DV00) CHECK HOUSEHOLD QUESTIONNAIRE, [LOCATION TO BE CHECKED].
WOMAN NOT SELECTED ___ (GO TO NEXT SECTION)
DV01) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IN ENSURED.
PRIVACY NOT POSSIBLE 2 (GO TO DV34)
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in [COUNTRY]. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.
FORMERLY MARRIED/LIVED WITH A MAN ___ (READ IN PAST TENSE)
NEVER MARRIED/NEVER LIVED WITH A MAN ___ (GO TO DV14)
DV03) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?
a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?
f) He (does/did) not trust you with any money?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
DV04) Now if you permit me, I need to ask some more questions about your relationship with your (last) husband/partner.
If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.
DV04 A) (Does/did) you (last) husband/partner ever:
a) say or do something to humiliate you in front of others?
NO 2
b) threaten to hurt or harm you or someone close to you?
NO 2
c) insult you or make you feel bad about yourself?
NO 2
DV04 B) CHECK 604: ASK ONLY IF RESPONDENT IS NOT A WIDOW
How often did this happen during the last 12 months: often, only sometimes or not at all?
a) say or do something to humiliate you in front of others?
SOMETIMES 2
NOT AT ALL 3
b) threaten to hurt or harm you or someone close to you?
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?
SOMETIMES 2
NOT AT ALL 3
DV05 A) (Does/did) your (last) husband/partner ever do any of the following things to you?
a) push you, shake you, or throw something at you?
NO 2
b) slap you?
NO 2
c) twist your arm or pull your hair?
NO 2
d) punch you with his fists or with something that could hurt you?
NO 2
e) kick you, drag you or beat you up?
NO 2
f) try to choke you or burn you on purpose?
NO 2
g) threaten to attack you with a knife, gun, or any other weapon?
NO 2
h) physically force you to have sexual intercourse with him even when you did not want to?
NO 2
i) force you to perform sexual acts you did not want to?
NO 2
DV05 B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
CHECK 604: ASK ONLY IF RESPONDENT IS NOT A WIDOW
a) push you, shake you, or throw something at you?
SOMETIMES 2
NOT AT ALL 3
b) slap you?
SOMETIMES 2
NOT AT ALL 3
c) twist your arm or pull your hair?
SOMETIMES 2
NOT AT ALL 3
d) punch you with his fist or with something that could hurt you?
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you or beat you up?
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you on purpose?
SOMETIMES 2
NOT AT ALL 3
g) threaten to attack you with a knife, gun, or other weapon?
SOMETIMES 2
NOT AT ALL 3
h) physically force you to have sexual intercourse with him even when you did not want to?
SOMETIMES 2
NOT AT ALL 3
i) force you to perform sexual acts that you did not want to perform?
SOMETIMES 2
NOT AT ALL 3
NOT A SINGLE 'YES' ___ (GO TO DV09)
DV07) How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
DV08) Did the following ever happen as a result of what your (last) husband/partner did to you:
a) You had cuts, bruises or aches?
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
NO 2
DV09) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?
NO 2 (GO TO DV12)
RESPONDENT IS A WIDOW ___ (GO TO DV12)
DV11) In the last 12 months, how often have you done this to your husband/partner: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
DV12) Does (did) your husband/partner drink alcohol?
NO 2 (GO TO DV14)
DV13) How often does (did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
IF SO, ASK:
From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?
NO 2 (GO TO DV17)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV17)
IF SO, ASK:
From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?
NO 2 (GO TO DV17)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV17)
DV15) Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND/PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY): _________ X
DV16) In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
DV17) CHECK 201, 226, AND 229:
NEVER BEEN PREGNANT ___ (GO TO DV20)
DV18) Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?
NO 2 (GO TO DV20)
DV19) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY): ____________ X
DV20) CHECK 618: EVER HAD SEX?
NEVER HAD SEX ___ (GO TO DV25)
DV21) The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3
ASK:
In the last 12 months has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?
NEVER MARRIED/NEVER LIVED WITH A MAN ___
ASK:
In the last 12 months, has anyone forced you to have sexual intercourse against your will?
NO 2
REFUSED TO ANSWER/NO ANSWER 3
OTHER ____ (GO TO DV26)
DV24) CHECK DV05(h) AND DV05(i):
OTHER ___ (GO TO DV28)
DV25) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?
NO 2 (GO TO DV28)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV28)
DV26) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
DK 98
DV27) Who was the person forcing you at that time?
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY): ____________ 96
DV28) CHECK DV05A (a-i), DV14, DV18, DV22, AND DV25:
NOT A SINGLE YES ___ (GO TO DV32)
DV29) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?
NO 2 (GO TO DV31)
DV30) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.
HUSBAND/PARTNER'S FAMILY B (GO TO DV32)
CURRENT/LAST/LATE HUSBAND/PARTNER D (GO TO DV32)
FRIEND E (GO TO DV32)
NEIGHBOR F (GO TO DV32)
RELIGIOUS LEADER G (GO TO DV32)
DOCTOR/MEDICAL PERSONNEL H (GO TO DV32)
POLICE I (GO TO DV32)
LAWYER J (GO TO DV32)
SOCIAL SERVICE ORGANIZATION K (GO TO DV32)
OTHER (SPECIFY): ____________ X (GO TO DV32)
DV31) Have you ever told anyone else about this?
NO 2
DV32) As far as you know, did your father ever beat your mother?
NO 2
DK 8
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW IN REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.
DV33) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
DV34) INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE __________