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DEMOGRAPHIC AND HEALTH SURVEY-BENIN 2001-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

DEPARTMENT

SUB-PREFECTURE/URBAN DISTRICT

RURAL/URBAN MUNICIPALITY

URBAN 1
RURAL 2

TOWN/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME___
RESULT ____

NEXT VISIT
DATE___
TIME___

FINAL VISIT
DAY____
MONTH___
YEAR 2001
NAME___
RESULT ____

RESULT CODES:

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

TOTAL NUMBER OF VISITS__

QUESTIONNAIRE USED:

FRENCH 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

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ____ and I work for the National Institute of Statistics and Economic Analysis. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you some questions about your health (and your children's health). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes. Whatever information you provide will be kept strictly confidential and will not be shown to other people.

We hope that you will participate in the survey as your opinion is important to us.

Do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer____
Date____

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

101) RECORD THE TIME

HOUR____
MINUTES ____

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)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS

YEARS______

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

104) Just before you moved here, did you live in 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 9998

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 1
HIGHER 3

109) What is the highest (grade/form/year) you completed at this level?
RECORD "00" FOR NO CLASS/YEAR FINISHED AND "98" FOR DON'T KNOW

GRADE/YEAR _____

109A) CHECK 106:

24 YEARS OR YOUNGER (GO TO 109B)
25 YEARS OR OLDER (GO TO 110)

109B) Are you currently attending school?

YES 1 (GO TO 110)
NO 2

109C) What is the main reason why 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

110) CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 114)

111) Now I would like you to read this sentence out loud to me; read as much as you can.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
CAN READ CERTAIN PARTS 2
CAN READ THE WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4

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

YES 1
NO 2

113) CHECK 111:

CODE '2', '3', OR '4' CIRCLED (GO TO 114)
CODE '1' OR '5' CIRCLED (GO TO 115)

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

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

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

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

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

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

117) What is your religion?

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

118) What is your nationality?

BENINESE 1
OTHER (SPECIFY)_____ 2 (GO TO 201)

118B) What is your ethnicity?

NAME OF 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

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:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

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 Q. 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME _____

213) Were any of these births twins?

SINGULAR 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?

MONTH_______
YEAR________

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217) IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS______

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

YES 1
NO 2

219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD
(RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

LINE NUMBER______ (GO TO NEXT BIRTH FOR FIRST BIRTH; GO TO 221 FOR ALL OTHERS)

220) 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 _____

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

YES 1
NO 2

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

YES 1
NO 2

223) 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)

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1996
IF NONE, RECORD '0'.

226) Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

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

MONTHS_____

228) At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

YES 1
NO 2 (GO TO 237)

230) When did the last such pregnancy end?

MONTH _____
YEAR _____

232) How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED MONTHS.

MONTHS______

233) Have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

233A) All together, how many pregnancies have you had that did not result in a live birth?

NUMBER OF PREGNANCIES_______

237) When did your last menstrual period start?
RECORD THE ANSWER BASED ON THE UNIT GIVEN

DATE, IF GIVEN _______
DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

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

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

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

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 AND ASK 302 FOR THIS METHOD. THEN READ THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND ASK 302 FOR THIS METHOD. IF THE METHOD IS NOT MENTIONED SPONTANEOUSLY OR RECOGNIZED AFTER DESCRIPTION, CIRCLE CODE 2 FOR THIS METHOD AND GO TO THE NEXT METHOD.

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

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) PILL: Women can take a pill every day.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES: Women can have an injection by a heath provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) DIAPHRAGM: Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10) FOAM OR JELLY: Women can place a suppository, a jelly or a cream in their vagina before intercourse.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12) RHYTHM/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
13) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
14) EMERGENCY CONTRACEPTION: As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2
15) 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_____
YES 1
NO 2

302) Have you ever used (METHOD)?

01) 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
02) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
03) PILL: Women can take a pill every day.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES: Women can have an injection by a heath provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) DIAPHRAGM: Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10) FOAM OR JELLY: Women can place a suppository, a jelly or a cream in their vagina before intercourse.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12) RHYTHM/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
13) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
14) EMERGENCY CONTRACEPTION: As an emergency measure after unprotected sexual intercourse women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303) CHECK 302:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 304)
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 329)

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

307) 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______

308) CHECK 302(01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 329)

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

YES 1
NO 2 (GO TO 329)

311) Which method are you using?
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATIONAL AMENORRHEA METHOD (LAM) K (GO TO 316A)
RHYTHM METHOD L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) _______ X (GO TO 316A)

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

BOX SEEN 1 (GO TO 312B)
BRAND ______ (GO TO 312B)
BOX NOT SEEN 2

312A) Do you know the brand name of the pills you are now using?
RECORD THE NAME OF BRAND

BRAND ______
DON'T KNOW 96

312B) How much does one packet (cycle) of pills cost you?

F. CFA________ (GO TO 316A)

FREE 9996 (GO TO 316A)
DON'T KNOW 9998 (GO TO 316A)

313) In what facility did the sterilization take place?
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.
IF CODES 'A' AND 'B' ARE CIRCLED IN 311, ASK 313-316 FOR FEMALE STERILIZATION ONLY.

NAME OF PLACE ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
COMMUNITY CENTER 15
OTHER PUBLIC (SPECIFY)______ 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/ CLINIC 21
RELIGIOUS HOSPITAL 22
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
OTHER PRIVATE MEDICAL (SPECIFY) _____ 27
OTHER (SPECIFY)______ 96
DON'T KNOW 98

314) CHECK 311:

CODE 'A' CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

CODE 'A' NOT CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

316) In what month and year was the sterilization performed?
316A) Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH_____
YEAR _____

317) CHECK 316/316A:

YEAR IS 1996 OR LATER (GO TO 319)
BEFORE JANUARY 1996 (GO TO 327)

319) CHECK 311/311A:
CIRCLE THE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE THE CODE FOR THE HIGHEST METHOD IN THE LIST.

