Abstract

The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Federal Office of Statistics with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal care, vaccination status, breastfeeding, and nutrition. Data collection took place two years after implementation of the National Policy on Population and addresses issues raised by that policy.

Fieldwork for the NDHS was conducted in two phases: from April to July 1990 in the southern states and from July to October 1990 in the northern states. Interviewers collected information on the reproductive histories of 8,781 women age 15-49 years and on the health of their 8,113 children under the age of five years.

OBJECTIVES

The Nigeria Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on socioeconomic characteristics, marriage patterns, history of child bearing, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of children.

The primary objectives of the NDHS are:

(i) To collect data for the evaluation of family planning and health programmes; (ii) To assess the demographic situation in Nigeria; and (iii) To support dissemination and utilisation of the results in planning and managing family planning and health programmes.

MAIN RESULTS

According to the NDHS, fertility remains high in Nigeria; at current fertility levels, Nigerian women will have an average of 6 children by the end of their reproductive years. The total fertility rate may actually be higher than 6.0, due to underestimation of births. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman.

One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). These levels, while low, reflect an increase over the past decade: ten years ago just 1 percent of Nigerian women were using a modem family planning method. Periodic abstinence (rhythm method), the pill, IUD, and injection are the most popular methods among married couples: each is used by about 1 percent of currently married women. Knowledge of contraception remains low, with less than half of all women age 15-49 knowing of any method.

Certain groups of women are far more likely to use contraception than others. For example, urban women are four times more likely to be using a contraceptive method (15 percent) than rural women (4 percent). Women in the Southwest, those with more education, and those with five or more children are also more likely to be using contraception.

Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong: half of women with five children say that they want to have another child.

Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children.

National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by women's educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20. Teenagers in the North have births at twice the rate of those in the South: 20 births per 1130 women age 15-19 in the North compared to 10 birdas per 100 women in the South. Nearly half of teens in the North have already begun childbearing, versus 14 percent in South. This results in substantially lower total fertility rates in the South: women in the South have, on average, one child less than women in the North (5.5 versus 6.6).

The survey also provides information related to maternal and child health. The data indicate that nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born, 87 die during their first year of life (infant mortality rate). There has been little improvement in infant and child mortality during the past 15 years. Mortality is higher in rural than urban areas and higher in the North than in the South. Undemutrition may be a factor contributing to childhood mortality levels: NDHS data show that 43 percent of the children under five are chronically undemourished. These problems are more severe in rural areas and in the North.

Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one-third of births and over 60 percent of all babies arc born at home. Only one-third of births are assisted by doctors, trained nurses or midwives. A third of the infants are never vaccinated, and only 30 percent are fully immunised against childhood diseases. When they are ill, most young children go untreated. For example, only about one-third of children with diarrhoea were given oral rehydration therapy.

Women and children living in rural areas and in the North are much less likely than others to benefit from health services. Almost four times as many births in the North are unassisted as in the South, and only one-third as many children complete their polio and DPT vaccinations. Programmes to educate women about the need for antenatal care, immunisation, and proper treatment for sick children should perhaps be aimed at mothers in these areas,

Mothers everywhere need to learn about the proper time to introduce various supplementary foods to breastfeeding babies. Nearly all babies are breastfed, however, almost all breastfeeding infants are given water, formula, or other supplements within the first two months of life, which both jeopardises their nutritional status and increases the risk of infection.

Geographic coverage

The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey. The sample was constructed so as to provide national estimates as well as estimates for the four Ministry of Health regions.

Analysis unit

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

Universe

The population covered by the 1990 DHS is defined as the universe of all women age 15-49 in Nigeria.

Kind of data

Sample survey data

Sampling procedure

The NDHS Sample was drawn from the National Master Sample for the 1987/1992 National Integrated Survey of Households (NISH) programme being implemented by the Federal Office of Statistics (FOS). NISH, as part of the United Nations National Household Survey Capability Programme, is a multi- subject household-based survey system.

The NISH master sample was created in 1986 on the basis of the 1973 census enumeration areas (EA). Within each state, EAs were stratified into three sectors (urban, semiurban, and rural), from which an initial selection of approximately 8C0 EAs was made from each state. EAs were selected at this stage with equal probability within sectors. A quick count of households was conducted in each of the selected EAs, and a final selection of over 4,000 EAs was made over the entire country, with probability proportional to size. This constitutes the NISH master sample from which the NDHS EAs were subsampled.

Prior to the NDHS selection of EAs, the urban and semiurban sectors of NISH were combined into one category, while the rural retained the NISH classification. A sample of about 10,000 households in 299 EAs was designed with twofold oversampling of the urban stratum, yielding 132 urban EAs and 167 rural EAs. The sample was constructed so as to provide national estimates as well as estimates for the four Ministry of Health regions.

The NDHS conducted its own EA identification and listing operation; a new listing of housing units and households was compiled in each of the selected 299 EAs. For each EA, a list of the names of the head of households was constructed, from which a systematic sample of 34 households was selected to be interviewed. A fixed number of 34 households per EA was taken in order to have better control of the sample size (given the variability in EA size of the NISH sample). Thus, the NDHS sample is a weighted sample, maintaining the twofold over sampling of the urban sector.

Mode of data collection

Face-to-face

Research instrument

Three questionnaires were used in the main fieldwork for the NDHS: a) the household questionnaire, b) the individual questionnaire, and c) the service availability questionnaire. The first two questionnaires were adapted from the DHS model B questionnaire, which was designed for use in countries with low contraceptive prevalence. The questionnaires were developed in English, and then translated into six of the major Nigerian languages: Efik, Hausa, Igbo, Kanuri,

Abstract

The Pakistan Demographic and Health Survey (PDHS) was fielded on a national basis between the months of December 1990 and May 1991. The survey was carried out by the National Institute of Population Studies with the objective of assisting the Ministry of Population Welfare to evaluate the Population Welfare Programme and maternal and child health services. The PDHS is the latest in a series of surveys, making it possible to evaluate changes in the demographic status of the population and in health conditions nationwide. Earlier surveys include the Pakistan Contraceptive Prevalence Survey of 1984-85 and the Pakistan Fertility Survey of 1975.

The primary objective of the Pakistan Demographic and Health Survey (PDHS) was to provide national- and provincial-level data on population and health in Pakistan. The primary emphasis was on the following topics: fertility, nuptiality, family size preferences, knowledge and use of family planning, the potential demand for contraception, the level of unwanted fertility, infant and child mortality, breastfeeding and food supplementation practices, maternal care, child nutrition and health, immunisations and child morbidity. This information is intended to assist policy makers, administrators and researchers in assessing and evaluating population and health programmes and strategies. The PDHS is further intended to serve as a source of demographic data for comparison with earlier surveys, particularly the 1975 Pakistan Fertility Survey (PFS) and the 1984-85 Pakistan Contraceptive Prevalence Survey (PCPS).

MAIN RESULTS

Until recently, fertility rates had remained high with little evidence of any sustained fertility decline. In recent years, however, fertility has begun to decline due to a rapid increase in the age at marriage and to a modest rise in the prevalence of contraceptive use. The lotal fertility rate is estimated to have fallen from a level of approximately 6.4 children in the early 1980s to 6.0 children in the mid-1980s, to 5.4 children in the late 1980s. The exact magnitude of the change is in dispute and will be the subject of further research. Important differentials of fertility include the degree ofurbanisation and the level of women's education. The total fertility rate is estimated to be nearly one child lower in major cities (4.7) than in rural areas (5.6). Women with at least some secondary schooling have a rate of 3.6, compared to a rate of 5.7 children for women with no formal education.

There is a wide disparity between women's knowledge and use of contraceptives in Pakistan. While 78 percent of currently married women report knowing at least one method of contraception, only 21 percent have ever used a method, and only 12 percent are currently doing so. Three-fourths of current users are using a modem method and one-fourth a traditional method. The two most commonly used methods are female sterilisation (4 percent) and the condom (3 percent). Despite the relatively low level of contraceptive use, the gain over time has been significant. Among married non-pregnant women, contraceptive use has almost tripled in 15 years, from 5 percent in 1975 to 14 percent in 1990-91. The contraceptive prevalence among women with secondary education is 38 percent, and among women with no schooling it is only 8 percent. Nearly one-third of women in major cities arc current users of contraception, but contraceptive use is still rare in rural areas (6 percent).

