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BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 2007
WOMAN’S QUESTIONNAIRE

NIPORT, MOHFW, Mitra and Associates

IDENTIFICATION

CLUSTER NUMBER____
HOUSEHOLD NUMBER____
NAME OF THE HOUSEHOLD HEAD____
NAME AND LINE NUMBER OF WOMAN____
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT:
DATE____
INTERVIEWER’S NAME____
RESULT:

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

NEXT VISIT:
DATE____
TIME____

SECOND VISIT:
DATE____
INTERVIEWER’S NAME____
RESULT:

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

NEXT VISIT:
DATE____
TIME____

THIRD VISIT:
DATE____
INTERVIEWER’S NAME____
RESULT:

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

FINAL VISIT:
DAY____
MONTH____
YEAR: 2007
INT. NUMBER____
RESULT:

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

TOTAL NUMBER OF VISITS____

SUPERVISOR
NAME____
DATE____

FIELD EDITOR
NAME____
DATE____

OFFICE EDITOR____
KEYED BY____

SECTION 1. RESPONDENT’S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is ____ and I am working with Mitra and Associates, a private research organization located in 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, men 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 you children. This 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 the survey is completely voluntary. If we should come to any question you don’t want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope you will participate in the 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 AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101) RECORD THE TIME.

HOUR____
MINUTES____

102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD ‘00’ YEARS.

YEARS____
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

103) Just before you moved here, did you live in a city, in a town, or in the village?

CITY 1
TOWN 2
VILLAGE 3

104) In what month and year were you born?

MONTH____
DON’T KNOW MONTH 98
YEAR____
DON’T KNOW YEAR 9998

105) How old were you at your last birthday? COMPARE AND CORRECT 104 AND/OR 105 IF INCONSISTENT.

AGE IN COMPLETED YEARS____

105A) Are you now married, separated, deserted, widowed, divorced or have you never been married?

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

106) Have you ever attended school/madrasha?

YES, SCHOOL 1 (GO TO 107)
YES, MADRASHA 2 (GO TO 107)
YES, BOTH 3
NO 4 (GO TO 110)

106A) What type of school have you last attended?

SCHOOL 1
MADRASHA 2

107) What is the highest level of school you attended: primary, secondary, or college and higher?

PRIMARY 1
SECONDARY 2
COLLEGE AND HIGHER 3

108) What is the highest class you completed at that level?

CLASS____

109) CHECK 107:

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

110) Now I would like to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)____ 4
BLIND/VISUALLY IMPAIRED 5

111) CHECK 110:

CODE ‘2’, ‘3’ OR ‘4’ CIRCLED (CONTINUE)
CODE ‘1’ OR ‘5’ CIRCLED (GO TO 113)

112) Do you read a newspaper or magazine?

YES 1
NO (GO TO 113)

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

ALMOST 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) Do you listen to the radio almost every day, at least once a week, or less than once a week?

ALMOST 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) Do you watch television almost every day, at least once a week, or less than once a week?

ALMOST 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

116) Do you belong to any of the following organizations?
Grameen Bank?
BRAC?
BRDB?
ASHA?
PROSHIKA?
Mother’s Club?
Any other organization (such as micro credit)?

GRAMEEN BANK
YES 1
NO 2
BRAC
YES 1
NO 2
BRDB
YES 1
NO 2
ASHA
YES 1
NO 2
PROSHIKA
YES 1
NO 2
MOTHER’S CLUB
YES 1
NO 2
OTHER (SPECIFY)____
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? IF NONE, RECORD ‘00’.

SONS ELSEWHERE____
DAUGHTERS ELSEWHERE____

206) Have you ever given birth to a boy or girl who was born alive but died? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

207) 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 (CONTINUE)
NO (PROBE AND CORRECT 201 TO 208 AS NECESSARY.

210) CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
NOT 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. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

NAME____

213) Were any of these births twins?

SING. 1
MULT. 2

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

BOY 1
GIRL 2

215) In what month and year was (NAME) born? PROBE: What is his/her birthday?

MONTH____
YEAR____

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217 IF ALIVE: How old was (NAME) at his/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/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), including any children who died after birth?

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

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

223) COMPARE 2008 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME
CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. ___
FOR EACH BIRTH SINCE JANUARY 2002: MONTH AND YEAR OF BIRTH ARE 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 IN 2002 OR LATER. IF NONE, RECORD ‘0’.

NUMBER OF BIRTHS____

225) FOR EACH BIRTH SINCE JANUARY 2002, ENTER ‘B’ IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE ‘B’ CODE. 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.)

226) Are you pregnant now?

YES 1
NO 2 (GO TO 228A)
UNSURE 8 (GO TO 228A)

227) How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER ‘P’s IN THE 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

228A) Have you ever heard of menstrual regulation (MR)? 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 regulate her periods.

YES 1
NO 2 (GO TO 229)

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

YES 1
NO 2

229A) CHECK 228B AND 229:

YES TO 228B OR YES TO 229
NO TO 228B AND NO TO 229 (GO TO 237)

230) When did the last such pregnancy/menstrual interruption occur?

MONTH____
YEAR____

231) CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 2002 OR LATER
LAST PREGNANCY ENDED BEFORE JANUARY 2002 (GO TO 237)

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 THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND ‘P’ FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS____

233) Since January 2002, have you had any other pregnancies that 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 JANUARY 2002. ENTER ‘T’ IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND ‘P’ FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any miscarriages, abortions, stillbirths or MR that ended before 2002?

YES 1
NO 2 (GO TO 237)

236) When did the last such pregnancy that terminated before 2002 end?

MONTH____
YEAR____

237) When did your last menstrual period start?

(DATE, IF GIVEN)____
DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

SECTION 3. CONTRACEPTION

301) 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.
Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD NOT MENTIONED SPONTANEOUSLY, CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

METHOD 01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 02. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 03. PILL: Women can have an operation to avoid becoming pregnant.
YES 1
NO 2
METHOD 04. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse/FWV.
YES 1
NO 2
METHOD 05. INJECTABLES: Women can have an injection by a doctor or nurse/FWV which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 06. IMPLANTS/NORPLANT: Women can have several small rods placed in their upper arm by a doctor or nurse/FWV which can prevent pregnancy for several years.
YES 1
NO 2
METHOD 07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 08. 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
METHOD 09. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
(SPECIFY)____
(SPECIFY)____
NO 2

302) Have you ever used (METHOD)?

Have you ever had an operation to avoid having any more children?
YES 1
NO 2
Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
METHOD 03. PILL: Women can have an operation to avoid becoming pregnant.
YES 1
NO 2
METHOD 04. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse/FWV.
YES 1
NO 2
METHOD 05. INJECTABLES: Women can have an injection by a doctor or nurse/FWV which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 06. IMPLANTS/NORPLANT: Women can have several small rods placed in their upper arm by a doctor or nurse/FWV which can prevent pregnancy for several years.
YES 1
NO 2
METHOD 07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 08. 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
METHOD 09. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2
YES 1
NO 2

303) CHECK 302:

NOT A SINGLE "YES" (NEVER USED)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

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 THE CALENDAR IN EACH BLANK MONTH (GO TO 322)

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

307) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any? IF NONE, RECORD ‘00’.

NUMBER OF CHILDREN____

308) CHECK 302 (01):

WOMAN NOT STERILIZED
WOMAN STERILIZED (GO TO 311A)

308A) CHECK 105A:

CURRENTLY MARRIED
SEPARATED/DESERTED/DIVORCED/WIDOWED (GO TO 319)

309) CHECK 226:

NOT PREGNANT OR UNSURE
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 319)

311) Which method are you using? CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 314)
MALE STERILIZATION B (GO TO 314)
PILL C
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G
SAFE PERIOD H (GO TO 316A)
WITHDRAWAL I (GO TO 316A)
OTHER (SPECIFY)____ X (GO TO 316A)

311A) CIRCLE ‘A’ FOR FEMALE STERILIZATION.

312) RECORD IF CODE ‘C’ FOR PILL IS CIRCLED IN 311.

YES (USING PILL): May I see the package of pills you are using? RECORD NAME OF BRAND IF PACKAGE SEEN.
PACKAGE SEEN, BRAND NAME (SPECIFY)____ 1 (GO TO 313A)
PACKAGE NOT SEEN 2
NO (USING CONDOM BUT NOT PILL): May I see the package of condoms you are using? RECORD NAME OF BRAND IF PACKAGE SEEN.
PACKAGE SEEN, BRAND NAME (SPECIFY)____ 1 (GO TO 313A)
PACKAGE NOT SEEN 2

313) PLEASE SHOW THE BRAND CHART FOR PILLS AND CONDOMS. Do you know the brand name of the (pills/condoms) you are using? RECORD NAME OF BRAND.

BRAND NAME (SPECIFY)____
DON’T KNOW 98

313A) Who obtained the (pills/condoms) the last time you got them?

RESPONDENT 1 (GO TO 316A)
HUSBAND 2 (GO TO 316A)
SON/DAUGHTER 3 (GO TO 316A)
OTHER RELATIVE 4 (GO TO 316A)
OTHER (SPECIFY)____ 6 (GO TO 316A)

314) Where did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE 11
FAMILY WELFARE CENTRE (FWC) 12
THANA HEALTH COMPLEX 13
SATELLITE CLINIC/EPI OUTREACH CENTER 14
MATERNAL AND CHILD WELFARE CENTER (MCWC) 15
OTHER (SPECIFY)____ 16
NGO SECTOR
NGO STATIC CLINIC 21
NGO SATELLITE CLINIC 22
OTHER (SPECIFY)____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
QUALIFIED DOCTOR 32
OTHER PRIVATE MEDICAL (SPECIFY)____ 36
OTHER (SPECIFY)____ 96
DON’T KNOW 98

315) CHECK 311/311A:

CODE ‘A’ CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?
YES 1
NO 2
DON’T KNOW 8
CODE ‘A’ NOT CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?
YES 1
NO 2
DON’T KNOW 8

316) In what month and year was the sterilization performed?

MONTH____
YEAR____

316A) Since what month and year have you been using (CURRENT METHOD) without stopping? PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH____
YEAR____

317) CHECK 316/316A, 215 AND 230: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A

YES (GO BACK TO 316/316A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).)
NO

318) CHECK 316/316A:

YEAR IS 2002 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.)
YEAR IS 2001 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2002.) (GO TO 320)

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 PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2002. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. ENTER METHOD USE CODE OR ‘0’ FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
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?

320) CHECK 311/311A: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 322)
FEMALE STERILIZATION 01 (GO TO 324)
MALE STERILIZATION 02 (GO TO 324)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
SAFE PERIOD 08 (GO TO 324)
WITHDRAWAL 09 (GO TO 324)
OTHER METHOD 96 (GO TO 324)

321) Where did you obtain (CURRENT METHOD) last time? PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE 11 (GO TO 324)
FAMILY WELFARE CENTRE 12 (GO TO 324)
UPAZILA HEALTH COMPLEX 13 (GO TO 324)
SATELLITE CLINIC/EPI OUTREACH 14 (GO TO 324)
MATERNAL AND CHILD WELFARE CENTRE (MCWC) 15 (GO TO 324)
GOVERNMENT FIELD WORKER (FWA) 16 (GO TO 324)
COMMUNITY CLINIC 17 (GO TO 324)
OTHER (SPECIFY)____ 18 (GO TO 324)
NGO SECTOR
NGO STATIC CLINIC 21 (GO TO 324)
NGO SATELLITE CLINIC 22 (GO TO 324)
NGO DEPOT HOLDER 23 (GO TO 324)
NGO FIELD WORKER (FWA) 24 (GO TO 324)
OTHER (SPECIFY)____ 26 (GO TO 324)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 324)
QUALIFIED DOCTOR 32 (GO TO 324)
TRADITIONAL DOCTOR 33 (GO TO 324)
PHARMACY 34 (GO TO 324)
OTHER PRIVATE MEDICAL (SPECIFY)____ 36 (GO TO 324)
OTHER SOURCE
SHOP 41 (GO TO 324)
FRIEND/RELATIVE 42 (GO TO 324)
OTHER (SPECIFY)____ 96 (GO TO 324)

322) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 324)

323) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE A
FAMILY WELFARE CENTRE B
UPAZILA HEALTH COMPLEX C
SATELLITE CLINIC/EPI OUTREACH D
MATERNAL AND CHILD WELFARE CENTRE (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
COMMUNITY CLINIC G
OTHER (SPECIFY)____ H
NGO SECTOR
NGO STATIC CLINIC I
NGO SATELLITE CLINIC J
NGO DEPOT HOLDER K
NGO FIELD WORKER (FWA) L
OTHER (SPECIFY)____ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC N
QUALIFIED DOCTOR O
TRADITIONAL DOCTOR P
PHARMACY Q
OTHER PRIVATE MEDICAL (SPECIFY)____ R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
OTHER (SPECIFY)____ X

324) 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 three months, was there any such clinic in this village or mohalla?

YES 1
NO 2 (GO TO 327)
DON’T KNOW 8 (GO TO 327)

325) Did you visit such a temporary health clinic in the last 3 months?

YES 1
NO 2 (GO TO 327)

326) What services did you receive?

FAMILY PLANNING METHODS A
IMMUNIZATIONS B
CHILD GROWTH MONITORING C
TETANUS TOXOID INJECTION D
ANTENATAL CARE E
VITAMIN A FOR CHILDREN F
OTHER (SPECIFY)____ X
DON’T KNOW Z

327) During the last six months has anyone visited you in your house to talk to you about family planning or to give you any family planning method?

YES 1
NO 2 (GO TO 401)

328) Who visited you to talk about family planning or to give you family planning methods? Anyone else? WRITE THE NAME OF THE FIELDWORKER(S)

NAME____
GOVERNMENT FP WORKER A
GOVERNMENT HEALTH WORKER B
NGO WORKER C
OTHER (SPECIFY)____ X

329) During the last six months, how many times did a worker or workers visit you to talk about family planning or to give you family planning methods?

NUMBER OF TIMES____
DON’T KNOW 98

330) When was the last time you were visited by a fieldworker who talked to you about family planning? IF MORE THAN ONE WORKER VISITED: When did the last worker visit you? IF LESS THAN ONE MONTH AGO WRITE ‘0’

MONTHS AGO____
DON’T KNOW 8

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2002 OR LATER
NO BIRTHS IN 2002 OR LATER (GO TO 601)

402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS 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 each separately.)

403) LINE NUMBER FROM 212

LAST BIRTH LINE NUMBER____

404) FROM 212 AND 216

NAME____
LIVING
DEAD

405) At the time you became pregnant with (NAME), did you want to become pregnant them, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

406) How much longer would you have liked to wait?

MONTHS 1 ____
YEARS 2 ____
DON’T KNOW 998

407) When you were pregnant with (NAME), did you see anyone for a medical checkup? IF YES: Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
IF CODE ‘D’ CIRCLED: WRITE NAME OF CSBA

NAME OF CSBA____
HEALTH PERSONNEL QUALIFIED DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
HEALTH ASSISTANT F
FAMILY WELFARE ASSISTANT G
OTHER PERSON
TRAINED TBA H
UNTRAINED TBA I
UNQUALIFIED DOCTOR J
OTHER (SPECIFY)____ X
NO ONE Y (GO TO 413A)

408) Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UN ABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
HOME
OWN HOME A
OTHER HOME B
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE C
FAMILY WELFARE CENTRE D
THANA HEALTH COMPLEX E
SAT. CLINIC/EPI OUTREACH F
MAT. AND CHILD WELFARE CENTER G
COMM. CLINIC H
OTHER (SPECIFY)____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SAT CLINIC K
OTHER (SPECIFY)____ L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
QUAL. DOCTOR N
TRAD. DOCTOR O
PHARMACY P
OTHER (SPECIFY)____ X

409) How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS____
DON’T KNOW 98

410) How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES____
DON’T KNOW 98

411) As part of your antenatal care during this pregnancy, were any of the following done at least once?
Were you weighed?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?
Did you have an ultrasonography?

WEIGHT
YES 1
NO 2
BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2
ULTRASON
YES 1
NO 2

412) During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 414)
DON’T KNOW 8

413) Were you told where to go if you had any of these complications?

YES 1 (GO TO 414)
NO 2 (GO TO 414)
DON’T KNOW 8 (GO TO 414)

413A) Why did you not see anyone for antenatal care?

TOO FAR A
INCONVENIENT SERVICE HOUR B
UNPLEASANT STAFF C
LACK OF EXPERIENCED STAFF D
LACK OF PRIVACY E
INADEQUATE DRUG SUPPLY F
LONG WAITING TIME G
SERVICE TOO EXPENSIVE H
RELIGIOUS REASON I
NOT NEEDED J
DID NOT KNOW OF NEED FOR CARE K
UNABLE TO GO/NOT PERMITTED TO LEAVE HOUSE L
DID NOT KNOW OF A PLACE M
OTHER (SPECIFY)____ X

414) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 417)
DON’T KNOW 8 (GO TO 417)

415) During this pregnancy, how many times did you get this tetanus toxoid injection?

TIMES____
DON’T KNOW 8

416) CHECK 415:

2 OR MORE TIMES (GO TO 421)
OTHER

417) At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

YES 1
NO 2 (GO TO 421)
DON’T KNOW 8 (GO TO 421)

418) Before this pregnancy, how many other times did you receive a tetanus injection? IF 7 OR MORE TIMES, RECORD ‘7’.

TIMES____
DON’T KNOW 8

419) In what month and year did you receive the last tetanus injection before this pregnancy?

MONTH____
DON’T KNOW MONTH 98
YEAR____ (GO TO 421)
DON’T KNOW YEAR 9998

420) How many years ago did you receive that tetanus injection?

YEARS AGO____

421) Did you take any iron tablet or iron syrup during this pregnancy? SHOW TABLETS/SYRUP.

YES 1
NO 2
DON’T KNOW 8

422A) Around the time of the birth of (NAME), did you have any of the following problems:
a) Long labor, that is, regular contractions that lasted more than 12 hours?
b) Excessive bleeding that was so much that you feared it was life threatening?
c) A high fever with bad smelling vaginal smelling vaginal discharge?
d) Convulsions?
e) Baby’s hands and feet came first during delivery?
f) Retained placenta?

A) LONG LABOR
YES 1
NO 2
DON’T KNOW 8
B) EXCESSIVE BLEEDING
YES 1
NO 2
DON’T KNOW 8
C) HIGH FEVER
YES 1
NO 2
DON’T KNOW 8
D) CONVULSIONS
YES 1
NO 2
DON’T KNOW 8
E) HANDS AND FEET FIRST
YES 1
NO 2
DON’T KNOW 8
F) RETAINED PLACENTA
YES 1
NO 2
DON’T KNOW 8

422B) CHECK 422A:

AT LEAST ONE ‘YES’
NOT A SINGLE ‘YES’ (GO TO 423)

422C) Did you seek assistance for this complication? IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED. IF CODE ‘D’ CIRCLED, WRITE NAME OF CSBA.

NAME OF CSBA____
HEALTH PERSONNEL
QUALIFIED DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
HEALTH ASSISTANT F
FAMILY WELFARE ASSISTANT G
OTHER PERSON
TRAINED TBA H
UNTRAINED TBA I
UNQUALIFIED DOCTOR J
RELATIVES K
NEIGHBORS/FRIENDS L
OTHER (SPECIFY)____ X
NO ONE Y (GO TO 422G)

422D) Where did you seek assistance for this complication? Anywhere else? PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)____

422E) CHECK 422D:

MORE THAN ONE CODE CIRCLED
ONLY ONE CODE CIRCLED (GO TO 423)

422F) Where did you first seek assistance for this complication? USE LETTER CODE FROM 422D.

FIRST PLACE____ (GO TO 423)

422G) Why did you not seek treatment for this complication?

NOT NECESSARY A
NOT UNDERSTAND THAT SERVICE IS NEEDED B
NOT CUSTOMARY C
COST TOO MUCH D
LACK OF MONEY E
TOO FAR F
TRANSPORT PROBLEM G
NO ONE TO ACCOMPANY H
POOR QUALITY SERVICE I
FAMILY DID NOT ALLOW J
BETTER CARE AT HOME K
NOT KNOWN HOW TO GO L
NO TIME TO GO M
NOT KNOWN WHERE TO GO N
NOT WANT SERVICE FROM MALE DOCTOR O
DID NOT THINK OF SERIOUSNESS OF COMPLICATION P
OTHER (SPECIFY)____ X

423) Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY. IF CODE ‘D’ CIRCLED, WRITE NAME OF CSBA

NAME OF CSBA____
HEALTH PERSONNEL
QUALIFIED DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
HEALTH ASSISTANT F
FAMILY WELFARE ASSISTANT G
OTHER PERSON
TRAINED TBA H
UNTRAINED TBA I
UNQUALIFIED DOCTOR J
RELATIVES K
NEIGHBORS/FRIENDS L
OTHER (SPECIFY)____ X
NO ONE Y

424) Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)____
HOME
YOUR HOME 11 (GO TO 430A)
OTHER HOME 12 (GO TO 430A)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
UPAZILA HEALTH COMPLEX 22
MATERNAL AND CHILD WELFARE CENTER 23
OTHER (SPECIFY)____ 26
NGO SECTOR
NGO STATIC CLINIC 31
OTHER (SPECIFY)____ 36
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)____ 46
OTHER (SPECIFY)____ 96 (GO TO 430A)

425) How long after (NAME) was delivered did you stay there? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DON’T KNOW 998

426) Was (NAME) delivered by caesarean section?

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

430A) CHECK 215:

LAST BIRTH IN JANUARY 2004 OR LATER
LAST BIRTH BEFORE JANUARY 2004 (GO TO 432)

Now I would like to ask you some specific questions about what was done with (NAME) immediately following delivery.

430B) What was used to cut the cord?

BLADE FROM DELIVERY BAG 1
BLADE FROM OTHER SOURCE 2
BAMBOO STRIPS 3
SCISSOR 4
OTHER (SPECIFY)____ 6
CORD WAS NOT CUT 7 (GO TO 430G)
DON’T KNOW 8 (GO TO 430G)

430C) Was the ____ (instrument) boiled before the cord was cut?

YES 1
NO 2
DON’T KNOW 8

430D) Was anything applied to the cord immediately after cutting and tying it?

YES 1
NO 2 (GO TO 430G)
DON’T KNOW 8 (GO TO 430G)

430E) What was applied to the cord after it was cut and tied? Anything else?

ANTIBIOTICS (POWDER/OINTMENT) A
ANTISEPTIC (DETOL/SAVLON HEXISOL) B
SPIRIT/ALCOHOL C
MUSTARD OIL WITH GARLIC D
CHEWED RICE E
TUMERIC JUICE/POWDER F
GINGER JUICE G
SHIDUR H
BORIC POWDER I
GENTIAN VIOLET (BLUE INK) J
TALCOM POWDER K
OTHER (SPECIFY)____ X
DON’T KNOW Z

430G) How long after (NAME) was born was the body wiped (dried)?

MINUTES____
NOT WIPED 95
DON’T KNOW 98

430H) How long after (NAME) was born was the body wrapped?

MINUTES____
NOT WRAPPED 95
DON’T KNOW 98

430J) How long after delivery was (NAME) bathed for the first time?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD IN DAYS.

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
NOT BATHED 995
DON’T KNOW 998

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

YES 1
NO 2 (GO TO 437)

433) How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DON’T KNOW 998

434) Who checked on your health at that time? IF CODE ‘D’ CIRCLED, WRITE NAME OF CSBA.

NAME OF CSBA____
HEALTH PERSONNEL
QUALIFIED DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
HEALTH ASSISTANT F
FAMILY WELFARE ASSISTANT G
OTHER PERSON
TRAINED TBA H
UNTRAINED TBA I
TRADITIONAL DOCTOR J
OTHER (SPECIFY)____ X

435) Where did the first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
HOME
OWN HOME 01
OTHER HOME 02
PUBLIC SECTOR
GOVERNMENT HOSPITAL MEDICAL/COLLE 11
FAMILY WELFARE CENTER 12
UPAZILA HEALTH COMPLEX 13
SATELLITE CLINIC EPI OUTRICH SITE 14
MATERNAL AND CHILD WELFARE CENTER 15
COMMUNITY CLINIC 16
OTHER (SPECIFY)____ 17
NGO SECTOR
NGO STATIC CLINIC 21
NGO SATELLITE CLINIC 22
OTHER (SPECIFY)____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
OTHER (SPECIFY)____ 36
OTHER (SPECIFY)____ 96

437) After (NAME) was born, did any medical persons check on your baby’s health?

YES 1
NO 2 (GO TO 441)
DON’T KNOW 8 (GO TO 441)

438) How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DON’T KNOW 998

439) Who checked on your baby’s health at that time? IF CODE ‘D’ CIRCLED, WRITE NAME OF CSBA.

NAME OF CSBA____
HEALTH PERSONNEL
QUALIFIED DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
HEALTH ASSISTANT F
FAMILY WELFARE ASSISTANT G
OTHER PERSON
TRAINED TBA H
UNTRAINED TBA I
TRADITIONAL DOCTOR J
OTHER (SPECIFY)____ X

440) Where did the first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
HOME
OWN HOME 01
OTHER HOME 02
PUBLIC SECTOR
GOVERNMENT HOSPITAL MEDICAL/COLLE 11
FAMILY WELFARE CENTER 12
UPAZILA HEALTH COMPLEX 13
SATELLITE CLINIC EPI OUTRICH SITE 14
MATERNAL AND CHILD WELFARE CENTER 15
COMMUNITY CLINIC 16
OTHER (SPECIFY)____ 17
NGO SECTOR
NGO STATIC CLINIC 21
NGO SATELLITE CLINIC 22
OTHER (SPECIFY)____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
QUALIFIED DOCTOR 32
TRADITIONAL DOCTOR 33
PHARMACY 34
OTHER (SPECIFY)____ 36
OTHER (SPECIFY)____ 96

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

YES 1
NO 2

442) Has your menstrual period returned since the birth of (NAME)?

YES 1 (GO TO 444)
NO 2 (GO TO 445)

443) Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 447)

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

MONTHS____
DON’T KNOW 98

445) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT
PREGNANT OR UNSURE (GO TO 447)

446) Have you begun to have sexual intercourse again since the birth of (NAME)?

YES 1
NO 2 (GO TO 448)

447) For how many months after the birth of (NAME) did you not have sexual intercourse?

MONTHS____
DON’T KNOW 98

448) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 455A)

449) 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 ____

449A) Was (NAME) given colostrum immediately after his/her birth?

YES 1
NO 2

450) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 452)

451) What was (NAME) given to drink? Anything else? RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY)____ X

452) CHECK 404: CHILD ALIVE?

ALIVE
DEAD (GO TO 454)

453) Are you still breastfeeding (NAME)?

YES 1 (GO TO 455A)
NO 2

454) For how many months did you breastfeed (NAME)?

MONTHS____
DON’T KNOW 98

455A) When you were pregnant with (NAME) did you live in a village, or in a town/city?

VILLAGE 1
TOWN/CITY 2 (GO TO 455C)

455B) Did you deliver (NAME) in the same village where you lived, a different village, or in a town/city?

SAME VILLAGE 1 (GO TO 455D)
DIFFERENT VILLAGE 2 (GO TO 455D)
TOWN/CITY 3 (GO TO 455D)

455C) Did you deliver (NAME) in the town/city where you lived, a different town/city, or in a village?

SAME TOWN/CITY 1
DIFFERENT TOWN/CITY 2
VILLAGE 3

455D) Write down the village/mohalla of the delivery place of (NAME).

VILLAGE____
CLUSTER VILLAGE/MOHALLA 1
OTHER THAN CLUSTER VILLAGE/MOHALLA 2

456) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD’S AND WOMAN’S NUTRITION

501) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) LINE NUMBER FROM 212

LINE NUMBER____

503) FROM 212 AND 216

NAME____
LIVING
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 531)

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

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 508)
NO CARD 3

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

YES 1 (GO TO 508)
NO 2 (GO TO 508)

506/506A) 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.
COPY DATE OF BIRTH IF WRITTEN ON CARD

BCG
DAY____
MONTH____
YEAR____
POLIO 0 (POLIO GIVEN AT BIRTH)
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____
HEPATITIS B1
DAY____
MONTH____
YEAR____
HEPATITIS B2
DAY____
MONTH____
YEAR____
HEPATITIS B3
DAY____
MONTH____
YEAR____

506B) CHECK 506:

BCG TO HEPATITIS ALL RECORDED (GO TO 510)
OTHER

507) Has (NAME) received any vaccinations that are not recorded on this card? RECORD ‘YES’ ONLY IF RESPONDENT MENTIONS BCG, POLIO 0 THROUGH 3, DPT 1 THROUGH 3, MEASLES, AND/OR HEP B VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE ‘66’ IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 510)
NO 2 (GO TO 510)
DON’T KNOW 8 (GO TO 510)

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

509A) A BCG vaccination against tuberculosis, that is, an injection in the left shoulder that usually causes a scar?

YES 1
NO 2
DON’T KNOW 8

509B) Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 509E)
DON’T KNOW 8

509C) Was the first polio vaccine received in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

509D) How many times was the polio vaccine received?

NUMBER OF TIMES____

509E) A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO (GO TO 509G)
DON’T KNOW 8 (GO TO 509G)

509F) How many times was a DPT vaccination received?

NUMBER OF TIMES____

509G) A measles injection or an MMR injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

YES 1
NO 2
DON’T KNOW 8

509H) A HEPATITIS B vaccination, that is, an injection given in the right thigh, sometimes given at the same time as DPT?

YES 1
NO 2 (GO TO 510)
DON’T KNOW 8 (GO TO 510)

509J) How many times was a HEPATITIS B vaccination received?

NUMBER OF TIMES____
DON’T KNOW 8

510) Did (NAME) receive any polio vaccine from the National Immunization Days (NID) on March 3, 2007?

YES 1
NO 2
DON’T KNOW 8

511) Did (NAME) receive a vitamin A dose (like this/any of these) within the last six months? SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2
DON’T KNOW 8

512) Has (NAME) had diarrhea in the last 2 weeks?

YES 1
NO 2 (GO TO 521)
DON’T KNOW 8 (GO TO 521)

513) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON’T KNOW 8

514) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON’T KNOW 8

515) Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 517)

516) Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE A
FAMILY WELFARE CENTER (FWC) B
UPAZILA HEALTH COMPLEX C
SAT. CLINIC/ EPI OUTREACH D
MATERNAL AND CHILD WELFARE CENTER E
GOVERNMENT FIELD WORKER (FWA) F
COMMUNITY CLINIC G
OTHER (SPECIFY)____ H
NGO SECTOR
NGO STATIC CLINIC I
NGO SATELLITE CLINIC J
NGO FIELDWORKER K
OTHER (SPECIFY)____ L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
QUALIFIED DOCTOR N
TRADITIONAL DOCTOR O
PHARMACY P
OTHER PRIVATE MED. (SPECIFY)____ Q
OTHER SOURCE
SHOP R
TRADITIONAL PRACTITIONER S
OTHER (SPECIFY)____ X

517) Does (NAME) still have diarrhea?

YES 1
NO 2
DON’T KNOW 8

518) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
a) A fluid made from a special saline packet
b) Homemade sugar-salt-water solution (laban gur)?
c) Zinc Syrup?
d) Zinc tablets?

FLUID FROM ORS PACKET
YES 1
NO 2
DON’T KNOW 8
LABAN GUR
YES 1
NO 2
DON’T KNOW 8
ZINC SYRUP
YES 1
NO 2
DON’T KNOW 8
ZINC
YES 1
NO 2
DON’T KNOW 8

519) Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 521)
DON’T KNOW 8 (GO TO 521)

520) What (else) was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HOME REMEDY/HERBAL MEDICINE I
OTHER (SPECIFY)____ X

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

YES 1
NO 2
DON’T KNOW 8

522) Has (NAME) had an illness with a cough at any time in the last 2 weeks?

YES 1 (GO TO 523)
NO 2
DON’T KNOW 8

522A) CHECK 521: HAD FEVER?

