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DEMOGRAPHIC AND HEALTH SURVEY
-BENIN 1996-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

DEPARTMENT

SUB-PREFECTURE/URBAN DISTRICT

RURAL/URBAN MUNICIPALITY

VILLAGE/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER

NAME OF HEAD OF HOUSEHOLD ___________________

NAME AND LINE NUMBER OF WOMAN _____________________

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME___
RESULT**

RESULT ____

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

NEXT VISIT:
DATE___
TIME___

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT __

TOTAL NUMBER OF VISITS ___

FRENCH QUESTIONNAIRE 1

LANGUAGE OF INTERVIEW:

FRENCH 1
ADJA 2
BARIBA 3
FON 4
DENDI 5
DITAMARI 6
YORUBA 7
OTHER 8

INTERPRETER:

YES 1
NO 2

SUPERVISOR
NAME _________________________
DATE ________

FIELD EDITOR
NAME _________________________
DATE ________

OFFICE EDITOR ____

KEYED BY ____

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

HOUR ____
MINUTES ____

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in COTONOU, in another city, in a rural location, or abroad?

NAME OF PLACE_______________________
COTONOU 1
MEDIUM SIZED CITY 2
OTHER CITY 3
RURAL 4
ABROAD 5

103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

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

104) Just before you moved to (NAME OF CURRENT PLACE OF RESIDENCE), did you live in Cotonou, in another city, in a rural location, or abroad?

NAME OF PLACE____________________
COTONOU 1
MEDIUM SIZED CITY 2
OTHER CITY 3
RURAL 4
ABROAD 5

105) In what month and year were you born?

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

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

AGE IN COMPLETED YEARS ____

107) Have you ever attended school?

YES 1
NO 2 (GO TO 114)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

109) What is the highest (grade/form/year) you completed at that level?
(CONVERT TO NUMBER OF YEARS COMPLETED)

NUMBER OF YEARS COMPLETED ____

110) CHECK 106:

AGE 24 OR BELOW (GO TO 111)
AGE 25 OR ABOVE (GO TO 113)

111) Are you currently attending school?

YES 1 (GO TO 113)
NO 2

112) What is the main reason you stopped attending school?

GOT PREGNANT 01
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
HAD ENOUGH SCHOOLING 07
FAILED AT SCHOOL 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) _____________ 96
DON'T KNOW 98

113) CHECK 108:

PRIMARY (GO TO 114)
SECONDARY OR HIGHER (GO TO 115)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)

115) Do you usually read a newspaper, a magazine, or any type of document at least once a week?

YES 1
NO 2

116) Do you listen to the radio often, sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

117) Do you watch television often, sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

118) What is your religion?

TRADITIONAL 1
ISLAM 2
CATHOLIC 3
PROTESTANT METHODIST 4
OTHER CHRISTIAN 5
OTHER (SPECIFY) ____________ 6
NONE 7

119) What is your nationality?

BENINESE 1
OTHER (SPECIFY) ___________ 2 (GO TO 120)

119B) What is your ethnicity?

ADJA AND SIMILAR 01
BARIBA AND SIMILAR 02
DENDI AND SIMILAR 03
FON AND SIMILAR 04
YOA AND LOKPA AND SIMILAR 05
BETAMARIBE AND SIMILAR 06
PEULH AND SIMILAR 07
YORUBA AND SIMILAR 08
OTHER (SPECIFY) ____________ 96

120) CHECK Q. 4 IN THE HOUSEHOLD QUESTIONNAIRE:

RESPONDENT IS NOT A USUAL RESIDENT (GO TO 121)
RESPONDENT IS A USUAL RESIDENT (GO TO 201)

121) Now I would like to ask about the place in which you usually live. What is the name of the place in which you usually live?

NAME OF PLACE_______________________
COTONOU 1
MEDIUM SIZED CITY 2
OTHER CITY 3
RURAL 4
ABROAD 5

122) MARK THE NAME OF THE DEPARTMENT OF PLACE OF RESIDENCE

ATACORA 1
ATLANTIQUE 2
BORGOU 3
MONO 4
OUEME 5
ZOU 6

123) Now I would like to ask about the household in which you usually live. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 125)
PIPED ELSEWHERE 12
PUBLIC TAP/STANDPIPE 13
WELL WATER
WELL EQUIPPED WITH MANUAL PUMP 21
PROTECTED WELL/WITH NOZZLE 22
UNPROTECTED WELL 23
SURFACE WATER
EQUIPPED SPRING 31
RIVER/BACKWATER/POND 32
RAINWATER IN TANK 41
OTHER RAINWATER 42
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 125)
OTHER (SPECIFY) ______________ 96

124) How far is this source from your house?

ON PREMISES 1
LESS THAN 1 KILOMETER 2
MORE THAN 1 KILOMETER 3
DON'T KNOW 8

125) What kind of toilet facility do members of your household usually use?

PIT/LATRINE
COVERED LATRINE 21
UNCOVERED LATRINE 22
SEPTIC PIT/SEALED PIT 23
NO FACILITY/OUTSIDE 31
OTHER (SPECIFY) _____________ 96

126) Does your household have:

Electricity?
YES 1
NO 2
A radio?
YES 1
NO 2
A television?
YES 1
NO 2
A refrigerator?
YES 1
NO 2
A bicycle?
YES 1
NO 2
A moped/motorcycle?
YES 1
NO 2
A car/truck/pickup truck?
YES 1
NO 2
A canoe?
YES 1
NO 2

127) What is the flooring material of your home?

