[NAME OF COUNTRY]

[NAME OF ORGANIZATION]

IDENTIFICATION *

PLACE NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER

REGION

URBAN/RURAL

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE **

NAME AND LINE NUMBER OF WOMEN

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT***

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS

***RESULT CODES:

COUNTRY SPECIFIC INFORMATION ON: LANGUAGE OF QUESTIONNAIRE, LANGUAGE OF INTERVIEW, NATIVE LANGUAGE OF RESPONDENT, AND WHETHER TRANSLATOR USED

FIELD EDITOR BY
NAME
DATE

OFFICE EDITOR BY
NAME
DATE

KEYED BY
NAME
DATE

* THIS SECTION SHOULD BE ADAPTED FOR COUNTRY-SPECIFIC SURVEY DESIGN.
** The following guidelines should be used to categorize urban sample points:
"Large cities" are national capitals and places with over 1 million population; "small cities" are places with between 50,000 and 1 million population; remaining urban sample points are "towns".

SECTION 1. RESPONDENT'S BACKGROUND

101 RECORD THE TIME.

102 First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in the countryside?

103 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

104 Just before you moved here, did you live in a city, in a town, or in the countryside?

105 In what month and year were you born?

106 How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107 Have you ever attended school?

108 What is the highest level of school you attended: primary, secondary, or higher? (2)

109 What is the highest (grade/form/year) you completed at that level? *

110 CHECK 108:

111 Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

112 Do you usually read a newspaper or magazine at least once a week?

113 Do you usually listen to a radio at least once a week?

114 Do you usually watch television at least once a week?

115 COUNTRY-SPECIFIC QUESTION ON RELIGION

.
116 COUNTRY-SPECIFIC QUESTION ON ETHNICITY.

*Revise according to the local education system.

117 CHECK Q. 4 IN THE HOUSEHOLD QUESTIONNAIRE

118 Now I would like to ask about the place in which you usually live.
Do you usually live in a city, in a town, or in the countryside?
IF CITY: In which city do you live? *

119 In which (STATE/PROVINCE) is that located? **

120 Now I would like to ask about the household in which you usually live.
What is the main source of water your household uses for handwashing and dishwashing? ***

121 How long does it take to go there, get water, and come back?

122 Does your household get drinking water from this same source?

123 What is the source of drinking water for members of your household? ***

124 What kind of toilet facility does your household have?***

125 Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

.

126) How many rooms in your household are used for sleeping?

127) MAIN MATERIAL OF THE FLOOR. ** RECORD OBSERVATION.

*Coding categories should be developed that are compatible with the 4 category system (large city, small city, town, countryside) used on the identification section of the cover sheet.

**Coding categories should be developed that are compatible with the regional categorization used on the identification section of the cover sheet.

***Coding categories to be developed locally and revised based on pretest, however the large categories must be maintained.

126 How many rooms in your household are used for sleeping?

127 Could you describe the main material of the floor* of your home?

128 Does any member of this household own:

A bicycle?
A motorcycle?
A car?

*Coding categories to be developed locally and revised based on pretest, however the large categories must be maintained. The material of walls or ceilings may be a better measure in some countries.

SECTION 2. REPRODUCTION

201 Now I would like to ask about all the births you have had during your life. Have you ever given birth?

202 Do you have any sons or daughters to whom you have given birth who are now living with you?

203 How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.

204 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

205 How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

206 Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but only survived a few hours or days?

207 In all, how many boys have died? And how many girls have died? IF NONE, RECORD '00'.

208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

209 CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct?

210 CHECK 208:

211 Now I would like to talk about of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

212 What name was given to your (first, next) baby?

213 RECORD SINGLE OR MULTIPLE BIRTH STATUS.

214 Is (NAME) a boy or girl?

215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

216 Is (NAME) still alive?

217 IF ALIVE:
How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

218 IF ALIVE: Is (NAME) living with you?

219 IF LESS THAN 15 YRS. OF AGE:
With whom does he/she live?
IF CHILD IS OVER 15: GO TO NEXT BIRTH.

220 IF DEAD:
How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

221 COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

222 CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1985.* IF NONE, RECORD '0'.

*For fieldwork beginning in 1991, 1992, or 1993, the year should be changed to 1986, 1987, or 1988, respectively.