The Government of Pakistan plays a major role in providing family planning services. Eighty-five percent of sterilised women and 81 percent of IUD users obtained services from the public sector. Condoms, however, were supplied primarily through the social marketing programme.

The use of contraceptives depends on many factors, including the degree of acceptability of the concept of family planning. Among currently married women who know of a contraceptive method, 62 percent approve of family planning. There appears to be a considerable amount of consensus between husbands and wives about family planning use: one-third of female respondents reported that both they and their husbands approve of family planning, while slightly more than one-fifth said they both disapprove. The latter couples constitute a group for which family planning acceptance will require concerted motivational efforts.

The educational levels attained by Pakistani women remain low: 79 percent of women have had no formal education, 14 percent have studied at the primary or middle school level, and only 7 percent have attended at least some secondary schooling. The traditional social structure of Pakistan supports a natural fertility pattern in which the majority of women do not use any means of fertility regulation. In such populations, the proximate determinants of fertility (other than contraception) are crucial in determining fertility levels. These include age at marriage, breastfeeding, and the duration of postpartum amenorrhoea and abstinence.

The mean age at marriage has risen sharply over the past few decades, from under 17 years in the 1950s to 21.7 years in 1991. Despite this rise, marriage remains virtually universal: among women over the age of 35, only 2 percent have never married. Marriage patterns in Pakistan are characterised by an unusually high degree of consangninity. Half of all women are married to their first cousin and an additional 11 percent are married to their second cousin.

Breasffeeding is important because of the natural immune protection it provides to babies, and the protection against pregnancy it gives to mothers. Women in Pakistan breastfeed their children for an average of20months. Themeandurationofpostpartumamenorrhoeais slightly more than 9 months. After tbebirth of a child, women abstain from sexual relations for an average of 5 months. As a result, the mean duration of postpartum insusceptibility (the period immediately following a birth during which the mother is protected from the risk of pregnancy) is 11 months, and the median is 8 months. Because of differentials in the duration of breastfeeding and abstinence, the median duration of insusceptibility varies widely: from 4 months for women with at least some secondary education to 9 months for women with no schooling; and from 5 months for women residing in major cities to 9 months for women in rural areas.

In the PDHS, women were asked about their desire for additional sons and daughters. Overall, 40 percent of currently married women do not want to have any more children. This figure increases rapidly depending on the number of children a woman has: from 17 percent for women with two living children, to 52 percent for women with four children, to 71 percent for women with six children. The desire to stop childbearing varies widely across cultural groupings. For example, among women with four living children, the percentage who want no more varies from 47 percent for women with no education to 84 percent for those with at least some secondary education.

Gender preference continues to be widespread in Pakistan. Among currently married non-pregnant women who want another child, 49 percent would prefer to have a boy and only 5 percent would prefer a girl, while 46 percent say it would make no difference.

The need for family planning services, as measured in the PDHS, takes into account women's statements concerning recent and future intended childbearing and their use of contraceptives. It is estimated that 25 percent of currently married women have a need for family planning to stop childbearing and an additional 12 percent are in need of family planning for spacing children. Thus, the total need for family planning equals 37 percent, while only 12 percent of women are currently using contraception. The result is an unmet need for family planning services consisting of 25 percent of currently married women. This gap presents both an opportunity and a challenge to the Population Welfare Programme.

Nearly one-tenth of children in Pakistan die before reaching their first birthday. The infant mortality rate during the six years preceding the survey is estimaled to be 91 per thousand live births; the under-five mortality rate is 117 per thousand. The under-five mortality rates vary from 92 per thousand for major cities to 132 for rural areas; and from 50 per thousand for women with at least some secondary education to 128 for those with no education.

The level of infant mortality is influenced by biological factors such as mother's age at birth, birth order and, most importantly, the length of the preceding birth interval. Children born less than two years after their next oldest sibling are subject to an infant mortality rate of 133 per thousand, compared to 65 for those spaced two to three years apart, and 30 for those born at least four years after their older brother or sister.

One of the priorities of the Government of Pakistan is to provide medical care during pregnancy and at the time of delivery, both of which are essential for infant and child survival and safe motherhood. Looking at children born in the five years preceding the survey, antenatal care was received during pregnancy for only 30 percent of these births. In rural areas, only 17 percent of births benefited from antenatal care, compared to 71 percent in major cities. Educational differentials in antenatal care are also striking: 22 percent of births of mothers with no education received antenatal care, compared to 85 percent of births of mothers with at least some secondary education.

