Ethiopia Atlas of Key Demographic. and Health Indicators

Ethiopia Atlas of Key Demographic and Health Indicators 2005

Ethiopia Atlas of Key Demographic and Health Indicators, 2005 Macro International Inc. Calverton, Maryland, USA September 2008 ETHIOPIANS AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS

This atlas is based on data from the 2005 Ethiopia Demographic and Health Survey (EDHS) and was produced by Macro International Inc. The EDHS is part of the worldwide MEASURE DHS project, which is funded by the U.S. Agency for International Development (USAID). Additional information about the EDHS may be obtained from the Central Statistical Agency (CSA), P.O. Box 1143,, Ethiopia; Telephone: (251) 111 55 30 11/111 15 78 41, Fax: (251) 111 55 03 34. E-mail: csa@ethionet.et. Additional information about the DHS project may be obtained by contacting the MEASURE DHS program, Macro International Inc., 11785 Beltsville Drive, Calverton, MD; Telephone: (301) 572-0200, Fax: (301) 572-0999, Internet: www.measuredhs.com. Recommended citation: Macro International Inc. 2008. Ethiopia Atlas of Key Demographic and Health Indicators, 2005. Calverton, Maryland, USA: Macro International Inc.

CONTENTS Ethiopia 2005 DHS Regions... 1 Wealth: Lowest Quintile... 2 Adult Literacy... 3 Exposure to Media... 4 Total Fertility Rate... 5 Teenage Pregnancy and Motherhood... 6 Contraceptive Prevalence... 7 Unmet Need for Family Planning... 8 Total Demand for Family Planning... 9 Infant Mortality Rate...10 Under-Five Mortality Rate...11 Assistance during Delivery...12 Vaccination Coverage...13 Vitamin A Supplementation...14 Moderate or Severe Anemia in Children...15 Moderate or Severe Anemia in Women...16 Child Nutrition: Stunting...17 Women s Nutrition: Low Body Mass Index (BMI)...18 Knowledge of HIV/AIDS Prevention: Abstinence...19 Knowledge of HIV/AIDS Prevention: Be Faithful...20 Knowledge of HIV/AIDS Prevention: Condoms...21 Multiple Sex Partners: Men...22 Higher-Risk Intercourse: Men...23 Prevalence of HIV...24 Prevalence of HIV: Women...25 Prevalence of HIV: Men...26 Female Decisionmaking...27 iii

Ethiopia Atlas of Key Demographic and Health Indicators, 2005 Ethiopia 2005 DHS Regions Elevation High : 4522m 0 meters Low : -125m Benishangul The 2005 Ethiopia DHS (EDHS) collected data from over 14,000 women and 6,000 men from every region in the country.the survey sampling method provides representative data for Ethiopia as a whole and for each of the 11 regions. 1

Wealth: Lowest Quintile Percentage of the de jure population in the lowest wealth quintile 31.6% 19.1% 17.5% 67.3% 11.4% 0.1% 5.7% 44.0% 10.7% 19.9% 71.8% Up to 10.0% 10.1% - 25.0% 25.1% - 50.0% Over 50.0% The EDHS divided the population into five wealth categories (quintiles), based on household assets such as bicycles and radios and characteristics of the household including access to water and sanitation facilities. By definition, 20 percent of the population at the national level falls into the lowest wealth quintile. Wealth is very unequally distributed in Ethiopia. Less than 10 percent of the population in and and less than 12 percent in, the most urbanized areas in the country, are in the lowest wealth quintile. In contrast, more than half of the residents of the very rural regions of and are in the lowest wealth quintile. In the very populous regions of and, between 10 and 25 percent of the households are classified among the poorest in the nation. 2

Adult Literacy Percentage of women 15-49 and men 15-59 who can read all or part of a sentence Men 6 67.5% 7 4 27.0% 8 54.0% 47.4% 2 76.6% 1 93.6% 78.4% 3 57.5% 5 22.0% 57.0% 11 9 10 61.5% Women 6 33.7% 7 4 15.6% 8 25.1% 23.2% 2 53.0% 1 54.9% 79.9% 3 22.8% 5 9.8% 22.4% 11 9 10 29.5% Regions 1-2 - 3-4 - 5-6 - 7-8 - Banishangul- 9-10 - 11 - Up to 25.0% 25.1% - 45.0% 45.1% - 65.0% Over 65.0% Adult literacy remains very low in Ethiopia, particularly among women. Less than one-fourth of women in,, Banishangul-,, and can read. Half or more of women are literate in only three regions,, and. Many more Ethiopian men are literate, ranging from a low of 22 percent in to over 90 percent in. More than half of men can read in all but three (,, and Banishangul-) of Ethiopia s 11 regions. 3

Exposure to Media Percentage of adults with weekly exposure to newspaper, television, or radio Men 6 45.9% 7 4 32.9% 8 28.6% 38.1% 2 61.1% 1 78.6% 77.9% 3 37.4% 5 23.0% 27.7% 11 9 10 39.0% Women 6 17.8% 7 4 11.6% 8 16.2% 13.9% 2 46.9% 1 53.7% 70.8% 3 10.9% 5 9.1% 13.4% 11 9 10 20.6% Regions 1-2 - 3-4 - 5-6 - 7-8 - Banishangul- 9-10 - 11 - Up to 15.0% 15.1% - 25.0% 25.1% - 50.0% Over 50.0% Mass media are a gateway to new ideas and a source of important health information. The DHS asked men and women if they were exposed to radio, newspapers, or television at least once a week. Nationwide, access to media is limited. As expected, urban residents have far more exposure to mass media than rural dwellers. Women, particularly in rural areas, have far less access to media than men. With the exception of the urban regions of,, and, less than 21 percent of women are exposed to even one medium weekly. Among men, on the other hand, access to media ranges from a low of 23 percent in to a high of 79 percent in. Radio is the most common medium for both men and women. 4

Total Fertility Rate Average number of children per woman age 15-49 5.1 5.2 5.1 4.9 1.4 3.8 3.6 4.0 5.6 6.2 6.0 Up to 2.0 2.1-5.0 5.1-6.0 Over 6.0 The total fertility rate represents the average number of children a women will have in her lifetime. Nationwide, the total fertility rate is 5.4. There is substantial variation among regions, ranging from only 1.4 children per woman in to 6 children in and 6.2 children in. Fertility is lowest in the urban areas and highest in the rural regions. Overall, the poorest and least educated women have the most children. 5

Teenage Pregnancy and Motherhood Percentage of women age 15-19 who have had a live birth or are pregnant with their first child 14.7% 27.1% 20.3% 20.3% 13.7% 4.3% 21.9% 30.8% 11.0% 19.0% 19.5% Up to 5.0% 5.1% - 15.0% 15.1% - 25.0% Over 25.0% Early pregnancy carries health risks for both the mother and the child. It also limits opportunities for young women, usually ending their chances for further education and employment. Women who start giving birth in their teens are also more likely to have larger families. In Ethiopia, one in six young women age 15-19 (17 percent) is pregnant or has already given birth by age 19. Teenage pregnancy is most common in (31 percent) and (27 percent) and least common in (4 percent). Nationwide, early pregnancy is most common in rural areas and among the least educated and poorest women. 6

Contraceptive Prevalence Percentage of currently married women using any modern method of contraception 16.2% 10.4% 15.7% 6.0% 31.5% 45.2% 29.1% 15.8% 11.4% 12.9% 2.7% Up to 10.0% 10.1% - 15.0% 15.1% - 25.0% Over 25.0% While over 85 percent of currently married women know about contraception, only 14 percent use any modern method, one of the lowest rates in Africa. Urban women are more likely to use a modern method than rural women. Just over 45 percent of women in and around 30 percent of women in and are current users. In contrast, only 3 percent of women and 6 percent of i women currently use a modern method. Injectables are the most widely used modern method in all regions. 7

Unmet Need for Family Planning Percentage of currently married women with an unmet need for spacing and limiting births 24.1% 29.7% 29.7% 13.4% 14.8% 10.3% 22.4% 23.5% 37.4% 41.4% 11.6% Up to15.0% 15.1% - 25.0% 25.1% - 35.0% Over 35.0% Currently married women who want to delay their next pregnancy or stop having children entirely but are not using contraception are considered to have an unmet need for family planning services. Nationwide, just over one-third of married women have an unmet need for family planning 20 percent for spacing and 14 percent for limiting pregnancy. Unmet need is highest in at 41 percent of currently married women and lowest in at only 10 percent. 8

Total Demand for Family Planning Percentage of currently married women who have an unmet need for family planning or who are currently using contraception 40.7% 41.1% 46.0% 20.0% 48.9% 68.2% 56.2% 39.6% 49.6% 55.2% 14.8% Up to 25.0% 25.1% - 40.0% 40.1% - 55.0% Over 55.0% The total demand for family planning includes both married women who are currently using family planning (met need) and married women with unmet need for family planning. The measure of total demand helps planners identify service delivery needs. Total demand for family planning is quite low in (15 percent) and (20 percent) where most women still want large families. Elsewhere in the country, total demand ranges from 40 percent in to a high of 68 percent in. 9

Infant Mortality Rate Per 1,000 live births in the 10-year period preceding survey 67 84 94 61 45 66 71 92 85 76 57 Up to 60 61-70 71-80 Over 80 The infant mortality rate measures the risk of death in the first year after birth. Nationwide, there were 77 infant deaths per 1,000 live births in the five years before the 2005 EDHS. At least half of these deaths occurred in the infants first month of life. Infant mortality is most common in and at 94 and 92 deaths per 1,000 live births, respectively. Infant mortality is lower in the largely rural and poor regions of (57) and (61) than in the urban regions of and ; however, this data must be interpreted with caution, since numbers associated with mortality are small and subject to large sampling errors. experiences the lowest rate nationwide at 45 deaths per 1,000 live births. 10

Under-Five Mortality Rate Per 1,000 live births in the 10-year period preceding survey 106 157 154 123 136 72 103 156 142 122 93 Up to 100 101-125 126-150 Over 150 The under-five mortality rate measures the risk of death in the first five years of life. For all of Ethiopia, 123 children per 1,000 births or 12 percent die before age five. The risk of child death varies by region in roughly the same pattern as infant mortality.,, and report more than 150 child deaths per 1,000 live births. Child mortality is lowest in at 72 deaths per 1,000 live births. 11

Assistance During Delivery Percentage of live births assisted by a traditional birth attendant in the five years preceding survey 13.8% 20.4% 29.6% 42.5% 72.4% 4.2% 61.5% 19.3% 14.8% 32.5% 71.6% Up to 5.0% 5.1% - 25.0% 25.1% - 50.0% Over 50.0% Assistance from a trained provider during childbirth reduces complications for both mother and child. In Ethiopia over 90 percent of women give birth at home, most often with help from relatives. About 28 percent of births are assisted by a traditional birth attendant. In,, and, traditional birth attendants assist over 60 percent of births. Rates are much lower in other parts of the country, especially in. 12

Vaccination Coverage Percentage of children 12-23 months who are fully vaccinated (BCG, measles, and three doses of DPT and polio vaccine) 32.9% 18.5% 17.1% 0.6% 43.4% 69.9% 34.9% 15.9% 20.3% 20.2% 2.8% Up to 5.0% 5.1% - 20.0% 20.1% - 40.0% Over 40.0% Complete immunization against common infectious diseases is vital for preventing illness and death among children. In Ethiopia, only 20 percent of children nationwide have been immunized against all six vaccine-preventable diseases tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles. There are marked regional differences in immunization. Less than 3 percent of children are fully immunized in and and less than 20 percent in,, and. In contrast, almost 70 percent of children have received all vaccinations in and 43 percent in. Children in urban areas are three times as likely to be fully immunized as children living in rural areas. 13

Vitamin A Supplementation Percentage of children 6-59 months who received vitamin A supplements in the six months prior to survey 65.3% 27.4% 43.2% 33.3% 46.7% 53.2% 36.1% 39.1% 49.9% 43.0% 38.8% Up to 30.0% 30.1% - 40.0% 40.1% - 50.0% Over 50.0% Vitamin A is an essential micronutrient for maintaining the body s immune system. Severe vitamin A deficiency can lead to eye damage and slow recovery from illnesses. Children need to eat foods rich in vitamin A and take a vitamin A supplement every six months. In Ethiopia as a whole, just over 45 percent of children age 6 months to 5 years received a supplement in the six months before the EDHS. Children living in are the least likely to receive vitamin A supplements (27 percent), and children living in are most likely to receive supplements (65 percent). 14

Moderate or Severe Anemia in Children Percentage of children 6-59 months with moderate or severe anemia 32.6% 29.6% 32.0% 33.2% 40.6% 27.9% 32.4% 36.5% 25.5% 33.7% 65.8% Up to 30.0% 30.1% - 35.0% 35.1% - 40.0% Over 40.0% In young children anemia can cause fatigue, weakness, and delays in normal physical and mental development. Anemia usually results from a diet poor in iron and other micronutrients, malaria, intestinal worms, and sickle cell disease. Just over half (54 percent) of all children in Ethiopia have any anemia, while 32 percent have moderate or severe anemia. Two-thirds of children in suffer from moderate or severe anemia, the highest rate nationwide. Moderate or severe anemia is least common among children in (26 percent) and (28 percent). 15

Moderate or Severe Anemia in Women Percentage of women age 15-49 with moderate or severe anemia 6.9% 10.7% 9.6% 14.3% 7.9% 3.9% 7.2% 12.5% 8.7% 9.2% 19.7% Up to 5.0% 5.1% - 10.0% 10.1% - 15.0% Over 15.0% Nationwide, moderate or severe anemia affects just under 10 percent of Ethiopian women. Anemia among women is a particular concern during pregnancy since it may be an underlying cause of spontaneous abortion, premature delivery, and maternal mortality. The pattern of regional differences for anemia in women is similar to the pattern for anemia in children. One in five women in has moderate or severe anemia, the highest rate nationwide. Less than 8 percent of women in and are affected, as are less than 4 percent in. 16

Child Nutrition: Stunting Percentage of children under age five whose height-for-age is below -2 SD from mean 41.0% 39.7% 56.6% 40.8% 30.8% 18.4% 38.7% 29.3% 51.6% 41.0% 45.2% Up to 20.0% 20.1% - 35.0% 35.1% - 50.0% Over 50.0% The EDHS measured height and weight for almost 5, children under five. Stunting, or being shorter than the age-appropriate height, is an indicator of poor nutrition. In Ethiopia stunting is very common. Nationwide, just under half (47 percent) of all children are stunted. Rural children are more likely to be stunted than urban children. Stunting is most common in (52 percent) and (57 percent) and least common in (18 percent). 17

Women's Nutrition: Low Body Mass Index (BMI) Percentage of women 15-49 who have a BMI <17 (moderately or severely thin) 15.6% 10.3% 9.4% 14.4% 9.5% 5.5% 7.3% 15.3% 8.2% 6.7% 17.4% Up to 7.0% 7.1% - 10.0% 10.1% - 15.0% Over 15.0% The EDHS measured women s height and weight to get an assessment of adult nutritional status known as the body weight index or BMI. A BMI measurement between 18.5 and 24.9 indicates normal weight. A BMI under 17.0 indicates moderate and severe thinness or acute undernutrition, which has grave consequences for women s health and for their current and future pregnancies. Throughout Ethiopia, about 9 percent of women have a BMI below 17. The regional differences are marked, however. Extreme thinness is most common in, affecting one in six women (17 percent), (16 percent), and (15 percent) and least common among women in (6 percent) and and (7 percent). 18

Knowledge of HIV/AIDS Prevention: Abstinence Percentage of adults 15-49 who know abstinence from sexual intercourse prevents transmission of HIV/AIDS Men 60.3% 5 80.6% Women 39.1% 5 8 78.1% 9 8 41.9% 58.1% 9 6 96.0% 86.3% 89.9% 6 1 76.8% 54.5% 1 7 7 82.3% 10 78.1% 10 69.4% 4 73.5% 2 83.1% 96.2% 3 4 41.5% 2 70.1% 73.9% 3 36.3% 11 22.8% 11 Regions 1-2 - 3-4 - 5-6 - 7-8 - Banishangul- 9-10 - 11 - Up to 35.0% 35.1% - 55.0% 55.1% - 75.0% Over 75.0% The EDHS asked all survey respondents about the three ways to prevent HIV transmission: abstinence before marriage, faithfulness to one partner, and use of condoms. Abstinence is the most widely known of the three methods, particularly among men. More than 75 percent of men in 8 of the 11 regions identified abstinence as a prevention method. Among women, knowledge is much lower; more than 75 percent of women identified abstinence in only two regions and. Knowledge levels are lowest among men (36 percent) and women (23 percent). 19

Knowledge of HIV/AIDS Prevention: Be Faithful Percentage of adults 15-49 who know having one uninfected sex partner reduces risk of HIV/AIDS Men 60.9% 5 72.1% Women 34.0% 5 8 77.1% 9 8 43.3% 57.9% 9 6 92.3% 79.7% 83.1% 6 1 72.1% 56.8% 1 7 7 87.4% 10 81.5% 10 68.3% 4 73.5% 2 85.6% 95.9% 3 4 36.9% 2 69.3% 77.5% 3 32.0% 11 26.2% 11 Regions 1-2 - 3-4 - 5-6 - 7-8 - Banishangul- 9-10 - 11 - Up to 45.0% 45.1% - 65.0% 65.1% - 85.0% Over 85.0% About 63 percent of women and 79 percent of men nationwide know that remaining faithful to one partner prevents HIV transmission. As with abstinence, more men know about being faithful than women. At least four in five men in (96 percent), (92 percent), (87 percent), (83 percent) and (82 percent), identified being faithful as a prevention method. is the only region where at least four in five women know that being faithful protects against HIV infection. Men and women in are much less knowledge than adults in other regions. 20

Knowledge of HIV/AIDS Prevention: Condoms Percentage of adults 15-49 who know using condoms during every sex reduces risk of HIV/AIDS Men 54.2% 5 58.2% Women 25.3% 5 8 57.2% 9 8 29.0% 35.9% 9 6 77.9% 74.9% 77.8% 6 1 52.3% 35.9% 1 7 7 78.5% 10 61.8% 10 41.0% 4 60.6% 2 70.9% 74.0% 3 4 27.2% 2 56.7% 60.7% 3 15.8% 11 10.6% 11 Regions 1-2 - 3-4 - 5-6 - 7-8 - Banishangul- 9-10 - 11 - Up to 40.0% 40.1% - 55.0% 55.1% - 70.0% Over 70.0% Using condoms is the least well known prevention method. Regional differences are very similar to knowledge of the other prevention methods. Men are more knowledgeable about condoms than women, and both men and women in are least informed about condoms by a considerable margin. 21

Multiple Sex Partners: Men Percentage of men 15-49 who had two or more sex partners in the 12 months prior to survey 4.5% 12.7% 2.0% 7.1% 7.6% 6.1% 2.2% 12.4% 6.5% 3.5% 3.2% Up to 2.5% 2.6% - 5.0% 5.1% - 7.5% Over 7.5% Nationwide, less than 1 percent of sexually active women and 4 percent of sexually active men reported having two or more partners in the 12 months before the survey. More than 10 percent of men reported having multiple partners in (13 percent) and (12 percent). Four percent or less of men said they had had multiple partners in (2 percent), (3 percent) and (4 percent). Never married men were more likely to have multiple partners than currently married and divorced men. 22

Higher-Risk Intercourse: Men Percentage of men who had sex with a non-marital, non-cohabitating partner in the 12 months prior to survey 15.9% 5.0% 3.5% 15.9% 22.3% 44.4% 20.8% 28.2% 4.6% 8.8% 2.6% Up to 5.0% 5.1% - 15.0% 15.1% - 25.0% Over 25.0% The EDHS defines higher-risk sex as sexual intercourse with someone other than a spouse or cohabiting partner. Higher-risk sex increases the chances of transmitting HIV and other sexually transmitted infections. The percentage of sexually active men reporting higher-risk sex in the 12 months before the survey varies markedly among regions. At the low end, 3 percent of men in and 4 percent in reported sex with non-marital/non-cohabiting partners. At the high end, 28 percent of men in and 44 percent of men in reported higherrisk sex. Between 16 and 22 percent of men in,,, and also reported higher-risk sex. 23

Prevalence of HIV Percentage of men and women age 15-49 who are HIV positive 2.1% 0.5% 1.7% 2.9% 3.2% 4.7% 3.5% 6.0% 0.2% 1.4% 0.7% Up to 1.0% 1.1% - 2.0% 2.1% - 4.0% Over 4.0% Over 5,700 women age 15-49 and just over 5, men age 15-49 gave informed consent to be tested for HIV during the EDHS. Based on these test results, the EDHS estimates a national HIV prevalence rate of 1.4 percent, much lower than neighboring Kenya and Uganda. The border region of has the highest rate in Ethiopia with 6 percent of men and women testing positive for HIV. HIV prevalence ranges from 3.2 to 4.7 percent in the urban regions of,, and. Less than 1 percent of adults in,, and tested positive for HIV. 24

Prevalence of HIV: Women Percentage of women age 15-49 who are HIV positive 2.6% 0.9% 1.8% 3.3% 4.4% 6.1% 4.6% 5.5% 0.1% 2.2% 1.3% Up to 1.0% 1.1% - 3.0% 3.1% - 5.0% Over 5.0% As in other African countries, HIV prevalence in Ethiopia is about twice as high among women as among men. The cumulative effect of physiological vulnerability of young women, their early age at marriage and sexual debut, the inability of many women to ask their partners to use a condom, and the high risk behavior of their male partners make women more vulnerable to infection than men. Nationwide, 1.9 percent of women tested positive for HIV. Infection rates are highest in (6.1 percent), (5.5 percent), (4.6 percent), and (4.4 percent). Consistent with other African countries, HIV is more prevalent in urban than rural areas. 25

Prevalence of HIV: Men Percentage of men age 15-49 who are HIV positive 1.6% < 0.05% 1.6% 2.4% 1.9% 3.0% 2.2% 6.7% 0.4% 0.4% < 0.05% Up to 0.5% 0.6% - 2.0% 2.1% - 3.0% Over 3.0% Just under I percent (0.9 percent) of men in Ethiopia are infected with HIV. There are considerable regional differences, however. About one in 15 men (6.7 percent) in are HIV positive. Between 2 and 3 percent of men are infected in,, and. In the rest of the country less than 2 percent of men tested positive for HIV. These pronounced regional differences are important indicators for targeting prevention programs. 26

Female Decisionmaking Percentage of currently married women who participate in all four decisions: own health care, making large purchases, making daily purchases, and visits to family or relatives 53.8% 37.8% 55.8% 41.0% 59.1% 81.3% 56.8% 27.5% 28.6% 41.7% 25.1% Up to 30.0% 30.1% - 40.0% 40.1% - 50.0% Over 50.0% When couples share in household and family decisions, women have more power over the circumstances in their daily lives. Decisionmaking can also affect family health, for example, if a woman needs her husband s permission to go to a health clinic or to visit friends and family for advice. The EDHS asked women if they routinely participated in four types of decisions deciding about women s own health care, making large household purchases, making household purchases for daily needs, and visits to family or relatives. Nationwide about 4 in 10 women said that they participated in making all four types of decisions. Shared decisionmaking is most common in (81 percent) and (59 percent). Less than one-third of women participate in all four decisions in (25 percent), (28 percent), and (29 percent). 27