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BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 2014 WOMAN'S QUESTIONNAIRE

IDENTIFICATION

CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
NAME OF THE HOUSEHOLD HEAD _____
NAME AND LINE NUMBER OF ELIGIBLE WOMAN ________________

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE _____
INTERVIEWER'S NAME ___________
RESULT* _____

*RESULT CODES

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

NEXT VISIT:
DATE _____
TIME _____

FINAL VISIT:
DAY _____
MONTH _____
YEAR _____
INT. CODE ____
RESULT ___

SUPERVISOR
NAME __________
DATE _____

FIELD EDITOR
NAME ___________
DATE _____

OFFICE EDITOR ____
KEYED BY ____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is _______________. I am working with NIPORT, the Ministry of Health and Family Welfare, and Mitra and Associates, a private research organization located in Dhaka. We are conducting a survey about health all over Bangladesh. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you 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.
In case you need more information about the survey, you may contact Mr. S. N. Mitra, Executive Director, Mitra and Associates, 2/17 Iqbal Road, Block A, Mohammadpur, Dhaka 1207, Bangladesh. Telephone number are 8118065, 9115503, 01711278663.

Do you have any questions? May I begin the interview now?

NAME OF INTERVIEWER: ___________
DATE: _____

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR ____
MINUTES _____

102. In what month and year were you born?

MONTH ____
DON'T KNOW MONTH 98
YEAR _____
DON'T KNOW YEAR 9998

103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS _____

103A. Are you now married, separated, deserted, divorced, widowed, or have you never been married?

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

104. Have you ever attended school/madrasha?

YES 1
NO 2 (GO TO 108)

104A. What type of school have you last attended?

SCHOOL 1
MADRASHA 2

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

PRIMARY 1
SECONDARY 2
HIGHER 3

106. What is the highest class you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

CLASS _____

107. CHECK 105:

PRIMARY (GO TO 108)
SECONDARY OR HIGHER (GO TO 110)

108. Now I would like you 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

109. CHECK 108:

CODE '2', '3' OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

110. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111. Do you listen to the radio at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112. Do you watch television at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113. What is your religion?

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

114. 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 later 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 BIRTHS _____

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

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

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (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?
RECORD NAME. BIRTH HISTORY NUMBER

NAME __________
BIRTH HISTORY NUMBER _____

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

BOY 1
GIRL 2

214. Were any of these births twins?

SING 1
MULT 2

215. In what month and year was (NAME) born?
PROBE: When 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).

HOUSEHOLD LINE NUMBER _____ (GO TO 221)

220. IF DEAD:
How old was (NAME) when he/she died?
IF '1 YR', 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 (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 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

225. (C) FOR EACH BIRTH SINCE JANUARY 2009, 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 229A)
UNSURE (GO TO 229A)

227. How many months pregnant are you?
(C) RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTHS OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS _____

228. When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 229A)
NO 2

229. Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

229A. Have you ever heard of menstrual regulation (MR)?

YES 1
NO 2 (GO TO 230)

229B. Have you ever used MR?

YES 1
NO 2 (GO TO 230)

229C. In the last three years did you use MR?

YES 1
NO 2 (GO TO 230)

229D. Where did you use it the last time?

PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL 11
DISTRICT HOSPITAL 12
MCWC 13
UPAZILLA HEALTH COMPLEX 14
UH AND FWC 15
FAMILY WELFARE VISITOR (FWV) 17
OTHER PUBLIC SECTOR (SPECIFY) _____ 16
NGO SECTOR
NGO STATIC CLINIC 21
OTHER NGO SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
QUALIFIED DOCTOR'S CHAMBER 32
NON-QUALIFIED DOCTOR'S CHAMBER 33
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 238)

231. When did the last such pregnancy end?

MONTH _____
YEAR ____

232. CHECK 231:

LAST PREGNANCY ENDED IN JAN. 2009 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 2009 (GO TO 238)

233. How many months pregnant were you when the last such pregnancy ended?
(C) 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 _____

234. Since January 2009, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2009.
(C) ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236. Did you have any miscarriages, abortions, or stillbirths that ended before 2009?

YES 1
NO 2 (GO TO 238)

237. When did the last such pregnancy that terminated before 2009 end?

MONTH ____
YEAR _____

238. 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

239. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

YES 1
NO 2 (GO TO 301A)
DON'T KNOW 8 (GO TO 301A)

240. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _____ 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning -- the various ways or methods that a couple can use to delay or avoid a pregnancy.

301A. Have you heard about EMERGENCY CONTRACEPTION PILLS (ECP)? As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.

YES 1
NO 2 (GO TO 301D)

301B. Have you ever used EC?

YES 1
NO 2 (GO TO 301D)

301C. Did you use EC in last 12 months?

YES 1
NO 2

301D. Have you heard about LACTATIONAL AMENORRHEA METHOD (LAM)? Up to 6 months after child birth, a woman can use a method that requires she breastfeeds frequently, day and night, and that her menstrual period has not returned.

YES 1
NO 2 (GO TO 302)

301E. Have you ever used LAM?

YES 1
NO 2

302. CHECK 103A:

CURRENTLY MARRIED (GO TO 302A)
SEPARATED/DESERTED/DIVORCED/WIDOWED (GO TO 311)

302A. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

304. 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 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
CONDOM G (GO TO 306)
LACTATIONAL AMEN. METHOD H (GO TO 308A)
SAFE PERIOD/PERIODIC ABST. I (GO TO 308A)
WITHDRAWAL J (GO TO 308A)
OTHER (SPECIFY) _____ X (GO TO 308A)

305. May I see the brand name of the pills you are using?
RECORD NAME OF BRAND IF PACKAGE SEEN. IF PACKAGE NOT SEEN SHOW THE BRAND CHART.
Please tell me among these which brand of pills are you using?
SHOW AND WRITE THE BRAND NAME OF THE PILLS.

