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DEMOGRAPHIC AND HEALTH SURVEY - BANGLADESH 1999-2000 - WOMEN'S QUESTIONNAIRE (ENGLISH)

BANGLADESH

IDENTIFICATION

DIVISION:
DISTRICT:
THANA:
UNION OR WARD:
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 ELIGIBLE WOMAN:

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT*

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

NEXT VISIT
DATE
TIME

FINAL VISIT
DATE
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
CODE
RESULT*

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR
KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ___. We came from the Mitra and Associates, a private research organization, is located at Dhaka. To assist in the implementation of socio-development programs in the country, we conduct different types of surveys. We are now conducting a national survey about the health of women and children under the authority of NIPORT of ministry of Health and Family Welfare. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?

Signature of interviewer:

Date:

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

101. RECORD THE TIME STARTED.

HOUR ___
MINUTES ___

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

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

NUMBER OF YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

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

CITY 1
TOWN 2
COUNTRYSIDE 3

105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___
DON'T KNOW YEAR 9998

106. How old are you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

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

CURRENTLY MARRIED 1
SEPARATED 2
DESERTED 3
DIVORCED 4
WIDOWED 5
NEVER MARRIED 6 (GO TO END)

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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 ___

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 112)

111. 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 113)

112. Do you usually read a newspaper or magazine?

YES 1
NO 2 (GO TO 113)

112. How often do you read newspaper or magazine: every day, at least once a week, or less than once a week?

EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3

113. Do you listen to the radio?

YES 1
NO 2 (GO TO 114)

113A. How often do you listen to the radio: every day, at least once a week, or less than once a week?

EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3

114. Do you watch television?

YES 1
NO 2 (GO TO 115)

114A. How often do you watch television: every day, at least once a week, or less than once a week?

EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3

115. What is your religion?

ISLAM 1
HINDUISM 2
BUDDHISM 3
CHRISTIANITY 4
OTHER (SPECIFY) 6

118. Do you belong to any of the following organizations?

Grameen Bank?
YES 1
NO 2
BRAC?
YES 1
NO 2
BRDB?
YES 1
NO 2
Mother's club?
YES 1
NO 2
Any other organization (such as micro credit)?
YES (SPECIFY) 1
NO 2

119. CHECK QUESTION 5 IN THE HOUSEHOLD SECTION:

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (GO TO 120)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

120. 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 OR KHULNA OR RAJSHAHI 1
SMALL CITY 2
TOWN 3
VILLAGE 4

121. In which division is that located?

RAJSHAHI 1
DHAKA 2
CHITTAGONG 3
KHULNA 3
BARISAL 3
SYLHET 3

122. Now I would like to ask you some questions about your household where you usually live. What is the main source of water your household uses for dishwashing?

PIPED WATER
PIPED INSIDE DWELLING 11
PIPED OUTSIDE DWELLING 12
WELL WATER
TUBE WELL OR DEEP 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

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

PIPED WATER
PIPED INSIDE DWELLING 11
PIPED OUTSIDE DWELLING 12
WELL WATER
TUBE WELL OR DEEP 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

123A. Do you boil drinking water?

YES 1
NO 2

124. 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 (GO TO 126)
OTHER (SPECIFY) 96

125. Do you share this facility with other households?

YES 1
NO 2

126. Does your household (or any member of your household) have:

Electricity?
YES 1
NO 2
Almirah (wardrobe)?
YES 1
NO 2
A table or chair?
YES 1
NO 2
A 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
A motorcycle?
YES 1
NO 2
A sewing machine?
YES 1
NO 2
Telephone?
YES 1
NO 2

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

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

128. 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

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

NATURAL FLOOR
EARTH OR BAMBOO (KATCHA) 11
RUDIMENTARY FLOOR
WOOD 21
FINISHED FLOOR (PUKKA)
CEMENT OR CONCRETE 31
OTHER (SPECIFY) 96

130. Does your household own any homestead?

IF 'NO', PROBE: Does your household own homestead any other places?

YES 1
NO 2

130A. Does your household own any land (other than the homestead land)?

YES 1
NO 2 (GO TO 132)

131. How much land does your household own (other than the homestead land)?

AMOUNT ___
ACRES ___
DECIMALS ___
SPECIFY UNIT ___
NONE 0000

132. In terms of household food consumption, how do you classify your household: deficit in whole year; sometimes deficit; neither deficit nor surplus; surplus.

DEFICIT IN WHOLE YEAR 1
SOMETIMES DEFICIT 2
NEITHER DEFICIT NOT SURPLUS 3
SURPLUS 4

133. Does your family have vulnerable group feeding (VGF) card?

YES 1
NO 2

134. Do you have any male or female member in this household who are receiving old age pension or widow or destitute benefit?

YES 1
NO 2

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

IF NONE, RECORD "00".

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you? 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 signs of life but survived only 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 207, 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 226)

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. IF NO NAME WAS GIVEN, RECORD 'NO NAME' IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

212. What name was given to your (first/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?

MONTH ___
YEAR ___

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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
NO 2

219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD.

RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.

LINE NUMBER ___ (GO TO NEXT BIRTH)

220. IF DEAD: How old was (NAME) when he or she died?

IF '1 YEAR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

(IF MORE THAN ONE BIRTH)

YES 1
NO 2

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

YES 1
NO 2

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

NUMBERS ARE THE SAME CHECK:

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

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE APRIL 1994 (BAISHAK 1401).

IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE APRIL 1994 OR BAISHAK 1401, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED). WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P'S IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ___

228. 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 have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 236)

230. When did the last such pregnancy end?

MONTH ___
YEAR ___

231. CHECK 230:

LAST PREGNANCY ENDED SINCE APRIL 1994 (BAISHAK 1401) (GO TO 231A)
LAST PREGNANCY ENDED BEFORE APRIL 1994 (BAISHAK 1401) (GO TO 235)

231A. Was that a stillbirth, a miscarriage, a menstrual regulation, or an abortion?

STILLBIRTH 1
MISCARRIAGE 2
MENSTRUAL REGULATION 3
ABORTION 4

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

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ___

233. Have you ever had any other pregnancies which did not result in a live birth?

YES 1
NO 2 (GO TO 235)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO APRIL 1994 (BAISHAK 1401).

ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. IN THE BOXES AT THE BOTTOM OF THE CALENDAR, FILL IN THE MONTH AND YEAR OF TERMINATION OF THE LAST NON-LIVE BIRTH PREGNANCY PRIOR TO APRIL 1994 (BAISHAK 1401).

