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BURKINA FASO DEMOGRAPHIC AND HEALTH SURVEY (EDSBF-III, 2003)
MEN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME ______
NAME OF HOUSEHOLD HEAD ______
CLUSTER NUMBER ______
HOUSEHOLD UNIT NUMBER ______
REGION ______
VILLAGE ______

URBAN/RURAL:

URBAN 1
RURAL 2

BIG CITY/OTHER CITY/RURAL:

OUAGADOUGOU 1
OTHER CITY 2
RURAL 3

NAME OF MALE RESPONDENT ______

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 2003
INT. NAME _____
RESULT _____

TOTAL NUMBER OF VISITS _____


LANGUAGE OF QUESTIONNAIRE: 01

LANGUAGE OF INTERVIEW:

FRENCH 1
MOR?? 2
DIOULA 3
FOULFOULD??/PEUL 4
S??NOUFO 5
OTHER 6

INTERPRETER USED:

YES 1
NO

SUPERVISOR
NAME _____
DATE _____

FIELD EDITOR
NAME _____
DATE _____

OFFICE EDITOR _____
KEYED BY _____


SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

INTRODUCTION AND CONSENT:

CONSENT AFTER INFORMATION:

Hello. My name is ______ and I am working with the National Institute of Demography and Statistics. We are in the process of conducting a national survey on the health of women and children. We would very much appreciate your participation in this survey.

I would like to ask you questions about your health (and the health of your children). This information will be useful to the government in order to put health services in place. The survey usually takes between 20 and 45 minutes. The information you will give us is strictly confidential and will not be shared with anyone.

Participation in this survey is completely voluntary and you may refuse to answer any or all of the questions. However, we hope you will participate in the survey since your views are important to us.

Do you have any questions to ask me about the survey?
May I begin the interview now?

SIGNATURE OF INTERVIEWER______
DATE ______

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


101. RECORD THE TIME:

HOUR _____
MINUTES______


To begin, I would like to ask you questions about yourself and your household.

102. Until the age of 12, did you mostly live in OUAGADOUGOU, in another city, or in a rural setting?

OUAGADOUGOU 1
OTHER CITY 2
RURAL 3


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

YEARS____

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)


104. Just before you moved here, did you live in OUAGADOUGOU, in another city, or in a rural setting?

OUAGADOUGOU 1
OTHER CITY 2
RURAL 3


105. In the last 12 months, how many times have you traveled and spent the night outside of your community?

NUMBER OF TRIPS ____
HAS NOT TRAVELED 00 (GO TO 107)


106. In the last 12 months, have you been away from your community for more than a month at a time?

YES 1
NO 2


107. In what month and year were you born?

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


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

AGE IN COMPLETED YEARS _______


109. Have you ever attended school?

YES 1
NO 2 (GO TO 113)


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

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
POST-SECONDARY 4


111. What is the highest grade you successfully completed at that level?
WRITE '0' FOR LESS THAN A YEAR COMPLETED AND '8' FOR DOESN'T KNOW.

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
5 FPP
8 DOESN'T KNOW
HIGH SCHOOL
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


111A. CHECK 108:

IF 24 YEARS OLD OR YOUNGER (GO TO 111B)
IF 25 YEARS OLD OR OLDER (GO TO 112)


111B. Are you currently attending school?

YES 1 (GO TO 112)
NO 2


111C. What is the main reason you stopped going to school?

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


112. CHECK 110:

PRIMARY (GO TO 113)
SECONDARY OR HIGHER (GO TO 116)


113. Now I would like you to read this sentence to me; read the most of it you can.

SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____ 4


114. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2


115. CHECK 113:

CODE '2', '3', OR '4' CIRCLED (GO TO 116)
CODE '1' CIRCLED (GO TO 117)


116. Do you read a newspaper or a magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4


117. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4


118. Do you watch television almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4


119. Do you currently have a job, whatever it may be, where you earn money?

YES 1 (GO TO 122)
NO 2


120. During the last 12 months, did you have a job, whatever it may be, where you earned money?

YES 1 (GO TO 122)
NO 2


121. During the last 12 months, what has been your principal activity?

WENT TO SCHOOL 1 (GO TO 129)
LOOKED FOR A JOB 2 (GO TO 129)
INACTIVE 3 (GO TO 129)
COULDN'T WORK/HANDICAPPED 4 (GO TO 129)
HOUSEWORK/CHILD CARE 5 (GO TO 129)
OTHER (SPECIFY) _____ 6 (GO TO 129)


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

OCCUPATION _______


123. CHECK 122:

WORKS IN AGRICULTURE (GO TO 124)
DOES NOT WORK IN AGRICULTURE (GO TO 125)


124. 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


125. During the last 12 months, how many months did you work?

NUMBER OF MONTHS ____


126. For this work are you paid entirely in cash, in cash and kind, entirely in kind, or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 129)
NOT PAID 4 (GO TO 129)


127. Who usually decides how the money you earn will be used?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5


128. On average, what percentage of the household expenses are paid for using the money you earn?

ALMOST NOTHING 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL/ALMOST ALL OF THEM 5
NONE, ALL HIS EARNINGS ARE SAVED 6


129. What is your religion?

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


130. What is your ethnicity?

BOBO 01
DIOULA 02
FULFULDE/PEUL 03
GOURMATCHE 04
GOUROUNSI 05
LOBI 06
MOSSI 07
SENOUFO 08
TOUAREG/BELLA 09
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98


131A. In your family, who usually has the last word in the following decisions:

Your own health care?
The purchase of important household items?
The purchase of daily household items?
Visiting family, friends or relatives?
What food will be prepared each day?