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 320A)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

320) Where did you obtain (CURRENT METHOD) when you started using it?
320A) Where did you learn to use the lactational amenorrhea method (LAM)? 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
STRAT AV HEALTH WORKER 16
HEALTH WORKER/COMMUNITY LIAISON 17
VENDING MACHINE 18
OTHER PUBLIC (SPECIFY)_____ 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
HEALTH AGENT (NGO) 26
OTHER PRIVATE MEDICAL (SPECIFY) ______ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH/MOSQUE 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY)______ 96

321) CHECK 311/311A:
CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE THE CODE FOR THE HIGHEST METHOD IN THE LIST.

PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATIONAL AMENORRHEA METHOD (LAM) 11 (GO TO 325)

322) You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320). At that time, where you told about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 325)

324) Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

325) CHECK 322:
When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320), were you told about other methods of family planning that you could use?

YES 1
NO 2

326) Were you ever told by a health worker or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

327) CHECK 311/311A:
CIRCLE METHOD CODE:

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 330A)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

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 (GO TO 331)
GOVERNMENT HEALTH CENTER 12 (GO TO 331)
FAMILY PLANNING CLINIC 13 (GO TO 331)
FIELDWORKER 14 (GO TO 331)
COMMUNITY CENTER 15 (GO TO 331)
STRAT AV HEALTH WORKER 16 (GO TO 331)
HEALTH WORKER/COMMUNITY LIAISON 17 (GO TO 331)
VENDING MACHINE 18 (GO TO 331)
OTHER PUBLIC (SPECIFY)______ 19 (GO TO 331)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 331)
RELIGIOUS HOSPITAL 22 (GO TO 331)
PHARMACY 23 (GO TO 331)
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24 (GO TO 331)
DOCTOR'S OFFICE 25 (GO TO 331)
HEALTH AGENT (NGO) 26 (GO TO 331)
OTHER PRIVATE MEDICAL (SPECIFY)______ 27 (GO TO 331)
OTHER SOURCE
SHOP/MARKET 31 (GO TO 331)
CHURCH/MOSQUE 32 (GO TO 331)
RELATIVES/FRIENDS 33 (GO TO 331)
OTHER (SPECIFY)______ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330) Where is this?
330A) Where did you learn to use the lactational amenorrhea method (LAM)? Any other place?
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.
RECORD ALL MENTIONED.

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
FIELDWORKER D
COMMUNITY CENTER E
STRAT AV HEALTH WORKER F
HEALTH WORKER/COMMUNITY LIAISON G
VENDING MACHINE H
OTHER PUBLIC (SPECIFY) ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
RELIGIOUS HOSPITAL K
PHARMACY L
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) M
DOCTOR'S OFFICE N
HEALTH AGENT (NGO) O
OTHER PRIVATE MEDICAL (SPECIFY) ______ P
OTHER SOURCE
SHOP/MARKET Q
CHURCH/MOSQUE R
RELATIVES/FRIENDS S
OTHER (SPECIFY)_____ X

331) In the last 12 months, were you visited by a field worker who talked to you about family planning?

YES 1
NO 2

332) In the last 12 months, have you visited a health facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POST-NATAL CARE, AND BREASTFEEDING

401) CHECK 224:

ONE OR MORE BIRTHS SINCE JANUARY 1996 (GO TO 402)
NO BIRTHS SINCE JANUARY 1996 (GO TO 487)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN TWO BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately).

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 not want to have any (more) children at all?

THEN 1 (GO TO 407 FOR LAST BIRTH; GO TO 423 FOR ALL OTHER BIRTHS)
LATER 2
NOT AT ALL 3 (GO TO 407 FOR LAST BIRTH; GO TO 423 FOR ALL OTHER BIRTHS)

406) How much longer would you have liked to wait?

MONTHS 1 _____
YEARS 2 _____

DON'T KNOW 998

407) Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[FOR LAST BIRTH ONLY]

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE/BIRTH ATTENDANT C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
MATRON E
OTHER (SPECIFY)_____ X
NO ONE Y (GO TO 415)

407A) Where did you see this person?
[FOR LAST BIRTH ONLY]

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
HEALTH CENTER (CSSP-DISTRICT HEALTH CENTER) 22
COMMUNITY HEALTH COMPLEX (CCS-PARISH HEALTH CENTER) 23
VILLAGE UNIT (UVS-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

408) How many months pregnant were you when you first received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]

MONTHS_____
DON'T KNOW 98

409) How many times did you receive antenatal care during this pregnancy?
[FOR LAST BIRTH ONLY]

NUMBER OF TIMES______
DON'T KNOW 98

410) CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[FOR LAST BIRTH ONLY]

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

411) How many months pregnant were you the last time you received antenatal care?
[FOR LAST BIRTH ONLY]

MONTHS _____
DON'T KNOW 98

412) During this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2
Did they give you an x-ray?
YES 1
NO 2

413) Were you told about the signs of pregnancy complications?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8 (GO TO 415)

414) Were you told where to go if you had any of these complications?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)

416) During this pregnancy, how many times did you get this injection?
[FOR LAST BIRTH ONLY]

TIMES _____
DON'T KNOW 8

416A) How many weeks before the delivery did you receive the last injection?
[FOR LAST BIRTH ONLY]

