Trends in Demographic
and Reproductive Health
Indicators in Ethiopia
Data from the 2000, 2005, and 2011
Demographic and Health Surveys
Trends in Demographic and
Reproductive Health Indicators
in Ethiopia
Data from the 2000, 2005, and 2011
Demographic and Health Surveys
Blake Zachary
Zhuzhi Moore
Pav Govindasamy
ICF International Inc.
Calverton, Maryland USA
February 2013
This report trends in demographic and reproductive health indicators from the 2000, 2005, and 2011
Ethiopia Demographic and Health Surveys (EDHS), which was carried out under the aegis of the Ministry
of Health (MOH) and was implemented by the Central Statistical Agency (CSA). The testing of blood
samples for HIV status was handled by the Ethiopia Health and Nutrition Research Institute (EHNRI). ICF
International provided technical assistance as well as funding to the project through the MEASURE DHS
project, a USAID funded project providing support and technical assistance in the implementation of
population and health surveys in countries worldwide. Funding for the EDHS was also provided by the
government of Ethiopia and various international donor organizations and governments: the United States
Agency for International Development (USAID), the HIV/AIDS Prevention and Control Office (HAPCO),
the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United
Kingdom Department for International Development (DFID), and the United States Centers for Disease
Control and Prevention (CDC). The opinions expressed in this report are those of the authors and do not
necessarily reflect the views of the donor organisations.
Additional information about the survey may be obtained from the Central Statistical Agency (CSA), P.O.
Box 1143, Addis Ababa, 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 programme may be obtained from MEASURE DHS, ICF
International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, U.S.A. Telephone:
1.301.572.0200; Fax: 1.301.572.0999; E-mail: reports@measuredhs.com.
Recommended citation:
ICF International Inc. 2013. Trends in Demographic and Reproductive Health Indicators in Ethiopia.
Calverton, Maryland, USA: ICF International Inc.
Cover photograph: © 2005 Virginia Lamprecht, Courtesy of Photoshare
TABLE OF CONTENTS
Tables and Figures ........................................................................................................................................................iv
1.
Introduction ..................................................................................................................................................... 1
1.1
Data Sources ..................................................................................................................................... 1
1.2
National Population Policy ............................................................................................................... 2
1.3
Health Policy and Priorities .............................................................................................................. 2
2.
Demographic, Social and Economic Indicators............................................................................................... 3
2.1
Population Size ................................................................................................................................. 3
2.2
Composition of the Household Population ....................................................................................... 4
2.3
Housing Characteristics .................................................................................................................... 6
2.4
Educational Attainment..................................................................................................................... 9
2.5
Ownership of and Exposure to Mass Media ................................................................................... 13
3.
Marriage ........................................................................................................................................................ 18
3.1
Currently Married Women and Men ............................................................................................... 18
3.2
Median Age at First Marriage ......................................................................................................... 20
3.3
Prevalence of Polygyny .................................................................................................................. 22
4.
Fertility .......................................................................................................................................................... 24
4.1
Fertility Rates .................................................................................................................................. 24
4.2
Median Age at First Birth ............................................................................................................... 26
4.3
Adolescent Fertility ......................................................................................................................... 27
5.
Fertility Preferences ...................................................................................................................................... 30
5.1
Desire for Children.......................................................................................................................... 30
5.2
Ideal Family Size ............................................................................................................................ 32
6.
Family Planning ............................................................................................................................................ 33
6.1
Knowledge of Family Planning ...................................................................................................... 33
6.2
Current Use of Family Planning ..................................................................................................... 35
6.3
Unmet Need for Family Planning ................................................................................................... 37
7.
Child Health .................................................................................................................................................. 40
7.1
Early Childhood Mortality .............................................................................................................. 40
7.2
Child Immunization ........................................................................................................................ 41
7.3
Treatment of Childhood Diseases ................................................................................................... 44
7.4
Nutritional Status of Children ......................................................................................................... 48
7.5
Anaemia Among Children .............................................................................................................. 53
8.
Maternal Health ............................................................................................................................................. 54
8.1
Antenatal Care ................................................................................................................................ 54
8.2
Tetanus Toxoid Injections ............................................................................................................... 55
8.3
Place of Delivery............................................................................................................................. 58
8.4
Nutritional Status ............................................................................................................................ 59
9.
HIV and AIDS............................................................................................................................................... 62
9.1
Comprehensive Knowledge ............................................................................................................ 62
9.2
Knowledge of Mother-to-Child Transmission ................................................................................ 63
9.3
Recent HIV Test and Result ............................................................................................................ 64
References ................................................................................................................................................................... 65
iii
TABLES AND FIGURES
Table 2.1
Trends in Basic Demographic Indicators .................................................................................. 3
Figure 2.1
Figure 2.2
Figure 2.3
Figure 2.4
Figure 2.5
Figure 2.6
Figure 2.7
Figure 2.8
Figure 2.9
Figure 2.10
Figure 2.11
Percent Distribution of Household Population, by Age Group ................................................. 4
Percentage of Female-Headed Households ............................................................................... 4
Average Household Size, by Residence .................................................................................... 5
Wealth Index, by Residence ...................................................................................................... 5
Percentage of Households with an Improved Source of Drinking Water, by Residence .......... 6
Percentage of Households with Access to Electricity, by Residence ........................................ 7
Percentage of Households with Access to Electricity, Sub-Saharan Africa .............................. 7
Percentage of Households with No Toilet, by Residence .......................................................... 8
Percentage of Households with No Toilet, Sub-Saharan Africa................................................ 8
Percentage of Women and Men Age Six and Above Who Have Never Attended School ........ 9
Percentage of Women Age Six and Above Who Have Never Attended School, by
ge Group .................................................................................................................................. 10
Percentage of Men Age Six and Above Who Have Never Attended School, by
Age Group ............................................................................................................................... 11
Percentage of Women and Men Age Six and Above Who Have Never Attended School,
Sub-Saharan Africa ................................................................................................................. 12
Age Specific School Attendance Ratios (Females/Males), by Age ......................................... 13
Percentage of Households with a Radio, by Residence ........................................................... 14
Percentage of Women and Men 15-49 Who Listen to the Radio at Least Once a Week,
by Residence ............................................................................................................................ 14
Percentage of Women 15-49 Who Listen to the Radio at Least Once a Week, SubSaharan Africa ......................................................................................................................... 15
Percentage of Households with a Television, by Residence.................................................... 15
Percentage of Women and Men 15-49 Who Watch TV at Least Once a Week, by
Residence................................................................................................................................. 16
Percentage of Women 15-49 Who Watch Television at Least Once a Week, Sub-Saharan
Africa ....................................................................................................................................... 17
Percentage of Households with a Phone, by Residence .......................................................... 17
Figure 2.12
Figure 2.13
Figure 2.14
Figure 2.15
Figure 2.16
Figure 2.17
Figure 2.18
Figure 2.19
Figure 2.20
Figure 2.21
Figure 3.1
Figure 3.2
Figure 3.3
Figure 3.4
Figure 3.5
Figure 3.6
Figure 4.1
Figure 4.2
Figure 4.3
Figure 4.4
Figure 4.5
Figure 4.6
Figure 4.7
Figure 4.8
Percentage of Women and Men 15-49 Never Married, by Age Group ................................... 18
Percentage of Women and Men 15-49 Currently Married ...................................................... 19
Median Age at First Marriage among Women and Men 25-49 ............................................... 20
Median Age at First Marriage among Women 25-49, Sub-Saharan Africa ............................ 21
Percentage of Currently Married Women and Men 15-49 in a Polygynous Union, by
Residence................................................................................................................................. 22
Percentage of Currently Married Women 15-49 in a Polygynous Union, Sub-Saharan
Africa ....................................................................................................................................... 23
Total Fertility Rate, by Residence ........................................................................................... 24
Total Fertility Rate, Sub-Saharan Africa ................................................................................. 25
Age-specific Fertility Rates, by Age Group ............................................................................ 25
Median Age at First Birth for Women 25-49, by Education ................................................... 26
Median Age at First Birth for Women 25-49, Sub-Saharan Africa ......................................... 27
Percentage of Women Age 15-19 Who Are Mothers or Pregnant with Their First Child,
by Residence ............................................................................................................................ 28
Percentage of Women Age 15-19 Who Are Mothers or Pregnant with Their First Child,
by Age ..................................................................................................................................... 28
Percentage of Women Age 15-19 Who Are Mothers or Pregnant with Their First Child,
Sub-Saharan Africa ................................................................................................................. 29
iv
Figure 5.1
Figure 5.2
Figure 5.3
Figure 5.4
Figure 6.1
Figure 6.2
Figure 6.3
Figure 6.4
Figure 6.5
Figure 6.6
Figure 6.7
Figure 6.8
Figure 6.9
Figure 7.1
Figure 7.2
Figure 7.3
Figure 7.4
Figure 7.5
