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EGYPT 1992 DEMOGRAPHIC AND HEALTH SURVEY WOMAN QUESTIONNAIRE

IDENTIFICATION

GOVERNORATE __________
PSU/SEGMENT NO. _____________
KISM/MARQAZ __________
BUILDING NO. ________________
SHIAKHA/VILLAGE __________
HOUSE NO___________
HOUSEHOLD NO. _________

URBAN 1
RURAL 2

LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4

NAME OF HOUSEHOLD HEAD _______________
ADDRESS IN DETAIL ______________
NAME OF WOMAN ______________
LINE NUMBER OF WOMAN ___________

GOVERNORATE ___
PSU/SEGMENT NO.___
HOUSEHOLD NO. ___
URBAN/RURAL ___
LOCALITY ___
LINE NUMBER ___

INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER'S NAME _____
SUPERVISOR 'S NAME_____
RESULT ______
NEXT VISIT: DATE _____ TIME ________

FINAL VISIT: DAY ____ MONTH ____ YEAR ____
TEAM ____
INTERVIEWER _____
SUPERVISOR _____
RESULT _____
TOTAL NUMBER OF VISITS ___

RESULT CODES:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _______

FIELD EDITOR
NAME _______
DATE _______
SIGNATURE _______

OFFICE EDITOR
NAME _______
DATE _______
SIGNATURE _______

CODER
NAME _______
DATE _______
SIGNATURE _______

KEYER
NAME _______
DATE _______
SIGNATURE _______

SECTION 1. RESPONDENT'S BACKGROUND

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 98

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

AGE IN COMPLETED YEARS ___

104. What is your current marital status?

MARRIED 1
WIDOWED 2
DIVORCED 3

105. Have you ever attended school?

YES 1
NO 2 (GO TO 110)

106. Are you currently attending school or the university?

YES 1
NO 2

107. What is the highest level of school you attended?

PRIMARY 1
PREPARATORY 2
SECONDARY 3
UPPER INTERMEDIATE 4
UNIVERSITY 5
MORE THAN UNIVERSITY 6

108. What is the highest grade which you successfully completed at that level?

GRADE __

109. CHECK 107:

PRIMARY (GO TO 110)
PREPARATORY OR HIGHER (GO TO 111)

110. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 112)

111. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

112. How many hours on average do you listen to the radio each day? IF LISTENS LESS THAN 1 HOUR, WRITE "00".

NUMBER OF HOURS PER DAY __
ALL OF THE TIME 96
NEVER 97
NOT SURE/DON'T KNOW 98

113. How many hours on average do you watch television each day? IF WATCHES LESS THAN 1 HOUR, WRITE "00".

NUMBER OF HOURS PER DAY __
ALL OF THE TIME 96
NEVER 97
NOT SURE/DON'T KNOW 98

114. What is your religion?

MOSLEM 1
CHRISTIAN 2
OTHER (SPECIFY) __3

115. CHECK QUESTION 010 IN THE HOUSEHOLD QUESTIONNAIRE.

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (I.E., IF SHE IS A VISITOR) (GO TO 116)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

116. Now I would like to ask about the place in which you usually live. Do you usually live in Cairo, Giza, Alexandria, another city or town, or in a village?

LOCALITY __
OUTSIDE EGYPT 5 (GO TO 118)

117. In which governorate is that located?

GOVERNORATE __

118. Now I would like to ask some questions about the household in which you usually live. In what type of dwelling does your household live?

APARTMENT 1
FREE STANDING HOUSE 2
OTHER (SPECIFY) 3

119. Is your dwelling owned by your household or not? IF OWNED: Is it owned solely by your household or jointly with someone else?

OWNED 1
OWNED JOINTLY 2
RENTED 3
OTHER (SPECIFY) 4

120. Could you describe the main material of the floor in your dwelling?

NATURAL FLOOR
EARTH/SAND 11
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
CERAMIC/MARBLE TILES 32
CEMENT TILES 33
CEMENT 34
WALL-TO-WALL CARPET 35
OTHER (SPECIFY) ___ 41

121. How many rooms are there in your dwelling (excluding the bathrooms, kitchen and stairway areas)?

ROOMS ___

122. How many of the rooms are used for sleeping?

ROOMS ___

123. Is there a special room used only for cooking inside or outside the dwelling?

YES 1
NO 2

124. What is the source of water your household uses for drinking?

PIPED WATER

PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 126)
PUBLIC TAP 12
WELL WATER

WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 126)
PUBLIC WELL 22
SURFACE WATER

NILE/CANALS 31
OTHER (SPECIFY) ___ 71

125. How long does it take to go there, get water, and come back?

MINUTES ___

126. Does your household get water for other uses (e.g., for handwashing and dishwashing) from the same source?

YES 1 (GO TO 128)
NO 2

127. What is the source of water for such uses?

PIPED WATER

PIPED INTO RESIDENCE/YARD/PLOT 11
PUBLIC TAP 12
WELL WATER

WELL IN RESIDENCE/YARD/PLOT 21
PUBLIC WELL 22
SURFACE WATER

NILE/CANALS 31
OTHER (SPECIFY) ___71

128. What kind of toilet facility does your household have?

MODERN FLUSH TOILET 11
TRADITIONAL WITH TANK FLUSH 12
TRADITIONAL WITH BUCKET FLUSH 13
PIT TOILET/LATRINE 21
NO FACILITY 31
OTHER (SPECIFY)___ 41

129. Does the dwelling unit have electrical connections in all or only part of the dwelling unit?

YES, IN ALL 1
YES, IN PART 2
HAS NO ELECTRICAL CONNECTIONS 3

130. Does your household have:

A radio with cassette recorder?
YES 1
NO 2
A black and white television?
YES 1
NO 2
A color television?
YES 1
NO 2
A video?
YES 1
NO 2

131. Does your household have:

An electric fan?
YES 1
NO 2
A gas/electric cooking stove?
YES 1
NO 2
A water heater?
YES 1
NO 2
A refrigerator?
YES 1
NO 2
A washing machine?
YES 1
NO 2
A sewing machine?
YES 1
NO 2

132. Do you or any member of your household own:

A bicycle?
YES 1
NO 2
A private car/motorcycle?
YES 1
NO 2
Transport equipment (truck, taxi, van, bus, etc.)?
YES 1
NO 2
Residential or commercial buildings other than the dwelling unit?
YES 1
NO 2
Farm or other land?
YES 1
NO 2
Livestock (donkeys, horses, cows, sheep, etc.)/ poultry?
YES 1
NO 2
Mechanical farm equipment (tractor, etc.)?
YES 1
NO 2

SECTION 2. REPRODUCTION

201. Now I would like to ask 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, RECORD '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 any sign of life only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

207. In all, 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 ___

209. CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct?

YES (GO TO 210)
NO (PROBE AND CORRECT 201-209 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 225)

211. Now I would like to talk to you about all of 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 LINES. COMPLETE QUESTIONS 213-220 AS APPROPRIATE FOR EACH BIRTH. AFTER COMPLETING ALL BIRTHS, GO TO 221.

212. What name was given to your (first/next) baby?

NAME ______

213. RECORD SINGLE OR MULTIPLE BIRTH STATUS.

SING 1
MULT 2

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

BOY 1
GIRL 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) his/her last birthday? RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ___

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

YES 1 (GO TO NEXT BIRTH)
NO 2

219. IF LESS THAN 15 YEARS OF AGE: With whom does he/she lives? IF 15 YEARS OR OLDER, GO TO NEXT BIRTH.

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3
(GO NEXT BIRTH)

220. IF DEAD: How old was he/she when he/she died? IF '1 YR', 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 ____
(GO NEXT BIRTH)

221. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)
NUMBERS ARE SAME __ (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 AGE AT DEATH 12 MONTHS: PROBE TO DETERMINE EXACT NUMBER OF MONTHS ___
FOR BIRTH INTERVALS OF FOUR YEARS OR MORE: PROBE FOR UNREPORTED BIRTHS ___

222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987. IF NONE, ENTER '0' AND GO TO 224. ___

223. FOR EACH BIRTH SINCE JANUARY 1987, ENTER "B" IN MONTH OF BIRTH IN COLUMN 1 OF CALENDAR AND "P" IN EACH OF THE 8 PRECEDING MONTHS. WRITE NAME OF THE CHILD TO THE RIGHT OF THE "B" CODE.

224. AT THE BOTTOM OF THE CALENDAR, ENTER NAME AND BIRTH DATE OF THE LAST CHILD BORN PRIOR TO HANUARY 1987, IF APPLICABLE.

225. Are you pregnant now?

YES 1
NO 2 (GO TO 228)
UNSURE 8 (GO TO 228)

226. How many months pregnant are you?

MONTHS ___

226A. ENTER "P" IN COLUMN 1 OF CALENDAR IN MONTH OF INTERVIEW AND IN EACH PRECEDING MONTH PREGNANT.

227. 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 become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 234)

229. When did the last such pregnancy end?

MONTH ___
YEAR ___

230. CHECK 229:
LAST PREGNANCY ENDED SINCE JANUARY 1987 (GO TO 231)
LAST PREGNANCY ENDED BEFORE JANUARY 1987 (GO TO 234)

231. How many months pregnant were you when the pregnancy ended?

MONTHS ___

231A. ENTER "T" IN COLUMN 1 OF CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT.

232. Did you ever have any other such pregnancies?

YES 1
NO 2 (GO TO 234)

233. ASK FOR DATES AND THE DURATIONS OF ANY OTHER PREGNANCIES BACK TO JANUARY 1987. ENTER "T" IN COLUMN 1 OF CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGANT.

234. When did your last menstrual period start?

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996 (GO TO 236)

235. How old were you when you had your first menstrual period?

AGE ___
DON'T KNOW 98

236. Between the first day of a period (i.e., menstrual cycle) and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times? PROBE: Are there any days during this time when the woman has a greater chance of becoming pregnant than on other days?

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

237. During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant? PROBE: What are the days of each month when the woman should be more careful so as not to get pregnant during them?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) ___ 5
DON'T KNOW 8

SECTION 3. CONTRACEPTIVE KNOWLEDGE AND USE

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. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 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 METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302. Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD.

01 PILL Women can take a pill every day.
YES/SPONT 1
YES/PROBED 2
NO 3
02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONT 1
YES/PROBED 2
NO
03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES/SPONT 1
YES/PROBED 2
NO 3
04 NORPLANT Women can have small rods placed in their arm by a doctor which stops them from becoming pregnant for several years.
YES/SPONT 1
YES/PROBED 2
NO 3
05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3
06 CONDOM Men can use a rubber covering during sexual intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3
07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3
08 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3
09 RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES/SPONT 1
YES/PROBED 2
NO 3
10 WITHDRAWAL Men can be careful and pull out before ejaculation.
YES/SPONT 1
YES/PROBED 2
NO 3
11 PROLONGED BREASTFEEDING Women can prolong the time that they breastfeed their babies to delay the next pregnancy.
YES/SPONT 1
YES/PROBED 2
NO 3
12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES/SPONT 1 (SPECIFY)
NO 3

303. Have you 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 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04 NORPLANT Women can have small rods placed in their arm by a doctor which stops them from becoming pregnant for several years.
YES 1
NO 2
05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES 1
NO 2
06 CONDOM Men can use a rubber covering during sexual intercourse.
YES 1
NO 2
07 FEMALE STERILIZATION Women 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 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
09 RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES 1
NO 2
10 WITHDRAWAL Men can be careful and pull out before ejaculation.
YES 1
NO 2
11 PROLONGED BREASTFEEDING Women can prolong the time that they breastfeed their babies to delay the next pregnancy.
YES 1
NO 2
12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304. Do you know where a person could go to get (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 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04 NORPLANT Women can have small rods placed in their arm by a doctor which stops them from becoming pregnant for several years.
YES 1
NO 2
05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES 1
NO 2
06 CONDOM Men can use a rubber covering during sexual intercourse.
YES 1
NO 2
07 FEMALE STERILIZATION Women can have an operation to avoid having any more children. Do you know a place where a person can have such an operation?

YES 1
NO 2
08 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
09 RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant. Do you know where a person can obtain advice on how to use periodic abstinence?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE "YES"(NEVER USED) (GO TO 306)
AT LEAST ONE "YES" (EVER USED) (GO TO 309)

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

YES 1 (GO TO 308)
NO 2

307. ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (GO TO 351)

308. What have you used or done? CORRECT 303 - 305 (AND 302 IF NECESSARY).

309. What is the first thing you ever did or method you ever used to delay or avoid getting pregnant?

PILL 01
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 311)
MALE STERILIZATION 08 (GO TO 311)
PERIODIC ABSTINENCE 09 (GO TO 311)
WITHDRAWAL 10 (GO TO 311)
PROLONGED BREASTFEEDING 11 (GO TO 311)
OTHER (SPECIFY) ____ 12 (GO TO 311)

310. Where did you go to get (FIRST METHOD USED) the first time?
WRITE THE NAME AND THE ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE METHOD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE)____________

MINISTRY OF HEALTH FACILITY

URBAN HOSPITAL 11
URBAN HEATLH UNIT 12
RURAL HOSPITAL 13
RURAL HEALTH UNIT 14
OTHER 15
OTHER GOVERNMENTAL FACILITY

TEACHING HOSPITAL 16
HEALTH INSURANCE ORGANIZATION 17
CURATIVE CARE ORGANIZATION 18
OTHER 19
PRIVATE VOLUNTARY ORGANIZATION

EGYPT FAMILY PLANNING ASSOCIATION 21
CSI PROJECT 22
OTHER 23
MEDICAL PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC 24
PRIVATE DOCTOR 25
PHARMACY 26
OTHER PRIVATE SECTOR

MOSQUE HEALTH UNIT 31
CHURCH HEALTH UNIT 32
OTHER VENDOR (SHOP, KIOSK, ETC.) 33
FRIENDS/RELATIVES 41
OTHER 42
DON'T KNOW 98

311. At the time when you first used, how many living children did you have, if any? IF NONE, RECORD '00' AND GO TO 313.

NUMBER OF CHILDREN ___

312. How many sons did you have? How many daughters? IF NONE RECORD '00'.

SONS ___
DAUGHTERS ___

313. When you first began to use 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?

WANTED CHILD LATER 1
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY) ___ 3

314. CHECK 104:

CURRENTLY MARRIED (GO TO 315)
WIDOWED/DIVORCED (GO TO 338)

315. CHECK 225:

NOT PREGNANT OR UNSURE (GO TO 316)
PREGNANT (GO TO 344)

316. CHECK 303:

WOMAN NOT STERILIZED (GO TO 317)
WOMAN STERILIZED (GO TO 318A)

317. Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 344)

318. Which method are you using?
318A. CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01 (GO TO 320)
IUD 02 (GO TO 320)
INJECTIONS 03 (GO TO 320)
NORPLANT 04 (GO TO 320)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 320)
CONDOM 06 (GO TO 320)
FEMALE STERILIZATION 07 (GO TO 320)
MALE STERILIZATION 08 (GO TO 320)
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
PROLONGED BREASTFEEDING 11
OTHER (SPECIFY) ____ 12

319. Why did you decide to use (CURRENT METHOD) rather than some other method of family planning? PROBE: Any other reasons? RECORD ALL MENTIONED.

RECOMMENDATION OF GOVERNMENT DOCTOR/NURSE A (GO TO 336)
RECOMMENDATION OF PRIVATE DOCTOR/NURSE B (GO TO 336)
RECOMMENDATION OF FAMILY PLANNING WORKER/RAIDYA C (GO TO 336)
RECOMMENDATION OF RELATIVES/FRIENDS D (GO TO 336)
SIDE EFFECTS OF OTHER METHODS E (GO TO 336)
SAW TV SPOT PROMOTING METHOD F (GO TO 336)
METHOD CONVENIENT TO USE G (GO TO 336)
EASILY AVAILABLE H (GO TO 336)
COST I (GO TO 336)
WANTED PERMANENT METHOD J (GO TO 336)
HUSBAND PREFERRED K (GO TO 336)
WANTED MORE EFFECTIVE METHOD L (GO TO 336)
OTHER (SPECIFY) ___ M (GO TO 336)
DON'T KNOW N (GO TO 336)

320. Why did you decide to use (CURRENT METHOD) rather than some other method of family planning? PROBE: Any other reasons? RECORD ALL MENTIONED.

RECOMMENDATION OF GOVERNMENT DOCTOR/NURSE A
RECOMMENDATION OF PRIVATE DOCTOR/NURSE B
RECOMMENDATION OF FAMILY PLANNING WORKER/RAIDYA C
RECOMMENDATION OF RELATIVES/FRIENDS D
SIDE EFFECTS OF OTHER METHODS E
SAW TV SPOT PROMOTING METHOD F
METHOD CONVENIENT TO USE G
EASILY AVAILABLE H
COST I
WANTED PERMANENT METHOD J
HUSBAND PREFERRED K
WANTED MORE EFFECTIVE METHOD L
OTHER (SPECIFY) ___ M
DON'T KNOW N

321. CHECK 318:
SHE/HE STERILIZED: ___Where did the sterilization take place?
USING IUD: ___ Where did you have the IUD inserted?
USING ANOTHER METHOD: ___ Where did you obtain (METHOD) the last time?

WRITE THE NAME AND THE ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE METHOD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE)____________

MINISTRY OF HEALTH FACILITY

URBAN HOSPITAL 11
URBAN HEALTH UNIT 12
RURAL HOSPITAL 13
RURAL HEALTH UNIT 14
OTHER 15
OTHER GOVERNMENTAL FACILITY

TEACHING HOSPITAL 16
HEALTH INSURANCE ORGANIZATION 17
CURATIVE CARE ORGANIZATION 18
OTHER 19
PRIVATE VOLUNTARY ORGANIZATION

EGYPT FAMILY PLANNING ASSOCIATION 21
CSI PROJECT 22
OTHER 23
MEDICAL PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC 24
PRIVATE DOCTOR 25
PHARMACY 26
OTHER PRIVATE SECTOR

MOSQUE HEALTH UNIT 31
CHURCH HEALTH UNIT 32
OTHER VENDOR (SHOP, KIOSK, ETC.) 33
FRIENDS/RELATIVES 41 (GO TO 324)
OTHER 42
DON'T KNOW 98 (GO TO 326)

322. How long does it take to travel from your home to this place? IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1 ___
HOURS 2 ___
DON'T KNOW 9998

323. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

324. Why did you decide to obtain your (CURRENT METHOD) from (CURRENT SOURCE IN 321) rather than from some other place? Any other reason?

(RECORD ALL RESPONSES) _______

RECOMMENDATION OF GOVERNMENT DOCTOR/NURSE A
RECOMMENDATION OF PRIVATE DOCTOR/NURSE B
RECOMMENDATION OF FRIEND/RELATIVE C
REPUTATION OF SOURCE AS GOOD PROVIDER D
PREVIOUS EXPERIENCE E
EASY ACCESS TO SOURCE F
COST OF SERVICES REASONABLE G
OTHER (SPECIFY) ____ H
DON'T KNOW I

325. Since you obtained the method from (CURRENT SOURCE), have you returned there for follow-up or advice about the method?

YES 1
NO 2

326. CHECK 318:

USING IUD (GO TO 327)
USING PILL (GO TO 333)
USING OTHER METHODS (GO TO 335)

327. Did you get the IUD at the place where you had it inserted or did you buy it from somewhere else?

YES, FROM THE SAME PLACE 1 (GO TO 331)
NO, FROM SOMEWHERE ELSE 2

328. From where did you buy the IUD? WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE METHOD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) ___________________

MINISTRY OF HEALTH FACILITY

URBAN HOSPITAL 11
URBAN HEALTH UNIT 12
RURAL HOSPITAL 13
RURAL HEALTH UNIT 14
OTHER 15
OTHER GOVERNMENTAL FACILITY

TEACHING HOSPITAL 16
HEALTH INSURANCE ORGANIZATION 17
CURATIVE CARE ORGANIZATION 18
OTHER 19
PRIVATE VOLUNTARY ORGANIZATION

EGYPT FAMILY PLANNING ASSOCIATION 21
CSI PROJECT 22
OTHER 23
MEDICAL PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC 24
PRIVATE DOCTOR 25
PHARMACY 26
OTHER PRIVATE SECTOR

MOSQUE HEALTH UNIT 31
CHURCH HEALTH UNIT 32
OTHER VENDOR (SHOP, KIOSK, ETC.) 33
FRIENDS/RELATIVES 41
OTHER 42
DON'T KNOW 98

329. How much did it cost to buy the IUD from that place?

COST (IN POUNDS) ___
FREE 96
DON'T KNOW 98

330. Would you be willing to pay the following to buy the IUD from this source: (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO, GO TO 331.)

5 pounds?
YES 1
NO 2 (GO TO 331)
7 pounds?
YES 1
NO 2 (GO TO 331)
10 pounds?
YES 1
NO 2 (GO TO 331)
15 pounds?
YES 1
NO 2 (GO TO 331)
20 pounds?
YES 1
NO 2 (GO TO 331)
30 pounds?
YES 1
NO 2 (GO TO 331)
More than 30 pounds?
YES 1
NO 2

331. How much did it cost to have the IUD inserted (including any extra fee for a physical examination)?

COST (IN POUNDS) ___
FREE 996
DON'T KNOW 998

332. Would you be willing to pay the following to have an IUD inserted: (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO, GO TO 336. FOR AMOUNT MORE THAN 200 POUNDS, GO TO 336 IF YES OR NO.)

5 pounds?
YES 1
NO (GO TO 336)
10 pounds?
YES 1
NO (GO TO 336)
25 pounds?
YES 1
NO (GO TO 336)
50 pounds?
YES 1
NO (GO TO 336)
100 pounds?
YES 1
NO (GO TO 336)
150 pounds?
YES 1
NO (GO TO 336)
200 pounds?
YES 1
NO (GO TO 336)
More than 200 pounds?
YES 1 (GO TO 336)
NO (GO TO 336)

333. How much does one cycle of pills cost you?

COST (IN PIASTRES) _____
FREE 996
DON'T KNOW 998

334. Would you be willing to pay for a cycle of pills if it cost:
(IF YES, CONTINUE WITH NEXT AMOUNT. IF NO, SKIP TO 336. FOR AMOUNT MORE THAN 5 POUNDS, SKIP TO 336 IF YES OR NO.)

50 piastres per cycle?
YES 1
NO (GO TO 336)
1 pound per cycle?
YES 1
NO (GO TO 336)
2 pounds per cycle?
YES 1
NO (GO TO 336)
3 pounds per cycle?
YES 1
NO (GO TO 336)
4 pounds per cycle?
YES 1
NO (GO TO 336)
5 pounds per cycle?
YES 1
NO (GO TO 336)
More than 5 pounds per cycle?
YES 1 (GO TO 336)
NO (GO TO 336)

335. How much did it cost to get your method? (IF LESS THAN 1 POUND, RECORD IN PIASTRES.)

COST (IN PIASTRES) 1 ___
COST (IN POUNDS) 2 ___
FREE 99996
DON'T KNOW 99998

336. Are you having any problems in using (CURRENT METHOD) ?

YES 1
NO 2 (GO TO 338)

337. What is the main problem?

HUSBAND DISAPPROVES 01
SIDE EFFECTS/ILLNESS CAUSED BY METHOD 02
SPOTTING/BLEEDING 03
PERIOD DID NOT COME 04
OTHER HEALTH CONCERNS 05
RAN OUT OF SUPPLIES 06
ACCESS/AVAILABLITY 07
COSTS TOO MUCH 08
FORGET TO TAKE/MISPLACE 09
INCONVENIENT TO USE 10
STERILIZED, WANTS CHILDREN 11
OTHER (SPECIFY) ___ 12
DON'T KNOW 98

338. CHECK 303 AND 318:
WOMAN OR HUSBAND STERILIZED ___ (GO TO 339)
NEITHER WOMAN OR HUSBAND STERILIZED ___ (GO TO 342)

339. In what month and year was the sterilization performed?

MONTH ___
YEAR ___

340. ENTER STERILIZATION METHOD CODE IN MONTH OF INTERVIEW IN COLUMN 1 OF CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION OR TO JANUARY 1987 IF OPERATION OCCURRED BEFORE 1987.

341. CHECK 339:

STERILIZED BEFORE JANUARY 1987 ___ (GO TO 401)
STERILIZED SINCE JANUARY 1987 ___ (GO TO 344)

342. CHECK 104:

CURRENTLY MARRIED (GO TO 343)
WIDOWED/DIVORCED (GO TO 344)

343. ENTER METHOD CODE FROM 318 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN SHE STARTED USING THIS METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE.

ILLUSTRATIVE QUESTIONS:

-When did you start using this method continuously?
-How long have you been using this method continuously?

344. I would like to ask some questions about all of the (other) periods in the last few years during which you or your husband used a method to avoid getting pregnant.

PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT PERIOD OF USE AND GOING BACK TO JANUARY 1987.

USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

RECORD PERIODS OF USE AND NONUSE IN COLUMN 1 OF THE CALENDAR. FOR EACH MONTH IN WHICH A METHOD WAS USED, ENTER THE CODE FOR THE METHOD; ENTER "0" IN THOSE MONTHS WHEN NO METHOD WAS USED.

FOR EACH PERIOD OF USE, ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

FOR EACH PERIOD OF USE, RECORD THE CODE FOR THE REASON FOR DISCONTINUATION IN COLUMN 2 OF THE CALENDAR NEXT TO LAST MONTH OF USE.

NUMER OF CODES ENTERED IN COLUMN 2 MUST BE THE SAME AS THE NUMBER OF INTERRUPTIONS OF CONTRACEPTIVE USE IN COLUMN 1.

ILLUSTRATIVE QUESTIONS

COLUMN 1:

-When was the last time you used a method? Which method was that?
-When did you start using that method? How long after the birth of (NAME)?
-How long did you use the method then?

344 A. COLUMN 2:

-Why did you stop using the (METHOD)?
-Did you become pregnant while using (METHOD), or did you stop to get pregnant, or stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
"How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

345. CHECK CALENDAR:
METHOD USED IN MONTH OF JANUARY 1987 (GO TO 346)
NO METHOD USED IN MONTH OF JANUARY 1987 (GO TO 347)

346. I see that you were using (METHOD) in January 1987. When did you start using (METHOD) that time? THIS DATE SHOULD NOT PRECEDE THE DATE OF BIRTH OF ANY CHILD BORN BEFORE JANUARY 1987.

MONTH ___ (GO TO 351)
YEAR ___ (GO TO 351)

347. I see that you were not using any method of contraception in January 1987. Did you ever use a method before that?

YES 1
NO 2 (GO TO 351)

348. CHECK 215:

HAD BIRTH BEFORE JANUARY 1987 (GO TO 349)
NO BIRTH BEFORE JANUARY 1987 (GO TO 350)

349. Did you use a method between the birth of (NAME OF LAST CHILD BORN BEFORE JANUARY 1987) and January 1987?

YES 1
NO 2 (GO TO 351)

350. When did you stop using a method the last time prior to January 1987?
THIS DATE SHOULD NOT PRECEDE THE DATE OF BIRTH OF ANY CHILD BORN BEFORE JANUARY 1987.

MONTH ___
YEAR ___

351. CHECK 104:

CURRENTLY MARRIED (GO TO 351A)
WIDOWED/ DIVORCED (GO TO 401)

351A. CHECK 318:

NOT CURRENTLY USING A METHOD (GO TO 352)
CURRENTLY USING PERIODIC ABSTINENCE, WITHDRAWAL, OTHER TRADITIONAL METHOD (GO TO 357)
CURRENTLY USING A MODERN METHOD (GO TO 401)

352. Do you intend to use a method to delay or avoid pregnancy at any time in the future?

YES 1 (GO TO 354)
NO 2
DON'T KNOW (GO TO 357)

353. What is the main reason you do not intend to use a method in the future?

WANTS CHILDREN 01 (GO TO 357)
LACK OF KNOWLEDGE 02 (GO TO 357)
HUSBAND OPPOSED 03 (GO TO 357)
COSTS TOO MUCH 04 (GO TO 357)
SIDE EFFECTS 05 (GO TO 357)
HEALTH CONCERNS 06 (GO TO 357)
HARD TO GET METHODS 07 (GO TO 357)
RELIGION 08 (GO TO 357)
OPPOSED TO FAMILY PLANNING 09 (GO TO 357)
FATALISTIC 10 (GO TO 357)
OTHER PEOPLE OPPOSED 11 (GO TO 357)
INFREQUENT SEX 12 (GO TO 357)
DIFFICULT TO GET PREGNANT 13 (GO TO 357)
MENOPAUSAL/HAD HYSTERECTOMY 14 (GO TO 357)
INCONVENIENT 15 (GO TO 357)
OTHER (SPECIFY) ___ 16 (GO TO 357)
DON'T KNOW 98 (GO TO 357)

354. Do you intend to use a method within the next 12 months?

YES 1
NO 2
DON'T KNOW 8

355. When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09 (GO TO 357)
WITHDRAWAL 10 (GO TO 357)
PROLONGED BREASTFEEDING 11 (GO TO 357)
OTHER (SPECIFY) ___ 12 (GO TO 357)
UNSURE/DON'T KNOW 98 (GO TO 357)

356. Where can you get (METHOD MENTIONED IN 355)?
WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT WOULD GET THE METHOD. PROSE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.
(NAME AND ADDRESS OF PLACE) _______________________

MINISTRY OF HEALTH FACILITY

URBAN HOSPITAL 11 (GO TO 359)
URBAN HEALTH UNIT 12 (GO TO 359)
RURAL HOSPITAL 13 (GO TO 359)
RURAL HEALTH UNIT 14 (GO TO 359)
OTHER 15 (GO TO 359)
OTHER GOVERNMENTAL FACILITY

TEACHING HOSPITAL 16 (GO TO 359)
HEALTH INSURANCE ORGANIZATION 17 (GO TO 359)
CURATIVE CARE ORGANIZATION 18 (GO TO 359)
OTHER 19 (GO TO 359)
PRIVATE VOLUNTARY ORGANIZATION

EGYPT FAMILY PLANNING ASSOCIATION 21 (GO TO 359)
CSI PROJECT 22 (GO TO 359)
OTHER 23 (GO TO 359)
MEDICAL PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC 24 (GO TO 359)
PRIVATE DOCTOR 25 (GO TO 359)
PHARMACY 26 (GO TO 359)
OTHER PRIVATE SECTOR

MOSQUE HEALTH UNIT 31 (GO TO 359)
CHURCH HEALTH UNIT 32 (GO TO 359)
OTHER VENDOR (SHOP, KIOSK, ETC.) 33 (GO TO 359)
FRIENDS/RELATIVES 41 (GO TO 401)
OTHER 42 (GO TO 401)
DON'T KNOW 98 (GO TO 401)

357. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 401)

358. Where is that?
WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT WOULD GET THE METHOD. PROSE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE) _______________________

MINISTRY OF HEALTH FACILITY

URBAN HOSPITAL 11
URBAN HEALTH UNIT 12
RURAL HOSPITAL 13
RURAL HEALTH UNIT 14
OTHER 15
OTHER GOVERNMENTAL FACILITY

TEACHING HOSPITAL 16
HEALTH INSURANCE ORGANIZATION 17
CURATIVE CARE ORGANIZATION 18
OTHER 19
PRIVATE VOLUNTARY ORGANIZATION

EGYPT FAMILY PLANNING ASSOCIATION 21
CSI PROJECT 22
OTHER 23
MEDICAL PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC 24
PRIVATE DOCTOR 25
PHARMACY 26
OTHER PRIVATE SECTOR

MOSQUE HEALTH UNIT 31
CHURCH HEALTH UNIT 32
OTHER VENDOR (SHOP, KIOSK, ETC.) 33
FRIENDS/RELATIVES 41 (GO TO 401)
OTHER 42 (GO TO 401)
DON'T KNOW 98 (GO TO 401)

359. How long does it take to travel from your home to this place? IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1 ___
HOURS 2 ___
DON'T KNOW 9998

360. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

SECTION 4: OTHER ISSUES RELATING TO CONTRACEPTION

401. CHECK 303:

EVER USED FAMILY PLANNING (GO TO 402)
NEVER USED FAMILY PLANNING (GO TO 440)

402. CHECK 318:

CURRENTLY USING PILL (GO TO 403)
NOT CURRENTLY USING PILL (GO TO 416)

403. Is this the first time that you have ever used the pill or have you used before?

FIRST TIME USED PILL 1 (GO TO 405)
USED PILL BEFORE 2

404. At the time you used the pill for the first time, did you consult a doctor or a nurse before you began using it?

YES 1
NO 2

405. May I see the package of pills you are using now? RECORD NAME OF BRAND

PACKAGE SEEN 1

BRAND NAME ___
PACKAGE NOT SEEN 2 (GO TO 408)

406. COUNT AND RECORD THE TOTAL NUMBER OF PILLS IN THE CYCLE (PACKET) REGARDLESS OF THE PILLS ALREADY TAKEN.

21 1
28 2

407. OBSERVE SEQUENCE IN WHICH PILLS TAKEN FROM CYCLE (PACKET) AND CIRCLE CORRECT CODE.

PILLS MISSING IN SEQUENCE 1 (GO TO 410)
PILLS MISSING OUT OF SEQUENCE 2 (GO TO 410)
NO PILLS MISSING 3 (GO TO 410)

408. Do you know the brand name of the pills which you are using now? RECORD NAME OF BRAND.

BRAND NAME ___
DON'T KNOW 98

409. Why don't you have a cycle (packet) of pills available?

HAS PERIOD, DOESN'T NEED YET 01
COST TOO MUCH TO BUY CYCLE 02
FORGOT TO BUY NEXT CYCLE 03
RESTING FROM PILL 04
MISPLACED/CAN'T FIND 05
HUSBAND AWAY/ILL 06
OTHER (SPECIFY) ____ 07

410. At any time in the past month did you fail to take a pill for more than one day for any reason?

YES 1
NO 2 (GO TO 412)

411. What was the main reason you stopped taking the pill?

SIDE EFFECTS/ILLNESS 01
SPOTTING/BLEEDING 02
PERIOD DID NOT COME 03
RAN OUT OF PILLS 04
HUSBAND AWAY 05
FORGOT TO TAKE/MISPLACED 06
OTHER (SPECIFY) ___ 07

412. Just about everyone misses taking the pill sometime. What do you do when you forget to take two or more pills?

START TAKING AGAIN AS USUAL 01
TAKE EXTRA/MISSED PILLS 02
USE ANOTHER METHOD 03
TAKE EXTRA PILL AND USE ANOTHER METHOD 04
OTHER (SPECIFY) ____ 05
NEVER FORGOT 06

413. CHECK 321:

CURRENT SOURCE: PHARMACY (GO TO 414)
ALL OTHER SOURCES (GO TO 417A)

414. Do you usually obtain the pill yourself? IF NO: Who obtains the method usually?

RESPONDENT HERSELF 1 (GO TO 419)
HUSBAND 2
OTHER (SPECIFY) ___ 3

415. Since you began using the pill this time, have you yourself ever gone to a pharmacy to obtain the method?

YES 1 (GO TO 419)
NO 2 (GO TO 422)

416. CHECK 303:

EVER USED PILL (GO TO 417)
NEVER USED PILL (GO TO 431)

417. Now I would like to ask some questions about the last time that you used the pill. During that time, did you yourself ever go to a pharmacy to obtain the pill?

YES 1 (GO TO 419)
NO 2

417A. Since you began using the pill this time, have you yourself ever gone to a pharmacy to obtain the pill?

YES 1 (GO TO 419)
NO 2

418. Did anyone else obtain the pill for you at a pharmacy? IF YES: Who obtained the pill for you from a pharmacy?

HUSBAND 1 (GO TO 422)
OTHER (SPECIFY) ____ 2 (GO TO 422)
NO ONE ELSE 3 (GO TO 422)
NEVER OBTAINED FROM PHARMACY 4 (GO TO 422)

419. Now I would like to talk with you about the service which you received at the pharmacy. Did anyone at the pharmacy tell or show you how to use the pill?

YES 1
NO 2

420. Did anyone at the pharmacy describe side effects or other problems which you might have while using the pill?

YES 1
NO 2

421. Did anyone at the pharmacy ever tell you about other family planning methods which you might use?

YES 1
NO 2

422. When you began to use the pill (this/that) time, did you consult a doctor or a nurse?

YES 1
NO 2 (GO TO 431)

423. Where did you go for this consultation?
WRITE THE NAME AND ADDRESS OF THE SOURCE. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) _______________________

MINISTRY OF HEALTH FACILITY

URBAN HOSPITAL 11
URBAN HEALTH UNIT 12
RURAL HOSPITAL 13
RURAL HEALTH UNIT 14
OTHER 15
OTHER GOVERNMENTAL FACILITY

TEACHING HOSPITAL 16
HEALTH INSURANCE ORGANIZATION 17
CURATIVE CARE ORGANIZATION 18
OTHER 19
PRIVATE VOLUNTARY ORGANIZATION

EGYPT FAMILY PLANNING ASSOCIATION 21
CSI PROJECT 22
OTHER 23
MEDICAL PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC 24
PRIVATE DOCTOR 25
OTHER PRIVATE SECTOR

MOSQUE HEALTH UNIT 31
CHURCH HEALTH UNIT 32
OTHER 42
DON'T KNOW 98 (GO TO 431)

424. Now I would like to talk with you about the service which you received at (SOURCE IN 423). Did you think that the wait for services was too long?

YES 1
NO 2

425. Were you given a physical examination? IF YES: Was the doctor male or female?

EXAMINED BY MALE DOCTOR 1
EXAMINED BY FEMALE DOCTOR 2
NOT EXAMINED 3

426. How much did it cost for the consultation (including any extra fee for a physical examination)? IF LESS THAN ONE POUND, RECORD '000'.

COST (IN POUNDS) ___
FREE 996
DON'T KNOW 998

427. In addition to the pill, were you told about other methods?

YES 1
NO 2

428. Were you told how to use the pill?

YES 1
NO 2

429. Were you told about problems or side effects which you might experience in using the pill?

YES 1
NO 2

430. After you began using the pill, did you return to (SOURCE IN 423) for consultation or follow-up?

YES 1
NO 2

431. CHECK 318:

NOT CURRENTLY USING IUD (GO TO 432)
CURRENTLY USING IUD (GO TO 433A)

432. CHECK 303 (IUD):

EVER USED IUD (GO TO 433)
NEVER USED IUD (GO TO 440)

433. Now I would like to ask some questions about the last time that you used the IUD. Where did you obtain the IUD?

WRITE THE NAME AND ADDRESS OF THE SOURCE. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) _______________________

433A. CHECK 321 AND CIRCLE THE CODE FOR THE SOURCE AT WHICH THE CURRENT USER HAD THE IUD INSERTED.

MINISTRY OF HEALTH FACILITY

URBAN HOSPITAL 11
URBAN HEALTH UNIT 12
RURAL HOSPITAL 13
RURAL HEALTH UNIT 14
OTHER 15
OTHER GOVERNMENTAL FACILITY

TEACHING HOSPITAL 16
HEALTH INSURANCE ORGANIZATION 17
CURATIVE CARE ORGANIZATION 18
OTHER 19
PRIVATE VOLUNTARY ORGANIZATION

EGYPT FAMILY PLANNING ASSOCIATION 21
CSI PROJECT 22
OTHER 23
MEDICAL PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC 24
PRIVATE DOCTOR 25
OTHER PRIVATE SECTOR

MOSQUE HEALTH UNIT 31
CHURCH HEALTH UNIT 32
OTHER 42
DON'T KNOW 98 (GO TO 440)

434. Now I would like to talk with you about the service which you received at (SOURCE IN 432). Did you think that the wait for services was too long?

YES 1
NO 2

435. Were you given a physical examination? IF YES: Was the doctor male or female?

EXAMINED BY MALE DOCTOR 1
EXAMINED BY FEMALE DOCTOR 2
NOT EXAMINED 3

436. In addition to the IUD, were you told about other methods?

YES 1
NO 2

437. Were you told how to be sure that the IUD was in place?

YES 1
NO 2

438. Were you told about problems or side effects which you might experience in using the IUD?

YES 1
NO 2

439. After you began using the IUD, did you return to (SOURCE IN 432) for consultation or follow-up?

YES 1
NO 2

440. There are many factors which help to influence the decision to use family planning. Can you tell me if any of the following ever caused you to seek more information about family planning?

Advice from friends/relatives?
YES 1
NO 2
Informational spots on television?
YES 1
NO 2
Advice from government doctor/clinic staff?
YES 1
NO 2
Advice from private doctor/clinic staff?
YES 1
NO 2
Advice from raiyda or other family planning extension worker?
YES 1
NO 2
A community activity (e.g., a meeting)?
YES 1
NO 2
Other (SPECIFY) ______?
YES 1
NO 2

441. How did you first hear about family planning?

TELEVISION 01
RADIO 02
PRINT MEDIA 03
HUSBAND 04
OTHER RELATIVES OR FRIENDS 05
GOVERNMENT DOCTOR/CLINIC STAFF 06
PRIVATE DOCTOR/CLINIC STAFF 07
RAIDYA/OTHER FP WORKER 08
COMMUNITY MEETING 09
OTHER (SPECIFY) ___ 10

442. In the last month, have you heard a message about family planning on:

the radio?
YES 1
NO 2
television?
YES 1
NO 2

443. CHECK 105, 107 AND 110:

ATTENDED PREPARATORY OR HIGHER LEVEL (GO TO 444)
ABLE TO READ (GO TO 444)
NOT ABLE TO READ (GO TO 445)

444. In the last month have you read an article about family planning in a newspaper or magazine?

YES 1
NO 2

445. There are many spots or messages regarding family planning on television. Can you tell me about the spots or messages which you have found most informative or helpful for you?
RECORD THE RESPONSE IN DETAIL. IF THE ANSWER IS A SERIES (E.G., KAREEMA MUBKTAR OR THE DOCTOR), PROBE TO FIND OUT WHICH SPECIFIC SPOTS IN THE SERIES WERE MOST HELPFUL OR INFORMATIVE RECORD UP TO THREE SPOTS.

________ 1
________ 2
________3
NEVER SAW FP MESSAGES 997

446. In the past year, have you ever attended a community meeting or talk in which there was discussion about family planning or Egypt's population problem?

YES 1
NO 2

447 In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW/UNDECIDED 8

448. If couples wish to avoid pregnancy, do you approve or disapprove of their using:

the condom?
APPR 1
DISAPPR 2
DK 3
the IUD?
APPR 1
DISAPPR 2
DK 3
female sterilization?
APPR 1
DISAPPR 2
DK 3
withdrawal?
APPR 1
DISAPPR 2
DK 3
male sterilization?
APPR 1
DISAPPR 2
DK 3
the pill?
APPR 1
DISAPPR 2
DK 3

449. In general do you think that your religion allows couples to use family planning or it forbids it?

ALLOWS 1
FORBIDS 2
DOESN'T KNOW 3

450. Do you think that your husband approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW/UNDECIDED 3

SECTION 5 FERTILITY PREFERENCES

501. CHECK 104:

CURRENTLY MARRIED (GO TO 502)
DIVORCED/ WIDOWED (GO TO 509)

502. CHECK 318:

NEITHER STERILIZED (GO TO 503)
SHE OR HE STERILIZED (GO TO 507)

503. CHECK 225:
NOT PREGNANT OR UNSURE: Now I have some questions 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, would you like to have another child, or would you prefer not to have any more children?

HAVE A (ANOTHER CHILD) 1
NO MORE/NONE 2 (GO TO 507)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 507)
UNDECIDED OR DON'T KNOW 8 (GO TO 507)

504. CHECK 225:
NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?
PREGNANT: How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS 1 ___ (GO TO 507)
YEARS 2 ___ (GO TO 507)
SOON/NOW 994 (GO TO 507)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 507)
OTHER (SPECIFY) ___ 996
DON'T KNOW 998

505. CHECK 203, 205 AND 225
HAS LIVING CHILD(REN) OR PREGNANT?

YES (GO TO 506)
NO (GO TO 507)

506. CHECK 225:
NOT PREGNANT OR UNSURE: How old would you like your youngest child to be when your next child is born?

PREGNANT: How old would you like the child you are expecting to be when your next child is born?

AGE OF CHILD
YEARS ____
DON'T KNOW 98

507. Have you and your husband ever discussed the number of children you would like to have?

YES 1
NO 2

508. Do you think your husband wants the same number of children that you want, or does he want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

509. CHECK 203 and 205:
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly number of children to have in your whole life, how many would that be?

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

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER __
OTHER ANSWER _____ (SPECIFY) 96 (GO TO 511)
DON'T KNOW 98 (GO TO 511)

510. How many boys and how many girls?

BOYS ___
GIRLS ___
OTHER ANSWER (SPECIFY) ___ 96
DON'T KNOW 98

511. When a couple is making a decision, sometimes the husband has more influence, in some cases, the wife has more influence, while other decisions are made jointly. In your family, who has (had) the most influence in deciding whether or not to have another --you or your husband--or do (did) you have equal say?

RESPONDENT HAS MORE INFLUENCE 1
BOTH HUSBAND AND RESPONDENT EQUAL 2
HUSBAND HAS MORE INFLUENCE 3
OTHER (SPECIFY) ___ 4

512. What do you think is the best number of months or years between the birth of one child and the birth of the next child?

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

513. Do you expect your children (if you would have any) to help you financially when you get old?

YES 1
NO 2
NOT SURE/DOESN'T KNOW 8

514. What is the highest level of school you would like for your daughter(s) to attain?

PRIMARY 01
PREPARATORY 02
SECONDARY 03
UPPER INTERMEDIATE 04
UNIVERSITY 05
MORE THAN UNIVERSITY 06
DEPENDS ON CHILD 95
NO ASPIRATIONS FOR EDUCATION 96
DON'T KNOW 98

515. What is the highest level of school you would like for your son(s) to attain?

PRIMARY 01
PREPARATORY 02
SECONDARY 03
UPPER INTERMEDIATE 04
UNIVERSITY 05
MORE THAN UNIVERSITY 06
DEPENDS ON CHILD 95
NO ASPIRATIONS FOR EDUCATION 96
DON'T KNOW 98

516. Does (did) your husband allow you to go out alone (or with your children) to buy household items or visit relatives?

YES, ALONE 1
YES, WITH CHILDREN 2
NOT ALLOWED TO GO OUT 3
OTHER (SPECIFY) ____ 4

517. In general, if a wife disagrees with her husband, do you think she should express her opinion or keep quiet?

EXPRESS OPINION 1
KEEP QUIET 2
NOT SURE/DON'T KNOW 8

518. Some say that a woman's place is not only at home but she should be able to work. Do you agree?

AGREE 1
DISAGREE 2
NOT SURE/DON'T KNOW 8

519. Who should have the last word on the following--the husband, the wife, both, or some else?

Visits to friends or relatives?
HUSB 1
WIFE 2
BOTH 3
OTHER 4
Household budget?
HUSB 1
WIFE 2
BOTH 3
OTHER 4
Having another child?
HUSB 1
WIFE 2
BOTH 3
OTHER 4
Children's education?
HUSB 1
WIFE 2
BOTH 3
OTHER 4
Children's marriage plans?
HUSB 1
WIFE 2
BOTH 3
OTHER 4
Use of family planning methods?
HUSB 1
WIFE 2
BOTH 3
OTHER 4
Wife's employment?
HUSB 1
WIFE 2
BOTH 3
OTHER 4

SECTION 6. PREGNANCY AND BREASTFEEDING

601. CHECK 222:

ONE OR MORE BIRTHS SINCE JANUARY 1987 (GO TO 602)
NO BIRTHS SINCE JANUARY 1987 (GO TO 644)

602. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. BEGIN WITH THE LAST BIRTH AND RECORD TWINS OR TRIPLETS IN SEPARATE COLUMNS. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

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

LINE NUMBER FROM Q212

LINE NUMBER ___

FROM Q212 AND Q216
FILL IN EACH COLUMN (COL.3: LAST BIRTH, COL.4: NEXT-TO-LAST BIRTH, COL.5: SECOND-FROM-LAST BIRTH)

NAME ______
ALIVE
DEAD

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

THEN 1 (GO TO 605)
LATER 2
NO MORE 3 (GO TO 605)

604. How much longer would you like to have waited?

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

605. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL

DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON

TRADITIONAL BIRTH ATTENDANT C
OTHER (SPECIFY) ____ D
NO ONE E (GO TO 609)

606. Where did you receive the antenatal care?

PUBLIC SECTOR

GVT. HOSPITAL A
GVT. HEALTH UNIT B
PRIVATE SECTOR

PVT. HOSPITAL/CLINIC C
PVT. DOCTOR D
OTHER (SPECIFY) ___ E

607. How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

MONTHS ___
DON'T KNOW 98

608. How many antenatal visits did you have during this pregnancy?

NO. OF VISITS ___
DON'T KNOW 98

609. When you were pregnant with (NAME) 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 611)
DON'T KNOW 8 (GO TO 611)

610. During this pregnancy, how many times did you get this injection?

TIMES __
DON'T KNOW 8

611. Where did you give birth to (NAME)?

HOME

YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR

GVT. HOSPITAL 21
GVT. HEALTH UNIT 22
PRIVATE SECTOR

PVT. HOSPITAL/CLINIC 31
OTHER (SPECIFY) ____ 41

612. Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL

DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON

TRADITIONAL BIRTH ATTENDANT C
RELATIVES/FRIENDS D
OTHER (SPECIFY) ___ E
NO ONE F

613. Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DON'T KNOW 8

614. Was (NAME) delivered by caesarian section?

YES 1
NO 2

615. 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

616. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 618)

617. How much did (NAME) weigh?

KILOGRAMS ___
DON'T KNOW 98

618. Has your period return since the birth of (NAME)? [ask only for last birth]

YES 1 (GO TO 620)
NO 2

619. ENTER "X' IN COL.3 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH (OR TO CURRENT PREGNENCY) (GO TO 621)

620. For how many months after the birth of (NAME) did you not have a period?
ENTER "X" IN COL.3 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS WITHOUT A PERIOD, STARTING IN THE MONTH AFTER BIRTH.
IF LESS THAN ONE MONTH WITHOUT A PERIOD, ENTER "0" IN COL.3 IN MONTH AFTER BIRTH.

621. CHECK 225: RESPONDENT PREGNANT?

NOT PREGANT (GO TO 622)
PREGNANT OR UNSURE (GO TO 624)

622. Have you resumed sexual relations since the birth of (NAME)? [ask only for last birth]

YES 1 (GO TO 624)
NO 2

623. ENTER "X" IN COL.4 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH. (GO TO 625)

624. For how many months after the birth of (NAME) did you not have sexual relations?
ENTER "X" IN COL.4 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS WITHOUT SEXUAL RELATIONS, STARTING IN THE MONTH AFTER BIRTH. IF LESS THAN ONE MONTH WITHOUT SEXUAL RELATIONS, ENTER "0" IN COL.4 OF CALENDAR IN THE MONTH AFTER BIRTH.

625. Did you ever breastfeed (NAME)?

YES 1 (GO TO 626)
NO 2

626. ENTER "N" IN COL.5 OF CALENDAR IN MONTH AFTER BIRTH.

627. Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01 (GO TO 638)
CHILD ILL/WEAK 02 (GO TO 638)
CHILD DIED 03 (GO TO 638)
NIPPLE/BREAST PROBLEM 04 (GO TO 638)
INSUFFICIENT MILK 05 (GO TO 638)
MOTHER WORKING 06 (GO TO 638)
CHILD REFUSED 07 (GO TO 638)
OTHER (SPECIFY) 08 (GO TO 638)

628. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, WRITE '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. [ask only for last birth]

IMMEDIATELY 000
HOURS 1 __
DAYS 2 __

629. CHECK 216: CHILD ALIVE? [ask only for last birth]

ALIVE (GO TO 630)
DEAD (GO TO 636)

630. Are you still breastfeeding (NAME)? [ask only for last birth]

YES 1
NO 2 (GO TO 636)

631. ENTER "X" IN COL 5 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH. [ask only for last birth]

632. How many times did you breastfeed last night between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. [ask only for last birth]

NUMBER OF NIGHTTIME FEEDINGS ___

633. How many times did you breastfeed yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. [ask only for last birth]

NUMBER OF DAYLIGHT FEEDINGS ___

634. At any time yesterday or last night was (NAME) given any of the following: [ask only for last birth]

Plain water?
YES 1
NO 2
Sugar water?
YES 1
NO 2
Juice?
YES 1
NO 2
Herbal tea?
YES 1
NO 2
Baby formula?
YES 1
NO 2
Fresh milk?
YES 1
NO 2
Tinned or powdered milk?
YES 1
NO 2
Other liquids?
YES 1
NO 2
Any mushy or solid food?
YES 1
NO 2

635. CHECK 634: FOOD OR LIQUID GIVEN YESTERDAY? [ask only for last birth]

"YES" TO ONE OR MORE (GO TO 640)
"NO" TO ALL (GO TO 639)

636. For how many months did you breastfeed (NAME)?

ENTER "X" IN COL. 5 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS OF BREASTFEEDING, STARTING IN THE MONTH AFTER BIRTH.

IF BREASTFED LESS THAN ONE MONTH, ENTER "0" IN COL. 5 IN MONTH AFTER BIRTH.

637. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) ___ 11

638. CHECK 216: CHILD ALIVE?

ALIVE (GO TO 640)
DEAD (GO TO 639)

639. Was (NAME) ever given water or anything else to drink or eat (other than breastmilk)?

YES 1
NO 2 (GO TO 643)

640. How many months old was (NAME) when you started giving the following on a regular basis?:
IF LESS THAN 1 MONTH, WRITE '00'.

Formula or milk other than breastmilk?
AGE IN MONTHS ___
NOT GIVEN 96
Plain water?
AGE IN MONTHS ___
NOT GIVEN 96
Other liquids?
AGE IN MONTHS ___
NOT GIVEN 96
Any mushy or solid food?
AGE IN MONTHS ___
NOT GIVEN 96

641. CHECK 216: CHILD ALIVE? [ask only for last birth]

ALIVE (GO TO 642)
DEAD (GO TO 643

642. Did (NAME) drink anything from a bottle with a nipple yesterday or last night? [ask only for last birth]

YES 1
NO 2
DON'T KNOW 8

643. GO BACK TO 603 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 644.

644. CHECK 215: ANY BIRTH IN 1984, 1985, OR 1986?

YES: NAME OF LAST BIRTH PRIOR TO JANUARY 1987____
NO: (GO TO 649)

645. Did you ever feed (NAME) at the breast?

YES 1
NO 2 (GO TO 647)

646. How many months did you breastfeed (NAME)?

MONTHS ___

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

MONTHS ___
DID NOT RETURN 96

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

MONTHS ___
NOT RESUMED 96

649. What should be the first food or liquid a baby gets after birth?

BREAST MILK/COLOSTRUM 1
SUGAR WATER 2
INFANT FORMULA 3
HONEY 4
HERBAL TEA 5
OTHER (SPECIFY) ___ 6

650. What health problems might be caused by bottlefeeding? RECORD ALL MENTIONED.

UNSANITARY WATER USED TO MIX FORMULA A
FORMULA DILUTED SO BABY NOT ADEQUATELY NOURISHED B
COLIC C
DIARRHEA D
POOR WEIGHT GAIN E
TOOTH DECAY F
OTHER (SPECIFY) ___ G
NONE/DON'T KNOW H

651. How old should an infant before he/she is first given other foods or liquids in addition to breastmilk?

MONTHS ___
DON'T KNOW 98

652. CHECK 222:

ONE OR MORE BIRTHS SINCE JANUARY 1987 (GO TO 701)
NO BIRTHS SINCE JANUARY 1987 (GO TO 741)

Section 7. Immunization and Health

701. ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. BEGIN WITH THE LAST BIRTH. RECORD TWINS OR TRIPLETS IN SEPARATE COLUMNS. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM Q212 ___

NAME
ALIVE
DEAD

702. Do you have a birth certificate where (NAME'S) vaccinations are written down? IF YES: May I see it, please?

YES, SEEN 1 (GO TO 704)
YES, NOT SEEN 2 (GO TO 706)
NO CARD 3

703. Did you ever have a vaccination certificate for (NAME)?

YES 1 (GO TO 706)
NO 2 (GO TO 706)

704. (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CERTIFICATE. (2) WRITE '44' IN 'DAY' COLUMN IF CERTIFICATE SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE WAS RECORDED.

BCG:
DAY__
MO__
YR__
POLIO 1:
DAY__
MO__
YR__
POLIO 2:
DAY__
MO__
YR__
POLIO 3:
DAY__
MO__
YR__
DPT 1:
DAY__
MO__
YR__
DPT 2:
DAY__
MO__
YR__
DPT 3:
DAY__
MO__
YR__
MEASLES:
DAY__
MO__
YR__
HEPATITIS 1
DAY__
MO__
YR__
HEPATITIS 2
DAY__
MO__
YR__
HEPATITIS 3
DAY__
MO__
YR__

705. Has (NAME) received any vaccinations that are not recorded on this certificate?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT 1-3, POLIO 1-3, HEPATITIS 1-3 AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 704)
NO 2 (GO TO 708)
DON'T KNOW 8 (GO TO 708)

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

YES 1
NO 2 (GO TO 708)
DON'T KNOW 8 (GO TO 708)

707. Please tell me if (NAME) (has) received any of the following vaccinations:

A BCG vaccination against tuberculosis, that is, an injection in the left shoulder that caused a scar?
YES 1
NO 2
DON'T KNOW 8
Polio vaccine, that is, drops in the mouth?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times?
NUMBER OF TIMES___
A DPT injection?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times?
NUMBER OF TIMES___
An injection against measles at nine months?
YES 1
NO 2
DON'T KNOW 8
An injection against hepatitis?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times?
NUMBER OF TIMES__

708. CHECK 216: CHILD ALIVE?

ALIVE (GO TO 710)
DEAD (GO TO 709)

709. GO BACK TO 702 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 740.

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 715)
DON'T KNOW 8 (GO TO 715)

712. Has (NAME) been ill with a cough in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

713. For how many days (has the cough lasted/did the cough last)? IF LESS THAN 1 DAY, RECORD '00'.

DAYS ___

714. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths?

YES 1
NO 2
DON'T KNOW 8

715. CHECK 710 AND 711: FEVER OR COUGH?

"YES" IN EITHER 710 OR 711 (GO TO 716)
OTHER (GO TO 720)

716. Was anything given to treat the fever/cough?

YES 1
NO 2 (GO TO 718)
DON'T KNOW 8 (GO TO 718)

717. What was given to treat the fever/cough? Anything else? RECORD ALL MENTIONED.

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
COUGH SYRUP C
OTHER PILL OR SYRUP D
UNKNOWN PILL OR SYRUP E
HOME REMEDY/HERBAL MEDICINE F
OTHER (SPECIFY) ___ G

718. Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 720)

719. Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED.

PUBLIC SECTOR

GVT. HOSPITAL A
GVT. HEALTH UNIT B
MEDICAL PRIVATE SECTOR

PVT. HOSPITAL/CLINIC C
PRIVATE DOCTOR D
PHARMACY E
OTHER PRIVATE SECTOR

TRADITIONAL PRACTITIONER F
RELATIVES/FRIENDS G
OTHER (SPECIFY) ____ H

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

YES 1 (GO TO 722)
NO 2
DON'T KNOW 8

721. GO BACK TO 702 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 740.

722. Has (NAME) had diarrhea in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

723. For how many days (has the diarrhea lasted/did the diarrhea last)? IF LESS THAN 1 DAY, RECORD '00.'

DAYS ___

724. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

725. CHECK 625/630: LAST CHILD STILL BREASTFEEDING? [ask for last birth only]

YES 1 (GO TO 726)
NO 2 (GO TO 728)

726. During (NAME)'s diarrhea, did you change the frequency of breastfeeding? [ask for last birth only]

YES 1
NO 2 (GO TO 728)

727. Did you increase the number of breastfeeds or reduce them or did you stop completely? [ask for last birth only]

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

728. (Aside from breastmilk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
GIVEN BREASTMILK ONLY 4
DON'T KNOW 8

729. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 731)
DON'T KNOW 8 (GO TO 731)

730. What was given to treat the diarrhea? Anything else? RECORD ALL MENTIONED.

MAHLOUL MOALGET EL-GAFFEF A
HOMEMADE SUGAR, SALT AND WATER SOLUTION B
ANTIBIOTIC (PILL OR SYRUP) C
OTHER PILL OR SYRUP D
INJECTION E
(IV) INTRAVENOUS F
HOME REMEDIES/HERBAL MEDICINES G
OTHER (SPECIFY) ____ H

731. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 733)

732. Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED.

PUBLIC SECTOR

GVT. HOSPITAL A
GVT. HEALTH UNIT B
MEDICAL PRIVATE SECTOR

PVT. HOSPITAL/CLINIC C
PRIVATE DOCTOR D
PHARMACY E
OTHER PRIVATE SECTOR

TRADITIONAL PRACTITIONER F
RELATIVES/FRIENDS G
OTHER (SPECIFY) ____ H

733. CHECK 730: MAHLOUL MOALGET EL-GAFFEF MENTIONED?

NO, MAHLOUL EL-GAFFEF NOT MENTIONED (GO TO 734)
YES, MAHLOUL EL-GAFFEF MENTIONED (GO TO 735)

734. Was (NAME) given mahloul moalget el-gaffef when he/she had the diarrhea?

YES 1
NO 2 (GO TO 736)
DON'T KNOW 8 (GO TO 736)

735. For how many days was (NAME) given mahloul moalget el-gaffef? IF LESS THAN 1 DAY, RECORD '00'.

DAYS __
DON'T KNOW 98

736. CHECK 730: HOMEMADE SUGAR, SALT AND WATER SOLUTION MENTIONED?

NO, HOME SOL'N NOT MENTIONED (GO TO 737)
YES, HOME SOL'N MENTIONED (GO TO 738)

737. Was (NAME) given a solution made from sugar, salt and water when he/she had the diarrhea?

YES 1
NO 2 (GO TO 739)
DON'T KNOW 8 (GO TO 739)

738. For how many days was (NAME) given the solution made from sugar, salt and water? IF LESS THAN 1 DAY, RECORD "00".

DAYS __
DON'T KNOW 98

739. GO BACK TO 702 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 740.

740. CHECK 730 AND 734 (ALL COLUMNS):

MAHLOUL MOALGET EL-GAFFEF GIVEN TO ANY CHILD (GO TO 743)
MAHLOUL MOALGET EL-GAFFEF NOT GIVEN TO ANY CHILD OR 730 AND 734 NOT ASKED (GO TO 741)

741. Have you ever heard of a special product called mahloul moalget el-gaffaf you can get for the treatment of diarrhea?

YES 1
NO 2 (GO TO 801)

742. Have you ever prepared mahloul moalget el-gaffaf to treat diarrhea in yourself or someone else?

YES 1
NO 2 (GO TO 801)

743. The last time you prepared the mahloul moalget el-gaffaf did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
PART OF PACKET 2

744. How much water did you use to prepare mahloul moalget el-gaffaf the last time you made it?

1/2 LITER 01
1 LITER 02
1 1/2 LITER 03
2 LITERS 04
FOLLOWED PACKAGE INSTRUCTIONS 05
OTHER (SPECIFY) ____ 06
DON'T KNOW 98

Section 8: Marriage

801. Now I would like to ask some questions about your marriage(s). How many times have you been married?

NUMBER OF TIMES MARRIED ___

802. In what month and year did you first enter into a marriage contract?

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

803. How old were you when you first entered into a marriage contract?

AGE ___
DON'T KNOW AGE 98

804. In what month and year did you start living with your (first) husband?

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

805. How old were you when you started living together with your (first) husband?

AGE ___
DON'T KNOW AGE 98

806. CHECK 804 AND 805:
YEAR AND AGE GIVEN?

YES (GO TO 807)
NO (GO TO 808)

807. RECORD CURRENT YEAR IN BOX ON RIGHT AND COMPLETE THE FOLLOWING IN ORDER TO CHECK THE CONSISTENCY OF 804 AND 805:

YEAR OF BIRTH (102) __
PLUS
AGE OF MARRIAGE (805) __
EQUALS
CALCULATED YEAR OF MARRIAGE ___

IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (804)?

YES (GO TO 808)
NO (PROBE AND CORRECT 804 AND 805)

IF NECESSARY, CALCULATE YEAR OF BIRTH

CURRENT YEAR ___
MINUS
CURRENT AGE (103) ___
EQUALS
CALCULATED YEAR OF BIRTH ___

808. DETERMINE MONTHS MARRIED OR IN UNION SINCE JANUARY 1987. ENTER "X" IN COLUMN 6 OF CALENDAR FOR EACH MONTH MARRIED OR IN UNION, AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE JANUARY 1987.

FOR WOMEN WHO ARE NOT CURRENTLY MARRIED OR WHO HAVE MARRIED MORE THAN ONCE: PROBE FOR DATE COUPLE STOPPED LIVING TOGETHER OR DATE WIDOWED, AND FOR STARTING DATE OF ANY SUBSEQUENT UNION.

809. CHECK COLUMN 6 OF CALENDAR:

IN MARITAL UNION AT ANY TIME SINCE JANUARY 1987 (GO TO 810)
NOT IN MARITAL UNION AT ANY TIME SINCE JANUARY 1987 (GO TO 814A)

810. Since January 1987, did you and your husband ever live apart (without visiting) for more than one month because of work, school or for any other reason?
(IF WOMAN HAD MORE THAN ONE HUSBAND DURING THE PERIOD, CIRCLE CODE '1' (YES) IF SHE LIVED APART FROM ANY OF HER HUSBANDS FOR MORE THAN ONE MONTH.)

YES 1
NO 2 (GO TO 901)

811. USE CALENDAR TO PROBE FOR ALL PERIODS THE WOMAN LIVED APART FROM HER HUSBAND(S) BACK TO JANUARY 1987. ENTER 'X' (NOT SEPARATED) OR THE CODE FOR THE TYPE OF SEPARATION IN COLUMN 7.

IF THE WOMAN MARRIED FOR THE FIRST TIME SINCE JANUARY 1987, RECORD "X" (NOT SEPARATED) IN THE MONTH AND YEAR OF MARRIAGE AND PROBE FOR PERIODS OF SEPARATION FOLLOWING THAT DATE. FOR WOMEN MARRIED FOR THE FIRST TIME BEFORE JANUARY 1987, BEGIN WITH JANUARY 1987 AND COMPLETE THE ENTIRE COLUMN.

ILLUSTRATIVE QUESTIONS

Did your husband ever leave and stay somewhere else for more than one month?
When did he leave?
For how many months was he away without visiting you?
Was he staying somewhere else in Egypt or in some other country?
Did you ever leave and stay elsewhere (e.g., because a family member was ill, etc.) for more than one month?
When did you leave?
For how many months were you away without seeing your husband?
Were you staying somewhere else in Egypt or in some other country?

812. CHECK 804-806:

BEGAN FIRST MARRIAGE BEFORE JANUARY 1987 (GO TO 813)
BEGAN FIRST MARRIAGE AT ANY TIME SINCE JANUARY 1987 (GO TO 901)

813. CHECK COLUMN 7 OF CALENDAR:

LIVING APART FROM HUSBAND IN JANUARY 1987 (GO TO 814)
NOT LIVING APART FROM HUSBAND IN JANUARY 1987 (GO TO 901)

814. I see that you were living apart from your husband in JANUARY 1987. When did you begin living apart that time?
THIS DATE SHOULD NOT PRECEDE THE DATE OF CONCEPTION OF ANY CHILD BORN BEFORE 1987.

MONTH __
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 98

814A In what month and year were you widowed (divorced from) your last husband?

MONTH __
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 98

Section 9. Husband's Background, Residence, and Woman's Work

901. CHECK 104:

CURRENTLY MARRIED (GO TO 902)
DIVORCED (GO TO 903)
WIDOWED (GO TO 904)

902. RECORD THE LINE NUMBER OF THE WOMAN'S HUSBAND FROM THE HOUSEHOLD QUESTIONNAIRE. IF THE HUSBAND IS NOT PRESENT IN THE HOUSEHOLD, RECORD '00'.

HUSBAND'S LINE NUMBER ___

903. How old was your husband on his last birthday?

AGE IN COMPLETED YEARS ___

904. In what month and year was your husband born? COMPARE AND CORRECT 903 AND/OR 904 IF INCONSISTENT.

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

905. Is (was) your (last) husband your first cousin, other blood relative, or no relation at all?

FIRST COUSIN 1
OTHER RELATIVE 2
NO RELATION AT ALL 3

906. Did your (last) husband ever attend school?

YES 1
NO 2 (GO TO 909)

907. What was the highest level of school he attended?

PRIMARY 1
PREPARATORY 2
SECONDARY 3
UPPER INTERMIDEATE 4
UNIVERSITY 5
MORE THAN UNIVERSITY 6
DON'T KNOW 8 (GO TO 909)

908. What was the highest grade which he completed at that level?

GRADE ___
DON'T KNOW 8

909. What kind of work does (did) your (last) husband mainly do? RECORD ANSWER IN DETAIL.

_______________

910. CHECK 909:

WORKS (WORKED) IN AGRICULTURE (GO TO 911)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 912)

911. (Does/did) your husband mainly work on his own land or family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS/FAMILY LAND 1 (GO TO 914)
RENTED LAND 2 (GO TO 914)
SOMEONE ELSE'S LAND 3 (GO TO 913)

912. Does (did) your husband work for someone else or himself?

FOR SOMEONE ELSE 1
FOR HIMSELF 2 (GO TO 914)

913. (Does/did) he earn a regular wage or salary?

YES 1
NO 2

914. Now I would like to ask some questions about places where you have lived. For most of the time until you were 12 years old, did you live in Cairo, Giza, Alexandria, another city or town or in a village?
(NAME OF LOCALITY AND GOVERNORATE) _________

CAIRO/GIZA 1
ALEXANDRIA 2
OTHER CITY/TOWN 3
VILLAGE 4
OUTSIDE EGYPT (SPECIFY) ___ 5

915. Have you lived in only one or in more than one community since January 1987?

ONE COMMUNITY 1
MORE THAN ONE COMMUNITY 2 (GO TO 917)

916. CHECK COVER PAGE OR Q116-Ql17 (FOR VISITORS) AND ENTER THE NAME OF THE PLACE WHERE THE RESPONDENT CURRENTLY RESIDES:
(NAME OF LOCALITY AND GOVERNORATE) _____________

ENTER (IN COLUMN 8 OF CALENDAR) THE APPROPRIATE CODE FOR COMMUNITY WHERE RESPONDENT CURRENTLY LIVES ("1" CAIRO/GIZA, "2" ALEXANDRIA, "3" OTHER CITY/TOWN, "4" VILLAGE, "5" OUTSIDE EGYPT)

FOR VISITORS, CHECK QUESTION 116 FOR RESIDENCE.
BEGIN IN THE MONTH OF INTERVIEW AND CONTINUE WITH ALL PRECEDING MONTHS BACK TO JANUARY 1987. (GO TO 918)

917. In what month and year did you move to (CURRENT COMMUNITY)?

ENTER (IN COLUMN 8 OF CALENDAR) "X" IN THE MONTH AND YEAR OF THE MOVE, AND IN THE SUBSEQUENT MONTHS, ENTER THE APPROPRIATE CODE FOR TYPE OF COMMUNITY ("1" CAIRO/GIZA, "2" ALEXANDRIA, "3" OTHER CITY/TOWN, "4" VILLAGE, OR "5" OUTSIDE EGYPT)
CONTINUE PROBING FOR PREVIOUS COMMUNITIES AND RECORD MOVES AND TYPES OF COMMUNITIES ACCORDINGLY

ILLUSTRATIVE QUESTIONS
-Where did you live before…..?
-In what month and year did you arrive there?
-Is that place in a city, a town, or in a village?

ENTER THE NAME OF THE LOCALITY AND THE GOVERNORATE IN WHICH THE RESPONDENT WAS LIVING IN JANUARY 1987:
(NAME OF LOCALITY AND GOVERNORATE) _____________________

918. CHECK 916 OR 917 FOR RESIDENCE IN JANUARY 1987:
When did you move to (PLACE OF RESIDENCE IN JANUARY 1987)?

LIVED THERE SINCE BIRTH 96 (GO TO 920)
MONTH ___
DON'T KNOW MONTH 98
YEAR ___
DON'T KNOW YEAR 98

919. Before you moved to (PLACE OF RESIDENCE IN JANUARY 1987), were you living in Cairo/Giza, Alexandria, another city or town or a village?
(NAME OF LOCALITY AND GOVERNORATE)____________

CAIRO/GIZA 1
ALEXANDRIA 2
OTHER CITY/TOWN 3
VILLAGE 4
OUTSIDE EGYPT (SPECIFY) ____ 5

920. Now I would like to ask you some questions about working. 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.
Before you married for the first time, did you do any of these things or any work?

YES 1
NO 2

921. Are you currently doing any of these things or any other work?

YES 1 (GO TO 924)
NO 2

922. Have you ever worked since January 1987?

YES 1 (GO TO 924)
NO 2

923. ENTER "0" IN COLUMN 9 OF CALENDAR IN EACH MONTH FROM JANUARY 1987 TO CURRENT MONTH (GO TO 928).

924. What is (was) your (most recent) occupation? That is, what kind of work do (did) you do?

______________

925. USE CALENDAR TO PROBE FOR ALL PERIODS OF WORK, STARTING WITH CURRENT OR MOST RECENT WORK, BACK TO JANUARY 1987. ENTER CODE FOR NO WORK OR FOR TYPE OF WORK IN COLUMN 9.

ILLUSTRATIVE QUESTIONS
-When did this job begin (and when did it end)?
-What did you do before that?
-How long did you work at that time?
-Were you self-employed or an employee?
-Were you paid for this work?
-Did you work at home or away from home?

926. CHECK COLUMN 9 OF CALENDAR:

WORKED IN JANUARY 1987 (GO TO 927)
DID NOT WORK IN JANUARY 1987 (GO TO 928)

927. I see that you were working in January 1987. When did you start that job?

MONTH ___ (GO TO 930)
DON'T KNOW MONTH 98 (GO TO 930)
YEAR ___ (GO TO 930)
DON'T KNOW YEAR 98 (GO TO 930)

928. I see that you were not working in January 1987. Did you ever work prior to January 1987?

YES 1
NO 2 (GO TO 930)

929. When did your last job prior to January 1987 end?

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

930. CHECK 921: CURRENTLY WORKING?

YES 1 (GO TO 931)
NO 2 (GO TO 934)

931. CHECK 215/216/218:
HAS CHILD BORN SINCE JANUARY 1987 AND LIVING AT HOME?

YES 1 (GO TO 932)
NO 2 (GO TO 934)

932. While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1 (GO TO 934)
SOMETIMES 2
NEVER 3

933. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

HUSBAND/PARTNER 01
OTHER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS 06
CHILD IS IN SCHOOL 07
CHILD TAKEN TO NURSERY 08
OTHER (SPECIFY) ____ 09

934. RECORD THE TIME

HOUR ___
MINUTES ___

SECTION 10. HEIGHT AND WEIGHT

1001 CHECK 222:

ONE OR MORE BIRTHS SINCE JANUARY 1987 (GO TO 1002)
NO BIRTHS SINCE JANUARY 1987 (GO TO 1101)

INTERVIEWER:
IN 1002 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1987 AND STILL ALIVE.
IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1987. 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 1987 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1987, USE ADDITIONAL FORMS)

1002. LINE NO. FROM Q.212

LIVING CHILD
____________

1003. NAME FROM Q.212 FOR CHILDREN

RESPONDENT
(NAME) ___________
LIVING CHILD
(NAME) ___________

1004. DATE OF BIRTH
FROM Q.l03 FOR RESPONDENT. FROM Q.215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH.

RESPONDENT
MONTH ___
YEAR ___
LIVING CHILD
DAY ___
MONTH ___
YEAR ___

1005. BCG SCAR ON TOP OF LEFT SHOULDER

LIVING CHILD
SCAR SEEN 1
NO SCAR 2

1006. HEIGHT (in centimeters)

RESPONDENT
____.__
LIVING CHILD
____.__

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

LIVING CHILD
LYING 1
STANDING 2

1008. WEIGHT (in kilograms)

RESPONDENT
____.__
LIVING CHILD
____.__

1009. DATE WEIGHED AND MEASURED

RESPONDENT
DAY ___
MONTH ___
YEAR __
LIVING CHILD
DAY ___
MONTH ___
YEAR __

1010. RESULT

RESPONDENT
MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) _______ 6
LIVING CHILD
CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) _________ 6

1011. NAME OF MEASURER: __________
NAME OF ASSISTANT: _________

THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 1101-1102 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNAIRE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD.

1101. DEGREE OF COOPERATION

POOR 1
FAIR 2
GOOD 3
VERY GOOD 4

1102. INTERVIEWER'S COMMENTS:

___________________________________

1103. FIELD EDITOR'S COMMENTS:

___________________________________

1104. SUPERVISOR'S COMMENTS:

___________________________________

1105. OFFICE EDITOR'S COMMENTS:

___________________________________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
FOR COLUMNS 1, 6, 8 AND 9, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COL. 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 PILL
2 IUD
3 INJECTABLES
4 NORPLANT
5 DIAPHRAGM/FOAM/JELLY
6 CONDOM
7 FEMALE STERILIZATION
8 MALE STERILIZATION
9 PERIODIC ABSTINENCE
L WITHDRAWAL
G PROLONGED BREASTFEEDING
W OTHER (SPECIFY) ______________

COL. 2: Discontinuation of Contraceptive Use

1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND DISAPPROVED
4 SIDE EFFECTS
5 HEALTH CONCERNS
6 ACCESS/AVAILABILITY
7 WANTED MORE EFFECTIVE METHOD
8 INCONVENIENT TO USE
9 INFREQUENT SEX/HUSBAND AWAY
C COST
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSE
D MARITAL DISSOLUTION/SEPARATION
W OTHER (SPECIFY) _____________
K DON'T KNOW

COL. 3: Postpartum Amenorrhea

X PERIOO DID NOT RETURN
O LESS THAN ONE MONTH

COL. 4: Postpartum Abstinence

X NO SEXUAL RELATIONS
O LESS THAN ONE MONTH

COL. 5: Breastfeeding

X BREASTFEEDING
O LESS THAN ONE MONTH
N NEVER BREASTFED

COL. 6: Marriage/Union

X MARRIED
O NOT IN UNION

COL. 7: Periods of Separation

X NOT SEPARATED
1 HUSBAND ABROAD
2 HUSBAND ELSEWHERE IN EGYPT
3 WIFE ABROAD
4 WIFE ELSEWHERE IN EGYPT

COL. 8: Moves and Types of Communities

X CHANGE OF COMMUNITY
1 CAIRO/GIZA
2 ALEXANDRIA
3 OTHER CITY/TOWN
4 VILLAGE
5 OUTSIDE EGYPT

COL. 9: Type of Employment

0 DID NOT WORK
I PAID EMPLOYEE, AWAY FROM HOME
2 PAID EMPLOYEE, AT HOME
3 SELF-EMPLOYED, AWAY FROM HOME
4 SELF-EMPLOYED, AT HOME
5 UNPAID WORKER, AWAY FROM HOME
6 UNPAID WORKER, AT HOME

BIRTH DATE: LAST CHILD BORN PRIOR TO JANUARY 1987

NAME : ___________
MONTH : ________
YEAR : ________

1993

02 FEB 01 _____ _____ _____ ______ 01 FEB
01 JAN 02 _____ _____ _____ ______ 02 JAN

1992 1 2 3 4

12 DEC 03 _____ _____ _____ ______ 03 DEC
11 NOV 04 _____ _____ _____ ______ 04 NOV
10 OCT 05 _____ _____ _____ ______ 05 OCT
09 SEP 06 _____ _____ _____ ______ 06 SEP
08 AUG 07 _____ _____ _____ ______ 07 AUG
07 JUL 08 _____ _____ _____ ______ 08 JUL
06 JUN 09 _____ _____ _____ ______ 09 JUN
05 MAY 10 _____ _____ _____ ______ 10 MAY
04 APR 11 _____ _____ _____ ______ 11 APR
03 MAR 12 _____ _____ _____ ______ 12 MAR
02 FEB 13 _____ _____ _____ ______ 13 FEB
01 JAN 14 _____ _____ _____ ______ 14 JAN

1991 1 2 3 4

12 DEC 15 _____ _____ _____ ______ 15 DEC
11 NOV 16 _____ _____ _____ ______ 16 NOV
10 OCT 17 _____ _____ _____ ______ 17 OCT
09 SEP 18 _____ _____ _____ ______ 18 SEP
08 AUG 19 _____ _____ _____ ______ 19 AUG
07 JUL 20 _____ _____ _____ ______ 20 JUL
06 JUN 21 _____ _____ _____ ______ 21 JUN
05 MAY 22 _____ _____ _____ ______ 22 MAY
04 APR 23 _____ _____ _____ ______ 23 APR
03 MAR 24 _____ _____ _____ ______ 24 MAR
02 FEB 25 _____ _____ _____ ______ 25 FEB
01 JAN 26 _____ _____ _____ ______ 26 JAN

1990 1 2 3 4

12 DEC 27 _____ _____ _____ ______ 27 DEC
11 NOV 28 _____ _____ _____ ______ 28 NOV
10 OCT 29 _____ _____ _____ ______ 29 OCT
09 SEP 30 _____ _____ _____ ______ 30 SEP
08 AUG 31 _____ _____ _____ ______ 31 AUG
07 JUL 32 _____ _____ _____ ______ 32 JUL
06 JUN 33 _____ _____ _____ ______ 33 JUN
05 MAY 34 _____ _____ _____ ______ 34 MAY
04 APR 35 _____ _____ _____ ______ 35 APR
03 MAR 36 _____ _____ _____ ______ 36 MAR
02 FEB 37 _____ _____ _____ ______ 37 FEB
01 JAN 38 _____ _____ _____ ______ 38 JAN

1989 1 2 3 4

12 DEC 39 _____ _____ _____ ______ 39 DEC
11 NOV 40 _____ _____ _____ ______ 40 NOV
10 OCT 41 _____ _____ _____ ______ 41 OCT
09 SEP 42 _____ _____ _____ ______ 42 SEP
08 AUG 43 _____ _____ _____ ______ 43 AUG
07 JUL 44 _____ _____ _____ ______ 44 JUL
06 JUN 45 _____ _____ _____ ______ 45 JUN
05 MAY 46 _____ _____ _____ ______ 46 MAY
04 APR 47 _____ _____ _____ ______ 47 APR
03 MAR 48 _____ _____ _____ ______ 48 MAR
02 FEB 49 _____ _____ _____ ______ 49 FEB
01 JAN 50 _____ _____ _____ ______ 50 JAN

1988 1 2 3 4

12 DEC 51 _____ _____ _____ ______ 51 DEC
11 NOV 52 _____ _____ _____ ______ 52 NOV
10 OCT 53 _____ _____ _____ ______ 53 OCT
09 SEP 54 _____ _____ _____ ______ 54 SEP
08 AUG 55 _____ _____ _____ ______ 55 AUG
07 JUL 56 _____ _____ _____ ______ 56 JUL
06 JUN 57 _____ _____ _____ ______ 57 JUN
05 MAY 58 _____ _____ _____ ______ 58 MAY
04 APR 59 _____ _____ _____ ______ 59 APR
03 MAR 60 _____ _____ _____ ______ 60 MAR
02 FEB 61 _____ _____ _____ ______ 61 FEB
01 JAN 62 _____ _____ _____ ______ 62 JAN

1987 1 2 3 4

12 DEC 63 _____ _____ _____ ______ 63 DEC
11 NOV 64 _____ _____ _____ ______ 64 NOV
10 OCT 65 _____ _____ _____ ______ 65 OCT
09 SEP 66 _____ _____ _____ ______ 66 SEP
08 AUG 67 _____ _____ _____ ______ 67 AUG
07 JUL 68 _____ _____ _____ ______ 68 JUL
06 JUN 69 _____ _____ _____ ______ 69 JUN
05 MAY 70 _____ _____ _____ ______ 70 MAY
04 APR 71 _____ _____ _____ ______ 71 APR
03 MAR 72 _____ _____ _____ ______ 72 MAR
02 FEB 73 _____ _____ _____ ______ 73 FEB
01 JAN 74 _____ _____ _____ ______ 74 JAN