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ARAB REPUBLIC OF EGYPT
MINISTRY OF HEALTH AND POPULATION
NATIONAL POPULATION COUNCIL

EGYPT DEMOGRAPHIC AND HEALTH SURVEY 2000
WOMAN'S QUESTIONNAIRE

IDENTIFICATION

GOVERNORATE____
PSU SEGMENT NO.______
KISM/MARQAZ______
BUILDING NO._______
SHIAKHA/VILLAGE______
HOUSING UNIT NUMBER________
HOUSEHOLD NO.________

URBAN/RURAL

URBAN 1
RURAL 2

LOCALITY

LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4

NAME OF HOUSEHOD HEAD______
ADDRESS IN DETAIL______
NAME OF WOMAN_______
LINE NUMBER OF WOMAN_________

INTERVIEWER VISITS (REPEAT FOR INTERVIEW VISITS 1 AND 2)
DATE_____
TEAM_____
INTERVIEWER_______
SUPERVISOR______
RESULT______

NEXT VISIT
DATE_____
TIME______

TOTAL VISITS_______

RESULT CODES

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

FIELD EDITOR
NAME_______
DATE__/__/2000
SIGNATURE________

OFFICE EDITOR
NAME_______
DATE__/__/2000
SIGNATURE______

CODER
NAME____
DATE__/__/2000
SIGNATURE______

KEYER
NAME_____
DATE__/__/2000
SIGNATURE______

SECTION1: RESPONDENT'S BACKGROUND

My name is______ and I am working with Ministry of Health and Population. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in the survey. I would like to ask you about your health and the health of your children. This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in the survey is voluntary and you can choose not to answer any of the questions. However, we hope that you will participate in the survey since your views are important.

At this time, do you want to ask me anything about the survey?

May I begin the interview now?

SIGNATURE OF INTERVIEWER:______
DATE:__/__/2000

RESPONDENT AGREE TO INTERVIEW_____
RESPONDENT DOES NOT AGREE TO INTERVIEW___ (GO TO 1101)

101) RECORD THE TIME

HOUR____
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 Cairo, Giza, Alexandria, another city or town or village?

(NAME OF LOCALITY AND GOVERNORATE)_______________
CAIRO/GIZA 1
ALEXANDRIA 2
OTHER CITY/TOWN 3
VILLAGE 4
OUTSIDE EGYPT (SPECIFY)_______ 5
OFFICE:CODE GOVERNORATE_____

103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR RECORD '00'.

YEARS____
ALWAYS 95 (GO TO 105)
VISITOR/TEMPORARY STAYING 96 (GO TO 105)

104) Just before you moved here, 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
OFFICE: CODE GOVERNORATE____

105) In what month and year were you born?

MONTH______
DONT KNOW MONTH 98
YEAR_____
DON'T KNOW YEAR 9998

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT

AGE IN COMPLETED YEARS______

107) What is your current marital status?

MARRIED 1
WIDOWED 2
DIVORCED 3
SEPARATED 4

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

NUMBER OF TIMES MARRIED_____

109) CHECK 108:

MARRIED ONCE: In what month and year did you enter into a marriage contract with your husband?

MARRIED TWO TIMES OR MORE: Now we would like to ask about your first husband. In what month and year did you enter into a marriage contract with your first husband?

MONTH____
DON'T KNOW MONTH 98
YEAR____ (GO TO 111)
DON'T KNOW YEAR 9998

110) How old were you when you entered into a marriage contract with your first husband?

AGE IN COMPLETED YEARS_______

111) CHECK 108:

MARRIED ONCE: In what month and year did you start living with your husband?

MARRIED TWO TIMES OR MORE:
In what month and year did you start living with your first husband?

MONTH_____
DON'T KNOW MONTH 98
YEAR_____ (GO TO 113)
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS_______

113) DETERMINE MONTHS MARRIED SINCE JANUARY 1995. ENTER "X" IN COLUMN 1 OF THE CALENDAR FOR EACH MONTH MARRIED, AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE JANUARY 1995.

FOR WOMEN WHO ARE NOT CURRENTLY MARRIED OR WHO HAVE MARRIED MORE THAN ONCE: PROBE FOR DATE WIDOWED, DIVORCED, OR SEPARATED, AND FOR STARTING DATE OF ANY SUBSEQUENT MARRIAGE.

114) Have you ever attended school?

YES 1
NO 2 (GO TO 201)

115) What is the highest level of school you attended?

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

116) What is the highest grade which you successfully completed at that level?

GRADE____

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 a girl who was born alive but later died? IF NO PROBE: Any baby who cried or showed any sign of life but 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. Id that correct?

YES___
NO___ (PROBE AND CORRECT 201-209 AS NECESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS____
NO BIRTHS____ (GO TO 226)

211) NOW I WOULD LIKE TO RECORD THE NAMES OF ALL YOUR BIRTHS, WHETHER STILL ALIVE OR NOT, STARTING WITH THE FIRST ONE YOU HAD.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINE AND MARK WITH A BRACKET. COMPLETE 213-221 FOR EACH BIRTH. USE ADDITIONAL FORMS IF THERE AR MORE THAN TEN BIRTHS. AFTER COMPLETING ALL BIRTHS, GO TO 222.

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

NAME_______

213) RECORD SINGLE OR MULTIPLE STATUS.

SING 1
MULT 2

214) Is (NAME) a boy or girl?

BOY 1
GIRL 2

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

MONTH____
YEAR_____

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS______

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

YES 1
NO 2

219) IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD "00" IF CHILD NOT LISTED IN THE HOUSEHOLD SCHEDULE).

HOUSEHOLD LINE NUMBER_____ (GO TO 221)

220) IF DEAD:
How old was (NAME) 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

221) Were there any other live births between (WHEN YOU FIRST MARRIED/NAME OF PREVIOUS BIRTH) and (NAME)?
CORRECT IF NECESSARY

YES 1 (GO TO NEXT BIRTH)
NO 2 (GO TO NEXT BIRTH)

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
CORRECT THE BIRTH HISTORY IF NECESSARY.

YES 1 (ADD TO TABLE)
NO 2

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

NUMBERS ARE THE 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 OR 1 YEAR: PROBE TO IDENTIFY EXACT NUMBER OF MONTHS___.

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1995.
IF NONE, RECORD "00" AND GO TO 226

_____

225) FOR EACH BIRTH SINCE JANUARY 1995, ENTER "B" IN THE MONTH OF BIRTH IN COLUMN 2 OF THE CALENDAR. ALSO ENTER THE MONTH AND YEAR OF THE MOST RECENT BIRTH PRIOR TO JANUARY 1995 (IF ANY) AT THE BOTTOM OF THE CALENDAR. FOR EACH BIRTH ENTERED IN THE CALENDAR, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "P" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.
(NOTE: THE NUMBER OF P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED).
WRITE THE NAME OF THE CHILD TO THE RIGHT OF THE "B" CODE.

226) Are you pregnant now?

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

227) How many months pregnant are you?

RECORD IN COMPLETED MONTHS

MONTHS______

228) RECORD NUMBER OF COMPLETED MONTHS. ENTER "Ps" IN COLUMN 2 OF THE CALENDAR FOR THE TOTAL NUMBER OF COMPLETED MONTHS, BEGINNING IN THE MONTH OF INTERVIEW.

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 become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

230) Unfortunately many women have pregnancies that do not end in a live birth. Sometimes a baby is stillborn, that is, the baby is born who does not breathe or show any life. Other times women have a miscarriage or abortion early during a pregnancy. It is very important in our study to know about such pregnancies so health programs can be developed for women.

USING THE INFORMATION IN THE CALENDAR, PROBE TO DETERMINE IF THE WOMAN HAD ANY STILLBIRTHS, MISCARRIAGES, OR ABORTIONS BACK TO JANUARY 1995.
IF THE WOMAN REPORTS A PREGNANCY THAT DID NOT END IN A LIVE BIRTH, ASK ABOUT THE MONTH AND YEAR IN WHICH THE PREGNANCY ENDED.
RECORD THE APPROPRIATE CODE FOR THE PREGNANCY OUTCOME ON THAT DATE IN COLUMN 2 IN THE CALENDAR. ("S" FOR STILLBIRTH, "M" FOR MISCARRIAGE AND "A" FOR ABORTION).
THEN ASK ABOUT THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "P" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.
(NOTE: THE DURATION OF THE PREGNANCY SHOULD BE RECORDED IN COMPLETED MONTHS. THE NUMBER OF P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED).

ILLUSTRATIVE QUESTIONS

TO IDENTIFY NON-LIVE BIRTH PREGNANCIES, ASK:

INTERVAL BETWEEN CURRENT PREGNANCY AND PRIOR BIRTH (LAST BIRTH):
Did you have any pregnancy that ended in a stillbirth after the birth of (NAME OF LAST BIRTH) and before your current pregnancy? Or any pregnancy that ended in a miscarriage or abortion?

INTERVAL BETWEEN LAST AND PRIOR BIRTH:
Did you have any pregnancy that ended in a stillbirth between (NAME OF LAST BIRTH) and (NAME OF PRIOR BIRTH)? Or any pregnancy that ended in a miscarriage or abortion?

INTERVAL BETWEEN NEXT-TO-LAST BIRTH AND PRIOR BIRTH:
Did you have any pregnancy that ended in a stillbirth between (NAME OF NEXT-TO-LAST BIRTH) and (NAME OF PRIOR BIRTH)? Or any pregnancy that ended in a miscarriage or abortion?

WOMEN WITH NO LIVE BIRTHS BUT WITH CURRENT PREGNANCY:
Before your current pregnancy, did you ever have any other pregnancy that ended in a stillbirth? Or any other pregnancy that ended in a miscarriage or abortion?

WOMEN WITH NO LIVE BIRTHS AND NOT CURRENTLY PREGNANT:
Have you ever had a stillbirth? IF YES: When did the last stillbirth occur? Have you ever had a miscarriage or abortion? IF YES: When did the last miscarriage or abortion occur?

FOR EACH PREGNANCY TERMINATION ASK:
How many months pregnant were you when the pregnancy ended?

231) IN THE BOXES AT THE BOTTOM OF THE CALENDAR, FILL IN THE MONTH AND YEAR AND OUTCOME OF THE LAST PREGNANCY THAT TERMINATED IN MISCARRIAGE, ABORTION OR STILLBIRTHS PRIOR TO JANUARY 1995

232) When did your last menstrual period start?

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
IN MENOPAUSE HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

233) From one menstrual period until the next, is there a time when a woman is more likely to become pregnant if she has sexual relations?

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

234) Is this time just before the period begins, during the period, right after her period or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN PERIODS 4
OTHER (SPECIFY)______ 6
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 1 IF METHOD IS RECOGNIZED AND CODE 2 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 302, ASK 303 BEFORE PROCEEDING TO THE NEXT METHOD.

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

01) PILL: A women can take a pill every day
YES 1
NO 2
02) IUD: A woman can have a loop or coil placed inside her by a doctor or a nurse.
YES 1
NO 2
03) INJECTABLES: A woman can have an injection by a doctor or a nurse which stops her from becoming pregnant for several months.
YES 1
NO 2
04) NORPLANT: A woman can have small rods placed in her arm by a doctor which stops her from becoming pregnant for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY: A woman can place a sponge, suppository, diaphragm, jelly or cream inside her vagina before intercourse
YES 1
NO 2
06) CONDOM: A man can use a rubber covering during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION: A woman can have an operation to avoid having any more children.
YES 1
NO 2
08) MALE STERILIZATION: A man can have an operation to avoid having any more children
YES 1
NO 2
09) RHYTHM OR PERIODIC ABSTINENCE: A couple 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: A man can be careful and pull out before ejaculation.
YES 1
NO 2
11) PROLONGED BREASTFEEDING: A woman can prolong the time that she breastfeeds her baby to delay the next pregnancy.
YES 1
NO 2
12) Have you heard of any other ways or methods that a woman or a man can use to avoid pregnancy?
YES (SPECIFY)________ 1
NO 2

303) Have you ever used (METHOD)?

01) PILL: A women can take a pill every day
YES 1
NO 2
02) IUD: A woman can have a loop or coil placed inside her by a doctor or a nurse.
YES 1
NO 2
03) INJECTABLES: A woman can have an injection by a doctor or a nurse which stops her from becoming pregnant for several months.
YES 1
NO 2
04) NORPLANT: A woman can have small rods placed in her arm by a doctor which stops her from becoming pregnant for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY: A woman can place a sponge, suppository, diaphragm, jelly or cream inside her vagina before intercourse
YES 1
NO 2
06) CONDOM: A man can use a rubber covering during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION: A woman 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: A man can have an operation to avoid having any more children. Have you ever had a husband who had an operation to avoid having children?
YES 1
NO 2
09) RHYTHM OR PERIODIC ABSTINENCE: A couple 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: A man can be careful and pull out before ejaculation.

YES 1
NO 2
11) PROLONGED BREASTFEEDING: A woman can prolong the time that she breastfeeds her baby to delay the next pregnancy.
YES 1
NO 2
12) Have you heard of any other ways or methods that a woman or man can use to avoid pregnancy?
YES 1
NO 2

304) CHECK 303:

NOT A SINGLE "YES" (NEVER USED)____
AT LEAST ONE "YES" (EVER USED)____ (GO TO 308)

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

YES 1 (GO TO 307)
NO 2

306) ENTER "0" IN COLUMN 2 OF THE CALENDAR IN EACH BLANK MONTH (GO TO 401)

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

(SPECIFY)_____________

308) Now I would like to ask you about the first time you did something or used a method to avoid getting pregnant. How many living children did you have at the time if any?
IF NONE, RECORD "00"

NUMBER OF CHILDREN______

309) CHECK 303 (FEMALE STERILIZATION):

WOMAN NOT STERILIZED____
WOMAN STERILIZED____(GO TO 313A)

310) CHECK 107:

CURRENTLY MARRIED___
WIDOWED/DIVORCED/SEPARATED___ (GO TO 353)

311) CHECK 226:

NOT PREGNANT OR UNSURE___
PREGNANT___ (GO TO 353)

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

YES 1
NO 2 (GO TO 353)

313) Which method are you using?
RECORD ALL RESPONSES
CIRCLE "7" FOR FEMALE STERILIZATION.

PILL 1
IUD 2
INJECTABLES 3
NORPLANT 4
DIAPHRAGM/FOAM/JELLY 5
CONDOM 6
FEMALE STERILIZATION 7 (GO TO 314A)
MALE STERILIZATION 8
PERIODIC ABSTINENCE 9
WITHDRAWAL L
PROLONGED BREASTFEEDING G
OTHER (SPECIFY)______X

314) ASK FOR HIGHEST METHOD CODED IN Q313:
In what month and year did you begin this current segment of use of (METHOD)?

MONTH_____
YEAR______

314A) In what month and year was the sterilization performed?

MONTH____
YEAR_____

315) IN CURRENT MONTH IN COLUMN 2 IN CALENDAR, ENTER CODE SHOWN TO THE LEFT OF THE CALENDAR FOR THE HIGHEST METHOD CIRCLED IN Q313. THEN ENTER METHOD CODE IN EACH MONTH OF USE BACK TO THE DATE THE WOMAN BEGAN THE CURRENT SEGMENT OR TO JANUARY 1995 IF THE CURRENT SEGMENT OF USE BEGAN BEFORE JANUARY 1995.

ILLUSTRATIVE QUESTIONS:
When did you start using (Method) continuously?
How long have you been using (Method) continuously?

316) CHECK 313 AND RECORD CODE FOR CURRENT METHOD.

IF MORE THAN ONE METHOD IS CIRCLED IN Q313, RECORD THE CODE FOR THE METHOD THAT IS HIGHEST ON THE LIST.

PILL 1 (GO TO 320)
IUD 2
INJECTABLES 3 (GO TO 320)
NORPLANT 4
DIAPHRAGM/FOAM/JELLY 5 (GO TO 320)
CONDOM 6 (GO TO 320)
FEMALE STERILIZATION 7
MALE STERILIZATION 8
PERIODIC ABSTINENCE 9
WITHDRAWAL L
PROLONGED BREASTFEEDING G
OTHER (SPECIFY)______X

317) CHECK 316:

USING IUD : Where did you have the IUD inserted?

USING NORPLANT: Where did you have the Norplant inserted?

SHE/HE STERILIZED: Where did the sterilization take place?

USING PERIODIC ABSTINENCE, WITHDRAWAL, PROLONGED BREASTFEEDING OR OTHER METHOD: Did you get advice from anyone about how to use (METHOD) at the time you began this current period of use?

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)________
OFFICE: CODE SOURCE____
MINISTRY OF HEALTH FACILITY (MOH)
URBAN HOSPITAL 1
URBAN HEALTH UNIT 2
RURAL HOSPITAL 3
RURAL HEALTH UNIT 4
MCH CENTER 5
MOBILE UNIT 6
OTHER MOH UNITS 7
OTHER GOVERNMENTAL FACILITY
TEACHING HOSPITAL 8
HEALTH INSURANCE ORGANIZATION 9
CURATIVE CARE ORGANIZATION A
OTHER GOVERNMENTAL B
NON-GOVERNMENTAL ORGANIZATIONS (NGO's)
EGYPT FAMILY PLANNING ASSOCIATION C
CSI PROJECT D
OTHER NON-GOVERNMENTAL E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
MOSQUE HEALTH UNIT I
CHURCH HEALTH UNIT J
OTHER VENDOR (SHOP, KIOSK, ETC,.) K
FRIENDS/RELATIVES L
OTHER (SPECIFY)_______X
NO ONE Y

318) ENTER THE CODE FOR THE SOURCE RECORDED IN 317 IN COLUMN 3 OF THE CALENDAR. IF THE CURRENT SEGMENT OF USE BEGAN SINCE JANUARY 1995, THE SOURCE CODE SHOULD BE ENTERED IN THE MONTH AND YEAR IN WHICH THE SEGMENT OF USE BEGAN. WRITE THE ADDRESS OF THE SOURCE TO THE RIGHT OF COLUMN 3. IF THE CURRENT SEGMENT OF USE BEGAN BEFORE JANUARY 1995, NO CODE WILL BE ENTERED IN THE CALENDAR IN COLUMN 3.

319) CHECK 317:

SOURCES CODE 1-9, A-X___ (GO TO 325)
SOURCE CODE "Y"___ (GO TO 353)

320) CHECK 316:

USING PILL: Where did you obtain the packet of pills you are using now (you used most recently)?

USING INJECTABLES: Where did you go for your last injection?

USING CONDOM, DIAPHRAGM, FOAM OR JELLY: From where did you obtain your most recent supply of (METHOD)?

WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED/GOT ADVICE ABOUT THE METHOD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE)________

OFFICE: CODE SOURCE____
MINISTRY OF HEALTH FACILITY (MOH)
URBAN HOSPITAL 1
URBAN HEALTH UNIT 2
RURAL HOSPITAL 3
RURAL HEALTH UNIT 4
MCH CENTER 5
MOBILE UNIT 6
OTHER MOH UNITS 7
OTHER GOVERNMENTAL FACILITY
TEACHING HOSPITAL 8
HEALTH INSURANCE ORGANIZATION 9
CURATIVE CARE ORGANIZATION A
OTHER GOVERNMENTAL B
NON-GOVERNMENTAL ORGANIZATIONS (NGO's)
EGYPT FAMILY PLANNING ASSOCIATION C
CSI PROJECT D
OTHER NON-GOVERNMENTAL E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
MOSQUE HEALTH UNIT I
CHURCH HEALTH UNIT J
OTHER VENDOR (SHOP, KIOSK, ETC,.) K
FRIENDS/RELATIVES L
OTHER (SPECIFY)_______X
DON'T KNOW Z

321) At the time that you began using (METHOD) during this current period of use, did you obtain / get advice about your (METHOD) at (SOURCE IN 320) or did you go to somewhere else?

YES, SAME PLACE 1
NO, SOMEWHERE ELSE 2 (GO TO 323)

322) ENTER THE CODE FOR THE SOURCE RECORDED IN 320 IN COLUMN 3 OF THE CALENDAR. IF THE CURRENT SEGMENT OF USE BEGAN SINCE JANUARY 1995, THE SOURCE CODE SHOULD BE ENTERED IN THE MONTH AND YEAR IN WHICH THE SEGMENT OF USE BEGAN. WRITE THE ADDRESS OF THE SOURCE TO THE RIGHT OF COLUMN 3. IF THE CURRENT SEGMENT OF USE BEGAN BEFORE JANUARY 1995, NO CODE WILL BE ENTERED IN THE CALENDAR IN COLUMN 3 IN JANUARY 1995. GO TO 325 AFTER.

323)Where did you first obtain/get advice about (METHOD) during your current period of use?

WRITE THE NAME AND ADDRESS OF THE PLACE WHERE THE RESPONDENT HAD OBTAINED THE METHOD/ADVICE. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE)________

OFFICE: CODE SOURCE____
MINISTRY OF HEALTH FACILITY (MOH)
URBAN HOSPITAL 1
URBAN HEALTH UNIT 2
RURAL HOSPITAL 3
RURAL HEALTH UNIT 4
MCH CENTER 5
MOBILE UNIT 6
OTHER MOH UNITS 7
OTHER GOVERNMENTAL FACILITY
TEACHING HOSPITAL 8
HEALTH INSURANCE ORGANIZATION 9
CURATIVE CARE ORGANIZATION A
OTHER GOVERNMENTAL B
NON-GOVERNMENTAL ORGANIZATIONS (NGO's)
EGYPT FAMILY PLANNING ASSOCIATION C
CSI PROJECT D
OTHER NON-GOVERNMENTAL E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
MOSQUE HEALTH UNIT I
CHURCH HEALTH UNIT J
OTHER VENDOR (SHOP, KIOSK, ETC,.) K
FRIENDS/RELATIVES L
OTHER (SPECIFY)_______X
DON'T KNOW Z

324) ENTER THE CODE FOR THE SOURCE RECORDED IN 323 IN COLUMN 3 OF THE CALENDAR. IF THE CURRENT SEGMENT OF USE BEGAN SINCE JANUARY 1995, THE SOURCE CODE SHOULD BE ENTERED IN THE MONTH AND YEAR IN WHICH THE SEGMENT OF USE BEGAN. WRITE THE ADDRESS OF THE SOURCE TO THE RIGHT OF COLUMN 3. IF THE CURRENT SEGMENT OF USE BEGAN BEFORE JANUARY 1995, NO CODE WILL BE ENTERED IN THE CALENDAR IN COLUMN 3 IN THE CALENDAR.

325) CHECK 317, 320, 323:

METHOD OBTAINED AT PHARMACY___
OTHER SOURCES/ NOT ASKED____ (GO TO 332)

326) Who usually goes to the pharmacy to obtain (CURRENT METHOD)?

RESPONDENT HERSELF 01 (GO TO 328)
HUSBAND 02
CHILDREN 03
OTHER FEMALE RELATIVE(S) 04
OTHER MALE RELATIVE(S) 05
FRIEND(S) 06
OTHER (SPECIFY)______ 96

327) During this current period of use, did you yourself ever go to the pharmacy to obtain/get advice about (CURRENT METHOD)?

YES 1
NO 2 (GO TO 332)

328) At any time when you went to the pharmacy during this current period if use to obtain/get advice about (METHOD), did anyone tell or show you how to use the (METHOD)?

YES 1
NO 2

329) At any time when you went to the pharmacy during this current period of use, were you told about the side effects or health problems you might have with the method?

YES 1
NO 2 (GO TO 331)

330) Where you told what to do if you experienced side effects or health problems?

YES 1
NO 2

331) Were you told about other methods of family planning which you could use?

YES 1
NO 2

332) CHECK 317, 320, 323:

METHOD OBTAINED AT CLINICAL SOURCE___
PHARMACY/ OTHER SOURCES/ NOT ASKED__ (GO TO 336)

333) At any time when you went to the (SOURCE IN 317, 320, 323) during this current period of use to (OBTAIN/GET ADVICE ABOUT CURRENT METHOD), were you told about side effects or health problems you might have with the method?

YES 1
NO 2 (GO TO 335)

334) Were you told what to do if you experiences side effects or health problems?

YES 1
NO 2

335) Were you told about other methods of family planning which you could use?

YES 1
NO 2

336) CHECK 316 AND CALENDAR:

CURRENTLY USING IUD___
CURRENTLY USING PILL __ (GO TO 342)
CURRENTLY USING OTHER METHOD__ (GO TO 349)

337) I would like to ask about when you began using the IUD during this current period of use.
First of all did you get the IUD at (SOURCE IN 317) or did you buy it from somewhere else?

YES, SAME PLACE 1 (GO TO 340)
NO, SOMEWHERE ELSE 2

338) From where did you buy the IUD?

WRITE THE NAME AND ADDRESS IF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE IUD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE)________

OFFICE: CODE SOURCE____
MINISTRY OF HEALTH FACILITY (MOH)
URBAN HOSPITAL 1
URBAN HEALTH UNIT 2
RURAL HOSPITAL 3
RURAL HEALTH UNIT 4
MCH CENTER 5
MOBILE UNIT 6
OTHER MOH UNITS 7
OTHER GOVERNMENTAL FACILITY
TEACHING HOSPITAL 8
HEALTH INSURANCE ORGANIZATION 9
CURATIVE CARE ORGANIZATION A
OTHER GOVERNMENTAL B
NON-GOVERNMENTAL ORGANIZATIONS (NGO's)
EGYPT FAMILY PLANNING ASSOCIATION C
CSI PROJECT D
OTHER NON-GOVERNMENTAL E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
MOSQUE HEALTH UNIT I
CHURCH HEALTH UNIT J
OTHER VENDOR (SHOP, KIOSK, ETC,.) K
FRIENDS/RELATIVES L
OTHER (SPECIFY)_______X
DON'T KNOW Z

339) How much did it cost to buy the IUD from that place?

COST (IN POUNDS)_______
FREE 95
DON'T KNOW Z

340) How much did it cost to have the IUD inserted (including all fees)?

COST (IN POUNDS)_____
FREE 995
DON'T KNOW 998

341) Would you be willing to pay the following for an IUD (including all costs)
(IF YES, CONTINUE WITH THE NEXT AMOUNT. IF NO GO TO 353. FOR AMOUNT MORE THAN 200 POUNDS, RECORD YES OR NO AND GO TO 353.)

5 pounds?
YES 1
NO 2 (GO TO 353)
10 pounds?
YES 1
NO 2(GO TO 353)
25 pounds?
YES 1
NO 2 (GO TO 353)
50 pounds?
YES 1
NO 2 (GO TO 353)
100 pounds?
YES 1
NO 2 (GO TO 353)
150 pounds?
YES 1
NO 2 (GO TO 353)
200 pounds?
YES 1
NO 2 (GO TO 353)
More than 200 pounds?
YES 1 (GO TO 353)
NO 2 (GO TO 353)

342) Now I would like to ask you some additional questions about this current segment of use of the pill.
May I see the package of pills you are using now?
RECORD NAME OF BRAND

PACKAGE SEEN 1
BRAND NAME (SPECIFY) _______ (GO TO 344)
PACKAGE NOT SEEN 2

343) Do you know the brand name of the pill which you are using now?
RECORD NAME OF BRAND

BRAND NAME (SPECIFY) ________
DON’T KNOW 98

344) How much does one cycle of pills cost?

COST
POUNDS______
PIASTERS______
FREE 9995
DON’T KNOW 9998

345) Would you be willing to pay the following for a cycle of pills?
(IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 346. AFTER ASKING ABOUT AMOUNT MORE THAN 5 POUNDS, RECORD YES OR NO AND GO TO 346)

50 piasters?
YES 1
NO 2 (GO TO 346)
75 piasters?
YES 1
NO 2 (GO TO 346)
1 pound?
YES 1
NO 2 (GO TO 346)
2 pounds?
YES 1
NO 2 (GO TO 346)
5 pounds?
YES 1
NO 2 (GO TO 346)
More than 5 pounds?
YES 1 (GO TO 346)
NO 2 (GO TO 346)

346) When was the last time you took a pill?
IF LESS THAN 24 HOURS, WRITE "00".

DAYS AGO____
MORE THAN ONE MONTH AGO 95

347) CHECK 346:

MORE THAN TWO DAYS AGO____
TWO DAYS AGO OR LESS____ (GO TO 353)

348) Why aren’t you taking the pill these days?

HUSBAND AWAY 01 (GO TO 353)
FORGOT 02 (GO TO 353)
HEALTH REASONS 03 (GO TO 353)
COSTS TOO MUCH 04 (GO TO 353)
NO NEED TO TAKE DAILY 05 (GO TO 353)
RAN OUT 06 (GO TO 353)
MENSTRUATING 07 (GO TO 353)
OTHER (SPECIFY)_____96 (GO TO 353)

349) CHECK CALENDAR AND RECORD SOURCE WHERE THE METHOD OBTAINED AT BEGINNING OF CURRENT SEGMENT:

SOURCE CODES (1-9, A-L) ____
SOURCES CODES (X, Z)___ (GO TO 353)

350) When you began using (METHOD IN 316) this time, how much did it cost you to obtain/ get advice about the method at (SOURCE RECORDED IN COLUMN 3 OF CALENDAR)?

COST
POUNDS___
PIASTERS_____
FREE 999995
DON’T KNOW 999998

351) CHECK 318:

USING INJECTABLES___
NOT USING INJECTABLES___ (GO TO 353)

352) Would you be willing to pay the following for the injectables (including all costs)?
(IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 353. AFTER ASKING ABOUT AMOUNT MORE THAN 20, RECORD YES OR NO AND GO TO 353)

2 pounds?
YES 1
NO 2 (GO TO 353)
5 pounds?
YES 1
NO 2 (GO TO 353)
10 pounds?
YES 1
NO 2 (GO TO 353)
15 pounds?
YES 1
NO 2 (GO TO 353)
20 pounds?
YES 1
NO 2 (GO TO 353)
More than 20 pound?
YES 1 (GO TO 353)
NO 2 (GO TO 353)

353) 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.

COLUMN 2 - SEGMENTS OF CONTRACEPTIVE USE SINCE JANUARY 1995

PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT PERIOD OF USE AND GOING BACK TO JANUARY 1995.

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

RECORD PERIODS OF USE AND NONUSE IN COLUMN 2 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.

ILLUSTRATIVE QUESTIONS FOR COLUMN 2:
- 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?

IF THERE ARE NO PRIOR SEGMENTS OF USE, GO TO 401.

COLUMN 3 SOURCE OD CONTRACEPTIVE METHOD SINCE JANUARY 1995

ASK FOR THE SOURCE OF THE METHOD FOR EACH SEGMENT OF USE PRIOR TO THE CURRENT SEGMENT OF USE IN THE CALENDAR THAT BEGAN IN JANUARY 1995 OR LATER. RECORD THE CODE OF THE SOURCE IN COLUMN 3 IN THE MONTH AND YEAR IN WHICH THE SEGMENT OF USE BEGAN.

FOR THE PILL, CONDOM, INJECTABLES AND DIAPHRAGM/FOAM/JELLY, THE SOURCE SHOULD BE THE PLACE FROM WHICH THE METHOD WAS OBTAINED AT THE TIME THE SEGMENT OF USE BEGAN.

ILLUSTRATIVE QUESTIONS FOR COLUMN 3
FOR MODERN METHODS (CODES 1-8):
- Where did you obtain the (method) when you began using it that time?

IF PHARMACY/OTHER SOURCE (CODES I, X):
- Did you consult a doctor or clinic, when you began using the (method) that time?
IF YES: Where did you consult?
IF NO: RECORD CODE FOR PHARMACY (H) OR OTHER SOURCE AS APPROPRIATE.

PROBE FOR THE EXACT ADDRESS OF EACH SOURCE. WRITE THE NAME TO THE RIGHT OF COLUMN 3 OF THE CALENDAR IN THE MONTH IN WHICH THE SEGMENT OF USE BEGAN.

FOR TRADITIONAL METHODS (CODES 9, L-X):
Did you seek advice about how to use (METHOD) when you began using it that time?
NUMBER OF CODES ENTERED IN COLUMN 3 MUST BE THE SAME AS THE NUMBER OF COMPLETE SEGMENTS OF CONTRACEPTIVE USE IN COLUMN 2.

COLUMN 4 REASON FOR DISCONTINUATION
FOR EACH PERIOD OF USE, ASK WHY SHE STOPPED USING THE METHOD AND RECORD THE REASON FOR DISCONTINUATION IN COLUMN 4 OF THE CALENDAR IN THE MONTH IN WHICH THE SEGMENT OF USE WAS TERMINATED .

IF A PREGNANCY FOLLOWED, ASK IF SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR WHETHER SHE DELIBERATELY STOPPED USING THE METHOD TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS
- 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)?

ENTER “0” IN EACH SUCH MONTH IN COLUMN 2

NUMBER OF CODES ENTERED IN COLUMN 4 MUST BE THE SAME AS THE NUMBER OF COMPLETE SEGMENTS OF CONTRACEPTIVE USE IN COLUMN 2

SECTION 4: FERTILITY PREFERENCES AND ATTITUDES ABOUT FAMILY PLANNING

401) CHECK 107:

CURRENTLY MARRIED___
DIVORCED/ WIDOWED/ SEPARATED___ (GO TO 417)

402) CHECK 313:

NEITHER STERILIZED___
SHE OR HE STERILIZED___ (GO TO 405)

403) CHECK 226:
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 405)
SAYS SHE CAN’T GET PREGNANT 3 (GO TO 417)
UNDECIDED OR DON’T KNOW 8 (GO TO 405)

404) CHECK 226:
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
YEARS 2
SOON/NOW 994 (GO TO 417)
SAYS SHE CAN’T GET PREGNANT 995 (GO TO 417)
OTHER (SPECIFY)____ 996 (GO TO 417)
DON’T KNOW 998 (GO TO 411)

405) CHECK 226:

NOT PREGNANT OR UNSURE___
PREGNANT___ (GO TO 412)

406) CHECK 313:

NOT CURRENTLY USING/ NOT ASKED___
CURRENTLY USING___ (GO TO 410)

407) CHECK 403:

WANTS ANOTHER SOON___
WANTS NO MORE___ (GO TO 409)
UNDECIDED/UNSURE___ (GO TO 410)

408) CHECK 404:

WANTS AFTER 24 OR MORE MONTHS OR 00-01 YEARS___
WANTS WITHIN 00-23 MONTHS OR 00-01 YEARS___ (GO TO 412)

409) CHECK 403:
WANTS A/ANOTHER CHILD___:
You have said that you do not want (a/another) child soon, but you are not using any method to delay a pregnancy. Can you tell me why? PROBE: Are there any other reasons?

WANTS NO MORE CHILDREN__:
You have said that you do not want any (more) children, but you are not using any method to avoid a pregnancy. Can you tell me why? PROBE: Are there any other reasons?

(RECORD ANSWER IN DETAIL)__________________
FERTILITY-RELATED REASONS
NOT HAVING SEX A
INFREQUENT SEX B
MENOPAUSAL/HYSTERECTOMY C
SUBFECUND D
INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND OPPOSED J
OTHER OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD RELATED REASONS
HEALTH CONCERN O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/ TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE
INTERFERES WITH BODY'S NORMAL PROCESSES S
OTHER (SPECIFY)_____X
DON'T KNOW Z

410) In the next few weeks, if you discovered that you were pregnant, would it be a big problem, a small problem or no problem at all for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM AT ALL 3

411) CHECK 313:

NOT CURRENTLY USING/NOT ASKED____
CURRENTLY USING___ (GO TO 417)

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

YES 1
NO 2 (GO TO 414)

413) Where is that?
WRITE THE NAME OF THE ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT WOULD GET 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 (MOH)
URBAN HOSPITAL 1
URBAN HEALTH UNIT 2
RURAL HOSPITAL 3
RURAL HEALTH UNIT 4
MOBILE UNIT 5
MCH CENTER 6
OTHER MOH UNITS 7
OTHER GOVERNMENTAL FACILITY
TEACHING HOSPITAL 8
HEALTH INSURANCE ORGANIZATION 9
CURATIVE CARE ORGANIZATION A
OTHER GOVERNMENTAL B
NON-GOVERNMENTAL ORRGANIZATIONS (NGO's)
EGYPT FAMILY PLANNING ASSOCIATION C
CSI PROJECT D
OTHER NGO's E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR G
PHARMACY H
OTHER PRIVATE SECTOR
MOSQUE HEALTH UNIT I
CHURCH HEALTH UNIT J
OTHER VENDOR (SHOP, KIOSK, ETC.,) K
FRIENDS/RELATIVES L
OTHER (SPECIFY)______X
DON'T KNOW Z

414) Do you think you will use a method at any time in the future?

YES 1
NO 2 (GO TO 416)
DON'T KNOW 8 (GO TO 416)

415) Which method would you prefer to use?

PILL 1 (GO TO 417)
IUD 2 (GO TO 417)
INJECTABLES 3 (GO TO 417)
NORPLANT 4 (GO TO 417)
DIAPHRAGM/FOAM/JELLY 5 (GO TO 417)
CONDOM 6 (GO TO 417)
FEMALE STERILIZATION 7 (GO TO 417)
MALE STERILIZATION 8 (GO TO 417)
PERIODIC ABSTINENCE 9 (GO TO 417)
WITHDRAWAL L (GO TO 417)
PROLONGED BREASTFEEDING G (GO TO 417)
OTHER (SPECIFY) ____ X (GO TO 417)
UNSURE Z (GO TO 417)

416) What is the main reason that you think that you will not use a method at any time in the future?

(RECORD ANSWER IN DETAIL)__________
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHER OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _____96
DON'T KNOW 98

417) CHECK 203 AND 205:

HAS LIVING CHILD(REN)__: 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 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 419)
DON'T KNOW 98 (GO TO 419)

418) 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 NUMBER WANTED_______
GIRLS NUMBER WANTED_____
DOES NOT MATTER, EITHER SEX NUMBER WANTED_____
OTHER ANSWER (SPECIFY)_____ 96

419) Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NOT SURE/ DON'T KNOW 8

420) Would you consider it appropriate for a couple to use family planning after the first birth?

YES 1
NO 2
DON'T KNOW 8

421) Would you consider it appropriate for a newly married couple to use family planning before the first pregnancy?

YES 1
NO 2
DON'T KNOW 8

422) In the past six months have you discussed family planning with your friends, neighbours or relatives?

YES 1
NO 2 (GO TO 424)

423) With whom?
Anyone else?

RECORD ALL MENTIONED

MOTHER A
FATHER B
SISTER(S) C
BROTHER(S) D
DAUGHTER E
MOTHER-IN-LAW F
FRIENDS/NEIGHBORS G
OTHER (SPECIFY)____X

424) In the past six months did a health worker, a raida rifia, or anyone else visit you to talk about family planning?
IF YES: Who visited you?

VISITED BY:
HEALTH WORKER A
RAIDA B
OTHER (SPECIFY)_____X
NO ONE VISITED Y

425) Have you visited any governmental health facility for any reason during the past six months?

YES 1
NO 2 (GO TO 427)

426) Did any staff member at the health facility speak to you about family planning methods during any of your visits?

YES 1
NO 2

427) Have you visited a private doctor or clinic for any reason during the past six months?

YES 1
NO 2 (GO TO 428)

428) Did the doctor or any staff person there speak to you about family planning methods during any of your visits?

YES 1
NO 2

429) During the past six months have you heard about family planning?

On television?
YES 1
NO 2
On radio?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
From a poster?
YES 1
NO 2
From leaflets or brochure?
YES 1
NO 2
From billboards or signboards?
YES 1
NO 2
At a community meeting?
YES 1
NO 2
From other sources?
YES 1 (SPECIFY)
NO 2

430) CHECK 302:

KNOWS PILL___
DOESN'T KNOW PILL___(GO TO 432)

431) Are you aware there is a special brand of pill that is appropriate for a woman to use while breastfeeding?
IF YES: What brand is that?
(MENTIONED HER EXACT WORDS)

YES, KNOW BRAND 1
YES, BUT CAN'T NAME BRAND 2
NOT AWARE 8

432) CHECK 107:

CURRENTLY MARRIED___
DIVORCED/WIDOWED/SEPARATED___ (GO TO 501)

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

434) In the past six months have you discussed family planning with your husband?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

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

SECTION 5: PREGNANCY AND BREASTFEEDING

501) CHECK 224:

ONE OR MORE BIRTHS SINCE JANUARY 1995____
NO BIRTHS SINCE JANUARY 1995 (GO TO 635)

502) ENTER THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995 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 questions about the health of all your children born in the past 5 years. (We will talk about one child at a time.)

503) LINE NUMBER FROM Q. 212

_____

504) FROM Q.212 AND Q.216:

NAME_____
ALIVE
DEAD

505) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later or did not want (more) children at all?

THEN 1 (GO TO 507)
LATER 2
NO MORE 8 (GO TO 507)

506) How much longer would you like to have waited?

MONTHS 1
YEARS 2
DON'T KNOW 998

507) 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
DAYA C
OTHER (SPECIFY)_____X
NO ONE Y (GO TO 513)

508) Where did you receive the antenatal care?
RECORD ALL PLACES

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH UNIT B
MCH CENTER C
PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
PVT. DOCTOR E
OTHER (SPECIFY)_____X

509) How many months pregnant were you when you first saw someone for an antenatal care for this pregnancy?

MONTHS___
DON'T KNOW 98

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

NO. OF VISITS___
DON'T KNOW 98

511) CHECK 510:
NUMBER OF RECEIVED ANTENATAL CARE:

ONCE___(GO TO 513)
MORE THAN ONCE/DK____

512) How many months pregnant were you when you last saw someone for an antenatal care for this pregnancy?

MONTHS_____
DON'T KNOW 98

513) When you were pregnant with (NAME), were you given any injection in the arm to prevent the baby from getting tetanus, that is, convulsion after birth?

YES 1
NO 2 (GO TO 518)
DON'T KNOW 8 (GO TO 518)

514) During this pregnancy, how many times did you get this injection?

TIMES____
DON'T KNOW 8

515) Where did you receive the tetanus injection(s)?
RECORD ALL PLACES

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH UNIT B
MCH CENTER C
PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
PVT. DOCTOR E
OTHER (SPECIFY)____X

516) When you received the tetanus toxoid injection, did anyone tell you that you should go for (other) antenatal care? [ask only for last birth]

YES 1
NO 2
DON'T KNOW 8

517) At that time, did anyone talk to you about family planning? [ask only for last birth]

YES 1
NO 2
DON'T KNOW 8

518) When you were pregnant with (NAME), did you see a doctor, nurse or other health worker for any other reason (other than for an antenatal checkup or a tetanus injection)?

IF YES: Whom did you see? Anyone else?

RECORD ALL PERSONS SEEN

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
OTHER (SPECIFY)____X
NO ONE Y (GO TO 524)

519) Where did you go to see the doctor (nurse and/or health worker)?
RECORD ALL PLACES

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH UNIT B
MCH CENTER C
PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
PVT. DOCTOR E
OTHER (SPECIFY) ____X

520) CHECK Q 507: HAD ANTENATAL CARE:

NO ANTENATAL CARE___
HAD ANTENATAL CARE___ (GO TO 526)

521) At any time did you seek this care because you thought there was a problem with the pregnancy?

YES 1
NO 2 (GO TO 525)

522) How many times during this pregnancy did you see a doctor, nurse, midwife or other health worker?

TIMES____
DON'T KNOW 8

523) How many months pregnant were you when you last saw a health worker during this pregnancy?

MONTHS___
DON'T KNOW 98

524) CHECK ID THE RESPONDENT HAD:

Q 507: ANTENATAL CARE
YES 1
NO 2
Q 513: TETANUS INJECTION
YES 1
NO 2
Q 518: OTHER CARE
YES 1
NO 2

525) CHECK Q 520:

AT LEAST ONE "YES" RESPONSE___
ALL RESPONSES "NO"____ (GO TO 529)

526) During the time that you were pregnant with (NAME), were any of the following done:

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

527) Were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 529)
DON'T KNOW (GO TO 529)

528) Were you told about where to go if you had any of those complications?

YES 1
NO 2
DON'T KNOW 8

529) During this pregnancy were you given or did you buy iron tablets or iron syrup?

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

530) During the whole pregnancy, for how many days did you take the tablets or syrup?

DAYS____
DON'T KNOW 998

531) Where did you give birth to (NAME)?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GVT. HOSPITAL 21
GVT. HEALTH UNIT 22
MCH CENTER 23
PRIVATE SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER (SPECIFY)_____96

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

HEALTH PROFESSIONAL
DOCTOR A
NIRSE/MIDWIFE B
OTHER PERSON
DAYA C
RELATIVES/FRIENDS D
OTHER (SPECIFY)____X
NO ONE Y (GO TO 534)

533) Was (NAME) delivered normal or caesarean?

NORMAL 1
CAESAREAN 2

534) Around the time of the birth of (NAME), did you have any of the following problems:

Long labor, that is, did your regular contractions last more than 12 hours?
YES 1
NO 2
Excessive bleeding that was so much that you feared it threatened your life?
YES 1
NO 2
A high fever with bad smelling vaginal discharge?
YES 1
NO 2
Convulsions not caused by fever?
YES 1
NO 2

535) 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

536) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 538)
DON'T KNOW 8 (GO TO 538)

537) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD OR OTHER RECORD IF AVAILABLE.

GRAMS FROM CARD 1
GRAMS FROM RECALL 2
DON'T KNOW 99998

538) After (name) was born, did a doctor, nurse or other health worker or the daya check on your health?

YES 1
NO 2 (GO TO 542)
DON'T KNOW 8 (GO TO 542)

539) How many days or weeks after the delivery did the first check take place?

DAYS 1
WEEKS 2
DON'T KNOW 998

540) Who checked on your health for the first time?
Anyone else?

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2
OTHER PERSON
DAYA 3
RELATIVES/FRIENDS 4
OTHER (SPECIFY)____6

541) Where did this first check take place?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GVT. HOSPITAL 21
GVT. HEALTH UNIT 22
MCH CENTER 23
PRIVATE SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER (SPCECIFY)_____96

542) In the first two months after delivery, did you receive a Vitamin A dose?
SHOW CAPSULE

YES 1
NO 2
DON'T KNOW 8

543) CHECK 528: ASSISTED AT DELIVERY BY DOCTOR OR NURSE/MIDWIFE

ASSISTED BY DOCTOR/NURSE/MIDWIFE___ (GO TO 547)
ASSISTED BY DAYA/OTHER___

544) In the first two months after delivery, did a doctor, nurse or other health worker check on his/her health?

YES 1
NO 2 (GO TO 547)
DON'T KNOW 8 (GO TO 547)

545) How many days or weeks after the delivery did the first check take place?

DAYS 1
WEEKS 2
DON'T KNOW 998

546) Has your period returned since the birth of (NAME)? [ask for last birth only]

YES 1 (GO TO 548)
NO 2

547) ENTER "X" IN COL.5 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH, (OR TO CURRENT PREGNANCY)
(GO TO 549)

548) For how many months after the birth of (NAME) did you not have a period?
ENTER "X" IN COL. 5 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 "O" IN COL.5 IN MONTH AFTER BIRTH.

549) CHECK 226: RESPONDENT PREGNANT? [ask for last birth only]

NOT PREGNANT___
PREGNANT OR UNSURE___ (GO TO 551)

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

YES 1
NO 2 (GO TO 552)

551) How long after the birth of (NAME) did you not have sexual relations?

RECORD PERIOD IN DAYS IF LESS THAN MONTH AND IN MONTHS OTHERWISE

DAYS 1
MONTHS 2
DON'T KNOW 998

552) At the time you were pregnant with (NAME) or after you delivered, did anyone give you advice about breastfeeding?

YES 1
NO 2 (GO TO 554)

553) Who gave you this advice?

RECORD ALL MENTIONED

HEALTH PROVIDER A
SOCIAL WORKER B
DAYA C
RELIGIOUS LEADERS D
NEIGHBORS/FRIENDS E
HOUSEHOLD MEMBER F
OTHER RELATIVES G
OTHER (SPECIFY)_____X

554) Did you ever breastfeed (NAME)?

YES 1 (GO TO 556)
NO 2

555) ENTER "N" IN COL.6 OF CALENDAR IN MONTH AFTER BIRTH. THEN GO TO 562.

556) How long after birth did you first put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS.

IF LESS THAN 24 HOURS, RECORD HOURS.

OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1
DAYS 2

557) Within the first three days after delivery, before your milk began flowing regularly was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 559)

558) What was (NAME) given to drink before your milk began flowing regularly?
Anything else?
RECORD ALL MENTIONED

MILK (OTHER THAN BREASTMILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SALT AND SUGAR SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY)_____X

559) CHECK 504 OR 216: CHILD ALIVE?

ALIVE___
DEAD___ (GO TO 561)

560) Are you still breastfeeding (NAME)?

YES 1 (GO TO 564)
NO 2

561) For how many months did you breastfeed (NAME)?
ENTER "X" IN COL.6 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS OF BREASTFEEDING, STARTING IN THE MONTH AFTER BIRTH. THEN GO TO 562.
IF LESS THAN A MONTH ENTER "0" IN THE MONTH AFTER BIRTH.

562) Why did you (never/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 CONTRACEPTIVE 10
OTHER (SPECIFY)______96

563) CHECK 504 OR 216:

ALIVE___ (GO TO 567)
DEAD___ (GO TO 571)

564) ENTER "X"IN COL.6 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH.

565) How many times did you breastfeed (NAME) last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER

NUMBER OF NIGHTTIME FEEDINGS______

566) How many times did you breastfeed (NAME) yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER

NUMBER OF DAYLIGHT FEEDINGS_____

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

YES 1
NO 2
DON'T KNOW 8

568) At any time yesterday or last night was (NAME), given any of the following:

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
Any other liquid?
YES 1
NO 2
Fruit?
YES 1
NO 2
Porridge, bread, rice, macaroni, or other food made from grains?
YES 1
NO 2
Sweet potatoes or other food made from tubers?
YES 1
NO 2
Eggs, fish, or poultry meat?
YES 1
NO 2
Any other solid or semi-solid food?
YES 1
NO 2

569) CHECK 568: FOOD OR LIQUID GIVEN YESTERDAY?

"YES" TO ONE OR MORE___
"NO" TO ALL___ (GO TO 571)

570) In total, how many times was (NAME) fed any solid or semi-solid food yesterday or last night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES____
DON'T KNOW 8

571) On how many days during the past seven days was (NAME) given any of the following:

RECORD THE NUMBER OF DAYS

Plain water?
Any kind of milk (other than breast milk)?
Liquids other than plain water or milk?
Food made from grains like porridge, bread, rice and macaroni?
Sweet potatoes or other foods tubers?
Eggs, fish, or poultry?
Meat?
Fruit?
Any other solid or semi-solid food?

572) RETURN TO 505 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 601.

SECTION 6: IMMUNIZATION AND HEALTH

601) ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1995 IN THE TABLE. 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).

602) LINE NUMBER FROM Q. 212

_____

603) FROM Q. 212
FROM Q. 216

NAME______
ALIVE__
DEAD___ (GO TO 603 FOR NEXT BIRTH. IF NO OTHER BIRTH, GO TO 635)

604) 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 606)
YES, NOT SEEN 2 (GO TO 608)
NO CERTIFICATE 3

605) Did you ever have a birth certificate with a vaccinations record for (NAME)?

YES 1 (GO TO 608)
NO 2 (GO TO 608)

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

BCG
DAY__
MO.___
YEAR____
POLIO 1
DAY___
MO.___
YEAR_____
POLIO 2
DAY___
MO.____
YEAR____
POLIO 3
DAY___
MO.___
YEAR_____
ACTIVATED DOSE
DAY____
MO.____
YEAR_____
DPT 1
DAY___
MO.___
YEAR_____
DPT 2
DAY___
MO.____
YEAR____
DPT 3
DAY___
MO.___
YEAR_____
ACTIVATED DOSE
DAY____
MO.____
YEAR_____
MEASLES
DAY____
MO.____
YEAR_____
HEPATITIS 1
DAY____
MO._____
YEAR_____
HEPATITIS 2
DAY____
MO.____
YEAR_____
HEPATITIS 3
DAY____
MO.____
YEAR_____
VITAMIN A (MOST RECENT)
DAY___
MO____
YEAR____

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE "66" IN CORRESPONDING DAY COLUMN IN 606).
NO 2
DON'T KNOW 8

608) Do you have a health card where (NAME"S) vaccinations are written down?
IF YES: May I see it, please?

YES, SEEN 1 (GO TO 610)
YES, NOT SEEN 2 (GO TO 612)
NO HEALTH CARD 3

609) Did you ever have a health card for (NAME)?

YES 1 (GO TO 612)
NO 2 (GO TO 612)

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

BCG
DAY___
MO.___
YEAR_____
POLIO 1
DAY___
MO.___
YEAR_____
DPT 1
DAY___
MO.___
YEAR_____
HEPATITIS 1
DAY___
MO.___
YEAR_____
POLIO 2
DAY___
MO.___
YEAR_____
DPT 2
DAY___
MO.___
YEAR_____
HEPATITIS 2
DAY___
MO.___
YEAR_____
POLIO 3
DAY___
MO.___
YEAR_____
DPT 3
DAY___
MO.___
YEAR_____
HEPATITIS 3
DAY___
MO.___
YEAR_____
POLIO 4
DAY___
MO.___
YEAR_____
MEASLES
DAY___
MO.___
YEAR_____
ACTIVATED POLIO
DAY___
MO.___
YEAR_____
ACTIVATED DPT
DAY___
MO.___
YEAR_____
VITAMIN A (MOST RECENT)
DAY___
MO.___
YEAR_____

611) Has (NAME) received any vaccinations that are not recorded on this health card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT, POLIO, MEASLES, AND/OR HEPATITIS 1-3 VACCINE (5)

YES 1 (PROBE FOR VACCINATIONS AND WRITE "66" IN CORRESPONDING DAY COLUMN IN 610. THEN GO TO 615)
NO 2 (GO TO 615)
DON'T KNOW 8 (GO TO 615)

612) CHECK 604 AND 608

NEITHER CERTIFICATE NOR HEALTH CARD SEEN___
CERTIFICATE OR HEALTH CARD SEEN___ (GO TO 615)

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

YES 1
NO 2 (GO TO 616)
DON'T KNOW 8 (GO TO 616)

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

A BCG vaccination against tuberculosis, that is, 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?
IF YES: How many times?

YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES____

When was the first polio vaccination received, just after birth or later?

AFTER BIRTH 1
LATER 2

A DPT injection?
IF YES: How many times?

YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES____

An injection against measles at nine months?

YES 1
NO 2
DON'T KNOW 8

An injection against hepatitis?
IF YES: How many times?

YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES____

615) Did (NAME) receive a vitamin A dose during the past six months?
SHOW CAPSULE

YES 1
NO 2
DON'T KNOW 8

616) At any time when you took your child for these immunizations, did anyone talk to you about family planning? [ask only for last birth]

YES 1
NO 2
DON'T KNOW/UNSURE 8

617) Did anyone talk to you about any other health services (nutrition/antenatal care) [ask only for last birth]

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 624)
DON'T KNOW 8 (GO TO 624)

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

YES 1
NO 2
DON'T KNOW 8

621) Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 623)

622) Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH UNIT B
MCH CENTER C
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
PVT. DOCTOR E
PHARMACY F
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER G
RELATIVES/FRIENDS H
OTHER (SPECIFY)____X

623) Was (NAME) given antibiotic to treat the cough?

YES 1
NO 2
DON'T KNOW 8

624) Has (NAME) had diarrhea in the last two weeks?

YES 1
NO 2 (GO TO 633)
DON'T KNOW 8 (GO TO 633)

625) Now I would like to know how much (NAME) was offered to drink during the diarrhea, was he/she offered less than usual to drink?
IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?

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

626) When (NAME) had diarrhea, was he/she offered to eat, about the same, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?

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

627) Was (NAME) given a fluid made from a special packet called mahloul moalget el-gaffaf to drink?

YES 1
NO 2
DON'T KNOW 8

628) Did anyone advice you to give (NAME) mahloul moalget el gafaf when (he/she) had diarrhea that time?
IF YES: Who?
RECORD ALL MENTIONED.

PUBLIC SECTOR
DOCTOR/HEALTH WORKER A
PRIVATE SECTOR
DOCTOR/HEALTH WORKER B
PHARMACY WORKER C
TRADITIONAL PRACTITIONER D
HUSBAND E
OTHER RELATIVE/FRIEND F
OTHER (SPECIFY)_____X
NO ONE Y

629) Was he/she given anything (else) to treat the diarrhea?

YES 1
NO 2 (GO TO 631)
DON'T KNOW 8 (GO TO 631)

630) What was given to treat the diarrhea? Anything else? RECORD ALL MENTIONED

HOMEMADE SUGAR, SALT AND WATER SOLUTION A
ANTIBIOTIC (PILL OR SYRUP) B
OTHER PILL OR SYRUP C
INJECTION (I.V.) INTRAVENOUS D
HOME REMEDIES/HERBAL MEDICINES E
OTHER (SPECIFY)____X

631) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 633)

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

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH UNIT B
MCH CENTER C
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
PVT. DOCTOR E
PHARMACY F
OTHER PRIVATE SECTOR
TRADITIONAL PRACTIONER G
RELATIVES/FRIENDS H
OTHER (SPECIFY) _____X

633) GO BACK TO 603 FOR NEXT BIRTH; OR IF NO MORE BIRTHS, GO TO 634.

634) CHECK 627, ALL COLUMNS:

NO CHILD RECEIVED ORS___
ANY CHILD RECEIVES ORS___ (GO TO 701)

635) Have you ever heard of a special product called mahloul maolget el-gaffaf you can get for the treatment of diarrhea?

YES 1
NO 2

SECTION 7: CHILDREN'S EDUCATION AND LABOR

701) CHECK 216 AND 217:

ONE OR MORE LIVING CHILDREN BETWEEN 6-15 YEARS____
NO LIVING CHILDREN BETWEEN 6-15 YEARS___ (GO TO 729)

702) ENTER THE LINE NUMBER OF EACH LIVING CHILD BETWEEN THE AGES 6-15 YEARS OLD. BEGIN WITH THE YOUNGEST CHILD. ASK THE QUESTIONS FOR EVERY CHILD. IF THERE ARE MORE THAN 3 CHILDREN BETWEEN THESE AGES, USE AN ADDITIONAL QUESTIONNAIRE.

Now I would like to ask you some questions about the education of your children who are between the ages 6 and 15 years of age. We will talk about one child at a time.

703) RECORD LINE NUMBER AND NAME FROM Q. 212

NAME____
LINE NO._____

704) Has (NAME) ever attended school?

YES 1 (GO TO 706)
NO 2
DON'T KNOW 8 (GO TO 720)

705) What are the most important reasons (NAME) has never attended school? RECORD UP TO 3 REASONS MENTIONED

CHILD SICK/WEAK/HANDICAPPED A
CHILD TOO YOUNG B
NEAREST SCHOOL TOO FAR C
SCHOOL OF POOR QUALITY D
CHILD NEEDED HOME:
TO CARE FOR YOUNGER CHILDREN E
TO HELP WITH DOMESTIC WORK OTHER THAN CHILD CARE, WORK IN FIELDS OR TENDS ANIMALS F
TO WORK IN FAMILY BUSINESS OR EARN MONEY FROM EMPLOYER G
SCHOOL COSTS TOO HIGH/NO MONEY TO PAY COSTS OF SCHOOLING H
SCHOOL NOT IMPORTANT I
CHILD IS NOT INTERESTED J
CHILD GOT MARRIED K
TRADITION/CUSTOM L
OTHER(SPECIFY)____X
(GO TO 720)

706) At what age did (NAME) first start going to school?


AGE___
DON'T KNOW 98

707) Has (NAME) ever repeated a grade of school?

YES 1
NO 2
DON'T KNOW 8

708) Is (NAME) currently attending school?

YES 1
NO 2 (GO TO 710)

709) During the current school year what level and grade is (NAME) attending?

LEVEL___ (GO TO 713)
GRADE___ (GO TO 713)

710) What is the highest level of school (NAME) has attended?
What is the highest grade that (NAME) has completed at that level?

LEVEL___
GRADE___

711) At what age did (NAME) stop going to school?

AGE____
DON'T KNOW 98

712) What are the most important reasons (NAME) stopped attending school? RECORD UP TO 3 REASONS MENTIONED

CHILD SICK/WEAK/HANDICAPPED A
CHILD FAILED/REPEAT A YEAR B
NEAREST SCHOOL TOO FAR C
SCHOOL OF POOR QUALITY D
CHILD NEEDED AT HOME:
TO CARE FOR YOUNGER CHILDREN E
TO HELP WITH DOMESTIC WORK OTHER THAN CHILD CARE, WORK IN FIELDS OR TENDS ANIMALS F
TO WORK IN FAMILY BUSINESS OR EARN MONEY FROM EMPLOYER G
SCHOOL COSTS TOO HIGH/NO MONEY TO PAY SCHOOL COSTS H
SCHOOL NOT IMPORTANT I
CHILD IS NOT INTERESTED J
CHILD GOT MARRIED K
CHILD HAD ENOUGH EDUCATION L
TRADITION/CUSTOM M
OTHER (SPECIFY)____X

(GO TO 720)

713) CHECK 212 AND 218:

LIVING WITH MOTHER___
NOT LIVING WITH MOTHER___ (GO TO 720)

714) How many days in the past 2 weeks has (NAME)'s school been open?

NO. OF DAYS_____

715) How many days in the past 2 weeks has (NAME) attended school?

NO. OF DAYS_____

716) CHECK 714 AND 715:

714 AND 715 ARE THE SAME 1 (GO TO 718)
ANSWER 714>715 2

717) What is the main reason (NAME) was absent from school in the last 2 weeks?

ILLNESS 01
BAD WEATHER 02
ABUSE BY TEACHERS 03
CHILD DIDN'T WANT TO GO 04
CHILD NEEDED AT HOME:
TO CARE FOR YOUNGER CHILDREN 05
TO HELP WITH DOMESTIC WORK OTHER THAN CHILD CARE, WORK IN FIELDS OR TENDS ANIMALS 06
TO WORK IN FAMILY BUSINESS OR EARN MONEY FROM EMPLOYER 07
OTHER (SPECIFY)______96
DON'T KNOW 98

718) Does (NAME) attend a public, private secular or religious school?

PUBLIC 1
PRIVATE SECULAR 2
RELIGIOUS 3

719) How much did your household spend on each of these school expenditure for (NAME) during this school year:

IF NOTHING IS SPENT ENTER "0000"

Registration and tuition fees per year, for (NAME)?
REG.______
DON'T KNOW 9998
Uniform, clothing, shoes, bags bought for child to wear at school per year, for (NAME)?
UNIF.______
DON'T KNOW 9998
Textbooks, exercise books, note books, pens per year for (NAME)?
BOOKS_____
DON'T KNOW 9998
Tutoring and other money paid to teachers for special classes for (NAME)?
TEACH.____
DON'T KNOW 9998
Any other expenses per year (transportation, incidentals and entertainment) for (NAME)?
OTHER_____
DON'T KNOW_____
(SPECIFY)__________

720) Has (NAME) ever done any kind of work for pay (cash or kind)?

YES 1
NO 2

721) Is (NAME) currently doing any kind of work for pay (cash or kind)?

YES 1
NO 2 (GO TO 724)

722) What is the kind of this work which (NAME) (EVER) do it?
RECORD ANSWER IN DETAIL

_________________

723) On average for how many hours a week does he/she do this work?
IF LESS THAN ONE HOUR RECORD "00"

NO. OF HOURS____
DON'T KNOW 98

724) Is (NAME) regularly engaged in unpaid family work (on the farm, etc...)?

YES 1
NO 2 (GO TO 726)
DON'T KNOW 8 (GO TO 726)

725) On average for how many hours a week does he/she do this works?

IF LESS THAN ONE HOUR RECORD "00"

NO. OF HOURS.______
DON'T KNOW 98

726) Does (NAME) regularly help in household chores at home (e.g cooking, cleaning, caring for children, for animals, etc)?

YES 1
NO 2 (GO TO 728)

727) On average for how many hours a week does he/she do this work?
IF LESS THAN ONE HOUR RECORD "00"

NO. OF HOURS_____
DON'T KNOW 98

728) GO BACK TO 704 FOR THE NEXT CHILD. IF THERE ARE NO MORE CHILDREN BETWEEN THE AGES 6 AND 15 GO TO 729.

729) If parents have one son and one daughter and can send only one child to the university , which child should they send?

SON 1
DAUGHTER 2
DEPEND ON THE CHILDREN'S CAPABILITIES 3
NOT SURE 8

SECTION 8: FEMALE CIRCUMCISION

801) Now I would like to talk to you about a different topic which is female circumcision. CHECK 214 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER___
HAS NO LIVING DAUGHTER____ (GO TO 809)

802) Have any of your daughters been circumcised?

IF YES: How many?

NUMBER CIRCUMCISED____
NO DAUGHTERS CIRCUMCISED 95 (GO TO 807)

803) Which of your daughters was circumcised the latest?

(DAUGHTER'S NAME)________

CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.

DAUGHTER'S LINE NUMBER FROM Q212_____

804) How old was she when she was circumcised?

AGE IN COMPLETED YEARS______
DON'T KNOW 98

805) Who performed the circumcision?
IF DOCTOR, PROBE: Was the doctor male or female?

MALE DOCTOR 01
FEMALE DOCTOR 02
TRAINED NURSE/MIDWIFE 03
DAYA 04
BARBER 05
GHAGARIA 06
OTHER (SPECIFY)____96
DON'T KNOW 98

806) Where was the circumcision performed?

AT HOME 1
PRIVATE HOSPITAL/CLINIC 2
GOVERNMENT HOSPITAL/CLINIC 3
RELATIVE/NEIGHBOR'S HOUSE 4
BARBER'S KIOSK 5
OTHER (SPECIFY)____6
DON'T KNOW 8

807) Do you intend to have any (other) of your daughters circumcised?

YES 1 (GO TO 809)
NO 2
ALL HER DAUGHTERS CIRCUMCISED 3 (GO TO 809)
DON'T KNOW 8 (GO TO 809)

808) Why don't you intend to have your daughter(s) circumcised?

Any other reasons?

RECORD ALL REASONS MENTIONED

DON'T BELIEVE IN/ACCEPT IT A
AFRAID OF COMPLICATIONS B
AGAINST RELIGION C
BETTER MARRIAGE PROSPECTS D
GREATER PLEASURE FOR HUSBAND E
OTHER (SPECIFY)_____X

809) During the past year, have you heard or seen anything about female circumcision:

On television?
YES 1
NO 2
On radio?
YES 1
NO 2
In newspaper or magazine?
YES 1
NO 2
At community meeting?
YES 1
NO 2
At the mosque or church?
YES 1
NO 2

810) During the past year have you discussed female circumcision with your relatives, friends or neighbors?

YES 1
NO 2

811) Has your opinion about female circumcision changed during the past year?
IF YES: Are you more likely or less likely to approve of circumcision now?

YES, MORE LIKELY TO APPROVE 1
YES, LESS LIKELY TO APPROVE 2
NO, OPINION SAME 3

812) What benefits do girls themselves get if they undergo this genital cutting? PROBE: Anything else? RECORD ALL MENTIONED

CLEANLINESS/HYGIENE A
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
PRESERVE VIRGINITY/ PREVENT PREMARITAL SEX D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS APPROVAL F
TRADITIONS G
OTHER (SPECIFY)_____X
NO BENEFITS Y

813) What benefits do girls themselves get if they do not undergo this genital cutting?
PROBE: Anything else? RECORD ALL MENTIONED

FEWER MEDICAL PROBLEMS A
AVOIDING PAIN B
MORE SEXUAL PLEASURE FOR HER C
MORE SEXUAL PLEASURE FOR THE MAN D
FOLLOWS RELIGION E
OTHER (SPECIFY)____X
NO BENEFITS Y

814) Do you think that this practice should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
OTHER (SPECIFY)_____6
DON'T KNOW 8

815) Do you think that men want this practice to be continued, or discontinued?

CONTINUED 1
DISCONTINUED 2
OTHER (SPECIFY)_____6
DON'T KNOW 8

816) I will read you some statements. Please tell me if you agree or disagree?

Circumcision is an important part of religious tradition.
AGREE 1
DISAGREE 2
DK 8
A husband will prefer his wife to be circumcised.
AGREE 1
DISAGREE 2
DK 8
Circumcision can cause severe complications, which may lead to the girl's death.
AGREE 1
DISAGREE 2
DK 8
Circumcision prevents adultery.
AGREE 1
DISAGREE 2
DK 8
Circumcision may cause a woman to have problems in becoming pregnant.
AGREE 1
DISAGREE 2
DK 8
Circumcision lessens sexual satisfaction for a couple.
AGREE 1
DISAGREE 2
DK 8
Childbirth is more difficult for a woman who has been circumcised.
AGREE 1
DISAGREE 2
DK 8

SECTION 9: HUSBAND'S BACKGROUND

901) CHECK 107:

CURRENTLY MARRIED___
DIVORCED/SEPARATED____ (GO TO 903)
WIDOWED____(GO TO 904)

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

HUSBAND'S LINE NUMBER_______

903) Now I would like to ask some questions about your (last) husband. How old was your (last) husband on his most recent birthday?

AGE IN COMPLETED YEARS________

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

MONTH____
DON'T KNOW MONTH 98
YEAR_____
DON'T KNOW YEAR 9998

905) Before you got married was your (last) husband related to you in anyway through blood or marriage?

YES 1
NO 2 (GO TO 907)

906) What type of relationship was it?

FIRST COUSIN ON FATHER'S SIDE 1
FIRST COUSIN ON MOTHER'S SIDE 2
SECOND COUSIN ON FATHER'S SIDE 3
SECOND COUSIN ON MOTHER'S SIDE 4
OTHER BLOOD RELATIVE 5
OTHER RELATIVE BY MARRIAGE 6

907) Did your (last) husband ever attend school?

YES 1
NO 2 (GO TO 910)

908) What was the highest level of school he attended?

PRIMARY 1
PREPARATORY 2
SECONDARY 3
UPPER INTERMEDIATE 4
UNIVERSITY 5
MORE THAN UNIVERSITY 6
DON'T KNOW 8 (GO TO 910)

909) What was the highest grade which he completed at that level?

GRADE____
DON'T KNOW 8

910) CHECK 107:

CURRENTLY MARRIED___
WIDOWED/DIVORCED/SEPARATED____ (GO TO 919)

911) Is your husband currently employed? IF NO: Is he retired or unemployed?

YES 1
NO, RETIRED 2
NO, UNEMPLOYED 3

912) CHECK 107:
HUSBAND CURRENTLY EMPLOYED___: What kind of work does your husband mainly do?
HUSBAND RETIRED OR UNEMPLOYED___: In the last job he had, what kind of work did your husband mainly do?

____________________
RECORD ANSWER IN DETAIL

913) Does (did) your (last) husband work for a member of his family, for someone else, or is he self-employed?

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 3
FOR HIMSELF 3 (GO TO 915)

914) Does (did) he ear a regular wage or salary?

YES 1
NO 2

915) CHECK 910:

WORKS (WORKED) IN AGRICULTURE___
DOES (DID) NOT WORK IN AGRICULTURE___ (GO TO 917)

916) (Does/Did) your husband mainly work in 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
RENTED LAND 2
SOMEONE ELSE'S LAND 3

917) Does your husband currently smoke cigarettes or tobacco?

YES 1
NO 2 (GO TO 919)

918) On average during a day, how many times does your husband smoke?

TIMES____
NOT SURE 98

919) Do you yourself currently smoke cigarettes or tobacco?

YES 1
NO 2 (GO TO 1001)

920) On average during a day, how many times do you smoke?

TIMES____
NOT SURE____

SECTION 10: WOMAN'S WORK AND DECISION MAKING

1001) 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 ever do any of these things or any other work?

YES 1
NO 2

1002) Are you currently doing any of these things or any other work?

YES 1 (GO TO 1004)
NO 2

1003) Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 1013)

1004) What is your occupation, that is, what kind of work do you mainly do?

RECORD ANSWER IN DETAIL

__________________

1005) Do you do this work for a member of your family, for someone else, or are you self-employed?

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

1006) CHECK 1004:

WORKS IN AGRICULTURE___
DOES NOT WORK IN AGRICULTURE___ (GO TO 1008)

1007) Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

1008) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF YEAR 2
ONCE IN AWHILE 3

1009) Are you paid in cash or do you earn both cash kind or are you not paid at all?

CASH 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 1012)
NOT PAID AT ALL 4 (GO TO 1012)

1010) CHECK 107:
CURRENTLY MARRIED__: Who mainly decides how money you earn will be used: you, your husband, you and your husband jointly, or someone else?

WIDOWED/DIVORCED/SEPARATED___: Who mainly decides how the money you earn will be used: you, someone else or you and someone else jointly?

RESPONDENT DECIDES 1
HUSBAND DECIDES 2
JOINTLY WITH HUSBAND 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

1011) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NON/HER INCOME IS SAVED 6

1012) Do you usually work at home or away from home?

HOME 1
AWAY 2

1013) Who in your family usually has the final on the following decisions:

Your own health care?
RESPONDENT 1
HUSBAND 2
RESP.AND HUSB JOINTLY 3
SOMEONE ELSE 4
RESP. AND SOME. JOINTLY 5
Making large household purchases?
RESPONDENT 1
HUSBAND 2
RESP.AND HUSB JOINTLY 3
SOMEONE ELSE 4
RESP. AND SOME. JOINTLY 5
Making household purchases for daily needs?
RESPONDENT 1
HUSBAND 2
RESP.AND HUSB JOINTLY 3
SOMEONE ELSE 4
RESP. AND SOME. JOINTLY 5
Visits to family, friends, or relatives?
RESPONDENT 1
HUSBAND 2
RESP.AND HUSB JOINTLY 3
SOMEONE ELSE 4
RESP. AND SOME. JOINTLY 5
What food should be cooked each day?
RESPONDENT 1
HUSBAND 2
RESP.AND HUSB JOINTLY 3
SOMEONE ELSE 4
RESP. AND SOME. JOINTLY 5

1014) CHECK 216:

HAS ONE OR MORE CHILDREN LIVING WITH HER___
HAS NO CHILDREN LIVING WITH HER___ (GO TO 1016)

1015) When your child (one of your children) is seriously ill, can you decide by yourself whether the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL ASK: If (your child/your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DON'T KNOW 8

1016) Many factors can keep a woman from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, would you consider each of the following to be a big problem for you?

Knowing where to go?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting permission to go?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money for treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not having health facility nearby?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having to find transport?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern there may not be a female provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1017) CHECK 112 AND 113:

PRIMARY OR LESS___
PREPARATORY OR HIGHER___ (GO TO 1020)

1018) Have you ever participated in a literacy program or any other program that involved learning to read or write (not including primary school)?

YES 1
NO 2

1019) Now I would like you to read out loud as much of this card as you can?
SHOW CARD TO RESPONDENT

CAN'T READ AT ALL 1
ABLE TO READ ONLY PART OF SENTENCES ON CARD 2
ABLE TO READ ALL OF CARD 3

1020) Do you usually read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

1021) Do you usually listen to the radio almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

1022) Do you usually watch television almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

1023) RECORD THE TIME

HOUR____
MONUTES_____

OBSERVATIONS

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 OR COLUMNS 1 AND 2 ALL MONTHS SHOULD BE FILLED IN

FORMATION TO BE CODED FOR EACH COLUMN
COLUMN 1: MARRIAGE
X MARRIED
0 NOT MARRIED

COLUMN 2: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
M MISCARRIAGE
A ABORTION
S STILL BIRTH
0 NO METHOD
1 PILL
2 IUD
3 INJECTIONS
4 NORPLANT
5 DIAPHRAGM/FOAM/JELLY
6 CONDOM
7 FEMALE STERILIZATION
8 MALE STERILIZATION
9 PERIODIC ABSTINENCE
L WITHDRAWAL
G PROLONGED BREASTFEEDING
X OTHER (SPECIFY)__________

COLUMN 3: SOURCE OF METHOD

1 URBAN HOSPITAL
2 URBAN HEALTH UNIT
3 RURAL HOSPITAL
4 RURAL HEALTH UNIT
5 MCH CENTER
6 MOBILE UNITS
7 OTHER MINISTRY OF HEALTH UNIT
8 TEACHING HOSPITAL
9 HEALTH INSURANCE ORGANIZATION
A CURATIVE CARE ORGANIZATION
B OTHER GOVERNMENTAL
C EGYPT FAMILY PLANNING ASSOCIATION
D CSI PROJECT
E OTHER NON-GOVERNMENTAL ORGANIZATION CLINIC
F PRIVATE HOSPITAL/CLINIC
G PRIVATE DOCTOR
H PHARMACY
I MOSQUE HEALTH UNIT
J CHURCH HEALTH UNIT
K OTHER VENDOR
L FRIENDS OR RELATIVES
X OTHER (SPECIFY)______
Y NO ONE
Z DON'T KNOW

COLUMN 4: DISCONTINUATION OF CONTRACEPTIVE USE

1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COST TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
U UNABLE TO GET PREGNANT/MENOPAUSE
D MARITAL DISSOLUTION/SEPARATION
I INFREQUENT SEX/HUSBAND AWAY
X OTHER (SPECIFY)____
Z DON'T KNOW

COLUMN 5: POST PARTUM AMENORRHEA

X PERIOD DID NOT RETURN
0 LESSTHAN ONE MONTH

COLUMN 6: BREAST FEEDING

X BREAST FEEDING
0 LESS THAN ONE MONTH
N NEVER BREASTFED

BIRTHDATE: LAST CHILD BORN PRIOR TO JANUARY 1995
NAME___
MONTH_____
YEAR______