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 ____

NEXT VISIT:
DATE___
TIME___

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

TOTAL NUMBER OF VISITS ___

FRENCH QUESTIONNAIRE 1

LANGUAGE OF INTERVIEW:

INTERPRETER:

SUPERVISOR
NAME _________________________
DATE ________

FIELD EDITOR
NAME _________________________
DATE ________

OFFICE EDITOR ____

KEYED BY ____

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

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?

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

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?

105) In what month and year were you born?

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

107) Have you ever attended school?

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

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

110) CHECK 106:

111) Are you currently attending school?

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

113) CHECK 108:

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

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

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

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

118) What is your religion?

119) What is your nationality?

119B) What is your ethnicity?

120) CHECK Q. 4 IN THE HOUSEHOLD QUESTIONNAIRE:

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?

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

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?

124) How far is this source from your house?

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

126) Does your household have:

127) What is the flooring material of your home?

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?

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

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

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

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'

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?

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

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

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

210) CHECK 208:

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.

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

213) Were any of these births twins?

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

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

216) Is (NAME) still alive?

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

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

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.

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]

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

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

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

224) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

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

227) Are you pregnant now?

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

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

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?

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

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)?

303) Have you ever used (METHOD)?

304) CHECK 303:

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

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'

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?

311) CHECK 303:

312) CHECK 227:

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

314) Which method are you using?
(CHECK THAT THE METHOD LISTED IS KNOWN AND ALREADY USED)
314A) CIRCLE '07' FOR FEMALE STERILIZATION

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

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

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

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.

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

320) Why do you regret the operation?

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

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

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

327) CHECK 314:
CIRCLE THE CODE OF THE METHOD

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.

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?

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

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

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

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.

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

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

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

337) Do you think that breastfeeding can affect a woman's chance of becoming pregnant?

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

339) CHECK 210:

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

341) CHECK 227 AND 311:

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

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 225:

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

404) FROM 212 AND 216

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?

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)

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.

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

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

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?

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

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

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

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

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

415) Was (NAME) delivered by caesarean section?

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

417) Was (NAME) weighed at birth?

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

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

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

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

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

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

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

425) Did you ever breastfeed (NAME)?

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.

427) CHECK 404:
CHILD ALIVE?

428) Are you still breastfeeding (NAME)?

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

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

431) CHECK 404:
IS CHILD ALIVE?

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

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

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

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

436) CHECK 435:
FOOD OR LIQUID GIVEN YESTERDAY?

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

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.

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

442) FROM Q. 212 AND Q. 216

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

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

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.

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).

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

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?

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

448C) How many times?

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

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

448F) How many times?

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

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

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

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

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

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

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

455) Was there any blood in the stools?

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

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

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

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

459B) CHECK 459:
CHILD RECEIVED ORS?

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

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

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

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

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

463) VITAMIN A
CHECK DEPARTMENT:

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

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

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?

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

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

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

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

470) CHECK 459, ALL COLUMNS:

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

SECTION 5. MARRIAGE

501) PRESENCE OF OTHERS AT THIS POINT

502) Are you currently married or living with a man?

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

504) Have you ever been married or have you ever lived with a man?

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

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

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

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

509) How many other wives does he have?

510) Are you the first, second?wife?

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

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?

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

514A) CHECK 502:

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)?

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?

515B) Have you had sexual intercourse with any person other than (your husband/live-in partner) in the last 12 months?

515C) When was the last time you had sexual intercourse with someone other than (your husband/live-in partner)?

515D) Was a condom used on this occasion?

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

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)?

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?

515H) CHECK 515F:

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

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

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.

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

SECTION 6. FERTILITY PREFERENCES

601) CHECK 314:

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?

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?

604) CHECK 602:

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

606) CHECK 313:
USING A METHOD?

607) Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

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

609) Which method would you prefer to use?

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

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

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.

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?

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

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

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

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

619) With whom? Anyone else?
RECORD ALL PERSONS MENTIONED

620) CHECK 502:

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?

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

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?

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

701) CHECK 502 AND 504:

702) How old is your husband/partner currently?

703) Did your husband/partner ever attend school?

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

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

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

707) CHECK 706:

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?

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

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?

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

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

713) CHECK 712:

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?

715) Do you do this work for a family member, for someone else, or are you self-employed?

716) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

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

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

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

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

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

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?

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

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

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

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

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

801C) CHECK 515 AND 515F:

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

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

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

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

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

801I) When you had the (ILLNESS(ES) FROM 801E) did you do something to avoid infecting your sexual partner(s)?

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

801K) CHECK 801B:

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

802) From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED

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

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

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

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

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

808A) Can AIDS be cured?

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

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

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

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

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

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.

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.

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

811D) CHECK 515 AND 515F:

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

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

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

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

RECORD THE NUMBER

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

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?

902) CHECK 901:

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

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

905) Is (NAME) male or female?

906) Is (NAME) still alive?

907) How old is (NAME)?

908) What year did he/she die in?

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

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

911) Was (NAME) pregnant when she died?

912) Did (NAME) die during childbirth?

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

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

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

IF NO OTHER BROTHERS OR SISTERS, GO TO 916

916) RECORD THE TIME

SECTION 10. HEIGHT AND WEIGHT

1001) CHECK 215:

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]

1003) NAME FROM Q. 212 FOR CHILDREN

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

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

1006) HEIGHT (in centimeters)

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

1008) WEIGHT (in kilograms)

1009) DATE WEIGHED AND MEASURED

1010) RESULT

FOR RESPONDENT

FOR CHILDREN BORN SINCE JANUARY 1993

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:___________