CEMENT 11
EARTH 21
WOOD 31
OTHER (SPECIFY) _____________ 96

SECTION 2. REPRODUCTION

201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

202) Do you have any sons or daughters to whom you have given birth who are now living with you?

YES 1
NO 2 (GO TO 204)

203) How many sons live with you? And how many daughters live with you?
IF "NONE", RECORD '00'

SONS AT HOME __
DAUGHTERS AT HOME __

204) Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF "NONE", RECORD '00'

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

207) How many boys have died? And how many girls have died?
IF NONE, RECORD '00'

BOYS DEAD ____
GIRLS DEAD ____

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

TOTAL ____

209) CHECK 208:
Just to makes 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:

AT LEAST ONE BIRTH (GO TO 211)
NO BIRTHS (GO TO 227)

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

LINE NO. _____

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

NAME ___________________

213) Were any of these births twins?

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: In what season was he/she born?

MONTH ____
YEAR ____

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

217) IF ALIVE: How old is (NAME) now?
RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ____

218) IF ALIVE: Is (NAME) living with you?

YES 1 (GO TO NEXT BIRTH FOR FIRST BIRTH; GO TO 220 FOR ALL OTHERS)
NO 2 (GO TO NEXT BIRTH FOR FIRST BIRTH; GO TO 220 FOR ALL OTHERS)

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

DAYS 1_____
MONTHS 2_____
YEARS 3____

220) SUBTRACT THE YEAR OF THE PREVIOUS BIRTH FROM THE YEAR OF BIRTH OF (NAME). IS THE DIFFERENCE 4 YEARS OR MORE?
[ALL BIRTHS EXCEPT FOR THE FIRST BIRTH]

YES 1
NO 2 (GO TO NEXT BIRTH)

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[ALL BIRTHS EXCEPT FOR THE FIRST BIRTH]

YES 1
NO 2

222) SUBTRACT THE YEAR OF LAST BIRTH FROM THE YEAR OF INTERVIEW. IS THE DIFFERENCE 4 YEARS OR MORE?

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 IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED ___
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED ___
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED ___
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS ___
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

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

NUMBER OF BIRTHS____

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.

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 WANT MORE CHILDREN 3

236) When did your last menstrual period start?
WRITE THE DATE, IF GIVEN AND CONVERT THE ELAPSED DURATION

DATE______________
DAYS AGO 1_____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

237) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

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

238) During which times of the menstrual cycle does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 01
RIGHT AFTER HER PERIOD HAD ENDED 02
IN THE MIDDLE OF THE CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY) ______________ 96
DON'T KNOW 98

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 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) Which ways or methods have you heard about?
302) Have you ever heard of (METHOD)?

01) PILL: Women can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
03) INJECTABLES: Women can have an injection by a doctor or a nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
04) NORPLANT: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
05) DIAPHRAGM, FOAM, JELLY: Women can place a sponge, diaphragm, or a spermicide (jelly or cream) inside themselves before intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
06) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
07) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
08) MALE STERILIZATION: Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
09) RHYTHM OR PERIODIC ABSTINENCE: 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.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
10) WITHDRAWAL: Men can be careful and pull out before climax.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO DIFFERENT METHODS.
SPECIFY______
SPONTANEOUS YES 1
NO 3

303) Have you ever used (METHOD)?

01) PILL: Women can take a pill every day.
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 doctor or a nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) NORPLANT: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY: Women can place a sponge, diaphragm, or a spermicide (jelly or cream) inside themselves before intercourse.
YES 1
NO 2
06) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
07) 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
08) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
09) RHYTHM OR PERIODIC ABSTINENCE: 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
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
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)

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

NUMBER OF CHILDREN ____

310) When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?

WANTED CHILD LATER 1
DID NOT WANT ANOTHER CHILD 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 using?
(CHECK THAT THE METHOD LISTED IS KNOWN AND ALREADY USED)
314A) CIRCLE '07' FOR FEMALE STERILIZATION

PILL 01
IUD 02 (GO TO 326)
INJECTABLES 03 (GO TO 326)
NORPLANT 04 (GO TO 326)
DIAPHRAGM/FOAM/GEL 05 (GO TO 326)
CONDOM 06 (GO TO 326)
FEMALE STERILIZATION 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
PERIODIC ABSTINENCE 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 326)
OTHER (SPECIFY)___________ 96 (GO TO 326)

315) May I see the package of pills you are using right now?
RECORD NAME OF BRAND IF PACKAGE IS SEEN

PACKAGE SEEN 1
BRAND NAME ____ (GO TO 317)
PACKAGE NOT SEEN 2

316) Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND

BRAND NAME ______________
DON'T KNOW 98

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

COST __ __ __ __ (GO TO 326)
FREE 9996 (GO TO 326)
DON'T KNOW 9998 (GO TO 326)

318) Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEATH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
COMMUNITY CENTER 15
OTHER PUBLIC (SPECIFY) _____________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ______________ 27
OTHER (SPECIFY) _______________ 96
DON'T KNOW 98

319) Do you regret that (you/your husband) had the operation to not have any more children?

YES 1
NO 2 (GO TO 321)

320) Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
HUSBAND/PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY) _____________ 96

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

MONTH ____ (GO TO 327)
YEAR____ (GO TO 327)

323) How do you determine which days of your monthly cycle not to have sexual relations to avoid getting pregnant?

