DIVISION
DISTRICT
UPAZILA
VILLAGE OR MOHALLA OR BLOCK
CLUSTER NUMBER
HOUSEHOLD NUMBER
RURAL OR MUNICIPALITY OR OTHER URBAN OR SMA?
MUNICIPALITY 2
OTHER URBAN 3
SMA 4
NAME AND LINE NUMBER OF ELIGIBLE WOMAN ___
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
RESPONDENT INCAPACITATED 6
OTHER (SPECIFY) 7
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
RESPONDENT INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
RESPONDENT INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY
MONTH
FEBRUARY 02
MARCH 03
APRIL 04
MAY 05
JUNE 06
JULY 07
AUGUST 08
SEPTEMBER 09
OCTOBER 10
NOVEMBER 11
DECEMBER 12
YEAR
CODE
RESULT
TOTAL NUMBER OF VISITS:
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?
May I begin the interview now?
Signature of interviewer ___
Date ___
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
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?
SMALL CITY 2
TOWN 3
VILLAGE 4
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
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?
SMALL CITY 2
TOWN 3
VILLAGE 4
105. In what month and year were you born?
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.
106A. Are you now married, separated, deserted, widowed, or divorced?
SEPARATED 2
DESERTED 3
DIVORCED 4
WIDOWED 5
NEVER MARRIED 6 (GO TO END)
106B. Do you have a marriage certificate or marriage registration?
NO 2
107. Have you ever attended school or madrasha?
YES, MADRASHA 2 (GO TO 108B)
YES, BOTH 3
NO 4 (GO TO 111)
108A. What type of schooling (NAME) have you last attended?
MADRASHA 2
108B. What level of school (NAME) have you last attended? What is the highest grade (NAME) completed at that schooling?
GRADE ___
GRADE IS 6 OR MORE THAN 6 (GO TO 112)
111. Can you read and write a letter in any language easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)
112. Do you usually read a newspaper or magazine?
NO 2 (GO TO 113)
112A. How often do you read newspaper or magazine: every day, at least once a week, or less than once a week?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
113. Do you listen to the radio?
NO 2 (GO TO 114)
113A. How often do you listen to the radio: every day, at least once a week, less than once a week?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NO 2 (GO TO 115)
114A. How often do you watch television: every day, at least once a week, less than once a week?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
HINDUISM 2
BUDDHISM 3
CHRISTIANITY 4
OTHER (SPECIFY) 6
118. Do you belong to any of the following organizations?
NO 2
NO 2
NO 2
NO 2
NO 2
119. CHECK QUESTION 5 IN THE HOUSEHOLD SECTION:
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?
SMALL CITY 2
TOWN 3
VILLAGE 4
121. In which division is that located?
DHAKA 2
CHITTAGONG 3
KHULNA 4
BARISAL 5
SYLHET 6
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?
IF TUBE WELL, PROBE
PIPED OUTSIDE DWELLING 12
SHALLOW TUBE WELL 22
DEEP TUBE WELL 23
SURFACE WELL OR OTHER WELL 24
RIVER OR STREAM 32
OTHER (SPECIFY) 96
123. What is the main source of drinking water for members of your household?
IF TUBE WELL, PROBE
PIPED OUTSIDE DWELLING 12
SHALLOW TUBE WELL 22
DEEP TUBE WELL 23
SURFACE WELL OR OTHER WELL 24
RIVER OR STREAM 32
OTHER (SPECIFY) 96
124. What kind of toilet facility does your household have?
PIT LATRINE 22
OPEN LATRINE 23
HANGING LATRINE 24
OTHER (SPECIFY) 96
126. Does your household (or any member of your household) have:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
127. What is the main material of the roof of your house?
128. What is the main material of the walls of your house?
TIN 32
129. What is the main material of the floor of your house?
130. Does your household own any homestead?
IF 'NO', PROBE: Does your household own homestead any other places?
NO 2
130A. Does your household own any land (other than the homestead land)?
NO 2 (GO TO 132)
131. How much land does your household own (other than the homestead land)?
DECIMALS ___
132. In terms of household food consumption, how do you classify your household: deficit in whole year; sometimes deficit; neither deficit nor surplus; surplus.
SOMETIMES DEFICIT 2
NEITHER DEFICIT NOT SURPLUS 3
SURPLUS 4
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
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?
NO 2 (GO TO 204)
203. How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.
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?
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?
IF NONE, RECORD '00'.
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 did not survive?
NO 2 (GO TO 208)
207. How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD ___
208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.
Just to make sure that I have this right: you have had in TOTAL ___ births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
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 BIRTH 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 or next) baby?