LESS THAN 2 WEEKS 1
2 WEEKS 2
MORE THAN 2 WEEKS 3
DON'T KNOW 8

417) During this pregnancy, were you given or did you buy iron tablets or syrup with iron?
SHOW TABLETS/SYRUP.
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 419)
DON'T KNOW 8 (GO TO 419)

418) During the whole pregnancy, for how many days did you take the iron, as tablets or as syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[FOR LAST BIRTH ONLY]

NUMBER OF DAYS_____
DON'T KNOW 998

419) During this pregnancy, did you have difficulty with your vision during the daylight?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

420) During this pregnancy, did you suffer from night blindness?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

421) During this pregnancy, did you take any drugs in order to keep you from getting malaria?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 422A)
DON'T KNOW 8 (GO TO 422A)

422) What drugs did you take?
RECORD ALL MENTIONED. IF RESPONDENT DOES NOT KNOW NAME OF DRUG, SHOW EXAMPLES.
[FOR LAST BIRTH ONLY]

FANSIDAR/MALOXINE A
CHLOROQUINE/NIVAQUINE B
UNKNOWN DRUG C
OTHER (SPECIFY) _____ X

422A) What other ways can you protect yourself against malaria?
RECORD ALL MENTIONED.
[FOR LAST BIRTH ONLY]

MOSQUITO NET A
MESH WINDOW B
INFUSION/DECOCTION C
OTHER (SPECIFY) _____ X

423) 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

424) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)

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

GRAMS FROM CARD 1 ____
GRAMS FROM RECALL 2 ____

DON'T KNOW 9998

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

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE/BIRTH ATTENDANT C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
MATRON E
VILLAGE AGENT (AVS-VILLAGE HEALTH AGENT) F
RELATIVE/FRIEND G
OTHER (SPECIFY)_____ X
NO ONE Y

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

NAME OF PLACE _____
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
HEALTH CENTER (CSSP-DISTRICT HEALTH CENTER) 22
COMMUNITY HEALTH COMPLEX (CSS-PARISH HEALTH CENTER) 23
VILLAGE UNIT (UVS-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 (GO TO 429)

428) Was (NAME) delivered by caesarean section?

YES 1 (GO TO 433)
NO 2 (GO TO 433)

429) After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

YES 1
NO 2 (GO TO 433)

430) How many days or weeks after delivery did the first check take place?
RECORD '00' IF SAME DAY.
[LAST BIRTH ONLY]

DAYS AFTER DELIVERY 1 ____
WEEKS AFTER DELIVERY 2 ____

DON'T KNOW 998

431) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON
[LAST BIRTH ONLY]

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
MATRON 22
OTHER (SPECIFY)______ 96
NO ONE 95

432) Where did this first check take place?
[LAST BIRTH ONLY]

NAME OF PLACE_______
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
HEALTH CENTER (CSSP-DISTRICT HEALTH CENTER) 22
COMMUNITY HEALTH COMPLEX (CCS-PARISH HEALTH CENTER) 23
VILLAGE UNIT (UVS-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

433) In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP
[LAST BIRTH ONLY]

YES 1
NO 2

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

YES 1 (GO TO 436)
NO 2 (GO TO 437)

435) Did your period return between the birth of (NAME) and your next pregnancy?
[ASK FOR ALL BIRTHS EXCEPT LAST BIRTH]

YES 1
NO 2 (GO TO 439)

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

MONTHS _____
DON'T KNOW 98

437) CHECK 226:
IS RESPONDENT PREGNANT?
[LAST BIRTH ONLY]

NOT PREGNANT (GO TO 438)
PREGNANT (GO TO 439)

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

YES 1
NO 2 (GO TO 440)

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

MONTHS_____
DON'T KNOW 98

440) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

441) 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____

442) In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 444)

443) What was (NAME) given to drink before your milk began flowing regularly? Anything else?
RECORD ALL MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY)____X

444) CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 445)
DEAD (GO TO 446)

445) Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS _____
DON'T KNOW 98

447) CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR IF NO MORE BIRTHS GO TO 454)

448) 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______

449) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS______

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

YES 1
NO 2
DON'T KNOW 8

451) Was sugar added to any of the foods or liquids given to (NAME) yesterday?

YES 1
NO 2
DON'T KNOW 8

452) How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES _____
DON'T KNOW 8

453) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION AND HEALTH

454) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.)

455) LINE NUMBER FROM Q. 212

LINE NUMBER______

456) FROM Q. 212 AND Q. 216

NAME _______

LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484)

457) Did (NAME) get a dose of vitamin A like this one during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2
DON'T KNOW 8

458) Do you have a card where (NAME)'s vaccination are written down?
IF YES: May I please see it?

YES, SEEN 1 (GO TO 460)
YES, NOT SEEN 2 (GO TO 462)
NO CARD 3

459) Have you ever had a vaccination card for (NAME)?

YES 1 (GO TO 462)
NO 2 (GO TO 462)

460) (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 (polio given at birth)
DAY _____
MONTH _____
YEAR ______
POLIO 1
DAY _____
MONTH _____
YEAR ______
POLIO 2
DAY _____
MONTH _____
YEAR ______
POLIO 3
DAY _____
MONTH _____
YEAR ______
DPT 1
DAY _____
MONTH _____
YEAR ______
DPT 2
DAY _____
MONTH _____
YEAR ______
DPT 3
DAY _____
MONTH _____
YEAR ______
MEASLES
DAY _____
MONTH _____
YEAR ______
VITAMIN A (MOST RECENT)
DAY _____
MONTH _____
YEAR ______

461) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (GO TO 464)
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

462) Did (NAME) receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

YES 1
NO 2 (GO TO 465A)
DON'T KNOW 8 (GO TO 465A)

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

463A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

463B) Polio vaccine, that is, drops in the mouth?

