GENERAL MANAGEMENT OF STATISTICS AND ECONOMIC STUDY

IDENTIFICATION

NAME OF LOCATION____

NAME OF HEAD OF HOUSEHOLD_____

EDSG CODE______

STRUCTURE NUMBER______

HOUSEHOLD NUMBER IN STRUCTURE_____

EDSG REGION______

PROVINCE___________

DEPARTMENT______

URBAN-RURAL MILIEU

RESIDENCE:

WOMAN'S NAME AND LINE NUMBER (FROM HOUSEHOLD QUESTIONNAIRE)____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME____
RESULT

RESULT CODES

FINAL VISIT
DAY_____
MONTH_____
YEAR 2000
NAME_____
RESULT_____

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE____
TIME____

TOTAL NO. OF VISITS_____

SUPERVISOR
NAME_____
DATE____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____

KEYED BY______

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Libreville, Port Gentil, in another city, in a rural location, or abroad?

103) How long have you been living continuously in (Name of current place of residence)?
If less than one year, record '00' years.

104) Just before you moved here, did you live in Libreville, Port Gentil, in another city, in a rural location, or abroad?

105) In what month and year were you born?

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 if INCONSISTENT.
IF RESPONDENT IS UNDER 15 OR OVER 49 YEARS OLD, STOP THE INTERVIEW AND MAKE THE APPROPRIATE CORRECTIONS TO THE HOUSEHOLD QUESTIONNAIRE.

107) Have you ever attended school?

107A) Did you go to a reading center?

108) What is the highest level of school you attended: primary, secondary, or higher?

109) What is the highest (grade/form/year) you completed at this level?

110) CHECK 106:

111) Are you currently attending school?

112) What is the main reason for which you stopped attending school?

113) CHECK 108:

114) Now I would like you to read this sentence out loud to me; read as much as you can.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

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

116) Do you usually listen to the radio?

116A) Do you listen to the radio every day or almost every day?

116B) What days of the week do you normally listen to the radio?
RECORD ALL RESPONSES GIVEN. IF THE RESPONSE IS "IT DEPENDS," "IT DOESN'T MATTER," OR "DON'T KNOW", YOU ONLY NEED TO RECORD ONE CODE.

116C) What time do you normally listen to the radio?
RECORD ALL RESPONSES GIVEN. IF THE RESPONSE IS "ALL DAY", "IT DEPENDS," "IT DOESN'T MATTER," or "DON'T KNOW", YOU ONLY NEED TO RECORD ONE CODE.

117) Do you watch television every day, at least once a week, less than once a week, or not at all?

118) What is your religion?

119) What is your nationality?

119A) Are you originally from Gabon?

120) What is your ethnicity?

SECTION 2: REPRODUCTION

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

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

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

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

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'

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

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

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

209) CHECK 208:
Just to Make sure that I have this right: you have had in total ______births during your life. Is that correct?

210) CHECK 208

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

213) Were any of these births twins?

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

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

216) Is (NAME) still alive?

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

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

219) 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.

220) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?

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

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 1995 OR LATER.
IF NONE, RECORD '0'

226) Are you pregnant now?

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED 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?

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

230) When did the last such pregnancy end?

231) CHECK 230:

232) How many months pregnant were you when the last such pregnancy ended?

233) Was this pregnancy terminated due to an elective abortion?

234) Did you yourself decide to have this abortion, or were you pushed or forced by someone else to have this abortion?

235) Who pushed or forced you to have this abortion?

236) What is the main reason you decided to end this pregnancy?

237) Can you tell me what means or procedures were used to terminate this pregnancy?

238) Where did the abortion take place?

239) CHECK 238:

CODES 11 TO 22 OR 42 CIRCLED: Who helped you at the time of the abortion?
PROBE: Anyone else?

CODES 41, 46, OR 96 CIRCLED: Was anyone present to help you during the abortion?
IF YES: Who helped you at the time of the abortion?
PROBE: Anyone else?

PROBE TO DETERMINE THE TYPE OF PERSON.
RECORD ALL PERSONS LISTED

240) How much did the abortion cost in total?
IF THE ABORTION DIDN'T COST ANYTHING, RECORD 000000

241) After the abortion, did you have a consultation?

242) Who consulted with you?
PROBE: Anyone else?
PROBE TO OBTAIN THE TYPE OF PERSON.
RECORD ALL PERSONS LISTED

243) After the abortion, did you have any complications, like, for example, bleeding or an infection?

244) Have you had any other pregnancies that did not result in a live birth?

