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DEMOGRAPHIC AND HEALTH SURVEY-BENIN 2006-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

DEPARTMENT

MUNICIPALITY

DISTRICT

TOWN/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER

URBAN/RURAL

URBAN 1
RURAL 2

NAME OF HEAD OF HOUSEHOLD

NAME AND LINE NUMBER OF WOMAN

CHECK HOUSEHOLD QUESTIONNAIRE:
ADDITIONAL QUESTIONS ON SEXUAL ACTIVITY (Q. 542, Q. 543) MUST BE ASKED TO THE MEN (1) OR TO THE WOMEN (2).

WOMEN 2

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER NAME____
RESULT _____

RESULT _____

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7

NEXT VISIT:
DATE____
TIME____

FINAL VISIT
DAY____
MONTH____
YEAR: 2006
INTERVIEWER NUMBER____
RESULT__

TOTAL NUMBER OF VISITS_____

LANGUAGE OF QUESTIONNAIRE:

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

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___

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ____ and I work for the INSAE. We are conducting a national survey on women's and children's health. 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 shared with anyone other than members of our survey team.

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)

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOUR ________
MINUTES ________

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

NAME OF PLACE (DISTRICT/MUNICIPALITY) ________
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 (DISTRICT/MUNICIPALITY) ________
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 first cycle, secondary 2nd cycle, higher, or other?

PRIMARY 1
SECONDARY 1 2
SECONDARY 2 3
HIGHER 4
OTHER 6

109) What is the highest (grade/form/year) you completed at this level?
CODE '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:
RESPONDENT'S LEVEL OF EDUCATION

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 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 IN LANGUAGE 4
BLIND 5

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 (GO TO 113)

112A) In what language was the literacy program in which you participated?
PROBE: Any other?
RECORD ALL MENTIONED

ADJA A
BARIBA B
FON C
DENDI D
DITAMARI E
YORUBA F
OTHER (SPECIFY) ________ X

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) In the last 12 months, how many times have you traveled outside of your community and slept somewhere other than your home?

NUMBER OF TRIPS ________
NONE 00 (GO TO 119)

118) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

119) What is your religion?

VODOUN 11
OTHER TRADITIONAL 12
ISLAM 21
CATHOLIC 31
PROTESTANT METHODIST 41
OTHER PROTESTANT 42
CELESTIAL 51
OTHER CHRISTIAN 52
OTHER RELIGIONS 61
NONE 71

120) What is your nationality?

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

121) What is your ethnicity?

ADJA AND SIMILAR 11
BARIBA AND SIMILAR 21
DENDI AND SIMILAR 31
FON AND SIMILAR 41
YOA AND LOKPA AND SIMILAR 51
BETAMARIBE AND SIMILAR 61
PEULH AND SIMILAR 71
YORUBA AND SIMILAR 81
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 did not survive?

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?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

215) In what month and year was (NAME) born?
PROBE: What was 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 2 YEARS, OR YEARS.

DAYS ________ 1
MONTHS ________ 2
YEARS ________ 3

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

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 THE 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 2001 OR LATER.
IF NONE, ENTER '0'.

225) FOR EACH BIRTH SINCE JANUARY 2001, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.
NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. WRITE THE NAME OF THE CHILD TO THE LEFT OF CODE 'B'.

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.
ENTER 'P' IN THE CALENDAR, BEGINNING WITH THE MONTH OF THE INTERVIEW AND FOR THE TOTAL 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 ________

231) CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 2001 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 2001 (GO TO 237)

232) How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING 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) Altogether, how many pregnancies have you had that did not result in a live birth?

NUMBER OF PREGNANCIES ________

234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2001.
RECORD 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any miscarriages, abortions, or stillbirths that ended before January 2001?

YES 1
NO 2 (GO TO 237)

236) When did the last such pregnancy that terminated before 2001 end?

MONTH ________
YEAR ________

237) When did your last menstrual period start?

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 240)
DON'T KNOW 8 (GO TO 240)

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

240) Are there any children who depend primarily on you?

YES 1
NO 2 (GO TO 301)

241) Among these children who depend primarily on you, are there any that are younger than 18 years old?

YES 1
NO 2 (GO TO 301)

242) Now I would like to talk about the children younger than 18 who depend primarily on you. Have you made any arrangements for someone to take care of these children if you were to get sick or if you were no longer able to take care of them?

YES 1
NO 2
UNSURE 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. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301) Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY: 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 to avoid becoming pregnant.
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 sexual intercourse.
YES 1
NO 2
10) FOAM OR JELLY: Women can place jelly or cream in their vagina before sexual 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
11A) CYCLE BEADS: A method which involves moving beads to count from the first day of your period (red bead).
YES 1
NO 2
12) 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
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 this method?

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children. Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03) PILL: Women can take a pill every day to avoid becoming pregnant.
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 sexual intercourse.
YES 1
NO 2
10) FOAM OR JELLY: Women can place jelly or cream in their vagina before sexual 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
11A) CYCLE BEADS: A method which involves moving beads each day to count from the first day of the menstrual period (red bead).
YES 1
NO 2
12) 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
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 children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN _________

308) CHECK 302:

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)
CYCLE BEADS N (GO TO 316A)
OTHER (SPECIFY) ________ X (GO TO 316A)

312) Why do you use the pill over another method?

FREE 01
COST/LESS EXPENSIVE 02
MORE AVAILABLE 03
WAS PRESCRIBED 04
MORE EFFECTIVE 05
NO SIDE EFFECTS 06
SUITS RESPONDENT 07
ONLY KNOWN METHOD 08
REVERSIBLE METHOD 09
RECOMMENDED TO RESPONDENT 10
OTHER (SPECIFY) ________ 96

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

HARMONIE 01 (GO TO 312C)
DUOFEM 02 (GO TO 312C)
MICROGYNON 03 (GO TO 312C)
EUGYNON 04 (GO TO 312C)
LO-FEMENAL 05 (GO TO 312C)
CONFIANCE 06 (GO TO 312C)
MINIDRIL 07 (GO TO 312C)
STEDIRIL 08 (GO TO 312C)
OTHER (SPECIFY) ________96 (GO TO 312C)
PACKAGE NOT SEEN 98

312B) Do you know the brand name of the pills you are using now?

HARMONIE 01
DUOFEM 02
MICROGYNON 03
EUGYNON 04
LO-FEMENAL 05
CONFIANCE 06
MINIDRIL 07
STEDIRIL 08
OTHER (SPECIFY) ________96
DON'T KNOW 98

312C) How much does one packet (cycle) of pills cost you?
ASK THE RESPONDENT IF THE COST PER PACKET REFERS TO ONE CYCLE OR THREE CYCLES AND RECORD THE CORRESPONDING PRICE.

PRICE OF 1 CYCLE______ 1 (GO TO 316A)
PRICE OF 3 CYCLES______ 2 (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 ON FEMALE STERILIZATION ONLY.

