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

IDENTIFICATION

REGION _____________

ZONE _______________

WOREDA _____________

TOWN _______________

KEBELE _____________

ENUMERAITION AREA __________

CLUSTER NUMBER_____

URBAN/RURAL:

URBAN 1
RURAL 2

TYPE OF PLACE:

LARGE CITY 1
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4

NAME OF HEAD OF HOUSEHOLD _________________

HOUSEHOLD NUMBER ______________

NAME AND LINE NUMBER OF MAN______

INTERVIEWER VISITS

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

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

NEXT VISIT:
DATE___
TIME____

FINAL VISIT
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
INTERVIEWER NUMBER ___ ___
RESULT ___

TOTAL NUMBER OF VISITS ___

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

M101. RECORD THE TIME.

MORNING/EVENING ______
MORNING 1
EVENING 2
HOUR ______
MINUTES ______

M102. 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

M103. 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 M105)
VISITOR 96 (GO TO M105)

M104. Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

M105. In what month and year were you born?

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

M106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS _________

M107. Have you ever attended formal school?

YES 1
NO 2 (GO TO M111)

M109. What is the highest grade you completed?

GRADE ______

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

M110. CHECK 109:

00-06 (GO TO M111)
07 AND HIGHER (GO TO M114)

M111. 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 M115)
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)___________ 4

M114. 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

M115. 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

M116. 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

M117. What is your religion?

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

M118. What is your ethnicity?
RECORD THE MAJOR ETHNIC GROUP.

ETHNICITY _______________________ ____

M119. Are you currently working?

YES 1 (GO TO M122)
NO 2

M120. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 201)

M122. What is your 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 HIM. MEN WHO WORK AS AGRICULTURAL WORKERS SHOULD BE RECORDED AS "SKILLED AGRICULTURAL WORKERS" OR "NON-SKILLED AGRICULTURAL WORKERS".

OCCUPATION _________________ ___

SECTION 2: REPRODUCTION

M201. Now I would like to ask about your children. I am interested only in the children that are biologically yours. Have you ever had children?

YES 1
NO 2 (GO TO M207)

M203. Are any of your children living with you now?
IF YES: How many?
IF NONE, RECORD '00'.

CHILDREN AT HOME __
NONE 00

M205. Do you have any children who are alive but not living with you?
IF YES: How many?
IF NONE, RECORD '00'.

CHILDREN AWAY _____
NONE 00

M207. Do you have any children who have died?
IF YES: How many?
IF NONE, RECORD '00'.

CHILDREN DEAD ___
NONE 00

M208. SUM ANSWERS TO M203, M205, AND M207, AND ENTER TOTAL.
IF NONE, RECORD '00'.

TOTAL ______

M209. CHECK M208:

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

IF HE HAS NOT HAD CHILDREN (M208 IS '00'): Just to make sure I have this right: you have not had any children during your life. Is that correct?

YES (GO TO M210)
NO (PROBE AND CORRECT M201-M208 AS NECESSARY.)

M210. CHECK M208:

HAS HAD CHILDREN (GO TO M211)
HAS NOT HAD ANY CHILDREN (GO TO M301)

M211. In what month and year was your last child born?

MONTH _____
YEAR ______

M212. What is the name of your last child?

NAME OF LAST CHILD_______

M213. When (NAME OF LAST CHILD)'s mother became pregnant with (him/her), did you want to have a child then, did you want to have a child but wanted to wait until later, or did you not want to have any (more) children at all?

WANTED THEN 1 (GO TO M301)
WANTED LATER 2
DID NOT WANT AT ALL 3 (GO TO M301)

M214. How much longer would you like to have waited?

MONTHS 1 ____
YEARS 2 ___

UNDECIDED/DON'T KNOW 998

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 M301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN M301, 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 M301, ASK M302.

M301. 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 sponge, 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

M302. Have you ever used (METHOD)?

