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DEMOGRAPHIC AND HEALTH SURVEYS - 1996-97 BANGLADESH - HUSBAND'S QUESTIONNAIRE

BANGLADESH

IDENTIFICATION

DIVISION:

DISTRICT:

UPAZILA OR THANA:

UNION:

VILLAGE OR MOHALL 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 MAN:

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

TOTAL NUMBER OF VISITS

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 HE 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?

NEVER MARRIED 1 (GO TO END)
MARRIED 2
WIDOWED 3 (GO TO END)
DIVORCED OR DESERTED 4 (GO TO END)

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
WITH DIFFICULTY 2
NOT AT ALL 3 (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
BUDDHISM 3
CHRISTIANITY 4
OTHER (SPECIFY) 5

119. Are you currently working?

YES 1
NO 2

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

___

121. CHECK 120:

WORKS IN AGRICULTURE (GO TO 122)
DOES NOT WORK IN AGRICULTURE (GO TO 123)
UNEMPLOYED (GO TO 201)

122. 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

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

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

124. 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

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

YES 1
NO 2

SECTION 2. REPRODUCTION

201. Now I would like to ask about your children. I am interested only in the children that are biologically yours. Have you ever had children?

YES 1
NO 2 (GO TO 206)

202. Do you have any sons or daughters 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 ENTER '00'.

SONS AT HOME ___
DAUGHTERS AT HOME ___

204. Do you have any sons or daughters who 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 had a son or daughter who was born alive but later died?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE ENTER '00'.

TOTAL ___

209. CHECK 207: Just to make sure that I have this right: you have TOTAL ___ children born alive during your life. Is that correct?

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

210. CHECK 208:

HAS HAD CHILDREN (GO TO 210A)
HAS NEVER HAD CHILDREN (NONE) (GO TO 301)

210A. In what month and year was your last child born?

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

210B. CHECK 210A:

LAST CHILD BORN SINCE BAISHAK 1398 (APRIL 1991) (GO TO 211)
BORN BEFORE BAISHAK 1398 (APRIL 1991) (GO TO 301)

211. When you were expecting your lastborn child, did you want to have the child then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

212. When one of your children is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?

CIRCLE ALL MENTIONED.

REPEATED WATER STOOLS A
ANY WATER STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING OR DRINKING WELL H
GETTER SICKER OR VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) X
DOES NOT KNOW Z

213. When one of your children is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?

CIRCLE ALL MENTIONED.

RAPID BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING OR DRINKING WELL F
GETTING SICKER OR VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY X
DOES NOT KNOW Z

214A. Do you have any child born since Baishak 1398 (April 1991) who is still alive?

YES 1
NO 2 (GO TO 301)

214B. What is the name of your child under age 5?

NAME ___

215A. Has (NAME) ever been sick?

YES 1
NO 2 (GO TO 301)

215B. Have you or your wife ever taken (NAME) to a health facility or health worker or any other place or person for treatment, when he or she was sick?

YES 1
NO 2 (GO TO 218)
DOES NOT KNOW 8 (GO TO 218)

216. The last time (NAME) was taken for treatment, what was his or her illness?

DIARRHEA A
FEVER B
COUGH C
SKIN DISEASE D
LOSS OF APPETITE E
OTHER (SPECIFY) X
CANNOT RECALL Z

217. Who took (NAME) for treatment the last time, yourself or your wife or somebody else?

HIMSELF 1
HIS WIFE 2
BOTH 3
OTHER PERSON (SPECIFY) 6
CANNOT RECALL 8

218. Did you ever bring or buy any medicine for (NAME)?

YES 1
NO 2 (GO TO 301)

219. Who bought or brought the medicine?

HIMSELF 1
HIS WIFE 2
BOTH 3
OTHER PERSON (SPECIFY) 6
CANNOT RECALL 8

220. Who gave the medicine to the child, yourself or your wife?

HIMSELF 1
HIS WIFE 2
BOTH 3
OTHER PERSON (SPECIFY) 6
CANNOT RECALL 8

221. Where did you get the medicine?

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
PHARMACY 23
OTHER (SPECIFY) 96
DOES NOT KNOW 98

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 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 method have you heard about?
302. Have you ever heard or (METHOD)?