YOUR OWN HEALTH CARE
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
THE PURCHASE OF IMPORTANT HOUSEHOLD ITEMS
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
THE PURCHASE OF DAILY HOUSEHOLD ITEMS
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
VISITING FAMILY, FRIENDS OR RELATIVES
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
WHAT FOOD WILL BE PREPARED EACH DAY
RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6


131B. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is it normal for a man to hit or beat his wife in the following situations:

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

IF SHE GOES OUT WITHOUT TELLING HIM
YES 1
NO 2
DOESN'T KNOW 8
IF SHE NEGLECTS THE CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
IF SHE ARGUES WITH HIM
YES 1
NO 2
DOESN'T KNOW 8
IF SHE REFUSES TO HAVE SEX WITH HIM
YES 1
NO 2
DOESN'T KNOW 8
IF SHE BURNS THE FOOD
YES 1
NO 2
DOESN'T KNOW 8


131C. Have you ever consumed alcoholic beverages?

YES 1
NO 2 (GO TO 201)


131D. Have you ever been intoxicated after consuming alcoholic beverages?

YES 1
NO 2


131E. Over the past three months, how many days have you consumed alcoholic beverages?

NUMBER OF DAYS ____
NONE/NEVER 95 (GO TO 201)


131F. CHECK 131D:

YES, HAS BEEN INTOXICATED (GO TO 131G)
NO, HAS NEVER BEEN INTOXICATED (GO TO 201)


131G. Over the past three months, how many times have you been intoxicated?

NUMBER OF TIMES ____
NONE/NEVER 95


SECTION 2: REPRODUCTION

Now I would like to ask you about your children, but only your biological children (not those with a different father).

201. Have you had any children?

YES 1
NO 2 (GO TO 206)
DOESN'T KNOW 8 (GO TO 206)


202. Do you have any sons or daughters of whom you are the father who are now living with you?

YES 1
NO 2 (GO TO 204)


203. How many of your sons live with you?
How many of your daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME ______
DAUGHTERS AT HOME ______


204. Do you have any sons or daughters of whom you are the father who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)


205. How many of your sons are alive but do not live with you?
How many of your daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE _____
DAUGHTERS ELSEWHERE _____


206. Have you ever fathered 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?

YES 1
NO 2 (GO TO 208)
DOESN'T KNOW 8 (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 _____ children during your life of which you are the father. Is that correct?

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


210. CHECK 208:

HAS HAD CHILDREN (GO TO 210A)
HAS NOT HAD CHILDREN (GO TO 301)


210A. In what year was your last child born?

YEAR ____


210B. At the time you were expecting your last child, did you want that child at that precise time, did you want to wait longer, or did you not want another child at all?

THAT TIME 1
LATER 2
NOT AT ALL 3


SECTION 3: CONTRACEPTION

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

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


301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03. PILL: Women can take a pill every day.
YES 1
NO 2 (GO TO NEXT METHOD)
04. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
05. 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 (GO TO NEXT METHOD)
06. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2 (GO TO NEXT METHOD)
07. CONDOM: Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08. FEMALE CONDOM: Women can place a latex sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
10. MOUSSE OR GEL: Women can insert a suppository, or put gel or cream inside their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
11. LACTATIONAL AMENORRHEA METHOD (LAM): Up until 6 months after giving birth, a woman can use a method that consists of nursing frequently, day and night, and that prevents her from getting her period again.
YES 1
NO 2 (GO TO NEXT METHOD)
12. 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 (GO TO NEXT METHOD)
13. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14. EMERGENCY CONTRACEPTION: A woman can take a pill on the days following sexual intercourse, up to three days after, to prevent pregnancy.
YES 1
NO 2 (GO TO NEXT METHOD)
15. 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.
YES 1
NO 2
(SPECIFY) ______


302. Have you ever used (METHOD)?
[THIS QUESTION IS ASKED ABOUT EACH METHOD IN 301 WITH '1' CIRCLED.]

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children. Have you ever had a partner that had an operation to avoid having any (more) children?
YES 1
NO 2
02. 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
03. PILL: Women can take a pill every day.
YES 1
NO 2
04. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05. 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
06. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07. CONDOM: Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a latex sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. MOUSSE OR GEL: Women can insert a suppository, or put gel or cream inside their vagina before sexual intercourse.
YES 1
NO 2
11. LACTATIONAL AMENORRHEA METHOD (LAM): Up until 6 months after giving birth, a woman can use a method that consists of nursing frequently, day and night, and that prevents her from getting her period again.
YES 1
NO 2
12. 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
13. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
14. EMERGENCY CONTRACEPTION: A woman can take a pill in the days following sexual intercourse, up to three days after, to prevent pregnancy.
YES 1
NO 2
15. OTHER METHOD(S) (SPECIFY) ______
YES 1
NO 2


303. CHECK 302:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 304)
AT LEAST ONE 'YES' (EVER USED) (GO TO 308)


304. Have you yourself or any of your sexual partners ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 309)


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


307. CHECK 302 (02):

MAN NOT STERILIZED (GO TO 308)
MAN STERILIZED (GO TO 309A)


308. Are you currently doing something or using any method to delay or avoid a pregnancy?

YES 1
NO 2 (GO TO 310)


309. Which method are you currently using?
309A. CIRCLE 'B' FOR MALE STERILIZATION.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTABLES E
IMPLANTS F
CONDOM G
FEMALE CONDOM H
DIAPHRAGM I
FOAM/JELLY J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER (SPECIFY) _____ X


Now I would like to ask you about a woman's risk of pregnancy.

