FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

ETHIOPIA

Demographic and Health Survey

2016
Key Indicators Report

Central Statistical Agency

Addis Ababa, Ethiopia

The DHS Program

ICF
Rockville, Maryland, USA

October 2016

WORLD BANK
The 2016 Ethiopia Demographic and Health Survey (2016 EDHS) was implemented by the Central Statistical
Agency (CSA) from January 18, 2016, to June 27, 2016. The funding for the 2016 EDHS was provided by the
government of Ethiopia, the United States Agency for International Development (USAID), the government of
the Netherlands, the Global Fund, Irish Aid, the World Bank, the United Nations Population Fund (UNFPA), the
United Nations Children’s Fund (UNICEF), and UN Women. ICF provided technical assistance through The DHS
Program, a USAID-funded project providing support and technical assistance in the implementation of population
and health surveys in countries worldwide.

Additional information about the 2016 EDHS may be obtained from the Central Statistical Agency of Ethiopia,
P.O. Box 1143, Addis Ababa, Ethiopia; Telephone +251-111-55-30-11/111-15 78-41; Fax: +251-111-55-03-34;
E-mail: [email protected].

Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD
20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; E-mail: [email protected]; Internet:
www.DHSprogram.com.

Recommended citation:

Central Statistical Agency (CSA) [Ethiopia] and ICF. 2016. Ethiopia Demographic and Health Survey 2016: Key
Indicators Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA. CSA and ICF.
CONTENTS
TABLES AND FIGURES .................................................................................................................................... v

ACRONYMS....................................................................................................................................................... vii

1 INTRODUCTION AND SURVEY OBJECTIVES ............................................................................. 1

2 SURVEY IMPLEMENTATION .......................................................................................................... 3

2.1 Sample Design ........................................................................................................................... 3
2.2 Questionnaires............................................................................................................................ 3
2.3 Anthropometry, Anaemia Testing, and HIV Testing ................................................................. 5
2.4 Health Facility Visit ................................................................................................................... 6
2.5 Pretest......................................................................................................................................... 6
2.6 Training of Field Staff................................................................................................................ 6
2.7 Fieldwork ................................................................................................................................... 7
2.8 Data Processing .......................................................................................................................... 7

3 KEY FINDINGS ..................................................................................................................................... 9

3.1 Response Rates .......................................................................................................................... 9
3.2 Household Drinking Water and Sanitation Facilities ................................................................. 9
3.3 Characteristics of Respondents ................................................................................................ 11
3.4 Fertility..................................................................................................................................... 13
3.5 Teenage Pregnancy and Motherhood ....................................................................................... 14
3.6 Fertility Preferences ................................................................................................................. 15
3.7 Family Planning ....................................................................................................................... 16
3.8 Need and Demand for Family Planning ................................................................................... 18
3.9 Early Childhood Mortality ....................................................................................................... 21
3.10 Maternal Care........................................................................................................................... 22
3.10.1 Antenatal Care ........................................................................................................... 22
3.10.2 Tetanus Toxoid Vaccination ...................................................................................... 23
3.10.3 Delivery Care ............................................................................................................. 23
3.10.4 Postnatal Care for the Mother .................................................................................... 23
3.10.5 Obstetrical Fistula ...................................................................................................... 25
3.11 Child Health and Nutrition ....................................................................................................... 26
3.11.1 Vaccination of Children ............................................................................................. 26
3.11.2 Childhood Acute Respiratory Infection, Fever, and Diarrhoea ................................. 29
3.11.3 Nutritional Status of Children .................................................................................... 30
3.11.4 Infant and Young Child Feeding Practices ................................................................ 32
3.12 Anaemia Prevalence in Children and Women ......................................................................... 34
3.13 HIV/AIDS Awareness, Knowledge, and Behaviour ................................................................ 36
3.13.1 Knowledge of HIV Prevention .................................................................................. 36
3.13.2 Knowledge among Young People ............................................................................. 38
3.13.3 Knowledge of Prevention of Mother to Child Transmission of HIV ......................... 38
3.13.4 Multiple Sexual Partners............................................................................................ 39
3.14 Coverage of HIV Testing Services........................................................................................... 41
3.15 Domestic Violence ................................................................................................................... 44
3.16 Female Genital Mutilation ....................................................................................................... 45
3.17 Maternal Mortality ................................................................................................................... 46

REFERENCES ................................................................................................................................................... 49

iii
TABLES AND FIGURES
Table 1 Results of the household and individual interviews ................................................................... 9
Table 2 Household drinking water ........................................................................................................ 10
Table 3 Household sanitation facilities ................................................................................................. 11
Table 4 Background characteristics of respondents .............................................................................. 12
Table 5 Current fertility ........................................................................................................................ 13
Table 6 Teenage pregnancy and motherhood........................................................................................ 15
Table 7 Fertility preferences by number of living children ................................................................... 16
Table 8 Current use of contraception by background characteristics .................................................... 17
Table 9 Need and demand for family planning among currently married women and sexually
active unmarried women .......................................................................................................... 20
Table 10 Early childhood mortality rates ................................................................................................ 22
Table 11 Maternal care indicators ........................................................................................................... 24
Table 12 Obstetrical fistula ..................................................................................................................... 26
Table 13 Vaccinations by background characteristics ............................................................................ 28
Table 14 Treatment for acute respiratory infection, fever, and diarrhoea ............................................... 29
Table 15 Nutritional status of children .................................................................................................... 31
Table 16 Breastfeeding status by age ...................................................................................................... 33
Table 17.1 Anaemia among children and women ...................................................................................... 35
Table 17.2 Anaemia among men ............................................................................................................... 36
Table 18 Knowledge of HIV prevention methods .................................................................................. 37
Table 19 Knowledge of HIV prevention among young people............................................................... 38
Table 20 Knowledge of prevention of mother-to-child transmission of HIV ......................................... 39
Table 21.1 Multiple sexual partners in the past 12 months: Women ......................................................... 40
Table 21.2 Multiple sexual partners in the past 12 months: Men .............................................................. 41
Table 22.1 Coverage of prior HIV testing: Women ................................................................................... 42
Table 22.2 Coverage of prior HIV testing: Men ........................................................................................ 43
Table 23 Spousal violence by background characteristics ...................................................................... 44
Table 24 Prevalence of female genital cutting (FGC) ............................................................................. 45
Table 25 Maternal mortality.................................................................................................................... 46

Figure 1 Trends in total fertility rate, 2000-2016 ................................................................................... 14

Figure 2 Trends in the use of family planning, 2000-2016 .................................................................... 18
Figure 3 Trends in unmet need, modern contraceptive use, and percentage of demand satisfied
with modern methods, 2000-2016............................................................................................ 21
Figure 4 Trends in childhood mortality, 2000-2016 ............................................................................... 22
Figure 5 Trends in maternal health care, 2000-2016 .............................................................................. 25
Figure 6 Nutritional status of children by age ........................................................................................ 32
Figure 7 Minimum acceptable diet by age, in months............................................................................ 34
Figure 8 Maternal mortality ratio (MMR) with confidence intervals for the 7 years preceding
the 2000, 2005, 2011, and 2016 EDHS .................................................................................... 47

v
ACRONYMS
AIDS Acquired immunodeficiency syndrome
ANC Antenatal care
ARI Acute respiratory infections
BCG Bacille Calmette-Guerin (vaccine)
CAPI Computer-Assisted personal interview
CHTTS CSPro HIV Test Tracking System
CPR Contraceptive prevalence rate
CSA Central Statistical Agency
CSPro Census Survey Program
DBS Dried blood spots
DPT Diphtheria, pertussis, Tetanus vaccine
EAs Enumeration areas
EDHS Ethiopia Demographic and Health Survey
EPHC Ethiopian Population and Housing Census
EPHI Ethiopia Public Health Institute
FGC Female gential cutting
FGM Female gential mutilation
HepB Hepatitis B (vaccine)
HEW Health extension worker
HF Health facility
Hib Haemophilus influenzae type B (vaccine)
HIV Human immunodeficiency virus
IFSS Internet file streaming system
IUD Intrauterine device
IYCF Infant and Young Child Feeding
LAM Lactational amenorrhoea method
MOFED Ministry of Finance and Economic Development
MoH Ministry of Health
NRERC National Research Ethics Review Committee
ORS Oral rehydration salts
ORT Oral rehydration therapy
PBS Promoting Basic Services (PROJECT)
PCV Pneumococcal conjugate vaccine
PMTCT Prevention of mother-to-child transmission
PNC Postnatal care
RV1 Rotavirus vaccine
SDM Standard days method
SNNPR Southern nations, nationalities, and people’s region
STDs Sexually transmitted diseases
TFR Total fertility rate
UNDP United Nations Development Programme
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
UN Women United Nations Entity on Gender Equality and the Empowerment of Women
USAID United States Agency for International Development
VAW Violence against women
VCT Voluntary counselling and testing
WHO World Health Organization

vii
1 INTRODUCTION AND SURVEY OBJECTIVES

T
he 2016 Ethiopia Demographic and Health Survey (EDHS) is the fourth Demographic and Health
Survey conducted in Ethiopia. It was implemented by the Central Statistical Agency (CSA) at the
request of the Ministry of Health (MoH). Data collection took place from January 18, 2016, to June
27, 2016.

Financial support for the 2016 EDHS was provided by the government of Ethiopia, the United States
Agency for International Development (USAID), the Government of the Netherlands, the Global Fund via
the MoH and the Ministry of Finance and Economic Development (MOFED), the World Bank via MOFED
and Promoting Basic Services (PBS), Irish Aid, the United Nations Population Fund (UNFPA), the United
Nations Children’s Fund (UNICEF), and UN Women. ICF provided technical assistance through The DHS
Program, which is funded by the United States Agency for International Development (USAID), and offers
support and technical assistance for the implementation of population and health surveys in countries
worldwide.

This key indicators report presents selected findings of the 2016 EDHS. A comprehensive analysis
of the data will be presented in a final report to be published in the first quarter of 2017.

The primary objective of the 2016 EDHS project is to provide up-to-date estimates of key
demographic and health indicators. More specifically, the 2016 EDHS:

 Collected data at the national level that allowed the calculation of key demographic indicators

 Explored the direct and indirect factors that determine the levels and trends of fertility and
childhood mortality

 Measured the levels of contraceptive knowledge and practice

 Collected data on key aspects of family health, including immunisation coverage among
children, prevalence and treatment of diarrhoea and other diseases among children under age
5, and maternity care indicators, including antenatal visits and assistance at delivery

 Obtained data on child feeding practices, including breastfeeding

 Collected anthropometric measures to assess nutritional status of children under 5, women age
15-49 and men age 15-59

 Conducted haemoglobin testing on eligible children 6-59 months, women age 15-49, and
men age 15-59 to provide information on the prevalence of anaemia among these groups

 Collected data on knowledge and attitudes of women and men about sexually-transmitted
diseases and HIV/AIDS, evaluated potential exposure to the risk of HIV infection by
exploring high risk behaviours and condom use

 Conducted HIV testing on dried blood spot (DBS) samples collected from women age 15-49
and men age 15-59 to provide information on the prevalence of HIV among adults of
reproductive age

 Collected data on prevalence of injuries and accidents among all household members

 Collected data on knowledge and prevalence of fistula and female genital cutting or mutilation
among women age 15-49 and their daughters age 0-14

 Obtained data on women’s experience of emotional, physical, and sexual violence

1
As the fourth DHS conducted in Ethiopia, following the 2000, 2005, and 2011 EDHS surveys, the 2016
EDHS provides valuable information on trends in key demographic and health indicators over time. The
information collected through the 2016 EDHS is intended to assist policy makers and programme
managers in evaluating and designing programmes and strategies for improving the health of the country’s
population.
Additionally, the 2016 EDHS included a health facility component that recorded data on children’s
vaccinations, which were then combined with the household data on children’s vaccinations (see Section
2.4).

2
2 SURVEY IMPLEMENTATION
2.1 Sample Design

T
he sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census (PHC),
which was conducted in 2007 by the Ethiopia Central Statistical Agency (CSA). The census frame
is a complete list of 84,915 enumeration areas (EAs) created for the 2007 PHC. An EA is a
geographic area covering on average of 181 households. The sampling frame contains information about the
EA location, type of residence (urban or rural), and estimated number of residential households. With the
exception of EAs in 6 zones of the Somali region, each EA has accompanying cartographic materials. These
delineate geographic locations, boundaries, main access, and landmarks in or outside the EA that help to
identify the EA. In Somali, cartographic frames were used in three zones, where a sketch map that delineates
the EA geographic boundaries is available for each EA; in the remaining six zones, satellite image maps
were used to provide a map for each EA.

Administratively, Ethiopia is divided into nine geographical regions and two administrative cities.
The sample for the 2016 EDHS was designed to provide estimates of key indicators for the country as a
whole, for urban and rural areas separately, and for each of the nine regions and the two administrative cities.

The 2016 EDHS sample was stratified and selected in two stages. Each region was stratified into
urban and rural areas, yielding 21 sampling strata. Samples of EAs were selected independently in each
stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower
administrative levels by sorting the sampling frame within each sampling stratum before sample selection,
according to administrative units in different levels, and by using a probability proportional to size selection
at the first stage of sampling.

In the first stage, a total of 645 EAs (202 EAs in urban areas and 443 EAs in rural areas) were
selected with probability proportional to the EA size (based on the 2007 PHC) and with independent selection
in each sampling stratum. A household listing operation was carried out in all the selected EAs from
September to December 2015. The resulting lists of households served as a sampling frame for the selection
of households in the second stage. Some of the selected EAs were large, with more than 300 households. To
minimise the task of household listing, each large EA selected for the 2016 EDHS was segmented. Only one
segment was selected for the survey, with probability proportional to the segment size. Household listing
was conducted only in the selected segment, that is, a 2016 EDHS cluster is either an EA or a segment of an
EA.

In the second stage of selection, a fixed number of 28 households per cluster were selected with an
equal probability systematic selection from the newly created household listing. All women age 15-49 and
all men age 15-59, who were either permanent residents of the selected households or visitors who stayed in
the household the night before the survey, were eligible to be interviewed. In half of the selected households,
all women age 15-49 were eligible for the female genital cutting (FGC) module, and only one woman per
household was selected for the violence against women (VAW) module. In all the selected households,
height and weight measurements were collected from children 0-59 months, women 15-49, and men 15-59.
Anaemia testing was performed on consenting women 15-49, men 15-59, and on children age 6-59 months
whose parent/guardian consented to the testing. In addition, dried blood spot (DBS) samples were collected
for HIV testing in the laboratory from women 15-49 and men 15-59 who consented to testing.

2.2 Questionnaires

Five questionnaires were used for the 2016 EDHS: the Household Questionnaire, the Woman’s
Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Health Facility
Questionnaire. These questionnaires, based on The DHS Program’s standard Demographic and Health
Survey questionnaires, were adapted to reflect the population and health issues relevant to Ethiopia. Input
was solicited from various stakeholders representing government ministries and agencies, nongovernmental

3
organisations, and international donors. After all questionnaires were finalised in English, they were
translated into Amarigna, Tigrigna, and Oromiffa.

The Household Questionnaire was used to list all the usual members and visitors of selected
households. Basic demographic information was collected on the characteristics of each person listed,
including his or her age, sex, marital status, education, and relationship to the head of the household. For
children under age 18, parents’ survival status was determined. The data on age and sex of household
members obtained in the Household Questionnaire were used to identify women and men who were eligible
for individual interviews. The Household Questionnaire also collected information on characteristics of the
household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the
dwelling unit, and ownership of various durable goods. The Household Questionnaire included an additional
module developed by The DHS Program to estimate the prevalence of injuries/accidents among all
household members.

The Woman’s Questionnaire was used to collect information from all eligible women age 15-49.
These women were asked questions on the following topics:

 Background characteristics (inlcuding age, education, and media exposure)

 Birth history and childhood mortality
 Family planning, including knowledge, use, and sources of contraceptive methods
 Fertility preferences
 Antenatal, delivery, and postnatal care
 Breastfeeding and infant feeding practices
 Vaccinations and childhood illnesses
 Women’s work and husbands’ background characteristics
 Knowledge, awareness, and behaviour regarding HIV/AIDS and other sexually transmitted
infections (STIs)
 Knowledge, attitudes, and behaviours related to other health issues (e.g., injections, smoking,
chat)
 Adult and maternal mortality
 Female genital cutting
 Fistula
 Violence against women

The Man’s Questionnaire was administered to all eligible men age 15-59. The Man’s Questionnaire
collected much of the same information elicited from the Woman’s Questionnaire but was shorter because
it did not contain a detailed reproductive history, questions on maternal and child health, or questions on
domestic violence.

The Biomarker Questionnaire was used to record biomarker data collected from respondents by
health technicians.

For the first time, the 2016 EDHS also used a Health Facility Questionnaire. This questionnaire was
used to record vaccination information for all children without a vaccination card identified during the
individual Woman’s Questionnaire.

The 2016 EDHS interviewers used tablet computers to record responses during the interviews. The
tablets were equipped with Bluetooth technology to enable remote electronic transfer of files (transfer of
assignment sheets from team supervisors to interviewers and transfer of completed questionnaires from
interviewers to supervisors). The computer-assisted personal interviewing (CAPI) data collection system
employed in the 2016 EDHS was developed by The DHS Program using the mobile version of CSPro. The
CSPro software was developed jointly by the U.S. Census Bureau, The DHS Program, and Serpro S.A.

4
2.3 Anthropometry, Anaemia Testing, and HIV Testing

The 2016 EDHS incorporated the following biomarkers: anthropometry, anaemia, and HIV testing.
These biomarkers were collected in all households. In contrast with the data collection procedures for the
household and individual interviews, biomarker data were initially recorded on the paper-based Biomarker
Questionnaire and subsequently entered into interviewers’ tablet computers. The survey protocol, including
biomarker collection, was reviewed and approved by the Federal Democratic Republic of Ethiopia Ministry
of Science and Technology and the Institutional Review Board of ICF.

Anthropometry. Height and weight measurements were recorded for children age 0-59 months, for
women age 15-49, and for men age 15-59.

Anaemia testing. Blood specimens for anaemia testing were collected from women age 15-49 and
men age 15-59 who voluntarily consented to be tested, and from all children age 6-59 months for whom
consent was obtained from their parents or other adults responsible for them. Blood samples were drawn
from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-11 months) and
collected in a microcuvette. Haemoglobin analysis was carried out on-site using a battery-operated portable
HemoCue analyser. Results were provided verbally and in writing. Parents or responsible adults of children
whose haemoglobin level was below 7 g/dl were instructed to take the child to a health facility for follow-
up care. Likewise, nonpregnant women and pregnant women were referred for follow-up care if their
haemoglobin levels were below 7 g/dl and 9 g/dl, respectively. All households in which anaemia testing was
conducted were given a brochure explaining the causes and prevention of anaemia.

HIV testing. Interviewers collected finger-prick blood specimens from women age 15-49 and men
age 15-59 who consented to HIV testing. The protocol for blood specimen collection and analysis was based
on the anonymous linked protocol developed for The DHS Program. This protocol allows for merging of
HIV test results with the sociodemographic data collected in the individual questionnaires after removal of
all information that could potentially identify an individual.

Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results
would not be made available to respondents. If a respondent consented to HIV testing, five blood spots from
the finger prick were collected on a filter paper card to which a barcode label unique to the respondent was
affixed. A duplicate label was attached to the Biomarker Data Collection Form. A third copy of the same
barcode was affixed to the Dried Blood Spot Transmittal Sheet to track the blood samples from the field to
the laboratory.

Respondents were also asked whether they would consent to having the laboratory store their blood
sample for future testing of hepatitis B and C, rubella, and measles. If the respondent did not consent to
future additional testing of their blood sample, their refusal was recorded on the Biomarker Data Collection
Form and the words “no additional testing” were written on the filter paper card. All respondents, irrespective
of whether they provided consent or not, were given an informational brochure on HIV and a list of nearby
sites providing HIV counselling and testing (HCT) services.

Blood samples were dried overnight and packaged for storage the following morning. Samples were
periodically collected from the field and transported to the laboratory at the Ethiopian Public Health Institute
(EPHI) in Addis Ababa. Upon arrival at EPHI, each blood sample was logged into the CSPro HIV Test
Tracking System database, given a laboratory number, and stored at -20°C until tested.

The HIV testing protocol stipulated that blood could be tested only after questionnaire data
collection had been completed, data had been verified and cleaned, and all unique identifiers other than the
anonymous barcode number had been removed from the data file. At the time of this report’s release, HIV
testing had not been completed.

