IDENTIFICATION

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

MEGA CITY/LARGE CITY/SMALL CITY/LARGE TOWN/SMALL TOWN/RURAL ______

PSU NUMBER _______
HOUSEHOLD NUMBER _______
NAME AND LINE NUMBER OF MAN _______
ADDRESS OF HOUSEHOLD _______

INTERVIEWER VISITS

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

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY ______
MONTH ______
YEAR ______
INT. NUMBER ______
RESULT CODE ______

TOTAL NUMBER OF VISITS ______

NATIVE LANGUAGE OF RESPONDENT ______

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 men, women 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 about 30 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 your household.

May I begin the interview now?

SIGNATURE OF INTERVIEWER _______
DATE _______

101. RECORD THE TIME.

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

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

104. In the last 12 months, on how many separate occasions have you traveled away from your home community for at least one night?

105. In the last 12 months, have you been away from your home community for more than one month at a time?

106. In what month and year were you born?

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108. Have you ever attended school?

109. What is the highest standard you completed?

110. CHECK 109:

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

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

113. CHECK 111:

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

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

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

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

118. What is your religion?

119. What is your caste or tribe?

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

121. Have you done any work in the last seven days?

122. 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, or any other such reason?

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

124. What have you been doing for most of the time over the last 12 months?

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

126. CHECK 125:

127. 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?

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

SECTION 2. REPRODUCTION

Now I would like to ask about any children you have had during your life. I am interested only in the children that are biologically yours.

201. Have you ever fathered any children with any woman?

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

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

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

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

206. Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

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

208. (In addition to the children that you have just told me about), do you have:

a. Any other living sons or daughters who are biologically your children but who are not legally yours or do not have your last/family name?

b. Any other sons or daughters who died who were biologically your children but who were not legally yours or did not have your last/family name?

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

210. CHECK 209:

211. Do the children that you have fathered all have the same biological mother?

212. In all, how many women have you fathered children with?

213. How old were you when your (first) child was born?

214. How many years old is your (youngest) living child?

SECTION 3. CONTRACEPTION AND MALE INVOLVEMENT

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.

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

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF
EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR METHODS 02, 06, 08, AND 09, ASK 302 IF 301 HAS CODE 1 CIRCLED.

302. Have you ever used (METHOD)?

303. CHECK 302 (02):
RESPONDENT IS STERILIZED?

Now I would like to talk about when you were sterilized.

304. 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.

305. In what month and year was the sterilization performed?

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

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

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

309. Do you regret that you had the sterilization?

310. 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?

Now I would like to ask you about a woman's risk of pregnancy.

311. 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?

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

313. Do you think that a woman who is breastfeeding her baby can become pregnant?

314. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a. Contraception is women's business and a man should not have to worry about it.
b. Women who use contraception may become promiscuous.

315. CHECK 301 (06):
KNOWS MALE CONDOM?

316. If a male condom is used correctly, do you think that it protects against pregnancy most of the time, only sometimes, or not at all?

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

318. 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.

319. In the last 3 months, have you visited a health facility or camp for any reason for yourself (or for your children)?

320. 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.

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

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

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

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

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

326. CHECK 214:

327. What is the name of your (youngest) child?

WRITE NAME OF (YOUNGEST) CHILD AND ENTER THE LINE NUMBER OF THE CHILD FROM THE HOUSEHOLD QUESTIONNAIRE. IF CHILD IS NOT LISTED IN THE LINE NUMBER OF (YOUNGEST) HOUSEHOLD SCHEDULE, WRITE '00' IN THE BOXES FOR THE LINE NUMBER.

328. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

329. Were you ever present during any antenatal check-up?

330 What was the main reason why (NAME)'s mother did not have any antenatal check-up?

331. At any time when (NAME)'s mother was pregnant with (NAME), did any health provider or health worker ever tell you about the following signs of pregnancy complications?

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

332. Were you ever told what to do if (NAME)'s mother had any pregnancy complication?

333. At any time during the pregnancy did any health provider or health worker speak to you about:

a. The importance of delivering the baby in a hospital or health facility?
b. The importance of proper nutrition for the mother during pregnancy?
c. Family planning or delaying your next child?

334. Was (NAME) born in a hospital or any other health facility?

335. When (NAME)'s mother was pregnant with (NAME), did anyone explain to you the importance of the following:

a. The need for the mother to breastfeed the baby immediately after delivery?
b. The need to keep the baby warm immediately after birth?
c. The need for cleanliness at the time of delivery?
d. The need for a new or unused blade to cut the cord?

336. What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?

337. When a child has diarrhea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?

SECTION 4. MARRIAGE AND SEXUAL LIFE

401. What is your current marital status?

402. Do you currently have one wife or more than one wife?
IF ONLY ONE WIFE, RECORD '01'.
IF MORE THAN ONE, ASK: How many wives do you currently have?

403. CHECK 402:

ONLY ONE WIFE: Please tell me the name of your wife.

MORE THAN ONE WIFE: Please tell me the name of each of your wives, starting with the one you married first.

WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE. IF A WIFE IS NOT LISTED IN THE HOUSEHOLD SCHEDULE, RECORD '00' IN THE LINE NUMBER BOXES. THE NUMBER OF LINES FILLED IN MUST BE EQUAL TO THE NUMBER OF WIVES. (IF RESPONDENT HAS MORE THAN FOUR WIVES, USE SPACE AT THE BOTTOM OF THE PAGE.)

404. Are you living with your wife/wives now, or is she/are they staying elsewhere?

405. For how long have you not been living with your wife/any of your wives?
IF LESS THAN 1 YEAR, RECORD MONTHS.
OTHERWISE RECORD COMPLETED YEARS.

406. CHECK 402:

ONLY ONE WIFE
Have you ever been married to any woman other than your current wife?

MORE THAN ONE WIFE
Have you ever been married to any other woman in addition to those you have told me about?

407. Have you been married once or more than once?

408. CHECK 402 AND 406:

409. In what month and year did you get married?
409A. Now I would like to ask about when you married your first wife. In what month and year was that?

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

411. CHECK 401:

412. CHECK 402 AND 406 AND, IF 402 AND 406 NOT ASKED, CHECK 407:

MARRIED ONLY ONCE (402 IS '01' AND 406 IS '2') OR (407 IS '1')
In what month and year did you start living with your wife?

MARRIED MORE THAN ONCE (402 GREATER THAN 01 OR 406 IS '1') OR (407 IS '2')
Now I would like to ask about when you started living with your first wife. In what month and year was that?

413. How old were you when you first started living with her?

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.

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

414. Have you ever had sexual intercourse?

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

416. CHECK 401:

417. Do you intend to wait until you get married to have sexual intercourse for the first time?

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

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

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

[ASK QUESTIONS 420-428 FOR RESPONDENT'S LAST THREE SEXUAL PARTNERS]

420. When was the last time you had sexual intercourse with this person?
[ASK FOR SECOND-TO-LAST AND THIRD-TO-LAST SEXUAL PARTNERS]

421. The last time you had sexual intercourse (with this second/third person), was a condom used?

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

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

424. 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.

425. CHECK 107:

426. How old is this person?

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

428. Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?
[ASK FOR LAST AND SECOND-TO-LAST SEXUAL PARTNERS ONLY]

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

430. CHECK 423, ALL COLUMNS:

431. In the last 12 months, did you pay anyone in exchange for sex?

432. The last time you paid someone in exchange for sex, was a condom used?

433. Was a condom used every time you paid someone in exchange for sex in the last 12 months?

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

435. CHECK 421, COLUMN 1 (CONDOM USE WITH LAST SEXUAL PARTNER):

436. You told me that the last time you had intercourse you used a condom. What brand of condom did you use the last time?

437. Who obtained the condom: you, your partner, or someone else?

438. How many condoms did you get the last time?

439. The last time you obtained condoms, how much did you pay in total, including the cost of the method and any consultation you may have had?

440. From where did you obtain the condom 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.

441. This last time you used a condom, did you use it to avoid pregnancy, to avoid a sexually transmitted disease, or for some other reason?
PROBE: Any other reason?
RECORD ALL MENTIONED.

442. CHECK 302 (02):
RESPONDENT EVER STERILIZED?

443. The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

444. What method did you or your partner use?
PROBE: Did you use any other method to prevent pregnancy?
RECORD ALL MENTIONED.

445. CHECK 421, ALL COLUMNS, AND 432:

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

447. 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.

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

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

502. CHECK 402:

HAS ONE WIFE
Is your wife currently pregnant?

HAS MORE THAN ONE WIFE
Are any of your wives currently pregnant?

503. CHECK 302(02):
EVER STERILIZED?

504. CHECK 502:

YES, PREGNANT
Now I have some questions about the future. After the child(ren) your wife/wives is/are expecting now, would you like to have another child or would you prefer not to have any more children at all?

NOT PREGNANT, UNSURE, OR NOT ASKED
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 at all?

505. How long would you like to wait from now before the birth of (a/another) child?

506. CHECK 203 AND 205:

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?

507. 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?

SECTION 6. SELECTED HEALTH AND NUTRITION ISSUES

601. 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?

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

602. 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.

603 CHECK 602:

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.

604. 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.

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

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

607. Have you ever had a blood transfusion?

608. Do you currently smoke cigarettes or bidis?

609. In the last 24 hours, how many cigarettes or bidis did you smoke?
IF NONE, RECORD '00'.

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

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

612. Do you drink alcohol?

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

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

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

616. Can tuberculosis be cured?

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

618. Do you currently have:

a. Diabetes?
b. Asthma?
c. Goiter or another thyroid disorder?

SECTION 7. ATTITUDES TOWARDS GENDER ROLES

701. In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:

702. 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?

703. When a wife knows her husband has a sexually transmitted disease, is she justified in asking that they use a condom?

704. 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.

705. Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to:

a. Get angry and reprimand her?
b. Refuse to give her money or other means of financial support?
c. Use force and have sex with her even if she doesn't want to?
d. Go and have sex with another woman?

706. CHECK 401:

707. (Is your wife/Are any of your wives) currently employed for cash?

708. Who decides how the money your wife earns will be used: mainly you, mainly your wife, or you and your wife jointly?

709. CHECK 128:

710. Would you say that the money you earn is more than what your wife earns, less than what she earns, or about the same?

711. Who decides how your earnings will be used: mainly you, mainly your wife, or you and your wife jointly?

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

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

Now I would like to talk about something else.

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

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

803. 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?

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

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

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

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

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

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

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

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

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

813. 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?

814. 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?

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

816. When was the last time you were tested?

817. 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?

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

819. 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.

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

821. 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.

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

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

824. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

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

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

827. Some men are circumcised. Are you circumcised?

828. CHECK 801:

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

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

829. CHECK 414 AND 415:

830. CHECK 828:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

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

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

832. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

833. Sometimes men have a sore or ulcer on or near their penis. During the last 12 months, have you had a sore or ulcer on or near your penis?

834. CHECK 831, 832, AND 833:

835. The last time you had (PROBLEM FROM 831/832/833), did you seek any kind of advice or treatment?

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

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

837. 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.
837A First we will talk about boys. Should boys be taught in school about_____?

837B. At what age should boys first be taught this topic in school?

837C. Now let us talk about girls. Should girls be taught in school about_____?

837D. At what age should girls first be taught this topic in school?

838. RECORD THE TIME

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 _______

PSU INFORMATION FORM

STATE______
PAGE ______ OF ______ PAGES

DISTRICT ______
TEHSIL/TALUK ______
CITY/TOWN/VILLAGE ______

CITY SIZE/ RURAL AREA_____

PSU NUMBER _____

ALTITUDE:

PSU COVERAGE BY ANGANWADI/ICDS CENTRE AND YEAR ESTABLISHED (IF YES):

NAME OF SUPERVISOR ______

PSU INFORMATION FORM (ONLY FOR 8 SPECIFIED CITIES)

[FOR CHENNAI, DELHI, HYDERABAD, INDORE, KOLKATA, MEERUT, MUMBAI, NAGPUR]

STATE______
PAGE ______ OF ______ PAGES

DISTRICT ______
TEHSIL/TALUK ______
CITY/TOWN/VILLAGE ______

CITY SIZE/ RURAL AREA_____

PSU NUMBER _____

ALTITUDE:

PSU COVERAGE BY ANGANWADI/ICDS CENTRE AND YEAR ESTABLISHED (IF YES):

IS PSU IN SLUM AREA ACCORDING TO:

NAME OF SUPERVISOR__________