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NATIONAL FAMILY HEALTH SURVEY, INDIA 2005-2006 (NFHS- 3) WOMAN'S QUESTIONNAIRE [STATE NAME]

IDENTIFICATION

STATE _______
DISTRICT _______
TEHSIL/TALUK _______
CITY/TOWN/VILLAGE _______

MEGA CITY/LARGE CITY/SMALL CITY/LARGE TOWN/SMALL TOWN/RURAL _____

MEGA CITY 1
LARGE CITY 2
SMALL CITY 3
LARGE TOWN 4
SMALL TOWN 5
RURAL 6

PSU NUMBER ______
HOUSEHOLD NUMBER _______
NAME AND LINE NUMBER OF WOMAN _______
ADDRESS OF HOUSEHOLD ________

IS WOMAN SELECTED FOR QUESTIONS ON HOUSEHOLD RELATIONS (SECTION 10)?

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______
INTERVIEWER'S NAME _______
RESULT _______

RESULT____

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

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DATE ______
MONTH ______
YEAR ______
INT. NO. ______
RESULT CODE _____

TOTAL NUMBER OF VISITS ____

NATIVE LANGUAGE OF RESPONDENT _____

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

SUPERVISOR
NAME ______
DATE ______

FIELD EDITOR
NAME ______
DATE ______

OFFICE EDITOR ______
KEYED BY ______

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND INFORMED CONSENT

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. Several different health-related topics will be discussed including use of health services, the quality of health care, marital and sexual relationships, and infectious diseases. This information will help the government to assess health and information needs and to better plan health services. The survey usually takes between 30 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and if you choose to participate, you may withdraw at any time. However, we hope that you will take part in this survey since your participation is important.

At this time, do you want to ask me anything about the survey?
ANSWER ANY QUESTIONS AND ADDRESS RESPONDENT'S CONCERNS.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to you household.

May I begin the interview now?

SIGNATURE OF INTERVIEWER _______
DATE ________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO THE QUESTIONS)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

101. RECORD THE TIME.

HOUR _______
MINUTES _______

102. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ______
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

103. Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

104. In what month and year were you born?

MONTH ______
DOESN'T KNOW MONTH 98
YEAR ______
DOESN'T KNOW YEAR 9998

105. How old were you at your last birthday?
COMPARE AND CORRECT 104 AND/OR 105 IF INCONSISTENT.

AGE IN COMPLETED YEARS ______

106. Have you ever attended school?

YES 1
NO 2 (GO TO 109)

107. What is the highest standard you completed?

STANDARD _______

108. CHECK 107:

STANDARD 0-5 (GO TO 109)
STANDARD 6 AND ABOVE (GO TO 112)

109. Now I would like you to read this sentence to me.
SHOW A SENTENCE FROM THE LITERACY CARD TO THE RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ______ 4
BLIND/VISUALLY IMPAIRED 5

110. Have you ever participated in a literacy programme or any other programme that involves learning to read or write (not including primary school)?

YES 1
NO 2

111. CHECK 109:

CODE '2', '3' OR '4' CIRCLED (GO TO 112)
CODE '1' OR '5' CIRCLED (GO TO 113)

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

113. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

114. Do you watch television almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

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

YES 1
NO 2

116. What is your religion?

HINDU 01
MUSLIM 02
CHRISTIAN 03
SIKH 04
BUDDHIST/NEO-BUDDHIST 05
JAIN 06
JEWISH 07
PARSI/ZOROASTRIAN 08
NO RELIGION 09
OTHER (SPECIFY) _______ 96

117. What is your caste or tribe?

CASTE 1 (SPECIFY) ________
TRIBE 2 (SPECIFY) ________
NO CASTE/TRIBE 3 (GO TO 201)
DOESN'T KNOW 8

118. Do you belong to a scheduled caste, a scheduled tribe, other backward class, or none of these?

SCHEDULED CASTE 1
SCHEDULED TRIBE 2
OBC 3
NONE OF THEM 4

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 do 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 girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

207. 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 correct?

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

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 227)

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 BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE.

[ASK QUESTIONS 212-221 FOR ALL OF THE BIRTHS]

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

NAME ________

213. Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH ___
YEAR ___

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS _____

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

YES 1
NO 2

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

LINE NUMBER ______ (GO TO NEXT BIRTH)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN 2 YEARS; OR YEARS.

DAYS 1 _____
MONTH 2 _____
YEARS 3 _____

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

223. Before the birth of (NAME OF FIRST BIRTH), did you have any other live births?
IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

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 OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2000 OR LATER. IF NONE, RECORD '0'.

226. FOR EACH BIRTH SINCE JANUARY 2001, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

FOR EACH BIRTH ASK: At any time when you were pregnant with (NAME), did you have an ultrasound test?

RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 IN THE MONTH OF BIRTH.

227. Are you pregnant now?

YES 1
NO 2 (GO TO 231)
UNSURE 8 (GO TO 231)

228. How many months pregnant are you?
RECORD NUMBER OF MONTHS PREGNANT. ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE REMAINING NUMBER OF MONTHS PREGNANT.

MONTHS ______

229. At any time during this pregnancy, have you had an ultrasound test?
RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 OF THE CALENDAR IN THE CURRENT MONTH.

230. 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?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 240)

232. When did the last such pregnancy end?

MONTH ______
YEAR ______

233. CHECK 232:

LAST PREGNANCY ENDED IN JANUARY 2001 OR LATER (GO TO 234)
LAST PREGNANCY ENDED BEFORE JANUARY 2001 (GO TO 240)

234. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF MONTHS THE PREGNANCY LASTED. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF MONTHS.

MONTHS______

235. At any time during this pregnancy, did you have an ultrasound test?
RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 OF THE CALENDAR IN THE MONTH IN WHICH THE PREGNANCY WAS TERMINATED.

236. Since January 2001, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 238)

237. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2001. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF MONTHS.

FOR EACH TERMINATED PREGNANCY ASK: At any time this pregnancy, did you have an ultrasound test?

RECORD 'Y' IF YES AND 'N' IF NO IN COLUMN 2 OF THE CALENDAR IN THE MONTH IN WHICH THE PREGNANCY WAS TERMINATED.

238. Did you have any pregnancies that terminated before January 2001 that did not result in a live birth?

YES 1
NO 2 (GO TO 240)

239. When did the last such pregnancy that terminated before January 2001 end?

MONTH ______
YEAR ______

240. When did your last menstrual period start?

DATE, IF GIVEN ______
DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

241. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 301)
DOESN'T KNOW 8 (GO TO 301)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _______ 6
DOESN'T KNOW 8

SECTION 3A. MARRIAGE AND COHABITATION

301. What is your current marital status?

CURRENTLY MARRIED 1 (GO TO 303)
MARRIED, GAUNA NOT PERFORMED 2 (GO TO 306)
WIDOWED 3 (GO TO 308)
DIVORCED 4 (GO TO 308)
SEPARATED 5 (GO TO 308)
DESERTED 6 (GO TO 308)
NEVER MARRIED 7

302. ENTER '0' IN COLUMN 3 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 2001. (GO TO 316)

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

LIVING WITH HUSBAND 1 (GO TO 305)
STAYING ELSEWHERE 2

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

MONTHS 1 _____
YEARS 2 _____

305. RECORD THE HUSBAND'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ______
LINE NO. _____

306. Besides yourself, does your husband have other wives?

YES 1
NO 2 (GO TO 308)
DOESN'T KNOW 8 (GO TO 308)

307. How many other wives does your husband have?

NUMBER OF OTHER WIVES ____
DOESN'T KNOW 8

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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 309A)

309. In what month and year did you get married?
309A. Now I would like to ask about when you married your first husband. In what month and year was that?

MONTH ______
DOESN'T KNOW MONTH 98
YEAR ______ (GO TO 311)
DOESN'T KNOW YEAR 9998

310. How old were you when you (first) got married?

AGE ______

311. CHECK 301:

CODE '2' CIRCLED (GO TO 314)
CODE '2' NOT CIRCLED (GO TO 312)

312. CHECK 308:

MARRIED ONLY ONCE:
In what month and year did you start living with your husband?

MARRIED MORE THAN ONCE:
Now I would like to ask about when you started living with your first husband. In what month and year was that?

MONTH ______
DOESN'T KNOW MONTH 98
YEAR ______ (GO TO 314)
DOESN'T KNOW YEAR 9998

313. How old were you when you first started living with him?

AGE ______

314. FOR CURRENTLY MARRIED WOMEN WHO HAVE BEEN MARRIED ONLY ONCE AND WOMEN WHO ARE MARRIED BUT GAUNA NOT PERFORMED:
DETERMINE MONTHS MARRIED OR MARRIED BUT GAUNA NOT PERFORMED SINCE JANUARY 2001. ENTER 'X' IN COLUMN 3 OF CALENDAR FOR EACH MONTH MARRIED, 'N' FOR EACH MONTH MARRIED BUT GAUNA NOT PERFORMED, AND '0' FOR EACH MONTH NOT MARRIED.

FOR CURRENTLY MARRIED WOMEN WHO HAVE BEEN MARRIED MORE THAN ONCE:
PROBE FOR DATE WHEN CURRENT MARRIAGE STARTED AND, IF APPROPRIATE,
FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS MARRIAGES.

FOR WOMEN WHO ARE NOT CURRENTLY MARRIED:
PROBE FOR DATE WHEN LAST MARRIAGE STARTED, WHEN SHE WAS MARRIED BUT GAUNA WAS NOT PERFORMED, TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS MARRIAGES.

315. CHECK 301:

CODE '2' CIRCLED (GO TO 316)
CODE '2' NOT CIRCLED (GO TO 317)

CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

Now I need to ask you some questions about sexual life in order to gain a better understanding of some family life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If you do not want to answer, just let me know and I will skip to the next question.

316. Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 318)

317. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00

AGE IN YEARS ______

FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND 95

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

CIRCLE CODE '1' IN 318 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 318 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
PERFORM THE CHECK AT THE BOTTOM OF THE COLUMN. IF 316 IS YES
OR NOT ASKED, ASK 320 FOR EACH METHOD WITH CODE '1' CIRCLED IN 318.

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03 PILL Women can take a pill every day or every week to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04 IUD OR LOOP Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2 (GO TO NEXT METHOD)
06 CONDOM OR NIRODH Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
07 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08 RHYTHM METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
09 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
10 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse
YES 1
NO 2 (GO TO NEXT METHOD)
11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO OTHER METHODS.
(SPECIFY) _______
YES 1
NO 2

319. CHECK 316:

YES OR NOT ASKED (GO TO 320 FOR KNOWN METHODS)
NO (GO TO 323)

320. Have you ever used (METHOD)?

01 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
02 MALE STERILIZATION Men can have an operation to avoid having any more children. Has your husband/partner ever had an operation to avoid having any more children?
YES 1
NO 2
03 PILL Women can take a pill every day or every week to avoid becoming pregnant.
YES 1
NO 2
04 IUD OR LOOP Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 CONDOM OR NIRODH Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
07 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
08 RHYTHM METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
09 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
10 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

321. CHECK 320:

NOT A SINGLE "YES" (NEVER USED) (GO TO 322)
AT LEAST ONE "YES" (EVER USED) (GO TO 325)

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

YES 1 (GO TO 324)
NO 2

323. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (GO TO 353)

324. What have you used or done?
CORRECT 320 AND 321(AND 318 IF NECESSARY).

325. CHECK 208:

ONE OR MORE BIRTHS (GO TO 326)
NO BIRTHS (GO TO 327)

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

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

NUMBER OF CHILDREN _______

327. CHECK 320(01):

WOMAN NOT STERILIZED (GO TO 328)
WOMAN STERILIZED (GO TO 330A)

328. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 329)
PREGNANT (GO TO 334)

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

YES 1
NO 2 (GO TO 344)

330. Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.
330A. CIRCLE 'A' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION A (GO TO 335)
MALE STERILIZATION B (GO TO 335)
PILL C
IUD/LOOP D (GO TO 334)
INJECTABLES E (GO TO 334)
IMPLANTS F (GO TO 334)
CONDOM/NIRODH G
FEMALE CONDOM H (GO TO 334)
DIAPHRAGM I (GO TO 334)
FOAM/JELLY J (GO TO 334)
RHYTHM METHOD K (GO TO 341A)
WITHDRAWAL L (GO TO 341A)
OTHER (SPECIFY) _______ X (GO TO 341A)

331. May I see the package of (pills/condoms) you are using?
RECORD NAME OF BRAND.

PACKAGE SEEN 1 (GO TO 333)
BRAND NAME (SPECIFY) _______ (GO TO 333)
PACKAGE NOT SEEN 2

332. Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

BRAND NAME (SPECIFY) _______
DOESN'T KNOW 998

333. How many (pill cycles/condoms) did you get the last time?

NUMBER OF PILL CYCLES/CONDOMS ______
DOESN'T KNOW 998

334. The last time you obtained (CURRENT METHOD IN 330), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST Rs_______ (GO TO 341A)
FREE 9995 (GO TO 341A)
DOESN'T KNOW 9998 (GO TO 341A)

335. In what facility did the sterilization take place?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 11
GOVT. DISPENSARY 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/PHC 14
SUB-CENTRE 15
GOVT. MOBILE CLINIC 16
CAMP 17
OTHER PUBLIC SECTOR HEALTH FACILITY 18
NGO OR TRUST HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL 31
PVT. DOCTOR/CLINIC 32
PVT. MOBILE CLINIC 33
OTHER PRIVATE HEALTH FACILITY 34
OTHER (SPECIFY) _________ 96
DOESN'T KNOW 98

336. CHECK 330/330A:

CODE 'A' CIRCLED (GO TO 337)
CODE 'A' NOT CIRCLED (GO TO 341)

337. Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

YES 1
NO 2

338. How would you rate the care you received during and immediately after the operation: very good, all right, not so good, or bad?

VERY GOOD 1
ALL RIGHT 2
NOT SO GOOD 3
BAD 4

339. How much did you pay in total for the sterilization, including any consultation you may have had?

COST Rs _______
FREE 99995
DOESN'T KNOW 99998

340. Do you regret that you had the sterilization?

YES 1
NO 2

341. In what month and year was the sterilization performed?
341A. In what month and year did you start using (CURRENT METHOD) continuously? PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH ______
YEAR ______

342. CHECK 341/341A, 215 AND 232:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 341/341A?

YES
FOR METHODS OTHER THAN STERILIZATION:
GO BACK TO 341/341A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

FOR FEMALE STERILIZATION:
GO BACK TO 329. ASK 329 AND FOLLOW CORRECT SKIP PATTERN.
NO (GO TO 343)

343. CHECK 341/341A:

YEAR IS 2001 OR LATER:
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. THEN (GO TO 344)

YEAR IS 2000 OR EARLIER:
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 2001. THEN (GO TO 351)

344. I would like to ask you some questions about the times you or your husband/partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2001. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:

COLUMN 1:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 4, ENTER CODES FOR DISCONTINUATION IN THE SAME ROW AS THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 4 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1. ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:

COLUMN 4:
Why did you stop using the (METHOD)?
Did you become pregnant while using (METHOD), did you stop using to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

345. CHECK 330/330A:
CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 330/330A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 353)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 356)
PILL 03
IUD/LOOP 04
INJECTABLES 05
IMPLANTS 06
CONDOM/NIRODH 07 (GO TO 352)
FEMALE CONDOM 08 (GO TO 349)
DIAPHRAGM 09 (GO TO 349)
FOAM/JELLY 10 (GO TO 349)
RHYTHM METHOD 11 (GO TO 356)
WITHDRAWAL 12 (GO TO 356)
OTHER METHOD 96 (GO TO 356)

346. You started using (CURRENT METHOD) in (DATE). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 348)
NO 2

347. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 349)

348. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

349. CHECK 346:

CODE '1' CIRCLED
At that time, were you told about other methods of family planning that you could use?

CODE '1' CIRCLED NOT
When you obtained (CURRENT METHOD) in (DATE), were you told about other methods of family planning that you could use?

YES 1 (GO TO 351)
NO 2

350. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

351. CHECK 330/330A:
CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 330/330A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 356)
MALE STERILIZATION 02 (GO TO 356)
PILL 03
IUD/LOOP 04
INJECTABLES 05
IMPLANTS 06
CONDOM/NIRODH 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
RHYTHM METHOD 11 (GO TO 356)
WITHDRAWAL 12 (GO TO 356)
OTHER METHOD 96 (GO TO 356)

352. Where did you obtain (CURRENT METHOD) the last time?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE __________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 356)
GOVT. DISPENSARY 12 (GO TO 356)
UHC/UHP/UFWC 13 (GO TO 356)
CHC/RURAL HOSPITAL/PHC 14 (GO TO 356)
SUB-CENTRE/ANM 15 (GO TO 356)
GOVT. MOBILE CLINIC 16 (GO TO 356)
CAMP 17 (GO TO 356)
ANGANWADI/ICDS CENTRE 18 (GO TO 356)
ASHA 19 (GO TO 356)
OTHER COMMUNITY-BASED WORKER 20 (GO TO 356)
OTHER PUBLIC MEDICAL SECTOR 21 (GO TO 356)
NGO OR TRUST HOSPITAL/CLINIC 31 (GO TO 356)
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL 41 (GO TO 356)
PVT. DOCTOR/CLINIC 42 (GO TO 356)
PVT. MOBILE CLINIC 43 (GO TO 356)
VAIDYA/HAKIM/HOMEOPATH 44 (GO TO 356)
TRADITIONAL HEALER 45 (GO TO 356)
PHARMACY/DRUGSTORE 46 (GO TO 356)
DAI (TBA) 47 (GO TO 356)
OTHER PRIVATE MEDICAL SECTOR 48 (GO TO 356)
OTHER SOURCE
SHOP 51 (GO TO 356)
HUSBAND 52 (GO TO 356)
FRIEND/RELATIVE 53 (GO TO 356)
OTHER (SPECIFY) _________ 96 (GO TO 356)

353. Were you ever told by a health or family planning worker about any methods of family planning that you can use to avoid pregnancy?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 356)

355. Where is that?
Any other place?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL PLACES MENTIONED.

NAME OF PLACE(S) ________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL A
GOVT. DISPENSARY B
UHC/UHP/UFWC C
CHC/RURAL HOSPITAL/PHC D
SUB-CENTRE/ANM E
GOVT. MOBILE CLINIC F
CAMP G
ANGANWADI/ICDS CENTRE H
ASHA I
OTHER COMMUNITY-BASED WORKER J
OTHER PUBLIC MEDICAL SECTOR K
NGO OR TRUST HOSPITAL/CLINIC L
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL M
PVT. DOCTOR/CLINIC N
PVT. MOBILE CLINIC O
VAIDYA/HAKIM/HOMEOPATH P
TRADITIONAL HEALER Q
PHARMACY/DRUGSTORE R
DAI (TBA) S
OTHER PRIVATE MEDICAL SECTOR T
OTHER SOURCE
SHOP U
FRIEND/RELATIVE V
OTHER (SPECIFY) _______ X

SECTION 3C. CONTACTS WITH HEALTH PERSONNEL

Now I would like to talk to you about any contacts you have had recently with an ANM or Lady Health Visitor.

356. In the last three months have you met with an ANM or LHV?

YES 1
NO 2 (GO TO 358)

357. In the last three months, how many times did you meet with (this person/these persons):

a. At home?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___
b. At the anganwadi centre?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___
c. At a health facility or camp?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___
d. Anywhere else?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___

358. In the last three months, have you met with an anganwadi worker or other community health worker?

YES 1
NO 2 (GO TO 361)

359. Who did you meet? Anyone else?
RECORD ALL MENTIONED.

ANGANWADI WORKER A
ASHA B
MPW C
OTHER (SPECIFY) _________ X

360. In the last three months, how many times did you meet with (this person/these persons):

a. At home?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___
b. At the anganwadi centre?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___
c. At a health facility or camp?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___
d. Anywhere else?
HOME ___
AWC ___
HEALTH FACILITY/CAMP ___
ELSEWHERE ___

361. CHECK 356 AND 358:

AT LEAST ONE 'YES' (GO TO 362)
BOTH 'NO' (GO TO 367)

362. During (this contact/all these contacts) with [PERSONS MENTIONED IN 356 AND 359] in the last three months, what were the different services provided and matters talked about? Anything else? RECORD ALL MENTIONED.

FAMILY PLANNING A
IMMUNIZATION B
ANTENATAL CARE C
DELIVERY CARE D
DELIVERY PREPAREDNESS E
POSTNATAL CARE F
DISEASE PREVENTION G
MEDICAL TREATMENT FOR SELF H
TREATMENT FOR SICK CHILD I
TREATMENT FOR OTHER PERSON J
MALARIA CONTROL K
SUPPLEMENTARY FOOD L
GROWTH MONITORING OF CHILD M
EARLY CHILDHOOD CARE N
PRE-SCHOOL EDUCATION O
NUTRITION/HEALTH EDUCATION P
FAMILY LIFE EDUCATION Q
MENSTRUAL HYGIENE R
OTHER (SPECIFY) ______ X

363. Who did you meet during your (most recent) contact?

ANM 1
LHV 2
ANGANWADI WORKER 3
ASHA 4
MPW 5
OTHER (SPECIFY) _________ 6

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

NICELY 1
SOMEWHAT NICELY 2
NOT NICELY 3

365. When she/he explained something to you, did she/he try to make sure that you understood the information?

YES 1
NO 2
NO EXPLANATION NEEDED 3

366. CHECK 357c AND 360c:

357c AND 360c ARE '00' OR BLANK (GO TO 367)
OTHER (GO TO 368)

367. In the last three months, have you visited a health facility or camp for any reason for yourself (or for your children)?

YES 1
NO 2 (GO TO 401)

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

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE __________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 11
GOVT. DISPENSARY 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/PHC 14
SUB-CENTRE 15
GOVT. MOBILE CLINIC 16
CAMP 17
ANGANWADI/ICDS CENTRE 18
OTHER PUBLIC SECTOR HEALTH FACILITY 19
NGO OR TRUST HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
PVT. MOBILE CLINIC 32
PHARMACY/DRUGSTORE 33
OTHER PRIVATE SECTOR HEALTH FACILITY 34
OTHER (SPECIFY) ________ 96

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

FAMILY PLANNING A
IMMUNIZATION B
ANTENATAL CARE C
DELIVERY CARE D
POSTNATAL CARE E
DISEASE PREVENTION F
MEDICAL TREATMENT FOR SELF G
TREATMENT FOR CHILD H
TREATMENT FOR OTHER PERSON I
GROWTH MONITORING OF CHILD J
HEALTH CHECK-UP K
OTHER (SPECIFY) _________ X

370. How long did you have to wait before you received the service you went for?

MINUTES 1 ____
HOURS 2 ____
NO WAIT AT ALL 995
DID NOT RECEIVE SERVICE 996 (GO TO 373)

371. Was the person who provided the service to you responsive to your problems and needs?

YES 1
NO 2

372. Did she/he respect your need for privacy if you needed it?

YES 1
NO 2
SAYS PRIVACY NOT NEEDED 3

373. Would you say that the (camp/health facility) was very clean, somewhat clean, or not clean?

VERY CLEAN 1
SOMEWHAT CLEAN 2
NOT CLEAN 3

SECTION 4. PREGNANCY, DELIVERY, POSTNATAL CARE AND CHILDREN'S NUTRITION

401. CHECK 225:

ONE OR MORE BIRTHS IN 2001 OR LATER (GO TO 402)
NO BIRTHS IN 2001 OR LATER (GO TO 556)

402. ENTER IN THE TABLE BELOW THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)

403. LINE NUMBER FROM 212

LINE NUMBER ______

404. FROM 212 AND 216:

NAME _______
LIVING ___ (GO TO 405)
DEAD ___ (GO TO 405)

405. 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 not want to have any(more) children at all?

THEN 1 (GO TO 407 FOR MOST RECENT BIRTH; GO TO 435 FOR OTHERS)
LATER 2
NOT AT ALL 3 (GO TO 407 FOR LAST BIRTH; GO TO 435 FOR OTHERS)

406. How much longer would you have liked to wait?

MONTHS 1 ____
YEARS 2 ____
DOESN'T KNOW 998

407. Was this pregnancy registered with the ANM?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 409)

408. Did you get a card from the ANM?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2

409. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[ASK FOR LAST BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR A
ANM/NURSE/MIDWIFE/LHV B
OTHER HEALTH PERSONNEL C
OTHER PERSON
DAI/TBA D
ANGANWADI/ICDS WORKER E
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 417)

410. Where did you receive antenatal care for this pregnancy? Any other place?
[ASK FOR LAST BIRTH ONLY]

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL PLACES MENTIONED.

NAME OF PLACE(S) ________
HOME
YOUR HOME A
PARENTS' HOME B
OTHER HOME C
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL D
GOVT. DISPENSARY E
UHC/UHP/UFWC F
CHC/RURAL HOSPITAL/PHC G
SUB-CENTRE H
ANGANWADI/ICDS CENTRE I
VILLAGE CLINIC BY ANM J
OTHER PUBLIC SECTOR HEALTH FACILITY K
NGO/TRUST HOSPITAL/CLINIC L
PRIVATE MEDICAL SECTOR
PVT. HOSP./MATERNITY HOME/CLINIC M
OTHER PRIVATE SECTOR HEALTH FACILITY N
OTHER (SPECIFY) ________ X

411. How many months pregnant were you when you first received antenatal care for this pregnancy?
[ASK FOR LAST BIRTH ONLY]

MONTHS ______
DOESN'T KNOW 98

412. How many times did you receive antenatal care during this pregnancy?
[ASK FOR LAST BIRTH ONLY]

NUMBER OF TIMES ____
DOESN'T KNOW 98

413. As part of your antenatal care during this pregnancy, were any of the following done at least once?
[ASK FOR LAST BIRTH ONLY]

a. Were you weighed?
b. Was your blood pressure measured?
c. Did you give a urine sample?
d. Did you give a blood sample?
e. Was your abdomen checked?
f. Were you told your expected delivery date?
g. Were you advised to deliver in a hospital or health facility?
h. Were you advised about proper nutrition during pregnancy?

WEIGHT
YES 1
NO 2
BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2
ABDOMEN
YES 1
NO 2
DELIVERY DATE
YES 1
NO 2
DELIVERY ADVICE
YES 1
NO 2
NUTRITION ADVICE
YES 1
NO 2

414. During (any of) your antenatal care visit(s), were you told about the following signs of pregnancy complications?
[ASK FOR LAST BIRTH ONLY]

a. Vaginal bleeding?
b. Convulsions?
c. Prolonged labour?

BLEEDING
YES 1
NO 2
CONVULSIONS
YES 1
NO 2
PROLONGED LABOUR
YES 1
NO 2

415. Were you told where to go if you had any pregnancy complications?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2

416. Was (NAME'S) father present during (any of) your antenatal visits?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2

417. During this pregnancy, were you given an injection to prevent you and the baby from getting tetanus?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 420)
DOESN'T KNOW 8 (GO TO 420)

418. During this pregnancy, how many times did you get a tetanus injection?
[ASK FOR LAST BIRTH ONLY]

TIMES ______
DOESN'T KNOW 8

419. CHECK 418:
[ASK FOR LAST BIRTH ONLY]

TWO OR MORE TIMES (GO TO 422)
OTHER (GO TO 420)

420. At any time before this pregnancy, did you receive any tetanus injections?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 422)
DOESN'T KNOW 8 (GO TO 422)

421. How many years ago did you receive the last tetanus injection before this pregnancy?
[ASK FOR LAST BIRTH ONLY]

YEARS AGO ______

422. During this pregnancy, were you given or did you buy any iron folic acid tablets or syrup? SHOW TABLETS/SYRUP.
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 424)
DOESN'T KNOW 8 (GO TO 424)

423. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK FOR LAST BIRTH ONLY]

NUMBER OF DAYS _________
DOESN'T KNOW 998

424. During this pregnancy, did you take any drug to get rid of worms in your intestines?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

425. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

426. During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

427. During this pregnancy, did you have convulsions not from fever?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

428. During this pregnancy, did you have swelling of the legs, body or face?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

429. During this pregnancy, did you feel excessive fatigue?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

430. During this pregnancy, did you have any vaginal bleeding?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

431. Did you receive any supplementary nutrition from the anganwadi centre during this pregnancy?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 433)

432. During this pregnancy, were you always able to get the supplementary nutrition from the anganwadi centre when you wanted it?
[ASK FOR LAST BIRTH ONLY]

YES, ALWAYS 1
NO 2

433. During the last three months of this pregnancy, did you meet with an ANM, Lady Health Visitor, anganwadi worker, or other community health worker?
IF YES: Where did you meet this/these person(s)?
[ASK FOR LAST BIRTH ONLY]

HOME ONLY 1
ELSEWHERE ONLY 2
BOTH HOME AND ELSEWHERE 3
DID NOT MEET 4 (GO TO 435)

434. During any of these meetings in the last three months of this pregnancy, did you receive advice on the following at least once?
[ASK FOR LAST BIRTH ONLY]

a. Breastfeeding?
b. Keeping the baby warm?
c. The need for cleanliness at the time of delivery?
d. Family planning or delaying your next child?

BREASTFEED
YES 1
NO 2
BABY WARM
YES 1
NO 2
CLEANLINESS
YES 1
NO 2
FAMILY PLAN
YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DOESN'T KNOW 8

436. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 438)
DOESN'T KNOW 8 (GO TO 438)

437. How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

1 KG FROM CARD _____
2 KG FROM RECALL ____
DOESN'T KNOW 99.998

438. Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
ANM/NURSE/MIDWIFE/LHV B
OTHER HEALTH PERSONNEL C
OTHER PERSON
DAI (TBA) D
FRIEND/RELATIVE E
OTHER (SPECIFY) _________ X
NO ONE Y

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

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ________
HOME
YOUR HOME 11 (GO TO 446 FOR LAST BIRTH; 448 FOR OTHER BIRTHS)
PARENTS' HOME 12 (GO TO 446 FOR LAST BIRTH; 448 FOR OTHER BIRTHS)
OTHER HOME 13 (GO TO 446 FOR LAST BIRTH; 448 FOR OTHER BIRTHS)
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 21
GOVT. DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/PHC 24
SUB-CENTRE 25
OTHER PUBLIC SECTOR HEALTH FACILITY 26
NGO/TRUST HOSPITAL/CLINIC 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/MATERNITY HOME/CLINIC 41
OTHER PRIVATE SECTOR HEALTH FACILITY 42
OTHER (SPECIFY) ______ 96 (GO TO 446 FOR LAST BIRTH; 448 FOR OTHER BIRTHS)

440. How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DOESN'T KNOW 998

441. Was (NAME) delivered by caesarean section?

YES 1
NO 2

442. Before you were discharged (FROM PLACE IN 439) after (NAME) was born, did any health personnel check on your health?

YES 1 (GO TO 461 FOR OTHER BIRTHS)
NO 2 (GO TO 445 FOR MOST RECENT BIRTH)

443. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[ASK FOR LAST BIRTH ONLY]

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DOESN'T KNOW 998

444. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR LAST BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11 (GO TO 459)
ANM/NURSE/MIDWIFE/LHV 12 (GO TO 459)
OTHER HEALTH PERSONNEL 13 (GO TO 459)
OTHER PERSON
DAI (TBA) 21 (GO TO 459)
OTHER (SPECIFY) ______ 96 (GO TO 459)

445. In the two months after you were discharged, did any health personnel, anganwadi worker, or traditional birth attendant [dai] check on your health?

YES 1 (GO TO 449)
NO 2 (GO TO 459)

446. Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.
[ASK FOR LAST BIRTH ONLY]

COSTS TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/ NO TRANSPORTATION C
DOESN'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) _______ X

447. At the time of delivery of (NAME) were the following done?
[ASK FOR LAST BIRTH ONLY]

a. Was a disposable delivery kit used?
b. Was the baby immediately wiped dry and then wrapped without being bathed?
c. Was a clean blade used to cut the cord?

DDK USED
YES 1
NO 2
DOESN'T KNOW 8
WIPE AND WRAP
YES 1
NO 2
DOESN'T KNOW 8
BLADE
YES 1
NO 2
DOESN'T KNOW 8

448. In the two months after (NAME) was born, did any health personnel, anganwadi worker, or a traditional birth attendant check on your health?

YES 1
NO 2 (GO TO 455 FOR MOST RECENT BIRTH)

449. How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[ASK FOR LAST BIRTH ONLY]

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DOESN'T KNOW 998

450. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR LAST BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
OTHER PERSON
DAI (TBA) 21
OTHER (SPECIFY) ______ 96

451. Where did this first check take place?
[ASK FOR LAST BIRTH ONLY]

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ______
HOME
YOUR HOME 11
PARENTS' HOME 12
OTHER HOME 13
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 21
GOVT. DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/PHC 24
SUB-CENTRE 25
ANGANWADI/ICDS CENTRE 26
OTHER PUBLIC SECTOR HEALTH FACILITY 27
NGO/TRUST HOSPITAL/CLINIC 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/MATERNITY HOME/CLINIC 41
OTHER PRIVATE SECTOR HEALTH FACILITY 42
OTHER (SPECIFY) ______ 96

452. CHECK 445:
[ASK FOR LAST BIRTH ONLY]

YES (GO TO 459)
NOT ASKED (GO TO 453)

453. Was the health of (NAME) also checked at this time?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 455)

454. Was this the first time the health of (NAME) was checked?
[ASK FOR LAST BIRTH ONLY]

YES 1 (GO TO 459)
NO 2 (GO TO 456)

455. In the two months after (NAME) was born, did any health personnel or a traditional birth attendant check on his/her health?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 459)
DOESN'T KNOW 8 (GO TO 459)

456. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[ASK FOR LAST BIRTH ONLY]

HOURS AFTER BIRTH 1 ____
DAYS AFTER BIRTH 2 ____
WEEKS AFTER BIRTH 3 ____
DOESN'T KNOW 998

457. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR LAST BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
OTHER PERSON
DAI (TBA) 21
OTHER (SPECIFY) _______ 96

458. Where did this first check of (NAME) take place?
[ASK FOR LAST BIRTH ONLY]

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _________
HOME
YOUR HOME 11
PARENTS' HOME 12
OTHER HOME 13
PUBIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 21
GOVT. DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/PHC 24
SUB-CENTRE 25
ANGANWADI/ICDS CENTRE 26
OTHER PUBLIC SECTOR HEALTH FACILITY 27
NGO/TRUST HOSPITAL/CLINIC 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/MATERNITY HOME/CLINIC 41
OTHER PRIVATE SECTOR HEALTH FACILITY 42
OTHER (SPECIFY) _______ 96

459. In the first two months after delivery, did you have:
[ASK FOR LAST BIRTH ONLY]

a) Massive vaginal bleeding?
YES 1
NO 2
b) Very high fever?
YES 1
NO 2

460. Has your menstrual period returned since the birth of (NAME)?
[ASK FOR LAST BIRTH ONLY]

YES 1 (GO TO 462)
NO 2 (GO TO 463)

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

YES 1
NO 2 (GOTO 465)

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

MONTHS_____
DOESN'T KNOW 98

463. CHECK 227:
IS RESPONDENT PREGNANT?
[ASK FOR LAST BIRTH ONLY]

NOT PREGNANT (GO TO 464)
PREGNANT OR UNSURE (GO TO 465)

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

YES 1
NO 2 (GO TO 466)

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

MONTHS_____
DOESN'T KNOW 98

466. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 473)

467. How long after birth did you first put (NAME) to the breast?
[ASK FOR LAST BIRTH ONLY]

IF LESS THAN HALF AN HOUR, CIRCLE '000'.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.

IMMEDIATELY/WITHIN HALF AN HOUR 000

HOURS 1 ____
DAYS 2 ____

468. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[ASK FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 470)

469. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[ASK FOR LAST BIRTH ONLY]

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA H
HONEY I
JANAM GHUTTI J
OTHER (SPECIFY) _______ X

470. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 471)
DEAD (GO TO 472)

471. Are you still breastfeeding (NAME)?

YES 1 (GO TO 474 FOR MOST RECENT BIRTH; GO TO 476 FOR OTHER BIRTHS)
NO 2

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

MONTHS _____
DOESN'T KNOW 98

473. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 472)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 478)

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

NUMBER OF NIGHT TIME FEEDINGS ______

475. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[ASK FOR LAST BIRTH ONLY]

NUMBER OF DAYLIGHT FEEDINGS ______

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

YES 1
NO 2
DOESN'T KNOW 8

477. GO BACK TO 405 IN NEXT COLUMN OR THE NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 478.

478. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2003 OR LATER AND LIVING WITH HER
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND GO TO 479) (NAME) _____________
DOES NOT HAVE ANY CHILDREN BORN IN 2003 OR LATER AND LIVING WITH HER (GO TO 501)

479. Now I would like to ask you about liquids (NAME FROM 478) drank yesterday during the day or at night. Did (NAME FROM 478) drink:

a. Plain water?
b. Commercially produced infant formula?
c. Any other milk such as tinned, powdered, or fresh animal milk?
d. Fruit juice?
e. Tea or coffee?
f. Any other liquids?

PLAIN WATER
YES 1
NO 2
DOESN'T KNOW 8
FORMULA
YES 1
NO 2
DOESN'T KNOW 8
MILK
YES 1
NO 2
DOESN'T KNOW 8
JUICE
YES 1
NO 2
DOESN'T KNOW 8
TEA/COFFEE
YES 1
NO 2
DOESN'T KNOW 8
OTHER LIQUIDS
YES 1
NO 2
DOESN'T KNOW 8

480. Now I would like to ask you about the food (NAME FROM 478) ate yesterday during the day or at night, either separately or combined with other foods. Did (NAME FROM 478) eat:

a. Any porridge or gruel?
b. Any commercially fortified baby food such as Cerelac or Farex?
c. Any bread, roti, chapati, rice, noodles, biscuits, idli, or any other foods made from grains?
d. Any pumpkin, carrots, or sweet potatoes that are yellow or orange inside?
e. Any white potatoes, white yams, cassava, or any other foods made from roots?
f. Any dark green, leafy vegetables?
g. Any ripe mangoes, papayas, cantaloupe, or jackfruit?
h. Any other fruits or vegetables?
i. Any liver, kidney, heart or other organ meats?
j. Any chicken, duck or other birds?
k. Any other meat?
l. Any eggs?
m. Any fresh or dried fish or shellfish?
n. Any foods made from beans, peas, or lentils?
o. Any nuts?
p. Any cheese, yogurt or other milk products?
q. Any food made with oil, fat, ghee or butter?
r. Any other solid or semi-solid food?

a. PORRIDGE OR GRUEL
YES 1
NO 2
DOESN'T KNOW 8
b. FORMULA
YES 1
NO 2
DOESN'T KNOW 8
c. BREAD, ROTI, CHAPATI, RICE, NOODLES, ETC.
YES 1
NO 2
DOESN'T KNOW 8
d. PUMPKIN, CARROTS, SWEET POTATOES
YES 1
NO 2
DOESN'T KNOW 8
e. WHITE POTATOES, YAMS, CASSAVA, OR OTHER ROOTS
YES 1
NO 2
DOESN'T KNOW 8
f. DARK GREEN, LEAFY VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
g. MANGOES, PAPAYAS, CANTALOUPE, OR JACKFRUIT
YES 1
NO 2
DOESN'T KNOW 8
h. OTHER FRUITS OR VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
i. LIVER, KIDNEY, HEART OR OTHER ORGAN MEATS
YES 1
NO 2
DOESN'T KNOW 8
j. CHICKEN, DUCK, OTHER BIRD
YES 1
NO 2
DOESN'T KNOW 8
k. OTHER MEAT
YES 1
NO 2
DOESN'T KNOW 8
l. EGGS
YES 1
NO 2
DOESN'T KNOW 8
m. FRESH OR DRIED FISH/SHELLFISH
YES 1
NO 2
DOESN'T KNOW 8
n. BEANS, PEAS, OR LENTILS
YES 1
NO 2
DOESN'T KNOW 8
o. NUTS
YES 1
NO 2
DOESN'T KNOW 8
p. CHEESE, YOGURT, OTHER MILK PRODUCTS
YES 1
NO 2
DOESN'T KNOW 8
q. OIL, FAT, GHEE, OR BUTTER
YES 1
NO 2
DOESN'T KNOW 8
r. SOLID, SEMI-SOLID FOODS
YES 1
NO 2
DOESN'T KNOW 8

481. CHECK 480:

AT LEAST ONE "YES" (GO TO 482)
NOT A SINGLE "YES" (GO TO 501)

482. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ______
DOESN'T KNOW 8

SECTION 5. IMMUNIZATION, HEALTH, AND WOMEN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. LINE NUMBER FROM 212:

LINE NUMBER _____

503. FROM 212 AND 216:

NAME _______
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

504. Has (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON AMPULES/SYRUPS/CAPSULES

YES 1
NO 2 (GO TO 507)
DOESN'T KNOW 8 (GO TO 507)

505. How many times has (NAME) received a vitamin A dose?
IF 7 OR MORE TIMES, RECORD '7'

TIMES ______
DOESN'T KNOW 8

506. How many months ago did (NAME) take the last dose?

MONTHS AGO ______
DOESN'T KNOW 98

507. Is (NAME) currently taking iron pills or iron syrup (like this/any of these)?
SHOW COMMON CAPSULES/SYRUPS.

YES 1
NO 2
DOESN'T KNOW 8

508. Has (NAME) taken any drug to get rid of intestinal worms in the past 6 months?

YES 1
NO 2
DOESN'T KNOW 8

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

YES, SEEN 1 (GO TO 511)
YES, NOT SEEN 2 (GO TO 514)
NO CARD 3

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

YES 1 (GO TO 514)
NO 2 (GO TO 514)

511. (1) COPY VACCINATION DATE 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. (3) IF ONLY PART OF DATE IS SHOWN ON CARD, RECORD '98' OR '9998' FOR 'DOESN'T KNOW' IN THE COLUMN FOR WHICH INFORMATION IS NOT GIVEN.

BCG
DAY _______
MONTH _______
YEAR ______
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY _______
MONTH _______
YEAR ______
POLIO 1
DAY _______
MONTH _______
YEAR ______
POLIO 2
DAY _______
MONTH _______
YEAR ______
POLIO 3
DAY _______
MONTH _______
YEAR ______
DPT 1
DAY _______
MONTH _______
YEAR ______
DPT 2
DAY _______
MONTH _______
YEAR ______
DPT 3
DAY _______
MONTH _______
YEAR ______
MEASLES
DAY _______
MONTH _______
YEAR ______
VITAMIN A (LAST DOSE)
DAY _______
MONTH _______
YEAR ______
VITAMIN A (NEXT-TO-LAST DOSE)
DAY _______
MONTH _______
YEAR ______

512. CHECK 511:

BCG' TO 'MEASLES' FILLED (GO TO 517)
OTHER (GO TO 513)

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 511) (GO TO 516)
NO 2 (GO TO 516)
DOESN'T KNOW 8 (GO TO 516)

514. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a Pulse Polio campaign?

YES 1
NO 2 (GO TO 518)
DOESN'T KNOW 8 (GO TO 518)

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

515A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DOESN'T KNOW 8

515B. Polio vaccine, that is, drops in the mouth, including vaccine received in a Pulse Polio campaign?

YES 1
NO 2 (GO TO 515E)
DOESN'T KNOW 8 (GO TO 515E)

515C. Was the first polio vaccine received in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

515D. How many times was the polio vaccine received?
IF MORE THAN 7, RECORD '7'.

NUMBER OF TIMES _______

515E. A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 515G)
DOESN'T KNOW 8 (GO TO 515G)

515F. How many times was a DPT vaccination received?

NUMBER OF TIMES _______

515G. An injection to prevent measles?

YES 1
NO 2
DOESN'T KNOW 8

516. CHECK 511 AND 514:
ANY VACCINATIONS RECEIVED?

YES (GO TO 517)
NO (GO TO 518)

517. Where did (NAME) receive most of his/her vaccinations?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _______
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 11
GOVT. DISPENSARY 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/PHC 14
SUB-CENTRE 15
GOVT. MOBILE CLINIC 16
CAMP 17
ANGANWADI/ICDS CENTRE 18
PULSE POLIO 19
OTHER PUBLIC SECTOR HEALTH FACILITY 20
NGO/TRUST HOSPITAL/CLINIC 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 41
PRIVATE DOCTOR/CLINIC 42
PRIVATE PARAMEDIC 43
VAIDYA/HAKIM/HOMEOPATH 44
PHARMACY/DRUGSTORE 45
OTHER PRIVATE HEALTH FACILITY 46
OTHER (SPECIFY) _______ 96

518. Has (NAME) had diarrhoea in the last 2 weeks?

YES 1
NO 2 (GO TO 532)
DOESN'T KNOW 8 (GO TO 532)

519. How long ago did the diarrhoea start?
IF LESS THAN ONE WEEK, RECORD NUMBER OF DAYS AGO; OTHERWISE RECORD WEEKS AGO.

NO. OF DAYS AGO 1 ____
NO. OF WEEKS AGO 2 _____
DOESN'T KNOW 998

520. Was there any blood in the stools?

YES 1
NO 2
DOESN'T KNOW 8

521. Now I would like to know how much (NAME) was given to drink during the diarrhoea. Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DOESN'T KNOW 8

522. When (NAME) had diarrhoea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DOESN'T KNOW 8

523. Did you seek advice or treatment for the diarrhoea from any source?

YES 1
NO 2 (GO TO 528)

524. Where did you seek advice or treatment?
Anywhere else?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S) RECORD ALL SOURCES MENTIONED.

NAME OF PLACE(S) ________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPALHOSPITAL A
GOVT. DISPENSARY B
UHC/UHP/UFWC C
CHC/RURAL HOSPITAL/PHC D
SUB-CENTRE/ANM E
GOVT. MOBILE CLINIC F
CAMP G
ANGANWADI/ICDS CENTRE H
ASHA I
OTHER PUBLIC SECTOR HEALTH FACILITY J
NGO/TRUST HOSPITAL/CLINIC K
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL L
PRIVATE DOCTOR/ CLINIC M
PRIVATE PARAMEDIC N
VAIDYA/HAKIM/HOMEOPATH O
TRADITIONAL HEALER P
PHARMACY/DRUGSTORE Q
OTHER PRIVATE HEALTH FACTOR R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
OTHER (SPECIFY) _______ X

525. CHECK 524:

TWO OR MORE CODES CIRCLED (GO TO 526)
ONLY ONE CODE CIRCLED (GO TO 527)

526. Where did you first seek advice or treatment?
USE LETTER CODE FROM 524.

FIRST PLACE ______

527. How many days after the diarrhoea began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.

DAYS______

528. Does (NAME) still have diarrhoea?

YES 1
NO 2
DOESN'T KNOW 8

529. Was he/she given any of the following to drink at any time since he/she started having the diarrhoea:

a. A fluid made from a special packet called [LOCAL NAME FOR ORS PACKET]?
b. Gruel made from rice [OR OTHER LOCAL GRAIN]?

FLUID FROM ORS PKT
YES 1
NO 2
DOESN'T KNOW 8
GRUEL
YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 532)
DOESN'T KNOW 8 (GO TO 532)

531. What (else) was given to treat the diarrhoea?
Anything else?
RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
INTRAVENOUS (IV) I
HOME REMEDY/ HERBAL MEDICINE J
OTHER (SPECIFY) ________ X

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 536)
DOESN'T KNOW 8 (GO TO 536)

534. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (GO TO 537)
DOESN'T KNOW 8 (GO TO 537)

535. When (NAME) had this illness, did he/she have a problem in the chest or a blocked or runny nose?

CHEST ONLY 1 (GO TO 537)
NOSE ONLY 2 (GO TO 537)
BOTH 3 (GO TO 537)
OTHER (SPECIFY) ______ 6 (GO TO 537)
DOESN'T KNOW 8 (GO TO 537)

536. CHECK 532:
HAD FEVER?

YES (GO TO 537)
NO OR DOESN'T KNOW (GO TO 552)

537. How long ago did the (fever/cough) start?
IF LESS THAN ONE WEEK, RECORD NUMBER OF DAYS AGO; OTHERWISE RECORD WEEKS AGO.

NO. OF DAYS AGO 1 _____
NO. OF WEEKS AGO 2 _____
DOESN'T KNOW 998

538. Now I would like to know how much (NAME) was given to drink during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DOESN'T KNOW 8

539. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DOESN'T KNOW 8

540. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 545)

541. Where did you seek advice or treatment?
Anywhere else?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S). RECORD ALL SOURCES MENTIONED.

NAME OF PLACE(S) _______
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL A
GOVT. DISPENSARY B
UHC/UHP/UFWC C
CHC/RURAL HOSPITAL/PHC D
SUB-CENTRE/ANM E
ANGANWADI/ICDS CENTRE F
GOVT. MOBILE CLINIC G
CAMP H
OTHER PUBLIC SECTOR HEALTH FACILITY I
ASHA J
NGO/TRUST HOSPITAL/CLINIC K
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL L
PRIVATE DOCTOR/ CLINIC M
PRIVATE PARAMEDIC N
VAIDYA/HAKIM/HOMEOPATH O
TRADITIONAL HEALER P
PHARMACY/DRUGSTORE Q
OTHER PRIVATE HEALTH FACTOR R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
OTHER (SPECIFY) _______ X

542. CHECK 541:

TWO OR MORE CODES CIRCLED (GO TO 543)
ONLY ONE CODE CIRCLED (GO TO 544)

543. Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

FIRST PLACE ______

544. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

DAYS _____

545. Is (NAME) still sick with a (fever/ cough)?

FEVER ONLY 1
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DOESN'T KNOW 8

546. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO TO 552)
DOESN'T KNOW 8 (GO TO 552)

547. What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
CHLOROQUINE A
PRIMAQUINE B
SP/FANSIDAR C
COMBINATION WITH ARTEMISININ D
OTHER ANTIMALARIAL E
UNKNOWN ANTIMALARIAL F
ANTIBIOTIC DRUG G
OTHER DRUGS
ASPIRIN H
ACETAMINOPHEN I
IBUPROFEN J
OTHER (SPECIFY) ______ X
UNKNOWN DRUG Z

548. CHECK 547:
ANY CODE A-G CIRCLED?

YES (GO TO 549)
NO (GO TO 552)

549. Did you already have (NAME OF DRUG FROM 547) at home when the child became ill? IF YES, CIRCLE CODE FOR THAT DRUG. ASK SEPARATELY FOR EACH

ANTIMALARIAL DRUGS
CHLOROQUINE A
PRIMAQUINE B
SP/FANSIDAR C
COMBINATION WITH ARTEMISININ D
OTHER ANTIMALARIAL E
UNKNOWN ANTIMALARIAL F
ANTIBIOTIC DRUG G
NONE OF THEM AT HOME Y

550. CHECK 547:
ANY CODE A-F CIRCLED?

YES (GO TO 551)
NO (GO TO 552)

551. How long after the fever started, did (NAME) first take (DRUG(S) FROM 547 A-F)?

SAME DAY 1
NEXT DAY 2
TWO DAYS AFTER FEVER 3
THREE DAYS AFTER FEVER 4
FOUR OR MORE DAYS AFTER FEVER 5
DOESN'T KNOW 8

552. GO TO 503 IN NEXT COLUMN OR THE NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, (GO TO 553).

553. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2001 OR LATER LIVING WITH THE RESPONDENT?

ONE OR MORE (GO TO 554)
NONE (GO TO 556)

554. The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) _____________ 96
DOESN'T KNOW 98

555. CHECK 529(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 557)

556. Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET] you can get for the treatment of diarrhoea?
IF SHE HAS NEVER HEARD OF ORS, SHOW GOVERNMENT AND COMMERCIAL ORS PACKETS AND ASK: Have you ever seen a packet like one of these before?

YES 1
NO 2

557. Now I would like to ask you some questions about medical care for you yourself. Many different factors can prevent women from getting medical advice or treatment for themselves.
When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem, or no problem?

a. Getting permission to go?
b. Getting money needed for treatment?
c. The distance to the health facility?
d. Having to take transport?
e. Finding someone to go with you?
f. Concern that there may not be a female health provider?
g. Concern that there may not be any health provider?
h. Concern that there may be no drugs available?

PERMISSION
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
GETTING MONEY
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
DISTANCE
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
TAKING TRANSPORT
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
FINDING SOMEONE
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
NO FEMALE PROVIDER
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
NO PROVIDER
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
NO DRUGS
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3

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

a. Milk or curd?
b. Pulses or beans?
c. Dark green leafy vegetables?
d. Fruits?
e. Eggs?
f. Fish?
g. Chicken or meat?

a. MILK OR CURD?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4
b. PULSES OR BEANS?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4
c. DARK GREEN LEAFY VEGETABLES?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4
d. FRUITS?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4
e. EGGS?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4
f. FISH?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4
g. CHICKEN OR MEAT?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4

Now I would like to ask you some questions about any injections you have had in the last 12 months.

559. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _______
NONE 00 (GO TO 564)

560. CHECK 559:

ONE INJECTION:
Was this injection administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker? IF YES, RECORD '01'.

MORE THAN ONE INJECTION:
Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _______
NONE 00 (GO TO 564)

561. The last time you had an injection given to you by a health worker, where did you go to get the injection?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ______
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 11
GOVT. DISPENSARY 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/PHC 14
SUB-CENTRE 15
GOVT. MOBILE CLINIC 16
CAMP 17
ANGANWADI/ICDS CENTRE 18
OTHER PUBLIC MEDICAL SECTOR 19
NGO OR TRUST HOSPITAL/CLINIC 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE DOCTOR/CLINIC 32
PRIVATE PARAMEDIC 33
VAIDYA/HAKIM/HOMEOPATH 34
PHARMACY/DRUGSTORE 35
OTHER PRIVATE MEDICAL SECTOR 36
OTHER PLACE
SHOP 41
AT HOME 42
OTHER (SPECIFY) ______ 96

562. Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1 (GO TO 564)
NO 2
DOESN'T KNOW 8

563. As far as you know, was the needle sterilized?

YES 1
NO 2
DOESN'T KNOW 8

564. Have you ever had a blood transfusion?

YES 1
NO 2

565. Do you currently smoke cigarettes or bidis?

YES 1
NO 2 (GO TO 567)

566. In the last 24 hours, how many cigarettes or bidis did you smoke?

CIGARETTES/BIDIS _______

567. Do you currently smoke or use tobacco in any other form?

YES 1
NO 2 (GO TO 569)

568. In what other form do you currently smoke or use tobacco?
Any other form?
RECORD ALL MENTIONED.

CIGAR/PIPE A
PAAN MASALA B
GHUTKA C
OTHER CHEWING TOBACCO D
SNUFF E
OTHER (SPECIFY) _______ X

569. Do you drink alcohol?

YES 1
NO 2 (GO TO 571)

570. How often do you drink alcohol: almost every day, about once a week or less often?

ALMOST EVERY DAY 1
ABOUT ONCE A WEEK 2
LESS OFTEN 3

571. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 575)

572. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ________ X
DOESN'T KNOW Z

573. Can tuberculosis be cured?

YES 1
NO 2
DOESN'T KNOW 8

574. If a member of your family got tuberculosis, would you want it to remain a secret from the neighbors or not?

YES, REMAIN A SECRET 1
NO 2
DOESN'T KNOW/NOT SURE/ DEPENDS 8

575. Do you currently have:

a. Diabetes?
b. Asthma?
c. Goiter or any other thyroid disorder?

DIABETES
YES 1
NO 2
DOESN'T KNOW 8
ASTHMA
YES 1
NO 2
DOESN'T KNOW 8
GOITER/THYROID
YES 1
NO 2
DOESN'T KNOW 8

576. CHECK 215:
ANY LIVE BIRTH IN 2000 OR LATER?

YES (GO TO NEXT SECTION)
NO (GO TO 601)

SECTION 5A. UTILIZATION OF ICDS SERVICES

577. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 5 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

578. LINE NUMBER FROM 212:

LINE NUMBER ______

579. FROM 212 AND 216:

NAME ______
LIVING (GO TO 580)
DEAD (GO TO 587)

580. During the last 12 months, has (NAME) received any benefits from the anganwadi or ICDS centre?
IF NO, PROBE: Any benefits such as supplementary food, growth monitoring, immunizations, health check-ups or education?

YES 1
NO 2 (GO TO 587)

581. In the last 12 months, how often has (NAME) received food from the anganwadi/ICDS centre?
IF CHILD RECEIVES TAKE HOME RATIONS FOR DAILY CONSUMPTION WEEKLY OR MONTHLY CODE '1'.

NOT AT ALL 0
ALMOST DAILY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
LESS OFTEN 4
DOESN'T KNOW 8

582. In the last 12 months, how often has (NAME) had a health check-up from the anganwadi/ICDS centre?

NOT AT ALL 0
AT LEAST ONCE A MONTH 1
LESS OFTEN 2
DOESN'T KNOW 8

583. In the last 12 months, has (NAME) received any immunizations through the anganwadi/ICDS centre?

YES 1
NO 2
DOESN'T KNOW 8

584. In the last 12 months, how often did (NAME) go to the anganwadi/ICDS centre for early childhood care or for preschool: regularly, occasionally, or not at all?

REGULARLY 1
OCCASIONALLY 2
NOT AT ALL 3
DOESN'T KNOW 8

585. In the last 12 months, how often has (NAME's) weight been measured by the anganwadi/ICDS centre?

NOT AT ALL 0 (GO TO 587)
AT LEAST ONCE A MONTH 1
AT LEAST ONCE IN 3 MONTHS 2
LESS OFTEN 3
DOESN'T KNOW 8 (GO TO 587)

586. After (NAME) was weighed, did you ever receive counselling from the anganwadi/ICDS worker or ANM?

YES 1
NO 2
DOESN'T KNOW 8

587. When you were pregnant with (NAME), did you receive any benefits from the anganwadi/ICDS centre?

YES 1
NO 2 (GO TO 589)

588. Did you receive any of the following benefits:

a. Supplementary food?
b. Health check-ups?
c. Health and nutrition education?

a. SUPPLEMENTARY FOOD
YES 1
NO 2
b. HEALTH CHECK UPS
YES 1
NO 2
c. HEALTH AND NUTRITION EDUCATION
YES 1
NO 2

589. When you were breastfeeding (NAME) did you receive any benefits from the anganwadi/ICDS centre?

YES 1
NO 2 (GO TO 591)
DID NOT BREASTFEED 3 (GO TO 591)

590. Did you receive any of the following benefits:

a. Supplementary food?
b. Health check-ups?
c. Health and nutrition education?

a. SUPPLEMENTARY FOOD
YES 1
NO 2
b. HEALTH CHECK UPS
YES 1
NO 2
c. HEALTH AND NUTRITION EDUCATION
YES 1
NO 2

591. GO TO 579 IN NEXT COLUMN OR IN FIRST COLUMN OF ADDITIONAL QUESTIONNIARE; OR IF NO MORE BIRTHS, GO TO 601.

SECTION 6. SEXUAL LIFE

601. CHECK 316 AND 317:

HAS NOT HAD SEXUAL INTERCOURSE (316 IS '2' OR 317IS '00') GO TO NEXT QUESTION (GO TO 618)

HAS HAD SEXUAL INTERCOURSE (CONTINUE)

READ TO RESPONDENTS
Now I need to ask you some more questions about relationships and sexual life. Once again, let me assure you that your answers are completely confidential. If we should come to any question that you don't want to answer, just let me know and I will skip to the next question.

602. CHECK 105:

15-24 YEARS OLD (GO TO 603)
25-49 YEARS OLD (GO TO 606)

603. How old was the person you first had sexual intercourse with?

AGE OF PARTNER ____ (GO TO 605)
DOESN'T KNOW 98

604. Would you say this person was ten or more years older than you?

YES 1
NO 2
DOESN'T KNOW 8

605. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DOESN'T KNOW/DOESN'T REMEMBER 8

606. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS AGO.

DAYS AGO 1____ (GO TO 608)
WEEKS AGO 2 ____ (GO TO 608)
MONTHS AGO 3 ____ (GO TO 608)
YEARS AGO 4 ____ (GO TO 617)

[ASK QUESTIONS 607-615 FOR THE LAST AND SECOND-TO-LAST BUSINESS PARTNERS]

607. When was the last time you had sexual intercourse with this other person?
[ASK FOR SECOND-TO LAST SEXUAL PARTNER ONLY]

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____

608. The last time you had sexual intercourse (with this other person), was a condom used?

YES 1
NO 2 (GO TO 610)

609. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

610. What was this person's relationship to you?

HUSBAND 01 (GO TO 615)
LIVE-IN PARTNER 02 (GO TO 615)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
OTHER FRIEND 04
RELATIVE 05
CASUAL ACQUAINTANCE 06
SEX WORKER CLIENT 07
OTHER (SPECIFY) ______ 96

611. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

612. CHECK 105:

15-24 YEARS OLD (GO TO 613)
25-49 YEARS OLD (GO TO 615)

613. How old is this person?

AGE OF PARTNER _____ (GO TO 615)
DOESN'T KNOW 98

614. Would you say this person is ten or more years older than you?

YES 1
NO 2
DOESN'T KNOW 8

615. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
[ASK FOR SECOND-TO LAST SEXUAL PARTNER ONLY]

YES 1 (GO BACK TO 607 IN NEXT COLUMN)
NO 2 (GO TO 617)

616. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF PARTNERS IN LAST 12 MONTHS ______
DOESN'T KNOW 98

617. In total, with how many different people have you had sexual intercourse in your lifetime? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF PARTNERS IN LIFETIME ______
DOESN'T KNOW 98

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

YES 1
NO 2 (GO TO 701)

619. Where is that? Any other place?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S). RECORD ALL SOURCES MENTIONED.

NAME OF PLACE(S) __________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL A
GOVT. DISPENSARY B
UHC/UHP/UFWC C
CHC/RURAL HOSPITAL/PHC D
SUB-CENTRE/ANM E
GOVT. MOBILE CLINIC F
CAMP G
ANGANWADI/ICDS CENTRE H
ASHA I
OTHER COMMUNITY BASED WORKER J
OTHER PUBLIC MEDICAL SECTOR (SPECIFY) _____ K
NGO OR TRUST HOSPITAL/CLINIC L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR M
PRIVATE PARAMEDIC N
VAIDYA/HAKIM/HOMEOPATH O
TRADITIONAL HEALER P
PHARMACY/DRUGSTORE Q
DAI (TBA) R
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ S
RATION SHOP T
OTHER SHOP U
VENDING MACHINE V
OTHER (SPECIFY) _______ X

620. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 301:

NEVER MARRIED (GO TO 714)
OTHER (GO TO 702)

702. CHECK 330/330A:

CODE 'A' OR CODE 'B' CIRCLED (GO TO 714)
OTHER (GO TO 703)

703. CHECK 227:

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 705)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 714)
UNDECIDED/DOESN'T KNOW:
AND PREGNANT 4 (GO TO 711)
AND NOT PREGNANT OR UNSURE 5 (GO TO 709)

704. CHECK 227:

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

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

MONTHS 1 ____
YEARS 2 ____
SOON/NOW 993 (GO TO 709)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 714)
OTHER (SPECIFY) ______ 996 (GO TO 709)
DOESN'T KNOW 998 (GO TO 709)

705. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 706)
PREGNANT (GO TO 711)

706. CHECK 329:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 707)
NOT CURRENTLY USING (GO TO 707)
CURRENTLY USING (GO TO 714)

707. CHECK 704:

NOT ASKED (GO TO 708)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 708)
00-23 MONTHS OR 00-01 YEAR (GO TO 711)

708. CHECK 703:

WANTS TO HAVE A/ANOTHER CHILD:
You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? PROBE: Any other reason?

WANTS NO MORE/NONE
You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? PROBE: Any other reason?

RECORD ALL REASONS MENTIONED.

NOT CURRENTLY MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC/UP TO GOD H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DOESN'T LIKE EXISTING METHODS U
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

709. CHECK 329:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 710)
NO, NOT CURRENTLY USING (GO TO 710)
YES, CURRENTLY USING (GO TO 714)

710. Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?

YES 1 (GO TO 712)
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 713)
DOESN'T KNOW 8 (GO TO 713)

712. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 714)
MALE STERILIZATION 02 (GO TO 714)
PILL 03 (GO TO 714)
IUD/LOOP 04 (GO TO 714)
INJECTABLES 05 (GO TO 714)
IMPLANTS 06 (GO TO 714)
CONDOM/NIRODH 07 (GO TO 714)
FEMALE CONDOM 08 (GO TO 714)
DIAPHRAGM 09 (GO TO 714)
FOAM/JELLY 10 (GO TO 714)
RHYTHM METHOD 11 (GO TO 714)
WITHDRAWAL 12 (GO TO 714)
OTHER (SPECIFY) ______ 96 (GO TO 714)
UNSURE 98 (GO TO 714)

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

FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 11
MENOPAUSAL/HYSTERECTOMY 12
SUBFECUND/INFECUND 13
FATALISTIC 14
WANTS AS MANY CHILDREN AS POSSIBLE 15
OPPOSITION TO USE
RESPONDENT OPPOSED 21
HUSBAND OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
LACK OF KNOWLEDGE
KNOWS NO METHOD 31
KNOWS NO SOURCE 32
METHOD-RELATED REASONS
HEALTH CONCERNS 41
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS/TOO FAR 43
COSTS TOO MUCH 44
INCONVENIENT TO USE 45
INTERFERES WITH BODY'S NORMAL PROCESSES 46
OTHER (SPECIFY) ______ 96
DOESN'T KNOW 98

714. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 716)
NUMBER _____
OTHER (SPECIFY) ______ 96 (GO TO 716)

715. 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?

BOYS _____
GIRLS _____
EITHER _____
OTHER (SPECIFY) ______ 96

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

a. On the radio?
b. On the television?
c. In a newspaper or magazine?
d. On a wall painting or hoarding?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
WALL PAINTING OR HOARDING
YES 1
NO 2

717. CHECK 301:

CURRENTLY MARRIED (GO TO 718)
OTHER (GO TO 723)

718. CHECK 330/330A:

CODE 'B' OR 'G' OR 'L' CIRCLED (GO TO 720)
NO CODE CIRCLED (GO TO 722)
OTHER (GO TO 719)

719. Does your husband know that you are using a method of family planning?

YES 1
NO 2 (GO TO 721)
DOESN'T KNOW 8 (GO TO 721)

720. Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER 6

721. CHECK 330/330A:

CODE 'A' OR CODE 'B' CIRCLED (GO TO 723)
OTHER (GO TO 722)

722. 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

723. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

a. She knows her husband has a sexually transmitted disease.
b. She knows her husband has sex with other women.
c. She is tired or not in the mood.

HAS STD
YES 1
NO 2
DOESN'T KNOW 8
OTHER WOMEN
YES 1
NO 2
DOESN'T KNOW 8
TIRED/NOT IN MOOD
YES 1
NO 2
DOESN'T KNOW 8

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801. CHECK 301:

CURRENTLY MARRIED OR MARRIED, GAUNA NOT PERFORMED (GO TO 802)
NEVER MARRIED (GO TO 806)
OTHER (GO TO 803)

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

AGE IN COMPLETED YEARS______

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

YES 1
NO 2 (GO TO 805)

804. What was the highest standard he completed?

STANDARD ______
DOESN'T KNOW 98

805. CHECK 801:

CURRENTLY MARRIED OR MARRIED, GAUNA NOT PERFORMED:
What is your husband's occupation? That is, what kind of work does he mainly do?

OTHER:
What was your (last) husband's occupation? That is, what kind of work did he mainly do?

OCCUPATION ______

806. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 810)
NO 2

807. 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.
In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 810)
NO 2

808. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

YES 1 (GO TO 810)
NO 2

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

YES 1
NO 2 (GO TO 817)

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

OCCUPATION ______

811. CHECK 810:

WORKS IN AGRICULTURE (GO TO 812)
DOES NOT WORK IN AGRICULTURE (GO TO 813)

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

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

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

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

HOME 1
AWAY 2

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

817. CHECK 301:

CURRENTLY MARRIED (GO TO 818)
OTHER (GO TO 823)

818. CHECK 816:

CODE '1' OR '2' CIRCLED (GO TO 819)
OTHER (GO TO 821)

819. Who decides how the money you earn will be used: mainly you, mainly your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER 6

820. Would you say that the money that you earn is more than what your husband earns, less than what he earns, or about the same?

MORE THAN HUSBAND 1
LESS THAN HUSBAND 2
ABOUT THE SAME 3
HUSBAND HAS NO EARNINGS 4 (GO TO 822)
DOESN'T KNOW 8

821. Who decides how your husband's earnings will be used: mainly you, mainly your husband, or you and your husband jointly?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER 6

822. Who usually makes the following decisions: mainly you, mainly your husband, you and your husband jointly, or someone else?

a. Decisions about health care for yourself?
b. Decisions about making major household purchases?
c. Decisions about making purchases for daily household needs?
d. Decisions about visits to your family or relatives?

a. HEALTH CARE
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER RESPONSE 6
b. MAJOR HOUSEHOLD PURCHASES
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER RESPONSE 6
c. DAILY HOUSEHOLD NEEDS
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER RESPONSE 6
d. VISITS TO FAMILY
RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER RESPONSE 6

823. Do you have any money of your own that you alone can decide how to use?

YES 1
NO 2

824 Are you usually allowed to go to the following places alone, only with someone else, or not at all?

a. To the market?
b. To the health facility?
c. To places outside this (village/community)?

MARKET
ALONE 1
WITH SOMEONE ELSE 2
NOT AT ALL 3
HEALTH
ALONE 1
WITH SOMEONE ELSE 2
NOT AT ALL 3
OUT
ALONE 1
WITH SOMEONE ELSE 2
NOT AT ALL 3

825. Do you have a bank or savings account that you yourself use?

YES 1
NO 2

826. Do you know of any programmes in this area that give loans to women to start or expand a business of their own?

YES 1
NO 2 (GO TO 828)

827. Have you yourself ever taken a loan, in cash or in kind, from any of these programmes, to start or expand a business?

YES 1
NO 2

828. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN YOUNGER THAN 10
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3

829. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a. If she goes out without telling him?
b. If she neglects the house or the children?
c. If she argues with him?
d. If she refuses to have sex with him?
e. If she doesn't cook food properly?
f. If he suspects her of being unfaithful?
g. If she shows disrespect for in-laws?

GOES OUT
YES 1
NO 2
DOESN'T KNOW 8
NEGL. CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
ARGUES
YES 1
NO 2
DOESN'T KNOW 8
REFUSES SEX
YES 1
NO 2
DOESN'T KNOW 8
POOR COOKING
YES 1
NO 2
DOESN'T KNOW 8
UNFAITHFUL
YES 1
NO 2
DOESN'T KNOW 8
DISRESPECT
YES 1
NO 2
DOESN'T KNOW 8

SECTION 9. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

Now I would like to talk about something else.

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

YES 1
NO 2 (GO TO 927)

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

RADIO A
TELEVISION B
CINEMA C
NEWSPAPERS/MAGAZINES D
POSTERS/HOARDINGS E
EXHIBITION/MELA F
HEALTH WORKERS G
ADULT EDUC. PROGRAMME H
RELIGIOUS LEADERS I
POLITICAL LEADERS J
SCHOOL/TEACHERS K
COMMUNITY MEETINGS L
HUSBAND M
FRIENDS/RELATIVES N
WORK PLACE O
OTHER (SPECIFY) _______ X

903. In your opinion, can people reduce their chances of getting HIV/AIDS by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DOESN'T KNOW 8

904. In your opinion, can people get HIV/AIDS from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

905. In your opinion, can people reduce their chances of getting HIV/AIDS by using a condom every time they have sex?

YES 1
NO 2
DOESN'T KNOW 8

906. In your opinion, can people get HIV/AIDS by sharing food with a person who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

907. In your opinion, can people get HIV/AIDS by hugging someone who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

908. In your opinion, can people reduce their chance of getting HIV/AIDS by abstaining from sexual intercourse?

YES 1
NO 2
DOESN'T KNOW 8

909. Is there anything else a person can do to avoid or reduce the chances of getting HIV/AIDS?

YES 1
NO 2 (GO TO 911)
DOESN'T KNOW 8 (GO TO 911)

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

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH SEX WORKERS E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
USE BLOOD ONLY FROM RELATIVES J
AVOID INJECTIONS K
USE ONLY NEW/STERILIZED NEEDLES L
AVOID IV DRIP M
AVOID SHARING RAZORS/BLADES N
AVOID KISSING O
AVOID MOSQUITO BITES P
OTHER (SPECIFY) _______ W
OTHER (SPECIFY) _______ X
DOESN'T KNOW Z

911. Is it possible for a healthy-looking person to have HIV/AIDS?

YES 1
NO 2
DOESN'T KNOW 8

912. Can HIV/AIDS be transmitted from a mother to her baby?

YES 1
NO 2 (GO TO 914)
DOESN'T KNOW 8 (GO TO 914)

913. Are there any special medications that a doctor or a nurse can give to a woman infected with HIV/AIDS to reduce the risk of transmitting HIV/AIDS to the baby?

YES 1
NO 2
DOESN'T KNOW 8

914. Have you heard about special antiretroviral drugs (USE LOCAL NAME(S)) that people infected with HIV/AIDS can get from a doctor or a nurse to help them live longer?

YES 1
NO 2

915. I don't want to know the results, but have you ever been tested to see if you have HIV/AIDS?

YES 1
NO 2 (GO TO 920)

916. When was the last time you were tested?

LESS THAN 12 MONTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3

917. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, was it required, or was it done without your consent?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3
WITHOUT CONSENT 4

918. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

919. Where was the test done?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 922)
GOVT. DISPENSARY 12 (GO TO 922)
UHC/UHP/UFWC 13 (GO TO 922)
CHC/RURAL HOSPISTAL/PHC 14 (GO TO 922)
SUB-CENTRE 15 (GO TO 922)
GOVT. MOBILE CLINIC 16 (GO TO 922)
VCT CLINIC 17 (GO TO 922)
STI CLINIC 18 (GO TO 922)
OTHER PUBLIC MEDICAL SECTOR (SPECIFY) ______ 19 (GO TO 922)
NGO OR TRUST HOSPITAL/CLINIC 21 (GO TO 922)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31 (GO TO 922)
VCT CLINIC 32 (GO TO 922)
STI CLINIC 33 (GO TO 922)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ 34 (GO TO 922)
OTHER (SPECIFY) _______ 96 (GO TO 922)

920. Do you know of a place where people can go to get tested for HIV/AIDS?

YES 1
NO 2 (GO TO 922)

921. Where is that? Any other place?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.
RECORD ALL PLACES MENTIONED.

NAME OF PLACE(S) ______
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL A
GOVT. DISPENSARY B
UHC/UHP/UFWC C
CHC/RURAL HOSP./PHC D
SUB-CENTRE E
GOVT. MOBILE CLINIC F
VCT CLINIC
STI CLINIC H
OTHER PUBLIC MEDICAL SECTOR (SPECIFY) ______ I
NGO OR TRUST HOSPITAL/CLINIC J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
VCT CLINIC L
STI CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ N
OTHER (SPECIFY) ______ X

922. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV/AIDS?

YES 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

923. If a member of your family got infected with HIV/AIDS, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

924. If a relative of yours became sick with the HIV/AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

925. In your opinion, if a female teacher has HIV/AIDS but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

926. In your opinion, if a male teacher has HIV/AIDS but is not sick, should he be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

927. CHECK 901:

HEARD ABOUT HIV/AIDS:
Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT HIV/AIDS:
Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

928. CHECK 316 AND 317:

HAS HAD SEXUAL INTERCOURSE (GO TO 929)
HAS NOT HAD SEXUAL INTERCOURSE (316 IS '2' OR 317 IS '00') (GO TO 936)

929. CHECK 927:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 930)
NO (GO TO 931)

Now I would like to ask you some questions about your health in the last 12 months.

930. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

931. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

933. CHECK 930, 931, AND 932:

AT LEAST ONE 'YES' (GO TO 934)
OTHER (GO TO 936)

934. The last time you had (PROBLEM FROM 930/931/932), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 936)

935. Who did you see?
Anyone else?
RECORD ALL PERSONS SEEN.

PUBLIC MEDICAL SECTOR
GOVT. DOCTOR A
PUBLIC HEALTH NURSE B
ANM/LHV C
MALE MPW/SUPERVISOR D
ANGANWADI WORKER E
VILLAGE HEALTH GUIDE F
ASHA G
OTHER PUBLIC SECTOR HEALTH WORKER (SPECIFY) ______ H
NGO WORKER I
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR J
PRIVATE NURSE K
COMPOUNDER/PHARMACIST L
VAIDYA/HAKIM/HOMEOPATH M
DAI (TBA) N
TRADITIONAL HEALER O
OTHER PRIVATE SECTOR HEALTH WORKER P
OTHER (SPECIFY) ______ X

Now I would like to ask your opinion about family life education for children.

936. For each of the following, please tell me whether or not it should be taught in school, and if yes, at what age the topic should first be taught.

936A. First we will talk about boys. Should boys be taught in school about_____ ?

a. Moral values
YES 1 (GO TO 936B)
NO 2
b. Changes in boys' bodies at puberty
YES 1 (GO TO 936B)
NO 2
c. Changes in girls' bodies at puberty, including menstruation
YES 1 (GO TO 936B)
NO 2
d. Sex and sexual behavior
YES 1 (GO TO 936B)
NO 2
e. Contraception
YES 1 (GO TO 936B)
NO 2
f. HIV/AIDS
YES 1 (GO TO 936B)
NO 2
g. Condom use to avoid sexually transmitted diseases
YES 1 (GO TO 936B)
NO 2

936B. At what age should boys first be taught this topic in school?

a. Moral Values
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
b. Changes in boys' bodies at puberty
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
c. Changes in girls' bodies at puberty, including menstruation
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
d. Sex and sexual behavior
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
e. Contraception
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
f. HIV/AIDS
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
g. Condom use to avoid sexually transmitted diseases
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8

936C. Now let us talk about girls. Should girls be taught in school about_____ ?

a. Moral values
YES 1 (GO TO 936D)
NO 2
b. Changes in boys' bodies at puberty
YES 1 (GO TO 936D)
NO 2
c. Changes in girls' bodies at puberty, including menstruation
YES 1 (GO TO 936D)
NO 2
d. Sex and sexual behavior
YES 1 (GO TO 936D)
NO 2
e. Contraception
YES 1 (GO TO 936D)
NO 2
f. HIV/AIDS
YES 1 (GO TO 936D)
NO 2
g. Condom use to avoid sexually transmitted diseases
YES 1 (GO TO 936D)
NO 2

936D. At what age should girls first be taught this topic in school?

a. Moral Values
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
b. Changes in boys' bodies at puberty
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
c. Changes in girls' bodies at puberty, including menstruation
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
d. Sex and sexual behavior
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
e. Contraception
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
f. HIV/AIDS
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8
g. Condom use to avoid sexually transmitted diseases
LESS THAN TEN 1
TEN TO TWELVE 2
THIRTEEN TO FIFTEEN 3
SIXTEEN OR OLDER 4
DOESN'T KNOW 8

SECTION 10. HOUSEHOLD RELATIONS

1000. CHECK FRONT COVER:
WOMAN SELECTED FOR THIS SECTION?

YES (GO TO 1001)
NO (GO TO 1028)

1001. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO NEXT QUESTION)
PRIVACY NOT POSSIBLE 2 (GO TO 1027)

READ TO THE RESPONDENT
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in India. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.

1002. CHECK 301 AND 308:

CURRENTLY MARRIED (GO TO 1003)

FORMERLY MARRIED (1003 TO 1013: READ IN PAST TENSE) (GO TO 1003)

MARRIED MORE THAN ONCE (1003 TO 1013: REFER TO CURRENT/LAST HUSBAND ONLY) (GO TO 1003)

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED (GO TO 1014)

First, I am going to ask you about some situations which happen to some women.

1003. Please tell me if these apply to your relationship with your (last) husband.

a. He (is/was) jealous or angry if you (talk/talked) to other men.
b. He frequently (accuses/accused) you of being unfaithful.
c. He (does/did) not permit you to meet your female friends.
d. He (tries/tried) to limit your contact with your family.
e. He (insists/insisted) on knowing where you (are/were) at all times.
f. He (does/did) not trust you with any money.

JEALOUS
YES 1
NO 2
DOESN'T KNOW 8
ACCUSES
YES 1
NO 2
DOESN'T KNOW 8
NOT MEET FRIENDS
YES 1
NO 2
DOESN'T KNOW 8
NO FAMILY
YES 1
NO 2
DOESN'T KNOW 8
WHERE YOU ARE
YES 1
NO 2
DOESN'T KNOW 8
MONEY
YES 1
NO 2
DOESN'T KNOW 8

Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband.

1004A. (Does/did) your (last) husband ever:

a. Say or do something to humiliate you in front of others?
YES 1 (GO TO 1004B)
NO 2
b. Threaten to hurt or harm you or someone close to you?
YES 1 (GO TO 1004B)
NO 2
c. Insult you or make you feel bad about yourself?
YES 1 (GO TO 1004B)
NO 2

CHECK 301: ASK ONLY IF RESPONDENT IS NOT A WIDOW:

1004B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a. Say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b. Threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c. Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1005A. (Does/did) your (last) husband ever do any of the following things to you:

a. Slap you?
YES 1 (GO TO 1005B)
NO 2
b. Twist your arm or pull your hair?
YES 1 (GO TO 1005B)
NO 2
c. Push you, shake you, or throw something at you?
YES 1 (GO TO 1005B)
NO 2
d. Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1005B)
NO 2
e. Kick you, drag you or beat you up?
YES 1 (GO TO 1005B)
NO 2
f. Try to choke you or burn you on purpose?
YES 1 (GO TO 1005B)
NO 2
g. Threaten or attack you with a knife, gun, or any other weapon?
YES 1 (GO TO 1005B)
NO 2
h. Physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 1005B)
NO 2
i. Force you to perform any sexual acts you did not want to?
YES 1 (GO TO 1005B)
NO 2

CHECK 301: ASK ONLY IF RESPONDENT IS NOT A WIDOW:

1005B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a. Slap you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b. Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c. Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d. Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e. Kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f. Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g. Threaten or attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h. Physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
i. Force you to perform any sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1006. CHECK 1005A (a-i):

AT LEAST ONE 'YES' (GO TO 1007)
NOT A SINGLE 'YES' (GO TO 1009)

1007. How long after you first got married to your (last) husband did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS ______
BEFORE MARRIAGE 95

1008. Did the following ever happen as a result of what your (last) husband did to you at any time:

a. You had cuts, bruises or aches?
b. You had severe burns?
c. You had eye injuries, sprains, dislocations, or minor burns?
d. You had deep wounds, broken bones, broken teeth, or any other serious injury?

CUTS/BRUISES
YES 1
NO 2
SEVERE BURNS
YES 1
NO 2
EYE INJURIES, SPRAINS DISLOCATIONS, ETC
YES 1
NO 2
OTHER SERIOUS INJURY
YES 1
NO 2

1009. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1012)

1010. CHECK 301:

RESPONDENT IS NOT A WIDOW (GO TO 1011)
RESPONDENT IS A WIDOW (GO TO 1012)

1011. In the last 12 months, how often have you done this to your husband: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1012. Does (did) your husband drink alcohol?

YES 1
NO 2 (GO TO 1014)

1013. How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1014. CHECK 301:

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED
From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?

EVER MARRIED
From the time you were 15 years old has anyone other than your (current/last) husband hit, slapped, kicked, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1017)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1017)

1015. Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND/PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) _______ X

1016. In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1017. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2 (GO TO 1021)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1021)

1018. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS ______
DOESN'T KNOW 98

1019. Who was the person who was forcing you at that time?

CURRENT HUSBAND 01
FORMER HUSBAND 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP-FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER ______ 96

1020. CHECK 301:

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED
In the last 12 months has anyone forced you to have sexual intercourse or perform any other sexual acts against your will?

EVER MARRIED
In the last 12 months, has anyone other than your (current/last) husband forced you to have sexual intercourse or perform any other sexual acts against your will?

YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

1021. CHECK 1005A (a-i), 1014, AND 1017:

AT LEAST ONE 'YES' (GO TO 1022)
NOT A SINGLE 'YES' (GO TO 1025)

1022. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop the person(s) from doing this to you again?

YES 1
NO 2 (GO TO 1024)

1023. From whom have you sought help to stop this?
Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1025)
HUSBAND'S FAMILY B (GO TO 1025)
CURRENT/LAST HUSBAND C (GO TO 1025)
CURRENT/FORMER BOYFRIEND D (GO TO 1025)
FRIEND E (GO TO 1025)
NEIGHBOUR F (GO TO 1025)
RELIGIOUS LEADER G (GO TO 1025)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1025)
POLICE I (GO TO 1025)
LAWYER J (GO TO 1025)
SOCIAL SERVICE ORGANIZATION K (GO TO 1025)
OTHER (SPECIFY) ______ X (GO TO 1025)

1024. Have you ever told anyone else about this?

YES 1
NO 2

1025. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DOESN'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE HOUSEHOLD RELATIONS MODULE ONLY.

1026. DID YOU HAVE TO INTERRUPT THIS SECTION OF THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

HUSBAND
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3

1027. INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE_______

1028. RECORD THE TIME.

HOUR ______
MINUTES______

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT ______

COMMENTS ON SPECIFIC QUESTIONS ______

ANY OTHER COMMENTS ______

SUPERVISOR'S OBSERVATIONS ______
NAME OF SUPERVISOR_______
DATE_______

EDITOR'S OBSERVATIONS______
NAME OF EDITOR______
DATE_______

INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1 AND 3, ALL MONTHS SHOULD BE FILLED IN. INFORMATION TO BE CODED FOR EACH COLUMN

[ASK COLUMNS 1-4 FOR ALL TWELVE MONTHS FROM 2001 THROUGH 2006]

COL. 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE?

[MONTH] ____
[YEAR] ____
B BIRTHS
P PREGNANCIES
T TERMINATIONS
[MONTH] ____
[YEAR] ____
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD/LOOP
5 INJECTABLES
6 IMPLANTS
7 CONDOM/NIRODH
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
L RHYTHM METHOD
M WITHDRAWAL
X OTHER (SPECIFY) _______

COL.2: ULTRASOUND CONDUCTED DURING PREGNANCY?

[MONTH] ____
[YEAR] ____
Y YES
N NO

COL. 3: MARRIAGE

[MONTH] ____
[YEAR] ____
X MARRIED
N MARRIED, GAUNA NOT PERFORMED
0 NOT MARRIED

COL. 4: DISCONTINUATION OF CONTRACEPTIVE USE?

[MONTH] ____
[YEAR] ____
0 INFREQUENT SEX/HUSBAND AWAY
1 METHOD FAILED/BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS/PROBLEMS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
L LACK OF SEXUAL SATISFACTION
M CREATED MENSTRUAL PROBLEM
G GAINED WEIGHT
N DID NOT LIKE METHOD
P LACK OF PRIVACY FOR USE
X OTHER (SPECIFY) _________
Z DOESN'T KNOW