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AFGHANISTAN DEMOGRAPHIC AND HEALTH SURVEY 2015 EVER-MARRIED WOMAN’S QUESTIONNAIRE

CENTRAL STATISTICS ORGANIZATION AND MINISTRY OF PUBLIC HEALTH

IDENTIFICATION

PROVINCE

DISTRICT

VILLAGE/NAHIA

CONTROLLER AREA

CLUSTER NUMBER

TYPE OF LOCATION

URBAN=1
RURAL=2

STRUCTURE/BUILDING NUMBER/GATE NUMBER

HOUSEHOLD NUMBER

NAME OF HOUSEHOLD HEAD

NAME AND LINE NUMBER OF WOMAN

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES=1
NO=2

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER’S NAME
RESULT

RESULT CODING:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER_________

NEXT VISIT
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER’S NAME
RESULT

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER’S NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT

TOTAL NUMBER OF VISITS

LANGUAGE OF INTERVIEW

DARI 1
PASHTO 2
OTHER________6

NATIVE LANGUAGE OF RESPONDENT

DARI 1
PASHTO 2
OTHER________6

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR
NAME

FIELD EDITOR
NAME

OFFICE EDITOR
NAME

KEYED BY
NAME

SECTION 1. RESPONDENT’S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

As-salamu alaykum. My name is _______________________________________. I am working with Central Statistics Organization. Weare conducting a survey about health all over Afghanistan, which is conducted with the joint effort of the Ministry of Public Health and Central Statistics Organization. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don’t have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don’t want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER:_________________
DATE:_________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR___
MINUTES____

102. In what month and year were you born?

MONTH___
DON’T KNOW MONTH 98
YEAR_____
DON’T KNOW YEAR 9998

103. How old were you at your last birthday?

COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS____

104. Have you ever attended school?

YES 1
NO 2 (GO TO 108)

104A. What type of school (Madrassa) have you attended?

SCHOOL 1
MADRASSA 2

105. What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3

106. What is the highest grade you completed?

IF COMPLETED LESS THAN GRADE ONE, RECORD ‘00’.

GRADE___

107. CHECK 105:

PRIMARY (GO TO 108)
SECONDARY OR HIGHER (GO TO 110)

108. Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT

IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE________)
BLIND/VISUALLY IMPAIRED 5

109. CHECK 108:

CODE ‘2’, ‘3’, OR ‘4’ CIRCLED (GO TO 110)
CODE ‘1’ OR ‘5’ CIRCLED (GO TO 111)

110. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111. Do you listen to the radio at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112. Do you watch television at least once a week, less then once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113. To which ethnic group do you belong?

PASHTUN 01
TAJIK 02
HAZARA 03
UZBEK 04
TURKMEN 05
NURISTANI 06
BALOCH 07
PASHAI 08
OTHER______96

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?

YES 1
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?

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?

SONS AT HOME___

And how many daughters live with you?

DAUGHTERS AT HOME___

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?

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you?

SONS ELSEWHERE___

And how many daughters are alive but do not live with you?

DAUGHTERS ELSEWHERE___

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?

YES 1
NO 2 (GO TO 208)

207. How many boys have died?

BOYS DEAD___

And how many girls have died?

GIRLS DEAD___

IF NONE, RECORD ‘00’.

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

TOTAL BIRTHS___

209. CHECK 208:

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
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 ROWS. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

212. What name given to your (first/next) baby?

NAME____________

213. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

214. Were any of these births twins?

SINGLE 1
MULTIPLE 2

215. In what month and years was (NAME) born? PROBE: When is his/her birthday?

MONTH___
YEAR______

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217. IF ALIVE: How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS___

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

YES 1
NO 2

219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD ‘00’ IF CHILD NOT LISTED IN HOUSEHOLD).

HOUSEHOLD LINE NUMBER____

(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.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

YES 1 (ADD BIRTH)
NO 2 (GO TO NEXT BIRTH)

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?

IF YES, RECORD THE BIRTH(S) IN TABLE.

YES 1
NO 2

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

NUMBERS ARE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 1389 OR LATER.

NUMBER OF BIRTHS___
NONE 0 (GO TO 226)

225. FOR EACH BIRTH SINCE HAMMAL 1389, ENTER ‘B’ IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE ‘B’ CODE. 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.)

226. Are you pregnant now?

YES 1
NO 2 (GO TO 230)
UNSURE 3 (GO TO 230)

227. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS

MONTHS____

ENTER ‘P’s IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228. When you got pregnant, did you want to get pregnant at the time?

YES 1 (GO TO 230)
NO 2

229. Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

230. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

YES 1
NO 2 (GO TO 238)

231. When did the last such pregnancy end?

MONTH___
YEAR_____

232. CHECK 231:

LAST PREGNANCY ENDED IN HAMMAL 1389 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE HAMMAL 1389 (GO TO 238)

233. How many months pregnant were you when the last such pregnancy ended?

RECORD NUMBER OF COMPLETED MONTHS

MONTHS____

ENTER ‘T’ IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND ‘P’ FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

234. Since Hammal 1389, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO HAMMAL 1389.

ENTER ‘T’ IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND ‘P’ FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236. Did you have any miscarriages, abortions or stillbirths that ended before 1389?

YES 1
NO 2 (GO TO 238)

237. When did the last such pregnancy that terminated before 1389 end?

MONTH___
YEAR_____

238. When did your last menstrual period start?

DATE, IF GIVEN_____________

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

239. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

YES 1
NO 2 (GO TO 301)
DON’T KNOW 8 (GO TO 301)

240. Is this time just before here period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER_______6
DON’T KNOW 8

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.

Have you ever heard of (METHOD)?

01. Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04. Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05. Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06. Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07. Male Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
09. Lactational Amenorrhea Method (LAM)
YES 1
NO 2
10. Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11. Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12. Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
13. Have you heard of any other ways or methods that women can use to avoid pregnancy?
YES 1 (SPECIFY)_______________
NO 2

302. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

304. Which method are you using? CIRCLE ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
MALE CONDOM G (GO TO 306)
LACTATIONAL AMEN. METHOD K (GO TO 308A)
RHYTHM METHOD L (GO TO 308A)
WITHDRAWAL M (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

305. What is the brand name of the pills you are using?

IF DON’T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

CONTRACEPTIVE LD 01
NOVA 02
CONTRACEPTIVE HD 03
LO FEMENAL 04
MICROGYNON (SMP) 05
FAMILIA 28 06
LYNESTRENOL 07
KHOSHI 08
OTHER_________96
DON’T KNOW 98

(GO TO 308A)

306. What is the brand name of the concoms you are using?

IF DON’T KNOW BRAND, ASK TO SEE THE PACKAGE.

