Kyrgyz Republic - Demographic and Health Survey 1997

The 1997 the Kyrgyz Republic Demographic and Health Survey (KRDHS) is a nationally representative survey of 3,848 women age 15-49. Fieldwork was conducted from August to November 1997. The KRDHS was sponsored by the Ministry of Health (MOH), and was funded by the United States Agency for International Development. The Research Institute of Obstetrics and Pediatrics implemented the survey with technical assistance from the Demographic and Health Surveys (DHS) program. The purpose of the KRDHS was to provide data to the MOH on factors which determine the health status of women and children such as fertility, contraception, induced abortion, maternal care, infant mortality, nutritional status, and anemia. Some statistics presented in this report are currently available to the MOH from other sources. For example, the MOH collects and regularly publishes information on fertility, contraception, induced abortion and infant mortality. However, the survey presents information on these indices in a manner which is not currently available, i.e., by population subgroups such as those defined by age, marital duration, education, and ethnicity. Additionally, the survey provides statistics on some issues not previously available in the Kyrgyz Republic: for example, breastfeeding practices and anemia status of women and children. When considered together, existing MOH data and the KRDHS data provide a more complete picture of the health conditions in the Kyrgyz Republic than was previously available. A secondary objective of the survey was to enhance the capabilities of institutions in the Kyrgyz Republic to collect, process, and analyze population and health data. MAIN FINDINGS FERTILITY Fertility Rates. Survey results indicate a total fertility rate (TFR) for all of the Kyrgyz Republic of 3.4 children per woman. Fertility levels differ for different population groups. The TFR for women living in urban areas (2.3 children per woman) is substantially lower than for women living in rural areas (3.9). The TFR for Kyrgyz women (3.6 children per woman) is higher than for women of Russian ethnicity (1.5) but lower than Uzbek women (4.2). Among the regions of the Kyrgyz Republic, the TFR is lowest in Bishkek City (1.7 children per woman), and the highest in the East Region (4.3), and intermediate in the North and South Regions (3.1 and3.9, respectively). Time Trends. The KRDHS data show that fertility has declined in the Kyrgyz Republic in recent years. The decline in fertility from 5-9 to 0-4 years prior to the survey increases with age, from an 8 percent decline among 20-24 year olds to a 38 percent decline among 35-39 year olds. The declining trend in fertility can be seen by comparing the completed family size of women near the end of their childbearing years with the current TFR. Completed family size among women 40-49 is 4.6 children which is more than one child greater than the current TFR (3.4). Birth Intervals. Overall, 30 percent of births in the Kyrgyz Republic take place within 24 months of the previous birth. The median birth interval is 31.9 months. Age at Onset of Childbearing. The median age at which women in the Kyrgyz Republic begin childbearing has been holding steady over the past two decades at approximately 21.6 years. Most women have their first birth while in their early twenties, although about 20 percent of women give birth before age 20. Nearly half of married women in the Kyrgyz Republic (45 percent) do not want to have more children. Additional one-quarter of women (26 percent) want to delay their next birth by at least two years. These are the women who are potentially in need of some method of family planning. FAMILY PLANNING Ever Use. Among currently married women, 83 percent report having used a method of contraception at some time. The women most likely to have ever used a method of contraception are those age 30-44 (among both currently married and all women). Current Use. Overall, among currently married women, 60 percent report that they are currently using a contraceptive method. About half (49 percent) are using a modern method of contraception and another 11 percent are using a traditional method. The IUD is by far the most commonly used method; 38 percent of currently married women are using the IUD. Other modern methods of contraception account for only a small amount of use among currently married women: pills (2 percent), condoms (6 percent), and injectables and female sterilization (1 and 2 percent, respectively). Thus, the practice of family planning in the Kyrgyz Republic places high reliance on a single method, the IUD. Source of Methods. The vast majority of women obtain their contraceptives through the public sector (97 percent): 35 percent from a government hospital, and 36 percent from a women counseling center. The source of supply