PLACE NAME__
NAME OF HOUSEHOLD HEAD__
CLUSTER NUMBER___
HOUSEHOLD NUMBER______
REGION__
RURAL 2
LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4
NAME AND LINE NUMBER OF WOMAN____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE__
INTERVIEWER'S NAME___
RESULT ____
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) __________
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE__
TIME__
FINAL VISIT
DAY__
MONTH__
YEAR __
NAME__
RESULT__
COUNTRY SPECIFIC INFORMATION: LANGUAGE OF QUESTIONNAIRE, LANGUAGE OF INTERVIEW, NATIVE LANGUAGE OF RESPONDENT, AND WHETHER TRANSLATOR USED
FIELD EDITOR
NAME__
DATE__
OFFICE EDITOR__
KEYED BY___
SECTION 1. RESPONDENT'S BACKGROUND
INFORMED CONSENT
Hello. My name is _________ and I am working with (NAME OF ORGANIZATION). We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey? May I begin the interview now?
Signature of interviewer: ______________
Date: _______
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
MINUTES___
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?
TOWN 2
COUNTRYSIDE 3
103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104) Just before you moved here, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
105) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107) Have you ever attended school?
NO 2 (GO TO 111)
108) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109) What is the highest (grade/form/year) you completed at that level?
SECONDARY OR HIGHER (GO TO 114)
111) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _______ 4
112) Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1' CIRCLED (GO TO 115)
114) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
115) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
116) Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
117) COUNTRY SPECIFIC QUESTION ON RELIGION.
118) COUNTRY SPECIFIC QUESTION ON ETHNICITY.
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202) Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (GO TO 204)
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?
NO 2 (GO TO 206)
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 did not survive?
NO 2 (GO TO 208)
207) 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?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (GO TO 226)
211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
212) What name was given to your (first/next) baby?
213) Were any of these births twins?
MULTIPLE 2
214) Is (NAME) a boy or a girl?
GIRL 2
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
NO 2 (GO TO 220)
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?
NO 2
219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD
(RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
220) IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS 2____
YEARS 3_____
221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[FOR ALL BIRTHS EXCEPT FIRST BIRTH]
NO 2
222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
FOR EACH LIVE BIRTH: YEAR OF BIRTH IS RECORDED__
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED___
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED___
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS___
224) CHECK 215 AND ENTER NUMBER OF BIRTHS IN 1995 OR LATER.
IF NONE, RECORD '0'.
225) FOR EACH LIVE BIRTH SINCE JANUARY 1995, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.
(NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)
227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.
228) 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?
LATER 2
NOT AT ALL 3
229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (GO TO 237)
230) When did the last such pregnancy end?
LAST PREGNANCY ENDED BEFORE JANUARY 1995 (GO TO 237)
232) How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
233) Have you ever had any other pregnancies that did not result in a live birth?
NO 2 (GO TO 237)
234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1995. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
235) Did you have any pregnancies that terminated before 1995 that did not result in a live birth?
NO 2 (GO TO 237)
236) When did the last such pregnancy that terminated before 1995 end?
237) When did your last menstrual period start?
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
238) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)
239) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ____ 6
DON'T KNOW 8
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.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
301) Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
302) Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) (GO TO 307)
304) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
305) ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 329)
306) What have you done or used?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).
307) 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'.
WOMAN STERILIZED (GO TO 311A)
PREGNANT (GO TO 318)
310) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 318)
311) Which method are you using?
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATIONAL AMENORRHEA METHOD K (GO TO 316A)
PERIODIC ABSTINENCE L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) __________ X (GO TO 316A)
312) QUESTIONS ON SOCIAL MARKETING SHOULD BE ADDED IN COUNTRIES THAT HAVE AN ACTIVE SOCIAL MARKETING PROGRAM.
313) In what facility did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE DOCTOR'S OFFICE 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) _______ 26
DON'T KNOW 98
CODE 'A' CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?
CODE 'A' NOT CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?
