Did you know that almost half of sexually active unmarried women in Nigeria age 15-49 have an unmet need for family planning, compared with only 19% of married women? Or that unmet need among sexually active unmarried women is lowest in Peru, at only 6%? These are the types of patterns and trends that jump off the screen in The DHS Program’s new family planning Tableau dashboard.
The DHS Program’s first Tableau dashboard visualizes 5 key family planning indicators in 58 countries. Users can explore global patterns and trends or deep dive into data from a single country.
The first view presents 5 family planning indicators for 3 groups of women (married women, sexually active unmarried women, and all women). Users can see at a glance how these indicators compare across these 3 groups of women, by background characteristics, and over time.
The “SDG visuals” option visualizes the more complex “demand satisfied by modern methods” indicator.
The “deep dive” presents the individual country data by 5 background characteristics (residence, education, age, wealth quintile, and subnational region).
In the global map view, users can see the range of any selected indicator across 58 recent DHS Program countries.
If you are brand new to Tableau, have no fear. Just click on the “?” icon and basic instructions will overlay your view.
July 11th is World Population Day. The Household Questionnaire collects information on all members of and visitors to households selected to participate in Demographic and Health Surveys. Basic information including age, sex, marital status, education, and relationship to the head of the household is collected for everyone who stayed in the selected households the night before the interview. Some of this information is visualized in a population pyramid, a great visualization of a country’s distribution of age groups by sex. The population pyramid is typically found in chapter 2 of Demographic and Health Survey Final Reports. Demographers can identify population trends based on a population pyramid’s shape and make predictions about that country’s population in the future.
Test your knowledge of demography, fertility, and population pyramids by taking The DHS Program’s #PopPyramid Quiz featuring population pyramids from recently published Demographic and Health Surveys (DHS). Hint: Use STATcompiler.com to find the answers.
Every year, hundreds of papers are published using DHS Program data. Datasets for individual DHS surveys are available for download from The DHS Program website by completing a simple registration form. Researchers and students can also access the IPUMS DHS data collection to facilitate comparative analysis of DHS Program data. Harmonized across time and space, IPUMS DHS features consistently named and coded variables for 32 African countries and 9 Asian countries, with more datasets constantly being added.
The IPUMS DHS team recently announced the winners of this year’s IPUMS Global Health paper awards, which highlight some of the most exciting research to take advantage of the IPUMS DHS integrated datasets. These papers were selected from a highly competitive field that included nearly 50 studies released in 2020.
Fan and Loria resolve a puzzle in prior research on intimate partner violence (IPV): Why is the relationship between IPV and contraceptive use negative in some countries and positive in others? Using 30 IPUMS DHS samples from 17 countries, the authors demonstrate that the relationship between IPV and family planning is modified by macro contextual factors, including legal prohibitions and national levels of female empowerment. This study stands out not just for answering an important social science question but also in its creative use of the broad range of information collected in DHS Program surveys, including variables on contraceptive use and type, family size preferences, husband-wife disagreement on fertility goals, various indicators of women’s status (e.g., education, employment, decision-making), and domestic violence. In addition, the authors draw on IPUMS DHS variables to determine the direction of causality: from the experience of IPV to increased contraceptive use, rather than from contraceptive use to increased incidence of IPV.
This study leverages geographic heterogeneity to determine the effect of reduced malaria burden on low-birth-weight rates across communities in 19 sub-Saharan African countries. Low birth weight is a serious health risk associated with cognitive and physical difficulties among children. This careful and cleverly designed study analyzes IPUMS DHS data from countries with at least two surveys and GPS data on survey cluster locations. After using optimal matching to pair DHS Program survey clusters separated in time, the authors use a difference-in-difference approach to compare the incidence of low birth weight in areas that did and did not experience malaria decline. Results reveal a substantial decline in low birth weight resulting from declines in malaria prevalence, especially for first-born children.
Congratulations to these scholars on this impressive accomplishment!
IPUMS DHS is a system that makes it easy to find and review thousands of DHS survey variables and to download a single fully harmonized data file with only the variables and samples that interest you. IPUMS DHS currently includes variables from DHS survey samples from 32 African and 9 Asian countries; more samples are constantly being added.
Special thanks to our guest blog contributors, Elizabeth Boyle and Miriam King!
Elizabeth Heger Boyle is Professor of Sociology & Law at the University of Minnesota. She studies the role of international laws and policies on women and children’s health around the world. She has written extensively on the impetus for and impact of laws related to female genital cutting, including the book Female Genital Cutting: Cultural Conflict in the Global Community. Her current research focuses on abortion policies globally and their effects; this includes a 2015 article in the American Journal of Sociology. Professor Boyle is currently co-Principal Investigator (with Dr. Miriam King) on IPUMS DHS, a National Institute of Child Health and Human Development grant that integrates Demographic and Health Surveys over time and across countries to make them more user-friendly for researchers. Professor Boyle has a Ph.D. in Sociology from Stanford University and a J.D. from the University of Iowa.
Miriam L. King is a Senior Research Scientist at the Institute for Social Research and Data Innovation at the University of Minnesota. She has managed data integration projects on the U.S. Current Population Survey, the U.S. National Health Interview Survey, and, most recently, the Demographic and Health Surveys. Her research has focused on the history of the U.S. census, data integration methods, U.S. historical fertility differences, living arrangements, and disparities in access to insurance for same-sex couples. Dr. King has a Ph.D. jointly in Demography and History from the University of Pennsylvania.
The DHS Program recently released three YouTube tutorial videos to help DHS data users access The DHS Program’s Code Share Library on GitHub. The Code Share Library was started in 2018 to provide code for producing DHS indicators listed in the Guide to DHS Statistics using statistical software like Stata or SPSS. This year, The DHS Program has begun preparing R code as well. You do not need to create a GitHub account to copy or download any code to produce DHS indicators; it is publicly available for use.
The first video, Overview of The DHS Program’s Code Share Library on GitHub, explains the main components of the Code Share Library, including Stata and SPSS repositories, the indicator list, ReadMe file, and chapter folder contents. In each repository on GitHub, there is an important ReadMe file with instructions for users to read before using the code provided.
One way to start using the Code Share Library is to download the entire repository on your computer. If any update is made to the code in the future, you will need to download the updated code from the Code Share Library. Another way to run the code is to copy and paste the code for your indicator of interest from GitHub to your own personal do file, without having to download the entire repository.
The third video, Running The DHS Program’s Shared Code on Stata, demonstrates how to run the code in Stata to construct indicator variables and produce tables for the indicators. The tables provide a simple tabulation that follows the standard DHS tabulation plan used for survey final reports.
Countless studies have shown that breast milk is beneficial to an infant’s growth and development during the first year of life. This year’s theme for World Breastfeeding Week from the WHO and World Alliance for Breastfeeding Action highlights the importance of supporting breastfeeding with skilled breastfeeding counseling.
The DHS Program has collected data for more than 30 years about initial breastfeeding, breastfeeding status and frequency, and the median duration of breastfeeding. Additionally, the Service Provision Assessment (SPA) provides insight on the overall readiness of health facilities to promote and support early breastfeeding as part of the antenatal care and newborn services package. Putting the baby to the breast within one hour of birth ensures that the infant receives the colostrum or “first milk” which contains antibodies to protect against infectious diseases and lipids to promote weight gain. Choosing to breastfeed exclusively for at least six months provides natural, renewable, and free food that does not require preparation or packaging.
In 2019, The DHS Program authored a study, Examining theRole of Health Facilities in Supporting Early Breastfeeding in Haiti and Malawi, about the relationship between the breastfeeding-related health service environment during antenatal care (ANC) and early initiation of breastfeeding. Using data from recent SPA surveys in Haiti and Malawi, three variables related to the health service environment are defined: availability of facilities with ANC services that report routine counseling on breastfeeding, provider training on breastfeeding, and observation of breastfeeding counseling during ANC and client’s report of breastfeeding counseling.
In Haiti, nearly all ANC facilities in both urban and rural areas report routine breastfeeding counseling during ANC, while 29% of urban and 26% of rural ANC providers received recent training in breastfeeding or infant and young child feeding (IYCF). Among urban and rural clients, 4% received counseling on breastfeeding.
The results of the analysis show that over 95% of facilities in both urban and rural areas of Haiti and Malawi report that breastfeeding counseling is provided. However, 26% to 40% of providers have received training in counseling on breastfeeding in the two years before the surveys, and only 4% to 10% of clients have received counseling. Analysis of linked SPA and DHS data show that having more providers recently trained on breastfeeding is significantly associated with increased odds of early breastfeeding among ANC clients in urban areas of Haiti and Malawi.
In Malawi, nearly all ANC facilities in both urban and rural areas report routine breastfeeding counseling during ANC, while 40% of both urban and rural ANC providers received recent training in breastfeeding or IYCF. Only 10% of urban clients and 4% of rural clients received counseling on breastfeeding.
This study clearly defines the role health institutions can play in promoting breastfeeding by providing support and education to new mothers and their families. By doing so health institutions can enable mothers to exclusively breastfeed for the first six months of life to ensure optimal growth, health, and development.
July 11th is World Population Day. This year’s UNFPA theme, Putting the brakes on COVID-19, is focused on safeguarding the health of women and girls during the pandemic. World Population Day is an opportunity to pause and reflect on how women are uniquely affected by the COVID-19 crisis:
Women make up the largest share of frontline health workers, so they are disproportionately exposed to the novel coronavirus.
Disrupted supply chains impact women’s access to modern contraceptives, which can result in unintended pregnancies.
Staying home to prevent the spread of COVID-19 puts already vulnerable women at a heightened risk of violence. In addition, gender-based violence prevention and protection efforts, social services, and care have been reduced during the pandemic.
The pandemic creates additional barriers to people who are pregnant to access antenatal care and safe-delivery services.
With the disruption of schools and community-based services, adolescents and young people may struggle to access information and services related to sexual and reproductive health.
A population pyramid is a great visualization of a country’s distribution of age groups by sex. Take The DHS Program’s #PopPyramid Quiz to test your knowledge of population pyramids from recently published Demographic and Health Surveys (DHS) and learn more about DHS indicators related to COVID-19 prevention.
Are facilities prepared to face infectious disease pandemics like COVID-19? A new fact sheet explores infection control and readiness in health facilities from seven Service Provision Assessments (SPA) conducted in Afghanistan, Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Senegal, and Tanzania. The SPA collects information on the availability of different health services in a country and facilities’ readiness to provide those services.
In six out of seven countries, fewer than 75% of facilities have soap and running water or alcohol-based disinfectant for handwashing. Senegal is the exception, where 95% of health facilities in Senegal have these resources for handwashing.
Availability of personal protective equipment (PPE) such as latex gloves, medical masks, and gowns varies. In Nepal, latex gloves are available in 80% of facilities, while only 19% have medical masks and 9% have gowns. In the Democratic Republic of Congo, gowns (83%) and latex gloves (75%) are more common than medical masks (14%).
In Haiti, only 17% of facilities have appropriate storage of infectious waste, and fewer than half of facilities have safe final disposal of infectious waste. In Tanzania, 44% of facilities have appropriate storage of infectious waste, while 36% have safe final disposal of infectious waste.
Fewer than 1 in 4 facilities in five countries offer in-patient care. Few facilities have oxygen.
Most facilities have a thermometer and stethoscope. In Bangladesh, 86% of facilities have a thermometer and 94% have a stethoscope.
Explore indicators on infection prevention, PPE, diagnostic capacity, and newly tabulated indicators on therapeutic readiness in the new fact sheet.
The current World Health Organization’s guidelines call for the public focus on handwashing, social distancing, communication with medical providers, and staying informed to help mitigate the spread of COVID-19. However, such guidance may be more aspirational than actionable for millions at risk of exposure to the virus in lower- and middle-income countries (LMICs) as revealed by recent Demographic and Health Surveys (DHS). DHS data from 2014 onward from more than 50 countries in Africa, Asia, and Latin America highlight the very different contexts for daily living in LMICs. These realities must be considered when developing country or context-specific strategies for reducing COVID-19 transmission.
The basics required for handwashing (soap and water) are taken for granted by many but are not readily available for millions of people. In Burundi (2016-17 DHS), only 5% of households were observed to have soap and water for handwashing (among those where handwashing places were observed). Soap and water were present in fewer than 20% of households in Malawi, Ethiopia, Benin, and Mali (see chart). A location for handwashing with soap and water was found in fewer than half of households in 21 out of 36 recent surveys for which The DHS Program has this information.
Household Size and Sleeping Arrangements:
Messaging about social distancing in the current pandemic focuses on staying home and reducing contact with people. In LMICs, self-quarantining to individual households and nuclear families may not be a particularly useful concept.
Households in Sierra Leone, Tajikistan, Guinea, Pakistan, Afghanistan, and Senegal are the largest, with six or more members on average. The ability to distance from sick or vulnerable family members within the household is crucial, but in many households sleeping quarters are crowded. Households in Pakistan, Madagascar, Ethiopia, and Cambodia have the highest average of people per sleeping room, at three or more.
Household Age Structure:
A recent article in the Hindustan Times pointed out that multi-generational households in India might be a risk factor for coronavirus transmission to the elderly. The 2015-16 India National Family Health Survey (India’s DHS) reported that 4 in 10 Indian households are non-nuclear families, many of which are multi-generational. This type of family structure makes social distancing, especially for the elderly, very challenging. When younger children go to school, or working-age adults go to work, they return home to multi-generational families in which the elderly are particularly vulnerable to coronavirus. While the proportion of population age 65+ in DHS countries is not large, there are some key things to note, particularly within the context of multigenerational households. In recent surveys, on average, about 5% of the population is 65+, but in countries like India (6.6%) and Indonesia (6.2%), these seemingly small percentages correspond to many millions of people due to population size.
The DHS Program’s STATcompiler allows users to create custom
tables, charts, and maps from 1000s of indicators across 90 countries.
Just this week, the STATcompiler has been updated to include new indicators to help contextualize the COVID-19 crisis in DHS countries, and two “COVID19” tags have been added to help users identify these indicators. Explore data on handwashing, sanitation, household size, sleeping arrangements, access to media, spousal violence, and more. Other relevant DHS indicators on household age structure, access to internet and cell phones, and tobacco use will be added in the coming weeks.
Health emergencies necessitate that urgent information be shared with the public in a timely manner. And yet large portions of the global population live without regular access to mass media. More than half of women age 15-49 in Liberia, Nigeria, Sierra Leone, Guinea, Benin, Timor-Leste, Niger, Malawi, Mozambique, the Democratic Republic of the Congo, Burundi, Papua New Guinea, Ethiopia, and Chad report that they do not have weekly access to information via radio, television, or newspaper.
In 30 out of 47 recent DHS surveys, at least 75% of households owned at least one mobile telephone. Still, ownership is lower in rural areas, and still uncommon in some countries; in Madagascar, for example, only one-third of households owned a mobile phone in 2016. Internet access, however, is very low across DHS countries. In Nigeria, only 16% of women and 35% of men age 15-49 used the internet in the past year (2018 NDHS). In Zambia, use was even lower, at 12% of women and 26% of men (2018 ZDHS).
Additional Considerations: Domestic Violence, Tobacco Use, and Access to Basic Health Services
And then there are potential secondary risk factors. How does cigarette smoking affect vulnerability? How will families cope with the stresses of a pandemic and the interpersonal conflicts exacerbated in quarantine settings? Will women and children continue to get the general health services they need, such as vaccinations, antenatal and delivery care, family planning, and nutritional support? These questions are important in all settings, but especially in those that are still in the process of building systems to support accessible, quality health care services. In Nigeria, for example, fewer than one-third of children age 12-23 months have received all 8 basic vaccinations, only about 40% of births are delivered in a health facility, and 19% of women have an unmet need for family planning.
Averaging across countries with data on spousal violence shows that 1 out of 4 women report physical, sexual, or emotional violence committed by their husband or partner within the last 12 months, and 36% report ever having faced such violence in their lifetime. These data suggest that social distancing may expose a significant proportion of already vulnerable women to a heightened risk of violence as women are forced to spend even more time with their abusers than usual and their access to sources of help is further limited by the pandemic.
There are countless other factors that are likely affecting COVID-19 transmission throughout the world. Urbanization, and slum environments in particular, are breeding grounds for contagion. In LMICs, millions of people migrate to city-centers for employment and are now migrating home to rural areas seeking safe-haven. These and myriad other factors can be explored in DHS datasets and final reports.
Pandemics require data-driven decisions. While it is one unique virus that has spanned the globe, individual nations, communities, cultures, and families all face it within their own contexts. We can’t collect DHS household data during a pandemic. But we owe it to families in DHS countries to use the information already collected to better inform decisions to provide recommendations that resonate in their settings and to safeguard their already fragile health infrastructure.