213. Were any of these births twins?
MULTIPLE 2
214. Is (NAME) a boy or a girl?
GIRL 2
215. In what month and year was (NAME) born?
YEAR ___
NO 2 (GO TO 220)
217. IF ALIVE: How old was (NAME) at his or her last birthday?
RECORD AGE IN COMPLETED YEARS.
218. IF ALIVE: Is (NAME) living with you?
NO 2
219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
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.
MONTHS 2 ___
YEARS 3 ___
221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
(ASK IF MORE THAN ONCE BIRTH)
NO 2
221A. IF DEAD: RECORD LINE NUMBER OF CHILD AS IN QUESTION 212 IF CHILD WAS BORN SINCE JUNE 1998.
222. Have you had any pregnancy outcome since the birth of (NAME OF LAST BIRTH)?
NO 2
223. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE THE SAME:
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 JUNE 1998.
IF NONE, RECORD '0'.
224A. CHECK 221A AND ENTER THE NUMBER OF BIRTH SINCE JUNE 1998 AND DEATHS OCCURRED SINCE JUNE 1998 FOR VERBAL AUTOPSY.
IF NONE, RECORD '0'.
225. FOR EACH BIRTH SINCE JUNE 1998, 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 OF '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.
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.
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?
LATER 2
NOT AT ALL 3
229. Have you ever had a pregnancy that miscarried, was aborted, or ended in a still birth or had a menstrual regulation?
NO 2 (GO TO 236)
230. When did the last such pregnancy end?
YEAR ___
LAST PREGNANCY ENDED BEFORE JUNE 1998 (GO TO 235)
231A. Was that a still birth, a miscarriage, a menstrual regulation, or an abortion?
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.
233. Have you ever had any other pregnancies which did not result in a live birth?
NO 2 (GO TO 235)
234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JUNE 1998.
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 JUNE 1998.
236. When did your last menstrual period start?
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
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)?
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
303. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
OTHER METHOD?
MENSTRUAL REGULATION MENTIONED (GO TO 303D)
303B. Have you ever heard of MR (menstrual regulation)? (MR means when a woman's menstrual period does not come on time, she can go to a health centre or to the FWV or to another provider and have a tube put in her for a short while to regularize her periods.)
NO 2 (GO TO 303D)
303C. Have you ever used MR (menstrual regulation)?
NO 2
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?
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?
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER METHOD (SPECIFY) 10
307. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.
WOMAN STERILIZED (GO TO 311A)
SEPARATED OR DESERTED OR DIVORCED OR WIDOWED (GO TO 319)
PREGNANT (GO TO 319)
310. Are you currently during something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 319)
311. Which method are you using?
311A. CIRCLE '01' FOR FEMALE STERILIZATION.
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 08 (GO TO 318)
WITHDRAWAL 09 (GO TO 318)
OTHER (SPECIFY) 10 (GO TO 318)
312A. May I see the package of pills that you are using now?
RECORD NAME OF BRAND IF PACKAGE IS SEEN.
312B. SHOW BRAND CHART FOR PILLS: Please tell me which of these is the brand of pills that you are using.
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.
312D. SHOW BRAND CHART FOR CONDOMS: Please tell me which of these is the brand of condoms that you are using.
DOES NOT KNOW 98 (GO TO 318)
313. Where did the sterilization take place?
FAMILY WELFARE CENTRE (FWC) 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
NGO SATELLITE CLINIC 22
QUALIFIED DOCTOR 32
DON'T KNOW 98
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?
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?
NO 2 (GO TO 316)
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?
YEAR ___
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 JUNE 1998 OR LATER, ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN THE SAME MONTH THAT USE OF CURRENT METHOD BEGAN.
ILLUSTRATIVE QUESTIONS:
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 question 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 PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JUNE 1998.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTHS.
ILLUSTRATIVE QUESTION:
COLUMN 1:
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:
COLUMN 2:
Where did you get advice on how to use the method (for rhythm or withdrawal)?
IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:
COLUMN 3:
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:
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.
CIRCLE METHOD CODE:
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 325A)
PILL 03
IUD 04
INJECTIONS 05
CONDOM 07 (GO TO 325A)
PERIODIC ABSTINENCE 08 (GO TO 325A)
WITHDRAWAL 09 (GO TO 325A)
OTHER METHOD (SPECIFY) 10 (GO TO 325A)
321. CHECK COLUMN 1 OF CALENDAR FOR MONTH STARTED USING CURRENT METHOD:
STARTED USING BEFORE JUNE 1998 (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?
NO 2 (GO TO 325)
DON'T KNOW 8 (GO TO 325)
323. Were you told what to do if you experience side effects or problems?
NO 2
ANY CODE '01' TO '06' CIRCLED: At that time, were you told about other methods of family planning which you could use?
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 HUSBAND 2
JOINT DECISION 3
OTHER (SPECIFY) 6
CIRCLE METHOD CODE:
MALE STERILIZATION 02 (GO TO 330)
PILL 03
IUD 04
INJECTIONS 05
CONDOM 07
PERIODIC ABSTINENCE 08 (GO TO 328)
WITHDRAWAL 09 (GO TO 328)
OTHER METHOD (SPECIFY) 10 (GO TO 328)
327. Where did you obtain (CURRENT METHOD) the last time?
FAMILY WELFARE CENTRE (FWC) 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
GOVERNMENT FIELDWORKER 16
COMMUNITY CLINIC 17
NGO SATELLITE CLINIC 22
NGO DEPOT HOLDER 23
NGO FIELDWORKER 24
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
FRIEND OR RELATIVES 42
DON'T KNOW 98
USING ANOTHER METHOD (GO TO 327C)
327B. Who obtained the (pills or condoms) the last time you got them?
HUSBAND 2
SON OR DAUGHTER 3
OTHER RELATIVE 4
OTHER (SPECIFY) 6
327C. Are you having any problems in using (CURRENT METHOD)?
NO 2 (GO TO 330)
327D. What problems are you having with using (CURRENT METHOD)?
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 K (GO TO 330)
RELIGION 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?
NO 2 (GO TO 330)
IF WOMAN SAYS MORE THAN ONE PLACE, ASK FOR THE PLACE SHE WOULD MOST LIKELY USE.
FAMILY WELFARE CENTRE (FWC) 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
GOVERNMENT FIELDWORKER 16
COMMUNITY CLINIC 17
NGO SATELLITE CLINIC 22
NGO DEPOT HOLDER 23
NGO FIELDWORKER 24
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
FRIEND OR RELATIVES 42
DON'T KNOW 98
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 or in a school. During the past 3 months, was there any such clinic in this village or mohalla?
NO 2 (GO TO 334A)
DON'T KNOW 8 (GO TO 334A)
332. Did you visit such a temporary health clinic in the last 3 months?
NO 2 (GO TO 334A)
333. What services did you receive?
CIRCLED ALL MENTIONED.
IMMUNIZATION B
CHILD GROWTH MONITORING C
T.T FOR PREGNANT WOMEN D
ANTENATAL CARE E
TT VACCINE FOR WOMEN AGE BETWEEN 15-45 YEARS F
VITAMIN 'A' FOR CHILDREN G
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 OF THE FIELD WORKER.
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?
DOES NOT KNOW 98
334C. When was the last visit?
IF MORE THAN ONE WORKER VISITED: When did the last worker visit you?
IF LES THAN ONCE MONTH AGO, WRITE '0'.
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 OF THE FIELD WORKER.
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?
DOES NOT KNOW 8
335C. When was the last visit?
IF MORE THAN ONCE WORKER VISITED (SEE 335A): When did the last worker visit you?
IF LESS THAN ONCE MONTHS AGO, WROTE '0'.
DOES NOT KNOW 8
OTHER RESPONSE (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?
DIFFERENT 2
DOES NOT KNOW 8
SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING
401. ASK QUESTIONS SEPARATELY FOR PREGNANCY, DELIVERY AND AFTER DELIVERY BUT RECORD RESPONSES IN SAME CODING CATEGORY.
What are the problems at the time of pregnancy that may cause death to the mother? Any other?
BLURRY VISION B
HIGH BLOOD PRESSURE C
PRE-ECLAMSIA D
CONVULSION OR ECLAMSIA E
EXCESSIVE VAGINAL BLEEDING F
FOUL-SMELLING DISCHARGE WITH HIGH FEVER G
JAUNDICE H
TETANUS I
BABY'S HAND OR FEET COME OR BABY IN BAD POSITION J
PROLONG LABOR K
OBSTRUCTED LABOR L
RETAINED PLACENTA M
TORNED UTERUS N
OTHER (SPECIFY) X
DON'T KNOW Y
NO BIRTHS SINCE JUNE 1998 (GO TO 501)
403. ENTER IN TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JUNE 1998. 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 212:
404. FROM QUESTION 212 AND 216:
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?
LATER 2 (GO TO 407)
NO OR NO MORE 3
406. How much longer would you like to have waited?
YEARS 2 ___
DON'T KNOW 998
407. When you were pregnant with (NAME), did you see anyone for a medical checkup i.e. antenatal care for this pregnancy?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
NURSE OR MIDWIFE OR PARAMEDIC B (GO TO 407B)
FAMILY WELFARE VISITOR C (GO TO 407B)
MA OR SACMO D (GO TO 407B)
HEALTH ASSISTANT (HA) E (GO TO 407B)
FAMILY WELFARE ASSISTANT (FWA) F (GO TO 407B)
UNTRAINED TRADITIONAL BIRTH ATTENDANT H (GO TO 407B)
UNQUALIFIED DOCTOR I (GO TO 407B)
NO ONE Y
407A. Why did you not see anyone? Any other reason?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
RECORD ALL MENTIONED.