5
2.4 Health Facility Visit

The Health Facility component of the survey was a separate activity conducted once the data
collection in the clusters was completed. When all interviews in a cluster were finalised, and the data was
sent to the central office by the supervisor, a program generated a file for the cluster with a list of all children
for whom a vaccination card was not seen by the interviewers and whose vaccination records had to be
checked at the health facilities.

For each identified child, the list included all identification information: cluster and household
number, mother’s full name and line number, father’s full name, child’s line number in the mother’s birth
history, name and age of the child, and the name and location of the heath facility where vaccinations were
administered. This file was transferred from the central office to the PC tablet of a health facility interviewer
working with the survey team. If the mother gave consent, the health facility interviewer went to the health
facility identified by the mother during the survey. He/she searched for the identified child in the family
folder or in any other records available at the health facility. When the children’s records were located, the
immunisation information was recorded for each child in the Health Facility Questionnaire.

As a result, two sources of immunisation information were available for each child: the vaccinations
recorded in the Woman’s Questionnaire (obtained from vaccination card or mother’s recall) and those
recorded from the health facility. The household survey data were complemented by the health facility data
to provide a more complete estimate of the vaccination coverage.

2.5 Pretest

The pretest for the 2016 EDHS was conducted from October 1-28, 2015, in Bishoftu at the Asham
African Training Centre. It consisted of in-class training, a biomarker training, and field practice days. The
field practice was conducted in clusters surrounding Bishoftu that were not included in the 2016 EDHS
sample. A total of 60 trainees attended the pretest. Some of the trainees had some experience with household
surveys, either involvement in previous Ethiopian DHS surveys or in other similar surveys. Following field
practice, a debriefing session was held with the pretest field staff, and modifications to the questionnaires
were made based on lessons drawn from the exercise.

2.6 Training of Field Staff

CSA recruited and trained 294 people for the main fieldwork to serve as team leaders, field editors,
interviewers, secondary editors, and reserve interviewers. The training took place from December 14, 2015,
to January 17, 2016, at the Debre Zeit Management Institute in Bishoftu. The training course consisted of
instruction regarding interviewing techniques and field procedures, a detailed review of questionnaire
content, instruction on how to administer the paper and electronic questionnaires, mock interviews between
participants in the classroom, and practice interviews with real respondents in areas outside the survey
sample.

In addition, 72 individuals were recruited and trained on how to collect biomarker data, including
taking height and weight measurements, testing for anaemia by measuring haemoglobin level, and preparing
dried blood spots (DBS) for HIV testing in the laboratory. The biomarker training was held from January 2-
11, 2016, and consisted of lectures, demonstrations of biomarker measurement or testing procedures, and
field practice with children at the training centre.

The interviewer training also included presentations given by various specialists and experts from
the Ministry of Health covering Ethiopia-specific policies and programmes on HIV/AIDS, child
immunisations, family planning, child nutrition, childhood diseases, and VAW.

A four-day field practice was organised, from January 12-15, 2016, to provide trainees with
additional hands-on experience before the actual fieldwork. A total of 36 teams were formed for field

6
practice. Each team consisted of a team leader, a field editor, three female interviewers, one male interviewer,
and two biomarker technicians.

Training participants were evaluated through homework, in-class exercises, quizzes, and
observations made during field practice. Ultimately, 132 individuals were selected as interviewers, 66 as
biomarker technicians, 33 as field editors, and 33 as team leaders. The selection of team leaders and field
editors was based on their experience in leading survey teams and their performance during the pretest and
the main training. Team leaders and field editors received additional instructions and practice using the CAPI
system to perform supervisory activities. Supervisory activities included assigning households and receiving
completed interviews from interviewers, recognising and dealing with error messages, receiving a system
update and distributing updates to interviewers, completing biomarker questionnaires and DBS transmittal
sheets, dealing with duplicated cases, closing clusters, and transferring interviews to the central office via a
secure Internet file streaming system (IFSS). In addition to the CAPI material, team leaders and field editors
received additional training on their roles and responsibilities and how to fulfill them.

Fifteen individuals were trained for two days on the Health Facility (HF) Questionnaire. The training
included a brief introduction to the 2016 EDHS survey and an overview of their tasks, including a detailed
training on the vaccination section of the woman’s questionnaire. Data from the field practice was used to
generate the list of children without vaccination cards, to be used as part of the training. In addition, the team
visited health facilities in order to see the various systems that exist in different health facilities.

2.7 Fieldwork

Data collection took place over a 5.5-month period, from January 18, 2016, to June 27, 2016.
Fieldwork was carried out by 33 field teams, each consisting of one team leader, one field editor, three female
interviewers, one male interviewer, two biomarker technicians, and one driver. In addition, 28 quality
controllers (14 for interviews and 14 for biormakers) were dispatched during data collection to support and
monitor fieldwork. Electronic data files were transferred to the CSA central office in Addis Ababa every few
days via the secured IFSS. Staff from CSA, MoH, and EPHI, and specialists from The DHS Program,
coordinated and supervised fieldwork activities.

2.8 Data Processing

All electronic data files for the 2016 EDHS were transferred via IFSS to the CSA central office in
Addis Ababa, where they were stored on a password-protected computer. The data processing operation
included secondary editing, which required resolution of computer-identified inconsistencies and coding of
open-ended questions. The data were processed by two individuals who took part in the main fieldwork
training; they were supervised by two senior staff from CSA. Data editing was accomplished using CSPro
software. During the duration of fieldwork, tables were generated to check various data quality parameters
and specific feedback was given to the teams to improve performance. Secondary editing and data processing
were initiated in January 2016 and completed in August 2016.

7
3 KEY FINDINGS
3.1 Response Rates

T able 1 shows response rates for the 2016 EDHS. A total of 18,008 households were selected for the
sample, of which 17,067 were occupied. Of the occupied households, 16,650 were successfully
interviewed, yielding a response rate of 98 percent.

In the interviewed households, 16,583 eligible women were identified for individual interviews;
interviews were completed with 15,683 women, yielding a response rate of 95 percent. A total of 14,795
eligible men were identified in the sampled households and 12,688 were successfully interviewed, yielding
a response rate of 86 percent. In general, response rates were higher in rural than in urban areas, especially
for men.

Table 1 Results of the household and individual interviews

Number of households, number of interviews, and response rates, according to
residence (unweighted), Ethiopia 2016
Residence
Result Urban Rural Total
Household interviews
Households selected 5,659 12,349 18,008
Households occupied 5,411 11,656 17,067
Households interviewed 5,232 11,418 16,650
Household response rate1 96.7 98.0 97.6
Interviews with women age 15-49
Number of eligible women 5,720 10,863 16,583
Number of eligible women interviewed 5,348 10,335 15,683
Eligible women response rate2 93.5 95.1 94.6
Interviews with men age 15-59
Number of eligible men 4,801 9,994 14,795
Number of eligible men interviewed 3,866 8,822 12,688
Eligible men response rate2 80.5 88.3 85.8

1
Households interviewed/households occupied
2
Respondents interviewed/eligible respondents

3.2 Household Drinking Water and Sanitation Facilities

Increasing household access to safe drinking water and sanitation facilities is a long-standing
development goal that Ethiopia and other countries have adopted. Table 2 includes a number of indicators
that are useful in monitoring household access to improved drinking water sources. The source of drinking
water is an indicator of whether it is suitable for drinking. Sources that are likely to provide water suitable
for drinking are identified as improved sources in Table 2. They include a piped source within the dwelling,
yard, or plot; a public tap or standpipe; tubewell/borehole; a protected well or spring; and rain water or
bottled water (WHO and UNICEF, 2014). Lack of ready access to a water source may limit the quantity of
suitable drinking water that is available to a household. Even if the water is obtained from an improved
source, water that must be fetched from a source that is not immediately accessible to the household may be
contaminated during transport or storage. Another factor in considering the accessibility of water sources is
that the burden of going for water often falls disproportionately on female members of the household. Finally,
home water treatment can be effective in improving the quality of household drinking water.

Table 2 indicates that about two-thirds of households in Ethiopia (65 percent) obtain their drinking
water from an improved source. This is an improvement since the 2011 EDHS, when 54 percent of
households obtained drinking water from an improved source. Use of improved drinking water sources is
more common among households in urban areas (97 percent) than among those in rural areas (57 percent).
The most common source of drinking water in urban areas is water piped into the dwelling, yard, or plot (63
percent), to a neighbor (12 percent) or to a public tap or standpipe (13 percent), resulting in about 9 in 10
urban households (88 percent) using piped water. In rural areas, the most common sources of drinking water
are public tap or standpipe (19 percent), a tube well or borehole (13 percent), and a protected spring (14
percent).

9
 Table 2 Household drinking water
Percent distribution of households by source of drinking water, time to obtain drinking
water, person who usually collects drinking water, and treatment of drinking water,
according to residence, Ethiopia 2016
Residence
Characteristic Urban Rural Total
Source of drinking water
Improved source 97.3 56.5 64.8
Piped into dwelling/yard/plot 63.0 1.8 14.3
Piped to neighbour 12.3 1.1 3.4
Public tap/standpipe 13.1 18.9 17.7
Tubewell/borehole 3.2 13.1 11.1
Protected dug well 1.5 7.0 5.9
Protected spring 3.3 13.9 11.7
Rain water 0.0 0.7 0.5
Bottled water, improved source for
drinking1 0.9 0.0 0.2
Unimproved source 2.7 43.4 35.1
Unprotected dug well 0.2 5.1 4.1
Unprotected spring 1.3 24.7 20.0
Tanker truck/cart with small tank 0.5 0.4 0.4
Surface water 0.7 13.2 10.7
Bottled water, unimproved source for
drinking1 0.0 0.0 0.0
Other source 0.0 0.1 0.1
Total 100.0 100.0 100.0
Time to obtain drinking water (round trip)
Water on premises 76.8 5.6 20.1
Less than 30 minutes 10.2 41.7 35.3
30 minutes or longer 12.6 52.6 44.5
Don’t know/missing 0.4 0.2 0.2
Total 100.0 100.0 100.0
Person who usually collects drinking water
Adult woman 16.6 68.2 57.7
Adult man 2.8 8.3 7.2
Female child under 15 years old 1.9 12.5 10.4
Male child under 15 years old 0.9 4.1 3.5
Other 1.0 1.3 1.2
Water on premises 76.8 5.6 20.1
Total 100.0 100.0 100.0
Water treatment prior to drinking2
Boil 2.8 2.0 2.2
Bleach/chlorine added 6.1 2.5 3.2
Strained through cloth 0.5 1.9 1.7
Ceramic, sand, composite, or other filter 1.6 0.9 1.0
Solar disinfection 0.0 0.1 0.1
Let it stand and settle 0.0 0.3 0.3
Other 0.4 0.1 0.2
No treatment 88.4 92.1 91.3
Percentage using an appropriate treatment
method3 10.5 5.5 6.5
Number 3,384 13,266 16,650
1
Because the quality of bottled water is not known, households using botled water for
drinking are classified as using an improved or unimproved source according to their
water source for cooking and washing.
2
Respondents may report multiple treatment methods so the sum of treatment may
exceed 100 percent.
3
Appropriate water treatment methods include boiling, bleaching, filtering, and solar
disinfection.

Overall, 20 percent of households in Ehtiopia have water on their premises, 77 percent in urban
areas versus only 6 percent in rural areas. Forty-five percent of households spend 30 minutes or longer to
obtain their drinking water, 53 percent in rural areas, as compared with only 13 percent in urban households.

Adult women (58 percent) are more likely than adult men (7 percent) to collect drinking water. In
rural households, adult women are more than eight times as likely as adult men to fetch the water for the
household (68 percent versus 8 percent). Female children under age 15 are more than two times as likely as
male children of the same age to collect drinking water (10 percent verus 4 percent).

More than 9 in 10 households (91 percent) do not treat their drinking water; this is more common
in rural than in urban areas (92 percent versus 88 percent). The most commonly used method of water

10
treatment is adding bleach or chlorine (3 percent). Overall, 7 percent of households use an appropriate
treatment method.

Table 3 presents the percent distribution of households by type of toilet or latrine facilities according
to residence. Six percent of households in Ethiopia use an improved and not shared toilet or latrine facility.
Another 9 percent of households (35 percent in urban areas and 2 percent in rural areas) use facilities that
would be considered improved if they were not shared by two or more households. Half of households in
urban areas (50 percent) use an unimproved toilet facility, compared with more than 9 in 10 (94 percent) of
households in rural areas. The most common type of toilet facility in both urban and rural households is a
pit latrine without a slab or open pit (41 percent in urban areas and 55 percent in rural areas). Overall, 32
percent of households have no toilet facility at all; they are almost exclusively rural, accounting for 39
percent of rural households. There has been an improvement since the 2011 EDHS, when 45 percent of all
households in rural areas did not have a toilet facility.

Table 3 Household sanitation facilities

Percent distribution of households by type of toilet/latrine facilities, according to
residence, Ethiopia 2016
Residence
Type of toilet/latrine facility Urban Rural Total
Improved, not shared facility
Flush/pour flush to piped sewer system 1.8 0.0 0.4
Flush/pour flush to septic tank 2.8 0.1 0.7
Flush/pour flush to a pit latrine 1.4 0.4 0.6
Ventilated improved pit (VIP) latrine 0.4 0.0 0.1
Pit latrine with a slab 9.4 2.3 3.8
Composting toilet 0.1 1.0 0.8
Total 15.9 3.9 6.3
Shared facility1
Flush/pour flush to piped sewer system 0.5 0.0 0.1
Flush/pour flush to septic tank 1.7 0.0 0.3
Flush/pour flush to pit latrine 3.0 0.2 0.7
Ventilated improved pit (VIP) latrine 1.1 0.0 0.2
Pit latrine with slab 27.7 1.4 6.7
Composting toilet 0.5 0.2 0.2
Total 34.6 1.8 8.5
Unimproved facility
Flush/pour flush not to sewer/septic
tank/pit latrine 0.8 0.0 0.2
Pit latrine without slab/open pit 40.5 55.2 52.2
Bucket 0.0 0.0 0.0
Hanging toilet/hanging latrine 0.6 0.0 0.1
No facility/bush/field 6.9 38.8 32.3
Other 0.8 0.3 0.4
Total 49.5 94.3 85.2
Total 100.0 100.0 100.0
Number 3,384 13,266 16,650

1
Facilities that would be considered improved if they were not shared by two or more
households

3.3 Characteristics of Respondents

Table 4 shows the weighted and unweighted numbers and the weighted percent distributions of
women and men age 15-49 interviewed in the 2016 EDHS, by background characteristics. About 6
respondents in 10 were under age 30 (58 percent of women and 55 percent of men), reflecting the young age
structure of the population. The majority of respondents are Orthodox (43 percent of women and 45 percent
of men), followed by Muslims (31 percent of women and men). Regarding ethnic self-identification, Oromo
is the largest ethnic group, making up 34 percent of women and 36 percent of men, followed by Amhara (30
percent of women and men). Eight percent of women and 7 percent of men are Tigray, constituting the third
largest ethnic group.

One-fourth of women (26 percent) and two-fifths of men (42 percent) have never married. Women
are more often married or living together with a partner (i.e., in union) than men (65 percent and 56 percent,
respectively). Women are also more likely than men to report that they are divorced or separated (6 percent
and 2 percent, respectively). Three percent of women report they are widowed, as compared with less than
1 percent of men.

11
 Table 4 Background characteristics of respondents
Percent distribution of women and men age 15-49 by selected background characteristics, Ethiopia 2016
Women Men
Background Weighted Weighted Unweighted Weighted Weighted Unweighted
characteristic percent number number percent number number
Age
15-19 21.6 3,381 3,498 22.2 2,572 2,533
20-24 17.6 2,762 2,903 16.2 1,883 1,969
25-29 18.9 2,957 2,845 17.0 1,977 2,030
30-34 15.0 2,345 2,241 14.1 1,635 1,585
35-39 12.3 1,932 1,917 11.9 1,386 1,375
40-44 8.2 1,290 1,302 10.4 1,206 1,217
45-49 6.5 1,017 977 8.2 947 869
Religion
Orthodox 43.3 6,786 6,413 44.5 5,160 4,956
Catholic 0.8 120 91 0.7 78 94
Protestant 23.4 3,674 2,814 22.1 2,561 1,970
Muslim 31.2 4,893 6,209 31.4 3,649 4,440
Traditional 0.8 123 84 0.3 31 28
Other 0.6 87 72 1.1 128 90
Ethnic group
Afar 0.7 107 947 0.5 63 527
Amhara 29.8 4,671 3,688 30.1 3,497 2,824
Guragie 2.8 444 655 2.7 311 481
Hadiya 2.4 372 230 1.9 217 169
Oromo 34.0 5,340 3,611 36.0 4,175 2,740
Sidama 4.0 627 355 4.2 490 304
Somali 2.8 441 1,463 2.6 299 1,042
Tigray 7.7 1,204 1,905 6.7 778 1,317
Welaita 3.1 494 322 2.8 321 222
Other 12.6 1,984 2,507 12.5 1,455 1,952
Marital status
Never married 25.7 4,036 4,278 42.1 4,882 5,084
Married 63.9 10,014 9,602 52.1 6,045 5,987
Living together 1.3 209 222 3.4 397 190
Divorced/separated 6.3 994 1,130 2.2 254 283
Widowed 2.7 429 451 0.2 28 34
Residence
Urban 22.2 3,476 5,348 19.8 2,303 3,559
Rural 77.8 12,207 10,335 80.2 9,302 8,019
Region
Tigray 7.2 1,129 1,682 6.1 708 1,130
Afar 0.8 128 1,128 0.7 82 665
Amhara 23.7 3,714 1,719 25.1 2,914 1,514
Oromiya 36.4 5,701 1,892 38.0 4,409 1,595
Somali 2.9 459 1,391 2.6 301 927
Benishangul-Gumuz 1.0 160 1,126 1.0 118 902
SNNP 21.0 3,288 1,849 20.4 2,371 1,465
Gambela 0.3 44 1,035 0.3 35 810
Harari 0.2 38 906 0.2 29 620
Addis Adaba 5.9 930 1,824 4.9 573 1,132
Dire Dawa 0.6 90 1,131 0.6 66 818
Education
No education 47.8 7,498 7,033 27.6 3,203 2,904
Primary 35.0 5,490 5,213 48.3 5,608 5,036
Secondary 11.6 1,817 2,238 15.4 1,785 2,142
More than secondary 5.6 877 1,199 8.7 1,010 1,496
Wealth quintile
Lowest 17.2 2,694 4,116 16.4 1,909 2,835
Second 17.9 2,801 2,099 18.0 2,088 1,664
Middle 19.1 3,001 1,947 20.3 2,359 1,655
Fourth 19.3 3,031 1,849 20.3 2,351 1,554
Highest 26.5 4,156 5,672 25.0 2,899 3,870
Total 15-49 100.0 15,683 15,683 100.0 11,606 11,578
Men 50-59 na na na na 1,082 1,110
Total 15-59 na na na na 12,688 12,688

Note: Education categories refer to the highest level of education attended, whether or not that level was
completed
na = Not applicable

The large majority of respondents live in rural areas (78 percent of women and 80 percent of men).
By region, the majority of women and men live in Oromiya region (36 percent of women and 38 percent of
men) followed by Amhara region (24 percent of women and 25 percent of men).

12
 Women are less educated than men; 48 percent of women have no education compared with 28
percent of their male counterparts. Fifteen percent of men reported attending at least some secondary school,
compared with 12 percent of women; and 9 percent have more than secondary education compared with 6
percent of women.

3.4 Fertility

To generate data on fertility, all women who were interviewed were asked to report the total number
of sons and daughters to whom they had ever given birth. To ensure that all information was reported, women
were asked separately about children still living at home, those living elsewhere, and those who had died. A
complete birth history was then obtained, including information on the sex, date of birth, and survival status
of each child; age at death for children who had died was also recorded.

Table 5 shows age-specific fertility rates (ASFRs) Table 5 Current fertility

among women by 5-year age groups for the 3-year period Age-specific and total fertility rates, the general fertility
preceding the survey. Age-specific and total fertility rates were rate, and the crude birth rate for the three years
preceding the survey, by residence, Ethiopia 2016
calculated directly from the birth history data. The sum of age-
Residence
specific fertility rates (known as the total fertility rate, or TFR) Age group Urban Rural Total
is a summary measure of the level of fertility. It can be 15-19 20 98 80
interpreted as the number of children a woman would have by 20-24 113 230 200
25-29 120 243 214
the end of her childbearing years if she were to pass through 30-34 112 210 190
those years bearing children at the current observed age-specific 35-39 77 153 138
40-44 14 80 69
rates. If fertility were to remain constant at current levels, a 45-49 0 27 22
woman from Ethiopia would bear an average of 4.6 children in TFR (15-49) 2.3 5.2 4.6
GFR 81 177 156
her lifetime. Trends in fertility since the early 2000s can be CBR 23.9 33.2 31.8
examined by observing a time series of estimates produced from
Notes: Age-specific fertility rates are per 1,000 women.
demographic surveys conducted in Ethiopia over the last 16 Rates for age group 45-49 may be slightly biased due
to truncation. Rates are for the period 1-36 months
years, beginning with the 2000 EDHS. The trends in TFRs since prior to interview.
2000 are presented in Figure 1. The data indicate that fertility in TFR: Total fertility rate expressed per woman
GFR: General fertility rate expressed per 1,000 women
Ethiopia has been declining since the 2000s. The TFR has age 15-44
CBR: Crude birth rate, expressed per 1,000 population
declined from 5.5 children per woman in 2000, to 5.4 children
per woman in 2005, to 4.8 children per woman in 2011, and to
4.6 children per woman in 2016.

Table 5 further indicates that fertility is notably higher among rural women than urban women. On
average, rural women will give birth to nearly three more children during their reproductive years than urban
women (5.2 versus 2.3 children per woman).

13
 Figure 1 Trends in total fertility rate, 2000-2016
Births per woman

5.5 5.4

4.8
4.6

EDHS 2000 EDHS 2005 EDHS 2011 EDHS 2016

3.5 Teenage Pregnancy and Motherhood

The issue of adolescent fertility is important on both health and social grounds. Children born to
very young mothers are at increased risk of sickness and death. Teenage mothers are more likely to
experience adverse pregnancy outcomes and are more constrained in their ability to pursue educational
opportunities than young women who delay childbearing.

Table 6 shows that 13 percent of women age 15-19 in Ethiopia have begun childbearing: 10 percent
have had a live birth, and 2 percent were pregnant with their first child at the time of interview. As expected,
the proportion of women age 15-19 who have begun childbearing rises rapidly with age, from 2 percent
among women age 15 to 28 percent among those age 19. Teenage childbearing is more common in rural
than in urban areas (15 versus 5 percent, respectively) and among women in Afar (23 percent) and Somali
regions (19 percent) compared with Addis Ababa (3 percent). The proportion of teenagers who have started
childbearing decreases with increasing level of education: nearly 3 in 10 women age 15-19 with no education
(28 percent) have begun childbearing compared with 12 percent of teenagers who have attained primary
education and 4 percent of those who have attained secondary education. Teenagers childbearing also
decerases steadily with wealth; 22 percent of teenagers in the lowest wealth quintile have begun childbearing
compared with 5 percent of those in the highest quintile.

14
 Table 6 Teenage pregnancy and motherhood
Percentage of women age 15-19 who have had a live birth or who are pregnant with their
first child, and percentage who have begun childbearing, by background characteristics,
Ethiopia 2016
Percentage of women Percentage
age 15-19 who: who have
Background Have had a Are pregnant begun Number of
characteristic live birth with first child childbearing women
Age
15 0.6 1.0 1.6 708
16 3.5 0.9 4.4 701
17 11.2 2.1 13.2 641
18 14.7 4.9 19.6 913
19 25.1 2.6 27.7 417
Residence
Urban 2.2 2.7 4.9 805
Rural 12.5 2.3 14.8 2,576
Region
Tigray 9.4 2.5 12.0 276
Afar 20.0 3.3 23.4 30
Amhara 7.0 1.3 8.3 767
Oromiya 14.5 2.5 17.0 1,234
Somali 13.1 5.6 18.7 105
Benishangul-Gumuz 11.5 2.1 13.6 34
SNNP 7.2 3.4 10.7 681
Gambela 14.7 1.5 16.2 9
Harari 15.3 1.6 16.9 8
Addis Ababa 1.9 1.1 3.0 217
Dire Dawa 9.3 3.2 12.5 20
Education
No education 24.1 3.8 27.9 469
Primary 9.8 2.3 12.1 2,148
Secondary 2.0 2.1 4.1 678
More than secondary 3.4 0.0 3.4 87
Wealth quintile
Lowest 16.4 5.3 21.8 511
Second 19.9 1.5 21.4 538
Middle 13.0 2.3 15.2 656
Fourth 5.3 1.3 6.6 678
Highest 2.8 2.3 5.1 998
Total 10.1 2.4 12.5 3,381

3.6 Fertility Preferences

Information on fertility preferences is used to assess the potential demand for family planning
services for the purposes of spacing or limiting future childbearing. To elicit information on fertility
preferences, several questions were asked of currently married women (pregnant or not) regarding whether
they want to have another child and, if so, how soon.

Overall, nearly 1 in 4 married women age 15-49 (37 percent) do not want any more children or are
sterilised. The proportion of women who want to stop childbearing or are sterilised increases rapidly with
the number of living children, from 9 percent of women with one child to 67 percent of those with six or
more children. On the other hand, the proportion of women who want to have another child soon decreases
sharply with the number of living children, from 57 percent among women with no living children to 22
percent among women with one living child, and to 10 percent among those with five or more living children.
Thus, the vast majority of married women want to either space their next birth or cease childbearing
altogether.

15
 Table 7 Fertility preferences by number of living children
Percent distribution of currently married women age 15-49 by desire for children, according to number of living children, Ethiopia 2016
Number of living children1
Desire for children 0 1 2 3 4 5 6+ Total
Have another soon2 57.0 21.5 18.2 16.0 13.0 10.4 9.5 17.5
Have another later3 28.1 63.1 51.7 41.1 34.7 26.4 10.5 35.7
Have another, undecided when 6.0 3.8 3.2 4.4 2.3 2.3 2.3 3.2
Undecided 2.6 2.2 4.4 5.2 5.6 7.2 7.2 5.2
Want no more 3.8 8.5 21.7 32.3 42.8 51.0 66.5 36.3
Sterilised4 0.0 0.0 0.1 0.2 0.6 0.9 0.8 0.4
Declare infecund 2.5 0.8 0.7 0.8 1.0 1.7 3.2 1.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number of women 709 1,625 1,531 1,482 1,348 1,201 2,328 10,223

1
The number of living children includes current pregnancy
2
Wants next birth within 2 years
3
Wants to delay next birth for 2 or more years
4
Includes both female and male sterilisation

3.7 Family Planning

Family planning refers to a conscious effort by a couple to limit or space the number of children
they have through the use of contraceptive methods. Contraceptive methods are classified as modern or
traditional methods. Modern methods include female sterilisation, male sterilisation, the intrauterine
contraceptive device (IUD), implants, injectables, the pill, male condoms, female condoms, emergency
contraception, standard days method (SDM), and lactational amhenorrea method (LAM). Methods such as
rhythm, withdrawal, and folk methods are grouped as traditional.

Table 8 shows the percent distribution of currently married women and sexually active unmarried
women, by contraceptive method they currently use and according to background characteristics. Overall,
36 percent of currently married women are using a method of family planning: 35 percent are using a modern
method, and 1 percent are using a traditional method. Among currently married women, the most popular
methods are injectables (23 percent), implants (8 percent), IUD, and the pill (2 percent each). The
contraceptive prevalence rate (CPR) among married women increases with age, peaking at age 25-29 (41
percent) before declining steadily to 19 percent among women age 45-49. Urban women are much more
likely than their rural counterparts to use any method of contraception (52 percent versus 33 percent). By
region, contraceptive prevalence rate ranges from 2 percent in Somali to 56 percent in Addis Ababa.
Contraceptive use increases with women’s education and household wealth. For instance, 31 percent of
women with no education are using a contraceptive method compared with 55 percent of women with more
than a secondary education. Women with no living children (30 percent) and those with five or more children
(28 percent) are the least likely to use any method of contraception.

Among sexually active unmarried women, 58 percent are currently using a contraceptive method:
55 percent are using a modern method and 3 percent are using a traditional method. The most commonly
used methods among sexually active unmarried women are injectables (35 percent), implants (11 percent),
the male condom, and emergency contraception (4 percent each).

16
Table 8 Current use of contraception by background characteristics
Percent distribution of currently married women and sexually active unmarried women age 15-49, by contraceptive method currently used, according to background
characteristics, Ethiopia 2016
Traditional
Modern method method
Emer- Any
Any Female gency tradi- Not cur- Number
Background Any modern sterili- Im- Inject- Male contra- tional With- rently of
characteristic method method sation IUD plants ables Pill condom ception SDM LAM method Rhythm drawal using Total women
CURRENTLY MARRIED WOMEN
Age
15-19 31.9 31.8 0.0 0.9 4.9 24.0 2.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 68.1 100.0 588
20-24 38.8 38.5 0.0 1.2 8.7 26.2 2.2 0.0 0.0 0.0 0.1 0.3 0.3 0.0 61.2 100.0 1,710
25-29 41.0 40.2 0.0 2.6 9.8 24.9 2.6 0.1 0.1 0.0 0.1 0.8 0.7 0.2 59.0 100.0 2,402
30-34 37.3 36.9 0.2 3.1 8.4 23.3 1.3 0.0 0.1 0.0 0.4 0.5 0.3 0.1 62.7 100.0 2,049
35-39 34.7 33.5 0.8 2.3 8.4 20.2 1.5 0.2 0.0 0.1 0.0 1.2 1.1 0.1 65.3 100.0 1,613
40-44 33.4 32.7 1.2 1.2 6.1 22.2 1.7 0.0 0.0 0.3 0.0 0.6 0.3 0.4 66.6 100.0 1,064
45-49 19.3 18.7 1.5 0.9 2.6 12.6 0.9 0.0 0.0 0.0 0.3 0.5 0.5 0.0 80.7 100.0 798
Residence
Urban 52.0 49.8 0.4 4.6 11.0 26.4 6.5 0.3 0.1 0.3 0.1 2.2 1.9 0.3 48.0 100.0 1,658
Rural 32.8 32.4 0.4 1.5 7.3 22.1 0.9 0.0 0.0 0.0 0.2 0.3 0.2 0.1 67.2 100.0 8,565
Region
Tigray 36.3 35.2 0.2 1.0 10.7 19.3 3.6 0.1 0.0 0.1 0.1 1.1 1.0 0.1 63.7 100.0 658
Afar 11.6 11.6 0.0 0.2 1.4 9.5 0.4 0.1 0.0 0.0 0.0 0.0 0.0 0.0 88.4 100.0 96
Amhara 47.3 46.9 0.5 3.0 12.1 29.3 2.0 0.0 0.0 0.0 0.0 0.4 0.3 0.1 52.7 100.0 2,414
Oromiya 28.6 28.1 0.2 1.7 5.1 19.6 1.2 0.0 0.0 0.1 0.2 0.5 0.4 0.1 71.4 100.0 3,987
Somali 1.5 1.4 0.0 0.1 0.1 0.6 0.4 0.0 0.0 0.0 0.1 0.2 0.0 0.2 98.5 100.0 324
Benishangul-
Gumuz 28.5 28.4 0.2 1.5 6.3 19.5 1.0 0.0 0.0 0.0 0.0 0.2 0.2 0.0 71.5 100.0 114
SNNP 39.9 39.6 0.9 1.3 8.0 27.7 1.6 0.0 0.1 0.0 0.2 0.3 0.2 0.1 60.1 100.0 2,173
Gambela 34.9 34.9 0.0 0.5 1.9 28.9 2.9 0.5 0.0 0.3 0.0 0.0 0.0 0.0 65.1 100.0 29
Harari 29.5 29.3 0.0 2.5 7.5 12.6 5.0 0.6 0.0 0.9 0.2 0.2 0.2 0.0 70.5 100.0 25
Addis Ababa 55.9 50.1 0.5 8.5 14.1 17.4 7.8 1.2 0.0 0.3 0.3 5.9 4.8 1.0 44.1 100.0 355
Dire Dawa 30.3 29.1 0.0 1.2 12.0 11.0 3.4 0.7 0.4 0.0 0.5 1.2 1.2 0.0 69.7 100.0 50
Education
No education 31.2 30.9 0.5 1.8 7.7 19.9 0.9 0.0 0.0 0.0 0.1 0.3 0.2 0.1 68.8 100.0 6,253
Primary 39.6 39.0 0.4 1.9 7.2 27.3 1.9 0.1 0.0 0.0 0.2 0.6 0.5 0.0 60.4 100.0 2,895
Secondary 52.4 50.6 0.0 3.2 8.9 32.9 5.0 0.2 0.0 0.1 0.2 1.8 1.6 0.2 47.6 100.0 654
More than
secondary 55.0 50.7 0.7 4.8 14.3 18.8 10.2 0.6 0.4 0.8 0.2 4.3 3.9 0.4 45.0 100.0 421
Wealth quintile
Lowest 22.0 21.9 0.0 0.7 5.4 14.2 1.4 0.0 0.0 0.1 0.1 0.1 0.1 0.0 78.0 100.0 1,980
Second 29.5 29.2 0.1 1.4 7.3 19.4 1.0 0.0 0.0 0.0 0.1 0.3 0.3 0.0 70.5 100.0 2,024
Middle 38.1 37.9 0.6 1.9 8.9 25.0 1.2 0.0 0.0 0.0 0.3 0.2 0.2 0.0 61.9 100.0 2,112
Fourth 41.4 40.8 1.0 2.1 7.8 29.3 0.6 0.0 0.0 0.0 0.0 0.6 0.3 0.3 58.6 100.0 2,011
Highest 47.6 45.7 0.5 4.1 9.9 25.5 4.9 0.3 0.1 0.2 0.3 1.9 1.7 0.2 52.4 100.0 2,096
Number of
living children
0 30.1 29.4 0.0 1.1 4.7 20.5 2.8 0.1 0.2 0.0 0.0 0.6 0.6 0.0 69.9 100.0 925
1-2 43.2 42.2 0.1 2.7 10.5 25.8 2.9 0.1 0.0 0.0 0.1 1.1 1.0 0.1 56.8 100.0 3,137
3-4 38.9 38.4 0.4 2.1 8.8 24.7 2.0 0.0 0.0 0.1 0.3 0.5 0.3 0.2 61.1 100.0 2,761
5+ 28.3 27.9 0.9 1.6 5.6 19.0 0.5 0.0 0.0 0.1 0.2 0.4 0.3 0.1 71.7 100.0 3,401
Total 35.9 35.3 0.4 2.0 7.9 22.8 1.8 0.1 0.0 0.1 0.1 0.6 0.5 0.1 64.1 100.0 10,223
SEXUALLY ACTIVE UNMARRIED WOMEN
Residence
Urban 56.4 50.4 0.0 1.7 9.9 25.2 1.4 7.6 4.6 0.0 0.0 5.9 3.4 2.5 43.6 100.0 93
Rural 60.1 60.1 0.0 0.0 11.4 46.1 0.0 0.0 2.4 0.2 0.0 0.0 0.0 0.0 39.9 100.0 83
Total 58.1 55.0 0.0 0.9 10.6 35.1 0.7 4.0 3.6 0.1 0.0 3.1 1.8 1.3 41.9 100.0 176

Note: If more than one method is used, only the most effective method is considered in this tabulation.
SDM = Standard days method
LAM = Lactational amenorrhoea method

A comparison of results from the past EDHS surveys reveals that the CPR among currently married
women in Ethiopia has increased steadily from 8 percent in 2000 to 36 percent in 2016 (Figure 2). The largest
increase is observed in the use of injectables, which increased from 3 percent in 2000 to 23 percent in 2016.
The use of implants has also increased during the same period, from less than 1 percent in 2005 to 8 percent
in 2016.

17
 Figure 2 Trends in the use of family planning, 2000-2016

8
Any method 15
29
36

6
Modern method 14
27
35

3 EDHS 2000
Injectables 10 EDHS 2005
21
23 EDHS 2011
EDHS 2016
0
Implants 0.3
3
8

2
Any traditional method 1
1
1
Percent

3.8 Need and Demand for Family Planning

Unmet need for family planning refers to fecund women who are not using contraception but who
wish to postpone their next birth (spacing) or stop childbearing altogether (limiting). This section discusses
the size and composition of the population of women who have an unmet need for family planning services.
This information is useful for planning reproductive health programmes.

The criteria used within The DHS Program to identify women with an unmet need for family
planning have recently been revised (Bradley et al. 2012). The revised definition was employed in
determining which women have an unmet need for family planning (Table 9).

Specifically, women are considered to have an unmet need for spacing if they are:

 At risk of becoming pregnant, not using contraception, and either do not want to become
pregnant within the next 2 years or are unsure if or when they want to become pregnant
 Pregnant with a mistimed pregnancy
 Postpartum amenorrhoeic for up to 2 years following a mistimed birth and not using
contraception

Women are considered to have an unmet need for limiting if they are:

 At risk of becoming pregnant, not using contraception, and want no (more) children
 Pregnant with an unwanted pregnancy
 Postpartum amenorrhoeic for up to 2 years following an unwanted birth and not using
contraception

Women who are classified as infecund have no unmet need because they are not at risk of becoming
pregnant.

18
 Women using contraception are considered to have a met need. Women using contraception who
say they want no (more) children are considered to have a met need for limiting, and women who are using
contraception and say they want to delay having a child or are unsure if or when they want a (another) child
are considered to have a met need for spacing.

Finally, total demand for family planning, percentage of demand satisfied, and percentage of
demand satisfied by modern methods are defined as follows:

 Total demand for family planning: the sum of unmet need (for spacing and limiting) and
total contraceptive use

 Percentage of demand satisfied: total contraceptive use divided by the sum of unmet need
and total contraceptive use

 Percentage of demand satisfied by modern methods: use of modern contraceptive methods

divided by the sum of unmet need and total contraceptive use

Table 9 presents data on unmet need, met need, and total demand for family planning among
currently married women and sexually active unmarried women. Data shows that 22 percent of currently
married women have an unmet need for family planning services, 13 percent for spacing and 9 percent for
limiting. As mentioned above, 36 percent of married women are currently using a contraceptive method; that
is, they have a met need for family planning. Therefore, nearly six in ten currently married women in Ethiopia
(58 percent) have a demand for family planning. At present, 62 percent of the potential demand for family
planning is being met, almost entirely by modern methods. Thus, if all married women who said they want
to space or limit their children were to use family planning methods, the CPR would increase from the current
level of 36 percent to 58 percent.

Among unmarried sexually active women, 26 percent have an unmet need for family planning,
almost all for spacing. About six in ten (58 percent) are currently using a contraceptive method. The total
demand for family planning among unmarried sexually active women is 85 percent. Currently, 69 percent
of the potential demand for family planning is being met, almost entirely by modern methods (65 percent).
If all of the unmarried sexually active women who said they want to space or limit their births were to use
family planning methods, the CPR would increase from 58 percent to 85 percent.