ARAMESH 01
SATHI 02
ASODAGI 03
MOH/UNFPA 04
OTHER_______96
DON’T KNOW 98

(GO TO 308A)

307. In what facility did the sterilization take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE_____________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) 11
OTHER PUBLIC SECTOR_____________16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR’S OFFICE 22
OTHER PRIVATE MEDICAL SECTOR_________26
OTHER___________96
DON’T KNOW 98

308. In what month and year was the sterilization performed?

MONTH___
YEAR_____

308A. Since what month and year have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH___
YEAR_____

309. CHECK 308/308A, 215 AND 231:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A

YES: GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUSE USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

NO: (GO TO 310)

310. CHECK 308/308A:

YEAR IS 1389 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. (GO TO 311)

YEAR IS 1388 OR EARLIER: ENTER CODE FOR METHOD USIDE IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO HAMMAL 1389. (GO TO 322)

311. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant in the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT USE, BACK TO HAMMAL 1389.

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:

When was the last time you used a method? Which method was that?
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 CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD 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:

Why did you stop using the (METHOD)? 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: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER ‘0’ IN EACH SUCH MONTH IN COLUMN 1

312. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH:

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314. CHECK 304:

CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
LACTATIONAL AMEN. METHOD 11 (GO TO 315A)
RHYTHM METHOD 12 (GO TO 315A)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

315. You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) 11
CHC/POLYCLINIC 12
BASIC HEALTH CENTER 13
HEALTH SUB-CENTER 14
HEALTH POST/SUB-HEALTH POST 15
COMMUNITY HEALTH WORKER 16
MOBILE CLINIC 17
OTHER PUBLIC SECTOR__________18
NON-GOVERNMENT SECTOR
MARIE STOPES 21
RED CROSS SOCIETY 22
AFGA 23
OTHER NGO SECTOR_________26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
FIELDWORKER 34
OTHER PRIVATE MEDICAL SECTOR_____________36
OTHER SOURCE
CHARITY FOUNDATION 41
REFUGEE CAMP 42
SHOP 43
FRIEND/RELATIVE 44
OTHER__________96

315A. Where did you learn how to use the rhythm/lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________________

PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) 11
CHC/POLYCLINIC 12
BASIC HEALTH CENTER 13
HEALTH SUB-CENTER 14
HEALTH POST/SUB-HEALTH POST 15
COMMUNITY HEALTH WORKER 16
MOBILE CLINIC 17
OTHER PUBLIC SECTOR__________18
NON-GOVERNMENT SECTOR
MARIE STOPES 21
RED CROSS SOCIETY 22
AFGA 23
OTHER NGO SECTOR_________26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
FIELDWORKER 34
OTHER PRIVATE MEDICAL SECTOR_____________36
OTHER SOURCE
CHARITY FOUNDATION 41
REFUGEE CAMP 42
SHOP 43
FRIEND/RELATIVE 44
OTHER__________96

316. CHECK 304:

CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07 (GO TO 323)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)

317. At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2 (GO TO 318)

317A. When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

318. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 320)

319. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

320. CHECK 317:

CODE ‘1’ CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE ‘2’ CIRCLED: When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

321. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

322. CHECK 304:

CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD ON LIST.

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323. Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) 11
CHC/POLYCLINIC 12
BASIC HEALTH CENTER 13
HEALTH SUB-CENTER 14
HEALTH POST/SUB-HEALTH POST 15
COMMUNITY HEALTH WORKER 16
MOBILE CLINIC 17
OTHER PUBLIC SECTOR__________18
NON-GOVERNMENT SECTOR
MARIE STOPES 21
RED CROSS SOCIETY 22
AFGA 23
OTHER NGO SECTOR_________26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
FIELDWORKER 34
OTHER PRIVATE MEDICAL SECTOR_____________36
OTHER SOURCE
CHARITY FOUNDATION 41
REFUGEE CAMP 42
SHOP 43
FRIEND/RELATIVE 44
OTHER__________96

(GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
COMMUNITY HEALTH WORKER F
MOBILE CLINIC G
OTHER PUBLIC SECTOR__________H
NON-GOVERNMENT SECTOR
MARIE STOPES I
RED CROSS SOCIETY J
AFGA K
OTHER NGO SECTOR_________L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
FIELDWORKER P
OTHER PRIVATE MEDICAL SECTOR_____________Q
OTHER SOURCE
CHARITY FOUNDATION R
REFUGEE CAMP S
SHOP T
FRIEND/RELATIVE U
OTHER__________X

326. In the last 12 months, were you visited by a community health worker who talked to you about family planning?

YES 1
NO 2

327. In the last 12 months, have you visited a health facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 401)

328. Did any staff member at the health facility speak to you about family planning methods?

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 1389 OR LATER (GO TO 402)
NO BIRTHS IN 1389 OR LATER (GO TO 556)

402. CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1389 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER____

404. FROM 212 AND 216:

NAME______________
LIVING
DEAD

405. When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 408)
NO 2

406. Did you want to have a baby later on, or did you not want to any (more) children?

LATER 1
NO MORE 2 (GO TO 408)

407. How much longer did you want to wait?

MONTHS 1 ____
YEARS 2 ____
DON’T KNOW 998

408. Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 415)

409. Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY HEALTH WORKER E
OTHER__________X

410. Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)________________
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL C
CHC/POLYCLINIC D
BASIC HEALTH CENTER E
HEALTH SUB-CENTER F
HP/SHP G
CHW H
MOBILE CLINIC I
OTHER PUBLIC SECTOR________J
NGO SECTOR
MARIE STOPES K
RED CROSS L
AFGA M
OTHER NGO________N
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC O
PRIVATE DOCTOR P
OTHER PRIVATE MED. SECTOR________Q
OTHER SOURCE
CHARITY/FOUNDATIONS R
REFUGEE CAMP S
OTHER___________X

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

MONTHS____
DON’T KNOW 98

412. How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES___
DON’T KNOW 98

413. As part of your antenatal care during this pregnancy, were any of the following done at least once:

Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

414. During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

YES 1
NO 2
DON’T KNOW 8

414A. What are the symptoms during pregnancy indicating the need to seek immediate care?

