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NATIONAL FAMILY, HEALTH SURVEY
(MCH AND FAMILY PLANNING)
WOMAN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF STATE______
PSU NUMBER ______
NAME OF DISTRICT______
NAME OF TEHSIL/TALUX______

URBAN/RURAL ______

URBAN 1
RURAL 2

NAME OF TOWN AND TOWN BLOCK OR VILLAGE______

LARGE CITY/SMALL CITY/TOWN/RURAL AREA ______

LARGE CITY 1
SMALL CITY 2
TOWN 3
RURAL AREA 4

HOUSEHOLD NUMBER _______
NAME AND LINE NUMBER OF WOMAN_______
ADDRESS OF HOUSEHOLD_______

INTERVIEW VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ______
INTERVIEWER'S NAME ______
RESULT ______

RESULTS ____

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

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY ______
MONTH ______
YEAR ______
NAME ______

TOTAL NUMBER OF VISITS ___

LANGUAGE OF QUESTIONNAIRE ______

01 ASSAMESE
02 BENGALI
03 ENGLISH
04 GUJARATI
05 HINDI
06 KANNADA
07 KASHMIRI
08 MALAYALAM
09 MARATHI
10 ORIYA
11 PUNJABI
12 SANSKRIT
13 SINDHI
14 TAMIL
15 TELUGU
16 URDU
17 OTHER (SPECIFY) _____
18 KONKANI

LANGUAGE OF INTERVIEW ______

01 ASSAMESE
02 BENGALI
03 ENGLISH
04 GUJARATI
05 HINDI
06 KANNADA
07 KASHMIRI
08 MALAYALAM
09 MARATHI
10 ORIYA
11 PUNJABI
12 SANSKRIT
13 SINDHI
14 TAMIL
15 TELUGU
16 URDU
17 OTHER (SPECIFY) _____
18 KONKANI

NATIVE LANGUAGE OF RESPONDENT ______

01 ASSAMESE
02 BENGALI
03 ENGLISH
04 GUJARATI
05 HINDI
06 KANNADA
07 KASHMIRI
08 MALAYALAM
09 MARATHI
10 ORIYA
11 PUNJABI
12 SANSKRIT
13 SINDHI
14 TAMIL
15 TELUGU
16 URDU
17 OTHER (SPECIFY) _____
18 KONKANI

TRANSLATOR USED?

YES1
NO 2

SPOT-CHECKED BY
NAME_______
DATE_______

FIELD EDITED BY
NAME_______
DATE_______

OFFICE EDITED BY
NAME_______
DATE_______

KEYED BY
NAME_______
DATE_______

KEYED BY _______

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOUR ______
MINUTES ______

First I would like to ask some questions about you and your household.

102. For most of the time until you were 12 years old, did you live in a city or a village?

CITY/TOWN 1
VILLAGE 2

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS______
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

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

CITY/TOWN 1
VILLAGE 2

105. In what month and year were you born?

MONTH ______
DOESN'T KNOW MONTH 98
YEAR______
DOESN'T KNOW YEAR 98

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

AGE IN COMPLETED YEARS______

107. What is your current marital status?

CURRENTLY MARRIED 1
SEPARATED 2 (GO TO 111)
WIDOWED 3 (GO TO 111)
DIVORCED 4 (GO TO 111)
NEVER MARRIED 5 (GO TO END)

108. Are you living with your husband now or is he staying elsewhere?

LIVING WITH HIM 1 (GO TO 111)
STAYING ELSEWHERE 2

109. During the last four weeks, did you stay with your husband at any time?

YES 1 (GO TO 111)
NO 2

110. For how long have you and your husband not been living together?
RECORD MONTHS OR YEARS.

MONTHS 1 ______
YEARS 2 ______

Now I would like to ask you some questions on your marriage.

111. Have you been married only once or more than once?

ONCE 1 (GO TO 115)
MORE THAN ONCE 2

112. How old were you at the time of your first marriage?

AGE IN COMPLETED YEARS______

113. How old were you when you started living with your first husband?

AGE IN COMPLETED YEARS______
GAUNA HAD NOT TAKEN PLACE 96

114. How old were you when your first marriage dissolved?

AGE IN COMPLETED YEARS______

115. How old were you at the time of your (current) marriage?

AGE IN COMPLETED YEARS______

116. How old were you when you started living with your (current) husband?

AGE IN COMPLETED YEARS______
GAUNA HAS NOT TAKEN PLACE 96 (GO TO END)

117. Before you got married, was your (current) husband related to you in any way?

YES 1
NO 2 (GO TO 119)

118. What type of relationship was it?

FIRST COUSIN ON FATHER'S SIDE 1
FIRST COUSIN ON MOTHER'S SIDE 2
SECOND COUSIN 3
UNCLE 4
OTHER BLOOD RELATIVE 5
BROTHER-IN-LAW 6
OTHER NON-BLOOD RELATIVE 7

119. What is the minimum legal age at marriage for a girl in India?

AGE IN YEARS______
DOESN'T KNOW 98

120. What is the minimum legal age at marriage for a boy in India?

AGE IN YEARS______
DOESN'T KNOW 98

121. Have you ever attended school?

YES 1
NO 2 (GO TO 124)

122. What is the highest grade you completed?

GRADE ______

123. CHECK 122:

GRADE 0-5 (GO TO 124)
GRADE 6-12 (GO TO 126)
GRADE 13+ (GO TO 125)

124. Can you read and write?

YES 1 (GO TO 126)
NO 2 (GO TO 126)

125. What is the highest degree you have obtained?

DEGREE NOT COMPLETED 01
NON-TECHNICAL DEGREE

BACHELOR'S DEGREE 02
MASTER'S DEGREE 03
PH. D 04
TECHNICAL DEGREE

BACHELOR'S DEGREE 05
MASTER'S DEGREE 06
TECHNICAL DIPLOMA/CERTIFICATE
NOT EQUIVALENT TO DEGREE 07
NON-TECHNICAL DIPLOMA/CERTIFICATE
NOT EQUIVALENT TO DEGREE 08
OTHER DEGREE (SPECIFY) ______ 09

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

YES 1
NO 2

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

YES 1
NO 2

128. Do you usually go to a Cinema Hall or Theatre to see a movie at least once a month?

YES 1
NO 2

129. CHECK QUESTION 5 IN THE HOUSEHOLD SCHEDULE:

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (GO TO 130)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

130. How long have you been visiting in this house?

DAYS 1______
MONTHS 2______
YEARS 3______

131. How much longer do you intend to stay here?

DAYS 1______
MONTHS 2______
YEARS 3______
DOESN'T KNOW 998

132. What is the main reason for your visiting this household?

VISITING FOR DELIVERY PURPOSE 1
VISITING FOR OTHER PURPOSE 2

Now I would like to ask about the place in which you usually live.

133. Do you usually live in a city, in a town, or in a village?
IF CITY: In which city do you live?

CITY NAME______
LARGE CITY (1 MILLION +) 1
SMALL CITY 2
TOWN 3
VILLAGE 4

134. In which state do you usually live?

ANDHRA PRADESH 01
ARUNACHAL PRADESH 02
ASSAM 03
BIHAR 04
GOA 05
GUJARAT 06
HARYANA 07
HIMACHAL PRADESH 08
JAMMU AND KASHMIR 09
KARNATAKA 10
KERALA 11
MADHYA PRADESH 12
MAHARASHTRA 13
MANIPUR 14
MEGHALAYA 15
MIZORAM 16
NAGALAND 17
ORISSA 18
PUNJAB 19
RAJASHTAN 20
SIKKIM 21
TAMIL NADU 22
TRIPURA 23
UTTAR PRADESH 24
WEST BENGAL 25
ANDMAN AND NICOBAR ISLANDS 26
CHANDIGARH 27
DADRA AND NAGAR HAVELI 28
DAMAN AND DIU 29
DELHI 30
LAKSHADWEEP 31
PONDICHERRY 32
OUTSIDE INDIA 33

Now I would like to ask about the household in which you usually live.

135. What is the main source of water your household uses for bathing and washing?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 137)
PUBLIC TAP 12
GROUND WATER
HANDPUMP IN YARD/PLOT 21 (GO TO 137)
PUBLIC HANDPUMP 22
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 23 (GO TO 137)
PUBLIC WELL 24
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41
TANKER TRUCK 51
OTHER (SPECIFY)______ 81

136. How long does it take to go there, get water and come back in one trip?

MINUTES ______

137. Does your household get drinking water from same source?

YES 1 (GO TO 139)
NO 2

138. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11
PUBLIC TAP 12
GROUND WATER
HANDPUMP IN YARD/PLOT 21
PUBLIC HANDPUMP 22
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 23
PUBLIC WELL 24
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41
TANKER TRUCK 51
OTHER_______ 81 (SPECIFY)

139. What kind of toilet facility does your household have?

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PUBLIC FLUSH TOILET 13
PIT TOILET/LATRINE
OWN PIT TOILET/LATRINE 21
SHARED PIT TOILET/LATRINE 22
PUBLIC PIT TOILET/LATRINE 23
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) _____ 41

140. What is the main source of lighting for your household?

ELECTRICITY 1
KEROSENE 2
GAS 3
OIL 4
OTHER (SPECIFY) _____ 5

141. How many rooms are there in your household?

ROOMS ______

142. Do you have a separate room which is used as a kitchen?

YES 1
NO 2

143. What type of fuel does your household mainly use for cooking?

WOOD 01
COW DUNG CAKES 02
COAL/COKE/LIGNITE 03
CHARCOAL 04
KEROSENE 05
ELECTRICITY 06
LIQUID PETROLEUM GAS 07
BIO-GAS 08
OTHER (SPECIFY) _____ 09

144. What materials have been used for the construction of roof, walls and floor of the house where you usually live?

ROOF_______
WALLS_______
FLOOR_______
PUCCA 1
KACHNA 2
SEMI-PUCCA 3

145. What is the religion of the head of the household?

HINDU 01
SIKH 02
BUDDHIST/NEO BUDDHIST 03
CHRISTIAN 04
JAIN 05
JEWISH 06
MUSLIM 07
ZOROASTRIAN 08
NO RELIGION 09
OTHER_____________(SPECIFY) 10

146. Does the head of the household belong to a scheduled tribe?

YES 1
NO 2 (GO TO 148)

147. What is the name of the tribe?

TRIBE NAME ______ (GO TO 149)

148. To which caste does the head of the household belong?

CASTE NAME ______
NO CASTE 996

149. Does your household own any agricultural land?

YES 1
NO 2 (GO TO 152)

150. What is the size of non-irritated land under cultivation, in acres?

ACRES ______
NONE 000
LESS THAN ONE 996

151. What is the size of irrigated land under cultivation, in acres?

ACRES ______
ONE 000
LESS THAN ONE 996

152. Does your household own any livestock?

YES 1
NO 2 (GO TO 155)

153. What type of livestock do you own?
RECORD ALL MENTIONED.

BULLOCK A
COW B
BUFFALO C
GOAT D
SHEEP E
CAMEL F
OTHER (SPECIFY) ______ G

154. Where do you usually keep the animals at night?

IN THE HOUSE 1
OUTSIDE THE HOUSE 2

155. Does the household own any of the following?

SEWING MACHINE
YES 1
NO 2
CLOCK/WATCH
YES 1
NO 2
SOFA SET
YES 1
NO 2
FAN
YES 1
NO 2
RADIO/TRANSISTOR
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
TELEVISION
YES 1
NO 2
VCR/VCP
YES 1
NO 2
BICYCLE
YES 1
NO 2
MOTORCYCLE/SCOOTER
YES 1
NO 2
CAR
YES 1
NO 2
BULLOCK CART
YES 1
NO 2
TRACTOR
YES 1
NO 2
THRESHER
YES 1
NO 2
WATER PUMP
YES 1
NO 2

156. How many people are there in your household?

NUMBER OF PERSONS ______

SECTION 2. REPRODUCTION

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

201. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME _____
DAUGHTERS AT HOME _____

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE _____
DAUGHTERS ELSEWHERE _____

206. Have you ever given birth to a boy or a girl who was born alive but 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 (GO TO 208)

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

BOYS DEAD ______
GIRLS DEAD ______

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

TOTAL ______

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

YES (GO TO 210)
NO, PROBE AND CORRECT 201-208 AS NECESSARY

210. Have you ever had a stillbirth?

YES 1
NO 2 (GO TO 212)

211. How many stillbirths have you had?

NUMBER OF STILLBIRTHS ___

212. Have you ever had an abortion?
PROBE FOR SPONTANEOUS AND INDUCED ABORTIONS.

YES 1
NO 2 (GO TO 214)

213. How many abortions have you had?
PROBE FOR NUMBER OF SPONTANEOUS AND INDUCED ABORTIONS.
IF NONE, RECORD '0'.

SPONTANEOUS ABORTIONS _____
INDUCED ABORTIONS _____

214. CHECK 208:

ONE OR MORE BIRTHS (GO TO 215)
NO BIRTHS (GO TO 226)

Now I would like to talk to you about all the births in your lifetime, whether currently alive or not, starting with the first one you had.

215. RECORD NAMES OF ALL THE BIRTHS IN 216.
RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

216. What name was given to your (first, next) baby?

NAME _______

217. RECORD SINGLE OR MULTIPLE BIRTH STATUS.

SING 1
MULT 2

218. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

219. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH ______
YEAR ______

220. Is (NAME) still alive?

YES 1
NO 2 (GO TO 223)

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

AGE IN YEARS______

222. IF ALIVE: Is (NAME) living with you?

YES 1 (GO TO NEXT BIRTH)
NO 2 (GO TO NEXT BIRTH)

223. IF DEAD: How old was he/she when he/she died?
IF "1 YEAR", PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

DAYS 1 ______
MONTHS 2 ______
YEARS 3 ______

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

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED
FOR AGE AT DEATH 12 MONTHS: PROBE TO DETERMINE EXACT NUMBER OF MO.
FOR EACH CALENDAR BIRTH INTERVAL 4 OR 4+ YEARS: EXPLANATION IS GIVEN.
NUMBERS ARE DIFFERENT, PROBE AND RECONCILE

225. CHECK 219 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1988.
IF NONE, RECORD '0'.

NUMBER OF BIRTHS_______

226. CHECK 107:

CURRENTLY MARRIED (GO TO 227)
WIDOWED, DIVORCED, OR SEPARATED (GO TO 232)

227. Are you pregnant now?

YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

228. How many months pregnant are you?

MONTHS ______

229. 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 become pregnant at all?

THEN 1 (GO TO 232)
LATER 2 (GO TO 232)
NOT AT ALL 3 (GO TO 232)

230. Are you currently menstruating?

YES 1
NO, IN MENOPAUSE 2 (GO TO 232)
NO, IN AMENORRHOEA 3 (GO TO 232)
NEVER MENSTRUATED 4 (GO TO 301)

231. When did your last menstrual start?

MONTH ______
YEAR ______

232. How old were you when you experienced your first month period?

AGE IN YEARS ______

SECTION 3. CONTRACEPTION

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

CIRCLE CODE 1 IN 302 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 IF RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

301. Which ways or methods have you heard about?

302. Have you ever heard of (METHOD)?

01. PILL Woman can take a pill every day.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
02. LOOP OR COPPER T Woman can have a loop or coil placed inside them by a doctor or a nurse.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
03. INJECTIONS Woman can have an injection given by a doctor or nurse which stops them from becoming pregnant for several months.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
04. CONDOM OR NIRODH Men can use a rubber sheath during sexual intercourse.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
05. FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
06. MALE STERILIZATION Men can have an operation to avoid having any more children.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
07. RHYTHM OR PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
08. WITHDRAWAL Men can be careful and pull out before climax.
YES, SPONTANEOUS 1
YES, PROBED 2
NO 3 (GO TO NEXT METHOD)
09. Have you heard of any other ways of methods that women or man can use to avoid pregnancy? LIST UP TO THREE METHODS.
OTHER METHOD (SPECIFY) ______
YES, SPONTANEOUS 1
NO 3 (GO TO 305)

303. Have you ever used (METHOD)?

01. PILL Woman can take a pill every day.
YES 1
NO 2
02. LOOP OR COPPER T Woman can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTIONS Woman can have an injection given by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04. CONDOM OR NIRODH Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
05. FEMALE STERILIZATION Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
06. MALE STERILIZATION Men can have an operation to avoid having any more children. Has your husband ever had an operation to avoid having any more children?
YES 1
NO 2
07. RHYTHM OR PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES 1
NO 2
08. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
09. OTHER METHOD(S) (SPECIFY) _______
YES 1
NO 2

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

01. PILL Woman can take a pill every day.
YES 1
NO 2
02. LOOP OR COPPER T Woman can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTIONS Woman can have an injection given by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04. CONDOM OR NIRODH Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
05. FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
06. MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
07. RHYTHM OR PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant. Do you know where a person can obtain advice on how to practice periodic abstinence?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE "YES" (NEVER USED) (GO TO 306)
AT LEAST ONE "YES" (EVER USED) (GO TO 308)

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

YES 1
NO 2 (GO TO 344)

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

Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant.

308. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ______

309. CHECK 107:

CURRENTLY MARRIED (GO TO 310)
WIDOWED/DIVORCED/SEPARATED (GO TO 352)

310. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 311)
PREGNANT (GO TO 345)

311. CHECK 303:

NEITHER STERILIZED (GO TO 312)
HE OR SHE STERILIZED (GO TO 313A)

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

YES 1
NO 2 (GO TO 342)

313. Which method are you using?
313A. CIRCILE '05' FOR FEMALE STERILIZATION.
CIRCILE '06' FOR MALE STERILIZATION.

PILL 01
LOOP/COPPER T 02 (GO TO 321)
INJECTION 03 (GO TO 328)
CONDOM/NIRODH 04 (GO TO 330)
FEMALE STERILIZATION 05 (GO TO 332)
MALE STERILIZATION 06 (GO TO 332)
RHYTHM/PERIODIC ABSTINENCE 07 (GO TO 341)
WITHDRAWAL 08 (GO TO 341)
OTHER (SPECIFY) _____ 09 (GO TO 341)

314. For how many months have you been using the pill continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTH ______
8 YEARS OR LONGER 96

315. At the time you first started using the pill, did you consult a doctor?

YES 1
NO 2

316. Once you started using the pill, did a health worker come to visit you for a follow-up related to your use of the pill?

YES 1
NO 2

317. Once you started using the pill, did you go to consult a medical or health person about your experience with the use of the pill?

YES 1
NO 2

318. Have you had any problems with the use of the pill?

YES 1
NO 2 (GO TO 320)

319. What problems have you had?
RECORD ALL PROBLEMS MENTIONED.

CRAMPS A
WEIGHT GAIN B
DIZZINESS C
BODY ACHE D
SPOTTING/BLEEDING E
WHITE DISCHARGE F
BREAST TENDERNESS G
NAUSEA/VOMITING H
CANCER I
ALLERGY J
HEADACHE K
OTHER (SPECIFY) _____ L

320. Where did you obtain the pills the last time?

NAME OF HOSPITAL IF CODE 11 OR 21 ________
PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 352)
PRIMARY HEALTH CENTRE 12 (GO TO 352)
SUB-CENTRE 13 (GO TO 352)
FAMILY PLANNING CLINIC 14 (GO TO 352)
MOBILE CLINIC 15 (GO TO 352)
GOVERNMENT PARAMEDIC 16 (GO TO 352)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 21 (GO TO 352)
PHARMACY/DRUGSTORE 22 (GO TO 352)
PRIVATE DOCTOR 23 (GO TO 352)
MOBILE CLINIC 24 (GO TO 352)
FIELD WORKER 25 (GO TO 352)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 352)
FRIENDS/RELATIVES 32 (GO TO 352)
OTHER (SPECIFY) _____ 41 (GO TO 352)

321. Who inserted the (LOOP/COPPER T)?

GOVERNMENT DOCTOR 1
GOVERNMENT PARAMEDIC 2
PRIVATE DOCTOR 3
PRIVATE NURSE 4

322. Where did you obtain the (LOOP/COOPER T)?

NAME OF HOSPITAL IF CODE 11 OR 21 _______
PUBLIC SECTOR
GOVT.MUNICIPAL HOSPITAL 11
PRIMARY HEALTH CENTRE 12
SUB-CENTRE 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
GOVERNMENT PARAMEDIC 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 21
PRIVATE DOCTOR 22
MOBILE CLINIC 23
OTHER (SPECIFY) ______ 31

323. For how many months have you been using the (LOOP/COPPER T) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS ______
8 YEARS OR LONGER 96

324. Since the (LOOP/COPPER T) was inserted, did any health worker visit you for follow-up related to use of the (LOOP/COPPER T)?

YES 1
NO 2

325. After the (LOOP/COPPER T) was inserted, did you go to consult a medical or health person about your experience with the use of the (LOOP/COPPER T)?

YES 1
NO 2

326. Have you had any problems with the use of the (LOOP/COPPER T)?

YES 1
NO 2 (GO TO 352)

327. What problems have you had?
RECORD ALL PROBLEMS MENTIONED.

CRAMPS A (GO TO 352)
BACKACHE B (GO TO 352)
IRREGULAR PERIODS C (GO TO 352)
EXCESSIVE BLEEDING D (GO TO 352)
WEAKNESS/INABLITY TO WORK E (GO TO 352)
EXPULSION F (GO TO 352)
OTHER (SPECIFY) _______ G (GO TO 352)

328. For how many months have you been using injections continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS ______
8 YEARS OR LONGER 96

329. Where did you obtain the injection the last time?

NAME OF HOSPITAL IF CODE 11 OR 21 ______
PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 352)
PRIMARY HEALTH CENTRE 12 (GO TO 352)
SUB-CENTRE 13 (GO TO 352)
FAMILY PLANNING CLINIC 14 (GO TO 352)
MOBILE CLINIC 15 (GO TO 352)
GOVERNMENT PARAMEDIC 16 (GO TO 352)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 21 (GO TO 352)
PRIVATE DOCTOR 22 (GO TO 352)
MOBILE CLINIC 23 (GO TO 352)
OTHER (SPECIFY) ______ 31 (GO TO 352)

330. For how many months have you been using (condoms/Nirodhs) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS ______
8 YEARS OR LONGER 96

331. Where did you obtain the (condoms/Nirodhs) the last time?

NAME OF HOSPITAL IF CODE 11 OR 21 ______
PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 352)
PRIMARY HEALTH CENTRE 12 (GO TO 352)
SUB-CENTRE 13 (GO TO 352)
FAMILY PLANNING CLINIC 14 (GO TO 352)
MOBILE CLINIC 15 (GO TO 352)
GOVERNMENT PARAMEDIC 16 (GO TO 352)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 21 (GO TO 352)
PHARMACY/DRUGSTORE 22 (GO TO 352)
PRIVATE DOCTOR 23 (GO TO 352)
MOBILE CLINIC 24 (GO TO 352)
FIELD WORKER 25 (GO TO 352)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 352)
HUSBAND 32 (GO TO 352)
FRIENDS/RELATIVES 33 (GO TO 352)
OTHER (SPECIFY) ______ 41 (GO TO 352)
DOESN'T KNOW 98 (GO TO 352)

332. In what month and year was the sterilization operation performed?

MONTH ______ (GO TO 334)
YEAR ______ (GO TO 334)
DOESN'T KNOW 9998

333. How long ago were (you/your husband) sterilized?

MONTHS AGO 1 ______
YEARS AGO 2 ______

334. Where did (you/your husband) obtain the sterilization?

NAME OF HOSPITAL IF CODE 11 OR 21 ______
PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL 11
PRIMARY HEALTH CENTRE 12
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
CAMP 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINC 21
PRIVATE DOCTOR 22
MOBILE CLINIC 23
OTHER (SPECIFY) ______ 31

335. How would you rate the care (you/he) received during or immediately after the operation: excellent, very good, all right, not so good, or very bad?

EXCELLENT 1
VERY GOOD 2
ALL RIGHT 3
NOT SO GOOD 4
VERY BAD 5
DOESN'T KNOW 8

336. Since the sterilization, has any health worker come to visit (you/your husband) for follow-up related to the sterilization?

YES 1
NO 2 (GO TO 338)
DOESN'T KNOW 8 (GO TO 338)

337. How would you rate the follow-up care services for the sterilization: excellent, very good, all right, not so good, or very bad?

EXCELLENT 1
VERY GOOD 2
ALL RIGHT 3
NOT SO GOOD 4
VERY BAD 5
DOESN'T KNOW 8

338. After the sterilization, did (you/your husband) go to consult a medical or health person about the sterilization?

YES 1
NO 2
DOESN'T KNOW 8

339. (Have you/Has your husband) had any problems as a result of the sterilization (operation)?

YES 1
NO 2 (GO TO 352)

340. What problems (have you/has he) had?
RECORD ALL PROBLEMS MENTIONED.

FEVER A (GO TO 352)
PAIN/BACKACHE B (GO TO 352)
SEPSIS C (GO TO 352)
WEAKNESS/INABILITY TO WORK D (GO TO 352)
FAILURE/GOT PREGNANT E (GO TO 352)
LOSS OF SEXUAL POWER F (GO TO 352)
OTHER (SPECIFY) __________ G (GO TO 352)

341. For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS ______ (GO TO 350)
8 YEARS OR LONGER 96 (GO TO 350)

342. What is the main reason you stopped using family planning?

METHOD FAILED/GOT PREGNANT 01
LACK OF SEXUAL SATISFACTION 02 (GO TO 345)
CREATED MENSTRUAL PROBLEM 03 (GO TO 345)
CREATED HEALTH PROBLEM 04 (GO TO 345)
INCONVENIENT TO USE 05 (GO TO 345)
HARD TO GET METHOD 06 (GO TO 345)
PUT ON WEIGHT 07 (GO TO 345)
DID NOT LIKE THE METHOD 08 (GO TO 345)
WANTED TO HAVE A CHILD 09 (GO TO 345)
WANTED TO REPLACE DEAD CHILD 10 (GO TO 345)
LACK OF PRIVACY FOR USE 11 (GO TO 345)
OTHER (SPECIFY) _______ 12 (GO TO 345)

343. What was the outcome of that pregnancy?

INDUCED ABORTION 1
SPONTANEOUS ABORTION 2
STILLBIRTH 3
LIVE BIRTH 4

344. CHECK 107:

CURRENTLY MARRIED (GO TO 345)
WIDOWED/DIVORCED/SEPARATED (GO TO 352)

345. Do you intend to use a method to delay or avoid pregnancy at any time in the future?

YES 1 (GO TO 347)
NO 2
DOESN'T KNOW 8 (GO TO 352)

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

WANTS CHILDREN 01 (GO TO 350)
WANTS A SON 02 (GO TO 350)
WANTS A DAUGHTER 19 (GO TO 350)
LACK OF KNOWLEDGE 03 (GO TO 350)
AFRAID OF STERILIZATION 04 (GO TO 350)
CAN'T WORK AFTER STERILIZATION 05 (GO TO 350)
COST TOO MUCH 06 (GO TO 350)
WORRY ABOUT SIDE EFFECTS 07 (GO TO 350)
HARD TO GET METHODS 08 (GO TO 350)
AGAINST RELIGION 09 (GO TO 350)
OPPOSED TO FAMILY PLANNING 10 (GO TO 350)
HUSBAND OPPOSED 11(GO TO 350)
OTHER PEOPLE OPPOSED 12 (GO TO 350)
DIFFICULT TO GET PREGNANT 13 (GO TO 350)
HEALTH DOES NOT PERMIT 14 (GO TO 350)
MENOPAUSAL/HAD HYSTERECTOMY 15 (GO TO 350)
INCONVENIENT 16 (GO TO 350)
DON'T LIKE EXISTING METHODS 17 (GO TO 350)
OTHER (SPECIFY) ______ 18 (GO TO 350)

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

YES 1
NO 2
DOESN'T KNOW 8

348. When you use a method, which method would you prefer to use?

PILL 01
LOOP/COPPER T 02
INJECTION 03
CONDOM/NIRODH 04
FEMALE STERILIZATION 05
MALE STERILIZATION 06
RHYTHM/PERIODIC ABSTINENCE 07 (GO TO 350)
WITHDRAWAL 08 (GO TO 350)
OTHER (SPECIFY) ______ 09 (GO TO 350)
UNSURE 98 (GO TO 350)

349. Where can you get (METHOD MENTIONED IN 348)?

NAME OF HOSPITAL IF CODE 11 OR 21 ______
PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 352)
PRIMARY HEALTH CENTRE 12 (GO TO 352)
SUB-CENTRE 13 (GO TO 352)
FAMILY PLANNING CLINIC 14 (GO TO 352)
MOBILE CLINIC 15 (GO TO 352)
GOVERNMENT PARAMEDIC 16 (GO TO 352)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 21 (GO TO 352)
PHARMACY/DRUGSTORE 22 (GO TO 352)
PRIVATE DOCTOR 23 (GO TO 352)
MOBILE CLINIC 24 (GO TO 352)
FIELD WORKER 25 (GO TO 352)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 352)
FRIENDS/RELATIVES 32 (GO TO 352)
OTHER (SPECIFY) ______ 41 (GO TO 352)
DOESN'T KNOW 98 (GO TO 352)

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

YES 1
NO 2 (GO TO 352)

351. What is that?

NAME OF HOSPITAL IF CODE 11 OR 21 _____
PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL 11
PRIMARY HEALTH CENTRE 12
SUB-CENTRE 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
GOVERNMENT PARAMEDIC 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 21
PHARMACY/DRUGSTORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELD WORKER 25
OTHER PRIVATE SECTOR
SHOP 31
FRIENDS/RELATIVES 32
OTHER (SPECIFY) ______ 41

352. In the last month, have you heard a message about family planning on:

The radio?
The television?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2

353. 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
DOESN'T KNOW 8

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 225:

ONE OR MORE BIRTHS SINCE JANUARY 1988 (GO TO 402)
NO BIRTHS SINCE JANUARY 1988 (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1988 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, RECORD ONLY THE LAST 3 BIRTHS).

Now I would like to ask you some more questions about the health of all your children born in the past four years. (We will talk about one child at a time)

LINE NUMBER FROM QUESTION 216:

LINE NO. ______

FROM QUESTIONS 216 AND Q.220:

NAME ______
LIVING ____
DEAD ____

403. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later or did you want no (more) children at all?

THEN 1 (GO TO 405)
LATER 2
NO MORE 3 (GO TO 405)

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

MONTHS 1 ______
YEARS 2 ______
DOESN'T KNOW 998

405. When you were pregnant with (NAME), did any health worker visit you at home for an antenatal check-up

YES 1
NO 2 (GO TO 408)

406. How many months pregnant were you when a health worker first visited you?

MONTHS ______

407. How many times did she visit you?

NO. OF VISITS ______

408. When you were pregnant with (NAME), did you go for an antenatal check-up?

YES 1
NO 2 (GO TO 412)

409. Whom did you see?
Anyone else?
RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
AYURVEDIC DOCTOR/VAID B
HOMEOPATH C
NURSE/MIDWIFE D
OTHER HEALTH PROFESSIONAL E
OTHER PERSON
TRAINED (TRADITIONAL) BIRTH ATTENDANT F
TRADITIONAL BIRTH ATTENDANT G
HAKIN H
OTHER (SPECIFY) _______ I

410. How many months pregnant were you when you first went for an antenatal check-up?

MONTHS _______

411. How many times did you go for an antenatal check-up?

NO. OF TIMES ______ (GO TO 413)

412. What is the main reason you did not go for an antenatal check-up?

LACK OF KNOWLEDGE OF SERVICES 01
NOT NECESSARY 02
NOT CUSTOMARY 03
FINANCIAL COST 04
INCONVENIENT 05
POOR QUALITY SERVICE 06
HEALTH STAFF VISIT AT HOME 07
NO TIME TO GO 08
NOT PERMITTED TO GO 09
OTHER (SPECIFY) ________ 10

413. Were you given any iron folic tablets during this pregnancy?

YES 1
NO 2

414. When you were pregnant with (NAME), were you given an injection in the arm to prevent you and the baby from getting tetanus, that is, convolutions?

YES 1
NO 2 (GO TO 416)
DOESN'T KNOW 8 (GO TO 416)

415. During this pregnancy how many times did you get this injection?

TIMES ___
DOESN'T KNOW 8

416. Where did you give birth to (NAME)?

HOME
YOUR HOME 11
PARENTS' HOME 12
OTHER HOME 13
PUBLIC SECTOR
GOVT. /MUNICIPL HOSPITAL 21
PRIMARY HEALTH CENTRE 22
SUB-CENTRE 23
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC/MATERNITY HOME 31
OTHER (SPECIFY) ________ 41

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

HEALTH PROFESSIONAL
DOCTOR A
AYURVEDIC DOCTOR/VAID B
NURSE/MIDWIFE C
ANM/LHV D
OTHER PERSON
TRAINED (TRADITIONAL) BIRTH ATTENDANT E
TRADITIONAL BIRTH ATTENDANT F
RELATIVE/FRIEND G
OTHER (SPECIFY) _______ H
NO ONE I

418. Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DOESN'T KNOW 8

419. Were there any complications in the delivery of (NAME)?

YES 1
NO 2 (GO TO 421)

420. What were the complications?
RECORD ALL MENTIONED.

CAESARIAN SECTION A
USE OF FORCEPS B
EXCESSIVE BLEEDING C
LONG PERIOD OF LABOR D
DELAYED DELIVERY OF PLACENTA E
OTHER (SPECIFY) _________ F

421. When (NAME) was born, was he/she: large, average or small?

LARGE 1
AVERAGE 2
SMALL 3
DOESN'T KNOW 8

422. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 424)

423. How much did (NAME) weigh?

GRAMS 1______
POUNDS 2
POUNDS ______
OUNCES ______
DOESN'T KNOW 99998

424. Has your period returned since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 426)
NO 2 (GO TO 427)

425. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 429)

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

MONTHS ______
DOESN'T KNOW 98

427. CHECK 227:
RESPONDENT PREGNANT?
[ASK FOR MOST RECENT BIRTH ONLY]

NOT PREGNANT (GO TO 428)
PREGNANT OR UNSURE (GO TO 429)

428. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 430)

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

MONTHS ______
DOESN'T KNOW 98

430. Did you ever breastfeed (NAME)?

YES 1 (GO TO 432)
NO 2

431. Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01(GO TO 442)
CHILD ILL/WEAK 02 (GO TO 442)
CHILD DIED 03(GO TO 442)
NIPPLE/BREAST PROBLEM 04 (GO TO 442)
INSUFFICIENT MILK 05 (GO TO 442)
MOTHER WORKING 06 (GO TO 442)
CHILD REFUSED 07 (GO TO 442)
OTHER (SPECIFY) ______ 08 (GO TO 442)

432. 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.
[ASK FOR MOST RECENT BIRTH ONLY]

IMMEDIATELY 000
HOURS 1______
DAYS 2______

433. Did you squeeze out the milk from the breast before you first put (NAME) to breast?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2

434. CHECK 220:
CHILD ALIVE?
[ASK FOR MOST RECENT BIRTH ONLY]

ALIVE (GO TO 435)
DEAD (GO TO 440)

435. Are you still breastfeeding (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 440)

436. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF NIGHTTIME FEEDINGS ____

437. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMBERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF DAYTIME FEEDING ____

438. At any time yesterday or last night, was (NAME) given any of the following?:
[ASK FOR MOST RECENT BIRTH ONLY]

PLAIN WATER
YES 1
NO 2
SUGAR/HONEY WATER
YES 1
NO 2
JUICE
YES 1
NO 2
TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
FRESH MILK
YES 1
NO 2
TINNED/POWDERED MILK
YES 1
NO 2
OTHER LIQUIDS
YES 1
NO 2
SOLID/MUSHY FOOD
YES 1
NO 2

439. CHECK 438:
FOOD OR LIQUID GIVEN YESTERDAY?
[ASK FOR MOST RECENT BIRTH ONLY]

"YES" TO ONE OR MORE (GO TO 444)
"NO" TO ALL (GO TO 443)

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

MONTHS ______
UNTIL DIED 96 (GO TO 443)

441. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) ______ 11

442. CHECK 220:
CHILD ALIVE?

ALIVE (GO TO 444)
DEAD (GO TO 443)

443. Was (NAME) ever given water or anything else to drink or eat (other than breast milk)?

YES 1
NO 2 (GO TO 447)

444. How many months old was (NAME) when you started giving the following on a regular basis?
IF LESS THAN 1 MONTH RECORD '00'

Plain water?
AGE IN MONTHS _______
NOT GIVEN 96
Formula or milk other than breast milk?
AGE IN MONTHS _______
NOT GIVEN 96
Other liquids?
AGE IN MONTHS _______
NOT GIVEN 96
Any solid or mushy food?
AGE IN MONTHS _______
NOT GIVEN 96

445. CHECK 220:
CHILD ALIVE?
[ASK FOR MOST RECENT BIRTH ONLY]

ALIVE (GO TO 446)
DEAD (GO TO 447)

446. Did (NAME drink anything from a bottle with a nipple yesterday or last night?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

447. GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 448.

SECTION 4B. IMMUNIZATION AND HEALTH

448. ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1988 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, RECORD ONLY THE LAST 3 BIRTHS.)

LINE NUMBER FROM QUESTION 216:

LINE NO. ______

FROM QUESTIONS 216 AND 220:

NAME ________
ALIVE_____
DEAD _____

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

YES, SEEN 1 (GO TO 451)
YES, NOT SEEN 2 (GO TO 453)
NO CARD 3

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

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

451. (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD
(2) WRITE '44' IN 'DAY' IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE RECORDED.

BCG
DAY____
MONTH _____
YEAR ____
P0
DAY____
MONTH _____
YEAR ____
D1
DAY____
MONTH _____
YEAR ____
D2
DAY____
MONTH _____
YEAR ____
D3
DAY____
MONTH _____
YEAR ____
P1
DAY____
MONTH _____
YEAR ____
P2
DAY____
MONTH _____
YEAR ____
P3
DAY____
MONTH _____
YEAR ____
MEA
DAY____
MONTH _____
YEAR ____

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 451) (GO TO 455)
NO 2 (GO TO 455)
DOESN'T KNOW 8 (GO TO 455)

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

YES 1
NO 2 (GO TO 455)
DOESN'T KNOW 8 (GO TO 455)

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

A BCG vaccination against tuberculosis, that is, an injection in the left shoulder that caused a scar?
YES 1
NO 2
DOESN'T KNOW 8
A vaccination against diphtheria, whooping cough and tetanus given as an injection?
IF YES: How many times?
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES _____
Polio vaccine, that is, drops in the mouth?
IF YES: How many times?
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES _____
IF YES: When was the first polio vaccine given -- just after birth or later?
JUST AFTER BIRTH 1
LATER 2
DOESN'T KNOW 8
An injection against measles?
YES 1
NO 2
DOESN'T KNOW 8

455. Was a dose of vitamin a liquid ever given to (NAME) to protect him/her from night blindness?

YES 1
NO 2
DOESN'T KNOW 8

456. Did (NAME) ever have:

WHOOPING COUGH?
YES 1
NO 2
MEASLES?
YES 1
NO 2
POLIO?
YES 1
NO 2
DIPHTHERIA?
YES 1
NO 2
CHICKEN POX?
YES 1
NO 2
RICKETS?
YES 1
NO 2

457. CHECK 220:
CHILD ALIVE?

ALIVE (GO TO 459)
DEAD (GO TO 458)

458. GO BACK TO 449 FOR NEXT BIRTH: OR, IF NO MORE BIRTHS, GO TO 489.

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 464)
DOESN'T KNOW 8 (GO TO 464)

461. Has (NAME) been ill with a cough in the last 24 hours?

YES 1
NO 2
DOESN'T KNOW 8

462. For how many days (has the cough lasted/did the cough last)?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS_______

463. When (NAME) was ill with a cough, did he/she breathe faster than usual with short, rapid breaths?

YES 1
NO 2
DOESN'T KNOW 8

464. CHECK 459 AND 460:
FEVER OR COUGH?

"YES" IN EITHER 459 OR 460 (GO TO 465)
OTHER (GO TO 469)

465. Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 467)

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

PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL A
PRIMARY HEALTH CENTRE B
SUB-CENTRE C
MOBILE CLINIC D
VILLAGE HEALTH GUIDE E
GOVERNMENT PARAMEDIC F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUGSTORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE SECTOR
SHOP L
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) _______ N

467. Was anything given to treat the fever/cough?

YES 1
NO 2 (GO TO 469)
DOESN'T KNOW 8 (GO TO 469)

468. What was given to treat the fever/cough?

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY) _______ H

469. Has (NAME) had diarrheas in the last two weeks?

YES 1 (GO TO 471)
NO 2
DOESN'T KNOW 8

470. GO BACK TO 449 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, SKIP TO 489.

471. Has (NAME) had diarrhea in the last 24 hours?

YES 1
NO 2
DOESN'T KNOW 8

472. For how many days (has the diarrhea lasted/did the diarrhea last)?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ______

473. Was there any blood in the stools?

YES 1
NO 2
DOESN'T KNOW 8

474. CHECK 430 AND 435:
LAST CHILD STILL BREASTFEEDING?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 477)

475. During (NAME)'s diarrhea, did you change the frequency of breastfeeding?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 477)

476. Did you increase the number of breastfeeds or reduce them, or did you stop completely?
[ASK FOR MOST RECENT BIRTH ONLY]

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

477. (Aside from breast milk), Was he/she given the same amount of fluids to drink as before the diarrhea, or more or less?

SAME 1
MORE 2
LESS 3
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 480)

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

PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL A
PRIMARY HEALTH CENTRE B
SUB-CENTRE C
MOBILE CLINIC D
VILLAGE HEALTH GUIDE E
GOVERNMENT PARAMEDIC F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUGSTORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE SECTOR
SHOP L
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) _______ N

480. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 482)
DOESN'T KNOW 8 (GO TO 482)

481. What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.

ORS FLUID FROM PACKET A
RECOMMENDED HOME FLUID B
ANTIBIOTIC (PILL OR SYRUP) C
OTHER PILL OR SYRUP D
INJECTION E
(I.V.) INTRAVENOUS F
HOME REMEDIES/HERBAL MEDICINE G
OTHER (SPECIFY) ________ H

482. CHECK 481:
ORS FLUID FROM PACKET MENTIONED?

YES, ORS FLUID MENTIONED (GO TO 484)
NO, ORS FLUID NOT MENTIONED

483. Was (NAME) given fluid made from an ORS packet when he/she had the diarrhea?

YES 1
NO 2 (GO TO 485)
DOESN'T KNOW 8 (GO TO 485)

484. For how many days was (NAME) given the ORS fluid?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ______
DOESN'T KNOW 98

485. CHECK 481:
RECOMMENDED HOME FLUID MENTIONED?

YES, HOME FLUID MENTIONED (GO TO 487)
NO, HOME FLUID NOT MENTIONED (GO TO 486)

486. Was (NAME) given a recommended home fluid made from sugar, salt and water when he/she had the diarrhea?

YES 1
NO 2 (GO TO 488)
DOESN'T KNOW 8 (GO TO 488)

487. For how many days was (NAME) given the fluid made from sugar, salt and water?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ______
DOESN'T KNOW 98

488. GO BACK TO 449 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 489.

489. CHECK 481 AND 483:

ORS FLUID FROM PACKET GIVEN TO ANY CHILD (GO TO 492)
ORS FLUID FROM PACKET NOT GIVEN TO ANY CHOLD OR 481 AND 483 NOT ASKED (GO TO 490)

490. Have you ever heard of a special product called ORS you can get for the treatment of diarrhea?

YES 1 (GO TO 492)
NO 2

491. Have you ever seen a packet like one of these before?
SHOW BOTH THE W.H.O AND A COMMERICAL PACKET.

YES 1
NO 2 (GO TO 496)

492. Have you ever prepared a solution with one of these packets to treat diarrhea for yourself or someone else?
SHOW BOTH THE W.H.O. AND A COMMERCIAL PACKET.

YES 1
NO 2 (GO TO 495)

493A. The last time you prepared the ORS, did you use the free W.H.O packet (SHOW THE W.H.O PACKET) or an alternative commercial packet (SHOW THE COMMERCIAL PACKET)?

FREE WHO PACKET 1
ALTERNATIVE COMMERICIAL PACKET 2

493. The last time you prepared the ORS, did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
PART OF PACKET 2
DOESN'T KNOW 8 (GO TO 495)

494. How much water did you use to prepare ORS the last time you made it?

200 ML. GLASSES 1 ______
1\2 LITER 901
1 LITER 902
1 1\2 LITER 903
2 LITERS 904
FOLLOWED PACKAGE INSTRUCTIONS 905
OTHER (SPECIFY) _______ 906
DOESN'T KNOW 998

495. Where can you get the ORS packet?
PROBE: Anywhere else?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL A
PRIMARY HEALTH CENTRE B
SUB-CENTRE C
MOBILE CLINIC D
VILLAGE HEALTH GUIDE E
GOVERNMENT PARAMEDIC F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUGSTORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE SECTOR
SHOP L
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) ________ N

496. CHECK 481 AND 486:

HOME-MADE FLUID GIVEN TO ANY CHILD (GO TO 497)
HOME-MADE FLUID NOT GIVEN TO ANY CHILD OR 481 AND 486 NOT ASKED (GO TO 501)

497.Where did you learn to prepare the recommended home fluid made from sugar, salt and water given to (NAME) when he/she had diarrhea?

PUBLIC SECTOR
GOVT./MUNICIPAL HOSPITAL 11
PRIMARY HEALTH CENTRE 12
SUB-CENTRE 13
MOBILE CLINIC 14
VILLAGE HEALTH GUIDE 15
GOVERNMENT PARAMEDIC 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUGSTORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE SECTOR
SHOP 31
TRADITIONAL PRACTITIONER 32
MASS MEDIA
TELEVISION 41
RADIO 42
PRINTED MATERIAL 43
OTHER (SPECIFY) _______ 51

SECTION 5. FERTILITY PREFERENCES

501. CHECK 107:

CURRENTLY MARRIED (GO TO 502)
WIDOWED/DIVORCED/SEPARATED (GO TO 514)

502. CHECK 313:

NEITHER STERILIZED (GO TO 503)
HE OR SHE STERILIZED (GO TO 508)

503. CHECK 227:

NOT PREGNANT OR UNSURE:
Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any(more) children?

PREGNANT
Now I have some questions about the future. After the child you are expecting, would you like to have child or would you prefer not to have any more children?

HAVE A (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 510)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 510)
UP TO GOD 4 (GO TO 510)
UNDECIDED OR DOESN'T KNOW 8 (GO TO 510)

504. Would you prefer your next child to be a boy or a girl or doesn't it matter?

BOY 1
GIRL 2
DOESN'T MATTER 3
UP TO GOD 4

505. CHECK 227:

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

PREGNANT
How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS 1 ____ (GO TO 510)
YEARS 2 ____ (GO TO 510)
SOON/NOW 994 (GO TO 510)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 510)
OTHER (SPECIFY) _______ 996
DOESN'T KNOW 998

506. CHECK 220 AND 227:
HAS LIVING CHILD(REN) OR PREGNANT?

YES (GO TO 507)
NO (GO TO 510)

507. CHECK 227:

NOT PREGNANT OR UNSURE
How old would you like your youngest child to be when your next child is born?

PREGNANT
How old would you like the child you are expecting to be when your next child is born?

AGE OF CHILD IN YEARS ______ (GO TO 510)
DOESN'T KNOW 98 (GO TO 510)

508. Do you regret that (you/your husband) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO 514)

509. Why did you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 514)
WANTS TO REPLACE CHILD WHO DIED 2 (GO TO 514)
HUSBAND WANTS ANOTHER CHILD 3 (GO TO 514)
SIDE EFFECTS 4 (GO TO 514)
OTHER (SPECIFY) ______ 5 (GO TO 514)

510. Do you think that your husband approves or disapproves of couples using a method to avoid a pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

511. How often have you talked to your husband about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

512. Have you and your husband ever discussed the number of children you would like to have?

YES 1
NO 2

513. Do you think your husband 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
DOESN'T KNOW 8

514. How long should a couple wait before starting sexual intercourse after the birth of a baby?

DAYS 1 ______
MONTHS 2 ______
YEARS 3 ______
UP TO COUPLE 995
OTHER (SPECIFY) _______996

515. In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2

516. CHECK 220:

HAS LIVING CHILD(REN)
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 life, how many would that be?

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER ______
OTHER ANSWER (SPECIFY) ______ 96 (GO TO 518)

517. How many of these children would you like to be boys and how many would you like to be girls?

BOYS ____
GIRLS____
EITHER_____
OTHER (SPECIFY) ______ 999996

518. In your opinion, what is the ideal interval between the birth of one child and the birth of the next child?

MONTH 1 _____
YEARS 2 _____
OTHER (SPECIFY) ______ 996

SECTION 6. HUSBAND'S BACKGROUND AND WOMAN'S WORK

601. CHECK 107:

CURRENTLY MARRIED (ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND.)

WIDOWED/DIVORCED/SEPARATED (GO TO 603)

602. How old was your husband on his last birthday?

AGE IN COMPLETED YEARS ______

603. Did your (last) husband ever attend school?

YES 1
NO 2 (GO TO 606)

604. What is the highest grade he completed?

GRADE _____

605. CHECK 604:

GRADE 0-5 (GO TO 606)
GRADE 6-12 (GO TO 608)
GRADE 13+ (GO TO 607)

606. (Can/Could) he read and write?

YES 1 (GO TO 608)
NO 2 (GO TO 608)

607. What is the highest degree he obtained?

DEGREE NOT COMPLETED 01
NON-TECHNICAL DEGREE
BACHELOR'S DEGREE 02
MASTER'S DEGREE 03
PH.D 04
TECHNICAL DEGREE
BACHELOR'S DEGREE 05
MASTER'S DEGREE 06
TECHNICAL DIPLOMA/CERTIFICATE NOT EQUIVANLENT TO DEGREE 07
NON-TECHNICAL DIPLOMA/CERTIF. NOT EQUIVALENT TO DEGREE 08
OTHER (SPECIFY) _______ 09

608. What kind of work does (did) your (last) husband mainly do?

_______

609. CHECK 608:

WORKS (WORKED) IN AGRICULTURE (GO TO 610)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 611)

610. (Does/did) your husband work mainly on his own land or family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS/FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

611. Aside from your own housework, are you currently working?

YES 1 (GO TO 613)
NO 2

612. 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?

YES 1
NO 2 (GO TO 620)

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

______

614. In your current work, do you work on the family farm/business, are your employed by someone else, or are you self-employed?

FAMILY FARM/BUSINESS 1
EMPLOYED BY SOMEONE ELSE 2
SELF-EMPLOYED 3

615. Do you earn cash from this work?
PROBE: Do you make money for working?

YES 1
NO 2

616. Do you do this work at home or away from home?

HOME 1
AWAY 2

617. CHECK 219/220/222:
HAS CHILD BORN SINCE JANUARY 1988 AND LIVING AT HOME?

YES (GO TO 618)
NO (GO TO 620)

618. While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1 (GO TO 620)
SOMETIMES 2
NEVER 3

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

HUSBAND 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY) ______ 09

620. RECORD THE TIME:

HOUR ______
MINUTES ______

621. PRESENCE OF OTHERS DURING MOST OF THE INTERVIEW TIME:

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
MOTHER-IN-LAW
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 7. HEIGHT AND WEIGHT

701. CHECK 219/220:

ONE OR MORE LIVING CHILDREN BORN SINCE JAN. 1988 (GO TO NEXT)
NONE LIVING CHILDREN BORN SINCE JAN. 1988, END INTERVIEW.

INTERVIEWER: IN 702 RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1988 AND STILL ALIVE. IN 703 AND 704 RECORD THE NAME AND BIRTH DATE FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1988. IN 705 AND 707 RECORD THE HEIGHT AND WEIGHT OF THE LIVING CHILDREN. (NOTE: IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1988, USE ADDITIONAL FORMS)

702. LINE NO. FROM QUESTION 216:

LINE NO. ______

703. NAME FROM QUESTION 216 FOR CHILDREN

NAME_______

704. DATE OF BIRTH.
FROM QUESTION 219 FOR CHILDREN, COPY MONTH AND YEAR OF BIRTH AND ASK FOR DAY OF BIRTH

DAY _____
MONTH ______
YEAR ______

705. HEIGHT (in centimeters)

CM ______

706. WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP?

LYING 1
STANDING 2

707. WEIGHT (in kilogram)

KG ______

708. DATE WEIGHED AND MEASURED.

DAY ______
MONTH ______
YEAR ______

709. RESULT:

CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) _______ 6

710. NAME OF MEASURE_______
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 ________
DATE ________

EDITOR'S OBSERVATIONS ______