245) All together, how many pregnancies have you had that were not terminated by an elective abortion?
IF NONE, RECORD 00

246) Check 229, 233, 244, and 245:

247) How old were you when you had your (first) pregnancy that was terminated by an elective abortion?

248) If you had another unwanted pregnancy, would you be prepared to have another abortion?

249) In addition to the pregnancy/ies that ended through an elective abortion, did you have other failed abortion attempts?
IF YES: In addition to the pregnancy/ies that ended through an elective abortion, how many other abortions have you attempted?

250) In your life, have you had any failed abortions?
IF YES: In total, how many of these attempted abortions have you had?

251) When did you last menstrual period start?

252) How old were you when you had your first period?

AGE IN YEARS_____
DON'T KNOW 98

253) 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?

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

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CONTINUE DOWN COLUMN 301A, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301A, ASK 302.

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

302) Have you ever used (method)?

303) CHECK 302:

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

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

306) 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'

307) When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?

308) Check 302:

309) CHECK 226:

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

311) CHECK 302 (01)

WOMAN NOT STERILIZED: Which method are you using?

WOMAN STERILIZED: CIRCLE 01 FOR FEMALE STERILIZATION

312) CHECK 311:

WOMAN OR MAN STERILIZED: In what month and year was the sterilization performed?

OTHER METHODS: Since what month and year have you been using (method from q 311) without stopping?

312A) CHECK 311:

312B) When you started using the pill for the first time, did you see a doctor, a midwife, or a nurse?

312C) When you obtained the pill for the first time, did you see a doctor, a midwife, or a nurse?

312D) CHECK 311:

CIRCLE METHOD CODE

314) CHECK 313:

WOMAN OR MAN STERILIZED: Where did the sterilization take place?

OTHER METHODS: Where did you obtain (METHOD FROM Q. 313) last time?

315) Do you know a place where you can get a method of family planning?

316) Where is this? Another place?
RECORD ALL MENTIONED

318) In the last 12 months, have you visited a health facility for any reason?

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

320) Do you think that breastfeeding can affect a woman's chances of becoming pregnant?

321) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

322) CHECK 208:

323) Have you ever relied on breastfeeding as a method of avoiding pregnancy?

324) CHECK 226 AND 311

325) Are you currently relying on breastfeeding to avoid getting pregnant?

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

402) ENTER IN THE TABLE THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE 1995. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRE).

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 Q. 212

404) FROM 212 AND 216:

405) At the time you became pregnant with (name), did you want to get pregnant then, did you want to wait until later, or did you want no (more) children at all?

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

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

407A) Did you receive a maternity card for this pregnancy?
IF YES: May I see it?

408) How many months pregnant were you when you first received antenatal care?

409) How many times did you receive antenatal care during this pregnancy?

410) CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

411) How many months pregnant were you the last time you received antenatal care?

412) During this pregnancy, were any of the following done at least once?

413) Were you told about the signs of pregnancy complications?

414) Were you told where to go if you had any of these complications?

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

415A) During this pregnancy, how many times did you get this injection?

416) During this pregnancy, were you given or did you buy any drugs that add iron to your blood?

417) During the whole pregnancy, for how many days did you take this drug?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

418) During this pregnancy, did you have difficulty with your vision during the daylight?

419) During this pregnancy, did you suffer form night blindness?

420) During this pregnancy, did you take any drugs in order to keep you from getting malaria?

421) What drugs did you take?
RECORD ALL MENTIONED.

422) When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?

423) Was (Name) weighed at birth?

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

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

426) Where did you give birth to (NAME)?
IF IT WAS A MATERNITY, PROBE TO DETERMINE IF IT WAS A HOSPITAL MATERNITY OR A HEALTH CENTER AND CIRCLE THE APPROPRIATE CODE.

426A) Were you satisfied with the services you received from (NAME OF ESTABLISHMENT FROM Q. 426) during (NAME)'s delivery?

426B) What were the main reasons for which you were unsatisfied?

426C) CHECK 426:
LOCATION OF DELIVERY?

426D) What is the main reason for which you did not delivery (name) in a sanitary structure?

426E) Was (NAME) carried to term or born premature?

426f) CHECK 426: LOCATION OF DELIVERY?

427) Was (NAME) delivered by cesarean section?

427A) Does (NAME) have a birth certificate?

428) After (NAME) was born, did you have a visit to be examined?

429) How many days or weeks after delivery did the first check take place?
RECORD 00 DAYS IF SAME DAY

430) Who check on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

431) Where did this first check take place?
IF IT WAS A MATERNITY, PROBE TO DETERMINE IF IT WAS A HOSPITAL MATERNITY OR A HEALTH CENTER AND CIRCLE THE APPROPRIATE CODE.

