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

IDENTIFICATION

DEPARTMENT

SUB-PREFECTURE/URBAN DISTRICT

RURAL/URBAN MUNICIPALITY

TOWN/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER

NAME OF HEAD OF HOUSEHOLD ___________________

NAME AND LINE NUMBER OF MAN_____________________

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 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 111)

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 this level?
(CONVERT TO NUMBER OF YEARS COMPLETED)

NUMBER OF YEARS COMPLETED ____

110) CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 112)

111) 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 113)

112) Do you read a newspaper or magazine at least once a week?

YES 1
NO 2

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

OFTEN 1
SOMETIMES 2
NEVER 3

113B) Do you watch television often, sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

114) What is your religion?

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

114B) What is your nationality?

BENINESE 1
OTHER (SPECIFY) _________ 2 (GO TO 115)

114C) 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

115) Are you currently working?

YES 1 (GO TO 117)
NO 2

116) Have you done any type of work in the last 12 months?

YES 1
NO 2 (GO TO 201)

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

OCCUPATION_____________________________

118) CHECK 117:

WORKS IN AGRICULTURE (GO TO 119)
DOES NOT WORK IN AGRICULTURE (GO TO 120)

119) 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

120) 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

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

THROUGHOUT THE YEAR 1 (GO TO 123)
SEASONALLY 2
ONCE IN A WHILE 3 (GO TO 124)

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

NUMBER OF MONTHS ____

123) In the months that you worked, how many days a week did you usually work?

NUMBER OF DAYS __ (GO TO 125)

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

NUMBER OF DAYS ____

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

YES 1
NO 2 (GO TO 201)

126) 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

SECTION 2. REPRODUCTION

201) Now I would like to ask you about your children. I'm only interested in your biological children. Do you have or have you had children?

YES 1
NO 2 (GO TO 206)

202) Do you have any sons or daughters 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 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", CODE '00'

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206) Have you ever had any children who were 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 Q. 203, 205 AND 207, AND ENTER THE TOTAL.
IF "NONE", RECORD '00'

TOTAL ____

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

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

210) CHECK 208:

HAS/HAD CHILDREN (GO TO 210A)
NEVER HAD CHILDREN (GO TO 301)

210A) In what month and year was your last child born?

MONTH ____
YEAR ____

210B) CHECK 201A, LAST CHILD:

NOT BEFORE JANUARY 1993 (GO TO 211)
BEFORE JANUARY 1993 (GO TO 301)

211) At the time you were expecting this last child, did you want a child then, did you want to wait until later, or did you not want to have any (more) children?

THEN 1
LATER 2
NOT AT ALL 3

SECTION 3: FAMILY PLANNING

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 heath provider 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 heath provider 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 a partner who 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 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 307)

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

YES 1
NO 2 (GO TO 309)

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

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

YES 1
NO 2 (GO TO 309)

308) Which method are you using?
(CHECK THAT THE METHOD LISTED IS KNOWN AND ALREADY USED)
(CIRCLE "08" FOR MALE STERILIZATION)

PILL 01 (GO TO 401)
IUD 02 (GO TO 401)
INJECTABLES 03 (GO TO 401)
NORPLANT 04 (GO TO 401)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 401)
CONDOM 06 (GO TO 401)
FEMALE STERILIZATION 07 (GO TO 401)
MALE STERILIZATION 08 (GO TO 401)
PERIODIC ABSTINENCE 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER (SPECIFY) ___________ 96 (GO TO 401)

309) What is the main reason that you do not use a contraceptive method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NO SEX 21
INFREQUENT SEX 22
WIFE MENOPAUSAL/HAD HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
WIFE POST-PARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
WIFE PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
SPOUSE/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

SECTION 4. MARRIAGE

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

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 402A)
NO, NOT IN UNION 3 (GO TO 404)

402) How many wives do you currently have?
402A) How many women do you live with as if married?

NUMBER OF WIVES/WOMEN ____

403) WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE OF HIS WIFE/WIVES.

IF A WIFE/WOMAN DOES NOT LIVE IN THE HOUSEHOLD, RECORD '00'.
THE NUMBER OF SPACES FILLED SHOULD BE EQUAL TO THE NUMBER OF WOMEN.

LINE NUMBER____ (GO TO 407)

404) 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

405) Have you ever been married or lived with a woman?

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

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

WIDOW 1
DIVORCED 2
SEPARATED 3

407) Have you been married or lived with a woman only once or more than once (including your current union)?

ONCE 1
MORE THAN ONCE 2

408) CHECK 407:

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

MARRIED/LIVED WITH WOMAN MORE THAN ONCE: Now we will talk about your first wife/partner. In what month and year did you start living with her?

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

409) How old were you when you started living with her?

AGE _____

409A) CHECK 401:

CURRENTLY MARRIED OR LIVES WITH A WOMAN (GO TO 410)
NOT IN A UNION (GO TO 410F)

410) 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 spouse/the woman with whom you live)?

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____

410A) CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex with (your spouse/the woman with whom you live), 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 spouse/the woman with whom you live), was a condom used?

YES 1
NO 2
DON'T KNOW 8

410B) Have you had sexual relations with someone other than (your spouse/the woman with whom you live) in the last 12 months?

YES 1
NO 2 (GO TO 410J)

410C) When was the last time you had sexual relations with someone other than (your spouse/the woman with whom you live)?

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____

410D) Was a condom used on this occasion?

YES 1
NO 2
DON'T KNOW 8

410E) During the last 12 months, how many different people other than (your spouse/the woman with whom you live) did you have sexual relations with?

NUMBER OF PEOPLE ____ (GO TO 410J)
DON'T KNOW 98 (GO TO 410J)

410F) 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 508)
DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____

410G) 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

410H) CHECK 410F:

LESS THAN 12 MONTHS SINCE LAST SEXUAL RELATIONS (GO TO 410I)
12 MONTHS OR MORE SINCE LAST SEXUAL RELATIONS (GO TO 410J)

410I) In total, with how many different people have you had sex in the last 12 months?

NUMBER OF PERSONS ____
DON'T KNOW 98

410J) CHECK 401:

CURRENTLY MARRIED OR LIVES WITH A WOMAN: The last time you had sexual relations, was it with (your spouse/the woman with whom you live), a regular partner, an acquaintance, someone who you paid, or someone else?

NOT CURRENTLY MARRIED/NOT LIVING WITH A WOMAN: The last time you had sexual relations, was it a regular partner, an acquaintance, someone who you paid, or someone else?

SPOUSE/WOMAN WITH WHOM HE LIVES 1
REGULAR PARTNER 2
ACQUAINTANCE 3
SOMEONE PAID 4
SOMEONE ELSE 5

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

YES 1
NO 2 (GO TO 415)

414) 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 SOURCE
SHOP/MARKET 31
CHURCH 32
RELATIVES/FRIENDS 33
GAS STATION 34
OTHER (SPECIFY) ______________ 96

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

AGE ____
FIRST TIME WHEN MARRIED 96

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

NOT IN UNION (GO TO 502)
CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO 503)

502) CHECK 404:

HAS REGULAR SEX PARTNER (GO TO 503)
HAS OCCASIONAL SEX PARTNER (GO TO 503)
DOES NOT HAVE SEX PARTNER (GO TO 505A)

503) Is your spouse (or one of your spouses/partners) currently pregnant?

YES 1
NO 2 (GO TO 505A)
UNSURE 8 (GO TO 505A)

504) When she became pregnant did you want her to get pregnant then, did you want to wait until later, or did you not want her to get pregnant?

THEN 1 (GO TO 505B)
LATER 2 (GO TO 505B)
NOT AT ALL 3 (GO TO 505B)

505A) SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO (MORE) 2 (GO TO 509
SAYS WIFE CANNOT GET PREGNANT 3 (GO TO 507)
SAYS HE CANNOT HAVE ANY CHILDREN 4 (GO TO 507)
UNDECIDED/DON'T KNOW 8 (GO TO 507)

505B) SPOUSE/PARTNER PREGNANT: Now I have some questions about the future. After the child your wife/partner is expecting now, would you like to have another child, or would you prefer not have any more children?

HAVE (A/ANOTHER) CHILD 1
NO (MORE) 2 (GO TO 507)
SAYS WIFE CANNOT GET PREGNANT 3 (GO TO 507)
SAYS HE CANNOT HAVE ANY CHILDREN 4 (GO TO 507)
UNDECIDED/DON'T KNOW 8 (GO TO 507)

506) CHECK 503:

SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER: How long would you like to wait from now before the birth of (a/another) child?

SPOUSE/PARTNER PREGNANT: After the birth of the child your spouse/partner is expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) _______________ 996
DON'T KNOW 998

507) CHECK 308:
USES A METHOD?

NOT ASKED (GO TO 508)
NOT CURRENTLY USING (GO TO 508)
CURRENTLY USING (GO TO 512)

508) Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?

YES 1 (GO TO 510)
NO 2
DON'T KNOW 8

509) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

510) Which contraceptive method would you prefer to use?

PILL 01 (GO TO 512)
IUD 02 (GO TO 512)
INJECTABLES 03 (GO TO 512)
NORPLANT 04 (GO TO 512)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 512)
CONDOM 06 (GO TO 512)
FEMALE STERILIZATION 07 (GO TO 512)
MALE STERILIZATION 08 (GO TO 512)
PERIODIC ABSTINENCE 09 (GO TO 512)
WITHDRAWAL 10 (GO TO 512)
OTHER (SPECIFY) _______________ 96 (GO TO 512)
DON'T KNOW 98 (GO TO 512)

511) What is the main reason that you think you would never use a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
WIFE MENOPAUSAL/HAD HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
WANTS CHILDREN 26
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

512) CHECK 202 AND 204:

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 514)

513) 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

514) 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

515) 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

516) 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 magazine?
YES 1
NO 2
On a poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2

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

YES 1
NO 2 (GO TO 520)

519) With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTERS F
SON G
MOTHER-IN-LAW H
FATHER-IN-LAW I
FRIENDS/NEIGHBORS J
OTHER (SPECIFY) _________ X

520) CHECK 401:

CURRENTLY MARRIED (GO TO 521)
LIVING WITH A WOMAN (GO TO 521)
NO, NOT IN A UNION (GO TO 601)

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

APPROVES 1
DISAPPROVES 2
INDIFFERENT 3
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

523) Do you think your spouse/partner wants the same number of children that you want, or does she want more or fewer than you want?

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

SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

601A) Have you ever heard of any illnesses that you can get from having sex?

YES 1
NO 2 (GO TO 601F)

601B) 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

601C) CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE (GO TO 601D)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 601F)

601D) Over the last 12 months, have you had any of these illnesses?

YES 1
NO 2 (GO TO 601F)
DON'T KNOW 8 (GO TO 601F)

601E) 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

601F) Have you had any discharge from your penis in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

601G) During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

601H) CHECK 601E, 601F, 601G:

HAS HAD AT LEAST ONE INFECTION (GO TO 601I)
HAS NOT HAD ANY INFECTION (GO TO 601N)

601I) The last time you had (INFECTION FROM 601E/DISCHARGE/SORE), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 601JA)

601J) Where did you go? 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

601JA) CHECK 410 AND 410F:

HAS HAD SEXUAL RELATIONS (GO TO 601K)
HAS NOT HAD SEXUAL RELATIONS (GO TO 601N)

601K) When you had (INFECTION(S) FROM 601E/DISCHARGE/SORE), did you inform the person/people you were having sexual intercourse with?