NAME OF PLACE ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
COMMUNITY CENTER 14
OTHER PUBLIC (SPECIFY) ________ 16
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 (FIRST METHOD FROM Q. 311) without stopping?
PROBE: For how long have you been using (FIRST METHOD FROM Q. 311) now without stopping?

MONTH ________
YEAR ________

316B) CHECK 316/316A, 215, AND 230:
THERE WAS A BIRTH IN 215 OR A PREGNANCY IN 230 THAT ENDED IN A MISCARRIAGE , ABORTION, OR STILLBIRTH AFTER THE MONTH AND YEAR OF THE START OF THE USE OF CONTRACEPTION BASED ON 316/316A.

YES (GO BACK TO 316/316A TO CORRECT, AND PROBE TO RECORD THE MONTH AND THE YEAR OF THE START OF THE CONTINUED USE OF THE CURRENT METHOD. DATE MUST BE AFTER THAT OF THE LAST BIRTH OR THE LAST PREGNANCY).

NO (GO TO 317)

317) CHECK 316/316A:

YEAR IS 2001 OR LATER (GO TO 319)
YEAR IS 2000 OR EARLIER (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 CIRCLED IN 311/311A.

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 (LAM) 11 (GO TO 320A)
RHYTHM METHOD 12 (GO TO 329)
WITHDRAWAL 13 (GO TO 329)
CYCLE BEADS 14
OTHER (SPECIFY) ________ 96 (GO TO 329)

320) Where did you obtain (CURRENT METHOD) when you first 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
BAR/SALOON 34
OTHER (SPECIFY) ________ 96
DON'T KNOW 98 (GO TO 328)

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

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

PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATIONAL AMENORRHEA METHOD (LAM) 11 (GO TO 325)
CYCLE BEADS 12 (GO TO 325)

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

YES 1 (GO TO 324)
NO 2

323) Were you ever told by a health worker or family planning worker 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:

CODE '1' CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED: You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320). At that time, were you told about other methods of family planning that you could use?

YES 1 (GO TO 327)
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 (LAM) 11 (GO TO 330A)
RHYTHM METHOD 12 (GO TO 329)
WITHDRAWAL 13 (GO TO 329)
CYCLE BEADS 14
OTHER METHOD 96 (GO TO 329)

328) Where did you obtain (CURRENT METHOD) 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 (NON-GOVERNMENTAL ORGANIZATION) 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)
BAR/SALOON 34 (GO TO 331)
OTHER (SPECIFY) ________ 96

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 that?
330A) 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.
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 (NON-GOVERNMENTAL ORGANIZATION) O
OTHER PRIVATE MEDICAL (SPECIFY) ________ P
OTHER SOURCE
SHOP/MARKET Q
CHURCH/MOSQUE R
RELATIVES/FRIENDS S
BAR/SALOON T
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 you 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, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

ONE OR MORE BIRTHS IN 2001 OR LATER (GO TO 402)
NO BIRTHS IN 2001 OR LATER (GO TO 487)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

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 C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 415)

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/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 they palpate your abdomen?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2
Did they give you an ultrasound?
YES 1
NO 2
Did they give you nutritional counseling?
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 416A)
DON'T KNOW 8 (GO TO 416A)

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

TIMES ________ (GO TO 417)
DON'T KNOW 8 (GO TO 417)

416A) At any time before this pregnancy, did you receive a tetanus injection?
[FOR LAST BIRTH ONLY]

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

416B) How many times did you get the tetanus injection before this pregnancy?
PROBE TO OBTAIN A RESPONSE.
[FOR LAST BIRTH ONLY]

NUMBER OF INJECTIONS ________
DON'T KNOW 98 (GO TO 417)

416C) When was the last injection?
IF LESS THAN ONE YEAR, RECORD '00'.
[FOR LAST BIRTH ONLY]

NUMBER OF YEARS ________
DON'T KNOW 98

417) During this pregnancy, were you given or did you buy iron tablets or vials with iron?
SHOW TABLETS/VIALS
[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, either as tablets or from vials?
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 [USE LOCAL TERM]?
[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 422I)
DON'T KNOW 8 (GO TO 422I)

422) What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.
[FOR LAST BIRTH ONLY]

FANSIDAR/SP A
CHLOROQUINE/NIVAQUINE B
QUININE C
UNKNOWN DRUG Z
OTHER (SPECIFY) ________ X

422A) CHECK 422:
TYPE OF DRUG TAKEN DURING PREGNANCY TO PREVENT MALARIA.
[FOR LAST BIRTH ONLY]

CODE 'A' CIRCLED (GO TO 422B)
CODE 'A' NOT CIRCLED (GO TO 422F)

422B) How many times did you take the FANSIDAR during this pregnancy?
[FOR LAST BIRTH ONLY]

NUMBER OF TIMES ________

422C) CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY.
[FOR LAST BIRTH ONLY]

CODE 'A' CIRCLED (GO TO 422D)
CODE 'A' NOT CIRCLED (GO TO 422F)

422D) When you were pregnant with (NAME), did you get FANSIDAR during an antenatal visit, during a different visit in a heath care facility, or from another source?
[FOR LAST BIRTH ONLY]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY) _________ 6

422E) Did you take three FANSIDAR pills two times in one month intervals during this pregnancy?
INSIST ON TWO TIMES AND ONE MONTH INTERVAL. IMPORTANT TO SHOW RESPONDENT FANSIDAR.
[FOR LAST BIRTH ONLY]

YES, IN FRONT OF HEALTH AGENT 1
YES, AT HOME 2
OTHER (SPECIFY) ________ 3
NO 4
DON'T KNOW 8

422F) CHECK 422:
TYPE OF DRUG TAKEN DURING PREGNANCY TO PREVENT MALARIA (CHLOROQUINE/NIVAQUINE)
[FOR LAST BIRTH ONLY]

CODE 'B' CIRCLED (GO TO 422G)
CODE 'B' NOT CIRCLED (GO TO 422I)

422G) Did you start by taking fifteen chloroquine/nivaquine pills in three days?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 422I)

422H) Did you then take three chloroquine/nivaquine pills a week until delivery?
[FOR LAST BIRTH ONLY]

YES 1
NO 2

422I) During this pregnancy, did you sleep under a mosquito net every night, most nights, rarely, or never?
[FOR LAST BIRTH ONLY]

EVERY NIGHT 1
MOST NIGHTS 2
RARELY 3
NEVER 4 (GO TO 422K)

422J) During this pregnancy, did you sleep under a mosquito net soaked in insecticide?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

422K) What other means of protection against malaria do you know of?
[FOR LAST BIRTH ONLY]

WIRE-MESH WINDOW A
INFUSION/DECOCTION B
MOSQUITO NET/FINE MESH C
BUG BOMB D
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 99998

426) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON. RECORD ALL PERSONS MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE: Was an adult present for the delivery?
IF YES, ASK: Who was present?

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
UNTRAINED MIDWIFE D
TRADITIONAL BIRTH ATTENDANT E
RELATIVE/FRIEND F
OTHER (SPECIFY) ________ X
NO ONE Y

427) Where did you give birth to (NAME)?
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 ________
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
STAND-ALONE MATERNITY WARD 23
VILLAGE UNIT 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)

427A) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD IN HOURS; IF LESS THAN ONE WEEK, RECORD IN DAYS.

HOURS ________1
DAYS ________2
WEEKS ________ 3

DON'T KNOW 998

428) Was (NAME) delivered by cesarean section?

YES 1 (GO TO 435 FOR ALL BIRTHS EXCEPT THE LAST BIRTH)
NO 2 (GO TO 435 FOR ALL BIRTHS EXCEPT THE LAST BIRTH)

428A) Before you were discharged after (NAME) was born, did any health care provider check on your health?
[FOR LAST BIRTH ONLY]

YES 1 (GO TO 433)
NO 2

428B) After you were discharged, after the birth of (NAME), did any heath care provider, traditional birth attendant, or auxiliary midwife check on your health?
[FOR LAST BIRTH ONLY]

YES 1 (GO TO 430)
NO 2 (GO TO 433)

429) After (NAME) was born, did any health care provider, traditional birth attendant, or auxiliary midwife check on your health?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 433)

430) How long after delivery did the first check take place?
RECORD '00' DAYS IF THE SAME DAY.

DAY 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.
[FOR LAST BIRTH ONLY]

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

432) Where did this first check 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.
[FOR LAST BIRTH ONLY]

NAME OF PLACE ________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
STAND-ALONE MATERNITY WARD 23
VILLAGE UNIT 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/any of these)?
SHOW BLUE/RED CAPSULE
[FOR LAST BIRTH ONLY]

YES 1
NO 2

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

YES 1
NO 2

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

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

438) Have you resumed sexual intercourse since the birth of (NAME)?
[FOR 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 LIQUIDS 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
MILK FROM WET NURSE J
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 449A)
DEAD (GO BACK TO 404 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 NON-NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[FOR LAST BIRTH ONLY]

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.
[FOR LAST BIRTH ONLY]

NUMBER OF DAYLIGHT FEEDINGS ________

449A) Did you know that a mother may not have enough breast milk to feed her baby?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 450)

449B) Do you know how to avoid this problem?
[FOR LAST BIRTH ONLY]

YES 1
NO 2

449C) Have you had/did you have this problem with (NAME)?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 450)

449D) If yes, did you use a wet nurse, artificial milk, or did you use a method to get enough breast milk to feed (NAME)?
[FOR LAST BIRTH ONLY]

WET NURSE 1
ARTIFICIAL MILK 2
METHOD TO GET BREAST MILK 3
OTHER (SPECIFY) ________ 6

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 during the day or night?

YES 1
NO 2
DON'T KNOW 8

452) How many times did (NAME) eat solid or semi-solid food 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 404 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION

454) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN THREE BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

455) LINE NUMBER FROM QUESTION 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 BLUE OR RED CAPSULE.

YES 1
NO 2
DON'T KNOW 8

458) Do you have a card where (NAME)'s vaccinations 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 ________
HepB 1
DAY ________
MONTH ________
YEAR ________
HepB 2
DAY ________
MONTH ________
YEAR ________
HepB 3
DAY ________
MONTH ________
YEAR ________
Hib 1
DAY ________
MONTH ________
YEAR ________
Hib 2
DAY ________
MONTH ________
YEAR ________
Hib 3
DAY ________
MONTH ________
YEAR ________
MEASLES
DAY ________
MONTH ________
YEAR ________
YELLOW FEVER
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, HepB 1-3 OR (DTCHB1-3), MEASLES, AND/OR YELLOW FEVER.

YES 1 (PROBE FOR VACCINATION 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 left forearm done at birth 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 upper left arm usually at the same time as polio drops?

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

462F) How many times?

NUMBER OF TIMES _________

463G) An injection to prevent measles done on the upper right arm?

YES 1
NO 2
DON'T KNOW 8

463H) An injection to prevent yellow fever done on the backside of the right thigh?

YES 1
NO 2
DON'T KNOW 8

463I) A vaccination against Hepatitis B, that is, an injection given in the upper right arm often at the same time as the DPT injection?

YES 1
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

463J) How many times?

NUMBER OF TIMES ________

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)
DON'T KNOW 8 (GO TO 465A)

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

POLIO CAMPAIGNS
FEB 2004 A
MAR 2004 B
OCT 2004 C
NOV 2004 D
FEB 2005 E
APR 2005 F
NOV 2005 G
DEC 2005 H
MAY 2006 I
JUNE 2006 J
MEASLES CAMPAIGNS
DEC 2005 K

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:
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
K-OTAB 2
K-OTHRINE 3
OTHER (SPECIFY) ________ 4
DON'T KNOW 8

465J) Was the saturation done by you yourself, in a health center, or by an NGO (Non-governmental organization)?

YOURSELF 1
HEALTH CENTER 2
NGO 3
OTHER (SPECIFY) _________ 4

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 469)
DON'T KNOW 8 (GO TO 469)

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

YES 1
NO 2
DON'T KNOW 8

469) CHECK 466 AND 467:
FEVER OR COUGH?

'YES' TO 466 OR 467 (GO TO 470)
OTHER (GO TO 475)

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

YES 1
NO 2 (GO TO 472)

471) 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(S).
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 (NON-GOVERNMENTAL ORGANIZATION) L
OTHER PRIVATE MEDICAL (SPECIFY) _________ M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
TRADITIONAL PRACTITIONER P
RELATIVES/FRIENDS Q
VENDOR R
OTHER (SPECIFY) ________ X

472) CHECK 466:
HAD A FEVER?

'YES' TO 466 (GO TO 472A)
'NO'/'DON'T KNOW' TO 466 (GO TO 475)

472A) Does (NAME) have a fever now?

YES 1
NO 2
DON'T KNOW 8

472B) Did (NAME) have convulsions at any time in the last 2 weeks?

YES 1
NO 2
DON'T KNOW 8

472C) CHECK 466 AND 472B:
FEVER OR CONVULSIONS?

'YES' TO 466 AND 472B (GO TO 473)
OTHER (GO TO 475)

473) Did (NAME) take any drugs for the fever?

YES 1
NO 2 (GO TO 474R)
DON'T KNOW 8 (GO TO 474R)

474) What drugs did (NAME) take?
RECORD ALL MENTIONED.
ASK TO SEE THE DRUGS IF THE TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG CANNOT BE DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO THE RESPONDENT.

FANSIDAR/SP A
CHLOROQUINE/NIVAQUINE B
AMODIAQUINE/FLOVAQUINE C
QUININE/QUINIMAX D
COARTEM E
HALFAN F
ARINATE/ARTHEMUS G
ASPIRIN/AAS H
PANADOL/PARACETAMOL I
IBUPROFEN/ACETAMINOPHEN J
INFUSION/DECOCTION K
OTHER (SPECIFY) ________ X
DON'T KNOW Z

474A) Did (NAME) get an injection or a suppository to treat (the fever/the convulsions)?

INJECTION A
SUPPOSITORY B
NONE Y
DON'T KNOW Z

474B) CHECK 474:
TYPE OF DRUG?

CODE 'A' CIRCLED (GO TO 474C)
CODE 'A' NOT CIRCLED (GO TO 474F)

474C) How long after the (fever/convulsions) started did (NAME) first take Fansidar?

SAME DAY 1
NEXT DAY 2
TWO DAYS AFTER FEVER 3
THREE DAYS AFTER FEVER 4
DON'T KNOW 8

474D) For how many days did (NAME) take Fansidar?
IF 7 DAYS OR MORE, RECORD '7'.

ONE TIME 0
DAYS ________
DON'T KNOW 8

474E) Did you have the Fansidar in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the Fansidar the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474F) CHECK 474:
TYPE OF DRUG?

CODE 'B' CIRCLED (GO TO 474G)
CODE 'B' NOT CIRCLED (GO TO 474J)

474G) How long after the (fever/convulsions/attacks) started did (NAME) first take chloroquine?

SAME DAY 1
NEXT DAY 2
TWO DAYS AFTER FEVER 3
THREE DAYS AFTER FEVER 4
DON'T KNOW 8

474H) For how many days did (NAME) take chloroquine?
IF 7 DAYS OR MORE, RECORD '7'.

DAYS ________
DON'T KNOW 8

474I) Did you have the chloroquine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the chloroquine the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474J) CHECK 474:
TYPE OF DRUG?

CODE 'C' CIRCLED (GO TO 474K)
CODE 'C' NOT CIRCLED (GO TO 474N)

474K) How long after the (fever/convulsions) started did (NAME) first take Amodiaquine/Flavoquine?

SAME DAY 1
NEXT DAY 2
TWO DAYS AFTER FEVER 3
THREE DAYS AFTER FEVER 4
DON'T KNOW 8

474L) For how many days did (NAME) take Amodiaquine?
IF SEVEN DAYS OR MORE, RECORD '7'.

DAYS ________
DON'T KNOW 8

474M) Did you have the Amodiaquine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the Amodiaquine the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474N) CHECK 474:
TYPE OF DRUG?

CODE 'D' CIRCLED (GO TO 474O)
CODE 'D' NOT CIRCLED (GO TO 474R)

474O) How long after the (fever/convulsions/attacks) started did (NAME) first take quinine?

SAME DAY 1
NEXT DAY 2
TWO DAYS AFTER FEVER 3
THREE DAYS AFTER FEVER 4
DON'T KNOW 8

474P) For how many days did (NAME) take quinine?
IF 7 DAYS OR MORE, RECORD '7'.

DAYS ________
DON'T KNOW 8

474Q) Did you have the quinine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the quinine the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474R) Was anything else done to treat (NAME)'s (fever/convulsions)?

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

474S) What was done for (NAME)'s (fever/convulsions/attacks)? Anything else?
RECORD ALL MENTIONED

CONSULTED TRADITIONAL PRACTITIONER A
USE DAMP COMPRESS B
GAVE MEDICINAL PLANTS C
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 CIRCLED (GO TO 477B)
'NO' TO 445 CIRCLED (GO TO 478)

477B) When (NAME) had diarrhea, was he/she given less breast milk than usual, about the same amount, or more than usual?
IF LESS, PROBE: Was he/she given much less breast milk 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 [LOCAL NAME OF ORS PACKET]?
YES 1
NO 2
DON'T KNOW 8
b) A government recommended homemade fluid?
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
(IV) 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 IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
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 (NON-GOVERNMENTAL ORGANIZATION) L
OTHER PRIVATE MEDICAL (SPECIFY) ________ M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
TRADITIONAL PRACTITIONER P
RELATIVES/FRIENDS Q
VENDOR R
OTHER (SPECIFY) ________ X

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 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 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2001 OR LATER LIVING WITH THE RESPONDENT.

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

485) What do you usually do with your (youngest) child's stools when he/she doesn't use the toilet? At other times?

CHILD USES TOILET OR LATRINE 01
PUT INTO TOILET OR LATRINE 02
PUT OUTSIDE DWELLING 03
PUT OUTSIDE OF COURTYARD 04
BURY IN COURTYARD 05
GETS RID OF IT BY WASHING IT WITH WATER 06
USES DISPOSABLE DIAPERS 07
USES WASHABLE DIAPERS 08
DOESN'T GET RID OF THEM 09
OTHER (SPECIFY) _________ 96

485A) When do you wash your hands? Any other times?

AFTER A BOWEL MOVEMENT A
BEFORE EATING B
BEFORE FEEDING CHILD C
AFTER CHILD'S BOWEL MOVEMENT D

486) CHECK 478A ALL COLUMNS:

NO CHILD RECEIVED ORS PACKET (GO TO 487)
CHILD RECEIVED ORS PACKET (GO TO 488)

487) Have you ever heard of a special product called [LOCAL NAME OF ORS PACKET] 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 yourself decide that he/she needs to be taken somewhere for medical treatment?

IF RESPONDENT ANSWERS THAT NONE OF HER CHILDREN HAVE EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) were seriously ill, could you yourself decide that he/she needs to be taken somewhere for medical treatment?

YES 1
NO 2
DEPENDS 3

490) Now I would like to ask you questions about health care for yourself. There are different reasons that prevent women from getting advice or medical treatment for themselves. When you are ill and want advice or medical treatment, are the following things a serious problem or not?

Knowing where to go.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Poor reception at Health Center.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Getting permission to go.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Getting money for treatment.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Not close to a health care establishment.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Finding a mode of transportation.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Not wanting to go alone.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Inefficient care.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Wait time too long.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Care costs too much.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Worry that there is no female health care professional.
SERIOUS PROBLEM 1
NOT A PROBLEM 2
Health care staff often absent or late.
SERIOUS PROBLEM 1
NOT A PROBLEM 2

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? Any other symptom?

FAST BREATHING A
DIFFICULTY BREATHING B
LOUD BREATHING C
CONVULSIONS D
UNCONSCIOUS E
VOMITING F
NOT ABLE TO DRINK/BREASTFEED H
NOT EATING/NOT DRINKING I
GETS SICKER/VERY SICK J
HOT BODY TEMPERATURE L
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?

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 (NON-GOVERNMENTAL ORGANIZATION) L
OTHER PRIVATE MEDICAL (SPECIFY) ________ M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
TRADITIONAL PRACTITIONER P
RELATIVES/FRIENDS Q
BAR/SALOON R
VENDOR S
OTHER (SPECIFY) ________ X

491) CHECK 215 AND 218:

AT LEAST ONE CHILD BORN IN 2003 OR LATER AND LIVING WITH HER (RECORD THE NAME OF THE YOUNGEST CHILD LIVING WITH HER)
NAME ________ (GO TO 492)
NO CHILD BORN IN 2003 OR LATER 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 the following liquids?

FOR EACH LIQUID DRANK AT LEAST ONCE IN THE LAST 7 DAYS, ASK: How many times total did (NAME FROM Q. 491) drink (LIQUID) yesterday during the day or night?
IF 7 TIMES OR MORE, RECORD '7'. IF DON'T KNOW, RECORD '8'

a) Water?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
b) Baby formula?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
c) Milk such as tinned, powdered, or fresh animal milk?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
d) Fruit juice?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
e) Other liquids such as sugar water, tea, coffee, carbonated beverages, or broths?
(LAST 7 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 in the last 7 did (NAME FROM Q. 491) eat one of the following foods?

FOR EACH FOOD EATEN AT LEAST ONCE IN THE LAST 7 DAYS, ASK: How many times total did (NAME FROM Q. 491) eat (FOOD) yesterday during the day or night?
IF 7 TIMES OR MORE, RECORD '7'. IF DON'T KNOW, RECORD '8'

a) Rice, corn, sorghum, or other grains?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
b) Pumpkin, yam, red or yellow squash, carrots, or red sweet potatoes?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
c) Other tuber based foods (for example: potatoes, white yams, cassava root, white sweet potatoes, or other tuber roots)?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
d) Any other green-leaf vegetables?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
e) Mango, papaya?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
f) All other fruits or vegetables (for example: banana, apple, applesauce, green beans, avocado, tomato)?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
g) Meat, poultry, fish, shellfish, or eggs?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
h) Other legume based foods (for example: lentils, beans, soy, legumes, or peanuts)?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
i) Cheese or yogurt?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________
j) All foods prepared with oil, fat, or butter?
(LAST 7 DAYS) NUMBER OF DAYS ________
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ________

493A) Do you usually sleep under a mosquito net?

YES 1
NO 2 (GO TO 495)

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

YES 1
NO 2 (GO TO 495)

494A) Was the mosquito net that you slept under last night soaked in insecticide?

YES 1
NO 2

495) Did you wash your hands before the last time you prepared a meal for your family?

YES 1
NO 2
NEVER PREPARED MEAL 3

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
YES, OTHER TOBACCO C
NO Y

497) CHECK 496:

CODE 'A' CIRCLED (GO TO 498)
CODE 'A' NOT CIRCLED (GO TO 499)

498) How many cigarettes have you smoked in the last 24 hours?

CIGARETTES ________

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

YES 1
NO 2 (GO TO 499C)

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

NUMBER OF DAYS ________
NONE/NEVER 95

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

YES 1
NO 2

499C) I would like to ask you some questions about your health over the last 6 months. Over the last 6 months, have you received an injection for any reason?
IF YES: How many injections did you receive?

IF NUMBER OF INJECTIONS IS OVER 94 OR IF DAILY FOR 3 MONTHS OR MORE, RECORD '95'. IF RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

NUMBER OF INJECTIONS ________
NONE 00 (GO TO 501)

499D) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?

IF NUMBER OF INJECTIONS IS OVER 94 OR IF DAILY FOR 3 MONTHS OR MORE, RECORD '95'. IF RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

NUMBER OF INJECTIONS ________
NONE 00 (GO TO 501)

499E) Where did you go to get the last injection?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MATERNITY CENTER 14
COMMUNITY PHARMACY 15
STRAT AV HEALTH WORKER 16
HEALTH WORKER 17
OTHER PUBLIC (SPECIFY) ________ 18
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
DENTIST 23
PRIVATE DOCTOR 24
HEALTH AGENT 25
OTHER PRIVATE MEDICAL (SPECIFY) ________ 26
OTHER SOURCE
AT HOME 31
OTHER (SPECIFY) ________ 96

499F) Did the person who administered the injection the last time take the syringe and needle from a new package that wasn't already opened?

YES 1
NO 2
DON'T KNOW 8

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 504)
YES, LIVING WITH A MAN 2 (GO TO 504)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 518)

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

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

505) 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) Other than yourself, does your husband/partner have other wives or does he live with other women as if married?

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

508) Including yourself, in total, how many other wives or partners does your husband live with now as if married?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ________
DON'T KNOW 98

509) Are you the first, second…wife?

RANK ________

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

ONCE 1
MORE THAN ONCE 2

511) CHECK 510:

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

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

MONTH ________
DON'T KNOW MONTH 98
YEAR ________ (GO TO 513)
DON'T KNOW YEAR 9998

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

AGE ________

513) CHECK 503:
IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED OR DIVORCED OR SEPARATED (GO TO 514)
WIDOW (GO TO 516)

514) CHECK 510:

MARRIED MORE THAN ONCE (GO TO 515)
MARRIED ONCE (GO TO 518)

515) How did your previous marriage or union end?

DEATH/WIDOWHOOD 1
DIVORCE 2 (GO TO 518)
SEPARATION 3 (GO TO 518)

516) To whom did most of your late husband's property go to?

RESPONDENT 1 (GO TO 518)
RESPONDENT'S CHILDREN 2
OTHER WIFE 3
OTHER WIFE'S CHILDREN 4
SPOUSE'S FAMILY 5
OTHER (SPECIFY) ________ 6
NO PROPERTY 7

517) Did you receive any of your late husband's assets or valuables?

YES 1
NO 2

518) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS ________ (GO TO 521)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 521)

520) Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 544)
NO 2 (GO TO 544)
DON'T KNOW/UNSURE 8 (GO TO 544)

521) CHECK 106:

AGE 15-24 (GO TO 522)
AGE 25-49 (GO TO 526)

522) The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

523) How old was the person you first had sexual intercourse with?

AGE OF PARTNER ________ (GO TO 526)
DON'T KNOW 98

524) Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (GO TO 526)
ABOUT THE SAME AGE 3 (GO TO 526)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 526)

525) Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

526) When was the last time you had sexual intercourse?
IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS

DAYS AGO 1_______
WEEKS AGO 2______
MONTHS AGO 3_____
YEARS AGO 4______ (GO TO 538)

527) The last time you had sexual intercourse (with this second/third) person, was a condom used?

YES 1
NO 2 (GO TO 529)

528) Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

529) The last time you had sexual intercourse (with this second/third) person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 531)

530) Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

531) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

HUSBAND 01 (GO TO 537)
LIVE-IN PARTNER 02 (GO TO 537)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANCE 04
PROSTITUTE 05
OTHER (SPECIFY) ________ 96

532) For how long (have you had/did you have) sexual relations with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS _______ 1
WEEKS ________ 2
MONTHS ________ 3
YEARS ________ 4

533) CHECK 106:

AGE 15-24 (GO TO 534)
AGE 25-49 (GO TO 537)

534) How old is this person?

AGE OF PARTNER ________ (GO TO 537)
DON'T KNOW 98

535) Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (GO TO 537)
ABOUT THE SAME AGE 3 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

536) Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

537) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO TO 527 IN NEXT COLUMN)
NO 2 (GO TO 541)

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

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS ________
DON'T KNOW 98

541) CHECK FOR PRESENCE OF OTHER PEOPLE. DO NOT CONTINUE UNTIL YOU ARE COMPLETELY ALONE WITH RESPONDENT.

PRIVACY OBTAINED 1
PRIVACY IMPOSSIBLE 2 (GO TO 544)

542) The first time you had sexual intercourse, did you want to have sexual intercourse, or were you forced against your will?

WANTED 1
WAS FORCED 2
REFUSED TO RESPOND/NO RESPONSE 3

543) Did anyone make you have sexual intercourse against your will in the last 12 months?

YES 1
NO 2
REFUSED TO RESPOND/NO RESPONSE 3

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

YES 1
NO 2 (GO TO 601)

545) Where is that? 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
MATERNITY CENTER D
COMMUNITY PHARMACY E
STRAT AV HEALTH WORKER F
HEALTH WORKER G
OTHER PUBLIC (SPECIFY) ________ I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PHARMACY K
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) L
DOCTOR'S OFFICE M
HEALTH AGENT (NON-GOVERNMENTAL ORGANIZATION) N
OTHER PRIVATE MEDICAL (SPECIFY) ________ O
OTHER SOURCE
SHOP/MARKET P
CHURCH/MOSQUE Q
SCHOOL R
RELATIVES/FRIENDS S
OTHER (SPECIFY) ________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311/311A:

NOT STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602) CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some questions 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 614)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW AND NOT PREGNANT/UNSURE 5 (GO TO 608)

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

MONTHS ________ 1
YEARS _________ 2

SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
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)
00-23 MONTHS OR 00-01 YEAR (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 you are not using a method? 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 you are not using a method?
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 K
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?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

609) CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (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?
IF MORE THAN ONE METHOD MENTIONED, ASK: Which one interests you the most?

CIRCLE THE CORRESPONDING CODE. IF SHE HAS NO INTEREST IN ANY METHOD, CIRCLE THE CODE CORRESPONDING TO THE HIGHEST METHOD AMONG THOSE MENTIONED.

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)
UNSURE 98 (GO TO 614)

612) What is the main reason that you think you will never use a contraceptive method at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NOT HAVING 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 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, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

620) With whom? Anyone else?
RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
COUSIN(S) F
DAUGHTER(S) G
SON(S) H
MOTHER(S)-IN-LAW I
FATHER(S)-IN-LAW G
FRIEND(S)/NEIGHBOR(S) K
OTHER (SPECIFY) ________ X

621) CHECK 501:

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

622) CHECK 311/311A:

CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623) You say that you are currently using a contraceptive method. 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
INDIFFERENT 3
DON'T KNOW 8

625) How many times in the last year have you talked to your husband/partner about family planning?

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 knows her husband has a disease that she can get during sexual intercourse?
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 recently gave birth?
YES 1
NO 2
DON'T KNOW 8
She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

629) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

630) CHECK 501:

CURRENTLY MARRIED/IN UNION (GO TO 631)
NOT IN UNION (GO TO 701)

631) Can you refuse sexual intercourse with your husband when you do not wish to have intercourse?

YES 1
NO 2
DEPENDS/UNSURE 8

632) Can you ask your husband to use a condom if you want him to use one?

YES 1
NO 2
DEPENDS/UNSURE 8

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

701) CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH 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 first cycle, secondary second cycle, higher, or other?

PRIMARY 1
SECONDARY 1 2
SECONDARY 2 3
HIGHER 4
OTHER 6
DON'T KNOW 8 (GO TO 706)

705) What was the highest (grade/form/year) he completed at that level?

GRADE ________
DON'T KNOW 8

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
NOT APPLICABLE 6

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 at home or away from home?

HOME 1
AWAY 2

715) 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

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
FATHER/MOTHER 4
UNCLE/AUNT 5
SOMEONE ELSE 6
RESPONDENT AND SOMEONE ELSE JOINTLY 7

718) On average, how much of your household's expenditures do your earnings pay for: none, 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 ALL SAVED 6

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 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 each 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 YOUNGER THAN 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
If she talks about protecting herself from AIDS?
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 844)

801A) How can a person get AIDS? Any other way?
RECORD ALL MENTIONED.

SEXUAL RELATIONS A
SEXUAL RELATIONS WITH MULTIPLE PARTNERS B
SEXUAL RELATIONS WITH PROSTITUTES C
NOT USING A CONDOM D
HOMOSEXUAL RELATIONS E
BLOOD TRANSFUSIONS F
INJECTIONS G
KISSING H
MOSQUITO BITES I
DIRTY OBJECTS J
OTHER (SPECIFY) ________ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

804) 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

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

YES 1
NO 2
DON'T KNOW 8

806) 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

807) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 810)
DON'T KNOW 8 (GO TO 810)

809) 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 TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

811) Can the virus that causes AIDS be transmitted from a mother to a child:

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

812) CHECK 811:

AT LEAST ONE 'YES' (GO TO 813)
OTHER (GO TO 814)

813) Are there any special drugs that a doctor, nurse, or midwife can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

814) Are there any special drugs that people infected with the AIDS virus can get from a doctor, nurse, or midwife?

YES 1
NO 2
DON'T KNOW 8

815) CHECK 215:

LAST BIRTH SINCE JANUARY 2003 (GO TO 816)
NO BIRTHS (GO TO 824)
LAST BIRTH BEFORE JANUARY 2003 (GO TO 824)

816) Now I would like to ask you some questions about your last birth. Did you see someone for antenatal care during this pregnancy?

YES 1
NO 2 (GO TO 824)

817) During any of the antenatal visits for this pregnancy, did anyone talk to you about:

Babies getting the AIDS virus from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting the AIDS virus?
YES 1
NO 2
DON'T KNOW 8
Getting tested for the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

818) Were you offered a test for the AIDS virus as part of your antenatal care?

YES 1
NO 2

819) I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 824)
DON'T KNOW 8 (GO TO 824)

820) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

821) Where was the test done?
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
SCREENING CENTER 14
STRAT AV HEALTH WORKER/MOBILE CLINIC 15
HEALTH WORKER 16
OTHER PUBLIC (SPECIFY) ________ 17
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
PRIVATE DOCTOR 23
HEALTH AGENT 24
OTHER PRIVATE MEDICAL (SPECIFY) ________ 26
OTHER (SPECIFY) ________ 96

822) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1 (GO TO 825)
NO 2

823) When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1 (GO TO 831)
12-23 MONTHS AGO 2 (GO TO 831)
2 OR MORE YEARS AGO 3 (GO TO 831)

824) I don't want to know the result, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 829)

825) When was the last time you were tested?

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

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

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

827) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

828) Where was the test done?
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 831)
GOVERNMENT HEALTH CENTER 12 (GO TO 831)
FAMILY PLANNING CLINIC 13 (GO TO 831)
SCREENING CENTER 14 (GO TO 831)
STRAT AV HEALTH WORKER/MOBILE CLINIC 15 (GO TO 831)
HEALTH WORKER 16 (GO TO 831)
OTHER PUBLIC (SPECIFY) ________ 17 (GO TO 831)
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21 (GO TO 831)
PHARMACY 22 (GO TO 831)
PRIVATE DOCTOR 23 (GO TO 831)
HEALTH AGENT 24 (GO TO 831)
OTHER PRIVATE MEDICAL (SPECIFY) ________ 26 (GO TO 831)
OTHER (SPECIFY) ________ 96 (GO TO 831)

829) Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 831)

830) Where is that? 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
SCREENING CENTER D
STRAT AV HEALTH WORKER/MOBILE CLINIC E
HEALTH WORKER F
OTHER PUBLIC (SPECIFY) ________ G
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE H
PHARMACY I
PRIVATE DOCTOR J
HEALTH AGENT K
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
OTHER (SPECIFY) ________ X

831) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

832) If you learned that you had the AIDS virus, would you like this to remain a secret?

YES, KEPT SECRET 1
NO 2
DON'T KNOW/UNSURE/DEPENDS 8

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

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

834) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

834A) If a health agent has the AIDS virus but is not sick, should he/she be allowed to continue healing the sick?

ALLOWED TO HEAL 1
NOT ALLOWED TO HEAL 2
DON'T KNOW/NOT SURE/DEPENDS 8

835) Do you personally know someone who has been denied health services in the last 12 months because he/she has or is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 3 (GO TO 840)
DON'T KNOW 8

836) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he/she has or is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

837) Do you personally know someone who has been verbally abused or teased in the last 12 months because he/she has or is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

838) CHECK 835, 836, AND 837:

OTHER (GO TO 839)
AT LEAST ONE 'YES' (GO TO 840)

839) Do you personally know someone who has or is suspected to have the AIDS virus?

YES 1
NO 2

840) Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

841) Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

841A) Do you agree or disagree with the following statement: People should have a pre-nuptial medical exam to know the serological status (affected by AIDS or not) of their partner before marriage.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

842) 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

843) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

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

843A) In the last 6 months, how many times have you heard an ad on the radio about AIDS and how to avoid it?
IF NONE, CIRCLE '00'. RECORD '95' FOR 95 TIMES OR MORE.

NONE 00
TOTAL _________

843B) In the last 6 months, how many times have you seen an ad on TV about AIDS and how to avoid it?
IF NONE, CIRCLE '00'. RECORD '95' FOR 95 TIMES OR MORE.

NONE 00
TOTAL _________

843C) In the last 6 months, how many times have you seen an ad poster about AIDS and how to avoid it?
IF NONE, CIRCLE '00'.

NONE 00
TOTAL _________

843D) In the last 6 months, how many times have you participated in a discussion about AIDS and how to avoid it?
IF NONE, CIRCLE '00'.

NONE 00
TOTAL _________

844) Do you think that young men should wait until marriage to have sexual intercourse?

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

845) Do you think that young women should wait until marriage to have sexual intercourse?

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

846) Do you think that married men should not have sexual intercourse with people other than their spouses?

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

847) Do you think that most of the men you know only have sexual intercourse with their spouses?

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

848) Do you think that married women should not have sexual intercourse with people other than their spouses?

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

849) Do you think that most of the women you know only have sexual intercourse with their spouses?

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

850) CHECK 801:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 853)

851) If a man has a sexually transmitted disease, what symptoms might he have? Any other symptoms?
RECORD ALL 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

852) If a woman has a sexually transmitted disease, what symptoms might she have? Any other symptoms?
RECORD ALL 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

853) CHECK 519:

HAS HAD SEXUAL INTERCOURSE (GO TO 854)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

854) CHECK 850:

HAS HEARD OF SEXUALLY TRANSMITTED INFECTIONS (GO TO 855)
HAS NOT HEARD OF SEXUALLY TRANSMITTED INFECTIONS (GO TO 856)

855) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

856) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

857) 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

858) CHECK 855, 856, AND 857:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 859)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 860G)

859) The last time you had (INFECTION FROM 855/856/857), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 860B)

860) Where did you go? Any other place?
CIRCLE ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC
FIELDWORKER D
COMMUNITY CENTER E
HEALTH WORKER F
HEALTH WORKER/COMMUNITY LIAISON G
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 (NON-GOVERNMENTAL ORGANIZATION) O
OTHER PRIVATE MEDICAL (SPECIFY) ________ P
OTHER SOURCE
SHOP/MARKET Q
TRADITIONAL PRACTITIONER R
RELATIVES/FRIENDS/NEIGHBOR S
VENDOR T
OTHER (SPECIFY) ________ X

860A) The last time you had (INFECTION FROM 855/856/857), did you do any of the following? Did you…

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

860B) When you had (INFECTION FROM 855/856/857), did you inform the people you were having sexual intercourse with?

YES 1
NO 2
SOME PEOPLE/NOT ALL 3

860C) When you had (INFECTION FROM 855/856/857), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 860E)
PARTNER(S) ALREADY INFECTED 3 (GO TO 860E)

860D) What did you do to avoid infecting your partner(s)? Did you…

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

860E) The last time you had (INFECTION FROM 855/856/857), did your partner seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 860G)
PARTNER NOT INFORMED 3 (GO TO 860G)
DON'T KNOW 8 (GO TO 860G)

860F) Where did he go? Any other place?
CIRCLE ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
FIELDWORKER D
COMMUNITY CENTER E
HEALTH WORKER F
HEALTH WORKER/COMMUNITY LIAISON G
OTHER PUBLIC (SPECIFY) ________ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC [NO CODE SPECIFIED]
RELIGIOUS HOSPITAL J
PHARMACY K
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) L
DOCTOR'S OFFICE M
HEALTH AGENT (NON-GOVERNMENTAL ORGANIZATION) N
OTHER PRIVATE MEDICAL (SPECIFY) ________ O
OTHER SOURCE
SHOP/MARKET P
TRADITIONAL PRACTITIONER Q
RELATIVES/FRIENDS/NEIGHBOR R
VENDOR S
OTHER (SPECIFY) ________ X

860G) Do you know of any organizations that are fighting AIDS in your town?

YES 1
NO 2 (GO TO 901)

860H) Which ones? Any other organizations?

NATIONAL COMMITTEE FOR THE FIGHT AGAINST AIDS/DEPARTMENTAL COMMITTEE FIGHTING AGAINST AIDS/COMMUNAL COMMITTEE FIGHTING AGAINST AIDS (CNLS/CDLS/CCLS) A
NATIONAL PROGRAM AGAINST AIDS (PNLS) B
POPULATION AND AIDS CONTROL PROJECT (PPLS) C
AIDS 3 D
BENIN HIV/AIDS PREVENTION PROGRAM (BHAPP) E
ID/RACINES F
WORLD BANK WEST AFRICAN REGIONAL HIV PROJECT (CORRIDOR) G
HEALTH CENTER/HOSPITAL H
POPULATION SERVICES INTERNATIONAL/BENINESE ASSOCIATION FOR HEALTH SOCIAL MARKETING AND COMMUNICATION (PSI/ABMS) I
OTHER (SPECIFY) _________ X

860I) Have you ever solicited at least once for one of the organizations that are fighting against AIDS?

YES 1
NO 2 (GO TO 901)

860J) The last time you went, which organization did you go to?