BASED ON CALENDAR 01
BASED ON BODY TEMPERATURE 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY) ____________ 96

326) For how many months have you used (METHOD FROM Q. 314) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS ____
8 YEARS OR MORE 96

327) CHECK 314:
CIRCLE THE CODE OF THE METHOD

PILL 01
IUD 02
INJECTABLES 03
NORPLANT 04
DIAPHRAGM/FOAM/GEL 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 329A)
MALE STERILIZATION 08 (GO TO 329A)
PERIODIC ABSTINENCE 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER (SPECIFY) ___________ 96 (GO TO 332)

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

NAME OF PLACE_____________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
COMMUNITY CENTER 15
OTHER PUBLIC (SPECIFY) _____________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) _____________ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH 32
RELATIVES/FRIENDS 33
GAS STATION 34
OTHER (SPECIFY) _____________ 96

329) Do you know of another place where you could have obtained (METHOD) the last time?
329A) At the time of the sterilization, did you know of another place where you could have gotten the same operation?

YES 1
NO 2 (GO TO 334)

330) People choose the place where they obtain family planning services for different reasons.
What is your main reason for going to (NAME OF PLACE FROM Q. 328 OR Q. 318) rather than another place?
RECORD ANSWER AND CIRCLE CODE

ACCESSIBILITY
CLOSER TO HOME 11 (GO TO 334)
CLOSER TO MARKET/WORK 12 (GO TO 334)
TRANSPORTATION AVAILABLE 13 (GO TO 334)
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLIER 21 (GO TO 334)
CLEANER 22 (GO TO 334)
OFFERS MORE PRIVACY 23 (GO TO 334)
WAIT TIME IS SHORTER 24 (GO TO 334)
OPEN HOURS ARE LONGER 25 (GO TO 334)
USES OTHER SERVICES IN THE ESTABLISHMENT 26 (GO TO 334)
COSTS LESS/CHEAPER 31 (GO TO 334)
WANTED ANONYMITY 41 (GO TO 334)
OTHER (SPECIFY) _____________ 96 (GO TO 334)
DON'T KNOW 98 (GO TO 334)

331) What is the main reason you did not use a contraceptive method to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POST-PARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _______________96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 334)

333) Where is this?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
COMMUNITY CENTER 15
OTHER PUBLIC (SPECIFY) ______________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) _________________ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH 32
RELATIVES/FRIENDS 33
GAS STATION 34
OTHER (SPECIFY) _______________ 96

334) Were you visited by a family planning program worker in the last 12 months?

YES 1
NO 2

335) Have you visited a health facility for any reason in the last 12 months?

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 affect a woman's chance of becoming pregnant?

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

338) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

INCREASED 1 (GO TO 401)
DECREASED 2
DEPENDS 3
DON'T KNOW 8

339) CHECK 210:

ONE OR MORE BIRTHS (GO TO 340)
NO BIRTHS (GO TO 401)

340) Have you ever relied on breastfeeding as a method of avoiding pregnancy?

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

341) CHECK 227 AND 311:

NOT PREGNANT OR UNSURE AND NOT STERILIZED (GO TO 342)
EITHER PREGNANT OR STERILIZED (GO TO 401)

342) Are you currently relying on breastfeeding to avoid getting pregnant?

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 225:

ONE OR MORE BIRTHS SINCE JANUARY 1993 (GO TO 402)
NO BIRTHS SINCE JANUARY 1993 (GO TO 465)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1993 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

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

403) LINE NUMBER FROM 212

LINE NUMBER ____

404) FROM 212 AND 216

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

405) 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 want no (more) children at all?

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

406) How much longer would you have liked to have waited?
(LESS THAN 1 YEAR, RECORD IN MONTHS; ONE YEAR OR MORE, RECORD IN YEARS)

MONTHS 1 __ __
YEARS 2 __ __
DON'T KNOW 998

407) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON. RECORD ALL PERSONS SEEN.

HEATH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ____________ X
NO ONE Y (GO TO 410)

408) How many months pregnant were you when you first received antenatal care?

MONTHS____
DON'T KNOW 98

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

NUMBER OF TIMES____
DON'T KNOW 98

410) When you were pregnant with (NAME), 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 412)
DON'T KNOW 8 (GO TO 412)

411A) During this pregnancy, how many times did you get this injection?

NUMBER OF TIMES ____
DON'T KNOW 8

411B) In the two weeks leading up to the birth of (NAME), were you given one of these injections?

YES 1
NO 2
DON'T KNOW 8

412) Where did you give birth to (NAME)?

NAME OF PLACE____
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
HEALTH CENTER (DISTRICT HEALTH CENTER) 22
COMMUNAL COMPLEX (PARISH HEALTH CENTER) 23
VILLAGE UNIT (VILLAGE HEALTH CENTER) 24
OTHER PUBLIC (SPECIFY) _______________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
RELIGIOUS HOSPITAL 32
OTHER PRIVATE MEDICAL (SPECIFY) ______________ 36
OTHER (SPECIFY) _____________ 96

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

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
VILLAGE HEALTH AGENT (COMMUNITY HEALTH WORKER) E
RELATIVE/FRIEND F
OTHER (SPECIFY) ______________ X
NO ONE Y

414) At the time of the birth of (NAME), did you have any of the following problems:

Long labor, that is, did your regular contractions last more than 12 hours?
YES 1
NO 2
Excessive bleeding that was so substantial that you feared it was life threatening?
YES 1
NO 2
A high fever with bad smelling vaginal discharge that you feared was life threatening?
YES 1
NO 2
Convulsions not caused by fever that you feared were life threatening?
YES 1
NO 2

415) Was (NAME) delivered by caesarean section?

YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

417) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 419 FOR LAST BIRTH, 420 FOR SECOND-TO-LAST BIRTH)

418) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE
(IF IN KILOGRAMS, CONVERT TO GRAMS)

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

419) Has your period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

YES 1 (GO TO 421)
NO 2 (GO TO 422)

420) Did your period return between the birth of (NAME) and your next pregnancy?
[FOR NEXT-TO-LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 424)

421) How many months after the birth of (NAME) did you not have a period?

MONTHS __ __
DON'T KNOW 98

422) CHECK 227:
RESPONDENT PREGNANT?
[FOR LAST BIRTH ONLY]

NOT PREGNANT (GO TO 423)
PREGNANT OR UNSURE (GO TO 424)

423) Have you resumed sexual intercourse since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 425)

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

MONTHS ____
DON'T KNOW 98

425) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 431)

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.

IMMEDIATELY 000
HOURS 1 ____
DAYS 2 ____

427) CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 428)
DEAD (GO TO 429)

428) Are you still breastfeeding (NAME)?

YES 1 (GO TO 432)
NO 2

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

MONTHS ____
DON'T KNOW 98

430) What was the main reason you stopped breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 0f"191"3
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) _____________ 96

431) CHECK 404:
IS CHILD ALIVE?

ALIVE (GO TO 434)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR IF NO MORE BIRTHS, GO TO 440)

432) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ____

433) How many times did you breastfeed yesterday during the hours of the day between sunrise and sunset?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER

NUMBER OF DAYLIGHT FEEDINGS ____

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

YES 1
NO 2
DON'T KNOW 8

435) At any time yesterday or last night, was (NAME ) given any of the following:

Plain water?
YES 1
NO 2
DON'T KNOW 8
Sugar water?
YES 1
NO 2
DON'T KNOW 8
Juice?
YES 1
NO 2
DON'T KNOW 8
Herbal tea?
YES 1
NO 2
DON'T KNOW 8
Baby formula?
YES 1
NO 2
DON'T KNOW 8
Tinned or powdered milk?
YES 1
NO 2
DON'T KNOW 8
Fresh milk?
YES 1
NO 2
DON'T KNOW 8
Any other liquids?
YES 1
NO 2
DON'T KNOW 8
Food made from (corn, millet, bread, sorghum, or soy)?
YES 1
NO 2
DON'T KNOW 8
Food made from (yams, manioc)?
YES 1
NO 2
DON'T KNOW 8
Eggs, fish, or poultry?
YES 1
NO 2
DON'T KNOW 8
Meat?
YES 1
NO 2
DON'T KNOW 8
Any other solid or semi-solid foods?
YES 1
NO 2
DON'T KNOW 8

436) CHECK 435:
FOOD OR LIQUID GIVEN YESTERDAY?

"YES" TO ONE OR MORE (GO TO 437)
"NO/DON'T KNOW" TO ALL (GO TO 438)

437) (Aside from breastmilk,) how many times did (NAME) eat yesterday, including meals and liquids?
IF "7 OR MORE TIMES", RECORD "7".

NUMBER OF TIMES____
DON'T KNOW 8

438) On how many days during the last seven days was (NAME) given any of the following:
RECORD NUMBER OF DAYS. IF DON'T KNOW, RECORD 8.

Plain water?
NUMBER OF DAYS__
Any kind of milk (other than breastmilk)?
NUMBER OF DAYS__
Liquids other than plain water or milk (herbal tea, juice, sugar water, etc…)?
NUMBER OF DAYS__
Food made from (corn, millet, bread, sorghum, soy)?
NUMBER OF DAYS__
Food made from (yam, manioc)?
NUMBER OF DAYS__
Eggs, fish, or poultry?
NUMBER OF DAYS__
Meat?
NUMBER OF DAYS__
Any other solid or semi-solid foods?
NUMBER OF DAYS__

439) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1993 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN TWO BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

441) LINE NUMBER FROM Q. 212

LINE NUMBER ____

442) FROM Q. 212 AND Q. 216

NAME _______________
LIVING (GO TO 443)
DEAD (GO TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465)

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

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3

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

YES 1 (GO TO 447)
NO 2 (GO TO 447)

445) (1) COPY VACCINATION DATES 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 (GIVEN AT BIRTH)
DAY ____
MONTH ____
YEAR ____
Polio 1
DAY ____
MONTH ____
YEAR ____
Polio 2
DAY ____
MONTH ____
YEAR ____
Polio 3
DAY ____
MONTH ____
YEAR ____
DTP 1
DAY ____
MONTH ____
YEAR ____
DTP 2
DAY ____
MONTH ____
YEAR ____
DTP 3
DAY ____
MONTH ____
YEAR ____
Measles
DAY ____
MONTH ____
YEAR ____

446) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DTP 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445) (GO TO 449)
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

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

YES 1
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

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

448A) A BCG vaccination against tuberculosis, that is, an injection in the left arm (upper third) done at birth that leaves a scar?

YES 1
NO 2
DON'T KNOW 8

448B) Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 448E)
DON'T KNOW 8 (GO TO 448E)

448C) How many times?