19
Table 9 Need and demand for family planning among currently married women and sexually active unmarried women
Percentage of currently married women and sexually active unmarried women age 15-49 with unmet need for family planning, percentage with met need for family
planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Ethiopia 2016
Percentage
Met need for family planning Total demand for family
of demand
Unmet need for family planning (currently using) planning1 Percentage satisfied by
Background For For For For For For of demand modern Number
characteristic spacing limiting Total spacing limiting Total spacing limiting Total satisfied2 methods3 of women
CURRENTLY MARRIED WOMEN
Age
15-19 18.7 1.9 20.5 29.3 2.7 31.9 48.0 4.5 52.5 60.9 60.7 588
20-24 15.8 2.7 18.5 34.2 4.5 38.8 50.0 7.2 57.3 67.7 67.1 1,710
25-29 16.5 4.5 21.0 30.5 10.5 41.0 47.0 15.0 62.0 66.1 64.8 2,402
30-34 14.8 10.0 24.9 20.9 16.5 37.3 35.7 26.5 62.2 60.0 59.2 2,049
35-39 10.2 16.6 26.8 12.3 22.4 34.7 22.5 39.0 61.5 56.4 54.5 1,613
40-44 5.2 18.8 24.1 6.7 26.7 33.4 11.9 45.5 57.5 58.1 57.0 1,064
45-49 3.1 14.4 17.5 2.0 17.3 19.3 5.1 31.7 36.8 52.4 51.0 798
Residence
Urban 5.7 5.7 11.3 36.9 15.1 52.0 42.5 20.8 63.3 82.1 78.6 1,658
Rural 14.4 10.0 24.4 18.6 14.2 32.8 33.0 24.2 57.2 57.3 56.7 8,565
Region
Tigray 11.8 6.2 18.0 25.3 11.0 36.3 37.1 17.1 54.3 66.9 64.8 658
Afar 12.9 4.3 17.2 9.7 1.9 11.6 22.6 6.3 28.9 40.3 40.3 96
Amhara 8.4 9.0 17.4 29.9 17.4 47.3 38.2 26.4 64.7 73.2 72.5 2,414
Oromiya 17.1 11.8 28.9 15.7 12.9 28.6 32.8 24.7 57.5 49.8 48.9 3,987
Somali 9.4 3.2 12.6 1.4 0.1 1.5 10.8 3.3 14.1 10.8 9.6 324
Benishangul-Gumuz 11.6 9.5 21.1 17.9 10.6 28.5 29.6 20.0 49.6 57.5 57.2 114
SNNP 12.7 8.1 20.8 22.6 17.2 39.9 35.4 25.4 60.7 65.7 65.3 2,173
Gambela 13.1 9.9 23.0 22.6 12.3 34.9 35.7 22.2 57.9 60.3 60.3 29
Harari 12.3 9.0 21.3 19.8 9.6 29.5 32.1 18.6 50.7 58.1 57.7 25
Addis Ababa 6.0 4.5 10.5 39.4 16.5 55.9 45.4 21.0 66.4 84.2 75.4 355
Dire Dawa 10.1 9.3 19.4 21.0 9.3 30.3 31.1 18.6 49.8 61.0 58.6 50
Education
No education 13.3 11.1 24.4 15.1 16.0 31.2 28.4 27.2 55.6 56.0 55.5 6,253
Primary 14.1 7.4 21.5 26.5 13.1 39.6 40.6 20.5 61.1 64.8 63.9 2,895
Secondary 9.7 3.4 13.1 44.1 8.3 52.4 53.8 11.7 65.5 80.0 77.3 654
More than secondary 5.5 5.3 10.8 47.9 7.1 55.0 53.4 12.4 65.8 83.6 77.1 421
Wealth quintile
Lowest 15.1 9.4 24.5 13.6 8.4 22.0 28.7 17.9 46.5 47.4 47.1 1,980
Second 16.7 10.8 27.4 17.1 12.3 29.5 33.8 23.1 56.9 51.8 51.3 2,024
Middle 14.4 9.7 24.1 21.6 16.5 38.1 36.0 26.2 62.2 61.2 61.0 2,112
Fourth 11.9 9.1 21.0 22.7 18.7 41.4 34.6 27.8 62.4 66.4 65.4 2,011
Highest 7.1 7.6 14.7 32.1 15.5 47.6 39.2 23.1 62.3 76.4 73.3 2,096
Total 13.0 9.3 22.3 21.5 14.3 35.9 34.5 23.7 58.2 61.7 60.6 10,223
SEXUALLY ACTIVE UNMARRIED WOMEN
Residence
Urban 22.1 0.0 22.1 48.8 7.6 56.4 70.9 7.6 78.5 71.8 64.3 93
Rural 29.8 1.4 31.2 40.0 20.1 60.1 69.8 21.5 91.3 65.8 65.8 83
Total 25.8 0.6 26.4 44.6 13.5 58.1 70.4 14.1 84.5 68.8 65.1 176

Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012.
1
Total demand is the sum of unmet need and met need.
2
Percentage of demand satisfied is met need divided by total demand.
3
Modern methods include female sterilisation, male sterilisation, pill, IUD, injectables, implants, male condom, female condom, emergency contraception, standard
days method (SDM), lactational amenorrhoea method (LAM), and other modern methods.

Figure 3 presents trends in unmet need, modern contraceptive use, and percentage of total demand
satisfied with modern methods among currently married women. These indicators help evaluate the extent
to which family planning programmes in Ethiopia meet the demand for services. As mentioned above, the
definition of unmet need for family planning has been recently revised (Bradley et al. 2012) so that data on
levels of unmet need are comparable over time and across surveys. The unmet need estimates in Figure 3 for
the previous EDHS surveys have been recalculated using the revised definition of unmet need. The
percentage of married women with unmet need for family planning has been declining over time, from 37
percent in 2000 to 22 percent in 2016. At the same time, the proportion of married women using modern
contraceptive methods has increased sharply from 6 percent in 2000 to 35 percent in 2016. The resulting
total demand for modern contraceptive methods among married women has increased from 45 percent in
2000 to 58 percent in 2016, and the percentage of the demand for family planning that is satisfied with
modern contraceptive methods has increased substantially from 14 percent in 2000 to 61 percent in 2016.

20
 Figure 3 Trends in unmet need, modern contraceptive use, and percentage of
demand satisfied with modern methods, 2000-2016
Percent

61
58
55
50 51
45

37 36 35

26 27 27
22

14 14

Unmet need Modern contraceptive Percentage of demand Total demand

use (MCPR) satisfied with modern
methods
EDHS 2000 EDHS 2005 EDHS 2011 EDHS 2016

3.9 Early Childhood Mortality

Infant and child mortality rates are basic indicators of a country’s socioeconomic situation and
quality of life (UNDP 2007). Estimates of childhood mortality are based on information collected in the birth
history section of the Woman’s Questionnaire, which includes questions about women’s childbearing
experience including the number of sons and daughters who live with their mother, the number who live
elsewhere, and the number who have died. For each live birth reported in the birth history, information was
collected on the name, date of birth (month and year), sex, whether the birth was single or multiple, and
survivorship. For living children, information was also collected on age at last birthday and whether the child
resided with the mother. For children who had died, the respondent was asked to provide the age at death.
Mortality rates for specific periods preceding the survey were calculated using direct estimation procedures
and are shown in Table 10.

This information is used to directly estimate the following five mortality rates:

Neonatal mortality: the probability of dying within the first month of life
Postneonatal mortality: the probability of dying after the first month of life but before the first
birthday (the difference between infant and neonatal mortality)
Infant mortality: the probability of dying before the first birthday
Child mortality: the probability of dying between the first and the fifth birthday
Under-5 mortality: the probability of dying between birth and the fifth birthday

All rates are expressed per 1,000 live births, except for child mortality, which is expressed per 1,000
children surviving to age 12 months.

As shown in Table 10, during the 5 years immediately preceding the survey, the infant mortality
rate was 48 deaths per 1,000 live births. The child mortality rate was 20 deaths per 1,000 children surviving
to age 12 months, while the overall under-5 mortality rate was 67 deaths per 1,000 live births. The neonatal
mortality rate was 29 deaths per 1,000 live births, and the postneonatal mortality rate was 19 deaths per 1,000
live births. The 2016 EDHS findings further indicate that all childhood mortality rates have declined over
time. For example, the under-5 mortality rate has declined from 116 deaths per 1,000 live births 10-14 years
prior to the survey (2002-2006) to 67 deaths per 1,000 live births in the 0-4 years prior to the survey (2012-
2016).

21
 Table 10 Early childhood mortality rates
Neonatal, post-neonatal, infant, child and under-5 mortality rates for five-year periods preceding
the survey, Ethiopia 2016
Mortality rates
Neonatal Postneonatal Infant Child Under-5
Period preceding mortality mortality mortality mortality mortality
survey (NN) (PNN)1 (1q0) (4q1) (5q0)
0-4 29 19 48 20 67
5-9 46 27 73 24 95
10-14 47 30 78 42 116

1
Computed as the difference between the infant and neonatal mortality rates

Figure 4 presents trends in childhood mortality in Ethiopia since the 2000 EDHS survey. Data show
that there has been a steady decline in infant, child, and under-5 mortality over the last 16 years. For example,
under-5 mortality rates for the 5 years preceding the survey declined from 166 deaths per 1,000 live births
to 123 deaths per 1,000 live births in 2005, to reach 67 deaths per 1,000 live births in 2016. Similarly, infant
mortality decreased from 97 deaths per 1,000 live births, to 77 deaths per 1,000 live births, and to 48 deaths
per 1,000 live births in the same period.

Figure 4 Trends in childhood mortality, 2000-2016

Deaths per 1,000
live births
166

123

97
88
77 77
67
59
48 50

31
20

Infant mortality Child mortality Under-5 mortality

EDHS 2000 EDHS 2005 EDHS 2011 EDHS 2016

3.10 Maternal Care

Proper care during pregnancy and delivery is important for the health of both the mother and the
baby. In the 2016 EDHS, women who had given birth in the 5 years preceding the survey were asked a
number of questions about maternal care. Mothers were asked whether they had obtained antenatal care
during the pregnancy for their most recent live birth in the 5 years preceding the survey and whether they
had received tetanus toxoid injections while pregnant. For each live birth over the same period, mothers were
also asked what type of assistance they received at the time of delivery. Finally, women who had a live birth
in the 2 years before the survey were asked if they received a postnatal checkup within 2 days of delivery.
Table 11 summarises information on the coverage of these maternal health services.

3.10.1 Antenatal Care

Antenatal care (ANC) from a skilled provider is important to monitor pregnancy and reduce
morbidity and mortality risks for the mother and child during pregnancy, delivery, and the postnatal period

22
(within 42 days after delivery). The 2016 EDHS results show that 62 percent of women who gave birth in
the five years preceding the survey received antenatal care from a skilled provider at least once for their last
birth. Three in 10 women (32 percent) had four or more ANC visits for their most recent live birth. Urban
women were more likely than rural women to have received ANC from a skilled provider (90 percent and
58 percent, respectively) and to have had four or more ANC visits (63 percent and 27 percent, respectively).
The percentage of women who used a skilled provider for ANC services and who had four or more ANC
visits for their most recent birth in the five years preceding the survey increases greatly with women’s
education. Among women with no education, 53 percent obtained ANC services from a skilled provider and
24 percent received four or more ANC visits compared with 98 percent and 73 percent, respectively, of
women with more than a secondary education. The use of ANC services by a skilled provider and proper
number of ANC visits also increases steadily with household wealth.

As shown in Figure 5, the percentage of women receiving antenatal care from a skilled provider has
increased from 27 percent in 2000 to 62 percent in 2016.

3.10.2 Tetanus Toxoid Vaccination

Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus, a major cause of
early infant deaths in many developing countries, often due to failure to observe hygienic procedures during
delivery. Table 11 shows that 49 percent of women received sufficient doses of tetanus toxoid to protect
their last birth against neonatal tetanus. The percentage of women whose last birth was protected from tetanus
is higher in urban than rural areas (72 percent versus 46 percent), and ranges from 30 percent in Afar to 82
percent in Addis Ababa. The percentage increases with women’s education and wealth. Forty-one percent
of women with no education report that their last live birth was protected against neonatal tetanus compared
to 83 percent of women with more than a secondary education. The proportion of women whose last live
birth was protected against tetanus was similar to that reported in the 2011 EDHS (48 percent).

3.10.3 Delivery Care

Access to proper medical attention and hygienic conditions during delivery can reduce the risk of
complications and infections that may lead to death or serious illness for the mother, baby, or both (Van
Lerberghe and De Brouwere 2001; WHO 2006). Slightly over one in 4 live births in the five years preceding
the survey were delivered by a skilled provider (28 percent) or in a health facility (26 percent). The
percentage of live births delivered by a skilled provider remained virtually unchanged for a period of 5 years
after 2000, but increased substantially after 2005; from 6 percent in the 2000 and 2005 EDHS, to 10 percent
in 2011 EDHS, and reached 28 percent in 2016 EDHS (Figure 5). A similar trend is observed for the
percentage of live births that occurred in a health facility; it increased from 5 percent in the 2000 and 2005
EDHS surveys, to 10 percent in the 2011 EDHS, and to 26 percent in the 2016 EDHS.

Eighty percent of births to urban mothers were assisted by a skilled provider and 79 percent were
delivered in a health facility, as compared with 21 percent and 20 percent, respectively, of births to rural
women. Afar has the lowest percentage of women whose births were delivered by a skilled provider or
delivered in a health facility (16 percent and 15 percent, respectively), while Addis Ababa has the highest
percentages for both indicators (97 percent each). Mothers’ educational status is highly correlated with
whether their deliveries are assisted by a skilled provider and whether they are delivered in a health facility.
For example, 17 percent of births to mothers with no education were assisted by a skilled provider and 16
percent were delivered in a health facility, as compared with 93 percent and 92 percent, respectively, of
births to mothers with more than a secondary education. A similar relationship is observed with household
wealth.

3.10.4 Postnatal Care for the Mother

A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery.
Thus, prompt postnatal care (PNC) for both the mother and the child is important to treat any complications
arising from the delivery, as well as to provide the mother with important information on how to care for

23
herself and her child. Safe motherhood programmes recommend that all women receive a check of their
health within 2 days after delivery.

To assess the extent of postnatal care utilisation, respondents were asked, for their last birth in the
2 years preceding the survey, whether they had received a checkup after delivery and the timing of the first
checkup. As shown in Table 11, 17 percent of women reported having received a PNC checkup in the first
2 days after birth.

The proportion of women receiving a postnatal checkup within 2 days of delivery is higher in urban
areas than in rural areas, lowest in Oromia and highest in Addis Ababa, and increases with women’s
education and household wealth.

Table 11 Maternal care indicators

Among women age 15-49 who had a live birth in the 5 years preceding the survey, percentage who received antenatal care from a skilled provider
for the last live birth, percentage with four or more ANC visits for the last live birth, and percentage whose last live birth was protected against
neonatal tetanus; among all live births in the 5 years before the survey, percentage delivered by a skilled provider and percentage delivered in a
health facility; and among women age 15-49 who had a live birth in the 2 years preceding the survey, percentage who received a postnatal checkup
in the first 2 days after the last live birth, by background characteristics, Ethiopia 2016
Women who had a live
Women who had a live birth in the 5 years Live births in the 5 years birth in the 2 years
preceding the survey preceding the survey preceding the survey
Percentage Percentage
whose last of women
Percentage live birth who had a
with was postnatal
antenatal protected Percentage Percentage checkup in
care from a Percentage against delivered by delivered in the first 2
Background skilled with 4+ ANC neonatal Number of a skilled a health Number of days after Number of
1
characteristic provider visits tetanus2 women provider1 facility births birth women
Age in months
<6 63.6 31.0 45.1 1,218 37.4 36.5 1,229 17.0 1,218
6-11 70.5 37.5 53.1 1,102 41.7 40.9 1,117 17.7 1,102
12-23 61.3 32.5 48.7 1,988 35.2 34.2 2,123 15.6 1,988
24-35 61.4 31.0 49.5 1,491 26.1 24.7 2,061 na na
36-47 60.0 28.8 48.6 1,016 21.0 18.5 2,153 na na
48-59 56.7 28.8 49.7 775 16.7 15.1 2,340 na na
Mother’s age at birth
<20 66.8 29.0 47.3 835 32.8 31.4 1,301 13.0 508
20-34 64.0 33.5 51.2 5,428 27.8 26.4 8,090 17.8 3,126
35-49 52.8 26.6 40.9 1,326 23.1 21.2 1,632 13.1 674
Residence
Urban 90.1 62.7 72.4 969 80.1 79.2 1,216 45.2 520
Rural 58.3 27.3 45.6 6,621 21.2 19.7 9,807 12.6 3,788
Region
Tigray 90.0 56.5 62.0 537 59.3 56.9 716 45.4 314
Afar 51.3 20.6 30.2 71 16.4 14.7 114 11.6 43
Amhara 67.1 31.5 44.8 1,632 27.7 27.1 2,072 18.4 789
Oromiya 50.7 22.1 46.7 3,129 19.7 18.8 4,851 9.0 1,915
Somali 43.6 11.8 38.4 269 20.0 17.9 508 11.9 178
Benishangul-Gumuz 68.7 42.0 53.4 81 28.6 25.7 122 14.5 45
SNNP 69.3 38.2 50.9 1,601 28.6 25.5 2,296 16.9 876
Gambela 72.3 43.4 55.4 21 46.9 45.0 27 16.9 10
Harari 75.9 34.9 70.1 17 51.2 50.2 26 37.4 10
Addis Ababa 96.8 89.1 81.5 198 96.8 96.6 244 55.4 110
Dire Dawa 87.4 66.0 71.5 33 56.7 56.2 47 27.8 18
Mother’s education
No education 53.3 24.1 41.3 4,791 17.2 15.9 7,284 10.6 2,606
Primary 73.0 38.5 57.4 2,150 38.6 36.8 2,951 20.7 1,319
Secondary 92.3 62.7 76.0 420 78.4 77.4 514 37.1 262
More than secondary 98.0 72.9 82.5 230 93.2 91.5 274 54.4 121
Wealth quintile
Lowest 49.8 19.1 38.6 1,637 13.1 12.4 2,605 8.5 989
Second 53.9 27.5 42.8 1,681 20.4 18.9 2,543 10.8 968
Middle 63.8 28.9 47.4 1,576 26.1 23.6 2,268 15.3 922
Fourth 64.5 32.7 52.3 1,441 26.7 25.4 2,013 13.8 750
Highest 85.8 56.8 68.9 1,255 66.9 65.4 1,594 41.0 679
Total 62.4 31.8 49.0 7,590 27.7 26.2 11,023 16.5 4,308

na = Not applicable
1
Skilled provider includes doctor, nurse, midwife, health officer, and health extension worker.
2
Includes mothers with two injections during the pregnancy of her last live birth, or two or more injections (the last within 3 years of the last live birth),
or three or more injections (the last within 5 years of the last live birth), or four or more injections (the last within 10 years of the last live birth), or five
or more injections at any time prior to the last live birth

24
 Figure 5 Trends in maternal health care, 2000-2016*
Percent
62

34
27 28 28 26

10 10
6 6 5 5

ANC by a skilled provider Birth attended by a skilled Birth occurred in a health facility
provider

EDHS 2000 EDHS 2005 EDHS 2011 EDHS 2016

* Skilled provider for EDHS 2000, 2005, and 2011 includes doctor, nurse, and midwife. Skilled provider for EDHS 2016 includes doctor,
nurse, midwife, health officer, and health extension worker.

3.10.5 Obstetrical Fistula

The 2016 EDHS included a series of questions to women age 15-49 on obstetric fistula, a condition
that develops when the blood supply to the tissues of the vagina, bladder, and/or rectum is cut off during
prolonged obstructed labor, resulting in the formation of an opening through which urine and/or feces pass
uncontrollably. Women who develop fistulas are often socially rejected.

More specifically, women age 15-49 were asked if they had heard of obstetrical fistula, and whether
they themselves had experienced the condition. Those who reported suffering from obstetrical fistula were
asked if they had ever been treated for it.

Table 12 shows that about 2 in 5 women interviewed in the survey had heard of obstetrical fistula
(39 percent). Knowledge of obstetric fistula is higher among urban women, women residing in Addis Ababa,
highly educated women, and those in the highest wealth quintile. Less than 1 percent of women reported
ever experiencing obstetrical fistula. Women in the Tigray (1 percent) are slightly more likely to have
experienced obstetrical fistula than other subgroups.

25
 Table 12 Obstetrical fistula
Percentage of women age 15-49 who have heard of obstetrical fistula and
percentage of women who reported that they ever had an obstetric fistula, by
background characteristics, Ethiopia 2016
Percentage of
Percentage of women age
women age 15-49 who
15-49 who have reported that
Background ever heard of they ever had an Number of
characteristic obstetrical fistula obstetrical fistula women
Age
15-19 36.8 0.2 3,381
20-24 41.6 0.3 2,762
25-29 38.5 0.6 2,957
30-34 36.6 0.6 2,345
35-39 35.9 0.4 1,932
40-44 43.4 0.7 1,290
45-49 41.1 0.6 1,017
Residence
Urban 66.6 0.3 3,476
Rural 30.7 0.5 12,207
Region
Tigray 65.8 1.1 1,129
Afar 35.5 0.5 128
Amhara 45.0 0.7 3,714
Oromiya 28.6 0.2 5,701
Somali 31.0 0.3 459
Benishangul-Gumuz 40.2 0.5 160
SNNP 28.0 0.3 3,288
Gambela 40.0 0.4 44
Harari 62.5 0.0 38
Addis Ababa 81.5 0.4 930
Dire Dawa 45.1 0.2 90
Education
No education 27.9 0.5 7,498
Primary 37.0 0.4 5,490
Secondary 65.2 0.1 1,817
More than secondary 84.9 0.1 877
Wealth quintile
Lowest 27.5 0.5 2,694
Second 28.2 0.5 2,801
Middle 28.6 0.6 3,001
Fourth 34.9 0.3 3,031
Highest 62.9 0.4 4,156
Total 38.6 0.4 15,683

3.11 Child Health and Nutrition

The 2016 EDHS collected data on a number of key child health indicators, including vaccinations
of young children, nutritional status as assessed by anthropometry, infant feeding practices, and treatment
practices when a child is ill.