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

463C) When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

463D) How many times was the polio vaccine received?

NUMBER OF TIMES _____

463E) A DPT vaccination, that is, an injection given in the thigh or buttocks, usually at the same time as polio drops?

YES 1
NO 2 (GO TO 463G)
DON'T KNOW 8 (GO TO463G)

463F) How many times?

NUMBER OF TIMES _____

463G) An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

464) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

YES 1
NO 2 (GO TO 465A)
NO VACCINATION IN THE LAST 2 YEARS 3 (GO TO 465A)
DON'T KNOW 8 (GO TO 465A)

465) At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL MENTIONED.

CAMPAIGN 1 (5, 6, 7/11/1999) A
CAMPAIGN 2 (3, 4, 5/12/1999) B
CAMPAIGN 3 (19, 20, 21/10/2000) C
CAMPAIGN 4 (23, 24, 25/11/2000) D

465A) CHECK RESPONSE TO QUESTION 29 OF HOUSEHOLD QUESTIONNAIRE

'YES' TO 29 (GO TO 465B)
OTHER (GO TO 466)

465B) Does (NAME) usually sleep under a mosquito net?

YES 1
NO 2

465C) Did (NAME) sleep under a mosquito net last night?

YES 1
NO 2
DON'T KNOW 8

465D) CHECK ANSWERS FOR 465B AND 465C

'YES' TO 465B OR 465C (GO TO 465E)
OTHER (GO TO 466)

465E) Now let's talk about the mosquito net that (NAME) sleeps under most often. How long ago was the mosquito net bought or obtained?
IF LESS THAN ONE MONTH, RECORD '00'. IF MORE THAN 95 MONTHS, RECORD '95'.

MONTHS ______
DON'T KNOW 98

465F) Was the mosquito net soaked or dipped in insecticide when it was purchased?

YES 1
NO 2
DON'T KNOW 8

465G) Since you obtained the mosquito net, have you soaked or dipped it in insecticide?

YES 1
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)

465H) How much time has passed since the last saturation of the mosquito net?

MONTHS _____
DON'T KNOW 98

465I) What is the name of the insecticide that you used to saturate the mosquito net?

ALAFIA 1
OTHER (SPECIFY)______ 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 467)
DON'T KNOW 8 (GO TO 467)

466A) Did (NAME) take any drugs to treat the fever?

YES 1
NO 2 (GO TO 467)
DON'T KNOW 8 (GO TO 467)

466B) What type of drug did (NAME) take?
RECORD ALL MENTIONED.
ASK TO SEE THE DRUG IF THE TYPE OF DRUG IS NOT KNOWN. IF THE TYPE OF DRUG CANNOT BE DETERMINED, SHOW THE RESPONDENT A TYPICAL ANTI-MALARIAL.

FANSIDAR/MALOXINE A
CHLOROQUINE/NIVAQUINE B
ASPIRIN/AAS C
AMODIAQUINE/FLAVOQUINE D
PARACETAMOL E
QUININE F
OTHER (SPECIFY)____ X
DON'T KNOW Z

466C) Did you seek advice or treatment for the fever?

YES 1
NO 2 (GO TO 467)

466D) Where did you seek advice or treatment? Anywhere else?
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.
RECORD ALL MENTIONED.

NAME OF PLACE______
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
HEALTH AGENT L
OTHER PRIVATE MEDICAL (SPECIFY)_____M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
TRADITIONAL PRACTITIONER P
RELATIVES/FRIENDS Q
OTHER (SPECIFY)___ X

466E) How many days did (NAME) have the fever before you sought advice or treatment?
IF MORE THAN 95 DAYS, RECORD '95'.

DAYS ______
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 475)
DON'T KNOW 8 (GO TO 475)

468) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 475)

471) Where did you seek advice or treatment? Anywhere else?
IF SOURCE IF HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL MENTIONED.

NAME OF PLACE______
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
HEALTH AGENT L
OTHER PRIVATE MEDICAL (SPECIFY)____M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
TRADITIONAL PRACTITIONER P
RELATIVES/FRIENDS Q
OTHER (SPECIFY)____ X

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

YES 1
NO 2 (GO TO 482A)
DON'T KNOW 8 (GO TO 482A)

476) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

477) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

477A) CHECK 445:
STILL BREASTFEEDING?

'YES' TO 445 (GO TO 477B)
OTHER (GO TO 478)

477B) When (NAME) had diarrhea, was he/she given less breastmilk than usual, about the same amount, or more than usual?
IF LESS, PROBE: Was he/she given much less breastmilk than usual or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

478) Was he/she given any of the following to drink?

a) A fluid made from a special packet called Orasel?
YES 1
NO 2
DON'T KNOW 8
b) A homemade fluid (Sugar-Salt-Water)?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 481)
DON'T KNOW 8 (GO TO 481)

480) What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.

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

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

YES 1
NO 2 (GO TO 482A)

482) Where did you seek advice or treatment? Anywhere else?
IF SOURCE IF HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.

NAME OF PLACE______
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
HEALTH AGENT L
OTHER PRIVATE MEDICAL (SPECIFY)____M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
TRADITIONAL PRACTITIONER P
RELATIVES/FRIENDS Q
OTHER (SPECIFY)____ X

REGISTRATION OF BIRTHS:

482A) Does (NAME) have a birth certificate? May I see it?
IF BIRTH CERTIFICATE IS PRESENT, CHECK THE BIRTH DATE. IF NO BIRTH CERTIFICATE IS PRESENT, TRY TO VERIFY THE DATE USING ANOTHER DOCUMENT (HEALTH CARD, ETC.). CORRECT DECLARED AGE, IF NECESSARY.