01) FEMALE STERILIZATION: Women 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, DOES NOT KNOW 2
02) MALE STERILIZATION: Men 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, DOES NOT KNOW 2
03) PILL: Women can take a pill every day to stop them from becoming pregnant.
YES 1
NO, DOES NOT KNOW 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO, DOES NOT KNOW 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, DOES NOT KNOW 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, DOES NOT KNOW 2
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse: Have you ever used a condom?
YES 1
NO, DOES NOT KNOW 2
08) DIAPHRAGM/FOAM/JELLY: Women can place a sponge, diaphragm, suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO, DOES NOT KNOW 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, DOES NOT KNOW 2
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO, DOES NOT KNOW 2
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO, DOES NOT KNOW 2

M303. CHECK M302:

NOT A SINGLE "YES" (NEVER USED) (GO TO M304)
AT LEAST ONE "YES" (EVER USED) (GO TO M306)

M304. Have you or any of your sex partners ever used anything or tried in any way to delay or avoid pregnancy?

YES 1
NO 2 (GO TO M312)

M305. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

M306. CHECK M302(02):

RESPONDENT NOT STERILIZED (CODE '1' NOT CIRCLED) (GO TO M307)
RESPONDENT STERILIZED (CODE '1' CIRCLED) (GO TO M308A)

M307. Are you, your wife (wives), or any other partner with whom you have sex currently doing something or using any method to delay or avoid a pregnancy?

YES 1
NO, DOES NOT KNOW 2 (GO TO M312)

M308. Which method are you using?
M308A. CIRCLE 'B' FOR MALE STERILIZATION.
IF RESPONDENT USES CONDOM, FOLLOW SKIP INSTRUCTION FOR CONDOM.

FEMALE STERILIZATION A (GO TO M401)
MALE STERILIZATION B (GO TO M401)
PILL C (GO TO M401)
IUD D (GO TO M401)
INJECTIONS E (GO TO M401)
IMPLANTS F (GO TO M401)
CONDOM G
DIAPHRAGM/FOAM/JELLY H (GO TO M401)
RHYTHM/PERIODIC ABSTINENCE I (GO TO M401)
WITHDRAWAL J (GO TO M401)
OTHER (SPECIFY) ______ X (GO TO M401)

M309. What is the brand name of the condom you last used?
RECORD NAME OF BRAND.

BRAND NAME_______
BRAND ______

NO BRAND NAME 95
DON'T KNOW 98

M310. Do you use more condoms now than a year ago, about the same number, or fewer?

MORE 1
SAME 2 (GO TO M401)
FEWER 3 (GO TO M401)

M311. What is the main reason you use more condoms now than a year ago?

FEAR OF GETTING AIDS 1 (GO TO M401)
FEAR OF GETTING OTHER STDS 2 (GO TO M401)
FAMILY PLANNING 3 (GO TO M401)
LESS EXPENSIVE NOW 4 (GO TO M401)
MORE AVAILABLE NOW 5 (GO TO M401)
INCREASED SEXUAL ACTIVITY 6 (GO TO M401)
OTHER (SPECIFY) _______ 7 (GO TO M401)
DON'T KNOW 8 (GO TO M401)

M312. What is the main reason you are not using a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
WIFE/PARTNER MENOPAUSAL/HYSTERECTOMY23
COUPLE SUBFECUND/INFECUND 24
WIFE PARTNER POSTPARTUM/BREASTFEEDING 25
WANTS AS MANY CHILDREN AS POSSIBLE 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

SECTION 4. MARRIAGE

M401. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (GO TO M404)
NO, NOT IN UNION 3 (GO TO M406)

M402. How many wives do you have?

NUMBER OF WIVES ____

M403. Besides your wife / wives, do you have any other women with whom you live as if married?

YES 1
NO 2 (GO TO M405)

M404. CHECK M401:

CURRENTLY MARRIED: How many other women are you living with as if you were married?

LIVING WITH A WOMAN: How many women are you living with as if you were married?