236. When did your last menstrual period start?

DATE IF GIVEN ___
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE OR HAS HAD HYSTERECTOMY 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 IN 302. 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. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
02. MALE STERILIZATION, VASECTOMY: Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
03. PILL, MAYA: Women can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
04. 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
05. 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
06. IMPLANTS, NORPLANTS: 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
07. CONDOM, RAJA: Men can put a rubber sheath on their penis before sexual intercourse.
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. LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeed frequently, day and night, and that her menstrual period has not returned.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
12. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES (SPECIFY) 1
PROBED YES 2
NO 3

303. Have you ever used (METHOD)?

01. FEMALE STERILIZATION: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02. MALE STERILIZATION, VASECTOMY: Has your husband ever had an operation to avoid having any more children?
YES 1
NO 2
03. PILL, MAYA: Women can take a pill every day.
YES 1
NO 2
04. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05. INJECTIONS: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
06. IMPLANTS, NORPLANTS: 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
07. CONDOM, RAJA: Men can put a rubber sheath on their penis before sexual intercourse.
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. LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeed frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303A. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 304)
AT LEAST ONE 'YES' (EVER USED) (GO TO 306A)

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

YES 1 (GO TO 306)
NO 2

305. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 328)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY)

306A. 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?

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
LACTATIONAL AMENORRHEA METHOD 11
OTHER METHOD (SPECIFY) 96

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

IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

308. CHECK 303 (01):

WOMAN NOT STERILIZED (GO TO 308A)
WOMAN STERILIZED (GO TO 311A)

308A. CHECK 106A:

CURRENTLY MARRIED (GO TO 309)
WIDOWED OR DIVORCED (GO TO 319)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 319)

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

YES 1
NO 2 (GO TO 319)

311. Which method are you using?
311A. CIRCLE '01' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION 01 (GO TO 313)
MALE STERILIZATION 02 (GO TO 313)
PILL 03
IUD 04 (GO TO 318)
INJECTIONS 05 (GO TO 318)
IMPLANTS 06 (GO TO 318)
CONDOM 07 (GO TO 312C)
PERIODIC ABSTINENCE 09 (GO TO 318)
WITHDRAWAL 10 (GO TO 318)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 318)
OTHER (SPECIFY) 96 (GO TO 318)

312A. May I see the package of pills that you are using now?
RECORD NAME OF BRAND IF PACKAGE IS SEEN

PACKAGE SEEN 1 (GO TO 318)
BRAND NAME ___
PACKAGE NOT SEEN 2

312B. SHOW BRAND CHART FOR PILLS: Please tell me which of these is the brand of pills that you are using.

BRAND NAME ___ (GO TO 318)
DOES NOT KNOW 98 (GO TO 318)

312C. May I see the package of condoms that you are using now?
RECORD NAME OF BRAND IF PACKAGE IS SEEN.

PACKAGE SEEN 1 (GO TO 318)
BRAND NAME ___
PACKAGE NOT SEEN 2

312D. SHOW BRAND CHART FOR CONDOMS: Please tell me which of these ist he brand of condoms that you are using.

BRAND NAME ___ (GO TO 318)
DOES NOT KNOW 98 (GO TO 318)

313. Where did the sterilization take place?

NAME OF PLACE ___
PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
NGO SECTOR
NGO STATIC CLINIC 21
NGO SATELLITE CLINIC 22
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
QUALIFIED DOCTOR 32
OTHER (SPECIFY) 96
DON'T KNOW 98

314. CHECK 311:

CODE '1' CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

CODE '2' CIRCLED: Before the sterilization operation, was your husband told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
CANNOT REMEMBER OR DON'T KNOW 8

315A. Do you regret that (you or your husband) had the operation not to have any more children?

YES 1
NO 2 (GO TO 316)

315B. 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

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

MONTH ___
YEAR ___

317. CHECK 316:

STERILIZED BEFORE APRIL 1994 (BAISHAK 1401): ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO APRIL 1994 (BAISHAK 1401) (GO TO 320)

STERILIZED AFTER APRIL 1994 (BAISHAK 1401): 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. ENTER METHOD OF SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH OF DATE OF OPERATION. (GO TO 319)

318. CHECK 311: IN CURRENT MONTH IN COLUMN 1 OF CALENDAR, ENTER CALENDAR METHOD CODE SHOWN TO THE LEFT OF THE CALENDAR FOR THE HIGHEST METHOD CIRCLED IN 311. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE. IF CURRENT METHOD STARTED IN APRIL 1994 (BAISHAK 1401) OR LATER, ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN THE SAME MONTH THAT USE OF CURRENT METHOD BEGAN.

ILLUSTRATIVE QUESTIONS:

When did you start using this method continuously?
How long have you been using this method continuously?
When you started using this method, where did you obtain it?

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

USE CALENDAR TO PROBE FOR EARLIER PERIOD OF USE AND NONUSE, STARTING WITH MORE RECENT USE, BACK TO APRIL 1994 (BAISHAK 1401). USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

ILLUSTRATIVE QUESTIONS FOR COLUMN 1:

When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS FOR COLUMN 2:

Where did you obtain the method when you started using it?
Where did you get advice on how to use the method (for LAM, rhythm, or withdrawal)?

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE THE 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 FOR COLUMN 3:

Why did you stop using the (METHOD)?
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

320. CHECK 311 OR 311A:

CIRCLE METHOD CODE:

NO CODE CIRCLED 00 (GO TO 328)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 325A)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07 (GO TO 325A)
PERIODIC ABSTINENCE 09 (GO TO 325A)
WITHDRAWAL 10 (GO TO 325A)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 324)
OTHER METHOD 96 (GO TO 325A)

321. CHECK COLUMN 1 OF CALENDAR FOR MONTH STARTED USING CURRENT METHOD:

STARTED USING AFTER APRIL 1994 (BAISHAK 1401) (GO TO 322)
STARTED USING BEFORE APRIL 1994 (BAISHAK 1401) (GO TO 326)

322. You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 325)
DON'T KNOW 8 (GO TO 325)

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

YES 1 (GO TO 325)
NO 2 (GO TO 325)

324. CHECK COLUMN 1 OF CALENDAR FOR MONTH STARTED USING CURRENT METHOD:

STARTED USING AFTER APRIL 1994 (BAISHAK 1401) (GO TO 325)
STARTED USING BEFORE APRIL 1994 (BAISHAK 1401) (GO TO 326)

325. CHECK 320:

ANY CODE '01'-'06' CIRCLED: At that time, were you told about other methods of family planning which you could use?

