Armenia Demographic and Health Survey

449 Pages·2017·6.81 MB·English

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Armenia
Demographic and
2015-16
Health Survey
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Armenia
Demographic and
Health Survey
2015-16

National Statistical Service
Yerevan, Armenia

Ministry of Health
Yerevan, Armenia

The DHS Program
ICF
Rockville, Maryland USA

August 2017
The 2015-16 Armenia Demographic and Health Survey (2015-16 ADHS) was implemented by the National
Statistical Service and the Ministry of Health from December 8, 2015, to April 5, 2016. The funding for the ADHS
was provided by the United States Agency for International Development (USAID), the United Nations
Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United
Nations Children’s Fund (UNICEF). ICF provided technical assistance through The DHS Program, a USAID-
funded project providing support and technical assistance in the implementation of population and health surveys
in countries worldwide.
Additional information about the 2015-16 ADHS may be obtained from the National Statistical Service of the
Republic of Armenia, Republic Avenue, 3 Government House, 0010, Yerevan, Republic of Armenia; Telephone:
374-11-524-213; Fax: [phone]; E-mail: [email protected]; Internet: http://www.armstat.am.
Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD
20850, USA; Telephone: [phone]; Fax: [phone]; E-mail: [email protected]; Internet:
www.DHSprogram.com.

Recommended citation:
National Statistical Service [Armenia], Ministry of Health [Armenia], and ICF. 2017. Armenia
Demographic and Health Survey 2015-16. Rockville, Maryland, USA: National Statistical Service,
Ministry of Health, and ICF.
CONTENTS

TABLES AND FIGURES ........................................................................................................................... ix
PREFACE ................................................................................................................................................... xv
ACKNOWLEDGEMENTS ..................................................................................................................... xvii
MILLENNIUM DEVELOPMENT GOAL INDICATORS ................................................................... xix
SUSTAINABLE DEVELOPMENT GOAL INDICATORS .................................................................. xxi
MAP OF ARMENIA ................................................................................................................................ xxii
1 INTRODUCTION AND SURVEY METHODOLOGY .............................................................. 1
1.1 Geography and Population .................................................................................................. 1
1.1.1 Geography .............................................................................................................. 1
1.1.2 Population .............................................................................................................. 1
1.2 Systems for Collecting Demographic and Health Data ....................................................... 2
1.3 Health Care System Updates in Armenia ............................................................................ 2
1.4 Objectives and Organization of the Survey ......................................................................... 4
1.5 Sample Design and Implementation .................................................................................... 5
1.6 Questionnaires ..................................................................................................................... 5
1.7 Anthropometry and Anemia Testing ................................................................................... 6
1.8 Pretest .................................................................................................................................. 7
1.9 Training of Field Staff ......................................................................................................... 8
1.10 Fieldwork and Data Processing ........................................................................................... 8
1.11 Response Rates .................................................................................................................... 9
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ............................. 11
2.1 Housing Characteristics ..................................................................................................... 12
2.1.1 Drinking Water .................................................................................................... 12
2.1.2 Sanitation Facility ................................................................................................ 14
2.1.3 Household Characteristics ................................................................................... 15
2.2 Secondhand Smoke Exposure ........................................................................................... 15
2.3 Household Possessions ...................................................................................................... 16
2.4 Wealth Quintiles ................................................................................................................ 16
2.5 Hand Washing ................................................................................................................... 17
2.6 Household Population by Age and Sex ............................................................................. 18
2.7 Household Size and Composition ...................................................................................... 20
2.8 Children’s Living Arrangements and Orphanhood ........................................................... 20
2.9 Educational Attainment of Household Members............................................................... 21
2.10 Child Protection ................................................................................................................. 25
2.10.1 Birth Registration ................................................................................................. 26
2.10.2 Child Discipline ................................................................................................... 26
2.11 Poverty Benefits ................................................................................................................ 29
3 BACKGROUND CHARACTERISTICS OF RESPONDENTS ............................................... 31
3.1 Background Characteristics of Respondents ..................................................................... 31
3.2 Educational Attainment of Respondents ........................................................................... 32
3.3 Exposure to Mass Media and Internet ............................................................................... 34
3.3.1 Mass Media .......................................................................................................... 35
3.3.2 Internet Usage ...................................................................................................... 36
3.4 Employment ...................................................................................................................... 38
Contents • iii
3.5 Occupation ......................................................................................................................... 41
3.6 Women’s Employment Characteristics ............................................................................. 44
3.7 Employment Abroad ......................................................................................................... 45
4 MARRIAGE AND SEXUAL ACTIVITY .................................................................................. 47
4.1 Marital Status ..................................................................................................................... 47
4.2 Age at First Marriage and Sexual Intercourse ................................................................... 48
4.2 Age at First Sexual Intercourse ......................................................................................... 50
4.3 Recent Sexual Activity ...................................................................................................... 51
5 FERTILITY ................................................................................................................................... 55
5.1 Current Fertility ................................................................................................................. 55
5.2 Fertility Differentials by Background Characteristics ....................................................... 56
5.3 Fertility Trends .................................................................................................................. 57
5.3.1 Retrospective Data ............................................................................................... 57
5.3.2 Comparison with Prior ADHS Surveys ............................................................... 58
5.4 Children Ever Born and Living ......................................................................................... 58
5.5 Birth Intervals .................................................................................................................... 59
5.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility ............................................... 61
5.7 Menopause ......................................................................................................................... 61
5.8 Age at First Birth ............................................................................................................... 62
5.9 Teenage Pregnancy and Motherhood ................................................................................ 63
6 FERTILITY PREFERENCES ..................................................................................................... 65
6.1 Fertility Preferences ........................................................................................................... 65
6.2 Ideal Number of Children .................................................................................................. 68
6.3 Fertility Planning ............................................................................................................... 70
6.4 Wanted and Unwanted Fertility ......................................................................................... 71
7 CONTRACEPTION ..................................................................................................................... 73
7.1 Knowledge of Contraceptive Methods .............................................................................. 73
7.2 Current Use of Contraception ............................................................................................ 75
7.3 Current Use by Background Characteristics ...................................................................... 76
7.4 Source of Family Planning ................................................................................................ 78
7.5 Informed Choice ................................................................................................................ 79
7.6 Discontinuation within 12 Months of Use ......................................................................... 80
7.7 Knowledge of the Fertile Period ........................................................................................ 82
7.8 Need for Family Planning .................................................................................................. 83
7.9 Future Use of Contraception .............................................................................................. 86
7.10 Exposure to Family Planning Messages in the Mass Media ............................................. 87
7.11 Contact of Nonusers with Family Planning Providers ....................................................... 89
7.12 Exposure to Reproductive Health Messages ..................................................................... 90
8. ABORTION ................................................................................................................................... 91
8.1 Pregnancy Outcomes ......................................................................................................... 92
8.2 Lifetime Experience with Induced Abortion ..................................................................... 94
8.3 Rates of Induced Abortion ................................................................................................. 95
8.4 Trends in Induced Abortion ............................................................................................... 97
8.5 Use of Contraceptive Methods before Abortion ................................................................ 98
8.6 Reasons for Abortion ......................................................................................................... 99

iv • Contents
9 REPRODUCTIVE HEALTH .................................................................................................... 101
9.1 Antenatal Care ................................................................................................................. 102
9.1.1 Antenatal Care Provider ..................................................................................... 102
9.1.2 Number and Timing of ANC Visits ................................................................... 103
9.1.3 Folate and Iron Supplements ............................................................................. 103
9.1.4 Antenatal Care Content ...................................................................................... 104
9.1.5 Ultrasound Tests ................................................................................................ 105
9.2 Assistance and Medical Care at Delivery ........................................................................ 106
9.2.1 Place of Delivery................................................................................................ 106
9.2.2 Assistance at Delivery ........................................................................................ 107
9.2.3 Caesarian Deliveries .......................................................................................... 107
9.2.4 Payment for Delivery ......................................................................................... 109
9.3 Postnatal Care for the Mother .......................................................................................... 111
9.3.1 Timing of Postnatal Checkups for the Mother ................................................... 111
9.3.2 Type of Provider of Postnatal Checkups for the Mother ................................... 112
9.4 Postnatal Care for the Newborn ....................................................................................... 112
9.4.1 Timing of Postnatal Care for Newborns ............................................................ 112
9.4.2 Type of Provider of Postnatal Care for Newborns ............................................. 114
9.4.3 Content of Postnatal Care for Newborns ........................................................... 114
9.5 Problems in Accessing Health Care ................................................................................ 115
9.6 Travel to Nearest Health Clinic ....................................................................................... 117
10 HEALTH INSURANCE, USE OF TOBACCO, KNOWLEDGE AND
ATTITUDES ABOUT TUBERCULOSIS ................................................................................ 119
10.1 Health Insurance .............................................................................................................. 119
10.2 Use of Tobacco ................................................................................................................ 122
10.3 Tuberculosis .................................................................................................................... 124
10.3.1 Knowledge and Attitudes about Tuberculosis ................................................... 124
10.3.2 Knowledge of Tuberculosis Symptoms ............................................................. 128
10.3.3 Knowledge of Organs Affected by Tuberculosis ............................................... 131
10.3.4 Misconceptions about How Tuberculosis is Spread .......................................... 132
11 CHILD HEALTH ........................................................................................................................ 135
11.1 Child’s Weight and Size at Birth ..................................................................................... 135
11.2 Vaccination Coverage...................................................................................................... 137
11.3 Trends in Vaccination Coverage ..................................................................................... 141
11.4 Acute Respiratory Infection ............................................................................................. 142
11.5 Fever ................................................................................................................................ 142
11.6 Diarrhea ........................................................................................................................... 143
11.7 Knowledge of ORS Packets ............................................................................................ 146
11.8 Disposal of Children’s Stools .......................................................................................... 146
11.9 Childhood Mortality ........................................................................................................ 147
12 NUTRITION ................................................................................................................................ 149
12.1 Nutritional Status of Children .......................................................................................... 150
12.1.1 Measurement of Nutritional Status among Young Children .............................. 150
12.1.2 Levels of Child Malnutrition ............................................................................. 151
12.1.3 Trends in Children’s Nutritional Status ............................................................. 156
12.2 Breastfeeding and Supplementation ................................................................................ 157
12.2.1 Initiation of Breastfeeding ................................................................................. 157
12.2.2 Breastfeeding Status by Age .............................................................................. 159
12.2.3 Duration of Breastfeeding .................................................................................. 161
12.2.4 Types of Complementary Foods ........................................................................ 161
Contents • v
12.3 Infant and Young Child Feeding (IYCF) Practices ......................................................... 163
12.4 Household Iodized Salt Consumption ............................................................................. 166
12.5 Micronutrient Intake in Children ..................................................................................... 167
12.6 Nutritional Status of Women ........................................................................................... 169
12.7 Micronutrient Intake among Mothers .............................................................................. 171
12.8 Anemia ............................................................................................................................ 173
12.8.1 Anemia Prevalence in Women ........................................................................... 174
