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25 Nov 2014
2015-16 (NFHS-4)
[STATE NAME]

NATIONAL FAMILY HEALTH SURVEY, INDIA 2015-2016 (NFHS-4) MAN'S QUESTIONNAIRE

IDENTIFICATION

STATE_________ __ __
DISTRICT_____________ __ __ __
TEHSIL/TALUK__________
CITY/TOWN/VILLAGE_____________

TYPE OF PSU

URBAN 1
RURAL 2

PSU NUMBER __ __
STRUCTURE NUMBER __ __ __
HOUSEHOLD NUMBER __ __
NAME AND LINE NUMBER OF MAN ______________ __ __
ADDRESS OF HOUSEHOLD____________

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*________

FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __ __
RESULT CODE* __

NEXT VISIT:
DATE____
TIME ____

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 CODES:

01 ASSAMESE
02 BENGALI
03 GUJARATI
04 HINDI
05 KANNADA
06 KASHMIRI
07 KONKANI
08 MALAYALAM
09 MANIPURI
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 QUESTIONNAIRE HINDI 04
** RESPONDENT'S MOTHER TONGUE_________ __ __
**LANGUAGE OF INTERVIEW________ ___ __
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 30-40 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.
ANSWER ANY QUESTIONS AND ADDRESS RESPONDENT'S CONCERNS.

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

YES 1
NO 2 (GO TO 107)

106. In the last 12 months, have you been away from home for six months or more at a time?

YES 1
NO 2

107. Have you ever attended school?

YES 1
NO 2 (GO TO 110)

108. What is the highest standard you completed?

STANDARD __ __

109. CHECK 108:

STANDARD 00-05 (GO TO 110)
STANDARD 06 AND ABOVE (GO TO 112)

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

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)______________4
BLIND/VISUALLY IMPAIRED 5

111. CHECK 110:

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

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

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

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

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

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

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

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

YES 1
NO 2

116. What is your religion?

HINDU 01
MUSLIM 02
CHRISTIAN 03
SIKH 04
BUDDHIST/NEO-BUDDHIST 05
JAIN 06
JEWISH 07
PARSI/ZOROASTRIAN 08
NO RELIGION 09
OTHER (SPECIFY)________96

117. What is your caste or tribe?

CASTE (SPECIFY)_________991
TRIBE (SPECIFY)_________992
NO CASTE/TRIBE 993 (GO TO 119)
DON'T KNOW 998

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

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

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

YES 1 (GO TO 123)
NO 2

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

YES 1 (GO TO 123)
NO 2

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

YES 1 (GO TO 123)
NO 2

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

GOING TO SCHOOL/STUDYING 1 (GO TO 201)
LOOKING FOR WORK 2 (GO TO 201)
RETIRED 3 (GO TO 201)
UNABLE TO WORK/ILL/HANDICAPPED 4 (GO TO 201)
HOUSEWORK/CHILDCARE 5 (GO TO 201)
OTHER (SPECIFY)__________6 (GO TO 201)

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

__________________________ __ __

124. 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

125. 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

SECTION 2A. REPRODUCTION

201. Now I would like to ask about any children you have had during your life. I am interested only in the children that are biologically yours. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203. a) How many sons live with you?
b) Any how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME __ __
DAUGHTERS AT HOME __ __

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE __ __
DAUGHTERS ELSEWHERE __ __

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

YES 1
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 208)

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

BOYS DEAD __ __
GIRLS DEAD __ __

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

a. Any other living sons or daughters who are biologically your children but who are not legally yours or do not have your last/ family name?
YES 1
NO 2
b. Any other sons or daughters who died who were biologically your children but who were not legally yours or did not have your last/family name?
YES 1
NO 2

208A. CHECK 208:

NO TO BOTH (GO TO 209)
OTHER (PROBE AND CORRECT 201-207 AS NECESSARY.)

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

TOTAL CHILDREN __ __

210. CHECK 209:

HAS HAD AT LEAST ONE CHILD (GO TO 211)
HAS NOT HAD ANY CHILDREN (GO TO 213)

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

AGE IN YEARS __ __

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

AGE IN YEARS __ __
NO LIVING CHILD 95

213. What is your current marital status?

CURRENTLY MARRIED 1
MARRIED, GAUNA NOT PERFORMED 2 (GO TO 221)
WIDOWED 3 (GO TO 221)
DIVORCED 4 (GO TO 221)
SEPARATED 5 (GO TO 221)
DESERTED 6 (GO TO 221)
NEVER MARRIED 7 (GO TO 228)

214. Do you currently have one wife or more than one wife?

ONLY ONE WIFE 1 (GO TO 216)
MORE THAN ONE WIFE 2

215. In total, how many wives do you have?

NUMBER OF WIVES __ __
DON'T KNOW 98

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

CHECK 214:

ONLY ONE WIFE (a. please tell me the name of your wife.)
MORE THAN ONE WIFE (b. Please tell me the name of each of your wives, starting with the one you married first.)
WIFE NUMBER __
NAME_______
LINE NUMBER IF HOUSEHOLD QUESTIONNAIRE __ __

217. How old was (NAME) on her last birthday?

AGE IN COMPLETED YEARS __ __

218. (Is your wife/Are your wives) living with you now or (is she/are they) staying elsewhere?

LIVING WITH HIM 1 (GO TO 220)
STAYING ELSEWHERE 2

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

MONTHS 1 __ __
YEARS 2 __ __

220. CHECK 214:

ONLY ONE WIFE (a. Have you ever been married to any woman other than your current wife?)
MORE THAN ONE WIFE (b. Have you ever been married to any other woman in addition to those you have told me about?)
YES 1 (GO TO 222)
NO 2 (GO TO 222)

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

ONCE 1 (GO TO 223)
MORE THAN ONCE (GO TO 223A)

222. CHECK 214 AND 220:

214 EQUALS '1' OR 220 EQUALS '2' (GO TO 223)
OTHER (GO TO 223A)

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

MONTH __ __
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 225)
DON'T KNOW YEAR 9998

223A. Now I would like to ask about when you married your first wife.
In what month and year was that?

MONTH __ __
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 225)
DON'T KNOW YEAR 9998

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

AGE __ __

225. CHECK 213:

MARRIED, GAUNA NOT PERFORMED (GO TO 228)
OTHER (GO TO 226)

226. CHECK 214 AND 220:
IF 214 AND 220 NOT ASKED, CHECK 221:

MARRIED ONLY ONCE (214 EQUALS '1' AND 220 EQUALS '2') OR (221 EQUALS '1') (a. In what month and year did you start living with your wife?)
MARRIED MORE THAN ONCE (214 EQUALS '2' OR 220 EQUALS '1') OR (221 EQUALS '2') (b. Now I would like to ask about when you started living with your first wife. In what month and year was that?)
MONTH __ __
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 229)
DON'T KNOW YEAR 9998

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

AGE __ __ (GO TO 229)

228. 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 301)

229. 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) WIFE 95

301. 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 can use to avoid pregnancy?
YES (SPECIFY)________1
NO 2

301A. CHECK 228: EVER HAD SEXUAL INTERCOURSE

YES OR NOT ASKED (GO TO 302)
NEVER HAD SEX (GO TO 311)

302. Have you or your (partner/partners) ever used any method?

YES 1
NO 2 (GO TO 311)

303. What have you or your (partner/partners) used or done?

RECORD ALL MENTIONED. CORRECT 301 (IF NECESSARY)

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

304. CHECK 303: RESPONDENT IS STERILIZED?

CODE 'B' RECORDED (GO TO 305)
CODE 'B' NOT RECORDED (GO TO 311)

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

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

MONTH __ __
YEAR __ __ __ __

307. 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

308. Did you receive compensation for the sterilization?

YES 1
NO 2 (GO TO 310)

309. How much compensation did you receive?

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

310. Do you regret that you had the sterilization?

YES 1
NO 2

311. In the last few months have you:

a. Heard about family planning on the radio?
YES 1
NO 2
b. Seen anything about family planning on the television?
YES 1
NO 2
c. Read about family planning in a newspaper or magazine?
YES 1
NO 2
d. Seen anything about family planning on a wall painting or hoarding?
YES 1
NO 2
e. Discussed family planning with a health worker or health professional?
YES 1
NO 2

312. Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant is she has sexual relations?