3.11.1 Vaccination of Children

Universal immunisation of children against six common vaccine-preventable diseases, namely

tuberculosis, diphtheria, whooping cough (pertussis), tetanus, polio, and measles, is crucial to reducing infant
and child mortality. Other childhood vaccines given in Ethiopia protect against hepatitis B, and Haemophilus
influenzae type b (Hib). The government of Ethiopia introduced the pneumococcal conjugate vaccine (PCV
13) and monovalent human rotavirus vaccine (RV1) into the national’s infant immunisation programme in
November 2011 and October 2012, respectively. The pneumococcal vaccine protects against Streptococcus
pneumoniae bacteria, which cause severe pneumonia, meningitis, and other illnesses. Rotavirus is a virus
that causes gastroenteritis; an inflammation of the stomach and intestines. If left untreated, it can lead to
severe dehydration and death.

The 2016 EDHS collected information on the coverage of all of these vaccines among children born
in the 3 years preceding the survey. The information obtained in the survey on differences in vaccination

26
coverage among subgroups of children is useful for programme planning and targeting resources towards
areas most in need.

According to the guidelines developed by the World Health Organization, children are considered
to have received all basic vaccinations when they have received a vaccination against tuberculosis (also
known as BCG), three doses each of the DPT-HepB-Hib (also called pentavalent), polio vaccines, and a
vaccination against measles. The BCG vaccine is usually given at birth or at first clinical contact, while the
DPT-HepB-Hib and polio vaccines are given at approximately age 6, 10, and 14 weeks. Measles vaccinations
should be given at or soon after age 9 months. The Ethiopia immunisation programme considers a child to
be fully vaccinated if the child has received all basic vaccinations, three doses of the pneumococcal conjugate
vaccine (PCV vaccine) (also given at age 6, 10, and 14 weeks), and two doses of the rotavirus vaccine (given
at age 6 and 10 weeks).

Information on vaccination coverage was obtained in three ways in the 2016 EDHS: from written
vaccination records, including the Infant Immunisation Card and other health cards, from mothers’ verbal
reports, and from health facility records. In the EDHS, for each child born in the 3 years before the survey,
mothers were asked to show the interviewer the Infant Immunisation Card or health card used to record the
child’s immunisations. If the Infant Immunisation Card or other health card was available, the interviewer
copied the dates of each vaccination received in the respective section of the Woman’s Questionnaire. If a
vaccination was not recorded in the Infant Immunisation Card or on the health card, the mother was asked
to recall whether that particular vaccination had been given. If the mother was not able to present the Infant
Immunisation Card or card for a child, she was asked to recall whether the child had received BCG, polio,
DPT-HepB-Hib, measles, pneumococcal, and rotavirus vaccine. If she indicated that the child had received
the polio, DPT-HepB-Hib, pneumococcal, or rotavirus vaccine, she was asked the number of doses that the
child received.

In addition, if the mother was not able to present the Infant Immunisation Card, and the child had
visited a health facility, a separate team visited the health facility to collect complementary vaccination
records. The purpose of obtaining information at the health facility was to complement the information
collected on vaccination based on mother’s recall.

Table 13 presents data on vaccination coverage among children age 12-23 months by background
characteristics. Children age 12-23 months are the youngest cohort to have reached the age by which a child
should be fully immunised. Data show that 39 percent of children age 12-23 months have received all basic
vaccinations. Sixteen percent of children in this age group have not received any vaccinations. Sixty-nine
percent of children have received the BCG, 73 percent the first dose of pentavalent, 81 percent the first dose
of polio, 67 percent the first dose of the pneumococcal vaccine, and 64 percent the first dose of rotavirus
vaccine. Fifty-four percent of children have received a measles vaccination. Coverage rates decline for
subsequent doses, with 53 percent of children receiving the recommended three doses of the pentavalent, 56
percent the three doses of polio, 49 percent the three doses of the pneumococcal vaccine, and 56 percent the
two doses of the rotavirus vaccine.

There is little difference in the vaccination coverage rates between male and female children.
However, full vaccination coverage is much higher in urban than rural areas (65 percent versus 35 percent).
Full vaccination coverage is highest in Addis Ababa (89 percent) and lowest in Afar (15 percent).
Vaccination coverage increases with mother’s education. About 3 in 10 (31 percent) of children whose
mothers have no education are fully vaccinated compared with more than 7 in 10 (72 percent) of children
whose mothers have more than a secondary education. Similar patterns are observed by household wealth.

27
Table 13 Vaccinations by background characteristics
Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card during home interview, the mother’s report, or vaccination card at health facility), and percentage with a
vaccination card seen, by background characteristics, Ethiopia 2016
Percentage with a
vaccination card
1 2
Pentavalent Polio Pneumococcal Rotavirus seen
All basic No During
Background vaccina- vaccina- home At health Number
characteristic BCG 1 2 3 0 1 2 3 1 2 3 1 2 Measles tions3 tions interview facility of children
Sex
Male 68.9 73.5 63.3 52.9 28.8 79.5 71.2 56.5 64.1 58.8 48.6 62.4 54.5 52.7 36.5 16.1 30.9 23.8 926
Female 69.4 73.0 66.6 53.3 25.7 81.5 72.2 56.3 69.5 62.0 49.6 65.4 57.2 55.8 40.3 15.8 36.9 23.0 1,078
Residence
Urban 88.8 91.1 87.8 79.5 61.2 92.7 87.1 79.5 81.4 78.6 72.9 82.1 79.1 76.0 64.6 3.7 67.3 15.0 232
Rural 66.6 70.9 62.1 49.7 22.7 79.0 69.7 53.4 65.1 58.1 46.0 61.7 52.9 51.5 35.1 17.5 29.8 24.4 1,772
Region
Tigray 88.1 92.3 90.1 81.4 40.8 92.3 86.9 79.3 90.6 87.9 77.7 84.0 79.8 80.1 67.3 4.7 58.3 28.0 152
Afar 43.5 47.1 26.8 20.1 12.5 68.5 53.5 36.4 38.3 24.3 17.5 32.5 23.3 30.1 15.2 28.9 16.7 8.4 20
Amhara 75.2 80.8 75.2 63.8 26.7 87.0 81.1 66.1 75.9 68.9 60.5 68.2 59.1 61.9 45.8 8.3 44.5 25.4 364
Oromiya 59.7 64.8 53.5 39.9 19.8 74.3 61.6 43.4 58.8 51.5 38.3 58.2 50.2 43.2 24.7 22.0 25.9 18.4 881
Somali 55.9 61.6 47.6 36.3 29.2 77.4 64.7 43.8 55.1 42.8 34.9 53.6 41.3 48.1 21.8 19.6 21.0 16.9 76
Benishangul-Gumuz 76.8 81.9 81.4 76.2 51.4 85.6 79.1 70.5 77.8 77.8 71.0 78.8 76.6 70.8 57.4 13.4 41.4 27.6 21
SNNP 76.2 76.7 70.9 59.0 28.8 82.2 77.4 63.6 66.9 61.6 48.6 63.7 54.7 57.6 46.9 14.9 28.8 34.0 419
Gambela 69.9 73.1 67.3 54.8 54.0 78.9 73.8 57.6 65.4 60.2 46.1 65.8 60.5 62.1 41.1 15.3 41.4 15.4 5
Harari 77.0 78.8 66.8 58.7 33.1 96.4 88.8 79.3 80.5 67.6 58.6 71.7 61.3 53.6 42.2 2.8 44.9 16.7 5
Addis Ababa 94.6 97.5 96.8 95.7 84.3 96.8 96.8 96.8 93.9 93.2 91.4 93.5 91.7 93.1 89.2 1.5 90.3 6.7 52
Dire Dawa 96.8 98.2 92.8 84.9 62.1 98.2 92.8 82.1 89.9 85.1 75.3 92.3 85.3 86.9 75.9 1.5 53.7 32.6 9
Education
No education 64.3 68.4 58.4 45.3 22.6 77.5 67.2 49.5 61.6 53.8 42.4 58.0 49.6 49.0 30.7 18.8 28.8 21.8 1,257
Primary 74.3 79.6 73.6 62.3 28.1 84.4 77.5 65.0 74.1 69.1 57.1 72.2 62.7 58.7 46.1 12.1 38.8 27.7 577
Secondary 84.1 86.6 84.3 80.3 45.8 90.7 88.4 78.2 81.3 80.7 70.0 79.5 79.1 78.3 69.6 8.8 57.0 19.6 103
More than secondary 93.6 87.7 87.5 79.0 73.6 88.5 81.8 78.6 85.2 80.4 74.3 82.1 81.5 79.6 71.8 5.3 59.1 20.6 68
Wealth quintile
Lowest 58.3 63.5 54.8 37.6 18.6 71.8 62.8 43.5 58.8 52.2 37.9 54.5 46.3 46.8 26.4 24.4 22.0 22.2 484
Second 64.1 70.8 58.2 48.4 17.2 81.7 68.5 54.6 65.6 56.2 48.1 58.6 49.2 44.6 31.4 15.5 29.1 23.5 436
Middle 72.4 70.1 62.5 53.2 27.8 79.7 70.8 55.3 62.4 56.0 44.3 61.8 51.9 54.6 39.1 15.3 28.0 26.6 424
Fourth 72.0 79.5 73.0 59.5 28.0 83.3 76.8 60.3 74.0 67.7 51.6 71.0 63.1 58.1 43.6 14.0 41.8 24.3 350
Highest 85.5 89.0 85.1 76.9 52.6 90.7 85.9 76.2 80.1 77.5 71.9 81.8 78.1 75.2 61.2 6.3 60.0 19.4 310
Total 69.2 73.2 65.1 53.2 27.1 80.6 71.7 56.4 67.0 60.5 49.1 64.0 56.0 54.3 38.5 15.9 34.1 23.3 2,004

1
Pentavalent is DPT-HepB-Hib
2
Polio 0 is the polio vaccination given at birth
3
BCG, measles, and three doses each of pentavalent and polio vaccine excluding polio vaccine given at birth

28
 3.11.2 Childhood Acute Respiratory Infection, Fever, and Diarrhoea

Acute respiratory infection (ARI), fever, and dehydration from diarrhoea are important contributing
causes of childhood morbidity and mortality in developing countries (WHO 2003). Prompt medical attention
when a child has the symptoms of these illnesses is, therefore, crucial in reducing child deaths. In the 2016
EDHS, for each child under age 5, mothers were asked if the child had experienced an episode of diarrhoea;
a cough accompanied by short, rapid breathing or difficulty breathing as a result of a chest-related problem
(symptoms of ARI); or a fever in the 2 weeks preceding the survey. Women were also asked if treatment
was sought when the child was ill.

Overall, 7 percent of children under age 5 had ARI symptoms, 14 percent had a fever, and 12 percent
experienced diarrhoea in the 2 weeks preceding the survey (data not shown). It should be noted that the
morbidity data collected are subjective because they are based on a mother’s perception of illnesses without
validation by medical personnel.

Table 14 shows that treatment from a health facility or provider was sought for 30 percent of children
with ARI symptoms, for 35 percent of children with fever, and for 43 percent of children with diarrhoea.
Three in ten children with diarrhoea received a rehydration solution from an oral rehydration salt (ORS)
packet; 33 percent were given zinc supplements, and 17 percent received both zinc supplements and ORS.

Table 14 Treatment for acute respiratory infection, fever, and diarrhoea

Among children under age 5 who had symptoms of acute respiratory infection (ARI) or had fever in the 2 weeks preceding the survey, percentage for whom advice or
treatment was sought from a health facility or provider, and among children under age 5 who had diarrhoea during the 2 weeks preceding the survey, percentage for
whom advice or treatment was sought from a health facility or provider, percentage given a fluid made from oral rehydration salt (ORS) packets (LEMLEM), percentage
given zinc, and percentage given ORS and zinc, by background characteristics, Ethiopia 2016
Children with symptoms of
ARI1 Children with fever Children with diarrhoea
Percentage for Percentage for Percentage for
whom whom whom
treatment was treatment was treatment was Percentage
sought from a sought from a sought from a given fluid Percentage
Background health facility/ Number of health facility/ Number of health facility/ from ORS Percentage given any Number of
characteristic provider2 children provider2 children provider2 packet given zinc ORS and zinc children
Age in months
<6 (28.1) 72 29.8 141 30.5 5.8 23.4 5.5 92
6-11 40.0 95 40.6 220 51.1 31.7 34.0 19.3 241
12-23 32.3 183 34.8 395 51.3 36.6 41.6 22.2 357
24-35 24.3 114 34.3 287 35.3 26.1 31.5 16.7 250
36-47 24.3 135 35.3 232 38.0 31.4 29.1 13.1 183
48-59 30.5 91 31.3 219 29.1 26.2 23.6 7.6 105
Sex
Male 32.1 349 35.6 768 38.8 30.2 30.9 17.3 649
Female 27.5 342 33.6 727 46.8 28.8 35.9 15.9 578
Residence
Urban 61.1 48 59.2 192 59.3 40.5 50.8 24.2 126
Rural 27.5 643 31.0 1,303 40.6 28.3 31.3 15.8 1,101
Region
Tigray 30.6 53 31.6 163 49.0 43.0 37.6 30.3 89
Afar (44.3) 4 40.4 18 53.0 32.9 41.4 20.1 12
Amhara 29.1 157 31.4 248 40.0 28.4 28.0 15.4 270
Oromiya 23.9 339 33.8 635 38.5 22.5 33.7 11.3 487
Somali (32.2) 10 28.0 40 44.7 44.2 33.4 26.1 29
Benishangul-Gumuz * 2 42.1 8 61.3 55.3 47.9 35.3 10
SNNP 43.2 117 36.7 335 46.5 33.3 34.6 19.8 301
Gambela * 1 46.9 4 57.5 39.7 38.0 21.6 4
Harari * 0 53.8 2 52.9 39.1 58.2 29.2 3
Addis Ababa * 6 64.1 35 (60.8) (55.8) (35.0) (23.0) 18
Dire Dawa * 2 51.2 6 66.1 51.1 53.3 36.3 5
Mother’s education
No education 26.1 476 29.2 898 35.8 27.9 26.1 13.5 767
Primary 35.2 177 41.6 481 54.6 31.6 47.1 21.4 370
Secondary * 26 43.6 78 46.1 31.7 33.8 19.7 72
More than secondary * 11 (56.7) 37 (68.8) (48.0) (50.2) (37.7) 19
Wealth quintile
Lowest 28.4 127 27.4 302 40.5 31.5 30.2 16.7 256
Second 23.4 188 26.1 333 32.7 19.8 25.6 8.9 282
Middle 24.9 158 34.0 307 39.0 33.1 27.0 17.1 270
Fourth 37.7 146 38.2 324 52.1 28.8 38.8 17.2 235
Highest 43.7 72 52.5 229 53.5 37.3 51.4 26.9 186
Total 29.8 691 34.6 1,495 42.6 29.5 33.3 16.6 1,227
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been
suppressed.
1
Symptoms of ARI (cough accompanied by short, rapid breathing, which was chest-related, and/or by difficult breathing, which was chest-related)
2
Excludes pharmacy, shop, and traditional practitioner

29
3.11.3 Nutritional Status of Children

Anthropometric indicators for young children were collected in the 2016 EDHS to provide outcome
measures of nutritional status. As recommended by WHO, evaluation of nutritional status in this report is
based on a comparison of three indices for the children in this survey, with indices reported for a reference
population of well-nourished children (WHO Multicentre Growth Reference Study Group 2006). The three
indices (height-for-age, weight-for-height, and weight-for-age) are expressed as standard deviation units
from the median for the reference group. Children who fall below minus two standard deviations (-2 SD)
from the median of the reference population are regarded as moderately malnourished, while those who fall
below minus three standard deviations (-3 SD) from the reference population median are considered severely
malnourished. Marked differences, especially with regard to height-for-age and weight-for-age, are often
seen between different subgroups of children within a country.

A total of 10,752 children under age 5 were eligible for weight and height measurements. For some
of the eligible children, however, complete and credible data on height, weight and/or age were not obtained.
In this report, height-for-age data are based on 88 percent of eligible children, weight-for-height data are
based on 89 percent of eligible children, and weight-for-age data are based on 90 percent of eligible children.

Table 15 shows nutritional status for children under age 5, according to the three anthropometric
indices, by background characteristics. Height-for-age is a measure of linear growth. Children whose height-
for-age is less than two standard deviations below the median (-2 SD) of the reference population are
considered short for their age or stunted, a condition reflecting the cumulative effect of chronic malnutrition.

The data show that 38 percent of children under 5 are considered short for their age or stunted (below
-2 SD), and 18 percent are severely stunted (below -3 SD). As shown in Figure 6, after being fairly stable in
the first 6-8 months of life, the prevalence of stunting increases steadily from age 9 months through the first
4 years of life, before declining slightly in the fourth year of life. Children age 24-35 months have the highest
proportion of stunting (48 percent). Stunting is slightly higher among male than female children (41 percent
versus 35 percent).

Stunting is greater among children in rural areas (40 percent) than urban areas (25 percent). There
are some regional variations; stunting ranges from a high of 46 percent in the Amhara region to a low of 15
percent in Addis Ababa. Mother’s education and wealth quintile are both inversely related to children’s
stunting levels. More than 4 in 10 children born to mothers with no education (42 percent) are stunted
compared with 18 percent of children whose mothers have more than a secondary education. Similarly,
stunting decreases from 42 percent among children in the lowest wealth quintile to 27 percent of those in the
highest wealth quintile.

Weight-for-height describes current nutritional status. A child who is below -2 SD from the
reference median for weight-for-height is considered too thin for his or her height, or wasted, a condition
reflecting acute or recent nutritional deficits. Overall, 10 percent of children in Ethiopia are wasted, and 3
percent are severly wasted (below -3 SD). Regional variations exist, with Somali and Afar having the highest
percentages of children who are wasted, 23 percent and 18 percent, respectively.

Weight-for-age is a composite index of weight-for-height and height-for-age and thus does not
distinguish between acute malnutrition (wasting) and chronic malnutrition (stunting). Children can be
underweight for their age because they are stunted, wasted, or both. Weight-for-age is an overall indicator
of a population’s nutritional health. The results show that 24 percent of all children are underweight (below
-2 SD), and 7 percent are severely underweight (below -3 SD). Children in rural areas are more likely than
those in urban areas to be underweight (25 percent versus 13 percent). The highest percentages of
underweight children are observed in Afar (36 percent) and Benishangul-Gumuz (34 percent). The
percentage of underweight children decreases with increasing mother’s education and household wealth.

30
Table 15 Nutritional status of children
Percentage of children under age 5 classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and
weight-for-age, by background characteristics, Ethiopia 2016
Height-for-age1 Weight-for-height Weight-for-age
Percent- Percent- Percent- Percent- Percent- Percent- Percent- Percent-
age age Mean Number age age age Mean Number age age age Mean Number
Background below below Z-score of below below above Z-score of below below above Z-score of
characteristic -3 SD -2 SD2 (SD) children -3 SD -2 SD2 +2 SD (SD) children -3 SD -2 SD2 +2 SD (SD) children
Age in months
<6 6.6 16.2 -0.3 1,108 5.8 15.4 9.6 -0.3 1,077 5.1 12.3 2.7 -0.4 1,158
6-8 5.3 15.3 -0.3 570 4.9 15.4 3.9 -0.6 572 3.6 12.7 1.2 -0.8 574
9-11 8.1 19.4 -0.7 500 3.7 11.0 3.6 -0.5 499 5.0 17.8 2.0 -0.8 511
12-17 15.0 34.9 -1.4 1,128 3.0 14.7 3.0 -0.6 1,142 7.6 22.6 0.9 -1.1 1,152
18-23 17.6 47.2 -1.7 892 2.3 10.6 2.7 -0.5 896 9.1 25.3 0.7 -1.2 902
24-35 21.9 47.8 -1.8 1,941 3.0 8.9 0.9 -0.4 1,951 7.9 25.9 0.6 -1.3 1,967
36-47 22.8 46.4 -1.8 2,012 1.8 6.8 2.3 -0.3 2,023 7.6 25.6 0.7 -1.3 2,040
48-59 21.1 42.2 -1.7 2,224 1.9 6.7 1.2 -0.5 2,253 6.7 29.4 0.3 -1.4 2,248
Sex
Male 19.3 41.3 -1.5 5,305 2.9 10.2 2.9 -0.5 5,358 7.6 25.2 1.0 -1.2 5,424
Female 15.8 35.3 -1.3 5,071 2.9 9.6 2.7 -0.4 5,054 6.2 21.9 0.9 -1.1 5,128
Mother’s interview
status
Interviewed 17.5 38.6 -1.4 9,686 3.0 10.1 2.8 -0.5 9,704 7.1 23.8 0.8 -1.2 9,852
Not interviewed, but
in household 21.3 33.6 -1.2 230 1.3 8.0 2.9 -0.3 225 5.9 21.9 4.5 -0.9 233
Not interviewed, not
in household3 17.8 36.5 -1.4 460 1.6 7.4 2.8 -0.2 483 4.2 19.4 1.1 -1.0 467
Residence
Urban 10.6 25.4 -1.0 1,131 2.1 8.7 3.1 -0.2 1,130 4.3 13.4 2.1 -0.7 1,140
Rural 18.4 39.9 -1.5 9,245 3.0 10.1 2.8 -0.5 9,283 7.3 24.8 0.8 -1.2 9,412
Region
Tigray 13.4 39.3 -1.5 691 3.4 11.1 1.3 -0.6 690 5.2 23.0 0.3 -1.3 699
Afar 22.3 41.1 -1.6 98 5.3 17.7 0.5 -1.0 101 14.4 36.2 0.5 -1.6 100
Amhara 19.6 46.3 -1.8 2,087 2.2 9.8 1.3 -0.6 2,079 8.3 28.4 0.3 -1.4 2,107
Oromiya 17.1 36.5 -1.3 4,491 3.5 10.6 3.8 -0.4 4,510 6.6 22.5 0.9 -1.1 4,573
Somali 12.8 27.4 -0.9 417 6.1 22.7 1.5 -1.1 431 10.1 28.7 1.4 -1.3 427
Benishangul-Gumuz 21.7 42.7 -1.7 106 3.1 11.5 1.5 -0.6 106 11.9 34.3 0.7 -1.4 108
SNNP 20.2 38.6 -1.5 2,188 1.7 6.0 2.7 -0.2 2,195 6.4 21.1 1.6 -1.0 2,234
Gambela 7.4 23.5 -0.9 23 3.4 14.1 1.6 -0.7 23 6.4 19.4 0.3 -1.1 23
Harari 12.6 32.0 -1.1 20 3.0 10.7 2.2 -0.5 20 5.8 20.0 0.7 -1.0 20
Addis Ababa 3.1 14.6 -0.6 216 0.4 3.5 7.0 0.1 216 0.3 5.0 2.9 -0.2 218
Dire Dawa 16.9 40.2 -1.3 40 4.2 9.7 1.5 -0.7 41 7.9 26.2 0.8 -1.3 42
Mother’s education4
No education 20.0 41.8 -1.5 6,533 3.5 10.7 2.6 -0.5 6,555 8.6 27.5 0.7 -1.3 6,642
Primary 14.7 35.1 -1.3 2,687 2.0 9.1 3.3 -0.4 2,686 4.4 18.0 1.0 -1.0 2,742
Secondary 5.9 21.9 -0.7 471 1.4 7.3 3.3 -0.2 463 2.4 11.3 2.9 -0.5 474
More than secondary 5.3 17.5 -0.9 223 3.8 7.4 1.8 -0.2 222 4.6 10.7 0.6 -0.6 224
Wealth quintile
Lowest 21.3 42.2 -1.6 2,344 3.9 14.1 3.8 -0.6 2,383 9.1 30.2 0.7 -1.4 2,412
Second 21.1 43.3 -1.6 2,419 3.4 10.1 1.7 -0.5 2,416 9.8 28.1 0.8 -1.3 2,453
Middle 16.7 38.3 -1.4 2,186 2.4 9.4 2.4 -0.5 2,200 5.5 22.0 1.1 -1.2 2,223
Fourth 15.3 36.5 -1.4 1,923 2.1 6.5 3.2 -0.3 1,918 4.3 17.8 0.7 -1.0 1,943
Highest 10.4 26.9 -1.0 1,504 2.3 8.2 2.9 -0.3 1,496 4.4 15.5 1.7 -0.8 1,521
Total 17.6 38.4 -1.4 10,376 2.9 9.9 2.8 -0.5 10,412 7.0 23.6 0.9 -1.2 10,552

Note: Table is based on children who stayed in the household the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the
median of the WHO Child Growth Standards adopted in 2006. The indices in this table are NOT comparable to those based on the previously used 1977
NCHS/CDC/WHO Reference. Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. Total includes
four children for whom information on mother’s education is missing.
1
Recumbent length is measured for children under age 2 or in the few cases when the age of the child is unknown and the child is less than 87 cm; standing height is
measured for all other children.
2
Includes children who are below –3 standard deviations (SD) from the WHO Growth Standards population median
3
Includes children whose mothers are deceased
4
For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household
Questionnaire.

31
 Figure 6 Nutritional status of children by age
Percent

60

50
Stunted

40

30 Underweight

20

10 Wasted

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59
Age (months)
Note: Stunting reflects chronic malnutrition; wasting reflects acute malnutriton;
underweight reflects chronic or acute malnutrition or a combination of both.
Plotted values are smoothed by a five-month moving average. EDHS 2016

3.11.4 Infant and Young Child Feeding Practices

Breastfeeding is sufficient and beneficial for infant nutrition in the first 6 months of life.
Breastfeeding immediately after birth also helps the uterus contract, hence reducing the mother’s postpartum
blood loss. Supplementing breast milk before the child is age 6 months is discouraged because it may inhibit
breastfeeding and expose the infant to illness. At a later stage of the baby’s development, breast milk should
be supplemented by other liquids and eventually by solid or mushy food to provide adequate nourishment
(Pan American Health Organization 2002).

The 2016 EDHS collected data on infant and young child feeding (IYCF) practices for all children
born in the 2 years preceding the survey. Table 16 shows breastfeeding practices by child’s age. In Ethiopia,
58 percent of infants under 6 months are exclusively breastfed. Contrary to recommendation by WHO that
children under age 6 months should be exclusively breastfed, 17 percent of infants 0-5 months consume
plain water, 5 percent, each, consume nonmilk liquids or other milk, and 11 percent consume complementary
foods in addition to breast milk. Five percent of infants under age 6 months are not breastfed at all. The
percentage exclusively breastfed decreases sharply with age from 74 percent of infants age 0-1 month to 64
percent of those age 2-3 months and, further, to 36 percent of infants age 4-5 months. Nine percent of infants
under 6 months use a bottle with a nipple, a practice that is discouraged because of the risk of illness to the
child.

It is recommended that a child continues to breastfeed until age 2. However, in Ethiopia, the
percentage of children who are currently breastfeeding decreases from 91 percent among children age 12-17
months to 76 percent among children age 18-23 months.

32
Table 16 Breastfeeding status by age
Percent distribution of youngest children under age 2 who are living with their mother, by breastfeeding status, percentage currently breastfeeding; and percentage
of all children under 2 using a bottle with a nipple, according to age in months, Ethiopia 2016
Breastfeeding status Number of
Breast- youngest
Breast- Breast- feeding and children
feeding and feeding and Breast- consuming Percentage under 2 Percentage
Exclusively consuming consuming feeding and comple- currently years living using a Number of
Age in Not breast- breast- plain water non-milk consuming mentary breast- with the bottle with a all children
months feeding feeding only liquids1 other milk foods Total feeding mother nipple under age 2
0-1 6.1 74.1 12.6 2.6 1.5 3.1 100.0 93.9 388 3.7 391
2-3 5.5 64.0 14.1 2.9 4.8 8.7 100.0 94.5 379 9.3 389
4-5 4.1 36.0 24.2 7.9 7.0 20.8 100.0 95.9 418 14.1 420
6-8 4.9 12.0 16.0 5.8 5.0 56.3 100.0 95.1 561 18.5 568
9-11 7.2 4.5 6.7 2.2 2.7 76.6 100.0 92.8 499 19.5 503
12-17 8.6 2.5 7.3 1.7 1.2 78.6 100.0 91.4 1,085 13.4 1,124
18-23 24.0 0.7 5.2 0.6 1.3 68.2 100.0 76.0 816 12.9 880
0-3 5.8 69.2 13.3 2.7 3.1 5.9 100.0 94.2 767 6.5 780
0-5 5.2 57.5 17.2 4.6 4.5 11.1 100.0 94.8 1,185 9.2 1,200
6-9 5.0 10.5 14.2 4.4 4.4 61.4 100.0 95.0 736 19.4 745
12-15 8.2 2.8 7.0 2.0 1.1 79.0 100.0 91.8 777 11.8 800
12-23 15.2 1.7 6.4 1.2 1.3 74.1 100.0 84.8 1,900 13.2 2,004
20-23 24.5 0.5 4.4 0.4 0.8 69.3 100.0 75.5 501 10.4 550

Note: Breastfeeding status refers to a “24-hour” period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only
consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfeeding, breastfeeding and consuming plain water, non-milk
liquids, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus
children who receive breast milk and non-milk liquids and who do not receive other milk and who do not receive complementary foods are classified in the non-
milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are
breastfeeding as well.
1
Non-milk liquids include juice, juice drinks, clear broth, or other liquids.

The minimum acceptable diet indicator is used to assess the proportion of children age 6-23 months
who meet minimum standards with respect to IYCF practices. Specifically, children age 6-23 months who
have a minimum acceptable diet meet all three IYCF criteria below:

1. Breastfeeding, or not breastfeeding and receiving two or more feedings of commercial infant
formula; fresh, tinned, or powdered animal milk; or yogurt.

2. Fed with foods from four or more of the following groups: a. infant formula, milk other than
breast milk, and cheese, yogurt or other milk products; b. foods made from grains, roots, and
tubers, including porridge and fortified baby food from grains; c. vitamin A-rich fruits and
vegetables; d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ
meats); and g. legumes and nuts.

3. Fed the minimum recommended number of times per day according to their age and
breastfeeding status:

a. For breastfed children, minimum meal frequency is receiving solid or semisolid food at
least twice a day for infants age 6-8 months and at least three times a day for children age
9-23 months.

b. For nonbreastfed children age 6-23 months, minimum meal frequency is receiving solid or
semisolid food or milk feeds at least four times a day.

Figure 7 shows the percentage of children being fed the minimum acceptable diet, by age. In total,
only 7 percent of children age 6-23 months have met the criteria for a minimum acceptable diet.

33
 Figure 7 Minimum acceptable diet by age, in months
Percent

9
8
7 7

6-8 9-11 12-17 18-23 Total 6-23 months

months months months months
EDHS 2016

3.12 Anaemia Prevalence in Children and Women

Anaemia is a condition that is marked by low levels of haemoglobin in the blood. Iron is a key
component of haemoglobin, and iron deficiency is estimated to be responsible for half of all anaemia
globally. Other causes of anaemia include hookworms and other helminths, other nutritional deficiencies,
chronic infections, and genetic conditions. Anaemia is a serious concern for children because it can impair
cognitive development, stunt growth, and increase morbidity from infectious diseases. The 2016 EDHS
included haemoglobin testing for children 6-59 months, women age 15-49, and men age 15-59. Haemoglobin
levels were successfully measured for 88 percent of children age 6-59 months eligible for testing, 92 percent
of the women age 15-49 eligible for testing, and 90 percent of the men age 15-59 eligible for testing (data
not shown).

Tables 17.1 and 17.2 present anaemia prevalence for children age 6-59 months and for women and
men age 15-49, by background characteristics. Haemoglobin levels were adjusted for altitude and, for
women and men only, smoking status. Children and pregnant women with haemoglobin levels below 11.0
g/dl, non-pregnant women with haemoglobin levels below 12.0 g/dl, and men with haemoglobin levels below
13.0 g/dl were defined as anaemic.

Overall, more than half of children 6-59 months (56 percent) suffered from some degree of anaemia:
25 percent were mildly anaemic, 28 percent were moderately anaemic, and 3 percent were severely anaemic.
The prevalence of any anaemia decreases with age from a high of 77 percent among children age 6-11 months
to a low of 40 percent among children age 48-59 months. Children in rural areas are more likely to be
anaemic than those in urban areas (57 percent and 47 percent, respectively). The lowest prevalence of
anaemia is among children living in Amhara (41 percent), and the highest is among those living in Somali
(83 percent). Anaemia prevalence decreases with increasing level of household wealth, from a high of 68
percent among children in the lowest wealth quintile to a low of 48 percent among children in the highest
wealth quintile.

About one-fourth of women age 15-49 (23 percent) are anaemic. The majority are mildly anaemic
(17 percent), 5 percent are moderately anaemic, and less than 1 percent are severely anaemic. The proportion
of women with any anaemia is notably higher in rural than in urban areas (25 percent versus 16 percent).
Anaemia prevalence among women ranges from 16 percent in Amhara and Addis Ababa to 59 percent in

34
Somali. Prevalence of anaemia among women decreases as wealth increases, from 33 percent of women in
the lowest wealth quintile to 17 percent of those in the highest wealth quintile.

Table 17.1 Anaemia among children and women

Percentage of children age 6-59 months and women age 15-49 years classified as having
anaemia, by background characteristics, Ethiopia 2016
Percentage with anaemia
Background Any Mild Moderate Severe
characteristic anaemia anaemia anaemia anaemia Number
CHILDREN
Sex
Male 56.0 23.8 29.2 3.1 4,811
Female 56.0 25.7 27.5 2.8 4,455
Age in months
6-11 76.9 29.4 44.0 3.5 1,043
12-23 67.7 25.5 38.4 3.8 2,022
24-35 57.6 23.4 29.4 4.8 1,948
36-47 50.0 24.4 23.9 1.7 2,019
48-59 39.6 23.1 15.0 1.5 2,235
Residence
Urban 47.2 23.5 22.2 1.4 937
Rural 57.0 24.8 29.0 3.1 8,330
Region
Tigray 53.8 26.9 25.4 1.5 612
Afar 73.2 26.6 42.8 3.8 91
Amhara 41.4 22.4 16.8 2.3 1,861
Oromiya 63.8 26.2 34.2 3.4 4,008
Somali 82.6 17.7 52.2 12.8 371
Benishangul-Gumuz 42.5 23.9 18.1 0.6 96
SNNP 49.6 24.7 23.5 1.4 1,992
Gambela 55.8 23.9 31.3 0.7 21
Harari 66.6 23.2 38.1 5.3 16
Addis Ababa 49.8 20.6 27.4 1.8 165
Dire Dawa 69.5 24.6 36.4 8.5 35
Wealth quintile
Lowest 67.6 24.3 37.2 6.1 2,145
Second 56.4 28.1 26.2 2.0 2,158
Middle 52.7 23.0 27.1 2.7 1,972
Fourth 51.0 23.5 25.9 1.6 1,716
Highest 47.7 23.8 22.4 1.5 1,277
Total 56.0 24.7 28.3 2.9 9,267
WOMEN
Residence
Urban 16.4 13.2 3.1 0.2 3,169
Rural 24.8 18.4 5.5 0.9 11,754
Region
Tigray 20.1 16.2 3.5 0.3 1,073
Afar 43.4 27.6 13.8 2.0 119
Amhara 16.3 13.8 2.3 0.1 3,645
Oromiya 26.2 19.2 5.9 1.2 5,422
Somali 59.1 29.9 24.4 4.7 417
Benishangul-Gumuz 18.9 15.6 3.1 0.2 146
SNNP 22.6 17.6 4.6 0.4 3,124
Gambela 26.1 20.6 5.2 0.3 42
Harari 27.2 18.6 7.4 1.2 32
Addis Ababa 15.9 12.5 3.4 0.1 825
Dire Dawa 29.0 20.7 7.0 1.3 77
Wealth quintile
Lowest 33.0 21.2 9.7 2.1 2,570
Second 25.4 18.9 5.6 0.9 2,703
Middle 22.5 17.9 4.2 0.3 2,913
Fourth 20.6 16.4 3.6 0.5 2,916
Highest 17.0 13.8 3.0 0.2 3,820
Total 23.0 17.3 5.0 0.7 14,923

Note: Table is based on children and women who stayed in the household the night before
the interview. Prevalence of anaemia, based on haemoglobin levels, is adjusted for altitude
(for children and women) and smoking (for women) using CDC formulas (CDC 1998).
Women and children with <7.0 g/dl of haemoglobin have severe anaemia, women and
children with 7.0-9.9 g/dl have moderate anaemia, and non-pregnant women with 10.0-11.9
g/dl and children and pregnant women with 10.0-10.9 g/dl have mild anaemia.

35
 Table 17.2 shows that about 1 in 5 men age 15-49 (18 Table 17.2 Anaemia among men
percent) are anaemic. The proportion of men with any anaemia Percentage of men age 15-49 with anaemia, according
is notably higher in rural than in urban areas (20 percent versus to background characteristics, Ethiopia 2016

9 percent). Anaemia prevalence among men ranges from 27 Background Any anaemia
characteristic <13.0 g/dl Number
percent in Afar to 7 percent in Addis Ababa. Prevalence of
Residence
anaemia among men decreases as wealth increases, from 26 Urban 8.9 1,963
percent of men in the lowest wealth quintile to 10 percent of Rural 20.1 8,767
Region
those in the highest wealth quintile. Tigray 20.4 671
Afar 27.2 76
Amhara 17.7 2,808
3.13 HIV/AIDS Awareness, Knowledge, and Oromiya 18.9 4,020
Behaviour Somali 24.4 249
Benishangul-Gumuz 14.1 102
SNNP 18.1 2,221
3.13.1 Knowledge of HIV Prevention Gambela 14.4 32
Harari 16.5 22
Addis Ababa 6.9 475
The 2016 EDHS included a series of questions that Dire Dawa 17.5 54
addressed respondents’ knowledge of HIV prevention, their Wealth quintile
awareness of modes of HIV transmission, and behaviours that Lowest 25.8 1,763
Second 23.4 2,007
can prevent the spread of HIV. Table 18 shows that 58 percent Middle 16.9 2,213
of women and 77 percent of men age 15-49 know that consistent Fourth 17.7 2,224
Highest 9.9 2,522
use of condoms is a means of preventing the spread of HIV. Total 15-49 18.1 10,730
Sixty-nine percent of women and 81 percent of men know that Men 50-59 24.9 1,038
limiting sexual intercourse to one faithful and uninfected Total 15-59 18.7 11,768
partner can reduce the chances of contracting HIV. About 5 in
Note: Prevalence is adjusted for altitude and for
10 women (49 percent) and 7 in 10 men (69 percent) know that smoking status, if known, using formulas in CDC 1998.
both using condoms and limiting sexual intercourse to one
uninfected partner are means of preventing HIV.