YES, SEEN 1 (GO TO 483)
YES, NOT SEEN 2
NO 3
DON'T KNOW 8

482B) IF BIRTH CERTIFICATE NOT SHOWN, ASK:
Was the birth of (NAME) declared to the civil state?

YES 1 (GO TO 483)
NO 2
DON'T KNOW 8 (GO TO 482D)

482C) Why wasn't (NAME)'s birth declared to the state?

COST TOO HIGH 1
DISTANCE TO REGISTRATION CENTER 2
DIDN'T KNOW BIRTH SHOULD BE REGISTERED 3
LATE AND DIDN'T WANT TO PAY FINE 4
DIDN'T KNOW WHERE TO GO TO REGISTER 5
OTHER (SPECIFY) ______ 6
DON'T KNOW 8

482D) Do you know how to declare your child's birth to the state?

YES 1
NO 2

483) GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484.

484) CHECK 456 ALL COLUMNS:
NUMBER OF CHILDREN BORN SINCE JANUARY 1996 AND STILL LIVING

ONE OR MORE (GO TO 485)
NONE (GO TO 487)

485) What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?

ALWAYS USE TOILET OR LATRINE 01
THROW INTO TOILET OR LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
RINSE AWAY WITH WATER 05
USE DISPOSABLE DIAPERS 06
USE WASHABLE DIAPERS 07
NOT DISPOSED OF 08
OTHER (SPECIFY) ____ 96

486) CHECK 478A ALL COLUMNS:

NO CHILD RECEIVED ORS PACKET OR 478A NOT ASKED (GO TO 487)
ONE CHILD RECEIVED ORS PACKET (GO TO 488)

487) Have you ever heard of a special product called ORASEL you can get for the treatment of diarrhea?

YES 1
NO 2

488) CHECK 218:

ONE OR MORE CHILDREN LIVING WITH HER (GO TO 489)
NO CHILDREN LIVING WITH HER (GO TO 490)

489) When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should to be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

490) Now I would like to ask you questions about health care for yourself. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem, or no problem?

Knowing where to go?
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Getting permission to go?
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Getting money needed for treatment?
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Not having an establishment nearby?
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Having to take transport?
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Not wanting to go alone?
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Concern that there may not be a female health provider?
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3

490A) When a child has a cough, what are the symptoms that indicate that he/she should be taken to a health care facility or to a health care professional?

FAST BREATHING A
DIFFICULTY BREATHING B
LOUD BREATHING C
FEVER D
NOT ABLE TO DRINK E
NOT EATING/NOT DRINKING F
GETS SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY)_____X
DON'T KNOW Z

490B) When a child has a cough, where would you go to seek advice or treatment? Any other place?
RECORD ALL MENTIONED.

NAME OF PLACE _____
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
HEALTH AGENT L
OTHER PRIVATE MEDICAL (SPECIFY) _____ M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
TRADITIONAL PRACTITIONER P
RELATIVES/FRIENDS Q
OTHER (SPECIFY) _____ X

491) CHECK 215 AND 218:

AT LEAST ONE CHILD BORN SINCE JANUARY 1998 AND LIVING WITH HER (RECORD THE NAME OF THE YOUNGEST CHILD LIVING WITH HER) (GO TO 492)
NAME_________
DOES NOT HAVE ANY CHILDREN BORN SINCE JANUARY 1998 AND LIVING WITH HER (GO TO 494)

492) Now I would like to ask you about the liquids (NAME FROM Q.491) drank over the last 7 days, including yesterday. How many days in the last 7 did (NAME FROM Q.491) drink each of the following?

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFORE PROCEEDING, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q.491) drink (item)?

IF 7 TIMES OR MORE, RECORD '7'. IF DON'T KNOW, RECORD '8'.

a) Water?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
b) Commercially produced infant formula?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
c) Milk such as tinned, powdered, or fresh animal milk?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
d) Fruit juice?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
e) Other liquids such as sugar water, gruel, tea, coffee, carbonated beverages, or broths?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES

493) Now I would like to ask you about the foods (NAME FROM Q.491) ate over the last 7 days, including yesterday. How many days during the last 7 did (NAME FROM Q.491) eat each of the following foods either separately or combined with other foods?

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFORE PROCEEDING, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q.491) eat (item)?

IF 7 TIME OR MORE, RECORD '7'. IF DON'T KNOW, RECORD '8'.

a) Any food made from grains (eg. Millet, sorghum, maize, rice, wheat, porridge, or other local grains)?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
b) Pumpkin, red or yellow yam or squash, carrots, or red sweet potatoes?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
c) Any other food made from roots or tubers (eg. White potatoes, white yams, manioc, cassava, or other local roots/tubers)?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
d) Any other green-leaf vegetables?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
e) Mango, papaya (or other local Vitamin A rich fruits)?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
f) All other fruit or vegetable (for example: banana, apple, applesauce, green beans, avocado, tomato)?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
g) Meat, poultry, fish, shellfish, or eggs?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
h) Other legume based foods (lentils, beans, soy, pod legumes, peanuts)?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
i) Cheese or yogurt?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES
j) All foods prepared with oil, fat, or butter?
(LAST SEVEN DAYS) NUMBER OF DAYS _____
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES

494) Did you sleep under a mosquito net last night?

YES 1
NO 2

495) The last time you prepared a meal for your family, before starting did you wash your hands?

YES 1
NO 2
NEVER PREPARED MEAL 8

496) Do you currently chew or smoke or consume cigarettes or tobacco?
IF YES: What do you chew, smoke, or consume?
RECORD ALL MENTIONED.