433) Has your period returned since the birth of (name)?

434) Did your period return between the birth of (name) and your next pregnancy?

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

436) CHECK 226:
IS RESPONDENT PREGNANT?

437) Have you resumed sexual intercourse since the birth of (name)?

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

439) Did you ever breastfeed (NAME)?

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

440A) In the first 24 hours, before breastfeeding (name), did you give him/her something else to drink?
IF YES: What did you give him/her to drink?

440B) Did you give (NAME) the first yellow milk?

440C) Why didn't you give (NAME) the first yellow milk?

441) CHECK 404:
IS CHILD LIVING?

442) Are you still breastfeeding (NAME)?

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

444) CHECK 404:
IS CHILD LIVING?

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

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

447) Did (Name) drink anything form a bottle with a nipple yesterday or last night?

449) Now I would like to ask you about the liquids (NAME) was given yesterday during the day or at night.
Did (NAME) receive any of the following yesterday during the day or night?

449A) Now I would like to ask about the food (NAME) was given yesterday during the day or at night. Did (NAME) receive any of the following yesterday during the day or night?

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

SECTION 4B. IMMUNIZATION AND HEALTH

451) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMNS OF ADDITIONAL QUESTIONNAIRES).

452) LINE NO. FROM Q 212

453) FROM Q 212 And Q 216

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

456) Have you ever had a vaccination care for (name)?

457) 1) COPY VACCINATION DATES 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

458) Has (name) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DTC 1-3, TETRACOQ/PENTACOQ 1-3, MEASLES, AND/OR YELLOW FEVER.

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

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

460A) A BCG vaccination against tuberculosis, that is, an injection given at birth in the upper arm that usually causes a scar?

460b) Polio vaccine, that is, drops in the mouth?

460c) When was the first polio vaccine received, just after birth or later?

460d) How many times was the polio vaccine received?

460e) A DTC vaccination, that is, an injection given in the shoulder or thigh usually at the same time as polio drops?

460f) How many times?

460g) The Tetracoq or Pentacoq vaccine, meaning an injection purchased at the pharmacy which protects the child against several illnesses at once?

460h) How many times?

460i) An injection to prevent measles, called Rouvax or sometimes ROR, done in the shoulder or the thigh, usually done at 9 months?

460j) An injection to prevent yellow fever, usually don't at the International Vaccination Center of Nkembo?

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

463a) Does (NAME) have a fever now?

463b) Did you seek advice or treatment for the fever?

463c) Where did you seek advice or treatment? Anywhere else?
RECORD ALL SOURCES MENTIONED

463d) Was anything given to (NAME) to treat the fever?

463e) What was given to treat the fever? Anything else?
RECORD ALL MENTIONED

463f) Does (NAME) usually sleep under a mosquito net?

463g) Did (NAME) sleep under a mosquito net last night?

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

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

467) Did you seek advice or treatment for the cough?

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

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

472a) Was there blood in the stools?

473) 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?

474) 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?

475) Was he/she given any of the following to drink?

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

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

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

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

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

481) CHECK 475A IN ALL COLUMNS:

482) Have you ever heard of a special product called SRO you can get for the treatment of diarrhea?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

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

504) What is your current marital status: are you a widow, divorced, or separated?

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

506) RECORD THE LINE NUMBER OF HER HUSBAND/PARTNER ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.

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

506b) How many other wives does your husband have?

506c) Are you the first, second?wife?

507) Have you been married or have you lived with a man only once or more than once?

508) CHECK 507:

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

MARRIED/LIVED WITH MAN MORE THAN ONCE --I would like to talk about the first time you were married or started living with a man. In what month and year were you married or did you start living with him?

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

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

514a) Was the man with whom you first had sexual intercourse younger than you, older than you, much older than you, or was he about the same age?

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

516) The last time you had sexual intercourse, was a condom used?

516a) What is the main reason you used the condom this time?

517) What is your relationship to the man with whom you last had sex?
IF FIANCÉ, FRIEND, PARTNER, ASK: Was your fiancé/friend/partner living with you when you last had sex?
IF YES, CIRCLE 1. IF NO, CIRCLE 2

518) For how long have/did you had/have sexual relations with this man?

519) Have you had sex with anyone else in the last 12 months?

520) The last time you had sexual intercourse with another man, was a condom used?

520A) What is the main reason you used the condom this time?

521) What is your relationship to this man?
IF FIANCÉ, FRIEND, PARTNER, ASK: Was your fiancé/friend/partner living with you when you last had sex?
IF YES, CIRCLE 1
IF NO, CIRCLE 2

522) For how long have/did you had/have sexual relations with this man?

522a) Apart from these two men, have you had sexual intercourse with any other person in the last 12 months?

522b) The last time you had sexual intercourse with this other man, was a condom used?

522c) What is the main reason you used the condom this time?

522d) What is your relationship to the man?
IF FIANCÉ, FRIEND, PARTNER, ASK: Was your fiancé/friend/partner living with you when you last had sex?
IF YES, CIRCLE 1
IF NO, CIRCLE 2

522e) For how long have/did you had/have sexual relations with this man?

523) In total, with how many different men have you had sex in the last 12 months?

523a) Have you ever received money, gifts, or favors in exchange for sexual relations?

523b) The last time you received money, gifts, or favors in exchange for sexual relations, was a condom used?

524) Do you know of a place where a person can get condoms?

525) Where is that?
PROBE: Any other place?
RECORD ALL MENTIONED.

526) CHECK 524:

KNOWS A SOURCE: If you wanted to, could you get yourself a condom?

DOESN'T KNOW A SOURCE: If you wanted to and if you knew where to go, could you get yourself a condom?

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311:

602) CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some question 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?

603) CHECK 224:

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

604) CHECK 226:

605) CHECK 310: USING A CONTRACEPTIVE METHOD?

606) CHECK 603:

607) CHECK 602:

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?

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?

RECORD ALL REASONS MENTIONED.

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

609) CHECK 310: USING A CONTRACEPTIVE METHOD?

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

611) Which method would you prefer to use?

612) What is the main reason that you think you will never use a contraceptive method at any time in the future?

613) Would you ever use a contraceptive method if you were married?

614) CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

615) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter?

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

617) In the last few months have you heard about family planning:

617a) Do you think it's acceptable or unacceptable to discuss family planning:

618) CHECK 501:

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

620) How often have you talked to your husband/partner about family planning in the last twelve months?

621) CHECK 311:

622) 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?

623) Who do you think should make the decision to use contraception within a couple: the man or the woman?

624) Who do you think usually makes the decision to use contraception within a couple: the man or the woman?

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701) CHECK 501 AND 502:

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

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

704) What was the highest level of school he attended: primary, secondary or higher?

705) What was the highest (grade/form/year) he completed at that level?*

706) CHECK 701:

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

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

DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE

706A) BASED ON THE ANSWER TO Q. 706, DETERMINE THE SOCIO-PROFESSIONAL CATEGORY AND CIRCLE THE APPROPRIATE CODE.

707) Aside from your own housework, are you currently working?

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

709) Have you done any work in the last 12 months?

710) What is your occupation, that is, what kind of work do you mainly do?

DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE

(RECORD THE PROFESSION AND THE ESTABLISHMENT WHERE THE PERSON WORKS)________________

710A) BASED ON THE ANSWER TO Q. 710, DETERMINE THE SOCIO-PROFESSIONAL CATEGORY AND CIRCLE THE APPROPRIATE CODE.

711) CHECK 712:

712) 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?
IF FISHER, CIRCLE CODE 6

713) Do you do this work for a member of your family, for someone else, or are you self-employed?

714) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

715) Are you paid or do you ear in cash or in kind for this work or are you not paid at all?

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

717) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

718) CHECK 217 AND 218:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

719) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

720) Are you looking for a job?

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801) How I would like to talk about something else. Have you ever heard of an illness called AIDS?

801A) From which sources of information have you learned about AIDS?
Any other sources?
RECORD ALL MENTIONED

810B) If you wanted more information on AIDS, where (from whom) would you like to get this information?
IF MORE THAN ONE SOURCE LISTED, AS WHICH IS THE PREFERRED SOURCE AND CIRCLE THE APPROPRIATE CODE.

802) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

803) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.

803A) CHECK 803:

803b) What does 'safe sex' mean to you?
CIRCLE ALL MENTIONED

804) Can people reduce their chance of getting the AIDS virus by having just one sex partner who has no other sex partners?

805) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

806) Can people reduce their chance of getting the AIDS virus by completely abstaining from sex?

807) Can people get the AIDS virus from mosquito bites?

808) Can people get the AIDS virus by sharing food with a person who has AIDS?

809) Is it possible for a healthy-looking person to have the AIDS virus?

809A) Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

809b) Can AIDS be cured?

811) Do you know someone personally who has AIDS or someone who died of AIDS?

811a) Can people get the AIDS virus because of witchcraft or other supernatural means?

812) Can the virus that causes AIDS be transmitted from a mother to a child?

813a) Can the virus that causes AIDS be transmitted from a mother to a child:

813b) Since you have heard of AIDS, have you changed your behavior to avoid getting AIDS?

813c) What have you done? Anything else?
RECORD ALL MENTIONED.

813d) Why have you done nothing to protect yourself against the virus that causes AIDS/
RECORD ALL MENTIONED

814) CHECK 501:

815) Have you ever talked about ways to prevent getting the virus that causes AIDS with your husband/partner?

816) Do you think it's acceptable or unacceptable to talk about AIDS:

816a) If a person learns that he/she is infected with the virus that causes AIDS, should this person be allowed to keep that a secret or should he/she communicate this information to the community?

817) 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?

817a) Should people with the AIDS virus who work with other people in shops, offices, or on farms be allowed to keep their jobs or not?

817b) Should children under age 15 be taught about using a condom to avoid getting AIDS?

817c) Have you ever been tested to see if you have the AIDS virus?

817d) Would you like to have a test for the AIDS virus?

817e) Do you know a place where you can go to get tested for the AIDS virus?

817f) CHECK 817C:

ALREADY HAD AIDS TEST: Where did you go for this test?

NOT YET TESTED FOR AIDS: Where can you go for this test?

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

819) If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

820) If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

820A) CHECK 514:

820b) During the last 12 months, have you had a disease which you got through sexual contact?

820c) CHECK 514:

820d) Now I would like to ask you some questions about your health in the last 12 months. Sometimes women experience vaginal discharge. During the last 12 months, have you had any vaginal discharge?

820e) When you had vaginal discharge:

820f) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

820g) CHECK 820b:

820h) CHECK 820d AND 820e:

820i) CHECK 820F:

820j) The last time you had (infection from 820b, 820c, 820d), did you seek any kind of advice or treatment?

820k) The last time you had (infection from 820b, 820c, 820d), did you do any of the follow? Did you?

820l) When you had (infection from 820b, 820c, 820d), did you inform the people were you having sexual intercourse with?

820m) Did the person/people with whom you were having sexual relations seek advice or treatment from a health worker or in a sanitary structure?

820n) When you had (infection from 820b, 820c, 820d), did you do something to avoid infecting your sexual partner(s)?

820o) What did you do to prevent infection in your partner(s)? Did you?

820p) We may have already discussed this. Have you ever used a condom during sexual relations to avoid getting AIDS or transmitting illnesses, like AIDS?

820q) Do you use a condom from time to time, often, or with each sexual encounter?

SECTION 9. MATERNAL MORTALITY

901) 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?

902) CHECK 901:

903) How many of these births did your mother have before you were born?

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

905) Is (NAME) male or female?

906) Is (NAME) still alive?

907) How old is (NAME)?

908) What year did he/she die in?

909) How old was (NAME) when he/she died?
IF MALE OR DIED BEFORE 12 YEARS OF AGE TO GO NEXT SIBLING.

910) Was (NAME) pregnant when she died?

911) Did (NAME) die during childbirth?

912) Did (Name) die within two months after the end of a pregnancy or childbirth?

913) How many living children did (name) give birth to in her life?

IF NO MORE BROTHERS AND SISTERS, GO TO 914

914) RECORD THE TIME

SECTION 10. HEIGHT AND WEIGHT

1001) IN Q 1003 (COLUMN 1), RECORD THE NAME OF THE RESPONDENT.

IN Q. 1002, 1003, AND 1004 (COLUMNS 2 AND 3), RECORD LINE NUMBER, NAME AND BIRTH DATE FOR THE CHILDREN BORN SINCE JANUARY 1995. ALSO ASK THE CHILDREN'S DATE OF BIRTH.

IN Q. 1006 AND 1008, RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1995, USE THE LAST COLUMN OF AN ADDITIONAL QUESTIONNAIRE.)

1002) LINE NO. FROM Q. 212

1003) NAME (FROM Q. 212 FOR CHILDREN)

1004) DATE OF BIRTH
FROM Q. 215, AND ASK FOR DAY OF BIRTH

1005) BCG SCAR ON INSIDE OF TOP OF LEFT SHOULDER

1006) HEIGHT (IN CENTIMETERS)

1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

1008) WEIGHT (IN KILOGRAMS)

1009) DATE WEIGHED AND MEASURED

1010) RESULT

1011) NAME OF MEASURER
NAME OF ASSISTANT

INTERVIEWER'S OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT

COMMENTS ON SPECIFIC QUESTIONS

ANY OTHER COMMENTS

SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR DATE

EDITOR'S OBSERVATIONS
NAME OF EDITOR DATE