 |
|
International Reproductive Health Surveys and Comparative Reports:
Surveys and Comparative Reports: Paraguay 2004 Reproductive Health
Survey |
|
Back to Surveys and
Comparative Reports
Paraguay 2004 Reproductive Health Survey, Final Report
English Language Executive Summary
Background
The 2004 national Survey of Demography and
Reproductive and Sexual Health, ENDSSR—2004, was conducted by the Paraguayan
Center of Population Studies
(CEPEP), with the cooperation of the United States Agency of International
Development (USAID), the United Nations Population Fund (UNFPA), the
International Planned Parenthood Federation (IPPF), and with the technical
assistance of the Division of Reproductive Health of the Centers for Disease
Control and Prevention (CDC) in Atlanta, Georgia USA. It is the fifth of a
series of surveys on this topic carried out at the national level by CEPEP,
with the objective of maintaining periodic evaluation of maternal and child
health topics and updating principal programmatic indicators. The results
obtained allow the Ministry of Health, NGOs and donor agencies to have the
updated current status of the reproductive health situation in the country
and makes possible the comparison of results with other national and
international surveys.
For ENDSSR 2004 a Master sample maintained by CEPEP was utilized as a
sampling frame. This master sample was created in 2001 based on census data
and all primary sampling units were updated in the field between August and
September 2003. For the first time, field work was assisted by
geo-referenced maps produced by CEPEP with cooperation of USAID. Each field
supervisor and team supervisor had a Geographic Position System (GPS) unit
that contained the location of the households in the 352 clusters that made
up the sample. The GPS units assisted in the location of sample households
in less time and with more reliability in each sample cluster than in
previous surveys.
As in past surveys in Paraguay, ENDSSR 2004 was implemented in the Eastern
region of the country, plus the Villa Hayes district as part of Metropolitan
Asuncion, but excluded the rest of the Chaco (Western Region) due to the low
density and dispersion of the population. About 98 percent of the population
is concentrated in the Eastern Region. The sampling design included a
three-stage probability sample selection self-weighted at the level of four
regions of Eastern Paraguay: (1) Metropolitan Asuncion, (2) North, (3) South
Central, excluding districts that are part of Metropolitan Asuncion, and (4)
East. This design permits estimations at the national level, urban and rural
areas and the four regions.
A total of 12,236 households were selected in the sample of which 10,792
were occupied. In these households, 7,519 eligible women (15–44 years of
age) were identified in the household questionnaire, and the individual
questionnaire was successfully completed for 7,321 of them (97.4%). Less
than one percent of eligible women refused to be interviewed and 1.2% were
not found for interview after up to three visits to each household. In
addition, information was obtained for 4,025 children less than five years
of age.
Household and
Respondent Characteristics
The results show that 78% of families own
their own households; 87% in rural areas and 72% in urban areas. Two-thirds
(67%) of households receive drinking water through household connections,
including 55% inside the house and 12% in the patio. More than 90% of the
households have household connections in Metropolitan Asuncion compared with
a range of 49% in the Eastern region to 69% in the Central-South region.
Almost two-thirds (65%) of households have a bathroom connected to a public
network or septic tank. This percentage ranges from 92% in Metropolitan
Asuncion to 60% in the Eastern region, 58% in the Central-South region and
30% in the North region. Almost all households (96%) report having
electricity and 58% report using gas for cooking meals.
An improvement in educational attainment was found compared with ENSMI-1998,
the last survey. The percentage of women with 12 years or more education
increased from 21% to 33% and the percentage with less than 3 years of
education decreased by 50% from 8% to 4%.
Slightly more than one-half of women (54%) are married (33%) or in a
consensual union (21%) and 39% have never been married or in a consensual
union. Only 11 percent of adolescents 15–19 years of age report that they
are married or in a consensual union. As reported below, 44% of 40-44 year
olds married before 20 years of age compared with 33% of 20-24 year olds.
Thirty percent of respondents report that the family normally speaks guarani
in the household and 36% speak both guarani and spanish; 31% speak only
spanish in the household and 3% speak other languages, principally
Portuguese (2%; 6% in the Eastern region).
Fertility
Paraguay has had an important decline in the Total Fertility Rate (TFR)
between 1998 and 2004. The survey data show that the TFR has declined from
3.9 children per women in the period from 1995–1998 to 3.4 from 1998–2001 to
2.9 from 2001–2004. This decline is inversely related to the significant
increase in the education level of Paraguayan women and increase in the
prevalence of modern methods of contraception.
As in the past, there still exist important differences in fertility by
residence, educational attainment, socioeconomic status (SES) and language
usually spoken in the home: the TFR for women in urban areas is 2.5 compared
with 3.7 for women in rural areas; the TFR for women with less six years of
education is 4.2 compared with 2.1 for women with 12 or more years of
education; the TFR is 5.4 for women in the very low category of SES compared
with only 1.9 for women classified as very high; If only guarani is usually
spoken in the home, the TFR is 3.9 versus 2.3 in homes where only spanish is
spoken.
Also contributing to the decline in fertility is the later age of marriage.