YES 1
NO 2 (GO TO 314)
DON'T KNOW 8 (GO TO 314)

313. Is this time just before her period begins, during her period, right after her period, 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

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

a. Contraception is women's business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b. Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8

315. CHECK 301 (06): KNOWS MALE CONDOM

YES (GO TO 316)
NO (GO TO 317)

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

MOST OF THE TIME 1
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 31)

318. 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
VADIYA/HAKIM/HOMEOPATH (AYUSH) B
GOVT. DISPENSARY C
UHC/UHP/UFWC D
CHC/RURAL HOSPITAL/BLOCK PHC E
PHC/ADDITIONAL PHC F
SUB-CENTRE/ANM
GOVT. MOBILE CLINIC H
CAMP I
ANGANWADI/CDS 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
VADIYA/HAKIM/HOMEOPATH (AYUSH) R
PHARMACY/DRUGSTORE S
DAI (TBA) T
OTHER PRIVATE HEALTH SECTOR U
OTHER SOURCE
TRADITIONAL HEALER V
SHOP W
FRIEND/RELATIVE X
OTHER (SPECIFY)__________Y

319. 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 32)

320. What type of health facility did you visit most recently for yourself (or for your children)?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE 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 31
PRIVATE HEALTH SECTOR
PVT. HOSPITAL/CLINIC 41
PVT. MOBILE CLINIC 42
VADIYA/HAKIM/HOMEOPATH (AYUSH) 43
PHARMACY/DRUGSTORE 44
OTHER PRIVATE SECTOR HEALTH FACILITY 45
OTHER (SPECIFY)___________96

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

FAMILY PLANNING A
IMMUNIZATION B
DISEASE PREVENTION C
MEDICAL TREATMENT FOR SELF D
TREATMENT FOR CHILD E
TREATMENT FOR OTHER PERSON F
GROWTH MONITORING OF CHILD G
HEALTH CHECK-UP H
OTHER (SPECIFY)_______X

322. CHECK 212:

(YOUNGEST) CHILD IS AGE 0-3 (GO TO 323)
OTHER (GO TO 401)

323. What is the name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD AND ENTER THE LINE NUMBER OF THE CHILD FROM THE HOUSEHOLD SCHEDULE.
IF CHILD IS NOT LISTED IN THE HOUSEHOLD SCHEDULE, WRITE '00' IN THE BOXES FOR THE LINE NUMBER.

(NAME OF (YOUNGEST) CHILD)________________
LINE NUMBER OF (YOUNGEST) CHILD FROM THE HOUSEHOLD SCHEDULE. __ __

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

YES 1
NO 2 (GO TO 326)
DON'T KNOW 8 (GO TO 327)

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

PRESENT 1 (GO TO 327)
NOT PRESENT 2 (GO TO 327)

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

HE DID NOT THINK IT WAS NECESSARY/DID NOT ALL 01
FAMILY DID NOT THINK IT NECESSARY/DID NOT ALLOW 02
CHILD'S MOTHER DID NOT WANT CHECK-UP 03
HAS HAD CHILDREN BEFORE 04
COSTS TOO MUCH 05
TOO FAR/NO TRANSPORTATION 06
NO FEMALE HEALTH WORKER AVAILABLE 07
OTHER (SPECIFY)___________96
DON'T KNOW 98

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

a. Vaginal bleeding?
YES 1
NO 2
b. Convulsions?
YES 1
NO 2
c. Prolonged labour?
YES 1
NO 2
d. Severe abdominal pain?
YES 1
NO 2
e. High blood pressure?
YES 1
NO 2

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

YES 1
NO 2

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

a. The importance of delivering the baby in a hospital or health facility?
YES 1
NO 2
b. The importance of proper nutrition for the mother during pregnancy?
YES 1
NO 2
c. Family planning or delaying your next child?
YES 1
NO 2

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

HOSPITAL/HEALTH FACILITY 1 (GO TO 333)
SOMEWHERE ELSE 2

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

a. Cord care?
YES 1
NO 2
b. The need for the mother to breastfeed the baby immediately after delivery?
YES 1
NO 2
c. The need to keep the baby warm immediately after birth?
YES 1
NO 2

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

COSTS TOO MUCH 01
FACILITY NOT OPEN 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER 05
NOT THE FIRST CHILD 06
CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 07
HE DID NOT THINK IT NECESSARY/DID NOT ALLOW 08
FAMILY DID NOT THINK IT WAS NECESSARY/DID NOT ALLOW 09
OTHER (SPECIFY)_____________96
DON'T KNOW 98

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

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8

SECTION 4. FERTILITY PREFERENCES

401. CHECK 213:

CURRENTLY MARRIED (GO TO 402)
NEVER MARRIED (GO TO 408)
OTHER (GO TO 405)

402. (Is your wife/Are any of your wives) currently pregnant?

YES 1
NO 2 (GO TO 405)
DON'T KNOW 8 (GO TO 405)

403. CHECK 303: RESPONDENT EVER STERILIZED?

CODE 'B' NOT RECORDED (GO TO 404)
CODE 'B' RECORDED (GO TO 408)

404. Now I have some questions about the future. After the (child/children) you and your (wife/wives) 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 407)
NO MORE 2 (GO TO 408)
UNDECIDED/DON'T KNOW 8 (GO TO 408)

405. CHECK 303: RESPONDENT EVER STERILIZED?

CODE 'B' NOT RECORDED (GO TO 406)
CODE 'B' RECORDED (GO TO 408)

406. 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 408)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 408)
WIFE/WIVES STERILIZED 4 (GO TO 408)
UNDECIDED/DON'T KNOW 8 (GO TO 408)

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

MONTHS 1 __ __
YEARS 2 __ __
SOON/NOW 993
OTHER (SPECIFY)_________996
DON'T KNOW 998

408. CHECK 203 AND 205:

HAS LIVING CHILDREN (a. 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 (b. If you could choose exactly the number of children to have in your whole life, how many would that be?)

NONE 00 (GO TO 501)
NUMBER __ __
OTHER (SPECIFY)____________96 (GO TO 501)

409. How many of these children would you like to be boys, how many would you like to be girls and for 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 __ __
EITHER __ __
OTHER (SPECIFY)________96

SECTION 5: SEXUAL LIFE

501. CHECK 228 AND 229:

HAS NOT HAD SEXUAL INTERCOURSE (228 EQUALS '2' OR 229 EQUALS '00') (GO TO 534)
HAS HAD SEXUAL INTERCOURSE (GO TO 501A)

501A. 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.

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

YES 1
NO 2

503. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 __ __ (GO TO 505)
WEEKS AGO 2 __ __ (GO TO 505)
MONTHS AGO 3 __ __ (GO TO 505)
YEARS AGO 4 __ __ (GO TO 518)

504. When was the last time you had sexual intercourse with this person?

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

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

YES 1
NO 2 (GO TO 507)

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

YES 1
NO 2

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

WIFE 01
LIVE-IN PARTNER 02
GIRLFRIEND NOT LIVING WITH RESPONDENT 03 (SKIP TO 510)
OTHER FRIEND 04 (SKIP TO 510)
RELATIVE 05 (SKIP TO 510)
CASUAL ACQUAINTANCE 06 (SKIP TO 510)
FEMALE SEX WORKER 07 (SKIP TO 510)
TG/MALE PARTNER 08 (SKIP TO 510)
OTHER (SPECIFY)_______96 (SKIP TO 510)

508. CHECK 214, 220, AND 221:

MARRIED ONLY ONCE (GO TO 509)
MARRIED MORE THAN ONCE A SKIP (GO TO 510)

509. CHECK 229:

FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (GO TO 511)
OTHER (GO TO 510)

510. How long ago did you first have sexual intercourse with this (second/third) person?

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

511. 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 __ __

512. CHECK 103:

AGE 15-24 (GO TO 513)
AGE 25-54 (GO TO 514)

513. How old is this person?

AGE OF PARTNER __ __
DON'T KNOW 98

514. Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO TO 504 IN NEXT COLUMN)
NO 2 (GO TO 516)

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

NUMBER OF PARTNERS __ __
DON'T KNOW 98

516. CHECK 507, ALL COLUMNS:

AT LEAST ONE PARTNER IS A SEX WORKER (GO TO 517)
NO PARTNERS ARE SEX WORKERS (GO TO 518)

517. CHECK 507 AND 505 (ALL COLUMNS):

OTHER (GO TO 522)
CONDOM USED WITH EVERY SEX WORKER (GO TO 521)

518. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

YES 1 (GO TO 520)
NO 2

519. Have you ever paid anyone in exchange for having sexual intercourse?

YES 1 (GO TO 522)
NO 2 (GO TO 522)

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

YES 1
NO 2 (GO TO 522)

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

YES 1
NO 2
DON'T KNOW 8

522. In total, with how many different people have you had a sex in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF PARTNERS __ __
DON'T KNOW 98

523. CHECK 505, COLUMN 1 (CONDOM USE WITH LAST SEXUAL PARTNER):

YES (GO TO 524)
NO, BLANK (GO TO 530)

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

BRAND NAME (SPECIFY)______________96
DON'T KNOW 98

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

RESPONDENT HIMSELF 1
PARTNER 2 (GO TO 529)
SOMEONE ELSE 3 (GO TO 529)

526. How many condoms did you get last time?

NUMBER __ __
DON'T KNOW 98

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

COST Rs. __ __ __
FREE 995
DON'T KNOW 998

528. From where did you obtain the condom the last time?

PUBLIC HEALTH SECTOR
GOVT./MUNICIPAL HOSPITAL 11
VADIYA/HAKIM/HOMEOPATH (AYUSH) 12
GOVT. DISPENSARY 13
UHC/UHPP/UFWC 14
CHC/RURAL HOSPITAL/BLOCK PHC 15
PHC/ADDITIONAL PHC 16
SUB-CENTRE/ANM 17
GOVT. MOBILE CLINIC 18
CAMP 19
ANGANWADI/ICDS CENTRE 20
ASHA 21
OTHER COMMUNITY BASED WORKER 22
OTHER PUBLIC HEALTH SECTOR 23
NGO OR TRUST HOSPITAL/CLINIC 31
PRIVATE HEALTH SECTOR
PVT. HOSPITAL/CLINIC/DOCTOR 41
PVT. PARAMEDIC 42
PVT. MOBILE CLINIC 43
VADIYA/HAKIM/HOMEOPATH (AYUSH) 44
TRADITIONAL HEALER 45
PHARMACY/DRUGSTORE 46
DAI (TBA) 47
OTHER PRIVATE HEALTH SECTOR 48
OTHER SOURCE
RATION SHOP 51
OTHER SHOP 52
WIFE 53
FRIEND/RELATIVE 54
VENDING MACHINE 55
OTHER (SPECIFY)______96
DON'T KNOW 98

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

AVOID PREGNANCY A
AVOID STD B
SOME OTHER REASON C

530. CHECK 303: RESPONDENT EVER STERILIZED?

CODE 'B' NOT RECORDED (GO TO 531)
CODE 'B' RECORDED (GO TO 533)

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

YES 1
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)

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

FEMALE STERILIZATION A
IUD/PPIUD B
INJECTABLES C
PILL D
FEMALE CONDOM E
DIAPHRAGM F
FOAM/JELLY G
STANDARD DAYS METHOD H
RHYTHM METHOD I
WITHDRAWAL J
OTHER (SPECIFY)______X

533. CHECK 505, ALL COLUMNS, AND 520:

ANY 'YES' (GO TO 601)
OTHER (GO TO 534)

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

YES 1
NO 2 (GO TO 601)

535. 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
GOVT./MUNICIPAL HOSPITAL A
VADIAY/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 (SPECIFY)_______M
NGO OR TRUST HOSPITAL/CLINIC N
PRIVATE HEALTH SECTOR
PVT. HOSPITAL/CLINIC/DOCTOR O
PVT. PARAMEDIC P
VADIAY/HAKIM/HOMEOPATH (AYUSH)
TRADITIONAL HEALER S
PHARMACY/DRUGSTORE T
DAI (TBA) U
OTHER PRIVATE HEALTH SECTOR V
OTHER SOURCE
RATION SHOP W
OTHER SHOP X
VENDING MACHINE Y
OTHER (SPECIFY)_____Z

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 6. OTHER HEALTH ISSUES

601. Now I would like to you ask you some questions about any injections you have had 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 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS __ __
NONE 00 (GO TO 603)

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

YES 1
NO 2
DON'T KNOW 8

603. Have you ever had a blood transfusion?

YES 1
NO 2

604. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 606)

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

CIGARETTES __ __

606. Do you currently smoke bidis?

YES 1
NO 2 (GO TO 608)

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

BIDIS __ __

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

YES 1
NO 2 (GO TO 610)

609. 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
PAN WITH TOBACCO F
OTHER CHEWING TOBACCO G
SNUFF H
OTHER (SPECIFY)_______X

610. CHECK 604, 606, AND 608:

AT LEAST ONE 'YES' (GO TO 611)
NEVER SMOKED (GO TO 614)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 614)

