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BURKINA FASO DEMOGRAPHIC AND HEALTH SURVEY - MEN'S QUESTIONNAIRE 1993


IDENTIFICATION

PROVINCE ______
DEPARTMENT ______
COMMUNE/URBAN CENTER ______
CLUSTER NUMBER ______
VILLAGE/SECTOR ______
HOUSEHOLD UNIT NUMBER ______

OUAGA, BOBO/KOUD, OTHER CITIES, OR RURAL?

OUAGA 1
BOBO/KOUD 2
OTHER CITIES 3
RURAL 4

NAME OF MAN INTERVIEWED ______
LINE NUMBER OF MALE RESPONDENT ______

INTERVIEWER VISITS

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

1 COMPLETED
2 NOT AT HOME
3 DEFERRED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____

TOTAL NUMBER OF VISITS _____


FRENCH QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW:

FRENCH 1
MOORE 2
DIOULA 3
FULFULDE 4
OTHERS 5

INTERPRETER USED?

YES 1
NO 2


SUPERVISOR
NAME _____
DATE _____

FIELD EDITOR
NAME _____
DATE _____

KEYED BY (NAME) _____
KEYED BY (DATE) _____
KEYED BY (CODE) _____


SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

101. RECORD THE TIME:

HOUR ____
MINUTES ____


102. In what month and year were you born?

MONTH_____
DOESN'T KNOW MONTH 98
YEAR_____
DOESN'T KNOW YEAR 98


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

AGE IN COMPLETED YEARS _______


104. Have you ever attended school?

YES 1
NO 2 (GO TO 107)


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

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 4


106. What is the highest grade you completed at that level?

GRADE _____
PRIMARY
0 LESS THAN ONE YEAR COMPLETED
1 CP1
2 CP2
3 CE1
4 CE2
5 CM1
6 CM2
8 DOESN'T KNOW
MIDDLE SCHOOL
0 LESS THAN ONE YEAR COMPLETED
1 6TH
2 5TH
3 4TH
4 3RD
8 DOESN'T KNOW
HIGH SCHOOL
0 LESS THAN ONE YEAR COMPLETED
1 2ND
2 1ST
3 FINAL
8 DOESN'T KNOW
POST-SECONDARY
0 LESS THAN ONE YEAR COMPLETED
1 ONE YEAR
2 TWO YEARS
3 THREE YEARS
4 FOUR YEARS
5 FIVE OR MORE YEARS
8 DOESN'T KNOW


107. What is your primary line of work?

OCCUPATION _____


108. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
OTHER (SPECIFY) _____ 4


109. What is your nationality?

BURKINABE 01
TOGOLESE 02 (GO TO 111)
BENINESE 03 (GO TO 111)
MALIAN 04 (GO TO 111)
NIGERIAN 05 (GO TO 111)
OTHER AFRICAN (SPECIFY) _____ 06 (GO TO 111)
OTHER (SPECIFY) _____ 07 (GO TO 111)


110. What is your ethnicity?

BOBO 01
DIOULA 02
FULFULDE/PEUL 03
GOURMANTCHE 04
GOUROUNSI 05
LOBI 06
MOSSI 07
SENOUFO 08
TOUARAG/BELLA 09
OTHER (SPECIFY) _____ 10


Now I would like to ask you questions about marriage.

111. Are you currently married or are you currently living with a woman?

YES 1
NO 2 (GO TO 115)


112. How many wives/spouses do you currently have?

NUMBER OF WIVES/SPOUSES ____


113. LINE NUMBER(S) OF THE WOMAN/WOMEN FROM THE HOUSEHOLD QUESTIONNAIRE :

LINE NO. _____


114. Do you intend to take more wives/partners in the future?

YES 1
NO 2 (GO TO 117)


115. Have you ever been married?

YES 1
NO 2 (GO TO 122)


116. Are you widowed, divorced, or separated?

WIDOWED 1
DIVORCED 2
SEPARATED 3


117. In what month and year did you consummate your (first) union?

MONTH_____
DOESN'T KNOW MONTH 98
YEAR_____
DOESN'T KNOW YEAR 98
MARRIAGE NOT CONSUMMATED 96 (GO TO 122)


118. How old were you when you consummated your (first) union?

AGE ____
DOESN'T KNOW AGE 98


119. CHECK 117 AND 118:
YEAR AND AGE OF CONSUMMATION OF MARRIAGE GIVEN?

YES (GO TO 120)
NO (GO TO 121)


120. CHECK COHERENCE OF 117 AND 118:

YEAR OF BIRTH (102) + AGE AT MARRIAGE (118) = CALCULATED YEAR OF MARRIAGE :

YEAR OF MARRIAGE _____

IF NECESSARY, CALCULATE YEAR OF BIRTH:
CURRENT YEAR - CURRENT AGE (103) = CALCULATED YEAR OF BIRTH

YEAR OF BIRTH ______

IS THE CALCULATED YEAR OF MARRIAGE WITHIN A YEAR OF THE RECORDED YEAR OF MARRIAGE (117)?

YES (GO TO 121)
NO (CHECK AND CORRECT 117 AND 118, THEN GO TO 121)


121. CHECK 115 AND 116:

IS WIDOWED, DIVORCED, OR SEPARATED (GO TO 122)
IS MARRIED OR LIVING IN UNION (GO TO 123)


122. At this time, do you have a regular partner, one or more occasional partners, or no partner at all?

A REGULAR PARTNER 1
ONE OR MORE OCCASIONAL PARTNERS 2
NO PARTNER 3


123. Do you have children?

YES 1
NO 2 (GO TO 201)


124. How many boys do you have?
How many girls do you have?

NUMBER OF BOYS ____
NUMBER OF GIRLS ____


SECTION 2: CONTRACEPTION

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


201. What are the ways or methods that you have heard about?

CIRCLE CODE '1' IN 202 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF METHOD IS RECOGNIZED AND CODE '3' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 202, ASK 203 BEFORE CONTINUING TO THE NEXT METHOD.


202. Have you ever heard of (METHOD)?
READ THE DESCRIPTION OF EACH METHOD.

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
03. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
04. MOUSSE, FOAM OR GEL: Women can place a mousse, gel or foam inside their vagina before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
05. CONDOM: Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
07. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
08. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
09. WITHDRAWAL: Men can be careful and pull out before ejaculation.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
10. PROLONGED ABSTINENCE: Beyond the avoidance of sex traditionally observed after a birth, some couples don't have sex for some months so the woman doesn't become pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
11. TALISMAN: Some women use amulets/charms to not become pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
12. OTHER METHODS: Have you heard of any other ways or methods that women or men can use to avoid pregnancy? IF YES, LIST UP TO TWO OTHER METHODS.
(SPECIFY) _____
YES 1
NO 3 (GO TO 204)


203. Have you ever used (METHOD)?
[THIS QUESTION IS ASKED ABOUT EACH METHOD IN 201 WITH '1' or '2' CIRCLED.]

01. PILL: Women can take a pill every day to avoid becoming pregnant. Has your partner ever used this method?
YES 1
NO 2
DOESN'T KNOW 8
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse. Has your partner ever used this method?
YES 1
NO 2
DOESN'T KNOW 8
03. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months. Has your partner ever used this method?
YES 1
NO 2
DOESN'T KNOW 8
04. MOUSSE, FOAM OR GEL: Women can place a mousse, gel or foam inside their vagina before sexual intercourse. Has your partner ever used this method?
YES 1
NO 2
DOESN'T KNOW 8
05. CONDOM: Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES 1
NO 2
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children. Has your partner ever had an operation to avoid having any more children?
YES 1
NO 2
DOESN'T KNOW 8
07. MALE STERILIZATION: Men can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
08. RHYTHM METHOD: Some couples avoid having sex on those days of her cycle when the woman is more likely to become pregnant.
YES 1
NO 2
DOESN'T KNOW 8
09. WITHDRAWAL: Men can be careful and pull out before ejaculation.
YES 1
NO 2
10. PROLONGED ABSTINENCE: Beyond the avoidance of sex traditionally observed after a birth, some couples don't have sex for some months so the woman doesn't become pregnant.
YES 1
NO 2
11. TALISMAN: Some women use amulets/charms to not become pregnant. Have you or your partner ever used this method?
YES 1
NO 2
DOESN'T KNOW 8
12. OTHER METHODS (SPECIFY) _____
YES 1
NO 2


204. CHECK 203:

NOT A SINGLE "YES" (NEVER USED) (GO TO 205)
AT LEAST ONE "YES" (EVER USED) (GO TO 207)


205. Have you or your spouse(s)/partner(s) ever used anything or tried in any way to delay or avoid getting pregnant?

YES ___
NO ___ (GO TO 209)


206. What have you used or done?
CORRECT 203-204 (AND 202 IF NECESSARY).


207. Are you or your spouse(s)/partner(s) currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 209)


208. Which method are you currently using?

PILL 01 (GO TO 212)
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
MOUSSE/FOAM/JELLY 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
RHYTHM METHOD 08 (GO TO 212)
WITHDRAWAL 09 (GO TO 212)
PROLONGED ABSTINENCE 10 (GO TO 212)
CHARM/AMULET 11 (GO TO 212)
OTHER (SPECIFY) _____ 12 (GO TO 212)


209. Do you or your spouse(s)/partner(s) intend to use contraception in the future?

YES 1
NO 2 (GO TO 211)
DOESN'T KNOW 8 (GO TO 212)


210. Which method would you prefer to use?

PILL 01 (GO TO 212)
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
MOUSSE/FOAM/JELLY 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
RHYTHM METHOD 08 (GO TO 212)
WITHDRAWAL 09 (GO TO 212)
PROLONGED ABSTINENCE 10 (GO TO 212)
CHARM/AMULET 11 (GO TO 212)
OTHER (SPECIFY) _____ 12 (GO TO 212)
DOESN'T KNOW (GO TO 212)


211. What is the main reason that you do not intend to use a contraceptive method?

WANTS CHILDREN 01
LACK OF INFORMATION 02
PARTNER DISAPPROVES 03
COST TOO HIGH 04
SIDE EFFECTS 05
HEALTH PROBLEMS 06
DIFFICULT TO OBTAIN 07
RELIGION 08
OPPOSES FAMILY PLANNING 09
FATALIST 10
OTHERS DISAPPROVE 11
INFREQUENT SEXUAL INTERCOURSE 12
WOMAN HAS DIFFICULTY GETTING PREGNANT 13
WOMAN IN MENOPAUSE/HAD HYSTERECTOMY 14
NOT CONVENIENT 15
STERILE/CANNOT HAVE CHILDREN 16
OTHER (SPECIFY) _____ 17
DOESN'T KNOW 98


212. Are you for or against information about family planning being given out on the radio or television?

FOR 1
AGAINST 2
DOESN'T KNOW 8


213. What is your main source of information about family planning?

HEALTH AGENT 01
RADIO/TELEVISION 02
NEWSPAPERS 03
RELATIVES/NEIGHBORS/FRIENDS 04
DOESN'T KNOW OF FAMILY PLANNING 05
OTHER (SPECIFY) ______ 06
DOESN'T KNOW 98


SECTION 3: FERTILITY PREFERENCES

301. 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 303)
SAYS HIS WIFE CAN'T GET PREGNANT 3 (GO TO 303)
SAYS HE CAN NO LONGER HAVE CHILDREN 4 (GO TO 303)
UNDECIDED/DOESN'T KNOW 8 (GO TO 303)


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

MONTHS 1 ____
YEARS 2 ____

SOON/NOW 994
SAYS HE OR WIFE CAN NO LONGER HAVE CHILDREN 995
OTHER (SPECIFY) _____ 996
DOESN'T KNOW 998


303. CHECK 111 AND 122:

IS MARRIED/IN UNION OR HAS REGULAR PARTNER (GO TO 304)
NOT MARRIED/NOT IN UNION AND NO REGULAR PARTNER (GO TO 308)


304. Do you think your wife (wives)/partner(s) approve(s) or disapprove(s) of couples that use a method to avoid becoming pregnant?

APPROVE(S) 1
DISAPPROVE(S) 2
DOESN'T KNOW 3


305. How many times over the last year have you discussed family planning with your wife (wives)/partner(s)?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3


306. Have you already discussed the number of children you want with your wife (wives)/partner(s)?

YES 1
NO 2


307. Do you think that your wife (wives)/partner(s) want(s) the same number of children that you want, or more or fewer than you want?

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


308. After the birth of a child, how long should a couple wait to begin having sexual intercourse?

MONTHS 1 ____
YEARS 2 ____
OTHER (SPECIFY) _____ 996


309. Should a mother wait until she is completely done breastfeeding before restarting sexual relations or does it not matter?

WAIT 1
NO IMPORTANCE 2


310. In general, do you approve or disapprove of couples that use a method to avoid becoming pregnant?

APPROVES 1
DISAPPROVES 2


311. CHECK 123 AND CHECK THE BOX:

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

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?

RECORD JUST A NUMBER OR ANOTHER RESPONSE.

NUMBER ____
OTHER (SPECIFY) _____ 96


312. In your opinion, what is the best interval in months or years between the birth of one child and the birth of the next child?

MONTHS 1 ____
YEARS 2 ____

OTHER (SPECIFY) ______ 996


SECTION 4: KNOWLEDGE AND ATTITUDES ABOUT AIDS

Now I would like to ask you some questions about a very important subject.

401. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 410)

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