The Bangladesh Multiple Indicator Cluster Survey (MICS 2012-2013) was conducted from December 2012 to April 2013 by the Bangladesh Bureau Statistics, Ministry of Planning. Technical and financial support for the survey was provided by the United Nations Children’s Fund (UNICEF) in Bangladesh. MICS 2012-2013 provides valuable information and the latest evidence on the situation of children and women in Bangladesh, updating information from the previous 2006 Bangladesh MICS survey as well as earlier data collected in the MICS rounds since 1996.
The survey presents data from an equity perspective by indicating disparities by sex, area, division, education, living standards, and other characteristics. Bangladesh MICS 2012-2013 is based on a sample of 51,895 households interviewed and provides a comprehensive picture of children and women in the seven divisions of the country.
In the MICS, child mortality rates are calculated based on an indirect estimation technique known as the Brass method using the data collection method of ‘time since first birth’ (TSFB). According to the survey results, the infant mortality rate in Bangladesh is 46 per 1,000 live births, and the under-five mortality rate 58 per 1,000 live births when a reference of TSFB 5-9 years is considered. Substantial disparities exist along the dimensions of education and living standards and between the different divisions for this estimate: children in the poorest households are four times as likely to die before reaching one and five years of age compared to children living in the richest households. In Sylhet division, both under-five and infant mortality rates are well above the national average.
Nutritional Status and Breastfeeding
Of the 35.9 per cent children below two years of age weighed at birth, 37.7 per cent were born with low weight. Proportion of children weighed at birth is more among households in the urban areas, as also in households with better educated head and having more wealthy households. During the data collection for the survey, weights and heights/lengths of all children under 5 years of age in the sample households were measured using recommended anthropometric equipment (see www.childinfo.org). Analysis of data show that about one in three children (31.9 per cent) were underweight (weight-for-age malnourished), two in five (42 per cent) were stunted (heightfor-age malnourished), and one in every ten children (9.6 per cent) were wasted (weight-for-height malnourished). Some 8.8 per cent of children were severely underweight and one in every 6 children (16.4 per cent) were stunted. Also about 1.6 per cent children in that age group were overweight. Disparities exist between urban and rural children and between children living in households of different education and wealth background.
Almost all newborn in Bangladesh, 97.1 per cent, were breastfed at some point after birth. However, only 57.4 per cent started breastfeeding at the correct time (i.e. within one hour of birth). The percentage of infants under 6 months of age who were exclusively breastfed is 56.4 and who received breast milk as the predominant source of nourishment during the day prior to the survey is 71.9. Overall, just two thirds, or 66.5 per cent, of children younger than two years were appropriately breastfed on the day prior to the survey. There is little difference in the pattern of breastfeeding across the country.
As far as complimentary feeding is concerned, 42.4 per cent infants aged 6-8 months received solid, semi-solid or soft foods during the day prior to the survey. Among children below the age of two years feeding with a bottle continued for 12.1 per cent cases.
Adequately iodized salt, defined as containing 15 or more parts per million (15+ ppm), is used in just over half of all households (54.3 per cent), with considerably higher consumption in urban areas and among richer households that than those in rural areas and from the poorer households. The overall consumption of iodized salt remains far below global standards: The World Health Organization (WHO) and UNICEF recommend Universal Salt Iodization as a safe, cost-effective and sustainable strategy to ensure sufficient intake of iodine.
Child Health and Care of Illness
Four of five mothers who gave birth within two years prior to the survey were adequately protected against neonatal tetanus (80.8 per cent). However, mothers in Sylhet division had significantly low protection from neonatal tetanus (66.7 per cent).
Of the children with diarrhoea, 64.6 per cent received oral rehydration therapy (ORT) and continued feeding during the episode.
About 3 per cent of children under-5 showed symptoms of pneumonia in the two weeks preceding the survey, of whom 35.8 per cent were taken to an appropriate health provider. Although appropriate medical care was sought for only one third of the children with ARI symptoms, antibiotic treatment was given to 74.3 per cent of them. The very high usage of antibiotics without prescription is prevalent across Bangladesh across all dimensions of education and wealth levels. Additionally, only 10.8 per cent of mothers or caretakers recognized the two danger signs of pneumonia, viz., fast breathing and difficulty in breathing, while 46.9 per cent knew at least one of them.
Cooking and heating with solid fuels lead to high levels of indoor smoke, thus causing damage to children’s health. MICS show that solid fuels is widely used as a main source of energy for domestic cooking in Bangladesh (88.2 per cent), particularly in rural areas (96 per cent versus 58.3 per cent in urban areas), although the main place of cooking is mostly in a separate building (57.8 per cent) or outdoors (21.2 per cent).
Water and Sanitation
Drinking water is used from the improved drinking water sources almost universally (97.9 per cent of the population). Among those who do not use improved drinking water sources, one fourth (25.6 per cent) use an appropriate water treatment method. About 74.2 per cent of users of improved drinking water sources have a water source directly on their premises, 20.4 per cent take less than 30 minutes to get to improved drinking water sources. In the majority of households where water sources is not available on the premises, water is usually collected by adult woman (88.8 per cent) in the household. The time taken to reach improved drinking water sources varies significantly between divisions, and between households of different education and wealth levels.
Safe drinking water is a human right and a basic requirement for good health. Microbiological contamination of drinking water can lead to diarrhoeal diseases including shigellosis and cholera. Arsenic content in drinking water was measured in Bangladesh for both household drinking and source water. About 24.8 per cent of the population had drinking water in the household with arsenic above the WHO provisional guideline value of 10 parts per billion (ppb), and 12.4 per cent of the population exceeded the Bangladesh standard of 50 ppb. Arsenic contamination was slightly greater at the source, with 25.5 per cent exceeding 10 ppb and 12.5 per cent above 50 ppb.
The bacteria species Escherichia coli (E. coli) is the most commonly recommended faecal indicator, and many countries including Bangladesh have set a standard that no E. coli should be found in a 100 mL sample of drinking water. Overall, 41.7 per cent of the population had source water with detectable E. coli, while this value was 61.7 per cent for household samples, reflecting contamination occurring at the household level.
Over half of Bangladesh population use improved sanitation facilities that are not shared (55.9 per cent). Open defecation is not widespread with only 3.9 per cent of the population practicing it. However, in Rangpur division and also in the poorest quintiles of households, open defection is more prevalent (15.5 and 13.5 per cent respectively). Child faeces are disposed of in a safe manner in 38.7 per cent of children under the age of 2; unsafe child faeces disposal practices are again most common in Rangpur division and among the poorest households.
Soap or other cleansing agents for handwashing are available in 94 per cent of Bangladesh households. In households where a place for handwashing was observed, 59.1 per cent had both water and soap present at the designated place, 35 per cent had only water, and 4.3 per cent had neither water nor soap. The proportion of households with both water and soap present is lower in rural areas and also in the poorer and less educated households, mainly due to the lack of availability of soap.
The Total Fertility Rate (TFR) in Bangladesh is 2.3, meaning that a Bangladeshi woman, by the end of her reproductive years, will have given birth to an average of 2.3 children. There were 83 number of births to women 15 to 19 years of age per 1,000 women in that age group (adolescent birth rate). Early childbearing is relatively common, with about one in four women (24.4 per cent) age 20- 24 having had live birth before the age of 18. About 61.8 per cent of women aged 15-49 and currently married use some form of contraception. Of these, 59.3 per cent use modern methods of contraception. The unmet need for contraception is relatively low among women age 15-49 (13.9 per cent).
About 58.7 per cent of women aged 15–49 who gave birth in the two years preceding the survey received antenatal care from skilled health personnel at least once, and 24.7 per cent had the recommended four antenatal care visits by any provider. Some 38 per cent had their blood pressure measured and gave urine and blood samples during antenatal checkup. Considerable differences exist in availing antenatal care between urban and rural areas, and between women of different education levels and from households of different wealth levels.
Only 31 per cent of all deliveries took place in health facilities and only 43.5 per cent of women were attended by skilled health personnel during their most recent live birth. Of all the births, 19.1 per cent of women had delivery by caesarean section. Substantial disparities exist by all dimensions of background characteristics. A woman who completed secondary or higher education, for example, is five times as likely to have delivery in a health facility as a woman with no education.