PROBE: Any other?

RECORD ALL MENTIONED.

VAGINAL BLEEDING A
SEVERE LOWER ABDOMEN PAIN B
SEVERE HEADACHE C
CONVULSION D
BLURRED VISION E
SWELLING FACE F
SWELLING HANDS AND FEET G
OTHER_______X
DON’T KNOW Z

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 418)
DON’T KNOW 8 (GO TO 418)

416. During this pregnancy, how many times did you get a tetanus injection?

TIMES___
DON’T KNOW 8

417. CHECK 416:

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

418. At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (GO TO 421)
DON’T KNOW 8 (GO TO 421)

419. Before this pregnancy, how many times did you receive a tetenus injection?

IF 7 OR MORE TIMES, RECORD ‘7’.

TIMES____
DON’T KNOW 8

420. How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO____

421. During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

SHOW TABLETS (TAQWAI KHON PILLS)

YES 1
NO 2 (GO TO 423)
DON’T KNOW 8 (GO TO 423)

422. 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.

DAYS______
DON’T KNOW 998

423. During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON’T KNOW 8

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON’T KNOW 8

431. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 433)
DON’T KNOW 8 (GO TO 433)

432. How much did name weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD 1 __________
KG FROM RECALL 2 __________
DON’T KNOW 99998

433. Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR ALL THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COM. HEALTH WK E
RELATIVE/FRIEND F
OTHER_________X
NO ONE ASSISTED Y

434. Where did you give birth to (NAME)?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________________
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
GOVT. HOSPITAL 21
CHC/POLYCLINIC 22
BASIC HEALTH CENTER 23
HEALTH SUB-CENTER 24
HP/SHP 25
MOBILE CLINIC 26
OTHER PUBLIC SECTOR_______27
NGO
MARIE STOPES 31
RED CROSS 32
OTHER NGO_________36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
PVT. MATERNITY HOME 42
PVT. DOCTOR’S OFFICE 43
OTHER PRIVATE MED. SECTOR________46
OTHER SOURCE
CHARITY/FOUNDATIONS 51
REFUGEE CAMP 52
OTHER__________96 (GO TO 438)

434A. How long after (NAME) was delivered did you stay there?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ____
DAYS 2 ____
WEEKS 3 _____
DON’T KNOW 998

435. Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

YES 1
NO 2

436. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

YES 1 (GO TO 439)
NO 2

437. Did anyone check on your health after you left the facility?

YES 1 (GO TO 439)
NO 2 (GO TO 442)

438. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about you health or examining you. Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO 2 (GO TO 442)

439. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY HEALTH WORKER 22
OTHER_______96

440. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DON’T KNOW 998

440A. How many times did you receive postnantal care during this pregnancy?

NUMBER OF TIMES____
DON’T KNOW 98

442. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (GO TO 446)
DON’T KNOW 8 (GO TO 446)

443. How many hours, days or weeks after the birth of (NAME) did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS AFTER BIRTH 1 ____
DAYS AFTER BIRTH 2 ____
WEEKS AFTER BIRTH 3 ____
DON’T KNOW 998

444. Who checked on (NAME)’s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY HEALTH WORKER 22
OTHER________96

445. Where did this first check of (NAME) take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________________
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
GOVT. HOSPITAL 21
CHC/POLYCLINIC 22
BASIC HEALTH CENTER 23
HEALTH SUB-CENTER 24
HP/SHP 25
MOBILE CLINIC 26
OTHER PUBLIC SECTOR_______27
NGO
MARIE STOPES 31
RED CROSS 32
OTHER NGO_________36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
PVT. MATERNITY HOME 42
PVT. DOCTOR’S OFFICE 43
OTHER PRIVATE MED. SECTOR________46
OTHER SOURCE
CHARITY/FOUNDATIONS 51
REFUGEE CAMP 52
OTHER__________96

446. In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?

SHOW COMMON TYPES OF AMPULES/CAPSULES.

YES 1
NO 2
DON’T KNOW 8

447. Has your menstrual period returned since the birth of (NAME)?

YES 1 (GO TO 449)
NO 2 (GO TO 450)

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

YES 1
NO 2 (GO TO 452)

449. For how many months after the birth of (NAME) di you not have a period?

MONTHS____
DON’T KNOW 98

450. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 451)
PREGNANT OR UNSURE (GO TO 452)

451. Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 453)

452. For how many months after the birth of (NAME) did you not have sexual intercourse?

MONTHS___
DON’T KNOW 98

453. Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

455. 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.

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

456. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 458)

457. What was (NAME) given to drink? Anything else?

RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
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
COFFEE I
HONEY J
OTHER_______X

458. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 459)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

459. Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON’T KNOW 8

461. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1389 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER____

503. FROM 212 AND 216

NAME________________
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

504. Do you have a card where (NAME)’s vaccinations are written down?

IF YES: May I see it please?

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 509)
NO CARD 3

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

YES 1 (GO TO 509)
NO 2 (GO TO 509)

506. (1) COPY DATES FROM THE CARD. (2) WRITE ‘44’ IN ‘DAY’ COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY___
MONTH___
YEAR_____
HEP B-0 (GIVEN AT BIRTH)
DAY___
MONTH___
YEAR_____
POLIO 0 (GIVEN AT BIRTH)
DAY___
MONTH___
YEAR_____
POLIO 1
DAY___
MONTH___
YEAR_____
POLIO 2
DAY___
MONTH___
YEAR_____
POLIO 3
DAY___
MONTH___
YEAR_____
POLIO 4
DAY___
MONTH___
YEAR_____
DPT 1/PENTAVALENT 1
DAY___
MONTH___
YEAR_____
DPT 2/PENTAVALENT 2
DAY___
MONTH___
YEAR_____
DPT 3/PENTAVALENT 3
DAY___
MONTH___
YEAR_____
PCV1
DAY___
MONTH___
YEAR_____
PCV2
DAY___
MONTH___
YEAR_____
PCV3
DAY___
MONTH___
YEAR_____
MEASLES 1
DAY___
MONTH___
YEAR_____
MEASLES 2
DAY___
MONTH___
YEAR_____
VITAMIN A (MOST RECENT)
DAY___
MONTH___
YEAR_____

507. CHECK 506:

BCG TO MEASLES 2 ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

508. Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?

