IDENTIFICATION (1)

PLACE NAME __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER __ __ __ __
HOUSEHOLD NUMBER __ __ __ __
NAME AND LINE NUMBER OF WOMAN __________

(1) This section should be adapted for country-specific survey design.

INTERVIEWER VISITS

FIRST VISIT:
DATE ______
INTERVIEWER'S NAME ________
RESULT* ________

SECOND VISIT:
DATE ______
INTERVIEWER'S NAME ________
RESULT* ________

THIRD VISIT:
DATE ______
INTERVIEWER'S NAME ________
RESULT* ________

NEXT VISIT:
DATE ______
TIME ______

FINAL VISIT:
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __ __ __
RESULT* __

TOTAL NUMBER OF VISITS: __

*RESULT CODES:

LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF INTERVIEW** __ __
NATIVE LANGUAGE OF RESPONDENT** __ __
TRANSLATOR USED (YES = 1, NO = 2)
LANGUAGE OF QUESTIONNAIRE** ENGLISH

**LANGUAGE CODES

SUPERVISOR
NAME ______
NUMBER __ __ __ __

FIELD EDITOR
NAME ______
NUMBER __ __ __ __

OFFICE EDITOR
NUMBER __ __

KEYED BY
NUMBER __ __

FEMALE GENITAL CURRING/MUTILATION FOR WOMAN'S QUESTIONNAIRE (1)

GC1. (2) How I would like to ask you some questions about a practice known as female circumcision. Have you ever heard of female circumcision?

GC2. In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

GC3. Have you yourself ever been circumcised?

GC4. Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

GC5. Was the genital area just nicked without removing any flesh?

GC6. (3) Was your genital area sewn closed?

GC7. How old were you when you were circumcised? IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

GC8. (4) Who performed the circumcision?

GC9. (5) CHECK 213, 215 AND 216:

GC09A. CHECK 213, 215 AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER OF EACH LIVING DAUGHTER BORN IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 3 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES). Now I would like to ask you some questions about your (daughter/daughters).

GC10. (5) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2000 OR LATER.

GC11. Is (NAME OF DAUGHTER) circumcised?

GC12. How old was (NAME OF DAUGHTER) when she was circumcised? IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

GC13. (3) Was her genital area sewn closed?

GC14. (4) Who performed the circumcision?

GC15. GO BACK TO GC11 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO GC16.

GC16. (2) Do you believe that female circumcision is required by your religion?

GC17. Do you think that female circumcision should be continued, or should it be stopped?

FEMALE GENITAL CUTTING/MUTILATION FOR WOMAN'S QUESTIONNAIRE FOOTNOTES

(1) Female genital cutting/mutilation module can be inserted into the woman's questionnaire wherever it is appropriate, and questions should be renumbered accordingly.

(2) Use local term for female circumcision.

(3) This question should be adapted to reflect country-specific methods of infibulation (that is, ways in which the vaginal orifice is narrowed or "closed").

(4) Coding categories to be developed locally and revised based on information collected before the survey and on the pretest; however, the broad categories must be maintained. The detailed coding categories for "health professional" are relevant in the countries where health professionals perform a large number of circumcisions.

(5) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016 or 2017, the year should be 2001 or 2002, respectively.