BANGLADESH

IDENTIFICATION

DIVISION:
DISTRICT:
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 WOMAN:

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_
CODE
RESULT

NAME
DATE

FIELD EDITED BY
OFFICE EDITED BY
KEYED BY
KEYED BY

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

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

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

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

ENGLISH 2

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

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

107. Have you ever attended school?

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

109. What is the highest class you completed?

113. CHECK 108:

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

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

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

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

118. What is your religion?

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

IF NONE, WRITE '0'.

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

120. CHECK QUESTION 7 IN THE HOUSEHOLD QUESTIONNAIRE:

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?

122. In which division is that located?

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?

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

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

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

127. Where do children in your household usually defecate?

128. Does your household have electricity?

129. Does your household have:

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

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

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

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

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?

202. Do you have any sons or daughter to whom you have given birth who are now living with you?

203. How many sons live with you? And how many daughters live with you?
IF NONE RECORD '00'.

204. Do you have any sons or daughter to whom you have given birth who are alive but do not live with you?

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

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?

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

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

209. CHECK 208:
Just to make sure that I have this right: you have had in TOTAL ___ births during your life. Is that correct?

210. CHECK 208:

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?

213. Were any of these births twins?

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

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

ENGLISH 2

216. Is (NAME) still alive?

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

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

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.

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)

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)

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

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

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

CHECK:

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?

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.

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?

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

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

BENGALI 1

ENGLISH 2

232. CHECK 231:

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

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.

234. Did you ever have any other such pregnancies?

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?

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)?

303. Have you ever used (METHOD)?

304. CHECK 303:

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

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?

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

310. CHECK 303:

311. CHECK 106A:

312. CHECK 227:

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

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

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

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

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

CIRCLE ALL MENTIONED.

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

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

FOR IUD USERS AND IMPLANT USERS.

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

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

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

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

318. Where did the sterilization take place?

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

320. Why do you regret it?

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

BENGALI 1

ENGLISH 2

321A. How much did the operation cost you?

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.

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:

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:

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:

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

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

327. CHECK 314:
CIRCLE METHOD CODE.

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.

328A. CHECK 315:

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

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?

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

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

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

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?

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.

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.

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

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

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

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

330F. CHECK 106A:

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

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

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

NAME OF PLACE ___

334. CHECK 328 AND 333:

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?

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

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

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?

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

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

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

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

344. CHECK 339 AND 342:

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

346. What supplies did you receive?

347. How many 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.

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

350. Why did she refer you to a clinic?

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

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

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

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

404. FROM QUESTION 212 AND 216

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?

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

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

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

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?

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

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

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

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

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

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

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

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)

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

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

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

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

425. Did you ever breastfeed (NAME)?

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.

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

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

427. CHECK 216:

CHILD ALIVE?

428. Are you still breastfeeding (NAME)?

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

430. Why did you stop breastfeeding (NAME)?

431. CHECK 404:
CHILD ALIVE?

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

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

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

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

442. FROM QUESTION 212 AND 216

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

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

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.

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).

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

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?

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

448C. IF YES: How many times?

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

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

448F. IF YES: How many times?

448G. An injection to prevent measles?

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

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

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

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

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

RECORD ALL MENTIONED.

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

455. Was there any blood in the stools?

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

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

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

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

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

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

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

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?

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

BENGALI 1

ENGLISH 2

503. How old were you when you got married?

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'.

506. CHECK 106A:

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

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

509. PRESENCE OF OTHERS AT THIS POINT.

SECTION 6. FERTILITY PREFERENCES
601. CHECK 106A:

601A. CHECK 314:

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?

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?

604. CHECK 227:

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

606. CHECK 313:
USING A METHOD?

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

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

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

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

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

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

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

617. CHECK 314:

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

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?

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?

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

)

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

707. CHECK 706:

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?

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

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?

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

713. CHECK 712:

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

715. In your current work, do you work for a member of your family, for someone else, or are you self-employed?

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

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

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?

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

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

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

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

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

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

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

805. CHECK 804:

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

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

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

809. RECORD THE TIME.

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:

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

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

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)

908. WEIGHT (IN KILOGRAMS)

909. DATE WEIGHED AND MEASURED:

910. RESULT:

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

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE:

COLUMN 3: MARRIAGE OR UNION

1403

1402

1401

1400

1399

1398

1997

1996

1995

1994

1993

1992

1991