RECORD ‘YES’ ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE ‘66’ IN THE CORRESPONDING DAY COLUMN IN 506)
NO 2
DON’T KNOW 8

(GO TO 511)

509. Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

YES 1
NO 2 (GO TO 511)
DON’T KNOW 8 (GO TO 511)

510. Please tell me if (NAME) had any of the following vaccinations?

510A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON’T KNOW 8

510B. Hepatitis B-0 dose, that is given at birth, along with BCG?

YES 1
NO 2
DON’T KNOW 8

510C. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 510F)
DON’T KNOW (GO TO 510F)

510D. Was the first polio vaccine given in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

510E. How many times was the polio vaccine given?

NUMBER OF TIMES____

510F. A DPT/PENTAVALENT vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 510H)
DON’T KNOW 8 (GO TO 510H)

510G. How many times was the DPT/PENTAVALENT vaccionation given?

NUMBER OF TIMES____

510H. A PCV vaccination, that is, an injection given in the thigh, to prevent him/her from getting pneumonia?

YES 1
NO 2 (GO TO 510J)
DON’T KNOW 8 (GO TO 510J)

510I. How many times was the PCV vaccination given?

NUMBER OF TIMES___

510J. A measles injection or an MMR/MR injection-that is, a shot in the arm at the age of 9 months or older- to prevent him/her from getting measles?

YES 1
NO 2 (GO TO 511)
DON’T KNOW 8 (GO TO 511)

510K. How many times was measles or MMR/MR injection given?

NUMBER OF TIMES___

511. Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?

SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2
DON’T KNOW 8

512. In the last seven days, was (NAME) given sprinkles with iron or any micronutirent powder like (this/any of these)?

SHOW COMMON TYPES OF SPRINKLES/SACHETS.

YES 1
NO 2
DON’T KNOW 8

513. Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON’T KNOW 8

514. Has (NAME) had diarrhea in the last 2 weeks?

YES 1
NO 2 (GO TO 525)
DON’T KNOW 8 (GO TO 525)

515. Was there any blood in the stools?

YES 1
NO 2
DON’T KNOW 8

516. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk).

Was he/she given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON’T KNOW 8

517. When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON’T KNOW 8

518. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 522)

519. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)___________________
PUBLIC SECTOR
GOVT. HOSPITAL A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HSC D
HP/SHP E
COMM. HEALTH WORKER F
MOBILE CLINIC G
OTHER PUBLIC SECTOR________H
NON-GOVERNMENT
MARIE STOPES I
RED CROSS J
OTHER NGO SECTOR_________K
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC L
PHARMACY M
PVT DOCTOR’S OFFICE N
OTHER PRIVATE MED. SECTOR______O
OTHER SOURCE
CHARITY/FOUNDATIONS P
REFUGEE CAMP Q
SHOP R
TRADITIONAL PRACTITIONER S
MARKET T
OTHER__________X

520. CHECK 519:

TWO OR MORE CODES CIRCLED (GO TO 521)
ONLY ONE CODE CIRCLED (GO TO 522)

521. Where did you first seek advice or treatment.

USE LETTER CODE FROM 519.

FIRST PLACE___

522. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid made from a special packet called SHEFA?
YES 1
NO 2
DON’T KNOW 8
b) A pre-packaged ORS liquid?
YES 1
NO 2
DON’T KNOW 8
c) A government-recommended homemade fluid? (Wheat Salt Solution WSS)
YES 1
NO 2
DON’T KNOW 8
d) A government-recommended homemade fluid? (Salt and Sugar Solution SSS)
YES 1
NO 2
DON’T KNOW 8

523. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 525)
DON’T KNOW 8 (GO TO 525)

524. What (else) was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/HERBAL MEDICINE J
OTHER__________________X

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

YES 1
NO 2 (GO TO 527)
DON’T KNOW (GO TO 527)

526. At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

YES 1
NO 2
DON’T KNOW 8

527. Has (NAME) had an illness with a cough at any timie in the last 2 weeks?

YES 1
NO 2 (GO TO 530)
DON’T KNOW 8 (GO TO 530)

528. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (GO TO 531)
DON’T KNOW 8 (GO TO 531)

529. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1
NOSE ONLY 2
BOTH 3
OTHER______6
DON’T KNOW 8

(GO TO 531)

530. CHECK 525: HAD FEVER?

YES (GO TO 531)
NO OR DK (GO BACK TO 503 IN NEXT COLUMN: OR, IF NO MORE BIRTHS, GO TO 553)

531. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough).

Was he/she given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON’T KNOW 8

532. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON’T KNOW 8

533. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 537)

534. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)___________________
PUBLIC SECTOR
GOVT. HOSPITAL A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HSC D
HP/SHP E
COMM. HEALTH WORKER F
MOBILE CLINIC G
OTHER PUBLIC SECTOR________H
NON-GOVERNMENT
MARIE STOPES I
RED CROSS J
OTHER NGO SECTOR_________K
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC L
PHARMACY M
PVT DOCTOR’S OFFICE N
OTHER PRIVATE MED. SECTOR______O
OTHER SOURCE
CHARITY/FOUNDATIONS P
REFUGEE CAMP Q
SHOP R
TRADITIONAL PRACTITIONER S
MARKET T
OTHER__________X

535. CHECK 534:

TWO OR MORE CODE CIRCLED (GO TO 536)
ONLY ONE CODE CIRCLED (GO TO 537)

536. Where did you first seek advice or treatment?

USE LETTER CODE FROM 534.

FIRST PLACE____

537. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DON’T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

538. What drugs did (NAME) take? Any other drugs?

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COMBANATION WITH ARTEMISININ E
ARTESUNATE MONOTHERAPY F
OTHER ANTIMALARIAL______G
ANTIBIOTIC DRUGS
PILL/SYRUP H
INJECTION I
OTHER DRUGS
ASPRIN J
PARACETAMOL K
IBUPROFEN L
OTHER_____________X
DON’T KNOW Z

552. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 1389 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINE TO 554)
NAME_____________
NONE (GO TO 556)

554. The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER___________96

555. CHECK 522(a) and 522(b), ALL COLUMNS:

NO CHILD RECIEVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 556A)

556. Have you ever heard of a special product called ORS (e.g. SHEFA) you can get for the treatment of diarrhea?

YES 1
NO 2

556A. Sometimes children have severe illness and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Any other symptoms?

CHILD NOT ABLE TO DRINK OR BREASTFEED A
CHILD BECOMES SICKER B
CHILD DEVELOPS A FEVER C
CHILD HAS FAST BREATHING D
CHILD HAS DIFFICULT BREATHING E
CHILD HAS BLOOD IN STOOL F
CHILD IS DRINKING POORLY G
OTHER_____________X

557. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 1392 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD THE NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 558)
NONE (GO TO 601)

558. Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 557) (drink/eat):

a) Plain water?
YES 1
NO 2
DON’T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON’T KNOW 8
c) Clear broth?
YES 1
NO 2
DON’T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?

IF YES: How many times did (NAME) drink milk?

IF 7 OR MORE TIMES, RECORD ‘7’.
YES 1 (NUMBER OF TIMES___)
NO 2
DON’T KNOW 8
e) Infant formula?

IF YES: How many times did (NAME) drink infant formula?

IF 7 OR MORE TIMES, RECORD ‘7’.
YES 1 (NUMBER OF TIMES___)
NO 2
DON’T KNOW 8
f) Any other liquids?
YES 1
NO 2
DON’T KNOW 8
g) Yogurt?

IF YES: How many times did (NAME) eat yogurt?

IF 7 OR MORE TIMES, RECORD ‘7’.
YES 1 (NUMBER OF TIMES___)
NO 2
DON’T KNOW 8
h) Any [BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G., Cerelac]?
YES 1
NO 2
DON’T KNOW 8
i) Bread, rice, noodles, porridge, or other foods made from grains?
YES 1
NO 2
DON’T KNOW 8
j) Pumpkin, carrots, squash that are yellow or orange inside?
YES 1
NO 2
DON’T KNOW 8
k) White potatoes, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON’T KNOW 8
l) Any dark green, leafy vegetables?
YES 1
NO 2
DON’T KNOW 8
m) Ripe mangoes or other vitamin-A rich fruits?
YES 1
NO 2
DON’T KNOW 8
n) Any other fruits or vegetables?
YES 1
NO 2
DON’T KNOW 8
o) Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON’T KNOW 8
p) Any meat, such as beef, lamb, goat, chicken, or duck?
YES 1
NO 2
DON’T KNOW 8
q) Eggs?
YES 1
NO 2
DON’T KNOW 8
r) Fresh or dried fish?
YES 1
NO 2
DON’T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON’T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON’T KNOW 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON’T KNOW 8

559. CHECK 558 (CATEGORIES "g" THROUGH "u"):

NOT A SINGLE "YES" (GO TO 560)
AT LEAST ONE "YES" (GO TO 561)

560. Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?

IF YES, PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

561. How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD ‘7’.

NUMBER OF TIMES___
DON’T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601. What is your current marital status: are you married, widowed, divorced, or separated?

CURRENTLY MARRIED 1
WIDOWED 2 (GO TO 609)
DIVORCED 3 (GO TO 609)
SEPARATED 4 (GO TO 609)

604. Is your husband living with you now or is he stayin elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

605. RECORD THE HUSBANDS NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD ‘00’

NAME_____________
LINE NO___

606. Does your husband have other wives or does he live with other women as if married?

YES 1
NO 2 (GO TO 609)
DON’T KNOW 8 (GO TO 609)

607. Including yourself, in total, how many wives does he have?

TOTAL NUMBER OF WIVES____
DON’T KNOW 98

608. Are you the first, second, ... wife?

RANK___

609. Have you been married only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

610. CHECK 609:

MARRIED ONLY ONCE: In what month and year did you start living with your husband?
MARRIED MORE THAN ONCE: Now I would like to ask about your first husband. In what month and year did yous tart living with him?

MONTH___
DON’T KNOW MONTH 98
YEAR_____ (GO TO 612)
DON’T KNOW YEAR 9998

611. How old were you when you first started living with him?

AGE___

612. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

613. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.

How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)
AGE IN YEARS_______
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND 95

614. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don’t want to answer, just let me know and we will go to the next question.

615. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____

628. PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN under 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

629. Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 701)

630. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)_______________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
COMMUNITY HEALTH WORKER F
MOBILE CLINIC G
OTHER PUBLIC SECTOR______H
NON-GOVERNMENT SECTOR
MARIE STOPES I
RED CROSS SOCIETY J
AFGA K
OTHER NGO SECTOR________L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
FIELDWORKER P
OTHER PRIVATE MEDICAL SECTOR_______Q
OTHER SOURCE
CHARITY/FOUNDATIONS R
REFUGEE CAMP S
SHOP T
FRIENDS/RELATIVES U
OTHER___________X

631. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON’T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702. CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

703. 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?

HAVE ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON’T KNOW 8 (GO TO 711)

704. 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN’T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON’T KNOW 8 (GO TO 710)

705. CHECK 226:

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?

MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN’T GET PREGNANT 994 (GO TO 712)
OTHER____________996 (GO TO 710)
DON’T KNOW 998 (GO TO 710)

706. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707. CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708. CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEAR (GO TO 711)

709. CHECK 704:

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?

RECORD ALL REASONS MENTIONED.

FERTILITY-RELATED REASONS
NOT HAVE SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN’T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY’S NORMAL PROCESSES U
OTHER__________X
DON’T KNOW Z

710. CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NO, NOT CURRENTLY USING (GO TO 711)
YES, CURRENTLY USING (GO TO 712)

711. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2
DON’T KNOW 8

712. 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?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 714)
NUMBER____
OTHER_________96 (GO TO 714)

713. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it’s a boy or a girl?

NUMBER OF BOYS ____
NUMBER OF GIRLS ____
NUMBER OF EITHER ____

OTHER____________96

714. In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Seen or read about family planning in internet?
YES 1
NO 2
Read about family planning in billboard?
YES 1
NO 2
Heard from health professionals?
YES 1
NO 2
Heard from local community leaders?
YES 1
NO 2

716. CHECK 601:

YES, CURRENTLY MARRIED (GO TO 717)
NO, NOT IN UNION (GO TO 801)

717. CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 718)
NOT CURRENTLY USING OR NOT ASKED (GO TO 720)

718. Would you say that using contraception is mainly your decision, mainly your husband’s decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER______6

719. CHECK 304:

NEITHER STERILIZED (GO TO 720)
HE OR SHE STERILIZED (GO TO 801)

720. Does your husband want the same number of children that you want, or does he want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON’T KNOW 8

SECTION 8. HUSBAND’S BACKGROUND AND WOMAN’S WORK

801. CHECK 601:

CURRENTLY MARRIED (GO TO 802)
FORMERLY MARRIED (GO TO 803)

802. How old was your husband on his last birthday?

AGE IN COMPLETED YEARS____

803. Did you (last) husband ever attend school?

YES 1
NO 2 (GO TO 806)

803A. What type of school (Madrassa) has he attended?