NO 2
DON'T KNOW 8
315) IN COUNTRIES WHERE STERILIZATION IS COMMON, ADD ADDITIONAL APPROPRIATE QUESTIONS FROM STERILIZATION MODULE.
316) In what month and year was the sterilization preformed?
316A) For how long have you been using (CURRENT METHOD) now without stopping?
PROBE: In what month and year did you start using (CURRENT METHOD) continuously?
YEAR IS 1994 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1995.) (GO TO 327)
318) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1995. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS: COLUMN 1:
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?
IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.
ILLUSTRATIVE QUESTIONS: COLUMN 2:
Where did you get advice on how to use the method [for lactational amenorrhea, rhythm, or withdrawal]?
IN COLUMN 3, ENTER CODES FOR REASON FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS: COLUMN 3:
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 325)
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)
322) You obtained (CURRENT METHOD FROM 319) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about side effects or problems you might have with the method?
NO 2
323) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (GO TO 325)
324) Were you told what to do if you experienced side effects or problems?
NO 2
CODE '1' CIRCLED: At that time, were you told about other family planning that you could use?
CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?
NO 2
326) Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
CIRCLE METHOD CODE:
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 331)
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)
328) Where did you obtain (CURRENT METHOD) the last time?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE AND SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ______ 16
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
CHURCH 32
FRIEND/RELATIVE 33
329) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 331)
330) Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
CHURCH N
FRIEND/RELATIVE O
331) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?
NO 2
332) In the last 12 months, have you visited a health facility for care for yourself (or your children)?
NO 2 (GO TO 401)
333) Did any staff member at the health facility speak to you about family planning methods?
NO 2
SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING
NO BIRTHS IN 1995 OR LATER (GO TO 487)
402) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately).
403) LINE NUMBER FROM 212:
LIVING (GO TO 405)
DEAD (GO TO 405)
405) 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?
LATER 2
NOT AT ALL 3 (GO TO 407 FOR LAST BIRTH; GO TO 423 FOR ALL OTHER BIRTHS)
406) How much longer would you like to have waited?
YEARS 2____
DON'T KNOW 998
407) Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[FOR LAST BIRTH ONLY]
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER (SPECIFY) _______ X
408) How many months pregnant were you when you first received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
409) How many times did you receive antenatal care during this pregnancy?
[LAST BIRTH ONLY]
DON'T KNOW 98
410) CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[FOR LAST BIRTH ONLY]
MORE THAN ONCE OR DON'T KNOW (GO TO 411)
411) How many months pregnant were you the last time you received antenatal care?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
412) During this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]
NO 2
NO 2
NO 2
NO 2
NO 2
413) Were you told about the signs of pregnancy complications?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 415)
DON'T KNOW 8 (GO TO 415)
414) Were you told where to go if you had these complications?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
416) During this pregnancy, how many times did you get this injection?
[FOR LAST BIRTH ONLY]
DON'T KNOW 8
417) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLET/SYRUP.
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 419)
DON'T KNOW 8 (GO TO 419)
418) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[FOR LAST BIRTH ONLY]
DON'T KNOW 998
419) During this pregnancy, did you have difficulty with your vision during the daylight?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
420) During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
421) During this pregnancy, did you take any drugs to prevent you from getting malaria?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)
422) What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[FOR LAST BIRTH ONLY]
CHLOROQUINE B
UNKNOWN DRUG C
OTHER (SPECIFY) _______ X
423) When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
424) Was (NAME) weighed at birth?
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)
425) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.
GRAMS FROM RECALL 2 ____
DON'T KNOW 99998
426) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
RELATIVE/FRIEND E
NO ONE Y
427) Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
OTHER HOME 12 (GO TO 429)
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ______ 26
OTHER PRIVATE MEDICAL (SPECIFY) ______ 36
428) Was (NAME) delivered by caesarean section?
NO 2 (GO TO 433 FOR LAST BIRTH; GO TO 435 FOR ALL OTHER BIRTHS)
429) After (NAME) was born, did a health professional or a traditional birth attendant check on your health?
NO 2 (GO TO 433)
430) How many days or weeks after delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
[FOR LAST BIRTH ONLY]
WEEKS AFTER DELIVERY 2 ___
DON'T KNOW 998
431) Who checked on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.
[FOR LAST BIRTH ONLY]
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
432) Where did this first check take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[FOR LAST BIRTH ONLY]
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ______ 26
OTHER PRIVATE MEDICAL (SPECIFY) ______ 36
433) In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.
[FOR LAST BIRTH ONLY]
NO 2
434) Has your period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 437)
435) Did your period return between the birth of (NAME) and your next pregnancy?
[FOR ALL BIRTHS EXCEPT THE LAST BIRTH]
NO 2 (GO TO 439)
436) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
437) CHECK 226:
IS RESPONDENT PREGNANT?
[FOR LAST BIRTH ONLY]
PREGNANT OR UNSURE (GO TO 439)
438) Have you resumed sexual relations since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 440)
439) For how many months after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
440) Did you ever breastfeed (NAME)?
NO 2 (GO TO 447)
441) 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.
HOURS 1 _____
DAYS 2 _____
442) In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?
NO 2 (GO TO 444)
443) What was (NAME) given to drink before your milk began flowing regularly?
Anything else? RECORD ALL LIQUIDS MENTIONED.
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) ______ X
444) CHECK 404:
IS CHILD LIVING?
DEAD (GO TO 446)
445) Are you still breastfeeding (NAME)?
NO 2
446) For how many months did you breastfeed (NAME)?
DON'T KNOW 98
447) CHECK 404:
IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454)
448) How many times did you breastfeed last night between sunset and sunrise?
IF NUMBER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
449) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
450) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
451) Was sugar added to any of the foods or liquids (NAME) ate yesterday?
NO 2
DON'T KNOW 8
452) How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
453) GO BACK TO 405 IN NEXT COLUMN; OR, IF MORE BIRTHS, GO TO 454.
SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION
454) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).
LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 484)
457) Did (NAME) receive a vitamin A dose like this during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP.
NO 2
DON'T KNOW 8
458) Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 462)
NO CARD 3
459) Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 462)
460) (1) COPY VACCINATION DATE 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.
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
MONTH___
YEAR____
461) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)
462) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)
463) Please tell me if (NAME) received any of the following vaccinations:
463A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
463B) Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 463E)
DON'T KNOW 8 (GO TO 463E)
463C) When was the first polio vaccine received, just after birth or later?
LATER 2
463D) How many times was the polio vaccine received?
463E) A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?
NO 2 (GO TO 463G)
DON'T KNOW 8 (GO TO 463G)
463G) An injection to prevent measles?
NO 2
DON'T KNOW 8
464) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?
NO 2 (GO TO 466)
NO VACCINATION IN THE LAST 2 YEARS 3 (GO TO 466)
DON'T KNOW 8 (GO TO 466)
465) At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.
CAMPAIGN 2 (TYPE/DATE) B
CAMPAIGN 3 (TYPE/DATE C
CAMPAIGN 4 (TYPE/DATE) D
466) Has (NAME) been ill with a fever at any time in the last two weeks?
NO 2
DON'T KNOW 8
467) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (GO TO 469)
DON'T KNOW 8 (GO TO 469)
468) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths?
NO 2
DON'T KNOW 8
469) CHECK 466 AND 467:
FEVER OR COUGH?
OTHER (GO TO 475)
470) Did you seek advice or treatment for the fever/cough?
NO 2 (GO TO 472)
471) Where did you seek advice or treatment for the fever/cough? Anywhere else?
RECORD ALL SOURCES MENTIONED.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ___________ F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ___________ L
TRADITIONAL PRACTITIONER N
"NO" OR "DON'T KNOW" IN 466 (GO TO 475)
473) Did (NAME) take any drugs for the fever?
NO 2 (GO TO 475)
DON'T KNOW 8 (GO TO 475)
474) What drugs did (NAME) take?
RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
CHLOROQUINE B
ASPIRIN C
IBUPROFEN/ACETAMINOPHEN D
OTHER (SPECIFY) _______ X
DON'T KNOW Z
475) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 483)
DON'T KNOW 8 (GO TO 483)
476) Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same, or more than usual to drink?
IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
477) When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
478) Was he/she given any of the following drink:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
479) Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 481)
DON'T KNOW 8 (GO TO 481)
480) What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS MENTIONED.
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ______ X
481) Did you seek advice or treatment for the diarrhea?
NO 2 (GO TO 483)
482) Where did you seek advice or treatment? Anywhere else?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) _____ F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
TRADITIONAL PRACTITIONER N
483) GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484.
484) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1995 OR LATER LIVING WITH THE RESPONDENT?
NONE (GO TO 487)
485) What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSE AWAY 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
NOT DISPOSED OF 09
OTHER (SPECIFY) ______ 96
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 488)
487) Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET] you can get for the treatment of diarrhea?
NO 2
HAS NO CHILDREN LIVING WITH HER (GO TO 490)
489) When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?
NO 2
DEPENDS 3
490) Now I would like to ask you some questions about medical care for you yourself. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
492) Now I would like to ask you about liquids (NAME FROM Q. 491) drank over the last seven days, including yesterday. How many days during the last seven days did (NAME FROM Q. 491) drink each of the following?
FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.
493) Now I would like to ask you about the types of foods (NAME FROM Q. 491) ate over the last seven days, including yesterday. How many days during the last seven days did (NAME FROM Q. 491) eat each of the following foods either separately or combined with other food?
FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) eat (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.
SECTION 5. MARRIAGE AND SEXUAL ACTIVITY
501) Are you currently married or living with a man?
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3
502) Have you ever been married or lived with a man?
YES, LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 514)
503) ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 1995. (GO TO 514)
504) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)
505) Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
506) RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
510) Have you been married or lived with a man only once, or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?
MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
512) How old were you when you started living with him?
513) DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE JANUARY 1995. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER '0' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 1995.
FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
514) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?
AGE IN YEARS___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95
515) When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 2___
MONTHS AGO 3___
YEARS AGO 4___ (GO TO 524)
516) The last time you had sexual intercourse, was a condom used?
NO 2
517) What is your relationship to the man with whom you last had sex?
IF MAN IS "BOYFRIEND" OR "FIANCÉ" ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ______ 96
518) For how long have you had sexual relations with this man?
WEEKS 2___
MONTHS 3___
YEARS 4___
519) Have you had sex with any other man in the last 12 months?
NO 2 (GO TO 524)
520) The last time you had sexual intercourse with another man, was a condom used?
NO 2
521) What is your relationship to this man?
IF MAN IS "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex with him?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) _________ 96
522) For how long have you had sexual relations with this man?
WEEKS 2___
MONTHS 3___
YEARS 4___
523) In total, with how many different men have you had sex in the last 12 months?
524) Do you know of a place where a person can get condoms?
NO 2 (GO TO 527)
525) Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)__________ F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY)___________ L
CHURCH N
FRIENDS/RELATIVES O
526) If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW/UNSURE 8
527) Do you know of a place where a person can get female condoms?
NO 2 (GO TO 601)
528) Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY) _______ L
CHURCH N
FRIENDS/RELATIVES O
529) If you wanted to, could you yourself get a female condom?
NO 2
DON'T KNOW/UNSURE 8
SECTION 6. FERTILITY PREFERENCES
HE OR SHE STERILIZED (GO TO 614)
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?
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 608)
NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?
PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2 ___
SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) ______ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)
PREGNANT (GO TO 610)
605) CHECK 310:
USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEARS (GO TO 610)
WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?
WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
608) In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4
609) CHECK 310:
USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)
610) Do you think that you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)
611) Which contraceptive method would you prefer to use?
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY) ______ 96 (GO TO 614)
UNSURE 98 (GO TO 614)
612) What is the main reason that you think you will not use a contraceptive method at any time in the future?
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
DON'T KNOW 98 (GO TO 614)
613) Would you ever use a contraceptive method if you were married?
NO 2
DON'T KNOW 8
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?
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY) ______ 96 (GO TO 616)
615) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
OTHER (SPECIFY) ____ 96
OTHER (SPECIFY) ____ 96
OTHER (SPECIFY) ____ 96
616) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?
DISAPPROVE 2
DON'T KNOW/UNSURE 3
617) In the last few months have you heard about family planning:
NO 2
NO 2
NO 2
618) COUNTRY-SPECIFIC QUESTIONS ON MEDIA MESSAGES ABOUT FAMILY PLANNING.
619) In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 621)
620) With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
MOTHER(S)-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) _____ X
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 628)
NO CODE CIRCLED (GO TO 624)
623) You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _____ 6
624) Now I want to ask you about your husband's/partner's views on family planning. Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
625) How often have you talked to your husband/partner about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3`
HE OR SHE STERILIZED (GO TO 628)
627) Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
628) Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)
702) How old was your husband/partner on his last birthday?
703) Did your (last) husband/partner ever attend school?
NO 2 (GO TO 706)
704) What was his highest level of school he ever attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 706)
705) What was the highest (grade/form/year) he completed at that level?
DON'T KNOW 98
CURRENTLY MARRIED/LIVING WITH A MAN: What is your husband's/partner's occupation? That is, what kind of work does he mainly do?
FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?
707) Aside from your own housework, are you currently working?
NO 2
708) 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?
NO 2
709) Have you done any work in the last 12 months?
NO 2 (GO TO 719)
710) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 713)
712) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
713) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
714) Do you usually work at home or away from home?
AWAY 2
715) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
716) Are you paid or do you earn in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)
717) Who mainly decides how the money you earn will be used?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
718) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6
719) Who in your family usually has the final say on the following decisions:
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
720) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRESENT/NOT LISTENING 2
NOT PRESENT 8
PRESENT/NOT LISTENING 2
NOT PRESENT 8
PRESENT/NOT LISTENING 2
NOT PRESENT 8
PRESENT/NOT LISTENING 2
NOT PRESENT 8
721) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
SECTION 8. HIV/AIDS AND OTHER SEXUAL TRANSMITTED INFECTIONS
801) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 817)
802) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 809)
DON'T KNOW 8 (GO TO 809)
803) What can a person do? Anything else?
RECORD ALL WAYS MENTIONED.
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PEOPLE WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
DON'T KNOW Z
804) Can people reduce their chances of getting the AIDS virus by having just one sex partner who has no other partners?
NO 2
DON'T KNOW 8
805) Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
806) Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
807) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
809) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
810) Do you know someone personally who has the virus that causes AIDS or someone who has died of AIDS?
NO 2
811) Can the virus the causes AIDS be transmitted from mother to a child?
NO 2 (GO TO 813)
DON'T KNOW 8 (GO TO 813)
812) Can the virus that causes AIDS be transmitted from a mother to a child:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO, NOT IN UNION (GO TO 815)
814) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?
NO 2
815) If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE 8
816) If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
817) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NO 2 (GO TO 820)
818) If a man has a sexually transmitted disease, what symptoms might he have?
Any others?
RECORD ALL SYMPTOMS MENTIONED.
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y
DON'T KNOW Z
819) If a woman has a sexually transmitted disease, what symptoms might she have?
Any others?
RECORD ALL SYMPTOMS MENTIONED.
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y
DON'T KNOW Z
MINUTES____
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:______
COMMENTS ON SPECIFIC QUESTIONS:______
ANY OTHER COMMENTS:______
SUPERVISOR'S OBSERVATIONS:_______
NAME OF THE SUPERVISOR:____
DATE:____
EDITOR'S OBSERVATIONS:_____
NAME OF EDITOR:_____
DATE:_____
This is the fold-out sheet at the end of the questionnaire on which information is recorded about events in the five to six years preceding the survey. Information is collected for each pregnancy (its duration and, for pregnancies that have ended, whether or not the outcome was a live birth), and use of contraception (column 1); source of methods at the beginning of each episode of use (column 2); reasons for discontinuation of methods (column 3); and marital history (column 4). Information is recorded by using the codes to the left of the calendar.
INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN
COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE
P PREGNANCIES
T TERMINATIONS
0 NO METHODS
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L PERIODIC ABSTINENCE
M WITHDRAWAL
X OTHER (SPECIFY) ____
COLUMN 2: SOURCE OF CONTRACEPTION
2 GOVERNMENT HEALTH CENTER
3 FAMILY PLANNING CLINIC
4 GOVERNMENT MOBILE CLINIC
5 GOVERNMENT FIELDWORKER
6 OTHER PUBLIC
7 PRIVATE HOSPITAL/CLINIC
8 PHARMACY
9 PRIVATE DOCTOR
A NON-GOVERNMENT MOBILE CLINIC
B NON-GOVERNMENT FIELDWORKER
C OTHER PRIVATE MEDICAL
D SHOP
E CHURCH
F FRIENDS/RELATIVES
X OTHER (SPECIFY) ____
COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ____
Z DON'T KNOW
COLUMN 4: MARRIAGE/UNION
O NOT IN UNION
11 NOV___ ___ ___ ___ 02
10 OCT___ ___ ___ ___ 03
09 SEP___ ___ ___ ___ 04
08 AUG___ ___ ___ ___ 05
07 JUL___ ___ ___ ___06
06 JUN___ ___ ___ ___ 07
05 MAY___ ___ ___ ___ 08
04 APR___ ___ ___ ___ 09
03 MAR___ ___ ___ ___10
02 FEB___ ___ ___ ___11
01 JAN___ ___ ___ ___12
11 NOV___ ___ ___ ___ 14
10 OCT___ ___ ___ ___ 15
09 SEP___ ___ ___ ___ 16
08 AUG___ ___ ___ ___ 17
07 JUL___ ___ ___ ___18
06 JUN___ ___ ___ ___ 19
05 MAY___ ___ ___ ___ 20
04 APR___ ___ ___ ___ 21
03 MAR___ ___ ___ ___22
02 FEB___ ___ ___ ___23
01 JAN___ ___ ___ ___24
11 NOV___ ___ ___ ___ 26
10 OCT___ ___ ___ ___ 27
09 SEP___ ___ ___ ___ 28
08 AUG___ ___ ___ ___ 29
07 JUL___ ___ ___ ___30
06 JUN___ ___ ___ ___ 31
05 MAY___ ___ ___ ___ 32
04 APR___ ___ ___ ___ 33
03 MAR___ ___ ___ ___34
02 FEB___ ___ ___ ___35
01 JAN___ ___ ___ ___36
11 NOV___ ___ ___ ___ 38
10 OCT___ ___ ___ ___ 39
09 SEP___ ___ ___ ___ 40
08 AUG___ ___ ___ ___ 41
07 JUL___ ___ ___ ___42
06 JUN___ ___ ___ ___ 43
05 MAY___ ___ ___ ___ 44
04 APR___ ___ ___ ___ 45
03 MAR___ ___ ___ ___46
02 FEB___ ___ ___ ___47
01 JAN___ ___ ___ ___48
11 NOV___ ___ ___ ___ 50
10 OCT___ ___ ___ ___ 51
09 SEP___ ___ ___ ___ 52
08 AUG___ ___ ___ ___ 53
07 JUL___ ___ ___ ___54
06 JUN___ ___ ___ ___ 55
05 MAY___ ___ ___ ___ 56
04 APR___ ___ ___ ___ 57
03 MAR___ ___ ___ ___58
02 FEB___ ___ ___ ___59
01 JAN___ ___ ___ ___60
11 NOV___ ___ ___ ___ 62
10 OCT___ ___ ___ ___ 63
09 SEP___ ___ ___ ___ 64
08 AUG___ ___ ___ ___ 65
07 JUL___ ___ ___ ___66
06 JUN___ ___ ___ ___ 67
05 MAY___ ___ ___ ___ 68
04 APR___ ___ ___ ___ 69
03 MAR___ ___ ___ ___70
02 FEB___ ___ ___ ___71
01 JAN___ ___ ___ ___72