In Zimbabwe, almost all currently married women have heard of at least one modern contraceptive method and 72% say they want to space their births or end childbearing, but only 48% are using a method of contraception, according to the 1994 Zimbabwe Demographic and Health Survey (ZDHS).(1) Nevertheless, the number of children a woman can expect to bear in her lifetime has fallen from 5.5 in 1988 to 4.3 in 1994, a decline of 22%. Infant mortality (reflecting deaths before age one) has remained at 53 deaths per 1,000 live births since 1988. The survey included 6,128 women aged 15-49 and 2,141 men aged 15-54 in 5,984 households, one-third of which were headed by women. Of the women who participated in the survey, 89% had had some formal education, 57% were Christian and 68% lived in rural areas. The researchers compared selected results of the 1994 survey with those from the 1984 Zimbabwe Reproductive Health Survey and the 1988 Zimbabwe DHS. Marriage Marriage (including both formal and informal unions) is nearly universal in Zimbabwe: Fewer than 1% of women aged 45-49 at the time of the survey had never been married. Overall, 62% of women aged 15-49 were married, 8% were divorced and 4% were widowed; 27% had never been married. In 1994, the median age at marriage among women aged 25- 49 was 18.9 years. Women appear to be marrying later than they did 20 years ago: The median age at marriage for those aged 20-24 was 19.8, compared with 18.9 among women aged 40-44. Women with a secondary school education married about three years later than those with no education (20.8 vs. 17.5 years), and urban women married about a year later than rural women (19.5 vs. 18.7 years). In 1994, 19% of women were in a polygynous union, up from 17% in 1988. Rural women were more likely to be in a polygynous union than were urban women (21% vs. 13%), and the proportion of women in such a union fell from 33% among those with no education to 20% among those with a primary education and 11% among those with at least a secondary education. The great majority of women in a polygynous union had one cowife. Fertility and Fertility Preferences Based on data for the three years preceding the ZDHS, the total fertility rate (TFR) among women aged 15-49 in Zimbabwe was 4.3 lifetime births per woman, down from 5.5 births in 1988. The Tirths), and women with some secondary schooling had a lower TFR than did those with a primary education or no education (3.3 vs. 4.7 or 5.2 births). In 1994, the median age at first birth among women aged 25-49 was 19.6 years. Though the median age at first birth had not changed since 1988, early childbearing had declined somewhat: Among women aged 30-34, 33% had had a birth before age 18, compared with 23% of women aged 20-24. Among women aged 25-49, the median age at first birth was higher among women with a secondary education than among those with no education (21.0 vs. 18.9 years) and was slightly higher in urban areas than in rural areas (19.8 vs. 19.4 years). More than one-third (36%) of married women in Zimbabwe said they wanted no more children. That proportion rose with the number of living children, from 5% of women with one child to 75% of women with six or more children. Among women with three living children, it increased with educational level, from 16% of those with no education to 27% of those with a primary education and 44% of those with at least a secondary education. Twenty-one percent of married women wanted another child within two years and 36% wanted another child later. Childbearing aspiration among married men were similar: Thirty-four percent wanted no more children, 21% wanted another child within two years and 40% wanted another child later. The average ideal family size among all women surveyed in 1994 was 4.3 children, down from 4.9 in 1988. Among currently married respondents, men wanted slightly larger families than women (4.9 vs. 4.7). Women who were younger and those who were better educated preferred smaller families: The ideal family size increased from 3.4 children among women aged 15-19 to 6.0 children among women aged 45-49, and from 3.4 children among women with a secondary education to 6.1 among those with no education. Rural women and men wanted more children (4.7 each) than did urban women and men (3.5 and 3.7, respectively). Women who had had a birth in the five years preceding the study reported 10% of those births as unwanted and 34% as mistimed. The wanted fertility rate, which represents the fertility level that would exist if all unwanted births in the three years before the survey had been prevented, was 3.5 children per woman, compared with the actual fertility rate of 4.3. Contraceptive Knowledge and Use Nearly all women in Zimbabwe (98%) knew of at least one modern contraceptive method in 1994, compared with 83% of women in 1984. The best known modern methods were the pill (96%), the condom (94%), the injectable (80%), tubal sterilization (70%) and the IUD (68%). The proportion of women who had heard of the condom nearly doubled between 1984 and 1994 (from 48% to 94%); knowledge of female sterilization increased from 40% to 70%, and that of the IUD, from 40% to 68%. Levels of knowledge among men were similar in 1994. Almost all (94%) currently married nonsterilized women who had heard of a method approved of family planning, and 82% believed their husband approved. Eighty-one percent said that both they and their husband approved of family planning, while only 4% said they both disapproved. In cases of disagreement, the husband was more likely than the wife to disapprove (11% vs. 1%). Among currently married women, 80% had ever used a method (72% a modern method, 30% a traditional method and 7% a folk method). Sixty-six percent had used the pill, 24% the condom and 12% the injectable; no other modern method had been used by more than 3% of married women. Eighty-one percent of sexually active unmarried women had used a modern method and 24% had used a traditional method. The researchers comment that the greater proportion of sexually active unmarried women than married women who had ever used a modern method reflects greater use of condoms (51% vs. 24%). Contraceptive prevalence among married women increased from 38% to 48% between 1984 and 1994. Among married women responding to the 1994 survey, use of any method rose from 31% of those aged 15-19 to 58% of those aged 25-29 and then decreased to 28% of those aged 45- 49. Use of modern methods increased from 27% to 42%, while use of traditional and folk methods decreased from 12% to 6%. The most prevalent modern method was the pill, used by 33% of currently married women. Men reported greater use of family