About 82.8 per cent of women age 15-49 years with a live birth in the last two years stayed in the health facility for 12 hours or more after the latest delivery. While 41.2 per cent of the newborns in the last two years received a post natal health check within 2 days after delivery, 40.4 of the mothers received a health check within 2 days after delivery. Provision of post-natal care service differs substantially between different divisions and between urban and rural areas. Education and wealth also play an important role in the level of service received by the mothers and the newborns.
Early Childhood Development
Only 13.4 per cent of children aged 3-4 years receive early childhood education. However, a much higher proportion of children (78 per cent) have adults engage with them in four or more activities that promote learning and school readiness during the three days prior to the survey. Survey shows that, 40.8 per cent of children’s biological mother and 10.1 per cent of children’s biological father engaged in four or more activities during the three days prior to the survey. Exposure to books in early years in Bangladesh is poor; less than one in ten children under 5 have three or more children’s books at home (8.8 per cent). Children of mothers with the higher education are relatively more exposed to books with 24.6 per cent having three or more children’s books at home. The percentage of children with two or more types of playthings stands at 60.3 per cent. One in ten children under-5 were left under inadequate care sometime during the week preceding the survey (11.6 per cent), which was mainly in terms of either left alone or in the care of another child under the age of 10.
The child development index score in Bangladesh is 63.9. The score is calculated based on the percentage of children aged 3-4 years who are developmentally on track in at least three of the following four domains: literacy/numeracy, physical, social/emotional and learning. Urban children, children who are attending early childhood education, and children of better educated mothers and wealthier households have slightly higher development index score.
Literacy and Education
Overall literacy among Bangladesh women age 15–24 years is high, at 82 per cent. Less than half of children in the first grade of primary school, attended pre-school during the previous school year (43.5 per cent). The net intake rate in primary education, i.e. the percentage of children of school-entry age who enter the first grade of primary school, is low at 33.1 per cent, and there are significant differences between divisions, with Sylhet having the lowest at 23.1 per cent. The primary school adjusted net attendance ratio is 73.2 per cent. 96.4 per cent of children entering the first grade of primary school eventually reach last grade, and the primary completion rate is 79.5 per cent. The primary completion rate is positively associated with mother’s education and household wealth status, but it is lower in urban areas than in rural areas. Girls have much higher completion rate than boys.
Transition rate to secondary school in Bangladesh is 94.7 per cent. 46.1 per cent of children of secondary school age currently attend secondary school or higher, 33.7 per cent are still attending primary school, and 14.6 per cent are out of school. Compared with urban areas, rural areas have lower percentage attending secondary school or higher, and higher percentage legging behind in primary education. However, the out of school ratio is almost the same in urban and rural areas. Mother’s education and household social economic status have a strong association with the out of school ratio.
Girls are in advantage in both primary school and secondary school attendance; the gender parity index for primary school age is 1.07 and for secondary school is 1.30. Gender disparity is significant in children of secondary school age, and is strongly associated with mother’s education and household wealth.
The percentage of mothers or caretakers of children under the age of 5 whose birth has not been registered but know how to register a birth is relatively high in Bangladesh (60.5 per cent), and registration of birth is still not widely practiced, with only 37 per cent of births registered.
The difference between knowledge and practice persists across all background dimensions of households.
Majority of children aged 1-14 years in Bangladesh experienced some form of psychological aggression or physical punishment in the month prior to the survey (82.3 per cent). This again does not match with only about 33.3 per cent of respondents believing that children need to be physically punished.
Almost one in four women age 15-49 were (first) married before the age of 15 (23.8 per cent). Among women aged 20-49 years, the proportion who married before the age of 18 is 62.8 per cent. Of young women between 15 and 19, 34.3 per cent are already married. Early marriage is widely practiced in Bangladesh and is prevalent across all household background, although trends based on other data sources show that it is in decline in recent years.
Polygyny is rare among Bangladesh women, particularly towards recent years. Only 1 per cent of youngest women (aged 15-19) are in polygynous union as compared to 7 per cent of the oldest (aged 45-49).
The age difference between spouses is large and marriage to a much older husband or partner is common in Bangladesh. Some 20.4 per cent of women age 15-19, and 21.8 per cent of women age 20-24, are married to spouses who are 10 or more years older. Surprisingly, marriage to older spouse is more common in women with better education and living in richer households. About 3.8 per cent of children aged 0-17 years live with neither of the biological parents. For 4.3 per cent of children reported to have one or both of his/her biological parents passed away. About 5 per cent of children have at least one biological parent living abroad.
HIV/AIDS and Orphanhood
More than half of women aged 15-49 in Bangladesh have heard of AIDS (55.8 per cent), but very few (6.6 per cent) have a comprehensive knowledge of HIV, meaning they can correctly identify two ways of preventing HIV infection; know that a healthy looking person can have HIV, and reject the two most common misconceptions about HIV transmission. Only one in five correctly identified all three means of mother-to-child transmission of HIV (21.7 per cent). On the whole, 37.2 per cent expressed accepting attitude towards people living with HIV on all four questions. On all HIV/AIDS related indicators, there are significant differences between urban and rural areas, between divisions, and between different education levels and socio-economic status.
Among young women of 15-24 years, 9.1 per cent correctly identified ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission. Additionally, 11.3 per cent of women age 15-49 know a place where they can be tested for HIV and 2.5 per cent of those who received antenatal care during their last pregnancy reported that they received counselling on HIV during antenatal care.
Some 0.3 per cent of children age 10-14 years in Bangladesh are orphans, of whom 76.7 per cent attend school. The ratio of school attendance of orphans to school attendance of non-orphans is 0.88.
Access to Mass Media and ICT
Of all women age 15-49 in Bangladesh, only 1.6 per cent read a newspaper or magazine, listened to the radio, and watched television, at least once a week. In young women between 15 and 24, 6.1 per cent used a computer and 3.0 per cent used internet during the 12 months prior to the survey. Access to mass media and ICT is more prevalent among younger women, and women who live in urban areas, with better education and living in richer households.
Kind of Data
Sample survey data [ssd]
Of the 55,120 households selected for the sample, 52,711 were found to be occupied. Of these, 51,895 were successfully interviewed for a household response rate of 98.5 per cent.
In the interviewed households, 59,599 women (age 15-49 years) were identified. Of these, 51,791 were successfully interviewed, yielding a response rate of 86.9 per cent within interviewed households.
There were 23,402 children under age five listed in the household questionnaires. Questionnaires were completed for 20,903 of these children, which corresponds to a response rate of 89.3 per cent within interviewed households.
Overall response rates for households, women’s questionnaire, and overall response rate for under-5 questionnaire are calculated for the individual interviews of women, and under-5s, respectively (Table HH.1).
Overall response rates 85.6 and 87.9 per cent are calculated for the individual interviews of women and under-5s, respectively (Table HH.1)
The household response rates were similar across divisions and areas of residence. The response rates of women and children under 5 were also in the same situation, with the exception of Sylhet where the women’s response rate was 83.8 per cent. Low response of Sylhet for women could be due to the regions’ known conservative social norms in practice, although this is not confirmed by any indicator. The results for Sylhet should be interpreted with some caution, as the response rate is low.
The weighted age and sex distribution of survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 51,895 households successfully interviewed in the survey, 237,396 household members were listed. Of these, 119,684 were males, and 117,712 were females.
Table HH.2 shows the age-sex structure of the household population. The proportions of child, working and old-age groups (0–14, 15–64 and 65 years and over) in the household population of the sample were 33.2, 61.3 and 5.5 per cent, respectively. In MICS 2006, these figures were 35.5, 59.8 and 4.7 per cent, higher in younger age and lower in older age. More significantly, the proportion of children aged 0-4 is 9.9 per cent in this survey as compared to 11.6 per cent in MICS 2006, indicating a drop of birth rate in recent years. Birth rate decrease is a trend that MICS 2006 had already identified after comparison with the census 2001.
The surveyed population indicates a sex ratio of 102, unchanged from that of MICS 2006. The dependency ratio was 63.2 per cent, much reduced from 67.2 per cent of MICS 2006. Similarly, the proportion of children aged 0-17 has also reduced from 42.3 per cent in MICS 2006 to 39.0 per cent in this survey. The total number of the children aged 0-17 is 92,546.
Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents age 15-49 and children under-5. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provides background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.
Table HH.3 provides basic background information on the households, including the sex of the household head, division, area, number of household members and education of head of the household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report.
Producers and sponsors
Authoring entity/Primary investigators
Government of the People's Republic of Bangladesh
Bangladesh Bureau of Statistics
United Nations Children's Fund
Statistics and Informatics Division
The sample for the Bangladesh Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, seven divisions and sixty four districts. The districts were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size (pps). After a household listing was carried out within the selected enumeration areas, a systematic sample of 20 households was drawn in each sample enumeration area. Four (04) of the selected enumeration areas were not visited because they were inaccessible due to rough weather and hilly remote road communication during the fieldwork period. These enumeration areas were one each from Bagerhat, Gaibandha, Rangamati and Sirajganj districts. The sample was stratified by districts, and is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A, Sample design.
Readers may note that we have included maps showing the districts for some of the indicators with different colours being used to represent different ranges of values. The reader should treat interpretation of these maps with some caution, because the associated sampling errors at the district level would be larger than those at the division level.
Map HH.1 shows the number of enumeration areas under the districts visited during the survey with division boundaries. It is to be noted that a new Rangpur division has been created in 2010 comprising eight districts from formerly Rajshahi division.
Dates of Data Collection (YYYY/MM/DD)
Mode of data collection
Type of Research Instrument
Four sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) a questionnaire for individual women administered in each household to all women age 15-49 years; 3) an under-5 questionnaire, administered to mothers (or caretakers) for all children under 5 living in the household; and 4) a water quality testing questionnaire to measure arsenic and E.coli content in the household drinking water in a sub-sample of households. The questionnaires included the following modules:
The Household Questionnaire included the following modules:
• List of Household Members
• Household Characteristics
• Child Discipline
• Water and Sanitation
• Salt Iodization
The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules:
• Women’s Background
• Access to Mass Media and use of Information/Communication Technology
• Child Mortality
• Desire for Last Birth
• Maternal and Newborn Health
• Post-Natal Health Checks
• Unmet Need
• Illness Symptoms
The Questionnaire for Children Under Five was administered to mothers or caretakers of children under 5 years of age2 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules:
• Birth Registration
• Early Childhood Development
• Care of Illness
The Questionnaire on Water Quality Testing was administered to a sub-sample of sampled households for measuring arsenic and E. coli- content in the household drinking water and included only one module. A sub-sample of 5 households were selected per cluster, out of the selected 20 household for the survey, to test arsenic content of the household drinking water and one of these 5 households was identified to test E.coli content in the drinking water. Source water for this household was tested for arsenic and E.coli content.
• Water Quality
The questionnaires are based on the MICS5 model questionnaire3 tested during the global MICS5 pilot study in Sirajganj and Bogra during May-June 2012. From the MICS5 pilot English version, the questionnaires were translated into Bengali and tested during the global MICS5 pilot. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Bangladesh MICS questionnaires is provided in Appendix F.
In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing and measured the weights and heights of children age under 5 years. Details and findings of these measurements are provided in the respective sections of the report.
Bangladesh Bureau of Statistics
United Nations Children's Fund
Data were entered using the CSPro software. The data were entered on 30 microcomputers and carried out by 30 data entry operators and 1 data entry supervisors. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS5 programme and adapted to the Bangladesh questionnaire were used throughout. Data processing began simultaneously with data collection in December, 2012 and was completed in May, 2013. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose.
Bangladesh Bureau of Statistics (BBS)
Statistics and Informatics Division, Ministry of Planning
Social Policy, Evaluation, Analytics and Research Section (SPEAR)
United Nations Children’s Fund (UNICEF)
BANGLADESH BUREAU OF STATISTICS
Statistics and Informatics Division, Ministry of Planning