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DEMOGRAPHIC AND HEALTH SURVEY - II
COTE D'IVOIRE 1998-99
WOMAN'S QUESTIONNAIRE

NATIONAL STATISTICAL INSTITUTE
REPUBLIC OF IVORY COAST

IDENTIFICATION:

DEPARTMENT ___
SUB PREFECTURE ___
CENSUS DISTRICT ___
CLUSTER NUMBER ___
STRUCTURE NUMBER ___
HOUSEHOLD NUMBER ___

ABIDJAN/OTHER CITIES/RURAL:

ABIDJAN 1
OTHER CITIES 2
RURAL 3

INTERVENTION ZONE:

YES 1
NO 2

NAME OF WOMAN ___
WOMAN'S LINE NUMBER ___

INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME____

RESULTS___

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

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

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

TOTAL NUMBER OF VISITS:____

INTERPRETER:

YES 1
NO 2

LANGUAGE OF INTERVIEW:

FRENCH 1
DIOULA 2
BAOULE 3
OTHERS 6

SUPERVISOR:
NAME ___
DATE ___

FIELD EDITOR:
NAME ___
DATE ___

OFFICE EDITOR ___

KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME:

HOUR: ___
MINUTES: ___

105) In what month and what 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: ___

106A) Do you understand French?

YES 1
NO 2

107) Have you ever attended school?

YES 1
NO 2 (GO TO 114)

108) What is the highest level of school you attended: primary, secondary 1st cycle, secondary 2nd 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?

PRIMARY
CP1 1
CP2 2
CE1 3
CE2 4
CM1 5
CM2 6
DON'T KNOW 8
SECONDARY 1ST CYCLE
6TH 1
5TH 2
4TH 3
3RD 4
DON'T KNOW 8
SECONDARY 2ND CYCLE
2ND 1
1ST 2
FINAL 3
DON'T KNOW 8
HIGHER
1ST YEAR 1
2ND YEAR 2
3RD YEAR 3
4TH YEAR 4
5TH YEAR OR HIGHER 5
DON'T KNOW 8

110) CHECK 106:

AGE 29 OR LESS: ___
AGE 30 OR MORE: ___ (GO TO 111A)

111) Are you currently attending school?

YES 1 (GO TO 113)
NO 2

111A) How old were you when you stopped attending school?

AGE: ___

112) What was the main reason 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
PREFERRED A JOB/TO GO TO WORK 07
HAD ENOUGH SCHOOLING 08
FAILED AT SCHOOL 09
DID NOT LIKE SCHOOL 10
SCHOOL NOT ACCESSIBLE/TOO FAR 11
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

113) CHECK 108:

PRIMARY: ___
SECONDARY OR HIGHER: ___ (GO TO 114A)

114) 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 115A)

114A) Do you usually read a newspaper or magazine at least once a month?

YES 1
NO 2 (GO TO 115A)

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

YES 1
NO 2

115A) Do you usually listen to the radio?

YES 1
NO 2 (GO TO 116G)

116) Do you usually listen to the radio every day?

YES 1 (GO TO 116B)
NO 2

116A) What days of the week do you normally listen to the radio?

RECORD ALL RESPONSES GIVEN.
IF THE RESPONSE IS "IT DEPENDS", "IT DOESN'T MATTER" OR "DON'T KNOW", YOU ONLY NEED TO RECORD ONE CODE.

MONDAY A
TUESDAY B
WEDNESDAY D
THURSDAY E
FRIDAY F
SATURDAY G
SUNDAY H
IT DEPENDS/DOESN'T MATTER X
DK Z

116B) What time do you normally listen to the radio?

RECORD ALL RESPONSES GIVEN.
IF THE RESPONSE IS "ALL DAY", "IT DEPENDS", "IT DOESN'T MATTER" OR "DK", YOU ONLY NEED TO RECORD ONE CODE.

BEFORE 8 O'CLOCK A
FROM 8 TO 12 O'CLOCK B
FROM 12 TO 14 O'CLOCK C
FROM 14 TO 18 O'CLOCK D
FROM 18 TO 20 O'CLOCK E
AFTER 20 O'CLOCK F
ALL DAY LONG G
IT DEPENDS/DOESN'T MATTER X
DON'T KNOW Z

116C) What type of radio program do you normally listen to?

PROBE TO OBTAIN THE TYPE OF PROGRAM.
RECORD ALL THE PROGRAMS MENTIONED.

MUSICAL VARIETY A
SPORTS B
SPOKEN NEWS C
REPORTING E
SHOWS ON HEALTH F
OTHER (SPECIFY): ___ X

116D) Have you had a chance to listen to the radio serial "Yamba Songo"?

YES 1
NO 2 (GO TO 116G)

116E) According to you, is this serial educational, or for entertainment?

EDUCATIONAL 1
ENTERTAINMENT 2 (GO TO 116G)
BOTH 3
DON'T KNOW 4 (GO TO 116G)

116F) According to you, what problems does "Yamba Songo" talk about?

RECORD ALL OF THE RESPONSES GIVEN.
IF THE RESPONSE IS "DON'T KNOW", YOU ONLY HAVE TO CIRCLE THAT CODE.

FAMILY PLANNING/CONTRACEPTION A
AIDS/HIV B
SEXUALLY TRANSMITTED DISEASES C
TREATMENT OF DIARRHEA/ORS D
HEALTH PROBLEMS E
OTHER (SPECIFY): ___ X
DON'T KNOW Z

116G) Do you usually watch television?

YES 1
NO 2 (GO TO 118)

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

YES 1
NO 2

117A) What days of the week do you normally watch television?

RECORD ALL RESPONSES GIVEN.
IF THE RESPONSE IS "ALL DAY", "IT DEPENDS", "IT DOESN'T MATTER" OR "DK", YOU ONLY NEED TO RECORD ONE CODE.

MONDAY A
TUESDAY B
WEDNESDAY D
THURSDAY E
FRIDAY F
SATURDAY G
SUNDAY H
EVERY DAY I
IT DEPENDS/DOESN'T MATTER X
DK Z

117B) What time do you normally watch television?

RECORD ALL RESPONSES GIVEN.
IF THE RESPONSE IS "ALL DAY", "IT DEPENDS", "IT DOESN'T MATTER" OR "DK", YOU ONLY NEED TO RECORD ONE CODE.

IN THE MORNING A
FROM 8 TO 12 O'CLOCK B
FROM 12 TO 14 O'CLOCK C
FROM 14 TO 18 O'CLOCK D
FROM 18 TO 20 O'CLOCK E
AFTER 20 O'CLOCK F
ALL DAY LONG G
IT DEPENDS/DOESN'T MATTER X
DON'T KNOW Z

117C) What type of television show do you normally watch?

PROBE TO OBTAIN THE TYPE OF SHOW.
RECORD ALL OF THE SHOWS WATCHED.

MUSICAL VARIETY A
SPORTS B
MOVIES/SERIALS C
TELEVISED NEWS D
REPORTING E
SHOWS ON HEALTH F
OTHER (SPECIFY): ___ X

118) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
TRADITIONAL 4
NO RELIGION/NONE 5
OTHER (SPECIFY): ___ 6

119) What is your ethnicity?

_____

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 and 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 a girl who was born alive but later died?

IF NO, PROBE: Any child that 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 DECEASED: ___
GIRLS DECEASED: ___

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: ___
NO: ___ (PROBE AND CORRECT 201-208 AS NECESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS: ___
NO BIRTHS: ___ (GO TO 227)

211) Now I would like to record all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL OF THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME: ___

213) Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

215) In what month and what 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 THE AGE IN COMPLETED YEARS.

AGE IN YEARS: ___

218) IF ALIVE: Does (NAME) live with you?

YES 1 (GO TO NEXT CHILD)
NO 2 (GO TO NEXT CHILD FOR FIRST BIRTH, GO TO 220 FOR ALL OTHERS)

219) IF DEAD: How old was (NAME) when he/she died?

IF "1 YEAR", PROBE: How many months old was (NAME)?

RECORD IN DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS: ___ 1
MONTHS: ___ 2
YEARS: ___ 3

220) (SKIP FOR FIRST BIRTH) FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH. IS THE DIFFERENCE 4 OR MORE?

YES 1
NO 2 (GO TO NEXT BIRTH)

221) (SKIP FOR FIRST BIRTH) Were there other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

222) FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH. IS THE DIFFERENCE 4 YEARS OR MORE?

YES 1 (GO TO 223)
NO 2 (GO TO 224)

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

YES 1
NO 2

224) 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 DECEASED CHILD: AGE AT DEATH IS RECORDED.
FOR THE AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS.
THE NUMBERS ARE DIFFERENT: ___ (PROBE AND RECONCILE)

225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1993.

IF NONE, RECORD '0'.

_____

227) Are you pregnant now?

YES 1
NO 2 (GO TO 236)
NOT SURE 8 (GO TO 236)

228) How many months pregnant are you?

RECORD NUMBER IN COMPLETED MONTHS.

MONTHS: ___

229) 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?

THEN 1
LATER 2
NOT WANT MORE CHILDREN 3

236) When did your last menstrual cycle start?

DATE, IF GIVEN: ___
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
YEARS: ___ 4
MENOPAUSAL 994
BEFORE THE LAST BIRTH 995
NEVER MENSTRUATED 996

237) 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 300)
DON'T KNOW 8 (GO TO 300)

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

DURING HER PERIOD 01
RIGHT AFTER HER PERIOD HAS ENDED 02
IN THE MIDDLE OF CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

SECTION 3. CONTRACEPTION

300) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301) Which ways or methods have you heard about?

302) Have you ever heard of (METHOD)?

01. PILL Women can take a pill every day.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
02. IUD/STERILET Women can have a sterilet that a doctor or nurse places inside their uterus.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
03. INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
04. 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, SPONTANEOUS 1
YES, DESCRIPTION 2
NO 3
05. DIAPHRAGM, FOAM OR GEL Women can place a sponge, a suppository, a diaphragm, gel, or cream in their vagina 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. RHYTHM/PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES, 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 ever heard of any other methods that men or women use to avoid pregnancy?
YES (SPECIFY): ___ 1
NO 3

303) Have you ever used (METHOD)?

01. PILL Women can take a pill every day.
YES 1
NO 2
02. IUD/STERILET Women can have a sterilet that a doctor or nurse places inside their uterus.
YES 1
NO 2
03. INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
04. 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
05. DIAPHRAGM, FOAM OR GEL Women can place a sponge, a suppository, a diaphragm, gel, or cream in their vagina 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 Have you ever had an operation to avoid having any more children?
YES 1
NO 2
08. MALE STERILIZATION Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO/DK 2
09. RHYTHM/PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11. Have you heard of any other methods that men or women can use to avoid pregnancy?
YES 1
NO 2

304) CHECK 303:

NOT A SINGLE 'YES' (NEVER USED): ___
AT LEAST ONE 'YES' (EVER USED): ___ (GO TO 309)

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

YES 1
NO 2 (GO TO 331)

307) What have you used or done?

CORRECT 303 AND 304 (AND 302 IF NECESSARY).

309) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

NUMBER OF CHILDREN: ___

310) When you first used family planning, was it because you wanted to have another child but at a later time, or was it because you did not want to have another child at all?

WANTED CHILD LATER 1
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY): ___ 6

311) CHECK 303:

WOMAN NOT STERILIZED: ___
WOMAN STERILIZED: ___ (GO TO 314A)

312) CHECK 227:

NOT PREGNANT OR UNSURE: ___
PREGNANT: ___ (GO TO 332)

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

YES 1
NO 2 (GO TO 331)

314) Which method are you using?

314A) CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 325A)
INJECTABLES 03 (GO TO 325A)
IMPLANT 04 (GO TO 325A)
DIAPHRAGM/FOAM/GEL 05 (GO TO 325A)
CONDOM 06 (GO TO 325A)
FEMALE STERILIZATION 07 (GO TO 317A)
MALE STERILIZATION 08 (GO TO 317A)
PERIODIC ABSTINENCE 09 (GO TO 322A)
WITHDRAWAL 10 (GO TO 325A)
OTHER (SPECIFY): ___96 (GO TO 325A)

314B) Why do you use the pill over another method?

COST/LESS EXPENSIVE 01
MORE AVAILABLE 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
REVERSIBLE METHOD 08
OTHER (SPECIFY): ___ 96

315) May I see the package of pills you are using right now?

(CIRCLE CODE OF BRAND IF PACKAGE IS SEEN)

LO FEMENA 01 (GO TO 317)
OVRETTE 02 (GO TO 317)
CONFIANCE 03 (GO TO 317)
NOVEL-DUO 04 (GO TO 317)
OTHER (SPECIFY): ___ 96 (GO TO 317)
PACKAGE NOT SEEN 98

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

RECORD NAME OF BRAND.

LO FEMENA 01
OVRETTE 02
CONFIANCE 03
NOVEL-DUO 04
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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

PRICE: ___ (GO TO 326)
FREE 9996 (GO TO 326)
DON'T KNOW 9998 (GO TO 326)

317A) Why did (you or your spouse/partner) have an operation to not have any more children, rather than using another method?

COST/LESS EXPENSIVE 01
MORE AVAILABLE 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
PERMANENT METHOD 08
OTHER (SPECIFY): ___ 96

318) Where 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.

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
FAMILY PLANNING CENTER 23
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 321)

320) Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
HUSBAND/PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY): ___ 96

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

MONTH: ___ (GO TO 327)
YEAR: ___ (GO TO 327)

322A) Why do you use the rhythm method rather than another method?

COST/FREE 01
NO PROBLEM OF AVAILABILITY 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
METHOD REVERSIBLE 08
OTHER (SPECIFY): ___ 96

323) How do you determine which days of your monthly cycle not to have sexual relations?

BASED ON CALENDAR 01
BASED ON BODY TEMPERATURE 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY): ___ 96

325A) Why do you use (METHOD FROM 314) rather than another method?

COST/NOT EXPENSIVE/COSTS NOTHING 01
NO AVAILABILITY PROBLEM 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
METHOD IS REVERSIBLE 08
PROTECTS AGAINST AIDS/STD 09
OTHER (SPECIFY): ___ 96

326) For how many months have you been using (METHOD) continuously?

IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS: ___
8 YEARS OR LONGER 96

327) CHECK 314:

CIRCLE THE CODE OF THE METHOD.

PILL 01
IUD 02
INJECTABLES 03
IMPLANT 04
DIAPHRAGM/FOAM/GEL 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 329A)
MALE STERILIZATION 08 (GO TO 329A)
PERIODIC ABSTINENCE 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER (SPECIFY): ___ 96 (GO TO 332)

328) Where did you obtain (METHOD) the last time?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
FREE CLINIC 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
FAMILY PLANNING CENTER 23
PHARMACY/PHARMACY DEPOT 24
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
CHURCH 35
ACQUAINTANCES/RELATIVES 36
TRADITIONAL PRACTITIONER 37
OTHER (SPECIFY): ___ 96

329) Do you know of another place where you could have obtained (METHOD) the last time?

329A) At the time of the sterilization operation, did you know of another place where you could have received the operation?

YES 1
NO 2 (GO TO 334)

329B) People choose the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF LOCATION LISTED AT 328 OR 318) instead of some other place you know about?

RECORD EVERYTHING THAT IS MENTIONED.

IF THE ANSWER IS 'DON'T KNOW' YOU ONLY NEED TO CIRCLE THAT CODE.

Other reasons?

ACCESS-RELATED REASONS
CLOSER TO HOME A
CLOSER TO MARKET/WORK B
AVAILABILITY OF TRANSPORT C
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLY D
CLEANER FACILITY E
OFFERS MORE PRIVACY F
SHORTER WAITING TIME G
LONGER HOURS OF OPERATION H
USE OTHER SERVICES AT THE FACILITY I
AVAILABILITY OF THE METHOD AT ALL TIMES J
LOWER COST/CHEAPER K
WANTED ANONYMITY L
OTHER (SPECIFY): ___ X
DON'T KNOW Z

330) INTERVIEWER:
- IF YOU ONLY CIRCLED ONE CODE FOR 329B, CIRCLE THE CODE CORRESPONDING TO THE SAME ANSWER AND GO TO 334.

- IF YOU CIRCLED SEVERAL CODES FOR 329B, ASK THE FOLLOWING QUESTION AND CIRCLE THE CODE CORRESPONDING TO THE ANSWER.

Among the reasons you gave me, what is the main reason?

ACCESS-RELATED REASONS
CLOSER TO HOME 11 (GO TO 334)
CLOSER TO MARKET/WORK 12 (GO TO 334)
AVAILABILITY OF TRANSPORT 13 (GO TO 334)
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLY 21 (GO TO 334)
CLEANER FACILITY 22 (GO TO 334)
OFFERS MORE PRIVACY 23 (GO TO 334)
SHORTER WAITING TIME 24 (GO TO 334)
LONGER HOURS OF OPERATION 25 (GO TO 334)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 334)
AVAILABILITY OF THE METHOD AT ALL TIMES 27 (GO TO 334)
LOWER COST/CHEAPER 31 (GO TO 334)
WANTED ANONYMITY 41 (GO TO 334)
OTHER (SPECIFY): ___ 96 (GO TO 334)
DK 98 (GO TO 334)

331) CHECK 227:

NOT PREGNANT OR NOT SURE: ___
PREGNANT: ___ (GO TO 332)

331A) What is the main reason that you are not using a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFERTILE 24
POSTPARTUM/BREASTFEEDING 25
WANTS (OTHER) CHILDREN 26
OPPOSED TO USE
RESPONDENT OPPOSED 31
HUSBAND/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
CULTURAL TABOOS 35
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 334)

333) Where is that?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
FREE CLINIC 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
FAMILY PLANNING CENTER 23
PHARMACY/PHARMACY DEPOT 24
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
CHURCH 35
ACQUAINTANCES/RELATIVES 36
TRADITIONAL PRACTITIONER 37
OTHER (SPECIFY): ___ 96

334) Were you visited by a family planning program worker in the last 12 months?

YES 1
NO 2

335) Have you visited a health facility for any reason in the last 12 months?

YES 1
NO 2 (GO TO 337)

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

YES 1
NO 2

337) Do you think that breastfeeding can affect a woman's chances of becoming pregnant?

YES 1
NO 2 (GO TO 401)
DON'T KNOW 8

338) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

INCREASED 1 (GO TO 401)
DECREASED 2
DEPENDS 3
DON'T KNOW 8

339) CHECK 210:

ONE OR MORE BIRTHS: ___
NO BIRTHS: ___ (GO TO 401)

340) Have you ever relied on breastfeeding as a method of avoiding pregnancy?

YES 1
NO 2 (GO TO 401)

341) CHECK 227 AND 311:

NOT PREGNANT OR UNSURE AND NOT STERILIZED: ___
EITHER PREGNANT OR STERILIZED: ___ (GO TO 401)

342) Are you currently relying on breastfeeding to avoid getting pregnant?

YES 1
NO 2

SECTION 4A. PREGNANCY AND BREASTFEEDING

401) CHECK 225:

ONE OR MORE BIRTHS SINCE JANUARY 1993: ___
NO BIRTHS SINCE JANUARY 1993: ___ (GO TO 465)

402) RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1993 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE THE ADDITIONAL QUESTIONNAIRE).

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

403) SEE SECTION 2: LINE NUMBER FROM 212.

404) FROM 212 AND 216:

LAST BIRTH
NAME: ___
LIVING: ___
DECEASED: ___
NEXT-TO-LAST BIRTH
NAME: ___
LIVING: ___
DECEASED: ___
SECOND-FROM-LAST BIRTH
NAME: ___
LIVING: ___
DECEASED: ___

405) At the time you became pregnant with (NAME), did you want to get pregnant then, did you want to wait until later, or did you want no (more) children at all?

THEN 1 (GO TO 407)
LATER 2
NO MORE 3 (GO TO 407)

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

MONTHS: ___ 1
YEARS: ___ 2
DON'T KNOW 998

407) When you were pregnant with (NAME), did you see anyone for prenatal care for this pregnancy?

IF YES: Whom did you see?

Anyone else?

PROBE TO OBTAIN THE TYPE OF PERSON.
RECORD ALL OF THE PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED BIRTH ATTENDANT E
TRADITIONAL BIRTH ATTENDANT F
TRADITIONAL HEALER G
OTHER (SPECIFY): ___ X
NO ONE Y (GO TO 410)

408) How many months pregnant were you when you first received prenatal care?

ASK TO SEE THE HEALTH CARD.

MONTHS: ___
DON'T KNOW 98

409) How many times did you receive prenatal care during this pregnancy?

NUMBER OF TIMES: ___
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 412)
DON'T KNOW 8 (GO TO 412)

411) During this pregnancy, how many times did you get this injection?

NUMBER OF TIMES: ___
DON'T KNOW 8

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

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
MATERNITY 22
HEALTH CENTER/MOTHER-INFANT CENTER 23
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER (SPECIFY): ___ 96

413) Who assisted you with the delivery of (NAME)?

Anyone else?

PROBE TO OBTAIN THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED BIRTH ATTENDANT E
TRADITIONAL BIRTH ATTENDANT F
FRIENDS/RELATIVES/NEIGHBORS G
OTHER (SPECIFY): ___ X
NO ONE Y

415) Was (NAME) delivered by cesarean?

YES 1
NO 2

416) 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

417) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418A)

418) How much did (NAME) weigh?

RECORD THE WEIGHT WRITTEN IN THE HEALTH CARD, IF AVAILABLE.

GRAMS FROM CARD: ___ 1
GRAMS FROM RECALL: ___ 2
DON'T KNOW 99998

418A) In the first month and a half following the birth of (NAME), did you consult someone to check on your health or the baby's health?

YES 1
NO 2 (GO TO 419)

418B) How many days after the birth was the first consultation?

DAYS AFTER BIRTH: ___ 1
WEEKS AFTER BIRTH: ___ 2
DON'T KNOW 998

418C) During this consultation, who checked on your health or the baby's health?

HEALTH PROFESSIONAL
DOCTOR 01
NURSE 02
MIDWIFE 03
OTHER PERSON
TRAINED BIRTH ATTENDANT 04
TRADITIONAL BIRTH ATTENDANT 05
TRADITIONAL HEALER 06
OTHER (SPECIFY): ___ 96

418D) Where did this first consultation take place?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
MATERNITY 22
HEALTH CENTER/MOTHER-INFANT CENTER 23
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER (SPECIFY): ___ 96

418E) During this visit, did the person you were consulting give you any information or advice on family planning?

YES 1
NO 2

419) (ASK FOR MOST RECENT BIRTH ONLY) Has your period returned since the birth of (NAME)?

YES 1 (GO TO 421)
NO 2 (GO TO 422)

420) (SKIP FOR MOST RECENT BIRTH) Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 424)

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

MONTHS: ___
DON'T KNOW 98

422) CHECK 227:
RESPONDENT PREGNANT?

NOT PREGNANT: ___
PREGNANT OR UNSURE: ___ (GO TO 424)

423) Have you resumed sexual relations again since the birth of (NAME)?

YES 1
NO 2 (GO TO 425)

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

MONTHS: ___
DON'T KNOW 98

425) Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 431)

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 IN DAYS.

IMMEDIATELY 000
HOURS: ___ 1
DAYS: ___ 2

427) CHECK 404:
CHILD ALIVE?

LIVING: ___
DECEASED: ___ (GO TO 429)

428) Are you still breastfeeding (NAME)?

YES 1 (GO TO 432)
NO 2

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

MONTHS: ___
DON'T KNOW 98

430) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY): ___ 96

431) CHECK 404:
CHILD ALIVE?

LIVING: ___ (GO TO 434)
DECEASED: ___ (GO BACK TO 405 IN THE NEXT COLUMN OR IF NO MORE BIRTHS, GO TO 440)

432) How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS: ___

433) How many times did you breastfeed yesterday during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS: ___

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

YES 1
NO 2
DON'T KNOW 8

435) At any time yesterday or last night, was (NAME) given any of the following:

Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Tinned or powdered milk?
Fresh milk/animal milk?
Infant formula?
Any other liquids?
Any other solid food or food in bottle?

WATER
YES 1
NO 2
DK 8
SUGAR WATER
YES 1
NO 2
DK 8
JUICE
YES 1
NO 2
DK 8
HERBAL TEA
YES 1
NO 2
DK 8
BABY FORMULA
YES 1
NO 2
DK 8
TINNED OR POWDERED MILK
YES 1
NO 2
DK 8
FRESH ANIMAL MILK
YES 1
NO 2
DK 8
INFANT FORMULA
YES 1
NO 2
DK 8
OTHER LIQUIDS
YES 1
NO 2
DK 8
SOLID/BOTTLED FOOD
YES 1
NO 2
DK 8

439) GO BACK TO 405 IN THE NEXT COLUMN OR IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440) ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1993 IN THE TABLE.
ASK THE QUESTIONS FOR ALL THE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRE).

441) SEE SECTION 2: LINE NUMBER FROM 212

LAST BIRTH: ___
NEXT-TO-LAST BIRTH: ___
SECOND-FROM-LAST BIRTH: ___

442) ACCORDING TO 212 AND 216:

NAME: ___
ALIVE: ___
DECEASED: ___ (GO TO 442 IN THE NEXT COLUMN, OR IF NO MORE BIRTHS, GO TO 465)

443) Do you have a card where (NAME)'s vaccinations are written down?

IF YES: May I see it please?

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3

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

YES 1 (GO TO 447)
NO 2 (GO TO 447)

445)
(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: ___
POLIO 0 (AT BIRTH)
DAY: ___
MONTH: ___
YEAR: ___
POLIO 1
DAY: ___
MONTH: ___
YEAR: ___
POLIO 2
DAY: ___
MONTH: ___
YEAR: ___
POLIO 3
DAY: ___
MONTH: ___
YEAR: ___
DTCOQ 1
DAY: ___
MONTH: ___
YEAR: ___
DTCOQ 2
DAY: ___
MONTH: ___
YEAR: ___
DTCOQ 3
DAY: ___
MONTH: ___
YEAR: ___
MEASLES
DAY: ___
MONTH: ___
YEAR: ___
YELLOW FEVER
DAY: ___
MONTH: ___
YEAR: ___

446) Has (NAME) received any vaccinations that are not recorded on this card?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, MEASLES, AND/OR YELLOW FEVER.

YES 1 (PROBE VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445) (GO TO 449)
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

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

YES 1
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

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

448A) 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

448B) Polio vaccine, that is, drops in the mouth?

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

448C) How many times?

NUMBER OF TIMES: ___

448D) When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

448E) DTCoq vaccination, that is, an injection usually given at the same time as polio drops?

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

448F) How many times?

NUMBER OF TIMES: ___

448G) Any injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

448H) An injection to prevent yellow fever?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

451) 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

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

YES 1
NO 2 (GO TO 454)

453) Where did you seek advice or treatment?

Anywhere else?

RECORD ALL MENTIONED

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
FREE CLINIC C
MEDICAL POST D
OTHER PUBLIC (SPECIFY): ___ E
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR F
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PHARMACY DEPOT H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER J
OTHER (SPECIFY): ___ X

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

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

455) Was there blood in the stools?

YES 1
NO 2
DON'T KNOW 8

456) On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF BOWEL MOVEMENTS: ___
DON'T KNOW 8

457) Was he/she given the same amount to drink as before the diarrhea, more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

458) Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

458A) CHECK 428:
CHILD STILL BREASTFEEDING?

YES TO 428: ___
NO TO 428 OR 428 NOT ASKED: ___ (GO TO 459)

458B) Was (NAME) breastfed in the same way before the diarrhea, or more or less?

SAME 1
MORE 2
LESS 3

459) When (NAME) had diarrhea, was he/she given any of the following to drink:

A fluid prepared from a special packet called ORS like this one? SHOW ORS PACKET
Homemade sugar-salt-water solution?
A light gruel?
Soup?
Milk or infant formula?
Yogurt-based drink?
Water?
Any other liquids?

ORS PACKET
YES 1
NO 2
DK 8
SUGAR-SALT-WATER SOLUTION
YES 1
NO 2
DK 8
LIGHT GRUEL
YES 1
NO 2
DK 8
SOUP
YES 1
NO 2
DK 8
MILK/FORMULA
YES 1
NO 2
DK 8
YOGURT DRINK
YES 1
NO 2
DK 8
WATER
YES 1
NO 2
DK 8
OTHER LIQUIDS
YES 1
NO 2
DK 8

460) Was anything else given to (NAME) to treat the diarrhea?

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

461) What was given to treat the diarrhea?

Anything else?

RECORD ALL MENTIONED

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS/DRIP C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY): ___ X

462) Did you seek advice or for a treatment for the diarrhea?

YES 1
NO 2 (GO TO 464)

463) Where did you seek advice or treatment?

Anywhere else?

RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
FREE CLINIC C
MEDICAL POST D
OTHER PUBLIC (SPECIFY): ___ E
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR F
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PHARMACY DEPOT H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER J
OTHER (SPECIFY): ___ X

464) GO BACK TO 442 IN THE NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465) When a child has diarrhea, should he/she be given less than usual to drink, the same amount, or more than usual?

LESS TO DRINK 1
ABOUT SAME AMOUNT TO DRINK 2
MORE TO DRINK 3
DON'T KNOW 8

466) When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

LESS TO EAT 1
ABOUT SAME AMOUNT TO EAT 2
MORE TO EAT 3
DON'T KNOW 8

467) When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?

What other symptoms?

RECORD ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETS SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY): ___ X
DON'T KNOW Z

468) When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?

What other symptoms?

RECORD ALL MENTIONED.

RAPID BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETS SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY): ___ X
DON'T KNOW Z

469) CHECK 459, ALL COLUMNS:

NO CHILD RECEIVED ORS, OR 459 NOT ASKED: ___
AT LEAST ONE CHILD RECEIVED ORS: ___ (GO TO 472)

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

YES 1
NO 2 (GO TO 477)

471) Have you ever used this product?

YES 1
NO 2 (GO TO 473)

472) Where did you get ORS the last time?

IF SOURCE IS A 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
HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
FREE CLINIC 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
PHARMACY 23
PHARMACY DEPOT 24
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
INFORMAL COMMERCIAL DISTRIBUTION 32
ACQUAINTANCES/RELATIVES 33
TRADITIONAL PRACTITIONER 34
OTHER (SPECIFY): ___ 96

473) Do you currently have an ORS packet in your home?

YES 1
NO 2 (GO TO 477)

474) Could I see the ORS packet you have?

IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING NUMBER.

ORASEL 1 (GO TO 476)
UNICEF 2 (GO TO 476)
NO BRAND 3 (GO TO 476)
OTHER (SPECIFY): ___ 6 (GO TO 476)
PACKET NOT SEEN 8

475) Do you know the brand name of the ORS packet that you have now?

RECORD THE NAME OF THE BRAND.

ORASEL 1
UNICEF 2
NO BRAND 3
OTHER (SPECIFY): ___ 6
PACKET NOT SEEN 8

476) How much did the packet of ORS cost?

COST: ___
FREE 996
DON'T KNOW 998

477) CHECK 459, ALL COLUMNS:

NO CHILD RECEIVED SALT/SUGAR SOLUTION OR 459 NOT ASKED: ___
AT LEAST ONE CHILD RECEIVED SALT/SUGAR SOLUTION: ___ (GO TO 501)

478) Have you heard of a solution of salt, sugar, and water that you prepare at home and that you give to children to treat diarrhea?

YES 1
NO 2 (GO TO 501)

479) Have you ever prepared this solution?

YES 1
NO 2

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501) PRESENCE OF OTHERS AT THIS POINT

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND/PARTNER
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

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

YES, CURRENTLY MARRIED 1 (GO TO 507)
YES, LIVING WITH A MAN 2 (GO TO 507)
MARRIAGE NOT CONSUMMATED 3 (GO TO 515F)
NO, NOT IN UNION 4

503) 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

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

YES, WAS MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515F)

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

WIDOW 1 (GO TO 511)
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

507A) RECORD THE LINE NUMBER OF HER HUSBAND ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A PART OF THE HOUSEHOLD, RECORD '00'.

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

YES 1
NO 2 (GO TO 511)

509) How many other wives does he have?

NUMBER: ___
DON'T KNOW 98 (GO TO 511)

510) Are you the first, second?wife?

RANK: ___

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

ONCE 1 (GO TO 512)
MORE THAN ONCE 2

511A) How much time went by between the end of your second-to-last union and the beginning of your last (current) union?

IF LESS THAN ONE YEAR, RECORD '00'.

LENGTH OF TIME IN COMPLETED YEARS: ___

512) CHECK 511:

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

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

MONTH: ___
DON'T KNOW MONTH 98
YEAR: ___ (GO TO 514A)
DON'T KNOW YEAR 9998

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

AGE: ___

514A) CHECK 502:

CURRENTLY MARRIED OR LIVES WITH A MAN: ___
NOT IN A UNION: ___ (GO TO 515F)

515) 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 with (your husband/the man with whom you live)?

IF "NEVER HAD RELATIONS", GO BACK TO 502, CIRCLE CODE 3 (MARRIAGE NOT CONSUMMATED) AND FOLLOW THE NEW INSTRUCTIONS STARTING WITH 502.

NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4
BEFORE THE LAST BIRTH 996

515A) CHECK 301 AND 302:

KNOWS WHAT A CONDOM IS:
The last time you had sex with (your husband/the man with whom you live), was a condom used?

DOES NOT KNOW WHAT A CONDOM IS:
Some men used a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex with (your husband/the man with whom you live), was a condom used?

YES 1
NO 2 (GO TO 515B)
DON'T KNOW 8 (GO TO 515B)

515AA) During this last sexual relation, who suggested using the condom?

RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
BOTH 3

515B) Have you had sexual relations with someone other than (your husband/the man with whom you live) in the last 12 months?

YES 1
NO 2 (GO TO 517)

515C) When was the last time you had sexual relations with someone other than (your husband/the man with whom you live)?

NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
BEFORE LAST BIRTH 996

515CA) The last time you had sexual relations with someone other than (your husband/the man with whom you live), was it with a regular partner, an acquaintance, for money, or someone else?

REGULAR PARTNER 1
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4

515D) Was a condom used on this occasion?

YES 1
NO 2 (GO TO 515E)
DON'T KNOW 8 (GO TO 515E)

515DA) During this last sexual relation, who suggested using the condom?

RESPONDENT 1
PARTNER 2
BOTH 3

515E) During the last 12 months, how many different people other than (your husband/the man with whom you live) did you have sexual relations with?

NUMBER OF PEOPLE: ___ (GO TO 517)
DON'T KNOW 98 (GO TO 517)

515F) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.

When was the last time you had sexual intercourse (if ever)?

NEVER 000 (GO TO 608)
DAYS AGO: ___ 1
WEEKS AGO: ___ 2
MONTHS AGO: ___ 3
YEARS AGO: ___ 4
BEFORE LAST BIRTH 996

515FA) The last time you had sexual relations, was it a regular partner, an acquaintance, for money, or someone else?

REGULAR PARTNER 1
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4

515G) CHECK 301 AND 302:

KNOWS WHAT A CONDOM IS:
The last time you had sex, was a condom used?

DOES NOT KNOW WHAT A CONDOM IS:
Some men used a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?

YES 1
NO 2 (GO TO 515H)
DK 8 (GO TO 515H)

515GA) During this last sexual relation, who suggested using the condom?

RESPONDENT HERSELF 1
PARTNER 2
BOTH 3

515H) CHECK 515F:

LESS THAN 12 MONTHS SINCE LAST SEXUAL RELATIONS: ___
12 MONTHS OR MORE SINCE LAST SEXUAL RELATIONS: ___ (GO TO 517)

515I) In total, with how many different people have you had sex in the last 12 months?

NUMBER OF PERSONS: ___
DK 98

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

YES 1
NO 2 (GO TO 518A)

518) Where is that?

RECORD ALL MENTIONED

IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
FREE CLINIC 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
FAMILY PLANNING CENTER 23
PHARMACY/PHARMACY DEPOT 24
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
CHURCH 35
ACQUAINTANCES/RELATIVES 36
TRADITIONAL PRACTITIONER 37
OTHER (SPECIFY): ___ 96

518A) CHECK 515A, 515D, 515G:

AT LEAST 1 'YES': ___
NO 'YES': ___ (GO TO 519)

518B) Where did you get the condom 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
HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
FREE CLINIC 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
FAMILY PLANNING CENTER 23
PHARMACY/PHARMACY DEPOT 24
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
CHURCH 35
ACQUAINTANCES/RELATIVES 36
TRADITIONAL PRACTITIONER 37
PARTNER HAD CONDOM 41 (GO TO 519)
OTHER (SPECIFY): ___ 96

518C) Do you know the brand name of the condoms that you used last time?

RECORD NAME OF BRAND.

PRUDENCE 01
PRUDENCE NOUVEAU 02
PROMESSE 03
PROTECTOR 04
GOLD CIRCLE 05
COOL 06
OTHER (SPECIFY): ___ 96
DK 98

518D) The last time you bought condoms, how many did you buy?

DETERMINE THE NUMBER AND RECORD.
RECORD '90' IF 90 OR MORE.

NUMBER OF CONDOMS: ___
DK 998

518E) How much did you pay?

COST: ___
FREE 9996
DK 9998

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

AGE: ___
FIRST TIME WHEN MARRIED 96

SECTION 6. FERTILITY PREFERENCES

601) CHECK 314:

NEITHER STERILIZED: ___
HE OR SHE STERILIZED: ___ (GO TO 612)

602) CHECK 227:

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

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DON'T KNOW (GO TO 604)

603) CHECK 227:

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 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY): ___ 996
DON'T KNOW 998

604) CHECK 227:

NOT PREGNANT OR UNSURE: ___
PREGNANT: ___ (GO TO 607)

605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606) CHECK 313: USING A METHOD?

NOT ASKED: ___
NOT CURRENTLY USING: ___
CURRENTLY USING: ___ (GO TO 612)

607) Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (GO TO 609)
NO 2
DON'T KNOW 8

608) 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 610)
DON'T KNOW 8 (GO TO 610)

609) Which method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTABLES 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
PERIODIC ABSTINENCE 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
OTHER (SPECIFY): ___ 96
NOT SURE 98

610) What is the main reason that you think you will never use a method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (GO TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUBFECUND/INFERTILE 24 (GO TO 612)
WANTS MORE CHILDREN 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND/PARTNER OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
CULTURAL TABOOS 35 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COSTS TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
OTHER (SPECIFY): ___ 96 (GO TO 612)
DON'T KNOW 98 (GO TO 612)

611) Would you use a method if you were married?

YES 1
NO 2
DON'T KNOW 8

612) CHECK 216:

HAS LIVING CHILDREN:
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

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

PROBE FOR A NUMERIC RESPONSE.

NUMBER: ___ (IF '00', GO TO 614)
OTHER (SPECIFY): ___ 96 (GO TO 614)

613) 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 BOYS: ___
OTHER (SPECIFY): ___ 96
NUMBER GIRLS: ___
OTHER (SPECIFY): ___ 96
NUMBER EITHER: ___
OTHER (SPECIFY): ___ 96

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

APPROVE 1
DISAPPROVE 2
NO OPINION 3

615) Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8

616) In the last few months have you heard about family planning:

On the radio?
On the television?
In a newspaper or in a magazine?
On a poster?
From leaflets or brochures?
On an advertising sign?
During a community meeting?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS/BROCHURES
YES 1
NO 2
ADVERTISING
YES 1
NO 2
COMMUNITY MEMBER
YES 1
NO 2

616A) What is your main source of information on family planning?

NONE 01
PUBLIC HEALTH WORKER 02
PRIVATE HEALTH WORKER 03
COMMUNITY HEALTH WORKER 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIENDS/RELATIVES 08
RADIO 09
TELEVISION 10
NEWSPAPERS/POSTERS 11
SCHOOL/LIBRARY 12
COMMUNITY MEETINGS 13
OTHER (SPECIFY): ___ 96
DK 98

618) In the last 12 months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 620)

619) With whom?

Anyone else?

RECORD ALL PERSONS MENTIONED.

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

620) CHECK 502:

YES, CURRENTLY MARRIED: ___
YES, LIVING WITH A MAN: ___
NO, NOT IN A UNION: ___ (GO TO 624)

621) Spouses/partner do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1 (GO TO 622B)
ONCE OR TWICE 2
MORE OFTEN 3

622A) Who usually starts the discussion on family planning, your, your husband/partner, or both?

RESPONDENT 1
HUSBAND/PARTNER 2
BOTH 3
DK 8

622B) CHECK 313: USES A METHOD?

CURRENTLY USES A METHOD: ___
NO, DOES NOT CURRENTLY USE A METHOD OR QUESTION NOT ASKED: ___ (GO TO 623)

622C) Before beginning (CURRENT METHOD), did you discuss which method you would use with your husband/partner?

YES 1
NO 2
DON'T RECALL 8

622D) After having started (CURRENT METHOD), did you discuss this method with your husband/partner?

YES 1
NO 2
DON'T RECALL 8

622E) CHECK 314:

CIRCLE CODE OF METHOD:

PILL 01
IUD 02
INJECTABLES 03
IMPLANT 04
DIAPHRAGM/FOAM/GEL 05
CONDOM 06 (GO TO 623)
FEMALE STERILIZATION 07
MALE STERILIZATION 08 (GO TO 623)
PERIODIC ABSTINENCE 09
WITHDRAWAL 10 (GO TO 623)
OTHER METHOD 96

622F) Did your husband/partner encourage you or discourage you from using (CURRENT METHOD)?

ENCOURAGE 1
DISCOURAGE 2
NEITHER/NEUTRAL 3
DK 8

623) 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

624) According to you, who should make the decision to use a contraceptive method, the man or the woman?

MAN 1
WOMAN 2
BOTH 3
SOMEONE ELSE 4

625) According to you, who generally makes the decision to use a contraceptive method, the man or the woman?

MAN 1
WOMAN 2
BOTH 3
SOMEONE ELSE 4

626) Do you think your mother (guardian) approves or disapproves of couples using a method to avoid or delay pregnancy?

IF THE MOTHER (GUARDIAN) IS DECEASED, ASK: "If your mother (guardian) were alive, do you think?"

APPROVE 1
DISAPPROVE 2
DK 8

627) Do you think your father (guardian) approves or disapproves of couples using a method to avoid or dy pregnancy?

IF THE FATHER (GUARDIAN) IS DECEASED, ASK: "If your father (guardian) were alive, do you think?"

APPROVE 1
DISAPPROVE 2
DK 8

628) Do you think that the use of contraceptives goes against or does not go against your religion?

GOES AGAINST 1
IS NOT AGAINST 2
HER RELIGION HAS NO POSITION ON THE SUBJECT 3
RESPONDENT DOES NOT HAVE A RELIGION 4
DK 8

629) Do you think that it is better to have small family or a large family to improve the quality of life?

SMALL FAMILY 1
LARGE FAMILY 2
NOT IMPORTANT/EITHER 3
DEPENDS 4
DK/NO OPINION 8

630) Have you encouraged a friend or relative to use family planning?

YES 1
NO 2

SECTION 7. PROFESSIONAL ACTIVITY

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

YES 1 (GO TO 712)
NO 2

710) 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 712)
NO 2

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

YES 1
NO 2 (GO TO 801A)

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

_____

713) CHECK 712:

WORKS IN AGRICULTURE: ___
DOES NOT WORK IN AGRICULTURE: ___ (GO TO 715)

714) 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

715) 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

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

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

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801A) Have you ever heard of any illness that can be transmitted from sex?

YES 1
NO 2 (GO TO 801K)

801B) What illnesses have you heard of?

RECORD ALL RESPONSES GIVEN.

SYPHILIS/POX A
GONORRHEA B
AIDS C
GENITAL WARTS/GENITAL TUMORS D
DISCHARGE E
ULCERATION F
ABDOMINAL PAIN G
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DK Z

801C) CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE: ___
HAS NEVER HAD SEXUAL INTERCOURSE: ___ (GO TO 801K)

801D) Over the last 12 months, have you had any of these illnesses?

YES 1
NO 2 (GO TO 801K)
DK 8 (GO TO 801K)

801E) Which illnesses did you have?

RECORD ALL RESPONSES.

SYPHILIS/POX A
GONORRHEA B
AIDS C
GENITAL WARTS/GENITAL TUMORS D
DISCHARGE E
ULCERATION F
ABDOMINAL PAIN G
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DK Z

801F) The last time that you had (ILLNESS FROM 801E) did you seek advice or treatment?

YES 1
NO 2 (GO TO 810H)

801G) Where did you seek advice or treatment?

Any other place?

CIRCLE ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
FREE CLINIC C
MEDICAL POST D
OTHER PUBLIC (SPECIFY): ___ E
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR F
PRIVATE HOSPITAL/CLINIC G
FAMILY PLANNING CENTER H
PHARMACY/PHARMACY DEPOT I
OTHER PRIVATE MEDICAL (SPECIFY): ___ J
OTHER PRIVATE SECTOR
SHOP/MARKET K
INFORMAL COMMERCIAL DISTRIBUTION L
CHURCH M
ACQUAINTANCES/RELATIVES N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY): ___ X
DON'T KNOW Z

801H) When you had the (ILLNESS(S) OF 801E) did you tell your sexual partner(s)?

YES 1
NO 2

801I) When you had the (ILLNESS(S) OF 801E) did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 801K)
PARTNER ALREADY INFECTED 3 (GO TO 801K)

801J) What did you do?

RECORD ALL MENTIONED

STOP SEXUAL INTERCOURSE A
USE A CONDOM DURING SEXUAL INTERCOURSE B
TAKEN DRUGS C
OTHER (SPECIFY): ___ X

801K) CHECK 801B:

DID NOT LIST "AIDS" OR QUESTION NOT ASKED: ___
LISTED "AIDS": ___ (GO TO 802)

801L) Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 811C)

802) From which sources of information have you learned most about AIDS?

Any other sources?

RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS/CENTER E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
THEATER I
FRIENDS/RELATIVES J
WORK PLACE K
OTHER (SPECIFY): ___ X

802A) If you wanted more information on AIDS, where (from whom) would you like to get this information?

RADIO 01
TV 02
NEWSPAPERS/MAGAZINES 03
PAMPHLETS/POSTERS 04
HEALTH WORKERS/CENTER 05
MOSQUES/CHURCHES 06
SCHOOLS/TEACHERS 07
COMMUNITY MEETINGS 08
THEATER 09
FRIENDS/RELATIVES 10
WORK PLACE 11
ENOUGH INFORMATION 12
OTHER (SPECIFY): ___ 96

802B) How can a person get infected with AIDS?

Any other way?

RECORD ALL MENTIONED

SEX A
SEX WITH SEVERAL PARTNERS B
SEX WITH PROSTITUTES C
NOT USING A CONDOM D
SEX WITH HOMOSEXUALS E
BLOOD TRANSFUSIONS F
INJECTIONS G
KISSING H
MOSQUITO BITES I
CUTTING WITH SOILED BLADES, SCISSORS, OR KNIVES K
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

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

804) What can a person do?

Anything else?

RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
AVOID SOILED BLADES, SCISSORS, OR KNIVES K
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER L
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

808) Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DON'T KNOW 8

808A) Can AIDS be cured?

YES 1
NO 2
DK 8

808B) Can AIDS be transmitted from a mother to a child?

YES 1
NO 2
DON'T KNOW 8

808C) Do you know someone personally who has AIDS or someone who died of AIDS?

YES 1
NO 2
DK 8

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

SMALL 1
MODERATE 2 (GO TO 809C)
GREAT 3 (GO TO 809C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 811A)

809B) Why do you think that you (have no risk/have small risk) for getting AIDS?

Any other reason?

RECORD ALL MENTIONED.

ABSTAINS FROM SEX B (GO TO 811A)
USES CONDOMS C (GO TO 811A)
ONLY HAS ONE SEXUAL PARTNER D (GO TO 811A)
HAS A LIMITED NUMBER OF SEXUAL PARTNERS E (GO TO 811A)
PARTNER DOESN'T HAVE ANY OTHER PARTNERS F (GO TO 811A)
DOESN'T HAVE HOMOSEXUAL RELATIONSHIPS G (GO TO 811A)
DOESN'T GET BLOOD TRANSFUSIONS H (GO TO 811A)
DOESN'T GET INJECTIONS I (GO TO 811A)
AVOIDS CUTTING WITH SOILED BLADES, SCISSORS, AND KNIVES K (GO TO 811A)
OTHER (SPECIFY): ___ X (GO TO 811A)

809C) Why do you think you have (moderate/great) risk of getting AIDS?

Any other reason?

RECORD ALL MENTIONED

DOESN'T USE CONDOMS C
HAS MORE THAN 1 SEXUAL PARTNER D
HAS SEVERAL SEXUAL PARTNERS E
PARTNER HAS OTHER PARTNERS F
HAS HOMOSEXUAL RELATIONSHIPS G
BLOOD TRANSFUSIONS H
RECEIVES INJECTIONS I
USES SOILED BLADES, SCISSORS, KNIVES K
OTHER (SPECIFY): ___ X

811A) Since you have heard of AIDS, have you changed your behavior to avoid getting AIDS?

IF YES, What have you done?

Anything else?

RECORD ALL MENTIONED.

DID NOT START HAVING SEX A (GO TO 811C)
STOPPED HAVING SEX B (GO TO 811C)
STARTED USING CONDOMS C (GO TO 811C)
RESTRICTED SEX TO ONE PARTNER D (GO TO 811C)
REDUCED NUMBER OF SEXUAL PARTNERS E (GO TO 811C)
ASKED PARTNER TO BE FAITHFUL F (GO TO 811C)
STOPPED HOMOSEXUAL RELATIONSHIPS G (GO TO 811C)
STOPPED RECEIVING INJECTIONS I
AVOIDS SOILED BLADES, SCISSORS, AND KNIVES K
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
NO CHANGE Y

811B) Has your knowledge of AIDS influenced or changed your decisions about having sex or sexual behavior?

IF YES, In what way?

RECORD ALL MENTIONED.

DID NOT START HAVING SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
OTHER (SPECIFY): ___ X
NO CHANGE IN SEXUAL BEHAVIOR X
DON'T KNOW Z

811C) Some people use condoms during sex to avoid getting AIDS or other sexually transmitted illnesses. Have you ever heard of condoms?

YES 1
NO 2 (GO TO 811F)

811D) CHECK 515 AND 515F:

HAS HAD SEX: ___
HAS NOT HAD SEX: ___ (GO TO 901)

811E) We may have already discussed this. Have you ever used a condom during sexual relations to avoid getting AIDS or transmitting illnesses like AIDS?

YES 1
NO 2 (GO TO 811G)

811EA) Do you use a condom from time to time, often, or with each sexual encounter?

TIME TO TIME 1 (GO TO 811G)
OFTEN 2 (GO TO 811G)
EACH ENCOUNTER 3 (GO TO 811G)

811F) CHECK 515 AND 515F:

HAS HAD SEX: ___
HAS NOT HAD SEX: ___ (GO TO 901)

811G) In the last 12 months, have you given or received money, gifts, or favors in exchange for sexual relations?

YES 1
NO 2

SECTION 9. TRADITIONAL PRACTICES

901) In parts of Ivory Coast and in other 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 923)

902) Have you yourself ever had this type of practice?

YES 1
NO 2 (GO TO 908)

903) What do you call the type of practice you underwent?

PROBE TO DETERMINE THE EXACT NAME OF THE TYPE OF PRACTICE.

____

904) How old were you when this occurred?

AGE IN COMPLETED YEARS: ___
DURING INFANCY 96
DK 98

905) Who performed the procedure?

DOCTOR 01
NURSE/MIDWIFE 02
TRADITIONAL BIRTH ATTENDANT 03
CIRCUMCISION PRACTITIONER 04
FEMALE CIRCUMCISER 05
"OLD WOMAN" 06
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

906) When you underwent this practice, did they totally close or partially close the opening of the vagina by stitching?

YES 1
NO 2

907) With your first period or when you got married, did someone have to make an incision to open the vaginal area?

YES 1
NO 2

908) CHECK 214 AND 217:

AT LEAST ONE LIVING DAUGHTER: ___
NO LIVING DAUGHTER(S): ___ (GO TO 916)

909) Did (NAME OF OLDEST DAUGHTER) undergo this practice?

YES 1
NO 2 (GO TO 912)
DON'T KNOW 8 (GO TO 912)

910) What do you call the type of practice that she underwent?

PROBE TO DETERMINE THE EXACT NAME OF THE TYPE OF PRACTICE.

911) How old was she when she was circumcised?

AGE IN COMPLETED YEARS: ___
DON'T KNOW 98

912) Who performed the procedure?

DOCTOR 01
NURSE/MIDWIFE 02
TRADITIONAL BIRTH ATTENDANT 03
CIRCUMCISION PRACTITIONER 04
FEMALE CIRCUMCISER 05
"OLD WOMAN" 06
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

913) Did anyone object to this type of practice that (NAME OF OLDEST DAUGHTER) underwent?

Anyone else?

RECORD ALL PERSONS MENTIONED.

RESPONDENT A (GO TO 916)
RESPONDENT'S HUSBAND B (GO TO 916)
RESPONDENT'S MOTHER C (GO TO 916)
RESPONDENT'S MOTHER-IN-LAW D (GO TO 916)
OTHER RELATIVE OF RESPONDENT E (GO TO 916)
OTHER RELATIVE OF HUSBAND F (GO TO 916)
OTHER (SPECIFY): ___ X (GO TO 916)
NO/NO ONE Y (GO TO 916)

914) Do you intend to have this practice done to (NAME OF OLDEST DAUGHTER)?

YES 1 (GO TO 916)
NO 2
DK 8 (GO TO 916)

915) Do you think that someone in your life (family/friends?) would, in spite of your opposition, have your daughter undergo this procedure?

YES 1
NO 2
DON'T KNOW 8

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

CONTINUED 1
DISCONTINUED 2 (GO TO 920)
DON'T KNOW 8 (GO TO 923)

917) Why do you think that this practice should be continued?

Any other reason?

RECORD ALL REASONS MENTIONED.

GOOD TRADITION A
CUSTOMS AND TRADITIONS B
RELIGIOUS REQUIREMENT C
HYGIENE D
BETTER MARRIAGE PROSPECTS E
GREATER SEXUAL SATISFACTION FOR HUSBAND F
PRESERVES VIRGINITY/PREVENTS IMMORALITY G
OTHER (SPECIFY): ___ X
DON'T KNOW Z

918) CHECK 917:

CODE A AND/OR CODE B CIRCLED: ___
NEITHER CODE A NOR CODE B CIRCLED: ___ (GO TO 923)

919) What do you mean by GOOD TRADITION/TRADITION/CUSTOM?

RECORD ALL REASONS MENTIONED

CUSTOM AND TRADITION B (GO TO 923)
RELIGIOUS REQUIREMENT C (GO TO 923)
HYGIENE D (GO TO 923)
BETTER MARRIAGE PROSPECTS E (GO TO 923)
GREATER SEXUAL SATISFACTION FOR HUSBAND F (GO TO 923)
PRESERVES VIRGINITY/PREVENTS IMMORALITY G (GO TO 923)
OTHER (SPECIFY): ___ X (GO TO 923)
DON'T KNOW Z (GO TO 923)

920) Why do you think this practice should be stopped?

Any other reason?

RECORD ALL REASONS MENTIONED.

BAD TRADITION A
AGAINST RELIGION B
MEDICAL COMPLICATIONS C
OWN EXPERIENCE WAS PAINFUL D
AGAINST WOMAN'S DIGNITY E
PREVENTS SEXUAL SATISFACTION F
OTHER (SPECIFY): ___ X
DON'T KNOW Z

921) CHECK 920:

CODE 'A' CIRCLED: ___
CODE 'A' NOT CIRCLED: ___ (GO TO 923)

922) What do you mean by BAD TRADITION?

RECORD ALL REASONS MENTIONED.

AGAINST RELIGION B
MEDICAL COMPLICATIONS C
OWN EXPERIENCE WAS PAINFUL D
AGAINST WOMAN'S DIGNITY E
PREVENTS SEXUAL SATISFACTION F
OTHER (SPECIFY): ___ X
DON'T KNOW Z

923) RECORD THE TIME:

HOUR: ___
MINUTES: ___

SECTION 10. HEIGHT AND WEIGHT

1001) IN 1003 RECORD RESPONDENT'S NAME.
IN 1006 AND 1008 RECORD THE RESPONDENT'S HEIGHT AND WEIGHT.

IN 1002, 1003, AND 1004 (COLUMN 2-4) RECORD THE LINE NUMBER, NAME, AND BIRTH DATE OF EACH CHILD BORN BEFORE JANUARY 1993 AND STILL ALIVE, STARTING WITH THE YOUNGEST.

IN 1006 AND 1008 RECORD THE HEIGHT AND WEIGHT OF THE LIVING CHILDREN.

NOTES: ALL WOMEN RESPONDENTS SHOULD BE WEIGHED AND MEASURED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN BEFORE JANUARY 1993, USE AN ADDITIONAL QUESTIONNAIRE.

TABLE FORMAT:
1. Respondent
2. Youngest living child
3. Next-to-youngest living child
4. Second from youngest living child

1002) LINE NO. FROM 212 FROM SECTION 2:

___

1003) NAME (FROM 212 FOR CHILDREN):

NAME: ___

1004) DATE OF BIRTH:

- FROM 215, AND ASK FOR DAY OF BIRTH.

DAY: ___
MONTH: ___
YEARS: ___

1005) BCG SCAR ON TOP OF LEFT SHOULDER?

SCAR SEEN 1
NO SCAR 2

1006) HEIGHT (IN CENTIMETERS):

_____

1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

LYING 1
STANDING 2

1008) WEIGHT (IN KILOGRAMS):

_____

1009) DATE WEIGHED AND MEASURED:

DAY: ___
MONTH: ___
YEAR: ___

1010) RESULT:

RESPONDENT
MEASURED 1
NOT PRESENT 2
REFUSED 4
OTHER (SPECIFY): ___ 6
CHILDREN
MEASURED 1
SICK 2
NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY): ___ 6

1011)
NAME OF MEASURER: ___
NAME OF ASSISTANT*: ____

*CODES: IF THE ASSISTANT IS A TEAM MEMBER, RECORD HIS/HER CODE, OTHERWISE USE THE FOLLOWING CODES: MOTHER (190); OTHER MEMBERS OF THE HOUSEHOLD (191); OTHER PERSONS (192).

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 ___