01. PILL, MAYA: Women 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 or a nurse.
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 any more 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 heard or any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES (SPECIFY) 1
NO 3

303. Have you ever used (METHOD)?

01. PILL, MAYA: Women 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 or a nurse.
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: Has your wife had an operation to avoid having any more children?
YES 1
NO 2
07. MALE STERILIZATION, VASECTOMY: Have you ever had an operation to avoid having any 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 heard or any other ways or methods 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 or your wife ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 331)

307. What have you used or done?
CORRECT 303-305 (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
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
MENSTRUAL REGULATION 08
SAFE PERIOD, COUNTING DAYS 09
WITHDRAWAL 10
OTHER (SPECIFY) 96

309. How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

310. CHECK 303:

MAN NOT STERILIZED (GO TO 313)
MAN STERILIZED (GO TO 314A)

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

YES 1
NO 2 (GO TO 331)

314. Which method are you using?
314A. CIRCLE '07' FOR MALE STERILIZATION.

PILL 01 (GO TO 328)
IUD 02 (GO TO 328)
INJECTIONS 03 (GO TO 328)
IMPLANTS 04 (GO TO 328)
CONDOM 05
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07 (GO TO 318)
MENSTRUAL REGULATION 08 (GO TO 328)
SAFE PERIOD, COUNTING DAYS 09 (GO TO 330A)
WITHDRAWAL 10 (GO TO 330A)
OTHER (SPECIFY) 96 (GO TO 330A)

317C. Please show me the package of condoms that you are using.

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

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

WIFE KEEPS 1
RAN OUT 2
OTHER (SPECIFY) 6

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

BRAND NAME ___
DOES NOT KNOW 98

317F. How much did the condom you last used cost?

COST ___
PARTNER OBTAINED 95
FREE 96
DOES NOT KNOW 98

317G. Do you use a condom every time that you have sexual intercourse or only sometimes?

EVERY TIME 1
ONLY SOMETIMES 2

317H. How many times have you used condoms during the last one month?

NUMBER OF TIMES ___ (GO TO 328)

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
OTHER (SPECIFY) 96
DOES NOT KNOW 98

319. Do you regret that (you or your wife) 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 01
PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER REASON (SPECIFY) 96

321. In what month and year was the sterilization operation performed?

USE CODES BELOW FOR MONTHS.

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

321A. How much did the operation cost you?

COST ___ (GO TO 329A)
FREE 9996 (GO TO 329A)
DOES NOT KNOW 9998 (GO TO 329A)

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 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 (GO TO 329)
NGO CLINIC 42
OTHER (SPECIFY) 96
DOES NOT KNOW 98

328A. CHECK 314:

USING PILLS OR CONDOMS (GO TO 328B)
USING ANOTHER METHOD (GO TO 329)

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

RESPONDENT 1
WIFE 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
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 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 ELSE WHERE 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. When a couple is making a decision, sometimes the husband has more influence, sometime 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?

RESPONDENT HAD MORE INFLUENCE 1 (GO TO 334)
WIFE HAD MORE INFLUENCE 2 (GO TO 334)
BOTH, HUSBAND AND WIFE EQUAL 3 (GO TO 334)
OTHER RELATIVE 4 (GO TO 334)
OTHER (SPECIFY) 6 (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
WIFE 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 5
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 HE SAYS MORE THAN ONE PLACE, ASK FOR THE PLACE HE 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 338)
DOES NOT KNOW 8 (GO TO 338)

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

YES 1
NO 2 (GO TO 338)

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

338. Have you ever visited a health facility or centre with your wife or your children?

YES 1
NO 2 (GO TO 351)

339. For what services did you go there?

CIRCLE ALL MENTIONED.

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

351. Have you ever recommended family planning 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

353. CHECK 302 AND 303:

HEARD ABOUT MALE STERILIZATION BUT DID NOT USE (GO TO 354A)
OTHER (GO TO 357)

354A. From where did you hear about male sterilization?

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

354B. Do you know of a place where you can obtain male sterilization?