310. 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 312)
DOESN'T KNOW 8 (GO TO 312)


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

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


312. Do you think that a woman who is breastfeeding her baby can become pregnant?

YES 1
NO 2
DEPENDS 3
DOESN'T KNOW 8


313. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one:

a) Contraception is women's business and a man should not have to worry about it.
b) Women who use contraception can be considered to have loose morals.
c) Since the woman is the one who becomes pregnant, she is the one that should use contraception.

A) CONTRACEPTION WOMEN'S BUSINESS
AGREE 1
DISAGREE 2
DOESN'T KNOW/NO OPINION 8
B) WOMEN USING CONTRACEPTION MAY HAVE LOOSE MORALS
AGREE 1
DISAGREE 2
DOESN'T KNOW/NO OPINION 8
WOMAN IS THE ONE THAT SHOULD USE CONTRACEPTION
AGREE 1
DISAGREE 2
DOESN'T KNOW/NO OPINION 8


SECTION 4: MARRIAGE AND SEXUAL ACTIVITY

401. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1 (GO TO 405)
YES, LIVING WITH A WOMAN 2 (GO TO 405)
FIRST MARRIAGE NOT CONSUMMATED 3 (GO TO 410)
NO, NOT IN UNION 4


402. Have you ever been married or lived with a woman as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410)


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

WIDOWED 1 (GO TO 407)
DIVORCED 2 (GO TO 407)
SEPARATED 3 (GO TO 407)


405. How many wives/partners do you currently have?

NUMBER OF WIVES/PARTNERS _____


406. RECORD THE NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH OF HIS WIVES/PARTNERS.

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. THE NUMBER OF BOXES FILLED IN SHOULD BE THE SAME AS THE NUMBER OF WIVES/SPOUSES IN 405.

NAME _____
LINE NO. _____


407. Have you been married or lived with a woman only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2


408. CHECK 407:

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

MARRIED/LIVED WITH A WOMAN MORE THAN ONCE: Now I would like to ask you about when you started living with your first wife/partner. In what month and year was that?

IF "FIRST MARRIAGE NOT CONSUMMATED", GO BACK TO 401, CIRCLE CODE '3' AND GO TO 410.

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____ (GO TO 410)
DOESN'T KNOW YEAR 9998


409. How old were you when you first started living with her?

AGE IN YEARS ____


Now I need to ask you some questions about sexual activity in order to better understand certain problems of family life.

410. How old were you when you had sexual intercourse for the very first time if you have had it at all?

NEVER 00 (GO TO 420)

AGE IN YEARS ____

FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 96


411. How long has it been since the last time you had sexual intercourse?
RECORD IN "NUMBER OF YEARS" ONLY IF THE LAST TIME WAS MORE THAN A YEAR AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 _____
WEEKS AGO 2 ______
MONTHS AGO 3 ______
YEARS AGO 4 _____ (GO TO 420)


412. The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 412F)


412A. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STD'S/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STD'S/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7


412B. Do you know the brand name of condom that was used on this occasion?
IF YES: What is the brand?

PRUDENCE 1
MOODS 2
NO BRAND 3
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7


412D. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 413)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 413)


412E. How much did you pay for the condoms?
RECORD THE PRICE OF 4 CONDOMS IN CFAF.

PRICE OF 4 CONDOMS/CFAF _____ (GO TO 413)
GIFT/FREE 9996 (GO TO 413)


412F. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN PARTNER H
FAITHFUL TO PARTNER I
AFRAID THAT PARTNER SUSPECTS HIM J
THEY HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STD'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANTS TO CONCEIVE S
OTHER (SPECIFY) _____ X
DOESN'T KNOW OF CONDOMS Z


413. What is your relationship to the woman with whom you last had sexual intercourse?
IF GIRLFRIEND OR FIANC??, ASK: Was your girlfriend/fianc?? living with you at the time you last had sexual intercourse with her? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 415)
GIRLFRIEND/FIANC?? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) ______ 07


414. For how long have you had sexual relations with this woman?
IF ONLY HAD SEXUAL RELATIONS WITH THIS WOMAN ONCE, RECORD '01' DAY.

NUMBER OF DAYS 1 _____
NUMBER OF WEEKS 2 _____
NUMBER OF MONTHS 3 _____
NUMBER OF YEARS 4 _____


415. Have you had sexual intercourse with another woman in the last 12 months?

YES 1
NO 2 (GO TO 420)


416. The last time you had sexual intercourse with this other woman, was a condom used?

YES 1
NO 2 (GO TO 416F)


416A. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STD'S/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STD'S/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7


416B. Do you know the brand name of condom that was used on this occasion?
IF YES: What is the brand?

PRUDENCE 1
MOODS 2
NO BRAND 3
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7


416D. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 417)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 417)


416E. How much did you pay for the condoms?
RECORD THE PRICE OF 4 CONDOMS IN CFAF.

PRICE OF 4 CONDOMS/CFAF_____ (GO TO 417)
GIFT/FREE 9996 (GO TO 417)


416F. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN PARTNER H
FAITHFUL TO PARTNER I
AFRAID THAT PARTNER SUSPECTS HIM J
THEY HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STD'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANTS TO CONCEIVE S
OTHER (SPECIFY) _______ X
DOESN'T KNOW OF CONDOMS Z


417. What is your relationship to this other woman?
IF GIRLFRIEND OR FIANC??, ASK: Was your girlfriend/fianc?? living with you at the time you last had sexual intercourse with her? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 418A)
GIRLFRIEND/FIANC?? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) _____ 07


418. For how long have you had sexual relations with this other woman?
IF ONLY HAD SEXUAL INTERCOURSE WITH THIS WOMAN ONCE, RECORD '01' DAY.

NUMBER OF DAYS 1 _____
NUMBER OF WEEKS 2 _____
NUMBER OF MONTHS 3 _____
NUMBER OF YEARS 4 _____


418A. Besides these two women, have you had sexual intercourse with someone else in the last 12 months?

YES 1
NO 2 (GO TO 420)


418B. The last time you had sexual intercourse with this other woman, was a condom used?

YES 1
NO 2 (GO TO 418CE)


418C. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STD'S/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STD'S/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7


418CA. Do you know the brand name of condom that was used on this occasion?
IF YES: What is the brand?

PRUDENCE 1
MOODS 2
NO BRAND 3
DOESN'T KNOW 6
OTHER (SPECIFY) _____ 7


418CC. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 418D)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 418D)


418CD. How much did you pay for the condoms?
RECORD THE PRICE OF 4 CONDOMS IN CFAF.

PRICE OF 4 CONDOMS/CFAF _____ (GO TO 418D)
GIFT/FREE 9996 (GO TO 418D)


418CE. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN PARTNER H
FAITHFUL TO PARTNER I
AFRAID THAT PARTNER SUSPECTS HIM J
THEY HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STD'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANTS TO CONCEIVE S
OTHER (SPECIFY) ______ X
DOESN'T KNOW OF CONDOMS Z


418D. What is your relationship to this other woman?
IF GIRLFRIEND OR FIANC??, ASK: Was your girlfriend/fianc?? living with you at the time you last had sexual intercourse with her? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

WIFE/LIVE-IN PARTNER 01 (GO TO 419)
GIRLFRIEND/FIANC?? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) ______ 07


418E. For how long have you had sexual relations with this other woman?
IF ONLY HAD SEXUAL RELATIONS WITH THIS WOMAN ONCE, RECORD '01' DAY.

NUMBER OF DAYS 1 _____
NUMBER OF WEEKS 2 _____
NUMBER OF MONTHS 3 _____
NUMBER OF YEARS 4 _____


419. In total, with how many different women (other than your spouse(s)) have you had sexual intercourse in the last 12 months?

NUMBER OF PARTNERS _____


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

YES 1
NO 2 (GO TO 501)


421. Where is that? Any other place?
RECORD ALL MENTIONED.

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

NAMES OF PLACE(S)______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MATERNITY CLINIC D
MOBILE CLINIC E
GROUND AGENT F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
GROUND AGENT K
OTHER PRIVATE (SPECIFY) _____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH AGENT N
MIDWIFE/HEALTH AID/MATRON O
PARA-PUBLIC SECTOR
INPS/CMIE P
MUTEC Q
OTHER (SPECIFY) _____ R
OTHER LOCATION
STORE/MARKET S
TRADITIONAL HEALER T
CHURCH U
FRIENDS/RELATIVES V
OTHER (SPECIFY) ______ X


422. If you wanted to, could you get yourself a condom?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8


SECTION 5: FERTILITY PREFERENCES

501. CHECK 401:

NOT MARRIED OR FIRST MARRIAGE NOT CONSUMMATED (GO TO 501A)
CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 501B)


501A. CHECK 411:

LAST SEXUAL INTERCOURSE LESS THAN 12 MONTHS AGO: CODE '1', '2', OR '3' CIRCLED (GO TO 501B)

LAST SEXUAL INTERCOURSE 12 OR MORE MONTHS AGO: CODE '4' CIRCLED OR QUESTION 411 NOT ASKED (GO TO 502(A))


501B. Is your wife/partner (one of your wives/partners) currently pregnant?

YES 1
NO 2 (GO TO 502(A))
DOESN'T KNOW 8 (GO TO 502(A))


501C. When she became pregnant, did you want her to become pregnant at that time, did you want her to become pregnant later, or did you not want her to become pregnant at all?

AT THAT TIME 1 (GO TO 502B)
LATER 2 (GO TO 502B)
NOT AT ALL 3 (GO TO 502B)


Now I have some questions about the future.