The proportion of women who married before 20 years of age has declined from
44% of 40–44 year old women in the sample to 33% of 20–24 year olds. At the
same time, the proportion of women 40–44 years of age having their first
birth before 20 years of age is 38% compared with 28% of 20–24 year old
women.
Family
Planning
Contraceptive prevalence among married women 15–44 years of age is 72.8
percent. This finding represents over a 90% increase in prevalence since
1987 when contraceptive prevalence was 37.6%. Contraceptive use increased by
27%, from 57.4% to 72.8%, since the last survey in 1998. The increase
recorded in rural areas since 1998 was higher, increasing by 48% from 49.3%
to 67.4%.
In spite of the increase in contraceptive use since 1998, there still exist
important differences by residence and region. Even with the greater
increase in contraceptive use in rural areas, prevalence in urban areas
(77%) is still higher than in rural areas (67%). Prevalence is lowest in the
mostly rural Northen Region at 61% compared with 76% in the Central-South
region, 75% in metropolitan Asuncion and 73% in the Eastern region.
Continued significant differences were also found by educational attainment
and socioeconomic status (SES). Only 61% of women with less than three years
of education use contraception compared with 80% of women with at least 12
years of education. A similar difference is found by SES with 63% of lower
SES women using contraception compared with 80% of high SES women.
As in past surveys, the pharmacy is the principal source of contraception
(50%). Almost one-third of couples (32%) obtain their methods in the public
sector, including 27% in Ministry of Health facilities. Most condom, pill
and injectable users went to pharmacies and most IUD and sterilization users
used public-sector facilities.
Non-Users and
Need for Services
Twenty-seven percent of married women were not using contraception at the
time of the survey. Of these women, 86% reported reasons related to
pregnancy, sub-fecundity or not being sexually active as the reason for
non-use. Also, 84% reported their intention to use contraception at some
time in the future and 97% of them know where to obtain contraception.
Of all women, 15% are estimated to be at risk of an unintended pregnancy and
are estimated to be in need of a modern method. This includes 6% of
non-users and 9% of women using traditional methods. The percentage in need
of a modern method is higher in rural areas (17%) and the Northern Region
(18%). Restricting the denominator to married women, 19% are in need of a
modern method with higher proportions in rural areas (23%) and in the
Northern Region (24%).
Adolescents
and Young Adults
More than one-half (56%) of adolescents and young adult women (15-24 years
of age) report that they have had sexual relations and 54% of them had
premarital sex at the time of their first sexual experience (prior to first
marriage or consensual union). The proportion of sexually experienced young
women 15–24 years of age have had a significant increase in premarital
sexual experience increasing from 35% in 1987 to 54% in 2004. Premarital
sexual experience in urban areas is higher in urban areas (58%) than in
rural areas (45%). Young women reporting premarital sexual experience have
had their sexual debut at a younger age than women reporting sexual debut at
marriage: 33% before 16 years of age and 35% at 16–17 years of age.
The proportion of young women using contraception at their first premarital
sexual experience increased by almost 10 percentage points in each of the
surveys conducted in 1987, 1995 and 1998. In the last six years, the
proportion using contraception at first premarital sex increased by more
than 20 percentage points, from 33% to 58%. Young adults and adolescents in
urban areas (62%) report a much higher percentage of contraceptive use at
first premarital sex than those living in rural areas ((47%). Condoms are
the principal method used.
About 80% of women 15–24 years of age reported receiving a course or lecture
on sex education in or out of the school environment representing an
important increase over previous surveys, increasing from 52% in 1995 to 61%
in 1998 to 80% in 2004.
Maternal
Health
Detailed information was obtained on all births reported between March 1999
and February 2004 and 94% of mothers reported that they had at least one
prenatal visit, 6 percentage points higher than 88% reporting prenatal care
in 1998. However, 10% of women 15–19 years of age, women living in
households where Guarani is the principal language spoken or women living in
the Northen region reported no prenatal care. The worst situation was found
for women with less than three years of education: 17% not receiving
prenatal care.
Almost three-fourths (71%) of women reported five or more prenatal visits,
but only 69% began prenatal care in the first trimester.
In Paraguay, the percentage of births in medical institutions has increased
significantly from 56% in 1998 to 74% in 2004. The range by region is from
60% in the Northern Region to 92% in Metropolitan Asuncion. Almost one-half
of the births (45%) were realized in Ministry of Health institutions, 16% in
private hospitals, and 7% in facilities belonging to the Institute of Social
Security. One-quarter (27%) of the births were delivered by cesarean
section, a significant increase since 1998 when 17% were reported to be
cesarean deliveries.
Almost all women (99%) with sexual experience know about PAP smears of which
70% have had a PAP test at sometime during their life. Of those with a PAP
test, 73% have had one in the last two years. Most PAP tests were realized
in public sector facilities (67%) and one-fourth (26%) in private
facilities. Six percent of women had their test in either CEPEP facilities
or in Brazil or Argentina.
Infant and Child Health
Of all live births between March 1999 and
February 2004, 93% of mothers reported that their baby was weighed at the
time of birth; 9% were reported to be less than 2500 grams.
