BANGLADESH

IDENTIFICATION

DIVISION:
DISTRICT:
UPAZILA OR THANA:
UNION:
VILLAGE OR MOHALLA OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:
DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE:

NAME OF HOUSEHOLD HEAD:
NAME AND LINE NUMBER OF HUSBAND:
NAME AND LINE NUMBER OF WIFE:

INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT *

NEXT VISIT
DATE TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
DAY
MONTH

YEAR 199_
NAME
RESULT

TOTAL NUMBER OF VISITS

NAME
DATE

FIELD EDITED BY:
OFFICE EDITED BY:
KEYED BY:

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

102. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

102A. Just before you moved here, did you live in a city, in a town, or in the countryside?

103. In what month and year were you born?
USE CODES BELOW FOR MONTHS.
IF HE DOES NOT KNOW, WRITE 'D K' IN BOXES.

BENGALI 1

ENGLISH 2

104. How old are you?
COMPARE AND CORRECT 103 AND/OR 104 IF INCONSISTENT.

105. Have you ever attended school?

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

107. What is the highest class you completed?

108. CHECK 106:

109. Can you read and write a letter in any language easily, with difficulty, or not at all?

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

111. Do you usually listen to the radio at least once a week?

112. Do you usually watch television at least once a week?

113. What is your religion?

114. What kind of work do you mainly do?

115. CHECK 114:

116. Do you work mainly on your own land, or do you rent land, or do you work on someone else's land?

SECTION 2. REPRODUCTION

201. Do you have any sons or daughters who are now living with you?

202. How many sons live with you? And how many daughters live with you?

IF NONE ENTER '00'.

203. Do you have any sons or daughters who do not live with you?

204. 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 ENTER '00'.

205. Have you ever had a son or daughter who was born alive but later died?

206. In all, how many boys have died? And how many girls have died?

IF NONE ENTER '00'.

207. SUM ANSWERS TO 202, 204, AND 206, AND ENTER TOTAL.

IF NONE ENTER '00'.

208. CHECK 207:

Just to make sure that I have this right: you have had TOTAL ___ children born alive during your life. Is that correct?

SECTION 3. CONTRACEPTION

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

CIRCLE CODE 1 IN 3-2 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

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

303. Have you ever used (METHOD)?

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

305. CHECK 303:

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

308. What have you used or done?

CORRECT 303-305 (AND 302 IF NECESSARY).

309. What was the first method you ever used?

311. How many living children did you have at the time, if any?
IF NONE, RECORD '00'.

311A. CHECK 303:

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

315. Which method are you using?
315A. CIRCLE '06' FOR MALE STERILIZATION.

316. At any time during the same month, do you regularly use any method other than (CURRENT METHOD)?

317. Which method is that?

318. CHECK 315:

320. Please show me the package of condoms that you are using.

320A. Why can't you show me the package of condoms that you are using?

320B. SHOW BRAND CHART FOR CONDOMS:
Please tell me which of these is the brand of condoms that you are using.

320C. How much did the condom you last used cost?

320D. Do you use a condom every time that you have sexual intercourse or only sometimes?

320E. How many times have you used condoms during the last one month?

321. In what month and year was the sterilization operation performed?
USE CODES BELOW FOR MONTHS.

BENGALI 1

ENGLISH 2

322A. Do you regret that (you or your wife) had the operation not to have any more children?

322B. Why do you regret it?

322C. Which method of family planning did you use most recently?

323. Where did you obtain (METHOD) the last time?
323A. Where did the sterilization take place?

NAME OF PLACE ___

323B. Did you pay for the service you received there?

323C. CHECK 322C OR 315:

325. Who obtained the (pills or condoms) the last time you got them?

325A. Have you yourself ever been to a health facility, a doctor, or a shop to get (pills or condoms?

325B. Did anyone there ever tell you about side effects or other problems that you might have using this method?

325C. Did anyone there ever tell you about other methods that you might use?

325H. Did you get the method that you wanted?

325I. Which method did you want?

325J. When a couple is making a decision, sometimes the husband has more influence, sometimes the wife has more influence and sometimes other people have more influence. In your family, who had the most influence in deciding to use family planning the first time you used a method?

325K. CHECK 314:

326. What is the main reason you decided to us (CURRENT METHOD FROM 315) rather than some other method of family planning?

328G. What is the main reason you are not using a method to delay or avoid pregnancy?

328H. Do you know where you can obtain a method of family planning?

328I. Where is that?

347. CHECK 310, 323, AND 328G:

347A. In some places, there is a clinic set up for a day or part of a day in someone's house or in a school. This is called a satellite clinic. During the past 3 months was there any such clinic in you village or mohalla?

347B. Did you ever visit such a clinic?

347C. What services did they provide?

CIRCLE ALL MENTIONED.

348. In the last month, have you heard or seen a message about family planning on:

349. Is it acceptable or not acceptable to you for information to be provided on the radio about:

350. During the last six months has anyone visited you in your house to talk to you about family planning or to give you any family planning method?

351. Has a family planning worker visited you in the last six months for another reason?

352. How many times did a family planning worker visit you in the last six months?

353. When was the last visit?

IF LESS THAN ONE MONTH AGO, WRITE '00'.

354. Did you receive any family planning supplies from the fieldworker during the last visit?

355. What supplies did you receive?

356. How many cycles or condoms?

357. Thinking back to all the visits you have ever had from family planning workers, which method of avoiding pregnancy did they discuss with you?

CIRCLE ALL MENTIONED.

358. Do you think that most of the men you know use some kind of family planning method?

359. Have you ever recommended family planning to a friend, relative, or anyone else?

360. In the past 12 months, have you visited a health facility for any reason?

361. Did anyone at the health facility speak to you about family planning methods?

SECTION 4. MARRIAGE
401. Have you been married only once or more than once?

402. In what month and year did you start living with your (first) wife?

BENGALI 1

ENGLISH 2

403. How old were you when you started living with her?

406. Now we need some details about you sexual activity in order to get a better understanding of family planning and fertility. When was the last time you had sexual intercourse?

408. PRESENCE OF OTHERS AT THIS POINT.

SECTION 5. FERTILITY PREFERENCES
501. CHECK 315:

502. 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?

503. How long would you like to wait from now before the birth of a (another) child?

504. CHECK 314: USING A METHOD?

505. Do you intend to use a method to delay or avoid pregnancy within the next 12 months?

506. Do you intend to use a method at any time in the future?

507. When you use a method, which method would you prefer to use?

508. Where can you get (METHOD MENTIONED IN 507)?

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

510. Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?

511. How often have you talked to you wife about family planning in the last year?

512. Have you and your wife ever discussed the number of children you would like to have?

513. Do you think your wife wants the same number of children that you want, or does she want more or fewer than you want?

514. Do you allow your wife to go out alone (or with your children) to buy household items or visit relatives?

515. In general, do you approve or disapprove of couples using a method to avoid pregnancy?

516. CHECK 216:

HAS LIVING CHILD(REN): 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 CHILD(REN): If you could choose exactly the number of children to have in your whole life, how many would that be?

RECORD SINGLE NUMBER OR OTHER ANSWER.

517. How many of these would you like to be boys and how many would you like to be girls?

518. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS
(TO BE FILLED IN AFTER COMPLETING THE INTERVIEW)
COMMENTS ABOUT RESPONDENT: ___
COMMENTS ON SPECIFIC QUESTIONS: ___
ANY OTHER COMMENTS: ___
SUPERVISOR'S OBSERVATIONS ___
NAME OF SUPERVISOR: ___
DATE: ___
EDITOR'S OBSERVATIONS ___