NUMBER OF TIMES ___

448D) When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

448E) A DPT vaccination (in the arm or thigh), that is, an injection usually given at the same time as polio drops?

YES 1
NO 2 (GO TO 448G)
DON'T KNOW 8 (GO TO 448G)

448F) How many times?

NUMBER OF TIMES___

448G) An injection to prevent MEASLES (on the upper right arm or in the back)?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

451) When (NAME) was ill with a cough, did he/she breathe more rapidly than usual with short, rapid breaths?

YES 1
NO 2
DON'T KNOW 8

452) Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 454)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
HEALTH CENTER (DISTRICT HEALTH CENTER) B
COMMUNAL COMPLEX (PARISH HEALTH CENTER) C
VILLAGE UNIT (VILLAGE HEALTH CENTER) D
COMMUNITY HEALTH AGENT E
OTHER PUBLIC (SPECIFY) ______________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
RELIGIOUS HOSPITAL H
PHARMACY I
DOCTOR'S OFFICE J
COMMUNITY HEALTH AGENT K
OTHER PRIVATE MEDICAL (SPECIFY) ______________ L
OTHER
SHOP/MARKET M
TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ________________ X

454) Has (NAME) had diarrhea in the last two weeks?

YES 1
NO 2 (GO TO 463)
DON'T KNOW 8 (GO TO 463)

455) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

456) On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF BOWEL MOVEMENTS ____
DON'T KNOW 98

457) Was he/she given the same amount to drink as before the diarrhea, more, or a little less, a lot less, or nothing?

SAME 1
MORE 2
A LITTLE LESS 3
A LOT LESS 4
NOTHING 5
DON'T KNOW 8

458) Was he/she given the same amount to eat as before the diarrhea, more, or a little less, a lot less, or nothing?

SAME 1
MORE 2
A LITTLE LESS 3
A LOT LESS 4
NOTHING 5
DON'T KNOW 8

459) When (NAME) had diarrhea, was he/she given any of the following to drink:

A fluid made from a special packet called ORS/ORASEL?
YES 1
NO 2
DON'T KNOW 8
Thin watery gruel made from (rice or other local grain, manioc, potato, yam, etc.)?
YES 1
NO 2
DON'T KNOW 8
A puree made with (rice or other local grain, manioc, potato, yam, etc.)?
YES 1
NO 2
DON'T KNOW 8
Soup?
YES 1
NO 2
DON'T KNOW 8
Homemade sugar-salt-water solution?
YES 1
NO 2
DON'T KNOW 8
Milk or infant formula?
YES 1
NO 2
DON'T KNOW 8
Yogurt-based drink?
YES 1
NO 2
DON'T KNOW 8
Water?
YES 1
NO 2
DON'T KNOW 8
Any other liquids?
YES 1
NO 2
DON'T KNOW 8

459B) CHECK 459:
CHILD RECEIVED ORS?

"YES" (GO TO 459C)
"NO/DON'T KNOW" (GO TO 460)

459C) When (NAME) had diarrhea, how did you prepare the ORS solution? How many packets of ORS (ORASEL) per liter of water?

ORS/LITER
LESS THAN 1 PACKET 1
1 PACKET 2
MORE THAN 1 PACKET 3
Was the water clean?
YES 1
NO 2

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

YES 1
NO 2 (GO TO 462)
DON'T KNOW 8 (GO TO 462)

461) What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED

PILL OR SYRUP A
INJECTION (I.M.) B
INJECTION (I.V.) C
HOME REMEDY/HERBAL MEDICINE D
OTHER (SPECIFY) _____________ X

462) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 463)

462B) Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
HEALTH CENTER (DISTRICT HEALTH CENTER) B
COMMUNAL COMPLEX (PARISH HEALTH CENTER) C
VILLAGE UNIT (VILLAGE HEALTH CENTER) D
COMMUNITY HEALTH AGENT E
OTHER PUBLIC (SPECIFY) _____________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
RELIGIOUS HOSPITAL H
PHARMACY I
DOCTOR'S OFFICE J
COMMUNITY HEALTH AGENT K
OTHER PRIVATE MEDICAL (SPECIFY) _________________ L
OTHER
SHOP/MARKET M
TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ____________ X

463) VITAMIN A
CHECK DEPARTMENT:

IF ATACORA OR BORGOU (GO TO 463A)
IF NOT ATACORA OR BOURGOU (GO TO 464)

463A) Did (NAME) get a capsule of vitamin A like this one?

YES 1
NO 2 (GO TO 464)

463B) How many months ago did the child get the last capsule?

NUMBER OF MONTHS ____

464) GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465) When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS TO DRINK 1
ABOUT THE SAME TO DRINK 2
MORE TO DRINK 3
DON'T KNOW 8

466) When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

LESS TO EAT 1
ABOUT THE SAME TO EAT 2
MORE TO EAT 3
DON'T KNOW 8

467) When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETS SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

468) When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED

RAPID BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETS SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

469) At what age do you think a child should be vaccinated against measles?

BEFORE 6 MONTHS 1
BETWEEN 6 AND 9 MONTHS 2
BETWEEN 9 AND 12 MONTHS 3
AFTER 12 MONTHS 4
DON'T KNOW 8

470) CHECK 459, ALL COLUMNS:

NO CHILD RECEIVED ORS (GO TO 471)
AT LEAST ONE CHILD RECEIVED ORS (GO TO 501)

471) Have you heard of a special product called ORS/ORASEL you can get for the treatment of diarrhea?

YES 1
NO 2

SECTION 5. MARRIAGE

501) PRESENCE OF OTHERS AT THIS POINT

CHILDREN UNDER 10 YEARS OLD
YES 1
NO 2
HUSBAND/PARTNER
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?

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

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 have you ever lived with a man?

YES, WAS MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515F)

506) What is your marital status now: are you a widow, divorced, or separated?

WIDOW 1 (GO TO 511)
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2 (GO TO 508)

507B) LINE NUMBER OF HUSBAND/PARTNER LIVING IN THE HOUSEHOLD

LINE NUMBER____

508) Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 511)

509) How many other wives does he have?

NUMBER ____
DON'T KNOW 98

510) Are you the first, second…wife?

RANK ____

511) Have you been married or have you lived with a man only once or more than once (including your current union)?

ONCE 1
MORE THAN ONCE 2

512) CHECK 511:

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 will talk about your first husband/partner. In what month and year did you start living with him?

MONTH ____
DON'T KNOW MONTH 98
YEAR ____ (GO TO 515)
DON'T KNOW YEAR 98

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

AGE ____

514A) CHECK 502:

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

515) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse with (your husband/live-in partner)?

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

515A) CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex with (your husband/live-in partner), was a condom used?

DOES NOT KNOW CONDOM: Some men use a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex with (your husband/live-in partner), was a condom used?

YES 1
NO 2
DON'T KNOW 8

515B) Have you had sexual intercourse with any person other than (your husband/live-in partner) 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/live-in partner)?

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

515D) Was a condom used on this occasion?

YES 1
NO 2
DON'T KNOW 8

515E) In total, how many different people have you had sexual intercourse with in the last 12 months?

NUMBER OF PERSONS ____ (GO TO 517)
DON'T KNOW 98 (GO TO 517)

515F) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)?

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

515G) CHECK 301 AND 302:

KNOWS CONDOM : The last time you had sex, was a condom used?

DOES NOT KNOW CONDOM: Some men use a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?

YES 1
NO 2
DON'T KNOW 8

515H) CHECK 515F:

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

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

NUMBER OF PERSONS ____
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 519)

518) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
COMMUNITY CENTER 15
OTHER PUBLIC (SPECIFY) ____________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) _____________ 27
OTHER
SHOP/MARKET 31
CHURCH 32
FRIENDS/RELATIVES 33
GAS STATION 34
OTHER (SPECIFY) ___________ 96

519) How old were you when you first had sexual intercourse?

AGE ____
FIRST TIME WHEN MARRIED 96

SECTION 6. FERTILITY PREFERENCES

601) CHECK 314:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 612)

602) CHECK 227:

NOT PREGNANT OR UNSURE: Now I have some question 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 606)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DON'T KNOW 8 (GO TO 604)

603) CHECK 602:

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 this 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
DON'T KNOW 998

604) CHECK 602:

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

605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 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 method to delay or avoid pregnancy within the next 12 months?

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

608) Do you think you will use a method any time in the future?

YES 1
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)

609) Which method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTABLES 03 (GO TO 612)
NORPLANT 04 (GO TO 612)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
PERIODIC ABSTINENCE 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
OTHER (SPECIFY) 96 (GO TO 612)
UNSURE 98 (GO TO 612)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (GO TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUBFECUND/INFECUND 24 (GO TO 612)
WANTS MORE CHILDREN 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)
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)
DON'T KNOW 98 (GO TO 612)

611) Would you use a method if you were married?

YES 1
NO 2
DON'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 ____
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 it not matter?

NUMBER OF BOYS____
OTHER (SPECIFY)____ 96
NUMBER OF GIRLS____
OTHER (SPECIFY)____ 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY)____ 96

614) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

615) Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

616) In the last few months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazines?
YES 1
NO 2
In a poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2

618) In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 620)

619) With whom? 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
FRIENDS/NEIGHBORS J
OTHER (SPECIFY) __________________ X

620) CHECK 502:

YES, CURRENTLY MARRIED (GO TO 621)
YES, LIVING WITH A MAN (GO TO 621)
NO, NOT IN A UNION (GO TO 701)

621) Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning. Do you think your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
INDIFFERENT 3
DON'T KNOW 8

622) How often have you talked to your husband/partner about family planning in the last twelve months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

623) Do you think 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
DON'T KNOW 8

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/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER IN UNION (GO TO 709)

702) How old is your husband/partner currently?

AGE ____

703) Did your husband/partner ever attend school?

YES 1
NO 2 (GO TO 706)

704) What was the highest level of school he attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 706)

705) What was the highest (grade/form/year) he completed at that level?
(CONVERT TO NUMBER OF YEARS COMPLETED)

NUMBER OF YEARS COMPLETED______
DON'T KNOW 98

706) What is (was) your husband'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) Does/did your husband/partner work mainly on his own land or on family land, or does/did he work on land that he rented from someone else, or does/did he work on someone else's land?

HIS LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

709) Aside from your own housework, are you currently working?

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. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing 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 801)

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

OCCUPATION____________________________

713) CHECK 712:

WORKS IN AGRICULTURE (GO TO 714)
DOES 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

715) Do you do this work for a family member, 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 (GO TO 718)
SEASONALLY 2
ONCE IN A WHILE 3 (GO TO 719)

717) During the last 12 months, how many months did you work?