CODE '11' CIRCLED: You first obtained advice for (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about other methods of family planning which you could use?

YES 1
NO 2

325A. You had told me that you are currently using family planning. Would you say that using family planning is mainly your decision, mainly your husband's decision or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER (SPECIFY) 6

326. CHECK 311 AND 311A:

CIRCLE METHOD CODE:

FEMALE STERILIZATION 01 (GO TO 327C)
MALE STERILIZATION 02 (GO TO 330)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
PERIODIC ABSTINENCE 09 (GO TO 328)
WITHDRAWAL 10 (GO TO 328)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 328)
OTHER METHOD 96 (GO TO 328)

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

NAME OF PLACE ___
PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
GOVERNMENT FIELD WORKER (FWA) 16
NGO SECTOR
NGO STATIC CLINIC 21
NGO SATELLITE CLINIC 22
NGO DEPOT HOLDER 23
NGO FIELDWORKER 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
OTHER PRIVATE SECTOR
SHOP 41
FRIEND OR RELATIVES 42
OTHER (SPECIFY) 96
DON'T KNOW 98

327A. CHECK 311 AND 311A:

USING PILL OR CONDOMS (GO TO 327B)
USING ANOTHER METHOD (GO TO 327C)

327B. Who obtained the (pills or condoms) the last time you got them?

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

327C. Are you having any problems in using (CURRENT METHOD)?

YES 1
NO 2 (GO TO 330)

327D. What problems are you having with using (CURRENT METHOD)?

WEIGHT GAIN A (GO TO 330)
WEIGHT LOSS B (GO TO 330)
TOO MUCH BLEEDING C (GO TO 330)
HYPERTENSION D (GO TO 330)
HEADACHE E (GO TO 330)
NAUSEA F (GO TO 330)
NO MENSTRUATION G (GO TO 330)
WEAK OR TIRED H (GO TO 330)
DIZZINESS I (GO TO 330)
HUSBAND DISAPPROVES J (GO TO 330)
OTHER RELATIVE DISAPPROVES L (GO TO 330)
ACCESS OR AVAILABILITY M (GO TO 330)
COSTS TOO MUCH N (GO TO 330)
INCONVENIENT TO USE O (GO TO 330)
STERILIZED, WANTS CHILDREN P (GO TO 330)
ABDOMINAL PAIN Q (GO TO 330)
OTHER (SPECIFY) X (GO TO 330)
DOES NOT KNOW Z (GO TO 330)

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

YES 1
NO 2 (GO TO 330)

329. 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 CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
GOVERNMENT FIELD WORKER (FWA) 16
NGO SECTOR
NGO STATIC CLINIC 21
NGO SATELLITE CLINIC 22
NGO DEPOT HOLDER 23
NGO FIELDWORKER 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
OTHER PRIVATE SECTOR
SHOP 41
FRIEND OR RELATIVES 42
OTHER (SPECIFY) 96
DON'T KNOW 98

330. CHECK 327 AND 329:

SATELLITE OR EPI OUTREACH NOT MENTIONED (GO TO 331)
SATELLITE OR EPI OUTREACH MENTIONED (GO TO 332)

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

YES 1
NO 2 (GO TO 334A)
DOES NOT KNOW 8 (GO TO 334A)

332. Did you visit such a temporary health clinic in the last 3 months?

YES 1
NO 2 (GO TO 334A)

333. What services did you receive?
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

334A. 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?
IF YES: Who came? Anyone else?
WRITE THE NAME AND WORKER IDENTIFICATION NUMBER OF THE FIELD WORKER.

NAME ___
IDENTIFICATION NUMBER ___
GOVERNMENT FP WORKER A
GOVERNMENT HEALTH WORKER B
NGO WORKER C
NO ONE Y (GO TO 335A)

334B. How many times did a worker or workers visit you for the family planning in the last six months?

TIMES ___
DOES NOT KNOW 8

334C. When was the last visit?

IF MORE THAN ONE WORKER VISITED: When did the last worker visit you?
IF LESS THAN ONE MONTH AGO, WRITE '0'.

MONTHS AGO ___
DOES NOT KNOW 8

335A. During the last six months has anyone visited you in your house to talk to you about your health or your child health or to give you any medicine such as vitamin A or ORS?
IF YES: Who came? Anyone else?
WRITE THE NAME AND WORKER IDENTIFICATION NUMBER OF THE FIELD WORKER.

NAME ___
IDENTIFICATION NUMBER ___
GOVERNMENT FP WORKER A
GOVERNMENT HEALTH WORKER B
NGO WORKER C
NO ONE Y (GO TO 336)

335B. How many times did a worker visit you for the health services in the last six months?

TIMES ___

335C. When was the last visit?

IF MORE THAN ONE WORKER VISITED: When did the last worker visit you?
IF LESS THAN ONE MONTH AGO, WRITE '0'.

MONTHS AGO ___
DOES NOT KNOW 8

336. CHECK 334A AND 335A:

BOTH FP AND HEALTH WORKER ('Y'S ARE NOT CIRCLED) (GO TO 337)
NEITHER HEALTH NOR FP WORKER ('Y'S ARE CIRCLED IN BOTH) (GO TO 338)
EITHER HEALTH OR FP WORKER ('Y' IS CIRCLED IN QUESTION 334A OR 335A) (GO TO 401)

337. Is he or she the same person who talked to you about family planning or gave you family planning method and talked to you about health or provided health services?

SAME 1 (GO TO 401)
DIFFERENT 2 (GO TO 401)
DOES NOT KNOW 8 (GO TO 401)

338. Did you discuss about family planning or health with a fieldworker in the last 6 months?

YES 1
NO 2 (GO TO 401)

338A. What did you discuss?

FAMILY PLANNING A
HEALTH B

339. When was the last time in the last 6 months you had contact with the fieldworker?
IF LESS THAN ONE MONTH AGO, WRITE '0'.