223 Are you pregnant now?

224 How many months pregnant are you?

225 At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

226 When did your last menstrual period start?

227 Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than any other times?

228 During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?*

*Coding categories to be developed locally and revised based on pretest.

SECTION 3. CONTRACEPTION

301 Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302 Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD.

303 Have you ever used (METHOD)?

304 Do you know where a person could go to get (METHOD)?

305 CHECK 303:

306 Have you ever used anything or tried in any way to delay or avoid getting pregnant?

307 What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY).

308 Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.
How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

309 CHECK 223:

310 CHECK 303:

311 Are you currently doing something or using any method to delay or avoid getting pregnant?

312 Which method are you using?*

312A CIRCLE '06' FOR FEMALE STERILIZATION.

313 At the time you first started using the pill, did you consult a doctor or a nurse? **

314 At the time you last got pills, did you consult a doctor or a nurse? **

315 May I see the package of pills you are using?
RECORD NAME OF BRAND.

316 Do you know the brand name of the pills you are using?
RECORD NAME OF BRAND.

317 How much does one (packet/cycle) of pills cost you?

*Method codes to be developed locally and include popular combinations of methods.
For countries where periodic abstinence is important, the types of methods to determine the fertile period should be included in the coding categories.
**Person consulted should be modified according to local practices.

318 CHECK 312:
SHE/HE STERILIZED
Where did the sterilization take place?*

USING ANOTHER METHOD
Where did you obtain (METHOD) the last time?*

319 How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

320 Is it easy or difficult to get there?

321 CHECK 312:

322 In what month and year was the sterilization performed?

323 For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

324 Do you intend to use a method to delay or avoid pregnancy at any time in the future?

325 What is the main reason you do not intend to use a method?

326 Do you intend to use a method within the next 12 months?

327 When you use a method, which method would you prefer to use?

*Coding categories to be developed locally and revised based on the pretest, however, the large categories must be maintained.

328 Where can you get (METHOD MENTIONED IN 327)?*

329 CHECK 312:

330 Do you know of a place where you can obtain a method of family planning?

331 Where is that?*

*Coding categories to be developed locally and revised based on the pretest, however, the large categories must be maintained.

332 How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

333 Is it easy or difficult to get there?

334 In the last month, have you heard a message about family planning on:
The radio?
Television?

335 Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?

336 COUNTRY-SPECIFIC QUESTIONS ON FAMILY PLANNING MESSAGES ON RADIO AND TELEVISION.

SECTION 4A. PREGNANCY AND BREASTFEEDING

401 CHECK 222:

402 ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1985* IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all your children in the past five years. (We will talk about one child at a time.)

LINE NUMBER FROM Q. 212

FROM Q. 212 AND Q. 216

403 At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

404 How much longer would you have liked to wait?

405 When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? **
IF YES: Whom did you see? Anyone else?
RECORD ALL PERSONS SEEN.

406 Were you given an antenatal card for this pregnancy?

407 How many months pregnant were you when you first received antenatal care for this pregnancy?

408 How many antenatal visits did you have during this pregnancy?

409 When you were pregnant with (NAME), were you given an injection in the arm*** to prevent the baby from getting tetanus, that is, convulsions after birth? (3)

410 During this pregnancy, how many times did you get this tetanus injection?

* For fieldwork beginning in 1991, 1992, or 1993, the year should be changed to 1986, 1987, or 1988, respectively.
** Coding categories to be developed locally and revised based on the pretest, however, the large categories must be maintained. The category "trained traditional birth attendant" (or "trained community health worker') should be used where the respondents can identify this category. It is also important to choose the appropriate term for "antenatal" care.
*** Vaccination practices may vary from country to country and should specify where the injection is given, e.g., the arm.

411 Where did you give birth to (NAME)?*

412 Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. *

* Coding categories to be developed locally and revised based on the pretest, however, the large categories must be maintained.

