Armenia Demographic and Health Survey 2010 - Measure DHS

402 Pages·2012·2.83 MB·English

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Armenia
Demographic and
Health Survey
2010

National Statistical Service
Yerevan, Armenia

Ministry of Health
Yerevan, Armenia

ICF International
Calverton, Maryland USA

April 2012

National Statistical
Service Ministry of Health
This report summarizes the findings of the 2010 Armenia Demographic and Health Survey (ADHS),
which was conducted by the National Statistical Service and the Ministry of Health of the Republic of
Armenia. ICF International provided technical assistance and the U.S. Agency for International
Development (USAID) provided funding under the terms of contract number GPO-C-00-08-00008-
00. Additional support for the 2010 ADHS was received from the United Nations Children’s Fund
(UNICEF), the United Nations Population Fund (UNFPA), and the Joint United Nations Programme
on HIV/AIDS (UNAIDS). The opinions expressed herein are those of the authors and do not
necessarily reflect the views of USAID or other donor organizations.
The ADHS is part of the worldwide MEASURE DHS program, which is designed to collect data on
fertility, family planning, and maternal and child health. Additional information about the 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: [phone]; Fax:
374-10-521-921; E-mail: [email protected]; Internet: http://www.armstat.am.
Information about the MEASURE DHS project may be obtained from ICF International,
11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: [phone]; Fax:
301-572-0999; E-mail: [email protected]; Internet: http://www.measuredhs.com.

Recommended citation:
National Statistical Service [Armenia], Ministry of Health [Armenia], and ICF International. 2012.
Armenia Demographic and Health Survey 2010. Calverton, Maryland: National Statistical Service,
Ministry of Health, and ICF International.
CONTENTS

Page

TABLES AND FIGURES .......................................................................................................... vii
PREFACE ................................................................................................................................ xiii
ACKNOWLEDGMENTS ......................................................................................................... xv
SUMMARY OF FINDINGS .................................................................................................. xvii
MILLENNIUM DEVELOPMENT GOAL INDICATORS ................................................. xxv
MAP OF ARMENIA .............................................................................................................. xxvi

CHAPTER 1 INTRODUCTION

1.1 Geography, Population, History, and Economy ............................................... 1
1.2 Systems for Collecting Demographic and Health Data ..................................... 3
1.3 Health Care System Updates in Armenia ......................................................... 3
1.4 Objectives and Organization of the Survey ...................................................... 5
1.5 Response Rates ............................................................................................... 8

CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION

2.1 Housing Characteristics ................................................................................... 9
2.2 Wealth Quintiles ........................................................................................... 14
2.3 Household Population by Age and Sex .......................................................... 15
2.4 Household Composition ............................................................................... 17
2.5 Educational Attainment of Household Members ............................................ 20
2.6 Child Protection ............................................................................................ 25

CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS

3.1 Background Characteristics of Respondents ................................................... 31
3.2 Educational Attainment of Respondents ........................................................ 32
3.3 Exposure to Mass Media ............................................................................... 34
3.4 Employment ................................................................................................. 37
3.5 Occupation ................................................................................................... 40
3.6 Employment Characteristics .......................................................................... 42
3.7 Employment Abroad ..................................................................................... 43
3.8 Use of Smoking Tobacco ............................................................................... 46

CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY

4.1 Marital Status ................................................................................................ 49
4.2 Age at First Marriage and Sexual Intercourse ................................................. 50
4.3 Recent Sexual Activity ................................................................................... 53
Contents | iii
CHAPTER 5 FERTILITY

5.1 Current Fertility ............................................................................................. 57
5.2 Fertility Differentials by Background Characteristics ....................................... 58
5.3 Fertility Trends .............................................................................................. 59
5.4 Fertility Rates From NSS and the ADHS ......................................................... 59
5.5 Children Ever Born and Living ....................................................................... 59
5.6 Birth Intervals ................................................................................................ 60
5.7 Postpartum Amenorrhea, Abstinence, and Insusceptibility ............................. 62
5.8 Menopause ................................................................................................... 63
5.9 Age at First Birth ............................................................................................ 63
5.10 Teenage Pregnancy and Motherhood ............................................................ 64