MONTHS AGO ___
DOES NOT KNOW 8

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. Now we will talk about possible problems that women might face when she is going to have a child. Please tell me what are the complications during pregnancy, childbirth and after delivery that needs medical treatment.
401A. Have you ever heard or (PROBLEMS)

1. SEVERE HEADACHE OR BLURRY VISION OR SWOLLEN ARMS AND LEGS
SPONTANEOUS YES 1
PROBED YES 2
NO 3
2. VAGINAL BLEEDING DURING PREGNANCY
SPONTANEOUS YES 1
PROBED YES 2
NO 3
3. LABOR FOR MORE THAN 18 HOURS
SPONTANEOUS YES 1
PROBED YES 2
NO 3
4. EXCESSIVE BLEEDING DURING OR AFTER DELIVERY
SPONTANEOUS YES 1
PROBED YES 2
NO 3
5. CONVULSION
SPONTANEOUS YES 1
PROBED YES 2
NO 3
6. FEVER FOR MORE THAN 3 DAYS DURING PREGNANCY OR AFTER DELIVERY
SPONTANEOUS YES 1
PROBED YES 2
NO 3
7. BAD SMELLING VAGINAL DISCHARGE
SPONTANEOUS YES 1
PROBED YES 2
NO 3
8. OTHERS (SPECIFY)
SPONTANEOUS YES 1
PROBED YES 2
NO 3

401B. CHECK 401 AND 401A:

AT LEAST ON '1' OR '2' CIRCLED (GO TO 401C)
NOT A SINGLE '1' OR '2' CIRCLED (GO TO 402A)

401C. Where can someone go to seek medical services for this (these) problem(s)? Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE A
FAMILY WELFARE CENTRE OR FWV B
THANA HEALTH COMPLEX C
SATELLITE CLINIC OR EPI OUTREACH SITE D
MATERNAL AND CHILD WELFARE CENTER (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
NGO SECTOR
NGO STATIC CLINIC G
NGO SATELLITE CLINIC H
NGO FIELDWORKER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC J
QUALIFIED DOCTOR K
TRADITIONAL DOCTOR L
PHARMACY M
OTHER (SPECIFY) X

402A. CHECK 215:

ONE OR MORE BIRTHS SINCE APRIL 1994 (BAISHAK 1401) (GO TO 402B)
NO BIRTHS SINCE APRIL 1994 (BAISHAK 1401) (GO TO 480A)

402B. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE APRIL 1994 OR BAISHAK 1401. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five 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, did you not want to have any (more) children at all?

FOR MOST RECENT BIRTH IN THE LAST FIVE YEARS:

THEN 1 (GO TO 406A)
LATER 2
NO OR NO MORE 3 (GO TO 406A)

FOR PREVIOUS BIRTHS IN THE LAST FIVE YEARS:

THEN 1 (GO TO 420)
LATER 2
NO OR NO MORE 3 (GO TO 420)

406. How much longer would you like to have waited?

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

406A. During the time you were pregnant with (NAME) did you receive any TT injection?

YES 1
NO 2 (GO TO 406C)
DON'T KNOW 8 (GO TO 406C)

406B. How many TT injection did you receive during the pregnancy with (NAME OF LAST CHILD)?

NUMBER ___

406C. Before the pregnancy wit (NAME OF LAST CHILD) did you receive any TT injection?

YES 1
NO 2 (GO TO 406E)
DON'T KNOW 8 (GO TO 406E)

406D. How many TT injections did you have before this pregnancy?

NUMBER ___

406E. CHECK 406A AND 406C:
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)

'YES' IN EITHER 406A AND 406C (GO TO 406F)
'YES' NEITHER IN 406A AND 406 C (GO TO 407)

406F. Did you have an immunization card where TT injections are recorded?
IF YES: May I see it, please?

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 406H)
NO CARD 3 (GO TO 406H)

406G. COPY TT INJECTIONS DATE FOR EACH INJECTION FROM THE CARD.

A FIRST TT INJECTION?
DATE ___
MONTH ___
YEAR ___
B. SECOND TT INJECTION?
DATE ___
MONTH ___
YEAR ___
C. THIRD TT INJECTION?
DATE ___
MONTH ___
YEAR ___
D. FOURTH TT INJECTION?
DATE ___
MONTH ___
YEAR ___
E. FIFTH TT INJECTION?
DATE ___
MONTH ___
YEAR ___

SUM ANSWER TO 406 B AND 406 D AND COMPARE WITH NUMBER OF TT INJECTION IN CARD. IF NUMBER ARE DIFFERENT, PROBE AND RECONCILE. (GO TO 407)

406H. You have mentioned that you received (NUMBER OF TT INJECTION IN QUESTION 406 B) TT injection during pregnancy with (NAME OF LAST CHILD). In what month(s) of pregnancy did you receive this (these) injections?
CODE 1 TO 9 FOR EACH INJECTION GIVEN, '0' FOR MONTH NOT KNOWN.

FRIST INJECTION
MONTH OF PREGNANCY ___
SECOND INJECTION
MONTH OF PREGNANCY ___
NOT APPLICABLE 98

407. When you were pregnant with (NAME), did you see anyone for a medical checkup, for example, antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
QUALIFIED DOCTOR A (GO TO 408)
NURSE OR MIDWIFE B (GO TO 408)
FAMILY WELFARE VISITOR C (GO TO 408)
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT (TTBA) D (GO TO 408)
UNTRAINED TRADITIONAL BIRTH ATTENDANT E (GO TO 408)
UNQUALIFIED DOCTOR F (GO TO 408)
OTHER (SPECIFY) X (GO TO 408)
NO ONE Y

407A. Why did you not see anyone? Any other reason?
RECORD ALL MENTIONED.

TOO FAR A (GO TO 412A)
INCONVENIENT SERVICE HOUR B (GO TO 412A)
UNPLEASANT STAFF BEHAVIOUR C (GO TO 412A)
LACK OF PROVIDER EXPERTISE D (GO TO 412A)
LACK OF PRIVACY E (GO TO 412A)
INADEQUATE DRUG SUPPLY F (GO TO 412A)
LONG WAITING TIME G (GO TO 412A)
SERVICE TOO EXPENSIVE H (GO TO 412A)
RELIGIOUS REASONS I (GO TO 412A)
NOT BENEFICIAL OR NEEDED J (GO TO 412A)
DID NOT KNOW OF NEED FOR SERVICE K (GO TO 412A)
WAS UNABLE OR NOT PERMITTED TO GO OUT OF THE HOUSE L (GO TO 412A)
DID NOT KNOW OF EXISTENCE M (GO TO 412A)
OTHER (SPECIFY) (GO TO 412A)

408. How many months pregnant were you when you first received medical checkup, for example, antenatal care for this pregnancy?

MONTHS ___
DON'T KNOW 8

409. How many times did you receive medical checkup during this pregnancy?

NUMBER OF TIMES ___
DON'T KNOW 98

410. CHECK 409:
NUMBER OF TIMES RECEIVED MEDICAL CHECKUP (i.e. ANTENATAL CARE).

ONCE (GO TO 412A)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

411. How many months pregnant were you the last time your received medical checkup, for example, antenatal care?

MONTHS ___
DON'T KNOW 8

412A. During this pregnancy, were you weighed at least once?