413 Was (NAME) born on time or prematurely?

414 Was (NAME) delivered by caesarian section?

415 When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?

416 Was (NAME) weighed at birth?

417 How much did (NAME) weigh?

418 Has your period returned since the birth of (NAME)?

419 Did your period return between the birth of (NAME) and your next pregnancy?

420 For how many months after the birth of (NAME) did you not have a period?

421 CHECK 223:
RESPONDENT PREGNANT?

422 Have you resumed sexual relations again since the birth of (NAME)?

423 For how many months after the birth of (NAME) did you not have sexual relations?

424 Did you ever breastfeed (NAME)?

425 Why did you not breastfeed (NAME)?

426 How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.

427 CHECK 216:
IS CHILD ALIVE?

428 Are you still breastfeeding (NAME)?

429 How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

430 How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

431 At any time yesterday or last night was (NAME) given any of the following?*:

Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Fresh milk?
Tinned or powered milk?
Other liquids?
Any solid or mushy food?

* List of liquids and foods to be developed locally and revised based on the pretest.
This list should include common weaning foods.

432 CHECK 431:
FOOD OR LIQUID GIVEN YEASTERDAY?

433 For how many months did you breastfeed (NAME)?

434 Why did you stop breastfeeding (NAME)?

435 CHECK 216:
CHILD ALIVE?

436 Was (NAME) ever given water or anything else to drink or eat (other than breastmilk)?

437 How many months old was (NAME) when you started giving the following on a regular basis? :
IF LESS THAN 1 MONTH, RECORD '00'.

* Terms to de developed locally and revised based on pretest (should include common weaning foods).

438 CHECK 216:
CHILD ALIVE?

439 Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

440 GO BACK TO 403 FOR NEXT BIRTH; OR. IF NO MORE BIRTHS, GO TO FIRST COLUMN OF 441.

SECTION 4B. IMMUNIZATION AND HEALTH

441 ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1985* IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM Q. 212

442 Do you have a card where (NAME'S) vaccinations are written down? **
IF YES: May I see it please?

443 Did you ever have a vaccination card for (NAME)?

444 (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD. **
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.
BCG
POLIO 1
POLIO 2
POLIO 3
DPT 1
DPT 2
DPT 3
MEASLES

445 Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINES.

446 Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

447 Please tell me if (NAME) received any of the following vaccinations: **

448 CHECK 216:
CHILD ALIVE?

449 GO BACK TO 442 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 480.

* For fieldwork beginning in 1991, 1992, or 1993, the year should be changed to 1986, 1987, or 1988, respectively.
** To be developed locally since immunization practices may vary from country to country, as may the terms used for the written record and for vaccinations. For example, of polio vaccine is given at birth, revise categories in 444 accordingly.
*** Adapt question locally after determining the most common injection site (usually the left arm or shoulder). All children under 5 years will be checked for a BCG scar, normally during the height and weight measurement (see Section 8).

450 Has (NAME) been ill with a fever at any time in the last 2 weeks?

451 Has (NAME) had an illness with a cough at any time in the last 2 weeks?

452 Has (NAME) had an illness with a cough in the last 24 hours?

453 For how many days (has the cough lasted/did the cough last)?
IF LESS THAN 1 DAY, RECORD '00'.

454 When (NAME) had the illness with a cough, did he/she breath faster than usual with short, rapid breaths?

455 CHECK 450 AND 451:
FEVER OR COUGH?

456 Was anything given to threat the fever/cough?

457 What was given to threat the fever/cough?*
Anything else?
RECORD ALL MENTIONED.

458 Did you seek advice or treatment for the fever/cough?

459 Where did you seek advice or treatment? **
Anywhere else?
RECORD ALL MENTIONED.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

* Appearance may aid in identifying syrup as antibiotic or an antimalarial (which a mother may describe as very bitter).
** Coding categories to be developed locally and revised based on the pretest, however, the large categories must be maintained.

460 Has (NAME) had diarrhea in the last two weeks? *

461 GO BACK TO 442 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 480.

462 Has (NAME) had diarrhea in the last 24 hours? *

463 For how many days (has the diarrhea lasted/did the diarrhea last)?
IF LESS THAN 1 DAY, RECORD '00'.

464 Was there any blood in the stools?

465 CHECK 424/428:
LAST CHILD STILL BREASTFED?

466 During (NAME)'s diarrhea, did you change the frequency of breastfeeding?

467 Did you increase the number of breastfeeds or reduce them, or did you stop completely?

468 (Asides from breastmilk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

469 Was anything given to treat the diarrhea?

470 What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.

471 Did you seek advice or treatment for the diarrhea?

472 Where did you seek advice or treatment? ***
Anywhere else?
RECORD ALL MENTIONED.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

* The term (s) used for diarrhea in these questions should encompass the expressions used for all forms of diarrhea, including bloody stools which are consistent with dysentery, watery stools, ect.
** The response categories should be adopted to include terms used locally both for the ORS packet and for the recommended home fluid. The ingredients promoted by the National Control of Diarrheal Diseases Program or by the Ministry of Health for marketing the recommended home fluid should be reflected in the categories.
*** Coding categories to be developed locally and revised based on the pretest, however, the large categories must be maintained.

473 CHECK 470:
ORS FLUID FROM PACKET MENTIONED?

474 Was (NAME) given (FLUID FROM ORS PACKET -- LOCAL NAME) when he/she had the diarrhea?*

475 For how many days was (NAME) given (LOCAL NAME)?*
LF LESS THAN 1 DAY, RECORD '00'.

476 CHECK 470:
RECOMMENDED HOME FLUID MENTIONED?

477 Was (NAME) given a recommended home fluid made from (RECOMMENDED INGREDIENTS) when he/she had the diarrhea?*

478 For how many days was (NAME) given the fluid made from (RECOMMENDED INGREDIENTS)?*
LF LESS THAN 1 DAY, RECORD '00'.

479 GO BACK TO 422 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 480.

* For terms for ORS packets and the recommended home fluid should correspond to the categories used in 470. The ingredients in the recommended home fluid should be reflected in the question as noted for question 470.

480 CHECK 470 AND 474 (ALL COLUMNS):

481 Have you ever heard of a special product called [LOCAL NAME] you can get for the treatment of diarrhea?

482 Have you ever seen a packet like this before?
SHOW PACKET.

483 Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?
SHOW PACKET.

484 The last time you prepared the (LOCAL NAME), did you prepare the whole packet at once or only part of the packet?

485 How much water did you use to prepare (LOCAL NAME) the last time you made it?*

486 Where can you get the (LOCAL NAME) packet?
PROBE: Anything else?
RECORD ALL PLACES MENTIONED. **

487 CHECK 470 AND 477 (ALL COLUMNS):

488 Where did you learn to prepare the recommended home fluid made from (RECOMMENDED INGREDIENTS)*** given to (NAME) when he/she had diarrhea?**

* Response codes to be developed according to local instructions for mixing ORS. If these include the use of a certain container, e.g. a soda bottle, this should be added as a response category.
** Coding categories for health facilities and providers to be developed locally and revised based on pretest, however, the large categories must be maintained.
*** Question to be developed locally according to the ingredients promoted for use in the recommended home fluid.

SECTION 5. MARRIAGE

501 Have you ever been married or lived with a man?

502 Are you now married or living with a man, or are you now widowed, divorced, or no longer living together?*

503 Is your husband/partner living with you now or is he staying elsewhere?

504 Does your husband/partner have other wives besides yourself? **

505 How many other wives does he have? **

506 Are you the first, second, ? wife?**

507 Have you been married or lived with a man only once, or more than once?

508 In what month and year did you start living with your (first) husband/partner?

509 How old were you when you started living with him?

510 CHECK 508 AND 509:
YEAR AND AGE GIVEN?

511 CHECK CONSISTENCY OF 508 AND 509:
YEAR OF BIRTH (105) PLUS AGE AT MARRIAGE (509) CALCULATED YEAR OF MARRIAGE

IF NECESSARY, CALCULATE YEAR OF BIRTH
CURRENT YEAR MINUS CURRENT AGE (106) CALCULATED YEAR OF BIRTH

IS THE CALCULTED YEAR OF MARRIAGE WITHIN ONE YEAR REPORTED YEAR OF THE REPORTED YEAR OF MARRIAGE (508)?

* Where visiting relationships are common, this category should be added to 501 and 502.
** Country-specific questions.

512 IF NEVER IN UNION:
Have you ever had sexual intercourse?

513 Now I need to ask you some questions about sexual activity in order to gain a better understanding of family planning and fertility.
How many times did you have sexual intercourse in the last four weeks?

514 How many times in a month do you usually have sexual intercourse?

515 When was the last time you had sexual intercourse?

516 How old were you when you first had sexual intercourse?

517 PRESENCE OF OTHERS AT THIS POINT.

SECTION 6. FERTILITY PREFERENCES

601 CHECK 312:

602 CHECK 223:

603 CHECK 223:
NOT PREGNANT OR UNSURE
Now I have some questions about the future.
Would you like to have (a/another) child, or would you prefer not to have any (more) children?

PREGNANT
Now I have some questions about the future.
After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

604 CHECK 223:
NOT PREGNANT OR UNSURE
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT
How long would you like to wait after the birth of the child you are expecting before the birth of another child?

605 CHECK 216 AND 223:
HAS LIVING CHILD(DREN) OR PREGNANT?

606 CHECK 223:
NOT PREGNANT OR UNSURE
How old would you like your youngest child to be when your next child is born?

PREGNANT
How old would you like the child you are expecting to be when your next child is born?

607 Given your present circumstances, if you had to do it over again, do you think (you/your husband) would make the same decision to an operation not to have any more children?

608 Do you regret that (you/your husband) had the operation not to have any more children?

609 Why do you regret it?

610 Do you think your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

611 How often have you talked to your husband/partner about family planning in the past year?

612 Have you and your husband/partner ever discussed the number of children you would like to have?

613 Does your husband/partner want the same number of children that you want, or does he want more or fewer than you want?

614 How long should a couple wait before starting sexual intercourse after the birth of a baby?

615 Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

616 In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

617 CHECK 216:
HAS LIVING CHILDREN
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN
If you could choose exactly the number of children to have in your whole life, how many would that be?

RECORD SINGLE NUMBER OR OTHER ANSWER.

618 What do you think is the best number of months or years between the birth of one child and the birth of the next child?

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701 CHECK 501:

702 Did your (last) husband/partner ever attend school?

703 What was the highest level of school he attended: primary, secondary, or higher?

704 What was the highest (grade/form/year) he completed at that level? *

* Revise according to the local education system.

705 What kind of work does (did) your (last) husband/partner mainly do?

706 CHECK 705:

707 Does (Did) your husband/partner work mainly on his own land or on family land, or does (did) he rent land, or does (did) he work on someone else's land?

708 Aside from your own housework, are you currently working?

709 As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?

710 What is your occupation, that is, what kind of work do you do?

711 In your current work, do you work for a member of your family, for someone else, or are you self-employed?

712 Do you earn cash for this work?
PROBE: Do you make money for working?

713 Do you do this work at home or away from home?

714 CHECK 215/216/218:
HAS CHILD BORN SINCE JAN. 1985* AND LIVING AT HOME?

* For fieldwork beginning in 1991, 1992, or 1993, the year should be changed to 1986, 1987, or 1988, respectively.

715 While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

716 Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

717 RECORD THE TIME

SECTION 8. HEIGHT AND WEIGHT

801 CHECK 222:

INTERVIEWER:
IN 802 (COLUMN 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1985* AND STILL ALIVE.
IN 803 AND 804 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1985*.
IN 806 AND 808 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1985* SHOULD BE WEIGHED AND MEASURED EVEN OF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1985.)

* For fieldwork beginning in 1991, 1992, or 1993, the year should be changed to 1986, 1987, or 1988, respectively.

802 LINE NO. FROM Q. 212

803 NAME FROM Q. 212 FOR CHILDREN

804 DATE OF BIRTH
FROM Q. 105 FOR RESPONDENT
FROM Q. 215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

805 BCG SCAR ON TOP OF LEFT SHOULDER**

** Adapt question locally after determining the most common injection site (usually the left arm or shoulder).

806 HEIGHT (In centimeters)

807 WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP?

808 WEIGHT (In kilograms)

809 DATE WEIGHED AND MEASURED

810 RESULT

811 NAME OF MEASURER: __________
NAME OF ASSISTANT: ___________

INTERVIEWER'S OBSERVATIONS

(TO BE FILLED IN AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT:
__________________________________

COMMENTS ON SPECIFIC QUESTIONS:
__________________________________

ANY OTHER COMMENTS:
__________________________________

SUPERVISOR'S OBSERVATIONS
__________________________________

NAME OF SUPERVISOR: ___________
DATE: __________

EDITOR'S OBSERVATIONS
__________________________________