of the method depends on the method being used. For example, most women using IUDs obtain them at women counseling centers (42 percent) or hospitals (39 percent). Government pharmacies supply 46 percent of pill users and 75 percent of condom users. Pill users also obtain supplies from women counseling centers or (33 percent). Fertility Preferences. A majority of women in the Kyrgyz Republic (45 percent) indicated that they desire no more children. By age 25-29, 20 percent want no more children, and by age 30-34, nearly half (46 percent) want no more children. Thus, many women come to the preference to stop childbearing at relatively young ages-when they have 20 or more potential years of childbearing ahead of them. For some of these women, the most appropriate method of contraception may be a long-acting method such as female sterilization. However, there is a deficiency of use of this method in the Kyrgyz Republic. In the interests of providing a broad range of safe and effective methods, information about and access to sterilization should be increased so that individual women can make informed decisions about using this method. INDUCED ABORTION Abortion Rates. From the KRDHS data, the total abortion rate (TAR)-the number of abortions a woman will have in her lifetime based on the currently prevailing abortion rates-was calculated. For the Kyrgyz Republic, the TAR for the period from mid-1994 to mid-1997 is 1.6 abortions per woman. The TAR for the Kyrgyz Republic is lower than recent estimates of the TAR for other areas of the former Soviet Union such as Kazakhstan (1.8), and Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively), but higher than for Uzbekistan (0.7). The TAR is higher in urban areas (2.1 abortions per woman) than in rural areas (1.3). The TAR in Bishkek City is 2.0 which is two times higher than in other regions of the Kyrgyz Republic. Additionally the TAR is substantially lower among ethnic Kyrgyz women (1.3) than among women of Uzbek and Russian ethnicities (1.9 and 2.2 percent, respectively). INFANT MORTALITY In the KRDHS, infant mortality data were collected based on the international definition of a live birth which, irrespective of the duration of pregnancy, is a birth that breathes or shows any sign of life (United Nations, 1992). Mortality Rates. For the five-year period before the survey (i.e., approximately mid-1992 to mid­1997), infant mortality in the Kyrgyz Republic is estimated at 61 infant deaths per 1,000 births. The estimates of neonatal and postneonatal mortality are 32 and 30 per 1,000. The MOH publishes infant mortality rates annually but the definition of a live birth used by the MOH differs from that used in the survey. As is the case in most of the republics of the former Soviet Union, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and is classified as a late miscarriage even if signs of life are present at the time of delivery. Thus, some events classified as late miscarriages in the MOH system would be classified as live births and infant deaths according to the definitions used in the KRDHS. Infant mortality rates based on the MOH data for the years 1983 through 1996 show a persistent declining trend throughout the period, starting at about 40 per 1,000 in the early 1980s and declining to 26 per 1,000 in 1996. This time trend is similar to that displayed by the rates estimated from the KRDHS. Thus, the estimates from both the KRDHS and the Ministry document a substantial decline in infant mortality; 25 percent over the period from 1982-87 to 1992-97 according to the KRDHS and 28 percent over the period from 1983-87 to 1993-96 according to the MOH estimates. This is strong evidence of improvements in infant survivorship in recent years in the Kyrgyz Republic. It should be noted that the rates from the survey are much higher than the MOH rates. For example, the KRDHS estimate of 61 per 1,000 for the period 1992-97 is twice the MOH estimate of 29 per 1,000 for 1993-96. Certainly, one factor leading to this difference are the differences in the definitions of a live birth and infant death in the KRDHS survey and in the MOH protocols. A thorough assessment of the difference between the two estimates would need to take into consideration the sampling variability of the survey's estimate. However, given the magnitude of the difference, it is likely that it arises from a combination of definitional and methodological differences between the survey and MOH registration system. MATERNAL AND CHILD HEALTH The Kyrgyz Republic has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. This system includes special delivery hospitals, the obstetrics and gynecology departments of general hospitals, women counseling centers, and doctor's assistant/midwife posts (FAPs). There is an extensive network of FAPs throughout the rural areas. Delivery. Virtually all births in the Kyrgyz