YES 1
NO 2
DON'T KNOW 8

412B. During this pregnancy, was your height measured?

YES 1
NO 2
DON'T KNOW 8

412C. During this pregnancy, did anyone take your blood pressure (put a cuff on your arm and pump air into it)?

YES 1
NO 2
DON'T KNOW 8

412D. When you were pregnant with (NAME), did anyone take your urine for testing?

YES 1
NO 2
DON'T KNOW 8

412E. When you were pregnant with (NAME), did anyone take your blood for testing?

YES 1
NO 2
DON'T KNOW 8

412F. When you were pregnant with (NAME), did anyone check or exam your eye for anemia?

YES 1
NO 2
DON'T KNOW 8

413. When you were pregnant with (NAME) were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 416)
DON'T KNOW 8 (GO TO 416)

414. Were you told where to go if you had these complications?

YES 1
NO 2
DON'T KNOW 8

416. Did you take any iron tablet or iron syrup during this pregnancy?
SHOW TABLET OR SYRUP.

YES 1
NO 2
DON'T KNOW 8

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

Long labor, that is, did your regular contractions last more than 18 hours?
YES 1
NO 2
DON'T KNOW 8
Excessive bleeding that was so much that you feared it was life threatening?
YES 1
NO 2
DON'T KNOW 8
A high fever with bad smelling vaginal discharge?
YES 1
NO 2
DON'T KNOW 8
Convulsions?
YES 1
NO 2
DON'T KNOW 8
Baby's hands and feet came first during delivery?
YES 1
NO 2
DON'T KNOW 8

420A. CHECK 420:

AT LEAST ONE 'YES' (GO TO 421)
NOT A SINGLE 'YES' (GO TO 422)

421. Did you seek any assistance for this complication?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

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

421A. When you had this complication did your husband become concerned?

YES 1
NO 2

421B. When you had this complication, did your mother-in-law become concerned?

YES 1
NO 2
NOT APPLICABLE 8

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

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

423. When (NAME) was born, was your husband around?

YES 1
NO 2

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

HEALTH PROFESSIONAL
QUALIFIED DOCTOR A
NURSE OR MIDWIFE B
FAMILY WELFARE VISITOR C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT (TTBA) D
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
UNQUALIFIED DOCTOR F
RELATIVES G
OTHER (SPECIFY) Z
NO ONE Z

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

HOME
OWN HOME 11 (GO TO 428)
OTHER HOME 12 (GO TO 428)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
THANA HEALTH COMPLEX 22
MATERNAL AND CHILD WELFARE CENTER (MCWC) 23
NGO SECTOR
NGO STATIC CLINIC 31
PRIVATE SECTOR
PRIVATE HOSPITAL OR CLINIC 41
OTHER (SPECIFY) 96 (GO TO 428)

427. Was (NAME) delivered by caesarian section?

YES 1 (GO TO 432)
NO 2 (GO TO 432)

428. After (NAME) was born, did any medical persons check on your health?

YES 1
NO 2 (GO TO 432)

429. How many days or weeks after the delivery did the first check takes place?
RECORD '00' DAYS IF SAME DAY

DAYS AFTER DELIVERY 1 ___
WEEKS AFTER DELIVERY 2 ___
DON'T KNOW 998

430. Who check on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
QUALIFIED DOCTOR A
NURSE OR MIDWIFE B
FAMILY WELFARE VISITOR C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
UNQUALIFIED DOCTOR F
OTHER (SPECIFY) X

431. Where did this first check take place?

HOME
OWN HOME 01
OTHER HOME 02
PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE 11
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
NGO SECTOR
NGO STATIC CLINIC 21
NGO SATELLITE CLINIC 22
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
OTHER (SPECIFY) 96

432. In the first two months after delivery, did you take a Vitamin A capsule like this?
SHOW CAPSULE.

YES 1
NO 2

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

YES 1 (GO TO 435)
NO 2 (GO TO 436)

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

YES 1
NO 2 (GO TO 438)

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

MONTHS ___
DON'T KNOW 98

436. CHECK 226:
RESPONDENT PREGNANT?

NOT PREGNANT OR UNSURE (GO TO 437)
PREGNANT (GO TO 438)

437. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 439)

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

MONTHS ___
DON'T KNOW 98

439. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 444)

440. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD "00" HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

441. CHECK 404:

CHILD ALIVE?

ALIVE (GO TO 442)
DEAD (GO TO 443)

442. Are you still breastfeeding (NAME)?

YES 1 (GO TO 445)
NO 2

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

MONTHS ___
DON'T KNOW 98

444. CHECK 404:

ALIVE (GO TO 337)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 451)

445. 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 ___

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

NUMBER OF DAYTIME FEEDINGS ____

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

YES 1
NO 2
DON'T KNOW 8

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

Plain water?
YES 1
NO 2
Sugar water or honey or juice?
YES 1
NO 2
Baby or infant formula?
YES 1
NO 2
Cow's or goat's milk?
YES 1
NO 2
Other liquids?
YES 1
NO 2
Banana or papaya or mango?
YES 1
NO 2
Green leafy vegetables?
YES 1
NO 2
Rice, wheat or porridge?
YES 1
NO 2
Meat or fish or eggs?
YES 1
NO 2
Dai?
YES 1
NO 2
Other (specify)?
YES 1
NO 2

450. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 451.

SECTION 4B, IMMUNIZATION AND HEALTH

451. ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE APRIL 1994 (BAISHAK 1401) IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN TWO BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

452. LINE NUMBER FROM QUESTION 212:

LINE NUMBER ___

453. FROM QUESTIONS 212 AND 216:

NAME ___
ALIVE (GO TO 454)
DEAD (GO TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 480)

454. Did (NAME) receive a Vitamin A dose like this during the last 6 months?
SHOW CAPSULE

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN 1 (GO TO 457)
YES, NOT SEEN 2 (GO TO 459)
NO CARD 3

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

YES 1 (GO TO 459)
NO 2 (GO TO 459)

457. COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

WRITE "44" IN "DAY" COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ___
MONTH ___
YEAR ___
POLIO 1
DAY ___
MONTH ___
YEAR ___
POLIO 2
DAY ___
MONTH ___
YEAR ___
POLIO 3
DAY ___
MONTH ___
YEAR ___
DPT 1
DAY ___
MONTH ___
YEAR ___
DPT 2
DAY ___
MONTH ___
YEAR ___
DPT 3
DAY ___
MONTH ___
YEAR ___
MEASLES
DAY ___
MONTH ___
YEAR ___

457A. Did you child (NAME) receive any polio vaccine from National Immunization Day (NID)?

