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GHANA DEMOGRAPHIC AND HEALTH SURVEY 1998
MEN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME______________
REGION ____________
EA NUMBER ____________
STRUCTURE NUMBER _____________
HOUSEHOLD NUMBER _______________

TYPE ______

Men's Questionnaire 1
Women's Questionnaire 2

NAME AND LINE NUMBER OF RESPONDENT______________

(For Office Use)

CITY/TOWN/VILLAGE _____

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

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 19___
NAME _____
RESULT ____

TOTAL NO. OF VISITS ___

RESULT ___
*RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE** ___

NATIVE LANGUAGE OF RESPONDENT** ___

LANGUAGE OF INTERVIEW** ___

**LANGUAGE CODES

1 ENGLISH
2 AKAN
3 GA
4 EWE
5 HAUSA
6 DAGBANI
7 OTHER (SPECIFY) _____

TRANSLATOR USED:

YES 1
NO 2

SUPERVISOR ____
NAME _____
DATE _____

FIELD EDITOR ____
NAME _____
DATE _____

OFFICE EDITOR ___
KEYED BY___

SECTION M1. RESPONDENT'S BACKGROUND

M100. RECORD THE TIME.

HOUR ___
MINUTES ___

M102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in 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 ONE YEAR ENTER '00'.

YEARS ___
ALWAYS (SINCE BIRTH) 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 in a village?

CITY 1
TOWN 2
VILLAGE 3

M105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR 19__
DON'T KNOW 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 is the highest level of school you attended: primary, middle/jss, secondary/sss, or higher?

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4

M109. What is the highest grade you completed at that level?

GRADE ___

M110. CHECK 108:

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

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (SKIP TO 113)

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 every day?

YES 1
NO 2

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

YES 1
NO 2

M115. What is your religion?

CATHOLIC 1
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
SPIRITUALIST 05
OTHER CHRISTIAN 06
MOSLEM 07
TRADITIONAL 08
NO RELIGION 09
OTHER (SPECIFY) ___ 96

M116. To which ethnic group do you belong?

ASANTE 01
AKWAPIM 02
FANTE 03
OTHER AKAN 04
GA/ADANGBE 05
EWE 06
GUAN 07
MOLE-DAGBANI 08
GRUSSI 09
GRUMA 10
HAUSA 11
OTHER (SPECIFY) ____ 96

M117. What is your occupation, that is, what kind of work do you mainly do?

_______ __
_______
_______

M118. CHECK M117:

WORKS (WORKED) IN AGRICULTURE ___ (SKIP TO M119)
DOES (DID) NOT OWRK IN AGRICULTURE ___ (SKIP TO M120)

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

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

M120. Do you do this work for a member of your family, for someone else, or are you self-employed?

FAMILY MEMBER 1
SOMEONE ELSE 2
SELF-EMPLOYED 3

M121. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THORUGHOUT THE YEAR 1 (SKIP TO M12)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

M122. During the last 12 months, how many months did you work?

NUMBER OF MONTHS ___

M123. How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?

PER HOUR 1 _____
PER DAY 2 _____
PER WEEK 3 _____
PER MONTH ____
PER YEAR 5 ____
OTHER (SPECIFY) _____ 9999996

SECTION M2. REPRODUCTION

M202. Do you have any sons or daughters whom you have fathered who are living with you?

YES 1
NO 2 (SKIP TO M204)

M203. How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME ___
DAUGHTERS AT HOME ___

M204. Do you have any sons or daughters whom you have fathered who are alive but do not live with you?

YES 1
NO 2 (SKIP TO M206)

M205. 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 ___

M206. Have you ever fathered a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (SKIP TO M208)

M207. How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL____

M209. Just to make sure that I have this right: you have had in TOTAL______ children during your life. Is that correct?

YES __ (SKIP TO M210)
NO __ (PROBE AND CORRECT M202-M207 AS NECESSARY.)

M210. CHECK M209:

HAS HAD CHILDREN __ (SKIP TO M211)
HAS NEVER HAD CHILDREN __ (SKIP TO M301)

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

MONTH ___
YEAR 19___

M212. CHECK M211:

LAST CHILD BORN SINCE JANUARY 1993 ___ (SKIP TO M213)
LAST CHILD BORN BEFORE JANUARY 1993 ___ (SKIP TO M301)

M213. When you were expecting your lastborn child, did you want to have the child 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

SECTION M3. CONTRACEPTION

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

CIRCLE CODE 1 IN M301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.

THEN PROCEED DOWN COLUMN M301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN M301, ASK M302 AND M303.

M301. Which ways or methods have you heard about?

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 a 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) NORPLANT Women can have several small rods placed in their upper arms by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION Women can have an operation to avoid having anymore children.
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 Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
12) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
1 (SPECIFY) _____
2 (SPECIFY) _____

M302. Have you and your husband/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 a 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) NORPLANT Women can have several small rods placed in their upper arms by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION Women can have an operation to avoid having any more children: Has your wife ever had an operation to avoid having any more children?
YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children: Has you ever had an operation to avoid having children?
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
12) OTHER METHOD 1
YES 1
NO 2
OTHER METHOD 2
YES 1
NO 1

M303. 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 a 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) NORPLANT Women can have several small rods placed in their upper arms by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside themselves before intercourse.
YES 1
NO 2
06) CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
07) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
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 Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant: Do you know where a person can go to obtain advice o how to use periodic abstinence?
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM) Do you know where a person can go to obtain advice on LAM?
YES 1
NO 2

M304. CHECK M302:

NOT A SINGLE "YES" (NEVER USED) ___ (SKIP TO M305)
AT LEAST ONE "YES" (EVER USED) ___ (SKIP TO M307)

M305. 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 (SKIP TO M310)

M306. What have you used or done?
CORRECT M302 AND M303 (AND M301 IF NECESSARY).

M307. Now I would like to ask you about the first time that you did something or used a method to avoid having a child. How many living children did you have at that time, if any?
IF NONE, RECORD '00'
.

NUMBER OF CHILDREN ___

M308. CHECK M302:

MAN NOT STERILIZED __ (SKIP TO M309)
MAN STERILIZED__ (SKIP TO M311A)

M309. Are you or your wife/partner currently doing something or using any method to delay or avoid having a child?

YES 1 (SKIP TO M311)
NO 2

M310. What is the main reason you are not using a method of contraception to avoid pregnancy?

FERTILITY-RELATED REASONS
NOT HAVING SEX 21 (SKIP TO M312)
INFREQUENT SEX 22 (SKIP TO M312)
MENOPAUSAL/HYSTERECTOMY 23 (SKIP TO M312)
SUBFECUND/INFECUND 24 (SKIP TO M312)
POSTPARTUM/BREASTFEEDING 25 (SKIP TO M312)
WANTS (MORE) CHILDREN 26 (SKIP TO M312)
WIFE PREGNANT 27 (SKIP TO M312)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (SKIP TO M312)
HUSBAND OPPOSED 32 (SKIP TO M312)
OTHERS OPPOSED 33 (SKIP TO M312)
RELIGIOUS PROHIBITION 34 (SKIP TO M312)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (SKIP TO M312)
KNOWS NO SOURCE 42 (SKIP TO M312)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (SKIP TO M312)
FEAR OF SIDE EFFECTS 52 (SKIP TO M312)
LACK OF ACCESS/TOO FAR 53 (SKIP TO M312)
COST TOO MUCH 54 (SKIP TO M312)
INCONVENIENT TO USE 55 (SKIP TO M312)
INTERFERES WITH BODY'S NATURAL PROCESS 56 (SKIP TO M312)
OTHER (SPECIFY) _____ 96 (SKIP TO M312)
DON'T KNOW 98 (SKIP TO M312)

M311. Which method are you using?

M311A. CIRCLE '08' FOR MALE STERILIZATION.

PILL 01
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
LACTATIONAL AMENORRHEA METHOD 11
OTHER (SPECIFY) _____ 96

M312. Have you used a condom in the last four weeks?

YES 1
NO 2 (SKIP TO M401)

M313. What is the brand name of the condom you last used?
RECORD NAME OF BRAND.

BRAND ___
NO BRAND NAME 95
DON'T KNOW 96

M314. How much did a pack of condoms cost you the last time you got them?

CEDIS _____
PARTNER OBTAINED IT 9991
FREE 9992
OTHER 9996
DON'T KNOW 9998

M315. How many condoms were in the pack the last time you got them?

NUMBER ___
DON'T KNOW 98

M316. Do you use more condoms now than a year ago, about the same number, or fewer?

MORE 1
SAME 2 (SKIP TO M401)
FEWER 3 (SKIP TO M41)

M317. What is the main reason you use more condoms now than a year ago?

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

SECTION 4M. MARRIAGE

M401. PRESENCE OF OTHERS AT THIS POINT.

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

M402. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2 (SKIP TO M402B)
NO, NOT IN UNION 3 (SKIP TO M403)

M402A. How many wives do you have?

NUMBER _____

M402B. How many women are you living with as if you are married?

NUMBER ___

M402C. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE/WIVES.
IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE '00'.
THE NUMBER OF BOXES FILLED MUST EQUAL THE NUMBER OF WIVES.

_____ (SKIP TO M406)

M403. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

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

M404. Have you ever been married or lived with a woman?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2 (SKIP TO M406)
NO 3 (SKIP TO M410)

M405. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1
DIVORCED 2
SEPARATED 3

M406. Have you been married or lived with a woman only once, or more than once?

ONCE 1
MORE THAN ONCE 2

M407. CHECK M406:

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

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

MONTH___
DON'T KNOW MONTH 98
YEAR 19___ (SKIP TO M410)
DON'T KNOW YEAR 9998

M408. How old were you when you started living with her?

AGE___

M409. CHECK M406:

MARRIED/LIVED WITH A WOMAN ONLY ONCE ___ (SKIP TO M410)

MARRIED/LIVED WITH A WOMAN MORE THAN ONCE ___ (Now we will talk about your current husband/partner. In what month and year did you start living with him?)

MONTH ___
DON'T KNOW MONTH 98
YEAR 19___
DON'T KNOW YEAR 9998

M410. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)?

NEVER 000 (SKIP TO M501)
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

M411. CHECK M301:

KNOWS CONDOM __ (The last time you had sex, was a condom used?)

DOES NOT KNOW CONDOM __ (Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?)

YES 1
NO 2

M412. Do you know of a place where you can get condoms?

YES 1
NO 2 (SKIP TO M414)

M413. Where is that? Anywhere else?
RECORD 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.

NAME OF PLACE ____
PUBLIC SECTOR
GVT. HOSPITAL/POLYCLINIC A
GVT. HEALTH CENTRE B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE SECTOR
HOSPITAL/CLINIC G
PHARMACY H
CHEMIST I
DRUG STORE J
MOBILE CLINIC K
FIELD WORKER L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE (SPECIFY) ____ O
OTHER SOURCE
CHURCH P
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) ____ S

M414. CHECK M402:

CURRENTLY MARRIED OR LIVING WITH A WOMAN ___ (In the last 12 months, how many different women have you had sex with, other than your (wife/wives/partner)?)

NOT IN UNION ___ (In the last 12 months, how many different women have you had sex with?)

NUMBER __

M415. How old were you when you first had sexual intercourse?

AGE ___
FIRST TIME WHEN MARRIED 96

SECTION M5. FERTILITY PREFERENCES

M501. CHECK M402:

NOT IN UNION ___ (SKIP TO M502)
CURRENTLY MARRIED OR LIVING WITH A WOMAN ___ (SKIP TO M503)

M502. CHECK M403:

REGULAR SEXUAL PARTNER ___ (SKIP TO M503)
OCCASIONAL SEXUAL PARTNER ___ (SKIP TO M503)
NO SEXUAL PARTNER ___ (SKIP TO M505A)

M503. Is your wife (or one of your wives/partner) pregnant now?

YES 1
NO 2 (SKIP TO M505A)
UNSURE 8 (SKIP TO M505A)

M504. When she became pregnant, did you want her to become pregnant then, did you want her to wait until later, or did you not want this pregnancy at all?

THEN 1 (SKIP TO M505B)
LATER 2 (SKIP TO M505B)
NOT AT ALL 3 (SKIP TO M505B)

M505.
(A) WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER? ___(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?)

(B) WIFE/PARTNER PREGNANT ___ (Now I have some questions about the future.
After the child your wife is expecting now, would you like to have another child, or would you prefer not to have any more children?)

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO M507)
SAYS HE CAN'T HAVE ANYMORE 3 (SKIP TO M507)
SAYS WIFE CAN'T GET PREGNANT 4 (SKIP TO M507)
UNDECIDED/DON'T KNOW 8 (SKIP TO M507)

M506. CHECK M503:

WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER? ___ (How long would you like to wait from now before the birth of (a/another) child?)

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

MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) ____ 996
DON'T KNOW 998

M507. CHECK M309: USING A METHOD?

NOT ASKED __ (SKIP TO M508)
NOT CURRENTLY USING __ (SKIP TO M508)
CURRENTLY USING __ (SKIP TO M512)

M508. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (SKIP TO M510)
NO 2
DON'T KNOW 8

M509. Do you think you will use a method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2 (SKIP TO M511)
DON'T KNOW 8 (SKIP TO M511)

M510. Which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
LACATATIONAL AMENORRHEA METHOD 11
OTHER (SPECIFY) ____ 96
UNSURE 98

M510A. Where can you get/obtain advice on (METHOD MENTIONED IN M510)?

PUBLIC SECTOR
GVT. HOSPITAL/POLYCLINIC 11 (SKIP TO M512)
GVT. HEALTH CENTRE 12 (SKIP TO M512)
FAMILY PLANNING CLINIC 13 (SKIP TO M512)
MOBILE CLINIC 14 (SKIP TO M512)
FIELD WORKER 15 (SKIP TO M512)
OTHER PUBLIC (SPECIFY) ____ 16 (SKIP TO M512)
PRIVATE SECTOR
HOSPITAL/CLINIC 21 (SKIP TO M512)
PHARMACY 22 (SKIP TO M512)
CHEMIST 23 (SKIP TO M512)
DRUG STORE 24 (SKIP TO M512)
MOBILE CLINIC 25 (SKIP TO M512)
FIELD WORKER 26 (SKIP TO M512)
FP/PPAG CLINIC 27 (SKIP TO M512)
MATERNITY HOME 28 (SKIP TO M512)
OTHER PRIVATE (SPECIFY) _____ 29 (SKIP TO M512)
OTHER SOURCE
CHURCH 31 (SKIP TO M512)
SHOP 32 (SKIP TO M512)
FRIEND/RELATIVE 33 (SKIP TO 512)
OTHER (SPECIFY) ____ 36 (SKIP TO 512)

M511. What is the main reason that you think you will never use a method?

NOT CURRENTLY MARRIED/NO PARTNER 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
WIFE PARTNER MENOPAUSAL/HAD WOMB REMOVED 23
SUBFECUND/INFECUND 24
WANTS MORE CHILDREN 25
OPPOSITION TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

M512. 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?)
PROBE FOR A NUMERIC RESPONSE.

NUMBER ___
OTHER (SPECIFY) _____ 96 (SKIP TO M514)

M513. 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?

BOYS NUMBER ___
GIRLS NUMBER ___
EITHER NUMBER ___
UP TO GOD 95
OTHER (SPECIFY) ______ 96

M514. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

M515. Is it acceptable or not acceptable to you for information on family planning to be provided:
On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8

M516. In the last few months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2

M517. In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (SKIP TO M519)

M518. With whom? Anyone else?
RECORD ALL MENTIONED.

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

M519. CHECK M402:

YES, CURRENTLY MARRIED ___ (SKIP TO M520)
YES, LIVING WITH A WOMAN ___ (SKIP TO M520)
NO, NOT IN UNION ___ (SKIP TO M601)

M520. Spouses/partners do not always agree on everything. Now I want to ask you about your wife's/partner's views on family planning.

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

M521. How often have you talked to your wife/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

M522. Do you think your wife/ partner wants the same number of children that you want, or does he want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

SECTION M6. AIDS

M601. Now I have a few questions about a very important topic. Have you ever heard of an illness called AIDS?

YES 1
NO 2

M602. From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED.

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

M603. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (SKIP TO M607)
DON'T KNOW 8 (SKIP TO M607)

M604. What can a person do? Any other ways?
RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOM C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
AVOID SHARING INFECTED BLADES K
SEEK PROTECTION FROM TRADITIONAL HEALER M
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) ______ X
DON'T KNOW Z

M605. CHECK M604:

MENTIONED SAFE SEX ___ (SKIP TO M606)
DID NOT MENTION SAFE SEX ___ (SKIP TO M607)

M606. What does "safe sex" mean to you?

ABSTAIN FROM SEX A
USE CONDOMS B
HAVE ONLY ONE SEX PARTNER C
AVOID SEX WITH PROSTITUTES D
AVID SEX WITH HOMOSEXUALS E
OTHER (SPECIFY) _____ X
DON'T KNOW Z

M607. Is it possible for a healthy looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

M608. 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
DON'T KNOW 8

M609. Is it possible for a woman who has the AIDS virus to pass the virus to her child through breastfeeding?

YES 1
NO 2
DON'T KNOW 8

M610. 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
SHOULD NOT BE INVOLVED 4
OTHER (SPECIFY) _____ 6

M611. If your relative is suffering from AIDS, who would you prefer to care for him/her?

RELATIVES 1
FRIENDS 2
GOVERNMENT ORGANIZATION 3
RELIGIOUS ORGANIZATION 4
NOBODY/ABANDON 5
OTHER (SPECIFY) _____ 6

M612. Do you think your chances of getting AIDS are small, moderate, great, or that you have no risk at all?

SMALL 1
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS AIDS 5
DON'T KNOW 8

M613. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior? IF YES, PROBE: In what way?
RECORD ALL MENTIONED.

DID NOT START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
STOPPED SEX WITH PROSTITUTES F
STOPPED HOMOSEXUAL CONTACTS G
OTHER (SPECIFY) ______ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DON'T KNOW Y

M614. Have you heard of other diseases apart from AIDS which could be transmitted through sexual intercourse?

YES 1
NO 2 (SKIP TO M618)

M615. Name the diseases. Any other? CIRCLE ALL MENTIONED.

GONORRHEA A
SYPHILIS B
HERPES C
HEPATITIS D
OTHER (SPECIFY) _____ X

M616. FOR EACH DISEASE MENTIONED IN Q.M615 ASK THE FOLLOWING QUESTION AND CIRCLE ALL THE PLACES MENTIONED:
Where can a person go to treat (NAME OF DISEASE)? Anywhere else?

GONORRHEA

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____ X

SYPHILIS

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____ X

HERPES

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____ X

HEPATITIS

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____ X

OTHER

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PRIVATE SECTOR
HOSPITAL F
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC I
COMM. HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
DRUG PEDDLER L
TRADITIONAL PRACTITIONER M
FAITH HEALER/SPIRITUALIST N
OTHER (SPECIFY) _____ X

M617. Do you think your chances of getting sexually transmitted diseases (STDs), other than AIDS, are small, moderate, great, or that you have no risk at all?

SMALL 1
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS STDs 5
DON'T KNOW 8

M618. RECORD THE TIME.

HOUR ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS
To be filled in after completing interview

Comments about Respondent
______________
______________
______________

Comments on
Specific Questions
_____________
_____________
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Any Other
Comments
_____________
_____________
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SUPERVISOR'S OBSERVATIONS
_____________
_____________
_____________

Name of Supervisor_______ Date:________

EDITOR'S OBSERVATIONS
_____________
_____________
_____________

Name of Editor__________ Date: ________