HEALTH AND DEMOGRAPHIC SURVEY
WOMEN'S QUESTIONNAIRE 1998
MINISTRY OF ECONOMY AND FINANCE
CENTRAL BUREAU OF THE CENSUS AND POPULATION STUDIES
REPUBLIC OF CAMEROON
PEACE - WORK - FATHERLAND
PROVINCE ___
DEPARTMENT ___
LAYER ___
DISTRICT ___
GAROUA/MAROUA/BAFOUSSAM/BAMENDA 2
OTHER CITIES 3
RURAL 4
VILLAGE CLUSTER ___
NEIGHBORHOOD/PLACE STRUCTURE ___
NAME OF HEAD OF HOUSEHOLD ___
HOUSEHOLD ___
WOMAN'S NAME ___
WOMAN'S LINE NUMBER ___
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
INTERVIEWER NAME___
NO HOUSEHOLD MEMBER AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY): ___ 7
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__
FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__
NO HOUSEHOLD MEMBER AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY): ___ 7
ENGLISH 2
FUFULDE 3
EWONDO 4
PIDGIN 5
OTHER 6
NO 2
SUPERVISOR
NAME: ___
DATE: ___
FIELD EDITOR
NAME: ___
DATE: ___
OFFICE EDITOR ___
KEYED BY ___
SECTION 1. RESPONDENT'S SOCIO-DEMOGRAPHIC CHARACTERISTICS
101) RECORD THE TIME
MINUTES _____
102) First I would like to ask some questions about you and your household.
For most of the time until you were 12 years old, did you live in Yaounde/Douala, in Garoua/Maroua/Bafoussam/Bamenda, in another city, in the countryside or abroad?
IF ABROAD, SPECIFY THE LOCATION OF RESIDENCE.
GAROUA/MAROUA/BAFOUSSAM/BAMENDA/LARGE CITY ABROAD 2
OTHER CITY/SMALL CITY ABROAD 3
COUNTRYSIDE/COUNTRYSIDE ABROAD 4
UNSPECIFIED ABROAD 5
103) How long have you been continuously live in (NAME OF CURRENT PLACE OF RESIDENCE)?
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104) Just before you moved to (NAME OF CURRENT PLACE OF RESIDENCE), did you live in Yaounde/Douala, in Garoua/Maroua/Bafoussam/Bamenda, in another city, in the countryside, or abroad?
IF ABROAD, SPECIFY THE LOCATION OF RESIDENCE.
GAROUA /MAROUA/BAFOUSSAM/BAMENDA/LARGE CITY ABROAD 2
OTHER CITY/SMALL CITY ABROAD 3
COUNTRYSIDE/COUNTRYSIDE ABROAD 4
UNSPECIFIED ABROAD 5
105) In what month and what year were you born?
DK MONTH 98
DK YEAR 9998
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCORRECT.
106A) Do you understand French?
NO 2
106B) Do you understand English?
NO 2
107) Have you ever attended school?
NO 2 (GO TO 114)
108) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109) What is the highest (grade/form/year) you completed at this level?
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
DK 8
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 7
DK 8
1ST YEAR 1
2ND YEAR 2
3RD YEAR 3
4TH+ YEAR 4
DK 8
AGE 25 OR ABOVE: ___ (GO TO 111A)
111) Are you currently going to school?
NO 2
111A) At what age did you stop going to school?
IF STILL IN SCHOOL, CIRCLE '96'.
STILL IN SCHOOL 96 (GO TO 113)
112) What is the main reason for which you stopped attending school?
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
PREFERRED A JOB/TO GO TO WORK 07
HAD ENOUGH SCHOOLING 08
FAILED AT SCHOOL 09
DID NOT LIKE SCHOOL 10
SCHOOL NOT ACCESSIBLE/TOO FAR 11
OTHER (SPECIFY): ___ 96
DON'T KNOW 98
SECONDARY OR HIGHER: ___ (GO TO 114A)
114) Can you read and understand a letter or a newspaper, easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 115A)
114A) Do you usually read a newspaper or magazine at least once a month?
NO 2 (GO TO 115A)
115) Do you usually read a newspaper or magazine at least once a week?
NO 2
115A) Do you usually listen to the radio?
NO 2 (GO TO 116G)
116) Do you usually listen to the radio every day?
NO 2
116A) What days of the week do you normally listen to the radio?
RECORD ALL RESPONSES GIVEN. IF THE RESPONSE IS 'IT DEPENDS', 'IT DOESN'T MATTER', OR 'DON'T KNOW', YOU ONLY NEED TO RECORD ONE CODE.
TUESDAY B
WEDNESDAY D
THURSDAY E
FRIDAY F
SATURDAY G
SUNDAY H
IT DEPENDS/DOESN'T MATTER X
DK Z
116B) What time do you normally listen to the radio?
RECORD ALL RESPONSES GIVEN. IF THE RESPONSE IS 'ALL DAY', 'IT DEPENDS', 'IT DOESN'T MATTER', OR 'DK', YOU ONLY NEED TO RECORD ONE CODE.
FROM 8 A.M. TO 12 P.M. B
FROM 12 P.M. TO 2 P.M. C
FROM 2 P.M. TO 6 P.M. D
FROM 6 P.M. TO 8 P.M. E
AFTER 8 P.M. F
ALL DAY LONG G
IT DEPENDS/DOESN'T MATTER X
DK Z
116C) What type of radio program do you normally listen to?
PROBE TO OBTAIN THE TYPE OF PROGRAM. RECORD ALL THE PROGRAMS.
SPORTS B
SPOKEN NEWS C
REPORTING D
SHOWS ON HEALTH E
OTHER (SPECIFY): ___ X
116D) Have you had a chance to listen to the radio series "Yamba Songo"?
IF THEY'VE NEVER HEARD OF THE SHOW, CIRCLE '3'.
NO 2 (GO TO 116G)
DON'T KNOW IT 3 (GO TO 116G)
116E) According to you, is this series educational, or for entertainment?
ENTERTAINMENT 2 (GO TO 116G)
BOTH 3
DK 8 (GO TO 116G)
116F) According to you, what problems does "Yamba Songo" talk about?
RECORD ALL OF THE RESPONSES GIVEN. IF THE RESPONSE IS 'DON'T KNOW,' YOU ONLY HAVE TO CIRCLE THAT CODE.
AIDS/HIV B
SEXUALLY TRANSMITTED DISEASES C
TREATMENT OF DIARRHEA/ORS D
HEALTH PROBLEMS E
OTHER (SPECIFY): ___ X
DK Z
116G) Do you usually watch television?
NO 2 (GO TO 118)
117) Do you usually watch television at least once a week?
NO 2
117A) What days of the week do you normally watch television?
TUESDAY B
WEDNESDAY D
THURSDAY E
FRIDAY F
SATURDAY G
SUNDAY H
EVERY DAY I
IT DEPENDS/DOESN'T MATTER X
DK Z
117B) What time do you normally watch television?
RECORD ALL THE RESPONSES GIVEN. IF THE RESPONSE IS 'ALL DAY', 'IT DEPENDS', 'DOESN'T MATTER', OR 'DON'T KNOW', YOU ONLY HAVE TO RECORD ONE CODE.
FROM 12 P.M. TO 2 P.M. C
FROM 2 P.M. TO 6 P.M. D
FROM 6 P.M. TO 8 P.M. E
AFTER 8 P.M. F
ALL DAY LONG G
IT DEPENDS/DOESN'T MATTER X
DK Z
117C) What type of television shows do you normally watch?
PROBE TO OBTAIN THE TYPE OF SHOW. RECORD ALL OF THE SHOWS WATCHED.
SPORTS B
MOVIES/SERIES C
SPOKEN NEWS D
REPORTING E
SHOWS ON HEALTH F
OTHER (SPECIFY): ___ X
PROTESTANT 2
MUSLIM 3
ANIMIST 4
OTHER (SPECIFY): ___ 6
NONE 7
WRITE DOWN THE NAME OF THE ETHNICITY. LEAVE THE CODE SPACE EMPTY.
FOR FOREIGNERS, MARK 'FOREIGNER'.
201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?
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?
NO 2 (GO TO 204)
203) How many sons live with you?
How many daughters live with you?
IF 'NONE,' RECORD '00'.
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?
NO 2 (GO TO 206)
205) How many sons are alive but do not live with you?
How many daughters are alive but do not live with you?
IF 'NONE', RECORD '00'.
DAUGHTERS ELSEWHERE: ___
206) Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any child who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
207) How many boys have died? And how many girls have died?
IF 'NONE', RECORD '00'.
GIRLS DECEASED: ___
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF 'NONE', RECORD '00'.
Just to make sure that I have this right: you have had in total ______births during your life. Is that correct?
NO: ___ (PROBE AND CORRECT 201-208 AS NECESSARY.)
NO BIRTHS: ___ (GO TO 227)
211) Now I would like to record all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL OF THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
212) What name was given to your (first, next) child?
213) Were any of these births twins?
MULT 2
214) Is (NAME) a boy or a girl?
GIRL 2
215) In what month and what year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season was he/she born?
YEAR: ___
NO 2 (GO TO 219)
217) IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD THE AGE IN COMPLETED YEARS.
218) IF ALIVE: Does (NAME) live with you?
NO 2 (GO TO NEXT CHILD)
219) IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months old was (NAME)?
RECORD IN DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS: ___ 2
YEARS: ___ 3
FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH.
IS THE DIFFERENCE 4 OR MORE?
NO 2 (GO TO NEXT BIRTH)
Were there other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
NO 2
222) FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH. IS THE DIFFERENCE 4 YEARS OR MORE?
NO 2 (GO TO 224)
223) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
NO 2
224) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED
FOR THE AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS
225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1995.
IF NONE, MARK '0'.
NO 2 (GO TO 236)
NOT SURE (GO TO 236)
228) How many months pregnant are you?
RECORD NUMBER IN COMPLETED MONTHS.
229) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?
LATER 2
NOT WANT MORE CHILDREN 3
236) When did your last menstrual cycle start?
WEEKS: ___ 2
MONTHS: ___ 3
YEARS: ___ 4
MENOPAUSAL 994
BEFORE THE LAST BIRTH 995
NEVER MENSTRUATED 996
237) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?
NO 2 (GO TO 239)
DK 8 (GO TO 239)
238) During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?
RIGHT AFTER HER PERIOD HAS ENDED 02
IN THE MIDDLE OF CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY): ___ 96
DK 98
239) Have you had a pregnancy that did not end in a live birth?
NO 2 (GO TO 301)
240) How many pregnancies have you had that did not end in a live birth?
241) Among these pregnancies, how many ended in: An abortion? A miscarriage? A stillbirth?
MISCARRIAGE: ___
STILLBIRTH: ___
Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.
301) Which ways or methods have you heard about? (SPONTANEOUSLY MENTIONED)
302) Have you heard of (METHOD)? (EACH METHOD READ ALOUD)
YES/PROBE 2
NO 3
YES/PROBE 2
NO 3
Women can have an injection by a health provider which stops them from becoming pregnant for several months.
YES/PROBE 2
NO 3
Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES/PROBE 2
NO 3
Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES/PROBE 2
NO 3
YES/PROBE 2
NO 3
YES/PROBE 2
NO 3
YES/PROBE 2
NO 3
YES/PROBE 2
NO 3
YES/PROBE 2
NO 3
NO 3
303) Have you ever used (METHOD)?
NO 2
NO 2
Women can have an injection by a health provider which stops them from becoming pregnant for several months.
NO 2
Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
NO 2
Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE 'YES' (USED): ___ (GO TO 309)
305) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 331)
307) What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).
309) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.
How many living children did you have at that time, if any?
IF NONE, RECORD '00'.
310) When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY): ___ 6
WOMAN STERILIZED (VOLUNTARY SURGICAL CONTRACEPTION): ___ (GO TO 314A)
PREGNANT: ___ (GO TO 332)
313) Are you currently doing something or using any method to avoid getting pregnant?
NO 2 (GO TO 331)
314) Which method are you using?
314A) CIRCLE 07 FOR 'FEMALE STERILIZATION'.
IUD 02 (GO TO 325A)
INJECTABLES 03 (GO TO 325A)
IMPLANT 04 (GO TO 325A)
DIAPHRAGM/FOAM/GEL 05 (GO TO 325A)
CONDOM 06 (GO TO 325A)
FEMALE STERILIZATION 07 (GO TO 317A)
MALE STERILIZATION 08 (GO TO 317A)
PERIODIC ABSTINENCE 09 (GO TO 322A)
WITHDRAWAL 10 (GO TO 325A)
OTHER (SPECIFY): ___ 96 (GO TO 325A)
314B) Why do you use the pill over another method?
MORE AVAILABLE 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
REVERSIBLE METHOD 08
OTHER (SPECIFY): ___ 96
315) May I see the package of pills you are using right now?
(RECORD NAME OF BRAND IF PACKAGE IS SEEN).
OVRETTE 02 (GO TO 317)
OTHER (SPECIFY): ___ 96 (GO TO 317)
PACKAGE NOT SEEN 98
316) Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND.
OVRETTE 02
OTHER (SPECIFY): ___ 96
DK 98
317) How much does one packet (cycle) of pills cost you?
FREE 9996 (GO TO 326)
DK 9998 (GO TO 326)
317A) Why did (you or your spouse/partner) have an operation to not have any more children, rather than using another method?
MORE AVAILABLE 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
PERMANENT METHOD 08
OTHER (SPECIFY): ___ 96
318) Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
HEALTH CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
SECULAR HOSPITAL/CLINIC 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
DK 98
319) Do you regret that (you or your husband) had the operation not to have any more children?
NO 2 (GO TO 321)
320) Why do you regret the operation?
HUSBAND/PARTNER WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY): ___ 96
321) In what month and year was the sterilization performed?
YEAR: ___ (GO TO 327)
322A) Why do you use the rhythm method rather than another method?
MORE AVAILABLE 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
REVERSIBLE METHOD 08
OTHER (SPECIFY): ___ 96
323) How do you determine which days of your monthly cycle during not to have sexual relations?
BASED ON BODY TEMPERATURE 02 (GO TO 326)
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03 (GO TO 326)
BASED ON BODY TEMPERATURE AND MUCUS 04 (GO TO 326)
NO SPECIFIC SYSTEM 05 (GO TO 326)
OTHER (SPECIFY): ___ 96 (GO TO 326)
325A) Why do you use (METHOD) rather than another method?
NO AVAILABILITY PROBLEM 02
WAS PRESCRIBED 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
IT SUITS ME 06
ONLY KNOWN METHOD 07
REVERSIBLE METHOD 08
PROTECTS AGAINST AIDS/STD 09
OTHER (SPECIFY): ___ 96
326) For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.
8 YEARS OR LONGER 96
327) CHECK 314: CIRCLE THE CODE OF THE METHOD.
IUD 02
INJECTABLES 03
IMPLANT 04
DIAPHRAGM/FOAM/GEL 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 329A)
MALE STERILIZATION 08 (GO TO 329A)
PERIODIC ABSTINENCE 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER (SPECIFY): ___ 96 (GO TO 332)
328) Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
HEALTH CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
SECULAR HOSPITAL/CLINIC 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
DOCTOR'S OFFICE 24
PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
RELATIVES/FRIENDS 35
329) Do you know of another place where you could have obtained (METHOD) the last time?
329A) At the time of the sterilization operation, did you know of another place where you could have received the operation?
NO 2 (GO TO 334)
329B) People choose the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF LOCATION LISTED AT 328 OR 318) instead of some other place you know about?
RECORD EVERYTHING THAT IS MENTIONED.
IF THE ANSWER IS 'DON'T KNOW' YOU ONLY NEED TO CIRCLE THE CORRESPONDING CODE AND SKIP TO 334.
Other reasons?
CLOSER TO MARKET/WORK B
AVAILABILITY OF TRANSPORT C
CLEANER FACILITY E
OFFERS MORE PRIVACY F
SHORTER WAITING TIME G
LONGER HOURS OF OPERATION H
USE OTHER SERVICES AT THE FACILITY I
AVAILABILITY OF THE METHOD AT ALL TIMES J
WANTED ANONYMITY L
OTHER (SPECIFY): ___ X
DK Z (GO TO 334)
330) INTERVIEWER:
- IF YOU ONLY CIRCLED ONE CODE FOR 329B, CIRCLE HERE THE CODE CORRESPONDING TO THE SAME ANSWER AND GO TO 334.
- IF YOU CIRCLED SEVERAL CODES FOR 329B, ASK THE FOLLOWING QUESTION AND CIRCLE THE CODE CORRESPONDING TO THE ANSWER.
Among the reasons you gave me, what is the main reason?
CLOSER TO MARKET/WORK 12 (GO TO 334)
AVAILABILITY OF TRANSPORT 13 (GO TO 334)
CLEANER FACILITY 22 (GO TO 334)
OFFERS MORE PRIVACY 23 (GO TO 334)
SHORTER WAITING TIME 24 (GO TO 334)
LONGER HOURS OF OPERATION 25 (GO TO 334)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 334)
AVAILABILITY OF THE METHOD AT ALL TIMES 27 (GO TO 334)
WANTED ANONYMITY 41 (GO TO 334)
OTHER (SPECIFY): ___ 96 (GO TO 334)
PREGNANT: ___ (GO TO 332)
331A) What is the main reason that you are not using a method of contraception to avoid pregnancy?
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFERTILE 24
POSTPARTUM/BREASTFEEDING 25
WANTS (OTHER) CHILDREN 26
HUSBAND/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
CULTURAL TABOOS 35
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DK 98
332) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 334)
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
HEALTH CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
SECULAR HOSPITAL/CLINIC 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
DOCTOR'S OFFICE 24
PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
RELATIVES/FRIENDS 35
334) Were you visited by a family planning program worker in the last 12 months?
NO 2
335) Have you visited a health facility for any reason in the last 12 months?
NO 2 (GO TO 337)
336) Did any staff member at the health facility speak to you about family planning methods?
NO 2
337) Do you think that breastfeeding can affect a woman's chances of becoming pregnant?
NO 2 (GO TO 401)
DK 8
338) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?
DECREASED 2
DEPENDS 3
DK 8
NO BIRTHS: ___ (GO TO 401)
340) Have you ever relied on breastfeeding as a method of avoiding pregnancy?
NO 2 (GO TO 401)
EITHER PREGNANT OR STERILIZED: ___ (GO TO 401)
342) Are you currently relying on breastfeeding to avoid getting pregnant?
NO 2
SECTION 4A. PREGNANCY AND BREASTFEEDING
401) CHECK 225:
NO BIRTHS SINCE JANUARY 1995: ___ (GO TO 465)
402) RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS.
BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).
Now I would like to ask you some more questions about the health of all your children born in the last 3 years. We will talk about one child at a time.
DECEASED: ___
405) At the time you became pregnant with (NAME), did you want to get pregnant then, did you want to wait until later, or did you want no (more) children at all?
LATER 2
NO MORE 3 (GO TO 407)
406) How much longer would you like to have waited?
YEARS: ___ 2
DK 998
407) When you were pregnant with (NAME), did you see anyone for prenatal care for this pregnancy?
IF YES: Whom did you see?
Someone else?
PROBE TO OBTAIN THE TYPE OF PERSON AND RECORD ALL OF THE PERSONS SEEN.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
NO ONE Y (GO TO 410)
408) How many months pregnant were you when you first received prenatal care?
DK 98
409) How many times did you receive prenatal care during this pregnancy?
DK 98
410) When you were pregnant with (NAME), were you given an injection to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (GO TO 412)
DK 8 (GO TO 412)
411) During this pregnancy, how many times did you get this injection?
DK 8
412) Where did you give birth to (NAME)?
OTHER HOME 12
HEALTH CENTER 22
OTHER PUBLIC (SPECIFY): ___ 26
SECULAR HOSPITAL/CLINIC 32
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 33
OTHER PRIVATE MEDICAL (SPECIFY): ___ 36
413) Who assisted you with the delivery of (NAME)?
Anyone else?
PROBE TO OBTAIN THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
FAMILY/FRIENDS E
NO ONE Y
414) At the time of the birth of (NAME), did you have any of the following problems:
A long labor, that is, did your regular contractions last more than 12 hours?
Excessive bleeding that was so much that you feared it was life threatening?
A high fever with bad smelling vaginal discharge?
Convulsions not caused by fever?
NO 2
NO 2
NO 2
NO 2
414A) After (NAME)'s birth, did you have complications?
IF YES: What type of complications?
DIFFICULTY WALKING B
OTHER (SPECIFY): ___ X
NO/NONE Y
415) Was (NAME) delivered by cesarean?
NO 2
416) When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DK 8
417) Was (NAME) weighed at birth?
NO 2 (GO TO 419)
418) How much did (NAME) weigh?
RECORD THE WEIGHT WRITTEN IN THE HEALTH CARD, IF AVAILABLE.
GRAMS FROM MEMORY: ___ 2
DON'T KNOW 99998
419) FOR MOST RECENT BIRTH: Has your period returned since the birth of (NAME)?
NO 2 (GO TO 422)
420) FOR BIRTH BEFORE LAST: Did your period return between the birth of (NAME) and your next pregnancy?
NO 2 (GO TO 424)
421) For how many months after the birth of name did you not have a period?
DK 98
422) CHECK 227: RESPONDENT PREGNANT?
PREGNANT OR UNSURE: ___ (GO TO 424)
423) Have you resumed sexual relations again since the birth of (NAME)?
NO 2 (GO TO 425)
424) For how many months after the birth of (NAME) did you not have sexual relations?
DK 98
425) Did you breastfeed (NAME)?
NO 2 (GO TO 431)
426) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD IN HOURS.
OTHERWISE RECORD DAYS.
HOURS: ___ 1
DAYS: ___ 2
DECEASED: ___ (GO TO 429)
428) Are you still breastfeeding (NAME)?
NO 2
429) For how many months did you breastfeed (NAME)?
DK 98
430) Why did you stop breastfeeding (NAME)?
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY): ___ 96
DECEASED: ___ (GO BACK TO 405 IN THE NEXT COLUMN, OR IF NO MORE BIRTHS, GO TO 440)
432) How many times did you breastfeed last night between sunset and sunrise?
(IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER).
433) How many times did you breastfeed yesterday during the daylight hours?
(IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER).
434) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DK 8
435) At any time yesterday or last night, was (NAME) given any of the following:
Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Tinned or powdered milk?
Fresh milk?
Any other liquids?
Food made from corn, rice, millet, sorghum, such as gruel, bread, or pasta?
Food made from tubers (manioc, yams, plantains, cocoyams, potatoes)?
Food made from peanuts, beans, or peas?
Food made from green leaves?
Eggs, fish, or poultry?
Meat?
Any other solid or semi-solid foods?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
439) GO BACK TO 405 IN THE NEXT COLUMN OR IF NO MORE BIRTHS, GO TO 440.
SECTION 4B. IMMUNIZATION AND HEALTH
440) ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995 IN THE TABLE.
ASK THE QUESTIONS FOR ALL THE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRE).
442) ACCORDING TO 212 AND 216:
DECEASED: ___ (GO TO 442 IN THE NEXT COLUMN, OR IF NO MORE BIRTHS, GO TO 465)
443) Do you have a card where (NAME)'s vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3
444) Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 447)
445)
(1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF THE CARD SHOWS THAT A VACCINE WAS GIVEN, BUT NO DATE IS RECORDED.
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
MONTH: ___
YEAR: ___
446) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, MEASLES, YELLOW FEVER, AND/OR HEPATITIS.
NO 2 (GO TO 449)
DK 8 (GO TO 449)
447) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?
NO 2 (GO TO 449)
DK 8 (GO TO 449)
448) Please tell me if (NAME) received any of the following vaccinations:
448A) A BCG vaccination against tuberculosis, that is, an injection in the left arm that leaves a scar.
NO 2
DK 8
448B) Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 448E)
DK 8 (GO TO 448E)
448D) When was the first polio vaccine was given, just after birth or later?
LATER 2
448E) DPT vaccination, that is, an injection usually given at the same time as polio drops?
NO 2 (GO TO 448G)
DK 8 (GO TO 448G)
448G) Any injection to prevent measles?
NO 2
DK 8
448H) An injection to prevent yellow fever?
NO 2
DK 8
449) Has (NAME) ever been ill with a fever at any time during the last 2 weeks?
NO 2 (GO TO 450)
DK 8 (GO TO 450)
449A) When (NAME) had a fever, did he/she:
Vomit?
Have chills?
Have convulsions?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
450) Has (NAME) been ill with a cough at any time in the last 2 weeks?
NO 2 (GO TO 453A)
DK 8 (GO TO 453A)
451) When (NAME) was ill with a cough, did he/she breathe more rapidly than usual with short, rapid breaths?
NO 2
DK 8
452) Did you seek advice or treatment for the cough?
NO 2 (GO TO 453A)
453) Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.
HEALTH CENTER B
OTHER PUBLIC (SPECIFY): ___ C
SECULAR HOSPITAL/CLINIC E
HEALTH CENTER/RELIGIOUS CLINIC/MISSION F
DOCTOR'S OFFICE G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
TRADITIONAL PRACTITIONER K
453A) Has (NAME) had diarrhea in the last 4 weeks?
NO 2 (GO TO 464)
DK 8 (GO TO 464)
453B) How many times did he/she have diarrhea over the last 4 weeks?
DK 98
454) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 464)
DK 8 (GO TO 464)
455) Was there blood in the stools?
NO 2
DK 8
456) On the worst day of the diarrhea, how many bowel movements did (NAME) have?
DK 98
457) Was he/she given the same amount to drink as before the diarrhea, or more, or less?
MORE 2
LESS 3
DK 8
458) Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?
MORE 2
LESS 3
DK 8
CHILD STILL BREASTFEEDING?
NO TO 428 OR 428 NOT ASKED: ___ (GO TO 459)
458B) Was (NAME) breastfed the same amount before the diarrhea, or more or less?
MORE 2
LESS 3
DK 8
459) When (NAME) had diarrhea, was he/she given any of the following to drink:
A fluid prepared from a special packet called ORS?
A light slurry made with corn, rice, millet, yams, manioc, plantain?
Soup?
Tea/Herbal Tea?
Homemade salt-sugar-water solution?
Milk or infant formula?
Yogurt based drink?
Water?
Any other liquids?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
460) Was anything else given to (NAME) to treat the diarrhea?
NO 2 (GO TO 462)
DK 8 (GO TO 462)
461) What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY): ___ X
462) Did you seek advice or for a treatment for the diarrhea?
NO 2 (GO TO 464)
463) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED.
HEALTH CENTER B
OTHER PUBLIC (SPECIFY): ___ C
SECULAR HOSPITAL/CLINIC E
HEALTH CENTER/RELIGIOUS CLINIC/MISSION F
DOCTOR'S OFFICE G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
TRADITIONAL PRACTITIONER K
464) GO BACK TO 442 IN THE NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.
465) When a child has diarrhea, should he/she be given less to drink than usual, the same amount, or more than usual?
ABOUT SAME AMOUNT TO DRINK 2
MORE TO DRINK 3
DK 4
466) When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?
ABOUT SAME AMOUNT TO EAT 2
MORE TO EAT 3
DK 8
467) When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETS SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY): ___ X
DK Z
468) When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETS SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY): ___ X
DK Z
AT LEAST ONE CHILD RECEIVED ORS: ___ (GO TO 472)
470) Have you ever heard of a special product called an ORS packet you can get for the treatment of diarrhea?
NO 2 (GO TO 477)
471) Have you ever used this product?
NO 2 (GO TO 473)
472) Where did you get the ORS packet last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
HEALTH CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
SECULAR HOSPITAL/CLINIC 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
DOCTOR'S OFFICE 24
PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
TRADITIONAL PRACTITIONER 32
473) Do you currently have an ORS packet in your home?
NO 2 (GO TO 477)
474) Could I see the ORS packet you have?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING NUMBER.
UNICEF 2 (GO TO 476)
NO BRAND 3 (GO TO 476)
OTHER (SPECIFY): ___ 6 (GO TO 476)
PACKET NOT SEEN 8
475) Do you know the brand name of the ORS packet that you have now?
RECORD THE NAME OF THE BRAND.
UNICEF 2
NO BRAND 3
OTHER (SPECIFY): ___ 6
PACKET NOT SEEN 8
476) How much did the packet of ORS cost?
FREE 996
DON'T KNOW 998
476A) CHECK 454, ALL THE COLUMNS:
NO CHILD HAD DIARRHEA IN THE LAST 2 WEEKS: ___ (GO TO 478)
476B) CHECK 459, ALL THE COLUMNS:
AT LEAST ONE CHILD RECEIVED ORS: ___ (GO TO 477)
476C) Why didn't you use an ORS packet when (NAME) had diarrhea?
NOT AVAILABLE 02
DON'T KNOW HOW TO PREPARE 03
CHILD REFUSED 04
PREFERRED ANOTHER SOLUTION 05
OTHER (SPECIFY): ___ 96
477) CHECK 459, ALL THE COLUMNS:
AT LEAST ONE CHILD RECEIVED SALT/SUGAR SOLUTION: ___ (GO TO 501)
478) Have you heard of a solution of salt, sugar, and water that you prepare at home and that you give to children to treat diarrhea?
NO 2 (GO TO 501)
479) Have you ever prepared this solution before?
NO 2
SECTION 5. MARRIAGE AND SEXUAL ACTIVITY
501) PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
502) Are you currently married or living with a man?
YES, LIVING WITH A MAN 2 (GO TO 507)
MARRIAGE NOT CONSUMMATED 3 (GO TO 515F)
NO, NOT IN UNION 4
503) Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
504) Have you ever been married or lived with a man?
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515F)
506) What is your current marital status: are you a widow, divorced, or separated?
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)
507) Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
507A) RECORD THE LINE NUMBER OF HER HUSBAND ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A PART OF THE HOUSEHOLD, RECORD '00'.
508) Does your husband/partner have any other wives, besides yourself?
NO 2 (GO TO 511)
509) How many other wives does he have?
DON'T KNOW 98 (GO TO 511)
510) Are you the first, second?wife?
511) Have you been married or have you lived with a man only once or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH MAN ONLY ONCE: In what month and year did you start living with your husband/partner?
MARRIED/LIVED WITH MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?
DK MONTH 98
DK YEAR 9998
513) How old were you when you started living with him?
NOT IN A UNION: ___ (GO TO 515F)
515) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
When was the last time you had sexual intercourse with (your husband/the man with whom you live)?
IF 'NEVER HAD RELATIONS', GO BACK TO 502, CIRCLE CODE 3 (MARRIAGE NOT CONSUMMATED) AND FOLLOW THE NEW INSTRUCTIONS STARTING WITH 502.
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
NUMBER OF YEARS: ___ 4
BEFORE THE LAST BIRTH 996
KNOWS WHAT CONDOMS ARE: The last time you had sex with (your husband/the man with whom you live), was a condom used?
DOES NOT KNOW WHAT CONDOMS ARE: Some men use a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex with (your husband/the man with whom you live), was a condom used?
NO 2 (GO TO 515B)
DK 8 (GO TO 515B)
515AA) During this last sexual relation, who suggested using the condom?
HUSBAND/PARTNER 2
BOTH 3
515B) Have you had sexual relations with someone other than (your husband/the man with whom you live) in the last 12 months?
NO 2 (GO TO 517)
515C) When was the last time you had sexual relations with someone other than (your husband/the man with whom you live)?
NUMBER OF WEEKS: ___ 2
NUMBER OF MONTHS: ___ 3
BEFORE LAST BIRTH 996
515CA) The last time you had sexual relations with someone other than your husband/the man with whom you live, was it with a regular partner, an acquaintance, for money, or someone else?
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4
515D) Was a condom used on this occasion?
NO 2 (GO TO 515E)
DK 8 (GO TO 515E)
515DA) During this last sexual relation, who suggested using the condom?
PARTNER 2
BOTH 3
515E) During the last 12 months, how many different people other than (your husband/the man with whom you live) did you have sexual relations with?
DK 98 (GO TO 517)
515F) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
When was the last time you had sexual intercourse (if ever)?
DAYS AGO: ___ 1
WEEKS AGO: ___ 2
MONTHS AGO: ___ 3
YEARS AGO: ___ 4
BEFORE LAST BIRTH 996
515FA) The last time you had sexual relations, was it a regular partner, an acquaintance, for money, or someone else?
ACQUAINTANCE 2
FOR MONEY 3
SOMEONE ELSE 4
KNOWS WHAT CONDOMS ARE: The last time you had sex, was a condom used?
DOES NOT KNOW WHAT CONDOMS ARE: Some men use a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?
NO 2 (GO TO 515H)
DK 8 (GO TO 515H)
515GA) During this last sexual relation, who suggested using the condom?
PARTNER 2
BOTH 3
12 MONTHS OR MORE SINCE LAST SEXUAL RELATIONS: ___ (GO TO 517)
515I) In total, with how many different people have you had sex in the last 12 months?
DK 98
517) Do you know of a place where you can get condoms?
NO 2 (GO TO 518A)
RECORD ALL MENTIONED.
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
HEALTH CENTER B
OTHER PUBLIC (SPECIFY): ___ C
SECULAR HOSPITAL/CLINIC E
HEALTH CENTER/RELIGIOUS CLINIC/MISSION F
DOCTOR'S OFFICE G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
BAR/NIGHTCLUB K
KIOSK L
INFORMAL COMMERCIAL DISTRIBUTION M
RELATIVES/FRIENDS N
518A) CHECK 515A, 515D AND 515G:
NO 'YES' RESPONSES: ___ (GO TO 519)
518B) Where did you get the condom last time?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
HEALTH CENTER 12
OTHER PUBLIC (SPECIFY): ___ 16
SECULAR HOSPITAL/CLINIC 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
DOCTOR'S OFFICE 24
PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
RELATIVES/FRIENDS 35
OTHER (SPECIFY): ___ 96
518C) Do you know the brand name of the condoms that you used last time?
RECORD NAME OF BRAND
PROMESSE 2
NO BRAND NAME 3
OTHER (SPECIFY): ___ 6
DK 8
518D) The last time you bought condoms, how many did you buy?
DETERMINE THE NUMBER AND RECORD.
DK 998
FREE 9996
DK 9998
519) How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
SECTION 6. FERTILITY PREFERENCES
601) CHECK 314:
HE OR SHE STERILIZED: ___ (GO TO 612)
NOT PREGNANT OR UNSURE:
Now I have some question about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
PREGNANT:
Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3(GO TO 606)
UNDECIDED/DK (GO TO 604)
NOT PREGNANT OR UNSURE:
How long would you like to wait from now before the birth of (a/another) child?
PREGNANT:
After the birth of this child you are expecting now, how long would you like to wait before the birth of another child?
YEARS: ___ 2
SOON/NOW 993(GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY): ___ 996
DK 998
PREGNANT: ___ (GO TO 607)
605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?
UNHAPPY 2
WOULD NOT MATTER 3
606) CHECK 313: USING A METHOD?
NOT CURRENTLY USING: ___
CURRENTLY USING: ___ (GO TO 612)
607) Do you think you will use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DK 8
608) Do you think you will use a method any time in the future?
NO 2 (GO TO 610)
DK 8 (GO TO 610)
609) Which method would you prefer to use?
IUD 02 (GO TO 612)
INJECTABLES 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
DIAPHRAGM/FOAM/GEL 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
PERIODIC ABSTINENCE 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
OTHER (SPECIFY): ___ 96 (GO TO 612)
UNSURE/DK 98 (GO TO 612)
610) What is the main reason that you think you will never use a method?
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUBFECUND/INFERTILE 24 (GO TO 612)
WANTS MORE CHILDREN 26 (GO TO 612)
HUSBAND/PARTNER OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
CULTURAL TABOO 35 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COSTS TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
DK 98 (GO TO 612)
611) Would you use a method if you were married?
NO 2
DK 8
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.
OTHER (SPECIFY): ___ 96 (GO TO 614)
613) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter?
BOYS: OTHER (SPECIFY): ___ 96
GIRLS: OTHER (SPECIFY): ___ 96
EITHER: OTHER (SPECIFY): ___ 96
614) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
615) Is it acceptable or not acceptable to you for information on family planning to be provided:
On the radio?
On the television?
NOT ACCEPTABLE 2
DK 8
NOT ACCEPTABLE 2
DK 8
616) In the last few months have you heard about family planning:
On the radio?
On the television?
In a newspaper or a magazine?
On a poster?
From leaflets or brochures?
On an advertising sign?
During a community meeting?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
616A) What is your main source of information on family planning?
PUBLIC HEALTH WORKER 02
PRIVATE HEALTH WORKER 03
COMMUNITY HEALTH WORKER 04
FAMILY PLANNING CLINIC 05
HUSBAND/PARTNER 06
OTHER RELATIVES 07
FRIENDS 08
RADIO 09
TELEVISION 10
NEWSPAPERS/POSTERS 11
SCHOOL/LIBRARY 12
COMMUNITY MEETINGS 13
OTHER (SPECIFY): ___ 96
DK 98
618) In the last few months, have you discussed the practice of family planning with anyone?
NO 2 (GO TO 620)
RECORD ALL PERSONS MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTERS(S) F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
OTHER (SPECIFY): ___ X
YES, LIVING WITH A MAN: __
NO, NOT IN A UNION: __ (GO TO 701)
621) Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.
Do you think your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?
DISAPPROVES 2
DK 8
622) How often have you talked to your husband/partner about family planning in the last twelve months?
ONCE OR TWICE 2
MORE OFTEN 3
622A) Who usually starts the discussion on family planning, you, your husband/partner, or both?
HUSBAND/PARTNER 2
BOTH 3
DK 8
622B) CHECK 313: USES A METHOD?
NO, DOES CURRENTLY USE A METHOD: ___ (GO TO 623)
622C) Before beginning (CURRENT METHOD), did you discuss which method you would use with your husband/partner?
NO 2
DON'T RECALL 8
622D) After having started (CURRENT METHOD), did you discuss this method with your husband/partner?
NO 2
DON'T RECALL 8
CIRCLE CODE OF METHOD
IUD 02
INJECTABLES 03
IMPLANT 04
DIAPHRAGM/FOAM/GEL 05
CONDOM 06 (GO TO 623)
FEMALE STERILIZATION 07
MALE STERILIZATION 08 (GO TO 623)
PERIODIC ABSTINENCE 09
WITHDRAWAL 10 (GO TO 623)
OTHER METHOD 96
622F) Did your husband/partner encourage you or discourage you from using (CURRENT METHOD)?
DISCOURAGE 2
NEITHER/NEUTRAL 3
DK 8
623) Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DK 8
624) According to you, who should make the decision to use a contraceptive method, the man or the woman?
WOMAN 2
BOTH 3
SOMEONE ELSE 4
625) According to you, who generally makes the decision to use a contraceptive method, the man or the woman?
WOMAN 2
BOTH 3
SOMEONE ELSE 4
626) Do you think your mother (guardian) approves or disapproves of couples using a method to avoid or delay pregnancy?
IF THE MOTHER (GUARDIAN) IS DEAD, ASK: "If your mother (guardian) were alive, do you think?"
DISAPPROVE 2
DK 8
627) Do you think your father (guardian) approves or disapproves of couples using a method to avoid or delay pregnancy?
IF THE FATHER (GUARDIAN) IS DEAD, ASK: "If your father (guardian) were alive, do you think?"
DISAPPROVE 2
DK 8
628) Do you think that the use of contraceptives goes against or does not go against your religion?
IS NOT AGAINST 2
HER RELIGION HAS NO POSITION ON THE SUBJECT 3
RESPONDENT DOES NOT HAVE A RELIGION 4
DK 8
629) Do you think that it's better to have small family or a large family to improve the quality of life?
LARGE FAMILY 2
NOT IMPORTANT/EITHER 3
DEPENDS 4
DK/NO OPINION 8
630) Have you encouraged a friend or relative to use family planning?
NO 2
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
701) CHECK 502 AND 504:
FORMERLY MARRIED/LIVED WITH A MAN: __ (GO TO 703)
NEVER MARRIED AND NEVER IN UNION: __ (GO TO 709)
702) How old was your husband/partner on his last birthday?
703) Did your (last) husband/partner ever attend school?
NO 2 (GO TO 706)
704) What was the highest level of school he attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
DK 8 (GO TO 706)
705) What was the highest (grade/form/year) he completed at that level?
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
DK 8
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 7
DK 8
1ST YEAR 1
2ND YEAR 2
3RD YEAR 3
4TH+ YEAR 4
DK 8
706) What is/was your (last) husband's occupation? That is, what kind of work does/did he mainly do?
DETERMINE THE ECONOMIC SECTOR AND CIRCLE THE APPROPRIATE CODE.
RECORD PROFESSION.
INDUSTRY/ BUILDING AND PUBLIC WORKS 02
COMMERCE 03
PUBLIC SERVICES AND ADMINISTRATION 04
STUDENT 05 (GO TO 709)
LOOKING FOR FIRST JOB 06 (GO TO 709)
OTHER (SPECIFY): ___ 96
DK 98
706A) BASED ON THE ANSWER TO 706, DETERMINE THE SOCIO-PROFESSIONAL CATEGORY AND CIRCLE THE APPROPRIATE CODE.
SENIOR EXECUTIVE/ENGINEER 12
MIDLEVEL EXECUTIVE/SUPERVISOR 13
EMPLOYEE/QUALIFIED WORKER 14
EMPLOYEE/UNQUALIFIED WORKER 15
UNSKILLED LABORER 16
INDEPENDENT WORKER 22
APPRENTICE 23
FAMILY AIDE 24
DK 98
DOES NOT WORK IN AGRICULTURE: __ (GO TO 709)
708) Does/did your husband/partner work mainly on his own land or on family land, or does/did he work on land that he rent from someone else, or does/did he work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
NOT APPLICABLE 6
709) Aside from your own housework, are you currently working?
NO 2
710) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things or any other work?
NO 2
711) Have you done any work in the last 12 months?
NO 2 (GO TO 726)
712) What is your occupation, that is, what kind of work do you mainly do?
DETERMINE THE ECONOMIC SECTOR AND CIRCLE THE APPROPRIATE CODE.
INDUSTRY/BUILDING AND PUBLIC WORKS 2
COMMERCE 3
PUBLIC SERVICES AND ADMINISTRATION 4
OTHER 6
712A) BASED ON THE ANSWER TO 712, DETERMINE THE SOCIO-PROFESSIONAL CATEGORY AND CIRCLE THE APPROPRIATE CODE.
SENIOR EXECUTIVE/ENGINEER 12
MIDLEVEL EXECUTIVE/SUPERVISOR 13
EMPLOYEE/QUALIFIED WORKER 14
EMPLOYEE/UNQUALIFIED WORKER 15
UNSKILLED LABORER 16
INDEPENDENT WORKER 22
APPRENTICE 23
FAMILY AIDE 24
DOES NOT WORK IN AGRICULTURE: ___ (GO TO 715)
714) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
NOT APPLICABLE 6
715) Do you do this work for a family member, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
716) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
723) Do you usually work at home or away from home?
AWAY 2
724) CHECK 217 AND 218: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?
NO: ___ (GO TO 801A)
725) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?
HUSBAND/PARTNER 02 (GO TO 801A)
OLDER FEMALE CHILD 03 (GO TO 801A)
OLDER MALE CHILD 04 (GO TO 801A)
OTHER RELATIVES 05 (GO TO 801A)
NEIGHBORS 06 (GO TO 801A)
FRIENDS 07 (GO TO 801A)
SERVANTS/HIRED HELP 08 (GO TO 801A)
CHILD IS IN SCHOOL 09 (GO TO 801A)
INSTITUTIONAL CHILDCARE 10 (GO TO 801A)
HAS NOT WORKED SINCE LAST BIRTH 95 (GO TO 801A)
OTHER (SPECIFY): ___ 96 (GO TO 801A)
726) Are you looking for a job?
NO 2
SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
801) Have you ever heard of an illnesses that you can get from having sex?
NO 2 (GO TO 801K)
801B) What illnesses have you heard of?
RECORD ALL RESPONSES.
GONORRHEA B
AIDS C
GENITAL WARTS/GENITAL TUMORS D
DISCHARGE/ULCERATION E
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DK Z
HAS NEVER HAD SEXUAL INTERCOURSE: ___ (GO TO 801K)
801D) Over the last 12 months, have you had any of these illnesses?
NO 2 (GO TO 801K)
DK 8 (GO TO 801K)
801E) Which illnesses did you have?
RECORD ALL RESPONSES.
GONORRHEA B
AIDS C
GENITAL WARTS/GENITAL TUMORS D
DISCHARGE/ULCERATION E
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DK Z
801F) The last time that you had (ILLNESS FROM 801E) did you seek advice or treatment?
NO 2 (GO TO 801H)
801G) Where did you seek advice or treatment?
Any other place?
CIRCLE ALL MENTIONED.
HEALTH CENTER B
OTHER PUBLIC (SPECIFY): ___ C
SECULAR HOSPITAL/CLINIC E
HEALTH CENTER/RELIGIOUS CLINIC/MISSION F
DOCTOR'S OFFICE G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
TRADITIONAL PRACTITIONER K
FRIENDS/RELATIVES L
DK Z
801H) When you had the (ILLNESS(S) OF 801E) did you tell your sexual partner(s)?
NO 2
801I) When you had the (ILLNESS(S) OF 801E) did you do something to avoid infecting your sexual partner(s)?
NO 2 (GO TO 801K)
PARTNER ALREADY INFECTED 3(GO TO 801K)
USE A CONDOM B
TAKE MEDICATION C
OTHER (SPECIFY): ___ X
LISTED 'AIDS': ___ (GO TO 802)
801L) Have you ever heard of an illness called AIDS?
NO 2 (GO TO 811C)
802) From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED.
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
THEATER I
FRIENDS/RELATIVES J
WORK PLACE K
OTHER (SPECIFY): ___ X
802A) If you wanted more information on AIDS, where (from whom) would you like to get this information?
IF SEVERAL SOURCES ARE LISTED, ASK WHICH WOULD BE THE PREFERRED SOURCE AND CIRCLE THE CORRESPONDING CODE.
TV 02
NEWSPAPERS/MAGAZINES 03
PAMPHLETS/POSTERS 04
HEALTH WORKERS 05
MOSQUES/CHURCHES 06
SCHOOLS/TEACHERS 07
COMMUNITY MEETINGS 08
THEATER 09
FRIENDS/RELATIVES 10
WORK PLACE 11
HAS ENOUGH INFORMATION 12
OTHER (SPECIFY): ___ 96
Any other way?
RECORD ALL MENTIONED.
SEX WITH SEVERAL PARTNERS B
SEX WITH PROSTITUTES C
NOT USING A CONDOM D
SEX WITH HOMOSEXUALS E
BLOOD TRANSFUSIONS F
INJECTIONS G
KISSING H
MOSQUITO BITES I
CUTTING WITH SOILED BLADES, SCISSORS, OR KNIVES K
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DK Z
803) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 807)
DK 8 (GO TO 807)
Anything else?
RECORD ALL WAYS MENTIONED.
ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
AVOID SOILED BLADES, SCISSORS AND KNIVES K
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER L
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
DK Z
DID NOT MENTION SAFE SEX: ___ (GO TO 807)
806) What does 'safe sex' mean to you?
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY): ___ X
DK Z
807) Is it possible for a healthy looking person to have the AIDS virus?
NO 2
DK 8
808) Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?
SOMETIMES 2
ALMOST ALWAYS 3
DK 8
NO 2
DK 8
808B) Can AIDS be transmitted from a mother to a child?
NO 2
DK 8
808C) Do you know someone personally who has AIDS or someone who died of AIDS?
NO 2
DK 8
809) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?
MODERATE 2 (GO TO 809C)
GREAT 3(GO TO 809C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 811A)
809B) Why do you think that you (have no risk/have small risk) for getting AIDS?
Any other reason?
RECORD ALL MENTIONED.
USES CONDOMS C (GO TO 811A)
ONLY HAS ONE SEXUAL PARTNER D (GO TO 811A)
HAS A LIMITED NUMBER OF SEXUAL PARTNERS E (GO TO 811A)
PARTNER DOESN'T HAVE OTHER PARTNERS F (GO TO 811A)
DOESN'T HAVE HOMOSEXUAL RELATIONSHIPS G (GO TO 811A)
DOESN'T GET BLOOD TRANSFUSIONS H (GO TO 811A)
DOESN'T GET INJECTIONS I (GO TO 811A)
AVOIDS CUTTING WITH SOILED BLADES, SCISSORS, AND KNIVES K (GO TO 811A)
OTHER (SPECIFY): ___ X (GO TO 811A)
809C) Why do you think you have a (moderate/great) risk of getting AIDS?
Any other reason?
RECORD ALL MENTIONED.
HAS MORE THAN ONE SEXUAL PARTNER D
HAS SEVERAL SEXUAL PARTNERS E
PARTNER HAS OTHER PARTNERS F
HAS HOMOSEXUAL RELATIONSHIPS G
GETS BLOOD TRANSFUSIONS H
GETS INJECTIONS I
USES SOILED BLADES, SCISSORS, KNIVES K
OTHER (SPECIFY): ___ X
811A) Since you have heard of AIDS, have you changed your behavior to avoid getting AIDS?
IF YES: What have you done?
Anything else?
RECORD ALL MENTIONED.
STOP HAVING SEX B (GO TO 811C)
START USING CONDOMS C (GO TO 811C)
RESTRICT SEX TO ONE PARTNER D (GO TO 811C)
REDUCE NUMBER OF SEXUAL PARTNERS E (GO TO 811C)
ASK PARTNER TO BE FAITHFUL F (GO TO 811C)
STOP HOMOSEXUAL RELATIONSHIPS G (GO TO 811C)
STOP INJECTIONS I
AVOID SOILED BLADES, SCISSORS, AND KNIVES K
OTHER (SPECIFY): ___ W
OTHER (SPECIFY): ___ X
NO CHANGE Y
811B) Has your knowledge of AIDS influenced or changed your decisions about having sex or sexual behavior?
IF YES, PROBE: In what way?
RECORD ALL MENTIONED.
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
OTHER (SPECIFY): ___ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DK Z
811C) Some people use condoms during sex to avoid getting AIDS or other sexually transmitted illnesses. Have you ever heard of condoms?
NO 2 (GO TO 901)
HAS NOT HAD SEX: ___ (GO TO 901)
811E) We may have already discussed this. Have you ever used a condom during sex to avoid getting AIDS or transmitting illnesses, like AIDS?
NO 2 (GO TO 901)
814) Do you use a condom from time to time, often, or with each sexual encounter?
OFTEN 2
EACH ENCOUNTER 3
901) 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, including those who are living with you, those living elsewhere and those who have died.
How many children did your mother give birth to, including you?
ONLY ONE BIRTH (RESPONDENT ONLY): ___ (GO TO 916)
903) How many of these births did your mother have before you were born?
(NOTE: 904-915 IN TABLE FORMAT)
904) What was the name given to your oldest (next oldest) brother or sister?
905) Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 908)
DK 8 (GO TO NEXT SIBLING)
908) What year did he/she die in?
DK 9998
909) How many years ago did (NAME) die?
910) How old was (NAME) when he/she died?
911) Was (NAME) pregnant when she died?
NO 2
912) Did (NAME) die during childbirth?
NO 2
913) Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2 (GO TO 915)
914) Did (NAME) die due to complications of pregnancy or childbirth?
NO 2
915) How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?
MINUTES: ___
1001) CHECK 215:
NO BIRTHS SINCE JANUARY 1995: ___ (GO TO END)
IN 1002 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1995 AND STILL ALIVE. IN 1003 AND 1004, RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1995. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1995 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1995, USE ADDITIONAL QUESTIONNAIRES.)
TABLE FORMAT:
1) RESPONDENT
2) YOUNGEST LIVING CHILD
3) NEXT-TO-YOUNGEST LIVING CHILD
1003) NAME FROM 212 FOR CHILDREN
(FROM 215, AND ASK FOR DAY OF BIRTH)
MONTH: ___
YEAR: ___
1005) BCG SCAR ON TOP OF LEFT SHOULDER
NO SCAR 2
1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?
STANDING 2
1009) DATE WEIGHED AND MEASURED
MONTH: ___
YEAR: ___
FOR RESPONDENT:
NOT PRESENT 2
REFUSED 4
OTHER (SPECIFY): ___ 6
FOR CHILDREN:
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY): ___ 6
NAME OF MEASURER
NAME OF ASSISTANT
TO BE FILLED OUT AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT____
COMMENTS ON SPECIFIC QUESTIONS____
ANY OTHER COMMENTS____
SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR____
DATE____
EDITOR'S OBSERVATIONS
NAME OF EDITOR____
DATE____