YES, CIGARETTES A
YES, PIPE B (GO TO 499)
YES, OTHER TOBACCO C (GO TO 499)
NO Y (GO TO 499)

498) In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES _____

499) Now I would like to ask you about alcoholic beverages. Have you ever drank alcoholic beverages?

YES 1
NO 2 (GO TO 499E)

499B) In the last 3 months, how many days did you drink alcoholic beverages?

NUMBER OF DAYS _____
NONE/NEVER 95

499C) Have you ever been drunk after drinking alcoholic beverages?

YES 1
NO 2 (GO TO 499E)

499D) In the last 3 months, how many days were you drunk?

NUMBER OF DAYS _____
NONE/NEVER 95

499E) Now, I would like to talk to you about injections. Over the last 3 months, have you received an injection for any reason?

YES 1
NO 2 (GO TO 501)

499F) In the last 3 months, how many injections did you receive?

NUMBER OF INJECTIONS _____
EVERY DAY 95

499G) The last time you received an injection, who was the person who administered it?

HEALTH PROFESSIONAL 1
PHARMACIST 2
TRADITIONAL PRACTITIONER 3
FRIEND/RELATIVE 4
RESPONDENT HERSELF 5
OTHER (SPECIFY)____6

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

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

YES, WAS MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 514)

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

WIDOW 1 (GO TO 510)
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

506) RECORD HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ____
LINE NUMBER _____

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

YES 1
NO 2 (GO TO 510)

508) How many other wives does he have?

NUMBER _____
DON'T KNOW 98 (GO TO 510)

509) Are you the first, second…wife?

RANK _____

510) Have you been married or have you lived with a man only once or more than once?

ONCE 1
MORE THAN ONCE 2

511) CHECK 510:

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

MARRIED/LIVED WITH MAN MORE THAN ONCE: I would like to talk about the first time you were married or started living with a man. In what month and year were you married or did you start living with him?

MONTH _____
DON'T KNOW MONTH 98
YEAR____ (GO TO 514)
DON'T KNOW YEAR 9998

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

AGE _____

514) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?

NEVER 00 (GO TO 524)
AGE IN YEARS____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

515) When was the last time you had sexual intercourse?
RECORD "YEARS AGO" ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.

DAYS AGO 1______
WEEKS AGO 2_____
MONTHS AGO 3_____
YEARS AGO 4______ (GO TO 524)

516) The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 517)

516A) What is the main reason you used a condom this time?

RESPONDENT WANTED TO AVOID STDs/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STDs/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY)_____ 6
DON'T KNOW 8

517) What is your relationship to the man with whom you last had sex?
IF "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1'. IF NO CIRCLE '2'

SPOUSE/COHABITING PARTNER 1 (GO TO 519)
BOYFRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
COMMERCIAL SEX WORKER 6
OTHER (SPECIFY) _____ 7

518) For how long have you had sexual relations with this man? Or for how long did you have sexual relations with this man?

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

519) Have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

520) The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 521)

520A) What is the main reason you used a condom that time?

RESPONDENT WANTED TO AVOID STDs/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STDs/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY)_____ 6
DON'T KNOW 8

521) What is your relationship to this man?
IF "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1'. IF NO CIRCLE '2'

SPOUSE/COHABITING PARTNER 1 (GO TO 522A)
BOYFRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
COMMERCIAL SEX WORKER 6
OTHER (SPECIFY) _____ 7

522) For how long have you had sexual relations with this man? Or how long did you have sexual relations with this man?

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

522A) Apart from these two men, have you had sexual intercourse with any other person in the last 12 months?

YES 1
NO 2 (GO TO 524)

522B) The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 522D)

522C) What is the main reason you used a condom that time?

RESPONDENT WANTED TO AVOID STDs/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STDs/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY)_____ 6
DON'T KNOW 8

522D) What is your relationship to the man?
IF "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1'. IF NO CIRCLE '2'

SPOUSE/COHABITING PARTNER 1 (GO TO 523)
BOYFRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
COMMERCIAL SEX WORKER 6
OTHER (SPECIFY) _____ 7

522E) For how long have you had sexual relations with this man? Or for how long did you have sexual relations with this man?

DAYS 1____
WEEKS 2_____
MONTHS 3_____
YEARS 4______

523) In total, with how many different men have you had sex in the last 12 months?

NUMBER OF PARTNERS_____

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

YES 1
NO 2 (GO TO 601)

525) Where is that? Any other place?
IF SOURCE IF HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL MENTIONED.

NAME OF PLACE______
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
HEALTH AGENT L
OTHER PRIVATE MEDICAL (SPECIFY)____M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
RELATIVES/FRIENDS P
GAS STATION Q
OTHER (SPECIFY)____ X

526) If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

526A) What are the condom brands you know?

PRUDENCE A
SULTAN B
NO BRAND C
OTHER (SPECIFY) ______ X

526B) CHECK IF YES TO 516 OR 520 OR 522B AND ASK:
What are the brands of condom you have already used?

PRUDENCE A
SULTAN B
OTHER (SPECIFY) _____ X
DON'T KNOW Z

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311/311A:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602) CHECK 226:

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 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 609)
NOT PREGNANT/NOT SURE AND UNDECIDED/ DON'T KNOW 4 (GO TO 608)
PREGNANT AND UNSURE/DON'T KNOW 5 (GO TO 610)

603) CHECK 226:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?

PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

RECORD IN MONTHS IF LESS THAN 24 MONTHS OR LESS THAN TWO YEARS AND IN COMPLETED YEARS IF 24 MONTHS OR MORE OR 2 YEARS OR MORE.