36
Table 18 Knowledge of HIV prevention methods
Percentage of women and men age 15-49 who, in response to prompted questions, say that people can reduce the risk of getting HIV by using condoms
every time they have sexual intercourse and by having one sex partner who is not infected and has no other partners, by background characteristics,
Ethiopia 2016
Women Men
Percentage who say HIV can be Percentage who say HIV can be
prevented by: prevented by:
Using Using
condoms and condoms and
Limiting sexual limiting sexual Limiting sexual limiting sexual
intercourse to intercourse to intercourse to intercourse to
Background Using one uninfected one uninfected Number of Using one uninfected one uninfected Number of
characteristic condoms1 partner2 partner1,2 women condoms1 partner2 partner1,2 men
Age
15-24 61.7 70.3 52.0 6,143 76.5 78.6 67.2 4,455
15-19 61.2 68.6 50.6 3,381 74.2 77.0 65.9 2,572
20-24 62.3 72.4 53.8 2,762 79.6 80.8 69.0 1,883
25-29 58.5 69.5 49.1 2,957 80.0 82.2 71.4 1,977
30-39 55.6 68.8 46.9 4,277 78.2 83.3 70.1 3,020
40-49 50.0 65.4 42.6 2,306 74.3 80.0 66.6 2,154
Marital status
Never married 66.7 72.6 56.4 4,036 76.8 79.2 68.1 4,882
Ever had sex 77.3 79.4 65.9 401 86.6 86.3 77.0 1,061
Never had sex 65.5 71.9 55.3 3,636 74.0 77.2 65.6 3,821
Married or living
together 54.0 67.7 45.4 10,223 77.1 82.1 68.9 6,441
Divorced/separated/
widowed 59.0 68.1 50.6 1,423 84.4 75.2 69.1 282
Residence
Urban 78.8 81.1 68.8 3,476 83.4 83.8 73.5 2,303
Rural 51.7 65.5 43.0 12,207 75.6 79.9 67.3 9,302
Region
Tigray 75.0 81.9 66.0 1,129 89.8 90.2 84.2 708
Afar 36.4 61.6 30.6 128 81.0 81.5 71.6 82
Amhara 61.2 72.5 52.1 3,714 83.2 85.5 76.1 2,914
Oromiya 52.8 68.4 45.9 5,701 75.3 78.6 65.7 4,409
Somali 13.4 25.6 10.3 459 42.5 57.9 38.1 301
Benishangul-Gumuz 44.2 49.7 32.8 160 77.8 79.0 67.8 118
SNNP 56.3 65.5 43.8 3,288 70.3 78.7 62.1 2,371
Gambela 55.9 60.5 43.9 44 78.3 80.8 69.2 35
Harari 52.8 72.0 47.3 38 67.4 81.8 62.0 29
Addis Ababa 84.6 82.3 73.4 930 91.2 81.6 76.5 573
Dire Dawa 61.5 60.2 45.5 90 75.3 80.5 64.8 66
Education
No education 44.6 61.4 37.0 7,498 71.5 77.2 64.2 3,203
Primary 62.8 71.6 51.9 5,490 76.1 79.4 66.8 5,608
Secondary 81.0 83.2 71.7 1,817 84.4 87.4 75.9 1,785
More than secondary 89.4 88.4 81.1 877 87.7 87.4 79.3 1,010
Wealth quintile
Lowest 41.6 57.3 34.8 2,694 71.3 74.1 62.1 1,909
Second 52.9 68.0 44.7 2,801 73.1 78.9 65.9 2,088
Middle 51.7 67.1 43.2 3,001 76.8 81.0 68.0 2,359
Fourth 57.0 68.8 46.6 3,031 78.2 81.8 69.2 2,351
Highest 76.2 78.8 66.0 4,156 83.3 85.3 74.6 2,899
Total 15-49 57.7 69.0 48.7 15,683 77.1 80.7 68.6 11,606
Men 50-59 na na na na 73.0 81.9 67.2 1,082
Total 15-59 na na na na 76.8 80.8 68.4 12,688

na = Not applicable
1
Using condoms every time they have sexual intercourse
2
Partner who has no other partners

By marital status, women who are currently in union (45 percent) and men who have never been
married and never had sex (66 percent) are the least likely to know that using condoms and limiting sexual
intercourse to one uninfected partner reduces the risk of HIV. This knowledge is lower among respondents
in rural areas (43 percent of women and 67 percent of men) than those in urban areas (69 percent of women
and 74 percent of men). Knowledge that using condoms and limiting sexual intercourse to one uninfected
partner reduces the risk of HIV transmission increases with respondents’ education and wealth.

37
3.13.2 Knowledge among Young Table 19 Knowledge about HIV prevention among young people
People Percentage of young women and young men age 15-24 with knowledge about
HIV prevention, by background characteristics, Ethiopia 2016
Table 19 shows knowledge of HIV Women age 15-24 Men age 15-24
prevention among young people age 15-24. Percentage Percentage
Knowledge of HIV prevention is defined as with with
knowledge knowledge
knowing that both condom use and limiting Background about HIV Number of about HIV Number of
characteristic prevention1 women prevention1 men
sexual intercourse to one uninfected partner
Age
are HIV prevention methods, knowing that a 15-19 24.0 3,381 37.6 2,572
healthy-looking person can have HIV, and 15-17 22.9 2,050 34.3 1,589
18-19 25.8 1,331 43.0 983
rejecting the two most common local 20-24 24.6 2,762 41.1 1,883
misconceptions about HIV transmission: that 20-22 25.0 1,808 40.1 1,216
23-24 23.8 954 42.9 667
HIV can be transmitted by mosquito bites or Marital status
by sharing food with a person who has HIV. Never married 28.3 3,500 39.2 3,889
Ever had sex 32.6 230 44.9 564
Knowledge of how HIV is transmitted is Never had sex 28.0 3,269 38.2 3,325
crucial to enabling people to avoid HIV Ever married 19.0 2,643 38.2 566

infection, and this is especially true for young Residence

Urban 41.7 1,467 47.7 867
people, who are often at greater risk because Rural 18.8 4,675 37.0 3,588
they may have shorter relationships with Region
Tigray 29.7 498 40.7 310
more partners or engage in other risky Afar 14.1 56 32.6 29
behaviours. Amhara 28.7 1,382 45.5 1,130
Oromiya 22.1 2,229 38.1 1,657
Somali 5.0 186 9.1 124
Table 19 shows that 24 percent of Benishangul-Gumuz 18.7 66 27.0 42
SNNP 20.3 1,251 33.9 916
young women and 39 percent of young men Gambela 25.7 18 36.3 15
15-24 have knowledge about HIV Harari 20.3 16 37.5 10
Addis Ababa 38.8 403 53.4 195
prevention. Among both sexes, urban youth Dire Dawa 21.8 37 48.9 27
are more likely than rural youth to have Education
No education 8.4 1,230 27.2 543
knowledge about HIV prevention. The Primary 21.4 3,333 37.3 2,744
percentage of youth with knowledge about Secondary 40.1 1,184 46.1 910
More than secondary 51.1 396 58.1 258
HIV prevention is lower among those age 15-
Wealth quintile
17 than among older youth, especially for Lowest 11.8 986 28.0 706
men. Ever married young women are much Second 19.7 1,058 35.2 738
Middle 18.3 1,185 38.4 937
less likely than other women (19 percent) to Fourth 23.4 1,164 38.4 955
Highest 38.8 1,750 49.8 1,118
have this knowledge, a pattern not observed
Total 15-24 24.3 6,143 39.1 4,455
for men. Urban youth, those living in Addis
Ababa, youth with more than a secondary 1
Knowledge about HIV prevention means knowing that consistent use of
condoms during sexual intercourse and having just one uninfected faithful partner
education, and youth from the wealthiest can reduce the chance of getting HIV, knowing that a healthy-looking person can
households are more likely than other have HIV, and rejecting the two most common local misconceptions about
transmission or prevention of HIV (that HIV can be transmitted by mosquito bites
subgroups to have knowledge about HIV and that a person can become infected by sharing food with a person who has
HIV).
prevention.

3.13.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV

Increasing general knowledge about prevention of HIV from mother to child and reducing the risk
of transmission using antiretroviral drugs are critical in reducing mother-to-child transmisstion (PMTCT) of
HIV. To assess MTCT knowledge, respondents were asked whether HIV can be transmitted from mother to
child through breastfeeding and whether a mother with HIV can reduce the risk of transmission to her baby
by taking certain drugs during pregnancy.

Table 20 shows that 74 percent of women and 73 percent of men know that HIV can be transmitted
through breastfeeding; 51 percent of women and 61 percent of men know that the risk of mother-to-child
transmission can be reduced if the mother takes special drugs during pregnancy. Overall, 48 percent of
women and 53 percent of men know that HIV can be transmitted by breastfeeding and that the risk of mother-
to-child transmission can be reduced by taking special drugs. Knowledge regarding PMTCT is higher in
urban than in rural areas, is lowest in Somali and highest in Addis Ababa, and increases with increasing
education and wealth.

38
Table 20 Knowledge of prevention of mother-to-child transmission of HIV
Percentage of women and men age 15-49 who know that HIV can be transmitted from mother to child during pregnancy, during delivery, by breastfeeding,
and by all three means, and percentage who know that the risk of mother to child transmission (MTCT) of HIV can be reduced by mother taking special drugs
during pregnancy, by background characteristics, Ethiopia 2016
Percentage of women who say: Percentage of men who say:
HIV can be HIV can be
transmitted by transmitted by
breastfeeding, breastfeeding,
Risk of MTCT and risk of Risk of MTCT and risk of
can be MTCT can be can be MTCT can be
reduced by reduced by reduced by reduced by
mother taking mother taking mother taking mother taking
HIV can be special drugs special drugs HIV can be special drugs special drugs
Background transmitted by during during Number of transmitted by during during Number of
characteristic breastfeeding pregnancy pregnancy women breastfeeding pregnancy pregnancy men
Age
15-24 75.2 54.0 50.0 6,143 72.6 59.3 52.2 4,455
15-19 73.9 52.7 48.7 3,381 71.1 56.5 50.1 2,572
20-24 76.9 55.7 51.6 2,762 74.6 63.2 55.2 1,883
25-29 75.2 52.4 49.1 2,957 73.0 65.7 56.1 1,977
30-39 73.5 49.9 46.1 4,277 73.6 61.4 53.1 3,020
40-49 70.5 44.6 41.2 2,306 70.5 57.7 51.1 2,154
Marital status
Never married 76.3 57.8 52.7 4,036 72.5 61.0 53.5 4,882
Ever had sex 79.7 68.7 60.6 401 76.9 73.1 62.5 1,061
Never had sex 75.9 56.6 51.9 3,636 71.3 57.7 51.0 3,821
Married or living together 73.2 48.0 44.9 10,223 72.8 60.2 52.5 6,441
Divorced/separated/
widowed 74.0 55.8 51.3 1,423 67.2 64.6 52.6 282
Currently pregnant
Pregnant 73.8 46.0 43.8 1,135 na na na na
Not pregnant or not sure 74.1 51.6 47.8 14,548 na na na na
Residence
Urban 84.2 78.0 72.2 3,476 76.1 79.5 67.0 2,303
Rural 71.2 43.6 40.5 12,207 71.6 56.0 49.4 9,302
Region
Tigray 81.6 69.5 63.4 1,129 82.5 77.9 68.7 708
Afar 74.5 42.4 39.7 128 70.7 50.9 45.0 82
Amhara 83.0 55.5 52.2 3,714 76.2 62.2 54.0 2,914
Oromiya 68.0 46.3 42.3 5,701 71.0 61.9 55.8 4,409
Somali 36.7 14.4 13.9 459 57.6 16.7 15.3 301
Benishangul-Gumuz 67.4 46.8 42.4 160 70.2 59.4 51.3 118
SNNP 73.8 44.3 41.5 3,288 69.1 51.0 42.4 2,371
Gambela 76.0 63.6 61.1 44 75.8 69.8 60.7 35
Harari 78.8 56.4 55.1 38 62.9 63.8 54.2 29
Addis Ababa 87.2 84.6 78.1 930 76.5 84.5 69.1 573
Dire Dawa 72.0 65.3 61.3 90 72.4 74.1 60.7 66
Education
No education 66.7 38.1 35.9 7,498 69.4 49.5 45.3 3,203
Primary 78.2 54.8 50.4 5,490 71.6 57.8 50.2 5,608
Secondary 86.1 77.1 71.4 1,817 77.2 76.0 64.1 1,785
More than secondary 86.7 87.4 78.6 877 79.6 84.8 72.1 1,010
Wealth quintile
Lowest 60.9 32.7 30.1 2,694 66.4 45.4 40.5 1,909
Second 69.8 44.6 41.6 2,801 72.9 54.6 48.7 2,088
Middle 72.3 43.6 40.1 3,001 72.1 56.9 51.0 2,359
Fourth 77.7 49.3 45.9 3,031 72.5 62.2 52.5 2,351
Highest 84.2 74.5 69.2 4,156 76.8 76.8 66.0 2,899
Total 15-49 74.1 51.2 47.5 15,683 72.5 60.6 52.9 11,606
Men 50-59 na na na na 74.5 57.4 52.5 1,082
Total 15-59 na na na na 72.7 60.4 52.9 12,688

3.13.4 Multiple Sexual Partners

Information on sexual behaviour is important in designing and monitoring intervention programmes

to control the spread of HIV. The 2016 EDHS included questions on respondents’ sexual partners during the
12 months preceding the survey and during their lifetime. Information was also collected on use of condoms
at respondents’ last sexual intercourse. These questions are sensitive, and it is recognised that some
respondents may have been reluctant to provide information on recent sexual behaviour. Results are shown
in Table 21.1 for women and Table 21.2 for men.

39
 Overall, less than 1 percent of women reported that they had two or more partners in the past 12
months. Among women who had two or more partners in the past 12 months, 19 percent reported using a
condom during their last sexual intercourse (data not shown). The mean number of lifetime partners among
all women who have ever had sexual intercourse is 1.6.

Three percent of men age 15-49 reported that they had two or more partners in the past 12 months,
and 19 percent of them reported using a condom during their last sexual intercourse. The mean number of
lifetime partners among all men who have ever had sexual intercourse is 2.9.

There are no major variations by background characteristics in the percentage of women and men
who had two or more partners in the past 12 months.

Table 21.1 Multiple sexual partners in the past 12 months: Women

Among all women age 15-49, the percentage who had sexual intercourse with two or
more sexual partners in the past 12 months; among those having two or more partners
in the past 12 months, the percentage reporting that a condom was used at last
intercourse; and the mean number of sexual partners during their lifetime for women who
ever had sexual intercourse, by background characteristics, Ethiopia 2016
Women who ever had sexual
All women intercourse1
Percentage
who had 2+ Mean number
partners in the of sexual
Background past 12 Number of partners in Number of
characteristic months women lifetime women
Age
15-24 0.3 6,143 1.3 2,862
15-19 0.3 3,381 1.1 832
20-24 0.3 2,762 1.4 2,030
25-29 0.5 2,957 1.5 2,699
30-39 0.2 4,277 1.7 4,168
40-49 0.5 2,306 2.1 2,291
Marital status
Never married 0.2 4,036 1.7 401
Married/living
together 0.2 10,223 1.6 10,206
Divorced/separated/
widowed 1.4 1,423 2.1 1,413
Residence
Urban 0.5 3,476 1.8 2,323
Rural 0.2 12,207 1.6 9,697
Region
Tigray 0.5 1,129 1.7 874
Afar 0.2 128 1.6 110
Amhara 0.4 3,714 1.8 2,976
Oromiya 0.3 5,701 1.7 4,517
Somali 0.1 459 1.1 358
Benishangul-Gumuz 0.2 160 1.8 128
SNNP 0.2 3,288 1.2 2,352
Gambela 0.7 44 2.3 37
Harari 0.2 38 1.4 30
Addis Ababa 0.5 930 1.9 572
Dire Dawa 0.3 90 1.7 67
Education
No education 0.3 7,498 1.7 7,090
Primary 0.3 5,490 1.6 3,493
Secondary 0.1 1,817 1.3 866
More than secondary 0.6 877 1.3 570
Wealth quintile
Lowest 0.1 2,694 1.5 2,287
Second 0.4 2,801 1.5 2,343
Middle 0.4 3,001 1.5 2,344
Fourth 0.1 3,031 1.8 2,252
Highest 0.5 4,156 1.8 2,795
Total 0.3 15,683 1.6 12,020

1
Means are calculated excluding respondents who gave non-numeric responses.

40
 Table 21.2 Multiple sexual partners in the past 12 months: Men
Among all men age 15-49, the percentage who had sexual intercourse with two or more sexual partners; among those
having two or more partners in the past 12 months, the percentage reporting that a condom was used at last intercourse;
and the mean number of sexual partners during their lifetime for men who ever had sexual intercourse, by background
characteristics, Ethiopia 2016
Men who had 2+ partners in Men who ever had sexual
All men the past 12 months intercourse1
Percentage
Percentage who reported
who had 2+ using a Mean number
partners in the condom during of sexual
Background past 12 Number of last sexual Number of partners in Number of
characteristic months men intercourse men lifetime men
Age
15-24 1.8 4,455 45.5 78 2.2 1,064
15-19 0.8 2,572 (56.9) 20 2.4 204
20-24 3.1 1,883 41.5 58 2.1 860
25-29 3.1 1,977 41.4 60 2.9 1,500
30-39 4.0 3,020 8.3 120 2.8 2,787
40-49 6.2 2,154 3.9 133 3.3 2,055
Marital status
Never married 2.2 4,882 60.6 108 3.7 1,009
Married/living
together 4.3 6,441 1.6 274 2.7 6,130
Divorced/separated/
widowed 3.3 282 * 9 3.9 266
Residence
Urban 3.6 2,303 64.0 83 4.3 1,481
Rural 3.3 9,302 7.3 308 2.5 5,925
Region
Tigray 2.6 708 (42.5) 18 3.3 440
Afar 5.9 82 (16.5) 5 3.3 67
Amhara 1.6 2,914 * 47 2.8 1,956
Oromiya 4.2 4,409 11.5 184 2.9 2,657
Somali 4.7 301 1.6 14 1.6 184
Benishangul-Gumuz 5.6 118 18.0 7 3.3 91
SNNP 3.7 2,371 8.8 87 2.4 1,514
Gambela 5.5 35 (32.4) 2 3.5 27
Harari 2.2 29 * 1 1.8 19
Addis Ababa 4.7 573 71.0 27 5.2 405
Dire Dawa 2.5 66 * 2 3.1 46
Education
No education 3.4 3,203 1.7 108 2.6 2,632
Primary 3.3 5,608 15.6 185 2.5 3,103
Secondary 2.9 1,785 46.4 52 3.6 898
More than secondary 4.6 1,010 45.0 47 4.4 773
Wealth quintile
Lowest 4.6 1,909 10.0 87 2.6 1,263
Second 3.0 2,088 5.4 62 2.1 1,417
Middle 3.0 2,359 (12.5) 71 2.5 1,498
Fourth 3.1 2,351 (6.9) 73 2.5 1,416
Highest 3.4 2,899 50.5 99 4.2 1,811
Total 15-49 3.4 11,606 19.4 392 2.9 7,405
Men 50-59 5.8 1,082 0.7 63 4.4 1,029
Total 15-59 3.6 12,688 16.8 454 3.1 8,435

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer
than 25 unweighted cases and has been suppressed. Total includes 5 women/men/households for whom information on
age is missing.
1
Means are calculated excluding respondents who gave non-numeric responses.

3.14 Coverage of HIV Testing Services

Knowledge of HIV status helps HIV-negative individuals make specific decisions to reduce risk
and increase safer sex practices so that they can remain disease free. Among those who are HIV infected,
knowledge of their status allows them to take action to protect their sexual partners, to access treatment, and
to plan for the future.

To assess awareness and coverage of HIV testing services, the 2016 EDHS respondents were asked
whether they had ever been tested for HIV. If they said that they had been, they were asked whether they

41
 had received the results of their last test and where they had been tested. If they had never been tested, they
were asked whether they knew a place where they could go to be tested.

Tables 22.1 and 22.2 show that about 7 in 10 women age 15-49 (69 percent) and more than 4 in 5
men (84 percent) knew where they could get an HIV test. Younger respondents age 15-19 were less likely
than older respondents to know a place where they could get tested for HIV. Never-married respondents who
had never had sex were less likely than others to know a place to get an HIV test. Knowledge of a place to
get an HIV test increases steadily with education and wealth.