Republic (96 percent) are delivered at health facilities: 95 percent in delivery hospitals and another 1 percent in either general hospitals or FAPs. Only 4 percent of births are delivered at home. Almost all births (98 percent) are delivered under the supervision of medically trained persons: 61 percent by a doctor and 37 percent by a nurse or midwife. Antenatal Care. As expected, the survey data indicate that a high proportion of respondents (97 percent) receive antenatal care from professional health providers: the majority from a doctor (65 percent) and a significant proportion from a nurse or midwife (32 percent). The general pattern in the Kyrgyz Republic is that women seek antenatal care early and continue to receive care throughout their pregnancies. The median number of antenatal care visits reported by respondents is 8. Immunization. Information on vaccination coverage was collected in the KRDHS for all children under three years of age. In the Kyrgyz Republic, child health cards are maintained in the local health care facilities or day care centers rather than in the homes of respondents. The vaccination data were obtained from the health cards in the health facilities or day care centers. In the Kyrgyz Republic, the percentage of children 12-23 months of age who have received all World Health Organization (WHO) recommended vaccinations is high (82 percent). BCG vaccination is usually given in delivery hospitals and was nearly universal (99 percent). Almost all children (100 percent) have received the first doses of polio and DPT/DT. Coverage for the second doses of polio and DPT/DT is also nearly universal (98 percent). The third doses of polio and DPT/DT have been received by 95 percent of children. This represents a dropout rate of 5 percent for both the polio and DPT/DT vaccinations. A high proportion of children (85 percent) have received the measles vaccine. NUTRITION Breastfeeding. Breastfeeding is almost universal in the Kyrgyz Republic; 95 percent of children born in the three years preceding the survey are breastfed. Overall, 41 percent of children are breastfed within an hour of delivery and 65 percent within 24 hours of delivery. The median duration of breastfeeding is lengthy (16 months). However, durations of exclusive and full breastfeeding, recommended by WHO, are short (2.1 and 2.9 months, respectively). Supplementary feeding. Supplementary feeding starts early in the Kyrgyz Republic. At age 0-3 months, 10 percent of breastfeeding children are given infant formula and 13 percent are given powdered or evaporated milk. By 4-7 months of age, 17 percent of breastfeeding children are given foods high in protein (meat, poultry, fish, and eggs) and 33 percent are given fruits or vegetables. Nutritional Status. In the KRDHS, the height and weight of children under three years of age were measured. These data are used to determine the proportion of children who are stunted (short for their age, a condition which may reflect chronic undernutrition) and the proportion who are wasted (underweight according to their height, a condition which may reflect an acute episode of undernutrition resulting from a recent illness). In a well-nourished population of children, it is expected that about 2.3 percent of children will be measured as moderately or severely stunted or wasted. For all of the Kyrgyz Republic, the survey found that 25 percent of children are severely or moderately stunted and 3 percent are severely or moderately wasted. PREVALENCE OF ANEMIA Testing of women and children for anemia was one of the major efforts of the 1997 KRDHS. Anemia has been considered a major public health problem in the Kyrgyz Republic for decades. Nevertheless, this was the first anemia study in the Kyrgyz Republic done on a national basis. The study involved hemoglobin (Hb) testing for anemia using the Hemocue system. Women. Thirty-eight percent of the women in the Kyrgyz Republic suffer from some degree of anemia. The great majority of these women have either mild (28 percent) or moderate anemia (9 percent). One percent have severe anemia. Children. Fifty percent of children under the age of three suffer from some degree of anemia. Twenty-four percent have moderate anemia. One percent of children are severely anemic. Thirty-two percent of the children living in the North Region and 24 percent of children living in the South and East Regions were diagnosed as having moderate or severe anemia. In Bishkek City the prevalence of moderate anemia among children was relatively low (13 percent). Certain relationships are observed between the prevalence of anemia among mothers and their children. Among children of mothers with moderate anemia, 0.5 percent have severe anemia and 37 percent have moderate anemia. The prevalence of moderate anemia among these children is more than twice as high as among children of non-anemic mothers.