Follow along on Twitter! #MyanmarDHS @DHSprogram Survey Methodology

The 2015-16 Myanmar Demographic and Health Survey (2015-16 MDHS) was implemented by the Ministry of Health and Sports of the Republic of the Union of Myanmar. Funding for the survey was provided by the United States Agency for International Development (USAID) and the Three Millennium Development Goal Fund (3MDG). ICF provided technical assistance through The DHS Program, which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs.

Objective The main objective of the 2015-16 MDHS is to provide information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child health, awareness and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking and knowledge of tuberculosis. This information is essential for programme managers and policymakers to evaluate and design programmes and strategies for improving the health of Myanmar’s population.

The Survey The 2015-16 MDHS is the 1st Demographic and Health Survey conducted in Myanmar as part of The DHS Program. It is designed to provide estimates at the national and regional levels, for urban and rural areas, and for each of Myanmar’s 15 states/regions.

Sample Design Sampling Frame: Based on the 2014 Census sampling frame First Stage: 442 clusters selected—123 urban and 319 rural Second Stage: 30 households were selected from each cluster, for a total sample size of 13,260 households Selected households were visited and interviewed; all women age 15-49 and half of all men age 15-49 in all of the selected households were interviewed.

Representing all of Myanmar Data were collected in non-state controlled areas and an IDP camp Interviewers from these regions were deliberately recruited Advocacy efforts in place before survey Additional security and training for some regions ADD CLUSTER MAP

15 Regions/States Covered by the MDHS

Questionnaires Household Questionnaire Woman’s Questionnaire English Questionnaires were translated into Myanmar

Questionnaires: Household Questionnaire Lists usual members and visitors to identify eligible individuals Basic characteristics of each person in the household collected (age, sex, education, etc.) Children’s school attendance Housing characteristics (access to drinking water, sanitation facilities, etc.) Anthropometry measurements for all children under 5, and women age 15-49 Anaemia testing for children 6-59 months, and women age 15-49 Identify women and men eligible for individual interview

Questionnaires: Woman’s Questionnaire Background characteristics (age, education, literacy, etc.) Birth history and child mortality Knowledge and use of family planning methods Fertility preferences Maternal health (antenatal, delivery, and postnatal care) Breastfeeding and infant feeding practices Child vaccinations and childhood illnesses Marriage and sexual activity Women’s work and husband’s background characteristics Women’s empowerment indicators Knowledge, awareness, and behaviour regarding HIV/AIDS and other STIs Adult and maternal mortality Domestic violence

Questionnaires: Man’s Questionnaire Background characteristics (age, education, literacy, etc.) Knowledge of family planning methods Fertility preferences Employment and gender roles Knowledge, awareness, and behaviour regarding HIV/AIDS and other STIs Other health issues

Biomarkers Height and weight measurements: Children under 5 Women age 15-49 Anemia testing: Children age 6-59 months

Pretest and Main Survey Training Training and pretest fieldwork in January 2015 in Mandalay Refresher training for trainers in September 2015 Main Survey Training: Training from 28 September-23 October, 2015, in Nay Pyi Taw 148 field staff trained Refresher training 30 November in 3 locations

Fieldwork and Data Processing Total of 19 teams 1 supervisor, 1 field editor, 3-4 female interviewers, and 1 male interviewer Fieldwork conducted from 7 December 2015 to 7 July 2016. Data processing started in the field with computer- assisted field editing (CAFÉ) on tablet computers. Paper questionnaire data was entered into tablets after check by field editor Questionnaires were re-entered by data processing staff in Nay Pyi Taw Data processing included secondary editing and was conducted from January 2016-July 2016.

Results of the Household and Individual Interviews Household Interviews Households selected 13,238 Households occupied 12,780 Households interviewed 12,500 Response rate 98% Interviews with Women age 15-49 Eligible women 13,454 Women interviewed 12,885 Response rate 96% Interviews with Men age 15-49 Eligible men 5,218 Men interviewed 4,737 Response rate 91%

Household and Respondent Characteristics #MyanmarDHS @DHSprogram

© 2009 Kyaw Thar, Courtesy of Photoshare Household Characteristics Drinking water and sanitation Electricity Ownership of goods Wealth Respondent Characteristics Education Mass media Employment and occupation © 2009 Kyaw Thar, Courtesy of Photoshare

Myanmar’s Households 23% of households are headed by females. Households have an average of 4.2 members. 29% of the population is under 15 years of age.

80 % of households have an improved source of drinking water Percent of households 80 % of households have an improved source of drinking water Nearly 8 in 10 rural households in Myanmar. In urban areas, bottled water is the most common water source. In urban areas, households get their water from tubewells/boreholes and protected wells or springs. Overall, 20% of households do not have access to clean drinking water.

Toilet Facilities Percent of households Nearly half of households have an improved sanitation facility not shared with other households, and 10% use a shared facility. 32% of households use an unimproved toilet facility. 11% of households have no toilet facility. Generally, households in urban areas have higher access to improved sanitation than rural areas. Rural households are more likely than urban households to have no toilet facility (14% versus 1% ).

Electricity Percent of households 56% of households have electricity in Myanmar. Electricity is more common in urban areas (92%) than in rural areas (42%).

Household Possessions Percent of households with: Mobile phones and televisions are the most common devices possessed by most households for information and communication. 73% of households have a mobile phone. Urban households are more likely to have a mobile phone (93%) than rural households (66%). More than half of households own a television; only about one-third of households own a radio. Motorcylces/scooters are the most commonly owned means of transport.

Wealth Index Wealth is determined by scoring households based on a set of characteristics, including access to electricity and ownership of various consumer goods. Households are then ranked, from lowest score to highest score. This list is then separated into 5 equal pieces (or quintiles) each representing 20% of the population. Therefore, those in the highest quintile may not be “rich” but they are of higher socioeconomic status than 80% of Myanmar people.

Wealth Index Lowest 2nd Middle 4th Highest Urban 4% 5% 10% 26% 56% Rural 26% 25% 24% 18% 7% Very few urban households are in the poorest 3 quintiles, while very few rural households are in the wealthiest quintile. Rakhine and Ayeyarwady have the largest proportion of households in the poorest quintile (>40%), while Yangon has the largest proportion of households in the wealthiest quintile (47%).

© 2009 Kyaw Thar, Courtesy of Photoshare Household Characteristics Drinking water and sanitation Electricity Ownership of goods Wealth Respondent Characteristics Education Mass media Employment and occupation © 2009 Kyaw Thar, Courtesy of Photoshare

Educational Attainment of Respondents age 15-49 Percent of women and men age 15-49 by highest level of education attended 13% of women and 12% of men have never attended school. 41% of women and 36% of men have attended only primary school; 36% of women and 45% of men have attended secondary school. Only 10% of women and 7% of men have gone beyond secondary school.

Percent of women and men age 15-49 who are literate Literacy Percent of women and men age 15-49 who are literate About 90% of Myanmars are literate. Almost all women and men in urban areas are literate, while less than 90% of those living in rural areas are literate.

Exposure to Mass Media Percent of women and men age 15-49 with access to media at least once a week Men are slightly more likely to be exposed to all media than women. Among women and men, television is the most widely accessed medium. 60% of women and men watch television at least once a week. 1 in 3 women and 29% of men have no exposure to any of the mass media on a weekly basis.

Percent of women and men age 15-49 Employment Percent of women and men age 15-49 Two-thirds of women are currently employed compared 91% of men. 6% of women were not currently working but had in the past year, while 27% had not been working in last year. 3% of men were not currently working but had in the past year, while 6% had not been working in the last 12 months.

Percent of women and men age 15-49 Occupation Percent of women and men age 15-49 Women are most likely to work in sales and service (25%) and unskilled manual labor (28%). Men work primarily in unskilled manual labor (31%), agriculture (29%), and skilled manual labor(21%).

Key Findings 80% of households have access to an improved source of drinking water. 48% of households have an improved sanitation facility; 11% of households have no sanitation facility. 56% of households have electricity. 13% of women and 12% of men have never attended school. 67% of women and 91% of men worked in the past 7 days.