Azerbaijan has undergone major socioeconomic and political changes: the war with Armenia, forced migration and population displacement, economic hardships, and deterioration of health and social services. These changes have affected practically all aspects of life for its people. The reported flaws associated with official statistics have prohibited any meaningful attempts at informed decision making, planning, and program evaluation in reproductive health. A nationwide survey was recommended to assess the reproductive health status of the population during this transition period, a period of profound changes in health needs and access to health care services. The national reproductive health survey conducted in Azerbaijan in 2001 (AZRHS01) is the first nationwide population-based survey aimed at providing a wide array of information about the current status of women's health in that country. The survey will aid in identifying unmet programmatic needs and will serve as a baseline for future studies and evaluations. The AZRHS01 was specifically designed to meet the following objectives:
- To assess fertility, abortion, contraception, and various other reproductive health issues in Azerbaijan.
- To enable policy makers, program managers, and researchers to evaluate existing reproductive health programs and develop new strategies.
- To study factors that affect fertility, contraceptive use, and maternal and infant health, such as geographic and sociodemographic factors, breast-feeding patterns, use of induced abortion, and availability of family planning services.
- To identify characteristics of women at risk for unintended pregnancy.
- To identify high-risk groups and focus additional reproductive health studies on them.
- To obtain data on the knowledge, attitudes, and behavior of young adults 15-24 years of age.
- To provide data on the level of reported STI symptoms and knowledge about transmission and prevention of AIDS.
- To provide data on women living in prolonged displacement.
Similar to the survey conducted in Georgia, completed in 2000, the AZRHS01 included an oversample of refugee women and women internally displaced by war and ethnic cleansing to document their specific health needs. The disruption associated with living in improvised settings makes safe motherhood difficult, limits contraceptive access and use, increases the risks of HIV/AIDS and other STIs, neglects the special needs of adolescents, and may increase the risk of violence against women. Public health surveillance systems often exclude data collection and analysis essential to addressing the specific issues of IDP/Rs. To our knowledge, no country or organization has attempted parallel documentation of the reproductive health status of a nation and an internally displaced group within the country. By collecting information from the general population and from IDP/Rs, the AZRHS01 can document specific needs associated with displacement, account for differences in reproductive health status between the two populations, and provide a useful tool for evaluating existing reproductive health programs and activities that specifically address displaced women and children.
The Division of Reproductive Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, coordinated survey activities and provided technical assistance to the local implementing agency, the Adventist Development and Relief Agency (ADRA), Baku, Azerbaijan.
Funding was provided by the United States Agency for International Development (USAID)—through the umbrella agreement managed by Mercy Corps (MC)—the United Nations Population Fund (UNFPA), and United Nations High Commissioner for Refugees (UNHCR).
Kind of Data
Sample survey data [ssd]
The AZRHS01 is based on face-to-face interviews with 7,668 women at their homes. The survey was designed to collect information from a representative sample of women of reproductive age throughout Azerbaijan (excluding the autonomous region of Nakhchivan and the occupied territories of Nagorno-Karabakh and surrounding areas).
The universe from which the respondents were selected included all females between the ages of 15 and 44 years, regardless of marital status, who were living in households in Azerbaijan when the survey was carried out
Producers and sponsors
Authoring entity/Primary investigators
Adventist Development and Relief Agency (ADRA)
Azerbaijan State Committee for Statistics
Division of Reproductive Health of the United States Centers for Disease Control and Prevention
Technical assistance in survey design, sampling, questionnaire development, training, data processing, and report writing
U.S. Agency for International Development
United Nations Population Fund
United Nations High Commissioner for Refugees
The household survey used a stratified multistage sampling design using the recent 1999 census as the sampling frame (State Committee of Statistics of the Azerbaijan Republic [SCS], 2000). For the AZRHS01, the geographic area of the Azerbaijan Republic was divided into four independent sampling strata. The strata were created by grouping regions with a similar concentration of IDPs and refugees (IDP/Rs), as recorded by the United Nations High Commissioner for Refugees (UNHCR, 2000). The sample was selected with probability proportional to the population size (PPS) within each stratum. Stratum 1 included six rayons that each consisted of more than 30% of their population constituted by IDP/Rs: Fizuli (53%), Xanlar (51%), Barda (44%), Naftalan (40%), Aghjabedi (32%), and Bilasuvar (31%). Stratum 2 included five rayons in which the IDP/Rs represented 20%-30% of the population: Imishli (25%), Saatli (23%), Belagan (22%), Mingechevir (21%), and Terter (20%). Stratum 3 included only the Baku district, which also had a relatively high concentration of IDP/Rs (14%). Stratum 4 included all other rayons, except those in Nakhchivan and the occupied territories of Nagorno-Karabakh and surrounding areas.
Regions with high concentrations of IDP/Rs (Strata 1 and 2) were oversampled for programmatic reasons. The oversampling in regions heavily populated by IDP/Rs was needed to include enough displaced women in the sample to allow independent estimates of their reproductive health status. This technique illustrates how surveys may be designed and integrated in the development, monitoring, and evaluation of targeted reproductive health programs. The oversampling of IDP/Rs was specifically designed to assess the reproductive health status of these women and measure the impact of the Azerbaijan Humanitarian Assistance Project (AHAP) funded by USAID and various projects targeting the IDP population supported by UNHCR and UNFPA. These projects aim to reduce the reliance on induced abortion by increasing access to and availability of effective contraceptive methods and by reducing the prevalence of STDs through the promotion of healthy behaviors among women (e.g., routine gynecologic exams) and child survival activities. These projects encompass various interventions, such as the establishment of modern health clinics for women; training of health professionals; development of information, education, and communication messages; social marketing; and provision of high-quality contraceptive supplies.
The first stage of the three-stage sample design was a selection of Census sectors with probability proportional to the number of households in each sector, after the sectors were grouped into four strata. This stage was accomplished by using a systematic sample with a random start in each stratum. During the first stage, 300 census sectors were selected and became primary sampling units (PSUs), as follows: Baku (80 PSUs), regions with more than 30% of the population being IDP/Rs (100 PSUs), regions with 20%-30% of the population being IDP/Rs (50 PSUs), and all other regions (70 PSUs). In the second stage of sampling, clusters of households were randomly selected in each census sector chosen in the first stage. The cluster size was based on the number of households required to obtain an average of 20 completed interviews per cluster. The total number of households in each cluster took into account estimates of unoccupied households, average number of women aged 15-44 per household, the interview of only one respondent per household, and an estimated response rate of 90% in urban areas and 92% in rural areas. Finally, in each of the households selected, one woman between age 15 and 44 was selected at random for interview (ifthere was more than one woman was in the household).
Because only one woman was selected from each household containing women of reproductive age, all results have been weighted to compensate for the fact that some households included more than one eligible female respondent. Survey results were also weighted to adjust for oversampling of households in the regions with a high concentration of IDP/R population and the undersampling in regions in which less than 20% of the population consisted of IDP/Rs.
Of the 11,162 households selected in the household sample, 8,246 included at least one eligible woman (aged 15-44 years). Of those, 7,668 women were successfully interviewed, yielding a response rate of 93%. About 5% of women were absent and could not be interviewed during several revisits. Virtually all respondents who were selected to participate and who could be reached agreed to be interviewed (the individual refusal rate was only 1.2%). Response rates were lower in Baku and its environs (86%) than in other urban areas (94%) and rural areas (96%).
The distribution of women in the sample by 5-year age groups differs slightly from the official estimates for the year 1999: the survey sample slightly overrepresents adolescent women (15- to 19- year-olds) and underrepresents women aged 25-29 by 2 percentage points, after confidence intervals are taken into account. The sample retains the same over- and underrepresentation for women aged 15-19 and 25-29 for both urban and rural residents. At least two factors may have contributed to the differences observed: (1) official estimates reflect the age composition recorded in 1999, 2 years before the survey took place, and (2) lower response rates occurred among 25- to 29-year-old women, who are most likely to be employed and not at home. The distribution of women in the sample by marital status (by 5-year age groups), however, does not differ significantly from the Census estimates.
Dates of Data Collection (YYYY/MM/DD)
Mode of data collection
Type of Research Instrument
The questionnaire included information on each woman's education, employment, living arrangements, and other background characteristics as well as histories of marriage, divorce, cohabitation, sexual activity, pregnancy, and contraceptive use. Additional questions investigated health risk behaviors that may affect reproductive health (e.g., smoking and drinking habits), women's health screening practices, and intimate partner violence. The questionnaire was developed in English, translated into Azeri and Russian, and translated back to ensure accuracy and linguistic equivalency.