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EGYPT DEMOGRAPHIC AND HEALTH SURVEY 2014: EVER-MARRIED WOMAN QUESTIONNAIRE.

IDENTIFICATION

GOVERNORATE_____________
PSU/SEGMENT NO. ____________
KISM/MARKAZ___________
BUILDING NO. ___________
SHIAKHA/VILLAGE__________
HOUSING UNIT NO.____________

URBAN/RURAL

URBAN 1
RURAL 2

HOUSEHOLD NUMBER______________
NAME OF HOUSEHOLD HEAD_____________
ADDRESS IN DETAIL______________
NAME OF WOMAN________________

LINE NUMBER OF WOMAN______________

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS):
DATE__________
TEAM__________
INTERVIEWER_________
SUPERVISOR__________
RESULT____

RESULT

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

NEXT VISIT (FOR INTERVIEWERS 1 AND 2):
DATE__________
TIME__________

FINAL VISIT:
DAY__ __
MONTH __ __
YEAR__ __
TEAM __ __
INT. NUMBER__ __
SUP. NUMBER__ __
RESULT__

TOTAL NUMBER OF VISITS____

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. This information will help the government to plan health services.
Your household was selected for the survey. The questions usually take 30 to 60 minutes.
All of the answers your give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been give to your household.

Do you have any questions? May I begin the interview now?

Signature of interviewer:______________
Date:______________

May I begin the interview now?

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO 1201)

101. RECORD THE TIME

HOUR __ __
MINUTES__ __

102. In what month and year were you born?

MONTH __ __
DON'T KNOW MONTH 98
YEAR__ __ __ __
DON’T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS __ __

104. What is your current marital status?

MARRIED 1
WIDOWED 2
DIVORCED 3
SEPARATED 4

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

NUMBER OF TIMES MARRIED __

106. CHECK 105:

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 you 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 108)
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS __ __

108. CHECK 105:

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

MARRIED MORE THAN ONCE: Now I would like to ask you 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 110)
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS __ __

110. DETERMINE ALL OF THE MONTHS SINCE JANUARY 2009 THAT THE RESPONDENT WAS MARRIED. ENTER 'X' IN COLUMN 1 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER '0' FOR EACH MONTH NOT MARRIED, SINCE JANUARY 2009.

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 2009.

111. Have you ever attended school?

YES 1
NO 2 (GO TO 115)

112. What is the highest level of school you have attended?

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

113. What is the highest grade you successfully completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '0'

GRADE __

114. CHECK 112:

PRIMARY (GO TO 115)
PREPARATORY OR HIGHER (GO TO 116)

115. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ A WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1 (GO TO 117)
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)___________4
BLIND/VISUALLY IMPAIRED 5 (GO TO 117)

116. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

117. Do you listen to the radio at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

118. Do you watch television at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

118A. Do you use a computer at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

118B. Do you use social media like Facebook or Twitter at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

118C. Do you access the internet at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

119. What is your religion?

MUSLIM 1
CHRISTIAN 2
OTHER (SPECIFY)____________6

SECTION 2: REPRODUCTION

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

YES 1
NO 2 (GO TO 205)

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 (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 __ __
DAUGTHERS ELSEWHERE__ __

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

YES 1
NO 2 (GO 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 209)
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?
RECORD NAME.

BIRTH NUMBER_____
NAME_______

213. Is (NAME) a boy or girl?

BOY 1
GIRL 2

214. Was (NAME) a twin or triplet?

SINGLE 1
MULTIPLE 2

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

MONTH __ __
YEAR __ __ __ __

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS __ __

218. Is (NAME) living with you?

YES 1
NO 2

219. RECORD HOUSE-HOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSE-HOLD).

HOUSEHOLD LINE NO. __ __ (GO TO 221)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1YR', 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 __ __
MONTH 2 __ __
YEARS 3 __ __

221. Were there any other live births (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 (ADD TO TABLE)
NO

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

NUMBERS ARE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 2009 OR LATER. IF NONE, RECORD '0' AND GO TO 225A.

NUMBER OF BIRTHS___

225. FOR EACH BIRTH SINCE JANUARY 2009, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 2 OF THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE RIGHT OF THE 'B' CODE.

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.

225A. ENTER THE MONTH AND YEAR OF THE MOST RECENT BIRTH PRIOR TO JANUARY 2009 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 THE NUMBER OF COMPLETED MONTHS.

MONTHS __

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

229. When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 230)
NO 2

229A. Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

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 other signs of 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 WOMEN HAD ANY STILLBIRTHS, MISCARRIAGES, OR ABORTIONS BACK TO JANUARY 2009.

IF THE WOMAN REPORTS A PREGNANCY THAT DID NOT END IN A LIVE BIRTH, ASK ABOUT THE MONTH AND YEAR IN WHICH THE PREGNANCY ENDED.
RECORD THE APPROPRIATE CODE FOR THE PREGNANCY OUTCOME ON THAT DATE IN COLUMN 2 IN THE CALENDAR ("S" FOR STILLBIRTH, "M" FOR MISCARRIAGE AND "A" FOR ABORTION). THEN ASK ABOUT THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "P" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.

NOTE: 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 THE MONTHS THAT THE PREGNANCY LASTED.

ILLUSTRATIVE QUESTIONS

TO IDENTIFY NON-LIVE BIRTH PREGNANCIES, ASK:

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

INTERVAL BETWEEN LAST AND PRIOR BIRTH
Did you have any pregnancy that ended in a still birth between (NAME OF LAST BIRTH) and (NAME OF PRIOR BIRTH)?

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

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

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

231. Did you have any (other) pregnancies before January 2009 that did not result in a live birth (pregnancy that ended in a stillbirth, miscarriage, or abortion)?

YES 1
NO 2

232. RECORD IN THE BOXES AT THE BOTTOM OF THE CALENDAR THE OUTCOME ("M", "A" OR "S") AND MONTH AND YEAR THAT THE PREGNANCY TERMINATED FOR THE LAST PREGNANCY THAT ENDED IN A STILLBIRTH, MISCARRIAGE, OR ABORTION PRIOR TO JANUARY 2009.
IF NONE RECODE '0' IN OUTCOME.

232A. CHECK THE CALENDAR:

ONE OR MORE ABORTIONS/MISCARRIAGES ("A" AND/OR "M") SINCE JANUARY 2009. (GO TO 232B)
NO ABORTIONS/MISCARRIAGES ("A" AND/OR "M") SINCE JANUARY 2009 (GO TO 233)

232B. CHECK THE CALENDAR FOR THE MOST RECENT PREGNANCY ENDING IN AN ABORTION OR MISCARRIAGE AND ASK:
Did you have any complications following with the miscarriage (abortion) you had in (DATE FROM CALENDAR)?

YES 1
NO 2 (GO TO 233)
DON'T KNOW (GO TO 233)

232C. What type of complication (s) did you have?
PROBE: Anything else?
RECORD ALL MENTIONED.

BLEEDING A
INFECTION B
OTHER (SPECIFY)___________X

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 women 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, 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 tlak about family planning-the various wasy or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

01. Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or nurse.
YES 1
NO 2
04. Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05. Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
06. Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07. Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. Diaphragm, Foam, Jelly. A women can place a sponge, suppository, diaphragm, jelly or cream inside her vagina before intercourse.
YES 1
NO 2
09. Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
10. Withdrawal. PROBE: Men can be careful and pull before climax.
YES 1
NO 2
11. Prolonged Breastfeeding.
YES 1
NO 2
12. Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
13. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS
SPECIFY____
YES 1
NO 2

302. CHECK 104:

CURRENTLY MARRIED (GO TO 303)
WIDOWED/DIVORCED/SEPARATED (GO TO 311)

303. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 304)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

305. Which method are you using?
CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION C (GO TO 307)
MALE STERILIZATION D (GO TO 307)
PILL E
IUD F (GO TO 308A)
MONTHLY INJECTION (MESOCEPT) G (GO TO 308A)
3-MONTH INJECTION (DEPO-PROVERA) H (GO TO 308A)
IMPLANTS I (GO TO 308A)
CONDOM K (GO TO 308A)
DIAPHRAGM/FOAM/JELLY N(GO TO 308A)
RHYTHM METHOD R (GO TO 308A)
WITHDRAWAL T (GO TO 308A)
PROLONGED BREASTFEEDING U (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

306. What is the brand name of the pills you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

MICROCEPT 01 (GO TO 308A)
MICROLUT 02(GO TO 308A)
LEVONOR 03 (GO TO 308A)
TRIOCEPT 04(GO TO 308A)
GYNERA 05(GO TO 308A)
NORDETTE 06(GO TO 308A)
EXLUTON 07(GO TO 308A)
MARVELON 08(GO TO 308A)
CILEST 09(GO TO 308A)
COTRABLAN 10(GO TO 308A)
OTHER (SPECIFY)_____________96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

307. In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE NAME OF THE PLACE.

NAME OF PLACE_____________________
MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 11
URBAN HEALTH UNIT 12
HEALTH OFFICE 13
RURAL HOSP'L 14
RURAL HEALTH UNIT 15
MCH CENTER 16
MOBILE UNIT 17
OTHER GOVERNMENTAL
UNIVERSITY/ TEACHING HOSPITAL 21
HEALTH INSURANCE ORG. 22
CURATIVE CARE ORGANIZATION 23
OTHER GOVERNMENTAL 26
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOCIATION 31
CSI PROJECT 32
OTHER NON-GOVERNMENTAL 36
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC 41
PRIVATE DOCTOR 42
OTHER PRIVATE MEDICAL
MOSQUE HEALTH UNIT 44
CHURCH HEALTH UNIT 45
OTHER (SPECIFY)________________46
DON'T KNOW 98

308. In what month and year was the sterilization performed?
308A. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH __ __
YEAR __ __ __ __

309. CHECK 308/308A, 215 AND THE CALENDAR:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A.

YES (GO BACK TO 308/308A, 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 310)

310. CHECK 308/308A:

YEAR IS 2009 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 2 OF THE CALENDAR AND IN EACH MONTH BACK TO CTHE DATE STARTED USING) (GO TO 311)

YEAR IS 2008 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN CLUMN 2 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 2009.) (GO TO 314)

311. I would like to ask some questions about all the 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 CONTRACEPTI USE SINCE JANUARY 2009

PROBE FOR EARLIER PERIODS OF USE AND NONUSE, WITH THE MOST RECENT PERIOD OF USE AND GOING BACK TO JANUARY 2009.
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-REASON FOR DISCOUNTINUATION

FOR EACH PERIOD OF USE, ASK WHY SHE STOPPED USING THE METHOD AND FOR DISCONTINUATION IN COLUMN 3 OF THE CALENDAR IN THE MONTH IN WHICH THE SEGMENT OF USE WAS TERMINATED.
IF A PREGNANCY FOLLOWED, ASK IF SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR WHETHER SHE DELIBERATELY STOPPED USING THE METHOD TO GET PREGNANT.
THE NUMBER OF CODES ENTERED IN COLUMN 3 MUST BE THE SAME AS THE NUMBER OF COMPLETE SEGMENTS OF CONTRACEPTIVE USE IN COLUMN 2.
ILLUSTRATIVE QUESTIONS FOR COLUMN 3

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 AND 3 AS APPROPRIATE, GO TO 312.

312. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH:

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314. CHECK 305:
CIRCLE METHOD CODE:
IF NO MORE THAN ONCE METHOD CODE CIRCLED IN 305, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRLCED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 401)
PILL 03
IUD 04 (GO TO 315A)
MONTHLY INJECTION (MESOCEPT) 05
3-MONTH INJECTION (DEPO-PROVERA) 06
IMPLANTS 07 (GO TO 315B)
CONDOM 08
DIAPHRAGM/FOAM/JELL 09
RHYTHM METHOD 10 (GO TO 315C)
WITHDRAWAL 11 (GO TO 315C)
PROLONGED BREASTFEEDING 12 (GO TO 315C)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 315C)

315. You started using (CURRENT METHOD) in (DATE FROM 308A). Where did you get it at that time?

315A. Where did you have the IUD inserted when you started using it in (DATE FROM
308A)?

315B. Where did you have the implant inserted when you started using it in (DATE FROM 308A)?

315C. Did you obtain advice about how to use (CURRENT METHOD) when you started using it in (DATE FROM 308A)?

IF YES: from where did you get the advice?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE_________________________
MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 11
URBAN HEALTH UNIT 12
HEALTH OFFICE 13
RURAL HOSP'L (CENTRAL) 14
RURAL HEALTH UNIT 15
MCH CENTER 16
MOBILE UNIT 17
OTHER GOVERNMENTAL
UNIVERSITY/TEACHING HOSPITAL 21
HEALTH INSURNACE ORGANIZATION 22
CURATIVE CARE ORGANIZATION 23
OTHER GOVERNMENTAL 26
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOCIATION 31
CSI PROJECT 32
OTHER NON-GOVERNMENTAL 36
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC 41
PRIVATE DOCTOR 42
PHARMACY 43
OTHER PRIVATE MEDICAL
MOSQUE HEALTH UNIT 44
CHURCH HEALTH UNIT 45
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______________46
OTHER NON-MEDICAL
VENDOR (SHOP, KIOSK, ETC) 61
FRIEND/RELATIVE 62
OTHER (SPECIFY)___________66
NO ONE 94
DON'T KNOW 98



316. CHECK 305:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 305, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

PILL 03
IUD 04
MONTHLY INJECTION (MESOCEPTION) 05
3-MONTH INJECTION (DEPO-PROVERA) 06
IMPLANTS 07
CONDOM 08 (GO TO 323)
DIAPHRAGM/FOAM/JELL 09 (GO TO 320)
RHYTHM METHOD 10 (GO TO 401)
WITHDRAWAL 11 (GO TO 401)
PROLONGED BREASTFEEDING 12 (GO TO 401)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 401)

317. At that time, were you told about the side effects or problems you might have with the method?
317A. When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

318. 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 (GO TO 320)

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

YES 1
NO 2

320. CHECK 317:

CODE '1' CIRCLED (At that time, were you told about other methods of family planning that you could use?)

CODE '1' NOT CIRCLED (When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning

YES (GO TO 322)
NO 2

321. 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

322. CHECK 305:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 305, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 401)
PILL 03
IUD 04 (GO TO 401)
MONTHLY INJECTION (MESOCEPT) 05
3-MONTH INJECTION (DEPO-PROVERA) 06
IMPLANTS 07
CONDOM 08
DIAPHRAGM/FOAM/JELLY 09
OTHER MODERN METHOD 95

323. Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 11 (GO TO 401)
URBAN HEALTH UNIT 12 (GO TO 401)
HEALTH OFFICE 13 (GO TO 401)
RURAL HOSP'L (CENTRAL) 14 (GO TO 401)
RURAL HEALTH UNIT 15 (GO TO 401)
MCH CENTER 16 (GO TO 401)
MOBILE UNIT 17 (GO TO 401)
OTHER GOVERNMENTAL
UNIVERSITY/TEACHING HOSPITAL 21 (GO TO 401)
HEALTH INSURANCE ORGANIZATION 22 (GO TO 401)
CURATIVE CARE ORGANIZATION 23 (GO TO 401)
OTHER GOVERNMENTAL 26 (GO TO 401)
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOCIATION 31 (GO TO 401)
CSI PROJECT 32 (GO TO 401)
OTHER NON-GOVERNMENTAL 36 (GO TO 401)
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC 41 (GO TO 401)
PRIVATE DOCTOR 42 (GO TO 401)
PHARMACY 43 (GO TO 401)
OTHER PRIVATE MEDICAL
MOSQUE HEALTH UNIT 44 (GO TO 401)
CHURCH HEALTH UNIT 45 (GO TO 401)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)___________46 (GO TO 401)
OTHER NON-MEDICAL
VENDOR (SHOP, KIOSK, ...ETC) 61 (GO TO 401)
FRIEND/RELATIVE 62 (GO TO 401)
OTHER (SPECIFY)_________66 (GO TO 401)
DON'T KNOW 98 (GO TO 401)

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

YES 1
NO 2

325. Where is that?
PROBE TO IDENITFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))______________________
MINISTRY OF HEALTH AND POPULATION
URBAN HOSP'L (GENERAL/DISTRICT) 11
URBAN HEALTH UNIT 12
HEALTH OFFICE 13
RURAL HOSP'L (CENTRAL) 14
RURAL HEALTH UNIT 15
MCH CENTER 16
MOBILE UNIT 17
OTHER GOVERNMENTAL
UNIVERSITY/TEACHING HOSPITAL 21
HEALTH INSURANCE ORGANIZATION 22
CURATIVE CARE ORGANIZATION 23
OTHER GOVERNMENTAL 26
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOCIATION 31
CSI PROJECT 32
OTHER NON-GOVERNMENTAL 36
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC 41
PRIVATE DOCTOR 42
PHARMACY 43
OTHER PRIVATE MEDICAL
MOSQUE HEALTH UNIT 44
CHURCH HEALTH UNIT 45
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)___________46
OTHER NON-MEDICAL
VENDOR (SHOP, KIOSK, ...ETC) 61
FRIEND/RELATIVE 62
OTHER (SPECIFY)_________66

SECTION 4. FERTILITY PREFERENCES

401. CHECK 104:
MARITAL STATUS

CURRENTLY MARRIED (GO TO 402)
WIDOWED/DIVORCED/SEPARATED (GO TO 412)

402. CHECK 305:
USING STERILIZATION

NEITHER STERILIZED (GO TO 402B)
HE OR SHE STERILIZED (GO TO 412)

403. 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?

HAVE (A/ANOTHER) CHILD 1 (GO TO 404)
NO MORE/NONE 2 (GO TO 410)
UNDECIDED/DON'T KNOW 8 (GO TO 410)

403B. 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 406)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 412)
UNDECIDED/DON'T KNOW 8 (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 412)
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 304:
USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 407)
CURRENTLY USING (GO TO 412)

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 403B:
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?

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)
NOT MENSTRUATED SINCE LAST BIRTH E (GO TO 410)
BREASTFEEDING F (GO TO 410)
UP TO GOD/FATALISTIC G (GO TO 410)
OPPOSITION TO USE
RESPONDENT OPPOSSED 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)
PREFERRED METHOD NOT AVAILABLE R (GO TO 410)
NO METHOD AVAILABLE S (GO TO 410)
INCONVIENIENT TO USE T (GO TO 410)
INTERFERES WITH BODY'S NORMAL PROCESSES U (GO TO 410)
OTHER (SPECIFY)____________X (GO TO 410)
DON'T KNOW Z (GO TO 410)

409. CHECK 304:
USING A CONTRACEPTIVE METHOD?

NO, NOT CURRENTLY USING, NOT ASKED (GO TO 410)
YES, CURRENTLY USING (GO TO 412)

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 01
MALE STERILIZATION 02
PILL 03
IUD 4
INJECTABLE 05
IMPLANTS 07
CONDOM 08
DIAPHRAGM/FOAM/JELLY 09
RHYTHM METHOD 10
WITHDRAWAL 11
PROLONGED BREASTFEEDING 12
OTHER MODERN METHOD 94
OTHER TRADITIONAL METHOD 95
OTHER 96
DON'T KNOW 98

412. CHECK 216:

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

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

NONE 00 (GO TO 413A)
NUMBER __ __
OTHER (SPECIFY)______________96 (GO TO 413A)

413. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or girl?

NUMBER OF BOYS __ __
NUMBER OF GIRLS __ __
NUMBER OF EITHER SEX__ __

OTHER (SPECIFY)_________96

413A. Now I would like you to think about what age is best for a person to marry?
What is the ideal age for a girl to marry?

IDEAL AGE FOR A GIRL TO MARRY __ __

AGE DOES NOT MATTER 95
DON'T KNOW/NOT SURE 98

413B. What is the ideal age for a boy to marry?

IDEAL AGE FOR BOY TO MARRY __ __

AGE DOES NOT MATTER 95
DON'T KNOW/NOT SURE 98

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

YES 1
NO 2

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

YES 1
NO 2

416. 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 a 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?

HEALTH WORKER A
RAIDA RIFIA B
OTHER (SPECIFY)__________X
NOT VISITED Y

420. Have you visited a governmental health facility for any reason 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 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?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
On a poster, billboard, or sign?
YES 1
NO 2
At a community meeting?
YES 1
NO 2
From a religious leader?
YES 1
NO 2

424A. CHECK 301:
METHOD 11

PROLONGED BREASTFEEDING NOT MENTIONED (GO TO 424B)
PROLONGED BREASTFEEDING MENTIONED (GO TO 424C)

424B. 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 425)

424C. 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 RETURNS 93
UNTIL SHE STOPS/CHILD WEANED 94
OTHER (SPECIFY)__________96
DON'T KNOW 98

424D. If a breastfeeding mother's menstrual period returns, is she protected from pregnancy?

YES 1
NO 2
DON'T KNOW 8

424E. If the child is given other liquids or solids, is a breastfeeding mother protected from pregnancy?

YES 1
NO 2
DON'T KNOW 8

424F. 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

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 104:
MARITAL STATUS

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

427. CHECK 304:
USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 428)
NOT CURRENTLY USING (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 305:

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, POSTNATAL CARE, AND BREASTFEEDING

501. CHECK 224:

ONE OR MORE BIRTHS IN 2009 OR LATER (GO TO 502)
NO BRITHS IN 2009 OR LATER (GO TO 704)

502. CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 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 some questions about your children born in the last five years. (We will talk about each separately).

503. BIRTHS HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER __ __

504. FROM 212 AND 216:

NAME______________

LIVING (GO TO 505)
DEAD (GO TO 505)

505. When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 508)
NO 2

506. Did you want to have a baby later on, or did you not want any(more) children?

LATER 1
NO MORE 2 (GO TO 508)

507. How much longer did you want to wait?

MONTHS 1 __ __
YEARS 2 __ __

DON'T KNOW 998

508. Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 515)

509. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
OTHER (SPECIFY)_________X

510. Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

HOME
YOUR HOME A
OTHER B
GOVERNMENT
URBAN HOSPITAL (GENERAL/DISTRICT) C
URBAN HEALTH UNIT D
RURAL HOSPITAL (CENTRAL) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOVERNMENT (SPECIFY)_________I
NONGOVERNMENTAL
EGYPTIAN FP ASSOCIATION J
CSI PROJECT K
OTHER NGO (SPECIFY)_________L
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC M
PRIVATE DOCTOR N
OTHER PRIVATE MEDICAL _________P
OTHER NON-MEDICAL X

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

NUMBER OF TIMES__ __
DON'T KNOW 98

512. How many months pregnant were you when you first received antenatal care for this pregnancy? [ASK FOR MOST RECENT BIRTH ONLY]

MONTHS __ __
DON'T KNOW 98

513. As part of your antenatal care during this pregnancy, were any of the following done at least once:

[ASK FOR MOST RECENT BIRTH ONLY]

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

514. During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

515. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[ASK FOR MOST RECENT BIRTH ONLY]

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

515A. CHECK 508:
[ASK FOR MOST RECENT BIRTH ONLY]

NO ANC (GO TO 515B)
HAD ANC (GO TO 516)

515B. Did any of the persons you saw for the tetanus injection (s) advise you that you should go for antenatal care?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

516. During this pregnancy, how many times did you get a tetanus injection?
[ASK FOR MOST RECENT BIRTH ONLY]

TIMES ___
DON'T KNOW 8

517. CHECK 516:
[ASK FOR MOST RECENT BIRTH ONLY]

2 OR MORE TIMES (GO TO 521)
OTHER (GO TO 518)

518. At any time before this pregnancy, did you receive any tetanus injections?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 521)
DON'T KNOW 8 (GO TO 521)

519. Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[ASK FOR MOST RECENT BIRTH ONLY]

TIMES___
DON'T KNOW 8

520. How many years ago did you receive the last tetanus injection before this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

YEARS AGO __ __

521. During the whole pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO (GO TO 523)
DON'T KNOW 8 (GO TO 523)

522. 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.
[ASK FOR MOST RECENT BIRTH ONLY]

DAYS __ __ __
DON'T KNOW 998

523. During this pregnancy, did you take any drug for intestinal worms?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

524. 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

525. Was (NAME) weighed at birth?

YES 1
NO 2 (GOTO 527)
DON'T KNOW 8

526. How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD__.__ __ __
KG FROM RECALL__.__ __ __

DON'T KNOW 99.998

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

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
DAYA C
RELATIVE/FRIEND E
OTHER (SPECIFY)___________X
NO ONE ASSISTED Y

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

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

(NAME OF PLACE(S))_______________
HOME
YOUR HOME 11 (GO TO 533)
OTHER HOME 12 (GO TO 533)
GOVERNMENT
URBAN HOSPITAL (GENERAL/DISTRICT) 21
URBAN HEALTH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL (CENTRAL) 24
RURAL HEALTH UNIT 25
MCH CENTER 26
OTHER GOVERNMENT (SPECIFY)___________27
NONGOVERNMENTAL
EGYPTIAN FP ASSOCIATION 31
CSI PROJECT 32
OTHER NGO (SPECIFY)___________36
PRIVATE MEDICAL
PRIVATE HOSPITAL CLINIC 41
PRIVATE DOCTOR 42
OTHER PRIVATE MEDICAL (SPECIFY)________46

529. How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS.
[ASK FOR MOST RECENT BIRTH ONLY]

HOURS 1 __ __
DAYS 2 __ __
WEEKS 3 __ __

DON'T KNOW 8

530. Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby?

YES 1
NO 2

531. I would like to talk to you about check on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 534)
NO 2

532. Did anyone check on your health after you left the facility?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 534)
NO 2 (GO TO 536)

533. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2(GO TO 536)

534. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
OTHER PERSON
DAYA 21
OTHER (SPECIFY)____________96

535. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

[ASK FOR MOST RECENT BIRTH ONLY]

HOURS 1 __ __
DAYS 2 __ __
WEEKS 3 __ __

DON'T KNOW 998

536. 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?
[ASK FOR MOST RECENT BIRTH ONLY]

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

537. How many times after delivery did a health professional visit your home to check on your health? [ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF TIMES __ __
DON'T KNOW 98

538. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health? [ASK FOR MOST RECENT BIRTH ONLY]

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

539. How many hours, days or weeks after the birth of (NAME) did the first check take place?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS AFTER BIRTH 1 __ __
DAYS AFTER BIRTH 2 __ __
WEEKS AFTER BIRTH 3 __ __

DON'T KNOW 998

540. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL DOCTOR 11
NURSE/MIDWIFE 12
OTHER PERSON DAYA 21
OTHER (SPECIFY)__________96

541. Where did this first check of (NAME) take place?
[ASK FOR MOST RECENT BIRTH ONLY]

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

HOME
YOUR HOME 11
OTHER HOME 12
GOVERNMENT
URBAN HOSPITAL (GENERAL/DISCTRICT) 21
URBAN HEALTH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL (CENTRAL) 24
RURAL HEALTH UNIT 25
MCH CENTER 26
OTHER GOVERNMENT (SPECIFY)_________27
NONGOVERNMENT
EGYPTIAN FP ASSOCIATION 31
CSI PROJECT 32
OTHER NGO (SPECIFY)___________36
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC 41
PRIVATE DOCTOR 42
OTHER PRIVATE MEDICAL (SPECIFY)________46
OTHER NON-MEDICAL (SPECIFY)_____________96

542. During the two weeks after birth, was a blood sample taken from (NAME'S) heel?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 544)
DON'T KNOW 8 (GO TO 544)

543. How many days after birth was the blood sample taken from (NAME's) heel?
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF DAYS __ __
DON'T KNOW 98

544. In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)? [ASK FOR MOST RECENT BIRTH ONLY]

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

545. Has your menstrual period returned since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 547)
NO 2 (GO TO 548)

546. Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 550)

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

MONTHS __ __
DON'T KNOW 98

548. CHECK 226:
IS RESPONDENT PREGNANT?
[ASK FOR MOST RECENT BIRTH ONLY]

NOT PREGNANT (GO TO 549)
PREGNANT OR UNSURE (GO TO 550)

549. Have you had sexual intercourse since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 551)

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

MONTHS __ __
DON'T KNOW 98

551. Did you ever breastfeed (NAME)?

YES 1(GO TO 553)
NO 2

552. CHECK 504: IS CHILD LIVING?
[ASK FOR MOST RECENT BIRTH ONLY]

LIVING (GO TO 558)
DEAD (GO BACK TO 505 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 601)

553. How long after birth did you first put (NAME) to the breast?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN 1 HOUR, RECORD '000'. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000

HOURS 1 __ __
DAYS 2 __ __

554. In the first three days after delivery, was (NAME) given anything to drink other than breast milk? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO (GO TO 556) 2

555. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[ASK FOR MOST RECENT BIRTH ONLY]

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 FORMAULA G
TEA/INFUSIONS H
COFFEE I
HONEY J
OTHER (SPECIFY)_______X

556. CHECK 504:
IS CHILD LIVING?

LIVING (GO TO 557)
DEAD (GO BACK TO 505 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601)

557. Are you still breastfeeding (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

559. GO BACK TO 505 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601.

SECTION 6. CHILD IMMUNIZATION AND TREATMENT OF CHILD ILLNESSES

601. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL QUESTIONNAIRE).

602. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER __ __

603. FROM 212 AND 216

NAME___________

LIVING (GO TO 604)
DEAD (GO TO 603 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 701)

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

YES, SEEN AND VACCINATION DATES RECORDED 1 (GO TO 605A)
YES, SEEN BUT NO VACCINATION DATES RECORDED 2 (GO TO 605A)
YES, NOT SEEN (GO TO 605A)
NO CARD 4

605. Did you ever have a vaccination card for (NAME)?

YES 1
NO 2

605A. Did you ever have a birth certificate where (NAME)'s vaccinations are written down?
IF YES: May I see it please?

YES, SEEN AND VACCINATION DATES RECORDED 1
YES, SEEN BUT NO VACCINATION DATES RECORDED 2
YES, NOT SEEN (GO TO 605C) 3
NO CERTIFICATE 4

605B. Did you ever have a birth certificate for (NAME) where vaccinations were written down?

YES 1
NO 2

605C. RECORD AVAILABILITY OF CARD AND /OR CERTIFICATE WITH VACCINATION DATES.

BOTH CARD AND CERTIFICATE WITH DATES SEEN 1
ONLY CARD WITH DATES SEEN 2
ONLY CERTIFICATE WITH DATES SEEN 3
NEITHER WITH DATES SEEN 4 (GO TO 609)

606. 1. COPY DATES FROM THE CARD OR CERTIFICATE. THE ORDER OF THE VACCINATIONS ON THE CARD AND CERTIFICATE MAY DIFFER FROM THE ORDER IN THE GRID SO MAKE SURE TO COPY THE CORRECT DATE FOR THE SPECIFIC VACCINATION.
2. WRITE '44' IN 'DAY' COLUMN IF CARD OR CERTIFICATE SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY __ __
MONTH __ __
YEAR __ __ __ __
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY __ __
MONTH __ __
YEAR __ __ __ __
POLIO 1
DAY __ __
MONTH __ __
YEAR __ __ __ __
POLIO 2
DAY __ __
MONTH __ __
YEAR __ __ __ __
POLIO 3
DAY __ __
MONTH __ __
YEAR __ __ __ __
POLIO 4
DAY __ __
MONTH __ __
YEAR __ __ __ __
POLIO 5
DAY __ __
MONTH __ __
YEAR __ __ __ __
ACTIVATED POLIO
DAY __ __
MONTH __ __
YEAR __ __ __ __
DPT 1
DAY __ __
MONTH __ __
YEAR __ __ __ __
DPT 2
DAY __ __
MONTH __ __
YEAR __ __ __ __
DPT 3
DAY __ __
MONTH __ __
YEAR __ __ __ __
ACTIVATED DPT DOSE
DAY __ __
MONTH __ __
YEAR __ __ __ __
HEPATITIS 1
DAY __ __
MONTH __ __
YEAR __ __ __ __
HEPATITIS 2
DAY __ __
MONTH __ __
YEAR __ __ __ __
HEPATITIS 3
DAY __ __
MONTH __ __
YEAR __ __ __ __
MEASLES
DAY __ __
MONTH __ __
YEAR __ __ __ __
MMR 1
DAY __ __
MONTH __ __
YEAR __ __ __ __
ACTIVATED MMR2
DAY __ __
MONTH __ __
YEAR __ __ __ __
PVT 1
DAY __ __
MONTH __ __
YEAR __ __ __ __
PVT 2
DAY __ __
MONTH __ __
YEAR __ __ __ __
PVT 3
DAY __ __
MONTH __ __
YEAR __ __ __ __
OTHER (SPECIFY)
DAY __ __
MONTH __ __
YEAR __ __ __ __

607. CHECK 606:

BCG TO MMR 2 ALL RECORDED (GO TO 611)
OTHER (GO TO 608)

608. Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 606 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 606) (GO TO 611)
NO 2 (GO TO 611)
DON'T KNOW 8 (GO TO 611)

609. Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

YES 1
NO 2 (GO TO 611)
DON'T KNOW 8 ( GO TO 611)

610. Please tell me if (NAME) had any of the following vaccinations:
610A. 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

610B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 610E)
DON'T KNOW 8

610C. Was the first polio vaccine given in the first two weeks after birth?

FIRST 2 WEEKS 1
LATER 2

610D. How many times was the polio vaccine given?

NUMBER OF TIMES____

610E. A DPT vaccination, that is, an injection given in the thigh or buttocks, often at the same time as polio drops?

YES 1
NO 2 (GO TO 610G)
DON'T KNOW 8

610F. How many times was the DPT vaccination given?

NUMBER OF TIMES __

610G. A hepatitis injection-that is, a shot to prevent him/her from getting hepatitis B often at the same time as DPT?

YES 1
NO 2 (GO TO 610I)
DON'T KNOW 8 (GO TO 610I)

610H. How many times was the hepatitis vaccination given?

NUMBER OF TIMES ___

610I. CHECK 215 AND RECORD YEAR OF BIRTH

YEAR 2014 (GO TO 610J)
YEAR 2013 OR BEFORE (GO TO 610L)

610J. A pentavalent vaccination-that is, a new type of vaccine at the same time as polio drops that prevents five diseases including diphtheria, tetanus, pertussis, hepatitis B and haemophilius influenzae type b?

YES 1
NO 2 (GO TO 610L)
DON'T KNOW 8 (GO TO 610L)

610K. How many times was the pentavalent vaccine given?

NUMBER OF TIMES __

610L. A measles injection or an MMR injection-that is, a shot in the arm at the age of 9 months or older-to prevent him/her from getting measles?

YES 1
NO (GO TO 611)
DON'T KNOW 8 (GO TO 611)

610M. How many times was the measles or MMR vaccination given?

NUMBER OF TIMES ___

611. Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

612. In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these?)

YES 1
NO 2
DON'T KNOW 8

613. Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

614. Has (NAME) had diarrhea in the last month?

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

614A. How many times has (NAME) had diarrhea in the last month?

NUMBER OF TIMES____

614B. Now I have some questions about the last time (NAME) had diarrhea. The last time (NAME) had diarrhea, was it in the last two weeks?

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


615. Was there any blood in the stools that time?

YES 1
NO 2
DON'T KNOW 8

616. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk)
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

617. 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

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

YES 1
NO 2 (GO TO 622)

619. Where did you seek advice or treatment?
Anywhere else?

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

RECORD ALL PLACES MENTIONED

(NAME OF PLACE(S))________________________
GOVERNMENT
URBAN HOSPITAL (GENERAL/DISTRICT) C
URBAN HEALTH UNIT D
HEALTH OFFICE E
RUAL HOSPITAL (CENTRAL) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOVERNMENT (SPECIFY)___________I
NONGOVERNMENTAL
EGYPTIAN FP ASSOCIATION J
CSI PROJECT K
OTHER NGO (SPECIFY)____________L
PRIVATE MEDICAL
PRIVATE MEDICAL/CLINIC M
PRIVATE DOCTOR N
PHARMACY O
OTHER PRIVATE MEDICAL (SPECIFY)_____________P
OTHER NON-MEDICAL_______________X

620. CHECK 619:

TWO OR MORE CODES CIRCLED (GO TO 621)
ONLY ONE CODE CIRLCED (GO TO 622)

621. Where did you first seek advice or treatment?

GOVERNMENT
URBAN HOSPITAL (GENERAL/DISTRICT) C
URBAN HEALTH UNIT D
HEALTH OFFICE E
RUAL HOSPITAL (CENTRAL) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOVERNMENT (SPECIFY)___________I
NONGOVERNMENTAL
EGYPTIAN FP ASSOCIATION J
CSI PROJECT K
OTHER NGO (SPECIFY)____________L
PRIVATE MEDICAL
PRIVATE MEDICAL/CLINIC M
PRIVATE DOCTOR N
PHARMACY O
OTHER PRIVATE MEDICAL (SPECIFY)_____________P
OTHER NON-MEDICAL_______________X

622. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid made from a special packet called mahloul moalget el gafaf?
b) A pre-packaged ORS liquid?
c) A government-recommended homemade fluid?

MAHLOUL MOALGET EL GAFAF
YES 1
NO 2
DON'T KNOW 8
ORS LQD
YES 1
NO 2
DON'T KNOW 8
HOMEMADE FLUID
YES 1
NO 2
DON'T KNOW 8

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

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

624. 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 ANTI-BIOTIC, ANTI-MOTILITY, 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
OTHER (SPECIFY)____________X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 630)
DON'T KNOW 8 (GO TO 630)

628. 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 631)
DON'T KNOW 8 (GO TO 631)

629. 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 631)
NOSE ONLY 2 (GO TO 631)
BOTH 3 (GO TO 631)
OTHER (SPECIFY)________6 (GO TO 631)
DON'T KNOW 8 (GO TO 631)

630. CHECK 625:
HAD FEVER?

YES (GO TO 631)
NO OR DON'T KNOW (GO BACK TO 603 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 639)

631. Now I would like to know how much (NAME) was given to drink (including breastmilk) 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

632. 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

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

YES 1
NO 2 (GO TO 637)

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

NAME OF PLACE(S)_______________________
GOVERNMENT
URBAN HOSPITAL (GENERAL/DISTRICT) C
URBAN HEALTH UNIT D
HEALTH OFFICE E
RUAL HOSPITAL (CENTRAL) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOVERNMENT (SPECIFY)___________I
NONGOVERNMENTAL
EGYPTIAN FP ASSOCIATION J
CSI PROJECT K
OTHER NGO (SPECIFY)____________L
PRIVATE MEDICAL
PRIVATE MEDICAL/CLINIC M
PRIVATE DOCTOR N
PHARMACY O
OTHER PRIVATE MEDICAL (SPECIFY)_____________P
OTHER NON-MEDICAL_______________X

635. CHECK 634:

TWO OR MORE CODES CIRLCED (GO TO 636)
ONLY ONE CODE CIRLCED (GO TO 637)

636. Where did you first seek advice or treatment?

GOVERNMENT
URBAN HOSPITAL (GENERAL/DISTRICT) C
URBAN HEALTH UNIT D
HEALTH OFFICE E
RUAL HOSPITAL (CENTRAL) F
RURAL HEALTH UNIT G
MCH CENTER H
OTHER GOVERNMENT (SPECIFY)___________I
NONGOVERNMENTAL
EGYPTIAN FP ASSOCIATION J
CSI PROJECT K
OTHER NGO (SPECIFY)____________L
PRIVATE MEDICAL
PRIVATE MEDICAL/CLINIC M
PRIVATE DOCTOR N
PHARMACY O
OTHER PRIVATE MEDICAL (SPECIFY)_____________P
OTHER NON-MEDICAL_______________X

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

YES 1
NO 2 (GO BACK TO 603 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 701)
DON'T KNOW 8 (GO BACK TO 603 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 701)

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

ANTIBIOTIC DRUGS
PILL/SYRUP A
INJECTION B
OTHER DRUGS
ASPIRIN C
ACETA-MINOPHEN D
IBUPROFEN E
OTHER ANTI PYRETIC (SPECIFY)___________F
COUGH DRUGS G
OTHER (SPECIFY)____________X
DON'T KNOW Z

639. GO BACK TO 603 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 701.

SECTION 7. CHILD HEALTH AND NUTRITION

701. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 702)
NAME___ (GO TO 702)
NONE (GO TO 704)

702. The last time (NAME FROM 701) passed stools, what was done to dispose of the stools?

CHILD USE TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN IN GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY)_______________________96

703. CHECK 622 (ITEMS (a) AND (b)), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 704)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 705)

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

YES 1
NO 2

705. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2011 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 706)
(NAME)____________________)
NONE (GO TO 801)

706. Now I would like to ask you about liquids or foods that (NAME FROM 705) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 705) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES DRANK MILK ___
e) Infant formula, that is, a special commercially produced breastmilk substitutes such as Similac, Bebelack and Biomeal?
YES 1
NO 2
DON'T KNOW 8
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES ATE YOGURT ___
h) Any (BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G., Cerelac)?
YES 1
NO 2
DON'T KNOW 8
i) Bread, rice noodles, porridge, or other foods made from grains
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) Potatoes, white potatoes, white yams, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, papayas (yellow) or apricots?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

707. CHECK 706 (CATEGORIES "g" THROUGH "u"):

NOT A SINGLE "YES" (GO TO 708)
AT LEAST ONE "YES" (GO TO 709)

708. Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

YES 1 (GO BACK TO 706 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 710)

709. How many times did (NAME FROM 705) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

710. CHECK 706 INFANT FORMULA (CATEGORY "e"):

NO/DON'T KNOW (GO TO 711)
YES (GO TO 712)

711. You told me that you did not give (NAME) infant formula yesterday during the day or night. Are you giving (NAME) infant formula at all now?

YES 1
NO 2 (GO TO 801)

712. Is the infant formula you are giving (NAME) subsidized by the government?

YES 1
NO 2
DON'T KNOW 8

713. Is the infant formula you are giving (NAME) available at your local primary health care clinic?

YES 1
NO 2
DON'T KNOW 8

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

801. CHECK 104:
MARITAL STATUS

CURRENTLY MARRIED (GO TO 802)
WIDOWED/DIVORCED/SEPARATED (GO TO 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?
FOR CURRENTLY MARRIED WOMEN 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 806A)

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 MARRIGE 7

806A. Does your (last) husband have other wives?

YES 1
NO 2 (GO TO 807)
DON'T KNOW 8 (GO TO 807)

806B. Including yourself, in total, how many wives does (did) he have?

TOTAL NUMBER OF WIVES __ __
DON'T KNOW 98

806C. Are you the first, second, ... wife?

RANK __ __

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

YES 1
NO 2 (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?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '0'.

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?

OCCUPATION_______________________

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 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?

OCCUPATION_________________

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 and?

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

822. CHECK 104:
MARITAL STATUS

CURRENTLY MARRIED (GO TO 823)
WIDOWED/DIVORCED/SEPARATED (GO TO 827D)

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 827A)
DON'T KNOW 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

827A. Who usually makes decisions about health care for yourself: you, your (husband), you and your (husband) jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY)_____________6

827B. Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY)____________6

827C. Who usually makes decisions about visits to your family or relatives?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY)_______________6

827D. Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

827E. Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

CHILDREN LESS THAN 10
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3

829. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 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 a big problem or not?

Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having to take transportation?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be any health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be any health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may be no drugs available?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

831. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 901)

832. What type of health insurance are you covered by?
RECORD ALL MENTIONED.

HEALTH INSURANCE THROUGH THE GENERAL AGENCY OF HEALTH INSURANCE A
HEALTH INSURNACE THOUGH EMPLOYER B
HEALTH INSURNACE THROUGH ANY OF THE SYNDICATES C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY)________________X

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 HEALTH PROVIDER 2
DAYA 3
BARBER 4
GHAGARIA 5
OTHER (SPECIFY)________________6
DON'T KNOW 8

904. CHECK 213, 216, AND 217

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

905. CHECK QUESTIONS 213 AND 217 AND IDENTIFY ALL OF THE WOMAN'S SURVIVING DAUGHTERS AGES 0-19 YEARS. ENTER THE NAME, AND LINE NUMBER FOR EACH DAUGHTER IN 906 BELOW BEGINNING WITH THE YOUNGEST DAUGHTER. USE ADDITIONAL QUESTIONNAIRE IF MORE THAN FOUR DAUGHTERS.

Now I would like to ask you about 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 YEARS (GO TO 908)
0-14 YEARS (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)
DON'T KNOW 8 (GO TO NEXT DAUGHTER OR TO 912)

910. Who performed the circumcision to (NAME)?

DOCTOR/NURSE/OTHER 1
HEALTH PROVIDER 2
DAYA 3
BARBER 4
GHARGARIA 5
OTHER (SPECIFY)______________6
DON'T KNOW 8

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

AGE __ __
DON'T KNOW 98 (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 (GO TO 918)
UNSURE (GO TO 918)

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
EDUCATIONAL SEMINAR G
HOME VISIT BY HEALTH WORKER H
FACILITY-BASED HEALTH WORKER I
HUSBAND J
OTHER RELATIVE/FRIENDS K
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.
AGREE 1
DISAGREE 2
DON'T KNOW 8
Circumcision prevents adultery
AGREE 1
DISAGREE 2
DON'T KNOW 8
Childbirth is more difficult for a woman who has been circumcised.
AGREE 1
DISAGREE 2
DON'T KNOW 8
Circumcision can cause severe consequences that can lead to a girl's death.
AGREE 1
DISAGREE 2
DON'T KNOW 8

SECTION 10. KNOWLEDGE OF HIV/AIDS AND SEXUALITY TRANSMITTED INFECTIONS.

1001. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 1019)

1002. Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?

YES 1
NO 2
DON'T KNOW 8

1003. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

1004. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

1005. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

1006. Can people reduce their chance of getting the AIDS virus abstaining from sexual intercourse?

YES 1
NO 2
DON'T KNOW 8

1007. Can the HIV virus be transmitted from a mother to her baby:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

1008. CHECK 1007:

AT LEAST ONE 'YES' (GO TO 1009)
OTHER (GO TO 1010)

1009. Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

1010. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

1011. Do you know of place where people can go to get tested for the virus that causes AIDS?

YES 1
NO 2
DON'T KNOW 8

1012. Where is that?

IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND ADDRESS OF THE PLACE. PROBE

GOVERNMENT
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH UNIT B
VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
STANDALONE GOVERNMENT LABORATORY F
OTHER GOVERNMENT (SPECIFY)_____________G
NON GOVERNMENTAL (SPECIFY)______________H
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
PHARMACY J
STANDALONE PRIVATE LABORATORY K
OTHER PRIVATE MEDICAL (SPECIFY)______________L
OTHER NON-MEDICAL (SPECIFY)_________________X

1013. Would you buy fresh vegetables from a shopkeeper or if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

1014. If a member of your family became sick with the virus, that causes AIDS, would you want it to remain a secret or no?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

1015. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your household?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

1016. In your opinion, if a female teacher has the AIDS virus but is not sick , should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

1017. In the last 6 months have you heard, seen, or received any information about HIV/AIDS?

YES 1
NO 2 (GO TO 1019)
DON'T KNOW 8 (GO TO 1019)

1018. Where did you hear or see that information?
PROBE: 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/NEIGHBORS J
OTHER (SPECIFY)___________X

1019. CHECK 104:
MARITAL STATUS

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

1020. Now I would like to ask you some questions about other health services you may have received.
Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 1022)

1021. Now I would like to ask you some questions about other health services you may have received. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2 (GO TO 1022)

1022. 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

1023. 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

1024. CHECK 1021, 1022, AND 1023:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 1025)
HAS HAD NOT AN INFECTION OR DOES NOT KNOW (GO TO 1100)

1025. The last time you had (PROBLEM FROM 1021/1022/1023), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1100)

1026. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH AND POPULATION
URBAN HOSPITAL (GENERAL/DISTRICT) A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL (CENTRAL) D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY/TEACHING HOSPITAL H
HEALTH INSURANCE ORGANIZATION I
CURATIVE CARE ORGANIZATION J
OTHER GOVERNMENTAL K
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOCIATION L
CSI PROJECT M
OTHER NON-GOVERNMENTAL N
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC O
PRIVATE DOCTOR P
PHARMACY Q
MOSQUE HEALTH UNIT R
CHURCH HEALTH UNIT S
OTHER NON-MEDICAL
VENDOR (SHOP, KIOSK, ETC.) T
FRIEND/RELATIVE U
OTHER (SPECIFY)____________X

SECTION 11. DOMESTIC VIOLENCE

1100. CHECK HOUSEHOLD QUESTIONNAIRE: IDENTIFICATION PAGE FOR SUB-SAMPLE AND Q300 FOR LINE NUMBR OF SELECTED WOMAN:

WOMAN SELECTED FOR THIS SECTION (GO TO 1101)
WOMAN NOT SELECTED (GO TO 1129)

1101. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (READ TO RESPONDENT: Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Egypt. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

1102. CHECK 104:

CURRENTLY MARRIED (GO TO 1103)
FORMERLY MARRIED (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND')

1103. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

1104. Now I need to ask some more questions about your relationship with your (last) husband.

1104A. Did your (last) husband ever:

a) say or do something to humiliate you in front of others?
YES 1 (TO 1104B)
NO 2
b) threaten to hurt or harm you or someone you care about?
YES 1 (TO 1104B)
NO 2
c) insult you or make you feel bad about yourself?
YES 1 (TO 1104B)
NO 2

1104B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1105(A). Did your (last) husband ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1 (GO TO 1105B)
NO 2
b) slap you?
YES 1 (GO TO 1105B)
NO 2
c) twist your arm or pull your hair?
YES 1 (GO TO 1105B)
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1105B)
NO 2
e) kick you, drag you, or beat you up?
YES 1 (GO TO 1105B)
NO 2
f) try to choke you or burn you on purpose?
YES 1 (GO TO 1105B)
NO 2
g) threaten to attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1105B)
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1105B)
NO 2
i) physically force you to perform any other sexual acts did you not want to?
YES 1 (GO TO 1105B)
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1105B)
NO 2

1105B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
g) threaten to attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts did you not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

1106. CHECK 1105A:

AT LEAST ONE 'YES' (GO TO 1107)
NOT A SINGLE 'YES' (GO TO 1109)

1107. How long after your first got married with your (last) husband did (this/any of these things) first happen?

MONTHS 1 __ __
YEARS 2 __ __

BEFORE MARRIAGE 995

1108. Did the following ever happen as a result of what your (last) husband did to you:

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

1109. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hitting you?

YES 1
NO 2 (GO TO 1111)

1110. In the last 12 months, how often have you done this to your (last) husband: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1111. Does (did) your (last) husband drink alcohol or use drugs?

YES, DRINKS A
YES, USES DRUGS B
DOES NOT DRINK OR USE DRUGS C (GO TO 1113)

1112. How often (did) he do this: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1113. Are (were) you afraid of your (last) husband: most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1114. CHECK 105:

MARRIED MORE THAN ONCE (GO TO 1115)
MARRIED ONLY ONCE (GO TO 1116)

1115(A). So far we have been talking about the behavior of your (current/last) husband. Now I want to ask you about the behavior of any previous husband.

a) Did any previous husband ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (GO TO 1115B)
NO 2
b) Did any previous husband physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (GO TO 1115B)
NO 2

1115B. How long ago did this last happen?

a) Did any previous husband ever hit, slap, kick, or do anything else to hurt you physically?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous husband physically force you to have intercourse or perform any other sexual acts against your will?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

1116. From the time you were 15 years old has anyone other than (your/any) husband hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1119)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1119)

1117. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
MOTHER-IN-LAW F
FATHER-IN-LAW G
OTHER IN -LAW H
TEACHER I
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLIDER M
OTHER (SPECIFY)___________________X

1118. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1119. CHECK CALENDAR AND BOTTOM OF CALENDAR:

EVER BEEN PREGNANT (GO TO 1120)
NEVER BEEN PREGNANT (GO TO 1122)

1120. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1122)

1121. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

CURRENT HUSBAND A
MOTHER/STEP-FATHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND G
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACJER ,
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY)________________X

1122. CHECK 1105(a-j), 1115, 1116, and 1120.

AT LEAST ONE 'YES' (GO TO 1123)
NOT A SINGLE 'YES' (GO TO 1126)

1123. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1125)

1124. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1126)
HUSBAND'S FAMILY B (GO TO 1126)
CURRENT/FORMER HUSBAND C (GO TO 1126)
FRIEND E (GO TO 1126)
NEIGHBOR F (GO TO 1126)
RELIGIOUS LEADER G(GO TO 1126)
DOCTOR/MEDICAL PERSONNEL H
POLICE I (GO TO 1126)
LAWYER J (GO TO 1126)
SOCIAL SERVICE ORGANIZATION K (GO TO 1126)
OTHER (SPECIFY)______________X (GO TO 1126)

1125. Have you ever told anyone about this?

YES 1
NO 2

1126. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS, FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1127. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

HUSBAND
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3

1128. INTERVIEWER'S COMMENTS/EXPLANANTION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

_________________________________________________________
_________________________________________________________

1129. RECORD THE TIME

HOUR __ __
MINUTES __ __

OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

1201. INTERVIEWER'S OBSERVATIONS

COMMENTS ABOUT RESPONDENT:
______________________________________________
______________________________________________
______________________________________________

COMMENTS ON SPECIFIC QUESTIONS:
______________________________________________
______________________________________________
______________________________________________

ANY OTHER COMMENTS:
______________________________________________
______________________________________________
______________________________________________

1202. SUPERVISOR'S OBSERVATIONS
______________________________________________
______________________________________________
______________________________________________

NAME OF SUPERVISOR: _______________________
DATE:_________

1203. EDITORS OBSERVATIONS

______________________________________________
______________________________________________
______________________________________________

NAME OF EDITOR: _________________________
DATE:________________________

CALENDAR:

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS1,2 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
E PILL
F IUD
G MONTHLY INJECTION
H THREE MONTH INJECTION
I IMPLANTS
K CONDOM
N DIAPHRAGM/FOAM OR JELLY
R RHYTHM METHOD
T WITHDRAWAL
U PROLONGED BREASTFEEDING
X OTHER (SPECIFY)________________

COL. 3: 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/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION __________________
X OTHER (SPECIFY) __________
Z DON'T KNOW

2014 1 2 CHILD'S NAME 3
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

2013 1 2 CHILD'S NAME 3
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

20121 2 CHILD'S NAME 3
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

2011 1 2 CHILD'S NAME 3
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

2010 1 2 CHILD'S NAME 3
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

2009 1 2 CHILD'S NAME 3
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 ("M", "A" OR "S") AND DATE OF LAST PREGNANCY TERMINATION PRIOR TO JANUARY 2009.

IF NONE, RECORD '0' IN OUTCOME
OUTCOME ___
MONTH __ __
YEAR __ __ __ __

BIRTH DATE OF LAST CHILD BORN MONTH PRIOR TO JANUARY 2009.
MONTH __ __
YEAR __ __ __ __