Figure 7.6
Figure 7.7
Figure 7.8
Figure 7.9
Figure 7.9
Figure 7.10
Figure 7.11
Figure 7.12
Figure 7.13
Figure 7.14
Figure 7.15
Figure 8.1
Percentage of Currently Married Women and Men 15-49 Who Want No More Children,
by Residence ............................................................................................................................ 30
Percentage of Currently Married Women 15-49 Who Want No more Children, SubSaharan Africa ......................................................................................................................... 31
Mean Ideal Number of Children for Women and Men 15-49, by Residence .......................... 32
Mean Ideal Number of Children for Women 15-49, Sub-Saharan Africa ............................... 32
Percentage of Currently Married Women and Men 15-49 Who Have Heard of at Least
One Modern Method of Family Planning ................................................................................ 33
Percentage of Currently Married Women 15-49 Who Have Heard of at Least One
Method of Family Planning, by Type ...................................................................................... 34
Percentage of Currently Married Women 15-49 Who Have Heard of at Least One
Modern Method of Family Planning, Sub-Saharan Africa ...................................................... 35
Percentage of Currently Married Women 15-49 Using a Modern Method of Family
Planning, by Residence............................................................................................................ 36
Percentage of Currently Married Women 15-49 Using a Modern Contraceptive Method,
Sub-Saharan Africa ................................................................................................................. 36
Percentage of Currently Married Women 15-49 Using a Family Planning Method, by
Type ......................................................................................................................................... 37
Percentage of Currently Married Women 15-49 with an Unmet Need for Family
Planning ................................................................................................................................... 37
Percentage of Currently Married Women 15-49 with an Unmet Need for Family
Planning, by Residence............................................................................................................ 38
Percentage of Currently Married Women 15-49 with an Unmet Need for Family
Planning, Sub-Saharan Africa ................................................................................................. 39
Early Childhood Mortality Rates per 1,000 Live Births for the Five Years Preceding
he Survey ................................................................................................................................. 40
Infant Mortality Rates for the Five Years Preceding the Survey, Sub-Saharan Africa ........... 41
Percentage of Children 12-23 Months Who Received Specific Vaccines at Any Time
Before the Survey .................................................................................................................... 42
Percentage of Children 12-23 Months Who Received All Vaccines, by Residence ............... 43
Percentage of Children Age 12-23 Months Fully Immunized, Sub-Saharan Africa ............... 44
Percentage of Children Under Age Five with Diarrhoea, by Type of Treatment .................... 45
Percentage of Children Under Age Five with Diarrhoea Taken to a Health Facility or
Health Provider for Treatment, Sub-Saharan Africa ............................................................... 46
Percentage of Children Under Age Five with Symptoms of ARI and Fever Taken to a
Health Facility or Health Provider for Advice or Treatment ................................................... 47
Percentage of Children Under Age Five with Symptoms of ARI Taken to a Health
Facility or Health Provider for Advice or Treatment, Sub-Saharan Africa ............................. 48
Percentage of Children Under Age Five Stunted, by Residence ............................................. 49
Percentage of Children Under Age Five Stunted, Sub-Saharan Africa ................................... 50
Percentage of Children Under Age Five Wasted, by Residence ............................................. 50
Percentage of Children Under Age Five Wasted, Sub-Saharan Africa ................................... 51
Percentage of Children Under Age Five Underweight, by Residence..................................... 51
Percentage of Children Under Age Five Underweight, Sub-Saharan Africa .......................... 52
Percentage of Children 6-59 Months with Anaemia, by Severity and Residence ................... 53
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey, by ANC Visits for the Most Recent Pregnancy.......................................................... 54
v
Figure 8.2
Figure 8.3
Figure 8.4
Figure 8.5
Figure 8.6
Figure 8.7
Figure 8.8
Figure 8.9
Figure 9.1
Figure 9.2
Figure 9.3
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey Who Had Four or More ANC Visits for the Most Recent Pregnancy, Sub-Saharan
Africa ....................................................................................................................................... 55
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey and Who Received Two or More Doses of Tetanus Toxoid Injections During
the Last Pregnancy, by Residence ........................................................................................... 56
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey and Who Received Two or More Doses of Tetanus Toxoid Injections During
the Last Pregnancy, Sub-Saharan Africa ................................................................................. 57
Percentage of Live Births in the Five Years Preceding the Survey Delivered in a Health
Facility, by Residence.............................................................................................................. 58
Percentage of Live Births in the Five Years Preceding the Survey Delivered in a Health
Facility, Sub-Saharan Africa ................................................................................................... 59
Percentage of Women 15-49 with a Body Mass Index (BMI) <18.5 Kg/M2, by Residence .. 60
Percentage of Women 15-49 with Any Anaemia, by Severity and Residence ........................ 60
Percentage of Women 15-49 with Any Anaemia, Sub-Saharan Africa................................... 61
Percentage of Women and Men 15-49 with Comprehensive Knowledge of HIV/AIDS,
by Age Group .......................................................................................................................... 62
Percentage of Women and Men 15-49 Who Know That HIV Can be Transmitted by
Breast-feeding and the Risk of MTCT Can be Reduced by the Mother Taking Special
Drugs During Pregnancy, by Residence .................................................................................. 63
Percentage of Women and Men 15-49 Who Were Tested for HIV in the Twelve Months
Preceding the Survey and Received the Results, by Residence............................................... 64
vi
1.
INTRODUCTION
This report highlights trends in key demographic and health indicators in Ethiopia from data collected in
three demographic and health surveys: the 2000 Ethiopia Demographic and Health Survey (EDHS), the
2005 EDHS, and the 2011 EDHS. Specifically, the report discusses changes in demographic and
reproductive health outcomes over the last 11 years, including changes in fertility, knowledge and practice
of family planning, maternal and child health and nutrition, and infant and child morbidity and mortality.
In addition, this report presents data on anaemia and HIV knowledge and behaviours collected in the 2005
EDHS and 2011 EDHS. This report also compares Ethiopia with other sub-Saharan African countries that
have data from similarly conducted recent demographic and health surveys.
The primary objective of this report is to provide information needed by planners, policymakers and
program administrators to assess the current situation and trends and to design more effective population
and reproductive health programs aimed at achieving more positive outcomes in the years to come.
1.1
Data Sources
Demographic data collection in Ethiopia began with the establishment of the Central Statistical Office
(currently referred to as the Central Statistical Agency or CSA) in 1960. Population and housing censuses
of Addis Ababa and Asmara cities in 1961 and 1963 were the first socio-demographic data collection
carried out by CSA. These censuses were conducted by city authorities with technical guidance from CSA.
In these two operations, basic demographic data on fertility, mortality and migration were collected.
Following these two operations, the first round of the multi-purpose National Sample Survey started in
1964. The operations of these surveys continued for four years from 1964 to 1967, covering the settled
rural population of all the regions (except Eritrea and Bale) and 195 urban centres. The second round of the
National Sample Survey was conducted during 1969-1970 and covered the settled rural population in all
regions (except Eritrea) and 91 major urban centres. In addition, various need-based health and nutrition
surveys were also conducted in the 1980s and 1990s, including the 1982/83 Rural Health Survey, the
1982/83 Rural Nutrition Survey, and the 1992 National Rural Nutritional Surveillance System. However,
the contents and coverage of these surveys were limited; and hence, the findings were not easily
comparable nationally.
To fulfil the increasing demand for national and regional level socio-economic and demographic data, the
Ethiopian government carried out three national population and housing censuses in 1984, 1994, and 2007.
Ethiopia has conducted a number of demographic surveys. These include the 1981 Demographic Survey,
the 1990 National Family and Fertility Survey, the 1995 Fertility Survey of Urban Addis Ababa, and the
2000, 2005, and 2011 Ethiopia Demographic and Health Surveys. The 2000, 2005, and 2011 EDHS
surveys collected information on fertility, family planning, contraceptive use, maternal and child health,
nutrition and breastfeeding practices, and HIV/AIDS and other sexually transmitted diseases (STDs).
All three EDHS surveys collected data from a nationally representative sample, were conducted by the
same organization (the CSA in 2000, the Population and Housing Census Commission Office – now
merged with the CSA – in 2005, and the CSA in 2011), and were managed by the same core group of
survey personnel. The EDHS surveys were conducted as part of the worldwide Demographic and Health
Surveys project funded by the United States Agency for International Development with technical
assistance from the US-based private entity, ICF International (formally ORC Macro), which has been
monitoring the DHS surveys since its inception in the early 1980s. This consistency allows Ethiopia to be
compared with other sub-Saharan African countries which have also conducted similar DHS surveys.
1
1.2
National Population Policy
Population policies had low priority in Ethiopia until the early 1990s. In 1993 the Transitional Government
adopted a national population policy (TGE, 1993a). Since then, developments have taken place nationally
and internationally that have a direct bearing on the country’s population. The primary objective of the
1993 national population policy is to harmonize the rate of population growth with socioeconomic
development in order to achieve a high level of welfare. The main long-term objective is to close the gap
between high population growth rates and low economic productivity and to expedite socioeconomic
development through holistic, integrated programmes. Other objectives include preserving the
environment, reducing rural-to-urban migration, and reducing morbidity and mortality, particularly infant
and child mortality. Population and development has been considered as a cross cutting issue in the
Growth and Transformation Plan and emphases is given to integrating population issues in sector
development plans.
1.3
Health Policy and Priorities
Ethiopia had no health policy until the early 1960s, when a health policy initiated by the World Health
Organization (WHO) was adopted. In the mid-1970s, during the Derg regime, a health policy was
formulated with emphasis on disease prevention and control. This policy gave priority to rural areas and
advocated community involvement (TGE, 1993b). The current health policy, promulgated by the
Transitional Government, takes into account broader issues such as population dynamics, food availability,
acceptable living conditions, and other essentials of better health (TGE, 1993b).
To realize the objectives of the health policy, the government established the Health Sector Development
Programme (HSDP), which is a 20-year health development strategy implemented through a series of four
consecutive 5-year investment programmes. The first phase (HSDP I) was initiated in 1996/97. The core
elements of the HSDP include: democratisation and decentralisation of the health care system;
development of the preventive and curative components of health care; ensuring accessibility of health care
for all segments of the population; and, promotion of private sector and NGO participation in the health
sector. The HSDP prioritizes maternal and newborn care, and child health, and aims to halt and reverse the
spread of major communicable diseases such as HIV/AIDS, TB, and malaria. The Health Extension
Programme (HEP) serves as the primary vehicle for prevention, health promotion, behavioural change
communication, and basic curative care. The HEP is an innovative health service delivery program that
aims for universal coverage of primary health care services. The programme is based on expanding
physical health infrastructure and developing Health Extension Workers who provide basic preventive and
curative health services in the rural community. Thus far, the country has implemented the HSDP in three
cycles and is currently extending it into the forth programme, HSDP IV. Assessment of HSDP III shows
remarkable achievements in the expansion and construction of health facilities, and improvement in the
quality of health service provision.
