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EVER-MARRIED WOMAN QUESTIONNAIRE 2008

WOMAN QUESTIONNAIRE

IDENTIFICATION
GOVERNORATE __________
PSU/SEGMENT NO. _____________
KISM/MARKAZ __________
BUILDING NO. ________________
SHIAKHA/VILLAGE __________
HOUSING UNIT NO___________
HOUSEHOLD NUMBER ___________

URBAN/RURAL

URBAN 1
RURAL 2

LOCALITY

LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4

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

GOVERNORATE_____
PSU/SEGMENT NO.____
HOUSEHOLD NO. _____

LINE NUMBER____

INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER _____
SUPERVISOR _____
RESULT ______

NEXT VISIT :
DATE _____
TIME ________

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
TEAM ____
INT. NUMBER _____
SUP. NUMBER _____
RESULT _____

TOTAL NUMBER OF VISITS ____

RESULT CODES:

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

FIELD EDITOR
NAME _______
DATE _______
SIGNATURE _______

OFFICE EDITOR
NAME _______
DATE _______
SIGNATURE _______

CODER
NAME _______
DATE _______
SIGNATURE _______

KEYER
NAME _______
DATE _______
SIGNATURE _______

SECTION 1. RESPONDENT'S BACKGROUND

INFORMED CONSENT

Hello. My name is _______________________________________ and I am working with the 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 this 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 this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this 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: _______________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . 2 (GO TO 1101)

101. RECORD THE TIME.

HOUR __
MINUTES __

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

YEARS __
ALWAYS 95 (Go to 104)
VISITOR/TEMPORARY STAYING 96 (Go to 104)

103. Just before you moved here, did you live in Cairo, Giza, Alexandria, in 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: GOVERNORATE CODE ____

104. In what month and year were you born?

MONTH __
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

105. How old were you at your last birthday?
COMPARE AND CORRECT 104 AND/OR 105 IF INCONSISTENT.

AGE IN COMPLETED YEARS __

106. What is your current marital status?

MARRIED 1
WIDOWED 2
DIVORCED 3
SEPARATED 4

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

NUMBER OF TIMES MARRIED ___

108. CHECK 107:

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

MARRIED MORE THAN ONCE: Now I 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 110)
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS __

110. CHECK 107:

MARRIED ONLY ONCE: In what month and year did you starting living together with your husband?

MARRIED MORE THAN ONCE: Now I would like to ask about your first husband. In what month and year did you start living together with your first husband?

MONTH __
DON'T KNOW MONTH 98
YEAR ____ (Go to 112)
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS __

112. DETERMINE ALL OF THE MONTHS SINCE JANUARY 2003 THAT THE RESPONDENT WAS MARRIED. ENTER 'X' IN COLUMN 1 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER 'O' FOR EACH MONTH NOT MARRIED, SINCE JANUARY 2003.

FOR WOMEN WHO ARE NOT CURRENTLY MARRIED OR WHO HAVE MARRIED MORE THAN ONCE: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS SINCE JANUARY 2003.

113. Have you ever attended school?

YES 1
NO 2 (Go to 117)

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

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

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

GRADE __

116. CHECK 114:

PRIMARY (Go to 117)
PREPARATORY OR HIGHER (Go to 118)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (Go to 119)

118. Do you 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

119. Do you 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

120. Do you 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

121. What is your religion?

MUSLEM 1
CHRISTIAN 2
OTHER (SPECIFY) _______6

SECTION 2.REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (Go to 206)

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

YES 1
NO 2 (Go to 204)

203. How many sons live with you? And how many daughters live with you? IF NONE, RECORD '00'.

SONS AT HOME __
DAUGHTERS AT HOME __

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

YES 1
NO 2 (Go to 206)

205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE, RECORD '00'.

SONS ELSEWHERE __
DAUGHTERS ELSEWHERE __

206. Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (Go to 208)

207. How many boys have died? And how many girls have died? IF NONE, RECORD '00'.

BOYS DEAD __
GIRLS DEAD __

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

TOTAL __

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

YES (Go to 210)
NO (PROBE AND CORRECT 201-209 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (Go to 211)
NO BIRTHS (Go to 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 LINES AND MARK WITH A BRACKET.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).

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

(NAME) ___________

213. Is (NAME) single or twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH __________
YEAR __________
OR SEASON _______

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 HOUSEHOLD)

HH LINE NO. ___ (GO TO 221)

220. IF DEAD: How old was (NAME) when he/she died? IF '1 YR', PROBE: How many months old was (NAME) when he/she died?
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) including any children who died after birth?

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.

YES 1 (ADD TO TABLE)
NO 2

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

NUMBERS ARE SAME (Go to CHECK)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. __
FOR EACH BIRTH SINCE JANUARY 2003: MONTH AND YEAR OF BIRTH 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. __

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 2003 OR LATER.
IF NONE, RECORD '0' AND GO TO 225a.

_____

225. FOR EACH BIRTH SINCE JANUARY 2003, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 2 OF THE CALENDAR.

FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF 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.

225a. ENTER THE MONTH AND YEAR OF THE MOST RECENT BIRTH PRIOR TO JANUARY 2003 IN THE BOXES AT THE BOTTOM OF THE CALENDAR.

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 NUMBER OF COMPLETED MONTHS.

MONTHS __

228. ENTER 'P's IN COLUMN 2 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF MONTHS OF THE CURRENT PREGNANCY COMPLETED.

229. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children 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 still born, that is, the baby is born who does not breath 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 2003.

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 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 AND PRIOR BIRTH
Did you have any pregnancy that ended in a still birth 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 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. Did you have any (other) pregnancies before January 2003 that did not result in a live birth (pregnancy that ended in a still birth, miscarriage or abortion)?

YES 1
NO 2

232. RECORD IN THE BOXES AT THE BOTTOM OF THE CALENDAR THE OUTCOME AND MONTH AND YEAR THAT THE PREGNANCY TERMINATED FOR THE LAST PREGNANCY THAT ENDED IN A STILL BIRTH, MISCARRIAGE, OR ABORTION PRIOR TO JANAURY 2003.
IF NONE RECODE '0' IN OUTCOME.

233. When did your last menstrual period start?

DATE, IF GIVEN ___________
DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

234. From one menstrual period to the next, are there certain days 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)

235. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY)_________ 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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.

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, 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.

302. Which ways or methods have you heard about?

FOR METHODS NOT MENTIONED, ASK: Have you ever heard of (METHOD)?

METHOD 01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1 (GO TO QUESTION 303 METHOD 01)
NO 2 (GO TO METHOD 02)
METHOD 02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1 (GO TO QUESTION 303 METHOD02)
NO 2 (GO TO METHOD 03)
METHOD 03 PILL Women can take a pill every day.
YES 1 (GO TO QUESTION 303 METHOD 03)
NO 2 (GO TO METHOD 04)
METHOD 04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1 (GO TO QUESTION 303 METHOD 04)
NO 2 (GO TO METHOD 05)
METHOD 05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1 (GO TO QUESTION 303 METHOD 05)
NO 2 (GO TO METHOD 06)
METHOD 06 IMPLANTS Women can have small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1 (GO TO QUESTION 303 METHOD 06)
NO 2 (GO TO METHOD 07)
METHOD 07 CONDOM Men can use a rubber covering during sexual intercourse.
YES 1 (GO TO QUESTION 303 METHOD 07)
NO 2 (GO TO METHOD 08)
METHOD 08 DIAPHRAGM, FOAM, JELLY A woman can place a sponge suppository, diaphragm, jelly or cream inside her vagina before intercourse.
YES 1 (GO TO QUESTION 303 METHOD 08)
NO 2 (GO TO METHOD 09)
METHOD 09 RHYTHM METHOD A couple can avoid having intercourse on the days of the month the woman is most to get pregnant.
YES 1 (GO TO QUESTION 303 METHOD 09)
NO 2 (GO TO METHOD 10)
METHOD 10 WITHDRAWAL Men can be careful and pull out before ejaculation.
YES 1 (GO TO QUESTION 303 METHOD 10)
NO 2 (GO TO METHOD 11)
METHOD 11 PROLONGED BREASTFEEDING Women can prolong the time that she breastfeeds her baby to delay the next pregnancy.
YES 1 (GO TO QUESTION 303 METHOD 11)
NO 2 (GO TO METHOD 12)
METHOD 12 EMERGENCY CONTRACEPTION Women can prevent after having sexual intercourse within five days by taking one or two doses of pills.
YES 1 (GO TO QUESTION 303 METHOD 12)
NO 2 (GO TO METHOD 13)
METHOD 13 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES
(SPECIFY) __________ 1
NO (SPECIFY) ___________ 2

303. Have you ever used (METHOD)?

METHOD 01 FEMALE STERILIZATION
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 02 MALE STERILIZATION
Have you ever had a husband who had an operation to avoid having any more children?
YES 1
NO 2
METHOD 03 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 06 IMPLANTS Women can have small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
METHOD 07 CONDOM Men can use a rubber covering during sexual intercourse.
YES 1
NO 2
METHOD 08 DIAPHRAGM, FOAM, JELLY A woman can place a sponge suppository, diaphragm, jelly or cream inside her vagina before intercourse.
YES 1
NO 2
METHOD 09 RHYTHM METHOD A couple can avoid having intercourse on the days of the month the woman is most to get pregnant.
YES 1
NO 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before ejaculation.
YES 1
NO 2
METHOD 11 PROLONGED BREASTFEEDING
YES 1
NO 2
METHOD 12 EMERGENCY CONTRACEPTION Women can prevent after having sexual intercourse within five days by taking one or two doses of pills.
YES 1
NO 2
METHOD 13 OTHER METHODS
OTHER METHOD 1
YES 1
NO 2

304. CHECK 303:

NOT A SINGLE "YES"(NEVER USED) (GO TO 305)
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 CALENDAR IN EACH BLANK MONTH. (GO TO 341)

307. What have you used or done?
CORRECT 302 AND 303 IF NECESSARY.

_________ (SPECIFY)

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

NUMBER OF CHILDREN __

309. CHECK 303 (01 - FEMALE STERILIZATION):

WOMAN NOT STERILIZED (GO TO 310)
WOMAN STERILIZED (GO TO 313A)

310. CHECK 106: MARITAL STATUS

CURRENTLY MARRIED (GO TO 311)
WIDOWED/ DIVORCED/ SEPARATED (GO TO 340)

311. CHECK 226: CURRENTLY PREGNANT

NOT PREGNANT OR UNSURE (GO TO 312)
PREGNANT (GO TO 340)

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

YES 1
NO 2 (GO TO 340)

313. Which method are you using? CIRCLE ALL MENTIONED.
313A. CIRCLE 'C' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION C
MALE STERILIZATION D
PILL E (GO TO 315A)
IUD F (GO TO 315A)
INJECTABLES G (GO TO 315A)
IMPLANTS H (GO TO 315A)
CONDOM I (GO TO 315A)
DIAPHRAGM/FOAM/JELLY K (GO TO 315A)
RHYTHM METHOD N (GO TO 315A)
WITHDRAWAL R (GO TO 315A)
PROLONGED BREASTFEEDING T (GO TO 315A)
OTHER (SPECIFY) __________ X (GO TO 315A)

314. CHECK 313/313A:
FEMALE STERILIZATION CODE "C" CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

MALE STERILIZATION CODE "D" CIRCLED: Before the sterilization operation, was your husband told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

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

315A. IF MORE THAN ONE METHOD RECORDED IN 313, ASK FOR METHOD HIGHEST ON LIST: In what month and year did you start using (CURRENT METHOD) continuously?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH __
YEAR ____

316. CHECK 315/315A, 215, AND THE CALENDAR:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 315/315A.

YES (GO BACK TO 315/315A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD) (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
NO (GO TO 317)

317. CHECK 315/315A:
YEAR IS 2003 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF
INTERVIEW IN COLUMN 2 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.

YEAR IS 2002 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 2 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 2003.

318. CHECK 313/313A:
CIRCLE METHOD CODE. IF MORE THAN ONE METHOD CODE CIRCLED IN 313/313A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION C
MALE STERILIZATION D
PILL E (GO TO 321)
IUD F
INJECTABLES G (GO TO 321)
IMPLANTS H
CONDOM I (GO TO 321)
DIAPHRAGM/FOAM/JELLY/CREAM K (GO TO 321)
RHYTHM METHOD N
WITHDRAWAL R
PROLONGED BREASTFEEDING T
OTHER METHOD (SPECIFY) ____________ X

319. CHECK 313/313A
IF MORE THAN ONE METHOD RECORDED IN 313/313A, CHECK AND ASK ABOUT METHOD HIGHEST ON THE LIST.

F/M STERIL. Where did the sterilization take place?
IUD Where did you have the IUD inserted?
IMPLANT Where did you have the implant inserted?
RHYTHM/WITHDRAWL/PRLNG.BR./OTHER Did you obtain about how to use (METHOD) at the time you began this current segment of use? If yes, from where did you get the advice?

IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME AND ADDRESS OF PLACE)____________

FOR OFFICE USE:

SOURCE CODE _____________
MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 1
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL 8
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOC D
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC G
PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE
MOSQUE HEALTH UNIT J
CHURCH HEALTH UNIT K
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) L
FRIEND/RELATIVE M
OTHER (SPECIFY) __________ X
NO ONE Y

320. CHECK 315/315A

YEAR IS 2003 OR LATER: ENTER SOURCE CODE FROM 319 IN COLUMN 3 OF
CALENDAR IN THE MONTH AND YEAR IN WHICH THE CURRENT SEGMENT OF USE BEGAN AND WRITE SOURCE NAME TO THE RIGHT OF THE CODE. THEN GO TO 326.

YEAR IS 2002 OR EARLIER: GO TO 326.

321. CHECK 313/313A
IF MORE THAN ONE METHOD RECORDED IN 313/313A, CHECK AND ASK ABOUT METHOD HIGHEST ON THE LIST.

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

INJECTION___: Where did you go for your last injection?

M CONDOM/DIAPHRAGM/FOAM/JELLY/CREAM___: From where did you obtain your most recent supply of (METHOD)?

IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND ADDRESS OF PLACE ________________________

FOR OFFICE USE:
SOURCE CODE _________________________

MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 1
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL 8
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOC D
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC G
PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE
MOSQUE HEALTH UNIT J
CHURCH HEALTH UNIT K
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) L
FRIEND/RELATIVE M
OTHER (SPECIFY)___________ X
DON'T KNOW Z

322. At the time you began this current period of use of (METHOD), did you obtain or consult about (METHOD) at (SOURCE IN 321) or did you go somewhere else?

YES, SAME PLACE 1
NO, SOMEWHERE ELSE 2 (GO TO 324)

323. CHECK 315/315A
YEAR IS 2003 OR LATER: ENTER SOURCE CODE FROM 321 IN COLUMN 3 OF CALENDAR IN THE MONTH AND YEAR IN WHICH THE CURRENT SEGMENT OF USE BEGAN AND WRITE SOURCE NAME TO THE RIGHT OF THE CODE. THEN GO TO 326.

YEAR IS 2002 OR EARLIER GO TO 326.

324. Where did you first obtain/get advice about (METHOD) during your current period of use? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND ADDRESS OF PLACE ____________

FOR OFFICE USE:
SOURCE CODE___________________

MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 1
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL 8
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOC D
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC G
PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE
MOSQUE HEALTH UNIT J
CHURCH HEALTH UNIT K
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) L
FRIEND/RELATIVE M
OTHER (SPECIFY)___________ X
DON'T KNOW Z

325. CHECK 315/315A
YEAR IS 2003 OR LATER: ENTER SOURCE CODE FROM 324 IN COLUMN 3 OF
CALENDAR IN THE MONTH AND YEAR IN WHICH THE CURRENT SEGMENT OF USE BEGAN AND WRITE SOURCE NAME TO THE RIGHT OF THE CODE. THEN CONTINUE WITH 326.

YEAR IS 2002 OR EARLIER GO TO 326

326. When you got (METHOD) at (SOURCE IN 319/321 or 324) were you told about side effects or problems you might have with this method?

YES 1 (GO TO 328)
NO 2
NO SOURCE/RELATIVE/FRIEND 3

327. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 329)

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

YES 1
NO 2

329. When you got (METHOD) at (SOURCE IN 319/321 or 324), were you told about other methods of family planning?

YES 1 (GO TO 331)
NO 2
NO SOURCE/RELATIVE/FRIEND 3

330. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

331. CHECK 313/313A:
USING FEMALE/MALE STERILIZATION: How much did you (your husband) pay in total for the sterilization, including any consultation you may have had?

USING OTHER METHOD: The last time you obtained (CURRENT METHOD) how much did you pay in total, including the cost of the (CURRENT METHOD) and any consultation you may have had?

COST ____(IN POUNDS)
FREE 9995 (Go to 333)
NO SOURCE/RELATIVE/FRIEND 9997 (GO TO 333)
DON'T KNOW 9998

332. CHECK 313/313A:
USING FEMALE/MALE STERILIZATION: Did you have any problem in affording the cost of the sterilization?

USING OTHER METHOD: The last time you obtained it, did you have any problem in affording the cost of the (CURRENT METHOD)?

YES 1
NO 2
DON'T KNOW 8

333. CHECK 313/313A:
CIRCLE METHOD CODE. IF MORE THAN ONE METHOD CODE CIRCLED IN 313/313A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION C (GO TO 340)
MALE STERILIZATION D (GO TO 340)
PILL E
IUD F (GO TO 340)
INJECTABLES G
IMPLANTS H (GO TO 340)
CONDOM I
DIAPHRAGM/FOAM/JELLY/CREAM K
RHYTHM METHOD N (GO TO 340)
WITHDRAWAL R (GO TO 340)
PROLONGED BREASTFEEDING T (GO TO 340)
OTHER METHOD (SPECIFY) ____________ X (GO TO 340)

334. Did you obtain a supply of your current method during the past month? IF YES: Did you obtain it within the past two weeks?

1-2 WEEKS AGO 1
3-4 WEEKS AGO 2
MORE THAN ONE MONTH AGO 3
DON'T KNOW 4

335. CHECK 313/313A AND RECORD THE METHOD CURRENTLY USED:

USING PILL (GO TO 336)
USING OTHER METHOD (GO TO 340)

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

PACKAGE SEEN 1 (GO TO 338)
BRAND NAME (SPECIFY) ______
PACKAGE NOT SEEN 2

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

BRAND NAME (SPECIFY) _______
DON'T KNOW 98

338. How many pill cycles did you get the last time?

NUMBER OF CYCLES _____
DON'T KNOW 98

339. How much does one cycle of pills cost?

COST ____ (POUNDS) ____ (PT)
FREE 9995
DON'T KNOW 9998

340. 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 delay or avoid getting pregnant.

COLUMN 2 - SEGMENTS OF CONTRACEPTIVE USE SINCE JANUARY 2003

PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT PERIOD OF USE AND GOING BACK TO JANUARY 2003.
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?

COLUMN 3 - SOURCE OF CONTRACEPTIVE METHOD SINCE JANUARY 2003

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

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

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

THE NUMBER OF CODES ENTERED IN COLUMN 3 MUST BE THE SAME AS THE NUMBER OF SEGMENTS OF CONTRACEPTIVE USE IN COLUMN 2.

ILLUSTRATIVE QUESTIONS FOR COLUMN 3

FOR MODERN METHODS (CODES C-K)
- Where did you obtain (METHOD) when you began using it that time?

FOR TRADITIONAL METHODS (CODES N-X);
- Did you seek advice about how to use (METHOD) when you began using it that time?
- From where did you get the advice?

IF PHARMACY/OTHER NONMEDICAL SOURCE(S) (CODES I, L, M, X):
- Did you consult a doctor or a clinic when you began using (METHOD) that time?
IF YES: Where did you consult?
IF NO: RECORD CODE FOR PHARMACY OR OTHER SOURCE

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.

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

ILLUSTRATIVE QUESTIONS FOR COLUMN 4

- 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.

AFTER COMPLETING COLUMNS 2, 3 AND 4 AS APPROPRIATE, GO TO 341

341. CHECK 302: METHOD 11

PROLONGED BREASTFEEDING NOT MENTIONED (GO TO 342)
PROLONGED BREASTFEEDING MENTIONED (GO TO 343)

342. Do you believe that breastfeeding can be a family planning method, that is, that breastfeeding can help a woman avoid becoming pregnant?

YES 1
NO 2 (GO TO 347)

343. Now I would like to ask some questions about the use of breastfeeding as a family planning method. For how many months after a baby is born is a woman protected from pregnancy if she breastfeeds?

NUMBER OF MONTHS ____
UNTIL PERIOD RETURN 93
UNTIL SHE STOPS/CHILD WEANED 94
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

344. If a breastfeeding mother's menstrual period returns, is she protected from pregnancy?

YES 1
NO 2
DON'T KNOW 8

345. If the child is given other liquids or solids, is a breastfeeding mother protected from pregnancy?

YES 1
NO 2
DON'T KNOW 8

346. If her baby sleeps through the night without feeding or feeds only a few times during the day, is a breastfeeding mother protected from pregnancy?

YES 1
NO 2
DON'T KNOW 8

347. CHECK 304:

NEVER USED METHOD (GO TO 348)
EVER USED METHOD (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

349. Where is that? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

________________________ (NAME AND ADDRESS OF PLACE)

FOR OFFICE USE:

SOURCE CODE___________________
MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 1
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL 8
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOC D
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC G
PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE
MOSQUE HEALTH UNIT J
CHURCH HEALTH UNIT K
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) L
FRIEND/RELATIVE M
OTHER (SPECIFY)___________ X
DON'T KNOW Z

SECTION 4. FERTILITY PREFERENCES

401. CHECK 106: MARITAL STATUS

CURRENTLY MARRIED (GO TO 402)
WIDOWED/DIVORCED/SEPARATED (GO TO 413)

402. CHECK 313/313A: USING STERILIZATION

NEITHER STERILIZED (GO TO 403)
HE OR SHE STERILIZED (GO TO 413)

403. CHECK 226: CURRENTLY PREGNANT

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 now, 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 413)
UNDECIDED AND PREGNANT 4 (GO TO 410)
UNDECIDED AND NOT PREGNANT/ UNSURE IF PREGNANT 5 (GO TO 409)

404. CHECK 226: CURRENTLY PREGNANT

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?

PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 ___
YEARS 2 ___
SOON/NOW 994 (GO TO 409)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 413)
OTHER (SPECIFY)_____________ 996 (GO TO 409)
DON'T KNOW 998 (GO TO 409)

405. CHECK 226: CURRENTLY PREGNANT

NOT PREGNANT OR UNSURE (GO TO 406)
PREGNANT (GO TO 410)

406. CHECK 312: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 407)
NOT CURRENTLY USING (GO TO 407)
CURRENTLY USING (GO TO 413)

407. CHECK 404: PREFERRED TIME BEFORE NEXT BIRTH

NOT ASKED (GO TO 408)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 408)
00-23 MONTHS OR 00-01 YEAR (GO TO 410)

408. CHECK 403: DESIRE FOR A(NOTHER) CHILD

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

_______________________ RECORD ALL REASONS MENTIONED.
FERTILITY-RELATED REASONS
NOT HAVING SEX A (GO TO 410)
INFREQUENT SEX B (GO TO 410)
MENOPAUSAL/HYSTERECTOMY C (GO TO 410)
SUBFECUND/INFECUND D (GO TO 410)
POSTPARTUM AMENORRHEIC E (GO TO 410)
BREASTFEEDING F (GO TO 410)
FATALISTIC G (GO TO 410)
OPPOSITION TO USE
RESPONDENT OPPOSED H (GO TO 410)
HUSBAND OPPOSED I (GO TO 410)
OTHERS OPPOSED J (GO TO 410)
RELIGIOUS PROHIBITION K (GO TO 410)
LACK OF KNOWLEDGE
KNOWS NO METHOD L (GO TO 410)
KNOWS NO SOURCE M (GO TO 410)
METHOD-RELATED REASONS
HEALTH CONCERNS N (GO TO 410)
FEAR OF SIDE EFFECTS O (GO TO 410)
LACK OF ACCESS/TOO FAR P (GO TO 410)
COSTS TOO MUCH Q (GO TO 410)
INCONVENIENT TO USE R (GO TO 410)
INTERFERES WITH BODY'S NORMAL PROCESSES S (GO TO 410)
OTHER (SPECIFY) ____________ X (GO TO 410)
DON'T KNOW Z (GO TO 410)

409. CHECK 312: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 410)
NO, NOT CURRENTLY USING (GO TO 410)
YES, CURRENTLY USING (GO TO 413)

410. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 412)
DON'T KNOW 8 (GO TO 412)

411. Which contraceptive method would you prefer to use? RECORD ONE METHOD ONLY

FEMALE STERILIZATION C (GO TO 413)
MALE STERILIZATION D (GO TO 413)
PILL E (GO TO 413)
IUD F (GO TO 413)
INJECTABLES G (GO TO 413)
IMPLANTS H (GO TO 413)
CONDOM I (GO TO 413)
DIAPHRAGM/FOAM/JELLY K (GO TO 413)
RHYTHM METHOD N (GO TO 413)
WITHDRAWAL R (GO TO 413)
PROLONGED BREASTFEEDING T (GO TO 413)
OTHER METHOD (SPECIFY) ____________ X (GO TO 413)
DON'T KNOW Z (GO TO 413)

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

FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY C23
SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 25
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS 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
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ____________ 96
DON'T KNOW 98

413. CHECK 216:

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

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

NONE 00 (GO TO 415)
NUMBER ____
OTHER (SPECIFY) _________ 96 (GO TO 415)

414. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

NUMBER BOYS_______
NUMBER GIRLS _______
NUMBER EITHER _______
OTHER (SPECIFY) __________96

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

YES 1
NO 2

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

YES 1
NO 2

416a.In your opinion, what is the ideal length of time that a woman should wait between births? RECORD RESPONSE EXACTLY AS GIVEN.

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 419)

418. Did you have a premarital examination before you got married?
IF NO: Did you have an consultation within two months after you married?

HAD EXAM BEFORE MARRIAGE 1
HAD EXAM WITHIN TWO MONTHS AFTER MARRIAGE 2
DID NOT HAVE EXAMINATION 3

419. Did a health worker, a raida rifia or anyone else visit you to talk about family planning during the past 6 months? IF YES: Who visited you?

VISITED BY:
HEALTH WORKER A
RAIDA RIFIA B
OTHER (SPECIFY) _______ X
NOT VISITED Y

420. Have you visited governmental health facility for any during the past 6 months?

YES 1
NO 2 (GO TO 422)

421. Did any staff member at the health facility speak to you about family planning methods during any of your visits

YES 1
NO 2

422. Have you visited a private doctor or clinic for any reason during the past 6 months?

YES 1
NO 2 (GO TO 424)

423. Did the doctor or any other staff member there speak to you about family planning methods during any of your visits?

YES 1
NO 2

424. During the past 6 months have you heard about family planning: On the radio? On the television? In a newspaper or magazine? On a poster, billboard, or sign? At a community meeting? From a religious leader?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER/MAGAZINE
YES 1
NO 2
POSTER/BILLBOARD/SIGN
YES 1
NO 2
COMMUNITY MEETING
YES 1
NO 2
RELIGIOUS LEADER
YES 1
NO 2

425. Is there a special brand of pill that is appropriate for a woman to use while breastfeeding? IF YES: What brand is that?

YES AND NAMED 1
BRAND NAME (SPECIFY) ___________
YES BUT DO NOT KNOW BRAND 2
DON'T KNOW 8

426. CHECK 106: MARITAL STATUS

CURRENTLY MARRIED (GO TO 427)
WIDOWED/ DIVORCED/ SEPARATED (GO TO 501)

427. CHECK 313/313A:

METHOD CODES D, I, OR R NOT CIRCLED (GO TO 428)
METHOD CODES D, I, OR R CIRCLED (GO TO 429)
NO CODE CIRCLED (GO TO 430)

428. Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER (SPECIFY) __________ 6

429. CHECK 313/313A:

NEITHER STERILIZED (GO TO 430)
HE OR SHE STERILIZED (GO TO 501)

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

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

SECTION 5. PREGNANCY AND POSTNATAL CARE AND BREASTFEEDING

501. CHECK 224:

ONE OR MORE BIRTHS IN 2003 OR LATER (GO TO 502)
NO BIRTHS IN 2003 OR LATER (GO TO 663)

502. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)

503. LINE NUMBER FROM 212

LINE NUMBER___

504. FROM 212 AND 216

NAME ______________
LIVING (GO TO 505)
DEAD (GO TO 505)

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 to have any (more) children at all?

THEN 1 (GO TO 507)
LATER 2
NOT AT ALL 3 (GO TO 507)

506. How much longer would you have liked to wait? RECORD RESPONSE EXACTLY AS GIVEN.

MONTHS 1 __
YEARS 2 __
DON'T KNOW 998

507. Did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
OTHER (SPECIFY) __________ X
NO ONE Y (GO TO 518)

508. Where did you receive antenatal care for this pregnancy? CIRCLE ALL MENTIONED. IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE(S)) _________________
HOME
YOUR HOME A
OTHER HOME B
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) C
URBAN H'LTH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL (COMPL'TARY) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) ________ I
NONGOVERNMENTAL
EGYPTIAN FP ASSOC J
CSI PROJECT K
OTHER NGO (SPECIFY) ________ L
PRIVATE MEDICAL
PVT.HOSPITAL/CLINIC M
PVT.DOCTOR N
OTHER PVT.MED.(SPECIFY) __________ P
OTHER NON-MEDICAL (SPECIFY) _________ X

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

NUMBER OF TIMES __________
DON'T KNOW 98

510. How many months pregnant were you when you first received antenatal care for this pregnancy?
[LAST BIRTH ONLY]

MONTHS __________
DON'T KNOW 98

511. How many months pregnant were you when you last received antenatal care for this pregnancy?
[LAST BIRTH ONLY]

NUMBER OF MONTHS __________
DON'T KNOW 98

512. Were you charged a single fee for all of the antenatal visits you made before (NAME'S) birth or did you pay separately for each visit?
[LAST BIRTH ONLY]

PAID SINGLE FEE FOR ALL VISITS 1
PAID SEPARATE FEE FOR EACH VISIT 2 (GO TO 513A)
BOTH 3
FREE 4 (GO TO 514)

513. How much did you pay in total for all of your antenatal care visits during this pregnancy including all the consultations with the provider and any drugs or laboratory tests you had at (FACILITY)?
[LAST BIRTH ONLY]

COST ________ (POUNDS)
DON'T KNOW 9998

513A.How much did you pay for your last antenatal care visit including the consultation with the provider and any drugs or laboratory tests you had at (FACILITY)?
[LAST BIRTH ONLY]

COST ________ (POUNDS)
DON'T KNOW 9998

514. Did you pay additional costs for drugs at a separate pharmacy/clinic/drug shop (at any time during the pregnancy/as a result of your last antenatal visit)?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)

515. How much in total did you pay for the additional drugs?
[LAST BIRTH ONLY]

COST ___________ (POUNDS)
DON'T KNOW 9998

516. Did you pay additional costs for laboratory tests you got at a separate laboratory facility (at any time during the pregnancy/as a result of your last antenatal visit)?
[LAST BIRTH ONLY]

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

517. How much in total did you pay for the additional lab tests?
[LAST BIRTH ONLY]

COST ___________ (POUNDS)
DON'T KNOW 9998

518. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 524)
DON'T KNOW 8 (GO TO 524)

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

TIMES ___
DON'T KNOW 8

520. Where did you receive the tetanus injection(s)? CIRCLE ALL MENTIONED. IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE(S)) _________________
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) C
URBAN H'LTH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL (COMPL'TARY) F
RURAL HEALITH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) ________ I
NONGOVERNMENTAL
EGYPTIAN FP ASSOC J
CSI PROJECT K
OTHER NGO (SPECIFY) ________
PRIVATE MEDICAL
PVT. HOSPITAL/CLINIC M
PVT. DOCTOR N
OTHER PVT. MED.(SPECIFY) __________ P
OTHER NON-MEDICAL (SPECIFY) _________ X

521. CHECK 507:
[LAST BIRTH ONLY]

NO ANC (GO TO 522)
HAD ANC (GO TO 523)

522. Did any of the persons you saw for the tetanus injection(s) advise you that you should go for antenatal care?
[LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

523. CHECK 519:
[LAST BIRTH ONLY]

2 OR MORE TIMES (GO TO 528)
OTHER (GO TO 524)

524. At any time before your pregnancy with (NAME), did you receive any tetanus injections?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 528)
DON'T KNOW 8 (GO TO 528)

525. Before your pregnancy with (NAME), how many times did you get a tetanus injection? IF 7 OR MORE TIMES, RECORD '7.'
[LAST BIRTH ONLY]

TIMES__
DON'T KNOW 8

526. In what month and year did you receive the last tetanus injection before your pregnancy with (NAME)?
[LAST BIRTH ONLY]

MONTH ___
DK MONTH 98
YEAR ____ (GO TO 528)
DK YEAR 9998

527. How many years ago did you receive that tetanus injection?
[LAST BIRTH ONLY]

YEARS AGO ____

528. When you were pregnant with (NAME), did you see a doctor, nurse, or anyone else for health care (other than an antenatal checkup or a tetanus injection)? IF YES: Whom did you see? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[LAST BIRTH ONLY]

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
OTHER (SPECIFY) __________ X
NO ONE Y (GO TO 530)

529. Where did you get that care? CIRCLE ALL MENTIONED. IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[LAST BIRTH ONLY]

(NAME OF PLACE(S)) _________________
HOME
YOUR HOME A
OTHER HOME B
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) C
URBAN H'LTH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL (COMPL'TARY) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) ________ I
NONGOVERNMENTAL
EGYPTIAN FP ASSOC J
CSI PROJECT K
OTHER NGO (SPECIFY) ________ L
PRIVATE MEDICAL
PVT. HOSPITAL/CLINIC M
PVT. DOCTOR N
OTHER PVT. MED.(SPECIFY) __________ P
OTHER NON-MEDICAL (SPECIFY) _________ X

530. CHECK 507, 518, 528:
[LAST BIRTH ONLY]

OTHER CARE ONLY (GO TO 531)
ANC/TT (GO TO 534)
NO CARE (GO TO 537)

531. At any time did you seek this care because you thought there was a problem with the pregnancy?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 534)

532. How many times did you receive care during this pregnancy?
[LAST BIRTH ONLY]

NUMBER OF TIMES ___
DON'T KNOW 98

533. How many months pregnant were you when you last received care?
[LAST BIRTH ONLY]

MONTHS ___
DON'T KNOW 98

534. As part of the care you got during this pregnancy, were any of the following done at least once? Were you weighed? Was your blood pressure measured? Did you give a urine sample? Did you give a blood sample?
[LAST BIRTH ONLY]

WEIGHT
YES 1
NO 2
BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

535. During (any of) your care visit(s), were you told about the signs of pregnancy complications?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

536. Were you told where to go if you had any of these complications?
[LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

537. During this pregnancy, were you given or did you buy any iron tablets or iron syrup? SHOW TABLETS/SYRUP.
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 539)
DON'T KNOW 8 (GO TO 539)

538. During the whole pregnancy, for how many days did you take the tablets or syrup? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[LAST BIRTH ONLY]

NUMBER OF DAYS ___
DON'T KNOW 998

539. 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

540. Was (NAME) weighed at birth?

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

541. How much did (NAME) weigh? RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

(KG FROM CARD) ____
(KG FROM RECALL) ____
DON'T KNOW 99998

542. Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
OTHER (SPECIFY) _________ X
NO ONE Y

543. Where did you give birth to (NAME)? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE(S)) _________________
HOME
YOUR HOME 11 (GO TO 546a)
OTHER HOME 12 (GO TO 546a)
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) 21
URBAN H'LTH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL (COMPL'TARY) 24
RURAL HEALTH UNIT 25
MCH CENTER 26
OTHER GOV'T (SPECIFY) ________ 27
NONGOVERNMENTAL
EGYPTIAN FP ASSOC 31
CSI PROJECT 32
OTHER NGO (SPECIFY) ________ 36
PRIVATE MEDICAL
PVT. HOSPITAL/CLINIC 41
PVT. DOCTOR 42
OTHER PVT. MED.(SPECIFY) __________ 46
OTHER NON-MEDICAL (SPECIFY) _________ 96

544. How long after (NAME) was delivered did you stay there? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 __
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998

545. Was (NAME) delivered by caesarean section?

YES 1
NO 2

546. How much did you pay for care for (NAME'S) delivery? Please include any payments to the health care providers, room and board and any drugs or laboratory tests in [FACILITY NAME].
[LAST BIRTH ONLY]

COST IN POUNDS _______
IN KIND 9994
FREE 9995
DON'T KNOW 9998

546a. How much did you pay for care for (NAME'S) delivery?
[LAST BIRTH ONLY]

COST IN POUNDS _______
IN KIND 9994
FREE 9995
DON'T KNOW 9998

547. Did you incur additional costs for drugs at a separate pharmacy/clinic/drug shop for the delivery?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 549)
DON'T KNOW 8 (GO TO 549)

548. How much in total did you for the additional drugs?
[LAST BIRTH ONLY]

COST ________ (POUNDS)
DON'T KNOW 9998

549. Did you incur additional costs for laboratory tests conducted at a separate laboratory facility?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 551)
DON'T KNOW 8 (GO TO 551)

550. How much in total did you pay for the additional lab tests?
[LAST BIRTH ONLY]

COST ________ (POUNDS)
DON'T KNOW 9998

551. CHECK 543:
[LAST BIRTH ONLY]

GOVERNMENT/PRIVATE MEDICAL (GO TO 552)
OTHER (GO TO 555)

552. Before you were discharged after (NAME) was born, did a health professional check on your health? IF YES: Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2
OTHER (SPECIFIC) _____ 6
NO ONE (GO TO 554) 7

553. How many hours, days or weeks after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[LAST BIRTH ONLY]

HOURS 1 __
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998

554. At any time in the two months after you were discharged, did a health professional or a traditional birth attendant check on your health? IF YES: Who checked on your health that time? RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A (GO TO 557)
NURSE/MIDWIFE B (GO TO 557)
OTHER PERSON
DAYA C (GO TO 557)
OTHER (SPECIFY) _________ X (GO TO 557)
NO ONE Y (GO TO 568)

555. Why didn't you deliver in a health facility? PROBE: Any other reason? RECORD ALL MENTIONED.
[LAST BIRTH ONLY]

COST TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) ______ X

556. At any time in the two months after (NAME) was born, did a health professional or a traditional birth attendant check on your health? IF YES: Who checked on your health? RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
OTHER (SPECIFY) _________ X
NO ONE Y (GO TO 568)

557. How many hours, days or weeks after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[LAST BIRTH ONLY]

HOURS 1 __
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998

558. Where did this first check take place? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[LAST BIRTH ONLY]

(NAME OF PLACE) _________________
HOME
YOUR HOME 11
OTHER HOME 12
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) 21
URBAN HEALTH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL (COMPL'TARY) 24
RURAL HEALTH UNIT 25
MCH CENTER 26
OTHER GOV'T (SPECIFY) ________ 27
NONGOVERNMENTAL
EGYPTIAN FP ASSOC 31
CSI PROJECT 32
OTHER NGO (SPECIFY) ________ 36
PRIVATE MEDICAL
PVT. HOSPITAL/CLINIC 41
PVT. DOCTOR 42
OTHER PVT. MED.(SPECIFY) __________ 46
OTHER NON-MEDICAL (SPECIFY) _________ 96

559. How much did you pay the provider for care for the first postnatal visit?
[LAST BIRTH ONLY]

COST _______ (POUNDS)
FREE 9995
DON'T KNOW 9998

560. Did you incur additional costs for drugs at a separate pharmacy/clinic/drug shop for this postnatal visit?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 562)
DON'T KNOW 8 (GO TO 562)

561. How much in total did you for the additional drugs?
[LAST BIRTH ONLY]

COST _______ (POUNDS)
DON'T KNOW 9998

562. Did you incur additional costs for laboratory tests conducted at a separate laboratory facility for this postnatal visit?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 568)
DON'T KNOW 8 (GO TO 568)

563. How much in total did you pay for the additional lab tests?
[LAST BIRTH ONLY]

COST _______ (POUNDS)
DON'T KNOW 9998

564. CHECK 558:
[LAST BIRTH ONLY]

IN OWN HOME (GO TO 565)
NOT IN OWN HOME (GO TO 566)

565. CHECK 556:
[LAST BIRTH ONLY]

DAYA/OTHER (GO TO 566)
DOCTOR/NURSE MIDWIFE (GO TO 568)

566. At any time during the two months after (NAME)'s delivery, did a doctor or nurse/midwife ever visit your home to check on your health?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 568)
DON'T KNOW 8 (GO TO 568)

567. How many times after delivery did a health professional visit your home to check on your health?
[LAST BIRTH ONLY]

NUMBER OF TIMES __
DON'T KNOW 98

568. During the two weeks after birth, was a blood sample taken from (NAME'S) heel?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 570)
DON'T KNOW 8 (GO TO 570)

569. How many days after birth was the blood sample taken from (NAME'S) heel?
[LAST BIRTH ONLY]

NUMBER OF DAYS __
DON'T KNOW 98

570. In the two months after (NAME) was born, did a health professional or traditional birth attendant check on his/her health? IF YES: Who checked on(NAME'S) health at that time? RECORD ALL MENTIONED

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
OTHER (SPECIFY) _________ X
NO ONE Y (GO TO 573)
DON'T KNOW Z (GO TO 573)

571. How many hours, days or weeks after the birth of (NAME) did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[LAST BIRTH ONLY]

HOURS 1 __
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998

572. Where did this first check of (NAME) take place? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[LAST BIRTH ONLY]

(NAME OF PLACE) _________________
HOME
YOUR HOME 11
OTHER HOME 12
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) 21
URBAN H'LTH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL (COMPL'TARY) 24
RURAL HEALTH UNIT 25
MCH CENTER 26
OTHER GOV'T (SPECIFY) ________ 27
NONGOVERNMENTAL
EGYPTIAN FP ASSOC 31
CSI PROJECT 32
OTHER NGO (SPECIFY) ________ 36
PRIVATE MEDICAL
PVT. HOSPITAL/CLINIC 41
PVT. DOCTOR 42
OTHER PVT. MED. (SPECIFY) __________ 46
OTHER NON-MEDICAL (SPECIFY) _________ 96

573. When you were pregnant with (NAME), when you delivered, or in the two months after the delivery, did anyone give you advice about family planning? IF YES: Who gave you the advice? RECORD ALL MENTIONED.
[LAST BIRTH ONLY]

HEALTH PROVIDER A
SOCIAL WORKER B
DAYA C
RELIGIOUS LEADER D
NEIGHBORS/FRIENDS E
HOUSEHOLD MEMBER F
OTHER RELATIVES G
OTHER (SPECIFY) ______ X
NO ONE Y

574. When you were pregnant with (NAME), when you delivered, or in the two months after the delivery, did anyone give you advice about breastfeeding? IF YES: Who gave you the advice? RECORD ALL MENTIONED.
[LAST BIRTH ONLY]

HEALTH PROVIDER A
SOCIAL WORKER B
DAYA C
RELIGIOUS LEADER D
NEIGHBORS/FRIENDS E
HOUSEHOLD MEMBER F
OTHER RELATIVES G
OTHER (SPECIFY) ______ X
NO ONE Y

575. In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)? SHOW (TYPES OF) CAPSULES.

YES 1
NO 2

576. Has your menstrual period returned since the birth of (NAME)?
[LAST BIRTH ONLY]

YES 1 (GO TO 578)
NO 2 (GO TO 579)

577. Did your period return between the birth of (NAME) and your next pregnancy?
[EXCLUDE LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 581)

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

MONTHS __
DON'T KNOW 98

579. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 580)
PREGNANT OR UNSURE (GO TO 581)

580. Have you resumed sexual relations since the birth of (NAME)?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 582)

581. For how many months after the birth of (NAME) did you not have sexual relations? IF LESS THAN 2 MONTHS, RECORD DAYS. OTHERWISE, RECORD BY COMPLETED MONTHS.
[LAST BIRTH ONLY]

DAYS 1 __
MONTHS 2 __
DON'T KNOW 998

582. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 586)

583. How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, RECORD '000'. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.
[LAST BIRTH ONLY]

IMMEDIATELY 000
HOURS 1 __
DAYS 2 __

584. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 586)

585. What was (NAME) given to drink? Anything else? RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/OTHER LIQUIDS H
HONEY I
OTHER (SPECIFY) ____ X

Q586 to Q589 are asked for for LAST BIRTH child, NEXT-TO-LAST BIRTH child and SECOND-FROM-LAST BIRTH child separately.

586. CHECK 504: IS CHILD LIVING?

LIVING (GO TO 587)
DEAD (FOR LAST BIRTH and NEXT-TO-LAST BIRTH child, GO BACK TO 505 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601. FOR SECOND-FROM-LAST BIRTH child, GO BACK TO 505 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 601)

587. CHECK 582: EVER BREASTFED?

EVER BREASTFED (GO TO 588)
NEVER BREASTFED (GO TO 592)

588. Are you still breastfeeding (NAME)?

YES 1 (FOR LAST BIRTH GO TO 590, FOR NEXT-TO-LAST BIRTH child and LAST BIRTH child GO TO 552)
NO 2

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

MONTHS __ (FOR LAST BIRTH GO TO 592)
DON'T KNOW 98

590. How many times did you breastfeed (NAME) last night between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[LAST BIRTH ONLY]

NUMBER OF NIGHTTIME FEEDINGS __

591. How many times did you breastfeed (NAME) yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[LAST BIRTH ONLY]

NUMBER OF DAYLIGHT FEEDINGS __

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

YES 1
NO 2
DON'T KNOW 8

AFTER FINISHING Q592, FOR LAST BIRTH CHILD AND NEXT-TO-LAST CHILD, GO BACK TO 505 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601. FOR SECOND-FROM-LAST BIRTH CHILD, GO BACK TO 505 IN NEXT COLUMN OF NEW QUESTIONNAIRE OR, IF NO MORE BIRTHS, GO TO 601.

SECTION 6. CHILD IMMUNIZATION AND HEALTH

601. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

602. LINE NUMBER FROM 212

LAST BIRTH NUMBER __
NEXT-TO-LAST BIRTH NUMBER __
SECOND-FROM-LAST BIRTH NUMBER __

603. FROM 212 AND 216

NAME _______
LIVING (GO TO 604)
DEAD (FOR LAST BIRTH COLUMN, GO TO 603 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 663. FOR NEXT-TO-LAST BIRTH COLUMN, GO TO 603 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 660. FOR SECOND-FROM-LAST BIRTH COLUMN, GO TO 603 IN NEXT COLUMN OF NEW QUESTIONNAIRE, OR IF NO MORE, GO TO 660.)

604. Has (NAME) ever received a vitamin A dose like (this)? SHOW CAPSULES

YES 1
NO 2 (GO TO 606)
DON'T KNOW 8 (GO TO 606)

605. Since how many months did (NAME) take the last dose?

MONTHS __
DK MONTH 98

606. Do you have a birth certificate for (NAME)? IF YES: May I see it please? RECORD IF CERTIFICATE INCLUDES VACCINATION RECORD OR NOT.

YES, SEEN AND VACCINATION DATES RECORDED. 1 (GO TO 608)
YES, SEEN BUT NO VACCINATION DATES RECORDED 2 (GO TO 610)
YES, BUT NOT SEEN 3 (GO TO 610)
NO CERTIFICATE 4

607. Did you ever have a birth certificate for (NAME)? IF YES: Did the certificate include a vaccination record?

YES, HAD CERTIFICATE WITH RECORD 1 (GO TO 610)
YES, CERTIFICATE WITH NO RECORD 2 (GO TO 610)
NO CERTIFICATE 3 (GO TO 610)

608. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. DO NOT INCLUDE VACCINATIONS RECEIVED DURING NIDS DAYS.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN (OTHER THAN DURING A NIDS DAY), BUT NO DATE IS RECORDED.

BCG
DAY __
MONTH__
YEAR
POLIO 1
DAY ___
MONTH __
YEAR ___
POLIO 2
DAY ___
MONTH __
YEAR ___
POLIO 3
DAY ___
MONTH __
YEAR ___
ACTIVATED DOSE
DAY __
MONTH __
YEAR ___
DTP 1
DAY __
MONTH __
YEAR __
DTP 2
DAY __
MONTH __
YEAR __
DTP 3
DAY __
MONTH __
YEAR __
ACTIVATED DOSE
DAY __
MONTH __
YEAR __
MEASLES
DAY __
MONTH __
YEAR __
HEPATITIS 1
DAY __
MONTH __
YEAR __
HEPATITIS 2
DAY __
MONTH __
YEAR __
HEPATITIS 3
DAY __
MONTH __
YEAR __
VITAMIN A DOSE 1
DAY __
MONTH __
YEAR __
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY__
MONTH ___
YEAR __
POLIO 4
DAY __
MONTH __
YEAR __
MMR
DAY __
MONTH __
YEAR __
VITAMIN A DOSE 2
DAY __
MONTH __
YEAR __
OTHER (SPECIFY)
DAY __
MONTH __
YEAR __

609. Has (NAME) received any vaccinations that are not recorded on the certificate other than those received during national immunization days? PROBE FOR INFORMATION FOR ALL VACCINATIONS NOT RECORDED.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE DAY COLUMN IN 608 FOR THE VACCINE(S))
NO 2
DON'T 8

610. 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 612)
YES, NOT SEEN 2 (GO TO 614)
NO 3

611. Did (NAME) ever have a health card?

YES 1 (GO TO 614)
NO 2

612 (1). COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. DO NOT INCLUDE VACCINATIONS RECEIVED DURING NIDS DAYS.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN (OTHER THAN DURING A NIDS DAY), BUT NO DATE IS RECORDED.

BCG
DAY __
MONTH__
YEAR
POLIO 1
DAY ___
MONTH __
YEAR ___
DTP 1
DAY __
MONTH __
YEAR __
HEPATITIS 1
DAY __
MONTH __
YEAR __
POLIO 2
DAY ___
MONTH __
YEAR ___
DTP 2
DAY __
MONTH __
YEAR __
HEPATITIS 2
DAY __
MONTH __
YEAR __
POLIO 3
DAY ___
MONTH __
YEAR ___
DTP 3
DAY __
MONTH __
YEAR __
HEPATITIS 3
DAY __
MONTH __
YEAR __
POLIO 4
DAY ___
MONTH __
YEAR ___
MEASLES
DAY __
MONTH __
YEAR __
ACTIVATED POLIO
DAY __
MONTH __
YEAR __
ACTIVATED DPT
DAY __
MONTH __
YEAR __
VITAMIN A DOSE 1
DAY __
MONTH __
YEAR __
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY__
MONTH ___
YEAR __
MMR
DAY __
MONTH __
YEAR __
VITAMIN A DOSE 2
DAY __
MONTH __
YEAR __
OTHER (SPECIFY)
DAY __
MONTH __
YEAR __

613. Has (NAME) received any vaccinations that are not recorded on the certificate excluding those received during national immunization days? PROBE FOR INFORMATION FOR ALL VACCINATIONS NOT RECORDED.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE DAY COLUMN IN 612 FOR THE VACCINE(S))
NO 2
DON'T 8

614. CHECK 608 AND 612

NO RECORD (GO TO 615)
DATES/CODES '44' OR '66' (GO TO 626)

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

YES 1
NO 2 (GO TO 628)
DON'T KNOW 8 (GO TO 628)

616. Please tell me if (NAME) received any of the following vaccinations: A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

617. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 620)
DON'T KNOW 8 (GO TO 620)

618. Excluding any doses gotten during national immunization days, how many times was a polio immunization received?

NUMBER OF TIMES __

619. Was the first polio vaccine received in the first two weeks after birth or later?

FIRST 2 WEEKS 1
AFTER FIRST 2 WEEKS 2

620. A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes given at the same time as polio drops?

YES 1
NO 2 (GO TO 622)
DON'T KNOW 8 (GO TO 622)

621. How many times was a DPT vaccination received?

NUMBER OF TIMES __

622. An injection to prevent measles at nine months?

YES 1
NO 2
DON'T KNOW 8

623. An injection against hepatitis?

YES 1
NO 2 (GO TO 625)
DON'T KNOW 8 (GO TO 625)

624. How many times was a hepatitis vaccination received?

NUMBER OF TIMES __

625. An MMR injection, that is an injection against measles, mumps, and rubella given at 18 months?

YES 1
NO 2
DON'T KNOW 8

626. During the past two years, did (NAME) receive any polio vaccinations as part of the national immunization day campaigns?

YES 1
NO 2 (FOR LAST BIRTH GO TO 627A, FOR NEXT-TO-LAST BIRTH AND SECOND-FROM-LAST BIRTH GO TO 628)
CHILD HAD NO VACCINATIONS 3 (FOR LAST BIRTH GO TO 627A, FOR NEXT-TO-LAST BIRTH AND SECOND-FROM-LAST BIRTH GO TO 628)
DON'T KNOW 8 (FOR LAST BIRTH GO TO 627A, FOR NEXT-TO-LAST BIRTH AND SECOND-FROM-LAST BIRTH GO TO 628)

627. How many times did (NAME) receive a polio vaccination at national immunization days in the past two years? IF NON-NUMERIC ANSWER, PROBE TO GET ESTIMATE.

NUMBER OF TIMES __

627A. At any time when you took (NAME) for immunizations, did anyone talk to you about family planning?
[LAST BIRTH ONLY]

YES 1
NO 2
NO VACCINATIONS/MOTHER DID NOT TAKE CHILD 3 (GO TO 628)
DK/UNSURE 8

627B. At any time when you took (NAME) for immunizations, did anyone talk to you about any other health services, for example, nutrition or antenatal care?
[LAST BIRTH ONLY]

YES 1
NO 2
DK/UNSURE 8

Q628.-Q658. are asked for for LAST BIRTH child, NEXT-TO-LAST BIRTH child and SECOND-FROM-LAST BIRTH child separately.

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

YES 1
NO 2 (GO TO 643)
DON'T KNOW 8 (GO TO 643)

629. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

630. Now I would like to know how much (NAME) was given to drink during the diarrhea. Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given 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

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

632. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 637)

633. Where did you seek advice or treatment? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. Anywhere else? RECORD ALL PLACES MENTIONED.

(1) (NAME OF PLACE(S)) _________________
(2) (NAME OF PLACE(S)) _________________
(3) (NAME OF PLACE(S)) _________________
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) C
URBAN HEALTH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL (COMPL'TARY) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) ________ I
NONGOVERNMENTAL

EGYPTIAN FP ASSOC J
CSI PROJECT K
OTHER NGO (SPECIFY) ________ L
PRIVATE MEDICAL
PVT. HOSPITAL/CLINIC M
PVT. DOCTOR N
PHARMACY O
OTHER PVT. MED.(SPECIFY) __________ P
OTHER NON-MEDICAL (SPECIFY) _________ X

634. CHECK 633:

TWO OR MORE CODES CIRCLED (GO TO 635)
ONLY ONE CODE CIRCLED (GO TO 636)

635. Where did you first seek advice or treatment? USE LETTER CODE FROM 633.

FIRST PLACE __

636. How many days after the diarrhea began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.

DAYS ___

637. Does (NAME) still have diarrhea?

YES 1
NO 2
DON'T KNOW 8

638. Was he/she given a fluid made from a special packet called mahloul moalget el gafaf?

YES 1
NO 2
DON'T KNOW 8

639. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 643)
DON'T KNOW 8 (GO TO 643)

640. What (else) was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS GIVEN

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY
HERBAL MEDICINE J
HOMEMADE SS SOLUTION K
OTHER (SPECIFY) ____ X

641. CHECK 640: GIVEN ZINC?

CODE "C" CIRCLED (GO TO 642)
CODE "C" NOT CIRCLED (GO TO 643)

642. How many times was (NAME) given zinc?

TIMES __
DON'T KNOW 98

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

YES 1
NO 2
DON'T KNOW 8

644. Has (NAME) had an illness with a cough at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 647)
DON'T KNOW 8 (GO TO 647)

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

YES 1
NO 2 (GO TO 648)
DON'T KNOW 8 (GO TO 648)

646. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1 (GO TO 648)
NOSE ONLY 2 (GO TO 648)
BOTH 3 (GO TO 648)
OTHER (SPECIFY) _______ 6 (GO TO 648)
DON'T KNOW 8 (GO TO 648)

647. CHECK 643: HAD FEVER?

YES (GO TO 648)
NO (GO TO 659)

648. Now I would like to know how much (NAME) was given to drink during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given 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

649. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

650. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 655)

651. Where did you seek advice or treatment? IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. Anywhere else? RECORD ALL PLACES MENTIONED.

(1) (NAME OF PLACE(S)) _________________
(2) (NAME OF PLACE(S)) _________________
(3) (NAME OF PLACE(S)) _________________
GOVERNMENT
URBAN HOSPITAL (GNRL/DSTRCT) C
URBAN H'LTH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL (COMPL'TARY) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) ________ I
NONGOVERNMENTAL
EGYPTIAN FP ASSOC J
CSI PROJECT K
OTHER NGO (SPECIFY) ________ L
PRIVATE MEDICAL
PVT. HOSPITAL/CLINIC M
PVT. DOCTOR N
PHARMACY O
OTHER PVT. MED.(SPECIFY) __________ P
OTHER NON-MEDICAL (SPECIFY) _________ X

652. CHECK 651:

TWO OR MORE CODES CIRCLED (GO TO 653)
ONLY ONE CODE CIRCLED (GO TO 654)

653. Where did you first seek advice or treatment? USE LETTER CODE FROM 651.

FIRST PLACE __

654. How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.

DAYS __

655. Is (NAME) still sick with a (fever/cough)?

YES 1
NO 2
DON'T KNOW 8

656. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO TO 659)
DON'T KNOW 8 (GO TO 659)

657. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.

ANTIBIOTIC
PILL/SYRUP A
INJECTION B (GO TO 659)

ANTI PYRETIC
ASPIRIN C (GO TO 659)
ACETAMINOPHEN D (GO TO 659)
IBUPROFEN E (GO TO 659)
OTHER ANTI PYRETIC (SPECIFY) _____ F (GO TO 659)
COUGH DRUG G (GO TO 659)
OTHER SPECIFY) _______ X (GO TO 659)
DON'T KNOW Z (GO TO 659)

658. Did you already have the antibiotic at home when (NAME) became ill?

YES 1
NO 2
DON'T KNOW 8

659. FOR LAST BIRTH COLUMN AND NEXT-TO-LAST BIRTH COLUMN, GO BACK TO 603 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 660. FOR SECOND-FROM-LAST BIRTH COLUMN, GO BACK TO 603 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 660.

660. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2003 OR LATER LIVING WITH THE RESPONDENT
ONE OR MORE NONE (GO TO QUESTION 661)
NONE (GO TO QUESTION 663)

661. The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

662. CHECK 638 ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO QUESTION 663)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO QUESTION 664)

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

YES 1
NO 2

664. 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?

YES 1
NO 2 (GO TO 701)

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

TELEVISION 01
RADIO 02
NEWSPAPER/MAGAZINE 03
PAMPHLET/BROCHURE 04
POSTER 05
MEDICAL PROVIDER 06
HUSBAND 07
OTHER RELATIVE 08
FRIENDS/NEIGHBORS 09
OTHER (SPECIFY)_________ 96

SECTION 7. MOTHER AND CHILD NUTRITION

701. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2005 OR LATER AND LIVING WITH HER
DOES NOT HAVE ANY CHILDREN BORN IN 2005 OR LATER AND LIVING WITH HER
(GO TO 801)

RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 702)

(NAME) ________________

702. As part of this study, we are also looking at the nutrition of mothers and children. To help us understand these issues, I will first ask you about what (NAME FROM 1201) may have drank or eaten yesterday during the day or at night. Then I will also ask you about what you may have eaten or drunk yesterday.

703. First I would like to ask you about liquids/foods (NAME FROM 701) had yesterday during the day or at night. Did (NAME FROM 701) had:

a. Plain water?
b. Infant formula, that is, a special commercially produced breastmilk substitutes such as Similac, Bebelack and Biomeal?
c. Any commercially fortified baby cereal (like Cerelac, or Riri or Gerber)?
d. Other porridge or gruel made from wheat, rice or other grains?

a PLAIN WATER
YES 1
NO 2
DK 8
b INFANT FORMULA
YES 1
NO 2
DK 8
c COMMERCIAL BABY CEREALS
YES 1
NO 2
DK 8
d OTHER PORRIDGE GRUEL
YES 1
NO 2
DK 8

704. Now I would like to ask you about (other) liquids or foods that (NAME FROM 701) or you may have had yesterday during the day or at night. I am interested in whether your child or you had the item even if it was combined with other foods.

Did (CHILD) drink (eat):

a. Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DK 8
b. Tea or coffee?
YES 1
NO 2
DK 8
c. Any other liquids?
YES 1
NO 2
DK 8
d. Bread, rice, noodles, macaroni, or other food made from grains?
YES 1
NO 2
DK 8
e. Any pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DK 8
f. Any potatoes, white potatoes or any other food made from roots or tubers?
YES 1
NO 2
DK 8
g. Any dark green leafy vegetables like spinach?
YES 1
NO 2
DK 8
h. Any legumes like fava beans, chickpeas, lentils, or peanuts?
YES 1
NO 2
DK 8
i. Ripe mangos, papayas, or (OTHER VITAMIN-A RICH FRUITS)?
YES 1
NO 2
DK 8
j. Any other vegetables or fruits?
YES 1
NO 2
DK 8
k. Any liver, kidney, heart or other organ meats?
YES 1
NO 2
DK 8
l. Any meat such as beef, lamb, goat, rabbit, chicken or duck?
YES 1
NO 2
DK 8
m. Any eggs?
YES 1
NO 2
DK 8
n. Any fresh or dried or smoked or canned fish or shellfish?
YES 1
NO 2
DK 8
o. Any legumes like fava beans, chickpeas, lentils, peas, peanuts or other nuts?
YES 1
NO 2
DK 8
p. Any cheese or yogurt or other milk products?
YES 1
NO 2
DK 8
q. Any oils, fats or butter or foods made with any of these?
YES 1
NO 2
DK 8
r. Any sugary foods such as chocolates, sweets, pastries, cakes, or biscuits?
YES 1
NO 2
DK 8
s. Any other solid or semi-solid food?
YES 1
NO 2
DK 8

Did MOTHER eat/drink:

a. Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DK 8
b. Tea or coffee?
YES 1
NO 2
DK 8
c. Any other liquids?
YES 1
NO 2
DK 8
d. Bread, rice, noodles, macaroni, or other food made from grains?
YES 1
NO 2
DK 8
e. Any pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DK 8
f. Any potatoes, white potatoes or any other food made from roots or tubers?
YES 1
NO 2
DK 8
g. Any dark green leafy vegetables like spinach?
YES 1
NO 2
DK 8
h. Any legumes like fava beans, chickpeas, lentils, or peanuts?
YES 1
NO 2
DK 8
i. Ripe mangos, papayas, or (OTHER VITAMIN-A RICH FRUITS)?
YES 1
NO 2
DK 8
j. Any other vegetables or fruits?
YES 1
NO 2
DK 8
k. Any liver, kidney, heart or other organ meats?
YES 1
NO 2
DK 8
l. Any meat such as beef, lamb, goat, rabbit, chicken or duck?
YES 1
NO 2
DK 8
m. Any eggs?
YES 1
NO 2
DK 8
n. Any fresh or dried or smoked or canned fish or shellfish?
YES 1
NO 2
DK 8
o. Any legumes like fava beans, chickpeas, lentils, peas, peanuts or other nuts?
YES 1
NO 2
DK 8
p. Any cheese or yogurt or other milk products?
YES 1
NO 2
DK 8
q. Any oils, fats or butter or foods made with any of these?
YES 1
NO 2
DK 8
r. Any sugary foods such as chocolates, sweets, pastries, cakes, or biscuits?
YES 1
NO 2
DK 8

705. CHECK 704 (CHILD):

AT LEAST ONE "YES" (GO TO QUESTION 706)
NOT A SINGLE "YES" (GO TO QUESTION 801)

706. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES __
DON'T KNOW 8

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801. CHECK 106: MARITAL STATUS

CURRENTLY MARRIED (GO TO QUESTION 802)
WIDOWED/DIVORCED/SEPARATED (GO TO QUESTION 804)

802. RECORD LINE NUMBER OF HUSBAND FROM HOUSEHOLD SCHEDULE. IF HUSBAND IS NOT PRESENT IN THE HOUSEHOLD, RECORD '00'.

HUSBAND'S LINE NUMBER __

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

AGE IN COMPLETED YEARS __

804. In what month and year was your (last) husband born? COMPARE AND CORRECT 803 AND/OR 804 IF INCONSISTENT.

MONTH __
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

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

YES 1
NO 2 (GO TO 807)

806. What type of relationship was it?

FIRST COUSIN FATHER'S SIDE 1
FIRST COUSIN MOTHER'S SIDE 2
SECOND COUSIN FATHER'S SIDE 3
SECOND COUSIN MOTHER'S SIDE 4
OTHER RELATIVE FATHER'S SIDE 5
OTHER RELATIVE MOTHER'S SIDE 6
RELATIVE BY MARRIAGE 7

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

YES 1
NO 2 (If no go to 810)

808. What is the highest level of school he attended?

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

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

GRADE __
DON'T KNOW 8

810. CHECK 801:

CURRENTLY MARRIED (What is your husband's occupation? That is, what kind of work does he mainly do?)

WIDOWED/DIVORCED/SEPARATED (What was your (last) husband's occupation? That is, what kind of work did he mainly do? )

___________________ (RECORD ANSWER IN DETAIL)

811. Aside from your own housework, have you done any work in the last seven days even if it was only for a short period of time?

YES 1 (GO TO 815)
NO 2

812. 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. In the last seven days, have you done any of these things or any other work even if it was only for a short period of time?

YES 1 (GO TO 815)
NO 2

813. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

YES 1 (GO TO 815)
NO 2

814. Have you done any work in the last 12 months even if it was only for a short period of time?

YES 1
NO 2 (GO TO 822)

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

________________ (RECORD ANSWER IN DETAIL) __

816. 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

817. Do you usually work at home or away from home?

HOME 1
AWAY 2

818. 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 THE YEAR 2
ONCE IN A WHILE 3

819. Are you paid in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

820. CHECK 815:

WORKS IN AGRICULTURE (GO TO 821)
DOES NOT WORK IN AGRICULTURE (GO TO 822)

821. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

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

822. CHECK 106: MARITAL STATUS

CURRENTLY MARRIED (GO TO 823)
WIDOWED/DIVORCED/SEPARATED (GO TO 828)

823. CHECK 819:

CODE 1 OR 2 CIRCLED (GO TO 824)
OTHER (GO TO 826)

824. Who decides how the money you earn will be used: mainly you, mainly your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER (SPECIFY) _____________ 6

825. Would you say that the money that you bring into the household is more than what your husband brings in, less than what he brings in, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND DOESN'T BRING IN ANY MONEY 4 (GO TO 827)
DON'T KNOW/NOT APPLICABLE 8

826. Who decides how your husband's earnings will be used: mainly you, mainly your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND DOESN'T BRING IN ANY MONEY 4
OTHER (SPECIFY) _______________ 6

827. Who usually makes the following decisions: mainly you, mainly your husband, you and your husband jointly, or someone else?

About health care for yourself?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6
About making major household purchases?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6
About making purchases for daily household needs?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6
About visits to your family or relatives?
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6

828. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3
HUSBAND
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3
OTHER MALES
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3
OTHER FEMALES
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3

829. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations: If she goes out without telling him? If she neglects the children? If she argues with him? If she refuses to have sex with him? If she burns the food?

GOES OUT
YES 1
NO 2
DK 8
NEGL.CHILDREN
YES 1
NO 2
DK 8
ARGUES
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8
BURNS FOOD
YES 1
NO 2
DK 8

830. Now I would like to ask you some questions about medical care for yourself. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following big problem or not?
Getting permission to go. Getting money needed for treatment. The distance to the health facility. Having to take transportation. Not wanting to go alone. Concern that there may not be a female health provider. Concern that there may not be any health provider. Concern that there may be no drugs available.

PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
TAKING TRANSPORT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO FEMALE PROV
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO DRUGS
BIG PROBLEM 1
NOT A BIG PROBLEM 2

SECTION 9: FEMALE CIRCUMCISION

INTERVIEWER: CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY. DO NOT READ THE FOLLOWING QUESTIONS IF THERE IS NO PRIVACY.

901. Now I would like to talk about the practice of female circumcision. Have you yourself been circumcised?

YES 1
NO 2 (GO TO 904)

902. How old were you when you were circumcised?

AGE IN COMPLETED YEARS __
DON'T KNOW 98

903. Who performed the circumcision?

DOCTOR 1
NURSE/OTHER HLTH PROVIDER 2
DAYA 3
BARBER 4
GHAGARIA 5
OTHER (SPECIFY) _________ 6
DON'T KNOW 8

904. CHECK 214, 216 AND 217

AT LEAST ONE DAUGHTER AGE 0-19 YEARS (GO TO 905)
NO DAUGHTERS 0-19 YEARS (GO TO 915)

905. CHECK QUESTIONS 214 AND 217 AND IDENTIFY ALL OF THE WOMAN'S DAUGHTERS AGES 0-19 YEARS. ENTER THE NAME, AND LINE NUMBER FOR EACH DAUGHTER IN 906 BELOW BEGINNING WITH THE YOUNGEST DAUGHTER. USE AN ADDITIONAL QUESTIONNAIRE IF MORE THAN FOUR DAUGHTERS.

Now I would like to ask you some questions about your daughters.

906. CHECK 212:
RECORD NAME(S) AND LINE NUMBER(S) FOR DAUGHTERS.

LINE NO. __
NAME ________

907. CHECK 217:

AGE 15-19 YRS (GO TO 908)
AGE 0-14 YRS (GO TO 909)

908. What is (NAME'S) marital status?

EVER MARRIED 1
NEVER MARRIED/SIGNED CONTRACT 2

909. Is (NAME) circumcised?

YES 1
NO 2 (GO TO NEXT DAUGHTER OR TO 912)
DK 8 (GO TO NEXT DAUGHTER OR TO 912)

910. Who performed the circumcision to (NAME)?

DOCTOR 1
NURSE/OTHER HLTH PRV. 2
DAYA 3
BARBER 4
GHAGARIA 5
OTHER (SPECIFY) _____ 6
DK 8

911. How old was (NAME) when she was circumcised?

AGE __
DK 98

AFTER FINISHING Q911, GO TO NEXT DAUGHTER OR IF NO MORE DAUGHTERS, GO TO 912.

912. CHECK 909 AND RECORD THE NUMBER OF DAUGHTERS AGE 0-19 YEARS WHO HAVE NOT BEEN CIRCUMCISED.

NUMBER __

913. CHECK 912:
AT LEAST ONE DAUGHTER NOT CIRCUMCISED (GO TO 914)
ALL DAUGHTERS CIRCUMCISED (GO TO 915)

914. You have (NUMBER IN 912 ) daughter(s) who (has/have) not been circumcised. Do you intend that (she/they) will be circumcised in the future?

YES 1
NO 2
HAVE NOT DECIDED/UNSURE 8

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

YES 1
NO 2

916. During the past year have you heard, seen or received any information about female circumcision?

YES 1
NO 2 (GO TO 918)
UNSURE 8 (GO TO 918)

917. Where did you hear or see that information? Anywhere else? RECORD ALL MENTIONED

TELEVISION A
RADIO B
NEWSPAPER/MAGAZINE C
PAMPHLET/BROCHURE D
POSTER E
COMMUNITY MEETING F
HOME VISIT BY HEALTH WORKER G
FACILITY-BASED HEALTH WORKER H
HUSBAND I
OTHER RELATIVE/FRIENDS J
OTHER (SPECIFY) ____________ X

918. Do you believe that the practice of female circumcision is required by religious precepts?

YES 1
NO 2
DON'T KNOW 8

919. Do you think that the practice of female circumcision should be continued or should it be stopped?

CONTINUED 1
STOPPED 2
DON'T KNOW 8

920. Do you think that men want this practice to continue or to stop?

CONTINUED 1
STOPPED 2
DON'T KNOW 8

921. I will read you some statements about circumcision. Please tell me if you agree or disagree. A husband will prefer his wife to be circumcised. Circumcision prevents adultery. Childbirth is more difficult for a woman who has been circumcised. Circumcision can cause severe consequences that can lead to a girl's death.

HUSBAND PREFER
DISAGREE 1
AGREE 2
DK 8
PREVENTS ADULTERY
DISAGREE 1
AGREE 2
DK 8
CHILDBIRTH DIFFICULT
DISAGREE 1
AGREE 2
DK 8
MAY LEAD TO GIRL'S DEATH
DISAGREE 1
AGREE 2
DK 8

SECTION 10.SEXUALLY TRANSMITTED INFECTIONS

INTERVIEWER: CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY. DO NOT READ THE FOLLOWING QUESTIONS IF THERE IS NO PRIVACY NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT OTHER HEALTH SERVICES YOU MAY HAVE RECEIVED.

1001. CHECK 106: MARITAL STATUS

CURRENTLY MARRIED (GO TO 1002)
WIDOWED/DIVORCED/SEPARATED (GO TO 1009)

1002. Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 1004)

1003. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

1004. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

1005. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

1006. CHECK 1003, 1004, AND 1005:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 1007)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1009)

1007. The last time you had (PROBLEM FROM 1003/1004/1005), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1009)

1008. Where did you go? Any other place? RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH AND POPULATION
URBAN HOSPITAL (GNRL/DSTRCT) A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL (COMPl'TARY) D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL H
TEACHING HOSPITAL I
HEALTH INSURANCE ORG J
CURATIVE CARE ORGANIZATION K
OTHER GOVERNMENTAL L
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOC M
CSI PROJECT N
OTHER NON-GOVERNMENTAL O
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC P
PRIVATE DOCTOR Q
PHARMACY R
MOSQUE HEALTH UNIT S
CHURCH HEALTH UNIT T
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) U
FRIEND/RELATIVE V
OTHER (SPECIFY) ________________ X

1009. RECORD THE TIME.

HOUR __
MINUTES __

1010. THANK THE RESPONDENT AND ADVISE THAT THE RESPONDENT OR OTHER MEMBERS OF THE HOUSEHOLD MAY BE ASKED TO PARTICIPATE AGAIN IN INTERVIEWS OR OTHER SURVEY ACTIVITIES IN THE FUTURE.

Thank you for taking the time to answer these questions. We may return to interview you or other members of your household again or to ask you to participate in other survey activities in the future. We hope that you will agree at that time.

OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

1101. INTERVIEWER'S OBSERVATIONS

COMMENTS ABOUT RESPONDENT:
________________________________

COMMENTS ON SPECIFIC QUESTIONS:
________________________________

ANY OTHER COMMENTS:
_________________________________

1102. SUPERVISOR'S OBSERVATIONS
__________________________________
NAME OF SUPERVISOR: _______ DATE: ______

1103. EDITOR'S OBSERVATIONS
__________________________________
NAME OF EDITOR:________ DATE: _______

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

COL. 1: MARRIAGE/UNION

X IN UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION

COL. 2: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
M MISCARRIAGE
A ABORTION
S STILL BIRTH
0 NO METHOD
C FEMALE STERILIZATION
D MALE STERILIZATION
E PILL
F IUD
G INJECTABLES
H IMPLANTS
I CONDOM
K DIAPHRAGM/FOAM OR JELLY
N RHYTHM METHOD
R WITHDRAWAL
T PROLONGED BREASTFEEDING
X OTHER (SPECIFY) _______

COL. 3: SOURCE OF CONTRACEPTION

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

COL. 4: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
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 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPA
D MARITA __________________
X OTHER (SPECIFY) __________

Z DON'T KNOW

2008 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 01 _____ _____ _____ ______ 01 DEC
11 NOV 02 _____ _____ _____ ______ 02 NOV
10 OCT 03 _____ _____ _____ ______ 03 OCT
09 SEP 04 _____ _____ _____ ______ 04 SEP
08 AUG 05 _____ _____ _____ ______ 05 AUG
07 JUL 06 _____ _____ _____ ______ 06 JUL
06 JUN 07 _____ _____ _____ ______ 07 JUN
05 MAY 08 _____ _____ _____ ______ 08 MAY
04 APR 09 _____ _____ _____ ______ 09 APR
03 MAR 10 _____ _____ _____ ______ 10 MAR
02 FEB 11 _____ _____ _____ ______ 11 FEB
01 JAN 12 _____ _____ _____ ______ 12 JAN

2007 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 13 _____ _____ _____ ______ 13 DEC
11 NOV 14 _____ _____ _____ ______ 14 NOV
10 OCT 15 _____ _____ _____ ______ 15 OCT
09 SEP 16 _____ _____ _____ ______ 16 SEP
08 AUG 17 _____ _____ _____ ______ 17 AUG
07 JUL 18 _____ _____ _____ ______ 18 JUL
06 JUN 19 _____ _____ _____ ______ 19 JUN
05 MAY 20 _____ _____ _____ ______ 20 MAY
04 APR 21 _____ _____ _____ ______ 21 APR
03 MAR 22 _____ _____ _____ ______ 22 MAR
02 FEB 23 _____ _____ _____ ______ 23 FEB
01 JAN 24 _____ _____ _____ ______ 24 JAN

2006 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 25 _____ _____ _____ ______ 25 DEC
11 NOV 26 _____ _____ _____ ______ 26 NOV
10 OCT 27 _____ _____ _____ ______ 27 OCT
09 SEP 28 _____ _____ _____ ______ 28 SEP
08 AUG 29 _____ _____ _____ ______ 29 AUG
07 JUL 30 _____ _____ _____ ______ 30 JUL
06 JUN 31 _____ _____ _____ ______ 31 JUN
05 MAY 32 _____ _____ _____ ______ 32 MAY
04 APR 33 _____ _____ _____ ______ 33 APR
03 MAR 34 _____ _____ _____ ______ 34 MAR
02 FEB 35 _____ _____ _____ ______ 35 FEB
01 JAN 36 _____ _____ _____ ______ 36 JAN

2005 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 37 _____ _____ _____ ______ 37 DEC
11 NOV 38 _____ _____ _____ ______ 38 NOV
10 OCT 39 _____ _____ _____ ______ 39 OCT
09 SEP 40 _____ _____ _____ ______ 40 SEP
08 AUG 41 _____ _____ _____ ______ 41 AUG
07 JUL 42 _____ _____ _____ ______ 42 JUL
06 JUN 43 _____ _____ _____ ______ 43 JUN
05 MAY 44 _____ _____ _____ ______ 44 MAY
04 APR 45 _____ _____ _____ ______ 45 APR
03 MAR 46 _____ _____ _____ ______ 46 MAR
02 FEB 47 _____ _____ _____ ______ 47 FEB
01 JAN 48 _____ _____ _____ ______ 48 JAN

2004 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 49 _____ _____ _____ ______ 48 DEC
11 NOV 50 _____ _____ _____ ______ 50 NOV
10 OCT 51 _____ _____ _____ ______ 51 OCT
09 SEP 52 _____ _____ _____ ______ 52 SEP
08 AUG 53 _____ _____ _____ ______ 53 AUG
07 JUL 54 _____ _____ _____ ______ 54 JUL
06 JUN 55 _____ _____ _____ ______ 55 JUN
05 MAY 56 _____ _____ _____ ______ 56 MAY
04 APR 57 _____ _____ _____ ______ 57 APR
03 MAR 58 _____ _____ _____ ______58 MAR
02 FEB 59 _____ _____ _____ ______ 59 FEB
01 JAN 60 _____ _____ _____ ______ 60 JAN

2003 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 61 _____ _____ _____ ______ 61 DEC
11 NOV 62 _____ _____ _____ ______ 62 NOV
10 OCT 63 _____ _____ _____ ______ 63 OCT
09 SEP 64 _____ _____ _____ ______ 64 SEP
08 AUG 65 _____ _____ _____ ______ 65 AUG
07 JUL 66 _____ _____ _____ ______ 66 JUL
06 JUN 67 _____ _____ _____ ______ 67 JUN
05 MAY 68 _____ _____ _____ ______ 68 MAY
04 APR 69 _____ _____ _____ ______ 69 APR
03 MAR 70 _____ _____ _____ ______ 70 MAR
02 FEB 71 _____ _____ _____ ______ 71 FEB
01 JAN 72 _____ _____ _____ ______ 72 JAN

OUTCOME AND DATE OF LAST PREGNANCY TERMINATION PRIOR TO JANUARY 2003

IF NONE, RECORD '0' IN OUTCOME
OUTCOME ______
MONTH ________
YEAR __________

BIRTH DATE OF LAST CHILD BORN MONTH PRIOR TO JANUARY 2003 YEAR
MONTH ________
YEAR __________