IDENTIFICATION

STATE ________
DISTRICT ________
TEHSIL/TALUK _________
CITY/TOWN/VILLAGE ________

URBAN/RURAL _______

LARGE CITY/SMALL CITY/TOWN/RURAL AREA _______

PSU NUMBER ________
HOUSEHOLD HUMBER ________
NAME AND LINE NUMBER OF WOMAN ________
ADDRESS OF HOUSEHOLD ________

INTERVIEWER VISITS

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

RESULT____

NEXT VISIT
DATE _______
TIME _______

FINAL VISIT
DAY _______
MONTH _______
YEAR 19______
NAME CODE _______
RESULT CODE _______

TOTAL NUMBER OF VISIT ________

NATIVE LANGUAGE OF RESPONDENT ______

SUPERVISOR
NAME _______
DATE _______

FIELD EDITOR
NAME _______
DATE _______

OFFICE EDITOR
NAME _______
DATE ______

KEYED BY
NAME ______
DATE ______

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME

Namaste. My name is _______ and I am working with (NAME OF ORGANIZATION). We are conducting a national survey about the health of women, men, and children. We would very much appreciate your participation in this survey.

I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The amount of time needed will be less than one hour. Participation in this survey is voluntary. If you decide to participate, you may stop answering questions at any time. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

We hope that you will participate in this survey since your views is important. Do you want to ask me anything about the survey at this time?

SIGNATURE OF INTERVIWER ________
DATE ________

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, a town, or a village?

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

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

105. In what month and year were you born?

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

107. What is your current marital status?

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

109. For how long have you and your husband not been living together?
IF LESS THAN 1 YEAR, RECORD MONTHS; OTHERWISE RECORD COMPLETED YEARS.

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

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

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

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

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

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

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

116. Have you ever attended school?

117. What is the highest grade you completed?

118. CHECK 117:

119. Can you read and write?

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

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

122. Do you watch television at least once a week?

123. Do you usually go to a cinema hall or theatre to see a movie at least once a month?

124. How often do you yourself consume the following items: daily, weekly, occasionally, or never:

Milk or Curd?
Pulses or beans?
Green leafy vegetables?
Other vegetables?
Fruits?
Eggs?
Chicken, meat, or fish?

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?

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

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

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

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

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

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

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

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

210. CHECK 208:

Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

211. RECORD NAMES OF ALL THE LIVE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).

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

213. Were any of these births twins?

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

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

216. Is (NAME) still alive?

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

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

218A. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD
RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD

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

220. Between (NAME OF PREVIOUS BIRTH) and (NAME OF THIS BIRTH) did you have any stillbirth, spontaneous abortion, or induced abortion?
FOR FIRST CHILD ASK: Before (NAME), did you have any stillbirth, spontaneous abotion, or induce abortion?

IF NONE, RECORD '0'. FOR SECOND TWIN, RECORD '0' IN EACH BOX WITHOUT ASKING.

221. After the last birth, did you have any stillbirth, spontaneous abortion, or induce abortion?
IF NONE, RECORD '0'.

222. CHECK 220 AND 221:
Just to make sure that I have this right: you have had in TOTAL ____STILLBIRTHS, ____ SPONTANEOUS ABORTIONS, and ___ INDUCED ABORTIONS during your life: Is that correct?

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

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

225. Have you ever had a stillbirth?

226. How many stillbirths have you had?

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

228. Have mnay abortions have you had?
PROBE FOR NUMBER OF SPONTANEOUS AND INDUCED ABORTIONS.
IF NONE, RECORD '0'.

229. CHECK 107:

230. Are you pregnant now?

231. How many months pregnant are you?

232. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

233. When did your last menstrual period start?

SECTION 3A. QUALITY OF CARE

301. During the last 12 months, has a health or family planning worker visited you at home?

302. How many times did a worker visit you in the last 12 months?

303. During these visits, what were the different matters talked about?
Anything else?
RECORD ALL MENTIONED.

304. When was the last time a health or family planning worker visited you at home?
IF LESS THAN ONE MONTH, RECORD '00' MONTHS.

