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DEMOGRAPHIC AND HEALTH SURVEY-ETHIOPIA 2005-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

LOCALITY NAME ____________________

NAME OF HOUSEHOLD HEAD __________________________

CLUSTER NUMBER ___ ___ ___

HOUSEHOLD NUMBER ___ ___

REGION ___ ___

LARGE CITY/SMALL CITY/TOWN/RURAL

LARGE CITY 1
SMALL CITY 2
TOWN 3
RURAL 4

NAME AND LINE NUMBER OF WOMAN___

HOUSEHOLD SELECTED FOR MALE INTERVIEW?

YES 1
NO 2

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

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
OTHER 6

LANGUAGE OF INTERVIEW:

AMARIGNA 1
OROMIGNA 2
TIGRIGNA 3
OTHER 6

LANGUAGE OF RESPONDENT:

AMARIGNA 1
OROMIGNA 2
TIGRIGNA 3
OTHER 6

TRANSLATOR USED:

YES 1
NO 2

SUPERVISOR
NAME _________________
DATE _________________ ___ ___

FIELD EDITOR
NAME _________________
DATE _________________ ___ ___

OFFICE EDITOR___ ___

KEYED BY ___ ___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION

Hello. My name is __________________________________ and I am working with the Population and Housing Census Commission Office (PHCCO). We are conduction a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes about 45 minutes to complete.
Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?

101. RECORD THE TIME.

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

101A. COLLECT ANY RELEVANT DOCUMENTS THAT MAY HAVE INFORMATION ON THE RESPONDENT'S AND HER CHILDREN'S AGE AND IMMUNIZATIONS.

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

YEARS ___ ___

ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

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

CITY 1
TOWN 2
COUNTRYSIDE 3

104. In what month and year were you born?

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

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

AGE IN COMPLETED YEARS ___ ___

106. Have you ever attended school?

YES 1
NO 2 (GO TO 110)

108. What is the highest grade you completed?

GRADE ___ ___

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

109. CHECK 108:

GRADE 00-06 (GO TO 110)
CHECK 07 AND ABOVE (GO TO 113)

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

CANNOT READ AT ALL 1
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

111. Have you ever participated in a Basic Education Program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

112. CHECK 110:

CODE '2','3', OR '4' CIRCLED (GO TO 113)
CIRCLE '1' OR '5' CIRCLED (GO TO 114)

113. 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

114. 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

115. 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

115A. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

NUMBER OF TRIPS ___ ___
NONE 00 (GO TO 116)

115B. In the last 12 months, have you been away from your home community for more than one month at a time?

YES 1
NO 2

116. What is your religion?

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

117. 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 live. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___ ___
DAUGHTERS AT HOME ___ ___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ___ ___
DAUGHTERS ELSEWHERE ___ ___

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___ ___
GIRLS DEAD ___ ___

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

TOTAL ___ ___

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 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. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).

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), including any children who died after birth?
[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, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED IN Q.215
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED IN Q.217
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN Q.220
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 1992 E.C. OR LATER. IF NONE, RECORD '0'

225. FOR EACH BIRTH SINCE MESKEREM 1992, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

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

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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 237)

230. When did the last such pregnancy end?

MONTH ___ ___
YEAR ___ ___ ___ ___

231. CHECK 230:

LAST PREGNANCY ENDED IN MESKEREM 1992 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE MESKEREM 1992 OR LATER (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ___ ___

233. Since Meskerem 1992, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO MESKEREM 1992.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any pregnancies that terminated before 1992 E.C. that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before 1992 E.C. end?

MONTH ___ ___
YEAR ___ ___ ___ ___

237. 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

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

YES 1
NO 2 (GO TO 239A)
DON'T KNOW 8 (GO TO 239A)

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

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

239A. Are you the primary care giver for any children?

YES 1
NO 2 (GO TO 301)

239B. Are any of these children for whom you are the primary caregiver under the age of 18?

YES 1
NO 2 (GO TO 301)

239C. Now I would like to ask you about the children who are under the age of 18 and for whom you are the primary caregiver. Have you made arrangements for someone to care for these children in the event that you fall sick or are unable to care for them?

YES 1
NO 2
UNSURE 8

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

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 MENTIONED IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

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 avoid becoming pregnant.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside their uterus by a doctor or nurse.
YES 1
NO 2
05) INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS (or NORPLANTS): Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for five 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 sheath and/or a suppository/tablet/jelly/cream in their vagina before intercourse.
YES 1
NO 2
09) STANDARD DAYS METHOD: Women can use a cycle of beads to count the days they are most likely to get pregnant and avoid sexual intercourse during those days.
YES 1
NO 2
10) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
11) RHYTHM METHOD: Every month that a woman is sexual 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
12) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
13) Have you heard 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 avoid becoming pregnant.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside their uterus by a doctor or nurse.
YES 1
NO 2
05) INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS (or NORPLANTS): Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for five 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 sheath and/or a suppository/tablet/jelly/cream in their vagina before intercourse.
YES 1
NO 2
09) STANDARD DAYS METHOD: Women can use a cycle of beads to count the days they are most likely to get pregnant and avoid sexual intercourse during those days.
YES 1
NO 2
10) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
11) RHYTHM METHOD: Every month that a woman is sexual 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
12) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
13) Have you heard 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 (GO TO 306)
NO 2

305. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (GO TO 331)

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 322)

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

YES 1
NO 2 (GO TO 322)

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

FEMALE STERILIZATION A (GO TO 319)
MALE STERILIZATION B (GO TO 319)
PILL C
IUD D (GO TO 315)
INJECTABLES E (GO TO 315)
IMPLANTS F (GO TO 315)
CONDOM G
DIAPHRAGM/FOAM/JELLY H (GO TO 315)
STANDARD DAYS METHOD I (GO TO 319A)
LACTATIONAL AMENORRHEA METHOD J (GO TO 319A)
RHYTHM METHOD K (GO TO 319A)
WITHDRAWAL L (GO TO 319A)
OTHER (SPECIFY)___________ X (GO TO 319A)

312. May I see the package of (pills/condoms) you are using?
RECORD NAME OF BRAND.

PACKAGE SEEN 1 (GO TO 314)
BRAND NAME (SPECIFY)___ (GO TO 314)
PACKAGE NOT SEEN 2

313. Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

BRAND NAME (SPECIFY) ______
DON'T KNOW 98

314. How many (pill cycles/packages of condoms) did you get the last time?

NUMBER OF CYCLES/PACKAGES ___ ___ ___
DON'T KNOW 998

315. The last time you obtained (CURRENT METHOD IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST ___ ___ ___ ___ . ___ ___ (GO TO 319A)

FREE 955 (GO TO 319A)
DON'T KNOW 998 (GO TO 319A)

319. In what month and year was the sterilization performed?
319A. In what month and year did you start using (CURRENT METHOD) continuously?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH ___ ___
YEAR ___ ___ ___ ___

321. CHECK 319/319A:

YEAR IS 1992 E.C. OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH STARTED USING) (GO TO 332)
YEAR IS 1991 E.C. OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO MESKEREM 1992.) (GO TO 329)

322. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO MESKEREM 1992.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
COLUMN 1:

* 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?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.
ILLUSTRATIVE QUESTIONS:
COLUMN 2:
* Where did you obtain the method when you started using it?
* Where did you get advice on how to use method [for LAM or rhythm]?

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:
COLUMN 3:
* Why did you stop using the (METHOD)?
* Did you become pregnant while using (METHOD), did you stop using to get pregnant, or did you 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)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1

323. CHECK 311/311A
CIRCLE METHOD CODE:

IF NO CODE CIRCLED IN 311/311A, CIRCLE '00'. IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 331)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 333)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 330)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 327)
STANDARD DAYS METHOD 09 (GO TO 327)
LACTATIONAL AMENORRHEA METHOD 10 (GO TO 327)
RHYTHM METHOD 11 (GO TO 333)
WITHDRAWAL 12 (GO TO 333)
OTHER METHOD 96 (GO TO 333)

324. You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 326)
NO 2

325. Were you ever told by a health facility/family planning worker/reproductive health agent about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 327)

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

YES 1
NO 2

327. CHECK 324:

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 (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?

YES 1 (GO TO 329)
NO 2

328. Were you ever told by a health facility/family planning worker/reproductive health agent about other methods of family planning that you could use?

YES 1
NO 2

329. CHECK 311/311A:
CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 333)
MALE STERILIZATION 02 (GO TO 333)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
DIAPHRAGM/FOAM/JELLY 08
STANDARD DAYS METHOD 09
LACTATIONAL AMENORRHEA METHOD 10 (GO TO 333)
RHYTHM METHOD 11 (GO TO 333)
WITHDRAWAL 12 (GO TO 333)
OTHER METHOD 96 (GO TO 333)

330. Where did you obtain (CURRENT METHOD) the last time?
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_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 333)
GOVERNMENT HEALTH CENTER 12 (GO TO 333)
GOVERNMENT HEALTH POST 13 (GO TO 333)
GOVERNMENT HEALTH STATION/CLINIC 14 (GO TO 333)
CBD 15 (GO TO 333)
OTHER PUBLIC (SPECIFY) ________16 (GO TO 333)
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY 21 (GO TO 333)
CBD/CBRHA 22 (GO TO 333)
OTHER NGO ______ 26 (GO TO 333)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 31 (GO TO 333)
PHARMACY 32 (GO TO 333)
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36 (GO TO 333)
OTHER SOURCE
DRUG VENDOR 41 (GO TO 333)
SHOP 42 (GO TO 333)
FRIEND/RELATIVE 43 (GO TO 333)
OTHER (SPECIFY) _____________ 96 (GO TO 333)

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

YES 1
NO 2 (GO TO 333)

332. Where is that? Any other 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.
RECORD ALL PLACES MENTIONED.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY G
CBD/CBRHA H
OTHER NGO ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
OTHER SOURCE
DRUG VENDOR M
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) _____________ X

333. In the last 12 months, were you visited by a community based health agent/distributor who talked to you about family planning?

YES 1
NO 2

334. 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)

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

YES 1
NO 2

SECTION 4. PREGNANCY, DELIVERY, POSTNATAL CARE AND NUTRITION

401. CHECK 224:

ONE OR MORE BIRTHS IN MESKEREM 1992 OR LATER (GO TO 402)
NO BIRTHS IN MESKEREM 1992 OR LATER (GO TO 550)

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1992 E.C. OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212

LINE NUMBER ___ ___

404. FROM 212 AND 216

NAME____

LIVING (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 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

406. How much longer would you have liked to wait?

MONTHS 1___ ___
YEARS 2___ ___

DON'T KNOW 998

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
COMMUNITY HEALTH AGENT D
OTHER (SPECIFY)__________________X
NO ONE Y (GO TO 414)

408. Where did you receive antenatal care for this pregnancy?
CIRCLE ALL MENTIONED. 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.
[FOR LAST BIRTH ONLY]

NAME OF PLACE_______________
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
OTHER PUBLIC (SPECIFY) ________F
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ I
OTHER (SPECIFY) _____________ X

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

MONTHS ___ ___
DON'T KNOW 98

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

NUMBER OF TIMES ___ ___
DON'T KNOW 98

411. As part of your antenatal care during this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]

Were you weighed?
YES 1
NO 2
Was you 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

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

YES 1
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)

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

YES 1
NO 2
DON'T KNOW 8

414. 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 417)
DON'T KNOW 8 (GO TO 417)

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

TIMES ___
DON'T KNOW 8

416. CHECK 415:
[FOR LAST BIRTH ONLY]

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 417)

417. At any time before this pregnancy, did you receive any tetanus injections?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)

418. Before this pregnancy, how many times did you get a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[FOR LAST BIRTH ONLY]

TIMES ___
DON'T KNOW 8

419. In what month and year did you receive the last tetanus injection before this pregnancy?
[FOR LAST BIRTH ONLY]

MONTH ___ ___
DON'T KNOW MONTH 98
YEAR ___ ___ ___ ___ (GO TO 421)
DON'T KNOW YEAR 9998

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

YEARS AGO ___ ___

421. During this pregnancy, were you given or did you buy any iron tablets?
[FOR LAST BIRTH ONLY]

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

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

NUMBER OF DAYS ___ ___ ___
DON'T KNOW 998

422A. During this pregnancy, did you receive any drug for intestinal parasites?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

425. During this pregnancy, did you take any drugs to prevent you from getting malaria?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 429)
DON'T KNOW 8 (GO TO 429)

426. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[FOR LAST BIRTH ONLY]

FANSIDAR/SP A
CHLOROQUINE B
OTHER (SPECIFY) ______________ X
DON'T KNOW Z

427. CHECK 426:
DRUGS TAKEN FOR MALARIA PREVENTION.
[FOR LAST BIRTH ONLY]

CODA 'A' CIRCLED (GO TO 428)
CODE 'A' NOT CIRCLED (GO TO 429)

428. How many times did you take Fansidar/SP during this pregnancy?
[FOR LAST BIRTH ONLY]

TIMES ___ ___

428A CHECK 407:
ANTENATAL CARE FROM A HEALTH PROFESSIONAL RECEIVED DURING THIS PREGNANCY.
[FOR LAST BIRTH ONLY]

CODE 'A' CIRCLED (GO TO 428B)
OTHER (GO TO 429)

428B. Did you get the Fansidar/SP during an antenatal visit to a health facility or from some other source?
[FOR LAST BIRTH ONLY]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY) __________ 6

429. 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

430. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 432)
DON'T KNOW 8 (GO TO 432)

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

KILOGRAMS FROM CARD. 1 ___.___ ___ ___
KILOGRAMS FROM RECALL 2 ___.___ ___ ___

DON'T KNOW 99.998

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

HEALTH PROFESSIONAL A
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT B
UNTRAINED TRADITIONAL BIRTH ATTENDANT C
COMMUNITY HEALTH AGENT D
RELATIVE/FRIEND E
OTHER (SPECIFY) _____________X
NO ONE Y

433. Where did you give birth to (NAME)?
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________
HOME
YOUR HOME 11 (GO TO 440)
OTHER HOME 12 (GO TO 440)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ________26
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 46
OTHER (SPECIFY) _____________ 96 (GO TO 440)

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

HOURS 1 ___ ___
DAYS 2 ___ ___
WEEKS 3 ___ ___

DON'T KNOW 998

435. Was (NAME) delivered by caesarean section?

YES 1
NO 2

436. Before you were discharged after (NAME) was born, did a health professional check on your health?

YES 1
NO 2 (GO TO 439 FOR LAST BIRTH; GO TO 451 FOR ALL OTHER BIRTHS)

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

HOURS 1 ___ ___
DAYS 2 ___ ___
WEEKS 3 ___ ___

DON'T KNOW 998

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

HEALTH PROFESSIONAL 11 (GO TO 449)
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 12 (GO TO 449)
UNTRAINED TRADITIONAL BIRTH ATTENDANT 13 (GO TO 449)
COMMUNITY HEALTH AGENT 15 (GO TO 449)
OTHER (SPECIFY) _____________96 (GO TO 449)

439. After you were discharged, did a health professional or a traditional birth attendant check on your health?

YES 1 (GO TO 442 FOR LAST BIRTH; GO TO 451 FOR ALL OTHER BIRTHS)
NO 2 (GO TO 449 FOR LAST BIRTH)

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

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

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

YES 1
NO 2 (GO TO 445 FOR LAST BIRTH)

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

HOURS 1 ___ ___
DAYS 2 ___ ___
WEEKS 3 ___ ___

DON'T KNOW 998

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

HEALTH PROFESSIONAL 11
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 12
UNTRAINED TRADITIONAL BIRTH ATTENDANT 13
COMMUNITY HEALTH AGENT 15
OTHER(SPECIFY)__________________96

444. Where did this first check 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.
[FOR LAST BIRTH ONLY]

NAME OF PLACE______________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ________26
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 46
OTHER (SPECIFY)__________ 96

444A. CHECK 439:
[FOR LAST BIRTH ONLY]

NOT ASKED OR NO (GO TO 445)
YES (GO TO 449)

445. In the two months after (NAME) was born, did a health professional or traditional birth attendant check on his/her health?

YES 1
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

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

HOURS 1 ___ ___
DAYS 2 ___ ___
WEEKS 3 ___ ___

DON'T KNOW 998

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

HEALTH PROFESSIONAL 11
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 12
UNTRAINED TRADITIONAL BIRTH ATTENDANT 13
COMMUNITY HEALTH AGENT 15
OTHER (SPECIFY)__________________96

448. Where did this first check 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.
[FOR LAST BIRTH ONLY]

NAME OF PLACE_______________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ________26
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 46
OTHER (SPECIFY)__________ 96

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

YES 1
NO 2

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

YES 1 (GO TO 452)
NO 2 (GO TO 453)

451. Did your period return between the birth of (NAME) and your next pregnancy?
[FOR ALL BIRTHS EXCEPT THE LAST BIRTH]

YES 1
NO 2 (GO TO 455)

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

MONTHS ___ ___
DON'T KNOW 98

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

NOT PREGNANT (GO TO 454)
PREGNANT OR UNSURE (GO TO 455)

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

YES 1
NO 2 (GO TO 456)

455. For how many month after the birth of (NAME) did you not have sexual relations?

MONTHS ___ ___
DON'T KNOW 98

456. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 463)

457. 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.
[FOR LAST BIRTH ONLY]

IMMEDIATELY 000

HOURS 1___ ___
DAYS 2___ ___

457A. Did you squeeze out and throw away the first milk?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 460)

459. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[FOR LAST 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 FORMULA G
TEA/INFUSIONS H
HONEY I
FRESH BUTTER J
FENUGREEK K
OTHER (SPECIFY) _________ X

460. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 461)
DEAD (GO TO 462)

461. Are you still breastfeeding (NAME)?

YES 1 (GO TO 464)
NO 2

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

MONTHS ___ ___
DON'T KNOW 98

463. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 466)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 468)

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

NUMBER OF NIGHTTIME FEEDINGS ___ ___

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

NUMBER OF DAYLIGHT FEEDINGS ___ ___

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

YES 1
NO 2
DON'T KNOW 8

467. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 468.

468. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 1994 E.C. OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER
NAME_________ (GO TO 469)
DOES NOT HAVE ANY CHILDREN BORN IN 1994 E.C. OR LATER AND LIVING WITH HER (GO TO 501)

469. Now I would like to ask about liquids (NAME FROM 468) drank yesterday during the day or at night. Did (NAME FROM 468) drink:

Plain water?
YES 1
NO 2
DON'T KNOW 8
Commercially produced infant formula?
YES 1
NO 2
DON'T KNOW 8
Any other milk such as powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
Fruit juice?
YES 1
NO 2
DON'T KNOW 8
Tea or coffee?
YES 1
NO 2
DON'T KNOW 8
Any other liquids?
YES 1
NO 2
DON'T KNOW 8

470. Now I would like to ask you about the food (NAME FROM 468) ate yesterday during the day or at night, either separately or combined with other foods. Did (NAME FROM 468) eat:

a. Any porridge or gruel (made from grains other than teff)?
YES 1
NO 2
DON'T KNOW 8
b. Any Cerifam, Fafa, Milupa, Babylac, Mother's Choice or other commercially fortified baby food?
YES 1
NO 2
DON'T KNOW 8
c. Bread, pasta, rice, noodles, biscuits, cookies or any other food made from oats, maize, barley, wheat, sorghum, millet, or other grain?
YES 1
NO 2
DON'T KNOW 8
d. Any food made from teff, like injera, kita or porridge?
YES 1
NO 2
DON'T KNOW 8
e. Any white potatoes, white yams, bulla, kocho, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
f. Any pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
g. Any dark green, leafy vegetables like kale, spinach or amaranth leaves?
YES 1
NO 2
DON'T KNOW 8
h. Any ripe mangoes, papayas?
YES 1
NO 2
DON'T KNOW 8
i. Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
j. Any liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
k. Any beef, pork, lamb, goat, rabbit [or wild game meat such as antelope or deer]?
YES 1
NO 2
DON'T KNOW 8
l. Any chicken, duck or other birds?
YES 1
NO 2
DON'T KNOW 8
m. Any eggs?
YES 1
NO 2
DON'T KNOW 8
n. Any fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
o. Any foods made from beans, peas, lentils or pulses?
YES 1
NO 2
DON'T KNOW 8
p. Any nuts or seeds such as peanuts, sesame or sunflower seeds?
YES 1
NO 2
DON'T KNOW 8
q. Any cheese or yogurt?
YES 1
NO 2
DON'T KNOW 8
r. Any foods made with oil, fat, or butter?
YES 1
NO 2
DON'T KNOW 8
s. Any other solid or semi-solid food?
YES 1
NO 2
DON'T KNOW 8

471. CHECK 470:

AT LEAST ONE "YES" (GO TO 472)
NOT A SINGLE "YES" (GO TO 501)

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

NUMBER OF TIMES ____
DON'T KNOW 8

SECTION 5. IMMUNIZATION, HEALTH, AND WOMEN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1992 E.C. 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.)

502. LINE NUMBER FROM 212

LINE NUMBER ___ ___

503. FROM 212 AND 216

NAME_______________

LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 547)

504. Has (NAME) ever received a vitamin A does like this?
SHOW CAPSULE.

YES 1
NO 2 (GO TO 507)
DON'T KNOW 8 (GO TO 507)

505. How many months ago did (NAME) take the last dose?

MONTHS AGO ___ ___
DON'T KNOW 98

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

YES, SEEN 1 (GO TO 509)
YES, NOT SEEN 2 (GO TO 511)
NO CARD 3

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

YES 1 (GO TO 511)
NO 2 (GO TO 511)

509 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (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 (POLIO GIVEN AT BIRTH)
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___
VITAMIN A (MOST RECENT)
DAY____
MONTH___
YEAR___
VITAMIN A (2nd MOST RECENT)
DAY____
MONTH___
YEAR___

510. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3 AND/OR MEASLES VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 509) (GO TO 515)
NO 2 (GO TO 515)
DON'T KNOW 8 (GO TO 515)

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

YES 1
NO 2 (GO TO 515)
DON'T KNOW 8 (GO TO 515)

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

512A. 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

512B. Polio vaccine, that is, drops in mouth?

YES 1
NO 2 (GO TO 512E)
DON'T KNOW 8 (GO TO 512E)

512C. Was the first polio vaccine received in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

512D. How many times was the polio vaccine received?

NUMBER OF TIMES ____

512E. A 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 512G)
DON'T KNOW 8 (GO TO 512G)

512F. How many times was a DPT vaccination received?

NUMBER OF TIMES ____

512G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

516. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

518. 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

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

YES 1
NO 2 (GO TO 524)

520. Where did you seek advice or treatment? Anywhere else?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, 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____
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
COMMUNITY HEALTH AGENT D
OTHER PUBLIC (SPECIFY) ________E
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ I
OTHER SOURCE
DRUG VENDOR J
SHOP K
TRADITIONAL HEALER L
OTHER (SPECIFY) _____________ X

521. CHECK 520:

TWO OR MORE CODES CIRCLED (GO TO 522)
ONLY ONE CODE CIRCLED (GO TO 523)

522. Where did you first seek advice or treatment?
USE LETTER CODE FROM 520.

FIRST PLACE ___

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

DAYS ___ ___

524. Does (NAME) still have diarrhea?

YES 1
NO 2
DON'T KNOW 8

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

a. A fluid made from an ORS packet like LEMLEM?
YES 1
NO 2
DON'T KNOW 8
b. Homemade sugar and salt solution?
YES 1
NO 2
DON'T KNOW 8
c. Other homemade fluid?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

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

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

528. CHECK 527:
GIVEN ZINC?

CODE "C" CIRCLED (GO TO 529)
CODE "C" NOT CIRCLED (GO TO 530)

529. How many times was (NAME) given zinc?
[FOR LAST BIRTH ONLY]

TIMES ___ ___
DON'T KNOW 98

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 534)
DON'T KNOW 8 (GO TO 534)

532. 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 535)
DON'T KNOW 8 (GO TO 535)

533. When (NAME) had this illness, did he/she have a problem in the chest or a blocked or runny nose?

CHEST ONLY 1 (GO TO 535)
NOSE ONLY 2 (GO TO 535)
BOTH 3 (GO TO 535)
OTHER (SPECIFY) ___________ 6 (GO TO 535)
DON'T KNOW 8 (GO TO 535)

534. CHECK 530:
HAD FEVER?

YES (GO TO 535)
NO OR DON'T KNOW (GO TO 546)

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

536. 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

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

YES 1
NO 2 (GO TO 542)

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

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
COMMUNITY HEALTH AGENT D
OTHER PUBLIC (SPECIFY) ________E
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ I
OTHER SOURCE
DRUG VENDOR J
SHOP K
TRADITIONAL HEALER L
OTHER (SPECIFY) _____________ X

539. CHECK 538:

TWO OR MORE CODES CIRCLED (GO TO 540)
ONLY ONE CODE CIRCLED (GO TO 541)

540. Where did you first seek advice or treatment?
USE LETTER CODE FROM 538.

FIRST PLACE ____

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

DAYS ___ ___

542. Is name still sick with a (fever/cough)?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 546)
DON'T KNOW 8 (GO TO 546)

544. What drugs did (NAME) take? Any other drugs?
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.

ANTIMALARIAL DRUGS
FANSIDAR/SP A
CHLOROQUINE B
ARTEMETHER-LUMEFANTRINE C
QUININE D
OTHER ANTIMALARIAL G
ANTIBIOTIC
BACTRIM H
AMPICILIN I
AMOXYCILIN J
CHLORIAMPHENICOL K
TETRACYCLINE L
OTHER ANTIBIOTIC M
OTHER DRUGS
ASPIRIN N
IBUPROFEN O
PARACETAMOL P
OTHER (SPECIFY) _________ X
DON'T KNOW Z

544A. CHECK 544:
ANY CODE A-M CIRCLED

YES (GO TO 545)
NO (GO TO 546)

545. Did you already have (NAME OF DRUG FROM 544) at home when the child became ill?
IF YES, CIRCLE CODE FOR THAT DRUG.
ASK SEPARATELY FOR EACH DRUG (A-M) GIVEN IN 544.

ANTIMALARIAL DRUGS
FANSIDAR/SP A
CHLOROQUINE B
ARTEMETHER-LUMEFANTRINE C
QUININE D
OTHER ANTIMALARIAL G
ANTIBIOTIC
BACTRIM H
AMPICILIN I
AMOXYCILIN J
CHLORIAMPHENICOL K
TETRACYCLINE L
OTHER ANTIBIOTIC M
NO DRUG AT HOME Y

545A. CHECK 544:

CODE A CIRCLED (GO TO 545B)
CODE A NOT CIRCLED (GO TO 545D)

545B. How long after the fever/cough started did (NAME) first take Fansidar/SP?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8

545C. For how many days did (NAME) take the Fansidar/SP?
IF 7 OR MORE DAYS RECORD '7'

DAYS ___
DON'T KNOW 8

545D. CHECK 544:

CODE B CIRCLED (GO TO 545E)
CODE B NOT CIRCLED (GO TO 545G)

545E. How long after the fever/cough started did (NAME) first take Choloroquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8

545F. For how many days did (NAME) take the Chloroquine?
IF 7 OR MORE DAYS RECORD '7'

DAYS ___
DON'T KNOW 8

545G. CHECK 544:

CODE C CIRCLED (GO TO 545H)
CODE C NOT CIRCLED (GO TO 545J)

545H. How long after the fever/cough started did (NAME) first take Artemether-Lumefantrine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8

545I. For how many days did (NAME) take the Aremether-Lumefantrine?
IF 7 OR MORE DAYS RECORD '7'

DAYS ___
DON'T KNOW 8

545J. CHECK 544:

CODE D CIRCLED (GO TO 545K)
CODE D NOT CIRCLED (GO TO 546)