PACKAGE/CHART SEEN 1 (GO TO 306A)
BRAND NAME (SPECIFY) _______ (GO TO 306A)
DON'T KNOW 8 (GO TO 306A)

306. May I see the brand name of the condom you are using?
RECORD NAME OF BRAND IF PACKAGE SEEN. IF PACKAGE NOT SEEN SHOW THE BRAND CHART.
Please tell me among these which brand of condom are you using?
SHOW AND WRITE THE BRAND NAME OF CONDOMS.

PACKAGE/CHART SEEN 1
BRAND NAME (SPECIFY) _______
DON'T KNOW 8

306A. Who obtained the (pills/condoms) the last time you got them?

RESPONDENT 1 (GO TO 308A)
HUSBAND 2 (GO TO 308A)
SON/DAUGHTER 3 (GO TO 308A)
OTHER RELATIVE 4 (GO TO 308A)
OTHER (SPECIFY) _____ 6 (GO TO 308A)

307. In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL 11
DISTRICT HOSPITAL 12
MCWC 13
UPAZILLA HEALTH COMPLEX 14
UH AND FWC 15
OTHER PUBLIC SECTOR (SPECIFY) _____ 16
NGO SECTOR
NGO STATIC CLINIC 21
OTHER NGO SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
QUALIFIED DOCTOR'S CHAMBER 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 36
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

308. In what month and year was the sterilization performed?

308A. 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 _____

309. CHECK 308A/308A, 215 AND 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A.

YES (GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).)
NO (GO TO 310)

310. CHECK 308/308A:

YEAR IS 2009 OR LATER ((C) ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.)
YEAR IS 2008 OR EARLIER ((C) ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2009. THEN SKIP TO 314)

311. 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 2009.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

(C) IN COLUMN 1, 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?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:
Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

312. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314. CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304,
CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 325A)
MALE STERILIZATION 02 (GO TO 325A)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
LACTATIONAL AMEN. METHOD 11 (GO TO 324)
SAFE PERIOD 12 (GO TO 324)
WITHDRAWAL 13 (GO TO 324)
OTHER MODERN METHOD 96 (GO TO 324)

323. Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL 11 (GO TO 325A)
DISTRICT HOSPITAL 12 (GO TO 325A)
MCWC 13 (GO TO 325A)
UPAZILLA HEALTH COMPLEX 14 (GO TO 325A)
UH AND FWC 15 (GO TO 325A)
SAT. CLINIC/EPI OUTREACH 17 (GO TO 325A)
COMMUNITY CLINIC 18 (GO TO 325A)
GOVT. FIELD WORKER (FWA) 19 (GO TO 325A)
OTHER PUBLIC SECTOR (SPECIFY) _____ 16 (GO TO 325A)
NGO SECTOR
NGO STATIC CLINIC 21 (GO TO 325A)
NGO SATELLITE CLINIC 22 (GO TO 325A)
NGO DEPO HOLDER 23 (GO TO 325A)
NGO FIELD WORKER 24 (GO TO 325A)
OTHER NGO SECTOR (SPECIFY) _____ 26 (GO TO 325A)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 325A)
QUALIFIED DOCTOR'S CHAMBER 32 (GO TO 325A)
NON-QUALIFIED DOCTOR'S CHAMBER 33 (GO TO 325A)
PHARMACY/DRUG STORE 34 (GO TO 325A)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36 (GO TO 325A)
OTHER SOURCE
SHOP 41 (GO TO 325A)
FRIENDS/RELATIVES 42 (GO TO 325A)
OTHER (SPECIFY) _____ 96 (GO TO 325A)

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

YES 1
NO 2 (GO TO 325A)

325. Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ___________
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSPITAL B
MCWC C
UPAZILLA HEALTH COMPLEX D
UH AND FWC E
SAT. CLINIC/EPI OUTREACH F
COMMUNITY CLINIC G
GOVT. FIELD WORKER (FWA) H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO DEPO HOLDER L
NGO FIELD WORKER M
OTHER NGO SECTOR (SPECIFY) _____ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
QUALIFIED DOCTOR'S CHAMBER P
NON-QUALIFIED DOCTOR'S CHAMBER Q
PHARMACY/DRUG STORE R
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ S
OTHER SOURCE
SHOP V
FRIENDS/RELATIVES W
OTHER (SPECIFY) _____ X

325A. 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 325D)
DON'T KNOW8 (GO TO 325D)

325B. Did you visit such temporary health clinic in the past three months?

YES 1
NO 2 (GO TO 325D)

325C. What services did you recieve?

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

325D. Are you aware of any community clinic in your area?

YES 1
NO 2 (GO TO 326)

325E. Did you visit the community clinic in the past three months?

YES 1
NO 2 (GO TO 326)

325F. What services did you receive?

FAMILY PLANNING METHOD A
IMMUNIZATIONS B
CHILD GROWTH MONITOR C
TETANUS INJECTION D
ANTENATAL CARE E
VITAMIN A FOR CHILDREN F
MEDICINE G
OTHER X (SPECIFY) ______
DON'T KNOW Z

326. In the last 6 months, were you visited by a fieldworker who talked to you about family planning or gave you a family planning method?