Table 22.1 Coverage of prior HIV testing: Women

Percentage of women age 15-49 who know where to get an HIV test, percent distribution of women age 15-49 by testing status and by whether they
received the results of the last test, percentage ever tested, and percentage who were tested in the past 12 months and received the results of the last
test, according to background characteristics, Ethiopia 2016
Percentage
who have
Percent distribution of women by testing status been tested for
and by whether they received the results of the HIV in the past
Percentage last test 12 months and
who know Ever tested Ever tested, received the
Background where to get and received did not receive Percentage results of the Number of
characteristic an HIV test results results Never tested1 Total ever tested last test women
Age
15-24 68.3 34.1 3.6 62.3 100.0 37.7 18.0 6,143
15-19 61.7 22.4 2.9 74.8 100.0 25.2 12.4 3,381
20-24 76.5 48.4 4.5 47.1 100.0 52.9 24.9 2,762
25-29 73.2 49.1 5.0 45.9 100.0 54.1 24.4 2,957
30-39 69.3 43.3 4.6 52.1 100.0 47.9 20.3 4,277
40-49 67.2 38.5 3.5 58.0 100.0 42.0 16.7 2,306
Marital status
Never married 68.9 27.9 2.9 69.1 100.0 30.9 14.3 4,036
Ever had sex 87.3 66.3 1.9 31.8 100.0 68.2 38.0 401
Never had sex 66.9 23.7 3.1 73.3 100.0 26.7 11.7 3,636
Married or living
together 69.0 43.4 4.7 51.8 100.0 48.2 21.3 10,223
Divorced/separated/
widowed 73.1 50.3 3.2 46.5 100.0 53.5 22.8 1,423
Residence
Urban 91.6 67.8 2.6 29.6 100.0 70.4 36.1 3,476
Rural 63.0 32.2 4.6 63.3 100.0 36.7 15.0 12,207
Region
Tigray 89.0 61.6 4.5 33.8 100.0 66.2 32.1 1,129
Afar 62.3 37.5 3.1 59.5 100.0 40.5 23.5 128
Amhara 77.2 49.1 4.0 46.8 100.0 53.2 20.8 3,714
Oromiya 55.4 28.4 4.0 67.6 100.0 32.4 15.4 5,701
Somali 43.4 12.8 1.1 86.1 100.0 13.9 8.5 459
Benishangul-Gumuz 73.5 43.6 2.9 53.4 100.0 46.6 23.5 160
SNNP 73.8 36.5 5.7 57.8 100.0 42.2 17.6 3,288
Gambela 80.2 58.2 2.6 39.3 100.0 60.7 33.5 44
Harari 81.3 53.6 4.5 41.9 100.0 58.1 29.3 38
Addis Ababa 95.1 71.6 1.5 26.8 100.0 73.2 34.8 930
Dire Dawa 80.8 60.9 2.6 36.5 100.0 63.5 39.0 90
Education
No education 59.0 31.4 4.3 64.3 100.0 35.7 13.6 7,498
Primary 71.9 39.8 4.2 56.0 100.0 44.0 20.4 5,490
Secondary 91.1 57.6 4.0 38.4 100.0 61.6 30.3 1,817
More than secondary 96.7 79.3 2.6 18.1 100.0 81.9 44.2 877
Wealth quintile
Lowest 53.3 23.8 3.1 73.1 100.0 26.9 10.7 2,694
Second 59.7 30.1 4.3 65.5 100.0 34.5 12.4 2,801
Middle 63.5 33.5 4.2 62.4 100.0 37.6 16.5 3,001
Fourth 71.6 37.9 5.8 56.3 100.0 43.7 17.1 3,031
Highest 88.8 63.7 3.4 33.0 100.0 67.0 34.5 4,156
Total 69.3 40.1 4.1 55.8 100.0 44.2 19.7 15,683

1
Includes ‘don’t know/missing’

Tables 22.1 and 22.2 also show coverage of HIV testing services among women and men age 15-
49. More than half of women and men (56 percent and 55 percent, respectively) had never been tested. Most
respondents who had been tested said that they had received the results of the last test they took. Overall, 40
percent of women and 43 percent of men had ever been tested and had received the results of their last test.

42
 Four percent of women and 3 percent of men had been tested but did not receive the test results. The
likelihood of having ever had an HIV test and receiving the results is lower in the 15-19 age group (22
percent of women and 18 percent of men), in respondents who had never married and had never had sex (24
percent of women and 25 percent of men), and among respondents in rural areas (32 percent of women and
37 percent of men).

Twenty percent of women and 19 percent of men age 15-49 had been tested in the 12-month period
preceding the survey and had been told the results of the last test they took.

Table 22.2 Coverage of prior HIV testing: Men

Percentage of men age 15-49 who know where to get an HIV test, percent distribution of men age 15-49 by testing status and by whether they received
the results of the last test, percentage ever tested, and percentage who were tested in the past 12 months and received the results of the last test,
according to background characteristics, Ethiopia 2016
Percentage
who have
been tested
Percent distribution of men by testing status for HIV in the
and by whether they received the results of the past 12
Percentage last test months and
who know Ever tested Ever tested, received the
Background where to get and received did not receive Percentage results of the Number of
characteristic an HIV test results results Never tested1 Total ever tested last test men
Age
15-24 79.2 28.9 2.0 69.1 100.0 30.9 14.7 4,455
15-19 73.7 18.2 1.6 80.2 100.0 19.8 8.9 2,572
20-24 86.6 43.7 2.5 53.8 100.0 46.2 22.8 1,883
25-29 88.4 56.1 2.9 41.0 100.0 59.0 27.6 1,977
30-39 85.9 50.8 3.1 46.1 100.0 53.9 20.4 3,020
40-49 87.9 48.4 3.2 48.4 100.0 51.6 17.7 2,154
Marital status
Never married 80.6 32.6 1.7 65.8 100.0 34.2 16.6 4,882
Ever had sex 95.2 61.6 1.4 37.0 100.0 63.0 36.1 1,061
Never had sex 76.6 24.5 1.7 73.7 100.0 26.3 11.2 3,821
Married or living
together 86.5 49.9 3.4 46.7 100.0 53.3 20.3 6,441
Divorced/separated/
widowed 90.5 60.4 4.2 35.4 100.0 64.6 29.6 282
Residence
Urban 94.6 64.8 2.2 33.0 100.0 67.0 33.2 2,303
Rural 81.5 37.4 2.8 59.8 100.0 40.2 15.4 9,302
Region
Tigray 89.6 55.8 2.5 41.6 100.0 58.4 24.6 708
Afar 90.9 49.9 1.4 48.7 100.0 51.3 29.1 82
Amhara 91.0 52.7 1.6 45.7 100.0 54.3 23.4 2,914
Oromiya 76.9 33.0 3.0 63.9 100.0 36.1 14.8 4,409
Somali 68.8 14.7 0.3 85.0 100.0 15.0 7.6 301
Benishangul-Gumuz 70.6 47.2 2.2 50.6 100.0 49.4 23.4 118
SNNP 86.2 40.9 3.9 55.2 100.0 44.8 14.7 2,371
Gambela 86.4 61.9 2.5 35.7 100.0 64.3 36.6 35
Harari 77.8 31.3 3.4 65.3 100.0 34.7 13.7 29
Addis Ababa 98.3 71.1 1.9 27.0 100.0 73.0 40.4 573
Dire Dawa 92.2 60.3 2.5 37.2 100.0 62.8 35.8 66
Education
No education 77.2 34.1 3.0 62.8 100.0 37.2 12.5 3,203
Primary 82.1 36.1 2.6 61.3 100.0 38.7 15.2 5,608
Secondary 95.2 60.9 2.3 36.8 100.0 63.2 30.9 1,785
More than secondary 97.6 76.3 2.6 21.1 100.0 78.9 39.4 1,010
Wealth quintile
Lowest 76.6 26.9 2.2 70.9 100.0 29.1 9.6 1,909
Second 76.2 34.0 2.8 63.2 100.0 36.8 11.8 2,088
Middle 83.0 39.5 2.8 57.7 100.0 42.3 17.5 2,359
Fourth 86.6 44.5 3.3 52.3 100.0 47.7 19.4 2,351
Highest 93.7 61.2 2.3 36.5 100.0 63.5 31.2 2,899
Total 15-49 84.1 42.9 2.7 54.5 100.0 45.5 19.0 11,606
Men 50-59 84.9 44.9 2.5 52.7 100.0 47.3 14.5 1,082
Total 15-59 84.2 43.0 2.7 54.3 100.0 45.7 18.6 12,688

1
Includes ‘don’t know/missing’

43
 3.15 Domestic Violence

In Ethiopia, domestic violence is widely acknowledged to be of great concern, not just from a human
rights perspective, but also from an economic and health perspective. The government of Ethiopia revised
its family law in 2000, its criminal law and constitution in 2005, to protect and guarantee the rights of women
and children, and to promote gender equality and equity. Reliable data are needed to further inform and
educate the population about the problem. To collect these data, the 2016 EDHS included questions on
violence against women. Information was collected on both domestic violence (also known as spousal
violence or intimate partner violence) and violence by other family members of unrelated individuals. Table
23 provides data for ever-married women age 15-49 who reported their experience of spousal emotional,
physical, and sexual violence. The final report will present additional data information regarding violence
against women.

Table 23 Spousal violence by background characteristics

Percentage of ever-married women age 15-49 who have ever experienced emotional, physical, or sexual violence committed by their husband/partner,
by background characteristics, Ethiopia 2016
Physical and Physical or Number of
Background Emotional Physical Sexual Physical and sexual and Physical or sexual or ever married
characteristic violence violence violence sexual emotional sexual emotional women
Age
15-19 21.6 27.1 10.0 7.5 7.2 29.6 33.4 289
20-24 22.6 23.9 8.5 5.4 3.9 27.0 33.0 669
25-29 19.6 24.0 12.0 8.6 5.7 27.4 32.5 982
30-39 24.7 25.8 11.3 8.5 6.6 28.6 36.6 1,642
40-49 29.3 24.4 12.2 8.8 8.2 27.8 37.5 887
Religion
Orthodox 25.6 25.4 11.7 7.8 5.8 29.3 37.0 1,900
Catholic * * * * * * * 33
Protestant 24.7 23.5 10.2 7.3 6.8 26.4 34.1 1,014
Muslim 20.7 24.7 11.2 9.3 7.1 26.6 32.6 1,448
Traditional (25.1) (38.2) (13.6) (2.8) (2.8) (49.0) (59.5) 38
Other (54.9) (40.4) (3.6) (0.0) (0.0) (44.0) (54.9) 37
Marital status
Married/living
together 22.7 23.3 10.6 7.3 5.6 26.6 33.7 3,897
Divorced/separated/
widowed 32.5 35.8 14.8 12.8 11.6 37.7 45.1 573
Residence
Urban 21.3 19.0 7.2 4.8 3.8 21.4 29.4 809
Rural 24.6 26.2 12.0 8.8 6.9 29.4 36.4 3,660
Region
Tigray 26.7 21.7 13.0 7.0 5.6 27.7 36.5 316
Afar 13.4 14.0 3.0 2.4 1.9 14.6 21.7 43
Amhara 25.8 24.2 11.4 7.3 5.2 28.3 37.1 1,085
Oromiya 25.4 31.2 14.4 11.9 9.7 33.7 39.2 1,746
Somali 7.1 6.8 0.4 0.4 0.2 6.8 9.4 132
Benishangul-Gumuz 25.6 20.4 7.6 4.3 3.4 23.8 32.5 44
SNNP 21.8 19.0 6.8 4.2 3.5 21.6 30.4 913
Gambela 23.6 26.4 8.6 6.1 4.2 28.9 35.7 13
Harari 31.2 28.7 5.2 5.2 4.2 28.7 37.7 10
Addis Ababa 18.9 20.7 7.0 5.0 4.2 22.7 27.9 146
Dire Dawa 19.2 21.1 8.6 2.3 2.0 27.4 32.0 23
Education
No education 25.9 26.6 12.9 9.3 7.7 30.2 37.3 2,725
Primary 24.2 25.1 9.4 7.3 5.6 27.2 35.1 1,236
Secondary 16.7 18.4 6.0 4.3 2.1 20.1 27.7 312
More than secondary 7.8 10.3 4.5 0.6 0.0 14.2 17.5 196
Wealth quintile
Lowest 24.3 25.4 14.1 10.3 7.0 29.2 36.5 845
Second 24.1 25.6 11.2 8.4 6.3 28.4 35.6 870
Middle 27.3 26.8 13.3 8.9 7.5 31.2 41.3 932
Fourth 23.9 25.5 10.9 8.0 7.2 28.4 33.4 829
Highest 20.6 21.6 6.6 5.0 4.1 23.2 29.3 993
Total 15-49 24.0 24.9 11.1 8.0 6.4 28.0 35.2 4,469

Note: Husband/partner refers to the current husband/partner for currently married women and the most recent husband/partner for divorced, separated,
or widowed women. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25
unweighted cases and has been suppressed.

44
 More than one-third of ever-married women (35 percent) report that they have experienced physical,
emotional, or sexual violence from their husband or partner at some point in time. Twenty-four percent of
women report that they experienced emotional violence, 25 percent experienced physical violence, and 11
percent experienced sexual violence. Experience of physical, emotional, or sexual violence from a husband
or partner is higher among older women 40-49 (38 percent), formerly married women (45 percent), those
living in rural areas (36 percent), and women in Oromia (39 percent), Harari (38 percent), and Amhara (37
percent). Experience of spousal violence decreases with increasing educational level and household wealth.

3.16 Female Genital Table 24 Prevalence of female genital cutting (FGC)

Cutting Percentage of women 15-49 who are circumcised and, among circumcised women, percent
distribution by type of circumcision, according to background characteristics, Ethiopia 2016
Female genital cutting Type of circumcision
(FGC), aslo known as female genital Percentage Number of
of women Cut, not Genital women
mutilation (FGM), is a common Background circum- Number of flesh Cut, flesh sewn circum-
practice in many societies in sub-Sa- characteristic cised women removed removed closed cised
haran Africa. In Ethiopia, the age at Age
15-19 47.1 1,670 3.0 72.0 7.4 786
which FGC is performed varies 20-24 58.6 1,290 3.1 79.4 6.8 756
among the different ethnic groups. 25-29 67.6 1,474 2.2 80.7 5.7 996
30-39 75.8 2,218 2.4 81.6 5.7 1,682
40-49 75.3 1,170 3.1 79.5 8.1 881
In half of the selected Religion
households, the 2016 EDHS Orthodox 54.2 3,424 3.6 64.8 2.3 1,856
Catholic (58.2) 66 * * * 39
included a series of questions from Protestant 65.8 1,862 2.1 92.5 2.5 1,226
all women age 15-49 to gather Muslim 82.2 2,362 2.2 84.5 13.4 1,942
Traditional (55.0) 62 * * * 34
information on women’s Other (9.9) 46 * * * 5
knowledge, prevalence, type of Ethnic group
Afar 98.4 55 4.0 84.4 71.0 54
circumcision, and attitudes towards Amhara 60.5 2,328 3.2 60.8 2.7 1,409
the practice of FGC. Guragie 78.3 205 6.9 78.2 2.7 160
Hadiya 92.3 184 1.2 92.9 12.6 170
Oromo 77.1 2,693 1.8 84.7 1.9 2,076
Table 24 shows the preva- Sidama 87.6 321 1.3 97.1 2.1 281
Somali 98.5 220 1.7 97.3 75.6 217
lence of FGC by background char- Tigray 23.0 565 10.4 49.0 5.3 130
acteristics. Sixty-five percent of Welaita 92.3 234 5.9 93.5 0.0 216
Other 38.1 1,018 1.3 90.1 4.1 388
women age 15-49 are circumcised: 3 Residence
percent of women had cutting with Urban 53.9 1,714 4.6 72.0 8.4 924
Rural 68.4 6,108 2.2 80.9 6.1 4,177
no flesh removed, 79 percent had
Region
cutting with flesh removed, and 7 Tigray 24.2 540 13.0 46.6 7.1 131
had their genital area sewn closed Afar 91.2 67 8.0 84.8 63.6 61
Amhara 61.7 1,826 1.8 57.7 2.8 1,127
after cutting. The proportion of Oromiya 75.6 2,881 2.0 85.4 1.6 2,178
Somali 98.5 229 1.9 97.2 73.1 225
circumcised women is lowest among Benishangul-
Orthodox women (54 percent) and Gumuz 62.9 75 6.2 69.1 3.2 47
SNNP 62.0 1,653 2.8 93.0 4.3 1,024
highest among Muslim women (82 Gambela 33.0 22 6.6 46.1 4.8 7
percent). Harari 81.7 18 0.6 96.7 4.5 15
Addis Ababa 54.0 466 5.1 66.5 1.4 251
Dire Dawa 75.3 47 4.4 86.8 10.1 35
Female circumcision is Education
most prevalent among the ethnic No education 72.9 3,787 2.4 80.4 8.0 2,759
Primary 62.0 2,679 2.7 79.7 4.9 1,662
groups of Afar and Somali (98 Secondary 49.9 907 4.4 73.3 4.4 453
percent and 99 percent, More than
secondary 50.6 449 2.7 73.7 5.0 228
respectively), followed by Welaita Wealth quintile
and Hadiya women (92 percent for Lowest 65.0 1,331 2.7 84.7 20.5 865
Second 69.3 1,405 2.3 76.9 2.9 975
both). Fifty-four percent of urban Middle 69.0 1,539 2.5 81.6 3.1 1,063
women are circumcised, as com- Fourth 68.6 1,475 2.0 79.6 2.5 1,012
Highest 57.3 2,072 3.7 74.7 5.9 1,187
pared with 68 percent of women in Total 15-49 65.2 7,822 2.7 79.2 6.5 5,101
rural areas. FGC is less prevalent
among women with higher Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates
that a figure is based on fewer than 25 unweighted cases and has been suppressed. Total
education and those in the highest includes 5 women/men/households for whom information on age is missing.
wealth quintile. For instance, half

45
(50 percent) of women with secondary education are circumcised, as compared with about three-fourths (73
percent) of women with no education.

3.17 Maternal Mortality

Maternal deaths are a subset of all female deaths and are associated with pregnancy and
childbearing. Two survey methods are generally used to estimate maternal mortality in developing countries:
the indirect sisterhood method (Graham et al. 1989) and a direct variant of the sisterhood method (Rutenberg
and Sullivan 1991). In this report, the direct estimation procedure is applied.

Age-specific estimates of maternal mortality from the reported survivorship of sisters are shown in
Table 25 for the 2-year period preceding the survey. These rates were calculated by dividing the number of
maternal deaths by woman-years of exposure. To remove the effect of truncation bias (the upper boundary
for eligibility among women interviewed in the survey is 49 years), the overall rate for women age 15-49
was standardised by the age distribution of survey respondents. A maternal death was defined as any death
reported as occurring during pregnancy or childbirth, or within two months after the birth or termination of
a pregnancy. Estimates of maternal mortality are therefore based solely on the timing of the death in
relationship to pregnancy.

The results in Table 25 indicate that the rate of mortality associated with pregnancy and childbearing
is 0.66 maternal deaths per 1,000 woman-years of exposure, down from 1.1 in the 2011 EDHS. The estimated
age-specific mortality rates display a plausible pattern, being generally higher during the peak childbearing
ages than in the younger and older age groups. However, the age-specific pattern should be interpreted with
caution because of the small number of events: only 118 maternal deaths among women of all ages. Maternal
deaths represent 25 percent of all deaths among women age 15-49 during the 7-year period preceding the
survey (118 maternal deaths divided by 473 female deaths).

Table 25 Maternal mortality

Direct estimates of maternal mortality rates for the seven years preceding the survey, by 5-year age groups,
Ethiopia 2016
Percentage of
female deaths Maternal Maternal
Age that are maternal deaths Exposure years mortality rate1
15-19 17.4 13 34,543 0.39
20-24 28.7 25 38,862 0.64
25-29 29.3 24 35,159 0.68
30-34 30.0 32 28,985 1.10
35-39 24.4 11 20,199 0.54
40-44 20.3 9 12,023 0.78
45-49 13.7 4 6,714 0.62
Total 15-49 25.1 118 176,485 0.66a

General fertility rate (GFR)2 160a

Maternal mortality ratio (MMR)3 412 CI: (273, 551)
Lifetime risk of maternal death4 0.021

CI: Confidence interval

1
Expressed per 1,000 woman-years of exposure
2
Expressed per 1,000 women age 15-49
3
Expressed per 100,000 live births; calculated as the age-adjusted maternal mortality rate times 100
divided by the age-adjusted general fertility rate
4
Calculated as 1-(1-MMR)TFR where TFR represents the total fertility rate for the 7 years preceding the
survey
a
Age-adjusted rate

The maternal mortality rate can be converted to a maternal mortality ratio by dividing the rate by
the general fertility rate during the 7-year period preceding the 2016 EDHS. The maternal mortality ratio is
expressed per 100,000 live births in order to emphasise the obstetrical risk of pregnancy and childbearing.
The estimate of the maternal mortality ratio for the 7-year period preceding the 2016 EDHS is 412 deaths
per 100,000 live births; that is, for every 1,000 births in Ethiopia, there are about 4 maternal deaths. The 95

46
percent confidence interval surrounding the maternal mortality estimate is 273 to 551 deaths per 100,000
live births.

Figure 8 presents trends in the maternal mortality ratio (MMR) for the 7-year period preceding the
2000, 2005, 2011, and 2016 EDHS surveys. The data presented in Figure 8 show a steady decline in the
MMR for the 7-year period preceding the surveys: from 871 deaths per 100,000 live births in the 2000
EDHS, to 673 deaths per 100,000 live births in the 2005 EDHS, and to 676 deaths in the 2011 EDHS, to
reach 412 deaths per 100,000 live births in the 2016 EDHS.

Figure 8 Maternal mortality ratio (MMR) with confidence intervals for the 7 years
preceding the 2000, 2005, 2011, and 2016 EDHS
Maternal deaths
per 100,000 live
births
1,200

1,039
1,000

871
800 799 810

703
673 676
600
548 541 551

400 412

273
200
Seven years Seven years Seven years Seven years
preceding preceding preceding preceding
the 2000 EDHS the 2005 EDHS the 2011 EDHS the 2016 EDHS
(1993-2000) (1998-2005) (2004-2011) (2009-2016)

47
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