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BURKINA FASO DEMOGRAPHIC AND HEALTH SURVEY (EDSBF-II) - 1998 WOMEN'S QUESTIONNAIRE

PROVINCE _____
DEPARTMENT _____
COMMUNE/URBAN CENTER _____
VILLAGE/SECTOR _____
CLUSTER NUMBER _____
NAME OF HEAD OF CONCESSION _____
CONCESSION NUMBER _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD UNIT NUMBER _____

URBAN/RURAL:

URBAN 1
RURAL 2

OUAGA/BOBO/OTHER CITIES/RURAL:

OUAGA 1
BOBO 2
OTHER CITIES 3
RURAL 4

INTERVENTION ZONE:

YES 1
NO 2

NAME OF FEMALE RESPONDENT ______

LINE NUMBER OF FEMALE 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 _____

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 _____

OFFICE EDITOR _____
KEYED BY _____

SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

101. RECORD THE TIME.

HOUR ____
MINUTES ____

103. To begin, I would like to ask you questions about yourself. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS ______

ALWAYS 95
VISITOR 96

105. In what month and year were you born?

MONTH _____
DOESN'T KNOW MONTH 98
YEAR _____
DOESN'T KNOW YEAR 9998

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS _______

106A. Do you understand French?

YES 1
NO 2

107. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

108. 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

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

GRADE ______
PRIMARY
0 LESS THAN ONE YEAR COMPLETED
1 1ST GRADE
2 2ND GRADE
3 3RD GRADE
4 4TH GRADE
5 5TH GRADE
8 DOESN'T KNOW
MIDDLE SCHOOL
0 LESS THAN ONE YEAR COMPLETED
1 6TH GRADE
2 7TH GRADE
3 8TH GRADE
4 9TH GRADE
8 DOESN'T KNOW
HIGH SCHOOL
0 LESS THAN ONE YEAR COMPLETED
1 10TH GRADE
2 11TH GRADE
3 12TH GRADE
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

110. CHECK 106:

AGE 29 YEARS OR YOUNGER (GO TO 111)
AGE 30 YEARS OR MORE (GO TO 111A)

111. Are you currently attending school?

YES 1 (GO TO 113)
NO 2

111A. At what age did you stop going to school?

AGE ____

112. What is the main reason you stopped going to school?

GOT PREGNANT 01
GOT MARRIED 02
TO WATCH CHILDREN 03
FAMILY NEEDED HELP IN FIELDS/AT WORK 04
COULD NOT PAY FEES 05
HAD TO EARN MONEY 06
PREFER WORKING 07
SUFFICIENTLY EDUCATED 08
FAILED IN SCHOOL 09
NO LONGER LIKED SCHOOL 10
SCHOOL INACCESSIBLE/TOO FAR 11
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

113. CHECK 108:

PRIMARY (GO TO 114)
SECONDARY OR HIGHER (GO TO 114A)

114. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 115A)

114A. Do you read a newspaper or magazine at least once a month?

YES 1
NO 2 (GO TO 115A)

115. Do you read a newspaper or magazine at least once a week?

YES 1
NO 2

115A. Do you listen to the radio?

YES 1
NO 2 (GO TO 116G)

116. Do you listen to the radio every day?

YES 1 (GO TO 116B)
NO 2

116A. On what days of the week do you listen to the radio?
RECORD ALL GIVEN RESPONSES. IF THE RESPONSE IS "IT DEPENDS", "WHENEVER" OR "DOESN'T KNOW", YOU SHOULD ONLY CIRCLE ONE CODE.

MONDAY A
TUESDAY B
WEDNESDAY C
THURSDAY D
FRIDAY E
SATURDAY F
SUNDAY G
IT DEPENDS/WHENEVER X
DOESN'T KNOW Z

116B. At what times do you usually listen to the radio?
RECORD ALL GIVEN RESPONSES. IF THE RESPONSE IS "IT DEPENDS", "WHENEVER" OR "DOESN'T KNOW", YOU SHOULD ONLY CIRCLE ONE CODE.

BEFORE 8:00 AM A
FROM 8 TO NOON B
FROM NOON TO 2:00 PM C
FROM 2:00-6:00 PM D
FROM 6:00-8:00 PM E
AFTER 8:00 PM F
ALL DAY G
DEPENDS/WHENEVER X
DOESN'T KNOW Z

116C. What types of radio programs do you usually listen to?
PROBE TO GET THE TYPES OF SHOWS. RECORD ALL TYPES MENTIONED.

MUSICAL VARIETY A
SPORTS B
NEWS D
REPORTING E
HEALTH PROGRAMMING F
OTHER (SPECIFY) ____ X

116CA. What radio stations do you usually listen to?
RECORD ALL RESPONSES.

NATIONAL RADIO (RAINBOW) A
PULSAR B
RADIO MARIA C
ARC-EN-CIEL (RAINBOW) D
HORIZON FM E
SALANKOLOTO F
ENERGIE G
RADIO EVANGILE DEVELOPPEMENT H
LUMIERE VIE ET DEVELOPPEMENT I
FOREIGN STATIONS J

116D. Have you ever had the chance to hear the radio program "Yamba Songo"?

YES 1
NO 2 (GO TO 116G)
DOESN'T KNOW THE SHOW 3 (GO TO 116G)

116E. According to you, is this series educational in nature or is it just entertainment?

EDUCATIONAL 1
ENTERTAINMENT 2 (GO TO 116G)
BOTH 3
DOESN'T KNOW 8 (GO TO 116G)

116F. In your opinion, which problems does "Yamba Songo" discuss?
RECORD ALL RESPONSES. IF THE RESPONSE IS "DOESN'T KNOW", YOU SHOULD ONLY CIRCLE THAT CODE.

FAMILY PLANNING/CONTRACEPTION A
HIV/AIDS B
SEXUALLY TRANSMITTED DISEASES C
ORS/TREATMENT OF DIARRHEA D
HEALTH PROBLEMS E
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

116G. Do you watch the television?

YES 1
NO 2 (GO TO 118)

117. Do you watch the television at least once a week?

YES 1
NO 2

117A. On what days of the week do you watch the television?
RECORD ALL GIVEN RESPONSES. IF THE RESPONSE IS "IT DEPENDS", "WHENEVER" OR "DOESN'T KNOW", YOU SHOULD ONLY CIRCLE ONE CODE.

MONDAY A
TUESDAY B
WEDNESDAY C
THURSDAY D
FRIDAY E
SATURDAY F
SUNDAY G
EVERYDAY I
IT DEPENDS/WHENEVER X
DOESN'T KNOW Z

117B. At what times do you usually watch the television?
RECORD ALL GIVEN RESPONSES. IF THE RESPONSE IS "IT DEPENDS", "WHENEVER" OR "DOESN'T KNOW", YOU SHOULD ONLY CIRCLE ONE CODE.

THE MORNING A
FROM NOON TO 2:00 PM C
FROM 2:00-6:00 PM D
FROM 6:00-8:00 PM E
AFTER 8:00 PM F
ALL DAY G
DEPENDS/WHENEVER X
DOESN'T KNOW Z

117C. What types of television programs do you usually watch?
PROBE TO GET THE TYPES OF SHOWS. RECORD ALL TYPES MENTIONED.

MUSICAL VARIETY A
SPORTS B
FILMS/SERIES C
NEWS D
REPORTING E
HEALTH PROGRAMMING F
OTHER (SPECIFY) ____ X

117D. What television stations do you usually watch?

NATIONAL STATION (TNB) A
FOREIGN STATIONS B

118. What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
TRADITIONAL 4
NOT RELIGIOUS/NONE 5
OTHER (SPECIFY) _____ 6

118A. What is your nationality?

BURKINABE 01 (GO TO 201)
NIGERIAN 02 (GO TO 201)
TOGOLESE 03 (GO TO 201)
BENINESE 04 (GO TO 201)
MALIAN 05 (GO TO 201)
IVOIRIAN 06 (GO TO 201)
GHANAN 07 (GO TO 201)
OTHER AFRICAN (SPECIFY) _____ 08 (GO TO 201)
OTHER (SPECIFY) _____ 09(GO TO 201)

119. What is your ethnicity?
WRITE DECLARED ETHNICITY, THEN CIRCLE CORRESPONDING CODE.

DECLARED ETHNICITY: ______
BOBO 01
DIOULA 02
FULFULDE/PEUL 03
GOURMATCHE 04
GOUROUNSI 05
LOBI 06
MOSSI 07
SENOUFO 08
TOUAREG/BELLA 09
OTHER (SPECIFY) _____ 10
DOESN'T KNOW 98

SECTION 2: REPRODUCTION

Now I would like to ask about all the births you have had during your life.

201. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

202. Do you have any sons of 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?
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?
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 at birth but did not survive more than a few hours or days?

YES 1
NO 2 (GO TO 208)

207. How many boys have died?
How many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD _____
GIRLS DEAD _____

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.

TOTAL ______

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

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

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 227)

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

211. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. REPEAT 212-221 FOR EACH SEPARATE BIRTH.

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

NAME ______

213. Was (NAME) a single birth or part of a multiple birth?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

MONTH _____
DOESN'T KNOW MONTH/SEASON 98
YEAR _____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

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 (GO TO NEXT BIRTH)

219. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 _____
MONTHS 2 _____
YEARS 3 _____

220. SUBTRACT THE BIRTH YEAR OF (NAME) FROM THE YEAR OF THE PREVIOUS BIRTH. IS THE DIFFERENCE FOUR OR MORE YEARS?
[DO NOT ASK FOR FIRST BIRTH]

YES 1
NO 2 (GO TO NEXT BIRTH)

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)? [DO NOT ASK FOR FIRST BIRTH]

YES 1
NO 2

[GO BACK AND REPEAT 212-221 FOR EACH ADDITIONAL BIRTH]

222. SUBTRACT THE BIRTH YEAR OF THE LAST CHILD FROM THE YEAR OF THE INTERVIEW. IS THE DIFFERENCE FOUR OR MORE YEARS?

YES 1 (GO TO 223)
NO 2 (GO TO 224)

223. Have you had any live births since the birth of (NAME OF LAST BIRTH)?

YES 1
NO 2

224. COMPARE 208 WITH NUMBER OF BIRTHS REGISTERED IN TABLE ABOVE AND MARK:

NUMBERS ARE SAME____
CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED (215) ____
CHECK: FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED (217) ____
CHECK: FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED (219) ____
CHECK: FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. ____
NUMBERS ARE DIFFERENT____ (PROBE AND RECONCILE)

225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1993:
IF NONE, RECORD '0'.

TOTAL _____

227. Are you pregnant now?

YES 1
NO 2 (GO TO 236)
UNSURE 8 (GO TO 236)

228. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

NUMBER OF MONTHS_____

229. 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

236. When did your last menstrual period start?
RECORD THE DATE, IF IT IS GIVEN.

DATE, IF IT IS GIVEN ______
NUMBER OF DAYS 1 _____
NUMBER OF WEEKS 2 _____
NUMBER OF MONTHS 3 _____
NUMBER OF YEARS 4 _____

IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER HAD PERIOD 996

237. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 300)
DOESN'T KNOW 8 (GO TO 300)

238. At what point in her menstrual cycle is a woman most likely to become pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
MIDDLE OF HER CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) ______ 6
DOESN'T KNOW 8

SECTION 3: CONTRACEPTION

300. 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.

CIRCLE CODE '1' IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF METHOD IS RECOGNIZED AND CODE '3' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 301 OR 302, ASK 303.

301. What are the ways or methods that have you heard about?
302. Have you ever heard of (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. 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 304)

303. Have you ever used (METHOD)?
THIS QUESTION IS ASKED ABOUT EACH METHOD IN 301 WITH '1' OR '2' CIRCLED.

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
04. MOUSSE, FOAM OR GEL: Women can place a mousse, gel or foam inside their vagina before sexual intercourse.
YES 1
NO 2
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. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07. MALE STERILIZATION: Men can have an operation to avoid having any more children. Have you ever had a partner who has an operation to avoid having any more children?
YES 1
NO 2
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 1
NO 2
09. WITHDRAWAL: Men can be careful and pull out before ejaculation.
YES 1
NO 2
10. OTHER METHOD(S) (SPECIFY) ______
YES 1
NO 2

304. CHECK 303:

NOT A SINGLE "YES" (NEVER USED) (GO TO 305)
AT LEAST ONE "YES" (EVER USED) (GO TO 309)

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

YES 1
NO 2 (GO TO 331)

307. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).

Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

309. How many living children did you have at that time?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ____

310. The first time you used family planning, was it because you wanted another child, but not until later, or was it because you didn't want any more children at all?

WANTED CHILD LATER 1
DIDN'T WANT CHILD AT ALL 2
OTHER (SPECIFY) _____ 6

311. CHECK 303:

WOMAN NOT STERILIZED (GO TO 312)
WOMAN STERILIZED (GO TO 314A)

312. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 313)
PREGNANT (GO TO 332)

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

YES 1
NO 2 (GO TO 331)

314. Which method are you currently using?
314A. CIRCLE '06' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 325A)
INJECTABLES 03 (GO TO 325A)
MOUSSE/FOAM/JELLY 04 (GO TO 325A)
CONDOM 05 (GO TO 325A)
FEMALE STERILIZATION 06 (GO TO 317A)
MALE STERILIZATION 07 (GO TO 317A)
RHYTHM METHOD 08 (GO TO 322A)
WITHDRAWAL 09 (GO TO 325A)
OTHER (SPECIFY) _____ 96 (GO TO 325A)

314B. Why do you use the pill over another method?

COST/LESS EXPENSIVE 01
MORE AVAILABLE 02
WAS PRESCRIBED TO RESPONDENT 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
CONVENIENCE 06
ONLY METHOD KNOWN 07
REVERSIBLE METHOD 08
OTHER (SPECIFY) ______ 96

315. May I see the package of pills you are currently using?
IF THE PACKAGE IS SHOWN, CIRCLE THE CORRESPONDING CODE.

MICRO-NOVUM 01 (GO TO 317)
LO-FEMENAL 02 (GO TO 317)
OVRETTE 03 (GO TO 317)
EUGYNON 04 (GO TO 317)
ADEPAL 05 (GO TO 317)
MINIPHASE 06 (GO TO 317)
MINIDRIL 07 (GO TO 317)
OTHER (SPECIFY) ______ 96 (GO TO 317)
PACKAGE NOT SEEN 98

316. What is the brand name of the pills you are currently using?

MICRO-NOVUM 01 (GO TO 317)
LO-FEMENAL 02 (GO TO 317)
OVRETTE 03 (GO TO 317)
EUGYNON 04 (GO TO 317)
ADEPAL 05 (GO TO 317)
MINIPHASE 06 (GO TO 317)
MINIDRIL 07 (GO TO 317)
OTHER (SPECIFY) ______ 96 (GO TO 317)
DOESN'T KNOW 98 (GO TO 317)

317. How much does one box (cycle) of pills cost you?

COST IN CFA _____ (GO TO 326)

FREE 9996 (GO TO 326)
DOESN'T KNOW 9998 (GO TO 326)

317A. Why did you (or your partner/spouse) choose to have an operation to no longer have children rather than another method?

COST/LESS EXPENSIVE 01
MORE AVAILABLE 02
WAS PRESCRIBED TO RESPONDENT 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
CONVENIENCE 06
ONLY METHOD KNOWN 07
DEFINITIVE METHOD 08
OTHER (SPECIFY) _____ 96

318. Where did the sterilization take place?

IF IT IS A HOSPITAL, MEDICAL CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ______
PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL 11
MEDICAL CENTER 12
OTHER PUBLIC (SPECIFY) _____ 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
FAMILY PLANNING CLINIC 22
OTHER PRIVATE MEDICAL (SPECIFY) _____ 27
DOESN'T KNOW 98

319. Do you regret having (your partner having) an operation in order to have no more children?

YES 1
NO 2 (GO TO 321)

320. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 1
HUSBAND/PARTNER WANTS ANOTHER CHILD 2
SIDE EFFECTS 3
CHILD DIED 4
OTHER (SPECIFY) ______ 6

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

MONTH _____
YEAR _____ (GO TO 327)

322A. Why do you use the rhythm method over another method?

COST/IS FREE 01
AVAILABILITY NOT A PROBLEM 02
WAS PRESCRIBED TO RESPONDENT 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
CONVENIENCE 06
ONLY METHOD KNOWN 07
REVERSIBLE METHOD 08
OTHER (SPECIFY) _____ 96

323. How do you determine which days in your menstrual cycle you should not have sexual intercourse?

BASED ON CALENDAR 1 (GO TO 326)
BASED ON BODY TEMPERATURE 2 (GO TO 326)
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 3 (GO TO 326)
BASED ON BODY TEMP AND CERVICAL MUCUS 4 (GO TO 326)
NO SPECIFIC SYSTEM 5 (GO TO 326)
OTHER (SPECIFY) _____ 6 (GO TO 326)

325A. Why do you use the (METHOD IN 314) over another method?

COST/NOT EXPENSIVE/IS FREE 01
AVAILABILITY NOT A PROBLEM 02
WAS PRESCRIBED TO RESPONDENT 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
CONVENIENCE 06
ONLY METHOD KNOWN 07
REVERSIBLE METHOD 08
PROTECTS AGAINST AIDS/STDS
OTHER (SPECIFY) _____ 96

326. For how many months have you been continuously using (METHOD)?
IF LESS THAN 1 MONTH, NOTE '00'.

NUMBER OF MONTHS ____
8 YEARS OR MORE 96

326A. If a contraceptive method was made available to you for free, would you accept it?
IF NO, PROBE FOR REASON AND CIRCLE THE CORRESPONDING RESPONSE.

YES 01
NO, ALREADY SPOILED 02
NO, QUALITY SUSPICIOUS 03
OTHER (SPECIFY) _____ 96

327. CHECK 314:
CIRCLE THE CODE OF THE METHOD USED.

PILL 01
IUD 02
INJECTABLES 03
MOUSSE/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06 (GO TO 329A)
MALE STERILIZATION 07 (GO TO 329A)
RHYTHM METHOD 08 (GO TO 332)
WITHDRAWAL 09 (GO TO 332)
OTHER METHOD 96 (GO TO 332)

328. Where did you last obtain (METHOD)?

IF IT IS A HOSPITAL, MEDICAL CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ______
PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
CSPS 13
SMI 14
DISPENSARY/MATERNITY POST 15
COMMUNITY PHARMACEUTICAL DEPOT 16
OTHER PUBLIC (SPECIFY) ______ 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
FAMILY PLANNING CLINIC 22
PHARMACY 23
NURSE'S OFFICE 24
OTHER PRIVATE (SPECIFY) ______ 27
OTHER SOURCE
STORE/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
HOTEL/ROOM FOR RENT 34
INFORMAL RETAIL CIRCUIT 35
FRIENDS/RELATIVES 36
OTHER (SPECIFY) ______ 95
OTHER (SPECIFY) ______ 96

329. Do you know of another place you could have gone last time to procure (METHOD)?
329A. At the time of your sterilization, did you know of another place where you could have had the same operation?

YES 1
NO 2 (GO TO 334)

329B. People choose where they go for family planning services for different reasons. What is the main reason why you went to (NAME OF PLACE IN 328 OR 318) rather than the other place you know of? Other reasons?

RECORD ALL MENTIONED. IF THE RESPONSE IS "DOESN'T KNOW", YOU SHOULD ONLY CIRCLE THAT CORRESPONDING CODE.

ACCESSIBILITY
CLOSE TO HOME A
CLOSE TO MARKET/WORK B
TRANSPORTATION AVAILABLE C
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/LIKEABLE D
CLEANER E
MORE PRIVACY F
SHORTER WAIT G
OPEN LONGER HOURS H
OTHER SERVICES OFFERED IN THE SAME ESTABLISHMENT I
AVAILABILITY OF METHOD AT ALL TIMES J
COSTS LESS K
WANTS ANONYMITY L
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

330. Amongst the reasons you've given me, what is the primary reason?

INTERVIEWER: IF YOU ONLY CIRCLED ONE CODE IN 329B, CIRCLE THE CODE CORRESPONDING TO THE SAME RESPONSE HERE AND CONTINUE TO 334. IF YOU CIRCLED SEVERAL CODES IN 329B, ASK THE FOLLOWING QUESTION AND CIRCLE THE CODE CORRESPONDING TO THE RESPONSE.

ACCESSIBILITY
CLOSE TO HOME 11
CLOSE TO MARKET/WORK 12
TRANSPORTATION AVAILABLE 13
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/LIKEABLE 21
CLEANER 22
MORE PRIVACY 23
SHORTER WAIT 24
OPEN LONGER HOURS 25
OTHER SERVICES OFFERED IN THE SAME ESTABLISHMENT 26
AVAILABILITY OF METHOD AT ALL TIMES 27
COSTS LESS 31
WANTS ANONYMITY 41
OTHER (SPECIFY) _______ 96
DOESN'T KNOW 98

331. CHECK 227:

NOT PREGNANT OR NOT SURE (GO TO 331A)
PREGNANT (GO TO 332)

331A. What is the main reason that you are not currently using a contraceptive method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUB-FECUND/IN FECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (OTHER) CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
CULTURAL TABOOS 35
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
DOESN'T KNOW 98

332. Do you know of a place where you can get contraception?

YES 1
NO 2 (GO TO 334)

333. Where is it?

IF IT IS A HOSPITAL, MEDICAL CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ______
PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
CSPS 13
SMI 14
DISPENSARY/MATERNITY POST 15
COMMUNITY PHARMACEUTICAL DEPOT 16
OTHER PUBLIC (SPECIFY) _____ 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
FAMILY PLANNING CLINIC 22
PHARMACY 23
NURSE'S OFFICE 24
OTHER PRIVATE (SPECIFY) _____ 27
OTHER SOURCE
STORE/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
HOTEL/ROOM FOR RENT 34
INFORMAL RETAIL CIRCUIT 35
FRIENDS/RELATIVES 36
OTHER (SPECIFY) ______ 95
OTHER (SPECIFY) ______ 96

334. In the last 12 months, have you had a visit from an agent that talked with you about family planning?

YES 1
NO 2

335. In the last 12 months, have you visited a health facility for any reason?

YES 1
NO 2 (GO TO 337)

336. Did any staff member at the health facility speak to you about family planning methods?

YES 1
NO 2

337. Do you think that breastfeeding can influence a woman's ability to become pregnant?

YES 1
NO 2 (GO TO 401)
DOESN'T KNOW 8

338. Do you think that breastfeeding increases or decreases a woman's chance of becoming pregnant?

INCREASES 1 (GO TO 401)
DECREASES 2
IT DEPENDS 3
DOESN'T KNOW 8

339. CHECK 210:

AT LEAST ONE BIRTH (GO TO 340)
NO BIRTHS (GO TO 401)

340. Have you previously relied on breastfeeding as a way to avoid becoming pregnant?

YES 1
NO 2 (GO TO 401)

341. CHECK 227 AND 311:

NOT PREGNANT OR NOT SURE AND NOT STERILIZED (GO TO 342)
PREGNANT OR STERILIZED (GO TO 401)

342. Are you currently relying on breastfeeding in order to avoid getting pregnant?

YES 1
NO 2

SECTION 4: FAMILY HEALTH AND BREASTFEEDING

SECTION 4A: PREGNANCY AND BREASTFEEDING

401. CHECK 225:

AT LEAST ONE BIRTH SINCE JANUARY 1993 (GO TO 402)
NO BIRTHS SINCE JANUARY 1993 (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH SINCE JANUARY 1993 IN THE REPRODUCTION TABLE. ASK THE QUESTIONS FOR ALL BIRTHS BEGINNING WITH THE LAST BIRTH. IF THERE ARE MORE THAN 3 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.

Now I would like to ask you some questions about the health of all your children born in the last five years. We will only talk about one child at a time.

402A. LINE NUMBER FROM 212:

LINE NO. _____

402B. FROM 212 AND 216:

NAME ______
LIVING ____
DEAD ____

403. At the time you became pregnant with (NAME), 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 (GO TO 405)
LATER 2
NOT AT ALL 3 (GO TO 405)

404. How much longer would you have liked to wait?

MONTHS 1 ____
YEARS 2 ____
DOESN'T KNOW 998

405. When you were pregnant with (NAME), did you see anyone for antenatal care?
IF YES: Whom did you see? PROBE: Anyone else?
CIRCLE ALL CODES CORRESPONDING TO PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER PERSON
TRADITIONAL BIRTH ASSISTANT D
OTHER (SPECIFY) ______ E
NO ONE F (GO TO 409)

406. Were you given a health card for this pregnancy?

YES 1
NO 2
DOESN'T KNOW 8

407. How many months pregnant were you when you first received antenatal care for this pregnancy?

NUMBER OF MONTHS _____
DOESN'T KNOW 98

408. How many prenatal visits did you have during this pregnancy?

NUMBER OF VISITS _____
DOESN'T KNOW 98

409. 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 411)
DOESN'T KNOW 8 (GO TO 411)

410. How many times did you get this injection?

NUMBER OF TIMES _____
DOESN'T KNOW 8

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

HOME
RESPONDENT'S HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
MATERNITY POST 22
DISPENSARY 23
OTHERS 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHERS (SPECIFY) _____ 41

412. Who assisted you with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
BIRTH ASSISTANT/MATRON D
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT E
TRADITIONAL BIRTH ASSISTANT F
RELATIVE G
OTHER (SPECIFY) ______ H
NO ONE I

413. Was (NAME) born full-term or premature?

FULL TERM 1
PREMATURE 2
DOESN'T KNOW 8

414. Was (NAME) delivered by caesarean section?

YES 1
NO 2

415. 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
DOESN'T KNOW 8

416. Was (NAME) weighed at birth?

YES 1
NO 2 (MOST RECENT BIRTH: GO TO 418; OTHERS: GO TO 419)

417. How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

GRAMS FROM CARD 1 _____
GRAMS FROM MEMORY 2 _____
DOESN'T KNOW 99998

418. Has your period come back since the birth of (NAME)?
[ONLY ASK OF MOST RECENT BIRTH]

YES 1 (GO TO 420)
NO 2 (GO TO 421)

419. Did your period come back between the birth of (NAME) and your next birth?
[ASK FOR ALL BUT MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 423)

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

NUMBER OF MONTHS_____
DOESN'T KNOW 98

421. CHECK 227:
IS RESPONDENT PREGNANT?
[ONLY ASK FOR MOST RECENT BIRTH]

NOT PREGNANT (GO TO 422)
PREGNANT OR UNSURE (GO TO 423)

422. Have you begun to have sexual intercourse again since the birth of (NAME)?
[ONLY ASK FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 424)

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

NUMBER OF MONTHS_____
DOESN'T KNOW 98

424. Did you breastfeed (NAME)?

YES 1 (MOST RECENT BIRTH: GO TO 426; OTHERS: GO TO 433)
NO 2

425. Why didn't you breastfeed (NAME)?

MOTHER SICK/WEAK 01 (GO TO 435)
CHILD SICK/WEAK 02 (GO TO 435)
CHILD DIED 03 (GO TO 435)
PROBLEMS WITH BREASTS/NIPPLES 04 (GO TO 435)
INSUFFICIENT MILK 05 (GO TO 435)
MOTHER WORKS 06(GO TO 435)
CHILD REFUSED 07 (GO TO 435)
OTHER (SPECIFY) _____ 08 (GO TO 435)

426. 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.
[ASK ONLY FOR MOST RECENT BIRTH]

IMMEDIATELY 000
HOURS 1 _____
DAYS 2 _____

427. CHECK 216:
CHILD LIVING?
[ASK ONLY FOR MOST RECENT BIRTH]

LIVING (GO TO 428)
DECEASED (GO TO 433)

428. Are you still breastfeeding (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 433)

429. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF NIGHTTIME FEEDINGS _____

430. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF DAYTIME FEEDINGS _____

431. Did (NAME) receive, at any moment yesterday or last night, any of the following:

Water?
Sugar Water?
Juice?
Herbal tea?
Baby formula?
Powdered or boxed milk?
Fresh (animal) milk?
Any other liquid?
Gruel?
Other food especially prepared for child?
Family dish?

[ASK ONLY FOR MOST RECENT BIRTH]

WATER
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
HERBAL TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
POWDERED OR BOXED MILK
YES 1
NO 2
FRESH (ANIMAL) MILK
YES 1
NO 2
ANY OTHER LIQUID
YES 1
NO 2
GRUEL
YES 1
NO 2
OTHER FOOD ESPECIALLY PREPARED FOR THE CHILD
YES 1
NO 2
FAMILY DISH
YES 1
NO 2

432. CHECK 431:
FOOD OR LIQUID GIVEN YESTERDAY?
[ASK ONLY FOR MOST RECENT BIRTH]

"YES" FOR ONE OR MORE (GO TO 437)
NOTHING AT ALL (GO TO 436)

433. For how many months did you breastfeed (NAME)?
IF LESS THAN 1 MONTH, RECORD '00'.

NUMBER OF MONTHS ____
UNTIL THEIR DEATH 96 (GO TO 436)

434. Why did you stop breastfeeding (NAME)?

MOTHER SICK/WEAK 01
CHILD SICK/WEAK 02
CHILD DIED 03
PROBLEMS WITH BREASTS 04
INSUFFICIENT MILK 05
MOTHER WORKS 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
BEGAN USING CONTRACEPTION 10
OTHER (SPECIFY) ______ 11

435. CHECK 216:
CHILD LIVING?

LIVING (GO TO 437)
DECEASED (GO TO 436)

436. Have you ever given (NAME) water, or something else to eat or drink that wasn't breast milk?

YES 1
NO 2 (GO TO 440)

437. How many months old was (NAME) when you began to regularly give them the following foods and drinks:

Boxed milk or milk other than breast milk?
Water?
Herbal tea?
Other liquids?
Gruel?
Solid foods?

IF LESS THAN ONE MONTH, RECORD '00'.

BOXED MILK OR MILK OTHER THAN BREAST MILK
AGE IN MONTHS ____ (LATER BIRTHS: GO TO 440)
NEVER BEEN GIVEN 96
WATER
AGE IN MONTHS ____ (LATER BIRTHS: GO TO 440)
NEVER BEEN GIVEN 96
HERBAL TEA
AGE IN MONTHS ____ (LATER BIRTHS: GO TO 440)
NEVER BEEN GIVEN 96
OTHER LIQUIDS
AGE IN MONTHS ____ (LATER BIRTHS: GO TO 440)
NEVER BEEN GIVEN 96
GRUEL
AGE IN MONTHS ____ (LATER BIRTHS: GO TO 440)
NEVER BEEN GIVEN 96
SOLID FOODS
AGE IN MONTHS ____ (LATER BIRTHS: GO TO 440)
NEVER BEEN GIVEN 96

438. CHECK 216:
CHILD LIVING?
[ASK ONLY FOR MOST RECENT BIRTH]

LIVING (GO TO 439)
DECEASED (GO TO 440)

439. Did (NAME) drink anything from a bottle yesterday or last night?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

440. RETURN TO 403 FOR THE NEXT BIRTH; OR (IF NO MORE BIRTHS, GO TO THE FIRST COLUMN OF 441.)

SECTION 4B: VACCINATION AND HEALTH

441. COMPLETE THE HEADING OF THE TABLE BY FOLLOWING THE SAME PROCEDURE AS FOR SECTION 4A. THERE IS AN IMPORTANT DIFFERENCE BETWEEN SECTIONS 4A AND 4B. SECTION 4A GATHERS INFORMATION ABOUT CHILDREN BOTH ALIVE AND DECEASED, WHEREAS SECTION 4B CONCERNS ONLY LIVING CHILDREN (442-477).

HOWEVER, YOU SHOULD COMPLETE THE HEADING OF THE TABLE IN SECTION 4B FOR ALL CHILDREN, LIVING OR DECEASED, BECAUSE THE QUESTIONS ABOUT THE TREATMENT OF CHILDREN'S DIARRHEA THAT ARE AT THE END OF THE SECTION (478-488) WILL BE ASKED OF ALL WOMEN.

441A. LINE NUMBER FROM 212:

LINE NO. _____

441B. FROM 212 AND 216:

NAME ______
LIVING ____
DEAD ____ (GO TO 441B IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 478)

442. Do you have a vaccination card for (NAME)?
IF YES: May I see it please?

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

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

YES 1 (GO TO 446)
NO 2 (GO TO 446)

444. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN DAY COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ____
MONTH ____
YEAR ____
POLIO 0
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 ____
IMOVAX 1
DAY ____
MONTH ____
YEAR ____
IMOVAX 2
DAY ____
MONTH ____
YEAR ____
MEASLES
DAY ____
MONTH ____
YEAR ____
YELLOW FEVER
DAY ____
MONTH ____
YEAR ____

445. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS: BCG, POLIO 0-3, DPT 1-3, IMOVAX 1-2, MEASLES AND/OR YELLOW FEVER VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 444)
NO 2 (GO TO 450)
DOESN'T KNOW 8 (GO TO 450)

446. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 450)
DOESN'T KNOW 8 (GO TO 450)

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

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

Polio vaccine, that is, drops in the mouth?

A measles injection?

An injection from a gun or syringe?

A BCG VACCINATION AGAINST TUBERCULOSIS
YES 1
NO 2
DOESN'T KNOW 8
POLIO VACCINE
IF YES: How many times?
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES _______
A MEASLES INJECTION
YES 1
NO 2
DOESN'T KNOW 8
AN INJECTION FROM A GUN OR SYRINGE
IF YES: How many times?
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES _____

450. Has (NAME) had a fever at any time in the last 2 weeks?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 455)
DOESN'T KNOW 8 (GO TO 455)

452. Has (NAME) suffered from a cough within the last 24 hours?

YES 1
NO 2
DOESN'T KNOW 8

453. How many days did/has the cough last/lasted?
IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS ____

454. 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
DOESN'T KNOW 8

455. CHECK 450 AND 451:
FEVER OR COUGH?

"YES" IN 450 OR 451 (GO TO 456)
OTHER (GO TO 458)

456. Did you seek advice or treatment for the fever or cough?

YES 1
NO 2 (GO TO 458)
DOESN'T KNOW 8 (GO TO 458)

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

PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
CSPS C
SMI D
DISPENSARY/MATERNITY POST E
COMMUNITY PHARMACEUTICAL DEPOT F
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE G
PHARMACY H
NURSE'S OFFICE I
RELIGIOUS DISPENSARY J
OTHER PRIVATE SECTOR
TRADITIONAL HEALER K
RELATIVE/NEIGHBOR/FRIEND L
OTHER (SPECIFY) _____ M

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

YES 1
NO 2 (GO TO 477)
DOESN'T KNOW 8 (GO TO 477)

460. Has (NAME) had diarrhea within the last 24 hours?

YES 1
NO 2
DOESN'T KNOW 8

461. How many days did/has the diarrhea last/lasted?
IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS ____

462. Was there blood in the stool?

YES 1 (FOR SECOND RECENT AND LATER BIRTHS: GO TO 466)
NO 2 (FOR SECOND RECENT AND LATER BIRTHS: GO TO 466)
DOESN'T KNOW 8 (FOR SECOND RECENT AND LATER BIRTHS: GO TO 466)

463. CHECK 428:
LAST INFANT STILL BEING BREASTFED?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES (GO TO 464)
NO (GO TO 466)

464. When (NAME) had diarrhea, did you change the number of feedings/nursings?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 466)

465. Did you increase or decrease the number of feedings, or did you stop them altogether?
[DO NOT ASK FOR MOST RECENT BIRTH]

INCREASED 1
DECREASED 2
STOPPED 3

466. (Besides breast milk), did you give the child the same amount to drink as before the diarrhea, more, or less?

SAME 1
MORE 2
LESS 3
DOESN'T KNOW 8

467. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 469)
DOESN'T KNOW 8 (GO TO 469)

468. What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.

LIQUID FROM ORS PACKETS A
RECOMMENDED HOUSE LIQUID (SSS) B
ERSEFLURIL/TYPHOMICINE C
GANIDAN/IMMODIUM/CHARCOAL/OTHER ANTI-DIARRHEIC D
INJECTION E
DRIP/SERUM F
MEDICINAL PLANTS/TRADITIONAL REMEDY (SPECIFY) _____ G
OTHER (SPECIFY) ______ H

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

YES 1
NO 2 (GO TO 471)

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

PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
CSPS C
SMI D
DISPENSARY/MATERNITY POST E
COMMUNITY PHARMACEUTICAL DEPOT F
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE G
PHARMACY H
NURSE'S OFFICE I
RELIGIOUS DISPENSARY J
OTHER PRIVATE SECTOR
TRADITIONAL HEALER K
RELATIVE/NEIGHBOR/FRIEND L
OTHER (SPECIFY) _____ M

471. CHECK 468:
LIQUID FROM ORS PACKET MENTIONED?

NO, ORS LIQUID NOT MENTIONED (GO TO 472)
YES, ORS LIQUID MENTIONED (GO TO 473)

472. Did (NAME) receive a liquid prepared from a special packet of powder to treat diarrhea?

YES 1
NO 2 (GO TO 474)
DOESN'T KNOW 8 (GO TO 474)

473. For how many days did (NAME) receive this liquid?
IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS ____
DOESN'T KNOW 98

474. CHECK 468:
RECOMMENDED HOMEMADE LIQUID MENTIONED?

NO, HOMEMADE LIQUID NOT MENTIONED (GO TO 475)
YES, HOMEMADE LIQUID MENTIONED (GO TO 476)

475. Did (NAME) receive a liquid recommended by a health personnel and prepared at home with a solution of salt and sugar water when he/she had diarrhea?

YES 1
NO 2 (GO TO 477)
DOESN'T KNOW 8 (GO TO 477)

476. For how many days did (NAME) receive the liquid prepared with a solution of salt and sugar water? IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS ____
DOESN'T KNOW 98

477. RETURN TO 441B FOR THE NEXT BIRTH. IF NO MORE BIRTHS, GO TO 478.

478. CHECK 468 AND 472, ALL COLUMNS:

NO CHILD RECEIVED ORS PACKET OR 468 AND 472 NOT ASKED (GO TO 479)
ANY CHILD RECEIVED ORS PACKET (GO TO 481)

479. Have you ever heard of a product called ORS you can get for the treatment of diarrhea?

YES 1
NO 2 (GO TO 481)

480. Have you already used this product?

YES 1
NO 2 (GO TO 482)

481. Where did you last obtain the ORS packet?

IF IT IS A HOSPITAL, MEDICAL CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______
PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
CSPS 13
SMI 14
DISPENSARY/MATERNITY POST 15
COMMUNITY PHARMACEUTICAL DEPOT 16
OTHER PUBLIC (SPECIFY) ______ 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
FAMILY PLANNING CLINIC 22
PHARMACY 23
NURSE'S OFFICE 24
OTHER PRIVATE (SPECIFY) ______ 27
OTHER SOURCE
STORE/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
HOTEL/ROOM FOR RENT 34
INFORMAL RETAIL CIRCUIT 35
FRIENDS/RELATIVES 36
OTHER (SPECIFY) _____ 95
OTHER (SPECIFY) _____ 96

482. Do you currently have an ORS packet in your house?

YES 1
NO 2 (GO TO 486)

483. May I see the ORS packet you have?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING CODE.
NOTE THE BRAND NAME.

BRAND NAME_______
ORASEL 1 (GO TO 485)
UNICEF 2 (GO TO 485)
NO BRAND 3 (GO TO 485)
OTHER (SPECIFY) _____ 6 (GO TO 485)
PACKET NOT SEEN 8

484. What is the brand name of the ORS packet that you have at this time?
NOTE THE BRAND NAME.

BRAND NAME_______
ORASEL 1
UNICEF 2
NO BRAND 3
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8

485. How much did the ORS packet you currently have cost you?

COST IN CFA _____

FREE 996
DOESN'T KNOW 998

486. CHECK 468 AND 472, ALL COLUMNS:

NO CHILD RECEIVED SALT/SUGAR SOLUTION OR 468 AND 472 NOT ASKED (GO TO 487)

AT LEAST ONE CHILD RECEIVED THE SALT/SUGAR SOLUTION (GO TO 501)

487. Have you ever heard of a solution of salt, sugar and water that one prepares at home and gives to children to treat diarrhea?

YES 1
NO 2 (GO TO 501)

488. Have you ever prepared this solution?

YES 1
NO 2

SECTION 5: MARRIAGE

501. PRESENCE OF OTHERS AT THIS POINT:

CHILDREN UNDER 10 YEARS
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

502. Are you currently married or living with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 507)
YES, LIVING WITH A MAN 2 (GO TO 507)
MARRIAGE NOT CONSUMMATED 3 (GO TO 515F)
NO, NOT IN UNION 4

503. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

504. Have you ever been married or lived with a man as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 515)

506. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 511AA)
DIVORCED 2 (GO TO 511AA)
SEPARATED 3 (GO TO 511AA)

507. Is your husband/partner living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

507A. NOTE HER HUSBAND'S LINE NUMBER ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT PART OF THE HOUSEHOLD, RECORD '00'.

LINE NUMBER_______

508. Does your husband/partner have any wives or partners other than you?

YES 1
NO 2 (GO TO 511)

509. How many other wives or partners does your husband have?

NUMBER OF WIVES/PARTNERS ______
DOESN'T KNOW 98 (GO TO 511)

510. Are you the first, second, ... wife?

RANK _____

511. INTERVIEWER: IF WOMAN IS CURRENTLY MARRIED/IN A UNION: Before your current marriage/union, were you married or did you live with a man, once or more than once?

ONE TIME 1 (GO TO 512)
MORE THAN ONE TIME 2

511AA. INTERVIEWER: IF WOMAN IS WIDOWED/DIVORCED/SEPARATED: Were you married or did you live with a man, once or more than once?

ONE TIME 1 (GO TO 512)
MORE THAN ONE TIME 2

511A. How much time passed between the end of your next-to-last union and the beginning of your last union (current union)? IF LESS THAN ONE YEAR, RECORD '00'.

DURATION IN FULL YEARS ____

512. CHECK 511 AND 511AA:

MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we are going to talk about your first husband/partner. In what month and year did you start living with him?

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____ (GO TO 514A)
DOESN'T KNOW YEAR 9998

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

AGE ____

514A. CHECK 502:

CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 515)
NOT IN UNION (GO TO 515F)

Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of certain problems related to family planning.

515. How long has it been since the last time you had sexual intercourse with your husband/the man with whom you live?

IF NEVER HAD SEXUAL RELATIONS, RETURN TO 502, CIRCLE CODE '3' FOR MARRIAGE NOT CONSUMMATED AND FOLLOW THE NEW INSTRUCTIONS BEGINNING AT 502.

DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 ____
BEFORE LAST BIRTH 996

515A. CHECK 301 AND 302:

YES, SHE HAS HEARD OF CONDOMS: Did you use a condom during your last sexual encounter with your husband/the man with whom you live?

NO, SHE HAS NEVER HEARD OF CONDOMS: Certain men use a condom, that is, they put a rubber sheath on their penis before having sexual intercourse. Did you use a condom during your last sexual encounter with your husband/the man with whom you live?

YES 1
NO 2 (GO TO 515B)
DOESN'T KNOW 8 (GO TO 515B)

515AA. During your last sexual encounter, who proposed using the condom?

RESPONDENT HERSELF 1
PARTNER/HUSBAND 2
BOTH 3

515B. Have you had sexual intercourse with someone other than your husband/the man with whom you live in the last 12 months?

YES 1
NO 2 (GO TO 517)

515C. When was the last time you had sexual intercourse with someone other than your husband/the man with whom you live?

DAYS AGO 1 ____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____
BEFORE LAST BIRTH 996

515CA. The last time you had sexual intercourse with someone other than your husband/the man with whom you live, was it with a regular partner, an acquaintance, for money, or with someone else?

REGULAR PARTNER 1
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4

515D. Was a condom used on this occasion?

YES 1
NO 2 (GO TO 515E)
DOESN'T KNOW 8 (GO TO 515E)

515DA. During this last sexual encounter, who proposed using the condom?

RESPONDENT HERSELF 1
PARTNER 2
BOTH 3

515E. With how many different people other than your husband/the man with whom you live have you had sexual intercourse in the last 12 months?

NUMBER OF PARTNERS _____
DOESN'T KNOW 98 (GO TO 517)

Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of certain problems related to family planning.

515F. How long has it been since the last time you had sexual intercourse, if you have ever had sexual intercourse?

NEVER 000 (GO TO 608)
DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____
BEFORE LAST BIRTH 996

515FA. The last time you had sexual intercourse, was it with a regular partner, an acquaintance, for money, or with someone else?

REGULAR PARTNER 1
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4

515G. CHECK 301 AND 302:

YES, SHE HAS HEARD OF CONDOMS: Did you use a condom during your last sexual encounter?

NO, SHE HAS NEVER HEARD OF CONDOMS: Certain men use a condom, that is, they put a rubber sheath on their penis before having sexual intercourse. Did you use a condom during your last sexual encounter?

YES 1
NO 2 (GO TO 515H)
DOESN'T KNOW 8 (GO TO 515H)

515GA. During this last sexual encounter, who proposed using the condom?

RESPONDENT HERSELF 1
PARTNER 2
BOTH 3

515H. CHECK 515F:

LESS THAN 12 MONTHS SINCE LAST SEXUAL ENCOUNTER (GO TO 515I)
12 MONTHS OR MORE SINCE LAST SEXUAL ENCOUNTER (GO TO 517)

515I. In total, with how many people have you had sexual intercourse in the last 12 months?

NUMBER OF PARTNERS _____
DOESN'T KNOW 98

517. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 518A)

518. Where is that?
Any other place?

RECORD ALL RESPONSES MENTIONED. EACH TIME A HOSPITAL, HEALTH CENTER, A CSPS OR A CLINIC IS MENTIONED, PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
CSPS C
SMI D
DISPENSARY/MATERNITY POST E
COMMUNITY PHARMACEUTICAL DEPOT F
OTHER PUBLIC (SPECIFY) ______ G
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE H
FAMILY PLANNING CLINIC I
PHARMACY J
NURSE'S OFFICE K
OTHER PRIVATE (SPECIFY) _____ L
OTHER LOCATION
STORE/MARKET M
BAR/NIGHTCLUB N
KIOSK O
HOTEL/ROOM FOR RENT P
INFORMAL COMMERCIAL CIRCUIT Q
FRIENDS/RELATIVES R
OTHER (SPECIFY) ______ X
OTHER (SPECIFY) ______ Y

518A. CHECK 515A, 515D, AND 515G:

AT LEAST ONE 'YES' (GO TO 518B)
NO 'YES' (GO TO 519)

518B. Where did you obtain condoms the last time?

IF IT IS A HOSPITAL, HEALTH CENTER, A CSPS OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _____
PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
CSPS 13
SMI 14
DISPENSARY/MATERNITY POST 15
COMMUNITY PHARMACEUTICAL DEPOT 16
OTHER PUBLIC (SPECIFY) ______ 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
FAMILY PLANNING CLINIC 22
PHARMACY 23
NURSE'S OFFICE 24
OTHER PRIVATE (SPECIFY) _____ 27
OTHER SOURCE
STORE/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
HOTEL/ROOM FOR RENT 34
INFORMAL RETAIL CIRCUIT 35
FRIENDS/RELATIVES 36
PARTNER HAD CONDOM 41 (GO TO 519)
OTHER (SPECIFY) ______ 96

518C. What is the brand name of the condoms you used the last time?

PRUDENCE 1
PACKAGING IS ALL WHITE 2
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8

518D. The last time you bought condoms, how many did you buy?
DETERMINE THE NUMBER OF CONDOMS AND RECORD THIS NUMBER.

NUMBER OF CONDOMS _____
DOESN'T KNOW 998

518E. How much did you pay?

COST IN CFA ____

FREE 9996 (GO TO 519)
DOESN'T KNOW 9998

518F. If condoms had to be offered to you for free, would you accept them?
IF THE RESPONSE IS NO, PROBE TO DETERMINE THE REASON AND CIRCLE THE CORRESPONDING CODE.

YES 1
NO, ALREADY SPOILED 2
NO, QUALITY SUSPICIOUS 3
OTHER (SPECIFY) _____ 4

519. What age were you when you had your first sexual encounter?

AGE ____
FIRST TIME WHILE MARRIED 96

SECTION 6: FERTILITY PREFERENCES

601. CHECK 314:

NEITHER HE NOR SHE STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 612)

602. CHECK 227:

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?

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 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DOESN'T KNOW 4 (GO TO 604)

603. CHECK 227:

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 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) _____ 996
DOESN'T KNOW 998

604. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 607)

605. If you were to become pregnant in the next several weeks, would you be happy, not happy, or indifferent?

HAPPY 1
NOT HAPPY 2
INDIFFERENT 3

606. CHECK 313:
USING A METHOD?

NOT ASKED (GO TO 607)
NOT CURRENTLY USING (GO TO 607)
CURRENTLY USING (GO TO 612)

607. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the next 12 months?

YES 1 (GO TO 609)
NO 2
DOESN'T KNOW 8

608. 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 610)
DOESN'T KNOW 8 (GO TO 610)

609. Which contraceptive method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTABLES 03 (GO TO 612)
MOUSSE/FOAM/JELLY 04 (GO TO 612)
CONDOM 05 (GO TO 612)
FEMALE STERILIZATION 06 (GO TO 612)
MALE STERILIZATION 07 (GO TO 612)
RHYTHM METHOD 08 (GO TO 612)
WITHDRAWAL 09 (GO TO 612)
OTHER 96 (SPECIFY) _____ 96 (GO TO 612)
UNSURE 98 (GO TO 612)

610. What is the main reason that you think you will never use a contraceptive method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUB-FECUND/IN FECUND 24 (GO TO 612)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND/PARTNER OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
CULTURAL TABOOS 35 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COSTS TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
OTHER (SPECIFY) _____ 96 (GO TO 612)
DOESN'T KNOW 98 (GO TO 612)

611. Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DOESN'T KNOW 8

612. 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.

NUMBER OF CHILDREN _____
OTHER (SPECIFY) _____ 96 (GO TO 614)

613. 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 ____
OTHER (SPECIFY) _____ 96
NUMBER OF GIRLS ____
OTHER (SPECIFY) _____ 96
NUMBER OF EITHER ____
OTHER (SPECIFY) _____ 96

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

APPROVE 1
DISAPPROVE 2
NO OPINION 3

615. In your opinion, is it appropriate or inappropriate to speak of family planning:

On the radio?
On television?

RADIO
APPROPRIATE 1
INAPPROPRIATE 2
DOESN'T KNOW 8
TELEVISION
APPROPRIATE 1
INAPPROPRIATE 2
DOESN'T KNOW 8

616. Over the last few months, have you heard or read messages about family planning:

On the radio?
On the television?
In a newspaper or magazine?
On a poster?
In brochures?
On a billboard?
During a community meeting?
In a health center/by a health agent?
At the mosque, church or temple?
At school/by a teacher?
At the workplace?
By a relative/friend?
By a neighbor?
During a theatrical performance?

THE RADIO
YES 1
NO 2
THE TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
ON A POSTER
YES 1
NO 2
IN BROCHURES
YES 1
NO 2
ON A BILLBOARD
YES 1
NO 2
DURING A COMMUNITY MEETING
YES 1
NO 2
IN A HEALTH CENTER/BY A HEALTH AGENT
YES 1
NO 2
AT THE MOSQUE, CHURCH OR TEMPLE
YES 1
NO 2
AT SCHOOL/BY A TEACHER
YES 1
NO 2
AT THE WORKPLACE
YES 1
NO 2
BY A RELATIVE/FRIEND
YES 1
NO 2
BY A NEIGHBOR
YES 1
NO 2
DURING A THEATRICAL PERFORMANCE
YES 1
NO 2

616A. What is your principal source of information on family planning?

NONE 01
PUBLIC HEALTH PROFESSIONAL 02
PRIVATE HEALTH PROFESSIONAL 03
COMMUNITY HEALTH PROFESSIONAL 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIEND/ACQUAINTANCE 08
RADIO 09
TELEVISION 10
NEWSPAPER/POSTERS 11
SCHOOL/TEACHER 12
COMMUNITY MEETING 13
PROMACO TEAM 14
THEATER 15
DOLOTIERE (COUNSELOR?) 16
CAMEL DRIVER 17
TRADITIONAL STORYTELLER 18
HOTEL OWNER 19
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

616B. If you had to choose, from what source would you like to receive information on family planning?

