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DEMOGRAPHIC AND HEALTH SURVEY -II
COTE D'IVOIRE - 1998-99
MEN'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 MAN ___
MAN'S LINE NUMBER ___

INTERVIEWER VISITS:

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

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

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__

FINAL VISIT:
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

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

TOTAL NUMBER OF VISITS: ___

LANGUAGE OF INTERVIEW:

1 FRENCH
2 DIOULA
3 BAOULE
6 OTHERS

INTERPRETER:

YES 1
NO 2

SUPERVISOR:
NAME ___
DATE ___

FIELD EDITOR:
NAME ___
DATE ___

OFFICE EDITOR ___

KEYED BY ___

SECTION 1. RESPONDENT'S SOCIO-DEMOGRAPHIC CHARACTERISTICS

101) RECORD THE TIME:

HOUR: ___
MINUTES: ___

105) In what month and year were you born?

MONTH: ___
DON'T KNOW MONTH 98
YEAR: ___
DON'T KNOW YEAR 9998

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS: ___

106A) Do you understand French?

YES 1
NO 2

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
SECONDARY, 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 108:

PRIMARY: ___
SECONDARY OR HIGHER: ___ (GO TO 111A)

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 112A)

111A) Do you usually read a newspaper or magazine at least once a month?

YES 1
NO 2 (GO TO 112A)

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

YES 1
NO 2

112A) Do you usually listen to the radio?

YES 1
NO 2 (GO TO 113G)

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

YES 1 (GO TO 113B)
NO 2

113A) 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

113B) 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
DK Z

113C) What type of radio program do you normally listen to?

PROBE TO OBTAIN THE TYPE OF PROGRAM.

RECORD ALL THE PROGRAMS.

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

113D) Have you had a chance to listen to the radio serial "Yamba Songo"?

YES 1
NO 2 (GO TO 113G)

113E) According to you, is this serial educational, or for entertainment?

EDUCATIONAL 1
ENTERTAINMENT 2 (GO TO 113G)
BOTH 3
DON'T KNOW 8 (GO TO 113G)

113F) According to you, what problems does "Yamba Songo" talk about?

RECORD ALL OF THE RESPONSES GIVEN.

IF THE RESPONSE IS 'DK', 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
DK Z

113G) Do you usually watch television?

YES 1
NO 2 (GO TO 115)

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

YES 1
NO 2

114A) What days of the week do you normally watch television?

RECORD ALL THE RESPONSES GIVEN.

IF THE RESPONSE IS 'IT DEPENDS', 'DOESN'T MATTER', OR 'DON'T KNOW', YOU ONLY HAVE 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

114B) What time do you normally watch television?

RECORD ALL THE RESPONSES GIVEN.

IF THE RESPONSE IS 'ALL DAY', 'IT DEPENDS', 'DOESN'T MATTER', OR 'DON'T KNOW', YOU ONLY HAVE 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

114C) What type of television shows 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
SPOKEN NEWS D
REPORTING E
SHOW ON HEALTH F
OTHER (SPECIFY): ___ X

115) Do you work at this time?

YES 1 (GO TO 117)
NO 2

116) Have you done any type of work in the last 12 months?

YES 1
NO 2 (GO TO 125)

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

_____

118) CHECK 117:

WORKS IN AGRICULTURE: ___
DOES NOT WORK IN AGRICULTURE: ___ (GO TO 120)

119) 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

120) 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


121) 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

125) What is your religion?

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

SECTION 2. REPRODUCTION

201) Now I would like to ask you about your children. I'm only interested in your biological children. Do you have or have you had children?

YES 1
NO 2 (GO TO 206)

202) Do you have children who are now living with you?

YES 1
NO 2 (GO TO 204)

203) How many sons live with you?
And how many daughters live with you?

IF NONE, RECORD '00'.

SONS AT HOME: ___
DAUGHTERS AT HOME: ___

204) Do you have any children who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

SONS ELSEWHERE: ___
DAUGHTERS ELSEWHERE: ___

206) Have you ever had any children who were born alive but later died?

IF NO, PROBE: Any baby who cried or showed signs of life at birth but did not survive?

YES 1
NO 2 (GO TO 208)

207) How many boys have died?
And how many girls have died?

IF NONE, RECORD '00'.

BOYS DECEASED: ___
GIRLS DECEASED: ___

208) SUM ANSWERS TO 203, 205, AND 207 AND ENTER TOTAL.

IF NONE, RECORD '00'.

TOTAL: ___

209) CHECK 208:

Just to makes sure that I have this right: you have had in TOTAL ___ children during your life. Is that correct?

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

210) CHECK 208:

HAS/HAD CHILDREN: ___
NEVER HAD CHILDREN: ___ (GO TO 300)

210A) In what month and year was your last child born?

MONTH: ___
YEAR: ___

210B) SEE 201A, LAST CHILD:

NOT BEFORE JANUARY 1994: ___
BEFORE JANUARY 1994: ___ (GO TO 300)

211) At the time you expecting this last child, did you want a child then, did you want to wait until later, or did you not want to have any (more) children?

THEN 1
LATER 2
NOT AT ALL 3

SECTION 3. FAMILY PLANNING

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 Women can have a sterilet that a doctor, midwife, 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, suppository, 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 can use to prevent pregnancy?
YES (SPECIFY): ___ 1
NO 3

303) Have you ever used (METHOD)?

01. PILL Women can take a pill every day.
YES 1
NO, DK 2
02. IUD Women can have a sterilet that a doctor, midwife, or nurse places inside their uterus.
YES 1
NO, DK 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, DK 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, DK 2
05. DIAPHRAGM, FOAM OR GEL Women can place a sponge, suppository, diaphragm, gel, or cream in their vagina before intercourse.
YES 1
NO, DK 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 a partner who had an operation to avoid having any more children?
YES 1
NO, DK 2
08. MALE STERILIZATION Have you ever had an operation to avoid having any more children?
YES 1
NO 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, DK 2
10. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11. Have you ever heard of any other methods that men or women can use to prevent pregnancy?
YES 1
NO/DK 2

304) CHECK 303:

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

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

YES 1
NO 2 (GO TO 309)

306) What have you done or used?

CORRECT 303 AND 304 (AND 302 IF NECESSARY).

307) At the moment, are you or your partner currently doing something or using any method to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 309)

308) Which method are you using?

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

308A) Why do you use the (METHOD FROM 308) over another method?

COST/LESS EXPENSIVE/NO COST 01 (GO TO 401)
MORE AVAILABLE 02 (GO TO 401)
WAS PRESCRIBED 03 (GO TO 401)
MORE EFFECTIVE 04 (GO TO 401)
NO SIDE EFFECTS 05 (GO TO 401)
IT SUITS ME 06 (GO TO 401)
ONLY KNOWN METHOD 07 (GO TO 401)
REVERSIBLE METHOD 08 (GO TO 401)
PROTECTS AGAINST AIDS/STI 09 (GO TO 401)
OTHER (SPECIFY): ___ 96 (GO TO 401)

309) What is the main reason that you do not use a contraceptive method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
WIFE MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFERTILE 24
WIFE POST-PARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
WIFE PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
SPOUSE/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
USE CONCERNS WIFE 61
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401) Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO 402A)
MARRIAGE NOT CONSUMMATED 3 (GO TO 410F)
NO, NOT IN UNION 4 (GO TO 404)

402) How many wives do you have?

402A) How many women do you live with as husband and wife?

NUMBER OF WOMEN: ___

403) WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE/WIVES.

IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, RECORD '00'.
THE NUMBER OF SPACES FILLED SHOULD BE EQUAL TO THE NUMBER OF WIVES.

___ (GO TO 407)

404) 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

405) Have you ever been married or lived with a woman?

YES, WAS MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410F)

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

WIDOWER 1
DIVORCED 2
SEPARATED 3

407) Have you been married or have you lived with a woman only once, or more than once?

ONCE 1
MORE THAN ONCE 2

408) CHECK 407:

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

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

MONTH: ___
DON'T KNOW MONTH 98
YEAR: ___ (GO TO 410)
DON'T KNOW YEAR 9998

409) How old were you when you started living with her?

AGE: ___

409A) CHECK 401:

CURRENTLY MARRIED OR LIVES WITH A WOMAN: ___
NOT IN A UNION: ___ (GO TO 410F)

410) 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 spouse/the woman with whom you live)?

IF "NEVER HAD RELATIONS", GO BACK TO 401, CIRCLE CODE 3 (MARRIAGE NOT CONSUMMATED) AND FOLLOW THE NEW INSTRUCTIONS STARTING WITH 401.

NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4

410A) CHECK 301 AND 302:

FAMILIAR WITH CONDOMS:
The last time you had sex with (your spouse/the woman with whom you live), was a condom used?

UNFAMILIAR WITH CONDOMS:
Some men use a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex with (your spouse/the woman with whom you live), was a condom used?

YES 1
NO 2 (GO TO 410B)
DON'T KNOW/NOT SURE 8 (GO TO 410B)

410AA) During this last sexual relation, who suggested using the condom?

RESPONDENT HIMSELF 1
SPOUSE/WOMAN 2
BOTH 3

410B) Have you had sexual relations with someone other than (your spouse/the woman with whom you live) in the last 12 months?

YES 1
NO 2 (GO TO 413)

410C) When was the last time you had sexual relations with someone other than (your spouse/the woman with whom you live)?

NUMBER OF DAYS: ___ 1
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3

410CA)The last time that you had sexual relations with someone other than your wife/the woman with who you live, was it with a regular partner, an acquaintance, for money, or with someone else?

REGULAR PARTNER 1
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4

410D) Was a condom used on this occasion?

YES 1
NO 2 (GO TO 410E)
DON'T KNOW 8 (GO TO 410E)

410DA) During this last sexual relation, who suggested using the condom?

RESPONDENT HIMSELF 1
PARTNER 2
BOTH 3

410E) During the last 12 months, how many different people other than (your spouse/the woman with whom you live) did you have sexual relations with?

NUMBER OF PEOPLE: ___ (GO TO 413)
DK 98 (GO TO 413)

410F) 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 509)
DAYS AGO: ___ 1
WEEKS AGO: ___ 2
MONTHS AGO: ___ 3
YEARS AGO: ___ 4

401FA) The last time you had sexual intercourse, was it with a regular partner, an acquaintance, for money, or with someone else?

REGULAR PARTNER 1
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4

410G) CHECK 301 AND 302:

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

DOES NOT KNOW CONDOM:
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, was a condom used?

YES 1
NO 2 (GO TO 410H)
DON'T KNOW 8 (GO TO 410H)

410GA) During this last sexual relation, who suggested using the condom?

RESPONDENT HIMSELF 1
PARTNER 2
BOTH 3

410H) CHECK 410F:

LESS THAN 12 MONTHS SINCE LAST SEXUAL RELATIONS: ___
12 MONTHS OR MORE SINCE LAST SEXUAL RELATIONS: ___ (GO TO 413)

410I) In total, with how many different people have you had sex in the last 12 months?

NUMBER OF PEOPLE: ___
DK 98

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

YES 1
NO 2 (GO TO 415)

414) Where is that?

RECORD ALL MENTIONED.

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.

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

414A) CHECK 410A, 410D, 410G:

AT LEAST ONE 'YES': ___
NO 'YES': ___ (GO TO 415)

414B) Where did you get the condoms 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.

Any other place?

RECORD ALL PLACES MENTIONED.

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 415)
OTHER (SPECIFY): ___ 96

414C) Do you know the brand name of the condoms that you used last time?

RECORD NAME OF BRAND.

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

414D) The last time you bought condoms, how many did you buy?

DETERMINE THE NUMBER OF CONDOMS AND RECORD THE NUMBER.
RECORD '90' FOR 90 AND MORE.

NUMBER OF CONDOMS: ___
DK 98

414E) How much did you pay?

COST: ___
FREE 9996
DK 9998

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

AGE: ___
FIRST TIME WHEN MARRIED 96

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

NOT IN UNION: ___
CURRENTLY MARRIED OR LIVING WITH A WOMAN: ___ (GO TO 503)

502) CHECK 404:

HAS REGULAR SEXUAL PARTNER: ___
HAS OCCASIONAL SEXUAL PARTNER: ___
DOES NOT HAVE SEXUAL PARTNER: ___ (GO TO 505A)

503) Is your spouse (or one of your spouses)/partner currently pregnant?

YES 1
NO 2 (GO TO 505A)
UNSURE 8 (GO TO 505A)

504) When she became pregnant did you want her to get pregnant then, did you want to wait until later, or did you not want her to get pregnant at all?

THEN 1 (GO TO 505B)
LATER 2 (GO TO 505B)
NOT AT ALL 3 (GO TO 505B)

505)
A) SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER:
Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not have any (more) children?

B) SPOUSE/PARTNER PREGNANT:
Now I have some questions about the future. After the child your wife/partner is expecting now, would you like to have another child, or would you prefer not have any more children?

HAVE (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 507)
SAYS WIFE CANNOT GET PREGNANT 3 (GO TO 507)
SAYS HE CANNOT HAVE ANY CHILDREN 4 (GO TO 507)
UNDECIDED/DK 8 (GO TO 507)

506) CHECK 503:

SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER:
How long would you like to wait from now before the birth of (a/another) child?

SPOUSE/PARTNER PREGNANT:
After the birth of this child your spouse/partner is expecting now, how long would you like to wait before the birth of another child?

MONTHS: ___ 1
YEARS: ___ 2
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY): ___ 996
DON'T KNOW 998

507) CHECK 308: USES A METHOD?

NOT ASKED: ___
NOT CURRENTLY USING: ___
CURRENTLY USING: ___ (GO TO 512)

508) Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?

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

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

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

510) Which contraceptive method would you prefer to use?

PILL 01 (GO TO 512)
IUD 02 (GO TO 512)
INJECTABLES 03 (GO TO 512)
IMPLANT 04 (GO TO 512)
DIAPHRAGM/FOAM/GEL 05 (GO TO 512)
CONDOM 06 (GO TO 512)
FEMALE STERILIZATION 07 (GO TO 512)
MALE STERILIZATION 08 (GO T0 512)
PERIODIC ABSTINENCE 09 (GO TO 512)
WITHDRAWAL 10 (GO TO 512)
OTHER (SPECIFY): ___ 96 (GO TO 512)
UNSURE 98 (GO TO 512)

511) What is the main reason that you think you would never use a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
WIFE MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFERTILE 24
WANTS CHILDREN 26
OPPOSED TO USE
RESPONDENT OPPOSED 31
SPOUSE/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
USE CONCERNS WIFE/PARTNER 61
OTHER (SPECIFY): ___ 96
DON'T KNOW 98

512) CHECK 202 AND 204:

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 514)
OTHER (SPECIFY): ___ 96 (GO TO 514)

513) 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

514) 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

515) 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

516) In the last six months, have you heard or seen something about family planning:

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

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPERS OR MAGAZINES
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2
SIGN/BILLBOARD
YES 1
NO 2
COMMUNITY MEETING
YES 1
NO 2


516A) 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
WIFE/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

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

YES 1
NO 2 (GO TO 520)

519) 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/STEPMOTHER G
FRIENDS/NEIGHBORS H
OTHER (SPECIFY): ___ X

520) CHECK 401:

YES, CURRENTLY MARRIED: ___
YES, LIVING WITH A WOMAN: ___
NO, NOT IN A UNION: ___ (GO TO 601A)

521) Spouses/partners do not always agree on everything. Now I want to ask you about your wife/(wives)/partner(s)' views on family planning.

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

APPROVES 1
DISAPPROVES 2
SOME APPROVE OTHERS DISAPPROVE 3
DON'T KNOW 8

522) How often have you talked to your wife/(wives)/partner(s) about family planning in the last twelve months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

601A) Have you ever heard of an illness that you can get from having sex?

YES 1
NO 2 (GO TO 601F)

601B) What illnesses have you heard of?

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

601C) CHECK 410 AND 410F:

HAS HAD SEXUAL INTERCOURSE: ___
HAS NEVER HAD SEXUAL INTERCOURSE: ___ (GO TO 601F)

601D) Over the last 12 months, have you had any of these illnesses?

YES 1
NO 2 (GO TO 601F)
DK 8 (GO TO 601F)

601E) 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

601F) Have you had any discharge from your penis in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

601G) During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

601H) CHECK 601E, 601F, 601G:

HAS HAD AT LEAST ONE INFECTION: ___
HAS NOT HAD ANY INFECTION: ___ (GO TO 601N)

601I) The last time you had (INFECTION FROM 601E/DISCHARGE/SORE), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 601JA)

601J) Where did you go for 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

601JA) CHECK 410 AND 410F:

HAS HAD SEXUAL RELATIONS: ___
HAS NOT HAD SEXUAL RELATIONS: ___ (GO TO 601N)

601K) When you had (INFECTION FROM 601E/DISCHARGE/SORE), did you inform the people were you having sexual intercourse with?

YES 1
NO 2

601L)
When you had (INFECTION FROM 601E/DISCHARGE/SORE), did you do something to avoid infecting your sexual partners?

YES 1
NO 2 (GO TO 601N)
PARTNER(S) ALREADY INFECTED 3 (GO TO 601N)

601M) What did you do?

RECORD ALL MENTIONED.

STOPPED SEX A
USED CONDOM B
TOOK DRUGS C
OTHER (SPECIFY): ___ X

601N) CHECK 601B:

DID NOT MENTION AIDS OR 601B NOT ASKED: ___
MENTIONED AIDS: ___ (GO TO 602)

601O) Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 611C)

602) 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

602A) If you wanted more information on AIDS, where (from whom) would you like to get this information?

IF SEVERAL SOURCES ARE LISTED, ASK WHICH WOULD BE THE PREFERRED SOURCE AND CIRCLE THE CORRESPONDING CODE.

Any other way?

RECORD ALL MENTIONED.

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

602B) How can one get 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

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

YES 1
NO 2 (GO TO 607)
DON'T KNOW 8 (GO TO 607)

604) What can a person do?

Anything else?

RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE PARTNERS 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 USING SOILED BLADES, SCISSORS, KNIVES K
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER L
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

608) 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

608A) Can AIDS be cured?

YES 1
NO 2
DK 8

608B) Can AIDS be transmitted from a mother to a child?

YES 1
NO 2
DON'T KNOW 8

608C) Do you know someone personally who has AIDS or someone who died of AIDS?

YES 1
NO 2
DK 8

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

SMALL 1
AVERAGE 2 (GO TO 609C)
GREAT 3 (GO TO 609C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 611A)

609B) Why do you think that you (have no risk/have a small risk) for getting AIDS?

Any other reason?

RECORD ALL MENTIONED.

ABSTAINS FROM SEX B (GO TO 611A)
USES CONDOMS C (GO TO 611A)
ONLY HAS ONE SEXUAL PARTNER D (GO TO 611A)
HAS A LIMITED NUMBER OF SEXUAL PARTNERS E (GO TO 611A)
AVOIDS PROSTITUTES F (GO TO 611A)
PARTNER DOESN'T HAVE OTHER PARTNERS G (GO TO 611A)
DOESN'T HAVE HOMOSEXUAL RELATIONSHIPS H (GO TO 611A)
DOESN'T GET BLOOD TRANSFUSIONS I (GO TO 611A)
DOESN'T GET INJECTIONS J (GO TO 611A)
AVOIDS CUTTING WITH SOILED BLADES, SCISSORS, AND KNIVES K (GO TO 611A)
OTHER (SPECIFY): ___ X (GO TO 611A)

609C) Why do you think you have (average/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
GOES TO PROSTITUTES F
PARTNER HAS OTHER PARTNERS G
HAS HOMOSEXUAL RELATIONSHIPS H
BLOOD TRANSFUSIONS I
INJECTIONS J
USES SOILED BLADES, SCISSORS, AND KNIVES K
OTHER (SPECIFY): ___ X

611A) 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 611C)
STOPPED HAVING SEX B (GO TO 611C)
STARTED USING CONDOMS C (GO TO 611C)
RESTRICTS SEX TO ONE PARTNER D (GO TO 611C)
REDUCES NUMBER OF SEXUAL PARTNERS E (GO TO 611C)
AVOIDS PROSTITUTES F (GO TO 611C)
ASKS PARTNER TO BE FAITHFUL G (GO TO 611C)
STOPS HOMOSEXUAL RELATIONSHIPS H (GO TO 611C)
STOPS INJECTIONS J
AVOIDS SOILED BLADES, SCISSORS, AND KNIVES K
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
NO CHANGE Y

611B) 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 SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
AVOID PROSTITUTES F
STOPPED HOMOSEXUAL RELATIONSHIPS H
OTHER (SPECIFY): ___ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DON'T KNOW Z

611C) 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 611F)

611D) CHECK 410 AND 410F:

HAS HAD SEX: ___
HAS NOT HAD SEX: ___ (GO TO 701)

611E) 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 611G)

611EA) Do you use a condom from time to time, often, or with each sexual encounter?

TIME TO TIME 1 (GO TO 611G)
OFTEN 2 (GO TO 611G)
EACH ENCOUNTER 3 (GO TO 611G)

611F) CHECK 410 AND 410F:

HAS HAD SEX: ___
HAS NOT HAD SEX: ___ (GO TO 701)

611G) Have you given or received money, gifts, or favors in exchange for sexual relations in the last 12 months?

YES 1
NO 2

SECTION 7. TRADITIONAL PRACTICES

701) In parts of Ivory Coast and in other countries, there is a practice of carving or cutting parts of the skin or flesh of the genitals of young girls. Have you ever heard of this practice?

YES 1
NO 2 (GO TO 709)

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

CONTINUE PRACTICE 1
STOP 2 (GO TO 706)
DK 8 (GO TO 709)

703) Why do you think this practice should be continued?

GOOD TRADITION A
CUSTOM AND TRADITION B
RELIGIOUS NECESSITY C
HYGIENE D
BETTER CHANCE OF MARRIAGE E
MORE PLEASURE FOR THE HUSBAND F
PRESERVES VIRGINITY/AVOIDS IMMORALITY G
OTHER (SPECIFY): ___ X
DK Z

704) CHECK 703:

CODE 'A' AND/OR 'B' ARE CIRCLED: ___
NEITHER CODE 'A' OR CODE 'B' ARE CIRCLED: ___ (GO TO 709)

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

RECORD ALL THE REASONS MENTIONED.

CUSTOM AND TRADITION B (GO TO 709)
RELIGIOUS NECESSITY C (GO TO 709)
HYGIENE D (GO TO 709)
BETTER CHANCE OF MARRIAGE E (GO TO 709)
MORE PLEASURE FOR THE HUSBAND F (GO TO 709)
PRESERVES VIRGINITY/AVOIDS IMMORALITY G (GO TO 709)
OTHER (SPECIFY): ___ X (GO TO 709)
DK Z (GO TO 709)

706) Why do you think the practice should be stopped?

What other reasons?

RECORD ALL THE REASONS MENTIONED.

BAD TRADITION A
AGAINST RELIGION B
MEDICAL COMPLICATIONS C
OWN PAINFUL EXPERIENCE D
AGAINST WOMAN'S DIGNITY E
PREVENTS SEXUAL SATISFACTION F
OTHER (SPECIFY): ___ X
DK Z

707) CHECK 706:

CODE 'A' IS CIRCLED: ___
CODE 'A' IS NOT CIRCLED: ___ (GO TO 709)

708) What do you mean by BAD TRADITION?

RECORD ALL THE REASONS MENTIONED.

AGAINST RELIGION B
MEDICAL COMPLICATIONS C
OWN PAINFUL EXPERIENCE D
AGAINST WOMAN'S DIGNITY E
PREVENTS SEXUAL SATISFACTION F
OTHER (SPECIFY): ___ X
DK Z

709) RECORD THE TIME:

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 ___