CHAPTER 6 FERTILITY PREFERENCES

6.1 Fertility Preferences ....................................................................................... 67
6.2 Ideal Number of Children ............................................................................. 69
6.3 Fertility Planning ........................................................................................... 71
6.4 Wanted and Unwanted Fertility .................................................................... 72

CHAPTER 7 CONTRACEPTION

7.1 Knowledge of Contraceptive Methods ........................................................... 75
7.2 Current Use of Contraception ....................................................................... 77
7.3 Current Use by Background Characteristics ................................................... 77
7.4 Access to Family Planning ............................................................................. 80
7.5 Informed Choice ........................................................................................... 82
7.6 Discontinuation within 12 Months of Use ..................................................... 83
7.7 Reasons for Using Traditional Methods .......................................................... 85
7.8 Knowledge of the Fertile Period .................................................................... 85
7.9 Need for Family Planning .............................................................................. 86
7.10 Future Use of Contraception ......................................................................... 88
7.11 Exposure to Family Planning Messages in the Mass Media ............................. 88
7.12 Contact of Nonusers with Family Planning Providers ..................................... 90
7.13 Men’s Attitudes toward Family Planning ........................................................ 92

CHAPTER 8 ABORTION

8.1 Pregnancy Outcomes .................................................................................... 95
8.2 Lifetime Experience with Induced Abortion ................................................... 97
8.3 Rates of Induced Abortion ............................................................................. 99
8.4 Trends in Induced Abortion ........................................................................ 100
8.5 Use of Contraceptive Methods before Abortion. .......................................... 101
8.6 Reasons for Abortion ................................................................................... 102
8.7 Method of Abortion .................................................................................... 103
8.8 Cost of Abortion .......................................................................................... 104
8.9 Counseling on Post-Abortion Use of Family Planning ................................... 105

iv | Contents
CHAPTER 9 INFANT AND CHILD MORTALITY

9.1 Assessment of Data Quality ......................................................................... 107
9.2 Levels and Trends in Childhood Mortality ................................................... 109
9.3 Comparison of Rates from the National Statistical Service and the ADHS .... 111
9.4 Socioeconomic Differentials in Childhood Mortality .................................... 111
9.5 Demographic Differentials in Childhood Mortality ...................................... 112
9.6 Perinatal Mortality ....................................................................................... 113
9.7 High-Risk Fertility Behavior ......................................................................... 114

CHAPTER 10 REPRODUCTIVE HEALTH

10.1 Antenatal Care ............................................................................................ 117
10.2 Assistance and Medical Care at Delivery ..................................................... 123
10.3 Postnatal Care for the Mother ..................................................................... 128
10.4 Postnatal Care for the Newborn .................................................................. 131
10.5 Problems in Accessing Health Care ............................................................. 132
10.6 Breast Examination and Pap Smear Test ...................................................... 134

CHAPTER 11 CHILD HEALTH

11.1 Child’s Weight and Size at Birth .................................................................. 139
11.2 Vaccination Coverage ................................................................................. 140
11.3 Trends in Vaccination Coverage .................................................................. 143
11.4 Acute Respiratory Infection ......................................................................... 144
11.5 Fever........................................................................................................... 145
11.6 Diarrhea ..................................................................................................... 146
11.7 Knowledge of ORS Packets ......................................................................... 150
11.8 Disposal of Children’s Stools ....................................................................... 150

CHAPTER 12 NUTRITION

12.1 Nutritional Status of Children ...................................................................... 153
12.2 Breastfeeding and Supplementation ............................................................ 158
12.3 Infant and Young Child Feeding (IYCF) Practices ......................................... 164
12.4 Micronutrient Intake in Children ................................................................. 166
12.5 Micronutrient Intake in Women .................................................................. 168

CHAPTER 13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS

13.1 Knowledge of HIV/AIDS and Methods of HIV Prevention ............................ 171
13.2 Rejection of Misconceptions about HIV/AIDS Transmission and
Comprehensive Knowledge of AIDS ............................................................ 175
13.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV .............. 179
13.4 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS ................. 181
13.5 Attitudes toward Negotiating Safer Sex ........................................................ 184
13.6 Attitudes toward Condom Education for Youth ........................................... 186
13.7 High-Risk Sex .............................................................................................. 188
13.8 Coverage of Prior HIV Testing ..................................................................... 193

Contents | v
13.9 Knowledge about Sexually Transmitted Infections and Self-Reporting
of STIs ......................................................................................................... 195
13.10 Prevalence of Medical Injections ................................................................. 198
13.11 HIV/AIDS-Related Knowledge and Behavior among Youth .......................... 200

CHAPTER 14 ACCESS TO AND UTILIZATION OF PRIMARY HEALTH
CARE SERVICES

14.1 Primary Health Care Provider ...................................................................... 210
14.2 Utilization of Primary Health Care Services ................................................. 214
14.3 Preventive Health Examination Visits ........................................................... 216
14.4 Exposure to General Health Care Messages in the Media ............................ 217
14.5 Health Insurance ......................................................................................... 219

CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND
HEALTH OUTCOMES

15.1 Employment and Cash Earnings................................................................... 221
15.2 Control Over Cash Earnings and Relative Magnitude of Women’s
Earnings ...................................................................................................... 222
15.3 Ownership of Assets .................................................................................... 226
15.4 Women’s Participation in Decisionmaking .................................................. 228
15.5 Attitudes toward Wife Beating ..................................................................... 232
15.6 Indicators of Women’s Empowerment ........................................................ 236
15.7 Current Use of Contraception by Women’s Status ....................................... 237

REFERENCES ........................................................................................................................ 239

APPENDIX A SAMPLE DESIGN FOR THE 2010 ARMENIA DHS
(2010 ADHS) .......................................................................................... 243

A.1 Introduction ............................................................................................... 243
A.2 Objectives of the Sample Design ................................................................ 243
A.3 Sample Frame ............................................................................................ 243
A.4 Stratification ............................................................................................... 243
A.5 Sample Allocation ....................................................................................... 244
A.6 Sample Selection ........................................................................................ 245
A.7 Sample Implementation ............................................................................. 245
A.8 Sample Weights .......................................................................................... 245

APPENDIX B ESTIMATES OF SAMPLING ERRORS ............................................... 249

APPENDIX C DATA QUALITY TABLES ........................................................................ 267

APPENDIX D PERSONS INVOLVED IN THE 2010 ARMENIA
DEMOGRAPHIC AND HEALTH SURVEY ............................................. 273

APPENDIX E QUESTIONNAIRES ................................................................................. 277
vi | Contents
TABLES AND FIGURES

Page
CHAPTER 1 INTRODUCTION

Table 1.1 Results of the household and individual interviews ........................................ 8

CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION

Table 2.1 Household drinking water ............................................................................ 10
Table 2.2 Household sanitation facilities ...................................................................... 11
Table 2.3 Hand washing .............................................................................................. 12
Table 2.4 Household characteristics ............................................................................ 13
Table 2.5 Household possessions ................................................................................ 14
Table 2.6 Wealth quintiles ........................................................................................... 15
Table 2.7 Household population by age, sex, and residence ........................................ 16
Table 2.8 Household composition ............................................................................... 17
Table 2.9 Birth registration of children under age 5 ..................................................... 18
Table 2.10 Children's living arrangements and orphanhood ........................................... 19
Table 2.11 Educational attainment of the female household population ........................ 21
Table 2.12 Educational attainment of the male household population ........................... 22
Table 2.13 School attendance ratios .............................................................................. 23
Table 2.14 Child discipline ............................................................................................ 26
Table 2.15 Child labor ................................................................................................... 28
Table 2.16 Child labor and school attendance ............................................................... 29

Figure 2.1 Population Pyramid ..................................................................................... 16
Figure 2.2 Percentage of Children under Age 15 Who Live Only with Their
Mother but Whose Father is Alive, Armenia 2000, 2005, and 2010 ............. 20
Figure 2.3 Age-specific Attendance Rates of the De Facto Population 5 to 24 Years ..... 24

CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS

Table 3.1 Background characteristics of respondents ................................................... 32
Table 3.2.1 Educational attainment: Women .................................................................. 33
Table 3.2.2 Educational attainment: Men ....................................................................... 34
Table 3.3.1 Exposure to mass media: Women ................................................................ 35
Table 3.3.2 Exposure to mass media: Men ..................................................................... 36
Table 3.4.1 Employment status: Women ........................................................................ 38
Table 3.4.2 Employment status: Men.............................................................................. 39
Table 3.5.1 Occupation: Women ................................................................................... 41
Table 3.5.2 Occupation: Men ........................................................................................ 42
Table 3.6 Type of employment: Women ..................................................................... 43
Table 3.7 Respondent's employment abroad ............................................................... 44
Table 3.8 Husband's employment abroad .................................................................... 45
Table 3.9.1 Use of tobacco: Women .............................................................................. 47
Table 3.9.2 Use of tobacco: Men ................................................................................... 48

Figure 3.1 Women's and Men's Employment Status in the Past 12 Months .................... 37
Figure 3.2 Trends in Employment Status, Armenia 2000-2010 ...................................... 40
Tables and Figures | vii
CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY

Table 4.1 Current marital status ................................................................................... 49
Table 4.2 Age at first marriage ..................................................................................... 50
Table 4.3 Median age at first marriage by background characteristics........................... 51
Table 4.4 Age at first sexual intercourse ....................................................................... 52
Table 4.5 Median age at first intercourse by background characteristics ....................... 53
Table 4.6.1 Recent sexual activity: Women .................................................................... 54
Table 4.6.2 Recent sexual activity: Men ......................................................................... 56

CHAPTER 5 FERTILITY

Table 5.1 Current fertility ............................................................................................ 57
Table 5.2 Fertility by background characteristics .......................................................... 58
Table 5.3 Trends in age-specific fertility rates ............................................................... 59
Table 5.4 Children ever born and living ....................................................................... 60
Table 5.5 Birth intervals ............................................................................................... 61
Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility ............................. 62
Table 5.7 Menopause .................................................................................................. 63
Table 5.8 Age at first birth ........................................................................................... 64
Table 5.9 Median age at first birth ............................................................................... 64
Table 5.10 Teenage pregnancy and motherhood ........................................................... 65

Figure 5.1 Trends in Age-Specific Fertility Rates, Armenia 2000, 2005, and 2010 ......... 58

CHAPTER 6 FERTILITY PREFERENCES

Table 6.1 Fertility preferences by number of living children ......................................... 67
Table 6.2.1 Desire to limit childbearing: Women ........................................................... 68
Table 6.2.2 Desire to limit childbearing: Men ................................................................. 69
Table 6.3 Ideal number of children ............................................................................. 70
Table 6.4 Mean ideal number of children .................................................................... 71
Table 6.5 Fertility planning status ................................................................................. 72
Table 6.6 Wanted fertility rates .................................................................................... 73

CHAPTER 7 CONTRACEPTION

Table 7.1 Knowledge of contraceptive methods .......................................................... 76
Table 7.2 Current use of contraception by age ............................................................ 77
Table 7.3 Current use of contraception by background characteristics ......................... 78
Table 7.4 Trends in the current use of contraception ................................................... 80
Table 7.5 Source of modern contraception methods ................................................... 81
Table 7.6 Informed choice .......................................................................................... 83
Table 7.7 Contraceptive discontinuation rates ............................................................. 84
Table 7.8 Reasons for discontinuation ......................................................................... 85
Table 7.9 Knowledge of fertile period .......................................................................... 86
Table 7.10 Need and demand for family planning among currently married women ..... 87
Table 7.11 Future use of contraception ......................................................................... 88
Table 7.12 Exposure to family planning messages .......................................................... 89
Table 7.13 Contact of nonusers with family planning providers ..................................... 91
Table 7.14 Men's attitudes toward use of contraception by women ............................... 92

viii | Tables and Figures