502(A). WIFE/PARTNER NOT PREGNANT/DON'T KNOW/NO WIFE/PARTNER: 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 504)
WIFE/PARTNER CAN'T GET PREGNANT 3 (GO TO 514)
UNDECIDED/DOESN'T KNOW AND PREGNANT 4 (GO TO 510)
NOT PREGNANT OR NOT SURE 5 (GO TO 504)


502(B). WIFE/PARTNER PREGNANT: After the child you and your wife/partner 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 504)
WIFE/PARTNER CAN'T GET PREGNANT 3 (GO TO 514)
UNDECIDED/DOESN'T KNOW AND PREGNANT 4 (GO TO 510)
NOT PREGNANT OR NOT SURE 5 (GO TO 504)


503. CHECK 502:

WIFE/PARTNER NOT PREGNANT/DOESN'T KNOW/NO WIFE/PARTNER: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER 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 510)
SAYS WIFE CAN'T GET PREGNANT 994 (GO TO 514)
AFTER MARRIAGE 995 (GO TO 509)
OTHER (SPECIFY) _____ 996 (GO TO 508)
DOESN'T KNOW 998 (GO TO 508)


504. CHECK 502:

WIFE/PARTNER NOT PREGNANT/DOESN'T KNOW/NO WIFE/PARTNER (GO TO 505)

WIFE/PARTNER PREGNANT (GO TO 510)


505. CHECK 308:
CURRENTLY USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 506)
NOT CURRENTLY USING (GO TO 506)
CURRENTLY USING (GO TO 508)


506. CHECK 503:

NOT ASKED (GO TO 508)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 508)
00-23 MONTHS OR 00-01 YEARS (GO TO 510)


508. In the weeks to come, if you were to discover that one of your wives/partners was pregnant, would it be an important problem, a small problem, or would it not be a problem at all?

IMPORTANT PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS CAN'T GET PREGNANT/CAN'T HAVE SEX 4


509. CHECK 308:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 510)
NO, NOT CURRENTLY USING (GO TO 510)
YES, CURRENTLY USING (GO TO 514)


510. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the near or distant future?

YES 1
NO 2 (GO TO 512)
DOESN'T KNOW 8 (GO TO 512)


511. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 514)
MALE STERILIZATION 02 (GO TO 514)
PILL 03 (GO TO 514)
IUD 04 (GO TO 514)
INJECTABLES 05 (GO TO 514)
IMPLANTS 06 (GO TO 514)
CONDOM 07 (GO TO 514)
FEMALE CONDOM 08 (GO TO 514)
DIAPHRAGM 09 (GO TO 514)
FOAM/JELLY 10 (GO TO 514)
LACTATIONAL AMEN. METHOD 11 (GO TO 514)
RHYTHM METHOD 12 (GO TO 514)
WITHDRAWAL 13 (GO TO 514)
OTHER METHOD (SPECIFY) ______ 96 (GO TO 514)
NOT SURE 98 (GO TO 514)


512. What is the main reason that you think you will not use a contraceptive method at any time in the near or distant future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 514)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 514)
SUB-FECUND/IN FECUND 24 (GO TO 514)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 514)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 514)
HUSBAND/PARTNER OPPOSED 32 (GO TO 514)
OTHERS OPPOSED 33 (GO TO 514)
RELIGIOUS PROHIBITION 34 (GO TO 514)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 514)
KNOWS NO SOURCE 42 (GO TO 514)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 514)
FEAR OF SIDE EFFECTS 52 (GO TO 514)
LACK OF ACCESS/TOO FAR 53 (GO TO 514)
COSTS TOO MUCH 54 (GO TO 514)
INCONVENIENT TO USE 55 (GO TO 514)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 514)
OTHER (SPECIFY) _____ 96 (GO TO 514)
DOESN'T KNOW 98 (GO TO 514)


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

YES 1
NO 2
DOESN'T KNOW 8


514. CHECK 203 AND 205:
PROBE FOR A NUMERIC RESPONSE. IF NONE, CIRCLE '00' AND GO TO 516.

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?

NONE 00 (GO TO 516)

NUMBER OF CHILDREN _____

OTHER (SPECIFY) _____ 96 (GO TO 516)


515. 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


516. Would you say that you approve or disapprove of couples that use a method to avoid becoming pregnant?

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW/NOT SURE 8


517. In the last few months have you heard about family planning:

On the radio?
On television?
In newspapers or magazines?
On posters?
In a prospectus/brochure?
At an educational or cultural performance?
At school?

ON THE RADIO
YES 1
NO 2
ON TELEVISION
YES 1
NO 2
IN NEWSPAPERS OR MAGAZINES
YES 1
NO 2
ON POSTERS
YES 1
NO 2
IN A PROSPECTUS/BROCHURE
YES 1
NO 2
AT EDUCATIONAL OR CULTURAL PERFORMANCES
YES 1
NO 2
AT SCHOOL
YES 1
NO 2


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

On the radio?
On television?
In newspapers or magazines?
On posters?
In a prospectus/brochure?
At performances?
At school?

ON THE RADIO
APPROPRIATE 1
INAPPROPRIATE 2
ON TELEVISION
APPROPRIATE 1
INAPPROPRIATE 2
IN NEWSPAPERS OR MAGAZINES
APPROPRIATE 1
INAPPROPRIATE 2
ON POSTERS
APPROPRIATE 1
INAPPROPRIATE 2
IN BROCHURES
APPROPRIATE 1
INAPPROPRIATE 2
AT EDUCATIONAL OR CULTURAL PERFORMANCES
APPROPRIATE 1
INAPPROPRIATE 2
AT SCHOOL
APPROPRIATE 1
INAPPROPRIATE 2


519. Over the last several months, have you discussed family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 521)


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

WIFE/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
COUSIN(S) F
DAUGHTER(S) G
SON(S) H
MOTHER-IN-LAW I
FATHER-IN-LAW J
FRIENDS/NEIGHBORS K
OTHER (SPECIFY) ______ X


521. CHECK 401:

YES, CURRENTLY MARRIED (GO TO 522)
YES, LIVING WITH A WOMAN (GO TO 522)
NO, NOT IN UNION OR FIRST MARRIAGE NOT CONSUMMATED (GO TO 528)


522. CHECK 309/309A:

AT LEAST ONE CODE CIRCLED (GO TO 523)
NO CODE CIRCLED (GO TO 524)


523. You have said that you are currently using a method of contraception. Would you say that using contraception is mainly your decision, mainly your wife's (wives')/partner's (partners') decision or a group decision made by all/both of you?