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)
407B. When you were pregnant with (NAME), the first time you go for antenatal care because just to check everything was fine or you had a problem?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
TO CHECK ONLY 2
408. How many months pregnant were you when you first received medical checkup i.e. antenatal care for this pregnancy?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
DON'T KNOW 98
409. How many times did you receive medical checkup during this pregnancy?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
DON'T KNOW 98
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NUMBER OF TIMES RECEIVED MEDICAL CHECKUP (ANTENATAL CARE)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)
411. How many months pregnant were you the last time you received medical checkup i.e. antenatal care?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
DON'T KNOW ___
412A. During this pregnancy, were you weighed at least once?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
412B. During this pregnancy, was your height measured?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
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)?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
412D. When you were pregnant with (NAME), did anyone take your urine for testing?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
412E. When you were pregnant with (NAME), did anyone take your blood for testing?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
412F. When you were pregnant with (NAME), did anyone check or exam you eye for anemia?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
412G. When you were pregnant with (NAME). did you have an ultrasonography test?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
413. When you were pregnant with (NAME) were you told about the signs of pregnancy complications?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2 (GO TO 415)
DON'T KNOW 8 (GO TO 415)
414. Were you told where to go if you had these complications?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
415. During this pregnancy, were you given a TT injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2 (GO TO 416)
DON'T KNOW 8 (GO TO 416)
415A. During this pregnancy, how many times did you get this injection?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
DON'T KNOW 8
416. Did you take any iron tablet or iron syrup during this pregnancy?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
SHOW TABLET OR SYRUP.
NO 2
DON'T KNOW 8
417. Around the time of the birth (NAME), did you have any of the following problems:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NOT A SINGLE 'YES' (GO TO 420)
419. Did you see 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.
NURSE OR MIDWIFE OR PARAMEDIC B
FAMILY WELFARE VISITOR C
MA OR SACMO D
HEALTH ASSISTANT E
FAMILY WELFARE ASSISTANT (FWA) F
UNTRAINED TRADITIONAL BIRTH ATTENDANT (DAI) H
UNQUALIFIED DOCTOR I
RELATIVES J
NEIGHBOURS OR FRIENDS K
NO ONE Z
420. During this pregnancy, did you suffer from night blindness (ratkana)?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
421. During this pregnancy, did you have difficulty with your vision during the daylight?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2
DON'T KNOW 8
425. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
NURSE OR MIDWIFE OR PARAMEDIC B
FAMILY WELFARE VISITOR C
MA OR SACMO D
HEALTH ASSISTANT E
FAMILY WELFARE ASSISTANT (FWA) F
UNTRAINED TRADITIONAL BIRTH ATTENDANT (DAI) H
UNQUALIFIED DOCTOR I
RELATIVES J
NEIGHBOURS OR FRIENDS K
NO ONE Z
426. Where did you give birth to (NAME)?
OTHER HOME 12 (GO TO 428)
UPAZILA HEALTH COMPLEX 22
MATERNAL AND CHILD WELFARE CENTER (MCWC) 23
427. Was (NAME) delivered by caesarian section?
NO 2 (GO TO 432)
428. After (NAME) was born, did any medical person check on your health?
NO 2 (GO TO 432)
429. How many days or weeks after the delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
WEEKS AFTER DELIVERY 2 ___
DON'T KNOW 998
430. Who checked on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.
NURSE OR MIDWIFE OR PARAMEDIC B
FAMILY WELFARE VISITOR C
MA OR SACMO D
HEALTH ASSISTANT E
FAMILY WELFARE ASSISTANT (FWA) F
UNTRAINED TRADITIONAL BIRTH ATTENDANT (DAI) H
UNQUALIFIED DOCTOR I
NO ONE Z
431. Where did this first check take place?
OTHER HOME 02
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
COMMUNITY CLINIC 16
NGO SATELLITE CLINIC 22
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
432. In the first two months after delivery, did you take a Vitamin A copsule like this?
SHOW CAPSULE.
NO 2
432A. After (NAME) was born did any medical persons check on your baby's health?
NO 2 (GO TO 433)
432B. How many days or weeks after the delivery did the first check takes place?
RECORD '00' DAYS IF SAME DAY.
WEEKS AFTER DELIVERY 2 ___
DON'T KNOW 998
432C. Who checked on your baby's health at that time?
NURSE OR MIDWIFE OR PARAMEDIC B
FAMILY WELFARE VISITOR C
MA OR SACMO D
HEALTH ASSISTANT E
FAMILY WELFARE ASSISTANT (FWA) F
UNTRAINED TRADITIONAL BIRTH ATTENDANT (DAI) H
UNQUALIFIED DOCTOR I
NO ONE Z
432D. Where did this first check take place?
OTHER HOME 02
FAMILY WELFARE CENTRE 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC OR EPI OUTREACH SITE 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
COMMUNITY CLINIC 16
NGO SATELLITE CLINIC 22
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
433. Has your period returned since the birth of (NAME)?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2 (GO TO 436)
434. Did your period return between the birth of (NAME) and your next pregnancy?
(REPEAT QUESTIONS FOR ALL CHILDREN BORN IN THE LAST FIVE YEARS, EXCLUDING THE MOST RECENT BIRTH)
NO 2 (GO TO 438)
435. For how many months after the birth of (NAME) did you not have your period?
DON'T KNOW 98
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
RESPONDENT PREGNANT?
PREGNANT (GO TO 438)
437. Have you resumed sexual relations since the birth of (NAME)?
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)
NO 2 (GO TO 439)
438. For how many months after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
439. Did you ever breastfeed (NAME)?
NO 2 (GO TO 444)
440. How long after the 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.
HOURS 1 ___
DAYS 2 ___
440A. Was (NAME) given colostrum immediately after his or her birth?
NO 2
CHILD ALIVE?
DEAD (GO TO 443)
442. Are you still breastfeeding (NAME)?
NO 2
443. For how many months did you breastfeed (NAME)?
DON'T KNOW 98
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 451)
447. Did (NAME) drink anything from a bottle with a nipple last 24 hours?
NO 2
DON'T KNOW 8
447A. Do you give (NAME) anything else to east solid or semi-solid beside breast milk?
NO 2 (GO TO 449)
448. How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids in last 24 hours?
IF 7 OR MORE TIMES, RECORD '7'.
449. At any time in 7 days was (NAME) given any of the following:
At any time yesterday (last 24 hours) was (NAME) given an of the following:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
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 JUNE 1998 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL FORM)
452. LINE NUMBER FROM 212
ALIVE (GO TO 454)
DEAD (GO TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)
454. Did (NAME) receive a Vitamin A dose like this during the lst 6 months?
SHOW CAPSULE
NO 2
DON'T KNOW 8
455. Do you have a cord where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 459)
NO CARD 3
456. Did you ever have a vaccination card for (NAME)?
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.
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
457A. Did your 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.
458. Has (NAME) received any vaccinations that wer not recorded on this card?
RECORD "YES" ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).
NO 2 (GO TO 463)
DON'T KNOW 8 (GO TO 463)
459. Did (NAME) ever receive any vaccinations to prevent him or her from getting diseases?
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, an injection in the left shoulder tha caused a scar?
NO 2
460B. Polio vaccine that is, drops in the mouth?
NO 2 (GO TO 460E)
DON'T KNOW 8 (GO TO 460E)
460C. How many times did (NAME) receive polio vaccine from clinic? From NID?
TIME FROM NID ___
460D. When was the first polio vaccine received, just after birth or later?
LATER 2
460E. DPT vaccination, that it, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?
NO 2 (GO TO 460G)
DON'T KNOW 8 (GO TO 460G)
460G. An injection to prevent measles?
NO 2
DON'T KNOW 8
463. Has (NAME) been ill with a fever at any time in the last two weeks?
NO 2
DON'T KNOW 8
464. Has (NAME) been ill with a cough at any time in the last 2 weeks?
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)
465. IN the last 2 weeks, did (NAME) had:
NO 2
NO 2
NO 2
FEVER OR COUGHS?
OTHER (GO TO 472)
467. Did you seek advice or treatment for (NAME) for the illness?
NO 2 (GO TO 472)
468. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.
FAMILY WELFARE CENTRE OR FWV B
UPAZILA HEALTH COMPLEX C
SATELLITE CLINIC OR EPI OUTREACH SITE D
MATERNAL AND CHILD WELFARE CENTER (MCWC) E
COMMUNITY CLINIC G
NGO SATELLITE CLINIC I
NGO FIELDWORKER J
QUALIFIED DOCTOR L
TRADITIONAL DOCTOR M
PHARMACY N
472. Has (NAME) had diarrhea in the last 2 weeks?
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?
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?
MORE 2
LESS 3
DON'T KNOW 8
475. When (NAME) had diarrhea, was he or she given any of the following to drink:
NO 2
NO 2
NO 2
NO 2
476. Was anything (else) given to treat the diarrhea?
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.
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES OR HERBAL MEDICINES D
OTHER (SPECIFY) X
478. Did you seek advice or treatment for the diarrhea?
NO 2 (GO TO 480)
479. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.
