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2015-16 (NFHS-4) [STATE NAME]

NATIONAL FAMILY HEALTH SURVEY, INDIA 2015-2016 (NFHS-4)
WOMAN'S QUESTIONNAIRE [STATE NAME]

IDENTIFICATION

STATE___________

DISTRICT__________

TEHSIL/TALUK_________

TYPE OF PSU (URBAN EQUALS 1, RURAL EQUALS 2) ________

URBAN 1
RURAL 2

PSU NUMBER ________

STRUCTURE NUMBER ________

HOUSEHOLD NUMBER ________

NAME AND LINE NUMBER OF WOMAN________

ADDRESS OF HOUSEHOLD__________

IS HOUSEHOLD SELECTED FOR THE STATE MODULE?

YES 1
NO 2

IS WOMAN SELECTED FOR QUESTIONS ON HOUSEHOLD RELATIONS (SECTION 11)?

YES 1
NO 2


INTERVIEWER VISITS

FIRST VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE*______

SECOND VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE*______

THIRD VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE*______

NEXT VISIT
DATE_______
TIME_______

FINAL VISIT
DAY ______
MONTH ______
YEAR _____
INT. NO ______
RESULT CODE * ______

TOTAL NUMBER OF VISITS _______

SUPERVISOR'S NAME_______

SUPERVISOR NUMBER ________

RESULT CODES*

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

**LANGUAGE HINDI 04

** RESPONDENT'S MOTHER TONGUE _______

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


**LANGUAGE OF INTERVIEW ________________ __ __

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

TRANSLATOR USED?

YES 1
NO 2

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND INFORMED CONSENT

Namaste. My name is _______. I am working with (NAME OF ORGANIZATION). We are conducting a survey about health all over India. The information on family welfare and health that we collect from households and individuals will help the government to plan health services. Your household was selected for the survey. The questions usually take about 40 - 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. Your participation in the survey is voluntary. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

If you have any questions about this survey you may ask me.
GIVE CARD WITH CONTACT INFORMATION.

Do you agree to participate in this survey?

SIGNATURE OF INTERVIEWER:_____________
DATE:______

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)


101. RECORD THE TIME.

HOUR _____
MINUTES _____


102. In what month and year were you born?

MONTH __ __
DON'T KNOW MONTH 98
YEAR __ __ __ __
DON'T KNOW YEAR 9998

103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS __ __


104. How long have you been living continuously in (CURRENT PLACE OF RESIDENCE)?
IF LESS THAN 1 YEAR, RECORD '00'

YEARS __ __
ALWAYS 95
VISITOR 96


105. Have you ever attended school?

YES 1
NO 2 (GO TO 108)


106. What is the highest standard you completed?

STANDARD ____


107. CHECK 106:

STANDARD 0-5 (GO TO 108)
STANDARD 6 AND ABOVE (GO TO 110)


108. 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 4 (SPECIFY LANGUAGE)_______4
BLIND/VISUALLY IMPAIRED 5


109. CHECK 108:

CODE '2', '3' OR '4' RECORDED (GO TO 110)
CODE '1' OR '5' RECORDED (GO TO 111)


110. 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


111. 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


112. 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


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

YES 1
NO 2


114. 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


115. What is your caste or tribe?

CASTE (SPECIFY) _________991
TRIBE (SPECIFY) _________992
NO CASTE/TRIBE 993 (GO TO 201)
DON'T KNOW 998


116. 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

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

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 226)

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW)

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

BIRTH HISTORY NUMBER AND NAME________________ __ __


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

BOY 1
GIRL 2


214. Were any of these births twins?

SINGLE 1
MULTIPLE 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. How old was (NAME) at (his/her) last birthday?
RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS __ __


218. Is (NAME) living with you?

YES 1
NO 2


219. IF ALIVE: RECORD HOUSE-HOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSE-HOLD).

LINE NUMBER __ __ (GO TO NEXT BIRTH)


220. 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 TWO 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 birth?

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)


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. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN JANUARY 2010 OR LATER.

NUMBER OF BIRTHS __
NONE 0 (GO TO 226)

225. C:
FOR EACH BIRTH SINCE JANUARY 2010, 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.

226. Are you pregnant now?

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


227. C: How many months are you?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS __ __


228. 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.

229. When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 231)
NO 2


230. Did you want to have the baby later on or did you not want any (more) children?

LATER 1
NO MORE 2


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

YES 1 (GO TO 248)
NO 2


232. When did the last such pregnancy end?

MONTH __ __
YEAR __ __ __ __


233. CHECK 232:

LAST PREGNANCY ENDED IN JANUARY 2011 OR LATER (GO TO 234)
LAST PREGNANCY ENDED BEFORE JANUARY 2011 (GO TO 248)


234. C: Did that pregnancy end in a miscarriage, an abortion, or a stillbirth?

CIRCLE RESPONSE CODE AND ENTER 'M' FOR MISCARRIAGE, 'A' FOR ABORTION, OR 'S' FOR STILLBIRTH IN COLUMN 1 OF THE CALENDAR IN MONTH IN WHICH PREGNANCY WAS TERMINATED.

MISCARRIAGE 1
ABORTION 2
STILLBIRTH 3


235. C: How many months pregnant were you when the last such pregnancy ended?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF CALENDAR IN MONTHS BEFORE THE PREGNANCY TERMINATED. TOTAL NUMBER OF 'P's MUST BE ONE LESS THAN NUMBER OF MONTHS PREGNANT AT TIME OF TERMINATION.

MONTHS __


236. C: 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 MONTH IN WHICH PREGNANCY WAS TERMINATED.

237. CHECK 234:

ABORTION (GO TO 238)
MISCARRIAGE OR STILLBIRTH (GO TO 244)


238. Where was the abortion performed?

PUBLIC HEALTH SECTOR
GOVT./MUNICIPAL HOSPITAL 11
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 12
GOVT. DISPENSARY/CLINIC 13
UHC/UHP/UFWC 14
CHC/RURAL HOSP./BLOCK PHC 15
PHC/ADDITIONAL PHC 16
SUB-CENTRE 17
GOVT/ MOBILE CLINIC 18
OTHER PUBLIC HEALTH SECTOR (SPECIFY)________19
NGO OR TRUST HOSPITAL/CLINIC 21
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC 31
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 32
DISPENSARY/CLINIC 33
OTHER PRIVATE HEALTH SECTOR (SPECIFY) __________34
OTHER
AT HOME 41
ELSEWHERE (SPECIFY) _________42


239. Who performed the abortion?

DOCTOR 1
NURSE/ANM/LHV 2
DAI 3
FAMILY MEMBER/RELATIVE/FRIEND 4
SELF 5
OTHER (SPECIFY) _________6


240. Did you have any complication from the abortion?

YES 1
NO 2 (GO TO 244)


241. Did you seek treatment for the complication?

YES 1
NO 2 (GO TO 243)


242. Where did you go for treatment?

PUBLIC HEALTH SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 244)
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 12 (GO TO 244)
GOVT. DISPENSARY/CLINIC 13 (GO TO 244)
UHC/UHP/UFWC 14 (GO TO 244)
CHC/RURAL HOSP./BLOCK PHC 15 (GO TO 244)
PHC/ADDITIONAL 16 (GO TO 244)
SUB-CENTRE 17 (GO TO 244)
GOVT. MOBILE CLINIC 18
OTHER PUBLIC HEALTH SECTOR (SPECIFY) __________19 (GO TO 244)
NGO OR TRUST HOSPITAL/CLINIC 21 (GO TO 244)
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 244)
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 32 (GO TO 244)
DISPENSARY/CLINIC 33 (GO TO 244)
OTHER PRIVATE HEALTH SECTOR (SPECIFY) ________34 (GO TO 244)
OTHER
AT HOME 41(GO TO 244)
ELSEWHERE (SPECIFY)_________42(GO TO 244)


243. Why did you not seek treatment?
Any other reason?
RECORD ALL MENTIONED.

COULD NOT AFFORD TREATMENT A
COULD NOT AFFORD TRANSPORT B
FEAR OF STIGMA BY PROVIDER C
FEAR OF STIGMA BY COMMUNITY D
COMPLICATION WAS MINOR/DID NOT REQUIRE TREATMENT E
PROBLEM RESOLVED ITSELF F
COULD NOT GET AWAY FROM FAMILY RESPONSIBILITIES G
HUSBAND DID NOT GIVE PERMISSION H
OTHER (SPECIFY)__________X


244. Since January 2011, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 246)


245. C:
ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY SINCE JANUARY 2010.

ENTER 'T' IN COLUMN 1 OF CALENDAR IN MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR REMAINING NUMBER OF COMPLETED MONTHS.
FOR EACH TERMINATED PREGNANCY ASK: 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 MONTH IN WHICH PREGNANCY WAS TERMINATED.

246. Did you have any pregnancies that terminated before January 2011 that did not result in a live birth?

YES 1
NO 2


247. When did the last such pregnancy that terminated before January 2011 end?

MONTH __ __
YEAR __ __ __ __


248. When did your last menstrual period start?
IF LESS THAN 1 WEEK, RECORD DAYS;
IF LESS THAN 1 MONTH, RECORD WEEKS;
IF LESS THAN 1 YEAR, RECORD MONTHS.

(DATE, IF GIVEN)___________
DAYS AGO 1 __ __
WEEKS AGO 2 __ __
MONTHS AGO 3 __ __
YEARS AGO 4 __ __

HAS HAD HYSTERECTOMY 993 (GO TO 251)
IN MENOPAUSE 994 (GO TO 250)
BEFORE LAST BIRTH 995 (GO TO 250)
NEVER MENSTRUATED 996 (GO TO 250)


249. CHECK 226:

LAST MENSTRUAL PEROD OVER 6 MONTHS AGO (GO TO 249A)
OTHER


249A. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 250)
PREGNANT (GO TO 254)


250. Some women undergo an operation to remove the uterus. Have you undergone such an operation?

YES 1
NO 2 (GO TO 254)
DON'T KNOW 8 (GO TO 254)


251. How many years ago was this operation (hysterectomy) performed?
IF LESS THAN 1 YEAR AGO, RECORD '00'.

YEARS AGO __ __
DON'T KNOW 98


252. Where was this operation performed?

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

PUBLIC HEALTH SECTOR
GOVT./MUNICIPAL HOSPITAL 11
GOVT. DISPENSARY 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/BLOCK PHC 14
PHC/ADDITIONAL PHC 15
SUB-CENTRE 16
GOVT. MOBILE CLINIC 17
CAMP 18
OTHER PUBLIC SECTOR HEALTH FACILITY 19
NGO OR TRUST HOSPITAL/CLINIC 21
PRIVATE HEALTH SECTOR
PVT. HOSPITAL 31
PVT. DOCTOR/CLINIC 32
PVT. MOBILE CLINIC 33
OTHER PRIVATE HEALTH FACILITY 34
OTHER (SPECIFY)_________96
DON'T KNOW 98


253. Why was this operation performed? Any other reason?

EXCESSIVE MENSTRUAL BLEEDING AND/OR PAIN A
FIBROID/CYSTS B
UTERINE DISORDER (RUPTURE) C
CANCER D
UTERINE PROLAPSE E
SEVERE POST-PARTUM HAEMORRHAGE F
OTHER (SPECIFY)________X


254. CHECK 248:

NEVER MENSTRUATED (GO TO 258)
OTHER (GO TO 255)


255. CHECK 103:

AGE 15-24 (GO TO 256)
AGE 25 OR MORE (GO TO 258)


256. How old were you when you had your first monthly period?

AGE IN COMPLETED YEARS __ __


257. Women use different methods of protection during their menstrual period to prevent bloodstains from becoming evident. What do you use for protection, if anything?
Anything else? RECORD ALL MENTIONED.