MONTHS 1_____
YEARS 2____

SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 609)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) _____ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605) CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606) CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
LESS THAN 24 MONTHS (GO TO 610)

607) CHECK 602:

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

RECORD ALL MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER (SPECIFY) _____ X
DON'T KNOW Z

608) In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem at all for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT 4

609) CHECK 311/311A:
USING A CONTRACEPTIVE METHOD?

NO CODE CIRCLED (GO TO 610)
AT LEAST ONE CIRCLED (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611) Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMENORRHEA METHOD (LAM) 11 (GO TO 614)
RHYTHM METHOD 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY) _____ 96 (GO TO 614)
DON'T KNOW/UNSURE 98 (GO TO 614)

612) What is the main reason that you think you will not use a contraceptive method at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) _____ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

613) Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DON'T KNOW 8

614) 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.

NONE 00 (GO TO 616)
NUMBER _____
OTHER (SPECIFY) _____ 96 (GO TO 616)

615) 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

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

APPROVE 1
DISAPPROVE 2
NO OPINION/UNSURE 3

617) 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
In a leaflet/brochure?
YES 1
NO 2
In a cultural/educational animated performance?
YES 1
NO 2
At school?
YES 1
NO 2

618) In your opinion, is it acceptable or not acceptable to talk about family planning:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In a newspaper or magazine?
ACCEPTABLE 1
NOT ACCEPTABLE 2
On a poster?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In a leaflet/brochure?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In a cultural/educational animated performance?
ACCEPTABLE 1
NOT ACCEPTABLE 2
At school?
ACCEPTABLE 1
NOT ACCEPTABLE 2

619) 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 621)

620) 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
FRIEND(S)/NEIGHBOR(S) J
OTHER (SPECIFY) _____ X

621) CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 628)

622) CHECK 311/311A:

AT LEAST ONE CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623) You say that you are currently using contraception. Would you say that using contraception is mainly your decision, your husband's/partner's decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _____ 6

624) 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
DON'T KNOW 8

625) How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

626) CHECK 311/311A:

NEITHER STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627) 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

628) Husbands and wives do not always agree on everything. Please tell me if you think a woman is justified in refusing to have sex with her husband when:

She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8
She recently gave birth?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with women other than his wives?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON'T KNOW 8

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

701) CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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

AGE IN COMPLETED YEARS _____

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

YES 1
NO 2 (GO TO 706)

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

GRADE ______
DON'T KNOW 98

706) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN: What is your husband's/partner's occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?

OCCUPATION____

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

YES 1 (GO TO 710)
NO 2

708) 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 710)
NO 2

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

YES 1
NO 2 (GO TO 719)

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

OCCUPATION_________

711) CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712) 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

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

715) Are you paid or do you earn in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 718)
NOT PAID 4 (GO TO 718)

716) Who mainly decides how the money you earn will be used?

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

717) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS SAVED 6

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

HOME 1
AWAY 2

719) Who in your household usually has the final say on the following decisions?

Your own health care?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making large household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making household purchases for daily needs?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Visits to family, friends, or relatives?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
What food should be cooked every day?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

720) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN UNDER 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8

721) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 818)

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

YES 1
NO 2 (GO TO 809)
DON'T KNOW 8 (GO TO 809)

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

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITION PRACTITIONER N
OTHER (SPECIFY)____W
OTHER (SPECIFY)_____ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

805) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

807) Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

811) Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

YES 1
NO 2

812) Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO 814)
DON'T KNOW 8 (GO TO 814)

813A) When can the virus that causes AIDS be transmitted from a mother to a child? Can it be transmitted:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

814) CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 815)
NO, NOT IN UNION/NOT LIVING WITH A MAN (GO TO 815A)

815) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

YES 1
NO 2

815A) Do you think it's acceptable or unacceptable to talk about AIDS:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In a newspaper or magazine?
ACCEPTABLE 1
NOT ACCEPTABLE 2
On a poster?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In a leaflet/brochure?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In a cultural/educational animated performance?
ACCEPTABLE 1
NOT ACCEPTABLE 2
At school?
ACCEPTABLE 1
NOT ACCEPTABLE 2

816) If a person learns that he/she is infected with the virus that causes AIDS, should this person be allowed to keep that a secret or should he/she communicate this information to the community?

CAN BE KEPT SECRET 1
COMMUNICATE TO COMMUNITY 2
DON'T KNOW/UNSURE 8

817) If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

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

817A) Should people with the AIDS virus who work with other people in shops, offices, or on farms be allowed to keep their jobs or not?

CONTINUE WORKING 1
NOT CONTINUING WORKING 2
DON'T KNOW/UNSURE/DEPENDS 8

817B) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

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

817C) Have you ever been tested to see if you have the AIDS virus?

YES 1 (GO TO 817FX)
NO 2

817D) Would you like to have a test for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 8

817E) Do you know a place where you can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 818)

817F) Where can you go for this test?
RECORD ALL MENTIONED.

817FX) Where did you go for this test?

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 A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MATERNITY D
MOBILE CLINIC E
FIELDWORKER F
OTHER (SPECIFY)_____ G
PRIVATE MEDICAL SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH WORKER N
ADBC/MATRON/MIDWIFE/NURSE'S AIDE O
PARA-PUBLIC SECTOR
INFORMATION AND ADVICE CENTER P
PNLS (NATIONAL PROGRAM AGAINST AIDS) Q
OTHER (SPECIFY)_____ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL PRACTITIONER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) _____ X

818) (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 901)

819) If a man has a sexually transmitted disease, what symptoms might he have? Any other signs or symptoms?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON'T KNOW Z

820) If a woman has a sexually transmitted disease, what symptoms might she have? Any other signs or symptoms?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON'T KNOW Z

820A) CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 820B)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

820B) During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

820C) Now I would like to ask you some questions about your health in the last 12 months. Sometimes women experience vaginal discharge. During the last 12 months, have you had any vaginal discharge?

