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DEMOGRAPHIC AND HEALTH SURVEY - BANGLADESH 1996-97 - WOMEN'S QUESTIONNAIRE (ENGLISH)

BANGLADESH

IDENTIFICATION

DIVISION:
DISTRICT:
THANA:
UNION:
VILLAGE OR MOHALLA OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:

DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE?

DHAKA OR CHITTAGONG 1
SMALL CITY 2
TOWN 3
VILLAGE 4

NAME OF HOUSEHOLD HEAD:
NAME AND LINE NUMBER OF WOMAN:

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
DAY
MONTH

01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER

YEAR 199_
CODE
RESULT

NAME
DATE

FIELD EDITED BY
OFFICE EDITED BY
KEYED BY
KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME.

HOUR ___
MINUTES ___

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

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?

CITY 1
TOWN 2
COUNTRYSIDE 3

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

BENGALI 1

MONTH __
YEAR 13__
01 BAISHAK
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA

ENGLISH 2

MONTH __
YEAR 19__
01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER

106. How old are you?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

106A. Are you now married, widowed, or divorced?

MARRIED 1
WIDOWED 2
DIVORCED OR DESERTED 3

107. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

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

PRIMARY 1
SECONDARY 2
COLLEGE OR UNIVERSITY 3

109. What is the highest class you completed?

CLASS ___

113. CHECK 108:

PRIMARY (GO TO 114)
SECONDARY OR COLLEGE (GO TO 115)

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

EASILY 1
WIT DIFFICULTY 2
NOT AT ALL (GO TO 116)

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

118. What is your religion?

ISLAM 1
HINDUISM 2 (GO TO 119A)
BUDDHISM 3
CHRISTIANLY 4
OTHER (SPECIFY) 6 (GO TO 119A)

119. How many times a day do you usually pray?

IF NONE, WRITE '0'.

TIMES ___

119A. Do you belong to any of the following organizations?

Grameen Bank?
YES 1
NO 2
BRAC?
YES 1
NO 2
BRDP?
YES 1
NO 2
Mother's club?
YES 1
NO 2
Any other organization?
YES 1
NO 2

120. CHECK QUESTION 7 IN THE HOUSEHOLD QUESTIONNAIRE:

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (GO TO 121)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

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

DHAKA OR CHITTAGONG 1
SMALL CITY 2
TOWN 3
VILLAGE 4

122. In which division is that located?

RAJSHANI 1
DHAKA 2
CHITTAGONG 3
KHULA 4
BARISHAL 5
SYLHET 6

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

PIPED WATER
PIPED INSIDE DWELLING 11
PIPED OUTSIDE DWELLING 12
WELL WATER
TUBE WELL 21
SURFACE WELL OR OTHER WELL 22
SURFACE WATER
POND OR TANK OR LAKE 31
RIVER OR STREAM 32
RAINWATER 41
OTHER (SPECIFY) 96

124. What is the source of drinking water for members of your household?

PIPED WATER
PIPED INSIDE DWELLING 11
PIPED OUTSIDE DWELLING 12
WELL WATER
TUBE WELL 21
SURFACE WELL OR OTHER WELL 22
SURFACE WATER
POND OR TANK OR LAKE 31
RIVER OR STREAM 32
RAINWATER 41
OTHER (SPECIFY) 96

125. What kind of toilet facility does your household have?

SEPTIC TANK OR MODERN TOILET 11
PIT TOILET OR LATRINE
WATER SEALED OR SLAB LATRINE 21
PIT LATRINE 22
OPEN LATRINE 23
HANGING LATRINE 24
NO FACILITY OR BUSH OR FIELD 31
OTHER (SPECIFY) 96

126. Where do adult women in your household usually defecate?

SEPTIC TANK OR MODERN TOILET 11
PIT TOILET OR LATRINE
WATER SEALED OR SLAB LATRINE 21
PIT LATRINE 22
OPEN LATRINE 23
HANGING LATRINE 24
NO FACILITY OR BUSH OR FIELD 31
OTHER (SPECIFY) 96

127. Where do children in your household usually defecate?

SEPTIC TANK OR MODERN TOILET 11
PIT TOILET OR LATRINE
WATER SEALED OR SLAB LATRINE 21
PIT LATRINE 22
OPEN LATRINE 23
HANGING LATRINE 24
NO FACILITY OR BUSH OR FIELD 31
OTHER (SPECIFY) 96
NO CHILDREN 97

128. Does your household have electricity?

YES 1
NO 2

129. Does your household have:

Alimirah (wardrobe)?
YES 1
NO 2
A table, chair or bench?
YES 1
NO 2
A watch or clock?
YES 1
NO 2
A cot or bed?
YES 1
NO 2
A radio that is working?
YES 1
NO 2
A television that is working?
YES 1
NO 2
A bicycle?
YES 1
NO 2

130. Does any member of your household own agricultural land?

YES 1
NO 2

131. What is the material of the roof of your house?

NATURAL ROOF
KATCHA (BAMBOO OR THATCH) 11
RUDIMENTARY ROOF
TIN 21
FINISHED ROOF
CEMENT OR CONCRETE 31
OTHER (SPECIFY) 96

132. What is the material of the walls of your house?

NATURAL WALLS
JUTE OR BAMBOO OR MUD (KATCHA) 11
RUDIMENTARY WALLS
WOOD 21
FINISHED WALLS
BRICK OR CEMENT 31
TIN 32
OTHER (SPECIFY) 96

133. What is the material of the floor of your house?

NATURAL FLOOR
EARTH OR BAMBOO (KATCHA) 11
RUDIMENTARY FLOOR
WOOD 2
FINISHED FLOOR (PULLA)
CEMENT OR CONCRETE 31
OTHER (SPECIFY) 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 daughter 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? And how many daughters live with you?
IF NONE RECORD '00'.

SONS AT HOME ___
DAUGHTERS AT HOME ___

204. Do you have any sons or daughter 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? And how many daughters are alive but do not live with you?

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

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 any sign of life but only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

208. SUM ANSWERS TO 203, 205, AND 307, AND ENTER TOTAL.
IF NONE RECORD '00'.

TOTAL ___

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 227)

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

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

NAME ___

213. Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

215. In what month and year was (NAME) born?
WRITE IN EITHER BENGAL OR ENGLISH DATES, BUT NOT BOTH.
USE CODES AT THE BOTTOM OF THE PAGE FOR MONTHS.

BENGALI 1

MONTH __
YEAR 1___
01 BAISHAK
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA

ENGLISH 2

MONTH __
YEAR 19__
01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

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

AGE IN YEARS ___

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

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

219. IF DEAD: How old was (NAME) when he or she died?
IF 'ONE YEAR', ASK: How many months old was (NAME)?
RECORD DAYS IF UNDER 1 MONTH; MONTHS IF LESS THAN 2 YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

220. FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH. IS THE DIFFERENCE 4 OR MORE?
(REPEAT QUESTION FOR ALL CHILDREN BORN EXCLUDING THE MOST RECENT BIRTH)

YES 1
NO 2 (NEXT BIRTH)

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
(REPEAT QUESTION FOR ALL CHILDREN BORN EXCLUDING THE MOST RECENT BIRTH)

YES 1
NO 2

222. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH.
IS THE DIFFERENCE 4 YEARS OR MORE?

YES 1 (GO TO 223)
NO 2 (GO TO 224)

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

YES 1
NO 2

224. COMPARE 208 WITH THE NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE SAME

CHECK:

FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED
FOR EACH LIVING CHILD: CURRENT AGE IN RECORDED
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED
FOR AGE AT DEATH 12 MONTH OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE BAISHAK 1395 OR APRIL 1991.
IF NONE RECORD '0'.

226. FOR EACH BIRTH SINCE BAISHAK 1398 (APRIL 1991) ENTER 'B' IN THE MONTHS OF BIRTH IN COLUMN 1 OF THE CALENDAR AND 'P' IN EACH OF THE 8 PRECEDING MONTHS. WRITE NAME TO THE LEFT OF THE 'B' CODE.

227. Are you pregnant now?

YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

228. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER "P" IN COLUMN 1 OF CALENDAR IN MONTH OF INTERVIEW AND IN EACH PRESIDING MONTH PREGNANT.

MONTHS ___

229. 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 become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 236)

231. When did the last such pregnancy end?
USE CODES BELOW FOR MONTHS

BENGALI 1

MONTH __
YEAR 1___
01 BAISHAK
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA

ENGLISH 2

MONTH __
YEAR 19__
01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER

232. CHECK 231:

LAST PREGNANCY ENDED SINCE BAISHAK 1398 OR APRIL 1991 (GO TO 232A)
LAST PREGNANCY ENDED BEFORE BAISHAK 1398 OR APRIL 1991 (GO TO 236)

232A. Was that a stillbirth, a miscarriage, a menstrual regulation, or an abortion?

STILLBIRTH 1
MISCARRIAGE 2
MENSTRUAL REGULATION 3
ABORTION 4

233. How many months pregnant were you when the pregnancy ended?
ENTER THE APPROPRIATE CODE IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT.

MONTHS ___

234. Did you ever have any other such pregnancies?

YES 1
NO 2 (GO TO 236)

235. ASK FOR DATES AND DURATION OF ANY OTHER PREGNANCIES BACK TO BAISHAK 1398 (APRIL 1991). ENTER THE APPROPRIATE CODE IN COLUMN 1 OF THE CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT.

236. When did your last menstrual period start?

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

SECTION 3. CONTRACEPTION
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 302, 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 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?
302. Have you ever heard of (METHOD)?

01. PILL, MAYA: Woman can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
02. IUD: Women can have a loop or coil placed inside them by a doctor.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
03. INJECTIONS: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
04. IMPLANT, NORPLANT: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
05. CONDOM, RAJA: Men can put a rubber sheath on their penis during sexual intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
06. FEMALE STERILIZATION, TUBAL LIGATION, TL: Women can have an operation to avoid having children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
07. MALE STERILIZATION, VASECTOMY: Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
08. MENSTRUAL REGULATION, MR: When a woman's menstrual period does not come on time, she can go to a health centre or to the FWV and have a tube put in her for a short while to bring her period.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
09. SAFE PERIOD, COUNTING DAYS, CALENDAR, RHYTHM METHOD: Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to get pregnant.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
10. WITHDRAWAL: Men can be careful and pull out before climax.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
11. Have you hear of any other ways or method that women or men can use to avoid pregnancy?
SPONTANEOUS YES (SPECIFY) 1
NO 3

303. Have you ever used (METHOD)?

01. PILL, MAYA: Woman can take a pill every day.
YES 1
NO 2
02. IUD: Women can have a loop or coil placed inside them by a doctor.
YES 1
NO 2
03. INJECTIONS: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04. IMPLANT, NORPLANT: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05. CONDOM, RAJA: Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
06. FEMALE STERILIZATION, TUBAL LIGATION, TL: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07. MALE STERILIZATION, VASECTOMY: Has your husband ever had an operation to avoid having more children?
YES 1
NO 2
08. MENSTRUAL REGULATION, MR: When a woman's menstrual period does not come on time, she can go to a health centre or to the FWV and have a tube put in her for a short while to bring her period.
YES 1
NO 2
09. SAFE PERIOD, COUNTING DAYS, CALENDAR, RHYTHM METHOD: Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to get pregnant.
YES 1
NO 2
10. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
11. Have you hear of any other ways or method that women or men can use to avoid pregnancy?
YES (SPECIFY) 1
NO 2

304. CHECK 303:

NOT A SINGLE "YES" (NEVER USED) (GO TO 305)
AT LEAST ONE "YES" (EVER USED) (GO TO 308)

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

YES 1 (GO TO 307)
NO 2

306. ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 330F)

307. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).

308. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. What was the first method that you ever used?

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
CONDOMS 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
MENSTRUAL REGULATION 08
SAFE PERIOD, COUNTING DAYS 09
WITHDRAWAL 10
OTHER (SPECIFY) 96

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

NUMBER OF CHILDREN ___

310. CHECK 303:

WOMAN NOT STERILIZED (GO TO 311)
WOMAN STERILIZED (GO TO 314A)

311. CHECK 106A:

CURRENTLY MARRIED (GO TO 312)
WIDOWED OR DIVORCED (GO TO 325)

312. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 313)
PREGNANT (GO TO 325)

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

YES 1
NO 2 (GO TO 325)

314. Which method are you using?
314A. CIRCLE '06' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 317A)
INJECTIONS 03 (GO TO 317B)
IMPLANTS 04 (GO TO 317A)
CONDOMS 05 (GO TO 317C)
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07 (GO TO 318)
MENSTRUAL REGULATION 08 (GO TO 325)
SAFE PERIOD, COUNTING DAYS 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 324)
OTHER (SPECIFY) 96 (GO TO 324)

315. May I see the package of pills you are using now?
RECORD NAME OF BRAND IF PACKAGE IN SEEN.

PACKAGE SEEN 1 (GO TO 317)
BRAND NAME ___
PACKAGE NOT SEEN 2

316. SHOW BRAND CHART FOR PILLS: Please tell me which of these is the brand of pills that you are now using?

BRAND NAME ___
DOES NOT KNOW 98

316A. Why don't you have a package of pills available?

CIRCLE ALL MENTIONED.

RAND OUT A
COST TOO MUCH B
HUSBAND AWAY C
HAS MENSTRUAL PERIOD D
NOT AVAILABLE AT HER SOURCE E
FWA HAS NOT BROUGHT RESUPPLY F
OTHER (SPECIFY) X

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

COST ___ (GO TO 324)
FREE 996 (GO TO 324)
DOES NOT KNOW 998 (GO TO 324)

317A. How much did it cost you to have the device put in?

FOR IUD USERS AND IMPLANT USERS.

COST ___ (GO TO 324)
FREE 996 (GO TO 324)
DOES NOT KNOW 998 (GO TO 324)

317B. How much does it cost you to get one injection?

COST ___ (GO TO 324)
FREE 996 (GO TO 324)
DOES NOT KNOW 998 (GO TO 324)

317C. May I see the package of condoms that you are using?
RECORD NAME OF BRAND.

PACKAGE SEEN 1 (GO TO 324)
BRAND NAME ___
PACKAGE NOT SEEN 2

317D. Why can't you show me the package of condoms that you are using?

HUSBAND KEEPS 1
RAN OUT 2
OTHER (SPECIFY) 3

317E. SHOW BRAND CHART FOR CONDOMS: Please tell me which of these is the brand of condoms that you are using/

BRAND NAME ___ (GO TO 324)
DOES NOT KNOW 98 (GO TO 324)

318. Where did the sterilization take place?

NAME OF PLACE ___
PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
MEDICAL PRIVATE SECTOR
PRIVATE CLINIC OR DOCTOR 21
TRADITIONAL DOCTOR 22
NGO CLINIC 42
OTHER (SPECIFY) 96
DOES NOT KNOW 98

319. Do you regret the (you or your husband) had the operation not to have any more children?

YES 1
NO 2 (GO TO 321)

320. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1
PARTNER WANTS ANOTHER CHILD 2
SIDE EFFECTS 3
CHILD DIED 4
OTHER REASON (SPECIFY) 6

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

BENGALI 1

MONTH __
YEAR 1___
01 BAISHAK
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA

ENGLISH 2

MONTH __
YEAR 19__
01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER

321A. How much did the operation cost you?

COST ___
FREE 996
DOES NOT KNOW 998

322. CHECK 321:
STERILIZED BEFORE BAISHAK 1398: ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO BAISHAK 1398 (APRIL 1991) (GO TO 329A)

STERILIZED AFTER BAISHAK 1398: ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION (GO TO 325)

323. You told me that you use the safe period (calendar, rhythm) method. Please tell me which days of your monthly cycle are not safe.

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD ENDS 2
IN THE MIDDLE OF HER CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) 6
DOES NOT KNOW 8

324. ENTER METHOD CODE FROM 314 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE.
ILLUSTRATIVE QUESTION:

When did you start using continuously?
How long have you been using this method continuously?

325. I would like to ask you some questions about the times you or your husband 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 THE MOST RECENT USE, BACK TO BAISHAK 1398 (APRIL 1991). USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER CODE I EACH MONTH OF METHOD USE OR '0' FOR NONUSE.

ILLUSTRATIVE QUESITONS:

COLUMN 1:

When was the last time you use a mthod? 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 LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 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 QUESTION:

COLUMN 2:

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 '0'0 IN EACH SUCH MONTHS IN COLUMN 1.

327. CHECK 314:
CIRCLE METHOD CODE.

NOT ASKED 00 (GO TO 330F)
PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
CONDOM 05
FEMALE STERILIZATION 06 (GO TO 329A)
MALE STERILIZATION 07 (GO TO 329A)
MENSTRUAL REGULATION 08 (GO TO 330F)
SAFE PERIOD OR RHYTHM 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER (SPECIFY) 96 (GO TO 332)

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

IF SOURCE IS A HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ___
PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE OR EPI CLINIC 14
MEDICAL PRIVATE SECTOR
PRIVATE CLINIC OR DOCTOR 21
TRADITIONAL DOCTOR 22
PHARMACY 23
OTHER PRIVATE SECTOR
SHOP 31
FRIENDS OR RELATIVES 32
FIELD WORKER, FWA 41 (GO TO 328E)
NGO CLINIC 42
OTHER (SPECIFY) 96
DOES NOT KNOW 98

328A. CHECK 315:

USING PILLS OR CONDOMS (GO TO 328B)
USING ANOTHER METHOD (GO TO 328C)

328B. Who obtained the (pills or condoms) the last time you got them?

RESPONDENT 1
HUSBAND 2 (GO TO 329)
SON OR DAUGHTER 3 (GO TO 329)
OTHER RELATIVE 4 (GO TO 329)
OTHER (SPECIFY) 6 (GO TO 329)

328C. At the place where you got your method the last time, did anyone there ever tell you about side effects or other problems you might have using this method?

YES 1
NO 2
CANNOT REMEMBER 8

328D. Did anyone there ever tell you about other methods that you might use?

YES 1 (GO TO 329)
NO 2 (GO TO 329)
CANNOT REMEMBER 8 (GO TO 329)

328E. Did the family planning fieldworker ever tell you about side effects or problems you might have with this (CURRENT METHOD)?

YES 1
NO 2
CANNOT REMEMBER 8

328F. Did the family planning fieldworker ever tell you about other methods that you might use?

YES 1
NO 2
CANNOT REMEMBER 8

329. Do you know another place where you could have obtained (CURRENT METHOD) the last time?
329A. At the time of the sterilization operation, did you know another place where you could have received the operation?

YES 1
NO 2 (GO TO 330A)

330. People select the place where they get family planning services for various reasons. What was the main reason you went to (NAME OF PLACE IN QUESTION 328 OR QUESTION 318) instead of the other place you know about?
RECORD RESPONSE AND CIRCLE CODE.

ACCESS-RELATED REASONS
CLOSER TO HOME 11
CLOSER TO MARKET OR WORK 12
AVAILABILITY OF TRANSPORT 13
SERVICE-RELATED REASONS
STAFF MORE COMPETENT OR FRIENDLY 21
CLEANER FACILITY 22
OFFERS MORE PRIVACY 23
SHORTER WAITING TIME 24
LONGER HOURS OF OPERATION 25
USE OTHER SERVICES AT THE FACILITY 26
LOWER COST OR CHEAPER 31
WANTED ANONYMITY 41
WORKER SUPPLIED AT HOME 51
METHOD NOT AVAILABLE ELSEWHERE 61
OTHER (SPECIFY) 96
DOES NOT KNOW 98

330A. What is the reason you decided to use (CURRENT METHOD) rather than some other method of family planning? Any other reason?
CIRCLE ALL MENTIONED.

FAMILY PLANNING WORKER RECOMMENDED A
FRIEND OR RELATIVE RECOMMENDED B
SIDE EFFECTS OF OTHER METHODS C
METHOD EASY TO USE D
ACCESS OR AVAILABILITY E
COST F
WANTED PERMANENT METHOD G
HUSBAND PREFERRED H
WANTED MORE EFFECTIVE METHOD I
FIELDWORKER CAME TO HOUSE J
OTHER (SPECIFY) X
DOES NOT KNOW Z

330B. Are you having any problems in using (CURRENT METHOD)?

YES 1
NO 2 (GO TO 334)

330C. What problems are you having with using (METHOD)?
PROBE: Any other problems?
CIRCLE ALL MENTIONED.

WEIGHT GAIN A
WIGHT LOSS B
TOO MUCH BLEEDING C
HYPERTENSION D
HEADACHE E
NAUSEA F
NO MENSTRUATION G
WEAK OR TIRED H
DIZZINESS I
HUSBAND DISAPPROVES J
OTHER RELATIVE DISAPPROVES K
RELIGION DISAPPROVES L
ACCESS OR AVAILABILITY M
COSTS TOO MUCH N
INCONVENIENT TO USE O
STERILIZED, WANTS CHILDREN P
ABDOMINAL PAIN Q
OTHER (SPECIFY) X
DOES NOT KNOW Z

330D. When you first started having these problems, did you talk to anyone about these problems?

YES 1
NO 2 (GO TO 334)

330E. Who did you talk to about these problems?

FIELDWORKER, FWA 1 (GO TO 334)
STAFF AT SATELLITE CLINIC 2 (GO TO 334)
STAFF AT FAMILY WELFARE CLINIC 3 (GO TO 334)
RELATIVE OR FRIEND 4 (GO TO 334)
OTHER (SPECIFY) 6 (GO TO 334)

330F. CHECK 106A:

CURRENTLY MARRIED (GO TO 331)
WIDOWED OR DIVORCED (GO TO 334)

331. What is the main reason you are not using a method of contraception to avoid pregnancy?

FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL OR HYSTERECTOMY 23
SUB FECUND OR INFECUND 24
POSTPARTUM OR BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS OR TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) 96
DOES NOT KNOW 98

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

YES 1
NO 2 (GO TO 334)

333. Where is that?
IF WOMAN SAYS MORE THAN ONE PLACE, ASK FOR THE PLACE SHE WOULD MOST LIKELY USE.

NAME OF PLACE ___

PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE OR EPI CLINIC 14
MEDICAL PRIVATE SECTOR
PRIVATE CLINIC OR DOCTOR 21
TRADITIONAL DOCTOR 22
PHARMACY 23
OTHER PRIVATE SECTOR
SHOP 31
FRIENDS OR RELATIVES 32
FIELDWORKER, FWA 41
NGO CLINIC 42
OTHER (SPECIFY) 96
DOES NOT KNOW 98

334. CHECK 328 AND 333:

SATELLITE CLINIC OR EPI SITE NOT MENTIONED (GO TO 335)
SATELLITE OR EPI CLINIC MENTIONED (GO TO 336)

335. 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. During the past 3 months, was there any such clinic in this village or mohalla?

YES 1
NO 2 (GO TO 339)
DOES NOT KNOW 8 (GO TO 339)

336. Did you ever visit such a temporary health clinic?

YES 1
NO 2 (GO TO 339)

337. What services did they provide?
CIRCLE ALL MENTIONED.

FAMILY PLANNING METHODS A
IMMUNIZATION B
CHILD GROWTH MONITORING C
T. T. FOR PREGNANT WOMEN D
ANTENATAL CARE E
OTHER (SPECIFY) X
DOES NOT KNOW Z

339. 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?

YES 1
NO 2 (GO TO 342)
DOES NOT KNOW 8 (GO TO 342)

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

TIMES ___
DOES NOT KNOW 98

341. When was the last visit?
IF LESS THAN ONE MONTH AGO, WRITE '00'.

MONTHS AGO ___ (GO TO 344)
DOES NOT KNOW 8 (GO TO 344)

342. During the last six months have you had any contact with a fieldworker about family planning?

YES 1
NO 2 (GO TO 344)
DOES NOT KNOW (GO TO 344)

343. When was the last time you had contact with the fieldworker about family planning?
IF LESS THAN ONE MONTH AGO, WRITE '00'.

MONTHS AGO ___
DOES NOT KNOW 8

344. CHECK 339 AND 342:

"YES" IN EITHER HAS BEEN VISITED OR CONTACT WITH FIELDWORKER (GO TO 345)
"NO" IN BOTH NO VISITS OR CONTACT WITH FIELDWORKER (GO TO 351)

345. Did you receive any family planning supplies from the fieldworker during the last visit or contact?

YES 1
NO 2 (GO TO 348)

346. What supplies did you receive?

PILLS 1
CONDOMS 2
INJECTION 3 (GO TO 348)
OTHER (SPECIFY) 6 (GO TO 348)

347. How many cycles or condoms?

CYCLES OR CONDOMS ___

348. Thinking back to all the contacts you have ever had from family planning workers, which methods of avoiding pregnancy did they discuss with you?
CIRCLE ALL MENTIONED.

PILLS A
IUD B
INJECTION C
IMPLANT OR NORPLANT D
CONDOMS E
FEMALE STERILIZATION F
MALE STERILIZATION G
NEVER DISCUSSED Y

349. Did the family planning fieldworker ever refer you to a clinic for any reason?

YES 1
NO 2 (GO TO 351)
DOES NOT KNOW 8 (GO TO 351)

350. Why did she refer you to a clinic?

FOR STERILIZATION 11
TO GET AN IUD INSERTED 12
TO GET INJECTION 13
TO GET OTHER FAMILY PLANNING METHODS 14
FOR TREATMENT OF SIDE EFFECTS 15
FOR OTHER HEALTH REASONS 16
FOR ANTENATAL CARE 17
OTHER (SPECIFY) 96

351. Have you ever recommended family panning to a friend, relative, or anyone else?

YES 1
NO 2

352. Do you think that women should have a medical checkup when they are pregnant, even if they are not sick?

YES 1
NO 2
DOES NOT KNOW 8

SECTION 4A. PREGNANCY AND BREASTFEEDING
401. CHECK 215:

ONE OR MORE BIRTHS SINCE BAISHAK 1398 (APRIL 1991) (GO TO 402)
NO BIRTHS SINCE BAISHAK 1398 (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE BAISHAK 1398 (APRIL 1991) IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all you children born in the past 5 years. (We will talk about one child at a time).
403. LINE NUMBER FROM QUESTION 212

LINE NUMBER ___

404. FROM QUESTION 212 AND 216

NAME ___
ALIVE ___
DEAD ___

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 want no (more) children at all?

THEN 1
LATER 2
NO MORE 3

407. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES, Whom did you see? Anyone else?
RECORD ALL MENTIONED

HEALTH PROFESSIONAL
DOCTOR A
NURSE OR MIDWIFE B
FAMILY WELFARE VISITOR C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT (DAI) D
UNTRAINED TRADITIONAL BIRTH ATTENDANT (DAI) E
OTHER (SPECIFY) X
NO ONE Y (GO TO 410)

408. How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

MONTHS ___
DOES NOT KNOW 98

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

NUMBER OF TIMES ___
DOES NOT KNOW 98

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

YES 1
NO 2 (GO TO 411A)
DOES NOT KNOW (GO TO 411A)

411. During this pregnancy how many times did you get this injection?

TIMES ___
DOES NOT KNOW 98

411A. When you were pregnant with (NAME), did anyone take your blood pressure (put a cuff on your arm and pump air into it?

YES 1
NO 2
DOES NOT KNOW 8

411B. When you were pregnant with (NAME), did anyone take your urine for testing?

YES 1
NO 2
DOES NOT KNOW 8

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

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
THANA HEALTH COMPLEX 22
PRIVATE SECTOR
PRIVATE HOSPITAL OR CLINIC 31
OTHER (SPECIFY) 96

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

HEALTH PROFESSIONAL
DOCTOR A
NURSE OR MIDWIFE B
FAMILY WELFARE VISITOR C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
RELATIVE F
OTHER (SPECIFY) X
NO ONE Y

414. Around the time of the birth of (NAME), did you have any of the following problems:

Long labor, that is did your regular contractions last more than 12 hours?
YES 1
NO 2
Excessive bleeding that was so much that you feared it was life threatening?
YES 1
NO 2
A high fever with bad smelling vaginal discharge?
YES 1
NO 2
Convulsions not caused by fever?
YES 1
NO 2

419. Has your period returned since the birth of (NAME)?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)

YES 1 (GO TO 421)
NO 2 (GO TO 421)

420. Did your period return between the birth of (NAME) and your next pregnancy?
(REPEAT QUESTIONS FOR ALL CHILDREN BORN IN THE LAST FOUR YEARS, EXCLUDING THE MOST RECENT BIRTH)

YES 1
NO 2 (GO TO 424)

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

MONTHS ___
DOES NOT KNOW 98

422. CHECK 227:
RESPONDENT PREGNANT?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)

NOT PREGNANT (GO TO 423)
PREGNANT OR UNSURE (GO TO 424)

423. Have you resumed sexual relations since the birth of (NAME)?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)

YES 1
NO 2 (GO TO 425)

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

MONTHS ___
DOES NOT KNOW 98

425. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 431)

426. How long after birth did you first put (NAME) to the breast?

(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
IF LESS THAN 1 HOUR RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

426A. Was (NAME) given colostrum (first milk from the breast) to drink?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)

YES 1
NO 2

426B. Was (NAME) given water or any other liquid to drink soon after birth?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)

YES 1
NO 2

427. CHECK 216:

CHILD ALIVE?

ALIVE (GO TO 428)
DEAD (GO TO 429)

428. Are you still breastfeeding (NAME)?

YES 1 (GO TO 432)
NO 2

429. For how many months did you breastfeed (NAME)?

MONTHS ___
DOES NOT KNOW 98

430. Why did you stop breastfeeding (NAME)?

MOTHER ILL OR WEAK 01
CHILD ILL OR WEAK 02
CHILD DIED 03
NIPPLE OR BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) 96

431. CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 435)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440)

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

NUMBER OF NIGHTTIME FEEDINGS ___

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

NUMBER OF DAYLIGHT FEEDING ___

435. At any time yesterday or last night was (NAME) given any of the following:

Plain water?
YES 1
NO 2
Sugar water or honey?
YES 1
NO 2
Juice?
YES 1
NO 2
Tea?
YES 1
NO 2
Baby formula?
YES 1
NO 2
Cow's milk?
YES 1
NO 2
Other liquids?
YES 1
NO 2
Meat?
YES 1
NO 2
Other solid or mushy food?
YES 1
NO 2

439. GO BACK TO 405 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH
440. ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE BAISHAK 1398 (APRIL 1991) IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

441. LINE NUMBER FROM QUESTION 212

LINE NUMBER ___

442. FROM QUESTION 212 AND 216

NAME ___
ALIVE (GO TO 443)
DEAD (GO TO 442 IN NEXT COLUMN; IF NOW MORE BIRTHS GO TO 501)

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

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3

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

YES 1 (GO TO 447)
NO 2 (GO TO 447)

445. COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE WAS RECORDED.

BCG
DAY
MONTH
YEAR
DPT 1
DAY
MONTH
YEAR
DPT 2
DAY
MONTH
YEAR
DPT 3
DAY
MONTH
YEAR
POLIO 1
DAY
MONTH
YEAR
POLIO 2
DAY
MONTH
YEAR
POLIO 3
DAY
MONTH
YEAR
MEASLES
DAY
MONTH
YEAR
VITAMIN A
DAY
MONTH
YEAR

446. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT 103, POLIO 0-3 AND/OR MEASLES VACCINE (S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445)
NO 2 (GO TO 449)
DOES NOT KNOW 8 (GO TO 449)

447. Did (NAME) ever receive any vaccinations to prevent him or her from getting diseases?

YES 1
NO 2 (GO TO 449)
DOES NOT KNOW 8 (GO TO 449)

448. Has (NAME) received any of the following vaccinations:

448A. A BCG vaccination against tuberculosis, that is, an injection in the left shoulder that caused a scar?

YES 1
NO 2
DOES NOT KNOW 8

448B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2
DOES NOT KNOW 8

448C. IF YES: How many times?

NUMBER OF TIMES ___

448D. When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

448E. DPT vaccination, that is, an injection usually given at the same time as the polio drops?

YES 1
NO 2
DOES NOT KNOW 8

448F. IF YES: How many times?

NUMBER OF TIMES ___

448G. An injection to prevent measles?

YES 1
NO 2
DOES NOT KNOW 8

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

YES 1
NO 2
DOES NOT KNOW 8

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

YES 1
NO 2 (GO TO 454)
DOES NOT KNOW (GO TO 454)

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

YES 1
NO 2
DOES NOT KNOW 8

452. Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 454)

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

RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
FAMILY WELFARE CENTRE B
THANA HEALTH COMPLEX C
SATELLITE CLINIC D
EPI CLINIC E
SATELLITE OR EPI CLINIC F
FWA OR FIELDWORKER G
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL OR CLINIC H
PHARMACY I
PRIVATE DOCTOR J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL DOCTOR L
NGO CLINIC M
HOMEOPATHIC DOCTOR N
OTHER (SPECIFY) X

454. Has (NAME) had diarrhea in the last two weeks?

YES 1
NO 2 (GO TO 464)
DOES NOT KNOW 8 (GO TO 464)

455. Was there any blood in the stools?

YES 1
NO 2
DOES NOT KNOW 8

457. Was he or she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DOES NOT KNOW 8

459. When (NAME) had diarrhea, was he or she given any of the following to drink:

A fluid made from a special saline packet?
YES 1
NO 2
DOES NOT KNOW 8
Home-made sugar-salt-water solution (laban gur)?
YES 1
NO 2
DOES NOT KNOW 8
Water?
YES 1
NO 2
DOES NOT KNOW 8
Any other liquids?
YES 1
NO 2
DOES NOT KNOW 8

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

YES 1
NO 2 (GO TO 462)
DOES NOT KNOW 8 (GO TO 462)

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

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS C
HOME REMEDIES OR HERBS D
OTHER (SPECIFY) X

462. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 464)

463. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
FAMILY WELFARE CENTRE B
THANA HEALTH COMPLEX C
SATELLITE CLINIC D
EPI CLINIC E
SATELLITE OR EPI CLINIC F
FWA OR FIELDWORKER G
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL OR CLINIC H
PHARMACY I
PRIVATE DOCTOR J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL DOCTOR L
NGO CLINIC M
HOMEOPATHIC DOCTOR N
OTHER (SPECIFY) X

464. In the past 6 months, has (NAME) taken a Vitamin A capusle?
SHOW CAPSULE.

YES 1
NO 2
NOT SURE OR DOES NOT KNOW 8

465. GO BACK TO 442 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. MARRIAGE
501. Have you been married only once or more than once?

ONCE 1
MORE THAN ONCE 2

502. In what month and year did you get married (for the first time)?

BENGALI 1

MONTH __
YEAR 1___ (GO TO 504)
01 BAISHAK
02 JAISTHA
03 ASHAR
04 SRABAN
05 BADHRA
06 ASHWIN
07 KARTIK
08 AGRAHAYAN
09 POUSH
10 MAGH
11 FALGUN
12 CHOITRA

ENGLISH 2

MONTH __
YEAR 19__ (GO TO 504)
01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER

503. How old were you when you got married?

AGE ___
DOES NOT KNOW AGE 98

504. DETERMINE MONTHS MARRIED SINCE BAISHAK 1398. ENTER "X" IN COLUMN 3 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE BAISHAK 1398.

FOR WOMEN WITH MORE THAN ONE MARRIAGE: PROBE FOR DATE WHEN CURRENT MARRIAGE STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS MARRIAGE.

FOR WOMEN NOT CURRENTLY MARRIED: PROBE FOR DATE WHEN LAST MARRIAGE STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS MARRIAGE.

505. How long after you were married did you start living with your husband?
IF IMMEDIATELY AFTER MARRIAGE, WRITE '00 DAYS'.

DAYS 1 ___
MONTHS 2 ___

506. CHECK 106A:

CURRENTLY MARRIED (GO TO 508)
WIDOWED OR DIVORCED (GO TO 509)

508. Is your husband living with you now of is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

508A. INTERVIEWER:
WRITE LINE NUMBER OF HUSBAND FROM THE HOUSEHOLD QUESTIONNAIRE. IF HUSBAND IS NOT LISTED, WRITE '00'.

LINE NUMBER OF HUSBAND ___

509. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES
601. CHECK 106A:

CURRENTLY MARRIED (GO TO 601A)
NOT CURRENTLY MARRIED (GO TO 629)

601A. CHECK 314:

NEITHER STERILIZED (GO TO 602)
SHE OR HE STERILIZED (GO TO 614)

602. CHECK 227:

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, would you like to have another child or would you prefer not to have any more children?

HAVE A (ANOTHER) CHILD 1
NO MORE OR NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 604)
UNDECIDED OR DOES NOT KNOW 8 (GO TO 604)

603. CHECK 227:

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

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

MONTHS 1 ___
YEARS 2 ___
SOON OR NOW 994
DAYS SHE CAN'T GET PREGNANT 995
OTHER (SPECIFY) 996
DOES NOT KNOW 998

604. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 607)

605. If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606. CHECK 313:
USING A METHOD?

NOT ASKED (GO TO 607)
NOT CURRENTLY USING (GO TO 607)
CURRENTLY USING (GO TO 614)

607. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (GO TO 609)
NO 2
DOES NOT KNOW 8

608. Do you think you will use a method at any time in the future?

YES 1
NO 2 (GO TO 611)
DOES NOT KNOW 8 (GO TO 611)

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

PILL 01
IUD 02
INJECTIONS 03
IMPLANT 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
MENSTRUAL REGULATION 08
CALENDAR, COUNTING DAYS 09 (GO TO 614)
WITHDRAWAL 10 (GO TO 614)
OTHER (SPECIFY) 96 (GO TO 614)
UNSURE 98 (GO TO 614)

609A. Where can you get (METHOD MENTIONED IN 609)?

NAME OF PLACE ___
PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11 (GO TO 614)
FAMILY WELFARE CENTRE 12 (GO TO 614)
THANA HEALTH COMPLEX 13 (GO TO 614)
SATELLITE CLINIC OR EPI CLINIC 14 (GO TO 614)
MEDICAL PRIVATE SECTOR
TRADITIONAL DOCTOR 21 (GO TO 614)
QUALIFIED DOCTOR 22 (GO TO 614)
PHARMACY 23 (GO TO 614)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 614)
FRIENDS OR RELATIVES 32 (GO TO 614)
FIELDWORKER, FWA 41 (GO TO 614)
NGO CLINIC 51 (GO TO 614)
OTHER (SPECIFY) 96 (GO TO 614)
DOES NOT KNOW 98 (GO TO 614)

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

FERTILITY-RELATED REASONS
INFREQUENT SEX 22
MENOPAUSAL OR HYSTERECTOMY 23
SUBFECUND OR INFECUND 24
WANTS MORE CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS OR TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) 96
DON'T KNOW 98

614. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

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

The radio?
YES 1
NO 2
The television?
YES 1
NO 2
Newspaper of magazine?
YES 1
NO 2
A poster or billboard?
YES 1
NO 2

617. CHECK 314:

RESPONDENT NOT STERILIZED (GO TO 618)
RESPONDENT STERILIZED (GO TO 620)

618. How often have you talked to your husband about family planning in the last three months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

619. Do you think your husband wants 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

620. Spouses or partners do not always agree on everything. Now I want to ask you about your husband's view on family planning. Do you think that your husband approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

621. In the last three months, have you discussed family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 624

)

622. With whom? Anyone else?
RECORD ALL MENTIONED.

HUSBAND OR PARTNER A
MOTHER B
FATHER C
SISTER(S) OR SISTERS-IN-LAW D
BROTHER(S) OR BROTHERS-IN-LAW E
DAUGHTER F
MOTHER-IN-LAW G
FATHER-IN-LAW H
FRIENDS OR NEIGHBORS I
OTHER (SPECIFY) X

624. Since you have been married, how frequently do you go shopping or marketing?

ONCE A MONTH OR MORE 1
SEVERAL TIMES A YEAR 2
ONCE A YEAR OR LESS 3
NEVER 4 (GO TO 626)

625. Do you usually go by yourself or do you go with children or your husband or other relatives?

BY HERSELF 1
WITH CHILDREN 2
WITH HUSBAND 3
WITH OTHER RELATIVES OR FRIENDS 4

626. Do you go outside the village or town or city alone (or with your young children)?

YES, ALONE 1 (GO TO 627)
YES, WITH CHILDREN 2 (GO TO 627)
NO 3
OTHER (SPECIFY) 6 (GO TO 627)

626A. Can you go outside the village or town or city alone (or with your young children)?

YES, ALONE 1
YES, WITH CHILDREN 2
NO 3 (GO TO 628)
OTHER (SPECIFY) 6

627. How frequently do you go outside this village or town or city?

ONCE A MONTH OR MORE 1
SEVERAL TIMES A YEAR 2
LESS THAN ONCE A YEAR 3
NEVER 4

628. Do you go to a health center or hospital alone (or with your young children)?

YES, ALONE 1 (GO TO 629)
YES, WITH CHILDREN 2 (GO TO 629)
YES, WITH HUSBAND 3 (GO TO 629)
NO 4
OTHER (SPECIFY) 6 (GO TO 629)

628A. Can you go to health center or hospital alone (or with your young children?

YES, ALONE 1
YES, WITH CHILDREN 2
YES, WITH HUSBAND 3
NO 4
OTHER (SPECIFY) 6

629. CHECK 216:

HAS LIVING CHILD(REN): If you could go back to the time you did not have any children and could chose 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.

NUMBER ___
OTHER ANSWER (SPECIFY) 96

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

BOYS ___
GIRLS ___
EITHER ___
UP TO GOD 95
OTHER (SPECIFY) 96

SECTION 7. HUSBAND'S BACKGROUND, RESIDENCE AND WOMAN'S WORK
701. CHECK 106A:

CURRENTLY MARRIED (GO TO 702)
WIDOWED OR DIVORCED OR SEPARATED (GO TO 703)

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

AGE ___

703. Did your (last) husband ever attend school?

YES 1
NO 2 (GO TO 706)
DOES NOT KNOW 8 (GO TO 706)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DOES NOT KNOW 8 (GO TO 706)

705. What was the highest (grade or form or year) he completed?

GRADE ___
DOES NOT KNOW 98

706. What kind of work does (did) your (last) husband mainly do?

___

707. CHECK 706:

WORKS (WORKED) IN AGRICULTURE (GO TO 708)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 709)

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

HIS OR FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

709. Aside from your own housework, are you currently working?

YES 1 (GO TO 712)
NO 2

710. As you know, some women take up jobs for which they are paid in cash or in 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?

YES 1
NO 2 (GO TO 801)

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

___

713. CHECK 712:

WORKS IN AGRICULTURE (GO TO 714)
DOES NOT WORK IN AGRICULTURE (GO TO 715)

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

OWN OR FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

715. In your current work, do you 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

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

THROUGHOUT THE YEAR 1
ONLY SOME TIMES (SEASONAL) 2
ONCE IN A WHILE 3

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

YES 1
NO 2 (GO TO 723)

722. Most of the time when you work for cash, do you decide how the money you earn will be used, or does someone else decide how your earnings are used?

RESPONDENT DECIDES 1
SOMEONE ELSE DECIDES 2
JOINTLY 3

723. Do you work at home or away from home?

HOME 1
AWAY 2

724. CHECK 217 AND 218:
HAS CHILD BORN SINCE BAISHAK 1398 AND LIVING AT HOME?

YES (GO TO 725)
NO (GO TO 801)

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

RESPONDENT 01
HUSBAND OR PARTNER 02
OLDER CHILD(REN) 03
OTHER RELATIVES 04
NEIGHBORS 05
FRIENDS 06
SERVANTS OR HIRED HELP 07
CHILD IS IN SCHOOL 08
INSTITUTIONAL CHILDCARE 09
OTHER (SPECIFY) 96

SECTION 8. AIDS
801. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 809)

802. From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS OR MAGAZINES C
PAMPHLETS OR POSTERS D
HEALTH WORKERS E
MOSQUES OR CHURCHES F
SCHOOLS OR TEACHERS G
COMMUNITY MEETINGS H
FRIENDS OR RELATIVES I
WORK PLACE J
OTHER (SPECIFY) X

803. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 807)
DON'T KNOW 8 (GO TO 807)

804. What can a person do? Any other ways?
RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
USE STERILE SYRINGES OR BUY SYRINGES F
AVOID BLOOD TRANSFUSIONS G
AVOID KISSING H
AVOID MOSQUITO BITES I
AVOID TRADITIONAL DOCTORS J
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON' KNOW Z

805. CHECK 804:

MENTIONED SAFE SEX (GO TO 806)
DID NOT MENTION SAFE SEX (GO TO 807)

806. What does "safe sex" mean to you?

ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY) X
DON'T KNOW Z

807. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

808. Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DON'T KNOW 8

809. RECORD THE TIME.

HOUR ___
MINUTES ___

SECTION 9. HEIGHT AND WEIGHT
901. CHECK 215:

ONE OR MORE BIRTHS BAISHAK 1398 (APRIL 1991): IN 902 (COLUMNS 2 AND 3) RECORD THE LIN NUMBER FOR EACH CHILD BORN SINCE BAISHAK 1398 AND STILL ALIVE. IN 903 AND 904 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE BAISHAK 1398. IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE BAISHAK 1398 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE BAISHAK 1398, USE ADDITIONAL QUESTIONNAIRES).

NO BIRTHS SINCE BAISHAK 1398 (APRIL 1991) (END QUESTIONNAIRE)

902. LINE NUMBER FROM QUESTION 212:
(FOR LIVING CHILD(REN) BORN SINCE BAISHAK 1398)

___

903. NAME FROM QUESTION 212 FOR CHILDREN:

NAME ___

904. DATE OF BIRTH FROM QUESTION 215 AND ASK FOR DAY OF BIRTH:
(FOR LIVING CHILD(REN) BORN SINCE BAISHAK 1398)

DAY ___
MONTH ___
YEAR ___

905. BCG SCAR ON TOP LEFT SHOULDER:
(FOR LIVING CHILD(REN) BORN SINCE BAISHAK 1398)

SCAR SEEN 1
NO SCAR 2

906. HEIGHT (IN CENTIMETERS)

___

907. WAS LENGTH OR HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?
(FOR LIVING CHILD(REN) BORN SINCE BAISHAK 1398)