305. Who visited you at that time?

305A. What type of services did you receive during this visit?
Any other service?
RECORD ALL MENTIONED.

306. Did she/he spend enough time with you?

307. Did she/he talk to you nicely, somewhat nicely, or not nicely?

308. Have you visited a health facility or camp for any reason for yourself (or your children) in the last 12 months?

309. During these visits in the last 12 months, what were the different matters talked about? Anything else?
RECORD ALL MENTIONED.

310. What type of health facility did you visit most recently for yourself (or your children)?

311. What service did you go for?
Any other service?
RECORD ALL MENTIONED.

311A. Did you receive the service that you went for?

312. CHECK 311A:

RECEIVED SERVICE:
How long did you have to wait before being served?

DID NOT RECEIVE SERVICE
How long did you have to wait before you learned that the service you went for would not be available?

313. During this visit did the staff spend enough time with you?

314. Did the staff talk to you nicely, somewhat nicely, or not nicely?

315. Did the staff respect your need for privacy?

316. Would you say the health facility was very clean, somewhat clean, or not clean?

Now I would like to ask about all the contacts you have had with health or family planning workers at home or anywhere else in the last 12 months or ever before.

317. During any of these contacts, which methods of delaying or avoiding pregnancy were discussed, if any?
PROBE: Any other methods discussed?
RECORD ALL MENTIONED.

SECTION 3B. 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

318. For each method I mention, please tell me if you have ever heard of the method and whether you have ever used the method at any time in your life?

319. CHECK 318:

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

321. What have you used or done?
CORRECT 318 AND 319.

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

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

323. CHECK 107:

324. CHECK 230:

325. CHECK 318:

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

327. Which method are you using?
327A. CIRCLE '04' FOR FEMALE STERILIZATION.
CIRCLE '05' FOR MALE STERILIZATION.

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

329. Where did you obtain the pills/condoms the last time?

IF SOURCE IS HOSPITAL OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF PLACE AND CIRCLE THE APPROPRIATE CODE.

330. Do you know where this person obtained the pills/condoms the last time?

IF SOURCE IS HOSPITAL OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF PLACE AND CIRCLE THE APPROPRIATE CODE.

331. May I see the packet of pills/condoms you are using now?
IF PACKET SEEN, RECORD BRAND NAME.

332. Do you know the brand name of the pills/condoms you are using now?

333. How much does one packet of pills/condoms cost you?

334. For that cost how many condoms/pill cycles do you get?

335. Have you been able to get the supply of pills/condoms whenever you need them?

336. For how many months have you been using the IUD/LOOP continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

337. Who inserted the IUD/LOOP?

338. Where did you go to get the IUD/LOOP inserted?

338A. How much did the IUD/LOOP insertion cost you?
IF NO CHARGE, RECORD `0000'.

339. In what month and year was your/your husband's sterilization operation performed?

340. Where did you/your husband get sterilized?

341. How much did the operation cost you?
IF NO CHARGE, RECORD '0000'.

342. How would you rate the care you/your husband received during or immediately after the operation/IUD insertion: very good, all right, not so good, or bad?

343. What improvements would you suggest in the care you/your husband received during or immediately after the operation/IUD insertion? Anything else?
RECORD ALL MENTIONED.

344. Who mainly motivated you to use (CURRENT METHOD)?

345. Did he/she tell you about any other methods that you might use?

346. Which other methods were you told about?
RECORD ALL MENTIONED.

347. At the time when you accepted the (CURRENT METHOD) did any health or family planning worker tell you about side effects or other problems you might have using the (CURRENT METHOD)?

348. Were you told what to do in case you experienced problems with the method?

349. Did you receive any follow-up, either at home or in a health facility, after you accepted the (CURRENT METHOD)?
PROBE FOR TYPE OF VISIT.