Tetanus, a major cause of neonatal death in Pakistan, can be prevented by immunisation of the mother during pregnancy. For 30 percent of all births in the five years prior to the survey, the mother received a tetanus toxoid vaccination. The differentials are about the same as those for antenatal care generally.

Eighty-five percent of the

Abstract

The 2017 Philippines National Demographic and Health Survey (NDHS 2017) is a nationwide survey with a nationally representative sample of approximately 30,832 housing units. The primary objective of the survey is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the NDHS 2017 collected information on marriage, fertility levels, fertility preferences, awareness and use of family planning methods, breastfeeding, maternal and child health, child mortality, awareness and behavior regarding HIV/AIDS, women’s empowerment, domestic violence, and other health-related issues such as smoking.

The information collected through the NDHS 2017 is intended to assist policymakers and program managers in the Department of Health (DOH) and other organizations in designing and evaluating programs and strategies for improving the health of the country’s population.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49

Universe

The survey covered all de jure household members (usual residents) and all women age 15-49 years resident in the sample household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling scheme provides data representative of the country as a whole, for urban and rural areas separately, and for each of the country’s administrative regions. The sample selection methodology for the NDHS 2017 is based on a two-stage stratified sample design using the Master Sample Frame (MSF), designed and compiled by the PSA. The MSF is constructed based on the results of the 2010 Census of Population and Housing and updated based on the 2015 Census of Population. The first stage involved a systematic selection of 1,250 primary sampling units (PSUs) distributed by province or HUC. A PSU can be a barangay, a portion of a large barangay, or two or more adjacent small barangays.

In the second stage, an equal take of either 20 or 26 sample housing units were selected from each sampled PSU using systematic random sampling. In situations where a housing unit contained one to three households, all households were interviewed. In the rare situation where a housing unit contained more than three households, no more than three households were interviewed. The survey interviewers were instructed to interview only the pre-selected housing units. No replacements and no changes of the preselected housing units were allowed in the implementing stage in order to prevent bias. Survey weights were calculated, added to the data file, and applied so that weighted results are representative estimates of indicators at the regional and national levels.

All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. Among women eligible for an individual interview, one woman per household was selected for a module on domestic violence.

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

Mode of data collection

Face-to-face [f2f]

Research instrument

Two questionnaires were used for the NDHS 2017: the Household Questionnaire and the Woman’s Questionnaire. Both questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to the Philippines. Input was solicited from various stakeholders representing government agencies, universities, and international agencies.

Cleaning operations

The processing of the NDHS 2017 data began almost as soon as fieldwork started. As data collection was completed in each PSU, all electronic data files were transferred via an Internet file streaming system (IFSS) to the PSA central office in Quezon City. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted to any inconsistencies and errors while still in the PSU. Secondary editing involved resolving inconsistencies and the coding of openended questions; the former was carried out in the central office by a senior data processor, while the latter was taken on by regional coordinators and central office staff during a 5-day workshop following the completion of the fieldwork. Data editing was carried out using the CSPro software package. The concurrent processing of the data offered a distinct advantage, because it maximized the likelihood of the data being error-free and accurate. Timely generation of field check tables allowed for more effective monitoring. The secondary editing of the data was completed by November 2017. The final cleaning of the data set was carried out by data processing specialists from The DHS Program by the end of December 2017.

Response rate

A total of 31,791 households were selected for the sample, of which 27,855 were occupied. Of the occupied households, 27,496 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 25,690 women age 15-49 were identified for individual interviews; interviews were completed with 25,074 women, yielding a response rate of 98%.

The household response rate is slightly lower in urban areas than in rural areas (98% and 99%, respectively); however, there is no difference by urban-rural residence in response rates among women (98% for each).

Sampling error estimates

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

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

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

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

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

Data appraisal

Data Quality Tables - Household age distribution - Age distribution of eligible and interviewed women - Completeness of reporting - Births by calendar years - Reporting of age at death in days - Reporting of age at death in months

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

Abstract

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

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

MAIN RESULTS

FERTILITY

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

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

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

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

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

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

FAMILY PLANNING

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

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

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

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

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

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

MATERNAL AND CHILD HEALTH

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

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