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REPUBLIC OF GHANA
GHANA DEMOGRAPHIC AND HEALTH SURVEYS - 1993
MAN?S QUESTIONNAIRE (ENGLISH)

IDENTIFICATION

PLACE NAME __________
NAME OF HOUSEHOLD HEAD___________
EA NUMBER _____________
STRUCTURE NUMBER ___________
HOUSEHOLD NUMBER ____________

REGION __________

URBAN/RURAL ______

URBAN 1
RURAL 2

NAME AND LINE NUMBER OF RESPONDENT (copy from household schedule) _____

NAME AND LINE NUMBER OF WIFE _____
NAME AND LINE NUMBER OF SECOND WIFE _____
NAME AND LINE NUMBER OF THIRD WIFE _____
ENTER '98', IF NOT MARRIED AND '99' IF PARTNER IS NOT A MEMBER OF HOUSEHOLD

FOR OFFICE USE

LARGE CITY/MEDIUM CITY/SMALL CITY/TOWN/VILLAGE _____

Large city 1,
Medium city 2
Small city 3
Town 4
Village 5

Large city 1,000,000 and over
Medium city 500,000-999,999
Small city 50,000-499,999
Town 5,000-49,999
Village less than 5,000

INTERVIEWER VISITS

INTERVIEW 1
DATE ___
INTERVIEWER'S NAME ___
RESULT* ___

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 2
DATE ___
INTERVIEWER'S NAME ___
RESULT* ___

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 3
DATE ___
INTERVIEWER'S NAME ___
RESULT* ___

FINAL VISIT
DAY ___
MONTH ___
YEAR ___
NAME ___
RESULT ___

TOTAL NUMBER OF VISITS ___

Result __
*RESULT CODES:

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

FIELD EDITED BY:
NAME ___
DATE ___

OFFICE EDITED BY:
NAME ___
DATE ___

KEYED BY:
NAME ___
DATE ___

KEYED BY: __

SECTION M1. RESPONDENT?S BACKGROUND

M101. RECORD THE TIME.

HOUR ___
MINUTES ___

M102. First I would like to ask some questions about your background. For most of the time until you were 12 years old, did you live in a city, in a town or in a village?

CITY 1
TOWN 2
VILLAGE 3

M103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN A YEAR, CODE "00"

YEARS ___
ALWAYS 95 (SKIP TO M105)
VISITOR 96 (SKIP TO M105)

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

CITY 1
TOWN 2
VILLAGE 3

M105. In what month and year were you born?

MONTH ___
DK MONTH 98
YEAR ___
DK YEAR 98

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

AGE IN COMPLETED YEARS ___

M107. Have you ever attended school?

YES 1
NO 2 (SKIP TO M111)

M108. What was the highest level of school you attended: primary, middle/jss, secondary, or higher?

PRIMARY 1
MIDDLE/JSS 2
SSS/COMM/VOC/TECH 3
POST SEC./NURSING/POLYTECH 4
HIGHER 5

M109. What was the highest (GRADE/FORM/YEAR) you completed at that level?

GRADE ___

M110. CHECK 108:

PRIMARY OR MIDDLE/JSS ___ (SKIP TO M111)
SECONDARY/SSS OR HIGHER ___ (SKIP TO M112)

M111. Can you read and understand a letter or newspapar easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (SKIP TO M113)

M112. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

M113. Do you usually listen to a radio at least once a week?

YES 1
NO 2

M114. Do you usually watch television at least once a week?

YES 1
NO 2

M115. What is your religious denomination?

CATHOLIC 01
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
PENTECOSTAL 05
SPIRITUALIST 06
OTHER CHRISTIAN 07
MOSLEM 08
TRADITIONAL 09
NO RELIGION 10
OTHER 96

M116. To which ethnic group do you belong?

ASANTE 01
AKWAPIN 02
FANTI 03
OTHER AKAN 04
GA-ADANGBE 05
EWE 06
GUAN 07
MOLE-DAGBANI 08
GRUSSI 09
GURMA 10
HAUSA 11
OTHER 96

M117. What kind of work do you mainly do?

_________________
_________________
_________________

M118. CHECK M117:

WORKS IN FARMING ___ (SKIP TO M119)
DOES NOT WORK IN FARMING ___ (SKIP TO M121)

M119. Do you work mainly on your own land or family land, or do you rent land, or do you work on someone else's land?

OWN/FAMILY LAND 1 (SKIP TO 121)
RENT LAND 2 (SKIP TO 121)
SOMEONE ELSE'S LAND 3

M120. Do you work mainly for money or do you work for a share of the crops?

MONEY 1
A SHARE OF CROPS 2

M121. CHECK Q.4 IN THE HOUSEHOLD SCHEDULE:

THE RESPONDENT IS NOT A USUAL RESIDENT OF THE HH __ (SKIP TO M122)
THE RESPONDENT IS A USUAL RESIDENT OF THE HH __ (SKIP TO M201)

M122. Now I would like to ask about the place where you usually live. Do you usually live in a city, town or village?

CITY 1
TOWN 2
VILLAGE 3

M123. In which region is that located?
IF USUAL RESIDENCE IS OUTSIDE GHANA, RECORD COUNTRY OF RESIDENCE:

(COUNTRY) ______
WESTERN 01
CENTRAL 02
GREATER ACCRA 03
VOLTA 04
EASTERN 05
ASHANTI 06
BRONG-AHAFO 07
NORTHERN 08
UPPER WEST 09
UPPER EAST 10
OUTSIDE GHANA 11

M124. Does the household in which you usually live have:
Electricity?

A functioning radio?
A functioning television?
A functioning refrigerator?
A functioning video?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
VIDEO
YES 1
NO 2

M125. How many rooms in your household are used for sleeping?

ROOMS ___

M126. Could you describe the main material of the floor of your home?

NATURAL FLOOR
EARTH/SAND/MUD 11
MUD MIXED WITH DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
LINOLEUM 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
TERRAZZO 36
OTHER (SPECIFY) ____ 96

M127. Does any member of your household own:

A bicycle?
A motorcycle?
A motor vehicle?
A tractor?
A cart/horse?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
MOTOR CYCLE
YES 1
NO 2
TRACTOR
YES 1
NO 2
CART/HORSE
YES 1
NO 2

SECTION 2. REPRODUCTION

Now I would like to ask about all the births you have fathered during your life time.

M201. Do you have any sons or daughters that you have fathered who are now living with you?

YES 1
NO 2 (SKIP TO M203)

M202. How many of your sons live with you?And how many of your daughters live with you?
IF NONE ENTER '00'.

SONS AT HOME ____
DAUGHTERS AT HOME ___

M203. Do you have any of your own sons or daughters tht are alive but are not living with you?

YES 1
NO 2 (SKIP TO M205)

M204. 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 ENTER '00'.

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

M205. Have you ever had a son or daugher born alive to you but who later died? IF NO PROBE: Any baby who cried or showed any sign of life but only survived a few hours or days?

YES 1
NO 2 (SKIP TO M207)

M206. In all, how many boys have died? And how many girls have died?
IF NONE ENTER '00'.

BOYS DEAD ___
GIRLS DEAD ___

M207. SUM ANSWERS TO M202, M204, AND M206, AND ENTER TOTAL. IF NONE ENTER '00'.

TOTAL ___

M208. CHECK M207:
Just to make sure that I have this right: you have had in TOTAL____ children born alive to you during your life. Is that correct?

YES __
NO __ (PROBE AND CORRECT M201-M207 AS NECESSARY)

M209. Between the first day of a woman's period and the first day of her next period, is there a certain time when she has a greater chance of becoming pregnant?

YES 1
NO 2 (SKIP TO M301)
DK 8 (SKIP TO M301)

M210. During which time between the first day of a woman's period and the first day of her next period does she have the greatest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) ____ 6
DK 8

SECTION M3. CONTRACEPTION

M301. Now I would like to talk about the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN M302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.

THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.

THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN M302, ASK M303 AND M304 BEFORE PROCEEDING TO THE NEXT METHOD.

M302. Have you ever used (METHOD)? READ DESCRIPTION OF EACH METHOD.

01) PILL Women can take a pill every day.
YES/SPONT 1
YES/PROBED 2
NO 3
02 IUD Women can have a loop or coil placed inside them by doctor or a nurse.
YES/SPONT 1
YES/PROBED 2
NO 3
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES/SPONT 1
YES/PROBED 2
NO 3
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3
05) CONDOM Men can use a rubber sheath during sexual intercourse. The rubber sheath is used to avoid pregnancy, to prevent transmission of diseases such as AIDS, or for cleanliness.
YES/SPONT 1
YES/PROBED 2
NO 3
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3
07) IMPLANT Women can have a NORPLANT implant inserted under the skin of their upper arm.
YES/SPONT 1
YES/PROBED 2
NO 3
08) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3
09) RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman ismore likely to become pregnant.
YES/SPONT 1
YES/PROBED 2
NO 3
10) WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONT 1
YES/PROBED 2
NO 3
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
1 (SPECIFY) ____
YES 1
NO 2
2 (SPECIFY) ____
YES 1
NO 2

M303. Have you (or your wife/partner) ever used (METHOD)?

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by doctor or a nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.

YES 1
NO 2
05) CONDOM Men can use a rubber sheath during sexual intercourse. The rubber sheath is used to avoid pregnancy, to prevent transmission of diseases such as AIDS, or for cleanliness.
YES 1
NO 2
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children. Has (any of) your partner(s) ever had an operation to avoid having any more children?
YES 1
NO 2
07) IMPLANT Women can have a NORPLANT implant inserted under the skin of their upper arm.

YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children. Have you had an operation to avoid having any more children?
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman ismore likely to become pregnant.
YES 1
NO 2
10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11) Any other ways or methods that women or men can use to avoid pregnancy
1 (SPECIFY) ___
YES 1
NO 2
2 (SPECIFY) ___
YES 1
NO 2

M304. Do you know where a person could go to get (METHOD)?

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by doctor or a nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES 1
NO 2
05) CONDOM Men can use a rubber sheath during sexual intercourse. The rubber sheath is used to avoid pregnancy, to prevent transmission of diseases such as AIDS, or for cleanliness.
YES 1
NO 2
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
07) IMPLANT Women can have a NORPLANT implant inserted under the skin of their upper arm.

YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman ismore likely to become pregnant. Do you know where a person can obtain advice on how to use periodic abstinence?
YES 1
NO 2

M305. CHECK M303:

NOT A SINGLE "YES" (NEVER USED) __ (SKIP TO M306)
AT LEAST ONE "YES" (EVER USED) __ (SKIP TO M308)

M306. Have you (or your wife/partner) ever used anything or tried in any way to delay or avoid having a child?

YES 1
NO 2 (GO TO M322)

M307. What have you used or done?
CORRECT M303-M305 (AND M302 IF NECESSARY).

(ENTER WHAT WAS DONE) ___________

M308. Now I would like to ask you about the time when you first did something or used a method to avoid getting your wife or partner pregnant?
How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

M309. CHECK M303:

MAN NOT STERILIZED __ (SKIP TO M310)
MAN STERILIZED __ (SKIP TO M311A)

M310. Are you (or your wife/partner) currently doing anything or using any method to delay or avoid having a child?

YES 1
NO 2 (SKIP TO M316)

M311. Which method are you using?
M311A. CIRCLE '08' FOR MALE STERILIZATION.

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERLIZATION 06
IMPLANT 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09 (SKIP TO M316)
WITHDRAWAL 10 (SKIP TO M316)
OTHER (SPECIFY) _____ 96 (SKIP TO M316)

M312. CHECK M311.

SHE/HE STERILIZED __ (Where did the sterilization take place?)

USING ANOTHER METHOD __ (Where did you (or your wife/partner) obtain (METHOD) last time?)

NAME OF PLACE _______
PUBLIC SECTOR
GOVT HOSPITAL/POLYCLINIC 11
GOVERNMENT HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14 (SKIP TO M315)
VILLAGE H. POST/FIELD WORKER 15 (SKIP TO M315)
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL 21
PHARMACY/CHEMIST/DRUG STORE 22
PRIVATE CLINIC/DOCTOR 23
MOBILE CLINIC 24 (SKIP TO M315)
VILLAGE H. POST/FIELD WORKER 25 (SKIP TO M315)
PPAG/FAMILY PLANNING CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33 (SKIP TO M315)
OTHER (SPECIFY) _____ 96 (SKIP TO M315)
DON'T KNOW 98 (SKIP TO M315)

M313. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD TIME IN MINUTES. OTHERWISE, RECORD TIME IN HOURS.

MINUTES 1 ___
HOURS 2 0__
DK 9998

M314. Is it convenient or inconvient to get there?

CONVENIENT 1
INCONVENIENT 2

M315. CHECK M310/M311:

NOT CURRENTLY USING CONDOM __ (SKIP TO M316)
USING CONDOM __ (SKIP TO M317)

M316. Have you used a condom in the last four weeks?

YES 1
NO 2 (SKIP TO M321)

M317. What is the brand name of the condom you last used?

BRAND ____
DK 98

M318. How did a single condom cost you the last time you bought one?

COST ___
PARTNER OBTAINED IT 995
FREE 995
DK 998

M319. Do you use more condoms now than a year ago, about the same number, or fewer?

MORE 1
SAME NUMBER 2 (SKIP TO M321)
FEWER 3 (SKIP TO M321)

M320. What is the main reason why you use more condoms now than a year ago?

FEAR OF GETTING AIDS 1
FEAR OF GETTING ANOTHER STD 2
FAMILY PLANNING 3
LESS EXPENSIVE NOW 4
MORE AVAILABLE NOW 5
OTHER (SPECIFY) _____ 6
DK 8

M321. CHECK M310:

NOT CURRENTLY USING A METHOD (SKIP TO M322)
USING A METHOD (SKIP TO M322)

M322. Do you intend to use a method to delay or avoid having a child at any time in the future?

YES 1 (SKIP TO M324)
NO 2
DK 8 (SKIP TO M332)

M323. What is the main reason why you do not intend to use a method?

WANT CHILDREN 01 (GO TO M332)
LACK OF KNOWLEDGE 02 (GO TO M332)
PARTNER OPPOSED 03 (GO TO M332)
COST TOO MUCH 04 (GO TO M332)
SIDE EFFECTS 05 (GO TO M332)
HEALTH CONCERNS 06 (GO TO M332)
HARD TO GET METHODS 07 (GO TO M332)
RELIGION 08 (GO TO M332)
OPPOSED TO FAMILY PLANNING 09 (GO TO M332)
FATALISTIC 10 (GO TO M332)
OTHER PEOPLE OPPOSED 11 (GO TO M332)
INFREQUENT SEX 12 (GO TO M332)
WIFE/PARTNER INFECUND 13 (GO TO M332)
INCONVENIENT 15 (GO TO M332)
NOT MARRIED/NO PARTNER 16 (GO TO M332)
OTHER (SPECIFY) 96 (GO TO M332)
DK 98 (GO TO M332)

M324. Do you intend to use a method within the next 12 months?

YES 1
NO 2
DK 8

M325. When you (and your wife/partner) use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
IMPLANT 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09 (SKIP TO M328)
WITHDRAWAL 10 (SKIP TO M328)
OTHER (SPECIFY) _____ 96 (SKIP TO M328)
UNSURE 98 (SKIP TO M328)

M326. Where can you get (METHOD MENTIONED IN M325)?

(NAME OF SOURCE) _______
PUBLIC SECTOR
GOVT HOSPITAL/POLYCLINIC 11 (SKIP TO M330)
GOVERNMENT HEALTH CENTRE 12 (SKIP TO M330)
FAMILY PLANNING CLINIC 13 (SKIP TO M330)
MOBILE CLINIC 14 (SKIP TO M332)
VILLAGE H. POST/FIELD WORKER 15 (SKIP TO M332)
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL 21 (SKIP TO M330)
PHARMACY/CHEMIST/DRUG STORE 22 (SKIP TO M330)
PRIVATE CLINIC/DOCTOR 23 (SKIP TO M330)
MOBILE CLINIC 24 (SKIP TO M332)
VILLAGE H. POST/FIELD WORKER 25 (SKIP TO M332)
PPAG/FAMILY PLANNING CLINIC 26 (SKIP TO M330)
MATERNITY HOME 27 (SKIP TO M330)
OTHER PRIVATE SECTOR
SHOP 31 (SKIP TO M330)
CHURCH 32 (SKIP TO M330)
FRIENDS/RELATIVES 33 (SKIP TO M332)
OTHER (SPECIFY) _____ 96 (SKIP TO M332)
DON'T KNOW 98 (SKIP TO M328)

M327. CHECK M325:

IINTENDS TO USE PERIODIC ABSTINENCE, WITHDREAWAL OR OTHER TRADITIONAL METHOD __ (SKIP TO M328)
INTENDS TO USE A MODERN METHOD __ (SKIP TO M332)

M328. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (SKIP TO M332)

M329. Where is that?
IF MORE THAN ONE ASK FOR THE NEAREST

(NAME OF SOURCE) ________
PUBLIC SECTOR
GOVT HOSPITAL/POLYCLINIC 11
GOVERNMENT HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14 (SKIP TO M332)
VILLAGE H. POST/FIELD WORKER 15 (SKIP TO M332)
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL 21
PHARMACY/CHEMIST/DRUG STORE 22
PRIVATE CLINIC/DOCTOR 23
MOBILE CLINIC 24 (SKIP TO M332)
VILLAGE H. POST/FIELD WORKER 25 (SKIP TO M332)
PPAG/FAMILY PLANNING CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33 (SKIP TO M332)
OTHER (SPECIFY) _____ 96 (SKIP TO M332)
DON'T KNOW 98 (SKIP TO M332)

M330. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS RECORD TIME IN MINUTES.
OTHERWISE, RECORD TIME IN HOURS.

MINUTES 1 ___
HOURS 2 0__
DK 9998

M331. Is it convenient or inconvenient to get there?

CONVENIENT 1
INCONVENIENT 2

M332. In the last month, have you heard or seen a message about family planning:

on the radio?
on television?
in a newspaper?
on poster/billboard?
from community health nurse?
from family planning worker?
from friends/relatives?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER
YES 1
NO 2
POSTER/BILLBOARD
YES 1
NO 2
COMMUNITY HEALTH NURSE
YES 1
NO 2
FAMILY PLANNING WORKER
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

M333. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8

M334. CHECK M302:

KNOWS CONDOM __ (SKIP TO M335)
DOES NOT KNOW CONDOM __ (SKIP TO M401)

M335. Do you agree or disagree with the following statements:
READ AND OBTAIN A RESPONSE FOR EACH STATEMENT.

Condoms are used primarily with casual partners.
AGREE 1
DISAGREE 2
UNDECIDED 3
Condoms reduce risk of sexually transmitted diseases.
AGREE 1
DISAGREE 2
UNDECIDED 3
Most women don't like men to use condoms.
AGREE 1
DISAGREE 2
UNDECIDED 3
Using condoms shows responsibility.
AGREE 1
DISAGREE 2
UNDECIDED 3
Condoms are used primarily for family planning purposes.
AGREE 1
DISAGREE 2
UNDECIDED 3
Condoms are embarrassing to obtain.
AGREE 1
DISAGREE 2
UNDECIDED 3
A condom can be used more than once.
AGREE 1
DISAGREE 2
UNDECIDED 3
Condoms make sex less enjoyable.
AGREE 1
DISAGREE 2
UNDECIDED 3

SECTION M4. MARRIAGE

M401. Have you ever been married or lived with a woman?

YES 1
NO 2 (SKIP TO M405)

M402. Are you now married or living with a partner, or are you now widowed, or divorced or separated?

MARRIED 1
CONSENSUAL UNION 2
WIDOWED 3 (SKIP TO M404)
DIVORCED 4 (SKIP TO M404)
SEPARATED 5 (SKIP TO M404)

M403. How many wives/partners do you currently have?

NUMBER ___

M404. How old were you when you started living with your (first) wife or partner?

AGE ___ (SKIP TO M406)

M405. IF NEVER MARRIED OR LIVED WITH A WOMAN:
Have you ever had sexual intercourse?

YES 1
NO 2 (SKIP TO M413)

M406. Now I would like to talk to you about some aspects of your sexual life in order to get a better understanding of family planning and fertility.

How many times did you have sexual intercourse in the last four weeks?

TIMES ___

M407. How many times in a month do you usually have sexual intercourse?

TIMES ___

M408. CHECK M406:

HAD SEXUAL INTERCOURSE ONE OR MORE TIMES IN LAST FOUR WEEKS ___ (SKIP TO M409)
ZERO TIMES ___ (SKIP TO M411)

M409. With how many different women have you had sex in the last four weeks?

NUMBER OF WOMEN ___

M410. Did you use a condom with any of these women?

YES 1
NO 2

M411. When was the last time you had sexual intercourse?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __

M412. How old were you when you first had sexual intercourse?

AGE __
FIRST TIME WHEN MARRIED 96

M413. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
WIFE
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2
OTHER MALES
YES 1
NO 2

SECTION M5. AIDS KNOWLEDGE AND OTHER SEXUALLY TRANSMITTED DISEASES

M501. Now I have a few questions about a very important topic.
Have you heard of an illness called AIDS?

YES 1
NO 2 (SKIP TO M509)

M502. From which sources of information or persons have you heard about AIDS in the last month? CIRCLE ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS C
HEALTH WORKERS D
MOSQUES/CHURCHES E
FRIENDS/RELATIVES F
SCHOOLS G
SLOGANS/MUSIC H
PAMPHLETS/POSTERS I
COMMUNITY MEETINGS J
OTHER (SPECIFY) ____ K
NONE L

M503. How is AIDS transmitted?
CIRCLE ALL MENTIONED.

NEEDLES/BLADES/SKIN WOUND A
MOTHER TO CHILD B
SEXUAL INTERCOURSE C
TRANSFUSION OF INFECTED BLOOD D
OTHER (SPECIFY) ____ E
DON'T KNOW F

M504. Do you think that you can get AIDS from:

shaking hands with someone who has AIDS?
hugging someone who has AIDS?
kissing someone who has AIDS?
sexual intercourse with someone who has AIDS?
wearing the clothes of someone who has AIDS?
sharing eating utensils with someone who has AIDS?
stepping on the urine or stool of someone who has AIDS?
mosquito, flea or bedbug bites?
not using condom?

HANDSHAKING
YES 1
NO 2
HUGGING
YES 1
NO 2
KISSING
YES 1
NO 2
SEXUAL INTERCOURSE
YES 1
NO 2
SHARING CLOTHES
YES 1
NO 2
SHARING EATING UTENSILS
YES 1
NO 2
STEPPING ON URINE/STOOL
YES 1
NO 2
MOSQUITO/FLEA/BEDBUG BITES
YES 1
NO 2
NOT USING A CONDOM
YES 1
NO 2

M505. Is it possible for a healthy looking person to have the AIDS virus?

YES 1
NO 2
DK 8

M506. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?

YES 1
NO 2
DK 8

M507. What do you suggest is the most important thing the government should do for people who have AIDS?

PROVIDE FREE MEDICAL TREATMENT 1
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE 3
GOVT. SHOULD NOT BE INVOLVED 4
OTHER (SPECIFY) ____ 6

M508. If your relative is suffering from AIDS, who would you prefer to care for him/her?

RELATIVES 1
FRIENDS 2
GOVERNMENT ORGANISATION 3
RELIGIOUS ORG./MISSION 4
NOBODY/ABANDON 5
OTHER (SPECIFY) ____ 6

Now I would like to talk to you about other diseases apart from AIDS.

509. Have you heard of other diseases apart from AIDS which could be transmitted through sexual intercourse?

YES 1
NO 2 (SKIP TO 601)

510. Name the diseases.
Any other?
CIRCLE AS MANY MENTIONED.

GONORRHEA A
SYPHILIS B
HERPES C
HEPATITIS D
OTHER (SPECIFY) ____ E

511. CHECK 510 FOR DISEASES MENTIONED AND ASK Q 512 ? Q 516 WHERE APPROPRIATE.

512. Where can on go to treat gonorrhea?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

513. Where can one go to treat syphilis?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

514. Where can one go to treat herpes?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

515. Where can one go to treat hepatitis?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

516. Where can one go to treat .....)
(NAME OF DISEASE RECORDED ON THE "OTHER SPECIFY" LINE OF Q 510).
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

SECTION M6. FERTILITY PREFERENCES

M601. CHECK M311:

SHE/HE NOT STERILIZED __ (SKIP TO M602)
HE OR SHE STERILIZED __ (SKIP TO M605)

M602. CHECK M401 AND M402:

CURRENTLY MARRIED OR LIVING TOGETHER __ (SKIP TO M603)
NOT MARRIED/NOT LIVING TOGETHER __ (SKIP TO M609)

M603. 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?

HAVE A(ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO M608)
WIFE CAN'T GET PREGNANT 3 (SKIP TO M608)
UNDECIDED OR DK 8 (SKIP TO M608)

M604. How long would you like to wait from now before the birth of a (another) child?
(RECORD IN MONTHS IF LESS THAN 2 YEARS)

MONTHS 1 __ (SKIP TO M608)
YEARS 2 __ (SKIP M608)
NOW 995 (SKIP TO M608)
OTHER (SPECIFY) ____ 996 (SKIP TO M608)
DK 998 (SKIP TO M608)

M605. Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have an operation not to have any more children?

YES 1
NO 2

M606. Do you regret that you (your wife) had the operation in order not to have any (more) children?

YES 1
NO 2 (SKIP TO M609)

M607. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (SKIP TO M609)
PARTNER WANTS ANOTHER CHILD 2 (SKIP TO M609)
COUPLE WANT ANOTHER CHILD 3 (SKIP TO M609)
SIDE EFFECTS 4 (SKIP TO M609)
OTHER REASON 5 (SKIP TO M609)

M608. Do you think that your wife/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DK 8

M609. How long should a couple wait before starting sexual intercourse after the birth of a baby?
(RECORD IN MONTHS IF LESS THAN 2 YEARS)

MONTHS 1 __
YEARS 2 __
OTHER (SPECIFY) ___ 996

M610. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again or doesn't it matter?

WAIT 1
DOESN'T MATTER 2

M611. In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2 (SKIP TO M612)

M611B. Who do you think should decide on which method to use?

SELF 01
SPOUSE 02
BOTH OF US 03
HEALTH PROFESSIONAL 04
RELATIVE 05
FRIEND 06
OTHER (SPECIFY) ____ 96

M612. CHECK M202 AND M204:

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?)

RECORD ONLY ONE NUMBER OR OTHER ANSWER. IF "NONE" CIRCLE 96 AND RECORD RESPONSE.

NUMBER ___
OTHER ANSWER (SPECIFY) ____ 96 (SKIP TO M614)

M613. How many of those children would be sons?
And how many would be daughters?

NUMBER BOYS ___
NUMBER GIRLS ___
NUMBER EITHER ___
UP TO GOD 999995
OTHER ANSWER ____ 999996


M614. What do you think is the best number of months or years between the birth of one child and the birth of the next child?

RECORD MONTHS IF LESS THAN 2 YEARS.

MONTHS 1 __
YEARS 2 __
OTHER (SPECIFY) ____ 996
DON'T KNOW 998

M615. RECORD THE TIME.

HOURS ___
MINUTES ___

SECTION M7. LANGUAGE INFORMATION

M701. WHAT IS THE RESPONDENT'S OWN LANGUAGE?

TWI 01
FANTI 02
GA-ADANGBE 03
EWE 04
NZEMA 05
DAGBANI 06
HAUSA 07
ENGLISH 08
OTHER (SPECIFY) ____ 96

M702. IN WHAT LANGUAGE DID YOU CONDUCT THE INTERVIEW?

TWI 01
FANTI 02
GA-ADANGBE 03
EWE 04
NZEMA 05
DAGBANI 06
HAUSA 07
ENGLISH 08
OTHER (SPECIFY) ____ 96

M703. FOR HOW MUCH OF THE INTERVIEW DID YOU DEPEND ON A THIRD PERSON TO INTERPRET FOR YOU?

NONE OF THE INTERVIEW 1 (END)
SOME OF THE INTERVIEW 2
MOST OF THE INTERVIEW 3
ALL OF THE INTERVIEW 4

M704. IF AN INTERPRETER WAS USED, INDICATE THE SEX AND APPROXIMATE AGE OF INTERPRETER.

ADULT FEMALE 1
TEENAGE FEMALE 2
ADULT MALE 3
TEENAGE MALE 4
CHILD 5

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 Supervisor:________
Date: _____

EDITOR'S OBSERVATIONS
________________________________
________________________________
________________________________

Name of Field Editor:_______
Date: ______