SCHOOL 1
MADRASSA 2

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DON’T KNOW 8 (GO TO 806)

805. What was the highest grade he completed at that level?

IF COMPLETED LESS THAN GRADE ONE, RECORD ‘00’.

GRADE___
DON’T KNOW 98

806. CHECK 801:

CURRENTLY MARRIED: What is your husband’s occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED: What was your (last) husband’s occupation? That is, what kind of work did he mainly do?

SPECIFY__________________

807. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 811)
NO 2

808. As you know, some women take 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. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

YES 1 (GO TO 811)
NO 2

810. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 815)

811. What is your occupation, that is, what kind of work do you mainly do?

SPECIFY_______________

812. Do you do this work for a member of your family, for someone else, or are you self-employed?

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

813. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

814. Are you paid in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

815. CHECK 601:

CURRENTLY MARRIED (GO TO 816)
NOT IN UNION (GO TO 823)

816. CHECK 814:

CODE 1 OR 2 CIRCLED (GO TO 817)
OTHER (GO TO 819)

817. Who usually decides how the money you earn will be used: you, your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER_________6

818. Would you say that the money that you earn is more than what your husband earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND HAS NO EARNINGS 4 (GO TO 820)
DON’T KNOW 8

819. Who usually decides how your husband’s earnings will be used: you, your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER 6

820. Who usually makes decisions about health care for yourself: you, your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER 6

821. Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER 6

822. Who usually makes decisions about visits to your family or relatives?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER 6

823. Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

824. Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

825. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN under 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3

826. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON’T KNOW 8
If she neglects the children?
YES 1
NO 2
DON’T KNOW 8
If she argues with him?
YES 1
NO 2
DON’T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON’T KNOW 8
If she burns the food?
YES 1
NO 2
DON’T KNOW 8

SECTION 9. HIV/AIDS

901. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 937)

902. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON’T KNOW 8

903. Can people get HIV from mosquito bites?

YES 1
NO 2
DON’T KNOW 8

904. Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON’T KNOW 8

905. Can people get HIV by sharing food with a person who has aids?

YES 1
NO 2
DON’T KNOW 8

906. Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON’T KNOW 8

907. Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON’T KNOW 8

908. Can HIV be transmitted from a mother to her baby:

During pregnancy?
YES 1
NO 2
DON’T KNOW 8
During delivery?
YES 1
NO 2
DON’T KNOW 8
By breastfeeding?
YES 1
NO 2
DON’T KNOW 8

909. CHECK 908:

AT LEAST ONE "YES" (GO TO 910)
OTHER (GO TO 910A)

910. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON’T KNOW 3

910A. From where did you hear or get information about HIV/AIDS? Any other source?

RADIO A
TELEVISION B
NEWSPAPER/MAGAZINE C
POSTER/BILLBOARD D
INTERNET E
HEALTH PROFESSIONALS F
RELIGIOUS INSTITUTIONS G
SCHOOL/TEACHER H
COMMUNITY MEETINGS I
WORKPLACE J
FRIENDS/RELATIVIES K
OTHER_______X

926. I don’t want to know the results, but have you ever been tested to see if you have HIV?

YES 1
NO 2 (GO TO 930)

927. How many months ago was you most recent HIV test?

MONTHS AGO___
TWO OR MORE YEARS 95

928. I don’t want to know the results, but did you get the results of the test?

YES 1
NO 2

929. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE______________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) 11
CHC/POLYCLINIC 12
BASIC HEALTH CENTER 13
HEALTH SUB-CENTER 14
HEALTH POST/SUB-HEALTH POST 15
STAND-ALONE VCT CENTER 16
FAMILY PLANNING CLINIC 17
MOBILE CLINIC 18
COMMUNITY HEALTH WORKER 19
OTHER PUBLIC SECTOR_________20
NGO
MARIE STOPES 21
RED CROSS SOCIETY 22
AFGA 23
OTHER NGO SECTOR______26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
STAND-ALONE VCT CENTER 32
PHARMACY 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL SECTOR_________37
OTHER SOURCE
HOME 41
CHARITY/FOUNDATIONS 42
REFUGEE CAMP 43
OTHER___________96

(GO TO 932)

930. Do you know of a place where people can go to get tested for HIV?

YES 1
NO 2 (GO TO 932)

931. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)_______________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
STAND-ALONE VCT CENTER F
FAMILY PLANNING CLINIC G
MOBILE CLINIC H
COMMUNITY HEALTH WORKER I
OTHER PUBLIC SECTOR______J
NON-GOVERNMENT SECTOR
MARIE STOPES K
RED CROSS SOCIETY L
AFGA M
OTHER NGO SECTOR________N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR O
STAND-ALONE VCT CENTER P
PHARMACY Q
MOBILE CLINIC R
FIELDWORKER S
OTHER PRIVATE MEDICAL SECTOR_______T
OTHER SOURCE
HOME U
CHARITY/FOUNDATIONS V
REFUGEE CAMP W
OTHER___________X

932. Would you buy fresh vegetables from a shopkeeper or vendor if you know that this person had HIV?

YES 1
NO 2
DON’T KNOW 8

933. If a member of your family got infected with HIV, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DK/NOT SURE/DEPENDS 8

934. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

935. In your opinion, if a female teacher has HIV but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

936. Should children 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

937. CHECK 901:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

938. CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
NEVER HAD SEXUAL INTERCOURSE (GO TO 946)

939. CHECK 937: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 940)
NO (GO TO 941)

940. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON’T KNOW 8

941. Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

YES 1
NO 2
DON’T KNOW 8

942. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON’T KNOW 8

943. CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY ‘YES’) (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)