IF MORE THAN ONE SOURCE CITED, ASK WHICH IS THE MOST PREFERRED AND CIRCLE THE CORRESPONDING CODE.

ANY OF THEM 01
PUBLIC HEALTH PROFESSIONAL 02
PRIVATE HEALTH PROFESSIONAL 03
COMMUNITY HEALTH PROFESSIONAL 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIEND/ACQUAINTANCE 08
RADIO 09
TELEVISION 10
NEWSPAPER/POSTERS 11
SCHOOL/TEACHER 12
COMMUNITY MEETING 13
PROMACO TEAM 14
THEATER 15
DOLOTIERE (COUNSELOR?) 16
CAMEL DRIVER 17
TRADITIONAL STORYTELLER 18
HOTEL OWNER 19
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

618. Over the last 12 months, have you discussed family planning with anyone?

YES 1
NO 2 (GO TO 620)

619. With whom did you discuss it? Anyone else?
RECORD ALL PERSONS MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FATHER-IN-LAW I
FRIEND(S)/NEIGHBOR(S) J
OTHER (SPECIFY) ______ X

620. CHECK 502:

YES, CURRENTLY MARRIED (GO TO 621)
YES, LIVING WITH A MAN (GO TO 621)
NO, NOT IN UNION (GO TO 624)

Spouses don't always agree on everything. Now I would like to ask you some questions about your husband's/partner's opinions on family planning.

621. Do you think that your husband/partner approves or disapproves of couples that use a method to avoid a pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

622. How many times over the last 12 months have you discussed family planning with your husband/partner?

NEVER 1 (GO TO 622B)
ONE OR TWO TIMES 2
MORE OFTEN 3

622A. Generally, who begins the discussion about family planning, you, your husband/partner, or both?

RESPONDENT 1
HUSBAND/PARTNER 2
BOTH 3
DOESN'T KNOW 8

622B. CHECK 313:
USING A CONTRACEPTIVE METHOD?

YES, CURRENTLY USING (GO TO 622C)
NO, NOT CURRENTLY USING/QUESTION NOT ASKED (GO TO 623)

622C. Before starting to use (CURRENT METHOD), did you discuss which method to use with your husband/partner?

YES 1
NO 2
DOESN'T REMEMBER 8

622D. After having started to use (CURRENT METHOD), did you discuss the method with your husband/partner?

YES 1
NO 2
DOESN'T REMEMBER 8

622E. CHECK 314:
CIRCLE THE CODE OF THE METHOD:

PILL 01
IUD 02
INJECTABLES 03
MOUSSE/FOAM/JELLY 04
CONDOM 05 (GO TO 623)
FEMALE STERILIZATION 06
MALE STERILIZATION 07 (GO TO 623)
RHYTHM METHOD 08
WITHDRAWAL 09 (GO TO 623)
OTHER METHOD 96

622F. Did your husband/partner encourage you to use or discourage you from using (CURRENT METHOD)?

ENCOURAGED 1
DISCOURAGED 2
NEITHER/NEUTRAL 3
DOESN'T KNOW 8

623. Do you think that your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

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

624. In your opinion, who should make the decision to use a method of family planning, the man or the woman?

MAN 1
WOMAN 2
BOTH 3
SOMEONE ELSE 4

625. In your opinion, who generally makes the decision to use a method of family planning, the man or the woman?

MAN 1
WOMAN 2
BOTH 3
SOMEONE ELSE 4

626. Do you think that your mother (or guardian) approves or disapproves of couples that use a method to avoid a pregnancy?

IF MOTHER OR GUARDIAN IS DECEASED, ASK THE QUESTION IN THIS MANNER: If your mother (guardian) were alive, do you think she would approve or disapprove of couples that use a method to avoid a pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

627. Do you think that your father (or guardian) approves or disapproves of couples that use a method to avoid a pregnancy?

IF FATHER OR GUARDIAN IS DECEASED, ASK THE QUESTION IN THIS MANNER: If your father (guardian) were alive, do you think he would approve or disapprove of couples that use a method to avoid a pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

628. Would you say that using contraception is contrary or not contrary to the precepts of your religion?

CONTRARY 1
NOT CONTRARY 2
THEIR RELIGION HAS NO POSITION ON THIS SUBJECT 3
RESPONDENT HAS NO RELIGION 4
DOESN'T KNOW 8

629. In your opinion, in order to raise a family's standard of living, is it preferable to have a small family or a large family?

SMALL FAMILY 1
LARGE FAMILY 2
EITHER/NO IMPORTANCE 3
IT DEPENDS 4
DOESN'T KNOW/NO OPINION 8

630. Have you ever encouraged or tried to persuade a friend or relative to use family planning?

YES 1
NO 2

SECTION 7: HUSBAND'S BACKGROUND AND WOMAN'S WORK

701. CHECK 502 AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVING WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 709)

702. How old was your husband/partner on his last birthday?

AGE ____
DOESN'T KNOW 98

703. Did your (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended: primary, secondary (1st cycle), secondary (2nd cycle), or higher?

PRIMARY 1
SECONDARY (1ST CYCLE) 2
SECONDARY (2ND CYCLE) 3
HIGHER 4
DOESN'T KNOW 8 (GO TO 706)

705. What was the highest grade he completed at that level?

GRADE ______
PRIMARY
0 LESS THAN ONE YEAR COMPLETED
1 1ST GRADE
2 2ND GRADE
3 3RD GRADE
4 4TH GRADE
5 5TH GRADE
8 DOESN'T KNOW
SECONDARY (1ST CYCLE)
0 LESS THAN ONE YEAR COMPLETED
1 6TH GRADE
2 7TH GRADE
3 8TH GRADE
4 9TH GRADE
5 FPP
8 DOESN'T KNOW
SECONDARY (2ND CYCLE)
0 LESS THAN ONE YEAR COMPLETED
1 10TH GRADE
2 11TH GRADE
3 12TH GRADE
4 FPB
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

706. What is (was) your husband's/partner's occupation? That is, what kind of work does (did) he mainly do?

OCCUPATION ______

707. CHECK 706:

WORKS/WORKED IN AGRICULTURE (GO TO 708)
DOES/DID NOT WORK IN AGRICULTURE (GO TO 709)

708. Did/Does your husband/partner work mainly on his own land or on family land, or does/did he work on land that he rents/rented from someone else, or does/did he work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
NOT APPLICABLE 6

709. Aside from your own housework, do you currently work?

YES 1 (GO TO 712)
NO 2

710. As you know, some women take up jobs for which they are paid in cash or kind. Some have a small business or work on the family farm or in the family business. Do you currently do any of these things or any other work?

YES 1 (GO TO 712)
NO 2

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

YES 1
NO 2 (GO TO 801A)

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

OCCUPATION _____

713. CHECK 710:

WORKS/WORKED IN AGRICULTURE (GO TO 714)
DOES/DID NOT WORK IN AGRICULTURE (GO TO 715)

714. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
NOT APPLICABLE 5

715. 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

716. 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

SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801A. Have you ever heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 801K)

801B. Which ones do you know of?
RECORD ALL MENTIONED.

SYPHILIS A
GONORRHEA B
AIDS C
CONDYLOMA (GENITAL WARTS) D
DISCHARGE E
ULCERS F
LOWER ABDOMINAL PAIN G
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

801C. CHECK 515:

HAS HAD SEXUAL INTERCOURSE (GO TO 801D)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 801K)

801D. In the last 12 months, have you had one of these infections?

YES 1
NO 2 (GO TO 801K)
DOESN'T KNOW 8 (GO TO 801K)

801E. Which infections did you have?
RECORD ALL MENTIONED.

SYPHILIS A
GONORRHEA B
AIDS C
CONDYLOMA (GENITAL WARTS) D
DISCHARGE E
ULCERS F
LOWER ABDOMINAL PAIN G
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

801F. The last time you had (INFECTION FROM 801E), did you seek advice or treatment?

YES 1
NO 2 (GO TO 801H)

801G. Where did you seek advice or treatment?
RECORD ALL MENTIONED.

PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
CSPS C
SMI D
DISPENSARY/MATERNITY POST E
COMMUNITY PHARMACEUTICAL DEPOT F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE H
FAMILY PLANNING CLINIC I
PHARMACY J
NURSE'S OFFICE K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
STORE/MARKET M
BAR/NIGHTCLUB N
KIOSK O
HOTEL/ROOM FOR RENT P
INFORMAL RETAIL CIRCUIT Q
FRIENDS/RELATIVES R
OTHER (SPECIFY) _____ X
OTHER (SPECIFY) _____ Y

801H. When you had (INFECTION(S) FROM 801E), did you inform your sexual partner(s)?

YES 1
NO 2

801I. When you had (INFECTION(S) FROM 801E), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 801K)
PARTNER ALREADY INFECTED 3 (GO TO 801K)

801J. What did you do?
RECORD ALL MENTIONED.

AVOIDED SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICATION C
OTHER (SPECIFY) ______ X

801K. CHECK 801B:

DID NOT MENTION 'AIDS' OR QUESTION NOT ASKED (GO TO 801L)
MENTIONED 'AIDS' (GO TO 802)

801L. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 811C)

802. From which sources have you heard about AIDS?
INSIST: Any other sources? RECORD ALL MENTIONED.

PUBLIC HEALTH PROFESSIONAL A
PRIVATE HEALTH PROFESSIONAL B
COMMUNITY HEALTH PROFESSIONAL C
FAMILY PLANNING CLINIC D
HUSBAND/PARTNER F
OTHER RELATIVES G
FRIENDS/RELATIONS H
RADIO I
TELEVISION J
NEWSPAPER/POSTERS K
BROCHURES L
MOSQUE/CHURCH/TEMPLE M
SCHOOL/TEACHER N
ASSOCIATION MEETING O
THEATER P
WORK PLACE Q
PROMACO TEAM R
DOLOTIERE (COUNSELOR?) S
CAMEL DRIVER T
TRADITIONAL STORYTELLER U
HOTEL/RESTAURANT OWNER V
OTHER (SPECIFY) _____ W

802AA. INTERVIEWER: IF YOU HAVE ONLY CIRCLED ONE CODE IN 802, CIRCLE THE CODE CORRESPONDING TO THE SAME RESPONSE HERE AND CONTINUE TO 802AB.

IF YOU CIRCLED MULTIPLE CODES IN 802, ASK THE FOLLOWING QUESTION AND CIRCLE THE CODE THAT CORRESPONDS TO THE RESPONSE: Amongst the sources you cited, which is the primary source?