CLOTH A
LOCALLY PREPARED NAPKINS B
SANITARY NAPKINS C
TAMPONS D
NOTHING E
OTHER (SPECIFY)__________X


258. 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)
DON'T KNOW 8 (GO TO 301)


259. 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
DON'T KNOW 8


SECTION 3A. MARRIAGE AND COHABITATION

301. What is your current marital status?

CURRENTLY MARRIED 1
MARRIED, GAUNA NOT PERFORMED 2 (GO TO 305)
WIDOWED 3 (GO TO 307)
DIVORCED 4 (GO TO 307)
SEPARATED 5 (GO TO 307)
DESERTED 6 (GO TO 307)
NEVER MARRIED 7 (GO TO 315)


302. Is your husband living with you now, or is he staying elsewhere?

LIVING WITH HER 1 (GO TO 304)
STAYING ELSEWHERE 2


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

MONTHS 1 __ __
YEARS 2 __ __


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

NAME___________
LINE NO. __ __

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

YES 1
NO 2 (GO TO 307)
DON'T KNOW 8 (GO TO 307)


306. Including yourself, in total, how many wives does he have?

NUMBER OF WIVES ___
DON'T KNOW 8


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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 308A)


308. In what month and year did you get married?

MONTH __ __
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 310)
DON'T KNOW YEAR 9998


308A. Now I would like to ask about when you married your first husband. In what month and year was that?

MONTH __ __
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 310)
DON'T KNOW YEAR 9998


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

AGE __ __


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

YES 1
NO 2 (GO TO 312)


311. What type of relationship was it?

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


312. CHECK 301: MARITAL STATUS

CODE '2' CIRCLED (GO TO 315)
CODE '2' NOT CIRCLED (GO TO 313)


313. CHECK 307:

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 __ __
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 316)
DON'T KNOW YEAR 9998


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

AGE __ __ (GO TO 316)

315. 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.

Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 317)


316. 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.

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


317. 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.
Have you ever heard of (METHOD)?

01. FEMALE STERILIZATION: Women can have 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.
YES 1
NO 2
03. IUD OR PPIUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04. 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
05. PILL: Women can take a pill every day or every week to avoid becoming pregnant.
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. LACTATIONAL AMENORRHOEA METHOD (LAM)
YES 1
NO 2
09. 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
10. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
11. EMERGENCY CONTRACEPTION: Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
12. Have you heard of any other ways or methods that women or men cause use to avoid pregnancy?
YES 1 (SPECIFY)_______________
NO 2


318. CHECK 315: EVER HAD SEXUAL INTERCOURSE

YES OR NOT ASKED (GO TO 319)
NEVER HAD SEX (GO TO 320)


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

YES 1(GO TO 321)
NO 2


320. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 350A)

321. What have you used or done?
RECORD ALL MENTIONED. CORRECT 317 (IF NECESSARY).

FEMALE STERILIZATION A
MALE STERILIZATION B
IUD/PPIUD C
INJECTABLES D
PULL E
CONDOM/NIRODH F
FEMALE CONDOM G
EMERGENCY CONTRACEPTION H
DIAPHRAGM I
FOAM/JELLY J
STANDARD DAYS METHOD K
LACTATIONAL AMENDMENT METHOD L
RHYTHM METHOD M
WITHDRAWAL N
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y


322. CHECK 321: EVER USED EMERGENCY CONTRACEPTION

CODE 'H' CIRCLED (GO TO 323)
CODE 'H' NOT CIRCLED (GO TO 325)


323. In the last 12 months, how many times have you used emergency contraceptive pills?

NONE 00 (GO TO 325)
NUMBER OF TIMES __ __


324. Where did you get the emergency contraceptive pills? Anywhere else?
RECORD ALL MENTIONED.

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


325. CHECK 208:

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


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

NUMBER OF CHILDREN __ __


327. CHECK 321: RESPONDENT STERILIZED?

CODE 'A' NOT RECORDED (GO TO 327A)
CODE 'A' RECORDED (GO TO 330A)


327A. CHECK 248 AND 250:

HAS HAD A HYSTERECTOMY (GO TO 342)
HAS NOT HAD A HYSTERECTOMY (GO TO 328)


328. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 329)
PREGNANT (GO TO 342)


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

YES 1
NO 2 (GO TO 342)


330. Which method are you using?
330A. RECORD 'A' FOR FEMALE STERILIZATION.

RECORD ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST. CORRECT 317 (IF NECESSARY).

FEMALE STERILIZATION (GO TO 331)
MALE STERILIZATION B (GO TO 331)
IUD/PPIUD C (GO TO 339A)
INJECTABLES D (GO TO 339A)
PILL E (GO TO 339A)
CONDOM/NIRODH F (GO TO 339A)
FEMALE CONDOM G (GO TO 339A)
DIAPHRAGM H (GO TO 339A)
FOAM/JELLY I (GO TO 339A)
STANDARD DAYS METHOD J (GO TO 339A)
LACTATIONAL AMEN. METHOD K (GO TO 339A)
RHYTHM METHOD L (GO TO 339A)
OTHER MODERN METHOD X (GO TO 339A)
OTHER TRADITIONAL METHOD Y (GO TO 339A)


331. In what facility did the sterilization take place?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF FACILITY/PLACE)_____________

PUBLIC HEALTH SECTOR
GOVT./MUNICIPAL HOSPITAL 11
GOVT. DISPENSAR 12
UHC/UHP/UFWC 13
CHC/RURAL HOSPITAL/BLOCK PHC 14
PHC/ADDITIONAL PHC 15
SUB-CENTRE 16
GOVT. MOBILE CLINIC 17
CAMP 18
OTHER PUBLIC SECTOR HEALTH FACILITY 19
NGO OR TRUST HOSPITAL/CLINIC 21
PRIVATE HEALTH SECTOR
PVT. HOSPITAL 31
PVT. DOCTOR/CLINIC 32
PVT. MOBILE CLINIC 33
OTHER PRIVATE HEALTH FACILITY 34
OTHER (SPECIFY)_____________96
DON'T KNOW 98


332. CHECK 330/330A: RESPONDENT STERILIZED?

CODE 'A' RECORDED (GO TO 333)
CODE 'A' NOT RECORDED (GO TO 339A)


333. Before your sterilization operation, were you told by a healthcare provider that you would not be able to have any (more) children because of this operation?

YES 1
NO 2


334. 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


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

AMOUNT Rs. __ __ __ __
FREE 99995
DON'T KNOW 99998


336. Did you receive compensation for the sterilization?

YES 1
NO 2 (GO TO 338)


337. How much compensation did you receive?

AMOUNT Rs. __ __ __ __
DON'T KNOW 9998


338. Do you regret that you had the sterilization?

YES 1
NO 2


339. In what month and year was the sterilization performed?
339A. Since what month and year have been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) without stopping?

MONTH __ __
YEAR __ __ __ __


340. CHECK 339/339A, 215 AND 232:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 339/339A?

YES (FOR METHODS OTHER THAN STERILIZATION: GO BACK TO 339A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OF PREGNANCY TERMINATION).

NO (FOR FEMALE STERILIZATION: CORRECT 339 OR 330 (IF NECESSARY). FOLLOW CORRECT SKIP PATTERN).


341. CHECK 339/339A:

YEAR IS 2011 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF CALENDAR AND IN EACH MONTH BACK TO DATE STARTED USING.) THEN CONTINUE WITH 342.
YEAR IS 2010 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF CALENDAR AND EACH MONTH BACK TO JANUARY 2010.) THEN SKIP TO 349


342. I would like to ask you some questions about the times you or your husband 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 2010.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION IN THE SAME ROW AS THE LAST MONTH OF USE NUMBER OF CODES IN COLUMN 3 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 3: d. Why did you stop using the (METHOD)?
e. 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:
f. 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.

343. CHECK 330/330A:

RECORD 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 350A)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 354)
IUD/PPIUD 03
INJECTABLES 04
PILL 05
CONDOM/NIRODH 06 (GO TO 347)
FEMALE CONDOM 07 (GO TO 347)
DIAPHRAGM 08 (GO TO 347)
FOAM/JELLY 09 (GO TO 347)
STANDARD DAYS METHOD 10 (GO TO 347)
LACTATIONAL AMENORRHOEA METHOD 11 (GO TO 354)
RHYTHM METHOD 12 (GO TO 354)
WITHDRAWAL 13 (GO TO 354)
OTHER MODERN METHOD 14 (GO TO 354)
OTHER TRADITIONAL METHOD 15 (GO TO 354)


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

YES 1 (GO TO 346)
NO 2


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

YES 1
NO 2 (GO TO 347)


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

YES 1
NO 2


347. CHECK 343:

CODE '01' RECORDED (When you got sterilized, were you told about other methods of family planning that you could use?)

CODE '01' NOT RECORDED (When you obtained (CURRENT METHOD) in (MONTH/YEAR), were you told about other methods of family planning that you could use?

YES 1 (GO TO 349)
NO 2


348. 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


349. CHECK 330/330A:

RECORD METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 330/330A, RECORD CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 354)
MALE STERILIZATION 02 (GO TO 354)
IUD/PPIUD 03
INJECTABLES 04
PILL 05
CONDOM/NIRODH 06
FEMALE CONDOM 07
DIAPHRAGM 08
FOAM/JELLY 09
STANDARD DAYS METHOD 10 (GO TO 354)
LACTATIONAL AMENORRHOEA METHOD 11 (GO TO 354)
RHYTHM METHOD 12 (GO TO 354)
WITHDRAWAL 13 (GO TO 354)
OTHER MODERN METHOD 14 (GO TO 354)
OTHER TRADITIONAL METHOD 15 (GO TO 354)


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

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

(NAME OF FACILITY/PLACE)_____________
PUBLIC HEALTH SECTOR
GOVT./MUNICIPAL HOSPITAL 11 (GO TO 354)
VAIDYA/HAKIM HOMEOPATH (AYUSH) 12 (GO TO 354)
GOVT. DISPENSAR 13 (GO TO 354)
UHC/UHP/UFWC 14 (GO TO 354)
CHC/RURAL HOSPITAL/BLOCK PHC 15 (GO TO 354)
PHC/ADDITIONAL PHC 16 (GO TO 354)
GOVT. MOBILE CLINIC 18 (GO TO 354)
CAMP 19 (GO TO 354)
ANGANWADI/ICDS CENTRE 20 (GO TO 354)
ASHA 21 (GO TO 354)
OTHER COMMUNITY-BASED WORKER 22 (GO TO 354)
OTHER PUBLIC HEALTH SECTOR 23 (GO TO 354)
NGO OR TRUST HOSPITAL/CLINIC 31 (GO TO 354)
PRIVATE HEALTH SECTOR
PVT. HOSPITAL 41 (GO TO 354)
PVT. DOCTOR/CLINIC 42 (GO TO 354)
PVT. MOBILE CLINIC 43 (GO TO 354)
VAIDYA/HAKIM/HOMEOPATH (AYUSH)
TRADITIONAL HEALER 45 (GO TO 354)
PHARMACY/DRUGSTORE 46 (GO TO 354)
DAI (TBA) 47 (GO TO 354)
OTHER PRIVATE HEALTH SECTOR 48 (GO TO 354)
OTHER SOURCE
SHOP 51 (GO TO 354)
HUSBAND 52 (GO TO 354)
FRIEND/RELATIVE 53 (GO TO 354)
OTHER (SPECIFY)________96


350A. CHECK 248 AND 250:

HAS HAD A HYSTERECTOMY (GO TO 354)
HAS NOT HAD A HYSTERECTOMY (GO TO 351)


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

YES 1
NO 2


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

YES 1
NO 2 (GO TO 354)


353. Where is that? Any other place?

RECORD ALL PLACES MENTIONED.

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

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


354. Now I would like to talk to you about any contacts you have had recently with an ANM or LHV. In the last three months have you met with an ANM or LHV?

YES 1
NO 2 (GO TO 356)


355. In the last three months, how many times did you meet with (this person/these persons):
IF NONE, RECORD '00'.

a. At home?
__ __
b. At the anganwadi centre?
__ __
c. At a health facility or camp?
__ __
d. Anywhere else?
__ __


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

YES 1
NO 2 (GO TO 359)


357. Who did you meet?
Anyone else?

RECORD ALL MENTIONED.

ANGANWADI/WORKER A
ASHA B
MPW C
OTHER (SPECIFY)_______X


358. In the last three months, how many times did you meet with (this person/these persons):
IF NONE, RECORD '00'.

a. At home?
__ __
b. At the anganwadi centre?
__ __
c. At a health facility or camp?
__ __
d. Anywhere else?
__ __


359. CHECK 354 AND 356:

AT LEAST ONE 'YES' (GO TO 360)
BOTH 'NO' (GO TO 363)


360. During (this contact/all these contacts) with (PERSON MENTIONED IN 354 AND 357) 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
BIRTH PREPAREDNESS E
COMPLICATION READINESS F
POSTNATAL CARE G
DISEASE PREVENTION H
MEDICAL TREATMENT FOR SELF I
TREATMENT FOR SICK CHILD J
TREATMENT FOR OTHER PERSON K
MALARIA CONTROL L
SUPPLEMENTARY FOOD M
GROWTH MONITORING OF CHILD N
EARLY CHILDHOOD CARE O
PRE-SCHOOL EDUCATION P
NUTRITION/HEALTH EDUCATION R
MENSTRUAL HYGIENE S
OTHER (SPECIFY)______X


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

ANM 1
LHV 2
ANGANWADI WORKER 3
ASHA 4
MPW 5
OTHER (SPECIFY)______6


362. CHECK 355(c) AND 358(c):

355 (c) AND 358(c) EQUALS 00 OR BLANK (GO TO 363)
OTHER (GO TO 364)


363. 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)


364. 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 HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF FACILITY/PLACE)___________

PUBLIC HEALTH SECTOR
GOVT./MUNICIPAL HOSPITAL 11
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 12
GOVT. DISPENSARY 13
UHC/UHP/UFWC 14
CHC/RURAL HOSPITAL/BLOCK PHC 15
PHC/ADDITIONAL PHC 16
SUB-CENTRE 17
GOVT/ MOBILE CLINIC 18
CAMP 19
ANGANWADI/ICDS CENTRE 20
OTHER PUBLIC SECTOR HEALTH FACILITY 21
NGO OR TRUST HOSPITAL/CLINIC 22
PRIVATE HEALTH SECTOR
PVT. HOSPITAL/CLINIC 31
PVT. MOBILE CLINIC 32
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 33
PHARMACY/DRUGSTORE 34
OTHER PRIVATE SECTOR HEALTH FACILITY 35
OTHER (SPECIFY)_________96


365. 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
MEDICAL TERMINATION OF PREGNANCY (MTP) L
OTHER (SPECIFY)_____X


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

401. CHECK 224:

ONE OR MORE BIRTHS IN JANUARY 2011 OR LATER (GO TO 402)
NO BIRTHS IN JANUARY 2011 OR LATER (GO TO 550)


402. ENTER IN THE TABLE BELOW THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2010 OR LATER. ASK THE QUESTIONS ABOUT ALL 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 child separately.)

403. LINE NUMBER FROM 212

LINE NUMBER __ __


404. FROM 212 AND 216

NAME_________
LIVING (GO TO 405)
DEAD (GO TO 405)


405. When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 408)
NO 2


406. Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
NO MORE 2 (GO TO 408)


407. How much longer did you want to wait?

MONTHS 1 __ __
YEARS 2 __ __
DON'T KNOW 998


408. How many months pregnant were you when you came to know about the pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

MONTHS __ __
DON'T REMEMBER 98


408A. Did you use a pregnancy testing kit to confirm this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2


409. Was this pregnancy registered?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 413)


410. How many months pregnant were you when you registered?
[ASK FOR MOST RECENT BIRTH ONLY]

MONTHS __ __
DON'T REMEMBER 98


411. With whom did you register?
[ASK FOR MOST RECENT BIRTH ONLY]

ANM 1
ASHA 2
AWW 3
OTHER 6


412. Did you receive a Mother and Child Protection Card after registration?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2


413. Did you see anyone for antenatal care for this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2(GO TO 422)


414. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON. RECORD ALL MENTIONED.
[ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR A
ANM/NURSE/MID-WIFE/LHV B
OTHER HEALTH PERSONNEL
DAI/TRADITIONAL BIRTH ATTENDANT C
COMMUNITY/VILLAGE HEALTH WORKER D
ANGANWADI/ICDS WORKER E
ASHA F
OTHER (SPECIFY) _______X


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

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

(NAME OF FACILITY/PLACE(S))_________
HOME
YOUR HOME A
PARENT'S HOME B
OTHER HOME C
PUBLIC HEALTH SECTOR
GOVT./MUNIC. HOSPITAL D
GOVT. DISP E
UHC/UHP/UFWC F
CHC/RUR. HOPS./BLOCK PHC G
PHC/ADD. PHC H
SUB-CENTRE I
ANGANWADI/ICDS CENTRE J
VILLAGE CLINIC BY ANM K
OTHER PUBLIC SECT. HEALTH FACILITY L
NGO/TRUST HOSP./CLINIC M
PVT. HEALTH SECTOR
PVT. HOSP./MATERNITY HOME/CLINIC N
OTHER PVT. SECT. HEALTH FACILITY O
OTHER (SPECIFY)_______X


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

MONTHS __ __
DON'T KNOW 98


417. How many times did you receive antenatal care during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

NUM. OF TIMES __ __
DON'T KNOW 98


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

a. Were you weighed?
b. Was your blood pressure measured?
c. Did you give a urine sample?
d. Was a sample of your blood taken for testing?
e. Was your abdomen examined?

WEIGHED
YES 1
NO 2
BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2
ABDOMEN
YES 1
NO 2


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

a. Vaginal bleeding?
b. Convulsions?
c. Prolonged labour?
d. Severe abdominal pain?
e. High blood pressure?

BLEEDING
YES 1
NO 2
CONVULSIONS
YES 1
NO 2
PROLONGED LABOUR
YES 1
NO 2
ABDOMINAL PAIN
YES 1
NO 2
HIGH BLOOD PRESSURE
YES 1
NO 2


420. Were you told where to go if you had any pregnancy complications?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2


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

YES 1
NO 2


422. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 425)
DON'T KNOW 8 (GO TO 425)


423. During this pregnancy, how many times did you get a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'. [ASK FOR MOST RECENT BIRTH ONLY]

TIMES __
DON'T KNOW 8


424. CHECK 423:
[ASK FOR MOST RECENT BIRTH ONLY]

2 OR MORE TIMES (GO TO 428)
OTHER (GO TO 425)

425. At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (SKIP TO 428)
DON'T KNOW (SKIP TO 428)


426. Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'. [ASK FOR MOST RECENT BIRTH ONLY]

TIMES __
DON'T KNOW 8


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

YEARS AGO __ __


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

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)


429. 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 MOST RECENT BIRTH ONLY]

NUM. OF DAYS __ __ __
DON'T KNOW 998


430. During this pregnancy, did you take any drug for intestinal worms?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8


431. During this pregnancy, did you use a mosquito net regularly, sometimes or never?
[ASK FOR MOST RECENT BIRTH ONLY]

REGULARLY 1
SOMETIMES 2
NEVER 3


431A. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8


432. During this pregnancy, did you have convulsions not from fever?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8


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

YES 1
NO 2
DON'T KNOW 8


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

YES 1
NO 2


435. During this pregnancy, were you always able to get the supplementary nutrition from the anganwadi centre? [ASK FOR MOST RECENT BIRTH ONLY]

YES, ALWAYS 1
NO 2


436. During the last three months of this pregnancy, did you meet with an ANM, Lady Health Visitor, ASHA, anganwadi worker, or other community health worker?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 439)


437. Where did you meet this/these person(s)?
[ASK FOR MOST RECENT BIRTH ONLY]

HOME ONLY 1
ELSEWHERE ONLY 2
BOTH HOME AND ELSEWHERE 3


438. 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 MOST RECENT BIRTH ONLY]

a. The importance of institutional delivery?
b. Cord care?
e. Breastfeeding?
d. Keeping the baby warm?
e. Family planning or delaying or avoiding another pregnancy?

INSTITUTIONAL DELIVERY
YES 1
NO 2
CORD CARE
YES 1
NO 2
BREASTFEEDING
YES 1
NO 2
BABY WARM
YES 1
NO 2
FAMILY PLANNING
YES 1
NO 2


439. During delivery, did you experience a breech presentation?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8


440. During delivery, did you experience prolonged labour?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8


441. During delivery, did you experience excessive bleeding?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8


442. 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
DON'T KNOW 8


443. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 445)
DON'T KNOW 8 (GO TO 445)


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

KG FROM CARD 1 __.__ __ __
KG FROM RECALL 2__.__ __ __


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

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


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

HOME
YOUR HOME 11 (GO TO 463)
PARENTS' HOME 12 (GO TO 463)
OTHER HOME 13 (GO TO 463)
PUBLIC HEALTH SECTOR
GOVT./MUNIC. HOSPITAL 21
GOVT. DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC 24
PHC/ADDITIONAL PHC 25
SUB-CENTRE 26
OTHER PUBLIC SECTOR HEALTH FACILITY 27
NGO/TRUST HOSPITAL/CLINIC 31
PVT. HOSPITAL SECTOR
PVT. HOSPITAL/MATERNITY HOME/CLINIC 41
OTHER PRIVATE SECTOR HEALTH FACILITY 42
OTHER (SPECIFY)______96 (GO TO 463)


447. What was the main mode of transportation used by you to reach the health facility for delivery? [ASK FOR MOST RECENT BIRTH ONLY]

GOVERNMENT AMBULANCE 01
OTHER AMBULANCE 02
JEEP/CAR 03
MOTORCYCLE/SCOOTER 04
BUS/TRAIN 05
TEMP/AUTO/TRACTOR 06
CART 07
ON FOOT 08 (GO TO 448B)
OTHER (SPECIFY) ______96


448. Who arranged the transportation to take you to the health facility for delivery?
RECORD ALL MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

DOCTOR A
ANM B
HEALTH WORKER C
ANGANWADI WORKER D
ASHA E
PRI MEMBER F
NGO G
CBO H
HUSBAND I
MOTHER-IN-LAW J
MOTHER K
RELATIVES/FRIENDS L
SELF M
OTHER (SPECIFY) ______X


448A. How much did it cost you out of your pocket for transportation?
IF NO MONEY PAID, RECORD '00000'.
[ASK FOR MOST RECENT BIRTH ONLY]

COST Rs. __ __ __ __ __
DON'T KNOW 99998


448B. How much did it cost you out of your pocket during delivery on: IF NO MONEY PAID, RECORD '00000'. [ASK FOR MOST RECENT BIRTH ONLY]

a. Hospital stay?
Rs. __ __ __ __ __
DON'T KNOW 99998
b. Tests done?
Rs. __ __ __ __ __
DON'T KNOW 99998
c. Medicines?
Rs. __ __ __ __ __
DON'T KNOW 99998
d. Other costs?
Rs. __ __ __ __ __
DON'T KNOW 99998


448C. CHECK 448B a-d:
[ASK FOR MOST RECENT BIRTH ONLY]

ALL ARE '00000' OR '99998' (GO TO 449)
OTHER (GO TO 450)


449. How much in total did it cost you out of your pocket for this delivery?
IF NO MONEY PAID, RECORD '00000'. [ASK FOR MOST RECENT BIRTH ONLY]

COST Rs. __ __ __ __ __
DON'T KNOW 99998


450. CHECK 448A, 448B a-d, AND 449:
[ASK FOR MOST RECENT BIRTH ONLY]

ALL ARE '00000' OR '99998' OR BLANK (GO TO 452)
OTHER (GO TO 451)


451. How was the out of pocket cost met?
RECORD ALL MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

BANK ACCOUNT/SAVINGS A
BORROWED FROM FRIENDS B
SELLING PROPERTY C
SELLING JEWELLERY D
INSURANCE E
OTHER (SPECIFY)______X


452. Did you receive any financial assistance for delivery care?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 456)


453. From where did you get assistance?
RECORD ALL MENTIONED. [ASK FOR MOST RECENT BIRTH ONLY]

JANANI SURAKSHA YOJANA (JSY) A
OTHER GOVT. SCHEMES B (GO TO 456)
OTHER (SPECIFY)______X (GO TO 456)


454. How many days after delivery did you receive the financial assistance under JSY?
IF THE SAME DAY, RECORD '00'. [ASK FOR MOST RECENT BIRTH ONLY]

DAYS __ __
DON'T KNOW 98


455. What was the total amount that you received?
[ASK FOR MOST RECENT BIRTH ONLY]

Rs. __ __ __ __ __ __
DON'T KNOW 999998


456. How long after (NAME) was delivered did you stay in the health facility?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. [ASK FOR MOST RECENT BIRTH ONLY]

HOURS 1 __ __
DAYS 2 __ __
WEEKS 3 __ __
DON'T KNOW 998


457. Was (NAME) delivered by caesarean section, that is, did they cut your belly open to take the baby out?

YES 1
NO 2 (GO TO 459 FOR MOST RECENT BIRTH; GO TO 476 FOR OTHER BIRTHS)


458. When was the decision made for you to have a C-section? Was it before the onset of labour on after the onset of labour or after the onset of labour?

BEFORE ONSET LABOUR 1
AFTER ONSET OF LABOUR 2
DON'T KNOW 8


459. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 462)


460. How long after delivery did the first check take place?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 __ __
DAYS 2 __ __
WEEKS 3 __ __
DON'T KNOW 998


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

HEALTH PERSONNEL
DOCTOR 11 (GO TO 470)
ANM/NURSE/MIDWIFE/LHV 12 (GO TO 470)
OTHER HEALTH PERSONNEL 13 (GO TO 470)
OTHER PERSON
ASHA 21 (GO TO 470)
DAI (TBA) 22 (GO TO 470)
OTHER (SPECIFY) _____96 (GO TO 470)


462. In the two months after you were discharged, did any health personnel, anganwadi worker, ASHA, or traditional birth attendant [dai] check on your health?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1(GO TO 466)
NO 2 (GO TO 470)


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

COSTS TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'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


464. At the time of delivery of (NAME) were the following done?
[ASK FOR MOST RECENT 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?

DELIVERY KIT USED
YES 1
NO 2
DON'T KNOW 8
WIPE AND WRAP
YES 1
NO 2
DON'T KNOW 8
BLADE
YES 1
NO 2
DON'T KNOW 8


465. In the two months after (NAME) was born, did any health personnel, anganwadi worker, ASHA, or traditional birth attendant (dai) check on your health?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 470)


466.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.

HOURS 1 ___
DAYS 2 ____
WEEKS 3 ___
DON'T KNOW 998


467. How many checkups were done in the first 10 days after delivery?
IF MORE THAN SEVEN, RECORD '7'. IF NONE, RECORD '0'
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF CHECK UPS __
DON'T KNOW 8


468. Who checked on your health (the first time/at that time)?
PROBE FOR MOST QUALIFIED PERSON. [ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
OTHER PERSON
ASHA 21
DAI (TBA) 22
OTHER (SPECIFY) _____96


469. Where did this first check take place?
[ASK FOR MOST RECENT BIRTH ONLY]

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

(NAME OF FACILITY/PLACE)______________
HOME
YOUR HOME 11
PARENTS' HOME 12
OTHER HOME 13
PUBLIC HEALTH SECTOR
GOVERNMENT/MUNICIPAL HOSPITAL 21
GOVERNMENT DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC 24
PHC/ADDITIONAL PHC 25
SUB-CENTRE 26
ANGANWADI/ICDS CENTRE 27
OTHER PUBLIC SECTOR HEALTH FACILITY 28
NGO/TRUST HOSP./CLINIC 31
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/MATERNITY HOME/CLINIC 41
OTHER PRIVATE SECTOR HEALTH FACILITY 42
OTHER (SPECIFY) ______96


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

YES 1
NO 2 (GO TO 474)
DON'T KNOW 8 (GO TO 474)


471. 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 MOST RECENT BIRTH ONLY]

HOURS AFTER BIRTH 1 __ __
DAYS AFTER BIRTH 2 __ __
WEEKS AFTER BIRTH 3 __ __
DON'T KNOW 998


472. Who checked on (NAME)'s health at that time?
[ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
ANM/NURSE/MIDWIFE/LHV 12
OTHER HEALTH PERSONNEL 13
OTHER PERSON
ASHA 21
DAI (TBA)
OTHER (SPECIFY) ________96


473. Where did this first check of (NAME) take place?
[ASK FOR MOST RECENT BIRTH ONLY]

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

(NAME OF FACILITY/PLACE)___________
HOME
YOUR HOME 11
PARENTS' HOME 12
OTHER HOME 13
PUBLIC HEALTH SECTOR
GOVERNMENT/MUNICIPAL HOSPITAL 21
GOVERNMENT DISPENSARY 22
UHC/UHP/UFWC 23
CHC/RURAL HOSPITAL/BLOCK PHC 24
PHC/ADDITIONAL PHC 25
SUB-CENTRE 26
ANGANWADI/ICDS CENTRE 27
OTHER PUBLIC SECTOR HEALTH FACILITY 28
NGO/TRUST HOSPITAL/CLINIC 31
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/MATERNITY HOME/CLINIC 41
OTHER PRIVATE SECTOR HEALTH FACILITY 42
OTHER (SPECIFY) ______96


474. In the first two months after delivery, did you have:
[ASK FOR MOST RECENT BIRTH ONLY]

a. Massive vaginal bleeding?
b. Very high fever?

VAGINAL BLEEDING
YES 1
NO 2
HIGH FEVER
YES 1
NO 2


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

YES 1 (GO TO 477)
NO 2 (GO TO 478)


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

YES 1
NO 2 (GO TO 480)


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

MONTHS __ __
DON'T KNOW 98


478. CHECK 226: IS RESPONDENT PREGNANT?
[ASK FOR MOST RECENT BIRTH ONLY]

NOT PREGNANT (GO TO 479)
PREGNANT OR UNSURE (GO TO 480)


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

YES 1
NO 2 (GO TO 481)


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

MONTHS __ __
DON'T KNOW 98


481. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 488)


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

IF LESS THAN ONE HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 __ __
DAYS 2 __ __


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

YES 1
NO 2 (GO TO 485)


484. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED. [ASK FOR MOST RECENT 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


485. CHECK 404: IS CHILD LIVING?
[ASK FOR MOST RECENT BIRTH ONLY]

LIVING (GO TO 486)
DEAD (GO TO 487)


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

YES 1 (GO TO 489)
NO 2


487. For how many months did you breastfeed (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

MONTHS __ __
DON'T KNOW 98


488. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 489)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 491) OR (GO BACK TO 405 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE); OR, IF NO MORE BIRTHS, GO TO 491)


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

YES 1
NO 2
DON'T KNOW 8


490. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 491 OR GO BACK TO 405 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 491

491. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2014 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 492))
(NAME)_________________
DOES NOT HAVE ANY CHILDREN BORN IN 2014 OR LATER AND LIVING WITH HER (GO TO 501)


492. Now, I would like to ask you about liquids or foods that (NAME FROM 491) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods. Did (NAME FROM 491) (drink/eat):

a. Plain water?
YES 1
NO 2
DON'T KNOW 8
b. Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c. Clear broth?
YES 1
NO 2
DON'T KNOW 8
d. Milk such as tinned, powdered, or fresh animal milk?
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK __
e. Infant formula?
IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA __
f. Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g. Yogurt?
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT __
h. Any commercially fortified baby food, e.g. Cerelac or Farex?
YES 1
NO 2
DON'T KNOW 8
i. Any bread, roti, chapati, rice, noodles, biscuits, idli, or any other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j. Any pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k. Any white potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l. Any dark, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
m. Any ripe mangoes, papayas, cantaloupe or jackfruit?
YES 1
NO 2
DON'T KNOW 8
n. Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o. Any liver, kidney, heart or other organ meat?
YES 1
NO 2
DON'T KNOW 8
p. Any chickens, duck, or other birds?
YES 1
NO 2
DON'T KNOW 8
q. Any other meat?
YES 1
NO 2
DON'T KNOW 8
r. Any eggs?
YES 1
NO 2
DON'T KNOW 8
s. Any fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
t. Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
u. Any cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
v. Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8


493. CHECK 492 CATEGORIES 'g' THROUGH 'v':

NOT A SINGLE 'YES' (GO TO 494)
AT LEAST ONE 'YES' (GO TO 495)


494. Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

YES 1 (GO BACK TO 492 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 501)


495. How many times did (NAME) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES __
DON'T KNOW 8


SECTION 5. CHILD IMMUNIZATIONS AND HEALTH

501. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2011 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. BIRTH HISTORY NUMBER FROM 212

BIRTH HISTORY 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 547)


504. Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?

YES 1
NO 2
DON'T KNOW 8


505. In the last seven days, was (NAME) given iron pills or iron syrup like (this/any of these)?
SHOW COMMON CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8


506. Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8


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

YES, SEEN 1 (GO TO 509)
YES, NOT SEEN 2 (GO TO 512)
NO CARD 3


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

YES 1 (GO TO 512)
NO 2 (GO TO 512)


509. (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 'DON'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 __ __ __ __
HEPATITIS B 0 (GIVEN AT BIRTH)
DAY __ __
MONTH __ __
YEAR __ __ __ __
HEPATITIS B 1
DAY __ __
MONTH __ __
YEAR __ __ __ __
HEPATITIS B 2
DAY __ __
MONTH __ __
YEAR __ __ __ __
HEPATITIS B 3
DAY __ __
MONTH __ __
YEAR __ __ __ __
MEASLES
DAY __ __
MONTH __ __
YEAR __ __ __ __
VITAMIN A (LAST DOSE) VITAMIN A (NEXT-TO-LAST DOSE)
DAY __ __
MONTH __ __
YEAR __ __ __ __


510. CHECK 509:

'BCG' TO 'MEASLES' FILLED (GO TO 515)
OTHER (GO TO 511)


511. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a Pulse Polio campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 509 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 509) (GO TO 514)
NO 2 (GO TO 514)
DON'T KNOW 8 (GO TO 514)


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

YES 1
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)


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

513A. A BCG vaccination against tuberculosis, that is, an injection in the arm of shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8


513B. Polio vaccine, that is, drops in the mouth including vaccine received in a Pulse Polio campaign?

YES 1
NO 2 (GO TO 513E)
DON'T KNOW (GO TO 513E)


513C. Was the first polio vaccine received in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2


513D. How many times was the polio vaccine given?
IF MORE THAN 7, RECORD '7'.

NUMBER OF TIMES __


513E. 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 513G)
DON'T KNOW 8 (GO TO 513G)


513F. How many times was a DPT vaccination given?
IF MORE THAN 7, RECORD '7'.

NUMBER OF TIMES ___


513G. An injection to prevent Hepatitis B?

YES 1
NO 2 (GO TO 513J)
DON'T KNOW 8 (GO TO 513J)


513H. Was the first Hepatitis B vaccine received in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2


513I. How many times was a Hepatitis B vaccination given?
IF MORE THAN 7, RECORD '7'.

NUMBER OF TIMES __


513J. A measles injection or an MMR injection-that is, a shot in the arm at the age of 9 months or older-to prevent (him/her) from getting measles?

YES 1
NO 2
DON'T KNOW 8


514. CHECK 509 AND 512: ANY VACCINATIONS RECEIVED?

YES 1 (GO TO 515)
NO 2 (GO TO 516)


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

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

(NAME OF FACILITY/PLACE)___________
PUBLIC HEALTH SECTOR
GOVERNMENT/MUNICIPAL HOSPITAL 11
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 12
GOVERNMENT DISPENSARY 13
UHC/UHP/UFWC 14
CHC/RURAL HOSPITAL/BLOCK PHC 15
PHC/ADDITIONAL PHC 16
SUB-CENTRE 17
GOVERNMENT MOBILE CLINIC 18
CAMP 19
ANGANWADI/ICDS CENTRE 20
PULSE POLIO 21
OTHER PUBLIC SECTOR HEALTH FACILITY 22
NGO/TRUST HOSPITAL/CLINIC 31
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL 41
PRIVATE DOCTOR/CLINIC 42
PRIVATE PARAMEDIC 43
VAIDYA/HAKIM/HOMEOPATH (AYUSH) 44
PHARMACY/DRUGSTORE 45
OTHER PRIVATE HEALTH FACILITY 46
OTHER (SPECIFY) ________96


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

YES 1
NO 2 (GO TO 529)
DON'T KNOW (GO TO 529)


517. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8


518. Now I would like to know how much (NAME) was given to drink (including breastmilk) 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 4
DON'T KNOW 8


519. 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
DON'T KNOW 8


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

YES 1
NO 2 (GO TO 525)


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

RECORD ALL SOURCES MENTIONED.

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

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


522. CHECK 521:

TWO OR MORE CODES CIRCLED (GO TO 523)
ONLY ONE CODE CIRCLED (GO TO 524)


523. Where did you first seek advice or treatment?
USE LETTER CODE FORM 521.

PUBLIC HEALTH SECTOR
GOVERNMENT/MUNICIPAL HOSPITAL A
VAIDYA/HAKIM/HOMEOPATH (AYUSH) B
GOVERNMENT DISPENSARY C
UHC/UHP/UFWC D
CHC/RURAL HOSPITAL/BLOCK PHC E
PHC/ADDITIONAL PHC F
SUB-CENTRE/ANM G
GOVERNMENT MOBILE CLINIC H
CAMP I
ANGANWADI/ICDS CENTRE J
ASHA K
OTHER PUBLIC HEALTH SECTOR L
NGO/TRUST HOSPITAL/CLINIC M
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL N
PRIVATE DOCTOR/CLINIC O
PRIVATE PARAMEDIC P
VAIDYA/HAKIM/HOMEOPATH (AYUSH) Q
PHARMACY/DRUGSTORE R
OTHER PRIVATE HEALTH SECTOR S
OTHER SOURCE
SHOP T
TRADITIONAL HEALER U
FRIEND/RELATIVE V
OTHER (SPECIFY) ______X


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

DAY _____


525. 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 nice (OR OTHER LOCAL GRAIN)?

FLUID FROM ORS PACKET
YES 1
NO 2
DON'T KNOW 8
GRUEL
YES 1
NO 2
DON'T KNOW 8


526. Was (he/she) given zinc at any time since (he/she) started having diarrhoea?

YES 1
NO 2
DON'T KNOW 8


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

YES 1
NO 2 (GO TO 529)
DON'T KNOW 8 (GO TO 529)


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

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


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

YES 1
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)


530. At any time during illness, did (NAME) have blood taken from (his/her) finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8


531. Has (NAME) had an illness with a cough at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 534)
DON'T KNOW 8 (GO TO 534)


532. 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 535)
DON'T KNOW 8 (GO TO 535)


533. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1 (GO TO 535)
NOSE ONLY 2 (GO TO 535)
BOTH 3 (GO TO 535)
OTHER (SPECIFY) ________(GO TO 535)
DON'T KNOW 8 (GO TO 535)


534. CHECK 529: HAD FEVER

YES (GO TO 535)
NO OR DON'T KNOW (GO TO 546)


535. Now I would like to know how much (NAME) was given to drink (including breastmilk) 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
DON'T KNOW 8


536. 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
DON'T KNOW 8


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

YES 1
NO 2 (GO TO 542)


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

RECORD ALL SOURCES MENTIONED.

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

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


539. CHECK 538:

TWO OR MORE CODES CIRCLED (GO TO 540)
ONLY ONE CODE CIRCLED (GO TO 541)


540. Where did you first seek advice or treatment?
USE LETTER CODE FROM 538.

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


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

DAYS __ __


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

YES 1
NO 2 (GO TO 546)
DON'T KNOW 8 (GO TO 546)


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

ANTIMALARIAL DRUGS
CHLOROQUINE A
PRIMAQUINE B
SP/FANSIDAR C
QUININE D
ARTEMISININ COMBINATION THERAPY E
OTHER ANTI-MALARIAL F
UNKNOWN ANTI-MALARIAL G
ANTIBIOTIC DRUG H
OTHER DRUGS
ASPIRIN I
ACETAMINOPHEN J
IBUPROFEN K
OTHER (SPECIFY) _______X
UNKNOWN DRUG Z


544. CHECK 543: ANY CODE 'A-G' RECORDED

YES (GO TO 545)
NO (GO TO 546)


545. How long after the fever started did (NAME) first take (DRUG(S) FROM 543 A-G)?

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


546. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 547.
FOR THIRD MOST RECENT BIRTH: GO TO 503 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS. GO TO 547.

547. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 548)
(NAME)____________
NONE (GO TO 550)


548. 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
DON'T KNOW 98


549. CHECK 525 (a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 550)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 552)


550. 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


551. CHECK 215: ANY LIVE BIRTH IN 2010 OR LATER

ONE OR MORE (GO TO 551)
NONE (GO TO 601)


SECTION 5A. UTILIZATION OF ICDS SERVICES

552. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2010 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).

553. BIRTH HISTORY NUMBER FROM 212

BIRTH HISTORY NUMBER __ __


554. FROM 212 AND:

NAME ______
LIVING _____
DEAD _____ (GO TO 562)


555. 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 562)


556. 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
DON'T KNOW 8


557. 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
DON'T KNOW 8


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

YES 1
NO 2
DON'T KNOW 8


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

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


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

NOT AT ALL 0 (GO TO 562)
AT LEAST ONCE A MONTH 1
AT LEAST ONCE IN 3 MONTHS 2
LESS OFTEN 3
DON'T KNOW 8 (GO TO 562)


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

YES 1
NO 2
DON'T KNOW 8


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

YES 1
NO 2 (GO TO 564)


563. Did you receive any of the following benefits:

a. Supplementary food?
YES 1
NO 2
b. Health check-ups?
YES 1
NO 2
c. Health and nutrition education?
YES 1
NO 2


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

YES 1
NO 2 (GO TO 566)
DID NOT BREASTFEED 3 (GO TO 566)


565. Did you receive any of the following benefits:

a. Supplementary food?
YES 1
NO 2
b. Health check-ups?
YES 1
NO 2
c. Health and nutrition education?
YES 1
NO 2

566. GO TO 554 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 601


SECTION 6. FERTILITY PREFERENCES

601. CHECK 301:

NEVER MARRIED (GO TO 614)
OTHER (GO TO 602)


602. CHECK 330/330A:

WOMAN OR MAN STERILIZED (GO TO 614)
OTHER (GO TO 602A)


602A. CHECK 248 AND 250:

HAS HAD A HYSTERECTOMY (GO TO 614)
HAS NOT HAD A HYSTERECTOMY (GO TO 603)


603. CHECK 226:

PREGNANT ____ (GO TO 604)
NOT PREGNANT OR UNSURE (GO TO 605)


604. 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 ANOTHER CHILD 1 (GO TO 606)
NO MORE 2 (GO TO 612)
UNDECIDED/DON'T KNOW 8 (GO TO 612)


605. 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 608)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON'T KNOW 8 (GO TO 611)


606. CHECK 226:

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 608)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
OTHER (SPECIFY) _________996 (GO TO 608)
DON'T KNOW 998 (GO TO 608)


607. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 608)
PREGNANT (GO TO 612)


608. CHECK 329: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 609)
NOT CURRENTLY USING (GO TO 609)
CURRENTLY USING (GO TO 614)


609. CHECK 606:

NOT ASKED (GO TO 610)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 610)
00-23 MONTHS OR 00-01 YEAR (GO TO 613)


610. CHECK 604 AND 605:

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?

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


611. CHECK 329: USING A CONTRACEPTIVE METHOD?

YES, CURRENTLY USING (GO TO 614)
NO, NOT CURRENTLY USING (GO TO 612)
NOT ASKED (GO TO 612)


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

YES 1 (GO TO 614)
NO 2
DON'T KNOW 8


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

YES 1
NO 2
DON'T KNOW 8


614. 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 616)
NUMBER __ __
OTHER (SPECIFY) ______96 (GO TO 616)


615. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

NUMBER OF BOYS __ __
NUMBER OF GIRLS __ __
NUMBER OF EITHER __ __
OTHER (SPECIFY) ______96


616. In the last few months have you:

a. Heard about family planning on the radio?
b. Seen anything about family planning on the television?
c. Read about family planning in a newspaper or magazine?
d. Seen anything about family planning 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


617. CHECK 301:

CURRENTLY MARRIED (GO TO 618)
OTHER (GO TO 622)


618. CHECK 330/330A: USING A CONTRACEPTIVE METHOD?

ANY CODE CIRCLED (GO TO 619)
NO CODE CIRCLED (GO TO 622)


619. 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


620. CHECK 330/330A:

WOMAN OR MAN STERILIZED (GO TO 622)
OTHER (GO TO 620A)


620A. CHECK 248 AND 250:

HAS A HAD A HYSTERECTOMY (GO TO 622)
HAS NOT HAD A HYSTERECTOMY (GO TO 621)


621. Does your husband want the same number of children that you want, or does he want more or fewer than you want?

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


622. Husbands and wives do not always agree on everything. Please tell 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
DON'T KNOW 8
OTHER WOMEN
YES 1
NO 2
DON'T KNOW 8
TIRED/NOT IN MOOD
YES 1
NO 2
DON'T KNOW 8


SECTION 7. OTHER HEALTH ISSUES

701. 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 healthcare provider?
g. Concern that there may not be any healthcare 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


702. Now I would like to ask you some questions about any injections you have had in the last 12 months. 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 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS __ __
NONE 00 (GO TO 704)


703. The last time you had an injection, was a disposable syringe used?

YES 1
NO 2
DON'T KNOW 8


704. Have you ever had a blood transfusion?

YES 1
NO 2


705. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 707)


706. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES __ __


707. Do you currently smoke bidis?

YES 1
NO 2 (GO TO 709)


708. In the last 24 hours, how many bidis did you smoke?

BIDIS __ __


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

YES 1
NO 2 (GO TO 711)


710. In what other form do you currently smoke or use tobacco? Any other form?

CIGAR A
PIPE B
HOOKAH C
GUTKHA/PAAN MASALA WITH TOBACCO D
KHAINI E
PAAN WITH TOBACCO F
OTHER CHEWING TOBACCO G
SNUFF H
OTHER (SPECIFY)________X


711. CHECK 705, 707, AND 709: CURRENTLY SMOKES OR USES TOBACCO

AT LEAST ONE 'YES' (GO TO 712)
OTHER (GO TO 715)


712. During the past 12 months, have you ever tried to stop smoking or using tobacco in any other form?

YES 1
NO 2


713. In the last 12 months, have you visited a doctor or other health provider?

YES 1
NO 2 (GO TO 715)


714. During any of these visits, were you advised to quit smoking or using tobacco in any other form?

YES 1
NO 2


715. In the last 30 days, did someone smoke (other than you) in your home or anywhere else when you were present?

YES 1
NO 2


716. Do you drink alcohol?

YES 1
NO 2 (GO TO 719)


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

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


718. What type of alcohol do you usually drink?

RECORD ALL MENTIONED.

TADI MADI A
COUNTRY LIQUOR B
BEER C
WINE D
HARD LIQUOR E
OTHER (SPECIFY)______X


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

YES 1
NO 2 (GO TO 723)


720. How does tuberculosis spread from one person to another? 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


721. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8


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

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


723A. Do you currently have:

a. Diabetes?
YES 1 (GO TO 723B)
NO 2 (GO TO NEXT)
DON'T KNOW 8 (GO TO NEXT)
b. Asthma?
YES 1 (GO TO 723B)
NO 2 (GO TO NEXT)
DON'T KNOW 8 (GO TO NEXT)
c. Goiter or any other thyroid disorder?
YES 1 (GO TO 723B)
NO 2 (GO TO NEXT)
DON'T KNOW 8 (GO TO NEXT)
d. Any heart disease?
YES 1 (GO TO 723B)
NO 2 (GO TO NEXT)
DON'T KNOW 8 (GO TO NEXT)
e. Cancer?
YES 1 (GO TO 723B)
NO 2 (GO TO NEXT)
DON'T KNOW 8 (GO TO NEXT)


723B. Have you sought treatment for this problem?

a. Diabetes?
YES 1
NO 2
b. Asthma?
YES 1
NO 2
c. Goiter or any other thyroid disorder?
YES 1
NO 2
d. Any heart disease?
YES 1
NO 2
e. Cancer?
YES 1
NO 2


724. Are you covered by any health scheme or any health insurance?

YES 1
NO 2 (GO TO 726)


725. What type of health scheme or health insurance? Any other type?
RECORD ALL MENTIONED.

EMPLOYEES STATE INSURANCE SCHEME (ESIS) A
CENTRAL GOVERNMENT HEALTH SCHEME (CGHS) B
STATE HEALTH INSURANCE SCHEME C
RASHTRIYA SWASTHYA BIMA YOJANA D
COMMUNITY HEALTH INSURANCE PROGRAMME E
OTHER HEALTH INSURANCE THROUGH EMPLOYER G
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE H
OTHER (SPECIFY)_______X


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

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
h. Fried foods?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4
i. Aerated drinks?
DAILY 1
WEEKLY 2
OCCASIONALLY 3
NEVER 4


727. Have you ever undergone:

a. A cervix examination?
YES 1
NO 2
b. A breast examination?
YES 1
NO 2
c. An oral cavity examination?
YES 1
NO 2


728. CHECK COVER PAGE: HOUSEHOLD SELECTED FOR STATE MODULE?

YES (GO TO 801)
NO (GO TO 1140)


SECTION 8. SEXUAL LIFE

801. CHECK 315 AND 316:

HAS NOT HAD SEXUAL INTERCOURSE (315 EQUALS '2' OR 316 EQUALS '00') (GO TO 819)
HAS HAD SEXUAL INTERCOURSE (GO TO 802)

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

803. CHECK 103:

15-24 YEARS OLD (GO TO 804)
25-49 (GO TO 805)


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

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


805. 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 OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 __ __ (GO TO 807)
WEEKLY 2 __ __ (GO TO 807)
MONTHS AGO 3 __ __ (GO TO 807)
YEARS AGO 4 __ __ (GO TO 818)


FOR QUESTIONS 806 THROUGH 817, ACCOUNT FOR LAST SEXUAL PARTNER AND SECOND-TO-LAST SEXUAL PARTNER.

806. When was the last time you had sexual intercourse with this other person?
[DO NOT ASK FOR MOST RECENT SEXUAL PARTNER]

DAYS AGO 1 __ __
WEEKS AGO 2 __ __
MONTHS AGO 3 __ __


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

YES 1
NO 2 (GO TO 809)


808. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2


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

HUSBAND 01
LIVE-IN PARTNER 02
BOYFRIEND NOT LIVING WITH RESPONDENT 03 (GO TO 812)
OTHER FRIEND 04 (GO TO 812)
RELATIVE 05 (GO TO 812)
CASUAL ACQUAINTANCE 06 (GO TO 812)
SEX WORKER/CLIENT 07 (GO TO 812)
OTHER (SPECIFY) _______ (GO TO 812)


810. CHECK 307:

MARRIED ONLY ONCE (GO TO 811)
MARRIED MORE THAN ONCE (GO TO 812)


811. CHECK 316:

FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (GO TO 813)
OTHER (GO TO 812)


812. How long ago did you first have sexual intercourse with this (second-to-last) person?

DAYS AGO 1 __ __
WEEKS AGO 2 __ __
MONTHS AGO 3 __ __
YEARS AGO 4 __ __


813. How many times during the last 12 months did you have sexual intercourse with this person?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

NUMBER OF TIMES __ __


814. CHECK 103:

AGE 15-24 (GO TO 815)
AGE 25-49 (GO TO 816)


815. How old is this person?

AGE OF PARTNER __ __
DON'T KNOW 98


816. Apart from this person, have you had sexual intercourse with any other person in the last 12 months? [ASK FOR MOST RECENT SEXUAL PARTNER]

YES 1 (GO BACK TO 806 IN NEXT COLUMN)
NO 2 (GO TO 818)


817. In total, with how many different people have you had sexual intercourse in the last 12 months? [DO NOT ASK FOR MOST RECENT SEXUAL PARTNER]

IF NON-NUMERIC, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS IN LAST 12 MONTHS __ __
DON'T KNOW 98


818. 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 __ __
DON'T KNOW 98


819. PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN LESS THAN 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2


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

YES 1
NO 2 (GO TO 901)


821. Where is that? Any other place?
RECORD ALL SOURCES MENTIONED.

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

(NAME OF FACILITY/PLACE(S)) ______
PUBLIC HEALTH SECTOR
GOVERNMENT/MUNICIPAL HOSPITAL A
VAIDYA/HAKIM/HOMEOPATH (AYUSH) B
UHC/UHP/UFWC D
CHC/RURAL HOSPITAL/BLOCK PHC E
PHC/ADDITIONAL PHC F
SUB-CENTRE/ANM G
GOVERNMENT MOBILE CLINIC H
CAMP I
ANGANWADI/ICDS CENTRE J
ASHA K
OTHER COMMUNITY BASED WORKER L
OTHER PUBLIC HEALTH SECTOR (SPECIFY) ______M
NGO OR TRUST HOSPITAL/CLINIC N
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR O
PRIVATE PARAMEDIC P
PRIVATE MOBILE CLINIC Q
VAIDYA/HAKIM/HOMEOPATH (AYUSH) R
TRADITIONAL HEALER S
PHARMACY/DRUGSTORE T
DAI (TBA) U
OTHER PRIVATE HEALTH SECTOR (SPECIFY) _______V
OTHER SOURCE
RATION SHOP W
OTHER SHOP X
VENDING MACHINE Y
OTHER (SPECIFY) ________Z


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

YES 1
NO 2
DON'T KNOW/UNSURE 8


SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 301:

CURRENTLY MARRIED (GO TO 902)
NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED (GO TO 909)
OTHER (GO TO 903)


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

AGE IN COMPLETED YEARS __ __


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

YES 1
NO 2 (GO TO 905)


904. What was the highest standard he completed?

STANDARD __ __
DON'T KNOW 98


905. CHECK 901:

CURRENTLY MARRIED. 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 _______________


906. CHECK 901:

CURRENTLY MARRIED (GO TO 907)
OTHER (GO TO 909)


907. In the last 12 months, has your husband been away from home for one month or more at a time?

YES 1
NO 2 (GO TO 909)


908. In the last 12 months, has your husband been away from home for six months or more at a time?

YES 1
NO 2


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

YES 1 (GO TO 913)
NO 2


910. 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 913)
NO 2


911. 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 913)
NO 2


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

YES 1
NO 2 (GO TO 917)


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

OCCUPATION ______________


914. 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


915. 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


916. 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


917. In the last 12 months, have you been away from home other than parental/in-laws home for one month or more at a time?

YES 1
NO 2


918. In the last 12 months, have you been away from home other than parental/in-laws home for six months or more at a time?

YES 1
NO 2


919. CHECK 301: MARITAL STATUS

CURRENTLY MARRIED (GO TO 920)
OTHER (GO TO 927)


920. CHECK 916: CASH EARNINGS

CODE '1' OR '2' CIRCLED (GO TO 921)
OTHER (GO TO 923)


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

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER 6


922. 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 924)
DON'T KNOW 8


923. 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
SOMEONE ELSE 4
OTHER 6


924. Who usually makes decisions about health care for yourself: mainly you, mainly your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6


925. Who usually makes decisions about making major household purchases: mainly you, mainly your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6


926. Who usually makes decisions about visits to your family or relatives: mainly you, mainly your husband, you and your husband jointly, or someone else?

RESPONDENT 1
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER 6


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

YES 1
NO 2


928. 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 ONLY 2
NOT AT ALL 3
HEALTH
ALONE 1
WITH SOMEONE ELSE ONLY 2
NOT AT ALL 3
OUT
ALONE 1
WITH SOMEONE ELSE ONLY 2
NOT AT ALL 3


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

YES 1
NO 2


930. Do you have any mobile phone that you yourself use?

YES 1
NO 2 (GO TO 931)


930A. CHECK 106: EDUCATION

STANDARD 0-5 OR BLANK (GO TO 930B)
STANDARD 6 AND ABOVE (GO TO 930C)


930B. CHECK 108: LITERACY

CODE '2', '3' OR '4' CIRCLED (GO TO 930C)
CODE '1' OR '5'5 CIRCLED (GO TO 931)


930C. Are you able to read text (SMS) messages?

YES 1
NO 2


931. Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4


932. Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONG AND JOINTLY 3
DOES NOT OWN 4


933. 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 935)


934. 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


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

CHILDREN UNDER 10

PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3


HUSBAND


PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3


OTHER MALES


PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3


OTHER FEMALES


PRESENT/LISTEN 1
PRESENT/NOT LISTEN 2
NOT PRESENT 3


936. 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
DON'T KNOW 8
NEGL. CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
POOR COOKING
YES 1
NO 2
DON'T KNOW 8
UNFAITHFUL
YES 1
NO 2
DON'T KNOW 8
DISRESPECT
YES 1
NO 2
DON'T KNOW 8


SECTION 10. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

1001. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2


1002. Have you ever heard of HIV?

YES 1
NO 2


1003. CHECK 1001 AND 1002: KNOWS ABOUT HIV/AIDS

AT LEAST ONE 'YES' (GO TO 1004)
OTHER (GO TO 1047)


1004. 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 EDUCATION 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


1005. 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
DON'T KNOW 8


1006. Can people get HIV/AIDS from mosquito bites?

YES 1
NO 2
DON'T KNOW 8


1007. Can people reduce their chances of getting HIV/AIDS by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8


1008. Can people get HIV/AIDS from blood products or blood transfusions?

YES 1
NO 2
DON'T KNOW 8


1009. Can people get HIV/AIDS by injecting drugs?

YES 1
NO 2
DON'T KNOW 8


1010. Can people get HIV/AIDS by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8


1011. Is there anything else a person can do to avoid or reduce the chances of getting HIV/AIDS?

YES 1
NO 2 (GO TO 1013)
DON'T KNOW 8 (GO TO 1013)


1012. 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
DON'T KNOW Z


1013. Is it possible for a healthy-looking person to have HIV/AIDS?

YES 1
NO 2
DON'T KNOW 8


1014. Can HIV/AIDS be transmitted from a mother to her baby:

a. During pregnancy?
b. During delivery?
c. By breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8


1015. CHECK 1014:

AT LEAST ONE 'YES' (GO TO 1016)
OTHER (GO TO 1017)


1016. 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
DON'T KNOW 8


1017. 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


1018. CHECK 208 AND 215:

NO BIRTHS (GO TO 1033)
LAST BIRTH SINCE JANUARY 2013 (GO TO 1019)
LAST BIRTH BEFORE JANUARY 2013 (GO TO 1033)


1019. CHECK 413 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 1020)
NO ANTENATAL CARE (GO TO 1027)

1020. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1021. During any of the antenatal visits for your last birth were you given any information about:

a. Babies getting HIV/AIDS from their mother?
b. Things that you can do to prevent getting HIV/AIDS?
c. Getting tested for HIV/AIDS?

AIDS FROM MOTHER
YES 1
NO 2
DON'T KNOW 8
THINGS TO DO
YES 1
NO 2
DON'T KNOW 8
TESTED FOR AIDS
YES 1
NO 2
DON'T KNOW 8


1022. Were you offered a test for HIV/AIDS as part of antenatal care?

YES 1
NO 2


1023. I don't want to know the results, but were you tested for HIV/AIDS as part of your antenatal care?

YES 1
NO 2 (GO TO 1027)


1024. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF FACILITY/PLACE)___________
PUBLIC HEALTH SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTRE 12
STAND-ALONE ICTC 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER 16
SCHOOL BASED CLINIC 17
OTHER PUBLIC SECTOR (SPECIFY) ________18
NGO OR TRUST HOSPITAL/CLINIC 20
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC PRIVATE DOCTOR 21
STAND-ALONE ICTC 22
PHARMACY 23
MOBILE CLINIC 24
FIELDWORKER 25
SCHOOL BASED CLINIC 26
OTHER PRIVATE HEALTH SECTOR (SPECIFY) _______27
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 32
OTHER (SPECIFY) _________96


1025. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2 (GO TO 1031)


1026. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1 (GO TO 1031)
NO 2 (GO TO 1031)
DON'T KNOW 8 (GO TO 1031)


1027. CHECK 446 FOR LAST BIRTH: PLACE OF BIRTH

IN A FACILITY (GO TO 1028)
OTHER PLACE (GO TO 1033)


1028. Between the time you went for delivery but before the baby was born, were you offered a test for HIV/AIDS?

YES 1
NO 2


1029. I don't want to know the results, but were you tested for HIV/AIDS at that time?

YES 1
NO 2 (GO TO 1033)


1030. I don't want to know the results, but did you get the results of the [test]?

YES 1
NO 2


1031. Have you been tested for HIV/AIDS since that time you were tested during your pregnancy?

YES 1
NO 2


1032. How many months ago was your most recent HIV test?

MONTHS AGO __ __ (GO TO 1039)
TWO OR MORE YEARS 95 (GO TO 1039)


1033. 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


1034. How many months ago was your most recent HIV test?

MONTHS AGO __ __
TWO OR MORE YEARS 95


1035. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2


1036. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF FACILITY/PLACE)_______________
PUBLIC HEALTH SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTRE 12
STAND-ALONE ICTC 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER 16
SCHOOL BASED CLINIC 17
OTHER PUBLIC SECTOR (SPECIFY)________18
NGO OR TRUST HOSPITAL/CLINIC 20
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC PRIVATE DOCTOR 21
STAND-ALONE ICTC 22
PHARMACY 23
MOBILE CLINIC 24
FIELDWORKER 25
SCHOOL BASED CLINIC 26
OTHER PRIVATE HEALTH SECTOR (SPECIFY)_______27
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 32
OTHER (SPECIFY) __________96


1037. Do you know of a place where people can go to get tested for HIV/AIDS?

YES 1
NO 2


1038. Where is that? Any other place?

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

(NAME OF FACILITY/PLACE(S))_______________
PUBLIC HEALTH SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTRE B
STAND-ALONE ICTC C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
SCHOOL BASED CLINIC G
OTHER PUBLIC SECTOR (SPECIFY)________H
NGO OR TRUST HOSPITAL/CLINIC I
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC PRIVATE DOCTOR J
STAND-ALONE ICTC K
PHARMACY L
MOBILE CLINIC M
FIELDWORKER N
SCHOOL BASED CLINIC O
OTHER PRIVATE HEALTH SECTOR (SPECIFY) _______P
OTHER SOURCE
HOME Q
CORRECTIONAL FACILITY R
OTHER (SPECIFY) ________X


1039. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV/AIDS?

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


1040. Do you think a child with HIV should be allowed to attend school with students who are HIV negative?

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


1041. 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
DON'T KNOW/NOT SURE/DEPENDS 8


1042. If a relative of yours became sick with HIV/AIDS, would you be willing to care for her or him in your own household?

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


1043. 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
DON'T KNOW/NOT SURE/DEPENDS 8


1044. 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
DON'T KNOW/NOT SURE/DEPENDS 8


1045. Do you think that people living with HIV should be treated in the same public hospital with patients who are HIV negative?

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


1046. Do you think that people living with HIV should be allowed to work in the same office with people who are HIV negative?

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


1047. CHECK 1001 AND 1002:

HEARD ABOUT HIV/AIDS: Apart from HIV/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


1048. CHECK 315 AND 316: HAD SEXUAL INTERCOURSE

HAS HAD SEXUAL INTERCOURSE (GO TO 1049)
HAS NOT HAD SEXUAL INTERCOURSE (315 EQUALS '2' OR 316 EQUALS '00') (GO TO 1101)


1049. CHECK 1047: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 1050)
NO (GO TO 1051)


1050. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

1051. 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
DON'T KNOW 8


1052. 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
DON'T KNOW 8


1053. CHECK 1050, 1051, AND 1052: HAS HAD AN STI

AT LEAST ONE 'YES' (GO TO 1054)
OTHER (GO TO 1101)


1054. The last time you had (PROBLEM FROM 1050/1051/1052), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1101)


1055. Where did you go?
Any other place?

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

(NAME OF FACILITY/PLACE(S))_________________
PUBLIC HEALTH SECTOR
GOVERNMENT HOSPITAL A
VAIDYA/HAKIM/HOMEOPATH (AYUSH) B
GOVERNMENT HEALTH CENTRE C
STAND-ALONE ICTC D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
SCHOOL BASED CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) ________I
NGO OR TRUST HOSPITAL/CLINIC J
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC PRIVATE DOCTOR K
VAIDYA/HAKIM/HOMEOPATH (AYUSH) L
STAND-ALONE ICTC M
PHARMACY N
MOBILE CLINIC O
FIELDWORKER P
SCHOOL BASED CLINIC Q
OTHER PRIVATE HEALTH SECTOR (SPECIFY) _______R
OTHER SOURCE
HOME S
CORRECTIONAL FACILITY T
OTHER (SPECIFY) ___________X


SECTION 11. HOUSEHOLD RELATIONS

1101. CHECK COVER PAGE: WOMAN SELECTED FOR THIS SECTION

YES (GO TO 1102)
NO (GO 1140)


1102. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO 1103)
PRIVACY NOT POSSIBLE 2 (GO TO 1139)


1103. READ TO 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.

1104. CHECK 301:

CURRENTLY MARRIED (GO TO 1105)
FORMERLY MARRIED (1105 TO 1115: READ IN PAST TENSE) (GO TO 1105)
NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED (GO TO 1118)


1105. First, I am going to ask you about some situations which happen to some women. 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 (insist/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
DON'T KNOW 8
ACCUSES
YES 1
NO 2
DON'T KNOW 8
NOT MEET FRIENDS
YES 1
NO 2
DON'T KNOW 8
NO FAMILY
YES 1
NO 2
DON'T KNOW 8
NO FAMILY
YES 1
NO 2
DON'T KNOW 8
WHERE YOU ARE
YES 1
NO 2
DON'T KNOW 8


1106A. Now if you will permit me, I need to ask some more questions about your relationship with you (last) husband. (Does/did) your (last) husband ever:

a. Say or do something to humiliate you in front of others?
YES 1 (GO TO 1106B-a)
NO 2 (GO TO 1106A-b)
b. Threaten to hurt or harm you or someone close to you?
YES 1 (GO TO 1106B-b)
NO 2 (GO TO 1106A-c)
c. Insult you or make you feel bad about yourself?
YES 1 (GO TO 1106B-c)
NO 2


1106B. 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 IN THE LAST 12 MONTHS 3
b. Threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c. Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3


1107A. Now if you will permit me, I need to ask some more questions about your relationship with you (last) husband. (Does/did) your (last) husband ever:

a. Push you, shake you, or throw something at you?
YES 1 (GO TO 1107B-a)
NO 2 (GO TO 1107A-b)
b. Twist your arm or pull your hair?
YES 1 (GO TO 1107B-b)
NO 2 (GO TO 1107A-c)
c. Slap you?
YES 1 (GO TO 1107B-c)
NO 2 (GO TO 1107A-d)
d. Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1107B-d)
NO 2 (GO TO 1107A-e)
e. Kick you, drag you or beat you up?
YES 1 (GO TO 1107B-e)
NO 2 (GO TO 1107A-f)
f. Try to choke you or burn you on purpose?
YES 1 (GO TO 1107B-f)
NO 2 (GO TO 1107A-g)
g. Threaten to attack you with a knife, gun, or any other weapon?
YES 1 (GO TO 1107B-g)
NO 2 (GO TO 1107A-h)
h. Physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 1107B-h)
NO 2 (GO TO 1107A-i)
i. Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1107B-i)
NO 2 (GO TO 1107A-j)
j. Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1107B-j)
NO 2


1107B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a. Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
b. Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
c. Slap you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
d. Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
e. Kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
f. Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
g. Threaten to attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
h. Physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
i. Physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
j. Force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3


1108. CHECK 1107 A (a-j): EXPERIENCED PHYSICAL VIOLENCE

AT LEAST ONE 'YES' (GO TO 1109)
NOT A SINGLE 'YES' (GO TO 1111)


1109. 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


1110. Did the following ever happen as a result of what your (last) husband did to you?

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


1111. 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 1113)


1112. In the last 12 months, how often have you done this to your (last) husband: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3


1113. (Does/did) your (last) husband drink alcohol?

YES 1
NO 2 (GO TO 1115)


1114. How often (does/did) he get drunk?

OFTEN 1
SOMETIMES 2
NEVER 3


1115. Are (Were) you afraid of your (last) husband: most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES 2
NEVER AFRAID 3


1116. CHECK 307:

MARRIED MORE THAN ONCE (GO TO 1117)
MARRIED ONLY ONCE (GO TO 1118)


1117A. So far we have been talking about the behavior of your (current/last) husband. Now I want to ask you about the behavior of any previous husband.

a. Did any previous husband ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 ( GO TO 1117B)
NO 2


1117B. If so, how long ago did this last happen?

0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3
b. Did any previous husband physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 ( GO TO 1117B)
NO 2


1117B. If so, how long ago did this last happen?

0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3


1118. CHECK 301:

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

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

YES 1
NO 2 (GO TO 1121)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1121)


1119. 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
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY)_________X


1120. In the last 12 months, how often has (this person/have these persons) physically hurt you:

OFTEN 1
SOMETIMES 2
NOT AT ALL 3


1121. CHECK 201, 226, AND 231:

EVER BEEN PREGNANT ('YES' ON 201 OR 226 OR 231)
NEVER BEEN PREGNANT (GO TO 1124)


1122. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1124)


1123. Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?

RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
FORMER HUSBAND/PARTNER B
CURRENT/FORMER BOYFRIEND C
FATHER/STEP-FATHER D
BROTHER/STEP-BROTHER E
OTHER RELATIVE F
IN-LAW G
OWN FRIEND/ACQUAINTANCE H
FAMILY FRIEND I
TEACHER J
EMPLOYER/SOMEONE AT WORK K
POLICE/SOLDIER L
PRIEST/RELIGIOUS LEADER M
STRANGER N
OTHER (SPECIFY)__________X


1124. CHECK 301:

EVER MARRIED (GO TO 1125)
NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED (GO TO 1126)


1125. Now I want to ask you about things that may have been done to you by someone other than (your/any) husband. 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 when you did not want to?

YES 1 (GO TO 1127)
NO 2 (GO TO 1129)
REFUSED TO ANSWER/NO ANSWER (GO TO 1129)


1126. 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 when you did not want to?

YES 1
NO 2 (GO TO 1131)
REFUSED TO ANSWER/NO ANSWER (GO TO 1131)


1127. Who was the person who was forcing you the very first time this happened?

CURRENT HUSBAND 01
FORMER HUSBAND 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 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 (SPECIFY)___________96


1128. CHECK 301:

EVER MARRIED. In the last 12 months, has anyone other than (your/any) husband physically forced you to have sexual intercourse when you did not want to?

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED . In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

YES 1 (GO TO 1130)
NO 2 (GO TO 1130)
REFUSED TO ANSWER/NO ANSWER (GO TO 1130)


1129. CHECK 1107 A (h-j) and 1117 A (b): EXPERIENCED SEXUAL VIOLENCE

AT LEAST ONE 'YES' (GO TO 1130)
NOT A SINGLE 'YES' (GO TO 1131)


1130. CHECK 301:

EVER MARRIED. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband?)

NEVER MARRIED OR MARRIED, GAUNA NOT PERFORMED. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS __ __
DON'T REMEMBER 98


1131. CHECK 1107 A (a-j), 1117 (a-b), 1118, 1122, 1125, AND 1126: EXPERIENCED ANY VIOLENCE

AT LEAST ONE 'YES' (GO TO 1132)
NOT A SINGLE 'YES' (GO TO 1137)


1132. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1134)


1133. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

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


1134. Have you ever told anyone else about this?

YES 1
NO 2


1135. CHECK 1133:

'H' IS CIRCLED (GO TO 1136)
'H' IS NOT CIRCLED (GO TO 1137)


1136. Where did you go for medical help? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC HEALTH SECTOR
GOVERNMENT/MUNICIPAL HOSPITAL A
VAIDYA/HAKIM/HOMEOPATH (AYUSH) B
GOVERNMENT DISPENSARY C
UHC/UHP/UFWC D
CHC/RURAL HOSPITAL/BLOCK PHC F
SUB-CENTRE/ANM G
GOVERNMENT MOBILE CLINIC H
CAMP I
ANGANWADI/ICDS CENTRE J
ASHA K
OTHER COMMUNITY-BASED WORKER L
OTHER PUBLIC HEALTH SECTOR M
NGO OR TRUST HOSPITAL/CLINIC N
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL O
PRIVATE DOCTOR/CLINIC P
PRIVATE MOBILE CLINIC Q
VAIDYA/HAKIM/HOMEOPATH (AYUSH) R
TRADITIONAL HEALER S
PHARMACY/DRUGSTORE T
DAI (TBA) U
OTHER PRIVATE HEALTH SECTOR V
OTHER (SPECIFY) ______X


1137. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'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 DOMESTIC VIOLENCE MODULE ONLY.


1138. 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


1139. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE. _______

1140. RECORD THE TIME

HOUR __ __
MINUTES __ __


INSTRUCTIONS:

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

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
A ABORTIONS
M MISCARRIAGES
S STILLBIRTHS
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD/PPIUD
4 INJECTABLES
5 PILL
6 CONDOM/NIRODH
7 FEMALE CONDOM
8 DIAPHRAGM
F FOAM OR JELLY
L LACTATIONAL AMENORRHOEA METHOD
R RHYTHM METHOD
W WITHDRAWAL
X OTHER MODERN METHODS
Y OTHER TRADITIONAL METHODS

COLUMN 2: ULTRASOUND CONDUCTED DURING PREGNANCY

Y YES
N NO

COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE

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

2015:

12 DEC 01 __ __ __ 01 DEC
11 NOV 02 __ __ __ 02 NOV
10 OCT 03 __ __ __ 03 OCT
09 SEP 04 __ __ __ 04 SEP
08 AUG 05 __ __ __ 05 AUG
07 JUL 06 __ __ __ 06 JUL
06 JUN 07 __ __ __ 07 JUN
05 MAY 08 __ __ __ 08 MAY
04 APR 09 __ __ __ 09 APR
03 MAR 10 __ __ __ 10 MAR
02 FEB 11 __ __ __ 11 FEB
01 JAN 12 __ __ __ 12 JAN

2014:

12 DEC 13 __ __ __ 13 DEC
11 NOV 14 __ __ __ 14 NOV
10 OCT 15__ __ __ 15 OCT
09 SEP 16__ __ __ 16 SEP
08 AUG 17 __ __ __ 17 AUG
07 JUL 18__ __ __ 18 JUL
06 JUN 19 __ __ __ 19 JUN
05 MAY 20 __ __ __ 20 MAY
04 APR 21__ __ __ 21 APR
03 MAR 22 __ __ __ 22 MAR
02 FEB 23 __ __ __ 23 FEB
01 JAN 24 __ __ __ 24 JAN

2013:

12 DEC 25 __ __ __ 25 DEC
11 NOV 26 __ __ __ 26 NOV
10 OCT 27 __ __ __ 27 OCT
09 SEP 28 __ __ __ 28 SEP
08 AUG 29 __ __ __ 29 AUG
07 JUL 30 __ __ __ 30 JUL
06 JUN 31 __ __ __ 31 JUN
05 MAY 32 __ __ __ 32 MAY
04 APR 33 __ __ __ 33 APR
03 MAR 34 __ __ __ 34 MAR
02 FEB 35 __ __ __ 35 FEB
01 JAN 36 __ __ __ 36 JAN

2012:

12 DEC 37 __ __ __ 01 DEC
11 NOV 38 __ __ __ 02 NOV
10 OCT 39 __ __ __ 39 OCT
09 SEP 40 __ __ __ 40 SEP
08 AUG 41 __ __ __ 41 AUG
07 JUL 42 __ __ __ 42 JUL
06 JUN 43 __ __ __ 43 JUN
05 MAY 44 __ __ __ 44 MAY
04 APR 45 __ __ __ 45 APR
03 MAR 46 __ __ __ 46 MAR
02 FEB 47 __ __ __ 47 FEB
01 JAN 48 __ __ __ 48 JAN

2011:

12 DEC 49 __ __ __ 49 DEC
11 NOV 50 __ __ __ 50 NOV
10 OCT 51 __ __ __ 51 OCT
09 SEP 52 __ __ __ 52 SEP
08 AUG 53 __ __ __ 53 AUG
07 JUL 54 __ __ __ 54 JUL
06 JUN 55 __ __ __ 55 JUN
05 MAY 56 __ __ __ 56 MAY
04 APR 57 __ __ __ 57 APR
03 MAR 58 __ __ __ 58 MAR
02 FEB 59 __ __ __ 59 FEB
01 JAN 60 __ __ __ 60 JAN

2010:

12 DEC 61 __ __ __ 61 DEC
11 NOV 62 __ __ __ 62 NOV
10 OCT 63 __ __ __ 63 OCT
09 SEP 64 __ __ __ 64 SEP
08 AUG 65 __ __ __ 65 AUG
07 JUL 66 __ __ __ 66 JUL
06 JUN 67 __ __ __ 67 JUN
05 MAY 68 __ __ __ 68 MAY
04 APR 69 __ __ __ 69 APR
03 MAR 70 __ __ __ 70 MAR
02 FEB 71 __ __ __ 71 FEB
01 JAN 72 __ __ __ 72 JAN

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: ________