IDENTIFICATION

GOVERNORATE

PSU/SEGMENT NO.

KISM/MARQAZ

BUILDING NO.

SHIAKHA/VILLAGE

HOUSING UNIT NO.

HOUSEHOLD NO. INSIDE SEGMENT.

NAME OF HOUSEHOLD HEAD

ADDRESS IN DETAIL

NAME OF WOMAN

LINE NUMBER OF WOMAN

INTERVIEWER VISITS

DATE

TEAM

INTERVIEWER

SUPERVISOR ASSISTANT

SUPERVISOR

RESULT

RESULT CODES:

NEXT VISIT:

DATE

TIME

FINAL VISIT

DAY
MONTH
YEAR

TEAM

INTERVIEWER

SUPERVISOR ASSISTANT

SUPERVISOR

RESULT

FIELD EDITOR

NAME
DATE
SIGNATURE

OFFICE EDITOR

NAME
DATE
SIGNATURE

CODER

NAME
DATE
SIGNATURE

KEYER

NAME
DATE
SIGNATURE

SECTION 1: 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. 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. We also may return later to interview you or other members of your household again. 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?

101. RECORD THE TIME.

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 in a village?

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

IF LESS THAN ONE YEAR RECORD "00".

104. Just before you moved here, did you live in Cairo, Giza, Alexandria, another city or town or in a village?

105. In what month and year were you born?

106. How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107. What is your current marital status?

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

109. CHECK 108:

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

MARRIED MORE THAN ONCE: 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?

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

111. CHECK 108:

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

MARRIED MORE THAN ONE TIME: In what month and year did you start living with your first husband?

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

113. DETERMINE MONTHS MARRIED SINCE JANUARY 1998. ENTER "X" IN COLUMN 1 OF THE CALENDAR FOR EACH MONTH MARRIED, AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE JANUARY 1998.

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 SINCE JANUARY 1998.

114. Have you ever attended school?

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

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

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?

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

203. How many sons live with you?

And how many daughters live with you?

IF NONE RECORD "00".

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

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".

206. Have you ever given birth to a boy or a girl who has born alive but later died?

IF NO, PROBE: Any baby who cried or showed any sign of live but only survived a few hours or days?

207. In all, how many boys have died?

And how many girls have died?

IF NONE RECORD "00".

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

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

210. CHECK 208:

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 TWINS AND TRIPLETS ON SEPARATE LINES AND MARK WITH A BRACKET. COMPLETE 213-221 FOR EACH BIRTH. USE ADDITIONAL FORMS IF THERE ARE MORE THAN TEN BIRTHS. AFTER COMPLETING ALL BIRTHS. GO TO 222.

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

213. RECORD SINGLE OF MULTIPLE STATUS.

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

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

216. Is (NAME) still alive?

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

218. Is (NAME) living with you?

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

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 ONE MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

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

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

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

NUMBERS ARE SAME: CHECK:

FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED__
FOR EACH BIRTH SINCE JANUARY 1998: MONTH AND 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 DETERMINE EXACT NUMBER OF MONTHS__

NUMBERS ARE DIFFERENT: PROBE AND RECONCILE

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1998. IF NONE, RECORD "0" AND GO TO 226.

225. FOR EACH BIRTH SINCE JANUARY 1998, ENTER "B" IN THE MONTH OF BIRTH IN COLUMN 2 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. ALSO ENTER THE MONTH AND YEAR OF THE MOST RECENT BIRTH PRIOR TO JANUARY 1998 (IF ANY) AT THE BOTTOM OF THE CALENDAR 1201).

226. Are you pregnant right now?

227. How many months pregnant are you? RECORD IN COMPLETED MONTHS.

228. RECORD MONTHS PREGNANT IN COMPLETED MONTHS. ENTER "P" IN COLUMN 2 OF CALENDAR FOR THE TOTAL NUMBER OF COMPLETED PREGNANCY MONTHS, BEGINNING WITH 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?

230. Unfortunately many women have pregnancies that do not end in a live birth. Sometimes a baby is still born, 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 STILL BIRTHS, MISCARRIAGES, OR ABORTIONS BACK TO JANUARY 1998. 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: ("B" FOR STILL BIRTH, "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: SINCE THE OUTCOME OF THE PREGNANCY IS RECORDED IN THE MONTH THAT PREGNANCY ENDED, 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 still birth 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 BIRTH AND PRIOR BIRTH: Did you have any pregnancy that ended in a still birth between (NAME OF NEXT TO 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 still birth 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 still birth? 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 still birth? IF YES: When did the last still birth 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. When did your last menstrual period start?