PUBLIC HEALTH PROFESSIONAL 02
PRIVATE HEALTH PROFESSIONAL 03
COMMUNITY HEALTH PROFESSIONAL 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIENDS/RELATIONS 08
RADIO 09
TELEVISION 10
NEWSPAPER/POSTERS 11
BROCHURES 12
MOSQUE/CHURCH/TEMPLE 13
SCHOOL/TEACHER 14
ASSOCIATION MEETING 15
THEATER 16
WORK PLACE 17
PROMACO TEAM 18
DOLOTIERE (COUNSELOR?) 19
CAMEL DRIVER 20
TRADITIONAL STORYTELLER 21
HOTEL/RESTAURANT OWNER 22
OTHER (SPECIFY) _____ 96

802AB. If you had to choose, from which source would you prefer to receive information on AIDS?

IF MULTIPLE SOURCES ARE CITED, ASK WHICH IS THE PREFERRED SOURCE AND CIRCLE THE CORRESPONDING CODE.

ANY OF THEM 01
PUBLIC HEALTH PROFESSIONAL 02
PRIVATE HEALTH PROFESSIONAL 03
COMMUNITY HEALTH PROFESSIONAL 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIENDS/RELATIONS 08
RADIO 09
TELEVISION 10
NEWSPAPER/POSTERS 11
BROCHURES 12
MOSQUE/CHURCH/TEMPLE 13
SCHOOL/TEACHER 14
ASSOCIATION MEETING 15
THEATER 16
WORK PLACE 17
PROMACO TEAM 18
DOLOTIERE (COUNSELOR?) 19
CAMEL DRIVER 20
TRADITIONAL STORYTELLER 21
HOTEL/RESTAURANT OWNER 22
OTHER (SPECIFY) _____ 96

802B. In your opinion, how can someone get AIDS?
INSIST: Any other way? RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS B
SEXUAL INTERCOURSE WITH PROSTITUTES C
NOT USING A CONDOM D
HOMOSEXUAL RELATIONS E
BLOOD INFUSIONS F
INJECTIONS G
KISSING H
MOSQUITO BITES I
DIRTY BLADES, SCISSORS, KNIVES, AND OTHER CUTTING IMPLEMENTS J
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

803. Is there something people can do to avoid contracting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 807)
DOESN'T KNOW 8 (GO TO 807)

804. In your opinion, what can one do?
PROBE: Anything else? RECORD ALL MENTIONED.

BE FAITHFUL A
ABSTAIN FROM HAVING SEX B
USE CONDOMS C
AVOID MULTIPLE PARTNERS D
AVOID PROSTITUTES E
AVOID HOMOSEXUAL RELATIONS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
AVOID DIRTY BLADES/SCISSORS/KNIVES/OTHER CUTTING IMPLEMENTS K
SEEK PROTECTION FROM TRADITIONAL HEALERS L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

807. Is it possible for a healthy-looking person to have AIDS?

YES 1
NO 2
DOESN'T KNOW 8

808. Do you think that a person with AIDS almost never dies from it, sometimes dies from it, or almost always dies from it?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DOESN'T KNOW 8

808A. Can AIDS can be cured?

YES 1
NO 2
DOESN'T KNOW 8

808B. Can AIDS be passed from mother to child?

YES 1
NO 2
DOESN'T KNOW 8

808C. Do you personally know anyone who has AIDS or has died of AIDS?

YES 1
NO 2
DOESN'T KNOW 8

808D. In your opinion, what should be done with people sick with AIDS?

SEND THEM TO THE HOSPITAL 1
KEEP THEM AT HOME 2
ISOLATE THEM 3
MORALLY SUPPORT THEM 4
OTHER (SPECIFY) _____ 5
DOESN'T KNOW 8

809. Do you think your risk of getting AIDS is small, moderate, significant, or do you think you run no risk at all in contracting AIDS?

SMALL 1
MODERATE 2 (GO TO 809C)
SIGNIFICANT 3 (GO TO 809C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 811A)

809B. Why do you think your risk of getting AIDS is small/Why do you think you run no risk of getting AIDS? Are there other reasons? RECORD ALL MENTIONED.

IS FAITHFUL A (GO TO 811A)
ABSTAINS FROM SEX B (GO TO 811A)
USES CONDOMS C (GO TO 811A)
ONLY HAS SEX WITH ONE PARTNER D (GO TO 811A)
LIMITS NUMBER OF SEXUAL PARTNERS E (GO TO 811A)
PARTNER IS FAITHFUL F (GO TO 811A)
DOESN'T HAVE HOMOSEXUAL RELATIONS G (GO TO 811A)
AVOIDS BLOOD TRANSFUSIONS H (GO TO 811A)
AVOIDS INJECTIONS I (GO TO 811A)
AVOIDS DIRTY BLADES/SCISSORS/KNIVES/OTHER CUTTING IMPLEMENTS K (GO TO 811A)
OTHER (SPECIFY) _____ X (GO TO 811A)

809C. Why do you think your risk of getting AIDS is moderate/Why do you think your risk of getting AIDS is significant? Are there other reasons? RECORD ALL MENTIONED.

DOESN'T USE CONDOMS C
HAS MORE THAN ONE PARTNER D
HAS NUMEROUS PARTNERS E
PARTNER HAS OTHER PARTNERS F
HOMOSEXUAL RELATIONS G
BLOOD TRANSFUSIONS H
INJECTIONS I
USES DIRTY BLADES, SCISSORS, KNIVES, OTHER CUTTING IMPLEMENTS K
OTHER (SPECIFY) _____ X

811A. Since you've heard about AIDS, have you changed your behavior in order to avoid getting the illness? IF YES, INSIST: What have you done? Anything else?
RECORD ALL MENTIONED.

HASN'T STARTED HAVING SEX A (GO TO 811C)
STOPPED HAVING SEX B (GO TO 811C)
STARTED TO USE CONDOMS C (GO TO 811C)
LIMITS SEX TO ONE PARTNER D (GO TO 811C)
REDUCED NUMBER OF PARTNERS E (GO TO 811C)
DEMANDED PARTNER TO BE FAITHFUL F (GO TO 811C)
STOPPED HOMOSEXUAL RELATIONS G (GO TO 811C)
STOPPED INJECTIONS I
AVOIDS DIRTY BLADES/SCISSORS/KNIVES/OTHER CUTTING IMPLEMENTS K
OTHER (SPECIFY) ____ W
OTHER (SPECIFY) ____ X
NO CHANGE Y

811B. Has knowing about AIDS influenced or changed your decision to have sexual relations or your sexual behavior? IF YES: In what way? RECORD ALL MENTIONED.

HASN'T STARTED HAVING SEX A
STOPPED HAVING SEX B
STARTED TO USE CONDOMS C
LIMITS SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
OTHER (SPECIFY) _____ X
HASN'T CHANGED SEXUAL BEHAVIOR Y
DOESN'T KNOW Z

811C. Some people use a condom during sexual intercourse to protect themselves from AIDS and other sexually transmitted infections. Have you already heard of this?

YES 1
NO 2 (GO TO 811F)

811D. CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE (GO TO 811E)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

811E. We might have already talked about this. Have you ever used a condom during sexual relations to avoid catching or transmitting illnesses such as AIDS?

YES 1
NO 2 (GO TO 811G)

811EA. Do you use a condom from time to time, often, or every time you have sexual relations?

FROM TIME TO TIME 1 (GO TO 811G)
OFTEN 2 (GO TO 811G)
EVERY TIME 3 (GO TO 811G)

811F. CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE (GO TO 811G)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

811G. During the last 12 months, have you given or received money, gifts or favors in exchange for sexual intercourse?

YES 1
NO 2

SECTION 9: FEMALE CIRCUMCISION

Now I would like to ask you questions about female circumcision, which consists of the total or partial removal of the external parts of a woman's genitalia. This practice exists within certain societies in Burkina and other countries.

901. Have you ever heard of female circumcision?

YES 1
NO 2 (GO TO 1001)

902. Have you been circumcised?

YES 1
NO 2 (GO TO 908)

903. What type of circumcision did you receive?

CLITORIS 1
CLITORIS/INNER LIPS 2
CLITORIS/INNER LIPS/OUTER LIPS 3
OTHER (SPECIFY) ______ 4

904. How old were you at the time of your circumcision?

AGE IN FULL YEARS ____
DOESN'T KNOW 98

905. Who performed your circumcision?

DOCTOR 01
NURSE/MIDWIFE 02
MATRON 03
TRADITIONAL MIDWIFE 04
CIRCUMCISER 05
OTHER (SPECIFY) ______ 96
DOESN'T KNOW 98

906. During your circumcision, did they partially or completely close the vaginal opening by sewing a seam?

YES 1
NO 2
DOESN'T KNOW 8

907. At the time of your first menstrual period or at the time of your marriage, did the vaginal zone have to be opened by making an incision?

YES/RESULT OF INITIAL OPERATION 0
YES/FOLLOWING INITIAL OPERATION 1
NO 2

908. CHECK 214 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER (GO TO 909)
HAS NO LIVING DAUGHTERS (GO TO 915A)

909. Has (NAME OF ELDEST DAUGHTER) undergone this practice?

YES 1
NO 2 (GO TO 914)
NOT YET 8 (GO TO 914)

910. What type of circumcision did (NAME OF ELDEST DAUGHTER) receive?

CLITORIS 1
CLITORIS/INNER LIPS 2
CLITORIS/INNER LIPS/OUTER LIPS 3
OTHER (SPECIFY) ______ 4

911. What age was she at the time of her circumcision?

AGE IN FULL YEARS ____
DOESN'T KNOW 98

912. Who performed her circumcision?

DOCTOR 01
NURSE/MIDWIFE 02
MATRON 03
TRADITIONAL MIDWIFE 04
CIRCUMCISER 05
OTHER (SPECIFY) ______ 96
DOESN'T KNOW 98

913. Did anyone object to (NAME OF ELDEST DAUGHTER)'s circumcision? Anyone else? RECORD ALL PERSONS MENTIONED.

RESPONDENT A (GO TO 915A)
HUSBAND OF RESPONDENT B (GO TO 915A)
MOTHER/MOTHER-N-LAW OF RESPONDENT C (GO TO 915A)
FATHER/FATHER-IN-LAW OF RESPONDENT D (GO TO 915A)
OTHER RELATIVE OF RESPONDENT E (GO TO 915A)
OTHER (SPECIFY) ____ X (GO TO 915A)
NO ONE Y (GO TO 915A)

914. Do you intend to have her circumcised?

YES 1 (GO TO 915A)
NO 2
DOESN'T KNOW 8 (GO TO 915A)

915. Do you think that someone around you (family, friends) could, without your permission, have your daughter circumcised?