FAMILY WELFARE CENTRE OR FWV B
UPAZILA HEALTH COMPLEX C
SATELLITE CLINIC OR EPI OUTREACH SITE D
MATERNAL AND CHILD WELFARE CENTER (MCWC) E
COMMUNITY CLINIC G
NGO SATELLITE CLINIC I
NGO FIELDWORKER J
QUALIFIED DOCTOR L
TRADITIONAL DOCTOR M
PHARMACY N
480. GO BACK TO 453 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501.
501. PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
NOT CURRENTLY MARRIED (WIDOWED, DIVORCED, DESERTED OR SEPARATED) (GO TO 507)
505. Is your husband staying with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
505A. How long he is not staying with you?
506. RECORD THE HUSBAND'S NAME AND LINE NUMBER FROM HE HOUSEHOLD QUESTIONNAIRE.
IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER ___
507. Have you been married or lived with a man only once, or more than once?
MORE THAN ONCE 2
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?
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?
510. How old was your husband when you started living with him?
512. DETERMINE MONTHS MARRIED SINCE JUNE 1998. ENTER "X" IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER "0" FOR EACH MONTHS NOT MARRIED, SINCE JUNE 1998.
FOR WOMEN WITH MORE THAN ONCE 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 TERMINATION DATES OF ANY PERVIOUS MARRIAGES.
SECTION 6. FERTILITY PREFERENCES
601A. CHECK 106A:
NOT CURRENTLY MARRIED (WIDOWED, DIVORCED, DESERTED OR SEPARATED) (GO TO 614)
HE OR SHE STERILIZED (GO TO 614)
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?
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)
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?
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
PREGNANT (GO TO 610)
USING A METHOD?
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 614)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)
WANTS A OR ANOTHER CHILD(REN): You have said that you do not want (a or another child soon, but you are not using any method to avoid pregnant. 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.
INFREQUENT SEX B
MENOPAUSAL OR HYSTERECTOMY C
SUBFECUND OR INFECUND D
POSTPARTUM AMENORRHEIC E
FATALISTIC F
HUSBAND OPPOSED H
OTHERS OPPOSED I
RELIGIOUS PROHIBITION J
KNOWS NO SOURCE L
FEAR OF SIDE EFFECTS N
LACK OF ACCESS OR TOO FAR O
COST TOO MUCH P
INCONVENIENT TO USE Q
INTERFERES WIT BODY'S NORMAL PROCESSES R
DON'T KNOW Z
USING A METHOD?
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?
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)
611. Which method would you prefer to use?
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 08 (GO TO 614)
WITHDRAWAL 09 (GO TO 614)
OTHER METHOD (SPECIFY) 10 (GO TO 614)
UNSURE 98 (GO TO 614)
612. What is the main reason that you think you will not use a method at any time in the future?
INFREQUENT SEX 12
MENOPAUSAL OR HYSTERECTOMY 13
SUBFECUND OR INFECUND 14
POSTPARTUM AMENORRHEIC 15
FATALISTIC 16
HUSBAND OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
KNOWS NO SOURCE 32
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS OR TOO FAR 43
COST TOO MUCH 45
INCONVENIENT TO USE 46
INTERFERES WIT BODY'S NORMAL PROCESSES 47
DON'T KNOW 98
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?
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY) 96 (GO TO 619)
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 GIRLS ___
EITHER ___
OTHER (SPECIFY) 96
619. In the last months have you heard about family planning:
SOMETIMES 2
NEVER 3
SOMETIMES 2
NEVER 3
SOMETIMES 2
NEVER 3
SOMETIMES 2
NEVER 3
SOMETIMES 2
NEVER 3
NOT CURRENTLY MARRIED (GO TO 701)
621. How often have you talked to your husband about family planning in the last three months?
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?
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?
NO 2 (GO TO 709A)
702. From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED.
TV B
NEWSPAPER OR MAGAZINE 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
BILLBOARD OR SIGN BOARD K
OTHER (SPECIFY) X
703. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 705)
DON'T KNOW 8 (GO TO 705)
704. What can a person do? Anything else?
RECORD ALL MENTIONED.
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 WIT HOMOSEXUALS G
AVOID SEX WITH PERSON WHO INJECT DRUGS INTRAVENOUSLY H
AVOID UNSAFE BLOOD TRANSFUSIONS I
AVOID UNSTERILIZED NEEDLE OR SYRINGE J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZOR OR BLADES N
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z
705. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
706. Can the virus that causes AIDS be transmitted from a mother to a child?
NO 2
DON'T KNOW 8
NOT CURRENTLY MARRIED (GO TO 709A)
708. Have you ever talked about ways to prevent getting the virus that causes AIDS with your husband?
NO 2
709A. (Apart from AIDS), have you heard about (other) infection or disease that can be transmitted through sexual contact?