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 woman can take a pill every day.

02. IUD: A woman can have a loop or coil placed inside her by a doctor or a nurse.

03. INJECTABLES: A woman can have an injection by a doctor or a nurse which stops her from becoming pregnant for several months.

04. IMPLANT: A woman can have small rod(s) placed in her arm by a doctor which stops her from becoming pregnant for several years.

05. DIAPHRAGM, FOAM, JELLY: A woman can place a sponge, suppository, diaphragm, jelly or cream inside her vagina before intercourse.

06. CONDOM: A man can use a rubber covering during sexual intercourse.

07. FEMALE STERILIZATION: A woman can have an operation to avoid having any more children.

08. MALE STERILIZATION: A man can have an operation to avoid having any more children.

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.

10. WITHDRAWAL: A man can be careful and pull out before ejaculation.

11. PROLONGED BREASTFEEDING: A woman can prolong the time that she breastfeeds her baby to delay the next pregnancy.

12. Have you heard of any other ways or methods that a woman or man can use to avoid pregnancy?

SPECIFY_____________

303. Have you ever used (METHOD)?

01 PILL: A woman can take a pill every day.

02. IUD: A woman can have a loop or coil placed inside her by a doctor or a nurse.

03. INJECTABLES: A woman can have an injection by a doctor or a nurse which stops her from becoming pregnant for several months.

04. IMPLANT: A woman can have small rod(s) placed in her arm by a doctor which stops her from becoming pregnant for several years.

05. DIAPHRAGM, FOAM, JELLY: A woman can place a sponge, suppository, diaphragm, jelly or cream inside her vagina before intercourse.

06. CONDOM: A man can use a rubber covering during sexual intercourse.

07. FEMALE STERILIZATION: Have you ever had an operation to avoid having any more children?

08. MALE STERILIZATION: Have you ever had a husband who had an operation to avoid having children?

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.

10. WITHDRAWAL: A man can be careful and pull out before ejaculation.

11. PROLONGED BREASTFEEDING: A woman can prolong the time that she breastfeeds her baby to delay the next pregnancy.

12. Have you heard of any other ways or methods that a woman or man can use to avoid pregnancy?

SPECIFY_____________

304. CHECK 303:

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

306. ENTER "0" IN COULMN 2 OF CALENDER IN EACH BLANK MONTH.

307. What have you used or done? CORRECT 303-304 (AND 302 IF NECESSARY).

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"

309. CHECK 303 (FEMALE STERILIZATION):

310. CHECK 107:

311. CHECK 226:

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

313. Which method are you using?

313A. CIRCLE "7" FOR FEMALE STERILIZATION

IF THE RESPONDENT MENTIONED MORE THAN ONE METHOD RECORD THE HIGHEST CODE.

314. CHECK 313: In what month and year did you start using (CURRENT METHOD) continuously this time? PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

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

315. IN CURRENT MONTH IN COLUMN 2 IN CALENDAR, ENTER CODE THE METHOD CIRCLED IN Q.313 THEN ENTER METHOD CODE IN EACH MONTH OF USE BACK TO THE DATE THE WOMAN BEGAN THE CURRENT SEGMENT OR TO JANUARY 1998 IF THE CURRENT SEGMENT OF USE BEGAN BEFORE JANUARY 1998.

316. CHECK 313:

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)?

USING IUD: Where did you have the IUD inserted?

USING IMPLANT: Where did you have the implant inserted?

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

USING PERIODIC ABSTINENCE, WITHDRAWAL, PROLONGED BREASTFEEDING OR OTHER: 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.

317. CHECK 313 AND CALENDAR:

318. 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 316) or did you buy it from somewhere else?

319. 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.

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

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

322. Would you be willing to pay the following for an IUD (including all costs)?

IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 338. FOR AMOUNT MORE THAN 200 POUNDS, RECORD YES OR NO AND GO TO 338.

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

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

325. How much does one cycle of pills cost?

326. Would you be willing to pay the following for a cycle of pills?

IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 333. AFTER ASKING ABOUT AMOUNT MORE THAN 5 POUNDS, RECORD YES OR NO AND GO TO 333.

327. How frequently do you take the injection you are using now?

328. How much did you pay the last time you got the injection?

329. Would you be willing to pay the following for the injectables (including all costs)?

IF YES, CONTINUE WITH NEXT AMOUND. IF NO GO TO 333. AFTER ASKING ABOUT AMOUNT MORE THAN 20, RECORD YES OR NO AND GO TO 333.)

330. How many implant rods were inserted?

331. How much did it cost you to get the implant rod(s) inserted?

332. How much did it cost you to obtain/get advice about the (METHOD IN 313) at (SOURCE IN 316)?

333. CHECK 316 AND RECORD SOURCE WHERE METHOD WAS OBTAINED.

334. At any time when you went to the pharmacy during this current period of use, were you told about side effects or health problems you might have with the (METHOD IN 313)?

335. Were you told at the pharmacy what to do if you experienced side effects or health problems?

336. Were you told at the pharmacy about other methods of family planning which you could use?

337. Were you told at the pharmacy how to use the (METHOD IN 313)?

338. You obtained (METHOD IN 313) from (SOURCE IN 316). When you got the (METHOD) were you told about other methods of family planning which you could use?

339. At any other time, did a family planning or health worker tell you about other methods of family planning which you could use?

340. When you got the (METHOD IN 313) this time, were you told about the side effects or problems you might have with the (METHOD)?

341. At any other time, did a family planning or health worker tell you about side effects or problems you might have from (METHOD IN 313)?

342. Were you told what to do if you experienced side effects or health problems?

343. 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 1998

PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT PERIOD OF USE AND GOING BACK TO JANUARY 1998. 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.

ILLUSTRATTIVE 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 344.

COLUMN 3 - REASON FOR DISCONTINUATION

FOR EACH PERIOD OF USE, ASK WHY SHE STOPPED USING THE METHOD AND RECORD THE REASON FOR DISCONTINUATION IN COLUMN 3 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 FOR COLUMN 3

-Why did you stop using (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 3 MUST BE THE SAME AS THE NUMBER OF COMPLETE SEGMENTS OF CONTRACEPTIVE USE IN COLUMN 2.

344. Have you ever heard (know) of "premarital examination" that is a consultation with a doctor or other staff as part of the preparation for marriage?

345. Before you married (for the first time) did you have a premarital examination?

346. Was family planning discussed during the premarital consultation?

347. In the last 6 months have you heard, seen, or received any information about family planning?

348. What was the last source you got information from?

SECTION 4: FERTILITY PREFERENCES AND ATTITUDES ABOUT FAMILY PLANNING

401. CHECK 107:

402. CHECK 313:

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?

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?

405. CHECK 226:

406. CHECK 312:

407. CHECK 403:

408. CHECK 404:

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?

410. CHECK 312:

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

412. Where is that?

WRITE THE NAME AND 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.

413. Do you think you will use a method at any time in the future?

414. Which method would you prefer to use?

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

416. CHECK 203 AND 205:

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

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

417. 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 to be a boy or girl?

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

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

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

421. Now I would like to ask about your opinion about family planning. Would you say that most, some, very few, or none of the couples use family planning in the reproductive ages living in this area?

422. Do you think the number of couples using family planning in this area is increasing, decreasing or staying about the same?

422A. CHECK 107:

423. 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?

424. Have you visited any governmental health facility for any reason during the past six months?

425. Did any staff member at this health facility speak to you about family planning methods?

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

427. Did the doctor or any staff person there speak to you about family planning methods?

428. CHECK 302:

429. 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?

SECTION 5: PREGNANCY AND BREASTFEEDING

501. CHECK 224:

502. ENTER THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998 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:

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 you not want (more) children at all?

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

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.

508. Where did you receive the antenatal care? RECORD ALL PLACED.

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

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

511. CHECK 510: NUMBER OF RECEIVED ANTENATAL CARE

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

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?

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

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

516. When you received the tetanus toxoid injection, did anyone tell you that you should go for (other) antenatal care?

517. At that time, did anyone talk to you about family planning?

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.

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

520. CHECK Q.507: HAD ANTENATAL CARE

521. Did you seek this care because you thought there was a problem with the pregnancy?

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

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

524. CHECK IF THE RESPONDENT HAD:

525. CHECK Q. 524:

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

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

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

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

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

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

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

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

533. Was (NAME) delivered normal or caesarean?

534. In the first two months after (NAME) was born, did a doctor, nurse or other health worker or the daya check on your house?

535. How many days or weeks after the delivery did the first check take place?

536. Who checked on your health for the first time?

537. Where did this first check take place?

538. In the first two month after delivery, did you receive a Vitamin A dose (red/blue capsule)? SHOW CAPSULE.

539. In the first two months after (NAME)'s delivery, did a doctor, nurse or other health worker check on his/her health?

540. How many days or weeks after the delivery did the first check take place?

541. Where did this first check take place?

541A. During the two weeks after the birth was a sample of blood take from the baby's heel?

541B. Where did this first check take place?

542. Has your period returned since the birth of (NAME)?

543. ENTER "X" IN COL. 4 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH. (OR TO CURRENT PREGNANCY)

GO TO 545.

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

ENTER "X" IN COL. 4 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS WITHOUT A PERIOD (OR UP TO THE NEXT PREGNANCY, STARTING IN THE MONTH AFTER BIRTH. IF LESS THAN ONE MONTH WITHOUT A PERIOD, ENTER "O" IN COL. 4 IN MONTH AFTER BIRTH.

545. CHECK 226: RESPONDENT PREGNANT?

546. Have you resumed sexual relations since the birth of (NAME)?

547. How long after the birth of (NAME) did you not have sexual relations? RECORD PERIOD IN DAYS IF LESS THAN ONE MONTH AND IN MONTHS OTHERWISE.

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

549. Who gave you this advice? RECORD ALL MENTIONED.

550. At the time you were pregnant with (NAME) or after you delivered, did anyone give you advice about family planning?

551. Who gave you this advice? RECORD ALL MENTIONED.

552. Did you ever breastfeed (NAME)?

553. ENTER "N" IN COL. 5 OF CALENDAR IN MONTH AFTER BIRTH. THEN GO TO 560.

554. How long after birth did you first but (NAME) to the breast?

IF LESS THAN 1 HOUR RECORD '00' HOURS. IF LESS THAN 24 HOURS RECORD HOURS. OTHERWISE, RECORD DAYS.

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

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

557. CHECK 504 OR 216: CHILD ALIVE?

558. Are you still breastfeeding (NAME)?

559. 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. THEN GO TO 560. IF LESS THAN A MONTH ENTER "0" IN THE MONTH AFTER BIRTH.

560. Why did you (never/stop) breastfeeding (NAME)?

561. CHECK 504 OR 216:

562. ENTER "X" IN COL. 5 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH.

563. How many times did you breastfeed (NAME) last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

564. How many times did you breastfeed (NAME) yesterday during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

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

567. CHECK 566: FOOD OR LIQUID GIVEN YESTERDAY?

568. (Aside from breastfeeding and other liquids), how many times did (NAME) eat yesterday, (INCLUDING BOTH MEALS AND SNACKS)?

IF 7 OR MORE TIMES, RECORD '7'.

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

570. 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 1998 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:

604. Do you have a birth certificate for (NAME)? IF YES: May I see it?

CHECK THE CERTIFICATE AND INDICATE WHETHER VACCINATION DATES ARE RECORDED ON THE CERTIFICATE OR NOT.

605. Did you ever have a birth certificate for (NAME)?

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.

607. Has (NAME) received any vaccination that is not recorded on the certificate?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT, POLIO, MEASLES, HEPATITIS B1-B3 AND MMR. (IN CASE OF POLIO, DPT, HEPATITIS, PROBE CAREFULLY TO BE SURE THAT CHILD RECEIVED THE VACCINATIONS WITH NO RECORD).

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

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

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.

611. Has (NAME) received any vaccinations that are not recorded on this health card?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT, POLIO, MEASLES, HEPATITIS B1-B3 AND MMR. (IN CASE OF POLIO, DPT, HEPATITIS, PROBE CAREFULLY TO BE SURE THAT THE CHILD RECIEVED THE VACCINATIONS IN FRONT OF THE VACCINATIONS WITH NO RECORD)

(GO TO 615)

612. CHECK 604 AND 608:

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

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

IF DON'T KNOW NUMBER OF TIMES, RECORD 8 IN BOX.

IF DON'T KNOW NUMBER OF TIMES, RECORD 8 IN BOX.

615. Did (NAME) receive a vitamin A blue capsule that is taken at 9 and 18 months? SHOW CAPSULE.

616. At any time when you took your child for these immunizations, did anyone talk to you about family planning?

617. Did anyone talk to you about any other health services (nutrition/antenatal care)?

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

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

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

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

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

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

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

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, about the same amount, or more than usual to drink?

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

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

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

627. Was (NAME) given a fluid mad from a special pack called mahloul moalget el-gaffaf to drink?

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

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

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

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

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

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

634. CHECK 627, ALL COLUMNS:

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

636. Now I would like to ask about your opinion about how many pregnant women living in this area receive antenatal care. Would you say that most, some, very few, or none of pregnant women go for antenatal care?

637. Do you think the number of women in this area receiving antenatal care is increasing, decreasing, or staying about the same?

638. In the last 6 months have you heard, seen, or received any information about the warning or danger signs women should be aware of in order to have a safe pregnancy?

639. What was the last source you got information from?

SECTION 7: INFECTIOUS DESEASES

701. Now I would like to talk about something else. Have you ever heard about AIDS disease?

702. From where did you last see or hear about HIV/AIDS?

703. Do you know of ways in which a person can be infected with the virus causing AIDS?

704. Please name me at least two ways in which a person can be infected with AIDS. RECORD ALL WAYS OF INFECTION THE RESPONDENT NAMES.

705. Have you ever heard about Hepatitis C?

706. From where did you last see or hear about the Hepatitis C virus?

707. Do you know of ways in which a person can be infected with the Hepatitis C virus?

708. Please name me at least two ways in which a person can be infected with the Hepatitis C virus. RECORD ALL WAYS OF INFECTION THE RESPONDENT NAMES.

709. In the last 6 months have you heard, seen, or received any information about what people should do to be sure that injections are given safely?

710. What did you hear?

711. What was the last source you got information from?

SECTION 8: FEMALE CIRCUMCISION

801. Did you ever hear about female circumcision?

802. Are you yourself circumcised?

803. CHECK 214 AND 216:

804. Has your daughter been circumcised? IF YES, RECORD 01 IN THE BOXES. IF NO, CIRCLE 95.

804A. How many of your daughters have been circumcised? RECORD NUMBER IN THE BOXES. IF NONE, CIRCLE 95.

805. Do you intend to have your daughter/any (other) of your daughters circumcised?

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

807. Do you think that this practice should be continued or should it be discontinued?

808. During the past year, have you heard or seen anything about female circumcision:

809. During the past year have you discussed female circumcision with your relatives, friends or neighbours?

810. I will read you some statements. Please tell me if you agree or disagree:

SECTION 9: HUSBAND'S BACKGROUND

901. CHECK 107:

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

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

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

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

906. What type of relationship was it?

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

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

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

910. CHECK 107:

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

912. CHECK 911:

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?

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

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

915. CHECK 912:

916. (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?

SECTION 10: WOMAN'S WORK

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?

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

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

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

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

1006. CHECK 1004:

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?

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

1009. Are you paid in cash, in both cash and kind, in kind only or are you not paid at all?

1010. CHECK 114 AND 115:

1011. Have you ever participated in a literacy program or any other program that involved learning to read or write (not including primary school)?

1012. Now I would like you to read out loudly as much of this card as you can. SHOW CARD TO RESPONDENT.

1013. 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?

1014. Do you usually listen to the radio almost every day, at least once a week, less than once a week or not at all?

1015. Do you usually watch television almost every day, at least once a week, less than once a week or not at all?

1016. THANK YOU FOR TAKING THE TIME TO ANSWER THESE QUESTIONS. WE MAY RETURN TO INTERVIEW YOU HOUSEHOLD IN THE FUTURE AND WE HOPE YOU WILL AGREE TO PARTICIPATE AGAIN AT THAT TIME.

1017. RECORD THE TIME.

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.

1102. INTERVIEWER'S COMMENTS:

___________________________

1103. FIELD EDITOR'S COMMENTS:

____________________________

1104. SUPERVISOR'S COMMENTS:

____________________________

1105. OFFICE EDITOR'S COMMENTS:

____________________________

INSTRUCTIONS:

1. ONLY ONE CODE SHOULD APPEAR IN ANY BOX
2. FOR COLUMNS 1 AND 2 ALL MONTHS SHOULD BE FILLED IN

INFORMATION TO BE CODED FOR EACH COLUMN:

COLUMN 1: MARRIAGE

COLUMN 2: BIRTH, PREGNANCIES, CONTRACEPTIVE

COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE

COLUMN 4: POST PARTUM AMENORRHEA

COLUMN 5: BREAST FEEDING