944. The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 946)

945. Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)_______________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
STAND-ALONE VCT CENTER F
FAMILY PLANNING CLINIC G
MOBILE CLINIC H
COMMUNITY HEALTH WORKER I
OTHER PUBLIC SECTOR______J
NON-GOVERNMENT SECTOR
MARIE STOPES K
RED CROSS SOCIETY L
AFGA M
OTHER NGO SECTOR________N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR O
STAND-ALONE VCT CENTER P
PHARMACY Q
MOBILE CLINIC R
FIELDWORKER S
OTHER PRIVATE MEDICAL SECTOR_______T
OTHER SOURCE
CHARITY/FOUNDATIONS U
REFUGEE CAMP V
SHOP W
OTHER___________X

946. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON’T KNOW 8

947. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

YES 1
NO 2
DON’T KNOW 8

SECTION 10. OTHER HEALTH ISSUES

1001. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD ‘90’. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS______
NONE 00 (GO TO 1004)

1002. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD ‘90’. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS_____
NONE 00 (GO TO 1004)

1003. The last time you got an injection from a health provider, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON’T KNOW 8

1004. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

1005. In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES____

1006. Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (GO TO 1007A)

1007. What (other) type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

CHELAM A
CHEWING TOBACCO B
SNUFF C
OTHER_______X

1007A. Do you currently use drugs?

YES 1
NO 2 (GO TO 1007C)

1007B. What type of drugs do you currently use?

RECORD ALL MENTIONED.

OPIUM A
HEROIN B
OTHER______X

1007C. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1007G)

1007D. How does tuberculosis spread from one person to another? PROBE: Any other ways?

[CIRCLE ALL MENTIONED]

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
BY SHARING UTENSILS B
BY TOUCHING A PERSON WITH TB C
THROUGH SHARING FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER____________X
DON’T KNOW Z

1007E. Can tuberculosis be cured?

YES 1
NO 2
DON’T KNOW 8

1007F. Have you ever been told by a doctor or nurse that you have/had tuberculosis?

YES 1
NO 2
DON’T KNOW 8

1007G. Have you ever heard of an illness called Hepatitis?

YES 1
NO 2 (GO TO 1008)
DON’T KNOW 8 (GO TO 1008)

1007H. Is there anything a person can do to avoid getting Hepatitis?

YES 1
NO 2 (GO TO 1007J)
DON’T KNOW 8 (GO TO 1007J)

1007I. What can a person do to avoid getting Hepatitis? PROBE: Any other ways?

[CIRCLE ALL MENTIONED]

SAFE SEX A
SAFE BLOOD TRANSFER B
DISPOSABLE SYRINGE C
AVOID CONTAMINATED FOOD/WATER D
AVOID CONTACT WITH INFECTED PERSON E
MAKING SURE THAT INSTRUMENTS OF DENTISTS ARE PROPERLY STERILIZED F
OTHERS_____________X
DON’T KNOW Z

1007J. Have you ever been told by a doctor or nurse that you have/had Hepatitis?

YES 1
NO 2 (GO TO 1008)
DON’T KNOW 8 (GO TO 1008)

1007K. What type of Hepatitis were you diagnosed with?

HEPATITIS A A
HEPATITIS B B
HEPATITIS C C
DON’T KNOW Z

1007L. Are you currently suffering from Hepatitis?

YES 1
NO 2 (GO TO 1008)
DON’T KNOW 8 (GO TO 1008)

1007M. What type of Hepatitis are you currently suffering from?

HEPATITIS A A
HEPATITIS B B
HEPATITIS C C
DON’T KNOW Z

1008. 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?

Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1101)

1010. What type of health insurance are you covered by?

RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER______________X

SECTION 11. FISTULA

1101. Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after sexual assault or after pelvic surgery.

Have you ever experienced a constant leakage of uring or stool from your vagina during the day and night?

YES 1 (GO TO 1103)
NO 2

1102. Have you ever heard of this problem?

YES 1 (GO TO 1201)
NO 2 (GO TO 1201)

1103. Did this problem start after you delivered a baby or had a stillbirth?

AFTER DELIVERED BABY 1
AFTER HAD STILLBIRTH 2
NEITHER 3 (GO TO 1105)

1104. Did this problem start after a normal labor and delivery, or after a very difficult labor and delivery?

NORMAL LABOR/DELIVERY 1 (GO TO 1106)
VERY DIFFICULT LABOR/DELIVERY 2 (GO TO 1106)

1105. What do you think caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER______6
DON’T KNOW 8 (GO TO 1107)

1106. How many days after [CAUSE OF PROBLEM FROM 1103 OR 1105] did the leakage start?

RECORD 90 IF 90 DAYS OR MORE.

NUMBER OF DAYS AFTER DELIVERY/OTHER EVENT_____

1107. Have you sought treatment for this condition?

YES 1 (GO TO 1109)
NO 2

1108. Why have you not sought treatment?

PROBE AND RECORD ALL MENTIONED.

DO NOT KNOW CAN BE FIXED A
DO NOT KNOW WHERE TO GO B
TOO EXPENSIVE C
TOO FAR D
POOR QUALITY OF CARE E
COULD NOT GET PERMISSION F
EMBARRASSMENT G
PROBLEM DISAPPEARED H
OTHER_______X

(GO TO 1201)

1109. From whom did you last seek treatment?

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2
OTHER PERSON
COMMUNITY HEALTH WORKER 3
OTHER__________6

1110. Did you have an operation to fix the problem?

YES 1
NO 2

1111. Did the treatment stop the leakage completely?

IF NO: Did the treatment reduce the leakage?

YES, STOPPED COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3
DID NOT RECEIVED TREATMENT 4

1111A. How was your family members’ support towards you when you were suffering from the problem?

EXCELLENT SUPPORT 1
GOOD SUPPORT 2
APPROPRIATE SUPPORT 3
POOR SUPPORT 4
NO SUPPORT AT ALL 5

SECTION 12. MATERNAL MORTALITY

1201. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER____

1202. CHECK 1201:

TWO OR MORE BIRTHS (GO TO 1203)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1300)

1203. How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS____

1204. What was the name given to your oldest (next oldest) brother or sister?

NAME____________

1205. Is (NAME) male or female?

MALE 1
FEMALE 2

1206. Is name still alive?

YES 1
NO 2 (GO TO 1208)

1207. How old is (NAME)?

AGE____ (GO TO (2))

1208. How many years ago did (NAME) die?

YEARS AGO____

1209. How old was (NAME) when he/she died?

AGE____

IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO (2).
1210. Was (NAME) pregnant when she died?

