent) than men (16 percent) pursue higher education. Language Preference. Among women, preferences for language of reading material are about equal for Moldovan (37 percent) and Russian (35 percent) languages. Among men, preference for Russian (39 percent) is higher than for Moldovan (25 percent). A substantial percentage of women and men prefer Moldovan and Russian equally (27 percent of women and 32 percent of men). Living Conditions. Access to electricity is almost universal for households in Moldova. Ninety percent of the population has access to safe drinking water, with 86 percent in rural areas and 96 percent in urban areas. Seventy-seven percent of households in Moldova have adequate means of sanitary disposal, with 91 percent of households in urban areas and only 67 percent in rural areas. Children's Living Arrangements. Compared with other countries in the region, Moldova has the highest proportion of children who do not live with their mother and/or father. Only about two-thirds (69 percent) of children under age 15 live with both parents. Fifteen percent live with just their mother although their father is alive, 5 percent live with just their father although their mother is alive, and 7 percent live with neither parent although they are both alive. Compared with living arrangements of children in 2000, the situation appears to have worsened. FERTILITY Fertility Levels and Trends. The total fertility rate (TFR) in Moldova is 1.7 births. This means that, on average, a woman in Moldova will give birth to 1.7 children by the end of her reproductive period. Overall, fertility rates have declined since independence in 1991. However, data indicate that fertility rates may have increased in recent years. For example, women of childbearing age have given birth to, on average, 1.4 children at the end of their childbearing years. This is slightly less than the total fertility rate (1.7), with the difference indicating that fertility in the past three years is slightly higher than the accumulation of births over the past 30 years. Fertility Differentials. The TFR for rural areas (1.8 births) is higher than that for urban areas (1.5 births). Results show that this urban-rural difference in childbearing rates can be attributed almost exclusively to younger age groups. CONTRACEPTION Knowledge of Contraception. Knowledge of family planning is nearly universal, with 99 percent of all women age 15-49 knowing at least one modern method of family planning. Among all women, the male condom, IUD, pills, and withdrawal are the most widely known methods of family planning, with over 80 percent of all women saying they have heard of these methods. Female sterilization is known by two-thirds of women, while periodic abstinence (rhythm method) is recognized by almost six in ten women. Just over half of women have heard of the lactational amenorrhea method (LAM), while 40-50 percent of all women have heard of injectables, male sterilization, and foam/jelly. The least widely known methods are emergency contraception, diaphragm, and implants. Use of Contraception. Sixty-eight percent of currently married women are using a family planning method to delay or stop childbearing. Most are using a modern method (44 percent of married women), while 24 percent use a traditional method of contraception. The IUD is the most widely used of the modern methods, being used by 25 percent of married women. The next most widely used method is withdrawal, used by 20 percent of married women. Male condoms are used by about 7 percent of women, especially younger women. Five percent of married women have been sterilized and 4 percent each are using the pill and periodic abstinence (rhythm method). The results show that Moldovan women are adopting family planning at lower parities (i.e., when they have fewer children) than in the past. Among younger women (age 20-24), almost half (49 percent) used contraception before having any children, compared with only 12 percent of women age 45-49. MATERNAL HEALTH Antenatal Care and Delivery Care. Among women with a birth in the five years preceding the survey, almost all reported seeing a health professional at least once for antenatal care during their last pregnancy; nine in ten reported 4 or more antenatal care visits. Seven in ten women had their first antenatal care visit in the first trimester. In addition, virtually all births were delivered by a health professional, in a health facility. Results also show that the vast majority of women have timely checkups after delivering; 89 percent of all women received a medical checkup within two days of the birth, and another 6 percent within six weeks. CHILD HEALTH Childhood Mortality. The infant mortality rate for the 5-year period preceding the survey is 13 deaths per 1,000 live births, meaning that about 1 in 76 infants dies before the first birthday. The under-five mortality rate is almost the same with 14 deaths per 1,000 births. The near parity of these rates indicates that most all early childhood deaths take place during the first year of life. Comparison with official estimates of IMRs suggests that this rate has been improving over the past decade. NUTRITION Breastfeeding Practices. Breastfeeding is nearly universal in Moldova: 97 percent of children are breastfed. However the duration of breast-feeding is not long, exclusive breastfeeding is not widely practiced, and bottle-feeding is not uncommon. In terms of the duration of breastfeeding, data show that by age 12-15 months, well over half of children (59 percent) are no longer being breastfed. By age 20-23 months, almost all children have been weaned. Exclusive breastfeeding is not widely practiced and supplementary feeding begins early: 57 percent of breastfed children less than 4 months are exclusively breastfed, and 46 percent under six months are exclusively breastfeed. The remaining breastfed children also consume plain water, water-based liquids or juice, other milk in addition to breast milk, and complimentary foods. Bottle-feeding is fairly widespread in Moldova; almost one-third (29 percent) of infants under 4 months old are fed with a bottle with

Total Fertility Rate may be defined as average number of children that would be born to a woman if she experiences the current fertility pattern throughout her reproductive span (15-49 years). The total fertility rate is a more direct measure of the level of fertility than the birth rate, since it refers to births per woman. This indicator shows the potential for population change in a country. A TFR of 2.1 i.e., two children per women is considered the replacement rate for a population, resulting in relative stability in terms of total population numbers. Rates above two children per woman indicate population growing in size and whose median age is declining. Rates below two children per woman indicate population decreasing in size and growing older. Office of Registrar General, India estates TFR annually through Sample Registration System, a large scales demographic Survey Conducted by them.

Libya LY: Fertility Rate: Total: Births per Woman data was reported at 2.274 Ratio in 2016. This records a decrease from the previous number of 2.312 Ratio for 2015. Libya LY: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 5.533 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 8.147 Ratio in 1971 and a record low of 2.274 Ratio in 2016. Libya LY: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Libya – Table LY.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representative survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health surveys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women. The 2008 NDHS was conducted by the Philippine National Statistics Office (NSO). Technical assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Government of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID). Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives: Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level. Analyze the direct and indirect factors which determine the levels and patterns of fertility. Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years. Collect data on environmental health, utilization of health facilities, prevalence of common noncommunicable and infectious diseases, and membership in health insurance plans. Collect data on awareness of tuberculosis. Determine women's knowledge about HIV/AIDS and access to HIV testing. Determine the extent of violence against women. MAIN RESULTS FERTILITY Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Philippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman. Fertility Differentials. Fertility varies substantially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fertility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On average, currently married women know eight methods of family planning. Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philippines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003. Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of demand satisfied has declined from 75 percent. MATERNAL HEALTH Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 percent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received antenatal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus. Delivery and Postnatal Care. Only 44 percent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth attendant or hilot. About 10 percent of births are delivered by C-section. The Department of Health (DOH) recommends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery. CHILD HEALTH Childhood Mortality. Childhood mortality continues to decline in the Philippines. Currently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years before the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortality decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families. There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among children of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births). NUTRITION Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, respectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be introduced when a child is six months old to reduce the risk of malnutrition. More than half of children ages 6-9 months are eating complementary foods in addition to being breastfed. The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in various age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines. HIV/AIDS Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for preventing transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmission. Knowledge of prevention methods is higher in urban areas than in rural areas and increases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college. TUBERCULOSIS Knowledge of TB. While awareness of tuberculosis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent mentioned blood in sputum, and 30 percent cited coughing with sputum. WOMEN'S STATUS Women's Status and Employment.

Nepal NP: Fertility Rate: Total: Births per Woman data was reported at 2.118 Ratio in 2016. This records a decrease from the previous number of 2.162 Ratio for 2015. Nepal NP: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 5.308 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 5.966 Ratio in 1965 and a record low of 2.118 Ratio in 2016. Nepal NP: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Nepal – Table NP.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

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 cause of infant deaths in developing countries, can be prevented if mothers receive tetanus toxoid vaccinations.

United Kingdom UK: Fertility Rate: Total: Births per Woman data was reported at 1.800 Ratio in 2016. This stayed constant from the previous number of 1.800 Ratio for 2015. United Kingdom UK: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 1.820 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 2.930 Ratio in 1964 and a record low of 1.630 Ratio in 2002. United Kingdom UK: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s UK – Table UK.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

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

The 2004 Malawi Demographic and Health Survey (MDHS) is a nationally representative survey of 11,698 women age 1549 and 3,261 men age 15-54. The main purpose of the 2004 MDHS is to provide policymakers and programme managers with detailed information on fertility, family planning, childhood and adult mortality, maternal and child health, as well as knowledge of and attitudes related to HIV/AIDS and other sexually transmitted infections (STIs). The 2004 MDHS is designed to provide data to monitor the population and health situation in Malawi as a followup of the 1992 and 2000 MDHS surveys, and the 1996 Malawi Knowledge, Attitudes, and Practices in Health Survey. New features of the 2004 MDHS include the collection of information on use of mosquito nets, domestic violence, anaemia testing of women and children under 5, and HIV testing of adults. The 2004 MDHS survey was implemented by the National Statistical Office (NSO). The Ministry of Health and Population, the National AIDS Commission (NAC), the National Economic Council, and the Ministry of Gender contributed to the development of the questionnaires for the survey. Most of the funds for the local costs of the survey were provided by multiple donors through the NAC. The United States Agency for International Development (USAID) provided additional funds for the technical assistance through ORC Macro. The Department for International Development (DfID) of the British Government, the United Nations Children's Fund (UNICEF), and the United Nations Population Fund (UNFPA) also provided funds for the survey. The Centers of Disease Control and Prevention provided technical assistance in HIV testing. The survey used a two-stage sample based on the 1998 Census of Population and Housing and was designed to produce estimates for key indicators for ten large districts in addition to estimates for national, regional, and urban-rural domains. Fieldwork for the 2004 MDHS was carried out by 22 mobile interviewing teams. Data collection commenced on 4 October 2004 and was completed on 31 January 2005. The principal aim of the 2004 MDHS project was to provide up-to-date information on fertility and childhood mortality levels, nuptiality, fertility preferences, awareness and use of family planning methods, use of maternal and child health services, and knowledge and behaviours related to HIV/AIDS and other sexually transmitted infections. It was designed as a follow-on to the 2000 MDHS survey, a national-level survey of similar scope. The 2004 MDHS survey, unlike the 2000 MDHS, collected blood samples which were later tested for HIV in order to estimate HIV prevalence in Malawi. In broad terms, the 2004 MDHS survey aimed to: Assess trends in Malawi's demographic indicators, principally fertility and mortality Assist in the monitoring and evaluation of Malawi's health, population, and nutrition programmes Advance survey methodology in Malawi and contribute to national and international databases Provide national-level estimates of HIV prevalence for women age 15-49 and men age 15-54. In more specific terms, the 2004 MDHS survey was designed to: Provide data on the family planning and fertility behaviour of the Malawian population and thereby enable policymakers to evaluate and enhance family planning initiatives in the country Measure changes in fertility and contraceptive prevalence and analyse the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding habits, and important social and economic factors Examine basic indicators of maternal and child health and welfare in Malawi, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and use of immunisation services. Particular emphasis was placed on malaria programmes, including malaria prevention activities and treatment of episodes of fever. Provide levels and patterns of knowledge and behaviour related to the prevention of HIV/AIDS and other sexually transmitted infections Provide national estimates of HIV prevalence Measure the level of infant and adult mortality including maternal mortality at the national level Assess the status of women in the country. MAIN FINDINGS Fertility Fertility Levels and Trends. While there has been a significant decline in fertility in the past two decades from 7.6 children in the early 1980s to 6.0 children per woman in the early 2000s, compared with selected countries in Eastern and Southern Africa, such as Zambia, Tanzania, Mozambique, Kenya, and Uganda, the total fertility rate (TFR) in Malawi is high, lower only than Uganda (6.9). Family planning Knowledge of Contraception. Knowledge of family planning is nearly universal, with 97 percent of women age 15-49 and 97 percent of men age 15-54 knowing at least one modern method of family planning. The most widely known modern methods of contraception among all women are injectables (93 percent), the pill and male condom (90 percent each), and female sterilisation (83 percent). Maternal health Antenatal Care. There has been little change in the coverage of antenatal care (ANC) from a medical professional since 2000 (93 percent in 2004 compared with 91 percent in 2000). Most women receive ANC from a nurse or a midwife (82 percent), although 10 percent go to a doctor or a clinical officer. A small proportion (2 percent) receives ANC from a traditional birth attendant, and 5 percent do not receive any ANC. Only 8 percent of women initiated ANC before the fourth month of pregnancy, a marginal increase from 7 percent in the 2000 MDHS. Adult and Maternal Mortality. Comparison of data from the 2000 and 2004 MDHS surveys indicates that mortality for both women and men has remained at the same levels since 1997 (11-12 deaths per 1,000). Child health Childhood Mortality. Data from the 2004 MDHS show that for the 2000-2004 period, the infant mortality rate is 76 per 1,000 live births, child mortality is 62 per 1,000, and the under-five mortality rate is 133 per 1,000 live births. Nutrition Breastfeeding Practices. Breastfeeding is nearly universal in Malawi. Ninety-eight percent of children are breastfed for some period of time. The median duration of breastfeeding in Malawi in 2004 is 23.2 months, one month shorter than in 2000. HIV/AIDS Awareness of AIDS. Knowledge of AIDS among women and men in Malawi is almost universal. This is true across age group, urban-rural residence, marital status, wealth index, and education. Nearly half of women and six in ten men can identify the two most common misconceptions about the transmission of HIV-HIV can be transmitted by mosquito bites, and HIV can be transmitted by supernatural means-and know that a healthy-looking person can have the AIDS virus.

The 2006 Uganda Demographic and Health Survey (UDHS) is a nationally representative survey of 8,531 women age 15-49 and 2,503 men age 15-54. The UDHS is the fourth comprehensive survey conducted in Uganda as part of the worldwide Demographic and Health Surveys (DHS) project. The primary purpose of the UDHS is to furnish policymakers and planners with detailed information on fertility; family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections. In addition, in one in three households selected for the survey, women age 15-49, men age 15-54, and children under age 5 years were weighed and their height was measured. Women, men, and children age 6-59 months in this subset of households were tested for anaemia, and women and children were tested for vitamin A deficiency. The 2006 UDHS is the first DHS survey in Uganda to cover the entire country. The 2006 Uganda Demographic and Health Survey (UDHS) was designed to provide information on demographic, health, and family planning status and trends in the country. Specifically, the UDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, and breastfeeding practices. In addition, data were collected on the nutritional status of mothers and young children; infant, child, adult, and maternal mortality; maternal and child health; awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections; and levels of anaemia and vitamin A deficiency. The 2006 UDHS is a follow-up to the 1988-1989, 1995, and 2000-2001 UDHS surveys, which were also implemented by the Uganda Bureau of Statistics (UBOS). The specific objectives of the 2006 UDHS are as follows: To collect data at the national level that will allow the calculation of demographic rates, particularly the fertility and infant mortality rates To analyse the direct and indirect factors that determine the level and trends in fertility and mortality To measure the level of contraceptive knowledge and practice of women and men by method, by urban-rural residence, and by region To collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS, and to evaluate patterns of recent behaviour regarding condom use To assess the nutritional status of children under age five and women by means of anthropometric measurements (weight and height), and to assess child feeding practices To collect data on family health, including immunizations, prevalence and treatment of diarrhoea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding To measure vitamin A deficiency in women and children, and to measure anaemia in women, men, and children To measure key education indicators including school attendance ratios and primary school grade repetition and dropout rates To collect information on the extent of disability To collect information on the extent of gender-based violence. MAIN RESULTS Fertility : Survey results indicate that the total fertility rate (TFR) for the country is 6.7 births per woman. The TFR in urban areas is much lower than in the rural areas (4.4 and 7.1 children, respectively). Kampala, whose TFR is 3.7, has the lowest fertility. Fertility rates in Central 1, Central 2, and Southwest regions are also lower than the national level. Removing four districts from the 2006 data that were not covered in the 20002001 UDHS, the 2006 TFR is 6.5 births per woman, compared with 6.9 from the 2000-2001 UDHS. Education and wealth have a marked effect on fertility, with uneducated mothers having about three more children on average than women with at least some secondary education and women in the lowest wealth quintile having almost twice as many children as women in the highest wealth quintile. Family planning : Overall, knowledge of family planning has remained consistently high in Uganda over the past five years, with 97 percent of all women and 98 percent of all men age 15-49 having heard of at least one method of contraception. Pills, injectables, and condoms are the most widely known modern methods among both women and men. Maternal health : Ninety-four percent of women who had a live birth in the five years preceding the survey received antenatal care from a skilled health professional for their last birth. These results are comparable to the 2000-2001 UDHS. Only 47 percent of women make four or more antenatal care visits during their entire pregnancy, an improvement from 42 percent in the 2000-2001 UDHS. The median duration of pregnancy for the first antenatal visit is 5.5 months, indicating that Ugandan women start antenatal care at a relatively late stage in pregnancy. Child health : Forty-six percent of children age 12-23 months have been fully vaccinated. Over nine in ten (91 percent) have received the BCG vaccination, and 68 percent have been vaccinated against measles. The coverage for the first doses of DPT and polio is relatively high (90 percent for each). However, only 64 percent go on to receive the third dose of DPT, and only 59 percent receive their third dose of polio vaccine. There are notable improvements in vaccination coverage since the 2000-2001 UDHS. The percentage of children age 12-23 months fully vaccinated at the time of the survey increased from 37 percent in 2000-2001 to 44 percent in 2006. The percentage who had received none of the six basic vaccinations decreased from 13 percent in 2000-2001 to 8 percent in 2006. Malaria : The 2006 UDHS gathered information on the use of mosquito nets, both treated and untreated. The data show that only 34 percent of households in Uganda own a mosquito net, with 16 percent of households owning an insecticide-treated net (ITN). Only 22 percent of children under five slept under a mosquito net on the night before the interview, while a mere 10 percent slept under an ITN. Breastfeeding and nutrition : In Uganda, almost all children are breastfed at some point. However, only six in ten children under the age of 6 months are exclusively breast-fed. HIV/AIDS AND stis : Knowledge of AIDS is very high and widespread in Uganda. In terms of HIV prevention strategies, women and men are most aware that the chances of getting the AIDS virus can be reduced by limiting sex to one uninfected partner who has no other partners (89 percent of women and 95 percent of men) or by abstaining from sexual intercourse (86 percent of women and 93 percent of men). Knowledge of condoms and the role they can play in preventing transmission of the AIDS virus is not quite as high (70 percent of women and 84 percent of men). Orphanhood and vulnerability : Almost one in seven children under age 18 is orphaned (15 percent), that is, one or both parents are dead. Only 3 percent of children under the age of 18 have lost both biological parents. Women's status and gender violence : Data for the 2006 UDHS show that women in Uganda are generally less educated than men. Although the gender gap has narrowed in recent years, 19 percent of women age 15-49 have never been to school, compared with only 5 percent of men in the same age group. Mortality : At current mortality levels, one in every 13 Ugandan children dies before reaching age one, while one in every seven does not survive to the fifth birthday. After removing districts not covered in the 2000-2001 UDHS from the 2006 data, findings show that infant mortality has declined from 89 deaths per 1,000 live births in the 2000-2001 UDHS to 75 in the 2006 UDHS. Under-five mortality has declined from 158 deaths per 1,000 live births to 137.

Haiti HT: Fertility Rate: Total: Births per Woman data was reported at 2.919 Ratio in 2016. This records a decrease from the previous number of 2.973 Ratio for 2015. Haiti HT: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 5.614 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 6.324 Ratio in 1960 and a record low of 2.919 Ratio in 2016. Haiti HT: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Haiti – Table HT.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Spain ES: Fertility Rate: Total: Births per Woman data was reported at 1.330 Ratio in 2016. This stayed constant from the previous number of 1.330 Ratio for 2015. Spain ES: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 1.450 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 3.010 Ratio in 1964 and a record low of 1.130 Ratio in 1998. Spain ES: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Spain – Table ES.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Oman OM: Fertility Rate: Total: Births per Woman data was reported at 2.666 Ratio in 2016. This records a decrease from the previous number of 2.737 Ratio for 2015. Oman OM: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 7.248 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 8.352 Ratio in 1982 and a record low of 2.666 Ratio in 2016. Oman OM: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Oman – Table OM.World Bank.WDI: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Ethiopia ET: Fertility Rate: Total: Births per Woman data was reported at 4.198 Ratio in 2016. This records a decrease from the previous number of 4.317 Ratio for 2015. Ethiopia ET: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 6.903 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 7.437 Ratio in 1984 and a record low of 4.198 Ratio in 2016. Ethiopia ET: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Ethiopia – Table ET.World Bank.WDI: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Bangladesh BD: Fertility Rate: Total: Births per Woman data was reported at 2.163 Ratio in 2023. This records a decrease from the previous number of 2.179 Ratio for 2022. Bangladesh BD: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 4.144 Ratio from Dec 1960 (Median) to 2023, with 64 observations. The data reached an all-time high of 6.839 Ratio in 1970 and a record low of 2.163 Ratio in 2023. Bangladesh BD: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Bangladesh – Table BD.World Bank.WDI: Social: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.;(1) United Nations Population Division. World Population Prospects: 2024 Revision; (2) Statistical databases and publications from national statistical offices; (3) Eurostat: Demographic Statistics.;Weighted average;Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Singapore SG: Fertility Rate: Total: Births per Woman data was reported at 1.200 Ratio in 2016. This records a decrease from the previous number of 1.240 Ratio for 2015. Singapore SG: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 1.720 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 5.760 Ratio in 1960 and a record low of 1.150 Ratio in 2010. Singapore SG: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Singapore – Table SG.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.