350. For how long have you been using this method continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

351. Have you had any problems related to the use of (CURRENT METHOD)?

352. What problems have you had related to the use of (CURRENT METHOD)?
PROBE: Any other problems?
RECORD ALL MENTIONED.

353. When you first started having these problems, did you talk to anyone about these problems?

354. Who did you talk to about these problems?
Any other person?
RECORD ALL PERSONS TALKED TO.

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

356. CHECK 107:

356A. CHECK 230:

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

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

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

360. Which method would you prefer to use?

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

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

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

364. In the last few months, have you heard or seen any message about family planning:

on radio?
on television?
in a cinema or film show?
in a newspaper or magazine?
on a wall painting or hoarding?
in a drama, folk dance, or street play?

SECTION 4A. ANTENATAL, NATAL, AND POSTNATAL CARE

401. CHECK 224:

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF LAST TWO BIRTHS SINCE JANUARY 1995 IN THE TABLE. ASK THE QUESTIONS ABOUT THESE TWO BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, RECORD ONLY LAST TWO BIRTHS.)

Now I would like to ask you some questions about the health of your children born since January 1995. (We will talk about one child at a time.)

LINE NUMBER FROM QUESTION 212:

FROM QUESTIONS 212 AND 216:

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?

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

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

406. Whom did you see?
Anyone?
RECORD ALL PERSONS SEEN.

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

408. CHECK 405 AND 407:

409. How many months pregnant were you when you first received an antenatal check-up?

410. How many times did you receive antenatal check-ups during this pregnancy?

411. Did you have the following performed at least once during any of your antenatal check-ups for this pregnancy:

Weight measured?
Height measured?
Blood pressure checked?
Blood?
Urine?
Abdomen examined?
Internal exam?
X-ray?
Sonogram or ultrasound?
Amniocentesis?

412. Did you receive advice on any of the following during at least one of your antenatal check-ups for this pregnancy:

Diet?
Danger signs of pregnancy?
Delivery care?
Newborn care?
Family planning?

413. What is the main reason you did not receive an antenatal check-up?

414. When you were pregnant with (NAME), did you experience any of the following problems at any time:

Night blindness? (USE LOCAL TERM)
Blurred vision?
Convulsions not from fever?
Swelling of the legs, body, or face?
Excessive fatigue?
Anemia?
Any vaginal bleeding?

415. When you were pregnant with (NAME), were you given any iron folic tablets or syrup?

416. Did you receive enough iron folic tablets or syrup to last about three months or longer?

417. Did you consume all the iron folic tablets or syrup you were given ?

418. When you were pregnant with (NAME), were you given an injection in the arm to prevent you and the baby from getting tetanus (USE LOCAL TERM FOR TETANUS)?

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

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

421. What is the main reason you did not go to a health facility for delivery?

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

423. CHECK 422:

424. What is the main reason you did not receive an antenatal check-up?

425. Was (NAME) delivered by caesarian section?

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

427. Was (NAME) weighted at birth?

428. How much did (NAME) weigh?

Now I would like to ask you about the 2-month period after the delivery of (NAME).

429. During that period, did a doctor or other health professional check your health or the health of your baby?

430. How soon after the birth of (NAME) did you first get a check-up?

431. Where did you get the check-up?

432. Did any of the following happen when you had the check-up:

Was your abdomen examined?
Did you receive advice on family planning?
Did you receive advice on breastfeeding?
Did you receive advice on baby care?

433. At any time during the two months after the delivery of (NAME), did you have any of the following: Massive vaginal bleeding? Very high fever?

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

435. Did your period return between the birth of (NAME) and your next pregnancy?
[ASK FOR SECOND-TO-LAST BIRTH ONLY]

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

437. CHECK 230:
RESPONDENT PREGNANT?
[ASK FOR MOST RECENT BIRTH ONLY]

438. Have you resumed sexual relations since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

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

440. Did you ever breastfeed (NAME)?

441. Why did you not breastfeed (NAME)?

442. 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.

443. Did you squeeze out the milk from the breast before you first put (NAME) to the breast?

444. CHECK 216:
CHILD ALIVE?

445. Are you still breastfeeding (NAME)?

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

447. Why did you stop breastfeeding (NAME)?

448. CHECK 216:
CHILD ALIVE?

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

450. At any time yesterday or last night, was (NAME) given any of the following:

Plain water?
Powdered milk?
Any other milk (other than breast milk)?
Any other liquid?
Green, leafy vegetables?
Fruits?
Any other solid or mushy food?

451. How often during the last seven days was (NAME) given any of the following:

Plain water?
Powdered milk?
Any other milk (other than breast milk)?
Any other liquid?
Green, leafy vegetables?
Fruits?
Any other solid or mushy food?

452. FOR THE MOST RECENT BIRTH: GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 453 FOR THE SECOND-TO-LAST BIRTH: GO TO 453

SECTION 4B. IMMUNIZATION AND HEALTH

453. ENTER THE LINE NUMBER AND NAME OF LAST TWO BIRTHS SINCE JANUARY 1995 IN THE TABLE. ASK THE QUESTIONS ABOUT THESE TWO BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, RECORD ONLY LAST TWO BIRTHS.)

LINE NUMBER FROM QUESTION 212:

FROM QUESTIONS 212 AND 216:

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

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

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

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

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

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

459A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

459B. A DPT vaccination against diphtheria, whooping cough, and tetanus given as an injection?

459C. How many times?

459D. Polio vaccine, that is, drops in the mouth?

459E. How many times?

459F. When was the first polio vaccine given just after birth or later?

459G. An injection against measles?

460. CHECK 456:
ANY VACCINATIONS RECEIVED?

461. Where did (NAME) receive most of his/her vaccinations?

462. Was a dose of vitamin A liquid or capsule ever given to (NAME) to protect him/her from night blindness (USE LOCAL TERM)?

463. How many months ago did (NAME) receive the last dose of Vitamin A?

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

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

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

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

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

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

470. Was there any blood in the stools?

471. (Including breast milk) Was he/she given the same amount to drink as before the diarrhoea, or more, or less?

472. Was he/she given the same amount of food as before the diarrhoea, or more, or less?

473. Did you seek advice or treatment for the diarrhoea?

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

475. When (NAME) had diarrhoea, was he/she given any of the following to drink:

A fluid made from a special packet called [LOCAL NAME]?
Gruel made from rice [OR OTHER LOCAL GRAIN, TUBER, OR PLANTAIN]?

476. CHECK 475:
FLUID FROM ORS PACKET GIVEN?

477. Where did you obtain the ORS packet?

478. Was anything (else) given to treat the diarrhoea?

479. What was given to treat the diarrhoea?
Anything else?
RECORD ALL MENTIONED.

480. FOR THE LAST BIRTH, GO BACK TO 454 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 481. FOR THE NEXT-TO-LAST BIRTH, GO TO 481.

481. CHECK 475 ALL COLUMNS:

482. Have you ever heard of a special product called (LOCAL TERM FOR ORS) you can get for the treatment of diarrhoea?
IF SHE NEVER HEARD OF ORS, SHOW GOVERNMENT AND COMMERCIAL ORS PACKETS AND ASK: Have you ever seen a packet like one of these before?

483. When a child has diarrhoea, should he/she be given less to drink than usual, about the same amount, or more than usual?

484. When a child is sick with diarrhoea, what signs of illness would tell you that he or she should be taken to a health facility or health worker? Any other signs?
RECORD ALL MENTIONED.

485. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
Any other signs?
RECORD ALL MENTIONED.

Now I would like to ask you about some health symptoms you yourself may have.

486. During the past three months, have you had any of the following problems with your vaginal discharge:

Any itching or irritation in vaginal area with the discharge?
A bad odour along with the discharge?
Severe lower abdominal pain with the discharge, not related with menstruation?
A fever along with the discharge?
Any other problem with the discharge?

487. During the past three months have you had a problem with pain or burning while urinating, or have you had more frequent or difficult urination?

488. CHECK 107:

489. Another problem some women have is feeling pain in their abdomen or vagina during intercourse. Do you often experience this kind of pain?

490. Do you ever see blood after having sex, at times when you are not menstruating?

491. CHECK 486, 487, 489 AND 490:

492. Have you seen anyone for advice or treatment to help you with (this problem/these problems)?
IF YES, ASK: Whom did you see? Anyone else?
RECORD ALL PERSONS SEEN.

SECTION 5A. FERTILITY PREFERENCES

501. CHECK 107:

502. CHECK 327/327A:

503. CHECK 230:

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 another child or would you prefer not to have any more children?

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

505. CHECK 230:

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?

506. CHECK 230:

NOT PREGNANT OR UNSURE
Do you think your husband would like to have (a/another) child or do you think he would prefer not have any (more) children?

PREGNANT
After the child you are expecting, do you think your husband would like to have another child or do you think he would prefer not have any more children?

507. CHECK 216:

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 to have in exactly the number of children to have in your whole life, how many would that be?

RECORD SINGLE NUMBER OR OTHER ANSWER.

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

509. In your opinion, how much education should be given to girls these days?

510. In your opinion, how much education should be given to boys these days?

SECTION 5B. STATUS OF WOMAN

511. Who makes the following decisions in your household:

What items to cook?
Obtaining health care for yourself?
Purchasing jewellery or other major household items?
Your going and staying with parents or siblings?

512. Do you need permission to: go to the market? To visit relatives or friends?

513. Are you allowed to have some money set aside that you can use as you wish?

514. Sometimes a wife can do things that bother her husband. Please tell me if you think that a husband is justified in beating his wife in each of the following situations:

If he suspects her of being unfaithful?
If her natal family does not give expected money, jewellery, or other items?
If she shows disrespect for in-laws?
If she goes out without telling him?
If she neglects the house or children?
If she doesn't cook food properly?

515. Since you completed 15 years of age, have you been beaten or mistreated physically by any person?

516. Who has beaten you or mistreated you physically?
Anyone else?
RECORD ALL PERSONS MENTIONED.

517. How often have you been beaten or mistreated physically in the last 12 months: once, a few times, many times, or not at all?

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

601. CHECK 107:

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

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

604. What is the highest grade he completed?

605. CHECK 604:

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

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

608. CHECK 607:

609. (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?

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

611. 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?

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

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

614. Do you do this work for your family's farm or business, for someone else, or are you self-employed?

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

616. Are you paid in cash or kind for this work, or are you not paid at all?

617. Generally, how much do your earnings contribute to the total family earnings: almost none, less than half, about half, more than half, or all?

618. Who mainly decides how the money you earn will be used?

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

620. CHECK 215/218:
HAS CHILD BEEN BORN SINCE JAN. 1995 AND LIVING AT HOME?

621. 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?

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

SECTION 7. AIDS

701. Have you ever heard of an illness called AIDS?

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

703. Is there anything a person can do to avoid getting AIDS?

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

705. RECORD THE TIME

706. PRESENCE OF OTHERS DURING MOST OF THE INTERVIEW TIME.

HEALTH INVESTIGATOR VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISIT)
DATE _____
INVESTIGATOR'S NAME _____
RESULT _____

NEXT VISIT
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR 19__
NAME CODE ____
RESULT CODE ____

TOTAL NUMBER OF VISITS ____

SECTION 8: HEIGHT AND WEIGHT

INTERVIEWER: IN 801 (COLUMNS 23) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1995 AND STILL ALIVE. IN 802 AND 803 RECORD THE NAME OF THE RESPONDENT AND ALL HER LIVING CHILDREN BORN SINCE JANUARY 1995, AND THE DATE OF BIRTH OF THE CHILDREN. IN 804 AND 806 RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND LIVING CHILDREN.
(NOTE: IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1995, CHECK BOX AND USE ADDITIONAL QUESTIONNAIRE)

[REPEAT QUESTIONS 801-809 FOR RESPONDENT, LAST BIRTH, AND NEXT-TO-LAST BIRTH]

801. LINE NUMBER FROM QUESTION 212
[DO NOT ASK FOR MOST RECENT BIRTH]

802. NAME FROM QUESTION 212 FOR CHILDREN

803. DATE OF BIRTH
[DO NOT ASK FOR MOST RECENT BIRTH]

FROM QUESTION 215 FOR CHILDREN, COPY MONTH AND YEAR OF BIRTH AND ASK FOR DAY OF BIRTH

804. HEIGHT (IN CENTIMETERS)

805. WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP?
[DO NOT ASK FOR MOST RECENT BIRTH]

806. WEIGHT (IN KILOGRAMS)

807. DATE WEIGHED AND MEASURED

808. RESULT

809. NAME OF MEASURER _______
NAME OF ASSISTANT_______

SECTION 9. ANAEMIA

901. As a part of this survey, we are studying anaemia among women and children. We request your cooperation in this regard. This will assist the Government of India to develop programs to prevent and treat anaemia.

Anaemia is a serious health problem in India, which results from poor nutrition. However, if a person is found to have anaemia, the person can be given iron folic tablets to cure the disease.

[We are also doing research on lead poisoning among children and we request your cooperation in this regard. This will assist the Government of India to develop programs to prevent and treat lead poisoning. The benefit to you is that you will learn whether your child has a high lead exposure that needs to be addressed. If children are exposed to too much lead from the environment around them, it can harm their intelligence, growth and hearing and can contribute to anaemia. However, it is possible to take steps to decrease the amount of lead that a child is exposed to. Children with severe lead poisoning can get medical treatment.]

If you decide to be tested for anaemia, we will request that you give a drop of blood from your finger for the test. (Also, if you have a child under 3 years old, please allow me to take a (few) drop(s) of blood from him/her for anaemia [and lead] testing). We will use disposable sterile instruments that are clean and completely safe. Your child will feel a slight pinch when the blood is drawn. There is essentially no risk to your child from this procedure. The blood will be analyzed with new equipment provided by the United Nations. The result(s) of the test(s) will be given to you right after the blood is taken. The results of the tests will be kept confidential and will not be shown to other persons. Are there any questions about the blood testing that you would like to ask me now?

May I ask you now to give your consent to have the test(s) done. If you decide not to have the test(s), it is your right, and we will respect your decision. Now please tell me whether you agree to have the test(s) (and allow me to test your child).

AFTER EXPLAINING THE ABOVE, I HAVE FOUND THAT (NAME OF RESPONDENT) AGREED TO GIVE A (FEW) DROP(S) OF BLOOD FOR HERSELF [AND FOR HER CHILD (REN) NAMED (NAME OF CHILD(REN))]

SIGNATURE OF INTERVIEWER ________
DATE ________

SIGNATURE OF WITNESS ________
DATE ________

(STATEMENTS ABOUT IN SQUARE BRACKETS WERE ADDED ONLY FOR USE IN DELHI AND MUMBAI)

902. RESPONDENT'S HAEMOGLOBIN LEVEL (G/DL)

903. RESULT

904. CHECK 215/216:

[IN 905 RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1995 AND STILL ALIVE. IN 906 RECORD THE NAMES OF THE LIVING CHILDREN. IN 907 RECORD THE HAEMOGLOBIN LEVEL IN THE BLOOD OF THE LIVING CHILDREN.
(NOTE:IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1995, CHECK BOX AND USE ADDITIONAL QUESTIONNAIRE)]

905. LINE NUMBER FROM QUESTION 212

906. NAME FROM QUESTION 212

907. HAEMOGLOBIN LEVEL IN THE BLOOD (G/DL)

DELHI AND MAHARASHTRA ONLY:

907A. CHECK SAMPLE:
IS PSU IN LEAD TESTING SAMPLE?

907B. LEAD LEVEL IN THE BLOOD (µg/dL)

908. RESULT

909. NAME OF MEASURER ________

910. CHECK 902 AND 907:

911. CHECK COLUMN (5) OF HOUSEHOLD SCHEDULE:

912. We detected a low level of haemoglobin in your (your child's) blood. This indicates you (your child) have developed severe anaemia, which is a serious health problem. We would like to inform the doctor at _______ about your (your child's) condition. This will assist you to obtain appropriate treatment of your (your child's) condition.

Do you agree that the information about the level of haemoglobin in your (your child's) blood may be given to the doctor.

AFTER EXPLAINING THE ABOVE, I HAVE FOUND THAT (NAME OF RESPONDENT)
AGREED FOR REFERRAL FOR HERSELF [AND FOR HER CHILD(REN), (NAME OF CHILD(REN))]

SIGNATURE OF INTERVIEWER ________
DATE ________

913. RECORD NAMES OF WOMAN AND CHILD (REN) WITH HAEMOGLOBIN LEVEL LESS THAN 7 G/DL ON REFERRAL FORM.

DELHI AND MAHARASHTRA ONLY:

913A. CHECK 907B:

913B. We detected a high level of lead in your child's blood. This indicates your child has developed lead poisoning, which is a serious health problem. We would like to inform the doctor at________ about your child's condition. This will assist you to obtain appropriate treatment of your child's condition.

Do you agree that the information about the level of lead in your child's blood may be given to the doctor?

AFTER EXPLAINING THE ABOVE, I HAVE FOUND THAT (NAME OF RESPONDENT)
AGREED FOR REFERRAL FOR HER CHILD(REN), (NAME OF CHILD(REN)).

SIGNATURE OF INVESTIGATOR________
DATE ________

SIGNATURE OF WITNESS _______
DATE ________

DELHI, MAHARASHTRA, AND TAMIL NADU ONLY:

914. Would you mind if we come again for a similar study at some future date after a year or so?

INTERVIEWER'S OBSERVATIONS
(TO BE FILLED OUT AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT _______
COMMENTS ON SPECIFIC QUESTIONS _______
ANY OTHER COMMENTS ______

SUPERVISOR'S OBSERVATIONS/COMMENTS _______
NAME OF SUPERVISOR _______
DATE ______

EDITOR'S OBSERVATIONS/COMMENTS _______
NAME OF EDITOR _______
DATE ______

RESULTS OF HAEMOGLOBIN MEASUREMENT IN THE BLOOD

DATE _______

HAEMOGLOBIN LEVEL IN THE BLOOD (G/DL):

WHO CLASSIFICATION OF ANAEMIA:

- NORMAL LEVEL: HB LEVEL ABOVE 11 G/DL
- MILD ANAEMIA: HB (10-10.9 G/DL)
- MODERATE ANAEMIA: HB (7-9.9 G/DL)
- SEVERE ANAEMIA HB (LESS THAN 7 G/DL)

In case of severe anaemia (Hb less than 7 G/DL), we recommend that you immediately contact your doctor.

DELHI AND MAHARASHTRA ONLY: RESULTS OF LEAD MEASUREMENT IN THE BLOOD

DATE _______

LEAD LEVEL IN THE BLOOD (µg/dL):

CLASSIFICATION OF LEAD LEVELS:
(BASED ON CLASSIFICATION SYSTEM OF CENTRE FOR DISEASE CONTROL AND PREVENTION OF THE UNITED STATES)

- CLASS I: PB LEVEL BELOW 10 µg/DL
- CLASS II: PB LEVEL 10-19 µg/DL
- CLASS III: PB LEVEL 20-44 µg/DL
- CLASS IV: PB LEVEL 45-65 µg/DL
- CLASS V: PB LEVEL ABOVE 65 µg/DL

CLASS I indicates no exposure to lead or exposure below the level of concern.

CLASS II and CLASS III indicate some exposure to lead has occurred. Families should attempt to minimize exposure to lead.

CLASS IV and CLASS V indicate children should be referred to a clinician for confirmation of blood lead level, medical evaluation and treatment.

In case of severe lead poisoning (Pb above 65 µg/DL, CLASS V), we recommend that you contact your doctor for immediate treatment.