IF YES: How many times did you receive from NID campaign?

RECORD '0' IF NOT RECEIVED

TIMES ___

458. Has (NAME) received any vaccinations that were not recorded on this card?

RECORD "YES" ONLY IF RESPONDENT MENTIONS BCG, POLIO1-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE "66" IN THE CORRESPONDING DAY IN 457) (GO TO 463)
NO 1 (GO TO 463)
DON'T KNOW 8 (GO TO 463)

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

YES 1
NO 2 (GO TO 463)
DON'T KNOW 8 (GO TO 463)

460. Please tell me if (NAME) received any of the following vaccinations:

460A. A bcg vaccination against tuberculosis, that is, and injection in the left shoulder that caused a scar?

YES 1
NO 2

460B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 460E)
DON'T KNOW 8 (GO TO 460E)

460C. How many times did (NAME) receive polio vaccine:

From clinic?
TIMES FROM CLINIC ___
From NID?
TIMES FROM NID ___

460D. When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

460E. DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 460G)
DON'T KNOW 8 (GO TO 460G)

460F. How many times?

NUMBER OF TIMES ___

460G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)

465. In the last 2 weeks, did (NAME) had:

Cough?
YES 1
NO 2
Rapid breathing?
YES 1
NO 2
Difficulty in breathing?
YES 1
NO 2
Chest in drawing?
YES 1
NO 2
Fever?
YES 1
NO 2

466. CHECK 463 AND 464:

FEVER OR COUGH?

"YES" IN 463 OR 464 (GO TO 467)
OTHER (GO TO 472)

467. Did you seek advice or treatment for (NAME) for the illness?

YES 1
NO 2 (GO TO 472)

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

PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE A
FAMILY WELFARE CENTRE OR FWV B
THANA HEALTH COMPLEX C
SATELLITE CLINIC OR EPI OUTREACH SITE D
MATERNAL AND CHILD WELFARE CENTER (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
NGO SECTOR
NGO STATIC CLINIC G
NGO SATELLITE CLINIC H
NGO FIELDWORKER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC J
QUALIFIED DOCTOR K
TRADITIONAL DOCTOR L
PHARMACY M
OTHER (SPECIFY) X

472. Has (NAME) had diarrhea is the last 2 weeks?

YES 1
NO 2 (GO TO 480)
DON'T KNOW 8 (GO TO 480)

473. When (NAME) had diarrhea, was he or she offered the same amount to drink, more than usual to drink, or less than usual to drink?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

474. Was he or she offered the same amount to eat, more than usual to eat or less than usual to eat?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

475. 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
DON'T KNOW 8
Home-made sugar-salt-water solution (laban gur)?
YES 1
NO 2
DON'T KNOW 8
Water?
YES 1
NO 2
DON'T KNOW 8
Any other liquids?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 478)
DON'T KNOW 8 (GO TO 478)

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

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

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

YES 1
NO 2 (GO TO 480)

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

PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE A
FAMILY WELFARE CENTRE OR FWV B
THANA HEALTH COMPLEX C
SATELLITE CLINIC OR EPI OUTREACH SITE D
MATERNAL AND CHILD WELFARE CENTER (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
NGO SECTOR
NGO STATIC CLINIC G
NGO SATELLITE CLINIC H
NGO FIELDWORKER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC J
QUALIFIED DOCTOR K
TRADITIONAL DOCTOR L
PHARMACY M
OTHER (SPECIFY) X

480. GO BACK TO 453 IN NEXT COLUMN; OR IF NOW MORE BIRTHS, GO TO 480A.

480A. CHECK 208 AND 226:

HAS ONE OR MORE CHILDREN AND/OR CURRENTLY PREGNANT (GO TO 480B)
NEITHER HAS ANY LIVING CHILDREN NOR CURRENTLY PREGNANT (GO TO 501)

480B. Many different factors can prevent women getting medical attention during the pregnancy and child birth. Sometimes women might have life threatening or serious situation during the pregnancy and childbirth. When you need medical advice or treatment for such situation, is each of the following a problem or no problem for you?

Knowing where to go.
PROBLEM 1
NO PROBLEM 2
Not having a health facility nearby.
PROBLEM 1
NO PROBLEM 2
Going to health center.
PROBLEM 1
NO PROBLEM 2
Lack of confidence on source or services.
PROBLEM 1
NO PROBLEM 2
Getting permission to go.
PROBLEM 1
NO PROBLEM 2
Getting money needed for treatment.
PROBLEM 1
NO PROBLEM 2
Getting someone to accompany.
PROBLEM 1
NO PROBLEM 2

SECTION 5. MARRIAGE

501. 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

501A. CHECK 106A:

CURRENTLY MARRIED (GO TO 505)
NOT CURRENTLY MARRIED (GO TO 507)

505. Is your husband staying with you now or is he staying elsewhere?

STAYING WITH HER 1
STAYING ELSEWHERE 2

506. RECORD THE HUSBAND'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ___
LINE NUMBER ___

507. Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

508. CHECK 507:

MARRIED ONLY ONCE: In what month and year did you start living with your husband?

MARRIED MORE THAN ONCE: Now we will talk about your first husband. In what month and year did you start living with him?

MONTHS ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 510)
DON'T KNOW YEAR 9998

509. How old were you when you started living with him?

AGE ___

510. DETERMINE MONTHS MARRIED SINCE APRIL 1994 OR BAISHAK 1401. ENTER "X" IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE APRIL 1994 (BAISHAK 1401).

FOR WOMEN WITH MORE THAN ONE MARRIAGE: PROBE FOR STARTING AND TERMINATION DATES OF ANY PERVIOUS UNIONS.

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

SECTION 6. FERTILITY PREFERENCES

601A. CHECK 106A:

CURRENTLY MARRIED (GO TO 601B)
NOT CURRENTLY MARRIED (GO TO 614)

601B. CHECK 311 AND 311A:

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

602. CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some questions about the future. Would you like to have (a or 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 now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A OR ANOTHER) CHILD 1
NO MORE OR NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 609)
UNDECIDED OR DON'T KNOW 8 (GO TO 609)

603. CHECK 226:

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

PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 ___
YEARS 2 ___
SOON OR NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 609)
OTHER (SPECIFY) 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 614)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

WANTS A OR ANOTHER CHILD(REN): You said that you do not want (a or another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why?

WANTS NO MORE CHILDREN: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why?
RECORD ALL MENTIONED.