DECISION OF RESPONDENT 1
DECISION OF WIFE (WIVES)/PARTNER(S) 2
GROUP DECISION 3
OTHER (SPECIFY) ______ 6


Now I would like to ask you some questions about your wife's (wives')/partner's (partners') opinions on family planning.

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

APPROVE(S) 1
DISAPPROVE(S) 2
DOESN'T KNOW 8


525. How many times over the last 12 months have you discussed family planning with your wife (wives)/partner(s) that you live with?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3


526. CHECK 309/309A:

CODE 'B' NOT CIRCLED: HE IS NOT STERILIZED (GO TO 527)
CODE 'B' CIRCLED: HE IS STERILIZED (GO TO 528)


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

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


528. Husbands and wives don't always agree on everything. Please, tell me if you think it is normal that a woman refuses to have sexual intercourse with her husband/partner when:

She knows that her husband has a sexually transmitted infection?
She knows that her husband has sexual intercourse with other women?
She has recently given birth?
She is tired or doesn't feel like it?

KNOWS HUSBAND HAS SEXUALLY TRANSMITTED INFECTION
YES 1
NO 2
DOESN'T KNOW 8
KNOWS HUSBAND HAS SEXUAL INTERCOURSE WITH OTHER WOMEN
YES 1
NO 2
DOESN'T KNOW 8
RECENTLY GIVEN BIRTH
YES 1
NO 2
DOESN'T KNOW 8
TIRED OR DOESN'T FEEL LIKE IT
YES 1
NO 2
DOESN'T KNOW 8


SECTION 6: AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

Now I would like to talk about something else.

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

YES 1
NO 2 (GO TO 624)


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

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


603. What can one do? Anything else?
RECORD ALL MENTIONED.

ABSTAIN FROM HAVING SEX A
USE CONDOMS B
ONLY HAVE SEX WITH ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PEOPLE WITH LOTS OF PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PEOPLE WHO USE IV DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALERS M
AVOID SHARING RAZORS OR BLADES N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z


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

YES 1
NO 2
DOESN'T KNOW 8


605. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8


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

YES 1
NO 2
DOESN'T KNOW 8


607. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8


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

YES 1
NO 2
DOESN'T KNOW 8


608A. Can someone contract AIDS by spell or witchcraft?

YES 1
NO 2
DOESN'T KNOW 8


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

YES 1
NO 2
DOESN'T KNOW 8


610. Do you personally know anyone who has the AIDS virus or is sick from AIDS, or someone who has died of AIDS?

YES 1
NO 2


611. Can the virus that causes AIDS be transmitted from a mother to her baby?

YES 1
NO 2 (GO TO 613)
DOESN'T KNOW 8 (GO TO 613)


612. When can the AIDS virus be transmitted from the mother to the child? Can it be transmitted:

During pregnancy?
During delivery?
By breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DOESN'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DOESN'T KNOW 8
BY BREASTFEEDING
YES 1
NO 2
DOESN'T KNOW 8


613. CHECK 401:

YES, CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 614)
NO, NOT CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 615)


614. Have you already spoken with your wife/partner about ways to avoid the AIDS virus?
IF MORE THAN ONE WIFE/PARTNER, ASK QUESTION IN PLURAL FORM.

YES 1
NO 2


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

On the radio?
On television?
In newspapers or magazines?
On posters?
In a prospectus/brochure?
At educational or cultural performances?
At school?

ON THE RADIO
APPROPRIATE 1
INAPPROPRIATE 2
ON TELEVISION
APPROPRIATE 1
INAPPROPRIATE 2
IN NEWSPAPERS OR MAGAZINES
APPROPRIATE 1
INAPPROPRIATE 2
ON POSTERS
APPROPRIATE 1
INAPPROPRIATE 2
IN A PROSPECTUS/BROCHURE
APPROPRIATE 1
INAPPROPRIATE 2
AT EDUCATIONAL OR CULTURAL PERFORMANCES
APPROPRIATE 1
INAPPROPRIATE 2
AT SCHOOL
APPROPRIATE 1
INAPPROPRIATE 2


616. If a person learns that he/she is infected with the virus that causes AIDS, should they be allowed to keep the information secret or should they be required to share the information with the community?

CAN BE KEPT SECRET 1
TOLD TO COMMUNITY 2
DOESN'T KNOW/NOT SURE 8


617. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8


618. Should people infected with the AIDS virus who work with other people in shops, offices and on farms be authorized to continue their work or not?

CAN CONTINUE TO WORK 1
CANNOT CONTINUE TO WORK 2
DOESN'T KNOW/NOT SURE/DEPENDS 8


619. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8


620. Have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 621)


620A. When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3


620B. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3


620C. I don't want to know the results, but did you get the results of the test?

