Albania Demographic and Health Survey 2008-09 …

1 AlbaniaAlbania 2008 -09 Demographic and Health Survey2008-09 Demographic and Health SurveyREPUBLIC OF Albania Albania Demographic and Health Survey 2008 -09 Institute of Statistics Institute of Public Health Tirana, Albania ICF Macro Calverton, Maryland, USA March 2010 Ministria e Sh ndet sis This report summarizes the findings of the 2008 -09 Albania Demographic and Health Survey ( 2008 -09 ADHS), which was conducted by the Institute of Statistics (INSTAT) and the Institute of Public Health (IPH). ICF Macro, an ICF International Company, provided technical assistance to the project through funding from UNICEF and MEASURE DHS, a USAID-funded project providing support and technical assistance in the implementation of population and Health surveys in countries worldwide. Funding for the 2008 -09 ADHS was provided by USAID, UNICEF, UNFPA, the Swiss Cooperation Office in Albania (SCO-A), the World Health Organization (WHO), and the Spanish Agency for International Development Cooperation (AECID).

2 The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID, UNICEF, UNFPA, SCO-A, WHO, or the Government of Albania . Additional information about the 2008 -09 ADHS may be obtained from either: The Institute of Statistics Lantona Sado, ADHS Coordinator Street address: Blvd Gergj Fishta #3, Tirana, Albania . Telephone: +355 (4) 2222411, Fax: +355 (4) 2228300, Email: or The Institute of Public Health Elizana Petrela, ADHS Coordinator Street address: Aleksander Moisiu # 80, Tirana, Albania . Telephone: +355 (4) 2363195, Fax: +355 (4) 2370058, Email: Additional information about the MEASURE DHS project may be obtained from ICF Macro, MEASURE DHS, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: Internet: Recommended citation: Institute of Statistics, Institute of Public Health [ Albania ] and ICF Macro.

3 2010. Albania Demographic and Health Survey 2008 -09. Tirana, Albania : Institute of Statistics, Institute of Public Health and ICF Macro. Introduction | iii INTRODUCTION In the early-mid 1990s, Albania entered a new phase of major changes, moving from a totalitarian to a democratic system and shifting gradually to the free market economy. This process led, naturally, to changes in various Demographic and Health characteristics of the Albanian society. The 2008 -09 Albania Demographic and Health Survey (ADHS) is a nationally representative study aimed at collecting and providing information on population, Demographic , and Health characteristics of the country. Population-based studies of this magnitude are a major undertaking that provide information on important indicators which measure the progress of a country. The ADHS results help provide the necessary information to assess, measure, and evaluate the existing programs in the country.

4 They also provide crucial information to policy-makers when drafting new policies and strategies related to the Health sector and Health services in Albania . The information collected in the 2008 -09 Albania Demographic and Health Survey will be used not only by local decision-makers and programme managers, but also by partners and foreign donors involved in various development areas in Albania , as well as by academic institutions to do further analysis with the collected data. The 2008 -09 ADHS is the result of hard and good quality work of many Albanian institutions as well as national and international organizations, which have shown a high level of professionalism and dedication to good quality data in the field of Health and demographics in Albania . Petrit VASILI Minister of Health Contents | v CONTENTS Page iii TABLES AND xi PREFACE.

5 Xix xxi LIST OF xxiii SUMMARY OF xxv MILLENNIUM DEVELOPMENT GOAL MAP OF CHAPTER 1 INTRODUCTION Geography and History ..1 The Albanian The Albanian Flag ..3 Characteristics of the Health System ..4 Health Care System ..4 Primary Health Care ..5 Country Epidemiological Profile ..6 Hospital Services ..7 Pharmaceutical Health Insurance Institute ..7 Human Resources ..8 Sources of Public Financing for Objectives and Organization of the Sample Design and Implementation ..10 Questionnaires.

6 10 Biomarkers ..12 Field Staff and Fieldwork ..13 Data Processing ..14 Response CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Household Population by Age and Household Composition ..19 Children s Living Arrangements ..20 Educational Attainment of Household Preschool Attendance and Primary School Participation ..26 Housing Characteristics ..28 vi Contents Drinking Sanitation Facilities ..32 Household Possessions.

7 32 Wealth Quintiles ..34 Birth CHAPTER 3 CHARACTERISTICS OF Survey RESPONDENTS Background Characteristics of Educational Level of Respondents ..39 Literacy ..41 Exposure to Mass Media ..42 Employment ..44 Employment Characteristics ..50 CHAPTER 4 FERTILITY Current Fertility Fertility Differentials by Background Fertility Trends ..56 Children Ever Born and Living ..57 Birth Intervals ..58 Age at First Teenage Pregnancy and CHAPTER 5 FAMILY PLANNING Knowledge of Contraceptive Ever Use of Contraception.

8 66 Current Use of Contraceptive Methods ..68 Trends in Contraceptive Use ..71 Differentials in Contraceptive Use by Background Other Forms of Fertility Number of Children at First Use of Knowledge of the Fertile Period ..74 Source of Contraception ..75 Cost of Contraception ..79 Informed Choice ..79 Contraceptive Discontinuation ..81 Future Use of Contraception ..81 Reasons for Not Intending to Use Contraception ..82 Preferred Method for Future Use ..83 Exposure to Family Planning Messages ..83 Contact of Non-users with Family Planning Providers ..84 Attitudes of Respondents Towards Family Planning.

9 85 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Introduction ..87 Contents | vii Marital Status ..87 Age at First Marriage ..88 Age at First Sexual Recent Sexual Activity ..96 Post-partum Amenorrhoea, Abstinence, and Termination of Exposure to Pregnancy .. 100 CHAPTER 7 FERTILITY PREFERENCES Desire for More Children .. 101 Need for Family Planning 104 Ideal Number of Children .. 107 Wanted and Unwanted Fertility .. 110 Planning Status of Births .. 110 Wanted Fertility .. 111 CHAPTER 8 INFANT AND CHILD MORTALITY Definitions and Methodology.

10 113 Assessment of Data Quality .. 114 Levels and Trends in Infant and Child 115 Socio-economic Differentials in Childhood 117 Demographic Differentials in Childhood Mortality .. 118 Perinatal 119 High-risk Fertility Behaviour .. 119 CHAPTER 9 MATERNAL Health Antenatal Care .. 124 Antenatal Care Provider .. 124 Number and Timing of Antenatal Care Visits .. 126 Components of Antenatal 126 Tetanus Toxoid Immunization .. 128 Delivery Care .. 129 Place of Delivery .. 130 Assistance during Delivery.