NO 2
709B. Have you heard about ___?
NO 2
NO 2
NOT A SINGLE "YES" (GO TO 712)
710. In a man, what signs and symptoms would lead you to think that he has such a disease? Any others?
RECORD ALL MENTIONED.
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 SYMPTOM L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z
711. In a woman, what signs and symptoms would lead you to think that she has such a disease? Any others?
RECORD ALL MENTIONED.
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 SYMPTOM L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z
712. 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:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
CHECK QUESTION 106A: IF NOT CURRENTLY MARRIED THAN SKIP TO ITEM 9.
NO 2
NO 2
NO 2
NOT A SINGLE "YES" (GO TO 801)
714. 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.
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
COMMUNITY CLINIC G
NGO SATELLITE CLINIC I
NGO FIELDWORKER J
QUALIFIED DOCTOR L
TRADITIONAL DOCTOR M
PHARMACY N
NO ONE Z
SECTION 8. HUSBAND'S BACKGROUND, WOMAN'S WORK
801. CHECK 106A:
WIDOWED OR DIVORCED OR DESERTED OR SEPARATED (GO TO 803)
802. How old was your husband or partner on his last birthday?
803. Have your husband ever attended school or madrasha?
YES, MADRASHA 2 (GO TO 805
YES, BOTH 3
NO 4 (GO TO 806)
804. What type of school (NAME) has he last attended?
MADRASHA 2
805. What level of school has he last attended? What is the highest grade he completed at that schooling?
GRADE ___
806. What kind of work does (did) your (last) husband mainly do?
807. Now I would like to ask you some question about your work. Aside from your own housework, are you currently working?
NO 2
808. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things or any other work?
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?
SEASONALLY OR PART OF THE YEAR 2
ONCE IN A WHILE 3
811A. Are you paid in cash or kind for this work or are you not paid?
KIND ONLY 2 (GO TO 812)
CASH AND KIND 3
NOT PAID (GO TO 812)
811B. Who mainly decides how the money you earn will be used?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
812. Who in your family usually has the final say on the following decisions:
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
813. How frequently do you go shopping or marketing?
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?
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, WITH CHILDREN 2 (GO TO 817)
NO 3
OTHER (SPECIFY) 6
816. Can you go outside the village or town or city alone (or with your young children)?
YES, WITH CHILDREN 2
NO 3 (GO TO 818)
817. How frequently do you go outside this village or town or city?
SEVERAL TIMES YEAR 2
ONCE A YEAR OR LESS 3
NEVER 4
818. Do you go to a health center or hospital alone (or with your young children)?
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, WITH CHILDREN 2
YES, WITH HUSBAND 3
NO 4
OTHER (SPECIFY) 6
MINUTES ___
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
P PREGNANCIES
H HYSTERECTOMY
T TERMINATIONS
0 NO METHOD
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTIONS
6 IMPLANTS
7 CONDOM
A PERIODIC ABSTINENCE
W WITHDRAWAL
X OTHER (SPECIFY)