TALKED 1
GAVE FAMILY PLANNING METHOD 2
TALKED AND GAVE METHOD 3
NO 4 (GO TO 401)

326A. Who visited you to talk about family planning or to give you family planning methods?

Name ___________

Anyone else?

Name ___________
GOVT. FP WORKER A
GOVT. HEALTH WORKER B
NGO WORKER C
OTHER (SPECIFY) _____ X

326B. During the last six months, how many times did a health worker or workers visit you to talk about family planning or to give you family planning methods?

NUMBER OF TIMES _____
DON'T KNOW 98

326C. 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 215:

ONE OR MORE BIRTHS IN 2011 OR LATER (GO TO 402)
NO BIRTHS IN 2011 OR LATER (GO TO 501)

402. CHECK 215:
ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2011 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 some questions about your children born in the last three years. (We will talk about each separately.)

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER _____

404. FROM 212 AND 216

NAME _______
LIVING (GO TO 405)
DEAD (GO TO 405)

405. When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 408)
NO 2

406. Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
NO MORE 2 (GO TO 408)

407. How much longer did you want to wait?

MONTHS 1 _____
YEARS 2 _____
DON'T KNOW 998

408. Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 415)

409. Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
IF 'D' MENTIONED WRITE THE NAME OF THE CSBA.

NAME _________
NAME _________
HEALTH PERSONNEL
QUAL. DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
COMMUNITY HEALTH CARE PROVIDER F
HEALTH ASST. G
FAMILY WELFARE ASSISTANT H
NGO WORKER I
OTHER PERSON
TRAINED TBA J
UNTRAINED TBA K
UNQUALIFIED DOCTOR L
OTHER (SPECIFY) _____ X

410. Where did you receive antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ____________
HOME
HOME A
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL B
DIST. HOSP. C
MCWC D
UPAZILLA HEALTH COMPLEX E
UH AND FAMILY WELFARE CENTRE F
SAT. CLINIC/EPI OUTREACH G
COMM. CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SAT CLINIC K
OTHER (SPECIFY) _____ L
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC M
QUAL. DOCTOR N
TRAD. DOCTOR O
PHARMACY P
OTHER (SPECIFY) _____ X

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

NUMBER OF TIMES _____
DON'T KNOW 98

413. As part of your antenatal care during this pregnancy, were any of the following done at least once?
Was your weight measured?
Was your blood pressure measured?
Did you have a urine test?
Did you have a blood test?
Did you have an ultrasonography?
Did you counsel about danger signs?

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
DANGER SIGNS
YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

415. When you got pregnant with (NAME), did any fieldworker/community worker visited you at your home to counsel on health pregnancy or checkup?

YES 1
NO 2 (GO TO 430)

416. Who visited?

HEALTH ASST. A
FAMILY WELFARE ASSISTANT B
NGO WORKER C
TRAINED TBA D
UNTRAINED TBA E
OTHER (SPECIFY) _____ X

417. What did they do:
Did s/he measure your weight?
Did s/he measure your blood pressure?
Did s/he do a urine test?
Did s/he do a blood test?
Did s/he counsel about danger signs?

WEIGHT
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2
DANGER SIGNS
YES 1
NO 2

418. How many home visits did you receive during the last pregnancy?

NUMBER OF TIMES _____
DON'T KNOW 98

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 6

433. 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 'D' MENTIONED WRITE THE NAME OF THE CSBA.

NAME __________
NAME __________
HEALTH PERSONNEL
QUAL. DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
COMMUNITY HEALTH CARE PROVIDER F
HEALTH ASST. G
FAMILY WELFARE ASSISTANT H
NGO WORKER I
OTHER PERSON
TRAINED TBA J
UNTRAINED TBA K
UNQUALIFIED DOCTOR L
RELATIVES M
NEIGHBORS/FRIENDS N
OTHER (SPECIFY) _____ X
NO ONE ASSISTED Y

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________
HOME
HOME 11 (GO TO 435i)
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL 21
DIST. HOSP. 22
MCWC 23
UPAZILLA HEALTH COMPLEX 24
UH AND FAMILY WELFARE CENTRE 25
COM. CLINIC 27
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
NGO SECTOR
NGO STATIC CLINIC 31
DELIVERY HUT 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
OTHER (SPECIFY) _____ 96 (GO TO 435i)

434A. 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

435. Was (NAME) delivered by caesarean section, that is, did they cut your belly open to take the baby out?

YES 1
NO 2 (GO TO 435i)

435A. What day of the week was the birth delivered by caesarean section?

SUNDAY 01
MONDAY 02
TUESDAY 03
WEDNESDAY 04
THURSDAY 05
FRIDAY 06
SATURDAY 07

435B. At what time of day was the caesarean section or operation done?

06:01 AM TO 09:00 AM 01
09:01 AM TO 12:00 NOON 02
12:01 PM TO 02:00 PM 03
02:01 PM TO 04:00 PM 04
04:01 PM TO 06:00 PM 05
06:01 PM TO 09:00 PM 06
09:01 PM TO 12:00 AM 07
12:01 AM TO 03:00 AM 08
03:01 AM TO 06:00 AM 09

435C. How many days before the delivery was the decision to have caesarean section made?

THE DAY OF DELIVERY 1
THE DAY BEFORE DELIVERY 2
2-7 DAYS BEFORE DELIVERY 3
8-30 DAYS BEFORE DELIVERY 4
30+ DAYS BEFORE DELIVERY 5

435D. Who proposed first to have the birth delivered by caesarean section, you, a family member or a doctor?