YES 1
NO 2
DON'T KNOW 8

820D) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

820E) CHECK 820B, 820C, 820D:

HAS HAD AN INFECTION (GO TO 820F)
HAS NOT HAD AN INFECTION (GO TO 901)

820F) The last time you had (INFECTION FROM 820B, 820C, 820D), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 820H)

820G) The last time you had (INFECTION FROM 820B, 820C, 820D), did you do any of the following? Did you…

Seek advice from a health worker in a clinic or hospital?
YES 1
NO 2
Seek advice or treatment from a traditional practitioner?
YES 1
NO 2
Seek advice or purchase drugs from a shop or a pharmacy?
YES 1
NO 2
Seek advice from friends or relatives?
YES 1
NO 2

820H) When you had (INFECTION FROM 820B, 820C, 820D), did you inform the people were you having sexual intercourse with?

YES 1
NO 2
SOME PEOPLE/NOT ALL 3

820I) When you had (INFECTION FROM 820B, 820C, 820D), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 901)
PARTNER(S) ALREADY INFECTED 3 (GO TO 901)

820J) What did you do to prevent infection in your partner(s)? Did you…

Stop sexual intercourse?
YES 1
NO 2
Use a condom during sexual intercourse?
YES 1
NO 2
Take drugs?
YES 1
NO 2

SECTION 9. FEMALE GENITAL CUTTING

901) Have you ever heard of female circumcision?

YES 1 (GO TO 903)
NO 2

902) In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard of this practice?

YES 1
NO 2 (END)

903) Have you yourself ever had your outer genitals cut?

YES 1
NO 2 (GO TO 909)

904) Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

YES 1 (GO TO 906)
NO 2
DON'T KNOW 8

905) Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

906) Was your genital area closed?

YES 1
NO 2
DON'T KNOW 8

907) How old were you when this occurred?
IF RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS_____

DURING INFANCY 95
DON'T KNOW 98

908) Who cut (or nicked) your genitals?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
MATRON 13
OTHER TRADITIONAL (SPECIFY) _____ 16
HEALTH PROFESSIONAL
DOCTOR 21
TRAINED NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _____ 26
DON'T KNOW 98

909) CHECK 214 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER (GO TO 910)
HAS NO LIVING DAUGHTER (GO TO 919)

910) Have any of your daughters had their genitals cut?
IF YES: How many?

NUMBER CIRCUMCISED________
NO DAUGHTER CIRCUMCISED 95 (GO TO 918)

911) To which of your daughters did this happen most recently?
INTERVIEWER: CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER

DAUGHTER'S NAME _____
DAUGHTER'S LINE NUMBER FROM Q.212________

912) Now I would like to ask you what was done to (NAME OF DAUGHTER FROM Q.911) at that time. Was any flesh removed from her genital area?

YES 1 (GO TO 914)
NO 2
DON'T KNOW 8

913) Was her genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

914) Was her genital area closed?

YES 1
NO 2
DON'T KNOW 8

915) How old was (NAME OF DAUGHTER FROM Q. 911) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS_____

DURING INFANCY 95
DON'T KNOW 98

916) Who cut (or nicked) the genitals?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
MATRON 13
OTHER TRADITIONAL (SPECIFY) _____ 16
HEALTH PROFESSIONAL
DOCTOR 21
TRAINED NURSE/MID-WIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _____ 26
DON'T KNOW 98

917) At the time that the genitals were cut or afterwards, did (NAME OF DAUGHTER FROM Q. 912) have any of the following problems:

Excessive bleeding?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Difficulty in passing urine or urine retention?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Swelling in the genital area?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Infection in the genital area/Wound that did not heal properly?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)

918) Do you intend to have this genital cutting done to any of your daughters in the future?

YES 1
NO 2
DON'T KNOW 8

919) What benefits do girls themselves get if they undergo this genital cutting?
PROBE: Any other benefits?
RECORD ALL MENTIONED

CLEANLINESS/HYGIENE A
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
PRESERVE VIRGINITY/ PREVENT PREMARITAL SEX D
MORE PLEASURE FOR THE MAN E
RELIGIOUS NECESSITY F
OTHER (SPECIFY) ____ X
NO BENEFITS Y
DON'T KNOW Z

920) What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED

FEWER MEDICAL PROBLEMS A
AVOID PAIN B
MORE SEXUAL PLEASURE FOR HER C
MORE SEXUAL PLEASURE FOR THE MAN D
FOLLOWS RELIGION E
OTHER (SPECIFY) _____ X
NO ADVANTAGES Y
DON'T KNOW Z

921) Would you say that this practice is a way to prevent a girl from having sex before marriage or does it have no effect on premarital sex?

PREVENT SEX 1
NO EFFECT 2
DON'T KNOW 8

922) Do you believe that this practice is required by your religion?

YES 1
NO 2
DON'T KNOW 8

923) Do you think that this practice should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

924) Do you think that men want this practice to be continued, or discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

925) RECORD THE TIME AT THE END OF THE INTERVIEW AND THANK THE RESPONDENT FOR HER ANSWERS.

HOUR___
MINUTES___

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:________________

COMMENTS ON SPECIFIC QUESTIONS:___________________

ANY OTHER COMMENTS:________________

SUPERVISOR'S OBSERVATIONS______________________

NAME OF SUPERVISOR:__________________________

DATE:______________________

EDITOR'S OBSERVATIONS:______________________

NAME OF FIELD EDITOR:___________________

DATE:______________