12.8.2 Anemia Prevalence in Children ......................................................................... 176
12.8.3 Knowledge about Anemia .................................................................................. 178
13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS ............................................ 189
13.1 Knowledge of HIV/AIDS and Methods of HIV Prevention ............................................ 190
13.2 Misconceptions about HIV Transmission and Comprehensive Knowledge
of AIDS ........................................................................................................................... 192
13.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV .............................. 193
13.4 Discriminatory Attitudes towards People Living with HIV ............................................ 194
13.5 Higher-Risk Sex .............................................................................................................. 196
13.5.1 Multiple Partners and Higher-Risk Sexual Intercourse...................................... 196
13.5.2 Transactional Sex ............................................................................................... 198
13.6 Coverage of Prior HIV Testing ....................................................................................... 199
13.7 Self-Reported Sexually Transmitted Infections ............................................................... 202
13.8 Prevalence of Medical Injections..................................................................................... 204
13.9 HIV/AIDS-Related Knowledge and Behavior among Youth .......................................... 206
13.9.1 HIV/AIDS-Related Knowledge among Young Adults ...................................... 206
13.9.2 Age at First Sex among Youth ........................................................................... 206
13.9.3 Abstinence and Premarital Sex .......................................................................... 208
13.9.4 Multiple Sexual Partners and Condom Use among Young People .................... 208
13.9.5 Recent HIV Tests among Youth ........................................................................ 209
14 DOMESTIC VIOLENCE ........................................................................................................... 211
14.1 Measurement of Violence ................................................................................................ 211
14.1.1 Use of Valid Measures of Violence ................................................................... 211
14.1.2 Ethical Considerations ....................................................................................... 213
14.2 Experience of Physical Violence ..................................................................................... 213
14.3 Experience of Sexual Violence ........................................................................................ 215
14.4 Experience of Different Forms of Violence .................................................................... 215
14.5 Violence during Pregnancy ............................................................................................. 216
14.6 Marital Control by Spouse ............................................................................................... 216
14.7 Forms of Spousal Violence .............................................................................................. 218
14.8 Spousal Violence by Background Characteristics ........................................................... 219
14.9 Violence by Spousal Characteristics and Women’s Empowerment Indicators ............... 221
14.10 Recent Spousal Violence by Any Husband ..................................................................... 222
14.11 Onset of Spousal Violence .............................................................................................. 224
14.12 Physical Consequences of Spousal Violence .................................................................. 224
14.13 Violence by Women against Their Husband ................................................................... 225
14.14 Help-seeking Behavior by Women Who Experience Violence ....................................... 227
15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH
OUTCOMES ............................................................................................................................... 229
15.1 Employment and Cash Earnings ...................................................................................... 230
15.2 Control Over Cash Earnings and Relative Magnitude of Women’s Earnings ................. 231
15.3 Ownership of Assets, Bank Accounts, and Mobile Phones ............................................. 234
15.4 Women’s Participation in Decision Making .................................................................... 243
vi • Contents
15.5 Attitudes toward Wife Beating ........................................................................................ 246
15.6 Attitudes toward and Ability to Negotiate Safer Sex with Husbands .............................. 249
15.7 Indicators of Women’s Empowerment ............................................................................ 251
15.8 Contraceptive Use by Women’s Status ........................................................................... 252
REFERENCES ......................................................................................................................................... 255
APPENDIX A SAMPLE DESIGN ....................................................................................................... 259
A.1 Introduction ..................................................................................................................... 259
A.2 Sample Frame .................................................................................................................. 259
A.3 Sample Design and Implementation ................................................................................ 261
A.4 Sample Probabilities and Sample Weights ...................................................................... 262
A.5 Survey Implementation.................................................................................................... 263
APPENDIX B ESTIMATES OF SAMPLING ERRORS ................................................................... 267
APPENDIX C DATA QUALITY TABLES ......................................................................................... 285
APPENDIX D PERSONS INVOLVED IN THE 2015-16 ARMENIA DEMOGRAPHIC
AND HEALTH SURVEY ............................................................................................. 291
APPENDIX E QUESTIONNAIRES ..................................................................................................... 295

Contents • vii