YES 1 (GO TO 623A)
NO 2 (GO TO 623A)


621. Would you like to get tested for AIDS?

YES 1
NO 2
DOESN'T KNOW/NOT SURE 8


622. Do you know of a place where you can get tested for the AIDS virus?

YES 1
NO 2 (GO TO 624)


623. Where can you go for this test?
ONLY RECORD FIRST RESPONSE.

IF IT'S A HOSPITAL, HEALTH 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 SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
GROUND AGENT 15
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
GROUND AGENT 25
OTHER PRIVATE (SPECIFY) _____ 26
OTHER SOURCE
STORE 31
CHURCH 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY) ______ 96


623A. Where did you go for this test?
ONLY RECORD FIRST RESPONSE.

IF IT'S A HOSPITAL, HEALTH 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 SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
GROUND AGENT 15
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
GROUND AGENT 25
OTHER PRIVATE (SPECIFY) _____ 26
OTHER SOURCE
STORE 31
CHURCH 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY) ______ 96


624. Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 627)


625. What are the signs or symptoms in a man that make you think he may have a sexually transmitted infection?
INSIST: Anything else?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING DURING URINATION D
RASH/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
IMPOTENCE L
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y (GO TO 626)
DOESN'T KNOW Z (GO TO 626)


625A. If you had any of these symptoms, where would you go for advice or health care?

PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
DISPENSARY 13
MEDICAL POST 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DISPERSAL CENTER 23
PRIVATE DOCTOR 24
PF/FISA CENTER 25
OTHER SOURCE
DBC AGENT 31
STORE 32
KIOSK 33
CHURCH 34
TRADITIONAL HEALER 35
RELATIVES/FRIENDS 36
OTHER (SPECIFY) _____ 96


626. What are the signs or symptoms in a woman that make you think she may have a sexually transmitted infection? INSIST: Anything else? RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING DURING URINATION D
RASH/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
DIFFICULTY GETTING PREGNANT/HAVING CHILDREN L
OTHER (SPECIFY) ______ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y
DOESN'T KNOW Z


627. CHECK 416:

HAS HAD SEXUAL INTERCOURSE (GO TO 627A)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 701)


627A. CHECK 624:

KNOWS OF STD'S (GO TO 628)
DOESN'T KNOW OF STD'S (GO TO 629)


Now I would like to ask you some questions about your health in the last 12 months.

628. During the last 12 months, have you had a sexually transmitted infection?

YES 1
NO 2
DOESN'T KNOW 8


629. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DOESN'T KNOW 8


630. Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DOESN'T KNOW 8


631. CHECK 628, 629, AND 630:

HAS HAD AN INFECTION (GO TO 632)
HAS NOT HAD AN INFECTION (GO TO 701)


632. The last time you had (INFECTION FROM 628/629/630), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 634)


633. The last time you had (INFECTION FROM 628/629/630), did you do any of the following things? Did you...

Seek advice from a health care worker in a hospital or clinic?
Seek advice or treatment from a traditional healer?
Seek advice or buy medication from a pharmacy or store?
Seek advice from family or friends?

ADVICE FROM A HEALTH CARE WORKER IN A HOSPITAL OR CLINIC
YES 1
NO 2
ADVICE OR TREATMENT FROM A TRADITIONAL HEALER
YES 1
NO 2
ADVICE OR BUY MEDICATION FROM A PHARMACY OR STORE
YES 1
NO 2
ADVICE FROM FAMILY OR FRIENDS
YES 1
NO 2


634. When you had (INFECTION FROM 628/629/630), did you inform your sexual partner(s)?

YES 1
NO 2
CERTAIN ONES/NOT ALL 3
DOES NOT HAVE SEXUAL PARTNER 4 (GO TO 701)


635. When you had (INFECTION FROM 628/629/630), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 701)
PARTNER ALREADY INFECTED 3 (GO TO 701)


636. What did you do to avoid infecting your partner(s)? Did you...

Stop having sexual intercourse?
Use a condom during sexual intercourse?
Take medication?

STOP HAVING SEXUAL INTERCOURSE
YES 1
NO 2
USE A CONDOM DURING SEXUAL INTERCOURSE
YES 1
NO 2
TAKE MEDICATION
YES 1
NO 2


SECTION 7: FEMALE CIRCUMCISION

I would now like to interview you about a subject relating to women's health.

701. Have you ever heard of female circumcision?

YES 1 (GO TO 703)
NO 2


702. In certain societies or countries such as Burkina Faso, a practice exists which consists of cutting a part of the external genital organs of girls. Have you ever heard of this practice?

YES 1
NO 2 (GO TO 801)


703. What are the advantages for a girl to be circumcised?
INSIST: Other advantages? RECORD ALL MENTIONED.

BETTER HYGIENE A
SOCIAL RECOGNITION B
BETTER CHANCES FOR MARRIAGE C
PRESERVATION OF VIRGINITY/PREVENT PREMARITAL SEX D
MORE SEXUAL PLEASURE FOR THE MALE E
RELIGIOUS NECESSITY F
OTHER (SPECIFY) ______ X
NO ADVANTAGE Y


704. What are the advantages for a girl not to be circumcised?
INSIST: Anything else? RECORD ALL MENTIONED.

LESS HEALTH PROBLEMS A
AVOID SUFFERING B
MORE SEXUAL PLEASURE FOR HERSELF C
MORE SEXUAL PLEASURE FOR THE MALE D
IN ACCORD WITH RELIGION E
OTHER (SPECIFY) ______ X
NO ADVANTAGE Y


705. Do you think that the practice of female circumcision is a way to avoid girls having premarital sex or do you think, on the contrary, that it has no effect?