NUMBER OF LIVE-IN PARTNERS ______

M405. WRITE THE NAMES AND LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE / WIVES AND PARTNER(S). IF A WIFE / PARTNER DOES NOT LIVE IN THE HOUSEHOLD, WRITE '00' IN THE LINE NUMBER BOX.
THE NUMBER OF BOXES FILLED MUST BE EQUAL TO THE NUMBER OF WIVES PLUS NUMBER OF LIVE-IN PARTNERS.

Please tell me the name(s) of your wife/wives and live-in partner(s)

NAME____
LINE NUMBER___ (GO TO M409)

M406. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

M407. Have you ever been married or lived with a woman?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO M409)
NO 3 (GO TO M501)

M408. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1
DIVORCED 2
SEPARATED 3

M409. Have you been married or lived with a woman only once, or more than once?

ONCE 1
MORE THAN ONCE 2

M410. CHECK M409:

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

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

MONTH ______
DON'T KNOW MONTH 98
YEAR ______ (GO TO M501)
DON'T KNOW YEAR 9998

M411. How old were you when you started living with her?

AGE ______

SECTION 5. FERTILITY PREFERENCES

M501. CHECK M401:

CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO M502)
NOT CURRENTLY IN UNION (GO TO M506)

M502. CHECK M402 AND M404:

HAS ONE WIFE/WOMAN HE IS LIVING WITH: Is your wife/the woman you are living with currently pregnant?

MORE THAN ONE WIFE/WOMAN HE IS LIVING WITH: Is one of your wives (the women you are living with) pregnant?

YES 1
NO 2 (GO TO M504)
DOES NOT KNOW/UNSURE 3 (GO TO M504)

M503. When she became pregnant, did you want her to become pregnant then, did you want her to have a child but wanted to wait or did you not want her to have a child at all?

THEN 1
WANTED TO WAIT 2
NOT AT ALL 3

M504. CHECK M502:

WIFE/PARTNER NOT PREGNANT/NOT SURE: 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?

WIFE/PARTNER PREGNANT: Now I have some questions about the future. After the child your wife/partner is 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 M506)
SAYS WIFE CAN'T GET PREGNANT 3 (GO TO M506)
SAYS HE CAN'T HAVE ANY MORE 4 (GO TO M506)
UNDECIDED/DOESN'T KNOW 8 (GO TO M506)

M505. CHECK M502:

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

WIFE/PARTNER PREGNANT: After the birth of the child your wife/partner is expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 ___
YEARS 2 ____

SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) _______ 996
DON'T KNOW 998

M506. CHECK M308:
USING A METHOD

NOT ASKED (GO TO M507)
NOT CURRENTLY USING (GO TO M507)
CURRENTLY USING (GO TO M509)

M507. Do you think you will use a method to avoid pregnancy at any time in the future?

YES 1 (GO TO M509)
NO 2
DON'T KNOW 8

M508. What is the main reason that you think you will never use a method at any time in the future?

NOT CURRENTLY MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22
WIFE/PARTNER MENOPAUSAL/HYSTERECTOMY 23
COUPLE SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 26

OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

M509. CHECK M203 AND M205:

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 M511)

M510. 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

M511. 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

M512. 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
From a pamphlet/poster?
YES 1
NO 2
At a community event?
YES 1
NO 2

M518. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING OR NOT PRESENT)

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

M519. 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 6. SEXUAL ACTIVITY

M601. 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 M701)
AGE _____
WHEN FIRST UNION STARTED 96

M602. 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____

M603. The last time you had sexual intercourse, did you use a condom?

YES 1
NO 2 (GO TO M605)
DOES NOT KNOW CONDOMS 3 (GO TO M605)

M604. What was the main reason you used a condom on that occasion?