NUMBER OF MONTHS ____

718) During the months you worked, how many days a week did you usually work?

NUMBER OF DAYS ____

719) During the last 12 months, approximately how many days did you work?

NUMBER OF DAYS ____

720) Do you earn cash for your work?
PROBE: Do you make money for working?

YES 1
NO 2 (GO TO 723)

721) How much do you usually earn for this work?
PROBE: Is this per hour, per day, per week, per month, or per year?

PER HOUR 1 __ __ __ __ __ __ __
PER DAY 2 __ __ __ __ __ __ __
PER WEEK 3 __ __ __ __ __ __ __
PER MONTH 4 __ __ __ __ __ __ __
PER YEAR 5 __ __ __ __ __ __ __
OTHER (SPECIFY) 99999996

722) CHECK 502:

YES, CURRENTLY MARRIED/YES, CURRENTLY LIVING WITH A MAN: Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

NO, NOT IN UNION: Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

RESPONDENT DECIDES 1
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

723) Do you usually work at home or away from home?

HOME 1
AWAY 2

724) CHECK 217 AND 218:
IS A CHILD LIVING AT HOME WHO WAS BORN SINCE JANUARY 1993 OR IS AGE 3 OR YOUNGER?

YES (GO TO 725)
NO (GO TO 801)

725) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

RESPONDENT 01
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILDCARE 10
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) _______________ 96

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801A) Have you ever heard of any illnesses that you can get from having sex?

YES 1
NO 2 (GO TO 801L)

801B) What illnesses have you heard of?
RECORD ALL RESPONSES

SYPHILIS A
GONORRHEA B
AIDS C
VAGINAL TRICHOMONIASIS D
GENITAL ULCERS E
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

801C) CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE (GO TO 801D)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 801K)

801D) Over the last 12 months, have you had any of these illnesses?

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

801E) Which illnesses did you have?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
VAGINAL TRICHOMONIASIS D
GENITAL ULCERS E
OTHER (SPECIFY) __________________ X
DON'T KNOW Z

801F) The last time that you had (ILLNESS FROM 801E) did you seek advice or treatment?

YES 1
NO 2 (GO TO 801H)

801G) Where did you seek advice or treatment? Any other place/Anyone else?
CIRCLE ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
FIELDWORKER D
COMMUNITY CENTER E
OTHER PUBLIC (SPECIFY) ______________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
RELIGIOUS HOSPITAL H
PHARMACY I
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) J
DOCTOR'S OFFICE K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) _______________ M
OTHER SOURCE
SHOP/MARKET N
RELATIVES/FRIENDS O
TRADITIONAL PRACTITIONER P
OTHER (SPECIFY) _______________ X
DON'T KNOW Z

801H) When you had the (ILLNESS(ES) FROM 801E) did you tell your sexual partner(s)?

YES 1
NO 2

801I) When you had the (ILLNESS(ES) FROM 801E) did you do something 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.

STOPPED SEXUAL INTERCOURSE A
USED A CONDOM DURING SEXUAL INTERCOURSE B
TOOK DRUGS C
OTHER (SPECIFY) ________________ X

801K) CHECK 801B:

DID NOT LIST "AIDS" (GO TO 801L)
LISTED "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 of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY) _______________ X

802B) How can you get AIDS? Any other way?
RECORD ALL MENTIONED

SEXUAL INTERCOURSE A
SEXUAL INTERCOURSE WITH SEVERAL PARTNERS B
SEXUAL INTERCOURSE WITH PROSTITUTES C
NOT USING A CONDOM D
SEXUAL RELATIONS WITH HOMOSEXUALS E
BLOOD TRANSFUSIONS F
INJECTIONS G
KISSING H
MOSQUITO BITES I
SOILED OBJECTS J
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

803) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

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

804) What can a person do? Anything else?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER K
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

808) Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

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

808A) Can AIDS be cured?

YES 1
NO 2
DON'T KNOW 8

808B) Can AIDS be transmitted from a mother to a child she carries in her womb?

YES 1
NO 2
DON'T KNOW 8

808C) Do you know someone personally who has AIDS or someone who died of AIDS?

YES 1
NO 2

809) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

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

809B) Why do you think that you (HAVE NO RISK/HAVE SMALL RISK) of getting AIDS? Any other reason?
RECORD ALL MENTIONED

ABSTAINS FROM SEX B (GO TO 811A)
USES CONDOMS C (GO TO 811A)
ONLY HAS ONE SEXUAL PARTNER D (GO TO 811A)
HAS A LIMITED NUMBER OF SEXUAL PARTNERS E (GO TO 811A)
PARTNER DOESN'T HAVE OTHER PARTNERS F (GO TO 811A)
DOESN'T HAVE HOMOSEXUAL RELATIONS G (GO TO 811A)
DOESN'T GET BLOOD TRANSFUSIONS H (GO TO 811A)
DOESN'T GET INJECTIONS I (GO TO 811A)
OTHER (SPECIFY) _____________ X (GO TO 811A)

809C) Why do you think you have (MODERATE/GREAT) risk of getting AIDS? Any other reason?
RECORD ALL MENTIONED

DOESN'T USE CONDOMS C
HAS MORE THAN 1 SEXUAL PARTNER D
HAS SEVERAL SEXUAL PARTNERS E
PARTNER HAS OTHER PARTNERS F
HAS HOMOSEXUAL RELATIONS G
BLOOD TRANSFUSIONS H
INJECTIONS I
OTHER (SPECIFY) _______________ X

811A) Ever since you heard of AIDS, have you changed your behavior to avoid getting AIDS?
IF YES, What have you done? Anything else?
RECORD ALL MENTIONED.

DIDN'T START SEX A (GO TO 811C)
STOPPED ALL SEX B (GO TO 811C)
STARTED USING CONDOMS C (GO TO 811C)
RESTRICTED SEX TO ONE PARTNER D (GO TO 811C)
REDUCED NUMBER OF SEXUAL PARTNERS E (GO TO 811C)
ASKED PARTNER TO BE FAITHFUL F (GO TO 811C)
STOPPED HOMOSEXUAL RELATIONS G (GO TO 811C)
STOPPED INJECTIONS H
OTHER (SPECIFY) _____________ X
NO CHANGE Y

811B) Has your knowledge of AIDS influenced or changed your decisions about having sex or sexual behavior? IF YES, In what way?
RECORD ALL MENTIONED.

DIDN'T START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
OTHER (SPECIFY) _______________ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DON'T KNOW Z

811C) Some people use condoms during sex to avoid getting AIDS or other sexually transmitted illnesses. Have you ever heard of condoms?

YES 1
NO 2 (GO TO 811I)

811D) CHECK 515 AND 515F:

HAS HAD SEX (GO TO 811E)
HAS NOT HAD SEX (GO TO 901)

811E) We may have already discussed this. Have you ever used a condom during sexual relations to avoid getting or transmitting illnesses, like AIDS?

YES 1
NO 2 (GO TO 811I)

811F) Do you know the brand name of the condoms that you used at that time?
RECORD NAME OF BRAND

PRUDENCE 1
OTHER 6 (GO TO 811I)
DON'T KNOW 8 (GO TO 811I)

811G) Do you think that Prudence is of superior quality, the same quality, or inferior quality than other brands of condoms?

SUPERIOR 1
SAME 2
INFERIOR 3
DON'T KNOW 8

811H) In the last 4 weeks, how many Prudence brand condoms have you used?

RECORD THE NUMBER

NUMBER OF PRUDENCE ____
DON'T KNOW 98

811I) Have you given or received money, gifts, or favors in exchange for sexual relations in the last 12 months?

YES 1
NO 2

SECTION 9. MATERNAL MORTALITY

901) 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 who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER ____

902) CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 916)

903) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ____

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

NAME___________________

905) Is (NAME) male or female?

MALE 1
FEMALE 2

906) Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DON'T KNOW 8 (GO TO NEXT SIBLING)

907) How old is (NAME)?

AGE____ (GO TO NEXT SIBLING)

908) What year did he/she die in?

YEAR 19 __ __ (GO TO 910)
DON'T KNOW 98

909) How many years ago did (NAME) die?

YEARS____

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

AGE____ (IF MALE, OR FEMALE WHO DIED BEFORE 12 YEARS OF AGE, GO NEXT SIBLING)

911) Was (NAME) pregnant when she died?

YES 1 (GO TO 914)
NO 2

912) Did (NAME) die during childbirth?

YES 1 (GO TO 915)
NO 2

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

YES 1
NO 2 (GO TO 915)

914) Did (NAME) die due to complications of pregnancy or childbirth?

YES 1
NO 2

915) How many children did (NAME) give birth to during her lifetime?

NUMBER OF CHILDREN____ (GO TO NEXT SIBLING)

IF NO OTHER BROTHERS OR SISTERS, GO TO 916

916) RECORD THE TIME

HOURS ____
MINUTES ____

SECTION 10. HEIGHT AND WEIGHT

1001) CHECK 215:

ONE OR MORE BIRTHS SINCE JANUARY 1993 (GO TO 1002)
NO BIRTHS SINCE JANUARY 1993 (END)

IN 1002 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1993 AND STILL LIVING. IN 1003 AND 1004, RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1993. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.

(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1993 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1993, USE ADDITIONAL QUESTIONNAIRES.)

1002) LINE NUMBER FROM Q. 212
[ONLY FOR CHILDREN BORN SINCE JANUARY 1993]

LINE NUMBER____

1003) NAME FROM Q. 212 FOR CHILDREN

NAME ________________

1004) DATE OF BIRTH:
FROM Q. 215, AND ASK FOR DAY OF BIRTH
[ONLY FOR CHILDREN BORN SINCE JANUARY 1993]

DAY ____
MONTH ____
YEAR ____

1005) BCG SCAR ON TOP OF LEFT SHOULDER
[ONLY FOR CHILDREN BORN SINCE JANUARY 1993]

SCAR SEEN 1
NO SCAR 2

1006) HEIGHT (in centimeters)

HEIGHT__ __ __ , __

1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?
[ONLY FOR CHILDREN BORN SINCE JANUARY 1993]

LYING 1
STANDING 2

1008) WEIGHT (in kilograms)

WEIGHT__ __ __ , ___

1009) DATE WEIGHED AND MEASURED

DAY ____
MONTH ____
YEAR ____

1010) RESULT

FOR RESPONDENT

MEASURED 1
NOT PRESENT 2
REFUSED 4
OTHER (SPECIFY) ___________ 6

FOR CHILDREN BORN SINCE JANUARY 1993

CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ___________ 6

1011) NAME OF MEASURER __________________________
NAME OF ASSISTANT __________________________

INTERVIEWER'S OBSERVATIONS

To be filled out 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:___________