YES 1
NO 2

355. Has any fieldworker ever discussed with you about male sterilization?

YES 1
NO 2

356. Some people say that vasectomy makes a man weak, while others say that it has no effect. What do you think?

MAKES HIM WEAK 1
NO EFFECT 2
DOES NOT KNOW 8

357. CHECK 208:

HAS LIVING CHILD(REN) (GO TO 358)
HAS NO LIVING CHILD(REN) (GO TO 401)

358. 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 has the most influence in deciding about the health care of children?

RESPONDENT HAD MORE INFLUENCE 1
WIFE HAD MORE INFLUENCE 2
BOTH, HUSBAND AND WIFE EQUAL 3
OTHER RELATIVE 6
OTHER (SPECIFY) 6

SECTION 4. MARRIAGE
401. WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE.

IF WIFE DOES NOT LIVE IN HOUSEHOLD, WRITE '00'.

___

401A. Have you been married only once or more than once?

ONCE 1
MORE THAN ONCE 2

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

BENGALI 1

MONTH __
YEAR 13__ (GO TO 501)
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 501)
01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER

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

AGE ___
DOES NOT KNOW AGE 98

SECTION 5. FERTILITY PREFERENCES
501. CHECK 314:

NEITHER STERILIZED (GO TO 502)
SHE OR HE STERILIZED (GO TO 514)

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?

HAVE A (ANOTHER) CHILD 1
NO MORE OR NONE 2 (GO TO 506)
SAYS WIFE CAN'T GET PREGNANT 3 (GO TO 506)
UNDECIDED OR DOES NOT KNOW 8 (GO TO 506)

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

MONTHS 1 ___
YEARS 2 ___
SOON OR NOW 995
OTHER (SPECIFY) 996
DOES NOT KNOW 998

506. CHECK 313: USING A METHOD?

NOT ASKED (GO TO 507)
NOT CURRENTLY USING (GO TO 507)
CURRENTLY USING (GO TO 514)

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

YES 1 (GO TO 509)
NO 2
DOES NOT KNOW 8

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

YES 1
NO 2 (GO TO 511)
DOES NOT KNOW 8 (GO TO 511)

509. 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 514)
WITHDRAWAL 10 (GO TO 514)
OTHER (SPECIFY) 96 (GO TO 514)
UNSURE (GO TO 514)

509A. Where can you get (METHOD MENTIONED IN 509)?

NAME OF PLACE ___
PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11 (GO TO 514)
FAMILY WELFARE CENTRE 12 (GO TO 514)
THANA HEALTH COMPLEX 13 (GO TO 514)
SATELLITE CLINIC 14 (GO TO 514)
MEDICAL PRIVATE SECTOR
PRIVATE CLINIC OR DOCTOR 21 (GO TO 514)
TRADITIONAL DOCTOR 22 (GO TO 514)
PHARMACY 23 (GO TO 514)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 514)
FRIENDS OR RELATIVES 32 (GO TO 514)
FIELDWORKER, FWA 41(GO TO 514)
NGO CLINIC 42 (GO TO 514)
OTHER (SPECIFY) 96 (GO TO 514)
DOES NOT KNOW 98 (GO TO 514)

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

FERTILITY-RELATED REASON
INFREQUENT SEX 22
MENOPAUSAL OR HYSTERECTOMY 23
SUB FECUND OR INFECUND 24
WANTS MORE CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE 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

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

APPROVES 1
DISAPPROVE 2
NO OPINION 3

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

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

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

YES 1
NO 2 (GO TO 521)

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

WIFE 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

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

522. How often have you talked to your wife about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3
SOMETIMES 4

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

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

529. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: If you would 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

530. 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 6. AIDS
601. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 609)

602. From which sources of information have you learned the 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

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

YES 1
NO 2 (GO TO 607)
DON'T KNOW 8 (GO TO 607)

604. 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'T KNOW Z

605. CHECK 604:

MENTIONED SAFE SEX (GO TO 606)
DID NOT MENTION SAFE SEX (GO TO 607)

606. 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

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

YES 1
NO 2
DON'T KNOW 8

608. Do you think that person with AIDS almost never die from the disease, sometimes die, or almost always dies from the disease?

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

609. RECORD THE TIME.

HOUR ___
MINUTES ___

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