The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Federal Office of Statistics with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal care, vaccination status, breastfeeding, and nutrition. Data collection took place two years after implementation of the National Policy on Population and addresses issues raised by that policy. Fieldwork for the NDHS was conducted in two phases: from April to July 1990 in the southern states and from July to October 1990 in the northern states. Interviewers collected information on the reproductive histories of 8,781 women age 15-49 years and on the health of their 8,113 children under the age of five years. OBJECTIVES The Nigeria Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on socioeconomic characteristics, marriage patterns, history of child bearing, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of children. The primary objectives of the NDHS are: (i) To collect data for the evaluation of family planning and health programmes; (ii) To assess the demographic situation in Nigeria; and (iii) To support dissemination and utilisation of the results in planning and managing family planning and health programmes. MAIN RESULTS According to the NDHS, fertility remains high in Nigeria; at current fertility levels, Nigerian women will have an average of 6 children by the end of their reproductive years. The total fertility rate may actually be higher than 6.0, due to underestimation of births. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman. One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). These levels, while low, reflect an increase over the past decade: ten years ago just 1 percent of Nigerian women were using a modem family planning method. Periodic abstinence (rhythm method), the pill, IUD, and injection are the most popular methods among married couples: each is used by about 1 percent of currently married women. Knowledge of contraception remains low, with less than half of all women age 15-49 knowing of any method. Certain groups of women are far more likely to use contraception than others. For example, urban women are four times more likely to be using a contraceptive method (15 percent) than rural women (4 percent). Women in the Southwest, those with more education, and those with five or more children are also more likely to be using contraception. Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong: half of women with five children say that they want to have another child. Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children. National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by women's educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20. Teenagers in the North have births at twice the rate of those in the South: 20 births per 1130 women age 15-19 in the North compared to 10 birdas per 100 women in the South. Nearly half of teens in the North have already begun childbearing, versus 14 percent in South. This results in substantially lower total fertility rates in the South: women in the South have, on average, one child less than women in the North (5.5 versus 6.6). The survey also provides information related to maternal and child health. The data indicate that nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born, 87 die during their first year of life (infant mortality rate). There has been little improvement in infant and child mortality during the past 15 years. Mortality is higher in rural than urban areas and higher in the North than in the South. Undemutrition may be a factor contributing to childhood mortality levels: NDHS data show that 43 percent of the children under five are chronically undemourished. These problems are more severe in rural areas and in the North. Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one-third of births and over 60 percent of all babies arc born at home. Only one-third of births are assisted by doctors, trained nurses or midwives. A third of the infants are never vaccinated, and only 30 percent are fully immunised against childhood diseases. When they are ill, most young children go untreated. For example, only about one-third of children with diarrhoea were given oral rehydration therapy. Women and children living in rural areas and in the North are much less likely than others to benefit from health services. Almost four times as many births in the North are unassisted as in the South, and only one-third as many children complete their polio and DPT vaccinations. Programmes to educate women about the need for antenatal care, immunisation, and proper treatment for sick children should perhaps be aimed at mothers in these areas, Mothers everywhere need to learn about the proper time to introduce various supplementary foods to breastfeeding babies. Nearly all babies are breastfed, however, almost all breastfeeding infants are given water, formula, or other supplements within the first two months of life, which both jeopardises their nutritional status and increases the risk of infection.