RESPONDENT 1 (GO TO 435F)
FAMILY MEMBER 2 (GO TO 435F)
DOCTOR 3

435E. Were you or your family told the reasons for having the operation?

YES 1
NO 2 (GO TO 435G)

435F. What were the reasons for making the decision to have the operation?
Any other reason?
CIRCLE ALL MENTIONED.

CONVENIENCE A
DO NOT WANT TO GO THROUGH LABOR PAIN B
MAL PRESENTATION C
PREMATURE BABY D
CORD PROLAPSED E
MULTIPLE BIRTHS F
FAILURE TO PROGRESS IN LABOR G
PRE-ECLAMPSIA H
DIABETES I
PREVIOUS C/S J
LESS PRESSURE ON BABY'S BRAIN K
OTHER COMPLICATIONS DURING DELIVERY L
OTHER X

435G. CHECK 212:

CHILD NOT FIRST BIRTH (GO TO 435H)
CHILD FIRST BIRTH (GO TO 435i)

435H. Did you have caesarean section before this birth?

YES 1
NO 2

435i. Did you or any of your family member ever used a mobile phone to get health services or advice for you or (NAME) during pregnancy or delivery?

YES 1
NO 2 (GO TO 435iv)

435ii. What was the reason the mobile phone was used?
Any other reason?
CIRCLE ALL MENTIONED.

TO ASK WHAT TO DO A
TO CONTACT SERVICE PROVIDER B
TO ARRANGE TRANSPORT C
TO ARRANGE FOR MONEY D
TO ARRANGE FOR DELIVERY E
OTHER (SPECIFY) _____ X

435iii. Who did you call?
Any other person?
CIRCLE ALL MENTIONED.

HEALTH PERSONNEL/QUAL. DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
COMMUNITY SKILLED BIRTH ATTENDANT D
MA/SACMO E
COMMUNITY HEALTH CARE PROVIDER F
HEALTH ASST. G
FAMILY WELFARE ASSISTANT H
NGO WORKER I
OTHER PERSON
TRAINED TBA J
UNTRAINED TBA K
UNQUALIFIED DOCTOR L
RELATIVES M
NEIGHBORS/FRIENDS N
OTHER (SPECIFY) _____ X

435iv. How much did you pay in total for your last delivery?
IF MORE THAN 999995, WRITE 999995

_________ (Taka)

DON'T KNOW 999998
NOTHING 000000 (GO TO 435AA)

435v. Where did you get the money for (NAME's) delivery?
Any other source?
CIRCLE ALL MENTIONED.

FAMILY FUND A
BORROWED B
SOLD ASSETS/MORTGAGE C
GIFT FROM FAMILY D
GIFT FROM NEIGHBOR/FRIEND E
VOUCHER F
INSURANCE G
OTHER (SPECIFY) _____ X

435AA. CHECK 434:
DELIVERED AT HOME?

YES (CODE 11 CIRCLED) (GO TO 435AB)
NO (ANY CODE 21 TO 96 CIRCLED) (GO TO 435AE)

435AB. Now I would like to ask you some specific questions about what was done with (NAME) during and immediately following delivery. Was a Clean Delivery Kit used during the delivery of (NAME)?
SHOW THE DELIVERY KIT.

YES 1
NO 2
DON'T KNOW 8

435AC. What was used to cut the cord?

BLADE FROM DELIVERY KIT 1
BLADE FROM OTHER SOURCE 2
BAMBOO STRIPS 3
SCISSORS 4
OTHER (SPECIFY) _____ 6
CORD WAS NOT CUT 7 (GO TO 435AE)
DON'T KNOW 8 (GO TO 435AE)

435AD. Was the (INSTRUMENT IN 435AC) boiled before the cord was cut?

YES 1
NO 2
DON'T KNOW 8

435AE. Was anything applied to the cord immediately after cutting and tying it?

YES 1
NO 2 (GO TO 435AG)
DON'T KNOW 8 (GO TO 435AG)

435AF. What was applied to the cord after it was cut and tied?
Anything else?

ANTIBIOTICS (POWDER/OINTMT.) 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
TALCUM POWDER K
HCLORHEXIDINE L
OTHER (SPECIFY) _____ X
DON'T KNOW Z

435AG. 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

435AH. How long after birth was (NAME) dried?

LESS THAN 5 MINUTES 1
5-9 MINUTES 2
10+ MINUTES 3
NOT DRIED 4
DON'T KNOW 8

435AI. After the birth, was (NAME) put directly on the bare skin of your chest?
Show the woman a picture of skin-to-skin position.

YES 1
NO 2
DON'T KNOW 8

435AJ. CHECK 434:
DELIVERED AT HOME?

YES (CODE 11 CIRCLED) (GO TO 438)
NO (ANY CODE 21 TO 96 CIRCLED) (GO TO 436)

436. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

YES 1 (GO TO 439)
NO 2

437. Did anyone check on your health after you left the facility?

YES 1 (GO TO 439)
NO (GO TO 442)

438. I would like to talk to you about checks on your health after delivery, for example, someone asking you about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO (GO TO 442)

439. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
IF '14' IS CIRCLED, WRITE THE NAME OF THE CSBA.