FERTILITY-RELATED REASONS
NOT HAVING SEX A
INFREQUENT SEX B
MENOPAUSAL OR HYSTERECTOMY C
SUB FECUND OR INFECUND D
POSTPARTUM AMENORRHEIC E
BREASTFEEDING F
FATALISTIC G
OPPOSITION TO USE
RESPONDENT OPPOSED H
HUSBAND OPPOSED I
OTHERS OPPOSED J
RELIGIOUS PROHIBITION K
LACK OF KNOWLEDGE
KNOWS NO METHOD L
KNOWS NO SOURCE M
METHOD-RELATED REASONS
HEALTH CONCERNS N
REAR OF SIDE EFFECTS O
LACK OF ACCESS OR TOO FAR P
COST TOO MUCH Q
INCONVENIENT TO USE R
INTERFERES WITH BODY'S NORMAL PROCESSES S
OTHER (SPECIFY) X
DON'T KNOW Z

609. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 610)
NOT CURRENTLY USING (GO TO 610)
CURRENTLY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611. Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTIONS 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
PERIODIC ABSTINENCE 09 (GO TO 614)
WITHDRAWAL 10 (GO TO 614)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 614)
OTHER METHOD (SPECIFY) 96 (GO TO 614)
UNSURE 98 (GO TO 614)

612. What is the main reason that you will not use a method at any time in the future?

FERTILITY-RELATED REASONS
NOT HAVING SEX 11
INFREQUENT SEX 12
MENOPAUSAL OR HYSTERECTOMY 13
SUB FECUND OR INFECUND 14
POSTPARTUM AMENORRHEIC 15
BREASTFEEDING 16
FATALISTIC 17
OPPOSITION TO USE
RESPONDENT OPPOSED 21
HUSBAND OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
LACK OF KNOWLEDGE
KNOWS NO METHOD 31
KNOWS NO SOURCE 32
METHOD-RELATED REASONS
HEALTH CONCERNS 41
REAR OF SIDE EFFECTS 42
LACK OF ACCESS OR TOO FAR 43
COST TOO MUCH 45
INCONVENIENT TO USE 46
INTERFERES WITH BODY'S NORMAL PROCESSES 47
OTHER (SPECIFY) 96
DON'T KNOW 98

614. CHECK 216:

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

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

NUMBER ___
OTHER (SPECIFY) 96 (GO TO 616)

615. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?

NUMBER OF BOYS ___
NUMBER OF GIRLS ___
EITHER ___
OTHER (SPECIFY) 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW OR UNSURE 8

617. Have you ever seen or heard of the Green Umbrella logo?

YES 1
NO 2 (GO TO 619)
DON'T KNOW 8 (GO TO 619)

618. What does the Green Umbrella logo mean to you?
CIRCLE ALL MENTIONED.

FAMILY PLANNING RELATED A
NOT FAMILY PLANNING RELATED B
HEALTH SERVICE RELATED C
DON'T KNOW OR UNSURE D

619. In the last month have you heard about family planning:

On the radio?
OFTEN 1
SOMETIMES 2
NEVER 3
On the television?
OFTEN 1
SOMETIMES 2
NEVER 3
In a newspaper or magazine?
OFTEN 1
SOMETIMES 2
NEVER 3
From a poster of billboard?
OFTEN 1
SOMETIMES 2
NEVER 3
From a leaflet?
OFTEN 1
SOMETIMES 2
NEVER 3
From a community events?
OFTEN 1
SOMETIMES 2
NEVER 3

619A. CHECK 106A:

CURRENTLY MARRIED (GO TO 620)
NOT CURRENTLY MARRIED (GO TO 701)

620. Now I want to ask you about your husband's views 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. How often have you talked to your husband about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 8

622. 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

SECTION 7. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

YES 1
NO 2 (GO TO 718)

701A. From which sources of information have you learned most about AIDS? Any other sources? RECORD ALL MENTIONED.

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

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

YES 1
NO 2 (GO TO 710)
DON'T KNOW 8 (GO TO 710)

703. What can a person do? Anything else?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX WITHIN MARRIAGE C
LIMIT SEX WITH TRUSTED PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID UNSAFE BLOOD TRANSFUSIONS I
AVOID UNSTERILIZED INJECTIONS OR USE DISPOSABLE INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BIRTHS L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZORS OR BLADES N
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z

704. CHECK 703:

NEITHER CODE 'C' NOR CODE 'D' CIRCLED (GO TO 705)
CODE 'C' AND/OR CODE 'D' CIRCLED (GO TO 707)

705. In your opinion, is there any chance of getting AIDS for a person with multiple sexual partners?

YES 1
NO 2 (GO TO 707)
DON'T KNOW 8 (GO TO 707)

706. If a person has sex with only one partner, does this person have a greater or a lesser chance of getting AIDS than a person who has sex with many partners?

GREATER CHANCE OF AIDS 1
LESSER CHANCE OF AIDS 2
DON'T KNOW 8

707. CHECK 703:

DID NOT MENTION USE OF CONDOMS DURING SEX (CODE 'B' NOT CIRCLED) (GO TO 709)
MENTIONED USE OF CONDOMS DURING SEX (CODE 'B' CIRCLED) (GO TO 710)

709. If a person uses a condom every time he or she has sexual intercourse, does this person have a greater or a lesser chance of getting AIDS than someone who does not use a condom?

GREATER CHANCE OF AIDS 1
LESSER CHANCE OF AIDS 2
DON'T KNOW 8

710. Is it possible for a health-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

714. CHECK 106A:

YES, CURRENTLY MARRIED (GO TO 715)
NOT CURRENTLY MARRIED (GO TO 718)

715. Have you ever talked about ways to prevent getting the virus that causes AIDS with your husband?

YES 1
NO 2

718. (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 721)

719. In a man, what signs and symptoms would lead you to think that he has such an infection? Any others?
RECORD ALL MENTIONED.

LOWER ABDOMINAL PAIN A
DISCHARGE FROM PENIS OR DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS OR INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES OR ULCERS G
GENITAL WARTS H
BLOOD IN URINE I
LOSS OF WEIGHT J
IMPOTENCE K
NO SYMPTOMS L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z

720. In a woman, what signs and symptoms would lead you to think that she has such an infection? Any others?
RECORD ALL MENTIONED.

LOWER ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS OR INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES OR ULCERS G
GENITAL WARTS H
BLOOD IN URINE I
LOSS OF WEIGHT J
INABILITY TO GIVE BIRTH K
NO SYMPTOMS L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z

721. Now I would like to ask you about some health symptoms you yourself may have. During the past 6 months, have you had any of the following problems:

1. Any itching or irritation in vaginal area with discharge?
YES 1
NO 2
2. A genital sore or ulcer?
YES 1
NO 2
3. A bad odor along with a discharge?
YES 1
NO 2
4. Severe lower abdominal pain with a discharge, not related with menstruation?
YES 1
NO 2
5. A fever along with a discharge?
YES 1
NO 2
6. Problem with pain or burning while urinating or more frequent or difficult urination?
YES 1
NO 2

FOR CURRENTLY MARRIED:

7. Pain in abdomen or vagina during intercourse?
YES 1
NO 2
8. Blood after having sex when you are not menstruating?
YES 1
NO 2
9. Any other problem with a discharge?
YES 1
NO 2

726. CHECK 721:

AT LEAST ONE "YES" (GO TO 727)
NOT A SINGLE "YES" (GO TO 801)

727. Have you seen anyone for advice or treatment to help you with (this or these) problem(s)?
IF YES, ASK: Whom did you see? Anyone else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL OR MEDICAL COLLEGE A
FAMILY WELFARE CENTRE OR FWV B
THANA HEALTH COMPLEX C
SATELLITE CLINIC OR EPI OUTREACH SITE D
MATERNAL AND CHILD WELFARE CENTER (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
NGO SECTOR
NGO STATIC CLINIC G
NGO SATELLITE CLINIC H
NGO FIELDWORKER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC J
QUALIFIED DOCTOR K
TRADITIONAL DOCTOR L
PHARMACY M
OTHER (SPECIFY) X
NO ONE Z

SECTION 8. HUSBAND'S BACKGROUND, WOMAN'S WORK

801. CHECK 106A:

CURRENTLY MARRIED (GO TO 802)
WIDOWED OR DIVORCED OR SEPARATED (GO TO 803)

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

AGE ___

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

YES 1
NO 2 (GO TO 806)
DON'T KNOW 8 (GO TO 806)

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

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

805. What was the highest (grade or form or year) he completed at that level?

GRADE ___
DON'T KNOW 98

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

___

807. Now I would like to ask you some questions about your work. Aside from your own housework, are you currently working?

YES 1 (GO TO 809)
NO 2

808. As you know, some women take up jobs for which they are paid in cash or kind. Others sell thing, 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 812)

809. What is your occupation, that is, what kind of work do (did) you mainly do?

___

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

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

811. Are you paid in cash or kind for this work or are you not paid?

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

812. Who in your family usually has the final say on the following decisions:

Your own health care?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
Child health care?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
Making large household purchases?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
Making household purchases for daily needs?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
Visits to family, friends, or relatives?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
What food should be cooked each day?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

812A. Do you think, if a woman faces complication during pregnancy, does her husband become concerned?

YES 1
NO 2
DON'T KNOW 8

813. 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 815)

814. 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 RELATIVES 4

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

YES, ALONE 1 (GO TO 817)
YES, WITH CHILDREN 2 (GO TO 817)
NO 3
OTHER (SPECIFY) 6 (GO TO 817)

816. Can you go outside the village or town or city along (or with your young children)?

YES, ALONE 1
YES, WITH CHILDREN 2
NO 3 (GO TO 818)
OTHER (SPECIFY) 6

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

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

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

YES, ALONE 1 (GO TO 8120)
YES, WITH CHILDREN 2 (GO TO 820)
YES, WITH HUSBAND 3 (GO TO 820)
NO 4
OTHER (SPECIFY) 6 (GO TO 820)

819. Can you go to a 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

820. RECORD THE TIME.

HOUR ___
MINUTES ___

SECTION 9. HEIGHT AND WEIGHT

901. CHECK 215:

ONE OR MORE BIRTHS SINCE APRIL 1994 (BAISHAK 1401) (GO TO 902)
NO BIRTH SINCE APRIL 1994 (BAISHAK 1401) (GO TO END)

IN 902 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE APRIL 1994 OR BAISHAK 1401 AND STILL ALIVE. IN 903 AND 904 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE APRIL 1994 (BAISHAK 1401). IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.

(NOT: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE APRIL 1994 OR BAISHAK 1401 SHOULD BE WEIGHED AND MEASURED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE APRIL 1994 OR BAISHAK 1401, USE ADDITIONAL QUESTIONNAIRES).

902. LINE NUMBER FROM QUESTION 212
(FOR LIVING CHILD(REN) BORN SINCE APRIL 1994)

___

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 APRIL 1994)

DAY___
MONTH ___
YEAR ___

905. BCG SCAR ON TOP LEFT SHOULDER
(FOR LIVING CHILD(REN) BORN SINCE APRIL 1994)

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 APRIL 1994)

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):
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: ______

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
H HYSTERECTOMY
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALES STERILIZATION
3 PILL
4 IUD
5 INJECTIONS
6 IMPLANTS
7 CONDOM
9 LACTATIONAL AMENORRHEA METHOD
A PERIODIC ABSTINENCE
W WITHDRAWAL
X OTHER (SPECIFY)

COLUMN 2: SOURCE OF CONTRACEPTION

1 HOSPITAL OR MEDICAL COLLEGE
2 FAMILY WELFARE CENTER
3 THANA HEALTH COMPLEX
4 SATELLITE OR EPI CLINIC
5 PRIVATE CLINIC OR DOCTOR
6 TRADITIONAL DOCTOR
7 PHARMACY
8 SHOP
9 FRIENDS OR RELATIVES
A FIELD WORKER OR FWA
B SHOP
C NGO CLINIC
X OTHER (SPECIFY)

COLUMN 3 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 4 MARRIAGE OR UNION

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

TERMINATION OF LAST PREGNANCY PRIOR TO APRIL 1994
IF NO PREVIOUS PREGNANCY, RECORD '00' FOR MONTH AND '0000' FOR YEAR

MONTH ___
YEAR ___

1407

BAISHAK 00 _ _ _ _

1406

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 _ _ _ _

1405

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 _ _ _ _

1404

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 _ _ _ _

1403

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 _ _ _ _

1402

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 _ _ _ _

1401

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 _ _ _ _

2000

04 APR 00 _ _ _ _
03 MAR 01 _ _ _ _
02 FEB 02 _ _ _ _
01 JAN 03 _ _ _ _

1999

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 _ _ _ _

1998

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 _ _ _ _

1997

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 _ _ _ _

1996

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 _ _ _ _

1995

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 _ _ _ _

1994

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 _ _ _ _

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
NAME OF EDITOR:
DATE: