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Republic of Ivory Coast Demographic and Health Survey
EDSCI-III, Woman's questionnaire

MINISTRY OF HEALTH AND OF THE FIGHT AGAINST AIDS, NATIONAL OFFICE OF STATISTICS

IDENTIFICATION

PLACE NAME_________
NAME OF HEAD OF HOUSEHOLD__________
CLUSTER NUMBER_____
STRUCTURE NUMBER________
HOUSEHOLD NUMBER________
REGION_______

RESIDENTIAL TYPE/ MILIEU______

URBAN 1
RURAL 2

LARGE CITY/CITY/SMALL CITY/RURAL/ CITY_______

LARGE CITY 1
CITY 2
SMALL CITY 3
RURAL 4

NAME AND LINE NUMBER OF WOMAN

NAME__________
LINE NUMBER____________

CHECK THE KISH TABLE IN THE HOUSHOLD QUESTIONNAIRE IF THE WOMAN WAS SELECTED FOR RELATIONSHIPS IN THE HOUSEHOLD

YES 1
NO 2

CHECK THE COVER OF HOUSEHOLD QUESTIONNAIRE IF SELECTED FOR MENS SURVEY, ANEMIA/HIV TEST IN THE HOUSEHOLD

YES 1
NO 2

INTERVIEWER VISITS

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE____ /201__
INTERVIEWER'S NAME
RESULT*____

NEXT VISIT
(REPEAT FOR INTERVIEWER 2)
DATE____ /201__
TIME______

FINAL VISIT
DAY_______
MONTH_______
YEAR 201___
INTERVIEWER CODE________
RESULT______

TOTAL NO. OF VISITS___________

RESULT CODES:

1COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)________________

LANGUAGE OF INTERVIEW

FRENCH 1
NATIONAL/LOCAL LANGUAGE 2

INTERPRETER

YES 1
NO 2

SUPERVISOR
NAME_______
DATE_______

FIELD EDITOR
NAME______
DATE______

OFFICE EDITOR_______

KEYED BY_______

PHRASES TO READ
MOM GOES TO THE MARKET.
THE KIDS DANCE WITH THEIR FATHER.
YOU MUST GO GET WATER FROM THE MARIGOT.
MOM IS PILING

Section 1. Respondent's background

INTRODUCTION AND CONSENT
INFORMED CONSENT

Hello. My NAME is ___. I am working with the National Office of Statistics (INS) and the Ministry of Health and the Fight Against AIDS (MSLS). We are conducting a survey about health in Cote d'Ivoire. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will NOt be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
May I begin the interview?

SIGNATURE OF INTERVIEWER_____________
DATE__________

RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2-END

101) RECORD THE TIME

HOUR_____
MINUTES______

102) In what month and year were you born?

MONTH______
DON'T KNOW MONTH 98
YEAR______
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS_______

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

106) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00

GRADE/YEAR______

107) CHECK 105:

PRIMARY
SECONDARY OR HIGHER (GO TO 110)

108) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF SENTENCE 2
ABEL TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5

109) CHECK 108:

CODE '2', '3', OR '4' CIRCLED
CODE '1' OR '5' CIRCLED (GO TO 111)

110) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111) Do you listen to the radio at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112) Do you watch television at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113) What is your religion?

MUSLIM 1
CATHOLIC 2
METHODIST 3
EVANGELICAL 4
OTHER CHRISTIAN RELIGION 5
ANIMIST 6
OTHER RELIGIONS 7
NO RELIGION 8

114) What is your ethnicity?
RECORD THE ETHNICITY. LEAVE THE CODIFICATION SPACES EMPTY.
FOR FOREIGNERS, RECORD NATIONALITY.

ETHNICITY__________

115) In the last 12 months, how many times have you been away from for one or more nights?

NUMBER OF TIMES
NONE 00 (GO TO 201)

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

YES 1
NO 2

Section 2. Reproduction

201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

202) Do you have any sons or daughters to whom you have given birth who are now living with you?

YES 1
NO 2 (GO TO 204)

203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'

SONS AT HOME_______
DAUGHTERS AT HOME_______

204) Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECODE '00'

SONS ELSEWHERE__________
DAUGHTERS ELSEWHERE_________

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2- (GO TO 208)

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

BOYS DEAD_______
GIRLS DEAD______

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

TOTAL BIRTHS____

209) CHECK 208:
Just to makes sure that I have this right: you have had in total ____births during your life. Is that correct?

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

210) CHECK 208:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 226)

211) now I would like to record the NAMEs of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.)

212) What NAME was given to you (first/next) baby?
RECORD NAME.
BIRTH HISTORY NUMBER

NAME____
BIRTH HISTORY NUMBER___

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

BOY 1
GIRL 2

214) Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

MONTH_____
YEAR____

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217) IF ALIVE:
How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS____

218) IF ALIVE: Is (NAME) living with you?

YES 1
NO 2

219) IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

HOUSEHOLD LINE NUMBER_______ (GO TO 221)

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

IF '1 YEAR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS, OR YEARS.

DAYS____ 1
MONTHS_____ 2
YEARS____ 3

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth? [##translator note: the very end of this sentence was cut off, but the translation provided is from the standard version, and therefore should not be substantively different from what was cut off]

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTHS IN TABLE.

YES 1
NO 2

223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK.

NUMBERS ARE THE SAME
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215:E NUMBER OF BIRTHS IN 2006 OR LATER.

NUMBER OF BIRTHS_______
NONE 0

226) Are you pregnant now?

YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS

MONTHS_____

228) When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 230)
NO 2

229) Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

230) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

YES 1
NO 2 (GO TO 238)

230a) Among these terminated pregnancies, were there any:

Miscarriages?
YES 1
NO 2
Abortions?
YES 1
NO 2
Stillbirths?
YES 1
NO 2

231) When did the last such pregnancy end?

MONTH____
YEAR___

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN 2006 OR LATER
LAST PREGNANCY ENDED BEFORE JAN. 2006 (GO TO 238)

233) How many months pregnant were you when the last such pregnancy ended?

MONTHS_____

234) Since January 2006, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2

236) Did you have any miscarriages, abortions or stillbirths that ended before 2006?

YES 1
NO 2 (GO TO 238)

237) When did the last such pregnancy that terminated before 2006 end?

MONTH_____
YEAR____

238) When did you last menstrual period start?
(DATE, IF GIVEN)____

DAYS AGO____ 1
WEEKS AGO_____ 3
MONTHS AGO_____ 2
YEARS AGO_____ 4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

239) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

YES 1
NO 2 -- (GO TO 301)
DON'T KNOW 8 (GO TO 301)

240) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAD ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY)__________ 6
DON'T KNOW 8

Section 3. Contraception

301) Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.
What methods have you heard of?
Have you ever heard of (METHOD)?

01) Female Sterilization
PROBE: Women can have an operation to avoid having any more children
YES 1
NO 2
02) Male Sterilization
PROBE: Men can have an operation to avoid having any more children
YES 1
NO 2
03) IUD
PROBE: Women can have a loop or coil placed inside their uterus by a doctor or a nurse.
YES 1
NO 2
04) Injectables
Probe: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05) Implants
PROBE: Women can have one or more 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
06) Pill
PROBE: Women can take a pill every day to avoid becoming pregnant
YES 1
NO 2
07) Condom
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) Female condom
PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) Lactational amenorrhea method (LAM)
YES 1
NO 2
10) Rhythm Method
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11) Withdrawal
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12) Emergency contraception
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
12a) Diaphragm
Women can place a latex disk on their cervix before intercourse.
YES 1
NO 2
12b) Foam/jelly/spermicide
Women can place a suppository, jelly, or cream in their vagina before intercourse to kill men's sperm. This cream can also be used on the diaphragm.
YES 1
NO 2
13) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
__________(SPECIFY)
__________(SPECIFY)
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 313)

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

YES 1
NO 2 (GO TO 313)

304) Which method are you using?
CIRCLE ALL MENTIONED
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 308A)
DIAPHRAGM I (GO TO 308A)
FOAM/JELLY J (GO TO 308A)
LACTATIONAL AMEN. METHOD K (GO TO 308A)
RHYTHM METHOD L (GO TO 308A)
WITHDRAWAL M (GO TO 308A)
CYCLE BEADS N (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

305) What is the brand NAME of the pills you are using?
IF DON'T KNOW BRAND, ASK TO SEE THE PACKAGE.

PILPLAN 01 (GO TO 308A)
OVRETTE 02 (GO TO 308A)
PLANIF 03 (GO TO 308A)
LO FEMENAL 04 (GO TO 308A)
MINIDRIL 05 (GO TO 308A)
STEDIRIL 06 (GO TO 308A)
ADEPAL 07 (GO TO 308A)
MICROGYNON 08 (GO TO 308A)
CONFIANCE 09 (GO TO 308A)
OTHER (SPECIFY)__________ 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

306) What is the brand NAME of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PRUDENCE 01 (GO TO 308A)
IPPF 02 (GO TO 308A)
KAMASSOUTRA 03 (GO TO 308A)
OTHER (SPECIFY) 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

307) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER________ (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE MEDICAL CENTER 22
OTHER PRIVATE MEDICAL______ (SPECIFY) 26
OTHER_____ (SPECIFY) 96
DON'T KNOW 98

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

308a) Since what month and year did you start using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD FIRST MENTIONED) now without stopping?

MONTH______
YEAR______

GO TO 314

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 315A)
RHYTHM METHOD 12 (GO TO 315A)
WITHDRAWAL 13 (GO TO 326)
CYCLE BEADS 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315a) Where did you learn how to use the rhythm/lactational amenorrhea method?
Probe to identity the type of source.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
HEALTH AGENT 15
OTHER_____ (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
HEALTH AGENT 25
OTHER PRIVATE MEDICAL__________ (SPECIFY) 26
OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIEND/RELATIVES 33
OTHER__________ (SPECIFY) 96

316) CHECK 304:
CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)

317) At that time, where you told about side effects or problems you might have with the method?

317a) When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

318) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 320)

319) Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

320) CHECK 317:
CODE 1 CIRCLED- At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED-When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

321) Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

322) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03 (GO TO 326)
INJECTABLES 04
IMPLANTS 05 (GO TO 326)
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
HEALTH AGENT 15
OTHER_____ (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 326)
PHARMACY 22 (GO TO 326)
PRIVATE DOCTOR 23 (GO TO 326)
MOBILE CLINIC 24 (GO TO 326)
HEALTH AGENT 25 (GO TO 326)
OTHER PRIVATE MEDICAL_____ (SPECIFY) 26 (GO TO 326)
OTHER SOURCE
SHOP 31 (GO TO 326)
RELIGIOUS INSTITUTIONS 32 (GO TO 326)
FRIEND/RELATIVES 33 (GO TO 326)
OTHER__________ (SPECIFY) 96 (GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))_______________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
HEALTH WORKER E
OTHER______ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH AGENT K
OTHER PRIVATE MEDICAL_________ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTIONS N
FRIEND/RELATIVES O
OTHER__________ (SPECIFY) X

326) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

YES 1
NO 2

327) In the last 12 months, have you visited a health care facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 328A)

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

YES 1
NO 2

328a) Do you approve of couples who use a family planning method to space out births?

APPROVE 1
DISAPPROVE 2 (GO TO 328C)
DEPENDS/DON'T KNOW 8 (GO TO 328C)

328b) Why?

HAVE CHILDREN WHEN YOU WANT A (GO TO 401)
PRESERVE WOMAN'S HEALTH B (GO TO 401)
SAFEGUARD THE CHILDREN'S FUTURE C (GO TO 401)
HEALTH OF NEWBORN D (GO TO 401)
OTHER_________ (SPECIFY) X (GO TO 401)

328c) Why?

HEALTH PROBLEMS A
SIDE EFFECTS B
CULTURAL TABOOS C
INTERFERES WITH NORMAL BODY PROCESSES D
PROHIBITED BY RELIGION E
PREVENTS HAVING CHILDREN F
OTHER _________(SPECIFY) X

Section 4. Pregnancy and postnatal care

401) CHECK 224:

ONE OR MORE BIRTHS IN 2006 OR LATER
NO BIRTHS IN 2006 OR LATER (GO TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask some questions about your children born in the last 5 years. (We will talk about each separately).

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER___________

404) FROM 212 AND 216

NAME_________
LIVING ______
DEAD______

405) When you got pregnant with (NAME), did you want to become pregnant at that time?

YES 1 (GO TO 408)
NO 2

406) Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
NO MORE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS________ 1
YEARS_________ 2
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 415)

409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEATH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY/VILLAGE FIELDWORKER E
OTHER______ (SPECIFY) X

410) Where did you receive this antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))___________

HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
OTHER_______ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
OTHER PRIVATE MEDICAL____________ (SPECIFY) H
OTHER______ (SPECIFY) X

411) How many months pregnant were you the last time you received antenatal care?

MONTHS_______
DON'T KNOW 98

412) How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES_______
DON'T KNOW 98

413) As part of your antenatal care during this pregnancy, were any of the following done at least once?

Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

BLOOD PRESSURE
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

YES 1
NO 2
DON'T KNOW 8

415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

416) During this pregnancy, how many times did you get a tetanus injection?

TIMES_________
DON'T KNOW 8

417) CHECK 416:

2 OR MORE TIMES-GO TO 421
OTHER____________

418) At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)

419) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD 7

TIMES
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO ______________

421) During this pregnancy, were you given or did you buy iron tablets or iron syrup?
SHOW TABLES/SYRUP

YES 1
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)

422) During the whole pregnancy, for how many days did you take the tables or syrup?
IF ANSWER NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS______
DON'T KNOW 998

423) During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2 -- (GO TO 424)
DON'T KNOW 8 (GO TO 424)

423a) Where do you usually obtain drugs for intestinal worms?

PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
PHARMACY IN A HEALTH STRUCTURE 14
OTHER_________ (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE PHARMACY 22
OTHER PRIVATE MEDICAL______ (SPECIFY) 26
STREET/MARKET 31
OTHER (SPECIFY)________ 96

423b) How much did you pay for these drugs?

PRICE_______
FREE 0000
PAID IN KIND 9997
DON'T KNOW 9998

424) During this pregnancy, did you take any drugs to keep you from getting malaria?

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

425) What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

SP/FANSIDAR A
CHLOROQUINE B
OTHER ______ (SPECIFY) X
DON'T KNOW Z

426) CHECK 425:
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION

CODE A CIRCLED
CODE A NOT CIRCLED (GO TO 430)

427) How many times did you take (SP/Fansidar) during this pregnancy?

TIMES___

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE A, B, OR C CIRCLED
OTHER (GO TO 430)

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility, or from another source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

430) 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

431) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 433)
DON'T KNOW 8 (GO TO 433)

432) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE

KG FROM CARD______ 1
KG FROM RECALL______ 2
DON'T KNOW 99,998

433) Who assisted with the delivery of (NAME)?
Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSON ASSISTING.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE IF ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEATH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
FRIEND/RELATIVES E
OTHER _____(SPECIFY) X
NO ONE ASSISTED Y

434) Where did you give birth to (NAME)?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))________

HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC HEALTH SECTOR_____ (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR______ (SPECIFY) 36
OTHER _______(SPECIFY) 96 (GO TO 438)

435) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

YES 1
NO 2

436) After (NAME) was born, did anyone check on your health while you were still in the facility?

YES 1 (GO TO 439)
NO 2

437) Did anyone check on your health after you left the facility?

YES 1 (GO TO 439)
NO 2 (GO TO 442)

438) Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO 2 (GO TO 442)

439) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEATH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE FIELDWORKER 22
OTHER_____ (SPECIFY) 96

440) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS_______ 1
DAYS_____ 2
WEEKS_______ 3
DON'T KNOW 998

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)

443) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS AFTER BIRTH______ 1
DAYS AFTER BIRTH_____ 2
WEEKS AFTER BIRTH_____ 3
DON'T KNOW 998

444) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEATH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE FIELDWORKER 22
OTHER______ (SPECIFY) 96

445) Where did this first check of (NAME) take place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))________

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR______ (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR______ (SPECIFY) 36
OTHER_____ (SPECIFY) 96

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS

YES 1
NO 2 (GO TO 447)
DON'T KNOW 8 (GO TO 447)

446A) How many doses of vitamin A did you get over those two months?

NUMBER______
DON'T KNOW 8

447) Has your menstrual period returned since the birth of (NAME)?

YES 1 (GO TO 449)
NO 2- (GO TO 450)

448) Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 452)

449) How many months after the birth of (NAME) did you not have a period?

MONTHS _________
DON'T KNOW 98

450) CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT
PREGNANT OR NOT SURE (GO TO 452)

451) Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 453)

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

MONTHS_____
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454) CHECK 404:
CHILD IS LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

455) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD 00 HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS

IMMEDIATELY 000
HOURS_____ 1
DAYS______ 2

456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
COFFEE I
HONEY J
OTHER ________(SPECIFY) X

458) CHECK 404:
IS CHILD LIVING?

LIVING
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

459) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

461) (GO BACK TO 405 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 501)

Section 5. Child immunization, health and nutrition

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER______

503) FROM 212 AND 216

NAME______
LIVING
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 533)

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

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 509)
NO CARD 3

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

YES 1 (GO TO 509)
NO 2

506)
1) COPY DATES FROM THE CARD
2) WRITE 44 IN DAY COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ______
MONTH ____
YEAR ______
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY ______
MONTH ____
YEAR ______
POLIO 1
DAY ______
MONTH ____
YEAR ______
POLIO 2
DAY ______
MONTH ____
YEAR ______
POLIO 3
DAY ______
MONTH ____
YEAR ______
DPT 1
DAY ______
MONTH ____
YEAR ______
DPT 2
DAY ______
MONTH ____
YEAR ______
DPT 3
DAY ______
MONTH ____
YEAR ______
MEASLES
DAY ______
MONTH ____
YEAR ______
YELLOW FEVER
DAY ______
MONTH ____
YEAR ______
VITAMIN A (MOST RECENT)
DAY ______
MONTH ____
YEAR ______

507) CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER

508) Has (NAME) received any vaccines that are not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE 66 IN THE CORRESPONDING DAY COLUMN IN 506) --(GO TO 511)
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

509) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

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

510) Please tell me if (NAME) had any of the following vaccinations:

510a) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

510b) Polio vaccine, that is, drops in the mouth?

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

510c) Was the first polio vaccine given in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

510d) How many times was the polio vaccine given?

NUMBER OF TIMES__

510e) A DPT/HepB/Hib vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 510G)
DON'T KNOW 3 (GO TO 510G)

510f) How many times was the DPT/HepB/Hibvaccination given?

NUMBER OF TIMES________

510g) An measles injection or an MMR injection- that is, a shot in the arm at the age of 9 months or older,- to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

512) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

513) Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 525)
DON'T KNOW -- (GO TO 525)

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

517) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, probe: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

518) Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 522)

519) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
HEALTH WORKER E
OTHER PUBLIC SECTOR________ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH AGENT K
OTHER PRIVATE MEDICAL_______ (SPECIFY) L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
MARKET O
OTHER _______(SPECIFY) X

520) CHECK 519:

TWO OR MORE CODES CIRCLED
ONLY ONE CODE CIRCLED (GO TO 522)

521) Where did you first seek advice or treatment?
USE LETTER CODE FROM 519

FIRST PLACE_____

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea?
a) A fluid made from a special packet called Oracel?
b) A pre-packaged ORS liquid?
c) A government-recommended homemade fluid?

FLUID FORM ORS PACKET
YES 1
NO 2
DON'T KNOW 8
ORS LIQUID
YES 1
NO 2
DON'T KNOW 8
HOMEMADE FLUID
YES 1
NO 2
DON'T KNOW 8

523) Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

524) What (else) was given to treat the diarrhea?
Anything else?
RECORD ALL TREATMENTS GIVEN.

Pill or syrup
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER _____(NOT ANTIBIOTIC, ANTIMOTILITY OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/HERBAL MEDICINE J
OTHER_______ (SPECIFY) X

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

YES 1
NO 2 (GO TO 527)
DON'T KNOW 8 (GO TO 527)

526) At any time during the illness, did (NAME) have blood taken from his/her finger or heal for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

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

YES 1
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

529) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) 6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

530) CHECK 525:
HAD FEVER?

YES
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

531) Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

533) Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 537)

534) Where did you seek advice or treatment?

Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
HEALTH WORKER E
OTHER PUBLIC HEATH SECTOR_______ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH AGENT K
OTHER PRIVATE MEDICAL_______ (SPECIFY) L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
MARKET O
OTHER________ (SPECIFY) X

535) CHECK 534:

TWO OR MORE CODES CIRCLED
ONLY ONE CODE CIRCLED (GO TO 537)

536) Where did you first seek advice or treatment?
USE LETTER CODE FROM 534

FIRST PLACE____

537) At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

538) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COMBINATION WITH ARTEMISININ E
OTHER ANTIMALARIAL ______(SPECIFY) F
ANTIBIOTIC
PILL/SYRUP G
INJECTION H
OTHER DRUGS
ASPIRIN I
ACETAMINOPHEN J
IBUPROFEN K
OTHER______ (SPECIFY) X
DON'T KNOW Z

539) CHECK 538:
ANY CODE A-F CIRCLED?

YES
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

540) CHECK 538: SP/FANSIDAR (A) GIVEN

CODE A CIRCLED
CODE A NOT CIRCLED (GO TO 542)

541) How long after the fever started did (NAME) first take (SP/Fansidar)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

542) CHECK 538: CHLOROQUINE (B) GIVEN

CODE B CIRCLED
CODE B NOT CIRCLED (GO TO 544)

543) How long after the fever started did (NAME) first take (Chloroquine)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

544) CHECK 538: AMODIAQUINE (C) GIVEN

CODE C CIRCLED
CODE C NOT CIRCLED (GO TO 546)

545) How long after the fever started did (NAME) first take (Amodiaquine)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

546) CHECK 538: QUININE (D) GIVEN

CODE D CIRCLED
CODE D NOT CIRCLED (GO TO 548)

547) How long after the fever started did (NAME) first take (Quinine)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

548) CHECK 538: COMBINATION WITH ARTEMISININ (E) GIVEN

CODE E CIRCLED
CODE E NOT CIRCLED (GO TO 550)

549) How long after the fever started did (NAME) first take (Combination with artemisinin)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

550) CHECK 538: OTHER ANTIMALARIAL (F) GIVEN

CODE F CIRCLED
CODE F NOT CIRCLED (GO TO 550)

551) How long after the fever started did (NAME) first take (Other antimalarial)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2006 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 554)
NAME________
NONE (GO TO 556)

554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER________ (SPECIFY) 07

555) CHECK 522A AND 522B, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 557)

556) Have you ever heard of a special product called [NAME OF ORS PACKET OR PRE-PACKAGED ORS LIQUID] you can get for the treatment of diarrhea?

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH RESPONDENT
ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 558)
NAME________
NONE (GO TO 601)

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME from 557) (drink/eat):
a) plain water?
b) juice or juice drinks?
c) clear broth?
d) milk such as tinned, powdered, or fresh animal milk?
IF YES, how many times did (NAME) drink milk?
IF 7 OF MORE TIMES, RECORD 7
e) Infant formula?
IF YES, how many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD 7
f) Any other liquids?
g) Yogurt?
IF YES, how many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD 7
h) Any brand like Cerelac, Bledine, Gallia, FariNOr,…?
i) bread, rice, NOodles, porridge, or any other foods made from grains?
j) pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
k) white potatoes, white yams, manioc, cassava, or any other foods made from roots?
l) any dark green, leafy vegetables?
m) ripe mangoes, papayas or tomatoes?
n) any other fruits or vegetables like poyo banana or green bean?
o) liver, kidney, heart or any other organ meats?
p) any meat, such as beef, pork, lamb, goat, chicken or duck?
q) eggs?
r) fresh or dried fish or shellfish?
s) any foods made from beans, peas, lentils, or nuts?
t) cheese or other food made from milk?
u) any other solid, semi-solid, or soft food?

PLAIN WATER
YES 1
NO 2
DON'T KNOW 8
JUICE OR JUICE DRINKS
YES 1
NO 2
DON'T KNOW 8
CLEAR BROTH
YES 1
NO 2
DON'T KNOW 8
MILK SUCH AS TINNED, POWDERED, OR FRESH ANIMAL MILK
YES 1
NUMBER OF TIMES DRANK MILK_____
NO 2
DON'T KNOW 8
INFANT FORMULA
YES 1
NUMBER OF TIMES DRANK FORMULA____
NO 2
DON'T KNOW 8
ANY OTHER LIQUIDS
YES 1
NO 2
DON'T KNOW 8
YOGURT
YES 1
NUMBER OF TIMES ATE YOGURT______
NO 2
DON'T KNOW 8
ANY BRAND LIKE CERELAC, BLEDINE, GALLIA, FARINOR,…
YES 1
NO 2
DON'T KNOW 8
BREAD, RICE, NOODLES, PORRIDGE, OR ANY OTHER FOODS MADE FROM GRAINS
YES 1
NO 2
DON'T KNOW 8
PUMPKIN, CARROTS, SQUASH OR SWEET POTATOES THAT ARE YELLOW OR ORANGE INSIDE
YES 1
NO 2
DON'T KNOW 8
WHITE POTATOES, WHITE YAMS, MANIOC, CASSAVA, OR ANY OTHER FOODS MADE FROM ROOTS
YES 1
NO 2
DON'T KNOW 8
ANY DARK GREEN, LEAFY VEGETABLES
YES 1
NO 2
DON'T KNOW 8
RIPE MANGOES, PAPAYAS OR TOMATOES
YES 1
NO 2
DON'T KNOW 8
ANY OTHER FRUITS OR VEGETABLES LIKE POYO BANANA OR GREEN BEAN
YES 1
NO 2
DON'T KNOW 8
LIVER, KIDNEY, HEART OR ANY OTHER ORGAN MEATS
YES 1
NO 2
DON'T KNOW 8
ANY MEAT, SUCH AS BEEF, PORK, LAMB, GOAT, CHICKEN OR DUCK
YES 1
NO 2
DON'T KNOW 8
EGGS
YES 1
NO 2
DON'T KNOW 8
FRESH OR DRIED FISH OR SHELLFISH
YES 1
NO 2
DON'T KNOW 8
ANY FOODS MADE FROM BEANS, PEAS, LENTILS, OR NUTS
YES 1
NO 2
DON'T KNOW 8
CHEESE OR OTHER FOOD MADE FROM MILK
YES 1
NO 2
DON'T KNOW 8
ANY OTHER SOLID, SEMI-SOLID, OR SOFT FOOD
YES 1
NO 2
DON'T KNOW 8

559) CHECK 558 (CATEGORIES G THROUGH U)

NOT A SINGLE YES
AT LEAST ONE YES (GO TO 561)

560) Did (NAME) eat any solid, semi-solid or soft foods yesterday during the day or at night?
IF YES, PROBE: What kind of solid, semi-solid, or soft foods did (NAME from 557) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO-2 (GO TO 601)

561) How many times did (NAME from 557) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD 7

NUMBER OF TIMES______
DON'T KNOW 8

Section 6. Marriage and sexual activity

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

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN- 2
NO 3 (GO TO 612)

602a) Did you consent to this marriage?

YES 1
NO 2

602b) CHECK 601:

NO, NOT IN UNION
YES, CURRENTLY MARRIED/CURRENTLY LIVING WITH A MAN (GO TO 604)

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

WIDOW 1 -- (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

605) RECORD THE LINE NUMBER OF HER HUSBAND/PARTNER ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME________
LINE NO.________

606) Does your husband/partner have other wives or does he live with other women as if married?

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

607) Including yourself, in total how many wives or live-in partners does he have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS__________
DON'T KNOW

608) Are you the first, second…wife?

RANK _____

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

ONLY ONCE 1
MORE THAN ONCE 2

610) CHECK 609:
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 --I would like to talk about your first (husband/partner). In what month and year were you married or did you start living with him?

MONTH _____
DON'T KNOW MONTH 98
YEAR ____ (GO TO 612)
DON'T KNOW year 9998

611) How old were you when you started living with him for the first time?

AGE _____

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

613) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.

How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)
AGE IN YEARS __________
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

614) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

615) When was the last time you had sexual intercourse.
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO________ 1
WEEKS AGO_______ 2
MONTHS AGO_______ 3
YEARS AGO________ 4 (GO TO 627)

616a) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

616) When was the last time you had sexual intercourse with this person?

DAYS AGO________ 1
WEEKS AGO ______ 2
MONTHS AGO _____ 3

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

YES 1
NO 2 (GO TO 619)

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

YES 1
NO 2

619) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE 2
IF NO, CIRCLE 3

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
CLIENT/PROSTITUTE 5 (GO TO 622)
OTHER_________ (SPECIFY) 6 (GO TO 622)

620) CHECK 609:

MARRIED ONLY ONCE
MARRIED MORE THAN ONCE (GO TO 622)

621) CHECK 613

FIRST TIME WHEN STARTED LIVING WITH HUSBAND (GO TO 623)
OTHER

622) How long ago did you first have sexual intercourse with this (second/third) person?

DAYS AGO________ 1
WEEKS AGO______ 2
MONTHS AGO_____ 3
YEARS AGO_______ 4

623) How many times during the last 12 months did you have sexual intercourse with this person?

NUMBER OF TIMES______
IF 95 OR MORE, RECORD 95

624) How old is this person?
PROBE TO GET AN ESTIMATE OF THEIR AGE.

AGE OF PARTNER______
DON'T KNOW 98

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

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 --(GO TO 627)

626) In total, how many different people have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE 95

NUMBER OF PARTNERS LAST 12 MONTHS_______
DON'T KNOW 98

627) In total, how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE 95

NUMBER OF PARTNERS IN LIFETIME__________
DON'T KNOW 98

628) PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN under 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 632)

630) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))_____________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
HEALTH WORKER E
OTHER PUBLIC SECTOR_________ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH AGENT K
OTHER PRIVATE MEDICAL__________ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTIONS N
FRIEND/RELATIVES O
OTHER______________ (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

633) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))______________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
HEALTH WORKER E
OTHER PUBLIC SECTOR_______ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH AGENT K
OTHER PRIVATE MEDICAL_________ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTIONS N
FRIEND/RELATIVES O
OTHER____________ (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

Section 7. Fertility preferences

701) CHECK 304:

NEITHER STERILIZED
HE OR SHE STERILIZED -- (GO TO 712)

702) CHECK 226:

PREGNANT
NOT PREGNANT OR UNSURE -- (GO TO 704)

703) 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 ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

704) 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW -- (GO TO 710)

705) CHECK 226:
NOT PREGNANT OR NOT SURE- 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 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER_________ (SPECIFY) 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

NO PREGNANT OR UNSURE
PREGNANT (GO TO 711)

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING
CURRENTLY USING (GO TO 712)

708) CHECK 705:

NOT ASKED
24 OR MORE MONTHS OR 02 OR MORE YEARS
00-23 MONTHS OR 00-01 YEARS (GO TO 711)

709) CHECK 704:
WANTS TO HAVE A/ANOTHER CHILD--You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?

Any other reason?

WANTS NO MORE/NONE--You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy?

Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) X
DON'T KNOW Z

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED
NO, NOT CURRENTLY USING
YES, CURRENTLY USING (GO TO 712)

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

YES 1
NO 2
DON'T KNOW 8

712) 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.

NONE 00 (GO TO 714)
NUMBER
OTHER_______ (SPECIFY) 96 (GO TO 714)

713) How many of these children would you like to be boys, how many would you like to be girls, and for how many would the gender not matter?

NUMBER OF BOYS______
NUMBER OF GIRLS________
NUMBER OF ANY GENDER_____
OTHER (SPECIFY) 96

714) In the last few months have you
Heard about family planning on the radio?
Heard about family planning on the television?
Read on family planning in a newspaper or magazine?
Read about family planning on posters or leaflets?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINES
YES 1
NO 2
POSTERS OR LEAFLETS
YES 1
NO 2

714a) CHECK 714: ASK QUESTIONS 715A ONLY TO THOSE WHO HAVE HEARD ABOUT FAMILY PLANNING ON THE RADIO, CHECKING 714.

HEARD ABOUT FAMILY PLANNING ON THE RADIO, YES, CIRCLE
OTHER -- (GO TO 715B)

715a) You told me that you heard about family planning on the radio. Did you hear about family planning on:
Radio Cote d'Ivoire or Frequence 2
Radio ONUCI-FM?
Community radio?
Commercial radio?
Religious radio?

RADIO COTE D'IVOIRE OR FREQUENCE
YES 1
NO 2
RADIO ONUCI-FM?
YES 1
NO 2
COMMUNITY RADIO
YES 1
NO 2
COMMERCIAL RADIO
YES 1
NO 2
RELIGIOUS RADIO
YES 1
NO 2

715b) CHECK 714: ASK QUESTIONS 715B ONLY TO THOSE WHO HAVE HEARD ABOUT FAMILY PLANNING ON THE TELEVISION, CHECKING 714.

HEARD ABOUT FAMILY PLANNING ON THE TELEVISION, YES, CIRCLE
OTHER -- (GO TO 715D)

715c) You told me that you heard about family planning on the television. Did you hear about family planning on:
Ivorian Radio television (RTI)?
European channels?
African channels?
Other television channels?

IVORIAN RADIO TELEVISION (RTI)
YES 1
NO 2
EUROPEAN CHANNELS
YES 1
NO 2
AFRICAN CHANNELS
YES 1
NO 2
OTHER TELEVISION CHANNELS
YES 1
NO 2

715d) CHECK 714: ASK QUESTIONS 715E AND 715F ONLY TO THOSE WHO HAVE HEARD AT LEAST ONE MESSAGE, CHECKING 714.

HEARD AT LEAST ONE MESSAGE, AT LEAST ONE YES CIRCLED
NOT A SINGLE YES CIRCLED (GO TO 716)

715e) Have you received the message on:
The existence of family planning services?
A place to obtain contraceptive methods?
Types of methods?
Advantages of family planning on health, the economy, etc?

EXISTENCE OF FAMILY PLANNING SERVICES
YES 1
NO 2
PLACE TO OBTAIN
YES 1
NO 2
TYPES OF METHODS
YES 1
NO 2
ADVANTAGES OF FAMILY PLANNING
YES 1
NO 2

715f) What type of message on antenatal consultations or delivery did you get?
The importance of going to antenatal consultation services?
Hygiene and diet recommendations (what to eat, type of exercise)?
The signs of complications or danger with a pregnancy?
How to prepare a woman for delivery?

THE IMPORTANCE OF ATTENDING
YES 1
NO 2
HYGIENE AND DIET RECOMMENDATIONS (
YES 1
NO 2
THE SIGNS OF COMPLICATIONS
YES 1
NO 2
PREPARE A WOMAN
YES 1
NO 2

716) CHECK 601:

YES, CURRENTLY MARRIED
YES, CURRENTLY LIVING WITH A MAN
NO, NOT IN UNION (GO TO 801)

717) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING
NOT CURRENTLY USING OR NOT ASKED (GO TO 720)

718) Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER_________ (SPECIFY) 6

719) CHECK 304:

NEITHER STERILIZED
HE OR SHE STERILIZED -- (GO TO 801)

720) Does your (husband/partner) want 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

Section 8. Husband's background and woman's work

801) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN
FORMERLY MARRIED/LIVING WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

802) How old was your (husband/partner) on his last birthday?

AGE_____

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

YES 1
NO 2 (GO TO 806)

804) What was the highest level of school he attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 806)

805) What was the highest (grade/form/year) he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00.

GRADE________
DON'T KNOW 98

806) CHECK 801:
CURRENTLY MARRIED/LIVING WITH A MAN: What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN What was your (last) (husband's/partner's) occupation? That is, what kind of work did he mainly do?

OCCUPATION____

807) Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 811)
NO 2

808) 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. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

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

OCCUPATION_____

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

813) 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

814) Are you paid in case or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

815) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN
NOT IN UNION (GO TO 823)

816) CHECK 814:

CODE 1 OR 2 CIRCLED
OTHER (GO TO 819)

817) Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER______ (SPECIFY) 6

818) Would you say that the money that you earn is more than what your (husband/partner) earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 820)
DON'T KNOW 8

819) Who usually decides how the money your (husband/partner) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER_______ (SPECIFY) 6

820) Who usually makes decisions about health care for yourself: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER ________(SPECIFY) 6

821) Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER______ (SPECIFY) 6

822) Who usually makes decisions about visits to your family or parents?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER________ (SPECIFY) 6

823) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

824) Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

825) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN under 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3

826) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT WITHOUT TELLING HIM
YES 1
NO 2
DON'T KNOW 8
NEGLECT CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

Section 9. HIV/AIDS

901) How I would like to talk about something else.
Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 937)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

904) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

907a) Can the virus that causes AIDS be transmitted through:
Sharp-edged objects
Injections?
Blood transfusions?
Toothbrushes?

SHARP-EDGED OBJECTS
YES 1
NO 2
DON'T KNOW 8
INJECTIONS
YES 1
NO 2
DON'T KNOW 8
BLOOD TRANSFUSIONS
YES 1
NO 2
DON'T KNOW 8
TOOTHBRUSHES
YES 1
NO 2
DON'T KNOW 8

908) Can the virus that causes AIDS be transmitted from a mother to a baby?
During pregnancy?
During delivery?
By breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

909) CHECK 908:

AT LEAST ONE YES
OTHER (GO TO 911)

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

YES 1
NO 2
DON'T KNOW 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2009
NO BIRTHS -- (GO TO 926)
LAST BIRTH BEFORE JANUARY 2009 (GO TO 926)

912) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE
NO ANTENATAL CARE (GO TO 920)

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

914) During any of the antenatal visits for your last birth were you given any information about the following subjects?
Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

AIDS FROM MOTHER
YES 1
NO 2
DON'T KNOW 8
THINGS TO DO
YES 1
NO 2
DON'T KNOW 8
TEST
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 920)

917) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)___________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
INDEPENDENT VCT CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
SCHOOL BASED CLINIC 16
OTHER PUBLIC SECTOR________ (SPECIFY) 17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
INDEPENDENT VCT CENTER 22
PHARMACY 23
MOBILE CLINIC 24
HEALTH AGENT 26
SCHOOL BASED CLINIC 26
OTHER PRIVATE MEDICAL______ (SPECIFY) 27
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 32
OTHER______ (SPECIFY) 96

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

YES 1
NO 2 (GO TO 924)

919) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1-- (GO TO 924)
NO 2-- (GO TO 924)
DON'T KNOW 8-- (GO TO 924)

920) CHECK 434 FOR LAST BIRTH

ANY CODE 21-36 CIRCLED
OTHER (GO TO 926)

921) Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?

YES 1
NO 2

922) I don't want to know the results, but were you tested for the AIDS virus at that time?

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

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

YES 1 (GO TO 927)
NO 2

925) How many months ago was your most recent HIV test?

MONTHS AGO______-- (GO TO 932)
TWO OR MORE YEAR AGO 96-- (GO TO 932)

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

YES 1
NO 2 (GO TO 930)

927) How many months ago was your most recent HIV test?

MONTHS AGO ______
TWO OR MORE YEARS AGO 96

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

YES 1
NO 2

929) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)___________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11-- (GO TO 932)
GOVERNMENT HEALTH CENTER 12-- (GO TO 932)
INDEPENDENT VCT CENTER 13-- (GO TO 932)
FAMILY PLANNING CLINIC 14-- (GO TO 932)
MOBILE CLINIC 15-- (GO TO 932)
SCHOOL BASED CLINIC 16-- (GO TO 932)
OTHER PUBLIC SECTOR________ (SPECIFY) 17-- (GO TO 932)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21-- (GO TO 932)
STAND-ALONE VCT CENTER 22-- (GO TO 932)
PHARMACY 23-- (GO TO 932)
MOBILE CLINIC 24-- (GO TO 932)
HEALTH AGENT 26-- (GO TO 932)
SCHOOL BASED CLINIC 26-- (GO TO 932)
OTHER PRIVATE MEDICAL________ (SPECIFY) 27-- (GO TO 932)
OTHER SOURCE
HOME 31-- (GO TO 932)
CORRECTIONAL FACILITY 32-- (GO TO 932)
OTHER_________ (SPECIFY) 96-- (GO TO 932)

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

YES 1
NO 2 (GO TO 932)

931) Where is that?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)_________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR_______(SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL______ (SPECIFY) M
OTHER______ (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW 8

933) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

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

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

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

936) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

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

937) CHECK 901:
HEARD ABOUT AIDS- Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

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

YES 1
NO 2

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE
NEVER HAD SEXUAL INTERCOURSE- (GO TO 946)

939) CHECK 937: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES
NO -- (GO TO 941)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

942) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES')
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)

944) The last time you had (INFECTION FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 946)

945) Where did you go?

Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)_________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
INDEPENDENT VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR________ (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL______ (SPECIFY) M
OTHER SOURCE
SHOP N
OTHER___________ (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW 8

947) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A HUSBAND
NOT IN UNION (GO TO 1001)

949) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/NOT SURE 8

950) Can you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

Section 10. Other health issues

1001) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD 90.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS________
NONE 00-GO TO 1004

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?

IF THE NUMBER OF INJECTIONS IS OVER 90 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD 90.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

NUMBER OF INJECTIONS__________
NONE-00 (GO TO 1004)

1003) The last time you got an injection from a health worker, did he/she take the syringe and needle form a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1004) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

1005) In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES______

1006) Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (GO TO 1008)

1007) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER______ (SPECIFY) X

1008) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

Getting permission to go to the doctor?
Getting money needed for advice or treatment
The distance to the health facility
None of the personnel are women?
Not wanting to go alone?

PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NONE WOMEN PERSONNEL
BIG PROBLEM 1
NOT A BIG PROBLEM 2
TO GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009) Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1011)

1010) What type of health insurance are you covered by?
RECORD ALL MENTIONED

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER_______ (SPECIFY) X

1011) Have you ever had problems with urinary or fecal incontinence?

YES 1
NO 2
DON'T KNOW 8

1011a) Have you ever heard of breast cancer?

YES 1
NO 2 (GO TO 1011C)
DON'T KNOW 8 (GO TO 1011C)

1011b) Have you ever had a test for breast cancer?

YES 1
NO 2
DON'T KNOW 8

1011c) Have you ever heard of cervical cancer?

YES 1
NO 2 (GO TO 1101)
DON'T KNOW 8 (GO TO 1101)

1011d) Have you ever had a test for cervical cancer?

YES 1
NO 2
DON'T KNOW 8

Section 11. Female genital cutting

1101) Have you ever heard of female circumcision?

YES 1 (GO TO 1103)
NO 2

1102) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (GO TO 1201)

1103) Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 1109)

1104) Now I would like to ask you what was done to you at that time.
Was any flesh removed from the genital area?

YES 1 -- (GO TO 1106)
NO 2
DON'T KNOW 8

1105) Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1106) Was your genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1107) How old were you when you were circumcised?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS________
AS A BABY/DURING INFANCY 95
DON'T KNOW 98

1108) Who performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL________ (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MID-WIFE 22
OTHER HEALTH PROFESSIONAL______ (SPECIFY) 26
DON'T KNOW 98

1109) CHECK 213, 215, 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 1996 OR LATER
HAS NO LIVING DAUGHTERS BORN IN 1996 OR LATER (GO TO 1116)

CHECK 213, 215, AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 1996 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 6 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about your (daughter/daughters).

1110) Birth history number and NAME of each living daughter born in 1996 or later

BIRTH HISTORY NUMBER________
NAME________

1111) Is (NAME OF DAUGHTER) circumcised?

YES 1
NO 2 (GO TO 1111 IN NEXT COLUMN OR IF NO MORE DAUGHTERS, GO TO 1116)

1112) How old was (NAME OF DAUGHTER) when she was circumcised?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS_______
DON'T KNOW 98

1113) Was her genital area sewn closed?
PROBE: was the genital area closed?

YES 1
NO 2
DON'T KNOW 8

1114) Who performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL________ (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MID-WIFE 22
OTHER HEALTH PROFESSIONAL _________(SPECIFY) 26
DON'T KNOW 98

1115) GO BACK TO 1111 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 1116

1116) Do you believe that female circumcision is required by your religion?

YES 1
NO 2
DON'T KNOW 8

1117) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

1117a) Is female circumcision legal?

YES 1
NO 2
DON'T KNOW 8

Section 12. Domestic Violence module

1201) CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: RESPONDENT SELECTED FOR DOMESTIC VIOLENCE?

IF YES
IF NO (GO TO 1301A)

1201a) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.
CIRCLE CODE CORRESPONDING TO THE SITUATION AND FOLLOW INSTRUCTIONS FOR CONTINUATION.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE (RETURN ONCE YOU ARE SURE TO BE ALONE WITH RESPONDENT) 2 (GO TO 1228)

READ TO THE RESPONDENT:
Now I would like to ask you some questions about certain aspects of your relationship as a couple. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Cote d'Ivoire. Let me assure you that your answers are completely confidential and will not be told to anyone. Additionally, you are the only person in your household that is being asked these questions and no one will know that you were asked these questions. If someone arrives while we are talking, we will talk about something else.

1202) CHECK 601, 602, AND 603:

CURRENTLY MARRIED/LIVING WITH A MAN
DIVORCED/WIDOWED/SEPARATED
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1214)

1203) When two people marry or live together, they share both good and bad moments. In your relationship with your (last) husband/partner do (did) the following happened frequently, only sometimes, or never?
a) He usually (spends/spent) his free time with you?
b) He (consults/consulted) you on different household matters?
c) He (is/was) affectionate with you?
d) He (respects/respected) you and your wishes?

FREE TIME
FREQUENTLY 1
SOMETIMES 2
NEVER 3
CONSULTS
FREQUENTLY 1
SOMETIMES 2
NEVER 3
AFFECTIONATE
FREQUENTLY 1
SOMETIMES 2
NEVER 3
RESPECTS
FREQUENTLY 1
SOMETIMES 2
NEVER 3

1204) Now I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insist/insisted) on knowing where you (are/were) at all time?
f) He (does/did) not trust you with any money?
g) He (prevents/prevented) you from working or he (isn't/wasn't) ok with you working?

JEALOUS
YES 1
NO 2
DON'T KNOW 8
ACCUSES
YES 1
NO 2
DON'T KNOW 8
NOT MEET FRIENDS
YES 1
NO 2
DON'T KNOW 8
NO FAMILY
YES 1
NO 2
DON'T KNOW 8
WHERE YOU ARE
YES 1
NO 2
DON'T KNOW 8
MONEY
YES 1
NO 2
DON'T KNOW 8
WORK
YES 1
NO 2
DON'T KNOW 8

1205) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

1205a) Did your (last) (husband/partner) ever do any of the following things to you:
1205b) How many times did this happen during the last 12 months?

a) say or do something to humiliate you in front of others?

YES 1
NO 2
a) NUMBER OF TIMES_______
IF WIDOW, DIVORCED, OR SEPARATED 95

b) Threaten to hurt or harm you or someone you care about?

YES 1
NO 2
a) NUMBER OF TIMES________
IF WIDOW, DIVORCED, OR SEPARATED 95

1206) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

1206a) (Does/did) your last husband/partner ever:
1206b) How many times did this happen during the last 12 months?

a) push you, shake you, or throw something at you?
YES 1
NO 2
A) NUMBER OF TIMES__________
IF WIDOW, DIVORCED, OR SEPARATED 95
b) slap you or twist your arm?
YES 1
NO 2
A) NUMBER OF TIMES_________
IF WIDOW, DIVORCED, OR SEPARATED 95
c) punch you with his fist or with something that could hurt you?
YES 1
NO 2
A) NUMBER OF TIMES______________
IF WIDOW, DIVORCED, OR SEPARATED 95
d) kick you or drag you?
YES 1
NO 2
A) NUMBER OF TIMES______________
IF WIDOW, DIVORCED, OR SEPARATED 95
e) try to strangle you or burn you?
YES 1
NO 2
A) NUMBER OF TIMES_____________
IF WIDOW, DIVORCED, OR SEPARATED 95
f) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2
A) NUMBER OF TIMES___________
IF WIDOW, DIVORCED, OR SEPARATED 95
g) attack you with a knife, gun, or other type of weapon?
YES 1
NO 2
A) NUMBER OF TIMES____________
IF WIDOW, DIVORCED, OR SEPARATED 95
h) physically force you to have sexual intercourse with him even when you did NOt want to?
YES 1
NO 2
A) NUMBER OF TIMES__________
IF WIDOW, DIVORCED, OR SEPARATED 95
i) force you to perform other sexual acts you did not want to?
YES 1
NO 2
A) NUMBER OF TIMES_____________
IF WIDOW, DIVORCED, OR SEPARATED 95

1207) CHECK 1206:

AT LEAST ONE YES
NOT A SINGLE YES (GO TO 1210A)

1208) How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?

NUMBER OF YEARS_______
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
AFTER SEPARATION/DIVORCE 96

1209a and 1209b)
1209a) Did the following ever happen because of something your (last) husband/partner did to you:
1209b) How many times did this happened during the last 12 months?

a) You had bruises and aches?
YES 1
NO 2
A) NUMBER OF TIMES_____________
IF WIDOW, DIVORCED, OR SEPARATED 95
b) You had an injury, a broken bone, or a sprain?
YES 1
NO 2
A) NUMBER OF TIMES_______________
IF WIDOW, DIVORCED, OR SEPARATED 95
c) You went to the doctor or health center as a result of something your husband/partner did to you?
YES 1
NO 2
A) NUMBER OF TIMES______
IF WIDOW, DIVORCED, OR SEPARATED 95

1210a) Did you ever do or say something to humiliate or threaten your (last) husband/partner in front of others?

YES 1
NO 2 (GO TO 1210)

1210b) How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?

NUMBER OF YEARS________
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
AFTER SEPARATION/DIVORCE 96

1210) Have you ever hit, slapped, kicked or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1212)

1211) In the last 12 months, how many times have you hit, slapped, kicked or done something to physically hurt your (last) husband/partner at a time when he was not already beating or physically hurting you?

NUMBER OF TIMES_______
IF WIDOWED, DIVORCED, OR SEPARATED 95

1212) Does (did) your (last) (husband/partner) drink alcohol?

YES 1
NO 2 -- (GO TO 1214)

1213) How often does (did) he get drunk: very often, only sometimes, or never?

VERY OFTEN 1
SOMETIMES 2
NEVER 3

1214) CHECK 1202;
MARRIED/LIVED WITH A MAN/SEPARATED/DIVORCED- From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?

NEVER MARRIED/NEVER LIVED WITH A MAN- From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?

YES 1
NO 2-GO TO 1219
NO ANSWER 6 (GO TO 1219)

1215) Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED

MOTHER A
FATHER B
STEP-MOTHER C
STEP-FATHER/MOTHER'S PARTNER D
SISTER E
BROTHER F
DAUGHTER G
SON H
EX-HUSBAND/EX-PARTNER I
FRIEND/CURRENT SEX PARTNER J
EX-FRIEND/FORMER SEX PARTNER K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE IN-LAW N
OTHER MALE IN-LAW O
FEMALE FRIEND/ACQUAINTANCE P
MALE FRIEND/ACQUAINTANCE Q
TEACHER R
EMPLOYER S
STRANGER T
OTHER________ (SPECIFY) X

1216) CHECK 1215:

MORE THAN ONE PERSON MENTIONED
ONLY ONE PERSON MENTIONED -- (GO TO 1218)

1217) Who has hit, slapped, kicked or done something to physically hurt you most often?

MOTHER 01
FATHER 02
STEP-MOTHER 03
STEP-FATHER 04
SISTER 05
BROTHER 06
DAUGHTER 07
SON 08
EX-HUSBAND/EX-PARTNER 09
FRIEND/CURRENT SEX PARTNER 10
EX-FRIEND/FORMER SEX PARTNER 11
MOTHER-IN-LAW 12
FATHER-IN-LAW 13
OTHER FEMALE RELATIVE/IN-LAW 14
OTHER MALE RELATIVE/IN-LAW 15
FEMALE FRIEND/ACQUAINTANCE 16
MALE FRIEND/ACQUAINTANCE 17
TEACHER 18
EMPLOYER 19
STRANGER 20
OTHER_________ (SPECIFY) 96

1218) In the last 12 months, how many times has this person hit, slapped, kicked, or done anything else to physically hurt you?

NUMBER OF TIMES __________
IF WIDOWED, DIVORCED, OR SEPARATED 95

1219) CHECK Q201, Q226, AND Q230: LIVE BIRTHS, PREGNANCIES, STILLBIRTHS

HAD AT LEAST ONE PREGNANCY [Q201=1, Q226=1, AND Q230=1]
NEVER HAD A PREGNANCY [Q201=2, Q226= (2 OR 8), AND Q230=2] (GO TO 1222)

1220) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 -- (GO TO 1222)

1221) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED

MOTHER A
FATHER B
STEP-MOTHER C
STEP-FATHER/MOTHER'S PARTNER D
SISTER E
BROTHER F
DAUGHTER G
SON H
EX-HUSBAND/EX-PARTNER I
FRIEND/CURRENT SEX PARTNER J
EX-FRIEND/FORMER SEX PARTNER K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE IN-LAW N
OTHER MALE IN-LAW O
FEMALE FRIEND/ACQUAINTANCE P
MALE FRIEND/ACQUAINTANCE Q
TEACHER R
EMPLOYER S
STRANGER T
OTHER_______ (SPECIFY) X

1222) CHECK 1206, 1209, 1214, AND 1220:

AT LEAST ONE YES
NOT A SINGLE YES (GO TO 1226)

1223) Did you try to get help?

YES 1
NO 2 (GO TO 1225)

1224) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED

MOTHER A-- (GO TO 1226)
FATHER B-- (GO TO 1226)
STEP-MOTHER C-- (GO TO 1226)
STEP-FATHER/MOTHER'S PARTNER D-- (GO TO 1226)
SISTER E-- (GO TO 1226)
BROTHER F-- (GO TO 1226)
DAUGHTER G-- (GO TO 1226)
SON H-- (GO TO 1226)
EX-HUSBAND/EX-PARTNER I-- (GO TO 1226)
FRIEND/CURRENT SEX PARTNER J-- (GO TO 1226)
EX-FRIEND/FORMER SEX PARTNER K-- (GO TO 1226)
MOTHER-IN-LAW L-- (GO TO 1226)
FATHER-IN-LAW M-- (GO TO 1226)
OTHER FEMALE IN-LAW N-- (GO TO 1226)
OTHER MALE IN-LAW O-- (GO TO 1226)
FEMALE FRIEND/ACQUAINTANCE P-- (GO TO 1226)
MALE FRIEND/ACQUAINTANCE Q-- (GO TO 1226)
TEACHER R-- (GO TO 1226)
EMPLOYER S-- (GO TO 1226)
STRANGER T-- (GO TO 1226)
OTHER_______ (SPECIFY) X-- (GO TO 1226)

1225) What is the main reason you have never sought help?

DON'T KNOW WHO TO GO TO 01
NO USE/NO NEED 02
PART OF LIFE 03
AFRAID OF DIVORCE/SEPARATION 04
AFRAID OF FURTHER BEATINGS 05
AFRAID OF GETTING PERSON BEATING HER INTO TROUBLE 06
EMBARRASSED 07
DON'T WANT TO DISGRACE FAMILY 08
OTHER _________(SPECIFY) 96

1226) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

1226a) Do you know of any services or support for women in trouble?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE HOUSEHOLD RELATIONSHIP MODULE ONLY.

1227) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

HUSBAND
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3

1228) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING SECTION 12.

COMMENTS______

Section 13. Maternal mortality

1301a) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother.
Did your mother give birth to any children other than yourself?

YES 1
NO 2 (GO TO 1301H)

1301b) How many boys did your mother have who are still living?

BOYS LIVING ___________

1301c) Other than yourself, how many girls did your mother have who are still living?

GIRLS LIVING ________

1301d) How many boys did your mother have who died?

BOYS DIED ________

1301e) How many girls did your mother have who died?

GIRLS DIED_________

1301f) Did your mother give birth to any other children, who you don't know if they are living or dead?

YES 1
NO 2 (GO TO 1301h)

1301g) How many other children did your mother give birth do, who you don't know if they are living or dead?

OTHER CHILDREN

1301h) ADD THE ANSWERS FORM 1301B, C, D, E, AND G, ADD 1 (THE RESPONDENT) AND RECORD THE TOTAL

TOTAL________

1301i) CHECK 1301H:
Just to make sure that I've understood, including yourself, your mother gave birth to _____ children total. Is that correct?

YES
NO (PROBE AND CORRECT 1301A-1301H AS NECESSARY)

1302) CHECK 1301H:

TWO OR MORE BIRTHS
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1314)

1303) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS_________

Now I would like to make a list of all your brothers and sisters, whether they are still alive or not, starting with the oldest.
RECORD THE NAME OF ALL BROTHERS AND SISTERS.

1304) What was the NAME given to your oldest (next oldest) brother or sister?

NAME______

1305) Is (NAME) male or female?

MALE 1
FEMALE 2

1306) Is (NAME) still alive?

YES 1
NO 2- (GO TO 1308)
DON'T KNOW 8- (GO TO NEXT COLUMN)

1307) How old is (NAME)?

AGE_______- (GO TO NEXT COLUMN)

1308) How many years ago did (NAME) die?

YEARS___

1309) How old was (NAME) when he/she died?
IF DON'T KNOW, probe:
Did (NAME) die before the age of 12?
IF YES, RECORD 95.
IF NO, ASK OTHER QUESTIONS TO GET AN ESTIMATE, FOR EXAMPLE: Did (NAME) die before getting married?

IF MAN, OR WOMAN DECEASED BEFORE AGED 12, GO TO NEXT COLUMN

AGE___________

1310) Was (NAME) pregnant when she died?

YES 1- (GO TO 1313)
NO 2

1311) Did (NAME) die during childbirth?

YES 1 -- (GO TO 1313)
NO 2

1312) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1313) How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

NUMBER OF LIVE BORN CHILDREN__________- (GO TO NEXT COLUMN)

IF NO OTHER BROTHERS OR SISTERS, GO TO 1314

1314) RECORD TIME

HOURS______
MINUTES________

Interviewer's observations

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

COMMENTS_________

COMMENTS ON SPECIFIC QUESTIONS:

COMMENTS_________

ANY OTHER COMMENTS:

COMMENTS_________

SUPERVISOR'S OBSERVATIONS

COMMENTS_________

NAME OF SUPERVISOR________
DATE___________

EDITOR'S OBSERVATIONS

COMMENTS_________

NAME OF EDITOR_________
DATE___________