NAME __________
HEALTH PERSONNEL
QUAL. DOCTOR 11
NURSE/MIDWIFE/PARAMEDIC 12
FAMILY WELFARE VISITOR 13
COMMUNITY SKILLED BIRTH ATTENDANT 14
MA/SACMO 15
COMMUNITY HEALTH CARE PROVIDER 16
HEALTH ASST. 17
FAMILY WELFARE ASSISTANT 18
NGO WORKER 21
OTHER PERSON
TRAINED TBA 31
UNTRAINED TBA 32
UNQUALIFIED DOCTOR 33
OTHER (SPECIFY) _____ 96

439A. Where did this first check take place?

HOME
HOME 11
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL 21
DIST. HOSP. 22
MCWC 23
UPAZILLA HEALTH COMPLEX 24
UH AND FAMILY WELFARE CENTRE 25
SAT. CLINIC/EPI OUTREACH 27
COMM. CLINIC 28
OTHER (SPECIFY) _____ 26
NGO SECTOR
NGO STATIC CLINIC 31
NGO SAT CLINIC 32
OTHER (SPECIFY) _____ 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
QUALIFIED DOC. CHAMBER 42
UNQUALIFIED DOC. CHAMBER 43
PHARMACY 44
OTHER (SPECIFY) _____ 96

440. 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

440A. During the first two days after delivery, did any health care provider either do the following for you at home or at a health facility:
Breast examination?
Check vaginal discharge?
Check temperature?
Counsel on danger signs?

BREAST EXAM.
YES 1
NO 2
VAG. DISCHARGE
YES 1
NO 2
TEMPERATURE
YES 1
NO 2
COUNSEL ON DANGER SIGNS
YES 1
NO 2

442. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (GO TO 445B)
DON'T KNOW (GO TO 445B)

443. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HRS AFTER BIRTH 1 ___
DAYS AFTER BRITH 2 ___
WKS AFTER BIRTH 3 ___
DON'T KNOW 998

444. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON. IF '14' MENTIONED WRITE THE NAME OF THE CSBA.

NAME __________
HEALTH PERSONNEL
QUAL. DOCTOR 11
NURSE/MIDWIFE/PARAMEDIC 12
FAMILY WELFARE VISITOR 13
COMMUNITY SKILLED BIRTH ATTENDANT 14
MA/SACMO 15
COMMUNITY HEALTH CARE PROVIDER 16
HEALTH ASST. 17
FAMILY WELFARE ASSISTANT 18
NGO WORKER 21
OTHER PERSON
TRAINED TBA 31
UNTRAINED TBA 32
UNQUALIFIED DOCTOR 33
OTHER (SPECIFY) _____ 96

445. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________
HOME
YOUR HOME 11
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL 21
DIST. HOSP. 22
MCWC 23
UPAZILLA HEALTH COMPLEX 24
UH AND FAMILY WELFARE CENTRE 25
SAT. CLINIC/EPI OUTREACH 27
COMM. CLINIC 28
OTHER (SPECIFY) _____ 26
NGO SECTOR
NGO STATIC CLINIC 31
NGO SAT CLINIC 32
OTHER (SPECIFY) _____ 36
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 41
QUALIFIED DOC. CHAMBER 42
UNQUALIFIED DOC. CHAMBER 43
PHARMACY 44
OTHER (SPECIFY) _____ 96

445A. During the first two days after delivery, did any health care provider do the following for (NAME) either at home or at a facility:
Examine the cord?
Counsel on danger signs?
Assess temperature?
Counsel you on breastfeeding?
Observe breastfeeding?
Assess weight?

EXAMINE CORD
YES 1
NO 2
COUNSEL ON DANGER SIGNS
YES 1
NO 2
TEMPERATURE
YES 1
NO 2
COUNSEL BF
YES 1
NO 2
OBSERVE BF
YES 1
NO 2
WEIGHT
YES 1
NO 2

445B. During the first month of (NAME)'s birth, did s(he) experience any illness?

YES 1
NO 2 (GO TO 446)

445C. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 446)

445D. Where did you seek advice or treatment?
Any other place?

HOME A
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL B
DISTRICT HOSP. C
MCWC D
UHC E
UH AND FWC F
SATELLITE CLINIC/EPI OUTREACH SITE G
COMMUNITY CLINIC H
FAMILY WELFARE ASSIST. I
OTHER (SPECIFY) _____ J
NGO SECTOR
NGO STATIC CLINIC L
NGO SATELLITE CLINIC M
NGO DEPO HOLDER N
NGO FIELD WORKER O
OTHER (SPECIFY) _____ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC Q
QUALIFIED DOCTOR R
UNQUALIFIED DOCTOR S
PHARMACY/DRUG STORE T
OTHER PVT. (SPECIFY) _____ U
OTHER (SPECIFY) _____ X

445E. Who provided the care?

HEALTH PROFESSIONAL/WORKER
QUALIFIED DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
CSBA D
MA/SACMO E
COMMUNITY HEALTH CARE PROVIDER F
HEALTH ASSISTANT H
NGO WORKER I
OTHER PROVIDER
TRAINED TBA J
UNTRAINED TBA K
UNQUALIFIED DOCTOR L
RELATIVES M
NEIGHBORS/FRIENDS N
OTHER (SPECIFY) _____ X

446. In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 449)
NO 2 (GO TO 450)

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

YES 1
NO 2 (GO TO 452)

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

MONTHS _____
DON'T KNOW 98

450. CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 451)
PREGNANT OR UNSURE (GO TO 452)

451. Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 453)

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

MONTHS _____
DON'T KNOW 98

453. Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

455. 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 _____

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

YES 1
NO 2 (GO TO 458)

457. 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
COFFEE I
HONEY J
OTHER (SPECIFY) _____ X

458. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 459)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

459. Are you still breastfeeding (NAME)?

YES 1 (GO TO 460)
NO 2

459A. For how many months did you breastfeed (NAME)?