HSDP IV is designed to provide massive training of health workers to improve the provision of quality
health services and the development of a community health insurance strategy for the country. In addition,
HSDP IV will prioritize maternal and newborn care, and child health, and aims to halt and reverse the
spread of major communicable diseases such as HIV/AIDS, TB and malaria (MOH 2010). In line with the
government’s current five-year national plan, the health sector continues to emphasize primary health care
and preventive services; with a focus on extending services to those who have not yet been reached and on
improving the effectiveness of services, especially addressing difficulties in staffing and the flow of drugs.
2
2.
DEMOGRAPHIC, SOCIAL AND ECONOMIC INDICATORS
2.1
Population Size
Despite Ethiopia’s long history, there were no estimates of its total population prior to the 1930s. The first
population and housing census was conducted in 1984. The 1984 census covered approximately 81% of
the population and official estimates were made for the remaining 19% (CSA 1991). A second census was
conducted in 1994 and a third in 2007 (CSA 1998; CSA 2008). Unlike the first census, the second and the
third censuses covered the entire population. Table 2.1 provides a summary of the basic demographic
indicators for Ethiopia from these three censuses.
The population has increased steadily over the last three decades, from 42.6 million in 1984 to 73.8 million
in 2007. There was a slight decrease in the population growth rates over these periods, from 3.1% per
annum in 1984 to 2.6% in 2007. Ethiopia is one of the least urbanized countries in the world; only 16% of
the population lives in urban areas. The majority of the population lives in the highland areas. More than
80% of the country’s total population lives in the regional states of Amhara, Oromiya, and SNNP.
Table 2.1
Trends in Basic Demographic Indicators
Indicator
Population (millions)
Growth rate (percent)
Density (population/km2)
Percent urban
Life expectancy
Female
Male
1984
Census1
1994
Census
2007
Census
42.6
3.12
34.0
11.4
53.5
2.9
48.6
13.7
73.8
2.6
67.1
16.1
53.4
51.1
53.5
50.9
na
na
1
Including Eritrea
Estimated from non-census data
na – not applicable
2
3
2.2
Composition of the Household Population
Age is an important demographic variable and is the primary basis of demographic classification in vital
statistics. Figure 2.1 shows the distribution of the household population in 2011 by five-year age groups.
As is typical in high fertility countries, children under 15 years of age account for a sizeable proportion
(nearly half) of the total population. A comparison of the EDHS survey findings over the last 11 years
shows little change in the age structure of the population (data not shown).
Figure 2.1
Percent Distribution of Household Population, by Age Group
80 +
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
Female
Male
20
15
10
5
0
5
10
15
20
2011 EDHS
EDHS survey findings over time indicate that approximately one-fourth of households in Ethiopia are
headed by women (Figure 2.2). This proportion has changed very little since 2000.
Figure 2.2
Percentage of Female-Headed Households
24
23
26
Female
Male
76
77
74
2000 EDHS
2005 EDHS
2011 EDHS
4
Figure 2.3 shows that the average household size has remained roughly the same (4.6 persons). However,
households in urban areas saw a slight decrease in average size in the last six years.
Figure 2.3
Average Household Size, by Residence
5.2
4.9
4.9
5.0
4.8
4.6
4.2
4.2
3.7
2000 EDHS
2005 EDHS
Total
Urban
2011 EDHS
Rural
The wealth index serves as an indicator of level of wealth that is consistent with expenditure and income
measures (Rutstein and Johnson, 2004). The index was constructed using household asset data via a
principal components analysis (Rutstein, 2008). The black line in the figure below is drawn at 20%, the
value one would expect if wealth were equally distributed across Ethiopia. Among households in rural
areas, there has been little change during the last six years in the percent among the lowest four quintiles.
Households in urban areas are disproportionately among the wealthiest with very few households among
the four lowest quintiles (Figure 2.4).
Figure 2.4
Wealth Index, by Residence
93
23 24
<1 2
23 24
1 1
Lowest
Urban 2005 EDHS
23 24
Second
22 23
5 8
1 1
Middle
Urban 2011 EDHS
Fourth
Rural 2005 EDHS
5
88
20%
10 5
Highest
Rural 2011 EDHS
2.3
Housing Characteristics
Household characteristics such as housing conditions and ownership of consumer durables serve as
indirect indicators of a household’s standard of living. Trends in these characteristics reflect a society’s
material progress, which has implications for the economic well-being and overall health status of the
population.
There has been an increase in the percent of households with access to electricity and improved source of
drinking water. Yet despite the overall increase, there continues to be a marked disparity in access to these
basic amenities by place of residence, with urban areas much more likely to have access.
An improved source of drinking water includes a piped source within the dwelling, yard, or plot; a public
tap/stand pipe, or borehole; a protected well; spring water; and rainwater (WHO and UNICEF, 2010).
Access to an improved source of drinking water has more than doubled in Ethiopia in the last 11 years
(Figure 2.5). This is largely due to a three-fold increase of an improved drinking water source among
households in rural areas.
Figure 2.5
Percentage of Households with an Improved Source of Drinking Water, by
Residence
95
92
86
54
42
35
25
26
14
2000 EDHS
2005 EDHS
Total
Urban
2011 EDHS
Rural
Note: Improved source of drinking water includes: water piped into the dwelling, yard, or
plot; public standpipes or taps; boreholes; protected wells and springs; rainwater; and
bottled water (WHO and UNICEF, 2010).
6
Access to electricity in the home has increased overall but the gap between households in urban and rural
areas is still quite large. In 2011, 85% of households in urban areas had electricity compared with only 5%
of households in rural areas (Figure 2.6).
Figure 2.6
Percentage of Households with Access to Electricity, by Residence
86
85
76
23
13
14
<1
2000 EDHS
2
5
2005 EDHS
2011 EDHS
Total
Urban
Rural
Figure 2.7 compares access to electricity in Ethiopia with access in other sub-Saharan African countries.
Ethiopia ranks in the middle when comparing households with access to electricity. For example,
households in Ghana are three times more likely to have electricity than households in Ethiopia while
households in Ethiopia are almost five times as likely to have electricity compared with households in
Burundi.
Figure 2.7
Percentage of Households with Access to Electricity, Sub-Saharan Africa
Ghana 2008
61
Sao Tome and Principe 2008-09
57
Senegal 2010-11
57
Nigeria 2008
50
Zimbabwe 2010-11
37
Kenya 2008-09
23
Ethiopia 2011
23
Madagascar 2008-09
17
Tanzania 2010
15
Sierra Leone 2008
12
Rwanda 2010
10
Malawi 2010
Burundi 2010
9
5
7
Access to toilet facilities is another important indicator of the well-being of a population. Figure 2.8 shows
that even though the overall percent of households with no toilet facilities has decreased over time, nearly
4 in 10 households have no toilets. The largest decrease is among households in rural areas where the
percent with no toilet facilities has decreased by half. Additionally, the urban-rural gap has also been
decreased by half.
Figure 2.8
Percentage of Households with No Toilet, by Residence
92
82
70
62
45
30
38
16
12
2000 EDHS
2005 EDHS
Total
2011 EDHS
Urban
Rural
Figure 2.9 shows a huge disparity among countries of sub-Saharan Africa, with respect to access to toilet
facilities. The proportion of households with no toilet is substantially higher in Ethiopia than in Rwanda
but one-third of the percent of households in Sao Tome and Principe.
Figure 2.9
Percentage of Households with No Toilet, Sub-Saharan Africa
Rwanda 2010
Burundi 2010
Malawi 2010
Kenya 2008-09
Tanzania 2010
1
4
11
12
14
Senegal 2010-11
18
Ghana 2008
18
Sierra Leone 2008
23
Zimbabwe 2010-11
26
Nigeria 2008
32
Ethiopia 2011
38
Madagascar 2008-09
43
Sao Tome and Principe 2008-09
61
8
2.4
Educational Attainment
One of the most important indicators of socioeconomic development in a country is the educational
attainment of its population. Moreover, education, especially for women, is closely linked with a number
of demographic and health outcomes including fertility, contraceptive use, and health and nutritional status
of mothers and children.
Figure 2.10 shows substantial improvement in educational attainment in the last 11 years. Nevertheless
women continue to lag behind men. The percent of women who have never attended school decreased by
more than 30% and the percent of men who have never attended school decreased almost 40%.
Figure 2.10
Percentage of Women and Men Age Six and Above Who Have Never Attended
School
77
67
62
52
52
38
Women
2000 EDHS
Men
2005 EDHS
9
2011 EDHS
In the last 11 years, the percent of women who have never attended school has decreased across all age
groups (Figure 2.11). The largest improvements are among school aged women age 7-24.
Figure 2.11
Percentage of Women Age Six and Above Who Have Never Attended School, by
Age Group
100
90
80
70
60
50
40
30
20
10
0
7-9
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
2000 EDHS
2005 EDHS
10
2011 EDHS
65+
In the last 11 years, the percent of men who have never attended school has decreased across all age groups
although not as dramatically compared with women (Figure 2.12).
Figure 2.12
Percentage of Men Age Six and Above Who Have Never Attended School, by Age
Group
100
90
80
70
60
50
40
30
20
10
0
7-9
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
2000 EDHS
2005 EDHS
11
2011 EDHS
Despite the improvement over the last six years, Ethiopian females and males rank among the lowest with
respect to educational attainment when compared with other sub-Saharan African countries. As Figure
2.13 shows, over 50% of women and nearly 40% of men in Ethiopia age six and over have never attended
school. This is noticeably higher than most other countries in the region with DHS surveys, except for
Senegal and Sierra Leone.