YES (GO TO 525)
NO OR DON’T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 531)

523) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (GO TO 525)
DON’T KNOW 8

524) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1
NOSE ONLY 2
BOTH 3
OTHER (SPECIFY)____ 6
DON’T KNOW 8

525) Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 527)

526) Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE A
FAMILY WELFARE CENTER (FWC) B
UPAZILA HEALTH COMPLEX C
SAT. CLINIC/ EPI OUTREACH D
MATERNAL AND CHILD WELFARE CENTER E
GOVERNMENT FIELD WORKER (FWA) F
COMMUNITY CLINIC G
OTHER (SPECIFY)____ H
NGO SECTOR
NGO STATIC CLINIC I
NGO SATELLITE CLINIC J
NGO FIELDWORKER K
OTHER (SPECIFY)____ L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
QUALIFIED DOCTOR N
TRADITIONAL DOCTOR O
PHARMACY P
OTHER PRIVATE MED. (SPECIFY)____ Q
OTHER SOURCE
SHOP R
TRADITIONAL PRACTITIONER S
OTHER (SPECIFY)____ X

Is (NAME) still sick with a (fever/cough)?

FEVER ONLY 1
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON’T KNOW 8

531) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2004 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 532) NAME____
NONE (GO TO 601)

532) Now I would like to as k you about liquids or food (NAME FROM 531) had yesterday during the day or at night.

A. Plain water?
B. Sugar Water/Honey/Juice
C. Commercially produced infant formula/baby formula?
D. Cow’s or goat’s milk or yoghurt?
E. Other liquid?
F. Papaya/mango?
G. Green leafy vegetables?
H. Other fruits and vegetables?
I. Rice, wheat, porridge, bread?
J. Meat/fish/eggs?
K. Dal?
X. Other solid or semi-solid?

A. PLAIN WATER
YES 1
NO 2
DON’T KNOW 8
B. SUGAR WATER/HO NEY/JUICE
YES 1
NO 2
DON’T KNOW 8
C. FORMULA/BABY FORMULA
YES 1
NO 2
DON’T KNOW 8
D. COW’S/GOAT MILK
YES 1
NO 2
DON’T KNOW 8
E. OTHER LIQUIDS
YES 1
NO 2
DON’T KNOW 8
F. PAPAYA/MANGO
YES 1
NO 2
DON’T KNOW 8
G. GREEN VEGETABLE
YES 1
NO 2
DON’T KNOW 8
H. OTHER FRUITS AND VEGETABLES
YES 1
NO 2
DON’T KNOW 8
I. RICE, WHEAT
YES 1
NO 2
DON’T KNOW 8
J. MEAT/FISH
YES 1
NO 2
DON’T KNOW 8
K. DAL
YES 1
NO 2
DON’T KNOW 8
X. OTHERS
YES 1
NO 2
DON’T KNOW 8

532A) CHECK 532 FOR CATEGORIES ‘F’ THROUGH ‘X’:

AT LEAST ONE ‘YES’ CIRCLED
NOT A SINGLE ‘YES’ (GO TO 601)

533) How many times did (NAME FROM 531) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD ‘7’.

NUMBER OF TIMES____
DON’T KNOW 8

SECTION 6. MARRIAGE

601) CHECK 105A:

CURRENTLY MARRIED
NOT CURRENTLY MARRIED (SEPARATED/DESERTED/DIVORCED/WIDOWED) (GO TO 605)

602) Is your husband staying with you no or is he staying elsewhere?

STAYING WITH HER 1 (GO TO 604)
STAYING ELSEWHERE 2

603) How long has your husband been staying away from you?

MONTHS____

604) 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 ____

605) Have you been married or lived with a man only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

606) CHECK 605:

MARRIED ONLY ONCE: In what month and year did you start living with your husband?
MONTH____
DON’T KNOW MONTH 98
YEAR____
DON’T KNOW YEAR 9998
MARRIED MORE THAN ONCE: Now I would like to ask about when you started living with your first husband. In what month and year was that?
MONTH____
DON’T KNOW MONTH 98
YEAR____
DON’T KNOW YEAR 9998

607) How old were you when you started living with him?

AGE____

608) How old was your husband when you started living with him?

AGE____

SECTION 7. FERTILITY PREFERENCES

701) CHECK 105A:

CURRENTLY MARRIED
NOT CURRENTLY MARRIED (SEPARATED/DESERTED/DIVORCED/WIDOWED) (GO TO 713)

701A) CHECK 311:

NEITHER STERILIZED
HE OR SHE STERILIZED (GO TO 713)

702) CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 704)
SAYS SHE CAN’T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON’T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON’T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)
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/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 704)
SAYS SHE CAN’T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON’T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON’T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)

703) CHECK 226:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?
MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (GO TO 708)
SAYS SHE CAN’T GET PREGNANT 994 (GO TO 713)
OTHER (SPECIFY)____ 996 (GO TO 708)
DON’T KNOW 998 (GO TO 708)
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/NOW 993 (GO TO 708)
SAYS SHE CAN’T GET PREGNANT 994 (GO TO 713)
OTHER (SPECIFY)____ 996 (GO TO 708)
DON’T KNOW 998 (GO TO 708)

704) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 709)

705) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED
NOT CURRENTLY USING
CURRENTLY USING (GO TO 703)

706) CHECK 703:

NOT ASKED
24 OR MORE MONTHS OR 02 OR MORE YEARS
00 TO 23 MONTHS OR 00 TO 01 YEAR (GO TO 709)

707) CHECK 702:

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason? RECORD ALL REASONS MENTIONED.
FERTILITY RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY’S NORMAL PROCESSES T
OTHER (SPECIFY)____ X
DON’T KNOW Z
WANTS NO MORE/NONE: 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 you are not using a method? Any other reason? RECORD ALL REASONS MENTIONED.
FERTILITY RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY’S NORMAL PROCESSES T
OTHER (SPECIFY)____ X
DON’T KNOW Z

708) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED
NO, NOT CURRENTLY USING
YES, CURRENTLY USING (GO TO 713)

709) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 711)
DON’T KNOW 8 (GO TO 713)

710) Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 713)
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
SAFE PERIOD 08 (GO TO 713)
WITHDRAWAL 09 (GO TO 713)
OTHER (SPECIFY)____ 96 (GO TO 713)
UNSURE 98 (GO TO 713)

711) What is the main reason that you think you will not use a contraceptive method at any time in the future?