YES 1 (GO TO 1213)
NO 2

1211. Did (NAME) die during childbirth?

YES 1 (GO TO 1213)
NO 2

1212. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1213. How many live born children did (NAME) give birth to during her lifetime?

NUMBER OF LIVE BORN CHILDREN____

IF NO MORE BROTHERS OR SISTERS, GO TO NEXT SECTION.

SECTION 13. DOMESTIC VIOLENCE MODULE

1300. CHECK HOUSEHOLD QUESTIONNAIRE - Q. 141 AND COVER PAGE OF WOMAN QUESTIONNAIRE:

WOMAN SELECTED FOR THIS SECTION (GO TO 1301)
WOMAN NOT SELECTED (GO TO 1333)

1301. CHECK FOR PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1332)

READ TO THE RESPONDENT

Now I would like to ask you questions about some other important aspects of a woman’s life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Afghanistan. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

1302. CHECK 601:

CURRENTLY MARRIED (GO TO 1303)
FORMERLY MARRIED (READ IN THE PAST TENSE AND USE ‘LAST’ WITH ‘HUSBAND’) (GO TO 1303)

1303. 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?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON’T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON’T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON’T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON’T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON’T KNOW 8

1304. Now I need to ask some more questions about your relationship with your (last) husband.

1304A. Did your (last) husband ever:

a) say or do something to humiliate you in front of others?
YES 1 (FOLLOW UP WITH 1304B)
NO 2
b) threaten to hurt or harm you or someone you care about?
YES 1 (FOLLOW UP WITH 1304B)
NO 2
c) insult you or make you feel bad about yourself?
YES 1 (FOLLOW UP WITH 1304B)
NO 2

1304B. FOR ANY ‘YES’ IN 1304A (a,b,c): How often did this happen during the last 12 months: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1305A. Did your (last) husband ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
b) slap you?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
c) twist your arm or pull your hair?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
e) kick you, drag you, or beat you up?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
f) try to choke you or burn you on purpose?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
g) threaten to attack you with a knife, gun, or other weapon?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1 (FOLLOW UP WITH 1305B)
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (FOLLOW UP WITH 1305B)
NO 2

1305B. FOR ANY ‘YES’ IN 1305A (a-j): How often did this happen during the last 12 months: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1306. CHECK 1305 (a-j):

AT LEAST ONE ‘YES’ (GO TO 1307)
NOT A SINGLE ‘YES’ (GO TO 1309)

1307. How long after you first (got married/started living together) with your (last)(husband/partner) did (this/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD ‘00’.

NUMBER OF YEARS____
BEFORE MARRIAGE 95

1308. Did the following ever happen as a result of what your (last) husband did to you:

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

1309. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1311)

1310. In the last 12 months, how often have you done this to your (last) husband: often, sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1311. Does (did) your (last) husband drink alcohol?

YES 1
NO 2 (GO TO 1313)

1312. How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1313. Are (Were) you afraid of your (last) husband: most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1314. CHECK 609:

MARRIED MORE THAN ONCE (GO TO 1315A)
MARRIED ONLY ONCE (GO TO 1316)

1315A. So far we have been talking about the behavior of your (current/last) husband. Now I want to talk about the behavior of any previous husband.

a) Did any previous husband ever hit, slap, kick, or do anything esle to hurt you physically?
YES 1 (FOLLOW UP WITH 1315B)
NO 2
b) Did any previous husband physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (FOLLOW UP WITH 1315B)
NO 2

1315B. FOR ANY ‘YES’ IN 1315A (a,b): How long ago did this last happen?

0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON’T REMEMBER 3

1316. From the time you were 15 years old has anyone other than (your/any) husband hit you, slapped you, kicked you, or done anything else to hurt you?

YES 1
NO 2 (GO TO 1319)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1319)

1317. Who has hurt you in this way? Anyone else?

RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
MOTHER-IN-LAW F
FATHER-IN-LAW G
OTHER IN-LAW H
TEACHER I
EMPLOYER/SOMEONE AT WORK J
POLICE/SOLDIER K
OTHER__________X

1318. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1319. CHECK 201, 226, 230:

EVER BEEN PREGNANT (YES ON 201 OR 226 OR 230) (GO TO 1320)
NEVER BEEN PREGNANT (GO TO 1324A)

1320. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1324A)

1321. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?

RECORD ALL MENTIONED.

CURRENT HUSBAND A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER__________X

1324A. CHECK 1305 (h-j) and 1315A(b):

AT LEAST ONE ‘YES’ (GO TO 1325)
NOT A SINGLE ‘YES’ (GO TO 1326)

1325. How old were you the first time you were forced to have sexually intercourse or perform any other sexual acts by (your/any) husband?

AGE IN COMPLETED YEARS_____
DON’T KNOW 98

1326. CHECK 1305A (a-j), 1315A (a,b), 1316, AND 1320:

AT LEAST ONE ‘YES’ (GO TO 1327)
NOT A SINGLE ‘YES’ (GO TO 1330)

1327. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1329)

1328. From whom have you sought help? Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A
HUSBAND’S FAMILY B
CURRENT/FORMER HUSBAND C
FRIEND D
NEIGHBOR E
RELIGIOUS LEADER F
DOCTOR/MEDICAL PERSONNEL G
POLICE H
LAWYER I
SOCIAL SERVICE ORGANIZATION J
OTHER_________X

(GO TO 1330)

1329. Have you ever told any one about this?

YES 1
NO 2

1330. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON’T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1331. 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?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

1332. INTERVIEWER’S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

_____________________________________

1333. RECORD THE TIME.

HOURS____
MINUTES____

INTERVIEWERS OBSERVATIONS

TO BE FILLED IN AFTER THE INTERVIEW

______________________________________

COMMENTS ON SPECIFIC QUESTIONS:

______________________________________

ANY OTHER COMMENTS:

______________________________________

SUPERVISOR’S OBSERVATIONS

______________________________________

NAME OF SUPERVISOR:__________________
DATE:_____________

EDITOR’S OBSERVATIONS

______________________________________

NAME OF EDITOR:____________________
DATE:_____________

INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 MALE CONDOM
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER_____________________
Z DON’T KNOW