planning than did women: At the time of the survey, 60% of currently married men said they were using a method, including 43% who reported relying on the pill. Unmarried men were more likely than married men to use condoms (50% vs. 6%). Contraceptive use was more common among urban married women than among their rural counterparts (58% vs. 44%). Urban women were also more likely than rural women to use a modern method (54% vs. 37%). Levels of use rose with education: Fifty-eight percent of women with at least a secondary education used a method, compared with 46% of those with a primary education and 33% of those with no formal education. Zimbabwean women were most likely to start using a contraceptive method after they had had one child (48% of ever-married women). Because most contraceptive users in Zimbabwe rely on the pill, the researchers analyzed the quality of pill use. More than half of pill users (56%) said they never failed to take the pill. Among those who had missed taking one or more pills (44%), only 36% had taken the appropriate corrective action. Among women who had stopped using a method in the five years before the study, 42% had done so to become pregnant, 15% had experienced method failure and about 15% had stopped as a result of side effects or health concerns. Nearly two-thirds (65%) of currently married women who were not using a method said they intended to use one in the future, including 54% who intended to do so within the next 12 months. Most of those who intended to use a method named the pill (59%) or the injectable (23%) as their preferred method. In 1994, 15% of currently married women in Zimbabwe had an unmet need for family planning -- 9% for means of spacing births and 6% for means of ending childbearing. Unmet need was nearly twice as prevalent among uneducated women as among women with a secondary education (19% vs. 10%), and the level among rural women was about double that among urban women (17% vs. 9%). Overall, 77% of the total demand for contraceptive services was being satisfied. Maternal and Child Health The mothers of 93% of the babies born in the three years preceding the survey had received prenatal care from trained medical personnel, almost unchanged from 91% in the 1988 DHS. Women were most likely to have received prenatal care from a nurse or midwife (72%) or from a doctor (21%). Women aged 35 or older, those in rural areas and those with less than a secondary education were more likely than other women to have received no prenatal care. A majority of births (69%) in the three years before the survey occurred in health facilities. The proportion of women who delivered at home decreased from 41% among women aged 35 or older to 29% among women aged younger than 35. Although only 21% of first births occurred at home, 45% of sixth or higher order births were home deliveries. Only 9% of urban women gave birth at home, compared with 38% of rural women, and 12% of women with a secondary education delivered at home, compared with 59% of women with no education. Fifty-seven percent of births were attended by a nurse or midwife, 17% by a traditional birth attendant, 13% by a doctor and 11% by a relative; only 3% of births were unattended. Nearly all infants (99%) born in the three years before the survey had been breastfed. However, exclusive breastfeeding was uncommon: Among infants less than two months old, only 19% were exclusively breastfed. Most children (95%) were breastfed until they were 10- 11 months old; by 22-23 months of age only 20% were still being breastfed, and all children were weaned by the time they were three years old. The median duration of breastfeeding was about 18 months; rural women breastfed their infants longer than did urban women (19.2 vs. 17.6 months), and uneducated women breastfed longer than women with a secondary education (20.1 months vs. 17.8 months). The infant mortality rate in Zimbabwe (based on data for the five years preceding the DHS) remained unchanged between 1988 and 1994, with 53 of every 1,000 babies dying before their first birthday. Mortality among children younger than five increased slightly, from 75 deaths per 1,000 births in 1988 to 77 per 1,000 in 1994. The researchers attribute these mortality patterns to a declining economy and an increase in AIDS. Under-five mortality was greater in rural areas than in urban areas (80 vs. 63 deaths per 1,000 births), and greater among the children of uneducated mothers than among those of mothers with a secondary education (93 vs. 57 deaths per 1,000 births). Using direct estimation techniques and data on the survival status of respondents' sisters, the researchers calculated a maternal mortality rate of 283 deaths per 100,000 live births for the 10 years preceding the 1994 survey. Maternal deaths make up approximately 15% of all deaths among women aged 15-49 in Zimbabwe. AIDS Knowledge of AIDS is almost universal in Zimbabwe: In 1994, 99% of women and almost 100% of men reported that they had heard of the disease. Most women and men had heard about AIDS on the radio (64% and 75%, respectively). More than half the respondents knew of at least one way to prevent AIDS, such as using a condom (57% of women and 66% of men), having only one sexual partner (41% and 52%, respectively) and abstaining from sex (11% and 16%, respectively). Only 1% of women and men cited a preventive method that reflected misinformation. About half of the women and men surveyed knew someone with AIDS. Nearly all women and men knew that AIDS cannot be cured (96% and 95%, respectively) and that AIDS can be transmitted from mother to child (93% and 92%, respectively). Most women (77%) and men (88%) said they had little or no chance of getting AIDS because they abstained from sex, used condoms or had only one partner. Among those who perceived their risk to be moderate or great, a majority of women (59%) but few men (2%) believed they were at risk because their spouse had another partners. In contrast, only 8% of women said they were at risk because they had many sex partners, compared with 30% of men. Men were more likely than women to have changed their sexual behavior because of AIDS (62% vs. 21%). The most common changes among men and women were restricting sex to one partner (34% and 10%, respectively) and using condoms (23% and 4%, respectively). Reference 1. Zimbabwe Central Statistical Office and Macro International Inc., Zimbabwe Demographic and Health Survey 1994, Calverton, Md., USA, 1995. Author not available, Fertility has Fallen in Zimbabwe, Reflecting Rising Contraceptive Use and Desire for Smaller Families. Vol. 22, International Family Planning Perspectives, 03-01-1996, pp 46+.