TO PREVENT STD/HIV 1 (GO TO M607)
TO PREVENT PREGNANCY 2 (GO TO M607)
TO PREVENT BOTH STD/HIV AND PREGNANCY 3 (GO TO M607)
DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS 4 (GO TO M607)
PARTNER INSISTED 5 (GO TO M607)
OTHER (SPECIFY)_________________________ 6 (GO TO M607)
DON'T KNOW 8 (GO TO M607)

M605. The last time you had sexual intercourse, did you or your partner do something or use some method to avoid a pregnancy?

YES 1
NO 2 (GO TO M607)
UNSURE/DOES NOT KNOW 3 (GO TO M607)

M606. What did you do or what did you use?

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTIONS E
IMPLANTS F
CONDOM G
DIAPHRAGM/FOAM/JELLY H
PERIODIC ABSTINENCE I
WITHDRAWAL J
OTHER (SPECIFY) ________ X
DON'T KNOW Z

M607. What is your relationship to the woman with whom you last had sex?
IF "GIRLFRIEND" OR "FIANC?E", ASK: Was your girlfriend/fianc?e living with you when you last had sex?
IF YES, RECORD '1'. IF NO, RECORD '2'.

SPOUSE/LIVE-IN PARTNER 1 (GO TO M609)
GIRLFRIEND/FIANC?E 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
PROSTITUTE 5
OTHER (SPECIFY) _______ 8

M608. How long have you had a sexual relationship with this woman you last had sex with?

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

M609. Have you had sex with anyone else in the last 12 months?

YES 1
NO 2 (GO TO M617)

M610. The last time you had sexual intercourse with this other woman, did you use a condom?

YES 1
NO 2 (GO TO M612)
DOES NOT KNOW CONDOMS 3 (GO TO M612)

M611. What was the main reason you used a condom on that occasion?

TO PREVENT STD/HIV 1 (GO TO M614)
TO PREVENT PREGNANCY 2 (GO TO M614)
TO PREVENT BOTH STD/HIV AND PREGNANCY 3 (GO TO M614)
DID NOT TRUST PARTNER/FEELS SHE HAS OTHER PARTNERS 4 (GO TO M614)
PARTNER INSISTED 5 (GO TO M614)
OTHER (SPECIFY) _________________________ 6 (GO TO M614)
DON'T KNOW 8 (GO TO M614)

M612. The last time you had sexual intercourse with this woman, did you or your partner do something or use some method to avoid a pregnancy?

YES 1
NO 2 (GO TO M614)
UNSURE/DOES NOT KNOW 3 (GO TO M614)

M613. What did you do or what did you use?

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD D
INJECTIONS E
IMPLANTS F
CONDOM G
DIAPHRAGM/FOAM/JELLY H
PERIODIC ABSTINENCE I
WITHDRAWAL J
OTHER (SPECIFY) ______ X
DON'T KNOW Z

M614. What is your relationship to this woman?
IF "GIRLFRIEND" OR "FIANC?E", ASK: Was your girlfriend/fianc?e living with you when you last had sex?
IF YES, RECORD '1'. IF NO, RECORD '2'.

SPOUSE/LIVE-IN PARTNER 1 (GO TO M616)
GIRLFRIEND/FIANC?E 2
FRIEND/ACQUAINTANCE 3
RELATIVE 4
WOMAN IS A PROSTITUTE 5
OTHER (SPECIFY) _____ 6

M615. How long have you maintained a sexual relationship with this woman?

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

M616. Altogether, with how many different women have you had sex in the last 12 months?

NUMBER OF PARTNERS ______

M617. Have you ever paid for sex?

YES 1
NO 2 (GO TO M701)

M618. How long ago was the last time you paid for sex?

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

DOES NOT REMEMBER 998

M619. The last time you paid for sex, did you use a condom?

YES 1
NO 2

SECTION 7: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

M701. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO M724)

M701A. From which sources of information have you heard about AIDS? Any other sources? RECORD ALL MENTIONED.

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

M702. Is there anything a person can do to avoid getting AIDS, or the virus which causes AIDS?

YES 1
NO 2 (GO TO M704)
DON'T KNOW 8 (GO TO M704)

M703. 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

M704. CHECK M703:

NEITHER CODE 'C' NOR CODE 'D' CIRCLED (GO TO M705)
CODE 'C' AND/OR CODE 'D' CIRCLED (GO TO M707)

M705. 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 M707)
DON'T KNOW 8 (GO TO M707)

M706. 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

M707. CHECK M703:

DID NOT MENTION USE OF CONDOMS DURING SEX (CODE 'B' NOT CIRCLED) (GO TO M708)
MENTIONED USE OF CONDOMS DURING SEX (CODE 'B' CIRCLED) (GO TO M709)

M708. 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 it does not make a difference?

DECREASES HIS CHANCES 1
INCREASES HIS CHANCES 2
DOESN'T MAKE A DIFFERENCE 3
DON'T KNOW/UNSURE 8

M709. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

M710. 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

M711. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO M713)
DON'T KNOW 8 (GO TO M713)

M712. 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

M713. CHECK M501:

CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO M714)
NOT IN UNION (GO TO M716)

M714. Have you ever talked about ways to prevent getting the virus that causes AIDS with your wife/the woman you are living with?

YES 1
NO 2

M716. 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/DEPENDS 8

M717. 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

M718. Have you ever been tested for AIDS?

YES 1 (GO TO M724)
NO 2

M719. Would you like to be tested for AIDS?

YES 1
NO 2

M724. CHECK M701:

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 M727)

M725. 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

M726. 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/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
INABILITY TO GIVE BIRTH K
NO SYMPTOMS L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
DON'T KNOW Z

M727. CHECK M601:

HAS HAD SEXUAL INTERCOURSE (GO TO M728)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO M736)

M728. During the last twelve months, have you had a sexually-transmitted disease?

YES 1
NO 2
DON'T KNOW 8

M729. Now I would like to ask you some questions about your health in the last twelve months. Sometimes, men experience a discharge from their penis. During the last twelve months, did you have a discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

M730. Sometimes, men experience a sore or ulcer on or near their penis. During the last twelve months, did you have a sore or ulcer on your penis?

YES 1
NO 2
DON'T KNOW 8

M731. CHECK M728, M729, AND M730:

HAS HAD AN INFECTION (AT LEAST ONE 'YES') (GO TO M732)
HAS NOT HAD ANY INFECTIONS (NOT A SINGLE 'YES') (GO TO M736)

M732. The last time you had the (sexually-transmitted disease/discharge from your penis/sore or ulcer on your penis) did you seek advice or treatment?

YES 1
NO 2 (GO TO M734)

M733. Where did you seek advice or treatment?
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 OF PLACE_____
GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
OTHER GOVERNMENT (SPECIFY) _________ 16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
OTHER NGO (SPECIFY) __________________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE DOCTOR/CLINIC 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36
OTHER SOURCES
OTHER (SPECIFY)________________________ 96

M734. When you had the (sexually-transmitted disease/discharge from your penis/sore or ulcer on your penis) did you inform the person or persons you were having sex with?

YES 1
NO 2
SOME, NOT ALL 3
DID NOT HAVE SEX PARTNERS AT THAT TIME 4

M735.When you had the (sexually-transmitted disease/discharge from your penis/sore or ulcer on your penis) did you do something to avoid infecting the person or persons you were having sex with?

YES 1
NO 2 (GO TO M736)
PARTNER ALREADY INFECTED 3 (GO TO M736)
NOT HAVING SEX AT THAT TIME 4 (GO TO M736)

M735A. What did you do? Anything else?
RECORD ALL MENTIONED.

USE CONDOM A
STOPPED HAVING SEX B
WASH PENIS BEFORE SEX C
REDUCED THE FREQUENCY OF SEXUAL INTERCOURSE D
OTHER (SPECIFY) ________ X

M736. 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: ___________________________________