MONTHS ____
DON'T KNOW 98

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 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. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER ____

503. FROM 212 AND 216

NAME _____
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN, OR IF NO MORE BIRTHS, GO TO 557)

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 509)
NO CARD 3

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

YES 1 (GO TO 509)
NO 2 (GO TO 509)

506. (1) COPY DATES FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

506A. DATE OF BIRTH

DAY ____
MONTH _____
YEAR _____
BCG
DAY _____
MONTH _____
YEAR _____
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY _____
MONTH _____
YEAR _____
PENTA 1
DAY _____
MONTH _____
YEAR _____
PENTA 2
DAY _____
MONTH _____
YEAR _____
PENTA 3
DAY _____
MONTH _____
YEAR _____
POLIO 1
DAY _____
MONTH _____
YEAR _____
POLIO 2
DAY _____
MONTH _____
YEAR _____
POLIO 3
DAY _____
MONTH _____
YEAR _____
POLIO 4
DAY _____
MONTH _____
YEAR _____
MR AT 9 MONTHS
DAY _____
MONTH _____
YEAR _____
MEASLES AT 9 MONTHS
DAY _____
MONTH _____
YEAR _____
MEASLES AT 15 MONTHS
DAY _____
MONTH _____
YEAR _____

507. CHECK 506A:

BCG TO MEASLES AT 15 MONTHS ALL RECORDED (GO TO 510I)
VIT. A (GO TO 508)

508. Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

509. Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

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

510. Please tell me if (NAME) had any of the following vaccinations:

510A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

510B. Polio vaccine, that is, drops in the mouth?

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

510C. Was the first polio vaccine given in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

510D. How many times was the polio vaccine given?

NUMBER OF TIMES ____

510E. A Pentavalent vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

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

510F. How many times was the Pentavalent vaccination given?

NUMBER OF TIMES ____

510G. A measles injection or a measles and rubella (MR) injection -- that is, a shot in the arm at the age of 9 months or older -- to prevent him/her from getting measles and/or rubella?

YES 1
NO 2
DON'T KNOW 8

510H. A measles injection, that is, a shot in the arm at the age of 15 months or older -- to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

510I. Did (NAME) receive any polio vaccine from the National Immunization Days (NID)?

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

510J. At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.

CAMPAIGN 1 (POLIO/JAN 2011) A
CAMPAIGN 2 (POLIO/FEB 2011) B
CAMPAIGN 3 (POLIO/JAN 2012) C
CAMPAIGN 4 (POLIO/FEB 2012) D
CAMPAIGN 5 (POLIO/DEC 2013) E
CAMPAIGN 6 (MR/JAN 2014) F
CAMPAIGN 7 (MR/FEB 2014) G

511. Within the last six months, was (NAME) given a vitamin A dose like
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

512. In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

513. Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

514. Has (NAME) had diarrhea in the last 2 weeks? (PLEASE USE THE LOCAL NAME)

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

515. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516. 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, 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

517. 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

518. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 522)

519. Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ____________
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSP. B
MCWC C
UHC D
UH AND FWC E
SATELLITE CLINIC/EPI OUTREACH SITE F
COMMUNITY CLINIC G
FAMILY WELFARE ASSISTANT H
OTHER (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO FIELD WORKER L
OTHER (SPECIFY) ______ M
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC N
QUALIFIED DOCTOR O
UNQUALIFIED DOCTOR P
PHARMACY Q
OTHER PRIVATE SECTOR (SPECIFY) _____ R
OTHER (SPECIFY) _____ X

522. Was he/she given any of the following at any time since he/she started having the diarrhea:

a) A fluid made from a special saline packet called ORSaline PACKET?
b) A homemade sugar-salt-water solution (laban gur)?
c) Zinc syrup?
d) Zinc tablets?

ORS PKT
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 TABLETS
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

528. 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 531)
DON'T KNOW 8 (GO TO 531)

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

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) _____ 6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

530. CHECK 525:
HAD FEVER?

YES (GO TO 531)
NO OR DK (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 557)

531. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). 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

532. When (NAME) had a (fever/cough), 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

533. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TOO 537)

536. Where did you first seek advice or treatment?
FILL UP THE BOXES ACCORDING TO THE SEQUENCE OF CARE RECEIVED.

SEQUENCE OF CARE
1 ___
2 ___
3 ___
4 ___
HOME A
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL B
DISTRICT HOSP. C
MCWC D
UHC E
UH AND FWC F
SATELLITE CLINIC/EPI OUTREACH SITE G
COMMUNITY CLINIC H
FAMILY WELFARE ASSIST. I
OTHER (SPECIFY) _____ J
NGO SECTOR
NGO STATIC CLINIC K
NGO SATELLITE CLINIC L
NGO DEPO HOLDER M
NGO FIELD WORKER N
OTHER (SPECIFY) _____ O
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC Q
QUALIFIED DOCTOR R
UNQUALIFIED DOCTOR S
PHARMACY/DRUG STORE T
OTHER PVT. (SPECIFY) _____ U
OTHER (SPECIFY) _____ X

537. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 557)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 557)

538. What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
PRIMAQUINE C
QUININE D
COMBINATION WITH ARTEMISININ E
OTHER ANTI-MALARIAL (SPECIFY) _____ F
ANTIBIOTIC DRUGS
BETA LACTUM G
MACROLIDES H
QUINOLONE I
CEPHALOS PORIN J
COTRIMOXAZOLE K
GENTAMYCIN L
METRONIDAZOLE M
OTHER DRUGS (SPECIFY) _____ X
DON'T KNOW Z

539. Did anybody prescribe the drug?

YES 1
NO 2 (GO TO 552)

540. Who prescribed the drug?

HEALTH PROFESSIONAL/WORKER
QUALIFIED DOCTOR A
NURSE/MIDWIFE/PARAMEDIC B
FAMILY WELFARE VISITOR C
CSBA D
MA/SACMO E
COMMUNITY HEALTH CARE PROVIDER F
HEALTH ASSISTANT G
FAMILY WELFARE ASSISTANT H
NGO WORKER I
OTHER PROVIDER
TRAINED TBA J
UNTRAINED TBA K
UNQUALIFIED DOCTOR L
DRUG SELLER M
OTHER (SPECIFY) _____ X

541. Where did you get the drug?

PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSPT. B
MCWC C
UHC D
UH AND FWC E
SATELLITE CLINIC/EPI OUTREACH SITE F
COMMUNITY CLINIC G
FAMILY WELFARE ASST. (FWA) H
OTHER (SPECIFY) ____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO DEPO HOLDER L
NGO FIELD WORKER M
OTHER (SPECIFY) _____ N
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC O
QUALIFIED DOCTOR P
UNQUALIFIED DOCTOR Q
PHARMACY/DRUG STORE R
OTHER PRIVATE (SPECIFY) _____ S
OTHER SOURCE
SHOP V
FRIEND/RELATIVE W
OTHER (SPECIFY) _____ X

552. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 557.

557. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2012 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 558)
NAME _________
NONE (GO TO 601)

558. Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 557) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK ____
e) Infant formula like Lactogen?
IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA _____
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT _____
h) Any commercially fortified baby food like Cerelac?
YES 1
NO 2
DON'T KNOW 8
i) Bread, rice, noodles, porridge, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables like spinach, poi sag, methi, kolmi, kochu?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, papayas, ripe kathal, bangi or other Vitamin A rich fruits?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits like banana, grapes, apple, guava or other vegetables like cabbage, patal, kopi?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fish, shrimps or crab?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from like paneer?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid, semi-solid, or soft food (bengali sweets)?
YES 1
NO 2
DON'T KNOW 8

559. CHECK 558 (CATEGORIES "g" THROUGH "u"):

NOT A SINGLE "YES" (GO TO 560)
AT LEAST ONE "YES" (GO TO 561)

560. Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

561. How many times did (NAME FROM 557) eat solid, semi-solid, 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 103A:

CURRENTLY MARRIED (GO TO 604)
SEPARATED/DESERTED/DIVORCED/WIDOWED (GO TO 609)

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

LIVING WITH HER 1 (GO TO 605)
STAYING ELSEWHERE 2

604A. How often did he come home in the past 12 months?

NUMBER OF TIMES _____
DID NOT COME IN THE LAST 12 MONTHS 96

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

NAME ____________
LINE NO. ____

609. Have you been married only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

610. CHECK 609:

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

MARRIED MORE THAN ONCE:
Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?

MONTH ____
DON'T KNOW MONTH 98
YEAR _____ (GO TO 611A)
DON'T KNOW YEAR 9998

611. How old were you when you first started living with him?

AGE ___

611A. Do you think you got married at an age that was right for you, or would you have preferred to marry earlier or later?

EARLIER 1
RIGHT TIME 2 (GO TO 611C)
LATER 3

611B. At what age would you have preferred to get married?

AGE IN YEARS ____

611C. Were you studying or attending school just before you got married?

YES 1
NO 2 (GO TO 611E)

611D. Did you continue your studies after marriage?
IF YES: For how long?

NO 1
YES, LESS THAN A YEAR 2
YES, FOR 1-2 YEARS 3
YES, FOR 3-4 YEARS 4
YES, FOR 5+ YEARS 5

611E. Were you working outside home just before you got married?

YES 1
NO 2 (GO TO 612)

611F. Did you continue working after marriage?
IF YES: For how long?

NO 1
YES, FOR LESS THAN A YEAR 2
YES, FOR 1-2 YEARS 3
YES, FOR 3-4 YEARS 4
YES, FOR 5+ YEARS 5

612. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

613. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.
How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 701)
AGE IN YEARS _____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

614. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

615. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____ (GO TO 701)

616. How many times during the last month did you have sexual intercourse?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

NUMBER OF TIMES ____

SECTION 7. FERTILITY PREFERENCES

701. CHECK 103A:

CURRENTLY MARRIED (GO TO 701A)
SEPARATED/DESERTED/DIVORCED/WIDOWED (GO TO 712)

701A. CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 710)

702. CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

703. 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 ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

704. 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 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (GO TO 710)

705. CHECK 226:

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

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

MONTHS 1 _____
YEARS 2 _____

SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
OTHER (SPECIFY) _____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707. CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708. CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEAR (GO TO 711)

709. CHECK 703 AND 704:

WANTS TO HAVE A/ANOTHER CHILD:
You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?

WANTS NO MORE/NONE:
You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?

RECORD ALL REASONS MENTIONED.

FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/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
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) ______ X

710. CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NOT CURRENTLY USING (GO TO 711)
CURRENTLY USING (GO TO 712)

711. 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 711B)
DON'T KNOW 8 (GO TO 711B)

711A. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 712)
MALE STERILIZATION 02 (GO TO 712)
IUD 03 (GO TO 712)
INJECTABLES 04 (GO TO 712)
IMPLANTS 05 (GO TO 712)
PILL 06 (GO TO 712)
CONDOM 07 (GO TO 712)
LACTATIONAL AMEN. METHOD 11 (GO TO 712)
SAFE PERIOD 12 (GO TO 712)
WITHDRAWAL 13 (GO TO 712)
OTHER (SPECIFY) ____ 96 (GO TO 712)
UNSURE 98 (GO TO 712)

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

FERTILITY-RELATED REASONS
NO SEX 21
INFREQUENT 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

712. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 714)
NUMBER _____
OTHER (SPECIFY) _____ 96 (GO TO 714)

713. 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 if it's a boy or a girl?

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

714. In the last month have you:
Heard about family planning on the radio?
Seen anything 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

714A. In the last month have you heard about family planning from any community health worker?

YES 1
NO 2 (GO TO 716)

714B. Were these government or non-government worker?

GOVERNMENT A
NON-GOVERNMENT B
DON'T KNOW C

716. CHECK 103A:

YES, CURRENTLY MARRIED (GO TO 717)
SEPARATED/DESERTED/DIVORCED/WIDOWED (GO TO 801)

717. CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 718)
NOT CURRENTLY USING OR NOT ASKED (GO TO 720)

718. Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

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

719. CHECK 304:

NEITHER STERILIZED (GO TO 720)
HE OR SHE STERILIZED (GO TO 801)

720. Does your (husband/partner) 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

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

801. CHECK 103A:

CURRENTLY MARRIED (GO TO 802)
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 1
NO 2 (GO TO 806)

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 1
COLLEGE AND HIGHER 3

805. What is the highest class he completed at that level?

CLASS _____

806. CHECK 801:

CURRENTLY MARRIED/LIVING WITH A MAN:
What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN:
What was your (last) (husband's/partner's) occupation? That is, what kind of work did he mainly do?

OCCUPATION ___________________

807. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 811)
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.
In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809. 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 811)
NO 2

810. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 815)

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

OCCUPATION _______________

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

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

813. 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

814. 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

815. CHECK 103A:

CURRENTLY MARRIED (GO TO 816)
SEPARATED/DESERTED/DIVORCED/WIDOWED (GO TO 823A)

816. CHECK 814:

CODE 1 OR 2 CIRCLED (GO TO 817)
OTHER (GO TO 820)

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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER (SPECIFY) _____ 6

820. 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
OTHER (SPECIFY) _____ 6

821. Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6

822. Who usually makes decisions about visits to your family or relatives?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6

823. Who usually makes decisions about your child health care?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6

823A. Do you go to a health centre or hospital alone or with your young children?

YES, ALONE 1 (GO TO 825)
YES, WITH CHILDREN 2 (GO TO 825)
NO 3
OTHER (SPECIFY) _____ 6

823B. 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

825. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN UNDER 10
PRES./LISTEN. 1
PRES. NOT LISTEN. 2
NOT PRES. 3
HUSBAND
PRES./LISTEN. 1
PRES. NOT LISTEN. 2
NOT PRES. 3
OTHER MALES
PRES./LISTEN. 1
PRES. NOT LISTEN. 2
NOT PRES. 3
OTHER FEMALES
PRES./LISTEN. 1
PRES. NOT LISTEN. 2
NOT PRES. 3

826. In your opinion, is a hand 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 burns the food?

GOES OUT
YES 1
NO 2
DON'T KNOW 8
NEGL. 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
BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

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 937)

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 get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

906A. Can people get the AIDS virus by using unsterilized needle or syringe?

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

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

YES 1
NO 2
DON'T KNOW 8

908. Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?

DURING PREG.
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

937. CHECK 901:

HEARD ABOUT AIDS:
Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS:
Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

937A. Have you heard about:
a) Syphilis?
b) Gonorrhea?

SYPHILIS
YES 1
NO 2
GONORRHEA
YES 1
NO 2

938: CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
NEVER HAD SEXUAL INTERCOURSE (GO TO 945A)

939. CHECK 937 AND 937A:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 940)
NO (GO TO 941)

940. 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

941. 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

942. 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

943. CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 945A)

944. The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 945A)

945. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _______________
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSPITAL B
MCWC C
UHC D
UH AND FWC E
SATELLITE CLINIC/EPI OUTREACH SITE F
COMMUNITY CLINIC G
FAMILY WELFARE ASST. H
OTHER (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO DEPO HOLDER L
NGO FIELD WORKER M
OTHER (SPECIFY) _____ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
QUALIFIED DOCTOR P
UNQUALIFIED DOCTOR Q
PHARMACY/DRUG STORE R
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) _____ S
OTHER SOURCE
OTHER (SPECIFY) _____ X

945A. 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

946. RECORD THE TIME.

HOUR _____
MINUTES _____

947. Thank you for taking the time to answer these questions. I would like to inform you that additional information on family planning and antenatal care for women who give birth in the past five years will be collected in the near future in order to find better ways to provide health services for women and families.
Another member of our team may return in a few days or weeks to ask you a few additional questions about these topics.
Do you agree to allow another member of our team to contact you about participating in a short interview?
Your responses will remain confidential.

RESPONDENT AGREES TO BE REVISITED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2

SIGNATURE OF INTERVIEWER: ________________
DATE: __________

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: ________________