The 1997 Reproductive Health Survey (RPS) is the sixth in a series of periodic enquiries conducted for the National Family Planning Board (NFPB) into measures of fertility, contraception and other reproductive health issues among women in the reproductive age group and young adults males.
A similar contraceptive prevalence survey was carried out in 1993 among women aged 15-44 and men aged 15-54.
The 1997 Reproductive Health Survey (RPS) is the sixth in a series of periodic enquiries conducted for the National Family Planning Board (NFPB) into measures of fertility, contraception and other reproductive health issues among women in the reproductive age group and young adults males. The findings are used to monitor and evaluate the effectiveness of the various interventions, which are aimed at achieving the overall goal and objectives of the national programme. It was previously called the Contraceptive Prevalence Survey (CPS) and covered a wide range of issues mainly related to family planning. With the recognition at the 1994 International Conference on Population and Development (ICPD) in Cairo that family planning is the single most important intervention in achieving reproductive health goals, it has been renamed the Reproductive Health Survey. In order to provide reproductive health services to young adults 15-24 years old, a young adult module was also included. Additional questions have been explored in the survey as they related to pap smears and breast self-examination.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Women aged 15-49 and young adult men aged 15-24
The 1997 JRHS covered a wide cross section of topics, including birth history, contraceptive knowledge and usage, attitudes towards reproduction, and behavioural risks. Background characteristics relating to the demographic and socio economic status of the population surveyed were also included. These comprised age structure, educational attainment, socioeconomic and employment status, religious affiliation and union status.
Results are shown by health regions and by urban and rural areas of residence as well as by demographic and socio economic characteristics. These variables have been selected as being important to the assessment of current programmes and to provide guidelines to areas that might benefit from special or intensified programme efforts. Some data was also produced at the parish level to inform parish administrators of the successes or weaknesses of their programmes.
The survey was of women aged 15-49 years and young men aged 15-24 years. Coverage of women was the same as that of the 1983 and 1989 Jamaica Contraceptive Prevalence Surveys, whereas the 1993 survey covered women aged 15-44 years. Conversely, the 1993 survey covered men aged 15-54 years, which provided information used to develop male responsibility programmes for preventing unintended pregnancies.
The 1993 coverage of men was not repeated in this survey, as preference was given to enlarging the sample of women so as to provide information at the parish level. Thus, the 1997 JRHS was designed to be the most comprehensive of the enquiries undertaken since 1983 by providing detailed information on women in their most active reproductive years (15-49) and on young adult males in the 15 to 24-year-old group.
Producers and sponsors
Statistical Institute of Jamaica (STATIN)
National Family Planning Board (NFPB)
Division of Reproductive Health, Centers for Disease Control and Prevention
McFarlane Consultants Ltd.
United States Agency For International Development
Population Reference Bureau
Development of a Summary Chartbook on the findings of the survey
The 1997 JRHS utilized the design adopted for the Continuous Social and Demographic Surveys conducted by the Statistical Institute of Jamaica. This design was based on a two-stage stratified sample in which the first stage is a selection of geographic areas and the second stage is a selection of dwellings. For the selection of the first stage units, the country was divided into enumeration districts (EDs), which were grouped into sampling regions consisting of a predetermined number of strata, approximately equal in size (where size is measured by the number of dwellings in each sampling region). Two EDs within each sampling region, selected with probability proportionate to size (determined by the number of dwellings), made up the sample at the first stage. At the second stage, a second predetermined number of dwellings were selected systematically from lists of dwellings arranged on a circular basis in each of the EDs designated in the first stage of selection. The third stage in this survey consisted of the random selection of one eligible male aged 15-24 or female aged 15-49 from the selected dwellings.
In the 1997 JRHS, the female sample was selected at the parish level and the male sample was, as in 1993, selected at the health region level. In the general sample design used by STATIN, the first stage sample was selected by using identical sampling fractions in each parish. The second stage selection of separate male and female households was made in the field. This facilitated enumeration of eligible respondents wherever possible at the first visit. The small populations of Hanover and Trelawny parishes necessitated oversampling the households in order to obtain a large enough sample to obtain meaningful estimates at the parish level. Based on these selections, and taking into consideration expected non-response rates, it was anticipated that a total of approximately 15,046 households would be needed in the female survey and 14,620 households in the male survey.
Of the total number of 15,140 households selected in the female survey, there were 6,641 (43.9 percent) eligible respondents identified; in the male survey, the number of eligible respondents was 2,470 (17.7 percent). Of the eligible households in the female survey, 12,124 questionnaires (80.1 percent) were completed; in the male survey, 11,159 questionnaires (80.2 percent) were completed.
One respondent was selected from each eligible household. There were 6,384 completed questionnaires (96.1 percent) in the female survey and 2,279 (92.3 percent) in the male survey.
All national results in the final report have been weighted to compensate for the over-sampling of smaller health regions and selection of one respondent per household.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
RECRUITMENT AND TRAINING
The Statistical Institute of Jamaica was responsible for the field work, editing the questionnaires and data entry. Accordingly, it was in charge of recruiting field staff, editors and data entry staff.
Because of the sensitive nature of the questions in the survey, only female interviewers were used in the female survey; in the male survey, both male and female interviewers were used. (Experience in Jamaica has shown that female interviewers are as effective as male interviewers at interviewing male respondents).
Training for field work for both the pretest and the main surveys was the responsibility of STATIN, with the assistance of eight local trainers for the technical aspects. The Survey Director provided overall coordination of the training sessions, with the support of two CDC staff members. All trainers were professionals with extensive training and experience in the field of demography, epidemiology and survey taking. Officers of the National Family Planning Board, including the Medical Director and Liaison Officers, provided the interviewers with necessary training on contraceptive technology. Training on questionnaire editing was provided by the Survey Director, and the CDC for training in data entry, using an updated version of the SURVEY software they developed for survey data entry and editing on micro computers.
Training for the field work was undertaken in two phases. The first phase was June 10-12,1997 for the pretest of the questionnaires and for survey procedures. The second series of training classes for the main surveys was carried out August 18-21, 1997, at four sites: Kingston, Oracabessa, Eltham, and Treasure Beach. This training consisted of classroom lectures, discussions, mock interviews and written tests. A total of 153 field personnel were trained. Of these, 22 were supervisors (14 males and 8 females) and 131 were interviewers (27 males and 104 females). One office clerk was included in the field training.
The organization of the field staff for administering the 1997 JRHS surveys was similar to that used for all other household surveys conducted by STATIN. The country was divided into four contiguous, nonoverlapping areas, each of which was managed by a senior supervisor. Within each area, there were four zones, each covering approximately 28 Primary Sampling Units. One supervisor and five interviewers were assigned to each zone.
Pretest field work was conducted in a few preselected areas and lasted 3 days. The original schedule for the main survey was for 3 months of field work, beginning August 22, 1997. There were, however, a number of interruptions, including unusually heavy rains. Accordingly, field work was extended for 1 month, to the end of December 1997.
Four separate survey instruments were developed for use in the 1997 Reproductive Health Survey; one household questionnaire and one individual questionnaire for both male and female surveys.
The Household Questionnaires - Forms RHS 1A and 1B, were used mainly to record information on gender and age to identify eligible members of the household from which the third stage sample was selected. One male aged 15-24 and one female aged 15-49 were then selected by using a random number chart.
The Individual Questionnaires were developed for recording the information collected from women and young adult men selected for interviewing.
The female Individual Questionnaire (Form RHS 2) was divided into the following nine sections:
- Section I Respondent's Background
- Section II Relationship Status and Partnership History
- Section III Fertility and Maternal Morbidity
- Section IV Cancer Screening
- Section V Contraceptive Knowledge and Usage
- Section VI Attitudes towards Contraception, Childbearing and Current Sexual Activity
- Section VII Family Life and Sex Education
- Section VIII Early Sexual Experience and Child Rearing
- Section IX General Attitudes and Opinions
The eight sections in the male Individual Questionnaire (Form RHS 3) are as follows:
- Section I Respondent's Background
- Section II Relationship Status and Partnership History
- Section III Family Life and Sex Education
- Section IV Reproductive History
- Section V Contraceptive Knowledge and First Sexual Experience
- Section VI Current Sexual Activity and Contraceptive Use
- Section VII Attitudes towards Childbearing and Contraception
- Section VIII General Attitudes and Opinions
The individual questionnaires were designed to provide comparisons with earlier surveys including the 1975/76 Jamaica Fertility Survey; the 1983, 1989 and 1993 Contraceptive Prevalence Surveys; and the 1987 Young Adult Reproductive Health Survey. To design the questionnaire, consultations were held between the Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), whose core questionnaires for family planning, maternal-child health and young adult reproductive health surveys provided guidelines; the National Family Planning Board; the Ministry of Health, United States Agency for International Development, the Survey Director; and the Statistical Institute of Jamaica.
Estimates of Sampling Error
The estimates for a sample survey are affected by two types of errors: non-sampling error and sampling error. Non-sampling error is the result of mistakes made in carrying out data collection and data processing, including the failure to locate and interview the right household, errors in the way questions are asked or understood, and data entry errors. Although intensive quality-control efforts were made during the implementation of the 1997 JRHS to minimize this type of error, nonsampling errors are impossible to avoid altogether and difficult to evaluate statistically. Sampling error is a measure of the variability between an estimate and the true value of the population parameter intended to be estimated, which can be attributed to the fact that a sample rather than a complete enumeration was used to produce it. In other words, sampling error is the difference between the expected value for any variable measured in a survey and the value estimated by the survey. This sample is only one of the many probability samples that could have been selected from the female population aged 15-49 and the male population aged 15-24 using the same sample design and projected sample size. Each of these samples would have yielded slightly different results from the actual sample selected.
Because the statistics presented in the Final Report are based on a sample, they may differ by chance variations from the statistics that would result if all women 15-49 years of age and all men aged 15-24 in Jamaica would have been interviewed. Sampling error is usually measured in terms of the variance and standard error (square root of the variance) for a particular statistic (mean, proportion, Or ratio). The standard error (SE) can be used to calculate confidence intervals (CI) of the estimates within which we can say with a given level of certainty that the true value of population parameter lies. For example, for any given statistic calculated from the survey sample, there is a 95 percent probability that the true value of that statistic will lie within a range of plus or minus two SE of the survey estimate. The chances are about 68 out of 100 (about two out of three) that a sample estimate would fall within one standard error of a statistic based on a complete count of the population.
The estimated sampling errors for 95% confidence intervals (1.96 x SE) for selected proportions and sample sizes are shown in Table 1 of the Final Report. The estimates in Table 1 can be used to estimate 95% confidence intervals for the estimated proportions shown for each sample size. The sampling error estimates include an average design effect of 1.6, needed because the JRHS did not employ a simple random sample but included clusters of elements in the second stage of the sample selection.
The selection of clusters is generally characterized by some homogeneity that tends to increase the variance of the sample. Thus, the variance in the sample for the JRHS is greater than a simple random sample would be due to the effect of clustering. The design effect represents the ratio of the two variance estimates: the variance of the complex design using clusters, divided by the variance of a simple random sample using the same sample size (Kish L., 1967). For more details regarding design effects for specific reproductive health variables, the reader is referred to the Le and Verma report, which studied demographic and health surveys in 48 countries (Le TN and Verma JK, 1997). The pattern of variation of design effects is shown to be consistent across countries and variables. Variation among surveys is high but less so among variables. Urban -rural and regional differentials in design effects are small, which can be attributed to the fact that similar sample designs and cluster sizes were used across domains within each country. At the country level, the overall design effect, averaged over all variables and countries, is about 1.5 (we used 1.6 in Table A. 1 to be slightly more conservative).
To obtain the 95% CI for proportions or sample sizes not shown in the table, one may interpolate. For example, for a sample size of 200 and a point estimate of 25% (midway between 0.20/0.80 and 0.30/0.70), the 95% CI would be plus or minus 7.5%; for a sample size of 300 (midway between 200 and 400) and an estimate of 20%, the 95% CI would be plus or minus 6.0%.
Differences between estimates discussed in this report were found to be statistically significant at the five percent level using a two-tailed normal deviate test (p=0.05). This means that in repeated samples of the same type and size, a difference as large as the one observed would occur in only 5% of samples if there were, in fact, no differences between the proportion in the population. In this text, terms such as "greater," "less," "increase," or "decrease" indicate that the observed differences were statistically significant at the 0.05 level using a two-tailed deviate test.
Statements using the phrase "the data suggest" indicate that the difference was significant at the 0.10 level but not the 0.05 level. Lack of comment in the text about any two statistics does not mean that the difference was tested and not found to be significant.
The relative standard error of a statistic (also called "coefficient of variation") is the ratio of the standard error (SE) for that statistic to the value of the statistic. It is usually expressed as a percent of the estimate. Estimates with a relative standard error of 30% or more are generally viewed as unreliable by themselves, but they may be combined with other estimates to make comparisons of greater precision. For example, an estimate of 20% based on a sample size of only 50 observations yields a SE of 7% (one half the 95% confidence interval shown in Table A.l of the Final Report). The relative standard error would be 35% (the ratio of the SE of 7% to the estimate of 20%), too large for the estimate to be reliable.
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.