NATIONAL COMMITTEE FOR THE FIGHT AGAINST AIDS/DEPARTMENTAL COMMITTEE FIGHTING AGAINST AIDS/COMMUNAL COMMITTEE FIGHTING AGAINST AIDS (CNLS/CDLS/CCLS) 11
NATIONAL PROGRAM AGAINST AIDS (PNLS) 12
POPULATION AND AIDS CONTROL PROJECT (PPLS) 13
AIDS 3 14
BENIN HIV/AIDS PREVENTION PROGRAM (BHAPP) 15
ID/RACINES 16
WORLD BANK WEST AFRICAN REGIONAL HIV PROJECT (CORRIDOR) 17
HEALTH CENTER/HOSPITAL 18
POPULATION SERVICES INTERNATIONAL/BENINESE ASSOCIATION FOR HEALTH SOCIAL MARKETING AND COMMUNICATION (PSI/ABMS) 19
OTHER (SPECIFY) _________ 96

860K) What was your main reason?

STI 1
INFORMATION 2
ADVICE 3
SCREENING 4
OTHER (SPECIFY) ________ 9

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 (GO TO 1001)

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 this 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 in any way?

YES 1
NO 2
DON'T KNOW 8

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

AGE IN YEARS COMPLETED ________

DURING INFANCY 95
DON'T KNOW 98

908) Who performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER (FEMALE) 11
TRADITIONAL BIRTH ATTENDANT 12
TRADITIONAL CIRCUMCISER (MALE) 13
OTHER TRADITIONAL (SPECIFY) ________ 16
HEALTH PROFESSIONAL
DOCTOR 21
TRAINED NURSE/MID-WIFE 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 been circumcised?
IF YES: How many?

NUMBER CIRCUMCISED ________
NO DAUGHTER CIRCUMCISED 95 (GO TO 918)

911) Which of your daughters was circumcised most recently?
CHECK 212 AND RECORD THE LINE NUMBER OF THE DAUGHTER.

DAUGHTER'S NAME ________
DAUGHTER'S LINE NUMBER FROM QUESTION 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 was done?
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 performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER (FEMALE) 11
TRADITIONAL BIRTH ATTENDANT 12
TRADITIONAL CIRCUMCISER (MALE) 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. 911) have any of the following problems:

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

918) Do you intend to have any of your daughters circumcised in the future?

YES 1
NO 2
DON'T KNOW 8

919) What benefits do girls get if they are circumcised?
PROBE: Any other benefits?
RECORD ALL MENTIONED

CLEANLINESS/HYGIENE A
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
PRESERVE VIRGINITY/PREVENT PREMARITAL SEX D
MORE SEXUAL 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: Nothing 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 ADVANTAGE 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?

PREVENTS 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

922A) Do you think that this practice is required by your traditions or your customs?

YES 1
NO 2
DON'T KNOW 8

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

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

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

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

924A) Did you know that there is a law in Benin prohibiting female genital cutting?

YES 1
NO 2 (GO TO 1001)
DON'T KNOW 8 (GO TO 1001)

924B) How were you informed?

NATIONAL RADIO A
AWARENESS CAMPAIGN BY NON-GOVERNMENTAL ORGANIZATION B
LOCAL AUTHORITIES C
COMMUNITY/LOCAL RADIO D
OTHER (SPECIFIC) ________ X

SECTION 10. MATERNAL MORTALITY

1001) Now I would like to ask you some questions about your brothers and sisters, that is all of the children born to your natural mother, including those who are living with you, those living elsewhere, and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER ________

1002) CHECK 1001:

TWO OR MORE BIRTHS (GO TO 1003)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1014)

1003) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ________

1004) What was the name given to your (next) oldest brother or sister?

NAME ________

1005) Is (NAME) male or female?

MALE 1
FEMALE 2

1006) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1008)
DON'T KNOW 8 (GO TO NEXT SIBLING)

1007) How old is (NAME)?

AGE ________ (GO TO NEXT SIBLING)

1008) How many years ago did (NAME) die?

YEARS ________

1009) How old was (NAME) when he/she died?

AGE____ (IF MAN, OR IF WOMAN DECEASED BEFORE AGE 12, GO TO NEXT SIBLING)

1010) Was (NAME) pregnant when she died?

YES 1 (GO TO 1013)
NO 2

1011) Did (NAME) die during childbirth?

YES 1 (GO TO 1013)
NO 2

1012) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1013) How many live born children did (NAME) give birth to during her lifetime?

NUMBER _________ (GO TO NEXT SIBLING)

IF NO OTHER BROTHERS OR SISTERS, GO TO 1014.

1014) RECORD TIME

HOUR____
MINUTES_____

INSTRUCTIONS: ONE CODE FOR EACH SPACE

BIRTHS AND PREGNANCIES

B BIRTHS
P PREGNANCY
E END OF PREGNANCY
2006
12 DEC 01____
11 NOV 02____
10 OCT 03____
09 SEP 04____
08 AUG 05_____
07 JUL 06______
06 JUN 07______
05 MAY 08_____
04 APR 09_____
03 MAR 10____
02 FEB 11_____
01 JAN 12_____
2005
12 DEC 13____
11 NOV 14____
10 OCT 15____
09 SEP 16____
08 AUG 17_____
07 JUL 18______
06 JUN 19______
05 MAY 20_____
04 APR 21_____
03 MAR 22____
02 FEB 23_____
01 JAN 24_____
2004
12 DEC 25____
11 NOV 26____
10 OCT 27____
09 SEP 28____
08 AUG 29_____
07 JUL 30______
06 JUN 31______
05 MAY 32_____
04 APR 33_____
03 MAR 34____
02 FEB 35_____
01 JAN 36_____
2003
12 DEC 37____
11 NOV 38____
10 OCT 39____
09 SEP 40____
08 AUG 41_____
07 JUL 42______
06 JUN 43______
05 MAY 44_____
04 APR 45_____
03 MAR 46____
02 FEB 47_____
01 JAN 48_____
2002
12 DEC 49____
11 NOV 50____
10 OCT 51____
09 SEP 52____
08 AUG 53_____
07 JUL 54______
06 JUN 55______
05 MAY 56_____
04 APR 57_____
03 MAR 58____
02 FEB 59_____
01 JAN 60_____
2005
12 DEC 61____
11 NOV 62____
10 OCT 63____
09 SEP 64____
08 AUG 65_____
07 JUL 66______
06 JUN 67______
05 MAY 68_____
04 APR 69_____
03 MAR 70____
02 FEB 71_____
01 JAN 72_____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING THE INTERVIEW

COMMENTS ABOUT THE RESPONDENT:__________________________

COMMENTS ON SPECIFIC QUESTIONS:___________________________

ANY OTHER COMMENTS:__________________________

SUPERVISOR'S OBSERVATIONS:______________________
NAME OF SUPERVISOR________________
DATE_____________________

EDITOR'S OBSERVATIONS:________________________
NAME OF EDITOR__________________________
DATE________________________