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DEMOGRAPHIC AND HEALTH SURVEY-COTE D'IVOIRE 1994-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

DEPARTMENT NAME____

SUB-PREFECTURE NAME____

CENSUS DISTRICT___

CLUSTER NUMBER___

STRUCTURE NUMBER____

HOUSEHOLD NUMBER___

URBAN/RURAL

URBAN 1
RURAL 2

LARGE CITY, SMALL CITY, OR COUNTRYSIDE?

LARGE CITY 1
SMALL CITY 2
COUNTRYSIDE 3

HEAD OF HOUSEHOLD'S NAME_____

NAME AND LINE NUMBER OF WOMAN____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME____

RESULT___

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

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE___
TIME_____

FINAL VISIT
DAY___
MONTH___
YEAR 94
NAME___
RESULT___

TOTAL NUMBER OF VISITS___

LANGUAGE OF INTERVIEW____

INTERPRETER USED?

YES
NO

SUPERVISOR
NAME____
DATE____

FIELD EDITOR
NAME___
DATE____

KEYED BY
NAME___
DATE____

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD TIME

HOUR___
MINUTES____

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

LARGE CITY 1
SMALL CITY 2
COUNTRYSIDE 3

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

YEARS _____

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

104) Just before you moved here, did you live in a large city, in a small city, or in the countryside?

LARGE CITY 1
SMALL CITY 2
COUNTRYSIDE 3

105) In what month and year were you born?

MONTH___
DON'T KNOW MONTH 98
YEAR___
DON'T KNOW YEAR 98

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

AGE IN COMPLETED YEARS___

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
SECONDARY 1ST CYCLE 2
SECONDARY 2ND CYCLE 3
HIGHER 4

109) What is the highest (grade/form/year) you completed at this level?*

GRADE___

PRIMARY
CP1 01
CP2 02
CE1 03
CE2 04
CM1 05
CM2 06
SECONDARY 1ST CYCLE
6TH 01
5TH 02
4TH 03
3RD 04
SECONDARY 2ND CYCLE
2ND 01
1ST 02
FINAL 03
HIGHER
01
02
03
04
ETC

110) CHECK 108:

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

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

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

YES 1
NO 2

113) Do you usually listen to the radio at least once a week?

YES 1
NO 2

114) Do you usually watch television at least once a week?

YES 1
NO 2

115) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
TRADITIONAL 4
NO RELIGION 5
OTHER (SPECIFY)_____ 6

116) What is your ethnicity?

ETHNICITY_____

117) CHECK Q. 4 IN HOUSEHOLD QUESTIONNAIRE:

RESPONDENT IS NOT A RESIDENT (GO TO 118)
RESPONDENT IS A RESIDENT (GO TO 201)

118) Now I would like to ask about the place in which you usually live. Do you usually live in a city, a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

119) In which [state/province] is that located?

NAME OF STATE/PROVINCE____

120) Now I would like to ask you about the household in which you usually live. What is the main source of water used to wash hands and dishes?

PIPED WATER
PIPED INTO DWELLING/YARD/PLOT 11 (GO TO 122)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 122)
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 122)
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 122)
OTHER (SPECIFY)_____ 71

121) How long does it take to go there, get water, and come back?

MINUTES____
ON PREMISES 996

121A) How far away is your house from (SOURCE OF WATER) in meters?

METERS____
ON PREMISES 9996

122) Does your household use this same source for drinking water?

YES 1 (GO TO 124)
NO 2

123) What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO DWELLING/YARD/PLOT 11
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41
TANKER TRUCK 51
BOTTLED WATER 61
OTHER (SPECIFY)_____ 71

124) What kind of toilet facility does your household have?

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
WC 21
TRADITIONAL PIT TOILET 22
VENTILATED IMPROVED PIT (VIP) LATRINE 23
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY)_____ 41

125) Does your household have:

Electricity?
YES 1
NO 2
A radio?
YES 1
NO 2
A television?
YES 1
NO 2
A refrigerator?
YES 1
NO 2

126) How many rooms in your household are used for sleeping?

NUMBER OF ROOMS_____

127) Could you describe the main material of the floor in your home?

NATURAL FLOOR
EARTH/SAND 11
DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES/CARPET 33
CEMENT 34
OTHER (SPECIFY)____ 41

128) Does any member of your household own:

A bicycle?
YES 1
NO 2
A motorcycle or motor scooter?
YES 1
NO 2
A car?
YES 1
NO 2

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? 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? 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 child who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD_________
GIRLS DEAD ________

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

TOTAL _____

209) CHECK 208:
Just to make 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 201-209 AS NECESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 223)

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME____

213) Were any of these births twins?
IF 'YES': Which ones? AND CIRCLE "2"

SINGULAR 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

MONTH _________
YEAR ___________

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

217) IF ALIVE: How old 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 (GO TO NEXT BIRTH)
NO 2 (GO TO NEXT BIRTH)

219) IF DEAD: How old was (NAME) when he/she died?
RECORD IN DAYS IF LESS THAN 1 MONTH, IN MONTHS IF LESS THAN TWO YEARS, OR IN YEARS.
IF "1 YEAR," GO TO 220

DAYS 1 __________
MONTHS 2 __________
YEARS 3 __________

220) How old was (NAME) in months when he/she died?

AGE IN MONTHS____

221) 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 1 YEAR OR 12 MONTHS: PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS___
THE NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

222) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1991.
IF NONE, RECORD '0'.

223) Are you pregnant now?

YES 1
NO 2 (GO TO 226)
NOT SURE 8 (GO TO 226)

224) How many months pregnant are you?

MONTHS_______

225) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, did you not want to have any more children, or were you not sure if you wanted another child or not?

THEN 1
LATER 2
NOT AT ALL 3
UNSURE 4

226) When did your last menstrual cycle start?

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

IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

YES 1
NO 2 (GO TO 229)
DON'T KNOW 8 (GO TO 229)

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

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF HER CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY)____ 5
DON'T KNOW 8

229) Have you ever been circumcised?

YES 1
NO 2 (GO TO 301)
NO RESPONSE 8 (GO TO 301)

230) Who performed the circumcision?

DOCTOR 1
NURSE 2
TRAINED MIDWIFE 3
TRADITIONAL MIDWIFE 4
OTHER (SPECIFY)____ 5
DON'T KNOW 8

231) How old were you when you were circumcised?

AGE AT CIRCUMCISION____

LESS THAN A YEAR 00
DON'T KNOW 98

SECTION 3. CONTRACEPTION

301) 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. Which ways or methods have you heard of?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN, PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE MOVING ON TO THE NEXT METHOD.

302) Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.

01) PILL: Women can take a pill every day.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
03) INJECTABLES: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
04) IMPLANTS: Women can have several small rods placed in their upper arm under the skin which can prevent pregnancy for several years.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
05) DIAPHRAGM/FOAM/JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
06) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
07) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
08) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
09) PERIODIC ABSTINENCE: Some couples avoid having sexual intercourse on certain days during her menstrual cycle when the woman is most likely to get pregnant.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO DIFFERENT METHODS.
SPECIFY____
YES, SPONTANEOUS 1
NO 3

303) Have you ever used (METHOD)?

01) PILL: Women can take a pill every day.
YES 1
NO 2
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) INJECTABLES: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.
YES 1
NO 2
04) IMPLANTS: Women can have several small rods placed in their upper arm under the skin which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM/FOAM/JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION: Women can have an operation to avoid having any more children: Have you had an operation to avoid having any more children?
YES 1
NO 2
08) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
09) PERIODIC ABSTINENCE: Some couples avoid having sexual intercourse on certain days during her menstrual cycle when the woman is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304) Do you know where to go to obtain (METHOD)?

01) PILL: Women can take a pill every day.
YES 1
NO 2
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) INJECTABLES: Women can have an injection by a heath provider which stops them from becoming pregnant for several months.
YES 1
NO 2
04) IMPLANTS: Women can have several small rods placed in their upper arm under the skin which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM/FOAM/JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
08) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
09) PERIODIC ABSTINENCE: Some couples avoid having sexual intercourse on certain days during her menstrual cycle when the woman is most likely to get pregnant: Do you know where to obtain information on periodic abstinence?
YES 1
NO 2

305) CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 306)
AT LEAST ONE 'YES' (EVER USED) (GO TO 308)

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

YES___
NO__ (GO TO 327)

307) What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY)

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

NUMBER OF CHILDREN____

309) CHECK 223:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 327)

310) CHECK 303:

WOMAN NOT STERILIZED (GO TO 311)
WOMAN STERILIZED (GO TO 314A)

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

YES 1 (GO TO 314)
NO 2

312) CHECK 303 AND 306:

WOMAN EVER USED A METHOD (AT LEAST ONE 'YES') (GO TO 313)
WOMAN NEVER USED A METHOD (NOT A SINGLE 'YES') (GO TO 327)

313) What is the main reason that you are not using a method of contraception to avoid pregnancy?

WANTS CHILDREN 01 (GO TO 327)
PREGNANT 02 (GO TO 327)
COSTS TOO MUCH 04 (GO TO 327)
SIDE EFFECTS 05 (GO TO 327)
HEALTH PROBLEMS 06 (GO TO 327)
DIFFICULT TO OBTAIN 07 (GO TO 327)
RELIGION 08 (GO TO 327)
BAD SERVICE 09 (GO TO 327)
FATALISTIC 10 (GO TO 327)
INFREQUENT SEX 12 (GO TO 327)
DIFFICULTY GETTING PREGNANT 13 (GO TO 327)
MENOPAUSAL/STERILIZED 14 (GO TO 327)
INCONVENIENT TO USE 15 (GO TO 327)
NOT MARRIED 16 (GO TO 327)
OTHER (SPECIFY)____ 17 (GO TO 327)
DON'T KNOW 98 (GO TO 327)

314) Which method are you using?
314A) CIRCLE '07' FOR FEMALE STERILIZATION

PILL 01
IUD 02 (GO TO 321)
INJECTABLES 03 (GO TO 321)
IMPLANTS 04 (GO TO 321)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 321)
CONDOM 06 (GO TO 321)
FEMALE STERILIZATION 07 (GO TO 321)
MALE STERILIZATION 08 (GO TO 321)
PERIODIC ABSTINENCE 09 (GO TO 324)
WITHDRAWAL 10 (GO TO 324)
OTHER (SPECIFY)____ 11(GO TO 324)

315) When you used the pill for the first time, did you consult a doctor, a nurse, or a midwife?

YES 1
NO 2
DON'T KNOW 8

316) The last time you obtained the pill, did you consult a doctor, a nurse, or a midwife?

YES 1
NO 2

317) May I see the package of pills you are using right now?
(RECORD NAME OF BRAND)

BOX SEEN 1 (GO TO 319)
BRAND___(GO TO 319)
BOX NOT SEEN 2

318) Do you know the brand name of the pills you are currently using?
(RECORD NAME OF BRAND)

NAME OF BRAND____
DON'T KNOW 98

319) How much does one packet of pills cost you?

PRICE ______

FREE 9996
DON'T KNOW 9998

320) How many cycles are there in a box?

NUMBER OF CYCLES_____
DON'T KNOW 98

321) CHECK 314:

SHE/HE STERILIZED: Where did the sterilization take place?

USED ANOTHER METHOD: Where did you obtain (METHOD) the last time?

NAME OF PLACE___
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
CLINIC 13
MEDICAL POST 14
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
PHARMACY 23
FAMILY PLANNING CENTER 24
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32 (GO TO 324)
ACQUAINTANCES/RELATIVES 33 (GO TO 324)
OTHER (SPECIFY)______ 41(GO TO 324)
DON'T KNOW 98 (GO TO 324)

322) How long does it take you to get from your home to this place?
IF 90 MINUTES OR LESS, RECORD THE ANSWER IN MINUTES. OTHERWISE, RECORD IN HOURS.

MINUTES 1____
HOURS 2____

DON'T KNOW 998

323) It is easy or difficult to get there?

EASY 1
DIFFICULT 2

324) CHECK 314:

SHE/HE STERILIZED (GO TO 325)
USED ANOTHER METHOD (GO TO 326)

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

MONTH____ (GO TO 332)
YEAR____ (GO TO 332)

326) For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'

MONTHS____ (GO TO 332)
8 YEARS OR LONGER 96 (GO TO 332)

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

YES 1 (GO TO 329)
NO 2
DON'T KNOW 8 (GO TO 333)

328) What is the main reason that you do not intend to use a method?

WANTS CHILDREN 01 (GO TO 333)
LACK OF INFORMATION 02 (GO TO 333)
PARTNER DOES NOT APPROVE 03 (GO TO 333)
COSTS TOO HIGH 04 (GO TO 333)
SIDE EFFECTS 05 (GO TO 333)
HEALTH PROBLEMS 06 (GO TO 333)
DIFFICULT TO OBTAIN 07 (GO TO 333)
RELIGION 08 (GO TO 333)
OPPOSES FAMILY PLANNING 09 (GO TO 333)
FATALISTIC 10 (GO TO 333)
OTHER PEOPLE DISAPPROVE 11 (GO TO 333)
INFREQUENT SEXUAL RELATIONS 12 (GO TO 333)
DIFFICULTY GETTING PREGNANT 13 (GO TO 333)
IN MENOPAUSE/STERILIZED 14 (GO TO 333)
INCONVENIENT 15 (GO TO 333)
NO HUSBAND OR PARTNER 16 (GO TO 333)
OTHER (SPECIFY)_______ 17 (GO TO 333)
DON'T KNOW 98 (GO TO 333)

329) Do you intend to use a method in the next 12 months?

YES 1
NO 2
DON'T KNOW 8

330) When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTABLES 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09 (GO TO 333)
WITHDRAWAL 10 (GO TO 333)
OTHER (SPECIFY)______ 11 (GO TO 333)
UNSURE 98 (GO TO 333)

331) Where can you obtain (METHOD FROM 330)?

PUBLIC SECTOR
HOSPITAL 11 (GO TO 335)
HEALTH CENTER 12 (GO TO 335)
CLINIC 13 (GO TO 335)
MEDICAL POST 14 (GO TO 335)
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21(GO TO 335)
PRIVATE HOSPITAL CLINIC 22 (GO TO 335)
PHARMACY 23 (GO TO 335)
FAMILY PLANNING CENTER 24 (GO TO 335)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 335)
CHURCH 32 (GO TO 337)
ACQUAINTANCES/RELATIVES 33 (GO TO 337)
OTHER (SPECIFY)_____ 41 (GO TO 337)
DON'T KNOW 98

332) CHECK 314:

USED PERIODIC ABSTINENCE, WITHDRAWAL, OR OTHER TRADITIONAL METHOD (GO TO 333)
USED MODERN METHOD (GO TO 337)

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

YES 1
NO 2 (GO TO 337)

334) Where is that?

NAME OF PLACE____
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
CLINIC C
MEDICAL POST D
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR E
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
FAMILY PLANNING CENTER H
OTHER PUBLIC SECTOR
SHOP I
CHURCH J (GO TO 337)
ACQUAINTANCES/RELATIVES K (GO TO 337)
OTHER (SPECIFY)____ L (GO TO 337)
DON'T KNOW M (GO TO 337)

335) How long does it take you to get from your home to this place?
IF 90 MINUTES OR LESS, RECORD THE ANSWER IN MINUTES. OTHERWISE, RECORD IN HOURS.

MINUTES 1____
HOURS 2_____

DON'T KNOW 998

336) It is easy or difficult to get there?

EASY 1
DIFFICULT 2

337) In the last month, have you heard about family planning:

On the radio?
YES 1
NO 2
On television?
YES 1
NO 2

338) Are you for or against information on family planning being provided on the radio or on television?

FOR 1
AGAINST 2
DON'T KNOW 8

339) What is your main source of information on family planning?

HUSBAND/PARTNER A
OTHER RELATIVES B
FRIENDS/NEIGHBORS C
RADIO/TELEVISION D
NEWSPAPERS/MAGAZINES E
BROCHURES/BOOKLETS F
POSTERS G
HEALTH FACILITY H
OTHER (SPECIFY)____ I

SECTION 4A: PREGNANCY AND BREASTFEEDING

401) CHECK 222:

ONE OR MORE BIRTHS SINCE JANUARY 1991 (GO TO 402)
NO BIRTHS SINCE JANUARY 1991 (GO TO 501)

402) RECORD THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRES.)

Now I would like to ask you some questions about the health of all your children born in the last 5 years. (We will talk about once child at a time.)

LINE NUMBER FROM Q. 212

LINE NO.____

FROM Q. 212 AND Q. 216

NAME___
LIVING___
DEAD___

403) At the time you became pregnant with (NAME), did you want to get pregnant then, did you want to wait until later, did you not want any (more) children at all, or were you not sure if you wanted another child or not?

THEN 1 (GO TO 405)
LATER 2
NOT AT ALL 3 (GO TO 405)
UNSURE 4 (GO TO 405)

404) How much longer would you like to have waited?

MONTHS 1 ____
YEARS 2 ____

DON'T KNOW 998 ____

405. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY)____ F
NO ONE Y (GO TO 409)

405A) Do you have a health card where the antenatal care that you received during your pregnancy with (NAME) and the care that (NAME) received was recorded?
IF YES: May I see it, please?

YES, SEEN 1
YES, NOT SEEN 2
NO CARD 3

406) IF "YES, SEEN" (CODE 1), RECORD THE INFORMATION FROM THE CARD IN QUESTIONS 407-417. ASK THE QUESTIONS ONLY FOR THE INFORMATION THAT IS MISSING FROM THE CARD. IF THE ANSWER IS "YES", BUT YOU DID NOT SEE THE CARD, OR IF THE WOMAN DOES NOT HAVE THE CARD, ASK THE QUESTIONS AS THEY ARE WRITTEN IN THE QUESTIONNAIRE.

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

MONTHS _____
DON'T KNOW 98

408) How many prenatal visits did you have during this pregnancy?

NUMBER OF VISITS ______
DON'T KNOW 98

409) When you were pregnant with (NAME), were you given an injection to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 411)
DON'T KNOW 8 (GO TO 411)

410) How many times did you get this injection?

NUMBER OF TIMES ____
DON'T KNOW 8

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

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
PUBLIC HOSPITAL 21
MATERNITY POST 22
HEALTH CENTER/MOTHER-INFANT CENTER 22
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER (SPECIFY)____ 41

412) Who assisted you with the delivery of (NAME)? Anyone else?
PROBE TO OBTAIN THE TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
RELATIVE F
OTHER (SPECIFY)_____ G
NO ONE H

413) Was (NAME) born full-term or prematurely?

FULL TERM 1
PREMATURE 2
DON'T KNOW 8

414) Was (NAME) delivered by cesarean section?

YES 1
NO 2

415) 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

416) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418)

417) How much did (NAME) weigh?

KILOGRAMS____
DON'T KNOW 98

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

YES 1 (GO TO 420)
NO 2 (GO TO 421)

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

YES 1
NO 2 (GO TO 423)

420) For how many months after the birth of (NAME) did you not have a period?

MONTHS____
DON'T KNOW 98

421) CHECK 223:
WOMAN PREGNANT?
[FOR LAST BIRTH ONLY]

NOT PREGNANT (GO TO 422)
PREGNANT OR UNSURE (GO TO 423)

422) Have you resumed sexual relations again since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 424)

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

MONTHS___
DON'T KNOW 98

424) Did you breastfeed (NAME)?

YES 1 (GO TO 426 FOR LAST BIRTH; GO TO 433 FOR ALL OTHER BIRTHS)
NO 2

425) Why didn't you breastfeed (NAME)?

MOTHER ILL/WEAK 01 (GO TO 435)
CHILD ILL/WEAK 02 (GO TO 435)
CHILD DEAD 03 (GO TO 435)
NIPPLE/BREAST PROBLEM 04 (GO TO 435)
NO MILK 05 (GO TO 435)
MOTHER WORKS 06 (GO TO 435)
CHILD REFUSED 07 (GO TO 435)
OTHER (SPECIFY)_____ 08 (GO TO 435)

426) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD IN HOURS. OTHERWISE, RECORD DAYS.
[FOR LAST BIRTH ONLY]

IMMEDIATELY 000

HOURS 1 _____
DAYS 2 _____

427) CHECK 216:
CHILD ALIVE?
[FOR LAST BIRTH ONLY]

LIVING (GO TO 428)
DEAD (GO TO 433)

428) Are you still breastfeeding (NAME)?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 433)

429) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[FOR LAST BIRTH ONLY]

NUMBER OF NIGHTTIME FEEDINGS___

430) 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 DAYTIME FEEDINGS____

431) At any time yesterday or last night, was (NAME) given any of the following:
[FOR LAST BIRTH ONLY]

Plain water?
YES 1
NO 2
Sugar water?
YES 1
NO 2
Rice water?
YES 1
NO 2
Juice?
YES 1
NO 2
Herbal tea?
YES 1
NO 2
Baby formula?
YES 1
NO 2
Fresh milk?
YES 1
NO 2
Tinned or powdered milk?
YES 1
NO 2
Other liquids?
YES 1
NO 2
Any solid or semi-solid food?
YES 1
NO 2

432) CHECK 431:
FOOD OR LIQUID GIVEN YESTERDAY?
[FOR LAST BIRTH ONLY]

'YES' TO ONE OR MORE (GO TO 437)
NOTHING AT ALL (GO TO 436)

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

MONTHS____
UNTIL HIS/HER DEATH 95

434) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DEAD 03
NIPPLE/BREAST PROBLEM 04
NO MILK 05
MOTHER WORKS 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY)____ 11

435) CHECK 216:
CHILD ALIVE?

LIVING (GO TO 437)
DEAD (GO TO 436)

436) Have you ever given (NAME) water or anything else to eat or drink (other than breastmilk)?

YES 1
NO 2 (GO TO 440)

437) How old was (NAME) when you started giving him/her the following regularly:
IF LESS THAN 1 MONTH, RECORD '00'.

Tinned milk or milk other than breastmilk?
AGE IN MONTHS____
NEVER GIVEN 96
Water?
AGE IN MONTHS____
NEVER GIVEN 96
Other liquids?
AGE IN MONTHS____
NEVER GIVEN 96
Solid or semi-solid foods?
AGE IN MONTHS____
NEVER GIVEN 96

438) CHECK 216:
CHILD ALIVE?
[FOR LAST BIRTH ONLY]

LIVING (GO TO 439)
DEAD (GO TO 440)

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

YES 1
NO 2
DON'T KNOW 8

440) GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO THE FIRST COLUMN OF 441.

SECTION 4B. IMMUNIZATION AND HEALTH

441) ENTER THE NAME AND LINE NUMBER OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS FOR ALL THE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRES.)

LINE NUMBER FROM Q. 212

LINE NUMBER____
NAME___

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

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

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

YES 1 (GO TO 446)
NO 2 (GO TO 446)

444) (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF THE CARD SHOWS THAT A VACCINE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY___
MONTH___
YEAR____
DTP POLIO 1
DAY___
MONTH___
YEAR____
DTP POLIO 2
DAY___
MONTH___
YEAR____
DTP POLIO 3
DAY___
MONTH___
YEAR____
YELLOW FEVER
DAY___
MONTH___
YEAR____
MEASLES
DAY___
MONTH___
YEAR____

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 444)
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)

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

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

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

A BCG vaccination against tuberculosis, that is, an injection in the left arm that leaves a scar.
YES 1
NO 2
DON'T KNOW 8
Polio vaccine, that is, drops in the mouth?
IF YES: How many times?
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ______
Any injection to prevent measles?
YES 1
NO 2
DON'T KNOW 8

448) CHECK 216:
CHILD ALIVE?

LIVING (GO TO 450)
DEAD (GO TO 449)

449) GO BACK TO 442 FOR THE NEXT BIRTH; OR, IF THERE ARE NO MORE BIRTHS, GO TO 480.

450) Has (NAME) ever been ill with a fever at any time during the last 2 weeks?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 455)
DON'T KNOW 8 (GO TO 455)

452) Has (NAME) been ill with a cough in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

453) IF Q. 452 = "NO": How many days did the cough last?
IF Q. 452 = "YES": For how many days has the cough lasted?
IF LESS THAN ONE DAY, RECORD '00'.

DAYS____

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

YES 1
NO 2
DON'T KNOW 8

455) CHECK 450 AND 451:
FEVER OR COUGH?

"YES" TO 450 OR 451 (GO TO 456)
OTHER (GO TO 460)

456) Was something given to treat the fever/cough?

YES 1
NO 2 (GO TO 458)
DON'T KNOW 8 (GO TO 458)

457) What was given to treat the fever/cough? Anything else?
RECORD ALL MENTIONED.

INJECTIONS A
PILL B
ANTI-MALARIAL C
COUGH SYRUP D
HOME REMEDY/MEDICAL PLANTS E
OTHER (SPECIFY)_____ F

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

YES 1
NO 2 (GO TO 460)

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

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
HEALTH POST C
MOBILE CLINIC D
HEALTH PROFESSIONAL E
PRIVATE MEDICAL SECTOR
CLINIC/HOSPITAL F
PHARMACY G
PHARMACY DEPOT H
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER I
OTHER (SPECIFY)_____ J

460) Has (NAME) had diarrhea in the last 2 weeks?

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

461) GO BACK TO 442 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 480.

462) Has (NAME) had diarrhea in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

463) IF Q. 462 = "NO": How many days did the diarrhea last?
IF Q. 462 = "YES": For how many days has the diarrhea lasted?
IF LESS THAN ONE DAY, RECORD '00'.

DAYS____

464) Was there blood in the stools?

YES 1
NO 2
DON'T KNOW 8

465) CHECK 424/428:
LAST CHILD STILL BREASTFEEDING?
[FOR LAST BIRTH ONLY]

YES (GO TO 466)
NO (GO TO 467A)

466) When (NAME) had diarrhea, did you change the number of breastfeedings?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 467A)

467) Did you increase or decrease the number of portions, or did you stop completely?
[FOR LAST BIRTH ONLY]

INCREASE 1
DECREASE 2
STOP COMPLETELY 3

467A) (Other than breastmilk), was he/she given the same amount of food to eat as before the diarrhea, more to eat, or less to eat?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

468) (Other than breastmilk), was he/she given the same amount to drink as before the diarrhea, more to drink, or less to drink?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

469) Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 471)
DON'T KNOW 8 (GO TO 471)

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

ORS LIQUID A
HOMEMADE LIQUID B
PILL OR SYRUP C
INJECTION D
IV DRIP E
GASTRIC TUBE F
HOME REMEDIES/HERBAL MEDICINE G
OTHER (SPECIFY)____ H

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

YES 1
NO 2 (GO TO 473)

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

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
HEALTH POST C
MOBILE CLINIC D
HEALTH PROFESSIONAL E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PHARMACY DEPOT H
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER I
OTHER (SPECIFY)_____ J

473) CHECK 470:
LIQUID FROM ORS PACKET MENTIONED

NO, ORS LIQUID NOT MENTIONED (GO TO 474)
YES, ORS LIQUID MENTIONED (GO TO 475)

474) Did (NAME) receive ORS when he/she had diarrhea?

YES 1
NO 2 (GO TO 476)
DON'T KNOW 8 (GO TO 476)

475) For how many days did (NAME) receive the ORS?
IF LESS THAN ONE DAY, RECORD '00'

DAYS____
DON'T KNOW 98

476) CHECK 470:
HOMEMADE LIQUID MENTIONED (CODE B)

NO, HOMEMADE LIQUID NOT MENTIONED (GO TO 477)
YES, HOMEMADE LIQUID MENTIONED (GO TO 478)

477) Did (NAME) receive a homemade liquid of water, sugar, and salt when he/she had diarrhea?

YES 1
NO 2 (GO TO 479)
DON'T KNOW 8 (GO TO 479)

478) For how many days did (NAME) receive the water, sugar, and salt solution?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS____
DON'T KNOW 98

479) GO BACK TO 442 FOR THE NEXT CHILD; OR, IF NO MORE CHILDREN, GO TO 480.

480) CHECK 470 (ALL COLUMNS) AND 474:

ORS SOLUTION MENTIONED (GO TO 484)
ORS SOLUTION NOT MENTIONED OR 470 AND 474 NOT ASKED (GO TO 481)

481) Have you ever heard of a special product called ORS that you can get to treat diarrhea?

YES 1 (GO TO 483)
NO 2

482) Have you ever seen a packet like this before?
(SHOW PACKET)

YES 1
NO 2 (GO TO 501)

483) Have you ever prepared a solution with one of these packets to treat diarrhea for yourself or for someone else?
(SHOW PACKET)

YES 1
NO 2 (GO TO 485)

484) How much water did you use to prepare the ORS packet the last time you made it?

½ LITER 01
1 LITER 02
1 ½ LITERS 03
2 LITERS 04
ACCORDING TO PACKET INSTRUCTIONS 05
OTHER (SPECIFY)____ 06
DON'T KNOW 98

485) Where can you get an ORS packet?
PROBE: Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
HEALTH POST C
MOBILE CLINIC D
HEALTH PROFESSIONAL E
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC/HOSPITAL F
PHARMACY G
PHARMACY DEPOT H
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER I
OTHER (SPECIFY)____ J
DON'T KNOW K

SECTION 5. MARRIAGE

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

YES 1 (GO TO 504)
NO 2

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

YES 1
NO 2 (GO TO 511)

503) Are you currently widowed, divorced, or separated?

WIDOWED 3 (GO TO 508)
DIVORCED 4 (GO TO 508)
SEPARATED 5 (GO TO 508)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

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

YES 1
NO 2 (GO TO 508)

506) How many other wives does he have?

NUMBER____
DON'T KNOW 98 (GO TO 508)

507) Are you the first, second, third…wife?

RANK _____

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

ONCE 1
MORE THAN ONCE 2

509) In what month and year did you start living with your (first) husband/partner?

MONTH_____
DON'T KNOW MONTH 98
YEAR____ (GO TO 513)
DON'T KNOW YEAR 98

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

AGE_____ (GO TO 513)

511) CHECK 201:

NEVER HAD ANY CHILDREN (GO TO 512)
ALREADY HAD CHILDREN (GO TO 513)

512) Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 515)

513) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse?

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

BEFORE LAST BIRTH 996

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

AGE___
FIRST TIME WHEN MARRIED 96

515) CHECK FOR THE PRESENCE OF OTHERS AT THIS TIME

CHILDREN AGE 10 OR LESS
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MEN
YES 1
NO 2
OTHER WOMEN
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601) CHECK 314:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 607)

602) CHECK 501:

CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 603)
NOT MARRIED/NOT IN UNION (GO TO 614)

603) CHECK 223:

NOT PREGNANT OR UNSURE: Now I have some question about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

PREGNANT: Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 610)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 610)
UNDECIDED/DON'T KNOW 8 (GO TO 610)

604) CHECK 223:

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 (GO TO 610)
YEARS____ 2 (GO TO 610)

SOON/NOW 994 (GO TO 610)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 610)
OTHER (SPECIFY)____ 996
DON'T KNOW 998

605) CHECK 216 AND 223:
HAS LIVING CHILD(REN) OR PREGNANT?

YES (GO TO 606)
NO (GO TO 610)

606) CHECK 223:

NOT PREGNANT OR NOT SURE: How old would you like your youngest child to be before your next child is born?

PREGNANT: How old would you like the child you're expecting now to be before your next child is born?

AGE OF YOUNGEST CHILD IN YEARS_____(GO TO 610)
DON'T KNOW 98 (GO TO 610)

607) In your current situation, if you could change it, do you think that (you/your husband/partner) would make the same decision to get sterilized?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 614)

609) Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 614)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 614)
SIDE EFFECTS 3 (GO TO 614)
OTHER REASON (SPECIFY)_____ 4 (GO TO 614)

610) Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

612) Have you ever talked to your husband about the number of children you would like to have?

YES 1
NO 2

613) 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

614) After the birth of a child, how long should a couple wait before resuming sexual relations?

MONTHS 1____
YEARS 2____

OTHER (SPECIFY)_____ 996

615) Should a mother wait until she is finished breastfeeding before resuming sexual relations or does it not matter?

WAIT 1
DOESN'T MATTER 2

616) Do you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2

617) CHECK 216:

HAS LIVING CHILD(REN): 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 CHILD(REN): If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NUMBER____
OTHER RESPONSE (SPECIFY)_____ 96

618) What do you think is the best interval between the birth of one child and the birth of the next?

MONTHS 1____
YEARS 2____

OTHER (SPECIFY)______ 996

619) Have you ever had an unintended pregnancy?

YES 1
NO 2 (GO TO 701)

620) How many unintended pregnancies have you had?

NUMBER_____

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

701) CHECK 501 AND 502:

HAS BEEN MARRIED OR LIVED WITH A MAN (GO TO 702) (ASK QUESTIONS ON THE CURRENT OR MOST RECENT HUSBAND/PARTNER)
NEVER MARRIED/NEVER IN UNION (GO TO 708)

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

YES 1
NO 2 (GO TO 705)

703) What was the highest level of school he attended: primary, secondary first cycle, secondary second cycle, or higher?

PRIMARY 1
SECONDARY 1ST CYCLE 2
SECONDARY 2ND CYCLE 3
HIGHER 4
DON'T KNOW 8 (GO TO 705)

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

GRADE

PRIMARY
CP1 01
CP2 02
CE1 03
CE2 04
CM1 05
CM2 06
SECONDARY 1ST CYCLE
6TH 01
5TH 02
4TH 03
3RD 04
SECONDARY 2ND CYCLE
2ND 01
1ST 02
FINAL 03
HIGHER
01
02
03
04
ETC
DON'T KNOW 98

705) What is/was your (last) husband's occupation?

OCCUPATION_____

706) CHECK 705:

WORKS/WORKED IN AGRICULTURE (GO TO 707)
DOES/DID NOT WORK IN AGRICULTURE (GO TO 708)

707) Does/did your husband/partner work mainly on his own land or on family land, or does/did he work on land that he rents/rented from someone else, or does/did he work on someone else's land?

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

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

YES 1 (GO TO 710)
NO 2

709) 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
NO 2 (GO TO 801)

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

OCCUPATION____

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3 (GO TO 713)

712) Do you earn a salary for this work?
PROBE: Do you earn money for this work?

YES 1
NO 2

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

HOME 1
AWAY 2

713A) Is this work temporary, seasonal, or permanent?

TEMPORARY 1
SEASONAL 2
PERMANENT 3

714) CHECK 215/216/218:
CHILD BORN SINCE JANUARY 1989 LIVING WITH HER?

YES (GO TO 715)
NO (GO TO 801)

715) While you work, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes with you, or never with you?

USUALLY 1 (GO TO 801)
SOMETIMES 2
NEVER 3

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

HUSBAND/PARTNER 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY)_____ 09

SECTION 8. MATERNAL MORALITY

801) 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. Please give me the names of all your brothers and sisters who live with you, who live elsewhere, or who are dead.
RECORD THE NAMES OF ALL BROTHERS AND SISTERS. IF NO BROTHERS OR SISTERS (GO TO 901)

802) What was the name given to your first born (next) brother or sister?

NAME____

803) Is (NAME) male or female?

MALE 1
FEMALE 2

804) Is (NAME) still alive?

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

805) How old is (NAME)?

AGE____ (GO TO NEXT COLUMN)

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

YEARS____

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

AGE____ (IF MALE OR DIED BEFORE 10 YEARS OF AGE, GO TO NEXT COLUMN)

809) Was (NAME) married?

YES 1
NO 2

810) Did (NAME) die during childbirth?

YES 1 (GO TO 813)
NO 2

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

YES 1 (GO TO 813)
NO 2
DON'T KNOW 8

812) Was (NAME) pregnant when she died?

YES 1
NO 2
DON'T KNOW 8

813) Did (NAME) die in a hospital, a health center, at home, or elsewhere?

HOSPITAL OR HEALTH CENTER 1
HOME 2
OTHER 3
DON'T KNOW 8

814) To how many children did (NAME) give birth?

NUMBER OF CHILDREN____

815) Now I would like to make sure I have this right. Your mother gave birth to ___ total children, including yourself?

YES (GO TO 816)
NO (CHECK AND CORRECT)

816) Among your brothers, ___ died?

YES (GO TO 817)
NO (CHECK AND CORRECT)

817) Among your sisters, ___ died?

YES (GO TO 901)
NO (CHECK AND CORRECT)

SECTION 9. KNOWLEDGE AND ATTITUDES ABOUT AIDS

901) Now I would like to ask you some questions about a very important subject. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 915)

902) Who have you heard talking about it?
RECORD ALL MENTIONED

SPOUSE/PARTNER A
HEALTH WORKER B
RADIO/TELEVISION C
NEWSPAPERS D
FRIEND(S)/RELATIVE(S)/NEIGHBOR(S) E
POSTER/AD CAMPAIGN F
OTHER (SPECIFY)____ G
DON'T KNOW H

903) Have you ever gone to conferences or talks about AIDS?

YES 1
NO 2
DON'T KNOW 8

904) In your opinion, how can you get AIDS?

SEXUAL INTERCOURSE A
BLOOD TRANSFUSIONS B
USE OF NON-STERILIZED SYRINGES AND NEEDLES C
FROM MOTHER TO CHILD D
EATING FROM THE SAME PLATE AS SOMEONE WITH AIDS E
WEARING THE CLOTHES OF SOMEONE WITH AIDS F
MOSQUITO/INSECT BITES G
OTHER (SPECIFY)___ H
DON'T KNOW L

904A) CHECK 904:

MENTIONED SEXUAL INTERCOURSE (GO TO 905)
DID NOT MENTION SEXUAL INTERCOURSE (GO TO 906)

905) From what type of sexual relations can you get AIDS?
RECORD ALL MENTIONED.

WITH A PARTNER A
WITH PROSTITUTES B
HOMOSEXUAL RELATIONS C
CASUAL RELATIONS D
OTHER (SPECIFY)____ E
DON'T KNOW F

906) Do you think that a woman with AIDS can give birth to a baby with AIDS?

YES 1
NO 2
DON'T KNOW 8

907) In your opinion, is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

908) Do you think that a person with AIDS can be cured?

YES 1
NO 2
DON'T KNOW 8

909) What do you think a person can do to avoid getting AIDS?
CIRCLE ALL MENTIONED

USE CONDOMS A
HAVE ONLY ONE PARTNER B
AVOID SEX WITH PROSTITUTES C
ABSTAIN FROM SEXUAL INTERCOURSE D
AVOID USING NON-STERILIZED SYRINGES AND NEEDLES E
AVOID ALL CONTACT WITH PEOPLE INFECTED WITH AIDS F
AVOID TOUCHING CONTAMINATED BLOOD G
OTHER (SPECIFY)____ H
DON'T KNOW I

910) How can one recognize someone who has AIDS?
CIRCLE ALL MENTIONED.

WEIGHT LOSS A
DIARRHEA B
VOMITING C
SHIVERS AND FEVER D
BLOOD ANALYSIS E
SPOTS ON THE SKIN F
PERSISTENT COUGH G
OTHER (SPECIFY)___ H
DON'T KNOW I

911) What do you think should be done with people who have AIDS?

SEND THEM TO THE HOSPITAL 1
KEEP THEM AT HOME 2
ISOLATE THEM 3
OTHER (SPECIFY)_____ 4
DON'T KNOW 8

912) Do you know or did you know someone with AIDS?

YES 1
NO 2
DON'T KNOW 8

913) Where can one get information on methods to prevent AIDS?
RECORD ALL MENTIONED.

PUBLIC SECTOR
PUBLIC HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
PRIVATE MEDICAL SECTOR
CLINIC/PRIVATE NURSE C
PHARMACY D
OTHER PRIVATE SECTOR
RADIO/TELEVISION/NEWSPAPER E
FRIENDS/RELATIVES/PARTNERS F
OTHER (SPECIFY)____ G
DON'T KNOW H

914) Where can one go to get tested for AIDS?
RECORD ALL MENTIONED.

PUBLIC SECTOR
PUBLIC HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
PRIVATE MEDICAL SECTOR
CLINIC/PRIVATE NURSE C
PHARMACY D
OTHER (SPECIFY)____ E
DON'T KNOW F

915) CHECK 513:

HAS HAD SEXUAL RELATIONS IN THE LAST 2 MONTHS (GO TO 916)
HAS NOT HAD SEXUAL RELATIONS IN THE LAST 2 MONTHS (GO TO 922)

916) Did you use condoms during the sexual relations you had in the last 2 months?

YES 1
NO 2 (GO TO 921)

917) Did you use them each time, sometimes, or rarely?

EACH TIME 1
SOMETIMES 2
RARELY 3

918) Why did you use condoms?
CIRCLE ALL MENTIONED

AVOID PREGNANCY A
AVOID SEXUALLY TRANSMITTED INFECTIONS B
AVOID AIDS C
OTHER (SPECIFY)____ D
DON'T KNOW E

919) Where did you or your husband/partner, get the condoms?

PUBLIC SECTOR
PUBLIC HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
PRIVATE MEDICAL SECTOR
CLINIC/PRIVATE NURSE 21
PHARMACY 22
OTHER PRIVATE SECTOR
SHOP/MINI-MART/SUPERMARKET 31
HOTEL/BAR/DANCE CLUB 32
FRIENDS/RELATIVES/PARTNERS 33
OTHER (SPECIFY)____ 41
DON'T KNOW 98

920) What is the brand name of the condoms that your husband/partner uses?

PRUDENCE 1
SULTAN 2
OTHERS (SPECIFY)____ 3
DON'T KNOW 8

921) With how many partners have you had sexual relations in the last 2 months?

NUMBER OF PARTNERS____

ONLY WITH HUSBAND/PARTNER 95
SEVERAL 96

922) RECORD TIME AT END OF INTERVIEW

HOUR____
MINUTES____

SECTION 10. HEIGHT AND WEIGHT

1001) CHECK 215, 216:

ONE OR MORE BIRTHS SINCE JANUARY 1991 (GO TO 1002)
NO BIRTHS SINCE JANUARY 1991 (END INTERVIEW)

INTERVIEWER: IN 1002 (COLUMNS 2-4) RECORD THE LINE NUMBER OF EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE.
IN 1003 AND 1004, RECORD THE NAME AND BIRTH DATE OF THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991. IN 1006 AND 1008, RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL THE CHILDREN HAVE DIED)
(IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1991, USE ADDITIONAL QUESTIONNAIRES)

1002) LINE NUMBER FROM Q. 212
[FOR ALL EXCEPT RESPONDENT]

LINE NUMBER____

1003) NAME FROM Q. 212

NAME___

1004) DATE OF BIRTH FROM QUESTION 105 FOR RESPONDENT, FROM QUESTION 215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

DAY___
MONTH____
YEAR___

1005) BCG SCAR ON TOP OF LEFT SHOULDER
[FOR ALL EXCEPT RESPONDENT]

SCAR SEEN 1
NO SCAR 2

1006) HEIGHT (IN CENTIMETERS)

HEIGHT____

1007) MEASURED LYING DOWN OR STANDING UP?
[FOR ALL EXCEPT RESPONDENT]

LYING 1
STANDING 2

1008) WEIGHT (IN KILOGRAMS)

WEIGHT____

1009) DATE WEIGHED AND MEASURED

DAY___
MONTH____
YEAR___

1010) RESULT

RESPONDENT

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

CHILDREN BORN SINCE JANUARY 1991

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

1011) NAME OF MEASURER______

NAME____

NAME OF ASSISTANT______

NAME____

ASSISTANT'S RELATIONSHIP TO CHILD____

MOTHER 90
OTHER MEMBERS OF HOUSEHOLD 91
OTHER PERSONS 92

INTERVIEWER'S OBSERVATIONS

(To be filled out after completing interview)

COMMENTS ABOUT RESPONDENT_______

COMMENTS ON SPECIFIC QUESTIONS______

ANY OTHER COMMENTS______

SUPERVISOR'S OBSERVATIONS_______

NAME OF SUPERVISOR___
DATE____

EDITOR'S OBSERVATIONS______

NAME OF EDITOR____
DATE___