COLUMN 2: SOURCE OF CONTRACEPTION
2 FAMILY WELFARE CENTER
3 THANA HEALTH COMPLEX
4 SATELLITE OR EPI CLINIC
5 COMMUNITY CLINIC
6 PRIVATE CLINIC OR DOCTOR
7 TRADITIONAL DOCTOR
8 PHARMACY
9 SHOP
A FRIENDS OR RELATIVES
B FIELDWORKER OR FWA
C NGO CLINIC
Z OTHER (SPECIFY)
COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE
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
0 NOT IN UNION
TERMINATION OF LAST PREGNANCY PRIOR TO JUNE 1998
IF NO PREVIOUS PREGNANCY, RECORD '00' FOR MONTH AND '0000' FOR YEAR
YEAR ___
1411
01 BAISHAK 02 _ _ _ _
1410
11 FALGUN 04 _ _ _ _
10 MAGH 05 _ _ _ _
09 POUSH 06 _ _ _ _
08 AGRAHAYAN 07 _ _ _ _
07 KARTIK 08 _ _ _ _
06 ASHWIN 09 _ _ _ _
05 BADHRA 10 _ _ _ _
04 ASHAR 11 _ _ _ _
03 ASHAR 12 _ _ _ _
02 JAISTHA 13 _ _ _ _
01 BAISHAK 14 _ _ _ _
1409
11 FALGUN 16 _ _ _ _
10 MAGH 17 _ _ _ _
09 POUSH 18 _ _ _ _
08 AGRAHAYAN 19 _ _ _ _
07 KARTIK 20 _ _ _ _
06 ASHWIN 21 _ _ _ _
05 BADHRA 22 _ _ _ _
04 ASHAR 23 _ _ _ _
03 ASHAR 24 _ _ _ _
02 JAISTHA 25 _ _ _ _
01 BAISHAK 26 _ _ _ _
1408
11 FALGUN 28 _ _ _ _
10 MAGH 29 _ _ _ _
09 POUSH 30 _ _ _ _
08 AGRAHAYAN 31 _ _ _ _
07 KARTIK 32 _ _ _ _
06 ASHWIN 33 _ _ _ _
05 BADHRA 34 _ _ _ _
04 ASHAR 35 _ _ _ _
03 ASHAR 36 _ _ _ _
02 JAISTHA 37 _ _ _ _
01 BAISHAK 38 _ _ _ _
1407
11 FALGUN 40 _ _ _ _
10 MAGH 41 _ _ _ _
09 POUSH 42 _ _ _ _
08 AGRAHAYAN 43 _ _ _ _
07 KARTIK 44 _ _ _ _
06 ASHWIN 45 _ _ _ _
05 BADHRA 46 _ _ _ _
04 ASHAR 47 _ _ _ _
03 ASHAR 48 _ _ _ _
02 JAISTHA 49 _ _ _ _
01 BAISHAK 50 _ _ _ _
1406
11 FALGUN 52 _ _ _ _
10 MAGH 53 _ _ _ _
09 POUSH 54 _ _ _ _
08 AGRAHAYAN 55 _ _ _ _
07 KARTIK 56 _ _ _ _
06 ASHWIN 57 _ _ _ _
05 BADHRA 58 _ _ _ _
04 ASHAR 59 _ _ _ _
03 ASHAR 60 _ _ _ _
02 JAISTHA 61 _ _ _ _
01 BAISHAK 62 _ _ _ _
1405
11 FALGUN 64 _ _ _ _
10 MAGH 65 _ _ _ _
09 POUSH 66 _ _ _ _
08 AGRAHAYAN 67 _ _ _ _
07 KARTIK 68 _ _ _ _
06 ASHWIN 69 _ _ _ _
05 BADHRA 70 _ _ _ _
04 ASHAR 71 _ _ _ _
03 ASHAR 72 _ _ _ _
2004
04 APR 02 _ _ _ _
03 MAR 03 _ _ _ _
02 FEB 04 _ _ _ _
01 JAN 05 _ _ _ _
2003
11 NOV 07 _ _ _ _
10 OCT 08 _ _ _ _
09 SEP 09 _ _ _ _
08 AUG 10 _ _ _ _
07 JUL 11 _ _ _ _
06 JUN 12 _ _ _ _
05 MAY 13 _ _ _ _
04 APR 14 _ _ _ _
03 MAR 15 _ _ _ _
02 FEB 16 _ _ _ _
01 JAN 17 _ _ _ _
2002
11 NOV 19 _ _ _ _
10 OCT 20 _ _ _ _
09 SEP 21 _ _ _ _
08 AUG 22 _ _ _ _
07 JUL 23 _ _ _ _
06 JUN 24 _ _ _ _
05 MAY 25 _ _ _ _
04 APR 26 _ _ _ _
03 MAR 27 _ _ _ _
02 FEB 28 _ _ _ _
01 JAN 29 _ _ _ _
2001
11 NOV 31 _ _ _ _
10 OCT 32 _ _ _ _
09 SEP 33 _ _ _ _
08 AUG 34 _ _ _ _
07 JUL 35 _ _ _ _
06 JUN 36 _ _ _ _
05 MAY 37 _ _ _ _
04 APR 38 _ _ _ _
03 MAR 39 _ _ _ _
02 FEB 40 _ _ _ _
01 JAN 41 _ _ _ _
2000
11 NOV 43 _ _ _ _
10 OCT 44 _ _ _ _
09 SEP 45 _ _ _ _
08 AUG 46 _ _ _ _
07 JUL 47 _ _ _ _
06 JUN 48 _ _ _ _
05 MAY 49 _ _ _ _
04 APR 50 _ _ _ _
03 MAR 51 _ _ _ _
02 FEB 52 _ _ _ _
01 JAN 53 _ _ _ _
1999
11 NOV 55 _ _ _ _
10 OCT 56 _ _ _ _
09 SEP 57 _ _ _ _
08 AUG 58 _ _ _ _
07 JUL 59 _ _ _ _
06 JUN 60 _ _ _ _
05 MAY 61 _ _ _ _
04 APR 62 _ _ _ _
03 MAR 63 _ _ _ _
02 FEB 64 _ _ _ _
01 JAN 65 _ _ _ _
1998
11 NOV 67 _ _ _ _
10 OCT 68 _ _ _ _
09 SEP 69 _ _ _ _
08 AUG 70 _ _ _ _
07 JUL 71 _ _ _ _
06 JUN 72 _ _ _ _
(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: