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DEMOGRAPHIC AND HEALTH SURVEY-ETHIOPIA 2000-
WOMAN'S QUESTIONNAIRE

IDENTIFICATION

REGION ________________

ZONE __________________

WOREDA _______________

TOWN _________________

KEBELE _______________

ENUMERATION AREA ________________

CLUSTER NUMBER __________________

URBAN/RURAL:

URBAN 1
RURAL 2

TYPE OF PLACE:

LARGE CITY 1
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4

HOUSEHOLD NUMBER _____________

NAME OF HOUSEHOLD HEAD _______________

NAME AND LINE NUMBER OF WOMAN _________________

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME____
RESULT____

RESULT ____

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

FINAL VISIT
DAY ___ ___
MONTH ___ ___
YEAR 1 9 ___ ___
INTERVIEWER NUMBER___ ___ ___
RESULT ___

LANGUAGE OF QUESTIONNAIRE:

AMARIGNA 1
OROMIGNA 2
TIGRIGNA 3
SOMALIGNA 4
AFARIGNA 5
OTHER (SPECIFY) ________ 6

LANGUAGE OF INTERVIEW:

AMARIGNA 1
OROMIGNA 2
TIGRIGNA 3
SOMALIGNA 4
AFARIGNA 5
OTHER (SPECIFY) ________ 6


RESPONDENT'S NATIVE LANGUAGE:

AMARIGNA 1
OROMIGNA 2
TIGRIGNA 3
SOMALIGNA 4
AFARIGNA 5
OTHER (SPECIFY) ________ 6

TRANSLATOR USED DURING INTERVIEW:

YES 1
NO 2

SUPERVISOR
NAME __________ ___ ___ ___
DATE __________

FIELD EDITOR
NAME __________ ___ ___ ___
DATE __________

OFFICE EDITOR ___ ___

KEYED BY___ ___

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

MORNING/EVENING
MORNING 1
EVENING 2
HOUR ___ ___
MINUTES ___ ___

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

103. How long have you been living continuously in (NAME OF WOREDA OR TOWN)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ___ ___

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

105. In what month and year were you born?

MONTH ___ ___
DON'T KNOW MONTH 98
YEAR ___ ___ ___ ___
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS ___ ___

107. Have you ever attended formal school?

YES 1
NO 2 (GO TO 111)

109. What is the highest grade you completed?

GRADE ___ ___

TECHNICAL/VOCATIONAL CERTIFICATE 13
UNIVERSITY/COLLEGE DIPLOMA 14
UNIVERSITY/COLLEGE DEGREE 15

110. CHECK 109:

CODES 00-06 (GO TO 111)
CODES 07 AND ABOVE (GO TO 114)

111. Now I would like you to read out loud as much of this sentence as you can.
SHOW CARD TO RESPONDENT.

CANNOT READ AT ALL 1 (GO TO 115)
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ___________4

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

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

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

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

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

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

117. What is your religion?

ORTHODOX 1
CATHOLIC 2
PROTESTANT 3
MOSLEM 4
TRADITIONAL 5
OTHER (SPECIFY) _______ 6

118. What is your ethnicity?
RECORD THE MAJOR ETHNIC GROUP.

ETHNICITY______________ ___ ___

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___ ___
DAUGHTERS AT HOME ___ ___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ___ ___
DAUGHTERS ELSEWHERE ___ ___

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___ ___
GIRLS DEAD ___ ____

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

TOTAL ___ ___

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 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.

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

NAME______________________

213. Were any of these births twins?

SINGULAR 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

MONTH ___ ___
YEAR ___ ___ ___ ___

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ____

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

YES 1
NO 2

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

LINE NUMBER ______ (GO TO NEXT BIRTH FOR FIRST BIRTH; GO TO 221 FOR ALL OTHERS)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[ALL BIRTHS EXCEPT FOR THE FIRST BIRTH]

YES 1
NO 2

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES: PROBE AND CORRECT Q212-Q221 AND IF NECESSARY Q202-209.

YES 1
NO 2

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

NUMBERS ARE SAME:
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1987 E.C. OR LATER.
IF NONE, RECORD '0'.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227. How many months pregnant are you?

MONTHS ______

228. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 234)

230A. When did the last such pregnancy end?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 230C)
DON'T KNOW YEAR 9998

230B. How many months/years ago did the last such pregnancy end?

MONTHS AGO 1___
YEARS AGO 2____

230C. How many months pregnant were you when the last such pregnancy ended?

MONTHS _____

230D. CHECK 230A OR 230B:

LAST PREGNANCY ENDED IN MESKEREM 1987 OR LATER OR 0-59 MONTHS AGO OR 0-4 YEARS AGO (GO TO 230E)
LAST PREGNANCY ENDED BEFORE MESKEREM 1987 OR 60 MONTHS AGO OR EARLIER OR 5 OR MORE YEARS AGO (GO TO 234)

230E. Have you had any other pregnancies in the last five years, which did not end in a live birth?

YES 1
NO 2 (GO TO 234)

230F. How many other pregnancies did you have in the last five years that did not end in a live birth?

NUMBER OF OTHER NON-LIVE PREGNANCIES _______

RECORD ALL PREGNANCIES IN MESKEREM 1987 OR LATER, OR 0-59 MONTHS AGO OR 0-4 YEARS AGO. COPY THE MONTH AND YEAR OF BIRTH OF THE LATEST PREGNANCY FROM 230A IN LINE 01 OF Q 231A, AND IF YEAR IS NOT KNOWN, THE NUMBER OF MONTHS OR YEARS AGO THE LATEST PREGNANCY ENDED FROM Q 230B IN Q 231B, AND THE NUMBER OF MONTHS PREGNANT FROM Q 230C IN Q 231C. THEN PROCEED TO Q 231-Q231C FOR EACH OF THE EARLIER NON-LIVE BIRTH PREGNANCIES.
CHECK TO MAKE SURE THAT THE DURATION OF EACH PREGNANCY LISTED BELOW IS CONSISTENT WITH INFORMATION IN Q.215, 217 AND 220. IF THERE ARE MORE THAN 5 SUCH PREGNANCIES USE EXTRA QUESTIONNAIRE. THE TOTAL NUMBER OF PREGNANCIES RECORDED IN THIS PAGE SHOULD EQUAL THE NUMBER OF NON-LIVE PREGNANCIES RECORDED IN Q230F + 1.

231A. When did the next pregnancy end?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 231C)
DON'T KNOW YEAR 98

231B. How many months or years ago did this pregnancy end?

MONTHS AGO 1 ___
YEARS AGO 2 ___

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

MONTHS ___

234. Have you ever received an injection in the arm to prevent against tetanus toxoid?

YES 1
NO 2 (GO TO 236)

234A. Do you have a vaccination card/ paper where tetanus toxoid injections (TT) have been recorded?
IF YES: May I see it please?

YES SEEN 1
YES, NOT SEEN 2 (GO TO 234C)
NO CARD/PAPER 3 (GO TO 234C)

234B. (1) COPY VACCINATION DATE FOR EACH TETANUS TOXOID INJECTION GIVEN (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A TT VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. (RECORD UP TO FIVE INJECTIONS)

TT 1
DAY___
MONTH___
YEAR___

234C. How many times have you received a tetanus toxoid (TT) injection in your entire life?

NUMBER OF TIMES ____
DON'T KNOW 98

236. 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

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

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

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

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

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) PILL: Women can take a pill every day to stop them from becoming pregnant.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTIONS: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have several 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: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) DIAPHRAGM/FOAM/JELLY: Women can place a diaphragm, suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
09) RHYTHM OR PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO DIFFERENT METHODS.
SPECIFY___
YES 1
NO 2

302. Have you ever used (METHOD)?

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any (more) children?
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any (more) children?
YES 1
NO 2
03) PILL: Women can take a pill every day to stop them from becoming pregnant.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTIONS: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have several 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: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) DIAPHRAGM/FOAM/JELLY: Women can place a diaphragm, suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
09) RHYTHM OR PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 328)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

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

NUMBER OF CHILDREN _____

308. CHECK 302(01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 328)

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

YES 1
NO 2 (GO TO 328)

311. Which method are you using?
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

FEMALE STERILIZATION A (GO TO 319C)
MALE STERILIZATION B (GO TO 319C)
PILL C
IUD D (GO TO 319A)
INJECTIONS E (GO TO 319A)
IMPLANTS F (GO TO 319A)
CONDOM G (GO TO 319A)
DIAPHRAGM/FOAM/JELLY H (GO TO 319A)
PERIODIC ABSTINENCE I (GO TO 319B)
WITHDRAWAL J (GO TO 319B)
OTHER (SPECIFY) ______ X (GO TO 319B)

312. What is the brand name of the pill you last used?
RECORD NAME OF BRAND.

BRAND NAME______
BRAND ______

NO BRAND NAME 95
DON'T KNOW 98

319A. Where did you obtain (CURRENT METHOD) when you started using it the last time?
319B. Where did you learn to use (CURRENT METHOD)?
319C. Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY) ___________________26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR/CLINIC 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY)__________________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43 (GO TO 330)
OTHER (SPECIFY)______________________ 46 (GO TO 330)
DID NOT CONSULT SOURCE 95 (GO TO 330)
DON'T KNOW 98 (GO TO 330)

319D. How long does it take to go to this place?

MINUTES ____ (GO TO 330)
DON'T KNOW 98 (GO TO 330)

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

YES 1
NO 2 (GO TO 330)

329. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME AND/OR LOCATION OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/OR LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY) ___________________26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR/CLINIC 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY)__________________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY)______________________ 46

330. In the last 12 months, were you visited by a field worker who talked to you about family planning?

YES 1
NO 2

331. In the last 12 months, have you visited a health facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN MESKEREM 1987 OR LATER (GO TO 402)
NO BIRTHS IN MESKEREM 1987 OR LATER (GO TO 486)

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1987 E.C. OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL SHEETS).

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

403. LINE NUMBER FROM 212

LINE NUMBER _______

404. FROM 212 AND 216

NAME _________

ALIVE (GO TO 405)
DEAD (GO TO 405)

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

THEN 1 (GO TO 406A FOR LAST BIRTH; GO TO 422 FOR ALL OTHER BIRTHS)
LATER 2
NOT AT ALL 3 (GO TO 406A FOR LAST BIRTH; GO TO 422 FOR ALL OTHER BIRTHS)

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

MONTHS 1 _____
YEARS 2 _____

DON'T KNOW 998

406A. During this pregnancy did you stop eating specific types of food that you normally eat, for cultural reasons?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 407)

406B. What did you stop eating? Anything else?
RECORD ALL MENTIONED.
[FOR LAST BIRTH ONLY]

MILK A
CHEESE, BUTTER B
ANY KIND OF MEAT C
ANY KIND OF VEGETABLE D
ANY KIND OF FRUIT E
OTHER (SPECIFY) ____________________ X

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

HEALTH PROFESSIONAL A
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT B
UNTRAINED TRADITIONAL BIRTH ATTENDANT C
OTHER (SPECIFY) ______________________ X
NO ONE Y (GO TO 415)

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

MONTHS _____
DON'T KNOW 98

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

NUMBER OF TIMES _____
DON'T KNOW 98

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[FOR LAST BIRTH ONLY]

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

411. How many months pregnant were you the last time you received antenatal care?
[FOR LAST BIRTH ONLY]

MONTHS___
DON'T KNOW 98

412. During this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]

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

413. Were you told about the signs of pregnancy complications?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8

414. Were you told where to go if you had these complications?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO 418)

415A. During this pregnancy, how many times did you get this injection?
[FOR LAST BIRTH ONLY]

TIMES ____
DON'T KNOW 8

418. During this pregnancy, did you have difficulty with your vision during the daylight?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

419. During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

420. During this pregnancy, were you given or did you buy any drugs in order to prevent you from getting malaria?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 422)
DON'T KNOW 8 (GO TO 422)

421. Which drug was that?
RECORD ALL MENTIONED.
[FOR LAST BIRTH ONLY]

FANSIDAR A
CHLOROQUINE B
PROGUANIL C
OTHER (SPECIFY)________________ X
DON'T KNOW Z

422. 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


423. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 425)
DON'T KNOW 8 (GO TO 425)

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

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

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

HEALTH PROFESSIONAL A
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT B
UNTRAINED TRADITIONAL BIRTH ATTENDANT C
RELATIVE/FRIEND/NEIGHBOUR D
OTHER (SPECIFY)______________________ X
NO ONE Y

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

HOME
YOUR HOME 11 (GO TO 428)
OTHER HOME 12 (GO TO 428)
GOVERNMENT
HOSPITAL 21
HEALTH CENTER 22
HEALTH STATION/CLINIC 23
OTHER GOVERNMENT (SPECIFY)_____________ 26
NONGOVERNMENTAL (NGO)
NGO HEALTH FACILITY 31
PRIVATE MEDICAL
PRIVATE HOSPITAL 41
PRIVATE DOCTOR/CLINIC 42
OTHER PRIVATE (SPECIFY)_______________46
OTHER (SPECIFY)____________________96 (GO TO 428)


427. Was (NAME) delivered by caesarian section?

YES 1 (GO TO 434)
NO 2 (GO TO 434)

428. After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

YES 1
NO 2 (GO TO 432 FOR LAST BIRTH; GO TO 434 FOR ALL OTHER BIRTHS)

429. How many days or weeks after the delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
[FOR LAST BIRTH ONLY]

DAYS AFTER DELIVERY 1 ___
WEEKS AFTER DELIVERY 2 ___

DON'T KNOW 998

430. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[FOR LAST BIRTH ONLY]

HEALTH PROFESSIONAL 1
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 2
UNTRAINED TRADITIONAL BIRTH ATTENDANT 3
OTHER (SPECIFY)______________________ 6

431. Where did this first check take place?
[FOR LAST BIRTH ONLY]

HOME
YOUR HOME 11
OTHER HOME 12
GOVERNMENT
HOSPITAL 21
HEALTH CENTER 22
HEALTH STATION/CLINIC 23
HEALTH POST 24
OTHER GOVERNMENT (SPECIFY)_____________ 25
NONGOVERNMENTAL (NGO)
NGO HEALTH FACILITY 31
PRIVATE MEDICAL
PRIVATE HOSPITAL 41
PRIVATE DOCTOR/CLINIC 42
OTHER PRIVATE (SPECIFY)_______________46
OTHER (SPECIFY)____________________96

432. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW CAPSULE.
[FOR LAST BIRTH ONLY]

YES 1
NO 2

432A. CHECK 404:
CHILD ALIVE?
[FOR LAST BIRTH ONLY]

ALIVE (GO TO 432C)
DEAD (GO TO 433)

432C. How many days after birth did you start exposing (NAME) to sunlight?
[FOR LAST BIRTH ONLY]

NOT STARTED 000

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

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

YES 1 (GO TO 435)
NO 2 (GO TO 436)

434. Did your period return between the birth of (NAME) and your next pregnancy?
NOTE: IF BORN AT SAME TIME AS LAST BIRTH, RESPONSE SHOULD BE THE SAME AS Q 433 FOR THE LAST BIRTH.
[FOR ALL BIRTHS EXCEPT THE LAST BIRTH]

YES 1
NO 2 (GO TO 438)

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

MONTHS ___
DON'T KNOW 98

436. CHECK 226:
RESPONDENT PREGNANT?
[FOR LAST BIRTH ONLY]

NOT PREGNANT (GO TO 437)
PREGNANT OR UNSURE (GO TO 438)

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

YES 1
NO 2 (GO TO 439)

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

DAYS 1 ___
MONTHS 2 ___

DON'T KNOW 998

439. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 444)

440. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000

HOURS 1 ___
DAYS 2 ___

440A. Did you squeeze out and throw away the first milk?

YES 1
NO 2

441. CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 442)
DEAD (GO TO 443)

442. Are you still breastfeeding (NAME)?

YES 1 (GO TO 445)
NO 2

442A. Why did you stop breastfeeding?
[FOR LAST BIRTH ONLY]

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY)_________ 96

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

MONTHS ___
DON'T KNOW 98

444. CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 447)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 451)

445. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ___ ___

446. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS ___ ___

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

YES 1
NO 2
DON'T KNOW 8

448. Now I would like to ask you about the types of foods [NAME] has been fed over the last seven days, including yesterday. How many days during last seven days was [NAME] GIVEN EACH OF THE FOLLOWING?
FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, ASK: In total, how many times yesterday during the day or at night was [NAME] given [ITEM]?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'

A. Plain water?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
B. Milk other than breast milk?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
C. Fruit juice?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
D. Any other liquids such as sugar water, tea, coffee, carbonated drinks, or soup broth?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
E. Any food made from grains e.g. millet, sorghum, maize, rice, wheat, barely, teff, oats?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
F. Any food made from pumpkins, carrots, red sweet potatoes, green leafy vegetables, mango, papaya?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
G. Any other food made from roots or tubers [e.g. white potatoes, cassava, enset or other local roots/tubers]?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
H. Any other fruits and vegetables [e.g. bananas, apples, avocados, tomatoes]?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
I. Meat, poultry, fish, egg, cheese, or yoghurt?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
J. Any food made from legumes [e.g. lentils, beans, soybeans, pulses, or peanuts]?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___
K. Any food made with oil, fat, or butter?
(LAST 7 DAYS) NUMBER OF DAYS ___
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES ___

449. How many times was (NAME) fed mashed or pureed food or solid or semi-solid food yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'

NUMBER OF TIMES ___
DON'T KNOW 8

450. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 451.

SECTION 4B. IMMUNIZATION AND HEALTH

451. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1987 E.C OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL SHEETS).

452. LINE NUMBER FROM 212

LINE NUMBER ___ ___

453. FROM 212 AND 216

NAME ______________

ALIVE (GO TO 454)
DEAD (GO TO 453 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 481)

454. Did (NAME) receive a Vitamin A dose like this during the last 6 months?
SHOW CAPSULE.

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN 1 (GO TO 457)
YES, NOT SEEN 2 (GO TO 459)
NO CARD/PAPER 3

456. Did you ever have a vaccination card/paper for (NAME)?

YES 1 (GO TO 459)
NO 2 (GO TO 459)

457. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD/PAPER. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY___
MONTH___
YEAR___
POLIO 0
DAY___
MONTH___
YEAR___
POLIO 1
DAY___
MONTH___
YEAR___
POLIO 2
DAY___
MONTH___
YEAR___
POLIO 3
DAY___
MONTH___
YEAR___
DPT 1
DAY___
MONTH___
YEAR___
DPT 2
DAY___
MONTH___
YEAR___
DPT 3
DAY___
MONTH___
YEAR___
MEASLES
DAY___
MONTH___
YEAR___

458. Has (NAME) received any vaccinations that are not recorded on this card/paper, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 457) (GO TO 461)
NO 2 (GO TO 461)
DON'T KNOW 8 (GO TO 461)

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

YES 1
NO 2 (GO TO 463)
DON'T KNOW 8 (GO TO 463)

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

460A. 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

460B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 460E)
DON'T KNOW 8 (GO TO 460E)

460C. When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

460D. How many times was the polio vaccine received?

NUMBER OF TIMES ______

460E. DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 460G)
DON'T KNOW 8 (GO TO 460G)

460F. How many times?

NUMBER OF TIMES ______

460G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

461. Were any of the vaccinations (NAME) received during the last three years given as a part of a national immunization day campaign?

YES 1
NO 2 (GO TO 463)
DON'T KNOW 8 (GO TO 463)

462. At which national immunization day campaigns did (NAME) receive vaccinations? RECORD ALL MENTIONED.

TIKEMT/HIDAR 1990 CAMPAIGN A
TIKEMT/HIDAR 1991 CAMPAIGN B
TIKEMT/HIDAR 1992 CAMPAIGN C

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)

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

YES 1
NO 2
DON'T KNOW 8

466. CHECK 463 AND 464:
FEVER OR COUGH?

"YES" IN 463 OR 464 (GO TO 467)
OTHER (GO TO 472)

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

YES 1
NO 2 (GO TO 472)

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

GOVERNMENT
HOSPITAL A
HEALTH CENTER B
HEALTH STATION/CLINIC C
HEALTH POST D
COMMUNITY-BASED OUTLET E
OTHER GOVERNMENT (SPECIFY) _____________ F
NONGOVERNMENTAL (NGO)
NGO HEALTH FACILITY G
COMMUNITY-BASED OUTLET H
OTHER NGO (SPECIFY) ______________ I
PRIVATE MEDICAL
PRIVATE HOSPITAL J
PRIVATE DOCTOR/CLINIC K
PHARMACY L
OTHER PRIVATE MEDICAL (SPECIFY)_______________ M
OTHER SOURCE
DRUG VENDOR N
SHOP O
TRADITIONAL PRACTITIONER P
OTHER (SPECIFY) _______ X

469. CHECK 463:
HAD FEVER?

"YES" IN 463 (GO TO 470)
"NO"/"DON'T KNOW" IN 463 (GO TO 472)

470. Did (NAME) take any drugs for the fever?

YES 1
NO 2 (GO TO 472)
DON'T KNOW 8 (GO TO 472)

471. What drugs did (NAME) take?
RECORD ALL MENTIONED. IF THE RESPONDENT HAS GIVEN A DRUG FOR THE CHILD BUT DOESN'T KNOW THE NAME OF THE DRUG, ASK TO SEE THE PACKET OF DRUGS SHE GAVE THE CHILD. BUT IF SHE DOESN'T HAVE ANY SAMPLE LEFT, THE INTERVIEWER HAS TO SHOW THE SAMPLES SHE HAS TO THE RESPONDENT IN ORDER TO HELP IDENTIFY.

FANSIDAR A
CHLOROQUINE B
QUININE C
ASPIRIN/PARACETAMOL D
IBUPROFEN/ACETAMINOPHEN E
ANTIBIOTICS (TETRACYCLINE, AMPICILINE, BACTRIUM, ETC.) F
OTHER (SPECIFY) _____________________ X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 480)
DON'T KNOW 8 (GO TO 480)

473. Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?

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

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

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

475. Was he/she given any of the following to drink:

Fluid from ORS packet?
YES 1
NO 2
DON'T KNOW 8
Homemade sugar and salt solution?
YES 1
NO 2
DON'T KNOW 8
Other homemade fluid?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 478)
DON'T KNOW 8 (GO TO 478)

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

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) _____________________ X

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

YES 1
NO 2 (GO TO 480)

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

GOVERNMENT
HOSPITAL A
HEALTH CENTER B
HEALTH STATION/CLINIC C
HEALTH POST D
COMMUNITY-BASED OUTLET E
OTHER GOVERNMENT (SPECIFY) _____________ F
NONGOVERNMENTAL (NGO)
NGO HEALTH FACILITY G
COMMUNITY-BASED OUTLET H
OTHER NGO (SPECIFY) ______________ I
PRIVATE MEDICAL
PRIVATE HOSPITAL J
PRIVATE DOCTOR/CLINIC K
PHARMACY L
OTHER PRIVATE MEDICAL (SPECIFY)_______________ M
OTHER SOURCE
DRUG VENDOR N
SHOP O
TRADITIONAL PRACTITIONER P
OTHER (SPECIFY) _______ X

480. GO BACK TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 481.

481. CHECK 453, ALL COLUMNS:
NUMBER OF LIVING CHILDREN BORN IN 1987 E.C OR LATER

ONE OR MORE (GO TO 482)
NONE (GO TO 486)

482. The last time you fed your child(ren) using your hands, did you wash your hands immediately before feeding (him/her/them)?

YES 1
NO 2

483. The last time you had to clean (your child/one of your children) after he/she defecated, did you wash your hands immediately afterwards?

YES 1
NO 2

484. What usually happens with your (youngest) child's stools when he/she does not use any toilet facility?

ALWAYS USE TOILET/LATRINE 01
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSED AWAY 06
NOT DISPOSED OF 07
OTHER (SPECIFY) _________ 96

485. CHECK 475, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET/NOT ASKED (GO TO 486)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 487)

486. Have you ever heard of a special product called ORS in a packet you can get for the treatment of diarrhea?

YES 1
NO 2

487. CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER (GO TO 488)
HAS NO CHILDREN LIVING WITH HER/NOT ASKED (GO TO 488A)

488. When (your child/one of your children) is seriously ill, can you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

488A. The last time you prepared a meal for your family, before starting did you wash your hands?

YES 1
NO 2
NEVER PREPARED MEALS 3

489. The last time you were sick did you seek medical treatment?

YES 1 (GO TO 501)
NO 2

489A. Why did you not seek medical treatment? Any other reasons?
RECORD ALL MENTIONED

DON'T KNOW WHERE TO GO A
DID NOT GET PERMISSION TO GO B
NO MONEY FOR TREATMENT C
NO HEALTH FACILITY NEARBY D
NO TRANSPORT E
DID NOT WANT TO GO ALONE F
CONCERN THAT THERE MAY NOT BE A FEMALE HEALTH PROVIDER G
OTHER REASONS (SPECIFY) ________________ X

SECTION 5. MARRIAGE

501. Are you currently married or living with a man?

CURRENTLY MARRIED 1 (GO TO 505)
LIVING WITH A MAN 2 (GO TO 505)
NOT IN UNION 3

502. Have you ever been married or lived with a man?

FORMERLY MARRIED 1
LIVED WITH A MAN 2 (GO TO 507)
NEVER MARRIED 3 (GO TO 601)

504. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 507)
DIVORCED 2 (GO TO 507)
SEPARATED 3 (GO TO 507)

505. Is your husband/partner living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

506. ASK NAME OF HUSBAND. THEN GO BACK TO THE HOUSEHOLD QUESTIONNAIRE AND COPY THE LINE NUMBER. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ____________________________
LINE NUMBER_____

506A. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 507)

506B. How many other wives does he have?

NUMBER ___
DON'T KNOW 98 (GO TO 507)

506C. Are you the first, second, …wife?

RANK ______

507. Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

508. CHECK 507:

MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 601)
DON'T KNOW YEAR 9998

509. How old were you when you started living with him?

AGE ____

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

NOT ASKED (GO TO 602)
NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602. CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

PREGNANT: Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 609)
UNDECIDED/DON'T KNOW 8 (GO TO 608)

603. CHECK 226:

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 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 609)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY)________ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
00-23 MONTHS OR 00-01 YEARS (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 2 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEARS (GO TO 610)

607. CHECK 602:

WANTS 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?

WANTS NO (MORE) CHILDREN: 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?

RECORD ALL MENTIONED.

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

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT 4

609. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 610)
NOT CURRENTLY USING (GO TO 610)
CURRENTLY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611. Which method would you prefer to use?
FOR WOMAN WHO MENTIONS MORE THAN ONE METHOD, RECORD METHOD SHE PREFERS MOST.

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTIONS 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 614)
PERIODIC ABSTINENCE 09 (GO TO 614)
WITHDRAWAL 10 (GO TO 614)
OTHER (SPECIFY) _______ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COST TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) _____ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

613. Would you ever use a method if you were married?

YES 1
NO 2
DON'T KNOW 8

614. 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?

PROBE FOR A NUMERIC RESPONSE.

NUMBER ______
OTHER (SPECIFY) ____ 96 (GO TO 616)

615. 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?

NUMBER OF BOYS____
OTHER (SPECIFY)_____ 999996
NUMBER OF GIRLS____
OTHER (SPECIFY)____ 999996
NUMBER OF EITHER SEX____
OTHER (SPECIFY)____ 999996

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

617. In the last few 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
Pamphlet/Poster?
YES 1
NO 2
Community events?
YES 1
NO 2

619. In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

620. With whom? Anyone else?
RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) __________________________ X

621. CHECK 501:

CURRENTLY MARRIED (GO TO 621A)
LIVING WITH A MAN (GO TO 621A)
NOT IN UNION (GO TO 701)

621A. CHECK 311/311A:

ANY CODE CIRCLED (GO TO 621B)
NO CODE CIRCLED (GO TO 622)

621B. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY)_________________________ 6

622. Now I want to ask you about your husband's/partner's views on family planning. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

623. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

624. Do you think your husband/partner 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 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 708)

702. How old was your husband/partner on his last birthday?

AGE IN COMPLETED YEARS ________

702A. Is your husband able to read and write a simple sentence?

YES 1
NO 2
DON'T KNOW 8

703. Did your (last) husband/partner ever attend formal school?

YES 1
NO 2 (GO TO 706)

705. What was the highest grade he completed?

GRADE____

TECHNICAL/VOCATIONAL CERTIFICATE 13
UNIVERSITY/COLLEGE DIPLOMA 14
UNIVERSITY/COLLEGE DEGREE 15
DON'T KNOW 98

706. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN: What is your husband's/partner's occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?

DO NOT RECORD NAME OR TYPE OF ESTABLISHMENT. RECORD THE ACTUAL TYPE OF WORK PERFORMED BY HIM. MEN WHO WORK AS AGRICULTURAL WORKERS SHOULD BE RECORDED AS "SKILLED AGRICULTURAL WORKERS" OR "NON-SKILLED AGRICULTURAL WORKERS".

OCCUPATION____

708. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things or any other work?

YES 1 (GO TO 710)
NO 2

709. Aside from housework, have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 720)

710. What is your usual occupation, that is, what kind of work do you mainly do?
DO NOT RECORD NAME OR TYPE OF ESTABLISHMENT. RECORD THE ACTUAL TYPE OF WORK PERFORMED BY HER. WOMEN WHO WORK AS AGRICULTURAL WORKERS SHOULD BE RECORDED AS "SKILLED AGRICULTURAL WORKERS" OR "NON-SKILLED AGRICULTURAL WORKERS".

OCCUPATION ___________ __

711. CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712. Do you work mainly on your own land, on family land or do you work on land belonging to a relative, on land that you rent from someone else, or do you work on someone else's land?

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

712A. Do you usually work throughout the agricultural season, or do you work only part of the agricultural season?

THROUGHOUT THE AGRICULTURAL SEASON 1 (GO TO 714)
PART OF THE AGRICULTURAL SEASON 2
ONCE IN A WHILE 3 (GO TO 714)

713. Do you usually work throughout the year, or do you work only part of the year?

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

714. 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

715. 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 (GO TO 718)
NOT PAID 4 (GO TO 718)

716. Who mainly decides how the money you earn will be used?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

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

HOME 1
AWAY 2

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

CHILDREN YOUNGER THAN 10
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8

721. Sometimes a husband is annoyed or angered by things which his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
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

SECTION 8. MATERNAL MORTALITY

801. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with her, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER __________

802. CHECK 801:

TWO OR MORE BIRTHS (GO TO 803)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 901)

803. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ________

804. What was the name given to your oldest (next oldest) brother or sister?
RECORD NAMES OF ALL SIBLINGS.

NAME____

805. Is (NAME) male or female?

MALE 1
FEMALE 2

806. Is (NAME) still alive?

YES 1
NO 2 (GO TO 808)
DON'T KNOW 8 (GO TO NEXT SIBLING)

807. How old is (NAME)?

AGE____

808. How many years ago did (NAME) die?

YEARS____

809. How old was (NAME) when he/she died?

AGE___ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT SIBLING)

810. Was (NAME) pregnant when she died?

YES 1 (GO TO 813)
NO 2

811. Did (NAME) die during childbirth?

YES 1 (GO TO 813)
NO 2

812. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

813. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

NUMBER OF CHILDREN___

IF NO MORE BROTHERS OR SISTERS, GO TO 901.

SECTION 9: FEMALE CIRCUMCISION

901. Have you ever heard of female circumcision?
IF NO, PROBE: Have you ever heard of the practice in which a girl may have parts of her genitals cut?

YES 1
NO 2 (GO TO 1001)

902. Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 904)

903. In some parts of Ethiopia, there is a type of circumcision where the genital area is sewn closed. Was this done to you?

YES 1
NO 2
DON'T KNOW 8

904. CHECK 214 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER (GO TO 905)
HAS NO LIVING DAUGHTER (GO TO 910)

905. Have any of your daughters been circumcised?
IF YES: How many?

NUMBER CIRCUMCISED _______
NO DAUGHTER CIRCUMCISED 95 (GO TO 910)

906. To which of your daughters did this happen most recently?
INTERVIEWER: CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER

DAUGHTER'S NAME _______
DAUGHTER'S LINE NUMBER FROM Q212 ______

907. Was (NAME OF THE DAUGHTER FROM Q.906)'s genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

908. How old was (NAME) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS _____

DURING INFANCY 95
DON'T KNOW 98

909. Who did the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 1
TRADITIONAL BIRTH ATTENDANT 2
OTHER TRADITIONAL (SPECIFY) ______ 3
HEALTH PROFESSIONAL 4
DON'T KNOW 8

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

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

SECTION 10: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

YES 1
NO 2 (GO TO 1018)

1001A. From which sources of information have you heard about AIDS? Any other sources? RECORD ALL MENTIONED.

RADIO A
TELEVISION B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
CHURCHES/MOSQUES F
SCHOOLS/TEACHERS G
COMMUNITY EVENT H
FRIENDS/RELATIVES I
WORK PLACE J
DRAMA/PERFORMANCE K
OTHER (SPECIFY) ______ X

1002. Is there anything a person can do to avoid getting infected with HIV which is the virus that causes AIDS?

YES 1
NO 2 (GO TO 1010)
DON'T KNOW 8 (GO TO 1010)

1003. What can a person do? Anything else?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS WITH UNCLEAN NEEDLES J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZORS/BLADES N
OTHER (SPECIFY)_____ W
OTHER (SPECIFY) ____ X
DON'T KNOW Z

1004. CHECK 1003:

NEITHER CODE 'C' NOR CODE 'D' CIRCLED (GO TO 1005)
CODE 'C' AND/OR CODE 'D' CIRCLED (GO TO 1007)

1005. In your view, is a person's chance of getting AIDS influenced by the number of sexual partners he or she has?

YES 1
NO 2 (GO TO 1007)
DON'T KNOW 8 (GO TO 1007)

1006. If a person has sex with only one partner, does this person have a greater or a lesser chance of getting AIDS than a person who has sex with many partners?

GREATER CHANCE OF AIDS 1
LESSER CHANCE OF AIDS 2

1007. CHECK 1003:

DID NOT MENTION USE OF CONDOMS DURING SEX (CODE 'B' NOT CIRCLED) (GO TO 1008)
MENTIONED USE OF CONDOMS DURING SEX (CODE 'B' CIRCLED) (GO TO 1010)

1008. Do you think that by using condoms during sexual intercourse a person decreases his/her chances of getting AIDS, increases his/her chances of getting AIDS, or does not make a difference?

DECREASES HIS CHANCES 1
INCREASES HIS CHANCES 2
DOESN'T MAKE A DIFFERENCE 3
DON'T KNOW/UNSURE 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 someone personally who has the virus that causes AIDS or someone who died from AIDS?

YES 1
NO 2
UNSURE/ DON'T KNOW 8

1012. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO 1014)
DON'T KNOW 8 (GO TO 1014)

1013. When can the virus that causes AIDS be transmitted from a mother to a child? Any other times?
RECORD ALL RESPONSES.

DURING PREGNANCY A
AT DELIVERY B
DURING BREASTFEEDING C
OTHER TIMES D
DON'T KNOW Z

1014. CHECK 501:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1015)
NOT IN UNION (GO TO 1016)

1015. Have you ever talked about ways to prevent getting the virus that causes AIDS with your husband/the man you are living with?

YES 1
NO 2

1016. If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community?

CAN BE KEPT PRIVATE 1
AVAILABLE TO COMMUNITY 2
DON'T KNOW/NOT SURE 8

1017. 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 own household?

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

1018. CHECK 1001:

KNOWS AIDS: Apart from AIDS, have you heard about (other) infections that can be transmitted through sexual contact?

DOES NOT KNOW AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 1101)

1019. In a man, what signs and symptoms would lead you to think that he has such an infection? Any others?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
BLOOD IN URINE I
LOSS OF WEIGHT J
IMPOTENCE K
NO SYMPTOMS L
OTHER (SPECIFY) _______ W
OTHER (SPECIFY) ______ X
DON'T KNOW Z

1020. In a woman, what signs and symptoms would lead you to think that she has such an infection? Any others?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
BLOOD IN URINE I
LOSS OF WEIGHT J
INABILITY TO GIVE BIRTH K
NO SYMPTOMS L
OTHER(SPECIFY)________ W
OTHER(SPECIFY)_____ X
DON'T KNOW Z

SECTION 11. SEXUAL ACTIVITY

1101. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?

NEVER 00 (GO TO 1114)
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 96
DON'T KNOW 98

1102. In order to know your risk of pregnancy we need to know about your recent sexual activity. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.

DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____ (GO TO 1111)

1103. The last time you had sexual intercourse, was a condom used?

YES 1
NO 2

1104. What is your relationship to the man with whom you last had sex?
IF "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, RECORD '1'. IF NO, RECORD '2'.

HUSBAND/COHABITING PARTNER 1 (GO TO 1106)
BOYFRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
OTHER (SPECIFY) _______ 6

1105. For how long have you had a sexual relationship with this man?

DAYS 1____
WEEKS 2___
MONTHS 3____
YEARS 4___

1106. Have you had sex with anyone else in the last 12 months?

YES 1
NO 2 (GO TO 1111)

1107. The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2

1108. What is your relationship to the man with whom you last had sex?
IF "GIRLFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, RECORD '1'. IF NO, RECORD '2'.

WIFE/COHABITING PARTNER 1 (GO TO 1110)
GIRLFRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
OTHER (SPECIFY) ________ 6

1109. For how long have you had a sexual relationship with this man?

DAYS 1____
WEEKS 2____
MONTHS 3___
YEARS 4____

1110. Altogether, with how many different men have you had sex in the last 12 months?

NUMBER OF PARTNERS_____

1111. Do you know of a place where one can get condoms?

YES 1
NO 2 (GO TO 1114)

1112. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME AND/OR LOCATION OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/OR LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________ 16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY)___________________ 26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) ________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) ________ 46

1113. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

1114. RECORD THE TIME.

MORNING/EVENING _____
MORNING 1
EVENING 2
HOUR _____
MINUTES _____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT: ____________________________________

COMMENTS ON SPECIFIC QUESTIONS: _____________________________________

ANY OTHER COMMENTS: _____________________________________

SUPERVISOR'S OBSERVATIONS:______________________________________

NAME OF THE SUPERVISOR:______________________________________
DATE: ___________________________________

EDITOR'S OBSERVATIONS: ______________________________________

NAME OF EDITOR:______________________________________________
DATE: ___________________________________