PREVENTS PREMARITAL SEX 1
NO EFFECT 2
DOESN'T KNOW 8


706. Do you think that female circumcision is demanded by your religion?

YES 1
NO 2
DOESN'T KNOW 8


707. Do you think that the practice of female circumcision should continue or disappear?

CONTINUE 1
DISAPPEAR 2
DEPENDS 3
DOESN'T KNOW 8


708. Do you think that men believe the practice of female circumcision should be maintained, or on the contrary, do you think they favor its abandonment?

MAINTAINED 1
ABANDONED 2
DEPENDS 3
DOESN'T KNOW 8


SECTION 8: MALE CIRCUMCISION

In certain societies and countries such as Burkina Faso, a practice exists which consists of cutting the skin around, that is, to say the foreskin of a man's penis. Now I would like to interview you about your own experience with the practice of circumcision.


801. Are you circumcised?

YES 1
NO 2 (GO TO 805)


802. What age were you at the time of your circumcision?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO OBTAIN AN ESTIMATE.

AGE IN FULL YEARS _____

DURING CHILDHOOD 95
DOESN'T KNOW 98


803. Who performed your circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
OTHER TRADITIONAL (SPECIFY) _____ 16
HEALTH CARE PROFESSIONALS
DOCTOR 21 (GO TO 805)
NURSE 22 (GO TO 805)
OTHER HEALTH CARE PROFESSIONAL (SPECIFY) _____ 26 (GO TO 805)
DOESN'T KNOW 98 (GO TO 805)


804. Were you circumcised during an initiation ceremony?

YES 1
NO 2


805. CHECK 209:

HAS HAD AT LEAST ONE CHILD (GO TO 806)
HAS HAD NO CHILDREN (GO TO 815)


806. CHECK 203 AND 205:

HAS HAD AT LEAST ONE SON (GO TO 807)
HAS HAD NO SONS (GO TO 815)


807. Have any of your boys been circumcised?
IF YES: How many?

NUMBER CIRCUMCISED _____
NO BOYS CIRCUMCISED 95 (GO TO 815)


808. Which of your boys has most recently been circumcised?

NAME OF SON _______


809. What age was (NAME IN 808) at the time of his circumcision?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO OBTAIN AN ESTIMATE.

AGE IN FULL YEARS _____

DURING CHILDHOOD 95
DOESN'T KNOW 98


810. Who performed the circumcision of your son (NAME IN 808)?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
OTHER TRADITIONAL (SPECIFY) _____ 16
HEALTH CARE PROFESSIONALS
DOCTOR 21 (GO TO 812)
NURSE 22 (GO TO 812)
OTHER HEALTH CARE PROFESSIONAL (SPECIFY) _____ 26 (GO TO 812)
DOESN'T KNOW 98 (GO TO 812)


811. Was your son (NAME IN 808) circumcised during an initiation ceremony?

YES 1
NO 2


812. During or after they cut (NAME OF SON IN 808)'s foreskin, did any of the following problems present themselves:

Excessive bleeding?
Difficulty urinating or retaining urine?
Swelling in the genital region?
Infection in the genital region/wound improperly healed?

EXCESSIVE BLEEDING
YES 1
NO 2
DOESN'T KNOW 8
DIFFICULTY URINATING OR RETAINING URINE
YES 1
NO 2
DOESN'T KNOW 8
SWELLING IN THE GENITAL REGION
YES 1
NO 2
DOESN'T KNOW 8
INFECTION IN THE GENITAL REGION/WOUND IMPROPERLY HEALED
YES 1
NO 2
DOESN'T KNOW 8


813. CHECK 801:
RESPONDENT IS CIRCUMCISED?

NO, RESPONDENT IS NOT CIRCUMCISED (GO TO 814)
YES, RESPONDENT IS CIRCUMCISED (GO TO 815)


814. What are the reasons that led you to circumcise your sons?
INSIST: Other reasons? RECORD ALL MENTIONED.

BETTER HYGIENE A (GO TO 815)
SOCIAL RECOGNITION B (GO TO 815)
MORE SEXUAL PLEASURE FOR THE WOMAN C (GO TO 815)
MORE SEXUAL PLEASURE FOR THE MAN D (GO TO 815)
MORE ENDURANCE/STRENGTH/HARDNESS E (GO TO 815)
RELIGIOUS NECESSITY F (GO TO 815)
OTHER (SPECIFY) _____ X (GO TO 815)
NO REASON Y (GO TO 815)


815. In the future, do you intend to have your sons circumcised?

YES 1
NO 2 (GO TO 817)
DOESN'T KNOW 8 (GO TO 817)


816. Why do you intend to circumcise your sons in the future?
INSIST: Other reasons? RECORD ALL MENTIONED.

BETTER HYGIENE A
SOCIAL RECOGNITION B
MORE SEXUAL PLEASURE FOR THE WOMAN C
MORE SEXUAL PLEASURE FOR THE MAN D
MORE ENDURANCE/STRENGTH/HARDNESS E
RELIGIOUS NECESSITY F
OTHER (SPECIFY) _____ X
NO REASON Y


817. RECORD THE TIME:

HOUR _____
MINUTES_____


INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT _____

COMMENTS ON SPECIFIC QUESTIONS _____

ANY OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
NAME _____
DATE _____

EDITOR'S OBSERVATIONS _____
NAME _____
DATE _____