LYING 1
STANDING 2

908. WEIGHT (IN KILOGRAMS)

___

909. DATE WEIGHED AND MEASURED:

DAY ___
MONTH ___
YEAR ___

910. RESULT:

RESPONDENT:
MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) 6
CHILD(REN):
CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) 6

911. NAME OF MEASURER:

___

NAME OF ASSISTANT:

___

INTERVIEWER'S OBSERVATIONS
(TO BE FILLED IN AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT:
COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR:
DATE:
EDITOR'S OBSERVATIONS:

CALENDAR
INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1, 3, AND 4, ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
S STILLBIRTHS
M MISCARRIAGES
R MENSTRUAL REGULATION
A ABORTION
0 NO METHOD
1 PILL
2 IUD
3 INJECTIONS
4 IMPLANTS
5 CONDOM
6 FEMALE STERILIZATION
7 MALE STERILIZATION
9 PERIODIC ABSTINENCE OR RHYTHM
W WITHDRAWAL
X OTHER (SPECIFY)

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE:

0 INFREQUENT SEX OR HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS OR TOO FAR
8 COST TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT OR MENOPAUSE
D MARITAL DISSOLUTION OR SEPARATION
X OTHER (SPECIFY)
Z DON'T KNOW

COLUMN 3: MARRIAGE OR UNION

X IN UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION

1403

12 CHOITRA 01 _ _ _
11 FALGUN 02 _ _ _
10 MAGH 03 _ _ _
09 POUSH 04 _ _ _
08 AGRAHAYAN 05 _ _ _
07 KARTIK 06 _ _ _
06 ASHWIN 07 _ _ _
05 BADHRA 08 _ _ _
04 SRABAN 09 _ _ _
03 ASHAR 10 _ _ _
02 JAISTHA 11 _ _ _
01 BAISHAK 12 _ _ _

1402

12 CHOITRA 13 _ _ _
11 FALGUN 14 _ _ _
10 MAGH 15 _ _ _
09 POUSH 16 _ _ _
08 AGRAHAYAN 17 _ _ _
07 KARTIK 18 _ _ _
06 ASHWIN 19 _ _ _
05 BADHRA 20 _ _ _
04 SRABAN 21 _ _ _
03 ASHAR 22 _ _ _
02 JAISTHA 23 _ _ _
01 BAISHAK 24 _ _ _

1401

12 CHOITRA 25 _ _ _
11 FALGUN 26 _ _ _
10 MAGH 27 _ _ _
09 POUSH 28 _ _ _
08 AGRAHAYAN 29 _ _ _
07 KARTIK 30 _ _ _
06 ASHWIN 31 _ _ _
05 BADHRA 32 _ _ _
04 SRABAN 33 _ _ _
03 ASHAR 34 _ _ _
02 JAISTHA 35 _ _ _
01 BAISHAK 36 _ _ _

1400

12 CHOITRA 37 _ _ _
11 FALGUN 38 _ _ _
10 MAGH 39 _ _ _
09 POUSH 40 _ _ _
08 AGRAHAYAN 41 _ _ _
07 KARTIK 42 _ _ _
06 ASHWIN 43 _ _ _
05 BADHRA 44 _ _ _
04 SRABAN 45 _ _ _
03 ASHAR 46 _ _ _
02 JAISTHA 47 _ _ _
01 BAISHAK 48 _ _ _

1399

12 CHOITRA 49 _ _ _
11 FALGUN 50 _ _ _
10 MAGH 51 _ _ _
09 POUSH 52 _ _ _
08 AGRAHAYAN 53 _ _ _
07 KARTIK 54 _ _ _
06 ASHWIN 55 _ _ _
05 BADHRA 56 _ _ _
04 SRABAN 57 _ _ _
03 ASHAR 58 _ _ _
02 JAISTHA 59 _ _ _
01 BAISHAK 60 _ _ _

1398

12 CHOITRA 61 _ _ _
11 FALGUN 62 _ _ _
10 MAGH 63 _ _ _
09 POUSH 64 _ _ _
08 AGRAHAYAN 65 _ _ _
07 KARTIK 66 _ _ _
06 ASHWIN 67 _ _ _
05 BADHRA 68 _ _ _
04 SRABAN 69 _ _ _
03 ASHAR 70 _ _ _
02 JAISTHA 71 _ _ _
01 BAISHAK 72 _ _ _

1997

03 MAR 01 _ _ _
02 FEB 02 _ _ _
01 JAN 03 _ _ _

1996

12 DEC 04 _ _ _
11 NOV 05 _ _ _
10 OCT 06 _ _ _
09 SEP 07 _ _ _
08 AUG 08 _ _ _
07 JUL 09 _ _ _
06 JUN 10 _ _ _
05 MAY 11 _ _ _
04 APR 12 _ _ _
03 MAR 13 _ _ _
02 FEB 14 _ _ _
01 JAN 15 _ _ _

1995

12 DEC 16 _ _ _
11 NOV 17 _ _ _
10 OCT 18 _ _ _
09 SEP 19 _ _ _
08 AUG 20 _ _ _
07 JUL 21 _ _ _
06 JUN 22 _ _ _
05 MAY 23 _ _ _
04 APR 24 _ _ _
03 MAR 25 _ _ _
02 FEB 26 _ _ _
01 JAN 27 _ _ _

1994

12 DEC 28 _ _ _
11 NOV 29 _ _ _
10 OCT 30 _ _ _
09 SEP 31 _ _ _
08 AUG 32 _ _ _
07 JUL 33 _ _ _
06 JUN 34 _ _ _
05 MAY 35 _ _ _
04 APR 36 _ _ _
03 MAR 37 _ _ _
02 FEB 38 _ _ _
01 JAN 39 _ _ _

1993

12 DEC 40 _ _ _
11 NOV 41 _ _ _
10 OCT 42 _ _ _
09 SEP 43 _ _ _
08 AUG 44 _ _ _
07 JUL 45 _ _ _
06 JUN 46 _ _ _
05 MAY 47 _ _ _
04 APR 48 _ _ _
03 MAR 49 _ _ _
02 FEB 50 _ _ _
01 JAN 51 _ _ _

1992

12 DEC 52 _ _ _
11 NOV 53 _ _ _
10 OCT 54 _ _ _
09 SEP 55 _ _ _
08 AUG 56 _ _ _
07 JUL 57 _ _ _
06 JUN 58 _ _ _
05 MAY 59 _ _ _
04 APR 60 _ _ _
03 MAR 61 _ _ _
02 FEB 62 _ _ _
01 JAN 63 _ _ _

1991

12 DEC 64 _ _ _
11 NOV 65 _ _ _
10 OCT 66 _ _ _
09 SEP 67 _ _ _
08 AUG 68 _ _ _
07 JUL 69 _ _ _
06 JUN 70 _ _ _
05 MAY 71 _ _ _
04 APR 72 _ _ _