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DEMOGRAPHIC AND HEALTH SURVEY
MEN'S QUESTIONNAIRE

IDENTIFICATION

PROVINCE ___
DEPARTMENT LAYER ___
DISTRICT ___
CITY/TOWNSHIP/GROUP CLUSTER ___
VILLAGE STRUCTURE ___
NEIGHBORHOOD/PLACE HOUSEHOLD ___
MAN'S NAME ___
MAN'S LINE NUMBER ___
NUMBER OF COUNTING ZONE ___

LINE NO. OF ELIGIBLE WIFE/WIVES OF INTERVIEWED HUSBAND ___

INTERVIEWER VISITS:

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

RESULTS___

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY COMPLETED
6 OTHER (SPECIFY)__

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR __
INTERVIEWER CODE__

RESULT__

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY COMPLETED
6 OTHER (SPECIFY)__

FRENCH QUESTIONNAIRE 1

LANGUAGE OF THE INTERVIEW

1 FRENCH
2 ENGLISH
3 FULFULDE
4 EWONDO
5 PIDGIN
6 OTHER

INTERPRETER

YES 1
NO 2

SUPERVISOR
NAME ___
DATE ___

FIELD EDITOR
NAME ___
DATE ___

OFFICE EDITOR ___

KEYED BY ___

SECTION 1. RESPONDENT'S SOCIO-DEMOGRAPHIC CHARACTERISTICS

101) RECORD THE TIME

HOUR: ______
MINUTE: ______

102) What is your date of birth?

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

103) How old are you?

AGE IN COMPLETED YEARS: ___

COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

104) Have you ever attended school?

YES 1
NO 2 (GO TO 107)

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?

ALL LEVELS

0 LESS THAN ONE YEAR
8 DON'T KNOW

FOR POST-SECONDARY: SEE THE INSTRUCTION MANUAL

PRIMARY
ANGLOPHONE/FRANCOPHONE

INFANT/CLASS ONE/SIL 1
STANDARD ONE/CLASS TWO/CP 2
STANDARD TWO/CLASS THREE/CE1 3
STANDARD THREE/CLASS FOUR/CE2 4
STANDARD FOUR/CLASS FIVE/CM1 5
STANDARD FIVE/CLASS SIX/CM2 6
STANDARD SIX/CLASS SEVEN 7

SECONDARY
ANGLOPHONE/FRANCOPHONE

FORM 1/SIXTH/1ST YEAR 1
FORM 2/FIFTH/2ND YEAR 2
FORM 3/FOURTH/3RD YEAR 3
FORM 4/THIRD/4TH YEAR 4
FORM 5/SECOND 5
LOWER SIXTH FORM/FIRST 6
UPPER SIXTH FORM/FINAL YEAR 7

107) What is your main occupation?

________

108) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY): ___ 4
NONE 5

109) What is your nationality?

CAMEROONIAN 1
OTHER AFRICAN 2
OTHER 3

110) Now I would like to ask you a few questions about marriage: How many spouses/wives do you currently have?

NUMBER: ___

111) Are you planning to take another (more than one) spouse/wife in the future?

YES 1
NO 2

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

AGE IN COMPLETED YEARS: ___

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

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

SECTION 2. CONTRACEPTION

201) Now I would like to talk about family planning, the various ways or methods that a couple can use to delay or avoid a pregnancy. Which resources or methods have you heard of?

CIRCLE CODE 1 IN 202 FOR EACH METHOD MENTIONED SPONTANEOUSLY.

THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 2 IF THE METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.

THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 202, ASK 203 BEFORE CONTINUING TO THE NEXT METHOD.

202) Have you ever heard of (method)?

01. Pill: Women can take a pill every day.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
03. Injectables: Women can have an injection by a health provider which stops them from becoming pregnant for several months.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
04. Diaphragm/foam/jelly: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
05. Condom (rubber): Men can put a rubber sheath on their penis during sexual intercourse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
06. Female Sterilization/tubal ligation: Women can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
07. Male sterilization/vasectomy: Men can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
08. Rhythm method/Ogino: Some couples avoid having sex during those times of the month when the woman is most likely to get pregnant.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
09. Abstinence: Outside of the cessation of sexual relations traditionally observed after giving birth, some couples avoid having sexual intercourse for months so that the woman doesn't become pregnant.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
10. Withdrawal: Men can be careful and pull out before climax.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
11. Other methods: Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES/SPONTANEOUS 1
SPECIFY METHOD 1 ________
SPECIFY METHOD 2 ________
SPECIFY METHOD 3 _______
NO 3

203) Have you or your wife/wives ever used (method)?

01. Pill: Women can take a pill every day.
YES 1
NO 2
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. Injectables: Women can have an injection by a health provider which stops them from becoming pregnant for several months.
YES 1
NO 2
04. Diaphragm/foam/jelly: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
05. Condom (rubber): Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
06. Female Sterilization/tubal ligation: Women can have an operation to avoid having any more children.

Has your wife undergone an operation to avoid having any more children?
YES 1
NO 2
07. Male sterilization/vasectomy: Men can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
08. Rhythm method/Ogino: Some couples avoid having sex during those times of the month when the woman is most likely to get pregnant.
YES 1
NO 2
09. Abstinence: Outside of the cessation of sexual relations traditionally observed after giving birth, some couples avoid having sexual intercourse for months so that the woman doesn't become pregnant.
YES 1
NO 2
10. Withdrawal: Men can be careful and pull out before climax.
YES 1
NO 2
11. Other methods: Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
METHOD ONE (SPECIFY): ___
YES 1
NO 2
METHOD TWO (SPECIFY): ___
YES 1
NO 2
METHOD THREE (SPECIFY): ___
YES 1
NO 2

204) CHECK 203

NO "YES" (NEVER USED):___ (GO TO 205)
AT LEAST ONE "YES" (USED): ___ (GO TO 207)

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

YES 1
NO 2 (GO TO 209)

206) What have you done or used?

CORRECT 203-204 (AND 202 IF NECESSARY)

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

YES 1
NO 2 (GO TO 209)

208) Which method are you using?

PILL 01 (GO TO 212)
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
DIAPHRAGM/FOAM/GEL 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
RHYTHM METHOD 08 (GO TO 212)
ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY): ___ 11 (GO TO 212)

209) Do you think you (yourself, or your wife/wives) will use a contraceptive method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 211)
DK 8 (GO TO 212)

210) Which contraceptive method would you prefer to use?

PILL 01 (GO TO 212)
IUD 02 (GO TO 212)
INJECTABLES 03 (GO TO 212)
DIAPHRAGM/FOAM/GEL 04 (GO TO 212)
CONDOM 05 (GO TO 212)
FEMALE STERILIZATION 06 (GO TO 212)
MALE STERILIZATION 07 (GO TO 212)
RHYTHM METHOD 08 (GO TO 212)
ABSTINENCE 09 (GO TO 212)
WITHDRAWAL 10 (GO TO 212)
OTHER (SPECIFY): ___ 11(GO TO 212)
DK 98 (GO TO 212)

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

WANTS CHILDREN 01
LACK OF INFORMATION 02
SPOUSE DISAPPROVES 03
COSTS TOO MUCH 04
SIDE EFFECTS 05
HEALTH PROBLEMS 06
DIFFICULT TO OBTAIN 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALIST/LEAVE IT UP TO GOD 10
FAMILY DISAPPROVES 11
INFREQUENT SEX 12
WOMAN HAS DIFFICULTY BECOMING PREGNANT 13
WOMAN MENOPAUSE/STERILIZATION 14
INCONVENIENT 15
OTHER (SPECIFY): ___ 16
DK 98

212) Is it acceptable or not acceptable to you for information on family planning to be provided on the radio or on television?

FOR/GOOD 1
AGAINST/BAD 2
DK 8

SECTION 3. FERTILITY PREFERENCES

301) Do you have children?

YES 1
NO 2 (GO TO 303)

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

NO. OF BOYS: ___
NO. OF GIRLS: ___

303) CHECK 203:

NOT STERILIZED: ___
STERILIZED: ___ (GO TO 312)

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

HAVE A/ANOTHER CHILD 1
NO MORE CHILDREN/NONE 2
SAYS WIFE CAN'T GET PREGNANT 3
SAYS HE CAN'T HAVE ANY (MORE) CHILDREN 4
NOT DECIDED/DON'T KNOW 8

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

YES/APPROVE 1
NO /DISAPPROVE 2
DK 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

307) Have you discussed with your wife (wives)/partner(s) the number of children you'd like to have?

YES 1
NO 2

308) Do you think that your wife (wives)/partner(s) wants the same number of children that you want, or does she want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DK 8

309) After giving birth, how long should a couple wait before resuming sexual intercourse?

MONTHS: ___ 1
YEARS: ___ 2
OTHER (SPECIFY): ___ 996

310) Should a mother wait until she's completely done breastfeeding before resuming sexual intercourse, or does this not matter?

WAIT 1
DOESN'T MATTER 2

311) Are you okay with couples using a method to delay or avoid a pregnancy?

YES, OKAY 1
NO, NOT OKAY 2

312) CHECK 301-302 AND CHECK THE BOX:

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

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

RECORD A SINGLE NUMBER OR OTHER RESPONSE:

NUMBER: ___
OTHER RESPONSE (SPECIFY): ___ 96 (GO TO 314)

313) How many boys and how many girls?

NO. OF BOYS ______
BOYS: IT IS GOD'S WILL 95

NO. OF GIRLS ______
GIRLS: IT IS GOD'S WILL 95

OTHER ANSWER (SPECIFY): ___ 96
DK 98

314) What do you think are the main advantages of having a lot of children?

RECORD THE CODES IN THE ORDER THAT THE RESPONSES ARE GIVEN.

IF THERE IS NO 2ND AND 3RD ADVANTAGE, MARK '00'.

HELP WITH THE WORK 01
FINANCIAL ASSISTANCE/AID 02
SUPPORT IN OLD AGE 03
AFFECTION/COMPANIONSHIP 04
RELIGIOUS/SOCIAL OBLIGATIONS 05
PRIDE/AFFIRMATION OF SELF 06
SOCIAL STATUS 07
POSTERITY/FAMILY NAME 08
NO ADVANTAGES 09
OTHER (SPECIFY): ___ 10
DK 98
1ST ADVANTAGE: ___
2ND ADVANTAGE: ___
3RD ADVANTAGE: ___

315) What do you think are the main disadvantages of having a lot of children?

RECORD THE CODES IN THE ORDER THAT THE RESPONSES ARE GIVEN.
IF THERE IS NO 2ND AND 3RD ADVANTAGE, MARK '00'.

COST/FINANCIAL EXPENSES 01
PROBLEMS WITH SUPERVISION 02
PROBLEM WITH DISCIPLINE 03
INCREASE IN WORK 04
CONSTRAINTS FOR PARENTS 05
WORRY ABOUT THE FUTURE 06
PROBLEMS FOR THE COUPLE'S RELATIONSHIP 07
ILLNESS/DEATH 08
NO DISADVANTAGES 09
OTHER (SPECIFY): ___ 10
1ST DISADVANTAGE: ___
2ND DISADVANTAGE: ___
3RD DISADVANTAGE: ___

316) According to you, starting with how many children, would one consider a woman to have a lot of children?

NUMBER: ___
DK 98

317) RECORD TIME

HOUR: ___
MINUTES: ___