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

YES 1
NO 2

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

YES 1
NO 2

615. Do you drink alcohol?

YES 1
NO 2 (GO TO 618)

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

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

617. 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

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

YES 1
NO 2 (GO TO 622)

619. 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
DON'T KNOW Z

620. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

621. If a family member of your 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

622A. Do you currently have:

a. Diabetes?
YES 1 (GO TO 622B)
NO 2
DON'T KNOW 8
B. Have you sought treatment for this problem?
YES 1
NO 2
b. Asthma?
YES 1 (GO TO 622B)
NO 2
DON'T KNOW 8
B. Have you sought treatment for this problem?
YES 1
NO 2
c. Goiter or any other thyroid disorder?
YES 1 (GO TO 622B)
NO 2
DON'T KNOW 8
B. Have you sought treatment for this problem?
YES 1
NO 2
d. Any heart disease?
YES 1 (GO TO 622B)
NO 2
DON'T KNOW 8
B. Have you sought treatment for this problem?
YES 1
NO 2
e. Cancer?
YES 1 (GO TO 622B)
NO 2
DON'T KNOW 8
B. Have you sought treatment for this problem?
YES 1
NO 2

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

YES 1
NO 2 (GO TO 626)

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

EMPLOYEES STATE INSURANCE SCHEME (SIS) A
CENTRAL GOVERNMENT HEALTH SCHEME (CHG.) B
STATE HEALTH INSURANCE SCHEME C
RASHTRIYA SWASTHYA BIMA YOJANA D
COMMUNITY HEALTH INSURANCE PROGRAMMED E
OTHER HEALTH INSURANCE THROUGH EMPLOYER F
MEDICAL REIMBURSEMENT FROM EMPLOYER G
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE H
OTHER (SPECIFY)______X

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

a. Milk or curd?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
b. Pulses or beans?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
c. Dark green leafy vegetables?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
d. Fruits?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
e. Eggs?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
f. Fish?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
g. Chicken or meat?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
h. Fried foods?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4
i. Aerated drinks?
DAILY 1
WEEKLY 2
OCC. 3
NEVER 4

627. Have you ever undergone an oral cavity examination?

YES 1
NO 2

SECTION 7. ATTITUDES TOWARDS GENDER ROLES

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

a. Making major household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
b. Making purchases for daily household needs?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
c. Deciding about visits to the wife's family or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
d. Deciding what to do with the money the wife earns from her work?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
e. Deciding how many children to have?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

701A. CHECK 213:

CURRENTLY MARRIED (GO TO 702)
OTHER (GO TO 704)

702. Who usually makes decisions about healthcare for yourself: mainly you, mainly your wife, you and your wife jointly, or someone else?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY)_____6

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

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY)_____6

704. Do you own this or any other house either alone or jointly

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY)_____6

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

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

706. 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?
YES 1
NO 2
DON'T KNOW 8
b. If she neglects the house or the children?
YES 1
NO 2
DON'T KNOW 8
c. If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d. If she refused to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e. If she doesn't cook food properly?
YES 1
NO 2
DON'T KNOW 8
f. If he suspects her or being unfaithful?
YES 1
NO 2
DON'T KNOW 8
g. If she shows disrespect for in-laws?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

708. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

a. She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON'T' KNOW 8
b. She knows her husband has sex with other women.
YES 1
NO 2
DON'T KNOW 8
c. She is tired or not in the mood.
YES 1
NO 2
DON'T KNOW 8

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

a. Get angry and reprimand her?
YES 1
NO 2
DON'T KNOW 8
b. Refuse to give her money or other means of financial support?
YES 1
NO 2
DON'T KNOW 8
c. Use force and have sex with her even if she doesn't want to?
YES 1
NO 2
DON'T KNOW 8
d. Go and have sex with another woman?
YES 1
NO 2
DON'T KNOW 8

710. CHECK 213:

CURRENTLY MARRIED (GO TO 711)
OTHER (GO TO 716)
711. (Is your wife/Are any of your wives) currently employed for cash?

YES 1
NO 2 (GO TO 715)
DON'T KNOW 8 (GO TO 715)

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

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
OTHER 6

713. CHECK 125:

CODE '1' OR '2' RECORDED (GO TO 714)
OTHER (GO TO 716)

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

MORE THAN WIFE 1
LESS THAN WIFE 2
ABOUT THE SAME 3
DON'T KNOW 8

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

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
OTHER 6

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

YES 1
NO 2
DON'T KNOW 8

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

YES 1
NO 2

802. Have you ever heard of HIV?

YES 1
NO 2

803. CHECK 801 AND 802: KNOWS ABOUT HIV/AIDS

AT LEAST ONE 'YES' (GO TO 804)
OTHER (GO TO 833)

804. 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
WIFE M
FRIENDS/RELATIVES N
WORK PLACE O
OTHER (SPECIFY)_________X

805. 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

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

YES 1
NO 2
DON'T KNOW 8

807. 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

808. Can people get HIV/AIDS by blood products or blood transfusion?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 813)
DON'T KNOW 8 (GO TO 813)

812. 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
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

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

YES 1
NO 2
DON'T KNOW 8

814. Can HIV/AIDS be transmitted from a mother to hear baby:

a. During pregnancy?
YES 1
NO 2
DON'T KNOW 8
b. During delivery?
YES 1
NO 2
DON'T KNOW 8
c. By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

815. CHECK 814:

AT LEAST ONE 'YES' (GO TO 816)
OTHER (GO TO 817)

816. Are there any special medications that a doctor or a nurse can give a woman infected with HIV/AIDS can get from a doctor or a nurse to help them live longer?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

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

YES 1
NO 2 (GO TO 823)

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

MONTHS AGO __ __
TWO OR MORE YEARS 95

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

YES 1
NO 2

822. Where was the test done?
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 HOSPITAL 11 (GO TO 825)
GOVT. HEALTH CENTRE 12 (GO TO 825)
STAND-ALONE ICTC 13 (GO TO 825)
FAMILY PLANNING CLINIC 14 (GO TO 825)
MOBILE CLINIC 15 (GO TO 825)
FIELDWORKER 16 (GO TO 825)
SCHOOL BASED CLINIC 17 (GO TO 825)
OTHER PUBLIC SECTOR (SPECIFY)_______18 (GO TO 825)
NGO OR TRUST HOSPITAL/CLINIC 20 (GO TO 825)
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21 (GO TO 825)
STAND-ALONE ICTC 22 (GO TO 825)
PHARMACY 23 (GO TO 825)
MOBILE CLINIC 24 (GO TO 825)
FIELDWORKER 25 (GO TO 825)
SCHOOL BASED CLINIC 26 (GO TO 825)
OTHER PRIVATE HEALTH SECTOR (SPECIFY)_______27 (GO TO 825)
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 32
OTHER (SPECIFY)________96

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

YES 1
NO 2 (GO TO 825)

824. 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
GOVERNMENT HOSPITAL A
GOVT. 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

825. 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

826. 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

827. 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
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

828. If a relative of yours became sick with the virus that causes 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

829. 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

830. 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

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

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

832. 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

833. Some men are circumcised, that is, the foreskin is completely from the penis. Are you circumcised?

YES 1
NO 2
DON'T KNOW 8

834. CHECK 801 AND 802:

HEARD ABOUT HIV/AIDS (a. 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

835. CHECK 228 AND 229: HAS HAD SEXUAL INTERCOURSE

HAS HAD SEXUAL INTERCOURSE (GO TO 836)
HAS NOT HAD SEXUAL INTERCOURSE (228 EQUALS '2' OR 229 EQUALS '00') (GO TO 843)

836. CHECK 834: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS

YES (GO TO 837)
NO (GO TO 838)

837. 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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

840. CHECK 837, 838, AND 839: HAS HAD AN STI

AT LEAST ONE 'YES' (GO TO 841)
OTHER (GO TO 843)

841. The last time you had (PROBLEM FROM 837/838/839), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 843)

842. Where did you go? Anywhere else?

RECORD ALL PLACES MENTIONED.

PUBLIC HEALTH SECTOR
GOVERNMENT HOSPITAL A
VAIDYA/HAKIM/HOMEOPATH (AYUSH) B
GOVT. 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 CLINIC
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

843. RECORD THE TIME

HOUR __ __
MINUTES __ __

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

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COMMENTS ON SPECIFIC QUESTIONS:

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ANY OTHER COMMENTS:

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SUPERVISOR'S OBSERVATIONS:

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NAME OF SUPERVISOR:______________
DATE: ______________