545K. How long after the fever/cough started did (NAME) first take Quinne?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8

545L. For how many days did (NAME) take the Quinine?
IF 7 OR MORE DAYS RECORD '7'

DAYS ___
DON'T KNOW 8

546. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 547

547. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1992 E.C. OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (GO TO 548)
NONE (GO TO 550)

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

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) ________96
DON'T KNOW 98

549. CHECK 525(a) ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 550)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 551)

550. Have you ever heard of a special product called ORS (like LEMLEM) that you can get for treatment of diarrhea?

YES 1
NO 2

551. Now I would like to ask you some questions about medical care for you 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.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for treatment.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting transport.
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 a female 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
No one to complete household chores.
BIG PROBLEM 1
NOT A BIG PROBLEM 2

554. Now I would like to ask you some questions about any injections you have had in the last 12 months. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAY FOR 3 MONTHS OR MORE, RECORD '90' IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___ ___
NONE 00 (GO TO 557A)

555. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___ ___
NONE 00 (GO TO 557A)

556. The last time you had an injection given to you by a health worker, where did you go to get the injection?
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___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
COMMUNITY HEALTH AGENT 14
OTHER PUBLIC (SPECIFY) ________16
NGO HEALTH FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 31
DENTAL CLINIC/OFFICE 32
PHARMACY 33
OFFICE OR HOME OF NURSE/HEALTH WORKER 34
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36
OTHER PLACE
AT HOME 41
OTHER (SPECIFY) _____________ 96

557. Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

557A. Do you have a tetanus injection card(s)?
IF YES: May I see it please?

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 558)
NO CARD 3 (GO TO 558)

557B. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD STARTING WITH THE MOST RECENT. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

DAY____
MONTH____
YEAR____

558. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 560)

559. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ___ ___

560. Do you currently smoke or use any other type of tobacco like gaya, shisha or suret?

YES 1
NO 2 (GO TO 562)

561. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED

PIPE A
CHEWING TOBACCO B
SNUFF/SURET C
SHISHA D
GAYA E
OTHER (SPECIFY) _______X

562. Have you ever head of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 566)

563. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED

THOUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

564. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

565. If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

566. CHECK 468:

HAS AT LEAST ONE CHILD BORN IN 1994 E.C.OR LATER AND LIVING WITH HER (GO TO 567)
DOES NOT HAVE ANY CHILDREN BORN IN 1994 E.C. OR LATER AND LIVING WITH HER (GO TO 601)

567. Now I would like to ask you about the foods and liquids you had yesterday during the day or at night, either separately or combined with other foods or liquids. Did (YOU) eat or drink:

a. Any porridge or gruel (made from grains other than teff)?
YES 1
NO 2
DON'T KNOW 8
b. Bread, pasta, rice, noodles, biscuits, cookies or any other food made from oats, maize, barley, wheat, sorghum, millet, or other grain?
YES 1
NO 2
DON'T KNOW 8
c. Any food made from teff, like injera, kita or porridge?
YES 1
NO 2
DON'T KNOW 8
d. Any white potatoes, white yams, bulla, kocho, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
e. Any pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
f. Any dark green, leafy vegetables like kale, spinach or amaranth leaves?
YES 1
NO 2
DON'T KNOW 8
g. Any ripe mangoes, papayas?
YES 1
NO 2
DON'T KNOW 8
h. Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
i. Any liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
j. Any beef, pork, lamb, goat, rabbit [or wild game meat such as antelope or deer]?
YES 1
NO 2
DON'T KNOW 8
k. Any chicken, duck or other birds?
YES 1
NO 2
DON'T KNOW 8
l. Any eggs?
YES 1
NO 2
DON'T KNOW 8
m. Any fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
n. Any foods made from beans, peas, lentils or pulses?
YES 1
NO 2
DON'T KNOW 8
o. Any nuts or seeds such as peanuts, sesame or sunflower seeds?
YES 1
NO 2
DON'T KNOW 8
p. Any cheese, yogurt, milk or other milk products?
YES 1
NO 2
DON'T KNOW 8
q. Any foods made with oil, fat, or butter?
YES 1
NO 2
DON'T KNOW 8
r. Any tea or coffee?
YES 1
NO 2
DON'T KNOW 8
s. Any sugary foods or drinks, such as pastry, cakes, chocolates, sweets or candies, sodas, fruit juices or drinks?
YES 1
NO 2
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601. Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 605)
YES, LIVING WITH A MAN 2 (GO TO 605)
NO, NOT IN UNION 3

602. Have you ever been married or lived together with a man as if married?

YES, FORMERLY MARRIED 1 (GO TO 604)
YES, LIVED WITH A MAN 2 (GO TO 604)
NO 3

603. ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO MESKEREM 1992. (GO TO 614)

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

WIDOWED 1 (GO TO 610)
DIVORCED 2 (GO TO 610)
SEPARATED 3 (GO TO 610)

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

LIVING TOGETHER 1
STAYING ELSEWHERE 2

606. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'

NAME ___________
LINE NO ___ ___

607. Besides yourself, does your husband/partner have other wives or does he live with women other than his wives as if married?

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

608. How many other wives or partners does your husband live with now?

OTHER NUMBER OF WIVES AND LIVE-IN PARTNERS ___ ___
DON'T KNOW 98

609. Are you the first, second, ...wife?
IF Q.608 IS DON'T KNOW: Do you know your rank?
IF YES: Are you the first, second, ...wife

RANK ___ ___
DON'T KNOW 98

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

ONLY ONCE 1
MORE THAN ONCE 2

611. CHECK 610:

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 I would like to ask about when you started living with your first husband/partner. In what month and year was that?

MONTH ___ ___
DON'T KNOW MONTH ___ ___
YEAR ___ ___ ___ ___ (GO TO 613)
DON'T KNOW YEAR 9998

612. How old were you when you first started living with him?

AGE ___ ___

613. DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE MESKEREM 1992. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER 'O' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE MESKEREM 1992.
FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

613A. CHECK 604:
IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED OR NOT WIDOWED (GO TO 613B)
WIDOWED 9GO TO 613D)

613B. CHECK 610:

MARRIED MORE THAN ONCE (GO TO 613C)
MARRIED ONLY ONCE (GO TO 614)

613C. How did your previous marriage or union end?

DEATH/WIDOWHOOD 1
DIVORCE 2 (GO TO 614)
SEPARATION 3 (GO TO 614)

613D. Who did most of your late husband's property go to?

RESPONDENT 1 (GO TO 614)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4sur
EQUAL SHARE WITH OTHERS 5
OTHER (SPECIFY)_________ 6
NO PROPERTY 7

613E. Did you receive any of your late husband's assets or valuables?

YES 1
NO 2

614. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

615. 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 had sexual intercourse for the very first time (if ever)?

NEVER HAD SEX 00
AGE IN YEARS ___ ___ (GO TO 616A)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 616A)

616. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 637)
NO 2 (GO TO 637)
DON'T KNOW/UNSURE 8 (GO TO 637)

616A. CHECK COVER PAGE:

HOUSEHOLD SELECTED FOR MALE SURVEY (GO TO 617)
HOUSEHOLD NOT SELECTED FOR MALE SURVEY (GO TO 637)

617. CHECK 105:

15-24 YEARS OLD (GO TO 618)
25-49 YEARS OLD (GO TO 622)

618. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

619. How old was the person you first had sexual intercourse with?

AGE OF PARTNER ___ ___ (GO TO 622)
DON'T KNOW 98

620. Was this person older than you, younger than you, or about same age as you?

OLDER 1
YOUNGER 2 (GO TO 622)
ABOUT THE SAME AGE 3 (GO TO 622)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 622)

621. Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

622. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS

DAYS AGO 1 ___ ___ (GO TO 624)
WEEKS AGO 2 ___ ___ (GO TO 624)
MONTHS AGO 3 ___ ___ (GO TO 624)
YEARS AGO 4 ___ ___ (GO TO 636)

623. When was the last time you had sexual intercourse with this other person?
[FOR ALL SEXUAL PARTNERS EXCEPT THE LAST PARTNER]

DAYS AGO 1 ___ ___
WEEKS AGO 2 ___ ___
MONTHS AGO 3 ___ ___

624. The last time you had sexual intercourse (with this other person), was a condom used?

YES 1
NO 2 (GO TO 626)

625. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

626. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND/GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'

SPOUSE 01 (GO TO 632)
LIVE-IN PARTNER 02 (GO TO 632)
BOYFRIEND/GIRLFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANCE 04
COMMERCIAL SEX WORKER 05
OTHER (SPECIFY)___________ 96

627. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS

15-24 YEARS OLD (GO TO 629)
25-49 YEARS OLD (GO TO 632)

629. How old is this person?

AGE OF PARTNER ___ ___ (GO TO 632)
DON'T KNOW 98

630. Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 632)
ABOUT THE SAME AGE 3 (GO TO 632)
DON'T KNOW 8 (GO TO 632)

631. Would you say this person is ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

632. The last time you had sexual intercourse (with this other person), did you or this person drink alcohol?

YES 1
NO 2 (GO TO 634 FOR LAST SEXUAL PARTNER; GO TO 635 FOR ALL OTHER PARTNERS)

633. Where you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

634. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
[FOR LAST SEXUAL PARTNER ONLY]

YES 1 (GO BACK TO 623 IN THE NEXT COLUMN)
NO 2 (GO TO 636)

635. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

NUMBER OF PARTNERS LAST 12 MONTHS ___ ___
DON'T KNOW 98

636. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS IN LIFETIME ___ ___
DON'T KNOW 98

637. Do you know a place where a person can get condoms?

YES 1
NO 2 (GO TO 701)

638. Where is that? Any other 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.
RECORD ALL SOURCES MENTIONED.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY G
CBD/CBRHA H
OTHER NGO ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
OTHER SOURCE
DRUG VENDOR M
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) _____________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 311/311A

NEITHER STERILIZED OR NOT ASKED (GO TO 702)
HE OR SHE STERILIZED (GO TO 713)

702. 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 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)

703. 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 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) _________ 996 (GO TO 708)
DON'T KNOW 998 (GO TO 708)

704. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 705)
PREGNANT (GO TO 709)

705. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 706)
NOT CURRENTLY USING (GO TO 706)
CURRENTLY USING (GO TO 713)

706. CHECK 703:

NOT ASKED (GO TO 707)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 707)
00-23 MONTHS OR 00-01 YEAR (GO TO 709)

707. CHECK 702:

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

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

RECORD ALL REASONS MENTIONED.

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
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
METHOD NOT AVAILABLE U
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

708. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 709)
NO, NOT CURRENTLY USING (GO TO 709)
YES, CURRENTLY USING (GO TO 713)

709. 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 711)
DON'T KNOW 8 (GO TO 711)

710. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 713)
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
DIAPHRAGM/FOAM/JELLY 09 (GO TO 713)
STANDARD DAYS METHOD 10 (GO TO 713)
LACTATIONAL AMEN. METHOD 11 (GO TO 713)
RHYTHM METHOD 12 (GO TO 713)
WITHDRAWAL 13 (GO TO 713)
OTHER (SPECIFY) ____________ 96 (GO TO 713)
UNSURE 98 (GO TO 713)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (GO TO 713)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 713)
SUBFECUND/INFECUND 24 (GO TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 713)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 713)
HUSBAND/PARTNER OPPOSED 32 (GO TO 713)
OTHERS OPPOSED 33 (GO TO 713)
RELIGIOUS PROHIBITION 34 (GO TO 713)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 713)
KNOWS NO SOURCE 42 (GO TO 713)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 713)
FEAR OF SIDE EFFECTS 52 (GO TO 713)
LACK OF ACCESS/TOO FAR 53 (GO TO 713)
COSTS TOO MUCH 54 (GO TO 713)
INCONVENIENT TO USE 55 (GO TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 713)
METHOD NOT AVAILABLE 57 (GO TO 713)
OTHER (SPECIFY) _____________ 96 (GO TO 713)
DON'T KNOW 98 (GO TO 713)

712. Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DON'T KNOW 8

713. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and 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.

NONE 00 (GO TO 715)
NUMBER ___ ___
OTHER (SPECIFY) ___________ 96 (GO TO 715)

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

NUMBER OF BOYS ___ ___
OTHER (SPECIFY)____ 98
NUMBER OF GIRLS ___ ___
OTHER (SPECIFY)____ 98
NUMBER OF EITHER SEX ___ ___
OTHER (SPECIFY)____ 98

715. 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
In a pamphlet/poster/leaflets/booklets?
YES 1
NO 2
At a community event?
YES 1
NO 2

717. CHECK 601:

YES, CURRENTLY MARRIED (GO TO 718)
YES, LIVING WITH A MAN (GO TO 718)
NO, NOT IN UNION (GO TO 723)

718. CHECK 311/311A:

NETHER CODE B, NOR CODE G, NOR CODE L CIRCLED, BUT ANY OTHER CODE(S) CIRCLED (GO TO 719)
CODE B, OR G, OR L CIRCLED (GO TO 720)
NO CODE CIRCLED (GO TO 722)

719. Does your husband/partner know that you are using a method of family planning?

YES 1
NO 2
DON'T KNOW 8

720. 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

721. CHECK 311/311A:

NEITHER STERILIZED OR NOT ASKED (GO TO 722)
HE OR SHE STERILIZED (GO TO 723)

722. 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

723. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a disease that can be transmitted through sexual contact?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with other women?
YES 1
NO 2
DON'T KNOW 8
She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

723A. When a wife knows her husband has a disease that can be transmitted through sexual contact, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

723B. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 723C)
NOT IN UNION (GO TO 801)

723C. Can you say no to your husband/partner if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/UNSURE 8

723D. Could you ask your husband/partner to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/UNSURE 8

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

801. CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

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

AGE IN COMPLETED YEARS ___ ___

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

YES 1
NO 2 (GO TO 806)

805. What was the highest grade he completed?

GRADE ___ ___

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

806. CHECK 801:

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?

OCCUPATION_____________________________ ___ ___

807. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 811)
NO 2

808. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809. 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 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

810A. What have you been doing for most of the time over the last 12 months?

GOING TO SCHOOL/STUDYING 01 (GO TO 818)
LOOKING FOR WORK 02 (GO TO 818)
RETIRED 03 (GO TO 818)
TOO ILL TO WORK 04 (GO TO 818)
HANDICAPPED, CANNOT WORK 05 (GO TO 818)
HOUSEWORK/CHILD CARE 06 (GO TO 818)
OTHER (SPECIFY) ___________ 96 (GO TO 818)

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

OCCUPATION_____________________ ___ ___

812. CHECK 811:

WORKS IN AGRICULTURE (GO TO 813)
DOES NOT WORK IN AGRICULTURE (GO TO 814)

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

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
DOES NOT WORK ON LAND 5

814. 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

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

HOME 1
AWAY 2

816. 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

817. 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

818. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 819)
NOT IN UNION (GO TO 825)

819. CHECK 817:

CODE 1 OR 2 CIRCLED (GO TO 820)
OTHER/NOT ASKED (GO TO 822)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6

821. Would you say that the money that you bring into the household is more than what your husband/partner 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/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 823)
DON'T KNOW 8

822. Who decides how your husband's/partner's earnings will be used: mainly you, mainly your husband/partner, or you your husband/partner jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4
OTHER 6

823. Who usually makes decisions about health care for yourself: mainly you, mainly your husband/partner, you and your husband/partner jointly, or someone else?

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

Who usually makes decisions about making major household purchases?

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

Who usually makes decisions about making purchases for daily household needs?

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

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

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

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

If she goes out without telling him?
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 9. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

YES 1
NO 2 (GO TO 917)

902. 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

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

YES 1
NO 2
DON'T KNOW 8

904. 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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

907. Can people get the AIDS virus because of the curse of God or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

908. Is there anything else a person can do to avoid or reduce the chances of getting the AIDS virus?

YES 1
NO 2 (GO TO 910)
DON'T KNOW 8 (GO TO 910)

909. What can a person do? Anything else?
RECORD ALL WAYS 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 PERSON WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) _____________W
OTHER (SPECIFY) _____________ X
DON'T KNOW __________________ Z

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

YES 1
NO 2
DON'T KNOW 8

910A. CHECK COVERAGE PAGE

HOUSEHOLD SELECTED FOR MALE SURVEY (GO TO 910B)
HOUSEHOLD NOT SELECTED FOR MALE SURVEY (GO TO 911)

910B. Can the virus that causes AIDS 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

910C. CHECK 910B:

AT LEAST ONE 'YES' (GO TO 910D)
OTHER (GO TO 910E)

910D. Are there any special medications that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to her baby?

YES 1
NO 2
DON'T KNOW 8

910E. Is there any special medication that people infected with the AIDS virus can get from a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

910F. CHECK 215:

LAST BIRTH SINCE MESKEREM 1995 (GO TO 910G)
NO BIRTHS (GO TO 910O)
LAST BIRTH BEFORE MESKEREM 1995 (GO TO 910O)

910G CHECK 407:
SEE ANYONE FOR ANTENATAL CARE DURING THAT PREGNANCY?

YES, PERSON SEEN (GO TO 910H)
NO ONE (GO TO 910O)

910H. During any of the antenatal visits for that pregnancy, did anyone talk to you about:

Babies getting the AIDS virus from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting the AIDS virus?
YES 1
NO 2
DON'T KNOW 8
Getting tested for the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

910I. Were you offered a test for the AIDS virus as part of your antenatal care?

YES 1
NO 2

910J. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 910O)

910K. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

910L. Where was the test done?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE DOW THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE PLACE_____________________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
GOVERNMENT HEALTH CENTER 12
VCT CENTER 13
GOVERNMENT HEALTH POST 14
FAMILY PLANNING CLINIC 15
STAND-ALONE VCT CENTER 16
OTHER PUBLIC (SPECIFY) ________17
NON-GOVERNMENT (NGO) HEALTH FACILITY 21
STAND-ALONE VCT CENTER 22
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 31
STAND ALONE VCT CENTER 32
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36
OTHER (SPECIFY) _____________ 96

910M. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1 (GO TO 910P)
NO 2

910N. When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1 (GO TO 912A)
12-23 MONTHS AGO 2 (GO TO 912A)
2 OR MORE YEARS AGO (GO TO 912A)

910O. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 911)

910P. When was the last time you were tested?

LESS THAN 12 MOTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO

910Q. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

910R. I don't want to know the results, but did you get the result of the test?

YES 1
NO 2

910S. Where was the test done?
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 THE PLACE_____________________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
VCT CENTER 13
GOVERNMENT HEALTH POST 14
FAMILY PLANNING CLINIC 15
STAND ALONE VCT CENTER 16
OTHER PUBLIC (SPECIFY) ________17
NON-GOVERNMENT (NGO) HEALTH FACILITY 21
STAND ALONE VCT CENTER 22
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 31
STAND ALONE VCT CENTER 32
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36
OTHER (SPECIFY) _____________ 96

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

YES 1
NO 2 (GO TO 912A)

912. Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.

NAME OF THE PLACE_____________________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
VCT CENTER C
GOVERNMENT HEALTH POST D
FAMILY PLANNING CLINIC E
STAND ALONE VCT CENTER F
OTHER PUBLIC (SPECIFY) ________G
NGO HEALTH FACILITY H
STAND ALONE VCT CENTER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
STAND ALONE VCT CENTER K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
OTHER (SPECIFY) _____________ M

912A. In the last few months have you heard or seen the following media messages on HIV/AIDS?

Value your life!
YES 1
NO 2
Stop stigma and discrimination!
YES 1
NO 2
Harmful traditional practices expose to HIV/AIDS!
YES 1
NO 2
Live and let live!
YES 1
NO 2
Care and support people living with HIV/AIDS!
YES 1
NO 2
I care, do you?
YES 1
NO 2
Let us take care of each other!
YES 1
NO 2
Let us fight HIV/AIDS together!
YES 1
NO 2
Abstain from sex before marriage!
YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

914. If a member of your family got infected with the AIDS virus, would you want it remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

915. 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

916. 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

916A. CHECK COVER PAGE:

HOUSEHOLD SELECTED FOR MALE SURVEY (GO TO 916B)
HOUSEHOLD NOT SELECTED FOR MALE SURVEY (GO TO 917)

916B. Do you personally know someone who is suspected to have the AIDS virus or who has the AIDS virus?

YES 1
NO 2 (GO TO 916F)

916C. Do you personally know someone who has been denied health services in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?

YES 1
NO 2

916D. Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?

YES 1
NO 2

916E. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?

YES 1
NO 2

916F. Do you agree or disagree with the following statement:
People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

916G. Do you agree or disagree with the following statement:
People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

916H. Should children age 12-14 be taught about using a condom to avoid AIDS?

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

916I. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid AIDS?

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

917. CHECK 901:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

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

YES 1
NO 2

918. CHECK 615:

HAS HAD SEXUAL INTERCOURSE (GO TO 919)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 1001)

919. CHECK 917:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 920)
NO 2 (GO TO 921)

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

YES 1
NO 2
DON'T KNOW 8

921. 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

922. 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

923. CHECK 920, 92, AND 922:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 924)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1001)

924. The last time you had (PROBLEM FROM 920/921/922), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1001)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
VCT CENTER C
GOVERNMENT HEALTH POST D
FAMILY PLANNING CLINIC E
STAND ALONE VCT CENTER F
OTHER PUBLIC (SPECIFY) ________G

NON-GOVERNMENT (NGO) HEALTH FACILITY H
STANDALONE VCT CENTER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/ CLINIC/DOCTOR J
STAND ALONE VCT CENTER K
PHARMACY L
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ M
OTHER SOURCE
DRUG VENDOR N
SHOP O
TRADITIONAL HEALER P
OTHER (SPECIFY) _____________ X

SECTION 10. HARMFUL TRADITIONAL PRACTICES

1001. 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 1011)

1002. Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 1004)
DON'T KNOW 8 (GO TO 1004)

1003. In some parts of Ethiopia, there is a type of circumcision where the genital area is sewn closed. Was it done to you?

YES 1
NO 2
DON'T KNOW 8

1004. CHECK 214 AND 216:

HAS ONE LIVING DAUGHTER (GO TO 1005)
HAS MORE THAN ONE LIVING DAUGHTER (GO TO 1005)
HAS NO LIVING DAUGHTER (GO TO 1010)

1005. CHECK 1004:

ONE LIVING DAUGHTER: Has your daughter been circumcised?
IF YES: RECORD '01'

MORE THAN ONE LIVING DAUGHTER: Have any of your daughters been circumcised?
IF YES: How many?
RECORD THE NUMBER

NUMBER CIRCUMCISED ___ ___
NO DAUGHTER CIRCUMCISED 95 (GO TO 1010)

1006. To which of your daughters did this happen (most recently)?
CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.

DAUGHTER'S NAME___
DAUGHTER'S LINE NUMBER FROM 212 ___ ___

1007. Was (NAME OF DAUGHTER FROM 1006)'s genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1008. 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

1009. Who did circumcision?

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

1010. Do you think that this practice should be continued or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

1011. Have you ever heard of uvulectomy/tonsillectomy?
IF NO PROBE: Have you ever heard of the practice in which a child may have parts of her or his uvula cut or tonsils scraped?

YES 1
NO 2 (GO TO 1016)

1012. Have you yourself ever had an uvulectomy or tonsillectomy?

YES 1
NO 2
DON'T KNOW 8

1013. CHECK 216:

HAS AT LEAST ONE LIVING CHILD (GO TO 1014)
HAS NO LIVING CHILD (GO TO 1015)

1014. Have any of your children ever had an uvulectomy or tonsillectomy?
IF YES: How many?

NUMBER ___ ___
NO CHILD 95

1015. Do you think that this practice should be continued or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

1016. Have you ever heard of marriage by abduction?
IF NO PROBE: Have you ever heard of the practice in which a girl is abducted and forced into marriage?

YES 1
NO 2 (GO TO 1021)

1016A. CHECK 601 AND 602

EVER MARRIED/EVER IN UNION (GO TO 1017)
NEVER MARRIED/NEVER IN UNION (GO TO 1018)

1017. Were you yourself married by abduction?

YES 1
NO 2

1018. CHECK 214,215 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER AGE 10 AND ABOVE (GO TO 1019)
HAS NO LIVING DAUGHTER/DAUGHTER BELOW AGE 10 (GO TO 1020)

1019. Have any of your daughters ever been married by abduction?
IF YES: How many?

NUMBER ___ ___
NO DAUGHTER 95

1020. Do you think that this practice should be continued or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

1021. Have you ever heard of obstetric fistula (USE LOCAL TERM)?
IF NO PROBE: Have you ever heard of a condition in which a woman continuously leaks urine and /or faeces following childbirth?

YES 1
NO 2 (GO TO 1101)

1022. Have you yourself experienced obstetric fistula?

YES 1
NO 2 (GO TO 1024)

1023. Have you ever been treated for obstetric fistula?

YES 1
NO 2

1024. Are there any (other) women in your household who suffer from obstetric fistula?

YES 1
NO 2 (GO TO 1101)

1025. How many (other) women in your household suffer from obstetric fistula?

NUMBER ___ ___
DON'T KNOW 98

SECTION 11. MATERNAL MORTALITY

1101. 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 you, 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 ___ ___

1102. CHECK 1101:

TWO OR MORE BIRTHS (GO TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1114)

1103. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ___ ___

1104. What was the name given to your oldest (next oldest) brother or sister?

NAME_________________________________

1105. Is (NAME) male or female?

MALE 1
FEMALE 2

1106. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DON'T KNOW 8 (GO TO NEXT SIBLING)

1107. How old is (NAME)?

AGE ___ ___ (GO TO NEXT SIBLING)

1108. How many years ago did (NAME) die?

YEARS___ ___

1109. How old was (NAME) when he/she died?

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

1110. Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111. Did (NAME) die during childbirth?

YES 1 (GO TO 1113)
NO 2

1112. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1113. 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 1114

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 THE EDITOR: _______________________________ DATE:_____________________________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COL 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 DIAPHRAGM/FOAM/JELLY
9 STANDARD DAYS METHOD
J LACTATIONAL AMENORRHEA METHOD
K RHYTHM METHOD
L WITHDRAWAL
X OTHER (SPECIFY) _________________

COL 2: SOURCE OF CONTRACEPTION

1 GOV'T HOSPITAL
2 GOV'T HEALTH CENTER
3 GOV'T HEALTH POST
4 GOV'T HEALTH STATION/CLINIC
5 CBD
6 OTHER PUBLIC
7 NON-GOV'T HEALTH FACILITY
8 NON-GOV'T CBD/CBRHA
9 OTHER NGO
A PVT HOSPITAL/CLINIC/DOCTOR
B PHARMACY
C OTHER PRIVATE MEDICAL
D DRUG VENDOR
E SHOP
F FRIENDS/RELATIVES
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/PARTNER 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
M METHOD NOT AVAILABLE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARTIAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ______________
Z DON'T KNOW

COL 4: MARRIAGE/UNION

X IN UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION
1997 E.C.
13 PAG 01 ______ _______ _______ _____
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
05 TIRR 09 ______ _______ _______ _____
04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____
1996 E.C.
13 PAG 01 ______ _______ _______ _____
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
05 TIRR 09 ______ _______ _______ _____
04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____
1995 E.C.
13 PAG 01 ______ _______ _______ _____
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
05 TIRR 09 ______ _______ _______ _____
04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____
1994 E.C.
13 PAG 01 ______ _______ _______ _____
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
05 TIRR 09 ______ _______ _______ _____
04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____
1993 E.C.
13 PAG 01 ______ _______ _______ _____
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
05 TIRR 09 ______ _______ _______ _____
04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____
1992 E.C.
13 PAG 01 ______ _______ _______ _____
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
05 TIRR 09 ______ _______ _______ _____
04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____