Figure 2.13
Percentage of Women and Men Age Six and Above Who Have Never Attended
School, Sub-Saharan Africa
Zimbabwe 2010-11
Sao Tome and Principe 2008-09
Malawi 2010
Kenya 2008-09
Madagascar 2008-09
Rwanda 2010
6
6
9
14
19
11
13
19
17
20
16
Tanzania 2010
22
27
18
Ghana 2008
31
22
Nigeria 2008
40
28
Burundi 2010
43
31
Ethiopia 2011
52
38
Senegal 2010-11
48
Sierra Leone 2008
46
Women
12
Men
57
58
School attendance is a good indication of future progress in educational attainment of a population as it
shows whether school-age children are taking advantage of the opportunity to attend school. Figure 2.14
shows the age specific attendance ratio which is the percent of females attending school divided by the
percent of males attending school at each age. A ratio of 1.00 indicates equality in the percent of females
and males attending school. Ratios greater than 1.00 indicate that there are more females attending school
compared to males. Ratios less than 1.00 indicate more males compared to females. There has been
dramatic reduction in the gender gap especially for children age 10 and older.
Figure 2.14
Age Specific School Attendance Ratios (Females/Males), by Age
1.20
More Females
1.00
More Males
0.80
0.60
0.40
0.20
0.00
7
8
9
10
11
12
13
2000 EDHS
2.5
14
15
16
2005 EDHS
17
18
19
20
21
22
23
24
2011 EDHS
Ownership of and Exposure to Mass Media
Research has shown that listening to the radio and watching television can be powerful tools to create
awareness about new technology and to stimulate the desire for information and behaviour change.
Families who own a radio or television are more likely to have greater exposure to health education
messages related to the management of common childhood diseases, infant feeding practices, and the
importance of vaccinating young children.
13
The overall percent of households with a radio increased due to a three-fold increase among rural areas
(Figure 2.15). Despite this positive trend, the survey findings indicate a continued urban-rural disparity. In
2011, almost twice as many households in urban areas owned a radio compared with households in rural
areas.
Figure 2.15
Percentage of Households with a Radio, by Residence
76
64
61
41
34
34
21
27
13
2000 EDHS
2005 EDHS
Total
2011 EDHS
Urban
Rural
Men are much more likely to listen to the radio at least once a week compared with women. Women and
men who live in urban areas are more likely to listen to the radio compared with women and men who live
in rural areas (Figure 2.16).
Figure 2.16
Percentage of Women and Men 15-49 Who Listen to the Radio at Least Once a
Week, by Residence
Women
Men
64
40
36
62
38
38
32
25
22
6
2000 EDHS
32
26
16
11
59
17
18
2011 EDHS
2000 EDHS
11
2005 EDHS
14
2005 EDHS
2011 EDHS
Ethiopia ranks lowest in women’s exposure to the radio when compared with other sub-Saharan African
countries (Figure 2.17).
Figure 2.17
Percentage of Women 15-49 Who Listen to the Radio at Least Once a Week, SubSaharan Africa
85
Sao Tome and Principe 2008-09
Kenya 2008-09
77
Ghana 2008
76
68
Rwanda 2010
63
Senegal 2010-11
Burundi 2010
58
Tanzania 2010
58
57
Malawi 2010
Madagascar 2008-09
54
Nigeria 2008
54
46
Sierra Leone 2008
33
Zimbabwe 2010-11
22
Ethiopia 2011
The survey findings show that although the proportion of urban households with a television increased
four-fold in the last 11 years, there was almost no change in the proportion of rural households with a
television (Figure 2.18).
Figure 2.18
Percentage of Households with a Television, by Residence
42
33
12
10
5
2
1
2011 EDHS
<1
2005 EDHS
<1
2000 EDHS
Total
Urban
15
Rural
Men are more likely than women to watch TV at least once a week. However, the differences are not as
pronounced as listening to the radio. The largest difference is in rural areas where men are almost twice as
likely as women to watch TV.
Figure 2.19
Percentage of Women and Men 15-49 Who Watch TV at Least Once a Week, by
Residence
Women
Men
60
51
48
40
37
22
22
16
4
1
2000 EDHS
8
8
6
1
2005 EDHS
3
2000 EDHS
2011 EDHS
16
11
11
4
2005 EDHS
2011 EDHS
Similar to radio exposure, women’s exposure to television is relatively lower in Ethiopia than in most other
sub-Saharan African countries (Figure 2.20).
Figure 2.20
Percentage of Women 15-49 Who Watch Television at Least Once a Week,
Sub-Saharan Africa
82
Sao Tome and Principe 2008-09
62
Senegal 2010-11
54
Ghana 2008
40
Nigeria 2008
36
Zimbabwe 2010-11
34
Kenya 2008-09
24
Tanzania 2010
19
Madagascar 2008-09
Malawi 2010
16
Ethiopia 2011
16
11
Sierra Leone 2008
9
Rwanda 2010
Burundi 2010
7
Household phone ownership has increased dramatically in the last 11 years from less than 1 in 100 to
nearly 3 in 10 (Figure 2.21). This is primarily due to the proliferation of mobile phones which currently
accounts for 85% of total phone ownership. Mobile phones are essentially the only phones owned by
households in rural areas. Phone ownership among households in urban areas increased eight times while
phone ownership among households in rural areas increased 13 times in the last 11 years.
Figure 2.21
Percentage of Households with a Phone, by Residence
84
40
29
8
6
1
<1
2000 EDHS
13
<1
2005 EDHS
Total
Urban
17
2011 EDHS
Rural
3.
MARRIAGE
The age at which women marry has a strong influence on fertility levels in a society because it is a
principal determinant of the length of time that women will be exposed to the risk of pregnancy during
their reproductive years. Early marriage is directly associated with the early initiation of childbearing and
high fertility which may have adverse effects on the health of mothers and newborns.
3.1
Currently Married Women and Men
In the EDHS surveys, ‘marriage’ was defined as a stable cohabitation between a man and a woman
irrespective of whether or not any validating legal, religious or customary ceremonies had been performed.
Under this definition, the term ‘never married’ excludes formal and informal unions. Figure 3.1 shows the
percent of women and men age 15-49 who have never married according to the 2011 EDHS by five-year
age groups. The survey findings show a consistent decrease in the proportion never-married as age
increases. There has been little change in Ethiopia in the last 11 years (data not shown).
Figure 3.1
Percentage of Women and Men 15-49 Never Married, by Age Group
100
80
60
40
20
0
15-19
20-24
25-29
30-34
Women
18
35-39
Men
40-44
45-49
2011 EDHS
Figure 3.2 shows the percent of women and men who were currently married or living together at the time
of each of the three EDHS surveys. The survey findings show a slight decrease in the percentage of women
age 15-49 who are currently married. However, the percent of men age 15-49 who are currently married is
slightly higher in 2011 compared with 2000.
Figure 3.2
Percentage of Women and Men 15-49 Currently Married
64
65
62
51
Women
2000 EDHS
53
Men
2005 EDHS
19
2011 EDHS
54
3.2
Median Age at First Marriage
One indicator that is used to explore trends in the timing of marriage is the median age at first marriage,
that is, the age by which 50% of women or men are married or cohabitating for the first time. The overall
median age at first marriage for Ethiopian women age 25-49 is 16.5 years, an increase from the 16.0 years
reported in the 2000 EDHS. The median age at first marriage for men age 25-49 is higher (23.1 years); it
has fluctuated somewhat in the last 11 years but has remained mostly unchanged (Figure 3.3).
Figure 3.3
Median Age at First Marriage among Women and Men 25-49
23.3
16.0
16.1
23.8
16.5
Women
2000 EDHS
Men
2005 EDHS
20
2011 EDHS
23.1
Women in Ethiopia marry at a much younger age than women in all other sub-Saharan African countries
compared in this report (Figure 3.4).
Figure 3.4
Median Age at First Marriage among Women 25-49, Sub-Saharan Africa
Rwanda 2010
21.4
Burundi 2010
20.3
Kenya 2008-09
20.0
Ghana 2008
19.8
Zimbabwe 2010-11
19.7
Senegal 2010-11
19.3
Madagascar 2008-09
18.9
Tanzania 2010
18.8
Sao Tome and Principe 2008-09
18.8
Nigeria 2008
18.3
Malawi 2010
17.8
Sierra Leone 2008
17.0
Ethiopia 2011
16.5
21
3.3
Prevalence of Polygyny
Polygyny is the practice of having more than one wife. There was an overall small but steady decrease in
the level of polygyny among women and men age 15-49 during the last 11 years in Ethiopia, mostly due to
the decrease in rural areas. The survey findings show that although rural marriages are more likely to be
polygynous than urban marriages, the proportion of polygynous marriages in urban areas changed little
during the same period (Figure 3.5).
Figure 3.5
Percentage of Currently Married Women and Men 15-49 in a Polygynous Union,
by Residence
Women
Men
15
14
12
13
11
12
9
8
7 7
6 6
5
6
1
Total
Urban
Rural
2000 EDHS
Total
2005 EDHS
22
2 2
Urban
2011 EDHS
5
Rural
Polygyny is relatively less common in Ethiopia than in most other sub-Saharan countries for which
comparable information is available (Figure 3.6).
Figure 3.6
Percentage of Currently Married Women 15-49 in a Polygynous Union,
Sub-Saharan Africa
Madagascar 2008-09
Burundi 2010
Rwanda 2010
3
6
8
Ethiopia 2011
11
Zimbabwe 2010-11
11
Kenya 2008-09
13
Malawi 2010
14
Ghana 2008
19
Tanzania 2010
21
Sao Tome and Principe 2008-09
25
Nigeria 2008
33
Senegal 2010-11
35
Sierra Leone 2008
37
23
4.
FERTILITY
Fertility is one of the three principal determinants of the size and structure of the population of a country
(the other two being mortality and migration).
4.1
Fertility Rates
The most commonly used measures of current fertility are the total fertility rate (TFR) and its component
age-specific fertility rates (ASFRs). The TFR is an estimate of the average number of births a woman
would have had at the end of her reproductive years if she bears children at the prevailing age-specific
fertility rates throughout her childbearing years (age 15-49). The ASFRs are defined in terms of the
number of live births among women in a particular age group divided by the number of woman-years in
that age group during the specific period.