Breastfeeding is almost universal in Paraguay considering that 95% of births
were breast-fed; 16% began breastfeeding within 10 minutes of birth and 23%
within one hour. Another 42% initiated breastfeeding before 24 hours after
birth. The average duration of breastfeeding is 11.8 months similar to the
average reported in the 1995 and 1998 surveys. Most breastfeeding was
suspended between 4 to 11 months (39%) or between 12 and 23 months (36%) of
age. The main reason for terminating breastfeeding for infants between 4 and
11 months was the mother returning to either work or school (64%). For those
between 12 and 23 months, the baby was most often considered to be “too big”
(61%).
Of infants less than 6 months of age, 22% were exclusively breast-fed and
28% predominantly breast-fed. The practice of exclusive breastfeeding was
highest among mothers in the Eastern Region and Metropolitan Asuncion and
those classified in the highest SES.
Two-thirds (65%) of children between 12 and 23 months of age were reported
to completely vaccinated, that is they have received a complete series of
BCG, polio, DPT and measles. In 1995, the last time immunization data was
collected, only 50% were reported to be completely vaccinated.
The infant mortality rate for the period 1999–2004 is estimated to be 29 per
1000 live births, similar to the estimate of 27/1000 for the period
1990–1995 in the 1995 survey. However, there is no significant difference
between these two estimates.
Knowledge,
Attitudes, and Behavior Related To STI's and HIV/AIDS
In Paraguay, with the exception of HIV/SIDA,
women 15–44 years of age have relatively low knowledge of sexually
transmitted infections (STIs). Without probing, only 41% of women could cite
a STI. After probing, 95% said that they have heard of at least one STI. The
infection most known after probing was syphilis (77%) followed by gonorrhea
(73%), vaginal drainage (67%) and fungal infection (58%). Less than half of
women knew of other infections associated with STIs.
When asked about HIV/AIDS, 99% of women had heard of AIDS, of which 88%
responded spontaneously that they knew about HIV/AIDS before probing.
Nevertheless, many women have a superficial knowledge about the infection
and disease. Six percent of women think that there is a cure for AIDS and
21% think that someone has to be ill with symptoms when they are infected
with the virus.
Also, in spite of the high percentage of women who say they know about AIDS,
only 2% of women could spontaneously mention all three of the principal
modes of transmission. When probed, this percentage increases to 79%. This
substantial difference in knowledge of modes of transmission between
spontaneous and probed approaches brings up the question of methodological
differences in questionnaire design.
Almost one-fourth of women (22%) with knowledge of AIDS say that they have
some risk of contracting HIV/AIDS: 21% a moderate risk and 2% high risk.
Among those saying that they have no risk, the main reasons are: confidence
in their partner (33%), sexually inactive (32%), have only one partner
(12%), they know their partner well (9%) and they do not have sex with
unknown persons (9%).
At the national level, 73% of women have heard about the test for HIV
infection, but only 13% have had the test; over half of those who have had
the test have done so since January of 2002. Of those who have had the test,
61% said that it was voluntary, 35% said that they had to present the result
for work, travel or military service, and 4% felt obligated to take the
test. Of those who have never had a test, 59% said that they saw no reason
to have the test.
Women who have had prenatal care since January 1999 were asked if they took
the test as part of prenatal care and were counseled about vertical
transmission of HIV. Only 37% said that they were counseled about the
HIV/AIDS test during prenatal care and 18%, one half of them, were offered
the test. Of these women, most (14%) took advantage of the test.
Verbal,
Physical, and Sexual Violence
As in 1995 and 1998 the 2004 survey asked about verbal and physical abuse,
and for the first time, included questions on sexual violence. The results
refer to physical violence suffered by the woman before 15 years of age by
her parents, sexual violation against all respondents, and for ever-married
women, abuse by a partner during her lifetime and in the past 12 months
prior to interview.
Of all women interviewed, 21% reported that they had seen or heard their
parents abusing each other before they were 15 years of age and 14% reported
they had received physical abuse from their parents; 49% reporting that they
received abuse from their father and 40% their mother.
Currently married women report that family decisions are usually taken
together by her and her partner. However, among women separated or divorced,
she usually made the decisions in the family. Among women who were never
abused, 79% reported that their partner consulted her about most things and
were affectionate (90%) and respected her rights (92%). The corresponding
proportions among abused women were 63%, 71% and 72%, respectively.
Of all ever-married women, 33% reported verbal abuse, 19% physical abuse and
8% sexual abuse from their current or a former partner at sometime during
her life. In the past 12 months, 15% reported verbal abuse, 7% physical
abuse and 2% sexual abuse against her will, by her current or former
partner.
Among all women, 7% reported that they had been raped at least one time; 59%
reported that the first (or only) rape occurred before 20 years of age,
including 6% prior to 10 years of age. The great majority of sexual
violations were committed by persons known by the victim; 67% were reported
to be their husband (34%), ex-husband (12%) or a boy friend or ex-boy friend
(22%). Only 12% reported that the aggressor was an unknown person.
Page last reviewed: 9/30/08
Page last modified: 4/17/06
Content source: Division
of Reproductive Health,
National Center for Chronic
Disease Prevention and Health Promotion |
|
|