YES 1
NO 2

601L) When you had (INFECTION(S) FROM 601E/DISCHARGE/SORE), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 601N)
PARTNER(S) ALREADY INFECTED 3 (GO TO 601N)

601M) What did you do?
RECORD ALL MENTIONED.

STOPPED SEX A
USED CONDOMS B
TOOK DRUGS C
OTHER (SPECIFY) _____________ X

601N) CHECK 601B:

DID NOT MENTION "AIDS" (GO TO 601O)
MENTIONED "AIDS" (GO TO 602)

601O) Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 611C)

602) 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

602B) 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

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

YES 1
NO 2 (GO TO 607)
DON'T KNOW 8 (GO TO 607)

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

ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE PARTNERS 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

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

YES 1
NO 2
DON'T KNOW 8

608) 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

608A) Can AIDS be cured?

YES 1
NO 2
DON'T' KNOW 8

608B) Can AIDS be transmitted from a mother to a child?

YES 1
NO 2
DON'T KNOW 8

608C) Do you know someone personally who has AIDS or someone who died of AIDS?

YES 1
NO 2

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

SMALL 1
MODERATE 2 (GO TO 609C)
GREAT 3 (GO TO 609C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 611A)

609B) 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 611A)
USES CONDOMS C (GO TO 611A)
ONLY HAS ONE SEXUAL PARTNER D (GO TO 611A)
HAS A LIMITED NUMBER OF SEXUAL PARTNERS E (GO TO 611A)
AVOIDS PROSTITUTES F (GO TO 611A)
PARTNER DOESN'T HAVE OTHER PARTNERS G (GO TO 611A)
DOESN'T HAVE HOMOSEXUAL RELATIONS H (GO TO 611A)
DOESN'T GET BLOOD TRANSFUSIONS I (GO TO 611A)
DOESN'T GET INJECTIONS J (GO TO 611A)
OTHER (SPECIFY) _____________ X (GO TO 611A)

609C) 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
GOES TO PROSTITUTES F
PARTNER HAS OTHER PARTNER(S) G
HAS HOMOSEXUAL RELATIONS H
BLOOD TRANSFUSIONS I
INJECTIONS J
OTHER (SPECIFY) ____________ X

611A) 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.

DID NOT START HAVING SEX A (GO TO 611C)
STOPPED HAVING SEX B (GO TO 611C)
STARTED USING CONDOMS C (GO TO 611C)
RESTRICTED SEX TO ONE PARTNER D (GO TO 611C)
REDUCED NUMBER OF SEXUAL PARTNERS E (GO TO 611C)
AVOIDED PROSTITUTES F (GO TO 611C)
ASKED PARTNER TO BE FAITHFUL G (GO TO 611C)
STOPPED HOMOSEXUAL RELATIONSHIPS H (GO TO 611C)
STOPPED INJECTIONS I
OTHER (SPECIFY) _____________ X
NO CHANGE Y

611B) Has your knowledge of AIDS influenced or changed your decisions about having sex or sexual behavior?
IF YES, In what way?
RECORD ALL MENTIONED.

DID NOT START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
AVOIDED PROSTITUTES F
STOPPED HOMOSEXUAL RELATIONS G
STOPPED INJECTIONS H
OTHER (SPECIFY) _______________ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DON'T KNOW Z

611C) 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 611I)

611D) CHECK 410 AND 410F:

HAS HAD SEX (GO TO 611E)
HAS NOT HAD SEX (GO TO 613)

611E) 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 611I)

611F) 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 611I)
DON'T KNOW 8 (GO TO 611I)

611G) 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

611H) In the last 4 weeks, how many PRUDENCE brand condoms have you used?
RECORD THE NUMBER

NUMBER OF PRUDENCE ____
DON'T KNOW 98

611I) Have you given or received money, gifts, or favors in exchange for sexual relations in the last 12 months?

YES 1
NO 2

613) RECORD TIME

HOURS ____
MINUTES ____

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: ___________