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

713) 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? PROBE FOR A NUMERIC RESPONSE.
NONE 00 (GO TO 715)
NUMBER____
OTHER (SPECIFY)____ 96 (GO TO 715)
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.
NONE 00 (GO TO 715)
NUMBER____
OTHER (SPECIFY)____ 96 (GO TO 715)

714) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

NUMBER OF BOYS____
NUMBER OF GIRLS____
NUMBER OF EITHER____
OTHER (SPECIFY)____ 96

715) In the last month have you:
Heard about family planning on the radio?
Seen shows about family planning on the television?
Read about family planning in a newspaper or magazine?
Read about family planning in a poster, billboard or leaflet?
Heard about family planning from a community event?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER/BILLBOARD
YES 1
NO 2
COMMUNITY EVENT
YES 1
NO 2

717) CHECK 105A:

YES, CURRENTLY MARRIED
NOT CURRENTLY MARRIED (SEPARATED/DESERTED/DIVORCED/WIDOWED) (GO TO 801)

722) Does your husband want 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

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

SECTION 8. HUSBAND’S BACKGROUND AND WOMAN’S WORK

801) CHECK 105A:

CURRENTLY MARRIED
SEPARATED/DESERTED/DIVORCED/WIDOWED (GO TO 803)

802) How old was your husband on his last birthday?

AGE IN COMPLETED YEARS____

803) Did your (last) husband ever attend school or madrasha?

YES, SCHOOL 1 (GO TO 804)
YES, MADRASHA 2 (GO TO 804)
YES, BOTH 3
NO 4 (GO TO 805)

803A) What type of schooling did your husband last attend?

SCHOOL 1
MADRASHA 2

804) What level of schooling did he last attend?

PRIMARY 1
SECONDARY 2
COLLEGE AND HIGHER 3

804A) What is the highest class he completed at that level?

CLASS____

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

OCCUPATION____

806) Now I would like to ask you some questions about your work. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 810)
NO 2

807) 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. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 810)
NO 2

808) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

YES 1 (GO TO 810)
NO 2

809) Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 814)

810) What is your occupation, that is, what kind of work do you mainly do?

OCCUPATION____

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

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

813) Are you paid in cash or kind for this work or are you not paid at all?

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

814) CHECK 105A:

CURRENTLY MARRIED
NOT CURRENTLY MARRIED (GO TO 822)

818) CHECK 813:

CODE 1 OR 2 CIRCLED
OTHER (GO TO 822)

819) Who usually decides how the money you earn will be used: mainly you, mainly your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

822) Who usually makes decisions about health care for yourself: you, your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

823) Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

824) Who usually makes decisions about making purchases for daily household needs?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

825) Who usually makes decisions about visits to your family or relatives?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

826) Who usually makes decisions about your child health care?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

826A) Do you go to a health centre or hospital alone or with your young children?

YES, ALONE 1 (GO TO 901)
YES, WITH CHILDREN 2 (GO TO 901)
NO 3
OTHER (SPECIFY)____ 6

826B) Can you go to a health centre or hospital alone or with your young children?

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

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 913)

902) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON’T KNOW 8

903) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON’T KNOW 8

904) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON’T KNOW 8

905) Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON’T KNOW 8

906) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON’T KNOW 8

906A) Can people get the AIDS virus by using unsterilized needles or syringes?

YES 1
NO 2
DON’T KNOW 8

906B) Can people get the AIDS virus through unsafe blood transfusion?

YES 1
NO 2
DON’T KNOW 8

908) Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON’T KNOW 8

913) CHECK 901:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
YES 1
NO 2
NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

914) Have you heard about:
a) Syphilis?
b) Gonorrhea?

SYPHILIS
YES 1
NO 2
GONORRHEA
YES 1
NO 2

915) CHECK 913/914: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES
NO (GO TO 917)

916) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON’T KNOW 8

917) Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DON’T KNOW 8

918) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON’T KNOW 8

919) CHECK 916, 917, 918:

HAS HAD AN INFECTION (ANY ‘YES’)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 922)

920) The last time you had (PROBLEM FROM 916/917/918), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 922)

921) Where did you go? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE A
FAMILY WELFARE CENTRE B
UPAZILA HEALTH COMPLEX C
SATELLITE CLINIC/EPI OUTREACH D
MATERNAL AND CHILD WELFARE CENTRE (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
COMMUNITY CLINIC G
OTHER (SPECIFY)____ H
NGO SECTOR
NGO STATIC CLINIC I
NGO SATELLITE CLINIC J
NGO DEPOT HOLDER K
NGO FIELD WORKER (FWA) L
OTHER (SPECIFY)____ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC N
QUALIFIED DOCTOR O
TRADITIONAL DOCTOR P
PHARMACY Q
OTHER PRIVATE MEDICAL (SPECIFY)____ R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
OTHER (SPECIFY)____ X

922) Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON’T KNOW 8

SECTION 10. OTHER HEALTH ISSUES

1001) Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1101A)

1002) How does tuberculosis spread from one person to another? PROBE: Any other ways? RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY)____ X
DON’T KNOW Z

1003) Can tuberculosis be cured?

YES 1
NO 2
DON’T KNOW 8

SECTION 11. DOMESTIC VIOLENCE MODULE

1101A) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN UNDER 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3

1101B) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she does not obey elders in the family?

GOES OUT
YES 1
NO 2
DON’T KNOW 8
NEGLECTS CHILDREN
YES 1
NO 2
DON’T KNOW 8
ARGUES
YES 1
NO 2
DON’T KNOW 8
REFUSES SEX
YES 1
NO 2
DON’T KNOW 8
DOESN’T OBEY ELDERS
YES 1
NO 2
DON’T KNOW 8

1101C) CHECK COVER PAGE:

WOMAN SELECTED FOR THIS SECTION
WOMAN NOT SELECTED (GO TO 1113)

1102) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1113)

1103) READ TO THE RESPONDENT
Now I would like to ask you questions about some other important aspects of a woman’s life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Bangladesh. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.

1104) As far as you know, did your father ever hit or beat your mother?

YES 1
NO 2 (GO TO 1106)
DON’T KNOW 8 (GO TO 1106)

1105) How often did your father hit or beat your mother: often, sometimes or rarely?

OFTEN 1
SOMETIMES 2
RARELY 3
DON’T KNOW 8

1106) CHECK 105A:

CURRENTLY MARRIED
NOT CURRENTLY MARRIED (SEPARATED/DESERTED/DIVORCED/WIDOWED) (READ IN PAST TENSE)

1107A) (Does/did) your (last) husband/partner ever do any of the following things to you:
a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you or beat you up?
f) try to choke you or burn you on purpose?
g) threaten or attack you with a knife, gun, or any other weapon?
h) physically force you to have sexual intercourse with him even when you did not want to?

A. PUSH/SHAKE/THROW
YES 1 (GO TO 1107B)
NO 2
B. SLAP
YES 1 (GO TO 1107B)
NO 2
C. TWIST ARM/PULL HAIR
YES 1 (GO TO 1107B)
NO 2
D. PUNCH
YES 1 (GO TO 1107B)
NO 2
E. BEAT UP
YES 1 (GO TO 1107B)
NO 2
F. CHOKE/BURN
YES 1 (GO TO 1107B)
NO 2
G. THREATEN/ATTACK WITH WEAPON
YES 1 (GO TO 1107B)
NO 2
H. FORCE SEX
YES 1 (GO TO 1107B)
NO 2

1107B) CHECK A: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED. How often did this happen during the last 12 months: often, only sometimes, or not at all?

A. PUSH/SHAKE/THROW
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
B. SLAP
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
C. TWIST ARM/PULL HAIR
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
D. PUNCH
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
E. BEAT UP
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
F. CHOKE/BURN
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
G. THREATEN/ATTACK WITH WEAPON
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
H. FORCE SEX
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1108) CHECK 1107B:

AT LEAST ONE ‘1’ OR ‘2’ CIRCLED FOR CATEGORIES ‘A’ THROUGH ‘G’
NOT A SINGLE ‘1’ OR ‘2’ CIRCLED FOR CATEGORIES ‘A’ THROUGH ‘G’ (GO TO 1113)

1109) Why did your husband hurt you in the last 12 months? Any other reason? RECORD ALL MENTIONED.

WITHOUT ANY REASON A
BECAUSE OF FINANCIAL CRISIS B
BECAUSE HUSBAND UNEMPLOYED C
BECAUSE OF FOOD CRISIS D
BECAUSE OF ENVY OR MALICE E
BECAUSE I REFUSED SEX F
I DISOBEYED HUSBAND/ELDER G
NEGLECTED HOUSEHOLD CHORES H
WENT OUT WITHOUT PERMISSION I
HUSBAND SUSPECTS INFIDELITY J
WIFE SUSPECTS INFIDELITY K
DOWRY ISSUE L
DEMAND FOR MONEY/OTHER RESOURCES FROM MY FAMILY M
HUSBAND DRUNK/HAD DRUGS N
NEGLECTED CHILDREN O
OTHER (SPECIFY)____ X

1109A) CHECK 1109:

‘L’ NOT CIRCLED
‘L’ CIRCLED (GO TO 1109C)

1109B) Is your husband hurting you related to demand for dowry?

YES 1
NO 2

1109C) CHECK 1109:

‘M’ NOT CIRCLED
‘M’ CIRCLED (GO TO 1109E)

1109D) Is your husband hurting you related to your inability to bring money/other resources from your family?

YES 1
NO 2

1109E) CHECK 1109:

‘N’ NOT CIRCLED
‘N’ CIRCLED (GO TO 1110)

1109F) Is your husband hurting you related to his drinking alcohol or taking drugs?

YES 1
NO 2

1110) Did you tell anyone about your husband hurting you?

YES 1
NO 2 (GO TO 1112)

1111) Whom did you tell? RECORD ALL MENTIONED.

FRIEND A
FATHER/MOTHER B
BROTHER/SISTER C
AUNT/UNCLE D
CHILDREN E
MOTHER-IN-LAW F
FATHER-IN-LAW G
OTHER RELATIVE H
POLIC I
DOCTOR/HEALTHWORKER J
MOULAVI/CLERIC K
COUNSELOR L
NGO/FEMALE M
LOCAL LEADER N
NEIGHBOUR O
OTHER (SPECIFY)____ X

1112) Did anyone provide any assistance to protect you from being hurt by your husband?

YES 1
NO 2 (GO TO 1113)

1112A) What type of assistance did you receive?

NEIGHBOURS TOOK AWAY HUSBAND A
ADVICE TO TELL POLICE BY NEIGHBOUR B
ADVICE TO FILE A CASE IN THE COURT AGAINST HUSBAND C
OTHER (SPECIFY)____ X

1113) RECORD THE TIME.

HOUR____
MINUTES____

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: ____

CALENDAR:

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE:

BIRTHS B
PREGNANCIES P
TERMINATIONS T
NO METHOD 0
FEMALE STERILIZATION 1
MALE STERILIZATION 2
PILL 3
IUD 4
INJECTABLES 5
IMPLANTS 6
CONDOM 7
SAFE PERIOD/RHYTHM METHOD L
WITHDRAWAL M
OTHER (SPECIFY)____ X

2007
08 AUG 01 ____
07 JUL 02 ____
06 JUN 03 ____
05 MAY 04 ____
04 APR 05 ____
03 MAR 06 ____
02 FEB 07 ____
01 JAN 08 ____

2006
12 DEC 09 ____
11 NOV 10 ____
10 OCT 11 ____
09 SEP 12 ____
08 AUG 13 ____
07 JUL 14 ____
06 JUN 15 ____
05 MAY 16 ____
04 APR 17 ____
03 MAR 18 ____
02 FEB 19 ____
01 JAN 20 ____

2005
12 DEC 21 ____
11 NOV 22 ____
10 OCT 23 ____
09 SEP 24 ____
08 AUG 25 ____
07 JUL 26 ____
06 JUN 27 ____
05 MAY 28 ____
04 APR 29 ____
03 MAR 30 ____
02 FEB 31 ____
01 JAN 32 ____

2004
12 DEC 33 ____
11 NOV 34 ____
10 OCT 35 ____
09 SEP 36 ____
08 AUG 37 ____
07 JUL 38 ____
06 JUN 39 ____
05 MAY 40 ____
04 APR 41 ____
03 MAR 42 ____
02 FEB 43 ____
01 JAN 44 ____

2003
12 DEC 45 ____
11 NOV 46 ____
10 OCT 47 ____
09 SEP 48 ____
08 AUG 49 ____
07 JUL 50 ____
06 JUN 51 ____
05 MAY 52 ____
04 APR 53 ____
03 MAR 54 ____
02 FEB 55 ____
01 JAN 56 ____

2002
12 DEC 57 ____
11 NOV 58 ____
10 OCT 59 ____
09 SEP 60 ____
08 AUG 61 ____
07 JUL 62 ____
06 JUN 63 ____
05 MAY 64 ____
04 APR 65 ____
03 MAR 66 ____
02 FEB 67 ____
01 JAN 68 ____

2001
12 DEC 69 ____
11 NOV 70 ____
10 OCT 71 ____
09 SEP 72 ____