YES 1
NO 2
DOESN'T KNOW 8

915A. Who makes the decision to circumcise a girl?

MOTHER 1
FATHER 2
BOTH (MOTHER/FATHER) 3
AUNT 4
UNCLE 5
GRANDPARENTS 6
OTHER (SPECIFY) _____ 7

916. Do you think that the practice of female circumcision should continue to be practiced, or on the contrary, that it should not continue to be practiced?

CONTINUED 1
STOPPED 2 (GO TO 919)
DOESN'T KNOW 8 (GO TO 920A)

917. Why do you think that the practice of female circumcision should continue to be practiced? Any other reason? RECORD ALL MENTIONED.

GOOD TRADITION A
CUSTOM AND TRADITION B
RELIGIOUS NECESSITY C (GO TO 920A)
HYGIENE D (GO TO 920A)
BETTER MARRIAGE PROSPECTS E (GO TO 920A)
MORE PLEASURE FOR HUSBAND F (GO TO 920A)
MORE PLEASURE FOR WIFE G (GO TO 920A)
PRESERVE VIRGINITY/AVOID IMMORALITY H (GO TO 920A)
OTHER (SPECIFY) _____ X (GO TO 920A)
DOESN'T KNOW Y (GO TO 920A)

918. What do you mean by GOOD TRADITION/CUSTOM AND TRADITION?
RECORD ALL RESPONSES MENTIONED.

CUSTOM AND TRADITION B (GO TO 920A)
RELIGIOUS NECESSITY C (GO TO 920A)
HYGIENE D (GO TO 920A)
BETTER MARRIAGE PROSPECTS E (GO TO 920A)
MORE PLEASURE FOR HUSBAND F (GO TO 920A)
MORE PLEASURE FOR WIFE G (GO TO 920A)
PRESERVE VIRGINITY/AVOID IMMORALITY H (GO TO 920A)
OTHER (SPECIFY) _____ X (GO TO 920A)
DOESN'T KNOW Y (GO TO 920A)

919. Why do you think that the practice of female circumcision should be stopped?
Any other reason? RECORD ALL MENTIONED.

BAD TRADITION A
AGAINST RELIGION B (GO TO 920A)
MEDICAL COMPLICATIONS C (GO TO 920A)
OWN PAINFUL EXPERIENCE D (GO TO 920A)
AGAINST THE DIGNITY OF WOMEN E (GO TO 920A)
IMPEDES SEXUAL SATISFACTION OF THE MAN F (GO TO 920A)
IMPEDES SEXUAL SATISFACTION OF THE WOMAN G (GO TO 920A)
LAW EXISTS AGAINST THE PRACTICE H (GO TO 920A)
OTHER (SPECIFY) _____ X (GO TO 920A)
DOESN'T KNOW Y (GO TO 920A)

920. What do you mean by BAD TRADITION?
RECORD ALL MENTIONED.

AGAINST RELIGION B
MEDICAL COMPLICATIONS C
OWN PAINFUL EXPERIENCE D
AGAINST THE DIGNITY OF WOMEN E
IMPEDES SEXUAL SATISFACTION OF THE MAN F
IMPEDES SEXUAL SATISFACTION OF THE WOMAN G
OTHER (SPECIFY) _____ X
DOESN'T KNOW Y

920A. In the last six months, have you heard or seen something about female circumcision:

On the radio?
On the television?
In a newspaper or magazine?
On a poster?
In brochures?
On a billboard?
During a community meeting?
In a health center/by a health agent?
At the mosque, church or temple?
At school/by a teacher?
At the workplace?
By a relative/friend?
By a neighbor?
During a theatrical performance?

ON THE RADIO
YES 1
NO 2
ON THE TELEVISION
YES 1
NO 2
IN A NEWSPAPER OR MAGAZINE
YES 1
NO 2
ON A POSTER
YES 1
NO 2
IN BROCHURES
YES 1
NO 2
ON A BILLBOARD
YES 1
NO 2
DURING A COMMUNITY MEETING
YES 1
NO 2
IN A HEALTH CENTER/BY A HEALTH AGENT
YES 1
NO 2
AT THE MOSQUE, CHURCH OR TEMPLE
YES 1
NO 2
AT SCHOOL/BY A TEACHER
YES 1
NO 2
AT THE WORKPLACE
YES 1
NO 2
BY A RELATIVE/FRIEND
YES 1
NO 2
BY A NEIGHBOR
YES 1
NO 2
DURING A THEATRICAL PERFORMANCE
YES 1
NO 2

920B. What is your principal source of information on female circumcision?

NONE 01
PUBLIC HEALTH PROFESSIONAL 02
PRIVATE HEALTH PROFESSIONAL 03
COMMUNITY HEALTH PROFESSIONAL 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIENDS/RELATIONS 08
RADIO 09
TELEVISION 10
NEWSPAPER/POSTERS 11
SCHOOL/TEACHER 12
COMMUNITY MEETING 13
PROMACO TEAM 14
THEATER 15
DOLOTIERE (COUNSELOR?) 16
CAMEL DRIVER 17
TRADITIONAL STORYTELLER 18
HOTEL/RESTAURANT OWNER 19
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

920C. If you had to choose, from what source would you prefer to receive information on female circumcision?

ANY OF THEM 01
PUBLIC HEALTH PROFESSIONAL 02
PRIVATE HEALTH PROFESSIONAL 03
COMMUNITY HEALTH PROFESSIONAL 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIENDS/RELATIONS 08
RADIO 09
TELEVISION 10
NEWSPAPER/POSTERS 11
SCHOOL/TEACHER 12
COMMUNITY MEETING 13
PROMACO TEAM 14
THEATER 15
DOLOTIERE (COUNSELOR?) 16
CAMEL DRIVER 17
TRADITIONAL STORYTELLER 18
HOTEL OWNER 19
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

920D. Do you know that a law exists in Burkina that prohibits female circumcision?

YES 1
NO 2

SECTION 10: MATERNAL MORTALITY

Now, I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother including those that live with you, those that live elsewhere, and those that are deceased.

1001. To how many children did your mother give birth in total, including yourself?

NATURAL MOTHER'S NUMBER OF BIRTHS ____

1002. CHECK 1001:

TWO OR MORE BIRTHS (GO TO 1003)
ONLY ONE BIRTH (RESPONDENT) (GO TO 1016)

1003. How many of your brothers and sisters were born alive before you?

NUMBER OF PRECEDING BIRTHS ____

1004. What was the name given to your oldest (next oldest) brother or sister?

NAME ______

1005. Is (NAME) male or female?

MALE 1
FEMALE 2

1006. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1008)
DOESN'T KNOW 8 (GO TO NEXT BIRTH)

1007. How old is (NAME)?

AGE _____ (GO TO NEXT BIRTH)

1008. In what year did (NAME) die?

YEAR _____ (GO TO 1010)
DOESN'T KNOW 9998

1009. How many years ago did (NAME) die?

YEARS AGO ______

1010. How old was (NAME) when he/she died?

______ (IF MALE OR WOMAN THAT DIED BEFORE 12 YEARS OF AGE, GO TO NEXT BIRTH)

1011. Was (NAME) pregnant when she died?

YES 1 (GO TO 1014)
NO 2
DOESN'T KNOW 8

1012. Did (NAME) die during childbirth?

YES 1 (GO TO 1015)
NO 2
DOESN'T KNOW 8

1013. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO 1015)
DOESN'T KNOW 8 (GO TO 1015)

1014. Did (NAME) die due to complications from pregnancy or childbirth?

YES 1
NO 2
DOESN'T KNOW 8

1015. How many children did (NAME) give birth to?

NUMBER OF CHILDREN _____ (GO TO NEXT BIRTH)

[IF NO MORE SIBLINGS, GO TO 916.]

1016. RECORD THE TIME:

HOUR ____
MINUTES ____

SECTION 11: HEIGHT AND WEIGHT

1101. CHECK 215, 216:

AT LEAST ONE BIRTH SINCE JANUARY 1993 (GO TO INSTRUCTIONS)
NO BIRTHS SINCE JANUARY 1993 (END OF INTERVIEW)

INTERVIEWER: IN 1102 (COLUMNS 2-4) RECORD THE LINE NUMBER OF EACH CHILD BORN SINCE JANUARY 1993 WHO IS STILL ALIVE.

IN 1103 AND 1104, RECORD THE NAME AND DATE OF BIRTH OF THE RESPONDENT AND EACH LIVING CHILD BORN SINCE JANUARY 1993.

IN 1106 AND 1108, RECORD THE WEIGHT AND HEIGHT OF THE RESPONDENT AND HER LIVING CHILDREN.

NOTE: ALL RESPONDENTS HAVING A BIRTH SINCE JANUARY 1993 MUST BE WEIGHED AND MEASURED, EVEN IF THE CHILDREN ARE DECEASED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN AFTER JANUARY 1993, USE AN ADDITIONAL QUESTIONNAIRE.

1102. LINE NUMBER ACCORDING TO 212:
[ASK FOR RESPONDENT'S CHILDREN ONLY]

LINE NO._____

1103. NAME (ACCORDING TO 212 FOR CHILDREN)

NAME_____

1104. BIRTH DATE (ACCORDING TO 215 AND ASK FOR DAY OF BIRTH)
[ASK FOR RESPONDENT'S CHILDREN ONLY]

DAY ____
MONTH ____
YEAR _____

1105. TB VACCINE SCAR ON THE TOP OF LEFT SHOULDER?
[ASK FOR RESPONDENT'S CHILDREN ONLY]

SCAR SEEN 1
NO SCAR 2

1106. HEIGHT IN CENTIMETERS:

HEIGHT (CM) _____

1107. WAS THE CHILD MEASURED LYING DOWN OR STANDING UP?
[ASK FOR RESPONDENT'S CHILDREN ONLY]

LYING DOWN 1
STANDING UP 2

1108. WEIGHT (IN KILOGRAMS):

WEIGHT (KG) _____

1109. DATE OF HEIGHT AND WEIGHT MEASUREMENT:

DAY ____
MONTH ____
YEAR ____

1110. RESULT:

RESPONDENT'S RESULT _____
MEASURED 1
ABSENT 3
REFUSED 4
OTHER (SPECIFY) ____ 6
CHILDREN'S RESULT(S) _____
CHILD MEASURED 1
CHILD SICK 2
CHILD ABSENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ____ 6

1111. NAME OF OPERATOR _____
OPERATOR CODE _____

NAME OF ASSISTANT _____
ASSISTANT CODE:

MOTHER 90
OTHER HOUSEHOLD MEMBERS 91
OTHER PERSONS 92

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 _____