Figure 4.1 presents trends in TFR in Ethiopia over the last 11 years. Overall, TFR decreased by more than
one child per woman, from 5.9 children in 2000 to 4.8 children in 2011. Fertility among women who live
in rural areas decreased steadily throughout the 11-year period whereas fertility in urban areas decreased
noticeably between 2000 and 2005 but increased slightly in 2011. The urban-rural fertility gap has
remained wide in 2011, with TFR among women in rural areas approximately twice as high as among
women in urban areas.
Figure 4.1
Total Fertility Rate, by Residence
6.4
6.0
5.5
5.9
5.4
4.8
3.3
2.6
2.4
2000 EDHS
2005 EDHS
Total
Urban
24
2011 EDHS
Rural
The TFR in Ethiopia is in the upper half of the spectrum, lower than several of other sub-Saharan African
countries compared in this report (Figure 4.2).
Figure 4.2
Total Fertility Rate, Sub-Saharan Africa
Ghana 2008
4.0
Zimbabwe 2010-11
4.1
Kenya 2008-09
4.6
Rwanda 2010
4.6
Madagascar 2008-09
4.8
Ethiopia 2011
4.8
Sao Tome and Principe 2008-09
4.9
Senegal 2010-11
5.0
Sierra Leone 2008
5.1
Tanzania 2010
5.4
Nigeria 2008
5.7
Malawi 2010
5.7
Burundi 2010
6.4
Turning to age specific fertility rates, fertility has decreased among all age groups in the last 11 years with
the sharpest decrease among women age 20-35 (Figure 4.3).
Figure 4.3
Age-specific Fertility Rates, by Age Group
300
250
200
150
100
50
0
15-19
20-24
25-29
2000 EDHS
30-34
2005 EDHS
25
35-39
40-44
2011 EDHS
45-49
4.2
Median Age at First Birth
Early initiation of childbearing has a detrimental effect on the health of the mother and the child. It also
lengthens the reproductive period, thereby increasing fertility. Figure 4.4 shows trends in the median age at
first birth by education for women age 25-49. There has been no change in overall women’s age at first
birth in Ethiopia over the last 11 years; the median age at first birth for women was 19.0 years in 2000 and
19.2 in 2011. The median age at first birth among women with no education was 18.8 years in both 2000
and 2011. However, the median age at first birth for women with secondary or higher education increased
by more than one year from 22.9 in 2000 to 24.1 in 2011.
Figure 4.4
Median Age at First Birth for Women 25-49, by Education
22.9
19.0
24.1
22.9
19.0
18.8
2000 EDHS
Total
18.7
2005 EDHS
No education
26
19.2
18.8
2011 EDHS
Secondary or higher
With the exception of Malawi, other countries have a higher median age at first birth among women age
25-49 compared with Ethiopia (Figure 4.5).
Figure 4.5
Median Age at First Birth for Women 25-49, Sub-Saharan Africa
Rwanda 2010
22.4
Burundi 2010
21.5
Senegal 2010-11
21.0
Ghana 2008
20.7
Nigeria 2008
20.4
Zimbabwe 2010-11
20.2
Madagascar 2008-09
20.1
Kenya 2008-09
19.8
Sao Tome and Principe 2008-09
19.5
Tanzania 2010
19.5
Sierra Leone 2008
19.3
Ethiopia 2011
19.2
Malawi 2010
4.3
18.9
Adolescent Fertility
The issue of adolescent fertility is important for health, demographic, and social reasons. Children born to
very young mothers face an increased risk of illness and death. Adolescent mothers themselves are more
likely than older women to suffer from severe complications during pregnancy and delivery because of
physiological immaturity.
27
Figure 4.6 presents trends in the percent of adolescent women age 15-19 who have begun childbearing—
that is they have given birth to a child or are currently pregnant with their first child. The percent of
teenage women who have begun childbearing decreased slightly in the last 11 years from 16% in 2000 to
12% in 2011. There has been a decrease in teenage childbearing among youth living in urban and rural
areas; however, the decrease is more pronounced in urban areas.
Figure 4.6
Percentage of Women Age 15-19 Who Are Mothers or Pregnant with Their First
Child, by Residence
19
18
17
16
15
12
9
7
4
2000 EDHS
2005 EDHS
Total
Urban
2011 EDHS
Rural
There has been a decrease in the percentage of teenage childbearing among women of each age in the last
11 years, with the decrease being more marked among women age 17-19 (Figure 4.7).
Figure 4.7
Percentage of Women Age 15-19 Who Are Mothers or Pregnant with Their First
Child, by Age
45
40
35
30
25
20
15
10
5
0
15
16
2000 EDHS
17
2005 EDHS
28
18
2011 EDHS
19
Figure 4.8 shows adolescent fertility among select sub-Saharan African countries. Childbearing at an early
age is relatively lower in Ethiopia than in most other sub-Saharan African countries.
Figure 4.8
Percentage of Women Age 15-19 Who Are Mothers or Pregnant with Their First
Child, Sub-Saharan Africa
Rwanda 2010
Burundi 2010
6
10
Ethiopia 2011
12
Ghana 2008
13
Kenya 2008-09
18
Senegal 2010-11
19
Sao Tome and Principe 2008-09
23
Tanzania 2010
23
Nigeria 2008
23
Zimbabwe 2010-11
24
Malawi 2010
26
Madagascar 2008-09
32
Sierra Leone 2008
34
29
5.
FERTILITY PREFERENCES
Information on fertility preferences provides insight into a couple’s attitude towards future childbearing
and desired completed family size.
5.1
Desire for Children
An important indicator of the potential demand of family planning is the percent of women who want no
more children. Figure 5.1 presents trends in the percent of currently married women and men age 15-49
who want no more children, including those who have been sterilized. Overall, the percent of currently
married women and men wanting no more children increased when compared with 2000 but decreased
when compared with 2005. The same trends are observed among women and men in urban and rural areas.
Figure 5.1
Percentage of Currently Married Women and Men 15-49 Who Want No More
Children, by Residence
Women
Men
48
42
37
40
46
41
37
32
37
34
31
29
31
33
25
Total
Urban
Rural
2000 EDHS
Total
2005 EDHS
33
28
24
Urban
Rural
2011 EDHS
Note: Women who have been sterilized are considered to want no more children. Men who have been
sterilized or who state in response to the question about desire for children that their wife has been sterilized
are considered to want no more children.
30
Figure 5.2 compares Ethiopia with other sub-Saharan African countries with respect to the percent of
currently married women who want no more children. The desire to limit childbearing is relatively higher
in Ethiopia compared with several other countries in sub-Saharan Africa.
Figure 5.2
Percentage of Currently Married Women 15-49 Who Want No more Children, SubSaharan Africa
Rwanda 2010
52
Sao Tome and Principe 2008-09
51
Kenya 2008-09
49
Madagascar 2008-09
41
Zimbabwe 2010-11
39
Malawi 2010
37
Ethiopia 2011
37
Ghana 2008
35
Burundi 2010
32
Sierra Leone 2008
30
Tanzania 2010
26
Senegal 2010-11
21
Nigeria 2008
19
31
5.2
Ideal Family Size
Another indicator of fertility preferences is the ideal number of children preferred by women and men age
15-49. There has been a noticeable decrease in the ideal average number of children reported by Ethiopian
women and men. Overall, Figure 5.3 shows that the ideal number of children decreased by one child
among woman (from 5.3 children in 2000 to 4.3 children in 2011) and about two and a half children
among men (from 6.4 children in 2000 to 4.8 children in 2011).
Figure 5.3
Mean Ideal Number of Children for Women and Men 15-49, by Residence
6.4
5.3
5.2
4.5
4.8
4.3
Women
2000 EDHS
Men
2005 EDHS
2011 EDHS
When compared with women age 15-49 in other countries in sub-Saharan Africa, Ethiopian women are
roughly in the middle regarding the ideal number of children they desire (Figure 5.4).
Figure 5.4
Mean Ideal Number of Children for Women 15-49, Sub-Saharan Africa
Rwanda 2010
3.3
Sao Tome and Principe 2008-09
3.5
Zimbabwe 2010-11
3.8
Kenya 2008-09
3.8
Malawi 2010
4.0
Burundi 2010
4.2
Ghana 2008
4.3
Ethiopia 2011
4.3
Madagascar 2008-09
4.7
Tanzania 2010
4.9
Sierra Leone 2008
5.0
Senegal 2010-11
5.2
Nigeria 2008
6.1
32
6.
FAMILY PLANNING
Information on knowledge and practice of family planning is of particular interest to policymakers,
program managers, and researchers concerned with planning and evaluating population and family
planning interventions.
6.1
Knowledge of Family Planning
Knowledge of a modern method of family planning is a precursor to the use of contraception. Figure 6.1
shows the percent of currently married women and men age 15-49 who have heard of at least one modern
method of family planning. The proportion of women and men with knowledge of a modern method of
family planning has increased steadily in the last 11 years and is nearly universal.
Figure 6.1
Percentage of Currently Married Women and Men 15-49 Who Have Heard of at
Least One Modern Method of Family Planning
85
90
2000 EDHS
93
87
2005 EDHS
Women
33
Men
97
99
2011 EDHS
Knowledge of all types of family planning methods among women age 15-49 has increased in the last 11
years (Figure 6.2). The pill was the most commonly known method in 2000 and 2005. In 2011, the most
commonly known method was injectables. There has also been a large increase in knowledge of implants,
male condoms, intrauterine devices (IUD), and female and male sterilization. The increase in knowledge is
especially pronounced for implants and male condoms.
Figure 6.2
Percentage of Currently Married Women 15-49 Who Have Heard of at Least One
Method of Family Planning, by Type
82 84
96
93
83
70
78
69
51
47
41
13
Pill
Injectables
20
Implants
2000 EDHS
29
26
29
23
10 12
Male condom
2005 EDHS
Note: Sterilization includes female and male.
34
IUD
2011 EDHS
Sterilization
24
17
Any
traditional
method
With the increase in knowledge of modern family planning methods, currently married women age 15-49
in Ethiopia are just as likely to have heard of at least one method compared with women in other subSaharan African countries (Figure 6.3).
Figure 6.3
Percentage of Currently Married Women 15-49 Who Have Heard of at Least One
Modern Method of Family Planning, Sub-Saharan Africa
Rwanda 2010
100
Malawi 2010
100
Sao Tome and Principe 2008-09
99
Burundi 2010
99
Zimbabwe 2010-11
99
Tanzania 2010
99
Ghana 2008
98
Ethiopia 2011
97
Kenya 2008-09
96
Madagascar 2008-09
95
Senegal 2010-11
6.2
93
Nigeria 2008
67
Sierra Leone 2008
66
Current Use of Family Planning
The current use of family planning measures actual contraceptive practice at the time of the survey. Trends
in current contraceptive use provide insight into one of the principal determinants of fertility and serve as a
key measure for assessing the success of national family planning program efforts.
35
As Figure 6.4 shows, current use of modern methods among currently married women age 15-49 increased
more than four times, from 6% to 27% in the last 11 years. Although women who live in urban areas are
more likely to use modern methods, a sharp increase can also be seen among women in rural areas.
Figure 6.4
Percentage of Currently Married Women 15-49 Using a Modern Method of Family
Planning, by Residence
50
42
28
27
23
14
6
11
3
2000 EDHS
2005 EDHS
Total
2011 EDHS
Urban
Rural
Use of modern contraceptive methods is much lower in Ethiopia than in several other sub-Saharan African
countries (Figure 6.5). For example, more than twice as many currently married women age 15-49 in
Zimbabwe as in Ethiopia use a modern method of contraception. At the same time, almost four times as
many Ethiopian women use a modern method as compared with women in Sierra Leone.
Figure 6.5
Percentage of Currently Married Women 15-49 Using a Modern Contraceptive
Method, Sub-Saharan Africa
Zimbabwe 2010-11
57
Rwanda 2010
45
Malawi 2010
42
Kenya 2008-09
39
Sao Tome and Principe 2008-09
34
Madagascar 2008-09
29
Tanzania 2010
27
Ethiopia 2011
27
Burundi 2010
18
Ghana 2008
17
Senegal 2010-11
12
Nigeria 2008
Sierra Leone 2008
10
7
36
When looking at specific methods, Figure 6.6 shows that use of injectables has increased dramatically
among currently married women age 15-49 who report using any method of family planning. Use of
implants also increased in the last 11 years while use of the pill has remained nearly the same.
Figure 6.6
Percentage of Currently Married Women 15-49 Using a Family Planning Method, by
Type
21
10
3
3
3
3
<1 <1
Injectables
Implants
1
Pill
2000 EDHS
6.3
2
2005 EDHS
1
2
1
Other Modern
Methods
2011 EDHS
1
1
Any Traditional
Method
Unmet Need for Family Planning
Figure 6.7 shows unmet need for family planning among currently married women age 15-49. There has
been a decrease in unmet need for limiting and spacing in the last 11 years. Overall unmet need decreased
from 37% in 2000 to 26% in 2011.
Figure 6.7
Percentage of Currently Married Women 15-49 with an Unmet Need for Family
Planning
36
37
16
17
26
10
Limiting
Spacing
21
20
2000 EDHS
2005 EDHS
17
2011 EDHS
Note: Unmet need was calculated using the revised definition (Bradley, et al., 2012).
37
Unmet need continues to be greater among women who live in rural areas. The difference between women
who live in urban and rural areas has not changed much in the last 11 years with regard for unmet need for
spacing. However, the urban-rural gap has narrowed for unmet need for limiting (Figure 6.8).
Figure 6.8
Percentage of Currently Married Women 15-49 with an Unmet Need for Family
Planning, by Residence
22
21
16
16
13
17
13
12
10
8
2005 EDHS
18
17
17
10
2000 EDHS
21
20
2011 EDHS
2000 EDHS
Limiting
8
8
2005 EDHS
2011 EDHS
Spacing
Total
Urban
Rural
Note: Unmet need was calculated using the revised definition (Bradley, et al., 2012).
38
Unmet need in Ethiopia among women age 15-49 is somewhere in the middle when compared with other
sub-Saharan African countries (Figure 6.9).
Figure 6.9
Percentage of Currently Married Women 15-49 with an Unmet Need for Family
Planning, Sub-Saharan Africa
Zimbabwe 2010-11
15
Madagascar 2008-09
19
Nigeria 2008
20
Rwanda 2010
21
Tanzania 2010
25
Kenya 2008-09
26
Malawi 2010
26
Ethiopia 2011
26
Sierra Leone 2008
28
Senegal 2010-11
30
Burundi 2010
32
Ghana 2008
36
Sao Tome and Principe 2008-09
38
Note: Unmet need was calculated using the revised definition (Bradley, et al., 2012).
39
7.
CHILD HEALTH
Childhood mortality in general and infant mortality in particular are often used as broad indicators of social
development. Trends in childhood mortality therefore contribute to a better understanding of a country’s
changing socioeconomic situation and quality of life. Because the Ethiopian government has undertaken a
number of interventions aimed at reducing childhood diseases and mortality, trend analyses provide an
opportunity to evaluate the performance of these programs.
7.1
Early Childhood Mortality
Infant, child, and under-five mortality rates obtained for the five years preceding the three EDHS surveys
confirm a decreasing trend in childhood mortality. Under-five mortality decreased by nearly 50% while
child mortality decreased by 60% over the last 11 years. Infant mortality decreased by almost 40% (Figure
7.1).
Figure 7.1
Early Childhood Mortality Rates per 1,000 Live Births for the Five Years Preceding
the Survey
166
123
97
77
49
39 37
48
88
77
59
50
38
31
22
Neonatal mortality
(NN)
Postneonatal
mortality
(PNN)
2000 EDHS
Infant mortality
(1q0)
2005 EDHS
40
Child mortality
(4q1)
2011 EDHS
Under-five mortality
(5q0)
When compared with other countries in the region, Ethiopia is in the lower third with reference to
childhood mortality (Figure 7.2). Infant mortality in Ethiopia is 55% higher than in Sao Tome and Principe
and 34% lower than in Sierra Leone.
Figure 7.2
Infant Mortality Rates for the Five Years Preceding the Survey, Sub-Saharan Africa
Sao Tome and Principe 2008-09
38
Senegal 2010-11
47
Madagascar 2008-09
48
Ghana 2008
50
Rwanda 2010
50
Tanzania 2010
51
Kenya 2008-09
52
Zimbabwe 2010-11
57
Ethiopia 2011
59
Burundi 2010
59
Malawi 2010
66
Nigeria 2008
75
Sierra Leone 2008
7.2
89
Child Immunization
Universal immunization of children from six vaccine-preventable diseases (tuberculosis, diphtheria,
whooping cough, tetanus, polio, and measles) is crucial in reducing childhood mortality. Information on
trends in vaccination coverage among children may give some indication of the success of child
immunization programs.
41
Figure 7.3 shows trends in the percent of children 12-23 months who had received specific vaccines by the
time of the survey. The proportion of children who had received all vaccinations, that is, one dose of BCG,
three doses each of DPT and polio, and one dose of measles vaccination, increased by 71% during the last
11 years. There was an increase in the coverage for all vaccines (except polio 1) with the largest increase in
measles vaccine coverage which doubled during the same period.
Figure 7.3
Percentage of Children 12-23 Months Who Received Specific Vaccines at Any Time
Before the Survey
66
60
56
46
45 44
32
37
35
35
27
21
20
24
14
BCG
DPT 3
2000 EDHS
Polio 3
2005 EDHS
42
Measles
2011 EDHS
All basic
vaccinations
The percent of children receiving all vaccines increased among children living in rural and urban areas.
However, there is still a large urban-rural gap with children in urban areas almost two and a half times
more likely to have received all basic vaccines (Figure 7.4).
Figure 7.4
Percentage of Children 12-23 Months Who Received All Vaccines,
by Residence
49
48
42
24
20
20
18
14
11
2000 EDHS
2005 EDHS
Total
Urban
43
2011 EDHS
Rural
Despite the noticeable increase in vaccination coverage among children 12-23 months in the last 11 years,
Ethiopian children rank low when compared with children in other sub-Saharan African countries. With
the exception of Nigeria, vaccination coverage among children in all other countries is noticeably higher
than in Ethiopia (Figure 7.5).
Figure 7.5
Percentage of Children Age 12-23 Months Fully Immunized, Sub-Saharan Africa
Rwanda 2010
90
Burundi 2010
83
Malawi 2010
81
Ghana 2008
79
Sao Tome and Principe 2008-09
77
Tanzania 2010
75
Kenya 2008-09
68
Zimbabwe 2010-11
65
Senegal 2010-11
63
Madagascar 2008-09
62
Sierra Leone 2008
7.3
40
Ethiopia 2011
24
Nigeria 2008
23
Treatment of Childhood Diseases
Prompt treatment of childhood diseases is an important element in improving the survival chances of
young children. Dehydration associated with severe diarrhoea is recognized as a major cause of morbidity
and mortality among young children. A simple and effective response to dehydration is a prompt increase
in the child’s fluid intake through some form of oral rehydration therapy (ORT). ORT may include the use
of a solution prepared from pre-packaged oral rehydration salts (ORS) or the use of recommended home
fluids (RHF) made at home from salt, sugar and water. Acute respiratory infection (ARI) is among the
leading causes of child morbidity and mortality in Ethiopia and throughout the world. Pneumonia is the
most serious outcome of ARI in young children. Early diagnosis and treatment with antibiotics can prevent
a large proportion of deaths that can result from pneumonia.
44
Figure 7.6 shows that among children under age five who had diarrhoea in the two weeks preceding the
survey, there has been a noticeable and steady increase in the percent of children who were taken to a
health facility or health provider. On the other hand, both the percent of children with diarrhoea who were
treated with ORS or RHF and those that did not receive any treatment increased substantially between
2000 and 2005 and then decreased somewhat between 2005 and 2011.
Figure 7.6
Percentage of Children Under Age Five with Diarrhoea, by Type of Treatment
49
39
32
32
22
42
31
19
13
Health facility or health
provider
Either ORS or RHF
2000 EDHS
2005 EDHS
No treatment
2011 EDHS
Note: Health provider excludes pharmacy, shop and traditional practitioner.
45
Figure 7.7 shows that Ethiopia has the lowest percentage of children under age five with diarrhoea in the
two weeks preceding the survey who were taken for advice or treatment to a health facility or provider
when compared with other sub-Saharan African countries. For example, children living in Malawi are
almost twice as likely to be taken to a health facility or health provider when they have diarrhoea as
Ethiopian children.
Figure 7.7
Percentage of Children Under Age Five with Diarrhoea Taken to a Health Facility or
Health Provider for Treatment, Sub-Saharan Africa
Malawi 2010
62
Burundi 2010
57
Ghana 2008
57
Sao Tome and Principe 2008-09
51
Kenya 2008-09
49
Tanzania 2010
48
Sierra Leone 2008
47
Nigeria 2008
42
Rwanda 2010
37
Zimbabwe 2010-11
36
Senegal 2010-11
35
Madagascar 2008-09
34
Ethiopia 2011
32
46
The practice of seeking medical advice or treatment for children who had symptoms of acute respiratory
infections (ARI) or fever in the last two weeks is very low in Ethiopia. Less than 3 in 10 children who had
symptoms of ARI or fever were taken to a health facility or health provider for advice or treatment (Figure
7.8). Nevertheless, there has been a noticeable increase in the percent of ill children taken to a health
facility or health provider for advice or treatment in the last 11 years.
Figure 7.8
Percentage of Children Under Age Five with Symptoms of ARI and Fever Taken to a
Health Facility or Health Provider for Advice or Treatment
27
24
19
18
18
16
ARI
2000 EDHS
Fever
2005 EDHS
47
2011 EDHS
Ethiopia ranks lowest in seeking advice and treatment for children with ARI when compared with other
sub-Saharan African countries. Almost three times as many children were taken to a health facility or
health provider when they had ARI symptoms in Sao Tome and Principe and Malawi as in Ethiopia
(Figure 7.9).
Figure 7.9
Percentage of Children Under Age Five with Symptoms of ARI Taken to a Health
Facility or Health Provider for Advice or Treatment, Sub-Saharan Africa
Sao Tome and Principe 2008-09
75
Malawi 2010
70
Ghana 2008
60
Kenya 2008-09
56
Burundi 2010
55
Rwanda 2010
50
Senegal 2010-11
50
Zimbabwe 2010-11
48
Sierra Leone 2008
46
Nigeria 2008
45
Madagascar 2008-09
42
Tanzania 2010
31
Ethiopia 2011
7.4
27
Nutritional Status of Children
Nutritional status is an important indicator of children’s’ overall health and well-being. Childhood
undernutrition results from prolonged and improper treatment of illness and inadequate food intake, and
undernourished children are at a greater risk of dying than well-nourished children. Children’s nutritional
status in the EDHS surveys was assessed from measurements of their height and weight. From these
measurements, three indices of nutritional status were calculated: height-for-age or stunting measures
chronic malnourishment; weight-for-height or wasting measures acute malnourishment; and weight-forage, a composite index of acute and chronic malnourishment, measures the percent of children who are
underweight.
48
Figure 7.9 shows a small decrease in the percent of children under age five who are stunted or too short for
their age, that is, whose height-for-age is below minus two standard deviations from the median of the
WHO reference population (WHO, 2006). The percent of children who are stunted has decreased by 24%
between 2000 and 2011. Children in rural areas are more likely to be stunted than children in urban areas
and the decrease was slightly greater among children in urban areas.
Figure 7.9
Percentage of Children Under Age Five Stunted, by Residence
59
58
52
46
51
48
44
2000 EDHS
Total
33
32
2005 EDHS
2011 EDHS
Urban
49
Rural
Ethiopian children are more likely than children in most other sub-Saharan African countries to be stunted
(Figure 7.10). Only Malawi and Burundi have higher proportions of stunting among children under age
five than Ethiopia.
Figure 7.10
Percentage of Children Under Age Five Stunted, Sub-Saharan Africa
Senegal 2010-11
27
Ghana 2008
28
Sao Tome and Principe 2008-09
29
Zimbabwe 2010-11
32
Kenya 2008-09
35
Sierra Leone 2008
36
Nigeria 2008
41
Tanzania 2010
42
Rwanda 2010
44
Ethiopia 2011
44
Malawi 2010
47
Burundi 2010
58
There has been a decrease in the overall percent of children who are wasted that is, whose weight-forheight is below minus two standard deviations from the median of the WHO reference population (WHO,
2006). Children in rural areas are more likely to be wasted than children in urban areas (Figure 7.11).
Figure 7.11
Percentage of Children Under Age Five Wasted, by Residence
13
12
7
13
12
2000 EDHS
9
10
10
2005 EDHS
Total
Urban
50
6
2011 EDHS
Rural
The proportion of children who are wasted in Ethiopia is three times higher than in Rwanda and Zimbabwe
which have the lowest proportion of children wasted among the 12 countries compared here (Figure 7.12).
Figure 7.12
Percentage of Children Under Age Five Wasted, Sub-Saharan Africa
Rwanda 2010
3
Zimbabwe 2010-11
3
Malawi 2010
Tanzania 2010
Burundi 2010
Kenya 2008-09
4
5
6
7
Ghana 2008
9
Ethiopia 2011
10
Senegal 2010-11
10
Sierra Leone 2008
10
Sao Tome and Principe 2008-09
11
Nigeria 2008
14
The proportion of children who are underweight (whose weight-for-age is below minus two standard
deviations from the median of the WHO reference population) in Ethiopia has decreased over the last 11
years by approximately 30% (WHO, 2006). Much of this decrease was between 2000 and 2005. Again, the
proportion underweight is higher among children in rural than urban areas (Figure 7.13).
Figure 7.13
Percentage of Children Under Age Five Underweight, by Residence
43
41
34
30
33
29
28
2000 EDHS
Total
17
16
2005 EDHS
2011 EDHS
Urban
51
Rural
Figure 7.14 shows that Ethiopian children are the most likely to be underweight when compared with other
sub-Saharan African countries, except for Burundi, that has the same percent. The proportion of Ethiopian
children who are underweight is about three times the proportion of Zimbabwean children who are
underweight.
Figure 7.14
Percentage of Children Under Age Five Underweight, Sub-Saharan Africa
Zimbabwe 2010-11
Rwanda 2010
10
11
Malawi 2010
13
Sao Tome and Principe 2008-09
13
Ghana 2008
14
Tanzania 2010
16
Kenya 2008-09
16
Senegal 2010-11
18
Sierra Leone 2008
21
Nigeria 2008
23
Ethiopia 2011
29
Burundi 2010
29
52
7.5
Anaemia Among Children
Anaemia is a condition characterised by a low level of haemoglobin in the blood. Haemoglobin is
necessary for transporting oxygen to tissues and organs in the body. Approximately half the global burden
of anaemia is due to iron deficiency. Iron deficiency, in turn, is largely due to an inadequate dietary intake
of bioavailable iron, inadequate dietary iron during periods of increased iron requirements (such as
childhood), increased blood loss due to hookworm infestation, and infections such as malaria. Nutritional
anaemia includes anaemia due to deficiency in iron plus deficiencies in folate, vitamins B and B12, and
certain trace elements involved with red blood cell production. Anaemia in children is associated with
impaired mental and physical development and with increased morbidity and mortality.
The prevalence of any anaemia among children 6-59 months has decreased since 2005 from 53% to 44%
in 2011. The proportion of any anaemia among children living in rural areas decreased from 55% to 46%,
due in large part to a reduction in moderate anaemia. All types of anaemia are more prevalent among
children living in rural areas than in urban areas (Figure 7.15).
Figure 7.15
Percentage of Children 6-59 Months with Anaemia, by Severity and Residence
53
4
4
55
44
3
47
4
46
36
28
20
2
3
29
21
25
18
21
21
18
16
2005 EDHS
2011 EDHS
2005 EDHS
2011 EDHS
Total
Mild anaemia (10.0-10.9 g/dl)
Urban
Moderate anaemia (7.0-9.9 g/dl)
53
22
22
2005 EDHS
2011 EDHS
Rural
Severe anaemia (< 7.0 g/dl)
8.
MATERNAL HEALTH
Child survival is directly linked to access to professional maternity care. In addition, there is overwhelming
evidence to support the benefits of professional maternity care in lowering maternal mortality.
8.1
Antenatal Care
Regular antenatal check-ups from trained health providers are necessary to monitor the progress of a
pregnancy and identify early on if a woman shows signs of complications. It is commonly recommended
that a woman see a trained health provider at least four times during her pregnancy.
Figure 8.1 shows an increase in the utilization of antenatal care services by pregnant women in the 11
years between the 2000 and 2011 surveys. During the same period, the percent of women who made four
or more ANC visits nearly doubled and the percentage who did not go for an ANC visit decreased,
especially between 2005 and 2011.
Figure 8.1
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey, by ANC Visits for the Most Recent Pregnancy
73 72
57
19
6
None
5
5
1
2000
2005
54
19
10 11
10 12
2-3
4+
2011
Ethiopia ranks lowest in the utilization of antenatal care services when compared with other sub-Saharan
African countries. The proportion of women age 15-49 in Ghana who had four or more ANC visits during
their last live birth is nearly four times higher when compared with Ethiopia (Figure 8.2).
Figure 8.2
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey Who Had Four or More ANC Visits for the Most Recent Pregnancy, SubSaharan Africa
Ghana 2008
78
Sao Tome and Principe 2008-09
72
Zimbabwe 2010-11
65
Sierra Leone 2008
56
Senegal 2010-11
50
Madagascar 2008-09
49
Kenya 2008-09
47
Malawi 2010
46
Nigeria 2008
45
Tanzania 2010
43
Rwanda 2010
35
Burundi 2010
Ethiopia 2011
8.2
33
19
Tetanus Toxoid Injections
Neonatal tetanus is a leading cause of neonatal deaths in Ethiopia and other developing countries where a
high proportion of deliveries are conducted at home or in other places where hygienic conditions do not
exist. Tetanus toxoid (TT) immunisation is given to pregnant women to prevent neonatal tetanus. If a
woman has received no previous TT injections, she needs two doses of TT during pregnancy for full
protection.
55
Between 2000 and 2011, there has been a marked improvement in the percent of women who had two or
more doses of TT injections during their last pregnancy and a reduction in the urban-rural gap (Figure 8.3).
Figure 8.3
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey and Who Received Two or More Doses of Tetanus Toxoid Injections During
the Last Pregnancy, by Residence
52
52
41
31
26
34
28
14
17
2000 EDHS
2005 EDHS
Total
Urban
56
2011 EDHS
Rural
The proportion of women in Ethiopia who received at least two doses of TT injections during their most
recent pregnancy is among the lowest when compared with other sub-Saharan countries. The percent of
women receiving two or more doses of TT injections is more than twice as high in Malawi and Sierra
Leone as in Ethiopia (Figure 8.4).
Figure 8.4
Percentage of Women 15-49 Who Had a Live Birth in the Five Years Preceding the
Survey and Who Received Two or More Doses of Tetanus Toxoid Injections During
the Last Pregnancy, Sub-Saharan Africa
Sierra Leone 2008
75
Malawi 2010
69
Senegal 2010-11
57
Ghana 2008
56
Kenya 2008-09
55
Sao Tome and Principe 2008-09
52
Tanzania 2010
48
Madagascar 2008-09
47
Nigeria 2008
45
Zimbabwe 2010-11
45
Rwanda 2010
34
Ethiopia 2011
34
Burundi 2010
32
57
8.3
Place of Delivery
An important contributor to lowering the health risks to mothers and children associated with a pregnancy
is increasing the proportion of babies delivered in a health facility and under the supervision of a health
professional. Figure 8.5 presents trends in the percent of live births in the five years preceding the survey
delivered at a health facility.
Only 1 in 25 live births among women in rural areas are delivered in a health facility compared with half of
live births among women in urban areas. However, the overwhelming majority of births in Ethiopia (90%)
continue to take place at home.
Figure 8.5
Percentage of Live Births in the Five Years Preceding the Survey Delivered in a
Health Facility, by Residence
50
42
32
10
5
5
2000 EDHS
2
2005 EDHS
4
2
Total
Urban
58
2011 EDHS
Rural
Figure 8.6 shows that Ethiopia ranks lowest in terms of delivery at a health facility when compared with
the other sub-Saharan countries included in this report. The percent of births delivered in a health facility is
more than seven times higher in Senegal, Malawi, and Sao Tome and Principe than in Ethiopia.
Figure 8.6
Percentage of Live Births in the Five Years Preceding the Survey Delivered in a
Health Facility, Sub-Saharan Africa
Sao Tome and Principe 2008-09
79
Malawi 2010
73
Senegal 2010-11
73
Rwanda 2010
69
Zimbabwe 2010-11
65
Burundi 2010
60
Ghana 2008
57
Tanzania 2010
50
Kenya 2008-09
43
Madagascar 2008-09
35
Nigeria 2008
35
Sierra Leone 2008
Ethiopia 2011
8.4
25
10
Nutritional Status
Maternal nutritional status has important implications for the health of mothers and children. Women with
poor nutritional health face a greater risk of an adverse pregnancy and are more likely to give birth to
children who are not healthy. Body mass index (BMI) is an important indicator of adult nutritional status
and is defined as weight in kilograms divided by height in metres squared (kg/m2). A cut-off point of 18.5
is used to define thinness or acute undernutrition.
59
Although the percent of women who are malnourished decreased between the 2000 and 2005 EDHS, the
survey findings show basically no change between the 2005 and 2011 surveys. Almost 3 in 10 women age
15-49 have a BMI below 18.5. The percent of women with a low BMI is somewhat higher among women
in rural than in urban areas (Figure 8.7).
Figure 8.7
Percentage of Women 15-49 with a Body Mass Index (BMI) <18.5 Kg/M2, by
Residence
32
30
27
28
27
29
23
20
19
Total
Urban
2000 EDHS
Rural
2005 EDHS
2011 EDHS
Note: Excludes pregnant women and those who had a birth in the two months before the survey.
Anaemia in pregnant women results in an increased risk of premature delivery and low birth weight. The
percent of any anaemia among women age 15-49 decreased in Ethiopia in the last six years, with a
reduction in both mild and moderate anaemia. The total percent of any anaemia among women decreased
from 26% in 2005 to 17% in 2011 (Figure 8.8).
Figure 8.8
Percentage of Women 15-49 with Any Anaemia, by Severity and Residence
1
28
1
26
9
8
1
17
3
1
1
18
18
4
3
<1
11
17
13
2
18
14
13
9
2005 EDHS
2011 EDHS
Total
Mild anaemia (10.0-10.9 g/dl)
2005 EDHS
2011 EDHS
Urban
Moderate anaemia (7.0-9.9 g/dl)
60
2005 EDHS
2011 EDHS
Rural
Severe anaemia (< 7.0 g/dl)
The percent of women age 15-49 with any anaemia in Ethiopia is the lowest of the sub-Saharan countries
compared here, except for Rwanda which has the same percent. The prevalence of anaemia is much higher
in most other sub-Saharan countries (Figure 8.9).
Figure 8.9
Percentage of Women 15-49 with Any Anaemia, Sub-Saharan Africa
Ethiopia 2011
17
Rwanda 2010
17
Burundi 2010
19
Zimbabwe 2010-11
28
Malawi 2010
29
Madagascar 2008-09
35
Tanzania 2010
40
Sao Tome and Principe 2008-09
43
Sierra Leone 2008
45
Senegal 2010-11
54
Ghana 2008
59
61
9.
HIV AND AIDS
Acquired immune deficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV).
HIV weakens the immune system making the body susceptible to secondary and opportunistic infections.
Without treatment, HIV infection leads to AIDS and death. The predominant mode of HIV transmission is
through sexual contact. Other modes of transmission are mother-to-child transmission (in which the mother
passes HIV to her child during pregnancy, delivery, or breastfeeding), use of contaminated blood supplies
for transfusions, and injections using contaminated needles or syringes.
HIV/AIDS is one of the most serious public health and development challenges in sub-Saharan Africa.
HIV/AIDS is now affecting all sectors of Ethiopian society. The future course of the HIV/AIDS epidemic
in Ethiopia depends on a number of factors including HIV/AIDS-related knowledge, social stigmatisation,
risk behaviour modification, access to high-quality services for sexually transmitted infections, provision
and uptake of HIV counselling and testing, and access to antiretroviral therapy.
9.1
Comprehensive Knowledge
Comprehensive knowledge about HIV/AIDS is defined as (1) knowing that both condom use and limiting
sex partners to one uninfected partner are HIV prevention methods, (2) being aware that a healthy-looking
person can have HIV, and (3) rejecting the two most common local misconceptions in Ethiopia—that HIV
can be transmitted through mosquito bites and by supernatural means.
Comprehensive knowledge of HIV/AIDS has increased since 2005 among both women and men age 1549. However, men continue to have greater knowledge at every age group than women. The largest
increase in knowledge has been observed among men age 25-29 (Figure 9.1).
Figure 9.1
Percentage of Women and Men 15-49 with Comprehensive Knowledge of
HIV/AIDS, by Age Group
Women
Men
40
40
30
30
20
20
10
10
0
0
15-19
20-24
25-29
30-39
40-49
15-19
62
20-24
25-29
30-39
40-49
9.2
Knowledge of Mother-to-Child Transmission
Increasing knowledge of ways in which HIV can be transmitted from mother to child and of the fact that
the risk of transmission can be reduced by using antiretroviral drugs is critical to reducing mother-to-child
transmission (MTCT) of HIV.
Knowledge of MTCT in Ethiopia has increased nearly two-fold for women and men age 15-49 in the last
six years. Women and men living in urban areas are more likely to know about MTCT compared with
those living in rural areas (Figure 9.2).
Figure 9.2
Percentage of Women and Men 15-49 Who Know That HIV Can be Transmitted by
Breast-feeding and the Risk of MTCT Can be Reduced by the Mother Taking Special
Drugs During Pregnancy, by Residence
Women
Men
71
67
53
52
47
42
20
26
32
41
21
13
2005 EDHS
2011 EDHS
2005 EDHS
63
2011 EDHS
9.3
Recent HIV Test and Result
Knowledge of their HIV status helps HIV negative individuals make specific decisions to reduce their risk
and increase safer sex practices so that they can remain free of the disease. For those who are infected with
HIV, knowledge of their status allows them to take action to protect their sexual partners, to seek
treatment, and to plan for the future.
In 2011 in Ethiopia, 1 in 5 women and men were tested for HIV and received their result during the year
preceding the survey (Figure 9.3). This figure is 10 times higher than that observed in 2005, showing an
increased awareness and utilization of opportunities for HIV testing and learning one’s HIV status.
Figure 9.3
Percentage of Women and Men 15-49 Who Were Tested for HIV in the Twelve
Months Preceding the Survey and Received the Results, by Residence
Women
Men
36
30
21
20
18
15
8
2
Total
Urban
8
1
2
Rural
Total
2005 EDHS
64
2011 EDHS
1
Urban
Rural
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Bradley, S.E.K., Trevor N. Croft, Joy D. Fishel, and Charles F. Westoff. 2012. Revising Unmet Need for
Family Planning. DHS Analytical Studies No. 25. Calverton, Maryland, USA: ICF International.
Central Statistical Agency (CSA). [Ethiopia]. 2008. The 2007 Population and Housing Census of Ethiopia.
Statistical Summary Report at National Level. Addis Ababa, Ethiopia: Central Statistical Agency.
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