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DEMOGRAPHIC AND HEALTH SURVEY-COTE D'IVOIRE 1994-MAN'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

NAME OF HOUSEHOLD HEAD____

NAME AND LINE NUMBER OF MAN___

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

HOURS___
MINUTES____

102) In what month and year were you born?

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

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS____

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

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

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

106) 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
DON'T KNOW
DON'T KNOW 98

107) Did you finish this level (primary, post-primary, secondary, higher)?

YES 1
NO 2

108) What kind of work do you do?

OCCUPATION____

109) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
TRADITIONAL 4
NO RELIGION 5
OTHER (SPECIFY)____6

110) What is your ethnicity?

ETHNICITY____

111) Now I would like to ask you some questions about marriage. Are you currently married or living with a woman?

YES 1
NO 2 (GO TO 114)

112) How many spouses/wives do you currently have?

NUMBER____

113) LINE NUMBER OF THE WIFE/WIVES IN HOUSEHOLD QUESTIONNAIRE

LINE NUMBER___ (GO TO 116)

114) Have you ever been married?

YES 1
NO 2 (GO TO 118)

115) Are you widowed, divorced, or separated?

WIDOWED 1
DIVORCED 2
SEPARATED 3

116) In what month and year did you get married or start living with a woman for the first time?

MONTH___
DON'T KNOW MONTH 98
YEAR____ (GO TO 119)
DON'T KNOW YEAR 98

117) How old were you when you got married or started living with a woman for the first time?

AGE IN COMPLETED YEARS___ (GO TO 119)
DON'T KNOW AGE 98 (GO TO 119)

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

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

119) Do you have any children?

YES 1
NO 2 (GO TO 201)

120) How many boys do you have? How many girls do you have?

NUMBER OF BOYS____
NUMBER OF GIRLS_____

SECTION 2. CONTRACEPTION

201) 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 about?

CIRCLE CODE 1 IN 202 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN READING THE NAME AND DESCRIPTION OF EACH METHOD MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF THE METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 202, ASK 203 BEFORE CONTINUING ON TO THE NEXT METHOD.

202) Have you ever heard of (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

203) Have you ever used (METHOD)?

01) PILL: Women can take a pill every day: Has your wife/have your wives ever used the pill?
YES 1
NO 2
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse: Has your wife/have your wives ever used an IUD?
YES 1
NO 2
03) INJECTABLES: Women can have an injection by a heath provider which stops them from becoming pregnant for several months: Has your wife/have your wives ever used injectables?
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: Has your wife/have your wives ever used an implant?
YES 1
NO 2
05) DIAPHRAGM/FOAM/JELLY: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse: Has your wife/have your wives ever used a diaphragm or foam?
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: Has your wife/have your wives had an operation to avoid having any more children?
YES 1
NO 2
08) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you had 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? Have you or your wife/wives ever used (METHOD)?
YES 1
NO 2

204) CHECK 203:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 205)
AT LEAST ONE 'YES' (EVER USED) (GO TO 207)

205) Have you ever used anything or tried in any way to delay or avoid a pregnancy?

YES 1
NO 2

206) What have you done or used?
CORRECT 203, 204, 205 (AND 202 IF NECESSARY)

207) Are you or your partner(s) currently doing something or using any method to delay or avoid a pregnancy?

YES 1
NO 2 (GO TO 209)

208) Which method are you using?

PILL 01 (GO TO 212)
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
IMPLANTS 04 (GO TO 212)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 212)
CONDOM 06 (GO TO 212)
FEMALE STERILIZATION 07 (GO TO 212)
MALE STERILIZATION 08 (GO TO 212)
PERIODIC ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY)____ 11 (GO TO 212)

209) Do you or your wife/wives/partner(s) intend to use a method to avoid a pregnancy in the future?

YES 1
NO 2 (GO TO 211)
DON'T KNOW 3 (GO TO 212)

210) What method would you prefer to use?

PILL 01 (GO TO 212)
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
IMPLANTS 04 (GO TO 212)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 212)
CONDOM 06 (GO TO 212)
FEMALE STERILIZATION 07 (GO TO 212)
MALE STERILIZATION 08 (GO TO 212)
PERIODIC ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY)____ 11 (GO TO 212)
NOT SURE 98 (GO TO 212)

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

WANTS CHILDREN 01
LACK OF INFORMATION 02
PARTNER DOES NOT APPROVE 03
COSTS TOO HIGH 04
SIDE EFFECTS 05
HEALTH PROBLEMS 06
DIFFICULT TO OBTAIN 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALISTIC 10
OTHER PEOPLE DISAPPROVE 11
INFREQUENT SEXUAL RELATIONS 12
WOMAN HAS DIFFICULTY GETTING PREGNANT 13
WOMAN IN MENOPAUSE/STERILIZED 14
INCONVENIENT 15
NOT MARRIED 16
OTHER (SPECIFY)____ 17
DON'T KNOW 98

212) 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

SECTION 3. FERTILITY PREFERENCES

301) CHECK 203 (07):

NOT STERILIZED (GO TO 302)
STERILIZED (GO TO 307)

302) Would you like to have a/another child, or would you prefer not have any (more) children?

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

303) Have you discussed with your spouse(s)/wife/wives how many children you would like to have?

YES 1
NO 2

304) How many times have you discussed this with your spouse(s)/wife/wives in the last year?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3

305) Do you think your spouse(s)/wife/wives want the same number of children that you want, more, or fewer than you want?

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

306) Do you think your wife/wives/partner(s) approve(s) of couples using a contraceptive method to avoid pregnancy?

YES 1
NO 2
DON'T KNOW 8

307) For how long should a couple wait before having sexual intercourse after the birth of a baby?

MONTHS 1_____
YEARS 2_____

OTHER (SPECIFY)_____ 996

308) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or does it not matter?

WAIT 1
NOT IMPORTANT 2

309) In general, do you approve of couples using a method to avoid pregnancy?

YES 1
NO 2

310) CHECK 119-120 AND CHECK BOX:

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

HAS LIVING CHILDREN: If you could go back to the time when 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?

PROBE FOR A NUMERIC RESPONSE.

NUMBER____
OTHER (SPECIFY)_____

SECTION 4. KNOWLEDGE AND ATTITUDES ABOUT AIDS

401) 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 415)

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

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

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

YES 1
NO 2
DON'T KNOW 8

404) In your opinion, how can you get AIDS?
RECORD ALL MENTIONED.

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

404A) CHECK 404:

MENTIONED SEXUAL INTERCOURSE (GO TO 405)
DID NOT MENTION SEXUAL INTERCOURSE (GO TO 406)

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

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

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

YES 1
NO 2
DON'T KNOW 3

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

YES 1
NO 2
DON'T KNOW 3

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

YES 1
NO 2
DON'T KNOW 3

409) What do you think a person can do to avoid getting AIDS?
RECORD 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

410) 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

411) 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

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

YES 1
NO 2
DON'T KNOW 8

413) 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

414) 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

415) Have you had sexual relations in the last 2 months?

YES 1
NO 2 (GO TO 422)

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

YES 1
NO 2 (GO TO 421)

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

EACH TIME 1
SOMETIMES 2
RARELY 3

418) Why did you use condoms?
RECORD ALL MENTIONED.

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

419) Where did you 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

420) What is the brand name of the condoms that you use?

PRUDENCE 1
SULTAN 2
OTHER (SPECIFY)_____ 3

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

NUMBER____

ONLY WITH WIFE/PARTNER95
SEVERAL 96

422) RECORD TIME AT END OF INTERVIEW

HOUR___
MINUTES____

INTERVIEWER'S OBSERVATIONS

(To be filled out after completing interview)

Comments about respondent:_______

Comments on specific questions:______

Any other comments:______

Supervisor's observations_______

Name of supervisor:_____
Date:_____

Editor's observations_______

Name of editor:____
Date:____